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Schär S, Mürner-Lavanchy I, Schmidt SJ, Koenig J, Kaess M. Child maltreatment and hypothalamic-pituitary-adrenal axis functioning: A systematic review and meta-analysis. Front Neuroendocrinol 2022; 66:100987. [PMID: 35202606 DOI: 10.1016/j.yfrne.2022.100987] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/04/2022]
Abstract
Alterations in hypothalamic-pituitary-adrenal (HPA) axis and its effector hormone cortisol have been proposed as one possible mechanism linking child maltreatment experiences to health disparities. In this series of meta-analyses, we aimed to quantify the existing evidence on the effect of child maltreatment on various measures of HPA axis activity. The systematic literature search yielded 1,858 records, of which 87 studies (k = 132) were included. Using random-effects models, we found evidence for blunted cortisol stress reactivity in individuals exposed to child maltreatment. In contrast, no overall differences were found in any of the other HPA axis activity measures (including measures of daily activity, cortisol assessed in the context of pharmacological challenges and cumulative measures of cortisol secretion). The impact of several moderators (e.g., sex, psychopathology, study quality), the role of methodological shortcomings of existing studies, as well as potential directions for future research are discussed.
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Affiliation(s)
- Selina Schär
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany; Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.
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Figaro-Drumond FV, Pereira SC, Menezes IC, von Werne Baes C, Coeli-Lacchini FB, Oliveira-Paula GH, Cleare AJ, Young AH, Tanus-Santos JE, Juruena MF, Lacchini R. Association of 11β-hydroxysteroid dehydrogenase type1 (HSD11b1) gene polymorphisms with outcome of antidepressant therapy and suicide attempts. Behav Brain Res 2020; 381:112343. [PMID: 31704233 DOI: 10.1016/j.bbr.2019.112343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/16/2019] [Accepted: 11/04/2019] [Indexed: 02/08/2023]
Abstract
The hypothalamic-pituitary-adrenal axis has been implicated in the pathophysiology of depressive disorders. HSD11B1 encodes 11β-hydroxysteroid dehydrogenase type1 enzyme, responsible for converting cortisone to cortisol. Genetic polymorphisms in HSD11B1 may impact in depression outcome and risk of suicide. This study aimed to assess whether HSD11B1 genotypes and haplotypes are associated with depression risk, severity of symptoms and suicidal attempts, considering early-life stress as an environmental factor. Here, 142 depressive patients and 103 healthy controls were included. Patients were enrolled from the Affective Disorders ambulatory and day hospital units, both within the University General Hospital of Ribeirao Preto. All subjects were clinically assessed applying the Mini-PLUS International Neuropsychiatric Interview, followed by the 21-item GRID-Hamilton Depression Scale, Childhood Trauma Questionnaire and Beck Scale for Suicidal Ideation (BSI). All subjects underwent antecubital vein puncture to obtain blood for DNA extraction. Genotyping of rs11119328 and rs11811440 were performed using allele-specific oligonucleotide polymerase chain reaction. We found a significant association of rs11119328 variant genotypes with increased risk for at least one suicide attempt (OR: 7.10, p = 0.049) and an association of variant genotypes of rs11811440 with euthymic mood under optimized pharmacological treatment (OR: 0.05, P = 0.014). These tests included correction for confounding factors. The association of genetic markers with depression risk, GRID-HAM-D21 and BSI scores and the number of suicidal attempts were nonsignificant. Haplotypes combining both markers were not associated with the studied phenotypes. We conclude that HSD11B1 polymorphisms may be relevant biomarkers for detecting subjects genetically vulnerable to poorer antidepressant response and higher risk of suicide attempts.
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Affiliation(s)
- Fernanda Viana Figaro-Drumond
- Department of Psychiatric Nursing and Human Sciences, Ribeirao Preto College of Nursing, University of Sao Paulo, Brazil
| | - Sherliane Carla Pereira
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Itiana Castro Menezes
- Department of Neuroscience and Behavior, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Cristiane von Werne Baes
- Department of Neuroscience and Behavior, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Fernanda Borchers Coeli-Lacchini
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Anthony J Cleare
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, United Kingdom
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, United Kingdom
| | - Jose Eduardo Tanus-Santos
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Mario F Juruena
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, United Kingdom
| | - Riccardo Lacchini
- Department of Psychiatric Nursing and Human Sciences, Ribeirao Preto College of Nursing, University of Sao Paulo, Brazil.
