O nível de cortisol é considerado uma forma de medir o estresse de pessoas. Um estudo foi realizado a fim de verificar se crianças que trabalhavam nas ruas durante o dia tem estresse mais alto do que crianças que não trabalhavam. O nível de cortisol de uma pessoa pode ser considerado uma função crescente até atingir um máximo e depois decrescente (função quasicôncava). O cortisol das crianças foram coletados 4 vezes ao dia,sendo considerado dois grupos de crianças: aquelas que trabalham na rua e aquelas que ficavam em casa. Para a análise dos dados, foi considerada uma metanálise de um modelo de dados funcionais sob enfoque Bayesiano. Cada individuo é analisado por um modelo de dados funcionais e a metánalise foi usada para termos uma inferência para cada grupo. A geração de uma amostra da distribuição a posteriori foi obtida pelo o método de Gibbs com Metrópolis-Hasting. Na comparação das curvas calculamos a probabilidade a posteriori ponto-a-ponto da função do cortisol de um grupo ser maior do que a do outro. / The level of cortisol is considered as a measure of peoples stress. We perform an statistical analysis of the data from a study conducted to evaluate if children that work on the streets during the day have higher stress than children who does not work. The cortisol level of a person can be considered as an increasing function until reaching a maximum level and then decreasing to almost zero (quasi-concave function). Childrens cortisol were collected 4 times in one day, where two groups of children were considered: those who work in the street and those who stay at home. To analyse the data we considered a meta-analysis of a functional data model under Bayesian approach. Each individual is analysed by a functional data model, and then, a meta-analysis was used to have inference for each group. We used the Gibbs Metropolis-Hastings method to sample from the posteriori distribution. Also, we calculated the pointwise posterior probability of the cortisol function of one group being greater than the cortisol function of other group to compare the groups.

Introdução: A neurobiologia dos transtornos de ansiedade (TA) é complexa e envolve interações ambientais e genéticas ainda não conhecidas. Esses transtornos, comumente, iniciam durante a infância e adolescência, persistindo ao longo da vida. O comprometimento da resposta biológica frente ao estímulo estressor, encontrado em muitos pacientes com TA, sugere a influência do eixo hipotálamo-hipófise-adrenal (HHA) nestes transtornos e, portanto, os polimorfismos associados ao eixo HHA poderiam ser estudados em genes candidatos. Os estudos que almejam entender a etiologia dos TA devem, também, explorar as alterações epigenéticas (incluindo a metilação do DNA) decorrentes das influências ambientais. Objetivos: Estudar, em adolescentes, polimorfismos genéticos funcionais do eixo HHA, interações Gene x Ambiente (G x A) e metiloma do DNA, considerando as diferentes trajetórias dos TA. Métodos: Foi realizada a extração de DNA das células do epitélio bucal de 228 adolescentes (131 casos e 97 controles para os TA) e foram genotipados, por PCR em tempo real, polimorfismos funcionais envolvidos com o eixo HHA (FKBP5: rs3800373, rs9296158, 3800373, rs9296158, 3800373, rs9296158, rs1360780, rs9470080 rs1360780, rs9470080 e rs4713916; NR3C1NR3C1 : rs6198;: rs6198;: rs6198; NR3C2NR3C2 : rs2070951;: rs2070951;: rs2070951; CRHR1CRHR1 CRHR1 : rs878886 : rs878886 e SERPINA6 SERPINA6 : rs746530) : rs746530) . Os participantes responderam à escala auto-aplicativa SCARED (Screen for Children Anxiety Related Emotional Disorder – Children rated) e realizaram entrevistas semiestruturadas para avaliação diagnóstica utilizando o K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime). O questionário CTQ (Childhood Trauma Questionnaire) foi aplicado em 90 adolescentes (54 casos e 36 controles para os TA) para avaliar a interação entre o trauma emocional e o polimorfismo do gene NR3C2 nos níveis séricos de BDNF. Uma subamostra de adolescentes (n=47) foi reavaliada, cinco anos após a primeira coleta, através das mesmas entrevistas