Grace Wyshak

The Somatosensory Amplification Scale and its relationship to hypochondriasis

Forty-one DSM-III-R hypochondriacs and seventy-five randomly chosen patients were obtained from a medical outpatient clinic, and completed a psychiatric diagnostic interview and a ten-item self-report questionnaire, the Somatosensory Amplification Scale (SSAS); The SSAS asks the respondent how much s/he is bothered by various uncomfortable visceral and somatic sensations, most of which are not the pathological symptoms of serious diseases. SSAS scores were normally distributed, and had acceptable test-retest reliability and internal consistency. They were not related to sociodemographic characteristics, or to aggregate medical morbidity. Amplification was significantly higher in the DSM-III-R hypochondriacs than in the comparison sample, and was significantly correlated with the degree of hypochondriacal symptomatology within each sample. In the comparison sample, it was also significantly associated with depressive and anxiety disorders, but not with antisocial personality or substance abuse. The association between the amplification scale and DSM-III-R hypochondriasis remained highly significant after controlling for these concurrent psychiatric disorders.

Delayed menarche and amenorrhea in ballet dancers

YOUNG female ballet dancers attending professional schools or dancing in companies in which thinness is much admired restrict their food intake and are highly active.1 The unusual eating habits and...

Evidence for a secular trend in age of menarche.

WE present data documenting a secular trend toward an earlier age of menarche in Europe and the United States in the past century. There has been recent controversy on whether such a change has tak...

Lower prevalence of breast cancer and cancers of the reproductive system among former college athletes compared to non-athletes.

The prevalence (lifetime occurrence) rate of cancers of the reproductive system (uterus, ovary, cervix and vagina) and breast cancer was determined for 5,398 living alumnae, 2,622 of whom were former college athletes and 2,776 non-athletes, from data on medical and reproductive history, athletic training and diet. The former athletes had a significantly lower risk of cancer of the breast and reproductive system than did the non-athletes. The relative risk (RR), non-athletes/athletes, for cancers of the reproductive system was 2.53. 95% confidence limits (CL) (1.17, 5.47). The RR for breast cancer was 1.86, 95% CL (1.00, 3.47). The analysis controlled for potential confounding factors including age, family history of cancer, age of menarche, number of pregnancies, use of oral contraceptives, use of oestrogen in the menopausal period, smoking, and leanness. Of the college athletes, 82.4% had been on pre-college teams compared to 24.9% of the college non-athletes. We conclude that long term athletic training may lower the risk of breast cancer and cancers of the reproductive system.

Medical and psychiatric determinants of outpatient medical utilization.

Ninety-two general medical outpatients were surveyed with an interview, questionnaires, and a medical record review to investigate the relationships among psychiatric disorder (depression and hypochondriasis), somatic symptoms, medical morbidity, and the utilization of ambulatory medical services. Medical utilization correlated with the number of somatic symptoms reported (r = 0.49, P = 0.0001), depressive symptoms (r = 0.34, P = 0.001), and the number of medical diagnoses in the medical record. Somatic symptoms were not significantly correlated with the number of medical diagnoses, but were related to hypochondriacal attitudes (r = 0.52, P = 0.0001) and depression (r = 0.51, P = 0.0001). In stepwise multiple regressions, the number of medical diagnoses accounted for 33% of the variance in medical utilization. Somatic symptoms were the second most powerful predictor, increasing R2 to 0.469. The next best predictors were two hypochondriacal attitudes and the presence of a major psychiatric diagnosis in the medical record. This five-step model explained 56% of the variance. Somatic symptoms are thus powerful determinants of medical utilization, even after controlling for medical morbidity. Depression, disease fear, and bodily preoccupation are also important predictors of utilization. Somatic symptoms are a final common pathway through which emotional disturbance, psychiatric disorder, and organ pathology all express themselves, and which prompt patients to visit doctors.

The prevalence of hypochondriasis in medical outpatients

SummaryForty-one DSM-III-R hypochondriacs were obtained by screening consecutive visitors to a general medical clinic and compared with 76 patients randomly chosen from the same setting. They completed a research battery consisting of a structured diagnostic interview (DIS) and self-report questionnaires to measure hypochondriacal symptoms and functional impairment. The criterion standard for diagnosing hypochondriasis was a structured interview of demonstrated reliability and validity. The six-month prevalence of DSM-III-R hypochondriasis was estimated to be between 4.2% and 6.3% of consecutive attenders who met the inclusion criterion of having visited the same physician before. This rate was somewhat lower than that found for generalized anxiety disorder and comparable to that of alcohol abuse. The hypochondriacal patients did not differ significantly from the comparison random sample in sociodemographic risk factors except that they were significantly more likely to be Black. Hypochondriacal symptomatology was similar in males and females; and in those over 65 and those under 65. Over a three-week interval, hypochondriacal symptoms remained stable, and hypochondriacal patients had significantly higher levels of long-term disability than did the comparison patients.

