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PubMed1994

The potential for faking on the Mississippi Scale for Combat-Related PTSD.

The Mississippi Scale for Combat-Related PTSD is widely used in the assessment of post-traumatic stress disorder (PTSD). The high face-validity of the scale may make it vulnerable to faking, however. The present study found that the scores of individuals instructed to respond "as if" they had PTSD did not differ from the scores of veterans with PTSD. Furthermore, although veterans who were diagnosed as having PTSD were found to have significantly higher Mississippi Scale scores than those who did not meet diagnostic criteria for PTSD, the mean score for all groups (veteran and non-veteran) exceeded the originally recommended diagnostic cut-off score of 107. A cutoff score of 121 was found to best differentiate veterans with PTSD from veterans who did not meet diagnostic criteria for the diagnosis, with high sensitivity but relatively low specificity.

Combat Disorders↗
PubMed1996

Mental defenses and posttraumatic stress disorder: assessment of criminal intent.

Since its formal introduction into psychiatric nomenclature more than a decade ago, the diagnosis of posttraumatic stress disorder (PTSD) has become firmly entrenched in the legal landscape. In part, this is because PTSD seems easy to understand. It is one of only a few mental disorders for which the psychiatric Diagnostic and Statistical Manual (DSM) describes a known cause. Since the diagnosis is usually based on patients' self-report, however, it creates the possibility of distortion aimed at avoidance of criminal punishment, and, as a result, has achieved mixed success as a criminal defense. When providing expert testimony, mental health witnesses must take care to distinguish between mere PTSD and a causal connection between PTSD and the criminal act in question. PTSD has not only been used to abrogate or diminish responsibility, but also to arrange pre-trial plea bargaining agreements or play a role in sentencing determinations. The author explores various uses and potential abuses of PTSD in criminal jurisprudence and offers suggestions regarding retrospective PTSD assessment.

Crime↗
PubMed1996

Compensation seeking status and psychometric assessment of combat veterans seeking treatment for PTSD.

Examined differences between compensation seeking (CS) veterans and noncompensation seeking (NCS) veterans on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and other psychological measures in 142 combat veterans evaluated for posttraumatic stress disorder (PTSD) at an outpatient Veterans Affairs (VA) hospital PTSD clinic. Patients were grouped on the basis of their compensation seeking status, with 69% classified as CS for PTSD. The CS veterans achieved significantly more pathological scores across a wide range of psychological inventories and MMPI-2 validity indices, although they did not differ in frequency of PTSD diagnoses from NCS veterans. Implications of these findings are discussed, and clinicians are advised to be aware of the compensation seeking status of combat-veterans being evaluated for PTSD.

Adult↗
PubMed1985

Objective determination of dark adaptation: accuracy of the evoked potential method.

The psychophysical threshold and the appearance of the visually evoked potential (VEP) were compared in the dark adapted state. Nineteen normal subjects and 11 persons with defective dark adaptation were studied. The VEP threshold was an average of 0.2 log units (standard deviation 0.2) above the subjective threshold in the normal group, and 0.4 log units above it in the night-blind subjects. In 7 normal subjects, the alpha-activity of the electroencephalogram interfered with the VEP recording and rendered the evaluation more difficult. The results indicate that the VEP can be used as an accurate method of objectively measuring dark adaptation.

Adaptation, Ocular↗
PubMed1988

Additive effects of clonidine and antidepressant drugs in the mouse forced-swimming test.

In the mouse forced-swimming model, dose-dependent reversal of immobility was induced by the alpha-agonist clonidine given IP 30 min before testing. In addition, three preferential inhibitors of 5-HT uptake (citalopram, indalpine and fluvoxamine) had similar activity in the dose range 8-16 mg/kg as did the 5-HT1 agonist 8-OH-DPAT (1-4 mg/kg). Pretreatment with alpha-methyl-paratyrosine (100 mg/kg) did not prevent clonidine (1 mg/kg) action, suggesting that there was mediation by alpha post-junctional receptors. The effect of clonidine was unaltered by prazosin (2 mg/kg) and reversed by yohimbine (4 mg/kg) and 5-MeODMT (1 mg/kg), whereas it was potentiated by reserpine (2.5 mg/kg), methysergide (2 mg/kg) and ketanserin (8 mg/kg). Moreover, an ineffective dose of clonidine (0.06 mg/kg at 45 min pre-testing) made active subthreshold doses of various antidepressants (given at 30 min pre-testing): imipramine (4 mg/kg), amitriptyline (1 mg/kg), maprotiline (8 mg/kg), citalopram (2 mg/kg), indalpine, fluvoxamine and mianserin (4 mg/kg), viloxazine (2 mg/kg). Similar interactions were found with iprindole and nialamide (32 mg/kg), which were inactive alone up to 64 mg/kg, and 8-OH-DPAT (0.5 mg/kg) but not with major and minor tranquillizers. It is suggested that one effect of antidepressants might be the triggering of different relationships between alpha-2 and 5-HT mechanisms.

Animals↗
PubMed1989

Cholinoceptive properties of human primordial, preantral, and antral oocytes: in situ hybridization and biochemical evidence for expression of cholinesterase genes.

