151
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Noradrenergic dysregulation in the pathophysiology of PTSD. Exp Neurol 2016; 284:181-195. [PMID: 27222130 DOI: 10.1016/j.expneurol.2016.05.014] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/07/2016] [Accepted: 05/09/2016] [Indexed: 12/17/2022]
Abstract
A central role for noradrenergic dysregulation in the pathophysiology of post-traumatic stress disorder (PTSD) is increasingly suggested by both clinical and basic neuroscience research. Here, we integrate recent findings from clinical and animal research with the earlier literature. We first review the evidence for net upregulation of the noradrenergic system and its responsivity to stress in individuals with PTSD. Next, we trace the evidence that the α1 noradrenergic receptor antagonist prazosin decreases many of the symptoms of PTSD from initial clinical observations, to case series, to randomized controlled trials. Finally, we review the basic science work that has begun to explain the mechanism for this efficacy, as well as to explore its possible limitations and areas for further advancement. We suggest a view of the noradrenergic system as a central, modifiable link in a network of interconnected stress-response systems, which also includes the amygdala and its modulation by medial prefrontal cortex. Particular attention is paid to the evidence for bidirectional signaling between noradrenaline and corticotropin-releasing factor (CRF) in coordinating these interconnected systems. The multiple different ways in which the sensitivity and reactivity of the noradrenergic system may be altered in PTSD are highlighted, as is the evidence for possible heterogeneity in the pathophysiology of PTSD between different individuals who appear clinically similar. We conclude by noting the importance moving forward of improved measures of noradrenergic functioning in clinical populations, which will allow better recognition of clinical heterogeneity and further assessment of the functional implications of different aspects of noradrenergic dysregulation.
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152
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Zhang L, Yang W, Yang Y, Liu H, Gu Z. Smartphone-based point-of-care testing of salivary α-amylase for personal psychological measurement. Analyst 2016; 140:7399-406. [PMID: 26415134 DOI: 10.1039/c5an01664a] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Here we report a smartphone-based potentiometric biosensor for point-of-care testing of salivary α-amylase (sAA), which is one of the most sensitive indices of autonomic nervous system activity, and therefore a promising non-invasive biomarker for mental health. The biosensing system includes a smartphone having a sAA-detection App, a potentiometric reader and a sensing chip with preloaded reagents. The saliva sample wicks into the reaction zone on the sensing chip so that the sAA reacts with the preloaded reagents, resulting in conversion of an electron mediator Fe(CN)6(3-) to Fe(CN)6(4-). The sensing chip is then pressed by fingers to push the reaction mixture into the detection zone for the potentiometric measurement. The potential measured by the smartphone-powered potentiometric reader is sent to the smartphone App via the USB port, and converted into sAA concentration based on a calibration curve. Using our method, sAA in real human sample is quantitatively analyzed within 5 min. The results are in good agreement with that obtained using a reference method, and correlated to psychological states of the subjects.
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Affiliation(s)
- Lin Zhang
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China.
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153
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Wan C, Couture-Lalande MÈ, Narain TA, Lebel S, Bielajew C. Salivary Alpha-Amylase Reactivity in Breast Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:353. [PMID: 27023572 PMCID: PMC4847015 DOI: 10.3390/ijerph13040353] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/09/2016] [Accepted: 03/16/2016] [Indexed: 11/24/2022]
Abstract
The two main components of the stress system are the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal-medullary (SAM) axes. While cortisol has been commonly used as a biomarker of HPA functioning, much less attention has been paid to the role of the SAM in this context. Studies have shown that long-term breast cancer survivors display abnormal reactive cortisol patterns, suggesting a dysregulation of their HPA axis. To fully understand the integrity of the stress response in this population, this paper explored the diurnal and acute alpha-amylase profiles of 22 breast cancer survivors and 26 women with no history of cancer. Results revealed that breast cancer survivors displayed identical but elevated patterns of alpha-amylase concentrations in both diurnal and acute profiles relative to that of healthy women, F (1, 39) = 17.95, p < 0.001 and F (1, 37) = 7.29, p = 0.010, respectively. The average area under the curve for the diurnal and reactive profiles was 631.54 ± 66.94 SEM and 1238.78 ± 111.84 SEM, respectively. This is in sharp contrast to their cortisol results, which showed normal diurnal and blunted acute patterns. The complexity of the stress system necessitates further investigation to understand the synergistic relationship of the HPA and SAM axes.
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Affiliation(s)
- Cynthia Wan
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | | | - Tasha A Narain
- Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Sophie Lebel
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Catherine Bielajew
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
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154
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Rash JA, Thomas JC, Campbell TS, Letourneau N, Granger DA, Giesbrecht GF. Developmental origins of infant stress reactivity profiles: A multi-system approach. Dev Psychobiol 2016; 58:578-99. [DOI: 10.1002/dev.21403] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/19/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Joshua A. Rash
- Department of Psychology; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Jenna C. Thomas
- Department of Psychology; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Tavis S. Campbell
- Department of Psychology; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Nicole Letourneau
- Faculty of Nursing and Cumming School of Medicine (Pediatrics and Psychiatry); University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
- Alberta Children's Hospital Research Institute; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Douglas A. Granger
- Institute for Interdisciplinary Saliva Bioscience Research; Arizona State University; Tempe AZ 85287
- Bloomberg School of Public Health and School of Medicine; The John Hopkins University School of Nursing; Baltimore MD 21205
| | - Gerald F. Giesbrecht
- Alberta Children's Hospital Research Institute; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
- Department of Pediatrics, Cumming School of Medicine; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
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155
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Reeves JW, Fisher AJ, Newman MG, Granger DA. Sympathetic and hypothalamic-pituitary-adrenal asymmetry in generalized anxiety disorder. Psychophysiology 2016; 53:951-7. [PMID: 26934635 DOI: 10.1111/psyp.12634] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 01/28/2016] [Indexed: 01/18/2023]
Abstract
Physiologic investigations of generalized anxiety disorder (GAD) have skewed toward assessment of the autonomic nervous system, largely neglecting hypothalamic-pituitary-adrenal (HPA) axis variables. Although these systems coordinate-suggesting a degree of symmetry-to promote adaptive functioning, most studies opt to monitor either one system or the other. Using a ratio of salivary alpha-amylase (sAA) over salivary cortisol, the present study examined symmetry between the sympathetic nervous system (SNS) and HPA axis in individuals with GAD (n = 71) and healthy controls (n = 37). Compared to healthy controls, individuals with GAD exhibited greater baseline ratios of sAA/cortisol and smaller ratios of sAA/cortisol following a mental arithmetic challenge. We propose that the present study provides evidence for SNS-HPA asymmetry in GAD. Further, these results suggest that increased SNS suppression in GAD may be partially mediated by cortisol activity.
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Affiliation(s)
- Jonathan W Reeves
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - Aaron J Fisher
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - Michelle G Newman
- Department of Psychology, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research, Arizona State University, Tempe, Arizona, USA.,Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,John Hopkins University School of Medicine, Baltimore, Maryland, USA
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156
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157
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Petrowski K, Wintermann GB, Kirschbaum C, Strahler J. Salivary alpha-amylase response following repeated psychosocial stress in patients with panic disorder. J Anxiety Disord 2016; 37:54-63. [PMID: 26625098 DOI: 10.1016/j.janxdis.2015.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study examined autonomic responses (salivary alpha-amylase, sAA; heart rate, HR) to repeated psychosocial stress as a candidate mechanism linking autonomic hyper-arousal and sensitization to the occurrence of panic disorder (PD). METHODS Thirty-three patients with PD and 34 healthy controls were exposed to the Trier Social Stress Test (TSST) twice on consecutive days. RESULTS sAA changes were comparable between PD and controls on both testing days with overall decreasing sAA responses (delta) on day two. In contrast, HR delta increased on day two in both groups. This sensitization was driven by female controls while male PD showed most pronounced HR changes to the first TSST. CONCLUSIONS Overall, a general autonomic hyper-arousal in PD could not be confirmed. In contrast, sAA responses slightly habituated to repeated stress. Whether sAA findings mirror assumed habituation effects of repeated stress exposure on normalizing autonomic reactivity remains to be investigated in longitudinal studies.
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Affiliation(s)
- Katja Petrowski
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Germany.
| | - Gloria-Beatrice Wintermann
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Clemens Kirschbaum
- Biological Psychology, Department of Psychology, Technische Universität Dresden, Germany
| | - Jana Strahler
- Clinical Biopsychology, Department of Psychology, Philipps-Universität Marburg, Germany
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158
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Beck A, Fábián G, Fejérdy P, Krause WR, Hermann P, Módos K, Varga G, Fábián TK. Alteration of consciousness via diverse photo-acoustic stimulatory patterns. Phenomenology and effect on salivary flow rate, alpha-amylase and total protein levels. ACTA ACUST UNITED AC 2015; 109:201-213. [PMID: 26709191 DOI: 10.1016/j.jphysparis.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 08/17/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
Long-term photo-acoustic stimulation is used for the induction of altered states of consciousness for both therapeutic and experimental purposes. Long-term photo-acoustic stimulation also leads to changes in the composition of saliva which have a key contribution to the efficiency of this technique in easing mucosal symptoms of oral psychosomatic patients. The aim of this study is to find out whether there is any cumulative effect of repeated stimulation and whether there are any detectable differences between diverse stimulatory patterns of long lasting photo-acoustic stimulation on the phenomenology of the appearing trance state and on salivary secretion. There was significant cumulative effect in relation with the appearance of day dreaming as phenomenological parameter, and in relation with protein output and amylase/protein ratio as salivary parameter. Pattern specific effect was detectable in relation with salivary flow rate only. Although our results clearly indicate the existence of certain cumulative and stimulation-pattern specific effects of repeated photo-acoustic stimulation, the absolute values of all these effects were relatively small in this study. Therefore, in spite of their theoretical importance there are no direct clinical consequences of these findings. However, our data do not exclude at all the possibility that repeated stimulation with other stimulatory parameters may lead to more pronounced effects. Further studies are needed to make clear conclusion in this respect.
