Psychological aspects of Crohn's disease

This is a critical review of 16 studies reporting a relationship between Crohn's disease and psychological variables. The studies reviewed indicate a relationship between the psychological variables of stressful life events, personality characteristics, and psychopathology and the onset and/or exacerbation of Crohn's symptoms. Personality characteristics such as depression, anxiety, and dependency are frequently reported as are the occurrence of stressful life events and the presence of psychopathology. The nature of the relationship is not explained by the research to date; however, the findings summarized in this report indicate that additional investigation into this association is warranted. A plan for such research is suggested.     

Type A and hardiness

The study examined the relationship between the Type A behavior pattern and personality hardiness and predicted an interaction between the two that would be influential for illness onset. Type A and hardiness were found to be conceptually different and empirically independent factors. Under high stressful life events, male executives who were high in Type A and low in hardiness tended toward higher general illness scores than any other executives. Type A and hardiness emerge from this study as bases for extrinsic and intrinsic motivation, respectively.     

Life events in bipolar disorder: towards more specific models

This article reviews the evidence concerning life events as a predictor of symptoms within bipolar disorder. First, key methodological issues in this area are described, and criteria used for including studies in this review are defined. Then findings that negative life events predict worse outcomes within bipolar disorder are reviewed. Beyond general studies on relapse, it is important to differentiate predictors of depression from predictors of mania. When severe negative life events occur, they appear to trigger increases in bipolar depression. Nonetheless, many depressions are unrelated to negative life events and appear to be triggered by other variables. The strongest evidence suggests that negative life events do not trigger mania, except perhaps in certain contexts. Retrospective findings for schedule-disrupting life events as a trigger for manic symptoms await further assessment within a longitudinal study. Life events involving goal attainment do appear to trigger manic symptoms. Overall, it is time to differentiate among specific types of life events, as these different forms of events point towards mechanisms linking stressors with symptom expression. These mechanisms provide clues into ways to integrate the social environment with biological vulnerability (see [Monroe, S.M., & Johnson, S.L. (1990)). the dimensions of life stress and the specificity of disorder. Journal of Applied Social Psychology, 20, 167-1694; Harris, T.O. (1991). Life stress and illness: the question of specificity. Annals of Behavioral Medicine, 13, 211-219]).     

Stressful life events and skin diseases: disentangling evidence from myth

The possibility of a causal influence of emotional stress, especially of stressful life events, on the course of various skin diseases has long been postulated. Clinical wisdom and experience, as well as many anecdotal observations and uncontrolled case series, support this opinion. We reviewed the available evidence on the role of stressful life events in triggering or exacerbating skin diseases. The role of stressful events in vitiligo, lichen planus, acne, pemphigus and seborrhoeic dermatitis was either controversial or insufficiently explored. The role of stressful events in psoriasis, alopecia areata, atopic dermatitis and urticaria was apparently clearer. However, only a few studies met acceptable methodological standards for stress measurement. Also, few studies considered common potential confounding factors (e.g. age, duration of illness, familial factors), and no study controlled adequately for the influence of other crucial factors (e.g. discontinuation of treatment, seasonal effects). Adding that the large majority of studies were retrospective, it seems wise to conclude that only preliminary evidence has been published so far on the role of stressful life events in bringing on or worsening any dermatological disease. Further research is mandatory, either in the form of prospective studies or, more feasibly, of well-designed case-control studies with adequate statistical power. Future studies should also pay more attention to protective as well as vulnerability factors in stressful events. Further, it would be important to investigate other sources of psychological stress, such as chronic stress and everyday stress. Measuring stress appraisal, although difficult, would also be important.     

