Health Psychology Intervention – Identifying Early Symptoms in Neurological Disorders

Authors: Simon B. N. Thompson

Abstract:

Cortisol is essential to the regulation of the immune system and pathological yawning is a symptom of multiple sclerosis (MS). Electromyography activity (EMG) in the jaw muscles typically rises when the muscles are moved – extended or flexed; and yawning has been shown to be highly correlated with cortisol levels in healthy people as shown in the Thompson Cortisol Hypothesis. It is likely that these elevated cortisol levels are also seen in people with MS. The possible link between EMG in the jaw muscles and rises in saliva cortisol levels during yawning were investigated in a randomized controlled trial of 60 volunteers aged 18-69 years who were exposed to conditions that were designed to elicit the yawning response. Saliva samples were collected at the start and after yawning, or at the end of the presentation of yawning-provoking stimuli, in the absence of a yawn, and EMG data was additionally collected during rest and yawning phases. Hospital Anxiety and Depression Scale, Yawning Susceptibility Scale, General Health Questionnaire, demographic, and health details were collected and the following exclusion criteria were adopted: chronic fatigue, diabetes, fibromyalgia, heart condition, high blood pressure, hormone replacement therapy, multiple sclerosis, and stroke. Significant differences were found between the saliva cortisol samples for the yawners, t (23) = -4.263, p = 0.000, as compared with the non-yawners between rest and poststimuli, which was non-significant. There were also significant differences between yawners and non-yawners for the EMG potentials with the yawners having higher rest and post-yawning potentials. Significant evidence was found to support the Thompson Cortisol Hypothesis suggesting that rises in cortisol levels are associated with the yawning response. Further research is underway to explore the use of cortisol as a potential diagnostic tool as an assist to the early diagnosis of symptoms related to neurological disorders. Bournemouth University Research & Ethics approval granted: JC28/1/13-KA6/9/13. Professional code of conduct, confidentiality, and safety issues have been addressed and approved in the Ethics submission. Trials identification number: ISRCTN61942768. http://www.controlled-trials.com/isrctn/

Keywords: Cortisol, Electromyography, Neurology, Yawning.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1109395

References:

