Modern health worries and idiopathic environmental intolerance

Objective

We conducted two studies to test whether modern health worries (MHWs) were associated with central features of a condition called idiopathic environmental intolerance (IEI) and medical care utilization.

Methods

In Study 1, 474 Internet users completed an Internet-based questionnaire that assessed MHWs, IEI features, and medical care utilization. In Study 2, the diagnostic specificity of MHWs was investigated by comparing the level of MHWs of three diagnostic groups: 46 people with IEI, 38 people with somatoform disorder but without IEI, and 46 people with neither IEI nor somatoform disorder.

Results

The good psychometric properties of the MHW scale were confirmed. MHWs were related to various features of IEI, and people who met IEI case criteria showed consistently higher levels of MHWs compared with people without IEI. The link between MHWs and number of doctor visits was mediated by perceived IEI complaints. In Study 2, the MHW scale effectively discriminated the IEI group from the non-IEI groups.

Conclusions

These results suggest that MHWs may contribute to the development of IEI. However, only prospective longitudinal studies will enable us to determine the predictive importance of MHWs for later development of IEI.     

Trauma experience in individuals with idiopathic environmental intolerance and individuals with somatoform disorders

OBJECTIVE: Results from previous studies suggest that past trauma experience increases the risk for medically unexplained somatic symptoms and somatoform disorders (SFD). This cross-sectional study examined the link between various lifetime traumas, idiopathic environmental intolerance (IEI), and SFD. METHODS: Two clinical groups of 54 subjects with IEI and 44 subjects with SFD were compared to 54 subjects (comparison group, CG) free from both IEI and SFD regarding self-reported traumas. The subjects were mainly recruited via advertisements in local newspapers. From 970 individuals screened for IEI and multiple somatic symptoms, 152 were included through a two-step selection procedure consisting of screening questionnaires, a medical examination, and structured interviews for IEI and mental disorders. RESULTS: In all three groups at least one potential traumatic event was reported rather frequently (CG: 70%; IEI: 82%; SFD: 73%). But contrary to our expectation, significant group differences were neither found in regard to the proportion of subjects with any trauma, nor traumas fulfilling DSM-IV criteria (CG: 41%; IEI: 48%; SFD: 59%), nor multiple traumas (CG: 43%, IEI: 56%, SFD: 39%). Only two trauma categories were endorsed more frequently by the two clinical groups than by the CG: the unspecified 'other' category (IEI, SFD>CG) and 'life-threatening illness' (IEI>CG). CONCLUSION: No clear evidence was found for increased rates of trauma experience in IEI and SFD. However, the results of this exploratory study should be considered as preliminary. Comparing larger IEI and SFD groups with a representative population-based sample may yield different results.     

The reliability and validity of the Symptom Interpretation Questionnaire

OBJECTIVE: Two studies were conducted to assess the construct validity of the Symptom Interpretation Questionnaire (SIQ) with particular attention to its relationship to social desirability, daily symptom, mood, hassles reports, and personality. METHODS: Participants completed a battery of self-report measures collected at one point in time and completed several measures on a daily basis for 60 days. The three subscales of the SIQ (Psychological, Somatic, Normalizing) were correlated with theoretically related and unrelated constructs to assess its convergent and discriminant validity. RESULTS: The Psychological Attribution scale was associated with a negative reporting style as evidenced by its association with low social desirability, neuroticism, and the report of psychological and physical symptoms, negative mood, and hassles. Somatic Attributions were inconsistently associated with daily somatic symptom reports and doctor visits, but were not associated with negative mood or hassles. Normalizing Attributions were not associated with social desirability or doctor visits, but were inconsistently related to daily negative mood and hassles. Normalizing attributions were also inconsistently related to "healthy" aspects of personality. CONCLUSION: These results suggest that the SIQ has a small degree of convergent validity but little discriminant validity, making it difficult to ascertain exactly what this measure taps.     

