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1.  Altered rectal sensory response induced by balloon distention in patients with functional abdominal pain syndrome 
Background
Functional abdominal pain syndrome (FAPS) has chronic unexplained abdominal pain and is similar to the psychiatric diagnosis of somatoform pain disorder. A patient with irritable bowel syndrome (IBS) also has chronic unexplained abdominal pain, and rectal hypersensitivity is observed in a majority of the patients. However, no reports have evaluated the visceral sensory function of FAPS precisely. We aimed to test the hypothesis that FAPS would show altered visceral sensation compared to healthy controls or IBS. The present study determined the rectal perceptual threshold, intensity of sensation using visual analogue scale (VAS), and rectal compliance in response to rectal balloon distention by a barostat in FAPS, IBS, and healthy controls.
Methods
First, the ramp distention of 40 ml/min was induced and the thresholds of discomfort, pain, and maximum tolerance (mmHg) were measured. Next, three phasic distentions (60-sec duration separated by 30-sec intervals) of 10, 15 and 20 mmHg were randomly loaded. The subjects were asked to mark the VAS in reference to subjective intensity of sensation immediately after each distention. A pressure-volume relationship was determined by plotting corresponding pressures and volumes during ramp distention, and the compliance was calculated over the linear part of the curve by calculating from the slope of the curve using simple regression.
Results
Rectal thresholds were significantly reduced in IBS but not in FAPS. The VAS ratings of intensity induced by phasic distention (around the discomfort threshold of the controls) were increased in IBS but significantly decreased in FAPS. Rectal compliance was reduced in IBS but not in FAPS.
Conclusion
An inconsistency of visceral sensitivity between lower and higher pressure distention might be a key feature for understanding the pathogenesis of FAPS.
doi:10.1186/1751-0759-3-13
PMCID: PMC2784791  PMID: 19925683
2.  Validity issues in the assessment of alexithymia related to the developmental stages of emotional cognition and language 
Objective
We examined developmental aspects of the emotional awareness of adolescents by evaluating their responses to a self-reported questionnaire based on the Toronto Alexithymia Scale-20 (TAS-20).
Methods
The items of the TAS-20 were modified to make them more understandable by adolescents, and nine new items related to a limited capacity for imagination were added. The Japanese Linguistic Ability Test and the multi-dimensional empathy scale for adolescents were administered to examine concurrent validity. Two hundred and two normative young adolescents and thirty-two adolescent patients with psychosomatic and/or behavioral problems participated in the study. Eighty junior high school students also participated in a separate examination of test-retest reliability.
Results
Thirteen items were extracted after exploratory and confirmatory factor analyses, and four core factors were identified in the resulting scale: Difficulty Identifying Feelings (DIF), Difficulty Describing Feelings (DDF), Externally-Oriented Thinking (EOT) and Constricted Imaginal Capacities (CIC). Interestingly, scores on the multi-dimensional empathy scale correlated positively with DIF and DDF, but negatively with EOT and CIC. Higher DDF scores were associated with higher Japanese linguistic abilities. DIF/DDF scores were higher for females than males, irrespective of linguistic ability. Test-retest reliability coefficients were significant. The patient group showed significantly higher DIF scores than the normative students.
Conclusion
The present findings indicated that subjective difficulties in identifying and describing feelings are associated with empathetic and linguistic abilities. The developmental aspect to emotional awareness herein described suggests that self-reported questionnaires for alexithymia must be carefully constructed and examined, even for adults.
doi:10.1186/1751-0759-3-12
PMCID: PMC2777913  PMID: 19886981
3.  Relationship between gender role, anger expression, thermal discomfort and sleep onset latency in women 
Background
Women with thermal discomfort from cold extremities (hands and feet; TDCE) often suffer from prolonged sleep onset latency (SOL). Suppressed anger could contribute to the genesis of both TDCE and prolonged SOL. The aim of the study was to test the hypothesis whether stereotypic feminine gender socialization (SFGS) is related to anger suppression (experienced anger inwards, Anger-In), which in turn could affect TDCE and SOL.
