Biomedical subjects

R Goldbeck

Publications and source records attributed to R Goldbeck.

4 recordsLinked to original sources

PubMed2002

Are functional motor and sensory symptoms really more frequent on the left? A systematic review.

OBJECTIVES: To test the hypothesis that unilateral motor and sensory symptoms unexplained by identifiable disease are more common on the left side of the body than the right. METHODS: Systematic review of the literature published since 1965. RESULTS: 121 eligible studies, involving 1139 patients, were analysed. The pooled proportion of functional left sided weakness and sensory symptoms in adults was 58% (95% confidence interval (CI) 55 to 61%). A much higher proportion of left sided symptoms (66%, 95% CI 61 to 71%) was found in studies where laterality featured in the title of the paper. However, when laterality was not mentioned in the title, no significant difference between left and right was observed (53% on the left, 95% CI 48 to 57%). This difference could not be explained on the basis of sex differences between the groups or the date of the study. Functional or "psychogenic" movement disorder was right sided in 68% (95% CI 61 to 75%). Handedness did not influence symptom lateralisation. CONCLUSIONS: The findings of this systematic review question whether functional weakness and sensory symptoms do in fact occur more commonly on the left side of the body. A type of outcome variable reporting bias in combination with non-blinding of investigators may be responsible for this long held but erroneous belief.

Aged↗

PubMed1997

New variant Creutzfeldt-Jakob disease: psychiatric features.

BACKGROUND: An apparently new variant of Creutzfeldt-Jakob disease (CJD), new variant CJD (nvCJD), was identified in the UK in 1996. There have now been 21 cases of nvCJD in the UK and one in France. Psychiatric symptoms are prominent in the initial presentation in these cases. METHODS: Cases of nvCJD are identified mainly by direct referral from neurologists and neuropathologists. Detailed clinical information was obtained by review of case notes and interviewing patients' relatives. We report the psychiatric features of the first 14 cases on nvCJD in the UK. Psychiatric notes were examined in all 13 of these cases who were seen by a psychiatrist. RESULTS: Eight cases were women. All 14 cases had early psychiatric features and in nine, the first symptom was psychiatric. 13 cases were seen by a psychiatrist and the majority were diagnosed as suffering from depression or depression secondary to organic disease. Two cases suffered from first-rank symptoms suggestive of psychotic illness and transient delusions and auditory or visual hallucinations occurred in the majority. All cases were referred to a neurologist as the illness evolved and neurological signs developed. INTERPRETATION: Psychiatric symptoms are a consistent early clinical feature in nvCJD. Analysis of the psychiatric symptoms does not suggest specific features that readily allow distinction from more common psychiatric disorders, although the occurrence of associated persistent sensory symptoms may raise the possibility of this diagnosis. Neurological signs, including ataxia, involuntary movements and cognitive impairment developed in all cases and the evolution of increasing neurological deficits is likely to remain critical to the clinical diagnosis of nvCJD.

Adult↗

PubMed1997

Denial in physical illness.

Denial is a concept often encountered in literature describing patients' psychological responses to physical illness. Definitions and theories of denial have drawn on clinical, cognitive, psychodynamic, organic, and interpersonal frameworks. Denial is related to other concepts such as lack of insight, self-deception, and anosognosia. Empirical studies have yielded mixed results with regard to the adaptive properties of denial. These results require interpretation in the light of: (1) the definitional complexities of denial; (2) the diversity of methods used for its assessment; and (3) the choice of different clinical samples and heterogeneous outcome measures. The clinical management of maladaptive denial poses a challenging problem which requires consideration of factors pertaining to the patient, the illness, the treating clinician, as well as the patient's social environment. To achieve further clarification of the role of denial in physical illness, future research would benefit from clearer definitions and more refined, consistent methods of assessment. A number of recommendations are outlined.

Adaptation, Psychological↗

PubMed1997

End-of-treatment self-efficacy: a predictor of abstinence.

Results of previous studies suggest that end-of-treatment self-efficacy in problem drinkers has limited predictive validity. One explanation for this finding has been the postulated existence of a ceiling effect, i.e. the possibility that subjects who rate themselves highly in terms of self-efficacy form a heterogeneous group with some subjects making inflated self-efficacy judgements based on an over-optimistic perception of their coping abilities. In the present study, end-of-treatment self-efficacy in 63 problem drinkers, as measured by the Situational Confidence Questionnaire and a newly designed Self-Efficacy Questionnaire (SEQ), was predictive of abstinence status at 3 month follow-up. In those patients who on the SEQ had expressed great confidence in their ability to remain abstinent over the follow-up period, the additional consideration of keyworkers' confidence in their patients' ability to remain abstinent as well as patients' anticipated need for future help improved the prediction of abstinence status. These results are discussed with respect to the postulated ceiling effect. A prognostic tree using just three baseline variables predicted abstinence status correctly in 88% of all cases.

Adult↗