Showing papers in "Psychosomatic Medicine in 1976"

Social support as a moderator of life stress

Abstract: Social support is defined as information leading the subject to believe that he is cared for and loved, esteemed, and a member of a network of mutual obligations. The evidence that supportive interactions among people are protective against the health consequences of life stress is reviewed. It appears that social support can protect people in crisis from a wide variety of pathological states: from low birth weight to death, from arthritis through tuberculosis to depression, alcoholism, and the social breakdown syndrome. Furthermore, social support may reduce the amount of medication required, accelerate recovery, and facilitate compliance with prescribed medical regimens.

Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation.

Abstract: Two groups of young, healthy, nonathletic volunteers were subjected to selective sleep stage deprivation. Six subjects were deprived of stage 4 sleep and seven subjects of REM sleep. The stage 4 deprived group reported more musculoskeletal symptoms during the deprivation condition than did the REM deprived group. The stage 4 deprived group also showed a significant increase in muscle tenderness between the baseline and deprivation conditions and an altered pattern of overnight change in muscle tenderness in response to deprivation. The REM deprived group did not show either of these changes. These results are discussed in the light of the previously postulated relationship between NREM sleep disturbance and muscoloskeletal pain in patients with so-called "Fibrositis syndrome."

Body image disturbances in anorexia nervosa and obesity.

Abstract: Measures were made of body image and personality features in patients with anorexia nervosa and obesity. It was hypothesized that obese and anorexic patients would display similar body image disturbances characterized by relative overestimation of body size in comparison with control subjects. Body image was measured by both a distorting photograph technique (a general measure) and a visual size estimation apparatus (for specific body regions). Personality features were assessed by the Eysenck Personality Inventory and a modified version of Rotter's Locus of Control Scale. Results indicated that both obese (N=16) and anorexic (N=18) subjects significantly differed from three control groups (P less than 0.01) in body size estimation on a general measure of body image. A measure of specific body regions did not differentiate between groups. For anorexic and obese patients, body size estimates were significantly correlated with personality features.

Plasma testosterone levels in the rapist.

Abstract: Plasma testosterone level was measured in 52 rapists and 12 child molesters who had completed the Buss-Durkee Hostility Inventory, the Megargee Overcontrolled Hostility Scale, and the Michigan Alcoholism Screening Test. The rapists were classified according to the degree of violence during the commission of the rape. The ranges and means of the plasma testosterone level for the rapist and child molester controls were within normal limits. The group of rapists who were judged to be most violent had a significantly higher mean plasma testosterone level than normals, child molesters, and other rapists in this study. Mean Buss-Durkee hostility rating scores for rapists were significantly higher than the mean for normals, but there was no correlation between individual hostility scores and plasma testosterone levels. There was no correlation between age, race, or length of incarceration and plasma testosterone level.

Facial expression and imagery in depression: an electromyographic study.

Abstract: When subjects are instructed to self-generate happy, sad, and angry imagery, discrete patterns of facial muscle activity can be detected using electromyographic (EMG) procedures. Prior research from this laboratory suggests that depressed subjects show attenuated facial EMG patterns during imagery conditions, particularly during happy imagery. In the present experiment, 12 depressed subjects and 12 matched normals were requested to generate happy and sad imagery, first with the instruction to simply "think" about the imagery, and then to self-regulate the affective state by "reexperiencing the feelings" associated with the imagery. Continuous recordings of facial EMG were obtained from the corrugator, zygomatic major, depressor anguli oris, and mentalis muscle regions. It was hypothesized that (a) these muscle sites would reliably differentiate between happy and sad imagery. (b) the instruction to self-generate the affective feeling state would produce greater EMG differences than the "think" instructions, and (c) the "think" instructions would be a more sensitive indicator of the difference between depressed and nondepressed subjects, especially for happy imagery. All three hypotheses were confirmed. The application of facial electromyography to the assessment of normal and clinical mood states, and the role of facial muscle patterning in the subjective experience of emotion, are discussed.

The communication of affection between cancer patients and their spouses.

