[Stress and pathophysiological mechanisms for the development of psychosomatic disease].

According to the biopsychosocial model, disease is the dysfunctional resultant of various fields of human function (biological, psychological, behavioral, socioeconomic). This article deals with the psycho-biological field of Psychosomatic research, namely, the effect of stress on the body. The human organism, in the prospect of evolution, has developed biological mechanisms for maintaining its homeostasis (οµοιόσταση), in its interchange with the stressor stimuli. This process is called allostasis. The response to mild - short-term stress induces activation of the hypothalamic - pituitary - adrenal axis, the sympathetic system and the immune system; a process that proves beneficial to the body. On the contrary, exposure to traumatic or chronic stress, with subsequent overactivation of the body's allostatic mechanisms, wears out its homeostatic ability and initiates pathophysiological mechanisms that pave the way for the development of physical and mental illness. The above procedure is called allostatic load or, in its most severe form, allostatic overload. More specifically, the experience of traumatic stress, either in childhood or in adulthood, induces dysregulation of neuroendocrine pathways in the Central Neural System (CNS), as well as immune dysfunction, and is associated with more frequent development of psychiatric and medical pathology, in a dose-dependent way. On the other hand, exposure to chronic repetitive stress induces neurobiological lesions at the level of the CNS, which undermine the body's very ability to respond to stress. At the same time, chronic stress has been associated with increased morbidity from major medical disorders, such as diabetes mellitus, obesity, metabolic syndrome and cardiovascular disease, through a variety of pathophysiological pathways. Finally, chronic stress causes dysfunction of the body's immuno-protective mechanisms, while at a cellular level, it induces oxidative stress and cellular apoptosis. However, regardless of the quantity and quality of the stressor stimuli, it has also emerged that the individual's personal characteristics judge the vulnerability to stress, too. Psychiatrists must insist on the scientific documentation of the biopsychosocial model, so that they can raise awareness amongst the medical community, aiming at a holistic care of the patients.

A 6-month study of postpartum depression and related factors in Athens Greece.

INTRODUCTION: Postpartum depression (PPD) affects women in various sociocultural environments around the world during a sensitive period of their lives. The purpose of this study was to investigate the prevalence and time course of PPD in a Greek urban environment as well as possible relations of PPD with certain clinical and sociodemographic factors. METHOD: The study was performed on a sample of 402 women that were recruited from a university obstetric clinic in Athens, Greece, during the first 24 hours after delivery. The women completed the Edinburgh Postnatal Depression Scale through telephone interviews. The telephone interviews were conducted the first week as well as the first, third, and sixth month after delivery. The first day after delivery, all women completed the Montgomery-Asberg Depression Rating Scale, the List of Threatening Experience, the State-Trait Anxiety Inventory, the Whitley Index, the Schalling-Sifneos Personality Scale, and the Maudsley Obsessive-Compulsive Inventory. In addition, the Blues Questionnaire was administered the first 3 days and the seventh day after delivery. Other clinical and sociodemographic data were obtained through questionnaires and personal interviews. RESULTS: A cutoff point of 12 in the Edinburgh Postnatal Depression Scale was used to define PPD. Eighty (19.8%) of the women in the sample experienced PPD during the first 6 months after delivery. The development of PPD was related significantly to the following factors: stressful events during pregnancy (P = .01), maternity blues on the seventh day after delivery (P = .01), obsessive preoccupation with cleaning (P = .04), and judgment that the baby is crying excessively at the first month interview (P = .02). CONCLUSION: The women's emotional condition before and after delivery, obsessionality, and difficulties in regulating the infant's emotions appear to contribute to the development of PPD during the first 6 months after delivery.

Three cases of zolpidem dependence treated with fluoxetine: the serotonin hypothesis.

Zolpidem is an imidazopyridine hypnotic that is believed to act selectively at alpha(1) subunit-containing gamma-aminobutyric acid type A (GABA(A)) receptors and thus to have minimal abuse and dependence potential. We present three cases of zolpidem abuse and dependence in which the drug was used not for sedation but for stimulation and anxiolysis. All of the patients were treated with fluoxetine (a selective serotonin reuptake inhibitor) and managed to discontinue the abuse and remain abstinent from the drug. The efficacy of this kind of medication on the abuse of a GABAergic agonist, in this case dependence on zolpidem, leads to a serotonergic and GABAergic system interaction hypothesis.