Excessive Psychological Stress Research Articles

“Immunohistochemical analysis of Sigma-1 receptor (σ-1R) expression in human pineal gland in relation to different causes of death”

Sigma-1 receptor (σ-1R) modulates cellular signaling pathways, probably acting as a ligand operated chaperone. When activated, the receptor translocates from the interface mitochondrion associated membrane of the endoplasmic reticulum to the cell membrane. σ-1R was demonstrated in some brain regions, including the pineal gland, and was proposed to be involved in several cerebral processes, including neuroprotective responses against homeostasis alterations. On this basis, the immunohistochemical expression of σ-1R in human pineal glands was evaluated, with particular regard to the different causes of death. Thirty-eight pineal glands obtained from forensic autopsies were divided into five groups according to the cause of death: sudden death, drowning, fire fatality, hanging, and hemorrhagic shock, and examined with hematoxylin-eosin stain and immunohistochemistry for σ-1R. Both pinealocytes and perivascular spaces were evaluated. The pineal glands from sudden death were only mildly positive for σ-1R, while a more evident immunopositivity was observed in hanging, fire fatality, hemorrhagic shock, and drowning. These results were confirmed in a two-by-two comparison between the sudden death group and other groups. Our data demonstrate for the first time with immunohistochemical techniques the presence of σ-1R expression in the human pineal gland and propose a direct correlation between σ-1R expression and duration of the death process, in particular when hypoxic conditions and/or excessive psychological stress are present.

Comparing the effect of assessment-simulation-animation-based against traditional education on nursing students’ anxiety and self-efficacy in maternity clinical practicum

BackgroundThe clinical practicum is the practical course that causes the most anxiety in nursing undergraduates. Although high-fidelity simulation education has been demonstrated to boost nursing students' self-efficacy and decrease anxiety in patient care, it is also associated with excessive psychological stress. Assessment-simulation-animation-based (ASA-based) education has been developed to solve the drawbacks of simulation-based education while preserving positive learning outcomes. ObjectivesTo compare the effects of ASA-based education and traditional education in reducing anxiety and improving self-efficacy of junior nursing students in their maternity clinical practicum. DesignThis study used a two-group pre-post quasi-experimental design. The comparison group was studied first followed by the experimental group. SettingsDepartment of Nursing and affiliated medical center at a medical university in southern Taiwan. ParticipantsWe enrolled 114 junior nursing students from two different class years. MethodsA convenience sample of junior nursing students was used in this study, with 55 in the experimental group and 59 in the comparison group. The intervention included online ASA-based education videos with pamphlets and was conducted three days a week for five weeks encompassing the maternity nursing clinical practicum. We developed and applied the Clinical Situation Anxiety Scale (CS-AS) and Clinical Situation Self-Efficacy Scale (CS-SES) before and after the intervention. Qualitative feedback was assessed after the intervention. Data were collected from both the comparison and experimental groups during the fall and spring terms of both the 2019–2020 and 2020–2021 academic years. ResultsCompared with the comparison group, the total CS-AS and CS-SES scores significantly improved from before to after the intervention in the experimental group. The students responded to the intervention by demonstrating clinical consistency, knowing what to do and how to do it and more confidently practicing health education. ConclusionOur results suggest that ASA-based education with videos and pamphlets contributed to reducing anxiety and increasing self-efficacy in nursing students during their maternity clinical practicum.

The natural course of idiopathic cervical dystonia.

