Cellular, Molecular, Physiological, and Behavioral Aspects of Spinal Cord Injury

1st Edition - May 10, 2022
Editors: Rajkumar Rajendram, Victor R Preedy, Colin R Martin
Language: English
Hardback ISBN:
9 7 8 - 0 - 1 2 - 8 2 2 4 2 7 - 4
eBook ISBN:
9 7 8 - 0 - 1 2 - 8 2 2 4 2 8 - 1

Spinal injury affects about 10 million people annually worldwide, impacting on the family unit and causing lifelong disabilities, with varied symptoms including paresthesia, sp… Read more

Cellular, Molecular, Physiological, and Behavioral Aspects of Spinal Cord Injury

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Spinal injury affects about 10 million people annually worldwide, impacting on the family unit and causing lifelong disabilities, with varied symptoms including paresthesia, spasticity, loss of motor control, and often severe pain. Cellular, Molecular, Physiological, and Behavioral Aspects of Spinal Cord Injury will enhance readers’ understanding of the biological and psychological effects of spinal cord injury. Featuring chapters on gene expression, metabolic effects, and behavior, this volume discusses in detail the impact of spinal cord injury to better understand the underlying pathways and processes. The book has applicability for neuroscientists, neurologists, clinicians, and anyone working to better understand these injuries.