Abnormalities in cognitive-emotional information processing in idiopathic environmental intolerance and somatoform disorders

Idiopathic environmental intolerance (IEI) represents a functional somatic syndrome marked by diverse bodily complaints attributed to various substances in the environment. Evidence for abnormalities in affective information processing similar to somatoform disorders (SFD) has recently been found in people with IEI. In order to further investigate these cognitive-emotional abnormalities, we compared people with IEI (n = 49), SFD only (n = 43), and non-somatoform controls (n = 54) with respect to their performance in the extrinsic affective Simon task (EAST). This task allowed us to dissociate indicators of automatic affective associations and emotional intrusion effects of both bodily complaints and IEI-trigger words. Negative association effects toward IEI-trigger words were strongest for IEI participants. Emotional intrusion effects of symptom words were larger both in IEI and SFD than in controls. The results of enhanced negative automatic evaluations of IEI-trigger words and greater attention allocation to symptom words support cognitive models of IEI.     

The List of Threatening Experiences: the reliability and validity of a brief life events questionnaire

During the 23 years since the original work of Holmes & Rahe, research into stressful life events on human subjects has tended towards the development of longer and more complex inventories. The List of Threatening Experiences (LTE) of Brugha et al., by virtue of its brevity, overcomes difficulties of clinical application. In a study of 50 psychiatric patients and informants, the questionnaire version of the list (LTE-Q) was shown to have high test-retest reliability, and good agreement with informant information. Concurrent validity, based on the criterion of independently rated adversity derived from a semistructured life events interview, making use of the Life Events and Difficulties Scales (LEDS) method developed by Brown & Harris, showed both high specificity and sensitivity. The LTE-Q is particularly recommended for use in psychiatric, psychological and social studies in which other intervening variables such as social support, coping, and cognitive variables are of interest, and resources do not allow for the use of extensive interview measures of stress.     

The Center for Epidemiologic Studies Depression Scale: factor validity and reliability in a French sample of adolescents with Intellectual Disability

The purpose of this study was to test the factor validity and reliability of the Center for Epidemiologic Studies Depression Scale (CES-D) within a sample of adolescents with mild to moderate Intellectual Disability (ID). A total sample of 189 adolescents (121 boys and 68 girls), aged between 12 and 18 years old, with mild to moderate ID were involved in two studies. In study 1, the content, phrasing and answering format of the CES-D were adapted for adolescents with ID. This instrument was renamed CES-D for ID (CES-D-ID) and two different versions based on two alternative answer scales (Likert and Likert-graphical) were developed and their psychometric properties were verified in study 2. The results provided support for the factor validity, reliability and invariance across gender and age of a 14-item version of the CES-D-ID based on a Likert-graphical answer scale.     

The hippocampal slice: a system for studying the pharmacology of seizures and for screening anticonvulsant drugs

Interictal spikes with a configuration similar to that occurring in grand mal epilepsy were generated by the application of penicillin to a hippocampal slice preparation. This slice preparation has potential value for screening anticonvulsant drugs and for studying epileptic activity. The effect of anticonvulsant drugs on seizure activity was tested at concentrations comparable to reported clinical serum concentrations. Phenytoin and diazepam were maximally effective at concentrations of 20 microgram/ml and 3-4 microgram/ml, respectively, in good agreement with their effective concentrations in clinical practice. Phenobarbital was more potent (5 microgram/ml) and mesuximide (50% potent at 80 microgram/ml) was least effective.     

Empirical Derivation of a New MMPI-2 Scale for Identifying Probable Malingering in Personal Injury Litigants and Disability Claimants: The 15-Item Malingered Mood Disorder Scale (MMDS)

A new 15-item MMPI-2 subscale, the Malingered Mood Disorder Scale (MMDS), was empirically derived from the original 32-item Malingered Depression Scale (MDS) of Steffan, Clopton, and Morgan (2003 Steffan , J. S. , Clopton , J. R. , & Morgan , R. D. ( 2003 ). An MMPI-2 scale to detect malingered depression (Md Scale) Assessment , 10 ( 4 ), 382 – 392 . [Google Scholar]). The MMDS was superior to the original MDS in identification of symptom exaggeration in personal injury litigants and disability claimants compared to non-litigating head-injured controls. Logistic regression revealed that a cut score of ≥ 7 on the MMDS produced good specificity (93.4%) with an associated sensitivity of 54.8%. An MMDS score of ≥ 8 was associated with 100% positive predictive power, i.e., no false positive errors. These results suggest that the MMDS may be useful in identifying personal injury litigants and disability claimants who exaggerate emotional disturbance on the MMPI-2.     

