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Ribette C, Rosenthal L, Raynaud JP, Franchitto L, Revet A. Primary care physicians' experience of caring for children with parents with mental health illness: a qualitative study among French general practitioners and paediatricians. BMC PRIMARY CARE 2023; 24:190. [PMID: 37718455 PMCID: PMC10506299 DOI: 10.1186/s12875-023-02145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Parental psychiatric disorders can have a significant impact on child development and the parent-infant bond, with a high risk of attachment disorders. Early identification of difficulties in the parent-child relationship is essential to prevent consequences for the child. Childcare practitioners have a major role to play in this early detection process, through regular mandatory consultations during the first two years of a child's life. Thus, the aim of this study was to collect the experience of private practitioners in their care of children of parents with a mental health illness. METHOD This is a cross-sectional, observational, qualitative study. Data were collected by means of semi-structured interviews with eleven general practitioners and private paediatricians between February and July 2021 in Toulouse and its suburbs. We only included practitioners who had followed children of parents with a mental health illness. The interviews were recorded with the agreement of the participants, before being transcribed anonymously. The data were analysed with NVivo software using interpretative phenomenological analysis. RESULTS Three main themes emerged from the results, which were further divided into several sub-themes. Addressing psychiatric disorders presents a risk for the therapeutic relationship. Practitioners express a need to preserve this relationship with the parent in joint care. Care is difficult and is permeated by the parents' emotional issues. Furthermore, practitioners face a conflict between their concerns for the parent-child bond and their desire not to stigmatise these families. They express a feeling of isolation in these follow-ups. This stressful care has a significant emotional impact on the doctors. Access to psychiatric training and multidisciplinary collaboration seem to be essential to improve the follow-up experience for practitioners, as these factors strengthen inter-professional connections. CONCLUSION Practitioners describe a parent-doctor relationship at risk, which is underpinned by the fear of care placement. This study illustrates the need to strengthen multidisciplinary work by promoting interprofessional exchanges, in order to improve the experience of practitioners in this care process. Addressing practitioners' fear of discussing parental psychiatric illness is very important, so as not to delay the implementation of preventive actions that are likely to improve the developmental prognosis for children.
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Affiliation(s)
- Cécile Ribette
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France.
| | - Lucie Rosenthal
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
| | - Jean-Philippe Raynaud
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
- CERPOP, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Ludivine Franchitto
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
| | - Alexis Revet
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
- CERPOP, University of Toulouse, Inserm, UPS, Toulouse, France
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2
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Liu Y, Shan L, Liu T, Li J, Chen Y, Sun C, Yang C, Bian X, Niu Y, Zhang C, Xi J, Rao Y. Molecular and cellular mechanisms of the first social relationship: A conserved role of 5-HT from mice to monkeys, upstream of oxytocin. Neuron 2023; 111:1468-1485.e7. [PMID: 36868221 DOI: 10.1016/j.neuron.2023.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/21/2021] [Accepted: 02/07/2023] [Indexed: 03/05/2023]
Abstract
Maternal affiliation by infants is the first social behavior of mammalian animals. We report here that elimination of the Tph2 gene essential for serotonin synthesis in the brain reduced affiliation in mice, rats, and monkeys. Calcium imaging and c-fos immunostaining showed maternal odors activation of serotonergic neurons in the raphe nuclei (RNs) and oxytocinergic neurons in the paraventricular nucleus (PVN). Genetic elimination of oxytocin (OXT) or its receptor reduced maternal preference. OXT rescued maternal preference in mouse and monkey infants lacking serotonin. Tph2 elimination from RN serotonergic neurons innervating PVN reduced maternal preference. Reduced maternal preference after inhibiting serotonergic neurons was rescued by oxytocinergic neuronal activation. Our genetic studies reveal a role for serotonin in affiliation conserved from mice and rats to monkeys, while electrophysiological, pharmacological, chemogenetic, and optogenetic studies uncover OXT downstream of serotonin. We suggest serotonin as the master regulator upstream of neuropeptides in mammalian social behaviors.
