Amygdala-hippocampus dynamic interaction in relation to memory

Typically the term "memory" refers to the ability to consciously remember past experiences or previously learned information. This kind of memory is considered to be dependent upon the hippocampal system. However, our emotional state seems to considerably affect the way in which we retain information and the accuracy with which the retention occurs. The amygdala is the most notably involved brain structure in emotional responses and the formation of emotional memories. In this review we describe a system, composed of the amygdala and the hippocampus, that acts synergistically to form long-term memories of significantly emotional events. These brain structures are activated following an emotional event and cross-talk with each other in the process of consolidation. This dual activation of the amygdala and the hippocampus and the dynamics between them may be what gives emotionally based memories their uniqueness.

[The psychology of suffering]

Man's common experience interpreted in the humanities points to the inevitability of suffering. Suffering was even termed a basic border situation (C. Jaspers). The so-called scientific psychology hardly analyses human suffering. S. Freud regarded culture as a source of suffering and the behaviourists did not see the need for an analysis of man's inner experience. Radical change of the view on suffering was brought about in the works of V. E. Frankl who thought man to be homo patients (to be a man means to suffer). There are various sources and kinds of suffering. Based on his own vast researches the author characterizes three kinds of man's suffering: physical (pain, somatic diseases), psychical (hardships, mental disorders and illnesses) and spiritual (lack of a meaningful life, moral dilemmas). He also puts forward a hypothesis that a psychic suffering is a correlative between both mental and spiritual sufferings. Suffering fulfills a variety of functions in the life and personality of a human being; it can cause a personality degradation or can further a personality development. Therefore, we can speak of the ambivalent character of suffering. The elementary psychological problem, encountered in suffering, is to give suffering some meaning. In order to do this one must ask about future: for whom and what do I suffer? Whereas the question about the ultimate origin of suffering (why do I suffer?) not only makes it possible to explain the issue fully but first of all allows us to recognize suffering as a mystery of human existence. The author proves that the analyses carried out by John Paul II in Salvifici doloris are coherent with the principles of logotherapy. However, the analyses are more profound since they point to individual, social, cultural and transcendental dimensions of suffering.

Stress vulnerability and climacteric symptoms: life events, coping behavior, and severity of symptoms

To explore a possible association between climacteric symptoms and ways of coping with stress, a comparative study was conducted among 19 menopausal women who sought treatment for climacteric symptoms (the study group) and 44 healthy menopausal women (the control group). Life stress was assessed using a life event method in which factor analysis extracted four ways that women cope with stress: avoidance-oriented coping, consultation-oriented coping, aggression-expression coping, and problem-solving coping. The study group had a higher symptom score and was more prone to avoidance-oriented coping than the control group despite experiencing the same number of undesirable life events. The severity of climacteric symptoms correlated positively with the number of undesirable life events and the degree of avoidance-oriented coping and correlated negatively with the degree of aggression- expression coping for the study group. These results suggest that vulnerability to stress contributes to worsening climacteric symptoms caused by stress.

Summation of behavioral and immunological stress: metabolic consequences to the growing mouse

To address the hypothesis that multiple stressors can have cumulative effects on the individual, we determined the effects of restraint (R) stress (4 h/day for 7 days), immunological (L) stress [lipopolysaccharide (LPS) injection, 0.45 microg/g body wt on days 6 and 7], and R + L (RL) on the growth and energetics of C57Bl/6 male mice. R and L each repeatedly increased (P<0.05) circulating corticosterone (>8 times), but RL caused even greater (>250%, P<0. 05) concentrations of circulating corticosterone than did either stressor alone. Only L and RL increased (P<0.05) circulating interleukin-1beta. Although R, L, and RL impaired growth (>75% below controls, P<0.05), RL reduced growth to a greater extent. All stressors inhibited (P<0.05) lean (>33% below controls) and fat (>120% below controls) energy deposition, and like the effects on growth, combined RL stress inhibited lean and fat energy deposition to a greater extent than did either stressor acting alone. These results demonstrated that the summation of multiple stress results in a cumulative cost to the growing animal.

