Positive Symptom Distress Index Research Articles

Is psychological distress intrinsic to fibromyalgia syndrome? Cross-sectional analysis in two clinical presentations

Clinical presentation of fibromyalgia syndrome (FMS) is heterogeneous and often involves psychological comorbidities. Clinical subgrouping of FMS patients has been proposed as a strategy to improve patients' long-term outcomes by helping identify specific treatment needs. Using the 90 Symptom Checklist Revised (SCL-90-R), we have assessed emotional distress in two FMS patient subpopulations discriminated on the basis of their differences in scores on specific items of the Fibromyalgia Impact Questionnaire (FIQ). Subjects classed as type II exhibited high emotional distress on all ten dimensions studied, which included somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, and additional items subscales, as well as on the global severity index (GSI), positive symptom total (PST), and positive symptom distress index (PDSI). T-scores in these patients were above diagnostic cutoff level of 60 on somatization, obsessive-compulsive, and depression subscales. In contrast, the profile exhibited by type I subjects fell entirely within normal values for nonpsychiatric population. Emotional status was significantly inversely correlated with present clinical pain in type I-, but not in type II-fibromyalgia patients. Regression analysis revealed a model based on phobic anxiety, paranoid ideation, and depression subscales as best contributing to classification. The present data suggest that associated psychological distress and maladaptive emotional responses that are commonly attributed to the general FMS population may be largely a distinguishing feature of one subset of patients.

P03-489 - Fibromyalgia and psychopathology

IntroductionFibromyalgia seems to be associated with various forms of psychopathology, particularly major affective disorders.ObjectiveTo evaluate associated psychopathology in a series of women with diagnosis of fibromyalgia.MethodsPatient inclusion from 1st March to 30th June 2010. Symptom Checklist (SCL-90-R) was used for evaluation. SPSS was used for statistical analysis of data and results.ResultsA total of 34 women voluntarily joined our study. Mean age was 52.2 years (standard deviation (SD) 7.17). 11.4% were singled, 74.3% married or unmarried couples, 8.6% were divorced, and 5.7% were widowers. 74.3% of women lived with their couple and/or children whereas 8.6% lived by their own, and 8.6% with their parents. Results obtained with SCL-90-R showed:Global Severity Index (GSI) 1.86 (Standard Deviation (SD) 0.54); Positive Symptom Distress Index (PSDI) 2.58 (SD 0.36); Positive Symptom Total (PST) 167.85 (SD 49.30); Somatization (SOM) 2.62 (SD 0.53); Obsessive-Compulsive (O-C) 2.59 (SD 0.78); Interpersonal Sensitivity (I-S) 1.50 (SD 0.86); Depression (DEP) 2.5 (SD 0.75); Anxiety (ANX) 1.75 (SD 0.74); Hostility (HOS) 1.11 (SD 0.82); Phobic Anxiety (PHOB) 1.09 (SD 0.84); Paranoid Ideation (PAR) 1.11 (SD 0.85); Psychoticism (PSY) 1.05 (SD 0.62), and other vague symptoms 2.15 (SD 0.70).ConclusionOur patients with fibromyalgia scored higher in somatization, obsession-compulsion, depression, and anxiety. In view of the results, there is an important association between fibromyalgia and various forms of psychopathology.

Psychopathological profile of patients with different forms of bruxism

The aim of the current study was to evaluate the prevalence of psychopathological symptoms in patients who self-reported different forms of bruxism by means of clinical and anamnestic diagnostic criteria. Eighty-five participants were divided into four groups as sleep bruxers (12), awake bruxers (24), sleep-awake bruxers (33), and non-bruxers (16). A self-report symptom inventory questionnaire (Symptom Checklist-90-Revised (SCL-90-R)) was filled out by all groups to determine their psychopathological symptoms. As regards mean psychopathological scores, patients with sleep-awake bruxism endorsed the highest scores. In addition, patients with awake bruxism showed higher scores than patients with sleep bruxism and non-bruxism in most SCL-90-R subscales. Kruskal-Wallis test revealed significant differences between groups in any of the SCL-90-R subscales, except for the psychoticism subscale. Mann-Whitney test followed by Bonferroni's test correction between non-bruxer and sleep-awake bruxer groups revealed significant differences in depression, anxiety, hostility, phobic anxiety, paranoid ideation, global severity index, positive symptom distress index, and positive symptom total in all SCL-90-R subscales. Statistical analysis of our study showed that differences between groups were significant in all SCL-90-R subscales except for the psychoticism subscale. Better distinction of bruxism forms may help to develop new treatment strategies for bruxism disorder.