psiquiátricas e nova extração de DNA salivar. Alguns participantes, na última avaliação, responderam ao MINI (Mini International Neuropsychiatric Interview) apropriado para a idade atual. A amostra foi organizada em 4 grupos, conforme o diagnóstico dos TA e o ano da coleta de saliva (anos de 2008 e 2013): (1) Desenvolvimento típico da adolescência (Controle; n=14); (2) Incidentes para os TA (ITA; n=11); (3) Persistentes para os TA (Caso; n=14) e (4) Remitentes para os TA (RTA; n=08). O metiloma do DNA foi analisado com o Infinium HumanMethylation 450 BeadChip da Illumina. Resultados: Não foi encontrada associação entre os polimorfismos estudados e os TA. Em relação à interação G x A, sugere-se que o polimorfismo rs2070951 do gene NR3C2 modera a associação entre negligência física e os níveis séricos de BDNF. Do ponto de vista epigenético, foi observada, nos grupos ITA e RTA, vias biológicas com padrão homogêneo e relacionadas ao sistema nervoso. Já nos grupos casos e controles para os TA, foram evidenciadas vias biológicas com padrão mais heterogêneo. Um perfil de hipometilação do DNA foi predominante nas vias encontradas. Na análise transversal, nós encontramos padrões opostos de metilação do DNA, conforme o período desenvolvimental avaliado: hipometilação no início da adolescência e hipermetilação em jovens adultos. Conclusão: Esse estudo abordou, em uma amostra de adolescentes, aspectos genéticos (genes candidatos envolvidos com o eixo HHA), ambientais (trauma emocional) e epigenéticos (metiloma do DNA) dos TA. Os achados sugerem que, embora sem associações entre os TA e genes envolvidos no eixo HHA, existe uma interação entre a presença de trauma emocional, polimorfismo genético do eixo HHA e marcadores biológicos. Os achados do metiloma do DNA sugerem, também, influências epigenéticas no curso dos TA. Novos estudos devem ser delineados para corroborar as influências genéticas e ambientais neste transtorno. / Background: The neurobiology of Anxiety Disorders (AD) is complex and involves environmental and genetic interactions understood. These disorders may have their onset during childhood and adolescence, persisting throughout life. The impairment of biological response against the stressor stimulus, described in many patients with AD, suggests a possible role of genetic polymorphisms of the hypothalamic-pituitary-adrenal (HPA) axis in these individuals. Studies that aim to understand the etiology of AD should also explore the epigenetic changes (including DNA methylation) arising from environmental influences. Objective: To study, in adolescents, functional genetic polymorphisms of HPA axis, Gene x Environment (G x E) interactions and DNA methylome, considering different AD outcomes. Methods: Saliva DNA was extracted from 228 adolescents (131 cases and 97 controls to AD) and we genotyped, by real time PCR, the functional polymorphisms involved with HPA axis (FKBP5: rs3800373, rs9296158, rs1360780, rs9470080 and rs4713916; 3800373, rs9296158, rs1360780, rs9470080 and rs4713916; 3800373, rs9296158, rs1360780, rs9470080 and rs4713916; 3800373, rs9296158, rs1360780, rs9470080 and rs4713916; 3800373, rs9296158, rs1360780, rs9470080 and rs4713916; 3800373, rs9296158, rs1360780, rs9470080 and rs4713916; 3800373, rs9296158, rs1360780, rs9470080 and rs4713916; NR3C1NR3C1 : rs6198; : rs6198; : rs6198; NR3C2NR3C2 : rs2070951; : rs2070951; CRHR1CRHR1CRHR1 CRHR1: rs878886 and : rs878886 and : rs878886 and : rs878886 and SERPINA6 SERPINA6 SERPINA6SERPINA6 : rs746530) : rs746530) . Participants responded to the scale self-applied Screen for Children Anxiety Related Emotional Disorder – Children rated (SCARED) and were diagnosed according to the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL). The Childhood Trauma Questionnaire (CTQ) was applied in 90 adolescents (54 cases e 36 controls to AD) to evaluate the interaction between emotional trauma and the NR3C2 polymorphism in the serum levels of BDNF. A sub-sample of adolescents (n = 47) was reassessed five years after the first evaluation by the same psychiatric semi-structured interviews and new extraction