The Brief Symptom Inventory: Measuring psychological distress in spinal cord injury.

Explored the appropriateness of the Brief Symptom Inventory (BSI) as a measure of psychological distress among 79 traumatic spinal cord injured (SCI) patients (aged 18–70 yrs) and emphasized the limitations of using the BSI as a replacement for the SCL-90—Revised (SCL-90—R). Ss' BSI scores were compared with a nonpatient normative group (N?=?974). Ss were significantly more psychologically distressed in somatization, depression, and phobic anxiety than the normative group. However, several somatization symptoms endorsed by these Ss are common physical effects of SCI rather than psychosomatic complaints. When comparing BSI and SCL-90—R scores of the same Ss, significant statistical differences were found with respect to the level of psychological distress being reported by each test. The BSI may not represent an equivalent abbreviated form of the SCL-90—R for the SCI population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of daily impairment in COPD.

Examined 16 adult patients with severe chronic obstructive pulmonary disease (COPD), as indicated by spirometry testing. Ss reported the degree of difficulty in performing 10 tasks of daily living and completed the SCL-90-R to assess affective and somatic states. Results indicate that while restriction of 3 activities was correlated with severity of lung impairment, difficulty in performing daily activities appeared more consistently correlated with emotional functioning. In particular, SCL-90-R subscales of somatization, anxiety, and depression were correlated with behavioral impairment of multiple daily activities. Implications for psychosocial interventions in the rehabilitation of COPD patients are discussed, including the differential impact of stress management training and treatments for depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bleeding tendency of unknown origin and protein Z levels

PURPOSE: The German Social law requires quality assurance of inpatient treatment, i.e. of the quality of therapy, allowing the comparison of different hospitals. METHODS: Since easy administrable assessment instruments are required, in this study (part of a greater survey on quality assurance at the Department of Psychiatry in Luebeck) a global self-rating by means of a visual analog scale (VAS) and the GAF (Global Assessment of Function) were compared with the ratings on the SCL-90-R scale in 386 psychiatric inpatients (mean age: 44.0 +/- 15.2 years). RESULTS: The comparison of the values on admission and at discharge yielded good correlations between the global VAS-value and the SCL-90-R symptom scores only at discharge. As parameter of therapeutic efficacy the difference of the scores on admission and at discharge was calculated. While the global self-rating (VAS) correlated well with the SCL-90-R scores, no relationship between the GAF-scores and the SCL-90-R scores were found. Schizophrenics and patients suffering behaviour or personality disorders often showed discrepancies of the self- and the therapist rating. CONCLUSIONS: These discrepancies offer some hints for the identification of problematic patients. However, the global assessment of therapeutic efficacy often yield controversial results, if the limits of such scores are not considered.     

Interleukin-1 beta inhibits glutamate release in hippocampus of young, but not aged, rats

OBJECTIVE: In addition to the physical symptoms of galactorrhoea and amenorrhoea, hyperprolactinaemia in women is also reported to be associated with psychological symptoms. Previous studies have found an increased incidence of depression, anxiety and hostility in female patients with hyperprolactinaemia. In this study, psychological symptoms were assessed in a large population of patients and symptom scores were compared between patients with definite evidence of pituitary adenoma on high-resolution CT scanning and those without, who were presumed to have idiopathic or 'functional' hyperprolactinaemia. DESIGN: Postal survey: population-control study of female patients with hyperprolactinaemia. PATIENTS: Sixty-five women with hyperprolactinaemia were compared with a control group of 26 women with normoprolactinaemic pituitary disease (acromegaly or nonfunctioning pituitary adenoma). The hyperprolactinaemic patients were subdivided according to whether a pituitary adenoma was visible on high-resolution CT scanning (39 patients) or whether they had normal CT scans, in which case they were categorized as having idiopathic or 'functional' hyperprolactinaemia (26 patients). MEASUREMENTS: Patients were sent 2 questionnaires, the Hospital Anxiety and Depression (HAD) Scale and the 90-item Symptom Checklist (SCL-90), to assess psychological wellbeing. RESULTS: Overall, 54% of hyperprolactinaemic patients were found to have definite or borderline anxiety as judged by HAD scores, compared with 27% of normoprolactinaemic control patients. Those with normal CT scans were significantly more likely to have definite or borderline anxiety (73% of patients) than those with CT evidence of a pituitary tumour causing their hyperprolactinaemia (41%, P < 0.003), despite similar levels of serum prolactin. A similar increased proportion of hyperprolactinaemic patients scored highly on the anxiety component of the SCL-90, although mean scores were not different from controls. No differences were seen in scores for depression, but both subgroups of hyperprolactinaemic patients scored more highly than controls for hostility on the SCL-90 questionnaire. CONCLUSION: These findings confirm the presence of significant anxiety in a proportion of women with hyperprolactinaemia. Hyperprolactinaemic women with no abnormality on CT scans displayed more psychological distress than those with definite pituitary microadenomas. These results may provide insight into the pathogenesis of 'functional' hyperprolactinaemia.     

The psychological profiles of patients with whiplash-associated headache

Headache often compounds chronic neck pain following whiplash injury. To better understand post-traumatic headache, the SCL-90-R symptom checklist was used to determine the psychological profiles of patients with whiplash-associated headache and of patients with whiplash-associated neck pain without headache. The psychological profiles of these patients were compared with previously published SCL-90-R profiles of patients with post-traumatic and nontraumatic headache, and of the normal population. Patients with whiplash-associated headache were not significantly different from those with other forms of post-traumatic headache or with whiplash-associated neck pain without headache. However, when patients with whiplash-associated headache and patients with nontraumatic headache were compared to normal data, significant differences emerged. Patients with nontraumatic headache exhibited higher scores on all subscales, whereas patients with whiplash-associated headache differed from the normal sample only on somatization, obsessive-compulsive, depression and hostility subscales, and the global severity index. These differences imply that patients with whiplash-associated headache suffer psychological distress secondary to chronic pain and not from tension headache and generalized psychological distress.     

Appropriateness of SCL-90-R adolescent and adult norms for outpatient and nonpatient college students.

Symptom Checklist-90—Revised (SCL-90-R) scores of 209 undergraduate clients from a university-based psychology clinic were compared with those of 435 nonpatient undergraduates and with adult and adolescent norms. College student outpatients were similar to adult outpatients on the SCL-90-R. However, when compared with norms based on unscreened community samples, nonpatient undergraduates were, like adolescents, considerably more symptomatic than adults. Although nonpatient undergraduates were significantly less symptomatic than outpatient undergraduates, the two distributions overlapped considerably, which presents a high risk of misclassification. Comparison of the study samples with other published data supports the generalizability of these findings. The data's implications for the use of the SCL-90-R in evaluating symptomatology and the clinical significance of change in college students are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of psychosocial adjustment in patients with implantable cardioverter defibrillators

Predictors of psychological distress/adjustment were examined in 25 patients following placement of ICDs. Patients completed a demographic questionnaire and a standardized questionnaire of psychological symptoms (i.e., Symptom Checklist-90 Revised; SCL-90-R). The number of discharges categorized by the patient as inappropriate and appropriate were also ascertained. The number of ICD discharges categorized as inappropriate and diminished levels of physical activity (r = 0.53 and 0.63, P < 0.01, respectively) did significantly relate to overall psychological distress. In addition, after controlling for age and prior psychiatric and physical health status through a stepwise multiple regression analysis, the occurrence of ICD discharges categorized as inappropriate and diminished physical activity continued to significantly predict overall psychological distress (R2 = 0.41, P < 0.01). However, the number of ICD discharges categorized as appropriate did not significantly predict overall psychological distress. The results of this investigation suggest that further refinement of the ICD could reduce the risk of exposure to potential psychological distress, and an analysis of prior and anticipated patient physical activity levels should be a factor when calibrating minimum ICD discharge threshold levels.     

Symptom severity and diagnoses related to sexual assault history

The current study examines associations between a history of sexual assault or abuse and severity of symptoms and diagnostic categories in an adult clinical outpatient sample. Twelve of 68 men (18%) and 71 of 120 women (59%) reported a history of sexual trauma. Abuse history was associated with mood and anxiety disorder diagnoses. Women were also more likely to receive these diagnoses; abused women were particularly likely to be diagnosed with an anxiety disorder. Abused subjects showed higher scores on every subscale of the SCL-90-R; there were no interactions between sex and history of abuse. Women scored higher than men on subscales indicating anxiety, phobia, and general distress. The results indicate an association between history of sexual trauma and symptom severity across a broad range of psychopathology, and with mood and anxiety disorders. There is no indication of differential gender effects of sexual assault.     

Mental health and support of women treated for breast cancer

This article presents the results of a pilot-study conducted on a small sample of women with breast cancer and the members of their social support system. The purpose was to determine the potential link between the mental health of the breast cancer patient and their support system. Mental health was assessed with the SCL-90-R (Derogatis, 1977), a self-report scale composed of 90 items divided into nine categories, offering three global indicators of distress: the Global Severity Index (GSI); the Positive Symptom Distress Index (PSDI), and the Positive Symptom Total (PST). The SCL-90-R was distributed to a sample of 14 subjects: seven women treated for breast cancer and seven significant others (social support). The results led to the definition of symptoms such as hostility, phobic anxiety and psychosis specific to either the woman or the support system.     

Stress symptoms of survivors of the Marmara region (Turkey) earthquakes: A follow-up study.

This study examined stress-related symptomatology of people in Turkey 1 year after 2 recent earthquakes and compared their symptoms with those at the time of the earthquakes. The survey, using the Symptom Check-List-90-Revised (SCL-90-R; L. R. Derogatis, 1977), enlisted 223 respondents in its 1st administration and 342 in its 2nd, 1 year later. These earthquake survivors had elevated levels on all subscales of the SCL-90-R but lower levels of stress symptoms in the 2nd administration with respect to anxiety, phobic anxiety, and psychotic symptoms. In contrast, there were no significant differences across administrations in measures of obsessive-compulsive behaviors, depression, anger, or paranoid thoughts. Higher overall levels of symptoms were found in women, those with lowest education levels, and those who had experienced loss of relatives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Awakening of intensive care patients after prolonged continuous sedation

OBJECTIVE: To investigate the relevance of the Symptom Checklist 90-R Obsessive-Compulsive subscale to cognition in individuals with brain tumor. DESIGN: A prospective study of patients assessed with a neuropsychological test battery. SETTING: A university medical center. PATIENTS: Nineteen adults with biopsy-confirmed diagnoses of malignant brain tumors were assessed prior to aggressive chemotherapy. MAIN OUTCOME MEASURES: Included in the assessment were the Mattis Dementia Rating Scale, California Verbal Learning Test, Trail Making Test B, Symptom Checklist 90-R, Mood Assessment Scale, Beck Anxiety Inventory, and Chronic Illness Problem Inventory. RESULTS: The SCL 90-R Obsessive-Compulsive subscale was not related to objective measures of attention, verbal memory, or age. It was related significantly to symptoms of depression (r = .81, P < .005), anxiety (r = .66, P < .005), and subjective complaints of memory problems (r = .75, P < .005). Multivariate analyses indicated that reported symptoms of depression contributed 66% of the variance in predicting SCL 90-R Obsessive-Compulsive Scores, whereas symptoms of anxiety contributed an additional 6% (P < .0001). CONCLUSIONS: Our data suggest that the SCL 90-R is best viewed as an indicator of unidimensional emotional distress and somatic effects of structural brain injury.     

Cognitive and somatic aspects of depression among a rehabilitation sample: Reliability and validity of SCL-90—R research subscales.

Administered the SCL-90-R to 78 adult patients with chronic pain, 52 adult patients with spinal cord injury, and a control group of 145 college students. Estimates of internal consistency, represented by coefficient alpha, were .69 for the Somatic Depression subscales and .91 for the Cognitive Depression subscales. Data suggestive of construct validity included differential correlations of r?=?.78 between the experimental Cognitive Depression scale and the SCL-90-R Obsessive Compulsive scale, and r?=?.66 between the experimental Somatic Depression scale and the SCL-90-R Somatization scale. Similar evidence of divergent validity was not clearly demonstrated with the remaining SCL-90-R subscales. multivariate analysis of variance (MANOVA) revealed that previously found item response patterning was replicated with the chronic pain and spinal cord injured Ss. Refinement of the research subscales and implications for clinical use among medical/rehabilitation samples are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

CSF cholecystokinin octapeptide in patients with bulimia nervosa and in normal comparison subjects

Cholecystokinin octapeptide (CCK-8) appears to modulate appetitive behavior, and in rodents, anxiety-related behavior. The authors studied CCK-8 in patients with bulimia nervosa. CSF concentrations of CCK-8 were measured in 11 drug-free female patients with DSM-III-R-defined bulimia nervosa and in 16 normal subjects. The bulimic patients had significantly lower levels of CCK-8 than the comparison subjects. CCK-8 concentrations were inversely correlated with scores on the anger-hostility, anxiety, and interpersonal sensitivity subscales of the SCL-90-R. They were not significantly correlated with age, percentage of standardized average body weight, or mean weekly frequency of binge eating or vomiting. The results indicate that central CCK-8 abnormalities may play a role in the pathophysiology of bulimia nervosa.     

Differential effects of avoidant and attentional coping strategies on adaptation to chronic and recent-onset pain.

