Preoperative Emotional States and Adrenal Cortical Activity

Abstract

Although it is widely accepted that the central nervous system is involved in the regulation of secretion of pituitary adrenocorticotropic hormone (ACTH), little is known of the relationships between specific emotional responses and the release of ACTH. Since the pituitary-adrenal system is generally stimulated under conditions in which the integrity of the organism is threatened, it might be expected that fear or anxiety most likely would be associated with increased ACTH release and subsequent increased secretion of adrenocortical hormones.Some studies have been made of both psychological and endocrine factors in human subjects during grossly threatening life situations. 1,2,4,8,13 As in other, previous studies, the initial hypothesis in this study of patients about to undergo cardiac or pulmonary surgery was that there would be a close relationship between the degree to which a patient was anxious and the plasma levels of his adrenocortical hormone. Attempts were made to predict this hormone level on the basis of the extent to which a patient, awaiting major surgery, was anxious. However, exploratory experience indicated that, although energy and affect are mobilized in a person to meet such stressful situations, the observable af-Institute of Research, made suggestions and contributions to this project. feet which correlated with adrenal hormone levels was not always anxiety. It was found that a number of emotional states in a heightened form were associated with ele¬ vated adrenal steroid hormone levels. This included such states as hostility, agitated de¬ pression, apprehension, etc., with the excep¬ tion of withdrawn depression.* From the data obtained, it appeared that what was crucial in studies of this kind was the evaluation of the amount of general emotional involvementf that a person had in a given situation, and not merely the degree to which he demonstrated "anxiety." Emo¬ tional involvement was considered the in¬ vestment of active feeling by the subject at the time in a direct interaction with a person or persons.It is suggested that the pituitary-adrenocortical system may be associated with a number of emotional states, which seem to have a common component of emotional involvement. This component may be a relatively broad, undifferentiated state un-* The depression to which we refer is the flat, resigned, apathetic type, and not one of agitation or intense grief. Both the latter forms of depression have highly active emotional involvement components.\ s=d\ It is hoped that the term "emotional involvement" will be descriptively self-explanatory. What we have in mind are things such as the impression of the observer that the interaction pattern which the subject tries to engage in or set up with other persons is characterized by directness, intensity, all-or-none qualities, and immediacy. These may be demonstrated through any modes of communication, i. e., verbal, gestural, or autonomic manifestations, with emphasis on the immediacy and directness of the emotional involvement.

Psychological Aspects of Pain Patient Treatment

“…The role of an invalid in pain makes very clear what patterns of behaviors they are allowed to assume, and also what behaviors can be excluded without criticism from others.14 A by-product of this change is that the expectation of society for the sufferer to engage in constructive, wage-earning work is nullified, and hence the patient is freed from many burdensome social responsibilities that he might normally have diffi¬ culty meeting. 3. Emotional and attentional needs of the sufferer are met.…”

Psychological Adjustment Following Open-Heart Surgery

“…"There was no significant predictable correlation between preoperative psychological assessment and the incidence of postoperative behavioral disorders. " Price, et al (1957), concurred with this conclusion in their study in which, on the basis of psychiatric interviews, they concluded that no characteristic manner of psychological adaptation was evident in the assessment of post-operative behavioral reactions.…”

“…, 1955;Giller, 1962;Coodley, 1961;Corman, et al_. , 1958;Moore, 1960;Price, et al , 1957;Hackett and Weisman, 1960;Meyer, 1958;Greenspan, et al , i960;Scott, 1961). The considerable advantages of having potential access to the individual prior to the stress experience, having an accurate medical record of the nature of the experience plus having occasion to observe clinically and to examine the individual in a reasonably controlled environment subsequent to the stress experience make this an unique situation for the study of adjustive reactions to stress.…”

Die Cortisol-Aufwachreaktion bei Patienten mit akuten und chronischen Rückenschmerzen

“…Basierend auf frühen Befunden nimmt Singer mit dem Engagement-Involvement-Ansatz an, dass Bewältigungsformen des "Nonengagement" mit Neigung zu passivem Meiden, Rückzug und Verleugnung erhöhte Cortisolwerte unter Stress vermindern, aktive Bewältigungsformen ("Engagement") dagegen mit erhöhten Cortisolwerten einhergehen [33,39].…”

“…Dessen Vertreter gehen auf Basis früher laborexperimenteller [33,39] und klinischer Studien [29] davon aus, dass eine sog. "Engagement-Nonengagement-Achse" direkt im Cortisolsystem reflektiert wird, wobei passiv-meidende Strategien -hier im Umgang mit Stress -mit verringerten, aktive Strategien dagegen mit erhöhten Cortisolkonzentrationen einhergehen [29,39] …”