A Comprehensive Overview on Stress Neurobiology: Basic Concepts and Clinical Implications

BackgroundSince the outbreak of COVID-19, no data have been available for hospitalised psychiatric patients who are suspected to have COVID-19. We performed a comprehensive investigation of the clinical features of hospitalised patients with schizophrenia with or without suspected COVID-19 in Hubei Province, China.AimTo explore the clinical characteristics of hospitalised patients with schizophrenia with suspected COVID-19 in Hubei Province, China.Methods21 hospitalised patients with schizophrenia with suspected COVID-19 (COVID-19 suspected group) in the isolation ward of a mental health hospital in Wuhan and 30 hospitalised patients with schizophrenia (clean group) in the general ward of another mental health hospital in Yichang were recruited. We retrospectively reviewed their clinical characteristics, laboratory findings and chest CT results before 21 February 2020. We also compared the emotional and mental symptoms between the two groups.ResultsMedical records revealed that 21 COVID-19 suspected patients were transferred to the isolation ward between 30 January 2020 and 15 February 2020. The mean age (SD) of COVID-19 suspected patients was 43.1 (2.6). 12 (57.1%) patients showed abnormalities on chest CT before onset of respiratory symptoms. 14 (66.7%) patients had psychiatric medications adjustment after detection of abnormal chest CT findings. By 21 February, one patient was confirmed to have COVID-19. Even though the remaining 20 (95.2%) were negative for at least two reverse transcription PCR tests, 11 (52.4%) patients met the diagnostic criteria for clinically confirmed cases. Compared with patients in the clean group, patients in the suspected COVID-19 group showed significantly higher stress, depression and anxiety levels and poorer sleep quality.ConclusionSetting up an independent isolation ward for hospitalised psychiatric patients who are suspected to have symptoms of COVID-19 helped control the spread of the epidemic. Patients with schizophrenia suspected to have COVID-19 showed increased stress and mood and sleep disturbances, which should be appropriately managed.

Mental health crucially depends upon affective states such as emotions, stress responses, impulses and moods. These states shape how we think, feel and behave. Often, they support adaptive functioning. At other times, however, they can become detrimental to mental health via maladaptive affect generation processes and/or maladaptive affect regulation processes. Here, we present an integrative framework for considering the role of affect generation and regulation in mental illness and well-being. Our model views affect generation as an iterative cycle of attending to, appraising and responding to situations. It views affect regulation as an iterative series of decisions aimed at altering affect generation. Affect regulation decisions include identifying what, if anything, should be changed about affect, selecting where to intervene in the affect generation cycle, choosing how to implement this intervention, and monitoring the regulation attempt to decide whether to maintain, switch or stop it. Difficulties with these decisions, often arising from biased inputs to them, can contribute to manifestations of mental illness such as clinical symptoms, syndromes and disorders. The model has a number of implications for clinical assessment and treatment. Specifically, it offers a common set of concepts for characterizing different affective states; it highlights interactions between affect generation and affect regulation; it identifies assessment and treatment targets among the component processes of affect regulation; and it is applicable to prevention and treatment of mental illness as well as to promotion and restoration of psychological well-being.

Although the underlying mechanism of stress remains unknown, it has been associated with the pathophysiology of gastroesophageal reflux diseases, the development of which appear to be accelerated by oxidative stress and fibrosis. The aim of the current study was to investigate the effect of chronic restraint stress on esophageal oxidative stress and fibrosis, as well as the impact of oxidative stress in a murine model whereby 8-week old C57BL/6J male mice were subjected to intermittent chronic restraint stress for a two-week period. The current study demonstrated that chronic restraint stress significantly reduced the body weight of mice compared with the control group. Although chronic restraint stress did not significantly alter the levels of triglycerides or cholesterol, free fatty acid concentration was significantly increased compared with the control group. Furthermore, chronic restraint stress significantly upregulated the expression levels of several fibrotic biomarkers including collagen type I, transforming growth factor β-1, α-smooth muscle actin and SMAD-3 compared with the control group. In addition, the expression levels of the reactive oxygen species (ROS) NADPH oxidase-4 and malondialdehyde were significantly increased, while the expression levels of nuclear factor erythroid 2-related factor 2 and heme oxygenase-1 were significantly decreased in esophageal tissue from mice in the chronic restraint stress group compared with the control group. In conclusion, chronic restraint stress may induce esophageal fibrosis by accumulating ROS and increasing fibrotic gene expression in a murine model.