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Goodkin K, Lee D, Molina R, Zheng W, Frasca A, O'Mellan S, Asthana D, Shapshak P, Khamis I. Complicated Bereavement: Disease State or State of Being? OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.2190/29hw-6knd-wfep-t9l0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The point at which the experience of grief in response to bereavement becomes “pathological” has been debated for many years without resolution. This article reviews the current status of this debate. The debate centers around the extent to which “complicated grief” represents a truly unique pathological entity, when contrasted with major depressive disorder, posttraumatic stress disorder, and “uncomplicated grief.” Significant research findings suggest it may be possible to distinguish grief from depressed as well as traumatic forms of distress, with acceptable reliability and validity. Yet, “complicated grief” relates to both of these types of distress as well as to a unique aspect—separation distress. It is at the intersection of these types of distress with significant disruption of daily life functioning that we find the proposed diagnosis of “complicated grief.” The question is whether this diagnosis should be designated at this time, and, if so, how. This article concludes in favor of a compromise position that the diagnosis should be incorporated into DSM-V but relegated to its Appendix B [disorders proposed for further study] due to the lack of clarity surrounding its diagnostic criteria.
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Affiliation(s)
| | - Diana Lee
- University of Miami School of Medicine, Florida
| | | | - Wenli Zheng
- University of Miami School of Medicine, Florida
| | | | | | | | | | - Imad Khamis
- University of Miami School of Medicine, Florida
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Tiersma ESM, van der Lee ML, Garssen B, Peters AAW, Visser AP, Fleuren GJ, van Leeuwen KM, le Cessie S, Goodkin K. Psychosocial factors and the course of cervical intra-epithelial neoplasia: a prospective study. Gynecol Oncol 2005; 97:879-86. [PMID: 15894367 DOI: 10.1016/j.ygyno.2005.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2004] [Revised: 12/24/2004] [Accepted: 03/02/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the influence of psychosocial factors on the course of cervical intra-epithelial neoplasia (CIN). METHODS A group of 93 patients with CIN 1 or 2 was followed for 2.25 years by half-yearly colposcopy and cytology. Negatively-rated life events, social support, and coping style were studied in relation to distress during follow-up and in relation to time till progression and regression of CIN. Human papillomavirus (HPV) infection was controlled for as well as sick role bias caused by suspicion of having cervical cancer and distress due to the abnormal cervical smear. RESULTS During follow-up, progression was found in 20 patients (22%), stable disease in 22 patients (24%), and regression in 51 patients (55%). Negatively-rated life events and lack of social support predicted distress longitudinally. No association was found between progression or regression of CIN and negatively-rated life events, lack of social support, coping style, and distress. CONCLUSION We found no evidence that psychosocial factors influence the course of CIN.
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Affiliation(s)
- E S M Tiersma
- Helen Dowling Institute, Center for Psycho-oncology, Utrecht, The Netherlands.
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Sherman AC, Leszcz M, Mosier J, Burlingame GM, Cleary T, Ulman KH, Simonton S, Latif U, Strauss B, Hazelton L. Group interventions for patients with cancer and HIV disease: Part II. Effects on immune, endocrine, and disease outcomes at different phases of illness. Int J Group Psychother 2004; 54:203-33. [PMID: 15104002 DOI: 10.1521/ijgp.54.2.203.40390] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There has been great interest in the potential impact of group interventions on medical outcomes. This article reviews the effects of professionally-led groups on immune activity, neuroendocrine function, and survival among patients with cancer or HIV disease. We examine findings concerning different types of group services at different phases of illness. Results are mixed, but the most prominent changes in immune and endocrine activity were associated with structured group interventions for patients with early-stage disease. These findings offer provocative illustrations of relevant mind-body interactions, but their clinical importance has yet to be demonstrated empirically. Group interventions have not been tied consistently to improved survival rates for patients with advanced cancer; few studies as yet have focused on survival outcomes among patients with early-stage cancer or HIV disease.
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Affiliation(s)
- Allen C Sherman
- Department of Otolaryngology, University of Arkansas for Medical Sciences, USA.
