Inflammatory cytokines,socioeconomic status,and acute stress responsivity

Socioeconomic status is a major determinant of coronary heart disease (CHD). Proinflammatory cytokines are implicated in the etiology of CHD, and are also sensitive to emotional stress. We hypothesised that concentration of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1 receptor antagonist (IL-1Ra) would be inversely related to socioeconomic status, and that cytokine responses to stress would be associated with SES. One hundred and twenty-five middle-aged men and 105 women from the Whitehall II epidemiological cohort were tested, and socioeconomic status was indexed by grade of employment, with participants divided into high, intermediate, and low status groups. Plasma concentrations at rest of TNF-alpha, IL-1Ra, and IL-6 (women only) were associated with socioeconomic status, with lower levels in the high status group, but the effect was non-linear. There was no relationship between socioeconomic status and cytokine responses to stress, but sex differences were observed, with men showing greater TNF-alpha, and women greater IL-6 and IL-1Ra increases. The role of inflammatory cytokines in mediating psychosocial influences on CHD is discussed.     

Status epilepticus in children: aetiology, treatment, and outcome

This retrospective study includes 65 children treated for status epilepticus at Tampere University Hospital in Finland. Aetiology of the condition, effectiveness of the treatment protocol, including short barbiturate anaesthesia to prevent prolonged status epilepticus episodes, and neurological outcome were evaluated. Symptomatic aetiology was present in 40% of status epilepticus episodes, and 37% of episodes were induced by fever. Neurological sequelae secondary to status epilepticus were identified in 15% of the cases and subsequent epilepsy in 23% during the mean follow-up time of 3.6 years. There were no status epilepticus-related deaths. The cut-off point of status epilepticus duration for significant risk for permanent neurological sequelae was 2 hours. Our treatment protocol, including short barbiturate anaesthesia in refractory cases, was able to abort status epilepticus in less than 2 hours in 75% of cases. We conclude that early and prompt use of barbiturate anaesthesia should be encouraged, and may explain our low morbidity figures.     

The social cognitive neuroscience of aggression,violence, and psychopathy

Social status is a key regulator of health and reproduction in mammals, including humans. Despite this, relatively little is known about how social status influences the mammalian brain. Furthermore, the extent to which status is an independent construct, i.e., not simply acting as a psychosocial stressor, is yet to be determined. Research to date reveals several promising mechanisms and/or systems associated with social status, including monoamine systems, hypothalamic neuroendocrine axes, and the hippocampus, though whether these differences are the cause or effect of status is often unclear. We review these candidates and propose how best to approach this research question in the future.     

Divorce, socioeconomic status, and children's cognitive-social competence at school entry

All 115 kindergarteners in a suburban school district were evaluated with an extensive battery of intellectual, academic, social, and adaptive behavior measures to determine the predictive significance of single-parent status on school-entry competencies. Divorce was found to add significant amounts of independent variance to the socioeconomic status predictions of several criteria, specifically those relating to social and academic competence. Both single-parent status and SES were more powerful predictors than other family background, developmental history, and health variables.     

MRI volumetry of the hippocampus, amygdala, entorhinal cortex, and perirhinal cortex after status epilepticus

Neuronal damage has been observed in the medial temporal lobe of both humans and animals following status epilepticus. The aim of the present study was to investigate the occurrence of medial temporal lobe damage in status epilepticus patients treated in hospital with a predetermined protocol and to assess whether the changes progress in a long-term follow-up. The volumes of the hippocampus, amygdala, entorhinal and perirhinal cortices were measured using magnetic resonance imaging (MRI) in nine adult patients with status epilepticus 3 weeks, 6 and 12 months after the insult. The control group included 20 healthy subjects. The etiology of status epilepticus was an acute process in one patient and a chronic process in eight cases. The mean duration of secondarily generalized tonic–clonic status epilepticus episodes was 1 h and 44 min. Volumetric MRI indicated that none of the patients developed marked volume reduction in the hippocampus, amygdala, or the entorhinal and perirhinal cortices during the 1-year follow-up period. Status epilepticus does not invariably lead to a progressive volume reduction in the medial temporal lobe structures of adult patients treated promptly in hospital with a predetermined protocol for rapid cessation of seizure activity.     

