A Novel Psychopathological Model Explains the Pathogenesis of Gastric Ulcers
The first detailed description of the morphology of gastric ulcer was reported ~230 years ago, but the mechanism has yet to be elucidated. Moreover, peptic ulcers, including duodenal and gastric ulcers, are currently considered an infectious disease caused by Helicobacter pylori, but how the infection leads to ulceration remains elusive. To address these challenges, a recently published Complex Causal Relationship was applied to analyze the existing data. Peptic ulcers were identified as a psychosomatic disease triggered by psychological stress, where Helicobacter pylori plays a secondary role in only the late phase of the disease. This etiology explained all the characteristics and observations/phenomena of peptic ulcers in a series of 6 articles. This second article focused on the pathogenesis of gastric ulcers. Based on hereditary predisposition, the accumulation of past life experiences incurs the formation of a negative lifeview. Consequently, the individual tends to negatively evaluate themselves or current life events, leading to acute psychological stress. The psychological stress triggers the release of aberrant neurotransmitters in the central nervous system, which in turn cause the transmission of pathogenic nerve impulses to the stomach, resulting in a ‘pre-ulcer lesion’ in the gastric wall and eventually, gastric ulcer. This psychopathological model elucidated 12 characteristics and 24 observations/phenomena of gastric ulcer, along with the roles of gastric acid, Helicobacter pylori, and NSAIDs. The effectiveness suggests that theoretical research and empirical study are equally important in medical explorations, and the guiding roles of philosophy are indispensable for the major progress of life science and medicine.
DOI: 10.29245/2578-2959/2022/3.1259 View / Download PdfBody Composition Changes in Psychiatric Patients Treated with Lithium and Valproate
Purpose: To compare the effects of lithium and valproate on the body composition of psychiatric patients.
Methods: This prospective cohort study evaluated the effects of lithium and valproate on body composition. Twenty-eight patients with type I bipolar disorder aged 23-54 years who just had started monotherapy were recruited. Body weight, percent body fat (PBF), soft lean mass, body mass index (BMI), and total body water were measured at baseline, one month, and six months. Changes in the body composition parameters between patients taking lithium (n=14) versus valproate (n=14) were compared.
Findings: Overall mean age of study participants was 37.21 (±8) years, and 53.5% of patients were female. Average body weight gains in the first month were 1.3 kg and 2.2 kg for the lithium and valproate groups, respectively (p-value = 0.042). Mean body weight gain in the six months compared to the baseline was only 0.6 kg for the lithium group, while it was 4.3 kg for the valproate group (p-value < 0.001). The average increase in PBF at six months among patients treated with lithium versus valproate was 0.07% versus 2.2% respectively (p-value = 0.018). Patients treated with lithium had a smaller increase in their BMI in the sixth month of the study compared to the valproate group, with a mean change of 0.2 versus 2.3 kg/m2, respectively (p-value = 0.019).
Conclusions: Our findings suggest that in patients with type I bipolar disorder, valproate leads to greater weight gain, BMI, and increase in PBF compared to lithium.
DOI: 10.29245/2578-2959/2022/3.1255 View / Download PdfThe Hyperplasia and Hypertrophy of Gastrin and Parietal Cells Induced by Chronic Stress Explain the Pathogenesis of Duodenal Ulcers
Peptic ulcers, including duodenal and gastric ulcers, are currently studied as an infectious disease caused by Helicobacter pylori. However, this etiology cannot elucidate the major characteristics and observations/phenomena of the disease, as well as the roles of gastric acid and NSAIDs. Additionally, many patients with severe ulcer symptoms have no infection, suggesting bacterial eradication cannot prevent relapses in all ulcer patients. To address these challenges, a recently published Complex Causal Relationship with its accompanying methodologies was applied to analyze the existing data. Peptic ulcers were identified as a psychosomatic disease triggered by psychological stress, where Helicobacter pylori plays a secondary role in only the late phase of ulceration. An integration of five major etiological theories in history illustrated the entire pathogenesis of peptic ulcers, which addressed all the characteristics, observations/phenomena, controversies, and mysteries of the disease in a series of 6 articles. This first article focuses on the pathogenesis of duodenal ulcers. The hyperplasia and hypertrophy of gastrin and parietal cells induced by chronic stress potentiate the individual’s response to immediate stress, resulting in the hypersecretion of gastric acid and eventually, duodenal ulceration. This psychopathological mechanism resolved all the controversies associated with Helicobacter pylori and explicitly elucidated 7 characteristics of duodenal ulcers, as well as 42 observations/phenomena. The roles of gastric acid, Helicobacter pylori, and NSAIDs in duodenal ulcers were also identified. The effectiveness validated the etiology of duodenal ulcers identified by the Complex Causal Relationship, indicating stress management is essential for a complete cure of the disease without relapse.