Psychologic stress and glycemic control: a comparison of patients with and without proliferative diabetic retinopathy

Using a case/control design, patients with (cases) and without (controls) proliferative diabetic retinopathy were compared using three psychosocial measures: life events, psychiatric symptomatology, and ego development. Cases reported significantly more symptoms. They also demonstrated a modest and significant correlation of negative life events with HgbA1c that was not shown in the controls. When the relationship of life events with glycemic control was explored in cases of varying durations of proliferative retinopathy, we found that the association between negative life events and HgbA1c was accounted for by the cases with a recent onset of retinopathy. Patients in this recent group showed a trend towards more negative life events that decreased with longer duration of proliferative retinopathy. This study suggests that the onset of proliferative retinopathy portends a life crisis during which metabolic control is sensitive to additional life stress and that this association is not found among patients whose illness is more stable.     

Mass media images of mental illness: A review of the literature

Studies that address the frequency, accuracy, and impact of mass media portrayals of mental illness are reviewed. Numerous studies of frequency and content of media depictions support clinical observations that mental illness is frequently depicted in the mass media, particularly the entertainment media, and that these depictions tend to be inaccurate and unfavorable. Limitations, such as age of the studies and mixed attention to psychiatry, psychology, and mental illness, however, leave a need for further such studies. Investigations of the specific impact of media images of mental illness support the belief that media presentations about mental illness, including those in entertainment form, can have significant effects on attitudes toward mental illness and treatment. These studies, however, are few in number and have demonstrated only short-term effects of specific portrayals. Further research is needed to demonstrate longlasting effects and the overall impact of multiple, repeated, media depictions.     

A prospective test of the stress-buffering model of depression in adolescent girls: no support once again

The stress-buffering model posits that social support mitigates the relation between negative life events and onset of depression, but prospective studies have provided little support for this assertion. The authors sought to provide a more sensitive test of this model by addressing certain methodological and statistical limitations of past studies with prospective data from 496 adolescent girls. Deficits in peer support predicted increases in depressive symptoms, and negative life events predicted onset of depressive pathology. However, none of the 14 prospective tests provided support for the stress-buffering model despite sufficient power. Results provide scant support for the stress-buffering model and suggest that it might be time to shift attention to alternative multivariate models concerning these risk factors.     

Self-esteem, life stress and psychiatric disorder

Using a special subsample from a survey of women in Edinburgh investigations were carried out into (a) which types of life event are associated with lowered self-esteem; (b) the role of life events and self-esteem in onset of psychiatric disorder; and (c) the additional significance of prior psychiatric consultation in determining onset. Stressors involving impaired relationships with others were the only ones clearly associated with lowered self-esteem. Minor psychiatric illness was predicted by stress of uncertain outcome, and, to a lesser extent, by impaired relationship stress. Onset of major depression was best predicted by an interaction between total stress experienced and low self-esteem. There was evidence that such onset involves a pre-existing low level of self-esteem on which life stress impinges, rather than life stress generating low self-esteem and then onset. A small group of subjects characterised by low self-esteem, prior psychiatric consultation and maladaptive coping seemed to be fluctuating in and out of psychiatric illness irrespective of stress.     

The neurodevelopmental hypothesis of schizophrenia: following a trail of evidence from cradle to grave

This is a critical review of the literature related to the neurodevelopmental hypothesis of schizophrenia which posits that the illness is related to abnormal brain development. The review focuses on data deriving from clinical studies, and it is organized according to the life phase from which the data were collected: conception and birth, infancy and childhood up to the onset of the illness, after illness onset, and postmortem. The neurodevelopmental hypothesis is supported by several pieces of evidence, including increased frequency of obstetric complications in patients with schizophrenia: the presence of minor physical anomalies; the presence of neurological, cognitive, and behavioral dysfunction long before illness onset; a course and outcome of the illness itself that is incompatible in most cases with a degenerative illness; the stability of brain structural measures over time; and the absence of postmortem evidence of neurodegeneration. A historical perspective on how this research accumulated and a section addressing important areas of future investigation are also provided. We conclude that schizophrenia is certainly not a degenerative brain disorder, and that it is likely that a brain insult in utero or at birth plays a role in its expression. Current evidence cannot completely exclude the role of environmental variables after birth. In addition, it is possible that other psychiatric disorders may also have a neurodevelopmental component.     

