Tim Brunson DCH

Welcome to The International Hypnosis Research Institute Web site. Our intention is to support and promote the further worldwide integration of comprehensive evidence-based research and clinical hypnotherapy with mainstream mental health, medicine, and coaching. We do so by disseminating, supporting, and conducting research, providing professional level education, advocating increased level of practitioner competency, and supporting the viability and success of clinical practitioners. Although currently over 80% of our membership is comprised of mental health practitioners, we fully recognize the role, support, involvement, and needs of those in the medical and coaching fields. This site is not intended as a source of medical or psychological advice. -- Tim Brunson, PhD

The Question of Commitment



by Tim Brunson, PhD

Long before I began pursing my current profession I started noticing that the vast bulk of humanity regularly comes up short when it comes to the goals that they wish to achieve. The attrition rates in our schools and universities are very similar to our failures with patients who desperately seek medical advice, which they fail to follow, or those who never seem to respond as hoped to psychotherapy.

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A Theory on the Cause and Possible Cure for Schizophrenia



by Alfred A Barrios, PhD

In my book Understanding Hypnosis: Theory, Scope and Potential (Barrios, 2009), I present an explanation for the cause of schizophrenia that derived from my theory of hypnosis (Barrios, 2001). Based on this explanation, I also present a possible cure for schizophrenia using hypnosis. This article will be a presentation of these very same ideas.

I would like to begin by giving you a brief overview of my theory of hypnosis, focusing especially on how the theory explains hypnotic phenomena such as hallucinations and delusions.

To begin with, I define hypnosis as a state of heightened belief produced by a series of positively-responded-to-suggestions. With each positive response the belief factor is increased (belief in what the hypnotist is suggesting). And I define belief as concentration on a thought to the exclusion of anything that would contradict that thought. Thus, in a state of heightened belief, any stimuli either sensory or cognitive that might contradict the suggestion given by the hypnotist are automatically blocked off. This highly focused state of mind then is capable of amplifying images to the point of becoming hallucinations, and amplifying thoughts to where they can become delusions.

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Are hypnosis and dissociation related? New evidence for a connection.



The authors revisit the question of the existence of a relationship between hypnotizability and dissociative capacity. In the present study, the State Scale of Dissociation (SSD) replaced the commonly employed Dissociative Experiences Scale (DES) as a measure of dissociation, due to the latter capturing primarily pathological aspects of dissociation. Relationships between the Harvard Scale of Hypnotic Susceptibility, Form A (HGSHS:A), the SSD, and the Phenomenology of Consciousness Inventory (PCI) were assessed in the context of hypnosis. Robust results were found when comparing pre- to post-SSD scores, suggesting heightened nonpathological forms of dissociation are indeed related to hypnotizability. The appropriateness of the DES and similar trait-based measures for evaluating hypnotic phenomena is discussed as well as the relationships between PCI and SSD subscales.

Int J Clin Exp Hypn. 2015;63(2):198-214. doi: 10.1080/00207144.2015.1002691. Cleveland JM1, Korman BM, Gold SN.

Using Space and Time in Therapeutic Interventions



by Tim Brunson, PhD

Mental and physical pathologies exist. They are conditions and events, which are part of the reality that we endure every second of our lives. They arise based upon external influences and – whether ephemeral or lasting – they permeate our being in a substantial way. They are, however, also encoded in relationship to the other programs and patterns within our minds. It is their relationship with these previous experiences that tend to give undesired (and even desired) states meaning and become the foundation as to how we understand them. A fundamental attribute of hypnotherapy is the probability of altering the relationship of programmed phenomena in a way that changes meaning – and therefore possibly changing our experiences. Most likely the most potent phenomena that we can alter are those that are related to a person's concept of space and time.

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Behaviorism, Hypnotherapy, and Choice



by Tim Brunson, PhD

Over the past several decades the rise of behaviorism within psychology has both been enlightening as well as often disturbing. By reclassifying psychology as the science of behavior rather than the science of the mind, behaviorists have insisted that all human physical and mental activities consist of observable phenomena, which can then be modified should the scientist or clinician understand how to apply or withhold positive or negative reinforcements. As such, this deterministic approach has served to strip away the role of choice, free will, and even calls into question the role of higher-level intelligence.

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Perceptually-oriented hypnosis: removing a socially learned pathology and developing adequacy...



Full title: Perceptually-oriented hypnosis: removing a socially learned pathology and developing adequacy: the case of invisible girl.

This is the first case review to explicate perceptual hypnotic principles such as differentiation, characteristics of an adequate personality, and the need for adequacy, as utilized in clinical hypnosis in a complex case that altered the distorted perceptions and personal meanings of an eleven-year-old girl who believed that she had Bipolar Disorder and her body and mind were damaged. This qualitative case study examines aspects of hypnosis during therapy from a perceptual point of view to illustrate frustrations in difficult cases and identify some of the causes and origins of alleged clinical pathology in adverse environments. Some moments of effective self-healing through supporting internally controlled changes in perception during hypnotic experiencing are highlighted rather than externally focusing on observed thoughts and behavior. Factors relevant to social psychological research, such as family dynamics, poverty, and interactions with social service agencies and institutions, creating learned pathology, are pointed out for future research.

Psychol Rep. 2014 Oct;115(2):545-64. doi: 10.2466/02.PR0.115c24z9. Epub 2014 Oct 13.

Woodard FJ. Author information: 1 Woodard Hypnosis and Research, Inc., Milford, New Hampshire.

Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis.



Conversion disorders are defined as neurological symptoms arising without organic damage to the nervous system, presumably in relation to various emotional stress factors, but the exact neural substrates of these symptoms and the mechanisms responsible for their production remain poorly understood. In the past 15 years, novel insights have been gained with the advent of functional neuroimaging studies in patients suffering from conversion disorders in both motor and non-motor (e.g. somatosensory, visual) domains. Several studies have also compared brain activation patterns in conversion to those observed during hypnosis, where similar functional losses can be evoked by suggestion. The current review summarizes these recent results and the main neurobiological hypotheses proposed to account for conversion symptoms, in particular motor deficits. An emerging model points to an important role of ventromedial prefrontal cortex (VMPFC), precuneus, and perhaps other limbic structures (including amygdala), all frequently found to be hyperactivated in conversion disorders in parallel to impaired recruitment of primary motor and/or sensory pathways at the cortical or subcortical (basal ganglia) level. These findings are only partly shared with hypnosis, where increases in precuneus predominate, together with activation of attentional control systems, but without any activation of VMPFC. Both VMPFC and precuneus are key regions for access to internal representations about the self, integrating information from memory and imagery with affective relevance (in VMPFC) and sensory or agency representations (in precuneus). It is therefore postulated that conversion deficits might result from an alteration of conscious sensorimotor functions and self-awareness under the influence of affective and sensory representations generated in these regions, which might promote certain patterns of behaviors in response to self-relevant emotional states.

Neurophysiol Clin. 2014 Oct;44(4):323-37. doi: 10.1016/j.neucli.2014.01.003. Epub 2014 Jan 28. Vuilleumier P. Author information: Laboratory for Behavioral Neurology and Imaging of Cognition (LABNIC), Department of Neuroscience (NEUFO), University Medical Center (CMU), 1, rue Micheli du Crest, 1205 Geneva, Switzerland. Electronic address: patrik.vuilleumier@unige.ch.

