The cognitive-behavioral model of hypochondriasis: misinformation and triggers.

According to the cognitive-behavioral model, hypochondriacal individuals hold dysfunctional assumptions about illness, which may be triggered by critical incidents. In this study 1,158 participants completed measures of hypochondriacal concerns and self-esteem, and estimated the likelihood of various symptoms indicating catastrophic and minor illnesses. Participants who were more hypochondriacal believed that catastrophic outcomes were more likely than did the less hypochondriacal participants, but they did not differ in their estimates for minor illnesses. Estimates of the likelihood of catastrophic illness and self-esteem independently contributed to the prediction of hypochondriacal concerns. In this study 2,177 participants completed a measure of hypochondriacal concerns, performed a scrambled-sentences task that included either illness terms or neutral terms, and completed a state anxiety inventory. The illness terms did not trigger higher levels of anxiety in the more hypochondriacal participants; instead, these terms appeared to make the less hypochondriacal participants as anxious as their hypochondriacal counterparts.     

Diurnal consequence of insomnia: impact on quality of life

Insomnia is not only a disease of sleep, it has also daily consequences: fatigue, irritability, impaired daytime functioning. These complaints are regent reported by the patients, however the objective tests assessing alertness in insomnia are usually not impaired when compared with good sleepers. We wanted to appreciate more accurately the daily consequences of insomnia, in terms of quality of life. 240 severe insomniacs (according to the DSM-IV criterias) and 391 good sleepers received a questionnaire on quality of life items. Depressed and anxious patients were excluded from this group. The questionnaire was built by a multidisciplinary group, based on insomniac's interviews. It was primarily tested in a small sample and then proposed in the entire group. Insomniac's quality of life appeared to be significantly impaired in comparison with good sleepers. They experienced more fatigue and more sleepiness during the daytime. They reported more attention disorders and memory complaints. They seemed to be more irritable and sensitive to the environment. At work they made more mistakes and had more sic leave. They also had poorer relationships with relatives and family than good sleepers.     

Pain in depression: STAR*D study findings

BACKGROUND: Pain complaints commonly accompany major depressive disorder (MDD). However, whether patients with MDD and pain complaints differ from those without pain complaints is not well studied. OBJECTIVE: The objective of this study was to compare depressed outpatients with and those without current pain complaints in terms of sociodemographic, clinical, and presenting symptom features. METHODS: The baseline clinical and sociodemographic data of a large representative outpatient sample with nonpsychotic MDD (n=3745) enrolled in the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study were collected. Baseline information on pain complaints was based on Item No. 25 (somatic pain) of the 30-item Inventory of Depressive Symptomatology-Clinician Rating (IDS-C(30)). RESULTS: After adjusting for sex, depression severity (IDS-C(30) less Item No. 25), and general medical comorbidities (as measured by the Cumulative Illness Rating Scale total score), we found clinically meaningful differences between patients with and those without pain complaints. Younger, African American, Hispanic, and less educated patients were more likely to report pain complaints. In addition, those with pain complaints were more likely to report anxious features with irritable mood, sympathetic nervous system arousal, and gastrointestinal problems as well as poorer quality of life. Neither a more chronic course of illness nor suicidal ideation was associated with pain. CONCLUSIONS: Pain complaints are common among outpatients with MDD and are associated with certain symptom features and poorer quality of life. However, the findings of this study suggest that depression accompanied by pain complaints does not increase the clinical psychiatric burden or chronicity of depression.     

Hypochondriacal concerns and somatic symptoms in patients with chronic airflow obstruction

In order to explore hypochondriacal concerns in patients with Chronic Airflow Obstruction (CAO) the authors administered the Illness Attitude Scales and the somatization, anxiety, depression and anger-hostility scales of the Hopkins Symptom Checklist to 50 patients with CAO and to matched family practice patients. Somatic symptoms were significantly correlated with fears of disease and hypochondriacal concerns in family practice patients, but were unrelated in CAO. Patients with CAO, although more anxious, depressed and with more severe somatic symptoms than family practice patients, had fewer hypochondriacal concerns. In this respect patients with CAO were unlike any other group previously studied.     

