Fever stress induced
Psychogenic fever: how psychological stress affects body temperature in the clinical population
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Psychogenic fever: how psychological stress affects body temperature in the clinical population
. 2015 Jun 3;2(3):368-78.
doi: 10.1080/23328940. 2015.1056907. eCollection 2015 Jul-Sep.
Takakazu Oka 1
- 1 Department of Psychosomatic Medicine; Graduate School of Medical Sciences; Kyushu University ; Fukuoka, Japan.
- PMID: 27227051
- PMCID: PMC4843908
- DOI: 10.1080/23328940.2015.1056907
Free PMC article
Takakazu Oka. Temperature (Austin). .
Free PMC article
. 2015 Jun 3;2(3):368-78.
doi: 10.1080/23328940.2015.1056907. eCollection 2015 Jul-Sep.
Takakazu Oka 1
- 1 Department of Psychosomatic Medicine; Graduate School of Medical Sciences; Kyushu University ; Fukuoka, Japan.
- PMID: 27227051
- PMCID: PMC4843908
- DOI: 10.1080/23328940. 2015.1056907
Psychogenic fever is a stress-related, psychosomatic disease especially seen in young women. Some patients develop extremely high core body temperature (Tc) (up to 41°C) when they are exposed to emotional events, whereas others show persistent low-grade high Tc (37-38°C) during situations of chronic stress. The mechanism for psychogenic fever is not yet fully understood. However, clinical case reports demonstrate that psychogenic fever is not attenuated by antipyretic drugs, but by psychotropic drugs that display anxiolytic and sedative properties, or by resolving patients' difficulties via natural means or psychotherapy. Animal studies have demonstrated that psychological stress increases Tc via mechanisms distinct from infectious fever (which requires proinflammatory mediators) and that the sympathetic nervous system, particularly β3-adrenoceptor-mediated non-shivering thermogenesis in brown adipose tissue, plays an important role in the development of psychological stress-induced hyperthermia. Acute psychological stress induces a transient, monophasic increase in Tc. In contrast, repeated stress induces anticipatory hyperthermia, reduces diurnal changes in Tc, or slightly increases Tc throughout the day. Chronically stressed animals also display an enhanced hyperthermic response to a novel stress, while past fearful experiences induce conditioned hyperthermia to the fear context. The high Tc that psychogenic fever patients develop may be a complex of these diverse kinds of hyperthermic responses.
Keywords: emotional fever; fever of unknown origin; human; psychogenic fever; stress; stress-induced hyperthermia.
Prominent psychogenic fever observed in…
Prominent psychogenic fever observed in a 15-year-old schoolgirl. She was referred from a…Figure 1.
Prominent psychogenic fever observed in a 15-year-old schoolgirl. She was referred from a pediatrician to my outpatient clinic because she repeatedly developed antipyretic drug-resistant fever of unknown causes. I asked the patient to record her axillary temperature (Ta) using an electrothermometer 4 times a day (8 a.m., 12 a.m., 4 p.m., and 8 p.m.) and the events of the day in a “fever diary” to better understand mind (stressor)-body (temperature) relationships. I also asked her mother and school nurse to make sure the temperature she recorded was accurate. The fever diary demonstrated that she developed a high Ta up to 39°C only on the days when she went to school (underlined black bar). (Unpublished observation.)
Chronic psychological stress-associated, persistent low-grade…
Chronic psychological stress-associated, persistent low-grade high axillary temperature (Ta) observed in a 56-year-old…Figure 2.
Chronic psychological stress-associated, persistent low-grade high axillary temperature (Ta) observed in a 56-year-old head nurse. She had antipyretic drug-resistant, low-grade (37–38°C) high Ta for more than 3 months. © Japanese Society of Psychosomatic Internal Medicine. Reproduced by permission of Japanese Society of Psychosomatic Internal Medicine. Permission to reuse must be obtained from the rightsholder.
