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Somatization and Symptoms Evaluation
Author Bios
Introduction
Defining Somatization
Detecting Symptoms
Dimensions of Symptoms
Measuring Symptoms
Psychiatric Comorbidity
Interpreting Symptom Measures
Functional Syndromes and Symptoms
Etiology of Symptoms
Levels of Etiological Certainty
Strengthening Etiological Classification
Confounding Etiological Factors
Symptoms and Patient Expectations
Currently selected section: Interpreting Patient Responses
Measuring Multiple Symptoms
Global Rating of Change
Measuring Somatization
Measuring Other Domains
Conclusions


Chapter 16: Somatization and Symptoms Evaluation: Interpreting Patient Responses
        

Problem 14.1

A 62-year-old man with congestive heart failure (CHF) is entered into a clinical trial evaluating the effectiveness of a new inotropic agent for reducing the symptoms of CHF. The patient completes the Chronic Heart Questionnaire (a disease-specific measure for CHF that evaluates various domains of symptoms, functional status, and health-related quality of life).

The patient's responses to two of the symptom items are shown in Figure 14.1 below.

Figure 14.1: Patient Responses to 2 items on the Chronic Heart Questionnaire at Baseline and 4 Weeks After Enrollment in a Congestive Heart Failure Clinical Trial
How much chest pain or shortness of breath have you had in the last 4 weeks? Answer categories are 1. An extreme amount, 2. A lot, 3. Quite a bit, 4. A moderate amount, 5. Some, 6. A little, 7. None at all. Baseline answer is 3. Quite a bit; 1 month answer is 6. A little. What about fatigue? How tired have you felt over the last four weeks? ? Answer categories are 1. Extremely tired, 2. Very tired, 3. Quite a bit of tiredness, 4. Moderately tired, 5. Somewhat tired, 6. A little tired, 7. Not tired at all. Baseline answer is 5. Somewhat tired; 1 month answer is 3. Quite a bit of tiredness.

Question 14.1

Presuming these are the only symptoms measured on the questionnaire, would you conclude that the patient's clinical status, from a symptomatic standpoint, is
Selection AImproved?
Selection B Worse?
Selection C Unchanged?
Selection D Uncertain?


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