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BACKGROUND: Individuals affected by empty nose syndrome secondary to turbinate-sparing techniques (ENS-type) experience decreased productivity and lifestyle disruption owing to considerable nasal-associated discomfort. This study aimed to evaluate the effect of psychosomatic intervention on ENS-type. METHODS: A prospective self-controlled study was conducted, and 28 patients suffering from ENS-type who met the diagnostic criteria for somatic symptom disorder (SSD) according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) received cognitive and behavioral therapy (CBT) plus antidepressants. Nasal symptom burden was evaluated using the 25-item Sino-Nasal Outcome Test (SNOT-25). Somatic symptom burden, anxiety severity, and depression severity were assessed by the 25-item Patient Health Questionnaire (PHQ-15), the 9-item PHQ (PHQ-9), and the 7-item Generalized Anxiety Disorder (GAD-7) scale, respectively. Patient assessments were completed prior to treatment and 3 and 12 months after the intervention. RESULTS: The total scores of the SNOT-25 declined posttreatment, showing a significant difference at the 3-month and 12-month follow-ups compared with the baseline scores (p < 0.001). The severity of the 5 most common subjective symptoms, including "nose is too open," "waking up at night," "lack of a good night's sleep," "difficulty falling asleep," and "reduced concentration," declined significantly at 3 and 12 months posttreatment compared to baseline levels. Statistically significant changes in the PHQ-15, PHQ-9, and GAD-7 scores were observed at 3 and 12 months posttreatment compared to baseline scores (p < 0.001). CONCLUSION: This study showed that some patients with ENS-type meeting the diagnostic criteria for SSD might benefit from psychiatric treatment.

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Chronic insomnia is a widespread and therapy resistant sleep disorder associated with multiple diseases and worsening of its course. Cognitive-behavior therapy of insomnia (CBT-I) is a pathogenetically based method of chronic insomnia treatment. 42 patients (male 14, female 28, age from 29 to 80) matched ICSD-3 criteria of chronic insomnia participated in the crossover study including 2-week courses of treatment by CBT-I and Zopiclone. All participants underwent polysomnography. Effectiveness of treatment was evaluated by questionnaires: Insomnia severity index (ISI), Pittsburgh sleep quality index, Beck depression inventory, Disfunctional beliefs about sleep, Sleep hygiene index. Treatment with CBT-I and zopiclone produced simular improvement of sleep quality with Insomnia severity index decreased to 3,6 (from 17,7±5,3 to 12,8±5,1) and 4,9 (from 16,5±5,8 to 12,9±6,2) respectively (р<0,05) while after two weeks of stopping treatment the significant difference remained only for CBT-I comparing with zopiclone treatment (12,9±6,2 and 15,5±4,6 points by ISI respectively) (p<0,05). The use of CBT-I leads to decrease of level of depression from 11,8±6,9 to 8,5±7, Sleep hygiene index decreases from 26,9±7,5 to 23,9±5,7 and disfunctional beliefs about sleep level drops from 104,9±29,7 to 84,4±34,2 (all these differences were significant at p<0,05). Analysis of the characteristics of responders and nonresponders has shown that the mean age of the first ones was younger comparing with nonresponders (40,5±12,9 and 57,2±11,7, p<0,05 respectively) that allows us to consider young age as predictor of CBT-I effectiveness. Treatment of chronic insomnia by CBT-I has simular efficacy as pharmacotherapy, but additionally it leads to the emprovement of emotional state and its therapeutistic effects after discontinuation lasts longer.

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OBJECTIVES: To examine the altered spontaneous brain activity in patients with social anxiety disorders (SAD) before and after cognitive behavior therapy (CBT),and determine the neuromechanism of formation,treatment and recovery of SAD. METHODS: Fifteen SAD patients were treated with an eight-week group CBT.The patients underwent functional magnetic resonance imaging (fMRI) at resting state before and after the treatments.Eighteen healthy controls (HC) were recruited and underwent a baseline fMRI scan.The regional homogeneity (ReHo) of the patients was compared with the healthy controls.Before the baseline scanning,all participants were assessed with the Liebowitz Social Anxiety Scale(LSAS),the Hamilton Anxiety Rating Scale (HAMA) and the Hamilton Depression Rating Scale (HAMD). RESULTS: All participants were right-handed.10 males and 4 females were in the patient group,with mean age of (27.07±8.11) years.13 males and 5 females were in the HC group,with mean age of (26.28±2.42) years.There was no difference for gender and age while significant differences were found in LSAS,HAMA,HAMD between patients and controls (P<0.01).After 8 weeks of group CBT,clinical assessments significantly decreased (P<0.05) in patients group.Compared with HC,the pre-treatment SAD patients showed significantly increased ReHo in right cerebellum lobe at baseline [(P<0.05,with Gaussian random field (GRF) correction]; but the difference became insignificant after the group CBT.The post-treatment patients showed increased ReHo in left putamen and right caudate compared with their pre-treatment conditions (P<0.05,with GRF correction).Pre-post ReHo change in right cerebellum posterior in patients was positively correlated with pre-post change of LSAS-fear scores (r=0.62,P=0.015). CONCLUSIONS: The activity of cerebellum might be one of the potential biomakers to modulate the treatment effect of CBT in SAD,which provides a basis for further investigation into the pathophysiology of SAD.

