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Retear bigger than preoperative tear size would lead to treatment failure after rotator cuff repair. J Shoulder Elbow Surg 2022; 31:310-317. [PMID: 34411721 DOI: 10.1016/j.jse.2021.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/05/2021] [Accepted: 07/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to (1) define treatment failure using the referred patient acceptable symptomatic state (PASS) values for pain visual analog scale (PVAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Single Assessment Numeric Evaluation (SANE) clinical scores and (2) identify the factors that lead to patient dissatisfaction after arthroscopic rotator cuff repair (ARCR). METHODS We analyzed the arthroscopic rotator cuff surgery registry data from January 2015 to December 2016. Patients were followed for ≥2 years and categorized as dissatisfied or satisfied based on our own definition of treatment failure at 2 years postoperatively. For defining treatment failure, the referred PASS values for the PVAS, ASES, and SANE scores were used. Patients who failed to attain the PASS value for the PVAS, ASES, or SANE score were categorized into the dissatisfied group. Pre- and postoperative imaging and basic demographic data were compared between groups. Univariable and multivariable logistic regression analyses were performed to identify the factors affecting patient satisfaction at 2 years after rotator cuff repair. RESULTS Of 117 patients, 30 (25.6%) were defined as the dissatisfied group (mean follow-up period, 37.5 months). Seventeen patients (14.5%) had confirmed retear on follow-up magnetic resonance imaging. In the univariate analysis, sex significantly differed between the groups (female, satisfied vs. dissatisfied groups: 39 [44.8%] vs. 22 [73.3%]; P = .010). Retear alone did not affect patient satisfaction in the univariate analysis (P = .11). Progressed retear size featured a significantly higher risk of patient dissatisfaction (P = .024; odds ratio 6.430, 95% confidence interval 1.270-32.541) in the multivariable analysis using symptom duration, sex, preoperative ASES score, preoperative tear size, retear, and progressed retear size as variables. Moreover, female sex had an increased odds for dissatisfaction (odds ratio 4.646, 95% confidence interval 1.590-13.578; P = .005). CONCLUSION Two years after ARCR, most patients (74.4%) reported satisfaction with their outcomes. However, satisfaction levels can be altered by female sex or progressed retear size compared with the preoperative state.
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Albert KM, Boyd BD, Taylor WD, Newhouse PA. Differential effects of estradiol on neural and emotional stress response in postmenopausal women with remitted Major Depressive Disorder. J Affect Disord 2021; 293:355-362. [PMID: 34233228 PMCID: PMC8349860 DOI: 10.1016/j.jad.2021.06.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/30/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Estrogen fluctuations throughout the lifespan may contribute to major depressive disorder (MDD) risk in women through effects on brain networks important in stress responding, and mood regulation. Although there is evidence to support ovarian hormone treatment for peri-menopausal depression, postmenopausal use has not been well examined. The objective of this study was to investigate whether estrogen modulation of the neural and emotional cognitive responses to stress differs between postmenopausal women with and without MDD history. METHODS 60 postmenopausal women completed an fMRI psychosocial stress task, after receiving no drug or 3 months of daily estradiol (E2). fMRI activity and subjective mood response were examined. RESULTS In women without a history of MDD, E2 was associated with a more negative mood response to stress and less activity in emotional regulation regions. In women with a history of MDD, E2 was associated with a less negative mood response to stress and less activity in emotion perception regions. LIMITATIONS This study was limited by open-label estradiol administration and inclusion of participants using antidepressants. CONCLUSIONS These results support a differential effect of estrogen on emotional and neural responses to psychosocial stress in postmenopausal women with MDD history and may reflect a shift in brain activity patterns related to emotion processing following menopause.
