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Sleep and armed conflict: future complications of war in Ukraine

Authors:
Anastasiia Shkodina at Poltava State Medical University
Anastasiia Shkodina
  • Poltava State Medical University
Anastasiia I. Zhyvotovska
Anastasiia I. Zhyvotovska
Anastasiia I. Zhyvotovska
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Dmytro Boiko at Poltava State Medical University
Dmytro Boiko
  • Poltava State Medical University
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Editorial
Sleep
and
armed
conflict:
future
complications
of
war
in
Ukraine
For
more
than
five
months
now,
Russian
troops
have
been
destroying
cities
in
Ukraine.
A
large
part
of
Ukraine
is
under
attack
24
hours
a
day
by
missiles,
artillery
and
aircraft,
and
in
some
places,
there
are
street
battles.
This
war
can
affect
the
psychological
state
of
all
people,
both
military
and
civilian
persons
who
are
in
Ukraine,
as
well
as
citizens
outside
of
Ukraine
because
physical
and
moral
exhaustion
has
become
an
urgent
problem
for
people.
A
human
reaction
to
a
stressful
event
depends
significantly
on
the
functioning
of
the
circadian
system,
which
prevents
the
fundamental
foundations
of
the
body’s
adaptation
to
envi-
ronmental
changes.
At
the
same
time,
the
stress
response
system
itself
has
a
basic
circadian
activity.
Over
the
past
two
years,
the
demands
of
social
isolation
associated
with
the
COVID-19
pandemic
have
created
a
new
way
of
life
for
people
on
the
Earth
that
exacerbates
the
misalignment
between
internal
and
social
circadian
cycles
and
can
lead
to
desyn-
chronization
with
higher
sensitivity
to
stress
and
vulnerability
to
stress-related
disorders
[1].
The
problem
of
sleep
during
the
war
is
rarely
addressed
in
modern
research
because
it
is
falsely
considered
to
be
of
insufficient
importance.
At
the
same
time,
the
war
in
Ukraine
demonstrates
the
importance
of
this
topic
and
the
need
for
thorough
research
in
this
field.
In
particular,
not
only
changes
in
the
quality
and
architecture
of
sleep
among
veterans,
but
also
in
the
civilian
population,
are
an
urgent
issue.
It
is
a
well-known
fact
that
war
causes
stress-related
mental
disorders,
including
post-traumatic
stress
disorder
and
adjustment
disorders,
which
may
be
associated
with
sleep
disturbances.
However,
it
is
worth
taking
into
account
that
poor
sleep
quality
can
act
as
an
additional
stress
factor
and
can
play
a
role
in
the
progression
of
neurological
diseases.
An
affected
population
is
a
heterogeneous
group
with
different
backgrounds,
medical
histories,
experiences,
and
coping
strategies.
However,
the
armed
conflict
determines
three
cohorts
for
research
on
sleep
disturbances
related
to
the
war,
such
as
veterans,
refugees,
and
civilians.
The
most
studied
cohort
of
victims
of
military
conflicts
is
veterans
and
combatants.
Being
under
constant
shelling
from
the
enemy,
traumatic
damage
to
the
nervous
system,
long-
term
stress,
and
field
living
conditions
lead
to
the
develop-
ment
of
sleep
disorders,
which
are
considered
a
link
between
post-traumatic
stress
disorder
and
combat
exposure
[2].
It
has
been
found
short
sleep
duration,
poor
sleep
efficiency,
long
sleep
onset
latency,
poor
sleep
quality,
higher
frequency
of
insomnia
symptoms,
and
nightmares
are
significantly
above
in
Iraq/Afghanistan
veterans
than
in
the
general
population.
The
poorer
sleep
quality
in
this
population
was
also
associated
with
more
severe
psychiatric
disorders
[3].
At
the
same
time,
the
study
of
Gulf
War
veterans
has
demonstrated
the
association
between
lower
subjective
sleep
quality
with
reduced
total
cortical
and
regional
frontal
lobe
volume
independent
of
psychiatric
comorbidity
[4].
Refugees’
sleep
can
be
disrupted
eiither
as
a
consequence
of
integration
in
the
host
country,
including
lifestyle
changes
such
as
diet
and
working
hours,
or
due
to
mental
health
disorders
associated
with
war.
It
has
been
shown
that
in
refugees,
unlike
migrants,
sleep
disturbances
are
more
correlated
with
psychiatric
symptoms
than
psychosocial
problems
[5].
A
study
of
internally
displaced
persons
after
the
Russian
invasion
of
Crimea
and
east
of
Ukraine
in
2014
shows
the
dominance
of
the
structure
of
anxiety
symptoms
and
depressive
symptoms
against
the
background
of
adjust-
ment
disorders
[6].
However,
the
research
on
the
neurological
consequences
of
disturbed
sleep
in
refugees
from
war-torn
regions
is
currently
insufficient.
The
consequences
of
war
for
the
civilian
population
in
the
armed
conflict
remain
the
least
studied.
Every
day,
civilian
Ukrainians
are
exposed
to
the
fear
of
danger,
which
threatens
their
lives,
and
numerous
air
warning
signals,
the
number
of
which
can
reach
30
per
day.
