Endocannabinoids and heart rate variability alterations after exposure to prolonged intensive physical exercise of the Hellenic Navy SEALs

Background

Recent research indicates that endocanabinoids (eCB) and heart rate variability (HRV) are associated with stress-induced experiences. However, these underlying mechanisms have not been elucidated.

Purpose

The aim of the present study is to investigate if exposure to acute and chronic stress promotes measurable changes concurrently to the peripheral eCB ligands and the HRV.

Methods

13 candidates under intense preparation for their enlistment in the Hellenic Navy SEALs (H.N.S.) participated in the study. All subjects underwent mental state examination, while HRV variables in time and frequency domains recordings were acquired. Furthermore, at baseline and 30 days after prolonged and intensive physical exercise hair were collected in order to measure eCB ligands, such as anandamide (AEA), 2-arachidonoylglycerol (2-AG), and the N-acyl ethanolamine (NAE) molecules: palmitoylethanolamide (PEA) and oleoylethanolamide (OEA).

Results

Comparing basal hair concentrations of eCB ligands before and after intensive physical exercise, we found that AEA, PEA and OEA were notably increased (p<0.01, p<0.05 and p<0.01 respectively) whereas no differences were observed regarding the ligand 2-AG. Regarding time domain features of HRV, a strong positive correlation was found between mean HR, AEA and PEA [r(13)=0.934, p<0.05, (r(13)=0.902, p<0.05]. Regarding frequency domain, a strong negative correlation was found between low frequency (LF) HRV and PEA (r(13)=−0.853, p<0.01). No statistically significant associations were noted between high frequency HRV and EC ligands.

Conclusions

These findings suggest that endocannabinoid-HRV interrelations might share a short-term, and long-term adaptability of the changes in self-regulation associated with stress. Further studies are required to determine the validity of peripheral eCB signaling and HRV as a biomarker for different aspects of stress response.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region of Attica

Prejudice against and desired social distance from refugees, people with mental illness and patients with COVID-19 in athens

Introduction

Stigma is omnipresent in human societies, both globally and historically; while it is also discerned in other primates. On these grounds, it has been suggested to be the product of natural selection and therefore to protect against threats to effective group functioning. Nonetheless, in contemporary society, stigma raises fundamental ethical concerns, while it actually impinges on public health

Objectives

To explore prejudicial attitudes and desired social distance from recovered COVID-19 patients, people with mental illness and refugees in Athens region.

Methods

A convenience sample of 360 residents of Athens region participated in the study, after being recruited from social media. The questionnaire was distributed online and encompassed: i) the Prejudicial Attitudes Survey, (ii) the Social Distance scale, (iii) the Interpersonal Reactivity Index and information about respondents’ socio-demographic characteristics and personal experience with the three population subgroups. The stigma measures were included three times, one for each out-group.

Results

Repeated ANOVA revealed that negative attitudes were predominantly expressed for refugees. On the contrary, positive attitudes were predominantly expressed for people with mental illness. Interestingly, desired social distance was greater from people with mental illness (mean = 32.37) compared to refugees (mean = 25.47) and recovered COVID-19 patients (mean = 24.17).

Conclusions

Stigma towards people with mental illness and refugees is still prevalent in Greece. Anti-stigma efforts should target prejudices in the case of refugees and social distance in the case of mental illness. To date, no stigma attached to COVID-19 has been discerned in the country

Disclosure

No significant relationships.

Hair loss in a female patient after administration of fluoxetine: a case report and review of the literature

OBJECTIVE

Fluoxetine is a pharmacological agent that has been widely used to determine the neurotransmission of serotonin in the central nervous system. It is the drug of choice in the treatment of depression due to its safer profile, fewer side effects, and greater tolerability.

PATIENTS AND METHODS

This is a case of a 30 year-old woman suffering from mild depression according to the DSM-V criteria who had been prescribed and administered fluoxetine in a dose of 20 mg p.o./per day.

