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A. Larson, M.B.A., M.D.

Professor, New York University Long Island School of Medicine

Other research has focused on medications to sustain alertness and vigilance during periods of inadequate sleep but have found not all aspects of cognition are improved equally. Decrements in cognitive performance due to stress were not limited to one area of cognition. Instead, in exercises designed to simulate stress of combat, every aspect of cognitive functioning tested was impaired compared to baseline, including rather simple functions such as reaction time and vigilance. The magnitude of cognitive decrement due to environmental stress was greater than that due to clinical hypoglycemia, treatment with sedating drugs, and alcohol intoxication (Lieberman 2005). Exposure to high levels of radiation, for example, can damage the subcortical basal ganglia and hippocampus that are critical to cognitive functioning (Madsen et al. Rats exposed to radiation equivalent to that of deep-space resulted in long-term cognitive deficits (Davis et al. Analog Mission Duration of 2 or More Years Available evidence from assignments in any analog lasting 2 or more years, as could occur for a Mars mission, is scant. Although they were in a relatively lush and diverse environment ­ with access to television and radio, and daily contact via an observation window ­ the inhabitants of Biosphere 2 nevertheless experienced psychological stress (MacCallum and Poynter, 1995). The team split into two factions within 6 months; stolen food was hoarded; and daily tasks were reported as monotonous. One month after the midpoint, some crew members reported experiencing depression that was severe enough to interfere with their ability to complete daily tasks (Poynter 2006). Problems that were experienced with Biosphere 2, in comparison to those of space flight, include poor selection of participants and lack of adequate preparation and training. Extensive publicity also may have influenced the experiences of the Biosphere 2 team by sensationalizing them. Two-year assignments, which are common at the Russian Antarctic Station of Vostok, provide additional evidence that lengthier periods spent in isolation and confinement increase behavioral and psychiatric problems (Otto 2007). Alcohol consumption contributed to the main power-generating building burning down, as well as, to the death of a station physician due to alcoholic liver failure. The depth of psychological stress that was experienced by some at the Vostok station is vividly illustrated by the unsubstantiated legend of a wintering-over Russian male, who after losing a game of chess, murdered his opponent with an axe (Anthony, 2006; Wheeler, 1999). These examples most likely do not generalize to astronauts and space travel due to the differences between analog and astronaut populations as well as the differences in mission characteristics. However, these examples have been included to emphasize the increased risk of behavioral health and psychiatric problems that are associated with extended stays in highly isolated, confined, and extreme environments; such long durations are clearly at the outside boundary of our experience and evidence base. Post-expedition cognitive and behavioral health the majority of reintegration research involves returning service men and women. Because of the potential confound of combat experience, this body of evidence was not considered for inclusion here. Still there are diary accounts and similar reports of difficulties by individuals returning home from expeditions. One such event occurred in the last decade of the 1800s when renowned Antarctic explorer Amundsen sent one of his men, Johansen, home early for insubordination. In a recent case study of one 29 year old man who circumnavigated the globe solo in a sailboat, significant differences manifested in two factors of personality. Compared to pre-trip measures, agreeableness was significantly lower at 180 days post-trip and remained stable at the level when 68 measured 360 days post-trip. Unlike agreeableness though, conscientiousness at 360 days post-trip was lower than that at 180 days, although still significantly higher than the pre-trip measure (Kjaergaard et al. Predictors and contributing factors to behavioral health Personality 1) Instrumentality and Expressivity Viewing personality in terms of instrumentality and expressivity has been found to be predictive in flight crews as well as in other aviation and space populations (Chidester and Foushee 1991; Chidester et al. Research with individuals who seek expeditions to Antarctica suggests that ideal candidates for wintering-over in such an isolated and confined environment are relatively low in neuroticism, need for orderand achievement motivation, as well as low in extraversion and conscientiousness (Palinkas et al. Breaking these findings down by occupation reveals that scientists are lower than military personnel on extraversion and lower than technical/support staff on both agreeableness and conscientiousness. The next section addresses the how personality traits may differentially contribute to adjustment differences between South versus North Pole winterover crew members. Personality as a predictor of adjustment Antarctic workers are higher than those in the Arctic in terms of extraversion, agreeableness, and conscientiousness (Steel et al. However, interpersonal conflict and tension is reportedly the greatest source of stress for individuals who are wintering-over in Antarctica (Natani and Shurley 1974; Stuster et al.