It
is
clear
that
in
such
conditions
the
quality
of
sleep
and
circadian
rhythmicity
cannot
remain
at
a
satisfactory
level,
which
in
turn
directly
affects
the
state
of
the
entire
body.
Sleep
and
circadian
rhythm
disorders
have
a
significant
impact
on
the
nervous
system.
Our
body
adapts
to
the
rhythmic
fluctuations
of
the
environment
and
foresees
periods
of
sleep
and
activity,
which
is
unfortunately
difficult
or
even
impossible
in
the
conditions
of
war.
Thus,
in
the
state
of
an
armed
conflict,
people
may
be
subject
to
loss
of
sleep,
deterioration
of
its
quality,
frequent
awakenings,
and
irregu-
r
e
v
u
e
n
e
u
r
o
l
o
g
i
q
u
e
x
x
x
(
2
0
2
0
)
x
x
x
–
x
x
x
NEUROL-2680;
No.
of
Pages
3
Please
cite
this
article
in
press
as:
Shkodina
AD,
et
al.
Sleep
and
armed
conflict:
future
complications
of
war
in
Ukraine.
Revue
neurologique
(2022),
https://doi.org/10.1016/j.neurol.2022.09.002
Available
online
at
ScienceDirect
www.sciencedirect.com
larity
of
the
circadian
rhythm.
Experimental
studies
have
indicated
that
sleep
loss
can
increase
inflammatory
markers
and
affect
metabolic
processes
that
play
an
important
role
in
the
development
of
many
diseases
of
the
nervous
system
[7].
The
disruption
of
circadian
regulation
caused
by
the
war
in
Ukraine
may
increase
the
number
of
paroxysmal
conditions
among
the
population.
It
is
well
known
that
sleep
deprivation
can
trigger
epileptic
seizures,
and
epilepsy
has
a
bidirectional
relationship
with
sleep
phases
and
patterns
[8].
Equally
important
is
evidence
of
a
close
relationship
between
sleep
disorders
and
headaches,
such
as
migraine,
tension-type
headache,
cluster
headache,
and
hypnic
headache
[9,10].
The
key
role
of
sleep
in
the
immunological
regulation
of
the
nervous
system
is
well
reflected
in
1
case-control
study,
which
demonstrates
that
sleep
disturbance
might
be
a
trigger
for
an
acute
MS
exacerbation
[11].
On
the
other
hand,
the
suppres-
sion
of
neurogenesis
and
the
strengthening
of
the
develop-
ment
of
neurodegenerative
diseases
as
a
result
of
chronic
sleep
restriction,
which
causes
circadian
and
neuronal
disorders,
are
emphasized
[12,13].
Sleep
is
often
seen
as
a
necessary
component
of
the
memory
consolidation
process.
Appropriate
integration
of
information
received
during
the
day
occurs
during
the
phase
of
slow
sleep,
the
deficit
of
which
can
be
observed
with
frequent
awakenings
[14].
Therefore,
we
can
assume
an
increase
in
the
frequency
of
cognitive
disorders
against
the
background
of
military
conflict.
And
the
most
obvious,
but
nevertheless
significant
conse-
quence
of
sleep
disorders
occured
against
the
war
in
Ukraine
can
be
an
imbalance
of
neurotransmitters,
which
can
lead
to
the
development
or
increase
in
the
severity
of
affective
disorders,
for
example
depression
[15].
Based
on
preliminary
evidence,
we
can
expect
an
increase
in
mental
and
neurological
disorders
among
both
veterans
and
the
civilian
population,
which
will
create
an
additional
burden
on
the
health
care
system.
We
have
demonstrated
the
likelihood
of
an
increase
in
sleep
and
circadian
rhythm
disorders,
which
can
increase
the
manifestations
of
mood
disorders
and
stress-related
disorders,
increase
the
frequency
of
paroxysmal
states,
and
increase
the
risk
of
developing
neurodegenerative
and
demyelinating
diseases.
Thus,
we
draw
attention
to
the
fact
that
the
war
in
Ukraine
will
have
inevitable
consequences
on
the
health
of
the
nervous
system.
We
believe
that
this
is
an
issue
that
should
be
addressed
now
to
identify
the
prevalence
of
sleep
and
circadian
rhythm
disorders,
as
well
as
to
prevent
the
consequences
for
the
nervous
system.
Disclosure
of
interest
The
authors
declare
that
they
have
no
competing
interest.
Funding
This
research
received
no
specific
grant
from
any
funding
agency
in
the
public,
commercial,
or
not-for-profit
sectors.
r
e
f
e
r
e
n
c
e
s
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DI,
Skrypnikov
AM,
Shkodina
AD,
Hasan
MM,
Ashraf
GM,
Rahman
MH.
Circadian
rhythm
disorder
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as
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Anastasiia
D.
Shkodina
a,b,
*
Anastasiia
I.
Zhyvotovska
a
Dmytro
I.
Boiko
a
r
e
v
u
e
n
e
u
r
o
l
o
g
i
q
u
e
x
x
x
(
2
0
2
0
)
x
x
x
–
x
x
x2
NEUROL-2680;
No.
of
Pages
3
Please
cite
this
article
in
press
as:
Shkodina
AD,
et
al.
