Use of psychometric measures and nonorganic signs testing in detecting nomogenic disorders in low back pain patients.

The effect of financial compensation on responses to psychometric testing was studied in 231 chronic back pain patients. Item by item comparison of responses to two tests, readministered within 4 hours, yielded inconsistency scores. These inconsistency scores, along with scores on other psychometric measures and on Waddell's nonorganic signs test, of a group of 97 patients anticipating or receiving financial compensation (AFC), and a group of 134 patients not receiving or anticipating financial compensation (non-AFC) were compared. The AFC group had significantly higher mean scores than did the non-AFC group on the inconsistency measures, on almost all psychometric tests and on nonorganic signs. Almost all non-AFC subjects scored "0" on nonorganics, whereas 83% of AFC subjects scored "2" or higher. Prediction analysis revealed that the nonorganics score alone can predict AFC/non-AFC status; 90% of subjects were correctly classified. The inconsistency scores correctly classified 78%. Together, they correctly classified 93%. It was concluded that nonorganic scores and inconsistency scores (as defined by the investigators) distinguish between, and can predict membership in AFC and non-AFC groups. The significantly higher inconsistency scores obtained by the AFC group suggest that these psychometric test results are unreliable and hence invalid for this group.

Fluoxetine treatment of obsessive-compulsive disorder.

Two patients suffering from severe obsessive-compulsive disorder which had proven refractory to clomipramine and/or phenelzine treatment were successfully treated with fluoxetine, a new drug with a strong serotonin uptake inhibiting action. Outcome of treatment was measured on psychometric tests including the Leyton Obsessive Inventory, Hopkins Symptom Checklist-90, Beck Depression Inventory, and daily self-reports of the duration and degree of discomfort of their most severe obsessions. The delay in responding to fluoxetine, the continuing improvement even after one year on the drug, and the prompt relapse with abrupt withdrawal of treatment were noted.

The structure of phobias in panic disorder.

Fear and avoidance of individual phobic situations were measured in 1168 patients with panic disorder suffering current attacks. Correlation and principal-components analyses give components of agoraphobia, illness phobia, and social phobia in panic disorder. Agoraphobia does not stand out so clearly as illness phobia and social phobia as a separate factor; 'fear of open spaces' shows some separation from other agoraphobic situations. Frequency of panic attacks and changes associated with their remission have no special relationship to agoraphobia. Closer attention to social and illness phobia may be fruitful in discerning the evolution of panic disorder.

Fluoxetine in panic disorder.

This paper presents the cases of two patients who suffered from panic disorder with agoraphobia and depression. One had been refractory to alprazolam and tricyclics and to behaviour therapy; she had responded to phenelzine, but due to a weight gain of 50 lbs, had discontinued treatment and she relapsed. The second patient, who also suffered from post-traumatic stress disorder, did not respond to alprazolam, imipramine or to phenelzine, but gained weight (33 lbs) on phenelzine. Both patients responded to fluoxetine 80 mg per day without concomitant weight gain.

An unusual case of pica.

This paper presents the case of a 29 year old woman who compulsively ate rocks and pebbles, a habit developed in childhood. Extensive psychometric testing did not demonstrate phobias, obsessions, tendency to increased anxiety, depression or anorexic or bulimic disorder. The development of pica is partially explained by a childhood eating disorder, obsessive personality traits, cultural factors and specific (personality induced) stresses. Stress-reducing measures were successful in eliminating the eating disorder.

The fluoxetine treatment of low-weight, chronic bulimia nervosa.

Ten low-weight (mean, 87.8% of ideal), chronic bulimic patients, seven of whom were previously unsuccessfully treated with antidepressant drugs, received fluoxetine 80 mg/day for 3 months. Endpoint analysis showed a significant decrease in bulimic episodes (p = 0.01), vomiting frequency (p less than 0.05), and depression scores (Hamilton Rating Scale for Depression, p less than 0.04; Beck Depression Inventory, p = 0.05; Hopkins Symptom Checklist-90 depression subscale, p less than 0.05). In addition, trait anxiety (State-Trait Anxiety Inventory trait: p less than 0.002), obsessive symptoms (Leyton Obsessional Inventory symptom: p = 0.01; Symptom Checklist-90 obsessive-compulsive disorders subscale: p = 0.02), and traits (Leyton Obsessional Inventory trait: p = 0.005) also decreased significantly. There was no change in state anxiety or in Leyton Obsessional Inventory interference and resistance scores. There was no significant increase in weight. Two patients were in remission, two were much improved, two improved, and four showed no change. Side effects were minimal. There were no dropouts.

