The latest medical research on Psychosomatic Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about psychosomatic medicine gathered by our medical AI research bot.

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Early life trauma and social processing in HIV: the role of neuroendocrine factors and inflammation.

Psychosomatic Medicine

Early life trauma (ELT) and HIV are associated with social processing deficits. In people with HIV (PWH), we examined whether facial emotion identification accuracy differs by ELT and whether neuroendocrine factors including cortisol, oxytocin (OT), and arginine vasopressin (AVP), and/or immune system measures play a role in the ELT-performance association.

We used secondary data from the placebo condition of a pharmacologic challenge study in PWH. Presence of ELT was measured with the Childhood Trauma Questionnaire (at least moderate experiences of sexual, physical, and/or emotional abuse). Social processing was measured with the Facial Emotion Perception Test (FEPT). Salivary immune system measures and cortisol were sampled across a 5-hour study session. Blood was collected at study session start (12 pm) to measure OT and AVP. We examined the association of ELT with FEPT and five biological moderators (from principal components analysis of 12 biomarkers) of ELT-FEPT associations.

Of 58 PWH (42 males; mean age = 33.7, standard deviation = 8.9 years), 50% endorsed ELT. ELT-exposed PWH demonstrated lower identification accuracy across all emotional expressions (unstandardized beta[B] = 0.13; standard error [SE] = 0.05; P = 0.021, d = 0.63) and had higher OT levels compared to ELT-unexposed PWH (t(1,56) = 2.12, P = 0.039; d = 0.57). For total accuracy, an OT/C-reactive protein (OT/CRP) factor moderated the ELT-FEPT association (B = 0.14; SE = 0.05; P = 0.014); accuracy was lower in ELT-exposed PWH versus ELT-unexposed PWH when the factor was low but not when high. Similar results were obtained for fearful, neutral, and happy faces (P's < 0.05). Regardless of ELT, a myeloid migration (MCP-1/MMP-9) factor was associated with reduced accuracy (P's < 0.05).

Our pilot findings suggest that ELT may alter social processing in PWH, and that OT and CRP may be a target for improving social processing in ELT-exposed PWH, and myeloid migration markers may be a target in PWH more generally.

Sleep Variability and Inflammation in Midlife and Older Women.

Psychosomatic Medicine

Shorter sleep duration and more sleep disturbances, in addition to greater night-to-night fluctuations in sleep (intraindividual variability; IIV), have been associated with elevated inflammation. However, these associations were only at the between-person level. The current study examined the within-person relationship between mean levels and IIV of sleep duration and sleep disturbances and C-reactive protein (CRP) in healthy, aging women.

Participants (N = 179) from a longitudinal study of activity and well-being in middle-aged and older women (Mage = 62; range = 50-75) completed a 7-day daily diary, every 3 months, for 2 years (up to 9 bursts). Sleep was assessed each day asking participants how many hours of sleep they got the night before and with the 4-item PROMIS Sleep Disturbance Short Form. Finger stick dried blood spot samples were collected following each 7-day daily diary.

In bursts when women experienced greater than average variability in sleep duration, they had higher CRP (γ = .06, p = .004). Within-person changes in mean sleep duration were not associated with CRP. Additionally, neither mean sleep disturbances nor sleep disturbance IIV were associated with CRP.

This study is the first to show that within-person changes in variable sleep duration are related to changes in inflammation. Findings from the current study suggest that greater variability in sleep duration is related to higher CRP, which may increase risk for early morbidity and mortality. Future studies should investigate inflammation as a pathway linking sleep variability and health.

Health care consumption, psychiatric diagnoses, and pharmacotherapy 1 and 2 years before and after newly diagnosed HIV: A case-control study nested in The Greater Stockholm HIV Cohort Study.

Psychosomatic Medicine

We compare individuals with newly diagnosed HIV with sex-, age- and socioeconomic status-matched HIV-negative controls; with the aim of studying the frequency of health care visits, the types of clinics visited, registered diagnoses and psychopharmacotherapy.