Sleep
and
armed
conflict:
future
complications
of
war
in
Ukraine.
Revue
neurologique
(2022),
https://doi.org/10.1016/j.neurol.2022.09.002
a
Poltava
State
Medical
University,
Poltava,
Ukraine
b
Municipal
Enterprise
‘‘1st
City
Clinical
Hospital
of
Poltava
City
Council’’,
Poltava,
Ukraine
*Corresponding
author.
E-mail
address:
ad.shkodina@gmail.com
(A.D.
Shkodina)
Received
2
July
2022
Received
in
revised
form
19
July
2022
Accepted
12
September
2022
Available
online
xxx
https://doi.org/10.1016/j.neurol.2022.09.002
0035-3787/#
2022
Elsevier
Masson
SAS.
All
rights
reserved.
r
e
v
u
e
n
e
u
r
o
l
o
g
i
q
u
e
x
x
x
(
2
0
2
0
)
x
x
x
–
x
x
x
3
NEUROL-2680;
No.
of
Pages
3
Please
cite
this
article
in
press
as:
Shkodina
AD,
et
al.
Sleep
and
armed
conflict:
future
complications
of
war
in
Ukraine.
Revue
neurologique
(2022),
https://doi.org/10.1016/j.neurol.2022.09.002
... Середнє значення ІМТ у осіб чоловічої статі склало 22,34 (СІ [20,[16][17][18][19][20][21][22][23][24]35]), у жінок -21,07 (СІ [19,29]) (р=0,019). ...
... Середнє значення ІМТ у осіб чоловічої статі склало 22,34 (СІ [20,[16][17][18][19][20][21][22][23][24]35]), у жінок -21,07 (СІ [19,29]) (р=0,019). ...
... Відмічена статистично значима різниця між значеннями ІМТ у студентів, які проживали у гуртожитку, ІМТ у середньому склав 20,82 (СІ [19,76]), порівняно із тими, які жили із сім'єю у власному житлі, де ІМТ склав 21,54 (СІ [19,82]), і тими, які в орендованому житлі, де ІМТ склав 21,87 (СІ [19,[22][23]74]) (р<0,0001). ...
HEALTHY LIFESTYLE INDICATORS AMING MEDICAL STUDENTS AT POLTAVA STATE MEDICAL UNIVERSITY
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Full-text available
  • May 2024
The aim of the research is to study the indicators of a healthy lifestyle among Master students at Poltava State Medical University, and factors influencing this choice. The article analyzes the results of a survey among 228 students of the 1st-3rd years of study at Poltava State Medical University. We used the Google Forms service (https://docs.google.com/forms) to conduct the survey. The questionnaire was distributed through student groups in Viber and Telegram social networks. Results. In this study, 94.7% of students agreed to participate. Male students made up 29.6% of participants, female participants constituted 70.4%. The average value of BMI was 22.34 (CI [20.16-24.35]) in men and 21.07 (CI [19.23-22.29]) (p=0.019) in women. A statistically significant difference was observed between the BMI values of students who lived in a dormitory, the average BMI was 20.82 (CI [19.26-21.76]), compared to those who lived with their families in their own housing, where BMI was 21.54 (CI [19.46-22.82]), and those in rented housing, where BMI was 21.87 (CI [19.22-23.74]) (p<0.0001). The mean score for tendency to crash diet for weight loss in the male group was 0.15 (CI [0-1.0]), compared to the female group, where it was 0.41 (CI [0-1.0]) (p=0.0104). The mean score for the frequency of walking in the group aged 16-18 was 2.25 (CI [1.0-3.0]), 19-21 - 2.33 (CI [1.0-3.0]), 22-24 - 1.33 (CI [1.0-2.0]), >24 - 2.0 (CI [1.0-2.0]) (p=0.00805). The mean score for the frequency of walking in the group of students living in rented housing was 2.18 (CI [1.0-3.0]), in the group living in a dormitory - 2.47 (CI [1.0-3.0]), in the group living with family - 2.07 (CI [1.0-2.0]) (p=0.0014). Conclusion. A healthy diet, sleep, and exercise must be balanced to improve mental and physical health, and thus to improve the performance of medical students. In general, students should be instructed to maintain proper sleep hygiene, recommended reducing the time spent using the devices, especially in the evening, avoiding alcoholic beverages, as well as setting various reminders and alarms.
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... Currently, cognitive behavioral therapy is considered the gold standard for the treatment of insomnia. Still, its widespread implementation has several obstacles, including limited public knowledge about the need for and function of sleep, the role of behavioral changes in improving sleep, and the lack of trained professionals (3,4). ...
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... Sleep disturbances and psychiatric symptoms play an important role in the structure of non-motor symptoms and are characterized by a complex network of interconnections, which causes variability in the clinical course [12]. Today, anxiety attracts special attention because, against the background of the ongoing war in Ukraine, this symptom may not be a manifestation of the underlying disease but a stressrelated mental disorder caused by circumstances [13,14]. The Russian-Ukrainian war has caused many challenges for healthcare in general, including mental health, and has worsened the quality of sleep [15]. ...
