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Ferber SG, Weller A, Soreq H. Boltzmann's Theorem Revisited: Inaccurate Time-to-Action Clocks in Affective Disorders. Curr Neuropharmacol 2024; 22:1762-1777. [PMID: 38500272 PMCID: PMC11284727 DOI: 10.2174/1570159x22666240315100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 03/20/2024] Open
Abstract
Timely goal-oriented behavior is essential for survival and is shaped by experience. In this paper, a multileveled approach was employed, ranging from the polymorphic level through thermodynamic molecular, cellular, intracellular, extracellular, non-neuronal organelles and electrophysiological waves, attesting for signal variability. By adopting Boltzmann's theorem as a thermodynamic conceptualization of brain work, we found deviations from excitation-inhibition balance and wave decoupling, leading to wider signal variability in affective disorders compared to healthy individuals. Recent evidence shows that the overriding on-off design of clock genes paces the accuracy of the multilevel parallel sequencing clocks and that the accuracy of the time-to-action is more crucial for healthy behavioral reactions than their rapidity or delays. In affective disorders, the multilevel clocks run free and lack accuracy of responsivity to environmentally triggered time-to-action as the clock genes are not able to rescue mitochondria organelles from oxidative stress to produce environmentally-triggered energy that is required for the accurate time-to-action and maintenance of the thermodynamic equilibrium. This maintenance, in turn, is dependent on clock gene transcription of electron transporters, leading to higher signal variability and less signal accuracy in affective disorders. From a Boltzmannian thermodynamic and energy-production perspective, the option of reversibility to a healthier time-toaction, reducing entropy is implied. We employed logic gates to show deviations from healthy levelwise communication and the reversed conditions through compensations implying the role of nonneural cells and the extracellular matrix in return to excitation-inhibition balance and accuracy in the time-to-action signaling.
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Ferber SG, Weller A. Diverse Underlying Mechanisms and Sex Differences Found in Translational Models of Cannabinoids Use: Towards Validation in Human Studies. Int J Mol Sci 2023; 24:16586. [PMID: 38068909 PMCID: PMC10706558 DOI: 10.3390/ijms242316586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
This Special Issue represents a continuation of our previous Special Issue entitled "Endocannabinoids, Cannabinoids and Psychiatry: Biological Mechanisms" [...].
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Goldstein Ferber S, Weller A, Hayes AM, Vannorsdall TD, Ajlouni Y, Qudah M, Zalsman G, Shoval G, Jannini TB, Fiedler R, Chen LX, Shayani DR, Kachuki Dory E, Stolowicz-Melman D, Evans C, Trow M, Di Lorenzo G, Rossi R. International study of the Complex Stress Reaction Syndrome: Implications for transdiagnostic clinical practice. World J Psychiatry 2023; 13:803-815. [PMID: 38058684 PMCID: PMC10696285 DOI: 10.5498/wjp.v13.i10.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/25/2023] [Accepted: 09/11/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The debate regarding diagnostic classification systems in psychiatry (categorial vs dimensional systems) has essential implications for the diagnosis, prevention and treatment of stress reactions. We previously found a unique pattern of stress reaction in a study executed during the coronavirus disease 2019 pandemic using large representative samples in two countries, and termed it the Complex Stress Reaction Syndrome (CSRS). AIM To investigate CSRS, Type A (psychiatric symptoms, spanning anxiety, depression, stress symptoms, and post-traumatic stress disorder (PTSD)), with or without long-coronavirus disease (COVID) residuals (CSRS, Type B, neuropsychiatric symptoms spanning cognitive deficits and fatigue, excluding systemic symptoms). Our two-tailed hypothesis was that CSRS is a condition related to an unrecognized type of stress reaction in daily life in the general population (Type A) or that it is related to the severe acute respiratory syndrome coronavirus 2 infection and its long-COVID residuals (Type B). METHODS 977 individuals in four continents (North America, Europe, Australia and the Middle East) completed the online study questionnaire in six languages using the Qualtrics platform. The study was managed by six teams in six countries that promoted the study on social media. The questionnaire assessed anxiety, depression, stress symptoms and PTSD (CSRS, Type A), cognitive deficits and fatigue (CSRS, Type B). The data were analyzed using Proportion Analyses, Multivariate Analysis of Co-Variance (MANCOVA), linear regression analyses and validated clinical cutoff points. RESULTS The results of the Proportion Analyses showed that the prevalence of 4 symptoms spanning anxiety, depression, stress symptoms, and PTSD was significantly higher than the most prevalent combinations of fewer symptoms across 4 continents, age groups, and gender. This supports the transdiagnostic argument embedded in the CSRS (Type A). The same pattern of results was found in infected/recovered individuals. The prevalence of the 4 psychiatric symptoms combination was significantly greater than that of 5 and 6 symptoms, when adding cognitive deficits and fatigue, respectively. MANCOVA showed a significant three-way interaction (age × gender × continent). Further analyses showed that the sources of this three-way interaction were threefold relating to two sub-populations at-risk: (1) Individuals that self-identified as non-binary gender scored significantly higher on all 4 psychiatric symptoms of the CSRS, Type A at young age groups (< 50 years old) in North America compared to (self-identified) women and men located in the 4 continents studied, and to other ages across the adult life span; and (2) This pattern of results (CSRS, Type A) was found also in women at young ages (< 40 years old) in North America who scored higher compared to men and women in other continents and other ages. Linear regression analyses confirmed the MANCOVA results. CONCLUSION These results show a combined mental health risk factor related to stress reactivity, suggesting that the CSRS is sensitive to populations at risk and may be applied to future identification of other vulnerable sub-populations. It also supports the transdiagnostic approach for more accurate prevention and treatment. Time will tell if such transdiagnostic syndromes will be part of the discussions on the next revisions of the traditional classification systems or whether the crisis in psychiatry further evolves.