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Bell CJ, Foulds JA, Horwood LJ, Mulder RT, Boden JM. Childhood abuse and psychotic experiences in adulthood: findings from a 35-year longitudinal study. Br J Psychiatry 2019; 214:153-158. [PMID: 30774061 DOI: 10.1192/bjp.2018.264] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The extent to which exposure to childhood sexual and physical abuse increases the risk of psychotic experiences in adulthood is currently unclear.AimsTo examine the relationship between childhood sexual and physical abuse and psychotic experiences in adulthood taking into account potential confounding and time-dynamic covariate factors. METHOD Data were from a cohort of 1265 participants studied from birth to 35 years. At ages 18 and 21, cohort members were questioned about childhood sexual and physical abuse. At ages 30 and 35, they were questioned about psychotic experiences (symptoms of abnormal thought and perception). Generalised estimating equation models investigated covariation of the association between abuse exposure and psychotic experiences including potential confounding factors in childhood (socioeconomic disadvantage, adverse family functioning) and time-dynamic covariate factors (mental health, substance use and life stress). RESULTS Data were available for 962 participants; 6.3% had been exposed to severe sexual abuse and 6.4% to severe physical abuse in childhood. After adjustment for confounding and time-dynamic covariate factors, those exposed to severe sexual abuse had rates of abnormal thought and abnormal perception symptoms that were 2.25 and 4.08 times higher, respectively than the 'no exposure' group. There were no significant associations between exposure to severe physical abuse and psychotic experiences. CONCLUSIONS Findings indicate that exposure to severe childhood sexual (but not physical) abuse is independently associated with an increased risk of psychotic experiences in adulthood (particularly symptoms of abnormal perception) and this association could not be fully accounted for by confounding or time-dynamic covariate factors.Declaration of interestNone.
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Affiliation(s)
- Caroline J Bell
- Associate Professor,Department of Psychological Medicine,University of Otago,New Zealand
| | - James A Foulds
- Senior Lecturer,Department of Psychological Medicine,University of Otago,New Zealand
| | - L John Horwood
- Professor,Department of Psychological Medicine and Director, Christchurch Health and Development Study,University of Otago,New Zealand
| | - Roger T Mulder
- Professor,Department of Psychological Medicine,University of Otago,New Zealand
| | - Joseph M Boden
- Associate Professor,Department of Psychological Medicine,University of Otago and Deputy Director, Christchurch Health and Development Study,New Zealand
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Dobler VB, Neufeld SA, Fletcher PF, Perez J, Subramaniam N, Teufel C, Goodyer IM. Disaggregating physiological components of cortisol output: A novel approach to cortisol analysis in a clinical sample - A proof-of-principle study. Neurobiol Stress 2019; 10:100153. [PMID: 31193494 PMCID: PMC6535687 DOI: 10.1016/j.ynstr.2019.100153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 01/17/2019] [Accepted: 03/04/2019] [Indexed: 12/12/2022] Open
Abstract
Although childhood adversity (CA) increases risk for subsequent mental illnesses, developmental mechanisms underpinning this association remain unclear. The hypothalamic-pituitary-adrenal axis (HPAA) is one candidate system potentially linking CA with psychopathology. However, determining developmental effects of CA on HPAA output and differentiating these from effects of current illness has proven difficult. Different aspects of HPAA output are governed by differentiable physiological mechanisms. Disaggregating HPAA output according to its biological components (baseline tonic cortisol, background diurnal variation, phasic stress response) may improve precision of associations with CA and/or psychopathology. In a novel proof-of-principle investigation we test whether different predictors, CA (distal risk factor) and current depressive symptoms, show distinct associations with dissociable HPAA components. A clinical group (aged 16-25) at high-risk for developing severe psychopathology (n = 20) were compared to age and sex matched healthy controls (n = 21). Cortisol was measured at waking (x4), following stress induction (x8), and during a time-environment-matched non-stress condition. Using piecewise multilevel modeling, stress responses were disaggregated into increase and decrease, while controlling for waking cortisol, background diurnal output and confounding variables. Elevated waking cortisol was specifically associated with higher CA scores. Higher non-stress cortisol was specifically associated with higher depressive scores. Following stress induction, depressive symptoms attenuated cortisol increase, whilst CA attenuated cortisol decrease. The results support a differential HPAA dysregulation hypothesis where physiologically dissociable components of HPAA output are differentially associated with distal (CA) or proximal (depressive symptoms) predictors. This proof-of-principle study demonstrates that future cortisol analyses need to disaggregate biologically independent mechanisms of HPAA output.
