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    Stress Consequences: Mental, Neuropsychological and Socioeconomic
    Stress Consequences: Mental, Neuropsychological and Socioeconomic
    Stress Consequences: Mental, Neuropsychological and Socioeconomic
    Ebook2,989 pages28 hours

    Stress Consequences: Mental, Neuropsychological and Socioeconomic

    By George Fink

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    About this ebook

    Stress is a universal phenomenon that impacts adversely on most people. This volume provides a readily accessible compendium that focuses on the physical and psychological consequences of stress for individuals and society. Clinical attention focuses on disorders of the stress control system (e.g. Cushing’s Syndrome: Addison’s Disease) and the adverse impact of stress on human physical and mental health. Detailed reviews address disorders such as PTSD, anxiety, major depression, psychoses and related disorders such as combat fatigue and burnout. The work covers interactions between stress and neurodegenerative disorders, such as Alzheimer’s disease and Parkinson’s disease, as well as stress-immune-inflammatory interactions in relation to cancer and autoimmune and viral diseases. Emphasis is also placed on the role of stress in obesity, hypertension, diabetes type II and other features of the metabolic syndrome which has now reached epidemic proportions in the USA and other countries.

    • Chapters offer impressive scope with topics addressing animal studies, disaster, diurnal rhythms, drug effects and treatments, cognition and emotion, physical illness, psychopathology, immunology and inflammation, lab studies and tests, and psychological / biochemical / genetic aspects
    • Richly illustrated in full color with over 200 figures
    • Articles carefully selected by one of the world’s most preeminent stress researchers and contributors represent the most outstanding scholarship in the field, with each chapter providing fully vetted and reliable expert knowledge
    LanguageEnglish
    PublisherAcademic Press
    Release dateApr 6, 2010
    ISBN9780123751751
    Stress Consequences: Mental, Neuropsychological and Socioeconomic

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      Book preview

      Stress Consequences - George Fink

      Stress Consequences

      Mental, Neuropsychological and Socioeconomic

      FIRST EDITION

      George Fink

      Professorial Research Fellow (formerly Director), Mental Health Research Institute of Victoria, Parkville, Melbourne, Victoria, Australia

      Formerly Director, MRC Brain Metabolism Unit, Edinburgh, Scotland, UK

      Academic Press

      Amsterdam • Boston • Heidelberg • London • New York • Oxford • Paris • San Diego • San Francisco • Singapore • Sydney • Tokyo

      Academic Press is an imprint of Elesvier

      Table of Contents

      Cover image

      Title page

      Copyright page

      General Introduction

      Note on Terminology of Corticotropin Releasing Factor/Hormone and the Catecholamines

      Reference

      Introduction to Stress Consequences

      Some caveats and points of controversy or interest

      Conclusion and Observations

      Acknowledgements

      Bibliography and Further reading

      Contributors

      I: General – Background

      Neuroimaging and Emotion

      Emotion

      Definition of Emotion

      Emotion Perception and Attention

      Memory and Learning

      Interoception and Subjective Feeling States

      Social Interaction

      Emotion Regulation

      Emotion Dysregulation

      Further Reading

      Psychological Stressors, Overview

      Historical and General Considerations

      Conceptual Progress

      Methodological Considerations and Recent Developments

      Further Reading

      Life Events and Health

      Measurement

      Health Associations

      Individual Differences

      Further Reading

      Sex Differences in Human Stress Response

      Sex Differences in Health and Disease

      Sex Differences in Subjective Aspects of the Human Stress Response

      Sex Differences in Physiological Aspects of the Human Stress Response

      Further Reading

      Ethnicity, Mental Health

      Introduction

      Ethnicity

      Ethnicity and Mental Health in the United Kingdom

      Problems with Existing Sources of Data

      Explaining Key Findings and Contradictions

      Conclusions

      Further Reading

      II: Genetics and Genomics – Susceptibility to Stress

      Neuroticism, Genetic Mapping of

      What Is Neuroticism, and Is It Genetic?

      Which Regions of the Genome Are Linked to Neuroticism?

      Have Association Studies Identified Any Genes Associated with Neuroticism?

      Roles of Candidate Genes in Stress

      See Also the Following Articles

      Further Reading

      Genetic Predispositions to Stressful Conditions

      How Genes and Stressful Events Can Interact

      Measuring Life Events

      Twin Studies of Exposure to Stress

      Molecular Genetic Approaches

      Further Reading

      Serotonin Transporter Genetic Modifications

      The Serotonin Transporter

      The 5-HTT Gene

      Functional Polymorphisms of the 5-HTT Gene

      The Serotonin Transporter-Linked Polymorphic Region and Stress

      Further Reading

      Relevant Website

      Monoamine Oxidase

      Stress and the Cycle of Violence

      Genetic Factors in Aggression and Violence

      MAOA as a Candidate Gene

      The Role of Stress and Abusive Upbringing in Aggression and Violence

      Conclusion

      Further Reading

      Relevant Website

      III: Mental Disorders

      A: Personality and Personality Disorders

      Stress of Self Esteem

      The Role of Personality in the Perception of Stress

      The Importance of Self-esteem and Locus of Control in the Perception of Stress

      Endocrinological Evidence for the Role of Self-esteem and Locus of Control in the Perception of Stress

      The Hippocampus as a Possible Mediator of the Relationship between Self-esteem, Locus of Control, and Stress

      Conclusion: Personality Variables, Brain Structures, and Stress Responses in a Developmental Context

      Further Reading

      Borderline Personality Disorder

      Phenomenology and Epidemiology of Borderline Personality Disorder

      Role of Neurobiology

      Role of Life Experience

      Psychological Structures in the Borderline Patient

      Treatment of Borderline Personality Disorder

      See Also the Following Articles

      Further Reading

      Multiple Personality Disorder

      Introduction

      History

      Definition and Characteristic Findings

      Etiology

      Diagnosis

      Treatment

      Miscellaneous Concerns

      Concluding Remarks

      Further Reading

      Trans-sexualism

      Introduction and Definitions

      Childhood Experiences of Transsexual People

      Factors that Discourage Transition

      The Transition Process

      Hormonal and Surgical Changes

      Health Effects of Stress for Transsexual People

      Religion and the Transsexual Person

      Violence and Fear

      Intimacy and the Transsexual Person

      Aging and Death and the Transsexual Person

      Conclusion

      Further Reading

      Type A Personality, Type B Personality

      Introduction

      Historical Perspective

      Conceptualization and Assessment

      Empirical Support

      Component Factors

      Beyond Coronary Heart Disease

      Conclusion

      Further Reading

      B: Anxiety and Fear

      Anxiety

      Anxiety and Fear

      Different Types of Anxiety

      Anxiety and Cognition

      Anxiety Disorders

      The Neuroanatomy of Anxiety

      See Also the Following Articles

      Further Reading

      Fear

      Components of Fear

      Measures of Fear

      Fear Stimuli

      Fear Learning

      Pathological Fear: Phobias

      The Neurophysiology of Fear

      See Also the Following Articles

      Further Reading

      Fear and the Amygdala

      Amygdala Anatomy

      Afferent and Efferent Connections

      The Amygdala and Fear Conditioning in Animals

      The Amygdala and Fear in Humans

      See Also the Following Articles

      Further Reading

      Defensive Behaviors

      Defensive Behaviors and the Stimuli That Elicit Them

      Across-Species Generality

      Defensive Behaviors as Independent Biobehavioral Systems

      Acute versus Chronic Behavioral Defenses

      Defensive Behaviors, Stress, and Psychopathology

      See Also the Following Articles

      Further Reading

      Panic Disorder and Agoraphobia

      Symptoms

      Diagnosis

      PD in the General Medical Setting

      Epidemiology

      Risk Factors

      Course and Prognosis

      Treatment

      Psychological Treatments: Psychodynamic Psychotherapy

      Behavioral Treatments

      Selection of Treatments

      See Also the Following Articles

      Further Reading

      Death Anxiety

      Empirical and Clinical Studies of Death Anxiety

      Theories of Death Anxiety

      See Also the Following Articles

      Further Reading

      C: Obsessive–Compulsive Disorder

      Obsessive–Compulsive Disorder

      Introduction

      Clinical Characteristics of OCD

      Biological Characteristics of OCD

      Brain Circuit Theories of OCD

      Neuropsychological Testing in OCD

      Neuroimaging Studies in OCD

      Conclusions

      Acknowledgment

      See Also the Following Articles

      Further Reading

      D: Posttraumatic Stress Disorder

      Acute Stress Disorder and Posttraumatic Stress Disorder

      Introduction

      Relationship between Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD)

