This paper reviews experimental contributions published in the last two decades and exploring the effect of emotional stress on neuroendocrine function in healthy humans. Laboratory studies allow standardization of the stressor and better control for known confounding factors. Commonly used stressors are mental arithmetics, speech tasks, the Stroop test, videogame playing, films or videotapes and interviews. Little is known about the generalizability of laboratory results, with some studies suggesting great caution in extrapolating data to real-life stress conditions. Another strategy is studying the psychoendocrine reaction to real-life stressors, such as bereavement or anticipated loss, academic examinations, everyday work and parachute jumping. The effects of different stressors on neuroendocrine axes are reviewed, as well as the influence of gender, age, personality, coping style, social support, biological and nonbiological interventions. The subjective perception of the situation is probably a main determinant of the psychoendocrine response pattern. In fact, marked variability in individual responses to a variety of stressors has frequently been observed. Evidently, the ‘objective’ characteristics of a given event are not the only determinants of reaction to the event itself. According to a constructivistic perspective, every given stressor has a strictly personal and idiosyncratic meaning and loses its ‘objective’ characteristics. Of course, biological factors may also play a part. In any case, it is mandatory to overcome a rigid dichotomy between psychological and biological processes. Dualistic conceptions which imply a determination of the physical by the psychological or vice versa should give place to a systemic conception, which implies mutual, circular interactions.

Background: The effects of having a child with Autism Spectrum Disorder (ASD) on parents are multifaceted and pervasive. While ample evidence has been provided that these families are under severe stress, there are still several knowledge gaps and unresolved questions.Objective: This study aimed at quantifying the subjective and objective burden of ASD in mothers and fathers, and at improving the understanding of the interplay between parental burden, child’s characteristics, and parents’ coping resources and strategies.Methods: The parents of 359 children/adolescents with ASD were compared to parents of age-matched patients with Down syndrome (N=145) and Type 1 diabetes mellitus (N=155). Child’s clinical characteristics and parents’ caregiving burden, psychological distress, coping resources and strategies were assessed.Results: The parents of children with ASD reported higher objective and subjective burden, more frequent psychological distress, lower social support. Mothers reported greater subjective burden than fathers. Structural equation modeling showed that the most consistent positive and negative predictors of objective and subjective burden were ASD symptom severity and social support, respectively. Other positive predictors were engagement, distraction and disengagement coping, intellectual disability, and adaptive functioning. Other negative predictors were spiritual wellbeing and hardiness. Some effects were indirect through social support and coping strategies.Conclusion: This study confirmed that parents of children with ASD carry a huge caregiving burden, and added to our understanding of the factors associated with burden. The findings may help inform the design of effective interventions aimed at reducing burden among the parents of children with ASD.

The possibility of a causal influence of emotional stress, especially of stressful life events, on the course of various skin diseases has long been postulated. Clinical wisdom and experience, as well as many anecdotal observations and uncontrolled case series, support this opinion. We reviewed the available evidence on the role of stressful life events in triggering or exacerbating skin diseases. The role of stressful events in vitiligo, lichen planus, acne, pemphigus and seborrhoeic dermatitis was either controversial or insufficiently explored. The role of stressful events in psoriasis, alopecia areata, atopic dermatitis and urticaria was apparently clearer. However, only a few studies met acceptable methodological standards for stress measurement. Also, few studies considered common potential confounding factors (e.g. age, duration of illness, familial factors), and no study controlled adequately for the influence of other crucial factors (e.g. discontinuation of treatment, seasonal effects). Adding that the large majority of studies were retrospective, it seems wise to conclude that only preliminary evidence has been published so far on the role of stressful life events in bringing on or worsening any dermatological disease. Further research is mandatory, either in the form of prospective studies or, more feasibly, of well-designed case-control studies with adequate statistical power. Future studies should also pay more attention to protective as well as vulnerability factors in stressful events. Further, it would be important to investigate other sources of psychological stress, such as chronic stress and everyday stress. Measuring stress appraisal, although difficult, would also be important.

UNDERSTANDING and enhancing patient compliance with physician-prescribed treatments are relevant aspects of medical care. In fact, poor compliance with medications may lead not only to negative health outcomes for the patient but also to wasting of economic resources. Previous studies have shown that 30% to 70% of patients affected by a long-standing diagnosis of a chronic disease have poor medication adherence.^1,2 Richards and colleagues² have reported that among patients with a chronic skin disease, such as psoriasis, 39% had not complied with treatment regimens prescribed by the dermatologist.