Reducing Teachers' Psychological Distress through a Mindfulness Training Program

Teachers constitute one of the professional collectives most affected by psychological problems. The purpose of this quasi-experimental study is to examine the efficacy of a mindfulness training programme to reduce psychological distress in a group of teachers. The sample comprised 68 teachers of Secondary School Education, from various public schools; half of them formed the experimental group, and the another half the control group. The levels of psychological distress were measured, in both groups, by the Symptom Checklist-90-R (SCL-90-R) before and after the application of the programme. Statistical analysis shows the significant reduction of three general measures of psychological distress (Global Severity Index, Positive Symptom Distress Index, and Positive Symptom Total), as well in all its dimensions (somatization, obsessive-compulsive, interpersonal sensibility, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism), in the experimental group compared with the control group. Follow-up measures show that these results were maintained for four months after termination of the intervention in the experimental group.

Psychological morbidity in ALS: The importance of psychological assessment beyond depression alone

The assessment of psychological morbidity in patients with ALS has centered around depression, hopelessness, and anxiety. The Brief Symptom Inventory (BSI) offers an opportunity to explore psychological morbidity more broadly. We administered this instrument to 111 patients with ALS as part of a larger study of quality of life. Scores of ALS patients on the Global Severity Index and Positive Symptom Distress Index were comparable to the majority of distressed psychiatric outpatients and significantly higher than those of non-patient adults. Among BSI subscales, scores on the Anxiety, Depression, Phobic Anxiety, and Somatization subscales also were not significantly different from distressed adult psychiatric outpatients, and were greater than normal mean scores for a non-patient population sample. Based on these data, ALS patients appear to be significantly more distressed than non-patients in the identified areas, and as distressed as approximately 68% of a distressed psychiatric outpatient sample. In conclusion, a substantial number of individuals with ALS experience psychological distress of various types. Because psychological health impacts lifespan and quality of life in these individuals, broadly-based mental health assessment and treatment should remain an important part of care for patients with ALS. The effects of physical symptoms on responses to questions used to assess psychological distress must be considered.

Relation between mental health and spirituality in Tehran University student

The aim of the current study was to investigate the relationship between mental health and spirituality in college students. To accomplish this goal, 304 college students were selected from different colleges of university of Tehran, and the following measures were administered on them: Symptom checklist 90-R (SCL-90) and spiritual Experiences scale. Analysis of data revealed that there was a significant negative correlation between spiritual dimensions including: relation with God, finding meaning in life, spiritual actualization and activities. Transcendental mystical experiences, social and religious activities, and positive symptom distress index (PSDI).

Mental Health Symptoms among Rural-to-Urban Migrants in China: A Comparison with Their Urban and Rural Counterparts

To examine the mental health symptoms among rural-to-urban migrants in China, in comparison with representative samples of their counterparts in the rural areas from where they emigrated and urban communities to which they immigrated. A cross-sectional survey conducted in 2004-2005 in China. Both rural-to-urban migrants (n=1006) and urban residents (n=1000) were recruited in Beijing; the rural resident sample (n=1020) was recruited from the eight provinces of origin for 75% of the migrant sample. Mental health symptoms were measured using the Symptom Checklist-90 (SCL-90). Both rural-to-urban migrants and rural residents scored higher than urban residents in all the SCL-90 global indices and subscales. The rural-to-urban migrants scored higher than rural residents on the SCL-90 Positive Symptom Distress Index and two subscales (depression and psychoticism). The difference remained significant after controlling for a number of key individual characteristics (age, gender, marital status, education, income and perceived general health) in the multivariate model. The data in the current study demonstrate that rural-to-urban migrants suffer from lower mental health status than both urban residents in the immigrating communities and their rural counterparts in the emigrating communities. The data suggest a possible deteriorative effect of migratory experience on mental health status among rural-to-urban migrants in China and suggest an urgent need for etiological studies and for mental health promotion and prevention efforts among this growing population.

