Psychological Characteristics of the Patients with Low Back Pain by Traffic and Industrial Accidents

OBJECTIVE: To survey characteristic patterns and speculate psychologic factors of the patients with low back pain associated with industrial injury or traffic accidents. METHOD: Nineteen low back pain patients after traffic (12 cases) or industrial (7 cases) accidents were compensation insurance status. 40 controls were low back pain patients without compensation insurance status. All had been evaluated with an electrodiagnostic study. Pain drawings and symptom check list for minor psychiatric disorder (SCL-MPD) were assessed to speculate the characteristics of the psychologic factors. RESULTS: In the electrodiagnostic study patients with compensation insurance status had segmental radiculopathy in5 cases (26.3%) and controls in 18 cases (45.5%). Pain drawings classified as Ransford scores were abnormal in 14 cases (73.7%) of the patients and in 9 cases (24.3%) of the controls. Visual inspection of the pain drawings classified as non-indicative were 12 cases (63.2%) of the patients and 13 cases (31.3%) of the controls. SCL-MPD showed higher somatization, depression and phobic-anxiety scores than the controls. CONCLUSION: Pain drawing and SCL-MPD are available for screening of the psychological factors and management for low back pain of compensation insurance stauts.

Hypocholesterolemia and neurotic symptoms

BACKGROUND: An association between low serum cholesterol concentrations and depressive symtoms has ever been found in several studies. The objective of this study is to evaluate neurotic symptoms in hypocholesterolemia. METHODS: In the course of two months (from June to August, 1998), 81 subjects were selected among the people who screened in adult disease survey of one university hospital. As the control group, 80 subjects were selected from a healthy population. In the study population, we excluded people who had medical history of hypertension, diabetes mellitus, ischemic heart disease, chronic liver disease and history of any medication to lipid metabolism and other psychotic disease history. Neurotic symptoms were measured by Symptom Checklist for Minor Psychiatric Disorders (SCL-MPD) questionnaire. RESULTS: There was no difference between the distribution of age and sex in the hypocholesterolemia groups. As the level of the education and kind of employment, no significant difference between two groups. Hypocholesterolemia groups scored significantly higher than conrol group in some questionnaire of SCL-MPD. The results of depression scale (p<0.01) and anxiety, hypochondriasis scale (p<0.05) were significant. The men of hypocholesterolemia groups have significant relation to hypochondriasis scale (p<0.001) and the women to anxiety scale (p<0.05). CONCLUSION: Though in some scale of neurotic symptoms, the association between hypocholesterolemia and neurotic symptoms was found in our study. There need to be a further study on the correlation of hypocholesterolemia and neurotic symptoms.

The relation between psychosocial factor of inorganic chest pain and neurotic symptoms

BACKGROUND: Compared to Europe and America neurotic chest pain patients seems to be much more prevalent in Korea. This study was designed to depict various neurotic symptoms of patients with inorganic chest pain. METHOD: In the course of one year(from March, 1997 to March, 1998), 70 subjects were selected among the people who visited the outpatient clinic of department of family medicine with symptom of chest pain. The control group was selected from a healthy population which matched nearly the same number as the chest pain group. Patients were tested by EKG, treadmill, chest X-ray, 2D-UCG and requested to answer SCL-MPD questionnaire. Statistical analysis by means of SPCC/PC+ and for significance using non-parametric Mann-Whitney U test was done. RESULTS: The chest pain group scored significantly higher than the control group in obsessive and compulsive, anger-hostility, depression, anxiety, and somatization scale. male chest pain group scored higher in somatization, anxiety, obsessive-compulsive, hypochondriasis, and depression scale. The female chest pain group scored higher in depression scale. CONCLUSION: Many inorganic chest pain patients complain through various neurotic symptoms. When approaching chest pain patients we should consider the possibility of a psychosocial cause.

Characteristics of the patients of chronic disease

BACKGROUND: It is very important for family physicians to practice with comprehensive approach to patients with chronic illness. A study was done to assess psychosocial aspects of patients with chronic illness and disability and to help physicians manage patients effectively. METHODS: SCL-MPD questionnaires were done in 93 patients with chronic illness and disability who were admitted between April and May in 1997. The results were statistically analyzed by chisquare test and Mann-Whitney U test. RESULTS: 1. The mean score of SCL-MPD were 17.5 for `depression' and 13.78 for `somatization' with statistical significance(P<0.005). 2. Comparison of dimensions of patients with back pain syndrome had higher scoresn for `depression (25.2)', `somatization (22.1)', `hypochondriasis (14.7)', `phobic anxiety (11.6)', `neurasthenic (8.1)' and `interpersonal sensitivity(8.0)' than other disease groups with statistical significance (P<0.05). 3. In comparison of dimensions between males and females, the female group gradually had higher scores than males and, especially, 'somatization' dimension was significantly higher in score (P<0.05). 4. Symptoms ranked top in male and female patients were `54-over coscern about your health' in males and `16-over concern with the fear of having a serious illness' in females. CONCLUSION: Family physicians have to consider not only physical impairment but also psychological aspect of patients with chronic illness for comprehensive management in medical practice.

