PubMed Health⌕ Search

Biomedical subjects

R H Dworkin

Publications and source records attributed to R H Dworkin.

At least 19 recordsLinked to original sources
PubMed1997

Assessment of pain in herpes zoster: lessons learned from antiviral trials.

Pain typically accompanies acute herpes zoster and, in a proportion of patients, it persists well beyond rash healing. Pain must therefore be analyzed in trials of antiviral agents in herpes zoster, but different methods have been used to analyze pain in recent published trials. These reports are reviewed and their methodological strengths and weaknesses examined. Based on this review, recommendations for the design and analysis of future trials of antiviral agents in herpes zoster are proposed. The principal recommendation is that antiviral efficacy should be evaluated both by distinguishing post-herpetic neuralgia from acute pain and by considering pain as a continuum. The primary endpoint should address both the prevalence and duration of post-herpetic neuralgia and should be examined in those patients who have post-herpetic neuralgia. Adopting the proposed recommendations in design and analysis of future trials should facilitate comparison across trials of the efficacy of antiviral agents in the treatment of herpes zoster.

Antiviral Agents↗
PubMed1996

Does affective blunting in schizophrenia reflect affective deficit or neuromotor dysfunction?

Schizophrenia inpatients withdrawn from all neuroleptic medication were administered measures of affective blunting, diminished affective experience, and neuromotor dysfunction. The correlations among the measures provided support for the hypothesis that measures of affective blunting reflect both neuromotor and affective deficits. Because the interpretation of such measures is therefore ambiguous, measures of diminished affective experience may have greater validity in research on affective deficits in schizophrenia than measures of blunted affective expression.

Adult↗
PubMed1996

Pain and its persistence in herpes zoster.

The nature and duration of pain associated with herpes zoster is highly variable. This review of research on pain in acute herpes zoster and postherpetic neuralgia (PHN) explores those observations relevant to the definition and pathogenesis of PHN and the design of treatment trials. A model for the pathogenesis of PHN is presented, which gains support from studies of risk factors. Several directions for future research are identified.

Animals↗
PubMed1996

Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: a meta-analysis of placebo-controlled trials.

Meta-analysis of four double-blind, randomized, placebo-controlled trials of oral acyclovir (800 mg five times daily) for the treatment of herpes zoster was conducted to provide definitive assessments of the effect of acyclovir on the resolution of zoster-associated pain. The studies involved a total of 691 patients, and the analysis was performed on an intent-to-treat basis. A range of milestones of pain cessation were evaluated by means of Cox regression models with adjustment for relevant prognostic factors. The proportion of patients with postherpetic neuralgia at 3 and 6 months was also determined. Advancing age and more severe pain at presentation were associated with more prolonged pain. Acyclovir was clearly shown to accelerate pain resolution by all of the measures employed. Benefit was especially evident in patients 50 years of age or older. Fewer acyclovir recipients had postherpetic neuralgia at 3 or 6 months. Overall, the reductions of pain duration and prevalence were approximately twofold.

Acyclovir↗
PubMed1996

Chronic pain and disease conviction.

OBJECTIVE: The results of cross-sectional and prospective studies suggest that the disease conviction scale of the Illness Behavior Questionnaire (IBQ) provides important information about chronic pain. To examine further the characteristics and correlates of this scale, the relationships between disease conviction and average pain intensity and interference of pain with daily activities were examined in a sample of chronic pain patients. DESIGN: The disease conviction scale and measures of hypochondriasis, psychological distress, pain intensity, and pain interference were administered to a sample of 127 chronic pain patients. RESULTS: The results suggested that pain intensity and interference were more strongly associated with disease conviction than with measures of psychological distress and hypochondriasis. In an analysis in which the relationships between the individual items of the disease conviction scale and pain intensity and interference were examined, disease conviction scale items that reflect consequences of pain and illness were significantly associated with both pain intensity and pain interference, whereas items that reflect disease conviction were in general not associated with either pain intensity or interference. CONCLUSION: These results suggest that items included in the disease conviction scale that reflect consequences of pain and illness, rather than disease conviction, may have contributed to the relationships that have been reported between disease conviction and other aspects of the chronic pain experience.

Activities of Daily Living↗
PubMed1996

The dimensions of schizophrenia phenomenology. Not one or two, at least three, perhaps four.

BACKGROUND: This confirmatory investigation examined the underlying structure of schizophrenia phenomenology through examination of the fit of several prominent dimensional models to observed symptom data. METHOD: Confirmatory factor analysis was conducted on a correlation matrix of schizophrenia signs and symptoms derived from case history ratings of 192 individuals with schizophrenia who were the subjects in the major twin studies of schizophrenia. RESULTS: Schizophrenia phenomenology appears best described by four underlying factors, namely negative symptoms, premorbid social adjustment deficits, reality distortion, and disorganisation. Of interest, the premorbid deficit dimension was directly associated with negative symptoms and disorganisation, but was inversely associated with reality distortion. CONCLUSIONS: These data clearly support the multidimensionality of schizophrenia phenomenology and provide objective support for a four-factor model over other models. This four-factor model may be useful in organising existing and future data concerning the genetic, neurobiological, neurological, and psychosocial features of schizophrenia.

Depression↗
PubMed1995

Pain responsivity in major depression and bipolar disorder.