Methods
148 women, a sub-sample of a larger survey carried out in the Canton Basel-Stadt (Switzerland), sent back detailed postal questionnaires about SOL, TDCE, anger expression (STAXI, state -trait -anger -expression -inventory) and SFGS using a gender power inventory, estimating the degree of gender specific power expression explicitly within women by stereotypic feminine or male attribution. Statistics was performed by path analysis.
Results
A significant direct path was found from stereotypic feminine attribution to Anger-In and prolonged SOL. Additionally, a further indirect path from Anger-In via TDCE to SOL was found. In contrast, stereotypic male attribution was not related to Anger-In but was significantly associated with outwardly expressed anger.
Limitations
Self-reported data, retrospective cross-sectional survey, prospective studies are required including physiological measurements.
Conclusion
Stereotypic feminine gender socialization may play an important determinant for anger suppression, which subsequently can lead to thermal discomfort from cold extremities and prolonged sleep onset latency.
doi:10.1186/1751-0759-3-11
PMCID: PMC2770539  PMID: 19825177
4.  Benzodiazepine prescription and length of hospital stay at a Japanese university hospital 
Background
The relationship between bed days and benzodiazepine prescription (BDZ) in Western countries is inconclusive, and no hospital-based report has documented this phenomenon in Japan. This study was done to assess the association between bed days and BDZ in a Japanese hospital.
Methods
21,489 adult patients (55.1% men, mean age 59.9 years old) hospitalized between April, 2005 and December, 2006 were enrolled in the study. Patient age, sex, ICD-10 diagnosis, prescription profile, and days of hospital stay were assessed in 13 non-psychiatric departments using a computer ordering system. Patients prescribed a benzodiazepine during hospitalization were defined as positive.
Results
Of the total sample, 19.9% were allocated to the benzodiazepine (+) group. Female sex and older age were significant factors associated with benzodiazepine prescription. The median number of bed days was 13, and the likelihood of BDZ significantly increased with the number of bed days, even after controlling for the effects of age, gender, and ICD-10 diagnosis. For example, when the analysis was limited to patients with 50 bed days or longer, the percentage of BDZ (32.7%) was equivalent to that of a report from France.
Conclusion
Irrespective of department or disease, patients prescribed benzodiazepine during their hospital stay tended to have a higher number of bed days in the hospital. The difference in the prevalence of BDZ between this study and previous Western studies might be attributed to the relatively short length of hospital stay in this study. Because BDZs are often reported to be prescribed to hospitalized patients without appropriate documentation for the indications for use, it is important to monitor the rational for prescriptions of benzodiazepine carefully, for both clinical and economical reasons.
doi:10.1186/1751-0759-3-10
PMCID: PMC2765986  PMID: 19818119
5.  Psychological factors that promote behavior modification by obese patients 
Background
The weight-loss effect of team medical care in which counseling is provided by clinical psychologists was investigated in an university hospital obesity (OB) clinic. Nutritional and exercise therapy were also studied. In our previous study, we conducted a randomized, controlled trial with obese patients and confirmed that subjects who received counseling lost significantly more weight than those in a non-counseling group. The purpose of this study was to identify the psychological characteristics assessed by ego states that promote behavior modification by obese patients.
Methods
147 obese patients (116 females, 31 males; mean age: 45.9 ± 15.4 years) participated in a 6-month weight-loss program in our OB clinic. Their psychosocial characteristics were assessed using the Tokyo University Egogram (TEG) before and after intervention. The Wilcoxon signed rank test was used to compare weight and psychological factors before and after intervention. Multiple regression analysis was used to identify factors affecting weight loss.
