Stress and Immunity

스트레스는 면역을 억제하거나 활성화시킨다. 스트레스에 의한 면역반응이 일정하지 않은 것은 스트레스의 정도, 기간, 대응능력에 따른 차이가 영향을 미치기 때문이다. 스트레스와 면역 간의 관계는 중추신경계, 신경내분비계 및 면역계 간의 의사소통, 즉 상호작용에 의해 이루어지고 있다. 중추신경계와 면역계가 상호 작용하는 주요 경로는 임파조직의 신경계 wiring system과 신경내분비계다. 정신사회적 인자와 면역기능 간의 중개자로는 뇌하수체에서 방 출되는 펩타이드, 호르몬 및 자율신경계 물질이 있다. 시상하부는 내분비계, 신경계 및 면역계를 통합하는 역할을 한다. 한편 내분비계는 면역계에 의해서 피드백을 받는다. 스트레스와 면역계 간에는 양 방향의 경로가 있는 것으로 가정된다. 즉 스트레스가 면역계에 영향을 미칠 뿐만 아니라 면역계가 정신사회적 기능에 영향을 미칠 수 있다. 어 떤 상황에서도 면역계, 내분비계 및 신경계 간의 상호작용으로 생체균형 (homeostasis)이 유지되는 것으로 보고 있다. 따라서 스트레스와 면역기능 간의 관계를 규명하기 위해서는 면역계, 내분비계, 자율신경계 및 뇌활동을 동시에 측 정, 비교하여 이들을 통합할 필요가 있다ope

Psychiatric Evaluation of Pain Disorder

통증의 발명 및 경과에는 기질적 이상은 물론 정신사회적 요인에 의해서도 영향을 받는다. 통증에 의한 이차적인 반응으로 불안, 우울과 같은 심리적 반응이 일어나는가 하면 통증이 정신장애의 양상으로 표현되기도 한다. 또한 만성 통증은 삶의 어려움을 반영한다. 따라서 통증장애의 평가에 있어서도 정신사회적 접근이 필요하다. 한편 이런 환자들에서 위약을 기질적 및 기능적인 통증을 감별하는데 사용하는 것은 위험하다. 특히 만성 통증 환자의 평가에는 여러 과가 공동으로 접근하는 통합적 접근, 즉 생물정신사회적 접근이 권장된다. 특히 이런 환자들의 심리적 문제에 대한 부정이 정신과적 접근을 어렵게 하기 때문에 이들에 대한 특수한 면담기술이 필요하다.ope

The Comparison of Stress Responses, Anger Expression and Alexithymia between Chronic Gastritis and Gastric Ulcer Patients

The objective of this study was to make a comparison between chronic superficial gastritis and gastric ulcer patients regarding stress responses, anger expression and alexithymia. The subjects included 100 patients with chronic superficial gastritis and 40 patients with gastric ulcer confirmed by gastroscopy. Stress responses were measured by the Stress Response Inventory(SRI) and anxiety, depression, somatization and hostility subscales of the Symptom Checklist-90-revised(SCL-90-R). Anger expression and anger suppression were assessed by the Anger Expression Scale. The level of alexithymia was assessed by the Toronto Alexithymia Scale(TAS). Multiple regression analysis showed that the patients with chronic gastritis scored significantly higher on tension subscale and somatization subscale of the SRI, and anxiety subscale of the SCL-90-R than those with gastric ulcer. However, no significant differences were found in the score of anger expression and anger suppression subscales and total score of TAS between the two groups. In chronic gastritis patients, women scored significantly higher on somatization subscale of the SRI than men, whereas in gastric ulcer patients, men scored significantly higher on somatization subscale of the SRI than women. These results suggest that chronic gastritis patients are more likely to have higher level of stress responses and higher susceptibility to stress than gastric ulcer patients. In addition, in chronic gastritis patients, women are more likely to somatize than men, but in gastric ulcer patients, men are more likely to somatize than women. However, there were no differences between the two groups in anger expression, anger suppression and alexithymia.ope

