Page 16 - JCBP-2-2

Journal of Clinical and
Basic Psychosomatics Allostatic overload in the medically ill

off. If the response to stress fails to disengage or shut at the Headache and Clinical Pharmacology Center of the
1,2
off at the right moment, allostatic load may ensue. If Academic Hospital Careggi (Florence, Italy) and described
1,2
subjects also perceive that environmental challenges in details elsewhere. 16
exceed their abilities to cope with the situation, allostatic The inclusion criteria for this study were (i) age ≥18 years
overload (AO) arises. AO implies an overuse of stress and (ii) a diagnosis of blood cancer (i.e., lymphocytic or
3
systems in a dysregulated manner, which leads to myeloid leukemia, non-Hodgkin’s lymphoma, Hodgkin’s
4
systemic inflammations and worsening of physical and lymphoma, and myeloproliferative neoplasm diagnosed
5,6
mental health. 3,5,6 AO has specific biological and clinical by hematologists based on blood tests, bone marrow
7,8
signatures. The first were analyzed via biological markers examination, and imaging tests) or systemic sclerosis
9
(e.g., resting systolic and diastolic blood pressure, body (according to the 2013 ACR/EULAR classification
mass index, plasma C-reactive protein, and cortisol). The criteria) or migraine (according to the International
8
19
latter were incorporated in the Diagnostic Criteria for Classification of Headache Disorders). 20,21 The only
Psychosomatic Research-Revised (DCPR-R), which refer exclusion criterion was the evidence of cognitive deficits
10
to AO when an identifiable source of distress in the form of or problems affecting the ability of reading, understanding,
life events and/or chronic stress exceeds individual coping and following the study assessment process.
skills and when clinical manifestations of distress and/or
impairment in social or occupational functioning and/in Patients gave written informed consent and were,
environmental mastery occur. 3,9,10 thereafter, evaluated by trained clinical psychologists
who collected sociodemographic information, data on
The relationship between stress and medical disease is
rather complex and passes through AO. Medically ill pharmacological and nonpharmacological treatments, and
4,10
on the clinical history of organic diseases via an ad hoc
patients are more likely to report AO compared to those set of questions already used in the past. The following
16
without a medical disease. 6,11,12 DCPR-R AO has been assessment instruments were administered: the Mini
observed with a relative high rate among outpatients International Neuropsychiatric Interview (MINI) or
22
with hypertension (32.50%), congestive heart failure the Structured Clinical Interview for DSM-5 Disorders,
13
(32.9%), essential hypertension and coronary heart Clinical Version (SCID-5-CV) and the Semi-Structured
14
23
disease (11.2%), migraine (29%), fibromyalgia (25%), Interview for the DCPR-R (DCPR-R-SSI). 10
17
15
16
and in primary care (15%). Medically ill patients with
18
DCPR-R AO showed significantly higher rates of mental Data collection from patients recruited at S. Chiara
disorders and psychosomatic syndromes, 13,15 compared to Hospital (Pisa, Italy) was approved by the Ethical
15
those without AO as well as higher levels of psychological Committee of the Tuscany Region (Area Vasta Nord Ovest
distress and lower levels of well-being and quality of life. 13 – CEAVNO, protocol number: 20097), and data collection
14
from patients recruited at the University Hospital Careggi
The present study aimed at examining DCPR-R AO
among subjects with different chronic or life-threatening (Florence, Italy) was approved by the Ethical Committee
medical diseases (i.e., blood cancer, systemic sclerosis, of the Tuscan region (Area Vasta Centro – CEAV,
and migraine) to verify whether (i) the three clinical protocol numbers: 11633_spe; 16425_spe). All procedures
contributing to this work were conducted in compliance
populations differ in terms of DCPR-R AO prevalence with the ethical standards of the relevant national and
and (ii) medically ill patients with or without DCPR-R AO institutional committees on human experimentation and
differ in terms of specific clinical features (i.e., co-occurring with the 2013 revision of the Helsinki Declaration of 1975.
mental disorders or psychosomatic syndromes).
2.2. Instruments
2. Methods
The Mini International Neuropsychiatric Interview was
22
2.1. Participants and procedure used among subjects with a diagnosis of blood cancer
This was an observational, cross-sectional study or systemic sclerosis. The MINI is a short, widely used
involving outpatients with a diagnosis of blood cancer structured interview allowing to formulate diagnoses
consecutively recruited from July 2021 to August 2023 at of most common mental disorders and suicidality in
the Hematological Unit of the S. Chiara Hospital (Pisa, Diagnostic and Statistical Manual of Mental Disorders
Italy); outpatients with a diagnosis of systemic sclerosis (DSM) and International Classification of Diseases. It was
consecutively recruited from June 2020 to October 2022 designed to meet the need for a short-structured psychiatric
at the Rheumatology Unit of the Academic Hospital interview for multicenter clinical trials and epidemiological
Careggi (Florence, Italy); and outpatients with a diagnosis studies and to be used as a first step in outcome tracking
of migraine recruited from September 2016 to May 2018 in non-research clinical settings. It has 11 modules

Volume 2 Issue 2 (2024) 2 https://doi.org/10.36922/jcbp.2758