Não há consenso na literatura quanto à utilização da laserterapia de baixa intensidade (LLLT) no tratamento da DTM dolorosa. O objetivo deste estudo foi analisar a efetividade da LLLT ativa e placebo na redução da dor, da ansiedade e do cortisol salivar de mulheres com dor miofascial em função das flutuações hormonais relacionadas ao ciclo menstrual. 124 mulheres, 94 diagnosticadas com dor miofascial (Research Diagnostic Criteria for Temporomandibular Disorders) foram divididas em: grupo laser (31), placebo (30), sem tratamento (33) e controle (30). A LLLT foi aplicada em pontos pré-estabelecidos da região orofacial, 2x/semana, oito sessões (780 nm, masseter e temporal anterior = 5 J/cm2, 20 mW, 10 segs. e região da ATM = 7,5 J/cm2, 30 mW, 10 segs.). A dor foi mensurada quanto à sua intensidade (Escala Visual Analógica), sensibilidade (limiar de dor à pressão em pontos orofaciais e corporais, LDP) e aspectos qualitativos/afetivos (Versão Reduzida do Questionánio de Dor de McGill, SF-MPQ). Além disso, foi dosado o cortisol salivar matutino a fim de se estabelecer os níveis de estresse, e aplicado o Inventário de Ansiedade de Beck para avaliar a ansiedade percebida. Foram também coletados dados relativos ao ciclo menstrual (data da última menstruação, uso de anticoncepcional, menopausa). Para as comparações intra-grupos ao longo da LLLT foram utilizados os Testes de Friedman e Kruskal-Wallis; para as comparações inter-grupos, o Mann-Whitney (p < 0,05). As mulheres com dor miofascial apresentaram LDP reduzido em relação às controles, não houve variação do LDP para nenhum grupo após a LLLT. Foi observada redução da intensidade de dor para os três grupos em comparação ao momento inicial (p < 0,05): Laser (80%), Placebo (85%) e Sem Tratamento (43%). Apenas no grupo Laser houve manutenção da redução da intensidade de dor de mulheres que não faziam uso de anticoncepcionais após 30 dias de finalização da LLLT (p < 0,001). O período pré-menstrual se mostrou crítico para todas as variáveris analisadas. Houve redução do escore total do SF-MPQ e da ansiedade para todos os grupos (p < 0,05). Os níveis de cortisol não diferiram entre mulheres com dor miofascial e controles, e também não variaram ao longo do tratamento. A LLLT ativa e placebo são capazes de reduzir variáveis subjetivas (intensidade de dor, índices do SF-MPQ e ansiedade), porém não alteram a sensibilidade à dor da região orofacial ou de pontos corporais, e o cortisol salivar. Ambas apresentam efetividade clínica similar em mulheres com dor miofascial durante o período de tratamento (sessões de laser), embora o laser ativo seja mais efetivo na manutenção dos resultados em mulheres em idade fértil sem o uso de anticoncepcionais (maior flutuação hormonal) / There is no consensus in the literature regarding the use of low-level laser therapy (LLLT) in the treatment of painful TMD. The aim of this study was to analyze the effectiveness of active and placebo LLLT in reducing pain, anxiety and salivary cortisol in women with myofascial pain based on the hormonal fluctuations related to the menstrual cycle. 124 women, 94 diagnosed with myofascial pain (Research Diagnostic Criteria for Temporomandibular Disorders) were divided into: laser group (31), placebo (30), without treatment (33) and control (30). The LLLT was applied at pre-established points of the orofacial region, 2x/week, eight sessions (780 nm, masseter and anterior temporal = 5 J/cm2, 20 mW, 10 sec. and ATM region = 7.5 J/cm2, 30 mW, 10 sec.). The pain was measured in terms of intensity (Visual Analogue Scale), sensitivity (pressure pain threshold at orofacial and corporal points, PPT) and qualitative/affective aspects (Short-Form of the McGill Pain Questionnaire, SF-MPQ). In addition, the morning salivary cortisol was measured to establish the stress levels, and the Beck Anxiety Inventory was applied to evaluate the perceived anxiety. Data of the menstrual cycle were also collected (date of last menstruation, use of oral contraceptives, menopause). For intra-group comparisons over LLLT, the Friedman and Kruskal-Wallis tests were used; for intergroup comparisons, Mann-Whitney (p < 0.05). Women with myofascial pain showed reduced PPT when compared to controls, there was no change in PPT for any group after LLLT. Pain intensity reduction was observed for all groups compared to the baseline (p < 0.05): Laser (80%), Placebo (85%) and Without Treatment (43%). Only in the Laser group, pain intensity reduction was maintained in