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Affiliation(s)
- Anita Beck
- Clinic of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Semmelweis University Budapest, Szentkirályi utca 47, 1088 Budapest, Hungary; Department of Oral Biology, Faculty of Dentistry, Semmelweis University Budapest, Nagyvárad tér 4, 1089 Budapest, Hungary.
| | - Gábor Fábián
- Clinic of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Semmelweis University Budapest, Szentkirályi utca 47, 1088 Budapest, Hungary.
| | - Pál Fejérdy
- Clinic of Prosthetic Dentistry, Faculty of Dentistry, Semmelweis University Budapest, Szentkirályi utca 47, 1088 Budapest, Hungary.
| | - Wolf-Rainer Krause
- Harzklinikum Dorothea Christiane Erxleben, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Thiestrasse 7-10, 33889 Blankenburg, Germany.
| | - Péter Hermann
- Clinic of Prosthetic Dentistry, Faculty of Dentistry, Semmelweis University Budapest, Szentkirályi utca 47, 1088 Budapest, Hungary.
| | - Károly Módos
- Department of Biophysics and Radiation Biology, Semmelweis University Budapest, Tűzoltó u. 37-47, 1094 Budapest, Hungary.
| | - Gábor Varga
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University Budapest, Nagyvárad tér 4, 1089 Budapest, Hungary.
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159
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The effect of physical exercise on salivary secretion of MUC5B, amylase and lysozyme. Arch Oral Biol 2015; 60:1639-44. [DOI: 10.1016/j.archoralbio.2015.07.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/04/2015] [Accepted: 07/13/2015] [Indexed: 11/20/2022]
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160
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Thinking of attachments reduces noradrenergic stress response. Psychoneuroendocrinology 2015; 60:39-45. [PMID: 26115145 DOI: 10.1016/j.psyneuen.2015.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/06/2015] [Accepted: 06/09/2015] [Indexed: 11/22/2022]
Abstract
Although there is much evidence that activating mental representations of attachments figure is beneficial for psychological health and can reduce stress response, no research has directly investigated whether attachment activation can ameliorate hormonal stress response. This study investigated whether activating an attachment figure or a non-attachment figure following administration of a socially evaluated cold pressor test to elicit stress impacted on glucocorticoid and noradrenergic response. Participants (N = 61) provided baseline salivary samples, underwent a cold pressor test, then imagined an attachment or non-attachment figure, and finally provided subsequent saliva samples. Participants who imagined a non-attachment figure had greater noradrenergic response following the stressor than those who imagined an attachment figure. These findings highlight that activating attachment representations can ameliorate the immediate noradrenergic stress response.
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161
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Symptoms of prenatal depression are associated with raised salivary alpha-amylase levels. Psychoneuroendocrinology 2015; 60:163-72. [PMID: 26150358 DOI: 10.1016/j.psyneuen.2015.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/17/2015] [Accepted: 06/17/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE Prenatal depression increases risk for a number of adverse offspring outcomes, however the biological mechanisms underlying this association remain unclear. It has been suggested that maternal glucocorticoids may mediate this link, though supporting evidence has been mixed. An alternative mechanism of effect may be via depression-induced changes in maternal sympathetic nervous system (SNS) function. We examined this hypothesis by determining the relationship between symptoms of maternal prenatal depression and diurnal salivary alpha-amylase (sAA) levels. METHODS 76 pregnant women were recruited during either the second or third trimester of pregnancy. Participants self-reported depressive symptoms using the Edinburgh postnatal depression scale. Saliva samples, to be assayed for alpha-amylase activity, were collected at home over two working days. RESULTS Participants with depressive symptoms in later pregnancy had elevated awakening sAA levels compared with non-depressed controls (t(73) = -2.737, p = 0.008), and continued to have raised sAA throughout the day (F(1) = 10.924, p = 0.002). CONCLUSIONS Our findings highlight that symptoms of depression during late pregnancy are associated with increased maternal SNS activity. Thus, changes in maternal SNS function, which may include increased vasoconstriction and reduced foetal blood flow, could, in part, mediate associations between prenatal depression and adverse offspring outcomes.
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162
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An K, Salyer J, Brown RE, Kao HFS, Starkweather A, Shim I. Salivary Biomarkers of Chronic Psychosocial Stress and CVD Risks. Biol Res Nurs 2015; 18:241-63. [DOI: 10.1177/1099800415604437] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The use of salivary biomarkers in stress research is increasing, and the precision and accuracy with which researchers are able to measure these biomarkers have dramatically improved. Chronic psychosocial stress is often linked to the pathogenesis of cardiovascular disease (CVD). Salivary biomarkers represent a noninvasive biological method of characterizing the stress phenomenon that may help to more fully describe the mechanism by which stress contributes to the pathogenesis and outcomes of CVD. Objectives: We conducted a systematic review of 40 research articles to identify the salivary biomarkers researchers have most commonly used to help describe the biological impact of chronic psychosocial stress and explore its associations with CVD risk. We address strengths and weaknesses of specimen collection and measurement. Methods: We used PubMed, CINAHL, EBSCO host, Web of Science, BIOSIS Previews, Biological Sciences (ProQuest), and Dissertations/Theses (ProQuest) to retrieve 387 initial articles. Once we applied our inclusion/exclusion criteria to specifically target adult human studies dealing with chronic stress rather than acute/laboratory-induced stress, 40 studies remained, which we synthesized using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Results: Cortisol was the biomarker used most frequently. Sources of psychosocial stress included job strain, low socioeconomic status, and environmental factors. Overall, psychosocial stress was associated with CVD risks such as vascular pathology (hypertension, blood pressure fluctuation, and carotid artery plaque) as well as metabolic factors such as abnormal blood glucose, dyslipidemia, and elevated cardiac enzymes. Conclusion: Diverse salivary biomarkers have been useful in stress research, particularly when linked to CVD risks.
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Affiliation(s)
- Kyungeh An
- School of Nursing, Virginia Commonwealth University, Richmond VA, USA
| | - Jeanne Salyer
- School of Nursing, Virginia Commonwealth University, Richmond VA, USA
| | - Roy E. Brown
- School of Nursing, Virginia Commonwealth University, Richmond VA, USA
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163
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Petrakova L, Doering BK, Vits S, Engler H, Rief W, Schedlowski M, Grigoleit JS. Psychosocial Stress Increases Salivary Alpha-Amylase Activity Independently from Plasma Noradrenaline Levels. PLoS One 2015; 10:e0134561. [PMID: 26247781 PMCID: PMC4527714 DOI: 10.1371/journal.pone.0134561] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/12/2015] [Indexed: 12/05/2022] Open
Abstract
Salivary alpha-amylase activity (sAA) and plasma noradrenaline (NA) concentrations are often considered to be surrogate markers of sympathetic activation in response to stress. However, despite accumulating evidence for a close association between sAA and noradrenaline and other indicators of sympathetic activity, reliability and generality of this relation remains unclear. We employed the Trier Social Stress Test (TSST) in order to directly compare the responses in sAA and NA to psychological stress in healthy volunteers (n = 23). The TSST significantly increased sAA and NA plasma levels with no significant differences in females and males. However, when subjects were divided according to their NA responses into low versus high responders, both groups did not significantly differ in their sAA before, during or after stress exposure. These data suggest that in response to acute psychological stress both plasma NA levels and sAA reflect sympathetic activity, however seemed to increase independently from each other.
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Affiliation(s)
- Liubov Petrakova
- Institute of Medical Psychology and Behavioral Immunobiology, University of Duisburg-Essen, Essen, Germany
| | - Bettina K. Doering
- Department of Clinical Psychology & Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Sabine Vits
- Institute of Medical Psychology and Behavioral Immunobiology, University of Duisburg-Essen, Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, University of Duisburg-Essen, Essen, Germany
| | - Winfried Rief
- Department of Clinical Psychology & Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University of Duisburg-Essen, Essen, Germany
| | - Jan-Sebastian Grigoleit
- Institute of Medical Psychology and Behavioral Immunobiology, University of Duisburg-Essen, Essen, Germany
- Laboratory of Neuronal Structure and Function, The Salk Institute for Biological Studies, La Jolla, California, United States of America
- * E-mail:
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164
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Abstract
Deviant physiological reactivity to infant stimuli has been suggested to underlie maladaptive parenting behavior. Our study involved 44 maltreating and 42 non-maltreating mothers. During a standardized cry paradigm, mothers listened to nine cry sounds of varying pitches. Saliva was collected at baseline, after each cry sound, and after a recovery episode. Salivary α-amylase (sAA) as a marker of autonomic nervous system (ANS) activity was assayed from saliva samples. Maltreating mothers showed lower overall sAA levels and an attenuated reactivity pattern to infant crying as compared to non-maltreating mothers. No effect of type of maltreatment (neglect only vs. neglect and abuse) was found. Furthermore, positive correlations between sAA and heart rate (HR) for non-maltreating mothers differed significantly from non-significant correlations between sAA and HR for maltreating mothers. This suggests anomalous asynchrony between different aspects of the ANS in maltreating mothers. Results indicate a lack of functional autonomic (re)activity as a contributing risk factor to child maltreatment.
