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Journal of Clinical and
Basic Psychosomatics Somatic symptom disorder etiology

Figure 2. Hippocampal transmitters and receptors are affected by hypercortisol
Abbreviations: ACh: Acetylcholine; GABA: Gamma-aminobutyric acid; SNS: Sympathetic nervous system.

directly opposite what the researchers hypothesized, likely unpredictable stress is equivalent to controllable stress is
given the contradictory literature they found on cortisol, needed. It is logical that chronic unpredictable stress is
trauma, and pain, and the lack of this paper’s map of the perceived as controllable, unlike chronic predictable stress,
neurochemical cascade for trauma, memory, and pain. which the subject comes to expect, knows the nature
and length of, and therefore comes to believe there is no
7. Secondary contributors: escaping.
Acetylcholinesterase and PAMP As further evidence of aceytlcholinesterase’s
7.1. Acetylcholinesterase importance, there is limited literature verifying its
increase in response to chronic stress when cortisol levels
Acetylcholinesterase, the enzyme that hydrolyses or breaks are high. 106-109 High levels of cortisol or exogenously
down ACh at the synapse should also be considered as administered hydrocortisone either stimulate the synthesis
a possible player in the T-A-P connection. Increased of acetylcholinesterase or speed up its degradation of
activity of acetylcholinesterase is linked to memory ACh. By degrading circulating ACh, high levels of
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impairment. 104,105 However, there is only one study to date acetylcholinesterase allow more glutamate release.
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that indicates acetylcholinesterase increases specifically in Acetylcholinesterase can also prevent ACh activation
the wake of trauma perceived as controllable. Its results are of the PNS, as discussed earlier, a key problem for
important in that they support the cortisol findings above, chronic psychogenic pain and somatization sufferers. 82,102
as well as encourage researchers to consider interplay of Furthermore, elevated acetylcholinesterase is linked to
HPA axis neurochemicals and receptors when it comes other PNS problems, such as increased muscle fatigue and
to understanding and treating traumatic amnesia and its degeneration at neuromuscular junctions in mice – the
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consequences. In 2005, Das et al. 106 discovered memory same complaints many fibromyalgia and chronic fatigue
impairment and higher levels of acetylcholinesterase in sufferers have. Finally, acetylcholinesterase is nearly an
rats who were exposed to chronic unpredictable stress, exact match of atropine’s protein sequence (99%), and
compared to those exposed to chronic predictable stress, butyrylcholinesterase, a cholinesterase that also hydrolyses
vs. only one episode of stress (control group). Replication ACh and other choline esters, is in fact, an exact match
of the study and confirmation of whether chronic (100%) of atropine’s protein sequence according to the

Volume 3 Issue 1 (2025) 11 doi: 10.36922/jcbp.4254