women who did not use oral contraceptives after 30 days of LLLT completion (p < 0.001). The pre-menstrual period was critical for all variables analyzed. There was a reduction in SF-MPQ total scores and anxiety for all groups (p < 0.05). Cortisol levels did not differ between women with myofascial pain and controls, besides they did not vary with the treatment. Active and placebo LLLT can reduce subjective variables (pain intensity, SF-MPQ indices and anxiety), but they do not change pain sensitivity at orofacial and corporal points, and salivary cortisol. Active and placebo LLLT shows similar clinical effectiveness in women with myofascial pain during the treatment period (laser sessions), although the active laser is more effective in maintaining the results in women of fertile age without oral contraceptives use (higher hormonal fluctuation)

As diferenças entre os sexos e o impacto dos hormônios sexuais no processamento emocional normal e patológico destacam-se na investigação do dimorfismo sexual na frequência, diagnóstico e terapêutica de patologias psiquiátricas. Transtornos depressivos e ansiosos não apenas são mais comuns em mulheres, quando comparadas aos homens, como parecem ser influenciados pelas concentrações hormonais séricas das mulheres em diferentes fases do ciclo reprodutivo. Ao mesmo tempo, o sexo e as concentrações dos hormônios sexuais, mostram influência na função do cérebro em uma diversidade de tarefas cognitivas e emocionais. O reconhecimento de expressões faciais de emoções básicas tem sido visto como função de extrema importância na adaptação social do indivíduo e existem evidências de que esteja relacionado com o desenvolvimento de transtornos psiquiátricos. Já foi demonstrado que esta tarefa é influenciada pelo sexo do indivíduo e seu ambiente hormonal, no entanto, a literatura carece de resposta sobre os mecanismos pelos quais estas diferenças acontecem. Em dois experimentos buscamos maior entendimento de como se dão as diferenças entre os sexos no reconhecimento de expressões faciais de emoções básicas (raiva, asco, medo, tristeza, surpresa e alegria). No experimento 1, 33 voluntários saudáveis do sexo masculino e 30 do sexo feminino foram testados quanto à acurácia no reconhecimento de expressões faciais, ao tipo de erro ao realizar esta tarefa e à emoção despertada durante este reconhecimento. No experimento 2, 24 voluntárias saudáveis foram testadas quanto à acurácia no reconhecimento de expressões faciais em três diferentes fases do ciclo menstrual: fase folicular precoce (primeiro ao quinto dia do ciclo), periovulatória (décimo segundo ao décimo quarto dia do ciclo), e lútea (vigésimo primeiro ao vigésimo terceiro dia do ciclo), em delineamento cruzado. Foi realizada dosagem sanguínea de estradiol, progesterona e testosterona ao final de cada sessão experimental, com o intuito de confirmar a fase do ciclo das voluntárias e buscar possíveis correlações entre esses hormônios e o processamento de expressões faciais. Utilizou-se análise de contraste na avaliação do desempenho no reconhecimento de todas as emoções básicas com o desempenho no reconhecimento da emoção alegria. No experimento 1, raiva e medo em faces femininas foram reconhecidos com maior acurácia por mulheres, quando comparadas aos homens. Não foram encontradas diferenças significativas entre os sexos quanto à emoção despertada durante a visualização de expressões faciais. O experimento 2 mostrou que o reconhecimento das emoções asco e tristeza em faces masculinas variou de maneira significativa durante as fases do ciclo menstrual. As mulheres na fase lútea obtiveram maior acurácia no reconhecimento de expressões de asco em comparação com a fase folicular precoce, enquanto o desempenho no reconhecimento de tristeza foi maior na fase periovulatória do que na fase lútea. Os resultados sugerem que as diferenças entre homens e mulheres na capacidade de reconhecer emoções não estejam relacionadas à valência da emoção despertada nos indivíduos durante o processamento emocional. A modulação do reconhecimento de expressões faciais pelas fases do ciclo menstrual aponta que este seja um dos fatores implicados nas diferenças entre os sexos nesta tarefa / The impact of sex and sexual hormones in the normal and pathological emotional processing has reached unique importance in the investigation of sexual dimorphism in prevalence, diagnostic features and therapeutics of psychiatric disorders. Depressive and anxiety disorders are not only more