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Affiliation(s)
- Veronika B. Dobler
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
| | - Sharon A.S. Neufeld
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
| | - Paul F. Fletcher
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Elisabeth House, Cambridge, CB21 5EF, UK
| | - Jesus Perez
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Elisabeth House, Cambridge, CB21 5EF, UK
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
- Department of Neuroscience, Instituto de Investigacion Biomedica de Salamanca (IBSAL), University of Salamanca, Spain
| | - Naresh Subramaniam
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
| | - Christoph Teufel
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Ian M. Goodyer
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
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Mazer AK, Cleare AJ, Young AH, Juruena MF. Bipolar affective disorder and borderline personality disorder: Differentiation based on the history of early life stress and psychoneuroendocrine measures. Behav Brain Res 2019; 357-358:48-56. [PMID: 29702176 DOI: 10.1016/j.bbr.2018.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 03/30/2018] [Accepted: 04/11/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Borderline Personality Disorder (BPD) and Bipolar Affective Disorder (BD) have clinical characteristics in common which often make their differential diagnosis difficult. The history of early life stress (ELS) may be a differentiating factor between BPD and BD, as well as its association with clinical manifestations and specific neuroendocrine responses in each of these diagnoses. OBJECTIVE Assessing and comparing patients with BD and BPD for factors related to symptomatology, etiopathogenesis and neuroendocrine markers. METHODOLOGY The study sample consisted of 51 women, divided into 3 groups: patients with a clinical diagnosis of BPD (n = 20) and BD (n = 16) and healthy controls (HC, n = 15). Standardized instruments were used for the clinical evaluation, while the history of ELS was quantified with the Childhood Trauma Questionnaire (CTQ), and classified according to the subtypes: emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect. The functioning of the hypothalamic-pituitary-adrenal (HPA) axis was evaluated by measuring a single plasma cortisol sample. RESULTS Patients with BPD presented with more severe psychiatric symptoms of: anxiety, impulsivity, depression, hopelessness and suicidal ideation than those with BD. The history of ELS was identified as significantly more prevalent and more severe in patients (BPD and BP) than in HC. Emotional abuse, emotional neglect and physical neglect also showed differences and were higher in BPD than BD patients. BPD patients had greater severity of ELS overall and in the subtypes of emotional abuse, emotional neglect and physical neglect than BD patients. The presence of ELS in patients with BPD and BP showed significant difference with lower cortisol levels when compared to HC. The endocrine evaluation showed no significant differences between the diagnoses of BPD and BD. Cortisol measured in patients with BPD was significantly lower compared to HC in the presence of emotional neglect and physical neglect. A significant negative correlation between the severity of hopelessness vs cortisol; and physical neglect vs cortisol were found in BPD with ELS. The single cortisol sample showed a significant and opposite correlations in the sexual abuse diagnosis-related groups, being a negative correlation in BD and positive in BPD. DISCUSSION Considering the need for a multi-factorial analysis, the differential diagnosis between BPD and BD can be facilitated by the study of psychiatric symptoms, which are more severe in the BPD patients with a history of early life stress. The function of the HPA axis assessed by this cortisol measure suggests differences between BPD and BP with ELS history. CONCLUSION The integrated analysis of psychopathology, ELS and neuroendocrine function may provide useful indicators to differentiate BPD and BD diagnoses. These preliminary data need to be replicated in a more significant sample with improved and multiple assessments of HPA axis activity.
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Affiliation(s)
| | - Anthony J Cleare
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience & South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Allan H Young
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience & South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Mario F Juruena
- Department of Neuroscience and Behavior, University of Sao Paulo, Brazil; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience & South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK.
