{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T07:08:57Z","timestamp":1780816137645,"version":"3.54.1"},"reference-count":68,"publisher":"Akademiai Kiado Zrt.","issue":"39","license":[{"start":{"date-parts":[[2021,9,26]],"date-time":"2021-09-26T00:00:00Z","timestamp":1632614400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["OH"],"published-print":{"date-parts":[[2021,9,26]]},"abstract":"<jats:p><jats:bold>\u00d6sszefoglal\u00f3.<\/jats:bold> A primer Sj\u00f6gren-szindr\u00f3ma (pSS) kr\u00f3nikus autoimmun\n                    betegs\u00e9g, melynek els\u0151dleges t\u00fcnetei az exokrin mirigyeket \u00e9rint\u0151 autoimmun\n                    folyamat k\u00f6vetkezt\u00e9ben l\u00e9trej\u00f6v\u0151 szem- \u00e9s sz\u00e1jsz\u00e1razs\u00e1g, sziszt\u00e9m\u00e1s\n                    manifeszt\u00e1ci\u00f3i k\u00f6z\u00f6tt pedig a leggyakoribbak a szellemi \u00e9s fizikai f\u00e1radts\u00e1g \u00e9s\n                    az \u00edz\u00fcleti f\u00e1jdalmak. A betegs\u00e9g l\u00e9lektani vonatkoz\u00e1sait nagy \u00e9rdekl\u0151d\u00e9s \u00f6vezi;\n                    k\u00f6zlem\u00e9ny\u00fcnk a vonatkoz\u00f3 kutat\u00e1si eredm\u00e9nyeket foglalja \u00f6ssze a h\u00e1tter\u00fckben\n                    h\u00faz\u00f3d\u00f3 pszichoneuroimmunmodul\u00e1ci\u00f3s h\u00e1tt\u00e9r r\u00f6vid bemutat\u00e1s\u00e1val. A pSS\n                    pszichol\u00f3giai t\u00e9nyez\u0151i k\u00f6zt a legr\u00e9gebben vizsg\u00e1ltak a depresszi\u00f3 \u00e9s a\n                    szorong\u00e1s. Ezek jelent\u0151s hat\u00e1ssal vannak a betegek \u00e9letmin\u0151s\u00e9g\u00e9re, j\u00f3ll\u00e9t\u00e9re,\n                    kognit\u00edv funkci\u00f3ira, s\u0151t a betegs\u00e9g aktivit\u00e1s\u00e1ra is. Bemutatjuk tov\u00e1bb\u00e1 a\n                    stressz \u00e9s a megk\u00fczd\u00e9si strat\u00e9gi\u00e1k jellegzetes mint\u00e1zatait pSS-ben, amelyek k\u00f6zt\n                    a betegs\u00e9gre jellemz\u0151 maladapt\u00edv strat\u00e9gi\u00e1k a legjelent\u0151sebbek a patogenezis\n                    meg\u00e9rt\u00e9se \u00e9s a kezel\u00e9s szempontj\u00e1b\u00f3l. Ilyenek a tagad\u00e1s, a has\u00edt\u00e1s \u00e9s a\n                    helyettes\u00edt\u00e9s. Kit\u00e9r\u00fcnk a Sj\u00f6gren-szindr\u00f3m\u00e1t k\u00eds\u00e9r\u0151 szem\u00e9lyis\u00e9gjellemz\u0151kre is,\n                    amely \u00edg\u00e9retes ter\u00fclet, de kev\u00e9s adat \u00e1ll rendelkez\u00e9s\u00fcnkre; az eddigi\n                    vizsg\u00e1latok alapj\u00e1n a neuroticismus a legink\u00e1bb pSS-re jellemz\u0151 t\u00e9nyez\u0151. A\n                    kognit\u00edv funkci\u00f3k \u00e9rintetts\u00e9g\u00e9nek \u00f6sszefoglal\u00e1sa \u00e9s az egy\u00e9b pszichol\u00f3giai\n                    t\u00e9nyez\u0151k (szellemi f\u00e1radts\u00e1g, szexualit\u00e1s, testk\u00e9pzavar, \u00e9letmin\u0151s\u00e9g) \u00f6sszegz\u00e9se\n                    ut\u00e1n egy\u00e9rtelm\u0171en levonhat\u00f3 a k\u00f6vetkeztet\u00e9s, hogy a Sj\u00f6gren-szindr\u00f3ma nemcsak\n                    biol\u00f3giai, hanem pszich\u00e9s, pszichoszoci\u00e1lis \u00e9s szoci\u00e1lis jelens\u00e9gszinteken is\n                    okoz zavarokat, t\u00fcneteket. Ez\u00e9rt rendk\u00edv\u00fcl fontos a betegs\u00e9g biopszichoszoci\u00e1lis\n                    szeml\u00e9let\u0171 kezel\u00e9se, a betegek akt\u00edv, intencion\u00e1lis r\u00e9szv\u00e9tele a pSS-sel val\u00f3\n                    megk\u00fczd\u00e9sben. Orv Hetil. 2021; 162(39): 1558\u20131566.<\/jats:p>\n                <jats:p><jats:bold>Summary.<\/jats:bold> Primary Sj\u00f6gren syndrome (pSS) is a chronic, autoimmune\n                    disorder. Primary symptoms are ocular and oral dryness as a of an autoimmune\n                    process affecting the exocrine glands. The most common systemic manifestations\n                    of the disease are mental and physical fatigue and arthralgia. Psychological\n                    features of pSS are studied with great interest; the present publication reviews\n                    the results of the related investigations alongside with the possible\n                    psychoneuroimmunomodulatory background. Among psychological factors in pSS,\n                    depression and anxiety have been studied the longest. These impact significantly\n                    the quality of life, wellbeing, cognitive functions and disease activity of the\n                    patients. Afterwards, we introduce the characteristic patterns of stress and\n                    coping mechanisms in pSS, among which maladaptive strategies, typical for the\n                    disorder are the most important regarding the pathogenesis and the therapy.