A Review of Studies Comparing Checklist and Interview Methods of Data Collection in Life Event Research

Abstract

This article is concerned with the relative merits of checklists and interviews as techniques for collecting data in the study of life events. It presents a detailed review of studies that have directly compared checklists and interviews. The author's conclusion is that the two techniques should not be seen as equivalent in the assessment of life events. Virtually all of the studies reviewed showed a marked tendency to overreport on checklists. The method appears inadequate in distinguishing truly stressful events from trivial occurrences. In contrast, the in-depth interview is sensitive to the subtleties of life events and should be the preferred method when data of any precision and accuracy are required in an empirical study.     

Life events and the onset of affective disorder. A longitudinal general population study

This paper examines the relationship between life events (ascertained by the Bedford College method) and the onset of affective disorder (defined according to the RDC scheme) in a longitudinal general population survey of women. Fall-off in the reporting of minor events is examined and discussed. Event rates, proportions of women challenged by events, and measures of the risk of RDC disorder associated with the experience of particular events are reported. The results based upon data from an initial interview were largely consistent with those based upon follow-up data, and underpinned earlier work. For both data sets, major difficulties were associated with illness onset. Severe dependent events showed stronger effects than severe independent events but both categories were rare. New substantive findings arising from short-term general population event research are unlikely.     

Contribution of life events to causation of psychiatric illness

This paper discusses the magnitude of the effect of life events in the causation of psychiatric illness. It is argued that an established epidemiological concept, relative risk, provides a useful measure of association which can be approximately adapted for retrospective controlled studies. Examination of studies employing general population controls consistently indicates effects of some importance, with risks of illness increased by factors of between 2 and 7 in the 6 months after an event. Risks are greater for the more stressful types of events, greater for depression and neuroses than schizophrenia, and even greater for suicide attempts. However, similar events occur commonly and a large proportion of event occurrences are not followed by illness. Events must interact with a wide variety of background factors, and the appropriate model is one of multifactorial causation.     

Recovery from infectious mononucleosis: a case for more than symptomatic therapy? A systematic review.

Infectious mononucleosis is usually an acute, transiently incapacitating condition, but for some sufferers it precipitates chronic illness. It is unclear which patients are at risk of a prolonged state of illness following onset of infectious mononucleosis and if there are any useful preventive measures that would facilitate recovery. The aim of this study was to review all cohort studies and intervention trials that provide information on: (a) the longitudinal course of ill health subsequent to the onset of infectious mononucleosis; (b) the relationship between psychosocial and clinical factors and recovery rate; and (c) the effect of interventions on recovery. A systematic review was conducted, based on a search of the PSYCHINFO, MEDLINE, EMBASE and CINHAL databases up to October 2001, and ISI Science and Social Sciences Citation Indices up to 22 November 2001. Eight papers were identified that gave data on illness following onset of infectious mononucleosis. The best evidence concluded that there is a distinct fatigue syndrome after infectious mononucleosis. Eight papers explored risk factors for prolonged illness following acute infectious mononucleosis. Results varied on the association of acute illness characteristics and psychological features with prolonged ill health. Poor physical functioning, namely lengthy convalescence and being less fit or active, consistently predicted chronic ill health. Three trials reported on interventions that aimed to shorten the time taken to resolve symptoms after uncomplicated infectious mononucleosis. None of the drug trials found any evidence that drug therapy shortens recovery time. The trial that compared the effect of activity with imposed bed rest, found that those patients allowed out of bed as soon as they felt able reported a quicker recovery. More information is needed on the course of ill health subsequent to the onset of infectious mononucleosis. Certain risk factors associated with delay may be amenable to a simple intervention in primary care.     

