Disruptive patterns of eating behaviors and associated lifestyles in males with ADHD

Background

Attention deficit hyperactivity disorder (ADHD) is a neurological/behavioral disorder characterized by inattention or hyperactivity and impulsivity, or combined symptomatology. Children with ADHD are predisposed to irregular and/or impulsive eating patterns often leading to compromised physical condition. The goal of the present study was to statistically evaluate parental scoring of patterned eating behaviors and associated lifestyles within a cohort of 100 boys diagnosed with ADHD in comparison to age-matched male controls.

Material/Methods

The study population consisted of 100 boys aged 6–10 years diagnosed with mixed type ADHD by DSM-IV criteria and 100 aged-matched healthy male control subjects. Patterns of eating behaviors and associated lifestyles were scored by structured parental interviews using a nominal rating scale.

Results

Interview scores indicated statistically significant differences in patterned eating behaviors in subjects with ADHD in comparison to healthy controls. Notably, subjects diagnosed with ADHD exhibited markedly diminished adherence to a traditional breakfast, lunch, and dinner schedule, which was linked to a significantly higher frequency (>5/day) of irregular eating times. In the ADHD cohort, disruptive patterns of eating behaviors were associated with diminished nutritional value of ingested food (expressed as lowered content of fruits and vegetables) and increased consumption of sweetened beverages.

Conclusions

Disruptive patterns of eating behaviors, metabolically unfavorable nutritional status, and diminished physical activities of male children diagnosed with ADHD are linked to compromised growth and development and appearance of metabolic diseases in adulthood.

ADHD and growth: questions still unanswered

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed childhood psychiatric disorders. It is manifested in every part of an affected child's behavior, with multiple symptomatology and heterogenous etiology. Published studies report that ADHD children may show changes in growth and development. Most of the studies on ADHD have been focused on connections between medication and growth changes and describe growth delays associated with medication. However, recent research results point to the low significance of the changes accompanying pharmacological treatment. Changes in growth may not only be a secondary effect of the treatment, but may also be specific characteristics of ADHD.

Convergent dysregulation of frontal cortical cognitive and reward systems in eating disorders

A substantive literature has drawn a compelling case for the functional involvement of mesolimbic/prefrontal cortical neural reward systems in normative control of eating and in the etiology and persistence of severe eating disorders that affect diverse human populations. Presently, we provide a short review that develops an equally compelling case for the importance of dysregulated frontal cortical cognitive neural networks acting in concert with regional reward systems in the regulation of complex eating behaviors and in the presentation of complex pathophysiological symptoms associated with major eating disorders. Our goal is to highlight working models of major eating disorders that incorporate complementary approaches to elucidate functionally interactive neural circuits defined by their regulatory neurochemical phenotypes. Importantly, we also review evidence-based linkages between widely studied psychiatric and neurodegenerative syndromes (e.g., autism spectrum disorders and Parkinson’s disease) and co-morbid eating disorders to elucidate basic mechanisms involving dopaminergic transmission and its regulation by endogenously expressed morphine in these same cortical regions.

Co-morbidity and self medication in schizophrenia: involvement of endogenous morphine signaling mechanisms

For over 30 years, empirical studies have demonstrated expression of chemically authentic morphine by diverse animal tissues and organs systems. De novo biosynthesis of endogenous morphine by animal cells displays striking similarities to the multi-enzyme mediated biosynthetic pathway previously characterized in great biochemical and molecular detail in opium poppy (Papaver somniferum). The committed enzyme step within this pathway involves an asymmetric Pictet-Spengler condensation of dopamine (DA) and 3,4 dihydroxyphenylacetaldehyde (DOPAL), the oxidation product of L- 3,4-dihydroxyphenylalanine (L-DOPA), to form the essential intermediate precursor tetrahydropapaveroline (THP). We have hypothesized that endogenous morphine is synthesized within peripheral sites via conversion of THP in a regulated biosynthetic pathway, or conversely, THP may be directly transported into the CNS and converted to endogenous morphine within a similar biosynthetic pathway. The fundamental chemical relationship of the prototype catecholamine DA and its immediate precursor L-DOPA to endogenous morphine expression indicates a novel reciprocally interactive mechanism that links catecholamine and "morphinergic" pathways in the activation and inhibition of key physiological responses, including higher order neural integration. Dysregulation of interactive DAergic and "morphinergic" signaling pathways within CNS foci may contribute to the etiological factors driving co-morbid behavioral syndromes in major psychiatric disorders. Our short review is designed to provide insights on comorbidity and self-medication in schizophrenia from a novel perspective involving endogenous morphine signaling mechanisms.