Gender differences in Parkinson's disease symptom profile

Gender symptom differences were studied in 948 subjects with Parkinson's disease (PD) using a questionnaire covering the most common symptoms associated with PD at debut (SP-1) and at present (SP-2). The symptoms most frequently reported by both genders were: tremor, fumblingness, writing problems, rigidity and fatigue. At SP-1 females reported neck-pain and low back pain more frequently than males. At SP-2 subjects reported an increased number of symptoms. The following symptoms were more frequent among males than females: writing difficulties, fumblingness, gait problems, speech problems, increased flow of saliva, lack of initiative. Sleep problems were common in both sexes with inability to turn in bed and calf muscle cramps in a high percentage. A majority of female subjects find their symptoms (e.g. depression) constantly distressing. Although depression is not one of primary reported symptoms (36%) attention is called for, due to the problem with compliance to treatment regimes. About 30% do not report having tremor and rigidity. This study indicates the usefulness of a symptom profile instrument capable of capturing the many symptoms involved in PD. Such an instrument could be used to detect apparent mistakes in medication and thereby increase the function and quality of life for the individual.

Exploratory behaviour and grooming after repeated restraint and chronic mild stress: effect of desipramine

In a previous study, we have recently shown that chronic treatment with desipramine either reduced or potentiated the locomotor response to the dopamine D(2)-like receptor agonist quinpirole, a behavioural response mediated by the mesolimbic dopamine system, depending on whether the animals were subjected, respectively, to repeated restraint or to chronic mild stress (different stressors randomly presented). In this study, we examined the interaction between prolonged exposure to either repeated restraint stress or chronic mild stress with the chronic administration of the antidepressant desipramine on two spontaneous behaviours, in which an involvement of the mesolimbic dopamine system has been suggested: novelty-induced exploratory activity and grooming. Exploratory activity in the open field was reduced by chronic mild stress regardless of the drug treatment, while it was not influenced by restraint stress. Desipramine reduced exploratory activity in rats subjected to restraint stress. Restraint stress increased grooming and desipramine reversed this effect, while increasing grooming in the chronic mild stress group. These findings suggest that antidepressants exert their effect by opposing the modifications induced by stress. The available experimental evidence is consistent with the hypothesis that an important role in the observed behavioural changes is played by the mesolimbic dopamine system.

Nociceptin prevents stress-induced ethanol- but not cocaine-seeking behavior in rats

This study examined whether nociceptin/orphanin FQ (NC), the endogenous ligand of the opioid receptor-like1 (ORL1) receptor, can block drug-seeking behavior induced by foot-shock stress. Male Wistar rats were trained to operantly self-administer ethanol or cocaine, and then subjected to daily extinction training until responding ceased. Subsequent exposure to 15 min of intermittent footshock elicited robust reinstatement of responding at the previously drug-paired lever. NC (0.1-2.0 microg; i.c.v.) significantly inhibited the effects of footshock stress on ethanol- but not cocaine-seeking behavior. The results support the hypothesis that the NC system participates in the regulation of behavioral responses to stress, and that drugs interacting with NC receptors may have therapeutic potential for the treatment of stress-induced alcohol-seeking behavior and relapse.

Psychological distress, health beliefs, and frequency of breast self-examination

Although monthly breast self-examination (BSE) is recommended for early breast cancer detection, most women do not comply. Few studies have examined the impact of psychological distress on BSE frequency. Recent research suggests that it may be particularly important to examine the role of distress in the recently identified phenomenon of BSE overperformance (> 1/month). One hundred thirty-five healthy women with and without family histories of breast cancer completed sociodemographic, health belief, general and cancer-specific psychological distress, and BSE frequency questionnaires. The central finding of the study was that BSE underperformance and overperformance had two distinct sets of predictors: health beliefs, specifically barriers against BSE and low confidence in BSE performance, were related to BSE underperformance, while higher levels of psychological distress, particularly cancer-specific intrusive thoughts, were related to BSE overperformance. Findings underscore the need to evaluate BSE under- and overperformance separately and to develop problem-specific interventions to increase compliance with monthly BSE.