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Affiliation(s)
- Yan Liu
- Chinese Institutes for Medical Research (CIMR) and Department of Neurobiology, School of Basic Medical Sciences, Beijing Key Laboratory of Neural Regeneration and Repair, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 10069, China.
| | - Liang Shan
- PKU-IDG/McGovern Institute for Brain Research, Peking-Tsinghua Center for Life Sciences, School of Life Sciences, School of Pharmaceutical Sciences, School of Chemistry and Chemical Engineering, Peking University, Beijing 100871, China; Chinese Institute for Brain Research, Beijing, Zhongguangcun Life Science Park, Beijing, China
| | - Tiane Liu
- PKU-IDG/McGovern Institute for Brain Research, Peking-Tsinghua Center for Life Sciences, School of Life Sciences, School of Pharmaceutical Sciences, School of Chemistry and Chemical Engineering, Peking University, Beijing 100871, China; Chinese Institute for Brain Research, Beijing, Zhongguangcun Life Science Park, Beijing, China
| | - Juan Li
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Yongchang Chen
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Changhong Sun
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Chaojuan Yang
- Chinese Institutes for Medical Research (CIMR) and Department of Neurobiology, School of Basic Medical Sciences, Beijing Key Laboratory of Neural Regeneration and Repair, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 10069, China
| | - Xiling Bian
- PKU-IDG/McGovern Institute for Brain Research, Peking-Tsinghua Center for Life Sciences, School of Life Sciences, School of Pharmaceutical Sciences, School of Chemistry and Chemical Engineering, Peking University, Beijing 100871, China; Chinese Institute for Brain Research, Beijing, Zhongguangcun Life Science Park, Beijing, China
| | - Yuyu Niu
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Chen Zhang
- Chinese Institutes for Medical Research (CIMR) and Department of Neurobiology, School of Basic Medical Sciences, Beijing Key Laboratory of Neural Regeneration and Repair, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 10069, China
| | - Jianzhong Xi
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Yi Rao
- Chinese Institutes for Medical Research (CIMR) and Department of Neurobiology, School of Basic Medical Sciences, Beijing Key Laboratory of Neural Regeneration and Repair, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 10069, China; PKU-IDG/McGovern Institute for Brain Research, Peking-Tsinghua Center for Life Sciences, School of Life Sciences, School of Pharmaceutical Sciences, School of Chemistry and Chemical Engineering, Peking University, Beijing 100871, China; Changping Laboratory, Yard 28, Science Park Road, Changping District, Beijing, China; Chinese Institute for Brain Research, Beijing, Zhongguangcun Life Science Park, Beijing, China; Research Unit of Medical Neurobiology, Chinese Academy of Medical Sciences, Beijing, China.
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Zayde A, Derella OJ, Kilbride A. Safe haven in adolescence: Improving parental reflective functioning and youth attachment and mental health with the Connecting and Reflecting Experience. Infant Ment Health J 2023; 44:268-283. [PMID: 36862314 DOI: 10.1002/imhj.22042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/28/2023] [Indexed: 03/03/2023]
Abstract
Attachment security provides a well-documented protective developmental function for children exposed to individual- and community-level trauma, yet the effectiveness of prevention and intervention efforts targeting attachment during adolescence has been relatively underexplored. The Connecting and Reflecting Experience (CARE) program is a transdiagnostic, bi-generational, group-based, mentalizing-focused parenting intervention developed to dismantle the intergenerational transmission of trauma and support secure attachment relationships across the developmental spectrum within an under-resourced community. This exploratory study evaluated outcomes among caregiver-adolescent dyads (N = 32) in the CARE condition of a nonrandomized clinical trial at an outpatient mental health clinic within a diverse, urban U.S. community with disproportionate trauma exposure exacerbated by COVID-19. Caregivers predominantly identified as Black/African/African American (47%), Hispanic/Latina (38%), and/or White (19%). At pre- and post-intervention, caregivers completed questionnaires regarding parental mentalizing and their adolescents' psychosocial functioning. Adolescents completed scales regarding attachment and psychosocial functioning. Results showed a significant decrease in caregivers' prementalizing on the Parental Reflective Functioning Questionnaire, improvement in adolescent psychosocial functioning on the Youth Outcomes Questionnaire, and an increase in adolescents' reports of attachment security on the Security Scale. These preliminary findings suggest that mentalizing-focused parenting interventions may be effective in fostering improved attachment security and psychosocial functioning during adolescence.
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Affiliation(s)
- Amanda Zayde
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Olivia J Derella
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Anna Kilbride
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
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Brockman R. Safety: From the Paris Morgue to Oxytocin. Psychodyn Psychiatry 2022; 50:585-602. [PMID: 36476024 DOI: 10.1521/pdps.2022.50.4.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
On Tuesday April 21, 1896, Freud gave a lecture to the Viennese medical community arguing that "hysteria," as it was then known, was caused by memories of actual physical and sexual abuse suffered in childhood. Freud rightly felt that he had made a major discovery about the science of hysteria, of psychotherapy, and of the mind. However, his idea was ridiculed. Freud's reaction to his detractors was swift: "They can go to hell." Freud withdrew "into a cocoon." When he emerged a year later, he brought with him a new science-the "science" of psychoanalysis, which for all its creativity and imagination, was devoid of science. One of the core concepts that would be sacrificed was safety itself. The "reality" of safety (and thus the reality of danger) was replaced by the "phantasy" of safety (and thus the phantasy of danger). This article reexamines some of the science that psychoanalysis took out. In particular the article looks at early attachment, safety, oxytocin, and the role of the autonomic nervous system. The reintroduction of science to psychotherapy is critical if psychotherapy is to be a science of the mind.
