Diagnósticos e intervenções de enfermagem frente aos riscos cardiovasculares originados pelo estresse na população em situação de rua / Diagnoses and nursing interventions against cardiovascular risks caused by stress in the homeless population

ntrodução: O estresse está relacionado às doenças cardiovasculares, que são responsáveis por 27% das mortes no Brasil. A população em situação de rua encontra-se exposta a fatores de risco necessitando avaliação e acompanhamento de saúde devido às condições de vida que levam ao estresse persistente e potencialmente fatal. Objetivo: Estabelecer diagnósticos e intervenções de enfermagem, relacionando estresse e DCV nesta população. Métodos e procedimento: Este é um estudo exploratório, transversal e quantitativo, realizado na área central de São Paulo com 119 voluntários selecionados por conveniência entre novembro de 2021 e julho de 2022, aprovado pelo CEP: 036417, CAAE:21519413.40000.5511. Resultado: 35% dos 119 entrevistados afirmam sentir muito estresse ou que isso afeta sua rotina. Valores de pressão arterial e frequência cardíaca estão acima do recomendado. A escala de Likert mostra 32% com proteção ineficaz, risco cardiovascular prejudicado e síndrome do estresse de realocação. Conclusão: Estratégias de saúde são cruciais para atender às necessidades humanas básicas da população em situação de rua, incluindo conscientização sobre riscos cardiovasculares e acesso a cuidados básicos de saúde. A implementação do processo de enfermagem pode ajudar a abordar essas necessidades. (AU)

Stress is related to cardiovascular diseases, which are responsible for 27% of deaths in Brazil. The homeless population is exposed to risk factors, requiring health evaluation and monitoring due to living conditions that lead to persistent and potentially fatal stress. Objective: To establish nursing diagnoses and interventions, relating stress and CVD in this population. Methods and procedure: This is an exploratory, cross-sectional, and quantitative study conducted in downtown São Paulo with 119 volunteers selected by convenience between November 2021 and July 2022, approved by CEP: 036417, CAAE:21519413.40000.5511. Result: 35% of 119 respondents report feeling high stress or that it affects their routine. Blood pressure and heart rate values are above recommended levels. The Likert scale shows 32% with ineffective protection, impaired cardiovascular risk, and relocation stress syndrome. Conclusion: Health strategies are crucial to meet the basic human needs of the homeless population, including awareness of cardiovascular risks and access to basic health care. The implementation of the nursing process can help address these needs.(AU)

El estrés está relacionado con las enfermedades cardiovasculares, que son responsables del 27% de las muertes en Brasil. A população em situação de rua encontra-se exposta a fatores de risco necessitando avaliação e acompanhamento de saúde devido às condições de vida que levam ao stress persistente e potencialmente fatal. Objetivo: Establecer diagnósticos e intervenciones de enfermagem, relacionando estresse e DCV nesta população. Método y procedimiento: Se trata de un estudio exploratorio, transversal y cuantitativo, realizado en el área central de São Paulo con 119 voluntarios seleccionados por conveniencia entre noviembre de 2021 y julio de 2022, aprobado por CEP: 036417, CAAE:21519413.40000.5511. Resultados: 35% de los 119 encuestados afirman sentir mucho estrés o que éste afecta su rutina. Los valores de presión arterial y frecuencia cardíaca están por encima de lo recomendado. Escala de Likert muestra 32% con protección ineficaz, riesgo cardiovascular alterado y síndrome de estrés de reubicación. Conclusión: Las estrategias de salud son cruciales para satisfacer las necesidades humanas básicas de las personas sin hogar, incluyendo la concienciación sobre los riesgos cardiovasculares y el acceso a la atención sanitaria básica. La aplicación del proceso de enfermería puede ayudar a abordar estas necesidades.(AU)

Alostasis y carga alostática de las enfermedades / Allostasis and allostatic load of diseases

Introducción: La homeostasis es la propiedad fundamental de los sistemas biológicos de preservar el medio interno. La presión arterial, el pH, las concentraciones plasmáticas de sodio y glucosa son ejemplos de variables homeostáticos, donde el propósito de la regulación fisiológica es fijar cada parámetro interno en un punto de ajuste, detecta errores y los corrige con realimentación negativa. Los fisiólogos han evidenciado que muchos errores no son constantes sino adaptativos. Objetivo: Exponer los conceptos novedosos acerca de la influencia de un ambiente de estrés sobre nuestra fisiología y sus efectos deletéreos a largo plazo. Métodos: Se realizó una revisión bibliográfica, en el motor de búsqueda Google académico, los descriptores: homeostasis, alostasis y carga alostática. Conclusiones: Se expuso los conceptos novedosos acerca de la influencia de un ambiente de estrés sobre nuestra fisiología y sus efectos deletéreos a largo plazo. La alostasis es el precio que el cuerpo paga por verse obligado a adaptarse a situaciones psicosociales o físicas adversas. La obesidad, la diabetes, la insulinoresistencia, la hipertensión arterial, son variables alostáticas, no homeostáticas, no son parámetros constantes, sino adaptativos, el organismo cambiará su medio interno para enfrentar el desafío o perturbación que le llega desde el exterior. Pensar en muchas de estas patologías bajo un modelo alostático puede enriquecer los recursos conceptuales del médico y modificar el abordaje de enfermedades prevalentes(AU)