\n                    These pSS-linked maladaptive strategies are denial, disengagement and focus and\n                    venting of emotions. As next, we give a summary about personality\n                    characteristics in pSS, which is a promising field to study, and yet very few\n                    related data are available; based on them, neuroticism seems to be the most\n                    common personality factor in Sj\u00f6gren\u2019s. After summarizing briefly cognitive\n                    functions and other psychological features (mental fatigue, sexuality, body\n                    image disturbance and quality of life), it is evident that pSS is determined not\n                    only by biological but also by psychological, psychosocial and social\n                    disturbances. Hence, treating pSS patients with a biopsychosocial perspective is\n                    crucial and so is the active and intentional participation of patients in their\n                    recovery. Orv Hetil. 2021; 162(39): 1558\u20131566.<\/jats:p>","DOI":"10.1556\/650.2021.32234","type":"journal-article","created":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T01:09:05Z","timestamp":1633914545000},"page":"1558-1566","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.1","source":"Crossref","is-referenced-by-count":4,"title":["A primer Sj\u00f6gren-szindr\u00f3ma pszichol\u00f3giai vonatkoz\u00e1sai"],"prefix":"10.1556","volume":"162","author":[{"given":"L\u00e1szl\u00f3","family":"V. 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Sj\u00f6gren's syndrome revisited: autoimmune epithelitis. Br J Rheumatol. 1996; 35: 204-206.","journal-title":"Br J Rheumatol"},{"key":"ref1","unstructured":"2 Binard A, Devauchelle-Pensec V, Fautrel B, et al. Epidemiology of Sj\u00f6gren's syndrome: where are we now? Clin Exp Rheumatol. 2007; 25: 1-4."},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"3 Mavragani CP, Moutsopoulos HM. The geoepidemiology of Sj\u00f6gren's syndrome. Autoimmun Rev. 2010; 9: A305-A310.","DOI":"10.1016\/j.autrev.2009.11.004"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1983","DOI":"10.1136\/annrheumdis-2014-205375","article-title":"Epidemiology of primary Sj\u00f6gren's syndrome: a systematic review and meta-analysis","volume":"74","author":"4 Qin","year":"2015","unstructured":"4 Qin B, Wang J, Yang Z, et al. Epidemiology of primary Sj\u00f6gren's syndrome: a systematic review and meta-analysis. Ann Rheum Dis. 2015; 74: 1983-1989.","journal-title":"Ann Rheum Dis"},{"key":"ref4","unstructured":"5 Alexander F. Psychosomatic medicine: its principles and applications. W W Norton & Co., New York, NY, 1950."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/jnr.490180103","article-title":"Psychoneuroimmunology: interactions between central nervous system and immune system","volume":"18","author":"6 Solomon","year":"1987","unstructured":"6 Solomon GF. Psychoneuroimmunology: interactions between central nervous system and immune system. J Neurosci Res. 1987; 18: 1-9.","journal-title":"J Neurosci Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1038\/nrrheum.2016.112","article-title":"Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways","volume":"12","author":"7 Sturgeon","year":"2016","unstructured":"7 Sturgeon JA, Finan PH, Zautra AJ. Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways. Nat Rev Rheumatol. 2016; 12: 532-542.","journal-title":"Nat Rev Rheumatol"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"8 Pryce CR, Fontana A. Depression in autoimmune diseases. In: Geyer MA, Ellenbroek BA, Marsden CA, et al. (eds.) Current topics in behavioral neurosciences. Springer Verlag, Cham, 2016; pp. 139-154.","DOI":"10.1007\/7854_2016_7"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s13075-020-02180-5","article-title":"Cognitive dysfunction in autoimmune rheumatic diseases","volume":"22","author":"Ol\u00e1h Cs","year":"2020","unstructured":"9 Ol\u00e1h Cs, Schwartz N, Denton C, et al. Cognitive dysfunction in autoimmune rheumatic diseases. Arthritis Res Ther. 2020; 22: 78.","journal-title":"Arthritis Res Ther"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1186\/s12955-018-1064-y","article-title":"A