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Biomedical subjects

H Weiner

Publications and source records attributed to H Weiner.

At least 325 records · Page 18Linked to original sources
PubMedDate not supplied

LHRH responsiveness in anorexia nervosa: intactness despite prepubertal circadian LH pattern.

Consistent with previous findings, six women with primary anorexia nervosa who underwent 24-hour endocrine studies were all observed to have immature (prepubertal or pubertal) patterns of circadian luteinizing hormone (LH) secretion. This abnormality was present despite negligible weight deficit (but active symptomatology) in three of the women. Regardless of the extent of immaturity of circadian pattern, each woman showed a completely normal release of LH in response to the single intravenous administration of luteinizing hormone releasing hormone (LHRH). These findings provide further evidence for the intactness of pituitary function and for the possibility of a functional hypothalamic disturbance in anorexia nervosa. The discrepant finding in certain other studies of inadequate LH response to LHRH in women with anorexia nervosa is reviewed, and the potential influences of differing variables in these studies and the possibility of a heterogeneous illness are emphasized.

Adolescent↗
PubMedDate not supplied

From simplicity to complexity (1950-1990): the case of peptic ulceration--I. Human studies.

The problem of the psychobiology of human peptic ulceration has become very much more complicated in the past 20 years, once it was realized that it was not one disease but many. It is recognized that 29 different forms exist. Two common but distinct forms of the disease are characterized by elevated or normal levels of pepsinogen-I. In a third form elevated levels of pepsinogen-II occur; however, this particular increase imparts more of a risk by a factor of 3 for gastric than for duodenal ulcer. In the light of such facts, all studies on the psychological characteristics and social contexts that characterize the onset of the disease must be reevaluated. In addition, a number of different pathophysiological disturbances of the regulation of gastric acid secretion, motility, and bicarbonate secretion characterize patients with the disease, and further subdivide patients with increased or normal pepsinogen-I levels.

Duodenal Ulcer↗
PubMedDate not supplied

From simplicity to complexity (1950-1990): the case of peptic ulceration--II. Animal studies.

Considerable progress has been made in the understanding of the formation of gastric erosions in rats. The role of gastric acid secretion in their pathogenesis has been clarified. Gastric erosions are also associated with slow gastric contractions. With several experimental procedures, the body temperature falls; preventing this decrease averts erosions. A fall in body temperature or exposure to cold is associated with the secretion of thyrotropin-releasing hormone (TRH), and both an increase and decrease in corticotropin-releasing factor (CRF) in discrete regions of rat brains. TRH produces gastric erosions, increases in acid secretion, and slow contractions, while CRF has the opposite effects. One of the major sites of interaction of the two peptides is in the dorsal motor complex of the vagus nerve. TRH increases serotonin (5-HT) secretion into the stomach. 5-HT counter-regulates acid secretion and slow contractions. Many other peptides stimulate or inhibit gastric acid secretion.

Animals↗
PubMedDate not supplied

Grief and depression after miscarriage: their separation, antecedents, and course.

Bereavement is a major risk factor for physical illness, grief, depression, and anxiety. In contrast to recent tendencies in the psychiatric literature to equate grief and depression, we propose that a careful discrimination between the two must be made for diagnostic, therapeutic, and investigative purposes. We report the results of a longitudinal study of a frequent but neglected event, miscarriage early in pregnancy, to make this point. Clinical criteria for differentiating grief and depressive reactions were developed based on phenomenological criteria and theoretical considerations. We hypothesized that the detrimental psychological and physical consequences occur only when the miscarriage was not mourned and resulted in a depressive reaction, but not in a grief reaction. In a controlled, representative study, 125 consecutive women were assessed shortly after their miscarriage (before the 20th week of gestation) and 6 months (N = 94) and 12 months (N = 90) later. Assessments included standardized questionnaires for life events, depression, physical complaints, anxiety, and a specific, multidimensional grief scale (Munich Grief Scale) that we had developed previously. Immediately after the miscarriage, the average anxiety and depression scores were elevated when compared with 80 pregnant and 125 age-matched community controls. Twenty percent of the patients who had miscarried showed a grief reaction, 12% showed a depressive reaction, and 20% responded with a combined depressive and grief reaction. The remaining women (48%) reported no changes in their emotional reactions. As predicted, longer-lasting psychological, social, and health status changes followed the initial depressive, but not the grief reactions. Depressive reactions were predicted by a history of previous depression, a lack of social resources, and an ambivalent attitude to the lost fetus. The grief measures were reliable and made it possible to discriminate between grief and depression.

