| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
BOOK REVIEWS |
Psychoneuroimmunology: Stress, Mental Disorders, and Health
Karl Goodkin and Adriaan P. Visser
reviewed by Charles L. Raison and Andrew H. Miller
Fundamentals of Psychoneuroimmunology
C. Song and B. E. Leonard
reviewed by Lucile Capuron, Jane F. Gumnick, and Andrew H. Miller
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1639 Pierce Dr., Suite 4000, Atlanta, GA 30322, Email: amill02@emory.edu
Karl Goodkin and Adriaan P. Visser
American Psychiatric Press, Progress in Psychiatry Number 59, Washington, DC, 444 pages, 2000
Strengths: Well written, details research methodology and limitations of the field, comprehensive discussion of HIV dementia.
Weaknesses: Derived from a 1993 symposium with insufficient update.
Target reader: Investigators of brain-immune system interactions, especially as these relate to HIV.
One gets a certain nostalgia reading through Psychoneuroimmunology: Stress, Mental Disorders, and Health, edited by Karl Goodkin and Adriaan Visser. This is a book full of natural killer cells and mitogen-stimulated lymphocytes and stress and its immunosuppressive effect on illness. There is little attention to current concerns of the field, such as the behavioral effects of cytokines, the role of inflammatory intracellular second-messenger systems on neuroendocrine functioning, or ways in which inflammatory processes integral to medical illness may contribute to the pathophysiology of depression and other mental conditions. Goodkin and Visser’s book, although recently published, harkens from a simpler time in a field that has both exploded and imploded since the papers that comprise this book were originally presented at an American Psychiatric Association meeting in 1993. Indeed, this book reads as if it had been dug up from a time capsule, largely untouched by developments subsequent to the mid-1990s. This is reflected not only in the book’s subject matter and theoretical orientations, but also in the footnotes. It is rare to see a reference more recent than the mid-1990s, with the vast bulk of citations reflecting work done before the conference that spawned this book in 1993. Thus, a significant weakness of this book is that it may be of primarily historical interest for workers in the field of psychoneuroimmunology, offering a frozen-frame vision of what was state-of-the-art in 1993 rather than a cutting edge exploration of immune-brain interactions.
In general, this volume is at its best when not presenting specific data, but rather in what might be called its "philosophical asides" in which the book’s contributors examine meta-issues. These, while articulated in the mid-1990s, remain pertinent today, especially in the area of behavior and immunosuppression. Especially valuable in this regard is the first chapter in which Keller, Schleifer, and colleagues sketch an admirably cogent review of the relationship between stress, variously defined, and changes of in vitro measures of immune functioning. They conclude that the evidence supports a consistent relationship between stress, and related conditions, and immune system changes but come to this conclusion only after reviewing confounding variables. These factors range from definitions of stress and differences in laboratory techniques to the complications of extrapolating from the test tube to real life immune changes. Interestingly, their cogent critique of the field foreshadows concerns that have helped shift psychoneuroimmunology away from an exclusive focus on behavior-mediated immunosuppression. Their conclusion that "the current state of psychoneuroimmunology research literature can be characterized as one of many disparate findings uncomfortably existing side by side with very little theory to integrate these findings" is as valid now, unfortunately, as it has been in the past. This chapter would serve admirably as a review of the immunosuppression literature for an introductory class at the undergraduate or even medical school level.
After this excellent first chapter, other contributions tend to be more hit or miss. For example, the article by Feaster and colleagues that comprises chapter 6 provides a very readable and useful review of methodological issues in conducting stress-immune system research, as well as an unusually in-depth discussion of various statistical niceties involved in this type of research. However, the remainder of the chapter focuses on a lengthy discussion of a single study completed in the early 1990s. This study, although interesting, is characteristic of many using HIV-infected individuals before the advent of medications sufficiently powerful to complicate analysis of the effect of stress on that illness. A general review of the literature on stress and HIV, including the longitudinal work of Lesserman and colleagues, would be more valuable to the reader.
Other highlights of the book include insightful discussions of the complicated relationship between in vitro and in vivo immune measures by Stein and Spiegel and an intriguing discussion of the effect of circadian patterns on immune measures commonly used to assess stress effects.
Several chapters appear quixotic in the larger context of psychoneuroimmunological research. A lengthy chapter by Visser and colleagues on cervical cancer is of interest only to specialists in cervical cancer because the discussion does not generalize in a meaningful way to larger issues relevant to the field. It also presented data that were admittedly described as "pilot" in the early 1990s. A similarly disease-specific chapter, authored by Wilkie and Goodkin, details phenomenology of HIV dementia. This chapter is more successful as a credible review of the subject, although outdated, but is slightly skewed when considered as an introduction to the following chapters on stress and HIV.
In addition to a central focus on HIV infection and other chapters thus far mentioned, the book examines issues involved in the therapeutic use of proinflammatory cytokines (again without reference to recent findings) and the effectiveness and immune effects of stress management in bereavement. The book concludes with a very brief review of the potential roles of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis in regulating the immune system.