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Goldstein Ferber S, Shoval G, Weller A, Zalsman G. Not one thing at a time: When concomitant multiple stressors produce a transdiagnostic clinical picture. World J Psychiatry 2023; 13:402-408. [PMID: 37547732 PMCID: PMC10401502 DOI: 10.5498/wjp.v13.i7.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 07/17/2023] Open
Abstract
A condition of exposure to multiple stressors resulting in a mixed clinical picture spanning conventional categories without meeting any of them in full, encompasses a risk for a list of comorbidities preventing appropriate prevention and treatment. New transformative transdiagnostic approaches suggest changes spanning conventional categories. They base their systems of classification on biomarkers as well as on brain structural and functional dysregulation as associated with behavioral and emotional symptoms. These new approaches received critiques for not being specific enough and for suggesting a few biomarkers for psychopathology as a whole. Therefore, they put the value of differential diagnosis at risk of avoiding appropriate derived prevention and treatment. Multiplicity of stressors has been considered mostly during and following catastrophes, without considering the resulting mixed clinical picture and life event concomitant stressors. We herewith suggest a new category within the conventional classification systems: The Complex Stress Reaction Syndrome, for a condition of multiplicity of stressors, which showed a mixed clinical picture for daily life in the post coronavirus disease 2019 era, in the general population. We argue that this condition may be relevant to daily, regular life, across the lifespan, and beyond conditions of catastrophes. We further argue that this condition may worsen without professional care and it may develop into a severe mental health disorder, more costly to health systems and the suffering individuals. Means for derived prevention and treatment are discussed.
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Ferber SG, Weller A, Soreq H. Control systems theory revisited: new insights on the brain clocks of time-to-action. Front Neurosci 2023; 17:1171765. [PMID: 37378011 PMCID: PMC10292755 DOI: 10.3389/fnins.2023.1171765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
To outline the complex biological rhythms underlying the time-to-action of goal-oriented behavior in the adult brain, we employed a Boolean Algebra model based on Control Systems Theory. This suggested that "timers" of the brain reflect a metabolic excitation-inhibition balance and that healthy clocks underlying goal-oriented behavior (optimal range of signal variability) are maintained by XOR logic gates in parallel sequences between cerebral levels. Using truth tables, we found that XOR logic gates reflect healthy, regulated time-to-action events between levels. We argue that the brain clocks of time-to-action are active within multileveled, parallel-sequence complexes shaped by experience. We show the metabolic components of time-to-action in levels ranging from the atom level through molecular, cellular, network and inter-regional levels, operating as parallel sequences. We employ a thermodynamic perspective, suggest that clock genes calculate free energy versus entropy and derived time-to-action level-wise as a master controller, and show that they are receivers, as well as transmitters of information. We argue that regulated multileveled time-to-action processes correspond to Boltzmann's thermodynamic theorem of micro- and macro-states, and that the available metabolic free-energy-entropy matrix determines the brain's reversible states for its age-appropriate chrono-properties at given moments. Thus, healthy timescales are not a precise number of nano- or milliseconds of activity nor a simple phenotypic distinction between slow vs. quick time-to-action, but rather encompass a range of variability, which depends on the molecules' size and dynamics with the composition of receptors, protein and RNA isoforms.
