Showing papers in "Psychosomatic Medicine in 1979"

Impact of Event Scale: a measure of subjective stress.

Abstract: Clinical, field, and experimental studies of response to potentially stressful life events give concordant findings: there is a general human tendency to undergo episodes of intrusive thinking and periods of avoidance. A scale of current subjective distress, related to a specific event, was based on a list of items composed of commonly reported experiences of intrusion and avoidance. Responses of 66 persons admitted to an outpatient clinic for the treatment of stress response syndromes indicated that the scale had a useful degree of significance and homogeneity. Empirical clusters supported the concept of subscores for intrusions and avoidance responses.

The stress response: a new perspective.

Abstract: A theory of the response to chronic intermittent stress, intergating many diverse studies, is presented. Chronic intermittent stress is presumed to be the type of stress most frequently encountered and most likely to cause physiological changes which predispose an organism to tissue damage. The theory states that all organisms are genetically predisposed to adapt to stress and that the physiological pattern of adaptation is similar across species. This pattern consists of a conditioned endocrine response before the stressor is presented accompanied by a decrease in arousal during the stress. These changes occur because the organism is predisposed to learn cues predictive of stress and to assess the threat potential of the stressor. This pattern is adaptive because it conserves resources and promotes homeostasis. Maladaptation is discussed in terms of failure to learn situational expectancies and appropriate responses. Implications of this theoretical perspective are examined.

The influence of the psyche and the brain on immunity and disease susceptibility: a critical review.

Abstract: In critically reviewing the sources of evidence connecting psyche and brain with the immune system, the authors include a brief review of current knowledge of the immune system, its interactions with the neuroendocrine system, and other factors influencing its regulation. These include developmental stages, aging, rhythmicity, and a variety of exogenous influences. The need for developing further information about normal base lines is emphasized. Against that background, many sources of data demonstrating connections between the central nervous system and the immune system are presented: indirect evidence from clinical and experimental illnesses involving the immune system, and direct changes in either humoral or cellular immunity after natural or experimental stress, conditioning, hypnosis, and direct brain stimulation. Possible mechanisms are discussed, as well as some important methodological issues for further research.

Lymphocyte and Granulocyte Reactions during Sleep Deprivation

Abstract: The possible influence of 48 hr of sleep deprivation on in vitro DNA synthesis of blood lymphocytes and on the adhesiveness and intracellular, stainable activity of alkaline phosphatase in blood granulocytes was studied in twelve young male volunteers. Following the sleep deprivation, all 12 subjects showed marked reductions of DNA synthesis after stimulation with phytohemagglutinin. Pre-exposure levels were regained 5 days after terminating the vigil. No changes were noted in granulocyte adherence or alkaline phosphatase activity. The results suggest that sleep deprivation may decrease cell-mediated immune reactions and thereby impair some aspects of host defense.

Resentful and reflective coping with arbitrary authority and blood pressure: Detroit.

Abstract: Two hypotheses about coping with an arbitrary authority, an angry boss, were tested: (1) styles of handling anger vary with social status, and (2) these styles are in turn related to blood pressure levels Two styles of coping were tested: model R-R, Resentful vs Reflective, and model I/O/R, Anger-In, Anger-Out, and Reflective Handling an angry boss by Reflection is reported by more women than men, by those in middle-class areas rather than lower class, and does not vary by race Working class report more use of Anger-Out than middle class who in turn report more use of Reflection In general, the Anger-In response did not vary by race, sex, or area of residence (12-18%) For model R-R, Reflection of boss's anger was related to lower blood pressure when compared to Resentful responses, within sex, race, and residence groups For model I/O/R, working-class, high stress persons who expressed Anger-Out showed the highest mean levels Reflection is an appraisal response related to vascular and neural deceleration in stress experiments This mode can be learned, and may aid in handling daily emotional-loaded stimuli to control blood pressure, along with learning a relaxation response

Psychological factors in the prognosis of malignant melanoma: a prospective study.