Copyright © 2014 Elsevier Masson SAS. All rights reserved.

I wept for four years and when I stopped I was blind.



The conversion phenomena of hysteria were the subject of intense study in the late nineteenth and early twentieth centuries, after which work on the subject went into decline. The patients are still with us, however, and I cite an epidemic of hysterical blindness among Cambodian refugees living in the U.S. as a poignant example. Since the advent of brain imaging technology, conversion hysteria has been receiving renewed attention. In this paper, I suggest that examining the ideas about hysteria from the past, especially those of Charcot and Janet are fertile areas of study, including the illness and its relation to hypnosis, shock, suggestion, and dissociation theory. I also address the role of the imaginary and the imagination in the illness and critique the implicit dualist model used in most brain imaging studies that distorts the integration of psyche and soma. I summon Merleau-Ponty's body-subject, infant research on intersubjectivity, and Vittorio Gallese's "embodied simulation" as possible windows onto the problem of hysterical conversion, and finally I suggest that along with imaging studies, more dynamic narrative strategies should be used if we hope to understand the metamorphoses, mimesis, and powerful emotions that all play a part in this mysterious disease.

Neurophysiol Clin. 2014 Oct;44(4):305-13. doi: 10.1016/j.neucli.2013.11.001. Epub 2013 Dec 8.

Hustvedt S. Author information: 544, Second Street, Brooklyn, NY 11215, United States. Electronic address: sirihustvedt55@gmail.com.

Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The effectiveness of stuttering treatments in Germany.



PURPOSE: Persons who stutter (PWS) should be referred to the most effective treatments available, locally or regionally. A prospective comparison of the effects of the most common stuttering treatments in Germany is not available. Therefore, a retrospective evaluation by clients of stuttering treatments was carried out. METHOD: The five most common German stuttering treatments (231 single treatment cases) were rated as to their perceived effectiveness, using a structured questionnaire, by 88 PWS recruited through various sources. The participants had received between 1 and 7 treatments for stuttering. RESULTS: Two stuttering treatments (stuttering modification, fluency shaping) showed favorable and three treatments (breathing therapy, hypnosis, unspecified logopedic treatment) showed unsatisfactory effectiveness ratings. The effectiveness ratings of stuttering modification and fluency shaping did not differ significantly. The three other treatments were equally ineffective. The differences between the effective and ineffective treatments were of large effect sizes. The typical therapy biography begins in childhood with an unspecified logopedic treatment administered extensively in single and individual sessions. Available comparisons showed intensive or interval treatments to be superior to extensive treatments, and group treatments to be superior to single client treatments. CONCLUSION: The stuttering treatment most often prescribed in Germany, namely a weekly session of individual treatment by a speech-language pathologist, usually with an assorted package of mostly unknown components, is of limited effectiveness. Better effectiveness can be expected from fluency shaping or stuttering modification approaches, preferably with an intensive time schedule and with group sessions. EDUCATIONAL OBJECTIVES: Readers will be able to: (a) discuss the five most prevalent stuttering treatments in Germany; (b) summarize the effectiveness of these treatments; and (c) describe structural treatment components that seem to be preferable across different kinds of treatments.

J Fluency Disord. 2014 Mar;39:1-11. doi: 10.1016/j.jfludis.2014.01.002. Euler HA(1), Lange BP(2), Schroeder S(3), Neumann K(4). Author information: (1)Department of Phoniatrics and Pediatric Audiology, Clinic of Otolaryngology, Head and Neck Surgery, St. Elisabeth Hospital, Ruhr-University Bochum, Bleichstr. 16, D-44787 Bochum, Germany. Electronic address: euler@uni-kassel.de. (2)Department of Medical Psychology and Medical Sociology, Georg-August-University Goettingen, Waldweg 37, D-37073 Goettingen, Germany. Electronic address: benjamin.lange@med.uni-goettingen.de. (3)Max Planck Institute for Human Development, Lentzeallee 94, D-14195 Berlin, Germany; Institute of Psychology, University of Kassel, Hollaendische Str. 36-38, D-34127 Kassel, Germany. Electronic address: sascha.schroeder@mpib-berlin.de. (4)Department of Phoniatrics and Pediatric Audiology, Clinic of Otolaryngology, Head and Neck Surgery, St. Elisabeth Hospital, Ruhr-University Bochum, Bleichstr. 16, D-44787 Bochum, Germany. Electronic address: Katrin.Neumann@rub.de.

Copyright © 2014 Elsevier Inc. All rights reserved.

Psychological and behavioural treatments for adults with non-epileptic attack disorder.



BACKGROUND: Psychogenic non-epileptic seizures, also known as non-epileptic attack disorder (NEAD), have the outward appearance of epilepsy in the absence of physiological or electroencephalographic correlates. Non-epileptic seizures can occur in isolation or in combination with epileptic seizures. The development and maintenance of non-epileptic seizures has been well documented and there is a growing literature on the treatment of non-epileptic seizures which includes non-psychological (including anti-anxiety and antidepressant pharmacological treatment) and psychological therapies (including cognitive behavioural therapy (CBT), hypnotherapy and paradoxical therapy). Various treatment methodologies have been tried with variable success. The purpose of this Cochrane review was to establish the evidence base for the treatment of non-epileptic seizures with behavioural and psychological therapies only. OBJECTIVES: To assess whether behavioural or psychological treatments for non-epileptic seizures or NEAD result in a reduction in the frequency of seizures or improvement in quality of life, or both, and whether any treatment is significantly more effective than others. SEARCH METHODS: We searched the Cochrane Epilepsy Group's Specialised Register (4 February 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1) (January 2013), MEDLINE (1946 to 4 February 2013), PsycINFO (4 February 2013) and SCOPUS (4 February 2013). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies SELECTION CRITERIA: Randomised controlled trials (RCTs) and before and after controlled and non-controlled studies were eligible for inclusion. Studies were required to assess one or more types of behavioural or psychological interventions, or both, for the treatment of non-epileptic seizures. Studies of childhood non-epileptic seizures were excluded from our review. DATA COLLECTION AND ANALYSIS: Two review authors (JM, JP) independently assessed the trials for inclusion and extracted data. Outcomes included reduction in seizure frequency and improvements in quality of life. MAIN RESULTS: Twelve studies, with a total of 343 participants, met our inclusion criteria (four RCTs and eight before and after non-controlled studies). Of the four RCTs, one examined patients with non-epileptic seizures and three had a mixed diagnosis (pseudoseizures, conversion disorder and somatisation disorder). Most of the non-randomised studies used non-epileptic seizure patients exclusively. Overall, five studies examined the effectiveness of psychotherapy, three examined CBT, two investigated hypnosis, one assessed paradoxical intention and one had a mixed intervention design. We classified two included studies as low risk of bias, one as unclear and nine as high risk of bias. Meta-analysis could not be undertaken due to the heterogeneity of design and interventions. Most included studies reported improved outcomes for the intervention under investigation. One RCT investigating the effectiveness of CBT in this patient group found a significant reduction in seizure frequency compared to controls (P < 0.001). AUTHORS' CONCLUSIONS: There is little reliable evidence to support the use of any treatment, including CBT, in the treatment of non-epileptic seizures. Further randomised controlled trials of CBT and other interventions are needed.

