The natural history of undiagnosed wrist pain in young women. A long-term follow-up.

43 young women with undiagnosed wrist pain were followed up for a median of 13 years (range 3 to 19). 26% were now free of pain and 35% had improved; 30% were unchanged and 9% were worse. Overall, 40% were still significantly troubled. There was no evidence that those patients suffered or had suffered from emotional or psychiatric disturbance which might have been responsible for the pain. Only three patients had developed ganglia.

Psychiatric morbidity in subjects with inner ear disease.

A prospective assessment of psychiatric morbidity in a sample of 207 patients with inner ear disorders, attending an ENT clinic, was carried out. As a group, they were found to have higher psychiatric morbidity on the general health questionnaire (GHQ) than either normal samples or samples affected by other forms of physical disease. Within the sample tinnitus patients scored the highest, and presbyacusis patients the lowest. High GHQ scores predicted an exaggerated self-rating of symptom severity in a visual analogue scale. Past psychiatric history did not play a role in the development of psychiatric morbidity. Elderly subjects complained more often of fear of collapsing in the street but this was not related, as has been suggested, to the subsequent development of agoraphobic symptoms. Factor analysis of GHQ items for the 'cases' yielded 'depression', 'anxiety' and 'personality' factors. No correlation was found between these factors and the rest of the clinical variables. It is concluded that tinnitus shows the clearest association with psychiatric morbidity and hence merits detailed psychological analysis. Such a study has been started at Addenbrooke's Hospital.