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Affiliation(s)
- Kimberly M. Albert
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Brian D. Boyd
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Warren D. Taylor
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States,Geriatric Research, Education, and Clinical Center, Tennessee Valley VA Health System, Nashville TN, United States
| | - Paul A. Newhouse
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States,Geriatric Research, Education, and Clinical Center, Tennessee Valley VA Health System, Nashville TN, United States
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Khaleghi M, Rajizadeh MA, Bashiri H, Kohlmeier KA, Mohammadi F, Khaksari M, Shabani M. Estrogen attenuates physical and psychological stress-induced cognitive impairments in ovariectomized rats. Brain Behav 2021; 11:e02139. [PMID: 33811472 PMCID: PMC8119870 DOI: 10.1002/brb3.2139] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/14/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Women are more vulnerable to stress-related disorders than men, which is counterintuitive as female sex hormones, especially estrogen, have been shown to be protective against stress disorders. METHODS In this study, we investigated whether two different models of stress act differently on ovariectomized (OVX) rats and the impact of estrogen on physical or psychological stress-induced impairments in cognitive-behaviors. Adult female Wistar rats at 21-22 weeks of age were utilized for this investigation. Sham and OVX rats were subjected to physical and psychological stress for 1 hr/day for 7 days, and cognitive performance was assessed using morris water maze (MWM) and passive avoidance (PA) tests. The open field and elevated plus maze tests (EPM) evaluated exploratory and anxiety-like behaviors. RESULTS In sham and OVX rats, both physical and psychological stressors were associated with an increase in EPM-determined anxiety-like behavior. OVX rats exhibited decreased explorative behavior in comparison with nonstressed sham rats (p < .05). Both physical stress and psychological stress resulted in disrupted spatial cognition as assayed in the MWM (p < .05) and impaired learning and memory as determined by the PA test when the OVX and sham groups were compared with the nonstressed sham group. Estrogen increased explorative behavior, learning and memory (p < .05), and decreased anxiety-like behavior compared with vehicle in OVX rats exposed to either type of stressor. CONCLUSIONS When taken together, estrogen and both stressors had opposite effects on memory, anxiety, and PA performance in a rat model of menopause, which has important implications for potential protective effects of estrogen in postmenopausal women exposed to chronic stress.
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Affiliation(s)
- Mina Khaleghi
- Department of Physiology and Pharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Amin Rajizadeh
- Department of Physiology and Pharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamideh Bashiri
- Department of Physiology and Pharmacology, Kerman University of Medical Science, Kerman Iran and Sirjan School of Medical Sciences, Sirjan, Iran
| | - Kristi Anne Kohlmeier
- Department of Drug Design and Pharmacology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Fatemeh Mohammadi
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Khaksari
- Endocrinology and Metabolism Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Shabani
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
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Balog M, Blažetić S, Ivić V, Labak I, Krajnik B, Marin R, Canerina-Amaro A, de Pablo DP, Bardak A, Gaspar R, Szűcs KF, Vari SG, Heffer M. Disarranged neuroplastin environment upon aging and chronic stress recovery in female Sprague Dawley rats. Eur J Neurosci 2021; 55:2474-2490. [PMID: 33909305 PMCID: PMC9290558 DOI: 10.1111/ejn.15256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/14/2021] [Accepted: 04/21/2021] [Indexed: 11/27/2022]
Abstract
Chronic stress produces long-term metabolic changes throughout the superfamily of nuclear receptors, potentially causing various pathologies. Sex hormones modulate the stress response and generate a sex-specific age-dependent metabolic imprint, especially distinct in the reproductive senescence of females. We monitored chronic stress recovery in two age groups of female Sprague Dawley rats to determine whether stress and/or aging structurally changed the glycolipid microenvironment, a milieu playing an important role in cognitive functions. Old females experienced memory impairment even at basal conditions, which was additionally amplified by stress. On the other hand, the memory of young females was not disrupted. Stress recovery was followed by a microglial decrease and an increase in astrocyte count in the hippocampal immune system. Since dysfunction of the brain immune system could contribute to disturbed synaptogenesis, we analyzed neuroplastin expression and the lipid environment. Neuroplastin microenvironments were explored by analyzing immunofluorescent stainings using a newly developed Python script method. Stress reorganized glycolipid microenvironment in the Cornu Ammonis 1 (CA1) and dentate gyrus (DG) hippocampal regions of old females but in a very different fashion, thus affecting neuroplasticity. The postulation of four possible neuroplastin environments pointed to the GD1a ganglioside enrichment during reproductive senescence of stressed females, as well as its high dispersion in both regions and to GD1a and GM1 loss in the CA1 region. A specific lipid environment might influence neuroplastin functionality and underlie synaptic dysfunction triggered by a combination of aging and chronic stress.
