Identifying persons at risk for PTSD after trauma with TSQ in the Netherlands.

In The Netherlands about 80% of the population experience a traumatic event while about 14% develop post traumatic stress disorder (PTSD). Considering this high prevalence the prevention or early treatment of posttraumatic stress is important from a health as well as cost-benefit perspective. The aim of this study was to examine whether we could identify subjects at risk of developing PTSD. We included 100 Dutch victims of different civil traumas that contacted the Victim Support Foundation. The trauma screening questionnaire (TSQ), was used as a screening tool. The results show that a cut-off score of 7 on the TSQ correctly identified most subjects with PTSD. We found a moderate positive correlation between PTSD and the severity of complaints. We also found a significant relationship between the TSQ and depression symptoms. This study indicates that the Dutch version of the TSQ is a useful instrument for identifying future cases of PTSD.

Somatoform dissociation and traumatic experiences in patients with rheumatoid arthritis and fibromyalgia.

OBJECTIVE: Trauma and dissociation tend to be interrelated. The objective of this study was to examine the frequency of traumatic experiences and somatoform dissociation in patients with fibromyalgia syndrome (FMS) or rheumatoid arthritis (RA), two conditions that are both characterized by pain and disability. METHODS: Patients with a diagnosis of FMS (2 male, 26 female; mean age 42 +/- 11 years) or RA (5 male, 46 female; mean age 46 +/- 10 years) completed the Fibromyalgia Impact Questionnaire (FIQ), the Somatoform Dissociation Questionnaire (SDQ), and the Traumatic Experience Checklist (TEC). RESULTS: Patients with FMS reported significantly higher levels of various forms of traumatization and dissociation than patients with RA. In patients with FMS, but not in patients with RA, there was a significant correlation between traumatization and dissociative symptoms. A possible dissociative disorder was indicated in 10% of the patients with FMS and 2% of the patients with RA. CONCLUSION: Traumatization experiences are frequent in FMS, but as compared to conversion disorder or dissociative identity disorder only a small subgroup of patients with FMS or RA shows the combination of traumatization and somatoform dissociation. The observation of somatoform dissociation calls for a broad treatment approach with a special role of the psychologist or psychiatrist.

Marital and sexual satisfaction in patients with RA and their spouses.

This study sets out to determine predictors of marital and sexual satisfaction in patients with rheumatoid arthritis (RA) and their spouses. Fifty-nine patients and their spouses completed questionnaires independent from each other. Multiple correlations with marital and sexual satisfaction were computed for demographic variables, disease status, psychological distress, and social support. The results indicate that psychological distress and social support are more important than objectively assessed disease status in determining marital and sexual satisfaction in patients with RA.

The Stanford Hypnotic Susceptibility Scale, Form C: normative data of a Dutch student sample.

Norms for the Dutch language version of the Standford Hypnotic Susceptibility Scale, Form C (SHSS:C; Weitzenhoffer & Hilgard, 1962) are presented. These norms are based upon a sample of 135 students at a Dutch university. Generally, the psychometric properties of the Dutch version of the SHSS:C are similar to other language versions. However, the mean score was somewhat lower than that found in the original norming studies at Stanford University.

The question of symptom lateralization in conversion disorder.

OBJECTIVE: The purpose of this study was to determine whether or not conversion symptoms are lateralized. Studies have shown a predominant left-oriented manifestation of symptoms for most somatoform disorders. The reports in the literature on the lateralization of conversion symptoms, however, are rather conflicting. They show left-sided, right-sided, or no symptom lateralization in conversion disorders. METHODS: One hundred fourteen patients with conversion disorder were screened for symptom lateralization. RESULTS: Those patients with unilateral symptoms (32.5%) showed no significant bias toward left or right symptom presentation. CONCLUSION: Based on these results, and the conflicting findings from previous studies, we conclude that there is insufficient support for lateralization theories in conversion disorder.

The negative effect of decreasing the level of activity in coping with pain in rheumatoid arthritis: an increase in psychological distress and disease impact.

The objective of this study was to analyze the effect of coping with pain in rheumatoid arthritis (RA) on subsequent changes in psychological distress and disease impact. A sample of 109 randomly selected RA patients was asked to participate in a longitudinal study. Patients were measured at baseline and after 3 years. Both measurements were completed in 80 patients. At each assessment the following variables were assessed: disease activity, pain, physical and psychological distress, disease impact, and coping. The relation between coping with pain at baseline and subsequent changes in psychological distress and disease impact was analyzed using stepwise regression. Disease status variables assessed at baseline and after 3 years were entered in the regression analysis as control variables. Results show that cognitive coping with pain at baseline was not related to subsequent changes in psychological distress or disease impact. On the other hand, behavioral pain coping assessed at baseline was related to subsequent changes in psychological distress and disease impact. "Decreasing activity" was related to an increase in self-reported psychological distress and disease impact after controlling for disease status at both assessments. It was concluded that cognitive pain coping did not predict any subsequent changes in psychological distress or disease impact. "Decreasing activity" as a behavioral pain coping style has a negative effect on subsequent changes in psychological distress and disease impact.

Behavioral coping and physical functioning: the effect of adjusting the level of activity on observed dexterity.