Abstract: Thirty-eight patients receiving chemotherapy for advanced cancer and 37 of their spouses were studied to assess changes since illness in the desire for affection (sexual, physical, and verbal) and changes in actual affectional behavior. Each participant in the study was interviewed and then completed the Beck Depression Inventory and an Affectional Needs and Behavior Scale. Results indicated that patients and spouses of both sexes experienced simultaneously an increase in the desire for physical closeness and a decrease in the desire for sexual intercourse. Women patients and their husbands were in greater agreement regarding the changes assessed than were men patients and their wives. In addition, women patients reported the highest level of depression, but were more likely than the other groups to have their affectional needs met. Interpretations of these findings and implications for the management of patients in advanced stages of life-threatening illness are discussed.

Daily self-reports on activities, life events, moods, and somatic changes during the menstrual cycle.

Abstract: 33 undergraduate students (11 males 11 females taking oral contraceptives and 11 females not taking oral contraceptives) filled out daily self-reports on pleasant activities stressful events moods and somatic changes for 35 consecutive days. By randomly assigning each male a pseudo cycle the data were analyzed to compare the 3 samples across the 3 phases of the menstrual cycle. Males reported more stable but less positive experiences than females and a stable low level of pain and water retention throughout the study. Both female samples reported increases in pain and water retention during the premenstrual and menstrual phases. Reports of negative affect impaired concentration and stressful events did not differ by samples but significant sample X Cycle interactions reflected differential increases in the 2 female samples during the premenstrual and menstrual phases. Subsequent analyses indicated that the experience of stressful events accounted for more of the variance than did cycle phase for negative mood factors but not for pain and water retention.(Authors modified)

The magnitude of premenstrual anxiety and depression.

Abstract: The magnitude of premenstrual mood changes in 50 parous adult women between the ages of 30 and 45 was assessed using standardized measures of depression and anxiety. Premenstrual test scores were compared with those obtained during the intermenstrual phase of the cycle and with normative data. Premenstrual state anxiety and depression mean scores were significantly higher than those obtained midcycle, but were much lower than those of patients with psychiatric disorders. Trait anxiety scores were low and were not significantly correlated with premenstrual depression and anxiety scores.

Limbic system-adrenal cortex regulation in depression and schizophrenia.

Abstract: Hypothalamo-pituitary-adrenal [HPA] activation and abnormal HPA regulatory mechanisms have been observed in depressed patients. Depressed and schizophrenic patients were studied to determine whether the HPA disturbances in depression are specific to this psychiatric illness or are mediated by nonspecific breakdown of psychological defense mechanisms. Despite the presence of severe ego defense breakdown and considerable secondary depressive symptomatology, the schizophrenic patients had normal HPA function. The depressed patients had elevated urine free cortisol excretion, high CSF cortisol levels, and did not show normal HPA suppression in response to dexamethasone. Within the depressed group significant correlations of HPA parameters were obtained with somatic features but not with ego breakdown features. After recovery depressed patients had more normal HPA function. The results indicate that HPA dysfunction can occur in association with primary depressive illness, that a psychoendocrine distinction can be made between primary depressive illness and secondary depressive symptomatology, and that psychological defense breakdown is not related to these neuroendocrine observations. Attention is drawn to the utility of urinary free cortisol measurement as a valuable index of HPA activation in psychoendocrine studies.

Survival and development of maternally deprived rats: role of body temperature.

Abstract: Rat pups, 10-12 days old, survived maternal deprivation if kept warm at 35 degrees, but died within 6 days if allowed to become hypothermic at a room temperature of 23 degrees. Normal body temperatures facilitated feeding, but even without food, warm pups survived starvation longer than cool ones. Increased survival could not be attributed to decreased oxygen consumption, and warm pups lost more body water and solids than cool pups. Striking differences in development that may have affected survival were observed over 72 hr of separation without food. Cool pups showed a virtual arrest of the growth of the tail, fur, tibia, and femur, and failed to increase brain weight, protein, DNA, RNA, and catecholamine contents. Warm pups showed developmental growth more comparable to that of normally mothered pups and significantly exceeded controls in the rate of accumulation of brain norepinephrine and dopamine.

Emotional labeling and overeating in obese and normal weight individuals.

