Download Endocrine problems related to mobility

Endocrine problems related to
mobility
G.Tolis*
MD, PhD,FRCP (GR/Canada)
S.Livadas  , N.Angelopoulos , D.Kaltsas 
Division of Endocrinology Metabolism
Hippokrateion Hospital, Athens, Greece
* Chairman  Fellows
WHO European Centre for Environment and Health, Rome Div ision
There are many health effects of transport,
and they have been dealt with separately
NOISE
ACCIDENTS
PHYSICAL
ACTIVITY
AIR POLLUTION
CLIMATE CHANGE
PSYCHOSOCIAL
EFFECTS
Migration health

Pre-migration factors

Transit factors

Destination factors
23/5/02
NSW Refugee Health Se rvice
ONE OF THE HISTORICAL
DEBATES IN PSYCHIATRY
• NATURE: behavior is programmed into the
genetic makeup of the individual
• NURTURE: behavior is the result of social and
environmental influences
The explosion of neuroscience
research is transforming conceptual
approaches toward mental illness.
The dichotomy between mind
and brain, or between
“nature” and “nurture” is no
longer relevant.
Principle : Altered genes do not, by themselves,
explain all of the variance of a given
major mental illness.
Behavior and social factors exert actions on the brain by
feeding back upon it to modify the expression of genes
and thus the function of nerve cells.
Learning, including learning that results in dysfunctional
behavior, produces alterations in gene expression.
Thus all of "nurture" is ultimately expressed as "nature.”
Kandel, ER. A New Intellectual Framework for Psychiatry. American Journal of
Psychiatry: Vol. 155(4) 1998, pp 457-469
Testosterone and Adult Personality
High testosterone levels
• Among prisoners, more dominance and
more violent crimes
• Trial lawyers, football players, actors
• Among men, lower marriage expectancy, higher
divorce rate, and more extramarital affairs
Mental Health Issues within the
Recent Refugee Population:
• High number of suicides among young Somali
boys and men
• Khat / substance abuse among the Somali
• Bosnian, Kosovo, Kurdish - Post traumatic
stress disorder…
Pressures on the Mental Health of
Refugees: a Social Model
• Bereavement
• Cultural bereavement /Alienation
• Problems of communication /
language
• Socioeconomic factors
• Poor housing/poverty
• Insecurity / racism
• Isolation/break–up of social networks
• Unemployment
• Generational tensions
• Acculturation / loss of status
• Loss of recognised role
Hormone Replacement Protocol in Humans : Example
The MR/GR
Balance Theory
Memory Performance
deKloet et al., 1999
MR
Activation
GR
Activation
facilitation
inhibition
Dose of administered glucocorticoids
Placebo
COGNITION
COGNITION
Hydrocortisone
Circulating Cortisol Levels
Metyrapone
Baseline Day
Experimental Day
Placebo
Modulatory Actions of Glucocorticoids and Memory Function in Humans
PHYSICAL PROBLEMS
• 1) TORTURE HAS BEEN ASSOCIATED
WITH A VARIETY OF HEALTH
PROBLEMS INCLUDING:
– DAMAGE TO THE NERVOUS OR
MUSCULOSKELETAL SYSTEM
– CARDIOVASCULAR DISEASE
– SENSE ORGAN DAMAGE
– GENITOURINARY PROBLEMS
– ENDOCRINE DYSFUNCTION
PSYCHOLOGICAL CONSEQUENCES
• 1) SOMATIZATION
• 2) MOOD DISORDER
• 3) ANXIETY DISORDERS
• 4) POST-TRAUMATIC STRESS
DISORDER
• 5) SLEEP DISTURBANCE
• 6) SUBSTANCE RELATED DISORDERS
Neuroendocrine responses to Social Interactions
Hormone levels can be changed in response to social
interactions
e.g. sexual interactions; testosterone
e.g. dominant/subordinate interaction
and stress hormones
e.g. Children in day care vs home
and stress hormone levels
So, by putting the subject in different social
Interactions, we might change hormone levels.
Conditioned hormone release
If a hormone has been released in a previous situation in
which something aversive or negative happened, then
encountering this situation again (without the negative
event) will automatically induce release of the same
hormone
E.g. Corticosteroid release in a taste aversion task
E.g. Corticosteroid release in a panic attack on a bridge.
Neuroendocrine Responses to cognitive stimuli
The way external stimuli are interpreted can trigger
hormone secretion
E.g. Examination Stress : Depends on the level of mastery
felt by individual
E.g. Depression : Negative appraisal of environment,
increased cortisol secretion
Immune, Endocrine, and Psychological Responses in
Civilians Displaced by War
Psychosomatic Medicine 62:502–508 (2000)
TABLE 1. Summary of Descriptive Nonparametric Statistics for COR-NEX2
Total Score and 10 Individual Scale Scores Obtained in
Displaced Persons vs Nondisplaced Residents
•
•
•
•
•
•
•
COR-NEX2 total score
Adaptation
Personality disorder
Fear
Depression
Anxiety
Hypersensitivity
P<0.00…
Immune, Endocrine, and Psychological Responses in
Civilians Displaced by War
Psychosomatic Medicine 62:502–508 (2000)
Serum Hormone Levels in
Displaced Persons vs Nondisplaced Residents
• Cortisol
P<0.001
• Prolactin
P<0.01
• b-Endorphin
Self-reported life event patterns and their relation to health among recently resettled
Iraqi and Kurdish refugees in Sweden.
Sondergaard HP, Ekblad S, Theorell T.
Center for Torture and Trauma Survivors (CTD), Stockholm, Sweden.
This paper presents the findings of a longitudinal study of life events in refugees belonging
to different language groups from Iraq. Eighty-six individuals were included in the study.
Data regarding life events and self-reported health measurements were collected after
baseline assessment with 3-monthly intervals on three occasions. Posttraumatic stress
disorder was diagnosed by means of a structured interview at baseline. The results indicate
that the subjects were influenced to a great extent by political events and the situation of
significant others in the home country. Further, the number of negative life events in the host
country showed a significant association with self-rated deteriorated health. In subjects with
posttraumatic stress disorder, the effects of certain life events were more pronounced.
J Nerv Ment Dis 2001 Dec;189(12):838-45
TRACT VIOLENCE
• Auditory
• Gustatory
• Olfactory
• Tactile
BRAIN STRUCTURE
Supra - Hypothalamic
DISHARMONY
Mesolimbic
Hypothalamic- Pituitary
Reticular Activating System
• Visual
Amygdala-Locus Caeruleus-Hippocampus-Thalamus-Raphe Nucleus
DA-NA-5HT-GABA-ACE//CRF-ACTH-ADH-POMC-βΕΝDOENCEPHALINS-PRL-GnRH-TRH-LEPTIN-NPY-MSH-GHRS
(GHRELIN-PYY)