The data were collected through the Stockholm Region administrative database (VAL) for men and women (people) living with newly diagnosed HIV (PLWH) in their medical records (930 men; 450 women) and controls. The odds ratios (OR) with 99% confidence intervals (CI) for psychiatric comorbidities and relevant pharmacotherapies were calculated during 2011-2018.

Substance use disorder was higher in PLWH than in controls, before and after newly diagnosed HIV in men (OR 1 year before 4.36, 99% CI 2.00-9.5 and OR 1 year after 5.16, 99% CI 2.65-10.08) and women (OR 1 year before 6.05, 99% CI 1.89-19.40 and OR 1 year after 5.24 99% CI, 1.69-16.32). Healthcare contacts and psychiatric disorders were more common in cases than controls one and two years after diagnosis; particularly for depression in men 1 year after HIV (OR = 3.14, 99%CI = 2.11-4.67) which was not found in women (1 year OR = 0.94, 99%CI = 0.50-1.77).

Before newly diagnosed HIV, PLWH have the same level of psychiatric diagnoses as their controls, except for substance use disorder. Psychiatric problems are more common in PLWH than in their controls after newly diagnosed HIV.

Through the Looking-Glass: Psychoneuroimmunology and the Microbiome-Gut-Brain Axis in the Modern Antiretroviral Therapy Era.

Psychosomatic Medicine

Depression, substance use disorders, and other neuropsychiatric comorbidities are common in people with HIV (PWH), but the underlying mechanisms are not sufficiently understood. HIV-induced damage to the gastrointestinal tract potentiates residual immune dysregulation in PWH receiving effective anti-retroviral therapy (ART). However, few studies among PWH have examined the relevance of microbiome-gut-brain axis: bi-directional crosstalk between the gastrointestinal tract, immune system, and central nervous system.

A narrative review was conducted to integrate findings from 162 articles relevant to psychoneuroimmunology (PNI) and microbiome-gut-brain axis research in PWH.

Early PNI studies demonstrated that neuroendocrine signaling via the hypothalamic-pituitary-adrenal axis and autonomic nervous system could partially account for the associations of psychological factors with clinical HIV progression. This review highlights the need for PNI studies examining the mechanistic relevance of the gut microbiota for residual immune dysregulation, tryptophan catabolism, and oxytocin release as key biological determinants of neuropsychiatric comorbidities in PWH (i.e., body-to-mind pathways). It also underscores the continued relevance of neuroendocrine signaling via the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and oxytocin release in modifying microbiome-gut-brain axis functioning (i.e., mind-to-body pathways).

Advancing our understanding of PNI and microbiome-gut-brain axis pathways relevant to depression, substance use disorders, and other neuropsychiatric comorbidities in PWH can guide the development of novel bio-behavioral interventions to optimize health outcomes. Recommendations are provided for bio-behavioral and neurobehavioral research investigating bi-directional PNI and microbiome-gut-brain axis pathways among PWH in the modern ART era.

Glucocorticoid receptor function and cognitive performance in women with HIV.

Psychosomatic Medicine

Alterations in glucocorticoid receptor (GCR) function may be a risk factor for cognitive complications among older people with HIV. We evaluated whether HIV-serostatus and age modify the GCR function-cognition association among women.

Eighty women with HIV (WWH; n = 40, <40 years of age [younger]; n = 40, >50 years [older]) and 80 HIV-uninfected women (n = 40 older, n = 40 younger) enrolled in the Women'sInteragency HIV Study completed a comprehensive neuropsychological test battery. Peripheral blood mononuclear cells (PBMCs) collected concurrent with neuropsychological testing were assessed for GCR function. Multivariable linear regression analyses were conducted to examine whether 1) HIV-serostatus and age were associated with GCR function and 2) GCR function-cognition associations are moderated by HIV-serostatus and age adjusting for relevant covariates.

