The impact of psychological stress on physiological indicators in healthcare workers: a cross-sectional study.

Background: Medical health workers play an essential role in the healthcare system and face unique workplace stressors. However, the impact of psychological stress on their physical health has received less attention compared to the general population. Methods: We retrospectively analyzed the Self-rating Depression Scale (SDS) questionnaires and blood testing results from 1963 medical health workers. Multivariate linear regression analysis using a backward stepwise selection strategy to identify physical examination indicators that were significantly affected by depression. Results: Depression severity, as measured by SDS index score, was positively correlated with the levels of hemoglobin (coefficient 0.0027, p = 0.0412), platelet count (coefficient 0.0005, p = 0.0198), and uric acid (coefficient 0.0004, p = 0.0492), while negatively correlated with red blood cell count (coefficient-0.0895, p = 0.0406). Similar results were observed in the subgroup analysis stratified by age and sex. Conclusion: Our study found a significant association between higher levels of depression and specific physiological indicators in healthcare professionals, including elevated hemoglobin, platelet counts, and uric acid levels, as well as decreased red blood cell counts. These changes in blood parameters may reflect underlying physiological stress and inflammation, potentially increasing overall health risks for healthcare workers. Addressing these physiological changes may be crucial for mitigating the health risks associated with depression. To validate our findings and develop targeted interventions, larger multi-center studies are needed to further explore the relationship between depression severity and blood parameters in healthcare professionals.

Impacts of Acute Psychological Stress on the Emotions of Individuals with Early Life Stress.

Objective: The study aimed to evaluate negative and positive emotional responses to acute psychological stress in individuals with early life stress (ELS). Methods: One hundred sixty-one participants from the Birmingham community in Alabama completed the study and were stratified into 2 groups based on measurements of ELS using the Childhood Trauma Questionnaire and a confirmatory clinical interview. Acute psychological stress, that is, the Trier Social Stress Test (TSST), was administered, and emotional responses were measured using the Visual Analogue Scale. Comparisons utilized chi-square for categorical variables and t-test for continuous variables. Analysis of covariance (ANCOVA) was applied to compare the 2 groups after controlling for confounding variables. Stepwise multiple linear regression analysis was used to investigate predictive power of variables for emotional responses to the TSST. Results: Participants with ELS experienced less pleasantness at the baseline (P = .02), and 1 minute (P = .04), but not 90 minutes time points compared to the non-ELS group. Participants in the ELS group also reported higher anxiety at baseline (P = .003), and 90 minutes (P = .04) post-TSST. Data analysis showed the effect of time on emotional responses during the TSST. Different emotional responses, including pleasantness, anxiety, fatigue, and vigor, were able to be predicted by ELS severity. Conclusion: Our data demonstrates that individuals with ELS presented different positive and negative emotional responses when exposed to acute psychological stress. Our findings may be useful for clinicians who work with individuals with ELS. Our findings also highlight the importance of recognizing emotional responses and of building up resilience in response to acute stress.

Differences in Breastfeeding Initiation and Duration by Migration History in the Hispanic Community Health Study/Study of Latinos.

Objective: To estimate differences in breastfeeding initiation and duration across dimensions of migration history (migration to the U.S. 50 states/District of Columbia [DC] in childhood, adulthood, or not at all) in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: We used data from HCHS/SOL on 520 individuals with a post-baseline live birth and information on breastfeeding collected at Visit 2 (2014-2017). We fit log binomial models adjusted for parity, age at pregnancy, education, income, and immigration history and incorporating sampling weights. Results: Overall, 84% of participants reported initiating breastfeeding and 30% reported breastfeeding for 6 or more months. On average, individuals reported breastfeeding for a median of 88 days (interquartile range: 156). Compared with those born in the U.S. 50 states/DC, individuals born in another country or U.S. territory who arrived in the U.S. 50 states/DC as children (<18 years old) were 2.7 times more likely to initiate breastfeeding (adjusted prevalence ratio 2.7, 95% confidence interval [CI]: 1.4, 4.9) and those who arrived as adults were 2 times more likely to initiate breastfeeding (adjusted prevalence ratio 2.0, 95% CI: 1.1, 3.6). We observed similar patterns for breastfeeding continuation. Conclusions: The timing and duration of life course experiences such as migration are key determinants of breastfeeding behavior among Hispanic/Latina postpartum persons.