The Comparison of Anger between Patients with Coronary Artery Disease and Healthy Individuals

The objective of this study was to make a comparison on anger level between patients with coronary artery diseases and healthy individuals. 233 patients with coronary artery diseases and 215 normal controls were enrolled in this study. The Anger Expression Scale, the anger and aggression subscales of the Stress Response Inventory(SRI) and the hostility subscale of the Symptom Checklist-90-revised(SCL-90-R) were used to assess the level of anger. The patients with coronary artery diseases scored significantly higher on the anger-out and anger total subscales of the anger expression scale, the anger and aggression subscales of the SRI than the normal controls. The patients with angina pectoris had significantly higher scores in the anger-out and anger-total subscale than those with myocardial infarction. Male subjects scored significantly higher on the anger-in subscale than females, whereas female subjects scored significantly higher on the anger-out subscale than male subjects. These results suggest that patients with coronary artery diseases are likely to have a higher level of anger or anger expression than normal controls and that there may be difference in anger expression between male and female patients. It is emphasized that anger management is needed to prevent the coronary artery disease patients from aggravating the illness.ope

Comparison of Alexithymia among Patients with Psychosomatic Disorders, Anxiety Disorders and Depressive Disorders

A comparison was made regarding the degree of alexithymia among patients with psychosomatic disorders, anxiety disorders and depressive disorders. The author examined the degree of alexithymia in three groups : 100 psychosomatic patients(including 47 patients with tension headache), 52 outpatients with anxiety disorden, and 50 outpatients with depressive disorders. Alexithymia was assessed by Alexithymia provoked Response Questionnaires(APRQ) developed as a semi-structured interview form. No significant difference was found in the degree of alexithymia among Patients with Psychosomatic disorders, anxiety disorders, and depressive disorders. On the other hand, patients with tension headache were significantly more alexithymic than patients with anxiety disorders and depressive disorders, respectively. However, there was no significant difference in degree of alexithymia between patients with anxiety disorders and those with depressive disorders. Multiple regression analysis revealed that demographic variables such as set age, education level, and marital status did not make a significant influence on alexithymia scores. These results suggest a greater degree of alexithymia in patients with a specific group of psychosomiatic disorders such as tension headache than in patients with emotional disorders, unlike the previous report that in general, psychosomatic patients are alexithymic. Thus, it is necessary to develop special forms of interview which can induce and encourage expression of emotion as a therapeutic strategy for patients with tension headache.ope

Cognitive-behavioral Approach to Patients with Cardiovascular Diseases

The author reviewed cognitive-behavioral approach to A type behavior pattern and hypertension which are known to be risk factors for coronary heart diseases. Those cognitive distortions frequently found in persons with A type behavior include all-nothing thinking, selective attention, personalization, and attribution of causality. Cognitive-behavioral techniques were also described, which can be applied to management of each characteristic of A type behavior pattern such as time urgency, perfectionism, achievement striving, low self-esteem, excessive work involvement, hostility, and depression. Cognitive-behavioral intervention for hypertension might help the patients to recognize and monitor anger-engendering conflicts, identify characteristic styles of responding, and experiment with alternative ways of managing conflict and anger. Since different features predominate in different individuals, it is necessary to develop treatment plan on the basis of individual characteristics and problems.ope

Experience of Cognitive-Behavioral Treatment for Patients with Chronic Headache

Cognitive-behavioral approach to two cases with chronic headache was presented. Cognitive-behavioral interventions focus on indirectly altering symptom-related physiological activity by changing the way patients cope with headache-eliciting stressors. This treatment focuses directly on the patients' cognitive and behavioral changes. Cognitive-behavioral treatment can be divided into three phases Education, self-monitoring, and problem-solving or coping-skills training. Literature reviews on the follow-up evaluation of therapeutic effectiveness revealed that cognitive-behavioral treatment is effective in the management of chronic headache.ope

Predominance of anger in depressive disorders compared with anxiety disorders and somatoform disorders