Cover image
Title page
Table of Contents
Copyright
Dedication
Contributors
Preface
Section A: Setting the scene and introductory chapters
Chapter 1: Causes of spinal injury: Motor vehicle accidents and beyond
Abstract
Introduction
Spinal injury in automobile drivers
Role of seatbelt and airbag in protecting spine
Mini-dictionary of terms
Key facts of spinal injury simulation
Summary points
References
Chapter 2: Magnetic resonance imaging (MRI) findings in spinal cord injury during acute and chronic phases
Abstract
Introduction
MRI sequences used in SCI
Protocols for MRI in SCI
MRI findings in acute SCI
MRI findings in subacute SCI
MRI findings in chronic SCI
Conclusion
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of SPAM
Summary points
References
Chapter 3: Exercise programs and spinal cord injury (SCI): Linking the clinical, physiological, and psychological consequences of SCI
Abstract
Prevalence and consequences of spinal cord injury
Clinical, physiological, and psychological consequences of SCI (Fig. 1)
Exercise and SCI (Fig. 2)
Conclusion and future perspective
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts on exercises and people with SCI
Summary points
References
Chapter 4: Use of anodal transcranial direct current stimulation: Features, facets, and applications to incomplete spinal cord injury
Abstract
Introduction
Characteristics of the iSCI individuals under a-tDCS protocols
Parameters of the a-tDCS after iSCI
Short and long-term effects of the a-tDCS
A-tDCS safety and adverse effects (AEs)
Clinical practice based on the a-tDCS
Applications to other areas of neuroscience
Dictionary of terms
Key facts of anodal transcranial direct current stimulation
Summary points
References
Further reading
Chapter 5: Neuromodulation and restoration of motor responses after severe spinal cord injury
Abstract
Neuromodulation exploits intrinsic information processing
A residual functional potential remains after SCI
Central nervous system reorganization after SCI
Mechanisms of spinal neuromodulation
The ideal candidate for the restoration of volitional motor responses through neuromodulation
Neuromuscular electrical stimulation for the recovery of independent stepping
Rationale for combining NMES with other neuromodulation modalities
Regaining of motor function after severe spinal cord injury
Multimodal rehabilitation
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of neuromodulation and restoration of motor responses after severe spinal cord injury
Summary points
References
Further reading
Chapter 6: Rehabilitation and wheelchair users after spinal cord injury: An overview
Abstract
Introduction
Applications to other areas of neuroscience
Key facts of clinical classification of SCI and mobility
Key facts on clinical complications of SCI
Summary points
References
Section B: Cellular and molecular aspects of spinal injury
Chapter 7: Gene expression and bone loss following spinal cord injury
Abstract
Introduction
Incidence and pathophysiological mechanisms of spinal cord injury
Altered gene expression due to spinal cord injury
Bone remodeling and osteometabolic dysfunction due to SCI
Molecular mechanisms of SCI-induced bone loss
Acute and chronic stages of bone loss following SCI
Changes in bone quality and quantity following SCI
Secondary complication due to SCI-induced bone loss
Conclusions
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of gene expression, bone loss, and spinal cord injury
Summary points
References
Chapter 8: Sperm DNA fragmentation and its relevance to men with spinal cord injury
Abstract
Introduction
How does SDF in men with SCI compare to other causes of infertility?
Molecular mechanisms of SDF
Etiologies of SDF in men with SCI
Improving sperm DNA quality in men with SCI
Conclusion
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of sperm DNA fragmentation
Summary points
References
Chapter 9: Beneficial and detrimental effects of cytokines after spinal cord injury
Abstract
Acknowledgments
Introduction
Cytokine expression after SCI
Cytokines promoting cell death and neurodegeneration after SCI
Cytokines in inflammation and glial scar formation
Cytokines in neuroprotection and repair
Epigenetic regulation of cytokine expression
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts
Summary points
References
Chapter 10: Neurovascular pathology following traumatic spinal cord injury
Abstract
Introduction
Secondary pathogenesis
Hemodynamic response
Neurovascular unit (NVU)
Endothelial cell (EC) response
Pericytic response
Astrocytic response
Therapeutic approach
Conclusions
Application to other areas of neuroscience
Mini-dictionary of terms
Key facts
Summary points
References
Chapter 11: Protein degradome in spinal cord injury
Abstract
Introduction
Protease-substrate repertoires
Degradomes in SCI
Cytoskeletal proteins
Extracellular matrix
Cell junction proteins
Ion channels
Clinical perspectives
Application to other neuroscience areas
Mini-dictionary of terms
Key facts of spinal cord degradomics
Summary points
References
Chapter 12: Proteomics of pressure ulcers in spinal cord injury
Abstract
Acknowledgments and sources of funding
Background
Patient’s management
Clinical proteomics
Proteomics in pressure ulcers
The importance of precision medicine
Limitations of proteomics
Conclusions
Application to other areas of neuroscience
Key facts of proteomics in PUs of spinal cord patients
Mini-dictionary of terms
Summary points
References
Chapter 13: Innate immune responses of glia and inflammatory cells in spinal cord injury
Abstract
Acknowledgments
Introduction
Overview of PRRs
Role of TLRs in SCI
Non-immune functions of TLRs in neurons: Relevance to SCI
Modulation of ECM proteins by TLRs: Relevance to SCI
Applications to other areas of neuroscience
Conclusions
Mini-dictionary of terms
Key facts of innate immunity in central nervous system injury
Summary points
References
Chapter 14: The role of oxidative stress in spinal cord injury animal models: A focus on nuclear factor erythroid-2 related factor 2
Abstract
Introduction
Oxidative stress characteristics and mechanisms
The implications of oxidative damage in SCI pathophysiology
Protection mechanisms by endogenous antioxidants via Nrf2-ARE system
Involvement of Nrf2 in blockage of oxidative stress post-SCI induced by exogenous stimuli
Concluding remarks
Application to others areas of neuroscience
Mini-dictionary of terms
Key facts of oxidative stress
Summary points
