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Abstract not available.

Abstract not available.

This collective case study of three men, from a pastoral care perspective, looks at how people change their meaning making and sources of support they find useful as they begin life on hemodialysis. Meaning making, a spiritual process, involves appraising the significance of ourselves and our lives in changing circumstances. The stresses of beginning dialysis may lead to altered meanings. Processes and themes in the subjects' narratives are compared to those from accounts by two more experienced dialysis patients. The new patients regarded this stage in their lives as temporary; the more experienced men had come to greater acceptance. Themes identified included illness cognitions, body images, changing relationships with families and others, the tension between dependence and autonomy, and optimism versus pessimism. The role of the men in determining who they wished to be in the circumstances was noted. Suggestions for further research and for pastoral support are provided.

This study attempts to identify the mechanism of the so-called afternoon nap zone. More specifically, it investigates a recent proposal that the afternoon nap zone represents the point in time after morning awakening when process-S has increased to a sufficiently high level to facilitate sleep onset, while at the same time an SCN-controlled circadian arousal process has not yet risen high enough to reverse this increased sleepiness. Eight normal male subjects aged 20--30 years, were monitored on two separate occasions under low ambient light (150 lux). Night sleep hours were maintained at 23:00--06:00h. PSG monitoring included EEG (C3-A2, O2-A1), right EOG-M1, left EOG-M2, submental EMG and core body temperature recorded continuously by a combination of the Oxford Medilog 9000 8-channel ambulatory recorder and the Minilogger temperature monitoring system. Following a baseline 24-hour day, bright light stimulation (10,000 lux) was given on two consecutive days either in the evening (20:00--22:00h) or morning (06:00--08:00h) in counter-balanced fashion with a 30 day washout periods between. Other than during a period of bright light stimulation, the level of daytime arousal was assessed every 60 min by quantified EEG spectral power followed by a 10 min duration simple reaction time test. In the baseline condition both the performance and Q-EEG variables confirmed the presence of a transitory afternoon nap zone as indexed by the timing of poorest performance and of greatest spectral power in a number of Q-EEG measures. Evening bright light treatment phase delayed these nap zone measures. Conversely, morning bright light phase advanced these measures. The finding that the timing of poorest performance and of the Q-EEG determined nap zone can be phase delayed by evening light and phase advanced by morning light supports the hypothesis tested, as well as supporting the existence of an SCN-dependent circadian arousal system in humans similar to that described by Edgar et al. (1993) in sub-human primates.

Glucose regulation, in both patients with diabetes and nondiabetes patients, has been shown to be associated with neuropsychological function, particularly episodic memory. The main purpose of this study was to examine this association in a large sample of young nondiabetic adults, using a repeated-measures design in which participants were assessed under both, glucose and saccharin conditions. Regression analyses revealed that glucoregulatory indices based on evoked glucose levels significantly predicted the verbal memory performance of 135 young adults, independent of demographic and vascular risk factors. Repeated multiple analyses of variances using cognitive measures by function as dependent variables revealed that worse glucose regulators showed poorer verbal memory performance compared to better glucose regulators, with the performance of average glucose regulators falling in between. There was no effect of solution nor did gender interact with glucose regulation. Although worse regulators showed evidence of hyperinsulinemia, glucoregulatory indices calculated on the basis of insulin levels or fasting glucose levels were less sensitive to cognitive variability relative to indices based on evoked glucose levels. Cardiovascular risk factors were indeed associated with hyperinsulinemia, however, these did not predict cognitive performance in this young group. These results were discussed in light of medial temporal lobe functions, including encoding and retrieval of information, and appear to be mediated by changes in lipid metabolism, insulin receptor distribution and function, and/or genetic susceptibility.

The perception of an event as being potentially harmful or stressful to the individual sets off a cascade of responses, including the activation of neurons located in the hypothalamus. Despite the extensive efforts in understanding the various neurochemical systems regulating this cascade of events, many questions remain unanswered concerning the underlying mechanisms involved. Evidence from our laboratory suggests involvement of bombesin (BB; a peptide of amphibian origin), in the mediation and/or modulation of the stress response. Two BB-like peptides have been identified in mammals, gastrin-releasing peptide (GRP) and neuromedin B (NMB). Experimental evidence acquired thus far seems to suggest the potential involvement of BB-like peptides in the mediation of the stress response as well as other related responses, such as fear and anxiety. However, very few experiments have focused on determining the specific roles of NMB and GRP in mechanisms underlying the integration of stress and/or anxiety responses. Thus, the overall objective of this thesis is to clarify the intrinsic role of each of these peptides in the hope of gaining a better understanding of the underlying mechanisms mediating stress-related responses. This extensive research project provides new evidence suggesting that both endogenous BB-like peptide systems, GRP and NMB, are significantly involved in the modulation/facilitation of stress-, anxiety- and/or fear-related behaviors. Their intrinsic roles appear to be different; whereas NMB seems to mediate both anxiety and fear, GRP seems to selectively alter more robust stress-related behaviors, such as fear. This thesis project provides important additional support for the involvement of this family of peptides in stress related responses. It also provides interesting insight into the different mechanism(s) of action that might underlie stress, anxiety and/or fear. This new evidence should help in the development of more specific, and therefore efficient, therapeutic agents in the prevention and treatment of stress-related disorders.

