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. Glaser.1@osu.edu

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. K.Vedhara@bristol.ac.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. Bjorn.Axtelius@odparod.lu.se

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. scohen@cmu.edu

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

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].

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].

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].

Goranchuk VV, Smirnov VS

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

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

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

McCain NL, Smith JC

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

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

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

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

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

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

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

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].

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

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

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

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

Hodel L, Grob PJ

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

Basics in psychoneuroimmunology.

Kropiunigg U

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

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

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

Psychosocial factors and immunity in nonhuman primates: a review.

Coe CL

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

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

[Stress and depression].

Brochier T, Olie JP

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

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

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

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

Marbach JJ

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

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

Behavioral factors in stress-induced immunomodulation.

Sandi C, Borrell J, Guaza C

` 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

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

[Immunology and psychiatry].

Consoli SM

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

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

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

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

Psychoneuroimmunology.

Baban A

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

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

Bochenkov AA, Smirnov VS, Goranchuk VV

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

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

[Psychogenic stimulation of the immune system by nutrition].

Bergler R, Zipperling C

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

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

Bochenkov AA, Goranchuk VV, Smirnov VS

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

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

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

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

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

Stress and anxiety.

Robinson L

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

Stress, emotion, and human immune function.

O'Leary A

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

Facial pain, distress, and immune function.

Marbach JJ, Schleifer SJ, Keller SE

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

Facial pain, distress, and immune function.

Marbach JJ, Schleifer SJ, Keller SE

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

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

Human psychoneuroimmunology today.

Biondi M, Kotzalidis GD

[Psychoimmunology].

Schwarz-Ottersbach E

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

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

Kropiunigg U, Hamilton G, Roth E, Simmel A

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

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

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

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

Lipowski ZJ

Adv Psychosom Med 1987;17:234-51

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

Biondi M, Pancheri P

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

Cancer from a biobehavioural and social epidemiological perspective.

Baltrusch HJ, Waltz M

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

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

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

Borysenko JZ

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

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

Psychosomatic aspects of cancer: an overview.

Murray JB

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

Psychosocial factors related to the incidence of cancer.

Scurry MT, Levin EM

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

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

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

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

Biondi M, Picardi A

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

Psychoneuroimmunology and cancer: historical perspectives and current research.

Fife A, Beasley PJ, Fertig DL

Annu Rev Psychol 1996;47:113-42

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

Cohen S, Herbert TB

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

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

Montagne G, Lalonde R, Brouillette MJ

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

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

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

[Psychosocial factors in patients with duodenal ulcer].

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

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

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

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

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

Pelletier KR

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