Brain Behav Immun 1999 Jun;13(2):155-74

Differential immune system changes with acute and persistent stress for optimists vs pessimists.

Cohen F, Kearney KA, Zegans LS, Kemeny ME, Neuhaus JM, Stites DP

Department of Psychiatry, University of California, San Francisco, USA.

This study investigated whether acute and persistent stressors and life change events were followed by changes in immune status, and whether dispositional optimism moderated these relationships. Thirty-nine healthy women ages 18-45 were followed prospectively for 3 months, with weekly assessment of acute and persistent stressors and monthly assessment of life events and immune parameters (NK cell cytotoxicity, and CD4 and CD8 T cell subsets). The study used an autoregressive linear model to examine how weekly appraised acute and persistent stress levels were associated with immune parameters in the subsequent week. Analyses revealed that the immune outcomes were differentially affected by acute and persistent stressors. Further, the association between acute stress and subsequent immune parameters was buffered by an optimistic perspective. However, when stress persisted at high levels, optimists showed more subsequent immune decrements than pessimists. Copyright 1999 Academic Press. Publication Types:

* Clinical trial

PMID: 10373279, UI: 99303529

Arch Gen Psychiatry 1999 May;56(5):450-6

Stress-related changes in proinflammatory cytokine production in wounds.

Glaser R, Kiecolt-Glaser JK, Marucha PT, MacCallum RC, Laskowski BF, Malarkey WB

Department of Medical Microbiology, The Institute for Behavioral Medicine Research, The Ohio State University, Columbus 43210, USA.

BACKGROUND: Several recent studies have shown that stress markedly delays wound healing. This study assessed the relationship between psychological stress and the secretion of proinflammatory cytokines at an actual wound site, providing in vivo data on the development of local immune responses that are central in the early stages of wound repair. METHODS: To study the dynamics of inflammation, skin blisters were induced on the forearm of 36 women (mean age, 57 years) by suction. After the blister roofs were removed, a plastic template was taped to the arm, and wells were filled with 70% autologous serum in buffer. Specimens were aspirated from blister chamber wells 5 and 24 hours after wounding. RESULTS: Women with higher perceived stress scores demonstrated significantly lower levels of 2 key cytokines--interleukin 1alpha and interleukin 8--at wound sites. In addition, subjects who had low levels of both cytokines after 24 hours reported more stress and negative affect, and they had higher levels of salivary cortisol than those who had high cytokine levels. CONCLUSION: Consistent with the evidence that stress delays wound healing, these data suggest a possible mechanism: psychological stress has measurable effects on proinflammatory cytokine production in the local wound environment.

PMID: 10232300, UI: 99247260

Lancet 1999 Feb 20;353(9153):627-31

Chronic stress in elderly carers of dementia patients and antibody response to influenza vaccination.

Vedhara K, Cox NK, Wilcock GK, Perks P, Hunt M, Anderson S, Lightman SL, Shanks NM

Department of Medicine, University of Bristol, UK.

BACKGROUND: There are many reports of psychological morbidity in spousal carers of patients with dementia. The consequences of this increased stress on the immune system are unclear. We investigated whether antibody responses to influenza vaccination differed between carers and a control group, and the relation of the antibody response to the hypothalamic-pituitary-adrenal (HPA) axis. METHODS: 50 spousal carers of dementia patients, median age 73 years (IQR 66-77), and 67 controls (68 years [66-71]) of similar socioeconomic status were enrolled. Anxiety and depression were measured by the Savage Aged Personality Screening Scale and stress by the Global Measure of Perceived Stress scale. Principal-component analysis was used to yield a summary score of emotional distress from these two scales. Salivary cortisol concentrations were measured over a single day at three times (0800-1000, 1100-1300, and 2000-2200). Participants received a trivalent influenza vaccine and IgG antibody titres to each strain were measured on days 0, 7, 14, and 28. FINDINGS: Mean scores of emotional distress were significantly higher in carers at each time point than in controls (all p < 0.0003). Mean (SD) salivary cortisol concentrations, calculated as area under the curve (AUC), were higher in carers than controls at all three assessments (6 months 16.0 [8.0] vs 11.2 [4.4], p=0.0001; respectively). Eight (16%) of 50 carers and 26 (39%) of 67 controls had a four-fold increase in at least one of the IgG titres (p=0.007). There was an inverse relation between AUC cortisol and IgG antibody titre to the Nanchang strain that was significant on day 14 (r=-0.216, p=0.039). INTERPRETATION: Elderly carers of spouses with dementia have increased activation of the hypothalamic-pituitary-adrenal axis and a poor antibody response to influenza vaccine. Carers may be more vulnerable to infectious disease than the population of a similar age. Comments: * Comment in: Lancet 1999 Jun 5;353(9168):1969-70

PMID: 10030328, UI: 99153399

Neuropsychobiology 1998;38(2):90-6

Lymphocyte response to mitogens: influence of life events and personality.

Gonzalez-Quijano MI, Martin M, Millan S, Lopez-Calderon A

Dpt. Enfermeria, Universidad Complutense, Madrid, Spain.

The aim of the present study was to examine the possibility that the accumulation of life events is associated with low lymphoproliferative response to mitogens in undergraduate students. We also analyzed the possible interaction between life events and personality traits. Lymphocyte response to phytohemagglutinin (PHA) was lower in subjects with high life events compared to those with low levels. Introverted subjects were found to exhibit lower lymphocyte responses to PHA than those who were extraverted, and there was no interaction between the effect of introversion and life events on the proliferative capacity. Lymphocyte proliferation was low in subjects with high anxiety scores, whether they had high or low levels of life events. In the group with high scores on independence a high accumulation of life events was not associated with lower lymphoproliferation; while in the group with low scores it was, suggesting that independence buffers the association between life stress and lower cellular immunity.

PMID: 9732209, UI: 98402567

J Clin Periodontol 1998 Jun;25(6):482-91

Therapy-resistant periodontitis. Psychosocial characteristics.

Axtelius B, Soderfeldt B, Nilsson A, Edwardsson S, Attstrom R

Department of Periodontology, Lund University, Sweden.

This study investigated the perspective of a stress system disorder in the pathogenesis of therapy-resistant periodontitis. The goal was to find indications that the stress-behaviour-immune system model holds as an explanatory model for the understanding of periodontal disease. 2 patient-groups were compared: one group classified as responding well to periodontal treatment (responsive-group, R-group, n=11); the other group was classified as responding less well to treatment (non-responsive-group, NR-group, n=11). Somatic and psychological factors were described as obtained by interviews and psychological testings. These findings were related to clinical data documented during the treatment of the patients. An exact logistic multivariate regression analysis was performed on a model based on variables selected by bivariate analysis (variable versus group). The results indicated that the NR-group patients displayed indications of more psychosocial strain and a more passive-dependent personality. The R-group patients displayed a more rigid personality and possibly a less stressful psychosocial situation in the past. The report highlights the possible contribution of stress factors in the context of therapy resistant periodontal disease, and the results seem to be understandable within the context of a stress system disorder perspective.

PMID: 9667482, UI: 98330056

Health Psychol 1998 May;17(3):214-23

Types of stressors that increase susceptibility to the common cold in healthy adults.

Cohen S, Frank E, Doyle WJ, Skoner DP, Rabin BS, Gwaltney JM Jr

Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA.

Two-hundred seventy-six volunteers completed a life stressor interview and psychological questionnaires and provided blood and urine samples. They were then inoculated with common cold viruses and monitored for the onset of disease. Although severe acute stressful life events (less than 1 month long) were not associated with developing colds, severe chronic stressors (1 month or longer) were associated with a substantial increase in risk of disease. This relation was attributable primarily to under- or unemployment and to enduring interpersonal difficulties with family or friends. The association between chronic stressors and susceptibility to colds could not be fully explained by differences among stressed and nonstressed persons in social network characteristics, personality, health practices, or prechallenge endocrine or immune measures. Comments: * Comment in: Health Psychol 1998 May;17(3):211-3

PMID: 9619470, UI: 98280769

Health Psychol 1998 May;17(3):211-3

It's long-term stressors that take a toll: comment on Cohen et al. (1998).

Leventhal H, Patrick-Miller L, Leventhal EA

Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick 08901-1293, USA.

In an extremely well-controlled study, Cohen et al. (1998) add to prior knowledge of stress-illness relationships by showing that self-reports of stress occurrence and duration of 1 month or more, rather than estimates of stressor severity, predict susceptibility to experimentally induced colds (i.e., viral replication and cold symptoms). Although ruling out obvious behavioral and personality factors as causes of the association of stressors to colds, they were unable to identify mediational immune factors, a deficit attributable to the difficulty of assessing the multi-layered, dynamic physiological processes within the bidirectional connections of the nervous (stress) and immune systems. The findings provide an interesting complement to data, showing that people use stressor duration in evaluating the illness implications of somatic symptoms (Cameron et al., 1995), and suggest caution with regard to overestimating the prevalence of stress-induced colds in natural settings. Publication Types: * Comment Comments: * Comment on: Health Psychol 1998 May;17(3):214-23

PMID: 9619469, UI: 98280768

Ann Behav Med 1997 Spring;19(2):83-90

Alzheimer caregiver stress: basal natural killer cell activity, pituitary-adrenal cortical function, and sympathetic tone.

Irwin M, Hauger R, Patterson TL, Semple S, Ziegler M, Grant I

University of California, San Diego, USA.

The association between Alzheimer caregiving and natural killer (NK) cell activity and basal plasma levels of adrenocorticotropic hormone (ACTH), cortisol, beta-endorphin, prolactin, epinephrine, norepinephrine, and neuropeptide Y was determined in 100 spousal Alzheimer caregivers and 33 age- and gender-comparable control volunteers upon intake into a study of the psychological and physiologic impact of caregiving. The relationship between these physiologic measures and individual characteristics such as age, gender, medical status, severity of stress, severity of depressive symptoms, and caregiver burden was tested. In addition, the association between NK activity and alterations of the neuroendocrine measures was investigated. As compared to controls, the Alzheimer caregivers had similar levels of NK activity and of basal plasma neuroendocrine hormones and sympathetic measures. While older age and male gender status were associated with increased levels of ACTH, neither medical caseness, severity of life stress, nor severity of depressive symptoms was associated with alterations in any of the multiple physiologic domains. Classification of Alzheimer caregiver burden identified caregivers who were mismatched in terms of the amount of care they were required to provide and the amount of respite time received. The mismatched caregivers had significantly higher basal plasma ACTH but no change in other physiological measures, as compared to non-mismatched caregivers. NK activity was negatively correlated with plasma levels of neuropeptide Y but not with any of the other neuroendocrine measures. Based on this cross-sectional evaluation of NK activity and neuroendocrine and sympathetic measures, we conclude that most Alzheimer caregivers do not show evidence of altered basal physiology.

PMID: 9603682, UI: 98262343

J Mass Dent Soc 1995 Winter;44(1):12-5, 36-7

Is there a myofascial, temporomandibular disorder personality?

Marbach JJ

Columbia University School of Public Health, Division of Sociomedical Sciences, USA.

It is widely accepted that abnormal personality factors play an important role in the etiology and maintenance of myofascial-type temporomandibular disorder, or M/TMD. However, the foundation on which this belief rests is based largely on clinical lore, rather than on any evidence. The continued belief in the stress theory has important implications. Clinicians continue to be trained in unproven but traditionally sanctioned treatments. Such approaches not only may lead to problems of patient care, they may forge an unstable foundation for future research. Two theories are examined in this article: the psychosomatic and psychophysiological models. The findings show that both theories lack evidence, and further research is warranted because definitive studies are unavailable. The data from this study do not support the contention that M/TMD cases are characterized by a specific premorbid personality.

PMID: 9520687, UI: 98181304

Psychosom Med 1998 Jan-Feb;60(1):48-51

Sleep as a mediator of the stress-immune relationship.

Hall M, Baum A, Buysse DJ, Prigerson HG, Kupfer DJ, Reynolds CF 3rd

Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.

OBJECTIVE: To evaluate the role of sleep in the relationship of intrusive thoughts/avoidance behaviors to natural killer cell (NKC) number and function. METHOD: Twenty-nine individuals seeking treatment for bereavement-related depression were studied in the sleep laboratory. Background and clinical variables, including the Impact of Event Scale (IES) and the Hamilton Rating Scale for Depression (HRSD), were administered during the week preceding a 3-night sleep study. Blood samples were collected upon awakening after the second or third night of sleep. RESULTS: Greater frequency of intrusive thoughts and avoidance behaviors was associated with more time spent awake during the first non-rapid eye movement period (NREM-1) and lower NKC number (p values < .01). Greater time spent awake during NREM-1 was associated with lower NKC numbers (p < .05). Regression analyses revealed that the significant relationship between symptoms of intrusion/avoidance and NKC number was no longer significant when time spent awake during NREM-1 was entered into the regression equation. Time spent awake during NREM-1 accounted for 12% of the variance in NKC number (p < .05), whereas intrusion/avoidance accounted for 7% of the variance in NKC number (NS). CONCLUSIONS: These results suggest that EEG-assessed sleep may be a significant correlate of the stress-immune relationship. Publication Types: * Clinical trial * Randomized controlled trial

PMID: 9492239, UI: 98151203

Crit Rev Oral Biol Med 1997;8(4):461-74

Psychosocial factors and secretory immunoglobulin A.

Valdimarsdottir HB, Stone AA

Department of Psychiatry, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.

This review focuses on studies that have examined the relation between psychosocial factors and secretory immunoglobulin A (s-IgA). Several studies have examined the relation between s-IgA and stressful circumstances ranging from major life events to minor daily events. The findings from these studies were often contradictory, since different experimenters reported different stress-related changes in s-IgA. The effects of stress reduction interventions, such as relaxation and imagery, on s-IgA levels have also been examined. Although these studies indicate that various interventions are associated with increases in s-IgA levels, methodological refinements are needed before more definitive conclusions can be made. The possibility that the relation between stress and s-IgA may be moderated by personality characteristics or mediated by psychological distress was supported in some studies. The review concludes with suggestions for future research. Publication Types: * Review * Review, tutorial

PMID: 9391755, UI: 98053243

Psychoneuroendocrinology 1997 Aug;22(6):423-41

Psychological and physiological responses during an exam and their relation to personality characteristics.

Spangler G

Institute of Psychology, University of Regensburg, Federal Republic of Germany.

The aim of the study was to compare emotional and physiological responses to real and control examinations and to assess their relation to personality characteristics. Emotional responses were assessed by state anxiety and perceived stress. The assessment of physiological responses included the activity of the cardiac system (heart periods, vagal tone), the adrenocortical system (cortisol) and the immune system (immune globulin A, sIgA). Emotional and physiological responses of 23 students (12 males, 11 females) were assessed during an oral exam at the end of a basic course in psychology which was a prerequisite for the students' final exams. For the control condition physiological responses were assessed one week before the examination during a memory test. The findings of the study demonstrate different emotional and physiological response patterns to examinations as compared to the control condition. Heightened anxiety was observed only before the exam. Whereas within-situation physiological responses (higher heart periods, cortisol, and sIgA; lower vagal tone) were observed both under the exam and control condition, responses to exam condition indicated pre-exam anticipatory activation and post-exam restricted recovery responses. With regard to personality characteristics subjects with high ego-resiliency showed more flexible adaptation than subjects with low ego-resiliency both on the emotional level (anxiety down-regulation after exam) and on the physiological level (situation-specific responses, quick recovery). Subjects with high ego-control exhibited a lower physiological reactivity under both conditions, i.e. they seemed to maintain longer their control also on a physiological level independent of the type of situation. Publication Types: * Clinical trial

PMID: 9364621, UI: 98031204

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J Psychosom Res 1997 Sep;43(3):271-8

Increased psychosocial stress and decreased mucosal immunity in children with recurrent upper respiratory tract infections.

