Middlesex Hospital Questionnaire Research Articles

Depression in chronic low back pain patients: Diagnostic efficiency of three self‐report questionnaires

Three self-report questionnaires (the Beck Depression Inventory, the MMPI-D scale, and the depression subscale of the Middlesex Hospital Questionnaire) were examined to see how accurately they could identify chronic low back pain patients who were suffering depression, as defined by DSM-III criteria. According to these criteria, 25% of a sample of 68 patients currently were depressed, a rate comparable to those reported by other studies that have used standardized criteria. On the basis of relative conditional probability ratios, the BDI was shown to be the most efficient instrument for identifying these cases and represents an excellent screening device for depression with this population. The individual items of the BDI then were examined, and the conditional probability ratios revealed that several may be helpful as indicators of possible depression among chronic low back pain patients. The relationship between depression and chronic pain is reconsidered in the light of these results.

Psychologic aspects of flatulent dyspepsia.

Psychologic and social factors have been implicated in the aetiology of dyspepsia. In this study these factors were investigated in relation to flatulent dyspepsia, a symptom complex that has traditionally been associated with gallbladder disease. Subjects completed the Middlesex Hospital Questionnaire and the Life Events Inventory and were interviewed in detail, using a semi-structured format. Three groups of patients with flatulent dyspepsia--those with and without gallbladder disease and post-cholecystectomy--all had significantly more associated somatic symptoms than non-dyspeptic subjects with gallbladder disease or normal controls, thus indicating greater emotional upset amongst dyspeptic patients. There was little evidence that symptoms were related to stressful life events.

Psychiatric disturbance and decision-making.

The relationship between psychiatric disorder (as measured by severity of psychoneurotic status and depression) and decision-making behaviour was examined in a sample of 39 hospitalised patients. Measures based on the conflict theory of decision-making of Janis and Mann (1977) and the expectancy-value theory of decision-making of Edwards (1961) were administered. Patients who scored highest on measures of psychoneurotic disorder--the Middlesex Hospital Questionnaire and the Beck Depression Inventory--were least confident about their decision-making. They also reported a high use of maladaptive decision-making coping patterns, in particular decision avoidance. Slightly over one-half of the patients demonstrated an ability to make rational decisions, while the remainder made either irrational decisions or avoided making any decision at all. Observation in the test session revealed that patients were strikingly slow in answering the questionnaires and often attempted to make no response. The importance of this area of research for patient assessment and treatment is discussed.

On the anticonvulsant and psychotropic properties of clobazam--a preliminary study.

Preliminary studies of patients who had brain damage, intractable epilepsy, and mental subnormality showed that clobazam in small doses (20 to 30 mg/day) was beneficial, and indicated that a more detailed investigation was worthwhile. In this study, 30 patients were followed up for at least 18 months in a continuing open-ended study. Fit frequency was found to be markedly reduced, few side effects have occurred, and the visual analogue scales and the Middlesex Hospital Questionnaire have shown improvement. "Breakthrough" has not been a problem at the dose level of 20 to 30 mg/day when given in addition to conventional anticonvulsant regimes, usually carbamazepine, phenytoin, or valproate. In the meanwhile, other psychosocial problems (for example, employment and marital problems) have improved. It therefore seems that clobazam is a useful additional drug in conventional anticonvulsant regimes.

Psychological disability in women who relinquish a baby for adoption.

During 1986, approximately 2000 women in Australia are likely to relinquish a baby for adoption. A study is presented of 20 relinquishing mothers that demonstrates a very high incidence of pathological grief reactions which have failed to resolve although many years have elapsed since the relinquishment. This group had abnormally high scores for depression and psychosomatic symptoms on the Middlesex Hospital questionnaire. Factors that militate against the resolution of grief after relinquishment are discussed. Guidelines for the medical profession that are aimed at preventing psychological disability in relinquishing mothers are outlined.

