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The objective of this study is to explore how HIV care affects health-related quality of life (HRQoL) among older people in Uganda.We enrolled older-aged (≥49 years) people with HIV receiving HIV care and treatment, along with age- and sex-similar people without HIV. We measured health-related quality of life using the EQ-5D-3L scale.People with HIV (Older people with HIV receiving care and treatment reported higher health-related quality of life than people without HIV in Uganda. Access to primary care through HIV programs and/or social network mobilization may explain this difference, but further research is needed to elucidate the mechanisms.

The aim of this narrative review was to demonstrate how the notion of allostatic load (AL) relates directly to the mental health disparities observed between Indigenous and non-Indigenous Australians. We also endeavored to synthesize the results of the limited number of studies examining stress and AL in Indigenous Australians in order to explore the potential public health benefits of the AL concept. A range of literature examining health inequalities, psychosocial determinants of mental illness and AL was explored to demonstrate the applicability of stress biology to the significant mental health burden faced by Indigenous Australians. Furthermore, all original studies indexed in MEDLINE that provided quantitative data on primary stress biomarkers in Indigenous Australians were selected for review. Evidence of hypothalamic-pituitary-adrenal axis dysregulation and increased AL is apparent even in the handful of studies examining stress biomarkers in Indigenous Australians. Urinary, salivary, hair and fingernail cortisol, hair cortisone, urinary epinephrine, heart rate variability and the cortisol awakening response are all AL parameters which have been shown to be dysregulated in Indigenous Australian cohorts. Furthermore, associations between some of these biomarkers, self-perceived discrimination, exposure to stressful life events and symptoms of psychiatric disorders in Indigenous Australians have also been demonstrated. The continued assessment of AL biomarkers and their relationship with past traumas, lifetime stressors and socio-economic factors amongst Indigenous Australians is important to addressing the mental health this population. Measurement of AL biomarkers in a culturally appropriate manner may lead to more targeted preventative measures, interventions and policies, which mitigate the effects of stress at both the individual and societal level.

People differ in their ability to regulate their physiological stress response. Individual differences in emotion regulation strategies such as suppression and reappraisal may explain this differential response to stress.The aim of the current study was to assess whether daily use of suppression and reappraisal as well as their interaction predicted physiological stress reactivity and/or recovery, as assessed by variations in cortisol levels.Thirty-eight healthy young adults (13 men) completed the Emotion Regulation Questionnaire and were exposed to a psychosocial stressor, throughout which salivary cortisol was measured.Linear regressions showed main effects of reappraisal and suppression on cortisol reactivity and a main effect of suppression on cortisol recovery, where both strategies were positively associated with stress phases. Moreover, results showed a significant interaction of suppression by reappraisal in predicting both cortisol reactivity and recovery. Simple slope tests revealed that reappraisal moderated the association between suppression and both phases of cortisol responsivity.Our results suggest that reappraisal represents a protective factor against the deleterious effects of suppression on stress responsivity. This study underlines the importance of investigating emotion regulation strategies as a means to understand individual differences in vulnerability to stress-related psychopathologies such as anxiety and depression.

Early experiences with parents may be particularly difficult for lesbian, gay and bisexual (LGB) individuals who face stigma that is linked to potentially distinct stress-related biobehavioural profiles. This study examined the association between parental bonding in relation to acute stress (cortisol reactivity) and chronic stress (allostatic load) in LGB and heterosexual individuals. The sample consisted of 87 healthy adults (mean [SD] age = 24.6 [0.6] years; LGB: n = 46, 43% women; and heterosexual n = 41, 49% women). Regressions tested the main effects of retrospectively assessed parental overprotection and care before the age of 16 on stress reactive cortisol (area under the curve) and allostatic load (indexed using 21 neuroendocrine, immune, metabolic and cardiovascular biomarkers), and whether sexual orientation status moderated this association. Results revealed that parental overprotection was associated with increased cortisol reactivity only for LGB participants, but not for heterosexual participants. By contrast, parental overprotection was associated with higher allostatic load only for heterosexual participants, but not for LGB participants. While the functional significance of this requires further study, these preliminary findings suggest that adaptive processes among LGB individuals may mitigate the negative effects of parental overprotection on markers of chronic stress. published

