Sustainable Reduction of Sleepiness through Salutogenic Self-Care Procedure in Lunch Breaks: A Pilot Study

The aim of the study was to elucidate the immediate, intermediate, and anticipatory sleepiness reducing effects of a salutogenic self-care procedure called progressive muscle relaxation (PMR), during lunch breaks. The second exploratory aim deals with determining the onset and long-term time course of sleepiness changes. In order to evaluate the intraday range and interday change of the proposed relaxation effects, 14 call center agents were assigned to either a daily 20-minute self-administered PMR or a small talk (ST) group during a period of seven months. Participants' levels of sleepiness were analyzed in a controlled trial using anticipatory, postlunchtime, and afternoon changes of sleepiness as indicated by continuously determined objective reaction time measures (16,464 measurements) and self-reports administered five times per day, once per month (490 measurements). Results indicate that, in comparison to ST, the PMR break (a) induces immediate, intermediate, and anticipatory reductions in sleepiness; (b) these significant effects remarkably show up after one month, and sleepiness continues to decrease for at least another five months. Although further research is required referring to the specific responsible mediating variables, our results suggest that relaxation based lunch breaks are both accepted by employees and provide a sustainable impact on sleepiness

Resilience mediates the relationship between household dysfunction in childhood and postpartum depression in adolescent mothers in Peru

National Institute of Mental HealthRevisión por pare

Capacity Building in Global Mental Health: Professional Training

We suggest that the optimal approach to building capacity in global mental health care will require partnerships between professional resources in high-income countries and promising health-related institutions in low- and middle-income countries. The result of these partnerships will be sustainable academic relationships that can educate a new generation of in-country primary care physicians and, eventually, specialized health professionals. Research capabilities will be an essential educational component to inform policy and practice, and to ensure careful outcome measurements of training and of intervention, prevention, and promotion strategies. The goal of these academic centers of excellence will be to develop quality, in-country clinical and research professionals, and to build a productive environment for these professionals to advance their careers locally. In sum, this article discusses human capacity building in global mental health, provides recommendations for training, and offers examples of recent initiatives. (Harv Rev Psychiatry 2012;20:47–57.

Development of a positive psychology intervention for patients with acute cardiovascular disease

The management of depression and other negative psychological states in cardiac patients has been a focus of multiple treatment trials, though such trials have not led to substantial improvements in cardiac outcomes. In contrast, there has been minimal focus on interventions to increase positive psychological states in cardiac patients, despite the fact that optimism and other positive states have been associated with superior cardiovascular outcomes. Our objective was to develop an 8-week, phone-based positive psychology intervention for patients hospitalized with acute cardiac disease (acute coronary syndrome or decompensated heart failure). Such an intervention would consist of positive psychology exercises adapted for this specific population, and it would need to be feasible for practitioners and patients in real-world settings. By adapting exercises that were previously validated in healthy individuals, we were able to generate a positive psychology telemedicine intervention for cardiac patients that focused on optimism, kindness, and gratitude. In addition, we successfully created a companion treatment manual for subjects to enhance the educational aspects of the intervention and facilitate completion of exercises. Finally, we successfully performed a small pilot trial of this intervention, and found that the positive psychology intervention appeared to be feasible and well-accepted in a cohort of patients with acute cardiac illness. Future studies should further develop this promising intervention and examine its impact on psychological and medical outcomes in this vulnerable population of cardiac patients

Effectiveness of the Relaxation Response-Based Group Intervention for Treating Depressed Chinese American Immigrants: A Pilot Study

Background:: This study examined the feasibility, safety and efficacy of an 8-week Relaxation Response (RR)-based group. Methods:: Twenty-two depressed Chinese American immigrants were recruited. Outcomes measures were response and remission rates, the Hamilton Rating Scale for Depression, Clinical Global Impressions Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, and the Multidimensional Scale of Perceived Social Support Scale. Results: Participants (N = 22) were 82% female, mean age was 53 (±12). After intervention, completers (N = 15) showed a 40% response rate and a 27% remission rate, and statistically significant improvement in most outcome measures. Discussion: The RR-based group is feasible and safe in treating Chinese American immigrants with depression

Chronic variable stress activates hematopoietic stem cells

Exposure to psychosocial stress is a risk factor for many diseases, including atherosclerosis1,2. While incompletely understood, interaction between the psyche and the immune system provides one potential mechanism linking stress and disease inception and progression. Known crosstalk between the brain and immune system includes the hypothalamic–pituitary–adrenal axis, which centrally drives glucocorticoid production in the adrenal cortex, and the sympathetic–adrenal–medullary axis, which controls stress–induced catecholamine release in support of the fight–or–flight reflex3,4. It remains unknown however if chronic stress changes hematopoietic stem cell activity. Here we show that stress increases proliferation of these most primitive progenitors, giving rise to higher levels of disease–promoting inflammatory leukocytes. We found that chronic stress induced monocytosis and neutrophilia in humans. While investigating the source of leukocytosis in mice, we discovered that stress activates upstream hematopoietic stem cells. Sympathetic nerve fibers release surplus noradrenaline, which uses the β3 adrenergic receptor to signal bone marrow niche cells to decrease CXCL12 levels. Consequently, elevated hematopoietic stem cell proliferation increases output of neutrophils and inflammatory monocytes. When atherosclerosis–prone ApoE−/− mice encounter chronic stress, accelerated hematopoiesis promotes plaque features associated with vulnerable lesions that cause myocardial infarction and stroke in humans

The African Global Mental Health Institute: Increasing capacity, inclusivity and translation of psychiatric research and care

The largest treatment gap for mental, neurological and substance use (MNS) disorders to date exists in Sub-Saharan Africa (e.g., South Africa, Malawi, Nigeria).  While efforts have been made to reduce the global burden of MNS disorders, there remain significant barriers to delivery of equitable mental health care in Africa and the diaspora. These barriers are deeply rooted in a lack of research structures to inform care delivery, few outlets to train in-country mental health professionals, and limited involvement of policymakers in translation of research findings. Given the demonstrated need across domains of research, education, service delivery and policy in Africa, it is in the purview of global leaders and mental health professionals to build the infrastructure necessary to make systematic, targeted strides to develop each of these areas. With this conceptual framework in mind, over fifty global leaders, psychiatrists, mental health professionals and advocates with expertise in cultural psychiatry convened at a global conference in Cape Town, South Africa in 2016 to establish the African Global Mental Health Institute (AGMHI). The AGMHI is an organizational effort that aims to reduce the global burden of mental illness through research, education and training, service delivery, and policy. Aligned with mental health initiatives posited by the World Health Organization (WHO) and the World Bank, the AGMHI represents an opportunity to explore and understand cultural nuance among populations in Africa and the diaspora. This article focuses on the AGMHI’s targeted strategies in the following actions: 1) bolstering training and education programs for clinicians and/or researchers in Africa and the diaspora to increase human capacity for mental health; 2) conducting and disseminating inclusive, culturally-relevant research (e.g., research that involves community stakeholders in its design and conduct) to meet the urgent need for a culturally-relevant evidence base;  3) identifying key stakeholders to promote sustainable mental health care and inform policy; and 4) fostering local and global collaborations (e.g., engaging local and national governments, non-governmental organizations (NGO), academic institutions, etc.) to share methods of improving access to mental health services. In concert with empirical data, these strategies were devised by members of the AGMHI, which is comprised of international leaders with decades of expertise in global psychiatry. While the MNS disorder treatment gap remains at large, the AGMHI believes these specific strategies are a step toward reducing the treatment gap and enhancing mental health care access globally