Objective: The object of this study was to make a comparison regarding various dimensions of anger between depressive disorder and anxiety disorder or somatoform disorder. Method: The subjects included 73 patients with depressive disorders, 67 patients with anxiety disorders, 47 patients with somatoform disorders, and 215 healthy controls (diagnoses made according to DSM-IV criteria). Anger measures-the Anger Expression Scale, the hostility subscale of the Symptom Checklist-90-Revised (SCL-90-R), and the anger and aggression subscales of the Stress Response Inventory-were used to assess the anger levels. The severity of depression, anxiety, phobia, and somatization was assessed using the SCL-90-R. Results: The depressive disorder group showed significantly higher levels of anger on the Stress Response Inventory than the anxiety disorder, somatoform disorder, and control groups (p<.05). The depressive disorder group scored significantly higher on the anger-out and anger-total subscales of the Anger Expression Scale than the somatoform disorder group (p<.05). On the SCL-90-R hostility subscale, the depressive disorder group also scored significantly higher than the anxiety disorder group (p<.05). Within the depressive disorder group, the severity of depression was significantly positively correlated with the anger-out score (r=0.49, p<.001), whereas, in the somatoform and anxiety disorder groups, the severity of depression was significantly positively correlated with the anger-in score (somatoform disorder: r=0.51, p<.001; anxiety disorder: r=0.57, p<.001). Conclusion: These results suggest that depressive disorder patients are more likely to have anger than anxiety disorder or somatoform disorder patients and that depressive disorder may be more relevant to anger expression than somatoform disorder.ope

Reduced lymphocyte proliferation and interleukin-2 production in anxiety disorders

OBJECTIVE: The purpose of this study was to examine the effect of anxiety on cell-mediated immunity. METHOD: The subjects consisted of 31 patients with anxiety disorders and 31 normal controls, who were gender-matched. Cell-mediated immune function was measured by the lymphocyte proliferative response to phytohemagglutinin (PHA), Interleukin-2 (IL-2) production, and natural killer cell activity (NKA). The extent of anxiety was assessed by the Hamilton rating scale for anxiety and the anxiety subscale of symptom checklist-90 revised (SCL-90-R). RESULTS: The patients with anxiety disorders were significantly lower than the normal controls in lymphocyte proliferative response to PHA and IL-2 production. However, there was no significant difference in NKA between the two groups. Also, no significant correlation was found between the duration of illness or the degree of anxiety and each immune measure in patients with anxiety disorders. CONCLUSIONS: The results suggest a reduced cell-mediated immune function in patients with anxiety disorders, compared with normal controls. These findings also imply that a variety of immune measures should be assessed at the same time in this kind of psychoneuroimmunology research. This would help elucidate the relationship between anxiety and immune function, which has been unclear in most previous research using a single immune measure.restrictio

Development of the Cognitive Stress Response Scale

Objective : The purpose of this study was to develop a cognitive stress response scale (CSRS) . Methods First, a preliminary survey was conducted for 109 healthy aduhs to obtain 29 response items. Second, a preliminary questionnaire was completed by 215 healthy subjects. Third, a comparison was made regarding cognitive responses among 73 patients with depressive disorders and 215 healthy subjects. Results : Factor analysis yielded 3 subscales : extreme-negative thought, aggressive-hostile thought, and self-depreciative thought. Reliability was computed by administering the CSRS to 62 healthy subjects during a 2-week interval. Test-retest relia­bility for 3 subscales and the total score were significantly high, ranging between. 87-.95. Internal consistency was computed, and Cronbach´s a for 3 subscales ranged between. 82-.91, and .94 for the total score. Convergent validity was computed by correlating the 3 subscales and the total score with the total score of the global assessment of recent stress (GARS) scale, the perceived stress questionnaire (PSQ), and the symptom checklist-90-revised (SCL-90-R). The correlations were all at signifi­cant levels. The depressive disorder group was significantly higher than control group in all the subscale scores and total scores of the CSRS. In total scores of the CSRS, female subjects were significantly higher than males. Conclusion : These results indicate that the CSRS is highly reliable and valid, and that it can be utilized as an effective measure for research related to cognitive assessment.ope