Objective: To assess the relationship between the Screen for Cognitive Impairment in Psychiatry (SCIP) score and illness severity, subjective cognition and functioning in a cohort of major depressive disorder (MDD) patients. Methods: Patients (n = 40) diagnosed with MDD (DSM-IV-TR) completed the SCIP, a brief neuropsychological test, and a battery of self-administered questionnaires evaluating functioning (GAF, SDS, WHODAS 2.0, EDEC, PDQ-D5). Disease severity was evaluated with the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression (CGI). Results: Age and sex were associated with performance in the SCIP. The SCIP-Global index score was associated with disease severity (r = −0.316, p r = −0.368, p r = −0.388, p r = −0.335, p F[3,34] = 4.478, p = .009; SDS, F[3,34] = 3.365, p = .030; EDEC-perceived cognitive deficits, F[3,34] = 5.216, p = .005; EDEC-perceived impacts of functional impairment, F[3,34] = 5.154, p = .005). Conclusions: This study confirms that the SCIP can be used during routine clinical evaluation of MDD, and that cognitive deficits objectively assessed in the SCIP are associated with disease severity and self-reported cognitive dysfunction and impairment in daily life.

SUMMARY We describe interpretation of an AEM survey around the La Grange allocation area, WA. This survey was designed to map aquifer bounds and the sea water intrusion, and then to assess groundwater in the region, and to facilitate planning water use. The simple, stratified nature of sediments of the western onshore Canning Basin allowed us to use blocky layered earth models and we found that five-layer models were the most parsimonious. After deriving surfaces representing the top of the Jarlemai siltstone and the top of the sea water ingress, we were able to effectively characterise the spatial characteristics of the sea water intrusion. We found that in places, sea water intruded 40 km inland, and could be found at a depth of over 250 m.

This article investigates the impact of deflation on real private consumption and residential investment by Dutch households during the 1980–2013 period. We estimate theoretically founded consumption and investment equations and show that a fall in the general price level significantly negatively affects both growth in real consumption and residential investment. The impact on residential investment is more delayed, but stronger.

Lesbian, gay men, and bisexual individuals (LGBs) often experience distress related to the recognition, self-acceptance, and disclosure of their sexual orientation.Retrospectively reported coping strategies enacted during sexual identity formation among LGBs were assessed in relation to current stress indices measured using environmental (frequency of perceived daily hassles), psychological (perceived distress), and biological (allostatic load [AL] levels representing physiological dysregulations) perspectives.Forty-six healthy LGBs between the ages of 18 and 45 (M = 23.91, SE = .80) participated. Questionnaires included the Ways of Coping Checklist adapted to disclosure milestones, Daily Hassles Inventory, and Perceived Stress Scale. AL was calculated using 21 biomarkers of neuroendocrine, immune, cardiovascular, and metabolic functioning.Avoidance coping during sexual identity formation was positively associated with frequency of daily hassles (β = .598, p.001), perceived stress (β = .361, p = .015), and AL (β = .405, p = .006). By contrast, seeking social support was negatively associated with perceived stress (β = -.598, p = .048).Emotion-focused coping strategies during LGB sexual identity development are associated with current indices of biopsychosocial stress.

Nationalism in Western art music has long been a source of intense controversy. Scholars have struggled to provide an adequate definition of the phenomenon with varying degrees of success; principally because it has always been assumed that the national in music must include purely musical elements in its definition. This assumption has led to often grossly inadequate ideas about how nationalism in music is created by a composer and perceived by a listener. A brief review and reassessment of traditional attempts to define nationalism in music may shed new light on the aesthetic realties of the national in music.

