Recurrent Takotsubo cardiomyopathy triggered by emotionally stressful events: A case report

BACKGROUND Takotsubo cardiomyopathy(TCM)is characterized by reversible left ventricular dysfunction triggered by emotional or physical stress.Only 1%-2%of patients with acute coronary syndrome are diagnosed with TCM.Although obstructive coronary artery disease is frequently considered to be the cause of chest pain,TCM should be considered in some clinical settings.In this case,clinicians did not make a timely and accurate diagnosis for TCM due to a lack of knowledge until the third hospitalization with a left ventriculogram.CASE SUMMARY A 55-year-old postmenopausal woman had intermittent chest pain following emotionally stressful events three times in the past 3 years.Cardiac troponin levels increased after each instance of symptom onset.A transthoracic echocardiogram showed reversible left ventricular dysfunction.The patient underwent three coronary angiograms without evidence of coronary artery disease.A left ventriculogram was first performed at the third hospitalization and revealed apical akinesia with ballooning of the apical region and consistent hypercontractile basal segments.The diagnosis of TCM was confirmed.The patient was treated with an angiotensin-converting-enzyme inhibitor(perindopril)and aβ-blocker(metoprolol).No complications occurred during the patient’s hospitalization.The patient was told to avoid stressful events.During the 9-mo follow-up visit,the patient was asymptomatic with an ejection fraction of 55%.CONCLUSION Clinicians should be conscious of the possibility of TCM,especially in postmenopausal women presenting with clinical manifestations similar to acute coronary syndrome without coronary occlusion.

Coping as a Mechanism Linking Stressful Life Events and Mental Health Problems in Adolescents

Objective Although stressful life events represent an etiologic factor of mental health problems in adolescents, few studies have been conducted to address mechanisms linking the stress-psychopathology relation. The present study was designed to examine coping as a mediate factor on the relationship between stressful life events and symptoms of anxiety and depression. Methods The participants were 13 512 students from eight cities of China, who participated in a school-based survey. Data were collected by a questionnaire comprising coping, stressful life events, anxiety, and depressive symptoms. As a model, a series of regression equations were used to examine whether coping mediated the association between stressful life events and symptoms of anxiety and depression. Results Each dimension of stressful life events showed significant correlation with anxiety, depression and coping （all P〈0.001）. In the model to analyze mediate effects, all standardized coefficients （β） were significant （all P〈0.01）, indicating marked mediator effects. Furthermore, negative coping might account for more mediate effects than positive coping on this relationship. Conclusion Coping partially mediated the relationship between stressful life events and mental health during adolescence. This study highlighted an important public health priority for preventive interventions targeting stress-related psychopathology, and for further promoting adolescents＇ mental health.

Psychological impact of chronic hepatitis C:Comparison with other stressful life events and chronic diseases

AIM： To examine the psychological impact of chronic hepatitis C （CHC） diagnosis in a large cohort of CHC patients as compared with other stressful life events and chronic diseases carrying a risk of life-threatening complications. METHODS： One hundred and eighty-five outpatients with compensated CHC were asked to self-grade, using a 100-mm visual analogue scale （VAS）, the degree of stress caused by the learning of CHC diagnosis and the perceived severity of their disease. Diagnosis-related stress was compared to four other stressful life events and perceived CHC severity was compared to four other common chronic diseases. RESULTS： Learning of CHC diagnosis was considered a major stressful event （mean ± SD scores： 72±25）, significantly less than death of a loved-one （89±13, P〈0.0001） and divorce （78 ± 23, P〈0.007）, but more than job dismissal （68 ± 30, P〈 0.04） and home removal （26±24, P〈 0.0001）. CHC was considered a severe disease （74± 19）, after AIDS （94±08, P〈 0.001） and cancer （91± 11, P〈 0.001）, but before diabetes （66±23, P〈0.001） and hypertension （62±20, P〈0.001）. Perceived CHC severity was not related to the actual severity of liver disease, assessed according to Metavir fibrosis score. In multivariate analysis, diagnosisrelated stress was related to perceived disease severity （P〈0.001）, trait anxiety （P〈 0.001） and infection through blood transfusion （P〈 0.001）. CONCLUSION： Our results show the considerable psychological and emotional burden that a diagnosis of CHC represents, even in the absence of significant liver disease. They should be taken into account when announcing a diagnosis of CHC in order to reduce its negative effects.

