<h4>Background</h4>Patients with bipolar spectrum disorders (BSD) frequently report medically unexplained somatic symptoms. However, the prevalence and the consequences for treatment and outcome are currently unknown.<h4>Methods</h4>To estimate the prevalence of somatic symptoms in BSD, we conducted a systematic review and meta-analysis of empirical studies published between 1980 and 2015. The odds for somatic symptoms in BSD were compared with unipolar depression (UPD) and general population or mixed psychiatric controls. Studies were retrieved from four electronic databases utilizing Boolean operations and reference list searches. Pooled data estimates were derived using random-effects methods.<h4>Results</h4>Out of 2634 studies, 23 were eligible for inclusion, yielding an N of 106,785 patients. The estimated prevalence of somatic symptoms in BSD was 47.8%. The estimated prevalence of BSD in persons with somatic symptoms was 1.4%. Persons with BSD had a higher prevalence of somatic symptoms compared with population or mixed psychiatric controls (OR 1.82, 95% CI 1.14-2.92). Persons with BSD had a similar prevalence of somatic symptoms compared with UPD controls (OR 0.99, 95% CI 0.68-1.44).<h4>Limitations</h4>This study is correlational; thus causal inferences cannot be made. Reporting of somatic symptoms likely varies with BSD severity and subtype. Some studies reported insufficient information regarding comorbid medical conditions and medications.<h4>Conclusions</h4>Persons with BSD suffer from somatic symptoms at a rate nearly double that of the general population, a rate similar to persons with UPD. Our results suggest the utility of an integrated care model in which primary care and specialist physicians collaborate with mental health professionals to jointly address psychological and bodily symptoms.

Autoerythrocyte sensitization syndrome is a psychologically induced painful bruising condition. Two female, 19 and 30-year-old presented with recurrent episodes of painful ecchymotic bruising over accessible areas of body. In the younger female, episodes were since 3 years and were precipitated by stress and trivial trauma. The elder female presented with similar lesions since 3 months which were spontaneous in presentation. There were no obvious psychiatric manifestations in either. Clinically, ecchymotic changes in various stages of development were seen. Routine hemogram and coagulation profile were normal. Histopathology showed extravasated erythrocytes, perivascular neutrophils and fibrinoid deposition. Intradermal injection of autologous whole blood produced a painful ecchymotic reaction after 2 h similar to the presenting lesions. Psychiatric evaluation revealed mild mixed depression - anxiety disorder in the younger female while the latter revealed no abnormalities. The diagnosis of autoerythrocyte sensitization syndrome was made based on clinical history and findings, positive autoerythrocyte sensitization test, psychiatric evaluation and absence of any other clinical or laboratory pathology. E-mail: drtainwala@gmail.com Oct-Dec 2013 4 4 305 305–308 16 12 2013 Copyright: © Indian Dermatology Online Journal This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Autoerythrocyte sensitization syndrome is a psychologically induced painful bruising condition. Two female, 19 and 30-year-old presented with recurrent episodes of painful ecchymotic bruising over accessible areas of body. In the younger female, episodes were since 3 years and were precipitated by stress and trivial trauma. The elder female presented with similar lesions since 3 months which were spontaneous in presentation. There were no obvious psychiatric manifestations in either. Clinically, ecchymotic changes in various stages of development were seen. Routine hemogram and coagulation profile were normal. Histopathology showed extravasated erythrocytes, perivascular neutrophils and fibrinoid deposition. Intradermal injection of autologous whole blood produced a painful ecchymotic reaction after 2 h similar to the presenting lesions. Keywords: Autoerythrocyte sensitization syndrome, anxiety-depression disorder gardner–diamond syndrome, intradermal test status released display-pdf yes is-olf no is-manuscript no is-preprint no is-journal-matter no is-scanned no is-retracted no INTRODUCTION Autoerythrocyte sensitization syndrome (AES) is an autoimmune vasculopathy with sensitization to phosphatidylserine, a component of erythrocyte stroma. AES usually develops after psychological stress and is characterized by induced or spontaneous development of single or multiple painful inflammatory skin lesions progressing to ecchymoses. We describe two rare cases presenting in females one of them being associated with an underlying psychiatric illness. CASE REPORTS Case 1 A 19-year-old female presented with recurrent painful bruises over her extremities since 10 days, the first episode being at age of 16 years. Some episodes followed trivial trauma. She experienced a burning sensation at the injured site few minutes after trivial trauma, with subsequent redness and an appearance of painful bruise lasting for