Granulocyte activation in humans is modulated by psychological stress and relaxation

Our aim was to study the possible relationship between psychological stress and granulocyte activation primarily in healthy students during an examination period (n = 11) and also in chronically anxious patients (n = 15). We employed cell surface markers: lactoferrin, L-selectin, alphaMbeta2-integrin and CD15s and flow cytometry to detect changes in the activation state of granulocytes, with the start of the stressed state in students at the beginning of an examination period, which was associated with elevated blood plasma cortisol level, and following relaxation hypnosis in both students, during their examination term, and patients. The ratios of all four types of marker-carrier granulocytes increased at the start of the examination period in students; an especially dramatic (ca. 5-fold) enhancement was observed in the proportion of lactoferrin-bearing cells relatively to the pre-examination term value. After hypnosis, the percentage of lactoferrin-exposing granulocytes decreased considerably both in students and in patients, by about half; a similar decrease was observed in the ratio of CD15s-carrier cells in patients. No significant alteration was observed during the study in state or trait anxiety levels, and in total or differential leukocyte counts. Thus, granulocyte activation could be associated with stress, while relaxation may facilitate reducing activation of these cells. In both groups of subjects, granulocyte surface lactoferrin appeared to be a sensitive "stress indicator". This needs further evaluation.     

Phagocytic reactivity of granulocytes in the peripheral blood of patients with multiple sclerosis and normal probands

For estimation of phagocytic activity the uptake by granulocytes of heat-inactivated, opsonised yeast particles (Saccharomyces cerevisiae) was measured. Peripheral granulocytes of multiple sclerosis patients revealed an enhanced ability for phagocytosis in comparison to normal healthy controls, if tested with normal serum as opsonic source. An activated state of cells in multiple sclerosis is supposed. The selective influence on granulocyte phagocytosis of treatment by ultraviolet-irradiated blood in multiple sclerosis patients supports the view of altered reactivity of these cells in comparison to normal controls.     

A comparison of two psychological treatments for bulimia nervosa

Two standardized psychological treatments for bulimia nervosa were studied. A cognitive behavioural approach was compared with a form of short-term focal psychotherapy. Twenty-four patients who met strict diagnostic criteria for bulimia nervosa were randomly allocated to the two treatments. All the interviews were tape-recorded so that checks on their content could be made. Assessments took place at the beginning and end of treatment, and at 4-, 8- and 12-month follow-up. None of the patients dropped out of treatment or follow-up, but 1 patient from each treatment group had to be withdrawn on clinical grounds. Patients in both groups made substantial improvements which were well maintained over the 12-month treatment-free follow-up period. The cognitive behavioural approach was superior to short-term focal psychotherapy in terms of its effect on the patients' overall clinical state, their general psychopathology and social adjustment, and their assessment of their outcome.     

Temperature self-regulation and relaxation with migraine patients and normals

Ten migraine headache subjects and 10 non-migraine subjects were divided equally into two groups: a progressive relaxation group and a finger temperature biofeedback group. Finger temperature, temporal artery pulse amplitude and forehead blood flow were monitored for all subjects during two baseline and six treatment sessions.

The biofeedback group achieved greater (albeit low magnitude) increases in finger temperature than the relaxation group, but no improvement in headache activity was obtained. However the relaxation group improved significantly in terms of headache intensity.

There was no significant difference in the ability to achieve finger temperature control, nor in stability point temperatures, between the migraine and non-migraine subjects.

No systematic relationship was found between finger temperature, forehead blood volume and temporal artery pulse amplitude. Possible mechanisms of the therapeutic effects of finger temperature training are examined in the light of these results.     

How Does Neurobiological Research Influence Psychoanalytic Treatments?—Clinical Observations and Reflections From a Study on the Interface of Clinical Psychoanalysis and Neuroscience

One of the counterarguments against empirical research in psychoanalysis is that research negatively influences the treatment situation. In this paper, the impact of a neurobiological study on psychoanalytically oriented treatments is presented from three different perspectives: patients' views, a study group of participating psychoanalysts and a clinical case example. Twenty chronically depressed patients, 20 healthy controls and 16 psychoanalysts participated in the project on research. Results show a clear influence of the neurobiological study on the course of treatments. Patients consistently reported that study participation had a positive impact on their treatment experiences. However, study participation was conflictual for the psychoanalysts and forced them to carefully reflect on their unconscious and conscious involvement to establish a psychoanalytic stance independent from empirical research.     

