Introducing the DizzyQuest: an app-based diary for vestibular disorders

Background

Most questionnaires currently used for assessing symptomatology of vestibular disorders are retrospective, inducing recall bias and lowering ecological validity. An app-based diary, administered multiple times in daily life, could increase the accuracy and ecological validity of symptom measurement. The objective of this study was to introduce a new experience sampling method (ESM) based vestibular diary app (DizzyQuest), evaluate response rates, and to provide examples of DizzyQuest outcome measures which can be used in future research.

Methods

Sixty-three patients diagnosed with a vestibular disorder were included. The DizzyQuest consisted of four questionnaires. The morning- and evening-questionnaires were administered once each day, the within-day-questionnaire 10 times a day using a semi-random time schedule, and the attack questionnaire could be completed after the occurrence of a vertigo or dizziness attack. Data were collected for 4 weeks. Response rates and loss-to-follow-up were determined. Reported symptoms in the within-day-questionnaire were compared within and between patients and subgroups of patients with different vestibular disorders.

Results

Fifty-one patients completed the study period. Average response rates were significantly higher than the desired response rate of > 50% (p < 0.001). The attack-questionnaire was used 159 times. A variety of neuro-otological symptoms and different disease profiles were demonstrated between patients and subgroups of patients with different vestibular disorders.

Conclusion

The DizzyQuest is able to capture vestibular symptoms within their psychosocial context in daily life, with little recall bias and high ecological validity. The DizzyQuest reached the desired response rates and showed different disease profiles between subgroups of patients with different vestibular disorders. This is the first time ESM was used to assess daily symptoms and quality of life in vestibular disorders, showing that it might be a useful tool in this population.

Electronic supplementary material

The online version of this article (10.1007/s00415-020-10092-2) contains supplementary material, which is available to authorized users.

Cortical processes of speech illusions in the general population

BACKGROUND

There is evidence that experimentally elicited auditory illusions in the general population index risk for psychotic symptoms. As little is known about underlying cortical mechanisms of auditory illusions, an experiment was conducted to analyze processing of auditory illusions in a general population sample. In a follow-up design with two measurement moments (baseline and 6 months), participants (n = 83) underwent the White Noise task under simultaneous recording with a 14-lead EEG. An auditory illusion was defined as hearing any speech in a sound fragment containing white noise.

RESULTS

A total number of 256 speech illusions (SI) were observed over the two measurements, with a high degree of stability of SI over time. There were 7 main effects of speech illusion on the EEG alpha band-the most significant indicating a decrease in activity at T3 (t = -4.05). Other EEG frequency bands (slow beta, fast beta, gamma, delta, theta) showed no significant associations with SI.

CONCLUSION

SIs are characterized by reduced alpha activity in non-clinical populations. Given the association of SIs with psychosis, follow-up research is required to examine the possibility of reduced alpha activity mediating SIs in high risk and symptomatic populations.

The Experience Sampling Method--a new digital tool for momentary symptom assessment in IBS: an exploratory study

BACKGROUND

Retrospective questionnaires are frequently used for symptom assessment in irritable bowel syndrome (IBS) patients, but are influenced by recall bias and circumstantial and psychological factors. These limitations may be overcome by random, repeated, momentary assessment during the day, using electronic Experience Sampling Methodology (ESM). Therefore, we compared symptom assessment by ESM to retrospective paper questionnaires in IBS patients.

METHODS

Twenty-six IBS patients (Rome III) were included, of which 16 were diagnosed with panic disorder (DSM-IV-TR). Patients scored symptoms using end-of-day diaries during 14 days and the gastrointestinal symptom rating scale (GSRS) once. ESM was used on seven consecutive days during the same time period.

KEY RESULTS

End-of-day diary abdominal pain scores were 0.4 (SE 0.1, p < 0.001) point higher (on a 1-to-5-point scale) compared to corresponding ESM mean-scores in IBS patients. The difference was even more pronounced for upper abdominal pain scores assessed by the GSRS (4.77 ± 1.50) compared to ESM mean-scores (2.44 ± 1.30, p < 0.001), both on 1-to-7-point scale. For flatulence, comparable results were found. Nausea and belching scores showed small, but significant differences between end-of-day diary and ESM. All tested symptoms were scored higher on GSRS compared to ESM mean-scores (p < 0.01). Affective comorbidity did not influence differences in pain reporting between methods.

CONCLUSIONS & INFERENCES

IBS patients report higher scores for abdominal pain in retrospective questionnaires compared to ESM, with a tendency to report peak rather than average pain scores. ESM can provide more insight in symptom course and potential triggers, and may lead to a better understanding of IBS symptomatology.

The association between motor subtypes and psychopathology in Parkinson's disease

BACKGROUND

In Parkinson's disease (PD) it has been suggested that various motor subtypes are also characterized by a different prevalence and severity of specific non-motor symptoms such as cognitive deterioration, depression, apathy and hallucinations. The aim of this study was to investigate the association between motor subtypes and psychopathology in PD.