cross-sectional study on self-reported physical and mental health-related quality of life in rheumatoid arthritis and the role of illness perception","volume":"16","author":"10 Berner","year":"2018","unstructured":"10 Berner C, Erlacher L, Fenzl KH, et al. A cross-sectional study on self-reported physical and mental health-related quality of life in rheumatoid arthritis and the role of illness perception. Health Qual Life Outcomes 2018; 16: 238.","journal-title":"Health Qual Life Outcomes"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"11 Karademas EC, Ktistaki G, Dimitraki G, et al. Adaptation to an autoimmune disorder: does mental flexibility impact illness-related self-regulation? Psychol Health 2016; 31: 276-291.","DOI":"10.1080\/08870446.2015.1083568"},{"issue":"5757","key":"ref11","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1136\/bmj.2.5757.297","article-title":"Rheumatoid arthritis and personality: a controlled study","volume":"2","author":"12 Ward","year":"1971","unstructured":"12 Ward DJ. Rheumatoid arthritis and personality: a controlled study. Br Med J. 1971; 2(5757): 297-299.","journal-title":"Br Med J"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"13 Marcenaro M, Prete C, Badini A, et al. Rheumatoid arthritis, personality, stress response style, and coping with illness. A preliminary study. Ann N Y Acad Sci. 1999; 876: 419-425.","DOI":"10.1111\/j.1749-6632.1999.tb07666.x"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1007\/s10067-017-3654-1","article-title":"The relationship between disease activity, quality of life, and personality types in rheumatoid arthritis and ankylosing spondylitis patients","volume":"36","author":"14 Donisan","year":"2017","unstructured":"14 Donisan T, Bojinc\u0103 VC, Dobrin MA, et al. The relationship between disease activity, quality of life, and personality types in rheumatoid arthritis and ankylosing spondylitis patients. Clin Rheumatol. 2017; 36: 1511-1519.","journal-title":"Clin Rheumatol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"406","DOI":"10.3349\/ymj.2020.61.5.406","article-title":"Contribution of personality traits, psychological factors, and health-related quality of life to medication adherence in patients with rheumatoid arthritis","volume":"61","author":"KM","year":"2020","unstructured":"15 Ko KM, Moon SJ, Koh JH, et al. Contribution of personality traits, psychological factors, and health-related quality of life to medication adherence in patients with rheumatoid arthritis. Yonsei Med J. 2020; 61: 406-415.","journal-title":"Yonsei Med J"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.jbspin.2016.03.006","article-title":"Comparison of the Big Five personality traits in fibromyalgia and other rheumatic diseases","volume":"84","author":"16 Bucourt","year":"2017","unstructured":"16 Bucourt E, Martaill\u00e9 V, Mulleman D, et al. Comparison of the Big Five personality traits in fibromyalgia and other rheumatic diseases. Jt Bone Spine 2017; 84: 203-207.","journal-title":"Jt Bone Spine"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"17 Milic V, Grujic M, Barisic J, et al. Personality, depression and anxiety in primary Sjogren's syndrome - Association with sociodemographic factors and comorbidity. PLoS ONE 2019; 14: e0210466.","DOI":"10.1371\/journal.pone.0210466"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1111\/j.1600-065X.2012.01138.x","article-title":"Rethinking inflammation: neural circuits in the regulation of immunity","volume":"248","author":"18 Olofsson","year":"2012","unstructured":"18 Olofsson PS, Rosas-Ballina M, Levine YA, et al. Rethinking inflammation: neural circuits in the regulation of immunity. Immunol Rev. 2012; 248: 188-204.","journal-title":"Immunol Rev"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.autneu.2013.12.007","article-title":"The cholinergic anti-inflammatory pathway: a critical review","volume":"182","author":"19 Martelli","year":"2014","unstructured":"19 Martelli D, McKinley MJ, McAllen RM. The cholinergic anti-inflammatory pathway: a critical review. Auton Neurosci. 2014; 182: 65-69.","journal-title":"Auton Neurosci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.bbi.2015.12.014","article-title":"Sympathetic innervation, norepinephrine content, and norepinephrine turnover in orthotopic and spontaneous models of breast cancer","volume":"53","author":"20 Szpunar","year":"2016","unstructured":"20 Szpunar MJ, Belcher EK, Dawes RP, et al. Sympathetic innervation, norepinephrine content, and norepinephrine turnover in orthotopic and spontaneous models of breast cancer. Brain Behav Immun. 