RESULTS

Six weeks after the initiation of the medication, the patient reported hair loss in the frontal area of the skull.

CONCLUSIONS

Since fluoxetine is a widely used antidepressant, clinicians should be aware of the skin complications in patients treated with antidepressants. There is further need for therapeutic monitoring in everyday clinical practice and before the prescription of an antidepressant agent, the specific guidelines, side-effect profile, drug-drug interactions and most current indications should always be taken into consideration.

Attitudes of psychology students to depression and its treatment: Implications for clinical practice

Stigma and mental health literacy affect access to and quality of treatment of major depression. Though mental health professionals seem better able to recognize major depression than the general public, they often hold similarly stigmatizing attitudes towards people suffering from the disorder. These attitudes are shaped jointly by the public stigma attached to mental illnesses as well as by the content and delivery of mental health professionals' undergraduate training. In line with this, the present study aimed to explore psychology students' ability to recognize major depression, their attitudes towards the disorder, and their views surrounding helpfulness of various interventions. A random sample of 167 undergraduate students was recruited from the psychology department of one public university in Athens. During one university hour, students were administered a vignette describing a woman fulfilling the DSM-IV criteria for major depression. A self-report questionnaire exploring students' recognition abilities, attitudes to depression and views on the helpfulness of various treatment modes was also administered. In total, 80.2% of students correctly recognized major depression from the vignette. Concerning their attitudes, students were unsure about the illness and ambivalent towards the person who suffers from it. With regard to available treatments for depression, students considered discussion with a friend to be the most helpful intervention. Counseling, cognitive behavioural therapy and psychoanalysis were also viewed in a positive light. On the contrary, antidepressants were not deemed helpful by most students. Finally, recognition of as well as attitudes towards depression and its treatments seemed to improve during the second year of undergraduate study; however they remained unchanged thereafter. Consistent with these, psychology students seem to have only a rudimentary knowledge on depression, that cannot not be qualified as mental health literacy. The core misconception espoused pertains to the view that major depression is not a medical illness; a finding which can also be interpreted in light of the lingering controversy on the medicalization of normal sadness and human predicament. The clinical implications of these findings are substantial. Mental health professionals-educators should reflect on their own beliefs and attitudes towards depression, as they may convey stigmatizing messages to their students and thus perpetuate the stigmatization of the illness. Concomitantly, psychology students' attitudes to depression and its treatment might render them incapable of understanding their patients, responding to their needs and providing them with appropriate help, while they may hinder their effective collaboration with psychiatrists.

The impact of depression and cardiophobia on quality of life in patients with essential hypertension

Patients with chronic conditions like hypertension may experience many negative emotions which endorse the development of anxiety and depression symptomatology, thus they increase their risk for poor quality of life. Several studies have shown an association between symptoms of psychological distress and hypertension. In this study we aimed to quantify the link between depression, cardiophobia and quality of life in hypertensive patients. A cross-sectional design was employed. A sample of 197 hypertensive patients (89 men-108 women, mean age 53 years, SD=12 ranged 25-78) from a university outpatient hypertension clinic in Greece participated. Ninety-four (47.7%) of the participants suffered from essential grade I hypertension; 68 (34.5%) were grade II; 16 (8.1%) were categorized as grade III, while only 11 (5.6%) patients were recorded as normotensives with high normal values. The questionnaires included: (a) question for the recording of social-demographic characteristics and clinical features, (b) The Short Form (SF-36) Health Survey, (c) The Beck Depression Inventory -I, and (d) The Cardiac Anxiety Questionnaire. There were no significant differences between the two genders with exception of marital status (p=0.010), dyslipidemia (p=0.050), grade of hypertension (p=0.014), cardiac left ventricular hypertrophy (p=0.004), renal failure (p=0.043) and stroke (p=0.024). Lower levels of quality of life and higher levels of depression and cardiophobia were observed compared to the general population. There were no significant differences on psychological measures between the two sexes (p>0.05). Cardiophobia was positively related to depressive symptomatology (r=0.533, p=0.000) while negatively to both physical and mental health summary measures of SF-36 health survey (r=-0.467, p=0.000 r=-0.537, p=0.000 respectively). Multiple linear regression models found that for psychical health depression and cardiac anxiety, avoidance activities had an influence on levels of quality of life in hypertensive patients, after controlling for age and other socio-demographic variables and clinical characteristics (Beta=-0.133, p=0.007, Beta=-0.364 p=0.000 and Beta=-0.167 p=0.006, respectively). For mental component summary depression and cardiophobia, heart focused attention had also impact on mental health in hypertensives (Beta=-0.438, p=0.016, Beta=-0.564, p=0.000 and Beta=-0.223, p=0.037, respectively) after adjustments. Heart focused anxiety symptoms-as avoidance activities and/or attention and monitoring cardiac activity, are related to hypertensive patients' present deteriorated depressive symptoms and levels of quality of life. Both depressive symptomatology and heart focused anxiety may be a mechanism partly responsible for hypertensive patients' present impaired levels of quality of life.

