Relationship between depressive and anxious state, the function of autonomic nervous system, and the level of uric acid

Oral abstracts / Journal of Psychosomatic Research 55 (2003) 133–145 after the first visit to the audiological clinic. The severity of tinnitus was classified in three categories: no/transient, only in specific situations, or continuous and severe. Results: Sixty-one percent of the patients with continuous severe tinnitus and 41% of patients with tinnitus only in specific situations had a current depression. Eleven percent of patients with no or transient tinnitus had a current depression, but 41% had recovered from an earlier depression. Only 7% of the patients with depression reported that they had any tinnitus prior to their psychological complaints, though the majority felt that tinnitus was the cause of their depression. Discussion and conclusions: A common neurochemical dysfunction in patients with severe tinnitus and patients with depressive disorders is possible probably in the serotonin system because of its involvement in the regulation of concentration, sleep, mood, and the modulation of the sensory processing in the central auditory system.

Psychosocial risk assessment in kidney transplant candidates in Cali, Colombia (preliminary report) Rincon HG, Gomez JE, Villadiego JS Introduction: Psychosocial risk assessment has been considered an important aspect in the comprehensive evaluation and clinical management of kidney transplant candidates. Objective: To detect psychosocial risk in kidney transplant candidates. Methods: Clinical assessment of risk was done within a liaison psychiatry program through a semistructured psychiatric interview that included information from transplant program nurse and patient selfevaluation questionnaires (PRIME MD, SCID II modules for borderline and antisocial personality disorder, and alcohol and substance abuse questionnaires). Psychosocial risk was classified as low (no psychosocial pathology), intermediate (mild to moderate mental illness without treatment or moderate to severe mental illness with treatment), and high (moderate to severe mental illness without treatment or severe family dysfunction). Results: Two hundred seventeen psychiatric evaluations were done as a part of kidney transplant protocol at Fundacio´n Clinica Valle del Lili (Cali, Colombia) between February 1998 and February 2003. Each clinical interview lasted an average of 15 min. Mean age was 46 years (range: 12 – 74); 50.7% were men; 58.5%, 35.9%, and 5.5% of patients had low, intermediate, or high psychosocial risk, respectively. Conclusions: Intermediate or high psychosocial risk was found in every 2 of 5 patients assessed. This method was useful in the clinical psychosocial risk assessment of this population.

The reliability and factorial validity of the Japanese version of the 20-item Toronto Alexithymia Scale Komaki G, Maeda M, Arimura T, Nakata A, Shinoda H, Ogata I, Shimura M, Kawamura N, Kubo C Introduction: We evaluated the reliability and factorial validity of a Japanese version of the Toronto Alexithymia Scale-20 (TAS-20), a selfreporting questionnaire for assessing alexithymia in a group of normal subjects (N = 347) and in a mixed group of psychosomatic and neurotic outpatients (N = 940). Results: The three-factor structured model was found to be reliable and replicable in the Japanese version of TAS-20 by confirmatory factor analysis of each group; for the normal subjects, GFI = 0.892, AGFI = 0.864, RMSEA = 0.066, and TLI = 0.829; for the patients, GFI = 0.923, AGFI = 0.904, RMSEA = 0.059, and TLI = 0.843. The one- or two-factor structured model was not reliable, respectively, for either group. However, item/factor parameter estimates indicated that the homogeneity was lower for factor 3 (external-oriented thinking), and further internal reliability coefficients showed that Cronbach’s alpha coefficient was

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lower than .6 for factor 3 compared with factor 1 (difficulty identifying feelings) and 2 (difficulty describing feelings). Correlations between the full scale TAS-20 and factor 3 was significantly correlated, as for other two factors. The test – retest correlations for normal subjects were statistically significant. Conclusion: The sufficient total test reliability and good test – retest reliability indicate that the Japanese version of the TAS-20 is reliable for use with the Japanese population, although external-oriented thinking had low internal consistency, indicating less homogeneity than other factored items.