European neuroborreliosis: quality of life 30 months after treatment

Eikeland R, Mygland Å, Herlofson K, Ljøstad U. European neuroborreliosis: quality of life 30 months after treatment.
Acta Neurol Scand: 2011: 124: 349–354.
© 2011 John Wiley & Sons A/S. Objectives – The prognosis after Lyme neuroborreliosis (LNB) is debated. The aim of this study was to assess health‐related Quality of Life (QoL) and neurological symptoms 30 months after treatment in European patients with LNB. Materials and methods – In a prospective case–control designed study, we investigated 50 well‐characterized patients with LNB who had participated in a treatment trial for LNB 30 months earlier and 50 matched control persons with the health QoL questionnaire Short‐Form 36 (SF‐36), the Fatigue Severity Scale (FSS), the Montgomery and Åsberg Depression Rating Scale (MADRS), the Starkstein Apathy Scale (SAS), and the Mini Mental State (MMS). Clinical and demographic data were collected by semi‐structured interviews and clinical neurological examination. Results – Lyme neuroborreliosis‐treated patients scored lower than control persons in the SF‐36 domains physical component summary (PCS) (44 vs 51 P < 0.001) and mental component summary (MCS) (49 vs 54 P = 0.010). They also scored lower than control persons in all the SF‐36 subscales, except for bodily pain, and on FSS (3.5 vs 2.1 P < 0.001), but not on MMS (28 vs 29 P = 0.106). There was a difference in MADRS (3.1 vs 0. 8 P = 0.003) and SAS (13 vs 11 P = 0.016), but the scores were low in both groups. Fatigue was the most frequently reported symptom among LNB‐treated patients (50%). Patients who reported complete recovery (56%) after LNB had similar QoL scores as the controls. Conclusion – European persons treated for LNB have poorer health‐related QoL and have more fatigue than persons without LNB.     

Association between painful physical symptoms and clinical outcomes in Taiwanese patients with major depressive disorder: A three‐month observational study

Introduction: Reports from non‐Asian populations indicate that painful physical symptoms are associated with poorer clinical and functional outcomes in patients with Major Depressive Disorder (MDD). This paper shows the changes in disease characteristics and quality of life in Taiwanese MDD patients, with or without painful physical symptoms, over 3 months' observation. Methods: Taiwanese patients from an observational study of six East Asian countries/regions were classified as painful physical symptom positive (PPS+) or negative (PPS−) based on a mean score of ≥2 or <2, respectively, on the modified Somatic Symptom Inventory. Changes from baseline in outcomes were compared between the groups. Results: Of 194 patients with MDD, 69% were PPS+ at baseline. These PPS+ patients were more depressed (17‐item Hamilton Depression Rating Scale total; mean [SD] 27.1 [6.26] versus 21.8 [5.94] PPS−, P<0.001), in more pain (Visual Analog Scale overall; median [range] 73.5 [9–100] versus 40 [0 to 80] PPS−, P<0.001) and had poorer quality of life at baseline (EuroQoL; mean [SD] 42.9 [18.26] versus 59.8 [18.21] PPS−,P<0.001). At endpoint (n=118), PPS− patients showed greater improvement on depression outcomes (Clinical Global Impression of Severity; P=0.011) and had a higher remission rate (52.8 % versus 14.6% PPS+, P=0.007). Discussion: Painful physical symptoms were frequently observed in Taiwanese patients with MDD. As PPS are associated with more severe depression, poorer quality of life, and poorer remission outcomes, clinical management should address both the mental and physical symptoms associated with this disorder.     

Distress and attitudes in patients perceived as hypochondriacal by medical staff

The aim of this study was to examine the characteristics of patients perceived by general physicians as hypochondriacal. The authors requested physicians at a general hospital to refer patients for a study of hypochondriasis. In order to measure depression, anxiety, and somatic symptoms, the authors administered several rating and self-rating scales, and to measure hypochondriacal attitudes they administered the Illness Attitude Scales (IAS) and the Illness Behavior Questionnaire (IBQ). The referred patients (N = 29) had more psychiatric disorders, were more depressed and more anxious, and had more severe somatic symptoms than matched medical patients who had not been referred. Self-rated hypochondriacal fears and beliefs did not differ significantly between the groups. Five of the referred patients (17%) whose initial diagnosis was hypochondriasis were subsequently found to have physical diseases that accounted for their symptoms. The implications of these findings for treatment are discussed.     

