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Psychodermatology: an update.

It has been estimated that in at least one third of dermatology patients, effective management of the skin disorder involves consideration of associated emotional factors. This article provides an overview of psychodermatology with a focus on the more recent literature and an emphasis on the clinical aspects and psychologic therapies for (1) cutaneous associations of psychiatric disorders and (2) psychiatric associations of certain cutaneous disorders that are known to be influenced by psychosomatic factors. This article also provides an update on the use of psychotropic drugs (i.e., the antianxiety, antidepressant, and antipsychotic agents) for the treatment of mental disorders that occur in conjunction with cutaneous conditions. Some of their other pharmacologic properties, such as the antihistaminic and analgesic effects of some antidepressant agents are also reviewed.

Analgesics↗

Psychogenic movement disorders.

Diagnosis and treatment of psychogenic movement disorders are challenging for both neurologists and psychiatrists. Symptoms can mimic the full range of organic abnormal involuntary movements, affect gait and speech, or present as unusual undifferentiated movements. Typical clinical characteristics of these disorders are acute onset, fast progression, movement patterns incongruent with organic movement disorders, distractibility, variability, and simultaneous occurrence of various abnormal movements and dysfunctions. Avoidance of iatrogenic damage by unnecessary invasive tests or inappropriate medication, as well as use of appropriate psychiatric treatments are pivotal steps in the management of these disorders. The few clinical trials specific to psychogenic movement disorders focus on antidepressants and psychotherapy. Presence of a comorbid psychiatric diagnosis of depression or an anxiety disorder is a positive prognostic factor, whereas long-standing symptoms, insidious onset of movements, and a psychiatric diagnosis of hypochondriasis, factitious disorder, or malingering are associated with poor outcome.

Humans↗

Religious stigmatization: an historical and psychophysiological enquiry.

The historical accounts of religious stigmatization occurring during the past 750 years have been surveyed, with more detailed attention being given to late nineteenth- and twentieth-century medical investigations of some well-known cases. A case showing some features of religious stigmatization is described. The possible relationship of the phenomena of religious stigmatization to disease and psychophysiological processes in the subject is examined.

Adolescent↗

Hypotheses linking neuroses with premature mortality.

The death risk for psychiatric patients has decreased over the last 30 years but still remains higher than that of the general population. The death risk for patients with a diagnosis of neurosis is higher than that for the general population. Previous studies are enlisted to investigate this mortality for socio-economic characteristics, alcohol and drug abuse, psychopathy and accident proneness. Possible psychosomatic aetiology of disease and subsequent death is examined. Psychological theories for premature death are discussed and some recommendations made for future areas of enquiry.

Accident Proneness↗

Mind-body innovations--an integrative care approach.

Integration of behavioral health and medicine has gained increased support recently within the new field of complementary medicine. Providers from both disciplines are acknowledging the "mind-body" connection and recognizing the value of treating the "whole" patient through working within an integrative delivery model. This paper describes two treatment programs which were developed using the principles of the mind-body connection and implemented within an integrative setting at a large HMO. The results of research studies are presented and discussed to demonstrate the efficacy of these programs.

Adult↗

Dizziness and panic disorder: a review of the association between vestibular dysfunction and anxiety.

Dizziness is a common and costly condition that causes significant distress and impairment yet often confounds appropriate diagnosis and treatment. Among patients presenting for evaluation and treatment of dizziness, rates of panic disorder are elevated to 5 to 15 times the general population rates. In addition, the limited studies to date of dizziness in patients with panic disorder suggest that panic patients frequently experience significant dizziness and often demonstrate evidence of vestibular dysfunction. In this paper we review studies investigating the relationship between panic disorder and vestibular dysfunction. Currently, there are three main explanatory models for the association between panic disorder and vestibular dysfunction: the psychosomatic model, the somatopsychic model, and the network alarm theory. Systematic investigations of the treatment of patients with vestibular symptoms and panic disorder are lacking, though prevalence, associated costs, and disability suggest that they are needed. Serotonin selective reuptake inhibitors are good candidates for future treatment studies.

Agoraphobia↗

Conservation of resources. A new attempt at conceptualizing stress.

Major perspectives concerning stress are presented with the goal of clarifying the nature of what has proved to be a heuristic but vague construct. Current conceptualizations of stress are challenged as being too phenomenological and ambiguous, and consequently, not given to direct empirical testing. Indeed, it is argued that researchers have tended to avoid the problem of defining stress, choosing to study stress without reference to a clear framework. A new stress model called the model of conservation of resources is presented as an alternative. This resource-oriented model is based on the supposition that people strive to retain, project, and build resources and that what is threatening to them is the potential or actual loss of these valued resources. Implications of the model of conservation of resources for new research directions are discussed.

Humans↗

Desirable versus undesirable life events: their relationship to stress and mental distress.

The research of Holmes, Rahe, and their associates disclosing that life events and stress are related to the onset of physical illness is extended to the psychological domain in the present study. Using a modified version of their life events checklist, it is shown that an accumulation of life events is correlated with self-reported tension and distress, with emotional disturbances manifested by depression, paranoid thinking, suicidal proclivity, and anxiety, as well as with behavioral indications of stress such as drinking and traffic accidents. Most importantly, it is shown that these relationships do not hold for desirable life events but primarily for undesirable events. Thus, the authors suggest that the quality of the events in terms of their desirability is the crucial determinant of stress and the above-mentioned relationships rather than simply the life change produced by the events, as suggested in earlier studies. Methodological and theoretical implications for future research are discussed, emphasizing the importance of studying additional stress-relevant dimensions such as anticipation of the events and control over their outcome.

Affective Symptoms↗

Lack of control as a determinant of perceived physical symptoms.

Two experiments were conducted to investigate the role of lack of control in determining the extent to which individuals report experiencing physical symptoms. In Experiment 1, subjects who had little control over a noise burst subsequently reported a higher incidence of physical symptoms than did subjects who could control the noise burst. Unfortunately, degree of failure may have been confounded with degree of control in Experiment 1. Thus, Experiment 2 was designed to determine if differential perceptions of control would produce differences in reported symptoms when degree of success was held constant. Greater symptoms were again reported by subjects in the no-control condition. Experiments 1 and 2 also explored questions concerning the mechanism underlying the effects of lack of control on reported physical symptoms. Both experiments failed to find evidence that subjects reported symptoms for ego-preserving reasons. Other data suggested that the symptoms reported by subjects were not related to their past experience with physical symptoms, nor were symptoms reported as a function of perceived or actual physiological arousal.

Affect↗