Continuing the review from the last post of research from Melbourne, Australia on psychogenic nonepileptic seizures (PNES), we have seen that there was no assessment of childhood stress in their subjects (1). This glaring omission meant that the opportunity to therapeutically address these issues in their patients was lost. Consequently it is not surprising that the outcome in their subjects was poor. In the 28% of their patients who returned a follow-up questionnaire (averaging four years later): Read the rest of this entry »
Archive for the ‘Stress Research’ Category
Stress and Seizures (3)
Monday, August 16th, 2010Stress and Seizures (2)
Sunday, August 15th, 2010Continuing the review of the research from Melbourne in the last post (1), the huge flaw is that the paper fails to report on childhood stress experience in patients with PNES (psychogenic non-epileptic seizures, which is a form of stress illness in many cases). Just how big a flaw is made clear in a paragraph from Dr Anna Luise Kirkengen’s latest book The Lived Experience of Violation: How Abused Children Become Unhealthy Adults (Zeta Books, 2010):
Stress and Seizures (1)
Thursday, August 12th, 2010One of the best recent research articles on a form of stress illness (1) has a huge flaw. The study was done over ten years at the Comprehensive Epilepsy Program at Royal Melbourne Hospital in Australia. They evaluate people who have seizures that are difficult for their regular doctors to manage. Among many other tests, patients have simultaneous video monitoring and EEG (brain wave) for five full days around the clock. This test identified 221 adult patients who outwardly appeared to be having seizures but the EEG showed they were not true epilepsy. These are called psychogenic (meaning “caused by a psychological process”) non-epileptic seizures (PNES). In the few patients I have seen who had these they were a form of stress illness. The patients are not deliberately pretending or faking, they are reacting to overwhelming life stresses.
Stress Illness Screening (3)
Tuesday, May 18th, 2010The search continues for a valid, ultra-short screening questionnaire for stresses capable of causing physical illness. Once that is in place, the next step is for primary care clinicians to learn how to further evaluate a patient with a positive screen. This should then lead to systems for follow-up care and monitoring, including the option of referral to mental health clinicians experienced with patients who have physical symptoms.
Stress Illness Screening (2)
Wednesday, May 12th, 2010In the last post we saw four questions (PHQ – 4) that screen for anxiety and depression. These are described in the reference below (1). However, to document that screening questions achieve their intended goals and are scientifically valid, it is not enough merely to come up with what sound like reasonable questions.
Stress Illness Screening (1)
Friday, May 7th, 2010One of the most frequent questions I get after my talks to medical clinicians is about rapid ways to screen for sources of stress. A validated questionnaire that revealed stress issues prior to the patient being seen would, theoretically, enable more accurate diagnosis in less time.
Child Maltreatment in High Income Countries (4)
Thursday, April 15th, 2010In the last post, we saw some of the difficulty researchers face in attempting to determine if child abuse increases the rate of chronic pain in adults. (Symptoms other than pain are not as well studied.) It is not uncommon for studies to have results that appear to conflict (1).
Child Maltreatment in High Income Countries (3)
Wednesday, April 14th, 2010The Lancet paper (1) reviews the evidence for a connection between child abuse and chronic pain in adults and finds some conflict in results. A prospective study of children whose maltreatment was confirmed by a court looked at rates of chronic pain when they reached age 29 compared with a group of matched controls and found no significant difference. On the other hand, retrospective studies of people with self-reported child maltreatment do show a significant increase in the rate of chronic pain.
Child Maltreatment in High Income Countries (2)
Tuesday, April 13th, 2010To continue the discussion of the comprehensive review of child abuse studies in The Lancet (1), the authors looked at the long-term consequences of child abuse. They reviewed previously published studies including those using prospective (following a group of abused children over time to assess outcomes) and retrospective (comparing teens and adults who report childhood maltreatment with those who report no prior abuse) research methods. Both techniques have limitations. Prospective methods may identify only a limited subset of abused children. Retrospective approaches may be influenced by what subjects recall and difficulty establishing whether abuse preceded or followed a particular consequence.
Child Maltreatment in High Income Countries (1)
Monday, April 12th, 2010Last year the British medical journal The Lancet published a major review of published research (172 references) on child abuse in developed countries (1). The authors were a multi-national team led by Prof Ruth Gilbert of the Institute of Child Health in London. They point out that statistics in this field are subject to significant problems since most cases are not reported when they occur and later recall by survivors may be inaccurate. These issues result in a range of estimates for prevalence but nevertheless it is clear that child maltreatment is common with major implications for public health.
