Archive for the ‘Stress Research’ Category

Stress Illness Screening (2)

Wednesday, May 12th, 2010

In 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.

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Stress Illness Screening (1)

Friday, May 7th, 2010

One 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.

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Child Maltreatment in High Income Countries (4)

Thursday, April 15th, 2010

In 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).

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Child Maltreatment in High Income Countries (3)

Wednesday, April 14th, 2010

The 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.

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Child Maltreatment in High Income Countries (2)

Tuesday, April 13th, 2010

To 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.

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Child Maltreatment in High Income Countries (1)

Monday, April 12th, 2010

Last 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.

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Blood Test for Stress Illness?

Wednesday, March 31st, 2010

Bethesda, Maryland.  April 1.  The Center for Irreproducible Results at the National Institution of Health today announced a stunning breakthrough that is certain to benefit hundreds of millions of patients.  Dr. Freddie P. Ignobel reports that she has found a blood test that can reliably confirm when physical symptoms are caused by life stresses and not by a disease of an organ or a metabolic problem.

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American Psychosomatic Society (4)

Thursday, March 18th, 2010

One important exception to the physiology-focused research presented at the APS meeting was a study led by my friend and colleague Dr Howard Schubiner.  His well-developed treatment program was used by a group of patients with fibromyalgia with good relief of their symptoms.  The process emphasizes techniques for uncovering the emotional issues that underly the symptoms in most cases.  Some patients did not benefit but most did which is a tremendous achievement in an illness as difficult as fibromyalgia.  It is likely that most forms of stress-related illness would benefit from this process.  Dr Schubiner’s book is due out by the end of this month and can be ordered via his web site (click on his name above).

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American Psychosomatic Society (3)

Monday, March 15th, 2010

I attended so many presentations at the annual APS meeting last week that I had no time left to post an entry here.  I also presented my talk on diagnosing physical symptoms connected to psychosocial stresses though only 20 people attended out of several hundred at the meeting.  One possible reason for that became apparent as I attended other symposia since most focused on the impact of stress on disease of body organs.  For example, numerous studies were presented or referred to that measured cortisone (a stress hormone) in saliva in various situations or showed images of brain activity.  There was far less about diagnosis and treatment of people whose symptoms are not explained by diagnostic tests, even though (as my readers know well) this is the largest single group of patients in all of primary care.

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American Psychosomatic Society (2)

Wednesday, March 10th, 2010

The 68th annual meeting of the American Psychosomatic Society got underway today with several presentations of interest.  First was a lecture that ties in with my recent blogs on assessing medical evidence.  The speaker presented studies that showed that people who took Vitamin E supplements for at least two years were about 40% less likely to suffer heart disease.  The researchers were well aware that people who take supplements are less likely to smoke and probably take better care of themselves in general.  So they attempted to account for those factors in every way they could using statistical techniques.  This gave their results enough credibility that they received wide attention from news media.  However, when this issue was studied using a PCRT (placebo-controlled randomized trial), which is a much more reliable method, the Vitamin E made no difference.  The speaker’s point was to be skeptical of results from population surveys because it is nearly impossible to account for all confounding factors.  He went on to talk about using genetic markers to make those surveys more reliable and accurate.

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