Introduction: Homeostasis is the fundamental property of biological systems to preserve the internal environment. Blood pressure, pH, plasma sodium and glucose concentrations are examples of homeostatic variables, where the purpose of physiological regulation is to fix each internal parameter at a set point, detect errors and correct them with negative feedback. Physiologists have shown that many errors are not constant but adaptive. Objective: To expose novel concepts about the influence of a stressful environment on our physiology and its deleterious long-term effects. Methods: A literature review was performed, in the academic Google search engine, the descriptors: homeostasis, allostasis and allostatic load. Conclusions: Novel concepts about the influence of a stressful environment on our physiology and its deleterious long-term effects were exposed. Allostasis is the price the body pays for being forced to adapt to adverse psychosocial or physical situations. Obesity, diabetes, insulin resistance, arterial hypertension, are allostatic variables, not homeostatic, they are not constant parameters, but adaptive, the organism will change its internal environment to face the challenge or perturbation that comes from the outside. Thinking about many of these pathologies under an allostatic model can enrich the conceptual resources of the physician and modify the approach to prevalent diseases(AU)

Impacto del tratamiento de adultos mayores con ISRS y su relación con los tratamientos odontológicos / The impact of treating older adults with SSRI and its relationship with dental treatments

La población mayor de 60 años es el grupo etario de mayor crecimiento en el mundo. Debido a que la depresión es una patología frecuente en la persona adulta mayor y anciana, los inhibidores de la recap- tación de la serotonina (ISRS) son el tratamiento de primera línea de elección. Este trabajo referencia la asociación del consumo de estos fármacos con la disminución de la densidad ósea mineral (DMO), el riesgo de fracturas y su repercusión en la atención odontológica. Además, incluye una breve descripción de la homeostasis ósea y la relación depresión-carga alostática. El trabajo interdisciplinario y una correcta anamnesis pueden detectar posibles complicaciones y riesgos vinculados con este tipo de medicamen- tos. Ello facilitaría un mejor manejo, más aún en el adulto mayor, donde una pequeña variable puede repercutir en su integridad (AU)

The population over 60 is the fastest growing age group in the world. Depression is a frequent pathology in the elderly and the elderly, with serotonin reuptake inhibitors (SSRI) being the 1st line treatment of choice. The association of the consumption of this drug with a decrease in bone mineral density (BMD), risk of fractures and its impact on dental care are referenced in this work. In addition, it includes a brief description of bone homeostasis and the depression-allostatic load relationship. Interdisciplinary work and a correct anamnesis can detect possible complications and risks linked to this type of medication, facilitating better management and even more so in the elderly, where a small variable can affect their integrity (AU)

How stress mediators can cumulatively contribute to Alzheimer's disease: an allostatic load approach / Como os mediadores de estresse podem contribuir cumulativamente para a doença de alzheimer: uma abordagem de carga alostática

ABSTRACT. Allostatic load is defined as the frequent activation of the neuroendocrine, immunological, metabolic and cardiovascular systems, which makes individuals more susceptible to stress-related health problems. According to this model, physiological dysregulations start to emerge decades before diseases manifest. Consequently, stress research has shifted its attention to anticipating the degree of this dysregulation to better understand the impact of stress hormones and other biomarkers on disease progression. In view of the growing number of studies that demonstrate the influence of modifiable risk factors on cognitive decline, in addition to the effects of chronic stress mediators, the objective of the present review was to present an overview of the development of cognitive changes based on studies on stress and its mediators.

RESUMO. A carga alostática é definida como a ativação frequente dos sistemas neuroendócrino, imunológico, metabólico e cardiovascular, o que torna os indivíduos mais suscetíveis a problemas de saúde relacionados ao estresse. Segundo este modelo, as desregulações fisiológicas começam a surgir décadas antes das doenças se manifestarem. Consequentemente, a pesquisa de estresse tem desviado sua atenção para antecipar o grau de desregulação para entender melhor o impacto dos hormônios do estresse e outros biomarcadores na progressão da doença. Tendo em vista o crescente número de estudos que demonstram a influência de fatores de risco modificáveis no declínio cognitivo, além dos efeitos dos mediadores crônicos do estresse, o objetivo da presente revisão foi apresentar uma visão geral do desenvolvimento de alterações cognitivas a partir de estudos sobre o estresse e seus mediadores.

Estresse de aculturação e carga alostática entre mulheres imigrantes mexicanas / Acculturation stress and allostatic load among Mexican immigrant women / Estrés aculturativo y carga alostática en las mujeres inmigrantes mexicanas

Objetivos este estudo de caso-controle comparou os níveis de estresse e carga alostática (CA) entre mulheres mexicanas nos EUA ( n = 19) e no México ( n = 40). Método medidas de estresse incluíram a Escala de Estresse Percebido (EEP) e a Escala de Estresse Social das Mulheres Hispânicas (EESMH). Uma medida composta por 8 indicadores de CA (pressão arterial sistólica e diastólica, índice de massa corporal (IMC), relação cintura-quadril, colesterol total, hemoglobina glicada (hemoglobina A1C), triglicerídeos e proteína C-reativa) foi calculada. Resultados não houve diferenças significativas entre os grupos na CA entre mulheres mexicanas imigrantes e não imigrantes ( t = 1,55, p = 0,126). Uma análise fatorial de componentes principais foi realizada nos 8 indicadores de CA; uma solução de 2 fatores explicou 57% da variância. As diferenças entre grupo nos dois fatores CA foram analisadas usando MANOVA. O IMC e a relação cintura-quadril foram menores, mas a pressão arterial e os triglicerídeos foram maiores no grupo dos EUA e foram mediados pelo tempo nos EUA. O maior estresse de aculturação foi significativamente relacionado ao aumento da relação cintura-quadril ( r = 0,57, p = 0,02). Considerações finais os resultados sugerem que algumas medidas de CA aumentam com o tempo nos EUA e o estresse de aculturação pode ser um fator significativo.