METHODS

An exploratory and confirmatory cluster analysis of motor and psychopathological symptoms was performed with a randomized sample of 173 patients each, stemming from two research databases: one from Stavanger University Hospital and one from Maastricht University Hospital. These databases contained data of standardized assessments of patients with the Unified Parkinson's Disease Rating Scale, the Montgomery-Asberg Depression Rating Scale, and the Mini-Mental State Examination.

RESULTS

PD patients can be accurately and reliably classified into four different subtypes: rapid disease progression subtype, young-onset subtype, non-tremor-dominant subtype with psychopathology and a tremor-dominant subtype. Cognitive deterioration, depressive and apathetic symptoms, and hallucinations all cluster within the non-tremor-dominant motor subtype, that is characterized by hypokinesia, rigidity, postural instability and gait disorder.

CONCLUSIONS

This study shows that non-tremor-dominant PD is associated with cognitive deterioration, depression, apathy, and hallucinations, which has implications for future research into the pathophysiology of psychopathology in PD.

Altered omega-3 polyunsaturated fatty acid status in depressed post-myocardial infarction patients

OBJECTIVE

Lower levels of long-chain omega-3 polyunsaturated fatty acids (n-3 LCPUFAs) and increased inflammation have been associated with both depressive disorder and myocardial infarction (MI). The present study investigated whether patients who develop depression post-MI, have higher arachidonic acid/eicosapentanoic acid (AA/EPA) ratios than non-depressed post-MI patients and whether depressed post-MI patients have signs of increased inflammation as measured by C-reactive protein (CRP).

METHOD

Serum AA/EPA ratio and plasma CRP levels were quantified in 50 post-MI patients, of which 29 were depressed and 21 non-depressed.

RESULTS

Compared with the non-depressed group, depressed post-MI patients had significantly higher AA/EPA ratios. No significant difference was observed in CRP levels.

CONCLUSION

Depressed post-MI patients had lower levels of n-3 LCPUFAs as measured by mean AA/EPA ratio and no signs of increased inflammation as determined by CRP levels.

Focal or generalized vascular brain damage and vulnerability to depression after stroke: a 1-year prospective follow-up study

BACKGROUND

Both the lesion location hypothesis and the vascular depression hypothesis have been proposed to explain the high incidence of depression in stroke patients. However, research studying both hypotheses in a single cohort is, at present, scarce.

OBJECTIVE

To test the independent effects of lesion location (left hemisphere, anterior region) and of co-occurring generalized vascular damage on the development of depression in the first year after ischemic stroke, while other risk factors for depression are controlled for.

METHODS

One hundred and ninety consecutive patients with a first-ever, supratentorial infarct were followed up for one year. CT was performed in the acute phase of stroke, while in 75 patients an additional MRI scan was also available. Depression was assessed at 1, 3, 6, 9, and 12 months after stroke using self-rating scales as screening tools and the SCID-I to diagnose depression according to DSM-IV criteria.

RESULTS

Separate analyses of the lesion location hypothesis and the vascular depression hypothesis failed to reveal significant support for either of these biological models of post-stroke depression. Similar negative results appeared from one overall, multivariate analysis including variables of both focal and generalized vascular brain damage, as well as other non-cerebral risk factors. In addition, level of handicap and neuroticism were independent predictors of depression in this cohort, as has been reported previously.

CONCLUSION

This study supports neither the lesion location nor the vascular depression hypothesis of post-stroke depression. A biopsychosocial model including both premorbid (prior to stroke) vulnerability factors, such as neuroticism and (family) history of depression, as well as post-stroke stressors, such as level of handicap, may be more appropriate and deserves further study.

Cognitive performance after first ever stroke related to progression of vascular brain damage: a 2 year follow up CT scan study

BACKGROUND

Stroke is one of the most common causes of cognitive impairment in the elderly. Ischaemic brain damage (white matter lesions and silent infarcts) progresses in a substantial number of stroke patients. The aim of this study was to investigate whether the progression of ischaemic brain damage is associated with cognitive functioning after first ever stroke.

METHODS

A total of 101 stroke patients were followed up for 2 years. Neuropsychological functioning was assessed at 1, 6, 12, and 24 months after stroke. Computed tomography was performed on all patients at baseline and 2 years after stroke. Progression in white matter lesions and (silent) infarcts was recorded.

RESULTS

Patients with progressive vascular brain damage performed worse on cognitive tasks, both 1 and 24 months after stroke, yet change in cognitive functioning was not different from that of patients without progressive vascular damage. During the follow up, improvement was noticed on most cognitive domains.

CONCLUSIONS

Although patients with progressive vascular brain damage after a first stroke performed somewhat worse on cognitive tests than those without such damage, both groups showed an improved or stable performance 2 years later. Thus, there is not a simple relation between progression of ischaemic brain damage and decline in cognitive functioning after first ever stroke.

Predictive accuracy of MCI subtypes for Alzheimer's disease and vascular dementia in subjects with mild cognitive impairment: a 2-year follow-up study

AIM

The aim of this study was to investigate the prognostic accuracy of different subtypes of mild cognitive impairment (MCI): amnestic MCI, multiple domain MCI, and single non-memory domain MCI, for the development of Alzheimer's dementia (AD) and vascular dementia (VaD).

PATIENTS

Nondemented patients from a memory clinic cohort (n = 118), and a stroke cohort (n = 80, older than 55 years and with a cognitive impairment).

