Association of stress level with facial pain: the role of coping.

It has been noted that stress factors, including coping with stress, are involved in pain problems. The aim of the present study was, firstly, to investigate the association of stress level with facial pain, and secondly, to assess the influence of coping strategies on this association. The study was part of the Northern Finland Birth Cohort 1966 project. The original material consisted of all people born in 1966 in Northern Finland. Of these, 5,696 participated in a follow-up study at the age of 31. As part of the study, data on facial pain, stress level of the subjects (measured with three items from the Work Ability Index), coping strategies in stressful situations (measured using the Ways of Coping Checklist) and sociodemographic background data were collected using questionnaires in 1997-98. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using generalized linear models. After adjustment for gender, education, and work history, facial pain was associated with a high stress level (OR 2.3, 95% CI 1.7-3.0). When coping strategies were added to the model, the strength of the association did not change essentially. The results emphasize the role of psychological stress in the background of facial pain. The association is independent of the coping strategy of the individual.

Anxiety as an enhancing phenomenon in origin of stress, CAN and PTSD in disabled children. Contribution to the ICD-10 re-classification.

This paper studies the contribution of anxiety in origin of functional behavioural disorders of children. The intense sensing of anxiety attributes to the shaping of one's personality. Adaptation and adjustment, accommodation and assimilation to stressful conditions producing anxiety are analyzed. There are diagnosed reactions of organism to the circumstances of the CAN syndrome and trauma. In these circumstances, a primary perception of reality is at stake that consequently leads to sociopathological features. This paper also provides the authors' opinions of psychoanalytical and behavioural schools on origin of personal decompensation and neurotic disorders. Causes of panic disorder and other diseases, in which a stress trauma plays a role, are considered. For these reasons the authors suggest classifying the CAN syndrome as a separate nosologic unit in the future ICD-11.

Phenomenology of mixed states: a principal component analysis study.

OBJECTIVES: To contribute to the definition of external and internal limits of mixed states and study the place of dysphoric symptoms in the psychopathology of mixed states. METHODS: One hundred and sixty-five inpatients with major mood episodes were diagnosed as presenting with either pure depression, mixed depression (depression plus at least three manic symptoms), full mixed state (full depression and full mania), mixed mania (mania plus at least three depressive symptoms) or pure mania, using an adapted version of the Mini International Neuropsychiatric Interview (DSM-IV version). They were evaluated using a 33-item inventory of depressive, manic and mixed affective signs and symptoms. RESULTS: Principal component analysis without rotation yielded three components that together explained 43.6% of the variance. The first component (24.3% of the variance) contrasted typical depressive symptoms with typical euphoric, manic symptoms. The second component, labeled 'dysphoria', (13.8%) had strong positive loadings for irritability, distressing sensitivity to light and noise, impulsivity and inner tension. The third component (5.5%) included symptoms of insomnia. Median scores for the first component significantly decreased from the pure depression group to the pure mania group. For the dysphoria component, scores were highest among patients with full mixed states and decreased towards both patients with pure depression and those with pure mania. CONCLUSIONS: Principal component analysis revealed that dysphoria represents an important dimension of mixed states.

Interactions between brief restraint, novelty and footshock stress on subsequent sleep and EEG power in rats.

Stress produces significant alterations in sleep that appear to vary with the type, intensity and duration of the stressor. Brief manual restraint may be stressful in rodents but is often required for experimental procedures. We examined the effects of brief manual restraint on sleep and its possible influence on sleep induced after footshock and after the opportunity to explore a neutral enclosure. Sleep was recorded during non-interrupted baseline and during 8-h light and 12-h dark periods after three sessions of 5-min manual restraint (M1-3), after 30 min in neutral enclosure alone (NE) or with previous manual restraint (mNE) and after 20 footshocks presented over the course of 30 min alone (FS) or with previous manual restraint (mFS). Compared to baseline, M1-3 increased total sleep and NREM during both light and dark periods and significantly increased dark period REM. Both NE and mNE increased dark period total sleep, NREM and REM; however, mNE also increased light period total sleep and NREM, but not REM. FS and mFS increased total sleep, NREM and REM during the dark period and total sleep and NREM during light period. FS also significantly decreased light period REM whereas mFS did not. M1, mNE and mFS significantly increased EEG delta power during NREM, but M2-3, NE and FS alone did not. The results revealed that manual restraint can increase sleep and EEG delta power and that increases in sleep may persist across repeated sessions whereas the magnitude of EEG delta power may vary across sessions. In addition, prior manual restraint may significantly alter the changes in sleep and EEG induced by footshock and by the opportunity to explore a neutral enclosure. The results suggest that mild stressors may interact in their effects on sleep.