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Tiersma ESM, van der Lee ML, Peters AAW, Visser AP, Jan Fleuren G, Garssen B, van Leeuwen KM, le Cessie S, Goodkin K. Psychosocial factors and the grade of cervical intra-epithelial neoplasia: a semi-prospective study. Gynecol Oncol 2004; 92:603-10. [PMID: 14766254 DOI: 10.1016/j.ygyno.2003.10.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2003] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To study the influence of psychosocial factors on the grade of cervical intra-epithelial neoplasia. METHODS The influence of psychosocial factors on the grade of cervical intra-epithelial neoplasia (CIN) was studied in a group of 342 patients with an abnormal cervical smear. Participants completed a set of questionnaires after colposcopy directed biopsy before knowing the biopsy result. Negatively rated life events, social support, and coping style were studied in relation to distress and grade of CIN. Infection with human papillomavirus (HPV) types was controlled for, as well as sick role bias caused by suspicion of having cervical cancer and distress due to the abnormal cervical smear. RESULTS Negatively rated life events, lack of social support, and emotional coping were significant predictors for level of distress. No significant relationship was found, however, between the psychosocial factors and grade of CIN. CONCLUSION No support was found for an influence of negatively rated life events, social support, coping style, and distress on grade of CIN.
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Wilkie FL, Goodkin K, Khamis I, van Zuilen MH, Lee D, Lecusay R, Concha M, Symes S, Suarez P, Eisdorfer C. Cognitive functioning in younger and older HIV-1-infected adults. J Acquir Immune Defic Syndr 2003; 33 Suppl 2:S93-S105. [PMID: 12853858 DOI: 10.1097/00126334-200306012-00006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In young adults, a major neurologic complication of HIV-1 infection is cognitive motor impairment. Epidemiologic findings suggest that increasing age is a significant risk factor for HIV-1-associated dementia as the AIDS-defining illness. Findings from the few studies that have directly measured cognition in younger and older HIV-1-infected adults, however, have been mixed, in part, because of small sample sizes and other methodologic differences between studies. The authors present preliminary findings on cognitive functioning in symptomatic HIV-1-infected younger (aged 20-39 years) and older (aged 50 years or older) adults. Independent of age, HIV-1 infection was accompanied by learning and memory retrieval deficits, which were significantly associated with high plasma viral loads in the young adults. Relative to the younger and older HIV-1-negative (HIV-1-) groups, only the younger HIV-1-positive (HIV-1+) group had significantly longer reaction times (RTs). Within the older HIV-1+ group, however, longer simple and choice RTs were significantly correlated with higher viral loads and lower CD4 cell counts. Although HIV-1 infection affects cognition independent of age, longitudinal studies involving large numbers of older individuals are needed to determine whether there are age differences in the prevalence, nature, and severity of HIV-1-associated cognitive dysfunction.
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Affiliation(s)
- Frances L Wilkie
- Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, FL 33136, USA.
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Abstract
Psychoneuroimmunology (PNI) is a rapidly evolving multidisciplinary field founded on the premise that psychosocial factors, the central nervous system, and the immune system are intimately linked. Following publication of scientific evidence supporting this link, a number of animal and human studies have been published, both inside and outside the area of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome. These studies support the existence of bidirectional feedback mechanisms operating between the brain and the immune system. To date, however, there is no all-encompassing model that predicts individual differences in the relationship among psychosocial factors, immunologic measures, and clinical disease progression in HIV type 1 (HIV-1) infection. This variability in human response has been explained by a number of cofactors (host as well as environmental) that appear to accelerate the course of the disease. Since psychosocial factors are highly amenable to behavioral interventions, several models for intervention research have been proposed to evaluate whether such interventions can enhance immune functioning, thereby curtailing disease progression. Examination of these interventions in the context of PNI and HIV-1 infection, however, is rather limited. Therefore, researchers and clinicians must not only consider conceptualizations and paradigms in this area of research, but also focus on empirically testable, theory-driven models that allow for the unique characteristics of individual patients.