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165
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Inoue A, Oshita H, Maruyama Y, Tanaka Y, Ishitobi Y, Kawano A, Ikeda R, Ando T, Aizawa S, Masuda K, Higuma H, Kanehisa M, Ninomiya T, Akiyoshi J. Gender determines cortisol and alpha-amylase responses to acute physical and psychosocial stress in patients with borderline personality disorder. Psychiatry Res 2015; 228:46-52. [PMID: 25979467 DOI: 10.1016/j.psychres.2015.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 01/10/2015] [Accepted: 04/05/2015] [Indexed: 11/30/2022]
Abstract
Borderline personality disorder (BPD) is characterized by affective instability, unstable relationships, and identity disturbance. We measured salivary alpha-amylase (sAA) and salivary cortisol levels in all participants during exposure to the Trier Social Stress Test (TSST) and an electric stimulation stress. Seventy-two BPD patients were compared with 377 age- and gender- matched controls. The State and Trait versions of the Spielberger Anxiety Inventory test (STAI-S and STAI-T, respectively), the Profile of Mood State (POMS) tests, and the Beck Depression Inventory (BDI), the Depression and Anxiety Cognition Scale (DACS) were administered to participants before electrical stimulation. Following TSST exposure, salivary cortisol levels significantly decreased in female patients and significantly increased in male patients compared with controls. POMS tension-anxiety, depression-dejection, anger-hostility, fatigue, and confusion scores were significantly increased in BPD patients compared with controls. In contrast, vigor scores were significantly decreased in BPD patients relative to controls. Furthermore, STAI-T and STAI-S anxiety scores and BDI scores were significantly increased in BPD patient compared with controls. DACS scores were significantly increased in BPD patient compared with controls. Different stressors (e.g., psychological or physical) induced different responses in the HPA and SAM systems in female or male BPD patients.
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Affiliation(s)
- Ayako Inoue
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Harumi Oshita
- Department of Applied Linguistics, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Yoshihiro Maruyama
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Yoshihiro Tanaka
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Yoshinobu Ishitobi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Aimi Kawano
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Rie Ikeda
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Tomoko Ando
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Saeko Aizawa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Koji Masuda
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Haruka Higuma
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Masayuki Kanehisa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Taiga Ninomiya
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Jotaro Akiyoshi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan.
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166
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Nagy T, van Lien R, Willemsen G, Proctor G, Efting M, Fülöp M, Bárdos G, Veerman EC, Bosch JA. A fluid response: Alpha-amylase reactions to acute laboratory stress are related to sample timing and saliva flow rate. Biol Psychol 2015; 109:111-9. [DOI: 10.1016/j.biopsycho.2015.04.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/25/2015] [Accepted: 04/25/2015] [Indexed: 11/26/2022]
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167
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Golbidi S, Frisbee JC, Laher I. Chronic stress impacts the cardiovascular system: animal models and clinical outcomes. Am J Physiol Heart Circ Physiol 2015; 308:H1476-98. [DOI: 10.1152/ajpheart.00859.2014] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/03/2015] [Indexed: 01/01/2023]
Abstract
Psychological stresses are associated with cardiovascular diseases to the extent that cardiovascular diseases are among the most important group of psychosomatic diseases. The longstanding association between stress and cardiovascular disease exists despite a large ambiguity about the underlying mechanisms. An array of possibilities have been proposed including overactivity of the autonomic nervous system and humoral changes, which then converge on endothelial dysfunction that initiates unwanted cardiovascular consequences. We review some of the features of the two most important stress-activated systems, i.e., the humoral and nervous systems, and focus on alterations in endothelial function that could ensue as a result of these changes. Cardiac and hematologic consequences of stress are also addressed briefly. It is likely that activation of the inflammatory cascade in association with oxidative imbalance represents key pathophysiological components of stress-induced cardiovascular changes. We also review some of the commonly used animal models of stress and discuss the cardiovascular outcomes reported in these models of stress. The unique ability of animals for adaptation under stressful conditions lessens the extrapolation of laboratory findings to conditions of human stress. An animal model of unpredictable chronic stress, which applies various stress modules in a random fashion, might be a useful solution to this predicament. The use of stress markers as indicators of stress intensity is also discussed in various models of animal stress and in clinical studies.
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Affiliation(s)
- Saeid Golbidi
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada; and
| | - Jefferson C. Frisbee
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Ismail Laher
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada; and
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168
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Nunes LAS, Mussavira S, Bindhu OS. Clinical and diagnostic utility of saliva as a non-invasive diagnostic fluid:
a systematic review. Biochem Med (Zagreb) 2015; 25:177-92. [PMID: 26110030 PMCID: PMC4470107 DOI: 10.11613/bm.2015.018] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/14/2015] [Indexed: 12/17/2022] Open
Abstract
This systematic review presents the latest trends in salivary research and its applications in health and disease. Among the large number of analytes present in saliva, many are affected by diverse physiological and pathological conditions. Further, the non-invasive, easy and cost-effective collection methods prompt an interest in evaluating its diagnostic or prognostic utility. Accumulating data over the past two decades indicates towards the possible utility of saliva to monitor overall health, diagnose and treat various oral or systemic disorders and drug monitoring. Advances in saliva based systems biology has also contributed towards identification of several biomarkers, development of diverse salivary diagnostic kits and other sensitive analytical techniques. However, its utilization should be carefully evaluated in relation to standardization of pre-analytical and analytical variables, such as collection and storage methods, analyte circadian variation, sample recovery, prevention of sample contamination and analytical procedures. In spite of all these challenges, there is an escalating evolution of knowledge with the use of this biological matrix.
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Affiliation(s)
| | - Sayeeda Mussavira
- Department of Biochemistry, Centre for Post Graduate Studies, Jain University, Bangalore, India
| | - Omana Sukumaran Bindhu
- Department of Biochemistry, Centre for Post Graduate Studies, Jain University, Bangalore, India
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169
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Representational similarity analysis offers a preview of the noradrenergic modulation of long-term fear memory at the time of encoding. Psychoneuroendocrinology 2015; 55:8-20. [PMID: 25705798 DOI: 10.1016/j.psyneuen.2015.01.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 12/12/2022]
Abstract
Neuroimaging research on emotional memory has greatly advanced our understanding of the pathogenesis of anxiety disorders. While the behavioral expression of fear at the time of encoding does not predict whether an aversive experience will evolve into long-term fear memory, the application of multi-voxel pattern analysis (MVPA) for the analysis of BOLD-MRI data has recently provided a unique marker for memory formation. Here, we aimed to further investigate the utility of this marker by modulating the strength of fear memory with an α2-adrenoceptor antagonist (yohimbine HCl). Fifty-two healthy participants were randomly assigned to two conditions - either receiving 20mg yohimbine or a placebo pill (double-blind) - prior to differential fear conditioning and MRI-scanning. We examined the strength of fear associations during acquisition and retention of fear (48 h later) by assessing the similarity of BOLD-MRI patterns and pupil dilation responses. Additionally, participants returned for a follow-up test outside the scanner (2-4 weeks), during which we assessed fear-potentiated startle responses. Replicating our previous findings, neural pattern similarity reflected the development of fear associations over time, and unlike average activation or pupil dilation, predicted the later expression of fear memory (pupil dilation 48 h later). While no effect of yohimbine was observed on markers of autonomic arousal, including salivary α-amylase (sAA), we obtained indirect evidence for the noradrenergic enhancement of fear memory consolidation: sAA levels showed a strong increase prior to fMRI scanning, irrespective of whether participants had received yohimbine, and this increase correlated with the subsequent expression of fear (48 h later). Remarkably, this noradrenergic enhancement of fear was associated with changes in neural response patterns at the time of learning. These findings provide further evidence that representational similarity analysis is a sensitive tool for studying (enhanced) memory formation.
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170
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Keeshin BR, Strawn JR, Out D, Granger DA, Putnam FW. Elevated salivary alpha amylase in adolescent sexual abuse survivors with posttraumatic stress disorder symptoms. J Child Adolesc Psychopharmacol 2015; 25:344-50. [PMID: 25803321 PMCID: PMC4955591 DOI: 10.1089/cap.2014.0034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Little is known regarding neuroendocrine responses in adolescent girls with posttraumatic stress disorder (PTSD) who have experienced sexual abuse. Therefore, we collected saliva samples three times daily for 3 days to assess concentrations of salivary alpha amylase (sAA) - a surrogate marker for autonomic nervous system (ANS) activity and, in particular, sympathetic activity - in sexually abused adolescent girls. METHODS Twenty-four girls (mean age: 15±1.4 years) who had experienced recent sexual abuse (i.e., sexual abuse occurred 1-6 months prior to study enrollment) and 12 healthy comparison subjects (mean age: 14.8±1.3 years) completed a structured interview and assessments to ascertain symptoms of posttraumatic stress, then collected saliva at home upon awakening, 30 minutes after waking, and at 5 p.m. on three consecutive school days. RESULTS For sexually abused girls, total PTSD symptoms were associated with higher overall morning levels of sAA (r[20]=0.51, p=0.02), a finding driven by intrusive symptoms (r[20]=0.43, p<0.05) and hyperarousal symptoms (r[20]=0.58, p=0.01). There were no significant differences in diurnal sAA secretion between the sexually abused girls and healthy comparison adolescents. CONCLUSIONS Overall morning concentrations of sAA in sexually abused girls are associated with overall PTSD severity as well as symptoms of hyperarousal and intrusive symptoms, possibly reflecting symptom-linked increases in ANS tone. These data raise the possibility that alterations in ANS activity are related to the pathophysiology of sexual abuse-related PTSD in adolescent girls, and may inform therapeutic interventions (e.g., antiadrenergic medications).
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Affiliation(s)
- Brooks R. Keeshin
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jeffrey R. Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dorothee Out
- Institute for Interdisciplinary Salivary Bioscience Research, Arizona State University, Tempe, Arizona.,Centre for Child and Family Studies, Leiden University, Leiden, the Netherlands
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, Arizona State University, Tempe, Arizona.,Johns Hopkins University School of Nursing, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Frank W. Putnam
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
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171
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Hassan SS, Rachakatla R, McGarvey T, Youakeem MF. Morphological changes in the salivary acini after in vivo cholinergic stimulation. Neurourol Urodyn 2015; 35:574-81. [PMID: 25810148 DOI: 10.1002/nau.22768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/26/2015] [Indexed: 11/11/2022]
Abstract
AIMS Overactive bladder syndrome treated by muscarinic receptor antagonists may be complicated by reduced salivation. Cholinergic agonists may reverse this effect. The aim of the present study was to determine the antagonizing effect of a cholinergic agonist (carbachol) on a muscarinic receptor antagonist (oxybutynin) in the submandibular acini in a rat model. METHODS Forty male Sprague Dawley rats were divided into three groups: Group I (control), Group II (vehicle), and Group III (treatment). Group III was subdivided so Group IIIa was treated with a muscarinic receptor antagonist (oxybutynin) for 1 week, Group IIIb was treated with oxybutynin for 3 weeks, and Group IIIc was treated with oxybutynin for 1 week and oxybutynin and a cholinergic agonist (carbachol) for 2 weeks. Histological and ultrastructural studies were performed on submandibular glands. RESULTS Group IIIa showed moderate atrophic changes in the serous acini and ducts. Group IIIb showed serous acini with distorted wall, widening of the inter-lobar space, and deposition of mononuclear cells in the connective tissue. Group IIIc had serous acini similar to Group I, with mildly dilated inter-lobar ducts, but some serous acini revealed double nuclei and the inter-lobar duct showed luminal vacuolations. Ultrastructural studies confirmed histological results. CONCLUSIONS Muscarinic receptor antagonist administration led to changes in the submandibular gland of rats, while concomitant administration of cholinergic agonists seemed to counteract these atrophic changes. Additional studies should assess carbachol as a cholinergic agonist in treating dry mouth in patients with overactive bladder syndrome who are taking the muscarinic receptor. Neurourol. Urodynam. 35:574-581, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Sherif S Hassan
- Department of Anatomy, A.T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, Missouri.,Department of Anatomy, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Raja Rachakatla
- Department of Anatomy, A.T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, Missouri
| | - Terence McGarvey
- Department of Anatomy, A.T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, Missouri
| | - Magdy F Youakeem
- Department of Anatomy, Faculty of Medicine, Cairo University, Cairo, Egypt
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172
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Attenuated acute salivary α-amylase responses to gustatory stimulation with citric acid in thin children. Br J Nutr 2015; 113:1078-85. [DOI: 10.1017/s0007114515000446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Salivary α-amylase (sAA) is responsible for the ‘pre-digestion’ of starch in the oral cavity and accounts for up to 50 % of salivary protein in human saliva. An accumulating body of literature suggests that sAA is of nutritional importance; however, it is still not clear how sAA is related to individual's nutritional status. Although copy number variations (CNV) of the salivary amylase gene (AMY1) are associated with variation in sAA levels, a significant amount of sAA variation is not explained by AMY1 CNV. To measure sAA responses to gustatory stimulation with citric acid, we used sAA ratio (the ratio of stimulated sAA levels to those of resting sAA) and investigated acute sAA responses to citric acid in children with normal (Normal-BMI, n 22) and low (Low-BMI, n 21) BMI. The AMY1 gene copy number was determined by quantitative PCR. We, for the first time, demonstrated attenuated acute sAA responses (decreased sAA ratio) to gustatory stimulation in Low-BMI (thinness grade 3) children compared with the Normal-BMI children, which suggest that sAA responses to gustatory stimulation may be of nutritional importance. However, child's nutritional status was not directly related to their resting or stimulated sAA levels, and it was not associated with AMY1 gene copy number. Finally, AMY1 CNV might influence, but did not eventually determine, sAA levels in children.
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173
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Salivary alpha amylase diurnal pattern and stress response are associated with body mass index in low-income preschool-aged children. Psychoneuroendocrinology 2015; 53:40-8. [PMID: 25588701 PMCID: PMC4336565 DOI: 10.1016/j.psyneuen.2014.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/08/2014] [Accepted: 12/15/2014] [Indexed: 11/24/2022]
Abstract
Physiological stress responses are proposed as a pathway through which stress can "get under the skin" and lead to health problems, specifically obesity. We tested associations of salivary alpha amylase (sAA) diurnal patterns and stress responses with body mass index (BMI) in young, low-income children (51% male; 54% non-Hispanic white). Diurnal saliva samples were collected three times per day across three days for 269 children (M age 50.8 months, SD 6.3). Individual sAA intercept and slope values were calculated using random effect models to represent morning sAA levels and rate of sAA change across the day. A subset of children (n=195; M age 56.6 months, SD 6.9) participated in a lab-based behavioral stress protocol. Area under the curve increase (AUCI) across four timepoints was calculated to represent increase in sAA output during stress elicitation. Children were weighed and height measured and BMI z-score was calculated. Linear regression was used to evaluate associations of sAA intercept, sAA slope, and sAA AUCI with BMI z-score, controlling for child age, sex, and race/ethnicity; maternal weight status; and family income-to-needs ratio. Diurnal and stress-response sAA patterns were related to child adiposity: for each 1-standard deviation unit (SDU) decrease in morning sAA level, the child's BMI z-score increased by 0.11 (SE 0.05) SDU's (p<.04); for each 1-SDU increase in sAA slope across the day, the child's BMI z-score increased by 0.12 (SE 0.05) SDU's (p<.03); and for each 1-SDU decrease in sAA AUCI during the stress elicitation, the child's BMI z-score increased by 0.14 (SE 0.06) SDU's (p<.03). Blunted stress responses and atypical diurnal patterns of sAA have been found following exposure to chronic life stressors such as poverty. Findings suggest that associations of stress, sAA, and elevated body mass index may develop very early in the lifespan.
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174
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Rodrigues L, Mouta R, Costa AR, Pereira A, Capela e Silva F, Amado F, Antunes CM, Lamy E. Effects of high-fat diet on salivary α-amylase, serum parameters and food consumption in rats. Arch Oral Biol 2015; 60:854-62. [PMID: 25795283 DOI: 10.1016/j.archoralbio.2015.02.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/13/2014] [Accepted: 02/20/2015] [Indexed: 01/14/2023]
Abstract
Salivary α-amylase, a major protein in saliva, has been described as a marker of sympathetic nervous system activity, hence for metabolic energy balance. In this context, its expression in overweight and obesity is of interest. Rats fed with a diet enriched with sunflower oil differentially gained weight yielding two subgroups according to their susceptibility (OP) or resistance (OR) to obesity. Elevated plasmatic levels of leptin in the OP subgroup and altered plasmatic lipid profiles (lower triglycerides and higher total cholesterol/high-density lipoprotein (HDL) ratio compared to controls) in the OR subgroup were observed. Animals from the OP subgroup presented higher α-amylase expression and activity even prior to the dietary treatment, suggesting that this salivary protein may constitute a putative indicator of susceptibility for fat tissue accumulation. After 18 weeks of high-fat diet consumption, salivary α-amylase levels did not significantly change in the OP subgroup, but increased 3-fold in the OR subgroup. The increase in α-amylase levels for the latter might represent an adaptation to lower starch intake. These results suggest that salivary α-amylase secretion might be useful to predict susceptibility for weight gain induced by high-fat diet consumption.
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Affiliation(s)
- Lénia Rodrigues
- Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), Universidade de Évora, 7002-554 Évora, Portugal.
| | - Raquel Mouta
- ICAAM, Universidade de Évora, 7002-554 Évora, Portugal.
| | - Ana Rodrigues Costa
- ICAAM e Departamento de Química, Escola de Ciências e Tecnologia, Universidade de Évora, 7002-554 Évora, Portugal.
| | - Alfredo Pereira
- ICAAM e Departamento de Zootecnia, Escola de Ciências e Tecnologia, Universidade de Évora, 7002-554 Évora, Portugal.
| | - Fernando Capela e Silva
- ICAAM e Departamento de Biologia, Escola de Ciências e Tecnologia, Universidade de Évora, 7002-554 Évora, Portugal.
| | - Francisco Amado
- Química Orgânica, Produtos Naturais e Agro-Alimentares (QOPNA) e Departamento de Química, Universidade de Aveiro, Aveiro, Portugal.
| | - Célia M Antunes
- Centro de Neurociências e Biologia Celular, Universidade de Coimbra, Coimbra, Portugal.
| | - Elsa Lamy
- ICAAM, Universidade de Évora, 702-554, Évora, Portugal.
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175
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Breines JG, McInnis CM, Kuras YI, Thoma MV, Gianferante D, Hanlin L, Chen X, Rohleder N. Self-compassionate young adults show lower salivary alpha-amylase responses to repeated psychosocial stress. SELF AND IDENTITY 2015; 14:390-402. [PMID: 26005394 DOI: 10.1080/15298868.2015.1005659] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In this study we tested the hypothesis that participants higher in dispositional self-compassion would show lower stress-induced reactivity of salivary alpha-amylase (sAA), a marker of sympathetic nervous system activation. Thirty-three healthy participants (18-34 years old) were exposed to a standardized laboratory stressor on two consecutive days. Self-compassion, self-esteem, and demographic factors were assessed by questionnaire and sAA was assessed at baseline and at 1, 10, 30, and 60 minutes following each stressor. Self-compassion was a significant negative predictor of sAA responses on both days. This relationship remained significant when controlling for self-esteem, subjective distress, age, gender, ethnicity, and Body Mass Index (BMI). These results suggest that self-compassion may serve as a protective factor against stress-induced physiological changes that have implications for health.
