Breakdown in Human Adaptation to ‘Stress’ Volume II: Towards a multidisciplinary approach

The widespread interest in "stressful" aspects of contemporary society which contribute to its burden of illness and diseases (e.g. gastro intestinal, cardiovascular) has led to a large number of state- ments and reports which relate the manifestations to a maladaptation of the individual. Furthermore, recent research suggests that under some condi tions stress may have a more generalized effect of decreasing the body IS ability to combat destructive forces and expose it to a variety of diseases. Breakdown in adaptation occurs when an individual cannot cope with demands inherent in his environment. These may be due to an excessive mental or physical load, including factors of a social or psychological nature and task performance requirements ranging from those which are monotonous, simple and repetitive to complex, fast, decision-taking ones. Experience shows however that not all people placed under the same condi tions suffer similarly, and it follows that to the social and psychological environment should be added a genetic factor influencing, through the brain, the responses of individuals. It is clear that, besides human suffering, this "breakdown in adaptation" causes massive losses of revenue to industry and national heal th authorities. Thus a reduction in "stress", before "breakdown" occurs, or an improvement in coping with it would be very valuable.

Table of Contents:
3 — PsychoNeuroImmunoLoGy and Breakdown in Adaptation: Interactions Within The Central Nervous System, The Immune and Endocrine Systems.- Immunology for nonimmunologists: some guidelines for incipient psychoneuroimmunologists.- Neuroendocrine interactions with brain and behaviour: a model for psychoneuroimmunology ?.- Psychoneuroimmunology.- Emotions, immunity and disease: an historical and philosophical perspective.- Immunoglobulins as stress markers ?.- Problems of clinical interdisciplinary research — investigation into bronchial asthma as a paradigm.- Factors involved in the classical conditioning of antibody responses in mice.- The bone marrow, our autonomous morphostatic “brain”.- Immune regulation of the hypothalamic — hypophysial — adrenal axis: a role for thymosins and lymphokines.- Stress and immune response: parameters and markers.- 4 — Breakdown in Human Adaptation and Gastrointestinal Dysfunction: Clinical, Biochemical and Psychobiolo- Gical Aspects.- The brain and the gut.- The role of psychiatric assessment in the management of functional bowel disease.- Application of psychological measures in epidemiological studies of gastrointestinal disease: a critical opinion.- Stress-related nicotine abuse and disorders of the gastrointestinal tract.- Use of quantitative methods for the study of psychological factors in ulcer patients.- Stress, the immune system and GI function.- Clinical recognition of stress related gastrointestinal disorders in adults.- Stress and inflammatory bowel disease (IBD).- Upper GI bleeding lesions related to- or associated with- stress.- 5 — Acute Effect of Psychological Stress on Cardiovascular System: Models and Clinical Assessment.- I. Systems Interplay in Stress Response.- Need for clinical models:physiopathological versus epidemiological study.- Psychosocial stress: endocrine and brain interactions and their relevance for cardiovascular processes.- Hormonal response to acute stress: focus on opioid peptides.- II. Myocardial Infarction Clinical Studies.- Emotional stress and heart disease: clinical recognition and assessment.- Possibilities and limitations of longterm studies on the effect of psychological stress on cardiovascular function.- Interaction between short- and long-term stress in cardiovascular disease.- Clinical clues of neuro-humoral interpretation of the genesis of coronary spasm.- Provocative testing for coronary spasm.- Hemodynamic characterization of different mental stress tests.- Experimental studies.- Thoracic autonomic nerves regulating the canine heart.- Nervous coronary constriction via ? -adrenoreceptors: counteracted by metabolic regulation, by coronary ? -adrenoreceptor stimulation or by flow dependent, endothelium-mediated dilation.- III. Cardiac Arrhythmias Clinical studies.- Clinical clues to psychological and neuro-humoral mechanisms of arrhythmogenesis.- Clinical clues and experimental evidence of the neuro-humoral interpretation of cardiac arrhythmias.- IV. Arterial Hypertension Clinical Studies.- Blood pressure control during mental stress.- Somatic responses to acute stress and the relevance for the study of their mechanisms.- Neurohumoral factors involved in the pathogenesis of hypertension.- Experimental studies.- Results of experimental studies favouring the hypothesis of the influence of stress on the genesis of hypertension.- Animal models for the assesment of stress on arterial blood pressure.- V. Methods.- Validation and quantification of mental stress tests, and their application to acute cardiovascular patients.-Methods and limits for the detection of the response of coronary circulation to acute stress.