Cochrane Database Syst Rev. 2014 Feb 11;2:CD006370. doi: 10.1002/14651858.CD006370.pub2. Martlew J(1), Pulman J, Marson AG. Author information: (1)Department of Neuropsychology, The Walton Centre, Jubilee House, 10th Avenue, Fazakerley, Liverpool, Mersyside, UK, L9 7AL.

Update of Cochrane Database Syst Rev. 2007;(1):CD006370.

Psychophysiology of Dissociated Consciousness.



Recent study of consciousnessconsciousness provides an evidence that there is a limit of consciousness, which presents a barrier between conscious and unconscious processes. This barrier likely is specifically manifested as a disturbance of neural mechanisms of consciousness that through distributed brain processing, attentional mechanisms and memory processes enable to constitute integrative conscious experience. According to recent findings a level of conscious integration may change during certain conditions related to experimental cognitive manipulations, hypnosis, or stressful experiences that can lead to dissociationdissociation of consciousness. In psychopathological research the term dissociation was proposed by Pierre Janet for explanation of processes related to splitting of consciousness due to traumatic events or during hypnosis. According to several recent findings dissociation of consciousness likely is related to deficits in global distribution of information and may lead to heightened levels of "neural complexity" that reflects brain integration or differentiation based on numbers of independent neural processes in the brain that may be specifically related to various mental disorders.

Curr Top Behav Neurosci. 2014 May 22. Bob P. Author information: Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, 1st Faculty of Medicine, Charles University, Ke Karlovu 11, 128 00, Prague, Czech Republic, petrbob@netscape.net.

Management and Diagnosis of Psycogenic Cough, Habit Cough, and Tic Cough: A Systematic Review.



ABSTRACT BACKGROUND: Several pharmacological and non-pharmacological therapeutic options have been used to treat cough that is not associated with a pulmonary or extrapulmonary etiology. METHODS: We conducted a systematic review to summarize the evidence supporting different cough management options in adults and children with psychogenic, tic and habit cough. Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus were searched from the earliest inception of each database to September 2013. Content experts were contacted and we searched bibliographies of included studies to identify additional references. RESULTS: A total of 18 uncontrolled studies were identified enrolling 223 patients (46% males, 96% children and adolescent). Psychogenic cough was the most common descriptive term used (90% of the studies). 95% of the patients had no cough during sleep; barking or honking quality of cough was described in only 8 studies. Hypnosis (3 studies), suggestion therapy (4 studies), and counseling and reassurance (7 studies) were the most commonly used interventions. Hypnosis was effective in resolving cough in 78% of the patients and improving it in another 5%. Suggestion therapy resolved cough successfully in 96% of the patients. The greatest majority of improvements noted with these forms of therapy occurred in the pediatric age group. The quality of evidence is low due to the lack of control groups, the retrospective nature of all the studies, heterogeneity of definitions and diagnostic criteria, and the high likelihood of reporting bias. CONCLUSION: Only low quality evidence exists to support a particular strategy to define and treat psychogenic, habit and tic cough. Patient values, preferences, and availability of potential therapies should guide treatment choice.

Chest. 2014 May 15. doi: 10.1378/chest.14-0795. Haydour Q, Alahdab F, Farah M, Moreno PB, Vertigan AE, Newcombe PA, Pringsheim T, Chang AB, Rubin BK, McGarvey L, Weir KA, Altman KW, Feinstein A, Murad M, Irwin RS.

Mindfulness-based hypnosis: blending science, beliefs, and wisdoms to catalyze healing.



We live in a global village, comprised of people with diverse cultural and religious orientations. How do we integrate these different beliefs and values into our clinical practice? Mindfulness-based psychotherapy (MBP), an evidence-based psychological intervention, provides a secular template for assimilating various cultural beliefs and wisdoms in therapies. MBP represents a cross-fertilization between Western psychological practice and Eastern meditative disciplines. Guided by MBP, this article describes how intention, mindfulness, acceptance, gratitude, and the "heart" can be combined with cognitive hypnotherapy to catalyze healing of emotional disorders-particularly depression. This integrated approach is referred to as mindfulness-based cognitive hypnotherapy (MBCH) as it assimilates cognitive hypnotherapy with mindfulness strategies. MBCH represents an attempt to broaden the comprehensiveness of hypnotherapy as an integrated form of psychotherapy. Additionally, based on new understanding of the heart as a complex information center, an innovative hypnotherapeutic strategy for generating psychophysiological coherence and psychological well-being is described.

Am J Clin Hypn. 2014 Jan;56(3):285-302. Alladin A.

Hypnotizability and Catechol-O-Methyltransferase (COMT) polymorphysms in Italians.



Higher brain dopamine content depending on lower activity of Catechol-O-Methyltransferase (COMT) in subjects with high hypnotizability scores (highs) has been considered responsible for their attentional characteristics. However, the results of the previous genetic studies on association between hypnotizability and the COMT single nucleotide polymorphism (SNP) rs4680 (Val(158)Met) were inconsistent. Here, we used a selective genotyping approach to e-evaluate the association between hypnotizability and COMT in the context of a two-SNP haplotype analysis, considering not only the Val(158)Met polymorphism, but also the closely located rs4818 SNP. An Italian sample of 53 highs, 49 low hypnotizable subjects (lows), and 57 controls, were genotyped for a segment of 805 bp of the COMT gene, including Val(158)Met and the closely located rs4818 SNP. Our selective genotyping approach had 97.1% power to detect the previously reported strongest association at the significance level of 5%. We found no evidence of association at the SNP, haplotype, and diplotype levels. Thus, our results challenge the dopamine-based theory of hypnosis and indirectly support recent neuropsychological and neurophysiological findings reporting the lack of any association between hypnotizability and focused attention abilities.

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Evidenced Supported Principles of change



by Tim Brunson, PhD

Psychotherapy is currently undergoing one of the most radical periods of change seen for the past hundred or so years. Originally, those who practice what we have come to consider as the sciences of mental health focused either on replicating methodologies associated with medicine or remained in the idealistic realms (i.e. Jungian). However, most recently those in the inner circles are now beginning to think more systemically and thus have created a hybrid that combines science and more holistic thinking. This trend has already crept into official literature. The recently published DSM-5, upon which most psychotherapists heavily rely, incorporates this new way of thinking for the first time – albeit while still holding on to the diagnostic categories contained in previous editions.

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The use of hypnosis in therapy to increase happiness.



In their journey through life, most people are looking for happiness. Definitions of happiness and the concepts of a pleasant, good, meaningful, and a full life are reviewed. Next, Seligman's (2002) concept of "authentic happiness" and a happiness formula, S+C+V (Set + Circumstances + Variables), are discussed. An integration of happiness, as a goal, and hypnosis, as a facilitative approach, are presented. Hypnotic techniques with case examples are given. Hypnosis is presented as an efficient companion intervention to work on these variables in a creative way and to pave the way to a happy and full life. The following results are presented: (1) hypnosis allows for increased executive attention with control of emotions, (2) focusing on positive imagery contributes to strengthening "happy pathways," and (3) emotions about the past, present, and future are subject to change.

