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      Relationship of Stressful Life Events, Anxiety and Depression to Hyperthyroidism in an Asian Population

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          Background: Psychological disturbances are well-known disorders in patients with hyperthyroidism, with anxiety and depression being the most commonly described. Stressful life events may play an important role in the relationship of anxiety, depression and hyperthyroidism. We assessed the associations of these disorders by three-part rating scales, including the Hamilton Rating Scale for Anxiety (HAM-A) indicating anxiety, the Zung Self-Rating Depression Scale (Zung Scale) indicating depression and the Social Readjustment Rating Scale (SRRS) indicating external stress from life events in this study. Methods: Eighty-six outpatients who visited an endocrine clinic with suspicion of thyroid disease and 18 healthy volunteers were enrolled in the study. In all of these individuals, thyroid functions were assessed and questionnaires were completed during an interview. Results: The outpatients with hyperthyroidism (n = 39) had higher scores of HAM-A (15.7 ± 1.1 vs. 8.0 ± 0.8, p < 0.001), Zung scale (46.2 ± 1.5 vs. 37.5 ± 1.4, p < 0.001) and SRRS (92.9 ± 13.5 vs. 56.9 ± 8.4, p = 0.015) than those with euthyroidism (n = 47). The scores of the three-part rating scales were also higher in the outpatients with hyperthyroidism than in healthy volunteers (n = 18), with no significant differences between the outpatients with euthyroidism and healthy volunteers. Conclusion: In patients with hyperthyroidism, anxiety, depression and stressful life events were more severe than in those with normal thyroid function. There were no correlations between these psychological disorders and thyroid function tests of the subjects with hyperthyroidism. The role of psychotherapy in the development of hyperthyroidism deserves further investigations.

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          Most cited references 10

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          Stressful life events and major depression: risk period, long-term contextual threat, and diagnostic specificity.

          Although stressful life events (SLEs) play a major role in many etiologic theories of major depression (MD), important questions remain about the nature of their association with the onset of depressive episodes. We assessed over the last year, in female twins ascertained from a population based registry, the occurrence of 15 classes of SLEs and the onset of DSM-III-R MD and 2-week generalized anxiety disorder (GAD). The sample contained 24,648 person-months, 316 onsets of MD, and 239 onsets of GAD. SLEs were rated on long-term contextual threat and dependence. Discrete time-survival analyses were employed. The association between SLEs and depressive onsets was usually strongest in the month of occurrence but extended for "difficulty-like" events for up to 6 months. The depressogenic effect of SLEs was strongly predicted by contextual threat level, although some low threat events significantly increased risk for MD. The risk for a depressive onset given the number of reported SLEs within one month was: no event, 0.9%; one, 3.4%; two, 6.8%; and three, 23.8%. Although a few events were relatively specifically depressogenic or anxiogenic, most SLEs increased risk for both MD and GAD. The risk period produced by SLEs range from short-lived to relatively prolonged. High threat events encompass most but not all of the depressogenic effects of SLEs. Multiple SLEs in the same month substantially increase the risk for a depressive onset. The specificity of most SLEs for depressive versus anxiety syndromes is modest.
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            Psychoneuroimmunology: interactions between the nervous system and the immune system

             R Ader,  N. Cohen,  D. Felten (1995)
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              Relationship between the number and impact of stressful life events and the onset of Graves' disease and toxic nodular goitre.

              In the last few decades, several studies have suggested a possible association between Stressful Life Events (SLEs) and the onset of Graves' Disease (GD). However, others have criticised this association and it has not yet been possible to prove it unequivocally. At present, we are not aware of studies correlating SLE and non autoimmune thyrotoxicosis. To assess possible associations between SLEs, the onset of GD and the onset of non autoimmune thyrotoxicosis (toxic nodular goitre, TNG). A case-control retrospective study. This study included 93 subjects, divided into three groups of 31 each: GD, TNG and control (CG). The GD and TNG patients had thyroid disease diagnosed within the last 12 months, with clinical and biochemical confirmation. In the CG, psychopathological and endocrine disturbances had been ruled out. All three groups consisted of nine males (29%) and 22 females (71%). The mean age was 38.4 +/- 10.9 years in the GD group, 48.3 +/- 11.1 years in the TNG group and 41.1 +/- 11.8 years in the CG group. SLEs were evaluated (number and impact) for the 12 months preceding the onset of symptoms of thyroid disease. SLE occurrences and their impact on each group of cases were measured. To assess SLEs, we used the Life Experiences Survey (LES). Our statistical analysis included descriptive techniques and parametric and/or nonparametric comparative tests. P 0.01). GD had a higher impact of positive SLEs than TNG (P = 0.004), and no significant differences were found between the GD group and CG. Neutral SLEs were similar in the three groups. These results suggest that SLEs are a precipitating factor of the onset of GD. We also demonstrated that SLEs do not seem to have any conclusive relationship with the onset of TNG.

                Author and article information

                Horm Res Paediatr
                Hormone Research in Paediatrics
                S. Karger AG
                19 November 2003
                : 60
                : 5
                : 247-251
                aDivision of Endocrinology and Metabolism, Department of Internal Medicine, and bDepartment of Medical Education and Research, Taichung Veterans General Hospital; cChung Shan Medical University; dNational Defense Medical Center; eNational Yang Ming University, and fDepartment of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
                74039 Horm Res 2003;60:247–251
                © 2003 S. Karger AG, Basel

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                Page count
                Figures: 1, Tables: 2, References: 32, Pages: 5
                Original Paper


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