Psychosomatic disorder: a treatment problem more difficult than neurosis? A comparative clinical study of psychosomatic and neurotic patients of the psychiatric policlinic of a general hospital

Oral galvanism related to dental implants

BACKGROUND

A range of different chemical interactions can generate an unexpected electronic current in a process called galvanism. Oral galvanism (OG) can also be generated by different chemical actions from diverse intraoral rehabilitated metals, including gold, copper, mercury, titanium, and titanium alloy. The main aim of this manuscript is to review OG, particularly focusing on titanium implants and related metallic materials. We searched the MEDLINE (PubMed), Embase, Scopus, and Google Scholar databases for relevant literature published through December 2019. The keywords included "galvanic current", "galvanism", "galvanic corrosion", "oral galvanism", combined with "oral", "oral cavity", "implant", and "saliva."

RESULTS

Out of 343 articles, 126 articles that met the inclusion criteria were reviewed. We examined and summarized research on OG through a division into four categories: definition and symptoms, diagnosis with testing methods, galvanic corrosion, and oral precancerous lesions with OG.

CONCLUSIONS

Patients with OG have high oral energy and current, and although this phenomenon may be due to the patient's mental illness, OG due to amalgam or mercury occurs. It is evident that the difference in electron potential caused by different elemental components such as titanium alloy and pure titanium, which are essential for manufacturing the implant fixture and the abutment, and chrome and nickel, which are essential for manufacturing the upper crown, causes OG. Since the oral cavity is equipped with an environment in which electric current can be transmitted easily due to saliva, it is imperative that clinicians review the systemic and local effects of salivation.

A Quantitative Genetic Analysis of Cognitive Abilities during the Second Half of the Life Span

Little is known about the importance of genetic effects on individual differences in cognitive abilities late in life. We present the first report from the Swedish Adoption/Twin Study of Aging (SATSA) for cognitive data, including general cognitive ability and 13 tests of specific cognitive abilities. The adoption/twin design consists of identical twins separated at an early age and reared apart (46 pairs), identical twins reared together (67 pairs), fraternal twins reared apart (100 pairs), and fraternal twins reared together (89 pairs); average age was 65 years. Heritability of general cognitive ability in these twins was much higher (about 80%) than estimates typically found earlier in life (about 50%). Consistent with the literature, heritabilities of specific cognitive abilities were lower than the heritability of general cognitive ability but nonetheless substantial. Average heritabilities for verbal, spatial, perceptual speed, and memory tests were, respectively, 58%, 46%, 58%, and 38%.

Onset and rate of cognitive change before dementia diagnosis: findings from two Swedish population-based longitudinal studies

We used data from two population-based longitudinal studies to estimate time of onset and rate of accelerated decline across cognitive domains before dementia diagnosis. The H70 includes an age-homogeneous sample (127 cases and 255 non-cases) initially assessed at age 70 with 12 follow-ups over 30 years. The Kungsholmen Project (KP) includes an age-heterogeneous sample (279 cases and 562 non-cases), with an average age of 82 years at initial assessment, and 4 follow-ups spanning 13 years. We fit mixed linear models to the data and determined placement of change points by a profile likelihood method. Results demonstrated onset of accelerated decline for fluid (speed, memory) versus crystallized (verbal, clock reading) abilities occurring approximately 10 and 5 years before diagnosis, respectively. Although decline before change points was greater for fluid abilities, acceleration was more pronounced for crystallized abilities after the change points. This suggests that onset and rate of acceleration vary systematically along the fluid-crystallized ability continuum. There is early onset in fluid abilities, but these changes are difficult to detect due to substantial age-related decline. Onset occurred later and acceleration was greater in crystallized abilities, suggesting that those markers may provide more valid identification of cases in later stages of the prodromal phase.

Effects of repeated testing in a longitudinal age-homogeneous study of cognitive aging

Estimates of gains related to repeated test exposure (retest effects) and within-person cognitive changes are confounded in most longitudinal studies because of the nonindependent time structures underlying both processes. Recently developed statistical approaches rely on between-person age differences to estimate effects of repeated testing. This study, however, demonstrates how retest effects can be evaluated at the group level in an age-homogeneous population-based study by use of a sampling-based design approach in which level and change of cognitive performance of previous participants, measured at ages 70, 75, 79, 81, 85, 88, 90, 92, 95, 97, and 99 years, were compared with performances of survivors of a representative sample identified and drawn from the same original population cohort but invited for the first time at age 85 with subsequent measurements at ages 88, 90, 92, 95, 97, and 99. The comparisons revealed a trend toward retest effects on two out of five cognitive measurements. The study demonstrates how a design-based approach can provide valuable insights into continuous learning processes embedded in population average aging trajectories that are not confounded with cohort and mortality-related selective attrition.

Height and body weight in elderly adults: a 21-year population study on secular trends and related factors in 70-year-olds

BACKGROUND

Body size in elderly adults is partly due to aging and partly to secular trends. This study describes secular trends in three anthropometric measures (i.e., height, body weight [BW], and body mass index [BMI]) of 70-year-olds over a period of 21 years and their relation to social and lifestyle factors.

METHODS

A total of 3128 70-year-olds from four birth cohorts born between 1901 and 1922 in Gothenburg, Sweden, were examined between 1971 and 1992 in the Geriatric Medicine Department, Göteborg University. Trends in anthropometric measures were examined by permutation test. Influence of the subjects' birth year, physical activity, smoking habits, and education on anthropometric measures were investigated by multiple linear regression.