common in women compared to men, but they also seem to be influenced by the hormonal status of women at different stages of the reproductive cycle. At the same time, the sex of the subject and the level of sex hormones have been suggested to play a role in brain function in a variety of emotional and cognitive tasks. The recognition of facial expressions of basic emotions has been recognized not only as of extreme importance in social adjustment as there is also evidence of its relation to the development of psychiatric disorders. It has been shown that this task is influenced by the sex and hormonal status of subjects, however, the literature shows a gap in explanations about how these differences occur. In two experiments we sought a better understanding of how sex differences in facial expressions recognition of basic emotion (anger, disgust, fear, sadness, surprise, happiness and neutral) happens. In experiment 1, 33 male and 30 female healthy volunteers were tested for accuracy in the recognition of facial expressions, the type of error when performing this task as well as the emotion aroused during this recognition. In experiment 2, 24 healthy female volunteers were tested for accuracy in the recognition of facial expressions in 3 different phases of menstrual cycle, early follicular (days 1 to 5), periovulatory phase (days 12 to 14) and luteal phase (days 21 to 23), in a crossover study design. Volunteers were tested for blood levels of estrogen, progesterone and testosterone at the end of each experimental session in order to confirm cycle phase and look for possible correlations between hormones and processing of facial expressions. We used contrast analysis in the recognition of each basic emotion against the recognition of happiness. In experiment 1, anger and fear, in feminine faces, were more accurately recognized by women in comparison to men. No significant differences among sexes were found on the emotion aroused while viewing facial expressions. Experiment 2 showed that the recognition of the emotions disgust and sadness, in male faces, varied significantly during the menstrual cycle phases. Women in luteal phase showed greater accuracy in recognizing expressions of disgust than when in early follicular phase whereas the recognition of sadness were more accurate during periovulatory phase than during luteal phase. These results suggest that differences between men and women in the ability to recognize emotions are not related to the valence of the emotions aroused in the subjects during emotional processing. This study also showed that the role played by the menstrual cycle in the ability to recognize facial expressions points to this feature as an important factor implicated in sex differences in this task.

O objetivo deste trabalho foi analisar o comportamento das interleucinas 12 (IL- 12) e 18 (IL-18) em pacientes com endometriose pélvica comparando-as a pacientes de um grupo controle com sintomas sugestivos de endometriose e ausência comprovada da doença. Avaliamos, também, as dosagens das referidas interleucinas em relação à fase do ciclo menstrual, quadro clínico, local da doença, estadiamento e classificação histológica. PACIENTES E MÉTODOS: Foram avaliadas 105 pacientes entre 18 e 40 anos submetidas à videolaparoscopia, ; divididas em 2 grupos: 72 pacientes com endometriose e 33 controles. Colheu-se sangue periférico e fluido peritoneal no intra-operatório e procedeu-se a avaliação das interleucinas, relacionando-se as dosagens entre o grupo controle e o grupo com endometriose e também entre os parâmetros já mencionados. Dividimos as pacientes segundo a fase do ciclo menstrual, o quadro clínico, o local de maior gravidade da doença (peritoneal, ovariana ou profunda), o estadiamento e a classificação histológica. As dosagens das interleucinas foram feitas através do método de ELISA e a análise estatística pela aplicação dos testes Kruskal-Wallis e Dunn. RESULTADOS: A média das dosagens da IL-12 no fluido peritoneal foi significativamente maior nas pacientes com endometriose (82,37 +/- 16,61 pg/mL) que no grupo controle (29,20 +/- 10,21pg/mL), p < 0,001. Não houve diferenças significativas na comparação das dosagens séricas de IL-12 entre pacientes e grupo controle. As médias das dosagens da IL-12 no sangue de pacientes com endometriose avançada foi significativamente mais elevada (196,74 +/- 33,71 pg/mL) que aquela de pacientes com doença inicial (82,04 +/- 16,63 pg/mL), p = 0,007. Não houve diferenças