      Epidemiology

      Risk Factors for ASD and PTSD

      Comorbid Disorders

      Biological Findings in ASD and PTSD

      Treatment of ASD and PTSD

      Summary

      Acknowledgments

      See Also the Following Articles

      Further Reading

      Posttraumatic Stress Disorder in Children

      Traumatic Events

      Posttraumatic Stress Disorder in Children: Clinical Picture

      Prevalence and Developmental Course

      Demographic Trends

      Factors that Precipitate Posttraumatic Stress Disorder in Children

      Assessing Posttraumatic Stress Disorder Symptoms in Children

      See Also the Following Articles

      Further Reading

      Posttraumatic Stress Disorder, Delayed

      Diagnostic Systems and Delayed Posttraumatic Stress Disorder

      Nature of the Delay Period

      Discussing Delayed Posttraumatic Stress Disorder

      See Also the Following Articles

      Further Reading

      HPA Alterations in PTSD

      Introduction

      Basal Cortisol Levels in Posttraumatic Stress Disorder

      Cortisol Levels in Response to Stress

      Basal Corticotropin Releasing Hormone and Adrenocorticotropic Hormone Levels in Posttraumatic Stress Disorder

      Glucocorticoid Receptors in Posttraumatic Stress Disorder

      The Dexamethasone Suppression Test in Posttraumatic Stress Disorder

      The Metyrapone Stimulation Test

      The Corticotropin Releasing Hormone Challenge Test and Adrenocorticotropic Hormone Stimulation Test in Posttraumatic Stress Disorder

      Findings of Cortisol in the Acute Aftermath of Trauma

      Conclusion

      Acknowledgments

      See Also the Following Articles

      Further Reading

      Posttraumatic Stress Disorder – Neurobiological basis for

      General Considerations

      Physiological Measures

      Brain Imaging

      See Also the Following Articles

      Further Reading

      Posttraumatic Stress Disorder – Clinical

      Overview of Posttraumatic Stress Disorder

      Cognitive-Behavioral Treatments for Posttraumatic Stress Disorder

      Real-World Treatment Considerations

      Childhood Sexual Abuse-Related Posttraumatic Stress Disorder

      Conclusion

      See Also the Following Articles

      Further Reading

      Nightmares

      Phenomenology of Frightening Awakenings

      Nightmares and Posttraumatic Stress Disorder

      Treatment Approaches

      Further Reading

      E: Mood Disorders: Depression

      Affective Disorders

      Phenomenology of Affective Disorders

      The Experience of Affective Disorders

      Behavior in Affective Disorders

      Affective Disorders and Personality

      Varieties of Affective Disorder

      History of the Concept of Affective Disorders

      Affective Disorders as Diseases

      Affective versus Other Psychiatric Disorders

      A Note on Nomenclature

      See Also the Following Articles

      Further Reading

      Depression and Manic–Depressive Illness

      Introduction

      Clinical Characteristics of Major Depression and Manic-Depression

      Biological Characteristics of Depression and Manic-Depression

      Neuroimaging Studies in Depression and Manic-Depression

      Brain Circuit Theories of Depression and Manic-Depression

      Psychological Testing in Depression and Manic-Depression

      Treatment of Major Depression and Manic-Depression

      Conclusion

      Acknowledgments

      Further Reading

      Corticotropin-Releasing Factor Circuitry in the Brain – Relevance for Affective Disorders and Anxiety

      Glucocorticoids in Affective Disorders: Early Evidence

      Corticotropin-Releasing Factor

      Corticotropin-Releasing Factor Receptors

      Extrahypothalamic Corticotropin-Releasing Factor Circuits and Depression

      Corticotropin-Releasing Factor in Depression

      Corticotropin-Releasing Factor and Anxiety Disorders

      Small-Molecule Corticotropin-Releasing Factor Antagonists

      Conclusions and Future Directions

      Acknowledgments

      Further Reading

      Depression, Immunological Aspects

      Introduction

      Immune System

      Biological Connections between the CNS and Immune System

      Depression Influences on Immunity

      Clinical Moderating Variables

      Behavioral Mechanisms: Role of Insomnia

      Depression Treatment: Effects of Antidepressant Medications

      Cytokines Influences on the CNS and Behavior: Implications for Depression

      Clinical Implications of Psychoneuroimmunology

      Acknowledgments

      See Also the Following Articles

      Further Reading

      Depression and Coronary Heart Disease

      Introduction

      Definitions of Depression

      The Course and Consequences of Depression in Coronary Heart Disease Patients

      Mechanisms

      Depression Treatment Trials in Coronary Heart Disease Patients

      Conclusion

      Further Reading

      Adjustment Disorders

      Definition

      Epidemiology

      Etiology

      Diagnosis

      Course and Prognosis

      Treatment

      Conclusions

      See Also the Following Articles

      Further Reading

      Bereavement

      Introduction

      Depressive Symptoms and Course

      Physical Symptoms, Substance Use, and Medical Treatment

      Psychiatric Disorders – Depression, Anxiety, and Mania

      Complicated or Traumatic Bereavement

      Mortality

      Pathologic Outcomes and Predictors of Outcome

      Treatment

      Further Reading

      F: Schizophrenia/Psychoses

      Psychotic Disorders

      Stress in Psychotic Disorders: Conceptual Framework

      Stressful Life Events and Psychosis

      Natural Disasters and Psychotic Disorders

      Expressed Emotion as a Stressor

      Treatment as Protection against Stress and Psychosis

      Further Reading

      Schizophrenia

      Introduction

      Schizophrenia: Definition and Etiology

      The Effects of External Stressors: Expressed Emotion and Life Events

      The Hypothalamic-Pituitary-Adrenocortical (HPA) Axis and Schizophrenia

      Stress, Early Development, and Schizophrenia: Neurobiological Findings

      Treatment Implications of the Vulnerability-Stress Model of Schizophrenia: Psychosocial Treatment Strategies

      Conclusion

      See Also the Following Articles

      Further Reading

      G: Substance Related Disorders

      Interactions Between Stress and Drugs of Abuse

      Introduction

      Influence of Stressors on Drug Self-Administration

      Factors Influencing Effects of Stressors

      Mechanisms of Stress Action

      Does Stress Induce a Drug-Prone Phenotype?

      Conclusions

      See Also the Following Article

      Further Reading

      Alcohol, Alcoholism, and Stress: A Psychobiological Perspective

      Introduction

      Alcohol and the Stress Response

      Effects of Stress on Alcohol Consumption

      Modifiers of the Stress–Alcohol Interaction

      Conclusion

      See Also the Following Articles

      Further Reading

      Smoking and Stress

      Introduction

      Personality Traits, Genetic, and Biological Predictors of Smoking and Stress

      Smoking as a Coping Response

      Smoking Cessation, Stress, and Coping

      The Psychobiology of Smoking, Coping, and Stress Diasthesis

      Summary

      See Also the Following Articles

      Further Reading

      Drug Use and Abuse

      Stress and Drug Addiction

      Clinical Evidence

      Animal Studies

      Effects of Drug Abuse on Stress Responses

      Neurobiological Mechanisms

      Treatment Implications

      See Also the Following Articles

      Further Reading

      Comorbid Disorders and Stress

      Introduction

      Prevalence of Comorbidity

      Substances

      Etiological Theories

      Comorbidity and Stress

      Major Depression, Substance Use Disorders, and Stress

      Conclusion

      See Also the Following Articles

      Further Reading

      H: Autistic Spectrum Disorders

      Neurodevelopmental Disorders in Children

      Autism and Asperger’s Disorder

      Attention-Deficit/Hyperactivity Disorder (ADHD)

      Stress Associated with Autism and ADHD

      Conclusion

      See Also the Following Articles

      Further Reading

      I: Behavioral disorders

      Attention-Deficit/Hyperactivity Disorder, Stress and

      Definition and Overview

      Aggravation, Complication, or Mimicking of ADHD Symptoms by Stress

      ADHD Symptoms as Stressors

      Conclusion

      See Also the Following Articles

      Further Reading

      J: Eating disorders

      Eating Disorders and Stress

      Clinical Overview of Eating Disorders

      Anorexia Nervosa

      Bulimia Nervosa

      Etiological Influences in Eating Disorders

      Further Reading

      K: Endocrine – Psychopathy - Cushings

      Cushing’s Syndrome, Neuropsychiatric Aspects

      Neuropsychiatric Symptoms in Patients with Spontaneous Untreated Cushing’s Syndrome

