Psychosocial factors in peptic ulcer and inflammatory bowel disease

Flare-Ups in Crohn's Disease: Influence of Stress and the External Locus of Control

(1) Background: The aim of this study was to explore the role of perceived stress and the health locus of control in Crohn's disease and their influence upon the development of flare-ups of this disease. (2) Methods: Stress and the external locus of control were evaluated in a sample of 64 Crohn's patients (flare-up phase versus latency phase). The perceived stress scale (PSS-14) and the multidimensional health locus of control scale were the measurement instruments used. (3) Results: The results indicate that the patients have high stress levels during a flare-up (26.13; 27.44; 28.79; 29.67); high stress levels (28.07; 29.67; 27.44; 28.07) if they have a high external locus of control; and that the external locus of control and stress levels have a significant influence upon the existence of flare-ups in those patients with low external locus of control levels (χ2 = 11.127; df = 1: p < 0.001). (4) Conclusions: Actions aimed at reducing stress and external locus of control levels are necessary in Crohn's disease.

Psychiatric symptoms among patients with acute abdominal pain

Background: Abdominal pain is a common cause of visits to emergency facilities. It is related to psychiatric disorders in primary care, but it is unclear if this also holds in emergency departments.Objective: Is to explore potential differences between diagnostic groups in patients with acute abdominal pain in an emergency ward regarding concurrent somatic-and psychiatric symptoms, 'Length of stay' (LOS) and perceived health.Method: The patients (N = 137) were divided into three groups; organic dyspepsia, specific abdominal diagnoses, and non-specific abdominal pain. The Prime-MD results for extra gastrointestinal symptoms (outside the gastrointestinal tract), psychiatric symptoms, frequency of symptoms, self-reported health, and LOS within the month before admittance were compared between the diagnostic groups.Results: There was a significant positive correlation between the number of physical extra gastrointestinal and psychiatric symptoms (p < .001), especially regarding anxiety (p < .001) and depression (p = .002). Patients with organic dyspepsia reported significantly more total (p = .016), extragastrointestinal (p = .026) (chest pain; p = .017, dizziness; p = .004, palpitations; p = .005, insomnia; p = .005 and worries; p = .001), and summarized anxiety and depression symptoms (p = .001-0.002) besides poorer general health (p < .001) compared to other abdominal conditions. Also, organic dyspepsia patients needed longer hospital stay than the non-specific abdominal group (p = .002) but similar to the specific abdominal disorders group.Conclusion: Organic dyspepsia is accompanied by more co-occurring physical, anxiety and depression symptoms as well as poorer perceived health than other abdominal pain conditions and comparably increased LOS. This suggests that psychiatric consultations might be beneficial for diagnosing and treating psychiatric comorbidity in emergency care.

Temperament and character in patients with acute abdominal pain

BACKGROUND

Several conditions presenting with abdominal pain are associated with specific personality factors although it is unclear if this is true also in emergency clinic settings.

OBJECTIVE

To study personality factors among patients with acute abdominal pain in an emergency ward.

METHODS

Consecutive patients (N = 165) with abdominal symptoms at an emergency clinic were administrated the Temperament and Character Inventory (TCI). Three main groups were identified; specific abdominal diagnoses, (N = 77), non-specific abdominal pain, (N = 67) and organic dyspepsia (N = 21). TCI results were compared between clinical groups and a control group (N = 122).

RESULTS

As compared to individuals with specific abdominal diagnoses and controls, those with organic dyspepsia were significantly more anxious (harm avoidance), (p = 0.003), and had lower ability to cooperate (cooperativeness) (p = 0.048 and p = 0.004 respectively). They were also significantly more unpretentious (self-transcendence) compared to individuals with specific abdominal diagnoses (p = 0.048), non-specific abdominal pain (p = 0.012) and controls (p = 0.004) and evidenced less mature character (sum of self-directedness and cooperativeness) compared to those with specific abdominal diagnoses and controls (p = 0.003).

CONCLUSION

Individuals seeking care at an emergency clinic with organic dyspepsia showed a distinguishable pattern of personality features that distinguished them from the other comparison groups. Therefore an evaluation of personality factors may add a new dimension to the diagnostic investigation in the emergency care of abdominal pain and contribute to the optimization of the treatment of organic dyspepsia.