significativas entre as dosagens de IL-18 no sangue e no fluido peritoneal de pacientes e grupo controle, nem em relação à comparação entre doença inicial e doença avançada. As médias das dosagens de IL-12 no fluido peritoneal foram mais elevadas em pacientes com endometriose com dismenorréia severa/incapacitante (82,21 +/- 20,54 pg/mL; p = 0,02), dispareunia de profundidade (101,62 +/- 29,25 pg/mL; p = 0,02) e dor acíclica (101,93 +/- 26,14 pg/mL; p = 0,02). As médias das dosagens de IL-18 no sangue foram mais elevadas em pacientes com endometriose com dismenorréia severa/incapacitante (77,59 +/- 16,50 pg/mL; p = 0,01) e dispareunia de profundidade (61,34 +/- 14,05 pg/mL; p = 0,03). Não houve diferenças significativas entre as dosagens de IL-12 e IL-18, no sangue ou no fluido peritoneal, de acordo com a localização da doença (peritônio, ovário ou doença profunda). Não houve diferenças significativas entre as dosagens de IL-12 e IL- 18, no sangue ou no fluido peritoneal, de acordo com a classificação histológica da doença (estromal, bem-diferenciada, padrão misto de diferenciação e indiferenciada). CONCLUSÕES: A interleucina 12 esteve aumentada no fluido peritoneal de pacientes com endometriose, e no sangue nos estádios avançados da doença. Não houve diferenças nas dosagens da interleucina 18 no sangue ou fluido peritoneal na endometriose em relação a mulheres sem a doença. / The aim of this work was to evaluate the behavior of interleukines 12 (IL-12) and 18 (IL-18) in patients with pelvic endometriosis comparing them with a control group that presented suggestive symptoms of endometriosis and proven absence of the disease, evaluating, also, the levels of the interleukines in relation to the phase of menstrual cycle, clinical symptoms, primary location, disease stage and histological classification. PATIENTS AND METHODS: 105 patients aging from 18 to 40 years have been submitted to the laparoscopic surgery and classified in 2 groups: 72 patients with endometriosis and 33 controls. Peripheral blood and peritoneal fluid were extracted and interleukins were evaluated, correlating the levels between the control group and the group with endometriosis, and also between the parameters previously mentioned. Patients were grouped according to the phase of the menstrual cycle, clinical symptoms, primary location, disease stage and histological classification. Interleukin levels have been measured by ELISA . Statistical analysis was performed by the application of Kruskal-Wallis and Dunn tests. RESULTS: Average levels of IL-12 in the peritoneal fluid was significantly higher in patients with endometriosis (82,37 +/- 16.61 pg/mL) when compared to the control group (29,20 +/- 10,21pg/mL), p < 0,001. No significant differences were found in the comparison of the serum levels of IL-12 between patients and control group.) Average levels of IL-12 in blood of patients with advanced endometriosis were significantly increased (196,74 +/- 33.71 pg/mL) when compared to patients with initial disease (82,04 +/- 16,63 pg/mL), p = 0,007. There were no significant differences between the levels of IL-18 in blood and in peritoneal fluid of patients and control group, nor between patients with initial disease and advanced disease. Average levels of IL-12 in peritoneal fluid were higher in patients with endometriosis with complaints of severe / incapacitating dysmenorrhea (82.21 +/- 20,54 pg/mL; p = 0,02), deep dyspareunia (101,62 +/- 29,25 pg/mL; p = 0,02) and acyclic pain (101,93 +/- 26,14 pg/mL; p = 0,02). Average levels of IL-18 in the blood were higher in patients with endometriosis and severe /incapacitating dysmenorrhea (77,59 +/- 16,50 pg/mL; p = 0,01) and deep dyspareunia (61,34 +/- 14,05 pg/mL; p = 0,03). There were no significant differences between the levels of IL-12 and IL-18, in blood or in peritoneal fluid, according to the primary location of the disease (peritoneal, ovarian or deep infiltrative disease). No significant differences were found between the levels of IL-12 and IL-18, in blood or peritoneal fluid, in accordance to the histological classification of the disease (estromal, well-differentiated, combined standard of differentiation and undifferentiated). CONCLUSIONS: Interleukin 12 wss increased in peritoneal fluid of patients with endometriosis, and in blood in advanced stages of the disease. There were no differences in the levels of interleukin 18 in blood or peritoneal fluid in endometriosis compared to women without the disease.

