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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)