Psychosocial determinants of irritable bowel syndrome

From a pure motor disorder of the bowel,in the past few years,irritable bowel syndrome (IBS) has become a multifactorial disease that implies visceral hypersensitivity,alterations at the level of nervous and humoral communications between the enteric nervous system and the central nervous system,alteration of the gut microflora,an increased intestinal permeability and minimum intestinal inflammation.Psychological and social factors can interfere with the communication between the central and enteric nervous systems,and there is proof that they are involved in the onset of IBS and influence the response to treatment and outcome.There is evidence that abuse history and stressful life events are involved in the onset of functional gastrointestinal disorders.In order to explain clustering of IBS in families,genetic factors and social learning mechanisms have been proposed.The psychological features,such as anxiety,depression as well as the comorbid psychiatric disorders,health beliefs and coping of patients with IBS are discussed in relation to the symptoms and outcome.

A natural model of behavioral depression in postpartum adult female cynomolgus monkeys (Macaca fascicularis)

Postpartum depression （PPD） is a modified form of major depressive disorders （MDD） that can exert profound negative effects on both mothers and infants than MDD. Within the postpartum period, both mothers and infants are susceptible; but because PPD typically occurs for short durations and has moderate symptoms, there exists challenges in exploring and addressing the underlying cause of the depression. This fact highlights the need for relevant animal models. In the present study, postpartum adult female cynomolgus monkeys （Macaca fascicularis） living in breeding groups were observed for typical depressive behavior. The huddle posture behavior was utilized as an indicator of behavioral depression postpartum （BDP） as it has been established as the core depressive-like behavior in primates. Monkeys were divided into two groups： A t3DP group （n=6）, which were found to spend more time huddling over the first two weeks postpartum than other individuals that formed a non-depression control group （n=4）. The two groups were then further analyzed for locomotive activity, stressful events, hair cortisol levels and for maternal interactive behaviors. No differences were found between the BDP and control groups in locomotive activity, in the frequencies of stressful events experienced and in hair cortisol levels. These findings suggested that the postpartum depression witnessed in the monkeys was not related to external factors other than puerperium period. Interestingly, the BDP monkeys displayed an abnormal maternal relationship consisting of increased infant grooming. Taken together, these findings suggest that the adult female cynomolgus monkeys provide a natural model of behavioral postpartum depression that holds a number of advantages over commonly used rodent systems in PPD modeling. The cynomolgus monkeys have a highly-organized social hierarchy and reproductive characteristics without seasonal restriction--similar to humans--as well as much greater homology to humans than rodents. As such, this model may provide a greater translational efficiency and research platform for systematically investigating the etiology, treatment, prevention of PPD.

Irritable bowel syndrome and chronic pelvic pain: A singular or two different clinical syndrome?

Irritable bowel syndrome （IBS） and chronic pelvic pain （CPP） are both somatoform disorders with a high prevalence within the population in general. The objective was to compare both entities, to find the differences and the similarities related to epidemiology and psychosocial aspects like stressful life events, physical and sexual abuse, illness behaviour and comorbidity. The technical literature was reviewed systematically from 1971 to 2006 and compared. According to literature, IBS and CPP seem to be one rather than two different entities with the same Iocalisation of pain. Both syndromes also are similar concerning prevalence, the coexistence of mental and somatoform disorders, the common history of sexual and physical abuse in the past and their health care utilization. It could be shown that there were many similarities between IBS and CPP. Nevertheless both are traded as different clinical pictures as far. Therefore it seems to be reasonable and necessary to generate a common diagnosis algorithm and to bring gynaecologists and gastroenterologists into dialogue.

Psychosocial factors affecting the etiology and management of type 1 diabetes mellitus:A narrative review

Type 1 diabetes(T1D)is one of the most common chronic diseases in children and adolescents worldwide.Its etiopathogenesis results from the interplay of genetic and environmental variables.Among the latter,psychological stress has been implicated in disease onset as well as disease management.Various studies,including large population-based studies,have highlighted the role of stressful life events in the etiopathogenesis of T1D.In this article,we also emphasize the importance of attachment in the early child-caregiver relationship,which can be seen as a measure of the quality of the relationship and is crucial for stress and emotional regulation.It serves as a model for all subsequent relationships in one’s life.We summarize some of the few studies performed in the field of attachment and T1D etiopathogenesis or management.T1D management demands a lifelong therapeutic regimen to prevent acute and chronic complications.In addition to psychological stress,psychological factors such as family functioning,developmental adjustment,autonomy,mental health problems and other factors have been found to relate to metabolic control.Psychological factors need to be understood not as a single directional causality-based principle but as a dynamic bi-or multidirectional system that is affected by the normal developmental transitions of childhood and adolescence.