Presentation,evaluation, and treatment of nonconvulsive status epilepticus

Nonconvulsive status epilepticus (NCSE) is much more common than is generally appreciated. It is certainly underdiagnosed, but its presentation is protean. Diagnostic criteria and treatment are controversial. Absence status is characterized by confusion or diminished responsiveness, with occasional blinking or twitching, lasting hours to days, with generalized spike and slow wave discharges on the EEG. Complex partial status consists of prolonged or repetitive complex partial seizures (with a presumed focal onset) and produces an "epileptic twilight state" with fluctuating lack of responsiveness or confusion. There is a clear overlapping of syndromes. Other confused, stuporous, or comatose patients with rapid, rhythmic, epileptiform discharges on the EEG may have "electrographic" status and should be considered in the same diagnostic category. NCSE typically occurs following supposedly controlled convulsions or other seizures, but with persistent neurologic dysfunction despite apparently adequate treatment. Confusion in the elderly or among emergency room patients is also a typical setting. The diagnosis of NCSE usually involves an abnormal mental status with diminished responsiveness, a supportive EEG, and often a response to anticonvulsant medication. All patients have clinical neurologic deficits, but the EEG findings and response to seizure medication are variable and are more controversial criteria. The response to drugs can be delayed for up to days. Experimental models and pathologic studies showing neuronal damage from status epilepticus pertain primarily to generalized convulsive status. Most morbidity from NCSE appears due to the underlying illness rather than to the NCSE itself. Some cases of prolonged NCSE or those with concomitant systemic illness, focal lesions, or very rapid epileptiform discharges may suffer more long-lasting damage. Although clinical studies show little evidence of permanent neurologic injury, the prolonged memory dysfunction in several cases and the similarities to convulsive status suggest that NCSE should be treated expeditiously. The diagnosis is important to make because NCSE impairs the patient's health significantly, and it is often a treatable and completely reversible condition.     

Humor coping, health status, and life satisfaction among older adults residing in assisted living facilities

The present study examined the relationships between humor coping, health status, and life satisfaction among older residents of assisted living facilities. A structural equation model with latent variables was specified for the three variables. Health status was expected to directly affect humor coping and life satisfaction. Humor coping was hypothesized to have a direct association with life satisfaction and indirectly affect the relationship between health status and life satisfaction. Participants completed the Multidimensional Functional Assessment Questionnaire, Coping Humor Scale, and Life Satisfaction Index A. The relationships between health status and humor coping and health status and life satisfaction were statistically significant. Both the direct association of humor coping on life satisfaction and the intervening role between health status and life satisfaction were not supported. Humor as a coping strategy seems to be available to older adults who are in better health.     

Childhood social adjustment, adolescent status, and young adult mental health

A sample of 2453 grade school children were followed through record sources into young adulthood. Data on peer status and social class were collected, and a subset was subsequently located in high school yearbooks. Those with mental health treatment during young adulthood were determined. Significant relationships were found between peer status and high school activity, and young adult adjustment, with low peer status children having two to three times greater risk for mental health treatment contact in young adulthood.     