PROGNOSTIC VALUES OF CIRCADIAN RHYTHM AND SLEEP PARAMETERS IN ASSESSMENT OF STATE ANXIETY IN PARKINSON’S DISEASE WITH REGARD TO MOTOR SUBTYPE
Article
Full-text available
  • Sep 2024
Introduction. Parkinson’s disease is characterized by motor and non-motor symptoms, the connection between which has recently attracted much attention from researchers. Sleep disturbances and anxiety can be non-motor signs of Parkinson’s disease. The specificity of non-motor symptoms in different motor subtypes is being actively studied, with the PIGD (postural instability and gait difficulty) subtype being associated with more severe non-motor symptoms. Methods. We conducted a clinical monocentric cross-sectional study that included 64 patients with Parkinson’s disease. Patients were assessed according to the Unified Parkinson’s Disease Rating Scale, and their motor subtype was determined by calculations using the method of Jankovich and Stebbins. We assessed circadian rhythm using the Ukrainian version of the Munich Chronotype Questionnaire, sleep quality – using the Pittsburgh Sleep Quality Index, excessive daytime sleepiness – using the Epworth Sleepiness Scale, and state anxiety – using the first block of the State-Trait Anxiety Inventory. Results. Our sample consisted of approximately equal numbers of men and women with a mean age of 63.80 ± 9.30 years. All patients were approximately equally distributed by motor subtype and sleep quality. At the same time, our sample was dominated by patients with a high level of state anxiety, morning chronotype, and the absence of excessive daytime sleepiness. State anxiety demonstrated a moderate direct correlation with sleep latency, mid-sleep, subjective sleep quality, subjective sleep latency, sleep disturbance, and total score of Pittsburgh Sleep Quality Index and a moderate indirect association with average weekly light exposure. It was found that an increased mid-sleep time, a decreased average weekly light exposure during the day, poor sleep quality, and PIGD subtype elevated the odds of more severe situational anxiety. Conclusions. Our study demonstrates the relationship between the level of situational anxiety and parameters of sleep and circadian rhythm in patients with Parkinson’s disease, considering their motor subtype. It was found that a later mid-sleep, lower average weekly light exposure, poor sleep quality, and PIGD subtype of Parkinson’s disease had a prognostic role regarding the increase in state anxiety
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... Наразі конфлікт призвів до руйнування інфраструктури, тисяч жертв і масових переміщень [1]. Численні дослідження повідомляють про проблеми із психічним здоров'ям як серед цивільного населення, так і серед військовослужбовців [2]. Дослідження продемонстрували, що збільшенню психічних та фізичних проблем зі здоров'ям передують травма та стрес, що є наслідком війни. ...
SLEEP QUALITY AND AVOIDANCE BEHAVIOR IN COMBATANTS WITH POST-TRAUMATIC STRESS DISORDER
Article
Full-text available
  • May 2024
Introduction. Post-traumatic stress disorder (PTSD) is often characterized by various symptoms that result in behavioral changes in patients, among which sleep disturbances and avoidant behavior are commonly observed. However, despite evidence indicating a complex bilateral relationship between emotions and sleep, only few studies have explored the associations between sleep disturbances and avoidant behavior in the context of PTSD. The aim of the study is to assess the severity of avoidant behaviour and insomnia in combatants with posttraumatic stress disorder. Materials and methods. We conducted a clinical study of 45 combatants who were divided into 2 groups: group 1 (n=24) included combatants with PTSD; group 2 (n=21) consisted of combatants without PTSD. The Pittsburgh Sleep Quality Questionnaire was used to analyse sleep quality, namely subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, sleep medication use, and daily dysfunction. Avoidance behavior was measured using a multidimensional experience avoidance questionnaire. Results. We found that group 1 demonstrated worse subjective sleep quality (p=0.002), longer sleep latency (p<0.001), lower sleep efficiency (p=0.019) and more severe sleep disturbances (p<0.001). There were no statistically significant differences between the groups in terms of sleep duration, severity of sleeping pills use, and daily dysfunction. The overall severity of sleep quality disorders was higher in group 1 compared to group 2 (p<0.001). Avoidance behavior (p=0.007) and repression and denial (p<0.001) were more pronounced in group 1 compared to group 2. At the same time, group 1 had lower stress endurance (p<0.001). The overall level of experiental avoidance in group 1 was higher than in group 2 (p<0.001). Numerous associations between sleep quality characteristics and experiental avoidance were found as well. Conclusions. The study has revealed that combatants with PTSD have more pronounced manifestations of behavioural avoidance, repression and denial, as well as a lower level of stress endurance. At the same time, combatants with PTSD demonstrate a deterioration in the subjective quality of sleep, a decrease in its effectiveness and an increase in the severity of its disturbances. It has been found that avoidance behavior in combatants has numerous connections with the characteristics of sleep quality that may be suggested as a potential factor for improving psychotherapeutic interventions.
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... The relationship between pain and other mental disorders, such as stress, anxiety, depression, and sleep disturbances, explains the need for psychological therapies [38,165,166]. It is well recognized that anxiety or depression can increase sleep problems and pain and that pain can accelerate mental disturbances and contribute to poor sleep quality [167][168][169][170]. In addition, anxiety, depression, and pain perception may depend on the patient's personality traits, which also makes psychological interventions for chronic pain appropriate [171][172][173]. ...