Case Report: Diagnosis and Treatment of Psychosomatic Gastritis at a Primary Health Clinic in West Surabaya, Indonesia

Indonesia is highly populated of a total 238,452,952 people with 274,396 gastritis cases. However, psychosomatic gastritis was just reported by very few patients. Because of the common gastritis cases in Indonesia and with the act of Healthcare and Social Security Agency or BPJS, so primary health cares should diagnose and manage the cases. This study aimed to determine the diagnosis and management of psychosomatic gastritis at a primary health clinic in West of Surabaya. It was a case study. It was a case on a woman aged 45 years old. She was high school graduate, married and had a child. She experienced reflux gastritis and psychiatric condition of depression and anxienty disorders. She was treated by psychiatrist at the first time and self-medicated for the gastritis. After stopping visiting the psychiatrist, she had problems of gastritis in four months. Then, she was referred to internist and examined Ultra Sonography of abdominal organs with normal result. There was a conventional method to determine psychosomatic gastritis that consicting of life styles, psychologic factor, social factor, and behavior assessment. This patient was a local migrant who struggled to gain a better life in the city, had a trigger for his father's death, had a relatively low socioeconomic state and lived in a monthly boarding house, and was a part-time worker. First-line care should establish a psychosomatic diagnosis of gastritis and treat psychological disorders together with their somatic abnormalities. Thus, the first level of health services must provide holistic services consisting of physical, psychological and social aspects.

Decreased stress resilience in young men significantly increases the risk of subsequent peptic ulcer disease - a prospective study of 233 093 men in Sweden

BACKGROUND

Psychosocial stress may influence peptic ulcer disease (PUD) risk, but it can be difficult to identify reliably whether stressful exposures pre-dated disease. The association of stress resilience (susceptibility to stress) with subsequent PUD risk has been incompletely investigated.

AIM

To assess if stress resilience in adolescence is associated with subsequent PUD risk.

METHODS

The participants comprised of 233 093 men resident in Sweden, born 1952-1956 and assessed for compulsory military conscription during 1969-1976, with data provided by national Swedish registers. Stress resilience was evaluated through semi-structured interviews by a certified psychologist. Cox regression assessed the association between stress resilience in adolescence and the risk of PUD from 1985 to 2009, between ages 28 and 57 years, with adjustment for parental socioeconomic index, household crowding and number of siblings in childhood, as well as cognitive function and erythrocyte sedimentation rate in adolescence.

RESULTS

In total, 2259 first PUD diagnoses were identified. Lower stress resilience in adolescence is associated with a higher risk of PUD in subsequent adulthood: compared with high resilience, the adjusted hazard ratios (and 95% CI) are 1.84 (1.61-2.10) and 1.23 (1.09-1.38) for low and moderate stress resilience, respectively.

CONCLUSION

Stress may be implicated in the aetiology of PUD and low stress resilience is a marker of risk.

Exposome in IBD: recent insights in environmental factors that influence the onset and course of IBD

It is generally agreed that environmental factors trigger the onset and cause flares of inflammatory bowel disease. Although we have learned much about genetic susceptibility factors of inflammatory bowel disease in recent years, our knowledge on these environmental factors is limited. The sum of all environmental factors a human is exposed to during lifetime has been termed the exposome. The challenge of investigating the exposome is discussed in this overview. The environmental exposure of a subject causes changes in the intestinal microbiota and subsequently changes the epigenetic imprinting of the mucosa and the associated immune system. Some relevant environmental factors have been investigated in recent years in inflammatory bowel disease and other (auto)inflammatory disease. These factors can be categorized in air pollution, diet, drugs, stress, infections, water pollution, food additives, and lifestyle. Examples from those categories and their potential pathophysiological mechanism are discussed.

