Prevalence of depression among general hospital surgical inpatients.

Previous studies report a wide range of prevalence rates of depressive illness among general hospital inpatients, all higher than in a non-patient population. Several factors may have influenced on these results. Mixed study population, depression-prone subgroups and continuous shift in what is a surgical inpatient population due to day surgery treatment are examples. In the present study, 108 patients were assessed with the Structured Clinical Interview for DSM-III-R Non-Patient (SCID-NP) version for current major depression (CMD) and for dysthymia. Furthermore, a patient self-rating scale for depressive symptoms and anxiety, the Hospital Anxiety and Depression Scale (HADS), was applied. CMD was diagnosed among 14/108 patients (13%). Depressive symptoms (HADS-D> or =8) were seen in 14 patients. Symptoms of anxiety (HADS-A> or =8) were seen in 12/14 CMD patients (86%). Ten of the 14 patients diagnosed as CMD (71%) did not receive any pharmacological antidepressant treatment. After excluding known depression-prone subgroups of patients representing a bias, this study showed that in a community hospital group of adult surgical patients between 18 and 65 years of age, the prevalence of depression is still somewhat higher than in the general population, but not as high as in the previous studies on general hospital patients to which we referred. Thus, this high prevalence of depression in part could be due to increased depression rates in certain population subgroups. However, this hypothesis alone is not sufficient to explain the present results fully.

The prevalence of current major depression and dysthymia in a Norwegian general practice.

Existing studies suggest that depression is underdiagnosed and undertreated in general practice, and that the known prevalence of this mood disorder in a primary care population may represent only the "tip of the iceberg'. A total of 100 consecutive patients in an average Norwegian general practice were tested, of whom 31 patients were diagnosed as having a depressive illness in this study; 28 patients were diagnosed as having current major depression and three as having dysthymia. In total, 21 of the 28 patients with current major depression presented with other symptoms as their major complaints at the consultation in which they were tested. Twelve of these 21 patients had some kind of pain problem.

Fibromyalgia and disability. Report of the Moss International Working Group on medico-legal aspects of chronic widespread musculoskeletal pain complaints and fibromyalgia.

The present article is the result of a working group conference held in Moss, Norway, in June 1993, financed by the Royal Norwegian Ministry of Health and Social Affairs. Its purpose was to review and focus upon problems and needs related to the medico-legal aspects of fibromyalgia and chronic widespread musculoskeletal complaints: thus to define directions for future work on issues which have generally not been addressed within the medical community. Our report describes specific problems in this area in regard to definition, evaluation and recommendation, and in currently available work and disability statistics. We have recommended international efforts to establish research programs through organizations such as the International Social Security Association and the World Health Organization. While our recommendations call for research into medico-legal interactions, causes and pathogenic mechanisms, prevention and treatment are also key and relevant concerns in the medico-legal setting.

[Fibromyalgia--a relationship between psyche and soma?]. / Fibromyalgi--et forhold mellom psyke og soma?

Fibromyalgia is regarded a state of pain that can both be triggered and maintained by a broad spectre of events, ranging from massive psychogenic stress to long-lasting excessive somatic strain. Based on a review of selected studies supported by the Norwegian Medical Research Council, this paper focuses on muscular exercise and related pain, the functional significance of certain neuropeptides, the contribution of the sympathetic nervous system and the psychological aspects of the condition.

Cerebrospinal fluid biogenic amine metabolites in fibromyalgia/fibrositis syndrome and rheumatoid arthritis.

OBJECTIVE: To compare the levels of biogenic amines in the cerebrospinal fluid (CSF) of primary fibromyalgia syndrome (PFS) patients with those in the CSF of controls. METHODS: Metabolites of serotonin, norepinephrine, and dopamine were identified in CSF, using high performance liquid chromatography with coulometric detection. RESULTS: CSF levels of metabolites from all 3 neurotransmitters were lower in PFS patients than in controls. CONCLUSION: A low rate of turnover of several neurotransmitters supports the proposed hypothesis of a metabolic defect in PFS and suggests that the defect occurs at a neuroregulatory level.

Electrodermal and microcirculatory activity in patients with fibromyalgia during baseline, acoustic stimulation and cold pressor tests.

