Pachydermodactyly--just a sign of emotional distress

Pachydermodactyly (PDD) is a benign, asymptomatic soft tissue swelling affecting the skin of the lateral aspects of the proximal interphalangeal joints of the fingers II-IV, mostly in young adolescent males, and could be interpreted as a consequence of tic-like behaviour as an obsessive-compulsive disorder in male adolescents. The differential diagnosis includes numerous diseases; a rapid clinical recognition of PDD would avoid many useless and expensive diagnostic tests. There is no effective medical treatment for PDD, but discontinuation of the tic-like mechanical traumatisation generally leads to a marked amelioration of the finger swelling. In this article we review the world literature, which contains 87 additional cases on this topic.

Higher emotional distress in female partners of cancer patients: prevalence and patient-partner interdependencies in a 3-year cohort

OBJECTIVE: Assessment and treatment of psychological distress in cancer patients was recognized as a major challenge. The role of spouses, caregivers, and significant others became of salient importance not only because of their supportive functions but also in respect to their own burden. The purpose of this study was to assess the amount of distress in a mixed sample of cancer patients and their partners and to explore the dyadic interdependence. METHODS: An initial sample of 154 dyads was recruited, and distress questionnaires (Hospital Anxiety and Depression Scale, Symptom Checklist 9-Item Short Version and 12-Item Short Form Health Survey) were assessed over four time points. Linear mixed models and actor-partner interdependence models were applied. RESULTS: A significant proportion of patients and their partners (up to 40%) reported high levels of anxiety, depression, psychological distress, and low quality of life over the course of the investigation. Mixed model analyses revealed that higher risks for clinical relevant anxiety and depression in couples exist for female patients and especially for female partners. Although psychological strain decreased over time, the risk for elevated distress in female partners remained. Modeling patient-partner interdependence over time stratified by patients' gender revealed specific effects: a moderate correlation between distress in patients and partners, and a transmission of distress from male patients to their female partners. CONCLUSIONS: Our findings provide empirical support for gender-specific transmission of distress in dyads coping with cancer. This should be considered as an important starting point for planning systemic psycho-oncological interventions and conceptualizing further research.

Descriptive/Inferential Cognitive Processes and Evaluative Cognitive Processes: Relationships Among Each Other and with Emotional Distress

We aimed to delineate key constructs from two forms of cognitive-behavioral therapy: cognitive therapy and rational-emotive behavior therapy. Furthermore, we aimed to investigate the interrelations among each other and with emotional distress. The key constructs of the underlying theories of these therapies (i.e., descriptive/inferential beliefs, evaluative beliefs) are often treated together as distorted cognitions and included as such in various scales. We used a cross-sectional design. Seventy-four undergraduate students (mean age = 24.68) completed measures of automatic thoughts and emotional distress. Three therapists trained in cognitive-behavioral therapy divided automatic thoughts into descriptive/inferential beliefs and evaluative beliefs by consensus. Correlation and mediation analyses were performed. These constructs showed medium to high associations to each other and to distress. The relationship between descriptive/inferential beliefs and distress was mediated by evaluative beliefs. Descriptive and inferential cognitions may not produce emotions without first being appraised in terms of personal relevance.

Facilitating Emotional Processing: An Experimental Induction of Psychotherapeutically Relevant Affective States

Psychotherapy research has shown that cognitive-affective meaning making is related to beneficial therapy outcomes. This study explores the underlying micro-processes by inducing specific cognitive-affective states and studying their immediate effects on emotional activation, the resolution of interpersonal grievances, and factors related to therapeutic progress, e.g., mastery experiences, clarification of meaning. Participants suffering from interpersonal grievances were randomly assigned to two conditions. A sentence completion task was employed to induce either the expression of emotional distress or cognitive-affective meaning making. Expressive writing was used to deepen processing. Findings of those participants adhering to the induction procedure (n = 85) showed no differences between conditions at baseline. During writing, participants in both conditions were equally emotionally activated. Directly after the writing task, participants in the meaning making condition (n = 50) reported less unresolved interpersonal grievances, and more mastery experiences, but, e.g., not more clarification, compared to those in the emotional expression condition (n = 35). Results suggest that engagement in specific states that promote meaning making of emotional experience facilitates emotional processing and is related to therapeutic benefit.

