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Introduction: Self-Help Plus (SH+) is a group-based psychological intervention developed by the World Health Organization for managing stress., Objective: To assess the effectiveness of SH+ in preventing mental disorders in refugees and asylum seekers in Western Europe., Methods: We conducted a randomized controlled trial in 5 European countries. Refugees and asylum seekers with psychological distress (General Health Questionnaire score ≥3), but without a Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) or ICD/10 diagnosis of mental disorder, as assessed with the Mini International Neuropsychiatric Interview (MINI), were randomized to SH+ or enhanced treatment as usual (ETAU). The primary outcome was the frequency of mental disorders with the MINI at 6 months. Secondary outcomes included the frequency of mental disorders at postintervention, self-identified problems, psychological symptoms, and other outcomes., Results: Four hundred fifty-nine individuals were randomly assigned to SH+ or ETAU. For the primary outcome, we found no difference in the frequency of mental disorders at 6 months (Cramer V = 0.007, p = 0.90, RR = 0.96; 95% CI 0.52-1.78), while the difference significantly favored SH+ at after the intervention (secondary outcome, measured within 2 weeks from the last session; Cramer V = 0.13, p = 0.01, RR = 0.50; 95% CI 0.29-0.87)., Conclusions: This is the first randomized indicated prevention study with the aim of preventing the onset of mental disorders in asylum seekers and refugees in Western Europe. As a prevention effect of SH+ was not observed at 6 months, but rather after the intervention only, modalities to maintain its beneficial effect in the long term need to be identified., (© 2021 The Author(s) Published by S. Karger AG, Basel.)

Background: Both medication and psychotherapy are effective in obsessive-compulsive disorder (OCD). However, they both have disadvantages. We aimed at studying the long-term effectiveness of integrated treatment compared with medication alone., Methods: A private practice sample of 20 consecutive patients with OCD (DSM-III-R) who achieved remission or marked improvement [Yale-Brown Obsessive-Compulsive Scale (YBOCS) score < or =10 and Global Assessment of Functioning (GAF) scale score > or =70] after drug treatment (clomipramine or selective serotonin reuptake inhibitors for 12-24 months) with or without concurrent cognitive psychotherapy were followed up. In the integrated treatment group, psychotherapy was started on the second or third visit and was timed to end after medication. Efforts were applied to integrate treatments within a biopsychosocial theoretical framework. As randomisation was not feasible in the study setting, treatment allocation was based on patients' preference. Patients were assessed before treatment, after treatment and at each follow-up contact with the YBOCS, the Hamilton Depression Rating Scale, and the GAF scale. Kaplan-Meier survival analysis was performed on the time to OCD relapse., Results: Of the factors studied (gender, age, duration of disorder, severity of OCD symptoms at baseline), only treatment was associated with outcome. Of 10 patients treated with medication alone, 8 relapsed. Of 10 patients who received integrated treatment, only 1 relapsed. The estimated mean survival time was significantly higher (p < 0.001) in the integrated treatment group (132 months, 95% CI 107-157) than in the medication group (25 months, 95% CI 12-38)., Conclusions: Although our results need confirmation by further, more robust studies, the long-term superiority of integrated treatment over medication alone was large. Patients with OCD might have viable options other than long-term drug treatment., (2005 S. Karger AG, Basel.)

Background: Many short-term trials suggested that the combination of psychotherapy with medication might be more effective than either treatment alone. However, only few studies examined the long-term effectiveness of this combination., Methods: A private practice sample of consecutive patients with DSM-III-R panic disorder with agoraphobia who achieved remission after drug treatment with or without concurrent cognitive-behavioural psychotherapy were followed up. Patients were assessed before treatment, after treatment and at each follow-up contact with the Marks-Sheehan Phobia Scale, the Hamilton Anxiety Rating Scale, and the Hamilton Depression Rating Scale. Kaplan-Meier survival analysis was performed on the time to panic disorder relapse. Cox regression analysis was used to control for the possible confounding effect of factors other than treatment., Results: Of patients who received medication alone (n = 32), 25 (78.1%) relapsed, prevalently (65.6%) during the first year. The estimated mean survival time was 12 months (95% CI 7-17). Of patients who received integrated treatment (n = 21), only 3 (14.3%) relapsed. The estimated mean survival time was 65 months (95% CI 44-86). Treatment was the only variable associated with the occurrence of relapse, with a hazard ratio of 12.6 (95% CI 2.5-63.3) for patients who received only medication., Conclusions: Some methodological limitations, such as treatment allocation by preference, suggest caution in the interpretation of our results. However, the long-term therapeutic advantage of integrated treatment over medication alone was large and independent from known prognostic factors. The long-term effectiveness of integrated treatment should be tested with a randomised controlled trial., (Copyright 2003 S. Karger AG, Basel)