Pharmacological and Non-pharmacological Approaches for the Management of Neuropathic Pain in Multiple Sclerosis
Article
  • Feb 2024
  • CNS DRUGS
Multiple sclerosis is a chronic infammatory disease that afects the central nervous system and can cause various types of pain including ongoing extremity pain, Lhermitte’s phenomenon, trigeminal neuralgia, and mixed pain. Neuropathic pain is a major concern for individuals with multiple sclerosis as it is directly linked to myelin damage in the central nervous system and the management of neuropathic pain in multiple sclerosis is challenging as the options available have limited efcacy and can cause unpleasant side efects. The literature search was conducted across two databases, PubMed, and Google Scholar. Eligible studies included clinical trials, observational studies, meta-analyses, systematic reviews, and narrative reviews. The objective of this article is to provide an overview of literature on pharmacological and non-pharmacological strategies employed in the management of neuropathic pain in multiple sclerosis. Pharmacological options include cannabinoids, muscle relaxants (tizanidine, baclofen, dantrolene), anticonvulsants (benzodiazepines, gabapentin, phenytoin, carbamazepine, lamotrigine), antidepressants (duloxetine, venlafaxine, tricyclic antidepressants), opioids (naltrexone), and botulinum toxin variants, which have evidence from various clinical trials. Non-pharmacological approaches for trigeminal neuralgia may include neurosurgical methods. Non-invasive methods, physical therapy, and psychotherapy (cognitive behavioral therapy, acceptance and commitment therapy and mindfulness-based stress reduction) may be recommended for patients with neuropathic pain in multiple sclerosis. The choice of treatment depends on the severity and type of pain as well as other factors, such as patient preferences and comorbidities. There is a pressing need for healthcare professionals and researchers to prioritize the development of better strategies for managing multiple sclerosis-induced neuropathic pain.
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... We conducted a study that included 100 healthcare workers (50 doctors and 50 nurses) and 50 physically and mentally healthy individuals during December 2020 -November 2021. The following recruitment was not conducting due to the full-scale Russian invasion of Ukraine that may affect healthcare system and mental health of the population in Ukraine (30,31). From the surveyed respondents, we formed the following groups: ...
Psychoeducational training for healthcare workers psychoeducational training for reducing the impact of COVID-19 pandemic on healthcare workers
Article
Full-text available
  • Jan 2023
Introduction. Healthcare workers are increasingly exposed to long-term traumatic events in the context of the COVID-19 pandemic. Methods. We conducted a study that included 100 healthcare workers and 50 healthy individuals. We used the Perceived Stress Scale, Hospital Anxiety and Depression Scale, and Global Patient Impression for Improvement in the assessment of the psychological condition of respondents. To improve the psychoemotional state of health care workers, we proposed a program of psychoeducational training that was conducted at the workplace. After it, we reassessed the level of perceived stress, anxiety, and depression. Results. During the COVID-19 pandemic, in healthcare workers, the level of stress and anxiety was higher than in non-medical specialties, and the level of depression was not significantly different. The reduction of stress and anxiety was found. The subjective assessment of the improvement of the general condition indicates its positive dynamics after the psychoeducational training in both doctors and nurses. Conclusion. We showed the effectiveness of the proposed psychoeducational methodology for improving the psychoemotional condition of healthcare workers during the COVID-19 pandemic.
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RETURNING FROM THE WAR: social and psychological aspects of veterans’ readaptation and resocialization to civilian life
Book
  • Jan 2024
The monograph is devoted to the analysis of the socio-psychological dimension of the readaptation and resocialization of war veterans to the conditions of civilian life. Taking into account the theoretical achievements of socio-psychological knowledge, the current problems of psychological recovery and resocialization of military personnel, military veterans, combatants, war participants and persons with disabilities as a result of war are considered. The socio-psychological mechanisms of integration of war veterans to full integration in the conditions of civilian society are proposed. The publication expands the theoretical and practical field of domestic socio-psychological discourse on the problems of readaptation and resocialization of war veterans. The collective monograph is addressed to specialists who implement the tasks of socio-psychological integration of war veterans, practical psychologists, scientists, teachers, students of all levels of higher education, and ordinary citizens who are faced with the need to create full-fledged conditions for the resocialization and readaptation of relatives, friends, and fellow citizens to the conditions of civilian life.
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Basic Anatomy and Physiology of the Central Nervous System
Chapter
  • Jan 2024
The first chapter will discuss basic concepts in the anatomy and physiology of the central nervous system, which are required to understand the pathophysiology of Alzheimer’s disease (AD). Anatomy of the central nervous system is part of the human anatomy. Knowledge of the anatomy of the central nervous system is necessary to understand the pathogenesis of diseases of the nervous system. The authors will give a brief overview of the central nervous system division, brain anatomy, and its functions. The nervous system controls, coordinates, and regulates the coordinated work of all organ systems and maintains the stability of the composition of its internal environment. The main functional unit of the nervous system is the synapse. We will explore various types of neurons and synaptic connections, as well as their microstructure, and cover the physiology and actions of the main neural pathways, neurotransmitters, and their receptors in the central nervous system. The structure and functioning of the glymphatic system will receive special consideration. This is a system of perivascular tunnels that provide waste processing and are formed by astroglial cells. The authors will also discuss the changes that occur in the central nervous system as consequences of normal ageing.
