Number of bodily symptoms predicts outcome more accurately than health anxiety in patients attending neurology, cardiology, and gastroenterology clinics

BACKGROUND: In consecutive new outpatients, we aimed to assess whether somatization and health anxiety predicted health care use and quality of life 6 months later in all patients or in those without demonstrable abnormalities. METHOD: On the first clinic visit, participants completed the Illness Perception Questionnaire (IPQ), the Health Anxiety Questionnaire (HAQ), and the Hospital Anxiety and Depression Scale (HADS). Outcome was assessed as: (a) the number of medical consultations over the subsequent 6 months, extracted from medical records, and (b) Short-Form Health Survey 36 (SF36) physical component score 6 months after index clinic visit. RESULTS: A total of 295 patients were recruited (77% response rate), and medical consultation data were available for 275. The number of bodily symptoms was associated with both outcomes in linear fashion (P<.001), and this was independent of anxiety and depression. Similar associations were found in people with or without symptoms due to demonstrable structural abnormalities. Health anxiety was associated only with health-related quality of life in patients with symptoms explained by demonstrable abnormalities. CONCLUSION: The number of bodily symptoms and degree of health anxiety have different patterns of association with outcome, and these need to be considered in revising the diagnoses of somatization and hypochondriasis.     

The Use of Legal Coercion in the Treatment of Substance Abusers: An Overview and Critical Analysis of Thirty Years of Research

Drug and alcohol use presents a serious social problem for most countries in the world. Of particular concern is the well-documented relationship between substance use and crime, which has contributed to an increased popularity and willingness to utilize more forceful means to pressure substance users into treatment. Although compulsory/legally mandated treatment is appealing, it has been one of the most fiercely debated topics in the addiction field, raising a number of issues including ethical concerns and motivational considerations. In this context, the most important question to be answered is whether or not compulsory treatment is effective in the rehabilitation of addicted offenders. Regrettably, three decades of research into the effectiveness of compulsory treatment have yielded a mixed, inconsistent, and inconclusive pattern of results, calling into question the evidence-based claims made by numerous researchers that compulsory treatment is effective in the rehabilitation of substance users. The present paper provides an overview of the key issues concerning the use and efficacy of legal coercion in the rehabilitation of substance users, including a critique of the research base and recommendations for future research.     

The effects of changes in arterial plasma calcium concentration on submandibular secretory potentials

1. The concentration of Ca in the arterial blood plasma perfusing submandibular glands of anaesthetized cats and possums (Trichosurus vulpecula) was altered by constant-rate close arterial injection of isotonic CaCl(2) or EDTA solutions.2. There were no significant changes in the resting potentials of surface acinar cells in either species when the arterial plasma Ca concentration was altered over the range 0-30 mM.3. Secretory potentials in response to parasympathetic stimuli and close arterial injection of ACh were reduced and finally abolished during EDTA injection, but temporarily restored by injection of CaCl(2).4. Secretory potentials in response to 1 Hz parasympathetic stimuli in the cat were enhanced by increasing the gland arterial Ca concentration up to 5 mM; but responses to 10 Hz stimuli or close arterial ACh injection were not affected. There was no such enhancement of secretory potentials in the possum.5. Increase in the gland arterial plasma Ca concentration above 5 mM caused reduction in the amplitudes of the secretory potentials to all stimuli in both species, until they were abolished at 7-10 mM in the possum and 15-20 mM in the cat.6. In both species, increase in the gland arterial plasma Ca concentration caused increase in the gland blood flow and enhancement of the vasodilator effects of parasympathetic stimuli and ACh injection. EDTA injection was sometimes associated with a vasoconstrictor response to parasympathetic stimuli.7. It is concluded that the secretory potentials, but not the resting potentials, of submandibular secretory cells require the presence of Ca in the interstitial fluid. It is suggested that Ca affects both the release of transmitter and at higher concentration the mechanism by which it activates the secretory cells.     

Glutamatergic Ventral Pallidal Neurons Modulate Activity of the Habenula–Tegmental Circuitry and Constrain Reward Seeking

Background

The ability to appropriately integrate and respond to rewarding and aversive stimuli is essential for survival. The ventral pallidum (VP) plays a critical role in processing both rewarding and aversive stimuli. However, the VP is a heterogeneous structure, and how VP subpopulations integrate into larger reward networks to ultimately modulate these behaviors is not known. We identify a noncanonical population of glutamatergic VP neurons that play a unique role in responding to aversive stimuli and constraining inappropriate reward seeking.

Diagnostic accuracy, internal consistency, and convergent validity of the Greek version of the patient health questionnaire 9 in diagnosing depression in rheumatologic disorders

Objective

The Patient Health Questionnaire 9 (PHQ‐9) was developed to screen for depressive disorders in community, primary care, and medical settings. We aimed to estimate its diagnostic accuracy, internal consistency, reliability, and convergent validity in diagnosing major depressive disorder (MDD) in Greek patients with rheumatologic disorders.