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Surtees PG, Wainwright NW, Brayne C. Psychosocial aetiology of chronic disease: a pragmatic approach to the assessment of lifetime affective morbidity in an EPIC component study. J Epidemiol Community Health 2000; 54:114-22. [PMID: 10715744 PMCID: PMC1731622 DOI: 10.1136/jech.54.2.114] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The Health and Life Experiences Questionnaire (HLEQ) was developed for use in a prospective cohort study of 25,000 men and women living in Norfolk and forms a component study of the European Prospective Investigation into Cancer and Nutrition (EPIC). The HLEQ includes an assessment of mood status over the life course allowing a limited capacity for the imposition of diagnostic criteria to enable eventual evaluation of mental health status for chronic disease outcomes. This paper reports estimates of HLEQ Major Depressive Disorder (MDD) prevalence and compares them with those obtained through interviewer-based methods. In addition evidence for the impact of recall, clustering or cohort effects on these estimates are examined. PARTICIPANTS 3491 eligible respondents to EPIC in Norfolk, aged 45-74 years, recruited from the first five general practices who completed the HLEQ. MAIN RESULTS MDD prevalence estimates were found to be closely comparable to those obtained recently (by interview) in the UK and to those lifetime MDD rates determined through international studies. Risk of MDD onset was found to vary with age as expected from earlier studies using interviewer-based assessments. Limited evidence was found to show that the distribution of first onset MDD episodes were compressed during the immediate pre-assessment period. Results were also consistent with previous evidence demonstrating the raised risk of MDD among women and of the decline in gender differences with advancing age. CONCLUSIONS These results suggest that estimates of putative MDD diagnostic status, derived through the HLEQ, and of associated demographic risk are similar to those derived by more intensive and costly assessment methods. Implications for the future study of MDD both as an outcome and as a risk factor for chronic disease are discussed.
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Affiliation(s)
- P G Surtees
- MRC Biostatistics Unit, University Forvie Site, Cambridge
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Baldewicz TT, Goodkin K, Blaney NT, Shor-Posner G, Kumar M, Wilkie FL, Baum MK, Eisdorfer C. Cobalamin level is related to self-reported and clinically rated mood and to syndromal depression in bereaved HIV-1(+) and HIV-1(-) homosexual men. J Psychosom Res 2000; 48:177-85. [PMID: 10719135 DOI: 10.1016/s0022-3999(99)00108-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE An examination of the relationship of plasma cobalamin (vitamin B(12)) level to overall psychological distress, specific mood states, and major depressive disorder was conducted in 159 bereaved men (90 HIV-1(+) and 69 HIV-1(-)). METHODS The relationship of a continuous measure of cobalamin level to psychological distress was examined, while controlling for HIV-1 serostatus, life stressors, social support, and coping styles. RESULTS Of this sample, 23.9% were either overtly or marginally cobalamin deficient; however, the deficiency rate was not significantly different by HIV-1 serostatus. Cobalamin level was inversely related to self-reported overall distress level and specifically to depression, anxiety, and confusion subscale scores, as well as to clinically rated depressed and anxious mood. Lower plasma cobalamin levels also were associated with the presence of symptoms consistent with major depressive disorder. CONCLUSION These findings suggest that cobalamin level may be physiologically related to depressed and anxious mood level, as well as to syndromal depression.
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Affiliation(s)
- T T Baldewicz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, PO Box 3119, Durham, NC 27710, USA.