Among older women, higher expression of baseline FKBP5 expression levels was associated with lower attention/working memory performance among WWH (B = 6.4, SE = 1.7, P = 0.0003) but not in women without HIV infection (B = -1.7, SE = 1.9, P = 0.37). There were no significant HIV-serostatus by Age interactions on DEX-stimulated expression of the genes regulated by the GCR nor LPS-stimulated TNF-α levels (with or without DEX stimulation) (P values > 0.13). HIV-serostatus was associated with GC target genes PER1 (P = 0.006) and DUSP1 (P = 0.02), but not TSC22D3 (P = 0.32), following DEX stimulation.

Collectively, these data suggest that HIV-serostatus and age may modify the influence of the GCR, such that the receptor is likely engaged to a similar extent, but the downstream influence of the receptor is altered, potentially through epigenetic modification of target genes.

Preoperative and postoperative memory in epilepsy patients with 'gliosis only' versus hippocampal sclerosis: a matched case-control study.

Neurology, Neurosurgery and Psychiatry

Gliosis only (GO) and hippocampal sclerosis (HS) are distinct histopathological entities in mesial temporal lobe epilepsy. This study explores whether this distinction also exists on a functional level when evaluating pre- and postoperative memory.

Using a retrospective matched case-control study design, we analysed verbal and visual memory performance in 49 patients with GO and 49 patients with HS before and one year after elective surgery.

Clinical differences were evident with a later age at seizure onset (18±12 vs 12±9 years) and fewer postoperative seizure-free patients in the GO group (63% vs 82%). Preoperatively, group and individual-level data demonstrated that memory impairments were less frequent, less severe and relatively non-specific in patients with GO compared with HS. Postoperatively, verbal memory declined in both groups, particularly after left-sided resections, with more significant losses in patients with GO. Factoring in floor effects, GO was also associated with more significant visual memory loss, particularly after left resections.

Compared with HS, GO is characterised by (1) a later onset of epilepsy, (2) less pronounced and more non-specific memory impairments before surgery, (3) a less successful surgical outcome and (4) a more significant memory decline after surgery. Overall, our results regarding cognition provide further evidence that GO and HS are distinct clinical entities. Functional integrity of the hippocampus appears higher in GO, as indicated by a better preoperative memory performance and worse memory outcome after surgery. The different risk-benefit ratios should be considered during presurgical patient counselling.

Somatic symptom disorder in patients with post-COVID-19 neurological symptoms: a preliminary report from the somatic study (Somatic Symptom Disorder Triggered by COVID-19).

Neurology, Neurosurgery and Psychiatry

To assess the diagnosis of somatic symptom disorder (SSD) in patients with unexplained neurological symptoms occurring after SARS-CoV-2 infection, also referred to as long COVID.

Patients were contacted for a standardised psychometric evaluation by phone, followed by a self-survey.

Although the patients did not meet the DSM-5 criteria for a functional neurological symptom disorder specifically, SSD diagnosis based on DSM-5 criteria was positive in 32 (64%) patients. In the remaining 18 patients, SSD was considered possible given the high score on diagnostic scales. Physical examination were normal for all. Brain MRI showed unspecific minor white matter hyperintensities in 8/46 patients. Neuropsychological assessment showed exclusively mild impairment of attention in 14 out of 15 tested patients, in discrepancy with their major subjective complaint. Forty-five (90%) patients met criteria for Chronic Fatigue Syndrome. Seventeen (32%) patients were screened positive for mood-anxiety disorders, 19 (38%) had a history of prior SSD and 27 (54%) reported past trauma. Additional self-survey highlighted post-traumatic stress disorder in 12/43 (28%), high levels of alexithymia traits and perfectionism. Long-lasting symptoms had a major impact with a high rate of insomnia (29/43, 67%), psychiatric follow-up (28/50, 56%) and work or pay loss (25/50, 50%).

A majority of patients with unexplained long-lasting neurological symptoms after mild COVID met diagnostic criteria for SSD and may require specific management.

NCT04889313.

Exploring the phenotype of Italian patients with ALS with intermediate ATXN2 polyQ repeats.

Neurology, Neurosurgery and Psychiatry

To detect the clinical characteristics of patients with amyotrophic lateral sclerosis (ALS) carrying an intermediate ATXN2 polyQ number of repeats in a large population-based series of Italian patients with ALS.