Idiopathic cervical dystonia (ICD) is by far the largest subgroup of dystonia. Still, its natural course is largely unknown. We studied the natural course of 100 ICD patients from our botulinum toxin clinics (age at ICD onset 45.8 ± 13.5years, female/male ratio 2.0) over a period of 17.5 ± 11.5years with follow-ups during botulinum toxin therapy and with semi-structured interviews. Two courses of ICD could be distinguished by symptom development of more or less than 6months. ICD-type 2 was less frequent (19% vs 81%, p < 0.001), had a more rapid onset (8.7 ± 8.0weeks vs 3.8 ± 3.5years), a higher remission rate (92% vs 5%, p < 0.001) and a higher prevalence of excessive psychological stress preceding ICD (63% vs 1%, p < 0.001). In both ICD-types, the plateau phase was non-progressive. Significant differences in patient age at ICD onset, latency and extent of remission, female/male ratio and prevalence of family history of dystonia could not be detected. ICD is a non-progressive disorder. ICD-type 1 represents the standard course. ICD-type 2 features rapid onset, preceding excessive psychological stress and a high remission rate. These findings will improve prognosis, treatment strategies and understanding of underlying disease mechanisms. They contradict the widespread fear of patients of a constant and continued decline of their condition. Excessive psychological stress may be an epigenetic factor triggering the manifestation of genetically predetermined dystonia.

Excessive psychological stress preceding the onset of idiopathic cervical dystonia

Idiopathic cervical dystonia (ICD) is the largest subgroup of dystonia. Psychological stress as a triggering factor has long been discussed, but detailed descriptions are lacking. We report on a group of 13 patients with ICD and preceding excessive psychological stress (age at ICD onset 39.0 ± 13.9 years, 7 females, 6 males). The observation period was 7.8 ± 5.0 years. Excessive psychological stress included partner conflicts (divorce and separation, domestic violence), special familial burdens, legal disputes and migration. It started 8.3 ± 3.9 months before ICD onset. In 85% of our patients (typical cases), ICD developed within 5.8 ± 4.4 weeks, then lasted 18.5 ± 8.3 months, before it started to remit 2.7 ± 0.8 years after its onset to 54.5 ± 35.3% of its maximal severity. Idiopathic dystonia is thought to be based upon a genetic predisposition triggered by epigenetic factors. Our study suggests that excessive psychological stress could be one of them. Pathophysiologic elements are only vaguely identified, but could include the endoplasmic reticulum stress response, cerebellar 5HT-2A receptors and the metabolism of heat shock proteins. Whilst the clinical presentation of ICD preceded by excessive psychological stress is typical, its course is atypical with rapid onset and fast and substantial remission.

COVID-19–Related Insomnia Populations Research and Management Strategies: A Review

Abstract Coronavirus disease 2019 (COVID-19) has affected the quality of sleep for various populations, causing anxiety and depression worldwide. COVID-19–related insomnia (COVIDRI) appears to be more common in certain populations, including females, urban residents and other individuals who reside in high-risk COVID-19–related areas, lack higher socioeconomic and educational levels, have a history of underlying mental illness, have no access to social support and work, or have been mandated for isolation. Among vulnerable populations, pregnant women, adolescents and children are more likely to suffer from anxiety and depression, which leads to irregular sleep-wake cycles and significantly poor sleep quality. Insomnia in COVID-19 patients is associated with decreased immune levels, excessive psychological stress and severe anxiety. The COVIDRI incidence and severity among frontline healthcare workers is high, especially among females and those working in isolation wards and intensive care units. The factors related to COVIDRI for college students during home study are stress from upcoming graduation, disharmonious family relationships and inadaptability to online education. For military personnel, anxiety and depression are the main causes of poor sleep quality. Based on the characteristics of different populations, active Chinese and Western medications, non-drug therapy, psychological counseling and suitable sleep management are vital measures to strengthen immunity, alleviate insomnia and limit recurrence.

Stress overload, influencing factors, and psychological experiences of nurse managers during early stages of the COVID-19 pandemic: a sequential explanatory mixed method study.