Branding scholars have been deeply engaged in the identification of different interactions between brand and consumer. Additionally with the evolution of the internet, increasing research has focused on which brand relationships translate to the on-line environment. The current research advances the examination of these relationship constructs in particular brand experience, brand identification, brand community, and behavioral loyalty through the simultaneous examination of the relationships in the off and on-line channels. To add clarity, the context of the study utilizes single-brand retailers to explore relationship dynamics, providing less brand noise than a multi-brand retailer. Our results demonstrate the effect of channel as a moderator among these brand and consumer relationships providing valuable insight into brand management in multi-channel settings. Additionally the benefits from the single-brand retailer setting are highlighted.

Behaviour, including academic performance, can be influenced by implicit primes; and both objective performance and subjective ratings are susceptible to priming effects. Here, we report a new priming effect on academic self-ratings. Participants twice completed a measure of academic self-concept. In the first session, they all used circles to answer questions regarding their own perceived academic ability. In the second session, half of the participants answered with ticks (often used to indicate a correct answer in academic feedback) and the other half with crosses (often used to indicate an incorrect answer in academic feedback). Participants who used crosses had significantly lower academic self-ratings compared to the first session. No such reduction in academic self-rating was observed in participants who used ticks. Moreover, response mode only affected the academic self-concept, and self-ratings regarding physical self-concept were unaffected by response mode. None of the participants reported awareness of the response mode manipulation.

Psychological states of anticipation modulate biological stress responsivity. While researchers generally investigate how subjective distress corresponds to the magnitude of stress reactivity, physiological recovery after acute stressors must also be considered when investigating disease vulnerabilities. This study assessed whether anticipatory stress would correspond to stress reactivity and recovery of salivary cortisol and blood pressure levels in response to a well-validated psychosocial stressor. Thirty participants (63% female; mean ± SEM age 45.4 ± 2.12 years) were exposed to the Trier Social Stress Test (TSST) consisting of a public speech and mental arithmetic. Ten salivary cortisol samples and systolic and diastolic blood pressure recordings were collected at time points spanning 50 min before and up to 50 min after stress exposure. These data were transformed into parameters representing stress reactivity (area under the curve) and stress recovery (percent change). The Primary Appraisal Secondary Appraisal scale assessed anticipatory stress before exposure to the TSST. Our results revealed that increased anticipatory stress predicted increased stress reactivity for cortisol (p = 0.009) but not blood pressure. For stress recovery, increased anticipatory stress predicted greater decrements of cortisol concentration (p = 0.015) and blood pressure (p = 0.039), even when controlling for total systemic "output" by incorporating baseline activity. This efficient shutdown of stress responses would have otherwise been ignored by solely investigating reactive increases. These findings underscore the importance of measuring multiple dynamic parameters such as recovery when investigating physiological stress response patterns as a function of psychosocial factors.

This study tested the effectiveness of a culturally adapted Chinese Basic Conversation Skill Module (CBCSM) for Hong Kong Chinese with schizophrenia. A total of 106 participants with schizophrenia who had mild to moderate levels of symptoms and dysfunction were recruited between January 2004 and September 2005. After random allocation, 35 participants were assigned to the CBCSM group with skill generalization training (SGT), 35 participants were assigned to the CBCSM group without SGT, and 36 participants were assigned to the placebo group. All participants were assessed by a blind rater at baseline, 5 weeks after commencement of skills training, and 3 and 6 months after completion of skills training on conversation skill mastery, subjective personal well being, and self esteem. After 15 sessions of intervention, the CBCSM group with SGT and the CBCSM group outperformed the placebo group in social skills. At the 6-month follow-up, social skill of CBCSM group with SGT was better than the CBCSM group and the placebo group. CBCSM with SGT was found to be effective in improving conversation skill of people with schizophrenia in Hong Kong. This combined strategy was also shown to be better than mere application of CBCSM in helping conversation skill mastery.

This article investigates whether there has been a structural increase in financial market integration in nine European countries and the US in the period 1980 to 2003. We employ a GARCH model with a smoothly time-varying correlation to estimate the date of change and the speed of the transition between the low and high correlation regimes. Our test produces strong evidence of greater comovement across the board for both stock markets and government bond markets. Dates of change and speeds of adjustment vary widely across country linkages. Stock market integration is a more gradual process than bond market integration. The impact of European monetary union (EMU) is rather limited, as it has mainly affected the timing of bond market correlation gains (but hardly their size) and has had little discernible effect on stock market integration.