      Improvement in Neuropsychiatric Symptoms after Treatment

      Brain-Imaging Studies in Cushing’s Syndrome

      Mechanisms for the Behavioral Effects of Cortisol

      Further Reading

      L: Sleep disruption and psychiatric disorders

      Sleep, Sleep Disorders, and Stress

      Normal Sleep

      Sleep Disorders

      Sleep, Sleep Disorders, and Physical and Emotional Stress

      Sleep and Stress System

      Conclusion

      Further Reading

      Night Shiftwork

      Introduction

      The Mechanism

      Effects on Sleep

      Alertness

      Performance

      Accidents

      Stress Indices

      Gastrointestinal Effects

      Cardiovascular Effects

      Mortality

      Conclusion

      See Also the Following Articles

      Further Reading

      Psychiatric Disorders Associated with Disturbed Sleep and Circadian Rhythms

      Introduction

      Mood Disorders

      Anxiety Disorders

      Conclusion

      Further Reading

      Relevant Websites

      M: Dementia – Alzheimer’s Disease

      Neurodegenerative Disorders

      Overview of Neurodegenerative Disorders

      Neurodegenerative Dementias: Alzheimer’s Disease

      Neurodegenerative Movement Disorders: Parkinson’s Disease

      Conclusions

      See Also the Following Articles

      Further Reading

      Alzheimer’s Disease

      The Clinical Picture of Alzheimer’s Disease

      Risk Factors for Alzheimer’s Disease

      The Pathophysiology of Alzheimer’s Disease

      The Hypothalamic-Pituitary-Adrenal Axis in Normal Brain Functioning

      Stress and the Hypothalamic-Pituitary-Adrenal Axis

      Stress and Alzheimer’s Disease

      A Possible Treatment Approach

      Conclusion

      Further Reading

      Diabetes Type 2 and Stress: Impact on Memory and the Hippocampus

      Introduction

      Memory in Aging: Normal Changes, Mild Cognitive Impairment, and Dementia

      Links between Diabetes and Dementia

      The Impact of Cortisol on Cognition and the Brain

      Impact of Diabetes on the Brain

      Possible Mechanisms for the Cognitive Impairments Seen in T2DM

      Summary

      Further Reading

      Chaperone Proteins and Chaperonopathies

      Proteins

      Definition

      Classification

      Biology

      Phylogenetic Domains

      Physiology

      Pathology and Medicine

      Mechanism

      To Fold, Refold, or Degrade

      See Also the Following Articles

      Further Reading

      Chaperonopathies

      Definitions and Classifications

      Molecular Pathology

      Impact of Defective Chaperones

      Examples of Chaperonopathies

      See Also the Following Articles

      Further Reading

      N: Suicide

      Adolescent Suicide

      Risk Factors for Suicide in Adolescents

      Neuroscientific Findings in Adolescent Suicide

      Treatments and Possible Effects of Antidepressants

      See Also the Following Articles

      Further Reading

      Suicide, Biology of

      Introduction

      A Model for Understanding Suicidal Behavior

      Stressors: Triggers for Suicidal Behavior

      Risk Factors Influencing the Threshold for Suicidal Behavior

      Summary

      Acknowledgments

      Further Reading

      Relevant Websites

      Suicide, Psychology of

      Diathesis

      Stress as a Precipitant of Suicide

      The Adequacy of Stressors

      The Situation

      Survivors

      Assisted Suicide

      Preventing Suicide

      See Also the Following Articles

      Further Reading

      Suicide, Sociology of

      Durkheim’s Theory

      Henry and Short’s Theory

      Naroll’s Theory

      Culture Conflict

      Measuring Regional Stress

      Multivariate Studies of Regional Suicide Rates

      Nonfatal Suicide Behavior

      See Also the Following Articles

      Further Reading

      Relevant Website

      IV: Neuropsychological

      Disease, Stress Induced

      Anatomy and Physiology of the Stress System

      Stress and Disease

      Disease and Stress

      Further Reading

      Somatic Disorders

      Psychosomatic Disorders

      Stress and the Onset of Organic Disorders

      Medically Unexplained Symptoms

      Anxiety and Depressive Disorders

      Further Reading

      Arthritis – Psychological

      Definition

      Stress and Rheumatoid Arthritis

      Stress and Osteoarthritis

      A Special Case: Arthritis in Children

      See Also the Following Articles

      Further Reading

      Diet and Stress, Psychiatric

      Introduction

      Biological Basis of Stress Eating

      Practical Treatment of Stress Eating

      Conclusion

      Further Reading

      Diet and Stress, Non-Psychiatric

      Introduction

      Animal Research into Stress and Eating Behavior

      Human Research into Stress and Food Intake

      Mechanisms Relating Stress to Eating

      Summary

      See Also the Following Articles

      Further Reading

      Depersonalization: Systematic Assessment

      Definition and Characteristics

      Etiology

      Assessment with the SCID-D-R

      Case Study

      Conclusions

      Further Reading

      Learning and Memory, Effects of Stress on

      Introduction

      Effects of Stress on Learning and Memory in Animals

      Memory, Learning, and Their Anatomical Bases in Humans

      Encoding in Stressful Situations

      Effects of Anticipated Stress on Memory

      Possible Mechanisms of the Relation between Stress and Memory

      Summary

      Further Reading

      Pain

      Introduction

      Stress-Induced Analgesia

      Stress-Induced Hyperalgesia

      Further Reading

      Migraine

      Introduction

      Epidemiology

      Neural Basis of Head Pain

      Genetics

      Migraine Mechanisms

      Classification of Headache Disorders

      Clinical Presentations and Differential Diagnosis of Migraine

      Management

      Summary

      Acknowledgment

      See Also the Following Article

      Further Reading

      Relevant Websites

      Asthma

      Stress as a Cause of Asthma

      Stress Brings on Asthma Attacks

      Stress Affects the Course of Asthma

      Stress Reduction Improves Asthma Outcomes

      See Also the Following Articles

      Further Reading

      Cancer

      Mind–Body Interactions and Cancer

      Stress and Cancer Incidence and Progression

      Coping Style and Cancer Incidence and Progression

      Social Support as a Stress Buffer

      Physiological Mechanisms of Stress and Support-Related Effects on Cancer Progression

      Stress Reactivity and Disease Progression

      Circadian Rhythm Disruption, Stress, and Cancer

      Psychoendocrinology and Cancer

      Psychoneuroimmunology and Cancer

      Psychosocial Interventions and Immune Function

      Immune Function and Disease Progression

      Stress and Autonomic Responses

      Conclusion

      Further Reading

      Cardiovascular Disease, Stress and

      Prevalence of Atherosclerosis – Cardiovascular Disease

      Established and Evolving Risk Factors of Atherosclerosis

      Alterations of the Function of the Stress System Leading to the Development of Atherosclerosis and Cardiovascular Disease

      Further Reading

      Psychosomatic Heart Disease: Role of Sympathetic and Sympathoadrenal Processes

      Mechanisms Underlying Coronary Heart Disease and Myocardial Infarction and Possible Relationship to Stress and Behavior

      Sympathoadrenal Function in Panic Disorder

      Sympathoadrenal Function in Major Depressive Disorder

      See Also the Following Articles

      Further Reading

      Relevant Website

      Hypertension

      Prevalence

      Etiological Factors

      Experimental Evidence

      Psychological Characteristics

      Lifestyle and Adverse Life Experience

      Stress Management and Quality of Life

      Further Reading

      C-Reactive Protein

      C-Reactive Protein: Function and Measurement

      Relationship between C-Reactive Protein and Cardiovascular Disease

      Stress-Related Psychosocial Cardiovascular Risk Factors and C-Reactive Protein

      Conclusion and Future Directions

      Acknowledgments

      Further Reading

      Cytokines, Chronic Stress, and Fatigue

      Cytokines: Description and Classification

      Cytokines: Central Nervous System and Endocrine Interactions

      Cytokine Measurement

      Cytokines and Chronic Stress

      Cytokines and Fatigue in Clinical Disorders

      Chronic Stress, Fatigue, and Cytokines: Relevance for Disease Processes

      Conclusion

      Further Reading

      Dermatological Conditions

      Overview of Stress and Dermatology

      Role of Stress over the Life Cycle

      The Role of Stress in a Wide Range of Dermatological Symptoms

      Stress and Some Specific Dermatological Disorders

      Further Reading

      Ulceration, Gastric

      Background

      Psychological Influences on Development of Ulceration

      Mechanisms

      Future Directions

      Further Reading

      V: Psychosocial

      Stress, Beneficial Effects of

      Types of Benefit

      Prevalence

      Etiological Factors

      Theoretical Developments

      Clinical Applications

      See Also the Following Articles

      Further Reading

      Psychosocial Factors and Stress

      General Background

      Overview of Psychosocial Factors Influencing Stress and Health

      Implications for Intervention

      See Also the Following Articles

      Further Reading

      Quality of Life

      The Concept of Quality of Life

      Assessment of Quality of Life

      Dimensions of Quality of Life

      Further Reading

      Aggression

      Types of Aggression

      Epidemiology of Aggression

      Genetics of Aggression

      Psychosocial Factors in Aggression

      Biology of Aggression

      Psychopharmacology of Aggression

      See Also the Following Articles

      Further Reading

      Anger

      Anger and Stress

      The Experience and Expression of Anger

      Anger Physiology

      Cognition, Anger, and Threat

      Anger Dyscontrol and Regulation

      Anger Treatment

      See Also the Following Articles

      Further Reading

      Hostility

      History of the Concept

      Conceptualization

      Assessment

      Link to Physical Disease in Longitudinal Studies

      Mechanisms of Association

      Intervention

      See Also the Following Articles

      Further Reading

      Violence

      Types of Biological Influences

      Summary

      Acknowledgments

      See Also the Following Articles

      Further Reading

      Antisocial Disorders

      Definition

      Development and Course

      Prevention and Treatment

      See Also the Following Articles

      Further Reading

      Domestic Violence

      Description

      Consequences

      Remediation Strategies

      Historical Perspectives

      See Also the Following Articles

      Further Reading

      Child Abuse

      Child Physical Abuse

      Child Neglect

      See Also the Following Articles

      Further Reading

      Child Physical Abuse

      Prevalence

      Etiology

      Mental Health Effects

      Treatment Approaches

      See Also the Following Articles

      Further Reading

      Child Sexual Abuse

      Definition and Epidemiology

      Symptomatology

      Assessment

      Treatment

      See Also the Following Articles

      Further Reading

      Childhood Stress

      Definitions of Stress

      Measurement of Stress

      Effects of Stress

      See Also the Following Articles

      Further Reading

      Marital Status and Health Problems

      Health Differences among Marital Status Groups

      Theories about the Explanation

      Selection on Health and Determinants of Health

      Social Causation, Intermediary Factors, and Biological Pathways

      See Also the Following Articles

      Further Reading

      Marital Conflict

      What Is Conflict?