RESULTS

'Multiple domain MCI' had the highest sensitivity for both AD (80.8%) and VaD (100%), and 'amnestic MCI' had the highest specificity (85.9% for AD, 100% for VaD). The positive predictive value was low for all subtypes (0.0-32.7%), whereas the negative predictive value was high (72.8-100%).

DISCUSSION

The subtype 'multiple domain MCI' has high sensitivity in identifying people at risk for developing AD or VaD. The predictive accuracy of the MCI subtypes was similar for both AD and VaD.

Demographic and CT scan features related to cognitive impairment in the first year after stroke

OBJECTIVE

Little is known about the relation between stroke related features and cognitive performance over time when stroke patients with dementia or less severe cognitive disorders are considered separately. We aimed to study the features (computed tomography (CT) scan and demographic) that could be related to vascular cognitive impairment one, six, and 12 months after stroke.

METHODS

A total of 176 patients with a first-ever brain infarct, a Mini Mental State Examination score > or = 15, age older than 40 years, and without pre-stroke dementia and other neurological or psychiatric disorders participated in this study. The following CT scan features were recorded: side of infarct, lacunar or territorial infarct, white matter lesions, silent infarcts, and brain atrophy. The demographic features studied were: age, level of education, and sex. Univariate and multivariate logistic regression analyses were performed to compare the three groups of patients (patients with dementia, patients with vascular cognitive impairment (VCI), and patients with vascular mild cognitive impairment (MCI)) with patients without cognitive disorders.

RESULTS

At one month none of the variables were predictors of dementia; at six months older age (odds ratio (OR) 9.4), low education (OR 14.7), and territorial infarct (OR 10.6) predicted dementia; and at 12 months low education (OR 8.7) and pre-stroke cerebrovascular damage (OR 7.4) predicted dementia. Predictors of VCI were low education (OR 3.4) and territorial infarct (OR 2.4) at one month post stroke; older age (OR 4.3) and low education (OR 4.1) at six months; and older age (OR 3.5) at 12 months. Predictors of vascular MCI were low education (OR 4.96) and territorial infarct (OR 3.58) at one month; and older age and lower education at six months (OR 3.4 and 3.7, respectively) and at 12 months (OR 3.5 and 2.28, respectively).

CONCLUSIONS

Territorial infarct, older age, and low educational level are predictors of cognitive disorders after stroke.

Cardiological risk factors for depressive symptoms after a first myocardial infarction

OBJECTIVE

To detect possible cardiological risk factors in the acute phase of MI for developing depressive symptoms after first MI.

DESIGN

Retrospective analysis of cardiac and psychiatric data of 111 consecutive patients admitted with a first MI.

METHODS

During one year, all consecutive patients with a first MI, less than 12 hours chest pain and a maximal aspartate aminotransferase (ASAT) value of at least 80 U/l, admitted to the University Hospital of Maastricht, were screened for the presence of depressive symptoms using the 90-item 'Symptom checklist' (SCL-90) questionnaire at one month post-MI. Inclusion criteria were fulfilled by 111 patients; 28 patients refused to participate in the study.

RESULTS

No correlation was found between LVEF, peak ASAT, peak CK value and characteristics, location or mode of treatment of the MI and depressive symptoms post-MI. A statistically significant negative correlation was found between SCL-90 depression score and cardiac tissue loss as defined by cumulative ASAT release at 24, 48 and 72 hours after the acute event (p values 0.029, 0.028 and <0.009, respectively) at the one month post-MI screening.

CONCLUSIONS

No cardiological parameters were correlated to depressive symptoms post-MI. If there was a connection at all, this appeared to be a negative correlation between infarct size as measured by ASAT release and the occurrence of depressive symptoms at one month post-MI.

A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction

BACKGROUND

The high incidence of post-stroke depression has been claimed to reflect a specific, stroke related pathogenesis in which lesion location plays an important role. To substantiate this claim, post-stroke depression should occur more often than depression after another acute, life threatening, disabling disease that does not involve cerebrovascular damage.

OBJECTIVES

To compare the cumulative one year incidence of depression after stroke and after myocardial infarction, taking into consideration differences in age, sex, and the level of handicap.

METHODS

In a longitudinal design, 190 first ever stroke patients and 200 first ever myocardial infarction patients were followed up for one year. Depression self rating scales were used as a screening instrument to detect patients with depressive symptoms. Major and minor depression was assessed at one, three, six, nine, and 12 months after stroke or myocardial infarction according to DSM-IV criteria, using the structured clinical interview from DSM-IV. The severity of depressive symptoms was measured with the Hamilton depression rating scale. Level of disability and handicap was rated with the Rankin handicap scale.

RESULTS

The cumulative one year incidence of major and minor depression was 37.8% in stroke patients and 25% in patients with myocardial infarction (hazard ratio 1.6; p = 0.06). This difference disappeared after controlling for sex, age, and level of handicap. In addition, no differences were found in the severity of depressive symptoms or in the time of onset of the depressive episode after stroke or myocardial infarction.