References
Chapter 15: Novel agent ONO-2506 suppresses astrocytic activation and attenuates post-spinal cord injury pain
Abstract
Introduction
Secondary injury of the spinal cord and astrocytic activation
Astrocytic activation and post-SCI neuropathic pain
Attenuation of post-SCI neuropathic pain by ONO-2506
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of ONO-2506
Summary points
References
Chapter 16: Neural tissue loss after spinal cord injury
Abstract
Acknowledgment
Introduction
Dysfunction of vascular system
Spinal cord edema
The inflammatory response and elimination of necrotic debris
Development of cysts/cavities and syrinx
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of post-traumatic loss of spinal cord tissue
Summary points
References
Chapter 17: Remodeling mitochondrial transport and cellular energetics in axonal regeneration and spinal cord injury
Abstract
Acknowledgment
Introduction
Complex motility patterns of axonal mitochondria
Molecular motors driving mitochondrial bi-directional transport in axons
Mitochondrial motor adaptors and receptors
Declined axonal mitochondrial transport in mature neurons
SNPH immobilizes axonal mitochondria in mature neurons and adult brains
Deleting SNPH anchoring boosts axon regeneration in vitro and in vivo
Enhanced mitochondrial transport facilitates axon regeneration
Remodeling mitochondrial transport promotes regeneration after SCI
Boosting energetic metabolism promotes regeneration after SCI
Conclusions and new challenges
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of SNPH-mediated decline of axonal mitochondrial transport in mature neurons
Key facts of the energy crisis that accounts for regeneration failure
Key facts of boosting local energy supply in injured axons
Summary points
References
Chapter 18: Neurotrophins and their role in axonal outgrowth following spinal cord injury
Abstract
Introduction
Structure and function of the neurotrophins
Neurotrophic gradients for guiding regenerating axons
Preclinical models of neurotrophin delivery to promote axonal outgrowth and regeneration following SCI
Challenges and considerations for neurotrophin delivery and clinical translation
Concluding remarks
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of neurotrophins in spinal cord injury
Summary points
References
Chapter 19: The neuroscience of transient receptor potential vanilloid type 4 (TRPV4) and spinal cord injury
Abstract
Introduction
TRPV4 role in non-injured conditions
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts about SCI
Key facts about TRPV4
Summary points
References
Chapter 20: Autoantibodies in spinal cord injury
Abstract
Introduction
Targets and possible origin of autoantibodies increased after SCI in humans
The levels of autoantibodies after SCI are independent of lesion level and severity
Autoantibodies increased after SCI target both CNS and peripheral antigens
Local versus systemic production of autoantibodies
Association of autoantibodies with neuropathic pain development
Roles of the autoantibodies increased after SCI in other pathologies
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of autoantibodies
Summary points
References
Chapter 21: Calpain role in the pathophysiology of spasticity after spinal cord injury
Abstract
Acknowledgments
Introduction
Spasticity after spinal cord injury (SCI)
Calpains and their role in spasticity after SCI
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of “spinal hyperexcitability”
Key facts of “spinal disinhibition”
Summary points
References
Chapter 22: Targeting mTOR signaling to promote autophagy for functional recovery after spinal cord injury
Abstract
Acknowledgments
Introduction
Natural compounds for inhibition of mTOR signaling and promotion of autophagy flux and functional recovery after SCI
Pharmacological inhibition of mTOR signaling for enhancing autophagy flux and functional recovery following SCI
Genetic and non-genetic inhibitors of mTOR signaling to regulate autophagy in SCI
Future directions
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of targeting mTOR signaling in promotion of autophagy for functional recovery after SCI
Summary points
References
Chapter 23: Tertiary damage: Hippocampal and brain changes after spinal cord injury
Abstract
Introduction
Sensorimotor cortex and corticospinal tract alterations after SCI in humans
Cognitive and emotional impairment after SCI
The effect of SCI on the hippocampus
SCI and other brain regions
Possible mechanisms underlying the tertiary damage
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of tertiary damage
Summary points
References
Section C: Physiological and metabolic effects
Chapter 24: Hormonal events and spinal cord injury: A focus on vasopressin and natriuretic peptide
Abstract
Introduction
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of vasopressin and natriuretic peptide changes after SCI
Summary points
References
Chapter 25: Linking sensorimotor plasticity, the motor cortex, and spinal cord injury
Abstract
Sensorimotor plasticity after spinal cord injury
Functional evaluation of motor cortex
Discussion
Applications to other areas of neuroscience
Key facts
Mini-dictionary of terms
Summary points
References
Chapter 26: Bone loss at the knee after spinal cord injury: Radiographic imaging, fracture risk, and treatment
Abstract
Introduction
Application to other areas of neuroscience
Bone loss at the knee after SCI
Relationship between bone loss and fracture risk after SCI
Interventions for bone loss after SCI
Summary and conclusions
Mini-dictionary terms
Key facts
Summary points
References
Chapter 27: Functional and morphological reorganization of the brain following spinal cord injury: Insights from MRI
Abstract
Introduction
Brain morphometry
Diffusion tensor imaging (DTI)
Functional MRI (fMRI)
MR spectroscopy
Structural reorganization—Insights from MRI
Functional reorganization—Insights from MRI
Structural and functional reorganization—Insights from MRI
Mechanisms underlying reorganization
Challenges related to MRI evaluation of SCI data
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts
Summary points
References
Chapter 28: Cardiometabolic changes and upper exercise as an augmentative strategy in spinal cord injury
Abstract
Introduction
Application to other areas of neuroscience
Main narrative text
Mini-dictionary of terms
Key facts: Cardiometabolic changes and exercise in SCI
Summary points
References