Psychophysiological correlates of hypochondriasis: a P300 study Papageorgiou C, Rabavilas A, Christodoulou GN Recent research considers the involvement of a heightened attentional focus on bodily sensation and a tendency to misinterpret these as essential pathogenetic premise of hypochondriasis (HP). However, the knowledge about these processes is limited. Since the P300 waveform obtained from scalp reflects high-order processing associated with the evaluation of attended stimuli, the present study aimed at examining the brain potential correlates in HP as they are reflected by P300 waveforms. We examined 15 drug-free HP patients (6 males and 9 females) and an equal number of healthy controls matched for age, sex, and educational levels using an auditory working memory test to elicit P300 waveforms and memory performance of immediate recall. HP patients as compared to controls showed significantly lower P300 amplitudes on the right prefrontal areas. The obtained patterns of differences classified correctly 83.3% of the two groups. In view of evidence that P300 amplitude may reflect the degree of updating of working memory following stimulus change, a reduced P300 in HP patients may reflect a reduced impact of attended stimuli on working memory operation. This deficiency possibly represents the inability of HP patients to differentiate relevant from irrelevant stimulus information.

Assessment of P200 after moderate to severe brain injury Papageorgiou C, Boviatsis E, Koujalis A, Kontopantelis E, Philis A, Uzunoglu N, Sakkas D, Rabavilas A, Christodoulou GN Traumatic brain injury (TBI) is a common problem and one capable of producing a host of neuropsychiatric problems such as posttraumatic stress disorders (PTSD). Although an organic etiology is certain, little psychophysiological evidence exists to explain the exact nature of it. Since the P200 component of event-related potentials (ERPs) is regarded as reflecting the concentration of attention, and its reduction has been implicated in PTSD, the present study aimed at examining the P200 component in TBI patients. We investigated 18 patients with a moderate and/or severe brain injury who presented at a university neurosurgery clinic and 25 healthy controls matched for age, sex, and educational levels. The auditory P200 of both groups were recorded during the administration of working memory task. TBI patients showed a striking decrease in P200 amplitude located at the left prefrontal area. This pattern of differences classifies correctly 88.4% of the subjects. These findings suggest that TBI is associated with defects in the concentration of attention. Additionally, the measurement of P200 component in further TBI groups may provide a potential model for better understanding of neurobiological mechanisms thought to be related both to TBI and PTSD.

Relationship between depressive and anxious state, the function of autonomic nervous system, and the level of uric acid Hirofumi I, Kawai Y, Miyata K, Kawamura N Purpose: Trevisan et al. (1997) reported that their patients’ uric acid level fell significantly when they were exposed to a natural disaster for a short

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Oral abstracts / Journal of Psychosomatic Research 55 (2003) 133–145

period of time; however, their uric acid level rose significantly, when exposed for a long period of time. This study aimed at analyzing the relation between the uric acid and the psychological factor and the function of autonomic nervous systems. Subjects and procedures: The subjects of this study were 396 patients (112 men, 284 women) who consulted the medical doctor dealing with psychosomatic diseases for the first time. Blood was collected at the time of hunger during the first visit to the clinic and the serum uric acid level was measured. Electrocardiogram in the standing position was recorded as a functional inspection of autonomic nervous system. The questionnaires including CMI, SDS, and STAI were filled out. Results: BMI and age were used as covariate. The subjects were divided into the three groups depending on their level of uric acid (low, median and high) and an analysis of covariance was performed according to sex. For the female subjects, a significant correlation was found in the three uric acid levels with the score of mental complaints of CMI, the score of proper anxiety of STAI and the function of autonomic nervous system. For the male subjects, no significant correlation was found.

Parental assessment of children conceived by artificial donor insemination — possible ways to reduce cognitive dissonance Schilling G, Conrad R The development of children conceived by artificial donor insemination has been under investigation in a lot of studies. Most of the studies found a normal cognitive and emotional development of these children. However, little is known with regard to adaptation processes in donor insemination parents, enabling them to cope with their negative feelings towards the genetically ‘‘strange’’ child. Twenty couples having conceived by donor insemination were compared to 23 couples having conceived in a natural way. All 43 couples had one child aged 4 or 5 years. All parents had to assess their children with regard to the question, how similar they were to themselves or to their partner concerning bodily features and personality features. There were significant differences between both groups with regard to similarities in personality features. Artificial donor insemination parents assessed their child to be highly similar to the social father as far as personality features are concerned. Our findings suggest a possible adaptation process reducing cognitive dissonance in donor insemination parents by emphasizing the importance of the social father for the personality development of their child.