Stressful life events,psychosocial health and general health in preschool children before age 4

Background The impact of stressful life events(SLEs)in early childhood is often ignored.We aimed to examine longitudinal associations between SLEs and psychosocial and general health in preschool children.Methods Twelve SLEs occurring before the age of 24 months were assessed and categorized by frequency(no events,1-2 SLEs,and>2 SLEs)and overall tension(no events,low,and high)(n=1431).Psychosocial and general health were meas-ured three times at the age of 24,36 and 45 months.The associations were examined by logistic regression models using generalized estimating equations to handle repeated measurements.Results Half(48.4%)of the families experienced SLEs,and 23.8%perceived high-tension SLEs before the children were aged 24 months.Gender differences were observed in the association between SLEs and psychosocial health.Compared to girls without SLEs,girls who experienced>2 SLEs[OR=3.31,95%confidence interval(CI)2.05-5.35]or high-tension SLEs(OR=3.01,95%CI 2.07-4.39)had higher odds of psychosocial problems from 24 to 45 months.The odds ratios in boys were 2.10(95%CI 1.36-3.24)and 1.47(95%CI 1.06-2.03),respectively.Moreover,only girls'risk of psychosocial problems increased after experiencing 1-2 SLEs(OR=2.15,95%CI 1.54-3.00)or low-tension SLEs(OR=1.90,95%CI 1.31-2.74).Regarding general health,children who experienced>2 SLEs(OR=1.96,95%CI 1.21-3.18)and high-tension SLEs(OR=1.60,95%CI 1.12-2.28)had higher odds of poor general health from 24 to 45 months.Conclusions The findings emphasized that young children's psychosocial and general health can be impacted by experienc-ing SLEs in early childhood.Attention and adequate support for families experiencing SLEs are needed to minimize the potential negative effect of SLEs on child health,particularly in girls.

Gene×environment interaction in major depressive disorder

Major depressive disorder(MDD)is a multifactorial disorder,where multiple susceptibility genes interact with environmental factors,predisposing individuals to the development of the illness.In this article,we reviewed different gene×environment interaction(G×E)studies shifting from a candidate gene to a genome-wide approach.Among environmental factors,childhood adversities and stressful life events have been suggested to exert crucial impacts on MDD.Importantly,the diathesis-stress conceptualization of G×E has been challenged by the differential susceptibility theory.Finally,we summarized several limitations of G×E studies and suggested how future G×E studies might reveal complex interactions between genes and environments in MDD.

Childhood Adversities Associated with Eating Disorders Reported by Adults

Background: It has been suggested that childhood events increase the risk of suffering from an eating disorder (ED) in adolescence or young adulthood. Our study here aimed at investigating whether there was an association between stressful childhood events and eating disorders later in life. Methods: Our population-based study was a part of the HeSSup (The Health and Social Support) postal survey in 2003, a follow-up survey with a random sample of working-aged subjects drawn from the Finnish Population Register in 1998. Participants in this study reported having been suffering from ED (N = 374), while controls (N = 18,639) reported no history of eating disorder in the questionnaire both in 1998 and 2003. The questionnaire included six questions related to childhood adversities. Results: Each childhood stressor increased the risk of developing ED cumulatively (one adversity OR 1.7 versus all six OR 8.3). Intrafamiliar conflicts (OR 2.0), being afraid of a family member (OR 1.5) or long-term illnesses in the family (OR 1.4) increased the ED-risk statistical significantly. Conclusion: Children exposed to stress are more likely to suffer from eating disorders as adults than those not exposed.

An Unusual Case of Functional Neurological Disorders and Psychogenic Coma following Physical Assault:Clinical and Medico-Legal Considerations

Functional neurological disorders can have different clinical manifestations,including coma,in the setting of an unknown etiology.In this article,we present a case of a young man affected by intellectual disabilities who,after a physical assault reported serious neurological alterations and a functional coma.This case shows how a stressful psychophysical event can bring acute and variable neurological manifestations of functional significance to a victim with previous intellectual disabilities.Despite the growing interest in this field,research is still very limited and studies in this field could better explain the nature of the psychogenic coma.From a medico-legal point of view,problems of evaluation may emerge for these disorders emerge as a result of acute psycho-physical stress and without any detectable structural alterations.