Drummond PD, Hewson-Bower B

Division of Psychology, Murdoch University, Perth, Australia.

The association between psychosocial stress and susceptibility to upper respiratory tract infection was investigated in 45 children with a history of recurrent colds and flu, and in 45 healthy children of similar age and distribution. In addition, mucosal immune protection against upper respiratory tract infections was assessed by measuring the concentration of secretory immunoglobulin A (sIgA) and its ratio to albumin in saliva. Several dimensions of psychosocial stress, including exposure to stressful experiences, stress-prone personality traits, and signs of emotional disturbance were elevated in children with a history of recurrent colds and flu. Furthermore, lower sIgA/albumin ratios in these children indicated a deficiency in local mucosal immunity. Thus, the findings are consistent with the view that psychosocial stress depletes local immune protection against viral invasion or bacterial colonization of the upper respiratory tract; this depletion may increase susceptibility to colds and flu. Alternatively, psychological disturbances could develop in response to frequent illness.

PMID: 9304553, UI: 97449537

Psychosom Med 1997 Jul-Aug;59(4):447-57

Chronic life stress alters sympathetic, neuroendocrine, and immune responsivity to an acute psychological stressor in humans.

Pike JL, Smith TL, Hauger RL, Nicassio PM, Patterson TL, McClintick J, Costlow C, Irwin MR

Department of Psychiatry-9116-A, Veteran's Affairs Medical Center, San Diego, CA 92161, USA.

OBJECTIVE: Life stress is hypothesized to alter the dynamic regulation of the autonomic, neuroendocrine, and immune systems. This study examined the effects of antecedent chronic life stress on psychological and physiological responsivity after acute challenge with a psychological stressor. METHOD: Using a within-subject mixed design, male volunteers with (N = 12) and without chronic life stress (N = 11) were administered a 12-minute laboratory stressor (mental arithmetic) vs a video control. RESULTS: Acute psychological stress induced subjective distress, increases of circulating concentrations of epinephrine, norepinephrine, beta-endorphin, adrenocorticotropic hormone (ACTH), and cortisol, and a selective redistribution of natural killer (NK) cells into the peripheral blood as compared with the video control condition. Although the two groups were almost identical at baseline in psychological, sympathetic, neuroendocrine, and immune domains, the chronic stress group showed greater subjective distress, higher peak levels of epinephrine, lower peak levels of beta-endorphin and of NK cell lysis, and a more pronounced redistribution of NK cells in response to the acute psychological challenge than the controls. Furthermore, the acute stressor induced a protracted decline in NK lysis per NK cell in the chronic stress group but had no effect in the controls. CONCLUSIONS: In summary, when persons who are undergoing chronic life stress are confronted with an acute psychological challenge, an exaggerated psychologic and peak sympathomedullary reactivity occurs that is associated with decrements in individual NK cell function and is protracted beyond termination of the stressor and sympathomedullary recovery.

PMID: 9251165, UI: 97394879

Psychosom Med 1997 Mar-Apr;59(2):178-86

Life events, frontal electroencephalogram laterality, and functional immune status after acute psychological stressors in adolescents.

Liang SW, Jemerin JM, Tschann JM, Wara DW, Boyce WT

Asian Health Services, Oakland, California 94607, USA.

OBJECTIVE: Past studies have found that environmental stress affects cellular immune function and that extensive variability exists in the magnitude and direction of stress-induced immune changes. Past research also suggests that individuals with greater right, relative to left, resting frontal electroencephalogram (EEG) activation perceive environmental stress as more aversive and have lower baseline cellular immune function. In this study, we examined environmental stressors, resting frontal EEG laterality, and immune responses to short-term psychological stressors in adolescent boys. METHODS: A sample of twenty-four 14-16 year old right-handed boys underwent a recording of resting EEG and collections of blood taken before and after a laboratory protocol designed to induce psychological stress. Blood samples were used to measure changes in mitogen lymphoproliferative responses, natural killer (NK) cell activity, and T-cell phenotypic subsets. Life events were measured using self-report questionnaires. RESULTS: Life events and frontal laterality showed a first order interaction in predicting changes in lymphocyte proliferation to tetanus toxoid (R2 increment = .26, p < .01) and pokeweed mitogen (R2 increment = .25, p < .02). The interaction also predicted changes in NK activity (R2 increment = .24, p < .02). CONCLUSIONS: Changes in lymphocyte proliferation and NK activity were associated with negative life events only among individuals with greater left frontal cortical activation. Our results suggest that recent psychosocial stress and individual differences in resting frontal cortical activation are together linked to immunologic responses to acute psychological stressors.

PMID: 9088055, UI: 97243075

Psychosom Med 1997 Mar-Apr;59(2):128-41

Posttraumatic stress symptoms, intrusive thoughts, loss, and immune function after Hurricane Andrew.

Ironson G, Wynings C, Schneiderman N, Baum A, Rodriguez M, Greenwood D, Benight C, Antoni M, LaPerriere A, Huang HS, Klimas N, Fletcher MA

Department of Psychology, University of Miami, Coral Gables, Florida 33124, USA.

OBJECTIVE: To examine the impact of and relationship between exposure to Hurricane Andrew, a severe stressor, posttraumatic stress symptoms and immune measures. METHODS: Blood draws and questionnaires were taken from community volunteer subjects living in the damaged neighborhoods between 1 and 4 months after the Hurricane. RESULTS: The sample exhibited high levels of posttraumatic stress symptoms by questionnaire (33% overall; 76% with at least one symptom cluster), and 44% scored in the high impact range on the Impact of Events (IES) scale. A substantial proportion of variance in posttraumatic stress symptoms could be accounted for by four hurricane experience variables (damage, loss, life threat, and injury), with perceived loss being the highest correlate. Of the five immune measures studied Natural Killer Cell Cytotoxicity (NKCC) was the only measure that was meaningfully related (negatively) to both damage and psychological variables (loss, intrusive thoughts, and posttraumatic stress disorder (PTSD). White blood cell counts (WBCs) were significantly positively related with the degree of loss and PTSD experienced. Both NKCC (lower) and WBC were significantly related to retrospective self-reported increase of somatic symptoms after the hurricane. Overall, the community sample was significantly lower in NKCC, CD4 and CD8 number, and higher in NK cell number compared to laboratory controls. Finally, evidence was found for new onset of sleep problems as a mediator of the posttraumatic symptom-NKCC relationship. CONCLUSIONS: Several immune measures differed from controls after Hurricane Andrew. Negative (intrusive) thoughts and PTSD were related to lower NKCC. Loss was a key correlate of both posttraumatic symptoms and immune (NKCC, WBC) measures. Comments: * Comment in: Psychosom Med 1997 Mar-Apr;59(2):142-3

PMID: 9088048, UI: 97243068

Psychosom Med 1997 Mar-Apr;59(2):114-27

Shaking up immunity: psychological and immunologic changes after a natural disaster.

Solomon GF, Segerstrom SC, Grohr P, Kemeny M, Fahey J

Department of Psychiatry, University of California, Los Angeles, USA.

OBJECTIVE: The 1994 Northridge earthquake created life disruption and psychological distress for employees of the nearby Sepulveda VA Medical Center. We were interested in the immunologic correlates of disruption and distress under these stressful circumstances. METHOD: Sixty-eight employees were examined beginning 11 days post-earthquake and were observed until about 4 months after the earthquake, during which time three psychological and immunologic assessments were done. Subjects experienced life disruption from the earthquake itself, damage to home and possessions, injury to self and others, and damage to and functional disruption of workplace. Questionnaires assessed degree of life disruption (personal and work-related), mood, earthquake-specific distress, and repression (alexithymia, coping style or "Type C", and "immunosuppression-prone" traits). Immune measures included lymphocyte subsets-total T (CD3+), helper T (CD4+), cytotoxic T (CD3 + CD8+), B (CD19+), and natural killer (NK; CD3 - CD16 + CD56+)-as well as lymphoid cell mitogenesis (PHA and PWM), and NK cell cytotoxicity. RESULTS: Along with a lessening degree of distress over time, a number of immunologic measures declined over the assessment period (CD3+, CD8+, CD16 + 56+ cells. T cell blastogenesis, and NK cell cytotoxicity). Furthermore, subjects reporting low distress had higher numbers of CD3+ and CD8+ cells and a higher proliferative response to PHA. Those with distress corresponding to life disruption had highest levels of CD3+ and CD8+ cells. Measures of repression did not relate directly to immunity. CONCLUSION: These results suggest that appropriateness of psychological reaction to the realistic degree of life stress was least disruptive of an aspect of immunity. Comments: * Comment in: Psychosom Med 1997 Mar-Apr;59(2):142-3

PMID: 9088047, UI: 97243067

Hautarzt 1997 Jan;48(1):5-11

[Psychophysiologic and psychoneuroimmunologic studies in neurodermatitis. Overview and critical evaluation].

[Article in German]

Buhk H, Muthny FA

Institut fur Medizinische Psychologie der Universitat, Munster.

Results of psychophysiological, psychoendocrinological, and psychoneuroimmunological research on the skin in patients with atopic dermatitis were evaluated. 11 investigations were selected and analysed with respect to both design and results. In 6 instances, healthy or ill control groups were included, rarely did the sample size exceed 30. With respect to physiology, blood pressure, heart rate and EDA were most commonly assessed; with respect to immunology, number of leucocytes and differential blood count and with respect to psychology, anxiety, neuroticism and stress perception. The results involving stress induction, itching induction and the relationship of personality and skin parameters were not consistent. The best established relationship is that between skin reactivity (flare, wheal size and pruritus) on the one hand and cognitive appraisal of stress-stimuli and the experimental situation on the other hand. Psychoendocrinological and even more psychoimmunological indicators of the stress of reaction-unlike psychophysiological indicators-were correlated with the skin response. Only half of the studies found an elevated physiological stress reaction in patients with atopic dermatitis. Publication Types: * Review * Review, tutorial

PMID: 9132389, UI: 97205929

Psychother Psychosom 1997;66(1):3-26

Psychological stress, neuroimmunomodulation, and susceptibility to infectious diseases in animals and man: a review.

Biondi M, Zannino LG

III Clinica Psichiatrica, University of Rome, La Sapienza, Italy.

This article reviews research on the role of psychological stress, personality, social support and other psychosocial factors in bacterial, viral and parasitic infections. After 100 years of research on man and animals, psychological stress is considered as a potential cofactor in the pathogenesis of infectious disease. Psychological stress seems able to alter the susceptibility of animals and man to infectious agents, influencing the onset, course and outcome of certain infectious pathologies. Many experiments have identified in neuroimmunomodulation the principal mediator of the alterations associated with conditions of stress. The development of psychoneuroimmunology has fostered in-depth study of the complex relationship between psychosocial factors, the central nervous system, the immune system and infectious disease. Although antimicrobial drugs have certainly remained the basis of all anti-infective therapy, this type of study has already led some authors to propose and experiment protocols of psychological intervention or psychoimmunotherapy in pathologies such as tuberculosis, or herpes simplex virus or human immunodeficiency virus infections. The psychoneuroimmunological approach to infectious diseases will probably grow in importance in the future not only in the setting of research in psychosomatic medicine but also in that of clinical microbiology. Publication Types: * Review * Review literature

PMID: 8996711, UI: 97149917

Exp Aging Res 1996 Oct-Dec;22(4):393-401

Psychoneuroendocrinological indicators of stress and intellectual performance among older adults: an exploratory study.

Kelly KS, Hayslip B Jr, Servaty HL

Department of Psychology, University of North Texas, Denton 76203, USA.

For an exploration of the relationship between task-specific anxiety and intellectual performance, 26 community-dwelling older adults were asked to perform a series of cognitive tasks to assess crystallized (Gc) and fluid (Gf) intellectual abilities. The volunteers then completed questionnaires concerning their beliefs about their task performance specific to each ability, as well as measures of both generalized and intellectual self-efficacy, everyday cognitive failures, and trait and state anxiety. Cortisol levels were assessed as a physiologic indicator of task anxiety, and Epstein-Barr virus (EBV) levels were measured to reflect nonspecific physiological changes. With trait anxiety taken into consideration, significant negative correlations were seen between cortisol levels and performance on all tasks measuring primarily fluid abilities, as well as between cortisol levels and self-efficacy concerning tasks measuring primarily crystallized abilities. EBV levels were not correlated with any of the task-specific measures, except for Letter Sets performance. These preliminary findings confirm that older persons' concerns about their task performance are indeed stressful when measured physiologically, apart from indicators of self-reported stress. PMID: 8968710, UI: 97123463

J Periodontol 1996 Oct;67(10 Suppl):1060-9

Exploratory case-control analysis of psychosocial factors and adult periodontitis.

Moss ME, Beck JD, Kaplan BH, Offenbacher S, Weintraub JA, Koch GG, Genco RJ, Machtei EE, Tedesco LA

Eastman Dental Center, Rochester, NY, USA.

We explored the association between social factors and adult periodontitis by comparing self-reported information for daily strains and symptoms of depression in 71 cases and 77 controls. Cases and controls were selected from among 1,426 participants in the Erie County Risk Factor Study. We found differences among those who scored higher than their peers on measures of social strain. The odds ratio (OR) and 95% confidence interval (95% CI) for the association between case status and Role Strain score of 2.27 or more was 2.84, 95% CI = 1.08 to 7.46. We also examined serum antibody, dichotomized at the median, for three periodontal pathogens (Bacteroides forsythus [IgG Bf], Porphyromonas gingivalis [IgG Pg], Actinobacillus actinomycetemcomitans [IgG Aa]), and assessed interaction between antibody levels and a Depression score derived from the Brief Symptom Inventory. IgG Pg and IgG Aa were both strongly associated with case status (OR = 4.52, 95% CI = 1.99 to 10.3 and OR = 5.29, 95% CI = 2.34 to 12.0, respectively). IgG Bf was associated with periodontal disease but only among individuals who had higher scores for Depression (OR = 6.75, 95% CI = 1.25 to 36.5). Smoking status was associated with case status (OR = 4.95, 95% CI = 1.86 to 13.2). We assessed these findings prospectively by examining factors associated with more extensive disease among the 71 case subjects after 1 year of follow-up. We found baseline smoking status and IgG Bf among individuals scoring high on Depression at baseline to be associated with more extensive disease (8.1% or more of the sites showing further breakdown). In this population an elevated Depression score may be a marker for social isolation, which could play a role in immune function during periods of social strain. This exploratory analysis has served to identify specific lines of inquiry concerning psychosocial measures as important environmental factors in adult periodontitis.

PMID: 8910824, UI: 97067411

J Affect Disord 1996 Sep 9;40(1-2):73-84

Primary dysthymia: a study of several psychosocial, endocrine and immune correlates.

Ravindran AV, Griffiths J, Merali Z, Anisman H

Department of Psychiatry, Royal Ottawa Hospital, Ontario, Canada.