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Correlation of Alzheimer’s Disease and Other Psychological and Non-Psychological Conditions
Chapter
  • Jan 2024
The primary cause of dementia in older people is Alzheimer’s disease (AD), which is typified by specific clinical and biochemical symptoms such as worsening memory loss and cognitive impairment. Furthermore, people with AD experience behavioural and psychological symptoms such as depression, apathy, aggression, and others, which will be explored in this chapter of the book. We will also discuss the clinical correlation between psychosis and AD. Recent research indicates a connection between sleep disturbances and AD. They are regarded as predictors of neurodegenerative disease. Long-term memory consolidation depends on sleep, and disturbances such as excessive daytime drowsiness and frequent awakenings may be early signs of AD. There are clinical links between AD and metabolic disorders. This chapter analyses the signs of osteoporosis and diabetes mellitus in an AD patient. Equally important is the link between AD and cardiovascular diseases such as atrial fibrillation and coronary heart disease, which can result in premature mortality. The association between older people’s gut microbiota and cognitive impairment will be discussed in this chapter. Older people’s microbiome structure maybe involved in controlling neuroinflammation, which is connected to various ageing-related neurological disorders, including AD.
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Circadian rhythm disorder and anxiety as mental health complications in post-COVID-19
Article
Full-text available
  • Apr 2022
  • ENVIRON SCI POLLUT R
In 2020, the world gained dramatic experience of the development of the 2019 coronavirus disease pandemic (COVID-19) caused by severe acute respiratory syndrome 2 (SARS-CoV-2). Recent researches notice an increasing prevalence of anxiety and circadian rhythm disorders during COVID-19 pandemic. The aim of the study was describing clinical features of circadian rhythm disorders and the level of anxiety in persons who have had COVID-19. We have conducted a cohort retrospective study that included 278 patients who were divided into 2 study groups according to medical history: group 1 includes patients with a history of COVID-19; group 2 consists of patients who did not have clinically confirmed COVID-19 and are therefore considered not to have had this disease. To objectify circadian rhythm disorders, they were verified in accordance with the criteria of the International Classification of Sleep Disorders-3. The level of anxiety was assessed by the State-Trait Anxiety Inventory. The most common circadian rhythm disorders were sleep phase shifts. We found that COVID-19 in the anamnesis caused a greater predisposition of patients to the development of circadian rhythm disorders, in particular delayed sleep phase disorder. In addition, it was found that after COVID-19 patients have increased levels of both trait and state anxiety. In our study, it was the first time that relationships between post-COVID-19 anxiety and circadian rhythm disorders had been indicated. Circadian rhythm disorders are associated with increased trait and state anxiety, which may indicate additional ways to correct post-COVID mental disorders and their comorbidity with sleep disorders.
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Insomnia in neurological diseases
Article
Full-text available
  • Dec 2021
Insomnia is defined as difficulties of initiating and maintaining sleep, early awakening and poor subjective sleep quality despite adequate opportunity and circumstances for sleep with impairment of daytime performance. These components of insomnia – namely persistent sleep difficulties despite of adequate sleep opportunity resulting in daytime dysfunction - appear secondary or co-morbid to neurological diseases. Comorbid insomnia originates from neurodegenerative, inflammatory, traumatic or ischemic changes in sleep regulating brainstem and hypothalamic nuclei with consecutive changes of neurotransmitters. Symptoms of neurological disorders (i.e motor deficits), co-morbidities (i.e. pain, depression, anxiety) and some disease-specific pharmaceuticals may cause insomnia and/or other sleep problems. This guideline focuses on insomnias in headaches, neurodegenerative movement disorders, multiple sclerosis, traumatic brain injury, epilepsies, stroke, neuromuscular disease and dementia. The most important new recommendations are: Cognitive behavioral therapy (CBTi) is recommended to treat acute and chronic insomnia in headache patients. Insomnia is one of the most frequent sleep complaints in neurodegenerative movement disorders. Patients may benefit from CBTi, antidepressants (trazodone, doxepin), melatonin and gaba-agonists. Insomnia is a frequent precursor of MS symptoms by up to 10 years. CBTi is recommended in patients with MS, traumatic brain injury and. Melatonin may improve insomnia symptoms in children with epilepsies. Patients with insomnia after stroke can be treated with benzodiazepine receptor agonists and sedating antidepressants. For patients with dementia suffering from insomnia trazodone, light therapy and physical exercise are recommended.
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Sleep Deprivation and Neurological Disorders
Article
Full-text available
Sleep plays an important role in maintaining neuronal circuitry, signalling and helps maintain overall health and wellbeing. Sleep deprivation (SD) disturbs the circadian physiology and exerts a negative impact on brain and behavioural functions. SD impairs the cellular clearance of misfolded neurotoxin proteins like α-synuclein, amyloid-β, and tau which are involved in major neurodegenerative diseases like Alzheimer’s disease and Parkinson’s disease. In addition, SD is also shown to affect the glymphatic system, a glial-dependent metabolic waste clearance pathway, causing accumulation of misfolded faulty proteins in synaptic compartments resulting in cognitive decline. Also, SD affects the immunological and redox system resulting in neuroinflammation and oxidative stress. Hence, it is important to understand the molecular and biochemical alterations that are the causative factors leading to these pathophysiological effects on the neuronal system. This review is an attempt in this direction. It provides up-to-date information on the alterations in the key processes, pathways, and proteins that are negatively affected by SD and become reasons for neurological disorders over a prolonged period of time, if left unattended.
