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Biomedical subjects

F Leavitt

Publications and source records attributed to F Leavitt.

At least 37 records · Page 2Linked to original sources
PubMed1987

Detection of simulation among persons instructed to exaggerate symptoms of low back pain.

A verbal pain measure was recently introduced that is accurate in differentiating patients with low back pain from persons who simulate pain. It consists of 103 pain words. Forty-five of these pain words accurately classified 219 out of 262 (83.6%) volunteers without pain who simulated back pain. In this study, 150 subjects with low back pain were administered the pain scale and instructed to exaggerate their pain sufficiently to convince a doctor of back pain that is severe enough to prevent them from working. Similar instructions were given to 267 persons without pain to determine the accuracy of the scale in detecting simulation, when some nidus of pain is present, and also to determine the influence of a pain history on scale accuracy. The pain measure detected 96 of 150 subjects with existing pain for an accuracy rate of 64.0%, and 218 of 267 subjects without pain for an accuracy rate of 81.7%. A selected cutoff score (-1.6) reduced classification error to less than 3% in the subject group with pain. The results underscore the impression that people who have pain to build on will be more difficult to detect when they simulate than people who engage in the process when they are pain free.

Adult↗
PubMed1986

Comparison of pain properties in fibromyalgia patients and rheumatoid arthritis patients.

Pain properties of 50 fibromyalgia patients were examined and compared with pain properties of 50 rheumatoid arthritis patients. In both fibromyalgia and rheumatoid arthritis, pain was bilateral, involved multiple sites, and was of equal intensity (60.8 versus 58.7, respectively, on a scale of 100). Fibromyalgia pain, however, was less localized to the joints and suggested greater spatial diffusion. It involved more kinds of pain experiences (radiating, steady, spreading, spasms, gnawing, unlocalized, pricking, crushing, shooting, pressing, splitting, cramping, nagging, and pins and needles), and was dispersed over larger areas of the body. The anatomic sites best for discrimination between patients with fibromyalgia and patients with rheumatoid arthritis were the lower back, thigh, abdomen, head, and hips for fibromyalgia, and wrist, foot, and fingers for rheumatoid arthritis. The traditional clinical description of aching and stiffness does not appear to accurately describe the complexity of the fibromyalgia pain syndrome.

Adolescent↗
PubMed1986

Psychologic classification of low-back pain patients: a prognostic tool.

The Pain Drawing Test and Back Pain Classification Scale (BPCS) were examined for their degree of correspondence in measuring psychologic disturbance and for their value in predicting treatment outcome in four areas: medication need, work status, patients' rating of improvement, and change in pain over a 12-month period. Agreement between the two measures in identifying patients as "not psychologically disturbed" was good; agreement was far less for patients identified as "psychologically disturbed." At the same time, both measures predicted clinical outcome with an equal degree of accuracy across the measures of outcome, except for "return-to-work status" where significant group trends with the BPCS did not reach significance with the Pain Drawing Test. The strong correlation between the two measures in predicting clinically important indexes of improvement suggests that differences in diagnosing the psychologically disturbed does not represent error. The difference may arise because the two scales tap different aspects of psychologic disturbance. Both scales appear to be of clinical value in the early identification of probable treatment failures.

Adult↗
PubMed1985

The value of the MMPI conversion 'V' in the assessment of psychogenic pain.

The conversion 'V' is a familiar MMPI pattern which is traditionally used as a clinical marker of psychogenic pain. The 'V' form is assumed to arise because conversion suppresses depression thereby lowering scores on scale D, and exacerbates physical sensations thereby increasing scores on Hs and Hy. An inverse relationship between scales Hs and Hy, and D is therefore expected. These assumptions were tested in 102 patients with low back pain and organic findings, and 93 patients with non-organic findings. The pattern of correlation among the three scales did not distinguish organic patients from non-organic patients in which conversion is assumed to account for pain. Scale D was not inversely related to scales Hs and Hy in the non-organic group as expected from theory. The findings do not support the use of the conversion 'V' as a clinical marker.

Adolescent↗
PubMed1985

Pain and deception: use of verbal pain measurement as a diagnostic aid in differentiating between clinical and simulated low-back pain.

The pain reports of 553 patients with low back pain and 347 healthy subjects faking low back pain were compared to determine if pain language can be employed as diagnostic aids in differentiating between clinical groups and groups attempting to feign a clinical condition. The best set of discriminating words correctly identified 90% of the subjects using 18 to 54 words in pain description, and 83% using 4 to 17 words in their pain report. The same pain words were used to categorize 366 new pain cases and 202 new fake cases. Cross-validation shrinkage was 8 and 7% respectively. Effectiveness in discriminating between pain and simulation was increased using selective cut-off scores. Patients in active treatment for back pain whose choice of pain words resemble those of the simulators reported 21% more clinical pain in a follow-up validation study suggesting that an accurate representation of malingering may have been achieved using a simulation research design.

Adult↗
PubMed1983

Chronic low back pain and depression.