Deterioration in the health-related quality of life of persons with multiple sclerosis: the possible warning signs

Baseline data from a population-based study examining the health-related quality of life (HRQL) of MS patients about to begin disease modifying therapy was used to determine the factors associated with the HRQL of Saskatchewan adults with relapsing-remitting MS. Participants completed a self-report questionnaire regarding demographic and socioeconomic status, fatigue, comorbid medical conditions, disability level (EDSS), number of attacks in past 6 months, illness intrusiveness (Illness Intrusiveness Ratings Scale), depression (Beck Depression Inventory), and HRQL (SF-36 Health Status Survey). Multiple linear regression models were used to identify the factors associated with the physical and mental health summary scores of the SF-36. We found poorer physical HRQL in those who are female; older; not working; have musculoskeletal or respiratory problems; greater fatigue, higher disability scores, and more MS attacks. High illness intrusiveness; digestive system problems; genitourinary problems; and headaches were associated with poorer mental HRQL. Interestingly, we found an interaction between sex and age in mental HRQL, with worse mental health in older men but better mental health in older women. These findings may assist health care providers in identifying patients who may be at risk for decline in their HRQL, permitting appropriate and timely interventions.     

Nonspecific factors and side effect complaints. Factors affecting the incidence of drowsiness in drug and placebo treated anxious and depressed outpatients.

Discriminant function analyses were applied to data obtained from anxious psychiatric outpatients treated with either chlordiazepoxide (n = 353) or placebo (n = 259) and depressed outpatients treated with either amitriptyline (n = 310) or placebo (n = 328), who had participated in controlled drug trials of 4 weeks' duration, in an attempt to identify factors associated with complaints of drowsiness made by these patients. Although the magnitude of the relationships between individual predictors and drowsiness was small, several factors emerged which had consistent impact across treatment groups. Predictors of complaints of drowsiness attributed to active drugs arose primarily from demographic attributes probably reflective of life style, and from illness and treatment history. In contrast, predictors of drowsiness attributed to placebo were almost exclusively confined to indices of the severity of several aspects of presenting symptomatology. In particular, more frequent complaints of drug-induced drowsiness were found among better educated individuals with an illness of long duration. Complaints of placebo-induced drowsiness were more common among patients with more severe emotional (phobic-obsessive) symptomatology and more frequent headaches and among those individuals in whom hypochondriasis was less severe.     

Health‐related quality of life in early Parkinson's disease: The impact of nonmotor symptoms

Nonmotor symptoms (NMS) are common in patients with established Parkinson's disease (PD) and have a major impact upon quality of life. We investigated the significance of NMS in relation to health‐related quality of life (HRQoL) in patients with newly diagnosed PD. Patients and healthy controls were recruited as part of the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in Parkinson's Disease Study. Prevalence of NMS was determined with the Non‐Motor Symptom Questionnaire. HRQoL was recorded with the 39‐item Parkinson's Disease Quality of Life Questionnaire (PDQ‐39). Further assessments included measures of motor disability, depression, sleep, and cognition. One hundred and fifty‐eight patients with newly diagnosed PD and 99 controls participated in this cross‐sectional study. Patients reported greater numbers of NMS than controls (mean 8.3 ± 4.3 versus 2.8 ± 2.5 symptoms; P < 0.001). Patients reported lowest HRQoL in the domains assessing bodily discomfort, mobility, and activities of daily living. Motor and nonmotor symptoms impacted negatively upon HRQoL scores. Patients with the postural instability and gait difficulty motor subtype reported worse HRQoL, compared with those with tremor‐dominant disease. Depression (P < 0.001), incomplete bowel emptying (P < 0.001), anxiety (P < 0.001), impaired concentration (P < 0.001), memory complaints (P < 0.001), and insomnia (P = 0.001) had the greatest negative impact upon HRQoL. NMS are common in patients with early PD and represent a significant cause of poorer health‐related quality of life. Cognitive, neuropsychiatric, and sleep disturbances are particularly associated with reduced well‐being. Screening and management of these symptoms should be prioritized at the time of diagnosis. © 2013 International Parkinson and Movement Disorder Society     

Memory impairment and depression in patients with Lyme encephalopathy: comparison with fibromyalgia and nonpsychotically depressed patients.

Lyme encephalopathy, primarily manifested by disturbances in memory, mood, and sleep, is a common late neurologic manifestation of Lyme disease. We compared 20 patients with Lyme encephalopathy with 11 fibromyalgia patients and 11 nonpsychotically depressed patients using the California Verbal Learning Test, Wechsler Memory Scale, Rey-Osterrieth Complex Figure Test, Minnesota Multiphasic Personality Inventory (MMPI), and Beck Depression Inventory. Compared with patients with fibromyalgia or depression, the Lyme encephalopathy group showed mild, but statistically significant, memory deficits on two of the three memory tests. In contrast, the patients with fibromyalgia scored significantly higher than both other groups on the MMPI scale most sensitive to somatic concerns (scale 1), while the depressed patients scored higher than the Lyme patients on the scales most sensitive to depression (scale 2) and anxiety (scale 7). Physical complaints and depression were not major factors in memory performance among Lyme patients. These data support the hypothesis that Lyme encephalopathy is caused by CNS dysfunction and cannot be explained as a psychological response to chronic illness.     

