Examining Proposed Changes to the Conceptualization of the Alexithymia Construct: The Way Forward Tilts to the Past

Taylor G.J. · Bagby R.M.

doi : 10.1159/000511988

Psychother Psychosom 2021;90:145–155

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The Role of Illness Behavior in the COVID-19 Pandemic

Cosci F. · Guidi J.

doi : 10.1159/000513968

Psychother Psychosom 2021;90:156–159

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Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment

Dubovsky S.L. · Ghosh B.M. · Serotte J.C. · Cranwell V.

doi : 10.1159/000511348

Psychother Psychosom 2021;90:160–177

Psychotic depression was initially considered to be at one end of a continuum of severity of major depression. Subsequent experience demonstrated that psychosis is an independent trait that may accompany mood disorders of varying severity. While much has been learned about the impact of severe mood congruent delusions and hallucinations on the course and treatment response of depression, less is known about fleeting or mild psychosis, mood incongruent features, or psychotic symptoms that reflect traumatic experiences. Acute treatment of psychotic unipolar depression generally involves the combination of an antidepressant and an antipsychotic drug or electroconvulsive therapy. There is inadequate information about maintenance treatment of unipolar psychotic depression and acute and chronic treatment of psychotic bipolar disorder. Decision-making therefore still must rely in part on clinical experience.

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What We Have Learned from Two Decades of Epidemics and Pandemics: A Systematic Review and Meta-Analysis of the Psychological Burden of Frontline Healthcare Workers

Busch I.M. · Moretti F. · Mazzi M. · Wu A.W. · Rimondini M.

doi : 10.1159/000513733

Psychother Psychosom 2021;90:178–190

In light of the current coronavirus disease 2019 (COVID-19) pandemic and potential future infectious disease outbreaks, a comprehensive understanding of the negative effects of epidemics and pandemics on healthcare workers’ mental health could inform appropriate support interventions. Thus, we aimed to synthesize and quantify the psychological and psychosomatic symptoms among frontline medical staff. We searched four databases up to March 19, 2020 and additional literature, with daily search alerts set up until October 26, 2020. Studies reporting psychological and/or psychosomatic symptoms of healthcare workers caring for patients with severe acute respiratory syndrome, H1N1, Ebola, Middle East respiratory syndrome, or COVID-19 were eligible for inclusion. Two reviewers independently conducted the search, study selection, quality appraisal, data extraction, and synthesis and involved a third reviewer in case of disagreement. We used random effects modeling to estimate the overall prevalence rates of psychological/psychosomatic symptoms and the I2 statistic. We included 86 studies, reporting data from 75,991 participants. Frontline staff showed a wide range of symptoms, including concern about transmitting the virus to the family (60.39%, 95% CI 42.53–76.96), perceived stress (56.77%, 95% CI 34.21–77.95), concerns about own health (45.97%, 95% CI 31.08–61.23), sleeping difficulties (39.88%, 95% CI 27.70–52.72), burnout (31.81%, 95% CI 13.32–53.89), symptoms of depression (25.72%, 95% CI 18.34–33.86), symptoms of anxiety (25.36%, 95% CI 17.90–33.64), symptoms of posttraumatic stress disorder (24.51%, 95% CI 18.16–31.46), mental health issues (23.11%, 95% CI 15.98–31.10), and symptoms of somatization (14.68%, 95% CI 10.67–19.18). We found consistent evidence for the pervasive and profound impact of large-scale outbreaks on the mental health of frontline healthcare workers. As the CO­VID-19 crisis continues to unfold, guaranteeing easy access to support structures for the entire healthcare workforce is vitally important.

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Brief Online Cognitive Behavioural Intervention for Dysfunctional Worry Related to the COVID-19 Pandemic: A Randomised Controlled Trial

Wahlund T. · Mataix-Cols D. · Olofsdotter Lauri K. · de Schipper E. · Lj?tsson B. · Aspvall K. · Andersson E.