Change in psychological parameters and quality of life among individuals with pulmonary and extrapulmonary tuberculosis following the intensive phase of therapy: A longitudinal observational study from central India.

BACKGROUND: Tuberculosis (TB) is a global health concern, impacting millions annually, with limited attention to the psychological distress it inflicts. Psychological comorbidities, such as depression, anxiety, and stress, significantly affect the quality of life (QoL) of TB patients. Available literature on this topic is restricted to the pulmonary TB (PTB) patients; while psychological issues of the extrapulmonary TB (EPTB) patients who comprise a significant proportion of this disease entity remains unexplored. Additionally, the impact of anti-TB treatment on psychological parameters has received limited attention and vice-versa. This study aimed to assess depression, anxiety, stress, and QoL of TB patients at diagnosis and to understand how these parameters change after the intensive phase of treatment. METHODS: A longitudinal observational study involving 40 TB patients (31 EPTB and 9 TB) was conducted to assess depression, anxiety, stress and QoL among them. Participants were followed up after the intensive treatment phase. RESULTS: At baseline, 32.5% (n = 13) and 65% (n = 26) participants experienced moderate-severe depression, and moderate-severe anxiety, and stress, respectively. QoL was notably compromised, especially in the psychological domain. Post-intensive treatment, anxiety and depression showed significant improvement (Z = -2.271, p = 0.023 and Z = -2.093, p = 0.036), but QoL and stress levels remained largely unchanged (p > 0.05). CONCLUSION: This study highlights the high prevalence of psychological distress and poor QoL among TB patients. Following intensive phase of therapy, severity of depression and anxiety reduced significantly; however, change in stress-level and QoL was non-significant. Although study is limited by in terms for small sample size, the need of holistic, multidisciplinary treatment approach (including mental health professionals) for such patients can't be overemphasized. Implementing baseline psychological screenings and providing mental health support if required, are critical to improve the overall health and QoL of these individuals.

A qualitative study of psychological stress and coping among persons using crack cocaine.

BACKGROUND: Research has identified a strong link between stress and drug use behaviours. Also, it has been established that the prolonged use of crack cocaine stimulates emotional, cognitive, neurological and social changes. This paper explores the psychological stressors that occur from crack cocaine use and the coping mechanisms used to mitigate them. This will provide an understanding of the intricate relationship between substance use and psychological well-being. METHODOLOGY: The study is qualitative and uses a descriptive phenomenological approach. The coping circumplex model is the theoretical model that underpins the study. Data was collected through 26 face-to-face in-depth semi-structured interviews with people who use crack cocaine. Data were analysed using thematic analysis. Participants consisted of 15 males and 11 females between the ages of 24-57 years, guaranteeing multiplicity within the study sample. RESULTS: Cravings, financial burdens, relationship breakdown and emotional /cognitive stimulation were revealed as psychological stressors. Maladaptive coping which includes self-harm, isolation, not speaking about/not dealing with emotions and using substances were adopted by study participants. Also, positive coping such as seeking help and keeping busy were adopted by study participants. Social and environmental factors such as stigma, easy accessibility of crack and flashbacks served as barriers to positive coping. Positive coping was linked to the availability and easy accessibility to social support and strong family bonds, underlining the importance of accessible support systems in managing the challenges linked with crack cocaine use. CONCLUSION: The challenges faced by study participants in coping with the psychological stressors linked to their crack cocaine use highlight the importance of adopting personalised and comprehensive strategies to tackle the intricate dynamics between psychological stress, coping and crack cocaine use.