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Affiliation(s)
- Marta Balog
- Department of Medical Biology and Genetics, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Senka Blažetić
- Department of Biology, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Vedrana Ivić
- Department of Medical Biology and Genetics, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Irena Labak
- Department of Biology, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Bartosz Krajnik
- Department of Experimental Physics, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Raquel Marin
- Laboratory of Cellular Neurobiology, Department of Basic Medical Sciences, School of Health Sciences, Universidad de La Laguna, La Laguna, Spain
| | - Ana Canerina-Amaro
- Laboratory of Cellular Neurobiology, Department of Basic Medical Sciences, School of Health Sciences, Universidad de La Laguna, La Laguna, Spain
| | - Daniel Pereda de Pablo
- Laboratory of Cellular Neurobiology, Department of Basic Medical Sciences, School of Health Sciences, Universidad de La Laguna, La Laguna, Spain
| | - Ana Bardak
- Department of Medical Biology and Genetics, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Robert Gaspar
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Kálmán Ferenc Szűcs
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Sandor G Vari
- Cedars-Sinai Medical Center, International Research and Innovation in Medicine Program, Los Angeles, CA, USA
| | - Marija Heffer
- Department of Medical Biology and Genetics, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
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Vlisides-Henry RD, Deboeck PR, Grill-Velasquez W, Mackey S, Ramadurai DKA, Urry JO, Neff D, Terrell S, Gao MM, Thomas LR, Conradt E, Crowell SE. Behavioral and physiological stress responses: Within-person concordance during pregnancy. Biol Psychol 2021; 159:108027. [PMID: 33476701 DOI: 10.1016/j.biopsycho.2021.108027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/17/2022]
Abstract
During pregnancy, a woman's emotions can have longstanding implications for both her own and her child's health. Within-person emotional concordance refers to the simultaneous measurement of emotional responses across multiple levels of analysis. This method may provide insight into how pregnant women experience emotions in response to stress. We enrolled 162 pregnant women and assessed concordance through autonomic physiology (electrodermal activity [EDA], respiratory sinus arrhythmia [RSA]), and coded behavior (Prosocial, Flight, Displacement) during the Trier Social Stress Test-Speech. We used multilevel models to examine behavioral-physiological concordance and whether self-reported emotion dysregulation moderated these effects. Participants exhibited EDA-Prosocial concordance, suggesting that prosocial behavior may be a marker of stress. Emotion dysregulation did not moderate concordance. These findings provide novel information about behavioral coping to stress in pregnancy. Given the importance of observed behavior in the maintenance and treatment of psychopathology, these findings may provide a launchpad for future perinatal intervention research.
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Affiliation(s)
- Robert D Vlisides-Henry
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA.
| | - Pascal R Deboeck
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Wendy Grill-Velasquez
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Shantavia Mackey
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Dinesh K A Ramadurai
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Joshua O Urry
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Dylan Neff
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Sarah Terrell
- 115 Health and Human Development Building, Dept. of Human Development and Family Studies, Pennsylvania State University, State College, PA 16802, USA
| | - Mengyu Miranda Gao
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Leah R Thomas
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Elisabeth Conradt
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA; 30 N 1900 E, Dept. of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA; 295 Chipeta Way, Dept. of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA
| | - Sheila E Crowell
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA; 501 Chipeta Way, Dept. of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA; 30 N 1900 E, Dept. of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA.