Dialectical behaviour therapy in an Irish community mental health setting.

Dialectical behaviour therapy (DBT) is a recommended treatment of patients with borderline personality disorder, yet there are few descriptions of the approach in public community mental health settings where the majority of such patients present. This study describes the development and evaluation of a DBT programme in an Irish setting. The DBT programme was run over a six month period. Participants were assessed at baseline and post intervention with the following instruments: The Structured Clinical Interview for DSM III R personality disorders (SCID II), the clinical Outcomes in Routine Evaluation (CORE) and the symptom checklist 90 Revised (SCL-90-Revised). Inpatient bed usage was determined from case note review. Outcome data was available for eight subjects. Significant improvement (p < 0.005) was seen on all CORE subscales. SCL-90-R showed significant improvement (p < 0.05) on the global severity index and on the positive symptom distress index. A decrease in self harming behaviour was found. Subjects' inpatient bed days dropped from a mean of 58 in the year pre intervention to a mean of four days in the year post intervention. A novel finding was that 43% of subjects who originally fulfilled criteria for avoidant personality disorder no longer did so post intervention. The study found that DBT can be applied in a community mental health setting with benefits similar to more specialist settings. Significant difficulties were encountered in implementing the programme. The clinical implications are that specialist psychotherapy services need to be an integral part of psychiatric services to achieve better outcomes for patients with borderline personality disorder.

Nurse Leader Mindfulness Meditation Program for Stress Management

The aim of this study was to rigorously evaluate a brief stress management intervention for nurse leaders. Despite the nursing shortage, evidence-based workplace approaches addressing nurse stress have not been well studied. Nurse leaders (n = 33) were randomly assigned to brief mindfulness meditation course (MMC) or leadership course (control). Self-report measures of stress were administered at baseline and within 1 week of course completion. Among MMC participants, change scores (from baseline to postintervention) on several subscales of the Symptom Checklist 90-Revised showed significantly more improvement in self-reported stress symptoms relative to controls. Mindfulness meditation course participants had significantly more improvement in Positive Symptom Distress Index (P = 0.010; confidence interval [CI] = -0.483 to -0.073) and Global Severity Index (P = 0.019; CI = -0.475 to -0.046) and nearly significantly more improvement in Positive Symptom Total (P = 0.066; CI = -16.66 to 0.581) compared with controls. Results support preliminary effectiveness of a 4-week MMC in reducing self-reported stress symptoms among nursing leaders.

Blood Levels of Brain-Derived Neurotrophic Factor Correlate with Several Psychopathological Symptoms in Anorexia Nervosa Patients

Background: Evidence of a role of brain-derived neurotrophic factor (BDNF) in the pathophysiology of eating disorders (ED) has been provided by association studies and by murine models. BDNF plasma levels have been found altered in ED and in psychiatric disorders that show comorbidity with ED. Aims: Since the role of BDNF levels in ED-related psychopathological symptoms has not been tested, we investigated the correlation of BDNF plasma levels with the Symptom Checklist 90 Revised (SCL-90R) questionnaire in a total of 78 ED patients. Methods: BDNF levels, measured by the enzyme-linked immunoassay system, and SCL-90R questionnaire, were assessed in a total of 78 ED patients. The relationship between BDNF levels and SCL-90R scales was calculated using a general linear model. Results: BDNF plasma levels correlated with the Global Severity Index and the Positive Symptom Distress Index global scales and five of the nine subscales in the anorexia nervosa patients. BDNF plasma levels were able to explain, in the case of the Psychoticism subscale, up to 17% of the variability (p = 0.006). Conclusion: Our data suggest that BDNF levels could be involved in the severity of the disease through the modulation of psychopathological traits that are associated with the ED phenotype.