Stressful life events across the lifespan and inflammation: An integrative data analysis.

Experiencing more stressful life events has been linked to higher levels of inflammation, but this association may depend on when in the lifespan the stressors occur. To address this knowledge gap, we tested two lifespan theories, the accumulation of risks and sensitive period models, by assessing the association between the total number of stressful events and their life stage occurrence on later-life C-reactive protein (CRP). We harmonized data across two cohort studies, maximizing variation in stressors reported across the lifespan. Participants (Ntotal = 7,952, 57.7% female, Mage = 69) from the Health and Retirement Study (HRS: n = 5,136, Mage = 70.6) and the English Longitudinal Study of Aging (ELSA: n = 2,816, Mage = 66.1) completed retrospective surveys of stressful life events and indicated what year(s) each event occurred and had blood drawn ∼4.5 years later. Stressful events were summed across the participants' lifespans (age 0 to current age) and within childhood (0-17 years), young adulthood (18-39), midlife (40-59), and late adulthood (60+). In main effects models, more cumulative stressors (γ = .05, SE = .02, p = .012) and stressors in young adulthood (γ = .06, SE = .03, p = .037) were associated with higher levels of CRP. In models with all life stages together among adults age 65+ (n = 4,972), experiencing more stressors in midlife significantly predicted higher levels of CRP (γ = .08, SE = .04, p = .038). Our findings replicate prior evidence of an association between cumulative stressors and inflammation and extend this work by identifying stressors in young adulthood and midlife as potentially unique sensitive periods that predict higher levels of later-life inflammation.

Mind the GAPS: Glia associated with psychological stress.

Glial cells are an integral component of the nervous system, performing crucial functions that extend beyond structural support, including modulation of the immune system, tissue repair, and maintaining tissue homeostasis. Recent studies have highlighted the importance of glial cells as key mediators of stress responses across different organs. This review focuses on the roles of glial cells in peripheral tissues in health and their involvement in diseases linked to psychological stress. Populations of glia associated with psychological stress ("GAPS") emerge as a promising target cell population in our basic understanding of stress-associated pathologies, highlighting their role as mediators of the deleterious effects of psychological stress on various health conditions. Ultimately, new insights into the impact of stress on glial cell populations in the periphery may support clinical efforts aimed at improving the psychological state of patients for improved health outcomes.

Correlation between psychological stress and depressive symptoms among Japanese university students: a cross-sectional analysis.

[Purpose] Higher education students face significant environmental changes, placing them at heightened risk of developing depressive symptoms that have been exacerbated by the coronavirus infectious disease pandemic. This study examined the association between psychological stress and depressive symptoms among Japanese university students. [Participants and Methods] We conducted an online and face-to-face questionnaire survey with 145 Japanese university students studying rehabilitation sciences. Depressive symptoms and psychological stress were evaluated using the Self-rating Depression Scale and Stress Response Scale-18, respectively. [Results] Among the participants, 88 had depressive symptoms. Compared to the non-depressive symptom group, the depressive symptom group experienced higher psychological stress and comprised significantly more women and individuals with insomnia. Logistic regression analysis revealed that psychological stress and insomnia were independent predictors of depressive symptoms. [Conclusion] Psychological stress is independently associated with depressive symptoms. The correlation between insomnia, stress, and depressive symptoms requires further investigation. Future research should explore the causal relationship between psychological stress and depressive symptoms and consider the factors that may influence this relationship.

Impact of smokeless tobacco on psychological and oxidative stress in unemployed indian youth.