Major tranquillisers used as antidepressants: A review

The use of major tranquillisers as antidepressants is reviewed and 34 double-blind trials evaluating this were found. Results suggest that some neuroleptics have antidepressant properties, although most studies have been conducted on mixed anxiety-depressive states. Advantages over the tricyclic antidepressants are the early onset of action and relative lack of side-effects. Post psychotic depression following major tranquilliser therapy is considered, and it is concluded that it is likely to be part of the underlying illness and not a drug-induced effect. It is suggested that further work with major tranquillisers in depression may be of value in exploring the mechanism of action of antidepressant drugs.     

Age and health perceptions of psychogeriatric patients

How the elderly perceive themselves has interested gerontologists for some time. Younger age perceptions have been associated with better psychological functioning or emotional adjustment. Most researchers and professionals agree that an important component of 'emotional adjustment' or 'mental health' is life satisfaction. Because of this consensus, numerous studies and papers have been written on life satisfaction in the elderly. In general, these studies have found significant correlations between life satisfaction and health, and despite the relative stability of life satisfaction, it can be affected by life events. While most studies have dealt with the 'healthy' elderly, there is little if any literature on elderly hospitalized psychiatric patients. This study explores age biases, health and age perceptions, as well as life satisfaction over the course of psychiatric hospitalization for geriatric patients. A questionnaire was developed to elicit age and health perceptions of psychogeriatric patients. The questionnaire was piloted with 17 geriatric patients admitted to the Geriatric Day Treatment Center. The questionnaire was administered to 24 patients admitted to the inpatient service of the Department of Geriatric Psychiatry during the first week of admission and on the week of discharge. The results of this study may help us with the educational needs of psychogeriatric patients regarding the normal aging process, as well as increase understanding of the effects of psychiatric illness on perceived age, health and life satisfaction in the geriatric population.     

Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study

BACKGROUND: The role of stress in the onset of chronic fatigue syndrome is unclear. Our objectives in this study were first, to determine the relation between the onset of chronic fatigue syndrome and stressful life events and difficulties. Secondly, we examined the role of a particular type of problem, dilemmas, in the onset of chronic fatigue syndrome. METHOD: We used a case-control design with 64 consecutive referrals from an Infectious Diseases/ Liaison Psychiatry Fatigue clinic and 64 age- and sex-matched controls from a general practice population control group in Leeds. We had two main outcome measures; the odds ratios of the risk of developing chronic fatigue syndrome after experiencing a severe life event, severe difficulties or both in the year and 3 months preceding onset; and the proportion of subjects in each group who experienced a dilemma prior to onset. RESULTS: Patients with chronic fatigue syndrome were more likely to experience severe events and difficulties in the 3 months (OR = 9, 95% CI 3.2 to 25.1) and year (OR = 4.3, 95% CI 1.8 to 10.2) prior to onset of their illness than population controls. In the 3 months prior to onset 19 of the 64 patients (30%) experienced a dilemma compared to none of the controls. CONCLUSIONS: Chronic fatigue syndrome is associated with stressful events and difficulties prior to onset. Those events and difficulties characterized as being dilemmas seem to be particularly important.     

Stressful life events and onset of mood disorders in children of bipolar parents during 14-month follow-up

