Psychogenic fever: how psychological stress affects body temperature in the clinical population.
Psychogenic fever: how psychological stress affects body temperature in the clinical population.
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DOI：
10.1080/23328940.2015.1056907
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发表时间：
2015-07
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影响因子：
--
通讯作者：
Oka T
中科院分区：
文献类型：
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作者：
Oka T
心因性发热是一种与压力相关的心身疾病，尤其常见于年轻女性。一些患者在经历情绪事件时会出现极高的核心体温 (Tc)（高达 41°C），而另一些患者则在慢性压力情况下表现出持续的低度高 Tc（37–38°C）。心因性发热的机制尚未完全清楚。然而，临床病例报告表明，心因性发热不是靠解热药缓解的，而是通过具有抗焦虑和镇静作用的精神药物，或者通过自然方法或心理治疗解决患者的困难来缓解。动物研究表明，心理压力通过与感染性发热（需要促炎介质）不同的机制来增加 Tc，并且交感神经系统，特别是棕色脂肪组织中 β3-肾上腺素受体介导的非颤抖产热，在心理压力引起的高热的发生中发挥着重要作用。急性心理压力会导致 Tc 短暂、单相增加。相反，重复的压力会诱发预期性体温过高，减少 Tc 的昼夜变化，或全天 Tc 略有增加。长期承受压力的动物也会对新的压力表现出增强的高热反应，而过去的恐惧经历会诱发对恐惧环境的条件性高热反应。心因性发热患者出现的高 Tc 可能是这些不同种类的高热反应的综合体。
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.