Abstract: Sixty-four patients with Stage I or II malignant melanoma who were apparently disease free rated the amount of adjustment needed to cope with their illness on a scale of 1 to 100. The resultant figure was called the melanoma adjustment score. Twenty-nine patients who relapsed within 1 year of surgery reported a score of 53 +/- 31 (mean +/- SD); 35 nonrelapsers reported a score of 80 +/- 20, p less than 0.001. Based upon analysis of indivual melanoma adjustment scores in the first 31 patients, we predicted that subjects scoring greater or equal to 65 would stay in remission, whereas those scoring greater than 65 would relapse. Applying this prospectively to the next 33 patients we correctly identified 25 of 33 outcomes (76%), p less than 0.03. This psychological variable was independent of known biological prognostic factors, which did not predict 1 year survival. The melanoma adjustment score was also independent of the number of positive lymph nodes, which did correlate with outcome in these patients. The results suggest a role for psychological factors in the one year prognosis of this malignancy.

Psychosocial risk factors in the developmental of infectious mononucleosis

Abstract: In a 4-year prospective seroepidemiological study of infectious mononucleosis (IM) of one class of some 1400 cadets at the West Point Military Academy, susceptibles and immunes were identified by the absence or presence of antibody to Epstein-Barr virus (EBV), the causative agent, and new infections by the appearance of antibody (seroconversion). On entry, about 1/3 lacked EBV antibody, of whom some 20% became infected (seroconverted); about 1/4 of seroconverters developed definite, clinical and recognized IM. Psychosocial factors that significantly increased the risk of clinical IM among seroconverters included: 1) having fathers who were "overachievers"; 2) having a high level of motivation; 3) doing relatively poorly academically. The combination of high motivation and poor academic performance interacted in predicting clinical IM. Additional data on presence of elevated titers among seroconverters with inapparent disease and on length of hospitalization among cases of clinical IM revealed that these two additional indices of infection or illness could also be predicted from the same set of psychosocial risk factors.

Brief group therapy in myocardial infarction rehabilitation: three- to four-year follow-up of a controlled trial

Abstract: A trial of brief group therapy as part of a rehabilitation program for postmyocardial infarction (MI) patients was carried out. Forty-four patients surviving their first MI were randomly allocated to either group therapy or control group status and were followed over 4 years. An additional group of 17 patients were referred for post-MI group therapy sessions after the termination of the controlled experiment and were followed for 3 years. Patients who received group therapy had significantly less follow-up coronary morbidity and mortality, and returned to work at significant higher percentages than control patients. Although neither group therapy nor control group patients meaningfully altered conventional coronary risk factors, group therapy patients (in the controlled trial) successfully altered selected coronary-prone behaviors. Educational information regarding the physiological and psychological aspects of coronary heart disease, presented in the group therapy sessions, was forgotten over follow-up. It is concluded that the supportive aspects of the group therapy experience played the most important role in determining the rehabilitation advantages seen for treatment patients.

Family attitudes reported in youth as potential predictors of cancer.

Abstract: In long-term prospective study of a cohort of former medical students, men who later developed cancer reported different family attitudes in youth from those of their healthy classmates. The items checked on a Family Attitude Questionnaire by the future cancer group indicated a lack of closeness to parents compared with the items checked by the healthy group. Family attitudes of the future mental illness/suicide group resembled those of the cancer group, while those of the essential hypertension and coronary heart disease groups were like those of the healthy group. These prospective findings appear to fit with those of retrospective studies concerning early family relationships in cancer patients.

Conditioned suppression of a thymus-independent antibody response.

Abstract: An illness-induced taste aversion was conditioned in mice by pairing cyclophosphamide, an immunosuppressive drug, with the consumption of saccharin, a novel drinking solution. Two weeks after conditioning, animals were injected with the hapten trinitrophenyl (TNP) coupled to the thymus-independent carrier, lipopolysaccharide. Serum antibodies to TNP were titered 6 days later by passive hemagglutination. Relative to control groups, conditioned animals provided with saccharin at the time of antigenic stimulation and, again, 3 days later showed a significant attenuation of their anti-TNP antibody response. In a second experiment, the conditioned stimulus (CS) consisted of the novel saccharin drinking solution plus the noxious internal effects of an injection of LiCl. Conditioned animals reexposed to the CS again showed the lowest antibody titers, but differed significantly from only one of the control groups. Taken together, the results of these experiments confirm previous reports of conditioned immunosuppression and suggest that the effects of conditioning on a primary humoral antibody response can be observed in response to a T-cell independent antigen in the mouse.