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Goldstein Ferber S, Shoval G, Rossi R, Trezza V, Di Lorenzo G, Zalsman G, Weller A, Mann JJ. Transdiagnostic considerations of mental health for the post-COVID era: Lessons from the first surge of the pandemic. World J Clin Cases 2023; 11:809-820. [PMID: 36818632 PMCID: PMC9928692 DOI: 10.12998/wjcc.v11.i4.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/28/2022] [Accepted: 01/16/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The Coronavirus disease 19 (COVID-19)-related psychiatric burden partly results from prolonged social stress world-wide. Studies have examined the psychiatric impact of COVID-19 on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) and International Classification of Diseases 11th Revision (ICD-11) categories, implicating multiple diagnoses, complicating clinical management.
AIM To verify whether COVID-19-related psychopathology spans multiple DSM-5 and ICD-11 diagnoses, but not in a random pattern. Consequently, empirical analysis of the multiple associated symptoms will better describe COVID-19-related psychopathology.
METHODS We conducted a bi-national study during the first surge of the pandemic: an Italian sample (n = 21217, studied March-April 2020); and three representative longitudinal samples from Israel (n = 1276, 1189, and 1432 respectively, studied May-July 2020). Data in Italy were collected by a national internet-based survey with an initially approached sample of about one million persons and in Israel by the Israeli Central Bureau of Statistics using probability-based national representative sampling. Data analysis focused on the frequency and patterns of reported multiple mental health symptoms.
RESULTS Combinations with all symptoms were more prevalent than combinations with fewer symptoms, with no majorities-minorities differences in both countries, demonstrating the generalizability of the transdiagnostic pattern of mental health issues in both nations. A history of previous mental disorder (Italian study) and an increase in symptom prevalence over time (Israel study) were associated with an increased number of symptoms. Conclusions: Based on finding correlated symptom diversity spanning conventional diagnostic categories, we suggest that the pattern of mental health issues associated with the COVID-19 pandemic is transdiagnostic.
CONCLUSION The findings have implications for improving prevention and treatment of COVID-19 related psychopathology and for post-pandemic times in conditions resulting from multiplicity of stressors with mixed symptomatology in the clinical picture.
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Ferber SG, Geva R, Weller A. When the Mind Comes to Live Inside the Body: The Ontogeny of the Perceptual Control Clock. Curr Neuropharmacol 2023; 21:13-21. [PMID: 35410607 PMCID: PMC10193756 DOI: 10.2174/1570159x20666220411095508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/18/2022] [Accepted: 04/09/2022] [Indexed: 02/04/2023] Open
Abstract
In this editorial, we discuss the neurobiological processes underlying the early emergence of awareness that we term the "when" and "how" the mind comes to live inside the body. We describe an accumulative developmental process starting during embryonic life and continuing to fetal and postnatal development, of coupling of heart rate, body movements, and sleep states on the behavioral level with underlying mechanisms on the structural, functional, cellular, and molecular levels. A developmental perspective is proposed based on Perceptual Control Theory (PCT). This includes a developing sequence of modules starting from early sensing of neural intensities to early manifestation of human mindful capacities. We also address pharmacological treatments administered to preterm infants, which may interfere with this development, and highlight the need to consider this potential "side effect" of current pharmaceuticals when developing novel pharmacogenomic treatments.
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Ferber SG. Meet the Editorial Board Member. Curr Neuropharmacol 2022. [DOI: 10.2174/1570159x2011220919094044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Goldstein Ferber S, Shoval G, Zalsman G, Weller A. Does COVID-19 related symptomatology indicate a transdiagnostic neuropsychiatric disorder? - Multidisciplinary implications. World J Psychiatry 2022; 12:1004-1015. [PMID: 36158308 PMCID: PMC9476837 DOI: 10.5498/wjp.v12.i8.1004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/28/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
The clinical presentation that emerges from the extensive coronavirus disease 2019 (COVID-19) mental health literature suggests high correlations among many conventional psychiatric diagnoses. Arguments against the use of multiple comorbidities for a single patient have been published long before the pandemic. Concurrently, diagnostic recommendations for use of transdiagnostic considerations for improved treatment have been also published in recent years. In this review, we pose the question of whether a transdiagnostic mental health disease, including psychiatric and neuropsychiatric symptomology, has emerged since the onset of the pandemic. There are many attempts to identify a syndrome related to the pandemic, but none of the validated scales is able to capture the entire psychiatric and neuropsychiatric clinical presentation in infected and non-infected individuals. These scales also only marginally touch the issue of etiology and prevalence. We suggest a working hypothesis termed Complex Stress Reaction Syndrome (CSRS) representing a global psychiatric reaction to the pandemic situation in the general population (Type A) and a neuropsychiatric reaction in infected individuals (Type B) which relates to neurocognitive and psychiatric features which are part (excluding systemic and metabolic dysfunctions) of the syndrome termed in the literature as long COVID. We base our propositions on multidisciplinary scientific data regarding mental health during the global pandemic situation and the effects of viral infection reviewed from Google Scholar and PubMed between February 1, 2022 and March 10, 2022. Search in-clusion criteria were "mental health", "COVID-19" and "Long COVID", English language and human studies only. We suggest that this more comprehensive way of understanding COVID-19 complex mental health reactions may promote better prevention and treatment and serve to guide implementation of recommended administrative regulations that were recently published by the World Psychiatric Association. This review may serve as a call for an international investigation of our working hypothesis.