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Shor-Posner G, Baldewicz T, Feaster D, Blaney NT, Miguez-Burbano M, Szapocznik J, Goodkin K, Eisdorfer C, Baum MK. Psychological distress in HIV-1 disease in relationship to hypocholesterolemia. Int J Psychiatry Med 1998; 27:159-71. [PMID: 9565721 DOI: 10.2190/95f4-hwvj-4c3c-xudk] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Altered levels of serum cholesterol, which are prevalent in early HIV-1 infection, have been associated with disturbances in mood state and behavior. The objective of this study was to evaluate the relationship of serum cholesterol status and psychological distress in HIV-1 seropositive and seronegative men. METHOD The association between serum cholesterol level and psychological distress, measured with the Profile of Mood States (POMS), was examined in 169 individuals (117 HIV-1 seropositive and 52 seronegative homosexual men), controlling for negative life events, social support, coping style, and HIV-1 serostatus. RESULTS Individuals with hypocholesterolemia (serum cholesterol levels < 150 mg/dL), exhibited significantly higher levels of distress, relative to individuals with values of cholesterol > 150 mg/dL (p = 0.01). HIV-1 seropositive men had significantly lower cholesterol levels (p = 0.0001) and higher levels of distress than the seronegative men (p = 0.03). A significant interaction between negative life events and cholesterol status was demonstrated as well (p = 0.04). CONCLUSIONS Hypocholesterolemia appears to be associated with increased psychological distress. Whereas the causal direction of the cholesterol-distress association cannot be specified, our results suggest that HIV-1 infected men with low cholesterol levels may benefit from being monitored for changes in distress level, so that appropriate psychosocial intervention can be instituted, as necessary.
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Affiliation(s)
- G Shor-Posner
- Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, FL 33101, USA
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Baldewicz T, Goodkin K, Feaster DJ, Blaney NT, Kumar M, Kumar A, Shor-Posner G, Baum M. Plasma pyridoxine deficiency is related to increased psychological distress in recently bereaved homosexual men. Psychosom Med 1998; 60:297-308. [PMID: 9625217 DOI: 10.1097/00006842-199805000-00016] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Previous research has demonstrated that a theoretical model including measures of life stressors, social support, and coping style significantly predicts psychological distress. This study tested plasma pyridoxine (vitamin B6) deficiency status as a predictor of overall psychological distress and specific mood states in this model, controlling for HIV-1 serostatus. METHOD Subjects included HIV-1+ (N = 76) and HIV-1- (N = 58) recently bereaved homosexual men. At baseline, subjects completed a battery of psychosocial questionnaires, together with a physical examination and venipuncture. The Profile of Mood States (POMS) provided measures of overall psychological distress as well as specific mood states. Pyridoxine deficiency status (a categorical measure of deficient vs. adequate status) was determined with a bioassay of erythrocyte aspartate aminotransferase activity. RESULTS Pyridoxine deficiency was a significant predictor of increased overall psychological distress in this model, controlling for life stressors, social support, coping style, and HIV-1 serostatus. In post hoc analyses of specific mood state effects, pyridoxine deficiency status was significantly associated with increases in depressed, fatigued, and confused mood levels, but not with those of anxiety, anger, or vigor. DISCUSSION These findings suggest that adequate pyridoxine status may be necessary to avert psychological distress in the setting of bereavement. Inasmuch as pyridoxine is a cofactor for 5-hydroxytryptophan decarboxylase--an enzyme in the biosynthesis pathway of serotonin--serotonin level in the brain is implicated as the mediating factor.
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Affiliation(s)
- T Baldewicz
- Department of Psychology, University of Miami School of Medicine, Florida 33136, USA
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Vingerhoets AJ, Assies J, Goodkin K, Van Heck GL, Bekker MH. Prenatal diethylstilbestrol exposure and self-reported immune-related diseases. Eur J Obstet Gynecol Reprod Biol 1998; 77:205-9. [PMID: 9578280 DOI: 10.1016/s0301-2115(97)00274-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare self-reports of immune-related diseases in diethylstilbestrol (DES) daughters and controls. Prenatal exposure to DES has been associated with several malformations in the lower genital tract, a higher prevalence of adenosis, and increased risk of clear cell adenocarcinoma, and estrogen-dependent tumors. Lately, reports have been published indicating a link between DES exposure and alterations in the immune system. The present study focuses on the possible clinical consequences of an affected immune system. STUDY DESIGN DES daughters (n=170) and control women (n=123) completed questionnaires containing lists of immune-related diseases, specified into three categories (i) allergies, (ii) auto-immune disorders, and (iii) infectious diseases. RESULTS DES daughters reported significantly more disease conditions than the controls. Analyses for separate disease categories (allergies, auto-immune disorders, infectious disease), yielded a statistically significant difference only for infectious disease. Within this last category, two infectious diseases yielded highly significant differences: bladder infection and measles. CONCLUSION The present findings suggest that DES daughters are at higher risk of developing immune-related disease states.
