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Topic Review
Existential Suffering in Palliative Care
Existential suffering refers to one's angst due to a perceived loss of meaning, hope, relationships, and a sense of self in thinking about death and dying. Quality palliative care not only takes care of patients’ physical and existential suffering but also fills their last days with opportunities for redemption, spiritual growth, and reconciliation. We propose a holistic approach as illustrated by the healing wheel, involving health care providers, the community, patients, and a Higher Power.
  • 2.5K
  • 29 Sep 2021
Topic Review
Extroversion and Neuroticism at Work
Extroversion and Neuroticism. Many studies have linked personality traits to the way in which workers carry out their tasks, with the aim of optimizing employee performance. Understanding this relationship is very useful for both recruiting members of staff and assigning them to positions that best fit their personality. It is generally accepted that there are five principal traits or factors that can be used to catalog the structure of each individual personality.
  • 969
  • 06 Feb 2021
Topic Review
Fibromyalgia Symptoms Overview
Fibromyalgia syndrome (FMS) can be conceptualized as a chronic disorder characterized by widespread musculoskeletal pain and other accompanying symptoms such as fatigue, insomnia, depression, anxiety and cognitive impairments. The etiology of FMS remains unknown, being one of the most accepted hypothesis the presence of central sensitization to pain and impairments in endogenous pain inhibitory mechanisms. The history of the development of FMS concept reveals how other symptoms -apart from pain- has become also relevant in FMS diagnosis and treatment. The central symptom of FMS is pain. FMS patients generally report high levels of clinical pain, which are related to greater impairments in health related quality of life, cognitive abilities and disease course. Fatigue and sleeping difficulties are also common symptoms of FMS. Fatigue have shown positive associations with pain, stiffness, sleep problems, increased body mass index, FMS severity, tenderness, disability, cognitive complaints, anxiety and depression. The majority of FMS patients report poor sleep quality, take longer to fall asleep, generally wake up during the night, sleep fewer hours, and usually wake up unrefreshed. Emotional disturbances (i.e., depression, anxiety) are also frequent in FMS. In fact, depression and anxiety disorders have showed a negative impact on the clinical course and work capacity of FMS patients. Cognitive impairments are also a relevant symptom in FMS. The most common complaints among FMS patients are executive function deficits, attention problems, forgetfulness, concentration difficulties, and mental slowness. Regarding the most frequent treatments for FMS, these can be classified as non-psychological and psychological. The former includes analgesic drugs, adjuvant drugs (i.e., antidepressants, benzodiazepines, anticonvulsants, etc.), nerve blocks, electrostimulation at different levels, infiltrations, etc. The psychological therapies with the most evidence are cognitive-behavioral, acceptance and commitment therapy and mindfulness. FMS is associated with a severe reduction of health related quality of life and psychosocial impairments. It is necessary to take all FMS symptoms and its relations into account in order to provide a more tailored and effective treatment, as well as, to improve the health related quality of life of FMS patients.
