A rapid review of home-based activities that can promote mental wellness during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, public health measures such as isolation, quarantine, and social distancing are needed. Some of these measures can adversely affect mental health. Activities that can be performed at home may mitigate these consequences and improve overall mental well-being. In this study, home-based activities that have potential beneficial effects on mental health were examined. METHODS: A rapid review was conducted based on a search of the following databases: MEDLINE, EMBASE, CINAHL, PyscINFO, Global Health, epistemonikos.org, covid19reviews.org, and eppi.ioe.ac.uk/covid19_map_v13.html. Eligible studies include randomized controlled trials and non-randomized studies published between 1/1/2000 and 28/05/2020 and that examined the impact of various activities on mental health outcomes in low-resource settings and contexts that lead to social isolation. Studies of activities that require mental health professionals or that could not be done at home were excluded. Two review authors performed title/abstract screening. At the full-text review stage, 25% of the potentially eligible studies were reviewed in full by two review authors; the rest were reviewed by one review author. Risk of bias assessment and data extraction were performed by one review author and checked by a second review author. The main outcome assessed was change or differences in mental health as expressed in Cohen's d; analysis was conducted following the synthesis without meta-analysis guidelines (SWiM). PROSPERO registration: CRD42020186082. RESULTS: Of 1,236 unique records identified, 160 were reviewed in full, resulting in 16 included studies. The included studies reported on the beneficial effects of exercise, yoga, progressive muscle relaxation, and listening to relaxing music. One study reported on the association between solitary religious activities and post traumatic stress disorder symptoms. While most of the included studies examined activities in group settings, particularly among individuals in prisons, the activities were described as something that can be performed at home and alone. All included studies were assessed to be at risk of bias in one or more of the bias domains examined. CONCLUSIONS: There is some evidence that certain home-based activities can promote mental wellness during the COVID-19 pandemic. Guidelines are needed to help optimize benefits while minimizing potential risks when performing these activities.

Falls Risk, Circadian Rhythms and Melatonin: Current Perspectives.

Aging is associated with weakening of the circadian system. The circadian amplitude of most physiological variables is reduced, while the circadian phase becomes more labile and tends to occur earlier with advancing age. As the incidence of falls in older persons could follow circadian variations, a better understanding of conditions in which falls occur can lead to the implementation of countermeasures (such as adjusting the scheduling of hospital staff, or changing the timing of anti-hypertensive medication if falls are related to undesirable circadian patterns of blood pressure and/or heart rate). This includes knowing the times of the day, days of the week, and times of the year when falls are more likely to occur at home or in the hospital. Additionally, the links between aging processes and factors associated with an increased risk of developing autonomic dysfunction are well established. A strong association between heart rate variability indexes and aging has been shown. Circadian rhythms of autonomous nervous system activity may play important role for maintenance of orthostatic tolerance. Whether one is concerned with disease prediction and prevention or maintenance of healthy aging, the study of circadian rhythms and the broader time structure underlying physiopathology is helpful in terms of screening, early diagnosis and prognosis, as well as the timely institution of prophylactic and/or palliative/curative treatment. Timing the administration of such treatment as a function of circadian (and other) rhythms also could lead to reduction of falls in older persons. Finally, a prominent circadian rhythm characterizes melatonin, which peaks during the night. The circadian amplitude of melatonin decreases as a function of age, raising the questions whether such a decrease in the circadian amplitude of melatonin relates to a higher risk of falls and, if so, whether melatonin supplementation may be an effective countermeasure. This narrative review assesses the relationships between fall risk and the potential role circadian rhythms and melatonin play in mitigating this risk. We aim to provide healthcare workers adequate information about fall risk in older persons, including the potential role of the circadian rhythms and/or melatonin, as well as to lay foundations for future fall prevention interventional studies.

Meditation Increases the Entropy of Brain Oscillatory Activity.