Psychogenic symptoms in patients with noncardiac chest pain

BACKGROUND: Patients with chest pain are common among outpatients. Several researches shows that chest pain patients can suffer from psychiatric illnesses such as hypochondriasis, depression, anxiety, somatization, panic disorder and so on. This study aims to examine the pschogenic symptoms in patients with noncardiac chest pain METHODS: In this study, the 98 people who have undergone treadmill test for chest pain during the three months from June 1st to September 30 of 1998 were selected, and the 98 patients were asked to respond to the prepared questionnaire and SCL-MPD(symptom check list-minor psychiatric disorders) before they underwent treadmill test. And then, they were classified into two groups. One group consisted of patients with noncardiac chest,pain, and the other group of patients with cardiac chest pain. These two groups were compared in 10 measures, and the compared results were analyzed by t-test. RESULTS: Among the 25 patients with cardiac chest pain, 15 patients were males and 10 patients (38%) were females, and among the 44 patients with noncardiac chest pain, 31 patients (70%) were males, 13 patients (30%) were females. The average age was 47 years old. The average age in patients with noncardiac chest pain was 48, and the 46 for those patients with cardiac chest pain . In the statistical analysis between the patients with cardiac chest pain and those with noncardiac chest pain, significant difference(p<0.005) was shown in the measures such as somatization, depression, phobic anxiety, obsessive-compulsive, neurasthenic, hypochondriacal, anxiety, anger-hostility, interpersonal sensitivity. CONCLUSIONS: As in the analysis the patients with noncardiac chest pain showed significant difference in the symptom check list-minor psychiatric disorder compared to those with cardiac chest pain. We conclude that primary care physician should take more interest in evaluating psychiatric symptoms in patients with noncardiac chest pain.

A Study of Psychogenic Symptoms in Chronic Low Back Pain Patients

BACKGROUND: Chronic low back pain(CLBP) is one of the most common afflictions of humans. Between 70% and 80% of the population experience back pain some time during their lives. Especially, back pain is the most common cause of limited activity in individual under age 45. METHODS: The prepared questionnaire and SCL-MPD(symptom check list-minor psychiatric disorders) were presented to subjects who visited our hospital for occupational routine check. The questionnaire was composed of duration and severity of back pain. The subject were divided into two groups, respectively with chronic low back pain history and without history. The differences of psychogenic symptoms between both groups were analysed. RESULTS: In general characteristics, there was no significant difference between both groups. There were significant differences in somatization, anxiety, depression, anger-hostilily, phobic anxiety, neurasthenic, hypochondriacal, interpersonal sensitivity and general dimensions between both groups(P<0.05). There was no significant difference in obsessive-compulsive dimension between both groups. CONCLUSIONS: These results showed the presence of various psychogenic symptoms in chronic low back pain patients. Such psychosocial variables will need to receive additional careful attention in primary care setting.

Minor psychiatric disorder Associated with Smoking in Men

BACKGROUND: Smoking is a very dangerous behavior and people know that it will lead to fatal health problems. But, many people continue to smoke. We studied psychiatric aspect of smoking. METHODS: We distributed self-questionnaire to people who visited Dong-San Medical Hospital for periodical examination and checkups between the months of April and June, 1996. It consisted of inquiries on their smoking status and symptom check list for minor psychiatric disorders(SCL-MPD). Among the total of 147 men 58 were current smokers, 63 non-smokers, 26 ex-smokers. We compared minor psychiatric differences between each groups by Student t-test. RESULTS: The mean age of current smokers, ex-smokers and non-smokers were 44.9 +/-8.9, 44.8+/-8.4 and 46.6+/-9.6, respectively. Among 10 dimensions of SCL-MPD, the smokers (includes current smokers and ex-smokers) had significantly higher scores on anger-hostility, interpersonal sensitivity and obsessive-compulsive dimensions than those of non-smokers(p<0.05). When comparing with current smokers and non-smokers, current smokers had significantly higher scores on anger-hostility and obsessive-compulsive dimensions(p<0.05). Between ex-smokers and non-smokers, ex-smokers had significantly higher scores on anger-hostility and obsessive-compulsive dimensions(.p<0.05). But, no significant differences were observed between current smokers and ex-smokers. CONCLUSIONS: Smokers(current smokers and ex-smokers) were highly associated with anger-hostility, interpersonal sensitivity and obsessive-compulsive disorders compared to non-smokers. But, no minor psychiatric differences were observed between current smokers and ex-smokers.

Neurotic characteristics in headache patients

BACKGROUND: Headache is one of the most common medical complaints. The majority of headaches are not associated with significant organic disease. Many persons are susceptible to headaches at times of emotional or physical distresses. The purpose of this study is to evaluate neurotic symptoms of headache patients. METHODS: The present study was made in the patients with headache symptoms. who had visits t,he outpatient clinic of Family Medicine of a University Hospital from April 1st to July 31st, 1996, 110 subjects with headaches and 136 controls which were closely matched according to sex, age and socioeconomic status. Neurotic symptoms were assessed using the Symptom Check List for Minor Psychiatric Disorders(SCL-MPD). The statistical analysis was made between the two groups. RESULTS: 1) All but 3 items were significantly higher in headache group(p<0.05 : 2 items;p<0.01 : 9 items ; p<0.001 : 53 items). 2) The headache group had a statistically significant higher score of the each neurotic dimension in comparison of the non-headache group (somatization, anxiety, depression , anger-hostility, interpersonal -sensitivity, phobic anxiety, obsessive -compulsive , neurasthenia, hypochondriasis and general) (p<0.001). 3) The age and the presence of occupation were significantly associated with headache symptoms. The somatization and depression scales had the strongest independent association with headaches as compared with other dimensions. CONCLUSIONS: Persons with headache had higher levels of neurotic symptoms and psychological distresses compared to the non-headache group. Physicians need to be aware of the various types of distresses comprehensively with psychosocial assessments and evaluations.