The author discusses the history of organized psychiatry from 1973 to 1986 and details the process that lead to the removal of the diagnosis of “ego-dystonic homosexuality” from the psychiatric diagnostic manual.

Recent studies with intravenous infusion of the NMDA receptor antagonist ketamine showed robust and rapid antidepressant effects within hours after treatment. Ketamine is a racemic mixture consisting of two enantiomers, R- and S-ketamine. In contrast to ketamine, S-ketamine is reported to be less prone to psychomimetic side effects, such as derealisation and hallucinations. In this report we describe the effect of ketamine and S-ketamine infusion therapy, respectively, in two patients with treatment-resistant major depression. Severity of depression was rated using the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI). While one patient did not respond to either treatment, in the other patient intravenous administration of ketamine as well as S-ketamine showed an antidepressant effect as assessed by a decrease in HAMD-21 and BDI at days 1 and 3 after infusion which faded until day 6. Both patients experienced psychomimetic side effects during ketamine infusion which were absent during treatment with S-ketamine. We conclude that S-ketamine might exert similar antidepressant effects as ketamine in drug-resistant depression but may be better tolerated by the patients.

The relationship between monetary indicators and inflation is ussually assumed to be linear, implying that looser monetary conditions always signal an increase in inflation. Recently, money growth in the euro area surged while inflation remained comparatively subdued. This seems at variance with linearity. At the same time, stock market uncertainty peaked, suggesting that part of the money growth resulted from portfolio adjustment and was hence non-inflationary. We employ a threshold regression model to verify the claim that the impact of monetary indicators on future inflation varies conditional on stock price volatility. We show that there is limited evidence to support this claim. On the other hand, our results indicate that stock market data may contain useful information regarding future inflation.

Effective population-based and patient-centered public health care is highly dependent on timely and reliable health-related information. The continuous growth and availability of health-related information brought about by the emergence of a new digital communications environment offers a range of opportunities that facilitate access to useful health information for the public health sector–for providers as well as patients. Such advancements, however, can only be realized if public health professionals are knowledgeable about existing sources of online health information, have the ability to successfully judge the reliability of online health information, and are able to acquire the information in a timely and efficient manner. This research follows on the heels of a survey of public health professionals in New York State that concluded that limited access and knowledge negatively impacted utilization of interactive health communication technologies. In this study, a survey was administered to ...

Behavioural scientists show altruism to exist as a distinctive personality. Yet when subjected to philosophical scrutiny, and altruistic personality is prima facie paradoxical. To motivate herself to help others, the altruist needs ‘extensivity’, the capacity to compassionately identify with others. To aid others effectively, however, the altruist must have individuation, the possession of highly developed autonomy and self-efficacy. We assert that a better understanding of the relationship between concern for others and concern for self reveals the paradox to be merely apparent. We find that, in extending themselves in caring behaviours, altruists actually enhance their individuality. Moreover, given the differences between compassion and empathy and the way empathy medicates between compassionate co-feeling and individuation, extensivity and individuation do not necessarily conflict. We conclude therefore that despite appearances the altruistic personality is a coherent construct.

While much professional interest, public advocacy and media attention accompanied the neuroscientific research advances of the Decade of the Brain, much less prominence was accorded to the very considerable progress in psychiatric treatment, rehabilitation and community-based services for persons with schizophrenia. The increasing availability of evidence-based practices and more optimistic views of optimal outcomes possible in schizophrenia are of much practical importance to consumers and practitioners alike. Expectations for substantial improvements in a larger proportion of individuals with schizophrenia than heretofore are emerging on psychiatry's radar screen, especially in symptom control, psychosocial functioning and quality of life. We believe that it is now realistic to set as a goal for professionals and consumers the feasibility of recovery from schizophrenia for half or more of individuals with the first episode of schizophrenia. In this issue of the International Review of Psychiatry, we aim...

