Telephone-Based versus In-Person Delivery of Cognitive Behavioral Treatment for Veterans with Chronic Multisymptom Illness: A Controlled, Randomized Trial.

Background: The goal of this randomized clinical trial was to examine the efficacy of a cognitive behavioral stress reduction treatment for reducing disability among veterans with chronic multisymptom illness (CMI).

Method: Veterans (=128) who endorsed symptoms of CMI were randomized to: usual care (n=43), in-person (=42) or telephone-delivered cognitive behavioral stress management (=43). Assessments were conducted at baseline, three months, and twelve months.

Increased risk of alcohol dependency in a cohort of National Guard troops with PTSD: a longitudinal study.

Studies show high rates of co-morbid post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) but there is no consensus on the causal direction of the relationship. Some theories suggest AUD develops as a coping mechanism to manage PTSD symptoms and others that AUD is a vulnerability factor for PTSD. A third hypothesis posits independent developmental pathways stemming from a shared etiology, such as the trauma exposure itself.

Gender differences in the risk and protective factors associated with PTSD: a prospective study of National Guard troops deployed to Iraq.

This study examines gender differences in post-traumatic stress symptoms (PTSS) and PTSS risk/protective factors among soldiers deployed to Iraq. We pay special attention to two potentially modifiable military factors, military preparedness and unit cohesion, which may buffer the deleterious psychological effects of combat. Longitudinal data were collected on 922 New Jersey National Guard soldiers (91 women) deployed to Iraq in 2008.

A longitudinal study of pain and pain catastrophizing in a cohort of National Guard troops at risk for PTSD.

A recent cross-sectional study of National Guard troops found that pain and pain catastrophizing were prevalent and highly correlated with posttraumatic stress disorder (PTSD). At issue in the present study was whether pain and catastrophizing before military deployment could account for individual differences in PTSD symptoms after deployment. An anonymous survey was administered to a population sample of New Jersey National Guard troops before they were sent overseas and again when they returned home (1 year later).

Catastrophic appraisal of acute and chronic pain in a population sample of new jersey national guard troops.

Objectives: Catastrophic appraisal has been implicated as a possible cause of psychiatric morbidity, psychological distress, and physical impairment in individuals with chronic pain. At issue in this study was whether catastrophizing was associated with psychiatric morbidity in a population sample of National Guard members. In addition, we sought to determine whether it could account for individual differences in psychological distress and impaired physical function in the presence of acute and chronic pain.

Illness trajectories in the chronic fatigue syndrome: a longitudinal study of improvers versus non-improvers.

The natural progression of chronic fatigue syndrome (CFS) in adults is not well established. The aims of this longitudinal study were to (a) compare CFS Improvers and Non-Improvers; (b) determine whether an initial diagnosis of fibromyalgia (FM) was associated with CFS nonimprovement; and (c) determine whether this effect could be explained by the presence of nonspecific physical symptoms. Consecutive referrals to a tertiary clinic that satisfied case criteria for CFS were invited to enroll in a longitudinal study.

Effects of repeated deployment to Iraq and Afghanistan on the health of New Jersey Army National Guard troops: implications for military readiness.

Objectives: We assessed the effects of prior military service in Iraq or Afghanistan on the health of New Jersey Army National Guard members preparing for deployment to Iraq.

Methods: We analyzed anonymous, self-administered predeployment surveys from 2543 National Guard members deployed to Iraq in 2008. We used bivariate and multivariate analyses to measure the effects of prior service in Afghanistan (Operation Enduring Freedom [OEF]) or Iraq (Operation Iraqi Freedom [OIF]) on mental and physical health.

Chronic fatigue syndrome in male Gulf war veterans and civilians: a further test of the single syndrome hypothesis.

Different modes of fatigue onset in male Gulf War veterans versus male civilians raise the possibility that chronic fatigue syndrome (CFS) may not be a single disease entity. We addressed this issue by comparing 45 male veterans with CFS to 84 male civilians who satisfied identical case criteria. All were evaluated for fibromyalgia (FM), multiple chemical sensitivity and psychiatric comorbidity.

A test of the symptom amplification hypothesis in patients with asthma.