In India, tobacco (nicotine) addiction among youth has increased, leading to substantial socioeconomic burdens, mortality, and morbidity. While minimal short-term nicotine consumption may have antioxidant effects, chronic exposure results in various adverse health outcomes. This study examines the impact of chronic nicotine consumption on cellular oxidative stress and psychological stress, and their correlation with Homocysteine (Hcy) levels in unemployed tobacco consumers. This case-control study included 156 healthy, educated, unemployed male volunteers aged 20-40 years, divided into nicotine-addicted (n = 80) and non-addicted (n = 76) groups. Psychological stress was assessed using perceived stress scales (PSS) and coping self-efficacy (CSE) scales. Oxidative stress markers, including Malondialdehyde (MDA), Superoxide Dismutase (SOD), and Catalase, were measured. Hcy levels were quantified using high-performance liquid chromatography (HPLC). Nicotine-addicted participants exhibited significantly higher perceived stress (p = 0.0001) and lower coping self-efficacy (p = 0.0001) compared to non-addicted individuals. MDA levels in erythrocytes were significantly increased (p = 0.0006), while SOD (p = 0.0001) and Catalase (p = 0.02) activities were significantly decreased in the addicted group. Nicotine intake influenced Hcy concentrations, with 55% of addicted individuals falling into moderate, 27.5% into intermediate, and 7.5% into severe Hcy categories. Chronic nicotine intake also reflected the hematological parameters (WBCs, RBCs, HGB, and Platelets). Chronic tobacco consumption induces oxidative stress and perceived psychological stress, leading to elevated Hcy levels in nicotine consumers. The study highlights the detrimental effects of nicotine addiction on cellular defensive mechanisms, emphasizing the need for targeted interventions to address this growing health issue among unemployed Indian youth.

Factors associated with health personnel-chaplain interactions in the hospital setting: a cross-sectional survey study.

Health personnel may seek chaplain support to discuss stressors related to complex patient cases, difficult team dynamics, and personal issues. In this survey study of 1376 healthcare interprofessional clinicians, participants reported interacting with chaplains most frequently over patient-related stressors in the prior 12 months. Factors associated with chaplain interactions to discuss all three stressors included: reporting chaplains provide spiritual support to health personnel, more years of service, seeking professional help to deal with stressors, and higher levels of secondary traumatic stress. Being a registered nurse (RN) and working in a critical care specialty were associated with increased odds of interactions with a chaplain to discuss patient-related stressors while identifying as Catholic or Protestant was associated with chaplain interactions to discuss team-related and personal stressors. Chaplains should tailor interventions to promote health personnel's spiritual well-being based on patient-related, team-related, and personal stressors. Healthcare institutions which do not employ chaplains should advocate for this resource. Leaders in healthcare settings with chaplains should promote increased staff awareness that chaplains are available to support wellbeing by discussing patient, team, or personal stressors.

African American Family Caregivers' Experiences and Mental Health: A Convergent Mixed-Methods Study.

BACKGROUND: Caregiving in the African American community is informed by strong cultural expectations but may be associated with negative experiences and poor mental health outcomes. OBJECTIVE: The purpose of this convergent mixed-methods study is to understand the relationship between caregiving experiences and mental health and explore stress management strategies in African American family caregivers of adults with chronic or disabling conditions. METHODS: African American family caregivers (N = 100) were recruited using community-engaged methods and completed a sociodemographic questionnaire, the Caregiver Reaction Assessment scale, and the Center for Epidemiologic Studies Depression (CES-D-10) Scale. A subsample (n = 24) participated in semi-structured interviews. Data were analyzed using linear regression and content analysis. A matrix was developed to integrate quantitative and qualitative results. RESULTS: Participants were on average 59 years old. Most were women and provided care to a parent. Lack of family support (B = 1.37, P = .03) and impact of caregiving on caregivers' finances (B = 1.74, P = .004), schedule (B = 2.92, P < .001), and health (B = 3.26, P < .001) were associated with depressive symptoms and were reported as stressful experiences. Negative interactions with the care recipient and caring for multiple people emerged as other sources of stress. Participants used independent and interpersonal coping strategies, as well as strategies to facilitate their caregiving role to reduce their stress. Values of reciprocity, limited use of community-based resources, and mental health stigma emerged as important cultural considerations. CONCLUSIONS: Our findings suggest the need for culturally-sensitive interventions to improve communication and care coordination within African American family caregiving networks and educational programs about mental health and caregiving resources endorsed by trusted community sources.