Generalized tonic-clonic status epilepticus: causes, treatment, complications and predictors of case fatality

We retrospectively reviewed the clinical course of 66 patients treated for generalized tonic-clonic status epilepticus at the Ege University neurological intensive care unit from 1988 to 1997. Seventy-two per cent of the study group had a pre-existing seizure disorder, and antiepileptic drug withdrawal was the most prominent cause of status epilepticus. The other causes included drug toxicity, central nervous system infection, cerebrovascular disease, tumour and trauma. Seventy-three per cent of all patients responded to the first-line therapy (diazepam and/or phenytoin), and the remainder were considered to have refractory status epilepticus and required pentobarbital anaesthesia. Overall case fatality was 21%, but death could be attributed directly to status epilepticus and/or treatment complication in 10% of the study group. Major determinants of fatal outcomes were: increasing age, longer duration of status epilepticus before initiation of therapy and central nervous system infection as a causal factor. Received: 9 December 1997 Received in revised form: 23 February 1998 Accepted: 30 March 1998     

Investigating the Relationship between Perceived Discrimination, Social Status, and Mental Health

A growing body of evidence suggests that experiences with discrimination have implications for mental health and that these associations may vary by social status. We use data from the Chicago Community Adult Health Study (CCAHS) to examine how two types of perceived discrimination, chronic everyday discrimination and major lifetime discrimination, are linked to mental health, and how this association varies by race/ethnicity, gender, and socioeconomic status. Results indicate that everyday discrimination is generally independently linked to greater depressive symptoms, loneliness, and hostility across all social status groups. Major discrimination is not associated with depressive symptoms or loneliness after adjusting for a host of covariates, but is associated with hostility, especially for certain groups. These findings highlight the need to examine multiple indicators of discrimination and mental health, and to pay attention to both differences and similarities in these associations by social status.     

Usefulness of L-arginine infusion for status epilepticus in mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes

We encountered an 11-year-old girl with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) who developed occipital lobe epilepsy at the age of 7 years and 4 months. Thereafter she had repeated status epilepticus associated with stroke-like episodes. Status epilepticus consisted of repetitive complex partial seizures with or without secondarily generalized tonic clonic seizures. The seizures did not respond to conventional anticonvulsive drugs, including diazepam, midazolam, phenytoin, lidocaine, chloral hydrate, and thiamylal sodium, and lasted for several hours (mean 9.5 hours). At the age of 11 years, intravenous infusion of L-arginine (0.5 g/kg body weight) was first given five hours after the onset of status epilepticus. The seizures and electroencephalographic abnormalities improved dramatically. After the introduction of L-arginine, in addition to shortened duration of status epilepticus (mean 3 hours), clinical recovery from the status epilepticus was prompt, and the average hospitalization periods could be shortened. There were no obvious adverse effects, including vomiting, hypotension, and urticaria. Our experience suggests that early intravenous administration of L-arginine may be useful in the treatment of status epilepticus associated with stroke-like episode in patients with MELAS.     

Anomia,socioeconomic status,and mental disturbance

Utilizing the 22-ltem Mental Health Scale developed by the staff of the Midtown Manhattan Project, the mental health status of a sample of 900 married women residing in a Western state is examined. The concern is with further investigation of prior research findings regarding associations between anomia, social class variables, and psychiatric impairment. The findings indicate that subjects' feelings of anomia maintain a significant relationship with psychiatric impairment within each socioeconomic category investigated. Data further reveal that the proportion of subjects reporting psychiatric symptomatology decreases with increasing status but that the relative risk of such symptoms for highly anomic respondents (compared to nonanomic subjects within each category) is much higher for the highest status groups than for the lower groups.     

Functional health status and its relationship to depressive personality disorder, dysthymia, and major depression: preliminary findings

Controversy continues on the extent to which depressive personality disorder (DPD) and dysthymic disorder (DYST) may be differentiated. Although affective disorders often are accompanied by changes in functional health status, to date no study has examined how functional health associated with affective disorders may assist in differentiating the two disorders. In this study, we hypothesized that measures of DPD would have fewer correlations with functional health status than would measures of DYST and major depressive disorder (MDD). African American women (n=110) completed questionnaires that assessed for depressive disorders, somatic concerns, and physical health. Measures of DPD, DYST, and MDD were all significantly correlated with functional health status. When symptoms of MDD were controlled, DYST was more associated with functional health status than was a DSM-IV measure of DPD, although a self-report measure of DPD--the Depressive Personality Disorder Inventory [DPDI; Huprich et al., 1996: J Clin Psychol 52:152-159]--remained significantly correlated with functional health status. When symptoms of DYST were controlled, DSM-IV symptoms of DPD were not strongly associated with functional health status, although measures of MDD and the DPDI were correlated with functional health status. We concluded that despite the overlap in depressive symptoms and functional health status, DPD may be less associated with functional health status in a primary care population than DYST and MDD. Implications for the assessment of DPD are provided.     