salivary DNA was performed. Some participants in the last evaluation responded to Mini International Neuropsychiatric Interview (MINI), which is a semi structure interview appropriate for the present age. The sample was organized in four groups according to the diagnosis of AD and the year of saliva collection (2008 and 2013): (1) Typically Developing Controls (TDC; n = 14); (2) Incident Anxiety Disorder (IAD; n = 11); (3) Persistent Anxiety Disorder (PAD; n = 14); (4) Remittent Anxiety Disorder (RAD; n = 8). DNA methylome was evaluated with Infinium HumanMethylation450 BeadChip. Results: We did not find any association between the genetic polymorphisms and AD. Considering the G x E interaction we suggest that rs2070951 polymorphism of NR3C2 gene moderates the association between physical neglect and serum BDNF levels. When we evaluated the DNA methylome, we observed more homogeneous biological pathways and mostly related with nervous system in individuals from IAD and RAD groups. On the other hand, in the TDC and PAD groups, we found biological pathways with a more heterogeneous pattern. A DNA hypomethylation profile was found predominant in the pathways. In a cross-sectional analysis, we found opposite patterns of DNA methylation, as the developmental period assessed: hypomethylation at the beginning of adolescence and hypermethylation in young adults. Conclusion: This study addressed, in an adolescent sample, genetics (candidate genes linked to HPA axis), environmental (emotional trauma) and epigenetic (DNA methylome) aspects of AD. The findings suggest that although there are no associations between AD and genes involved in HPA axis, there is an interaction between the presence of trauma, genetic polymorphism involved in this axis and biomarkers. The DNA methylome findings also suggest epigenetic influences on the course of TA. Further studies should be designed to corroborate the genetic influences in this disorder.

La dépression majeure (DM) est une pathologie complexe et hétérogène associée avec des altérations du réseau cérébral, une dérégulation de l’axe hypothalamus-pituitaire-surrénales et avec des déficits de la neurogenèse adulte hippocampique (NHA). De nombreuses évidences pointent sur l’implication de la NHA dans les troubles de l’humeur et les troubles anxieux, ce qui a conduit à la formulation de l’ « hypothèse neurogénique », laquelle postule que des neurones néo-formés dans l’hippocampe du sujet adulte sont impliqués dans l’étiologie et dans l’efficacité du traitement de la DM. L’objectif de cette étude a été de déterminer le rôle des neurones formés à l’âge adulte après que les animaux aient été exposés à un stress ainsi que les mécanismes sous-jacents. Nos résultats suggèrent que l’augmentation de la neurogenèse est suffisante pour estomper les effets d’un stress chronique au niveau comportemental et hormonal, et donc pour induire un effet de type antidépresseur, comportementalement et physiologiquement. Les effets surviennent sans doute via le noyau du lit de la strie terminale antéro-dorsale. / Major depressive disorder (MDD) is a complex and heterogeneous disorder hypothesized to be associated with alterations in brain circuitry, dysregulations of the hypothalamic–pituitary–adrenal axis and impairments in adult hippocampal neurogenesis (AHN). Multiple lines of evidence point to the involvement of AHN in mood and anxiety disorders, leading to the formation of the “neurogenesis hypothesis”, which postulates that adult-born hippocampal neurons are involved in the etiology and treatment efficacy of MDD. The purpose of this study was to determine the role of adult-born neurons after the onset of stress exposure and the mechanism that underlies the observed results. Our results suggest that increasing neurogenesis is sufficient to buffer against the effects of chronic stress on certain behavioral and endocrine levels and thus to display antidepressant-like effects, both behaviorally and physiologically. Adult-born neurons might have exerted some of their effects via the anteromedial division of the bed nucleus of the stria terminalis (BSTMA).