The relationship between working conditions and sick leave in Swedish dental hygienists.

UNLABELLED: The purpose of this study was to examine the relationship between working conditions and sick leave in Swedish dental hygienists. Seventy-one percent of 577 randomly selected dental hygienists responded to a questionnaire. From those who responded (n=411) a homogenous group of 252 was selected. They were assigned to four groups that exhibited either musculoskeletal disorders (MSD), low well-being (LWB), both low well-being and musculoskeletal disorders (BLM), or relative health (main group or M group). These groups were further divided according to number of sick days taken per year. Non-parametric statistics and logistic regressions were used for analyses. Those with MSD worked more clinical hours and treated more patients per day than the other groups. While the M group had fewer sick days, better work climates and decreased demands on work efficiency, increased sick leave within this group was related to greater staff numbers and less commitment to improving work processes. In the M group, role ambiguity and LWB were associated with absence of 1-3 days, compared with those who took no sick leave. Respondents in the LWB group, who perceived role ambiguity, were absent more than 7 days/year, compared with those who perceived role clarity. Management issues were the distinguishing factor for those who had severe health problems. IN CONCLUSION: role ambiguity is the predominant psychosocial factor associated with sick leave. Psychosocial management factors rather than physical work factors seem important for work and sick leave rates among dental hygienists.

Clinical evaluation of hormonal stress state in medical ICU patients: a prospective blinded observational study.

OBJECTIVE: To evaluate whether classification of patients as having low, moderate, or high stress based on clinical parameters is associated with plasma levels of stress hormone. DESIGN AND SETTING: Prospective, blinded, observational study in an 18-bed medical ICU. PATIENTS: Eighty-eight consecutive patients. INTERVENTIONS: Patients were classified as low (n=28), moderate (n=33) or high stress (n=27) on days 0 and 3 of ICU stay, based on 1 point for each abnormal parameter: body temperature, heart rate, systemic arterial pressure, respiratory rate, physical agitation, presence of infection and catecholamine administration. The stress categories were: high: 4 points or more, moderate 2-3 points, low 1 point. Plasma growth hormone (GH), insulin-like growth factor 1 (IGF-1), insulin, glucagon, cortisol were measured on days 0 and 3. MEASUREMENTS AND RESULTS: Plasma cortisol and glucagon were significantly higher and IGF-1 lower in high vs. low stress patients on days 0 and 3. High stress patients were more likely to have high cortisol levels (odds ratio 5.8, confidence interval 1.8-18.9), high glucagon (8.7, 2.1-36.1), and low IGF-1 levels (5.9, 1.8-19.0) than low stress patients on day 0. Moderate stress patients were also more likely to have high cortisol and glucagon levels than low stress patients. Insulin and GH did not differ significantly. Results were similar for day 3. CONCLUSIONS: Moderate and severe stress was significantly associated with high catabolic (cortisol, glucagon) and low anabolic (IGF-1) hormone levels. The hormonal stress level in ICU patients can be estimated from simple clinical parameters during routine clinical evaluation.

Stress symptoms induced by repeated morphine withdrawal in comparison to other chronic stress models in mice.