5-HT7 receptor signaling: improved therapeutic strategy in gut disorders

Serotonin (5-hydroxytryptamine; 5-HT) is most commonly known for its role as a neurotransmitter in the central nervous system (CNS). However, the majority of the body’s 5-HT is produced in the gut by enterochromaffin (EC) cells. Alterations in 5-HT signaling have been associated with various gut disorders including inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and enteric infections. Recently, our studies have identified a key role for 5-HT in the pathogenesis of experimental colitis. 5-HT₇ receptors are expressed in the gut and very recently, we have shown evidence of 5-HT₇ receptor expression on intestinal immune cells and demonstrated a key role for 5-HT₇ receptors in generation of experimental colitis. This review summarizes the key findings of these studies and provides a comprehensive overview of our current knowledge of the 5-HT₇ receptor in terms of its pathophysiological relevance and therapeutic potential in intestinal inflammatory conditions, such as IBD.

Anxiety disorders and risk of self-reported ulcer: a 10-year longitudinal study among US adults

OBJECTIVE

Previous epidemiologic studies have documented a link between anxiety disorders and ulcer among adults. Few studies have examined these associations over time and little is understood about the pathways underlying these relationships.

METHOD

Data were drawn from n = 2101 adult participants in the Midlife Development in the United States I and II. Data on ulcer diagnoses were collected through self-report: among participants in the current sample, 38 reported ulcer at Waves 1 and 2 (prevalent ulcer), and 18 reported ulcer at Wave 2 but not at Wave 1 (incident ulcer). Panic attacks and generalized anxiety disorder at Wave 1 (1994) were examined in relation to prevalent (past 12 months) and incident ulcer approximately 10 years later at Wave 2 (2005).

RESULTS

Anxiety disorders at Wave 1 were associated with increased prevalence of ulcer [odds ratio (OR) = 4.1, 95% confidence interval (CI) = 2.0-8.4], increased risk of incident ulcer at Wave 2 (OR = 4.1, 95% CI = 1.4-11.7) and increased risk of treated ulcer at Wave 2 (OR = 4.7, 95% CI = 2.3-9.9) compared with those without anxiety.

CONCLUSIONS

In this large population sample of adults, anxiety disorders were associated with an increased risk of ulcer over a 10-year period. These relationships do not appear to be explained by confounding or mediation by a wide range of factors. Future studies should address potential mechanisms underlying the relationship between anxiety and ulcer.

The effects of vitamin A on cells of innate immunity in vitro

Retinoid treatment is suggested to promote development of inflammatory bowel disease, although preclinical studies are not supportive. We evaluated the effect of retinoids on cytokine response in in vitro-differentiated human dendritic cells (ivDCs) and macrophages (ivMACs) derived from healthy human donors and in cultured human THP-1 cells. Effect on human intestinal epithelial cell integrity was also assessed. Each cell type was incubated (±lipopolysaccharide [LPS]) with all-trans retinoic acid (ATRA), 13-cis-RA (isotretinoin) and 4-oxo-13-cis-RA. Cytokine analysis was performed by array analysis. Cultured human endothelial colorectal adenocarcinoma (Caco-2) cells were incubated with these retinoids and media analyzed for leakage by spectrofluorometric analysis. ATRA consistently and significantly inhibited LPS-induced release of the pro-inflammatory cytokines tumor necrosis factor, interleukin (IL)-6, macrophage inflammatory protein (MIP)-1α and MIP-1β. All retinoids tested stimulated release of the anti-inflammatory cytokines granulocyte-macrophage colony-stimulating factor and IL-10, and also monocyte chemotactic protein-1, vascular endothelial growth factor and eotaxin-1. Incubation with retinoids did not significantly alter the permeability of Caco-2 monolayers. Pre-treatment of each cell type with retinoids promoted an anti-inflammatory cytokine profile with only minimal effect on intestinal epithelial cell permeability; consistent with in vivo studies.

Restoring psychology's role in peptic ulcer

This paper reviews the history of the transition from the belief that gastrointestinal ulcers are caused primarily by psychological factors to the current state of belief that they are caused primarily by infection and argues that neither is fully accurate. We argue that psychological factors play a significant role as predisposing to vulnerability, modulating of precipitation, and sustaining of gastric ulceration. We review data that challenge the assumption of a simple infectious disease model and adduce recent preclinical data that confirm the predisposing, modulatory, and sustaining roles for psychological factors. We note that others, too, are now challenging the adequacy of the contemporary simple bacterial infection model. We hope to replace the competition between psychology and medicine with cooperation in understanding and treating patients suffering gastric ulceration and ulcer.