CONCLUSIONS

Depression occurs equally often during the first year after stroke and after myocardial infarction when non-specific factors such as sex, age, and level of handicap are taken into account. Thus the relatively high incidence of post-stroke depression seems not to reflect a specific pathogenic mechanism. Further research is needed to investigate whether vascular factors play a common role in the development of depression after stroke and myocardial infarction.

The contribution of somatic symptoms to the diagnosis of depressive disorder in Parkinson's disease: a discriminant analytic approach

This study assessed the sensitivity of individual depressive symptoms and their relative contribution to the diagnosis of depressive disorder in patients with Parkinson's disease. The Structured Clinical Interview for DSM-IV Depression and the Hamilton and Montgomery-Asberg depression rating scales (Ham-D, MADRS) were administered to 149 consecutive nondemented patients. The contribution of the individual items of these scales to the diagnosis of "depressive disorder" was calculated by discriminant analysis. The discriminant models based on the Ham-D and MADRS scores were both highly significant. Nonsomatic core symptoms of depression had the highest correlation coefficient. Somatic items had mostly low correlation coefficients, with the exception of reduced appetite and early morning wakening (late insomnia). Nonsomatic symptoms of depression appear to be the most important for distinguishing between depressed and nondepressed patients with Parkinson's disease, along with reduced appetite and early morning awakening.

Vascular cognitive disorders: memory, mental speed and cognitive flexibility after stroke

This study investigated the occurrence of cognitive disorders 1 and 6 months after stroke in a cohort of patients with a first-ever stroke. In addition, it was investigated whether age, sex and level of education are risk factors for vascular cognitive disorders. Memory, simple speed, cognitive flexibility and overall cognitive functioning were examined in 139 patients at 1 and 6 months post-stroke. Inclusion criteria on admission were first cerebral stroke, age>/=40, no other neurological or psychiatric disorders and ability to communicate. Mean age was 69.3 years (S.D.=12.3). Patients were compared with a healthy control group matched for age, sex and level of education. A large group of patients who, at 1 month after stroke, scored below the cutoff on cognitive domains, scored above the cutoff on most of these cognitive domains at 6 months. For overall cognitive functioning, 16 out of 39, for memory, 13 out of 26 and for cognitive flexibility, 15 out of 49 patients, who at 1 month scored below the cutoff, scored above the cutoff at 6 months. Simple speed did not change; 12 patients scored above the cutoff and 7 patients scored below the cutoff at 6 months after stroke. Speaking in terms of improvement or deterioration, most people remained stable on the four cognitive domains (ranging from 37.6% to 83.5%), and a substantial group improved (ranging from 12.9% to 52.1%). Older and female patients had more cognitive disturbances. Overall, the conclusion is that the prognosis of cognitive functioning after stroke is general favourable, especially in younger patients.

Daily hassles and stress vulnerability in patients with a whiplash-associated disorder

The objectives of this study were to examine the self-reported, daily problems of patients with a whiplash-associated disorder (WAD) and a healthy control group, with the hypothesis that WAD patients would report more person-dependent hassles and perceive them as more serious than the healthy control group, due to the prior experience of a whiplash injury. In addition, it was expected that the person-independent seriousness rating would be elevated, reflecting the increased vulnerability of WAD patients to common stressors. Finally, a strong relationship was expected between frequency or seriousness of daily problems on the one hand and level of distress on the other. Forty-seven WAD patients seeking treatment and 47 matched healthy control participants completed the everyday problem checklist (EPCL). The level of distress was measured by the symptom checklist (SCL-90). As expected, most EPCL-scores in the WAD group were higher than the scores of the healthy participants. Regression analysis further revealed that 61% of the variance in general distress in the WAD group could be explained by EPCL scores and educational background. Chronic WAD patients report a high stress load, which is related specifically to personal functioning after the whiplash injury. In addition, WAD patients (especially those with a low educational level) appear to be more vulnerable and react with more distress than healthy people to all kinds of stressors. Stress responses probably play an important role in the maintenance or deterioration of whiplash-associated complaints.

Markers for depression in Parkinson's disease

OBJECTIVE

To assess whether general risk factors for depression are also markers of depression in patients with Parkinson's disease (PD) and to identify additional disease-specific markers.

METHOD

A two-step logistic regression was performed on data from 161 consecutively referred PD patients, 40 of whom suffered from major depressive disorder. A first logistic model was created with five general risk factors for depression. Next, five potential disease-specific markers were added to see whether this would improve the model.

RESULTS

The logistic model of general risk factors for depression also predicted depression in PD patients. A family history of depression was the most important marker. 'Right-sided onset' was the only disease-specific marker that improved the model.

CONCLUSION

Established risk factors for depression in the general population are also markers of depression in PD. The importance of correcting for general risk factors for depression in the search for disease-specific risk factors is stressed.

Clinical correlates of depression following myocardial infarction

OBJECTIVE

Post-MI depression increases mortality, especially in the first 18 months after MI. Identifying patients at risk for post-MI depression is therefore important. In the present study we investigated possible correlates for post-MI depression on an a priori basis.

METHOD

Based on the literature, four clinically easily attainable variables were selected as possible correlates for post-MI depression. These were prescription of benzodiazepines during acute hospitalization, cardiac complications during acute hospitalization, history of depression, and not being able to stop smoking within six months after MI. A consecutive cohort of 173 first-MI patients was screened with the SCL-90 depression scale and DSM-III-R criteria for major depression. Of this cohort 35 depressed patients were compared with 35 non-depressed post-MI patients, matched for gender, age, and severity of MI.