Successful fluvoxamine treatment of a case of refractory obsessive-compulsive disorder.

Fluvoxamine, a potent and selective serotonin uptake inhibitor, effectively reduced compulsive handwashing and other rituals in a patient previously refractory to behaviour therapy, clomipramine, MAO inhibitors and other pharmacotherapy. Treatment effect was delayed but broadly patholytic, reducing anxiety and depression scores as well as ratings of obsessiveness.

A treatment program for functional paraplegia/Munchausen syndrome.

Two patients, referred following lengthy, extensive and frequent medical evaluations, were diagnosed as suffering from chronic factitious disorder with physical symptoms (DSM III). A treatment plan to eliminate the positive reinforcements apparently operating in the hospital and home environment, while preventing "loss of face" of the patient, was formulated and successfully carried out. Two detailed case histories to provide evidence for the diagnosis, the "faradic massage" treatment, patient response, and follow-up are documented.

The extent of bile reflux and development of gastric cancer after resections in rat.

Authors performed gastric resections (Billroth II, Billroth I, Billroth II+, Braun anastomosis and Roux Y reconstruction) and laparotomies in five groups, of 110 Wistar male rats. Thirty-eight weeks postoperatively the surviving 91 animals were sacrificed, and histological study was made of the frequency of gastric stump cancer in the individual groups and the extent of bile reflux characteristic of the individual GEA types was measured. Based on their results, the risk of stump cancer was higher in operation types associated with considerable bile reflux (a cancer incidence rate of 50% after Billroth II, 28.5% after Billroth I). Following gastric resections accompanied by insignificant bile reflux (Billroth II + Braun, Roux Y) the risk of gastric stump cancer was significantly lower.

Trazodone treatment of bulimia nervosa.

Thirteen consecutive referrals of bulimic patients who met DSM-III criteria for bulimia were treated in an open-label, flexible-dose study with trazodone. Three of the 13 dropped out before the fourth week of treatment, the minimum duration of treatment for evaluable subjects, and hence were not included in the analyses. For the 10 evaluable patients, the mean duration of treatment was 6.9 weeks and the mean maximum dose of trazodone was 410 mg (range, 250-600 mg). The number of binge eating and vomiting episodes was significantly decreased (p = 0.05 and 0.06, respectively). These episodes were reduced to zero in four patients and by 55-99% in two patients. Carbohydrate cravings and urges to binge eat were significantly diminished in intensity (p less than 0.02 and 0.008, respectively). The total score (p = not significant) and three subscale scores (p = 0.04, 0.09, and 0.10) of the Eating Disorders Inventory decreased. The mean Hamilton Depression Scale score fell from 10.4 to 3.3 (p = 0.002). Only mild side effects were noted: five subjects complained of morning drowsiness and two of headache. Mean weight was essentially unchanged: pretreatment, 58.5 kg; posttreatment, 57.3 kg. The lack of weight gain represents an advantage of trazodone over other currently prescribed antidepressants, particularly for this group of patients whose fear of becoming fat is a part of their basic pathology.

Delineating social phobia.

The natural history--including psychiatric symptoms, precipitating factors, onset and course of illness, and personality characteristics--of 47 social phobics, 80 agoraphobics, and 72 simple phobics was examined. The social phobia group differed from the agoraphobia group by having a lower mean age, fewer females and married members, and a higher educational and occupational status. They were less fearful generally, less obsessive, and less likely to follow a fluctuating or phasic course. There was overlap between the two groups with regard to main phobias, and they were similar with regard to adjacent symptomatology. Both the social and agoraphobia groups differed in similar and significant ways from simple phobics.

Phenelzine and exposure in the treatment of phobias.

A double-blind study was carried out on 40 agoraphobic and socially phobic patients, matched, then randomly assigned to one of four treatment groups; phenelzine-exposure, phenelzine-no exposure, placebo-exposure, and placebo-no exposure. Exposure consisted of encouraging the patient to face the phobic situation a predetermined number of times. Assessments, made at the beginning and end of 8 weeks of therapy and 8 weeks thereafter, showed that the phobia ratings of groups decreased significantly. The combined exposure group improved significantly more than the combined no exposure group during treatment. At 8 weeks follow-up there was some deterioration in the phenelzine-exposure and placebo-no exposure groups. Exposure, with or without phenelzine, was the superior treatment modality. The antiphobic effect of phenelzine was not supported, although it seemed to reduce subjective anxiety during exposure experiences. The possibility that effect of phenelzine is dose-related is discussed.