Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Psychogenic fever M. Khalid Hasan & A. C. White To cite this article: M. Khalid Hasan & A. C. White (1979) Psychogenic fever, Postgraduate Medicine, 66:2, 152-154, DOI: 10.1080/00325481.1979.11715228 To link to this article: http://dx.doi.org/10.1080/00325481.1979.11715228
Published online: 07 Jul 2016.
Submit your article to this journal
View related articles
Citing articles: 17 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Australian Catholic University]
Date: 13 August 2017, At: 18:27
Psychogenic fever Entity or nonentity?
M. Khalid Hasan, MD, FRCP(C) A. C. White, MRC Psych, DPM(London)
Downloaded by [Australian Catholic University] at 18:27 13 August 2017
Consider What is meant by "psychogenic fever"?
The literature bas long suggested that body temperature rises under emotional stress, and "psychogenic fever" bas been recorded prior to some types of stressful situations. The rise in temperature is attributed to apprehension. We studied temperature in a psychiatrie population in a university hospital to discover the actual incidence of psychogenic fever.
Is psychogenic fever a new concept? /s occurrence of psychogenic fever substantiated by the study reported?
ln 1958 White and Long 1 reported that 3.6% of ali patients newly admitted to a university hospital had fever without discernible organic cause. Among patients admitted for the first time to the psychiatrie service, the incidence was 14.1 %, four times greater than that observed in patients admitted to medicine, surgery, pediatrie, or obstetric services. They commented that the difference might have been influenced by a factor of selection and concluded that defervescence after a day or two in the hospital, without apparent organic cause or administration of a drug, should suggest that the patient had psychogenic fever and an underlying emotional problem.
The concept of "emotional pyrexia" goes back as far as Aristotle,2 who wrote "passions produce heat." ln 1554 Lange3 wrote on "love fever," "white fever," or "morbus virgineus." Davy4 in 1839 found that "brain work raised the body temperature as measured by thermometer," and added that "taking 98° F as the standard, lunatics had a higher leve!." Wunderlich5 in 1871 noted that in the vasomotor neuroses-"which are by no means thoroughly understood as yet"-body temperature can be raised. Charcot, and later Dejerine,6 described neurasthenie fever. A review of psychogenie fever was published in 1872 by Tuke. 7
Table. 1. Resulta of statistical analy... of temperatures and pu1ae ratM laken ln momlllg (AM), before ward rounds (WR), and in evening (PM) in peychiMric petlents being eeen by different consultants Consultant t values Temperature
Pulse
AM vs WR WR vs PM AM vs PM AM vs WR WR vs PM AM vs PM 1 2 3 4 5 Ali
1.2809 0.1736 0.1869 1.0198 2.6646t 0.5589
3.8073t 2.5511t 1.0449 0.4730 3.3311t 3.5039t
2.6886* 2.2667* 1.0054 0.3180 0.8440 2.8420t
0.6733 0.0571 3.0880t 1.1877 0.5413 2.5321t
3.8143t 2.8523t 5.5282:j: 1.7186 2.8150t 7.2934:j:
1.1323 2.5679t 2.5697t 0.6065 1.8177 4.3005:j:
*Significant at 5% level. tSignificant at 2% or 1% level. :j:Significant at 0.2% or 0.1% level.
152
VOL66/NO 2/AUGUST 1979/POSTGRAOUATE MEDICINE
Downloaded by [Australian Catholic University] at 18:27 13 August 2017
Beeson8 described a transient rise in body temperature without apparent cause occurring immediately after hospitalization. Alvarez9 described patients with transient elevations in temperature on their first clinic visits. Wynn 10 reported that 67% of 324 men reporting for the draft had a temperature above 99 F, with 15% having a temperature above 100 F. He also noted that the average temperature of 40 nurses reporting for a board examination was 98.9 F. Renbourne 11 found a temperature elevation in schoolboys before a school boxing match and attributed it to apprehension. On the basis of these reports, we decided that if psychogenic fever is related to emotional problems, a psychiatrie population, especially that in a university hospital unit dealing mainly with patients with psychoneuroses, should yield a high incidence of episodes of psychogenic fever.
Method of study The study was undertaken during September and October of 1974. Oral temperatures and pulse rates were taken at 10 AM and 6 PM and also immediately before ward rounds. The period before ward rounds was believed to be the most stressful part of the day for patients because of imminent interaction with consultants, sorne of whom generated more anxiety in patients
than did others. Ali thermometers used to record temperature were checked for accuracy and were left in the mouth for a minimum of five minutes. No food or drink was taken for at !east onehalf hour before recordings were made. Temperatures over 98.6 F were rechecked, and if an abnormal temperature was again recorded, full hematologie and biochemical profiles, ESR, and cultures of midstream urine samples were obtained. Comparisons of temperature and pulse rate in the morning and evening, morning and before ward rounds, and before ward rounds and evening were made by means of a t-test for ali patients grouped according to consultant seeing them and for ali patients as one group. Eighty patients were studied. Results from those with fever of known cause or who did not complete a series of recordings were excluded. The total number of groups of readings, ie, morning, ward rounds, and evening, was 201. Results are shown in table 1.