Objectives this case-control study compared levels of stress and allostatic load (AL) among Mexican women in the US ( n =19) and Mexico ( n = 40). Method measures of stress included the Perceived Stress Scale (PSS) and the Hispanic Women's Social Stressor Scale (HWSSS). A composite measure of 8 indicators of AL (systolic and diastolic blood pressure, body mass index (BMI), waist-to-hip ratio, total cholesterol, glycated hemoglobin (hemoglobin A1C), triglycerides and C-reactive protein) was calculated. Results there were no significant group differences in AL between Mexican and Mexican immigrant women ( t = 1.55, p = .126). A principal component factor analysis was conducted on the 8 AL indicators; a 2-factor solution explained 57% of the variance. Group differences in the two AL factors were analyzed using MANOVA. BMI and waist-to-hip ratios were lower, but blood pressure and triglycerides were higher in the US group and were mediated by time in the US. Greater acculturation stress was significantly related to increased waist-to-hip ratio ( r = .57, p = .02). Final remarks findings suggest some measures of AL increased with time in the US, and acculturation stress may be a significant factor.

Objetivos este estudio de casos y controles ha comparado los niveles de estrés y carga alostática (CA) en mujeres mexicanas en los EE.UU. ( n = 19) y México ( n = 40). Método las medidas de estrés incluyeron la Escala de Estrés Percibido (EEP) y la Escala de Estrés Social de las Mujeres Hispanas (HWSSS, por sus siglas en inglés). Se calculó una medida compuesta de 8 indicadores de CA (presión arterial sistólica, presión arterial diastólica, índice de masa corporal (IMC), relación cintura/cadera, colesterol total, hemoglobina glicosilada (HbA1c), triglicéridos, y proteína C reactiva). Resultados no hubo diferencias significativas de CA entre los grupos de mujeres mexicanas e inmigrantes mexicanas ( t = 1,55, p = 0,126). Se realizó un análisis factorial de componente principal de los 8 indicadores de CA; una solución de 2 factores explicó el 57% de la varianza. Las diferencias de grupo en los dos factores de CA se analizaron utilizando MANOVA. El IMC y la relación cintura/cadera disminuyeron, pero la presión arterial y los triglicéridos aumentaron en el grupo de los EE.UU. y estuvieron influenciados por el tiempo de residencia en los EE.UU. Un mayor estrés aculturativo se relacionó significativamente con el aumento de la relación cintura/cadera (r = 0,57, p = 0,02). Comentarios finales los hallazgos sugieren que algunas medidas de CA aumentan con el tiempo de residencia en los EE.UU. y el estrés aculturativo puede ser un factor importante.

Social Factors Contributing to the Development of Allostatic Load in Older Adults: A Correlational-Predictive Study / Factores sociales que contribuyen al desarrollo de la carga alostática en adultos mayores: un estudio correlacional-predictivo / Fatores sociais que contribuem para o desenvolvimento da carga alostática em idosos: um estudo preditivo correlacional

ABSTRACT Objective: To determine if social factors, such as housing conditions, satisfaction with one's house, neighborhood characteristics, social support, family relations and church attendance affect allostatic load in older adults. Materials and method: A correlational-predictive, cross-sectional study was conducted. The instruments used were sociodemographic data, the perceived family relationships instrument, the Medical Outcomes Study-Social Support Survey and the abbreviated version of the Neighborhood Environment Walkability Scale. The allostatic load biomarkers used were: systolic and diastolic blood pressure, body mass index, waist circumference, waist-hip ratio, total cholesterol, high density lipoprotein, glycated hemoglobin, fibrinogen, and C-reactive protein. Sample size was estimated to contrast the no relation (R2= 0) hypotheis in a multiple lineal regression model with 11 covariables, with a significance level of .05, power of 90% (.90), when coefficient of determination (R2) is .15, resulting in a sample of 131 older adults. The statistical analysis included descriptive measures and generalized linear models. Results: The participants had either medium- or high-risk allostatic load. Multivariate linear regression model analysis showed that better housing conditions, satisfaction with own house, presence of dead-end streets, and church attendance reduce allostatic load, while dangerous traffic increases allostatic load. Conclusions: There are several social factors contributing to the development of allostatic load in older adults. It is necessary to create nursing care strategies toward the social environment to decrease allostatic load in older adults.

RESUMEN Objetivo: determinar si factores sociales como las condiciones de vivienda, la satisfacción con la casa, las características del vecindario, el apoyo social, las relaciones familiares y la asistencia a la iglesia contribuyen al desarrollo de la carga alostática en los adultos mayores. Materiales y método: se realizó un estudio correlacional y predictivo de corte transversal. Los instrumentos utilizados fueron una hoja de datos sociodemográficos, el instrumento de relaciones familiares percibidas, el cuestionario de Apoyo Social y la Escala de Movilidad Activa en el Entorno Comunitario, versión corta. Los biomarcadores de carga alostática utilizados fueron: presión arterial sistólica y diastólica, índice de masa corporal, circunferencia de la cintura, relación cintura-cadera, colesterol total, lipoproteína de alta densidad, hemoglobina glicosilada, fibrinógeno y proteína C-Reactiva. La muestra se calculó para para el contraste de la hipótesis de no relación (R2= 0), en un modelo de regresión lineal múltiple con 11 covariables, con un nivel de significancia del .05 y una potencia del 90 % (.90), cuando el coeficinete de determinación poblacional (R2) es .15, tamaño de muestra que resultó en 131 adultos mayores. El análisis estadístico incluyó medidas descriptivas y modelos lineales generalizados. Resultados: los participantes tenían un riesgo medio o alto de carga alostática. El análisis del modelo de regresión lineal multivariante mostró que las mejores condiciones de vivienda, la satisfacción con la propia casa, la presencia de calles sin salida y la asistencia a la iglesia reducen la carga alostática y que el tráfico peligroso aumenta la carga alostática. Conclusiones: existen varios factores sociales que contribuyen al desarrollo de la carga alostática en adultos mayores. Es necesario crear estrategias de cuidado de enfermería hacia el entorno social para disminuir la carga alostática en el adulto mayor.

