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,There are many health effects of transport,and they have been dealt with separatelyand they have been dealt with separately

ACCIDENTSNOISE

AIR POLLUTIONCLIMATE CHANGE

PHYSICALACTIVITY

PSYCHOSOCIALEFFECTS

23/5/02 NSW Refugee Health Se rvice

Migration health

Pre-migration factors

Transit factors

Destination factors

ONE OF THE HISTORICAL ONE OF THE HISTORICAL DEBATES IN PSYCHIATRYDEBATES IN PSYCHIATRYONE OF THE HISTORICAL ONE OF THE HISTORICAL DEBATES IN PSYCHIATRYDEBATES IN PSYCHIATRY

• NATURE: behavior is programmed into the NATURE: behavior is programmed into the genetic makeup of the individualgenetic makeup of the individual

• NURTURE: behavior is the result of social and NURTURE: behavior is the result of social and environmental influencesenvironmental influences

• NATURE: behavior is programmed into the NATURE: behavior is programmed into the genetic makeup of the individualgenetic makeup of the individual

• NURTURE: behavior is the result of social and NURTURE: behavior is the result of social and environmental influencesenvironmental influences

The explosion of neuroscience The explosion of neuroscience research is transforming conceptual research is transforming conceptual approaches toward mental illness.approaches toward mental illness.

The dichotomy between The dichotomy between mind and brain, or between mind and brain, or between “nature” and “nurture” is “nature” and “nurture” is no longer relevantno longer relevant..

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. Kandel, ER. A New Intellectual Framework for Psychiatry. American Journal of American Journal of Psychiatry:Psychiatry: Vol. 155(4) 1998, pp 457-469 Vol. 155(4) 1998, pp 457-469

Principle :Principle : Altered genes do not, by themselves, Altered genes do not, by themselves, explain all of the variance of a given explain all of the variance of a given

major mental illness. major mental illness.

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

Testosterone and Adult Personality

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

Memory Performance

Dose of administered glucocorticoids

The MR/GRBalance Theory

deKloet et al., 1999

facilitation inhibition

MRActivation

GRActivation

Modulatory Actions of Glucocorticoids and Memory Function in HumansModulatory Actions of Glucocorticoids and Memory Function in Humans

Baseline DayExperimental Day

Met

yrap

on

eP

lace

bo

Pla

ceb

oH

ydro

cort

iso

ne

CirculatingCirculating Cortisol Levels Cortisol Levels

CO

GN

ITIO

N

CO

GN

ITIO

N

PHYSICAL PROBLEMS

• 1) TORTURE HAS BEEN ASSOCIATED

WITH A VARIETY OF HEALTH

PROBLEMS INCLUDING:

– DAMAGE TO THE NERVOUS ORMUSCULOSKELETAL 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; testosteronee.g. dominant/subordinate interaction

and stress hormonese.g. Children in day care vs home and stress hormone levels

So, by putting the subject in different socialInteractions, 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

• Prolactin

• b-Endorphin

P<0.001

P<0.01

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

• Auditory

• Gustatory

• Olfactory

• Tactile

• Visual

Supra - Hypothalamic

Mesolimbic

Hypothalamic- Pituitary

Reticular Activating System

TRACT VIOLENCE BRAIN STRUCTURE

Amygdala-Locus Caeruleus-Hippocampus-Thalamus-Raphe Nucleus

DA-NA-5HT-GABA-ACE//CRF-ACTH-ADH-POMC-βΕΝDO-ENCEPHALINS-PRL-GnRH-TRH-LEPTIN-NPY-MSH-GHRS (GHRELIN-PYY)

DISDIS-HARMONY