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Psychosomatic Medicine 64:921-938 (2002)
© 2002 American
Psychosomatic Society
ORIGINAL ARTICLES |
From Duke University Medical Center (F.J.K., C.L.E., D.S.) and Duke University (F.J.K., A.L.H.B., A.K.A.,), Durham, North Carolina; Wayne State University (M.A.L., D.J.M.), Detroit, Michigan; University of North Carolina (J.W.C.), Chapel Hill, North Carolina; University of Lousiville School of Medicine (J.L.S.), Louisville, Kentucky; and Ohio University (L.F.), Athens, Ohio.
Correspondence: Address reprint requests to: Francis J. Keefe, PhD, Duke University Medical Center, Box 3159, Durham, NC 27710. Email: keefe003@mc.duke.edu
OBJECTIVE: This article provides an overview of how psychosomatic research on pain has evolved over the past 60 years as exemplified by studies published in Psychosomatic Medicine.
METHODS: Each issue of Psychosomatic Medicine from 1939 to 1999 was reviewed to identify papers that dealt with pain, painful medical conditions, or pain management. A total of 150 papers were identified and grouped into seven categories: 1) case studies; 2) studies of personality traits and other individual differences; 3) psychophysiological studies of pain; 4) studies using pain induction techniques; 5) studies examining the relation of relation of race, ethnicity, and culture to pain; 6) studies of pain unique to women; and 7) studies examining treatments for pain.
RESULTS: A substantial number of studies on pain and painful conditions were published in the Journal in the 1940s and 1950s, and that number has almost doubled in the most recent full decade of the Journal. Within the pain area, however, the topics of interest to psychosomatic researchers have been, and continue to be, quite diverse. Although publications on certain methods or topics (eg, psychodynamic case studies, physiological correlates of pain) have decreased over time, publications on other topics (eg, personality traits and individual differences) have remained relatively constant, and publications on still other topics (eg, studies using pain induction techniques; studies of race, ethnicity, and culture; women’s pain; and treatment studies) have flourished recently.
CONCLUSIONS: Considered overall, the results of our review suggest that the face of pain research published in PM has changed considerably in the past 60 years. Given the ongoing commitment of psychosomatic researchers to this area, we expect this evolution to continue in the years to come.
Key Words: pain, • pain assessment, • pain management, • chronic pain.
Abbreviations: ACTH = adrenocorticotropic hormone; • CBT = cognitive-behavioral therapy; • EEG = electroencephalography; • EMG = electromyography; • MDQ = Menstrual Distress Questionnaire; • MMPI = Minnesota Multiphasic Personality Inventory; • PM = Psychosomatic Medicine; • PMSS = premenstrual symptoms and syndromes; • RCT = randomized, controlled trial; • TMD = temporomandibular disorder.
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Lesley A. Allen, Javier I. Escobar, Paul M. Lehrer, Michael A. Gara, and
Robert L. Woolfolk
Chris Dickens, Linda McGowan, David Clark-Carter, and Francis Creed
Jeffrey Dersh, Peter B. Polatin, and Robert J. Gatchel
Don R. Lipsitt
Abstract 1 of 4
Psychosomatic Medicine 64:939-950 (2002)
© 2002 American
Psychosomatic Society
REVIEW ARTICLES |
From the Department of Psychiatry (L.A.A., J.I.E., P.M.L., M.A.G.), Robert Wood Johnson Medical School–University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey; and Department of Psychology (R.L.W.), Rutgers University, New Brunswick, New Jersey.
Correspondence: Address reprint requests to: Lesley A. Allen, PhD, Department of Psychiatry, RWJMS–UMDNJ, 671 Hoes Lane, Piscataway, NJ 08854. Email: allenla@umdnj.edu
ABSTRACT
OBJECTIVE: Patients presenting with multiple medically unexplained physical symptoms, termed polysymptomatic somatizers, often incur excessive healthcare charges and fail to respond to standard medical treatment. The present article reviews the literature assessing the efficacy of psychosocial treatments for polysymptomatic somatizers.
