title: Psychological stress is associated with relapse in type 1 autoimmune hepatitis.
abstract: OBJECTIVE
  The pathophysiological basis of relapse and recrudescence in type 1 autoimmune hepatitis (AIH) is poorly understood. This study examined factors associated with biochemical relapse in type 1 AIH, and specifically addressed whether psychological stress was associated with a relapsing-remitting disease course.
  
  
  METHODS
  A case-control study design was used to analyse 33 patients with AIH followed at the Yale Liver Clinic during a 4-year period. Twenty-two patients with 46 episodes of relapse or recrudescence (cases) and 11 controls in long-term remission were identified during this period. Clinical variables were collected to establish factors associated with relapse. All patients were administered the Social Readjustment Rating Scale (SRRS), a psychological stress questionnaire consisting of 43 weighted life events. Stress is judged to be low when the score is 0-150; mild, 151-200; moderate, 201-300 and major >300.
  
  
  RESULTS
  AST, ALT, prednisone dose and SRRS score were all significantly different between cases and controls. The mean SRRS score for cases with relapse/recrudescence was 239 vs 152 for the control group, P=0.048 and remained significant on ancova analysis which accounted for covariables, P=0.05. Cases also identified additional stressors not represented in the SRRS at a significantly higher rate than controls. Conversely, the controls spontaneously identified coping strategies that may have allowed them to manage stress more effectively.
  
  
  CONCLUSIONS
  Psychological stress is a significant factor that is associated with relapse in type 1 autoimmune hepatitis. Management of AIH may benefit from strategies to reduce stress and promote psychological well being.
authors.affiliation: Liver Center, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Savita
authors.initials: S
authors.lastname: Srivastava
authors.forename: James L
authors.initials: JL
authors.lastname: Boyer
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003237:Connecticut; D005260:Female; D019693:Hepatitis, Autoimmune / Q000188:drug therapy / Q000276:immunology / Q000523:psychology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D036301:Qualitative Research; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents