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C Bass

Publications and source records attributed to C Bass.

At least 19 recordsLinked to original sources
PubMed1992

Chest pain and breathlessness: relationship to psychiatric illness.

Chest pain and breathlessness are common somatic symptoms of emotional disorder in ambulatory care. Chronic chest pain has a prevalence of 12% and is associated with high utilization of health care. Of patients with chest pain and breathlessness who are referred to a cardiac clinic but subsequently shown not to have heart disease, the majority continue to report symptoms. Those patients with the worst outcome, in terms of continuing limitation of activity and use of medical resources, are those with chest pain but normal coronary arteries. A number of studies that fail to support a unitary theory of causation of noncardiac chest pain are described. A multifactorial, interactive model is proposed, with contributions from physical factors, such as palpitations and intercostal muscle pain; psychologic factors, which include enhanced awareness of and selective attention to bodily sensation; and environmental factors, such as previous exposure to cardiorespiratory disease in first-degree relatives or significant others. Although there have been few controlled intervention studies in patients with unexplained cardiorespiratory symptoms, there is evidence for the efficacy of both drug treatments and psychologic treatment. The results of intervention studies in patients with chest pain and normal coronary arteries are eagerly awaited. Atypical chest pain and breathlessness are common causes of office consultations and/or functional disability. The diagnoses should be established on the basis of positive evidence of psychiatric illness rather than by exclusion. The etiology is multifactorial, and management is aimed at treating the underlying psychosocial problems and/or psychiatric illness. Cognitive-behavioral treatments are probably as effective as drug treatments in the short-term, and the care of these patients would be improved by a more detailed explanation of noncardiac causes and a greater opportunity for patients to discuss their fears.

Chest Pain↗
PubMed1992

Psychophysiological investigations of patients with unilateral symptoms in the hyperventilation syndrome.

Anxiety states sometimes lead to hyperventilation (HV) which may, in turn, give rise to a variety of physical symptoms. One way in which HV may present is with unilateral somatosensory symptoms, often left-sided. We report nine such cases. The mechanisms of lateralisation was examined using EEG and bilateral somatosensory evoked potentials which were carried out before and after HV. No difference in conduction velocity was found between affected and unaffected arms, but non-specific abnormalities were frequently noted in the EEGs. The results support the role of a central rather than a peripheral mechanism in the production of unilateral symptoms in HV.

Adult↗
PubMed1991

Hyperventilation provocation in patients with chest pain and a negative treadmill exercise test.

Seventeen (39%) of 44 patients with chest pain but without significant ST depression on treadmill exercise had their usual chest pain reproduced during or after 3 min of voluntary hyperventilation (VHV) at rest. These patients with hyperventilation positive tests had not only significantly more hyperventilation-related symptoms and respiratory complaints but also shorter breath-holding times, lower mean resting end-tidal pCO2 and higher mean respiratory rates than those with negative tests and normal controls. Of the psychological variables, only phobic avoidance scores for agoraphobia were higher in patients with positive tests. These findings suggest that in two fifths of patients with exercise tests negative for ischaemia, chest pain is associated with HV, but abnormalities of breath control and relative hypocapnia are present even in the absence of chest pain. It is possible that a chronic abnormality of respiratory control may interact with attitudinal factors in the experience of non-cardiac chest pain.

Adult↗
PubMed1991

The test-retest reliability of the hyperventilation provocation test.

The hyperventilation provocation test (HPT) has been widely used for reproducing symptoms of panics. It is assumed that subjects experience similar symptoms on consecutive occasions of hyperventilation. Fourteen subjects with a history of panics and fourteen without such a history underwent the HPT on two occasions one week apart. In the group of 28 subjects as a whole, there were moderate similarities between the HPTs in both the choice and severity of symptoms reported, even when pre-existing symptoms were controlled statistically. Nevertheless, in the subject-by-subject analysis, many subjects showed no resemblance between the two HPTs in the choice of symptoms. This suggests that many subjects would not show any resemblance between the symptoms experienced in an HPT and those of their latest panic even if hyperventilation occurred in that panic.

Adult↗
PubMed1991

Unexplained chest pain and breathlessness.

Complaints of chest pain and breathlessness are common in both primary care and medical outpatient settings. A subgroup of these patients who find their way into tertiary care settings and subsequently are found to have no relevant organic pathology are at risk of continuing morbidity. One possible reason for this is that diagnostic strategies often focus on establishing an organic cause of pain and ignore psychosocial factors. In this article I have attempted to describe not only the prevalence but also the clinical characteristics of patients with medically unexplained cardiorespiratory symptoms. A method of establishing a positive diagnosis of noncardiac chest pain has also been outlined. This is based on an interactive and overlapping model that takes into account not only a number of psychological and social factors but also current physical and cardiac risk factors. It is important for nonpsychiatric physicians to diagnose noncardiac pain at an earlier stage in the evolution of the disorder. This would have major beneficial effects for patients, including (1) fewer unnecessary investigations; (2) less distress and functional disability; (3) reduced cost to the hospital; and (4) fewer iatrogenic complications.

Chest Pain↗
PubMed1991

Somatisation disorder in a British teaching hospital.