Am J Clin Hypn. 2014 Jan;56(3):269-84. Ruysschaert N.

Plasma oxytocin concentrations and OXTR polymorphisms predict social impairments in children...



Full title: Plasma oxytocin concentrations and OXTR polymorphisms predict social impairments in children with and without autism spectrum disorder.

The neuropeptide oxytocin (OXT) and its receptor (OXTR) regulate social functioning in animals and humans. Initial clinical research suggests that dysregulated plasma OXT concentrations and/or OXTR SNPs may be biomarkers of social impairments in autism spectrum disorder (ASD). We do not know, however, whether OXT dysregulation is unique to ASD or whether OXT biology influences social functioning more generally, thus contributing to, but not causing, ASD phenotypes. To distinguish between these possibilities, we tested in a child ASD cohort, which included unaffected siblings and unrelated neurotypical controls (ages 3-12 y; n = 193), whether plasma OXT concentrations and OXTR SNPs (i) interact to produce ASD phenotypes, (ii) exert differential phenotypic effects in ASD vs. non-ASD children, or (iii) have similar phenotypic effects independent of disease status. In the largest cohort tested to date, we found no evidence to support the OXT deficit hypothesis of ASD. Rather, OXT concentrations strongly and positively predicted theory of mind and social communication performance in all groups. Furthermore, OXT concentrations showed significant heritability between ASD-discordant siblings (h2 = 85.5%); a heritability estimate on par with that of height in humans. Finally, carriers of the "G" allele of rs53576 showed impaired affect recognition performance and carriers of the "A" allele of rs2254298 exhibited greater global social impairments in all groups. These findings indicate that OXT biology is not uniquely associated with ASD, but instead exerts independent, additive, and highly heritable influences on individual differences in human social functioning, including the severe social impairments which characterize ASD.

Proc Natl Acad Sci U S A. 2014 Aug 4. pii: 201402236.

Psychosynthesis: a transpersonal model for hypnotically mediated psychotherapy.



Psychosynthesis is one of the first Western transpersonal models of personality and psychotherapy. It was developed in 1910 by the Italian psychiatrist Roberto Assagioli. In this article, basic constructs involving the realms of consciousness, subpersonalities, and the importance of the will, and the neo-Jungian functions, will be introduced and related to the practice of hypnotically mediated psychotherapy. That which makes this model unique is its recognition of the human spirit and how that impacts consciousness and its inclusion as an important element to be included in therapy. A guideline for selecting interventions based upon the patient's symptom will be described as well as a discussion of some of the therapy techniques associated with this model.

Am J Clin Hypn. 2014 Jan;56(3):249-68. Appel PR.

Can grapheme-color synesthesia be induced by hypnosis?



Grapheme-color synesthesia is a perceptual experience where graphemes, letters or words evoke a specific color, which are experienced either as spatially coincident with the grapheme inducer (projector sub-type) or elsewhere, perhaps without a definite spatial location (associator sub-type). Here, we address the question of whether synesthesia can be rapidly produced using a hypnotic color suggestion to examine the possibility of "hypnotic synesthesia", i.e., subjectively experienced color hallucinations similar to those experienced by projector synesthetes. We assess the efficacy of this intervention using an "embedded figures" test, in which participants are required to detect a shape (e.g., a square) composed of local graphemic elements. For grapheme-color synesthetes, better performance on the task has been linked to a higher proportion of graphemes perceived as colored. We found no performance benefits on this test when using a hypnotic suggestion, as compared to a no-suggestion control condition. The same result was found when participants were separated according to the degree to which they were susceptible to the suggestion (number of colored trials perceived). However, we found a relationship between accuracy and subjective reports of color in those participants who reported a large proportion of colored trials: trials in which the embedded figure was accurately recognized (relative to trials in which it was not) were associated with reports of more intense colors occupying a greater spatial extent. Collectively, this implies that hypnotic color was only perceived after shape detection rather than aiding in shape detection via color-based perceptual grouping. The results suggest that hypnotically induced colors are not directly comparable to synesthetic ones.

Front Hum Neurosci. 2014 Apr 28;8:220. doi: 10.3389/fnhum.2014.00220. Anderson HP(1), Seth AK(2), Dienes Z(1), Ward J(1). Author information: (1)School of Psychology, University of Sussex Brighton, UK ; Sackler Centre for Consciousness Science, University of Sussex Brighton, UK. (2)School of Psychology, University of Sussex Brighton, UK ; School of Engineering and Informatics, University of Sussex Brighton, UK.

A Case of Successful Use of Hypnosis in the Treatment of Parasomnia Overlap Disorder.



A young male patient was successfully treated for parasomnia overlap disorder (POD) using hypnosis. In 2006, this 16-year-old patient underwent a clinical evaluation for episodes of sleep talking, sleepwalking, and dream enactment. This initial assessment was followed by polysomnographic evaluation, a brain MRI, and three sessions of treatment using hypnosis. From the beginning, until the last contact in December 2011, benefits from the hypnotic suggestions were noted and documented.

Behav Sleep Med. 2014 Apr 16:1-10. Kohler WC(1), Kurz PJ, Kohler EA. Author information: (1)a Florida Sleep Institute , Spring Hill.

Hypnosis aided fixed role therapy for social phobia: a case report.



This case study details how hypnosis aided fixed role therapy (HAFRT) was employed in the successful treatment of a case of social phobia with a history of refractory outcomes to previous therapy trials. The treatment consisted of 10 office sessions, scheduled every two weeks, of HAFRT along with twice a day self-hypnotic sessions where the patient performed multiple visualization rehearsals of the vignettes that were successfully mastered in hypnosis during office visits. The results indicated that this patient was able to engage in social and professional affairs that were impossible prior to treatment. The patient retained the therapy gains at follow up 6 months later.

Am J Clin Hypn. 2014 Apr;56(4):405-12. Iglesias A, Iglesias A.

Current issues in the treatment of specific phobia...



Full title: Current issues in the treatment of specific phobia: recommendations for innovative applications of hypnosis.

Specific phobia is the most common and treatable of the anxiety disorders. Exposure-based therapies are the treatment of choice and empirically validated protocols are available that promise rapid and effective results. In many cases, however, patients are reluctant to comply with demanding schedules of exposure, increasing the risk of treatment failure. Furthermore, in clinical practice, patients often present with multiple phobias and other Axis I and Axis II disorders that can further complicate therapy. This article covers four important issues that have been addressed in the literature: (a) managing resistance to treatment, (b) reducing length of treatment, (c) clarifying the optimal application of relaxation training, and (d) applying advances in cognitive neuroscience. These issues are reviewed and recommendations proposed for ways in which to modify current treatments. Specific suggestions are provided for implementing these recommendations including examples of innovative applications of standard hypnotic techniques.

Am J Clin Hypn. 2014 Apr;56(4):389-404. Spiegel SB.

A causal model explaining the relationships governing beliefs, attitudes, and hypnotic...



Full title: A causal model explaining the relationships governing beliefs, attitudes, and hypnotic responsiveness.