The present study was aimed at evaluating chronic stress models in mice with special attention to morphine treatment. We hypothesized that repeated periods of drug withdrawal induce chronic stress. To verify this hypothesis, mice were made dependent on morphine and then subjected to several types of repeated withdrawal. Body weight reduction, thymus involution, adrenal gland enlargement and activation of the hypothalamo-pituitary-adrenal axis were used as signs of chronic stress. The changes were compared to those induced by 'laboratory' models of chronic stress (2 weeks of repeated restraint or rat exposure) and to a disease model of streptozotocin-induced diabetes mellitus (STZ-DM). Mice were made dependent using increasing doses of morphine three times a day for 3 days (10-20-40 mg/kg s.c.). Thereafter, withdrawal was induced either spontaneously (morphine 40 mg/kg injected at 24- or 72-hour time intervals for 2 weeks) or repeatedly precipitated by naloxone (10 mg/kg s.c.) injected daily 3 h after morphine. The results show that repeated periods of spontaneous drug withdrawal (24 or 72 h) in morphine-dependent mice represent a mild stress load. Repeated withdrawal precipitated by naloxone induced clear chronic stress-like changes. Changes observed in the naloxone-precipitated withdrawal model were even more pronounced than those found in laboratory models, namely repeated restraint or exposure to the rat. The most severe chronic stress state developed in mice during untreated STZ-DM. Thus, naloxone-precipitated withdrawal in mice seems to be an appropriate model of chronic stress.

Airflow and autonomic responses to stress and relaxation in asthma: the impact of stressor type.

The impact of stress on respiratory airflow in asthmatics is unclear. Part of the uncertainty may spring from the different physiological effects of different stressors. Given their potential to elicit increases in parasympathetic vagal activity, stressful situations that present few opportunities for coping (passive coping stressors) may be particularly problematic for people with asthma. Thirty-one adult asthmatics participated in a protocol including a widely used passive coping stressor (the cold pressor test), an active coping stressor (mental arithmetic), an interview about an upsetting asthma-related incident (viewed as a potential passive coping stressor given the exposure to unpleasant memories), and progressive muscle relaxation. Repeated measurements of airflow (via peak expiratory flow), vagal tone (via heart rate variability), and other variables were obtained. The cold pressor test, asthma interview and progressive muscle relaxation produced significant decreases in airflow compared to the baseline period. The cold pressor test and progressive muscle relaxation produced significant, complementary increases in vagal tone. These results suggest that passive coping stressors and other stimuli (e.g., certain forms of relaxation) that elicit increased vagal tone may be associated with poorer asthma control, a view consistent with a significant negative correlation between the participant's mean vagal tone response to the tasks and score on a measure of asthma self-efficacy.

Stress, depression, and anhedonia: caveats concerning animal models.

Numerous animal models of depression have been advanced, each having multiple attributes and some limitations. This review provides caveats concerning etiologically valid animal models of depression, focusing on characteristics of the depressive subtype being examined (e.g. typical vs atypical major depression, dysthymia, melancholia), and factors that contribute to the interindividual behavioral variability frequently evident in stressor-related behavioral paradigms. These include the stressor type (processive vs systemic stressors), and characteristics of the stressor (controllability, predictability, ambiguity, chronicity, intermittence), as well as organismic variables (genetic, age, sex), experiential variables (stressor history, early life events) and psychosocial and personality factors that moderate stressor reactivity. Finally, a model of depression is reviewed that evaluates the effects of stressors on hedonic processes, reflected by responding for rewarding brain stimulation. Anhedonia is a fundamental feature of depression, and assessment of stressor-related reductions in the rewarding value of brain stimulation, especially when coupled with other potential symptoms of depression, provides considerable face, construct and predictive validity. Stressful events markedly impact rewarding brain stimulation, and this effect varies across strains of mice differentially reactive to stressors, is modifiable by antidepressant treatments, and allows for analyses of the contribution of different brain regions to anhedonic processes. The paradigm is sensitive to several factors known to acts as moderators of stress responses, but analyses remain to be conducted with regard to several such variables.

Reactivity of the hypophyseal-adrenocortical system to stress in rats with active and passive behavioral strategies.

Rats with active (KHA) and passive (KLA) behavioral strategies showed no strain-related differences in basal corticosterone levels or in changes in corticosterone levels after exposure to mildly stressful stimuli. Only severe immobilization stress produced significant interstrain differences in the reactivity of the hypophyseal-adrenocortical system, as evidenced by the greater increase in blood corticosterone in KHA rats 30 min after stressing. The hormonal stress response in KHA rats was prolonged, as the elevated blood corticosterone level in these animals persisted longer than in KLA rats. The data provide evidence not only that the hypophyseal-adrenocortical systems have different sensitivities to severe stresses in these strains, but also that active and passive animals have different rates of inactivation of the stress reaction.

Cortisol concentrations in 12- to 18-month-old infants: stability over time, location, and stressor.