Individual versus group therapy for obesity: Comparison of dropout rate and treatment outcome

To compare outcome and dropout rates of an individual nutritional counselling (IT) and a cognitive behavioural group therapy (GT) after 6 months of treatment. One hundred and twenty-nine women (72 in the IT and 57 in the GT group) aged 18-65 years, with body mass index (BMI) > or =25 kg/m(2). Body weight, height and waist circumference were measured. Obesity Related Well Being 97 questionnaire (ORWELL 97), Body Uneasiness Test (BUT), Symptom Check List 90 (SCL 90) and Binge Eating Scale (BES) tests were used to evaluate psychometrical variables. After 6 months, 37.2% (54.2% of initial IT sample and 15.8% of initial GT sample) of subjects abandoned the treatment programme. Completers were older (p<0.03) and had a worse BUTa General Severity Index score (p<0.04) than non-completers. IT had a higher dropout rate than GT. After 6 months of treatment completers lost 6.39% of initial weight and obtained improvements in all studied variables, except scores of SCL 90 and BUTb Positive Symptom Distress Index questionnaires. IT and GT groups did not differ significantly. Outcomes of IT and GT were comparable in all studied variables, whereas dropout rate of IT was higher than that of GT, suggesting that some characteristics of GT can contribute to the reduction of attrition. Younger age and better body image (measured by BUT) were associated to dropout. After weight loss we observed improvements in almost all variables in both groups without differences.

Impact of Pulmonary Rehabilitation on Psychosocial Morbidity in Patients With Severe COPD

To assess the effect of pulmonary rehabilitation (PR) on psychosocial morbidity, functional exercise capacity, and health-related quality of life (HRQL) in patients with severe COPD. A prospective, randomized, controlled trial with blinding of outcome assessment and data analysis. A tertiary-care respiratory service. Forty patients (mean age, 65 +/- 8 years [+/- SD]) with severe chronic flow limitation (FEV(1), 35 +/- 13%) without respiratory failure (Pao(2), 72 +/- 9 mm Hg; Paco(2), 42 +/- 5 mm Hg) were randomized either to a control group or to a PR group (PRG). Sixteen weeks of PR that included breathing retraining and exercise. At baseline and 16 weeks, we evaluated psychosocial morbidity using two questionnaires (the Millon Behavior Health Inventory [MBHI] and the Revised Symptom Checklist [SCL-90-R]) and measured 6-min walk distance (6WMD) and HRQL using the Chronic Respiratory Questionnaire (CRQ). We found differences in favor of the PRG in the following MBHI domains: introversive, forceful, and sensitive personality styles (all p </= 0.05) and chronic tension (p </= 0.01). Results of the depression, hostility, global severity, positive symptom distress index (all p </= 0.01), somatization, anxiety, psychoticism, and positive symptom (all p </= 0.05) domains of the SCL-90-R favored the PRG. We also found statistically and clinically significant differences between groups in 6MWD (85 m; p < 0.01) and in two domains of the CRQ: dyspnea (1.0; p < 0.01) and mastery (0.6; p < 0.05). The other two domains of CRQ showed strong trends in favor of PRG: 0.7 for both fatigue and emotional function (minimal important difference, 0.5). PR may decrease psychosocial morbidity in COPD patients even when no specific psychological intervention is performed. Findings from this study also confirm the positive impact of PR on functional exercise capacity and HRQL.

Non-motor manifestations in essential tremor: Use of a validated instrument to evaluate a wide spectrum of symptoms

