Differential immune system changes with acute and persistent stress for optimists vs pessimists.

This study investigated whether acute and persistent stressors and life change events were followed by changes in immune status, and whether dispositional optimism moderated these relationships. Thirty-nine healthy women ages 18-45 were followed prospectively for 3 months, with weekly assessment of acute and persistent stressors and monthly assessment of life events and immune parameters (NK cell cytotoxicity, and CD4 and CD8 T cell subsets). The study used an autoregressive linear model to examine how weekly appraised acute and persistent stress levels were associated with immune parameters in the subsequent week. Analyses revealed that the immune outcomes were differentially affected by acute and persistent stressors. Further, the association between acute stress and subsequent immune parameters was buffered by an optimistic perspective. However, when stress persisted at high levels, optimists showed more subsequent immune decrements than pessimists.

Persistent stress as a predictor of genital herpes recurrence.

BACKGROUND: Results of several studies suggest that psychological stress and negative mood can trigger genital herpes recurrences, but results are inconsistent. OBJECTIVE: To determine whether short-term or persistent psychological stress or specific negative moods are predictive of genital herpes recurrences in women. METHODS: A prospective cohort study followed up participants for 6 months using weekly assessments of stress and mood, monthly assessments of life change events, and diary reports of genital herpes recurrences confirmed by medical examination when feasible. The community sample consisted of 58 women, aged 20 to 44 years, with a 1- to 10-year history of visible genital herpes recurrence and at least 1 recurrence in the previous 6 months. RESULTS: Persistent stress predicted recurrence in the subsequent week (odds ratio, 1.08 per unit increase in stress; 95% confidence interval, 1.01-1.15; P=.03). After adjusting for recurrence in the previous week, the more weekly persistent stress reported, the greater the likelihood of recurrence the following week. Also, an increased recurrence rate occurred after the month during which participants experienced their highest levels of anxiety (P =.03). There were no significant associations between recurrence and short-term stress, life events, depressive mood, anger, or phase of menstrual cycle. CONCLUSIONS: Persistent stressors and highest level of anxiety predicted genital herpes recurrence, whereas transient mood states, short-term stressors, and life change events did not. Women with herpes can be reassured that short-term stressful life experiences and dysphoric mood states do not put them at risk for increased outbreaks of recurrent genital herpes.

Psychotherapies for the person with HIV disease.

Work with patients with HIV infections demands the highest degree of professional skill, empathy, and self-understanding on the part of the therapist. He or she must be an excellent diagnostician, must be knowledgeable about the use of medications in a wide array of clinical conditions, and must be willing to confront both psychodynamic issues of the past and realistic medical and social concerns of the present and future. The therapy must be driven not by the disease but informed by the evolving needs, of the individual patient for self-understanding and a sense of enhancing competence. Although decline and death must be confronted during therapy, its center is on living and creating an engaged quality of life "in spite of". To help a person find the sweet-tasting strawberry of life in the face of what would otherwise be an intolerable situation can be one of the most meaningful acts we engage in as therapists.

Occupational and personal risk estimates for HIV contagion among incoming graduate nursing students.

In an effort to measure both fear of HIV/AIDS contagion and possible co-factors, two cohorts (n = 331) of incoming graduate level nursing students were surveyed during two consecutive academic years. All completed a Risk Perception Scale and an AIDS Attitude Scale; additionally, 118 completed an AIDS Knowledge Scale. Findings indicate this population had tremendous fears of the possibility of HIV infection. Estimates of potential contagion far outweighed scientific estimates of risk, and in some cases corresponded to behaviors that are scientifically purported to have no risk. Of interest in this same regard were perceptions of increased risk in the case of visible testimony to disease (that is, in the case of holding a patient with Kaposi's sarcoma lesions versus one without) and in the case of a patient with AIDS (versus an HIV seropositive, asymptomatic patient). Results showed that exaggerated perceptions of risk were correlated with a lack of knowledge and with negative HIV-related attitudes. The study indicates the need for AIDS education that addresses biomedical findings and fact while concurrently addressing perceptions that may preclude the assimilation and application of such knowledge.