Discussion The results show a significant difference between morning and evening temperatures for the group as a whole. This is attributable to normal circadian variation, evening temperature usually being higher than morning. No statistically significant change continued
VOL 66/NO 2/AUGUST 1979/POSTGRADUATE MEDICINE
l\1. Khalid Hasan Dr Hasan (pictured) was formerly senior registrar and lecturer in psychiatry. University of Birmingham Medical School. Birmingham. England. and is now chief. division of psychiatry. Beckley Appalachian Regional Hospital, Beckley. West Virginia. and assistant clinical professor. Marshall University School of Medicine. Huntington. West Virginia.
A. C. White Dr White was former! y senior registrar in psychiatry. University of Birmingham Medical School. and is now consultant psychiatrist. Queen Elizabeth Medical Center. University of Birmingham.
153
Downloaded by [Australian Catholic University] at 18:27 13 August 2017
No differences other than circadien varia· lions were sean in temperatures laken in the morning, just betore ward rounds, and in the evening.
of temperature from 98.6 F, the value taken as normal, was seen in moming, ward rounds, or evening recordings ofindividuals or groups. In one consultant's group (consultant no. 5), moming temperatures were significantly lower than those obtained before ward rounds. The explanation was not clear. Pulse rates before ward rounds varied from the moming rates in the expected direction, ie, a significantly higher rate was noted in patients of physicians considered to provoke more anxiety than others. In spi te of an increase in anxiety as measured by pulse rate, temperatures in moming and before ward rounds did not differ significantly. One patient bad a considera bi y raised oral temperature for which no physical cause could be found. Rec-
A review of the literature suggests that body temperature may rise when a person is onder emotional stress. The term "psychogenic fever" has been applied to this phenomenon. A study of temperature and pulse rate of psychiatrie patients diagnosed predominantly as neurotic in a uni-
Address reprint requests to M. Khalid Hasan, MD, Division of Psychiatry, Beckley Appalachian Regional Hospital, 306 Stanaford Rd, Beckley, WV 25801.
References 1. White KL, Long WN: The incidence of psychogenic fever in a university hospital. J Chronic Dis 5:567-568, 1958 2. Aristotle: Parts of Animais. Peck AL (translator). London, W Heineman Ltd, 1955 3. Lange J: Medicinalium Epistolarum Miscellaneae. Base!, T Oporinus, 1554 4. Davy J: Researches physiological and anatomical. Vol 1. London, Smith and Eider, 1839, p 203
S. Wunderlich CA: On the Temperatures in Diseases. Ed 2. London, New Sydenham Society, 1871 6. Dejerine JM: Semiologie des Affections du Systeme Nerveux. Paris, Masson & Cie, 1914 7. Tuke DH: Illustration of the Influence of the Mind Upon the Body in Health and Disease. Vol 1. London, JA Churchill, 1872 8. Beeson PB: Fever Clinics 2:1361, 1944 9. Alvarez WC: So-called fever or brucellosis
in nervous persons. Gastroenterology 5:320, 1945 IO. Wynn FB: The psychic factors as an element in temperature disturbance shown by sorne observations in the selective draft. JAMA 73:31, 1919 II. Renbourne ET: Body temperature and pulse rate in boys and young men prior to sporting contests: A study of emotional hyperthermia, with a review of the litera ture. J Psychosomat Res 4:149-175, 1960
154
versity teaching hospital was undertaken. Cbanges in pulse rate indicated that the period before ward rounds was more stressful tban otber times of the day. However, psychogenie fever in these patients was not found. One case of factitious fever was uncovered during the study.
tai temperatures obtained a few da ys la ter were normal, and oral readings then were found to be normal also. It eventually transpired that this patient hoped to lengthen ber stay in the hospital by simulatinga fever. This she did by substituting a thermometer she bad prewarmed for the "test" one during the recording sessions. Hers was a case of factitious fever. Summary
The au thors wish to thank consultants and nursing staff of the psychiatry units of the Queen Elizabeth Medical Center, Birmingham, England, and the Midland Nerve Hospital (teaching hospital of the University of Birmingham Medical School) for their help and cooperation; Prof W. H. Trethowan for advice and editing; and Mrs A. K. Marlow, West Midlands Regional Health Authority, for statistical analysis.