Behavioral effects Of 8-OH-DPAT in chronically stressed male and female rats

The present study tested the hypothesis that chronic stress desensitizes serotonergic 5-HT(1A) receptors and alters behavioral changes following 5-HT(1A) agonist administration. Eating, acoustic startle response (ASR), and locomotor activity were measured in stressed and nonstressed male and female rats after 8-OH-DPAT administration. Stressed rats were paired and stressed by around-the-clock intermittent foot shock. Controllable stress (CS) rats could avoid/terminate shock for themselves and their yoked partners by pulling a ceiling chain, whereas their partners, the uncontrollable stress (UCS) rats, could not. Rats earned their entire daily ration of food by pressing a lever. In previous experiments, this paradigm was stressful, but not debilitating and rats continued to eat, groom, sleep, and avoid/escape greater than 99% of shock trials. Locomotor activity and ASR were measured in the present study after saline and 8-OH-DPAT administration (0.25 mg/kg, IP) before, 24 h, and 72 h after shock onset. 8-OH-DPAT only decreased food intake significantly in male and female rats after the first administration. Stress decreased food intake in both the CS and UCS rats, with UCS rats eating the least. However, the effects of stress and 8-OH-DPAT were not additive. 8-OH-DPAT significantly increased peak startle amplitude at 100 and 120 dB, and decreased latency to peak startle amplitude at 100 dB in male and female rats. In contrast, 8-OH-DPAT did not alter percent prepulse inhibition (%PPI) at 100 dB, but significantly decreased %PPI in males but not females at 120 dB. Stress did not have a consistent effect on ASR, but reduced %PPI in males, but not females. Neither stress nor 8-OH-DPAT significantly altered locomotor activity. Although the results do not show an increased sensitivity to 8-OH-DPAT in stressed rats, the unexpectedly weak effects of 8-OH-DPAT alone on the behavioral measures chosen limits the conclusions that can be drawn.

Influence of prepartum chronic ultramild stress on maternal pup care behavior in mice

BACKGROUND

Stress administered to pregnant rodents has been shown to lead to biological and behavioral alterations in both mother and pups. Most of these stress procedures use noxious stressors. Chronicity is obtained by simple repetition of one or two stressors and may be more representative of moderate daily stress experienced during normal life than stress during severe life events. The effects of this procedure were assessed by observing maternal pup-care behavior and testing maternal aggression.

METHODS

The subjects included eight controls and eight stressed B6D2F1 females. Chronic ultramild stress was applied from mating to postpartum day (PD) 0. Pup-care behavior was observed on PD 1. Maternal aggression against a male intruder was tested on PD 8, which corresponds to the peak in the display of this behavior.

RESULTS

Prenatal stress did not affect basic pup-care behavior, but dramatically impaired defense behavior designed to protect the pups from an external attacker.

CONCLUSIONS

The results suggest that gestating females subjected to chronic ultramild stress suffer from a long-lasting decline in recognition of external distress cues either from a resident intruder and/or their own litter. It is assumed these effects are due to the chronicity of the stress rather than its severity.

Hormone profiles in humans experiencing military survival training

BACKGROUND

Clinical models of the human response to intense, acute stress have been limited to laboratory settings or cross sectional characterizations. As a result, data about the sensitivity of the human neuroendocrine activation to realistic stressors of varying magnitudes are limited. The U.S. Army survival course offers a unique opportunity to examine, in a controlled manner, the human response to acute, realistic, military stress.

METHODS

Salivary data were collected in 109 subjects at baseline during four stress exposure time points and at recovery. Serum data was collected at baseline and recovery in 72 subjects and at baseline and during stress exposure in a subgroup of subjects (n = 21).

RESULTS

Cortisol significantly increased during the captivity experience and was greatest after subjects' exposure to interrogations. Cortisol remained significantly elevated at recovery. Testosterone was significantly reduced within 12 hours of captivity. Reductions of both total and free T4 and of total and free T3 were observed, as were increases in thyrotropin.

CONCLUSIONS

The stress of military survival training produced dramatic alterations in cortisol, percent free cortisol, testosterone, and thyroid indices. Different types of stressors had varying effects on the neuroendocrine indices. The degree of neuroendocrine changes observed may have significant implications for subsequent responses to stress.

Plasma neuropeptide-Y concentrations in humans exposed to military survival training

BACKGROUND

Neuropeptide-Y (NPY) is present in extensive neuronal systems of the brain and is present in high concentrations in cell bodies and terminals in the amygdala. Preclinical studies have shown that injections of NPY into the central nucleus of the amygdala function as a central anxiolytic and buffer against the effects of stress. The objective of this study was to assess plasma NPY immunoreactivity in healthy soldiers participating in high intensity military training at the U.S. Army survival school. The Army survival school provides a means of observing individuals under high levels of physical, environmental, and psychological stress, and consequently is considered a reasonable analogue to stress incurred as a result of war or other catastrophic experiences.