Methods

In a 2‐phase sampling design study, we recruited 475 patients with established rheumatologic disorders. One of 2 of the high scorers (PHQ‐9 score ≥9, n = 85) and 1 of 3 of the low scorers (PHQ‐9 score 0–8, n = 128) were interviewed using the Mini International Neuropsychiatric Interview to confirm MDD. A receiver operator characteristic curve analysis was performed to confirm the optimum threshold value. The scale's dimensional structure was tested with factor analysis, and internal consistency reliability was assessed with Cronbach's alpha. Psychological distress (Symptom Check List‐90‐Revised [SCL‐90‐R]), disability (Health Assessment Questionnaire disability index), and health‐related quality of life (HRQOL; World Health Organization Quality of Life Instrument [WHOQOL‐BREF]) were also assessed to test convergent validity with bivariate correlations.

Results

At an optimum threshold of 10, the PHQ‐9 showed a sensitivity of 81.2% and a specificity of 86.8%. The area under the curve was 0.91. The PHQ‐9 presented unidimensional structure with good scale reliability (α = 0.82). The PHQ‐9 score presented the greatest correlations with SCL‐90‐R depression (r = 0.736) and WHOQOL‐BREF mental HRQOL scales (r = ?0.571), and all other correlations with disability and HRQOL were in the expected direction.

Conclusion

At a cutoff of 10, the PHQ‐9 is an accurate, reliable, and valid measure for screening for MDD among Greek rheumatologic patients.

     

Depressive disorder and social stress in Pakistan compared to people of Pakistani origin in the UK

Purpose  

Depressive disorder is more common in low to middle than high-income countries, but the reasons for this have not been explicitly defined.     

Dual neuronal response to tumor necrosis factor-alpha following spinal cord injury

BACKGROUND: Numerous studies have shown that tumor necrosis factor α (TNF-α) is closely correlated with spinal cord injury (SCI), but the mechanisms of TNF-α and therapeutic treatments for SCI are still poorly understood. OBJECTIVE: To determine the role of TNF-α in the pathogenesis of SCI. DESIGN, TIME AND SETTING: An in vivo experiment based on genetically engineered animals was performed at the Medical University of South Carolina, Charleston, South Carolina, USA, between June 2007 and October 2008.MATERIALS: TNF-α transgenic rats (Xenogen Biosciences in Cranbury, New Jersey, USA) were utilized in this study. METHODS: TNF-α transgenic (tg) and wild-type (WT) rats underwent a complete single-level laminectomy at the 10th thoracic vertebra (T10).MAIN OUTCOME MEASURES: Motor function of rat hindlimb was assessed using the Basso, Beattie, and Bresnahan hindlimb locomotor rating scale. Histological evaluation of spinal cord tissue loss was conducted. Immunohistochemistry for astrocytes, microglia/macrophages, and TNF receptors (TNFRs) was performed on spinal cord tissue sections. TNF-α mRNA expression was detected by real-time polymerase chain reaction. The concentrations of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) in the supernatant were determined using an enzyme-linked immunosorbent assay kit for rat NGF or BDNF, respectively. The rats were injected subcutaneously with etanercept to verify that TNF-α was the direct effect of the modulation of behavioral and neurodegenerative outcomes in the TNF-α tg rats. RESULTS: TNF-α tg rats showed higher expression of TNF-α mRNA in the spinal cord prior to SCI. TNF-α tg rats showed worse motor deficits than WT rats in the acute period (< 3 days) after SCI (P < 0.01), while in the chronic period, TNF-α tg rats exhibited persistent elevated baseline levels of TNF-α mRNA and improved recovery in motor function and tissue healing compared to WT rats (P < 0.01). Following SCI, the number of microglia/macrophages in TNF-α tg rat was always greater than in WT rat (P < 0.01). There were no significant differences in NGF and BDNF levels in the supernatant of spinal cord homogenates. TNFR1 expression was significantly greater in the TNF-α tg rats compared to the WT rats (P < 0.01). However, TNFR2 expression did not reveal a significant increase in the TNF-α tg rats compared to the WT rats. Finally, treatment with etanercept reduced injury acutely, but exacerbated the injury chronically.CONCLUSION: Overexpression of TNF-α is deleterious in the acute phase, but beneficial in the chronic phase in the response to SCI. The role of TNF-α post-injury may depend on TNF-α expression in the spinal cord and its differential binding to TNFR1. Our observations may have clinical relevance that antagonists or inhibitors of TNF-α could be administered within the early time window post-injury, and appropriate amounts of TNF-α could be administered during the chronic stage, in order to improve the final neurological recovery in patients with SCI.