Psychoneuroimmunology: Then and Now

Movement, touch and talk in Norwegian psychomotor physiotherapy

People suffering from musculoskeletal disorders are frequently treated by physiotherapists using a wide variety of therapeutic approaches. In debates over the relative merits of hands-on and hands-off therapies, proponents of hands-off methods have argued that hands-on clinical work turn patients into «passive» recipients. But this is a simplistic proposition. Psychomotor physiotherapy is a Norwegian therapeutic approach characterized by a more or less continuous bodily dialogue combined with talk in examination and treatment sessions alike. Touch is thus a significant part of the ongoing interaction between patient and therapist. Through concrete examples, the article shows how the physiotherapists-using hands-on methods extensively-induce active responses in the patients, aid them to trust their bodies, change dysfunctional habits and become aware of their capacity for handling their health problems. The therapists do this by exploring and molding patients' movements, handling their muscle tensions and encouraging ways of breathing in combination with talk. The examples demonstrate that the body is just as «communicative» as talk itself and how new insights-to patients and therapists alike-can be obtained by juxtaposing verbal and bodily messages systematically. The examples also suggest that the meaning of "touch" varies. Consequently, what touch entails will necessarily inform clinical practice. Combining the theoretical framework of psychomotor therapy with phenomenology, perspectives from neuroscience and insights from the social sciences, the article casts new light on potentials and challenges triggered by the intertwining of talk and bodily handling typical of psychomotor therapy clinical work. A case is made for a view of the body as intrinsically communicative and for a more profound understanding of what not only psychomotor therapy but physiotherapy generally can offer.

A Pilot Study of a Mindfulness-Based Stress Reduction Programme in Patients Suffering from Atopic Dermatitis

Introduction: Patients with atopic dermatitis (AD) have several potential stressors including the symptoms of the disease itself, the stigmatization due to their appearance, and emotional and psychological strain. Psychological factors and stress can trigger and exacerbate the symptoms of skin diseases and there is evidence that stress has a relevant clinical effect on the function of skin cells in vivo. Our objective was to evaluate in a pilot study the feasibility, acceptance, and effectiveness of a Mindfulness-Based Stress Reduction (MBSR) programme in AD patients in a clinical setting. Methods: 10 patients took part in an 8-week MBSR programme, which included, e.g., mindful and conscious awareness of the body and bodywork, and seated meditation. We assessed sociodemographics and disease related variables with standardized measures at predefined time points including Score of Atopic Dermatitis, Patient Oriented Eczema Measure, Dermatology Life Quality Index, Perceived Stress Questionnaire, Freiburg Mindfulness Inventory (FMI), and others. Participants also gave qualitative feedback regarding the effects of the intervention. Results: The mean age was 53.10 years (SD = 15.04), seven patients were female, and disease duration was 36.6 years (SD = 25.5). Calculating pre-post effect sizes (Cohen’s d), the FMI indicated significant improvement in the “presence” and “acceptance” subscales. There was also tendency for less stress. This was confirmed by the qualitative statements of the participants. Conclusions: The MBSR programme is feasible and acceptable for AD patients. Considering the long disease history and the severity of disease burden, the effects of this intervention seem promising as an adjunct to conventional treatments for patients with AD.

Hepatitis B-related hepatocellular carcinoma and stress: untangling the host immune response from clinical outcomes

Chronic hepatitis B virus (HBV) infection is a major public health challenge on the global scale. Affecting hundreds of millions worldwide, HBV is a leading risk factor for hepatocellular carcinoma (HCC). Clinical outcomes from chronic HBV infection are varied and appear to be influenced by a complex and dysregulated host immune response. In turn, much attention has been given to the immunologic response to HBV in an effort to identify host factors that lead to the development of HCC. However, the role of nonimmunologic host factors, such as chronic stress, in HBV-related HCC is poorly defined. Indeed, a growing appreciation for the effects of stress on chronic liver diseases raises the question of its role in chronic HBV infection. In this light, the present review will untangle the roles of key host factors in HBV-related HCC with an emphasis on chronic stress as a viable contributor. First discussed is the interplay of stress, inflammation and chronic liver disease. The host immune response's role as a driver of HBV-related HCC is then reviewed, allowing for a close exploration of the effects of stress on immune function in chronic hepatitis B and as a potential risk factor for HBV-related HCC.

Hereditary angioedema: Assessing the hypothesis for underlying autonomic dysfunction

Background

Attacks of Hereditary Angioedema due to C1-inhibitor deficiency (C1-INH-HAE)are often triggered by stressful events/hormonal changes.