Signal detection theory measures of thermal pain responsivity were examined in patients with major depression and bipolar disorder and in control subjects. Patients with major depression had significantly poorer sensory discrimination of painful thermal stimuli than control subjects, but they did not differ from the control subjects in their sensory discrimination of warm thermal stimuli of lower intensity. Patients with bipolar disorder did not differ significantly in sensory discrimination from either the patients with major depression or the control subjects. Patients with major depression had significantly higher (i.e., more stoical) response criteria than the control subjects for the painful thermal stimuli and also for the lower intensity stimuli; patients with bipolar disorder had significantly higher criteria than control subjects for only the lower intensity stimuli. The results suggest that reduced responsivity to pain in major depression may reflect sensory as well as affective abnormalities. Complaints of pain are very common in mood disorders, and continued examination of experimental pain in individuals with these disorders has the potential to enhance our understanding of this phenomenon.

Adult↗
PubMed1994

Pain insensitivity in schizophrenia: a neglected phenomenon and some implications.

The literature on insensitivity to pain in schizophrenia is reviewed. Numerous reports indicate that, relative to normals, individuals with schizophrenia are insensitive to physical pain associated with illness and injury. In addition, insensitivity to pain of various sorts administered in experimental studies has been reported frequently in this population. This extensive and diverse literature of clinical and experimental reports suggests that many individuals with schizophrenia are less sensitive to pain than normal individuals. However, because the experimental studies--almost all of which were conducted before 1980--suffer from a variety of methodological limitations, this research provides neither a satisfactory characterization nor an adequate explanation of pain insensitivity in schizophrenia. It is argued that this widely reported but currently neglected phenomenon has important implications for physical health, self-mutilation, homelessness, premorbid development, and affective flattening in individuals with schizophrenia.

Affective Symptoms↗
PubMed1994

Social competence deficits in adolescents at risk for schizophrenia.

Social competence in subjects at risk for schizophrenia and affective disorder and in normal-comparison subjects was examined in childhood and adolescence. Based on interviews with the parents of the subjects and with the children and adolescents themselves, subjects at risk for schizophrenia had poorer overall social competence than subjects at risk for affective disorder and comparison subjects in early adolescence and adolescence but not in childhood. In analyses of specific aspects of social competence, the adolescents at risk for schizophrenia had significantly poorer peer relationships and decreased hobbies/interests than the adolescents at risk for affective disorder and the normal-comparison adolescents. With respect to school adjustment, however, the two groups of adolescent offspring of parents with psychiatric disorders had significantly poorer adjustment than the comparison adolescents but did not differ from each other on this measure. These results suggest that various aspects of poor social competence may precede the onset of schizophrenia and play an important role in its development.

Adolescent↗
PubMed1993

Childhood precursors of affective vs. social deficits in adolescents at risk for schizophrenia.

Childhood attentional and neuromotor precursors of social competence and affective deficits in adolescents at risk for schizophrenia, adolescents at risk for affective disorder, and matched comparison adolescents were examined. The subjects were offspring of parents with schizophrenia or affective disorder and of normal parents matched on age, sex, and socioeconomic status from the New York High-Risk Project (Sample B). On the basis of interviews conducted when the subjects were children and adolescents, social competence was rated from child reports and parent reports, affective deficits were assessed by affective flattening ratings, and smiling was assessed by counting broad smiles. Adolescents at risk for schizophrenia had significantly greater social and affective deficits than adolescents at risk for affective disorder and comparison adolescents. In subjects at risk for schizophrenia, childhood neuromotor dysfunction predicted adolescent affective flattening, and childhood attentional dysfunction predicted adolescent social deficits. The results suggest that affective and social deficits in schizophrenia have different childhood precursors.

Adolescent↗
PubMed1992

A high-risk method for studying psychosocial antecedents of chronic pain: the prospective investigation of herpes zoster.

Although patients with chronic pain are often psychologically distressed, it has been difficult to determine whether this distress is an antecedent of chronic pain or whether it is caused by the experience of living with chronic pain. The aim of this investigation was to develop a method that would allow individuals who are at risk for the development of chronic pain to be studied before their pain has become chronic. Patients with acute herpes zoster were assessed with demographic, medical, pain, and psychosocial measures. Pain was assessed in follow-up interviews at 6 weeks and 3, 5, 8, and 12 months after these initial assessments. There were no significant differences between patients who developed short-term herpes zoster pain and patients who did not develop short-term pain for any of the measures at the initial assessment, except for one measure of pain intensity. Patients who developed chronic herpes zoster pain, however, had significantly greater pain intensity, higher state and trait anxiety, greater depression, lower life satisfaction, and greater disease conviction at the initial assessment than patients who did not develop chronic pain. In discriminant analyses, disease conviction, pain intensity, and state anxiety each made a unique contribution to discriminating patients who did and who did not develop chronic pain. This study demonstrates the feasibility of investigating psychosocial antecedents of the development of chronic pain by prospectively examining the longitudinal course of herpes zoster.

Adult↗
PubMed1992

Affective deficits and social deficits in schizophrenia: what's what?

Affective deficits and social deficits have played an important role in theory and research on schizophrenia, and it has generally been assumed that these are two different types of symptoms. The aim of these comments is to argue that the distinction between these symptoms is not straightforward and that the apparent differences between affective and social deficits virtually disappear when current approaches to their definition and measurement are considered. The implications of this point with regard to theory and research on the etiology and treatment of schizophrenia are discussed, and an approach that has the potential to reveal whether specific schizophrenic symptoms are more closely associated with affective deficits or with social deficits is described.

Affect↗
PubMed1992

Simple schizophrenia: an investigation of Bleuler's criteria based on the major twin studies of schizophrenia.

Schizophrenics fulfilling Bleuler's criteria for simple schizophrenia--no evidence of hallucinations, delusions, and catatonic behavior--were similar to schizophrenics with more typical forms of the disorder with respect to negative symptoms, premorbid social adjustment, and age at onset. These results support the validity of the simple schizophrenia subtype by providing evidence that schizophrenics without conspicuous positive symptoms are similar to those with such symptoms on these core features of the disorder.

Delusions↗