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Sensitization is defined as a non-associative learning process occurring when repeated administrations of a stimulus result in a progressive amplification of a response (Shettleworth, 2010). The purpose of this review paper is to discuss whether brain sensitization is helpful in common health problems in man. The paper reviews data on brain sensitization covering increased behavioral, physiological, cognitive, and emotional responses in man and animals. The paper concludes that brain sensitization may be a helpful concept to understand subjective and "unexplained" health complaints (nonspecific muscle pain, mood changes, fatigue, and gastrointestinal complaints), and, therefore, relevant for evidence based treatment and prevention of these common health problems.

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BACKGROUND: The prevalence, diagnostics and therapy of the burnout syndrome are increasingly discussed in the public. The unclear definition and diagnostics of the burnout syndrome are scientifically criticized. There are several therapies with unclear evidence for the treatment of burnout in existence. OBJECTIVES: The health technology assessment (HTA) report deals with the question of usage and efficacy of different burnout therapies. METHODS: For the years 2006 to 2011, a systematic literature research was done in 31 electronic databases (e.g. EMBASE, MEDLINE, PsycINFO). Important inclusion criteria are burnout, therapeutic intervention and treatment outcome. RESULTS: 17 studies meet the inclusion criteria and are regarded for the HTA report. The studies are very heterogeneous (sample size, type of intervention, measuring method, level of evidence). Due to their study design (e.g. four reviews, eight randomized controlled trials) the studies have a comparable high evidence: three times 1A, five times 1B, one time 2A, two times 2B and six times 4. 13 of the 17 studies are dealing with the efficacy of psychotherapy and psychosocial interventions for the reduction of burnout (partly in combination with other techniques). Cognitive behaviour therapy leads to the improvement of emotional exhaustion in the majority of the studies. The evidence is inconsistent for the efficacy of stress management and music therapy. Two studies regarding the efficacy of Qigong therapy do not deliver a distinct result. One study proves the efficacy of roots of Rhodiola rosea (evidence level 1B). Physical therapy is only in one study separately examined and does not show a better result than standard therapy. DISCUSSION: Despite the number of studies with high evidence the results for the efficacy of burnout therapies are preliminary and do have only limited reach. The authors of the studies complain about the low number of skilled studies for the therapy of burnout. Furthermore, they point to the insufficient evaluation of the therapy studies and the need for further research. Some authors report the effects of considerable natural recovering. Numerous limitations affect the quality of the results. Intervention contents and duration, study design and study size are very diverse and do not permit direct comparison. Most of the samples are small by size with low statistical power, long-term follow-ups are missing. Comorbidities and parallel utilized therapies are insufficient documented or controlled. Most of the studies use the Maslach Burnout Inventory (MBI) as diagnostic or outcome-tool, but with different cut-off-points. It should be noticed that the validity of the MBI as diagnostic tool is not proved. Ethical, juridical and social determining factors are not covered or discussed in the studies. CONCLUSION: The efficacy of therapies for the treatment of the burnout syndrome is insufficient investigated. Only for cognitive behavioural therapy (CBT) exists an adequate number of studies which prove its efficacy. Big long-term experimental studies are missing which compare the efficacy of the single therapies and evaluate their evidence. The natural recovering without any therapy needs further research. Additionally, it has to be examined to what extent therapies and their possible effects are thwarted by the conditions of the working place and the working conditions.

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OBJECTIVES: This study was investigated to prove the effectiveness of Cognitive Behavior Treatment Program in mentally ill sex offenders and to be used as basic data for development of optimized treatment program for mentally ill sex offenders. METHODS: Cognitive Behavior Treatment Program was carried out over 10 weeks for 30 mentally ill sex offenders. With Interpersonal Responsiveness Index (IRI), UCLA Loneliness Scale (UCLALS), Coping Using Sex Inventory (CUSI) and Rape Myth Acceptance Scale (RMAS), the effectiveness of the treatment programme was evaluated. The data was analyzed with paired t-test. RESULTS: The results with 23 subjects showed no significant score changes after treatment program in IRI and UCLALS. However, there was a statistically significant improvement in the scores of CUSI and RMAS. CONCLUSION: Despite several limitations, this study showed significant effects of Cognitive Behavior Treatment Program on mentally-ill sex offenders. Therefore, treatment focused on the changes of cognitive and emotional characteristics of sex offenders along with the treatment for main psychiatric illness should be provided for mentally ill sex offenders to prevent recidivism. More studies to develope optimized treatment programme for mentally ill sex offenders are needed in the future.

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