The relationship between primary dysthymia (chronic, low grade depression) and indices of major and minor life stresses, uplifts and coping styles was examined. Additionally, circulating lymphocyte subsets were assessed in dysthymic patients to determine their relationship to stress/coping factors or plasma levels of cortisol, ACTH or norepinephrine. Primary dysthymia was found to be associated with increased minor stressors (daily hassles), reduced uplifts, as well as particular reliance on emotion-focused rather than problem-oriented coping strategies. Interestingly, among dysthymics, the early onset group exhibited a greater degree of hassles and greater emotion-focused coping compared to the late onset subgroup. Although hassles and coping styles were correlated with depressed mood, only coping styles predicted severity of depressed affect. It seems that although dysthymia is characterized by increased hassles and reduced uplifts, these variables do not distinguish between the severity of the depressive affect, whereas the coping styles employed in the face of the increased hassles and reduced uplifts are more closely aligned with depression severity. Dysthymia was associated with elevated levels of circulating natural killer (NK) cells. Since levels of plasma cortisol, ACTH or norepinephrine were not increased in the dysthymic subjects, it is likely that the elevated NK cell number was unrelated to these neuroendorcrine measures. In control subjects circulating NK cells were inversely related to the severity of hassles recently encountered, while in dysthymic patients stress and coping factors were unrelated to NK cell numbers. Thus, it appears that the altered NK cells in dysthymic patients were not related to the increased stress perception and altered coping which characterize these patients.

PMID: 8882917, UI: 97037270

J Psychosom Res 1996 Aug;41(2):129-37

Modulation of immune response to rDNA hepatitis B vaccination by psychological stress.

Jabaaij L, van Hattum J, Vingerhoets JJ, Oostveen FG, Duivenvoorden HJ, Ballieux RE

Department of Immunology, University Hospital, Utrecht, The Netherlands.

In a previous study it was shown that antibody formation after vaccination with a low-dose recombinant DNA (rDNA) hepatitis B vaccine was negatively influenced by psychological stress. The present study was designed to assess whether the same inverse relation between HBs-antibody levels and psychological stress could be observed, while administering the standard, and thus higher, dose of vaccine. Volunteers (n = 68) scoring extremely low or high on a combination of questionnaires measuring daily problems and psychoneurotic symptoms were selected for participation. Antibody levels were determined 2, 6, and 7 months after the first vaccination. Questionnaires were completed before entering the study and at month 6. In contrast to the previous study, psychological stress was not found to be related to the antibody levels at any timepoint. These results suggest that, under certain conditions, stress-induced immunomodulation in vivo might be dependent on antigen dose.

PMID: 8887826, UI: 97042626

Proc Natl Acad Sci U S A 1996 Apr 2;93(7):3043-7

Chronic stress alters the immune response to influenza virus vaccine in older adults.

Kiecolt-Glaser JK, Glaser R, Gravenstein S, Malarkey WB, Sheridan J

Department of Psychiatry, The Ohio State University College of Medicine, Columbus 43210,

To determine whether a chronic stressor (caregiving for a spouse with a progressive dementia) is associated with an impaired immune response to influenza virus vaccination, we compared 32 caregivers' vaccine responses with those of 32 sex-, age-, and socioeconomically matched control subjects. Caregivers showed a poorer antibody response following vaccination relative to control subjects as assessed by two independent methods, ELISA and hemagglutination inhibition. Caregivers also had lower levels of in vitro virus-specific-induced interleukin 2 levels and interleukin 1beta; interleukin 6 did not differ between groups. These data demonstrate that down-regulation of the immune response to influenza virus vaccination is associated with a chronic stressor in the elderly. These results could have implications for vulnerability to infection among older adults.

PMID: 8610165, UI: 96181530

Oncol Nurs Forum 1996 Apr;23(3):441-8

The relationship between stress and the development of breast cancer: a literature review.

Bryla CM

Clinical Center Nursing Department, National Institutes of Health, Bethesda, MD, USA.

PURPOSE/OBJECTIVES: To review literature that explores the relationship between stress and the development of breast cancer and investigates the immune system as a possible mediator. Personality traits, response to stress, and stressful life events are considered. DATA SOURCES: Published articles, book chapters, books, and workbooks from nursing and medical literature. DATA SYNTHESIS: Studies show that a relationship exists between stress and the development of breast cancer. Most of the literature describes this relationship according to the patient's personality traits, her response to stress, or the occurrence of stressful life events. The immune system may mediate the physiologic influence of stress on breast cancer. CONCLUSIONS: Although the difficulty of measuring stress makes it difficult to demonstrate a tangible relationship between stress and breast cancer, studies reveal that stress is related to breast cancer in various ways. Dealing positively with stress may improve the quality of life of patients with breast cancer. IMPLICATIONS FOR NURSING PRACTICE: Nurses must understand the ubiquitous nature of stress and its relationship to breast cancer. Although they may not be able to prevent stress, patients can learn techniques (e.g., stress management, social support, communication, laughing and crying) to deal with it positively. Publication Types: * Review * Review, tutorial

PMID: 8801505, UI: 96271109

J Psychosom Res 1996 Apr;40(4):417-23

Psychologic characteristics associated with acute stressor-induced leukocyte subset redistribution.

Mills PJ, Dimsdale JE, Nelesen RA, Dillon E

Department of Psychiatry, University of California, San Diego, La Jolla 92103-0804, USA.

This study examined relationships between psychologic characteristics and enumerative immune responses to an acute laboratory stressor. Lymphocyte subsets were measured in 104 subjects at rest and following a 6-minute laboratory naturalistic speaking stressor. Multiple linear regression was utilized to assess relationships between immune reactivity (change scores) and anger expression, hostility, anxiety, depression, and stress. The task resulted in significant increases over baseline in WBC (p < 0.001), T-suppressor/cytotoxic CD8 cells (p = 0.010) natural killer CD56 cells (p < 0.0001), and CD57 (p < 0.0001) cells, and significant decreases in T-cells (p = 0.012), T-helper cells (p = 0.003), B-cells (p < 0.001), and the T-helper/suppressor ratio (p < 0.001). In general, the regression suggested that moderate associations exist between certain psychologic attributes and acute subset redistribution. For example, the increase in natural killer cell subsets was significantly negatively associated with anger expression, hostility, and depression. Suppressor/cytotoxic (CD8) cell reactivity was associated with baseline as well as with the task-induced changes in anxiety. B-cell (CD19) responses were related to the subject's age, expression of anger, and depression scores. As with the cardiovascular reactivity literature, these findings suggest that a relationship exists between certain psychologic characteristics such as anger and anxiety and immune reactivity to acute stress.

PMID: 8736422, UI: 96347087

Psychiatry 1995 Nov;58(4):299-312

Stress and depressive symptoms prospectively predict immune change among HIV-seropositive men. HIV Neurobehavioral Research Center Group.

Patterson TL, Semple SJ, Temoshok LR, Atkinson JH, McCutchan JA, Straits-Troster K, Chandler JL, Grant I

University of California, San Diego, USA.

LIFE stress, mood, and other psychosocial factors may help to explain variability in HIV (human immunodeficiency virus) disease progression. Attempts to support this notion empirically have produced mixed findings; several studies report a positive relationship between psychosocial factors and various indicators of disease progression or immune function (e.g., Evans et al. 1992; Goodkin et. al. 1992), whereas others have failed to detect any association (e.g., Perry et. al. 1992).

PMID: 8746489, UI: 96363470

J Pers Soc Psychol 1995 Oct;69(4):736-43

Individual differences in cardiac sympathetic control predict endocrine and immune responses to acute psychological stress.

Uchino BN, Cacioppo JT, Malarkey W, Glaser R

Department of Psychology/Health Psychology Program, University of Utah, Salt Lake City 84112, USA.

Potential mechanisms coordinating individual differences in cardiovascular reactivity and endocrine and immune responses to acute psychological stress were examined. Twenty-three young, healthy women performed a mental arithmetic challenge while measures of cardiovascular, endocrine, and immune function were assessed. Results revealed that the acute stressor was associated with changes in the cardiovascular, endocrine, and immune systems. More important analyses revealed that individual differences in cardiovascular reactivity predicted stress-induced cortisol changes. Furthermore, cardiac sympathetic control, as indexed by preejection period, was specifically related to changes in natural killer cell activity. These results suggest that distinct physiological pathways are activated in response to acute psychological stress.

PMID: 7473028, UI: 96003378

Z Rheumatol 1995 Sep-Oct;54(5):319-23

[Coping with stress and rheumatoid factor--a comparative study].

[Article in German]

Mur E, Kopp M, Gunther V

Universitatsklinik fur Innere Medizin Ordinariat fur Physikalische Medizin der Medizinischen Fakultat, Innsbruck, Osterreich.

Forty-six seropositive female RA patients were compared to 28 seronegative female RA patients and 51 healthy women using the stress-coping questionnaire of Janke et al. (9). In comparison to healthy controls, patients with RA exhibit a stress-coping behavior characterized by more cognitive coping mechanisms, less self-accusation, less aggression, and less use of alcohol or pharmaca. They too use more substitutive gratification, a strategy which is used by seropositive patients even more than by seronegative patients. Further, compared to healthy controls and seronegative patients, seropositive patients describe more attempts to control their reactions in stress situations.

PMID: 8578888, UI: 96084279

Psychosom Med 1995 May-Jun;57(3):295-8

Stability of individual differences in cellular immune responses to acute psychological stress.

Marsland AL, Manuck SB, Fazzari TV, Stewart CJ, Rabin BS

Department of Psychology, University of Pittsburgh, Pennsylvania, USA.

To determine the stability of individual differences in cellular immune reactions to acute mental stress, we correlated enumerative and functional lymphocyte responses to an evaluative speech task across two experimental sessions scheduled 2 weeks apart in 30 young men. Relative to pretask baseline measurements, the speech stressor elicited a diminished proliferative response to phytohemagglutinin and concanavalin A, a decrease in circulating CD19 lymphocytes, and an increase in both CD8 and CD56 lymphocytes across the two occasions of testing. Test-retest correlations were significant for the magnitude of change in proliferative response to PHA (r = .50, p < .005) and in numbers of circulating CD8 and CD56 cells (r = .53, and .42, respectively; p's < .02). Concomitant cardiovascular responses also correlated significantly over the two experimental sessions (heart rate: r = .78, p < .0001; systolic and diastolic blood pressure: r = .79 and .48, p < .0001 and .007). These data provide initial evidence that interindividual variability of cellular immune responses to acute psychological stress is moderately reproducible on retesting and may therefore denote a stable dimension of individual differences.

PMID: 7652131, UI: 95380595

J Psychosom Res 1995 May;39(4):445-57

Psychosocial correlates of immune responsiveness and illness episodes in US Air Force Academy cadets undergoing basic cadet training.

Lee DJ, Meehan RT, Robinson C, Smith ML, Mabry TR

University of Miami School of Medicine, Department of Epidemiology & Public Health, Florida, USA.

This study examined psychosocial correlates of immune function and illness in 89 male first-year US Air Force Academy cadets. A psychosocial questionnaire was administered to cadets prior to their arrival at the academy and was readministered during cadet orientation and during the stressful environment of Basic Cadet Training (BCT). Immune responsiveness was analyzed by PHA-, PMA-, or anti-CD3-stimulated thymidine uptake in mononuclear leucocytes. Illness episodes were assessed via medical chart review and self-reported symptoms. There were significant increases in distress levels as cadets entered BCT. No psychosocial measure assessed prior to arrival at the academy predicted level of PHA-, PMA-, and anti-CD3-stimulated thymidine uptake or risk of illness. However, hostility levels reported during BCT predicted risk of illness in the four weeks following psychosocial assessment (odds ratio = 7.1; 95% confidence interval: 1.4-36.1). Elevated response to environmental stressors and lower well-being levels also predicted impending illness, but only in the cohort of cadets who had not contracted food poisoning prior to assessment during BCT (OR = 9.3, CI = 1.9-46.7; OR = 0.09, CI = 0.02-0.53). These results suggest that self-report measures of hostility, response to environmental stressors and well-being may be useful predictors of impending illness episodes in males encountering high stress environments. PMID: 7562674, UI: 96055741

Psychol Rep 1995 Apr;76(2):451-7

Effects of a behavioral stress-management program on anxiety, mood, self-esteem, and T-cell count in HIV positive men.

Taylor DN

This study evaluated the effects of a behavioral stress-management program on anxiety, mood, self-esteem, and T-cell count in a group of HIV-positive men who were asymptomatic except for T-cell counts below 400. The program consisted of 20 biweekly sessions of progressive muscle relaxation and electromyograph biofeedback-assisted relaxation training, meditation, and hypnosis. Ten subjects were randomly assigned to either a treatment group of a no-treatment control group, and the 2 groups were compared on pre- to posttreatment changes in the dependent measures. Analysis showed that, compared with the no-treatment group, the treatment group showed significant improvement on all the dependent measures, which was maintained at a 1-mo. follow-up. Since stress is known to compromise the immune system, these results suggest that stress management to reduce arousal of the nervous system and anxiety would be an appropriate component of a treatment regimen for HIV infection. Publication Types: * Clinical trial * Randomized controlled trial

PMID: 7667456, UI: 95396963

Psychosom Med 1995 Mar-Apr;57(2):154-64

Heterogeneity in neuroendocrine and immune responses to brief psychological stressors as a function of autonomic cardiac activation.

Cacioppo JT, Malarkey WB, Kiecolt-Glaser JK, Uchino BN, Sgoutas-Emch SA, Sheridan JF, Berntson GG, Glaser R

Department of Psychology, Ohio State University, Columbus 43210-1222, USA.

Human responses to brief psychological stressors are characterized by changes and large individual differences in autonomic, neuroendocrine, and immune function. The authors examined the effects of brief psychological stressors on cardiovascular, neuroendocrine, and cellular immune response in 22 older women to investigate the common effects of stress across systems. They also used interindividual variation in heart rate reactivity, cardiac sympathetic reactivity (as indexed by preejection period reactivity in their reactivity paradigm), and cardiac vagal reactivity (as indexed by respiratory sinus arrhythmia reactivity) to explore the heterogeneity in human responses to brief psychological stressors. The results revealed that brief psychological stressors heightened cardiac activation, elevated plasma catecholamine concentrations, and affected the cellular immune response. It was also found that individuals characterized by high, relative to low, cardiac sympathetic reactivity showed higher stress-related changes in adrenocorticotropic hormone and cortisol plasma levels but comparable changes in epinephrine and norepinephrine concentrations. These data suggest that the effects of psychological stressors on cardiovascular and cellular immune response are governed by coordinated regulatory mechanism(s) and that going beyond the simple notion of heart rate reactivity to examine neural substrates may shed light on the interrelationships among and the regulatory mechanisms for the autonomic, endocrine, and immune responses to stressors.

PMID: 7792374, UI: 95312630

Med Tr Prom Ekol 1995;(4):19-22

[Patterns of the changes in the indices of B-system immunity in acute psychoemotional stress].

[Article in Russian]

Goranchuk VV, Smirnov VS

Psychoemotional stress induces in healthy individuals increased serum Ig and C3 subunit of complement. Response of B immunity psychoemotional stress remains within the limits of basic functioning. State of B immunity in psychologic comfort condition insignificantly depends on individual psychology. Uniqueness on individual immune reactions in psychoemotional stress presents depression of reserved B lymphocytes, which could be easily seen in people of controversial personality type. PMID: 7613777, UI: 95338499

Brain Behav Immun 1994 Dec;8(4):293-312

Reduced cytokine levels and T-cell function in healthy males: relation to individual differences in subclinical anxiety.

