Concerning semantic problems in psychological evaluation

Chronic fatigue and chronic fatigue syndrome: clinical epidemiology and aetiological classification

To determine the medical and psychiatric diagnoses that have an aetiological role in chronic fatigue we conducted a prospective study of 405 (65% women) patients who presented for evaluation with this chief complaint to an academic medical centre. The average age was 38.1 years and the average duration of fatigue at entry in the study was 6.9 years. All patients were given comprehensive physical and laboratory evaluations and were administered a highly structured psychiatric interview. Psychiatric diagnoses explaining the chronic fatigue were identified in 74% of patients and physical disorders were diagnosed in 7% of patients. The most common psychiatric conditions in this series were major depression, diagnosed in 58% of patients, panic disorder, diagnosed in 14% of patients, and somatization disorder, diagnosed in 10% of patients. Primary sleep disorders, diagnosed in 2% patients, and chronic infections, confirmed in 1.6% patients, explained the majority of cases whose chronic fatigue was attributed to a physical disorder. Thirty per cent of patients met the criteria used to define the chronic fatigue syndrome (CFS). Compared with age- and gender-matched control subjects with chronic fatigue, CFS patients had a similarly high prevalence of current psychiatric disorders (78% versus 82%), but were significantly more likely to have somatization disorder (28% versus 5%) and to attribute their illness to a viral infection (70% versus 33%). We conclude that most patients with a chief complaint of chronic fatigue, including those exhibiting the features of CFS, suffer from standard mood, anxiety and/or somatoform disorders. Careful research is still needed to determine whether CFS is a distinct entity or a variant of these psychiatric illness.

Self-report measures of insomnia in adults: rationales, choices, and needs

Self-report measures continue to provide key information in the evaluation and treatment of insomnia. While knowledge development about insomnia continues to require multi-trait, multi-method studies, self-report measures remain central in most study designs. The available stock of insomnia-related questionnaires has a substantial heterogeneity in their formats, foci, scopes, and other attributes. While there may be benefits from using specially tailored questionnaires in particular circumstances, in other cases the information quality of a study will be downgraded by poor choice of questionnaires. To assist clinicians and investigators in selecting questionnaires wisely, the present paper reviews questionnaire criteria and attribute priorities for clinical trials, theory tests, observational studies, and aging studies concerning insomnia. An extensive table of currently available questionnaires is provided, and some needs for future questionnaire development are also identified.

Italian validation of the Symptom Rating Test (SRT) and Symptom Questionnaire (SQ)

Two self-rating scales of psychological distress, the Symptom Rating Test (SRT) and the Symptom Questionnaire (SQ), have been validated in translations in Italy. They were administered in several studies to psychiatric patients (neurotics and depressives), matched controls, and patients suffering from various organic illnesses (dermatologic disorders, hypertension, secondary amenorrhea and patients undergoing amniocentesis). The SRT and the SQ sensitively discriminated between psychiatric patients and normals, between different levels of psychological distress in several of the somatic illnesses, and detected significant changes in the psychological status of patients participating in medical procedures such as amniocentesis. The scales were found to be useful in research in psychiatry and psychosomatic medicine. The findings suggest that the Italian translations are valid and sensitive scales of distress and can apparently be used as effectively in research as the original. They are likely to be of value in cross-cultural research in Canada. Both scales may be helpful in the psychological assessment of Italian immigrants in North America and Australia, especially in those whose English is poor.