2016; 53: 223-233.","journal-title":"Brain Behav Immun"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"21 Madden KS, Felten SY, Felten DL, et al. Sympathetic neural modulation of the immune system. I. Depression of T cell immunity in vivo and in vitro following chemical sympathectomy. Brain Behav Immun. 1989; 3: 72-89.","DOI":"10.1016\/0889-1591(89)90007-X"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s00726-011-1186-6","article-title":"Adrenergic modulation of immune cells: an update","volume":"45","author":"Marino F","year":"2013","unstructured":"22 Marino F, Cosentino M. Adrenergic modulation of immune cells: an update. Amino Acids 2013; 45: 55-71.","journal-title":"Amino Acids"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/j.ejphar.2018.07.039","article-title":"Endocannabinoid system, stress and HPA axis","volume":"834","author":"Micale V","year":"2018","unstructured":"23 Micale V, Drago F. Endocannabinoid system, stress and HPA axis. Eur J Pharmacol. 2018; 834: 230-239.","journal-title":"Eur J Pharmacol"},{"key":"ref23","unstructured":"24 Johnson EO, Vlachoyiannopoulos PG, Skopouli FN, et al. Hypofunction of the stress axis in Sj\u00f6gren's syndrome. J Rheumatol. 1998; 25: 1508-1514."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/j.neuroimage.2012.06.055","article-title":"Endotoxin-induced systemic inflammation activates microglia: [11C]PBR28 positron emission tomography in nonhuman primates","volume":"63","author":"25 Hannestad","year":"2012","unstructured":"25 Hannestad J, Gallezot JD, Schafbauer T, et al. Endotoxin-induced systemic inflammation activates microglia: [11C]PBR28 positron emission tomography in nonhuman primates. Neuroimage 2012; 63: 232-239.","journal-title":"Neuroimage"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.mce.2013.05.007","article-title":"Extra-adrenal glucocorticoid synthesis: immune regulation and aspects on local organ homeostasis","volume":"380","author":"26 Talab\u00e9r","year":"2013","unstructured":"26 Talab\u00e9r G, Jondal M, Okret S. Extra-adrenal glucocorticoid synthesis: immune regulation and aspects on local organ homeostasis. Mol Cell Endocrinol. 2013; 380: 89-98.","journal-title":"Mol Cell Endocrinol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.autrev.2006.03.003","article-title":"Immunohistopathology of Sj\u00f6gren's syndrome","volume":"6","author":"27 Konttinen","year":"2006","unstructured":"27 Konttinen YT, Porola P, Konttinen L, et al. Immunohistopathology of Sj\u00f6gren's syndrome. Autoimmun Rev. 2006; 6: 16-20.","journal-title":"Autoimmun Rev"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1016\/0008-8749(92)90236-I","article-title":"Estrogen accelerates immune complex glomerulonephritis but ameliorates T cell-mediated vasculitis and sialadenitis in autoimmune MRL lpr\/lpr mice","volume":"144","author":"28 Carlsten","year":"1992","unstructured":"28 Carlsten H, Nilsson N, Jonsson R, et al. Estrogen accelerates immune complex glomerulonephritis but ameliorates T cell-mediated vasculitis and sialadenitis in autoimmune MRL lpr\/lpr mice. Cell Immunol. 1992; 144: 190-202.","journal-title":"Cell Immunol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/S0002-9440(10)65111-5","article-title":"Estrogen deficiency accelerates autoimmune exocrinopathy in murine Sjogren's syndrome through Fas-mediated apoptosis","volume":"155","author":"29 Ishimaru","year":"1999","unstructured":"29 Ishimaru N, Saegusa K, Yanagi K, et al. Estrogen deficiency accelerates autoimmune exocrinopathy in murine Sjogren's syndrome through Fas-mediated apoptosis. Am J Pathol. 1999; 155: 173-181.","journal-title":"Am J Pathol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.jaut.2012.01.004","article-title":"Sex steroids in Sj\u00f6gren's syndrome","volume":"39","author":"30 Konttinen","year":"2012","unstructured":"30 Konttinen YT, Fuellen G, Bing Y, et al. Sex steroids in Sj\u00f6gren's syndrome. J Autoimmun. 