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Ferber SG, Weller A. The Inanimate Third: Going Beyond Psychodynamic Approaches for Remote Psychotherapy during the
COVID
‐19 Pandemic. BRITISH JOURNAL OF PSYCHOTHERAPY 2022; 38:316-337. [PMID: 35601049 PMCID: PMC9111788 DOI: 10.1111/bjp.12720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/13/2021] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Abstract
The COVID‐19 pandemic exposed the field of psychotherapy to the need to provide treatment remotely. We discuss the question of whether remote therapy can be curative and if the electronic device used to manage these sessions unites or separates the therapist and the patient. We term the electronic device as ‘the inanimate third’ in the therapeutic process and discuss the objectivity of the device as opposed to the subjective emotional processes involved. We deal with emotional themes relevant to the COVID‐19 pandemic and associated social distancing practices, such as longing, loneliness, the perception of the future and the lost past, and the efficacy of the therapeutic stimulation of fantasy and hope. We also evaluate the possibility of existing transference and countertransference processes while working remotely. We suggest the term ‘social paradox’ to describe the situation in which an objective entity such as the digital media symbolizes both distance and intimacy as well as separation and unity. We conclude by stating that containment of the social paradox by the therapeutic dialogue is possible as the existence of the dialogue eliminates elements of the paradox.
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Ferber SG, Als H, McAnulty G, Klinger G, Weller A. Multi-level hypothalamic neuromodulation of self-regulation and cognition in preterm infants: Towards a control systems model. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 9:100109. [PMID: 35755927 PMCID: PMC9216652 DOI: 10.1016/j.cpnec.2021.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 11/21/2022] Open
Abstract
Preterm infants, age-corrected for prematurity, score on average, 10 points lower on IQ tests than full-term infants tested at comparable ages. This review focuses on the potential contribution of the hypothalamus to cognitive neuro-regulatory development in preterm infants through its bidirectional neural connections with the prefrontal cortex and its neuroendocrine activity. It aims to clarify the central role of the hypothalamus in preterm high stress situations and in influencing cognitive development via its connectivity to the cerebral cortex. The review further evaluates epigenomic sensitivity to environmental inputs. Recent results suggest that an optimal range of DNA methylations (via a continuous process of decreasing levels of receptor methylations that are too high, and increasing levels that are too low) appears necessary in order to reach an adaptive level of receptor availability. Several studies have demonstrated amelioration of preterm infants' stress while in the Newborn Intensive Care Unit (NICUs) and following discharge. The authors postulate that feedback mechanisms and correction signals are the basis for a hypothalamic homeostatic modulating function, a "hypothalamic resistance response", which may account for the stress reduction brought about by in- and post-NICU early interventions and their results of promoting self-regulation and cognition.