RESULTS

In univariate analyses, complications during hospitalisation (OR = 2.14; CI = 0.89-5.14), prescription of benzodiazepines (OR = 3.67; CI = 1.11-12.1), history of depression (OR = 3.0; CI = 0.87-10.4), and not being able to stop smoking (OR = 4.5; CI = 1.11-18.2) were clinical correlates for post-MI depression. Multivariate analyses showed that none of these variables were independent of the others in predicting depression.

CONCLUSIONS

A number of easily measurable patient characteristics identify those MI-patients at risk of post-MI depression. Further investigations should focus on the predictive value of these factors in relation to post-MI depression.

Sensitivity and specificity of observer and self-report questionnaires in major and minor depression following myocardial infarction

This study evaluated screening abilities of self-report questionnaires for depression in first myocardial infarction (MI) patients. One month post-MI, 206 patients with first MI were screened for major and minor depression using the 90-item Symptom Check List (SCL-90), the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS), and the 17-item Hamilton Depression Rating Scale (Ham-D). The Structured Clinical Interview for DSM-IV criteria was used as the gold standard. Sensitivity and specificity for different cutoff points, using relative operating characteristics curves, were assessed. The internal consistency for all scales was good. When screening for major and minor depression, the optimal cutoff scores are lower than those for screening major depression only. The SCL-90, BDI, HADS, and Ham-D proved to have acceptable abilities for screening post-MI major and minor depression.

Research into the specificity of depression after stroke: a review on an unresolved issue

Iwo decades of research have failed to generate consistent insight into the specificity of poststroke depression (PSD). This is, at least in part, caused by methodological difficulties. Differences in symptom profile between PSD and depression with no or another medical cause were described, but no specific and unequivocal clinical picture has been established so far. Prevalence rates of PSD varied largely between studies. In community based studies using standardised diagnostic instruments for depression, relatively low prevalence rates were reported compared to inpatient or rehabilitation studies. PSD occurs most frequently in the first few months after stroke, while a new incidence peak may occur 2-3 years after stroke. Two systematic reviews on the relation between lesion location and depression did not support the claim that left hemisphere lesions are a risk factor for PSD. A new concept of vascular depression has been proposed, which relates depression in the elderly to acute or chronic damage to the cerebral vascular system. Future efforts should aim at increasing the uniformity of study designs, assessment tools should be further improved for use in cognitively impaired patients and appropriate control groups should be defined to study the characteristic features of PSD.

The relationship between depressive and vital exhaustion symptomatology post-myocardial infarction

OBJECTIVE

Many peri-myocardial infarction patients experience decreased wellbeing, which is either conceptualized as depression or as vital exhaustion. The objective of the present study is to investigate whether or not depression and vital exhaustion are separate entities. It was hypothesized that, if depression and vital exhaustion are separate phenomena, the correlation between two depression questionnaires would be higher than those between either of the two depression questionnaires and a vital exhaustion questionnaire.

METHOD

Subjects were 143 patients who had recently experienced a first acute myocardial infarction (MI). At 1, 3, 6 and 12 months post-MI, patients completed two self-report depression questionnaires (the Zung-SDS and the Depression scale of the SCL-90), and a vital exhaustion questionnaire (the Maastricht Questionnaire). Correlation coefficients were calculated for the two depression questionnaires and the vital exhaustion questionnaire. Furthermore, an exploratory principal component analysis was performed on the combined items of the three questionnaires.

RESULTS

Strong and virtually identical correlations were found between the three measures at all four time-points. A one-factor model was the best fit in the exploratory principal component analysis.

CONCLUSION

The present results do not support the hypothesized separate conceptual identity of depression and vital exhaustion.

Efficacy and safety of fluoxetine in the treatment of patients with major depression after first myocardial infarction: findings from a double-blind, placebo-controlled trial

OBJECTIVE

Depression and hostility are significant risk factors for mortality and morbidity after myocardial infarction (MI). Much research is still needed to identify effective ways to reduce emotional distress in patients with cardiovascular disease. This double-blind, placebo-controlled study investigated the efficacy and safety of the antidepressant fluoxetine in patients with depression after their first MI.

METHODS

Fifty-four patients with major depression after MI were randomly assigned to receive a flexible-dose regimen of fluoxetine or placebo for the first 9 weeks of a double-blind, placebo-controlled trial. Patients without serious adverse effects who wished to continue participating in the study were given fluoxetine or placebo for an additional 16 weeks. To evaluate the efficacy of fluoxetine, the 17-item Hamilton Depression Rating Scale (HAMD-17) and the Hostility Scale of the 90-item Symptom Check List (SCL-90) were used as primary measures of outcome. To evaluate the safety of fluoxetine, cardiac function was measured before and after treatment with echocardiography and electrocardiography.