Introdução: o diagnóstico da Síndrome do Ovário Policístico (SOP) na adolescência é desafiador e vem sendo alvo de intensas discussões. Sua prevalência em mulheres adultas em idade fértil varia de 5-10%. Entretanto, a prevalência em adolescentes obesas ainda não foi descrita na literatura. Somado a isso, ainda não é bem estabelecida a relação da SOP com alterações metabólicas e cardiovasculares nesta população. Dessa maneira, objetivamos avaliar a prevalência e as características da SOP na população de adolescentes obesas acompanhadas em um centro hospitalar quaternário. Métodos: realizamos um estudo transversal com 49 adolescentes obesas pós-menarca, com idade média de 15,6 anos. Foi realizada avaliação antropométrica e revisão de prontuários médicos. O hiperandrogenismo clínico e laboratorial foram quantificados utilizando o índice de Ferriman-Gallwey e as dosagens androgênicas, respectivamente. A morfologia ovariana foi avaliada por ultrassonografia suprapúbica. Todas as pacientes tiveram seus perfis metabólicos analisados. Resultados: ao adotarmos a nova Diretriz para SOP na adolescência da Sociedade de Endocrinologia Pediátrica Americana, encontramos uma prevalência de 18,4% de SOP em nossa população de adolescentes obesas. Quando utilizamos os critérios de Rotterdam, da Sociedade de Excesso Androgênico e SOP e do Instituto Nacional de Saúde Americano, as prevalências foram de 26,4%, 22,4% e 20,4%, respectivamente. A irregularidade menstrual foi constatada em 65,3% das pacientes. O hiperandrogenismo clínico foi observado em 16,3% das meninas, e 18,4% tinham concentrações de testosterona total acima do valor de normalidade. A ultrassonografia revelou que 18,4% das meninas tinham ovários policísticos. Adolescentes obesas com SOP apresentaram maior prevalência de síndrome metabólica. Conclusão: a prevalência de SOP em adolescentes obesas é alta quando comparada àquela observada na literatura / Background: polycystic ovary syndrome (PCOS) in adolescence is a challenging diagnosis and therefore has raised intense discussions. Its prevalence in childbearing age women ranges from 5 to 10%. However, the prevalence in obese adolescents has not yet been reported. Besides, the relationship of PCOS with metabolic and cardiovascular disorders in this specific population has not been established. Thus, we aimed to assess the prevalence and characteristics of PCOS in a population of obese adolescents followed at a quarternary hospital. Methods: we performed a cross-sectional study with 49 postmenarcheal obese adolescents with a mean age of 15.6 years. Anthropometric assessment and review of medical records were performed. Clinical and laboratory hyperandrogenism were evaluated using Ferriman-Gallwey index and serum androgens, respectively. The ovarian morphology was evaluated by supra-pubic ultrasound. All patients had their metabolic profile evaluated. Results: the prevalence of PCOS in obese adolescents, according to the new guideline for PCOS in adolescence of the American Pediatric Endocrinology Society, was 18.4%. When assessed by the Rotterdam, the Androgen Excess and PCOS Society and the National Institute of Health criteria, the prevalence of PCOS was 26.4%, 22.4% and 20.4%, respectively. Menstrual irregularity was found in 65.3% of the patients. Clinical hyperandrogenism was observed in 16.3% while 18.4% had total testosterone concentrations above the normal range. Ultrasonography revealed that 18.4% had polycystic ovaries. Obese adolescents with PCOS had higher prevalence of metabolic syndrome. Conclusion: the prevalence of PCOS in obese adolescents is high compared to that observed in the literature

Ovarian steroid hormones are neuroactive steroids with widespread actions in the brain, and are thus able to influence mood, behavior and cognition. In this thesis the effects of progesterone withdrawal and the direct effects of the progesterone metabolite allopregnanolone are evaluated. Allopregnanolone, through binding to the GABAA receptor complex, enhances inhibitory neurotransmission, thus exerting anxiolytic, sedative and antiepileptic effects. The acoustic startle response (ASR) is a withdrawal reflex evoked by sudden or noxious auditory stimuli, and can be measured in humans as an eye blink. ASR is significantly increased in several anxiety disorders, and notably also during progesterone withdrawal. Sensorimotor gating can be assessed by measuring prepulse inhibition of the startle response (PPI). The CNS circuits regulating PPI are sensitive to hormone fluctuations. GABAergic drugs are involved in cognitive impairment and animal studies have indicated that allopregnanolone may inhibit learning. The main purpose of this research was to evaluate the behavioral effects of progesterone withdrawal on the startle response and sensorimotor gating in PMDD patients and healthy controls, in healthy third trimester pregnant women and healthy postpartum women. A second aim was to evaluate allopregnanolone effects on memory and cognition in healthy women and also on the startle response and PPI. We found that PMDD patients have an increased startle response across the menstrual cycle and a deficiency in sensorimotor gating during the late luteal phase. Ovarian steroids affect sensorimotor gating; pregnant women have lower levels of PPI than late postpartum women. Acutely administered allopregnanolone did not affect the ASR or PPI. Allopregnanolone impairs episodic memory in healthy women. In conclusion, our studies suggest that ovarian steroids, including allopregnanolone, do not influence the startle response. Ovarian steroids affect sensorimotor gating; pregnancy, a condition with high levels of ovarian steroids, suppresses PPI. Theoretically, the variability in PPI across reproductive events is due to effects mediated by the progesterone or estradiol receptors but is not mediated by allopregnanolone. PMDD patients display decreased PPI during the late luteal phase, suggesting underlying pathophysiology in common with other anxiety disorders. The most vulnerable memory system, the episodic memory, is impaired by the allopregnanolone in healthy women.