Psychological and immunological predictors of genital herpes recurrence.

The relationships among stressful life experience, mood, helper-inducer (CD4+) and suppressor-cytotoxic (CD8+) T cells and genital herpes simplex virus (HSV) recurrence were investigated prospectively in 36 patients with recurrent HSV. The following factors were measured monthly for six months: stressful life experience (including current acute and ongoing stressors, residual effects of previous stressors, and anticipation of future stressors), negative mood, health behaviors, other possible HSV triggers, HSV recurrences, and the proportion of CD4+ and CD8+ cells (in half the sample). Results averaging monthly scores over the six-month study period indicated that: 1) subjects with high levels of stressful experience had a lower proportion of both CD4+ and CD8+ cells, 2) subjects with high levels of depressive mood, anxiety, or hostility had a lower proportion of CD8+ cells, and 3) subjects with high levels of depressive mood who did not report many symptoms of other infections had a higher rate of HSV recurrence. A model is proposed linking depressive mood, CD8+ cells, and HSV recurrence.

Reintroducing the internship: reactions of three departments of psychiatry.

The reintroduction of the internship requirement has caused a number of changes in psychiatric education in the past decade. Many psychiatric educators and departments of psychiatry have been faced with the challenges of organizing internships and establishing an internship curriculum. This has been especially challenging because the psychiatrists involved have seldom had full postgraduate training in the fields being organized and have not previously administrated clinical services in those areas. The authors discuss the goals of the internship for future psychiatrists and the pros and cons of university versus community general hospital based internships for future psychiatrists, and find several potential advantages to the latter. Also discussed are their consistent observations of internship programs for future psychiatrists over the past decade in three geographically separate regions and in state and private institutions. They and most other faculty members in their respective departments believe that the reinstitution of the internship has had largely beneficial effects on future psychiatrists.

Utilization review of the late adolescent patient in a mental health center: steps toward the development of criteria for the adequacy of assessment and treatment.

This study is concerned with an attempt to determine whether meaningful utilization review criteria could be productively generated by viewing a patient population from a developmental perspecitve. During a 2-year period, a multidisciplinary panel at Yale University sought to identify the sociodemographic, clinical, and administrative issues posed by late adolescents seeking treatment at the Connecticut Mental Health Center, New Haven. We sought to address the following questions: a) From what segment of the population were we drawing our adolescent patients? b) Who referred them for help? c) What kinds of problems led to referral? d) What were the diagnostic characteristics of the adolescent's evaluation? e) Under what conditions do adolescents terminate treatment? The charts of over 1222 adolescent patients were studied to help us answer these questions. Our investigation revealed that the adolescent patients seen at the Mental Health Center were sociodemographically and diagnostically heterogeneous. An increasingly large number of adolescents are referring themselves for evaluation and treatment, rather than being sent by schools, physicians, or social welfare agencies. The majority of patients seeking help come from blue collar or working class backgrounds mainly because of intrapsychic complaints of anxiety and depression. Upwardly mobile, they constitute a group who have completed their high school education, often live away from home, and are struggling with problems of defining an identity different from that of their family. Review of their charts indicated that significant sholastic, medical, and developmental information was frequently lacking or vaguely recorded. Our chart review also indicated that many clinicians did not ask their patients about symptoms relating to body functioning such as difficulties with sleeping, eating, or psychosomatic complaints. The study also discovered that it was difficult in the great majority of the charts reviewed to specify the adolescent's own perception of the difficulties which led them to seek help. Suggestions are then outlined for developing review criteria dealing with the emancipated adolescent, parental involvement in the treatment of the adolescent, treatment plans, and the termination of treatment. The comparative advantages of combining utilization review criteria from both a traditional "disease model" and a "developmental model" are discussed. The panel concluded that input from both perspectives is necessary in understanding the impact of a mental health delivery system upon adolescent patients, their family, and the community.