The Clinical neuropsychologist
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Back pain is experienced by up to of 85% of the United States population. Most often it resolves with minimal to no medical treatment. For those whose pain endures, worsens, or becomes protracted, conservative care is typically first attempted. ⋯ Empirical findings with the MMPI-2 Restructured Form (MMPI-2-RF) are presented next, including descriptive analyses with a sample of 1341 individuals assessed as part of a pre-surgical psychological screening. Correlations between MMPI-2-RF scale scores and measures of the primary risk factors identified in this review are reported for a smaller sample of 197 pre-surgical candidates. Interpretive implications of the MMPI-2-RF findings are discussed along with suggestions for further research in this area.
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Fibromyalgia is a chronic pain-related disorder that typically includes cognitive complaints as well as non-specific somatic complaints, such as fatigue and sleep disturbance (Wolfe et al., 2010). Fibromyalgia has also been shown to be associated with a high rate of failure on performance validity testing (PVT), which has not been examined with respect to other self-reported symptoms that are now part of the diagnostic criteria for the disorder. We evaluated 85 patients with fibromyalgia who completed objective measures of pain, sleep, and fatigue along with symptom validity measures (Word Memory Test or Test of Memory Malingering and Reliable Digit Span). ⋯ Disability status analyses were significant for daily pain, weekly pain, and fatigue, but not sleep. The implication of this study is that PVT performance and disability status are associated with exaggeration of non-cognitive symptoms such as pain, sleep, and fatigue in persons with fibromyalgia. This study reinforces the importance of effort testing when working with medical populations.
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This study aimed to determine if systematic variation of the diagnostic terminology embedded within written discharge information (i.e., concussion or mild traumatic brain injury, mTBI) would produce different expected symptoms and illness perceptions. We hypothesized that compared to concussion advice, mTBI advice would be associated with worse outcomes. Sixty-two volunteers with no history of brain injury or neurological disease were randomly allocated to one of two conditions in which they read a mTBI vignette followed by information that varied only by use of the embedded terms concussion (n = 28) or mTBI (n = 34). ⋯ Statistically significant group differences due to terminology were found on selected NSI scores (i.e., total, cognitive and sensory symptom cluster scores (concussion > mTBI)), but there was no effect of terminology on illness perception. When embedded in discharge advice, diagnostic terminology affects some but not all expected outcomes. Given that such expectations are a known contributor to poor mTBI outcome, clinicians should consider the potential impact of varied terminology on their patients.
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Opioid analgesics provide effective treatment for noncancer pain, but many health providers have concerns about cognitive effects, tolerance, dependence, and addiction. Misuse of opioids is prominent in patients with chronic pain and early recognition of misuse risk could help providers offer adequate patient care while implementing appropriate levels of monitoring to reduce aberrant drug-related behaviors. Many persons with chronic pain also have significant medical and psychiatric comorbidities that affect treatment decisions. ⋯ The assessment of different domains using semi-structured interviews, sensory and neuropsychological testing, and standardized self-report measures permits identification of somatosensory, emotional, cognitive, behavioral, and social issues in order to facilitate treatment planning. In this review we discuss opioid abuse and misuse issues that often arise in the treatment of patients with chronic pain, and present an overview of assessment and treatment strategies that can be effective in improving outcomes associated with the use of prescription opioids for pain. Finally we briefly discuss the effect of opiate analgesics on cognition and review some intervention strategies for chronic pain patients.
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Case Reports
Maple syrup urine disease (MSUD): a case with long-term follow-up after liver transplantation.
Maple syrup urine disease (MSUD) is a rare hereditary metabolic condition where the body is unable to breakdown amino acids causing toxic buildup. Acute and long-term management of MSUD involves a restricted diet and regular monitoring of amino acid levels; however, more recently liver transplants have been shown to be successful in treating this condition. Even with successful management of MSUD there is evidence from pediatric cases that shows a distinct pattern of neurocognitive deficits associated with this condition, including impaired nonverbal skills and psychomotor functioning with relatively intact verbal abilities. ⋯ The patient also showed reduced adaptive functioning and mild anxiety. This case demonstrates neurocognitive deficiencies within the context of normal magnetic resonance imaging. The possible underlying mechanism of this neuropsychological profile is discussed in relation to other neurodevelopmental models.