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Lorzadeh N, Kazemirad N, Kazemirad Y. Human immunodeficiency: Extragonadal comorbidities of infertility in women. IMMUNITY INFLAMMATION AND DISEASE 2020; 8:447-457. [PMID: 32621331 PMCID: PMC7416027 DOI: 10.1002/iid3.327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/21/2020] [Indexed: 12/12/2022]
Abstract
Introduction Infertility is mediated by several changes system‐wide. These changes are likely to cause other systems‐related pathologies, such as changes in systemic immune response, particularly inflammatory response can lead to cardiovascular diseases and breast cancer. Methods These morbidities can exist immediately or years after the diagnosis of infertility. Therefore, understanding the mechanism is important to move toward therapeutic interventions. Results Several extragonadal pathologies are reported due to infertility, as well as, how these might also contribute to reproductive disabilities. Detailed evidence are still not present that can give stronger result. Conclusion This review highlights some of the most frequent comorbidities that are seen in infertile women, hence requiring a need for complete clinical screening and care, as well as diagnosis and treatment in early stages.
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Affiliation(s)
- Nahid Lorzadeh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nastaran Kazemirad
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Kornfield SL, Hantsoo L, Epperson CN. What Does Sex Have to Do with It? The Role of Sex as a Biological Variable in the Development of Posttraumatic Stress Disorder. Curr Psychiatry Rep 2018; 20:39. [PMID: 29777319 PMCID: PMC6354938 DOI: 10.1007/s11920-018-0907-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW This review highlights the neurobiological aspects of sex differences in posttraumatic stress disorder (PTSD), specifically focusing on the physiological responses to trauma and presents evidence supporting hormone and neurosteroid/peptide differences from both preclinical and clinical research. RECENT FINDINGS While others have suggested that trauma type or acute emotional reaction are responsible for women's disproportionate risk to PTSD, neither of these explanations fully accounts for the sex differences in PTSD. Sex differences in brain neurocircuitry, anatomy, and neurobiological processes, such as those involved in learning and memory, are discussed as they have been implicated in risk and resilience for the development of PTSD. Gonadal and stress hormones have been found to modulate sex differences in the neurocircuitry and neurochemistry underlying fear learning and extinction. Preclinical research has not consistently controlled for hormonal and reproductive status of rodents nor have clinical studies consistently examined these factors as potential moderators of risk for PTSD. Sex as a biological variable (SABV) should be considered, in addition to the endocrine and reproductive status of participants, in all stress physiology and PTSD research.
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Affiliation(s)
- Sara L Kornfield
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Room 3005, Philadelphia, PA, 19104, USA.
| | - Liisa Hantsoo
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Room 3005, Philadelphia, PA, 19104, USA
| | - C Neill Epperson
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Room 3005, Philadelphia, PA, 19104, USA
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA
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Faye C, McGowan JC, Denny CA, David DJ. Neurobiological Mechanisms of Stress Resilience and Implications for the Aged Population. Curr Neuropharmacol 2018; 16:234-270. [PMID: 28820053 PMCID: PMC5843978 DOI: 10.2174/1570159x15666170818095105] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/25/2017] [Accepted: 07/27/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Stress is a common reaction to an environmental adversity, but a dysregulation of the stress response can lead to psychiatric illnesses such as major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and anxiety disorders. Yet, not all individuals exposed to stress will develop psychiatric disorders; those with enhanced stress resilience mechanisms have the ability to adapt successfully to stress without developing persistent psychopathology. Notably, the potential to enhance stress resilience in at-risk populations may prevent the onset of stress-induced psychiatric disorders. This novel idea has prompted a number of studies probing the mechanisms of stress resilience and how it can be manipulated. METHODS Here, we review the neurobiological factors underlying stress resilience, with particular focus on the serotoninergic (5-HT), glutamatergic, and γ-Aminobutyric acid (GABA) systems, as well as the hypothalamic-pituitary axis (HPA) in rodents and in humans. Finally, we discuss stress resiliency in the context of aging, as the likelihood of mood disorders increases in older adults. RESULTS Interestingly, increased resiliency has been shown to slow aging and improved overall health and quality of life. Research in the neurobiology of stress resilience, particularly throughout the aging process, is a nascent, yet, burgeoning field. CONCLUSION Overall, we consider the possible methods that may be used to induce resilient phenotypes, prophylactically in at-risk populations, such as in military personnel or in older MDD patients. Research in the mechanisms of stress resilience may not only elucidate novel targets for antidepressant treatments, but also provide novel insight about how to prevent these debilitating disorders from developing.