The "Melancholia Rating Scale": a useful instrument for the assessment of affective disorders. Validity and reliability of the Spanish adaptation

This instrument has been constructed with the purpose of quantifying the severity of depressive states, i.e. to identify the depressive patient and to measure the response to treatment with an antidepressant. Type of instrument: Ordinal rating scale, 11 items, 5 grades. Eleven variables are assessed: Activity (motor); Activity (verbal); Retardation (intellectual); Anxiety (psychic); Suicidal impulses; Lowered mood; Self-depreciation and guilt feelings; Emotional retardation; Sleep disturbances; Tiredness and pain; Work and interests. Tests were done to verify concurrent validity with the Hamilton Depression Scale (HDS); some data on inter-observer reliability are given.     

The validity of military screening for mental health problems: diagnostic accuracy of the PCL,K10 and AUDIT scales in an entire military population

Depression, alcohol use disorders and post‐traumatic stress disorder (PTSD) are serious issues among military personnel due to their impact on operational capability and individual well‐being. Several military forces screen for these disorders using scales including the Kessler Psychological Distress Scale (K10), Alcohol Use Disorders Identification Test (AUDIT), and Post‐traumatic Stress Disorder Checklist (PCL). However, it is unknown whether established cutoffs apply to military populations. This study is the first to test the diagnostic accuracy of these three scales in a population‐based military cohort. A large sample of currently‐serving Australian Defence Force (ADF) Navy, Army and Air Force personnel (n = 24,481) completed the K10, AUDIT and PCL‐C (civilian version). Then, a stratified sub‐sample (n = 1798) completed a structured diagnostic interview detecting 30‐day disorder. Data were weighted to represent the ADF population (n = 50,049). Receiver operating characteristic (ROC) analyses suggested all three scales had acceptable sensitivity and specificity, with areas under the curve from 0.75 to 0.93. AUDIT and K10 screening cutoffs closely paralleled established cutoffs, whereas the PCL‐C screening cutoff resembled that recommended for US military personnel. These self‐report scales represent a cost‐effective and clinically‐useful means of screening personnel for disorder. Military populations may need lower cutoffs than civilians to screen for PTSD. Copyright © 2014 John Wiley & Sons, Ltd.     

The family attitude scale: reliability and validity of a new scale for measuring the emotional climate of families

Research on outcomes from psychiatric disorders has highlighted the importance of expressed emotion (EE), but its cost-effective measurement remains a challenge. This article describes development of the Family Attitude Scale (FAS), a 30-item instrument that can be completed by any informant. Its psychometric characteristics are reported in parents of undergraduate students and in 70 families with a schizophrenic member. The total FAS had high internal consistency in all samples, and reports of angry behaviour in FAS items showed acceptable inter-rater agreement. The FAS was associated with the reported anger, anger expression and anxiety of respondents. Substantial associations between the parents' FAS and the anger and anger expression of students was also observed. Parents of schizophrenic patients had higher FAS scores than parents of students, and the FAS was higher if disorder duration was longer or patient functioning was poorer. Hostility, high criticism and low warmth on the Camberwell Family Interview (CFI) were associated with a more negative FAS. The highest FAS in the family was a good predictor of a highly critical environment on the CFI. The FAS is a reliable and valid indicator of relationship stress and expressed anger that has wide applicability. ©1997 Elsevier Science Ireland Ltd.     