RESULTS

Individuals in later-born cohorts were found to be 1 to 2 cm taller and 1.5 to 6.3 kg heavier than earlier-born cohorts. For BMI, a positive trend was significant only in 70-year-old male participants. "Year of birth" was a positive predictor for BW (p <.001) and BMI (p <.001) in male participants and for height (p <.05) and BW (p <.01) in female participants. Physical inactivity was a positive (p <.01) and "current smoking" a negative (p <.001) predictor for BMI in both sexes. "More than basic education" was a positive predictor for height (p <.001) in both sexes and a negative predictor for body weight (p <.01) and BMI (p <.001) in female participants only.

CONCLUSIONS

Trends of increasing height, BW, and BMI were found among the Swedish elderly participants. This may be partly due to differences in smoking habits, physical activity, education, food habits, childhood nutrition, and living conditions between the cohorts.

Alexithymia in psychiatric consultation-liaison patients

Alexithymic characteristics were assessed by the Toronto Alexithymia Scale (TAS), a self-report measure of alexithymia, in 230 consecutive outpatients referred to a psychiatric consultation-liaison service. The prevalence of alexithymia was 37.8% (50.5% in men and 28.2% in women). Alexithymia was significantly associated with the following variables: male gender, low socioeconomic status, the presence of psychiatric disorder, especially depression, with old age and with a high level of psychological distress. No significant association between alexithymia and the presence of somatic illness was found.

Bereavement among elderly people: grief reactions, post-bereavement hallucinations and quality of life

Ratings of grief reactions, post-bereavement hallucinations and illusions and quality of life were made during the first year after the death of a spouse among 14 men and 36 women in their early seventies. In both sexes, the reactions were generally moderate or mild and characterized by loneliness, low mood, fatigue, anxiety and cognitive dysfunctioning. Feeling lonely was the most persistent problem during the year. Post-bereavement hallucinations or illusions were very frequent and considered helpful. Half of the subjects felt the presence of the deceased (illusions); about one third reported seeing, hearing and talking to the deceased (hallucinations). Former marital harmony was found to make a person more prone to loneliness, crying and hallucinations or illusions. The quality of life was significantly lower among the bereaved than among married people and those who never married, but equalled that found among divorcees.

The alexithymia construct. A potential paradigm for psychosomatic medicine

During the past decade, the alexithymia construct has undergone theoretical refinement and empirical testing and has evolved into a potential new paradigm for understanding the influence of emotions and personality on physical illness and health. Like the traditional psychosomatic medicine paradigm, the alexithymia construct links susceptibility to disease with prolonged states of emotional arousal. But whereas the traditional paradigm emphasizes intrapsychic conflicts that are presumed to generate such emotional states, the alexithymia construct focuses attention on deficits in the cognitive processing of emotions, which remain undifferentiated and poorly regulated. This paper reviews the development and validation of the construct and discusses its clinical implications for psychosomatic medicine.

Low power laser biostimulation of chronic oro-facial pain. A double-blind placebo controlled cross-over study in 40 patients

The efficacy of low power laser stimulation in the treatment of chronic oro-facial pain conditions was investigated in a double-blind placebo controlled modified cross-over study in 40 patients. The laser was an invisible infrared (IR) diode laser with an emission at 904 nanometer (nm). Treatment effect was evaluated by means of VAS-scales and global assessment of pain. Outcome of treatment was correlated to changes in urinary excretion of 5-hydroxyindoleacetic acid (5-HIAA). The clinical impression was that placebo was superior to laser stimulation. No statistically significant difference between the analgesic effect of the laser and placebo irradiation was found on VAS-scales. A significant (P = 0.05) increase in 5-HIAA excretion was found in the placebo group. It is concluded that the possibility of a substantial placebo response should be taken into consideration using 904 nm (IR) lasers for pain treatment in patients with this type of chronic oro-facial pain.

Pain in oral galvanism

The present study reports on a controlled investigation of 38 patients with signs and symptoms of presumed oral galvanism, referred to the Department of Oral and Maxillofacial Surgery of the University of Helsinki for examination and treatment. A significant difference in mental health and in intraoral sensitivity threshold was found between patients and controls: patients with oral galvanism were mentally more disturbed and had a lower sensibility threshold than those in the control group. There was no statistical difference in electrical currents, potential or energy capacity in the dental metallic restorations between patients and controls. The frequency of allergies and oral candida infection was similar to that of a normal population. The possibility of exposure to mercury was excluded through a head hair analysis. The psychic background of complaints and findings is emphasized and a hypothesis for the mechanism giving rise to discomfort is presented.

The nature and effectiveness of general hospital psychiatric services

Inpatient psychiatric episodes in general hospitals represented 58% of the total for the United States by the end of the 1970s. Given this growth, recent studies of the nature and effectiveness of general hospital psychiatric care are reviewed. Surprisingly, the data base continues to be largely descriptive rather than experimental. Evidence is particularly needed about the relative clinical and cost-effectiveness of general hospital treatment vis-a-vis that of other inpatient and community alternatives. Future research must also consider the effect of a general hospital's organizational characteristics upon the manner in which it structures and delivers psychiatric care.