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Affiliation(s)
- Charlène Faye
- CESP/UMR-S 1178, Univ. Paris-Sud, Fac Pharmacie, Inserm, Université Paris-Saclay, 92296 Chatenay-Malabry, France
| | - Josephine C. McGowan
- Doctoral Program in Neurobiology and Behavior, Columbia University, New York, NY, USA
| | - Christine A. Denny
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Integrative Neuroscience, New York State Psychiatric Institute/Research Foundation for Mental Hygiene, Inc., New York, NY, USA
| | - Denis J. David
- CESP/UMR-S 1178, Univ. Paris-Sud, Fac Pharmacie, Inserm, Université Paris-Saclay, 92296 Chatenay-Malabry, France
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Bale TL, Epperson CN. Sex as a Biological Variable: Who, What, When, Why, and How. Neuropsychopharmacology 2017; 42:386-396. [PMID: 27658485 PMCID: PMC5399243 DOI: 10.1038/npp.2016.215] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/22/2016] [Accepted: 09/16/2016] [Indexed: 12/22/2022]
Abstract
The inclusion of sex as a biological variable in research is absolutely essential for improving our understanding of disease mechanisms contributing to risk and resilience. Studies focusing on examining sex differences have demonstrated across many levels of analyses and stages of brain development and maturation that males and females can differ significantly. This review will discuss examples of animal models and clinical studies to provide guidance and reference for the inclusion of sex as an important biological variable relevant to a Neuropsychopharmacology audience.
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Affiliation(s)
- Tracy L Bale
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry,Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA, USA
| | - C Neill Epperson
- Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry,Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA, USA
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA, USA
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10
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Sex differences and stress across the lifespan. Nat Neurosci 2015; 18:1413-20. [PMID: 26404716 DOI: 10.1038/nn.4112] [Citation(s) in RCA: 466] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/17/2015] [Indexed: 12/11/2022]
Abstract
Sex differences in stress responses can be found at all stages of life and are related to both the organizational and activational effects of gonadal hormones and to genes on the sex chromosomes. As stress dysregulation is the most common feature across neuropsychiatric diseases, sex differences in how these pathways develop and mature may predict sex-specific periods of vulnerability to disruption and increased disease risk or resilience across the lifespan. The aging brain is also at risk to the effects of stress, where the rapid decline of gonadal hormones in women combined with cellular aging processes promote sex biases in stress dysregulation. In this Review, we discuss potential underlying mechanisms driving sex differences in stress responses and their relevance to disease. Although stress is involved in a much broader range of diseases than neuropsychiatric ones, we highlight here this area and its examples across the lifespan.