several days. She gave no history of bleeding tendencies or any underlying psychiatric illnesses. Cutaneous examination revealed residual ecchymotic irregular patches, 2 cm × 3 cm on the right arm and the legs, non-tender on palpation [ Figure 1 ]. Rest of mucocutaneous, general and systemic examination was normal. Complete hemogram, platelet count, complete coagulation profile and antinuclear antibodies done to rule out other causes of purpuras were within normal limits. Radiological investigations were normal. Intradermal injection of 0.1 ml of autologous blood on flexure aspect of left forearm caused an immediate burning sensation at the injection site followed 2 h later by development of an oval, 2 cm, sharply defined erythematous macule [ Figure 2 ]. Agle and Ratnoff noted marked emotional liability in the patients coinciding with psychic stress. The exact mechanism how stress influences physiological process and changes immune reactivity so that the organism react with formation of erythrocyte antibody is not clear. The development of disease usually is preceded by slight mechanical injuries, stress, surgical procedures and hard physical work, though they can develop spontaneously as well. There may be a prodrome stage consisting of malaise, fatigue etc., Lesions develop stereotypically with initial burning or stinging sensation, followed 4-5 h later by development of painful edematous indurated and erythematous plaques of 3-10 cm. The onset of new lesions is most probable after physical trauma or stress. Treatment of GDS is still problematic ( dermatosis sine therapia ) as no method of treatment is sufficiently effective in this disease. Glucocorticoids, cytostatic drugs, hormonal contraceptives, antibiotics, quinolones are not effective; their effect is similar to placebo.[ 17 ] Though there is no satisfactory treatment of GDS, plasmapheresis, Positive intracutaneous test is a very useful tool to support the diagnosis.[ 20 ] Positive psychic disorders and dependence of lesions development from stress along with absence of hematological disorders and specific changes by histological examination will help to make the correct diagnosis. This condition should be kept as a differential diagnosis of recurrent painful purpura. Timely and correct diagnosis helps to avoid exhaustive investigations and aggressive treatment. Footnotes Source of Support: Nil Conflict of Interest: None declared. REFERENCES

Abstract Background Bipolar disorder (BD) with somatic symptoms is prevalent in adolescent patients. Interoception has an important impact on physical and emotional regulation. However, it is unclear the characteristics of interoception and its relationship to somatization and emotional symptoms in adolescents with BD. Methods This study recruited 71 adolescent BD subjects during rehabilitation and 111 age-matched controls. Demographic characteristics, interoception, somatization, depression, and anxiety symptoms were assessed. Mann-Whitney U tests, partial correlation analysis, and multiple linear regression were used to explore the alteration of interoception in BD patients and its association with clinical symptoms. Results After adjusting for differential demographic variables, adolescent BD patients scored lower on several dimensions of interoception and higher on somatization and emotional symptoms than controls. Moreover, there were significant differences on the interoceptive dimensions of not-distracting, not-worrying, and trusting between BD patient groups with and without somatization. Correlational analysis revealed that the interoceptive indicators of BD patients were significantly correlated with emotional and somatic symptoms. The dimension of not-distracting was the only interoceptive predictor of somatization symptoms and emotional problems in adolescents with BD, maintaining its predictive stability even after controlling for emotional symptoms. This indicates that the capacity for focused attention is a key interoceptive element affecting the expression of somatic and emotional issues in BD adolescent patients. Conclusion Adolescents with BD exhibit deficits in interoception, somatization and emotional issues. The not-distracting aspect of interoception significantly correlates with emotional and somatic symptoms in adolescents with BD, offering insights and targeted strategies for managing psychosomatic symptoms in this demographic. Page 1/13 Not-distracting in body sensations: interoceptive focus andsomatic symptom in adolescent bipolar disorder patients Jialin Lv Shandong Second Medical University Juan Li Chinese Academy of Sciences Hang Xu Chinese Academy of Sciences Lin Sun Shandong Second Medical University Guohui Zhu Weifang Mental Health Center Weiwen Wang Chinese Academy of Sciences Research Article Keywords: Bipolar disorder, Adolescent, Interoception, Somatization, Depression, Anxiety Posted Date: October 24th, 2024 DOI: https://doi.org/10.21203/rs.3.rs-5297700/v1 License:   This work is licensed under a Creative Commons Attribution 4.0 International License. The not-distracting aspect of interoception signicantly correlates with emotional and somatic symptoms in adolescents with BD, offering insights and targeted strategies for managing psychosomatic symptoms in this demographic. 