Results
Overall, 101 subjects (68.7%) completed the program, and their data was analyzed. The subjects mean weight loss was 6.2 ± 7.3 kg (Z = 7.72, p < 0.01), and their mean BMI decreased by 2.4 ± 2.7 kg/m2 (Z = 7.65, p < 0.01). Significant differences were observed for the Adult (A) ego state (0.68 ± 3.56, Z = 1.95, p < 0.05) and the Free Child (FC) ego state (0.59 ± 2.74, Z = 2.46, p < 0.01). The pre-FC ego state had a significant effect on weight loss (β = 0.33, p < 0.01), and a tendency for changes in the A ego state scores to affect weight loss (β = - 0.20, p = 0.06) was observed.
Conclusion
This study of a 6-month weight-loss program that included counseling by clinical psychologists confirmed that the A ego state of obese patients, which is related to their self-monitoring skill, and the FC ego state of them, which is related to their autonomy, were increased. Furthermore, the negative aspects of the FC ego state related to optimistic and instinctive characteristics inhibited the behavior modification, while the A ego state represented objective self-monitoring skills that may have contributed to weight loss.
doi:10.1186/1751-0759-3-9
PMCID: PMC2759949  PMID: 19781055
6.  Effect of two yoga-based relaxation techniques on memory scores and state anxiety 
Background
A yoga practice involving cycles of yoga postures and supine rest (called cyclic meditation) was previously shown to improve performance in attention tasks more than relaxation in the corpse posture (shavasana). This was ascribed to reduced anxiety, though this was not assessed.
Methods
In fifty-seven male volunteers (group average age ± S.D., 26.6 ± 4.5 years) the immediate effect of two yoga relaxation techniques was studied on memory and state anxiety. All participants were assessed before and after (i) Cyclic meditation (CM) practiced for 22:30 minutes on one day and (ii) an equal duration of Supine rest (SR) or the corpse posture (shavasana), on another day. Sections of the Wechsler memory scale (WMS) were used to assess; (i) attention and concentration (digit span forward and backward), and (ii) associate learning. State anxiety was assessed using Spielberger's State-Trait Anxiety Inventory (STAI).
Results
There was a significant improvement in the scores of all sections of the WMS studied after both CM and SR, but, the magnitude of change was more after CM compared to after SR. The state anxiety scores decreased after both CM and SR, with a greater magnitude of decrease after CM. There was no correlation between percentage change in memory scores and state anxiety for either session.
Conclusion
A cyclical combination of yoga postures and supine rest in CM improved memory scores immediately after the practice and decreased state anxiety more than rest in a classical yoga relaxation posture (shavasana).
doi:10.1186/1751-0759-3-8
PMCID: PMC2734564  PMID: 19674483
7.  Reduced complexity of activity patterns in patients with Chronic Fatigue Syndrome: a case control study 
Background
Chronic fatigue syndrome (CFS) is an illness characterised by pervasive physical and mental fatigue without specific identified pathological changes. Many patients with CFS show reduced physical activity which, though quantifiable, has yielded little information to date. Nonlinear dynamic analysis of physiological data can be used to measure complexity in terms of dissimilarity within timescales and similarity across timescales. A reduction in these objective measures has been associated with disease and ageing. We aimed to test the hypothesis that activity patterns of patients with CFS would show reduced complexity compared to healthy controls.
Methods
We analysed continuous activity data over 12 days from 42 patients with CFS and 21 matched healthy controls. We estimated complexity in two ways, measuring dissimilarity within timescales by calculating entropy after a symbolic dynamic transformation of the data and similarity across timescales by calculating the fractal dimension using allometric aggregation.
Results
CFS cases showed reduced complexity compared to controls, as evidenced by reduced dissimilarity within timescales (mean (SD) Renyi(3) entropy 4.05 (0.21) vs. 4.30 (0.09), t = -6.6, p < 0.001) and reduced similarity across timescales (fractal dimension 1.19 (0.04) vs. 1.14 (0.04), t = 4.2, p < 0.001). This reduction in complexity persisted after adjustment for total activity.