Introduction Recent studies suggest an association between non-motor symptoms and essential tremor (ET). Few studies have assessed psychological symptoms in ET. These studies were limited to western white populations and utilized scales that were specific to only one or two psychiatric domains. By contrast, the Symptom Checklist-90R (SCL-90R) is a validated clinical scale to screen for symptoms related to a spectrum of nine different psychological domains. Objective To determine whether a wide spectrum of non-motor manifestations is associated with ET in patients in an Asian cohort. Methods Consecutive ET patients and a group of control subjects were evaluated using the SCL-90R, which is comprised of items in nine major symptom dimensions and three global indices, including the positive symptom distress index. Results ET patients ( N=84) and controls ( N=78) were similar in age (50.0±18.0 vs 46.0±14.4 years), gender and other demographic variables. ET patients had higher scores in three of nine major symptom dimensions: anxiety, phobic anxiety ( p<0.0005) and psychoticism ( p=0.005). In multivariate analysis, the anxiety ( p<0.0005) and the positive symptom distress index scores ( p<0.0005) were greater in ET patients compared to controls after adjusting for sex, age, marital status and educational level. The severity, but not duration of ET was correlated with the severity of anxiety symptoms. Conclusions Utilizing the SCL-90R, we highlighted that ET patients reported more non-motor symptoms than healthy controls. The more frequent occurrence of anxiety symptoms in our Asian cohort extends the observation that such non-motor manifestations should be considered in the clinical management of ET.

Comparison of Neuropsychiatric Side Effects in an Observational Cohort of Efavirenz- and Protease Inhibitor-Treated Patients

Purpose: To compare the extent of neuropsychiatric disturbances in two similar groups of HIV-infected patients treated for >4 weeks with either efavirenz (EFV) or protease inhibitors (PIs) as part of their antiretroviral therapy (ART). Method: A cross-sectional, questionnaire-based cohort of HIV patients who received two nucleoside reverse transcriptase inhibitors combined with either EFV (n = 75) or one or more PIs (n = 77) for at least 4 weeks and were tolerating therapy. The extent of neuropsychiatric disturbances was evaluated based on self-reported symptoms using the psychological evaluation test SCL-90-R. Treatment duration was broken down into quartiles of 30-198 days, >198-365 days, >365-637 days, and >637 days. Results: In the first 6 months of therapy, significantly higher (worse) scores were seen in 39/75 (52%) of the patients receiving EFV. The EFV-treated group had significantly higher scores for somatization, anxiety, obsessive-compulsive behavior, the Global Severity Index, and the Positive Symptom Distress Index, with trends for higher scores in paranoid ideation and depression symptom subcategories. Over the following 6 to 12 months of therapy, the EFV group scored higher than the PI group in somatization, anxiety, obsessive-compulsive behavior, hostility, depression, the Global Severity Index, and the Positive Symptom Total, but the differences were not significant. After 12 months of therapy, the EFV group had significantly lower scores than the PI group for somatization, interpersonal sensitivity, Global Severity Index, and Positive Symptom Total. Conclusion: EFV-induced neuropsychiatric symptoms can last up to 200 days after treatment initiation. However, symptom severity appears to decline over time in EFV-treated patients versus patients treated with a PI-based ART.

Comparison of Neuropsychiatric Side Effects in an Observational Cohort of Efavirenz- and Protease Inhibitor-Treated Patients

Purpose: To compare the extent of neuropsychiatric disturbances in two similar groups of HIV-infected patients treated for >4 weeks with either efavirenz (EFV) or protease inhibitors (PIs) as part of their antiretroviral therapy (ART). Method: A cross-sectional, questionnaire-based cohort of HIV patients who received two nucleoside reverse transcriptase inhibitors combined with either EFV (n = 75) or one or more PIs (n = 77) for at least 4 weeks and were tolerating therapy. The extent of neuropsychiatric disturbances was evaluated based on self-reported symptoms using the psychological evaluation test SCL-90-R. Treatment duration was broken down into quartiles of 30-198 days, >198-365 days, >365-637 days, and >637 days. Results: In the first 6 months of therapy, significantly higher (worse) scores were seen in 39/75 (52%) of the patients receiving EFV. The EFV-treated group had significantly higher scores for somatization, anxiety, obsessive-compulsive behavior, the Global Severity Index, and the Positive Symptom Distress Index, with trends for higher scores in paranoid ideation and depression symptom subcategories. Over the following 6 to 12 months of therapy, the EFV group scored higher than the PI group in somatization, anxiety, obsessive-compulsive behavior, hostility, depression, the Global Severity Index, and the Positive Symptom Total, but the differences were not significant. After 12 months of therapy, the EFV group had significantly lower scores than the PI group for somatization, interpersonal sensitivity, Global Severity Index, and Positive Symptom Total. Conclusion: EFV-induced neuropsychiatric symptoms can last up to 200 days after treatment initiation. However, symptom severity appears to decline over time in EFV-treated patients versus patients treated with a PI-based ART.