[1] S. B. N. Thompson, “Born to yawn? Cortisol linked to yawning: a new hypothesis,” Medical Hypotheses, vol. 77, pp. 861-862, 2011.
[2] A. C. Gallup, and G. G. Jr. Gallup, “Yawning as a brain cooling mechanism: nasal breathing and forehead cooling diminish the incidence of contagious yawning,” Evolutionary Psychology, Vol. 5, no. 1, pp. 92- 101, 2007.
[3] S. B. N. Thompson, and P. Bishop, “Born to yawn? Understanding yawning as a warning of the rise in cortisol levels: randomized trial,” Interactive J Medical Research, vol. 1, no. 5, pp. 1-9, 2012, doi: 10.2196/ijmr.2241.
[4] O. Walusinski, “Historical perspectives,” in The mystery of yawning in physiology and disease, J. Bogousslavsky, Eds. Basel: Karger, 2010, pp. 1-21.
[5] M. J. Vigier (translated by), “Les aphorismes d’Hippocrate,” J-A. Lyon: Huguetan, 1620.
[6] Z. A. Erkut, E. Endert, I. Huitinga, and D.F. Swaab, “Cortisol is increased in post-mortem cerebrospinal fluid of multiple sclerosis patients: relationship with cytokines and sepsis,” Multiple Sclerosis, 2002, vol. 8, pp. 229-236.
[7] F. M. Butterworth, G. E. Ristow, and E. Collarini, “Fluctuation of plasma cortisol levels in multiple sclerosis,” Le Journal Canadien des Sciences Neurologiques, 1979, vol. 6, no. 1, pp. 59-63.
[8] G. Flesner, A. Ek, and O. Soderhamn, “Lived experience of MS-related fatigue – a phenomenological interview study,” International J Nursing Studies, 2003, vol. 40, pp. 707-717.
[9] B. Périn, O. Gogefroy, S. Fall, and G. de Marco, “Alertness in young healthy subjects: an fMRI study of brain region interactivity enhanced by a warning signal,” Brain and Cognition, 2010, vol. 72, pp. 271-281.
[10] R. J. Mills, and C. A. Young, “A medical definition of fatigue in multiple sclerosis,” Quarterly J Medicine, 2008, vol. 101, pp. 49-60.
[11] J. Iriarte, M. L. Subira, and P. De Castro, “Modalities of fatigue in multiple sclerosis: correlation with clinical and biological factors,” Multiple Sclerosis, 2000, vol. 6, pp. 124-130.
[12] A. Morelli, S. Ravera, and I. Panfoli, “Myelin sheath: a new possible role in sleep mechanism,” Sleep Medicine, 2011, vol. 12, pp. 198-199.
[13] T. Postert, D. Pöhlau, S. Meves, I. Nastos, and H. Przuntek, “Pathological yawning as a symptom of multiple sclerosis,” J Neurology, 1996, vol. 243, no. 3, pp. 300-301.
[14] A. C. Gallup, and G. G. Jr. Gallup, “Yawning and thermoregulation,” Physiology and Behavior, 2008, vol. 95, pp. 10-16.
[15] A. C. Gallup, G. G. Jr. Gallup, and C. Feo, “Yawning, sleep, and symptom relief in patients with multiple sclerosis,” Sleep Medicine, 2010, vol. 11, pp. 329-330.
[16] A. C. Gallup, M. L. Miller, and A. B. Clark, “The direction and range of ambient temperature influences yawning in budgerigars (Melopsittacus undulates),” J Comparative Psychology, 2010, vol. 124, pp. 133-138.
[17] F. Zellini, G. Niepel, and C. R. Tench, “Constantinescu CS. Hypothalamic involvement assessed by T1 relaxation time in patients with relapsing-remitting multiple sclerosis,” Multiple Sclerosis, 2009, vol. 15, no. 12, pp. 1442-1449.
[18] F. Nahab, “Exploring yawning with neuroimaging,” in The mystery of yawning in physiology and disease, J. Bogousslavsky, Eds. Basel: Karger, 2010, pp. 128-133.
[19] J. Anias-Calderon, L. Verdugo-Diaz, and R. Drucker-Colin, “Adrenalectomy and dexamethasone replacement on yawning behavior,” Behavior Brain Res, 2004, vol. 154, pp. 255-259.
[20] H. Krestel, C. Weisstanner, C. Hess, C. Bassetti, A. Nirkko, and R. Wiest, “Insular and caudate lesions release abnormal yawning in stroke patients,” Brain Struct Funct, 2013, doi 10.1007/s00429-013-0684-6.
[21] R. P. Snaith RP, and A. S. Zigmond, “Hospital Anxiety and Depression Scale,” Acta Psych Scand, 1994, vol. 67, pp. 361-370.
[22] O. A. Abiodun, “A validity study of the Hospital Anxiety and Depression Scale in general hospital units and a community sample in Nigeria,” Br J Psychiatry, 1994, vol. 165, pp. 169-172.
[23] D. Goldberg, “Use of the General Health Questionnaire in clinical work,” Br Med J, 1986, vol. 293, pp. 1188-1189.
[24] M. H.Banks, “Validation of the General Health Questionnaire in a young community sample,” Psychological Medicine, 1983, vol.13, pp. 349- 353.
[25] A. Lobo, M. J. Pérez-Echeverría, and J. Artal, “Validation of the scaled version of the General Health Questionnaire (GHQ28) in a Spanish population,” Psychological Medicine, 1986, vol. 16, pp. 135-140.
[26] K. W. Bridges, and D. Goldberg, “The validation of the GHQ28 and the use of the MMSE in neurological in-patients,” Br J Psychiatry, 1986, vol. 148, pp. 548-553.
[27] O. Walusinki, “How yawning switches the default-mode network to the attentional network by activating the cerebrospinal fluid flow,” Clinical Anatomy, 2014, vol. 27, pp. 201-209.
[28] S. B. N. Thompson, “Dementia and memory. A handbook for students and professionals,” Aldershot: Ashgate, 2006, pp. 117-118.
[29] G. Abbey, S. B. N. Thompson, T. Hickish, and D. Heathcote, “A metaanalysis of prevalence rates and moderating factors for cancer-related post-traumatic stress disorder,” Psycho-Oncology, 2014, vol. 23, pp. 1- 12, doi: 10.1002/pon.3654.