      What Happens During Conflict?

      What Are the Consequences of Conflict?

      See Also the Following Articles

      Further Reading

      Divorce, Children of

      Divorce-Related Stressors

      Mental Health Consequences

      Risk and Resilience

      Implications for Prevention

      See Also the Following Articles

      Further Reading

      Incest

      Incest: Definition and Descriptive Characteristics

      Diagnosis

      The Psychological Impact of Incest

      Treatment of Incest Victims

      See Also the Following Articles

      Further Reading

      Elder Abuse

      Demographics of Elder Abuse

      Characteristics of the Abused

      Characteristics of the Abuser

      Theories about the Cause of Elder Abuse

      Institutional Abuse

      Signs and Symptoms of Elder Abuse

      See Also the Following Articles

      Further Reading

      Relevant Website

      Male Partner Violence

      Prevalence

      Psychological Impact

      Physical Impact

      Prevention

      Intervention

      Conclusion

      See Also the Following Articles

      Further Reading

      Sexual Assault

      Prevalence of Traumatic Events and Sexual Assault

      Psychological Sequelae of Sexual Assault

      Treatment of Sexual Assault-Related PTSD

      Predictors of PTSD

      Conclusion

      See Also the Following Articles

      Further Reading

      Sexual Offenders

      General Considerations

      Definitional Considerations

      Treatment of Sex Offenders

      Concluding Remarks

      See Also the Following Articles

      Further Reading

      Adolescence

      Introduction

      Normal Adolescence

      Common Stressors

      Unusual Stressors

      See Also the Following Articles

      Further Reading

      Premenstrual Dysphoric Disorder

      Diagnostic Issues

      Etiology

      Further Reading

      Caregivers, Stress and

      Caregiving Burden

      The Stress Process

      Longitudinal Effects of Caregiving

      Psychosocial Interventions for Caregivers

      Further Reading

      Childbirth and Stress

      Introduction

      Physical Outcome

      Maternal Satisfaction

      Psychopathology

      Conclusion

      Further Reading

      Coping Skills

      Stress and Coping

      Chronic Illness

      Structured Coping Programs: Learning How to Cope Effectively

      Summary

      Acknowledgments

      See Also the Following Articles

      Further Reading

      Homosexuality, Stress and

      Heterosexism

      Gender Beliefs and Gender Stress

      Homophobia

      Moral Condemnations of Homosexuality

      Antigay Violence

      The Stress of Being in the Closet

      Further Reading

      Impotence, Stress and

      Overview

      Physiology of Erection

      Erectile Dysfunction

      Evaluation and Treatment

      Further Reading

      Menopause and Stress

      Menopause as a Stressful Life Event

      Impact of Stress on Menopause Symptomatology

      Stress and Ovarian Function

      Conclusions

      See Also the Following Articles

      Further Reading

      Parenting, Stress of

      Why Parenting Can Be Stressful

      Types of Parenting Stress

      Effects of Stress on Parents

      Effects of Parenting Stress on Children

      Interventions for Parents and Children

      Further Reading

      Prison

      Scope of the Problem

      Prison Inmates

      Prison Staff

      Limitations and Conclusion

      Further Reading

      Religion and Stress

      Religion as a Concept

      Religion as a Cure for Stress

      Religion as a Cause of Stress

      Religion as a Correlate of Stress

      Further Reading

      Organ Transplantation, Stress of

      Prevalence of Organ Transplantation

      The Transplantation Process for the Individual Patient

      Interventions to Minimize Stressor Effects during the Transplant Process

      Acknowledgments

      Further Reading

      VI: Socioeconomic

      Health and Socioeconomic Status

      Socioeconomic Gradient in Health

      Model

      Explanations

      See Also the Following Articles

      Further Reading

      Income Levels and Stress

      Absolute Income and Health

      Relative Income and Health

      Income Inequality and Health

      Income and Health: The Role of Social Comparisons

      Acknowledgments

      See Also the Following Articles

      Further Reading

      Job Insecurity: The Health Effects of a Psychosocial Work Stressor

      Job Insecurity and the Labor Market

      The Job Insecurity Concept

      Mechanisms

      Psychological Health

      General Measures of Physical Health

      Health Outcomes of Interest to the Organization

      Effects beyond the Individual and the Workplace

      Who Experiences Job Insecurity: The Public Health Impact

      Summary

      See Also the Following Articles

      Further Reading

      Effort–Reward Imbalance Model

      Theory

      Research Evidence

      Implications for Intervention

      See Also the Following Articles

      Further Reading

      Environmental Factors

      Historical Background

      The Impact of Environmental Factors on Stressors

      Differential Exposure and Vulnerability to Environmental Stressors

      See Also the Following Articles

      Further Reading

      Industrialized Societies

      Process of Industrialization and Epidemiological Transition

      Stressful Social Environments and Health

      Concluding Remarks

      See Also the Following Articles

      Further Reading

      Community Studies

      Conceptualizing Life Stressors

      Life Stressors and Adaptation

      Stress Moderators

      Integrative Models

      Acknowledgments

      Further Reading

      Crime Victims

      Victimization

      Psychological and Physical Health Consequences

      Responses to Specific Crimes

      Support and Treatment Services

      Further Reading

      Crisis Intervention

      Impact of Crises

      Planning for Crisis

      Interventions During and After the Crisis

      Critical Incident Needs Assessment Teams

      Conclusion

      Further Reading

      Crowding Stress

      Introduction

      Crowding Stress: Psychosocial Effects

      Physiological Changes in Crowding Stress

      Possible Molecular Mechanisms of Crowding Stress

      Crowding of Flies and Worms

      Cell Crowding

      Molecular Crowding

      Conclusions

      Further Reading

      Cultural Factors in Stress

      Culture as Adaptation

      Cultural Stress

      Acculturative Stress

      See Also the Following Articles

      Further Reading

      Cultural Transition

      Cultural Transition in the Central Eastern European (CEE) Countries as Field Experience

      Changing Attitudes and Values and Cultural Transition

      See Also the Following Articles

      Further Reading

      Economic Factors and Stress

      Introduction: The Economy as a Population Stressor

      The Economy’s Effect on Hazard Avoidance

      The Economy’s Effect on Coping Assets

      The Economy’s Effect on Tolerance for Coping

      Socioeconomic Status and Stress

      Policy Implications and Conclusions

      See Also the Following Articles

      Further Reading

      Education Levels and Stress

      What Education Levels Indicate

      Lower Exposure to Stressful Situations

      Better Response in Stressful Situations

      Higher Socioeconomic Status

      Learned Effectiveness and the Sense of Control

      Life-Course Compounding

      Signs of Lower Stress

      See Also the Following Articles

      Further Reading

      Employee Assistance and Counseling

      History

      Rationale

      EAPs and Stress

      Program Characteristics

      Challenges and Future Directions

      See Also the Following Articles

      Further Reading

      Environmental Stress, Effects on Human Performance

      Theories of Effects of Stressors on Performance

      Patterns of Stressor Impairment

      Compensatory Control under Stress

      Latent Degradation under Stress

      Further Reading

      Indigenous Societies

      Introduction

      Stress in Unacculturated Indigenous Societies

      Stress and Acculturation in Indigenous Societies

      Stress and Migration

      Conclusion

      See Also the Following Articles

      Further Reading

      Minorities and Stress

      Basic Issues

      Disadvantaged Minorities

      Treatment Considerations

      See Also the Following Articles

      Further Reading

      Racial Harassment/Discrimination

      Introduction: Discrimination Persists

      Studies of Discrimination and Health

      Understanding the Context of Discrimination and Responses to It

      Measurement Issues

      Pathways from Discrimination to Health

      Conclusion

      See Also the Following Articles

      Further Reading

      School Stress and School Refusal Behavior

      School Stress and Linkage to School Refusal Behavior

      Major Characteristics of School Refusal Behavior

      Etiology and Major Functions of School Refusal Behavior

      Assessment of School Refusal Behavior

      Treatment of School Refusal Behavior

      Further Reading

      School Violence and Bullying

      Hostile School Behavior: Prevalence and Concerns

      Connection between Bullying and Violent Offending

      Antecedents and Consequences of Hostile Experiences

      The Effects of Witnessing Hostile Behaviors

      See Also the Following Articles

      Further Reading

      Relevant Websites

      Social Capital

      Forms and Functions of Social Capital

      Measurement of Social Capital

      Social Capital and Population Health

      Mechanisms Linking Social Capital and Health

      Negative Effects of Social Capital

      See Also the Following Articles

      Further Reading

      Social Networks and Social Isolation

      Introduction

      Theoretical Orientations

      Health, Social Networks, and Social Integration

      A Conceptual Model Linking Social Networks to Health

      Conclusion

      Acknowledgments

      See Also the Following Article

      Further Reading

      Social Status and Stress

      Social Status, Health, and Stress

      Indicators of Social Status

      Social Status and Exposure to Stressful Conditions

      Social Status and Vulnerability to Stressful Conditions

      See Also the Following Articles

      Further Reading

      Social Support

      Theoretical Perspectives

      Social Support as a Mechanism for Coping with Stress

      Social Support as a Source of Stress

      Summary and Conclusion

      See Also the Following Articles

      Further Reading

      Transport-Related Stress

      The Natural Stress of Driving

      Driver Stress and Driver Behavior

      Stress after Motor Vehicle Accidents

      Aggressive Driving and Stress

      Driving Stress and Road Rage

      What Can Be Done to Reduce Stress in Driving?