[Group psychoeducational intervention in relatives of patients suffering from schizophrenia]

The present research paper aims at assessing the effectiveness of a psychoeducational intervention in relatives' groups of patients with schizophrenia or schizoaffective disorder. It examines the possible influence of the intervention on family members as well as on the course of the patient illness. Of a total of 131 relatives, 83 consisted the experimental group and 48 the control group. The relatives of the experimental group were divided into 5 groups and attended 18 psychoeducational sessions. Their patients as well s the patients and the relatives of the control group attended no specific intervention and continued their routine care. The psychoeducational intervention included education about the illness, communication skills training and training in problem-solving. It combined educational and psychotherapeutic techniques. The psychometric tools administered were: The Family Burden Scale, The Family Rituals Scale, The General Health Questionnaire GHQ-28, the Center for Epidemiological studies - Depression Scale (CES-D), the Opinions about Mental Illness Scale OMI, two scales concerning the knowledge about the illness, two questionnaires concerning expectations and feedback about the group process and questionnaires regarding sociodemographic characteristics of the sample and information about the illness. The number of hospitalizations of patients (n=91) during the research year was investigated. An interaction between group and measurement was found. While patient hospitalizations of both research groups did not differ significantly at the year before the study with X2=0.54, p=0.46), they differed when measured a year after the intervention, where patients in the intervention group had statistically significant fewer hospitalizations compared to the patients in the control group (x2=4.58, significant at p=0.032). As to the "compliance" in the medication, two statistical tests were conducted, taking into consideration that "compliance" by patients starting with a "very good" one can't be improved, while by those beginning with poor compliance can't be worsened. In the first investigation, which involved patients with possibility of amelioration or deterioration of "compliance", an improvement of patients (n=12) in the intervention group was recorded. This finding is statistically significant (p=0.0005). The second statistical test included all patients who were giving as an initial reply for the 'compliance' any value below "very good". In the intervention group there were 32 patients, 14 of whom showed improved "compliance" during the research year. This change is statistically significant (p=0.0014). The findings verify that the participation of relatives in psychoeducational groups leads to statistically significant improvement in the course of patient illness, as evident by the reduction in hospitalization rates and the improvement in adherence to pharmacotherapy. The study shows that relatives' psychoeducation constitutes a useful tool in improving the course of illness and empowering the family. The widespread implementation of relatives' psychoeducation in Greece is both necessary and challenging.

Homocysteine, cortisol, diabetes mellitus, and psychopathology

OBJECTIVE

This study investigates the association of homocysteine and cortisol with psychological factors in type 2 diabetic patients.