Altered physiology of acid secretion in depression-prone Flinders rats results in exacerbated NSAID and stress-induced gastric damage

BACKGROUND

Flinders Sensitive Line (FSL) rats are characterized by hypersensitivity to cholinergic stimuli and have been extensively used for studying depressive disorders. A link between depression and peptic ulcers has long been established; however, there is a lack of data from animal models.

METHODS

We studied the physiology of acid secretion in FSL and Flinders Resistant Line (FRL) rats in vivo and in vitro. We also examined the susceptibility of Flinders rats to water immersion restraint stress (WIRS) or NSAID-induced gastric damage and explored the effect of an anticholinergic agent, atropine, in reversing this effect.

KEY RESULTS

Basal acid output was more than twofold greater in FSL compared with FRL rats in vivo, 213.5 and 92.8 μEq/3 h/100 g (P = 0.02), respectively. Carbachol was a more potent secretagog in vitro, and somatostatin was a less potent inhibitory agent, while paradoxically stimulating acid secretion over and above the carbachol response in gastric glands from FSL rats. The FSL rats were more susceptible to indomethacin and WIRS-induced gastric mucosal damage compared with FRL rats. Atropine reduced acid output, which resulted in a reduction in indomethacin and stress-induced gastric damage in FSL rats.

CONCLUSIONS & INFERENCES

Our study, for the first time, demonstrates that the altered vagally mediated physiology of acid secretion in depression-prone FSL rats contributes to gastric hypersecretion and, consequently, results in exacerbated stress and NSAID-induced gastric damage. Flinders rats may be a useful animal model for studying acid-related and also gastrointestinal functional disorders in depression.

Is childhood physical abuse associated with peptic ulcer disease? Findings from a population-based study

This study investigated childhood physical abuse and ulcers in a regionally representative community sample. Age, race and sex were controlled for in addition to five clusters of potentially confounding factors: adverse childhood conditions, adult socioeconomic status, current health behaviors, current stress and marital status, and history of mood/anxiety disorders. Childhood physical abuse is associated with many negative physical and psychological adult health outcomes. Two recent studies demonstrate a potential link between childhood physical abuse and peptic ulcer disease in adulthood. The authors use regional data for the Canadian provinces of Manitoba and Saskatchewan from the 2005 Canadian Community Health Survey. Of the 13,069 respondents with complete data on abuse and ulcers, 7.3% (n = 1,020) report that they had been physically abused as a child by someone close to them and 3.0% (n = 493) report that they had been diagnosed with peptic ulcers by a health professional. The regional response rate is approximately 84%. Findings show that those reporting abuse had more than twice the prevalence of ulcers than did those not reporting abuse (6.6% vs. 2.7%). The fully adjusted odd ratio of peptic ulcers among those who had reported childhood physical abuse is 1.68 (95% CI = 1.22, 2.32). A significant and stable relationship between childhood physical abuse and peptic ulcers is found, even when taking into account five clusters of potentially confounding factors. Prospective studies that apply the biopsychosocial model are likely to be the most effective for identifying the pathways that connect childhood physical abuse and ulcer disease.

Behavioral interventions may prolong remission in patients with inflammatory bowel disease

Inflammatory Bowel Diseases (IBDs) are chronic, relapsing and remitting gastrointestinal conditions with no known cure. Previous studies have linked behavioral factors, including stress and medication adherence, to relapse.

PURPOSE

We sought to determine the effect of participation in a behavioral self-management program on incidence of flare within 12 months following behavioral intervention when compared to the natural history of flare incidence prior to program participation.

RESULTS

Results from a 2-level regression model indicated that those participants in the treatment group were 57% less likely to flare in the following 12 months (compared to 18% in the control group). The decline in "flare odds" was about 2 times greater in treatment versus controls (OR=0.52, t(34)=2.07, p<0.05). Office visits, ER visits, and disease severity (all p<0.05) were identified as moderators of flare risk.