METHODS: Relevant articles were identified by scanning Medline and PsychLit. Thirty-four randomized, controlled studies were located. Whenever possible results from each study were transformed into effect sizes. An analysis of the efficacy of the psychotherapeutic approaches is provided.
RESULTS: Various psychosocial interventions have been investigated with polysymptomatic somatizers. Although the majority of studies suggest psychosocial treatments benefit this population, the literature is tarnished by methodological shortcomings. Effect sizes are modest at best. Long-term improvement has been demonstrated in fewer than one-quarter of the trials.
CONCLUSIONS: Although seemingly beneficial, psychosocial treatments have not yet been shown to have a lasting and clinically meaningful influence on the physical complaints of polysymptomatic somatizers.
Key Words: somatization • irritable bowel syndrome • chronic fatigue syndrome • fibromyalgia • treatment
Abbreviations: CBT = cognitive behavior therapy; • CFS = chronic fatigue syndrome; • DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, fourth edition; • EMG = electromyographic; • IBS = irritable bowel syndrome.
Abstract 2 of 4
Psychosomatic Medicine 64:52-60 (2002)
© 2002 American
Psychosomatic Society
ORIGINAL ARTICLES |
From the Department of Psychiatry (C.D., L.M., F.C.), Manchester University, Manchester; and Psychology Department (D.C.-C.), Staffordshire University, Staffordshire, United Kingdom.
Correspondence: Address reprint requests to: Dr. Chris Dickens, Senior Lecturer in Psychological Medicine, Department of Psychiatry, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom. Email: c.dickens@man.ac.uk
OBJECTIVE: This systematic review and meta-analysis examined the strength of association between rheumatoid arthritis and depression. In addition, we investigated the extent to which sociodemographic characteristics, level of pain, and method of assessing depression might affect the degree of depression.
METHODS: CD-ROM databases and bibliographies were searched to identify all studies comparing depression in patients with rheumatoid arthritis and control subjects using standardized assessments. Effect sizes (Pearson’s r) and probabilities were combined across studies. We examined the extent to which the association between rheumatoid arthritis and depression could be attributed to level of pain (using contrasts), sociodemographic differences between groups (combining methodologically restricted studies), and methods of assessing depression (examining heterogeneity across studies).
RESULTS: Twelve independent studies comparing depression in
patients with rheumatoid arthritis with depression in healthy control
subjects were found. Effect sizes for depression were small to
moderate (r = .21, p < .0001; heterogeneous). This
effect was not reduced in studies controlling for sociodemographic
characteristics (r = .27, p < .0001). The effect sizes did
vary in a linear manner in proportion to the effect size for
pain (z = 2.67, p = .0064). The effect sizes produced by different
measures of depression were heterogeneous (
2
for Fisher’s Z = 24.6, p = .0002), with the Hospital Anxiety
and Depression Scale giving effect sizes most dissimilar to those of
other measures.
CONCLUSIONS: Depression is more common in patients with rheumatoid arthritis than in healthy individuals. This difference is not due to sociodemographic differences between groups, but it may be attributable, in part, to the levels of pain experienced. Variation in the methods of assessing depression partly accounts for the differences among studies examining the levels of depression in patients with rheumatoid arthritis.
Key Words: pain, • depression, • rheumatoid arthritis, • meta-analysis, • systematic review.
Abbreviations: AIMS = Arthritis Impacts Measurement Scale; • BDI = Beck Depression Inventory; • CES-D = Center for Epidemiological Studies Depression Scale; • GDS = Geriatric Depression Scale; • GWB-D = General Well-Being Depression Scale; • HADS = Hospital Anxiety and Depression Scale; • IDD = Inventory to Diagnose Depression; • MMPI = Minnesota Multiphasic Personality Inventory; • PDI = Psychiatric Diagnostic Interview; • POMS = Profile of Mood States; • RA = rheumatoid arthritis.
Abstract 3 of 4
Psychosomatic Medicine 64:773-786 (2002)
© 2002 American
Psychosomatic Society
REVIEW ARTICLES |
From the PRIDE Research Foundation (J.D., P.B.P.), Dallas, Texas; and Departments of Psychiatry and Rehabilitation Sciences (R.J.G.), The University of Texas Southwestern Medical Center, Dallas, Texas.