The brain-skin axis in vitiligo.

Vitiligo is an acquired autoimmune skin disease characterized by patchy depigmentation of the skin, often accompanied by white hair. The aetiology of vitiligo is complex and difficult to cure, and its disfiguring appearance significantly impacts patients' mental and physical health. Psychological stress is a major factor in inducing and exacerbating vitiligo, as well as affecting its treatment efficacy, though the specific mechanisms remain unclear. Increasing research on the brain-skin axis in skin immunity suggests that psychological stress can influence local skin immunity through this axis, which may play a crucial role in the pathogenesis of vitiligo. This review focuses on the role of brain-skin axis in the pathogenesis of vitiligo, and explores the possible mechanism of brain-skin axis mediating the pathogenesis of vitiligo from the aspects of sympathetic nervous system, hypothalamic-pituitary-adrenal (HPA) axis and hormones and neuropeptides, aiming to provide the necessary theoretical basis for psychological intervention in the prevention and treatment of vitiligo.

Ginsenoside Rg1 ameliorates stress-exacerbated Parkinson's disease in mice by eliminating RTP801 and α-synuclein autophagic degradation obstacle.

Emerging evidence shows that psychological stress promotes the progression of Parkinson's disease (PD) and the onset of dyskinesia in non-PD individuals, highlighting a potential avenue for therapeutic intervention. We previously reported that chronic restraint-induced psychological stress precipitated the onset of parkinsonism in 10-month-old transgenic mice expressing mutant human α-synuclein (αSyn) (hαSyn A53T). We refer to these as chronic stress-genetic susceptibility (CSGS) PD model mice. In this study we investigated whether ginsenoside Rg1, a principal compound in ginseng notable for soothing the mind, could alleviate PD deterioration induced by psychological stress. Ten-month-old transgenic hαSyn A53T mice were subjected to 4 weeks' restraint stress to simulate chronic stress conditions that worsen PD, meanwhile the mice were treated with Rg1 (40 mg· kg-1 ·d-1, i.g.), and followed by functional magnetic resonance imaging (fMRI) and a variety of neurobehavioral tests. We showed that treatment with Rg1 significantly alleviated both motor and non-motor symptoms associated with PD. Functional MRI revealed that Rg1 treatment enhanced connectivity between brain regions implicated in PD, and in vivo multi-channel electrophysiological assay showed improvements in dyskinesia-related electrical activity. In addition, Rg1 treatment significantly attenuated the degeneration of dopaminergic neurons and reduced the pathological aggregation of αSyn in the striatum and SNc. We revealed that Rg1 treatment selectively reduced the level of the stress-sensitive protein RTP801 in SNc under chronic stress conditions, without impacting the acute stress response. HPLC-MS/MS analysis coupled with site-directed mutation showed that Rg1 promoted the ubiquitination and subsequent degradation of RTP801 at residues K188 and K218, a process mediated by the Parkin RING2 domain. Utilizing αSyn A53T+; RTP801-/- mice, we confirmed the critical role of RTP801 in stress-aggravated PD and its necessity for Rg1's protective effects. Moreover, Rg1 alleviated obstacles in αSyn autophagic degradation by ameliorating the RTP801-TXNIP-mediated deficiency of ATP13A2. Collectively, our results suggest that ginsenoside Rg1 holds promise as a therapeutic choice for treating PD-sensitive individuals who especially experience high levels of stress and self-imposed expectations.

Stress as a possible trigger in anti-N-methyl-á´ -aspartate receptor encephalitis: a case series.