Healthcare systems had an exceptionally difficult time during the early COVID-19 pandemic. Nurse managers in particular made enormous contributions to ensuring the safety of patients and front-line nurses while being under excessive psychological stress. However, little is known about their experiences during this time. The aim of this study was thus to assess the level of stress overload and psychological feelings of nurse managers during the early COVID-19 pandemic. A mixed methods sequential explanatory design study with non-random convenience sampling was performed, following the STROBE and COREQ checklists. The study was conducted at the Affiliated Dongyang Hospital, Wenzhou Medical University, with data collected from six provinces in southern China (Zhejiang, Hubei, Shanghai, Jiangsu, Hunan and Jiangxi) during March 2020 and June 2020. A total of 966 nurse managers completed the Stress Overload Scale and Work-Family Support Scale. In addition, a nested sample of nurse managers participated in semi-structured face-to-face interviews. The data were then analyzed using qualitative content analysis, Pearson correlation, and multiple linear regression. The quantitative results showed that nurse managers experienced a moderate level of stress load. There was a significant negative correlation between work-family support and stress load (r = -0.551, p < 0.01). Concerns about protecting front-line nurses and work-family support were the main factors affecting the stress load, which accounted for 34.0% of the total variation. Qualitative analysis identified four main thematic analyses that explained stress load: (1) great responsibility and great stress, (2) unprecedented stress-induced stress response, (3) invisible stress: the unknown was even more frightening, and (4) stress relief from love and support. Taken together these findings indicate that concern about protecting front-line nurses and negative work-family support of nurse managers were the main factors causing stress overload. Implementing measures focused on individual psychological adjustment combined with community and family support and belongingness is one potential strategy to reduce psychological stress among nurse managers.

The Advance of Maternal Health and Fetal Outcomes

Maternal health and fetal outcomes have become one of the global public health issues. Among all factors, maternal nutrition and psychological stress play the significant role in the physical and mental health of newborns. Improper nutrition or excessive psychological stress may lead to a series of adverse pregnancy outcomes, such as congenital malformations, neuropsychological defects and mental disorders, such as autism (AD), schizophrenia and attention deficit / hyperactivity disorder (ADHD). Clinically, it can be intervened in a variety of ways. In terms of nutrition, such as folic acid, docosahexaenoic acid, choline and leucine, it can be supplemented with multiple nutrients. In terms of psychology, it can be family-based intervention and mindfulness-based plan to alleviate maternal stress and maternal depression. Most of the clinical studies tend to supplement nutrition or psychological intervention. The research on combination therapy needs to further explore its clinical effectiveness and whether it can achieve the effect of one plus one more than two.

Distance education of physical education under the conditions of marital state

The article analyzes the methods of teaching physical culture to students during military operations in Ukraine on a remote basis. Educational institutions of Ukraine take care of the life and health of their students, so learning continues remotely, in such a way as to ensure not only the acquisition of knowledge, but also, most importantly, safe and comfortable learning in general. In particular, I drew attention to the fact that physical education lessons should be aimed at rest and health of the body, and not at overloading students and their bodies.&#x0D; Therefore, these programs are aimed at unloading. The main consequences of the sedentary lifestyle of student youth on their bodies have been revealed. Since students spend most of their time working with tools, a tendency to decrease motor activity of students has been revealed.&#x0D; Ways and methods of involving student youth in physical exercises in the conditions of distance education are proposed.&#x0D; The role, place and possibilities of distance education in the physical education of students and teachers are defined.&#x0D; The concept of "distance education technology" appeared.&#x0D; Since the full-scale invasion, distance learning has become an integral part of the educational process in Ukraine. Online training allows students to gain knowledge in war zones and abroad, including training in physical education. The complexity of this subject is due to the seemingly mandatory offline presence, but, fortunately, modern technologies allow classes to be conducted through camera lenses. All participants in the educational process are currently experiencing excessive psychological stress, which leads to apathy of children, fatigue and exhaustion of teachers, and it is this discipline that allows you to distract yourself from the events that are happening outside the window of every Ukrainian and bring your mental health to order.