VOL 66/NO 2/AUGUST 1979/POSTGRADUATE MEDICINE
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Psychogenic fever M. Khalid Hasan & A. C. White To cite this article: M. Khalid Hasan & A. C. White (1979) Psychogenic fever, Postgraduate Medicine, 66:2, 152-154, DOI: 10.1080/00325481.1979.11715228 To link to this article: http://dx.doi.org/10.1080/00325481.1979.11715228
Published online: 07 Jul 2016.
Submit your article to this journal
View related articles
Citing articles: 17 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Australian Catholic University]
Date: 13 August 2017, At: 18:27
Psychogenic fever Entity or nonentity?
M. Khalid Hasan, MD, FRCP(C) A. C. White, MRC Psych, DPM(London)
Downloaded by [Australian Catholic University] at 18:27 13 August 2017
Consider What is meant by "psychogenic fever"?
The literature bas long suggested that body temperature rises under emotional stress, and "psychogenic fever" bas been recorded prior to some types of stressful situations. The rise in temperature is attributed to apprehension. We studied temperature in a psychiatrie population in a university hospital to discover the actual incidence of psychogenic fever.
Is psychogenic fever a new concept? /s occurrence of psychogenic fever substantiated by the study reported?
ln 1958 White and Long 1 reported that 3.6% of ali patients newly admitted to a university hospital had fever without discernible organic cause. Among patients admitted for the first time to the psychiatrie service, the incidence was 14.1 %, four times greater than that observed in patients admitted to medicine, surgery, pediatrie, or obstetric services. They commented that the difference might have been influenced by a factor of selection and concluded that defervescence after a day or two in the hospital, without apparent organic cause or administration of a drug, should suggest that the patient had psychogenic fever and an underlying emotional problem.
The concept of "emotional pyrexia" goes back as far as Aristotle,2 who wrote "passions produce heat." ln 1554 Lange3 wrote on "love fever," "white fever," or "morbus virgineus." Davy4 in 1839 found that "brain work raised the body temperature as measured by thermometer," and added that "taking 98° F as the standard, lunatics had a higher leve!." Wunderlich5 in 1871 noted that in the vasomotor neuroses-"which are by no means thoroughly understood as yet"-body temperature can be raised. Charcot, and later Dejerine,6 described neurasthenie fever. A review of psychogenie fever was published in 1872 by Tuke. 7
Table. 1. Resulta of statistical analy... of temperatures and pu1ae ratM laken ln momlllg (AM), before ward rounds (WR), and in evening (PM) in peychiMric petlents being eeen by different consultants Consultant t values Temperature
Pulse
AM vs WR WR vs PM AM vs PM AM vs WR WR vs PM AM vs PM 1 2 3 4 5 Ali
1.2809 0.1736 0.1869 1.0198 2.6646t 0.5589
3.8073t 2.5511t 1.0449 0.4730 3.3311t 3.5039t
2.6886* 2.2667* 1.0054 0.3180 0.8440 2.8420t
0.6733 0.0571 3.0880t 1.1877 0.5413 2.5321t
3.8143t 2.8523t 5.5282:j: 1.7186 2.8150t 7.2934:j:
1.1323 2.5679t 2.5697t 0.6065 1.8177 4.3005:j:
*Significant at 5% level. tSignificant at 2% or 1% level. :j:Significant at 0.2% or 0.1% level.
152
VOL66/NO 2/AUGUST 1979/POSTGRAOUATE MEDICINE
Downloaded by [Australian Catholic University] at 18:27 13 August 2017
Beeson8 described a transient rise in body temperature without apparent cause occurring immediately after hospitalization. Alvarez9 described patients with transient elevations in temperature on their first clinic visits. Wynn 10 reported that 67% of 324 men reporting for the draft had a temperature above 99 F, with 15% having a temperature above 100 F. He also noted that the average temperature of 40 nurses reporting for a board examination was 98.9 F. Renbourne 11 found a temperature elevation in schoolboys before a school boxing match and attributed it to apprehension. On the basis of these reports, we decided that if psychogenic fever is related to emotional problems, a psychiatrie population, especially that in a university hospital unit dealing mainly with patients with psychoneuroses, should yield a high incidence of episodes of psychogenic fever.
Method of study The study was undertaken during September and October of 1974. Oral temperatures and pulse rates were taken at 10 AM and 6 PM and also immediately before ward rounds. The period before ward rounds was believed to be the most stressful part of the day for patients because of imminent interaction with consultants, sorne of whom generated more anxiety in patients
than did others. Ali thermometers used to record temperature were checked for accuracy and were left in the mouth for a minimum of five minutes. No food or drink was taken for at !east onehalf hour before recordings were made. Temperatures over 98.6 F were rechecked, and if an abnormal temperature was again recorded, full hematologie and biochemical profiles, ESR, and cultures of midstream urine samples were obtained. Comparisons of temperature and pulse rate in the morning and evening, morning and before ward rounds, and before ward rounds and evening were made by means of a t-test for ali patients grouped according to consultant seeing them and for ali patients as one group. Eighty patients were studied. Results from those with fever of known cause or who did not complete a series of recordings were excluded. The total number of groups of readings, ie, morning, ward rounds, and evening, was 201. Results are shown in table 1.
