Retrospective Assessment Of Symptoms Research Articles

Towards an Accurate and Systematic Characterization of Persistently Asymptomatic Infection with SARS-CoV-2

People with persistently asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection experience no symptoms throughout the course of infection, while pre-symptomatic individuals report symptoms attributable to the virus. Transmission of SARS-CoV-2 from individuals without symptoms contributes to pandemic spread, but the extent of transmission from persistently asymptomatic individuals remains unknown. We describe three methodological issues that hinder attempts to estimate this proportion. First, incomplete symptom assessment likely overestimates the asymptomatic fraction. Second, studies with inadequate follow-up misclassify pre-symptomatic individuals. Third, serological studies may identify people with previously unrecognized infection, but reliance on poorly defined antibody responses and retrospective symptom assessment may result in misclassification. We provide recommendations regarding definitions, detection, documentation and follow-up to improve the identification and evaluation of people with persistently asymptomatic SARS-CoV-2 infection and their contacts. Accurate characterisation of the persistently asymptomatic fraction may shed light on COVID-19 pathogenesis, transmission dynamics, and inform public health responses.

Patient-Specific Stress-Abdominal Pain Interaction in Irritable Bowel Syndrome: An Exploratory Experience Sampling Method Study.

INTRODUCTION:Gastrointestinal symptoms in irritable bowel syndrome (IBS) have been correlated with psychological factors using retrospective symptom assessment. However, real-time symptom assessment might reveal the interplay between abdominal and affective symptoms more reliably in a longitudinal perspective. The aim was to evaluate the association between stress and abdominal pain, using the Experience Sampling Method (ESM) as a real-time, repeated measurement method.METHODS:Thirty-seven patients with IBS (26 women; mean age 36.7 years) and 36 healthy controls (HC; 24 women; mean age 31.1 years) completed an electronic ESM during 7 consecutive days. Abdominal pain and stress were scored on an 11-point Numeric Rating Scale at a maximum of 10 random moments each day.RESULTS:Abdominal pain scores were 2.21 points higher in patients with IBS compared with those in HC (P < 0.001), whereas stress levels did not differ significantly (B: 0.250, P = 0.406). In IBS, a 1-point increase in stress was associated with, on average, 0.10 points increase in abdominal pain (P = 0.017). In HC, this was only 0.02 (P = 0.002). Stress levels at t = −1 were not a significant predictor for abdominal pain at t = 0 in both groups, and vice versa.DISCUSSION:Our results demonstrate a positive association between real-time stress and abdominal pain scores and indicate a difference in response to stress and not a difference in experienced stress per se. Furthermore, an in-the-moment rather than a longitudinal association is suggested. This study underlines the importance of considering the individual flow of daily life and supports the use of real-time measurement when interpreting potential influencers of abdominal symptoms in IBS.

Neurocognitive Functioning in Alcohol Use Disorder: Cognitive Test Results Do not Tell the Whole Story

Objectives: It is textbook knowledge that individuals with alcohol use disorder (AUD) show large neurocognitive deficits. However, these patients display a number of additional impairments (e.g., lack of drive and motivation) that may contribute to poor test results. The impact of these secondary mediators has not been explored systematically. Based on prior findings that low performance motivation, a negative attitude toward cognitive assessment, and momentary symptoms compromise neuropsychological test results in depression, schizophrenia, and obsessive-compulsive disorder, we examined the possibility that impaired test results in AUD partially represent an epiphenomenon. Methods: Fifteen patients with AUD and 20 matched nonclinical individuals underwent a comprehensive neuropsychological test battery. The neurocognitive assessment was flanked by the Momentary Influences, Attitudes and Motivation Impact on Cognitive Performance Scale (MIAMI), which captures momentary influences affecting performance. Results: Patients with AUD performed worse than nonclinical controls on most test parameters. Group differences achieved a very large effect size for parameters tapping speed and accuracy. Patients with AUD showed deviant scores, particularly on the post version of the MIAMI (retrospective assessment of symptoms and influences during testing) and the total scores. For accuracy, the MIAMI scores represented a partial mediator. For speed, significant group effect sizes were rendered nonsignificant when the MIAMI was taken into account. Conclusion: Like other psychiatric patients, patients with AUD show marked neurocognitive impairments that seem to be aggravated by, for example, distraction and lack of effort. This tentatively suggests that performance only partly reflects cortical impairments in areas hosting neurocognitive faculties. Contextual factors deserve greater attention in patients with addiction. The cross-sectional design of our study limits conclusions relating to causality.