Chapter 29: Electrophysiological outcome measures in spinal cord injury: A new narrative
Abstract
Introduction
Discussion
Applications to other areas of neuroscience
Key facts of electrophysiological measures
Summary points
References
Chapter 30: Features and physiology of spinal stretch reflexes in people with chronic spinal cord injury
Abstract
Funding acknowledgments
Introduction
Spinal stretch reflexes
Function of the soleus stretch reflex pathways in intact human locomotion
Features of spinal stretch reflexes in people with SCI
Soleus stretch reflexes during locomotion in people with chronic incomplete SCI
Stretch reflexes in spastic gait after SCI
Consideration of CNS plasticity in addressing the reflex hyperexcitability in chronic SCI
Conclusion
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of spinal reflexes
Summary points
References
Chapter 31: Metabolic syndrome in spinal cord injury: Impact on health
Abstract
Introduction
Changes in body composition after spinal cord injury
Insulin resistance in spinal cord injury: Pathophysiology and clinical features
Diagnostic challenges of metabolic syndrome in people with spinal cord injury
Cardiovascular reflections of metabolic syndrome in spinal cord injury
Pathophysiology of androgen deficiency in men with chronic spinal cord injury
Correlates of androgen deficiency in chronic spinal cord injury
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of metabolic syndrome in spinal cord injury: Impact on health
Summary points
References
Chapter 32: Body composition and spinal cord injury
Abstract
Introduction
Body composition
Body composition changes following traumatic spinal cord injury
Sarcopenia and SCI
Body composition assessment
Imaging techniques
Novel technique
Summary of body composition assessment methods
Choosing a body composition method for use in SCI
Applications to other areas of neuroscience
Key facts
Mini-dictionary of terms
Summary points
References
Chapter 33: Energy requirements and spinal cord injury
Abstract
Introduction
Energy expenditure
Energy expenditure following SCI
Methods for determining energy requirements
Doubly labeled water
Indirect calorimetry
Predictive equations
Predictive equations validated in SCI
Choosing an energy requirement method for use in SCI
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of energy metabolism
Summary points
References
Chapter 34: Virtual walking and spinal cord injury neuropathic pain
Abstract
Introduction
SCI-related neuropathic pain as a deafferentation pain
Mirror therapy: A precursor to virtual walking
What is VR?
Non- or partially-immersive virtual walking in SCI
Immersion, embodiment, and interactivity
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of virtual walking and spinal cord injury neuropathic pain
Summary points
References
Chapter 35: Cervical spinal cord injury and thermoregulatory processes: A new narrative
Abstract
Introduction
Homeostasis
Thermoregulatory process in able-bodied individuals
Differences between healthy individuals and cSCI patients
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of spinal cord injury
Key facts of American Spinal Injury Association
Summary points
References
Chapter 36: Spinal cord injury and the gut microbiota
Abstract
Introduction
Spinal cord injury-induced dysautonomia
Gut dysbiosis after SCI: Pre-clinical studies
Gut dysbiosis after SCI: Clinical studies
Demographic factors (injury level, injury completeness, age, sex)
Gut dysbiosis and health/disease after SCI
Mini-dictionary of terms
Key facts of the gut microbiome
Summary points
References
Section D: Behavioral and psychological effects
Chapter 37: Risk factors and predictors of depression after spinal cord injury: Emphasis on the inflammatory process
Abstract
Introduction
Pathophysiological overview: From local inflammation to systemic inflammation after SCI
Depression and spinal cord injury
Conclusion
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of depression
Summary points
References
Chapter 38: Spirituality, hope, and resilience in the recovery and adaptation process following spinal cord injury
Abstract
Introduction
Responses to trauma: The quest narrative and the role of spirituality, hope, and resilience
Spirituality after SCI
Hope after SCI
Resilience after SCI
The relationship between spirituality, hope, and resilience after SCI
Implications for SCI rehabilitation: Person-centered care that embraces spirituality, hope, and resilience
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of “Spirituality, hope, and resilience in the recovery and adaptation process following spinal cord injury”
Summary points
References
Chapter 39: Wellness intervention for persons with spinal cord injury
Abstract
Introduction
What is wellness?
Measurement of wellness in SCI
Health behaviors: Targets for wellness interventions
Behavior change theory for supporting behavior change interventions in SCI
Exemplar wellness interventions for persons with SCI: Examples, settings, and results
Design of future wellness interventions for persons with SCI
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of wellness interventions
Summary points
References
Chapter 40: Sexual life in individuals with spinal cord injury and management
Abstract
Introduction
Sexual life in men with SCI
Physiology of normal sexual function
Problems affecting sexual life in men with SCI
Management of sexual problems in men with SCI
Sex life in women with SCI
Problems affecting sexual life in women with SCI and their management
Conclusion
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of sexual life in individuals with SCI and management
Summary points
References
Chapter 41: Depressive symptoms in rehabilitation post-spinal cord injury
Abstract
Introduction
Screening and assessment of depression post-SCI
Theoretical correlates of depression post-SCI
Management of depression post-SCI
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of screening and diagnosis
Key facts of management
Summary points
References
Chapter 42: Self-harm behaviors in patients with spinal cord injuries: From non-adherence to suicide
Abstract
Introduction
Self-harm behaviors and suicidal behaviors
Self-harm behaviors as presenting symptoms
Suicide behaviors and SCI
Risk mitigation
Applications to other areas of neuroscience
Suicide mitigation safety planning for all populations
Conclusion
Mini-dictionary of terms
Key facts of self-harm
Summary points
References
Index