We describe 33 patients (31 women, 2 men; mean age 47 years) who satisfied research criteria for somatization disorder (SD), a disorder characterised by persistent or recurrent unexplained somatic symptoms beginning before the age of 30. The mean duration of symptoms was 30 years (range 12-57). Twenty patients had co-existing physical disease: seven (21%) had histories of chronic physical disease in childhood, whereas in 13 (39%) the physical disorders began in adult life, after many years of somatic complaints, and were largely coincidental. All had been repeatedly investigated for their symptoms. Twenty-one patients (64%) were receiving medication for spurious physical disorders, most commonly 'angina' and 'asthma'. Hysterectomies had been performed in 16 (52%) of the 31 women at a mean age of 37 years, but pathology was detected in only two. Twenty-nine patients (88%) had received previous treatment for psychiatric illness, and 20 (61%) were receiving invalidity benefits. British psychiatrists do not usually diagnose SD, but focus selectively on symptoms that suggest more familiar psychiatric syndromes. Similarly, medical specialists often diagnose 'functional syndromes' affecting the system that interests them. Over time these patients acquire spurious organic diagnoses and develop physical disorders that make the assessment of new symptoms more difficult. Disability is invariably in excess of what might be predicted from physical findings. We conclude that a diagnosis of SD draws attention to a group of patients who are chronically ill and unresponsive to conventional medical and psychiatric treatment. They use a lot of resources to little avail and thus merit more research.

Adult↗
PubMed1991

Expression of blood group antigens H-2, Le(y), and sialylated-Le(a) in human colorectal carcinoma. An immunohistochemical study using double-labeling techniques.

In this study, double-labeling immunohistochemistry was used to gain insight into the coexpression or interrelationship between blood group antigens (BGA) that are differentiation antigens in the normal colon, and BGA that are sequential moieties in the same synthetic pathway. Paired-wise Sialylated-Le(a)/Le(y) and H-2/Le(y) was studied. The Sialylated-Le(a) and Le(y) are synthesized from type 1 and type 2 backbones, respectively. In the normal colon, the Le(y) and Sialylated-Le(a) are expressed by cells at the base and surface of the crypt, respectively, representing undifferentiated and differentiated enterocytes. The H-2 is considered oncofetal in nature, and is considered to be the immediate precursor in the synthesis of Le(y). In individual cancers. Sialylated-Lea and Le(y) were detected in different cancer cells within the same malignant glands, separately in different glands, and in different subcellular compartments of the same cell. Both H-2 and Le(y) were coexpressed in the same individual cells in 92% of cancers expressing both these BGA. In 50% of the cancers, the H-2 and Le(y) also were expressed separately in different malignant glands within individual tumors. These findings indicate that, in colorectal cancers, differentiation antigens (Sialylated Le(a) and Le(y)) are expressed by different individual cells within the same malignant gland somewhat, recapitulating the normal colon crypt. Antigens of different backbones occasionally may be expressed in the same cells but within different subcellular compartments. Precursor accumulation is common in cancers, and antigens in the same synthetic pathway are coexpressed in the same cell. The expression of H-2 and Le(y) in different glands (lack of coexpression) may be explained possibly by aberrant synthesis of Le(y) by an alternate pathway.

ABO Blood-Group System↗
PubMed1990

Symptom specificity in patients with panic.

Thirteen patients with panic disorder with predominantly cardiorespiratory (CR) symptoms were compared with seven patients with predominantly gastrointestinal (GI) symptoms in an experimental procedure that involved exposure to phobia talk and voluntary hyperventilation (VHV). The CR patients had not only higher baseline anxiety, but also during phobia talk had a greater fall in pCO2 and reported more respiratory symptoms than the GI patients. Moreover, the CR group found VHV more unpleasant and more like their panic attacks than the GI panickers, and reported more physical symptoms after it. These findings suggest that patients with PD are not only heterogeneous with respect to the system to which panic symptoms refer (Cr or GI) but that provoking arousal in one system is more likely to produce distress if that system is the major focus of complaint. These findings, if replicated, would not support the suggestion that panic disorder is a uniform illness.

Adult↗
PubMed1989

Non-cardiac chest pain.

Psychiatric illness is present in up to 50 per cent of new patients attending a cardiac clinic with chest pain. This article provides guidance on the positive diagnostic features of such illness.

Chest Pain↗
PubMed1989

Fear talk versus voluntary hyperventilation in agoraphobics and normals: a controlled study.

Twenty-three drug-free patients with agoraphobia and panic disorder (DSM-III criteria) had, at rest, lower mean end-tidal PCO2 (32 v. 36 mmHg) and higher mean heart rate (92 v. 83 bpm) than did 18 controls. During 5 min of listening to fear talk, only eight (35%) patients and three (16%) controls panicked, but panic was associated with marked physiological changes in only two patients and one control. Patients said that breathlessness began slightly more often before than after panic. In 59% of patients the symptoms from voluntary hyperventilation (VHV) were very similar or identical to those of their usual panics. Compared with the remainder, these patients felt more unpleasant during hyperventilation (HV); in such patients HV may aggravate somatic symptoms. Agoraphobics with panic differed from controls in having higher baseline arousal, but were not more reactive than controls to HV or fear talk.

Agoraphobia↗
PubMed1989

Fatigue states.

Explore the source record for details and available documents.

Chronic Disease↗
PubMed1989

Hyperventilation clinical practice.

There is uncertainty about the diagnosis and definition of the hyperventilation syndrome. We prefer to regard hyperventilation (or hypocapnia with which it is synonymous) as a physiological response to abnormally increased respiratory "drive", which can be caused by a wide range of organic, psychiatric and physiological disorders, or a combination of these. This review outlines a clinical scheme for the diagnosis and assessment of hyperventilation and its causes.

Adult↗