Objective

Our study evaluates the relationship between autonomic nervous system (ANS) and contact/complement system activation.

Methods

Twenty-three HAE patients (6 males, mean age 47.5±11.4 years) during remission and 24 healthy controls (8 males, mean age 45.3±10.6 years) were studied. ECG, beat-by-beat blood pressure, respiratory activity were continuously recorded during rest (10’) and 75-degrees-head-up tilt (10’). C1-INH, C4, cleaved high molecular weight kininogen (cHK) were assessed; in 16 patients and 11 controls plasma catecholamines were also evaluated. Spectral analysis of heart rate variability allowed extraction of low-(LF) and high-(HF) frequency components, markers of sympathetic and vagal modulation respectively.

Results

HAE patients showed higher mean systolic arterial pressure (SAP) than controls during both rest and tilt. Tilt induced a significant increase in SAP and its variability only in controls. Although sympathetic modulation (LFnu) increased significantly with tilt in both groups, LF/HF ratio, index of sympathovagal balance, increased significantly only in controls.

At rest HAE patients showed higher noradrenaline values (301.4±132.9 pg/ml vs 210.5±89.6pg/ml, p = 0.05). Moreover, in patients tilt was associated with a significant increase in cHK, marker of contact system activation (49.5 ± 7.5% after T vs 47.1 ± 7.8% at R, p = 0.01).

Conclusions

Our data are consistent with altered ANS modulation in HAE patients, i.e. increased sympathetic activation at rest and blunted response to orthostatic challenge. Tilt test-induced increased HK cleavage suggests a link between stress and bradykinin production.

Chlorisondamine, a sympathetic ganglionic blocker, moderates the effects of whole-body irradiation (WBI) on early host defense to a live bacterial challenge

There is a growing consensus that long-term deficits in the brain are due to dynamic interactions between multiple neural and immune cell types. Specifically, radiation induces an inflammatory response, including changes in neuromodulatory pro- and anti-inflammatory cytokine secretion. The purpose of this study was to establish that there is sympathetic involvement in radiation-induced decrements early in in vivo immune function host defense. Female, 8-9 week-old C57BL/6J mice were exposed to whole-body irradiation (WBI). There were 8 groups with radiation (0 vs. 3 Gy protons), immune challenge (Escherichia coli) and exposure to the sympathetic ganglionic blocker, chlorisondamine (1 mg/kg weight, i.p.), as independent variables. Ten days post-irradiation, mice were inoculated with E. coli intraperitoneally and sacrificed 90-120 min later. The data suggest that radiation-induced changes in immune function may in part be mediated by the sympathetic nervous system. Briefly, we found that radiation augments the bacteria-induced inflammatory cytokine response, particularly those cytokines involved in innate immunity. However, this augmentation can be reduced by the ganglionic blockade.

Special issue on exercise immunology: current perspectives on aging, health and extreme performance

The aim of this special issue is to highlight outstanding exemplars of empirical research and review papers that reflect the breadth of current developments in exercise immunology. The contributions to this issue are categorized according to four major themes: (1) exercise and immune-aging; (2) the effects of acute exercise on cellular shifts and gene expression; (3) the effects of exercise on immune regulation during stress and disease; and (4) extreme performance and the impact of dietary counter measures on immunity. We discuss the papers appearing in this issue, in accordance with these major themes, and summarize their important contributions to this exciting and expanding field.

"Anatomy of an Illness": control from a caregiver's perspective

Caregivers of loved ones with chronic illnesses experience an uncontrollable challenge with potentially negative behavioral and medical consequences. Extensive research has demonstrated immune and endocrine regulation can be significantly disrupted by negative behavioral factors based on both animal models and human studies. However, fewer studies have focused on how psychosocial interventions might reverse the negative consequences of stressors such as caregiving. The distress of caring for individuals with cancer has only recently begun to receive attention. These interventions addressing caregiver distress are rare overall and caregivers of patients receiving hematopoietic stem cell transplants (HSCT) have received even less attention. HSCT caregivers report feelings of loss of control. Animal studies suggest that control over aversive events can mitigate the negative consequences of stressors. Caregivers of allogeneic HSCT patients for blood cancers must be available 24/7 for three months or longer following stem cell infusion to closely monitor the recipients' health and well-being. Does establishing a greater sense of control have positive impacts on caregivers? A randomized control trial of a cognitive behavioral stress management intervention for allogeneic HSCT caregivers is briefly described. A model of caregiver mental health which may potentially impact the patient's quality of life is proposed. These relationships exist in a complex system that includes genetic influences, sex, social environment, and prior experience. This system fits well within recent formulations of a "complexity science" approach to health and well-being.

