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Official Journal of the International Society of Pteridinology

Editor-in-Chief: Fuchs, Dietmar

IMPACT FACTOR 2018: 0.531

CiteScore 2018: 0.67

SCImago Journal Rank (SJR) 2018: 0.195
Source Normalized Impact per Paper (SNIP) 2018: 0.318

ICV 2018: 145.86

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Volume 18, Issue 1


Preliminary Evidence on the Direction of Effects Between Day-to-Day Changes in Cellular Immune Activation, Fatigue and Mood in a Patient with Prior Breast Cancer: A Time-Series Analysis Approach

Prof. Dr. Dr. Christian Schubert
  • Corresponding author
  • Clinical Department of Medical Psychology and Psychotherapy, Innsbruck Medical University, Schöpfstrasse 23a, A-6020 Innsbruck, Austria, Phone: ++43 512 504 25982, Telefax: ++43 512 504 28797
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  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Mechthild Neises / Kurt Fritzsche
  • Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Freiburg, Germany
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/ Willi Geser / Francisco M. Ocana-Peinado / Dietmar Fuchs / Ralf Hass
  • Department of Biochemistry and Tumor Biology, Clinic of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
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  • De Gruyter OnlineGoogle Scholar
/ Gerhard Schmid-Ott / Christina Burbaum
  • Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Freiburg, Germany
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Published Online: 2013-08-10 | DOI: https://doi.org/10.1515/pteridines.2007.18.1.139


This study on a patient with prior breast cancer investigated the cause-effect relations between immune system activation, fatigue and mood under real-life conditions. The 60-year old woman (primary diagnosis 5 years ago, relapse one year ago, currently no signs of recurrence) collected her entire urine for 31 days in 12 hour intervals for the determination of immune activation marker neopterin and creatinine concentrations by HPLC. This study used only the daytime urinary neopterin concentrations (from approx. 8 a.m. to 8 p.m.) and cross-correlated them with daily data from mood (3-Skalen-EWL) and fatigue (VAS) questionnaires which the patient filled in for 31 days. Serial dependencies were controlled for by applying moving average smoothing. When averaged over the whole observation period, daily fatigue, daily mood and daily urinary neopterin (average 173 μmol per mol creatinine) were within normal limits. Cross-correlational analyses revealed that increases in urinary neopterin significantly preceded increases in fatigue by 24 hours (lag 1: r = +0.424; p <0.05). The opposite direction of effects, however, existed between mood and neopterin, i.e., decreases in mood preceded increases in neopterin by 96 hours (lag 4: r = −0.697; p <0.05). The results in this patient suggest a disturbed stress system activity where negative emotions are associated with increases instead of decreases in the degree of cellular immune activation and where cellular immune activation may trigger central nervous system symptoms such as fatigue. Despite some restrictions in data quality this study shows the feasibility of gathering evidence on naturally occurring psychoimmunological cause-effect relations based on extensive serial data collection and time series analysis.

Keywords : neopterin; fatigue; mood; breast cancer; time series analysis

About the article

Published Online: 2013-08-10

Published in Print: 2007-02-01

Citation Information: Pteridines, Volume 18, Issue 1, Pages 139–147, ISSN (Online) 2195-4720, ISSN (Print) 0933-4807, DOI: https://doi.org/10.1515/pteridines.2007.18.1.139.

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