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Hoppen TH, Chalder T. Childhood adversity as a transdiagnostic risk factor for affective disorders in adulthood: A systematic review focusing on biopsychosocial moderating and mediating variables. Clin Psychol Rev 2018; 65:81-151. [PMID: 30189342 DOI: 10.1016/j.cpr.2018.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/25/2018] [Accepted: 08/14/2018] [Indexed: 02/09/2023]
Affiliation(s)
| | - Trudie Chalder
- Academic Department of Psychological Medicine, King's College London, UK
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Fogelman N, Canli T. Early life stress and cortisol: A meta-analysis. Horm Behav 2018; 98:63-76. [PMID: 29289660 DOI: 10.1016/j.yhbeh.2017.12.014] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/27/2017] [Accepted: 12/24/2017] [Indexed: 12/16/2022]
Abstract
Given the high prevalence of early life stress (ELS) and the potential physiological dysregulation such experiences can lead to, this meta-analysis tested the relationship between ELS and cortisol. Search terms related to ELS and cortisol were entered in to PsycINFO and PubMed. Effect sizes were extracted for four outcomes variables: cortisol awakening response (CAR), baseline cortisol (cortisol at one time point), non-stressed cortisol over time (cortisol captured at two or more time points), and cortisol reactivity to an acute stressor. The articles were additionally coded for potential confounding variables, population-related, ELS-related and cortisol-related moderators. There was no significant relationship between ELS and the CAR (g=0.19, p=0.268), ELS and baseline cortisol (g=-0.072, p=0.328), ELS and non-stressed cortisol over time (g=0.09, p=0.292) or ELS and cortisol reactivity (g=-0.089, p=0.363). However, there was a significant amount of heterogeneity amongst relationships. Within the ELS-CAR relationship, in those who had experienced ELS that was sexually, physically or emotionally abusive, the CAR was heightened. Within the ELS-Baseline relationship, if blood samples were collected the ELS was associated with a blunting effect of cortisol. The non-significant main effects challenge the commonly held belief in the literature that ELS affects cortisol later in life. However, the high degree of heterogeneity uncovered by this analysis and significant moderators suggest that the literature may benefit from consistent operationalizations of ELS and standardized methods of how cortisol is measured.
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Affiliation(s)
- Nia Fogelman
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA.
| | - Turhan Canli
- Department of Psychology, Department of Psychiatry, Stony Brook University, Stony Brook, NY 11794, USA
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Abstract
Although it has been proposed that the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis may act as a possible pathway linking early life stress to psychosis, this relationship has not yet been fully confirmed. This study aimed to investigate the relationship between childhood adversity (CA), cortisol levels, and psychosis. Eighty-five patients with psychosis and 170 control subjects were enrolled in the study. CA was evaluated using the Florence Psychiatric Interview, and Childhood Experience of Care and Abuse Questionnaire. Positive symptoms (PS) were assessed using the Positive and Negative Syndrome Scale. Cortisol levels were evaluated in saliva samples. Patients experienced more CA and showed higher cortisol levels than controls. Patients with CA showed higher morning cortisol levels and more severe PS than those without CA. Patients with higher morning cortisol levels showed severe delusions. These findings suggest that both CA and dysregulation of the HPA axis could be related to psychosis.
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Vargas Alves Nunes A, Odebrecht Vargas Nunes S, Strano T, Pascolat G, Schier Doria GM, Nasser Ehlke M. Folie à Deux and its interaction with early life stress: a case report. J Med Case Rep 2016; 10:339. [PMID: 27906088 PMCID: PMC5134243 DOI: 10.1186/s13256-016-1128-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Folie à deux is a very rare psychiatric syndrome in which a psychotic symptom is transmitted from one individual to another. We present a case of folie à deux occurring during childhood, which is not an usual presentation of this syndrome. In this case, the disorder is correlated with child abuse and neglect, which possibly had a role in the development of the symptoms in our case. Case presentation We present a case of folie à deux between an “induced” 9-year-old black Brazilian boy and the “inducer”, his grandmother. They were found to be sharing similar auditory and visual hallucinations and delusional beliefs. The boy was neglected by his parents and was being cared for by his grandmother, who had a history of mental disorder. Conclusions The close relationship between the boy and his grandmother, the family history of first-degree psychosis, and the child abuse and neglect suffered by the boy may have altered his vulnerability to early-onset psychosis and, in this case, folie à deux.
