Social influences on the concept of fibromyalgia.

Despite relevant evidence of physical illness promoting fibromyalgia syndrome (FMS), some authors claim that it is a psychological illness, or due to "psychological amplification." Good evidence for such views is lacking. Selection processes lead to increased rates of psychological illness in general practice and in specialist practice. The physical distress of FMS can increase both anxiety and depression. Questionable research supported by the insurance industry has tended to provide negative and disparaging views of pain. Current imaging studies support the view that central effects connected with FMS relate to the processing of noxious stimulation more than affective disorder.

Suicidality in a sample of Arctic households.

We investigated the association of suicidal ideation and behavior with depression, anxiety, and alcohol abuse in a Canadian Arctic Inuit community. Inuit (N = 111) from a random sample of households completed assessments of anxiety and depression, alcohol abuse, and suicidality. High rates of suicidal ideation within the past week (43.6%), and suicide attempts within last 6 months (30%), were reported. Ideation was more frequent among younger persons, whereas those favoring local native language were less likely to report a wish to die. Higher overall suicidality scores were associated with higher anxiety, and alcohol abuse, but not with depression or gender. Implications for future research are discussed.

The taxonomy of pain.

An ideal taxonomy should be comprehensive and its categories should be mutually exclusive. Every item should have a particular place either on its own or with other items that resemble it. This is rarely, if ever, achievable in practice in medicine. The reasons for this are explained. The taxonomy developed by the Task Force on Taxonomy of the International Association for the Study of Pain is described as well as the basis for it.

Problems with insurance-based research on chronic pain.

Evidence acquired through research is increasingly being used to manage medical problems, and, where applicable, to decide on which medically related conditions warrant compensation for disability. Consensus-based guidelines are supposedly prepared by learned individuals, making use of the best evidence and their experiences to provide group wisdom for practicing clinicians. Because bias is always a problem, research strives to minimize bias through scrupulous methodology, while consensus panels work carefully through the constitution of the group and disclosure of conflicts of interest by participants. Where research is not funded at arm's length by the external funding agency the potential for bias is enormous, especially when substantial funds are at stake, depending on the outcome of the study. In order that future research and consensus group recommendations may result in better care and a fairer compensation system, substantial efforts to minimize bias will be required.

Alzheimer's disease with and without cerebral infarcts.

OBJECTIVE: To compare the clinical and pathological features of Alzheimer's disease (AD) patients with and without associated cerebral infarcts (CI). METHODS: The consecutive records of 57 prospectively studied demented patients fulfilling the CERAD criteria for the pathological diagnosis of AD were reviewed. Cases with cortical Lewy bodies were excluded. CI were found in 22 cases (39%) (AD+CI group): large infarcts (5), lacunes (13) and/or hippocampal sclerosis (4), and were absent in 35 cases (AD group). Microscopic infarcts, cribiform change, amyloid angiopathy, and white matter rarefaction were not considered in this classification, but were quantified. Cortical atrophy, neurofibrillary tangle and senile plaque (diffuse and neuritic) load were also measured. Pathological evaluation was independent of clinical information. Clinical and pathological data were compared between both groups. RESULTS: AD+CI cases were significantly older, more commonly female, less educated, and more often had blue collar occupations, sleep disturbances, frontal release signs, and EEG spikes than AD cases. Other differences found (acute/subacute onset, behavioral disturbances, and leukoaraiosis on CT scan) disappeared after controlling for age. The frequency of known vascular risk factors and focal motor and sensory signs did not differ between the groups, which showed remarkable clinical similarity overall. The only significant differences on pathological exam were hippocampal microinfarcts and white matter lesions, although there was a trend for lower neurodegenerative lesion load in the AD+CI group. The ischemic lesions were located in temporal lobe in 50% of AD+CI patients; these cases had a significantly lower neocortical neurodegenerative lesion load than those with CI in other sites. CONCLUSIONS: The presence of CI in AD increases significantly with age, but has scarce influence on the clinical features, and cannot be predicted from common vascular risk factors. In spite of a trend, there are no major differences in neurodegenerative lesion load between AD and AD+CI groups, except when CI are located in the temporal lobe (including hippocampus), suggesting that this location may be important in the physiopathology of mixed vascular and AD dementia.

The persistence of folly: critical examination of dissociative identity disorder. Part II. The defence and decline of multiple personality or dissociative identity disorder.

In this second part of our review, we continue to explore the illogical nature of the arguments offered to support the concept of dissociative identity disorder (DID). We also examine the harm done to patients by DID proponents' diagnostic and treatment methods. It is shown that these practices reify the alters and thereby iatrogenically encourage patients to behave as if they have multiple selves. We next examine the factors that make impossible a reliable diagnosis of DID--for example, the unsatisfactory, vague, and elastic definition of "alter personality." Because the diagnosis is unreliable, we believe that US and Canadian courts cannot responsibly accept testimony in favour of DID. Finally, we conclude with a guess about the condition's status over the next 10 years.

The persistence of folly: a critical examination of dissociative identity disorder. Part I. The excesses of an improbable concept.

OBJECTIVE: To examine the concept of dissociative identity disorder (DID). METHOD: We reviewed the literature. RESULTS: The literature shows that 1) there is no proof for the claim that DID results from childhood trauma; 2) the condition cannot be reliably diagnosed; 3) contrary to theory, DID cases in children are almost never reported; and 4) consistent evidence of blatant iatrogenesis appears in the practices of some of the disorder's proponents. CONCLUSIONS: DID is best understood as a culture-bound and often iatrogenic condition.

Clinical correlates of insight in schizophrenia.

111 schizophrenic patients diagnosed in accordance with DSM-III were rated on Landmark's symptom checklist, on demographic variables, and on variables descriptive of the course of illness. Of the 111 patients, 108 (97.3%) showed poor insight into their illness at some time in the past and 65 (58.6%) at the time of assessment. Those presently showing poor insight were significantly (Pearson rs, p< .01, 2-tailed) more frequently rated as currently displaying poor judgement also in other matters (r =.50), as showing social withdrawal (r=.42) and poor rapport (r=.33), and as being preoccupied with their delusions or hallucinations (r=.31) and as being unreliable informants (r=.41). They usually had lower education (r=.33), their income in the last taxation year was lower (r = .47), and their work functioning was less adequate (r = .30).