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Affiliation(s)
- Juliana G Breines
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Christine M McInnis
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Yuliya I Kuras
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Myriam V Thoma
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Danielle Gianferante
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Luke Hanlin
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Xuejie Chen
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Nicolas Rohleder
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
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176
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Abstract
OBJECTIVE The maternal autonomic nervous system (ANS) has received little attention in the investigation of biological mechanisms linking prenatal stress to fetal cortisol (F) excess. In vitro, norepinephrine and epinephrine inhibit placental 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2), which protects the fetus from F overexposure by inactivating it to cortisone (E). Here, we investigated the acute ANS stress response to an amniocentesis and its association with amniotic fluid F, E, and E/(E + F) as a marker of fetoplacental 11β-HSD2 activity. METHODS An aliquot of amniotic fluid was obtained from 34 healthy, second-trimester pregnant women undergoing amniocentesis. Repeated assessment of mood states served to examine the psychological stress response to amniocentesis. Saliva samples were collected to measure stress-induced changes in salivary α-amylase concentrations in response to amniocentesis. Cardiac parameters were measured continuously. RESULTS Undergoing amniocentesis induced significant psychological and autonomic alterations. Low-frequency (LF)/high-frequency (HF) baseline, suggested to reflect sympathovagal balance, was negatively correlated with amniotic E/(E + F) (r=-0.53, p = .002) and positively with F (r = 0.62, p < .001). In contrast, a stronger acute LF/HF response was positively associated with E/(E + F) (r = 0.44, p = .012) and negatively with F (r=-0.40, p = .025). CONCLUSIONS These findings suggest that the maternal ANS is involved in the regulation of the fetoplacental barrier to stress. Allostatic processes may have been initiated to counterbalance acute stress effects. In contrast, higher LF/HF baseline values, possibly indicative of chronic stress exposure, may have inhibited 11β-HSD2 activity in the fetoplacental unit. These results parallel animal findings of up-regulated placental 11β-HSD2 in response to acute stress but impairment under chronic stress.
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177
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O’Leary ÉD, Howard S, Hughes BM, James JE. Salivary α-Amylase Reactivity to Laboratory Social Stress With and Without Acute Sleep Restriction. J PSYCHOPHYSIOL 2015. [DOI: 10.1027/0269-8803/a000134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A growing literature suggests that salivary α-amylase (sAA) may serve as a minimally invasive marker of psychophysiological stress-induced activity of the sympathetic-adrenal-medullary system (SAM). Previous inconsistencies in the experimental literature relating sAA response to short sleep duration may be as a result of poor reliability of self-reported sleep time, suggesting that further examination of sAA response following verified sleep loss is required. With regard to the potential usefulness of sAA as a biomarker of psychosocial stress in the laboratory, previous research has also relied primarily on traditional psychosocial stress protocols, including physically present evaluative observers. The present study aimed to examine sAA response following a period of verified acute sleep restriction compared to a rested condition, in addition to examining the sensitivity of sAA response to a laboratory stress protocol that exposed participants to negative social evaluation presented by video relay. One hundred and eight healthy young adults (age 17–22 years; M = 18.39 years, SD = 0.87) completed a laboratory social stress task and provided saliva samples pre- and post-stressor presentation, after a night of partial sleep restriction or a full night’s rest. Marked increases in sAA activity to the video-relayed stressor were observed in both rested and sleep restricted groups. Further, sleep restricted participants exhibited significantly increased basal levels of sAA activity. The data corroborate previous limited data indicating a general upregulation of sAA activity following poor sleep and support previous findings concerning the efficacy of an experimental paradigm that presents laboratory social stress by means of video recording.
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Affiliation(s)
- Éanna D. O’Leary
- Centre for Research on Occupational and Life Stress and School of Psychology, National University of Ireland, Galway, Ireland
| | - Siobhán Howard
- Department of Psychology, Mary Immaculate College, University of Limerick, Ireland
| | - Brian M. Hughes
- Centre for Research on Occupational and Life Stress and School of Psychology, National University of Ireland, Galway, Ireland
| | - Jack E. James
- Centre for Research on Occupational and Life Stress and School of Psychology, National University of Ireland, Galway, Ireland
- Department of Psychology, Reykjavík University, Iceland
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178
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Wolf OT, Schulte JM, Drimalla H, Hamacher-Dang TC, Knoch D, Dziobek I. Enhanced emotional empathy after psychosocial stress in young healthy men. Stress 2015; 18:631-7. [PMID: 26365125 DOI: 10.3109/10253890.2015.1078787] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Empathy is a core prerequisite for human social behavior. Relatively, little is known about how empathy is influenced by social stress and its associated neuroendocrine alterations. The current study was designed to test the impact of acute stress on emotional and cognitive empathy. Healthy male participants were exposed to a psychosocial laboratory stressor (trier social stress test, (TSST)) or a well-matched control condition (Placebo-TSST). Afterwards they participated in an empathy test measuring emotional and cognitive empathy (multifaceted empathy test, (MET)). Stress exposure caused an increase in negative affect, a rise in salivary alpha amylase and a rise in cortisol. Participants exposed to stress reported more emotional empathy in response to pictures displaying both positive and negative emotional social scenes. Cognitive empathy (emotion recognition) in contrast did not differ between the stress and the control group. The current findings provide initial evidence for enhanced emotional empathy after acute psychosocial stress.
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Affiliation(s)
- Oliver T Wolf
- a Department of Cognitive Psychology , Institute of Cognitive Neuroscience, Ruhr-University Bochum , Germany
| | - Judith M Schulte
- a Department of Cognitive Psychology , Institute of Cognitive Neuroscience, Ruhr-University Bochum , Germany
| | - Hanna Drimalla
- b Department of Social Cognition , Berlin School of Mind and Brain, Humboldt-Universität Berlin , Berlin , Germany , and
| | - Tanja C Hamacher-Dang
- b Department of Social Cognition , Berlin School of Mind and Brain, Humboldt-Universität Berlin , Berlin , Germany , and
| | - Daria Knoch
- c Social Psychology and Social Neuroscience, Institute of Psychology, University of Bern , Switzerland
| | - Isabel Dziobek
- b Department of Social Cognition , Berlin School of Mind and Brain, Humboldt-Universität Berlin , Berlin , Germany , and
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179
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Patacchioli FR, Ghiciuc CM, Bernardi M, Dima-Cozma LC, Fattorini L, Squeo MR, Galoppi P, Brunelli R, Ferrante F, Pasquali V, Perrone G. Salivary α-amylase and cortisol after exercise in menopause: influence of long-term HRT. Climacteric 2015; 18:528-35. [PMID: 25602168 DOI: 10.3109/13697137.2015.1008444] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This observational prospective study analyzed the effect of an incremental cardiopulmonary exercise test (CPET) on the secretion of salivary biomarkers of the adrenergic nervous system and hypothalamus-pituitary-adrenal (HPA) axis activity by measuring salivary α-amylase and cortisol diurnal trajectories in the setting of long-term hormone replacement therapy (HRT). METHODS Fifteen healthy sedentary postmenopausal women who were current HRT users and 15 women who had never used HRT were consecutively recruited. α-Amylase and cortisol were measured in salivary samples collected on the CPET day and on a rest day. Cardiovascular and respiratory fitness parameters were recorded during the CPET challenge. RESULTS The participants had very homogeneous somatic characteristics, and they were all in generally good health. The postmenopausal never-HRT users presented an abnormal diurnal pattern of α-amylase at baseline and a flattened response to CPET. In contrast, women on HRT had a physiological α-amylase diurnal pattern and increased salivary α-amylase production during the CPET-induced challenge. The CPET challenge physiologically activated the HPA axis activity, as shown by the increase in the concentration of salivary cortisol during the effort test. HPA axis activity was not affected by long-term HRT. Postmenopausal women using HRT exhibited a cardiorespiratory functional capacity that was significantly (p < 0.05) higher than that of non-users. CONCLUSIONS Our findings show that healthy postmenopausal women present an asymmetry between adrenergic nervous system and HPA axis activities under both basal and stress conditions. HRT was able to modify the abnormal adrenergic nervous system activity, most likely by reducing the sympathetic hyperactivity that characterizes menopause.
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Affiliation(s)
- F R Patacchioli
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome , Italy
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Abstract
The present research elaborates on the regulatory fit hypothesis by investigating a biological stress marker in a motivational fit- and non-fit-situation. Recent stress theories lead to the assumption that the participants' stress level in fit-situations remains constant or rather decreases, whereas under non-fit-conditions an increase of the stress activity is observed. We tested this hypothesis by assessment of salivary α-amylase (sAA), a saliva-based stress marker presumed to reflect noradrenergic activity. The results indicated that participants in a fit-situation show a decrease in sAA, whereas participants in a non-fit-situation demonstrate a contrary effect with an increase in sAA. These findings extend the concept of regulatory fit by illustrating that there are differences in sAA activity depending on whether participants are in a fit-situation. The experience of regulatory fit appears to be associated with a reduction of stress.
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Affiliation(s)
- Sebastian Schwab
- a Institute of Cognitive and Team/Racket Sport Research, German Sport University Cologne , Köln , Germany and
| | - Oliver T Wolf
- b Department of Cognitive Psychology , Ruhr-University Bochum , Bochum , Germany
| | - Daniel Memmert
- a Institute of Cognitive and Team/Racket Sport Research, German Sport University Cologne , Köln , Germany and
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181
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Giles GE, Mahoney CR, Brunyé TT, Taylor HA, Kanarek RB. Stress effects on mood, HPA axis, and autonomic response: comparison of three psychosocial stress paradigms. PLoS One 2014; 9:e113618. [PMID: 25502466 PMCID: PMC4264740 DOI: 10.1371/journal.pone.0113618] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/27/2014] [Indexed: 11/18/2022] Open
Abstract
Extensive experimental psychology research has attempted to parse the complex relationship between psychosocial stress, mood, cognitive performance, and physiological changes. To do so, it is necessary to have effective, validated methods to experimentally induce psychosocial stress. The Trier Social Stress Test (TSST) is the most commonly used method of experimentally inducing psychosocial stress, but it is resource intensive. Less resource intense psychosocial stress tasks include the Socially Evaluative Cold Pressor Task (SECPT) and a computerized mental arithmetic task (MAT). These tasks effectively produce a physiological and psychological stress response and have the benefits of requiring fewer experimenters and affording data collection from multiple participants simultaneously. The objective of this study was to compare the magnitude and duration of these three experimental psychosocial stress induction paradigms. On each of four separate days, participants completed either a control non-stressful task or one of the three experimental stressors: the TSST, SECPT, or MAT. We measured mood, working memory performance, salivary cortisol and alpha-amylase (AA), and heart rate. The TSST and SECPT exerted the most robust effects on mood and physiological measures. TSST effects were generally evident immediately post-stress as well as 10- and 20-minutes after stress cessation, whereas SECPT effects were generally limited to the duration of the stressor. The stress duration is a key determinant when planning a study that utilizes an experimental stressor, as researchers may be interested in collecting dependent measures prior to stress cessation. In this way, the TSST would allow the investigator a longer window to administer tasks of interest.