      Acknowledgment

      Further Reading

      Unemployment, Stress, and Health

      Introduction

      Health Effects of Unemployment

      Selection

      Mechanisms

      Unemployment and Health in the Life Course

      Policy Implications

      See Also the Following Articles

      Further Reading

      Work–Family Balance

      Defining Work–Family Balance

      Prevalence and Emergence of Interest in Work–Family Balance

      Work–Family Balance and the Stress Process

      Promoting Work–Family Balance

      Gaps and Needed Research

      See Also the Following Articles

      Further Reading

      Workplace Stress

      Introduction

      Impact of the Work Environment

      Models of Work Stress

      Type A Behavior

      Gender Differences in Response to Work Stress

      Psychobiological Mechanisms Linking Work Stress to Health Problems

      Concluding Remarks

      Acknowledgment

      See Also the Following Articles

      Further Reading

      Burnout

      Definition and Assessment

      A Mediation Model of Burnout and Engagement

      Implications for Interventions

      See Also the Following Articles

      Further Reading

      Subject Index

      Copyright

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      07 08 09 10 11 10 9 8 7 6 5 4 3 2 1

      General Introduction

      George Fink

      Stress is not something to be avoided. Indeed, it cannot be avoided, since just staying alive creates some demand for life-maintaining energy. Complete freedom from stress can be expected only after death.  Hans Selye

      Stress is one of the most frequently used but ill-defined words in the English language. Stress is a phenomenon that has quite different meanings at different times and under different circumstances for different individuals. Stress is a function of three main interactive and often interdependent variables: (i) excitability/arousal; (ii) perceived aversiveness; and (iii) uncontrollability. We all know when we are stressed – e.g. late for an important meeting and stuck in dense traffic or in a plane that shows no sign of push-back for reasons unknown – but find it difficult rationally to define our feelings. The definition proposed by the distinguished Berkeley psychologist, Richard Lazarus, is perhaps apposite for many stressful situations in man – that is, a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize.

      Hans Selye, sometimes called the father of stress, coined and defined stress as the nonspecific response of the body to any demand. For some, Selye’s definition is too biological and ignores cognitive and psychological factors, a criticism that seems to stem from the misconception that cognition is not a function of the brain. For others, Selye’s definition is too general. However, Selye’s publications show that he understood psychological or cognitive stress. Furthermore, the generality of Selye’s definition makes it pertinent for the molecular, genotypic and phenotypic analysis of stress and stress responses across all species from bacteria to man.

      The contributions of Walter Bradford Cannon, working at Harvard in the 1920s and 30s, are arguably of equal importance for our understanding of the stress response. Thus, Cannon first proposed the term homeostasis (from the Greek homoios, or similar, and stasis, or position) for the coordinated physiological processes that enable the organism to cope with the stressful challenge by maintaining or quickly restoring steady state within the organism. Cannon also coined the term fight or flight to describe an animal’s response to threat. Homeostasis, ‘stability through constancy,’ which has dominated physiological and medical thinking since 1859 (Claude Bernard’s milieu intérieur) seems in several circumstances (e.g. work-induced increase in cardiovascular load) to be giving way to allostasis, which provides ‘stability through change.’ Homeostasis depends on negative feedback control systems: allostasis refers to the dynamic maintenance of homeostasis by appropriate central nervous regulation of the cybernetic set points that adjust physiological parameters to meet various stresses/challenges.

      The purpose of Stress Science and this companion volume Stress Consequences is to package key up-to date concepts and information regarding stress and its consequent and/or associated adverse effects on human health into a systematically formatted and reader friendly handbook. Stress Science is focused on the fundamental neuroendocrine response to stress and its adverse effects on several key somatic systems. The mental, neuropsychological and socioeconomic consequences of stress are covered in this companion volume on Stress Consequences.

      Note on Terminology of Corticotropin Releasing Factor/Hormone and the Catecholamines

      The central nervous regulation of the anterior pituitary gland is mediated by substances, mainly peptides, which are synthesized in the hypothalamus and transported to the gland by the hypophysial portal vessels. Because these compounds are transported by the blood, the term hormone or neurohormone gained acceptance in the neuroendocrine literature. The major hypothalamic peptide involved in the stress response is the 41-amino acid corticotropin releasing factor (CRF). The Endocrine Society (USA), following convention, adopted the term corticotropin releasing hormone (CRH). However, this nomenclature has been challenged. Hauger et al. (2003), in liaison with the International Union of Pharmacology Committee on Receptor Nomenclature and Drug Classification, argued that the function of CRF extends well beyond the biology of a hormone, and that it should therefore be termed corticotropin releasing factor (CRF) rather than hormone. Since the terminology of CRF versus CRH has yet to be resolved, the two terms and abbreviations are here used interchangeably, depending on author preference.

      Adrenaline and noradrenaline are catecholamines that play a pivotal role in the stress response. These terms are synonymous with epinephrine and norepinephrine, respectively. Both sets of terms are used interchangeably in the endocrine, neuroendocrine and stress literature, and this principle has been adopted here. Style has depended on author preference, but wherever possible within-article consistency has been ensured. The adjectival forms, adrenergic and noradrenergic, are used universally.

      Reference

      Hauger RL, Grigoriadis DE, Dallman MF, Plotsky PM, Vale WW, Dautzenberg FM. International Union of Pharmacology. XXXVI. Current status of the nomenclature for receptors for corticotropin-releasing factor and their ligands. Pharmacological Reviews. 2003;55(1):21–26.

      Introduction to Stress Consequences

      George Fink

      his mind is walking up and down, walking up and down, in his old prison

      (Description of Dr Manette, from a Tale of Two Cities by Charles Dickens)

      Stress Consequences, the clinical sequel to the largely basic science-focused Stress Science, starts with a chapter by Harrison and Critchley that outlines the impact of modern brain imaging on our understanding of cognition, emotions and mind. The second chapter by Monroe and Slavich reminds us, with examples, that It is also commonly assumed that with the accelerating progress of civilization, more and more people are afflicted with mental and physical disorders. Historical accounts, however, suggest that such ideas about stressors, civilization, and disease have been common for quite some time.

      The present work covers most stress consequences – mental, neuropsychological, psychosocial and socio-economic – that are likely to be of relevance to psychiatrists, psychologists, psychotherapists, sociologists, epidemiologists, economists, stress researchers and students. Stress Consequences will also prove of interest to physicians and other health care workers, endocrinologists and neuroendocrinologists, policy and lawmakers and to the lay reader interested in the impact of stress on humans and human society.

      The selection of topics and articles that comprise Stress Consequences was based on their importance for understanding stress and its impact, their relevance for psychiatry, medicine and health care delivery, psychology, sociology and economics, their timeliness, and the robustness of their concepts and data. Most of the articles are derived from the recently published Encyclopedia of Stress. Readers are referred to the earlier companion volume, Stress Science, for reviews of the relationship between stress and circadian and seasonal rhythms, neural plasticity and memory, inflammation and immunity, fetal stress and the thrifty phenotype hypothesis, feeding, obesity and the metabolic syndrome, disorders of the cardiovascular system and reproductive disorders. Stress Science also reviews some aspects of genetics and genomics, such as the article by Craig on Genetic Polymorphisms in Stress Response, which are relevant to Stress Consequences.

      Obesity and cardiovascular disorders, introduced in Stress Science and frequently referred to as epidemics, receive further coverage in the present volume on Stress Consequences, especially in the sections on Neuropsychological and Socioeconomic.

      What follows is a brief outline of a few points of interest or controversy that perhaps deserve editorial comment.