Suicidal tendencies and body image and experience in anorexia nervosa and suicidal female adolescent inpatients Stein D, Orbach I, Shani-Sela M, Har-Even D, Yaruslavsky A, Roth D, Meged S, Apter A Background: The aim of this study was to assess the relationship between body image and suicidal tendencies in anorexia nervosa (AN). Methods: Three groups of hospitalized female adolescents — nonsuicidal AN, suicidal psychiatric, and nonsuicidal psychiatric patients — and a community control group with no psychiatric disturbance were compared with regard to suicidal tendencies (in the form of attitudes to life and death), body image and experience, depression and anxiety. Results: The AN and suicidal patients showed less attraction to life and more repulsion by life, and more attraction to death and less repulsion by death compared with the two other groups. The AN and suicidal patients were also different from either one or both control groups in showing more negative attitudes and feelings towards their bodies, lower sensitivity to body clues, less bodily control, and elevated depression and anxiety. These between-group differences in suicidal tendencies were retained after controlling for age, body mass index, the different body image dimensions, anxiety and depression. Conclusions: Our findings suggest that female AN in-patients with no evidence of overt suicidal behavior demonstrate elevated suicidal tenden-

cies that are similar to those of suicidal psychiatric inpatients. These selfdestructive tendencies are highly associated with a pervasive sense of disturbance of body image and experience.

The relationship of depressive symptoms and cardiovascular disease in elderly Japanese – American men Takeshita J, Masaki K, Thompson D, Fujii D, Chen R, Ahmed I, Rodriquez B, Curb J The Honolulu Heart Program is a prospective population-based cohort of cardiovascular disease established in 1965. At the fourth examination (1991 – 1993), depressive symptoms were measured in 3196 participants aged 71 – 93 years using an 11-question version of the Center for Epidemiologic Studies Depression Scale (CES-D-11). The presence of depressive symptoms was defined as a score > 9. The overall prevalence of depressive symptoms was 9.9%; antidepressants were used in 0.8% of the population. Variation of depressive symptoms among age groups (ages 71 – 74, 8.8%; ages 75 – 79, 10.5%; ages 80 – 84, 10.5%; ages 85 and older 10.0%) was not statistically significant. Cross-sectional analysis showed that those with depressive symptoms had significantly higher rates of prevalent stroke (4.7% vs. 2.4%, P = .01) compared to those without depressive symptoms. However, there was no significant increase in prevalent coronary heart disease (CHD) (16.7% vs. 14.5% P = .29) in those with depressive symptoms. Longitudinal analysis showed no significant increased risk of 7-year incident CHD (R2 = 1.24, 95% CI = 0.80 – 1.94) or incident stroke (R2 = 1.004, 95% CI = 0.51 – 2.0) in those with depressive symptoms. There were no significant differences in heart rate and premature ventricular contractions (PVC) as noted on electrocardiograms (EKG). These findings are in marked contrast to the growing body of literature, which note a strong relationship between depression and cardiovascular disease.

Stress and immunity plasma IL-6 elevation in response to restraint stress Kubo C Several recent reports demonstrated that restraint stress elevates plasma IL-6 levels; however, the precise mechanism whereby stress stimuli trigger the production of IL-6 remains to be clarified. The plasma IL-6 response of germ-free (GF) mice was compared to that of specific pathogen-free (SPF) mice. The stress-induced plasma IL-6 elevation in the SPF mice was completely inhibited by pretreatment with 6-hydroxydopamine, indicating that the activation of the sympathetic nervous system during stress is critical for this IL-6 elevation. In addition, almost identical stressinduced IL-6 elevation was found in the GF mice. The expression levels of IL-6 mRNA in the liver increased after 1 hour of stress in both the GF and SPF mice in findings based on a semiquantitative RT-PCR method, although no such increase was observed in the spleen and kidney of either group of mice. These results thus indicate that restraint stress is capable of elevating the plasma IL-6 levels independently of the intestinal microflora and that the liver is one of the main sources of the increased plasma IL-6 during stress.

The transcendental meditation program and cardiovascular disease in native Hawaiians Nidich S, Grandinetti A, Schneider R, Chang H, Ricketts L, Toomey M The NIH-NCCAM-sponsored Center for Natural Medicine and Prevention (CNMP) is a consortium of eight leading academic and medical institutions focused on studying the effects of Maharishi Vedic Medicine, a traditional system of health care, on cardiovascular disease in minority aging populations at risk for CVD. The research program is based on over a decade of findings indicating the effectiveness of the Transcendental