Challenges to bonnet monkey (Macaca radiata) social groups: Mother-infant dyad and infant social interactions

The mother-infant dyad is crucial to early development in a variety of species. The complexity of social groupings in nonhuman primates makes this relationship resilient as well as susceptible to early challenges associated with environmental chaos. Quantitative behavior observations of bonnet monkey mother-infant interactions were collected from 28 mother-infant dyads between one and twelve months of age. Social groups were subjected to several prenatal and/or postnatal housing relocations within a single year resulting in two study groups. One group experienced relocations (ATYPICAL, n = 14) and the second group (TYPICAL, n = 14) was conceived and reared in the same location. Behaviors in the ethogram included mother-infant interactions and infant social interactions with other members of the group. Observations between ages of two to four months were analyzed by a mixed model analysis of variance including fixed effects of per and postnatal history (TYPICAL, ATYPICAL), age, and history by age interaction and random effects of mother and infant nested within mother. A significant effect of relocation history was noted on a number of infant behaviors. ATYPICAL infants were out of direct contact with their mother at an earlier age but remained in her proximity. Control of proximity shifted to offsrping in the ATYPICAL group compared to the TYPICAL group. Furthermore, greater social interactions between two and four months of age with other members of the social group as well as the ir mother were observed in the ATYPICAL group. It is suggested that continuous challenge associated with relocation may affect the infant at later developmental ages due to these early differences in ways that are yet unclear.

Immune perturbations in patients along the perioperative period: alterations in cell surface markers and leukocyte subtypes before and after surgery

BACKGROUND

Surgery renders patients susceptible to life-threatening complications, including infections, multiple organ failure, and presumably cancer metastases. Surgery-induced immune perturbations were suggested to contribute to such deleterious effects, but also to facilitate post-injury healing. Preoperative psychological and physiological stress responses may contribute to these immune perturbations, and could thus jeopardize patients even before surgery. The current study assessed the effects of various operations on an array of immune indices during the perioperative period. To qualify immune changes before surgery, patients' immune status was also compared to that of healthy controls.

METHODS

A total of 81 subjects (operated patients and healthy controls) provided up to five daily blood samples during the perioperative period, for assessment of leukocyte subtypes (granulocytes, monocytes, Tc, Th, NK, NKT, CD4+CD25+, CD8(bright)CD4(dim), and B cells) and their surface markers (HLA-DR and LFA-1).

RESULTS

Even before surgery patients displayed immune perturbations, including reduced lymphocyte HLA-DR expression and increased monocyte LFA-1 expression. Following surgery, we recorded a reduction in lymphocyte numbers that was subtype specific, increased granulocyte numbers, and reduced expression of HLA-DR by lymphocytes and monocytes. Finally, no significant associations were found between alteration in leukocyte numbers and cell surface markers (although these indices showed high correlations with other variables), implying differential mediating mechanisms.

CONCLUSION

Several immune alterations are manifested prior to surgery, and contribute to the marked postoperative changes, which are commonly interpreted as immune suppression. We discuss the possible adaptive and maladaptive nature of these perturbations in the context of natural injury, stress, and surgery.

Life stress, negative mood states, and antibodies to heat shock protein 70 in endometrial cancer

Heat shock protein 70 (HSP70), an intracellular chaperone "stress protein," has been identified in the extracellular milieu, where it may exert regulatory effects upon monocytes. HSPs are overexpressed in many cancers and implicated in tumorigenesis. Few studies have examined the relationship between psychosocial factors and HSP levels, particularly in cancer. The purpose of the present study was to examine the relationship between negative psychosocial states (life events stress and negative mood states) and serum concentration of HSP70 antibodies among women with endometrial cancer, the fourth most common cancer among women in the United States. Thirty-six women scheduled to undergo surgery for suspected endometrial adenocarcinoma underwent a psychosocial assessment and peripheral venous blood draw. Life events stress was assessed using an abbreviated version of the Life Experiences Survey; negative mood states were assessed using abbreviated versions of the Structured Interview Guide for the Hamilton Anxiety and Depression Scales and the Profile of Mood States. HSP70 antibody levels were regressed sequentially on life events stress and negative mood variables while controlling for body mass index (BMI) and cancer stage. Results revealed that greater HSP70 antibody concentrations were associated with greater impact of recent negative life events (p=.04), anxious symptomatology (p=.007), depressive symptomatology (p=.03), and total mood disturbance (p=.001) after controlling for BMI and cancer stage. While based on a modest sample size, these preliminary results suggest that larger-scale research exploring the relationships among psychosocial factors and HSP70 in cancer patients may be warranted.

