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Psychoneuroimmunology: Stress, Mental Disorders and Health.

Whitfield, Charles L. M.D., F.A.S.A.M.

The Journal of Nervous and Mental Disease: February 2002 - Volume 190 - Issue 2 - p 129-130
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Psychoneuroimmunology: Stress, Mental Disorders and Health. Goodkin, Karl, and Visser, Adriaan P. (Eds.) Washington, DC: American Psychiatric Press, 2000. xxiii + 444 pp. $55.00.

This book originated as an extension of a symposium on psychoneuroimmunology (PNI) presented at the 146th annual meeting of the American Psychiatric Association in 1993. Authors updated their presentations and then submitted them as chapters for this book.

I had a mixed reaction to it. On the one hand, some of its chapters provided a bit of potentially useful information to the clinical practice of psychiatry, neurology, and medicine. But unfortunately, most of it rings with academic jargon and detailed animal and research study results and citations. Only 3 of the 11 chapters address “mental health” issues to any degree, and these three present only a little clinically useful information.

The rest of the book is about the psychoneuroimmunologic aspects of cancer and HIV infections. These otherwise scholarly summaries would have been fine in a volume with another title and perhaps published by a medical organization that addresses physical medicine. This book could represent another example of psychiatry trying to make itself appear to be more like general academic medicine.

The first two chapters are titled “Stress, Depression, Immunity, and Health” and “Behavioral States and Immune Responsiveness,” and the fifth chapter “Psychoneuroimmune and Endocrine Effects on Cancer Progression.” These three chapters address evidence indicating that stress and depression are connected to changes in immune function, based on both functional and enumerative measures. Older age appears to be associated with more depressed immune function in the presence of stress and clinical depression. Despite recent advances, the relationships among psychiatric disorders, neurobiology, and immune functioning are still not well understood. For example, major depression has ambiguous and conflicting PNI findings that have not been reproducible.

In perhaps the clearest chapter, Sara Stein and David Spiegel give us some interesting and potentially useful information. For example, there is good evidence that psychologic and social stressors may evoke subtle and powerful perturbations within the PNI cascade. Thus, stress-induced disturbances are likely to influence the rate of cancer progression and overall survival, and the literature suggests that there is a lack of immune and endocrine responsiveness in advanced cancer. Yet, this connection cannot be consistently predictable among individuals. Perhaps the most important finding in the entire book, from my perspective, is that from the data available it is now apparent that social support and emotional expression can, in certain instances, buffer stressor-induced and endocrine changes, and potentially lead to prolonged survival. There is sufficient evidence of stressor- and support-induced modulation of the immune system and of the clinical salience of these effects in modulating the rate of disease progression. Chapter 10, “Bereavement, Immunity, and the Impact of Bereavement Support Groups in HIV-I Infection,” addresses PNI changes in bereavement among HIV-positive people and supports Stein and Spiegel’s observation that social support and emotional expression can buffer PNI changes.

The remainder of the chapter titles include “Cervical Cancer: Psychosocial and Psychoneuroimmunologic Issues,” “Neoadjuvant and Immunostimulation in Oncologic Surgery,” “Longitudinal Psychoneuroimmunologic Relationships in the Natural History of HIV-I Infections: The Stressor-Support Coping Model,” “Cognitive Function in HIV-I Infection,” “Immune Function, Brain, and HIV-I Infection,” “Stress Management and Psychosocial Predictors of Disease Course in HIV-I Infection,” and “Psychoneuroimmunology: Perspectives of an Immunologist.”

I recommend this book for academically oriented medical libraries but not for general hospital libraries or general psychiatrists or physicians. Selected oncologists and AIDS-treatment specialists may find sections useful enough to warrant buying it despite its high price.

Charles L. Whitfield, M.D., F.A.S.A.M.

Institute on Alcohol and Drug Studies

© 2002 Lippincott Williams & Wilkins, Inc.