Burnout syndrome in medical professionals: a manifestation of chronic stress with counterintuitive passive characteristics

By operational criteria, burnout appears to be a multifaceted behavioral syndrome consisting of maladaptive individual responses subsequent to prolonged stressful situations. Given the intense physical and cognitive demands of providing high quality healthcare to a wide spectrum of patients, healthcare professionals are particularly susceptible to developing burnout syndrome, a notable phenomenon that has gleaned significant societal attention in recent years. Clearly, widespread manifestation of burnout by health care professionals represents a serious potential threat to the overall quality of patient care and to the realization of positive outcomes to multiple treatment strategies. It will most certainly engender a serious negative impact on the economic viability of the entire healthcare system. Presently, our brief review focuses on current research efforts to 1) provide precise behavioral and psychiatric diagnostic criteria for burnout syndrome in healthcare professionals, 2) identify potential etiological factors and ongoing stressors, and 3) outline an integrative approach for treatment and prevention.

Low dose morphine adjuvant therapy for enhanced efficacy of antipsychotic drug action: potential involvement of endogenous morphine in the pathophysiology of schizophrenia

Major thematic threads linking extensive preclinical and clinical efforts have established a working mechanistic scheme whereby atypical antipsychotic drugs ameliorate negative DSM IV diagnostic criteria by effecting relatively potent blockade of serotonin (5-HT)(2A) receptors coupled with weaker antagonism of dopamine D(2) receptors in frontal cortical areas. These contentions are more or less supported by in vitro binding experiments employing cloned receptors on cultured cells, although significant functional involvement of 5-HT(2C) receptors has also been proposed. It is interesting that a key statistical analysis indicates a major shift in usage back to typical antipsychotic agents for management of schizophrenia from 1995–2008, whereas off-label usage of atypical antipsychotic agents was markedly increased or expanded for bipolar affective disorder. Importantly, meta-analyses generally did not support efficacy differences between the other atypical antipsychotics compared with the older typical agents. A critical examination of putative functional linkages of morphine and its type-selective mu opioid receptor to higher order cortical regulation of cognitive processes may provide novel insights into human behavioral processes that are severely impaired in schizophrenia spectrum disorders.

Intracerebellar application of P19-derived neuroprogenitor and naive stem cells to Lurcher mutant and wild type B6CBA mice

Background

Neurotransplantation has great potential for future treatments of various neurodegenerative disorders. Preclinically, the Lurcher mutant mouse represents an appropriate model of genetically-determined olivocerebellar degeneration. The aim of the present study was to assess survival of naïve and neurally differentiated P19 carcinoma stem cells following transplantation into the cerebellum of Lurcher mice and wild type littermates.

Material/Methods

Adult normal wild type (n=51) and Lurcher mutant mice (n=87) of the B6CBA strain were used. The mean age of the animals at the time of transplantation was 261.5 days. Suspension of naive and neurally differentiated P19 carcinoma stem cells was injected into the cerebellum of the mice. In the Lurcher mutants, 2 depths of graft injection were used. Three weeks after implantation the brains of experimental animals were examined histologically.

Results

Survival of neuroprogenitor grafts at a depth of 1.6 mm was significantly higher in wild type vs. Lurcher mutant mice. In wild type mice, the typical graft localization was in the middle of the cerebellum, whereas in Lurcher mice the graft was never found inside the degenerated cerebellum and was primarily localized in the mesencephalon.

Conclusions

We conclude that the appearance and low survival rate of cerebellar P19 carcinoma stem cell grafts in the Lurcher mutant mice weigh against the therapeutic value of this cell line in preclinical studies of neurodegeneration.

Parkinson's disease, L-DOPA, and endogenous morphine: a revisit

Clinical observations stemming from widespread employment of restorative L-3,4-dihydroxyphenylalanine (L-DOPA) therapy for management of dyskinesia in Parkinson's Disease (PD) patients implicate a regulatory role for endogenous morphine in central nervous system dopamine neurotransmission. Reciprocally, it appears that restorative L-DOPA administration has provided us with a compelling in vivo pharmacological model for targeting peripheral sites involved in endogenous morphine expression in human subjects. The biological activities underlying endogenous morphine expression and its interaction with its major precursor dopamine strongly suggest that endogenous morphine systems are reciprocally dysregulated in PD. These critical issues are examined from historical and current perspectives within our short review.

