Stress,the immune system and psychiatric illness

Anecdotal evidence suggesting a causal relationship between psychiatric illness, environmental stress and a malfunctioning immune system goes back to antiquity. Recently, clinical and experimental studies have established the interrelationship between neuroendocrine regulation, the immune system and abnormalities in central neurotransmission which may be deranged as a consequence of stressful events. This short review is an attempt to assess the evidence implicating altered immune responsiveness in depression and schizophrenia and to consider the impact of different types of environmental stress in triggering the immune malfunction. While these findings are of considerable biological importance, it is presently unclear whether the immunological changes are primary or secondary to the disease states.     

Life events and psychiatric disorders

During a 28-day period, 469 patients attending a psychiatric emergency clinic were studied. The diagnoses made were compared to the severity of psychosocial stressors according to the DSM III axis IV. The largest diagnostic subgroup comprised alcohol problems (29.8 per cent), followed by psychosis (18.6 per cent), depression (12.9 per cent), neurotic (10.1 per cent) and acute breakdown due to external crisis (9.9 per cent). It was found that the more ‘endogenous’ the psychiatric illness, the lower were the ratings of stressful life events. DSM III does not contain sufficiently detailed information concerning axis IV to enable it to be used for research purposes and for clinical use it gives the clinician very little new information.     

The stress profile in China: A pilot study in patients with psychological disorders

The stress Profile was translated into Chinese and used as an instrument for assessment of stress in 20 Chinese patients and 28 normal subjects. The Chinese profile was then validated for reliability and also against the Hamilton anxiety and depression rating scales (HRSA and HRSD). Good correlations were recorded for the total and sub scores of the Stress Profile in test–retest and interrater reliabilities and there was a significant correlation with the HRSD, but not quite significant with the HRSA. However, after treatment, the correlations became significant with both Hamilton scales.     

Job stress,personality, and psychological distress as determinants of somatization and functional somatic syndromes in a population of nurses

The objective of the present study was to examine the respective contribution of job stress dimensions (work demands, job control, and social support at work), personality traits (neuroticism and alexithymia), and psychological distress (anxiety and depression) to somatization in a population of nurses. Therefore, a number of logistic regression analyses were conducted, with the presence versus absence of three functional somatic syndromes (functional dyspepsia (FD), irritable bowel syndrome (IBS), and idiopathic chronic fatigue (CF) and current somatization, defined as the presence of at least two medically unexplained symptoms (median number of symptoms for the sample) and four medically unexplained symptoms (highest quartile for the sample) during the past month, as the outcome variables. The results pointed out that job stress dimensions significantly and independently contributed to IBS (job control) and CF (work demands). The personality trait neuroticism was a significant predictor of both current somatization and functional somatic syndromes, whereas alexithymia primarily predicted the presence of more severe and/or more enduring forms of somatization. Finally, three out of five outcome variables were predicted by psychological distress. Future studies should examine (a) to what extent distinct patterns of associations can be found between specific job stress dimensions on the one hand, and specific functional somatic syndromes on the other and (b) the potential interaction between job stress and personality dimensions in determining somatization. Copyright © 2003 John Wiley & Sons, Ltd.     

Stress among primary teachers: Individuals in organizations

The following article is based on a survey of over 250 class teachers working in 30 primary schools in a large regional authority in Scotland. The study aimed to: (i) establish the prevalence and nature of occupational stress among primary school teachers, and (ii) determine the relationship between stress, anxiety and organizational phenomena. The data were collected by means of a specifically designed questionnaire and standardized measures of psychiatric morbidity. These important data are discussed in terms of their implications for training, organizational change and the direction of future research.     

Stress, psychological distress, and coping in patients on the waiting list for lung transplantation: an exploratory study

Little information is available in literature on quality of life, stress and coping during the period patients are waiting for lung transplantation. This study explored potential stressful events that patients experience during the waiting period assessed the level of anxiety and depression and explored the use of coping strategies. Cross sectional analysis were performed. Between 3 and 27 months the number of patients that participated varied between 70 and 21. Measurements took place every 3 months until 27 months after waiting list placement. Instruments were the State Trait Anxiety Inventory, the Self-rating Depression Scale (SDS)-Zung and questions concerning stress and coping. Feeling tension caused by 'having to wear a beeper', and 'being afraid that the transplantation will come too late' were identified as important stress factors. Patients on the waiting list experienced more anxiety and depression, compared to the general population. The longer patients had been on the waiting list, the more anxiety and depression they experienced. Positive coping strategies like 'trying to relax' were more frequently used than negative ones like 'taking sedatives'. Stress, anxiety, and depression occur frequently in waiting list patients.     