The author developed a new scale aimed at measuring beliefs about "hypnotic states" and investigated the influence of such beliefs and attitudes on hypnotic responses in a large sample of Japanese undergraduate students. Exploratory factor analysis of this new questionnaire examining beliefs about hypnotic states yielded four factors: Dissociative or Depersonalized Experience, Loss of Self-Control, Therapeutic Expectation, and Arousing Extraordinary Ability. The results of structural equation modeling showed that Therapeutic Expectation and Arousing Extraordinary Ability influenced hypnotizability through attitudes toward hypnosis, while also directly affecting subjective experiences without mediating attitudes. Present findings suggest that it is more effective to enhance therapeutic expectations than to correct misconceptions about hypnotic states in modification of patients' beliefs before initiating treatment.

Int J Clin Exp Hypn. 2014;62(2):231-50. doi: 10.1080/00207144.2014.869142. Shimizu T.

Author information: a Akita University , Japan.

Childhood anxiety and psychophysiological reactivity: hypnosis to build discrimination...



Full title: Childhood anxiety and psychophysiological reactivity: hypnosis to build discrimination and self-regulation skills.

Clinically anxious, worried, and fearful children and teens need clinicians' assistance in reducing their exaggerated psychophysiological stress reactivity. Affective neuroscience finds that chronic activation of the body's emergency response system inhibits neurogenesis, disrupts neuronal plasticity, and is detrimental to physical and mental health. Patterns of faulty discrimination skills, for example, over-estimation of threat and danger and under-estimation of their coping capacity, fuel this over-arousal. Similarly, contributory patterns of reduced self-regulation skills are shown by "stuck" attention to and poor control of their exaggerated psychophysiological reactivity and somatization. This article considers the literature and focuses on cognitive hypnotherapy to enhance these under-developed capacities. A case illustration highlights various hypnotic phenomena and techniques, psychoeducation, and relaxation training that address the goals of interrupting these unproductive, interconnected patterns and fostering new patterns of more realistic and accurate discrimination capacities and sturdier psychophysiological self-regulation skills.

Am J Clin Hypn. 2014 Apr;56(4):343-67. Kaiser P.

Modelling psychiatric and cultural possession phenomena with suggestion and fMRI.



Involuntary movements occur in a variety of neuropsychiatric disorders and culturally influenced dissociative states (e.g., delusions of alien control and attributions of spirit possession). However, the underlying brain processes are poorly understood. We combined suggestion and fMRI in 15 highly hypnotically susceptible volunteers to investigate changes in brain activity accompanying different experiences of loss of self-control of movement. Suggestions of external personal control and internal personal control over involuntary movements modelled delusions of control and spirit possession respectively. A suggestion of impersonal control by a malfunctioning machine modelled technical delusions of control, where involuntary movements are attributed to the influence of machines. We found that (i) brain activity and/or connectivity significantly varied with different experiences and attributions of loss of agency; (ii) compared to the impersonal control condition, both external and internal personal alien control were associated with increased connectivity between primary motor cortex (M1) and brain regions involved in attribution of mental states and representing the self in relation to others; (iii) compared to both personal alien control conditions, impersonal control of movement was associated with increased activity in brain regions involved in error detection and object imagery; (iv) there were no significant differences in brain activity, and minor differences in M1 connectivity, between the external and internal personal alien control conditions. Brain networks supporting error detection and object imagery, together with representation of self and others, are differentially recruited to support experiences of impersonal and personal control of involuntary movements. However, similar brain systems underpin attributions and experiences of external and internal alien control of movement. Loss of self-agency for movement can therefore accompany different kinds of experience of alien control supported by distinct brain mechanisms. These findings caution against generalization about single cognitive processes or brain systems underpinning different experiences of loss of self-control of movement.

Cortex. 2014 Apr;53:107-19. doi: 10.1016/j.cortex.2014.01.004. Deeley Q(1), Oakley DA(2), Walsh E(3), Bell V(4), Mehta MA(4), Halligan PW(5). Author information: (1)Cultural and Social Neuroscience Research Group, Forensic and Neurodevelopmental Sciences, Kings College London, Institute of Psychiatry, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, UK. Electronic address: q.deeley@iop.kcl.ac.uk. (2)Division of Psychology and Language Sciences, University College London, UK. (3)Cultural and Social Neuroscience Research Group, Forensic and Neurodevelopmental Sciences, Kings College London, Institute of Psychiatry, London, UK. (4)Cultural and Social Neuroscience Research Group, Centre for Neuroimaging Sciences, Kings College London, Institute of Psychiatry, London, UK. (5)School of Psychology, Cardiff University, UK.

Copyright © 2014 Elsevier Ltd. All rights reserved.

Prevalence and pattern of psychiatric morbidity and health related quality of life in patients...



Full title: Prevalence and pattern of psychiatric morbidity and health related quality of life in patients with ischemic heart disease in a tertiary care hospital.

BACKGROUND: Psychiatric morbidity and Health Related Quality of Life (Hr-QoL) in Ischemic Heart Disease (IHD) are relatively less studied in our country. AIMS: This cross-sectional observational study was undertaken to assess the common psychiatric disorders and Hr-QoL in IHD. MATERIALS AND METHODS: One-hundred and thirty patients with IHD were evaluated for psychiatric morbidity and Hr-QoL. Tools used were SCID-1, Euro QoL-5D, and Socio-demographic data sheet. The data were analyzed using SPSS v 10.0 software, Chi-square test, T-test, ANOVA were used as needed. RESULTS: Psychiatric morbidity was assessed using psychiatric assessment schedule SCID-I for generating diagnosis as per DSM-IV criteria. Major depressive disorder was found in 34.6% (n=45) patients. 23.8% (n=31) patients had a diagnosis of depression due to general medical condition. Anxiety disorder due to general medical condition was present in 36.9% (n=48) patients. Around 95.4% of patients reported psychiatric symptoms, either depression or anxiety. Though widely disputed, low educational status was reported as significantly associated with psychiatric morbidity in IHD. Female sex of the patient and the presence of diabetes mellitus were associated with psychiatric morbidity in a significant manner. Majority of patients with poor quality of life were in the domain of anxiety/depression. CONCLUSION: The findings of our study reveal a high rate of psychiatric morbidity and impaired quality of life in IHD Patients.

Indian J Psychiatry. 2013 Oct;55(4):353-9. doi: 10.4103/0019-5545.120554. John S. Department of Psychiatry, Amala Institute of Medical Sciences, Thrissur, Kerala, India.

Prevalence and pattern of psychiatric morbidity and health related quality of life...



Full title: Prevalence and pattern of psychiatric morbidity and health related quality of life in patients with ischemic heart disease in a tertiary care hospital.