Targeting mitochondrial biogenesis for promoting health

Mitochondrial biogenesis is a key physiological process that is required for normal growth and development and for maintenance of ongoing cellular energy requirements during aging. Of equivalent and or greater importance is the regulated enhancement of mitochondrial biogenesis upon physiological demand coupled to multiple cellular insults. Basically, cellular survival mechanisms following a variety of disease-related pathophysiological insults are entrained by convergent mechanisms designed to regain homeostatic control of mitochondrial biogenesis. Recent molecular studies represent a clearly defined approach to maximize normative cellular expression of mitochondrial biogenesis for maintenance of cellular energy requirements and as an anti-aging strategy in healthy human populations. This report focuses on mitochondrial transcription factor A, peroxisome proliferator-activated receptor gamma coactivator 1-alpha, PINK1 and Parkin. Designing agents to target mitochondrial function represents a compelling therapeutic strategy for enhancement of cellular expression of mitochondrial biogenesis in diverse human populations afflicted with metabolic, degenerative, neurodegenerative, and metastatic diseases.<br />

Reciprocal regulation of cellular nitric oxide formation by nitric oxide synthase and nitrite reductases

Our mini-review focuses on dual regulation of cellular nitric oxide (NO) signaling pathways by traditionally characterized enzymatic formation from L-arginine via the actions of NO synthases (NOS) and by enzymatic reduction of available cellular nitrite pools by a diverse class of cytosolic and mitochondrial nitrite reductases. Nitrite is a major metabolic product of NO and is found in all cell and tissue types that utilize NO signaling processes. Xanthine oxidoreductase (XOR) has been previously characterized as a housekeeping enzyme responsible for cellular uric acid formation via enzymatic conversion of hypoxanthine and xanthine. It has become apparent that XOR possesses multi-functional enzymatic activities outside the realm of xanthine metabolism and a small but significant literature also established a compelling functional association between administered sodium nitrite, XOR activation, and pharmacologically characterized NO transductive effects in positive cardiovascular function enhanced pulmonary perfusion, and protection against ischemia/reperfusion injury and hypoxic damage and oxidative stress. Similar positive vascular and cellular effects were observed to be functionally associated with mitochondrial aldehyde dehydrogenase and cytochrome c/cytochrome c oxidase. The profound implications of a reciprocal regulatory mechanism responsible for cytosolic and mitochondrial NO production are discussed below.

Endogenous morphine: up-to-date review 2011

Positive evolutionary pressure has apparently preserved the ability to synthesize chemically authentic morphine, albeit in homeopathic concentrations, throughout animal phyla. Despite the establishment of a progressively rigorous and mechanistically focused historical literature extending from the mid 1970s to the mid 1980s that supported the expression of chemically authentic morphine by animal cellular and organ systems, prejudicial scepticism and early dismissal by scientists and clinicians most often obscured widespread acceptance of the biological importance and medical implications of endogenous morphine. The current critical paper presents and evaluates key recent coordinated studies in endogenous morphine research, highlighting those that have advanced our understanding of the functional roles of cognate alkaloid-selective μ(3) and μ(4) opiate receptors. We propose that the expression of endogenous morphine by animal and human cells is designed to mediate homeopathic regulation of metabolic activity via activation of cognate μ(3) and μ(4) receptors that serve as transductive conduits for shortcircuit Ca(++) fluxes. The implications of endogenous morphine coupling to nitric oxide regulation of mitochondrial function, with special reference to the cardiovascular system, are now formulated after many years of neglect.

Dopamine D4 receptor gene DRD4 and its association with psychiatric disorders

Dopamine receptors control neural signals that modulates behavior. Dopamine plays an important role in normal attention; that is the reason for studying the genes of the dopaminergic system, mainly in connection with disorders of attention. DRD4 influences the postsynaptic action of dopamine and is implicated in many neurological processes, exhibits polymorphism and is one of the most studied genes in connection with psychiatric disorders. Associations were found with ADHD (attention deficit hyperactivity disorder), substance dependences, several specific personality traits, and reaction to stress. These findings have implications for pharmacogenetics. This article reviews the principle published associations of DRD4 variants with psychiatric disorders.

