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On “Stress and the Heart: Biobehavioral Aspects of Sudden Cardiac Death”
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Letters
explain how dental pain caused mental illness. Dickinson suggested that afferent dental pain became derailed in the medulla oblongata and redirected mistakenly into motor efferents resulting in behavioral change. 2 Van Doorn believed that abscessed teeth release toxins into the systemic circulation, resulting in distant nervous effects and psychopathology." Levinson emphasized the developmental antecedents of distress occurring in infants cutting their first teeth. 4 Finally, Mummery reported that even healthy teeth could result in mental disorder if the tooth had roots sufficiently elaborate to cause local pressure on the nervous system. 5 Dental pain is not more likely to exacerbate a psychiatric disorder than any other type of pain, but, because dental health is relatively neglected in medical school curricula, it is more likely to be overlooked by psychiatrists. Therefore, patients must have their dental status and all other aspects of their physical and mental functioning evaluated if assessment is to be adequate and treatment appropriate. W. Vaughn McCall, M.D. John Umstead Hospital Butner, North Carolina 27509
References I. Upson HS: Illsomllia alld Nel'l'eSlraill. New York. Knicker-boeker. 19011 2. Dickinson WP: Renex neuroses with which the teeth are associated. Tht' Dema/ R('\'iell' 4:641-655. 1890 3. Van Doom JW: The relation of dental lesions to insomnia and nerve strain. The Dema/ Cosmos 51 :677--{>85. 1909 4. Levinson JL: On dental irritation as a predisposing cause of many anomalous kinds of nervous affections. Lallcel 1:156-157.IR56 5. Mummery JR: A remarkable case of strabismus and blanching of the hair. arising from a diseased tooth: with additional instances of nervous disorders arising from dental irritation. Transaclions of Ihe Odomolo!iical Soci· t'ly ofGrt'a1 Briliall 12:252-264. 1880
On "Stress and the Heart: Biobehavioral Aspects ofSudden Cardiac Death" SIR: The role of the right frontal cortex in the development and progression of coronary heart VOLUME 32· NUMBER I· WINTER 1991
disease (CHD) manifested by lower galvanic skin responses associated with right-hemisphere damage. discussed by Cathrine Frank, M.D., and Stephen Smith, M.D.,' is supported by a number of studies. Pronounced blood pressure changes have been noted in women during lateralized presentation of an emotionally laden film/ and rightsided activation has been observed in the frontal and anterior temporal regions associated with facial behavior of women indicating disgust.' Disgust and glare have been correlated with hostile components of speech associated with CHD incidence,4 and the "traditional" Type A components of impatience and a sense of hurry have been correlated with somatic risk factors of CHD in adolescent girls. 5 The latter correlation may have been mediated by dopamine lateralized to the right hemisphere. in which the metabolic rate is higher in females. 6 Ernest H. Friedman, M.D. Case Western Reserve University East Cleveland, Ohio
References I. Frank C. Smith S: Stress and the hean: biobehavioral aspects of sudden cardiac death. Psychosomalics 31 :255264. 1990 2. Williing W: Psychophysiological correlates of human brain asymmetry: blood pressure changes during lateralized presentation of an emotionally laden film. Nt'liropsych%gia 28:457--470. 1990 3. Davidson RJ. Ekman P. Saron CD. et al: Approach-with· drawal and cerebral asymmetry: emotional expression and brain physiology. I. J Pel's Soc Psycho/5R:330-34 I. 1990 4. Chesney MA. Ekman P. Friesen WV. et al: Type A behavior and speech components. psyc}lOsom Med 53:307-319. 1990 5. Keltinkangas-Jarvinen L. Jokinen J: Type A behavior. coping mechanisms and emotions related to somatic risk factors of coronary hean disease in adolescents. J Psy·
c1lOsomRes33:17-27.1989 6. Friedman EH. Jankovic J: Tardive oculogyria (Ieller and reply). Ne/lr%!iy40:728. 1990
In Reply SIR: We wish to thank Dr. Friedman for his comments on our review article, "Stress and the Heart: Biobehavioral Aspects of Sudden Cardiac Death." Our review deals primarily with sudden 115
.