O ACTH é considerado o principal fator atuante no desenvolvimento, na manutenção e na esteroidogênese da glândula adrenal. No entanto, existem evidências que peptídeos N-Pomc, derivados do processamento da Proopiomelanocortina (POMC), possam atuar na manutenção do córtex adrenal, embora ainda não seja conhecida sua importância e mesmo quais são os peptídeos que atuam na suprarrenal. Nesse trabalho tivemos como objetivo avaliar os efeitos de peptídeos sintéticos de 28 aminoácidos derivados do N-Pomc (N-PomcCys, N-PomcMet e N-PomcSer) na morfologia e função da suprarrenal de camundongos, cujo gene Pomc foi condicionalmente silenciado com Tamoxifeno (Tmx). Foram obtidos animais machos adultos (CrePomcfloxflox) com um sistema \"knock-out\" condicional Cre-Lox induzível por Tmx, que foram tratados através de minibombas osmóticas por 21 dias com os peptídeos ou com salina, e como controle animais Pomcfloxflox não tratados. Foram analisados: 1) dados metabólicos; 2) a concentração de ACTH e de corticosterona plasmáticos; 3) a morfologia e a reconstrução anatômica da adrenal; 4) a capacidade funcional através da coloração com Oil Red O (ORO) e 5) a capacidade de proliferação através da expressão da proteína PCNA. A caracterização dos animais CrePomcfloxflox + Tmx após o silenciamento mostrou a redução de 60% da concentração de ACTH plasmático e esses animais apresentaram 1) redução do gasto energético, aumento da ingestão de alimentos e ganho de peso corpóreo; 2) alteração significante a área ou o volume das adrenais; 3) redução da produção de gotículas lipídicas e 4) redução do número de núcleos positivos para a proteína PCNA. Esses animais silenciados para a Pomc e tratados com os peptídeos N POMCCys e N-POMCMet apresentaram 1) aumento da corticosterona plasmática e apenas o N-POMCCys aumentou o ACTH plasmático; 2) aumento de núcleos marcados para PCNA. Concluímos, que os camundongos Cre Pomcflox/flox silenciados para a Pomc com o Tamoxifeno apresentaram alterações metabólicas, morfológicas e fisiológicas. A análise do efeito biológico dos peptídeos N-POMC mostrou ação desses peptídeos na função e na manutenção do córtex adrenal. / ACTH is considered the main active factor in the development, maintenance and steroidogenesis of the adrenal gland. However, there is evidence that N-Pomc peptides, derived from the processing of Proopiomelanocortina (POMC), may play a role in the maintenance of the adrenal cortex, although their importance is not yet known. In this work we aimed to evaluate the effects of synthetic peptides of 28 amino acids derived from N-Pomc (N-PomcCys, N-PomcMet e N-PomcSer) on the morphology and function of the adrenal cortex of mice whose Pomc gene was conditionally silenced with Tamoxifen (Tmx). Adult males (CrePomcfloxflox) were obtained with a Tmx inducible Cre-Lox conditional knock-out system, which were treated by osmotic minipumps for 21 days with the peptides or with saline, and as control untreated Pomcfloxfloxanimals. We analyzed: 1) metabolic data; 2) plasma ACTH and corticosterone concentration; 3) the morphology and the anatomical reconstruction of the adrenal; 4) functional capacity through staining with Oil Red O (ORO) and 5) the ability to proliferate through expression of PCNA protein. The characterization of the CrePomcfloxflox + Tmx animals after silencing showed a 60% reduction in plasma ACTH concentration and these animals presented 1) reduction of energy expenditure, increased food intake and body weight gain; 2) significant alteration of adrenal area or volume; 3) reduction of the production of lipid droplets and 4) reduction of the number of nuclei positive for the PCNA protein. These animals that were silenced to Pomc and treated with peptides N-PomcCys, N-PomcMet had 1) increase in plasma corticosterone and only N-POMCCys increased plasma ACTH; 2) increase of nuclei marked for PCNA. We conclude that CrePomcflox/flox mice silenced for Pomc with Tamoxifen presented metabolic, morphological and physiological alterations. The analysis of the biological effect of N-POMC peptides showed the action of these peptides on the function and maintenance of the adrenal cortex.