METHODS

Plasma levels of NPY were assessed at baseline (prior to initiation of training), and 24 hours after the conclusion of survival training in 49 subjects, and at baseline and during the Prisoner of War (P.O.W.) experience (immediately after exposure to a military interrogation) in 21 additional subjects.

RESULTS

Plasma NPY levels were significantly increased compared to baseline following interrogations and were significantly higher in Special Forces soldiers, compared to non-Special Forces soldiers. NPY elicited by interrogation stress was significantly correlated to the subjects' behavior during interrogations and tended to be negatively correlated to symptoms of reported dissociation. Twenty-four hours after the conclusion of survival training, NPY had returned to baseline in Special Forces soldiers, but remained significantly lower than baseline values in non-Special Forces soldiers. NPY was positively correlated with both cortisol and behavioral performance under stress. NPY was negatively related to psychological symptoms of dissociation.

CONCLUSIONS

These results provide evidence that uncontrollable stress significantly increases plasma NPY in humans, and when extended, produces a significant depletion of plasma NPY. Stress-induced alterations of plasma NPY were significantly different in Special Forces soldiers compared to non-Special Forces soldiers. These data support the idea that NPY may be involved in the enhanced stress resilience seen in humans.

[EEG study of the anxiolytic effect of scopolamine]

Effect of the central M-cholinolytic scopolamine on spatial organization of the rat brain electrical activity was studied under conditions of high and low emotional-stress responses. The EEG changes were estimated by 840 parameters. A possibility of the EEG discrimination by means of interstrain differences in responses to scopolamine, was shown. A more obvious decrease in spectral power and potentials coherence was revealed in Maudsley Reactive rats (MR) as compared with the Maudsley Nonreactive rats (MNRA), in parieto-temporal and occipital areas of the right hemisphere, and the reverse interrelationship occurred in the anterior parts of the right and posterior parts of the left hemisphere. These findings suggest some specifics in the spatial distribution of the maximum scopolamine action foci depending on the initial emotional level. Changes occurring under the scopolamine effect in different EEG frequency bands are different in the MR and the MNRA rats. The findings are discussed in respect to the EEG indices of anxiolytic component of cholinergic regulation of the brain activity.

A review of psychological risk factors in back and neck pain

STUDY DESIGN

The literature on psychological factors in neck and back pain was systematically searched and reviewed.

OBJECTIVES

To summarize current knowledge concerning the role of psychological variables in the etiology and development of neck and back pain.

SUMMARY OF BACKGROUND DATA

Recent conceptions of spinal pain, especially chronic back pain, have highlighted the role of psychological factors. Numerous studies subsequently have examined the effects of various psychological factors in neck and back pain. There is a need to review this material to ascertain what conclusions may be drawn.

METHODS

Medical and psychological databases and cross-referencing were used to locate 913 potentially relevant articles. A table of 37 studies was constructed, consisting only of studies with prospective designs to ensure quality. Each study was reviewed for the population studied, the psychological predictor variables, and the outcome.

RESULTS

The available literature indicated a clear link between psychological variables and neck and back pain. The prospective studies indicated that psychological variables were related to the onset of pain, and to acute, subacute, and chronic pain. Stress, distress, or anxiety as well as mood and emotions, cognitive functioning, and pain behavior all were found to be significant factors. Personality factors produced mixed results. Although the level of evidence was low, abuse also was found to be a potentially significant factor.

CONCLUSIONS

Psychological factors play a significant role not only in chronic pain, but also in the etiology of acute pain, particularly in the transition to chronic problems. Specific types of psychological variables emerge and may be important in distinct developmental time frames, also implying that assessment and intervention need to reflect these variables. Still, psychological factors account for only a portion of the variance, thereby highlighting the multidimensional view. Because the methodologic quality of the studies varied considerably, future research should focus on improving quality and addressing new questions such as the mechanism, the developmental time factor, and the relevance that these risk factors have for intervention.