Background: Estrogen has been reported to enhance well-being and quality of life during the climacteric phase. In women with an intact uterus estrogen treatment is always combined with progestins in order to protect the endometrium from hyperplasia and malignancies. However, in certain women the addition of progestins causes cyclicity in negative mood symptoms and physical symptoms similar to those encountered during ovulatory cycles in women with premenstrual dysphoric disorder (PMDD). The ovarian hormones estradiol and progesterone have profound effects on a number of neurotransmitter systems in the brain, such as the gamma aminobutyric acid (GABA) system and the serotonergic system. Progesterone metabolites, such as allopregnanolone and pregnanolone (also referred to as neurosteroids) modify the GABAA receptor in the central nervous system (CNS) and enhance GABAergic inhibitory transmission. Neurosteroid sensitivity in human studies can be studied by saccadic eye movement measurements using pharmacodynamic challenges with pregnanolone. Altered neurosteroid sensitivity has been suggested as a possible contributory factor to the progesterone/progestin-induced adverse mood effects of hormone replacement therapy (HRT). There is also evidence of estrogen treatment affecting the serotonergic system in postmenopausal women, although progestin addition has been less well studied. Aims and method: The aim was to investigate whether the negative mood symptoms experienced during the progestin or progesterone phase of HRT were associated with changes in neurosteroid sensitivity, or changes in platelet serotonin uptake site (transporter) and serotonin2A (5-HT2A) receptor binding. The intention was also to investigate whether hormonal changes during the normal menstrual cycle affect these peripheral serotonergic parameters. Postmenopausal women with climacteric symptoms were given HRT in two randomized, double-blinded, placebo-controlled crossover studies. The women received 2 mg estradiol (E2) continuously during 28- day cycles. Synthetic progestins or natural progesterone were added sequentially during the last 14 days, and compared to a placebo addition. Before treatment, as well as during the last week of each treatment cycle the pharmacodynamic response to pregnanolone was assessed using saccadic eye movement measurements. Throughout the studies daily symptom ratings were made. In the study regarding synthetic progestins, platelet serotonin transporter and 5-HT2A receptor binding were assayed before entering the study, as well as during the last week of each treatment cycle. In the study on reproductive women, blood samples were collected for analysis of platelet serotonin transporter and 5-HT2A receptor binding at six different points in time during the menstrual cycle. Results and conclusion: The addition of synthetic progestins to estrogen treatment increased negative mood symptoms and physical symptoms, whereas positive symptoms decreased. The addition of progestins also increased the sensitivity to pregnanolone. The addition of natural progesterone to estrogen treatment increased the sensitivity to pregnanolone. However, in this study the pregnanolone sensitivity was enhanced also during estrogen treatment. Women expressing cyclicity in negative mood symptoms were more sensitive to pregnanolone than women without symptom cyclicity. Thus, it is evident that mood deterioration during HRT is associated with altered neurosteroid sensitivity. Platelet serotonin transporter and 5-HT2A receptor binding did not change during the different treatment conditions in HRT. Thus, we were unable to explain the negative mood changes of HRT by use of these peripheral serotonergic parameters. In the study on reproductive women however, it was clear that the serotonergic variables did change during the menstrual cycle. Binding to the serotonin transporter was higher in the late follicular phase than in the ovulatory, early luteal or mid-luteal phases. Binding to the 5-HT2A receptor was higher in the early follicular phase and the early luteal phase than in the mid-luteal phase. These findings may provide a link between the ovarian steroids, and the GABAergic and serotonergic neurotransmitter systems, which in turn, could explain part of the specific vulnerability that women have for the development of adverse mood effects during HRT, mood and anxiety disorders and for the deterioration of mood so frequently seen during the luteal phase.

