Stress and sarcoidosis
Sarcoidosis is a stress-related disorder? (Tetsuo Yamaguchi mail to Anne Grenier-Taylor)
Patient's stories about stress and sarcoidosis from Sarcoid Message Forum, Sarcoid BYTE and other links.
Abstracts from 7th congress of WASOG (World Association of Sarcoidosis and Other Granulomatous Disorders), Stockholm June 16-19, 2002.
Perceived stress in sarcoidosis
by J. De Vries1, M. Drent2
Dept. of Clinical Health Psychology1, Tilburg University, Dept. of Pulmonology2, University Hospital Maastricht, The Netherlands
Introduction There seems to be a relationship between major life events and sarcoidosis. However, studies concerning perceived stress in sarcoidosis patients are lacking. Therefore, the aim of the present study was to examine the role of perceived stress in sarcoidosis. Method Members of the Dutch Sarcoidosis Society (n=1046; 59.0% females; median age range: 40-49) completed the Perceived Stress Scale (PSS) (1), a symptom inventory, Beck Depression Inventory (BDI), and the Fatigue Assessment Scale (FAS). Results Compared with existing data (1), sarcoidosis patients scored higher on the PSS (t=23.8, p<0.001). Females scored higher on the PSS than males (t=-4.1, p<0.001). Patients who reported psychological problems also scored higher on the PSS (t=-16.5, p<0.001), while gender and having psychological problems were unrelated to each other. Patients with additional medical diseases also experienced more stress (t=-2.99, p<0.01). Perceived stress correlated 0.62 (p<0.001) with the BDI. When looking at the two subscales of depression, it appeared that perceived stress was more related to the cognitive subscale (r=0.67, p<0.001) than to the physical depression subscale (r=0.42, p<0.001). Conclusion In conclusion, perceived stress plays a role in sarcoidosis. Moreover, especially the cognitive depression subscale was related to perceived stress. 1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983; 24: 385-396.
Psychosocial and Economic Issues in ACCESS
by M Judson; J Steimel; D Rabin; C Rand; G Knatterud; C Rose; D Lackland; ACCESS Research Group
Med Univ of South Carolina; Johns Hopkins Med Center; Georgetown Univ Med Center; Clinical Trials and Surverys Corp; National Jewish Med Center; National
736 sarcoidosis patients were analyzed for the relationship between the clinical severity of sarcoidosis and psychosocial and economic parameters. Lower annual family income and public or no health insurance coverage were strongly associated with increased clinical severity of sarcoidosis at presentation. 706 ACCESS cases and their matched controls had quality of life measured by the MOS SF-36 scale and depression by the CES-D scale. Cases had a marked decrease in quality of life compared to controls. This relationship held after adjustment for age, race, gender, income and education level (sarcoidosis cases 2.67 times more likely, p < 0.001). Sarcoidosis cases also had statistically higher depression scores. The time from the onset of the first sarcoidosis symptom and first physician visit was determined in 189 sarcoidosis. The diagnosis of sarcoidosis was made on the first physician visit on 15.3% of the time. The presence of pulmonary symptoms was associated with a prolonged time until diagnosis (p<0.02) while the presence of a skin lesion was associated with a shorter time until diagnosis (p<0.02). Patients with pulmonary symptoms required more visits (4.84+0.38) compared to those without pulmonary symptoms. The type of physician, patient's race, family income had no effect on the time until diagnosis.
