Symptoms and the perception of disease

Measures of Symptom Exaggeration for Mental Health Disorders: A Systematic Review

Introduction .- Measures that help detect exaggeration of symptoms can be valuable for informing more accurate diagnoses and aid in treatment and case management. We completed a systematic review to identify measures that assess symptom exaggeration in mental health disorders. Methods .- Eligible studies assessed exaggeration of symptoms with a psychometrically validated measure in patients presenting with a mental health disorder. We searched MEDLINE and PsycINFO from inception to June 2013 for relevant studies. To determine study eligibility, reviewers screened title and abstracts of identified citations, and reviewed full texts of all potentially eligible citations. Data extractors completed data abstraction of eligible studies. Results .- Of 8435 unique citations, 105 studies consisting of 112 cohorts were eligible, and we identified 36 unique, validated measures assessing exaggeration of symptoms. The most frequently used measures were symptom validity indicators embedded in the Minnesota Multiphasic Personality Inventory (MMPI-2) (n=48, 46%), the Structured Interview of Reported Symptoms (SIRS) (n=12, 11%), and the Personality Assessment Inventory (PAI) (n=11, 10%). Most studies (n=96; 91%) failed to test reliability of their measure of symptom exaggeration. The symptom validity indicators in the MMPI/MMPI-2 and the SIRS both showed moderate to high internal consistency, range 0.47 to 0.85 and 0.48 to 0.95, respectively. Conclusions .- Multiple measures assessing symptom exaggeration have been used in patients with mental health disorders. The symptom validity indicators of the MMPI/MMPI-2 are the most widely used measures to assess symptom exaggeration. Assessment and reporting of reliability is poor across studies; we require further assessment of psychometric properties for existing measures of symptom exaggeration.

Fatigue and social impairment in multiple sclerosis: the role of patients' cognitive and behavioral responses to their symptoms

OBJECTIVES

The aim of this study was to test whether the way in which multiple sclerosis (MS) patients interpret and respond to their symptoms may help to explain their experience of fatigue and social impairment.

METHOD

In a cross-sectional study, 149 patients with a definite diagnosis of MS completed validated questionnaires that measured their symptom interpretation and behavioral response, fatigue, mood, and social adjustment. A neurologist assessed their level of neurological impairment.

RESULTS

Regression analyses revealed that patients' cognitive interpretations of their symptoms, such as a tendency to attribute a wide range of symptoms to their MS and feelings of embarrassment about symptoms, were significantly associated with fatigue and social adjustment over and above neurological impairment, remission status, and mood. The behavioral variables including an all-or-nothing response to symptoms and rest/avoidance behaviours were also strongly associated with fatigue and social impairment. The degree of neurological deficit was not associated with either physical or mental fatigue, although it was associated with social impairment. Depression, anxiety, and remission status were also related to fatigue, and depression to social impairment.

CONCLUSION

These findings suggest that treatment approaches that challenge unhelpful cognitive interpretations and behavioural responses to symptoms, and address anxiety and depression, may be important in improving the overall management of fatigue in MS.