Use of verbal pain measurement in the detection of hidden psychological morbidity among low back pain patients with objective organic findings

Abstract

Patients with positive physical findings to explain low back pain arc believed lo belong to two organic subgroups. One group has organic disease alone: in the other, organic disease is accompanied by psychological disturbance. Separation of patients with medical findings into groups with varying levels of psychological disturbance is difficult, because emotional disturbance is often hidden. In this study, the pain report of 124 patients with organic findings alone, and 50 patients with organic and psychological findings was examined to determine whether pain measurement could he used to identify accurately patients belonging 10 the two groups. the pain groups differed in the use of 43 pain words from the Low Back Pain Symptom Check List. Using a set of weights derived From discriminant analysis. the 33 pain words predicted 99.2% of the patients with organic disease alone and 86.0% of the patients with organic disease and psychological disturbance. The results were replicated in a new sample of 140 patients. Cross-validation shrinkage in accuracy was 8.3%. The results of the two studies suggest that pain measurement may he a useful clinical indicator of psychological disturbance in patients with organic findings.     

exploring drug users' illness representations of hiv,hepatitis b and hepatitis c using repertory grids

Abstract

Hepatitis B and C viruses are more prevalent among injecting drug users than HIV. This study explored drug users' illness representations of hepatitis B and C using repertory grid methodology. Initially, nine drug users were presented with six elements including hepatitis B and C, and HIV. Constructs were elicited via the sequential form variation of the method of triads. Elements were rated on elicited constructs using a five-point scale, and analyzed using “Flexigrid”. In a second quantitative research stage, 52 drug users were presented with six elements and supplied constructs. Results of the first stage indicated participants were able to generate constructs relating to Leventhal et al.'s (1980) features of illness representations. Most constructs, however, were causal in nature. Participants perceived hepatitis B, C and HIV similarly along the causal component. This similarity on the causal component was largely replicated in the second research stage. Participants, however, distinguished HIV from hepatitis B and C along serious, cure and timeline features. Participants did not distinguish hepatitis B from hepatitis C. The implications of these results for health promotion are discussed.     

Epidemiologie psychischer Störungen

The discipline of epidemiology not only contributes to knowledge regarding the distribution and prevalence of mental disorders but also to a better understanding of their causes and consequences. This article focuses on the prevalence and disease burden. Epidemiological studies show that mental disorders are more common than previously thought and that they are associated with a particularly high societal burden. Costs of illness are higher in mental disorders compared to many widespread somatic conditions because of their high prevalence, chronic course, young age of first onset and the profile of disability. The extent of inability to work due to mental disorders is rising steadily although a general decline in absenteeism has been observed across other disease types. This raises the question of whether mental disorders have increased recently. Furthermore, the general need for treatment is discussed as well as the corresponding mental health care options. Finally, it has been found that, despite the quantitatively relatively well-developed health care system in Germany, there are still signs of a significant undertreatment in the field of psychotherapy.     

Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study

Objective

There has been uncertainty about whether refugees and asylum seekers with PTSD can be treated effectively in standard psychiatric settings in industrialized countries. In this study, Narrative Exposure Therapy (NET) was compared to Treatment As Usual (TAU) in 11 general psychiatric health care units in Norway. The focus was on changes in symptom severity and in the diagnostic status for PTSD and depression.

Method

Refugees and asylum seekers fulfilling the DSM-IV criteria for PTSD (N = 81) were randomized with an a-priori probability of 2:1 to either NET (N = 51) or TAU (N = 30). The patients were assessed with Clinician Administered PTSD Scale, Hamilton rating scale for depression and the MINI Neuropsychiatric Interview before treatment, and again at one and six months after the completion.

Results

Both NET and TAU gave clinically relevant symptom reduction both in PTSD and in depression. NET gave significantly more symptom reduction compared to TAU as well as significantly more reduction in participants with PTSD diagnoses. No difference in treatment efficacy was found between refugees and asylum seekers.

Conclusions

The study indicated that refugees and asylum seekers can be treated successfully for PTSD and depression in the general psychiatric health care system; NET appeared to be a promising treatment for both groups.

ClinicalTrials.gov registry number

NCT00218959.     

Introduction: Using Techniques via the Therapeutic Relationship

In this work, we have the opportunity to hear people’s most private concerns, worries, distress, and share in their hopes, aspirations, and dreams for the future. The work involved in the practice of cognitive behavior therapy; our knowledge, theories, techniques, and strategies are practically useless if we are unable to relate to our clients. Relational attributes were incorporated as part of the defining features essential to therapeutic change in the seminal guide for cognitive therapy (A. T. Beck, Rush, Shaw, & Emery, 1979). Conceptualizations of “collaboration” and “empiricism” have since been misconstrued with the construct of the working alliance in the past, although both have unique distinctions and implications for practice. This article presents an introduction to a special series in Cognitive and Behavioral Practice, which illustrates the vital role of collaborative empiricism within culturally responsive CBT, through the structure of the therapy session, cognitive case conceptualization, self-monitoring, interventions focused on cognitive change, and exposure to emotions and situations. We invite you to join with us in considering the extent to which the ideas shared herein are relevant for your work with clients. It is also our hope that you will consider evaluating and incorporating the utility of these ideas in your therapy.     

Eye movements across viewpoint changes in multiple object tracking

Observers can visually track multiple objects that move independently even if the scene containing the moving objects is rotated in a smooth way. Abrupt scene rotations yield tracking more difficult but not impossible. For nonrotated, stable dynamic displays, the strategy of looking at the targets' centroid has been shown to be of importance for visual tracking. But which factors determine successful visual tracking in a nonstable dynamic display? We report two eye tracking experiments that present evidence for centroid looking. Across abrupt viewpoint changes, gaze on the centroid is more stable than gaze on targets indicating a process of realigning targets as a group. Further, we show that the relative importance of centroid looking increases with object speed.     

Multisensory self‐motion encoding in parietal cortex

Navigation through the environment requires the brain to process a number of incoming sensory signals, such as visual optical flow on the retina and motion information originating from the vestibular organs. In addition, tactile as well as auditory signals can help to disambiguate the continuous stream of incoming information and determining the signals resulting from one's own set of motion. In this review I will focus on the cortical processing of motion information in one subregion of the posterior parietal cortex, i.e., the ventral intraparietal area (VIP). I will review (1) electrophysiological data from single cell recordings in the awake macaque showing how self‐motion signals across different sensory modalities are represented within this area and (2) data from fMRI recordings in normal human subjects providing evidence for the existence of a functionally equivalent area of macaque area VIP in the human cortex.     

Structural equation modelling of human judgement

Structural equation modelling (SEM) is outlined and compared with two non-linear alternatives, artificial neural networks and “fast and frugal” models. One particular non-linear decision-making situation is discussed, that exemplified by a lexicographic semi-order. We illustrate the use of SEM on a dataset derived from 539 volunteers' responses to questions about food-related risks. Our conclusion is that SEM is a useful member of the armoury of techniques available to the student of human judgement: it subsumes several multivariate statistical techniques and permits their flexible combination, and it provides robust goodness-of-fit statistics and is available in (generally) easy-to-use computer packages. Although the number of tasks for which SEM provides a persuasive psychological model is small, it is very useful in identifying the important variables and their inter-relations that contribute to task performance, and thus can constitute a valuable intermediate staging point between raw data and a fully fledged psychological theory.