2012; 39: 49-56.","journal-title":"J Autoimmun"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"31 Liu WH, Chen Y, Bai XW, et al. Identification and characterization of a novel neuropeptide (neuropeptide Y-HS) from leech salivary gland of Haemadipsa sylvestris. Chin J Nat Med. 2016; 14: 677-682.","DOI":"10.1016\/S1875-5364(16)30080-2"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"4760","DOI":"10.2174\/1381612820666140130203636","article-title":"Neuroimmune aspects of Sjogren's syndrome: role of VIP\/VPAC system in immune and salivary gland epithelial cell function","volume":"20","author":"32 Hauk","year":"2014","unstructured":"32 Hauk V, Calafat M, Grasso E, et al. Neuroimmune aspects of Sjogren's syndrome: role of VIP\/VPAC system in immune and salivary gland epithelial cell function. Curr Pharm Des. 2014; 20: 4760-4765.","journal-title":"Curr Pharm Des"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1159\/000486859","article-title":"Vasoactive intestinal peptide protects salivary glands against structural injury and secretory dysfunction via IL-17A and AQP5 regulation in a model of Sj\u00f6gren syndrome","volume":"24","author":"33 Li","year":"2014","unstructured":"33 Li C, Zhu F, Wu B, Wang Y. Vasoactive intestinal peptide protects salivary glands against structural injury and secretory dysfunction via IL-17A and AQP5 regulation in a model of Sj\u00f6gren syndrome. Neuroimmunomodulation 2014; 24: 300-309.","journal-title":"Neuroimmunomodulation"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1002\/cphy.c150015","article-title":"Regulation of the hypothalamic-pituitary-adrenocortical stress response","volume":"6","author":"34 Herman","year":"2016","unstructured":"34 Herman JP, McKlveen JM, Ghosal S, et al. Regulation of the hypothalamic-pituitary-adrenocortical stress response. Compr Physiol. 2016; 6: 603-621.","journal-title":"Compr Physiol"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"35 Harboe E, Tjensvoll AB, Vefring HK, et al. Fatigue in primary Sj\u00f6gren's syndrome - a link to sickness behaviour in animals? Brain Behav Immun. 2009; 23: 1104-1108.","DOI":"10.1016\/j.bbi.2009.06.151"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1152\/physrev.00039.2016","article-title":"Neuroimmune interactions: from the brain to the immune system and vice versa","volume":"98","author":"36 Dantzer","year":"2018","unstructured":"36 Dantzer R. Neuroimmune interactions: from the brain to the immune system and vice versa. Physiol Rev. 2018; 98: 477-504.","journal-title":"Physiol Rev"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"2499","DOI":"10.1111\/j.1460-9568.2008.06549.x","article-title":"Central nervous action of interleukin-1 mediates activation of limbic structures and behavioural depression in response to peripheral administration of bacterial lipopolysaccharide","volume":"28","author":"37 Konsman","year":"2008","unstructured":"37 Konsman JP, Veeneman J, Combe C, et al. Central nervous action of interleukin-1 mediates activation of limbic structures and behavioural depression in response to peripheral administration of bacterial lipopolysaccharide. Eur J Neurosci. 2008; 28: 2499-2510.","journal-title":"Eur J Neurosci"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"2282","DOI":"10.1126\/science.1067859","article-title":"Control of synaptic strength by glial TNF\u03b1","volume":"295","author":"38 Beattie","year":"2002","unstructured":"38 Beattie EC, Stellwagen D, Morishita W, et al. Control of synaptic strength by glial TNF\u03b1. Science 2002; 295: 2282-2285.","journal-title":"Science"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"344","DOI":"10.7326\/0003-4819-103-3-344","article-title":"Neuropsychiatric dysfunction in primary Sjogren's syndrome","volume":"103","author":"39 Malinow","year":"1985","unstructured":"39 Malinow KL, Molina R, Gordon B, et al. Neuropsychiatric dysfunction in primary Sjogren's syndrome. Ann Intern Med. 1985; 103: 344-350.","journal-title":"Ann Intern Med"},{"key":"ref39","unstructured":"40 Valt\u00fdsd\u00f3ttir ST, Gudbj\u00f6rnsson B, Lindqvist U, et al. Anxiety and depression in patients with primary Sjogren's syndrome. J Rheumatol. 2000; 27: 165-169."