Topiramate in the preventive treatment of episodic migraine: a combined analysis from pilot,double-blind,placebo-controlled trials

The safety and efficacy of medications for preventive treatment of migraine is the subject of current concern and investigation in health care. Two single-center, double-blind, placebo-controlled studies were conducted to evaluate the efficacy and safety of topiramate for migraine prophylaxis. Seventy patients with a diagnosis of migraine were randomly assigned to topiramate-treated and placebo groups. The studies consisted of a 4-week baseline phase, a 6-8 week titration, and 8-12 weeks of maintenance. Topiramate was titrated from an initial dose of 25 mg/day to a target dose of 100 mg BID. The primary efficacy measure, the mean 28-day migraine frequency, was lower in topiramate-treated patients than in the placebo group (3.2 versus 3.8, P=.001). Similarly, topiramate treatment resulted in a significantly greater mean reduction in migraine frequency than did placebo (1.55 versus 0.47, P=.001) and a significantly higher responder rate (35.3% versus 8.3%, P=.008). Paresthesia was the most common side effect reported with topiramate treatment. Other topiramate-associated adverse events included altered taste, memory impairment, diarrhea, and appetite suppression/weight loss. The rates of discontinuation were similar for the topiramate group (n=10) and the placebo group (n=8). These results suggest that topiramate is effective and well tolerated in the preventive treatment of migraine headaches.     

Electromyographic and vasomotor activity in tension, migraine, and combined headache patients: The influence of postural variation

Electromyographic (EMG) and temporal artery vasomotor activity was evaluated in three groups of headache patients (tension, migraine and combined) and nonheadache control subjects while in reclining, sitting and standing positions. Analysis of the EMG data revealed that at all measurement sites (bilateral frontalis, bilateral trapezius) the three headache groups demonstrated significantly higher levels than the nonheadache group but did not differ from each other. A secondary analysis of the trapezius EMG data revealed that a large percentage of headache patients had “normal” EMG levels in the reclining position but showed abnormalities in the sitting and standing positions. Analysis of the left temporal artery vasomotor activity revealed that all three headache groups vasoconstricted to a significantly greater extent than the nonheadache group in the sitting and standing positions. However, a diagnosis by position interaction was found for the right temporal artery with the migraine group demonstrating a unique pattern of activity.     

心理行为干预对乳腺癌患者情绪反应及免疫功能的影响

按随机和匹配原则,将40名乳腺癌放疗患者分入干预组和对照组。对干预组患者进行为期4周的心理行为干预,对照组仅接受相应的医药治疗。以肿瘤病人情绪适应问卷(MAC)和免疫测试法研究患者干预前后的情绪反应和免疫功能,探讨心理行为干预对乳腺癌患者情绪反应和免疫功能的影响。结果发现,心理行为干预有利于提高患者NK细胞活性(NKCA);并有助于维持放疗期间患者的白细胞水平。     

A diathesis-stress conceptualization of expressed emotion and clinical outcome

A sizeable body of research has demonstrated that expressed emotion (EE) predicts clinical relapse in a number of distinct psychiatric disorders. These findings have provided the impetus for the development of interventions that attempt to reduce patients' relapse rates by modifying aspects of the family environment believed to be associated with high levels of EE. Despite the efficacy of these treatments, however, we know little about how EE develops in relatives of psychiatric patients or about the mechanisms through which high EE leads to relapse. Moreover, there is not a coherent theory that attempts to integrate findings concerning the impact of high EE on relapse in different disorders. The purpose of this article is to elucidate a diathesis-stress conceptualization of EE to explain both the development and manifestation of high EE in relatives of disordered patients and the impact of high EE on the course of patients' disorders. In this context, we use a diathesis-stress perspective to examine why EE predicts symptom relapse and poor clinical outcome in schizophrenia, depressive disorders, and borderline personality disorder. We conclude by discussing treatment implications of the diathesis-stress perspective and by outlining what we believe are fruitful directions for future research.     