Conclusion
Patients with CFS show evidence of reduced complexity of activity patterns. Measures of complexity applied to activity have potential value as objective indicators for CFS.
doi:10.1186/1751-0759-3-7
PMCID: PMC2697171  PMID: 19490619
8.  Age distribution and gender differences in psychogenic fever patients 
Psychogenic fever is one of the most common psychosomatic diseases. In Japan, psychogenic fever has generally been reported to occur in adolescents, with a peak seen at age 13. However, in our department we have encountered many adults with psychogenic fever. Therefore, we investigated all outpatients who visited the Psychosomatic Department of the University of Occupational and Environmental Health between April 2003 and March 2007. Of the 2705 outpatients that were seen, 55 patients (2.0%) were diagnosed with psychogenic fever. The patients ranged in age from 11 to 82 years old, with a mean age of 33.6 ± 17.9 (mean ± SD) years. In addition to the adolescents, many of the patients were in their 20 s and 30 s, and the male:female ratio was 1:2.2. This study suggests that psychogenic fever commonly occurs not only in adolescents but also in adults.
doi:10.1186/1751-0759-3-6
PMCID: PMC2674591  PMID: 19379524
9.  The effectiveness of the Uchida-Kraepelin test for psychological stress: an analysis of plasma and salivary stress substances 
Background
The hypothalamic-pituitary-adrenocortical (HPA) axis and sympathetic adrenomedullary (SAM) system are the major stress-response pathways. Plasma adrenocorticotropic hormone (ACTH) represents HPA axis activity, while plasma catecholamines are used as markers of the SAM system. Salivary alpha amylase (AA), chromogranin A (CgA), and immunoglobulin A (IgA) are candidate markers of stress activation, although their role has not been established. The Uchida-Kraepelin (U-K) test is a questionnaire that requires intense concentration and effort, and has been used as a tool to induce mental stress. However, it is not clear whether or not the test is effective as a psychological/mental stressor.
Methods
In this study, normal young women took the U-K test and serial measurements of plasma ACTH and catecholamines (dopamine, noradrenaline, and adrenaline) (n = 10), as well as salivary AA, CgA, and IgA (n = 16) before, during and after the test.
Results
We found no changes in any of these parameters at any time point during or after the U-K test.
Conclusion
Our findings indicate that the U-K test is not a suitable for measuring the psychological/mental stress of young women because the plasma data showed that it did not affect the HPA axis and SAM system. The U-K test should be employed carefully as a psychological/mental stressor due to insufficient scientific evidence of its effectiveness. In addition, salivary AA, CgA, and IgA should not simply be compared with previous reports, because the mechanism of secretion and normal range of each salivary parameter remain unknown. Salivary AA, CgA, and IgA may not be suitable candidate markers of psychological/mental stress.
doi:10.1186/1751-0759-3-5
PMCID: PMC2679058  PMID: 19341484
10.  Relation between psychosocial variables and the glycemic control of patients with type 2 diabetes: A cross-sectional and prospective study 
Background
This cross-sectional and prospective study used a variety of psychological inventories to evaluate the relationship between psychosocial factors and the glycemic control of patients with type 2 diabetes.
Methods
Participants were 304 patients with type 2 diabetes who were treated as outpatients at diabetes clinics. All participants were assessed for HbA1c and completed the following self-report psychological inventories: 1) Diabetes Treatment Satisfaction Questionnaire (DTSQ), 2) Problem Areas in Diabetes Survey (PAID), 3) Well-being Questionnaire 12 (W-BQ12), 4) Self-Esteem Scale (SES), 5) Social Support Scale, and 6) Self-Efficacy Scale. HbA1c was again measured one year later. The relationships between the psychosocial variables obtained by analysis of the psychological inventories and baseline or one-year follow-up HbA1c were determined.
