Chiari 1000 Registry Project: assessment of surgical outcome on self-focused attention, pain, and delayed recall.

BACKGROUND: Prior research has typically found a negative relationship between chronic pain and memory, and we examined whether cognitive control processes (e.g. reflection and rumination) moderated this relationship in individuals with Chiari malformation Type I (CM). CM is a neurological condition in which the cerebellar tonsils descend into the medullary and upper cervical spine regions potentially resulting in severe headaches and neck pain. METHODS: CM patients who had (n = 341) and had not (n = 297) undergone decompression surgery completed the McGill Pain Questionnaire-Short Form-Revised (SF-MPQ-2), the Rey Auditory Verbal Learning Test (RAVLT), and the Rumination-Reflection Questionnaire (RRQ). Immediate recall scores were compared to those of 102 healthy controls, and delayed recall performance was compared across other variables within the CM group. RESULTS: CM patients performed more poorly on immediate recall than did controls. Within CM patients, we observed main effects for reflection and age, and a pain x reflection x surgical status (surgery v. no surgery) interaction in which non-decompressed individuals with low levels of pain and high levels of reflection showed superior delayed recall relative to non-decompressed individuals with higher pain and all decompressed individuals. CONCLUSIONS: CM patients show an immediate recall deficit relative to controls, regardless of surgical status. High levels of reflection were associated with better delayed recall performance in non-decompressed CM patients with lower pain levels. High levels of chronic pain may overwhelm increased focused attention abilities, but higher levels of reflection partially overcome the distracting effects of pain and this may represent a type of resilience.

Posttraumatic stress disorder symptoms, salivary cortisol, medication adherence, and CD4 levels in HIV-positive individuals.

Previous research has reported rates of posttraumatic stress disorder (PTSD) following diagnosis with a life-threatening disease ranging from 5 to 42%. However, few studies have examined the impact of PTSD symptoms on disease markers or adherence to medical regimens. The present study represents an initial examination of the relationships among self-reported PTSD symptoms stemming from diagnosis with HIV, CD4 cell counts, salivary cortisol levels and adherence to highly active antiretroviral therapy (HAART) in 110 African-American and Caucasian individuals with HIV. Results revealed that the relationship between PTSD and disease progression is multifaceted: PTSD symptoms were related to worse adherence to HAART therapy, but were also associated with lower morning salivary cortisol levels and higher CD4 cell counts.

Amnesia, neuroendocrine levels and PTSD in motor vehicle accident victims.

PRIMARY OBJECTIVE: To examine the initial neuroendocrine responses and subsequent PTSD symptomatology among amnesic and non-amnesic victims of motor vehicle accidents. It was hypothesized that amnesic patients would be less likely to meet PTSD criteria at 1 month follow-up and would display lower catechalomine levels and higher basal cortisol than non-amnesics. METHODS AND PROCEDURE: Fifteen-hour urinary hormone samples were collected from 70 MVA victims upon hospital admission. Participants were assessed for PTSD symptomatology 1 month later. MAIN OUTCOMES AND RESULTS: Amnesic patients displayed lower NE/cortisol ratios than non-amnesics, were less likely than non-amnesics to develop PTSD, and displayed fewer PTSD symptoms than non-amnesics. CONCLUSIONS: Amnesics may physiologically experience a motor vehicle accident differently from non-amnesics and have lower subsequent PTSD incidence. These results provide partial support for the hypothesis that amnesia for a traumatic event can serve as a buffering function in the development of subsequent PTSD among MVA victims.

Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims.

BACKGROUND: This study was designed to examine the relationship between urinary hormone levels collected upon admission to the trauma unit following a motor vehicle accident and posttraumatic stress disorder symptomatology 1 month later. METHODS: Fifteen-hour urine samples were collected from 63 male and 36 female motor vehicle accident victims and were used to assess levels of catecholamines and cortisol reflecting peritraumatic and acute-phase posttraumatic levels. Presence of posttraumatic stress disorder symptomatology was assessed 1 month after the accident. RESULTS: Motor vehicle accident victims subsequently diagnosed with acute posttraumatic stress disorder excreted significantly lower levels of cortisol in 15-hour urines collected upon admission to the hospital. In addition, urinary levels of cortisol predicted a significant percentage of the variance in intrusive and avoidant thoughts 1 month after the accident. CONCLUSIONS: The results of our study suggest that initial cortisol levels in the immediate aftermath of a traumatic event contribute, in part, to subsequent symptoms of posttraumatic stress disorder.

Similarity of prior trauma exposure as a determinant of chronic stress responding to an airline disaster.

The cumulative effects of trauma were examined in 108 workers at the site of a major air disaster at 4 time points over a year following the crash. The influence of trauma history on chronic distress and physiological arousal associated with the crash were examined. Stress levels were expected to differ on the basis of the similarity of prior trauma exposure to work at the crash site. Prior traumatic exposure that was "dissimilar" to this type of work was associated with greater vulnerability to crash-related stress, that is, more distress and crash-related intrusions during the year following the crash. Accumulation of a variety of different traumatic experiences appeared to sensitize workers to the new stressor and to perpetuate chronic stress. Understanding the role of trauma history is important for improving intervention efforts aimed at alleviating stress following a trauma.

Time-of-day effects on response of natural killer cells to acute stress in men and women.