The study population includes 1330 patients with ALS identified through the Piemonte and Valle d'Aosta Register for ALS, diagnosed between 2007 and 2019 and not carrying C9orf72, SOD1, TARDBP and FUS mutations. Controls were 1274 age, sex and geographically matched Italian subjects, identified through patients' general practitioners.

We found 42 cases and 4 controls with≥31 polyQ repeats, corresponding to an estimated OR of 10.4 (95% CI 3.3 to 29.0). Patients with≥31 polyQ repeats (ATXN2+) compared with those without repeat expansion (ATXN2-) had more frequently a spinal onset (p=0.05), a shorter diagnostic delay (p=0.004), a faster rate of ALSFRS-R progression (p=0.004) and King's progression (p=0.004), and comorbid frontotemporal dementia (7 (28.0%) vs 121 (13.4%), p=0.037). ATXN2+ patients had a 1-year shorter survival (ATXN2+ patients 1.82 years, 95% CI 1.08 to 2.51; ATXN2- 2.84 years, 95% CI 1.67 to 5.58, p=0.0001). ATXN2 polyQ intermediate repeats was independently related to a worse outcome in Cox multivariable analysis (p=0.006).

In our population-based cohort, ATXN2+ patients with ALS have a distinctive phenotype, characterised by a more rapid disease course and a shorter survival. In addition, ATXN2+ patients have a more severe impairment of cognitive functions. These findings have relevant implications on clinical practice, including the possibility of refining the individual prognostic prediction and improving the design of ALS clinical trials, in particular as regards as those targeted explicitly to ATXN2.

Risk of stroke in multiple sclerosis and neuromyelitis optic spectrum disorder: a Nationwide cohort study in South Korea.

Neurology, Neurosurgery and Psychiatry

People with multiple sclerosis (MS) are more likely to develop stroke than those without. However, little is known about the association between neuromyelitis optica spectrum disorder (NMOSD) and the risk of stroke. We aimed to estimate the risk of stroke in patients with MS and NMOSD in South Korea.

Data from the Korean National Health Insurance between January 2010 and December 2017 were analysed. A total of 1541/1687 adult patients with MS/NMOSD, who were free of stroke were included. Matched controls were selected based on age, sex and the presence of hypertension, diabetes mellitus and dyslipidaemia.

The risk of developing stroke was 2.78 times higher (adjusted HR (aHR), 95% CI 1.91 to 4.05) in patients with MS compared with controls matched by age, sex, hypertension, diabetes mellitus and dyslipidaemia. The risk of stroke in NMOSD was also higher than that in matched controls (aHR=1.69, 95% CI 1.10 to 2.61) and not statistically different from that of MS (p=0.216). The patients with MS had a higher risk for either of ischaemic or haemorrhagic stroke (HR=2.63 and 2.93, respectively), whereas those with NMOSD had a higher risk for ischaemic stroke (HR=1.60) with marginal statistical significance.

The risk of stroke is increased in patients with MS and NMOSD and seemed comparable between the two conditions. This is the first study that estimates the risk of stroke in patients with MS and NMOSD within the same population.

Prevalence of young-onset dementia: nationwide analysis of routinely collected data.

Neurology, Neurosurgery and Psychiatry

Young-onset dementia prevalence is understudied internationally. Previous studies have been limited by low case numbers, reliance on single sources of routinely collected health data for case identification and inclusion of a limited age range. Our objective was to determine the 1-year period prevalence of diagnosed dementia in people aged 0-64 in the entire New Zealand population using routinely collected health data.

A population-based descriptive study was carried out in New Zealand (population 4.8 million) using routinely collected deidentified health data from 2016 to 2020. Dementia cases in seven linked health datasets in the New Zealand Integrated Data Infrastructure were identified using diagnostic codes and/or use of antidementia medication. Prevalence for each of the four study years was calculated by age, sex and ethnicity.