Discussion The results show a significant difference between morning and evening temperatures for the group as a whole. This is attributable to normal circadian variation, evening temperature usually being higher than morning. No statistically significant change continued
VOL 66/NO 2/AUGUST 1979/POSTGRADUATE MEDICINE
l\1. Khalid Hasan Dr Hasan (pictured) was formerly senior registrar and lecturer in psychiatry. University of Birmingham Medical School. Birmingham. England. and is now chief. division of psychiatry. Beckley Appalachian Regional Hospital, Beckley. West Virginia. and assistant clinical professor. Marshall University School of Medicine. Huntington. West Virginia.
A. C. White Dr White was former! y senior registrar in psychiatry. University of Birmingham Medical School. and is now consultant psychiatrist. Queen Elizabeth Medical Center. University of Birmingham.
153
Downloaded by [Australian Catholic University] at 18:27 13 August 2017
No differences other than circadien varia· lions were sean in temperatures laken in the morning, just betore ward rounds, and in the evening.
of temperature from 98.6 F, the value taken as normal, was seen in moming, ward rounds, or evening recordings ofindividuals or groups. In one consultant's group (consultant no. 5), moming temperatures were significantly lower than those obtained before ward rounds. The explanation was not clear. Pulse rates before ward rounds varied from the moming rates in the expected direction, ie, a significantly higher rate was noted in patients of physicians considered to provoke more anxiety than others. In spi te of an increase in anxiety as measured by pulse rate, temperatures in moming and before ward rounds did not differ significantly. One patient bad a considera bi y raised oral temperature for which no physical cause could be found. Rec-
A review of the literature suggests that body temperature may rise when a person is onder emotional stress. The term "psychogenic fever" has been applied to this phenomenon. A study of temperature and pulse rate of psychiatrie patients diagnosed predominantly as neurotic in a uni-
Address reprint requests to M. Khalid Hasan, MD, Division of Psychiatry, Beckley Appalachian Regional Hospital, 306 Stanaford Rd, Beckley, WV 25801.
References 1. White KL, Long WN: The incidence of psychogenic fever in a university hospital. J Chronic Dis 5:567-568, 1958 2. Aristotle: Parts of Animais. Peck AL (translator). London, W Heineman Ltd, 1955 3. Lange J: Medicinalium Epistolarum Miscellaneae. Base!, T Oporinus, 1554 4. Davy J: Researches physiological and anatomical. Vol 1. London, Smith and Eider, 1839, p 203
S. Wunderlich CA: On the Temperatures in Diseases. Ed 2. London, New Sydenham Society, 1871 6. Dejerine JM: Semiologie des Affections du Systeme Nerveux. Paris, Masson & Cie, 1914 7. Tuke DH: Illustration of the Influence of the Mind Upon the Body in Health and Disease. Vol 1. London, JA Churchill, 1872 8. Beeson PB: Fever Clinics 2:1361, 1944 9. Alvarez WC: So-called fever or brucellosis
in nervous persons. Gastroenterology 5:320, 1945 IO. Wynn FB: The psychic factors as an element in temperature disturbance shown by sorne observations in the selective draft. JAMA 73:31, 1919 II. Renbourne ET: Body temperature and pulse rate in boys and young men prior to sporting contests: A study of emotional hyperthermia, with a review of the litera ture. J Psychosomat Res 4:149-175, 1960
154
versity teaching hospital was undertaken. Cbanges in pulse rate indicated that the period before ward rounds was more stressful tban otber times of the day. However, psychogenie fever in these patients was not found. One case of factitious fever was uncovered during the study.
tai temperatures obtained a few da ys la ter were normal, and oral readings then were found to be normal also. It eventually transpired that this patient hoped to lengthen ber stay in the hospital by simulatinga fever. This she did by substituting a thermometer she bad prewarmed for the "test" one during the recording sessions. Hers was a case of factitious fever. Summary
The au thors wish to thank consultants and nursing staff of the psychiatry units of the Queen Elizabeth Medical Center, Birmingham, England, and the Midland Nerve Hospital (teaching hospital of the University of Birmingham Medical School) for their help and cooperation; Prof W. H. Trethowan for advice and editing; and Mrs A. K. Marlow, West Midlands Regional Health Authority, for statistical analysis.
VOL 66/NO 2/AUGUST 1979/POSTGRADUATE MEDICINE