Endogenous extra-cellular heat shock protein 72: Releasing signal(s) and function

Exposure to acute physical and/or psychological stressors induces a cascade of physiological changes collectively termed the stress response. The stress response is demonstrable at the behavioural, neural, endocrine and cellular levels. Stimulation of the stress response functions to improve an organism's chance of survival during acute stressor challenge. The current review focuses on one ubiquitous cellular stress response, up-regulation of heat shock protein 72 (Hsp72). Although a great deal is known about the function of intra-cellular Hsp72 during exposure to acute stressors, little is understood about the potential function of endogenous extra-cellular Hsp72 (eHsp72). The current review will develop the hypothesis that eHsp72 release may be a previously unrecognized feature of the acute stress response and may function as an endogenous 'danger signal' for the immune system. Specifically, it is proposed that exposure to physical or psychological acute stressors stimulate the release of endogenous eHsp72 into the blood via an alpha1-adrenergic receptor-mediated mechanism and that elevated eHsp72 functions to facilitate innate immunity in the presence of bacterial challenge.

Distinct neural circuits reflect sex, sexual maturity, and reproductive status in response to stress in Drosophila melanogaster

Studies in mammalian systems have shown an array of changes in transmitter signaling in diverse brain regions in response to stress, which differ depending on the age and genetic makeup of the animal, as well as the type of stress. Here, we exploit the genetic tractability of the fruit fly, Drosophila melanogaster, a comparatively simple but useful model in which to elucidate conserved components of stress response pathways. We show that structures within the mushroom bodies and central complex, two distinct anatomical regions within the Drosophila brain, modulate behavioral responses to two different environmental stressors. Modification of behavioral output after exposure to these stressors was dependent on the sex, sexual maturity, and reproductive status of the animal. These parameters also affected whether a mutant Drosophila strain carrying specific defects within the mushroom bodies and/or central complex modified its response to stress relative to wild-type flies. Our results suggest that for each population, unique subsets of neurons are recruited into the stress response circuitry and differentially affect locomotor behavior and cardiac function. These data also provide evidence for neural plasticity in the adult insect brain.

Treatment of inflammatory bowel disease: a role for hypnotherapy?

Fifteen patients with severe or very severe inflammatory bowel disease on corticosteroids but not responding to medication received 12 sessions of "gut-focused hypnotherapy" and were followed up for a mean duration of 5.4 years with disease severity being graded as remission, mild, moderate, severe, or very severe. Two patients (13.4%) failed to respond and required surgery. At follow-up for the remaining 13 patients, 4 (26.6%) were in complete remission, 8 (53.3%) had mild severity, and 1 (6.7%) was moderately severe. Quality of life became good or excellent in 12 (79.9%). Corticosteroid requirements dramatically declined with 60% of patients stopping them completely and not requiring any during follow-up. Hypnotherapy appears to be a promising adjunctive treatment for inflammatory bowel disease and has steroid sparing effects. Controlled trials to clearly define its role in this disease area are justified.

Psychosocial influences on immunity, including effects on immune maturation and senescence

Studies investigating the influence of psychosocial factors on immunity played a critical and formative role in the field of psychoneuroimmunology (PNI), and have been a major component of articles published in Brain, Behavior and Immunity (BBI). An analysis of papers during the first two decades of BBI from 1987-2006 revealed three behavior-related topics were most prominent: (1) stress-induced changes in immune responses, (2) immune correlates of psychopathology and personality, and (3) behavioral conditioning of immunity. Important subthemes included the effect of early rearing conditions on immune maturation in the developing infant and, subsequently, psychosocial influences affecting the decline of immunity in the senescent host. The responsiveness of cell functioning in the young and elderly helped to validate the view that our immune competence is malleable. Many technical advances in immune methods were also evident. Initially, there was a greater reliance on in vitro proliferative and cytolytic assays, while later studies were more likely to use cell subset enumerations, cytokine quantification, and indices of latent virus reactivation. The reach of PNI extended from the traditional clinical entities of infection, autoimmunity, and cancer to attain a broader relevance to inflammatory physiology, and thus to asthma, cardiovascular and gastrointestinal disease. There continue to be many theoretical and applied ramifications of these seminal findings. Fortunately, the initial controversies about whether psychological processes could really impinge upon and modify immune responses have now receded into the pages of history under the weight of the empirical evidence.