Abstract: It was hypothesized that obese individuals respond to unlabeled high arousal by overeating, while no such response was predicted for labeled high arousal states. Obese and normal weight subjects were led to believe that they were hearing their own heart beat, and that it was either fast or slow. A label for this heart rate either was or was not provided, and subjects' eating behavior was measured unobtrusively. The results supported these hypotheses: aroused obese subjects ate more when they could not identify the cause of their arousal than when a label was known. When obese subjects were calm, the presence or absence of a label did not affect their eating. Furthermore, obese subjects showed significant affect reduction following eating. Normal weight subjects were not affected by the presence or absence of an arousal label. Instead, they ate more when they called themselves calm than when anxious, and more when hungry than when full.

Emotionally induced decreases in pulmonary flow rates in asthmatic children.

Abstract: This study found that vividly remembered incidents of intense anger and similarly recalled fear decreased 1-sec forced expiratory flow rates (FEV1)in 35 male and 25 female chronic asthmatic children who had no psychopathology. FEV1 increased with relaxation. Changes in FEV1 following anger correlated with changes following fear as highly as the reliabilities of the responses permitted, although anger produced a greater decrease than fear. FEV1 decrease following anger and fear correlated with FEV1 increase due to relaxation. The amount of change in each of the three conditions correlated with history of emotionally precipitated asthma. This pattern was interpreted to mean that the same phenomenon underlies emotional-bronchoconstriction, relaxation-bronchodilitation, and emotionally triggered asthma. No relationship was found between degree of allergic sensitivity (atopy) and FEV1 changes in any of the three conditions nor did atopy correlate with history of emotionally triggered asthma. These results do not support the view that psychological and allergic factors are inversely related, alternative causes of asthma.

Resemblances of twins and their parents in pattern A behavior.

Abstract: A twin study was conducted to determine the relative contribution of genetic and environmental factors to the development of Pattern A behavior. Thirty-five sets of college-aged MZ twins and 21 sets of DZ twins completed the lenkins Activity Survey for Health Prediction. This self-administering questionnaire yields scales measuring Pattern A behavior and its related traits of Speed and Impatience, Job Involvement, and Hard-driving Competitiveness. Results showed a modest genetic component for the Hard-driving Competitive aspect of Pattern A. Data were also presented regarding resemblances between the twins and their parents on Pattern A.

Stages of bone marrow transplantation: a psychiatric perspective.

Abstract: Patients undergoing bone marrow transplantation were closely followed by a psychiatric service functioning as part of a multidisciplinary team. A somewhat predictable pattern of psychological reactions to the stress of various stages of the procedure appeared to emerge. Approaches to patient evaluation, typical patient responses, and suggestions for working with these patients and their families are described.

Classically conditioned changes of blood glucose level.

Abstract: This paper reviews the literature dealing with classically conditioned changes of blood glucose level. When conditioning procedures are employed, the repeated administration of large amounts of insulin, or of glucose, leads to a conditioned decrease of blood glucose whereas the repeated administration of smaller amounts of insulin leads to a conditioned increase of glucose. These responses are interpreted as instances of reflex compensation by the central nervous system for rapid alterations of glucose availability. Instances of more naturally occurring changes of glucose levels, which appear to be under the control of the nervous system and to be conditionable, are also discussed. A model that accounts for the observed responses has been formulated and is presented.

Signal detection theory and the psychophysics of pain: an introduction and review.

Abstract: A brief explanation of signal detection theory is presented, followed by a review of the literature in which differences in pain report were analyzed to determine if changes were in sensitivity (physiological processes) or in response bias (a subject's willingness to report that a signal occurred). Three kinds of studies are reviewed: modification, procedural, and comparative and normative. The advantages of using a signal detection approach in pain research are emphasized. It is concluded that experimenters applying signal detection analysis to pain research should give greater consideration to methodological procedures and be cognizant of all possibilities for shifts in sensitivity (d)'.

Assessment of the reliability of and the effect of neutral instructions on the symptom ratings on the Moos Menstrual Distress Questionnaire.