Early trauma, attachment experiences and comorbidities in schizophrenia.

To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities. Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships - Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively. Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale. Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.

The impact of attention-deficit hyperactivity disorder across the lifespan on substance use disorders

Introduction Attention-deficit hyperactivity disorder (ADHD) affects not only children, but persists into adulthood with a prevalence rate up to 4.4% in the general population. The association between ADHD and substance use disorders (SUDs) is getting more into the scientific focus. However, the impact of ADHD on SUD regarding the economic system and healthcare is still underestimated. Aim of the work The aim of this study was to analyze the impact of childhood and adult ADHD on SUD by comparing the SUD clinical outcome between a group of SUD inpatients having a history of childhood ADHD and another group of SUD inpatients having concurrent adult ADHD. Participants and methods A cross-sectional comparative study was conducted at the Addiction Treatment Center at El Maamoura Mental Hospital. In all, 102 adult male patients were assessed using a clinical psychiatric interview and psychometric assessment using the Arabic version of Wender Utah Rating Scale for retrospective assessment of symptoms of childhood ADHD. Also, the Arabic version of the Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was used to screen for adult ADHD. Results Sixty-four patients out of the total studied sample had a history of childhood ADHD. Of them, only 36 patients fulfilled the DSM-IV-TR criteria for adult ADHD. The presence of adult ADHD was associated with an earlier mean age of onset of SUD (13.22 vs. 14.86 years), a larger number of hospital admissions (4.21 vs. 6.83 times), and a shorter mean period of abstinence (124.53 vs. 271.50 days) than patients with a history of childhood ADHD. Conclusion In comparison with childhood ADHD, the presence of adult ADHD among patients with SUD was associated with a more complicated course of SUDs and a poorer clinical outcome.

Electronic monitoring of symptoms and lung function to assess asthma control in children

BackgroundAsthma remains poorly controlled in children. Home monitoring of asthma control may help to improve the level of asthma control. ObjectivesTo compare 2 methods to assess asthma control: (1) prospective home monitoring, based on daily assessment of forced expiratory volume in 1 second (FEV1) and electronic symptom score, and (2) Asthma Control Questionnaire (ACQ) with retrospective assessment of symptoms and FEV1. MethodsNinety-six children with asthma were prospectively followed up during 1 year. Asthma control was assessed by home monitoring, including an electronic symptom score based on Global Initiative for Asthma (GINA) criteria and FEV1 measurements. In the hospital, the ACQ was completed and FEV1 was measured. Kappa analysis was performed to assess levels of agreement between the 2 methods. ResultsAgreement between the 2 methods was low (κ coefficient of 0.393). In 29 children (37%), prospective home monitoring was less optimistic than the retrospective assessment of asthma control by the ACQ. ConclusionThis study found low agreement between asthma control based on GINA criteria by means of prospective home monitoring and the hospital ACQ. The prospective home monitor detected more cases of less well-controlled asthma than the ACQ. However, optimization of adherence to home monitor use is necessary. Trial Registrationclinicaltrials.gov Identifier: NCT01239238.