Schizophrenia is often conceptualized by clinicians and researchers alike as a chronic illness with persisting, relapsing or deteriorating symptoms, and no hope for sustained remission and recovery of functioning. Countering this perspective, retrospective and prospective studies with both chronic and recent onset patients suggest that schizophrenia has a heterogeneous course, which can be favorably influenced by comprehensive and continuous treatment as well as personal factors such as family support and good neurocognitive functioning. The factors influencing recovery are mostly malleable through treatment and may often lead to a sustained remission of symptoms and normal or near-normal levels of functioning.To facilitate future research in this area, an operational definition of recovery from schizophrenia is proposed that includes symptom remission; full- or part-time involvement in work or school; independent living without supervision by family or surrogate caregivers; not fully dependent on financi...

To promote recovery in larger numbers of persons with schizophrenia, considerable research will be required in generating and validating a variety of operational definitions of the construct of 'recovery'. Definitions will vary both in terms of the inclusiveness of their dimensions and their use of dimensional or categorical criteria.When categorical criteria are used, differences in quantitative thresholds for meeting the criteria for recovery will require long-term follow-up studies to choose from. A multi-modal approach to validation of criteria for recovery will likely be most desirable.There will be the need for research and development on instruments for measuring psychosocial functioning, including surveys and focus groups that can clarify the range of normative behavior in the general population using these instruments and their psychometric properties. Studies for identifying those who recover from schizophrenia will need to be longitudinal and prospective, including controlled clinical trials, e...

Several advanced nuclear plant concepts are characterized by the use of innovative cooling systems that remove the heat released inside the containment following a hypothetical accident, such as a loss-of-coolant accident, through passive heat transfer mechanisms. The design and installation of a localized passive containment cooling system (PCCS) inside a double-wall concrete containment requires the reliable knowledge of temporal and spatial distribution of noncondensable gas concentration, especially hydrogen, in a multicompartment geometry. Testing was conducted in the Large-Scale Containment Test Facility located at the Westinghouse Science and Technology Center in Pittsburgh, and the testing was modified to simulate in approximately one-tenth scale the main features of a concrete containment, designed by the Italian National Electric Utility (ENEL), in which the heat is removed through internal heat exchangers (HX) located in the dome region, and connected by an intermediate fluid loop to external HXs placed outside the double barrier concrete containment. No active component like pumps or human intervention are required for the operation of the system. The facility instrumentation, the test program, and the experimental results are described along with the first results obtained in the application of the FUMO code to the analysis of these experimental tests. The experimental more » data measured during the tests include temperature distributions inside the containment, helium concentrations at four internal locations, and laser Doppler anemometer measures to determine the atmosphere mixing under different simulated accident conditions. The experimental results indicate that helium, which simulates the hydrogen that may be released during some accident sequences, is distributed rather homogeneously inside the facility. The very good mixing exhibited by the helium indicates that the localized PCCS induces efficient convective motions inside the containment atmosphere, and this is a positive indication for safety analysis. « less

Gay men and lesbians reportedly use and abuse alcohol and substances at rates higher than the general population. This higher rate has been questioned, but, whether gay men and lesbians have more use and abuse or not, unique clinical considerations are involved in addiction treatment for gay men and lesbians. The psychodynamic factors that contribute to the creation and powerful influence of internalized homophobia for gay men and lesbians can explain the predisposition to substance use and abuse. Parents may not be able to acknowledge or reward the differences that may be apparent in the pre-homosexual child. The child will learn to hide or dissociate from those differences. In addition, the psychology of difference, that is, learning how to live with and accept things about one's self that are different from the majority, will contribute to further denial and dissociation from true feelings and needs. Substance use allows the expression of suppressed and repressed desires and needs and facilita...

