Providentia

Does Progesterone Relieve Stress?

Animal studies have suggested that neuroactive steroids, in particular progesterone and its metabolites, have stress-dampening effects. However, few studies have explored these effects in humans. In a study published in a recent issue of Experimental and Clinical Psychopharmacology, researchers investigated the effects of acute progesterone administration on responses to the Trier Social Stress Test (TSST) to induce stress under laboratory conditions . Healthy men participated in the TSST 3.5 hrs after intramuscular injection of 0, 50, or 100 mg progesterone (sample sizes of 16, 14, and 14 respectively). Cardiovascular heart rate, blood pressure , hormonal plasma adrenocorticotrophic hormone, cortisol, and noradrenaline , and subjective e.g., anxiety, arousal responses to stress in the three groups were also measured. Before the TSST, progesterone injections increased plasma levels without altering physiological or subjective states. Stress produced its expected physiological and subjective effects among placebo-treated individuals. Progesterone 50 mg attenuated peak increases in plasma cortisol and reduced changes in negative mood and ALERTness after stress, yet it increased plasma noradrenaline and systolic blood pressure. Progesterone 100 mg also attenuated stress-induced increases in ALERTness and arousal, yet it potentiated stress-induced increases in diastolic pressure. Thus, progesterone dampened some of the psychological effects of stress but produced inconsistent effects on physiological stress responses.  The researchers discuss the results in terms of the paradoxical nature of progesterone and related substances.  Whether progesterone can restore homeostasis after a stressful event is something that requires further research with larger samples.

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Barking Woman Declared Unfit for Trial

A 43-year old Suffolk, Virginia woman has been declared unfit for trial following a bizarre assault .  Lillian Beasley was charged following an incident in March when Beasly had apparently gotten into a physical confrontation with the woman she had attacked.  According to the police report, Beasley had been on the property earlier and told to leave.  After returning she became verbally abusive and, when the victim put up her hands defensively, Beasley bit one of her fingers and almost tore it off her hand.  Police found Beasley throwing herself into the mud and barking in the victim's front yard and charged her with malicious wounding and trespassing. 

At her appearance in General District Court, the forensic psychiatrist testified that Beasley was unable to assist in mounting a defense.  The case will be re-evaluated in November.

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Why Adolescents Drink

Prevention programs in adolescence are particularly effective if they target homogeneous risk groups of adolescents who share a combination of particular needs and problems. Existing programs tend to focus on adolescents who engage in chronic binge drinking.  These adolescents are often defined as  risky single-occasion drinking (RSOD) adolescents (i.e., five drinks or more at a single occasion) which has typically been associated with low life satisfaction, depression, poor academic performance, and sexually inappropriate behaviour.  A recent study published in the European Journal of Psychological Assessment takes this further by examining RSOD adolescents according to their motivation to engage in drinking. An easy-to-use coding procedure was developed and validated using cluster analyses and structural equation modeling based on two randomly selected subsamples of a nationally representative sample of 2,449 12- to 18-year-old RSOD students in Switzerland. Results revealed that the coding procedure classified RSOD adolescents as either enhancement drinkers (drinking for enjoyment) or coping drinkers (drinking to deal with personal problems). The high concordance  with the results of the cluster analyses demonstrated the convergent validity of the coding classification. The fact that enhancement drinkers in both subsamples were found to go out more frequently in the evenings and to have more satisfactory social relationships, as well as a higher proportion of drinking peers and a lower likelihood to drink at home than coping drinkers demonstrates the concurrent validity of the classification. To conclude, the coding procedure appears to be a valid, reliable, and easy-to-use tool that can help better adapt prevention activities to adolescent risky drinking motives.  The research results are discussed in terms of developing better prevention programs by focusing on specific motivations for drinking in adolescents.

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Near-fatal Condition Linked to Serotonin Syndrome

In 1993, Lindy Andrews was first diagnosed with depression and posttraumatic stress disorder.  After being prescribed various medications for depression, the now-55 year old New Zealand woman developed increasingly bizarre symptoms including speech difficulties, tendon problems, and tremors.  Working at a Tauranga radio station, she was forced to quit her job out of embarrassment over her impaired speech and her condition worsened.  By 2007, she was completely disabled and using crutches to walk.  Although her medications were changed repeatedly, it was only in November of last year when psychiatrist Brian Abbott identified her symptoms as serotonin syndrome and took her off all psychiatric medications.  Symptoms of serotonin syndrome can include changes in mental status, autonomic functioning, and neuromuscular activation.  Despite at least one known fatality in 1984, most cases are relatively mild and can be treated with withdrawal from serotonin-enhancing medication and supportive care.   While the actual incidence remains unclear (many cases are undiagnosed), many family doctors who prescribe medications that increase blood serotonin levels (such as anti-depressants) remain unaware of the potentially fatal drug reaction.  

In Lindy Andrews' case, her condition has been worsened by the length of time that she remained on medication.  Although she still requires crutches following surgery to repair tendon problems, she is slowly returning to normal but feels that she was "robbed" of seventeen years of her life.  Now crusading for better patient rights to information on possible life-threatening problems associated with prescribed medication, Andrews is hoping that publicizing her case will boost patient awareness.  She states, "I want something positive to come out of this. I can't have my life back but I can have something else.".  After the serotonin syndrome was diagnosed, Andrews contacted Pfizer-Wyeth, the company which produced one of the medications she had taken  in her search for compensation.  Following a lengthy correspondence, the company replied that they were not liable since it was the responsibility of the physician to discuss potential risks with the patient.  Her case is continuing.