Letters
explain how dental pain caused mental illness. Dickinson suggested that afferent dental pain became derailed in the medulla oblongata and redirected mistakenly into motor efferents resulting in behavioral change. 2 Van Doorn believed that abscessed teeth release toxins into the systemic circulation, resulting in distant nervous effects and psychopathology." Levinson emphasized the developmental antecedents of distress occurring in infants cutting their first teeth. 4 Finally, Mummery reported that even healthy teeth could result in mental disorder if the tooth had roots sufficiently elaborate to cause local pressure on the nervous system. 5 Dental pain is not more likely to exacerbate a psychiatric disorder than any other type of pain, but, because dental health is relatively neglected in medical school curricula, it is more likely to be overlooked by psychiatrists. Therefore, patients must have their dental status and all other aspects of their physical and mental functioning evaluated if assessment is to be adequate and treatment appropriate. W. Vaughn McCall, M.D. John Umstead Hospital Butner, North Carolina 27509
References I. Upson HS: Illsomllia alld Nel'l'eSlraill. New York. Knicker-boeker. 19011 2. Dickinson WP: Renex neuroses with which the teeth are associated. Tht' Dema/ R('\'iell' 4:641-655. 1890 3. Van Doom JW: The relation of dental lesions to insomnia and nerve strain. The Dema/ Cosmos 51 :677--{>85. 1909 4. Levinson JL: On dental irritation as a predisposing cause of many anomalous kinds of nervous affections. Lallcel 1:156-157.IR56 5. Mummery JR: A remarkable case of strabismus and blanching of the hair. arising from a diseased tooth: with additional instances of nervous disorders arising from dental irritation. Transaclions of Ihe Odomolo!iical Soci· t'ly ofGrt'a1 Briliall 12:252-264. 1880
On "Stress and the Heart: Biobehavioral Aspects ofSudden Cardiac Death" SIR: The role of the right frontal cortex in the development and progression of coronary heart VOLUME 32· NUMBER I· WINTER 1991
disease (CHD) manifested by lower galvanic skin responses associated with right-hemisphere damage. discussed by Cathrine Frank, M.D., and Stephen Smith, M.D.,' is supported by a number of studies. Pronounced blood pressure changes have been noted in women during lateralized presentation of an emotionally laden film/ and rightsided activation has been observed in the frontal and anterior temporal regions associated with facial behavior of women indicating disgust.' Disgust and glare have been correlated with hostile components of speech associated with CHD incidence,4 and the "traditional" Type A components of impatience and a sense of hurry have been correlated with somatic risk factors of CHD in adolescent girls. 5 The latter correlation may have been mediated by dopamine lateralized to the right hemisphere. in which the metabolic rate is higher in females. 6 Ernest H. Friedman, M.D. Case Western Reserve University East Cleveland, Ohio
References I. Frank C. Smith S: Stress and the hean: biobehavioral aspects of sudden cardiac death. Psychosomalics 31 :255264. 1990 2. Williing W: Psychophysiological correlates of human brain asymmetry: blood pressure changes during lateralized presentation of an emotionally laden film. Nt'liropsych%gia 28:457--470. 1990 3. Davidson RJ. Ekman P. Saron CD. et al: Approach-with· drawal and cerebral asymmetry: emotional expression and brain physiology. I. J Pel's Soc Psycho/5R:330-34 I. 1990 4. Chesney MA. Ekman P. Friesen WV. et al: Type A behavior and speech components. psyc}lOsom Med 53:307-319. 1990 5. Keltinkangas-Jarvinen L. Jokinen J: Type A behavior. coping mechanisms and emotions related to somatic risk factors of coronary hean disease in adolescents. J Psy·
c1lOsomRes33:17-27.1989 6. Friedman EH. Jankovic J: Tardive oculogyria (Ieller and reply). Ne/lr%!iy40:728. 1990
In Reply SIR: We wish to thank Dr. Friedman for his comments on our review article, "Stress and the Heart: Biobehavioral Aspects of Sudden Cardiac Death." Our review deals primarily with sudden 115