Differences in Stress Perception of Medical Students Depending on In-Person Communication and Online Communication during the COVID-19 Pandemic: A Japanese Cross-Sectional Survey.

Excessive psychological stress in medical students affects their mental health and causes problems such as burnout and depression. Furthermore, changes in the learning environment to online learning due to the COVID-19 pandemic have had a psychological effect on medical students. However, the relationships between medical students' perceived stress and different methods of communication, including in-person and online communication, remain unclear. The purpose of this study was to investigate the differences in stress perception of medical students depending on in-person communication and online communication during the COVID-19 pandemic. This study was a cross-sectional study conducted from September to October in 2020. All of the students of Okayama University School of Medicine were asked to participate in a questionnaire survey. The explanatory variables were the frequency and length of communications with others (by in-person or online communication), empathy, and lifestyle. The main outcome measure was perceived stress. Subgroup analysis was conducted for students who preferred to be by themselves and students who preferred to study together and interact with other people. Univariate analysis and multivariate multiple regression analysis were conducted. Gender and grade, which have been shown to be associated with stress in previous studies, were used as covariates for multiple regression analysis. Valid responses to the questionnaire survey were received from 211 (29.4%) of the 717 students. There was no significant association between perceived stress and online communication, but the number of people with which students had in-person communication (1-2 people compared to 0 as a control, regression coefficient [B] = -4.4, 95% confidence interval [CI]; -7.8, -1.1, more than 10 people, B = -12, 95% CI: -18, -5.8) and the length of communication (more than 120 min, B = -4.5, 95% CI: -8.1, -0.92) were associated with a reduction in perceived stress. In subgroup analysis, the number of people with in-person communication and the length of communication had significant associations with stress reduction even in the group of students who had a preference for being by themselves. In-person communications rather than online communications were associated with a lower level of perceived stress. In subgroup analysis, this trend was statistically significant in the group of students who had a preference for being by themselves.

Transient asystole associated with vasovagal reflex in an oral surgery patient: A case report

The perioperative cardiac events may be brought about by a relative imbalance of autonomic activities due to excessive psychological and physical stress. The present case study focuses on the asystole that can occur as a serious cardiac adverse event associated with vasovagal reflex likely to be triggered by venipuncture for securing an intravenous line during dental care. In addition, we describe and discuss herein the management of intravenous sedation for a dental phobic patient who experienced the vasovagal reflex involved in an unexpected transient asystole. The patient with vasovagal reflex episodes in daily life, who had no past medical history relevant to cardiovascular disorders, was scheduled for dental extraction under intravenous sedation. Immediately after peripheral intravenous catheterization, she complained of discomfort and nausea, and a II-lead electrocardiogram revealed asystole following bradycardia associated with vasovagal reflex. Oxygenation and intravenous fluid loading in the supine position with elevation of the lower extremities restored sinus rhythm and normal hemodynamics without the intervention of cardiopulmonary resuscitation. With administration of intravenous atropine and betamethasone as premedication, she was uneventfully treated in stress-free psychosomatic conditions under optimal sedation with midazolam without any signs of cardiovascular disorders. After administration of flumazenil, the patient satisfactorily recovered from sedation without re-sedation. The present case suggests that an asystole associated with vasovagal reflex can be triggered by venipuncture for intravenous catheterization during dental anxiety likely to affect the imbalance between sympathetic and parasympathetic activities.

Glucocorticoid Induces Atrial Arrhythmogenesis via Modification of Ion Channel Gene Expression in Rats.