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Roles of clock genes in the pathogenesis of Parkinson's disease
Article
  • Dec 2021
  • AGEING RES REV
Parkinson's disease (PD) is a common motor disorder that has become increasingly prevalent in the ageing population. Recent works have suggested that circadian rhythms disruption is a common event in PD patients. Clock genes regulate the circadian rhythm of biological processes in eukaryotic organisms, but their roles in PD remain unclear. Despite this, several lines of evidence point to the possibility that clock genes may have a significant impact on the development and progression of the disease. This review aims to consolidate recent understanding of the roles of clock genes in PD. We first summarized the findings of clock gene expression and epigenetic analyses in PD patients and animal models. We also discussed the potential contributory role of clock gene variants in the development of PD and/or its symptoms. We further reviewed the mechanisms by which clock genes affect mitochondrial dynamics as well as the rhythmic synthesis and secretion of endocrine hormones, the impairment of which may contribute to the development of PD. Finally, we discussed the limitations of the currently available studies, and suggested future potential studies to deepen our understanding of the roles of clock genes in PD pathogenesis.
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ANALYSIS OF PRIMARY HEADACHES MANAGEMENT IN POLTAVA REGIONS
Article
  • Jan 2021
  • Wiad Lek
Objective: The aim: Assess quality of diagnosis and treatment of primary headaches (PH) in Poltava region. Patients and methods: Materials and methods: There were examined 195 patients with PH who were previously consulted by different specialists due to headaches. We analyzed previously established diagnoses, previous consultations and prescribed investigations due to headache, drugs that were prescribed for headache treatment. Results: Results: The misdiagnoses of PH were made due to considering the headache as secondary (as sign of dyscirculatory encephalopathy, arterial hypertension, autonomic dysfunction, cervical ostheochondrosis). Patients older 40 years were misdiagnosed more often with dyscirculatory encephalopathy, while patients under 40 years were more frequently misdiagnosed with autonomic dysfunctions. Patients sought medical help for headache problem and were repeatedly examined by different specialists (general practitioner, neurologist, cardiologist, ophthalmologist, oyorhinolaryngologist, neurosurgeon). Doctors prescribed a large number of identical uninformative neuroimaging and neurofunctional methods regardless of PH nosologies. Also it had been often prescribed therapy with the use of vascular, metabolic, nootropic drugs without specific pathogenetic effects for PH. Conclusion: Conclusions: It is necessary to improve the diagnosis and treatment of PH according to international standards by raising awareness among general practitioners, neurologists and other specialists about the basics of PH diagnosis and treatment.
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Clinical features of adjustment disorder in internally displaced women
Article
  • Jun 2020
  • Wiad Lek
Objective: The aim: To study the clinical features of internally displaced women with adjustment disorders. Patients and methods: Materials and methods: Clinical features of internally displaced women with adjustment disorders are investigated. Comprehensive clinical psychopathological and psychodiagnostic assessment of 58 women have been conducted, their medical history data have been analyzed. Results: Results: According to the analysis of the questionnaire severity of psychopathological symptoms prevalence of phobic anxiety, somatization with the presence of distress were observed in internally displaced women. In the clinical presentation of psychopathological disorders, the following symptoms of anxiety-depressive syndrome complex prevailed: mental fatigue 93.1 ± 3.9%; decrease in working capacity in 89.7 ± 4.2% of women; decrease in mood 79.3 ± 6.9%; anxiety 75.7 ± 3.8%; decrease in libido in 65.7 ± 4.9%; physical fatigue - 51.7 ± 4.4% of the examined. Conclusion: Conclusions: Analysis of clinical and psychopathological symptoms of women with adjustment disorder indicates the dominance in the structure of symptoms of anxiety and depressive symptoms in mixed and isolated forms. According to the analysis of the questionnaire of severity of psychopathological symptoms, in internally displaced women, the prevalence of phobic anxiety, somatization with the presence of distress was observed.