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Affiliation(s)
- Alessandra Vargas Alves Nunes
- Pediatrics Department, Hospital Universitário Evangélico de Curitiba, 2885 Padre Agostinho, apto 1304 torre barigui, ZIP 80710-000, Curitiba, Paraná, Brazil.
| | | | - Talita Strano
- Pediatrics Department, Hospital Universitário Evangélico de Curitiba, 2885 Padre Agostinho, apto 1304 torre barigui, ZIP 80710-000, Curitiba, Paraná, Brazil
| | - Gilberto Pascolat
- Pediatrics Department, Hospital Universitário Evangélico de Curitiba, 2885 Padre Agostinho, apto 1304 torre barigui, ZIP 80710-000, Curitiba, Paraná, Brazil
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Castellini G, Lelli L, Ricca V, Maggi M. Sexuality in eating disorders patients: etiological factors, sexual dysfunction and identity issues. A systematic review. Horm Mol Biol Clin Investig 2016; 25:71-90. [DOI: 10.1515/hmbci-2015-0055] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/24/2015] [Indexed: 11/15/2022]
Abstract
AbstractThe scientific community appears to be less interested in sexuality of eating disorders (EDs) as compared to other psychiatric or medical comorbidities. However, a clear association between sexual problems and ED psychopathology was reported from different perspectives. The overarching goal of this systematic review was to evaluate the general approach of the scientific literature toward the topic of sexuality and EDs. In particular, four different categories of research have been individuated, encompassing the role of puberty, and sexual abuse in the pathogenesis of the disorders, sexual dysfunctions, and the association between sexual orientation and EDs psychopathology. Timing of puberty with its hormonal consequences and the changes in the way persons perceive their own body represent a crucial period of life for the onset of the disorder. Sexual abuse, and especially childhood sexual abuse are well-recognized risk factors for the development of ED, determining a worse long-term outcome. Recent research overcome the approach that considers sexual activity of EDs patients, in terms of hypersexuality and dangerous sexual behaviors, considering the sexuality of EDs persons in terms of sexual desire, satisfaction, orgasm and pain. Results from this line of research are promising, and describe a clear relationship between sexual dysfunction and the core psychopathological features of EDs, such as body image disturbances. Finally, the analysis of the literature showed an association between sexual orientation and gender dysphoria with EDs psychopathology and pathological eating behaviors, confirming the validity of research developing new models of maintaining factors of EDs related to the topic of self-identity.
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Chen WT, Yeh TL, Lehti V, Cheng SH, Chu CL, Chen KC, Lee IH, Chen PS, Yang YK. Daily life events influence the results of the Dexamethasone Suppression Test in healthy women. Behav Med 2012; 38:49-53. [PMID: 22676630 DOI: 10.1080/08964289.2012.679327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although the Dexamethasone Suppression Test (DST) plays an important role in psychosomatic research, confounding factors limit the sensitivity and specificity of the DST. The aim of this study was to investigate the relationship between the intensity of daily life stressors and DST results in healthy participants after controlling the confounding factors. The subjects of this study consisted of 75 healthy volunteers. The intensity of daily life events was assessed using the Taiwanese version of the Recent Life Change Questionnaire (RLCQ). Neuroticism was assessed using the Maudsley Personality Inventory (MPI). The Dexamethasone Suppression Test (DST) was also performed. The regression model showed that daily life events (RLCQ score) were correlated significantly with cortisol level on day 1 and D% only in women. This finding implies that daily life events should be considered as an independent variable in women in further studies when the DST is applied.
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Hypothalamic-pituitary-adrenal axis dysfunction as a neurobiological correlate of emotion dysregulation in adolescent suicide. World J Pediatr 2012; 8:197-206. [PMID: 22886191 DOI: 10.1007/s12519-012-0358-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 06/09/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Biological markers of vulnerability for current or future risk of suicide in adolescents could be important adjuncts to the treatment and prevention of this phenomenon. DATA SOURCES We conducted a PubMed search of all English-language articles published between January 1990 and June 2011 using the following search terms: ("hypothalamic-pituitary-adrenal" OR "HPA") AND ("adolescence" OR "adolescent" OR "teenager") AND ("depression" OR "major depressive disorder" OR "suicidal behavior" OR "suicidal ideation" OR "suicidal thoughts" OR "deliberate self-harm" OR "suicidal attempt" OR "suicide"). RESULTS HPA axis activity can be examined using different methods that do not have the same biological interpretation. An abnormal HPA axis functioning together with an anomalous interaction between HPA mechanisms and other systems such as the serotonergic system may be one of the neurobiological correlates of emotion dysregulation (ED). ED may play an important role in adolescent suicidal behavior. Some psychopathological conditions such as depression or childhood psychological trauma that increase suicidal risk in adolescents are also associated with HPA axis dysregulation. ED, a personality trait, can also be viewed as a predisposing factor that augments the vulnerability to suffer from psychiatric conditions. CONCLUSIONS Correlating HPA axis dysfunction with psychological factors such as ED could lead to a better understanding of the role of HPA abnormalities in adolescent suicide and may enhance preventive and treatment strategies.
