Symptom or illness? The exhausting life of an adolescent with chronic fatigue syndrome

This case report presents the assessment of a 16-year old boy with chronic fatigue syndrome (CFS). Questions on the etiology, dynamics, diagnostics and treatment of this complex condition are briefly discussed.     

Dysmorphophobie – Symptom oder Diagnose?

Dysmorphophobia as a new psychiatric syndrome was described by the Italian psychiatrist Morselli in 1891. Dysmorphophobic symptoms are associated with several other psychiatric disorders. The term of dysmorphophobia will be discussed along a theoretical review. We present the case of a 20-year-old patient with dysmorphophobic symptoms. In the scope of ICD 10, DSM-III-R/DSM IV diagnostical criteria we outline problems of the diagnostical classification of dysmorphophobic signs.     

Social Context and Symptom Fluctuation†

While research has demonstrated strong relationships between negative symptoms and social difficulties in schizophrenia, little is known about the possible role of employment status and setting in this relationship. Seventy-seven participants with a diagnosis of schizophrenia spectrum disorder, who were either unemployed (n = 34), employed within a specialty mental health setting (n = 23), or employed within a community setting (n = 20) were assessed twice, six weeks apart, as to their negative symptoms and social functioning. Work in community settings generally predicted an increase in the levels of social functioning over time. However, individuals with high levels of negative symptoms who were employed in community settings evinced substantial decline in social functioning over time compared to unemployment or to employment in specialty mental health settings. These results are consistent with action models of psychopathology and encourage heightened sensitivity to individual symptomatic profiles in the course of vocational rehabilitation.     

Variations in Symptom Prevalence and Clinical Correlates in Younger Versus Older Youth with Obsessive–Compulsive Disorder

Few studies have examined the phenomenology of obsessive–compulsive disorder (OCD) in younger children. A sample of 292 treatment seeking youth with a primary diagnosis of OCD was divided into the young child (3–9 years old) and older child (10–18 years old) groups. Overall OCD severity did not differ between groups. However, older youth demonstrated stronger intensity of obsessive and compulsive symptoms, while younger children were rated as having less resistance and control of compulsions. Older youth exhibited increased occurrence of comorbid depression, and an increased occurrence of sexual, magical thinking, and somatic obsessions, as well as, checking, counting and magical thinking compulsions. Conversely, the group of younger children exhibited significantly poorer insight, increased incidence of hoarding compulsions, higher rates of comorbid attention deficit/hyperactivity disorder, disruptive behavior, and parent-rated anxiety, and more frequently exhibited hoarding compulsions. These differences suggest domains to consider when screening for OCD among younger/older pediatric cohorts.     

Symptom Checklist 90–Revised in neurological outpatients

The Symptom Checklist 90–Revised (SCL-90-R) is an international, widely used, self-report questionnaire of multidimensional complaints with normative data for healthy control subjects and psychiatric patients. The questionnaire is also often used in neurological patients. Little is known about the amount and pattern of complaints in this group, and normative data are lacking. We therefore analyzed self-reported symptoms on the SCL-90-R of a neurological population (N = 600). Moreover, we compared the answer patterns of five subgroups: neurodegenerative disease, cerebrovascular disease, epilepsy, brain tumor, and traumatic brain injury. Neurological outpatients scored significantly higher in comparison with normative data from healthy control subjects, with most pronounced scores on Inadequacy of Thinking and Acting, Depression, and Somatization (p < .01, effect sizes 1.69, 0.83, and 0.83). No differences between the various pathologies were found. Although it is difficult to determine whether the complaints arise directly from the neurological disease or more indirectly from psychiatric disturbances accompanying the disease, simply comparing a neurological patient to normative data for healthy control subjects can lead to inappropriate classifications. Complaints of our patients should not be directly interpreted as psychopathology. A two-step procedure in which scores on the SCL-90-R are first compared to healthy control subjects and secondly to neurological patients can be helpful in the interpretation.     

Symptom control in children and adolescents with attention-deficit/hyperactivity disorder on switching from immediate-release MPH to OROS® MPH

Abstract Aim The aim of this study was to assess the impact of switching from immediate-release (IR) methylphenidate (MPH) to OROS^? MPH (CONCERTA^?), a once-daily long-acting MPH formulation, in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Methods Subjects with ADHD aged 6–16 (n=105),who were stably maintained on their current IR MPH regimen (10–60 mg/day), were switched to 18, 36 or 54mg OROS^? MPH once daily for 21 days, depending on pre-study daily MPH dose.ADHD symptoms were assessed by parents, teachers and investigators. Results By Day 21, parent/caregiver IOWA Conners ratings had decreased from baseline by 2.7 points to 5.2 (I/O), and by 1.8 points to 5.0 (O/D). Teacher IOWA Conners ratings were maintained. Decreases in IOWA Conners ratings are indicative of ADHD symptom improvement. Approximately 75% of parents and investigators rated therapy as good or excellent. OROS^? MPH therapy was well tolerated. Conclusions Switching from IR MPH to OROS^? MPH maintained and may have improved symptom control in children and adolescents with ADHD, during the course of this study. The changes in parent/caregiver IOWA Conners ratings suggest that OROS^? MPH improves symptom control in the after-school period. This is consistent with the 12-h duration of action previously demonstrated for OROS^? MPH.     