Psychoendocrinology of the menstrual cycle: I. Enjoyment of daily activities and moods.

Abstract: Thirty-three women participated in a study of the relationship between moods and enjoyment of activities during the menstrual cycle. All subjects had normal cycles and were screened for psychological health. None were taking oral contraceptives. Each subject filled out daily the Profile of Mood States (POMS) and the Social--Sexual Activities Log (SAAL). They also completed the Moos Menstrual Distress Questionnaire (MDQ) once a month. The SSAL was developed as part of this research in order to provide a means of assessing subjective enjoyment of daily activities. SSAL items were developed from semistructural individual interviews and assessed behavior across eight different categories. Results suggest that the SSAL is a reliable self-report instrument. Although there were no changes in either moods or enjoyment of activities as a function of cycle phase with either the POMS or the SSAL, scores on the MDQ showed the usual cycle-related differences. These findings raise questions concerning the validity of retrospective methods in general, and of the MDQ in particular, as techniques for assessment of personal distress during the menstrual cycle. Equally important, the results suggest that when changes in psychological states are assessed concurrently during the menstrual cycle, the fluctuations observed in a healthy population are minimal.

Results of behavior modification in the treatment of chronic pain.

Abstract: Two hundred patients with chronic pain were treated in an in-patient program in which behavior modification was the major therapeutic modality. The patients were characterized by having had pain of many years' duration, multiple operations, treatment failures, prolonged disability, compensation factors, and dependency on medication. At hospital dismissal, 59% of the patients had achieved moderate improvement or better. At a 3-mo follow-up, 40% of the admitted patients (75% of those successfully treated) were still doing well, and after 1 yr, 25% of those originally admitted continued to do well (65% of those successfully treated).

Assessing personality factors in essential hypertension with a brief self-report instrument.

Abstract: A 16-item self-report instrument was designed and cross-validated, comparing essential hypertensives with normotensives. After item selection using two sets of standardization groups, scores obtained from three additional sets of hypertensive and normotensive groups were significantly different. The scores were not significantly related to variables such as age, sex, socioeconomic status, hypochondriasis, social desirability or target organ involvement. The instrument's factorial structure for hypertensives consisted of factors labeled anger arousal, resentment, anxiety, and attention seeking. Hypertensives reported higher levels of hostility and anxiety than normotensives. High and low scoring subgroups on the instrument were examined on the 16 PF, with hypertensive high scorers demonstrating a different profile than low scoring hypertensives. The existence of two psychological types of essential hypertensives was suggested.

Platelet monoamine oxidase activity correlates with social affiliative and agonistic behaviors in normal rhesus monkeys.

Abstract: After a 4-mo study period, quantitative measures of stable behavioral traits in individual rhesus monkeys correlated significantly with platelet monoamine oxidase (MAO) activity. In particular, behavioral items reflecting social activity and social contact, both agonistic and affiliative, were inversely correlated with enzyme activity. Time spent alone was positively correlated. Since platelet MAO activity is generally stable and predominantly controlled by genetic factors, it might serve as a "genetic marker" for individual differences in "normal" behaviors possibly related to differences in MAO activity in the brain and other tissues.

Long-Term Effect of Relaxation on Blood Pressure and Anxiety Levels of Essential Hypertensive Males: A Controlled Study

Abstract: The long-term effect of relaxation in lowering blood pressure and anxiety was evaluated in this study. Eighteen male Caucasian essential hypertensives with moderate elevations in blood pressure were studied. Relaxation significantly reduced both blood pressure and anxiety. Control procedures had no

Psychosocial risk factors for lung cancer.