Alcohol use and abuse in random samples of physicians and medical students.

BACKGROUND This study sought to resolve conflicting views about whether physicians are especially prone to alcohol abuse. METHODS Using an anonymous, mailed questionnaire on substance use, we surveyed 500 physicians, 510 pharmacists, and 974 of their students. The physicians and pharmacists were selected randomly from the state societys membership lists, and students selected were from local school lists. Follow-up surveys were sent to nonresponders at two-week intervals. RESULTS The physicians and medical students did not drink especially heavily and were no more vulnerable to alcoholism than were their counterparts in pharmacy and other professions. Physicians differed from pharmacists in their style of drinking (greater frequency, smaller quantity), but not in total amount of alcohol consumed. Drinking habits among physicians were not associated with medical specialty or type of practice, but were positively related to gender (males drank more than females) and to age (older doctors were more apt to qualify as heavy drinkers than were younger doctors). CONCLUSIONS Physicians were no more likely to abuse substances nonmedically than were other professionals. Any group in which alcohol use is nearly universal incurs a risk of abuse and impairment that cannot be ignored.

Adverse birth outcomes among native-born and immigrant women: replicating national evidence regarding Mexicans at the local level.

Objectives: For almost two decades, the literature has consistently described an epidemiologic paradox relating to better birth outcomes among high-risk groups, particularly new immigrants from Mexico and Southeast Asia. We hypothesize that regardless of their sociodemographic profile, Mexican immigrants will exhibit lower rates of low birth weight and preterm deliveries than native-(U.S.) born women of Mexican origin, non-Hispanic White and Black women, and Puerto Rican women. Methods: We studied 57,324 live-born singleton infants born to residents in the city of Chicago in a linked data set of 1994 birth–death records. Multivariate logistic regression was used to analyze race/ethnicity differentials in two pregnancy outcome measures, low birth weight and preterm birth. Results: Overall better birth outcome is related to maternal immigrant status regardless of race/ethnic groups. Immigrant Mexican women had a significantly lower risk of both low birth weight [adjusted odds ratio (AOR): 0.78, 95% confidence interval (CI) 0.66–0.91] and preterm births (AOR: 0.75, 95% CI 0.65–0.86) and were at 28% and 33% lower risks of delivering a low birth weight infant or a premature infant, respectively, than non-Hispanic White women.

Breast cancer among former college athletes compared to non-athletes: a 15-year follow-up.

A growing body of evidence indicates that physical activity is protective against breast cancer. In 1996–97, we conducted a 15-year follow-up of 5398 college alumnae comprised of former college athletes with their non-athletic classmates. Participants completed a detailed mailed questionnaire on their health history from 1981–82 to the present. Excluding women who had died and non-deliverable questionnaires, 84.7% (n = 3940) of the participants in our earlier study responded to the questionnaire; the response rate for former athletes was 86.6% (n = 1945), for non-athletes, 83.0% (n = 1995). Results confirmed our earlier findings. Based on self-reports, former college athletes had a significantly lower risk of breast cancer than the non-athletes. The OR for the 15-year incidence of breast cancer is 0.605 with 95% confidence interval (CI) (0.438–0.835); the 15-year incident breast cancers were 64 among the athletes and 111 among the non-athletes. Among women under 45 the protective effect of physical activity on the risk of breast cancer is considerably greater; odds ratio (OR) = 0.164, 95% CI (0.042–0.636). Athletic activity during the college and pre-college years is protective against breast cancer throughout the life span, and more markedly among women under 45. These results confirm our earlier findings and the findings of other investigators.

Lower Prevalence of Diabetes in Female Former College Athletes Compared With Nonathletes

The prevalence rate of diabetes was determined for 5398 living college alumnae (2622 former college athletes and 2776 nonathletes) from data on medical history, athletic training, and diet. For all ages, the prevalence rate among the former athletes was 0.57% (15/2622) and among the nonathletes was 1.3% (37/2776). The former college athletes and the nonathletes had similar percentages in family history of diabetes, i.e., 12.0 and 13.5%, respectively. For cases occurring at age ≥20 yr (thus assessing the effects of college athletic training), 0.5% (13/2622) of the former college athletes had diabetes compared to 1.2% (32/2776) of the nonathletes; the relative risk is 2.24 [95% confidence limits (CL), 1.19 and 4.74, respectively]. Omitting cases of gestational diabetes, the relative risk of diabetes in nonathletes versus athletes is 3.41 (95% CL, 1.33 and 8.70). The percentages of former athletes and nonathletes that are insulin-using, non-insulin-using, and gestational diabetics did not differ significantly. The athletes were leaner than the nonathletes at all ages up to 70 yr. Of the former college athletes, 82% had been on precollege teams, compared to 25% of the college nonathletes; 74% of the former athletes were exercising regularly, compared to 57% of the nonathletes. We conclude that long-term athletic training is associated with a lower risk of the development Of diabetes.