OBJECTIVE: To assess the relationship between behavioral coping and dexterity in rheumatoid arthritis (RA) after controlling for disease activity, impairment of the hands, and pain. METHODS: A random sample of 109 patients with RA was assessed twice within one year. Dexterity, disease activity, and impairment of the hands were measured using observational methods. Pain and coping with RA were assessed using self-report instruments. RESULTS: Correlational findings showed that "decreasing activity" to cope with pain was negatively related to dexterity. "Pacing" as a way of coping with limitations was positively related to dexterity. Both relations were significant after controlling for duration of disease, impairment of hands, disease activity, and pain. "Decreasing activity" as a way of coping with pain was related to a decrease in dexterity in the subsequent year, after controlling for baseline measurements of dexterity, impairment, and disease activity as well as measurements of current disease activity and pain. "Pacing" as a way of coping with limitations was unrelated to subsequent changes in dexterity, after controlling for the above mentioned variables. CONCLUSION: Behaviorial coping is related to current and subsequent levels of dexterity. Therefore, it is concluded that more attention should be given to behaviorial coping in both research and clinical practice.

The analysis of a blood pressure diary for a patient report.

In order to make a more valid assessment of blood pressure (BP), self-monitoring of BP by the patient is generally advised. Self-monitoring usually results in a lower BP level. We are currently investigating whether the BP lowering effect of self-monitoring may be enhanced by not only monitoring BP but also monitoring physical and emotional status at the moment of and activity prior to the BP measurement in a diary. In this article we focus on the individual feedback that the participating patients received. Various methods that can be used for this purpose are described. For our individual reports we first assessed linear trends in the variables. When a trend was present, residuals were calculated. Then a principal-components analysis on BP measurements, BP estimates, symptoms, moods, and activities was performed. Results are presented for two hypertensive patients.

Perception of heart rate and blood pressure: the role of alexithymia and anxiety.

While the ability to estimate heart rate in a laboratory setting appears to be related to anxiety and alexithymia, it is still unclear how the ability to estimate blood pressure is related to these psychological measures. The perception of heart rate and blood pressure in 24 normotensive subjects with varying degrees of alexithymia and anxiety was examined. Results indicate that the estimation of heart rate is related to psychological characteristics, while the estimation of blood pressure is not. More anxious subjects perceived heart rate more accurately than less anxious subjects. Furthermore, high alexithymic subjects perceived heart rate less accurately than low alexithymic subjects. The accuracy of estimation of blood pressure was, however, not related to alexithymia or anxiety. These findings provide further evidence that blood pressure estimates in a laboratory setting are mainly based upon situational cues.

Disease-specific stressors in rheumatoid arthritis: coping and well-being.

Results with Coping with Rheumatic Stressors (CORS) are reported. The CORS measures eight coping styles directed at the most important chronic stressors of RA i.e. pain, limitations, and dependence. The relation between coping and well-being was analysed while controlling for relevant disease status variables. Comforting cognitions, decreasing activity and diverting attention were styles of coping with pain that were related to well-being, when level of pain was controlled. Optimism, pacing, and seeking creative solutions were styles of coping with limitations. Both optimism and pacing were related to well-being, when functional capacity was being controlled. Acceptance and showing consideration were styles of coping with dependence. Consideration was the only coping style related to well-being, when functional capacity and social network were being controlled.

Stress caused by rheumatoid arthritis: relation among subjective stressors of the disease, disease status, and well-being.

Two integrated studies, examining the chronic stressors specific to the disease rheumatoid arthritis, are described. Pain, limitation, and dependence were rated as the most annoying chronic stressors of the disease. Pain was measured with the Visual Analog Scale and the McGill Pain Questionnaire. Both pain scores were only weakly related to the medical assessment variables. New scales were developed to measure perceived limitation and dependence. Perceived limitation was inversely related to both mobility and self-care, but this association was not strong. Perceived dependence was unrelated to any of the health status measures. All three stressors were associated with indicators of quality of life even after controlling for interaction with clinical assessment and functional status variables. It was concluded from these studies that patients with rheumatoid arthritis must cope simultaneously with pain, limitation, and dependence.

[Pain in rheumatoid arthritis measured with the visual analogue scale and the Dutch version of the McGill Pain Questionnaire]. / Pijn bij reumatoïde artritis gemeten met de visuele analoge schaal en de Nederlandse versie van de 'McGill pain questionnaire'.

Chronic pain is an important symptom of rheumatoid arthritis (RA). Pain is a complex experience and is not easily measured with a single instrument. Recently a Dutch version of the McGill Pain Questionnaire (MPQ) became available. The MPQ is a measure of the quality of pain as opposed to the traditional measures of pain intensity such as the Visual Analog Scale (VAS). In a study of 415 RA patients both measures of pain were administered. Both pain measures were only weakly related to medical variables. The VAS is easily administered and is reliable. The MPQ offers insight in the sensory experience of pain and gives more information about the quality of life of the patient. The conclusion is that the MPQ is a useful instrument to obtain a better picture of the complexity of the pain experience in RA.

Cardiovascular responses and problem solving efficiency: their relationship as a function of task difficulty.

In this study the relationship was examined between cardiovascular changes and performance efficiency in adult males performing an anagram solution task. Three conditions (n = 20 in each) were used, differing in the percentage of solvable anagrams (100, 50, and 30%). Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured before, during, and after the task. It was found that subjects who performed better in the 100% condition had an increase in pulse pressure (PP), that is, a greater rise of SBP than of DBP, whereas subjects who performed less in that condition showed a decrease in PP. Conversely, subjects who performed better in the 50 and 30% conditions showed a decrease in PP, whereas subjects who performed less in these conditions showed an increase in PP. With respect to HR changes, no significant correlations with performance were detected. Consistencies with data from endocrinological research were pointed out. Consideration was also given to the possible role of anxiety in mediating the relationship between physiological patterning and task performance.