This article reviews research on the role of psychological stress, personality, social support and other psychosocial factors in bacterial, viral and parasitic infections. After 100 years of research on man and animals, psychological stress is considered as a potential cofactor in the pathogenesis of infectious disease. Psychological stress seems able to alter the susceptibility of animals and man to infectious agents, influencing the onset, course and outcome of certain infectious pathologies. Many experiments have identified in neuroimmunomodulation the principal mediator of the alterations associated with conditions of stress. The development of psychoneuroimmunology has fostered in-depth study of the complex relationship between psychosocial factors, the central nervous system, the immune system and infectious disease. Although antimicrobial drugs have certainly remained the basis of all anti-infective therapy, this type of study has already led some authors to propose and experiment protocols of psychological intervention or psychoimmunotherapy in pathologies such as tuberculosis, or herpes simplex virus or human immunodeficiency virus infections. The psychoneuroimmunological approach to infectious diseases will probably grow in importance in the future not only in the setting of research in psychosomatic medicine but also in that of clinical microbiology.

Background: Nineteenth-century physicians working with cancer patients frequently reported that severe emotional losses and grief occurred in some cases before cancer. Research on psychoneuroimmunology seems to reactivate this interest and could give a possible convincing background., Method: We recently observed the case of a 45-year-old woman who developed symptoms of breast cancer (ductal infiltrating carcinoma, T1, N1, M0) 3 years after the loss of her only child. The affection for the child compensated inadequacies of her marriage, which became increasingly unstable. The child died in a dramatic accident at home, while his mother was near him but unable to help., Results: The patient had a moderate genetic-familial risk of mammary cancer. Animal studies strongly suggest that stress, through neuroimmunomodulatory mediatory mechanisms, can significantly affect appearance and progression of mammary cancer. The patient developed long-lasting intense grief, despair and hopelessness., Discussion: We discuss the case from three main standpoints: genetic and risk factors for breast cancer; findings which demonstrated a relationship between stress, neuroimmunomodulation and cancer in animals; data from autopsy studies which found foci of latent breast cancer in 20% of healthy women in the same age range. Stress does not create cancer. However we hypothesize that in this case it could have contributed by the activation of a latent neoplasia and/or by impairing immunosurveillance during a critical life phase.

Tension-type headache (TTH) is an ill-defined nosographic entity. The classification of headaches according to the Headache Classification Committee of the International Headache Society is closer to clinical reality with respect to the past classification. From an aetiopathological standpoint, hypotheses trying to explain primary headache disorders in a unified way are interesting. The treatment of this disorder requires a thorough diagnostic framing, which should take into account its psychosomatic aspects, focusing on the individual patient and his history. In fact, the many studies which aimed at characterising the disorder from a psychological viewpoint are not able to provide generalizable indications. In the same way, as it appears that none of the currently available treatments (drugs, biofeedback and psychotherapy) demonstrates clear superiority over the others, the choice should involve an intervention targeted on those factors which are held to be most important in an individual patient. Finally, as for acupuncture and other physical therapies, although interesting results are reported, these treatments are difficult to assess and should be reserved to particular cases.

The impact of stress and its neuroendocrine correlates on immune function are well established and individual variations could be attributed to modulation by personality characteristics. To assess the influence of everyday life stress and personality on neuroendocrine and immune function, we administered, to 18 healthy adults, the Minnesota Multiphasic Personality Inventory (MMPI) to assess their personality, the State-Trait Anxiety Inventory to measure anxiety, the Reaction Scheme Test to assess their coping reaction style, the Life Events Survey to assess the impact of stressful life events, and the Subjective Stress Questionnaire to assess perceived stress. The endocrine evaluation comprised prolactin, cortisol, and growth hormone plasma levels, while the immunological evaluation assessed T4, T8, and T11 lymphocyte percentages, as well as natural killer cell count and activity. All evaluations were made at baseline and after 8 months. We found a reduction of the T11 lymphocyte percentage to be accompanied by a reduction in the scores of the MMPI scale of Subtle Defensiveness and by an increase in the scores of the Social Introversion Scale. A positive correlation was found between prolactin and T4 lymphocyte percentage. These preliminary data show that some personality and endocrine measures correlate with immune function.