Psychological profile of women with chronic pelvic pain

Using the Middlesex Hospital Questionnaire (MHQ) and the Zung Self-Rating Depression Scale (SDS) psychological distress was measured in 30 women who underwent laparoscopy for chronic pelvic pain and in 30 matched controls. Both organic pelvic pain patients (OPPs) and idiopathic pelvic pain patients (IPPs) reported higher scores for somatisation than controls. IPPs scored higher than OPPs and controls on the Zung SDS, while no difference emerged in this scale between OPPs and controls. No correlations were found between age or duration of symptoms and somatisation and depression scores. On the basis of the above reported results the authors suggest that some forms of idiopathic chronic pelvic pain might represent an expression of a depressive disorder.

Teacher stress and psychoneurotic symptoms.

Summary. One hundred and twenty‐seven schoolteachers completed the Teacher‐Event Stress Inventory (TESI) (a measure of self‐reported teacher stress) and the Middlesex Hospital Questionnaire (MHQ) (which provides scores on six scales measuring aspects of clinically recognised psychoneurotic status: anxiety, phobic, obsessional, somatic, depressive and hysterical). The correlations between TESI scores and each of the MHQ scale scores were presented separately for male and female teachers. Eleven of the 12 correlations were positive and significant. These indicated an association between self‐reported teacher stress and psychoneurotic symptoms which appeared to be greatest in the areas of anxiety, somatic and depressive symptoms.

Psychosocial Aspects during Pregnancy and Obstetrical Complications

The relationship between life events, anxiety, social support, coping style and obstetrical complications was studied in a sample of 419 pregnant women. They were interviewed during the 6th month of pregnancy. The Paykel Interview for Recent Life Events, the free anxiety subscale of the Middlesex Hospital Questionnaire (MHQ) and a 5-factor scale, derived from Standley et al. (1979) for the evaluation of specific anxiety in pregnancy were used; Surtees' Index of Social Support and a scale of coping style derived from Andrews et al. (1978) were also administered to the subjects. To permit a prospective study, only obstetrical complications occurring after the interview were considered. Of the 419 women interviewed, 100 were excluded from the study after delivery because they were affected by complications or diseases of clear organic origin, or complications of any kind in the period of pregnancy previous to the interviews, or because we were unable to obtain data on the delivery. In 142 of the women, the d...

Stress and epilepsy: the value of a benzodiazepine--lorazepam.

Twenty four patients with drug resistant epilepsy were given lorazepam and placebo added to their pre-existing drug regime. With lorazepam there was a significant reduction in seizures, especially in those with focal and partial complex attacks. The drug proved effective whether or not the patients regarded stress as a trigger to their seizures, but on the Middlesex Hospital Questionnaire there were differences between those with high and low scores.

Cognitive impairment in patients with severe migraine.

A controlled study of a group of patients with severe migraine revealed that they gave a consistently poorer performance on a series of memory and information-processing tests (12 subtests in all). Migraine sufferers were also found to differ from controls significantly on the anxiety, obsessionality and somatic scales of the Middlesex Hospital Questionnaire, although it was considered unlikely that the differences in cognitive performance could be explained by these results.

Psychosomatic study of 60 patients with vertigo.

The authors examined 60 consecutive patients hospitalized in Modena University Otorhinolaryngological Clinic for vertigo by means of an interview and of three self-rating scales (Zung's SDS, SAS and the Middlesex Hospital Questionnaire). The control group was composed of an equal number of patients hospitalized in the same ward and period for different nonsurgical otiatric diseases; the two groups were matched for age, sex, residential area, sociocultural conditions, duration of hospitalization and disease. According to the clinical diagnosis carried out when discharged from hospital, the patients where divided into five groups (Ménière's disease, neuronitis, vertebrobasilar insufficiency, neurosensorial deafness, nucleoreticular syndrome of Ararslan). The data regarding depression (MHQ and SDS), anxiety (MHQ and SAS), neuroticism, somatization (MHQ) and the prevailing of hysterical personality traits in women (MHQ) resulted particularly relevant from a statistical viewpoint (p less than 0.01).