Taken as a whole, Psychoneuroimmunology: Stress, Mental Disorders, and Health does not live up to the vast scope claimed in its title. It will be read with more enjoyment if viewed as a modest and somewhat dated account of work evolving out of several laboratories whose interests lie primarily in the effects of stress on immune measures that might worsen disease outcomes.
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1639 Pierce Dr., Suite 4000, Atlanta, GA 30322, Email: amill02@emory.edu
C. Song and B. E. Leonard
J. Wiley & Sons, New York, 2000, 285 pages
Strengths: Covers major areas of psychoneuroimmunology related to psychiatric diseases, excellent chapter on animal models relevant to PNI research.
Weaknesses: Text not referenced, bibliographies largely out-dated, chapters do not follow logical progression.
Target readers: Neuroscientists, psychiatrists
The exciting new field of psychoneuroimmunology (PNI) explores the complex interrelationship of brain and immune system. Data supporting meaningful neuroimmune interactions have grown exponentially over the past several decades, and the time has come to apply findings of PNI to the understanding of the pathophysiology of disease. Fundamentals of Psychoneuroimmunology by Cai Song and Brian Leonard is one in a series of recent reviews of the field; however, in contrast to the other volumes, this book provides a timely emphasis on the relevance of PNI to neuropsychiatric disorders.
The book begins with a brief historical overview of mind-body interactions followed by an introduction of fundamental concepts of PNI (Chapter 2). An overview of the immune response precedes a review of bi-directional communication between neurotransmitters/hormones and the immune system. Chapter 2 also introduces the relatively new and compelling concept of "sickness behavior;" a set of behavioral signs and symptoms that accompany immune activation (such as during infection or autoimmune disease). Of special relevance to PNI, these signs and symptoms overlap with the symptoms of major depression, and thus sickness behavior provides a critical segue into the relevance of the immune system to behavioral disorders discussed in subsequent chapters. This chapter, because of its short length and the vast amount of pertinent material to be covered, is necessarily oversimplified. No references are provided in the text for specific statements and the reader must take the information on faith (not a good habit for scientists). The bibliography (more appropriately titled "Suggested Readings") is significantly outdated with no references more recent than 1997. This problem of nonreferenced text and outdated bibliographies recurs throughout the book, leaving the reader with few guideposts for further exploration of topics of interest.
Chapters 3 and 12 (which logically could have been consecutive contributions) detail research methods and models used in PNI, and provide the reader with a primer of methodology pertinent to experimental findings in the field. Topics include biochemical analysis of brain neurotransmitters and metabolites, assays of the immune system, common methods of behavioral analysis and relevant animal models employed to study major psychiatric and neurologic disorders.
Chapter 4 examines the impact of stress on the immune system, an area of inquiry that has provided some of the earliest and most compelling data that document relationships between brain and immune system. Major factors that influence stress-immune interactions are discussed including characteristics of the stressor as well as the stressed individual; issues of age and gender are highlighted. Although hormonal mediators of the immunologic effects of stress have been extensively examined, the review of these mediators is not presented in a logical fashion. An example is the lack, until the summary of this chapter, of any cogent discussion of the pivotal role of corticotropin releasing hormone in stress-induced immune suppression.
Several chapters consider the role of PNI in depression, schizophrenia, anxiety disorders, Alzheimer’s disease, and autoimmune disorders. Despite some overlap and redundancy in these chapters, readers will find many intriguing clues as to possible roles of the immune system in the behavioral manifestations for each of these diseases. Sufficient detail is provided in these chapters to stimulate further inquiry, yet none is sufficiently comprehensive enough to stand alone as a review of any disorder. Chapter 13, "Psychoneuroimmunology of HIV infection and chronic fatigue syndrome" is the weakest offering in the book. The field of PNI in HIV research is ever changing with important recent findings that psychosocial factors significantly influence disease outcome. No HIV reference more recent than 1993 is cited. Readers are advised to go elsewhere (see accompanying review), if their primary interests are in PNI and HIV.
Appearing from nowhere, in Chapter 11, is an intriguing discussion of the possible role of the thymus gland in neuroimmune interactions. The authors provide a thought-provoking presentation of the consequences of thymic involution and/or thymectomy to the regulation of mood. Yet another chapter of interest is the one related to polyunsaturated fatty acids and psychiatric disorders. This addition is especially timely in that there is recent clinical data regarding the efficacy of omega 3 fatty acids in bipolar disorder.
The book closes with chapters addressing the impact of drugs of abuse on the immune system and sigma receptors. There is no logic to the appearance of these contributions at this point in the book, but again, although not comprehensive, interesting tidbits are provided to stimulate an appetite for additional exploration. However, the reader will have to go elsewhere for more detailed information.
In summary, Fundamentals of Psychoneuroimmunology, despite its noted flaws, is a thought-provoking book that catalogues many possibilities regarding the contribution of the immune system to psychiatric disorders. In a field where it is time for the "rubber to meet the road," this contribution forces one to consider the inclusion of the immune system into any comprehensive understanding of the pathophysiology of disease.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