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The Cost of Pain

A two-year study by researchers at the Centre for Pain Research at the National University of Ireland in Galway has concluded that the health costs for chronic pain patients (duration of pain longer than three months) averages 6000 to 10000 euros each year in terms of loss of earnings, hospital bills, and additional support costs.  More than one chronic pain patient in ten (21.5%) had been in pain for more than ten years with likelihood of chronic pain increasing with age.  Back pain was most common in younger age groups while knee pain was more common in patients over 65.  Although chronic pain problems can be linked to accidents or illnesses, 43% of the pain sample reported no discernible cause.  The study also found that chronic pain sufferers were five times more likely than the general population to experience depression.

In presenting the study results, psychologist Brian McGuire reported that there was a severe shortage of pain specialists and multidisciplinary pain programs in the U.K. People with severe pain often require hospital stays, outpatient services, and specialized treatment services which, combined with loss of earning potential, aggravates their financial difficulties.  Support groups for chronic pain patients are urging better services to treat and manage chronic pain.

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Dutch Police Arrest Suspect After Memorial Service Stampede

Dutch prosecutors have announced that a 39-year old man is being held for a psychiatric assessment following an incident at a war memorial service in central Amsterdam.  The service, with Queen Beatrix and other royal family members in attendance, was disrupted when the suspect began yelling during a moment of silence.  Dressed an an orthodox Jew and carrying a suitcase, the suspect was believed by some bystanders to be carrying a bomb which led to panic.  The resulting stampede led to 63 people being injured.  After the suspect was taken into custody, the Queen and royal family members returned to the scene and the ceremony was completed.  The incident came one year after an assassination attempt on the Queen's life.

The suspect is reported to have a history of drug and violence-related convictions.  He has been charged with disrupting the public peace and causing bodily harm.

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Does Physical Activity Prevent Decline?

A study published in the March 2010 issue of GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry examines the association between physical activity and cognitive performance in a longitudinal study. Researchers examined data from 17,333 noninstitutionalized persons aged 50 years or older in 11 European countries who participated in Wave 1 (2004/2005) and Wave 2 (2006/2007) of the Survey of Health, Ageing, and Retirement in Europe (SHARE).  Physical activity at baseline was measured as self-reported frequency of sports or activities requiring vigorous activity, and frequency of activities demanding a moderate level of activity. Cognitive function was measured at baseline and after a mean of 2.5 years of follow-up by delayed word recall and verbal fluency tests. The effects of physical activity at baseline on cognitive performance at follow-up were statistically adjusted for sociodemographic variables (age, education), comorbid medical factors, functional impairment (basic and instrumental activities of daily living, maximum grip strength), depressive symptoms, and body mass index. The results showed that, after adjusting for potential confounders, physical inactivity (neither moderate nor vigorous) was found to be associated with a higher rate of cognitive decline over a mean follow-up of 2.5 years (ß = –1.79 (SE = 0.17) for verbal fluency; ß = –0.35 (SE = 0.04) for delayed word recall). Further analyses showed that vigorous activities more than once a week were especially related to change in cognition over time. The authors concluded that engagement in moderate and vigorous physical activities protects against cognitive decline in older age. Participation in physical activities may be of particular importance when other risk factors for cognitive decline are present.

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Investigation Continuing into Calgary Infanticide Case

Investigation into the death of a 27-year old Calgary woman last fall took a bizarre turn when police discovered the remains of three newborn infants in her basement apartment.  Harsimrat Kahlon (known as "Simmi" to her friends) worked as an assistant to a Calgary law firm and was in a common-law relationship with a long-distance trucker who was frequently away from home.  After her husband, Harnek Mahal, came home to find his wife dead in the bedroom of the neat, basement suite they had shared for three years.  After an autopsy determined the cause of death to be complications resulting from childbirth, her husband discovered the body of one of the infants in the apartment.  Police later found two more bodies and announced that all three had been born at different times in separate pregnancies (one boy and two girls).  Although it has yet to be determined whether all three infants were Kahlon's, evidence points to infanticide. 

Her husband has denied knowing that Kahlon had ever been pregnant and she had apparently gone to extreme lengths to conceal the pregnancies and subsequent deaths.  Only one infant had been born in a hospital in 2005 although it has not been verified whether that newborn is one of the bodies found.  All three bodies had been kept in airtight containers inside suitcases in one of the apartment closets.  The hermetically sealed containers had apparently limited the decay of the bodies and contained any resulting odours. 

A psychological autopsy has been undertaken by consulting psychiatrist, Dr. Thomas Dalby.  In reviewing Kahlon's diary and other available documentation, Dr. Dalby reported that the deceased had been experiencing long-term depression and borderline personality disorder.  He added that, "She didn't address the babies, and therefore there was no remorse, but it was clear that she was significantly depressed at times, looked at herself as worthless and had lost her will for life".  He also stated that Kahlon's apparently insisted on keeping the bodies near to her despite opportunities to dispose of them to prevent discovery. 

While infanticide by mothers has been linked to possible post-partum psychosis, Simmi Kahlon's motive in these deaths will likely never be known for certain.  The case is ongoing.

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