Excess psychological stress is one of the precipitating factors for paroxysmal atrial fibrillation (AF), although the involved mechanisms are still uncertain. To test a hypothesis that one of the stress-induced hormones, glucocorticoid, is involved in the pathogenesis of stress-induced AF, we investigated whether the glucocorticoid could alter the temporal profile of cardiac ion channels gene expression, thereby leading to atrial arrhythmogenesis.Dexamethasone (DEX, 1.0 mg/kg) was injected subcutaneously in Sprague-Dawley rats. At predetermined times after DEX injection (0, 1, 3, 6, 12, and 24 hours), the mRNA levels of cardiac ion channel genes (erg, KvLQT1, Kv4.3, Kv4.2, Kv2.1, Kv1.5, Kv1.4, Kv1.2, SUR2A, Kir6.2, Kir3.4, Kir3.1 Kir2.2, Kir2.1, SCN5A, and α1C) were determined using RNase protection assay. DEX induced immediate and transient increase in the mRNA level of Kv1.5 and Kir2.2 with peaks at 6 (5.0 fold) and 3 hours (3.3 fold) after DEX injection, respectively. Patch-clamp studies revealed a significantly increased current density of the corresponding current, IKur and IK1 at 6 hours after DEX injection. Simultaneously, electrophysiological study in isolated perfused hearts showed significantly increased number of repetitive atrial responses induced by single atrial extrastimulus (3.2 ± 2.4 to 26.7 ± 16.4, P = 0.004) with shorting of the refractory period (36.4 ± 4.6 to 27.4 ± 5.5 ms, P = 0.049) after DEX injection.Glucocorticoid immediately modified Kv1.5 and Kir2.2 gene expression at pretranslational levels, thus leading to effective refractory period shortening that could be arrhythmogenic. These results implied that transient glucocorticoid-induced biochemical modification of cardiac ion channels might be one of the mechanisms underlying the stress-induced paroxysmal AF.

The influence of family therapy on psychological stress and social adaptability of depressed patients.

with the increase of study and life pressure, the number of depressed college students showed an increasing trend year by year, and the drug treatment alone could not achieve a comprehensive recovery of depression patients, so it was more necessary to pay attention to the spiritual treatment. this research aimed to better understand the relationship between college students' depression and life events, social support, psychological pressure, and coping style, and the influence of systematic family therapy on depression degree, psychological stress, and social adaptability of college students with depression. in this study, 105 college students with depression were selected as the research object, and healthy college students were taken as the control group. Through questionnaire, the differences in life events, social support, psychological stress, and coping styles between the groups were compared. The correlation between the degree of depression and various variables were analyzed, and the impact path of each variable on depression was analyzed using the path analysis model. Depression patients were then divided into a conventional group treating with conventional medications and an observation group treating with systematic family interventions. Differences in Hamilton Depression Scale-17, (HAMD-17), CPSS, and Social Adaptive Functioning Evaluation (SAFE) scores were compared and analyzed between the two groups before treatment (T1), during the treatment (T2), and after treatment(T3). there were significant differences in scores of life events, social support, psychological stress, and coping styles between the healthy control group and the depressed patients (P < 0.05). There was an obvious correlation between different depression degrees and life events, social support, psychological stress, and coping styles (P < 0.05). Life events, social support, and psychological stress had a direct and significant impact on depression (0.250, 0.218, and 0.392; P < 0.05), and they also had an indirect and significant impact on depression through coping styles (P < 0.05). The systematic family treatment model could significantly reduce HAMD-17 and CPSS scores (P < 0.05), and significantly improve SAFE scores (P < 0.05). adverse life events, lack of social support, excessive psychological stress, and negative coping styles can aggravate college students' depression. Systematic family therapy can improve the degree of depression, reduce the psychological stress, and enhance the social adaptability of college students with depression.