In more areas of the post-industrial world, however, seasonal shortages are a thing of the past. In these areas, restriction of caloric intake is the goal, while maintaining adequate protein, mineral, vitamin, and fiber consumption. In many cultures, recreational foods-sometimes aptly dubbed junk food-have become popular with both young and middle-aged adults. They are full of calories but relatively empty of essential nutrients, such as amino acids, vitamins, minerals, and anti-oxidants. Candy, carbonated sodas, beer, fried chips, pastries, and cakes are examples of junk food. Health is promoted by restricting-or altogether avoiding-foods heavy in fat (especially saturated fat), sodium, or "empty calories. Particularly in economically welldeveloped nations where food is plentiful, several psychologically-driven eating disorders have developed, especially among girls and young women. Women aged 15­34 years old have the highest prevalence of eating disorders, manifested either as abnormally high or abnormally low caloric intake. Anorexia nervosa, bulimia nervosa, binge-eating, and chronic excessive eating leading to obesity are the most commonly seen eating disorders. The patient perceives herself as "too fat" whatever her body weight may be; hence, reduction of food intake to the point of starvation. The patient appears to believe, at some level, that starving will postpone sexual development which is perceived as frightening. In earlier generations, eating disorders were limited to a few post-industrialized countries, but with the spread of modern urban culture by movies and television, anorexia nervosa, in particular, may occur almost anywhere. The primary risk factor both for anorexia and bulimia is "dieting, " the intentional major restriction of caloric intake in order to lose or maintain weight (Hsu, 1996). The prevalence of dieting is about 50% in American women and 40% in Swedish women (Hsu, 1996); the prevalence of dieting is low in developing countries, but increases with Westernization. Whatever the psychodynamics and tactics for "self starvation, " most patients with anorexia compulsively pursue physical activity, thus burning up more calories. At some point in the weight loss process, metabolic changes progress, leading to amenorrhea and other more serious biological changes. These can even result in death, if the patient is not hospitalized to receive metabolic as well as psychiatric care. A related disorder is bulimia nervosa, characterized by binges of overeating, often followed by self-induced vomiting (purging). This behavior also has a complex psychogenic origin, and is now suspected to have some neurobiological roots. Bulimia has profound biopsychosocial effects on patients, overlapping with those of anorexia. Affective disorders, such as anxiety and depression, are common co-morbidities both for bulimia and anorexia. Both these weightlosing disorders cause malnourishment symptoms similar to those found in groups suffering from famine. The frequency of dieting nearly doubles between ages 14 and 18 years in Westernized girls. Only about half of those on diets are overweight by weight-height tables, and those who are markedly underweight for their height are at highest risk for an eating disorder. Girls on diets see themselves as "too fat, " whereas boys on diets are usually trying to increase muscle mass. One can help prevent eating disorders by targeting group-based educational programs to young women, to try and get them to adopt more healthful and natural "ideal body images, " adopt nutritionally sound eating patterns, and learn the present and future nutritional dangers inherent in most of the constant and rapid fire parade of "crash diet" fads streaking through the culture. Chronic overeating rests somewhere between an eating disorder and a noxious lifestyle; when coupled with a lack of adequate physical activity, the result is obesity. The prevalence of obesity continues to rise mostly in industrialized nations, and transitional nations are now starting this pattern. In industrialized areas, obesity is increasing more rapidly among families with low education, less income, and among people of color. This appears to be tied to the fact that starchy and fatty foods are cheaper than vegetables, fruits, and protein-rich foods; long-standing cultural food preferences; and-in a potentially healthy twist-devaluing the "ultra-slim" body image favored by rich, urbane Caucasians. Overeating may sometimes be encouraged by parents who have experienced food shortages. They continually urge their children to eat more at meals and to eat snacks, perhaps driven by a fear that food shortages may occur again, or perhaps in the belief that fat children are healthier.

Syndromes

• Breathing problems, pneumonia
• Stomach pain
• Blue lips, fingers, or fingernails
• Funny taste in the mouth
• Weakness
• Kicking
• Small, weak muscles or short, tight (spastic) muscles, which may cause problems and prevent normal leg growth
• Myeloma
• Slowing of activity