DOI: 10.29245/2578-2959/2022/3.1257 View / Download PdfPsychological Impact of Vision Loss
A diagnosis of conditions leading to vision loss can be devastating and often impacts mental health. Understanding this allows us to consider what provisions might help those who are impacted. We undertook 18 semi-structured interviews with patients diagnosed with eye disease leading to vision loss to explore its psychological impact. Participants also completed the Beck Depression Inventory (BDI), providing a snapshot of their depression and anxiety levels at the time of interview. NVivo-12 software (QSR International Ltd, Burlington, Massachusetts, USA) was used to inductively analyse and code data to identify themes related to the psychological impact. Participants had a mean BDI score of 9.6, and thematic analysis generated five key themes and associated subthemes. Coming to terms with the diagnosis included discussion of subthemes of “denial” and moving towards “acceptance”. Effects on mental health included depression/low mood, anxiety, and stress-related worsening of vision. Loss included various losses following initial loss of vision. Effects on identity included facing a curtailed life, worry that visual impairment might define a person’s identity, and feelings of frustration with their own loss of function and with others’ reactions to their disability. The future included thoughts about long-term consequences, both negative and positive (e.g., maximizing experiences given the vision one has left). Although such a diagnosis will nearly always have a psychological impact and require work to move toward acceptance, support could mitigate impact on mental health, such as practical support (e.g., advice on low vision aids), and psychological support.
DOI: 10.29245/2578-2959/2021/3.1256 View / Download PdfPainting a Complete Picture of the Pathogenesis of Peptic Ulcers
Peptic ulcers, including duodenal and gastric ulcers, were currently considered an infectious disease caused by Helicobacter pylori. However, this etiology cannot explain the major characteristics and observations/phenomena of the disease. To address the challenge, a Complex Causal Relationship with its accompanying methodologies was applied to analyze the existing data. Peptic ulcers were identified as a psychosomatic disease triggered by psychological stress, whereas Helicobacter pylori plays a secondary role in the late phase of peptic ulceration. This etiology addresses all the characteristics, observations/phenomena, controversies, and mysteries of peptic ulcers in a series of 6 articles. This third article discusses the etiology in-depth, painting a complete picture of the pathogenesis of peptic ulcers. The early phase is a long-term abstract psychopathological process, starting from early life when the impacts of multiple psychosomatic factors are transformed into hyperplasia and hypertrophy of gastrin and parietal cells and/or negative life-views via superposition mechanism. These pre-existing abnormalities potentiate the individual’s response to current psychological stress in the intermediate phase, resulting in hypersecretion of gastric acid and/or pre-ulcer lesions. The late phase is a corrosion process caused by gastric acid, Helicobacter pylori, and/or NSAIDs, resulting in duodenal and/or gastric ulcers. This complete picture highlights the importance of past life experience in peptic ulcers and visualizes the non-causal roles of gastric acid, Helicobacter pylori, and NSAIDs. Significantly, the holistic view provided by the complete picture suggests that life phenomena and diseases are highly complex, and an advanced way of thinking is indispensable for life science and medical studies.
DOI: 10.29245/2578-2959/2022/3.1261 View / Download Pdf