Real-Time Psychological Stress Detection According to ECG Using Deep Learning

Today, excessive psychological stress has become a universal threat to humans. That stress can heavily affect work and study when a person repeatedly is exposed to high stress. If that exposure is long enough, it can even cause cardiovascular disease and cancer. Therefore, both monitoring and managing of stress is imperative to reduce the bad outcomes from excessive psychological stress. Conventional monitoring methods firstly extract the characteristics of the RR interval of an electrocardiogram (ECG) from a time domain and a frequency domain, then use machine learning models, like SVM, random forest, and decision tree, to distinguish the level of that stress. The biggest limitation of using these methods is that at least one minute of ECG data and other signals are indispensable to ensure the high accuracy of the results. This will greatly affect the real-time application of the models. To satisfy real-time detection of stress with high accuracy, we proposed a framework based on deep learning technology. The proposed monitoring framework is based on convolutional neural networks (CNN) and bidirectional long short-term memory (BiLSTM). To evaluate the performance of this network, we conducted the experiments applying conventional methods. The data for the 34 subjects were collected on the server platform created by the group at the Institute of Psychology of the Chinese Academy of Sciences and our group. The accuracy of the proposed framework was up to 0.865 on three levels of stress using a 10 s ECG signal, a 0.228 improvement compared with conventional methods. Therefore, our proposed framework is more suitable for real-time applications

Пріоритетність клінічного застосування фотодинамічної терапії за допомогою лазера «HELBO Thera Lite» при лікуванні захворювань тканин пародонта в постковідний період

Abstract. The availability of a huge number of tools, methods and techniques for the treatment of generalized periodontitis is not always effective in clinical practice, especially during a pandemic over COVID-19. The use of high-tech innovative techniques, including photodynamotherapy with HELBO Thera Lite laser can be a particularly promising area as an adjunct to the comprehensive treatment of generalized periodontitis. The technique is characterized by a decent arsenal of advantages over competitors on the market – is 92 % effective against typical periodontal pathogens, minimally invasive, does not require additional use of pharmaceuticals, including antibiotics, does not cause and is not accompanied by excessive psychological stress, has no side effects on others organs and systems. The relevance of its use in dental practice can significantly improve traditional methods of comprehensive treatment of generalized periodontitis, especially in patients after coronavirus infection, which further requires scientifically proved confirmation by studying the features of clinical, microbiological, biochemical and immunological parameters. Key words: generalized periodontitis, photodynamic therapy, Helbo therapy, coronavirus infection.

Regular Physical Exercise for Prevention and Treatment of Low Back Pain: A Systematic Review

Introduction: Low back pain is one among the main health problems during life time with a high prevalence, which causes functional loss and reduced productivity. Low back pain specifically affects the lumbar region of the spine. The pain is usually related with mostly muscle tension, and often limits our range of movement. Low back pain (LBP) is a common problem involving the muscles, nerves, and bones of the back. Objective: The purposes of this review study are to describe about low back pain and to examine the most recommended exercise for prevention and management of low back pain, to review scientific evidence on the effect of physical exercise on low back pain and to review the risk factors which lead to develop low back pain. Methods: The review of related literature search strategy were used the terms in relation with LBP and exercise, exercise prescription for LBP, exercise testing for LBP, recommended exercise for LBP, the effect of exercise on back pain and etc. A search was conducted in the following databases: online research databases, web of knowledge, and science direct, sport discus, Google scholar and from other relevant citations. Results: Based on LBP analysis and outcome functions, can be categorized as acute (<6 wk), sub-acute (6-12 wk), and chronic. Risk factors associated with low-back pain include age greater than 34 years, degenerative diseases such as arthritis or osteoporosis, a family or personal history of back pain or trauma, a sedentary lifestyle, low job satisfaction, and low socioeconomic status, excess body weight, psychological stress or depression and physically hard work. Common symptoms of LBP: pain that is dull or achy, contained to the low back, stinging, burning pain that moves from the low back to the backs of the thighs, sometimes into the lower legs or feet, muscle spasms and tightness in the low back, pelvis, and hips, pain that worsens after prolonged sitting or standing, difficulty standing up straight, walking, or going from standing to sitting and pain that worsens with bending, lifting, standing or walking. Regular exercise particularly endurance and stretching exercises such as walking, biking, and swimming, has the good evidence of efficacy among exercise regimen, whether for whom with acute, sub-acute, or chronic low back pain. Generally, to reduce and manage LBP following low-impact endurance, strength and stretching regular exercises are advised.