CONCLUSIONS

We have demonstrated 1) a statistical model estimating the likelihood of flare rates in the 12 months following a behavioral intervention for IBD (compared to a control condition), and 2) that the introduction of a behavioral intervention can alter the natural course of a chronic, relapsing and remitting gastrointestinal condition such as IBD.

[The effect of stress-relieving interventions on inflammatory bowel disease: quality assessment of 10 therapeutic studies]

OBJECTIVES

Patient comments and empirical studies suggest an influence of stress on inflammatory bowel diseases (IBD). We performed a quality assessment of previous studies on the effect of stress reduction on IBD in order to formulate recommendations for future studies and to evaluate their potential for improvement.

METHODS

Studies were searched for in the PubMed online library and in the bibliographies of the located sources. Based on an analysis of the study design and the methodology of individual studies, we made specific recommendations following recognized methodological principles and used them to evaluate the analyzed studies.

RESULTS

The 10 studies identified differed in terms of exclusion criteria, distribution of characteristics, stress reduction, and effect measurements. The recommendations formulated had not been followed exhaustively in these studies.

CONCLUSIONS

Computation of sample size to detect relevant effects, orientation toward previous studies, documentation of potential confounders, and confidence intervals are criteria that are easy to consider and well-known, and that, if applied to future studies, might enhance the quality of IBD research.

Adjustment to inflammatory bowel disease: the relative influence of illness perceptions and coping

BACKGROUND

The Common Sense Model (CSM) of illness representations was used in the current study to examine the relative contribution of illness perceptions and coping strategies in explaining adjustment to inflammatory bowel disease (IBD).

METHODS

Participants were 80 adults consecutively attending an outpatients' clinic with a diagnosis of either Crohn's disease or ulcerative colitis. Respondents completed and returned a questionnaire booklet that assessed illness perceptions, coping, and adjustment. Adjustment was measured from the perspectives of psychological distress, quality of life, and functional independence.

RESULTS

Illness perceptions (particularly perception of consequences of IBD) were uniformly the most consistent variables explaining adjustment to IBD. Coping did not significantly add to predicting adjustment once illness perceptions were controlled for and therefore did not mediate the relationship between illness perceptions and adjustment, as proposed in the CSM.

CONCLUSIONS

The results suggest the importance of addressing illness perceptions in developing appropriate psychological interventions for IBD.

'I feel as if my IBS is keeping me hostage!' Exploring the negative impact of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) upon university-aged women

The purpose of this article is to describe the negative impact of irritable bowel syndrome (IBS) and/or inflammatory bowel disease (IBD) upon university-aged women. This exploratory study was conducted using phenomenology, with heuristic inquiry as the guiding theoretical orientation. Seven women participated in an email interview and in a semistructured interview. The findings indicate that women with active IBD/IBS commonly experience an anxiety reaction, followed by an attack of illness. This attack then triggers a cascade of impact that negatively influences their emotional and physical well-being, ultimately affecting their overall quality of life. Health-care professionals can play an important role in minimizing the impact of IBD/IBS upon those affected, and possible interventions are suggested.

Early life stress enhances the vulnerability to chronic psychosocial stress and experimental colitis in adult mice

Early life stress enhances the vulnerability to both mood and chronic inflammatory disorders, suggesting a link between these stress-related disorders. To study this, we exposed male C57BL/6 mice to early life stress [maternal separation (MS), 3 h/d, d 1-14] and to adult chronic psychosocial stress [chronic subordinate colony housing (CSC)] and measured changes in neuroendocrine parameters and in the severity of a chemically induced colitis. In both unseparated and MS mice, 19 d of CSC exposure resulted in a transient decrease in body weight gain, increased anxiety-related behavior, and decreased vasopressin mRNA expression in the hypothalamic paraventricular nucleus compared with respective nonstressed mice. However, only CSC-stressed MS mice showed elevated CRH mRNA expression in the paraventricular nucleus and reduced plasma corticosterone. Subsequent treatment with dextran sulfate sodium (1%, 7 d) resulted in a more severe colonic inflammation in MS compared with unseparated mice. This was indicated by an increased histological damage score and increased TNF secretion (nonstressed MS mice), more severe body weight loss and inflammatory reduction in colon length (CSC-stressed MS mice), and increased interferon-gamma secretion (nonstressed and CSC-stressed MS mice). In conclusion, early life stress and subsequent exposure to chronic psychosocial stress in adulthood induced neuroendocrine abnormalities, which likely contributed to enhanced vulnerability to chemically induced colitis. The combined use of MS and CSC represents a potential animal model providing novel (patho)physiological insights into the complex interactions between neuroendocrine and inflammatory actions upon chronic stress exposure. These findings may further help to reveal mechanisms of hypocortisolemic disorders.