RESUMO Objetivo: determinar se fatores sociais, como as condições de moradia, a satisfação com a casa, as características do bairro, o apoio social, as relações familiares e a freqüência à igreja afetam a carga alostática em idosos. Materiais e método: um estudo de correlação transversal e preditivo foi realizado. Os instrumentos utilizados foram dados sociodemográficos, o instrumento de relações familiares percebido, o Medical Outcomes Study-Social Support Survey e a Abbreviated Neighborhood Environment Walkability Scale. Os biomarcadores de carga alostática utilizados foram: pressão arterial sistólica e diastólica, índice de massa corporal, circunferência da cintura, relação cintura-quadril, colesterol total, lipoproteína de alta densidade, hemoglobina glicada, fibrinogênio e proteína C-reativa. A amostra foi calculada para o contraste do hipóseo de nenhuma relação (R2 = 0), em um modelo de regresión múltiple linear con 11 covariáveis, com um nível de significância de 0.05 e uma potencia de 90% (0.90), quando o coeficiente de determinação populacional (R2) es .15, o tamanho da amostra resultou em 131 idosos. A análise estatística incluiu medidas descritivas e modelos lineares generalizados. Resultados: os participantes tinham risco médio ou alto de carga alostática. A análise multivariada do modelo de regressão linear mostrou que melhores condições de moradia, satisfação com a casa própria, presença de ruas sem saída e freqüência à igreja reduzem a carga alostática e o tráfego perigoso aumenta a carga alostática. Conclusões: existem vários fatores sociais que contribuem para o desenvolvimento da carga alostática em idosos. É necessário criar estratégias de cuidados de enfermagem em direção ao ambiente social para diminuir a carga alostática no idoso.

The Staging of Major Mood Disorders: Clinical and Neurobiological Correlates

OBJECTIVE: Staging of psychiatric disorders is gaining momentum and the purpose of this review is to examine whether major mood disorders can be defined according to stages. METHODS: In April 2018 the PubMed electronic data base was scrutinized by a combination of various search terms like “major depressive disorder and staging,”“bipolar disorder and neuroprogression,” etc. To incorporate the latest findings the search was limited to the last 10 years. Both original and review articles were examined by reading the abstracts, and papers which were found to be particularly applicable were read in full and their reference lists were also consulted. RESULTS: A significant increase occurred in the number of papers published on the topic of staging of mood disorders. Staging formats were found for both major mood disorders, with the caveat that many more articles were discovered for bipolar disorder. Current evidence points to allostatic load and neuroprogression as the basis for staging of mood disorders. CONCLUSION: Principal affective illnesses may be characterized by distinct stages, for instance early, intermediate and late. These phases inform the management so that clinicians should incorporate the staging schema into everyday practice and implement treatment strategies according to the phase of the illness.

Allostatic load and canine companionship: a comparative study using biomarkers in older adults / Carga alostática e companhia canina: um estudo comparativo utilizando biomarcadores em idosos / Carga alostática y compañía canina: un estudio comparativo mediante biomarcadores en adultos mayores

ABSTRACT Objective: to compare the biomarkers and the allostatic load levels in a sample of older persons with and without canine companionship. Method: descriptive and comparative study. Data were collected using a sociodemographic questionnaire and a fasting blood sample. The allostatic load comprised 11 biomarkers that are primary and secondary stress mediators, which arise from the following systems: neuroendocrine, immune, metabolic, cardiovascular and anthropometric. Results: a significant difference was found in two biomarkers: cortisol (t= -3.091, df=104, p=0.003) and total cholesterol (t= -2.566, df=104, p=0.012), in the allostatic load levels between older adults with and without a canine companionship (U= 1714.00, Z= 2.01, p=0.044). By associating the allostatic load level with the canine companionship, there was a higher frequency of older adults with low allostatic load among those who have canine companion, compared with those who do not have canine companionship. (χ2= 3.69, df=1, p= 0.043). Conclusion: canine companionship influences health in a positive way, as the allostatic load is lower in older adults who have a dog as companion, in addition to presenting lower levels of cortisol and total cholesterol.

RESUMO Objetivo: comparar os biomarcadores e o nível de carga alostática em uma amostra de idosos com e sem companhia canina. Método: estudo descritivo e comparativo. Os dados foram coletados por meio de uma ficha sociodemográfica e uma amostra de sangue em jejum. A carga alostática incluiu 11 biomarcadores que são mediadores primários e secundários de estresse, os quais são resultantes dos sistemas: neuroendócrino, imune, metabólico, cardiovascular e antropométrico. Resultados: houve diferença significativa em dois biomarcadores: cortisol (t= -3,091; gl=104; p=0,003) e colesterol total (t= -2,566; gl=104; p=0,012), no nível de carga alostática entre os idosos com e sem companhia canina (U= 1714,00; Z= 2,01; p= 0,044). Ao associar o nível de carga alostática com a companhia canina, houve uma maior frequência de idosos com baixa carga alostática naqueles que têm companhia canina, em comparação com aqueles que não têm a companhia canina (χ2= 3,69; gl=1; p=0,043). Conclusão: a companhia canina interfere na saúde de maneira positiva, pois a carga alostática dos idosos que têm um cão como companhia é menor, além de apresentarem uma concentração menor de cortisol e de colesterol total.