Probiotic supplements for relieving stress in healthy participants: A protocol for systematic review and meta-analysis of randomized controlled trials.

Background:Psychological stress is a ubiquitous subjectively negative emotional experience, but excessive psychological stress has adverse effects on the happiness in our lives and physical and mental health, and may cause many health problems. Studies have found that probiotics have a certain role in alleviating negative emotions, reducing abnormal behaviors, improving cognitive function, and also showing the great potential of probiotics in relieving psychological stress. At present, many clinical trials have been carried out to intervene in populations with psychological stress with probiotic supplements, but there still lack of targeted systematic review and meta-analysis.Methods and analysis:The Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Psycoinfo, Cumulative Index to Nursing and Allied Health Literature will be searched to obtain the eligible randomized controlled trials published up to March 1, 2019. Meanwhile, the references to relevant publications will also be reviewed to identify other studies, and will re-search before finial summary for analysis. EndNote X7 will be used as a document manager for duplicate checking and screening of literature. The risk of bias will be assessed and the date of included studies will be analyzed by Revman V5.3.5.Results:The primary outcome will be subjective stress level, general mild psychiatric symptoms of participants. The secondary outcome will be cortisol level and adverse effects likely to be related to treatment.Conclusion:The systematic review and meta-analysis will provide evidence to assess the efficacy and safety of probiotics in relieving psychological stress.PROSPERO registration number:PROSPERO CRD42019122930.

CLINICAL SPECIFICITY OF ADAPTATION DISORDERS IN STUDENTS

Aim: To study the clinical features of the adaptation disorders state of medical students. Material and methods of research: To solve the aim, following the principles of bioethics and deontology, a comprehensive clinical-anamnestic, clinical-psychopathological and psychodiagnostic examination of 412 students of both sexes (216 women and 196 men), Kharkiv National Medical University, average age 18.0±2.0 years. Among the surveyed 215 students of eastern Ukraine; 87 students – residents of Luhansk and Donetsk regions, enrolled in KhNMU to the beginning of the ATO and 110 students – migrants from the ATO zone. Research methods: clinical, psychopathological, psychodiagnostic, statistical. Results As shown by the results of the study, 27.0±1.7 % of students from eastern Ukraine, 36.4±1.9 % of students from residents of Luhansk and Donetsk regions who entered KhNMU for the beginning of the ATO and 92.2±3.1 % of students are migrants disadaptive states detected from the ATO zone. In the course of the work, it was established that disadaptive states of medical students manifest anxiety and depressive disorders. Depressive disorders were characterized by a lowered background of mood, affect of anguish and expectation of unhappiness, psychomotor inhibition, fixation on negative events, depressive self-assessment, reduction of the level of impulses, the presence of moderate and severe depressive episodes on the Hamilton depression scale Anxiety disorders were characterized by the dominance of the general anxious mood background with a sense of internal tension, anxiety with inability to relax, irritability, aptitude for affinity reactions, hyperesthesia, internal stress, violation of the sleep-wake cycle, presence of moderate and severe anxiety episodes on the Hamilton depression scale, high level of reactive anxiety and personal anxiety on the Spielberger-Khanin scale and excessive nervous and mental voltage on the Nemchin scale. Conclusions. Migrant students show a higher level of adaptation disorders, compared to students who enrolled in KhNMU at the beginning of the ATO, in 27.0±1.7 % of the examined I groups, 36.4±1.9 % of the examined II and 92.2±3.1 % III group revealed disadaptive states The clinical picture of disadaptive states of presentation is a combination of anxiety and depressive symptoms with a predominance of moderate and severe anxiety and depressive episodes, high levels of reactive anxiety and personal anxiety and excessive psychological stress.