Zorrilla EP, Redei E, DeRubeis RJ

Department of Psychology, University of Pennsylvania, Philadelphia 19104.

Previous studies of psychopathological populations and populations challenged by significant life events have shown that high levels of anxiety and depression are associated with impaired cellular immunity. However, less is known about the sources and psychoimmunological relevance of subclinical variations in distress in healthy populations faced with typical levels of life stress. In the present study, we examined the relations of state distress to T-cell function and in vivo cytokine levels in 40 male college freshmen on two occasions. In addition, we assessed the possible contribution of dispositional determinants of distress to immune-related differences in mood. Relative to characteristically less anxious subjects, subjects who were characteristically more anxious (but subclinically anxious) had more anxious mood and had significantly lower lymphocyte proliferative responses to the mitogen concanavalin A (Con A) as well as lower levels of circulating interleukin-1 beta. In addition, subjects with more negative attributional styles for bad events exhibited reduced Con A-stimulated T-cell responses and lower levels of circulating interleukin-2. Finally, subjects who were more depressed (but subclinically depressed) also had reduced blastogenic responses. Individual differences in cortisol and beta-endorphin were not shown to mediate these relationships. The present study provides evidence that dispositionally related variations in distress in psychiatrically healthy, relatively unstressed college males have immunological correlates that suggest altered T-cell and macrophage activity.

PMID: 7696716, UI: 95210754

Am J Psychiatry 1994 Oct;151(10):1479-84

Psychological distress and natural killer cells in gay men with and without HIV infection.

Sahs JA, Goetz R, Reddy M, Rabkin JG, Williams JB, Kertzner R, Gorman JM

HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY. OBJECTIVE: The variability of the decline in immune function among those infected by HIV raises the possibility that psychological factors might help to explain the differences. Since studies of other populations have shown natural killer (NK) cells to be affected by psychiatric conditions, the authors examined this relationship in the context of HIV infection, expecting to find fewer NK cells to be associated with greater psychological distress. METHOD: Forty-six HIV-negative and 74 HIV-positive gay men who were participating in a longitudinal study had NK cells enumerations performed (by staining for CD56) 36 months after entry into the study. Comparisons were made between HIV-negative, HIV-positive asymptomatic, and HIV-positive symptomatic men by using a variety of clinician-rated and self-report measures of psychological function and absolute NK cell number. RESULTS: HIV-negative men had more NK cells than the groups of HIV-positive men. The groups' measures of psychological distress did not differ in any clinically meaningful ways. In general, the presence of DSM-III-R diagnoses and the measures of distress did not relate to NK cell number. CONCLUSIONS: NK cell number is not related to measures of psychological distress in these gay men with and without HIV infection. PMID: 7916542, UI: 94379257

Arch Psychiatr Nurs 1994 Aug;8(4):221-7

Stress and coping in the context of psychoneuroimmunology: a holistic framework for nursing practice and research.

McCain NL, Smith JC

College of Nursing, Rush University, Chicago, IL. Nurses who specialize in mental health routinely deal with stress and coping as priority issues. Yet there has been no consensus on an overriding framework for organizing and interpreting knowledge concerning the influences of stress on health and well-being. In addition, stress-management interventions have often been piecemeal. This article surveys traditional and emerging conceptualizations of stress and stress management, with a special focus on the transactional model and psychoneuroimmunology as complementary integrative frameworks. The authors recommend a comprehensive approach for stress management that includes behavioral, cognitive, and combination strategies for active coping as well as cognitive-behavioral techniques for relaxation. Publication Types: * Review * Review, tutorial PMID: 7979554, UI: 95070328

Psychosom Med 1994 May-Jun;56(3):216-24

Influence of life stress on immunological reactivity to mild psychological stress.

Brosschot JF, Benschop RJ, Godaert GL, Olff M, De Smet M, Heijnen CJ, Ballieux RE

Department of Clinical and Health Psychology, Faculty of Social Sciences, University of Utrecht, The Netherlands. This study investigated the effects of self-reported life stress and locus of control on reactivity of several immune parameters to a mild and short-lasting interpersonal stressor. Subjects were 86 male teachers aged 24 to 55 years. Immune reactivity was defined as changes in numbers of monocytes. T-lymphocytes and subsets, HLA-DR+ cells, and NK cells as well as changes in (in vitro) proliferative responses of peripheral blood lymphocytes to the antigens PHA and PWM. Multiple regression analysis was used to study the interaction effects of life stress and locus of control by experimental condition on immune reactivity. Life stress, but not locus of control, influences reactivity of the immunological parameters to the stressor. In particular, high numbers of daily hassles were associated with stressor-induced decreases in numbers of T cells and NK cells in peripheral blood. On the other hand, numbers of HLA-DR+ cells in high life stress scorers decreased only slightly during the stressor, whereas they increased in the control condition. The findings suggest that accumulated life stress is related to reactivity of immunological parameters to subsequent experimental stress. Possible physiological explanations and implications of these effects are discussed. PMID: 8084967, UI: 94367156

Aten Primaria 1994 Mar 15;13(4):161-4

[The perception of health, social support and family function in HIV seropositivity].

[Article in Spanish]

de la Revilla L, Marcos Ortega B, Castro Gomez JA, Aybar Zurita R, Marin Sanchez I, Mingorance Perez I

Centro de Salud de Almanjayar, Unidad Docente de Medicina Familiar y Comunitaria, Granada Norte. OBJECTIVE. To discover the perception of health, social support and family function for asymptomatic HIV carriers. DESIGN. This was an observation crossover study, using validated questionnaires. SETTING. Almanjayar and Cartuja Health Centres in Granada. PATIENTS AND OTHER PARTICIPANTS. 58 HIV+ patients belonging to the two basic areas were included. They were selected from the archives of the health centres and from the infectious diseases clinic of the referral hospital. There were an equal number of controls with similar socio-demographic characteristics. MEASUREMENTS AND MAIN RESULTS. The questionnaires used were as follows: GHQ, DUKE-UNC, the family APGAR, which measure health perception, social support and family function, respectively. Of seropositive patients, 58% presented a negative perception of their health, mainly expressed through symptoms of anguish and anxiety; as against 25% of the control group. As to social support, 29% of the HIV+ carriers perceived low levels of support, as against 6.9% of the control group. We found family dysfunction among 46% of seropositive patients, as against 12% of the control group. The Chi squared test was used for the analysis: all the differences were significant. CONCLUSIONS. Patients who are HIV carriers, even when they are asymptomatic, have a poor health perception, which can be attributed to the nature of the illness. The low level of social support detected, linked to the stress involved in being seropositive, may be the origin of the family dysfunction observed in 46% of our sample. We recommend action at individual, family and community levels in order to improve these patients' quality of life, strength their support structures and restore balance to family function. PMID: 8180300, UI: 94235761

J Consult Clin Psychol 1994 Feb;62(1):130-40

Emotional disclosure through writing or speaking modulates latent Epstein-Barr virus antibody titers.

Esterling BA, Antoni MH, Fletcher MA, Margulies S, Schneiderman N

Department of Psychology, University of Miami, Coral Gables, Florida 33124. Healthy Epstein-Barr virus (EBV) seropositive undergraduates (N = 57) completed a personality inventory, provided blood samples, and were randomly assigned to write or talk about stressful events, or to write about trivial events, during three weekly 20-min sessions, after which they provided a final blood sample. Individuals assigned to the verbal/stressful condition had significantly lower EBV antibody titers (suggesting better cellular immune control over the latent virus) after the intervention than those in the written/stressful group, who had significantly lower values than those in the written/trivial control group. Subjects assigned to the written/stressful condition expressed more negative emotional words than the verbal/stressful and control groups and more positive emotional words than the verbal/stressful group at each time point. The verbal/stressful group expressed more negative emotional words compared with the control group at baseline. Content analysis indicated that the verbal/stressful group achieved the greatest improvements in cognitive change, self-esteem, and adaptive coping strategies. Publication Types: * Clinical trial * Randomized controlled trial PMID: 8034815, UI: 94308368

J Psychosom Res 1994 Jan;38(1):63-78

Changes in cognitive coping strategies predict EBV-antibody titre change following a stressor disclosure induction.

Lutgendorf SK, Antoni MH, Kumar M, Schneiderman N

Department of Psychology, University of Miami, Coral Gables, FL 33124. Previous research has shown that emotional disclosure of traumatic or stressful events is associated with facilitating insight into the experience, improving mood, and modulating some aspects of the immune system. The current study examined how cognitive changes and experiential involvement during an emotional disclosure induction protocol relate to immune functioning, as measured by IgG antibody titres to the Epstein-Barr virus viral capsid antigen (EBV-VCA). Seventy-six college undergraduates were randomly assigned to either a disclosure induction or an assessment-only control condition. Experimental subjects met with an experimenter for three weekly 20-min individual sessions during which time they were asked to discuss a stressful or traumatic topic which they had previously discussed only minimally with others. Blood was drawn a week prior to the first session and at one week following the third session. Subjects completed the Impact of Event Scale (IES) after session 1 and at followup, and the extent of experiential involvement in disclosure during each session was assessed by means of the Experiencing Scale. Mood was assessed before and after each disclosure using the Nowlis Mood Adjective Checklist. Although the disclosure induction did not directly affect EBV-VCA antibody titres, individual differences in subjects' ability to involve themselves in the disclosure process and abandon their avoidance of the stressful tropic during the course of the 3-wk period were predictive of antibody decrements. These associations were more pronounced for individuals who disclosed older and more troublesome events. Publication Types: * Clinical trial * Randomized controlled trial PMID: 8126691, UI: 94172595

J Psychosom Res 1994 Jan;38(1):51-61

The variability of type I hypersensitivity reactions: the importance of mood.

Laidlaw TM, Booth RJ, Large RG

Dept Psychiatry and Behavioural Science, University of Auckland, New Zealand. Immediate (Type I) hypersensitivity skin reactions to allergens or antigens have been used as immune measures that may be subject to intentional modulation. In preliminary experiments using hypnosis we encountered unacceptably large, uncontrollable variability. A method was subsequently devised in which serial, five-fold dilutions of allergen or histamine were administered to the subject's forearm and reactions were recorded photographically on slide film. Areas were determined by computer-assisted image analysis. Seven healthy volunteers were tested for eight sessions (testing included mood scales, blood pressure, pulse and skin temperature). Mean wheal size and titration gradient data from allergen reactions correlated strongly with the psychological factor of liveliness but not stress, although no manipulation of mood was involved. A stepwise regression analysis accounted for 61% of the variance of the allergen mean wheal data, and 31% was from the liveliness factor alone. Thus, the more lively the subject felt, the smaller was the allergic response. PMID: 8126690, UI: 94172594

Zh Nevropatol Psikhiatr Im S S Korsakova 1994;94(5):74-6

[The characteristics of the interferon system parameters in typologically different groups of patients with borderline mental disorders during treatment].

[Article in Russian]

Naidenova NN, Mishenev MV, Semke VIa, Golovin OD, Vasil'eva OA

Lymphocyte gamma-interferon production and levels of serum interferon were studied in 94 patients with borderline psychiatric disorders on treatment. It was shown that parameters of interferon system in the acute disease period and their dynamics through the treatment depend on typological features of personality and initial level of interferon production. The patients with aggressive features of personality in acute disease exhibit significantly higher levels of serum interferon than those in patients with submissive features which drop after recovery. The same tendency occurred in hysterical patients (hystero-expressive and hystero-impressive types). These findings may be due to different reaction of immune system to chronic emotional stress in different types of personality. PMID: 7900460, UI: 95208391

Psychother Psychosom 1994;62(3-4):176-84

Personality, endocrine and immune changes after eight months in healthy individuals under normal daily stress.

Biondi M, Peronti M, Pacitti F, Pancheri P, Pacifici R, Altieri I, Paris L, Zuccaro P

III Clinica Psichiatrica, University of Rome, La Sapienza, Italy. The impact of stress and its neuroendocrine correlates on immune function are well established and individual variations could be attributed to modulation by personality characteristics. To assess the influence of everyday life stress and personality on neuroendocrine and immune function, we administered, to 18 healthy adults, the Minnesota Multiphasic Personality Inventory (MMPI) to assess their personality, the State-Trait Anxiety Inventory to measure anxiety, the Reaction Scheme Test to assess their coping reaction style, the Life Events Survey to assess the impact of stressful life events, and the Subjective Stress Questionnaire to assess perceived stress. The endocrine evaluation comprised prolactin, cortisol, and growth hormone plasma levels, while the immunological evaluation assessed T4, T8, and T11 lymphocyte percentages, as well as natural killer cell count and activity. All evaluations were made at baseline and after 8 months. We found a reduction of the T11 lymphocyte percentage to be accompanied by a reduction in the scores of the MMPI scale of Subtle Defensiveness and by an increase in the scores of the Social Introversion Scale. A positive correlation was found between prolactin and T4 lymphocyte percentage. These preliminary data show that some personality and endocrine measures correlate with immune function. PMID: 7846261, UI: 95148842

Schweiz Med Wochenschr 1993 Dec 11;123(49):2323-41

[Psyche and immunity. A selected literature study of psychoneuroimmunology in healthy persons].

[Article in German]

Hodel L, Grob PJ

Departement fur Innere Medizin, Universitatsspital Zurich. In the new field of psychoneuroimmunology essential ground has already been broken. Precisely in man, however, only hypotheses are possible in important areas: one that is commonly voiced is that stress weakens the immune system and would favour the onset of disease. A situation report is presented which summarizes, classifies and compares all 67 published studies relating psychic influences to immunologic factors in healthy human beings. A notable proportion turned out to be doubtful from the formal standpoint, e.g. no controls (40 publications) or with fewer than 30 probands (19). In 13 of these studies neuroendocrinologic parameters were taken into account and in 14 biological (health/disease) parameters. 42 studies were based on "externally defined" stress situations (partner loss, examinations, care of severely ill family members, space shuttle mission, etc.), 16 on specific personality traits and 9 on experimental stress situations or relaxation efforts. Since the studies varied widely in design, psychic starting position, psychic assessment (91 different methods) and immunity (68 varying parameters) and also in regard to the biological result (various "endpoints" of health/disease), only a few general conclusions can be drawn. Subjective or objective stress can be associated with diminished lymphocyte functions such as reduced mitogen stimulation and natural killer cell activity, elevated antibody titers against some latent and/or ubiquitous viruses, and reduced immunoglobulin A in saliva. This is confirmed to varying degrees, usually on a shortterm basis and not in all studies. Others contain evidence that the immunologic changes mentioned may be associated with particular personality traits (anxiety, depression, loneliness, good coping, power motive syndrome, social support, etc.). What the immunologic changes had in common was that they moved within a relatively narrow range and overstepped the norm little or only marginally. Whether the immunologic "anomalies" observed reflect a weakened immune system or an adequate "homeostatic" immune modulation by psychic signals, or point to adequate immune defence in an altered "antigen situation" arising from a changed lifestyle in stress situations, cannot be said. There is little evidence of a relationship to disease onset. While the present review shows certain relationships between psychic and immunologic factors, their biological relevance remains unclear. The often voiced hypothesis that stress weakens the immune system and a larger number of diseases therefore ensue cannot be confirmed or denied by the available data. The results permit other, contradictory hypotheses. Publication Types: * Review * Review, multicase PMID: 8272808, UI: 94098262

Ann Med 1993 Oct;25(5):473-9

Basics in psychoneuroimmunology.