Results
Baseline HbA1cwas significantly correlated with age, diet treatment regimen, number of microvascular complication of diabetes, and the total scores of DTSQ, W-BQ12, PAID, SES and the Self-Efficacy Scale. Hierarchical stepwise multiple regression revealed that significant predictors of baseline HbA1c were total DTSQ and PAID scores, along with age, diet treatment regimen, and number of microvascular complication of diabetes after adjustment for demographic, clinical and other psychosocial variables. Two hundred and ninety patients (95.4% of 304) were followed and assessed one year after baseline. Hierarchical stepwise multiple regression analysis showed the significant predictors of follow-up HbA1c to be total DTSQ and PAID scores, along with age and diet treatment regimen. However, the correlation between baseline and follow-up HbA1c was so high that the only other variable to retain significance was diet treatment regimen once baseline HbA1c was included in the regression of follow-up HbA1c.
Conclusion
The DTSQ and the PAID predicted both current and future HbA1c to a similar and significant degree in patients with type 2 diabetes.
doi:10.1186/1751-0759-3-4
PMCID: PMC2667542  PMID: 19298645
11.  Allergies and major depression: a longitudinal community study 
Background
Cross-sectional studies have reported associations between allergies and major depression but in the absence of longitudinal data, the implications of this association remain unclear. Our goal was to examine this association from a longitudinal perspective.
Methods
The data source was the Canadian National Population Health Survey (NPHS). This study included a short form version of the Composite International Diagnostic Interview (CIDI-SF) to assess major depression and also included self report items for professionally diagnosed allergies of two types: non-food allergies and food allergies. A longitudinal cohort was followed between 1994 and 2002. Proportional hazards models for grouped time data were used to estimate unadjusted and adjusted hazard ratios.
Results
A slightly increased incidence of non-food allergies in respondents with major depression was observed: adjusted hazard ratio 1.2 (95% 1.0 – 1.5, p = 0.046). Some evidence for an increased incidence of major depression in association with non-food allergies was found in unadjusted analyses, but the association did not persist after multivariate adjustment. Food allergies were not associated with major depression incidence, nor was major depression associated with an increased incidence of food allergies.
Conclusion
Findings from the present study support the idea that major depression is associated with an increased risk of developing non-food allergies. An effect in the opposite direction could not be confirmed. The observed effect may be due to shared genetic factors, epigenetic factors, or immunological changes that occur during depression.
doi:10.1186/1751-0759-3-3
PMCID: PMC2637296  PMID: 19171035
12.  Biopsychosocial approaches to a patient with vomiting of 10 years' duration – a case of temporal lobe epilepsy 
Background
Vomiting is commonly encountered in clinical medicine. When organic gastrointestinal, metabolic, and brain diseases are ruled out, many cases are considered to be functional. We experienced an adult patient with epilepsy whose main symptom was vomiting. Biopsychosocial approaches were needed to control the symptoms.
Case presentation
A 26-year-old female with a 10-year history of persistent vomiting was found to have temporal lobe epilepsy (TLE). Throughout this time, during which the vomiting had become part of a vicious cycle, her epilepsy was poorly controlled by medication. Biopsychosocial approaches were employed successfully and the patient subsequently undertook training to become a home-helper, started a job, and was able to leave her parents' house and live independently. All of her symptoms resolved after she became self-sufficient.
Discussion
Vomiting without impaired consciousness is seldom considered to be a manifestation of epilepsy. Difficulty in recording an electroencephalogram (EEG) because of the presence of persistent vomiting delayed the diagnosis. The improvement of symptoms was thought to have been due to the patient's emotional stabilization and physical improvement, which may have stabilized the limbic system.
Conclusion
When an illness persists for many years and conditioning and a vicious cycle occur secondarily, systematic biopsychosocial approaches are needed in addition to general treatment. Also, secondary symptoms make the diagnosis more difficult when efforts at treatment are ineffective.
doi:10.1186/1751-0759-3-2
PMCID: PMC2642859  PMID: 19166585
13.  Prospects of Psychosomatic Medicine 
doi:10.1186/1751-0759-3-1
PMCID: PMC2642858  PMID: 19161633

Results 1-13 (13)