Nonrestorative sleep: Symptom or unique diagnostic entity?

Nonrestorative sleep (NRS) refers to the subjective experience of sleep as insufficiently refreshing, often despite the appearance of normal sleep according to traditionally assessed objective parameters. This has led researchers to pursue alternative physiological markers of nonrestorative or unrefreshing sleep, though much of this research remains controversial and inconclusive. This review summarizes the recent findings on NRS in the literature and discusses some of the issues inherent in current efforts to define and measure NRS. We offer a summary of recommended clinical approaches to NRS and discuss a new potential paradigm for the assessment of NRS-an approach modelled on current diagnosis of insomnia.     

Safety of Intravenous Thrombolysis within 4.5 h of Symptom Onset in Patients with Negative Post-Treatment Stroke Imaging for Cerebral Infarction

Background  

Patients with stroke symptoms but negative diffusion-weighted imaging (DWI) might have transient ischemic attacks (TIA) or stroke mimics. Brain DWI is important for the diagnosis of cerebral infarction but it is not available before thrombolysis for most patients to avoid treatment delay. This study aimed to evaluate the safety of IV thrombolysis in patients with a negative post-treatment DWI for cerebral infarction.     

Symptom features of postpartum depression: are they distinct?

The clinical features of postpartum depression and depression occurring outside of the postpartum period have rarely been compared. The 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR(16)) provides a means to assess core depressive symptoms. Item response theory and classical test theory analyses were conducted to examine differences between postpartum (n=95) and nonpostpartum (n=50) women using the QIDS-SR(16). The two groups of females were matched on the basis of age. All met DSM-IV criteria for nonpsychotic major depressive disorder. Low energy level and restlessness/agitation were major characteristics of depression in both groups. The nonpostpartum group reported more sad mood, more suicidal ideation, and more reduced interest. In contrast, for postpartum depression sad mood was less prominent, while psychomotor symptoms (restlessness/agitation) and impaired concentration/decision-making were most prominent. These symptomatic differences between postpartum and other depressives suggest the need to include agitation/restlessness and impaired concentration/decision-making among screening questions for postpartum depression.     

Symptom subtypes of obsessive-compulsive disorder: are they relevant for treatment?

Several symptom subtypes of obsessive-compulsive disorder (OCD) have been identified on the basis of the predominant obsessions and compulsions. The objectives of the present article were to review the literature on the relationship between OCD symptom subtypes and treatment response and to suggest strategies that might assist with the choice of treatment and improve treatment outcome in patients with various subtypes. An extensive literature search was performed, relevant studies were identified, and their results reported. Overt compulsions were generally associated with a relatively good response to the behaviour therapy technique of exposure and response prevention (ERP) and with poorer response to serotonin re-uptake inhibitors (SRIs). Washing/cleaning and checking compulsions tend to respond well to ERP, whereas the majority of studies show that washing/cleaning compulsions are associated with a poorer response to SRIs. Most studies suggest that patients with the symmetry, ordering and arranging subtype do not fare worse with ERP and SRIs than patients with other symptom subtypes. Some studies suggested that obsessions might respond to SRIs somewhat better than to ERP. In the majority of the studies, hoarding and the subtype characterized by sexual or religious obsessions and absence of overt compulsions ('pure obsessions') have been associated with poor response to ERP and SRIs. It was concluded that treatment strategies cannot be precisely tailored to OCD symptom subtypes. Many other factors influence the outcome of treatment and need to be considered along with the symptom subtypes when making decisions about treatment. While ERP and SRIs remain the mainstay of treatment regardless of the symptom subtype, the addition of cognitive therapy techniques and/or antipsychotic medications may enhance treatment response in the presence of certain features discussed in the article.     