We address the hypothesis that the entropy of neural dynamics indexes the intensity and quality of conscious content. Previous work established that serotonergic psychedelics can have a dysregulating effect on brain activity, leading to subjective effects that present a considerable overlap with the phenomenology of certain meditative states. Here we propose that the prolonged practice of meditation results in endogenous increased entropy of brain oscillatory activity. We estimated the entropy of band-specific oscillations during the meditative state of traditions classified as 'focused attention' (Himalayan Yoga), 'open monitoring' (Vipassana), and 'open awareness' (Isha Shoonya Yoga). Among all traditions, Vipassana resulted in the highest entropy increases, predominantly in the alpha and low/high gamma bands. In agreement with previous studies, all meditation traditions increased the global coherence in the gamma band, but also stabilized gamma-range dynamics by lowering the metastability. Finally, machine learning classifiers could successfully generalize between certain pairs of meditation traditions based on the scalp distribution of gamma band entropies. Our results extend previous findings on the spectral changes observed during meditation, showing how long-term practice can lead to the capacity for achieving brain states of high entropy. This constitutes an example of an endogenous, self-induced high entropy state.

Assessing the efficacy of melatonin to curtail benzodiazepine/Z drug abuse.

The abuse of benzodiazepine (BZP) and Z drugs has become, due to the tolerance and dependence they produce, a serious public health problem. Thirty years ago, we demonstrated in experimental animals the interaction of melatonin with central BZD receptors, and in 1997 we published the first series of elderly patients who reduced BZP consumption after melatonin treatment. Almost every single neuron in the hypothalamic suprachiasmatic nuclei (SCN), the central pacemaker of the circadian system, contains γ-aminobutyric acid (GABA) and many results in animals point out to a melatonin interaction with GABA-containing neurons. In addition, central-type BZD antagonism, that obliterates GABAA receptor function, blunted most behavioral effects of melatonin including sleep. Melatonin is involved in the regulation of human sleep. This is supported by the temporal relationship between the rise of plasma melatonin levels and sleep propensity as well as by the sleep-promoting effects of exogenously administered melatonin. Both meta-analyses and consensus agreements give support to the therapeutic use of melatonin in sleep disorders. This action is attributed to MT1 and MT2 melatoninergic receptors localized in the SCN, as well as in other brain areas. This review discusses available data on the efficacy of melatonin to curtail chronic BZD/Z drug use in insomnia patients. A major advantage is that melatonin has a very safe profile, it is usually remarkably well tolerated and, in some studies, it has been administered to patients at very large doses and for long periods of time, without any potentiality of abuse. Further studies on this application of melatonin are warranted.

Effects of different "relaxing" music styles on the autonomic nervous system.

The objective of this study was to assess the effects on heart rate variability (HRV) of exposure to different styles of "relaxing" music. Autonomic responses to musical stimuli were correlated with subjective preferences regarding the relaxing properties of each music style. Linear and nonlinear HRV analysis was conducted in 25 healthy subjects exposed to silence or to classical, new age or romantic melodies in a random fashion. At the end of the study, subjects were asked to choose the melody that they would use to relax. The low-to-high-frequency ratio was significantly higher when subjects were exposed to "new age" music when compared with silence (3.4 ± 0.3 vs. 2.6 ± 0.3, respectively, P < 0.02), while no differences were found with "classical" or "romantic" melodies (2.1 ± 0.4 and 2.2 ± 0.3). These results were related to a reduction in the high frequency component with "new age" compared to silence (17.4 ± 1.9 vs. 23.1 ± 1.1, respectively P < 0.004). Significant differences across melodies were also found for nonlinear HRV indexes. Subjects' preferences did not correlate with autonomic responses to melodies. The results suggest that "new age" music induced a shift in HRV from higher to lower frequencies, independently on the music preference of the listener.

Do not worry, be mindful: effects of induced worry and mindfulness on respiratory variability in a nonanxious population.

Generalized anxiety disorder (GAD) is characterized by chronic worry. Mindfulness-based stress reduction is thought to remediate excessive worry, because it counteracts a permanent defense state of enhanced vigilance to potential threats. The present study aimed to compare respiratory variability (RV) during worry and mindfulness. Following an 8-minute baseline, 37 healthy participants underwent 11-min worry and mindfulness inductions, in randomized order, using auditory scripts. Respiration was measured by chest and abdominal inductance belts. RV was quantified by (1) autocorrelation to assess linear breathing variability and (2) sample entropy to assess nonlinear breathing variability. Compared to baseline and mindfulness, worry showed decreased autocorrelation in all respiratory parameters and compared to mindfulness, worry showed decreased entropy in respiratory rate. These results suggest that, in contrast to mindfulness, worry is characterized by decreased respiratory stability and flexibility, and therefore worry and mindfulness seem to have countering effects on RV and respiratory regulation.