Daily rhythms in physiology and behaviour are orchestrated by theautonomously rhythmic cells of the suprachiasmatic nucleus (SCN).Restricting food intake to the rest phase of nocturnal rodents, leads to thedevelopment of meal anticipatory behaviour, corticosterone and bodytemperature. Given that lesions to the SCN fail to abolish meal anticipation, asecond oscillator of unknown location, referred to as the food-entrainableoscillator (FEO) is thought to exist. Although the site of the FEO is unknown,several hypothalamus nuclei, including the dorsomedial hypothalamus(DMH) are thought to play a role in meal anticipation. Given thatadrenalectomy is reported to abolish meal anticipation, an intact HPA axis isalso thought to contribute to the functioning of the FEO. Some forms ofobesity are characterised by high basal levels of circulating corticosterone. Inaddition, limited access to high fat diet, fails to induce the development ofrobust meal anticipation in rats. During our initial studies, the effect of a standard and 45% high fat diet onthe development of meal anticipatory behaviour and hypothalamic c-Fosexpression were investigated. Restricted access to high fat diet led toattenuation of meal anticipation compared to those fed standard diet. Thiswas concurrent with a failure to develop an anticipatory rise in DMH c-Fosexpression. A meal anticipatory rise in corticosterone is thought to benecessary for the presence of meal anticipation as well as adaptation ofmetabolism to daily restricted feeding. In the next set of studies, weconfirmed that restricted access to standard diet leads to the development ofa meal anticipatory rise in plasma corticosterone. In contrast we observed adramatic post-anticipatory rise in plasma corticosterone in rats givenrestricted access to the 45% high fat diet. We hypothesised that the highcorticosterone levels resulting from high fat diet were a contributing factor tothe lack of meal anticipation in high fat fed rats. With the aid of apharmacokinetic study, a suitable experiment was designed for daily dosingof a potent glucocorticoid receptor antagonist, RU486, with the aim ofrescuing meal anticipation in high fat fed rats. Interestingly, treatment withRU486 successfully rescued meal anticipation in high fat fed rats, butattenuated meal anticipation in standard diet restricted fed rats. In the finalseries of studies the effect of diet and feeding regime on glucose toleranceand metabolism were investigated. High fat feeding was found to reduceglucose tolerance in both ad lib and restricted fed rats, with RU486 treatmentimproving glucose tolerance in a time dependant manner. Restricted accessto food was found to induce post satiation lipogenesis in both standard dietfed and to a lesser extent in high fat fed rats, an effect which may bebeneficial in reducing obesity. Overall the results provide further insight intothe complex role of corticosterone in promoting or preventing mealanticipatory behaviour. An anticipatory rise in plasma corticosterone isrequired for meal anticipation, as repeated daily dosing of RU486 inhibit mealanticipation. The high basal levels of corticosterone in high fat fed rats mayprevent meal anticipation, insulin secretion and post-satiation lipogenesiswhich may in fact be a homeostatic mechanism to prevent obesity. Nonetheless, treatment with RU486 rescues behavioural meal anticipationand glucose tolerance.