Correspondence: Address reprint requests to: Robert J. Gatchel, PhD, Division of Psychology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390-9044. Email: robert.gatchel@utsouthwestern.edu
ABSTRACT
OBJECTIVE: Numerous studies have documented a strong association between chronic pain and psychopathology. Previous research has shown that chronic pain is most often associated with depressive disorders, anxiety disorders, somatoform disorders, substance use disorders, and personality disorders. The primary objective of this review article is to describe the nature of the relationship between chronic pain and each of these types of psychopathology. In addition, this article will explore how each of these disorders are expressed within the context of chronic pain, with a consideration of both diagnostic and treatment issues.
METHODS: Medline and PsychLit searches of the chronic pain/psychopathology literature from 1980 through 2000 were conducted using the keywords chronic pain, psychopathology, psychiatric disorders, and psychological disorders.
RESULTS: The relationship between chronic pain and psychopathology has generated substantial empirical and theoretical interest, with depressive disorders receiving much of the attention.
CONCLUSIONS: Although no single theoretical model can fully explain the causal relationship between chronic pain and psychopathology, a diathesis-stress model is emerging as the dominant overarching theoretical perspective. In this model, diatheses are conceptualized as preexisting, semidormant characteristics of the individual before the onset of chronic pain that are then activated and exacerbated by the stress of this chronic condition, eventually resulting in diagnosable psychopathology.
Key Words: chronic pain, • psychopathology, • psychiatric disorders, • psychological disorders.
Abbreviations: CLBP = chronic low back pain; • DSM = Diagnostic and Statistical Manual of Mental Disorders; • MDD = major depressive disorder; • MMPI = Minnesota Multiphasic Personality Inventory; • PD = Personality Disorder; • SNAP = Schedule for Nonadaptive and Adaptive Personality; • SCID = Structured Clinical Interview for the DSM.
[Full Text of Dersh et al.] [Reprint (PDF) Version of Dersh et al.]
Abstract 4 of 4
Psychosomatic Medicine 63:896-909 (2001)
© 2001 American
Psychosomatic Society
ORIGINAL ARTICLE |
From Harvard Medical School, Cambridge, MA.
Correspondence: Address reprint requests to: Don R. Lipsitt, MD, Mount Auburn Hospital—Clark 218, 330 Mount Auburn St., Cambridge, MA 02238. Email: don_lipsitt@hms.harvard.edu
OBJECTIVE: The objectives of this review are 1) to briefly describe the parallel historical developments of consultation-liaison (C-L) psychiatry; 2) to analyze the extent to which the literature of C-L psychiatry and psychosomatic medicine relate to each other, given that both fields have evolved simultaneously in the history of psychiatry; and 3) to propose possible explanations for observed publication patterns in selected C-L resources and the journal Psychosomatic Medicine.
METHODS: The quasi–citation analysis includes two segments: 1) a review of selected key C-L psychiatry references to determine the extent to which classic articles from Psychosomatic Medicine are cited; and 2) an analysis of 60 years of Psychosomatic Medicine, sampling issues from the first 5 years of each decade and all issues of the year 2000 for articles of potential relevance to C-L psychiatry. References to Psychosomatic Medicine articles in C-L resources are tallied as percentages of total references in each source. Articles in Psychosomatic Medicine are assigned to one of three categories (A, B, or C) according to their perceived relevance to C-L psychiatry, from most (A) to least (C) relevant.
RESULTS: The review of C-L sources ("basic" reading lists and reference lists of seminal articles and textbooks) revealed a wide range of Psychosomatic Medicine citations, from 0% to 27.4% (average, 7.5%). The survey of Psychosomatic Medicine sorted 1705 articles for their relevance to C-L psychiatry into category A (9.5–40.6%, average 21.3%), category B (70.4–86.3%, average 72.3%), and category C (0.7–12.1%, average 6.4%) for each half-decade for the past 60 years. The lowest number of category A articles appeared in the years 1970 to 1975, and the highest number appeared in 1950 to 1955; reciprocal results were found for category B articles. The lowest number of category C articles appeared in 1980 to 1985, and the highest number appeared in 1940 to 1945. For the six issues of 2000, the distributions of articles in categories A, B, and C are similar, continuing an upward trend beginning in 1975 of core (category A) articles. Explanations for publication patterns are speculatively related to various factors, such as a paucity of C-L research and researchers, the broad definition of C-L psychiatry, editorial policies, and the impact of World War II.
