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Biomedical subjects

N D Spence

Publications and source records attributed to N D Spence.

10 recordsLinked to original sources
PubMed1979

Intractable facial pain.

Case histories of 225 patients with intractable pain attending the Pain Clinic of a large metropolitan teaching hospital were retrospectively analysed. The 29 cases of intractable facial pain were investigated to determine if there were any clinical or historical factors which might indicate intractability and thus speed diagnosis of such cases in future. Significant factors were age, duration of pain, number of surgical interventions and psychiatric factors. Patients with intractable facial pain are more likely to be over 40 years of age, to have pain of long duration, to have had one or more operations, and to require psychiatric assistance than patients with non-intractable facial pain. Temporomandibular joint dysfunction pain and atypical facial pain merged in the intractable state and differ from intractable neuralgias with respect to sex ratio and psychiatric assistance. The incidence of intractable facial pain in South Australia was eight cases per million population per year. Compared to those with intractable pain at other body sites, patients with intractable facial pain have unilateral pain, do not suffer major impairment to their daily lives and are not concerned with monetary compensation. Patients with intractable pain are more likely to show a pattern of organic preoccupation, non-acceptance of reassurance and disease conviction. These findings, together with some current psychiatric aspects of intractable pain, including the concept of illness behaviour, are discussed. It is suggested that early psychiatric assessment will improve management but it is realised that although it is not possible to apply some of the factors studied to each patient, the findings may alert the clinician to potential intractability.

Age Factors↗
PubMed1977

Ethnicity and illness behaviour.

The 52-item Illness Behaviour Questionnaire (IBQ) was administered to 134 general practice patients of Greek, Anglo-Greek, and Anglo-Saxon origin. Responses were scored on 7 dimensions of illness behaviour labelled general hypochondriasis, disease conviction, psychological versus somatic perception of illness, affective inhibition, affective disturbance, denial and irritability. Results of a three-way analysis of variance (ethnicity, age and sex) indicated that Greek patients were significantly more likely to differ from Their Anglo-Saxon counterparts on the initial 3 IBQ scales. Compared with the Anglo-Saxon group, the Greek sample showed greater hypochrondriacal concern, were more likely to manifest conviction as to the presence of serious physical disease, and took a more somatic view of illness. Anglo-Greek patients varied from one scale to another in the degree to which their responses resembled the pattern of illness behaviour reported by Greek patients. They were most similar to the latter in their hypochondriacal attitude, and least similar in their psychological perception of illness. Although the IBQ responses to the Greek sample were consistent with patterns described in other studies of Mediterranean cultural groups, it was found that relationships observed between ethnicity and illness behaviour were to some extent dependent upon age and sex.

Adult↗
PubMed1976

Illness behaviour syndromes associated with intractable pain.

One hundred patients, referred for the management of intractable pain, completed a 52-item Illness Behaviour Questionnaire (IBQ). Responses were scored on 7 scales: general hypochondriasis, disease conviction, psychological versus somatic perception of illness, affective inhibition, affective disturbance, denial, and irritability. IBQ scale profiles were subjected to numerical analysis and 6 taxonomic clusters were identified. Patients in groups 1-3 were characterized by a relatively non-neurotic, reality-oriented attitude to illness, as indicated by low scores on the first three scales. Patients in groups 4-6 manifested greater evidence of 'abnormal illness behaviour', and presented syndromes resembling 'hysteria', 'conversion reaction', and 'hypothchondriasis' respectively.

Adult↗
PubMed1976

Is illness behavior related to chronicity in patients with intractable pain?

One hundred patients, referred for the management of intractable pain, completed a 52-item Illness Behaviour Questionnaire (IBQ). Responses were scored on 7 scales: general hypochondriasis, disease conviction, psychological versus somatic perception of illness, affective inhibition, affective disturbance, denial and irritability. IBQ scale profiles were used to study the relationship between chronicity of pain and pattern of illness behaviour reported. Except in the case of one scale, no significant correlation emerged. This overall lack of association between chronicity and illness behaviour remained even when the patient sample was restricted to those 20 patients having substantial organic pathology associated with their pain. These findings suggest that degree of chronicity is unlikely to play a major role in determining the illness behaviour manifested by patients with intractable pain.

Chronic Disease↗
PubMed1975

Hostility and depressive illness.

This study employs a method of classification based on "information measure" taxonomy to investigate an aspect of hostility in nonendogenously depressed, endogenously depressed and nondepressed patients. Results show that there are no statistically significant differences between the three groups as such, but that a patient's self-rating of anger is substantially related to his position on the endogenous-nonendogenous depression dimension. The greater the anger score, the more likely the patient is to present a depressive syndrome of a nonendogenous type. These observations provide support for previous findings in this area and prompt certain tentative theoretical speculations.

Adjustment Disorders↗