Examined the effectiveness of attentional (AT) and avoidant (AV) coping strategies for somatic, behavioral, and psychological adaptation to clinical pain among 30 chronic (CP) and 30 recent-onset pain (RP) patients. It was hypothesized that RP Ss would demonstrate greater adaptation (lower anxiety, depression, pain severity, and somatization ratings and higher levels of social activity) when employing AV rather than AT strategies. CP Ss using AT strategies were predicted to demonstrate greater adaptation than CP Ss using AV strategies. Ss completed the Coping Scale (A. G. Billings and R. H. Moos, 1981) as well as parts of the SCL-90 (Revised) and the West Haven-Yale Multidimensional Pain Inventory (R. D. Kerns et al, 1985). Results support the hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term outcome of trauma in adults: the psychological impact of a fatal bus accident

The psychological impact of trauma on 36 parents and spouses was examined 1 year (1989), 3 years (1991), and 5 years (1993) after a fatal school bus accident in Western Norway in 1988. The course and outcome of posttraumatic symptoms (Impact of Event Scale [IES]) and symptoms of general psychological distress (SCL-90) were examined in relation to type of trauma (loss vs. no loss) and prior exposure to trauma. A large proportion of the sample reported high levels of symptoms on SCL-90 and IES (Intrusion). No associations were observed between type of trauma and any of the symptom measures. Prior exposure to trauma did not affect the scores on IES but was associated with a sustained vulnerability for general psychological distress (SCL-90). Different trajectories of the symptoms indicate that two psychological processes may be involved in long-term adjustment to trauma.     

Deconstructing therapy outcome measurement with rasch analysis of a measure of general clinical distress: The Symptom Checklist-90-Revised.

Rasch analysis was used to illustrate the usefulness of item-level analyses for evaluating a common therapy outcome measure of general clinical distress, the Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1994). Using complementary therapy research samples, the instrument's 5-point rating scale was found to exceed clients' ability to make reliable discriminations and could be improved by collapsing it into a 3-point version (combining scale points 1 with 2 and 3 with 4). This revision, in addition to removing 3 misfitting items, increased person separation from 4.90 to 5.07 and item separation from 7.76 to 8.52 (resulting in alphas of .96 and .99, respectively). Some SCL-90-R subscales had low internal consistency reliabilities; SCL-90-R items can be used to define one factor of general clinical distress that is generally stable across both samples, with two small residual factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exposure to missile attacks: the impact of the Persian Gulf War on physical health behaviours and psychological distress in high and low risk areas in Israel

The purpose of this study was to compare residents of an area (Tel-Aviv), which was severely afflicted by SCUD missiles during the Persian Gulf War (high risk region), to residents of a low-risk region (Jerusalem) in terms of: (a) changes in physical health, in use of medical or psychological services, and in health behaviours during the period of the war compared to the preceding month; (b) levels of psychological distress (somatization and anxiety) during the war; (c) characteristics of persons at highest risk for psychological distress. Respondents were randomly chosen and interviewed by telephone (N = 545 in Tel-Aviv, N = 406 in Jerusalem). The respondents in both regions reported significant yet similar deterioration in physical health status, and an increase in detrimental health behaviours during the Gulf War. Tel-Aviv residents had significantly higher levels of psychological distress as compared to residents of Jerusalem: in somatization 18 vs 12% respectively (OR = 2.44, CI = 1.39-4.28), in anxiety 34 vs 26% respectively (OR = 1.62, CI = 1.1-2.42). In addition to place of residence, age, ethnicity, religiosity and self-assessed health were identified as characteristics of persons at greater risk for psychological distress.     

Emotionality and mental health: Longitudinal findings from the normative aging study.

The present longitudinal study examined the relation between the temperament types of emotionality and extraversion, as assessed by the Eysenck Personality Inventory-Q (Floderus, 1974), and self-reported psychological symptoms 10 years later, as assessed by the revised version of the Hopkins Symptom Checklist (SCL-90-R; Derogatis, 1983). The sample consisted of 1,324 older men, participants in the Normative Aging Study. Those high in emotionality were expected to report higher levels of symptoms than those low in emotionality. Symptoms of depression and anxiety, however, were hypothesized to be higher among emotional introverts, whereas hostility and psychoticism were expected to be higher among emotional extraverts. Canonical correlation analysis showed that emotionality and extraversion accounted for 25% of the variance in mental health 10 years later. However, emotionality accounted for most of the variance, with extraversion accounting for only 2%. The results are interpreted as support for the construct of negative affectivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controlled external lumbar drain as treatment for therapy resistant intracranial hypertension--case report

The study investigated the psychological health level and related psychosocial factors of nurses. Through cluster sampling, 650 clinical nurses, who come from 5 city hospitals in Changsha, were interviewed with the Symptom Check List-90 (SCL-90), The Life Event Scale, Type A Behavior Questionnaire, and The Social Support Rating Scale. The results indicated that subjects' average symptom score and most factor scores of SCL-90 were significantly higher than that of the chinese norm. Somatization, depression, and obsession are common psychological problems of the clinical nurses, and the psychological health level of middle age group was significantly lower than that of other groups. Regression analysis (both single factor and multiple factors) suggested that TH and CH scores on Type A Questionnaire as well as life event score on the life event score were negatively related to psychological health level while social support score was positively related to it. The influences of psychosocial factors on psychological health level of clinical nurses were discussed.