RESUMEN Objetivo: comparar los biomarcadores y el nivel de carga alostática en una muestra de adultos mayores con y sin acompañamiento canino. Método: estudio descriptivo, comparativo. Los datos se colectaron mediante una ficha sociodemográfica y una muestra de sangre en ayuno. La carga alostática incluyó 11 biomarcadores que son mediadores primarios y secundarios del estrés, los cuales provienen de los sistemas: neuroendocrino, inmune, metabólico, cardiovascular y antropométrico. Resultados: hubo diferencia significativa en dos biomarcadores: cortisol (t=-3.091, gl=104, p=0.003) y colesterol total (t=-2.566, gl=104, p=0.012), en el nivel de carga alostática entre los adultos mayores con y sin compañía canina (U=1714.00, Z=2.01, p=0.044). Al asociar el nivel de carga alostática con la compañía canina, existió mayor frecuencia de adultos mayores con carga alostática baja en quienes son acompañados por un canino, comparado con aquellos que no tienen acompañamiento canino (χ2=3.69, gl=1, p=0.043). Conclusión: el acompañamiento canino interviene en la salud de forma positiva, ya que es menor la carga alostática de los adultos mayores que tienen un perro como compañía, asimismo, presentan menor concentración de cortisol y colesterol total.

Eurycoma Longifolia as a potential adoptogen of male sexual health: a systematic review on clinical studies / 中国天然药物

Eurycoma longifolia (EL) has been well recognized as a booster of male sexual health. Over the past few decades, numerous in vivo animal studies and human clinical trials have been conducted across the globe to explore the promising role of EL in managing various male sexual disorders, which include erectile dysfunction, male infertility, low libido, and downregulated testosterone levels. The aim of the present review is to analyze and summarize the literature on human clinical trials which revealed the clinical significance and therapeutic feasibility of EL in improving male sexual health. This systematic review is focused on the following databases: Medline, Wiley Online Library, BioMed Central, Hindawi, Web of Knowledge, PubMed Central and Google Scholar, using search terms such as "Eurycoma longifolia", "EL", "Tongkat Ali", "male sexual health", "sexual infertility", "erectile dysfunction", "male libido", and "testosterone levels". Notably, only human clinical studies published between 2000 and 2014 were selected and thoroughly reviewed for relevant citations. Out of 150 articles, 11 met the inclusion criteria. The majority of articles included were randomized placebo-controlled trials, multiple cohort studies, or pilot trials. All these studies demonstrated considerable effects of EL on male sexual health disorders. Among them, 7 studies revealed remarkable association between the use of EL and the efficacy in the treatment of male sexual disorders, and remaining 4 studies failed to demonstrate sufficient effects on male sexual health. In summary, there is convincing evidence for the prominence of EL in improving the male sexual health. The review also substantiates the use of current methodology in the development of novel and more rationale natural herbal medicines for the management of male sexual disorders.

Neuroinflammation and Psychiatric Illness

Neuroinflammation is one of important allostatic loads contributory to the various psychiatric illness. It is mediated mainly by glial cells, which produce both proinflammatory and antiinflammatory cytokines, and the balance of them determines the inflammatory process in the central nervous system. S100 calcium-binding protein B, which is used as an inflammatory marker is also released by glial cells. In the molecular level, oxidative stress contributes to the neuroinflammation. Their disturbances have been revealed in the psychiatric illness and related with the dysregulation of the glutamatergic and monoaminergic systems. There is a possibility to use them as disease markers. The approach for inflammation using antiinflammatory drugs and antioxidants could be connected to the development of disease-modifying treatments. Also, a searching examination about specific subtypes who are vulnerable to inflammation in the patients is required to confirm their efficacy clearly.

Staging Models in Bipolar Disorder: A Systematic Review of the Literature

Bipolar disorder is manifested as severe dysregulation of mood with recurrent manic and major depressive episodes. It is associated with psychiatric and medical comorbidities, inadequate response to currently available pharmacological agents and a progressively deteriorating course in many patients. The index episode is often depressive in nature, while the first manic or hypomanic episode may occur several years later in the course of the disorder causing delay in diagnosis and use of inappropriate treatment strategies. Staging has been used to great advantage in other branches of medicine like cardiology and oncology. There is growing realization that major mental disorders are fundamentally progressive, with simpler treatment requirements and better prognosis during initial stages of the illness. Defining these conditions into clinically applicable stages not only helps in better understanding the trajectory of a particular disorder, but also assists in management. Patients with a chronic, recalcitrant condition like bipolar disorder are likely to greatly benefit from this approach. If the illness is correctly identified early in its course, proper treatment can be instigated arresting progression to latter phases which are associated with myriad complications in the biopsychosocial realm. With these considerations, a search of the MEDLINE data base was conducted to seek out literature pertaining to staging models in bipolar disorder. A thorough scrutiny of the existing research work revealed that a number of investigators have endeavored to stage define bipolar disorder. This paper outlines staging proposals for bipolar disorder which have the greatest supporting evidence in the literature.

Resposta ao estresse: II. resiliência e vulnerabilidade / Stress response: II. resilience and vulnerability / Respuesta al estrés: II. resiliencia y vulnerabilidad

A crescente exposição a estressores na vida cotidiana aumentou significativamente a investigação da resposta ao estresse nas duas últimas décadas. Embora associada a consequências negativas, pois muitas patologias físicas e mentais são desencadeadas por exposição crônica a estressores, esta resposta é indispensável para sobrevivencia do indivíduo e é extremamente adaptativa quando ativada de forma aguda. Na parte I desta revisão foram abordados os conceitos de homestase e alostase e os sistemas fisiológicos ativados durante a resposta ao estresse. Na parte II serão discutidos fatores que modulam a resposta ao estresse tais como sexo, temperamento, períodos críticos do desenvolvimento e a presença ou ausência de suporte social. A interação entre os fatores genéticos e ambientais gera os perfis da resposta psicofisiológica que caracterizam os fenótipos de susceptibilidade e resiliência frente aos estressores e sua relação com uma patologia mental cada vez mais presente na sociedade moderna, o transtorno de estresse pós-traumático.