RESULTS

The a priori difference in antidepressive efficacy (4-point difference in HAMD-17 scores between the fluoxetine and placebo groups) was not met. However, the response rate among patients receiving fluoxetine was significantly greater than that among patients receiving placebo at week 25 (48 vs. 26%, p = .05). Among patients with mild depression (HAMD-17 score < or =21), HAMD-17 scores were significantly different (p < .05) between the fluoxetine and placebo groups at weeks 9 (by 5.4 points) and 25 (by 5.8 points). Also, hostility scores at week 25 were significantly reduced among patients receiving fluoxetine (p = .02). Analysis of electrocardiographic and echocardiographic parameters revealed no decrease in cardiac function as a result of treatment with fluoxetine.

CONCLUSIONS

Although the overall difference between the fluoxetine and placebo groups was not significant, there was a trend favoring fluoxetine in this relatively small sample. The response rate in the group receiving fluoxetine was comparable with that observed in other studies of patients with cardiovascular disease. In addition, fluoxetine seemed to be particularly effective in patients with mild depression and was associated with a statistically significant reduction in hostility. The results of this study suggest that fluoxetine can be safely used to treat patients with post-MI depression beginning 3 months after the event.

The validity of the Hamilton and Montgomery-Asberg depression rating scales as screening and diagnostic tools for depression in Parkinson's disease

The concurrent validity of the Hamilton Rating Scale for Depression (HAMD-17) and the Montgomery-Asberg Depression Rating Scale (MADRS) against the DSM-IV diagnosis 'depressive disorder' was assessed in patients with Parkinson's disease (PD). Sixty-three non-demented Parkinson's Disease (PD) patients who attended the outpatient department of an academic hospital were diagnosed according to a standardised research protocol. This protocol consisted of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to establish the presence or absence of 'depressive disorder' according to the DSM-IV criteria, as well as the HAMD-17 and the MADRS. Receiver Operating Characteristics curves (ROC curves) were obtained and the positive and negative predictive values (PPV, NPV) were calculated for different cut-off scores. Maximum discrimination between depressed and non-depressed patients was reached at a cut-off score of 13/14 for the HAMD-17, and at 14/15 for the MADRS. At lower cut-offs, like 11/12 for the HAMD-17 and 14/15 for the MADRS, the high sensitivity and NPV make these scales good screening instruments. At higher cut-offs, such as 16/17 for the HAMD-17 and 17/18 for the MADRS, the high specificity and PPV make these instruments good diagnostic instruments. The diagnostics performance of the HAMD-17 is slightly better than that of the MADRS. This study shows that it is justified to use the HAMD-17 and the MADRS to measure depressive symptoms in both non-depressed and depressed PD patients, to diagnose depressive disorder in PD, and to dichotomize patient samples into depressed and non-depressed groups.

Distribution of psychological aspects in subgroups of chronic low back pain patients divided on the score of physical performance

This study investigates whether different subgroups of chronic low back pain patients (CLBPs) differ in psychological aspects assessed with the Symptom Checklist (SCL-90) and the Multidimensional Pain Questionnaire (MPI-DLV). Four subgroups of CLBPs are discerned using the results of lumbar dynamometry: 1. Patients with performances lower than healthy subjects (expected performance; n = 45). 2. Patients with performances comparable to healthy subjects (normal performance; n = 18). 3. Patients with inconsistent test behaviour (submaximal performance; n = 6). 4. Patients with performances that could be either maximal or submaximal (gray-zone performance; n = 10). Significant differences in psychological aspects were found between patients with submaximal and patients with expected performances but not between patients with normal and patients with expected performances. All patients with submaximal performance report a high degree of psychological distress, in contrast to 30% of those with normal performance and 20% of those with expected performance. Because of the differences found in psychological aspects between the CLBP subgroups, it is thought that a physical screening together with a psychological screening provides better insight in the two aspects of the deconditioning syndrome and thus can give better treatment indications than a physical screening alone.

Psychometric properties of the Multidimensional Pain Inventory, Dutch language version (MPI-DLV)

The purpose of this study was to investigate the psychometric properties of a Dutch translation of the Multidimensional Pain Inventory, MPI-DLV. Data was available on 733 chronic pain patients. There were three issues of special interest. The first one related to the comparability between the MPI-DLV and the American and German MPI versions with regard to the psychometric aspects. The second dealt with the construct validity of the MPI-DLV scale 'general activity'. It was predicted that patients with high scores on this scale would be in better physical condition, as measured on a working-to-tolerance bicycle ergometer test. In relation to the third issue, attention was given to the factor-invariance between fibromyalgia patients and back pain patients. From the results obtained it was concluded that (1) the factorial structure of the three MPI parts is replicated and the reliability estimates and validity indicators are similar to those from the American and German versions; (2) patients with high scores on the 'general activity' scale are in better physical condition and (3) MPI-DLVs of fibromyalgia and back pain patients do have similar factorial structures. Evidence was also obtained that the MPI-DLV is sensitive to treatment changes. Applications of the MPI-DLV are discussed.