BACKGROUND: Psychiatric morbidity and Health Related Quality of Life (Hr-QoL) in Ischemic Heart Disease (IHD) are relatively less studied in our country. AIMS: This cross-sectional observational study was undertaken to assess the common psychiatric disorders and Hr-QoL in IHD. MATERIALS AND METHODS: One-hundred and thirty patients with IHD were evaluated for psychiatric morbidity and Hr-QoL. Tools used were SCID-1, Euro QoL-5D, and Socio-demographic data sheet. The data were analyzed using SPSS v 10.0 software, Chi-square test, T-test, ANOVA were used as needed. RESULTS: Psychiatric morbidity was assessed using psychiatric assessment schedule SCID-I for generating diagnosis as per DSM-IV criteria. Major depressive disorder was found in 34.6% (n=45) patients. 23.8% (n=31) patients had a diagnosis of depression due to general medical condition. Anxiety disorder due to general medical condition was present in 36.9% (n=48) patients. Around 95.4% of patients reported psychiatric symptoms, either depression or anxiety. Though widely disputed, low educational status was reported as significantly associated with psychiatric morbidity in IHD. Female sex of the patient and the presence of diabetes mellitus were associated with psychiatric morbidity in a significant manner. Majority of patients with poor quality of life were in the domain of anxiety/depression. CONCLUSION: The findings of our study reveal a high rate of psychiatric morbidity and impaired quality of life in IHD Patients.

Indian J Psychiatry. 2013 Oct;55(4):353-9. doi: 10.4103/0019-5545.120554. John S. Department of Psychiatry, Amala Institute of Medical Sciences, Thrissur, Kerala, India.

Psychiatric morbidity in prisoners.



BACKGROUND: Prisoners are having high percentage of psychiatric disorders. Majority of studies done so far on prisoners are from Western countries and very limited studies from India.AIM: Study socio-demographic profile of prisoners of a central jail and to find out current prevalence of psychiatric disorders in them. MATERIALS AND METHODS: 118 prisoners were selected by random sampling and interviewed to obtain socio-demographic data and assessed on Indian Psychiatric Interview Schedule (IPIS) with additional required questions to diagnose psychiatric disorders in prisoners. RESULTS: Mean age of prisoners was 33.7 years with 97.5% males, 57.6% from rural areas and 65.3% were married. Average education in studied years was 6.6 years and 50.8% were unskilled workers. 47.4% were murderers while 20.3% of drugs related crimes. 47.5% were convicted and history of criminal behavior in family was in 32.2% prisoners. Current prevalence of psychiatric disorders was 33%. Psychotic, depressive, and anxiety disorders were seen in 6.7%, 16.1%, and 8.5% prisoners respectively. 58.8% had history of drug abuse/dependence prior to imprisonment. CONCLUSION: One prison of Hadoti region of Rajasthan is full of people with mental-health problems who collectively generate significant levels of unmet psychiatric treatment need. Prisons are detrimental to mental-health. Beginning of reforms is the immediate need.

Indian J Psychiatry. 2013 Oct;55(4):366-70. doi: 10.4103/0019-5545.120562. Kumar V(1), Daria U(2). (1)Department of Psychiatry, Jhalawar Medical College, Jhalawar, Rajasthan, India. (2)Department of Anesthesia, Jhalawar Medical College, Jhalawar, Rajasthan, India.

Psychiatric morbidity and marital satisfaction among spouses of men with alcohol dependence.



BACKGROUND: Alcohol dependence has adverse health and social consequences; Alcohol related problems primarily occur within the family context and maximum impact is felt on spouses, given the intimate nature of their elationship. Spouses play an important role in treatment programs related to alcohol. There is thus a need to study psychiatric morbidity and marital satisfaction in spouses of alcohol dependent patients in order to understand and address such issues. AIMS: The aim of this study was to assess the pattern of psychiatric morbidity, marital satisfaction in spouses of men with alcohol dependence syndrome and explore the association. MATERIALS AND METHODS: For psychiatric morbidity, 60 spouses of men with alcohol dependence syndrome were evaluated. Marital satisfaction was assessed using the marital satisfaction scale. Severity of alcohol dependence in the husbands and consequences of drinking was assessed using short alcohol dependence data and drinkers inventory of consequences respectively. RESULTS: More than half of the spouses (65%) had a psychiatric disorder. Primarily mood and anxiety disorder were present. Major depressive disorder was present in 43%. Psychiatric morbidity, marital dissatisfaction in spouses and higher adverse consequences alcohol dependence in their husbands, were found to be significantly correlated with each other and their association was robust particularly when problems in the physical, interpersonal and intrapersonal domains were high. CONCLUSION: Psychological distress and psychiatric morbidity in spouses of alcohol dependent men is high, with marital satisfaction being low. Addressing these issues will be beneficial as spouses are known to play an important role in the treatment of alcohol dependence syndrome.

Indian J Psychiatry. 2013 Oct;55(4):360-5. doi: 10.4103/0019-5545.120557. Kishor M, Pandit LV, Raguram R. Department of Psychiatry, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India.

Emetophobia: A fear of vomiting.



Emetophobia is an intense, irrational fear of vomiting including fear of feeling nausea, seeing or hearing another person vomit, or seeing vomitus itself. It may occur at any age and we need to understand its symptomatology. We report a case of emetophobic child whose fear of vomiting started after an attack of acute appendicitis. In the initial stage, fear was limited to vomiting, later it became generalized to a fear of seeing the vomitus, worries that parents may suffer vomiting, fear of vomiting in public places followed by avoiding social activities. Patient improved on short course of anti-anxiety drugs and Graded Exposure Therapy.

Indian J Psychiatry. 2013 Oct;55(4):390-2. doi: 10.4103/0019-5545.120556. Faye AD, Gawande S, Tadke R, Kirpekar VC, Bhave SH. Department of Psychiatry, N. K. P. Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India.

A case of Hallervorden-Spatz disease presenting as catatonic schizophrenia.



Hallervorden-Spatz disease belongs to a group of disorders characterized by predominant involvement of basal ganglia. These cases may present to the psychiatrist with symptoms of depression, nervousness and rarely other psychotic symptoms. Very few cases of this disease have been reported from India. We report a case of Hallervorden-Spatz disease that presented to the psychiatry outpatient department with catatonia. This case highlights how presentation of Hallervorden-Spatz disease may overlap with catatonic symptoms and hence a high index of suspicion is required to make an accurate diagnosis.

Indian J Psychiatry. 2013 Oct;55(4):386-9. doi: 10.4103/0019-5545.120553. Pawar Y(1), Kalra G(2), Sonavane S(1), Shah N(1). (1)Department of Psychiatry, Lokmanya Tilak Medical College and Sion Hospital, Sion, Mumbai, India. (2)M.G.M. Institute of Health Sciences, M.G.M. University of Health Sciences, New Mumbai, Maharashtra, India.

A neurobiological approach to the cognitive deficits of psychiatric disorders.



Deficits in brain networks that support cognitive regulatory functions are prevalent in many psychiatric disorders. Findings across neuropsychology and neuroimaging point to broad-based impairments that cross traditional diagnostic boundaries. These dysfunctions are largely separate from the classical symptoms of the disorders, and manifest in regulatory problems in both traditional cognitive and emotional domains. As such, they relate to the capacity of patients to engage effectively in their daily lives and activity, often persist even in the face of symptomatically effective treatment, and are poorly targeted by current treatments. Advances in cognitive neuroscience now allow us to ground an understanding of these cognitive regulatory deficits in the function and interaction of key brain networks. This emerging neurobiological understanding furthermore points to several promising routes for novel neuroscience-informed treatments targeted more specifically at improving cognitive function in a range of psychiatric disorders.