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1536","DOI":"10.1007\/s12325-020-01606-5","article-title":"A prospective, observational, cohort study to assess the efficacy and safety of prolonged-release fampridine in cognition, fatigue, depression, and quality of life in multiple sclerosis patients: the FAMILY study","volume":"38","author":"41 Mitsikostas","year":"2021","unstructured":"41 Mitsikostas DD, Doskas T, Gkatzonis S, et al. A prospective, observational, cohort study to assess the efficacy and safety of prolonged-release fampridine in cognition, fatigue, depression, and quality of life in multiple sclerosis patients: the FAMILY study. Adv Ther. 2021; 38: 1536-1551.","journal-title":"Adv Ther"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1111\/j.1532-5415.2012.03908.x","article-title":"Depressive symptoms and subjective and objective sleep in community-dwelling older women","volume":"60","author":"42 Maglione","year":"2012","unstructured":"42 Maglione JE, Ancoli-Israel S, Peters KW, et al. Depressive symptoms and subjective and objective sleep in community-dwelling older women. J Am Geriatr Soc. 2012; 60: 635-643.","journal-title":"J Am Geriatr Soc"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1186\/s12888-018-1715-x","article-title":"Anxiety and depression in primary Sj\u00f6gren's syndrome: a cross-sectional study","volume":"18","author":"43 Cui","year":"2018","unstructured":"43 Cui Y, Xia L, Li L, et al. Anxiety and depression in primary Sj\u00f6gren's syndrome: a cross-sectional study. BMC Psychiatry 2018; 18: 131.","journal-title":"BMC Psychiatry"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1002\/art.21990","article-title":"Quality of life and psychological status in patients with primary Sj\u00f6gren's syndrome and sicca symptoms without autoimmune features","volume":"55","author":"44 Champey","year":"2006","unstructured":"44 Champey J, Corruble E, Gottenberg JE, et al. Quality of life and psychological status in patients with primary Sj\u00f6gren's syndrome and sicca symptoms without autoimmune features. Arthritis Rheum. 2006; 55: 451-457.","journal-title":"Arthritis Rheum"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1016\/j.jbspin.2015.10.005","article-title":"Sicca symptoms are associated with similar fatigue, anxiety, depression, and quality-of-life impairments in patients with and without primary Sj\u00f6gren's syndrome","volume":"83","author":"45 Milin","year":"2016","unstructured":"45 Milin M, Cornec D, Chastaing M, et al. Sicca symptoms are associated with similar fatigue, anxiety, depression, and quality-of-life impairments in patients with and without primary Sj\u00f6gren's syndrome. Joint Bone Spine 2016; 83: 681-685.","journal-title":"Joint Bone Spine"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1111\/j.1600-0404.2011.01530.x","article-title":"Primary Sjogren's syndrome: cognitive symptoms, mood and cognitive performance","volume":"125","author":"46 Segal","year":"2012","unstructured":"46 Segal BM, Pogatchnik B, Holker E, et al. Primary Sjogren's syndrome: cognitive symptoms, mood and cognitive performance. Acta Neurol Scand. 2012; 125: 272-278.","journal-title":"Acta Neurol Scand"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1111\/j.1741-2358.2004.00027.x","article-title":"UK patients with primary Sj\u00f6gren's syndrome are at increased risk from clinical depression","volume":"21","author":"47 Stevenson","year":"2004","unstructured":"47 Stevenson HA, Jones ME, Rostron JL, et al. UK patients with primary Sj\u00f6gren's syndrome are at increased risk from clinical depression. Gerodontology 2004; 21: 141-145.","journal-title":"Gerodontology"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1762","DOI":"10.1093\/rheumatology\/keq158","article-title":"Psychopathological and personality features in primary Sj\u00f6gren's syndrome - associations with autoantibodies to neuropeptides","volume":"49","author":"48 Karaiskos","year":"2010","unstructured":"48 Karaiskos D, Mavragani CP, Sinno MH, et al. Psychopathological and personality features in primary Sj\u00f6gren's syndrome - associations with autoantibodies to neuropeptides. Rheumatology 2010; 49: 1762-1769.","journal-title":"Rheumatology"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.3899\/jrheum.141361","article-title":"Risk of psychiatric disorders following primary Sj\u00f6gren syndrome: a nationwide population-based retrospective cohort study","volume":"42","author":"49 Shen","year":"2015","unstructured":"49 Shen CC, Yang AC, Kuo BI, et al. Risk of psychiatric disorders following primary Sj\u00f6gren syndrome: a nationwide population-based retrospective cohort study. J Rheumatol. 2015; 42: 1203-1208.","journal-title":"J Rheumatol"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"50 R\u00f3zsa S, Purebl G, Sus\u00e1nszky \u00c9, et al. Dimensions of coping: Hungarian adaptation of the Ways of Coping Questionnaire. [A megk\u00fczd\u00e9s dimenzi\u00f3i: a Konfliktusmegold\u00f3 K\u00e9rd\u0151\u00edv hazai adapt\u00e1ci\u00f3ja.] Mentalhig Pszichoszom. 