Cardiac side-effects of two selective serotonin reuptake inhibitors in middle-aged and elderly depressed patients

Selective serotonin reuptake inhibitors (SSRIs) are the 'new' drugs of first choice for the treatment of depression in the older patient. Systematic studies on the effects of SSRIs on cardiac function are scarce, despite the high prevalence of cardiac disorders in the older depressed patient. This is a study which systematically assessed cardiac function by echocardiography in middle-aged and elderly depressed patients treated with SSRI. In a double-blind randomized trial, 20 patients were assigned to receive fluvoxamine 100 mg/day [DOSAGE ERROR CORRECTED] or fluoxetine 20 mg/day [DOSAGE ERROR CORRECTED] for 6 weeks. Cardiac function was assessed by left ventricle ejection fraction, aortic flow integral and early or passive/late or active mitral inflow, and electrocardiography. Neither SSRI significantly affected cardiac function. Compared with patients without a history of myocardial infarction and/or hypertension, patients with such a history showed a significant improvement in left ventricular ejection fraction. Despite our small study sample, these data indicate that both fluoxetine and fluvoxamine do not affect cardiac function adversely.

Within-person relationships among pain intensity, mood and physical activity in chronic pain: a naturalistic approach

Fifty-seven chronic pain patients rated their pain intensity, mood and activity level, at a random time schedule, eight times a day during 6 consecutive days, according to the Experience Sampling Method (ESM). Within-person correlations among pain intensity, mood and activity level were calculated. We found pain intensity to be significantly associated with mood. However, the associations between pain intensity and activity level, and activity level and mood could not be supported. Further, we examined whether the relationship between pain intensity and mood was the result of a pattern across the day. Results showed that pain intensity and mood were worst in the morning and improved during the afternoon among participants whose pain intensity and mood were correlated significantly. We suggest that attentional as well as behavioural processes might explain the established day pattern of pain intensity and mood.

Validating the MPI-DLV using experience sampling data

The present study investigates the relationship between scale scores on the Dutch version of the Multidimensional Pain Inventory (MPI-DLV) and data derived from comparable items from an experience sampling procedure. Fifty-seven chronic pain patients participated in the study, which lasted 6 consecutive days. Special attention was given to the relationship between the MPI-DLV pain intensity score and the mean experience sampling pain intensity score. Significant correlations were found between the MPI-DLV scales Pain Severity, Interference, Solicitous, Punishing and Distracting Responses, and Household Chores and their experience sampling analogues. A marginally significant correlation was found with regard to the MPI-DLV Life Control scale. The General Activity and Affective Distress scales had no relationship with the analogous experience sampling items. The significant correlations were regarded as further validation of the MPI-DLV. A regression analysis revealed that 58% of the variance of the experience sampling pain intensity score could be explained by the MPI-DLV present pain intensity item score.

[Depression following a first heart infarct; similarities with and differences from 'ordinary' depression]

OBJECTIVE

To determine frequency and clinical features of major depressive disorder according to DSM IV criteria in patients following a first myocardial infarction.

DESIGN

Questionnaire.

SETTING

Departments of Cardiology and Psychiatry, University Hospital Maastricht, the Netherlands.

METHOD

Depression was assessed using the Zung 'Self-rating depression scale' (Zung-SDS) and the 'Symptom checklist' (SCL)-90 in 228 patients who filled the questionnaires out themselves (response: 60-70%), 1, 3, 6 en 12 months after their first heart attack. When the score on one or both lists was above threshold, the patient was invited for a clinical interview with a psychiatrist.

RESULTS

One month post infarction 10% were diagnosed with a major depressive episode, a percentage which increased to 34% one year post infarction. The clinical features of the depression in these patients were the same as in a matched sample of depressed psychiatric inpatients without a cardiac history, except that hostility was significantly increased in the post-infarction patients. There was no mortality.

CONCLUSION

Depressive disorder is a frequent comorbid disease after a first myocardial infarction.

Operant conditioning of the pain experience

Two experiments were carried out to study operant conditioning of pain report. Further, it was investigated whether pain-related psychophysiological and psychological measures (skin conductance response and magnitude matching) could also be conditioned operantly. In both experiments subjects received 12 painful electric shocks of equal intensity. In Exp. 1 healthy subjects were assigned to either a control group or an up-conditioning group. Up-conditioning occurred by verbally rewarding increases in pain report and punishing decreases. Analyses indicated that up-conditioning of both pain report and the pain-related psychophysiological measures succeeded. To rule out alternative explanations of the results (attention shift towards pain and conditioning of anxiety) the verbal punishments were adjusted in Exp. 2. A down-conditioning group was also added. The attempt to replicate the results of Exp. 1 failed and down-conditioning of the pain report could not be established. These inconsistent results are most probably due to modified punishment of responses. The consequences for the results of Exp. 1 are discussed. Based on the results of post hoc analyses, some suggestions are made for operant conditioning studies of pain.