It is not clear whether the psychological disturbances associated with chronic low back pain are the cause or the result of the chronicity. It is also not clear whether increasing duration of low back pain is associated with depression. Three groups of patients (N = 148), with recent (0-6 months), relatively longstanding (6-24 months) and chronic (more than 24 months) low back pain were given the MMPI, Multiple Affect Adjective Check List (MAACL), State Trait Anxiety Inventory (STAI) and Low Back Pain Questionnaire (LBPQ). Increasing chronicity is associated with significant increases on MMPI Hs, D, HY, PT and MA scales, and on STAI Trait Anxiety scale. These results suggest that chronicity leads to the development of psychopathological characteristics and that these characteristics include a heightened awareness of somatic functioning and the vegetative aspects of the depressive syndrome, but that there is no increase in depressive mood or in the perception of the pain itself.

Adult↗
PubMed1983

Psychological and social correlates of the back pain classification scale.

The Back Pain Classification Scale (BPCS) identifies patients whose low back pain reflects a primary psychological disturbance. BPCS scores were related to the MMPI, State-Trait Anxiety Inventory, Multiple Affect Adjective Check List, and Social Readjustment Rating Scale scores; to distribution, intensity, and activities affecting pain; and to social characteristics of 116 patients. High scores on the BPCS (psychological disturbance) are associated with elevated MMPI profiles, and with more widely distributed and more intense pain. Stepwise multiple regression solutions indicate that the MMPI Hypochondriasis (Hs) scale accounts for 15.5% of the variance. No other variable accounts for as much as 3% of the variance. Scores on Hs relate primarily to words in the BPCS psychologically disturbed pole, supplying convergent validity to the BPCS. BPCS scores are unrelated to social characteristics, implying usefulness with the variety of patients seen for evaluation of low back pain.

Adult↗
PubMed1982

Fibrositis and psychologic disturbance.

Thirty patients with fibrositis and 2 control groups, one of rheumatoid arthritis patients and the other of arthritis patients with other than rheumatoid arthritis, were compared on the basis of the Minnesota Multiphasic Personality Inventory (MMPI) to assess the role of psychologic factors in fibrositis. Patients with fibrositis differed in both elevation and variability in their MMPI profiles, indicating that they were more psychologically disturbed than patients with rheumatoid or other types of arthritis. The fact that almost all of the fibrositis patients' MMPI scales were higher suggests that we might be dealing with a number of different psychologic disturbances that have stiffness and musculoskeletal pain as principal and common symptoms.

Adult↗
PubMed1982

Rorschach and pain characteristics of patients with low back pain and "conversion V" MMPI profiles.

Two studies examined the relationship between Rorschach determinants, MMPI scale scores, and pain reports in order to clarify the meaning of the MPI "conversion V" pattern among patients with low back pain. Study I showed that patients without demonstrable organic disease of the back produce Rorschach response summaries marked by lower F+%, lower Sum C, and higher F% than patients with demonstrable organic disease. Study 2 showed that only the increase in F% was associated with significant elevations of the MMPI Hs and Hy scales. The results suggest that elevated MMPI "conversion V" profiles are indicative of psychological disturbance among patients with low back pain. It is unlikely, however, that the disturbance is hysterical. Instead, the psychopathology is probably marked by tension and constraint rather than the over-reactivity of hysteria. The implications of these findings for diagnosis are discussed.

Adolescent↗
PubMed1980

Validity of a back pain classification scale for detecting psychological disturbance as measured by the MMPI.

Constructed a Back Pain Classification Scale (BPCS) to detect serious psychological disturbance in low back pain patients, validated against the MMPI. One hundred and twenty patients with low back pain were classified as functional or organic on the basis of BPCS scores. The group identified as psychologically disturbed (functional) had significantly higher MMPI elevations on Scales F, HS, D, HY, PD, MF, PA, PT and SC. None of their scale scores was significantly lower than the group identified as organic. T-scores above 70 were present only on Scales 1 and 3, which suggests a high incidence of essentially neurotic disorders in patients classified as functional. The use of the BPCS as a viable alternative to the MMPI in the medical setting was discussed.

Adult↗
PubMed1980

Presurgical adjustment in male transsexuals with and without hormonal treatment.

The effects on hormonal treatment on the adjustment of adult males requesting sex reassignment surgery were examined in two studies. In study 1, the Minnesota Multiphasic Personality Inventory (MMPI) profiles of 19 patients who received no hormonal therapy and 22 patients who received 12 or more months of estrogen and medroxyprogesterone acetate treatment were compared. Patients receiving hormonal therapy not only showed significantly less psychopathology, but their scores on MMPI scales indicating neurotic and study 2, using correlational techniques to assess the effects of both hormonal treatment and cross-dressing on psychopathology. Length of hormonal treatment was related to emotional adjustment on four clinical scales of the MMPI. Scores indicating greater adjustment were associated with longer periods of treatment. Length of full-time cross-dressing, on the other hand, was not associated with patients' level of adjustment. These findings have important implications for those involved in personality evaluation of transsexuals and for future research. A more rigorous criteria for psychopathology may be required for those persons already exposed to hormonal therapy. It if further suggested that personality research with presurgical transsexuals include a drug hormone history.

Adolescent↗