Programs that view individuals with schizophrenia as capable of taking a more active role in managing their illness have gained importance in the United States and Europe. The Medication and Symptom Management Modules, developed by the UCLA Center for Research on Treatment and Rehabilitation of Psychosis, have demonstrated feasibility and efficacy in equipping people who have schizophrenia with disease management skills. These programs, integrating psychoeducational treatment and social skills training methods, were implemented in a German version at ten treatment sites in Germany and Switzerland and field-tested by a multicenter working group. Both modules showed excellent feasibility, were integrated into most of the treatment settings, and have influenced the implementation and development of psychoeducational illness management programs throughout Europe. A coping-oriented treatment, including some elements of these modules as well as stress management, was implemented at treatment sites in G...

A cluster analysis of the Life Assessment Scale for Mental Illness revealed 11 categories, including social adaptation, personal hygiene, basic conversation skills, using social resources, and coping with changes at work. Nine of these 11 clusters or categories differentiated persons with schizophrenia who were institutionalized from those who were participating in community-based rehabilitation or work activities, thereby providing discriminative validity to the Scale. In addition, gender was a discriminating factor for 3 of the clusters. Shorter lengths of hospitalization were positively related to levels of social adjustment.

Functional assessment of persons with psychiatric disabilities requires reliable and valid instruments that can be used by clinicians for planning psychosocial rehabilitation services. Two such instruments, the Independent Living Skills Inventory and the Independent Living Skills Survey are operationalized and behaviorally specific tools that can be administered as questionnaires or interviews. Both instruments have well-documented reliability and validity and are ‘user-friendly.”

The reader is encouraged to try to solve the problem now, before proceeding. In our solution to this problem we realized that A1 A2 A3A4 need not be a square. This observation led to the study of families of rectangles that satisfy hypotheses like those of Problem 749, and ultimately to this paper. A quick solution to Problem 749 is provided by Theorem 1, which is a special case of Feuerbach's Relation (see [4] or [6]).

A three-stage 'problem-oriented' approach to cultural adaptation of the Basic Conversation Skills Module (BCSM) was applied with patients having schizophrenic or affective disorders in Bulgaria. The adaptation proceeded through: (1) identification of possible problems in the initial process of training; (2) a social validation stage for statistical verification of these problems in a broader social context; and (3) refining the components of the training process and testing the revised version of the BCSM with a second group of patients. The study revealed the cultural specificity of two conversational behaviors: 'opening lines' for starting a conversation and 'making self-disclosure'. The utility of the adapted BCSM in Bulgaria was highlighted. The proposed procedure seems suitable for adaptation of similar psychosocial rehabilitation programs from one culture to another.

Change and growth are essential parts of human development. Sometimes help is needed for change necessitating psychotherapeutic interventions. The desire for some specific changes, however, may be based on misunderstanding, fear, or prejudice. The therapist must take a clear and objective view, understand what motivates the change, and not promise the impossible. Gay men and lesbians, or people who are begining to become aware fo a homosexual orientation, may wish to try and change that orientation based on a combination of internalized and external homophobia. This combination lead to the higher exxpression of the illness of substance abuse among gays and lesbians. The gay and lesbian substance abuser who has not been able to accept and integrate his or her sexual orientation may well seek the help of psychotherapy to change orientation, hoping to somehow get life back on track. Denial of sexual orientation, however, usually extends to denial around issues of substance use and abuse. Before any real move...

Seikatsu Rinsho is a Japanese theory about the aberrant patterns of social life exhibited by persons with severe mental illness. This theory serves as the foundation of psychosocial rehabilitation in Japan. The manner in which two rehabilitation programs implement Seikatsu Rinsho is reviewed in this paper. Japanese paradigms of rehabilitation are compared to models of intervention popular in the West. Strategies for measuring its effects are also discussed.

This study assesses whether the degree of exchange rate pass-through in the Netherlands has changed during the run-up to Economic and Monetary Union. VAR models are estimated on rolling sample periods to show that the pass-through of changes in the guilder-mark exchange rate has increased, while the pass-through of changes in the guilder-pound and guilder-dollar have remained more or less stable. This supports the view that the Netherlands and Germany have become increasingly integrated. This is in contrast to Taylor's (Economic Review 44, 1384–408, 2000) claim that the decline in inflation has been associated with a significant decline in the degree to which firms pass-through changes in costs.

