Steven E. Locke

Life change stress, psychiatric symptoms, and natural killer cell activity.

&NA; Previous research has linked stress with adverse health change; however, the immunologic mechanisms mediating these changes remain poorly understood. To test whether “stress” was associated with alterations in cell‐mediated immunity, we examined the correlations of self‐reported life change stress (LCS) and psychiatric symptoms with natural killer cell activity (NKCA) among 114 healthy undergraduate volunteers. Although the bivariate correlation between LCS and NKCA was not significant, subjects reporting few psychologic symptoms in the face of large amounts of LCS (“good copers”) had significantly higher NKCA than those experiencing high levels of both symptoms and LCS (“poor copers”). Furthermore, self‐reported psychiatric symptoms were found to inversely correlate with NKCA, suggesting that symptoms such as anxiety and depression may negatively affect immunity.

The effect of a telephone counseling intervention on self-rated health of cardiac patients

Objective: The objective of this study was to evaluate the effectiveness of a telephone-based intervention on psychological distress among patients with cardiac illness. Methods: We recruited hospitalized patients surviving an acute coronary syndrome with scores on the Hospital and Anxiety Depression Scale (HADS) indicating mild to severe depression and/or anxiety at 1 month postdischarge. Recruited patients were randomized into either an intervention or control group. Intervention patients received up to six 30-minute telephone-counseling sessions focused on identifying cardiac-related fears. Control patients received usual care. For both groups, we collected patients’ responses to the HADS and to the Global Improvement (CGI-I) subscale of the Clinical Global Impressions (CGI) Scale at baseline and at 2, 3, and 6 months postbaseline using Interactive Voice Recognition (IVR) technologies. We used mixed-effects analysis to estimate patients’ changes in CGI-I measures over the three time points of data collection postbaseline. Results: We enrolled 100 patients, and complete CGI-I measures were collected for 79 study patients. The mean age was 60 years (standard deviation = 10), and 67% of the patients were male. A mixed-effects analysis confirmed that patients in the intervention group had significantly greater improvements in self-rated health (SRH) between baseline and month 3 than the control group (p = .01). Between month 3 and month 6, no significant differences in SRH improvements were observed between the control and intervention groups. Conclusions: Study patients reported greater SRH improvement resulting from the telephone-based intervention compared with control subjects. Future research should include additional outcome measures to determine the effect of changes in SRH on patients with comorbid physical and emotional disorders. ACS = acute coronary syndrome; ADL = activities of daily living; CAD = coronary artery disease; CGI = Clinical Global Impressions Scale; CGI-I = Global Improvement subscale of the Clinical Global Impressions (CGI) Scale; ENRICHD = Enhancing Recovery in Heart Disease Patients trial; HADS = Hospital and Anxiety Depression Scale; HTS = Healthcare Technology Systems; ICD-9 = International Classification of Diseases, Ninth Edition; IRB = Institutional Review Boards; IVR = interactive voice recognition; MI = myocardial infarction; SADHART = the Sertraline Antidepressant Heart Attack Randomized Trial; SRH = self-rated health.

Improving psychologic adjustment to chronic illness in cardiac patients. The role of depression and anxiety

AbstractBACKGROUND: Poor mood adjustment to chronic medical illness is often accompanied by decrements in function. OBJECTIVE: To evaluate the effectiveness of a telephone-based intervention for psychologic distress and functional impairment in cardiac illness. DESIGN: Randomized, controlled trial. METHODS: We recruited survivors of acute coronary syndromes using the Hospital and Anxiety Depression Scale (HADS) with scores indicative of mood disturbances at 1-month postdischarge. Recruited patients were randomized to experimental or control status. Intervention patients received 6 30-minute telephone counseling sessions to identify and address illness-related fears and concerns. Control patients received usual care. Patients’ responses to the HADS and the Workplace Social Adjustment Scale (WSAS) were collected at baseline, 2, 3, and 6 months using interactive voice recognition technology. At baseline, the PRIME-MD was used to establish diagnosis of depression. We used mixed effects regression to study changes in outcomes. RESULTS: We enrolled 100 patients. Mean age was 60; 67% of the patients were male. Findings confirmed that the intervention group had a 27% improvement in depression symptoms (P=.05), 27% in anxiety (P=.02), and a 38% improvement in home limitations (P=.04) compared with controls. Symptom improvement tracked those for WSAS measures of home function (P=.04) but not workplace function. CONCLUSIONS: The intervention had a moderate effect on patient’s emotional and functional outcomes that were observed during a critical period in patients’ lives. Patient convenience, ease of delivery, and the effectiveness of the intervention suggest that the counseling can help patients adjust to chronic illness.

Motivational syndromes associated with natural killer cell activity.