The development of a brief screening instrument for depression and suicidal ideation for elderly: the Depression and Suicide Screen

The early detection of depression and suicidal ideation is essential for the prevention of suicide in the community. This study therefore aimed to develop a brief screen for depression and suicidal ideation that can be easily administered in primary-care settings. The Self-rating Depression Scale (SDS), the Hospital Anxiety and Depression Scale (HADS) and a modified version of the Composite International Diagnostic Interview (CIDI) were administered by 353 residents of a single community aged 64 years and over. A five-item screen was derived from SDS and HADS, using CIDI as the external criterion (study 1). The scale was modified so that it was more appropriate for our use, and was labeled the Depression and Suicide Screen (DSS). Its validity and reliability were examined among a further 382 residents of the same community aged 64 years and over, using the Short-Form Geriatric Depression Scale (GDS-S) as the external criterion (study 2). The DSS was internally consistent (Cronbach's alpha=0.62). Its reliability in detecting depression (defined as >or= 6 in GDS-S) and suicidal ideation (screened out by the inquiry by our trained staff) was 0.768 and 0.721, respectively. For depression, the sensitivity was 0.705; specificity, 0.729; positive predictive value (PPV), 0.446; negative predictive value (NPV), 0.888; and the overall diagnostic power, 0.723. For suicidal ideation, its sensitivity was 0.698; specificity, 0.693; PPV, 0.317; NPV, 0.926; and overall diagnostic power, 0.694. The DSS demonstrated a reasonable level of sensitivity and specificity in identifying both depression and suicidal ideation among the elderly within a community.     

The reliability and validity of the forensic Camberwell Assessment of Need (CANFOR): a needs assessment for forensic mental health service users

No instrument exists that measures the individual needs of forensic mental health service users (FMHSUs). The aim of this study was therefore to develop a valid and reliable individual needs assessment instrument for FMHSUs that incorporated staff and service user views and measured met and unmet needs. The Camberwell Assessment of Need was used as a template to develop CANFOR. Consensual and content validity were investigated with 50 forensic mental health professionals and 60 FMHSUs. Both were found to be satisfactory. Concurrent validity was tested using the Global Assessment of Functioning and a five-point needs scale, and again was found to be satisfactory. Reliability studies were carried out with 77 service users and 65 staff in high and medium security psychiatric services in the UK. Inter-rater reliability, rating whether a need was present or not, was high for service users (0.991) and staff (0.998). Similarly high reliability was found for unmet needs (0.985 and 0.972, respectively). Test-retest reliability was found to be moderately high for service users (0.795) and staff (0.852) when ratings were made two weeks apart. Similar levels were found for ratings of unmet needs (0.813 and 0.699, respectively). The average interview time was 23 minutes. CANFOR has good validity and reliability, and is suitable for further testing with other service user groups.     

Chemosensory function and psychological profile in patients with multiple chemical sensitivity: comparison with odor-sensitive and asymptomatic controls

OBJECTIVE: We addressed the question if patients with multiple chemical sensitivity (MCS) differ from participants with self-reported odor sensitivity without MCS and asymptomatic controls in terms of chemosensory, cognitive, and clinical psychological endpoints. METHODS: In a clinical study 23 MCS patients, 21 participants with self-reported odor sensitivity, and 23 controls were investigated using electrophysiological and psychophysical olfactometric tests [chemosensory-event-related potentials (CSERP), olfactory thresholds, odor identification, trigeminal sensitivity]. The participants filled in a mood list, a list of complaints (BL), a Symptom Check List, a State-Trait Anxiety Inventory (STAI), and an MCS questionnaire. RESULTS: The olfactometric investigations revealed no significant differences between the groups. The MCS group reached significantly higher scores on negative mood states following odorant exposure, on health complaints, global indices, and the somatization subscale of the Symptom Check List, trait and state anxiety and symptoms, and triggering matters of the MCS questionnaire. CONCLUSIONS: Our findings reveal that neither olfactory functions, nor chemosensory or cognitive olfactory information processing are impaired in MCS patients. They rather support findings of altered psychological profile and moderate psychopathology.