Social learning contributions to the etiology and treatment of functional abdominal pain and inflammatory bowel disease in children and adults

This paper reviews empirical work on cognitive and social learning contributions to the etiology and treatment of illness behavior associated with functional abdominal pain and inflammatory bowel disease. A particular emphasis is placed on randomized controlled trials, the majority of which are multi-modal in orientation, incorporating elements of cognitive behavioral therapy, social learning, and relaxation. Based on this review, we offer methodological and clinical suggestions: (1) Research investigations should include adequate sample sizes, long-term follow-up assessments, and a credible, active control group. (2) Standard gastrointestinal practice should include, when appropriate, learning opportunities for patients and family members, for example, instruction regarding the encouragement of wellness behavior.

Trends in healthcare use in the New York City region following the Terrorist Attacks of 2001

BACKGROUND

In 2001, terrorism led to emotional stress, disruptions in adherence to treatments and access to services, and exposure to environmental contaminants in New York City (NYC).

METHODS

To describe healthcare use following the terrorist attacks of 2001, we examined insurance claims for January 2000 to March 2002 among more than 2 million residents of the NYC region who were enrolled in the health plans of a large insurer, including overall use by care setting and use for selected conditions that may be associated with stress or other disaster consequences. For all enrollees and for those residing at varying distances from the World Trade Center (WTC), we compared observed use to expected use, based on comparable intervals in prior years and adjusted for seasonal and secular trends.

RESULTS

Use declined across all care settings in the 3 weeks following September 11. From October 1 to December 31, 2001, outpatient visits rose beyond expected both overall and for specific cardiovascular, gastrointestinal, and dermatologic conditions. Declines in overall mental health service use began immediately after September 11 and were sustained through March 2002. Changes in healthcare use were more marked among those residing within 10 miles of the WTC than those residing at greater distances.

CONCLUSIONS

A transient decline in visits across all settings occurred immediately after September 11, followed by a sustained increase in demand for health care for conditions that may be associated with stress or other disaster consequences.

Evidence that stress contributes to inflammatory bowel disease: evaluation, synthesis, and future directions

BACKGROUND

There is a long but inconsistent history of observations suggesting that psychologic stress contributes to the course of ulcerative colitis (UC) and Crohn's disease (CD). This study evaluated the strength of evidence for a causal link between stress, depression, and inflammatory bowel disease course.

METHODS

Literature review and unstructured qualitative analysis of all reported prospective studies of stress or depression and disease outcomes and randomized controlled studies (RCTs) of stress reduction interventions.

RESULTS

Although results remain inconsistent, prospective studies support a role for psychologic stress in the course of UC and for depressive symptoms in the course of CD. RCTs do not support the benefit of stress reduction for unselected patients with CD. UC has not been studied with adequately designed RCTs. Animal models suggest mechanisms whereby stress can exacerbate preexisting inflammatory disease, especially through increased epithelial permeability.

CONCLUSIONS

A synthesis of the literature is presented suggesting approaches to reconcile apparently contradictory findings. Recommendations for further research emphasize refinements to avoid type II error and to identify subgroups of patients who are most likely to experience stress-related effects on illness or to benefit from stress reduction intervention.