1 Introduction Bipolar disorder (BD) is a high-recurrence chronic mental illness characterized by alternating episodes of mania and depression (1). Patients with BD are found across all age groups, but the early symptoms of BD usually appear during adolescence (age during 10–24 years old), with the highest incidence occurring between the ages of 15 and 19 years old (2). More obvious somatic issue in adolescent patients may attribute to the rapid psychological, physiological, and neurological development at this stage. Adolescent patients frequently complain of physical pain, such as stomachaches and headaches, or exhibit eating disorders, either overeating or undereating (11). These indicates the necessity of illustrating the pathological mechanisms of physical and emotional disturbance in adolescent BD patients. Interoception refers to the individual's perception of their own internal physiological states and emotional sensations(12). For example, it was found that somatic symptoms of depression (such as sleep and eating disturbances) are signicantly linked to interoception (16). A study on chronic pain and interoception found that patients with chronic pain exhibit lower interoceptive accuracy and higher interoceptive sensitivity (17). Existing research has found that abnormalities in interoception vary across different psychiatric conditions. For instance, individuals with depression exhibit impaired interoceptive accuracy (18), while patients with severe anxiety symptoms report more bodily sensations, showing heightened interoceptive sensitivity (19, 20). In schizophrenia, the manifestation of interoception is more complex; some studies have found that individuals with schizophrenia have lower interoceptive accuracy compared to healthy populations (21). Other research has reported that patients with psychosis score higher on average than healthy controls in assessments of interoceptive awareness across four dimensions: attention, emotion awareness, self-regulation, and body listening. This is considered an abnormal manifestation of excessive coupling between internal and external interoception (22). Not- Page 10/13 worry refers to the tendency not to worry or experience emotional distress associated with pain or discomfort. Patients who worry less about their bodily troubles feel more reassured and report milder symptom severity. Self-regulation refers to the ability to regulate psychological distress by attention to body sensations. Individuals with weaker this skills may be more prone to experiencing somatic symptoms, as well as anxiety and depression. Trust pertains to the feeling that one's body is safe and trustworthy. The higher the subjective trust in their perceived bodily condition, the lower the severity of symptoms they report (29). Therefore, clinical strategies should concentrate on improving attentional and cognitive exibility to alleviate the preoccupation with bodily sensations. This study has three main limitations: Firstly, the reliance on self-report scales to measure interoception could introduce subjective bias. Secondly, the limited sample

matic symptoms Psoriasis and psoriatic arthritis Atopic dermatitis (atopic eczema) Pruritus Nodular prurigo Vulvodynia Male genital dysaesthesia Burning mouth syndrome Urticaria and angioedema? Open in a new tab 3. DEFINITION OF SOMATIC DISORDERS Somatization is the phenomenon of experiencing bodily symptoms, most commonly pain and itch, in the absence of a biological cause. 1 , 2 , 12 Somatization may occur with or without the existence of a dermatological disease. 1 , 2 , 12 Somatic symptoms can be solely focussed on the skin, with pruritus or discomfort being the most prevalent, 3 or with other symptoms including headache, back pain, exhaustion, gastrointestinal symptoms, chest pain, shortness of breath and paresthesiae. 12 There is often a preoccupation with abnormal thoughts, feelings and behaviours. 12 , 13 This leads to significant stress and for the affected individual. 12 , 13 Disorders presenting with cutaneous somatic symptoms (Table  1 ), or with somatic overlay in established immunodermatoses (Table  2 ), frequently present in both primary and secondary care. 2 , 14 Somatic symptom disorders and somatic symptoms and related disorders have been newly categorized in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM‐5) within the last 10 years (Table  3 ). 13 TABLE 3. Somatization—diagnostic criteria Diagnostic Criterion One or more somatic symptoms that are distressing or result in significant disruption of daily life. Excessive thoughts, feelings, or behaviours related to the somatic symptoms or associated health concerns as manifested by at least one of the following: Disproportionate and persistent thoughts about the seriousness of one's symptoms. Persistently high level of anxiety about health or symptoms. Excessive time and energy devoted to these symptoms or health concerns. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months). Specif