Cognitive, behavioral, and physiological changes in Alzheimer disease patients as a function of incontinence medications.

OBJECTIVE: Authors evaluated the cognitive, neurophysiologic, and behavioral effects of incontinence medications in patients with Alzheimer disease (AD). METHODS: Nine patients were evaluated, both on and off incontinence medication, for cognitive status, neuropsychiatric status, activities of daily living, and serum anticholinergic level. Caregivers were interviewed to evaluate behavioral status and caregiver burden. RESULTS: Patients showed better performance on specific measures of cognition and behavior when not taking medication for incontinence. A significant, inverse correlation was found between mental status and anticholinergic level. CONCLUSION: Although the sample size was small, the findings suggest that, in patients with AD, incontinence medications with anticholinergic properties may have detrimental effects on mental status and behavior.     

Wealth, Health, and the Moderating Role of Implicit Social Class Bias

Background

Subjective social status (captured by the MacArthur Scale of Subjective Social Status) is in many cases a stronger predictor of health outcomes than objective socioeconomic status (SES).

Purpose

The study aims to test whether implicit beliefs about social class moderate the relationship between subjective social status and inflammation.

Methods

We measured implicit social class bias, subjective social status, SES, and baseline levels of interleukin-6 (IL-6), a marker of inflammation, in 209 healthy adults.

Results

Implicit social class bias significantly moderated the relationship between subjective social status and levels of IL-6, with a stronger implicit association between the concepts “lower class” and “bad” predicting greater levels of IL-6.

Conclusions

Implicit social class bias moderates the relationship between subjective social status and health outcomes via regulation of levels of the inflammatory cytokine IL-6. High implicit social class bias, particularly when one perceives oneself as having low social standing, may increase vulnerability to inflammatory processes.     

Immigration, stress, and depressive symptoms in a Mexican-American community

This study assessed levels of depressive symptomatology in a household probability sample of Mexico-born (N = 706) and U.S.-born (N = 538) Mexican Americans. We hypothesized that immigration status differences in acculturation, strain, social resources, and social conflict, as well as differences in the associations of these variables with depression, would account for differences in depression between U.S.-born and Mexico-born respondents. U.S.-born Mexican Americans had higher depression scores than those born in Mexico. When cultural and social psychological variables were controlled in a multiple regression analysis, the immigrant status difference persisted. Tests of interaction terms suggested greater vulnerability to the effects of low acculturation and low educational attainment among the U.S.-born relative to those born in Mexico; however, the immigrant status difference persisted after controlling for these interactions. Unmeasured variables such as selective migration of persons with better coping skills, selective return of depressed immigrants, or generational differences in social comparison processes may account for the immigration status difference.     

Unilateral Limbic Epileptic Status Activity: Stereo EEG, Behavioral, and Cognitive Data

We report data from four patients with unilateral epileptiform status activity within different structures of the temporal lobe, recorded during stereoelectroencephalographic presurgical evaluation. The ictal clinical symptoms accompanying neocortical and mesiobasal limbic discharges (two patients with complex partial status epilepticus) consisted of various psychosensory and vegetative signs, which can be understood on the basis of the spatiotemporal analysis of the discharges. The other two patients with circumscribed long-lasting mesiobasal limbic epileptiform activity represent unilateral pure limbic status epilepticus and were characterized by a marked behavioral syndrome (with stickiness, aggressivity, etc.) and a monomorphic gustatory aura continua, respectively. The latter patient, with left hippocampal discharges of nearly continuous epileptiform character, was also assessed with tachistoscopic tasks. Performance revealed cognitive impairment only in the epileptically discharging hemisphere and in dependence on the quality of the EEG pattern. After unilateral selective amygdalohippocampectomy, the two patients with limbic status epilepticus were seizure free and had markedly improved behavior and cognitive functions. Thus, patients with nonconvulsive status epilepticus represent an ideal model, although rare, to correlate behavior alterations and brain dysfunction.     