Telomeres are the outermost parts of linear chromosomes. They consist of tandemly repeated non-coding short nucleotide sequences (TTAGGG in all vertebrates), in humans spanning over the last 2 to 15 kilobase pairs of the chromosome. Due to the end-replication problem, telomeres shorten with each cellular division. A critically short telomere will trigger the cell to enter a state of cellular senescence or to apoptose. The rate of telomere shortening can be accelerated by factors such as oxidative stress and inflammation. Taken together, this contributed to making telomere length a candidate biomarker of health and aging. Studies have shown that leukocyte telomere length progressively shortens with age, and that it independent of age is associated with age-related morbidity, lifestyle factors, and mortality. This thesis was aimed at exploring the relationships of leukocyte telomere length with various functional and structural attributes of the brain. In Paper I, telomere length was shown to be longer among non-demented carriers of the apolipoprotein E (APOE) ε4 allele, a well-established risk factor for Alzheimer’s disease. However, the rate of telomere shortening was greater among the ε4 carriers, possibly due to the higher levels of oxidative stress and inflammation associated with this allele. Furthermore, performance on episodic memory tests was inversely related to telomere length among ε4 carriers. The results may contribute to a better understanding of the pathophysiology related to the APOE ε4 allele. The volume of the hippocampus, a structure in the brain critical for episodic memory function, was in Paper II found to be inversely related to telomere length among non-demented APOE ε3/ε3 carriers. No correlation between hippocampal volume and telomere length was discernible among ε4 carriers, but they fit the pattern exhibited by the ε3/ε3 carriers as they tended to have smaller hippocampi and longer telomere length compared with the ε3/ε3 carriers. The results are possibly explained by a low proliferative activity among subjects with smaller hippocampi, which might also explain the inverse association between telomere length and episodic memory performance in Paper I. In Paper III, we describe results corroborating earlier findings of shorter telomere length among individuals suffering from depression. Moreover, we found that the shorter telomere length among the patients to a large extent could be linked to a hypocortisolemic state; a state which has been associated with chronic stress. The findings corroborate the link between telomere length and stress, and underline the role of stress in depressive illness. Two prominent manifestations of the aging brain are atrophy and white matter hyperintensities. In Paper IV, we report that white matter hyperintensities and cerebral subcortical atrophy were associated with shorter telomere length in aged non-demented individuals. Cortical atrophy was not associated with telomere length. Inflammation may be the underlying cause of the associations, as it is linked to telomere attrition, subcortical atrophy, and white matter hyperintensities. Taken together, these results show that leukocyte telomere length has the potential of being used as a biomarker for structural and functional attributes of the brain. Furthermore, the findings can provide new insights into mechanisms of disease and aging of the brain

No description available.

Le trouble du déficit de l’attention/hyperactivité (TDA/H) est un des troubles comportementaux le plus commun chez les enfants. TDAH a une étiologie complexe et des traitements efficaces. Le médicament le plus prescrit est le méthylphénidate, un psychostimulant qui bloque le transporteur de la dopamine et augmente la disponibilité de la dopamine dans la fente synaptique. Des études précliniques et cliniques suggèrent que le cortisol peut potentialiser les effets de la dopamine. Un dysfonctionnement du système hypothalamo-hypophyso-surrénalien (HHS) est associé avec plusieurs maladies psychiatriques comme la dépression, le trouble bipolaire, et l’anxiété. Nous avons fait l’hypothèse que le cortisol influence l’efficacité du traitement des symptômes du TDAH par le méthylphénidate. L’objectif de cette étude est de mesurer les niveaux de cortisol le matin au réveil et en réponse à une prise de sang dans un échantillon d’enfants diagnostiqué avec TDAH âgé de 8 ans. Le groupe était randomisé dans un protocole en chassé croisé et en double aveugle avec trois doses de méthylphénidate et un placebo pour une période de quatre semaines. Les enseignants et les parents ont répondu aux questionnaires SWAN et à une échelle d’évaluation des effets secondaires. Les résultats ont démontrés qu’un niveau de cortisol élevé au réveil prédit les sujets qui ne répondent pas au traitement du TDAH, si on se fie aux rapports des parents. En plus, la réactivité au stress élevé suggère un bénéfice additionnel d’une dose élevée de méthylphénidate selon les enseignants. Aussi, les parents rapportent une association entre la présence de troubles anxieux co-morbide avec le TDAH et une meilleure réponse à une dose élevée. Cette étude suggère qu’une forte réactivité de l’axe HHS améliore la réponse clinique à des doses élevées, mais qu’une élévation chronique du niveau de cortisol pourrait être un marqueur pour les non répondeurs. Les résultats de cette étude doivent être considérés comme préliminaires et nécessitent des tests plus approfondis des interactions possibles entre les médicaments utilisés pour traiter le TDAH et l’axe HHS. / ADHD is the most common behavioural disorder in children with complex aetiology and efficacious treatments. The most prescribed medication for ADHD is methylphenidate, a psychostimulant that blocks the dopamine transporter and increases dopamine availability in the synaptic cleft. Preclinical and clinical studies show that cortisol may enhance dopamine effects. Dysregulation of the hypothalamic-pituitaryadrenal axis is also associated with many psychiatric disorders such as depression, bipolar disease, and anxiety. We hypothesized that cortisol has an influence on the efficacy of the treatment of ADHD symptoms with methylphenidate. The objective of this study was to measure the salivary level of cortisol in a sample of 8-year-old children with ADHD upon waking and in response to a venipuncture. The children were then randomized to three doses of methylphenidate and a placebo in a double-blind cross-over design. Teachers and parents rated the behaviour of the children using the SWAN and a side effect rating scale. The results showed that high morning cortisol is a good predictor of a nonresponder under active medication, as reported by parents. Also, the high stress reactivity group, but not the low stress reactivity group, demonstrated a greater benefit going to a higher dose of methylphenidate, according to teachers. In addition, parents demonstrated an association between anxiety comorbid disorders and a better response to a high dose of methylphenidate. This study suggests that a strong reactivity of the HPA axis improves the clinical response at high dose, but that chronically elevated cortisol might be a marker for non responders. The results of this study should be seen as preliminary and require further testing of the possible interactions between ADHD medication and HPA activity.