Anti-N-methyl-ᴅ-aspartate receptor (NMDAR) encephalitis is a rare disease with a range of neurological and psychiatric presentations. Antibodies against NMDAR receptor are purported to be pathologic, and the two known potential immunological triggers are tumors and viral infection. In half of the cases, the trigger is not known. We present two cases where stress seemed to have triggered encephalitis. These cases illustrate the possible role of stress in leading to immune dysregulation, which can lead to encephalitis. We review the role of stress in anti-NMDAR encephalitis and possible mechanisms by which stress can trigger an immune dysregulation.

Are diagnoses of unruptured intracranial aneurysms associated with quality of life, psychological distress, health anxiety, or use of healthcare services in untreated individuals? A longitudinal, nested case-control study.

Introduction: Increasing imaging examination rates leads to a corresponding rise in the detection rates of unruptured intracranial aneurysms (UIAs). There is limited knowledge on how the detection of UIA affects health-related outcomes in untreated patients. Research question: Is the diagnosis of UIA associated with psychosocial outcomes, healthcare services utilisation, or sick leave in untreated individuals? Material and methods: Nested case-control study with 96 participants diagnosed with UIAs through magnetic resonance angiography (MRA) screening, not receiving preventive aneurysm obliteration. Comparisons were made with Control1 (192 participants with negative MRAs) and Control2 (192 individuals not MRA screened). Quality of life, psychological distress, and health anxiety were assessed using EQ-5D-5L including EQ VAS, Hopkins Symptom Checklist-10, and Whiteley Index-6, respectively. Healthcare service utilisation and sick leave was measured using registry data. Median follow-up was 32-55 months for the different outcomes. Results: UIA were in general not associated with psychosocial outcomes, neither compared to pre-screening values nor to controls. The exemption was a lower mean EQ VAS score at follow-up for cases (76.7) versus Control1 (80.0), regression coefficient -3.87 (95% CI (-7.60, -0.14). Cases had significantly higher rates of radiology exams compared to controls, with 1.47 (95% CI 1.25, 1.74) exams per person-year versus 0.91 (C95% CI 0.75, 1.09) for Control1 and 0.95 (95% CI CI 0.79, 1.14) for Control2. No significant differences were observed in other psychosocial outcomes, healthcare services utilisation, or sick-leave. Discussion and conclusions: The overall impact of untreated UIAs appears to be limited when assessed years after diagnosis.

Screen Time, Outdoor Play, and Sleep Routines in Early Childhood: Longitudinal Associations with Parenting Stress during Toddler to Preschool Years.

INTRODUCTION: Our study examined the longitudinal relationship between parenting stress and screen time, outdoor play, and sleep routines in toddler to preschool-aged children. METHOD: We conducted a descriptive quantitative analysis of a prospective observational cohort study of 300 families with an 18-month-old toddler who were followed for 2 years. Parenting stress was measured using a subscale of the Parenting Stress Index-4 Short Form at child age 18 months. Screen time, outdoor play, and sleep routines were parent-reported at child age 36 months. Multivariable regression estimated associations between parenting stress and screen time behaviors, outdoor play, and sleep routines. RESULTS: Data from 280 children (42.1% female) showed that 39.6% did not have rules around screen time and 82% of families reported frequently having the television on without anyone watching. In adjusted models, a 1-standard deviation increase in parenting stress at 18 months was associated with increased odds of having a television on without anyone watching (OR 1.26, 95% CI: 1.01, 1.57) and decreased odds of not having rules about the amount of screen time at 36 months (OR 0.75, 95% CI: 0.58, 0.96). DISCUSSION: Increased parenting stress in early childhood was associated with some suboptimal screen time behaviors and sleep routines when children were preschool-aged.

The effectiveness of cognitive behavioral therapy in women with gynecological cancer: A systematic review and meta-analysis of randomized controlled trials.