METHOD

Homocysteine, cortisol, and psychological variables were analyzed from 131 diabetic patients. Psychological factors were assessed with the Eysenck Personality Questionnaire (EPQ), Hostility and Direction of Hostility Questionnaire (HDHQ), the Symptom Checklist 90-R (SCL 90-R), the Zung Self-Rating Depression Scale (ZDRS), and the Maudsley O-C Inventory Questionnaire (MOCI). Blood samples were taken by measuring homocysteine and cortisol in both subgroups during the initial phase of the study (T0). One year later (T1), the uncontrolled diabetic patients were reevaluated with the use of the same psychometric instruments and with an identical blood analysis.

RESULTS

The relation of psychoticism and homocysteine is positive among controlled diabetic patients (P value = 0.006 < 0.05) and negative among uncontrolled ones (P value = 0.137). Higher values of cortisol correspond to lower scores on extraversion subscale (r(p) = -0.223, P value = 0.010). Controlled diabetic patients showed a statistically significant negative relationship between homocysteine and the act-out hostility subscale (r(sp) = -0.247, P = 0.023). There is a statistically significant relationship between homocysteine and somatization (r(sp) = -0.220, P = 0.043).

CONCLUSIONS

These findings support the notion that homocysteine and cortisol are related to trait and state psychological factors in patients with diabetes mellitus type 2.

Myocarditis after administration of clozapine

OBJECTIVE

Clozapine is an atypical antpsychotic medication with established efficacy in patients diagnosed of resistant schizophrenia. However, clozapine has multiple side effects. Cardiac complications such as myocarditis and cardiomyopathy have always been related with treatment with clozapine.

METHODS

A 42 year old Caucasian male, with history of schizophrenia developed a acute myocarditis after commencement of clozapine.

RESULTS

The patient recovered with intensive medical support. The symptoms occurred approximately 20 days after starting clozapine.

CONCLUSIONS

Myocarditis is an ingreasingly recognized complication associated with clozapine. Use of clozapine must be based on a balance of its risks and benefits on an individual basis which for the most part defines its use in treatment refractory schizophrenia. Appropriate monitoring of adverse events is an essential part of the clinical usage of clozapine and should be charted for at least two years.

Oxytocin and diabetes mellitus: a strong biochemical relation. Review

Oxytocin (OXT) is a neurohypophysial hormone which is synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. OXT is currently attracting considerable attention because it has been discovered that it regulates various functions of behavior especially in the context of social interactions. OXT is a key component in bone formation, glycemia, male sexuality, cardiac differentiation and pregnancy and thus it is important to be further explored. The authors review various aspects of gestational diabetes, including definition, screening, diagnostic procedures, complications, clinical evaluation, indications of delivery and neonatal aspects. Not only the relation among diabetes mellitus, oxytocin and neurophysiology concerning erectile dysfunction, but also the role of OXT in the activity of arginine and vasopressin is investigated. It is imperative to develop technological and experimental methods that will be able to reveal the oxytocin and its potential.

Abduction of Children by Their Parents: The Psychopathological Approach of the Problem in Mixed-ethnicity Marriages

Introduction:

Children abduction by one parent and their transport refers to a foreign country is a gradually increasing phenomenon worldwide as well as Greece. Data from the Greek Ministry of Justice show that the frequency of such incidences is up to one a day (360/year). Some but not all of these cases come to the attention of the International Social Services (Division of Greece).

Method:

Records of fifty (50) cases of inter family abduction were obtained. These were cases that took place during the year 2003. These records were studied and analysed. The majority of cases concerned abductions within the European Union. Permission from the Personal Data Protection service was obtained before the research.

Results:

It was found that fathers were predominantly the abductors (60%). Based on the medical records of the parents, the abductor had established psychopathology (fathers 51,1%; mothers 48,5%). The abducting fathers made significant use of violence (50%) compared to the mother abductors (20%). The legal procedures that ensued the abductions were particularly prolonged: The trial period until the reach of a verdict took an average of 3 years.

Conclusions:

In the cases of children abduction by a parent, there is high correlation between the action and the psychopathology of the abductor. The need for establishment of services appropriate to face this multidisciplinary problem is imminent. The long time each case takes to be resolved has obvious implications for the mental health of the children and the parents involved.