EPA-0421 – Stimulant abuse in patients with comorbid adult attention-deficit hyperactivity disorder “ADHD” and substance use disorders “SUD”

Comorbidity is common among adults with ADHD, including substance abuse. Researchers have undertaken studies on the role of self medication in symptom control in adults with ADHD. Individuals with ADHD may use specific drugs, such as cocaine, that act in a manner similar to prescribed ADHD medications to lessen symptoms. Assessment of rate of abuse of stimulants among patients with comorbid ADHD and other SUD. The aim of this study was to estimate prevalence rate of stimulant use among patients with comorbid ADHD and SUD and to compare it with patients diagnosed with SUD only. This cross-sectional comparative study was conducted in addiction treatment center at El Maamoura psychiatric hospital. One hundred and two adult males were assessed using Arabic version of Wender Utah Rating Scale (WURS) for retrospective assessment of symptoms of childhood ADHD. Arabic version of Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was used to screen for adult ADHD. DSM IV TR criteria were used for final diagnosis. Type of drug of abuse was determined using Urine screen and semi-structred questionnaire. Thirty six patients out of the 102 patients screened positive for Adult ADHD (35.3%). Four patients of the ADHD group were abusing cocaine (11.1%) while non of the non ADHD group used cocaine (FEp = 0.014). Patients with adult ADHD have significant higher rates of abuse of cocaine in comparison to patients with SUD only.

2628 – Prevalence and characteristics of adult attention-deficit hyperactivity disorder among substance use inpatients

Comorbidity is common among adults with ADHD, including substance abuse. To our knowledge relation between ADHD and SUD has not been studied in Arab countries. Assessment of scope of comorbidity between ADHD and SUD in Egyptian patients. Estimating prevalence rate of adult ADHD among substance use inpatients and to compare substance use inpatients with and without adult ADHD regarding onset, and severity of SUD. This cross-sectional comparative study was conducted in addiction treatment center at El Maamoura psychiatric hospital. One Hundred and two adult males were assessed using Arabic version of Wender Utah Rating Scale (WURS) for retrospective assessment of symptoms of childhood ADHD. Arabic version of Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was used to screen for adult ADHD. DSM IV TR criteria were used for final diagnosis. 36 patients were diagnosed as having adult ADHD (35.3%) according to DSM-IV TR criteria. Presence of adult ADHD was associated with an earlier mean age of onset of SUD (15.58 vs. 13.22 years) and larger number of hospital admissions, (6.83 vs. 3.39 times). ADHD subjects achieved a shorter mean period of abstinence (124.53 vs. 209.82 days). Data were fed to the computer using the Predictive Analytics Software (PASW Statistics 18). Significance of the obtained results was judged at the 5% level. The results of this study confirm the high rates of adult ADHD among substance use patients mentioned in other studies. Presence of adult ADHD was associated with a more complicated course of SUD.

2709 – Impact of attention-deficit hyperactivity disorder “ADHD” across lifespan on substance use disorders “SUD”

Introduction Attention-deficit hyperactivity disorder (ADHD) affects not only children but persists for up to 4.4% in the general population. Comorbidity is common among adults with ADHD, including substance abuse. Objectives Assessment of impact of both childhood and adult ADHD on SUD. Aim The aim of this study was to estimate prevalence rate of past history of childhood ADHD and current adult ADHD among substance use inpatients and to compare between the two groups regarding onset and severity of substance use disorder. Methods This cross-sectional comparative study was conducted in addiction treatment center at El Maamoura psychiatric hospital. One hundred and two adult males were assessed using Arabic version of Wender Utah Rating Scale (WURS) for retrospective assessment of symptoms of childhood ADHD. Arabic version of Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was used to screen for adult ADHD. DSM IV TR criteria were used for final diagnosis. Results Sixty Four patients of the total studied sample had past history of childhood ADHD. Of which, only 36 patients fulfilled the DSM - IV TR criteria for adult ADHD. Presence of adult ADHD was associated with an earlier mean age of onset of SUD (13.22 vs. 14.86 years), larger number of hospital admissions, (4.21 vs. 6.83 times) and a shorter mean period of abstinence (124.53 vs. 271.50 days). Conclusions In comparison to childhood ADHD, presence of adult ADHD was associated with a more complicated course of substance use disorders and poorer outcome.