2008; 9: 217-241. [Hungarian]","DOI":"10.1556\/Mental.9.2008.3.3"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1080\/13548500123876","article-title":"Situational patterns in coping with primary Sj\u00f6gren's syndrome","volume":"6","author":"51 Andersson","year":"2001","unstructured":"51 Andersson SI, Manthorpe R, Theander E. Situational patterns in coping with primary Sj\u00f6gren's syndrome. Psychol Health Med. 2001; 6: 29-40.","journal-title":"Psychol Health Med"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/1477-7525-7-46","article-title":"Primary Sj\u00f6gren's syndrome: health experiences and predictors of health quality among patients in the United States","volume":"7","author":"52 Segal","year":"2009","unstructured":"52 Segal B, Bowman SJ, Fox PC, et al. Primary Sj\u00f6gren's syndrome: health experiences and predictors of health quality among patients in the United States. Health Qual Life Outcomes 2009; 7: 46.","journal-title":"Health Qual Life Outcomes"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1093\/rheumatology\/keu387","article-title":"Psychological profiles in patients with Sjogren's syndrome related to fatigue: a cluster analysis","volume":"54","author":"53 van Leeuwen","year":"2015","unstructured":"53 van Leeuwen N, Bossema ER, Knoop H, et al. Psychological profiles in patients with Sjogren's syndrome related to fatigue: a cluster analysis. Rheumatology 2015; 54: 776-783.","journal-title":"Rheumatology"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1136\/ard.2007.084152","article-title":"Stress, coping strategies and social support in patients with primary Sjogren's syndrome prior to disease onset: a retrospective case-control study","volume":"68","author":"54 Karaiskos","year":"2009","unstructured":"54 Karaiskos D, Mavragani CP, Makaroni S, et al. Stress, coping strategies and social support in patients with primary Sjogren's syndrome prior to disease onset: a retrospective case-control study. Ann Rheum Dis. 2009; 68: 40-46.","journal-title":"Ann Rheum Dis"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/0022-3999(85)90033-9","article-title":"The value of the MMPI conversion \"V\" in the assessment of psychogenic pain","volume":"29","author":"55 Leavitt","year":"1985","unstructured":"55 Leavitt F. The value of the MMPI conversion \"V\" in the assessment of psychogenic pain. J Psychosom Res. 1985; 29: 125-131.","journal-title":"J Psychosom Res"},{"key":"ref55","unstructured":"56 Lachar D. MMPI: Clinical Assessment and Automated Interpretation (WPS professional handbook series). Western Psychological Services, 1974."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1111\/j.1600-0404.1990.tb00951.x","article-title":"Nervous system manifestations in Sj\u00f6gren's syndrome","volume":"81","author":"57 Hietaharju","year":"1990","unstructured":"57 Hietaharju A, Yli-Kerttula U, H\u00e4kkinen V, et al. Nervous system manifestations in Sj\u00f6gren's syndrome. Acta Neurol Scand. 1990; 81: 144-152.","journal-title":"Acta Neurol Scand"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1136\/ard.2008.098301","article-title":"Neuropsychiatric syndromes in patients with systemic lupus erythematosus and primary Sj\u00f6gren syndrome: a comparative population-based study","volume":"68","author":"58 Harboe","year":"2009","unstructured":"58 Harboe E, Tjensvoll AB, Maroni S, et al. Neuropsychiatric syndromes in patients with systemic lupus erythematosus and primary Sj\u00f6gren syndrome: a comparative population-based study. Ann Rheum Dis. 2009; 68: 1541-1546.","journal-title":"Ann Rheum Dis"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1007\/s10067-013-2453-6","article-title":"Characterization of cognitive dysfunction in Sj\u00f6gren's syndrome patients","volume":"33","author":"59 Epstein","year":"2014","unstructured":"59 Epstein LC, Masse G, Harmatz JS, et al. Characterization of cognitive dysfunction in Sj\u00f6gren's syndrome patients. Clin Rheumatol. 2014; 33: 511-521.","journal-title":"Clin Rheumatol"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"234","DOI":"10.3109\/03009742.2013.846409","article-title":"Pain in primary Sj\u00f6gren's syndrome: the role of catastrophizing and negative illness perceptions","volume":"43","author":"60 Segal","year":"2014","unstructured":"60 Segal BM, Pogatchnik B, Rhodus N, et al. Pain in primary Sj\u00f6gren's syndrome: the role of catastrophizing and negative illness perceptions. Scand J Rheumatol. 