Abortion, Spontaneous↗
PubMedDate not supplied

Immune system changes after the death of a partner in HIV-positive gay men.

The objectives of this study were to determine 1) whether immune changes relevant to HIV progression occurred in HIV-seropositive men after the death of their intimate partner, and 2) whether depressed mood was associated with these immune changes. The bereaved group consisted of 39 gay men whose intimate partners had died of AIDS over the past year; the nonbereaved group consisted of 39 age- and HIV serostatus-matched nonbereaved men. Immunological parameters were assayed from blood samples drawn before and within 1 year after the death of the partner (bereaved group) or over an equivalent time period (nonbereaved group). In the HIV-seropositive bereaved men only, a significant increase in immune activation and a significant decrease in the proliferative response to phytohemagglutinin occurred after the death of the partner. These immunological changes were not explained by the use of recreational drugs, alcohol, cigarettes, or AZT. These data indicate that the death of an intimate partner in HIV-positive men is associated with immune changes that are relevant to HIV progression.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Psychological and immunological reactions of family members to patients undergoing bone marrow transplantation.

The authors' goal was to evaluate the impacts of patients' bone marrow transplant (BMT) on their spouse/partner's (subjects) psychological and immunological status at four key points in the course of their transplant. Subjects' (N = 24) psychological and immunological status was prospectively evaluated at four key points in the patient's BMT which included: at patients' admission to hospital and 0-, 20-, and 34-day intervals after BMT infusion. Psychological variables examined included: a) general psychological distress and negative affect; b) tendency to respond in a socially desirable manner; c) state negative affect; and d) coping style, specifically if escape-avoidance coping was used. Immune variables examined included: percentages of total T cells and of CD4+, CD8+ cells, B cells, and natural killer (NK) cells, and NK cytotoxicity. Greatest abnormality in immune variables was detected before the initiation of BMT (i.e., between admission and day 0) with normalization between days 21 and 34 thereafter. During the waiting period before BMT, the subjects had the highest scores on negative affects, escape-avoidance coping, and psychological symptoms. These progressively declined after the BMT procedure. Significant correlations were found among trait anxiety, escape-avoidance coping, and total percentage of T cells and of CD4+ cells. Escape-avoidance coping was reliably correlated with percentage of B cells. The greatest psychological and immunological impacts on spouse/partners of BMT patients were found in the period directly after hospital admission and before BMT infusion. Alterations in immune values occurred in anticipation of BMT in the spouse/partners. Psychological symptoms followed this same pattern, being most elevated before BMT and decreasing in the successive evaluations post-BMT for the spouse/partners. The most significant and consistent psychological variable in predicting immune changes was escape-avoidance coping, with less escape-avoidance coping predicting better immune functioning.

Adaptation, Psychological↗
PubMedDate not supplied

Use of animal models in peptic ulcer disease.