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Affiliation(s)
- Richard Brockman
- Clinical Professor of Psychiatry at Columbia University Medical Center and Visiting Professor of Psychiatry at the University of Namibia School of Medicine. He is also an award-winning playwright. His plays have been produced in London, New York, and Chicago
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Lasheras G, Farré-Sender B, Osma J, Martínez-Borba V, Mestre-Bach G. Mother-infant bonding screening in a sample of postpartum women: comparison between online vs offline format. J Reprod Infant Psychol 2022; 40:500-515. [PMID: 33950755 DOI: 10.1080/02646838.2021.1921716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS We aim to study the the reliability and factorial structure of the Postpartum Bonding Questionnaire (PBQ)administered through two different formats, offline (paper-and-pencil) and online. We also compared clinical, obstetrical, reproductive, and psychopathological variables related to poor mother infant bonding (MIB). METHODS A cross-sectional study was conducted on 1,269 mothers. The offline group included 812 women who attended a 40-day postpartum clinical appointment. The online group consisted of 457 women recruited during admission for delivery who volunteered to carry out the online protocol 40 days postpartum. All the participants individually completed the PBQ, the Edinburg Postnatal Depression Scale (EPDS) and other clinical and sociodemographic variables. RESULTS The 4-factor solution proposed in the PBQ and its Spanish validation showed good model fit for both samples. Online participants reported higher levels of stress, depressive symptoms, and poor bonding, specifically on PBQ scores and the Rejection and Anger subscales. No differences were found in both samples regarding the type of statistical associations between PBQ and sociodemographic, reproductive, obstetric and psychological outcomes. CONCLUSION Online assessment may be an appropriate option for detecting possible alterations in MIB due to the reduction of desirability bias, the increased perception of anonymity, and being a more cost-effective method.
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Affiliation(s)
- Gracia Lasheras
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
| | - Borja Farré-Sender
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
| | - Jorge Osma
- Department of Psychology and Sociology, Universidad De Zaragoza. Instituto De Investigación Sanitaria De Aragón, Zaragoza, Spain
| | - Verónica Martínez-Borba
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I. Instituto De Investigación Sanitaria De Aragón, Zaragoza, Spain
| | - Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional De La Rioja, La Rioja, Spain
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Muacevic A, Adler JR, Bhaskaran J, Akter M, Watts T. Review of the Current Knowledge of Reactive Attachment Disorder. Cureus 2022; 14:e31318. [PMID: 36514636 PMCID: PMC9736782 DOI: 10.7759/cureus.31318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/11/2022] Open
Abstract
Reactive attachment disorder (RAD), classified under Trauma and Stressor Related Disorders in the DSM-5 manual, is a childhood psychiatric illness due to familial or social neglect or due to maltreatment. It is characterized by an inhibited and withdrawn social and emotional behavior toward an adult caregiver, typically before the age of 5. Neurobiological changes in patients with RAD have been shown to be substantially significant with features such as loss of grey matter volume and neurotransmitter deficiencies that not only impact the ability to form healthy attachments but also increase the risk of comorbidities such as depression and anxiety. Different theories, including the current mediation hypothesis and learning theory of attachment, showed childhood maltreatment from caregivers and desensitization toward deficiencies in social development in children from special education teachers to be key components in the development of RAD. Patients with RAD had an increased risk of developing psychiatric comorbidities, including learning disabilities and mood disorders. Institutionalized care and childhood maltreatment have a significant impact on the development of RAD. RAD is an underdiagnosed and underreported condition with significant repercussions that can severely impact the development of a child. By being able to raise awareness and promote further research into refining the diagnostic methodology, treatment protocols, and long-term follow-up, children afflicted with this condition may be able to develop better socio-emotional bonds and reduce the incidence of comorbidities such as depression and attention deficit hyperactivity disorder.
