Psychosomatic medicine
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Psychosomatic medicine · Mar 1999
Comparative StudyImpact of gender, menstrual cycle phase, and oral contraceptives on the activity of the hypothalamus-pituitary-adrenal axis.
Results from animal and human studies suggest that disregulations of the hypothalamus-pituitary-adrenal (HPA) axis are involved in several behavioral, circulatory, endocrine, and immune disorders with clear-cut gender differences in disease prevalence. The aim of the present study was to investigate sex-specific HPA response patterns with a focus on the contribution of gonadal steroids as possible mediators. ⋯ We conclude that gender, menstrual cycle phase, and OC use exert important effects on HPA responsiveness to psychosocial stress in healthy subjects. Although men seem to have a stronger hypothalamic drive in response to stressful stimulation than women, differences in salivary-free cortisol levels, at least in part, may be explained by estradiol-induced changes in corticosteroid-binding protein levels. ACTH and cortisol secretion is not affected by OC use per se but the amount of bioavailable unbound cortisol ("free") is greatly reduced in this group of women after stimulation. Inasmuch as none of these differences between the study groups emerged in total blood cortisol levels, we strongly advocate for the simultaneous measurement of free and total cortisol levels in future studies on HPA functioning.
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Psychosomatic medicine · Jan 1999
Randomized Controlled Trial Clinical TrialGender, depression, and one-year prognosis after myocardial infarction.
The purpose of this study was to assess gender differences in the impact of depression on 1-year cardiac mortality in patients hospitalized for an acute myocardial infarction (MI). ⋯ Depression in hospital after MI is a significant predictor of 1-year cardiac mortality for women as well as for men, and its impact is largely independent of other post-MI risks.
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Psychosomatic medicine · Jul 1998
Meta AnalysisDo antidepressants have an analgesic effect in psychogenic pain and somatoform pain disorder? A meta-analysis.
A significant amount of evidence indicates that some antidepressants have an analgesic effect. We wished to determine whether this analgesic effect could be demonstrated in studies that had used antidepressants for the treatment of pain in patients diagnosed with psychogenic pain or somatoform pain disorder. Meta-analysis was used for this purpose. ⋯ The results indicate that, in patients diagnosed with psychogenic pain or somatoform pain disorder, antidepressant treatment resulted in a reduction in pain that was significantly greater than that of placebo. Possible explanations for these results are discussed.
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Psychosomatic medicine · May 1998
Abuse-related posttraumatic stress disorder and alterations of the hypothalamic-pituitary-adrenal axis in women with chronic pelvic pain.
Although numerous organic conditions may cause chronic pelvic pain (CPP), diagnostic laparoscopy reveals a normal pelvis in many patients with CPP. However, psychological studies yield a high frequency of psychopathology and increased prevalences of chronic stress and traumatic life events, ie, sexual and physical abuse, in women with CPP, suggesting a relationship between posttraumatic stress disorder (PTSD) and CPP. As chronic stress and PTSD have been associated with specific alterations of the hypothalamic-pituitary-adrenal (HPA) axis, we explored stress history, psychopathology and HPA axis alterations in women with CPP. ⋯ Women with CPP demonstrate HPA axis alterations, that partly parallel and partly contrast neuroendocrine correlates of PTSD, but show marked similarity to findings in patients with other stress-related bodily disorders. These findings suggest that a lack of protective properties of cortisol may be of relevance for the development of bodily disorders in chronically stressed or traumatized individuals.
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The goal of this study was to evaluate the prevalence and type of psychiatric disorders coexisting with burning mouth syndrome (BMS), to compare the clinical features of patients with BMS alone with patients with multiple diagnoses, and to investigate the number and severity of life events that occur before the onset of BMS. ⋯ BMS has high psychiatric comorbidity but can occur in the absence of psychiatric diagnoses.