Mind-body hypnotic imagery in the treatment of auto-immune disorders

For many years Western Medicine has considered the immune system to be separate and independent from the central nervous system. However, significant scientific advances and research discoveries that occurred during the past 50 years have presented additional facts that the immune system does interact with the central nervous system with mutual influence. This article provides a systematic review of the literature on the connection between the brain and the immune system and its clinical implications. It then provides a rational foundation for the role of using hypnosis and imagery to therapeutically influence the immune system. Five case examples are provided with illustrated instructions for clinicians on how hypnosis and imagery may be utilized in the treatment of patients with auto-immune disorders. Suggestions for future research in this field are included.

Personalidade e câncer de mama e do aparelho digestório

Como a literatura indica influência de características de personalidade na formação do câncer, este estudo objetivou verificar se elas seriam gerais ou variariam segundo o tipo de neoplasia. Foram aplicadas entrevistas psicológicas e forma reduzida do TAT em 15 mulheres entre 41 e 60 anos, distribuídas em um grupo de 10 com câncer de mama (CM) e outro de cinco com câncer do aparelho digestório (CAD). Resultados revelaram predominância de organizações de personalidade borderline no grupo CM e neurótica no CAD. Ambos os grupos apresentaram perdas e frustrações antecedendo a doença, clivagem do ego entre razão e afeto, conflitos entre pulsões agressivas e sexuais e com figura materna e predomínio do pensamento operatório, indicando dificuldade de representação psíquica das pulsões. Foram realizadas considerações relativas à importância da psicoterapia com pacientes neoplásicos, auxiliando na construção e fortalecimento da capacidade de simbolizar.

The power of the placebo

The placebo is much more than a control medicine in a clinical trial. The placebo response is the largest component of any allergy treatment and consists of two components: nonspecific effects (eg, natural recovery) and a "true placebo effect" that is the psychological therapeutic effect of the treatment. Belief in the beneficial nature of the treatment is a key component of the true placebo effect, and can be enhanced by factors such as interaction with the physician and the sensory impact of the treatment. Negative beliefs can generate a nocebo effect that may explain some psychogenic illnesses; this is the basis of much research in psychoneuroimmunology. An understanding of the placebo and nocebo effects is important for general allergy practice, and harnessing the power of the true placebo effect is a major challenge to modern medicine.

Imagery in the Clinical Setting: A Tool for Healing

This article addresses the why and how of imagery and its relation with holistic theories. The description of clinical applications, program development, and research demonstrates successful interventions in virtually every area of nursing. Case examples show the profound healing that is experienced by the patient and the nurse simultaneously through this work. Imagery is harmless, is time- and cost-effective, and creates a healing partnership between the nurse and patient.

Immune suppression while awaiting surgery and following it: dissociations between plasma cytokine levels, their induced production, and NK cell cytotoxicity

Surgery may render patients susceptible to life-threatening complications, including infections and later metastases. Suppression of cell mediated immunity (CMI) and perturbations in the cytokine network were implicated in these outcomes. The current study assessed the effects of various surgeries on a wide array of immune indices, and compared patients' pre-operative immune status to that of control subjects. A total of 81 subjects (controls, moderate and major surgeries) provided up to five daily blood samples. Whole blood procedures were conducted within hours of blood withdrawal, assessing NK cell number and cytotoxicity, and plasma cytokine levels and induced production (IFNgamma, IL-6, IL-10, and IL-12). Our findings indicate that surgery reduced NK cell numbers/ml blood, and independently suppressed NK activity per NK cell and per ml blood. Among other perturbations in the cytokine network, pro-CMI cytokine production (IL-12 and IFNgamma) was reduced by surgery. Surprisingly, plasma levels of IFNgamma and IL-6 increased following surgery, while their in vitro induced production showed opposite effects. Patients awaiting surgery exhibited impaired IL-12 induced production and NK activity/ml, and reduced IFNgamma plasma levels. No significant associations were found between NK cytotoxicity and Th1 cytokines, although these indices showed high correlations with other variables. Overall, our findings indicate that patients exhibit impaired immune functions even before operation, which seem to contribute to the evident post-operative immune suppression. In the peri-operative context, induced cytokine production and plasma cytokines levels reflect different processes. Last, we suggest that peri-operative suppression of NK activity is mediated by neuroendocrine responses rather than Th1 cytokines.

