Intractable facial pain and illness behaviour

Management of intractable facial pain (IFP) patients is time consuming and potentially frustrating. Earlier identification of IFP patients may be helped by considering such cases in terms of their illness behaviour rather than a large range of other diagnostic labels. A group of 24 IFP patients, with diagnoses including temporomandibular joint dysfunction pain, atypical facial pain and facial neuralgia, completed a questionnaire designed to measure illness behaviour. Compared to a control group of patients with minor odontogenic pain, IFP patients were more somatically preoccupied, could not accept reassurance from a doctor as easily, and were less likely to acknowledge psychological aspects of illness. These attitudes, similar to those reported by other intractable pain patients, are unlikely to be related to degree of organic pathology or chronicity of pain. Use of a discriminant function resulted in three-quarters of the total sample being correctly separated into the two clinical groups on the basis of their IBQ scores.     

The predictive value of cranial ultrasound and of somatosensory evoked potentials after nerve stimulation for adverse neurological outcome in preterm infants

Thirty-nine preterm infants were studied to compare the predictive value of somatosensory evoked responses (SEPs) following median-nerve and posterior tibial-nerve stimulation with the predictive value of cranial ultrasound. With regard to the SEP, a normal median-nerve response was by no means a guarantee of a normal outcome. A normal posterior tibial-nerve response, however, almost guaranteed a normal outcome, but the test was very time consuming and the number of false positive responses was high (sensitivity. 95.6%, specificity 50%). The presence of parenchymal involvement, either due to a haemorrhage or cystic leukomalacia predicted cerebral palsy with a sensitivity of 95.6% and a specificity of 68.5%. The combination of an abnormal posterior tibial response and the presence of parenchymal brain lesions had the best predictive value with a sensitivity of 91.3% and a specificity of 81.2%. These results show that, although posterior tibial-rferve responses have a better predictive value than median-nerve responses, these values were lower than that of cranial ultrasound. The best prediction was obtained when a combination of posterior-tibial responses and cranial ultrasound was used.     

The effect of growth rate on the adhesion of the oral bacteria Streptococcus mutans and Streptococcus milleri

As a preliminary to measuring the hydrophobicity of continuous-culture cells, batch-grown cells of a number of Streptococcus mutans strains were tested for their ability to adhere to hexadecane. The hydrophobic properties of such cells were markedly affected by experimental variables such as the composition of the growth medium and the buffer in which the cells were subsequently suspended. For example, the replacement of glucose by fructose in a chemically-defined growth medium (CDM) increased cell hydrophobicity. Strep. mutans B13 and Streptococcus milleri B448 were separately grown glucose-limited in the CDM at various dilution rates from D = 0.04 h-1 to D = 0.7 h-1, corresponding to mean generation times of 17 and 1 h. Slow-growing cells of both strains were more hydrophobic than fast-growing cells, which, in conjunction with previous studies, supports the suggestion that hydrophobic bonding may play a role in bacterial adherence.     

Illness behaviour and coronary artery by-pass surgery.

122 patients awaiting coronary artery by-pass surgery completed an Illness Behaviour Questionnaire. Their responses were factor analysed and 11 meaningful factors accounting for 68.9% of the variance were identified. The first 50 patients were followed-up and 2 groups of “good-outcome” (n = 38) and “poor-outcome” patients (n = 12) were identified. Factor scores were used to produce a discriminant function equation capable of separating the 2 groups at a significant level. Complete relief from angina was found to be associated with the following combination of attitudes: high responsiveness to reassurance, low interpersonal discord, high illness vulnerability, low pain-related illness anxiety, low irritability, and low health concern.     

Patterns of depression and illness behaviour in general hospital patients

Little interest has been taken in the characteristics of depression in medical and surgical patients and its correlations with syndromes which may be subsumed under the rubric of abnormal illness behaviour. Depressive symptoms and abnormal illness behaviour as measured by self-rating scales were studied among 325 inpatients of a general hospital. A principal component analysis was carried out. A first factor reflecting general severity was characterized by depressed affect, somatic symptoms, retardation, hypochondriasis, and disease conviction and showed considerable stability within the group. A second factor suggested that in contrast to the younger patients, older patients had a tendency to focus on somatic problems and not psychological determinants, were likely to attribute all difficulties to physical illness, and lacked readiness to report interpersonal friction.     

Depressive illness and dependency

The relationship has been examined in depressed in-patients between type of depression (as categorised by the Levine-Pilowsky Depression Questionnaire) and dependency (as measured by the Interpersonal Dependency Inventory) at time of discharge. No relationship could be demonstrated between dependency and depressive category.