Takotsubo cardiomyopathy after the first electroconvulsive therapy regardless of adjuvant beta-blocker use: a case report and literature review

Takotsubo cardiomyopathy (TC) is a rare complication of electroconvulsive therapy (ECT), an effective and safe treatment for severe cases of depression and psychosis. There are reports on 16 patients who developed TC after ECT, and these were predominantly female patients treated with antidepressants for depressive disorder. We describe a case of a 40-year-old male patient, with a history of schizophrenia and heavy caffeine and nicotine use, treated for acute psychotic episode with haloperidol and clozapine. Propranolol was administered because of clozapine-induced tachycardia. After 8 weeks without therapeutic response, the patient was referred for standard ECT procedure, which included premedication and bifrontotemporal stimulation. Two hours later, the patient experienced gastric pain and had increased troponin and natriuretic peptide levels and ST-elevation. After inotrope and anticoagulant treatment and replacement of antipsychotics, the patient remained stable. Contrary to common opinion, previous adrenergic blockade in this patient did not prevent TC occurrence. TC pathophysiology remains unclear although it has been related to the burst of norepinephrine neurons. Psychosis has also been associated with catecholamine dysfunction, and excessive psychological stress with long-term norepinephrine dysfunction. Animal models have shown that ECT, clozapine, and nicotine and caffeine use could considerably increase catecholamine levels. Clinical understanding of rare cardiac ECT complications could improve early recognition of patients at risk for TC and ensure safe ECT protocols.

A new theory of depression based on the serotonin/kynurenine relationship and the hypothalamicpituitary- adrenal axis

The serotonergic and immunological hypothesis of depression proposes that certain types of excessive stress distort the relationship between the activities of the innate immune and central nervous systems, so that the stress caused by an infection, or excessive psychological stress, activate toll-like receptors such as the TLR-4, the transcription factor NF-kB, the inflammasome NLRP3, as well as the secretion of interleukin-1 beta (IL-1β), interleukin-6 (IL-6) and other factors of the innate immune response, causing first, the general symptoms of the disease which appear with any infection, but also those characteristic of depressive illness such as dysphoria and anhedonia. The evidence indicates that, if the stimulus persists or recurs within 24 hours, the indole-2, 3-dioxygenase enzyme (IDO) of the kynurenine metabolic pathway, which increases the synthesis of quinolinic acid, is activated with an associated reduction of serotonin synthesis. Quinolinic acid activates NMDA receptors in the central nervous system and stimulates the secretion of interleukins IL-6 and 1L-1β, among others, promoting hyper-activity of the HPA axis and reinforcing a bias of the tryptophan metabolism to produce quinolinic acid, and interleukins by the innate immune system, further reducing the synthesis of serotonin and consolidating the depressive process. We discuss the evidence showing that this process can be initiated by either interleukin stimulated by an infection or some vaccines or excessive psychological stress that activates the HPA axis together with said innate immune response, causing a process of aseptic inflammation in the central nervous system.

Litigation in Perinatal Care: The Deposition Process.

Litigation in perinatal nursing represents a disproportionate share of indemnity payouts and results in excessive psychological stress. Testimony at deposition or trial can be challenging for clinicians; little is taught in training or postgraduate education regarding litigation. Nurses, midwives, and physicians can effectively navigate the deposition process and prepare for trial testimony by understanding the plaintiff's goals, recognizing the role of documentation, and becoming familiar with various plaintiff's strategies including reptile theory. Knowledge of psychological concepts such as confirmation bias and cognitive dissonance may assist clinicians in responding to plaintiff's lines of questioning. Deposition preparation is crucial to the defense and requires active participation on the part of clinicians; it may include mock deposition or use of simulation laboratories. Common mistakes in deposition may be avoided with foresight and anticipatory planning by clinicians working closely with risk managers and defense attorneys. This article provides an overview of the deposition process, including the plaintiff's goals and common approaches, as well as the role of documentation and common errors of deponents.