Effects of indomethacin ( A…
Effects of indomethacin ( A ), diazepam ( B ), and SR59230A (…Figure 3.
Effects of indomethacin (A), diazepam (B), and SR59230A (C), on social defeat stress-induced hyperthermia in rats. Rats received an intraperitoneal injection of indomethacin, a cyclooxygenase inhibitor (5 mg/kg), diazepam, an anxiolytic drug (4 mg/kg), SR59230A, a β3-adrenoceptor antagonist (5 mg/kg), or their respective vehicles at the time point indicated by arrows and were subsequently exposed to social defeat stress (Stress) or left undisturbed (Control) during the period indicated by the horizontal bars. © John Wiley and Sons. Reproduced by permission of John Wiley and Sons. Permission to reuse must be obtained from the rightsholder.
Possible mechanisms of psychological stress-induced…
Possible mechanisms of psychological stress-induced hyperthermia in comparison with infectious fever. Infectious fever…Figure 4.
Possible mechanisms of psychological stress-induced hyperthermia in comparison with infectious fever. Infectious fever is induced by warmth-seeking behavior and shivering thermogenesis of the skeletal muscles, as well as sympathetic nerve-mediated non-shivering thermogenesis in brown adipose tissue and peripheral vasoconstriction. The HMS axis is known to mediate both sympathetic activation and shivering. In contrast, the brain region responsible for warmth-seeking behavior is currently unknown. Evidence suggests that neither the POA nor the DMH mediate warmth-seeking behavior. Infectious/inflammatory fever is accompanied with elevated acute-phase proteins such as CRP and sickness behavior. By contrast, psychological stress increased Tc without accompanying sickness-related symptoms because it increases Tc via cytokines and PGE2-independant manner. So far, it is not known how psychological stress activates the DMH neurons to increase Tc or how the POA and other brain regions are involved in the psychological stress-induced hyperthermia. BAT, brown adipose tissue; CRP, C-reactive protein; DMH, dorsomedial hypothalamic nucleus; HMS, hypothalamic-medullary-sympathetic; IML, intermediolateral cell column; IL, interleukin; Mϕ, macrophage; PG, prostaglandin; POA, preoptic area; rRPa, rostral raphe pallidus nucleus; Tc, core body temperature. Reprinted from Advances in Neuroimmune Biology, Vol 3, Oka T, Oka K, Mechanisms of psychogenic fever, Pages 3-17. © IOS Press. Reproduced by permission of IOS Press. Permission to reuse must be obtained from the rightsholder.
Possible mechanisms for enhanced psychological…
Possible mechanisms for enhanced psychological stress-induced hyperthermic response in chronically stressed rats. BAT,…Figure 5.
Possible mechanisms for enhanced psychological stress-induced hyperthermic response in chronically stressed rats. BAT, brown adipose tissue; SNS, sympathetic nervous system; Tc, core body temperature, UCP1, Uncoupling protein 1.
Effects of stress interview on…
Effects of stress interview on core and peripheral temperatures in a 26-year-old CFS…Figure 6.
Effects of stress interview on core and peripheral temperatures in a 26-year-old CFS patient. Changes in axillary (armpit) and tympanic membrane (tym.) temperatures (A) and fingertip temperature (B) during and after a 60-minute stress interview. Stress interview was conducted for one hour (0 min – 60 min). © BioMed Central. Reproduced by permission of BioMed Central. Permission to reuse must be obtained from the rightsholder.
Inhibitory effects of tandospirone, a…
Inhibitory effects of tandospirone, a 5-HT1A receptor agonist, on the axillary temperature (Ta)…Figure 7.