Immediate effects of snoezelen? treatment on adult psychiatric patients and community controls

The effectiveness of Snoezelen? multi-sensory stimulation treatment was evaluated with 50 psychiatric patients (25 men, 25 women) and 50 hospital employees (25 men, 25 women). Pre and post-treatment physiological responses (galvanic skin conductance response, heart rate, and percentage blood oxygen) were compared and participants were evaluated post-treatment for perceived psychological benefits with a nine-item questionnaire. Results indicate that participation in a single 20-minute Snoezelen? session had significant and positive physiological effects on both the patient and staff groups. Also, post-treatment participants in both groups did not perceive any change on the dimension reserved-outgoing but felt more sleepy, passive, relaxed, cheerful, focused, optimistic, calm, and comfortable. Consequently, beneficial physiological and psychological Snoezelen? treatment effects were apparent for both patients and controls.     

A pilot study of an intervention for breast cancer survivors and their spouses

Recent studies have shown that interventions that increase breast cancer patients' communication with family members lead to reduced patient distress. In this article, we report on a treatment development and pilot study of an intervention for couples coping with breast cancer. In phase 1 of this study, 10 couples participated in two focus groups that generated ideas and themes for the intervention. In phase 2, we developed and pilot tested our intervention with 48 couples: 12 in a 2-session format, 21 in a 1-session format, and 15 in a non-experimental control group. Our response rate shows that breast cancer patients and spouses were willing to participate and that treatment providers were willing to refer patients and their spouses. The 2-session format showed the most promise for producing positive change in mental health functioning and cancer-related stress.     

Immediate effects of snoezelen® treatment on adult psychiatric patients and community controls

The effectiveness of Snoezelen® multi-sensory stimulation treatment was evaluated with 50 psychiatric patients (25 men, 25 women) and 50 hospital employees (25 men, 25 women). Pre and post-treatment physiological responses (galvanic skin conductance response, heart rate, and percentage blood oxygen) were compared and participants were evaluated post-treatment for perceived psychological benefits with a nine-item questionnaire. Results indicate that participation in a single 20-minute Snoezelen® session had significant and positive physiological effects on both the patient and staff groups. Also, post-treatment participants in both groups did not perceive any change on the dimension reserved-outgoing but felt more sleepy, passive, relaxed, cheerful, focused, optimistic, calm, and comfortable. Consequently, beneficial physiological and psychological Snoezelen® treatment effects were apparent for both patients and controls.     

The combined use of rational-emotive therapy and biofeedback in the treatment of childhood migraine

The available literature on the psychological treatment of childhood migraine was reviewed and evaluated. The current treatment modalities have relled essentially upon biofeedback techniques and neglected the potential cognitive factors that might lead to successful results. A case example is provided that demonstrates the combined treatment of childhood migraine using both biofeedback and rational emotive therapy (RET). Continued relief was reported during a follow-up interview conducted a year and a half after the treatment concluded. While both the biofeedback and RET elements for treatment were considered important for alleviation of the migraine condition, the subject reported that it was the RET training that proved most effective in dealing with stressors related to the onset of migraine attacks.     

Changes in Cognitions, Emotions, and Behaviors in Depressed Patients and Their Spouses Following Marital Cognitive Therapy, Traditional Cognitive Therapy, Pharmacotherapy, and No Intervention

This study evaluated specific influences of a cognitive marital treatment (CMT) for depression based on an integration of cognitive theory of depression and systems theory. The effects of CMT on variables representing cognitions, emotions, and behaviors were compared with the effects of traditional cognitive therapy (CT), pharmacotherapy (PT), and no treatment (NT). Subjects were Major Depression Disorder and Dysthymic outpatients and their spouses. The changes considered were for pre–post treatment and pre-treatment–follow-up. CMT affected a wider range of variables than other treatments. In most instances it was also superior to the NT condition. Most of the gains were manifested at termination and lasted through follow-up. The variables affected by CMT were patients' and spouses' cognitions and emotions. PT had best effects on patients' emotions. CT affected patients' cognitions, but did not achieve superiority on any of the compared variables. None of the treatments produced significant changes in behaviors.     

Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease.