Abstract: The Moos Menstrual Distress Questionnaire (MDQ) Form T, was analyzed for split-half and test-retest reliability. Also, an Experimental Group (N = 47)received neutral instructions to determine if knowledge of the purpose of the questionnaire would affect symptom ratings. Results indicated that the MDQ is internally consistent and does have high test-retest reliability. Also, altered instructions did not significantly affect symptom ratings. However, the MDQ, Form T, was not able to differentiate between Ss who were in different menstrual cycle phases when completing the questionnaire. It is suggested that Form T be used instead as originally intended to compare the ratings of different Ss in different cycle phases.

Sexual life and sexual frigidity among women developing acute myocardial infarction.

Abstract: The various aspects of the sexual life of 100 female patients aged 40-60 with acute myocardial infarction were compared with those of a control group of 100 female patients of the same age, hospitalized for other diseases. Sexual frigidity and dissatisfaction were found among 65% of the coronary patients as compared with 24% of the controls. The commonest cause for sexual dissatisfaction was premature ejaculation or impotence in the husband. The incidence of premarital sexual relations was greater among the frigid patients when compared with those who achieved orgasm. The coronary patients had an earlier menopausal age than the controls. The number of coronary patients who underwent artificial abortions in the past was lower than in the control group. All these findings were statistically significant at a level of P less than 0.05. No connection was found between extramarital relations and sexual frigidity. There was no relation found between sexual frigidity and diabetes, essential hypertension, marital status, pathological gynecological findings, or localization of the infarction. Until now, sexual frigidity and dissatisfaction appear to have been a neglected aspect in the female coronary patient.

Effects of progressive relaxation on sleep disturbance: an electroencephalographic evaluation.

Abstract: Subjects with reported sleep-onset disturbance were given progressive relaxation training, placebo, or no-treatment. All three conditions showed significant improvement in daily reported sleep onset over the duration of the study. Between-condition effects were limited to relaxation superiority over no-treatment on Stage 1 sleep, and over placebo on postquestionnaire items and sleep-latency reports at 1-year follow-up.

A consultation-liaison psychiatry clinical clerkship.

Abstract: Toward the goal of increasing the relevance of clinical psychiatry to the future practice of medicine, a full-time psychiatry clerkship has been developed on the Consultation-Liaison Psychiatry Service at the University of Vermont. This new Psychiatry Clinical clerkship was begun on a pilot basis in January, 1973, and made fully operational in January, 1974. It uses the problem oriented medical record system and the audit of student performance as basic instructional tools. A description of the background or curricular matrix of the Consultation-Liaison Psychiatry Clinical Clerkship (CLPCC) is followed by an outline of the rotation's goals, and evaluation and educational strategies as developed over 2 years. Certain performance outcomes are reported for the 1 year of full operation. These outcomes are parameters of student performance on several standardized measures applied to all Psychiatry Clerkship students. The CLPCC students seem to be at least as adequate as students on all other clerkship rotations, in terms of their knowledge of psychopharmacology, their use of the Problem Oriented Record, their ability to assess psychosocial problems, and their ability to define a psychosocial treatment plan. Further, the CLPCC students are statistically significantly more positive about their rotation as an educational experience compared with students on other psychiatry rotations. While further evaluation measures are planned to compare the CLPCC students with those who have had one of the several traditional clinical clerkship experiences in psychiatry, our experience to date would indicate that the CLPCC is a viable alternative to traditional clerkships on psychiatric services and one that may enable a greater application of psychiatric principles to the practice of medicine.

The effect of biofeedback training on respiratory resistance of asthmatic children.

Abstract: In a pilot study four children with severe asthma were trained to lower their respiratory resistance by means of biofeedback training techniques. Total respiratory resistance measured continuously by the forced oscillation method was used as the feedback signal. Each child demonstrated lowered respiratory resistance after most sessions. Results were comparable with the improvement seen after bronchodilator inhalation therapy. A nonasthmatic child demonstrated no significant changes of respiratory resistance after using the same techniques. Arguments are presented in support of the hypothesis that changes in total respiratory resistance were primarily due to changes in lower airway resistance. Lowering of airway resistance in asthmatic children by use of biofeedback appears possible; its promise calls for further clinical evaluation.

The effects of testosterone on plasma and platelet monoamine oxidase (MAO) an plasma dopamine-beta-hydroxylase (DBH) activities in the male rhesus monkey.