Stress in nurses: coping,managerial support and work demand

One hundred and six ward‐based nurses of 340 approached completed questionnaires measuring sources of stress within their work, the managerial support available to them, the strategies they used to cope with work stress and levels of anxiety, depression, and work satisfaction. Univariate analysis identified consistent relationships between work stress and each of these outcomes. Lack of managerial support was also associated both with negative mood states and, particularly, with low levels of work satisfaction. Multivariate analyses showed the key predictors of negative affect to be lack of management support, job overspill, having to make decisions under time pressure and lack of recognition by the organisation. These data fit well into existing models of work stress, and their implications for organisational change are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

Perceived Demands of Schooling,Stress and Mental Health: Changes from Grade 6 to Grade 9 as a Function of Gender and Cognitive Ability

The link between perceived demands of school, stress and mental health in relation to gender is complex. The study examined, with two waves of longitudinal data at age 13 and age 16, how changes in perceived academic demands relate to changes in perceived stress, taking into account gender and cognitive ability, and to investigate how these factors affect the level of psychosomatic and depressive symptoms at the age of 16. A nationally representative sample including about 9000 individuals from the Swedish longitudinal Evaluation Through Follow up database born in 1998 was included. A growth modelling approach was applied to examine relations over time. The results show girls to have a considerably higher self‐reported level of mental health problems at the end of compulsory school than boys. This gender difference is entirely accounted for by perceived school demands and stress in grades 6 and 9. Students who were stronger in inductive than vocabulary ability reported lower levels of perceived academic demands and less stress in grade 6. There is a need to develop interventions for minimizing the consequences of stress among adolescents and modify those particular aspects of academic demands which cause stress and poor mental health, especially among girls. Copyright © 2016 John Wiley & Sons, Ltd.     

Mesh infection without erosion after ObTape sling insertion: a diagnostic challenge

Infection is a recognised complication of using synthetic mesh tapes in continence surgery. It has only been reported alongside erosion after trans-obturator sling insertion for urodynamic stress incontinence. A 41-year-old patient developed mesh infection. This infection was diagnosed 16 months after insertion, when it became an abscess and discharged through her groin. The condition was not suspected earlier, despite having examination under anesthesia and repeat cystoscopy. The patient recovered upon removing the mesh and remains continent. This case documents the possible development of mesh infection without erosion. It highlights the importance of taking this possibility into consideration when dealing with patients after continence surgery and explores how it can be detected.     

Stress and coping in caregivers of patients awaiting solid organ transplantation

Caregivers for patients undergoing solid organ transplantation play an essential role in the process of transplantation. However, little is known about stress and coping among these caregivers. Six hundred and twenty-one primary caregivers of potential candidates for lung (n = 317), liver (n = 147), heart (n = 115), and/or kidney (n = 42) transplantation completed a psychometric test battery at the time of the candidate's initial pre-transplant psychosocial evaluation. Caregivers were generally well adjusted, with only 17% exhibiting clinical symptoms of depression (Beck Depression Inventory-II score >13) and 13% reporting clinical levels of anxiety (State Trait Anxiety Inventory score >48). Greater caregiver burden and negative coping styles were associated with higher levels of depression. Greater objective burden and avoidant coping were associated with higher levels of anxiety. Caregivers evidenced a high degree of socially desirable (i.e., defensive) responding, which may reflect a deliberate effort to minimize fears or worries so as to not jeopardize patients' listing status.     

临终关怀降低老年临终患者家属心理应激及负性情绪的效果

目的 提高老年临终患者的生活质量，降低其家属心理应激及焦虑、抑郁情绪。方法 将76例老年临终患者及其家属（76名）随机分为研究组和对照组，每组38例患者和38名家属。对照组按常规进行护理，研究组在常规护理的基础上接受临终关怀护理干预。在干预前及干预1个月后采用家属应激量表（RSS）、焦虑自评量表（SAS）、抑郁自评量表（SDS）对两组患者家属进行评定。结果 干预后研究组患者家属RSS总分及心理痛苦和生活被扰乱2个维度评分显著低于对照组（均P〈0．01），SAS、SDS评分显著低于对照组（P〈0．05，P〈0．01）。结论 临终关怀护理在降低老年临终患者家属应激水平的同时，也降低了其焦虑、抑郁程度。     