Effects of stress on reproduction in non-rodent mammals: the role of glucocorticoids and sex differences

The means by which stress influences reproduction is not clearly understood, but may involve a number of endocrine, paracrine and neural systems. Stress impacts on the reproductive axis at the hypothalamus (to affect GnRH secretion) and the pituitary gland (to affect gonadotrophin secretion), with direct effects on the gonads being of less importance. Different stressors have different effects and there are differences in response to short- and long-term stress. Many short-term stresses fail to affect reproduction and there are reports of stimulatory effects of some 'stressors'. There are species differences in the way that specific stressors affect reproduction. Sex differences in the effects of a particular stressor have been delineated and these may relate to effects of stress at different levels of the hypothalamo-pituitary axis. The significance of stress-induced secretion of cortisol varies with species. In some instances, there appears to be little impact of short-term increases in cortisol concentrations and protracted increases in plasma concentration seem to be required before any deleterious effect on reproduction is apparent. Issues of sex, sex steroid status, type of stressor and duration of stress need to be considered to improve understanding of this issue.

Recurrent headache, coping, and quality of life in children: a review

OBJECTIVES

To clarify the concepts of coping with pain and quality of life (QoL) and to present a literature review of the strategies that children with recurrent headaches use to cope with their pain, the impact of recurrent headaches on children's QoL, and the influence of personal and situational variables on headache, coping, and QoL in children.

METHODS

The literature search encompassed published articles that were found by means of a CD-ROM search of MEDLINE (1966 to December 1998) and PsycLIT (1974 to December 1998) and the snowball method.

RESULTS

In pediatric headache research, only three studies have been found in which children report the use of various coping strategies, and only two studies considered QoL. Demographic factors and psychological variables such as depression, anger, and anxiety influence headache prevalence. The impact of headache-related variables such as headache type, severity, perceived cause, and prior experience on QoL has only been studied in adults.

CONCLUSIONS

More research on coping and QoL is needed in pediatric headache. The conceptual model that is presented in this article may serve as a guide.

Cognitive sequelae in children treated for acute lymphoblastic leukemia with dexamethasone or prednisone

PURPOSE

The cognitive sequelae of treatment for childhood acute lymphoblastic leukemia (ALL) were compared in a group of patients who received dexamethasone during the intensification and maintenance phases of therapy with those in a historical control group for whom antileukemia therapy was similar, except that the corticosteroid component of therapy was prednisone.

METHODS

Patients treated for ALL on Dana-Farber Cancer Institute protocols 87-01 (n = 44) and 91-01 (n = 23) were evaluated by standard cognitive and achievement tests. Corticosteroid therapy was delivered in 5-day pulses given every 3 weeks during intensification and continuation phases of therapy for a total of 2 years.

RESULTS

Children treated on protocol 87-01 received prednisone at a dose of 40 mg/m2/d (standard risk, SR) or 120 mg/ m2/d (high risk, HR); those treated on protocol 91-01 received dexamethasone at a dose of 6 mg/m2 per day (SR) or 18 mg/m2 per day (HR). Children treated on protocol 91-01 performed less well on cognitive testing. Subsample analysis indicated that cranial radiation therapy and methotrexate dose did not account for differences in cognitive outcomes.

CONCLUSIONS

The findings of this preliminary study are consistent with the hypothesis that dexamethasone therapy can increase risk for neurocognitive late effects in children treated for ALL and indicate that further investigation of this question is warranted.

[Prophylactic effect of antioxidant Aekol on behavioral (psychoemotional) disturbances caused by chronic stress in rats]

Antioxidant preparation "Aekol" containing vitamins A, E, and K3, was shown to possess antidepressant properties and to exert a prophylactic effect on behavioural (psychoemotional) disturbances induced by a chronic stress in rats: a depressive condition associated with an enhanced anxiety, elimination of individual differences in behaviour, weakening of the relationships among behavioural parameters recorded in the same animal in three different tests.

Psychosocial stress and HPA functioning: no evidence for a reduced resilience in healthy elderly men

In order to investigate if HPA functioning is altered with age, the present study was conducted. Fifteen healthy elderly men (60-76 years; mean age 66.5 +/- 1.48 yrs.) and 12 younger adults (20-29 years; mean age 25.6 +/- 0.77 yrs.) collected salivary free cortisol profiles after awakening for basal HPA activity. Then, all subjects were exposed to the "Trier Social Stress Test" (TSST). This psychosocial stress protocol consists of a free speech and a mental arithmetic task of 13 minutes duration performed in front of an audience. Beside the assessment of endocrine and cardiovascular responses to the stressful task ratings of depression, mood and perceived stressfulness were obtained. Results show that younger and elderly men had similar morning cortisol profiles after awakening with both groups showing the expected rise after awakening (P=0.004). The TSST induced significant increases in ACTH, total plasma cortisol, saliva free cortisol, and heart rates (all P<0.0001). Regardless of age, both age groups showed comparable endocrine response patterns when confronted with the stressor. However, cardiovascular responses were significantly higher in younger men compared to elderly men (P=0.03). Catecholamine data revealed significant norepinephrine and epinephrine increases due to the stressor (both P<0.0001) with a trend toward elevated norepinephrine levels in elderly men (P=0.058). In sum, the investigated basal and response parameters of HPA functioning neither support the idea of a reduced resilience in healthy aged humans nor do they appear to strengthen assumptions derived from the so called "glucocorticoid cascade hypothesis".