Radiofrequency lesion adjacent to the dorsal root ganglion for cervicobrachial pain: a prospective double blind randomized study

Each of 20 consecutive patients with a history of at least 1 year of intractable chronic cervicobrachial pain was randomly assigned to one of two treatment groups. The pretreatment investigation included at least three diagnostic segmental nerve blocks in each patient. Each patient in Group 1 received a 67 degrees C radiofrequency lesion adjacent to the dorsal root ganglion. The patients in Group II were treated in an identical manner as those in Group I, except that no actual radiofrequency lesion was made. Neither the therapist nor the patients were aware of the treatment group assignment. All patients were questioned about their pain experience 1 week before and 8 weeks after the procedure. The following tests were used in evaluating patient response: Visual Analogue Scale (VAS); McGill Pain Questionnaire, Dutch Language Version (MPQ-DLV); and Multidimensional Pain Inventory, Dutch Language Version (MPI-DLV). These tests showed that 8 weeks after the procedure, there was a significant number of "successful" patients in Group I compared to Group II (P = 0.0027); there was a significant reduction in VAS score (P < 0.01) and also in parameters measured with MPQ-DLV and MPI-DLV in Group I. This study indicates that a 67 degrees C radiofrequency lesion adjacent to the dorsal root ganglion can result in a significant alleviation of pain in chronic cervicobrachial pain.

Profile characteristics of the MPI-DLV clusters of pain patients

This article describes an investigation into whether there are differences among the four pain patient clusters from the Multidimensional Pain Inventory-Dutch Language Version (MPI-DLV) in terms of prescribed analgesic medication, level of intelligence, and other personality characteristics (MMPI). Dysfunctional patients were distinguished by a higher level of analgesic medication intake. Patients classified as Average were marked by a marginally significant higher level of intelligence. The personality profile of Interpersonally Distressed patients indicated an elevated neurotic triad and a tendency to a passive-aggressive personality structure. Patients classified as Dysfunctional and Average were marked by the so-called conversion-V. There were no elevated scales in the Adaptive Coper profile. Clinical implications are discussed.

Effects of producing a radiofrequency lesion adjacent to the dorsal root ganglion in patients with thoracic segmental pain

OBJECTIVE

To evaluate the effectiveness of a radiofrequency lesion adjacent to the dorsal root ganglion (RF-DRG) on a consecutive group of patients presenting with chronic thoracic pain.

DESIGN

Retrospective study by a disinterested third party.

SETTING

Clinical outcome study.

PATIENTS

Forty-three patients with a minimum of 6 months history of unilateral thoracic segmental pain, unresponsive to conservative therapy were involved.

INTERVENTIONS

Patients were selected for a radiofrequency lesion adjacent to the dorsal root ganglion after two or more prognostic nerve blocks had been performed under fluoroscopic control. The level which provided the best analgesic response was selected. At this level, a radiofrequency lesion was made at 67 degrees for 60 s immediately adjacent to the dorsal root ganglion.

OUTCOME MEASURES

Rating of pain was done on a four-step verbal rating scale.

RESULTS

A radiofrequency lesion adjacent to the dorsal root ganglion provided short-term (8 weeks) relief of pain in 67% and long-term relief (> 36 weeks) of pain in 52% of patients with a limited segmental distribution of pain. If more than two segmental levels were involved, the procedure was found to be less effective.

CONCLUSIONS

There was a significantly (p < 0.05) better short-term and long-term pain relief in patients with a clearly localized pain that was confined to one or two thoracic segmental levels, compared to patients with more than two segmental levels involved in the pain syndrome.

Hypochondriasis in ENT practice

In this study the incidence of hypochondriasis among new ENT out-patients was investigated. A validated questionnaire, which was administered twice with an interval of 3 months, was used to make the diagnosis. Medical information also played a part in the assessment. The diagnosis hypochondriasis applied to 13% of the patients who completed the entire diagnostic procedure. This group made very frequent use of a range of medical services and took a large amount of medicine. Compared with the non-hypochondriacal ENT group, the hypochondriacal group had a more negative opinion about their own health, although those in the latter group were less ill, measured by objective criteria. In order to be able to diagnose hypochondriasis in ENT practice, psychological or psychiatrical consultation is necessary.

Is the match/mismatch model based on a statistical artefact?

In the match/mismatch model, recently formulated by Rachman and coworkers, it is stated that incorrectly predicted aversive experiences are generally followed by an immediate adjustment of the predictions concerning aversiveness of the next experience. This model can be considered to reflect a psychological process of the formation of expectations. In the present article it is argued that a simple H0 model, assuming that predictions are completely randomly generated by the subject, may account for the same effects. This H0 model is used in a stringent test of empirical data to determine if there are any effects of the discrepancy between prediction and experience on next prediction that exceed the effects explained by the H0 model. Although the H0 model produces effects very similar to the empirically observed effects, there is clear support for the hypothesized influence of the discrepancy between prediction and experience. Therefore, the model appears to reflect 'real' psychological processes and not chance findings.

The effects of underestimated pain and their relationship to habituation

The intensity of a painful stimulus was experimentally manipulated in order to induce underpredictions of pain. The experiment aimed at (1) replicating previous findings on the effects of underpredicted pain and (2) investigating the relationship between underpredicted pain and habituation. Most previous findings were replicated: underpredictions of pain were followed by raised expectations of pain and increased fear of pain. In addition, the underprediction had long-term effects on fear of pain, uncertainty about predictions, and expected aversiveness of the painful stimulus. In contrast to previous findings and to Rachman's match/mismatch model, it was found that underpredicted pain can have dishabituating effects. It is theorized that inaccurately predicted pain can cause dishabituation, depending on the extent of the underprediction and on the subjective certainty of the prediction. Theoretical and clinical implications are discussed.