doi : 10.1159/000512843

Psychother Psychosom 2021;90:191–199

Introduction: Worries about the immediate and long-term consequences of the COVID-19 pandemic may for some individuals develop into pervasive worry that is disproportionate in its intensity or duration and significantly interferes with everyday life. Objective: The aim of this study was to investigate if a brief self-guided, online psychological intervention can reduce the degree of dysfunctional worry related to the COVID-19 pandemic and associated symptoms. Methods: 670 adults from the Swedish general population reporting daily uncontrollable worry about CO­VID-19 and its possible consequences (e.g., illness, death, the economy, one’s family) were randomised (1:1 ratio) to a 3-week self-guided, online cognitive behavioural intervention targeting dysfunctional COVID-19 worry and associated symptoms, or a waiting list of equal duration. The primary outcome measure was a COVID-19 adapted version of the Generalised Anxiety Disorder 7-item scale administered at baseline and weeks 1–3 (primary endpoint). Follow-up assessments were conducted 1 month after treatment completion. The trial was registered on ClinicalTrials.gov (NCT04341922) before inclusion of the first participant. Results: The main pre-specified intention-to-treat analysis indicated significant reductions in COVID-19-related worry for the intervention group compared to the waiting list (? = 1.14, Z = 9.27, p < 0.001), corresponding to a medium effect size (bootstrapped d = 0.74 [95% CI: 0.58–0.90]). Improvements were also seen on all secondary measures, including mood, daily functioning, insomnia, and intolerance of uncertainty. Participant satisfaction was high. No serious adverse events were recorded. Conclusions: A brief digital and easily scalable self-guided psychological intervention can significantly reduce dysfunctional worry and associated behavioural symptoms related to the COVID-19 pandemic.

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Physical Exercise as a Resilience Factor to Mitigate COVID-Related Allostatic Overload

E?ry A.a,c · Békési D.b · E?ry A.c · R?zsa S.d,e

doi : 10.1159/000514331

Psychother Psychosom 2021;90:200–206

Introduction: The long-lasting threat of COVID-19 makes it necessary to explore strategies to improve coping skills which enable us to master a balanced life in the face of adversity. Objective: To unravel the most challenging aspects of COVID-19 in a nonclinical adult population and identify predictors of lost balance and consequent allostatic overload (AO). We examined the role of regular, moderate-intensity formula aerobic exercise (312 meridian exercise) in preventing allostatic overload through increasing well-being. Methods: An online survey was conducted to measure CO­VID-related allostatic overload according to clinimetric criteria. The Psychosocial Index (PSI), Kellner’s Symptom Questionnaire (KSQ), short Depression Anxiety Stress Scales (DASS-21), Public Health Surveillance Well-Being Scale ­(PHS-WB), and Whiteley-7 were used to explore mental health characteristics. Univariate statistics logistic regression analysis and a general linear model were used. Results: According to 442 valid answers, 217 adults practiced physical exercise (PE) frequently (fPE, 3–5 times/every day) while 120 did it less regularly (1–2 times/week), and 105 did not exercise/practiced irregularly (controls). Restriction-related stressors were most challenging, resulting in AO in 29% (n = 128) of the sample. The main predictors were additional stressors (p = 0.005) and anxiety symptoms (p < 0.001). The prevalence of AO was lower (p = 0.018) in the fPE group when compared to controls. KSQ distress symptoms were also lower in fPE (p < 0.0001), while total well-being was increased (p < 0.001) after adjusting for sex, age, and number of chronic diseases. According to the PHS-WB, both physical and mental well-being were higher (p = 0.003 and p = 0.004, respectively) in fPE. Conclusions: Frequent moderate exercise is associated with better mental and physical well-being and a lower prevalence of AO.

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Response to "Acute and Persistent Withdrawal Syndromes following Discontinuation of Psychotropic Medications" by Cosci et al. (2020)

Huff C.

doi : 10.1159/000514045

Psychother Psychosom 2021;90:207–208

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Persistent Postwithdrawal Syndrome after Benzodiazepine Discontinuation. A Reply to Huff

Cosci F.a–c · Chouinard G.d

doi : 10.1159/000515015

Psychother Psychosom 2021;90:209–210

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Questioning the Consensus on Placebo and Nocebo Effects

Hardman D.a · Hutchinson P.b · Ongaro G.c

doi : 10.1159/000513466

Psychother Psychosom 2021;90:211–212

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“Consensus on Placebo and Nocebo Effects Connects Science with Practice:” Reply to “Questioning the Consensus on Placebo and Nocebo Effects”

Evers A.W.M.a,b · Colloca L.c · Blease C.d · Gaab J.e · Jensen K.B.f · Atlas L.Y.g · Beedie C.J.h · Benedetti F.i · Bingel U.j · Büchel C.k · Bussemaker J.l · Colagiuri B.m · Crum A.J.n · Finniss D.G.o · Geers A.L.p · Howick J.q · Klinger R.r · Meeuwis S.H.a · Meissner K.s · Napadow V.t · Petrie K.J.u · Rief W.v · Smeets I.w · Wager T.D.x · Wanigasekera V.y · Vase L.z · Kelley J.M.A · Kirsch I.A · on behalf of the Consortium of Placebo Experts

doi : 10.1159/000514435

Psychother Psychosom 2021;90:213–214

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Embitterment in the General Population after Nine Months of COVID-19 Pandemic

Muschalla B. · Vollborn C. · Sondhof A.

doi : 10.1159/000514621

Psychother Psychosom 2021;90:215–216

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