  • 803
  • 26 Oct 2020
Topic Review
Fibromyalgia Syndrome
Pain has a multidimensional nature in which three dimensions are usually differentiated: the sensory-discriminative, the emotional-affective and the cognitive-evaluative. Based on the duration, it is possible to distinguish between acute pain, when it is present for a period lower than 6 months; or chronic pain, if pain is present more than 6 months. Fibromyalgia Syndrome is a complex chronic pain disorder in which widespread and persistent musculoskeletal pain is accompanied by different symptoms such as fatigue, insomnia, morning stiffness, depression, anxiety and cognitive impairments. Fibromyalgia began to be studied from the 16th century and it received different names during its historical development. The main landmarks in the development of fibromyalgia term include -among others- when the French physician Guillaume de Baillou in 1642 provided the first description of the disease using the term “muscular rheumatism”. The British neurologist W.R. Gowers in 1904 coined the term “fibrositis” in an article on lumbago. In 1944, F. Elliot suggested that the pain experimented by fibromyalgia patients might involve the spinal cord and thalamus. In 1968, E.F. Traut stated the first near-modern description of fibromyalgia with systemic features. In 1976, the term fibromyalgia was coined by P.K. Hench as a form of non-articular rheumatism based on the absence of specific inflammatory damage. In 1977, H.A. Smythe and H. Moldofsky continued the work of P.K. Hench and proposed the first measure for evaluating fibromyalgia. Nevertheless, it was not until 1981 that the medical community accepted this disease under the term "fibrositis" or “fibromyalgia” thanks to the work of Yunus et al. The distinction between primary and secondary fibromyalgia disappeared sometime later. During the 1980s, different authors suggested other formal and ad-hoc criteria sets. In 1987, the American Medical Association accepted fibromyalgia as a real disease. Shortly thereafter and as a result of this recognition, the American College of Rheumatology (ACR) created a committee to establish the diagnostic criteria for this disorder. The first official diagnostic criteria were proposed in 1990 by the ACR. In 1994, fibromyalgia was also recognized by the International Association for the Study of Pain. During the 1990s, there was an increase in fibromyalgia research. In 2010, the ACR proposed a new version of the diagnostic criteria based exclusively on the use of the Widespread Pain Index and the Symptom Severity Scale. In addition, other two subsequent diagnostic proposals were performed. In 2011, Wolfe et al. revised and modified the 2010 ACR diagnostic criteria to facilitate its use in epidemiological or community studies, but not for self-diagnosis in the clinical context. In 2016, ACR criteria were proposed to combine the 2010 and 2011 ACR criteria into a single set to overcome the previous limitations. Definitely, fibromyalgia involves high personal, family and financial costs. Fibromyalgia also implies high economic costs for the socio-health system. Fibromyalgia notably reduces perceived functioning in physical, psychological, and social spheres, and has a negative impact on personal relationships, parenting, work, daily activities, mental health and social relationships.
  • 1.4K
  • 05 Nov 2020
Topic Review
Five-Minute Speech Sample for High Expressed Emotion
Expressed Emotion (EE) describes the tone of a caregiver’s response to a patient with a mental disorder, and it is used to predict relapse. The Five-Minute Speech Sample (FMSS) is a 5-min interview with a caregiver that evaluates only two EE dimensions. The FMSS emerged as a valid and reliable tool for measuring EE as a predictor of relapse in patients with schizophrenia and major depressive disorder. Patient age and duration of illness had no significant effect on the results. Future meta-analyses should include more studies to reduce publication bias. EE may be a good predictor of relapse when examined through a fast measurement technique such as the FMSS, which may also be useful to analyze the psychopathological structure of caregivers. 
  • 961
  • 18 Jan 2023
Topic Review
Food Addiction in Eating Disorders
Food addiction (FA) has been mentioned as a potential subtype of obesity, and has been associated with Eating Disorders (ED). A first approach of a phenotypic characterization of food addiction (FA) found three clusters (dysfunctional, moderate and functional). 
  • 536
  • 16 Mar 2022
Topic Review
HPA Axis and Allopregnanolone
Under stressful conditions, the hypothalamic-pituitary-adrenal (HPA) axis acts to promote transitory physiological adaptations that are often resolved after the stressful stimulus is no longer present. In addition to corticosteroids (e.g., cortisol), the neurosteroid allopregnanolone (3α,5α-tetrahydroprogesterone, 3α-hydroxy-5α-pregnan-20-one) participates in negative feedback mechanisms that restore homeostasis. Chronic, repeated exposure to stress impairs the responsivity of the HPA axis and dampens allopregnanolone levels, participating in the etiopathology of psychiatric disorders, such as major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). MDD and PTSD patients present abnormalities in the HPA axis regulation, such as altered cortisol levels or failure to suppress cortisol release in the dexamethasone suppression test. Herein, we review the neurophysiological role of allopregnanolone both as a potent and positive GABAergic neuromodulator but also in its capacity of inhibiting the HPA axis. The allopregnanolone function in the mechanisms that recapitulate stress-induced pathophysiology, including MDD and PTSD, and its potential as both a treatment target and as a biomarker for these disorders is discussed. 