Psychometric analysis of the Yale-Brown Obsessive–Compulsive Scale Second Edition Symptom Checklist

The Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) was recently revised to address several clinical and conceptual issues. The resultant measure, named the Yale-Brown Obsessive–Compulsive Scale—Second Edition, consists of two primary scales: the Severity Scale and the Symptom Checklist. Although the Severity Scale has been the subject of a comprehensive psychometric analysis, no data have been reported on the psychometric properties of the Y-BOCS-II Symptom Checklist (Y-BOCS-II-SC). Accordingly, in the present study, clinician ratings on the Y-BOCS-II-SC for 130 patients with obsessive–compulsive disorder (OCD) were examined on a number of validity and reliability indices. Partially consistent with past factor analytic studies of the Y-BOCS Symptom Checklist, the Y-BOCS-II-SC yielded four factors representing symmetry/ordering, contamination/washing, hoarding, and sexual/religious/aggression dimensions; checking rituals cross-loaded with other dimensions. Generally, the Y-BOCS-II-SC dimensions were internally consistent and rated stably across raters and over a short interval. The Y-BOCS-II-SC symptom dimensions showed good convergence with self-reported obsessive–compulsive symptoms, and were at best moderately associated with divergent measures (e.g., OCD symptom severity, depressive symptoms, and symptoms of anxiety). Overall, the Y-BOCS-II-SC shows good psychometric properties; we highlight several domains in which the Y-BOCS-II-SC may have clinical and research utility, as well as several areas for future study.     

Brief Multidimensional Students’ Life Satisfaction Scale—PTPB Version (BMSLSS-PTPB): Psychometric Properties and Relationship with Mental Health Symptom Severity Over Time

Youth life satisfaction is a component of subjective well-being, an important part of a strengths-based approach to treatment. This study establishes the psychometric properties of the Brief Multidimensional Students' Life Satisfaction Scale-PTPB Version (BMSLSS-PTPB). The BMSLSS-PTPB showed evidence of construct validity with significant correlations as expected to measures of youth hope and youth symptom severity, and no relationship as expected to youth treatment outcome expectations. A longitudinal analysis was conducted examining the relationship between youth-reported life satisfaction and mental health symptom severity (youth-, caregiver-, and clinician-report) for 334 youth (aged 11-18 years) receiving in-home treatment. Results indicated that life satisfaction consistently increased over the course of treatment but increased faster in youth whose symptom severity, as rated by all reporters, decreased over the course of treatment. Implications, future directions, and limitations of the study are discussed.     

Comorbid Personality Disorders in Obsessive–Compulsive Disorder and Its Symptom Dimensions

The current paper was aimed at: (1) investigating the comorbidity between obsessive–compulsive disorder (OCD) and personality disorders (PDs) using an OCD sample and clinician-administered structured interviews; (2) exploring the associations of different cluster comorbid PDs with the specific symptom dimensions of OCD; (3) analyzing the variables which could play a significant role in the probability of having at least one comorbid PD, controlling for confounding variables. The SCID-II and Y-BOCS, together with a series of self-report measures of OCD, depression and anxiety symptoms were administered to a clinical sample of 159 patients with a primary diagnosis of OCD. 20.8 % of the participants suffered from at least one comorbid PD; the most common was obsessive–compulsive PD (9.4 %), followed by narcissistic PD (6.3 %). In OCD patients with comorbid cluster C PDs, the percentage of responsibility for harm, injury, or bad luck symptoms was significantly greater than other OCD symptom dimensions (p < .005). Logistic regression found some evidence supporting the association between severity of OCD symptoms and comorbid PDs. PDs are prevalent among Italian people with OCD and should be routinely assessed, as comorbidity may affect help-seeking behaviour and response to treatment.     

Hypochondriasis. Symptom at the crossroad or a road crossing the syndromes?

Even if widely described, hypochondriasis remains a multidimensional concept which has to be carefully reconsidered: different meanings are indeed involved in its use, coming from historical and classical psychiatry, and from psychoanalysis as well as from the new trends in psychosomatic medicine and liaison psychiatry. The syndrome/symptom confusion has to be avoided. It also appears that some light should be shed on the concept of the term "hypochondriasis", which has been used abusively in modern psychiatry.     

The Rey AVLT Serial Position Effect: A Useful Indicator of Symptom Exaggeration?

This investigation explored the usefulness of serial position patterns during word recall on the Rey Auditory Verbal Learning Test (RAVLT; Rey, 1964 Rey, A. 1964. L'examen clinique en psychologie, Paris: Presses Universitaires de France.  [Google Scholar]) as an indicator of poor effort. Significantly better recall for early (primacy) and recent (recency) material defines the serial position effect (SPE; Rundus, 1971 Rundus, D. 1971. Analysis of rehearsal processes in free recall. Journal of Experimental Psychology, 89: 63–77. [Crossref] , [Google Scholar]). The SPE on the RAVLT was examined in four groups: normal controls (NC), symptom-coached simulators (SC), test-coached simulators (TC), and a group of moderate to severe subacute traumatic brain injury (TBI) patients. Normal control participants and TBI patients demonstrated the expected SPE. Only the SC simulators clearly suppressed the primacy effect. The SPE appears neither sensitive nor specific enough to be used independently of more sensitive symptom validity tests in the detection of suboptimal effort. It may be especially problematic when used with clients presenting with sophisticated styles of exaggeration and in settings with lower base rates of compromised effort.     