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Holleman M, Vreeburg SA, Dekker JJM, Penninx BWJH. The relationships of working conditions, recent stressors and childhood trauma with salivary cortisol levels. Psychoneuroendocrinology 2012; 37:801-9. [PMID: 22000684 DOI: 10.1016/j.psyneuen.2011.09.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 09/19/2011] [Accepted: 09/21/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND An etiological model has been suggested where stress leads to high cortisol levels and hypothalamic-pituitary-adrenal (HPA) axis dysregulation, resulting in somatic diseases and psychopathology. To evaluate this model we examined the association of different stressors (working conditions, recent life events and childhood trauma) with various cortisol indicators in a large cohort study. METHODS Data are from 1995 participants of the Netherlands Study of Depression and Anxiety (NESDA). Most of the selected participants had a current or remitted anxiety and/or depressive disorder. Working conditions were assessed with self-report questionnaires, life-events and childhood trauma were assessed with interview questionnaires. Cortisol levels were measured in seven saliva samples, determining the 1-h cortisol awakening response (CAR), evening cortisol levels and cortisol suppression after a 0.5mg dexamethasone suppression test (DST). RESULTS Regression analyses--adjusted for covariates--showed two significant associations: low social support at work and high job strain were associated with more cortisol suppression after the DST. No other associations were found with any of the cortisol variables. CONCLUSIONS Working conditions, recent stressors and childhood trauma were not convincingly associated with cortisol levels.
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Affiliation(s)
- Michiel Holleman
- Research Department of Arkin Mental Health Institute, Amsterdam, The Netherlands.
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14
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Li W, Newell-Price J, Jones GL, Ledger WL, Li TC. Relationship between psychological stress and recurrent miscarriage. Reprod Biomed Online 2012; 25:180-9. [PMID: 22687324 DOI: 10.1016/j.rbmo.2012.03.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 03/17/2012] [Accepted: 03/20/2012] [Indexed: 01/20/2023]
Abstract
Stress arousal may compromise the feedback regulation of the hypothalamo-pituitary-adrenal axis, releasing stress-related biomarkers and thereby affecting establishment of pregnancy. This study examined the relationship between stress and recurrent miscarriage (RM) and the impact of stress on establishment of pregnancy. The stress status of 45 patients with unexplained RM and 40 fertile women was investigated with the Fertility Problem Inventory (FPI), Perceived Stress Scale (PSS), Positive and Negative Affect Schedule, peripheral natural killer (NK) cells and cortisol. Patients with unexplained RM had significantly higher scores on the FPI (P<0.05, adjusted OR 1.02), PSS (P<0.05, adjusted OR 1.13) and Negative Affect scale (P<0.05, adjusted OR 1.12) and lower scores on the Positive Affect scale (P<0.05, adjusted OR 0.89) than fertile controls. Patients who had live births (n=20) during the study period had significantly lower scores in the Positive Affect scale (P<0.05, adjusted OR 1.17) than those who miscarried (n=10). There was a little association between psychological stress measurements and biochemical stress measurements. These results suggest that stress is a risk factor of RM. Within women with RM, moderate stress appears to be associated with improved pregnancy outcome.
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Affiliation(s)
- W Li
- Academic Unit of Reproductive and Developmental Medicine, Dept Human Metabolism, University of Sheffield, Sheffield, S102SF, UK.
