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Biomedical subjects

D A Fishbain

Publications and source records attributed to D A Fishbain.

At least 19 recordsLinked to original sources
PubMed1992

Drug abuse, dependence, and addiction in chronic pain patients.

It is claimed that a significant percentage of chronic pain patients suffer from drug/alcohol abuse/dependency/addiction. To address this question, 24 articles alluding to chronic pain patient drug/alcohol dependence/addiction were reviewed according to the following criteria: method for drug misuse diagnosis, which drug misuse diagnosis used (abuse, dependence, or addiction), and percentage of patients within each diagnostic category of drug misuse. The result of the review indicated that only seven studies utilized acceptable diagnostic criteria and/or definitions for the drug misuse diagnoses and gave percentages of drug misuse. Within these seven studies, the prevalence percentages for the diagnoses for drug abuse, drug dependence, and drug addiction were in the range of 3.2-18.9%. It is concluded that these diagnoses occur in a significant percentage of chronic pain patients. However, there is little evidence in these studies that addictive behaviors are common within the chronic pain population.

Behavior, Addictive↗
PubMed1992

Detoxification of nonopiate drugs in the chronic pain setting and clonidine opiate detoxification.

Although the pain physician is most familiar with the treatment of the opiate withdrawal syndrome, other drugs are abused by the chronic pain patient. The pain physician should then be familiar with the withdrawal syndromes associated with other drug groups. The withdrawal syndromes associated with hypnosedatives, psychotomimetics, nicotine, stimulants, ergot alkaloids, beta adrenergic blocking agents, antidepressants, muscle relaxants, and alpha-adrenergic agonists are described. Drug detoxification protocols for these drugs are reviewed. Additionally, the rationale for clonidine opiate detoxification is discussed, and current clonidine detoxification protocols are reviewed.

Analgesics↗
PubMed1992

Monosymptomatic hypochondriacal psychosis: belief of contracting rabies.

The authors describe a forty-one-year-old female with possible monosymptomatic hypochondriacal psychosis (MHP): a delusional belief that she had contracted rabies. This is the first report of this type of delusion in MHP. The patient failed to respond to multiple somatic therapies and finally made a serious suicide attempt. The authors discuss the reasons for the failed treatment and suggest a sequential protocol for treatment of MHP based on the current literature.

Adult↗
PubMed1991

The misdiagnosis of conversion disorder in a psychiatric emergency service.

During a 1-year period, 8400 patient presentations to a psychiatric emergency service were screened for the conversion symptom of extremity paresis/paralysis. Of 4220 unduplicated presentations, three patients had this complaint. These cases were reviewed and followed up. All had received a DSM-III diagnosis of conversion disorder, but in each case the patient's conversion symptom was attributed to organic disease. This had medicolegal consequences in one case and threatened legal consequences in the others. Although the frequency of this alleged conversion symptom was 0.07%, in reality it was 0.0%. Guidelines for the management of the alleged conversion symptom of paresis/paralysis are discussed.

Adult↗
PubMed1991

Chronic pain patients and the nonorganic physical sign of nondermatomal sensory abnormalities (NDSA).

The nonorganic physical sign of nondermatomal sensory abnormalities (NDSA) is frequently found in chronic pain patients. The presence of NDSA qualifies the patient for a potential DSM-III diagnosis of conversion disorder. DSM-III (Axis I and II) diagnoses and personality styles were assigned to 283 mixed chronic pain patients. Discriminant analysis was used to identify diagnoses and personality styles significantly related to NDSA. The demographic variables of workers' compensation (WC) status, age, sex, and race were used as control variables. The discriminant function comprised all control variable, and psychiatric diagnoses accounted for only 22.1% of the variance. Age and WC status, i.e., the demographic variables, explained most of the variance (16.8%), with psychiatric diagnoses adding little (5.3%). The vast majority of the variance is unexplained, indicating the presence of "unexplained" factors for the presence of NDSA in chronic pain patients.

Adult↗
PubMed1991

Completed suicide in chronic pain.

Although convergent lines of evidence indicate that one can expect a high rate of suicide completion for chronic pain patients, this problem has not previously been investigated. Follow-up data from our pain center revealed three chronic pain patients (two men and one woman) who completed suicide. These three cases are presented. The sequential nature of the data enabled us to calculate suicide rates for our chronic pain population and subsamples of this population: 16.5 women per year; 29.3 men per year; 57.1 white men and 34.9 white women in the age range of 35-64 years per year; and 78.6 white worker compensation men in the age range of 35-64 years per year. Calculation of the 95% confidence interval and comparison of these suicide rates to the general population of the United States using the Z statistic indicated that all chronic pain patient suicide rates were significantly greater than that of the general population. White men, white women, and white worker compensation men with chronic pain in the age range of 35-64 years are twice, three, and three times as likely, respectively, as their counterparts in the general population to die by suicide. Although no firm conclusions can be drawn because of the small suicide sample, these case reports indicate a need for further studies of chronic pain patient suicide rates at other pain centers.

Adult↗
PubMed1991

More Munchausen with chronic pain.

Munchausen's syndrome is a popular name for a factitious disorder with physical symptoms. We have identified four Munchausen patients within a sample of 2,860 chronic pain patients for a frequency of 0.14%. These patients are described and an attempt is made to develop a profile of the Munchausen patient presenting with chronic pain.

Adult↗
PubMed1991

Impact of a humanmade disaster on the utilization pattern of a psychiatric emergency service.

In May 1980, Liberty City Miami, a black area, suffered a humanmade disaster: a riot. The effects of the riot on the utilization pattern of the only psychiatric emergency service (PES) for the Liberty City catchment area were studied in two ways: autocorrelation and cross-correlation analyses were used to determine whether PES presentations demonstrated a 7-day cycle and whether this cycle was disturbed by the riot; and analyses of variance (ANOVAs) were used to compare numerically the riot week to the preceding week, the riot week to the following 12 weeks, and the 12 pre-riot weeks to the 12 post-riot weeks. Black PES presentations did not demonstrate a statistically discernable cycle, and none of the ANOVAs were statistically significant. It was concluded that the riot did not have a significant psychiatric morbidity effect as measured by PES presentation data. These results are discussed in reference to previous disaster studies.

Analysis of Variance↗
PubMed1989

DSM-III diagnoses of patients with myofascial pain syndrome (fibrositis).

Rheumatology centers report that chronic pain patients with myofascial pain (fibrositis) are prone to psychiatric pathology. However, the distribution of DSM-III diagnoses in this population is unknown. This distribution is reported for 238 chronic pain patients with fibrositis. Statistical comparisons of men and women were also made with regard to the prevalence of each diagnosis, and the results were compared to published DSM-III diagnoses prevalence data for mixed chronic pain patients and rheumatology fibrositis patients. In our sample, women with fibrositis were equally as likely as men with fibrositis to have current depression. Within the general chronic pain population, women are more likely to have current depression. The incidence of current major depression and current and past major depression was much lower in our fibrositis sample than that reported by rheumatology programs. These results indicate that there may be psychiatric differences between chronic pain patients with and without fibrositis. Fibrositis patients in rheumatology programs may also be psychiatrically different from chronic pain program patients with fibrositis.

Adult↗