Kropiunigg U

Institute for Medical Psychology, University of Vienna, Austria. Central nervous, endocrine and immune systems (IS) are all considered to be important regulators of psychological and physical wellbeing. Research into psychoneuroimmunology became relatively widespread in the 1970s. More and more studies considered these systems to be interactive units. Disciplines ranging from anatomy to psychology revealed the IS as the target of brain and endocrine signals. Findings also suggest that the IS is active even in a bidirectional feedback loop. Today the IS is no longer regarded as autonomous and scientists begin to see the emergence of a new psychosomatic paradigm. So far, evidence for the mind-body interaction paradigm has been collected with regard to the role of nerve fibres in lymphatic tissues, the effects of brain lesions on the IS, the interplay of neurotransmitters, hormones and immunotransmitters in a network of bidirectional feedback loops between the brain and the IS, the effects of ontogeny, learning and conditioning on the development of the IS, the impact of experimental and naturally occurring stressors on the IS, the possible immune modulating effects of personality characteristics, life style and psychodynamic processes and the role of the IS in disease. Research findings in most of the mentioned topics are presented. Publication Types: * Review * Review, tutorial PMID: 8251148, UI: 94072173

J Psychosom Res 1993 Sep;37(6):637-42

Personality characteristics and serum IgE level in patients with atopic dermatitis.

Scheich G, Florin I, Rudolph R, Wilhelm S

Nordsee Clinic, Norderney, F.R.G. On the basis of clinical observations it was predicted that patients with atopic dermatitis (AD) differ from patients with chronic obstructive bronchitis (OB) in three personality variables; excitability (EX), inadequate stress coping (CO), and paranoidity (PA). Sixty-one patients with AD and 15 with OB were assessed using standard scales. Systematic comparisons between groups strongly confirmed these hypotheses. It was further assumed that AD patients with clinically relevant serum IgE levels (IgE > 100 IU/ml) score significantly higher on EX and CO than those with normal serum IgE levels (IgE < 100 IU/ml). In contrast, no significant differences between these subgroups were expected regarding paranoidity (which may be a consequence of the AD patients' cosmetic problems). These assumptions again were supported by the findings of the present study. The results underline the potential importance of assessing personality variables and serum IgE levels in the diagnosis of AD patients. PMID: 8410749, UI: 94016016

J Psychosom Res 1993 May;37(4):361-9

Influence of perceived psychological stress and distress on antibody response to low dose rDNA hepatitis B vaccine.

Jabaaij L, Grosheide PM, Heijtink RA, Duivenvoorden HJ, Ballieux RE, Vingerhoets AJ

Department of Immunology, University Hospital, Utrecht, The Netherlands. The present study focused on the relationship between psychological stress and immune reaction to a novel antigen. Participants completed questionnaires on daily hassles, psychoneurotic complaints, coping style, and loneliness, 2 and 6 months after the first of a series injections with a low dose recombinant DNA hepatitis B vaccine. Antibody response was determined 7 months after the first vaccination. Based on the psychological questionnaires two different stress measures were calculated: a Stress Index score-month-2 and a Stress Index score-month-6 indicating stress levels experienced at the beginning and at the end of the study respectively. Antibody levels were found to be negatively related with the Stress Index score-month-2. Although the influence of psychological stress reported on month 6 tended to be in the same direction, this effect was not significant. Coping styles and loneliness were not associated with antibody formation. These results suggest that antibody formation to rDNA hepatitis B vaccine is negatively influenced by psychological stress. PMID: 8510062, UI: 93286995

Psychosom Med 1993 May-Jun;55(3):298-308

Psychosocial factors and immunity in nonhuman primates: a review.

Coe CL

Department of Psychology, University of Wisconsin, Madison 53706. This review summarizes research from several laboratories that has assessed the influence of psychosocial factors on immune responses in nonhuman primates. These studies have demonstrated that the formation and disruption of social relationships should be viewed as significant psychobiological events with many immunologic sequelae, especially for the young monkey. Prolonged changes in leukocyte numbers, in vitro measures of lymphocyte function, and antibody responses to antigenic challenge have been reliably observed. There is also evidence in infant monkeys suggesting that normal maternal care may be important for the development and maintenance of the physiological set points for certain immune responses. Similarly, immune responses in adult monkeys can be affected by the level of aggression occurring within the group. Collectively, this research reiterates the important influence that psychosocial variables can have on basic physiological responses, particularly when social relationships are in the process of change. Publication Types: * Review * Review, tutorial PMID: 8346337, UI: 93348365

J Behav Med 1993 Apr;16(2):143-61

Stress and psychosocial factors: effects on primary cellular immune response.

Snyder BK, Roghmann KJ, Sigal LH

Department of Pediatrics, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903. Life stress is associated with decreases in some immune functions, but little is known about the effect of stress on immune response to active immunization. We examined the relationships between stressful events, psychosocial, and biologic factors and primary immune response to a novel antigen-keyhold limpet hemocyanin (KLH). Lymphocyte proliferation (LP) was measured prior to immunization and 3 and 8 weeks following KLH immunization. At 3 weeks, LP was significantly lower in subjects reporting more "bad" stress and those experiencing more psychological distress, while "good" stress and social support tended to be associated with higher LP. There was a trend toward the more stressed subjects having lower baseline, but higher 8-week, LP responses. The model that best fits these data suggests that psychosocial processes mediate the relationship between stressful events and primary immune response, while biologic factors, such as recent weight gain, show direct independent effects on immune response. PMID: 8315644, UI: 93301921

Encephale 1993 Mar;19 Spec No 1:171-8

[Stress and depression].

[Article in French]

Brochier T, Olie JP

Service Hospitalo-Universitaire de Sante Mentale et Therapeutique, Centre Hospitalier Sainte-Anne, Paris. Stress largely influences our depression models. Animal models of depression and for the detection of antidepressants, and severity of psychosocial stressors scale have emphasized the role of stress in depression. Life events, who are understood as social stressors, may be recent prior to onset (6-12 months) of depression (provoking agents) or remote e.g. loss of parent in childhood (predisposing factors). Many results from studies must be interpreted cautiously because of retrospective designs and other methodological limitations. Among predisposing factors, loss due to separation may have a greater influence than loss due to death of a first-degree relative. Neurotic depressives sometimes have more provoking life events than endogenous depressive subjects but there is no difference in the augmentation of these life events prior to the onset of depression. Concerning the relapses and the recurrences, Kraepelin noted that the onset of new episodes seemed to become more autonomous. Several data do not confirm this classic position. What influence has the maintenance treatment on the stress reaction? Several psychosocial models of depression have taken into account the interactions of stress, life events and depression. In Harris and Brown's and Seligman's models, particular attention has been given to the notion of vulnerability in relation to the aetiology of depression. The view that neither vulnerability nor provoking agents by themselves explain the disorder gives rise to an alternative representation (Dohrenwend). Coping is of great interest to epidemiologists and geneticists in the problems of mental illness. Publication Types: * Review * Review, tutorial PMID: 8281898, UI: 94109336

Psychother Psychosom 1993;60(3-4):168-76

Association of cutaneous mast cells and sensory nerves with psychic stress in psoriasis.

Harvima IT, Viinamaki H, Naukkarinen A, Paukkonen K, Neittaanmaki H, Harvima RJ, Horsmanheimo M

Department of Dermatology, University of Kuopio, Finland. Association of stress with psoriatic skin symptoms was studied in 13 patients with psoriasis by dividing the patients into low- and high-stress groups based on their clinical examination and answers to three questionnaires (General Health Questionnaire, a somatization scale, and a life change questionnaire). This study focused on skin mast cells and sensory nerves which are the principal components in neurogenic inflammation. Mast cells were stained enzyme-histochemically for tryptase and chymase, and neuropeptides substance P (SP), vasoactive intestinal peptide (VIP), and calcitonin gene-related peptide (CGRP) were demonstrated immunohistochemically. Compared to the low-stress group (n = 7), the patients in the high-stress group (n = 6) had more severe skin and joint symptoms. Furthermore, mast cells positive for chymase activity were prominently reduced, but tryptase-positive mast cells only slightly decreased in the lesional skin of the high-stress group. A similar tendency was also observed in the nonlesional skin. In the papillary dermis of the lesional skin, both VIP- and CGRP-immunoreactive nerves could be observed in the high-stress group whereas in the low-stress group these nerve fibers were hardly visible in the corresponding area. No association of SP with stress was observed. This study suggests that psychic stress is associated with exacerbation of psoriasis, and stress may induce alterations in the psoriatic lesions by increasing the neuropeptide content with a concomitant decrease in the activity of neuropeptide-degrading enzymes, especially mast cell chymase. PMID: 8272475, UI: 94097837

Behav Med 1993 Spring;19(1):13-9

Relationships between self-reported symptoms of infection, menstrual-cycle-related distress, and cycle phase.

Groer M, Carr J, Younger MS

College of Nursing, University of Tennessee, Knoxville. This study examined the relationships between symptoms of common infectious illnesses, menstrual cycle phase, and cycle-related distress. Sixty-five women who had regular menstrual cycles and were not taking birth control pills were the convenience sample for this research. Subjects completed the Menstrual Distress Questionnaire (MDQ), the Perceived Stress Scale (PSS), and an investigator-developed symptom checklist (SCL) that inventoried symptoms of common respiratory, skin, gastrointestinal, and genitourinary infections. The subjects completed all questionnaires three times during the menstrual cycle (during menstruation, midcycle, and premenstruum). The results of the study indicated a highly significant clustering of infectious illness symptoms during the perimenstrual period compared with midcycle. There were significant relationships between scores on the MDQ and PSS and the frequency and intensity of infection symptoms throughout the cycle. Analysis of covariance (ANCOVA) of the effects of phase, PSS, MDQ, and SCL scores revealed that phasic influences were not significant when MDQ scores were controlled. PSS and MDQ scores significantly influenced symptom scores when phase was controlled, suggesting a general relationship between distress and infectious symptoms during the menstrual cycle. PMID: 8219525, UI: 94033937

J Oral Rehabil 1992 Nov;19(6):545-60

The 'temporomandibular pain dysfunction syndrome' personality: fact or fiction?

Marbach JJ

Columbia University, School of Public Health, Division of Sociomedical Sciences, New York, NY 10032. It is widely accepted that abnormal personality traits are important factors in the aetiology and maintenance of the temporomandibular pain and dysfunction syndrome (TMPDS). However, the foundation upon which this paradigm rests is largely based on clinical lore rather than evidence. The continued belief in the stress theory has onerous implications. First of all, clinicians could be lulled into a false sense of security about the efficacy of traditionally sanctioned treatments. Second, and potentially more important is the chilling effect on research that results from the premature and unsupported conclusions voiced by many, that certain issues regarding the diagnosis and treatment of TMPDS are solved. Such conclusions will lead not only to problems of patient care but may forge an unstable foundation for future research. Three theories are examined for convergent evidence in support of the putative relationship between personality and TMPDS. They are the 1) psychosomatic 2) coping and 3) psychophysiological theories. Currently evidence lacks for all three theories although there is partial support for the latter. It has not been demonstrated that TMPDS cases are characterized by a specific premorbid personality. PMID: 1469491, UI: 93108084 Brain Behav Immun 1992 Jun;6(2):141-56

Modulation of human natural killer cell activity by exposure to uncontrollable stress.

Sieber WJ, Rodin J, Larson L, Ortega S, Cummings N, Levy S, Whiteside T, Herberman R

Department of Psychology, Yale University, New Haven, Connecticut 06520-7447. Changes in natural killer cell (NK) activity and proportions of circulating T and NK lymphocyte subsets were assessed in adult males immediately after exposure to controllable or uncontrollable stress (noise) as well as 24 and 72 h later, in order to track the time course of the effects of stress. The role of control-relevant personality variables as moderators of the stress-immunosuppression relationship was considered. Subjects who perceived they had control over the noise as well as no-noise "control" subjects showed no reduction in NK activity. By contrast, subjects who perceived that they had no control over the stressor showed reduced NK activity immediately after the conclusion of the first 20-min stress session, and the reduced NK activity was found as long as 72 h later. Optimism and one's desire to be in control enhanced the negative impact of uncontrollable noise on NK activity. No differences between conditions were found on number of NK cells or a variety of T cell subsets. The results suggest the importance of perceived control in moderating the short- and long-term effects of stress on NK activity. PMID: 1504368, UI: 92369495

Behav Brain Res 1992 May 8;48(1):95-8

Behavioral factors in stress-induced immunomodulation.

Sandi C, Borrell J, Guaza C

Research Group of Psychobiology, Cajal Institute, CSIC, Madrid, Spain. Individual differences in the exploratory response to novelty were found to be related with the vulnerability to develop stress-induced immunological alterations. We studied the effect of exposure to inescapable shock on antibody formation against sheep red blood cells (SRBC) in rats selected according to their locomotor activity in a novel situation. Interestingly, antibody titers were only enhanced in shocked animals with the highest locomotor activity. These results emphasize the importance of taking into account individual differences for the study of the mechanisms involved in stress-induced immunomodulation, suggesting a behavioral procedure (novelty reactions) to deal with individual variability in the effects of stress on the immune system. PMID: 1622560, UI: 92322165

` Arch Gen Psychiatry 1992 May;49(5):396-401

Relationships over 1 year between lymphocyte subsets and psychosocial variables among adults with infection by human immunodeficiency virus.

Perry S, Fishman B, Jacobsberg L, Frances A

Department of Psychiatry, Cornell University Medical College, New York, NY. To examine relationships between immune and psychosocial variables among adults infected with human immunodeficiency virus type 1, 221 subjects without acquired immunodeficiency syndrome were assessed for degree of depression, anxiety, psychiatric symptoms, social support, stressful life events, hardiness, hopelessness, bereavement, and intrusive and avoidant thoughts about acquired immunodeficiency syndrome. At entry, none of 22 psychosocial variables significantly correlated with lymphocyte subsets. Among subjects seen 6 and 12 months later, severity of physical symptoms was associated with greater emotional distress, but the CD4 cell count was predicted by neither clinical ratings of psychopathology and global functioning nor by standardized self-report measures of constructs used in psychoimmune research. We conclude that among our sample, physical symptoms contributed to emotional distress, but emotional distress did not contribute to the CD4 cell count, a marker of disease progression. Comments: * Comment in: Arch Gen Psychiatry 1994 Mar;51(3):246-8 PMID: 1586275, UI: 92264879

Rev Prat 1992 Apr 15;42(8):997-1003

[Immunology and psychiatry].

[Article in French]

Consoli SM

Unite medico-psychologique, hopital Broussais, Paris. This review of scientific literature comes within the interest arisen from ten years by psychoneuroimmunology, a field connecting several disciplines and illustrating in a new way the psychosomatic relationships. A first category of works has been dedicated to the study of psychiatric disorders associated with various diseases concerning immunity (systemic diseases, endocrine diseases, cancers, infectious diseases), but also to the possible effect of distressing life events on the upset activation of immune functions, or even to the discovery of predisposing personality profiles (type C profile, depressive vulnerability). A second category of works concerns the analysis of the immune disturbances associated with certain psychiatric diseases, such as depression or schizophrenia, but also with some distressing life conditions, like bereavement. Animal experimentation and human experimentation provide various informations on the factors conditioning the immunomodulating effects of stress, sometimes in the direction of an inhibition, sometimes in the direction of an activation of immune functions. Finally, several papers shed light on the immunomodulating effects of psychotropic drugs. All these works open new horizons to the scientific knowledge and let us glimpse an extension to the use of psychologic therapeutics, as well of pharmacological ones as of non pharmacological. Publication Types: * Review * Review, tutorial PMID: 1621062, UI: 92320223 Am J Psychiatry 1992 Mar;149(3):367-70

Serum prolactin levels in homosexual and bisexual men with HIV infection.