Neuroimmunoendocrine circuitry of the ‘brain-skin connection’

The skin offers an ideally suited, clinically relevant model for studying the crossroads between peripheral and systemic responses to stress. A 'brain-skin connection' with local neuroimmunoendocrine circuitry underlies the pathogenesis of allergic and inflammatory skin diseases, triggered or aggravated by stress. In stressed mice, corticotropin-releasing hormone, nerve growth factor, neurotensin, substance P and mast cells are recruited hierarchically to induce neurogenic skin inflammation, which inhibits hair growth. The hair follicle is both a target and a source for immunomodulatory stress mediators, and has an equivalent of the hypothalamus-pituitary-adrenal axis. Thus, the skin and its appendages enable the study of complex neuroimmunoendocrine responses that peripheral tissues launch upon stress exposure, as a basis for identifying new targets for therapeutic stress intervention.

From the brain-skin connection: the neuroendocrine-immune misalliance of stress and itch

Perceived stress has long been allied with disturbances of the dynamic equilibrium established between the nervous, endocrine and immune systems, thus triggering or aggravating disease manifestation. Several common skin diseases are now acknowledged to be worsened by psychological stress, particularly immunodermatoses such as atopic dermatitis, psoriasis, seborrheic eczema, prurigo nodularis, lichen planus, chronic urticaria, alopecia areata and pruritus sine materia. Itch (pruritus) is perhaps the most common symptom associated with a majority of these inflammatory skin diseases, and acute as well as chronic stress perceptions are recognized to trigger or enhance pruritus. A wealth of mediators released systemically or locally in the skin in response to stress increase sensory innervation, upregulate the production of other pruritogenic agents, perpetuate (neurogenic) inflammation and lower the itch threshold. In the present review, we explore recent frontiers in both stress and pruritus research and portray the perpetuation of chronic skin inflammation and itch as a neuroendocrine-immune 'misalliance'. We argue that key candidate molecules of the stress response with strong pruritogenic potential, such as nerve growth factor, corticotropin-releasing hormone and substance P, and mast cells, which may be considered as 'central cellular switchboards of pruritogenic inflammation', need to be further explored systematically in order to develop more effective therapeutic combination strategies for itch management in chronic, stress-vulnerable inflammatory skin diseases.

Adrenergic receptors mediate stress-induced elevations in extracellular Hsp72

Heat-shock protein concentrations in the blood increase after exposure to a variety of stressors, including trauma and psychological stress. Although the physiological function of extracellular heat shock protein remains controversial, there is evidence that extracellular heat shock protein 72 (Hsp72) can facilitate immunologic responses. The signal(s) that mediate(s) the in vivo elevation of extracellular Hsp72 in the blood after stressor exposure remain(s) unknown. Here we report that Hsp72 increases in the circulation via an α1-adrenergic receptor-mediated signaling pathway. Activation of α1-adrenoceptors results in a rapid increase in circulating Hsp72, and blockade of α1-adrenoceptors prevents the stress-induced rise in circulating Hsp72. Furthermore, our studies exclude a role for β-adrenoceptors, glucocorticoids, and ACTH in mediating stress-induced elevations in circulating extracellular Hsp72. Understanding the signals involved in elevating extracellular Hsp72 could facilitate the use of extracellular Hsp72 to bolster immunity and perhaps prevent exacerbation of inflammatory diseases during stress.

Physical sciences and psychological medicine: the legacy of Prof John Dunne

Fifty years ago, on July 13, 1955, Professor John Dunne delivered his presidential address to the annual meeting of the Royal Medico-Psychological Association in Dublin, focussing on the contributions of 'the physical sciences to psychological medicine.' In his address, Professor Dunne discussed (a) the principle of conditioning, and the work of Hans Selye, especially in relation to 'General Adaptation Syndrome' and the role of stress in producing psychosomatic symptoms; (b) cybernetics and the generation of partial models of cerebral functioning, such as Grey Walter's Conditioned Reflex Analogue and the Electronic Delayed Storage Automatic Computer of Cambridge and (c) the development of integrated, holistic models of cerebral functioning, that took account of advances in both physical medicine and psychoanalytic thought. Professor Dunne placed particular emphasis on the importance of basic scientific research and the development of broadly based models of psychiatric care, both of which were to play critical roles in the development of more scientifically-based, bio-psycho-social models of service provision in the decades to follow.