临终关怀降低老年临终患者家属心理应激及负性情绪的效果

目的 提高老年临终患者的生活质量,降低其家属心理应激及焦虑、抑郁情绪.方法 将76例老年临终患者及其家属(76名)随机分为研究组和对照组,每组38例患者和38名家属.对照组按常规进行护理,研究组在常规护理的基础上接受临终关怀护理干预.在干预前及干预1个月后采用家属应激量表(RSS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)对两组患者家属进行评定.结果 干预后研究组患者家属RSS总分及心理痛苦和生活被扰乱2个维度评分显著低于对照组(均P＜0.01),SAS、SDS评分显著低于对照组(P＜0.05,P＜0.01).结论 临终关怀护理在降低老年临终患者家属应激水平的同时,也降低了其焦虑、抑郁程度.     

Relationship Between Early‐life Stress Load and Sleep in Psychiatric Outpatients: A Sleep Diary and Actigraphy Study

The present study aimed to investigate whether stress experienced early in life is associated with actigraphic and subjective sleep measures in a sample of adult psychiatric outpatients. A total of 48 psychiatric outpatients completed self‐report questionnaires assessing current depression, current anxiety symptoms and stress load during childhood (before the age of 13 years), adolescence (between the age of 13 and 18 years) and adulthood (between the age of 19 and current age). Sleep‐related activity was measured using 24‐h wrist actigraphy over a 7‐day period at home, during which participants also kept a sleep diary. High stress load in childhood, but not in adolescence, was associated with shortened actigraphically assessed total sleep time, prolonged sleep onset latency, decreased sleep efficiency and an increased number of body movements in sleep, even after accounting for the effects of later occurring stress and psychopathological symptoms such as depression and anxiety scores. Unexpectedly, no significant associations between early‐life stress load and subjective sleep measures were found. Results are consistent with findings from previous studies indicating an association between childhood adversities and higher levels of nocturnal activity. The findings suggest that high stress load during childhood might be a vulnerability factor for sleep continuity problems in adulthood. Copyright © 2012 John Wiley & Sons, Ltd.     

Comorbid Anxiety Disorders in Civilians Seeking Treatment for Posttraumatic Stress Disorder

Research indicates that posttraumatic stress disorder (PTSD) is associated with high rates of comorbid psychiatric diagnoses. Yet, it remains unknown whether PTSD is associated with greater comorbidity relative to patients with other anxiety disorders. This study examined prevalence of comorbid anxiety disorders with PTSD relative to other disorders among a treatment-seeking population. Patients with PTSD (n = 83) evidenced greater overall comorbidity as compared to patients with other anxiety (n = 151) or Axis I (n = 73) disorders. Compared to patients with panic disorder, patients with PTSD were more likely to be diagnosed with depression and social phobia, but not other anxiety disorders. Extent of anxiety disorder comorbidity was not related to PTSD severity. These findings are discussed in terms of their relevance for treatment of PTSD.     

Sex differences in cortisol excretion during anticipation of a psychological stressor: possible support for the tend–and–befriend hypothesis

The present experiment tested the hypothesis that differential neuroendocrine elicitation is prompted by subjects' cognitive expectations of an anticipated stressor. Subjects making a ‘threat appraisal’ of an academic examination were predicted to have increased hypothalamic–pituitary–adrenal (HPA) activation, while activation was expected to be unchanged in subjects making a ‘challenge appraisal.’ Self‐reported anxiety in relation to these variables was also examined. HPA activation was assessed by urinary cortisol at baseline (at least 1 week before the examination) and at pre‐test (immediately before the examination). Contrary to the hypothesis, there was an unexpected sex × time interaction that was particularly robust in subjects making a challenge appraisal. Males in the challenge appraisal group had a significant increase in cortisol excretion from baseline to pre‐test, with greater reported anxiety than the threat appraisal group. In contrast, females had a decrease in cortisol excretion that was significant for only the challenge appraisal group, although reported anxiety between the challenge and threat groups was not different. Results may support the recent proposition that the female stress response has evolved differently than that of males, or they may reflect sex differences in production of corticosteroid‐binding globulin. Copyright © 2001 John Wiley & Sons, Ltd.     