Fatigue is common in the general population, and is the hallmark of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Although the occurrence of sleep difficulties is known to be common in subjects with fatigue, research on insomnia in such subjects is absent. The current study sought to examine the impact comorbid insomnia has on level of fatigue in subjects with chronic fatigue. The aim of this study is to assess the relationship between insomnia and chronic fatigue, and examine if the relationship is affected by the endocrine activity in the HPA axis. The following hypotheses were tested: 1) Do patients with chronic fatigue and comorbid insomnia experience more fatigue than patients with chronic fatigue without comorbid insomnia? 2) Do patients with chronic fatigue and with initially comorbid insomnia experience more fatigue after treatment than chronic fatigue patients without comorbid insomnia? 3) Do patients with chronic fatigue who experience improvement in insomnia after treatment also experience less fatigue by the end of treatment compared with patients who do not experience improvement in insomnia? 4) Is the potential relationship between insomnia and chronic fatigue influenced by the activity of the HPA axis as expressed by variation in cortisol output measured by Trier Social Stress Test for Groups (TSST-G)? The study sample consisted of 75 patients with chronic fatigue. Thirty-three met criteria for insomnia, while 42 did not. While staying at Hysnes Rehabilitation Center in Trondheim, Norway, they received a work-related Acceptance and Commitment Therapy (ACT) treatment intervention lasting 3.5 weeks. In addition, they participated in a standardized stress test (Trier Social Stress Test) pre- and post-treatment. Saliva cortisol samples were collected during the test in order to measure variation in cortisol output. The current finding is the first description of how insomnia in patients with chronic fatigue is associated with higher levels of fatigue (p < .05). Further, this study gives preliminary support indicating that remission of insomnia in patients with chronic fatigue can significantly reduce levels of fatigue (p < .05), and furthermore improve the physiological stress-response (p < .05). These results might encourage clinicians to assess and provide specific treatment for insomnia in patients with chronic fatigue as this might improve their treatment results. An aim for further research should be to investigate the effect of specified treatment for insomnia in patients with chronic fatigue.

Playing violent video games may provoke aggression. Psycho-physiological methods may provide knowledge about the underlying psychological processes. Most previous studies have been performed in laboratory settings at daytime with adults. Thus the aim of this thesis was to investigate psycho-physiological (autonomic and HPA related reactions), sleep-related and emotional responses in teenage boys to playing a violent and a non-violent video game at home before going to sleep. In Study I the autonomic responses differed between the violent and the non-violent game during playing and more distinctly during sleep. In Study II the HPA axis was not affected by video gaming at all. In Study III, the effect of habits of playing violent games was assessed (≤ 1h/day and ≥ 3h/day). High versus low experience of violent gaming were related to different autonomic, sleep-related and emotional processes at exposure to a violent and a non-violent game, during playing and during sleep. The present thesis demonstrated that violent and non-violent games induce different autonomic responses during playing and – more distinctly – during sleep. Frequent gaming seems to influence physiological, sleep-related and emotional reactions, possibly as an expression of desensitization processes.