Considerable progress has been made in the understanding of the formation of gastric erosions by the use of animals. The role of gastric acid secretion in their pathogenesis has been clarified. Gastric erosions are associated with the presence of acid in the stomach and slow gastric contractions. With several different experimental procedures, the animal's body temperature falls; preventing the fall averts erosions. A fall in body temperature or exposure to cold are associated with the secretion of thyrotropin-releasing hormone (TRH), and both increased and decreased concentration of corticotropin-releasing factor (CRH) in discrete regions of rat brains. Thyrotropin-releasing hormone when injected into specific sites in the brain produces gastric erosions and increases acid secretion and slow contractions, whereas CRH has the opposite effects. One of the major sites of interaction of the two peptides is in the dorsal motor complex of the vagus nerve. Thyrotropin-releasing hormone increases serotonin (5-HT) secretion into the stomach. Serotonin counter-regulates acid secretion and slow contractions. Many other peptides injected into discrete brain sites stimulate or inhibit gastric acid secretion.

Animals↗
PubMedDate not supplied

Notes on an evolutionary medicine.

OBJECTIVE: Medicine does not have a comprehensive theory of health, ill-health, and disease. Its explanations of disease are firmly rooted in pathological anatomy brought about by infection, intoxication, trauma, and mutations in genes. Because medical concepts have been influenced mainly by classical physics, it is mechanistic, materialistic, deterministic, reductionistic, linear-causal, and strongly biased toward proximate explanations of disease. Of late, many thoughtful persons have attempted to provide medicine with a more comprehensive theory that integrates the documented roles of physical, social, environmental, and psychological factors in the etiology and pathogenesis of ill-health and disease (eg, Refs. 1-3). METHOD: Until very recently (4), no one has clearly pointed out that such a comprehensive theory should be guided by the concepts of evolutionary and organismic biology. Darwin's great theory states that evolution is "driven," but not exclusively so, by natural and sexual selection. Natural selection acts on variants that differ in adaptive capacities. Those capable of adaptation survive to reproduce. Failure to adapt reduces reproductive fitness and success, and leads to injury or death. But this formulation could be expanded to regard ill-health and disease as adaptive failures, whereas health usually may be conceived of as equivalent to adaptive success. Adaptations are determined by many factors-genetic, morphological, physiological, and behavioral. Selective pressures are many and varied. However, social primates are at a selective advantage, and are among the most successful species and varieties. Social behavior (eg, support) seems to enhance the chances of survival and reproductive fitness. Physiological (immunological, metabolic, cardiovascular) and behavioral adaptations are geared specifically for interactions with the environment. Emotions have evolved as ways of matching physiological responses with environmental demands and signaling the organism's state. RESULTS: This study will review aspects of evolutionary theory that would lead to a unified, integrated theory of health, illness, and disease, and to a clearer taxonomy in medicine.

Adaptation, Psychological↗
PubMedDate not supplied

Praise be to psychosomatic medicine.

OBJECTIVE: To celebrate the 60th anniversary of the publication of Psychosomatic Medicine, a review of its first 45 years of existence was performed to highlight the conceptual, methodological, and scientific advances made. METHOD: A very selective overview of key articles was made to illustrate the evolution of concepts and to document scientific progress. CONCLUSION: Psychosomatic Medicine has published important contributions to the development of an integrative theory of medicine.

History, 20th Century↗
PubMedDate not supplied

[Psychological factors of non-ulcer dyspepsia].

Given the absence of any demonstrable organic reason for non-ulcer dyspepsia, and the well known fact, that the psyche influences stomach function, it is widely held, that psychological factors cause NUD. To now, studies are concerned with the psychopathology and personality of NUD-patients, their illness behaviour, and with the relation between stress and abdominal pain. A critical review of these studies revealed, that among the psychological variables mainly anxiety and illness behaviour seems to play a central role in NUD. However, future studies should focus more on the distinction towards other functional disorders and on the differentiation within the heterogeneous group of NUD-patients (especially with regard to physiological variables). Besides this, it seems rewarding to examine the so far scientifically neglected group of subjects with abdominal pain, who do not contact a physician.

Abdominal Pain↗
PubMedDate not supplied

[The organism in health and disease. On the path to an integrated biomedical model: sequelae of the theory of psychosomatic medicine].