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Hormone therapy use in women veterans accessing veterans health administration care: a national cross-sectional study. J Gen Intern Med 2015; 30:169-75. [PMID: 25373833 PMCID: PMC4314474 DOI: 10.1007/s11606-014-3073-9] [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: 04/06/2014] [Revised: 09/19/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED The majority of women Veterans using VA (Veterans Administration) care fall in the 45-65 year-old age range. Understanding how menopause is managed in this group is of importance to optimizing their health. OBJECTIVE National population estimates showed a prevalence of hormone therapy (HT) use by women over 45 years of 4.7 % (2009-2010). Our study described the frequency of HT use among women Veterans in VA, and examined whether mental health (MH) was predictive of HT use. DESIGN This was a cross-sectional analysis of national VA administrative data for fiscal year 2009. PARTICIPANTS Women Veterans over the age of 45 (N = 157,195) accessing VA outpatient care were included in the analysis. MAIN MEASURES Logistic regression analyses using HT use as the dependent variable. KEY RESULTS Mean age was 59.4 years (SD =12.2, range =46-110), and 16,227 (10.3 %) of all women used HT. Hysterectomy (OR 3.99 [3.53, 4.49]) and osteoporosis (1.34 [1.27, 1.42]) were the strongest medical indicators of HT use. A total of 49,557 (31.5 %) women in the sample received at least one primary diagnosis of a MH disorder and were more likely to use HT than women with no MH diagnoses (unadjusted OR 1.56, 95 % CI [1.50, 1.61]). Women Veterans with a mood disorder (depression/bipolar) or anxiety disorder [post-traumatic stress disorder (PTSD), other anxiety diagnoses] were more likely to use HT after controlling for demographics and medical comorbidity. CONCLUSION The prevalence of HT use among women Veterans using VA is more than twice that of the general population. Prior work suggested that women Veterans were discontinuing HT at comparable rates, but these data demonstrate that decline in VA HT use has not kept pace with that of civilian medical care. The association of MH diagnosis with HT use suggests that MH plays an important role in VA rates. Further study is needed to understand contributing patient and provider factors.
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Comasco E, Frokjaer VG, Sundström-Poromaa I. Functional and molecular neuroimaging of menopause and hormone replacement therapy. Front Neurosci 2014; 8:388. [PMID: 25538545 PMCID: PMC4259109 DOI: 10.3389/fnins.2014.00388] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/12/2014] [Indexed: 01/30/2023] Open
Abstract
The level of gonadal hormones to which the female brain is exposed considerably changes across the menopausal transition, which in turn, is likely to be of great relevance for neurodegenerative diseases and psychiatric disorders. However, the neurobiological consequences of these hormone fluctuations and of hormone replacement therapy in the menopause have only begun to be understood. The present review summarizes the findings of thirty-five studies of human brain function, including functional magnetic resonance imaging, positron and single-photon computed emission tomography studies, in peri- and postmenopausal women treated with estrogen, or estrogen-progestagen replacement therapy. Seven studies using gonadotropin-releasing hormone agonist intervention as a model of hormonal withdrawal are also included. Cognitive paradigms are employed by the majority of studies evaluating the effect of unopposed estrogen or estrogen-progestagen treatment on peri- and postmenopausal women's brain. In randomized-controlled trials, estrogen treatment enhances activation of fronto-cingulate regions during cognitive functioning, though in many cases no difference in cognitive performance was present. Progestagens seems to counteract the effects of estrogens. Findings on cognitive functioning during acute ovarian hormone withdrawal suggest a decrease in activation of the left inferior frontal gyrus, thus essentially corroborating the findings in postmenopausal women. Studies of the cholinergic and serotonergic systems indicate these systems as biological mediators of hormonal influences on the brain. More, hormonal replacement appears to increase cerebral blood flow in several cortical regions. On the other hand, studies on emotion processing in postmenopausal women are lacking. These results call for well-powered randomized-controlled multi-modal prospective neuroimaging studies as well as investigation on the related molecular mechanisms of effects of menopausal hormonal variations on the brain.
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Affiliation(s)
- Erika Comasco
- Department of Neuroscience, Uppsala University Uppsala, Sweden ; Department of Women's and Children's Health, Uppsala University Uppsala, Sweden
| | - Vibe G Frokjaer
- Department of Neurology, Center for Integrated Molecular Brain Imaging and Neurobiology Research Unit 6931, Copenhagen University Hospital Copenhagen, Denmark
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Allen AP, Kennedy PJ, Cryan JF, Dinan TG, Clarke G. Biological and psychological markers of stress in humans: focus on the Trier Social Stress Test. Neurosci Biobehav Rev 2013; 38:94-124. [PMID: 24239854 DOI: 10.1016/j.neubiorev.2013.11.005] [Citation(s) in RCA: 435] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/01/2013] [Accepted: 11/06/2013] [Indexed: 12/24/2022]
Abstract
Validated biological and psychological markers of acute stress in humans are an important tool in translational research. The Trier Social Stress Test (TSST), involving public interview and mental arithmetic performance, is among the most popular methods of inducing acute stress in experimental settings, and reliably increases hypothalamic-pituitary-adrenal axis activation. However, although much research has focused on HPA axis activity, the TSST also affects the sympathetic-adrenal-medullary system, the immune system, cardiovascular outputs, gastric function and cognition. We critically assess the utility of different biological and psychological markers, with guidance for future research, and discuss factors which can moderate TSST effects. We outline the effects of the TSST in stress-related disorders, and if these responses can be abrogated by pharmacological and psychological treatments. Modified TSST protocols are discussed, and the TSST is compared to alternative methods of inducing acute stress. Our analysis suggests that multiple readouts are necessary to derive maximum information; this strategy will enhance our understanding of the psychobiology of stress and provide the means to assess novel therapeutic agents.