Validity of a simpler definition of major depressive disorder

Background: In previous reports from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we developed a briefer definition of major depressive disorder (MDD), and found high levels of agreement between the simplified and DSM‐IV definitions of MDD. The goal of the present study was to examine the validity of the simpler definition of MDD. We hypothesized that compared to patients with adjustment disorder, patients with MDD would be more severely depressed, have poorer psychosocial functioning, have greater suicidal ideation at the time of the intake evaluation, and have an increased morbid risk for depression in their first‐degree family members. Methods: We compared 1,486 patients who met the symptom criteria for current MDD according to either DSM‐IV or the simpler definition to 145 patients with a current diagnosis of adjustment disorder with depressed mood or depressed and anxious mood. Results: The patients with MDD were more severely depressed, more likely to have missed time from work due to psychiatric reasons, reported higher levels of suicidal ideation, and had a significantly higher morbid risk for depression in their first‐degree family members. Both definitions of MDD were valid. Conclusions: The simpler definition of MDD was as valid as the DSM‐IV definition. This new definition offers two advantages over the DSM‐IV definition—it is briefer and therefore more likely to be recalled and applied in clinical practice, and it is free of somatic symptoms thereby making it easier to apply with medically ill patients. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Depression,illness beliefs and severity of illness

The relationship of affective status to abnormal illness behavior (AIB), locus of control and severity of illness was investigated in a series of patients seen for psychiatric consultation in a general hospital. Results showed no relationship between depression and the actual severity of illness, AIB dimensions or locus of control. Patients with chronic pain complaints, however, ascribed their problems to emotional factors and acknowledged affective distress more than those without chronic pain. More externally located individuals had greater hypochondriacal fear, disease conviction and affective distress. Thus, patients with chronic pain may ‘organize’ illness around psychosomatic constructs. The externally located patient's pessimism and feelings of physical vulnerability may require more active psychological support. Therapeutic implications are discussed.     

The correlates of hypochondriasis in depressed patients

Of 100 inpatients with depressive illness, fifty-three had evidence of depressed mood prior to their hypochondriacal symptoms, sixteen had the opposite sequence of development and thirty-one had no hypochondriacal symptoms. Comparisons of the three groups revealed some differences that would suggest a less severe depressed mood in association with hypochondriacal symptoms. Whether hypochondriasis preceded or followed depressed mood did not make any other difference to the total clinical picture. This should not be taken to imply that treatment and prognosis are the same in hypochondriacal and nonhypochondriacal depressions.     

Hypochondriacal beliefs and attitudes in family practice and psychiatric patients

Beliefs and attitudes which can be responsible for hypochondriacal behavior were explored by administering the Illness Attitude Scales and two distress scales to patients attending a family practice clinic, nonpsychotic psychiatric outpatients and a random group of employees. Family practice patients were more distressed, had more hypochondriacal concerns and had more bodily preoccupations than employees and took more precautions about their health. Psychiatric patients were more distressed and had more fears about illness and death than family practice patients, yet took fewer precautions about their health. The findings appear to have implications for treatment.     

Prognosis of treated hypochondriasis. A clinical study

Thirty-six patients who had hypochondriacal neurosis for 6 months or longer were treated with individual psychotherapy which focused predominantly on presenting complaints, fears and beliefs. Antianxiety drugs were used at times of anxiety. Sixty-four percent either recovered or improved to the extent that they no longer believed that they had a disease. The improvement was largely maintained on a 2-year follow-up. Good outcome was associated with illnesses of less than 3 years duration, the absence of an additional diagnosis of a personality disorder and there was a nonsignificant trend to belong to a higher social class. Outcome was not associated with age, sex, or severity of initial ratings of anxiety, depression or somatic symptoms. It appears that the prognosis of treated hypochondriacal neurosis is good in a substantial proportion of patients.     

The significance of somatic and psychosocial factors for coping with illness by patients with multiple sclerosis

The coping behavior of 298 multiple sclerosis patients was assessed by means of a questionnaire. Despite more pronounced somatic complaints, women view their psychological situation more positively than men; they are more optimistic, less anxious, less depressed, and less preoccupied with their illness and its consequences. In the event of reduced working capacity due to the disease, men are more frequently disabled than housewives. However, there is evidence that early disability compensation may have a negative effect on the psychological well-being and the coping behavior. Careful thought should therefore be given to the timing when the question of a pension is discussed.     

