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Stress the immune system and psychiatry. Edited by Brian Leonard and Klara Miller. Wiley-Liss New York 1995 238 pp. $48

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2:106-108 (1996)
STRESS, THE IMMUNE SYSTEM, AND PSYCHIATRY. Edited by Brian Leonard and Klara
Miller. Wiley-Liss, New York, 1995.238 pp.,
T h e editors of this timely book on stress and immunity have brought together a group of authors who review both our past and current understanding of the
complex interactions between the brain and the immune system, including questions about future directions for the field of psychoneuroimmunology.
Importantly, this book is aimed a t clinicians, while
many books on this topic are written for immunology
and neuroscience specialists. T h e authors use both
style and content to make research data available in a
manner which will arouse the interest of clinicians who
question the interrelatedness of the mind and body.
Robert Ader contributed the forward to this impressive collection of work, and provides a critical overview of the field of psychoneuroimmunology as only
someone with his historical significance can do. H e
eloquently outlines what we have learned to date
about brain-immune system interactions; however, he
candidly points out that “we are unable to define the
functional significance of the neuroanatomical and
neuroendocrine pathways that have been found to
connect the nervous and immune systems and, on the
other hand, we cannot yet specify the neuroanatomical
or neuroendocrine mechanisms that underlie the functional relationships between behavior and immunity
that have been demonstrated to exist.” Nonetheless,
Ader encourages more thoughtful research from creative clinicians and researchers in the future to provide
answers to the many questions about brain-immune
system interactions. Likewise, the editors have compiled this book in a manner which provides a detailed
review of basic psychoneuroimmunology, including
both pertinent human and animal research, concluding with insights about future research directions.
Adrian J. Dunn contributes the initial chapter which
provides a general historical introduction to psychoneuroimmunology, in which he describes the bidirectional influences of the immune and nervous system
and the role of neurotransmitters, endocrine secretions, and cytolunes and other peptides. H e introduces
and defines the concept of stress and reviews the effects of stress on immune function, including the
evidence for both immunosuppressive and immunoenhancing effects. Similarly, he explains the bidirectional aspect of immune activation and stress, and
postulates on the clinical significance of autoimmunity
and host ability to combat infections and tumors.
Other early chapters provide further basic information on the various components of psychoneuro0 1996 WILEY-LISS, INC.
immunology. Breard, Costa, and Kordon describe the
organization and function of neuroimmune networks
including the concept of paracrine networks, the role
of signaling mechanisms, and the evidence for brain,
endocrine, and immune interactions. Next, Danter
and Mormede elaborate on the influences of stress on
immunity, clarifylng how current models, which describe the relationship between stress and disease, are
interactive and multifactorial rather than simply linear
and unicausal. They draw attention to the need for
more pertinent clinical research to clarify the interactions among variables that have been shown to be
strongly associated with health and illness outcome.
Next, Koolhaas and Bohus provide a review of animal
models of stress and immunity in a chapter that maintains a clinical focus, while documenting the substantial foundation of research data on physical stress,
restraint, electric shock, and social stress models.
Biondi and Pancheri provide a thorough review of
the past two decades of human research studies in a
chapter that outlines the challenges of clinical research
strategies in psychoneuroimmunology and provides a
foundation for the remainder of the book. These authors examine the relevant issues of experimental design, nature of stressors, confounding variables of
immune parameters, psychometric testing, and other
mediating mechanisms. They point out how the conflicting nature of much of the literature and variability
in study design pose obstacles to the drawing of specific clinical conclusions; however, they also clarify
those clinical conditions which have been studied
more rigorously. For example, they describe how
available data suggest that more severe and long-lasting stressors, such as bereavement, are associated with
more persistent and, perhaps, intense alterations of
immunological parameters than acute and less severe
stressors, such as examination stress.
Depression has been one of the most popular clinical conditions studied by psychoneuroimmunologists
both in the lay press and the scientific literature.
Leonard devotes a chapter to an examination of the
immunological aspects of depressive illness. H e not
only reviews the numerous studies which examine immune function in depressed patients, but also he reviews the literature addressing the role of serotonin,
dopamine, noradrenaline and adrenaline, acetylcholine, and opioids in the modulation of the immune
system and the central nervous system. Leonard clarifies the clinical research which integrates the extensive
literature on the role of the hypothalamic-pituitaryadrenal (HPA) axis in depression and those studies
which have addressed the interrelationship of the HPA
axis and immune parameters in depressed patients.