In addition to their well-known involvement in neuromuscular junctions and in brain cholinergic synapses, cholinergic mechanisms have been implicated in the growth and maturation of oocytes in various species. Functional acetylcholine receptors were electrophysiologically demonstrated in amphibian and mammalian oocyte membranes, and activity of the acetylcholine-hydrolyzing enzyme, acetylcholinesterase (AChE), was biochemically measured in the exceptionally big oocytes of the frog Xenopus laevis. However, biochemical methods could not reveal whether AChE was produced within the oocytes themselves or in the surrounding follicle cells. Furthermore, this issue is particularly important for understanding growth and fertilization processes in the much smaller human oocytes, in which the sensitivity of AChE biochemical measurements is far too low to be employed. To resolve this question, a molecular biology approach was combined with biochemical measurements on ovarian extracts and sections. To directly determine whether the human cholinesterase (ChE) genes are transcriptionally active in oocytes, and, if so, at what stages in their development, the presence of ChE mRNA was pursued. For this purpose frozen ovarian sections were subjected to in situ hybridization using 35S-labeled human ChE cDNA. Highly pronounced hybridization signals were localized within oocytes in primordial, preantral, and antral follicles, but not in other ovarian cell types, demonstrating that within the human ovary ChE mRNA is selectively synthesized in viable oocytes at different developmental stages.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2007

[Simulation and aggravation in ENT medical examinations. A prospective study].

OBJECTIVE: The occurrence and characteristics of simulation and aggravation in audiology still lack detailed scientific research. A reliable and reasonable classification of simulation and aggravation, which could help assess a patient's cooperative behavior, has not been defined. PATIENTS AND METHODOLOGY: All patients who underwent an audiological medical examination were included in this study prospectively. These patients were examined based on a well structured and predetermined sequence of actions. As a result, they were grouped into one of four categories, from category 0 for no simulation or aggravation to category III for severe simulation and aggravation. For category III, reliable and valid thresholds for pure tone audiometry only can be achieved by using objective audiological measurements such as brainstem electric response audiometry. Measured thresholds were then compared with simulated or aggravated thresholds and finally correlated with socio-economic factors. RESULTS: A total of 61 individuals were included in this study. Only 42% (26/61) showed no simulation or aggravation (category 0). In all 10% were grouped in category III. The remaining 48% fell into categories I and II. Statistical evaluation revealed no significant differences in thresholds between categories I, II and III. The tendency to simulation or aggravation increased with patient' age, level of education and the frequency of medical examinations prior to this investigation. CONCLUSION: Simulation and aggravation is a frequent phenomenon (approximately 58% of all audiological examinations). Additional work on defining a unique schema for the classification of simulation and aggravation is necessary. The use of such a schema is highly recommended.

Artifacts↗
PubMed1998

[Objective methods for simulated detection of unilateral deafness with special reference to DPOAE (distortion-product otoacoustic emissions) exemplified by a case report].

The simulation of unilateral deafness is very rare. Objective findings are of special interest if it happens. A patient with alleged deafness on the left-hand side due to commotio cerebri was treated in our hospital. Pure tone audiometry showed deafness on the left-hand side and normal hearing on the right-hand side. However, stapedius reflexes were found ipsilaterally left as well as contralaterally right, at 0.5 to 2 kHz with a stimulation of approximately 90 dB SPL. Transiently evoked otoacoustic emissions (TEOAE) and distortion-product otoacoustic emissions (DPOAE) were measured. The TEOAE had the same reproducibility but a very low response on both sides, such that inner ear function could not be evaluated. In comparison, the DP gram showed clear DP amplitudes over the whole frequency range on both sides. Nonphysiological DPs could be excluded by assessing the DP growth rate at three different frequencies. By means of brainstem electric response audiometry (BERA), with which the IV/V complex was detectable up to stimulation with 20 dB SPL clicks, and the Stenger test, a neural or central hearing loss could be excluded. Normal hearing on the left-hand side was thus confirmed. In cases of simulated deafness it is possible to prove a normal inner ear function by DPOAE. DPOAE therefore complements the list of potential audiological simulation tests.

Adult↗
PubMed2001

Predictive tests for non-return to work in patients with chronic low back pain.

Return to work (RTW) is the primary goal in the rehabilitation of patients with chronic low back pain. In spite of expensive rehabilitative efforts, many patients do not RTW. To increase cost effectiveness, predictive tests for non-RTW are needed to select patients for rehabilitation. The reliability of these tests must be high, to prevent exclusion of patients who might improve. This study evaluates the reliability and predictive validity of four tests and the following psychosocial factors for non-RTW: nationality, off-work duration, unemployment and work load. It was designed as a prospective cohort study of 99 patients with chronic low back pain. Upon entry, physical work load, time off work, unemployment and nationality were recorded. The study investigated four tests with an anticipated prognostic value for non-RTW: the Numeric Pain Rating Scale (NRS, 9-10 of a maximum of 10), the Step Test and Pseudo Strength Test (precipitous cessation) and Behavioural Signs. After 12 months, the RTW rate was obtained from the physicians responsible for sick-listing by postal survey. The response rate regarding RTW was 91% at 1 year. The RTW rate at 1 year was 20%. All investigated tests significantly correlated with non-RTW. Regression analysis showed that the best prediction of non-RTW was obtained when at least two out of the four tests were positive (positive predictive value 0.97, sensitivity 0.45). Unemployment, time off work, nationality and physical work load were less predictive. The results show that the combination of the four prognostic tests allows a very reliable prognosis of non-RTW. The cost effectiveness of rehabilitation aiming at RTW will, therefore, be increased by excluding patients with two or more positive tests.

Adult↗
PubMed2000

Epidemic occupational pseudo-illness: the plague of acronyms.

Genuine disorder caused by repetitive movement has unmistakable features vitally different from occupational pseudo-illness, which comes and goes in new guises and massive epidemics wherever the label legitimizes gain from compensation. The assumption of an existing label such as the carpal tunnel syndrome gives the false idea of greater potential for deception. The solution to the menace lies in logical reasoning, which recognizes falsity before it begins to dominate the minds of the community.

Carpal Tunnel Syndrome↗