Nondermatomal somatosensory deficits in patients with chronic pain disorder: clinical findings and hypometabolic pattern in FDG-PET

Patients with chronic pain disorders often show somatosensory disturbances that are considered to be functional. This paper aims at a more precise clinical description and at a documentation of functional neuroimaging correlates of this phenomenon. We examined 30 consecutive patients with unilaterally accentuated chronic pain not explained by persistent peripheral tissue damage and ipsilateral somatosensory disturbances including upper and lower extremities and trunk. The patients were assessed clinically and with conventional brain CT or MRI scan. In the last 11 patients functional neuroimaging was carried out (18-fluordeoxyglucose positron emission tomography=FDG-PET). Depressive symptoms were assessed with the Hamilton depression scale (HAMD-17) and pain intensity was rated with a visual analogue scale for pain (VAS). All patients suffered from mild to moderate depressive symptoms. All patients had experienced a prolonged antecedent phase of severe emotional distress; most of them remembered a "trigger episode of somatic pain" on the affected side. Somatosensory deficits were a replicable hyposensitivity to touch and heat perception of nondermatomal distribution. Conventional imaging procedures (brain CT or MRI scans) showed no structural changes. However, in 11 patients functional imaging with FDG-PET showed a significant hypometabolic pattern of changes in cortical and subcortical areas, mainly in the post-central gyrus, posterior insula, putamen, and anterior cingulate cortex. In summary, pain-related nondermatomal somatosensory deficits (NDSDs) are a phenomenon involving biological as well as psychosocial factors with replicable neuroperceptive clinical findings and a complex neurodysfunctional pattern in the FDG-PET.

Aptitude–Treatment interaction effects in psychooncological interventions

Objective: To examine aptitude–treatment interaction (ATI) effects in cancer patients receiving psychoonco- logical interventions (POIs). Method: N=36 cancer patients were treated with POI. Hierarchical linear regression was used to test two interaction effects between patient baseline characteristics (aptitudes) and process analyses of therapy sessions (treatment) on change in mental health during POI. Results: Patients with high emotional distress did best when their therapy reduced arousal, and patients with lower emotional distress benefited most if therapists emphasized arousal induction. The interaction between the coping style of the patient (internalizing vs. externalizing) and the focus of the treatment (emotion vs. behavior) did not predict POI outcomes. Conclusions: The ATI effect of patient's distress and therapist's arousal induction/reduction may help therapists to make differential treatment decisions in POI. Tailoring treatments to cancer patients based on their personal characteristics may enhance the effectiveness of POI.

Less structured movement patterns predict severity of positive syndrome, excitement, and disorganization

Disorganized behavior is a key symptom of schizophrenia. The objective assessment of disorganized behavior is particularly challenging. Actigraphy has enabled the objective assessment of motor behavior in various settings. Reduced motor activity was associated with negative syndrome scores, but simple motor activity analyses were not informative on other symptom dimensions. The analysis of movement patterns, however, could be more informative for assessing schizophrenia symptom dimensions. Here, we use time series analyses on actigraphic data of 100 schizophrenia spectrum disorder patients. Actigraphy recording intervals were set at 2 s. Data from 2 defined 60-min periods were analyzed, and partial autocorrelations of the actigraphy time series indicated predictability of movements in each individual. Increased positive syndrome scores were associated with reduced predictability of movements but not with the overall amount of movement. Negative syndrome scores were associated with low activity levels but unrelated with predictability of movement. The factors disorganization and excitement were related to movement predictability but emotional distress was not. Thus, the predictability of objectively assessed motor behavior may be a marker of positive symptoms and disorganized behavior. This behavior could become relevant for translational research.

Social exclusion and shame in obesity

Weight bias often results in the social exclusion of individuals with obesity. The direct, short-term psychological effects of social exclusion in obesity have not been investigated yet. This study experimentally tests whether social exclusion elicits stronger negative emotions in individuals with obesity compared to normal-weight controls. Specifically, we test whether social exclusion has a specific impact on shame. In total, N = 299 individuals (n = 130 with body mass index [BMI] ≤ 30 and n = 169 with BMI N 30) were randomly assigned to a social exclusion condition or a control condition that was implemented with an online Cyberball paradigm. Before and after, they filled out questionnaires assessing state emotionality. Social exclusion increased negative emotionality in both groups compared to the control condition (p b 0.001) according to a multivariate ANOVA. However, the interaction of group and social exclusion was also significant (p = 0.035) and arose from a significant, specific increase of shame in the group with obesity during social exclusion (p b 0.001, Cohen's d = 0.7). When faced with social exclusion, individuals with obesity do not respond with more intensive negative emotions in general compared to controls, but with a specific increase in shame. As social exclusion is frequent in individuals with obesity, psychological interventions focussing shame-related emotional distress could be crucial.