Diurnal influences on natural killer (NK) cell changes to acute stress were assessed in 21 men and 21 women assigned to either an acute stress (mental arithmetic) or control task condition. Sessions began at either 8 a.m. or 2 p.m. Number of NK (CD3-CD56+) cells and NK activity were measured at baseline, during the 5-min task, and 60 and 90 min after the task. Both morning and afternoon stress participants had elevated NK cell numbers during the task. After the task, number of NK cells decreased in morning stress participants but remained significantly above baseline levels 60 and 90 min posttask. NK cell numbers in afternoon stress participants decreased to below baseline levels 60 and 90 min after the task. Changes in NK activity were driven primarily by diurnal influences. NK activity increased in all morning participants and stayed increased 60 and 90 min posttask. NK activity of all afternoon participants also increased during the task but dropped below baseline 60 and 90 min later. Greater increases in NK levels and activity during the task were associated with greater heart rate changes.

Responses of natural killer cell activity to acute laboratory stressors in healthy men at different times of day.

To assess possible diurnal variations in natural killer reactivity to acute laboratory stressors, this study investigated changes in natural killer cell activity (NKCA) during and after three stressors (mental arithmetic, speech, and the Stroop) at 3 times of the day (08:00, 12:00, and 16:00) in 30 healthy men. NKCA activity increased during mental arithmetic and speech tasks at all 3 times of the day. Change in NKCA was greatest in the afternoon. Differences in the magnitude of mood changes were also observed at the 3 times of day, parallel to immune reactivity. These findings suggest that the dynamics of stress-related NKCA are more complex than previously believed and that time of day may affect the way they are generated or interpreted.

Chronic stress and natural killer cell activity after exposure to traumatic death.

OBJECTIVE: The present study examined the effects of working at the crash site of USAir Flight 427 on psychological, cardiovascular, and immunological sequelae of stress within 2 months of the recovery work and again 6 months after the crash. METHOD: A total of 159 workers at the crash site and 41 controls were examined within 2 months of the crash and again 6 months after the crash. Subjects were initially grouped according to whether they had contact with human remains. For a finer-grained analysis of exposure to bodies, subjects were also grouped by degree of exposure, determined by the area in which the workers were stationed. Dependent measures included intrusive thoughts, coping styles, and symptom reporting, as well as heart rate and blood pressure, and NK cell number and activity. RESULTS: Workers exposed to body parts at the actual crash site, and those who were exposed to remains without expecting to be, exhibited more symptoms of stress than workers who saw bodies and body parts at the morgue and those who did not see human remains. Non-morgue workers who were exposed to bodies or body parts had the highest levels of intrusive thoughts at both time points, and the highest NK cell activity at Time 1. NK activity in this group decreased to levels comparable with other groups at Time 2. CONCLUSIONS: Increased NK activity is unusual in chronic stress situations, and may be because of acute stress experienced as a result of being asked to talk and think about the crash. The finding that the more one was exposed to human remains the less distress he or she reported is discussed in terms of adaptation, expectancy, and control.

Acute and chronic distress and posttraumatic stress disorder as a function of responsibility for serious motor vehicle accidents.

In this study on the effects of attributions of responsibility for traumatic events, stress, coping, and symptoms of posttraumatic stress disorder (PTSD) were measured, including intrusive thoughts among 130 victims of serious motor vehicle accidents (MVAs) 14-21 days and 3, 6, and 12 months after their accident. MVA victims and 43 control participants were categorized by accident and attribution of responsibility for their accidents (self-responsible, other-responsible, and control). Although initially all MVA victims reported higher levels of intrusive thoughts and were more likely to meet criteria for PTSD diagnoses, only other-responsible participants continued to demonstrate increased distress 6 and 12 months postaccident. Self-responsible participants used more self-blame coping than other-responsible participants, although within the self-responsible group, use of self-blame was associated with more distress.

Time course of natural killer cell activity and lymphocyte proliferation in response to two acute stressors in healthy men.

To clarify the time course of immune system activity during and after acute stressor exposure, this study collected immune measures from 31 men at 6 times (before, during, and after 2 common laboratory stressors; mental arithmetic with harassment or a cold pressor task). The 6-min stressor period was associated with increased self-report of pain and distress in both stressor groups and with increased systolic and diastolic blood pressure and heart rate in the mental arithmetic group. Increased natural killer cell activity in this group was observed during the task (2 and 5 min into the task) and 5 min after the task ended. A significant Group x Time effect was observed for lymphocyte proliferation to pokeweed mitogen, and a significant Group x Time x Dilution effect was observed for proliferation to concanavalin A. Inspection of the data suggested that this interaction was due to a reduction in proliferation in both stressor groups during the task period.

The effect of ion-exchange column chromatography on separation of X and Y chromosome-bearing human spermatozoa.

Separation of X and Y chromosome-bearing spermatozoa has been attempted using ion-exchange column chromatography, with cation- and anion-exchange resins of low, intermediate, and high ionic strength. Examination of F-bodies on the Y chromosome of treated human sperm and progeny resulting from insemination of treated rabbit spermatozoa indicates that in none of the cases investigated did the treatment cause a separation of X and Y chromosome-bearing spermatozoa. The treatment does appear to filter out dead rabbit (and bull) spermatozoa, but the possible beneficial effects of this phenomenon are as yet uninvestigated.