Zastosowanie izotonicznego roztworu NaCl u chorych z ostrym zapaleniem błony śluzowej nosa i zatok przynosowych

The mucous membrane of the nose and paranasal sinuses has several important physiological functions. Inflammation of the nose and paranasal sinuses impairs filtration, humidification and warming of the inhaled air. It also affects the beating of cilia and the mucociliary clearance within the nose and lumen of the sinuses. The result is impairment of the mechanism by which the removal of the stagnant pathological discharge from the paranasal sinuses and of foreign matter (environmental pollutants) from the nasal mucosa would be otherwise effected. The use of special products to cleanse the nasal mucosa may considerably improve its function. Day-to-day ENT practice offers evidence of beneficial effects of nasal douching with isotonic sea water solutions. Products which cleanse nasal mucosa are now used as an adjunct to treatment of rhinosinusitis and rhinitis co-existing with nasal polyps. was a retrospective assessment of symptoms in patients with acute rhinosinusitis depending on the therapeutic modality used, especially in a group of patients using an isotonic solution (0.9% NaCl) in addition to standard treatment. Medical records of 80 patients, males and females with symptoms of acute rhinosinusitis were included in the final evaluation. The following medical records including fully documented medical history and physical findings in compliance with the EP3OS were randomly selected from the medical records at the ENT Outpatient Clinic: 40 patients with acute rhinosinusitis treated symptom-relieving medication (Group A) and symptom-relieving medication with topical nasal corticosteroids (Group C); 40 patients with acute rhinosinusitis treated symptom-relieving medication plus isotonic NaCl solution twice a day (Group B) and symptom-relieving medication with topical nasal corticosteroids plus isotonic NaCl solution twice a day (Group D). Seven-days-treatment resulted in the decreasing of severity of the disease by 39.59% in control group and by 73.62% in patients using isotonic solution NaCl. The use of isotonic NaCl solutions as an adjunct to the treatment of acute rhinosinusitis results in highly statistically significant improvement of nasal patency (by 45.1% in control group and by 72.0% in patients using isotonic solutions) due to decreased swelling of the mucosa of the nasal turbinate. The use of isotonic NaCl solutions as an adjunct to the treatment of acute rhinosinusitis results in a highly statistically significant improvement in function of smell. Treatment with local nasal corticosteroids in combination with isotonic NaCl solutions produces a significant reduction in the severity of symptoms in patients with rhinosinusitis. The therapeutic effect in these patients is statistically significantly better than in patients treated with local nasal corticosteroids alone. The findings of the present study support the investigators' opinion that the isotonic solution (0.9% NaCl) should be recommended for nasal douching may be a valuable adjunct to the standard medical treatment of acute rhinosinusitis.

Programma 2000: Celebrating 10 Years of Activity of an Italian Pilot Programme on Early Intervention in Psychosis

This paper describes the structure and the organization of the single Italian programme specifically targeted at the early detection of and interventions for subjects at onset of or at high risk of psychosis, Programma 2000. Programma 2000 is a comprehensive multi-modal protocol of early intervention in psychosis, set up in Milan in 1999. The service has been very active since its opening, and at the time of writing (spring (April) 2008), more than 300 young patients have been evaluated through a detailed protocol that embraces Health of the Nation Outcome Scale (HoNOS), Brief Psychiatric Rating Scale (BPRS), Cognitive Behavioural Assessment 2.0, Disability Assessment Schedule, Camberwell Family Interview, Wechsler Adult Intelligence Scale and the Early Recognition Inventory Retrospective Assessment of Symptoms. The treatment includes psychoeducation, cognitive behavioural therapy (CBT), both structured and unstructured psychosocial interventions and pharmacotherapy, when necessary. The programme focuses on young people aged 17-30 years: to date, a total of 132 subjects with definite psychosis or within the high-risk category have been enrolled in treatment after assessment. Patients with first-episode psychosis were, on average and expectedly, more severe than those in the at-risk group, and were more likely to be prescribed antipsychotic drugs. A large majority of patients in both groups received tailored CBT; individual sessions of skills training were provided to two-thirds of patients. In both groups, improvement was found in both the BPRS and HoNOS, and in the level of global functioning as assessed on Global Assessment of Functioning at 6 month and 1 year follow up. Global functioning was more sensitive to change than symptom severity, reflecting the intensive and personalized efforts to improve social and role functioning in patients. Programma 2000 is still in development but it has already gained the support of therapists and other relevant people involved in the life of subjects at onset, or at high risk of psychosis.