Abstract: The existence of psychosocial risk factors for the development of malignancy has been postulated by many investigators. This study investigated selected psychosocial factors as predictors of malignancy. 110 male patients with undiagnosed subacute or chronic pulmonary x-ray lesions participated in a semistructured interview. Ratings were made of 5 subscales: 1) childhood instability, 2) job stability, 3) marriage stability, 4) lack of plans for the future, and 5) recent significant loss. The composite scale correctly predicted the diagnosis of 53 (80%) of the 66 patients with benign disease and 27 (61%) of the 44 with lung cancer. The scale was at least as important as smoking history in predicting diagnoses. Thus, significant psychosocial risk factors for the development of malignant disease might well be incorporated in selecting high-risk individuals for cytological or other screening for lung cancer.

Psychoendocrinology of the menstrual cycle: II. The relationship between enjoyment of activities, moods, and reproductive hormones.

Abstract: Fourteen women served as subjects in a study of the relationships between emotional states, enjoyment of activities, and reproductive hormones. Each subject was psychologically and physically healthy, had a documented history of normal and regular menstrual cycles, was not taking oral contraceptives, and was involved in an ongoing heterosexual relationship. Each woman participated for at least two complete menstrual cycles. The Profile of Mood States and the Social-Sexual Activities Log were filled out daily; other questionnaires were completed less frequently. Blood was drawn between 3 and 5 times/week and was analyzed, using radioimmunoassay methods, from plasma levels of estradiol, progesterone, and luteinizing hormone. Twenty-seven of the twenty-eight cycles appeared to be normal and ovulatory, according to accepted endocrinological criteria. Results showed that in this sample of healthy women there was no relationship between mood states or enjoyment of activities and phase of the menstrual cycle, and no relationship between these psychological states and absolute levels of the reproductive hormones estradiol and progesterone.

Social interactions, communications, and the coronary-prone behavior pattern: a psychophysiological study.

Abstract: Sixty subjects classified as either Type A or Type B interacted in pairs by pressing buttons which transmitted messages through a television screen while the heart rate and digital blood volume pulse were computer-monitored. Partners could cooperate, compete, punish, reward, or withdraw on each interaction and could send 1 of 55 messages communicating feelings, requests, and behavioral intentions between interactions. Interactions and communications between Type A subjects were strikingly different from Type B subjects. Type A's were noticeably more aggressive competitive. Type A dyads also exhibited larger digital vasomotor responses than Type B dyads. When Type A subjects and Type B subjects interacted with each other, rather than with a same-type partner, the differences between them in behavior and vasomotor response largely disappeared.

Psychological stress, ego defenses, and cortisol production in children hospitalized for elective surgery.

Abstract: This study was designed to investigate the relationship between the effectiveness of coping mechanisms and physiological indicators of distress in children faced with the experience of hospitalization and surgery. Twenty-five children between the ages of 7 and 11 were studied in the out-patient department, 2 weeks before surgery, and again during their hospital stay. Effectiveness of defenses and defense style was measured by a clinical interview and by the Rorschach test. Cortisol production rates were measured by the analysis of 24-hour urine collections at home and again in the hospital. Ward adjustment was also rated by a ward questionnaire. The results indicated no relationship between defense effectiveness and cortisol production rates in the out-patient department and an inverse relationship between cortisol production and defense effectiveness under the stress of hospitalization. Defense style was found to correlate with coping under stress. Four different groups of children emerged, suggesting four different types of reaction to the hospital experience.

Emotional disturbance and cognitive deficits in hyperthyroidism.

Abstract: Assessment of cognitive and emotional variables in 19 females with hyperthyroidism was made pretreatment, at 3 weeks, and after euthyroidism was established. A matched group of normal controls was similarly tested. Group differences on cognitive measures did not reach statistical significance, but cognitive deficits and symptoms of emotional disorder were significantly associated with the severity of thyroid toxicity previous to treatment. Measures of cognitive function and personality features moved towards control group values as euthyroidism was established. The implication of these findings is discussed in the context of a review of previous literature. The observed cognitive disturbance and emotional distress appear to be reflections of thyroid toxicity.