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Key Words
- Cognitive
- Controlled process variable, (CPV)
- Corticotropin-releasing hormone, (CRH)
- Epigenetics
- Hypothalamic pituitary adrenal axis, (HPA axis)
- Hypothalamic pituitary gonadal axis, (HPG axis)
- Hypothalamic pituitary thyroid axis, (HPT axis)
- Hypothalamus
- Lateral hypothalamus, (LH)
- Magnetic resonance imaging, (MRI)
- Neuro-regulatory development
- Newborn intensive care unit, (NICU)
- Oxytocin, (OT)
- Prefrontal cortex
- Prefrontal cortex, (PFC)
- Premature infants
- Set point, (SP)
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Goldstein Ferber S, Weller A, Ben-Shachar M, Klinger G, Geva R. Development of the Ontogenetic Self-Regulation Clock. Int J Mol Sci 2022; 23:993. [PMID: 35055184 PMCID: PMC8778416 DOI: 10.3390/ijms23020993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/07/2022] [Accepted: 01/15/2022] [Indexed: 01/27/2023] Open
Abstract
To date, there is no overarching proposition for the ontogenetic-neurobiological basis of self-regulation. This paper suggests that the balanced self-regulatory reaction of the fetus, newborn and infant is based on a complex mechanism starting from early brainstem development and continuing to progressive control of the cortex over the brainstem. It is suggested that this balance occurs through the synchronous reactivity between the sympathetic and parasympathetic systems, both which originate from the brainstem. The paper presents an evidence-based approach in which molecular excitation-inhibition balance, interchanges between excitatory and inhibitory roles of neurotransmitters as well as cardiovascular and white matter development across gestational ages, are shown to create sympathetic-parasympathetic synchrony, including the postnatal development of electroencephalogram waves and vagal tone. These occur in developmental milestones detectable in the same time windows (sensitive periods of development) within a convergent systematic progress. This ontogenetic stepwise process is termed "the self-regulation clock" and suggest that this clock is located in the largest connection between the brainstem and the cortex, the corticospinal tract. This novel evidence-based new theory paves the way towards more accurate hypotheses and complex studies of self-regulation and its biological basis, as well as pointing to time windows for interventions in preterm infants. The paper also describes the developing indirect signaling between the suprachiasmatic nucleus and the corticospinal tract. Finally, the paper proposes novel hypotheses for molecular, structural and functional investigation of the "clock" circuitry, including its associations with other biological clocks. This complex circuitry is suggested to be responsible for the developing self-regulatory functions and their neurobehavioral correlates.
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Ferber SG, Braun K, Weller A. The roots of paternal depression: Experienced and nonexperienced trauma or Folie a Deux? Dev Psychobiol 2021; 63:e22197. [PMID: 34674247 DOI: 10.1002/dev.22197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 08/19/2021] [Accepted: 08/30/2021] [Indexed: 12/14/2022]
Abstract
The transition to fatherhood may be challenged with anxiety and trepidation. A high prevalence has been found for paternal depression and it is reactive to maternal depression. This review aims to address potential sources of paternal depression, which may have adverse consequences on child development. We describe through three hypotheses how fathers may be at risk of depression during the transition to fatherhood: (1) psychological (interacting with ecological systems); (2) brain functional∖structural changes; and (3) (epi)genomic. We propose that paternal stressful experiences during the transition to fatherhood may be the source for paternal depression through direct stressful paternal experiences or via (potential, currently debated) nonexperienced (by the father) epigenomic transgenerational transmission. On the other hand, we suggest that resilient fathers may undergo a transient dysphoric period affected by identifying with the newborn's vulnerability as well as with the mother's postpartum vulnerability resulting in "paternity blues." In accordance with recent views on paternal "heightened sensitivity" toward the infant, we propose that the identification of both parents with the vulnerability of the newborn creates a sensitive period of Folie a Deux (shared madness) which may be a healthy transient, albeit a quasi-pathological period, recruited by the orienting response of the newborn for survival.
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Ferber SG, Weller A, Maor R, Feldman Y, Harel-Fisch Y, Mikulincer M. Perceived social support in the social distancing era: the association between circles of potential support and COVID-19 reactive psychopathology. ANXIETY STRESS AND COPING 2021; 35:58-71. [PMID: 34652983 DOI: 10.1080/10615806.2021.1987418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Stressors related to the COVID-19 pandemic are risk factors for psychopathology, but psychosocial protective factors might play a crucial role in buffering the pathogenic effects of the outbreak. DESIGN In the current study, we examined the association of inner resources and potential external sources of support for coping with the pandemic and related lockdowns to mental health during the pandemic, while controlling for sociodemographic variables as covariates. METHODS We tested the model in a probability-based internet survey of a representative sample of the Israeli adult population (N = 812) conducted during the COVID-19 pandemic. RESULTS Perceived support in close relationships was negatively associated with the intensity of depression, anxiety, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Larger rings of potential support such as perceived belongingness to a community and trust in government were also negatively related to anxiety and depression but were positively associated with the intensity of OCD and PTSD. CONCLUSIONS Findings support the "tend and befriend" theory in the social distancing era and highlight the importance of keeping personal relationships alive when facing a mass trauma.