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Affiliation(s)
- Grace E. Giles
- Department of Psychology, Tufts University, Medford, Massachusetts, United States of America
| | - Caroline R. Mahoney
- Department of Psychology, Tufts University, Medford, Massachusetts, United States of America
| | - Tad T. Brunyé
- Department of Psychology, Tufts University, Medford, Massachusetts, United States of America
| | - Holly A. Taylor
- Department of Psychology, Tufts University, Medford, Massachusetts, United States of America
| | - Robin B. Kanarek
- Department of Psychology, Tufts University, Medford, Massachusetts, United States of America
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182
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Ditzen B, Ehlert U, Nater UM. Associations between salivary alpha-amylase and catecholamines – A multilevel modeling approach. Biol Psychol 2014; 103:15-8. [DOI: 10.1016/j.biopsycho.2014.08.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 08/06/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
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183
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Kuebler U, von Känel R, Heimgartner N, Zuccarella-Hackl C, Stirnimann G, Ehlert U, Wirtz PH. Norepinephrine infusion with and without alpha-adrenergic blockade by phentolamine increases salivary alpha amylase in healthy men. Psychoneuroendocrinology 2014; 49:290-8. [PMID: 25128931 DOI: 10.1016/j.psyneuen.2014.07.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/23/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mental stress reliably induces increases in salivary alpha amylase (sAA), a suggested surrogate marker for sympathetic nervous system (SNS) reactivity. While stress-induced sAA increases correlate with norepinephrine (NE) secretion, a potential mediating role of noradrenergic mechanisms remains unclear. In this study, we investigated for the first time in humans whether a NE-stress-reactivity mimicking NE-infusion with and without alpha-adrenergic blockade by phentolamine would induce changes in sAA. METHODS In a single-blind placebo-controlled within-subjects design, 21 healthy men (29-66 years) took part in three different experimental trials varying in terms of substance infusion with a 1-min first infusion followed by a 15-min second infusion: saline-infusion (trial-1), NE-infusion (5 μg/min) without alpha-adrenergic blockade (trial-2), and with phentolamine-induced non-selective blockade of alpha1- and alpha2-adrenergic receptors (trial-3). Saliva samples were collected immediately before, during, and several times after substance infusion in addition to blood pressure and heart rate readings. RESULTS Experimental trials significantly differed in sAA reactivity to substance-infusion (p=.001) with higher sAA reactivity following NE-infusion with (trial-3; p=.001) and without alpha-adrenergic-blockade (trial-2; p=.004) as compared to placebo-infusion (trial-1); sAA infusion reactivity did not differ between trial-2 and trial-3 (p=.29). Effective phentolamine application was verified by blood pressure and heart rate infusion reactivity. Salivary cortisol was not affected by NE, either with or without alpha-adrenergic-blockade. CONCLUSIONS We found that NE-infusion stimulates sAA secretion, regardless of co-administered non-selective alpha-adrenergic blockade by phentolamine, suggesting that the mechanism underlying stress-induced sAA increases may involve NE.
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Affiliation(s)
- Ulrike Kuebler
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Nadja Heimgartner
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; Department of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | | | - Guido Stirnimann
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Petra H Wirtz
- Biological and Health Psychology, University of Bern, Bern, Switzerland.
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184
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Doane LD, Van Lenten SA. Multiple time courses of salivary alpha-amylase and dimensions of affect in adolescence. Psychoneuroendocrinology 2014; 49:47-53. [PMID: 25076484 DOI: 10.1016/j.psyneuen.2014.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/27/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
Abstract
Previous research has illustrated associations among daily experiences, emotions and stress-responding physiological systems. Recently, investigators have examined salivary alpha-amylase (sAA), a surrogate marker of the autonomic nervous system, and its associations with affect. The current study examined associations among affective valence, arousal and sAA across three different time courses at the momentary, daily and inter-individual level to understand varying influences of adolescents' daily emotional experiences on sAA reactivity and diurnal sAA activity. Adolescents (N=82) provided salivary samples and diary reports of affect and experiences five times a day for three consecutive days. They also completed self-report questionnaires on trait affect. Findings from multilevel growth curves demonstrated that adolescents in our sample displayed typical sAA diurnal rhythms with levels dropping 30 min after waking and then increasing across the day to a peak in the late afternoon. Within person momentary experiences of high arousal positive affect were associated with momentary sAA reactivity. Prior day experiences of high arousal negative affect were associated with a greater amylase awakening response (i.e., greater decrease) and flatter slopes the next day. Trait positive affect was also associated with flatter sAA slopes. Our findings suggest that both affective arousal and valence should be accounted for when examining differences in sAA reactivity and diurnal patterns. Further, our results indicated that emotion-physiology transactions among adolescents occur over varying time scales for salivary alpha-amylase as well as cortisol.
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Affiliation(s)
- Leah D Doane
- Department of Psychology, Arizona State University, United States.
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185
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Schumacher S, Gaudlitz K, Plag J, Miller R, Kirschbaum C, Fehm L, Fydrich T, Ströhle A. Who is stressed? A pilot study of salivary cortisol and alpha-amylase concentrations in agoraphobic patients and their novice therapists undergoing in vivo exposure. Psychoneuroendocrinology 2014; 49:280-9. [PMID: 25127086 DOI: 10.1016/j.psyneuen.2014.07.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/26/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
In cognitive behavioural therapy of phobic anxiety, in vivo exposure is considered as an effective treatment strategy. Apparently, it involves the experience of stress and anxiety in patients. Given the therapist's role during exposure sessions, it is conceivable that the performance is also accompanied with the experience of stress in therapists, especially when unversed in conducting psychotherapy. Studies confirmed that cognitive behavioural therapists tend to avoid therapist-guided in vivo exposure. The objective of this study was the simultaneous investigation of therapist's and patient's stress response during in vivo exposure. Therefore, 23 agoraphobic patients and their 23 treating therapists in training provided five saliva samples during an in vivo exposure and five samples during an ordinary therapy session. Before and during exposure session, subjective evaluations of stress and anxiety were assessed. Results suggested that therapists reported similar levels of perceived stress as patients before exposure. Both groups displayed significantly elevated salivary cortisol (sC) levels during exposure compared to the control session and a trend for alterations in salivary alpha-amylase (sAA) activity was found. Therapists reached peak concentrations of sC before start of the intervention followed by a decline during exposure, while patients displayed peak levels of cortisol secretion after 60 min of exposure. In vivo exposure seems to be a demanding intervention not only for the patient, but also for therapists in training. However, it was also demonstrated that physiological and subjective stress rather decrease during the intervention and that both groups rated exposure to be substantially successful. Based on the presented results, another potential factor contributing to the under-usage of exposure treatment is conceivable and needs to be addressed in future research.
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Affiliation(s)
- Sarah Schumacher
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany; Department of Psychology, Humboldt University of Berlin, Berlin, Germany.
| | - Katharina Gaudlitz
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Jens Plag
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Robert Miller
- Department of Biopsychology, Technical University Dresden, Dresden, Germany
| | - Clemens Kirschbaum
- Department of Biopsychology, Technical University Dresden, Dresden, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
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186
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Okada M, Kakehashi M. Effects of outdoor temperature on changes in physiological variables before and after lunch in healthy women. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2014; 58:1973-81. [PMID: 24599494 PMCID: PMC4190455 DOI: 10.1007/s00484-014-0800-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 01/26/2014] [Accepted: 01/31/2014] [Indexed: 05/12/2023]
Abstract
Previous studies of autonomic nervous system responses before and after eating when controlling patient conditions and room temperature have provided inconsistent results. We hypothesized that several physiological parameters reflecting autonomic activity are affected by outdoor temperature before and after a meal. We measured the following physiological variables before and after a fixed meal in 53 healthy Japanese women: skin temperature, systolic and diastolic blood pressure, salivary amylase, blood glucose, heart rate, and heart rate variability. We assessed satiety before and after lunch using a visual analog scale (100 mm). We recorded outdoor temperature, atmospheric pressure, and relative humidity. Skin temperature rose significantly 1 h after eating (greater in cold weather) (P = 0.008). Cold weather markedly influenced changes in diastolic blood pressure before (P = 0.017) and after lunch (P = 0.013). Fasting salivary amylase activity increased significantly in cold weather but fell significantly after lunch (significantly greater in cold weather) (P = 0.007). Salivary amylase was significantly associated with cold weather, low atmospheric pressure, and low relative humidity 30 min after lunch (P < 0.05). Cold weather significantly influenced heart rate variability (P = 0.001). The decreased low frequency (LF)/high frequency (HF) ratio, increased Δ LF/HF ratio, and increased Δ salivary amylase activity imply that cold outdoor temperature is associated with dominant parasympathetic activity after lunch. Our results clarify the relationship between environmental factors, food intake, and autonomic system and physiological variables, which helps our understanding of homeostasis and metabolism.