Relation of heart rate recovery to psychological distress and quality of life in patients with chronic heart failure

BACKGROUND: Psychological distress, poor disease-specific quality of life (QoL), and reduction in vagally mediated early heart rate recovery (HRR) after exercise, all previously predicted morbidity and mortality in patients with chronic heart failure (CHF). We hypothesized lower HRR with greater psychological distress and poorer QoL in CHF. DESIGN: All assessments were made at the beginning of a comprehensive cardiac outpatient rehabilitation intervention program. METHODS: Fifty-six CHF patients (mean 58+/-12 years, 84% men) completed the Hospital Anxiety and Depression Scale and the Minnesota Living With Heart Failure Questionnaire. HRR was determined as the difference between HR at the end of exercise and 1 min after exercise termination (HRR-1). RESULTS: Elevated levels of anxiety symptoms (P=0.005) as well as decreased levels of the Minnesota Living With Heart Failure Questionnaire total (P = 0.025), physical (P=0.026), and emotional (P=0.017) QoL were independently associated with blunted HRR-1. Anxiety, total, physical, and emotional QoL explained 11.4, 8, 7.8, and 9.0%, respectively, of the variance after controlling for covariates. Depressed mood was not associated with HRR-1 (P=0.20). CONCLUSION: Increased psychological distress with regard to elevated anxiety symptoms and impaired QoL were independent correlates of reduced HRR-1 in patients with CHF. Reduced vagal tone might explain part of the adverse clinical outcome previously observed in CHF patients in relation to psychological distress and poor disease-specific QoL.

Association of fatigue and psychological distress with quality of life in patients with a previous venous thromboembolic event

Health-related quality of life (QoL) has been associated with several social and medical conditions in patients with deep vein thrombosis (DVT) and pulmonary embolism (PE). To the best of our knowledge, there is no study investigating the relationship of QoL with psychological variables in this patient population. We assumed as a hypothesis an association between heightened levels of fatigue and psychological distress, as well as decreased QoL in patients with an objectively diagnosed venous thromboembolic event. Study participants were 205 consecutively enrolled out-patients (47.4 years, 54.6% men) with DVT and/or PE. Approximately 10 days before blood collection for thrombophilia work-up, QoL, fatigue, and psychological distress were assessed using the Short Form Health Survey (SF-12), the Multidimensional Fatigue Symptom Inventory Short Form (MFSI-SF) as well as the Hospitality Anxiety and Depression scale (HADS). After controlling for demographic and medical factors, fatigue (p < 0.01) but not psychological distress (p>0.05) was negatively associated with physical QoL, explaining 11.0% of the variance. Fatigue (p < 0.001) and psychological distress (p < 0.001) were significant predictors of mental QoL, explaining an additional 36.2% and 3.6% of the variance. Further analyses revealed that all subscales of the HADS (e.g. anxiety and depression) and of the MFSI-SF (e.g. general fatigue, physical fatigue, emotional fatigue, mental fatigue and vigor) were significant predictors of mental QoL. MFSI-SF subscales also predicted physical QoL. The findings suggest that fatigue and psychological distress substantially predict QoL in patients with a previous venous thromboembolic event above and beyond demographic factors.

Sympathy, distress, and prosocial behavior of preschool children in four cultures

This study examined emotional responding (sympathy and distress) and prosocial behavior as well as their relations across four cultures in a specific context. Preschool children (N = 212) from two Western cultures, Germany and Israel, and two South-East Asian cultures, Indonesia and Malaysia, participated in this study. Children's emotional reactions and prosocial behavior were observed when interacting with an adult in a quasi-experimental situation. Results showed that children from the two South-East Asian cultures, as compared to children from the two Western cultures, displayed more self-focused distress and less prosocial behavior. Across cultures, a positive relation between sympathy and prosocial behavior and a negative relation between self-focused distress and prosocial behavior were found. The strengths of these relations were moderated by culture. These results are discussed with regard to their cultural meaning in the specific experimental situation as well as to general culture-specific characteristics.