Inhibitory effects of tandospirone, a 5-HT1A receptor agonist, on the axillary temperature (Ta) and severity of fatigue in a 30-year-old woman with psychogenic fever. Vertical lines show axillary temperature (black line) and fatigue level (dotted line, with numerical rating scale in which 10 represents the most severe fatigue imaginable and 0 represents none). (A) Before the treatment (August 5th), (B) After tandospirone treatment Sep. 9th, and (C) After tandospirone treatment Sep. 18th. The patient started to take tandospirone, a 5-HT1A agonist, 30 mg from Sep. 2nd and 60 mg from Sep. 9th. © Japanese Society of Psychosomatic Internal Medicine. Permission to reuse must be obtained from the rightsholder. Before the treatment, as her Ta induced 0.5°C increased from 36.8°C to 37.3°C, her fatigue level increased remarkably from 4 to 9. She asked for the treatment of her low-grade fever hypochondriacally (A). However, after the treatment with tandospirone, she became less concerned about her low-grade fever, when although her Ta increased from 36.8°C to 37.3°C, her fatigue level increased from just 1 to 2 (B). Her Ta did not exceed 37°C (C).
Fever and fatigue chart recorded…
Fever and fatigue chart recorded by a 24-year-old patient with chronic fatigue syndrome…Figure 8.
Fever and fatigue chart recorded by a 24-year-old patient with chronic fatigue syndrome and fibromyalgia syndrome. She worked as a telephone operator, a sedentary job. This chart tells that her axillary temperature is higher on the workday than on a day-off, showing that “workday hyperthermia” and the increase in axillary temperature is associated with increased fatigue. Reprinted from Advances in Neuroimmune Biology, Vol 4, Oka T, Influence of psychological stress on chronic fatigue syndrome, Pages 301-9. © IOS Press. Reproduced by permission of IOS Press. Permission to reuse must be obtained from the rightsholder.
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Olivier B. Olivier B. Temperature (Austin). 2015 Aug 3;2(3):324-5. doi: 10.1080/23328940.2015.1071701. eCollection 2015 Jul-Sep. Temperature (Austin). 2015. PMID: 27227037 Free PMC article.
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Neural circuit for psychological stress-induced hyperthermia.
Nakamura K. Nakamura K. Temperature (Austin). 2015 Oct 12;2(3):352-61. doi: 10.1080/23328940.2015.1070944. eCollection 2015 Jul-Sep. Temperature (Austin). 2015. PMID: 27227049 Free PMC article. Review.
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A neurologist reported an influx of patients with "psychogenic fever" amid the pandemic stress.
medical editor Ekaterina Evchenko
According to Turgunkhuzhaev, doctors of medical centers are noticing an influx of patients who complain of fever up to 37.4 in the evening. Mostly they are middle-aged people who did not get sick or had COVID-19with a "clean" CT scan of the lungs and tests that did not reveal systemic inflammation. According to the doctor, this condition may be caused by the phenomenon of psychogenic fever, which was described in detail by Takakazu Oka, a Japanese specialist in psychosomatic conditions.
This is a hyperthermic reaction of the body to mental stress, which is most often not accompanied by mental disorders and does not depend on the patient's consciousness. In rare cases, the temperature can reach 41 degrees, but mostly psychogenic hyperthermia is characterized by a temperature of 37-38 for weeks, months, in rare cases - several years, after an acute traumatic situation, without a significant reaction to antipyretic drugs.
In his work, Takazu Oka distinguishes two principal mechanisms for the formation of elevated temperature: caused by infection and not caused by infection, writes Turgunkhuzhaev.
“Everything is clear with the first one. There is an infection, or its systemic display in blood counts, look for, treat. With the second, everything is not very clear, especially if the patient has neither clinical nor hormonal reasons for hyperthermia. And if we omit all the diagnostic search that can be applied to the patient, then it is worth remembering about one more condition that can cause a rise in temperature. Psychogenic, stress-induced, functional hyperthermia is a common cause of fever of unknown cause in a situation where there is no evidence for a systemic inflammatory response,” writes Oybek Turgunkhuzhaev.