How do the experiences of the early separated and the early bereaved differ and to what extent do such differences affect outcome?

From a survey of 40- to 49-year-old women from Chichester, West Sussex, 45 were selected whose mothers died before they were aged 11, 38 who were evacuated from their mothers during the 1939–1945 War and 45 who were separated from their mothers for other reasons for at least a year before they were aged 10. A series of 69 non-mother-bereaved or non-mother-separated controls of similar age-range was also collected. Each subject was interviewed at home and asked to complete the Middlesex Hospital Questionnaire, a modified Zung Depression Scale and the Navran Dependency Scale of the MMPI. There were significant differences between the groups in terms of place of birth, age of the mother at time of the initial break and size of the original sibship. Significantly more evacuees were cared for by foster mothers and significantly more of the “other” separations had a poor relationship with their natural mother. For all groups increased test scores were associated with lower parental social class and poor replacement care. Poor outcome was also associated with being later born for the early bereaved, having a poor relationship with the natural mother for the evacuees and being separated after age 4 for the “other” separations.

The mental health of early mother separated women.

A community based research project was undertaken to discover whether early mother separation was related to adult mental disorder. A population sample of 73 women aged 40-49, who experienced continuous mother absences in excess of 1 year due either to family difficulties (n = 42) or external factors (n = 31), were interviewed about early life experiences and mental health. Controls (n = 69) matched for parental social class and age at father death were similarly interviewed. Three self-administered tests, the Middlesex Hospital Questionnaire, a modified Zung Depression Scale and the Navran Dependency Scale of the MMPI were also completed. It was shown that separation alone was unrelated to adult psychopathology or mental disorder. Poor preseparation maternal relationships, both alone and in combination with two or more changes of care plus unsatisfactory replacement care, contributed to an increase in psychiatric morbidity and psychopathology.

Factors associated with psychiatric symptoms in patients undergoing chronic hemodialysis.

Psychiatric morbidity in a sample of 85 patients undergoing chronic hemodialysis was assessed using standard questionnaires (General Health Questionnaire and Middlesex Hospital Questionnaire). Examination of the effects of demographic, illness, treatment, and history variables on questionnaire scores revealed that psychiatric symptoms were more frequent in women than in men, in those on home dialysis, in those living in rural areas, in unemployed men and in those with a disturbed nuclear family. Factor analysis of symptoms assessed by one of the questionnaires (GHQ) revealed six factors: general general dissatisfaction, suicidal ideation, confidence and well-being usefulness and enjoyment, concentration and alertness, sleep disturbance, Interview responses revealed a high incidence of general distress and anxiety and also a high incidence of sexual problems

The Middlesex Hospital Questionnaire: a validity study with American psychiatric patients.

The Middlesex Hospital Questionnaire (MHQ) was used as a screening test for psychiatric disorder in 169 new outpatients. The profile obtained on the six subscales of the MHQ was strikingly similar in this American sample compared to four previous British reports. The MHQ significantly differentiated between diagnostic groups, most particularly between neuroses and personality disorders. Moreover, 75 per cent of the patients could be correctly classified as either neurosis or personality disorder on the basis of their MHQ total and subscale scores. The MHQ appears to be particularly useful in identifying phobic disorders, and the phobia subscale consistently discriminated between anxiety-phobic states and other diagnostic groups.

