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A close relationship between anxiety and pain has been demonstrated in different conditions. The nocebo effect, whereby a verbal stressor is capable of inducing hyperalgesia, has been shown to be a good model to study such a relationship. In particular, nocebo hyperalgesia has been found to be associated to the hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis and benzodiazepines can antagonize both nocebo hyperalgesia and HPA hyperactivity, thus suggesting that anxiety play a major role. Here we investigate how stressful stimuli can modulate pain.
As a stressor, we used a nocebo procedure whereby verbal suggestions of hyperalgesia were given to healthy volunteers before administration of either tactile or low-intensity painful stimuli. Pain perception was assessed by means of a Numerical Rating Scale (NRS), raging from 0= no pain to 10= unbearable pain. The nocebo procedure was carried out after a pre-conditioning session in which two different conditioned stimuli were associated to either pain or no pain.
We found that the conditioned stimulus that was associated to pain was capable, when presented alone, of turning a tactile stimulus into pain.
These data suggest that a stressor, probably through anticipatory anxiety, can induce allodynic effects, whereby tactile stimuli become painful. These findings, along with previous data about placebo effects, indicate the powerful modulation of pain by placebos and nocebos.
This study aims to empirically identify profiles of functioning, and the correlates of those profiles in a sample of patients with stable schizophrenia in a real-world setting. The second aim was to assess factors associated with best profile membership.
Three hundred and twenty-three outpatients were enrolled in a cross-sectional study. A two-step cluster analysis was used to define groups of patients by using baseline values for the Heinrichs-Carpenter Quality of Life Scale (QLS) total score. Logistic regression was used to construct models of class membership.
Our study identified three distinct clusters: 50.4% of patients were classified in the “moderate” cluster, 27.9% in the “poor” cluster, 21.7% in the “good” cluster. Membership in the “good” cluster versus the “poor” cluster was characterized by less severe negative (OR = .832) and depressive symptoms (OR = .848), being employed (OR = 2.414), having a long-term relationship (OR = .256), and treatment with second-generation antipsychotics (SGAs) (OR = 3.831). Nagelkerke R2 for this model was .777.
Understanding which factors are associated with better outcomes may direct specific and additional therapeutic interventions, such as treatment with SGAs and supported employment, in order to enhance benefits for patients, as well as to improve the delivery of care in the community.
The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses.
A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer–Salovey–Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters.
We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (⩾14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC.
If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person.
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