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Affiliation(s)
- Masahiro Okada
- Department of Food and Dietetics, Hiroshima Bunka Gakuen Two-Year College, 3-5-1 Nagatsukanishi, Asaminami-ku, Hiroshima, 731-0136 Japan
| | - Masayuki Kakehashi
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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187
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Saliva pH as a biomarker of exam stress and a predictor of exam performance. J Psychosom Res 2014; 77:420-5. [PMID: 25439341 DOI: 10.1016/j.jpsychores.2014.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/01/2014] [Accepted: 07/04/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Salivary pH is regulated by the sympathetic and parasympathetic nervous system; therefore, it may serve as a biomarker of stress. AIMS To assess the associations between the cognitive and emotional dimensions of exam stress and pH levels, and the predictability of salivary pH in relation to test performance. METHODS A prospective study. Eighty-three nursing students answered a questionnaire on stress appraisals, experienced stress, test anxiety (including worry and emotionality subscales) and health behaviors, and gave a saliva sample for measuring pH on the morning of their first term exam and three months later. Their performance on the test (grades) was also recorded. RESULTS Levels of pH in saliva were higher (levels of acidity were lower) in the post exam compared to the exam period, in parallel to lower threat appraisal, experienced stress, and test anxiety levels post exam. Controlling for smoking, physical activity and working hours per week, pH levels at both time points were predicted by appraised threat regarding the exam situation, experienced stress, and the emotionality dimension of test anxiety. pH at Time 1 predicted performance on the exams and mediated the associations of experienced stress and emotionality subscale with test performance. CONCLUSIONS the present study indicates that pH levels may serve as a reliable, accessible and inexpensive means by which to assess the degree of physiological reactions to exams and other naturalistic stressors.
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188
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Behringer V, Stevens JMG, Hohmann G, Möstl E, Selzer D, Deschner T. Testing the effect of medical positive reinforcement training on salivary cortisol levels in bonobos and orangutans. PLoS One 2014; 9:e108664. [PMID: 25250566 PMCID: PMC4177400 DOI: 10.1371/journal.pone.0108664] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 09/01/2014] [Indexed: 11/17/2022] Open
Abstract
The management of captive animals has been improved by the establishment of positive reinforcement training as a tool to facilitate interactions between caretakers and animals. In great apes, positive reinforcement training has also been used to train individuals to participate in simple medical procedures to monitor physical health. One aim of positive reinforcement training is to establish a relaxed atmosphere for situations that, without training, might be very stressful. This is especially true for simple medical procedures that can require animals to engage in behaviours that are unusual or use unfamiliar medical devices that can be upsetting. Therefore, one cannot exclude the possibility that the training itself is a source of stress. In this study, we explored the effects of medical positive reinforcement training on salivary cortisol in two groups of captive ape species, orangutans and bonobos, which were familiar to this procedure. Furthermore, we successfully biologically validated the salivary cortisol assay, which had already been validated for bonobos, for orangutans. For the biological validation, we found that cortisol levels in orangutan saliva collected during baseline conditions were lower than in samples collected during three periods that were potentially stressful for the animals. However, we did not find significant changes in salivary cortisol during medical positive reinforcement training for either bonobos or orangutans. Therefore, for bonobos and orangutans with previous exposure to medical PRT, the procedure is not stressful. Thus, medical PRT provides a helpful tool for the captive management of the two species.
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Affiliation(s)
- Verena Behringer
- Department of Primatology, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
- Centre for Research and Conservation, Royal Zoological Society of Antwerp, Antwerp, Belgium
| | - Jeroen M. G. Stevens
- Centre for Research and Conservation, Royal Zoological Society of Antwerp, Antwerp, Belgium
| | - Gottfried Hohmann
- Department of Primatology, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Erich Möstl
- Department of Biomedical Sciences/Biochemistry, University of Veterinary Medicine, Vienna, Austria
| | - Dieter Selzer
- Working Group for Wildlife Biology, Justus-Liebig-University Gießen, Gießen, Germany
| | - Tobias Deschner
- Department of Primatology, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
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189
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van Lien R, Neijts M, Willemsen G, de Geus EJC. Ambulatory measurement of the ECG T-wave amplitude. Psychophysiology 2014; 52:225-37. [PMID: 25123155 DOI: 10.1111/psyp.12300] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 07/03/2014] [Indexed: 11/29/2022]
Abstract
Ambulatory recording of the preejection period (PEP) can be used to measure changes in cardiac sympathetic nervous system (SNS) activity under naturalistic conditions. Here, we test the ECG T-wave amplitude (TWA) as an alternative measure, using 24-h ambulatory monitoring of PEP and TWA in a sample of 564 healthy adults. The TWA showed a decrease in response to mental stress and a monotonic decrease from nighttime sleep to daytime sitting and more physically active behaviors. Within-participant changes in TWA were correlated with changes in the PEP across the standardized stressors (r = .42) and the unstandardized naturalistic conditions (mean r = .35). Partialling out changes in heart rate and vagal effects attenuated these correlations, but they remained significant. Ambulatory TWA cannot replace PEP, but simultaneous recording of TWA and PEP provides a more comprehensive picture of changes in cardiac SNS activity in real-life settings.
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Affiliation(s)
- René van Lien
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands, and EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
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190
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Yfanti K, Kitraki E, Emmanouil D, Pandis N, Papagiannoulis L. Psychometric and biohormonal indices of dental anxiety in children. A prospective cohort study. Stress 2014; 17:296-304. [PMID: 24766350 DOI: 10.3109/10253890.2014.918602] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The stress of dental treatment often elicits negative emotions in children, expressed as dental fear or anxiety. Highly anxious children obstruct treatment and avoid therapy, further amplifying oral health problems. The aim of this study was to examine the neuroendocrine and autonomic nervous system responses to dental treatment and their possible interactions and associations with psychometric indices of anxiety, caries, previous dental experience, anesthesia, age and gender in school children. Upon informed consent, saliva was obtained from 97 children (59% males, mean age ± SD: 89.73 ± 15 months) in the Clinic of pediatric dentistry before treatment, immediately post-treatment and at the recall visit to determine cortisol and salivary alpha-amylase (sAA) levels. Dental and general anxiety was assessed through specific questionnaires completed by the children. Compared to pre-treatment, cortisol levels were increased following treatment, while sAA levels were higher at the recall. Pre- and post-treatment cortisol and sAA responses were positively correlated. Dental and general anxiety questionnaire scores were also significantly correlated with each other. The integrated autonomic and neuroendocrine responses prior to treatment were correlated with state anxiety and those following treatment with dental anxiety. However, univariable and multivariable linear regression analysis associated post-treatment cortisol, but not sAA, levels with dental anxiety. No associations of cortisol or sAA responses with caries, age, gender, previous dental experience or anesthesia were detected. These data provide some evidence that both sAA and cortisol levels are altered in children in anticipation or during dental treatment, but only cortisol levels are associated to dental anxiety.
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Affiliation(s)
- Konstantina Yfanti
- Department of Pediatric Dentistry, Dental School, National and Kapodistrian University of Athens , Athens , Greece
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191
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Heart rate response to post-learning stress predicts memory consolidation. Neurobiol Learn Mem 2014; 109:74-81. [DOI: 10.1016/j.nlm.2013.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/25/2013] [Accepted: 12/04/2013] [Indexed: 01/29/2023]
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192
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Cubała WJ, Landowski J. Low baseline salivary alpha-amylase in drug-naïve patients with short-illness-duration first episode major depressive disorder. J Affect Disord 2014; 157:14-7. [PMID: 24581822 DOI: 10.1016/j.jad.2013.12.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/24/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Altered monoamine neurotransmission accompanied by hypothalamic-pituitary-adrenal axis dysfunction and autonomic nervous system hyperactivity have been associated with major depressive disorder (MDD). Salivary α-amylase (sAA) is indicative of autonomic activation and reflects central noradrenergic activity. Scarce studies on sAA in MDD produce confounded results and no data is available regarding baseline sAA activity. METHODS The basal, non-stimulated sAA activity was studied in this cross-sectional case-control study on 20 non-late-life adult, short-illness-duration first-episode, treatment-naïve MDD patients and in 20 age- and sex-matched healthy controls. Depressed patients showed a basal score in the Hamilton Rating Scale for Depression (HAMD-17) higher than 20. RESULTS The sAA was significantly lower in depressed individuals as compared to controls (p=0.011). In post hoc analysis significantly lower sAA was present in melancholic MDD (p=0.016) as related to controls whereas no difference was seen between non-melancholic MDD patients and controls. The sAA activity was not significantly correlated neither with duration nor the severity of depressive symptoms as measured by the total HAMD-17 score. LIMITATIONS The current study is limited by its cross-sectional design, small sample size, and factors related to saliva sampling methodology. CONCLUSION Low baseline sAA levels were found in MDD in basal, non-stimulated conditions. The study provides no support for elevated sAA in drug-naïve patients with short-illness-duration first episode MDD. The results support the evidence for decreased central noradrenergic transmission in MDD when sAA activity is considered indicative of central noradrenergic function.
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Affiliation(s)
| | - Jerzy Landowski
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk 80-952, Poland
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193
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Dreifus L, Engler H, Kissler J. Retrieval-induced forgetting under psychosocial stress: no reduction by delayed stress and beta-adrenergic blockade. Neurobiol Learn Mem 2014; 110:35-46. [PMID: 24486967 DOI: 10.1016/j.nlm.2014.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 01/10/2014] [Accepted: 01/14/2014] [Indexed: 11/17/2022]
Abstract
Retrieval-induced forgetting (RIF) is the phenomenon that 'retrieval-practice', the repeated retrieval of a subset of initially learned material, can impair the recall of episodically related memories. Previous studies showed that RIF is eliminated when retrieval-practice is carried out under psycho-social stress, anxiety, or in negative mood. However, pharmacological manipulation by hydrocortisone did not eliminate the effect. This study investigated the effect of beta-adrenergic blockade on stress-induced modulations of RIF, addressing possible interactive effects of the glucocorticoid and sympatho-adrenomedullary systems. Participants learned categorized word lists and then received either 60 mg propranolol or a placebo. After 90 min they were exposed to the TSST. A third group did not receive any medication and performed a non-stressful control task with the same timing as the other two groups. Finally, all participants underwent retrieval-practice and final recall. Both TSST groups exhibited a stress-induced increase in cortisol-levels, and the placebo group also exhibited large increases in markers of sympathetic nervous system activity and more psychological distress at the time of retrieval-practice. Although, overall recall was poorer under stress, an overall RIF effect emerged irrespective of group and showed no clear modulation by stress with or without beta-adrenergic blockade. In previous demonstrations of RIF elimination by negative emotion, state induction and retrieval-practice followed very briefly after initial learning. Given that both the previous study of hydrocortisone effects on RIF and the present study used longer delays between learning and retrieval-practice, the possibility that stress effects on retrieval-practice eliminate RIF only relatively briefly after learning is discussed.