Endocrinologic and psychologic aspects of galactorrhea associated with normal menstrual cycles

Twelve cases of galactorrhea in women with normal menstrual cycles who were radiologically free of any pituitary adenomas were investigated. Determinations were made for serum thyroid-stimulating hormone (TSH), T 3 resin uptake (T 3RU), total thyroxine by radioimmunoassay (T 4), free thyroxine index (FT 4I), norepinephrine, epinephrine, prolactin and urinary luteinizing hormone, total estrogens, pregnanediol and total catecholamines. Psychologic evaluation and assessment were also done using the Middlesex Hospital Questionnaire and the Eysenk, manual dexterity. Bender Gestalt and trial-making scales. Hypothyroidism associated with moderate hyperprolactinemia and anovulation were the main features in eight cases. Associated psychologic disturbances were reported. The other four cases showed significant elevations in serum epinephrine, norepinephrine and urinary total catecholamines with concomitant pathologic scales of anxiety and neuroticism. Thyroxine replacement and psychotherapy are recommended in the treatment of such cases.

The factorial reliability of the Middlesex Hospital Questionnaire in normal subjects.

The internal reliability of the Middlesex Hospital Questionnaire and its component subscales has been checked by means of principal components analyses of data on 256 normal subjects. The subscales (with the possible exception of Hysteria) were found to contribute to the general underlying factor of psychoneurosis. In general, the principal components analysis points to the reliability of the subscales, despite some item overlap.

On the validity of the Middlesex Hospital Questionnaire: a comparison of diagnostic self-ratings in psychiatric out-patients, general practice patients, and 'normals' based on the Hebrew version.

The short clinical diagnostic self-rating scale for psycho-neurotic patients (The Middlesex Hospital Questionnaire) was translated into everyday Hebrew and tested on 216 subjects for: (1) concurrent validity with clinical diagnoses; (2) discriminatory validity on a psychoneurotic gradient of psychiatric out-patients, general practice patients, and normal controls; (3) validity of subscales and discrete items using matrices of Spearman rank correlation coefficients; (4) construct validity using Guttman's smallest space analysis based on coefficients of similarity. The Hebrew MHQ was found to retain its validity and to be easily applicable in waiting-room situations. It is a useful method for generating and substantiating hypotheses on psychosomatic and psychosocial interrelationships. The MHQ seems to enable the expression of the 'neurotic load' of a general practice subpopulation as a centile on a scale, thereby corroborating previous epidemiological findings on the high prevalence of neurotic illness in general practice. There is reason to believe that the MHQ is a valid instrument for the analysis of symptom profiles of subjects involved in future drug trials.

Oxypertine and Medazepam in Patients Suffering from Anxiety Neurosis. Report of a Double Blind Study

In two centres a total of 50 patients with anxiety neurosis was studied in a randomised, between patient, double blind comparison of the therapeutic efficacies of two new anxiolytic agents, oxypertine ( Integrin) and medazepam ( Nobrium). Treatment was continued for four weeks. Assessments were made using the Middlesex Hospital Questionnaire ( MHQ), the Hamilton Anxiety Scale and the Graphic Scale. On all three ratings both agents produced a significant improvement in the patients' condition. Significant differences between the two agents were recorded by the MHQ sub tests and total score. Phobic anxiety responded significantly better to medazepam ( p < 0·03). Depression responded significantly better to oxypertine ( p < 0·02) which was also associated with a greater improvement in three of the remaining four sub tests and a significantly greater reduction in score for overall neuroticism ( p < 0·05).

The contribution of psychological features to the symptoms of treated hypertensive patients.

Twenty-seven symptoms of 859 treated hypertensive patients were evaluated using a self-administered questionnaire and correlated with the depression (DEP), free-floating anxiety (FFA), phobic anxiety (PHO), obsessionality (OBS) and extraversion (HYS) scores of the Middlesex Hospital Questionnaire. The psychological features were associated with 24 of the 27 symptoms, and the extent to which these measurements determined the presence of a symptom was calculated. DEP and FFA were correlated with most of the symptoms, PHO with weak limbs, blurred vision, slow walking pace, nocturia and a lessened interest in sex. HYS was positively associated with the frequency of sexual intercourse in men and negatively with complaints of dyspnoea, tingling in the limbs and a slow walking pace. OBS was only associated with diarrhoea.