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Faravelli C, Lo Sauro C, Godini L, Lelli L, Benni L, Pietrini F, Lazzeretti L, Talamba GA, Fioravanti G, Ricca V. Childhood stressful events, HPA axis and anxiety disorders. World J Psychiatry 2012; 2:13-25. [PMID: 24175164 PMCID: PMC3782172 DOI: 10.5498/wjp.v2.i1.13] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 10/24/2011] [Accepted: 01/21/2012] [Indexed: 02/05/2023] Open
Abstract
Anxiety disorders are among the most common of all mental disorders and their pathogenesis is a major topic in psychiatry, both for prevention and treatment. Early stressful life events and alterations of hypothalamic pituitary adrenal (HPA) axis function seem to have a significant role in the onset of anxiety. Existing data appear to support the mediating effect of the HPA axis between childhood traumata and posttraumatic stress disorder. Findings on the HPA axis activity at baseline and after stimuli in panic disordered patients are inconclusive, even if stressful life events may have a triggering function in the development of this disorder. Data on the relationship between stress, HPA axis functioning and obsessive-compulsive disorder (OCD) are scarce and discordant, but an increased activity of the HPA axis is reported in OCD patients. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. While several hypothesis have attempted to explain these findings over time, currently the most widely accepted theory is that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology. All theories are reviewed and the authors conclude that childhood life events and HPA abnormalities may be specifically and transnosographically related to all anxiety disorders, as well as, more broadly, to all psychiatric disorders.
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Affiliation(s)
- Carlo Faravelli
- Carlo Faravelli, Carolina Lo Sauro, Department of Psychology, University of Florence, 50135 Firenze, Florence, Italy
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Abstract
In the last decade, a substantial number of population-based studies have suggested that childhood trauma is a risk factor for psychosis. In several studies, the effects held after adjusting for a wide range of potentially confounding variables, including genetic liability for psychosis. Less is known about the mechanisms underlying the association between childhood trauma and psychosis. Possible pathways include relationships between negative perceptions of the self, negative affect, and psychotic symptoms, as well as biological mechanisms such as dysregulated cortisol and increased sensitivity to stress. Psychotic patients with a history of childhood trauma tend to present with a variety of additional problems, including post-traumatic stress disorder, greater substance abuse, higher levels of depression and anxiety, and more frequent suicide attempts. Initial studies suggest that trauma-specific treatments are as beneficial for these patients as for other diagnostic groups.
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Affiliation(s)
- Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Sex-specific cortisol levels in bipolar disorder and schizophrenia during mental challenge--relationship to clinical characteristics and medication. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1100-7. [PMID: 21420462 DOI: 10.1016/j.pnpbp.2011.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/10/2011] [Accepted: 03/11/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Our objective was to examine the cortisol release during a mental challenge in severe mental disorders versus healthy controls (HC), analyzing effects of sex, clinical characteristics and medication, and comparing Bipolar Disorder (BD) to Schizophrenia (SCZ). METHODS Patients with BD and SCZ (n=151) were recruited from a catchment area. HC (n=98) were randomly selected from the same area. Salivary samples were collected before and after a mental challenge and cortisol levels determined. RESULTS During the challenge there was an interaction between group and sex (P = 0.015) with male patients having a blunted cortisol release compared to male HC (P = 0.037). Cortisol change did not differ significantly between BD and SCZ. In all patients, the cortisol change correlated with number of psychotic episodes (r = -0.23, P = 0.025), and in females patients, with number of depressive episodes (r = -0.33, P = 0.015). Patients using antidepressants had a greater cortisol release during challenge than those not using antidepressants (P = 0.043). CONCLUSIONS Male patients with severe mental disorders seem to have a uniform abnormal cortisol release during mental challenges which associates with clinical course, and with beneficial effects of antidepressants.
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Antonova L, Aronson K, Mueller CR. Stress and breast cancer: from epidemiology to molecular biology. Breast Cancer Res 2011; 13:208. [PMID: 21575279 PMCID: PMC3219182 DOI: 10.1186/bcr2836] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Stress exposure has been proposed to contribute to the etiology of breast cancer. However, the validity of this assertion and the possible mechanisms involved are not well established. Epidemiologic studies differ in their assessment of the relative contribution of stress to breast cancer risk, while physiological studies propose a clear connection but lack the knowledge of intracellular pathways involved. The present review aims to consolidate the findings from different fields of research (including epidemiology, physiology, and molecular biology) in order to present a comprehensive picture of what we know to date about the role of stress in breast cancer development.
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Affiliation(s)
- Lilia Antonova
- Center for Cancer Therapeutics, Ottawa Hospital Research Institute, 501 Smyth Rd, TOHCC 3rd floor, Ottawa, ON, K1H 8L6, Canada.
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