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Goldstein Ferber S, Weller A, Yadid G, Friedman A. Discovering the Lost Reward: Critical Locations for Endocannabinoid Modulation of the Cortico-Striatal Loop That Are Implicated in Major Depression. Int J Mol Sci 2021; 22:1867. [PMID: 33668515 PMCID: PMC7918043 DOI: 10.3390/ijms22041867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 12/14/2022] Open
Abstract
Depression, the most prevalent psychiatric disorder in the Western world, is characterized by increased negative affect (i.e., depressed mood, cost value increase) and reduced positive affect (i.e., anhedonia, reward value decrease), fatigue, loss of appetite, and reduced psychomotor activity except for cases of agitative depression. Some forms, such as post-partum depression, have a high risk for suicidal attempts. Recent studies in humans and in animal models relate major depression occurrence and reoccurrence to alterations in dopaminergic activity, in addition to other neurotransmitter systems. Imaging studies detected decreased activity in the brain reward circuits in major depression. Therefore, the location of dopamine receptors in these circuits is relevant for understanding major depression. Interestingly, in cortico-striatal-dopaminergic pathways within the reward and cost circuits, the expression of dopamine and its contribution to reward are modulated by endocannabinoid receptors. These receptors are enriched in the striosomal compartment of striatum that selectively projects to dopaminergic neurons of substantia nigra compacta and is vulnerable to stress. This review aims to show the crosstalk between endocannabinoid and dopamine receptors and their vulnerability to stress in the reward circuits, especially in corticostriatal regions. The implications for novel treatments of major depression are discussed.
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Goldstein Ferber S, Shoval G, Zalsman G, Mikulincer M, Weller A. Between Action and Emotional Survival During the COVID-19 era: Sensorimotor Pathways as Control Systems of Transdiagnostic Anxiety-Related Intolerance to Uncertainty. Front Psychiatry 2021; 12:680403. [PMID: 34393847 PMCID: PMC8358206 DOI: 10.3389/fpsyt.2021.680403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/16/2021] [Indexed: 12/29/2022] Open
Abstract
Objectives: The COVID-19 pandemic and aligned social and physical distancing regulations increase the sense of uncertainty, intensifying the risk for psychopathology globally. Anxiety disorders are associated with intolerance to uncertainty. In this review we describe brain circuits and sensorimotor pathways involved in human reactions to uncertainty. We present the healthy mode of coping with uncertainty and discuss deviations from this mode. Methods: Literature search of PubMed and Google Scholar. Results: As manifestation of anxiety disorders includes peripheral reactions and negative cognitions, we suggest an integrative model of threat cognitions modulated by sensorimotor regions: "The Sensorimotor-Cognitive-Integration-Circuit." The model emphasizes autonomic nervous system coupling with the cortex, addressing peripheral anxious reactions to uncertainty, pathways connecting cortical regions and cost-reward evaluation circuits to sensorimotor regions, filtered by the amygdala and basal ganglia. Of special interest are the ascending and descending tracts for sensory-motor crosstalk in healthy and pathological conditions. We include arguments regarding uncertainty in anxiety reactions to the pandemic and derive from our model treatment suggestions which are supported by scientific evidence. Our model is based on systematic control theories and emphasizes the role of goal conflict regulation in health and pathology. We also address anxiety reactions as a spectrum ranging from healthy to pathological coping with uncertainty, and present this spectrum as a transdiagnostic entity in accordance with recent claims and models. Conclusions: The human need for controllability and predictability suggests that anxiety disorders reactive to the pandemic's uncertainties reflect pathological disorganization of top-down bottom-up signaling and neural noise resulting from non-pathological human needs for coherence in life.
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Ferber SG, Namdar D, Hen-Shoval D, Eger G, Koltai H, Shoval G, Shbiro L, Weller A. The "Entourage Effect": Terpenes Coupled with Cannabinoids for the Treatment of Mood Disorders and Anxiety Disorders. Curr Neuropharmacol 2020; 18:87-96. [PMID: 31481004 PMCID: PMC7324885 DOI: 10.2174/1570159x17666190903103923] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 12/27/2022] Open
Abstract
Mood disorders are the most prevalent mental conditions encountered in psychiatric practice. Numerous patients suffering from mood disorders present with treatment-resistant forms of depression, co-morbid anxiety, other psychiatric disorders and bipolar disorders. Standardized essential oils (such as that of Lavender officinalis) have been shown to exert clinical efficacy in treating anxiety disorders. As endocannabinoids are suggested to play an important role in major depression, generalized anxiety and bipolar disorders, Cannabis sativa was suggested for their treatment. The endocannabinoid system is widely distributed throughout the body including the brain, modulating many functions. It is involved in mood and related disorders, and its activity may be modified by exogenous cannabinoids. CB1 and CB2 receptors primarily serve as the binding sites for endocannabinoids as well as for phytocannabinoids, produced by cannabis inflorescences. However, ‘cannabis’ is not a single compound product but is known for its complicated molecular profile, producing a plethora of phytocannabinoids alongside a vast array of terpenes. Thus, the “entourage effect” is the suggested positive contribution derived from the addition of terpenes to cannabinoids. Here, we review the literature on the effects of cannabinoids and discuss the possibility of enhancing cannabinoid activity on psychiatric symptoms by the addition of terpenes and terpenoids. Possible underlying mechanisms for the anti-depressant and anxiolytic effects are reviewed. These natural products may be an important potential source for new medications for the treatment of mood and anxiety disorders.
