Page 114 - JCBP-3-3

Journal of Clinical and
Basic Psychosomatics Psychogenic fever and palpitations in autonomic dysfunction

(ii) Generalized Anxiety Disorder-7 (GAD-7): A validated 1000 ms ), and the low frequency/high-frequency ratio
2
self-report measure for anxiety used in primary care, was 1.324 (normal range: 0.50 – 2.00). These results suggest
scored from 0 (not at all) to 3 (nearly every day), with that the patient’s sympathetic and parasympathetic nerve
a total possible score of 0 to 21. The Cronbach’s alpha activities were balanced. The 5-min heart rate variability
for internal consistency reliability in the Chinese examination exhibited a heart rate variance of <2 (normal:
population ranged from 0.84 to 0.93. 13-17 >2) and a heartbeat interval variance was 0.009 s (normal:
(iii) Patient Health Questionnaire-9 (PHQ-9): A widely >0.02 s), indicating that the patient’s heart rate adjustment
used depression screening tool, scored similarly to function was slightly impaired.
the GAD-7, with a total score range of 0 to 27. The After a comprehensive evaluation, we ruled out
Cronbach’s alpha for internal consistency reliability of infective endocarditis, other infectious diseases,
the Chinese version of the PHQ-9 was 0.86. 18,19
(iv) Fatigue Scale-14 (FS-14): A standardized questionnaire autoimmune disorders, viral infections, thyroidopathies,
and hematological disorders. Our provisional diagnosis
assessing both physical and mental fatigue across 14 encompassed autonomic nervous system (ANS)
items. The total score range is 0 to 14, with higher dysfunction, somatic symptom disorder, and anxiety.
scores indicating a greater level of chronic fatigue. 20,21 Deanxit, a combination of melitracen and flupentixol
Cronbach’s alpha for internal consistency reliability of
the FS-14 in the Chinese community was 0.863. 22 (0.5 mg flupentixol and 10 mg melitracen per tablet), is
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(v) Patient Health Questionnaire-15 (PHQ-15): This an antidepressant commonly used to treat depression.
tool assesses the presence and severity of somatic Its efficacy in alleviating anxiety and somatic symptoms,
such as dizziness, has been well-established.
Given
30,31
symptoms over the past 4 weeks. The sum score ranges the patient’s questionnaire results indicating comorbid
from 0 to 30, with higher scores indicating a higher mental symptoms, Deanxit was empirically prescribed at
self-rated symptom burden. Cronbach’s alpha for the
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internal consistency reliability of the Chinese version a dosage of one tablet daily. The patient was also advised
of the PHQ-15 was 0.83. 24 to perform deep abdominal breathing exercises, engage in
(vi) Perceived Stress Scale-10 (PSS-10): This scale evaluates brisk walking for 40 min daily, and do stretching exercises
self-reported stress levels over the previous month, during the subsequent clinic visit (March 4, 2024).
with scores ranging from 0 (never) to 5 (very often), Furthermore, his diet was modified to consist of one-third
and a total possible score range of 0 – 40. Higher scores entree, one-third lean meat, and one-third vegetables, with
indicate higher levels of stress Cronbach’s alpha for 80% fullness per meal. Blood pressure was to be monitored
25
internal consistency reliability of the Chinese version regularly.
of PSS-10 was 0.754. 26 After a month of therapy, the patient’s temperature had
(vii) Pittsburgh Sleep Quality Index (PSQI): A self- decreased, with a maximum of about 37.2℃. Blood pressure
report measure assessing sleep quality over the past measured at home was approximately 130/80 mmHg. On
month. Component scores range from 0 to 3, and the his third visit to the clinic (April 1, 2024), his blood pressure
total score ranges from 0 to 21, with higher scores was 138/93 mmHg, and his heart rate was 65 beats/min.
indicating poorer sleep quality. Cronbach’s alpha for Subsequently, Deanxit was adjusted to half a tablet per day,
27
internal consistency reliability of the Chinese version while the rest of the treatments remained unchanged. After
of the PSQI was 0.78. 28 1 month of continued treatment, the patient’s temperature

Questionnaire assessments of the patient’s fluctuated between 37.0 and 37.2℃, and his sleep had
characteristics revealed the following: the patient described improved. A follow-up phone call revealed a PSQI score of
himself as quiet and introverted. Moreover, his PHQ-9 18 (May 22, 2024), up from 13 (February 21, 2024). Based
score was 6 (indicating mild depression, with a range of on these improvements, we revised our final diagnosis
5 – 9), GAD-7 score was 13 (indicating moderate anxiety, to include autonomic nervous dysfunction, PF, somatic
with a range of 10 – 14), PHQ-15 score was 12 (indicating symptom disorder, anxious state, and post-VSD closure.
moderate somatic symptom disorder, with a range of 10 3. Discussion
– 14) (Appendix 1), FS-14 score was 8 (indicating fatigue,
with ≥3 indicating fatigue), PSQI score was 13 (indicating This case report describes a middle-aged male who
average sleep, with a range of 11 – 15), and PSS-10 score presented with recurrent fever, palpitations, and fatigue,
was 19. The patient’s autonomic response test report ultimately leading to a diagnosis of PF after a year of
(February 21, 2024) showed that the low-frequency intermittent medical consultations. Unlike symptoms
power was 362 ms (normal range: 200 – 1,000 ms ), the where symptoms can be fully explained by deviations in
2
2
high-frequency power was 273 ms (normal range: 200 – measurable biological variables, this case identified three
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Volume 3 Issue 3 (2025) 108 doi: 10.36922/jcbp.4864