Gorman JM, Warne PA, Begg MD, Cooper TB, Novacenko H, Williams JB, Rabkin J, Stern Y, Ehrhardt AA

HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY 10032. OBJECTIVE: Prolactin is a neurohormone that may be secreted in response to stress and also has regulatory effects on the immune system. Some, but not all, studies suggest that prolactin levels are higher than normal in persons with HIV infection. The authors measured prolactin levels in HIV-positive and HIV-negative homosexual and bisexual men to assess possible differences in levels and then examined relationships between prolactin level and measures of medical status, anxiety, depression, stress, and neuropsychological test performance. METHOD: Blood for prolactin level determination was obtained from 121 HIV-seropositive and 79 HIV-seronegative homosexual and bisexual men enrolled in a longitudinal study. The men also underwent a daylong assessment that included medical, immunological, psychiatric, psychosocial, psychosexual, and neuropsychological evaluations. RESULTS: There was no statistically significant difference in serum prolactin level among the seronegative men, the seropositive men with no or minimal physical symptoms, and the seropositive men with significant physical symptoms of HIV infection. Furthermore, within the HIV-seropositive group, the correlations between serum prolactin level and measures of depression, anxiety, stress, and neuropsychological test performance were all nonsignificant. CONCLUSIONS: Serum prolactin level does not seem to respond to HIV infection or to be related to stress or psychiatric symptoms in HIV-infected men. As none of the subjects had AIDS, the possibility cannot be ruled out that prolactin level increases in very late stages of HIV infection. PMID: 1346949, UI: 92160974

Psychosom Med 1992 Jan-Feb;54(1):22-9

Stress-induced modulation of the immune response to recombinant hepatitis B vaccine.

Glaser R, Kiecolt-Glaser JK, Bonneau RH, Malarkey W, Kennedy S, Hughes J

Department of Medical Microbiology and Immunology, Ohio State University College of Medicine, Columbus 43210. Each of a series of three hepatitis B (Hep B) inoculations was given to 48 second-year medical students on the 3rd day of a 3-day examination series to study the effect of academic stress on the ability to generate an immune response to a primary antigen. Those students who seroconverted after the first injection (25%) were significantly less stressed and anxious than those who did not seroconvert at that time. In addition, students who reported greater social support demonstrated a stronger immune response to the vaccine at the time of the third inoculation, as measured by antibody titers to Hep B surface antigen (HBsAg) and the blastogenic response to a HBsAg peptide (SAg). PMID: 1553399, UI: 92205003

Acta Med Austriaca 1992;19 Suppl 1:62-5

The possible etiological role of psychological disturbances in Graves' disease.

Harsch I, Paschke R, Usadel KH

Institute of Reproductive Medicine, Westfalische Wilhelms Universitat Munster, Germany. In the discussion of possible factors in the etiology of Graves' disease, stress has always played a major role. We investigated the possible influence of present depression (depressivity scale DS) and anxiety (State Trait Angstinventar STAI X1) on peripheral lymphocyte subpopulations in 10 patients with Graves' disease. The tests were done in hyperthyroidism and after 2-4 months in stable euthyroidism. Parallel to the psychometric testing, peripheral lymphocyte subpopulations were investigated. Elevated anxiety as a constant personality trait was investigated with the State Trait Angstinventar STAI X2 in 19 hyperthyroid patients with Graves' disease. 5 of the 10 patients had a pathological T4:T8 ratio and very high raw values for present anxiety (mean = 53,8; STAI X1), as well as a a high percentile for depression (median 93,1; DS). The other 5 patients with a normal T4:T8 ratio had much lower values for anxiety (mean = 37,8; STAI X1) and depression (median 78,4; DS). In those patients, the T4:T8 ratio remained normal in stable euthyroidism, while the values for anxiety and depression decreased. This also happened in the patients with a formerly pathologic T4:T8 ratio. However, the pathologic T4:T8 ratio persisted in those patients. The STAI X2 percentage ranking for the 19 hyperthyroid patients was 76,5. The value for healthy people is 55,5. Therefore a significantly elevated anxiety--representing a constantly elevated internal psychological stress--seems to be present in patients with Graves' disease. Since psychological stress is known to influence the immune system, such a constant personality trait could be a predisposing factor for Graves' disease. PMID: 1519457, UI: 92391252

Rev Roum Physiol 1992 Jan-Jun;29(1-2):39-48


Baban A

Department of Physiology, Institute of Public Health and Medical Research, Cluj-Napoca, Romania. The recent findings on the close relation between the nervous and immune systems have led to the developing of a new interdisciplinary field: psychoneuroimmunology. This review outlines the topic of the research, the limits and the future trends of psychoneuroimmunology, emphasizing the reciprocal relationship between biological and psychological processes. Publication Types: * Review * Review, tutorial PMID: 1472551, UI: 93112666

Kosm Biol Aviakosm Med 1991 Sep-Oct;25(5):8-10

[Specific features of humoral immunity and nonspecific resistance in pilots].

[Article in Russian]

Bochenkov AA, Smirnov VS, Goranchuk VV

Immune responses of the flying personnel to adverse flight effects were investigated. Altogether 134 pilots in the age of 22 to 42 years were examined. A significant decline of IgA, IgM, IgG, C3, alpha-antitrypsin, and R-proteins was found. Correlation analysis of over 100 anthropometric, psychophysiological, immune parameters as well as questionnaire data helped identify correlates and develop mathematical models which included IgA and IgM as parameters. Analysis shows that there is a relationship between personality features and humoral immunity of pilots: emotional strain increases, emotional stability decreases while immunoglobulins decline. In response to flight effects, changes in physiological functions, personality features, humoral immunity, and nonspecific resistance were interrelated. PMID: 8577153, UI: 96164121

Acta Neurol (Napoli) 1991 Aug;13(4):315-27

Stress, cancer and immunity. New developments in biopsychosocial and psychoneuroimmunologic research.

Baltrusch HJ, Stangel W, Titze I

Immunehematology, Transfusion Medicine, Bloodbank, Hannover Medical University, Germany. Research in biobehavioral oncology has been focused on stress as one dispositional factor in the multifactorial origin and in the clinical progression of malignant disease. New insights into the transduction of environmental influences to the immune system and to other body systems by the brain and neurotransmitters have increased the salience of this approach. Behavioral medicine in the area of cardiovascular disease has been successful due to the introduction of a "Type A" or coronary prone behavior pattern in large epidemiologic studies. This pattern is marked by both psychologic and physiologic hyperresponsiveness. Type A persons appear to be hostile, easily angered, competitive and hard-driving. More recently, behavioral oncologists have similarly attempted at conceptualizing a "Type C" or biopsychosocial cancer risk pattern, as they have noted the denial and suppression of emotions, in particular anger. Other features of this pattern are "pathological niceness", avoidance of conflicts, exaggerated social desirability, harmonizing behavior, over-compliance, over-patience, as well as high rationality and a rigid control of emotional expression ("anti-emotionality"). This pattern, usually concealed behind a facade of pleasantness, appears to be effective as long as environmental and psychological homeostasis is maintained, but collapses in the course of time under the impact of accumulated strains and stressors, especially those evoking feelings of depression and reactions of helplessness and hopelessness. As a prominent feature of this particular coping style, excessive denial, avoidance, suppression and repression of emotions and own basic needs appears to weaken the organism's natural resistance to carcinogenic influences. This may mean that the excessive use of denial and suppression/repression has important psychophysiologic effects linked to tumor biology and host-defense. Recent studies reveal that psychosocial stressors which are met by inadequate and repressive coping styles are associated with changes in immunocompetence, including both humoral and cell-mediated immunity. Relationships between different immune parameters (natural killer cell activity, lymphocytes, serotonin uptake, mean platelet volume) and mood states, psychological coping styles and personality variables are outlined. Recent findings indicate also that in certain malignancies (eg. breast cancer) the clinical course of the disease is influenced by psychosocial factors and coping style, as well as that the risk of cancer recurrence and metastasis is influenced by the type and duration of a given stressor. Individuals with a more favorable outcome have higher fighting spirit, a greater potential for aggression and lesser suppressive tendencies. Psychological intervention in cancer patients in its different forms and within the frame of the over-all treatment has now become a matter of scientific discussion and research. Publication Types: * Review * Review, tutorial PMID: 1781308, UI: 92142801

Am J Psychiatry 1991 Jun;148(6):733-8

Stressful life events and symptom onset in HIV infection.

Kessler RC, Foster C, Joseph J, Ostrow D, Wortman C, Phair J, Chmiel J

Institute for Social Research, University of Michigan, Ann Arbor 48106-1248. OBJECTIVE: The authors' goal is to provide basic epidemiologic data on the issue of reactivity to stress and HIV symptom onset by studying the relationship between a broad set of naturally occurring stressor events and HIV natural history in a large longitudinal community sample of HIV-seropositive homosexual men. METHOD: Subjects were recruited from a cohort of 1,011 homosexual men enrolled in the Chicago site of the Multicenter AIDS Cohort Study who also participated in the Coping and Change Study. The men were given self-administered questionnaires assessing behavioral, psychological, and psychosocial variables. Relationships between reports of stressful life events and longitudinal biomedical data measuring illness progression were examined. Life events were assessed by reports on the numbers of lovers, friends, and acquaintances who were diagnosed with AIDS or had died of AIDS and by scores on a checklist of 24 more general serious stressor events. The variables indicating progression of illness among initially asymptomatic men were a drop in T-helper lymphocyte percent (CD4%) between pairs of examinations of at least 25% and onset between examinations of thrush and/or fever lasting a minimum of 2 weeks. RESULTS: The authors found no evidence that serious stressor events have any meaningful effect on symptom onset indicated by either a drop in CD4% or onset of fever or thrush. CONCLUSIONS: There is no need for asymptomatic people with HIV infection to restrict their lives in order to avoid exposure to stressful life experiences or to develop special skills for coping with stress to forestall the progression of HIV illness. Publication Types: * Clinical trial * Multicenter study Comments: * Comment in: Am J Psychiatry 1992 Mar;149(3):416-7 PMID: 1674646, UI: 91241396 Zentralbl Hyg Umweltmed 1991 Mar;191(2-3):241-64

[Psychogenic stimulation of the immune system by nutrition].

[Article in German]

Bergler R, Zipperling C

Psychologischen Institut Universitat Bonn. Psychogenic influences on the immune system become evident via the nervous system, particularly in its paraspecific part and the parameters there of. On the one hand the sifting and systematization of the investigations carried out so far forces criticism and evaluation of methods, shows on the other hand however a number of important findings and conclusions, which can be deduced from this knowledge. (1) Immunosuppressive effects have to a great extent their roots in psycho-social influences, leading to an overtaxing of the human capacity to adapt; occupational stress, depression, helplessness, loneliness, hopelessness, lack of social support, suppression of emotional disturbance and aggression, psychological vulnerability, etc. (2) A psychogenic stimulation of the immune system is founded in certain personality traits (self-confidence, openness, etc.) and a life-style, which is characterized by security and support in the social sphere, by the ability to handle one's illness positively, by recognizing effective forms of coping with stress, as well as trust and faith in realizing the unlikely and a will to survive based on self-discipline. (3) Forms of hyperalimentation, malnutrition and wrong eating habits result in immunosuppressive effects and, in highly developed industrial countries, have their roots in stress situations, which cannot be coped with (e.g. stress due to separation from partner, stress connected with divorce, occupational stress, loneliness, helplessness, lack of social support, suppression of emotional disturbance and aggression, sleep deprivation, immobilization, etc.) and are therefore founded in variables of life-style and biography. Publication Types: * Review * Review, academic PMID: 2059287, UI: 91282897

Gig Tr Prof Zabol 1991;(12):20-3

[Relations between the indicators of humoral immunity and psychological adaptation of pilots].

[Article in Russian]

Bochenkov AA, Goranchuk VV, Smirnov VS

Peripheral blood serum A, M and G immunoglobulins were measured in 123 pilots, 22 to 42 years of age, distributed in groups as to the degree of frustrational tension (FT), related frustrational tension (RFT) and frustrational intolerance (FI). Inverse correlation was found between the indices of psychic adaptation (FT, RFT and FI) and the M immunoglobulin content. No evident correlation was traced between the levels of the circulating A and G immunoglobulins and the psychological peculiarities assessed in the pilots. PMID: 1840107, UI: 92283438

Behav Med 1991-92 Winter;17(4):167-76

Brief uncontrollable stress and psychological parameters influence human plasma concentrations of IgM and complement component C3.

Endresen IM, Relling GB, Tonder O, Myking O, Walther BT, Ursin H

Department of Biological and Medical Psychology, University of Bergen, Norway. Thirty-eight men participated in a study of immunological, hormonal, and psychological parameters before and after acute stress situations. A brief but acute stress was repeated daily for 4 days. This exposure caused the plasma levels of IgM and C3 to increase from Basal Day to Experimental Day 4. Significant correlations between endocrine and immunological parameters, and also between psychological measures and immunological parameters, were found. Use of psychological defense was related both to endocrine and immunological changes. The authors concluded that psychological stress may influence immunological functions both indirectly, by hormonal changes, and directly, by nervous regulation during brief but acute stress periods. PMID: 1793998, UI: 92173415

Presse Med 1990 Dec 22-29;19(44):2019-22

[Relationship between autoimmune diseases and personality traits in women].

[Article in French]

Dupond JL, Humbert P, Taillard C, de Wazieres B, Vuitton D

Service de Medecine interne - Immunologie clinique, Hopital Jean-Minjoz, Besancon. The personality traits of 40 women with non organ-specific dysimmune diseases were studied by means of a questionnaire devised to evaluate behavioural components including 48 items divided into 8 different patterns. The patients fell into 3 groups. Group I comprised 20 women with collagen diseases, including systemic lupus erythematosus (n = 8), scleroderma (n = 4), Sharp's syndrome (n = 4), polymyositis (n = 3) and Shulman's syndrome (n = 1). Group II was made of 10 women with either primary (n = 6) or secondary (n = 4) Sjogren's syndrome. Group III consisted of 10 women with vasculitis. Results were compared with those obtained in a control population of 41 women without dysimmune disease. At the time of examination the mean daily dose of prednisone was 10.5 mg. All 40 patients differed from the control group by their unobtrusiveness, self depreciation (P less than 0.01), hyperconformability and excessive kindness (P less than 0.02). Additional traits were a tendency towards contradiction and intolerance in patients with Sjogren's syndrome and a lack of agressiveness combined with a feeling of inferiority in patients with vasculitis. These results confirms that patients with dysimmune disease are psychologically fragile and suggest that the possibility of psychotherapy should be examined in these patients. PMID: 2148613, UI: 91102132

Nurs Clin North Am 1990 Dec;25(4):935-43

Stress and anxiety.