Traditional Western biomedicine emphasizes changes in structure as explanations of disease, that are produced by single causes. It seeks to understand the proximate, molecular mechanisms of disease. The consequences of this line of thought are varied and many, and are not the purpose of this essay. Psychosomatic medicine research has always been more concerned with a broader and more integrated perspective in health, illness and disease. It has attempted to study and understand persons in terms of the behaviors of interacting systems - the physiology of the organism. In the past 20 years a language has evolved that speaks of the organism's functions in dynamic, time-related terms. Both phenomenologically and mathematically functions can be described in terms of rhythms which with disease undergo change. Each function has its own characteristic features (amplitude, frequency and form) it is frequency modulated. These rhythms are the product of oscillators, and/or positive and negative or mixed feedback systems. When perturbed they undergo changes in features. Many rhythms (e.g. circadian ones) are under environmental control, or are entrained by the environment and by social relationships.

Animals↗
PubMedDate not supplied

Nonobesity at the time of mastectomy is highly predictive of 10-year disease-free survival in women with breast cancer.

25 unselected women with operable breast cancer were followed after radical mastectomy until they died of recurrent cancer (non-survivors), or for 10 years if there was no recurrence (survivors): all the women still alive at 10 years were clinically and radiographically disease-free. Survivors and non-survivors were compared with respect to premastectomy height, and deviation from ideal weight. There were 16 women in the survivor group; at the time of mastectomy, they averaged 11% above ideal weight and only 4 of them (25%) were obese (20% or more above ideal weight). There were 9 women in the non-survival group; they averaged 51% above ideal weight at the time of mastectomy and all of them were obese, as defined. The intergroup difference in mean deviation from ideal weight was very highly significant (P less than 0.0001). Of the 13 women who were obese at mastectomy, only 4 (31%) became survivors, while 100% of the 12 women who were non-obese at mastectomy became survivors; the difference in percent survival was very highly significant (P less than 0.005). Separate evaluation of the roles of height and weight showed that height was not a factor and weight accounted entirely for the observed differences. It appears that maintenance of nonobesity may be a more effective way of decreasing mortality from breast cancer than any other measure proposed to date.

Adult↗
PubMedDate not supplied

[Assessment of grief exemplified pregnancy loss: development and initial results on the validity of the Munich Grief Scale].

Bereavement research is hampered conceptually by confounding of grief and depression, methodologically by a lack of generally agreed-upon measures. Therefore we developed the Munich Grief Scale (MGS) based on the Perinatal Grief Scale (PGS, Potvin et al. 1989) and results from a previous study. Validation included comparisons with standardized self-report scales of depression, anxiety and physical symptoms. It was based on a follow-up study of 125 patients who had miscarried and 3 comparison groups who either suffered from a miscarriage or a stillbirth. Self-reports were compared to expert ratings of grief and depression. The MGS is a economical, reliable self- and expert rating scale after pregnancy loss. The applicability of the grief measures to other kinds of bereavements remains to be determined.

Abortion, Spontaneous↗
PubMedDate not supplied

[Is the "biopsychosocial model" a helpful construct?].

In 1977, G. L. Engel proposed a biopsychosocial model, applicable to all illness and disease. It was based on systems theory which orders the world into a ladder (of systems) from the most elementary particles to social phenomena and the cosmos. Systems theory was proposed to combat reductionism and to deal with complexity and order. Central to that theory is the concept of emergence that the properties of each "higher" or more complex system are not explainable either by their components nor by those at a lower level. However, no one form of complexity exists. Some forms of complexity arise out of the interactions of the components, especially as the result of feed-back, which in turn allows us to understand order, and sudden change. Living systems are characterized by genetic programs, self-replication, self-organization and adaptability. These properties exist at every "level", and thus make systems theory and its hierarchies no longer necessary, and also eliminate the concept of emergence.

Adaptation, Psychological↗