Dialogues Clin Neurosci. 2013 Dec;15(4):419-29. Etkin A(1), Gyurak A(2), O'Hara R(1). (1)Departments of Psychiatry and Behavioral Sciences and Psychology, Stanford University, Stanford, California, USA. (2)Departments of Psychiatry and Behavioral Sciences and Psychology, Stanford University, Stanford, California, USA, Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.

Socio-demographic and clinical predictors of absenteeism...



Full title: Socio-demographic and clinical predictors of absenteeism - A cross-sectional study of urban industrial employees.

CONTEXT: Public sector undertakings are facing a threat of privatization due to unsatisfactory performance putting pressure on management and in turn to employees. There is an increasing trend of absenteeism observed amongst employees citing job stress. AIM: To find an association between job stress and absenteeism in relation to socio-demographic and clinical profile. MATERIALS AND METHODS: The study was conducted in an urban aeronautical industry with 68 employees who mentioned stress at workplace during evaluation. Job stress was assessed using Professional Life Stress Scale (David Fontana). Those who scored more than 30 (n = 43) were taken up for the study after an informed consent. A semi-structured questionnaire was administered to find socio-demographic and clinical profile. Employees who reported taking leave in last six months just to avoid work or workplace constitute the "absenteeism" group. The absenteeism group was compared to non-absenteeism group using Fisher exact/Chi-square test or independent t-test depending on type of variables. RESULTS: Out of 43 subjects, 18 had absenteeism while 25 did not have absenteeism. Comparing the two groups, interstate migration, having more than one previous job, commuting time more than an hour, co-morbid anxiety/depression, and alcohol abuse were significantly associated with absenteeism (P < 0.05). Absentees complained more about fatigue and relationship problem with colleagues than non-absentees (P < 0.05). Factors like age, sex, marital status, education, gross pay, job tenure, past or family history of psychiatry illnesses had no significant association with absenteeism (P > 0.05). CONCLUSION: In absenteeism research, one of the widely accepted models is Steerand Rhode's "Process model of absenteeism." The model postulates job stress as one of the barriers for attendance. Thus, knowing the factors for absenteeism would help in preventing absenteeism.

Ind Psychiatry J. 2013 Jan;22(1):17-21. doi: 10.4103/0972-6748.123589. Chakraborty S, Subramanya AH. Department of Psychiatry, Hindustan Aeronautics Limited Hospital, Bangalore, Karnataka, India.

Depression and experience of vision loss in group of adults in rehabilitation setting...



Full title: Depression and experience of vision loss in group of adults in rehabilitation setting: Mixed-methods pilot study.

There is a paucity of literature regarding the relationship between the experience of vision loss and depression. Therefore, the current pilot study aimed to explore whether significant differences existed in levels of depression between adults with different vision loss experiences. A group of adults aged between 20 and 65 yr old with irreversible vision loss in a rehabilitation setting was interviewed. Semistructured interviews were conducted in order to explore patients' experience of vision loss. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive levels; 39.5% (n = 15) of patients met CES-D criteria for depression. In addition, higher levels of depression (p < 0.05) were identified in patients whose interviews revealed greater self-awareness of impairment, inadequate social support, and longer rehabilitation stay. Current findings draw attention to variables such as self-awareness of impairment and perceived social support and suggest that depression following vision loss may be related to patients' emotional experiences of impairment and adjustment processes.

J Rehabil Res Dev. 2014 Jan;50(9):1301-14. doi: 10.1682/JRRD.2012.08.0138. Senra H, Vieira CR, Nicholls EG, Leal I. University of Deusto, Faculty of Psychology, Avenida de las Universidades 24, 48007 Bilbao, Spain. 23/Jan/2014 17:0123/Jan/2014 17:01 hugo_senra@hotmail.com.

Impacts of mustard gas exposure on veterans mental health: A study on the role of education.



BACKGROUND: The mustard gas (MG) exposure can impair physical health and therefore increase the probability of the posttraumatic stress disorder (PTSD) and psychological disorders. AIM: The aim of this study was to investigate long-term effects of MG exposure on veterans' mental health. MATERIALS AND METHODS: This was a cross-sectional study. In order to assess prevalence of mental health and PTSD of 100 MG victims 25 years after the exposure to MG in Iran-Iraq conflict, the general health questionnaire (GHQ-28) and Impact of Event Scale-Revised, respectively was administered. RESULTS: The mean (±standard deviation (SD)) age of participants was 40.63 (±5.86) years. The mean GHQ-28 (47.34) of the study group was higher compared to standardized cutoff point (23) of the Iranian community. Also, it was found that 38 participants (38%) suffer from PTSD. The results of this study showed that academic education in the PTSD group was less than that in the non-PTSD group (P=0.03). In addition, in multivariate analysis it was found that only education level of the veterans and their wives were effective on the mental health score (adjusted P=0.036 and 0.041, respectively). The mean score of depression and psychosocial activity subscale in patients at higher education level was lower than patients at lower education level (P<0.05). CONCLUSION: This study found that sulfur mustard (SM) exposure can be effect on mental health even 25 years after exposure. Therefore, the psychological state should be more considered in chemical injured veterans and it is important that providing more mental health centers for this community.

Ind Psychiatry J. 2013 Jan;22(1):22-5. doi: 10.4103/0972-6748.123604. Karami GR(1), Ameli J(2), Roeintan R(3), Jonaidi-Jafari N(4), Saburi A(5). (1)Department of Psychiatry, Baqiyatallah University of Medical Sciences, Tehran, Iran. (2)Department of Neurology, Baqiyatallah University of Medical Sciences, Tehran, Iran. (3)Department of Neurosurgery, Baqiyatallah University of Medical Sciences, Tehran, Iran. (4)Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. (5)Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Mollasadra St, Vanak Sq, Tehran, Iran ; Atherosclerosis and Coronary Artery Research Centre, Birjand University of Medical Sciences, Vali-e-Asr Hospital, Ghaffari St, Birjand, Iran.

"I Just Have to Stick with It and It'll Work": Experiences of Adolescents and Young Adults...



Full title: "I Just Have to Stick with It and It'll Work": Experiences of Adolescents and Young Adults with Mental Health Concerns.

Mental health issues are common among adolescents and young adults but service utilization in this group is low. This study aimed to better understand the experiences of older adolescents and young adults who were experiencing symptoms of depression or anxiety, including the factors that affected their decision to seek treatment and their feelings about their experience of mental health issues. We conducted semi-structured interviews with 37 older adolescents and young adults. Participants tended to have a sophisticated understanding of the causes of mental disorders, but to have been unsure about whether their own experiences of depression or anxiety were the result of a mental disorder, or just "normal" experiences. They reported concerns about taking medication and about keeping information about their condition private. They also felt that it was important to them to be active participants in their own care.

Community Ment Health J. 2014 Jan 24. [Epub ahead of print] Bluhm RL, Covin R, Chow M, Wrath A, Osuch EA. Department of Philosophy and Religious Studies, Old Dominion University, Norfolk, VA, USA.

Depression during pregnancy: Prevalence and obstetric risk factors among pregnant women...



Full title: Depression during pregnancy: Prevalence and obstetric risk factors among pregnant women attending a tertiary care hospital in Navi Mumbai.