2014; 43: 234-241.","journal-title":"Scand J Rheumatol"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1007\/s00296-014-3008-0","article-title":"Illness perceptions and psychological distress associated with physical health-related quality of life in primary Sj\u00f6gren's syndrome compared to systemic lupus erythematosus and rheumatoid arthritis","volume":"34","author":"61 Kotsis","year":"2014","unstructured":"61 Kotsis K, Voulgari PV, Tsifetaki N, et al. Illness perceptions and psychological distress associated with physical health-related quality of life in primary Sj\u00f6gren's syndrome compared to systemic lupus erythematosus and rheumatoid arthritis. Rheumatol Int. 2014; 34: 1671-1681.","journal-title":"Rheumatol Int"},{"key":"ref61","doi-asserted-by":"publisher","unstructured":"62 Isik H, Isik M, Aynioglu O, et al. Are the women with Sj\u00f6gren's syndrome satisfied with their sexual activity? Rev Bras Reumatol. 2017; 57: 210-216.","DOI":"10.1016\/j.rbre.2017.01.002"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1002\/acr.22968","article-title":"Treatment guidelines for rheumatologic manifestations of Sj\u00f6gren's syndrome: use of biologic agents, management of fatigue, and inflammatory musculoskeletal pain","volume":"69","author":"63 Carsons","year":"2017","unstructured":"63 Carsons SE, Vivino FB, Parke A, et al. Treatment guidelines for rheumatologic manifestations of Sj\u00f6gren's syndrome: use of biologic agents, management of fatigue, and inflammatory musculoskeletal pain. Arthritis Care Res. 2017; 69: 517-527.","journal-title":"Arthritis Care Res"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1093\/rheumatology\/kep141","article-title":"Health-related quality of life, employment and disability in patients with Sj\u00f6gren's syndrome","volume":"48","author":"64 Meijer","year":"2009","unstructured":"64 Meijer JM, Meiners PM, Huddleston Slater JJ, et al. Health-related quality of life, employment and disability in patients with Sj\u00f6gren's syndrome. Rheumatology 2009; 48: 1077-1082.","journal-title":"Rheumatology"},{"key":"ref64","doi-asserted-by":"publisher","unstructured":"65 Liu Z, Dong Z, Liang X, et al. Health-related quality of life and psychological status of women with primary Sj\u00f6gren's syndrome: a cross-sectional study of 304 Chinese patients. Medicine (Baltimore) 2017; 96: e9208.","DOI":"10.1097\/MD.0000000000009208"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1126\/science.847460","article-title":"The need for a new medical model: a challenge for biomedicine","volume":"196","author":"66 Engel","year":"1977","unstructured":"66 Engel GL. The need for a new medical model: a challenge for biomedicine. Science 1977; 196: 129-136.","journal-title":"Science"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1007\/s10943-005-2775-z","article-title":"Religion and bio-psycho-social health: a review and conceptual model","volume":"44","author":"67 Marks","year":"2005","unstructured":"67 Marks L. Religion and bio-psycho-social health: a review and conceptual model. J Relig Health 2005; 44: 173-186.","journal-title":"J Relig Health"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"983","DOI":"10.3109\/10826089909039390","article-title":"Primary socialization theory and a bio\/psycho\/social\/spiritual practice model for substance use","volume":"34","author":"Leukefeld CG","year":"1999","unstructured":"68 Leukefeld CG, Leukefeld S. Primary socialization theory and a bio\/psycho\/social\/spiritual practice model for substance use. Subst Use Misuse 1999; 34: 983-991.","journal-title":"Subst Use Misuse"}],"container-title":["Orvosi Hetilap"],"original-title":[],"link":[{"URL":"https:\/\/akjournals.com\/view\/journals\/650\/162\/39\/article-p1558.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/akjournals.com\/downloadpdf\/journals\/650\/162\/39\/article-p1558.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T08:34:59Z","timestamp":1698654899000},"score":1,"resource":{"primary":{"URL":"https:\/\/akjournals.com\/view\/journals\/650\/162\/39\/article-p1558.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,26]]},"references-count":68,"journal-issue":{"issue":"39"},"URL":"https:\/\/doi.org\/10.1556\/650.2021.32234","relation":{},"ISSN":["0030-6002","1788-6120"],"issn-type":[{"value":"0030-6002","type":"print"},{"value":"1788-6120","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,26]]}}}