The present study sought to measure the accuracy of symptom reporting in patients with asthma by calculating the difference between a subjective rating of illness severity and an objective test of lung function (forced expiratory volume in 1 second). At issue was the hypothesis that self-reported "symptom amplification" or sensory awareness accounts for differences in the accuracy of symptom reporting. Spirometric examination was performed, and psychological tests of symptom amplification, emotional distress, and neuroticism were administered.

Localization of pain and self-reported rape in a female community sample.

Objective: Studies suggest that rape increases risk of medically unexplained pain in women. At present it is not clear whether rape is associated with pain at specific locations or at multiple locations. In this study we tested the hypothesis that rape was associated with a preferential increase in risk of pelvic pain that was not explained by pain at other sites.

Sub-typing CFS patients on the basis of 'minor' symptoms.

The diagnosis of chronic fatigue syndrome (CFS), an illness characterized by medically unexplained fatigue, depends on a clinical case definition representing one or more pathophysiological mechanisms. To prepare for studies of these mechanisms, this study sought to identify subtypes of CFS. In 161 women meeting 1994 criteria for CFS, principal components analysis of the 10 'minor' symptoms of CFS produced three factors interpreted to indicate musculoskeletal, infectious and neurological subtypes.

Sexual and physical abuse in women with fibromyalgia syndrome: a test of the trauma hypothesis.

Objectives: According to the trauma hypothesis, women with fibromyalgia syndrome (FMS) are more likely to report a history of sexual and/or physical abuse than women without FMS. In this study, we rely on a community sample to test this hypothesis and the related prediction that women with FMS are more likely to have posttraumatic stress disorder than women without FMS.

Methods: Eligibility for the present study was limited to an existing community sample in which FMS and major depressive disorder were prevalent.

Positive straight-leg raising in lumbar radiculopathy: is documentation affected by insurance coverage?

Objective: To evaluate whether differences exist in documentation of straight-leg raising (SLR), based on insurance coverage.

Design: Retrospective study.

Setting: Managed care organization (MCO).

Is childhood abuse a risk factor for chronic pain in adulthood?

Childhood sexual and physical abuse often are viewed as important factors in the development and persistence of chronic pain syndromes in adulthood. Nevertheless, earlier reviews on this issue have reached conflicting conclusions regarding the veracity of the relationship. In this critical review of existing research on childhood abuse and pain in adulthood, surprisingly mixed evidence is found, with significant effects found most consistently in very large cross-sectional studies that rely on self-reported abuse status.

Functional imaging of pain in patients with primary fibromyalgia.

Objective: To examine the function of the nociceptive system in patients with fibromyalgia (FM) using functional magnetic resonance imaging (fMRI).

Methods: Two groups of women, 9 with FM and 9 pain-free, volunteered to participate. In Experiment 1, we assessed psychophysical responses to painful stimuli and prepared participants for fMRI testing.

Medical versus nonmedical mental health referral: clinical decision-making by telephone access center staff.

A database review investigated decisions of clinicians staffing a university-based telephone access center in referring new adult patients to nonpsychiatrists versus psychiatrists for initial ambulatory behavioral health care appointments. Systematically collected demographic and clinical data in a computer log of calls to highly trained care managers at the access center had limited predictive value with respect to their referral decisions. Furthermore, while 28% of the 610 study patients were initially referred to psychiatrists, billing data revealed that in-person therapists soon cross-referred at least 20% more to a psychiatrist.

Psychiatric morbidity in the chronic fatigue syndrome: are patients with personality disorder more physically impaired?

Objective: The long-term consequences of chronic fatigue syndrome (CFS) include substantial impairment in physical functioning and high levels of work disability. In the absence of a medical explanation for this impairment, some have speculated that it may be due to comorbid psychiatric illness or personality disorder. We addressed this possibility by comparing the functional status of three CFS groups: no psychiatric diagnosis, psychiatric illness only, psychiatric illness and personality disorder.

Comorbid illness in women with chronic fatigue syndrome: a test of the single syndrome hypothesis.

Objective: Evidence of comorbidity among unexplained illness syndromes raises the possibility that all are variants of a single functional disorder, leading some to suggest that separate case definitions for chronic fatigue syndrome (CFS), fibromyalgia (FM), and multiple chemical sensitivity (MCS) may be unnecessary. Our objective was to determine whether discrete diagnostic labels provide useful information about physical functioning, symptom severity, and risk of psychiatric illness.

Methods: The sample consisted of 163 consecutive female referrals with CFS enrolled at a tertiary clinic.