The factor structure of the Brief Symptom Inventory: intellectual disability evidence

AbstractThe use of psychometrics to assess the mental health of people with mild intellectual disabilities is a developing field of clinical and methodological interest. The available measures however tend to be few in number, with an even smaller minority progressing through the required rigorous psychometric development process. An assessment and potential outcome measure that has begun to be employed with people with intellectual disabilities is the Brief Symptom Inventory. This study examines the construct validity of the inventory through an exploratory factor analysis, with a sample of 335 intellectually disabled participants. Eight clear and interpretable factors emerged from the factor analysis with a high degree of overlap being apparent with the original factor solution. Such factor findings do not compromise the extant composite and global psychometric measures of the inventory, namely the global severity index, positive symptom distress index and positive symptom total. The results are discussed in the context of the apparent need for conducting confirmatory factor analysis as the next stage in the psychometric evaluation and clinical evolution of the Brief Symptom Inventory. Copyright © 2004 John Wiley &amp; Sons, Ltd.

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The relation between sexual and cardiovascular health in women is not well defined. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning.To investigate associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters, and self-perception of body image.Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited.Patients underwent physical, laboratory, and clitoral color Doppler ultrasound examinations and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, and the Body Uneasiness Test (BUT).Clitoral PI was positively correlated with body mass index (r = 0.441, P < .0001), waist circumference (r = 0.474, P < .0001), glycemia (r = 0.300, P = .029), insulin (r = 0.628, P = .002), homeostatic model assessment index (r = 0.605, P = .005), triglycerides (r = 0.340, P = .011), total cholesterol (r = 0.346, P = .010), and low-density lipoprotein cholesterol (r = 0.334, P = .016). All relations, with the exception of glycemia, retained statistical significance after adjusting for age, smoking habit, and years since menopause (P < .0001 for body mass index, waist circumference, and triglycerides; P < .05 for all other associations). Analysis of covariance, after adjusting for confounders, showed that women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (obesity: F = 17.79, P = .001; MetS: F = 7.37, P = .019). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β = 0.434, P = .007). Clitoral PI was negatively associated with Female Sexual Function Index arousal (β = −0.321, P = .014) and satisfaction (β = −0.289, P = .026) scores and positively associated with Middlesex Hospital Questionnaire somatized anxiety symptoms, even after adjusting for age, smoking habit, years since menopause, and current use of psychiatric medication (β = 0.354, P = .011). A positive association also was observed between PI and the BUT positive symptom distress index (β = 0.322, P = .039) and BUT for dislike of the womb, genitals, and breast (β = 0.538, P < .0001; β = 0.642, P < .0001; β = 0.549, P < .0001, respectively). After introducing waist circumference as another covariate, the associations between clitoral PI and the BUT positive symptom distress index and BUT dislike of the womb, genitals, and breast retained statistical significance (P = .038 for positive symptom distress index; P < .0001 for dislike of womb, genitals, and breast).Clitoral vascular resistance is positively associated with MetS (in particular insulin resistance), decreased sexual arousal, body image concerns, and increased somatized anxiety symptoms. Further studies are needed to establish whether treatment of metabolic abnormalities might improve clitoral color Doppler ultrasound indices and sexual outcomes.