      Some caveats and points of controversy or interest

      Posttraumatic Stress Disorder and Hypocortisolemia? Science is a debate, especially when data are subjective as is often the case with symptoms of mood and mental state and when hormonal and neurotransmitter changes may be relatively subtle. This uncertainty problem is exemplified by posttraumatic stress disorder (PTSD). Thus, early studies by Mason and associates (1986) found that urinary-free cortisol levels during hospitalization were significantly lower in PTSD than in major depressive disorder, bipolar I, manic, and undifferentiated schizophrenia, but similar to those in paranoid schizophrenia. Mason et al underscored the fact that the low, stable cortisol levels in PTSD patients (Vietnam combat veterans) are remarkable because the overt signs of anxiety and depression in PTSD would usually be expected to be associated with cortisol elevations. Mason et al (1986) conclude that the findings suggest a possible role of defensive organization as a basis for the low, constricted cortisol levels in PTSD and paranoid schizophrenic patients.

      As explained by Rachel Yehuda (see "HPA Alterations in PTSD" in the present work, and also Yehuda 2006), the apparently low cortisol levels in PTSD are thought to reflect hyper-responsiveness of the hypothalamic-pituitary-adrenal system (HPA) to cortisol (glucocorticoid) negative feedback inhibition (for explanation see Stress Science: Neuroendocrinology). The observation of low cortisol in a disorder – PTSD – precipitated by extreme stress directly contradicts the popular glucocorticoid cascade hypothesis which posits that stress-induced increased plasma cortisol concentrations (hypercortisolemia) result in damage to areas of the brain, such as the hippocampus, that are involved in memory and cognition (see articles by BS McEwen, RM Sapolsky and the section on Neuronal Plasticity-Memory in Stress Science: McEwen 2007). But of greater concern is the fact that the data of Mason et al (1986) have not been universally replicated. Thus, when compared with levels in normal controls, ambient cortisol concentrations in PTSD over a 24-h period have been reported differently in several different publications as significantly lower, significantly higher, and not significantly different (e.g. Yehuda 2006, and HPA Alterations in PTSD in the present work; Young & Breslau 2004). Furthermore, most cortisol levels, high or low, in persons with PTSD are within the normal endocrine range, not suggestive of endocrine pathology.

      There is, therefore, room for healthy skepticism about accepting hypocortisolemia as a universal and canonical feature of PTSD or other chronic conditions, such as chronic fatigue syndrome and fibromyalgia. As Rachel Yehuda stresses, the clinical significance of cortisol alterations within the normal endocrine range awaits to be determined by more sophisticated and rigorous neuroendocrine follow-up studies that are likely to involve genetics, genomics, molecular biology and brain imaging.

      A different slant on within-normal range cortisol levels is offered by a recent study of 4000 former or current British civil servants (Michael Marmot’s Whitehall II study). Kumari et al (2009) report that statistically low salivary cortisol concentrations at waking predicted new-onset of reported fatigue during an approximately 2.5-year follow-up. It is not clear whether the low cortisol levels are an effect or cause of fatigue. The authors speculate that their findings might also be relevant for conditions such as chronic fatigue syndrome and burnout (see Maslach and Leiter, present volume). However, although statistically significant (over a relatively huge N), it is not clear whether the seemingly small effect size of the difference between the fatigued and non-fatigued groups would enable salivary cortisol to be used to predict fatigue within individuals.

      Human hippocampus - does size matter? Much is often made of hippocampal volume (determined in man by magnetic resonance imaging: MRI) and major depressive disorder – indeed, a Medline search draws down nigh on 270 papers on the subject. This issue is dealt with in the present volume by Rubin and Carroll (Depression and Manic-Depressive Illness) and Harrison and Critchley (Neuroimaging and Emotion). The clear signal that emerges from both of these detailed reviews is that reduction in hippocampal volume, thought by some to reflect the effect of prolonged depression, PTSD or chronic stress (e.g. Lupien et al 2009) is not a consistent finding in major depression. The literature shows that reduction in hippocampal volume cannot be attributed to high levels of cortisol: indeed, reduced hippocampal volume has also been reported in PTSD patients in whom cortisol levels are assumed to be lower than normal (Lupien et al 2009), and in patients with cardiovascular disease (Rubin and Carroll). In a meta-analysis of 2418 patients with major depressive disorder and 1,974 healthy individuals, Koolschijn et al (2009) reported that the MRI data in patients with major depressive disorder showed large volume reductions in frontal regions, especially in the anterior cingulate and orbitofrontal cortex, with smaller reductions in the prefrontal cortex. The hippocampus, the putamen and caudate nucleus showed moderate volume reductions. In a monumental review of the literature, Savitz and Drevets (2009) conclude that a significant number of studies have failed to find evidence of hippocampal atrophy in depressed patients, and based on these data, we suggest that the following caveat obtains: the majority of studies reporting evidence of hippocampal atrophy have made use of elderly, middle-aged or chronically ill populations. Clearly, much more research is required to improve our understanding of the relationships between mental symptoms, changes in regional brain volumes and neuroendocrine data.

      Corticotropin releasing factor antagonists – novel potential anxiolytics and antidepressants: Numerous studies have shown that major depressive disorder often requires more than one step of treatment to elicit a remission of symptoms. Frequently, a second medication needs to be added to augment the first, which nowadays is usually a selective serotonin reuptake inhibitor [SSRI] (Trivedi et al 2006). Current data raise the question of whether to use augmentation agents (or other treatment combinations) as first-line treatment in an attempt to achieve greater remission rates sooner and in more patients than those associated with the use of SSRIs alone (Trivedi et al 2006). According to Trivedi and Daly (2008), treatment-resistant depression (TRD) is a common problem in the management of major depressive disorder, with 60% to 70% of all patients meeting the criteria for TRD. Non-pharmacological treatments, such as collaborative therapy, are being tested in clinical trials, but there remains an unmet need for new anxiolytic and antidepressant agents. This point was underscored by the first Advances in Neuroscience for Medical Innovation Symposium (Agid et al 2007), which recommended that We should not pursue improved selective serotonin- or noradrenaline-reuptake inhibitors (SSRIs/SNRIs), or the other classes of drugs that have reached their limits. For reasons explained by Gutman and Nemeroff (in the present volume), small molecule antagonists of the corticotropin releasing factor-1 receptor (CRF-R1) might provide suitable alternatives to the classical monoamine targeted anxiolytic and antidepressant drugs. Several novel CRF-R1 antagonists are currently under investigation (Gilligan et al 2009).

      Incidental to drug discovery, the finding that the CRF family of peptides and receptors may play a key role in mood and stress-induced behavior is an important spin-off of the CRF-41 story (see review by Gutman and Nemeroff here and many papers in Stress Science: Neuroendocrinology)

      Alzheimer’s Dementia, the aging brain, chaperone proteins and diabetes type 2: No modern work on stress and mental disorder would be complete without a discussion of the aging brain, Alzheimer’s Disease and vascular dementia. The five papers on this subject in Stress Consequences comprise two on chaperone proteins – mainly heat shock proteins that tend to minimize cellular stress across all species from archaea to man. A relatively new twist to this theme is the paper by Convit, Rueger and Wolf on the impact of diabetes type 2 and stress on memory and the hippocampus, and the relationship between diabetes type 2, glucocorticoids, Alzheimer’s Disease and cognitive impairment.

      Gastro-duodenal (peptic) ulcers – Stress-Helicobacter pylori interactions: The etiology of gastric and duodenal ulceration and the conceptual switch from only stress to only bacteria as the cause of ulceration, followed by a sober realization that both factors may play a role, has heuristic value for our understanding of disease pathogenesis. As explained by Murison and Milde in the present volume, Ulcerations played a key role in Hans Selye’s description of the general adaptation syndrome and constituted one of the elements of this nonspecific response to diverse nocuous agents, together with shrinkage of the thymus and enlargement of the adrenal glands (see also Fink, Stress: Definition and History in Stress Science: Neuroendocrinology). The (2005 Nobel Prize winning) discovery by Marshall and Warren that 80% of gastric and 90% of duodenal ulcers appeared to be caused by or were associated with Helicobacter pylori (Marshall and Warren 1984: Cover and Blaser, 2009) overturned the long-held view that stress was the cause of peptic ulceration. However, several studies reviewed by Murison and Milde and also by Creed in the present volume show that stress may still play a significant role in peptic ulceration, either alone, or as a factor that predisposes to ulcer induction by H. pylori. This is exemplified by the fact that the Hanshin-Awaji earthquake that occurred on January 17, 1995 was followed by a significant increase in the number of people with peptic ulceration (see Creed in the present volume, and Matsushima et al 1999). In most of these people ulceration developed in conjunction with H.Pylori, but among the physically injured, stomach ulcers developed independently of this infectious agent. Thus, argues Creed, there is a clear relationship with stress, which must be considered alongside other risk factors for peptic ulcer – H. pylori infection, non-steroidal anti-inflammatory drugs, smoking, and an inherited predisposition. In her critical review of the interaction between stress and H. pylori in the causation of peptic ulcers, Susan Levenstein concludes, "Peptic ulcer is a valuable model for understanding the interactions among psychosocial, socioeconomic, behavioral, and infectious factors in causing disease. The discovery of H. pylori may serve, paradoxically, as a stimulus to researchers for whom the concepts of psychology and infection are not necessarily a contradiction in terms" (Levenstein 2000).