Vulnerability Following a Critical Life Event: Temporary Crisis or Chronic Distress? A Psychological Controversy, Methodological Considerations, and Empirical Evidence

This contribution deals with psychological vulnerability resulting from marital breakup after a long-term relationship. Despite the existing vast body of consolidated knowledge on divorce and psychological adaptation, there are still several controversies concerning the vulnerabilizing impact of marital breakup. One major issue refers to the question of whether vulnerability after marital breakup is a temporary crisis or rather a chronic strain. In this chapter we want to present two possible methodological options to tackle this question: First, comparing a sample of almost 1000 middle-aged persons, who were married on average 19 years, and who experienced a marital split within the last 5 years (4 time groups), with a group of age-matched married controls with regard to various indicators of psychological vulnerability (such as depression and hopelessness). Second, comparing within the divorced group the most vulnerable individuals (in terms of depression, hopelessness, life satisfaction) with those who were the least affected, regarding intra-personal resources (personality, resilience), divorce circumstances, post-divorce situation, and socio-economic resources. The study results underline the vulnerabilizing impact of marital breakup, but at the same time they reveal individual differences in psychological adaptation especially due to personality, new partnership, economic resources, and last but not least due to time. Furthermore our data strongly suggest that there is not a generalized psychological vulnerability after marital breakup, but that the emotional dimensions such as depression or feelings of not overcoming the loss are more affected than the more cognitive ones such as life satisfaction.

Emotional processing in a ten-session general psychiatric treatment for borderline personality disorder: a case study

This study examines the effects of a borderline-specific treatment, called general psychiatric management, on emotional change, outcome and therapeutic alliance of an outpatient presenting with borderline personality disorder. Based on the sequential model of emotional processing, emotional states were assessed in a 10-session setting. The case showed an increase in expressions of distress and no change in therapeutic alliance and tended towards general deterioration. Results suggest emotional processing may play a lesser role in general psychiatric management in early phase treatment than previously hypothezised.

Psychometric properties of the Trauma and Distress Scale, TADS, in an adult community sample in Finland

BACKGROUND: There is increasing evidence that a history of childhood abuse and neglect is not uncommon among individuals who experience mental disorder and that childhood trauma experiences are associated with adult psychopathology. Although several interview and self-report instruments for retrospective trauma assessment have been developed, many focus on sexual abuse (SexAb) rather than on multiple types of trauma or adversity. METHODS: Within the European Prediction of Psychosis Study, the Trauma and Distress Scale (TADS) was developed as a new self-report assessment of multiple types of childhood trauma and distressing experiences. The TADS includes 43 items and, following previous measures including the Childhood Trauma Questionnaire, focuses on five core domains: emotional neglect (EmoNeg), emotional abuse (EmoAb), physical neglect (PhyNeg), physical abuse (PhyAb), and SexAb.This study explores the psychometric properties of the TADS (internal consistency and concurrent validity) in 692 participants drawn from the general population who completed a mailed questionnaire, including the TADS, a depression self-report and questions on help-seeking for mental health problems. Inter-method reliability was examined in a random sample of 100 responders who were reassessed in telephone interviews. RESULTS: After minor revisions of PhyNeg and PhyAb, internal consistencies were good for TADS totals and the domain raw score sums. Intra-class coefficients for TADS total score and the five revised core domains were all good to excellent when compared to the interviewed TADS as a gold standard. In the concurrent validity analyses, the total TADS and its all core domains were significantly associated with depression and help-seeking for mental problems as proxy measures for traumatisation. In addition, robust cutoffs for the total TADS and its domains were calculated. CONCLUSIONS: Our results suggest the TADS as a valid, reliable, and clinically useful instrument for assessing retrospectively reported childhood traumatisation.

Relationship between psychological distress and endogenous anticoagulants in patients with a previous venous thromboembolic event

Psychological distress, particularly anxiety and depression, has been associated with a prothrombotic state. However, the relationship between psychosocial factors and endogenous anticoagulants protein S (PS) and protein C (PC) has not previously been investigated. We explored the association between psychological distress, PS, and PC in patients with an objectively diagnosed venous thromboembolic event (VTE).