Robinson L

Department of Psychophysiological Nursing, School of Nursing, University of Maryland, Baltimore. Anxiety is the psychophysiologic signal that the stress response has been initiated. The stress response's by-product, stress, is difficult to define. The response has multiple dimensions that have yielded research with many foci. Most salient to nursing are investigations of psychobiologic variables, the influence of life events, and the interactional model of the stress response. The stress response can be viewed as an interactional process that causes psychophysiologic reactions that are immediate and can occur up to and including physiologic events 3 weeks after confrontation with the stressor. The literature suggests that neuroendocrine alterations in response to confrontation with a stressor may influence immunocompetence. Intervention and prevention studies of stress focus on pharmacotherapy, psychotherapy, behavioral techniques, personality engineering, relaxation training, and biofeedback. Nursing research on stress has proliferated in the 1980s. Implications for nursing intervention include coping strategies that fall into four categories: behavioral, physical, cognitive, and emotional. Publication Types: * Review * Review, tutorial PMID: 2235645, UI: 91045261

Psychol Bull 1990 Nov;108(3):363-82

Stress, emotion, and human immune function.

O'Leary A

Rutgers--The State University of New Jersey. This article provides a review of empirical evidence linking emotional processes to immune function in humans. Acute stressors have produced mixed effects on immunity, presumably through differential activation of physiological stress systems. Chronic stress has been associated with suppression of immune function, and there is evidence that the immune system may not adapt over time. Effects of stress accompanying social disruption and psychological depression, when demonstrated, have been consistently adverse. Certain personality styles may enhance or degrade immune response. Relationships between psychosocial factors and immunity have been identified for several diseases, including cancer, acquired immune deficiency syndrome, and autoimmune diseases; psychosocial interventions have been tested with variable results. Theoretical and methodological considerations are summarized and directions for future research suggested. Publication Types: * Review * Review, tutorial PMID: 2270233, UI: 91102157

Brain Behav Immun 1990 Sep;4(3):243-54

Facial pain, distress, and immune function.

Marbach JJ, Schleifer SJ, Keller SE

Division of Sociomedical Sciences, School of Public Health, Columbia University, New York, New York 10032. Chronic facial pain syndromes are associated with high levels of distress and depression. Immune system measures were investigated in otherwise healthy patients suffering from chronic temporomandibular pain and dysfunction syndrome (TMPDS) and in matched controls. No mean differences were found between TMPDS patients and the controls on any of the immune measures; however, both ConA and PWM responses in TMPDS patients were decreased in relation to the level of demoralization (P less than 0.05). Cognitive symptoms such as low self-esteem and perceptions of helplessness/hopelessness were implicated in these effects. In addition, among patients pain severity was independently associated with decreased ConA response (P less than 0.05). The data suggest possible correlates of stress-induced changes in the immune system. PMID: 2083380, UI: 91191151

Brain Behav Immun 1990 Sep;4(3):243-54

Facial pain, distress, and immune function.

Marbach JJ, Schleifer SJ, Keller SE

Division of Sociomedical Sciences, School of Public Health, Columbia University, New York, New York 10032. Chronic facial pain syndromes are associated with high levels of distress and depression. Immune system measures were investigated in otherwise healthy patients suffering from chronic temporomandibular pain and dysfunction syndrome (TMPDS) and in matched controls. No mean differences were found between TMPDS patients and the controls on any of the immune measures; however, both ConA and PWM responses in TMPDS patients were decreased in relation to the level of demoralization (P less than 0.05). Cognitive symptoms such as low self-esteem and perceptions of helplessness/hopelessness were implicated in these effects. In addition, among patients pain severity was independently associated with decreased ConA response (P less than 0.05). The data suggest possible correlates of stress-induced changes in the immune system. PMID: 2083380, UI: 91191151

Biol Psychiatry 1990 Jan 1;27(1):22-30

Reduction of immune function in life stress and depression.

Irwin M, Patterson T, Smith TL, Caldwell C, Brown SA, Gillin JC, Grant I

Veterans Administration Medical Center, Clinical Research Center on Alcoholism, San Diego, CA 92161. Reduced cell-mediated immune function has been found in depressed patients and in distressed persons undergoing threatening life events. The present study examines the interaction between severe life stress and major depression to produce immune alterations in 36 matched pairs of hospitalized depressed patients and nondepressed controls. Both major depressive disorder and the presence of threatening life events in control subjects are independently associated with a 50% reduction of natural killer (NK) cytotoxicity. A decrease in natural cytotoxicity is significantly associated with depressive symptoms but not with age, alcohol consumption, or tobacco smoking. These findings of altered immunity provide further evidence that the physiological responses in chronic stress parallel those found in the syndrome of depression. PMID: 2297549, UI: 90122996

J Clin Lab Anal 1990;4(1):22-38

Human psychoneuroimmunology today.

Biondi M, Kotzalidis GD

Third Psychiatric Clinic, University of Rome, La Sapienza, Italy. Studies in human psychoneuroimmunology began around 1919, but a systematic approach wasn't used until the work of Solomon in the 1960s. Recently, the new specialty has achieved relative independence due to considerable data acquisition. Stress research has revealed relationships between neuroendocrine and immune changes. In parallel, increasing evidence of immunological alterations in psychiatric diseases has expanded the field; presently, immunological correlates of psychosomatic diseases and personality are sought. On the other hand, while immunological disease has been psychologically assessed for many years, a clear-cut link between psyche and immunological changes has yet to be shown. This fact, along with the therapeutic implications of advancing knowledge, will influence strongly the future trends of psychoneuroimmunology. Concepts emerging from the study of this field will be of heuristic value to both psychiatry and immunology and will help define new and expanded limits for both disciplines. Publication Types: * Review * Review, academic PMID: 2179498, UI: 90188650 Schweiz Rundsch Med Prax 1989 Mar 28;78(13):362-7


[Article in German]

Schwarz-Ottersbach E

Psychoneuroimmunology, an interdisciplinary field of research, is concerned with the interactions between the central nervous system, the endocrine system and the immune system. In this survey the importance of psychosocial factors is illustrated by means of a number of studies reviewed from the literature: 1. Psychosocial factors related to illness (except aids): In animal experiments it could be shown that the effects of aversive stimulation on tumor growth were dependent on the type and manner of application of the stressors. The influence of personality factors and psychological states on the course and possibly also on the susceptibility to illness was frequently confirmed with regard to upper respiratory infections, coronary artery disease, rheumatoid arthritis and cancer. 2. Psychosocial factors related to changes in immunity: Changes in immunity could be demonstrated relating to bereavement of close relatives as well as in mental illness. In spite of immunologic abnormalities found in the various diseases the importance of the aforementioned immunosuppression on possible subsequent onset of illness is not yet clarified. The fact that we can experimentally strengthen or weaken the immune system by means of psychological methods offers a further possibility to influence the course and prognosis of various diseases by means of psychologically induced changes in immunity. Publication Types: * Review * Review, tutorial PMID: 2657967, UI: 89266333

Psychother Psychosom Med Psychol 1989 Jan;39(1):18-25

[Selective effect of personality markers and psychosocial stress on T lymphocyte subpopulations].

[Article in German]

Kropiunigg U, Hamilton G, Roth E, Simmel A

Measurements were made of cellular immune system parameters in a group of healthy medical students. On the basis of psychosocial stress encountered during a five-day topic-centered self-awareness course, we investigated modulation in immunity in relation to personality characteristics. 6 days before the beginning of the seminar personality profiles were drawn and blood samples taken. Further immunological measurements were made on day four of the seminar and three weeks after its conclusion. On the fourth day of the seminar we observed throughout the group higher lymphocyte and suppressor/cytotoxic T lymphocyte counts in comparison with counts one week earlier, and likewise a heightened responsiveness to PHA- and IL-2 stimulation. The T lymphocyte counts had dropped. In subjects with a higher need for succorance/nurturance, the depression of the immune system was manifested in a drop in the helper/inducer T lymphocyte counts, and in the more achievement- and order-oriented subjects in a downregulation as observed by higher suppressor/cytotoxic T lymphocyte counts. Our results show that under psychosocial stress, healthy people experience on the one hand an activation of the immune system, and on the other hand an immunodepression bearing a specific relation to personality characteristics. PMID: 2521532, UI: 89113582

Brain Behav Immun 1987 Mar;1(1):7-20

Stress-related immune suppression: health implications.

Glaser R, Rice J, Sheridan J, Fertel R, Stout J, Speicher C, Pinsky D, Kotur M, Post A, Beck M, et al

Department of Medical Microbiology and Immunology, Ohio State University College of Medicine, Columbus. This study used a year-long prospective design to assess linkages among distress, immunity, and illness. Serial blood samples were collected from 40 first-year medical students at the first, third, and fifth examination periods, as well as 1 month before each. There were significant decrements in the production of gamma-interferon by concanavalin A-stimulated lymphocytes obtained at the time of examinations. Antibody titers to Epstein-Barr virus (EBV) increased during examination periods, suggesting reactivation of latent EBV and therefore poorer cellular immune control of latent virus. We obtained data that suggest that T-cell killing by memory T lymphocytes of EBV transformed autologous B lymphocytes also declined during examination periods. The activity of a lymphokine, leukocyte migration inhibition factor, normally suppressed during recrudescence of herpes simplex virus type 2 infections, was altered during examination periods and an increase in both plasma and intracellular levels of cyclic AMP associated with examination stress was observed. An increase in the incidence of self-reported symptoms of infectious illness was also associated with examination periods. The data support the linkage between stress-related immunosuppression and health. PMID: 2837297, UI: 88241156

Ann N Y Acad Sci 1987;496:620-7

Type A behavior and cancer mortality. Theoretical considerations and preliminary data.

Fox BH, Ragland DR, Brand RJ, Rosenman RH

If stress and cancer are related by coping failure, that connection presumably involves the immune system. This involvement has already been shown in animals. It can be hypothesized that Type A personalities (driving, impatient, sometimes hostile) go through states of repeated frustration because of unachieved goals. From that point of view, Type A individuals are alternately able to cope and unable to cope. Such a pattern would theoretically tend toward repeated episodes of suppression and recovery of the immune system, with increased probability of growth of transformed cells. An opposing hypothesis, derived from human survival studies, suggests that a subgroup of Type B individuals (termed "Type C"--accepting, giving-up) are more likely to suffer a poor prognosis. A preliminary study relating Type A/B behavior pattern to cancer mortality was done in a cohort of 3154 men from the Western Collaborative Group Study (WCGS). The cancer mortality rate for the period 1960-1977 was 0.037 for Type A subjects (58 cancer deaths/1589 Type A subjects), and 0.025 for Type B subjects, yielding an odds ratio of 1.55. The odds ratio dropped to 1.29 (95% confidence interval = 0.84-1.96) when controlled for age, cigarette smoking, serum cholesterol, systolic blood pressure, and education. Preliminary analysis from a follow-up to mid-1983 shows a similar association. The findings suggest that, if anything, Type A subjects are more likely to die of cancer than Type B subjects. Although the finding is not strongly suggestive of a clinically or theoretically significant association between Type A/B behavior pattern and cancer mortality, it is sufficiently interesting to warrant further investigation. PMID: 3474993, UI: 87269174

Can J Psychiatry 1986 Feb;31(1):14-21

Psychosomatic medicine: past and present. Part III. Current research.

Lipowski ZJ

A comprehensive classification of contemporary psychosomatic studies by their subject and methodology, respectively, is presented. Representative examples of the current research in this field are provided. Special emphasis is given to the most prominent areas of investigation, i.e. psychophysiology, psychoendocrinology, psychoimmunology, and studies of the impact of stressful life events on health. The widening scope and diversity of psychosomatic research are underscored by its illustrative examples. PMID: 3948100, UI: 86133075

Adv Psychosom Med 1987;17:234-51

Mind and immunity. A review of methodology in human research.

Biondi M, Pancheri P

Publication Types: * Review PMID: 3296691, UI: 87238177

Soc Sci Med 1985;20(8):789-94

Cancer from a biobehavioural and social epidemiological perspective.

Baltrusch HJ, Waltz M

Malignant neoplasm should not be viewed as a 'psychogenic' nor as a 'primarily organic' disease but as an interaction of various forces, in which psychosocial factors may play an important role. To understand the increase in neoplastic disease, which has taken place in this century, requires a theoretical framework including social, psychosocial and behavioural dimensions, as well as the endocrine and immunologic mechanisms acting as pathogenic pathways. Recent theoretical developments in health psychology and allied disciplines on coping behaviour and social support should be integrated into biomedical models of the aetiology, pathogenesis and clinical course of malignant neoplasia. Environmental stressors, as well as mediating variables at the cognitive, affective, behavioural and physiological levels of adaptation, are suggested as major components of a model of multidimensional pathology. A growing body of research on the role of psychosocial factors in adjustment to cancer and its treatment has contributed new insights into possible variables and causal mechanisms which may be relevant in the aetiology of the disease. Closeness to parents in childhood and the ability to form close interpersonal relationships in later adult life very possibly influence the ability of the individual to cope effectively with environmental stressors prior to neoplastic disease and with the considerable stresses of being a cancer patient subsequent to diagnosis and treatment. Pathogenic pathways for future investigation include mental health variables, such as self-esteem and sense of control, at the psychological level and immunity surveillance at the biological. An integration and cross-fertilization of current work in the aetiology of and adjustment to cancer is suggested linking psychosomatic and somatopsychic models. Publication Types: * Review PMID: 3890192, UI: 85218882

Lancet 1983 Jun 25;1(8339):1400-2

Academic stress, power motivation, and decrease in secretion rate of salivary secretory immunoglobulin A.

Jemmott JB 3d, Borysenko JZ, Borysenko M, McClelland DC, Chapman R, Meyer D, Benson H

The effect of academic stress on immune function, as measured by the rate of secretion of salivary secretory immunoglobulin A (s-IgA), was studied prospectively in 64 first-year dental school students. Perceived stress and s-IgA secretion rate were measured five times--during an initial low-stress period, three high-stress periods coinciding with major examinations, and a final low-stress period. The s-IgA secretion rate was significantly lower in high-stress than low-stress periods for the whole group. In addition, personality characteristics differentiated patterns of s-IgA secretion rates. Students characterised by a great need to establish and maintain warm personal relationships secreted more s-IgA at each point than did all other subjects. The s-IgA secretion rates of those with a high inhibited need for power continued to decline through the final low-stress period rather than recovering as in all other subjects. PMID: 6134179, UI: 83217983

Gen Hosp Psychiatry 1982 Apr;4(1):69-74

Behavioral--physiological factors in the development and management of cancer.

Borysenko JZ

Recent clinical and animal model studies have demonstrated an effect of behavioral variables on the course of cancer. Unrelieved anxiety, helplessness, depression, and the inability to modulate the expression of anger have been implicated as specific predictors of poor prognosis. The endocrinological sequelae of these emotional states may affect certain parameters of cell-mediated immunity involved in host resistance to neoplasia. Both corticosteroids and catecholamines are likely mediators of behavioral effects on immunological function. Hormonal variations may also affect growth of tumors directly, or through nonimmunological tissue specific mechanisms. Behavioral interventions based on elicitation of the relaxation response provide a means of influencing affective and physiological states that may have particular relevance to cancer. Practice of such interventions reduces anxiety and provides a substrate for coping that enhances the patient's sense of control. Such "immunization" against helplessness can forestall depression. Physiological effects of such behavioral interventions occur both on a direct and an indirect level. Elicitation of the relaxation response per se produces physiological alterations consistent with decreased arousal of the sympathetic nervous system. Furthermore, by reducing fear and helplessness, physiological changes related to such dysphoric states may be minimized Publication Types: * Review PMID: 7042459, UI: 82187847

Biol Psychiatry 1980 Oct;15(5):699-709

The relationship of age, anxiety, and serum immunoglobulins with crystallized and fluid intelligence.