  • 775
  • 13 Jun 2021
Topic Review
Images and Logics of Discovery in Psychiatric Care
A psychopathological phenomenon is an experienced condition whose peculiar features emerge within an interpersonal context. In different interpersonal (e.g., socio-cultural) contexts and in different contexts of care (e.g., bio-medical, psychotherapeutic or community settings), different phenomena may emerge from the same patient and they can be given different psychopathological significance. Symptom variance (which is taboo for ticking-boxes interviewing techniques) is an effect of the milieu in which a given phenomenon emerges.
  • 263
  • 29 Dec 2022
Topic Review
Impulsivity
In psychology, impulsivity (or impulsiveness) is a tendency to act on a whim, displaying behavior characterized by little or no forethought, reflection, or consideration of the consequences. Impulsive actions are typically "poorly conceived, prematurely expressed, unduly risky, or inappropriate to the situation that often result in undesirable consequences," which imperil long-term goals and strategies for success. Impulsivity can be classified as a multifactorial construct. A functional variety of impulsivity has also been suggested, which involves action without much forethought in appropriate situations that can and does result in desirable consequences. "When such actions have positive outcomes, they tend not to be seen as signs of impulsivity, but as indicators of boldness, quickness, spontaneity, courageousness, or unconventionality" Thus, the construct of impulsivity includes at least two independent components: first, acting without an appropriate amount of deliberation, which may or may not be functional; and second, choosing short-term gains over long-term ones. Impulsivity is both a facet of personality and a major component of various disorders, including ADHD, substance use disorders, bipolar disorder, antisocial personality disorder, and borderline personality disorder. Abnormal patterns of impulsivity have also been noted instances of acquired brain injury and neurodegenerative diseases. Neurobiological findings suggest that there are specific brain regions involved in impulsive behavior, although different brain networks may contribute to different manifestations of impulsivity, and that genetics may play a role. Many actions contain both impulsive and compulsive features, but impulsivity and compulsivity are functionally distinct. Impulsivity and compulsivity are interrelated in that each exhibits a tendency to act prematurely or without considered thought and often include negative outcomes. Compulsivity may be on a continuum with compulsivity on one end and impulsivity on the other, but research has been contradictory on this point. Compulsivity occurs in response to a perceived risk or threat, impulsivity occurs in response to a perceived immediate gain or benefit, and, whereas compulsivity involves repetitive actions, impulsivity involves unplanned reactions. Impulsivity is a common feature of the conditions of gambling and alcohol addiction. Research has shown that individuals with either of these addictions discount delayed money at higher rates than those without, and that the presence of gambling and alcohol abuse lead to additive effects on discounting.
  • 865
  • 25 Oct 2022
Topic Review
Intellectual Disability
Intellectual disability (ID), also known as general learning disability and formerly mental retardation (MR), is a generalized neurodevelopmental disorder characterized by significantly impaired intellectual and adaptive functioning. It is defined by an IQ under 70, in addition to deficits in two or more adaptive behaviors that affect everyday, general living. Intellectual functions are defined under DSM-V as reasoning, problem‑solving, planning, abstract thinking, judgment, academic learning, and learning from instruction and experience, and practical understanding confirmed by both clinical assessment and standardized tests. Adaptive behavior is defined in terms of conceptual, social, and practical skills involving tasks performed by people in their everyday lives. Once focused almost entirely on cognition, the definition now includes both a component relating to mental functioning and one relating to an individual's functional skills in their daily environment. As a result of this focus on the person's abilities in practice, a person with an unusually low IQ may still not be considered to have an intellectual disability. Intellectual disability is subdivided into syndromic intellectual disability, in which intellectual deficits associated with other medical and behavioral signs and symptoms are present, and non-syndromic intellectual disability, in which intellectual deficits appear without other abnormalities. Down syndrome and fragile X syndrome are examples of syndromic intellectual disabilities. Intellectual disability affects about 2 to 3% of the general population. Seventy-five to ninety percent of the affected people have mild intellectual disability. Non-syndromic, or idiopathic cases account for 30 to 50% of these cases. About a quarter of cases are caused by a genetic disorder, and about 5% of cases are inherited from a person's parents. Cases of unknown cause affect about 95 million people (As of 2013).
  • 1.1K
  • 20 Oct 2022
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