Depression in Sarcoidosis
Examining the Link between Sarcoidosis and Depression
Stress became a leading new idea in psychosomatic theory in the 1950s and Hans Selye emerged as its best known and most effective proponent. Selye was a Vienna-born, Prague-trained physician and biochemist who settled in Montreal in the 1930s and wrote the leading endocrinology textbook in 1947. In 1950 he published a 1,025-page monograph entitled The Physiology and Pathology of Exposure to Stress, in which he elaborated ideas he had been developing since 1936 on what he called the ''General Adaptation Syndrome.'' Selye’s theory was that various ''stressors'' (cold, heat, solar radiation, burns, ''nervous stimuli'') produce a generalized, stereotyped response in the biological organism as it works to ''perform certain adaptive functions and then to reestablish normalcy.'' As the organism automatically mobilizes its defense mechanisms, the hypothalamus (a nerve center at the base of the brain) is excited first. Later, after a chain of effects, the adrenal glands produce ''corticoid'' hormones. Corticoid hormones cause a characteristic set of somatic reactions including the development of gastrointestinal ulcers. Due largely to their synthetic scope, Selye’s ideas swept the field and exerted an enormous influence. As F.L. Engel noted in 1956, ''(Selye’s theory of stress and the diseases of adaptation) has permeated medical thinking and influenced medical research in every land, probably more rapidly and more intensely than any other theory of disease ever proposed.'' The ''stress syndrome'' became even more popular and widely known in the sixties, partly because of its appeal as a replacement for older, increasingly discredited psychoanalytically-based psychosomatic theories and partly due to Selye’s charisma and prodigious output. He published forty books and over 1,700 scientific papers in the course of his career. Selye was frequently quoted throughout medicine, nursing, and other health fields, and his fame spread to the wider culture, a reputation he deliberately cultivated by publishing such books for the general reader as The Story of the Adaptive Syndrome (1952), The Stress of Life (1956 and 1976), and Stress Without Distress (1974). Yet by the 1970s there was discord in the field of stress research as Selye conceived it. Growing confusion and controversy riddled theory and experiment. Some critics blamed Selye for having caused a great deal of it with his conceptual inconsistencies and his shifting and sometimes contradictory formulations.
Good Stress and Bad Stress
Norman Cousins story. ''Anatomy of an Illness''
Russian scientist Ivan Pavlov showed in his classic studies in the 1920s the conditioning effect on dogs. Coupling the food giving with ringing bells, the dogs learned that bells ringing meant food and salivated with this stimulus which per se doesn’t have anything to do with food. Today it is known that when an animal has been given one or more trials on active drug and then been subjected to a saline injection, the animal proceeds to mimic the behavioral or physiological response which was observed after the active drug. Robert Ader and Nicholas Cohen were able to show an immunosuppressive effect on rats in the 1970s through pairing cyclophosphamide with saccharin. Later on they reported of conditioned eczemas in humans induced with a placebo and diminished reaction to tuberculin injection when the spot was preconditioned to saline.
Psychoneuroimmunology by Ader & Cohen .
Neuroendocrinology of stress
A contribution on the neuroendocrine control of the immune system.
We are presently studying the effects of Melatonin in the treatment of chronic refractary sarcoidosis.
We have treated with Melatonin two cases of chronic refractary sarcoidosis unresponsive to long-term steroidal therapy.
A more detailed report on this research has appeared in The Lancet November 4, Vol 346, pp 1229-1230, 1995.
A 34-year-old woman with sarcoidosis since 1990 had steroid treatment for 16 month from diagnosis with no improvement of her chest radiograph. Dispnoea was present and FVC was reduced. High-resolution computed tomography (CT) of the lung showed swelling of hilar lymphonodes and a diffuse fibrosis characterised by interstitial reticular parenchymal infiltrates and thickening of bronchial walls. Serum angiotensin-converting-enzyme (ACE) values were increased (180 U/l).
A 20 mg Melatonin daily therapy was started. 4 months later, dyspnoea had disappeared and the chest radiograph showed reduction of the reticular nodulation. Melatonin was continued and a year later a chest radiograph showed no interstitial involvement. In September 1993 Melatonin was tapered to 10 mg daily and discontinued in June, 1994. In January 1995, CT confirmed disappearence of the interstitial involvement and reduction of hilar lymphonodes.
In 1992 Sarcoidosis was diagnosed after a skin biopsy in a 45-year-old woman with reddish nodular papules on her right knee, which spread to her right cheekbone, left ear, and right elbow. Chest radiograph showed interstitial nodules; exertional dyspnoea was present; after a nine months steroidal therapy the patient did not improve: lung CT showed swelling of hilar lymponodes and micronodular and nodular interstitial images. ACE concentrations were increased. After treatment with 20 mg Melatonin daily for 5 months, the skin lesions were almost completely cleared, and dyspnoea reduced.CT scan showed disappearence of lymphonodes swelling and interstitial thickening.
Resolutions of symptoms and radiological findings of these two cases of chronic sarcoidosis, previously unresponsive to steroid treatment, suggests that Melatonin might be a useful treatment. There were no side-effects. Further studies on acute sarcoidosis and on more patients with chronic sarcoidosis are needed to validate our observations.
Matteo L. Cagnoni
Dept of Dermatology University of Siena, Italy,
Via Bolognese 178, 50139, Florence, Italy.
Melatonin as immunoregulatory agent
Stress and other disorders
Psychophysiology of Stress in Dermatology
Stress of spaceflight produces marked effects on several parameters of immune responses?
Physiology, Gravity, and Space