Should IV Thrombolysis be given in Patients with Suspected Ischemic Stroke but Unknown Symptom Onset and Without Diffusion-Weighted Imaging Lesion? – Results of a Case-Control Study

BackgroundMany acute ischemic stroke (AIS) patients present with unknown time of symptom onset (UTO). In these situations, wake-up MRI protocols can guide treatment decisions: patients with DWI (diffusion-weighted imaging) but no fluid-attenuated inversion recovery lesion were shown to benefit from IVT (intravenous thrombolysis). However, initial MRI of some stroke patients is DWI negative, leaving it unclear whether this subgroup profits from IVT. Therefore, we aimed to compare the safety and efficacy of IVT in wake-up AIS patients with or without a DWI lesion in initial imaging.MethodsWe performed a case-control study. All AIS patients with UTO who underwent wake-up MRI and were treated with IVT at a German University Hospital from 2013 to 2017 were included. Patients without (DWI-) were compared to patients with DWI lesion (DWI+) regarding clinico-radiological characteristics, adverse events, and outcome at discharge. Likely stroke mimics were excluded.ResultsEleven DWI- and 32 DWI+ patients were included. There were no statistically significant differences regarding functional scores, age, sex, door-to-needle time, bleeding complications, and death. DWI+ patients more frequently had anterior circulation stroke (P = .049) and higher modified Rankin Scale (mRS) scores at discharge (P = .048). Solely in the DWI+ group 3 bleeding complications (2 asymptomatic hemorrhagic transformations, 1 muscle hematoma) and 3 deaths occurred (P = .29). A favourable outcome (mRS≤ 2) was achieved in 82% of the DWI- and in 58% of the DWI+ group (p > .05).ConclusionsOur data suggest that IVT may be used in DWI- patients with UTO with acute neurological symptoms very likely to be related to AIS.     

The Relationships Between Obsessive–Compulsive Symptom Dimensions and Cognitions in Obsessive–Compulsive Disorder

Several studies have linked obsessive–compulsive symptoms to specific obsessive–compulsive cognitions, however methodologies have varied, and no study has determined obsessive–compulsive symptoms using the most widely used clinician rating scale, the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS). Considering that almost all studies that used factor analysis to ascertain OCD symptom dimensions were based on the Y-BOCS and that self-report instruments assessing obsessive–compulsive symptoms correlate poorly with the Y-BOCS, there is a need to use the Y-BOCS to examine the relationship between obsessive–compulsive cognitions and obsessive–compulsive symptom dimensions. This study examined the relationship between five Y-BOCS-derived obsessive–compulsive symptom dimensions and the three obsessive–compulsive cognitive domains identified by the obsessive-beliefs questionnaire (OBQ). The symmetry/ordering symptom dimension was associated with increased perfectionism/intolerance of uncertainty, the unacceptable/taboo thoughts symptom dimension was associated with increased importance/control of thoughts and the doubt/checking symptom dimension was associated with increased responsibility/threat estimation. There was no statistical evidence of an association between any OBQ belief sub-scale and the hoarding symptom dimension nor the contamination/cleaning symptom dimension. The findings encourage symptom-based approaches to cognitive-behavioural therapy for some OCD symptoms and call for further research on cognitions associated with contamination/cleaning symptoms and hoarding.     

Symptom complaints following reports of blast versus non-blast mild TBI: does mechanism of injury matter?

Patients with a reported history of mild traumatic brain injury (mild TBI) due to blast (n?=?298) or non-blast (n?=?92) mechanisms were asked to complete the Neurobehavioral Symptom Inventory (NSI) and the Post-traumatic Stress Disorder Checklist (PCL). Mechanism of injury did not account for a significant amount of variance in post-concussion symptom reporting overall, nor did severity of mild TBI (i.e., brief loss of consciousness versus only an alteration of consciousness). Symptom reporting was greater in those injured more than 1 month ago compared to those injured less than 1 month ago and in those reporting higher levels versus lower levels of PTSD symptoms. When examining specific symptoms, the only symptom that significantly varied between groups was hearing difficulty (with the blast-injured group reporting more severe difficulty with hearing). Findings suggest that greater symptom reporting is most strongly related to emotional distress.