The World Health Organization-Composite International Diagnostic Interview (WHO-CIDI) is a highly structured interview for the assessment of mental disorders, based on the definitions and criteria of the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Over the past decade it has become evident that the CIDI does not sufficiently address the assessment needs of women. Women are affected by most mental disorders, particularly mood and anxiety disorders, approximately twice as frequently as men. Women-specific disorders, such as Premenstrual Syndrome (PMS), Premenstrual Dysphoric Disorder (PMDD), psychiatric disorders during pregnancy and postpartum as well as during the perimenopause, menopause and beyond are not addressed by the standard CIDI diagnostic modules. In addition, the CIDI in its current form does not address the potential effect that female reproductive milestones may have on diagnosis, treatment and prevention of mental disorders in women. Our aim was to develop a new women specific platform (CIDI-VENUS; CIDI-V) to be embedded in the existing CIDI that will address the above mentioned current deficiencies. Guided by a team of experts in the field of Women’s Mental Health from Canada and Germany the following modules were developed: 1) A complete menstrual history and comprehensive contraceptive history with a link to the Premenstrual Symptoms Screening Tool (PSST). 2) A complete perinatal history of pregnancies, miscarriages, terminations, still births, death of a child, with details of current pregnancy including gestation and expected date of confinement, labour history and breastfeeding, history of tobacco, alcohol, and other substance use including prescription drugs during pregnancy and postpartum, a section on specific phobias and on recurrent obsessive/compulsive thoughts/behaviours (OCD) related to the baby with a link to the Perinatal Obsessive-Compulsive Scale (POCS), as well as a link to the Edinburgh Postnatal Depression Scale (EPDS). 3). A detailed history of use of hormone therapy (e.g. pills, patches, implants, etc.) with a focus on (peri-) menopausal women, differentiating between physical and psychological symptoms with a link to the Menopause Visual Analogue Scales (M-VAS) and to the Greene Climacteric Scale. 4) An iterative module concluding each CIDI section to specify the course of mental disorders during the reproductive stages and menopausal transition. While retaining core diagnostic sections and diagnostic algorithms, the CIDI-V is enriched by women-specific diagnostic modules, providing a wealth of clinically relevant information about women’s mental health, not available anywhere else in our current psychiatric diagnostic instruments.

It is known that some psychiatric disorders may deteriorate in relation to the menstrual cycle. However, in some conditions, such as premenstrual dysphoric disorder (PMDD), symptomatology is triggered mainly by the variations in ovarian steroid hormones. Although symptoms induced by fluctuations in ovarian steroids often are affective, little is known about how emotion processing in women is influenced by variations, or actual levels, of ovarian steroid hormones. The general aim of this thesis was to evaluate menstrual cycle effects on reactivity in emotion generating and controlling areas in the corticolimbic system to emotional stimulation and anticipation, in healthy controls and women with PMDD. A second aim was to evaluate corticolimbic reactivity during long-term administration of exogenous ovarian steroids. In study I, III and IV effects of the menstrual cycle on emotional reactivity in women with PMDD was studied. In study I, women with PMDD in displayed higher amygdala reactivity than healthy controls to emotional faces, not in the luteal phase as was hypothesised, but in the follicular phase. No difference between menstrual cycle phases was obtained in women with PMDD, while healthy controls had an increased reactivity in the luteal phase. The results of study I was further elaborated in study III, where women with PMDD were observed to have an increased anticipatory reactivity to negative emotional stimuli. However, no differences in amygdala reactivity to emotional stimuli were obtained across the menstrual cycle. Finally, in study IV the hypothesis that amygdala reactivity increase in the luteal phase in women with PMDD is linked to social stimuli rather than generally arousing stimuli was suggested, tested and supported. In study II, re-exposure to COC induced mood symptoms de novo in women with a previous history of COC-induced adverse mood. Women treated with COC reported increased levels of mood symptoms both as compared to before treatment, and as compared to the placebo group. There was a relatively strong correlation between depressive scores before and during treatment. The effects of repeated COC administration on subjective measures and brain function were however dissociated with increased aversive experiences accompanied by reduced reactivity in the insular cortex.