STRESS AND WORK-LIFE IN A UNIVERSITY HOSPITAL IN TURKEY: EVALUATION OF THE BRIEF SYMPTOM INVENTORY AND WAYS OF COPING INVENTORY IN HOSPITAL STAFF

It has long been recognized that work can influence mental well-being. Quality of medical care is dependent upon the mental well-being of health care professionals. Determination of factors in job stress is important, because it will help to prevent it. The aim of this study was to evaluate the relationship of work-related stress with work life variables by using The Brief Symptom Inventory (BSI) and Brief Coping Styles Inventory (BCSI). A survey was conducted among hospital staff of a university teaching hospital in Turkey. Response rate was 52.4 % (N=152). A questionnaire included 47 questions on sociodemographic variables and lifestyle. Nineteen questions were derived from the Work-life Evaluation Scales. Psychological symptom status was assessed with BSI. Coping styles with stress behavior was evaluated with BCSI. Most participants showed medium level BSI subscale scores, but global indexes were at a higher level. Females had higher depression and anxiety scores than did males; graduates of university programs (mostly nurses) had higher somatisation, obsessive compulsive interpersonal sensitivity, depression, hostility, paranoid ideation, global severity index, positive symptom total and positive symptom distress index scores than did other respondents of other educational levels, staff who were employed by the university (i.e., residents and nurses) had higher BSI symptom scores. In conclusion, even though the respondents did not seem generally to be dissatisfied concerning their work-life, the majority of staff had depressive symptoms and were distressed. Nurses and residents in particular, should receive counseling concerning coping styles with stress.

Antecedents of dental anxiety: learned responses versus personality traits.

The origins of dental fear and anxiety are numerous and complex. The purpose of the present study was to evaluate the relative effects of learned responses and subjective personality traits on the development of dental anxiety. The study was carried out in kibbutzim (closed homogeneous societies) in Israel where all subjects had received dental treatment from the same dentist since childhood with no choice of dentist. Subjects were requested to fill out questionnaires concerning their dental anxiety (DAS) in the past and at present, an evaluation of their dentist in the past and at present, and a psychopathologic symptom survey (SCL-90). The results show that dental anxiety at present correlates significantly with the evaluation of the present dentist; with dental anxiety as remembered from childhood; and with the following SCL-90 scales: interpersonal sensitivity, anxiety, phobic anxiety and Positive Symptom Distress Index. The best predictors of dental anxiety at present were the evaluation of the present dentist and past dental anxiety (as remembered from childhood). The results suggest that the level of the subject's dental anxiety is affected by environmental factors (evaluation of the present dentist, memories of anxiety from childhood), and by personality traits as evaluated by the SCL-90 questionnaire.

Cross-sectional study of quality of life and symptoms in chronic renal disease patients: The modification of diet in renal disease study

The purposes of this study were to measure health-related quality of life in the Modification of Diet in Renal Disease clinical trial; correlate quality of life measures with demographic, medical, and laboratory variables; and compare quality of life in various chronic diseases. The 1,284 patients enrolled in the baseline period of the Modification of Diet in Renal Disease study who completed at least one measurement of quality of life or symptoms served as the subjects of this study. The Quality of Well-Being (QWB) scale, which was a general health-related quality of life index, the Symptom Checklist-90R (SCL-90R), which provided a global measure of mental health, and the Patient Symptom Form, which assessed the frequency of symptoms specific to this population, were used as measurements. The mean ± SD QWB score was 0.74 ± 0.09. Using multivariate analysis, there was a significant negative correlation between the overall QWB score and age and female gender, and a significant positive correlation between the QWB and level of education, income, and glomerular filtration rate (GFR). For the SCL-90R subscores, the mean normalized Global Symptom Index was 49.7 ± 9.6, the Positive Symptom Total was 47.9 ± 10.4, and the mean Positive Symptom Distress Index was 51.3 ± 12.6. Using multivariate analysis, significant inverse relationships were seen between each of the SCL-90R subscores and income, serum albumin level, and GFR. The most commonly reported medical symptoms in this cohort included tiring easily, weakness, lack of pep or energy, difficulty sleeping, and abdominal bloating or gas. Symptoms in which the severity index score had a negative correlation with GFR included tiring easily, weakness, lack of pep and energy, muscle cramps, easy bruising or bleeding, bad taste in mouth, and hiccoughs. In conclusion, patients with moderate to advanced renal insufficiency have a reduced quality of life and an increased frequency and severity of both symptoms and psychological distress, with the magnitude of these changes negatively correlated with GFR.