Objective: This study aimed to perform a meta-analysis of randomized control trials to evaluate the effects of cognitive behavioral therapy on depression, anxiety, fatigue, distress, the fear of cancer recurrence, and the quality of life in gynecological cancer patients. Methods: An extensive literature search of PubMed, Web of Science, Scopus, and CINAHL was performed, and a meta-analysis was conducted on ten studies that included 1027 patients. The quality of the data was evaluated using the Cochrane Risk of Bias tool. The effect size of the mean difference and standardized mean difference were computed using Revman 5.4.1. Results: Gynecological cancer patients receiving cognitive behavioral therapy showed decreases in depression (P < 0.001), anxiety (P = 0.01), fatigue (P < 0.001), distress (P = 0.03), and the fear of cancer recurrence (P = 0.01) compared to those receiving no treatment, whereas no improvement in quality of life was seen in the cognitive behavioral therapy group (P = 0.05). Conclusions: Cognitive behavioral therapy was shown to be a useful treatment for the symptoms experienced by women with gynecological cancer, with significant effect sizes. However, more research is required to validate the efficacy of cognitive behavioral therapy in patients with gynecological cancer, considering the limitations of this study's small sample size and statistical heterogeneity. Systematic review registration: PROSPERO- CRD42024516039.

Changes in Anxiety-Related Behaviors, Voiding Patterns, and Urinary Bladder Contractile Properties in Male Mice Exposed to Water Avoidance Stress for 1 Day and 28 Days.

Repeated water avoidance stress (WAS) for 10 days is a common rodent model to mimic the effect of chronic psychological stress on urinary bladder dysfunction. However, it remains obscure whether changes in the stress exposure period impact urinary bladder impairment differently. Therefore, this study aimed to investigate the effect of 1 (acute), 10 (chronic), and 28 (prolonged) days of WAS on anxiety-related behavior, voiding pattern, urinary bladder mast cells, and bladder contractility in C57BL/6J male mice. Mice exposed to 1 and 10 days of WAS showed decreased unsupported rearing. A decreased total void area after 1 and 10 days of the WAS was observed, which was reversed in the 28-day-WAS group. There was an increased number of degranulated mast cells in the bladder of the 10-day-WAS group. The 1-day WAS exposure enhanced tonic contractile response to a muscarinic agonist, carbachol, which was reversed by 5-HT3 receptor antagonist pre-incubation. Interestingly, the 28-day WAS group showed a similar tonic contractile response to the control group. Our findings provide more insightful information about using 1-day WAS as an acute psychological stress model, and stress exposure longer than 10 days did not produce anxiety-like behavior and urinary bladder impairment.

Integrative Treatment Approaches with Mind-Body Therapies in the Management of Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a complex pathophysiology characterized by intense pruritus, often associated with psychological stress and atopic and non-atopic comorbidities that significantly reduce quality of life. The psychological aspects of AD and the interaction between the mind and body via the skin-brain axis have led to an interest in mind-body therapies (MBT). The aim of this article is, therefore, to reinforce the importance of psychodermatological care in AD. We performed a focused literature review on holistic practices or integrative MBT in AD, including education, cognitive behavioral therapy, habit reversal, meditation, mindfulness, hypnotherapy, eye movement desensitization and reprocessing, biofeedback, progressive muscle relaxation, autonomous sensory meridian response, music therapy, massage, and touch therapy. A multidisciplinary holistic approach with MBT, in addition to conventional pharmacologic antipruritic therapies, to break the itch-scratch cycle may improve AD outcomes and psychological well-being. Although there is a paucity of rigorously designed trials, evidence shows the potential benefits of an integrative approach on pruritus, pain, psychological stress, anxiety, depressive symptoms, and sleep quality. Relaxation and various behavioral interventions, such as habit reversal therapy for replacing harmful scratching with massaging with emollient 'plus', may reduce the urge to scratch, while education may improve adherence to conventional therapies.