The neurobiological link between compassion and love

Love and compassion exert pleasant feelings and rewarding effects. Besides their emotional role and capacity to govern behavior, appetitive motivation, and a general ‘positive state’, even ‘spiritual’ at times, the behaviors shown in love and compassion clearly rely on neurobiological mechanisms and underlying molecular principles. These processes and pathways involve the brain’s limbic motivation and reward circuits, that is, a finely tuned and profound autoregulation. This capacity to self-regulate emotions, approach behaviors and even pair bonding, as well as social contact in general, i.e., love, attachment and compassion, can be highly effective in stress reduction, survival and overall health. Yet, molecular biology is the basis of interpersonal neurobiology, however, there is no answer to the question of what comes first or is more important: It is a cybernetic capacity and complex circuit of autoregulation that is clearly ‘amazing’.

Genetics in Psychiatry - up-to-date review 2011

Psychiatric genetics is a popular and much-discussed topic. Many candidate genes have been investigated in relation to psychiatric disorders and many connections have been found. The utilization of these investigations is currently at a theoretical level. Nevertheless, these findings of candidate genes will be important for further research and subsequent clinical use, for example in pharmacogenetics). Due to the rapidly growing number of empirical studies that provide profound analysis of different genes and their variants in different psychiatrical symptomatology, the field is highly divided, and providing a succinct overview is challenging. This article attempts to provide an up-to-date review of the most important and most discussed genes (mainly transporter and receptor genes) contributing to the etiology of psychiatric disorders.

Identification of a µ opiate receptor signaling mechanism in human placenta

BACKGROUND

Previous studies report that genes in the morphine biosynthetic pathway have been found in placental tissue. Prior researchers have shown that kappa opioid receptors are present in human placenta. We determined if a µ opiate receptor was present and which subtype was expressed in human placenta. We also sought to demonstrate a functional µ opiate receptor in human placenta.

MATERIAL/METHODS

Polymerase chain reactions as well as DNA sequencing were performed to identify the µ opiate receptor subtypes present in human placenta. The functionality of the receptor was demonstrated by real time amperometric measurements of morphine induced NO release.

RESULTS

The µ4 opiate receptor sequence was present as well as the µ1 opioid receptor transcript. The addition of morphine to placental tissue resulted in immediate nitric oxide release and this effect was blocked by naloxone.

CONCLUSIONS

In the present study, an intact morphine signaling system has been demonstrated in human placenta. Morphine signaling in human placenta probably functions to regulate the immune, vascular, and endocrine functions of this organ via NO.

Interactive effects of endogenous morphine, nitric oxide, and ethanol on mitochondrial processes

Positive evolutionary pressure has preserved the ability to synthesize chemically authentic morphine, albeit in homeopathic concentrations, throughout animal phyla. The prototype catecholamine dopamine (DA) serves as an essential chemical intermediate in morphine biosynthesis both in plants and animals, thereby providing considerable insight into the roles reciprocal "morphinergic" and catecholamine regulation of diverse physiological processes. Primordial, multi-potential cell types, before the emergence of specialized plant and animal cells/organ systems, required selective mechanisms to limit their responsiveness to environmental noise. Accordingly, cellular systems that emerged with the potential for recruitment of the free radical gas nitric oxide (NO) as a multi-faceted autocrine/paracrine signaling molecule were provided with extremely positive evolutionary advantages. Endogenous "morphinergic" in concert with NO-coupled signaling systems have evolved as autocrine/paracrine regulators of metabolic homeostasis, energy metabolism, mitochondrial respiration and energy production. Basic physiological processes involving "morphinergic"/NO-coupled regulation of cardiovascular mitochondrial function, with special emphasis on the interactive effects of ethanol, are discussed within the context of our review.

Biological indications of a novel "short" µ opiate receptor in domestic chicken

Previous work from our laboratory has established that cellular signaling processes of endogenous morphine are mediated by cognate G protein coupled receptor (GPCR) proteins, designated µ(3) and µ(4) opiate receptors. µ(3) and µ(4) opiate receptors are structurally unique "short" 6 transmembrane helical (TMH) domain GPCRs that are selectively responsive to endogenous morphine, not to families of endogenous opioid peptides, and are uniquely coupled to activation of constitutive nitric oxide synthase (cNOS). Based on high resolution predictive measures, it appears likely that domestic poultry express a µ opiate receptor mRNA encoding potentially two novel GPCRs with similar biochemical characteristics as described for µ(3) and µ(4) opiate receptors as well as traditional µ(1) opioid receptors. The biological indications of these novel µ opiate receptors are discussed within the context of this short review.

