Practising through the pandemic

Practising psychotherapy online during Covid-19; uncertainties and crisis management; after effects of lockdown; trauma and its effects on autonomic nervous system; how we regulate. This article consists of my work during the global Covid-19 crisis and to address the consequences of it on mental health.

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Case report: Perioperative management of a patient with familial dysautonomia

Journal of Clinical Intensive Care and Medicine ◽

10.29328/journal.jcicm.1001038 ◽

2021 ◽

Vol 6 (2) ◽

pp. 029-032

Author(s):

Sarebanha Melodie ◽

Valente Laura ◽

Kalra Minnea ◽

Joseph Layon A ◽

Crimi Ettore

Keyword(s):

Intensive Care Unit ◽

Nervous System ◽

Autonomic Nervous System ◽

Crisis Management ◽

Autosomal Recessive ◽

Perioperative Management ◽

Hemodynamic Instability ◽

Familial Dysautonomia ◽

Autonomic Nervous ◽

Noxious Stimuli

Familial dysautonomia is a rare autosomal recessive neurodegenerative disease affecting cells of the autonomic nervous system. Patients with this disease are insensitive to pain but their autonomic nervous system is still activated with noxious stimuli. This report details a case of a patient with familial dysautonomia who underwent right ankle open reduction and internal fixation for a bimalleolar right ankle fracture. The patients preoperative and intraoperative course were uneventful but shortly after handoff to the intensive care unit, the patient experienced an autonomic crisis. Management of these patients is complex, requiring maintenance of physiologic homeostasis as well as preventing hemodynamic instability caused by noxious stimuli. Any deviations from baseline may cause an autonomic crisis, as happened in our patient. Herein, we detail the perioperative management of a patient with familial dysautonomia in further detail.

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Role of the central autonomic nervous system intrinsic functional organisation and psychosocial factors in primary microvascular angina and Takotsubo syndrome

Open Heart ◽

10.1136/openhrt-2020-001315 ◽

2020 ◽

Vol 7 (2) ◽

pp. e001315

Author(s):

Magdalena Maria Cattaneo ◽

Emanuele Pravatà ◽

Micol Provenzi ◽

Marco Moccetti ◽

Alain Kaelin ◽

...

Keyword(s):

Mental Health ◽

Nervous System ◽

Autonomic Nervous System ◽

Takotsubo Syndrome ◽

Mental Health Score ◽

Microvascular Angina ◽

Health Score ◽

Autonomic Nervous ◽

Sf 36 ◽

Functional Organisation

Introduction and objectiveDysfunctional central autonomic nervous system network (CAN) at rest may result in aberrant autonomic responses to psychosocial stressors. We hypothesised that patients with primary microvascular angina (MVA) or Takotsubo syndrome (TTS) would exhibit a peculiar functional organisation of the CAN, potentially associated with psychological patterns.MethodsPatients underwent a psychosocial evaluation: a clinical diagnostic interview, Millon Clinical Multiaxial Inventory III, State-Trait Anxiety Inventory form Y and Short Form 36 Health Survey (SF-36). The strength of intrinsic functional connectivity (FC) between various nodes of the CAN was investigated using cerebral resting state functional MRI (RS-fMRI).ResultsWe evaluated 50 (46 women) stable patients: 16 patients with MVA, 17 patients with TTS and 17 patients with previous acute myocardial infarction (AMI). Compared with AMI, patients with MVA showed a lower (higher impairment) SF-36 Body-Pain score (p 0.046) and a higher SF-36 Mental-Health score (p 0.039). Patients with TTS showed the strongest FC between two nodes of the CAN (sympathetic midcingulate cortex and parasympathetic primary motor area) (F 6.25, p 0.005) using RS-fMRI.ConclusionsThe study implements an innovative collaborative research among cardiologists, neuroscientists and psychiatrists (‘Neuro-psycho-heart Team’). MVA showed a discrepancy between the highest level of self-reported body pain and the best mental health score, which might suggest a mechanism of somatisation. TTS exhibited an increased functional integration between two areas of the CAN involved in interoceptive pain awareness and negative emotional status. We implemented an innovative research collaboration among cardiologists, neuroscientists and psychiatrists. These data are hypothesis generating and suggest potential prospective investigations on pathophysiology and implementation of psychotherapy and stress-reducing techniques as therapeutic strategies.Trial registration numberNCT02759341.

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Effects of Meditation on Mental Health and Cardiovascular Balance in Caregivers

10.20944/preprints202012.0035.v1 ◽

2020 ◽

Author(s):

Lourdes Díaz-Rodríguez ◽

Keyla Vargas-Román ◽

Juan Carlos Sanchez-Garcia ◽

Raquel Rodríguez-Blanque ◽

Guillermo Arturo Cañadas- De la Fuente ◽

...