Book Reviews
In subsequent chapters, the relationship of other
clinical conditions to the immune system are described, including schizophrenia, multiple sclerosis,
and food allergies. T h e authors carefully review the
literature to elucidate the possible interrelationships
of the brain and immune system for each of these
illnesses. In the concluding chapter, Rosch offers
thought-provoking direction for future research in
psychoneuroimmunology, including psychoelectroneuroimmunology, a term he coins for the study of
energies generated internally by emotions and intense
mental activities which may influence immune activities. While this latter concept is purely speculative,
Rosch integrates important concepts described earlier in
the book to address the larger arena of psychoneuroimmunology and psychosomatic illness. He specifically
addresses the role of stress and AIDS, tuberculosis,
streptococcal infections and the common cold. H e
eloquently articulates the need for more imaginative
future research by drawing from the creative achievements of such pioneers as Claude Bernard, Walter
Canon, Hans Selye, and Louis Pasteur.
At a time when a topic such as psychoneuroimmunology generates more research than any one investigator can keep up with, this book provides an
important review for clinicians. It is a practical guide
which provides a brief account of both the past and
present work on stress and immunity and translates
relevant findings into clinically accessible information.
Psychiatrists and other mental health professionals
with any interest in the field of psychoneuroimmunology will find this book to be a useful and concise review.
J. Stephen McDaniel
Associate Professor of Psychiatry and Behavioral
Emory University School of Medicine
Atlanta, Georgia
PANIC DISORDER: Clinical, Biological, and
Treatment Aspects. Gregory M. Asnis, M.D., and
Herman M. van Praag, M.D., Ph.D. John Wiley &
Sons, Inc., New York, 1995. 354 pp., $39.95.
The editors of Panic Disorder: Clinical, Biological, and
Treatment Aspects set for themselves a rather lofty goal
(p. 2 ) : “The purpose of this book is to provide, in one
volume, a comprehensive review of what is known
about panic disorder. It has focused on psychological,
clinical, and biological aspects of this anxiety disorder,
providing both clinicians and academicians a resource
to better understand, study, and treat this illness.”
This edited book is presented in three sections and
contains a total of 13 chapters. Part I, “Clinical Aspects
of Panic Disorder,” is comprised of five chapters describ-
ing phenomenology and differential diagnosis (Rathus
and Asnis), the epidemiology (Eaton and Keyl) and genetics (Woodman and Crowe) of panic disorder, its
comorbidity with other psychiatric disorders (Wetzler
and Sanderson), and its relationship to suicidal behavior
(Arnold, Sanderson and Beck). Part 11, “Biologrcal Underpinnings of Panic Disorder,” contains six chapters
covering the relationship of the norepinephrine (Asnis
and van Praag) and serotonin (Kahn et al.) neurotransmitter systems to panic disorder and models of panic disorder based on challenge with caffeine (Uhde), lactate
(Cowley et al.) cholecystokinin (Bradwejn and Koszycki),
and carbon dioxide (Papp and Gorman). Part 111, “Treatment of Panic Disorder,” includes two chapters, one on
somatic treatments (Raj and Sheehan) and one on cognitive-behavioral approaches (Sanderson and Wetzler).
The editors have certainly assembled a cast of characters
with significant expertise in their areas.
How well have the editors achieved their stated goal?
As a clinical psychologist with less than complete knowledge of biochemistry, I may not be the ideal person to
evaluate their success or failure in goal attainment, but I
will try nonetheless. The editors seem to have intended
to communicate primarily with a medical audience and
have assumed that readers possess a fair degree of sophstication in that regard. Not possessing that degree of sophistication myself, I found that I labored through
several of the chapters in the text, most notably in Part
11. I was surprised that the chapter contributors seemed
to put little effort into the definition of terms or the description of procedures that may be foreign to many who
are not intimately involved in biochemistry or neurobiology research. While experienced persons may have no
difficulty and may gain much from their reading, I wonder how much medical students or persons without this
specific background would be able to take from their effort and whether they would persist in their attempts to
understand this rather heady material. O n the other
hand, I did make the commitment to that struggle and
found that I had acquired quite a bit of useful information by the time I got to the end. Within the limits of my
knowledge, it seems that each and every chapter contributor in Part I1 has done a thorough review and analysis of his or her assigned area.
Part I was quite a bit easier to digest, with the exception of the chapter on the genetics of panic disorder, which may be described in the same terms as the
chapters in Part 11. I was generally quite pleased with
the quality of these chapters as well. T h e chapter by
Arnold et al. on panic disorder and suicide stands as
one of the best reviews of this issue that I have had the
pleasure to read, and all other contributors to Part I
have covered their territory well.
The chapters in Part I11 are both of high quality.
While I must leave it to physicians who read the book to
determine whether the recommendations by Raj and
Sheehan are on the mark, I found that chapter to present
a very cogent and user-friendly strategy for the systematic pharmacotherapy of panic disorder. Nonmedical
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miller, immune, liss, system, psychiatry, new, 1995, leonard, klar, york, brian, edited, stress, wiley, 238
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