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PubMed1985

Variables affecting pure tone and speech audiometry in experimentally simulated hearing loss.

Previous studies have found that subjects simulating hearing losses can provide information which is useful to audiological clinicians when patients produce exaggerated hearing levels with no apparent organic aetiology. Two groups of normally-hearing subjects were used, designated unsophisticated or sophisticated in audiometric testing. Each subject was instructed to feign any amount of hearing loss in both ears prior to carrying out pure tone and speech audiometry using monosyllabic speech material. A number of variables was studied to identify factors influencing success or failure in simulating hearing loss and to investigate strategies used by the subjects. Analysis of the audiometric results revealed no typical degree of hearing loss for tones or speech. The majority of the subjects simulated sensori-neural pure tone losses with flat audiometric configuration. Approach mode, ascending or descending, had no significant effect on simulated tonal threshold. Four strategies for simulating a loss were identified. A fair degree of test/retest reliability in hearing loss for speech and tones was observed. Large discrepancies in hearing loss for speech and tones were recorded with the hearing loss for tones typically in excess of that for speech. Responses during speech audiometry showed a high occurrence of 'no response' errors. No significant differences were recorded between the sophisticated and unsophisticated groups, except in the pattern of response during speech audiometry, when the sophisticated subjects gave significantly fewer correct responses and 'no response' errors.

Adult↗
PubMed1992

Non-organic hearing loss in young persons: transient episode or indicator of deep-seated difficulty.

Depressed auditory thresholds without evidence of organic hearing loss are observed in a small percentage of children and young adults. Several studies suggest that non-organic hearing loss (NOHL) is a manifestation of, or reaction to stress. Proposed treatments range from ignoring the apparent hearing loss through the use of psychotherapy and/or counselling to confronting the individual with evidence to prove that there is no real loss of function. Few studies report on long-term outcome. Thirty-eight subjects who had been diagnosed more than six and up to twenty-seven years ago as having NOHL were identified from records. Efforts were made to determine if there was any evidence of longer term effects. Nine were untraceable. Of those reviewed one was established as a malingerer; five had concurrent speech problems; one was possibly dyslexic; five were or had been under psychiatric care. These findings suggest that NOHL may, in some individuals, indicate underlying problems that merit detailed investigation and treatment.

Adolescent↗
PubMed1997

Antinuclear antibodies in children with chronic nonspecific complaints.

Children who are chronically complaining nonspecific symptoms such as headache, fatigue, abdominal pain, and low grade fever are commonly seen in daily pediatric outpatient clinics. Some of them are unable to go to school and are diagnosed as school refusal by physicians or educational staff. On the other hand, there are children who do not fulfill any criteria of collagen diseases and whose anti-nuclear antibodies (ANA) are found to be positive. Some of these children have chronic nonspecific complaints. We prospectively studied the prevalence of ANA in children who visited a pediatric outpatient clinic because of chronic nonspecific complaints. Surprisingly, 74 out of 140 symptomatic children (52.4%) were positive for ANA, while only 5 out of 82 healthy control children (6.1%) were positive (p < 0.0001). 39 of 74 ANA positive patients (52.1%) have low ANA titers < or = 1:80, nevertheless 36 patients (47.9%) have high ANA titers > or = 1:160. ANA fluorescent patterns were homogeneous and speckled in 75.3%, speckled in 17.6% and others in 6.8%. ANA positive patients tended to have general fatigue and low grade fever, while gastrointestinal problems such as abdominal pain and diarrhea and orthostatic dysregulation symptoms were commonly seen in ANA negative patients. Children who were unable to go to school more than 1 day a week were seen significantly more in ANA positive patients than in negative patients. Autoantibody analysis using Western immunoblot revealed that 26 out of 63 ANA positive sera (41.3%) had antibodies to the 62 kD protein which had not been previously noticed. These data suggest that autoimmune mechanism may play a role in childhood chronic nonspecific symptoms. We therefore propose a new disease entity of the autoimmune fatigue syndrome in children. When chronically complaining children visit a pediatric out-patient clinic, immunological approaches should be considered before they are discriminated as school refusal or having psychogenic disorders.

Abdominal Pain↗
PubMed1995

The Australian RSI debate: stereotyping and medicine.

The vehement scientific debate which took place in Australia in the 1980s over the epidemic of the chronic cervicobrachial pain syndrome known as repetition strain injury (RSI) was remarkable for the accompanying social commentary offered by many of the medical participants. This commentary was to have a profound effect on relationships between individual doctors and their patients with RSI. It reflected and reinforced the prevailing stereotypes within Australian society, not only of working women, but also of recipients of workers' compensation payments. On the other hand, some of the medical responses to the epidemic were severely criticized by social scientists who analysed the epidemic. In the process of such criticism, a number of stereotypes of doctors were also reinforced.

Adult↗
PubMed2001

'Insuring' a correct differential diagnosis--a 'forensic' collaborative experience.