Keyword(s):

Mental Health ◽

Nervous System ◽

Autonomic Nervous System ◽

Repeated Measures ◽

Controlled Clinical Trial ◽

Loved One ◽

Autonomic Nervous ◽

Significant Amelioration ◽

Vagal Nerve Activity ◽

And Control

Background: Caring for a loved one can be rewarding but also associated with substantial caregiver burden, developing mental outcomes and affecting happiness. Eventually, these physical and psychological disorders can lead to an imbalance of the autonomic nervous system. Meditation has been found to offer multiple benefits to relieve these disorders and reduce the risk of cardiovascular disease. The aim of this study was to determine the effects of a four-week 16-hour presential meditation program on physiological and psychological parameters and vagal nerve activity in high-burden caregivers, comparing the results with those not receiving this program. Methods: A non-randomized repeated-measures controlled clinical trial was conducted, dividing participants between intervention and control groups by convenience allocation because random assignment was ethically inappropriate. Results: After the meditation program, the experimental group showed a significant reduction in anxiety levels (F= 24.92, p<0.001), a non-significant amelioration of depression levels (F= 1.75, p=0.19), and significantly improved heart rate variability (F= 8.40, p<0.05) and SDNN (F=15.59, p<0.05). Conclusions: Meditation can be a useful therapy to enhance the mental health and autonomic nervous system balance of informal caregivers, improving symptoms of physical and mental overload.

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Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind–Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology

Biomolecules ◽

10.3390/biom11050708 ◽

2021 ◽

Vol 11 (5) ◽

pp. 708

Author(s):

Hyun-Jeong Yang ◽

Eugene Koh ◽

Yunjeong Kang

Keyword(s):

Mental Health ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Nervous System ◽

Autonomic Nervous System ◽

Cardiovascular Health ◽

Brain Activation ◽

Poor Mental Health ◽

Cortisol Secretion ◽

Autonomic Nervous

Women have been reported to be more vulnerable to the development, prognosis and mortality of cardiovascular diseases, yet the understanding of the underlying mechanisms and strategies to overcome them are still relatively undeveloped. Studies show that women’s brains are more sensitive to factors affecting mental health such as depression and stress than men’s brains. In women, poor mental health increases the risk of cardiovascular disease, and conversely, cardiovascular disease increases the incidence of mental illness such as depression. In connection with mental health and cardiovascular health, the presence of gender differences in brain activation, cortisol secretion, autonomic nervous system, vascular health and inflammatory response has been observed. This connection suggests that strategies to manage women’s mental health can contribute to preventing cardiovascular disease. Mind–body interventions, such as meditation, yoga and qigong are forms of exercise that strive to actively manage both mind and body. They can provide beneficial effects on stress reduction and mental health. They are also seen as structurally and functionally changing the brain, as well as affecting cortisol secretion, blood pressure, heart rate variability, immune reactions and reducing menopausal symptoms, thus positively affecting women’s cardiovascular health. In this review, we investigate the link between mental health, brain activation, HPA axis, autonomic nervous system, blood pressure and immune system associated with cardiovascular health in women and discuss the effects of mind–body intervention in modulating these factors.

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Autonomic dysfunction in autism: The roles of anxiety, depression, and stress

Autism ◽

10.1177/1362361320985658 ◽

2021 ◽

pp. 136236132098565

Author(s):

Emily C Taylor ◽

Lucy A Livingston ◽

Mitchell J Callan ◽

Chris Ashwin ◽

Punit Shah

Keyword(s):

Mental Health ◽

Nervous System ◽

Autonomic Nervous System ◽

Autistic Traits ◽

Physical Symptoms ◽

Autism Spectrum ◽

Physical And Mental Health ◽

Autonomic Nervous ◽

Autistic Adults ◽

Anxiety Depression

Autism spectrum disorder (ASD) is associated with atypical autonomic nervous system (ANS) function. However, little is known about this relationship, while accounting for co-occurring mental health conditions (e.g. anxiety) that are also associated with ANS dysfunction. In addition, research on the ANS has typically involved physiological measurements, without using more clinically meaningful measures of ANS dysfunction, such as the self-reported frequency of ANS-related physical health symptoms. Furthermore, very little is known about ANS function in autistic adults, given that previous research has focused on ANS dysfunction in children with ASD. Addressing these gaps in the literature, we compared ANS function in adults with(out) ASD (Study 1). Although autistic adults reported greater ANS dysfunction than matched neurotypical controls, this difference was not significant after controlling for anxiety and depression. Similarly, in a large nonclinical sample (Study 2), we found that anxiety and stress mediated the relationship between autistic traits and ANS dysfunction. Together, we conclude that ANS dysfunction is not a feature of ASD per se, but instead attributable to the high levels of anxiety and stress in autistic adults. We discuss the clinical relevance of these findings for managing ANS dysfunction and other physical and mental health concerns in autistic adulthood. Lay abstract The autonomic nervous system (ANS) is responsible for the functioning of the heart, bladder, pupils and several other bodily functions. Therefore, when the ANS functions abnormally, individuals can experience a number of physical symptoms, including dizziness, abnormal sweating and digestive difficulties. Currently, it is unclear if autistic adults experience ANS dysfunction. Therefore, in this study, we investigated whether autistic adults report more ANS-related physical symptoms, indicating greater ANS dysfunction, and whether this may be related to autism, or rather anxiety, depression, or stress. The findings suggest that ANS dysfunction, where found in autism, is due to co-occurring stress and anxiety. We therefore propose that treating stress and anxiety may be an effective way to ameliorate ANS-related health problems in autistic adults.

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