Psychological correlates of progression of atherosclerosis in men.

Abstract: Patients who underwent repetitive repetitive coronary angiograms at an average interval of 17 months completed the Jenkins Activity Survey (n = 66) and were given the Rosenman diagnostic interview to measure Type A behavior (n = 45). Significant progression of coronary artery disease was judged to be an increase in occlusion of 25% or more, or progression to total occlusion in any vessel. At subsequent study, 30% of the patients showed evidence of progression. Progression was much more likely in patients with initially more severe disease and was marginally related to cigarette smoking when initial level of disease was controlled. Interview assessment of Type A did not discriminate reliably between the groups in the smaller sample of patients given this measure. There was significant positive association between magnitude of Activity Survey Type A scores and progression of disease, although mean scores on the Type A scale were not reliably different between the Progression and No Progression groups. The pattern of results suggested that extreme Type B subjects (classified by Activity Survey) were unlikely to show progression over this time period.

Psychologic correlates of serum indicators of stress in man: a longitudinal study.

Abstract: Correlations between serum uric acid, cortisol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and psychometric indices of stress--namely, anxiety, hostility, and depression--were investigated in 20 students over a 2 1/2 month academic quarter. There were three peak periods of stress, with two occurring during midterm and final exams. The observed changes in serum cortisol were highly correlated with changes in anxiety and depression. Serum uric acid was significantly depressed during the first half of the quarter, but returned to control levels after midterm exams. Serum cholesterol and the LDL cholesterol subfraction were significantly elevated above control levels and remained elevated throughout the quarter after the first day of classes. Absolute levels of HDL cholesterol varied little throughout the quarter, however, the ratio of HDL cholesterol/total cholesterol was significantly depressed twice in the quarter, each time following approximately 10 days after the peak period of stress.

Adjustment in diabetic adolescent Girls: I. Development of the Diabetic Adjustment Scale.

Abstract: A 37-item scale was designed to assess life adjustment in 105 adolescent girls with juvenile diabetes. The scale elicited information on peer relationships, family relationships, body image concerns, dependence-independence conflicts, school adjustment, and attitudes toward diabetes. Results of this initial attempt at measuring diabetic adjustment suggest that this group of girls was relatively well adjusted and that their attitudes toward diabetes correlate positively with many adjustment factors. The importance of self-report scales which address the realities of life with diabetes is emphasized.

Medical outcome in asthmatic patients: effects of airways hyperreactivity and symptom-focused anxiety.

Abstract: Hypotheses about medical outcome in asthma, indexed by rates of rehospitalization within 6 months after discharge from long-term intensive care, were evaluated. Predictions for rehospitalization were based on the levels of airways hyperreactivity, indexed by inhalation challenges with histamine or methacholine, and levels of anxiety focused upon and concurrent with periods of asthmatic distress, indexed by Panic-Fear symptomatology. Results indicated that, although some prediction could be made on the basis of levels of anxiety and airways hyperreactivity alone, the best predictions resulted from the combined effects of these factors. Almost half of the patients who had highly hyperreactive airways and a tendency to disregard symptoms of breathing difficulty were rehospitalized. By comparison, none of the patients who had less hyperreactive airways and a tendency to be vigilant about their symptoms were rehospitalized. The hypotheses and results are discussed with respect to symptom-focused and general, illness-dependent types of anxiety which have different effects upon medical outcome in chronic asthma. The results have implications for the application of anxiety-reducing forms of intervention in asthma.