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Blaney NT, Goodkin K, Feaster D, Morgan R, Millon C, Szapocznik J, Eisdorfer C. A psychosocial model of distress over time in early hiv-1 infection: The role of life stressors, social support and coping. Psychol Health 1997. [DOI: 10.1080/08870449708407411] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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From human papillomavirus (HPV) to cervical cancer: Psychosocial processes in infection, detection, and control. Ann Behav Med 1996; 18:219-28. [DOI: 10.1007/bf02895283] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Goodkin K, Burkhalter JE, Tuttle RS, Blaney NT, Feaster DJ, Leeds B. A Research Derived Bereavement Support Group Technique for the Hiv-1 Infected. OMEGA-JOURNAL OF DEATH AND DYING 1996. [DOI: 10.2190/xhh4-la07-2j9j-pc3e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A brief, semi-structured, bereavement support group for HIV seropositive and at risk homosexual men suffering a recent loss of a close friend or lover is described. The intervention employed a set of topics to stimulate group discussion. These topics were organized into three phases: making contact, venting of emotion, and “moving on.” Our predictive theoretical model integrating life stressor appraisal, social support availability, and active coping was incorporated. Therapeutic foci are active monitoring of stressor load; accurate stressor appraisal; extending, using and evaluating one's social support network; and selection of adaptive coping strategies. Three vignettes illustrate the integration of the research protocol with clinical issues. Implications for clinical care are discussed.
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Affiliation(s)
- Karl Goodkin
- University of Miami School of Medicine, Florida and Helen Dowling Institute for Biopsychosocial Medicine, Rotterdam, The Netherlands
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Goodkin K, Feaster DJ, Tuttle R, Blaney NT, Kumar M, Baum MK, Shapshak P, Fletcher MA. Bereavement is associated with time-dependent decrements in cellular immune function in asymptomatic human immunodeficiency virus type 1-seropositive homosexual men. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1996; 3:109-18. [PMID: 8770514 PMCID: PMC170257 DOI: 10.1128/cdli.3.1.109-118.1996] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Seventy-nine human immunodeficiency virus type 1 (HIV-1)-seropositive homosexual men participating in a longitudinal study of HIV-1 infection were assessed twice, 6 months apart, to investigate associations between bereavement and cellular immune function. Subjects were assessed by using a theory-driven model comprising life stressors, social support and coping style, and control variables. Natural killer cell cytotoxicity was decreased among the bereaved at both times. Lymphocyte proliferative response to phytohemagglutinin was decreased among the bereaved at the second time point but not at the first. These functional immune decrements are associated with increased neuroendocrine responses of the sympathetic adrenomeduallary system as well as the limbic-hypothalamic-pituitary-adrenal axis. Implications for differential neuroendocrine responses over time are discussed. Active coping style was independently and positively related to both immune measures. The results imply that a bereavement support group intervention merits investigation for an effect on immunological measures and clinical progression of HIV-1 infection as well as grief resolution.
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Affiliation(s)
- K Goodkin
- Department of Psychiatry, University of Miami School of Medicine, Florida 33136-1045, USA.
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Van Der Pompe G, Antoni MH, Mulder CL, Heijnen C, Goodkin K, De Graeff A, Garssen B, De Vries MJ. Psychoneuroimmunology and the course of breast cancer: An overview the impact of psychosocial factors on progression of breast cancer through immune and endocrine mechanisms. Psychooncology 1994. [DOI: 10.1002/pon.2960030404] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Goodkin K, Antoni MH, Sevin B, Fox BH. A partially testable, predictive model of psychosocial factors in the etiology of cervical cancer i. Biological, psychological and social aspects. Psychooncology 1993. [DOI: 10.1002/pon.2960020203] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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