Treatment of this condition consists in prescribing the correct anti-anxiety or antidepressant therapy, or identifying psychological triggers that should be excluded from avoidance.
Turgunkhuzhaev stressed that the psychogenic fever was described by scientists as scientists, and also against the backdrop of a pandemic.
“Many of us have already experienced such a state. For example, during a session, or while talking about a very uncomfortable and stressful event in your life, being at an unloved job, the doctor said.
He advised his colleagues to openly discuss with patients the likelihood of their developing functional hyperthermia due to stress, show them scientific articles and, if necessary, refer them to a psychotherapist or psychiatrist.
Comments Cackl e
Tachycardia is one of the most common heart rhythm disorders. The main mechanism for the development of pathology is to increase the automatism of the sinus node. In this case, the heart rate increases to more than 90 beats per minute. Tachycardia may not have subjective manifestations. Most often it is felt as an increased heartbeat. In the presence of pathologies of the cardiovascular system, this type of arrhythmia can worsen the general condition and provoke the development of complications. Therefore, the treatment of tachycardia should be prescribed and strictly monitored by a specialist.
Causes of tachycardia
Increased or increased heart rate does not always mean that there are problems with the cardiovascular system. For example, in preschool age, it is considered the norm and does not require special assistance. Symptoms of tachycardia of the heart can also appear in practically healthy people as a result of the activation of physiological compensatory mechanisms, that is, as a response of the body to the influence of one or another external factor. The reaction of the nervous and cardiovascular systems, accompanied by the release of adrenaline into the blood, causes an increase in heart rate. The occurrence of tachycardia can be provoked by the following factors:
- stress, exercise and emotional arousal;
- increase in ambient air temperature;
- use of caffeinated drinks, alcohol, certain drugs;
- abrupt change in body position, etc.
When the provoking factor stops, the heart rhythm gradually returns to normal.
However, tachycardia often accompanies the presence of certain pathological conditions. It can be a manifestation of various cardiovascular diseases - arterial hypertension, myocardial infarction, heart disease (rheumatic or congenital), cardiosclerosis, etc. In addition, tachycardia can be neurogenic in nature, that is, it can be associated with disorders of the autonomic nervous system and brain. Other causes include fever, which develops against the background of an infectious and inflammatory process (pneumonia, tonsillitis, etc. ).
Symptoms of the disease
For tachycardia, which is a sign of a disease, the following symptoms are characteristic.
- Feeling interruptions and / or "failures" in the work of the heart - the most common manifestations.
- Shortness of breath (shortness of breath) that occurs with little exertion or even at rest.
- Pain in the region of the heart (accompanying an attack of tachycardia in vegetative-vascular dystonia and some other diseases).
- Dizziness and darkening of the eyes, pre-syncope and even fainting (this is due to a violation of the blood supply to the brain).
In general, the manifestation of clinical symptoms of tachycardia depends on the nature of the underlying disease, as well as on the severity and duration of the arrhythmia itself.
Consequences of tachycardia
Physiological tachycardia, which occurs in healthy people even in the presence of severe subjective manifestations, does not pose a threat to life and has a good prognosis. In patients with heart disease, the consequences can be quite serious. The main and severe complications are the development of heart failure, loss of consciousness and even sudden death. In addition, the presence of tachycardia increases the risk of blood clots, which in turn leads to frequent heart attacks and stroke. Therefore, timely assistance with tachycardia is so important.
Diagnosis of tachycardia
ECG plays a leading role in the differential diagnosis of tachycardia and helps to identify its causes. This method allows you to determine the type of pathology, as well as rhythm and heart rate. With an increase in the severity of symptoms of cardiac tachycardia, it is advisable to conduct daily Holter ECG monitoring. This method is highly informative. It allows you to identify and analyze any heart rhythm disturbances within 24 hours. Holter monitoring helps to detect ischemic changes during normal physical activity.
