Note: This letter appeared in the Journal of the Royal Society of Medicine, Volume 83, July 1990.
We read with interest the paper by Bowman (December 1989 JRSM, p 712) which suggests that the positive monospot test may only be present within the first four weeks of the illness. They also questioned the specificity of V P-I antigen, a view recently supported by Lynch and Seth. (1)
We are, however, interested in their comment that the General Health Questionnaire (GHQ) is having a limited usefulness in the context, of postviral syndrome. They have used an older version of the GHQ which includes 60 questions. There is a 30 item GHQ which was derived from the GHQ-60 by excluding symptoms that were commonly present in subjects with entirely physical illness thus the GHQ-30 could be regarded as a measure of more purely psychological or psychosocial symptoms (2). Another difficulty with postviral syndrome patients is that by definition they suffer from chronic symptoms. By using the GHQ as a screening instrument, it is likely that there will be a number of cases that will not be detected by GHQ (false negatives). It has been suggested that false negatives largely result from the relative insensitivity of the GHQ for chronic disorders (3,4). To overcome this problem Goodchild and Duncan-Jones have proposed a new scoring procedure (C-GHQ) to eliminate the insensitivity of the GHQ for chronic complaints (5).
Further investigation on this showed that the new scoring method was better with regard to both the GHQ at the measure of severity and GHQ with the screening instrument (6,7). We therefore suggest that in future investigation of the psychological well being of patients with postviral syndrome the shorter version of the GHQ with the revised scoring methods is to be used.
~B T FARID Consultant Psychiatrist
~A CHANDRA Registrar in Psychiatry New Cross Hospital Wolverhampton WV10 0QP
References
1 Lynch S, Seth R. Postviral fatigue syndrome and the V P-I antigen. Lancet 1989;ii.1160-1
2 Huppert FA, et al. The factor structure of the General Health Questionnaire (GHQ-30). Br J Psychiatry 1989; 155:178-85
3 BenJamin S, elm P, Haran D. Community screening for mental illness: A validity study of the General Health Questionnaire. Br J Psychiatry 1982;140:174-80
4 Finlay-Jones RA, Murphy E. Severity of psychiatric disorder and the 30-item GHQ. Br J Psychiatry 1979; 134:609-16
5 Goodchild ME, Duncan-Jones P. Chronicity and the General Health Questionnaire. Br J Psychiatry 1985; 146:55-62
6 Koetar MWJ, Van Den Brink W, Ormel J. Chronic psychiatric complaints and the General Health Questionnaire. Br J Psychiary 1989;155:186-90.
7 Surtees PG. Psychiatric disorder in the community and the General Health Questionnaire. Br J Psychiatry 1987;150:828-35
Source: B T Farid and A Chandra. Postviral syndrome. J R Soc Med. 1990 Jul; 83(7): 476. PMCID: PMC1292747 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292747/