Correlates of Generalized Tonic-Clonic Seizures with Intellectual, Neuropsychological, Emotional, and Social Function in Patients with Epilepsy

Relationships between generalized tonic-clonic seizures and indicators of psychological functioning were evaluated in 94 adults with epilepsy who had exceptionally clear seizure histories. Patients were divided according to lifetime numbers of attacks and the presence or absence of a history of major motor status epilepticus. History of status epilepticus or history of more than 100 individual convulsions was associated with decreased functioning in all areas. Abilities were poorest for the group with a history of status, whereas emotional and psychosocial adjustment were worst in persons having large numbers of single convulsions. Possible reasons for the decreased test scores other than seizures were explored in great detail, but none could account for the differences in performance across the groups.     

Motor and electroencephalographic response of refractory experimental status epilepticus in rats to treatment with MK-801, diazepam, or MK-801 plus diazepam

Pharmacologic control of refractory status epilepticus has been little-studied in experimental models. In this experiment, rats in status epilepticus induced by lithium and pilocarpine were treated with MK-801 alone, diazepam alone or MK-801 plus diazepam, with treatment begun at a time when this model of status is refractory to anticonvulsant drugs. EEG samples were digitized before and for two hours after treatment, and the digitized samples subjected to computerized frequency analysis. MK-801 plus diazepam halted all manifestations of status epilepticus. Although neither MK-801 alone nor diazepam alone stopped the ongoing electrographic status epilepticus, both drugs diminished motor seizures and total EEG power. MK-801 treatment prevented the progression of changes in EEG pattern which normally occurs in this model of status epilepticus, while diazepam did not. MK-801, with and without diazepam, allowed the rats to survive the episode of status epilepticus, but rats treated with MK-801 alone required several days to recover completely, while the MK-801 plus diazepam rats appeared normal the next day. MK-801 may be a useful agent for treatment of human refractory status epilepticus, because of its neuroprotective action as well as its ability to potentiate GABAergic drugs.     

Job characteristics,occupational status,and ambulatory cardiovascular activity in women

Background: Prior research concerning the effects of occupational status and work stress on ambulatory blood pressure (AmBP) has seldom included women, and available results are equivocal. Moreover, the concurrent effects of occupational status and job characteristics have rarely been investigated. Some research is consistent with the idea that stressful job characteristics are especially detrimental to health in low-status workers, creating a cumulative physiological burden.Purpose: To examine the independent and joint effects of occupational status and perceived demands, control, and social support at work on AmBP and heart rate (HR) in women.Methods: One hundred eight women (M age = 41.07 years) wore an AmBP monitor for 2 days and completed a self-report assessment of job control, demands, and support (i.e., Karesek et al.’s Job Content Questionnaire).Results: After controlling for numerous potential confounds, occupational status and job characteristics accounted for 18% and 22% of the inter-individual variability in ambulatory systolic blood pressure (SBP) and HR, respectively. Occupational status independently predicted ambulatory cardiovascular activity and interacted with job characteristics, particularly in relation to SBP.Conclusions: Inasmuch as ambulatory SBP and HR predict future cardiovascular morbidity and mortality, women with both lower status occupations and stressful job circumstances could be at disproportionately high cardiovascular risk. Laura Bogart is now with RAND Corporation, Santa Monica, California. This research was supported in part by a Kent State University Summer Research and Creativity Grant and by NIH Grant MH66101-01. We thank Amy Jones and Evangelia Banou for assistance with data collection and data entry.