This article reports three studies that taken together support two hypotheses: (a) that the stressed power motivation syndrome is associated with relatively low natural killer cell activity (NKCA) and (b) that the unstressed affiliation motivation syndrome is associated with higher NKCA. In Study 1, college students who were relatively high in stressed power motivation had significantly lower NKCA than did their peers. In addition, students high in unstressed affiliation motivation had significantly greater NKCA than did those showing less evidence of this syndrome. Study 2 replicated these findings on a sample of middle-class men. In Study 3, which tested the hypotheses among adult patients from a Health Maintenance Organization, results were in the same direction but less significant. Meta-analyses clearly indicate that the combined evidence from the three studies reliably supports both hypotheses.

Failure of Hypnotic Suggestion to Alter Immune Response to Delayed-Type Hypersensitivity Antigensa

The ability to alter delayed-type hypersensitivity via hypnotic suggestion was tested in 12 highly hypnotizable, untrained subjects and 30 nonhypnotized controls. Subjects were skin-tested bilaterally with a standardized panel of delayed hypersensitivity antigens and instructed either to enhance or suppress the skin test response unilaterally. Compared with results in controls, the skin test response reflected no effect of hypnotic suggestion with regard to either the area of induration or the degree of inflammation assessed histologically.

Chronic fatigue syndrome. 1: Etiology and pathogenesis.

Chronic fatigue syndrome (CFS) is a disorder of unknown etiology characterized by debilitating fatigue and other somatic and neuropsychiatric symptoms. A range of heterogeneous clinical and laboratory findings have been reported in patients with CFS. Various theories have been proposed to explain the underlying pathophysiologic processes but none has been proved. Research findings of immunologic dysfunction and neuroendocrine changes suggest the possible dysregulation of interactions between the nervous system and the immune system. Without a clear understanding of its etiopathogenesis, CFS has no definitive treatment. Management approaches have been necessarily speculative, and they have evolved separately in a number of medical and nonmedical disciplines. The results of several controlled treatment studies have been inconclusive. An accurate case definition identifying homogeneous subtypes of CFS is needed. The integration of medical and psychologic treatment modalities and the use of both biologic and psychologic markers to evaluate treatment response will enhance future treatment strategies.

Evaluation of computer-based medical histories taken by patients at home

The authors developed a computer-based general medical history to be taken by patients in their homes over the internet before their first visit with their primary care doctor, and asked six doctors and their participating patients to assess this history and its effect on their subsequent visit. Forty patients began the history; 32 completed the history and post-history assessment questionnaire and were for the most part positive in their assessment; and 23 continued on to complete their post-visit assessment questionnaire and were for the most part positive about the helpfulness of the history and its summary at the time of their visit with the doctor. The doctors in turn strongly favored the immediate, routine use of two modules of the history--the family and social histories--for all their new patients. The doctors suggested further that the summaries of the other modules of the history be revised and shortened to make it easier for them to focus on clinical issues in the order of their preference.

Design and Development of a Mental Health Assessment and Intervention System

Mental health disorders are the leading cause of disability and functional impairment in the United States (1 in 5). The negative effect of mental health disorders is felt both in the personal and public lives of the affected individuals, particularly in the workplace where it adversely impacts productivity. Only a small fraction of the affected people in the work force seeks help. The cost to employers and the economy of these untreated individuals is staggering. Some employers have tried to address employees’ emotional well-being by establishing Employee Assistance Programs. Yet, even these programs do not sufficiently address existing barriers to the detection and treatment of mental health disorders in the workplace. This paper describes the design of an automated workplace program that uses an Interactive, computer-assisted telephonic system (Interactive Voice Response or IVR) to assess workers for a variety of mental health disorders and subsequently refers untreated and inadequately treated workers to appropriate treatment settings.

Managing the community response to bioterrorist threats

To date, biological weapons have proven to be more of a psychological threat than a physical danger, and while they may someday result in significant mortality they would seem always to create larger numbers of psychological illness. At least in the United States, they have proven to be weapons not of mass destruction but of mass psychogenic illness.

Presidential Address: Psychosomatic Medicine and Biodefense Preparedness—A New Role for the American Psychosomatic Society

Biodefense preparations in the United States have focused mostly on improving biosurveillance and hospital surge capacity in the event of an outbreak or a weapons of mass destruction (WMD) event. However, what if an invisible bioweapon or dirty bomb was released in a major population center, or if avian flu took hold with sustained human to human transmission? Suddenly, we need to combine efforts from psychosomatic medicine and general medicine with public health practice to triage nonexposed patients with somatic symptoms from those with medical sequelae resulting from hazardous exposures. This would better enable the limited acute care resources to be directed to those most in need of urgent medical care. Furthermore, psychosomatic medicine experts are potentially important players in biodefense planning related to risk communication and health education strategies in a WMD scenario or outbreak in which individuals must make informed choices about their need for immediate medical attention. WMD = weapons of mass destruction; APS = American Psychosomatic Society; PDBPR = Psychosocial Dimensions of Biodefense Preparedness and Response; CDC = Centers for Disease Control and Prevention; DHHS = Department of Health and Human Services; SAMHSA = Substance Abuse and Mental Health Services Administration; DOD = Department of Defense; SARS = severe acute respiratory syndrome.