Cohen D, Eisdorfer C, Vitaliano PP, Bloom V

Serum immunoglobulin concentrations (IgG, IgA, and IgM), cognitive performance (crystallized and fluid intelligence), and self-reports of anxiety were evaluated in 24 men and women 60-75 years, and 50 men and women, 30-45 years. Trait anxiety was an important factor relating to performance differences between the young and old on crystallized and fluid subtests. IgM was inversely related to performance in the older age groups. Anxiety was not related to serum immunoglobulin levels. PMID: 7417627, UI: 81021959

J Genet Psychol 1980 Jun;136(2d Half):185-94

Psychosomatic aspects of cancer: an overview.

Murray JB

An overview of research on the psychosomatic aspects of cancer indicated that earlier psychoanalytic interpretations which focused on intrapsychic elements have given way to considerations of rehabilitation of victims of cancer and assistance with the complex emotional reactions of patients to terminal disease and of patients' families both to the disease and to death. Publication Types: * Review PMID: 6993629, UI: 80229440

Int J Psychiatry Med 1978-79;9(2):159-77

Psychosocial factors related to the incidence of cancer.

Scurry MT, Levin EM

The recent data concerning the relationship between psychosocial factors and the incidence of cancer have been reviewed covering life events, personality factors, psychiatric diagnoses, and loss-separation-hopelessness. The multiple methodological and design problems in this area of investigation are the factors that stand out and make interpretation difficult. Nevertheless, an association between oncogenesis and a number of factors such as extraversion, neuroticism, and lack of closeness to family is suggested. Many studies raise additional questions without providing definitive answers. A long term prospective study which has been designed to look at cancer outcome and multiple psychosocial factors is needed to determine if such factors add to the risk of oncogenesis. PMID: 755022, UI: 80005762

Can Psychiatr Assoc J 1974 Apr;19(2):207-17

Possible interaction of environmental and biological factors in the etiology of schizophrenia. Review and integration.

Strahilevitz M

Publication Types: * Review PMID: 4597833, UI: 74167196

Psychiatry Res 1999 Jan 18;85(1):51-61

On the role of immunological factors as mediators between psychosocial factors and cancer progression.

Garssen B, Goodkin K

Helen Dowling Institute, Rotterdam, The Netherlands. Thirty-eight prospective studies on the role of psychological factors in cancer initiation and progression are reviewed. Despite the availability of many prospective studies, there is no certainty about the role of any specific factor. An important reason might be that the interactions among several psychological factors, and the interactions of psychological and biomedical risk factors, have rarely been studied. Some evidence has been found that a low level of social support, a tendency towards helplessness, and repression of negative emotions are factors that promote cancer progression. The effect of psychological factors has been more convincingly demonstrated with respect to cancer progression than cancer initiation, and more convincingly in intervention than in natural history studies. Possible mechanisms mediating associations between psychological factors and disease outcome are discussed. The role of immunosurveillance seems modest overall, and alternative pathways are suggested. Publication Types: * Review * Review, tutorial PMID: 10195316, UI: 99209691

Psychother Psychosom 1996;65(5):229-45

Clinical and biological aspects of bereavement and loss-induced depression: a reappraisal.

Biondi M, Picardi A

Universita La Sapienza, Dipartimento di Scienze, Psichiatriche e Medicina Psicologica, Roma, Italia. Loss and bereavement can be regarded as risk factors for the development of psychiatric and medical illness. Vulnerability to physical illness and mortality are increased during the first 2 years of bereavement, with men at higher risk than women. Symptoms of anxiety and a frank depressive syndrome are common during the first months of bereavement and, although depressive symptoms are usually transient and self-limited, bereaved individuals not rarely go on to develop major depression. In our perspective, loss perceived as irreparable, and persistence of perceived loss may favour the development of complicated grief and depression. Factors such as unexpectedness, absence of social support, concurrent loss or illness, and grief proneness may predict poor adjustment after bereavement. Complicated bereavement should be distinguished from uncomplicated bereavement, because patients with the latter need no treatment. In humans, there is evidence of increased adrenocortical activity and altered immune function following bereavement, whereas in non-human primates, biogenic amine systems appear to be involved in the response to maternal or social separation. According to a 'psychosomatic view of the brain', critical life events can both affect brain neurotransmitters and contribute to psychological and somatic symptoms of depression. Emotional events may be transduced into long-lasting brain changes, involving neurotransmitters, neuropeptides and receptors. Although only very limited evidence exists, long-term consequences could involve changes at the gene expression level. Publication Types: * Review * Review, tutorial

Adv Neuroimmunol 1996;6(2):179-90

Psychoneuroimmunology and cancer: historical perspectives and current research.

Fife A, Beasley PJ, Fertig DL

Division of Psychiatry, Brigham and Women's Hospital, Boston, MA 02115, USA. The belief that cancer might be related to temperament or distress has been emphasized throughout the history of medicine. The field of psychoneuroimmunology has its origins in psychosomatic medicine, and has evolved to the investigations of complex interactions between the psyche and the nervous, immune, and endocrine systems. Such interactions may have implications in both cancer risk and survival. Publication Types: * Historical article * Review * Review, tutorial PMID: 8876773, UI: 97030832

Annu Rev Psychol 1996;47:113-42

Health psychology: psychological factors and physical disease from the perspective of human psychoneuroimmunology.

Cohen S, Herbert TB

Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA. This review addresses the importance of studies of human psychoneuroimmunology in understanding the role of psychological factors in physical illness. First, it provides psychologically and biologically plausible explanations for how psychological factors might influence immunity and immune system-mediated disease. Second, it covers substantial evidence that factors such as stress, negative affect, clinical depression, social support, and repression/denial can influence both cellular and humoral indicators of immune status and function. Third, at least in the case of the less serious infectious diseases (colds, influenza, herpes), it considers consistent and convincing evidence of links between stress and negative affect and disease onset and progression. Although still early in its development, research also suggests a role of psychological factors in autoimmune diseases. Evidence for effects of stress, depression, and repression/denial on onset and progression of AIDs and cancer is less consistent and inconclusive, possibly owing to methodological limitations inherent in studying these complex illnesses, or because psychological influences on immunity are not of the magnitude or type necessary to alter the body's response in these cases. What is missing in this literature, however, is strong evidence that the associations between psychological factors and disease that do exist are attributable to immune changes. Publication Types: * Review * Review, tutorial PMID: 8624135, UI: 96193329

Can J Psychiatry 1994 Oct;39(8):404-9

[Psychoimmunology and AIDS: a review of the literature].

[Article in French]

Montagne G, Lalonde R, Brouillette MJ

Centre hospitalier Pierre Boucher, Longueil, Quebec. In recent years, several studies have been carried out concerning the effect of psychosocial factors on the course of infection due to the human immunodeficiency virus (HIV). After summarizing the current status of general knowledge in the field of psychoimmunology, this article reviews the results of studies conducted in regard to HIV. Two conclusions are reached. The first is that current research has not shown psychosocial factors to have any impact on either the immunity status of seropositive patients or the medical complications inherent to AIDS. The second conclusion is that several types of intervention, in particular psychoeducational approaches, stress management programs, and the strengthening of social and family support, give good results where the psychosocial well-being of patients is concerned and should motivate various health professionals to improve the focus of their interventions. Furthermore, significant methodological weaknesses in several indexed studies are noted, and these should be rectified to enable future studies to confirm or correct the present observations. Publication Types: * Review * Review, tutorial PMID: 7834597, UI: 95136200

Physiol Behav 1994 Apr;55(4):681-4

Effect of a preferred companion in modulating stress in adult female rhesus monkeys.

Gust DA, Gordon TP, Brodie AR, McClure HM

Yerkes Regional Primate Research Center, Emory University, Atlanta, GA 30322. Using a counterbalanced design, seven adult female rhesus monkeys were removed from their social group and housed in a novel environment both alone and with a companion chosen on the basis of quantitative affiliative behaviors. Blood samples (n = 2) were collected from all study animals before the exposure to the novel environment, then at 2, 24, and 96 h thereafter for cortisol and immunological analyses. During both conditions, subjects showed evidence of stress as indicated by elevated cortisol concentrations and decreases in absolute numbers of lymphocyte subsets. There was no significant interaction between condition (alone vs. companion) and time in cortisol percent change and further planned post hoc analyses showed no significant between-condition differences for any of the postseparation time points. Similarly, no significant interaction was found between conditions and time for the absolute number of CD4+CD8-T cells, CD8+CD4- T cells, or CD20+CD2- B cells. However, planned post hoc comparisons showed that subjects in the companion condition exhibited a significantly smaller percent change from baseline than in the alone condition at the 24 h and 96 h sample periods in absolute numbers of CD4+CD8- and CD8+CD4- T cells. Results showed that adult female rhesus monkeys exhibited a profound stress response when removed from their social group to a novel environment and that recovery time of T cell subsets was significantly enhanced by the presence of a preferred companion. PMID: 8190794, UI: 94248218

J Perinat Neonatal Nurs 1994 Mar;7(4):42-51

Characterizations and psychoneuroimmunologic implications of secretory immunoglobulin A and cortisol in preterm and term breast milk.

Groer MW, Humenick S, Hill PD

This article combines data from two separate investigations. One study examined relationships between psychosocial factors and preterm milk immune variables. The other examined relationships between psychosocial and breastfeeding satisfaction factors and perceived milk sufficiency in term mothers. Milk samples were collected on the fifth postpartum day and frozen. Both studies collected data on anxiety, but other psychosocial variables differed. Mood states and social support were studied in preterm mothers, while breastfeeding satisfaction, milk maturation, and infant suckling characteristics were studied in term mothers. Milk samples were assayed for secretory immunoglobulin A (sIgA) and cortisol. sIgA and cortisol levels were higher in the milk from preterm mothers and were inversely related to each other in both preterm and term milk. In preterm mothers, anger and vigor were positively correlated with higher milk sIgA. The findings suggest that cortisol is present in milk and may potentially influence the secretion of milk sIgA. The relationships that were found when comparing psychosocial, dyadic, and stress factors with milk sIgA and cortisol are provocative and suggest new paradigms for studying lactation. PMID: 8151510, UI: 94202000

Actas Luso Esp Neurol Psiquiatr Cienc Afines 1994 Mar-Apr;22(2):77-82

[Psychosocial factors in patients with duodenal ulcer].

[Article in Spanish]

Garcia-Camba E, Moreno MD, Nieto MA, Martinez Velarte M

Servicio de Psiquiatria, Hospital de la Princesa, Universidad Autonoma, Madrid. The authors review the current literature on psychosocial aspects of duodenal ulcer. The initial simple psychosomatic approach, has evolved to a multifactorial schema in which stress and individual vulnerability plays an important role. Psychological features (personality, Type A behaviour, alexithymia, anxiety, depression) and socioenvironmental factors (stress, life events, coping, social support) are analyzed. Newer aspects like the probable stress influence on immunity and infection by Helicobacter pylori are considered. Publication Types: * Review * Review, tutorial PMID: 8079675, UI: 94360800

Health Psychol 1993 Nov;12(6):435-42

Stress and the memory T-cell response to the Epstein-Barr virus in healthy medical students.

Glaser R, Pearson GR, Bonneau RH, Esterling BA, Atkinson C, Kiecolt-Glaser JK

This study investigated the memory T-cell proliferative response to several early and late Epstein-Barr virus (EBV) polypeptides. Blood samples were collected twice, 1 month before a 3-day block of examinations and again on the last day of the exam series. Ss were 25 healthy, EBV seropositive medical students. The proliferative response to 5 of the 6 EBV polypeptides significantly decreased during examinations. In addition, Ss high (above the median) in seeking support, as measured by the COPE, had lower proliferative responses to 3 EBV polypeptides (p17, p52/50, and p85), as well as higher levels of antibody to EBV virus capsid antigen. The data provide further evidence that psychological stress can modulate the cellular immune response to latent EBV. PMID: 8293726, UI: 94123659

Int J Psychiatry Med 1993;23(2):119-48 Published erratum appears in Int J Psychiatry Med 1996;26(2):247

Psychoneuroimmunological aspects of disease progression among women with human papillomavirus-associated cervical dysplasia and human immunodeficiency virus type 1 co-infection.

Goodkin K, Antoni MH, Helder L, Sevin B

Center for the Biopsychosocial Study of AIDS, University of Miami School of Medicine, Florida. OBJECTIVE: Psychosocial associations have been observed with level of cervical dysplasia or "pre-cancer" and invasive cervical cancer [related to human papillomavirus (HPV) infection]. Psychoneuroimmunological relationships have been observed in human immunodeficiency virus type 1 (HIV-1) infection, which is being described in an increasing number of women. Our objective was to review these relationships regarding effects that might be expected in HIV-1 and HPV co-infected women. METHOD: This review was based on a Medline literature search supplemented by a manual search of selected journals unrepresented in that database. RESULTS: Relationships of psychosocial factors and level of cervical dysplasia were similarly observed with reference to immunological and health status in asymptomatic and early symptomatic HIV-1 infected homosexual men, suggesting that a potentiating effect may occur in HIV-1 and HPV co-infected women. Consistency of relationships across studies appeared to be enhanced by the use of a biopsychosocial model integrating the effects of life stressors, social support and coping style as well as psychiatric disorders. CONCLUSIONS: Research is indicated on the relationships between psychosocial factors, immunological status and clinical health status in this group of women. Because of the high prevalence of psychosocial risk factors for chronic psychological distress in these women and the known immunological and health status decrements occurring with progression of these two infections, a clinical screening program based on the biopsychosocial model is recommended as a means of secondary prevention. If effective in generating treatment referrals, such a program would likely improve quality of life and could aid in the determination of relationships with immunological and health status as well. Publication Types: * Review * Review, tutorial PMID: 8395480, UI: 93366549

Am J Health Promot 1992 May-Jun;6(5):345-58

Mind-body health: research, clinical, and policy applications.

Pelletier KR

Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, California 94304. PURPOSE OF THE REVIEW. This critical review presents an overview of the development in the field of mind-body medicine over the last 10 years and has taken tentative steps toward suggesting the components of a new model of health based on psychoneuroimmunology. While documenting the major shortcomings of present research design, methodology, data analysis, and subsequent hypotheses, this article points out areas of sufficient promise for practical and responsible clinical applications of the research. SEARCH METHOD USED. A thorough review of the clinical and experimental medical literature related to the interaction between mind and body is presented, and the new and complex research in the field of psychoneuroimmunology is analyzed. SUMMARY OF IMPORTANT FINDINGS. Despite the mixed and sometimes conflicting findings in current research, there is an increasingly compelling body of scientific evidence indicating that mind-body interactions are at the root of both health and disease. Research demonstrates that psychological factors seem to play a causal role in the onset and course of many chronic disorders and that psychological, emotional, psychosocial, and behavioral interventions have at least as much proof of effectiveness as many purely medical treatments. MAJOR CONCLUSIONS. There is a substantial growing body of scientific and clinical knowledge which demonstrates an inextricable interaction between mind and body. Such an approach empowers individuals and organizations to assume greater responsibility for health as a basis for the development of a true health care system. Publication Types: * Review * Review, tutorial PMID: 10148755, UI: 93904779

Dernière mise à jour : vendredi 29 octobre 1999 17:02:16

Dr Jean-Michel Thurin

Stress Immunité