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Affiliation(s)
- Laura Dreifus
- Department of Psychology, University of Konstanz, 78457 Konstanz, Germany.
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Johanna Kissler
- Department of Psychology and Physical Education, University of Bielefeld, 33501 Bielefeld, Germany
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194
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van den Bos R, Taris R, Scheppink B, de Haan L, Verster JC. Salivary cortisol and alpha-amylase levels during an assessment procedure correlate differently with risk-taking measures in male and female police recruits. Front Behav Neurosci 2014; 7:219. [PMID: 24474909 PMCID: PMC3893681 DOI: 10.3389/fnbeh.2013.00219] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/19/2013] [Indexed: 01/10/2023] Open
Abstract
Recent laboratory studies have shown that men display more risk-taking behavior in decision-making tasks following stress, whilst women are more risk-aversive or become more task-focused. In addition, these studies have shown that sex differences are related to levels of the stress hormone cortisol (indicative of activation of the hypothalamus-pituitary-adrenocortical-axis): the higher the levels of cortisol the more risk-taking behavior is shown by men, whereas women generally display more risk-aversive or task-focused behavior following higher levels of cortisol. Here, we assessed whether such relationships hold outside the laboratory, correlating levels of cortisol obtained during a job-related assessment procedure with decision-making parameters in the Cambridge Gambling Task (CGT) in male and female police recruits. The CGT allows for discriminating different aspects of reward-based decision-making. In addition, we correlated levels of alpha-amylase [indicative of activation of the sympatho-adrenomedullary-axis (SAM)] and decision-making parameters. In line with earlier studies men and women only differed in risk-adjustment in the CGT. Salivary cortisol levels correlated positively and strongly with risk-taking measures in men, which was significantly different from the weak negative correlation in women. In contrast, and less strongly so, salivary alpha-amylase levels correlated positively with risk-taking in women, which was significantly different from the weak negative correlation with risk-taking in men. Collectively, these data support and extend data of earlier studies indicating that risky decision-making in men and women is differently affected by stress hormones. The data are briefly discussed in relation to the effects of stress on gambling.
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Affiliation(s)
- Ruud van den Bos
- Department of Organismal Animal Physiology, Radboud University NijmegenNijmegen, Netherlands
| | - Ruben Taris
- Police Academy, Recruitment and SelectionApeldoorn, Netherlands
| | | | - Lydia de Haan
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht UniversityUtrecht, Netherlands
| | - Joris C. Verster
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht UniversityUtrecht, Netherlands
- Centre for Human Psychopharmacology, Swinburne University of TechnologyMelbourne, Australia
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195
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Haile CN, De La Garza R, Mahoney JJ, Newton TF. Effects of methamphetamine on the noradrenergic activity biomarker salivary alpha-amylase. Drug Alcohol Depend 2013; 133:759-62. [PMID: 23968815 PMCID: PMC4432865 DOI: 10.1016/j.drugalcdep.2013.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/26/2013] [Accepted: 07/28/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Methamphetamine (METH) potently activates the sympathetic nervous system (SNS) by increasing central and peripheral norepinephrine (NE). Salivary α-amylase (sAA) is a biomarker of SNS activation that correlates with plasma NE levels. The purpose of this study was to determine the impact of METH on sAA activity and whether changes in sAA activity were correlated with subjective effects ratings. METHODS Non-treatment seeking METH-dependent volunteers (N=8) participated in this within-subjects laboratory-based study. Volunteers received randomly administered intravenous METH (0mg, 30 mg) and sAA activity, cardiovascular measures and subjective ratings were assessed at baseline (-15 min) and five post-METH time points (10, 20, 30, 45, and 60 min). RESULTS METH (30 mg) increased sAA activity over time. sAA activity significantly correlated with diastolic blood pressure following 0mg METH and systolic blood pressure following 30 mg METH. Subjective ratings (ANY EFFECT, HIGH, GOOD, STIMULATED, LIKE, WLLING TO PAY) highly correlated with sAA over five post-METH time points (N=40; r's=0.543-0.684, p's<0.001). Age, body mass index and METH amount received on a mg/kg basis were significantly associated with sAA activity. Multiple linear regression analysis indicated sAA activity remained a significant predictor of subjective ratings following METH after controlling for these factors. CONCLUSIONS The NE peripheral biomarker sAA activity is associated with METH's subjective effects.
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Affiliation(s)
- Colin N Haile
- Baylor College of Medicine, Menninger Department of Psychiatry & Behavioral Sciences, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA.
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196
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Banks JB, Tartar JL, Welhaf MS. Where's the impairment: An examination of factors that impact sustained attention following a stressor. Cogn Emot 2013; 28:856-66. [DOI: 10.1080/02699931.2013.857643] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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197
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Stress reactivity in war-exposed young children with and without posttraumatic stress disorder: Relations to maternal stress hormones, parenting, and child emotionality and regulation. Dev Psychopathol 2013; 25:943-55. [DOI: 10.1017/s0954579413000291] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe current study examined biomarkers of stress in war-exposed young children and addressed maternal and child factors that may correlate with children's stress response. Participants were 232 Israeli children aged 1.5–5 years, including 148 children exposed to continuous war. Similarly, 56 were diagnosed with posttraumatic stress disorder (PTSD) and 92 were defined as exposed-no-PTSD. Child cortisol (CT) and salivary alpha amylase (sAA), biomarkers of the hypothalamic–pituitary–adrenal and sympathetic–adrenal–medullary arms of the stress response, were measured at baseline, following challenge, and at recovery. Maternal CT and sAA, PTSD symptoms, and reciprocal parenting, and child negative emotionality and regulatory strategies were assessed. Differences between war-exposed children and controls emerged, but these were related to child PTSD status. Children with PTSD exhibited consistently low CT and sAA, exposed-no-PTSD displayed consistently high CT and sAA, and controls showed increase in CT following challenge and decrease at recovery and low sAA. Exposed children showed higher negative emotionality; however, whereas exposed-no-PTSD children employed comfort-seeking strategies, children with PTSD used withdrawal. Predictors of child CT included maternal CT, PTSD symptoms, low reciprocity, and negative emotionality. Findings suggest that high physiological arousal combined with approach strategies may be associated with greater resilience in the context of early trauma.
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198
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Leitzke BT, Hilt LM, Pollak SD. Maltreated youth display a blunted blood pressure response to an acute interpersonal stressor. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2013; 44:305-13. [PMID: 24175880 DOI: 10.1080/15374416.2013.848774] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although there is much evidence of hypothalamic-pituitary-adrenal axis dysfunction among individuals who have experienced child maltreatment, dysregulation of the autonomic nervous system (ANS) has received less attention. Understanding the role of the ANS in maltreated children may help clarify how these children respond to subsequent life stress. We explored ANS reactivity among 111 youth (ages 9-14), 34 of whom had experienced verified child maltreatment. ANS activity was assessed via blood pressure-a convenient, noninvasive physiological index-while youth underwent a social stress task. Blood pressure and subjective mood ratings were obtained prior to and following the task. Nonmaltreated youth experienced an increase in systolic blood pressure following the stressor, whereas maltreated youth did not. Self-reported subjective mood worsened for both groups. The current data suggest that children who experienced early stress exposure demonstrate blunted ANS reactivity. Results are discussed in terms of children's healthy adaptations to transient social stressors. In addition, we discuss the cost-effectiveness and benefits of physiological measures such as blood pressure for understanding risk for psychopathology.
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Affiliation(s)
- Brian T Leitzke
- a Department of Psychology , University of Wisconsin-Madison
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199
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Koss KJ, George MRW, Cummings EM, Davies PT, El-Sheikh M, Cicchetti D. Asymmetry in children's salivary cortisol and alpha-amylase in the context of marital conflict: links to children's emotional security and adjustment. Dev Psychobiol 2013; 56:836-49. [PMID: 24037991 DOI: 10.1002/dev.21156] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 07/03/2013] [Indexed: 01/25/2023]
Abstract
Recent research supports the promise of examining interactive models of physiological processes on children's adjustment. The present study investigates interactions between children's autonomic nervous system activity and adrenocortical functioning in the context of marital discord; specifically, testing models of concurrent responses proposed by Bauer et al. ([2002] Developmental and Behavioral Pediatrics 23:102-113) in the prediction of children's behavioral responses to conflict and adjustment. Asymmetry and symmetry in children's salivary alpha-amylase and cortisol were examined in 195 children (M age = 8 years) in response to viewing conflict vignettes. Results were partially consistent with an interactive model in the context of high marital discord; asymmetry among higher alpha-amylase and lower cortisol related to higher emotional insecurity and concurrent and subsequent maladjustment. In contrast, patterns of symmetrical responses were related to greater maladjustment for children exposed to lower levels of marital discord, supporting an additive model. Findings support the importance of a multisystem approach to investigating the adaptiveness of children's physiological stress responses, while also highlighting the value of considering physiological responses in the context of family risk.
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Affiliation(s)
- Kalsea J Koss
- Institute of Child Development, University of Minnesota, Minneapolis, MN, 55455.
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200
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Propper CB, Holochwost SJ. The influence of proximal risk on the early development of the autonomic nervous system. DEVELOPMENTAL REVIEW 2013. [DOI: 10.1016/j.dr.2013.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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