The peripheral sympathetic activity was studied in 27 patients with fibromyalgia and 29 healthy controls through simultaneous measurements of electrodermal variables and blood flow at palmar skin sites during baseline, acoustic stimulation, and cold pressor tests. Compared to the controls, the patient group showed a significantly larger overall increase in the skin electrical conductance and less vasoconstriction during acoustic stimulation and cold pressor tests. These findings imply an increased activity of cholinergic and decreased activity of adrenergic components of the peripheral sympathetic nervous system in patients with fibromyalgia.

Modulation of pain in fibromyalgia (fibrositis syndrome): cerebrospinal fluid (CSF) investigation of pain related neuropeptides with special reference to calcitonin gene related peptide (CGRP).

The cerebrospinal fluid (CSF) levels of calcitonin gene related peptide (CGRP) were 0.94 +/- 0.06 fmol/ml (mean +/- SEM), of substance P, 35.1 +/- 3.2 fmol/ml and of substance P (1-7), 10.8 +/- 1.2 fmol/ml, as measured by radioimmunoassay in 26 female patients with fibromyalgia. No correlation was found between the levels of CGRP and the substance P and substance P (1-7) levels (r = 0.316, p = 0.14). Our results show that the anatomical coexistence of pain related neuropeptides in neurons is not necessarily reflected by the levels of these peptides measured in the CSF. The presence of CGRP in the CSF could be important since it can enhance the nociceptive activity of tachykinins. This may be of importance in the pathogenesis of pain in fibromyalgia.

Altered sympathetic nervous system response in patients with fibromyalgia (fibrositis syndrome).

Twenty-seven female patients with fibromyalgia and 29 female healthy controls underwent an auditive stimulation test and a left hand cold pressor test at 10 and 4 degrees C. The microcirculatory changes observed, indicate that, as a response to 80 dB, 1000 Hz, 2 seconds sounds and cooling with associated pain, the vasoconstrictory responses are less in patients with fibromyalgia than in normal controls. This could indicate altered sympathetic nervous activity in patients with fibromyalgia and that the cutaneous manifestations previously interpreted as Raynaud's phenomenon should be reconsidered.

Treatment of fibromyalgia (fibrositis syndrome): a parallel double blind trial with carisoprodol, paracetamol and caffeine (Somadril comp) versus placebo.

Forty-three of fifty-eight (74.1%) female patients with fibromyalgia completed an eight-week treatment period testing the combination of carisoprodol, paracetamol (acetaminophen) and caffeine versus placebo. Twenty-three patients received placebo and twenty active medication. In the placebo group 56.5% of the patients used additional analgesics or nonsteroidal anti-inflammatory drugs compared to only 20% in the active treatment group (p = 0.015). Forty-three percent of the patients in the placebo group and none of the patients in the active treatment group used tricyclic antidepressants, anxiolytics or sedatives (p = 0.0008). Active treatment gave statistically significant improvement after treatment for pain (p less than 0.01), for sleep quality (p less than 0.01) and for the general feeling of sickness (p less than 0.05). In the active treatment group increased pressure pain threshold after eight weeks was found at 70% of the sites measured, while the pressure pain threshold was increased at only 30% of the sites in the placebo group. In the placebo group improvement was found for the pain and sleep quality (p less than 0.05). This improvement may in part be due to the large amounts of extra medication in this group. Thus, the combination of carisoprodol and paracetamol (acetaminophen) and caffeine are effective in the treatment of fibromyalgia.

Cerebrospinal fluid levels of beta-endorphin in patients with fibromyalgia (fibrositis syndrome).

Cerebrospinal fluid (CSF) samples from 18 female patients with fibromyalgia (fibrositis syndrome) were analyzed for beta-endorphin. The mean CSF level of beta-endorphin was 20.7 +/- 0.7 fmol/ml in the patients compared to 20.5 +/- 2.0 fmol/ml (mean +/- SEM) in healthy controls (p greater than 0.05). Thus, patients with fibromyalgia (fibrositis syndrome) seem to have normal CSF levels of the pain modulatory neuropeptide beta-endorphin.

Characterization of a substance P-Gly12 amidating enzyme in human cerebrospinal fluid.

Enzyme activity capable of converting the glycine-extended substance P precursor, substance P-Gly12, into substance P was purified from human cerebrospinal fluid. The conversion reaction was monitored by radioimmunoassay measurement of substance P formation. The chemical identity of the product was verified by reversed-phase HPLC. The enzyme reaction was stimulated by Cu(II) ion and ascorbic acid and inhibited by the presence of diethyldithiocarbamate. By HPLC molecular sieving, the major enzyme activity appeared as a protein of 26,000 molecular weight.