BACKGROUND: Although multiple studies have examined the association between stressful life events (SLEs) and the development of mood disorders, the exact nature of the association and the degree to which it is independent from familial loading (FL) and gender-specific are still not fully elucidated. AIMS: To study the association between person-independent and -dependent SLEs and first onset or recurrence of a DSM-IV mood disorder episode (MDE) in offspring of bipolar parents. To examine interaction effects of SLEs with familial loading and gender. METHOD: Offspring of bipolar parents (N=132) were assessed with the K-LEDS, the FHRDC and the K-SADS. Logistic regression analysis was used to examine main and interaction effects of various operationalizations of SLEs, familial loading and gender. RESULTS: Dependent SLEs were more likely to occur before onset among the 13 offspring who had a MDE onset during the 14-month follow-up (39%) than in a comparable period among the 67 controls without any lifetime diagnosis (10%). Associations were slightly stronger for first onsets than for recurrences. The association between SLEs and MDE onset/recurrence was independent of socio-demographic characteristics and familial loading, but disappeared when adjusted for baseline anxious/depressive symptoms. Gender and familial loading did not modify the influence of any SLE measure on the development of mood disorders. CONCLUSIONS: In this sample of bipolar offspring dependent stressful SLEs triggered the onset of MDEs, but this association disappeared after adjustment of prior anxious/depressive symptoms, indicating that the association between SLEs and MDE is probably a spurious association. No interaction was found between SLE and FL and gender. Prior anxious/depressive symptoms seem to increase the risk for both occurrence of dependent SLEs and MDE onset or recurrence. LIMITATIONS: Limited statistical power due to small number of MDE onsets.     

Intellectual characteristics of diabetic children at diagnosis and one year later

Examined neurocognitive functions in 63 newly diagnosed pediatric patients with insulin-dependent diabetes mellitus (DM) at onset of illness (T0) and 1 year postdiagnosis (T1). Siblings (S) serving as controls were assessed at T0 only. Subjects were given age-appropriate tests of verbal and visuospatial abilities. In addition, DM were interviewed regularly during diabetes clinic to determine current diabetic control and different intervening glycemic-related events. Results revealed no differences between DM and S at T0, nor any specific impairment in DM predating illness. Also, DM did not demonstrate any acquired impairment after 1 year of illness. Children with early onset DM (less than 5 years) scored lower in spatial ability at T0 and T1 than children with later onset DM, who scored lower in verbal ability. Episodes of asymptomatic and mild chronic hypoglycemia correlated positively, not negatively, with improved outcome over time. There were no adverse effects of severe hypoglycemia. Ketonuria and hospitalizations were associated with lower performance IQs 1 year after onset, as was diabetic ketoacidosis at onset. Results are discussed in terms of critical periods of sensitivity of different brain regions to the effects of diabetes and the need for longer follow-up of these children.     

Transient bacteraemia: a possible cause of sudden life threatening events

The concept proposed is that transient bacteraemia occurring in otherwise healthy individuals can cause acute life threatening events due to bacterial toxaemia even though the bacteraemia is rapidly cleared (<20 min). This is most likely to occur in infancy at around two to three months of age when anti-toxin IgG reaches its nadir. Sudden unexpected death in infancy, acute life threatening events, haemorrhagic shock and encephalopathy, and the triad of retinal haemorrhage, encephalopathy and bilateral thin film subdural haematomata are conditions which could be caused by this mechanism. Investigations need to be directed to measuring bacterial toxins in blood, CSF and urine; anti-toxin IgG in blood; and bacterial specific nucleic acid sequences in blood, CSF and urine using polymerase chain reaction in order to confirm recent bacteraemia. Furthermore the upper respiratory tract bacterial flora should be mapped in cases and appropriately matched live healthy community controls. Sudden onset, profound life threatening physiological dysfunction occurring in later life could also be caused by a similar mechanism and should be investigated in a similar way; candidate conditions include epilepsy, migraine, stroke and cardiac arrhythmias.     

Prediction of Symptoms and Illness Behaviour From Measures of Life Change and Verbalized Depressive Themes

A new measure of depressiveness in speech content and the Schedule of Recent Experiences are used to predict illness reports and clinic use in two samples of subjects. The results suggest that the more life change the subjects reported, the more depressiveness they verbalized, and that both life change and depressiveness scores predict illness reports and health service users. Multivariate combinations of the measures of life change and depressiveness gave better predictions than either measure alone, and the measure of depressiveness for the most part gave somewhat better predictions than the life change measure. This suggests that it is important to quantify reactions to life events. In addition, it suggests that the two longstanding currents of interest in psychosomatic medicine which concern the importance of life events on the one hand and of affective and intrapsychic events on the other can profitably be integrated.