From a total population of 4 027 332-4 169 754 individuals aged 0-64, we identified 3396-3474 cases of 'all-cause' dementia in each of the study years (prevalence crude range: 83-84/100 000 people aged 0-64; 139-141/100 000 people aged 30-64 years; 204-207/100 000 people aged 45-64 years). Age-standardised prevalence was higher in males than females. Age-standardised and sex-standardised prevalence was higher in Māori and Pacific People than European and Asian.

By using a large study population and multiple national health datasets, we have minimised selection bias and estimated the national prevalence of diagnosed young-onset dementia with precision. Young-onset dementia prevalence for the total New Zealand population was similar to reported global prevalence, validating previous estimates. Prevalence differed by ethnicity, which has important implications for service planning.

Ipsilateral and axial tremor response to focused ultrasound thalamotomy for essential tremor: clinical outcomes and probabilistic mapping.

Neurology, Neurosurgery and Psychiatry

NCT01932463, NCT01827904, and NCT02252380.

To investigate the effects of MRgFUS in patients with ET with an emphasis on ipsilateral-hand and axial tremor subscores.

Tremor scores and adverse effects of 100 patients treated between 2012 and 2018 were assessed at 1 week, 3, 12, and 24 months. A subgroup analysis of ipsilateral-hand tremor responders (defined as patients with ≥30% improvement at any time point) and non-responders was performed. Correlations and predictive factors for improvement were analysed. Weighted probabilistic maps of improvement were generated.

Significant improvement in axial, contralateral-hand and total tremor scores was observed at all study visits from baseline (p<0.0001). There was no significant improvement in ipsilateral subscores. A subset of patients (n=20) exhibited group-level ipsilateral-hand improvement that remained significant through all follow-ups (p<0.001). Multivariate regression analysis revealed that higher baseline scores predict better improvement in ipsilateral-hand and axial tremor. Probabilistic maps demonstrated that the lesion hotspot for axial improvement was situated more medially than that for contralateral improvement.

MRgFUS significantly improved axial, contralateral-hand and total tremor scores. In a subset of patients, a consistent group-level treatment effect was observed for ipsilateral-hand tremor. While ipsilateral improvement seemed to be less directly related to lesion location, a spatial relationship between lesion location and axial and contralateral improvement was observed that proved consistent with the somatotopic organisation of the ventral intermediate nucleus.

Relationship between motor cortical and peripheral axonal hyperexcitability in amyotrophic lateral sclerosis.

Neurology, Neurosurgery and Psychiatry

Previous studies have shown that patients with amyotrophic lateral sclerosis (ALS) have hyperexcitability in both the motor cortex and peripheral motor axons, but the relationship between central and peripheral excitability has not been fully disclosed.

Threshold tracking transcranial magnetic stimulation (TMS) and motor nerve excitability testing were prospectively performed in 53 patients with ALS and 50 healthy subjects, and their relations to compound muscle action potential (CMAP) amplitude and revised ALS Functional Rating Scale were cross-sectionally analysed.

Compared with controls, patients with ALS showed both cortical and peripheral hyperexcitability; TMS showed reduced short-interval intracortical inhibition (interstimulus interval 1-7 ms) (p<0.001) and shortened silent period (p<0.05), and median nerve excitability testing revealed greater changes in depolarising threshold electrotonus (TEd) and greater superexcitability (p<0.0001, both), suggesting reduced axonal potassium currents. Significant correlations between cortical and peripheral excitability indices were not found. Greater changes in TEd (90-100 ms) (R=-0.33, p=0.03) and superexcitability (R=0.36, p=0.01) were associated with smaller amplitude of CMAP, whereas cortical excitability indices had no correlation with CMAP amplitude. More rapid motor functional decline was associated with only greater TEd (90-100 ms) (β=0.46, p=0.001).

Our results suggest that in ALS, cortical excitability is continuously high regardless of the extent of the peripheral burden, but peripheral hyperexcitability is associated with the extent of the peripheral burden and disease evolution speed. Alterations of ion channel function may play an important role in ALS pathophysiology.