      Biology of psychosocial and socioeconomic stress consequences: The biological basis for most of the psychosocial and socioeconomic consequences of stress is outlined in many articles in the present volume, as well as in the earlier companion volume, Stress Science: Neuroendocrinology. For further information, the reader might wish to consult the Encyclopedia of Stress, 2nd edition (Editor in Chief, George Fink, 2007, Academic Press) and recent reviews such as those by Marmot & Bell (2009), McEwen (2007) and Shonkoff et al (2009).

      Conclusion and Observations

      Stress research has made huge advances since Hans Selye’s note to Nature in 1936 and the publication of Walter Cannon’s The Wisdom of the Body (1932). This is especially the case with respect to the fundamental neuroendocrinology of the stress response (see Stress Science: Neuroendocrinology). However, there are still many unknowns. Thus, for example, in spite of the power of modern structural and functional human brain imaging, our understanding of the relationships between the changes in the nervous system and the signals in the endocrine system remain poor. In fact, as outlined above, we appear to have no clue as to the significance of stress neuroendocrinology for changes in hippocampal volume, which can be reduced under conditions of either presumed low or presumed high HPA activity. The glucocorticoid vunerability and neurotoxicity hypothesis seems to have achieved canonical status. But is the hypothesis correct for man – does it apply invariably to all humans under all conditions? What precisely does a change in the volume of the hippocampus or other brain regions signify functionally? Are MRI-determined changes in hippocampal and amygdala volume, trait, or, as seems to be the case in schizophrenia (Velakoulis et al 2006), state dependent? Are we missing some major conceptual or factual points that are staring us in the face?

      In terms of understanding stress, cognitive performance and behavior, have we progressed significantly beyond the century-old Yerkes-Dodson Law which, simply put, states that the relationship between arousal and behavioral performance can be linear or curvilin-ear depending upon the difficulty of the task (Diamond et al 2007)?

      This skeptical view has an optimistic side in that the stress field offers numerous opportunities and challenges for future researchers. This seems especially to be the case with respect to the interactions between emotion, cognition, memory, mental state and behavior, and how they translate into the nano-world of the synapse on the one hand and society, culture and economics on the other. Inextricably bound to this are gene-environment interactions (GxE) that are thought to play a role in stress-induced disorders of mood, mental state and behavior. Touched on in Section II of the present volume, and also in Stress Science, GxE together with its cognate disciplines is a crucial field under intense investigation. The present volume on Stress Consequences shows that there is an exciting future for bright sparks interested in clinically relevant stress research.

      Acknowledgements

      I am grateful to Ann Elizabeth Fink for putting up with yet another round of stress, and to Mica Haley, Elsevier Neuroscience Acquisitions Editor for her continuing support. I should also like to thank Professors Robert Rubin and Bernard (Barney) Carroll for the helpful discussions regarding post-traumatic stress disorder. Any errors are mine.

      Bibliography and Further reading

      Agid Y. How can drug discovery for psychiatric disorders be improved?. Nature Reviews Drug Discovery. 2007;6:189–201. doi:10.1038/nrd2217 (March 2007).

      Cannon WB. The Wisdom of the Body. New York: Norton; 1932.

      Cover TL, Blaser MJ. Helicobacter pylori in Health and Disease. Gastroenterology. 2009;136:1863–1873.

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      Contributors

      T. Åkerstedt     Karolinska institutet, Stockholm, Sweden

      K.J. Ajrouch     Eastern Michigan University, Ypsilanti, MI, USA

      R.A. Allison     American Medical Association, Phoenix, AZ, USA

      O. Almkvist     Karolinska Institutet and University of Stockholm, Stockholm, Sweden

      T.C. Antonucci     University of Michigan, Ann Arbor, MI, USA

      L.E. Arnold     Ohio State University, Columbus, OH, USA

      B. Ataca     Bogazici University, Istanbul, Turkey

      N.E. Avis     Wake Forest University School of Medicine, Winston-Salem, NC, USA

      W.R. Avison     University of Western Ontario, London, ON, Canada

      S. Ayers     University of Sussex, Brighton, UK

      M.W. Baldwin     McGill University, Montreal, Quebec, Canada

      J.C. Ballenger     Medical University of South Carolina, Charleston, SC, USA

      M. Barad     University of Los Angeles, Los Angeles, CA, USA

      M. Bartley     University College London Medical School, London, UK

      D. Benedek     Uniformed Services University of the Health Sciences, Bethesda, MD, USA

      M. Berk     University of California, Los Angeles, CA, USA

      L.F. Berkman     Harvard School of Public Health, Boston, MA, USA

      J.W. Berry     Queen’s University, Kingston, ONT, Canada

      D. Blackwood     University of Edinburgh, Edinburgh, UK

      D.C. Blanchard     University of Hawaii, Honolulu, HI, USA

      R.J. Blanchard     University of Hawaii, Honolulu, HI, USA

      S.R. Bornstein     University Hospital, Duesseldorf, Duesseldorf, Germany

      K. Bottigi     University of Minnesota, Minneapolis, USA

      A.B. Butler     University of Northern Iowa, Cedar Falls, IA, USA

      M. van den Buuse     The Mental Health Research Institute of Victoria, Parkville, Victoria, Australia

      B.J. Carroll     Pacific Behavioral Research Foundation, Carmel, CA, USA

      R.A. Catalano     University of California Berkeley, CA, USA

      T. Chandola     University College London, London, UK

      G. Chapman     University of Nevada, Las Vegas, NV, USA

      A. Christensen     University of California, Los Angeles, Los Angeles, CA, USA

      G.P. Chrousos     University of Athens, Athens, Greece

      P.J. Clayton     American Foundation for Suicide Prevention, New York, NY, USA

      E.F. Coccaro     University of Chicago, Chicago, IL, USA

      J.A. Cohen     Drexel University College of Medicine, Philadelphia, PA, USA

      J.K. Cohen     Pittsburgh PA, USA

      A. Convit     Department of Psychiatry, New York University School of Medicine, Millhauser Laboratories, New York, and Nathan Kline Institute, Orangeburg, NY, USA

      E. Conway de Macario     New York State Department of Health and The University of Albany (SUNY), Albany, NY, USA

      L.C. Cook     University of Nevada, Las Vegas, NV, USA

      D. Copolov     The Mental Health Research Institute of Victoria, Parkville, Victoria, Australia

      I.W. Craig     King’s College London, London, UK

      F. Creed     University of Manchester, Manchester, UK

      H.D. Critchley     University College London, London, UK

      P. Csermely     Semmelweis University, Budapest, Hungary

      M. Dascalu     Washington University School of Medicine, St. Louis, MO, USA

      T. Dawood     Baker Heart Research Institute and Monash University, Alfred Hospital, Melbourne, Victoria, Australia

      A. DeLongis     University of British Columbia, Vancouver, BC, Canada

      M. Devich-Navarro     University of California, Los Angeles, CA, USA

      M.A. Dew     University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA, USA

      Laura J. Dietz     University of Pittsburgh Medical Center, Pittsburgh, PA, USA

      A.F. DiMartini     University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA, USA

      J.E. Dimsdale     University of California, San Diego, CA, USA

      B. Donohue     University of Nevada at Las Vegas, Las Vegas, NV, USA

      J. Drescher     New York, NY, USA

      W.W. Dressler     University of Alabama, Tuscaloosa, AL, USA

      E.K. Englander     Bridgewater State College, Bridgewater, MA, USA

      N.C. Feeny     Case Western Reserve University, Cleveland, OH, USA

      R.M. Fernquist     Central Missouri State University, Warrensburg, MO, USA

      M.H. Fernstrom     University of Pittsburgh Medical Center, Pittsburgh, PA, USA

      J.E. Ferrie     University College London Medical School, London, UK

      E.B. Foa     University of Pennsylvania, Philadelphia, PA, USA

      E. Ford     University of Sussex, Brighton, UK

      N. Frasure-Smith     Centre Hospitalier de l’Université de Montréal Research Center, University of Montreal, McGill University, and Montreal Heart Institute Research Center, Montreal, Canada

      J.E. Gaugler     University of Minnesota, Minneapolis, USA

      E.L. Gibson     Roehampton University, London, UK

      M.R. Gignac     Pittsburgh, PA, USA

      D.G. Gilbert     Southern Illinois University-Carbondale, Carbondale, IL, USA

      L. Giner     Fundacion Jimenez Diaz and Universidad Autonoma de Madrid. Madrid. Spain

      G.M. Goodwin     University of Oxford, Oxford, UK

      W.M. Greenberg     Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, and New York University School of Medicine, New York, NY, USA

      T. Grieger     Uniformed Services University of the Health Sciences, Bethesda, MD, USA

      L.M. Groesz     University of Texas at Austin, Austin, TX, USA

      J.G. Grzywacz     Wake Forest University School of Medicine, Winston-Salem, NC, USA

      M.A. Gupta     University of Western Ontario and Mediprobe Research Inc., London, Canada

