The article by McDonald et al1 in the January issue of the Archives purports to confirm the authors' hypothesis that "psychological distress is associated with greater mortality" among a group of North American patients with amyotrophic lateral sclerosis (ALS). As the authors indicate, the proposition that psychological factors may influence the course of a variety of medical conditions of poor prognosis (eg, widely metastatic cancer) is rather controversial, with various studies reaching affirmative and negative conclusions. However, study of this theory for ALS is particularly problematic. In part, this arises from varying rates of disease progression (and, indeed, the authors' "psychologically well" group with 6 to 10 years average duration of illness by the end of the study may have more indolent disease, for which they attempted to partially control). However, a major difficulty is the use of survival as a criterion for disease progression.
Duration of survival in
Honig LS. Survival in Amyotrophic Lateral Sclerosis. Arch Neurol. 1995;52(2):126. doi:10.1001/archneur.1995.00540260028008
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