Cortisol and prolactin concentrations during repeated blood sample collection from freely moving, mouse-sized mammals (Phodopus spp.)

BACKGROUND AND PURPOSE

Validation of a method for obtaining blood samples that does not change cortisol or prolactin concentrations yet allows serial blood samples to be collected from animals under anesthesia, without prior handling, from freely interacting social groups of small mammals.

METHODS

Results from five experiments are reported. Male dwarf hamsters (Phodopus spp.) were housed in modified home cages under continuous flow of compressed air that could be switched to isoflurane in O2 vehicle without approaching the cages.

RESULTS

Dwarf hamsters respond to manual restraint with behavioral distress and increase in the concentration of the dominant glucocorticoid, cortisol, and decrease in prolactin concentration. Both effects are evident within one minute. In contrast, when this new method was used, neither cortisol nor prolactin changed in response to repeated sample collection (up to 8 successive samples at 2 hour intervals), prolonged isoflurane exposure, or substantial blood volume reduction (30%). Prolactin concentration was suppressed and cortisol concentration was increased in response to stimuli from other hamsters tested without anesthesia. Suppression of prolactin concentration was graded in response to the degree of stress and equaled the pharmacologic reduction caused by bromocryptine mesylate (50 microg of CB154 x 3 days).

CONCLUSIONS

The technique is superior to alternatives for studies of behavioral endocrinology of freely interacting small mammals.

Pituitary-adrenocortical responses to the first dyadic encounters in male rhesus monkeys: effect of dominance relationship

Male rhesus monkeys unfamiliar with each other were paired in a cage, and blood samples were collected before and a few hours after pair formation. Adrenocorticotrophic hormone (ACTH) and cortisol levels in each blood sample were measured. Dominant-subordinate status was ascertained through two rank tests, the food competition test and the agonistic behavior test, which were performed immediately after pair formation. As a result, the dominance relationship was determined in seven pairs formed from five animals, and the differences in ACTH and cortisol values between the dominant and subordinate animal in these pairs were compared statistically. The day after the first encounter, a second encounter was conducted in randomly selected pairs of monkeys. In the first encounters, higher levels of both ACTH and cortisol were detected in dominant animals in comparison to subordinate animals. Changing the animal's partner altered the stress responses whenever the animal's dominant-subordinate status changed. The elevated levels of ACTH and cortisol in dominant animals disappeared on the day after the first encounter. In dominant animals, the pituitary-adrenocortical stress response reacts sharply to situational demands, whereas subordinate animals have a weaker response. This acute stress response is different from a chronic stress response. When the subordinate animal cannot escape, its hypothalamic-pituitary-adrenocortical axis appears to be suppressed.

The role of generalized pain and pain behavior in tender point scores in fibromyalgia

OBJECTIVE

To determine and assess the significance of the independent role of pain, pain behavior, depression, and weekly stress in tender point scores in objectively diagnosed fibromyalgia (FM) patients.

METHODS

One hundred eleven patients with FM recruited from the community and private and university based clinics participated in a comprehensive evaluation of their pain, psychological distress, and pain behavior. Tender point assessment was carried out across 18 discrete sites according to American College of Rheumatology criteria. Pain was assessed with a composite index of 4 pain measures; psychological distress consisted of measures of stress and depression, and pain behavior was measured by an objective index derived from a 10 minute videotaped sequence in which 5 pain behaviors were recorded.

RESULTS

Multiple regression analyses revealed that high pain, high pain behavior, and shorter illness duration were related independently to tender point scores. Measures of depression and weekly stress were not independently related to tender point scores.

CONCLUSION

Tender point scores are related to generalized pain and pain behavior tendencies in patients with FM, and do not independently reflect generalized psychological distress.