The relationship of Expressed Emotion (EE) and schizophrenic relapse has been studied repeatedly in homes where schizophrenic persons live with family members, but rarely studied in residential-care settings where they live with nonfamilial caregivers. Actually, all caregivers who live and interact with mentally ill people might be expected to exhibit attitudes classifiable by EE criteria; yet, despite the prominent role of special residences in the care of schizophrenic persons [1], few investigators have focused on EE attitudes of nonfamilial caregivers. Three studies have investigated EE in nonfamilial environments. Herzog [2] reported that 65% of staff on a psychiatric ward had highEE attitudes toward one or more patients. The attitudes varied with patient diagnosis and behavioral agitation. Heinssen and colleagues found that 22% of patients on an inpatient unit - primarily those rated as hostile, uncooperative, or impulsive - were discussed by staff in

Rationale/statement of the problem : High blood glucose levels increase individuals’ susceptibility to age-related diseases and mortality. However, the molecular mechanisms by which hyperglycemia impairs cellular function is unclear. Emerging research suggests that mitochondrial dysfunction may be a potential allostatic mechanism that mediates the deleterious effects of hyperglycemia via dynamic pathways. Mitochondria are ubiquitous organelles that are the primary producer of cellular energy and, therefore, central to health and disease. In addition, mitochondria contain their own genetic material – the mitochondrial DNA (mtDNA). Importantly, mutations in mtDNA cause human neurological diseases, and hyperglycemia can impair mitochondrial DNA and function. Here, we hypothesized that in patients with inherited mtDNA mutations, those with poor glucose homeostasis or with diabetes would present with more severe neurological symptoms than those with normal glucose balance. Methods : A literature review and retrospective study of 86 patients with the mtDNA 3243A > G mutation was conducted. We assessed glucose homeostasis and neurological symptoms using the Newcastle Mitochondrial Disease Assessment Scale (NMDAS), and Chi-squared statistics were used to compare the incidence of neurological symptoms in patients with or without glucose intolerance. Results : In patients with pre-existing mitochondrial disease, the incidence of neurological symptoms, including cerebellar ataxia (OR: 9.52; 95% CI: 2.03-44.52) and peripheral neuropathy (OR: 3.91; 95% CI: 1.43-10.76) were greater in those with glucose intolerance than in those with no diagnosed glucose intolerance. In addition, a dose–response relationship linked the severity of glucose intolerance and incidence of cerebellar ataxia. Conclusions : These preliminary results suggest that mtDNA mutations may render brain tissue more susceptible to glucose toxicity. Given that the accumulation of mtDNA damage occurs with senescence, our findings may have implications for resilience in the elderly. In addition to metabolic stress (i.e., hyperglycemia), mitochondrial functions are modulated by mediators of stress (i.e., cortisol), suggesting that integration of psychoneuroendocrine mediators can occur within mitochondria, thus contributing to the “wear and tear” of allostatic load. In this presentation, we introduce mitochondrial allostatic load (MAL) as a biological mechanism that might contribute to explain how metabolic and psychosocial stresses synergistically influence health and disease susceptibility.

Schizophrenia is a disease characterized by cognitive, psychophysiological, and interpersonal deficits that result in a marked vulnerability to stress (Dawson and Neuchterlein 1984; Nuechterlein 1977; Strauss et al. 1987). Episodes of illness occur in vulnerable individuals who experience stressful life events (G. W. Brown and Rutter 1966; Lukoff et al. 1984) or stressful interactions with family members (G. W. Brown et al. 1972; Imber Mintz et al. 1987; Leff and Vaughn 1985). Similarly, overstimulating therapeutic environments have been shown to exacerbate psychosis (Drake and Sederer 1986; Liberman 1982; Linn et al. 1980; Van Putten 1976). A full understanding of disease-specific deficits resulting from stress and vulnerability is necessary for developing psychosocial treatment programs that augment pharmacotherapies in significantly ameliorating the symptoms and disabilities of schizophrenia.