Rajkumar Rajendram

Dr Rajkumar Rajendram is a clinician scientist with a focus on internal medicine, anaesthesia, intensive care and peri-operative medicine. He graduated with distinctions from Guy’s, King’s and St. Thomas Medical School, King’s College London in 2001. As an undergraduate he was awarded several prizes, merits and distinctions in pre-clinical and clinical subjects.

Dr Rajendram began his post-graduate medical training in general medicine and intensive care in Oxford. He attained membership of the Royal College of Physicians (MRCP) in 2004 and completed specialist training in acute and general medicine in Oxford in 2010. Dr Rajendram subsequently practiced as a Consultant in Acute General Medicine at the John Radcliffe Hospital, Oxford.

Dr Rajendram also trained in anaesthesia and intensive care in London and was awarded a fellowship of the Royal College of Anaesthetists (FRCA) in 2009. He completed advanced training in regional anaesthesia and intensive care. He was awarded a fellowship of the Faculty of Intensive Care Medicine (FFICM) in 2013 and obtained the European diploma of intensive care medicine (EDIC) in 2014. He then moved to the Royal Free London Hospitals as a Consultant in Intensive Care, Anaesthesia and Peri-operative Medicine. He has been a fellow of the Royal College of Physicians of Edinburgh (FRCP Edin) and the Royal College of Physicians of London (FRCP Lond) since 2017 and 2019 respectively. He is currently a Consultant in Internal Medicine at King Abdulaziz Medical City, National Guard Heath Affairs, Riyadh, Saudi Arabia.

