OBJECTIVE: Recent studies of the relationship between fibromyalgia and psychiatric disorders have yielded conflicting findings, and many of these inconsistencies seem to result from methodological differences. METHOD: We compared 36 patients with fibromyalgia and 33 patients with rheumatoid arthritis from a tertiary care clinic using physician-administered, structured psychiatric interviews and self-reported measures of illness appraisal, coping, and functional disability. RESULTS: Patients with fibromyalgia had significantly higher lifetime prevalence rates of mood and anxiety disorders, as well as higher mean numbers of medically unexplained physical symptoms across several organ systems. Ninety percent of the patients with fibromyalgia had a prior psychiatric diagnosis compared with less than half of the patients with rheumatoid arthritis. CONCLUSIONS: Despite the absence of organic pathology, the patients with fibromyalgia had equal or greater functional disability and were less well adapted to their illness. Although the pathophysiology of fibromyalgia remains unclear, co-morbid psychiatric disorders and functional disability remain an important focus of treatment in this population.

Activities of Daily Living↗

PubMedDate not supplied

Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: II. Sexual, physical, and emotional abuse and neglect.

OBJECTIVE: Two recent reports have found associations between fibromyalgia and sexual victimization, but had methodologic characteristics that limited their interpretation. METHOD: We compared 36 patients with fibromyalgia and 33 patients with rheumatoid arthritis by using structured interviews for sexual, physical, and emotional victimization histories, as well as dimensional self-report measures of victimization severity. RESULTS: Compared with the patients with rheumatoid arthritis, those with fibromyalgia had significantly higher lifetime prevalence rates of all forms of victimization, both adult and childhood, as well as combinations of adult and childhood trauma. Although childhood maltreatment was found to be a general risk factor for fibromyalgia, particular forms of maltreatment (eg, sexual abuse per se) did not have specific effects. Experiences of physical assault in adulthood, however, showed a strong and specific relationship with unexplained pain. Trauma severity was correlated significantly with measures of physical disability, psychiatric distress, illness adjustment, personality, and quality of sleep in patients with fibromyalgia but not in those with rheumatoid arthritis. CONCLUSIONS: Fibromyalgia seems to be associated with increased risk of victimization, particularly adult physical abuse. Sexual, physical, and emotional trauma may be important factors in the development and maintenance of this disorder and its associated disability in many patients.

Activities of Daily Living↗

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Taking decisions seriously: young children's understanding of conventional truth.

Research suggests that young children may see a direct and one-way connection between facts about the world and epistemic mental states (e.g., belief). Conventions represent instances of active constructions of the mind that change facts about the world. As such, a mature understanding of convention would seem to present a strong challenge to children's simplified notions of epistemic relations. Three experiments assessed young children's abilities to track behavioral, representational, and truth aspects of conventions. In Experiment 1, 3- and 4-year-old children (N = 30) recognized that conventional stipulations would change people's behaviors. However, participants generally failed to understand how stipulations might affect representations. In Experiment 2, 3-, 5-, and 7-year-old children (N = 53) were asked to reason about the truth values of statements about pretenses and conventions. The two younger groups of children often confused the two types of states, whereas older children consistently judged that conventions, but not pretenses, changed reality. In Experiment 3, the same 3- and 5-year-olds (N = 42) participated in tasks assessing their understanding of representational diversity (e.g., false belief). In general, children's performance on false-belief and "false-convention" tasks did not differ, which suggests that conventions were understood as involving truth claims (as akin to beliefs about physical reality). Children's difficulties with the idea of conventional truth seems consistent with current accounts of developing theories of mind.

Analysis of Variance↗

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Reifenstein's syndrome--a target cell failure.

The features of Reifenstein's Syndrome comprise hypospadias, microtestes, gynecomastia, azoospermia and elevated gonadotropins. The disease is inherited as either a male limited autosomal dominant or as a X-linked recessive trait and affects only genetic males. A case is reported suffering from this condition. Pituitary function was evaluated using the GnRH-test and appeared to be normal. Prolactin and testosterone values were in the normal range. The patient was a phenotype male and sexual function was satisfactory. Primary tubular failure resulting in hypergonadotropic hypogonadism was diagnosed. No other relatives were found to be affected. The syndrome seems to be due to relative insensitivity of Leydig cells to androgens.

Adult↗

PubMedDate not supplied

Rhinophyma in tuberous sclerosis.

Search of the literature thus far indicates no prior description of rhinophyma occuring in tuberous sclerosis. There have been numerous reports of the usual skin lesion, adenoma sebaceum, together with the associated manifestations of severe mental retardation and convulsive seizures. In a 27-year-old woman, full-blown, severely deforming rhinophyma had its onset one year prior to her hospital admission. The family, horrified by her appearance, desired surgical intervention. The report includes a review of the literature and a description of the patient and of the surgical technique employed. The question of the desirability and difficulty involved in skin grafting is discussed, as are the microscopic findings and postoperative course. Particular attention is directed toward differential diagnosis and associated findings.

Adult↗

PubMedDate not supplied

Intranasal budesonide aqueous pump spray (Rhinocort Aqua) for the treatment of seasonal allergic rhinitis. Rhinocort Aqua Study Group.

To determine the relative efficacy, compare the incidence of adverse events, and ascertain the systemic glucocorticoid effect of the nasal application of several doses of budesonide, 406 patients with seasonal ragweed-induced allergic rhinitis were randomized in a double-blind, parallel group design to receive intranasal budesonide aqueous pump spray (Rhinocort Aqua) 32 micrograms, 64 micrograms, 128 micrograms, 256 micrograms, or placebo once daily for 4 weeks. A total of 231 adults and 175 children participated in the study conducted at 14 centers in two geographic regions, the Midwest and the Northeast United States, during the 1994 ragweed season. Pollen counts were collected at each site by the Rotorod method. The primary efficacy parameter was the change from baseline nasal index score (NIS) for the overall study population--defined as the sum of scores for nasal congestion, runny nose, and sneezing. The study was powered only to evaluate the overall study population for statistical significance. Significant differences in NIS were observed in each active treatment group compared with placebo (p < or = 0.003). Compared with placebo, budesonide aqueous spray significantly reduced individual symptoms of runny nose and sneezing at all doses (p < or = 0.008), and nasal congestion and nasal itching at all doses except 64 micrograms (p < or = 0.022). In the Midwest pollen belt where the 1994 ragweed season was representative of a typical pollen season, it was possible to establish a dose-response relationship for comparison of budesonide aqueous spray 256 micrograms versus 32 micrograms (p = 0.017). The incidence of adverse events was similar between budesonide aqueous-treated and placebo-treated patients. Importantly, there was no effect of budesonide aqueous spray on basal or ACTH-stimulated plasma cortisol levels in either adults or children at the end of 4 weeks of treatment. Intranasal budesonide aqueous pump spray, administered once daily, was efficacious and was generally well tolerated in both adults and children with seasonal allergic rhinitis.

Administration, Intranasal↗

PubMedDate not supplied

US Hospital Ships.

Explore the source record for details and available documents.

History, 20th Century↗