CONCLUSIONS: Although C-L psychiatry and psychosomatic medicine have common roots, the reliance of the C-L literature on classic Psychosomatic Medicine articles has varied markedly, from none to about one-quarter of its references. Nevertheless, Psychosomatic Medicine has consistently published articles of theoretical and clinical interest to C-L psychiatrists, with more than 90% of published articles considered to be of high or moderate relevance to C-L psychiatry. A far higher percentage of articles in Psychosomatic Medicine would seem to be relevant to the field of C-L psychiatry than are cited in significant C-L literature. Psychosomatic Medicine’s essential focus on empirical research may dissuade the more clinically oriented C-L psychiatrists.
Key Words: psychosomatic medicine, • consultation-liaison psychiatry, • citation analysis.
Abbreviations: APS = American Psychosomatic Society; • C-L = consultation-liaison; • PM = Psychosomatic Medicine.
Copyright © 2003 by the American Psychosomatic Society
The Greek term, diathesis, is very closely linked with the inherited and aquired miasms and constitutional predisositions to particular symptom syndromes.
1. A diathesis is a inherited or acquired condition of the organism which makes it susceptible to peculiar disease states; a constitutional predisposition toward certain disorders. Greek, diathesis, dia-asunder and tithenai-to place.
2. A constitutional state which mistunes the body, and, or mind
3. Diathetic constitutions are a catagory of constitutional predisposition to certain disorders, i.e., lympathic, venous, leuco-phlegmatic, scrofolous, psoric, sycotic, etc..
Study Guide: Hahenmann integrated the Hippocratic diathetic constitutions inot his homoeopathic system. In particular he uses the term, Angeboren Koeper-Constitutionen in the Organon of the Healing Art.
Angebornen Koeper-Constitutionen
In Aphorism. 81 of the German Organon Hahnemann uses the term 'angebornen Koerper-Constitutionen' to discribe the congenital bodily constitution. The genetic constitution represents the family genus of the paternal and material lineages. This represents the inherited diathetic mind/body constitution and its predispositions. The interdependance of temperament and constitution is as inseparable as the link between the essential nature (G. wesen) and the vital force. One does not appear without the other. Such relationships are called functional polarities or complementary opposites.
Hahnemann saw the unity of the organic whole while the orthodox school fell under the way of reductionist pathology and disease names. Our teacher pointed out that the reductionist looks at the products of disease and mistake them for the cause of the disease and the disease itself. 'Tolle Causum' they cry yet they do not yet realize that the cause of an event, can never be at the same time, the event itself. Even in early homeopathy the constitution view of the human organism was clearly defined and the local basis of disease refuted. *Vide § 42 of the 1st Organon (1810).
"But the human organism in its living state is a complete whole, a unity. Every sensation, every manifestation of power, every affinity of the component parts of one part is intimately associated with the sensation, the functions and the affinites of the component part of all other parts. No part can suffer without all other parts. No part can suffer wihout all other parts sympathising and simultanesouly undergoing more or less change."
*Organon of Medicine 5th & 6th edition, Dudgeon and Boeriecke, P. Jain, Lts, New Delhi, Appendix, page 194..
Thus diathesis is a constitutional state which may be physical and psychological as well as inherited or acquired. The concept of diathesis is closely linked to susceptibility, predisposition and the miasms in homeopathy. This material is very cryptic to most modern homeopath yet those who have put this system to work find it practical and indespensible to daily practice. Homeopathic reference works have record a great amount of information on constitutional diathesis and dynamic remedies which reflect a similar state. Hering and Knerr record a large amount of material in their writings. Refer Diathetic Constitutions
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