Among people first suspected of having a stroke, approximately 6% have functional/psychological conditions. Wilkins et al. evaluated the incidence and characteristics of “functional stroke mimics” (FSM) at a large general hospital in the Middle East. FSM frequencies varied by nationality. Arab and African patients, who were often migrant workers, had FSM twice as often compared to other nationalities (15.6% and 16.8%, respectively, versus 5.2% to 7.9%), Further study is needed but potential etiologies may be stress due to lack of stability, income vulnerability, and/or trauma history. Culturally sensitive mental health assessment and treatment will likely be beneficial.
Pages 416–421; http://dx.doi.org/10.1097/PSY.0000000000000563
In an accompanying editorial, Löwe and Gerloff discuss possible reasons for intercultural variation in the frequency of functional disorders and related conditions. In current models, symptom perception is guided by top-down central nervous system processes. Cultural beliefs, prior illnesses, and stressful life situations influence patients’ expectations, sensory input, and perception of somatic symptoms. Also, sociocultural and economic factors such as insurance status, health literacy, and health care experiences predict health care use in these patients. Care for patients with functional disorders should include access to effective treatment, patient and provider education and participation, and interdisciplinary collaboration.
Pages 412–415; http://dx.doi.org/10.1097/PSY.0000000000000594
Mechanisms underlying the perception and experience of persistent physical symptoms are not well understood. Based on a review of recent literature, Henningsen et al. propose a model for bodily distress compatible with a model of the brain as an active predictive processing device rather than one passively waiting for sensory input. Following this model, persistent and recurrent symptoms are described as failure of inference, and clinically well-known factors like expectation are assigned a role, not only in the later amplification of bodily signals, but particularly at the very basis of symptom perception.
Pages 422–431; http://dx.doi.org/10.1097/PSY.0000000000000588
Cognitive dysfunction has been reported in people with fibromyalgia. In a meta-analysis of 23 case-control studies with 2096 participants, Wu et al. found that cognitive function was significantly lower in fibromyalgia patients than in healthy controls. Large effect sizes were found in learning/memory and attention/psychomotor speed; medium effect sizes were reported in executive function and working memory. Depression and anxiety scores were associated with the effect size of group differences in cognitive function and may partially explain the heterogeneity across studies.
Pages 432–438; http://dx.doi.org/10.1097/PSY.0000000000000575
Sevinc et al. compared mindfulness-based stress reduction and relaxation response meditation by investigating neural activity during body scans. Both types were associated with common and dissociable neural activity, including in regions previously associated with present-moment awareness and attention to the body. Mindfulness elicited activation of neural regions associated with sensory awareness and salience, whereas relaxation activated neural regions commonly associated with top-down control. These findings suggest that meditation types may reduce stress through different neural mechanisms with implications for their use in clinical settings.
Pages 439–451; http://dx.doi.org/10.1097/PSY.0000000000000590
Elevated stress reactivity is related to metabolic problems, but neural, hormonal, and cognitive correlates of insulin resistance (IR) are largely unknown. Wolf et al. examined eye-blink response (EBR) data in adults to gauge reactivity to negative, positive, or neutral images. Higher IR corresponded to greater reactivity to unpleasant versus pleasant visual stimuli. Participants with pre- or type 2 diabetes showed worse cognitive performance, dysregulated urinary cortisol, and frontal alpha asymmetry, which is a neural biomarker for negative affect predisposition.
Pages 452–459; http://dx.doi.org/10.1097/PSY.0000000000000582
Although it has been suggested that alexithymia is associated with cardiovascular diseases, studies are few and the direction of the association is uncertain. In a prospective cohort study of 5586 participants without cardiovascular history at baseline, Wiernik et al. found that alexithymia at baseline was not associated with cardiovascular events after an average of 11 years of follow-up. The results do not support the hypothesis that targeting alexithymia could be effective in primary prevention of cardiovascular illness.
Pages 460–467; http://dx.doi.org/10.1097/PSY.0000000000000592
Hermann-Lingen et al. measured blood pressure, depressive symptoms, and quality of life in patients aged 50 to 85 years with cardiovascular risk factors. Although diagnosed arterial hypertension and antihypertensive medication usually have an adverse impact on quality of life, recent reports suggest that actual blood pressure may be positively related to better well-being. In the older adults in this study, higher systolic blood pressure was independently related to fewer depressive symptoms and better quality of life in both cross-sectional and longitudinal settings, although the magnitude of the effect sizes was typically small.
Pages 468–474; http://dx.doi.org/10.1097/PSY.0000000000000591
Autonomic nervous system (ANS) imbalance has been cross-sectionally associated with inflammatory processes. Hu et al. examined cross-sectional and bidirectional prospective associations between cardiac autonomic measures and inflammation markers. Autonomic imbalance is associated with higher levels of inflammation. Independent data from two studies showed that higher heart rate predicts subsequent higher levels of C-reactive protein and interleukin-6. Inflammation markers may also predict future ANS activity, but evidence for this was less consistent.
Pages 475–482; http://dx.doi.org/10.1097/PSY.0000000000000589
In a study of sleep problems, symptom burden, and survival in individuals with cancer, Steel et al. administered questionnaires and measured cytokine levels to assess biological mediation in 294 patients with advanced cancers. Shorter sleep duration was linked to increased symptom burden. A curvilinear relationship was observed between sleep duration and survival, with circulating IL-2 mediating this association. Screening and treatment of sleep problems in patients diagnosed with cancer may be beneficial for both psychological well-being and disease biology.
Pages 483–491; http://dx.doi.org/10.1097/PSY.0000000000000579
Children from families with lower socioeconomic status (SES) exhibit greater physiological dysregulation and poorer health. Despite recognition of environmental contributors, little is known about the influence of neighborhood attributes. Roubinov et al. examined the role of community-level risks and availability of resources in the relation of family SES to kindergarten children’s daily cortisol levels and physical health. Findings indicated that higher opportunity neighborhoods may protect against the negative consequences of low SES on children’s stress physiology and physical health. Public health interventions that bolster neighborhood opportunities may benefit young children, particularly those growing up in families experiencing socioeconomic difficulties.
Pages 492–501; http://dx.doi.org/10.1097/PSY.0000000000000585