Although visuoconstructive impairment has been reported in both Alzheimer's (DAT) and Huntington's (HD) disease, there is little knowledge concerning how this cognitive deficit differs quantitatively and qualitatively in these two progressive dementias. To address this issue, the present study compared performances on the Clock Drawing Test (CDT: command and copy) of 25 DAT patients, 25 equally demented HD patients, and 25 elderly normal controls (NC). In the command condition, both patients groups were significantly impaired compared to the NC group. Although there was no significant difference between DAT and HD patients' total quantitative scores, a qualitative error analysis revealed a number of dissociations between the two patient groups. Graphic difficulties, very common in HD patients, were virtually absent in DAT patients; in contrast, conceptual errors were almost exclusively seen in DAT patients and were related to the severity of their dementia. Perseveration and "stimulus-bound" responses were also more frequent in DAT patients, and both groups made visuospatial errors. In the copy condition, the DAT, but not the HD, patients evidenced a marked improvement in performance. These results indicate that while both DAT and HD patients have significant visuoconstructive difficulties even in the early stages of their disorders, the specific cognitive processes underlying their quantitative impairments are quite different. It is possible that the DAT patients' conceptual errors are yet another indicator of the deterioration of their semantic knowledge.     

A comparison of psychological and pharmacological treatment of pediatric migraine

A comparison was carried out of the efficacy of psychological and drug treatments for children with migraine. Forty-three children aged between 8 and 16 years (mean age: 11.3 years) who suffered from migraine received either progressive relaxation or cephalic vasomotor feedback, both with stress management training, or metoprolol, a beta-blocker. Psychological treatment was administered in ten sessions lasting six weeks and the drug treatment lasted ten weeks. Relaxation and stress management training reduced the headache index (frequency×intensity of headache episodes), more effectively than metoprolol with cephalic vasomotor feedback and stress management training in between. An overall improvement over time was found with regard to frequency and intensity of headache episodes and analgesics intake. When comparing pre- to post-treatment data, children treated with relaxation training improved significantly in headache frequency and intensity, whereas those treated with cephalic vasomotor feedback improved significantly in headache frequency and duration as well as mood. The clinical improvement was stable at an 8-months follow-up.     

One-day behavioral treatment for patients with comorbid depression and migraine: a pilot study

BackgroundMigraine is a common and disabling disorder that is highly comorbid with depression. The comorbidity of depression and migraine is a major health concern as it results in poorer prognosis and quality of life. Yet, effective treatments have rarely been investigated.Method45 patients with comorbid migraine and depression were assigned to a 1-day Acceptance and Commitment Training plus Migraine Education workshop (ACT-ED; N = 31) or to Wait List/Treatment as Usual (WL/TAU; N = 14). Assessment of depressive symptoms, general functioning, and migraine related disability were completed at baseline and 2-, 6-, and 12 weeks after the workshop.ResultsAt the 3-month follow up, participants in the ACT-ED condition exhibited significantly greater improvements in depressive symptoms, general functioning, and migraine-related disability than patients in the WL/TAU group.ConclusionA 1-day ACT-ED workshop is a promising approach to the treatment for depression and disability in migraineurs that merits further investigation.     

A sociocultural stress, appraisal, and coping model of subjective burden and family attitudes toward patients with schizophrenia

A sociocultural stress, appraisal, and coping model was developed to understand relatives' burden of care and negative affective attitudes toward patients with schizophrenia. Ninety-two African American and 79 White patients and a significant other (80% mothers) completed 2 10-min family problem-solving discussions. In addition, the Kreisman Rejection Scale and a global self-report rating of family burden were administered to relatives, and a self-report rating of substance use was administered to patients. Results indicated that subjective burden of care and patients' odd and unusual thinking during the family discussion each independently predicted relatives' attitudes toward patients, suggesting that negative attitudes are based in part on both patients' symptoms and perceived burden of care. African American relatives' perceived burden was also predicted by patients' substance abuse. Finally, White family members were significantly more likely than African Americans to feel burdened by and have rejecting attitudes toward their schizophrenic relative suggesting that cultural factors play an important role in determining both perceived burden and relatives' attitudes toward patients.     

Cost-Effectiveness and Health Care Utilization in a Multidisciplinary Pain Center: Comparison of Three Treatment Groups

Recent literature supports the efficacy of multidisciplinary pain management in treating persons suffering from chronic pain. However, the components of multidisciplinary pain management need to be evaluated in terms of effects on patients' quality of life as well as saving of future health care dollars. Therefore, cost-effectiveness of three treatment groups was compared by examining treatment outcome, posttreatment health care costs, and posttreatment health care visits. Results revealed that patients receiving both medical and psychological treatment (multidisciplinary pain management) exhibited the largest improvements in functional capacity, while being the least costly after their treatment program had ended. In contrast, patients who received only medical treatment exhibited significant deterioration in outcome after their treatment ended, and consumed substantially more posttreatment health care dollars.