Abstract: Dopamine-beta-hydroxylase (DBH) and monoamine oxidase (MAO) in plasma and platelets were studied in male rhesus monkeys to evaluate the effects of changes in endogenous testosterone on the activity of these enzymes. High plasma testosterone concentrations attained at the end of the mating season were associated with relatively low levels of platelet MAO activity. When testosterone levels fell, platelet MAO increased significantly. Mean differences in platelet MAO activity between a group of castrated and control males were in the direction expected, with the highest MAO activity in the castrated monkeys, but these differences did not attain statistical significance. No significant mating season or castration effects were seen in plasma DBH or MAO enzyme activities. These data support the hypothesis of a link between testosterone and some monoamine systems, and possibly the monoamine-related behaviors linked to testosterone in primates.

Visceral learning in asthma.

Abstract: The hypothesis of visceral learning has opened a new avenue in the search for a pathway between psychosocial stimuli and physiological changes. To apply this approach to asthma required a technique for the measurement of the airways' patency, which could be interfaced with the strategy of visceral learning. The method of forced oscillations was shown to correlate highly with whole body plethysmography. The rapid output of the instrument was used on line to control a visual reinforcement signal. Forty-six mild asthmatics, blind to the effect sought in order to minimize the role of suggestion, were tested in a series of evolving experiments. In the first series, two groups of subjects (N=15,13) were able, with this sensory feedback, to decrease (p less than 0.01) their total respiratory resistance; subsequently a smaller group of subjects (N=5), who received reinforcement signals unrelated to the state of their airways, showed no such change. Similar results were obtained in the second series of tests; in A-B-B-A order, the subjects (N=13) received either contingent or noncontingent reinforcement; furthermore, the reinforcement was available only if their lung volume was within the range observed during baseline.

Stress-induced growth hormone release: psychologic and physiologic correlates.

Abstract: Although growth hormone (GH) has been shown to rise in humans undergoing stressful procedures such as cardiac catheterization, venipuncture, and arterial catheterization, such changes in GH usually occur in a minority of subjects —considerably fewer than those experiencing elevations in cortisol (1,2). The fact that stress-induced GH release occurs in a minority of subjects exposed to a stressful situation raises the possibility that activation of this neuroendocrine system is a function of a specific type of stress response, coping style, or psychophysiologic organization. The present study is a preliminary inquiry into the psychologic characteristics, subjective states, and physiologic variables that differentiate subjects who do and do not release GH during a stressful situation.

Inhibition of Huggins tumors by forced restraint.

Abstract: Three experiments demonstrated that chronically administered restraint inhibits the development of DMBA-induced rat mammary tumors. The effect is exhibited in a lower proportion of positive responses, increased latency of tumor development, and lower number of tumors in positive animals when restrained animals are compared with controls. Organ weights failed to show a stress response to restraint. Molar activity data from Experiment III indicated that early in the experiment activity increased among the restrained animals on release from restraint. A fourth experiment, which employed a crystal accelerometer to assess activity, produced a similar activity pattern and also provided evidence of adrenal ascorbic acid depletion as a function of restraint.

Psychological responses to the use of the fetal monitor during labor.

Abstract: Fetal monitoring, a major advance in obstetrical care, transforms the labor room into an intensive care setting. The psychological effects of this new technology were investigated by means of structured interviews with 25 postpartum women. The multiplicity of psychological responses obtained are described. The relationship of demographic, obstetrical, and psychosocial variables to women's overall positive or negative reaction to the monitor was investigated. Personality characteristics and life experiences with pregnancy and childbirth were factors that shaped the manner in which the monitor was experienced. The effect of fetal monitoring on maternal anxiety is discussed. The impact of mechanization on the total experience of childbirth is noted.

Ventilatory response to carbon dioxide inhalation in depression.

Abstract: The ventilatory response to carbon dioxide (CO2 response) was determined in 18 patients admitted to an inpatient service with endogenous depressive illness. Admission mean CO2 response value for the group was below the mean value for a control group. At the time of hospital discharge marked clinical improvement had occurred in depressive symptomatology; mean CO2 response had increased slightly and was no longer significantly below the control value. CO2 response deserves further investigation as a possible physiologic characteristic of certain depressed patients.