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Ferber SG, Roth TL, Weller A. Epigenetic fragility of the endocannabinoid system under stress: risk for mood disorders and pharmacogenomic implications. Epigenomics 2020; 12:657-660. [PMID: 32396405 DOI: 10.2217/epi-2020-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Goldstein Ferber S, Trezza V, Weller A. Early life stress and development of the endocannabinoid system: A bidirectional process in programming future coping. Dev Psychobiol 2019; 63:143-152. [PMID: 31849055 DOI: 10.1002/dev.21944] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/31/2019] [Accepted: 11/21/2019] [Indexed: 01/06/2023]
Abstract
The endocannabinoid system (ECS) critically regulates stress responsivity and emotional behavior throughout development. It regulates anxiety-like behaviors in humans and animal models. In addition, it is sensitive to early life stress at the gene expression level in a sex-dependent and region-dependent manner, and these changes are already evident in the adolescent brain. The ECS modulates the neuroendocrine and behavioral effects of stress, and is also capable of being affected by stress exposure itself. Early life stress interferes with the development of corticolimbic circuits, a major location of endocannabinoid receptors, and increases vulnerability to adult psychopathology. Early life stress alters the ontogeny of the ECS, resulting in a sustained deficit in its function, particularly within the hippocampus. Specifically, exposure to early stress results in bidirectional changes in anandamide and 2-AG tissue levels within the amygdala and hippocampus and reduces hippocampal endocannabinoid function at puberty. CB1 receptor densities across all brain regions are downregulated later in life following exposure to early life stress. Manipulations affecting the glucocorticoid and the endocannabinoid systems persistently adjust individual emotional responses and synaptic plasticity. This review aims to show the bidirectional trajectories of endocannabinoid modulation of emotionality in reaction to early life stress.
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Ferber SG, Als H, McAnulty G, Peretz H, Zisapel N. Melatonin and mental capacities in newborn infants. J Pediatr 2011; 159:99-103.e1. [PMID: 21315375 DOI: 10.1016/j.jpeds.2010.12.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 11/15/2010] [Accepted: 12/22/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate the role of melatonin in the emergence of mental capacities in the newborn infant. STUDY DESIGN Assessment of Preterm Infant Behavior examination was performed at 2 weeks post-term age for 39 (21 preterm and 18 term) infants. 6-Suphatoxymelatonin from nocturnal urine samples was analyzed by enzyme-linked immunosorbent assays, and the Mental Developmental Index, assessed by Bayley scales, was correlated at 4, 6, and 9 months' corrected age. RESULTS Multivariate analysis of variance with repeated measures showed that improved autonomic function at 2 weeks of age was associated with higher Mental Developmental Index scores at 9 months when related to the amount of melatonin at 4, 6, and 9 months of age. CONCLUSIONS Early compromised autonomic system function in preterm infants is associated with lower mental capacities and is related to lower melatonin levels at later ages.
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Ferber SG. The father-infant co-regulation and infant social proficiency with a stranger. Infant Behav Dev 2010; 33:235-40. [PMID: 20176403 DOI: 10.1016/j.infbeh.2009.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Revised: 06/21/2009] [Accepted: 11/26/2009] [Indexed: 11/28/2022]
Abstract
A growing body of knowledge is available on the father's instrumental role in the development of the child, but there is less data on the role he fulfills in preparing the child for challenging social encounters. The present study was designed to investigate the predictive value of the toddler's co-regulation with the father and the capacities the infant shows during a later encounter with a stranger, beyond the effect of the co-regulation of the toddler with the mother. Thirty-one toddlers were engaged in three interactions: with the mother, father, and a stranger. The order of the first two interactions was randomized, while the session with the stranger, which involved a game of peek-a-boo with an object, was always last. The sessions were videotaped and coded according the Early Interaction Scale (EIS) off-line by trained coders. The results indicate that the extent of the infant's proficiency in interacting with the stranger was predicted by his or her social proficiency and his or her co-regulation with the father, beyond the contribution of his or her proficiency and co-regulation with the mother.