Mr. J was referred to a speech and language therapist (SLT) by a consultant psychiatrist. He had sustained an industrial accident which he claimed was responsible for a range of problems which included a speech and language problem. Some three years after his accident, he brought an action for damages arising out of the accident. His solicitor, on the recommendation of the consultant psychiatrist, contacted the SLT requesting his views as to whether Mr. J's speech difficulties were due to the injuries sustained and requesting recommendations for further treatment. The SLT saw Mr. J and concluded that he had problems at all communication levels, the greatest being an articulatory impairment. Some reports suggested a psychological basis for his problems and others, including the psychiatrists', suggested an organic basis.

Accidents, Occupational↗
PubMed2004

Pavlov and Cushing.

Explore the source record for details and available documents.

Conditioning, Classical↗
PubMed1985

"Compensation neurosis". An invalid diagnosis.

The concept of "compensation neurosis"--sometimes denoted by one of its numerous synonyms--has been invoked for many years in discussing the emotional sequelae of accidental injury when litigants present with symptoms and disability that are disproportionate to the original injury or to any demonstrable continuing physical abnormality. Although such "diagnoses" carry with them certain assumptions about the aetiology and the prognosis of the patient's symptoms, the clinical validity of these terms has not come under scrutiny in the literature dealing with issues of diagnosis and classification. An examination of "compensation neurosis" as an illness entity, using standard criteria of diagnostic validity, does not support the view that such a distinct disease exists. It is concluded that the possibility of financial gain after a compensable injury should be regarded as one of several potential secondary gains from an hysterical conversion reaction, and that multiple factors need to be considered in the medical assessment and treatment of litigants who complain of continuing symptoms after recovery from physical injury.

Accidents↗
PubMed1995

Exaggerated hearing loss in noise induced hearing loss compensation claims in Victoria.

OBJECTIVE: To determine the incidence of exaggerated hearing loss in people claiming workers compensation for noise induced hearing loss, as well as the ability of a range of testers to detect this exaggeration. SUBJECTS: 333 people who claimed compensation for noise induced hearing loss between 13 September 1993 and 31 July 1994 in Victoria and who had undergone two independent subjective hearing tests. METHOD: The hearing test results and referral decisions made by testers were examined in the light of the results of a single objective hearing test (cortical evoked response audiometry). RESULTS: The incidence of exaggerated hearing loss was 17.7%. Testers performing the first subjective hearing test detected only 2.2% of claimants who exaggerated. The audiologist performing the second subjective test detected 94.2% of claimants who exaggerated. CONCLUSIONS: The high incidence of exaggerated hearing loss and the large difference in ability to detect this exaggeration by the two groups of testers demonstrate the need for appropriate test procedures to be followed and a second hearing test to be reintroduced. Without accurate testing, there will be overpayment for noise induced hearing loss claims.

Clinical Competence↗
PubMed1995

Deception and self-harm in the quest for freedom: an audit of Vietnamese boat people admitted to a regional hospital in Hong Kong.

OBJECTIVES: To document the medical problems of detained Vietnamese boat people admitted to hospital in Hong Kong, and to identify the medical problems or features that may indicate an intention to abscond. DESIGN AND SETTING: A retrospective review of the records of all Vietnamese boat people admitted to the Medical Unit of the Prince of Wales Hospital, Hong Kong, between 1 October 1993 and 30 September 1994. RESULTS: 614 Vietnamese boat people were admitted during the 12 months (comprising 3% of total admissions). 92 (15%) of these absconded from hospital after admission (compared with 0.06% for all other admissions). Gastrointestinal bleeding, clinical sepsis, drug overdose and spontaneous pneumothorax were the most common presentations among those who absconded. One-third (33.8%) of the 80 patients whose symptoms indicated gastrointestinal bleeding had insignificant endoscopic findings. Needle puncture marks were found in nine of the 75 patients with unexplained bacteraemia and in five of the 12 patients with spontaneous pneumothorax. CONCLUSIONS: Clinicians who provide medical care to Vietnamese boat people should be aware of the high incidence of absconding from hospital and that self-inflicted injuries are not uncommon and may identify intending absconders.

Adult↗
PubMed2006

Suicidal and homicidal soldiers in deployment environments.

Suicidal and homicidal soldiers present one of the most frequent and challenging scenarios for deployed mental health providers. A chart review of 425 deployed soldiers seen for mental health reasons found that 127 (nearly 30%) had considered killing themselves and 67 (nearly 16%) had considered killing someone else (not the enemy) within the past month. Of these, 75 cases were considered severe enough to require immediate intervention. Interventions included unit watch, comprehensive treatment, and medical evacuation. Of the 75 dangerous soldiers, 5 were evacuated out of theater. The rest were returned to duty. Evacuation to a hospital in the rear is often the quickest and most risk-free option but is seldom the best choice for maintaining the fighting force. This article presents several case examples and describes methods for dealing with suicidal and homicidal soldiers during deployment.

Adult↗