Original article: Grass pollen symptoms interfere with the recollection of birch pollen symptoms – a prospective study of suspected, asymptomatic skin sensitization

Background: Asymptomatic skin sensitization (AS) is a risk factor for the development of allergic symptoms. A meticulous definition of this condition requires a systematic assessment of clinical symptoms before inclusion.Objective: To examine the concordance between retrospective assessment of seasonal allergic symptoms and prospective seasonal symptom registration among subjects with AS.Methods: On the basis of a population survey, autumn 2002, including skin prick tests (positive if ≥3 mm) and a screening questionnaire, 87 subjects with AS to birch and/or grass pollen, birch and/or grass pollen allergic symptomatic subjects (n = 63) and healthy controls (n = 40) were included in January to March 2003, completed diary cards on symptom and medication use during the relevant seasons 2003, and were examined at follow up in autumn 2003. Allergy: positive SPT and symptoms ≥ seven diary days.Results: Eleven AS subjects (birch: n = 10) subsequently developed allergic symptoms, yet nine admitted, at follow up, to have had symptoms before inclusion, or even denied pollen‐related symptoms despite a significant diary. Compared with AS subjects sensitized to grass pollen, AS subjects sensitized to birch pollen had significantly larger skin prick reactions and more often and severe pollen symptoms.Conclusion: In the context of double‐sensitization, retrospective symptom assessment is not a reliable method for ensuring that subjects classified, as asymptomatically skin sensitized, are truly, asymptomatic. This matter should be considered in studies on allergy development.

The course of schizophrenia: Some remarks on a yet unsolved problem of retrospective data collection

The retrospective assessment of symptoms and syndromes is a basic measure in research of the longitudinal course of schizophrenia. In spite of its importance there have been few studies evaluating the standard of quality of instruments for retrospective data collection. Combining retrospectively and cross-sectionally collected data on schizophrenic symptomatology in a cohort study over a period of 5 years revealed a significant underestimation of symptoms when assessed in retrospect. The need for studies on the validity of instruments for the retrospective assessment of symptoms is stressed.

Vital exhaustion and depression: A conceptual study

Excess fatigue, hopelessness, listlessness, loss of libido, increased irritability and problems with sleep have been found to increase the risk for a first non-fatal MI. These complaints are thought to reflect a state of 'vital exhaustion'. Most, if not all, of these feelings are also characteristic for subjects suffering from a depressive disorder. The aim of the present study was to explore whether a state of vital exhaustion is characterized more by depressed mood than by loss of vigour and excess fatigue. The Profile of Mood States was used to assess depressed mood, vigour and fatigue. Subjects monitored these factors themselves for a period of three weeks to circumvent retrospective recall bias and to investigate depressed mood, vigour and fatigue in a natural context. Current affective, cognitive, motivational and somatic symptoms of depression were further assessed retrospectively with the Beck Depression Inventory. The results with self-monitoring indicate that exhausted subjects suffer from loss of vigour and excess fatigue, while a depressed mood was almost absent. The retrospective assessment of symptoms of depression yielded similar results. It appeared that the most frequently reported symptoms were: 'fatigability', 'work inhibition', 'sleep disturbance' and 'loss of libido', while 'depressed mood', the key symptom for depressive disorders, was hardly mentioned. Based upon these results, we suggest that what we term 'vital exhaustion' is distinct from depression.

Beta-blockade in the hyperventilation syndrome. A retrospective assessment of symptoms and complaints.

The effect of beta-adrenergic blockade on ventilatory parameters and on subjective complaints was studied in 73 patients suffering from hyperventilation syndrome. The beta-blockade made the PA,CO2 increase as much as tranquillizer therapy. No effect of any kind of therapy was found on the subjective complaints. A remarkable dissociation was found between the measured ventilatory parameters and the quantified subjective complaints. It is concluded that beta-blockade is an effective therapy for the basic problem of hypocapnia in the hyperventilation syndrome; in this respect it is to be preferred over other therapies such as tranquillizers.