Review article: psychosocial factors in the quality of life of patients with inflammatory bowel disease

Information on quality of life in inflammatory bowel disease is limited. Despite the clear importance of this topic to patients, quality of life measurement is seldom undertaken in day-to-day management of patients or included in clinical trials. Although previous reviews have dealt with quality of life, the area of psychosocial functioning has not been specifically addressed. The aim of this study was to review the psychosocial factors affecting quality of life in patients with inflammatory bowel disease, using an electronic search of MEDLINE, EMBASE, CINAHL and psycINFO. Of the 751 articles identified by the search, 107 were considered relevant and included in the review. A number of psychosocial factors appear to be important, including gender, socioeconomic status, ethnicity and perceived stress. To improve the quality of life in patients with inflammatory bowel disease, clinicians' attention needs to be drawn towards this subject, with an awareness of those patient groups more vulnerable to impaired quality of life. These identified variables also represent important factors, which should be adjusted for when conducting research into quality of life in these patients.

Social disruption stress exacerbates alpha-galactosylceramide-induced hepatitis in mice

OBJECTIVE

Psychosocial stress has been suggested as a possible aggravating factor in liver diseases, however, the underlying mechanism has yet to be clarified. Recently, our research revealed that electric foot-shock stress aggravated NK1.1 Ag(+) T cell-dependent alpha-galactosylceramide (alpha-GalCer)-induced hepatitis in mice via a mechanism mediated by endogenous glucocorticoids. In this study, we examined whether or not such aggravation could be applied to a psychosocially stressful situation, e.g. social disruption stress.

METHODS

Male wild-type C57BL/6 (B6) or B6 hepatitis virus type B surface antigen transgenic (HBs-tg) mice, a hepatitis B virus carrier mouse model, were exposed 3 times in 1 week to social disruption stress in which an 8-month-old aggressive male intruder was placed into their home cage (5 mice per group) for 2 h. Twelve hours after the final exposure to the stress, the wild-type and HBs-tg mice were intravenously injected with alpha-GalCer.

RESULTS

The stress-exposed wild-type mice exhibited significantly reduced thymus weight loss compared with the control animals. Moreover, this stress regimen led to a significant increase in serum alanine aminotransferase levels in both the wild-type and the HBs-tg mice, although the increase in the HBs-tg mice was higher than that in the wild-type mice.

CONCLUSION

These findings demonstrated that, similar to electric foot-shock stress, social disruption stress exacerbated alpha-GalCer-induced hepatitis.

Screening for psychosocial risk factors in patients with chronic orofacial pain

BACKGROUND

The authors compiled information about recent advances in screening for psychosocial risk factors considered to be yellow flags for potentially poor outcomes among patients with chronic orofacial pain (most commonly temporomandibular disorders).

TYPES OF STUDIES REVIEWED

The authors conducted MEDLINE searches for the period 1995 through 2002 using the terms "temporomandibular disorders," "assessment" and "psychological," as well as "primary care," "screening" and "psychological disorders." They also searched personal files for relevant articles.

RESULTS

Psychosocial dysfunction is prevalent among patients with chronic orofacial pain. Yellow flags include high levels of disability; psychological disorders; and prolonged or excessive use of opiates, benzodiazepines, alcohol or other drugs. The authors identified several reliable, valid and brief patient self-administered questionnaires that can be used to screen for these yellow flags. Some of these are the Research Diagnostic Criteria/ Temporomandibular Disorders Axis II, Alcohol Use Disorders Identification Test and Patient Health Questionnaire.

CLINICAL IMPLICATIONS

Dentists can improve the quality of care for patients with chronic orofacial pain by screening for psychosocial risk factors and by referring patients with risk factors for psychological or psychiatric assessment and treatment.

Behavioral medicine and clinical health psychology: introduction to the special issue, a view from the decade of behavior

This collection of articles follows prior special issues on behavioral medicine published in the Journal of Consulting and Clinical Psychology in 1982 and 1992. From the vantage point of the Decade of Behavior, the field has grown in scope, depth of basic science foundations, and evidence of applied utility. Yet many challenges remain-especially in addressing a wide range of health problems across diverse populations and in a health care context characterized by rapid changes in technology and by a growing concern with costs and evidence-based practice.

Behavioral medicine: 2002 and beyond

This article highlights future directions for research and practice in behavioral medicine. Topics addressed include social and environmental issues, the role of technology, translational research, improving and developing interventions, and professional training and retraining.