The heightened exposure to everyday stressors in recent decades has significantly increased the number of stress response studies. Although stress response has often been associated to negative outcomes, since a number of physical and psychological diseases are triggered by chronic stress exposure, this response is essential to survival and extremely adaptive when activated in an acute manner. In Part I of this review homeostasis, allostasis and the functioning of physiological systems mobilized to cope with stress were examined. In Part II stress response modulators such as sex, temperament, ontogenetically sensitive periods and the presence or absence of social support will be discussed. The interaction between genetic and environmental factors generates the profiles that characterize susceptible and resilient phenotypes, and their relationship with an increasingly common psychopathology in modern society, Posttraumatic Stress Disorder.

La creciente exposición a los agentes estresantes en la vida diaria aumentó significativamente la investigación de la respuesta al estrés en las dos últimas décadas. Aunque asociada a las consecuencias negativas, pues muchas patologías físicas y mentales son desencadenadas por exposición crónica a estresantes, esta respuesta es indispensable para sobrevivencia del individuo y es extremamente adaptativa cuando activada de forma aguda. En la parte I de este repaso fueron abordados los conceptos de homeostasis y alostasis y los sistemas fisiológicos activados durante la respuesta al estrés. En la parte II serán discutidos factores que modulan la respuesta al estrés tales como sexo, temperamento, períodos críticos del desarrollo y la presencia o ausencia de soporte social. La interacción entre os factores genéticos y ambientales genera los perfiles de la respuesta psicofisiológica que caracterizan los fenotipos de susceptibilidad y resiliencia frente a los estresantes y su relación con una patología mental cada vez más presente en la sociedad moderna, el trastorno por estrés postraumático.

Resposta ao estresse: l. homeostase e teoria da alostase / Stress response: l. homestasis and allostasis theory / Respuesta al estrés: l. homeostasis y teoría de la alostasis

Os seres vivos desenvolvem ao longo de sua história evolutiva mecanismos de enfrentamento às condições adversas originadas tanto no ambiente geofísico como no ambiente social. Esta resposta adaptativa é coordenada e envolve diferentes sistemas funcionais, particularmente, os sistemas nervoso, endócrino e imune, e é denominada de resposta ao estresse e deve atender a duas demandas principais da vida: sobrevivência e reprodução. Esta revisão tem o objetivo de discutir o emprego do conceito clássico de homeostase e um conceito alternativo, alostase, que inclui os mecanismos preditivos e reativos de regulação, assim como os diferentes níveis de impacto dos estressores crônicos, resultando em sobrecarga alostática que pode ou não se seguir de falha alostática. Os mecanismos neurais, hormonais, imunes, sistêmicos e moleculares, que compreendem os sistemas alóstaticos subjacentes à resposta ao estresse são também apresentados.

Over the course of their evolution organisms developed mechanisms to cope with challenging situations originating from both physical and social environments. These adaptive mechanisms are coordinated and involve the sequential and/or simultaneous recruitment of different functional systems, mainly neural, endocrine and immune, the so-called stress response. They operate to maintain physiological variables at suitable. This review aims to discuss the use of the classical homeostasis concept and allostasis, an alternative model, which includes reactive and predictive mechanisms, as well as the different levels of impact of the chronic stressor, resulting in allostatic overload or allostatic failure. The organizing role of neural, hormonal, immune, systemic and molecular mechanisms, which comprise the allostatic systems underlying the stress response, is also presented.

Los seres vivos desarrollan a lo largo de su historia evolutiva mecanismos de enfrentamiento a las condiciones adversas originadas tanto en el ambiente geofísico como en el ambiente social. Esta respuesta adaptativa es coordinada y envuelve distintos sistemas funcionales, particularmente, el sistema nervioso, endócrino e inmune y es denominada de respuesta al estrés y debe atender a las dos demandas principales de la vida: supervivencia y reproducción. Esta revisión tiene como objetivo de discutir el empleo del concepto clásico de homeostasis y una concepto alternativa, alostasis, que incluye los mecanismos y el impacto de los agentes de estresores crónicos resultando en sobrecarga alostática o falla alostática. Los mecanismos neuronales, hormonales e inmunes, sistémicos y moleculares que comprenden los sistemas alóstaticos subyacentes a la respuesta al estrés son también presentados.

Depression as an Inflammatory Disease / 대한정신약물학회지

Inflammation is an immune response engaged with the reciprocal interactions among the neural, endocrine and immune system. From this psychoneuroimmunological view, inflammation is one of important allostatic loads contributory to depression. Sickness behaviors in the inflammatory state share many parts of depressive symptoms and patients treated with cytokines for various illnesses are at increased risk of developing depression. The dysfunctions of cytokines and hypothalamic-pituitary-adrenal axis have been widely investigated to find out inflammatory responses. Inflammatory mediators such as cytokines, glucocorticoid and C-reactive protein affect the etiopathogenesis of depression via altered monoamine and glutamate neurotransmission, glucocorticoid receptor resistance and neurogenesis. Although inflammation is subtle and not easy to be detected in the wide population, it is basal pathophysiology and plays an important role at least to the vulnerable patients. From this perspectives, inflammatory markers may be useful in the diagnosis and prediction of treatment response, leading to the possibility of tailored treatments. Understanding depression as a kind of inflammatory disease would provide new opportunities for the psychiatry beyond monoamine theory.