Insomnia and major depression are both common problems among people with chronic pain. Although each has been studied quite extensively in this population, they have seldom been considered together. Thus, the goal of the present research was to compare patients with chronic pain who either did or did not meet criteria for major depressive disorder, with a particular emphasis on measures of sleep and sleep disturbance. Thirty-three patients with chronic pain and comorbid major depression and 27 chronic pain patients without comorbid major depression completed structured diagnostic interviews on sleep and mood, and completed retrospective and 4-day diary measures of sleep, sleep-related behaviours, sleep-related cognitions, pain, and mood. The measures of sleep-related variables were selected because of their relevance to a cognitive-behavioural model of insomnia. A diagnosis of insomnia was highly prevalent in both groups, with fully 53 of 60 (88.3%) participants meeting DSM-IV criteria. Participants with major depression reported significantly higher levels of pain and more dysfunctional attitudes and behaviours related to sleep. They were also more likely to have sleep disorders other than insomnia. However, specific sleep parameters such as sleep onset latency, time awake after sleep onset, sleep efficiency, and total sleep time did not differ between the groups, whether they were assessed retrospectively or with daily diaries. Insomnia symptoms were highly associated with pain severity among participants with major depression; however, the majority of pain, sleep, and mood-related correlates of insomnia severity did not differ significantly between the groups. Partial correlation coefficients, controlling for pain severity, substantially decreased the associations between depression and cognitive-behavioural variables related to sleep, thus suggesting that pain may be more important than depression in the etiology of insomnia. That is, chronic pain itself may disturb sleep so extensively that comorbid depression has little incremental effect. The results are discussed in terms of the potential applicability of cognitive-behavioural interventions for insomnia in chronic pain patients with comorbid major depressive disorder.

The purpose of this dissertation is to examine the role internalized shame and Post Traumatic Stress Disorder (PTSD) play in the treatment outcomes of people in methadone programs. Clients at two methadone treatment sites were surveyed with Cook's Shame Scale and the MEMPI PK and PS sub-scales for PTSD. Over 63%—ten times that found in the general population and two and a half times the frequency found in other chemically dependent populations—tested for PTSD, which is often passed over as a generalized anxiety disorder. The study showed that the symptoms of PTSD, internalized shame and low self-esteem are highly intercorrelated in this population. The study also showed that there is a strong relationship between internalized shame and PTSD test scores, methadone dose levels, are predictors and the frequency of drug use, frequency which are treatment outcome variables. Secondary findings show that there is a correlation between sexual abuse, age of first drug use, shame and PTSD scores. Internalized shame, PTSD PS Scale scores and race also showed some trends. These findings, along with research on the biochemical effects of not only chemical dependency, but also of trauma and internalized shame support the understanding that PTSD and internalized shame do play a role in affecting treatment outcomes. Research in related fields describe biochemical feedback loops created by responses to trauma and the biochemistry of chemical dependency. These feedback loops are perpetuated and exacerbated by continued drug use and untreated trauma symptomology. The resultant biochemical deficiencies can be stabilized and replenished through time when direct interventions are made on the physical, behavioral and emotional levels of treatment. Methadone, while helping to decrease the use of heroin, may actually contribute to furthering the progression of chemical dependency and block treatment of PTSD by covering symptoms which when addressed could lessen or resolve and improve treatment outcomes. Further studies, which find ways to examine and measure these different aspects of trauma, internalized shame and PTSD need to be designed to understand more clearly how these conditions affect various outcome variables. A variety of therapeutic modalities which focus on overall wellness and recovery can be used and tested to design comprehensive treatment. Hopefully, this study will begin to build a bridge between conventional methadone treatment—which uses behavioral modification and drug replacement therapies—with the exciting new findings in neurobiochemistry.

Sleep disturbances are common in persons with Alzheimer's disease (AD) (Hart et al., 2003) and pose a great strain on their family caregivers (Hope, Keene, Gedling, Fairburn, & Jacoby, 1998) including their emotional functioning (Schulz & Martire, 2004). The current study is the first to examine the impact of daily sleep and mood in persons with AD on their caregiver's sleep and emotional functioning. The study examined sleep and mood across eight days in 40 family caregivers of persons with AD. It was hypothesized that poor sleep in the person with AD person would have a negative impact on caregiver emotional functioning the next day. Furthermore, it was hypothesized that sleep disruption or the mood in the person with AD would mediate the association between AD person sleep and caregiver mood. The results demonstrated a direct link between poor sleep in persons with AD and caregiver negative affect (NA), but not positive affect (PA). The results also indicated that poor caregiver sleep and NA in the person with AD partially mediated the relationship between AD person sleep and caregiver NA. The results suggest that addressing AD person and caregiver sleep and AD person affect may improve caregiver emotional functioning. Improving AD person sleep and mood, and caregiver emotional functioning has important implications that may prolong the time until institutionalization.