      D.A. Gutman     Emory University School of Medicine, Atlanta, GA, USA

      D. Hamaoka     Uniformed Services University of the Health Sciences, Bethesda, MD, USA

      N.A. Harrison     University College London, London, UK

      P. Haynes     University of Arizona, Tucson, AZ, USA

      M. Hebert     University of Hawaii, Honolulu, HI, USA

      D.H. Hellhammer     University of Trier, Trier, Germany

      H. Hill     University of Nevada at Las Vegas, Las Vegas, NV, USA

      K.N. Hipke     Wisconsin Psychiatric Institute and Clinics, Madison, WI, USA

      M. Hirshkowitz     Baylor College of Medicine and Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX, USA

      G.R.J. Hockey     University of Sheffield, Sheffield, UK

      C.J. Holahan     University of Texas at Austin, Austin, TX, USA

      A. Holen     Norwegian University of Science and Technology, Trondheim, Norway

      C.P. Holstege     University of Virginia, Charlottesville, VA, USA

      H. Holstege     Calvin College, Grand Rapids, MI, USA

      P. Huezo-Diaz     King’s College London, London, UK

      K. Iley     Canterbury Christ Church University, Canterbury, UK

      M. Ingram     University of Arizona, Tucson, AZ, USA

      M.R. Irwin     UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA

      S. Jain     University of California San Diego, San Diego, CA, USA

      K.D. Jennings     University of Pittsburgh, Pittsburgh, PA, USA

      D.C. Jimerson     Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

      S. Joseph     University of Nottingham, Nottingham, UK

      I.M.A. Joung     Erasmus University, Rotterdam, Netherlands

      J. Juvonen     University of California, Los Angeles, Los Angeles, CA, USA

      G. Kaltsas     University of Athens, Athens, Greece

      A.A. Kaptein     Leiden University Medical Center, Leiden, The Netherlands

      M. Karataraki     Penn State University College of Medicine, Hershey, PA, USA

      R. Kastenbaum     Arizona State University, Tempe, AZ, USA

      I. Kawachi     Harvard School of Public Health, Boston, MA, USA

      C.A. Kearney     University of Nevada, Las Vegas, NV, USA

      C. Kirschbaum     Technical University of Dresden, Dresden, Germany

      R.P. Kluft     Temple University, Philadelphia, PA, USA

      H. Knight     University of Edinburgh, Edinburgh, UK

      H.W. Koenigsberg     Bronx VA Medical Center, Bronx, NY, USA

      W.J. Kop     Uniformed Services University of the Health Sciences, Bethesda, MD, USA

      M.S. Kopp     Semmelweis University, Budapest, Hungary

      R.L. Kormos     University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA, USA

      M.P. Koss     University of Arizona, Tucson, AZ, USA

      L. Kovács     Babes-Bolyai University, Clvj-Napoca, Romania

      B.M. Kudielka     University of Trier, Trier, Germany

      A.M. La Greca     University of Miami, Coral Gables, FL, USA

      G.W. Lambert     Baker Heart Research Institute, Melbourne, Victoria, Australia

      J.E. Lansford     Duke University, Durham, NC, USA

      M. Le Moal     Université de Bordeaux, Bordeaux, France

      M.P. Leiter     Acadia University, Wolfville, Nova Scotia, Canada

      F. Lespérance     Centre Hospitalier de l’Université de Montréal Research Center, University of Montreal, and Montreal Heart Institute Research Center, Montreal, Canada

      D. Lester     Richard Stockton College of New Jersey, Pomona, NJ, USA

      J.D. Levine     University of California, San Francisco, CA, USA

      T.J. Linares     Case Western Reserve University, Cleveland, OH, USA

      M. Lindau     Uppsala University, Uppsala, Sweden

      G. Lindbeck     Karolinska institutet, Stockholm, Sweden

      R.L. Lindsay     Arizona Child Study Center, Phoeniz, AZ, USA

      P.A. Linley     University of Leicester, Leicester UK

      U. Lundberg     Stockholm University, Stockholm, Sweden

      A.J.L. Macario     New York State Department of Health and The University of Albany (SUNY), Albany, NY, USA

      D.F. MacKinnon     Johns Hopkins University School of Medicine, Baltimore, MD, USA

      T. Maier-Paarlberg     University of Nevada at Las Vegas, Las Vegas, NV, USA

      H.M. Malin     Institute for Advanced Study of Human Sexuality, San Francisco, CA, USA

      A.P. Mannarino     Allegheny General Hospital, Pittsburgh, PA, USA

      J.J. Mann     Columbia University and New York State Psychiatric Institute, New York, NY, USA

      E.C. Manning     University of Chicago, Chicago, IL, USA

      J.R. Mantsch     Marquette University, Milwaukee, WI, USA

      V. March     University of Pittsburgh Medical Center, Pittsburgh, PA, USA

      M. Marmot     University College London, London, UK

      P. Martikainen     University of Helsinki, Helsinki, Finland

      C. Maslach     University of California, Berkeley, CA, USA

      F.J. McClernon     Duke University Medical Center, Durham, NC, USA

      P.T. McFarland     University of California, Los Angeles, Los Angeles, CA, USA

      A.M. McMurtray     West Los Angeles Veteran’s Affairs Medical Center and University of California, Los Angeles, CA, USA

      M.F. Mendez     West Los Angeles Veteran’s Affairs Medical Center and University of California, Los Angeles, CA, USA

      A.M. Milde     University of Bergen, Bergen, Norway

      P.J. Mills     University of California San Diego, San Diego, CA, USA

      I. Mino     Harvard University, Cambridge, MA, USA

      J. Mirowsky     University of Texas at Austin, Austin, TX, USA

      A.H. Mohammed     Karolinska Institutet, Stockholm, and Växjö University, Växjö, Sweden

      S.A. Mohammed     University of Michigan Ann Arbor, MI, USA

      S.M. Monroe     University of Oregon, Eugene, OR, USA

      R.H. Moos     Dept. of Veterans Affairs Health Care System and Stanford University Medical Center, Palo Alto, CA, USA

      M.E. Mor Barak     University of Southern California School of Social Work and Marshall School of Business, Los Angeles, CA, USA

      R. Murison     University of Bergen, Bergen, Norway

      M.W. Nash     King’s College London, London, UK

      J.Y. Nazroo     University of Manchester, Manchester, UK

      C.B. Nemeroff     Emory University School of Medicine, Atlanta, GA, USA

      R. Norbury     Warneford Hospital and University of Oxford, Oxford, UK

      R.W. Novaco     University of California, Irvine, CA, USA

      S. Nowakowski     San Diego State University/University of California, San Diego, CA, USA

      A. Öhman     Karolinska Institutet, Stockholm, Sweden

      M.A. Oquendo     Columbia University and New York State Psychiatric Institute, New York, NY, USA

      S. Packer     New School for Social Research, New York, NY, USA

      K. Pajer     The Ohio State University, Columbus, OH, USA

      B.L. Parry     University of California, San Diego, CA, USA

      S. Pejovic     Penn State University College of Medicine, Hershey, PA, USA

      Avril Pereira     Mental Health Research Institute of Victoria, Melbourne, Australia

      P.V. Piazza     Université de Bordeaux, Bordeaux, France

      C.M. Pierce     Harvard University, Cambridge, MA, USA

      M.L. Pilati     Rio Hondo College, Whittier, CA, USA

      N. Pomara     Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, and New York University School of Medicine, New York, NY, USA

      L.H. Powell     Rush University Medical Center, Chicago, IL, USA

      W.E. Profit     Los Angeles, CA, USA

      P. Prolo     University of California, Los Angeles, and Veterans Administration Greater Los Angeles Health Care System, Los Angeles, CA, USA

      J.C. Pruessner     McGill University, Montreal, Quebec, Canada

      E. Puterman     University of British Columbia, Vancouver, BC, Canada

      N.M. Ramadan     Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA

      D. de Ridder     Utrecht University, Utrecht, The Netherlands

      N.J. Rinehart     Monash University, Clayton, Victoria, Australia

      I. Robbins     St. George’s Hospital, London, UK

      G.M. Rooker     Pittsburgh, PA, USA

      C.E. Ross     University of Texas at Austin, Austin, TX, USA

      A.E. Roth     Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA

      R.T. Rubin     VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

      M. Rueger     New York University School of Medicine, New York, NY, USA

      L. Saldana     Medical University of South Carolina, Charleston, SC, USA

      F.M. Saleh     University of Massachusetts Medical School, Worcester, MA USA

      S. Sandberg     University College London, London, UK

      I.N. Sandler     Arizona State University, Tempe, AZ, USA

      A. Sharafkhaneh     Baylor College of Medicine and Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX, USA

      W.S. Shaw     University of Massachusetts, Worcester, MA, USA

      J. Siegrist     University of Duesseldorf, Duesseldorf, Germany

      L.J. Siever     Bronx VA Medical Center, Bronx, NY, USA

      E.K. Simon     Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA

      S.M. Skevington     University of Bath, Bath, UK

      G.M. Slavich     University of Oregon, Eugene, OR, USA

      R.G. Smart     Centre for Addiction and Mental Health, Toronto, Canada

      D. Spiegel     Stanford

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