Rehabilitation in Endocrine Patients: A Novel Psychosomatic Approach

Background: There are data to suggest low bone mineral density is disproportionately prevalent among those with psychiatric disorders. This paper aims to review the current evidence on the relationship between depression and bone mineral density, and identify potential mechanisms. Methods: Relevant sources were identified from the Pubmed and Web of Science (ISI) databases from the first relevant publication in 1994 to the present, 2007, using a combination of key words and terms including depression, major depressive disorder, osteoporosis, bone mineral density, hypothalamic-pituitary-adrenal axis, cortisol, cytokines, leptin, antidepressants, selective serotonin reuptake inhibitors, smoking, alcohol, physical activity and diet. Reference lists of chosen articles were further reviewed for associated publications. Results: The possible association between psychiatric illness, in particular depression, and osteoporosis has been the subject of a growing body of research yielding various findings, although most identify some effect on bone. In addition to medication-related processes and/or modifiable lifestyle factors associated with mood disturbances, endocrine and immune alteration secondary to depression may play a pathogenetic role in bone metabolism. Conclusions: Additional longitudinal studies, with the advantage of temporal sequencing, remain to be conducted, as well as research into potential mechanisms surrounding the association. Nevertheless, the current findings are of clinical relevance, given the health burden of both depression and osteoporosis.

Section: Discussionmentioning

confidence: 99%

Depression and Bone Metabolism

Williams

Pasco

Jacka

et al. 2008

“…One could argue that a majority of our patients was suffering from depression rather than PTED. Negative life events can also be associated with depression, be it primary or secondary [30,31,32], and there is also some literature on anger, irritability, aggressiveness and hostility in the context of depression [33,34,35,36,37,38,39]. In contrast to depression, affect modulation is unimpaired in PTED patients, who can display a normal and positive affect when distracted or engaged in revenge fantasies.…”

Section: Discussionmentioning

confidence: 99%

Posttraumatic Embitterment Disorder in Comparison to Other Mental Disorders

Lindén

Baumann

Rotter

et al. 2007

Background: The term ‘posttraumatic embitterment disorder’ (PTED) was recently introduced to describe a subtype of adjustment disorders, characterized by prolonged embitterment, severe additional psychopathological symptoms and great impairment in most areas of life in reaction to a severe negative but not life threatening life event. The aim of this study is an empirical description and validation of the clinical concept of PTED, by comparing clinically defined PTED patients with patients suffering from other mental disorders on measures of posttraumatic stress and psychopathological distress. Methods: Fifty inpatients, suffering from PTED according to previously defined clinical diagnostic criteria, were compared with another 50 patients, matched by age and gender, who did not meet clinical criteria for PTED but for other mental disorders. Psychiatric diagnoses were assessed by the Mini International Neuropsychiatric Interview. Self-report measures included the Bern Embitterment Scale, the Impact of Event Scale, the PTED Self-Rating Scale and the SCL-90. Results: According to the Mini International Neuropsychiatric Interview both groups fulfilled the criteria for many disorders with a significantly higher occurrence of major depression and chronic adjustment disorder but less generalized anxiety disorder lifetime in PTED patients. Patients with PTED scored significantly higher on the global scores and on most subdimensions of the SCL-90, the Impact of Event Scale, the Bern Embitterment Scale and the PTED Self-Rating Scale. Conclusions: Clear differences were found between PTED patients and patients with other mental disorders in regard to the quality and intensity of psychopathological as well as posttraumatic stress symptoms. PTED can help further subclassify and specify adjustment and reactive disorders.

“…As the patient was pointing out, quality of life may be compromised even though the patient is apparently doing fine according to a hormonal viewpoint. In fact, in clinical endocrinology, there is often the tendency to rely exclusively on ‘hard data’, preferably expressed in the dimensional numbers of laboratory measurements, excluding ‘soft information’, such as disability and well-being [61,62,63]. Soft information, however, can now be assessed.…”

Section: Psychosocial Foundations Of Clinical Assessmentmentioning

confidence: 99%

Psychosomatic Assessment

Fava

Sonino²

2009

Self Cite

The primary goal of psychosomatic medicine is the incorporation of its operational strategies into clinical practice. The traditional attitude toward disease and the functional/organic dichotomy were criticized by George Engel in the early sixties. Only recently, however, there has been increasing awareness of the limitations of disease as the primary focus of medical care. It is not that certain disorders lack an organic explanation; it is our assessment that is inadequate in most clinical encounters. The research evidence which has accumulated in psychosomatic medicine offers unprecedented opportunities for the identification and treatment of medical problems. Taking full advantage of clinimetric methods (such as the use of Emmelkamp’s two levels of functional analysis and the Diagnostic Criteria for Psychosomatic Research) may greatly improve the clinical process, including shared decision making and self-management. Endorsement of the psychosomatic perspective may better clarify the pathophysiological links and mechanisms underlying symptom presentation. Pointing to individually targeted methods may improve final outcomes and quality of life.