Dr Rajendram’s focus on improving outcomes from Coronavirus Disease 2019 (COVID-19) has involved research on point of care ultrasound and phenotypes of COVID-19. Dr Rajendram also recognises that nutritional support is a fundamental aspect of medical care. This is particularly important for patients with COVID-19. As a clinician scientist he has therefore devoted significant time and effort into nutritional science research and education. He is an affiliated member of the Nutritional Sciences Research Division of King’s College London and has published over 400 textbook chapters, review articles, peer-reviewed papers and abstracts.

Affiliations and expertise

Consultant in Internal Medicine, King Abdulaziz Medical City, National Guard Heath Affairs, Riyadh, Saudi Arabia

Victor R Preedy

Victor R. Preedy BSc, PhD, DSc, FRSB, FRSPH, FRSC, FRCPath graduated with an Honours Degree in Biology and Physiology with Pharmacology. After gaining his University of London PhD, he received his Membership of the Royal College of Pathologists. He was later awarded his second doctorate (DSc), for his contribution to protein metabolism in health and disease. He is Professor of Clinical Biochemistry (Hon) at King’s College Hospital and Emeritus Professor of Nutritional Biochemistry at King’s College London. He has Honorary Professorships at the University of Hull, and the University of Suffolk. Professor Preedy was the Founding Director and then long-term Director of the Genomics Centre at King’s College London from 2006 to 2020. Professor Preedy has been awarded fellowships of the Royal Society of Biology, the Royal College of Pathologists, the Royal Society for the Promotion of Health, the Royal Institute of Public Health, the Royal Society for Public Health, the Royal Society of Chemistry and the Royal Society of Medicine. He carried out research when attached to the National Heart Hospital (part of Imperial College London), The School of Pharmacy (now part of University College London) and the MRC Centre at Northwick Park Hospital. He has collaborated with international research groups in Finland, Japan, Australia, USA, and Germany. To his credit, Professor Preedy has published over 750 articles, which includes peer-reviewed manuscripts based on original research, abstracts and symposium presentations, reviews and edited books.

Affiliations and expertise

Professor, Department of Clinical Biochemistry, King’s College Hospital, London, UK; Emeritus Professor, Faculty of Life Sciences and Medicine, King’s College London, UK Visiting Professor, University of Hull, UK

Colin R Martin

Colin R. Martin RN, BSc, MSc, PhD, MBA, YCAP, FHEA, C.Psychol, AFBPsS, C.Sci is Professor of Clinical Psychobiology and Applied Psychoneuroimmunology and Clinical Director of the Institute of Health and Wellbeing at the University of Suffolk, UK. He is a Chartered Health Psychologist and a Chartered Scientist. He also trained in analytical biochemistry, this aspect reflecting the psychobiological focus of much of his research within mental health. He has published or has in press well over 300 research papers and book chapters. He is a keen book author and editor having written and/or edited more than 50 books. These outputs include the prophetic insight into the treatment of neurological disease, Handbook of Behavior, Food and Nutrition (2011), Nanomedicine and the Nervous System (2012), Oxidative Stress and Dietary Antioxidants in Neurological Disease (2020), Zika Virus Impact, Diagnosis, Control and Models (2021), Factors Affecting Neurodevelopment: Genetics, Neurology, Behavior and Diet (2021), Diagnosis and Treatment of Spinal Cord Injury (2022), The Neurobiology, Physiology, and Psychology of Pain (2022) and The Handbook of Lifespan Cognitive Behavioral Therapy: Childhood, Adolescence, Pregnancy, Adulthood, and Aging (2023). Professor Martin is particularly interested in all aspects of the relationship between underlying physiological substrates and behavior, particularly in how these relationships manifest in both acute and chronic psychiatric disorder. He has published original research germane to significant mental health disorders including the areas of schizophrenia, anxiety, depression, self-esteem, alcohol and drug dependency, high secure forensic mental health and personality disorder. He has a keen interest in the impact of postviral illness and is actively involved in clinical research post-Covid pandemic and in particular, the impact of Long Covid on psychological, neurological, physiological and social functioning. He is involved in collaborative International research with many European and Non-European countries.

Affiliations and expertise

Professor of Clinical Psychobiology and Applied Psychoneuroimmunology and Clinical Director: Institute for Health and Wellbeing, University of Suffolk, Ipswich, UK