Chronic alcohol exposure increases ganglia endogenous morphine levels

INTRODUCTION

We have previously demonstrated that alcohol has the ability to release low levels of endogenously expressed, chemically authentic, morphine from neural tissues.

MATERIAL AND METHODS

Presently, we demonstrate that chronic exposure of Mytilus edulis pedal ganglia tissues maintained in organotypic culture to very concentrations of 1 mM and 10 mM ethanol induces a time dependent increase in both endogenous morphine and dopamine (DA) levels.

RESULTS

Chronic incubation of M. edulis pedal ganglia with 3 concentrations of DA resulted in statistically significant elevations of cellular morphine levels, thereby confirming previous studies from our laboratory establishing DA as an essential precursor in the morphine biosynthetic pathway.

CONCLUSIONS

By understanding multiple debilitating effects of alcohol on "morphinergic" signaling, we may understand the ravages of neural processes associated with alcohol abuse and how its treatment may be made more effective.

Catechol-O-methyltransferase: potential relationship to idiopathic hypertension

Catecholamine signaling pathways in the peripheral and central nervous systems (PNS, CNS, respectively) utilize catechol-O-methyltransferase (COMT) as a major regulatory enzyme responsible for deactivation of dopamine (DA), norepinephrine (NE) and epinephrine (E). Accordingly, homeostasis of COMT gene expression is hypothesized to be functionally linked to regulation of autonomic control of normotensive vascular events. Recently, we demonstrated that morphine administration in vitro resulted in decreased cellular concentrations of COMT-encoding mRNA levels, as compared to control values. In contrast, cells treated with E up regulated their COMT gene expression. In sum, these observations indicate a potential reciprocal linkage between end product inhibition of COMT gene expression by E and morphine. Interestingly, the observed effects of administered E on COMT gene expression suggest an enhancement of its own catabolism or, reciprocally, a stimulation morphine biosynthesis.

Opioid peptides and opiate alkaloids in immunoregulatory processes

Among the various non-neuronal cell types known to express and utilize neuropeptides, those of the immune system have received much attention in recent years. In particular, comparative studies in vertebrates and invertebrates have shown that endogenous opioid peptides are engaged in receptor mediated autoregulatory immune and neuroendocrine processes. The majority of these immune processes are stimulatory, as determined by their effects on conformational changes indicative of immunocyte activation, cellular motility, and phagocytosis. Endogenous opioid peptides form an effective network of messenger molecules in cooperation with cytokines, opiate alkaloids, and certain regulatory enzymes (neutral endopeptidase 24.11). Peptide-mediated immunostimulatory effects observed in this system are operationally counteracted by the inhibitory effects of morphine and related opiates. Opioid/opiate signaling processes are mediated by several types of receptors with different degrees of selectivity. Among them the recently identified, opioid insensitive µ(3) receptor deserves attention on account of its specificity for opiate alkaloids.

Endogenous reward mechanisms and their importance in stress reduction, exercise and the brain

Stress can facilitate disease processes and causes strain on the health care budgets. It is responsible or involved in many human ailments of our time, such as cardiovascular illnesses, particularly related to the psychosocial stressors of daily life, including work. Besides pharmacological or clinical medical treatment options, behavioral stress reduction is much-needed. These latter approaches rely on an endogenous healing potential via life-style modification. Hence, research has suggested different ways and approaches to self-treat stress or buffer against stressors and their impacts. These self-care-centred approaches are sometimes referred to as mind-body medicine or multi-factorial stress management strategies. They consist of various cognitive behavioral techniques, as well as relaxation exercises and nutritional counselling. However, a critical and consistent element of modern effective stress reduction strategies are exercise practices. With regard to underlying neurobiological mechanisms of stress relief, reward and motivation circuitries that are imbedded in the limbic regions of the brain are responsible for the autoregulatory and endogenous processing of stress. Exercise techniques clearly have an impact upon these systems. Thereby, physical activities have a potential to increase mood, i.e., decrease psychological distress by pleasure induction. For doing so, neurobiological signalling molecules such as endogenous morphine and coupled nitric oxide pathways get activated and finely tuned. Evolutionarily, the various activities and autoregulatory pathways are linked together, which can also be demonstrated by the fact that dopamine is endogenously converted into morphine which itself leads to enhanced nitric oxide release by activation of constitutive nitric oxide synthase enzymes. These molecules and mechanisms are clearly stress-reducing.

