ABSTRACT
OBJECTIVE: Research has demonstrated that emergency department visits for injured children are highly stressful experiences, especially when they include a painful procedure. This pilot study explored the impact of an intervention, which included preparation and distraction on procedure-related distress in children treated for laceration repair in the emergency department. METHOD: Distress and parent ratings of satisfaction were compared between children who received individualized preparation and distraction interventions for laceration repair provided by a child life specialist and children who received no intervention. Twenty-four subjects, aged 3 to 13 yr, were recruited from a pediatric emergency department within a university medical center. Patients receiving the intervention were provided with preprocedure age appropriate information relating to the laceration repair and distraction during the procedure. RESULTS: Results showed that children who received psychosocial intervention had lower observed distress behaviors during suturing compared with patients who did not receive the intervention. Results also showed that parents of patients who received the intervention perceived less distress in their children and rated their overall care significantly higher. CONCLUSION: These findings have significant implications for children's health care and supporting family needs when a child enters the emergency department.
Subject(s)
Anxiety/therapy , Lacerations/therapy , Adolescent , Child , Child, Preschool , Emergency Medical Services/methods , Emergency Service, Hospital , Female , Humans , Male , Parents/psychology , Patient Satisfaction , Pilot Projects , Psychiatric Status Rating Scales , Treatment OutcomeABSTRACT
This study examined whether there was a cortisol response to inoculation or if pre-inoculation levels were already elevated due to an anticipatory response to going to the doctors' office. For 4-year-old children, a base saliva sample was obtained in the home on a non-stress day, and a pre-inoculation saliva sample was obtained in the doctors' office prior to the stress. Doctors' office pre-inoculation cortisol was higher than home-based cortisol, suggesting the occurrence of an anticipatory cortisol response to the impending stress. Post-inoculation cortisol levels (+20 min) were comparable to home-based cortisol, indicating that there was no cortisol response to the inoculation itself. While there was no mean increase in cortisol, individual differences in cortisol response existed. Cortisol increases were related to important aspects of child behavioral functioning, including internalizing and externalizing behavior ratings.
Subject(s)
Hydrocortisone/metabolism , Vaccination/psychology , Child Behavior/physiology , Child, Preschool , Female , Humans , Hydrocortisone/analysis , Injections, Intramuscular/psychology , Male , Saliva/chemistry , Stress, Psychological/metabolismABSTRACT
Stress has been implicated in the etiology of numerous mental and physical illnesses. Thus, it is important to identify factors that buffer individuals against stress. The purpose of this study was to examine the influence of perceived control (PC) on the biological and subjective stress responses, and to investigate the potential moderating effect of locus of control (LOC) on this relationship. Stress was induced with a noise-cognitive paradigm, and PC was manipulated by offering the option of manual control over noise intensity. Saliva cortisol and subjective stress were measured. There was no main effect of control on cortisol. However, LOC moderated the relation between control and cortisol; participants with more internal LOC, who also perceived themselves to have control over the stressor, showed a reduced cortisol response in the PC condition. The results are discussed in light of their implications for elucidating the determinants of the effects of perceived control on stress.
Subject(s)
Hydrocortisone/analysis , Internal-External Control , Self Efficacy , Stress, Psychological/blood , Stress, Psychological/diagnosis , Adolescent , Adult , Female , Humans , Male , Noise/adverse effects , Reproducibility of Results , Saliva/chemistry , Stress, Psychological/psychology , Surveys and Questionnaires , Time FactorsABSTRACT
Decades of research on schizophrenia have not produced major breakthroughs, but gradual progress has been made in identifying risk factors and clarifying the nature of the etiologic process. This article provides an overview of trends in research findings as well as current assumptions about the interplay between environmental and genetic factors in the etiology of schizophrenia. Based on the cumulative findings, it appears that both genetic and prenatal factors can give rise to constitutional vulnerability. Subsequent neuromaturational processes, especially those that occur during adolescence, and exposure to stressful events can trigger the behavioral expression of this vulnerability.
Subject(s)
Brain/abnormalities , Brain/physiopathology , Schizophrenia/etiology , Schizophrenia/physiopathology , Brain/metabolism , Cognition Disorders/etiology , Disease Progression , Dopamine/metabolism , Humans , Life Change Events , Schizophrenia/complicationsABSTRACT
Psychosocial stress is included in most etiologic models of schizophrenia, frequently as a precipitating factor for psychosis in vulnerable individuals. Nonetheless, the stress-diathesis model has not been tested prospectively in prodromal patients as a predictor of psychosis. The biological effects of stress are mediated by the hypothalamic-pituitary-adrenal (HPA) axis, which governs the release of steroids, including cortisol. The past few decades have witnessed an increased understanding of the neural effects of stress and cortisol, including both normal and abnormal diatheses. As few biological markers have been evaluated as risk factors for psychosis in prodromal patients, the HPA axis and its interaction with intervening life events are apt candidates for study. In this article, we review the HPA axis and its neural effects, present a model for how stress might precipitate psychosis in vulnerable individuals, review the empirical evidence of a link between stress and schizophrenia symptoms, and propose a research design and appropriate statistical models to test the stress-diathesis model for psychosis onset in prodromal patients.
Subject(s)
Schizophrenia/etiology , Schizophrenic Psychology , Schizotypal Personality Disorder/etiology , Stress, Psychological/complications , Animals , Disease Progression , Humans , Hydrocortisone/blood , Hypothalamo-Hypophyseal System/physiopathology , Pituitary-Adrenal System/physiopathology , Risk Factors , Schizophrenia/diagnosis , Schizophrenia/physiopathology , Schizotypal Personality Disorder/diagnosis , Schizotypal Personality Disorder/physiopathology , Stress, Psychological/physiopathologyABSTRACT
OBJECTIVE: In the prefrontal cortex, the enzyme catechol O-methyltransferase (COMT) is critical in the metabolic degradation of dopamine, a neurotransmitter hypothesized to influence human cognitive function. The COMT gene contains a functional polymorphism, Val158Met, that exerts a fourfold effect on enzyme activity. The current study investigated whether prefrontal cognition varies with COMT genotype. METHOD: Val158Met was genotyped in 73 healthy volunteers. A task of prefrontal cognition, the Wisconsin Card Sorting Test, was also administered. RESULTS: Subjects with only the low-activity met allele made significantly fewer perseverative errors on the Wisconsin Card Sorting Test than did subjects with the val allele. CONCLUSIONS: These data are consistent with those of previous studies, suggesting that a functional genetic polymorphism may influence prefrontal cognition.