It is a standard examination method that allows to exclude heart pathology in case of any rhythm disturbances. Thanks to echocardiography, the doctor receives data on the size of the chambers of the heart, the thickness of the walls of the myocardium, and changes in the valvular apparatus. This examination allows you to identify violations of local contractility.
This is an invasive method for examining patients with cardiac pathology. An electrophysiological study is used with appropriate indications before surgery for the treatment of arrhythmias. Used to diagnose different types of tachycardia in a limited number of patients. This method is reduced to determining the nature of the propagation of an electrical impulse through the myocardium, allowing you to determine the mechanisms of tachycardia or conduction disorders of the heart.
Additional research methods are used to identify the causes of cardiac pathology. The specialist may prescribe a blood test (general and thyroid hormones), electroencephalography. Rarely, an MRI of the heart is done, usually to look for congenital abnormalities.
Treatment of tachycardia
Drugs belonging to the following groups are used to treat tachycardia.
- Antiarrhythmic. These are medicines with different mechanisms of action. Only the attending physician can prescribe them, based on clinical data. Self-medication is dangerous, because the same medications can be effective for one type of tachycardia and contraindicated for another.
- Sedatives. These are most often synthetic or herbal products. They are prescribed for the treatment of tachycardia associated with vegetative-vascular dystonia. Such funds help to normalize the functioning of the nervous system and, as a result, reduce the frequency of arrhythmia attacks.
If tachycardia is accompanied by a drop in blood pressure, pressor amines are usually prescribed to raise it to a level of 100-110 mm Hg. Art.
Minimally invasive surgery is a common definitive treatment for tachycardia. It is performed under local anesthesia. This can be radiofrequency catheter ablation, the installation of an artificial pacemaker, etc. Among the main reasons that require serious surgical care are the following.
- Hormonal disorders. Common causes of tachycardia are thyrotoxicosis (too much thyroid hormone) and pheochromocytoma (a hormonally active tumor in the kidney or adrenal glands). In such cases, surgical removal of the neoplasm or the area of the gland that produces excess hormones is usually recommended.
- Structural and functional changes. Cardiac surgery is performed in the presence of gross congenital heart defects, severe circulatory disorders (IBC), to eliminate the consequences of rheumatism, etc.
In some cases, arrhythmia does not require special treatment if it is a symptom of anemia, due to the presence of a malignant blood disease (for example, leukemia), occurs against a background of fever, etc. For tachycardia caused by such causes, the treatment is to eliminate the underlying disease.
Prevention of tachycardia
Timely assistance in detecting tachycardia helps to avoid the occurrence of its attacks in the future. Therefore, it is important, first of all, to consult a doctor who will prescribe the correct treatment. Prevention of this disease consists in its early diagnosis, treatment of cardiac pathology, as well as elimination of the influence of non-cardiac factors that provoke the development of heart rate disorders.
Normalization of nutrition
It is important to limit or completely eliminate the consumption of products containing caffeine, alcohol. Instead of strong coffee or tea, you can drink herbal infusions that have a sedative effect. You should limit the consumption of sweet and fatty foods, follow the principles of a healthy diet. The most correct and useful choice for people suffering from heart disease will be a plant-milk diet. The presence of fruit and vegetable juices in the diet is also important.
Taking vitamins and microelements
To prevent heart palpitations, it is recommended to take magnesium, which regulates the effects of calcium in heart cells. This microelement contributes to the establishment of rhythmic contractions and relaxations of the heart muscle. Potassium is also important for the proper functioning of the body. Please note that all drugs should be prescribed by a doctor based on the causes of the disease and provoking factors.
Sports and reasonable physical activity stimulate the heart and at the same time increase the body's resistance to the release of excess adrenaline. As a result, the general emotional background is normalized, irritability decreases. It is important to strictly dose the load, avoiding overvoltage. Regular and prolonged exposure to fresh air helps to reduce the frequency of occurrence of tachycardia attacks.