No abstract

An exploration was undertaken of the psychological characteristics of 19 patients with psychogenic voice disorders who failed to respond to standard methods of speech therapy. Excessive anxiety, musculoskeletal tension and difficulties in expressing feelings or being assertive were common, usually associated with unsatisfactory interpersonal relationships, especially with members of the family. Fifteen were offered psychological therapy, 14 being offered joint therapy with a speech therapist and a psychologist employing a cognitive‐behavioural approach. Of the 12 who participated in the co‐therapy programme, six improved both in their voice and psychosocial adjustment.

A survey of speech therapists in the United Kingdom showed that they usually undertook the treatment of psychogenic voice disorders. Their pre-qualification education had provided advice that was usually reflected accurately in the experience they gained in practice, though during their education about a third had lacked any opportunity to treat or observe psychogenic voice disorders. The appropriate duration of treatment appears to be in doubt. At present, speech therapists acquire many of the psychological skills required for treatment after qualification.There is a substantial need for post-qualification courses, although more practical instruction on psychological treatment might advantageously be incorporated in initial education.

BackgroundFascin is associated with increased cell motility in colorectal tumours but is absent from the normal colonic epithelium. We examined the expression of fascin in inflammatory bowel disease (IBD) and its location at regions undergoing restitution and regeneration. Tissue repair is essential for disease remission and we sought to determine the effects of therapeutic modalities on fascin expression and function using an in vitro model.MethodsImmunohistochemistry was performed on colonic tissue from IBD patients to determine changes in fascin expression and distribution. A human colorectal epithelial cell line was treated with 5-aminosalicylate (a common treatment for IBD), or sodium butyrate to determine the effect on fascin expression and cell motility.ResultsFascin overexpression was observed in both ulcerative colitis and Crohn's colitis and expression correlated with disease severity. Immunoreactivity was more intense and widespread in Crohn's compared to ulcerative colitis. Interestingly, highly expressing foci were consistently observed at the edges of ulcers where flattened, motile epithelial cells are actively involved in restitution, and also in areas of mucosal regeneration.5-aminosalicylate reduced fascin expression in colorectal epithelial cells and inhibited their motility. Conversely, sodium butyrate increased fascin expression and stimulated cell motility in the same cells.ConclusionsOur data shows that fascin is overexpressed in inflammatory bowel disease and its location is indicative of a role in tissue repair. Our in vitro studies show that different therapeutic modalities may have converse effects on fascin expression and may have significant consequences for disease remission and the clinical management of IBD.