Effects of Thematically Relevant and General Stressors on Specificity of Responding in Asthmatic and Nonasthmatic Subjects

Abstract: Twenty-nine mild asthmatics and 12 nonasthmatics were exposed to three films of varying emotional content to assess differential patterns of physiological response in the cardiac, ventilatory, and bronchial systems. Results indicated that only cardiac interbeat interval (IBI) and total respiratory resistance (RT) were reliable indices of reactivity. In a film of thematic relevance to asthmatics which depicted asthmatic children in a hospital setting, asthmatics evidenced sustained elevation of RT throughout the entire film with no reactivity in IBI. Nonasthmatics did not evidence any significant reactivity to the film. In a film of a generally stressful nature which depicted industrial accidents, asthmatics evidenced elevated RT in response to the accident scenes. Both asthmatic and nonasthmatic subjects responded to the post-accident periods with increases in IBI. In a film depicting a mother giving up her child for adoption, asthmatics responded to the relinquishing of the child with elevated RT. These results are discussed in terms of the necessity of evolving a comprehensive theory of specificity patterns in psychosomatic disorders which goes beyond models of symptom specificity and stimulus-response specificity, neither of which can adequately account for these results. The results are further seen as supporting the utility of selecting stressors of thematic relevance to asthmatics and measuring symptom-relevant indices of physiological reactivity to isolate these specificity patterns in response to stress.

Adjustment in diabetic adolescent girls: II. Adjustment, self-esteem, and depression in diabetic adolescent girls

Abstract: The Rosenberg Self-Esteem Scale, Beck Depression Inventory, and Sullivan Diabetic Adjustment Scale were administered to 105 adolescent girls with diabetes. Results indicate that levels of self-esteem and depression highly correlate with the level of adjustment as assessed on the Diabetic Adjustment Scale (DAS). That is, the adjustment of adolescent diabetic girls in peer and family relationships, dependence-independence conflicts, and attitudes toward diabetes is significantly related to self-esteem; and the level of depression is significantly related to all these adjustment factors as well as body image. The results point to the usefulness of the DAS as a potential screening device for low self-esteem and depression in adolescent girls who have diabetes. The importance of diabetes as a scapegoat for normal adolescent concerns is discussed. It was also hypothesized that depression in adolescents may be expressed through concerns about diabetes. The importance of exploring relationships with peers and fathers is emphasized.

Taste Detection and Preferences in Diabetics and their Relatives

Abstract: In order to determine whether a generalized defect in glucose recognition exists in diabetes, taste detection and preference were measured in adult onset diabetics (AOD), juvenile onset diabetics (JOD), and healthy first-degree relatives of diabetics (NR). Controls (C) were age and sex matched nondi

Renin, cortisol, and aldosterone during transcendental meditation.

Abstract: The effects of transcendental meditation (TM) on plasma renin activity (PRA) and plasma concentrations of aldosterone, cortisol, and lactate were studied by measuring these variables before, during, and after 20--30 min of meditation. Subjects, who rested quietly rather than meditating, served as controls. There were no differences in the basal values for these variables between meditators and controls, but controls, in contrast to meditators, showed a significant increase in cortisol between the first (A) and second (B) samples of the control period. PRA increased slightly (14%) but significantly (p less than 0.03) during TM, but not during quiet rest in controls. Cortisol decreased progressively (after sample B) throughout the experiment to the same degree in both groups. Aldosterone and lactate did not change. The data do not support the hypothesis that TM induces a unique state characterized by decreased sympathetic activity or release from stress, but do suggest that meditators may be less responsive to an acute stress.

Behavioral intervention with muscle-contraction headache: a review.

Abstract: Studies involving behavioral intervention with muscle-contraction headache are reviewed. Intervention approaches have most frequently involved frontal electromyographic feedback and relaxation instructions. Although behavioral intervention packages have been more effective than control procedures in reducing headache activity, identification of active components of these packages is difficult. Specifically,, the contribution of placebo, expectancy and demand factors, reactive effects of self-monitoring, and home practice have not been adequately assessed. The importance of assessing individual differences in etiology and in response to intervention is stressed. The results of some studies are congruent with the hypothesized muscle tension etiology of muscle-contraction headaches but the results from others suggest that factors other than muscle-tension may be involved. Supportive laboratory research on the intervention procedures and cost-efficiency of electromyographic feedback and relaxation instructions are discussed.