Il apparaît, suite aux résultats de plusieurs études comportementales et d’imagerie cérébrale, que les hormones gonadiques peuvent moduler le fonctionnement cérébral chez la femme. Les asymétries cérébrales fonctionnelles (ACFs), en particulier, changeraient en fonction du niveau de progestérone et d’œstrogène. On a également observé que lorsque le taux d’œstrogène est bas, les performances aux tâches impliquant l’hémisphère droit sont améliorées. Par contre, les preuves de l’action physiologique de ces deux hormones sur le cerveau ne sont pas très nombreuses. Le peu d’études d’électrophysiologie cognitive qui ont porté sur les effets du cycle menstruel ont rapporté que la composante P300 y serait sensible. Aucune n’a cependant utilisé une tâche d’habileté spatiale ou de rotation mentale qui sont connues pour impliquer davantage l’hémisphère droit. Le but de la présente étude est de documenter les changements électrocorticaux reliés aux variations hormonales lors d’une tâche de rotation mentale. Notre hypothèse de départ est que le taux d’œstrogène influencera l’activité électrocorticale et la latéralisation. Les potentiels évoqués cognitifs ont été comparés chez les mêmes femmes (n=12) lors d’une tâche de rotation mentale, répétée à deux périodes du cycle menstruel. Nos résultats démontrent que la condition de rotation induit une latéralisation de l’activité pariétale, vers l’hémisphère gauche, quand le niveau d’œstrogène est bas. Par contre, lorsque le niveau d’œstrogène est élevé, il n’y a aucune latéralisation. Par ailleurs, nous avons observé une augmentation de l’amplitude de la P300 lors du niveau oestrogénique élevé. En conclusion, les fluctuations oestrogéniques du cycle menstruel ont un impact sur la latéralisation de l’activité électrocorticale, lors d’un effort de rotation mentale. / After many behavioral and some neuroimaging studies, it appears that the gonadic hormones can modulate the neuronal function of women's brain. In particular, the functional cerebral asymmetries can be affected by the level of progesterone and estrogens. It has been observed that when the level of estrogen is low, the performance at task that engages more the right hemisphere is enhanced. However, there is a lack of evidence for the physiological actions of these two hormones on the brain. The few event-related potential studies taking into account the menstrual cycle effects, had noticed that the component P300 can be affected. No electrophysiological study has used a mental rotation task or spatial ability tests which are known for their right hemisphere dominance. The aim of the present research is to document the effect of hormonal variations on the electrocortical activity, using a mental rotation task. Our hypothesis is that estrogen levels affect electrocortical activity and lateralization. The ERPs were compared in the same women (n = 12) during a mental rotation task, repeated over two periods of the menstrual cycle. Our results show a lateralization of the left parietal activity when estrogen levels are low and during the rotation. Whereas when the estrogen level is high, there is no lateralization. In addition, we observed an increase in the amplitude of P300 for this same high level. In conclusion, estrogens fluctuations associated with the menstrual cycle have an impact on the lateralization of electrocortical activity, when a mental rotation is needed.

Eteriniai aliejai plačiai naudojami aromaterapijoje, kosmetologijoje, farmacijoje bei parfumerijoje. Nors plačiai kalbama apie eterinių aliejų įtaką žmogui ir jų panaudojimą, tačiau moksliniais tyrimais patvirtintų duomenų apie jų poveikį nėra daug. Šio magistrinio darbo tikslas - ištirti levandų eterinių aliejų poveikį kognityvinėms funkcijoms ir širdies ritmui. Eksperimentai buvo atliekami su 19-25 metų amžiaus vyrais ir moterimis. Moterys buvo tiriamos folikulinės, ovuliacinės, geltonkūnio ir vėlyvosios geltonkūnio mėnesinių ciklo fazių metu, o vyrai – vieno eksperimento metu kvėpavo levandų eteriniu aliejumi, kito – vandeniu. Kiekvieno eksperimento metu prieš ir po kvėpavimo levandų eteriniu aliejumi buvo atliekami kognityviniai (trumpalaikės regimosios atminties, dėmesio ir reakcijos laiko) testai bei nenutrūkstamai registruojama elektrokardiograma. Naudojant Eysenck‘o testą buvo įvertintas tiriamųjų intraversijos - ekstraversijos ir neurotiškumo - emocinio stabilumo asmenybės bruožų išreikštumas. Gauta, kad: 1. Neskirstant tiriamųjų į grupes negautas reikšmingas kvėpavimo levandų eteriniu aliejumi poveikis reakcijos laikui, trumpalaikei regimajai atminčiai, dėmesio parametrams – protino produktyvumo koeficientui, regimosios informacijos apimčiai, informacijos apdorojimo greičiui bei širdies ritmui. 2. Dėmesio tikslumo koeficientas po kvėpavimo eteriniu aliejumi statistiškai patikimai geresnis nei prieš kvėpavimą, kai tiriamieji neskirstomi į grupes. Vyrams šis... [toliau žr. visą tekstą] / Essential oils are mostly used in aromatherapy, cosmetics, pharmacology and in perfumes industry. Though there are wide discussions about influence of essential oils on the human organism, there are not many scientific studies on the influence of these oils and mechanisms of their action. The main purpose of Master thesis is to investigate influence of lavender essential oil on cognitive functions and heart rate. The experiments were conducted with 19 -25 years old males and females. Women were examined in the follicular, ovulation, luteal and late luteal phases of menstrual cycle. Men were examined twice – with essential oil and water (as control). During every experiment before and after inhalation of the lavender essential oil cognitive tests (short-term memory, attention and reaction time) were performed and electrocardiogram was continuously recorded. The personality traits were identified using Eysenck test and subjects were categorized as introvert-extravert and neurotic-emotionally stabile. The main findings are as follows: 1. There was no statistically significant effect of lavender essential oil on reaction time, short term memory, parameters of attention - coefficient of mental productivity, capacity of visual information, velocity of information processing and heart rate when subjects were not subdivided into groups. 2. Coefficient of accuracy increased statistically significantly after breathing with lavender essential oil when subjects were not subdivided into... [to full text]