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Sleep disorders in migrants and refugees: a systematic review with implications for personalized medical approach
Article
  • May 2020
Background Sleep disorders are very common in migrants and refugees, often as a comorbid disorder to different somatic or psychiatric diagnoses and psychological disturbances such as metabolic syndrome, post-traumatic stress disorder, depression, and anxiety disorders.Objectives To review published prevalence rates as well as possible predictors for sleep disturbances in these vulnerable groups, including pre-migration stress, acculturation, and trauma before, during, and after migration, integration, and lifestyle in the host country with implications for predictive, preventive, and personalized medical approach (3PM).Data sourcesElectronic databases PubMed, PsycInfo, and Web of Knowledge were searched using (combined) search terms “migrant,” “asylum seeker,” “refugee,” “sleep disturbances,” “sleep disorder,” “insomnia,” and “sleep wake disorder.”Study eligibility criteriaPeer-reviewed studies from 2000 to 2018 reporting data on prevalence and/or predictors of any measure of sleep disturbance were included.ParticipantsStudies on international migrants and refugees, as well as internally displaced populations, were included.Methods We conducted a systematic review on the topic of sleep disorders in migrant and refugee populations. Only published articles and reviews in peer-reviewed journals were included.ResultsWe analyzed five studies on sleep disorders in migrants, five studies on adult refugees, and three on refugee children and adolescents. Prevalence of sleep disorders in migrants and refugees ranges between 39 and 99%. In migrant workers, stress related to integration and adaptation to the host society is connected to higher risks of snoring, metabolic diseases, and insomnia. Sleep disturbances in refugees are predicted by past war experience. Sleep difficulties in adult and child refugees are strongly correlated to trauma. Torture of parents and grandparents can predict sleep disorders in refugee children, while being accompanied by parents to the host country has a protective effect on children’s sleep.Conclusions and implicationsConsidering the differences in risk factors, vulnerability, and traumatic life events for different migrant populations, origins of sleep difficulties vary, depending on the migrant populations. Effects on sleep disturbances and sleep quality may be a result of integration in the host country, including changes of lifestyle, such as diet and working hours with implication for OSAS (obstructive sleep apnea) and insomnia. Compared with migrant populations, sleep disturbances in refugee populations are more correlated with mental health symptoms and disorders, especially PTSD (post-traumatic stress disorder), than with psychosocial problems. In juvenile refugee populations, psychological problems and disturbed sleep are associated with traumatic experiences during their journey to the host country. Findings highlight the need for expert recommendations for development of 3P approach stratified in the following: (1) prediction, including structured exploration of predisposing and precipitating factors that may trigger acute insomnia, screening of the according sleep disorders by validated translated questionnaires and sleep diaries, and a face-to-face or virtual setting and screening of OSAS; (2) target prevention by sleep health education for female and male refugees and migrant workers, including shift workers; and (3) personalized medical approach, including translated cognitive behavioral treatment for insomnia (CBT-I) and imagery rehearsal therapy for refugees and telehealth programs for improved CPAP adherence in migrants, with the goal to enable better sleep health quality and improved health economy.
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Memory: Necessary for Deep Sleep?
Article
  • Mar 2020
  • CURR BIOL
Patients with hippocampus lesions suffer profound failures in episodic memory. Sleep plays a key role in processing hippocampus-dependent memories. Lesioning this structure may fundamentally alter the architecture of human sleep, posing fundamental questions about the link between sleep and memory processing.
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Sleep and inflammation: partners in sickness and in health
Article
  • Jul 2019
  • NAT REV IMMUNOL
The discovery of reciprocal connections between the central nervous system, sleep and the immune system has shown that sleep enhances immune defences and that afferent signals from immune cells promote sleep. One mechanism by which sleep is proposed to provide a survival advantage is in terms of supporting a neurally integrated immune system that might anticipate injury and infectious threats. However, in modern times, chronic social threats can drive the development of sleep disturbances in humans, which can contribute to the dysregulation of inflammatory and antiviral responses. In this Review, I describe our current understanding of the relationship between sleep dynamics and host defence mechanisms, with a focus on cytokine responses, the neuroendocrine and autonomic pathways that connect sleep with the immune system and the role of inflammatory peptides in the homeostatic regulation of sleep. Furthermore, I discuss the therapeutic potential of harnessing these reciprocal mechanisms of sleep–immune regulation to mitigate the risk of inflammatory and infectious diseases. Sleep enhances immune defences, and afferent signals from immune cells promote sleep. However, in response to chronic stressors, the normally adaptive function of sleep can become dysregulated, with implications for inflammatory and antiviral responses.
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Combat exposure, post-traumatic stress symptoms, and health-related behaviors: The role of sleep continuity and duration
Article
  • Dec 2018
Study Objectives Aggression, substance misuse, and other health risk behaviors are common among combat veterans. We examined whether sleep quality and quantity predict the association between combat exposure, post-traumatic stress symptoms, and adverse health-related behaviors. Methods Soldiers (N= 2420) from a brigade combat team completed surveys assessing combat experiences, and psychological and behavioral health factors, approximately three months following deployment to Afghanistan in 2011. Results Respondents were 93.5% male; 73% were age 18–29 years old. The response rate was 80% (3076/3832); 94% (2876/3076) of the soldiers who attended the recruitment briefings consented to participate in this research. Complete data were available across the variables used in this study for up to 2420 Soldiers. Sleep continuity disturbance accounted for the association of combat exposure with post-traumatic stress symptoms and aggression, alcohol use, and risky behavior. Moreover, for soldiers who reported sleep duration of < 6 hours per day, the indirect association of combat exposure and post-traumatic stress on aggression, alcohol use, risky behavior, and opioid use was strongest. Conclusions This study is the first to model sleep problems as a predictor of the association between combat exposure and post-traumatic stress symptoms and frequently reported health-related behavior problems. Sleep disturbance is highly prevalent among Warfighters. While not fully preventable in operational contexts, these problems can be effectively mitigated post-deployment with appropriate policy and intervention resources. Improving the sleep characteristics of combat-exposed soldiers following deployment should reduce subsequent post-traumatic stress and related health compromising behavior, thereby enhancing force readiness.
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