CONTEXT: Depression affects about 20% of women during their lifetime, with pregnancy being a period of high vulnerability. Prevalence of depression during pregnancy ranges from 4% to 20%. Several risk factors predispose to depression during pregnancy including obstetric factors. Depression during pregnancy is not only the strongest risk factor for post-natal depression but also leads to adverse obstetric outcomes. AIMS: To study the prevalence of depression during pregnancy and its associated obstetric risk factors among pregnant women attending routine antenatal checkup. SETTINGS AND DESIGN: Cross-sectional observational survey done at the outpatient department (OPD) of the department of obstetrics of a tertiary care hospital in Navi Mumbai. MATERIALS AND METHODS: One hundred and eighty-five pregnant women were randomly administered the Beck Depression Inventory (BDI) for detecting depression. Additional socio-demographic and obstetric history was recorded and analyzed. RESULTS: Prevalence of depression during pregnancy was found to be 9.18% based upon BDI, and it was significantly associated with several obstetric risk factors like gravidity (P = 0.0092), unplanned pregnancy (P = 0.001), history of abortions (P = 0.0001), and a history of obstetric complications, both present (P = 0.0001) and past (P = 0.0001). CONCLUSIONS: Depression during pregnancy is prevalent among pregnant women in Navi-Mumbai, and several obstetric risk factors were associated to depression during pregnancy. Future research in this area is needed, which will clearly elucidate the potential long-term impact of depression during pregnancy and associated obstetric risk factors so as to help health professionals identify vulnerable groups for early detection, diagnosis, and providing effective interventions for depression during pregnancy.

Ind Psychiatry J. 2013 Jan;22(1):37-40. doi: 10.4103/0972-6748.123615 Ajinkya S(1), Jadhav PR(2), Srivastava NN(3). (1)Department of Psychiatry, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India. (2)Department of Pharmacology, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India. (3)MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India.

Recovery from sleep disturbance precedes that of depression and anxiety...



Full title: Recovery from sleep disturbance precedes that of depression and anxiety following mild traumatic brain injury: a 6-week follow-up study.

OBJECTIVES: The detailed course of mental disorders at the acute and subacute stages of mild traumatic brain injury (mTBI), especially with regard to recovery from sleep disturbances, has not been well characterised. The aim of this study was to determine the course of depression, anxiety and sleep disturbance, following an mTBI. SETTING: We recruited patients with mTBI from three university hospitals in Taipei and healthy participants as control group for this study. PARTICIPANTS: 100 patients with mTBI (35 men) who were older than 20 years, with a Glasgow Coma Scale score of 13-15 and loss of consciousness for <30 min, completed the baseline and 6-week follow-up assessments. 137 controls (47 men) without TBI were recruited in the study. None of the participants had a history of cerebrovascular disease, mental retardation, previous TBI, epilepsy or severe systemic medical illness. PRIMARY OUTCOME MEASURES: The Beck Anxiety Inventory (BAI), the Beck Depression Inventory II (BDI), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI) were assessed for the patients with mTBI at baseline and 6 weeks after mTBI and for the controls. RESULTS: The ESS scores were not significantly different between the mTBI at baseline or at 6 weeks after mTBI and controls. Although the BAI, BDI and PSQI scores of the mTBI group were significantly different than those of the control group at baseline, all had improved significantly 6 weeks later. However, only the PSQI score improved to a level that was not significantly different from that of the control group. CONCLUSIONS: Daytime sleepiness is not affected by mTBI. However, mTBI causes depression and anxiety and diminished sleep quality. Although all these conditions improve significantly within 6 weeks post-mTBI, only sleep quality improves to a pre-mTBI level. Thus, recovery from mTBI-induced sleep disturbance occurs more rapidly than that of mTBI-induced depression and anxiety.

BMJ Open. 2014 Jan 23;4(1):e004205. doi: 10.1136/bmjopen-2013-004205. Ma HP, Ou JC, Yeh CT, Wu D, Tsai SH, Chiu WT, Hu CJ. Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

Prevention of Post-Stroke Generalized Anxiety Disorder, Using Escitalopram...



Full title: Prevention of Post-Stroke Generalized Anxiety Disorder, Using Escitalopram or Problem-Solving Therapy.

This study examined the efficacy of antidepressant treatment for preventing the onset of generalized anxiety disorder (GAD) among patients with recent stroke. Of 799 patients assessed, 176 were randomized, and 149 patients without evidence of GAD at the initial visit were included in this double-blind treatment with escitalopram (N=47) or placebo (N=49) or non-blinded problem-solving therapy (PST; 12 total sessions; N=53). Participants given placebo over 12 months were 4.95 times more likely to develop GAD than patients given escitalopram and 4.00 times more likely to develop GAD than patients given PST. Although these results should be considered preliminary, the authors found that both escitalopram and PST were effective in preventing new onset of post-stroke GAD.

J Neuropsychiatry Clin Neurosci. 2014 Jan 23. doi: 10.1176/appi.neuropsych.11020047. [Epub ahead of print] Mikami K, Jorge RE, Moser DJ, Arndt S, Jang M, Solodkin A, Small SL, Fonzetti P, Hegel MT, Robinson RG.

An analysis of paramilitary referrals to psychiatric services at a tertiary care center.



BACKGROUND: There is a dearth of specialized mental health services for Indian paramilitary service personnel. Those requiring psychiatric evaluation are referred to government psychiatric services often with minimal information. Hence, major diagnostic and decision making relies on the psychiatrist's clinical evaluation and judgment. The aim of the present study was to quantitatively evaluate the paramilitary referrals to psychiatric services at a tertiary care referral center. MATERIALS AND METHODS: A retrospective chart analysis of all consecutive referrals by various Indian paramilitary services to a tertiary care hospital (2008-2010) was carried out. RESULTS: Among the sample of 18 referrals, all were males (mean age: 37 years ± standard deviation (SD) =7.79). Various reasons for referral included: Evaluation of fitness for duty (83.3%), fitness to handle firearms (16.7%), and for disability certification (5.6%). There were no informants at all in 22.2%, and family members were available in only 11.1%. Hence, most referrals were admitted to the psychiatry ward for observation for various lengths of time. The mean duration of assessment (outpatient and inpatient) was 17.89 days (SD = 20.74) and final reported diagnoses were schizophrenia, depression, and bipolar disorder in 16.7, 11.1, and 11.1%, respectively. There was concurrent history of alcohol and nicotine dependence (40%). A large group (40%) was diagnosed not to suffer from a major mental illness, while a firm and final diagnosis could not be arrived at in 16.7% subjects. Only one subject was given the fitness to handle firearms, fitness for duty was refused in three (16.7%) subjects, and one subject was referred to neurology after being diagnosed as a case of seizure disorder. CONCLUSION: There is an urgent need for intensive training both to paramilitary physicians as well as to general hospital psychiatrists regarding proper assessment of paramilitary personnel, as there are frequent chances of the cases being undiagnosed or improperly diagnosed.

Ind Psychiatry J. 2013 Jan;22(1):54-9. doi: 10.4103/0972-6748.123622. Verma R(1), Mina S(1), Deshpande SN(2). (1)Department of Psychiatry, Lady Hardinge Medical College and Smt. S. K. Hospital, New Delhi, India. (2)Departments of Psychiatry, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

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