Proinflammation and preconditioning protection are part of a common nitric oxide mediated process

In the pathophysiology of many different diseases, proinflammatory disease processes repeatedly seem to represent a basic principle. Proinflammation, as any biologic process, has the capacity of exerting negative effects, since its components are toxic and autotoxic. Since proinflammation is a common phenomenon and is, capable of executing negative 'side effects', it is understandable and plausible why it seems to be involved in many different disease states. The different clinical manifestations of proinflammation (different diseases) may actually represent a common and consistent pathophysiological entity that is not separable by its molecular implications. Simultaneously, preconditioning protection counter-intuitively may rely on the same molecular process involving nitric oxide as a chemical messenger.

The neurobiology of stress management

BACKGROUND AND OBJECTIVE

Stress is natural and belongs to life itself. To sustain it and even grow with it biology invented different mechanisms, since stress resistance is obligatory. These pathways, we surmise, can be activated and learned intentionally, through professional stress management training or 'mind-body medicine', or endogenously and automatically through autoregulation. Since the primary goal of various stress-reducing approaches is corresponding, we expect to find an overlapping physiology and neurobiological principle of stress reduction. These common pathways, as we speculate, involve some of the very same signalling molecules and structures.

METHODS

Concepts of stress and stress management are described and then associated with underlying molecular and neurobiological pathways. Evidence is gathered from different sources to substantiate the hypothesis of an overlapping neurobiological principle in stress autoregulation.

RESULTS

Stress describes the capacity and mechanisms to sustain and adjust to externally or internally challenging situations. Therefore, organisms can rely on the endogenous ability to self-regulate stress and stressors, i.e., autoregulatory stress management. Stress management usually consists of one to all of the following instruments and activities: behavioral or cognitive, exercise, relaxation and nutritional or food interventions (BERN), including social support and spirituality. These columns can be analyzed for their underlying neurobiological and autoregulatory pathways, thereby revealing a close connection to the brain's pleasure, reward and motivation circuits that are particularly bound to limbic structures and to endogenous dopamine, morphine, and nitric oxide (NO) signalling. Within this work, we demonstrate the existence of opioid, opiate, dopamine and related pathways for each of the selected stress management columns.

DISCUSSION

Stress management techniques may possess specific and distinct physiological effects. However, beneficial behaviors and strategies to overcome stress are, as a more general principle, neurobiologically rewarded by pleasure induction, yet positively and physiologically amplified and reinforced, and this seems to work via dopamine, endorphin and morphine release, apart from other messenger molecules. These latter effects are unspecific, however, down-regulatory and clearly stress-reducing by their nature.

CONCLUSIONS

There seems to exist a common neurobiological mechanism, i.e., limbic autoregulation, that involves dopamine, morphine and other endogenous signalling molecules, e.g., other opioid receptor agonists, endocannabinoids, oxytocin or serotonin, many of which act via NO release, and this share seems to be of critical importance for the self-regulation and management of stress: stress management is an endogenous potential.

Psychiatric implications of endogenous morphine: up-to-date review

For over 30 years empirical studies have repeatedly demonstrated that the biosynthesis of morphine by diverse animal and human tissues occurs. Recently, the blue mussel's neural tissues and human white blood cells were used to demonstrate the de novo biosynthesis of morphine for small precursor molecules derived from the aromatic amino acid L-tyrosine. Because catecholamine precursors, i.e., L-3,4-dihydroxyphenylalanine (L-DOPA), were also found to be utilized as morphine precursors, a novel reciprocally interactive mechanism is apparent that links catecholamine and opioid pathways in the activation and inhibition of diverse tissue responses. Additionally, these observations provide new insights into morphinergic signalling that transcend analgesia and addiction. We have also linked the biological effects of nitric oxide into a common effect in endogenous morphine signalling. Given the singular importance of dopamine and morphine's interaction in the CNS, the presence and association of this signalling with nitric oxide all promises to provide novel answers for mental health phenomena, which have been lacking because of the inability in accepting the empirical endogenous morphine studies.