BACKGROUND: Sparse information on early development of hypothalamic pituitary adrenal (HPA) axis responsivity in human infants limits our understanding of stress hormone regulation and vulnerability to psychopathology. We considered whether infant cortisol stress response (CSR) is a suitable endocrine phenotype for developmental stress research. METHODS: We assessed stability of key CSR parameters across time, location, and stressor through saliva samples taken before and then 20 and 40 min following exposure to two stressors administered 1 week apart in 27 infants aged 12 to 18 months. Time-matched home samples were collected to control for circadian rhythm and to evaluate baseline stability. RESULTS: Baseline cortisol concentrations, peak percent change, and area under the curve (AUC) were stable across time and stressors. Following both stressors, half the infants exhibited peak cortisol concentrations at 20 min poststress; half peaked at 40 min poststress. For 56% of the infants, peak response time was inconsistent across stressors. CONCLUSIONS: In humans, baseline and CSR are stable by 12 to 18 months. Variation in CSR time course across stressors indicates that infant CSR should be sampled beyond 30 min. Results support using infant CSR, particularly as measured by AUC, as a valid endocrine phenotype for developmental stress research.

Prenatal stress modifies behavior in offspring of bank voles (Clethrionomys glareolus).

The aim of the present study was to investigate the effect of prenatal stress on behavior of adult bank vole males and females. Pregnant females were submitted to stress by short encounters of two females at the same stage of pregnancy, to crowded condition by transfer to a cage with four to five nonpregnant females, or stressed by immobilization. The stressors were applied on Days 13, 14, and 15 of pregnancy. The results indicate that prenatal stress influenced adult offspring behavior tested in the presence of the same sex, as compared to controls. Females and males differ in their reactions to stress. Prenatal stress decreased the nonaggressive behavior of females but males did not change their amicable approaches toward males. In bank vole males, prenatal social or immobilization stress increased aggression, but females made more attacks only after prenatal stressing by immobilization. This indicates that in bank vole females classical stressor involved different mediators from those associated with prenatal social stresses. Our results indicate that prenatal stress in bank voles decreases the social activity of female offspring and increases aggression in male offspring. Social stress applied to females in late pregnancy may increase the number of aggressive males in a population.

The relationship of stress and anxiety with chronic periodontitis.

AIM: This case-control study investigates the relationship of stress and anxiety with periodontal clinical characteristics. METHOD: Seventy-nine selected patients (mean age 46.8+/-8 years) were assigned to three groups in accordance with their levels of probing pocket depth (PPD): control group (PPD< or =3 mm, n=22), test group 1 (at least four sites with PPD > or =4 mm and < or =6 mm, n=27) and test group 2 (at least four sites with PPD >6 mm, n=30). An inclusion criterion of the study required that patients presented a plaque index (PI) with a value equal to or larger than 2 in at least 50% of dental surfaces. All subjects were submitted to stress and anxiety evaluations. Stress was measured by the Stress Symptom Inventory (SSI) and the Social Readjustment Rating Scale (SRRS), while the State-Trait Anxiety Inventory (STAI) was used to assess anxiety. Clinical measures such as PI, gingival index (GI), PPD and clinical attachment level (CAL) were collected. Patient's medical history and socioeconomic data were also recorded. RESULTS: The mean clinical measures (PI, GI, PPD and CAL) obtained for the three groups, were: control group, 1.56+/-0.32, 0.68+/-0.49, 1.72+/-0.54 and 2.04+/-0.64 mm; group 1, 1.56+/-0.39, 1.13+/-0.58, 2.67+/-0.67 and 3.10+/-0.76 mm, group 2, 1.65+/-0.37, 1.54+/-0.46, 4.14+/-1.23 and 5.01+/-1.60 mm. The three groups did not differ with respect to percentage of clinical stress, scores of the SRRS, trait and state anxiety. Frequency of moderate CAL (4-6 mm) and moderate PPD (4-6 mm) were found to be significantly associated with higher trait anxiety scores after adjusting for socioeconomic data and cigarette consumption (p<0.05). CONCLUSIONS: Based on the obtained results, individuals with high levels of trait anxiety appeared to be more prone to periodontal disease.