Relationships between Dietary Habits and Allostatic Load Index in Metabolic Syndrome Patients / 가정의학회지

BACKGROUND: Allostatic load (AL) measures overall physiological wear and tear on one's body, as a preclinical marker of pathophysiologic processes that precede the onset of disease. We studied the association of dietary habits with AL. METHODS: Consecutive patients visiting a tertiary hospital Health Promotion Center from September 2009 to February 2010, older than 20 years with metabolic syndrome were selected for study (n = 204). By multivariable linear regression analysis, we investigated the association of various dietary habits evaluated by questionnaires. RESULTS: In male, multivariable linear regression showed a significant negative association between fat preference and AL with BMI > or = 30 (1st quartile [Q] vs. 2Q: beta = -3.71; 95% confidence interval [CI], -6.26 to -1.16), a significant negative association between salt preference and AL with BMI 25-30 (beta = -1.36; 95% CI, -2.46 to -0.26), a negative association between appetite control and AL with BMI < 25 (1Q vs. 3Q: beta = -1.54; 95% CI, -3.00 to -0.096), a significant positive association between appetite control and AL with BMI 25-30 (1Q vs. 3Q: beta = 1.30; 95% CI, 0.12 to 2.48), and a significant positive association between eating in response to food cues and AL in males with BMI 25-30 (1Q vs. 4Q: beta = 1.09; 95% CI, 0.020 to 2.15). CONCLUSION: Our results suggest that metabolic syndrome patients should be discouraged from eating fat and eating in response to food cues, and should be educated about nutrition and balanced diet.

The "selfish brain" hypothesis for metabolic abnormalities in bipolar disorder and schizophrenia / A hipótese do "cérebro egoísta" para alterações metabólicas no transtorno bipolar e na esquizofrenia

Metabolic abnormalities are frequent in patients with schizophrenia and bipolar disorder (BD), leading to a high prevalence of diabetes and metabolic syndrome in this population. Moreover, mortality rates among patients are higher than in the general population, especially due to cardiovascular diseases. Several neurobiological systems involved in energy metabolism have been shown to be altered in both illnesses; however, the cause of metabolic abnormalities and how they relate to schizophrenia and BD pathophysiology are still largely unknown. The "selfish brain" theory is a recent paradigm postulating that, in order to maintain its own energy supply stable, the brain modulates energy metabolism in the periphery by regulation of both allocation and intake of nutrients. We hypothesize that the metabolic alterations observed in these disorders are a result of an inefficient regulation of the brain energy supply and its compensatory mechanisms. The selfish brain theory can also expand our understanding of stress adaptation and neuroprogression in schizophrenia and BD, and, overall, can have important clinical implications for both illnesses (AU)

Alterações metabólicas são frequentes em pacientes com esquizofrenia e transtorno bipolar (TB), levando a uma alta prevalência de diabetes e síndrome metabólica nessa população. Além disso, as taxas de mortalidade entre pacientes são mais altas do que na população geral, especialmente em decorrência de doenças cardiovasculares. Vários sistemas neurobiológicos envolvidos no metabolismo energético têm demonstrado alterações nas duas doenças; no entanto, a causa das alterações metabólicas e a forma como elas se relacionam com a fisiopatologia da esquizofrenia e do TB ainda são arenas em grande parte desconhecidas. A teoria do "cérebro egoísta" é um paradigma recente que postula que, para manter estável seu próprio fornecimento de energia, o cérebro modula o metabolismo da energia na periferia regulando tanto a alocação quanto a ingestão de nutrientes. Apresentamos neste artigo a hipótese de que as alterações metabólicas observadas nesses transtornos são resultado de uma regulação ineficiente do fornecimento de energia do cérebro e seus mecanismos compensatórios. A teoria do cérebro egoísta também pode expandir nosso entendimento sobre a adaptação ao estresse e a neuroprogressão na esquizofrenia e no TB, e, acima de tudo, pode ter implicações clínicas importantes para as duas doenças (AU)

The reliance and significance of stability as a new way to reveal the essence of syndrome in Chinese medicine / 中国中西医结合杂志

Stability is the important feature of the control system. Stability exists extensively in the biological systems such as different cell types during the process of individual development, new biological properties formed under the environment and/or diet factors, drug addition, long-term memory formation, and so on. The underlying mechanisms generally include epigenetically modification, the emergence of certain substance with long half life, the formation of positive feedback loop, and the activation of stem cells. Introduction of stability into researches of Chinese medicine syndrome is essentially to explore the mechanisms of quantitative changes into the qualitative alternation. It is also helpful for us to choose an appropriate time window of animal models for Chinese syndrome and to consider what are the core effects of Chinese materia medica in improving syndrome. The stability not only meets the features of Chinese medicine theories, but also agrees with the progress of modern systems theory and biology. We hope it could promote studies on Chinese medicine syndrome.

El concepto de alostasis: un paso más allá del estrés y la homeostasis / Allostasis: a step beyond stress and homeostasis

En el intento de entender los procesos que favorecen el desarrollo de enfermedad y teniendo una mirada holística de la medicina, no podemos hoy entender el estrés solamente como un mecanismo de defensa del organismo frente a una agresión. Numerosas situaciones cotidianas fuerzan los mecanismos de los sistemas fisiológicos y por lo tanto las respuestas son más complejas; aparece aquí el concepto de ôalostasisõ. Ante un agente estresor, los sistemas alostáticos nos permiten responder al estrés psíquico o físico, interno o externo, activando el sistema nervioso autónomo, el eje hipotálamohipófiso-adrenal, el sistema cardiovascular, el metabolismo y el sistema inmunitario. Frente a una situación nueva se genera una evaluación cognitiva, condicionada en cada individuo por lo genético, sus experiencias durante el desarrollo yconductas que ha ido aprendiendo a lo largo de la vida, lo que da como resultado una respuesta neuroinmunoendocrina; estas respuestas son fisiológicas y permiten la adaptación frente a situaciones de estrés. Cuando la alostasis es ineficaz o inadecuada o el agente que la motiva se prolonga en el tiempo y no se alcanza la adaptación, se produce una activación desproporcionada o ineficaz, dando lugar a lo que se conoce como "carga alostática", lo cual puede, a largo plazo, ser causa de patología tanto orgánica como psíquica. Entender los conceptos de alostasis y carga alostática nos permite una mirada más integradora y compleja sobre temas clásicos y a veces simplificados como son el estrés y la homeostasis. La búsqueda de respuestas acerca de por qué nos enfermamos nos fuerza a pensar en la relación entre la genética, el medio ambiente y las vulnerabilidades interindividualesen el proceso de enfermar.