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Affiliation(s)
- Andrew P Allen
- Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland; Department of Psychiatry, University College Cork, Cork, Ireland
| | - Paul J Kennedy
- Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland; Department of Psychiatry, University College Cork, Cork, Ireland
| | - John F Cryan
- Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Timothy G Dinan
- Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland; Department of Psychiatry, University College Cork, Cork, Ireland
| | - Gerard Clarke
- Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland; Department of Psychiatry, University College Cork, Cork, Ireland.
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Palmer SR, Evans A, Broughton H, Huddart S, Drayton M, Rankin J, Draper ES, Cameron A, Paranjothy S. The role of maternal stress in early pregnancy in the aetiology of gastroschisis: an incident case control study. PLoS One 2013; 8:e80103. [PMID: 24260340 PMCID: PMC3832654 DOI: 10.1371/journal.pone.0080103] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/07/2013] [Indexed: 12/04/2022] Open
Abstract
Objective The incidence of gastroschisis, a congenital anomaly where the infant abdominal wall is defective and intestines protrude from the abdominal cavity, is increasing in many countries. The role of maternal stress in some adverse birth outcomes is now well established. We tested the hypothesis that major stressful life events in the first trimester are risk factors for gastroschisis, and social support protective, in a case-control study in the United Kingdom. Methods Gastroschisis cases and three controls per case (matched for maternal age) were identified at routine 18-20 week fetal anomaly ultrasound scan, in 2007-2010. Face to face questionnaire interviews were carried out during the antenatal period (median 24 weeks gestation) asking about serious stressful events and social support in the first trimester. Data were analysed using conditional logistic regression. Results Two or more stressful life events in the first trimester (adjusted OR 4.9; 95% CI 1.2-19.4), and moving address in the first trimester (aOR 4.9; 95% CI 1.7-13.9) were strongly associated with risk of gastroschisis, independent of behavioural risk factors including smoking, alcohol, and poor diet. Perceived availability of social support was not associated with reduced risk of gastroschisis (aOR 0.8; 95% CI 0.2-3.1). Conclusions Stressful maternal life events in the first trimester of pregnancy including change of address were strongly associated with a substantial increase in the risk of gastroschisis, independent of stress related high risk behaviours such as smoking, alcohol consumption and poor diet. This suggests that stress pathways are involved in the aetiology of gastroschisis.
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Affiliation(s)
- Stephen R. Palmer
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Annette Evans
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Hannah Broughton
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Simon Huddart
- Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Mark Drayton
- Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Judith Rankin
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Elizabeth S. Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Alan Cameron
- The University of Glasgow, Glasgow, United Kingdom
- The Ian Donald Fetal Medicine Unit, Southern General Hospital, Glasgow, United Kingdom
| | - Shantini Paranjothy
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
- * E-mail:
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Abstract
This editorial provides a summary of the state of research on stress-related changes associated with aging and discuss how factors such as inflammation and sex steroid alterations may interact with psychosocial stress to affect the risk for mood and cognitive disturbance in older individuals. The authors provide an integrated summary of four studies reported in this issue of the journal and views on future direction in stress and aging research and interventions targeting resilience to stress.
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Affiliation(s)
- Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Paul A. Newhouse
- Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University School of Medicine
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