Fatigue and Depression in Epilepsy

Fatigue is commonly reported as an adverse effect of antiepileptic drugs. In other disorders, fatigue has been closely correlated with depression. We examined the frequency of fatigue in epilepsy patients, the contribution of depression to fatigue, and the impact of fatigue upon quality of life. We measured fatigue and depression with the Fatigue Severity Scale (FSS) and Center for Epidemiological Studies-Depression scale (CES-D), respectively in 89 patients with epilepsy at an epilepsy center, 26 depressed controls (DC), and 30 normal health adults (NHA). Patients with epilepsy also completed the Quality of Life in Epilepsy (QOLIE-10) scale. Forty-four percent of epilepsy patients met criteria for severe fatigue, while 52% were depressed. The correlation between fatigue and depression was high among epilepsy patients (r = .60, p = .0001). Both fatigue and depression had an inverse relationship with quality of life in epilepsy (p < .0001). Fatigue in epilepsy is common and is closely associated with depression. Fatigue is associated with significant impairment in quality of life in epilepsy.     

Illness coping strategies and hypochondriacal traits among medical inpatients

The Illness Coping Strategies scale (ICS) is an 18-Likert-item scale developed to examine illness appraisal and coping by medical patients more comprehensively than instruments which screen for hypochondriacal traits in this population. This study has examined the association of hypochondriacal traits with illness coping strategies addressed by the ICS among 101 randomly selected inpatients drawn from a general medicine unit of a teaching general hospital. Despite the exclusion of patients with substance abuse or organic mental disorder, or referral for psychiatric consultations, hypochondriacal traits were prevalent in this inpatient sample. Five factor-derived subscales of the ICS (disease vigilance, limit activity, overresponsiveness, self-treatment and obsessive worry) were extracted, and internal consistency and test-retest reliabilities were determined. Multiple regression analysis on a composite measure of hypochondriasis revealed that the five ICS factor scales accounted for 26 percent of the variance. Patients with a high hypochondriacal index had associated high scores on symptom vigilance, limit activity and obsessive worry subscales, suggesting that these illness coping strategies may represent an important aspect of hypochondriacal illness presentation. The self-treatment subscale appeared to act as a suppressor variable, contributing to the prediction of the hypochondriacal index by extracting self treatment aspects from the other illness coping factors. Illness coping responses found to be associated with hypochondriacal traits in this study were rather passive strategies which promoted increased vigilance and concern about symptoms while providing few opportunities to reduce uncertainty regarding health status.     

The diagnostic spectrum in patients with suspected chronic Lyme neuroborreliosis – the experience from one year of a university hospital’s Lyme neuroborreliosis outpatients clinic

Background and purpose: Studies addressing the diagnostic relevance of anti‐Borrelia burgdorferi (BB) serum antibodies in patients with non‐specific symptoms and suspected chronic Lyme neuroborreliosis (LNB) are scarce. Methods: In this study, we enrolled within 1 year 122 patients with suspected chronic LNB. One hundred and fourteen patients had previously tested positive for BB. All patients had previously received antibiotic treatment. Each patient received a clinical examination and measurement of BB‐specific antibodies. The diagnosis of neuroborreliosis was made according to the national guidelines of the German Society of Neurology. Nine patients had acute borreliosis. One of the nine met the criteria of acute LNB. Of the remaining 113 patients, 85 patients underwent a lumbar puncture. Ten seronegative subjects without lumbar puncture were also considered. In 61.8% of these 95 patients the quality of life, of sleep, mood, and anxiety were assessed. Results: Of 95 patients, 25.3% had symptoms without a somatic cause or evidence of borreliosis, 38.9% had a well‐defined illness unrelated to BB infection, and 29.5% suffered from symptoms without a detectable somatic cause, displaying antibodies against BB. Six patients were grouped as post‐LNB syndrome. Most common symptoms in all categories were arthralgia, myalgia, dysaesthesia, depressive mood and chronic fatigue. Conclusion: Patients with persistent symptoms with elevated serum antibodies against BB but without signs of cerebrospinal fluid inflammation require further diagnostic examinations to exclude ongoing infection and to avoid co‐infections and other treatable conditions (e.g. autoimmune diseases). One patient with acute LNB, who was treated with ceftriaxone for 3 weeks suffered from LNB with new headaches and persistent symptoms 6 months later. These data should encourage further studies with new experimental parameters.