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Ferber SG, Feldman R, Makhoul IR. The development of maternal touch across the first year of life. Early Hum Dev 2008; 84:363-70. [PMID: 17988808 DOI: 10.1016/j.earlhumdev.2007.09.019] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 09/19/2007] [Accepted: 09/20/2007] [Indexed: 11/26/2022]
Abstract
The developmental trajectories of specific forms of maternal touch during natural caregiving were examined across the first year in relation to the development of mother-infant reciprocal communication. One hundred and thirty-one mothers and infants in four groups aged 3, 6, 9, and 12 months were observed in a cross-sectional design at home during natural caregiving and mother-child play sessions. Microanalytic coding of the caregiving sessions considered nine forms of maternal touch, which were aggregated into three global touch categories: affectionate, stimulating, and instrumental. Play sessions were coded for maternal sensitivity and dyadic reciprocity. Maternal affectionate and stimulating touch decreased significantly during the second 6 months of life. In parallel, dyadic reciprocity increased in the second half year. Dyadic reciprocity was predicted by the frequency of affectionate touch but not by any other form of touch. Results contribute to specifying the role of touch as it evolves across the first year of life within the global mother-infant communication system.
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Ferber SG, Makhoul IR. Neurobehavioural assessment of skin-to-skin effects on reaction to pain in preterm infants: a randomized, controlled within-subject trial. Acta Paediatr 2008; 97:171-6. [PMID: 18177441 DOI: 10.1111/j.1651-2227.2007.00607.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the immediate and sustained effects of Kangaroo Care on reaction to pain of premature infants. PATIENTS AND METHODS A controlled, within-subject randomized study, performed in a large neonatal intensive care unit. Thirty premature infants were observed with blood test stick (BT) or without the blood test stick (W) procedure, either during Kangaroo care (K) or during standard within-crib care (C). Each of the four conditions (BTK, WK, BTC, WC) was observed in four separate sessions: baseline session - 10 min; intervention (BT or W) - 2 min; posttest - 10 min and follow-up - 20 min, in crib (starting 1 h after treatment). For neurobehavioural assessment, the naturalistic observation method was adopted from the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). RESULTS During the BTK session (blood test stick with K-care), we observed a decrease in motor disorganization and extension movements and an increase in attention signs, both negative and positive. Significant neurobehavioural changes were sustained in the follow-up period after K-care in comparison to the within-crib-care intervention sessions. CONCLUSIONS K-care, as compared to within-crib condition, led to a decrease in stressful neurobehavioural signs after BT procedures in premature infants. Painful procedures such as the BT procedure in premature infants should be performed while the infants are being held in K-care position.
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Ferber SG, Makhoul IR, Weller A. Does sympathetic activity contribute to growth of preterm infants? Early Hum Dev 2006; 82:205-10. [PMID: 16243459 DOI: 10.1016/j.earlhumdev.2005.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Revised: 08/18/2005] [Accepted: 08/22/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emerging evidence on faster growth in preterm infants with higher heart rate as opposed to the classical approach calls for further research. AIMS to test whether (1) high or low heart rate and (2) heart rate during the first days of life predict greater weight gain in preterm infants. METHODS A retrospective study analyzing two daily measures of heart rate obtained during restful sleep, total daily calorie intake and daily weight gain measured always in the morning before meal were collected from the medical files. RESULTS Analysis of 90 healthy preterm infants born at 32-36 weeks of gestation revealed that increased mean heart rate during hospitalization predicted greater weight gain even when controlling for calorie intake, birth weight, gestational age, appropriateness of birth weight for gestational age, and length of hospitalization. Mean heart rate during the first three days of life yielded the same pattern of results. Post-hoc analysis of variance between infants with mean daily heart rate </=139 bpm vs. >/=140 bpm showed that infants with higher heart rate achieved a significantly higher weight gain. CONCLUSIONS It is suggested that, contrary to adults, in neonates an anabolic activity is represented by increased sympathetic functioning within the normal range. The implications of a slower growth rate for additional developmental care and individual considerations of appropriate stimulation in preterm infants are discussed.
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Ferber SG. "With sorrow you will have sons": the constructive consequence of maternity blues. Psychoanal Rev 2006; 93:117-30. [PMID: 16637775 DOI: 10.1521/prev.2006.93.1.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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