Association between personal basic information,sleep quality,mental disorders and erectile function: a cross‐sectional study among 334 Chinese outpatients

Male erectile dysfunction (ED) may cause anxiety and depression, while mental disorders and sleep disturbances may also be closely related to ED. However, the exact nature of their relationship remains unclear, and whether personal basic background data affect erectile function is unknown. We conducted a cross‐sectional study among Chinese outpatients with ED from January 2012 to December 2014. All the men answered a questionnaire collecting information about mental health status, sleep disturbances and personal data, underwent a physical examination and had a blood sample drawn. Sleep disturbances were assessed on the basis of a 19‐item version of the Pittsburgh Sleep Quality Index, which includes questions on sleep patterns during the past month. Among the 462 patients, 128 patients with alcohol abuse, diabetes, hypertension, hyperlipidaemia, psychiatric drugs, neurologic injury or abnormal hormones were excluded from the study; 86.27% and 68.66% of the patients suffered from anxiety and depression respectively. Sleep quality and anxiety symptoms significantly affected erectile function, whereas personal income and education level had no significant effects. Our study suggested that it is necessary to pay attention to the psychological status of patients with ED, especially anxiety disorder. Sleep quality may be an important factor affecting erectile function according to the personal data.     

Psychological distress and health behaviours among Cambodian Americans at risk for developing diabetes

This paper reports secondary data analysis of associations between psychological distress and health behaviours among Cambodian Americans. Data are from baseline assessments from a diabetes prevention trial. All participants met stucriteria for depression and were free of diabetes. Participants (n = 191) completed surveys, a food frequency assessment, and wore sleep and physical activity actigraphy devices for 7 days. A factor analysis of symptoms of post-traumatic stress, baksbat (a Cambodian culture-bound syndrome), depression, and anxiety yielded a single factor named ‘psychological distress’. Multivariate models controlling for psychotropic medications were run for the following outcomes: sleep actigraphy, self-reported sleep, physical activity actigraphy, self-reported physical activity, nutrition, and substance use. For actigraphy, higher distress was associated with lower moderate/vigorous physical activity and higher mean variability of 24 h total sleep time. Higher distress was also associated with worse self-reported sleep quality as indicated by standard, and culturally-specific, sleep indicators. Higher distress was also associated with lower use of food labels, lower carbohydrate consumption, and higher alcohol consumption as a coping mechanism. Interventions to mitigate diabetes risk in high-distress populations may benefit from strategies to decrease psychological distress. The sequelae of complex trauma may transcend discrete psychiatric diagnoses.     

Cutaneous leishmaniasis: a diagnostic challenge for plastic surgeons

Owing to the relatively low number of patients with cutaneous leishmaniasis seen in plastic surgery clinics, these lesions may easily be confused with other skin diseases and cutaneous malignancies. Seven patients with cutaneous leishmaniasis, who had been misdiagnosed as cutaneous malignancies, were referred to our plastic surgery department. The final diagnoses were made using a Tzanck smear examination and histopathologic examination. Systemic or intralesional meglumine antimonite was successfully used to treat the lesions. Plastic surgeons should be aware that some atypical skin lesions might be a cutaneous leishmaniasis, even if they have a malignant appearance. Surgery may worsen the course of disease, but early medical treatment prevents severe scarring.     

Sex,stress, and health: Does stress predict health symptoms differently for the two sexes?

Objectives: Previous studies have been inconsistent with regard to the extent to which stress perception, rather than stressor exposure, predicts negative health symptoms. Because sex differences have been observed in all three of these variables, in this study the possibility that sex differences also exist in the relationships between them is investigated. Methods: Self‐report inventories of perceived stress, stressor exposure, and negative health symptoms were given to 107 young‐adult participants (65 females, 42 males). Results: Sex differences were observed in the associations among perceived stress, stressor exposure, and negative health symptom rates. Specifically, while higher perceived stress and higher stressor exposure rates independently predicted higher negative health symptoms rates in females, only higher stressor exposure rates independently predicted higher negative health symptoms in males. Indeed, unexpectedly, after controlling for exposure to stressors there was a trend towards higher perceived stress predicting lower negative health symptoms in males. Conclusions: While exposure to stress was a significant negative predictor of health for both sexes, perception of stress was predictive only for females. One implication of this finding is that different psychological models are needed to predict health symptoms in the two sexes. Copyright © 2005 John Wiley & Sons, Ltd.