In an attempt to understand the process of development of disease and taking a holistic view of medicine, we can nolonger understand stress only as a defense mechanism of the organism against aggression. Many everyday situations force a number of physiological responses which together result in a more complex answer; here the concept of “allostasis”. As a response to psychological or physical stress, internal or external, allostatic systems activate the autonomic nervoussystem, the hypothalamic-pituitary-adrenal axis, the cardiovascular system, metabolism, and the immune system.Facing a new situation generates a cognitive evaluation, which is conditioned by each individual’s genetics, experiencesduring development, and behavior acquired throughout life, all resulting in a neuro-immune-endocrine response, which is initially physiological and yields to adaptation. When allostasis is ineffective or inappropriate, or the stressor agent extends over time, adaptation is not achieved, producing what is known as “allostatic load”. In the long term, this may result in both organic and psychological disease. Understanding the concept of allostasis and allostatic load, allow us to have a more inclusive and complex insight on stress and homeostasis, a classical subject often times oversimplified. The search for answers for why we get sick forces us to think about the relationship between genetics, environment andinterindividual vulnerabilities in the process of becoming ill.

Neuropéptidos, estrés y alergia / Neuropeptides, stress and allergy

Histophysiological and biochemical data are exposed supporting the close connection between the central nervous system (cortex limbic system hypothalamus hypophysis) and the endocrine one. Evidences that some neural peptides (opioid neuropeptides: ONP) have specific receptors in immune cells and on the other hand that these cells produce cytokines that influence the neurons are described. It seems reasonable that under acute or chronic stress situations both systems strongly interconnected to maintain the homeostasis. The acute stress influences the innate immune response meanwhile the chronic one seems to affect the adaptative or acquired mechanism specially at the cytotoxic level. Allergic patients are deeply worsened by acute and chronic stress considering that the mastocytes are the tarjet of numerous cytokines and ONP released during the unpleasant events. So, we recommend peace in the mind, faith in the heart and work in the hands.

Psychobiology of childhood maltreatment: effects of allostatic load?

OBJECTIVE: Facing an adverse physical or psychosocial situation, an individual is forced to adapt in order to survive. Allostasis is the term used to refer to adapting processes used to maintain the stability of an organism through active processes. When allostatic response is excessive or inefficient, the organism develops an allostatic load. The cascade of molecular and neurobiological effects associated with childhood abuse and neglect could be an example of allostatic response that could precipitate allostatic load in organism still vulnerable during its development. This article reviews the psychobiological consequences related to childhood abuse and neglect. METHOD: A selective review with a systematic procedure was performed to investigate studies showing explicit association between childhood maltreatment and psychobiological/neurobiological consequences. We searched electronic database MedLine-PubMed to identify English-language articles from 1990 to 2007. RESULTS: From 115 articles we selected 55 studies from MedLine and 30 from their reference lists, in a total of 85 articles (JCR IF range: 1-31.4; median: 5.88). Only 29 studies showed direct and explicit association between them. CONCLUSION: Structural consequences of childhood maltreatment include disruptive development of corpus callosum, left neocortex, hippocampus, and amygdale; functional consequences include increased electrical irritability in limbic areas, frontal lobe dysfunctions and reduced functional activity of the cerebellar vermis; and neurohumoral consequences include the reprogramming activity of hypothalamo-pituitary-adrenal (HPA) axis and subsequently the stress response.

OBJETIVO: Frente a uma situação psicossocial ou física adversa, o indivíduo é forçado a se adaptar de maneira que possa sobreviver. Alostase é o termo utilizado para descrever os processos adaptativos usados para manter a estabilidade de um organismo por meio de processos ativos. Quando a resposta alostática é excessiva ou ineficiente, o organismo desenvolve um peso alostático. A cascata de efeitos moleculares e neurobiológicos associados ao abuso e negligência na infância poderia ser um exemplo de respostas alostáticas e, dessa forma, poderia precipitar peso alostático em um organismo ainda vulnerável no seu desenvolvimento. Este artigo revisa as conseqüências psicobiológicas relacionadas com os maus-tratos na infância. MÉTODO: Uma revisão seletiva com base sistemática foi realizada na base de dados MedLine, procurando artigos em inglês que investigassem uma associação direta e explícita entre maus-tratos na infância e conseqüências psicobiológicas em humanos durante o período de 1990-2007. RESULTADOS: De 115 artigos, foram selecionados 55 estudos do MedLine e 30 de suas listas de referências, num total de 85 artigos (JCR IF: 1-31,4; mediana: 5,88). Especificamente apenas 29 estudos investigaram uma associação direta e explícita entre eles. CONCLUSÃO: Em resumo, as conseqüências estruturais dos maus-tratos na infância incluem anormalidades no desenvolvimento do corpo caloso, neocórtex esquerdo, hipocampo e amígdala; as conseqüências funcionais incluem um aumento da irritabilidade nas áreas límbicas, disfunções do lobo frontal e redução da atividade funcional do vermis cerebelar; e as conseqüências neuro-humorais englobam a reprogramação do eixo HPA e subsequentemente à resposta ao estresse.