Salivary cortisol determinations and self-rating scales in the assessment of stress in patients undergoing the extraction of wisdom teeth.

OBJECTIVE: To investigate salivary cortisol levels in patients undergoing third molar removal under local and general anaesthesia. DESIGN: Random sampling of two independent groups. METHODS: Samples of saliva were collected from patients prior to and after surgery for the removal of impacted wisdom teeth. The samples were analysed to assess cortisol levels. Patients were also asked to complete a Hospital Anxiety and Depression questionnaire on the day of surgery. RESULTS: Patients receiving treatment under local anaesthesia showed lower levels of stress response than those having treatment under general anaesthesia on the actual day of surgery did (Fig. 1). No other significant differences were noted. CONCLUSION: Local anaesthesia is the preferred mode of pain control for patients who express no strong preference for type of anaesthetic.

Stressor categorization: acute physical and psychological stressors elicit distinctive recruitment patterns in the amygdala and in medullary noradrenergic cell groups.

It has been hypothesized that the brain categorizes stressors and utilizes neural response pathways that vary in accordance with the assigned category. If this is true, stressors should elicit patterns of neuronal activation within the brain that are category-specific. Data from previous immediate-early gene expression mapping studies have hinted that this is the case, but interstudy differences in methodology render conclusions tenuous. In the present study, immunolabelling for the expression of c-fos was used as a marker of neuronal activity elicited in the rat brain by haemorrhage, immune challenge, noise, restraint and forced swim. All stressors elicited c-fos expression in 25-30% of hypothalamic paraventricular nucleus corticotrophin-releasing-factor cells, suggesting that these stimuli were of comparable strength, at least with regard to their ability to activate the hypothalamic-pituitary-adrenal axis. In the amygdala, haemorrhage and immune challenge both elicited c-fos expression in a large number of neurons in the central nucleus of the amygdala, whereas noise, restraint and forced swim primarily elicited recruitment of cells within the medial nucleus of the amygdala. In the medulla, all stressors recruited similar numbers of noradrenergic (A1 and A2) and adrenergic (C1 and C2) cells. However, haemorrhage and immune challenge elicited c-fos expression in subpopulations of A1 and A2 noradrenergic cells that were significantly more rostral than those recruited by noise, restraint or forced swim. The present data support the suggestion that the brain recognizes at least two major categories of stressor, which we have referred to as 'physical' and 'psychological'. Moreover, the present data suggest that the neural activation footprint that is left in the brain by stressors can be used to determine the category to which they have been assigned by the brain.

[From stressful life events to anxiety disorders]. / De l'événement de vie stressant aux troubles anxieux.

Stress is usually defined on the basis of the consequences observed after a threatening environmental change. This type of definition is mainly attributable to Seyle who conceived stress reaction as a final pathway, related to numerous aggressions against physical or psychological integrity, and threatening homeostasis. On the other hand, different authors showed that aggression does not systematically leads to retroactive undoing, as some types of environmental modifications can provoke an increase of knowledge, enriching both coping style and adaptative processes. Life events can be considered as a neurohormonal activation following action, the activation process being strictly dependent on the suddenness and unexpectedness of the event. "Normal" (at times necessary) stress, allowing the adaptative and sometimes survival processes, has thus to be distinguished from pathological stress, which provokes suffering. Stressful life event is modifying the environment, and the subject has to mobilize all his capacity, specificity and defense style in order to cope with the new situation. In this view, stressful life events may provoke enrichment and reinforcement for some and severe anxious disorders for others. Numerous factors are involved in the deleterious effect of a stressful life event, explaining why the modalities of the answer are so dramatically variable between different subjects.

Successful coping, adaptation and resilience in the elderly: an interpretation of epidemiologic data.

The elderly are often thought to suffer inevitable declines in functional abilities due to normal aging and concomitant diseases (acute and chronic). This view may be true for many aspects of physical health. However, an abundance of evidence suggests that mental health diverges from physical health in that Coping, Adaptation and Resilience (CAR) functions are surprisingly well-preserved throughout most of the life span. The normal "anatomy" and "physiology" of the CAR construct is described. It's robust relationship with the abnormalities of DSM-IV geriatric mental disorders is illustrated. Opportunities for new approaches to treatment are noted. These insights from the elderly are applicable to all age groups.