Rosemary G. Platts

The assessment of fatigue in primary Sjögren's syndrome.

Objective. Disabling fatigue is a prominent feature of primary Sjögrens syndrome (PSS). We evaluated a number of questionnaires for their ability to discriminate fatigue in PSS from that in other rheumatic disorders and healthy controls. Methods. 33 female caucasian patients with PSS, 45 with rheumatoid arthritis (RA), 16 with systemic lupus erythematosus (SLE) and 30 controls completed self‐administered questionnaires including; Visual Analogue Scales (VAS), the Chalder Fatigue Scale (CFS), the Nottingham Health Profile (NHP) and the Medical Outcomes Short Form 36 Questionnaire (SF‐36). Results. All patient groups scored significantly worse than controls on the ‘Energy’ dimension of the NHP, the fatigue VAS and the ‘Vitality’ domain of the SF‐36. No significant differences were observed between PSS patients and controls using the CFS. Conclusions. The NHP, VAS and SF‐36 are useful in identifying fatigue in these rheumatic disorders. Further work is required to identify the characteristic features of fatigue in these conditions.

Psychological characteristics of people with perceived food intolerance in a community sample

In most adults who believe themselves to be food intolerant there is no objective supporting evidence. It has therefore been proposed that the misperception of intolerance to food is linked to psychiatric illness or personality disorder. This hypothesis was tested in a community-derived sample of individuals who attributed an adverse symptom to a type of food. A random mailing recruited 955 participants aged > or =18 years, of whom 232 perceived themselves to be food intolerant (PFI). All recruits were sent two questionnaires, the General Health Questionnaire-28 (GHQ-28) and the shortened version of the Eysenck Personality Questionnaire (EPQ-R). A total of 535 GHQ-28 and 518 EPQ-R forms were returned that were correctly completed, an overall response rate of 55%. For the subscales of the EPQ-R, neuroticism was greater in those with a PFI than those without. Women with a PFI were more extroverted than control women. For the GHQ-28 subscales, women with a PFI had significantly higher scores than control women on somatic symptoms, anxiety, insomnia, and severe depression. There was a greater percentage of psychiatric caseness among women with a PFI than among men with a PFI or control women. Nevertheless, this percentage was no greater than that reported among a reference sample derived from NHS and university staff. It is concluded that perceived food intolerance is associated with psychological distress in women with a PFI, and neurotic symptoms in both men and women with a PFI, but there is no greater prevalence of psychiatric disorder among women or men with a PFI than there is in some professional groups.

Episodic and semantic memory in accounts of food intolerance

It was hypothesized that accounts of occasions of eating followed by adverse symptoms (i.e. perceived food intolerance) would contain greater detail when based on recall of actual events, using episodic memory. Where accounts lacked detail it was hypothesized that recalled events were based on knowledge about food intolerance, without personal experience of a plausible incident. These hypotheses were tested by categorizing the contents of interviews of respondents to a randomized survey of the electorate in the Birmingham area, who attributed one or more adverse symptoms to one or more foods. The majority of interview records provided evidence for semantic memory rather than recall of actual episodes of food ingestion followed by symptoms(s). Vagueness of recollection correlated negatively with patho-physiological plausibility of the perceived food intolerance. Greater detail and specificity in accounts of food-symptom episodes was positively correlated with plausibility. Rareness of food-symptom(s) contingencies also correlated with detail and specificity in accounts of episodes and with plausibility of food intolerance. Detail and specificity of accounts of the eating of foods followed by symptoms, when coupled with rareness of the contingency of that food being followed by those symptoms, may prove to be a better predictor of physically diagnosed food intolerance than plausibility by patho-physiological criteria alone. Copyright

No unique role for nausea attributed to eating a food in the recalled acquisition of sensory aversion for that food

Currently in the U.K., as in the U.S.A. 20 years ago, when students were asked to name a food that they did not like, more dislike for the food was attributed to nausea or vomiting after eating than to other gastrointestinal symptoms or to illness in other parts of the body. However, when members of the public first identified adverse symptoms and then attributed them to foods, and dislike for the food was first enquired about on a later occasion, there was no evidence for a unique role for a causal association with nausea in the human acquisition of food aversions. Furthermore, fear of the symptom was more prevalent than acquired sensory aversion when there was more precise recall of memories of the food being followed by nausea or vomiting and greater likelihood of there having been causal contingency rather than mere coincidence. Therefore, the more frequent invocation of nausea than of some other symptoms as the cause of a sensory aversion to a food may result from personal theory of the body, rather than from a veridically recalled occasion when nausea was contingent on eating the food---an event that must occur for aversion to arise from associative conditioning.