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Physiological Indicators of Acute and Chronic Stress in Securely and Insecurely Attached Dogs Undergoing a Strange Situation Procedure (SSP): Preliminary Results. Vet Sci 2022; 9:vetsci9100519. [PMID: 36288132 PMCID: PMC9610408 DOI: 10.3390/vetsci9100519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary The attachment bond that dogs form towards their owners shares similar features with the bond children form towards their caregivers. Insecurely attached children struggle to find support from their caregivers and therefore to regulate their own emotional response in times of distress. We aimed to investigate whether the quality of dog attachment to the owner may affect their physiological response to stress. We selected ten insecure and ten secure dogs from a sample of individuals who underwent a Strange Situation Procedure (SSP) to assess their attachment pattern towards the owner. The SSP is specifically designed to progressively generate stress. We collected saliva samples before and after the test to measure cortisol concentrations, as an indicator of acute stress, as well as a hair sample to assess chronic stress. We also measured blood pressure, heart rate, respiratory rate and rectal temperature after the completion of the test. The results showed that salivary cortisol concentrations were higher in insecure dogs, particularly after the test. Heart rate also tended to be higher in insecure dogs. No difference in hair cortisol levels were found between secure and insecure dogs. Dogs’ physiological response to acute stress may be affected by the quality of the attachment to the owners. Abstract The quality of the attachment bond towards the caregiver may affect the dog’s physiological responses to stressful stimuli. This study aimed to measure chronic and acute physiological parameters of stress in ten securely and ten insecurely attached dogs. The twenty experimental subjects were selected from a sample of dogs that participated with their owners in the Strange Situation Procedure. Saliva samples were collected before (T0) and after (T1) the test. Blood pressure, heart rate, respiratory rate, and rectal temperature were measured after the test, only. At this time, a hair sample was also collected. RM ANOVA was used to analyse cortisol concentrations between secure and insecure dogs at T0 and T1. Mann–Whitney U test or T test were used for other physiological parameters. Insecure dogs had significant higher salivary cortisol concentrations than secure dogs at T1 (p = 0.024), but only a non-significant trend towards higher cortisol concentrations at T0 (p = 0.099). Post-test heart rate also tended to be higher in insecure compared to secure dogs (p = 0.077). No significant differences in hair cortisol concentration were found. The quality of attachment may affect the dog’s physiological response to acute stress, at least when related to separation from the caregiver. The effect of attachment on chronic stress requires further investigation.
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Packard K, Opendak M. Rodent models of early adversity: Impacts on developing social behavior circuitry and clinical implications. Front Behav Neurosci 2022; 16:918862. [PMID: 35990728 PMCID: PMC9385963 DOI: 10.3389/fnbeh.2022.918862] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Flexible and context-appropriate social functioning is key for survival across species. This flexibility also renders social behavior highly plastic, particularly during early development when attachment to caregiver can provide a template for future social processing. As a result, early caregiving adversity can have unique and lasting impacts on social behavior and even confer vulnerability to psychiatric disorders. However, the neural circuit mechanisms translating experience to outcome remain poorly understood. Here, we consider social behavior scaffolding through the lens of reward and threat processing. We begin by surveying several complementary rodent models of early adversity, which together have highlighted impacts on neural circuits processing social cues. We next explore these circuits underlying perturbed social functioning with focus on dopamine (DA) and its role in regions implicated in social and threat processing such as the prefrontal cortex (PFC), basolateral amygdala (BLA) and the lateral habenula (LHb). Finally, we turn to human populations once more to examine how altered DA signaling and LHb dysfunction may play a role in social anhedonia, a common feature in diagnoses such as schizophrenia and major depressive disorder (MDD). We argue that this translational focus is critical for identifying specific features of adversity that confer heightened vulnerability for clinical outcomes involving social cue processing.
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Affiliation(s)
- Katherine Packard
- Department of Neuroscience, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Maya Opendak
- Department of Neuroscience, Kennedy Krieger Institute, Baltimore, MD, United States
- Solomon H. Snyder Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Implementation Outcomes and Challenges of Partnerships between Resource Parents and Parents with Sick Infants in Intensive Neonatal Care Units: A Scoping Review. CHILDREN 2022; 9:children9081112. [PMID: 35892615 PMCID: PMC9331213 DOI: 10.3390/children9081112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022]
Abstract
Parents with a sick child in a neonatal intensive care unit (NICU) usually experience stress, anxiety, and vulnerability. These precarious feelings can affect early parent–child interactions and have consequences for the child’s neurodevelopment. Parents who have had a sick child in an NICU (veteran parents) can offer helpful interventions for these vulnerable families. This article is a scoping review of parental interventions used with the families of NICU infants, and an overview of French perspectives. Two independent reviewers studied the scientific literature published in English between 2001 to 2021 using Covidence software. The databases used were MEDLINE, ISI Web of Science, the Cochrane Database, and Google Scholar. Themes were identified from the articles’ results using an open coding approach. The data are presented in a narrative format. Ten articles were included, and four major themes addressed: (1) description of activities, (2) recommendations, (3) impact, and (4) barriers (resulting from recruitment, training, remuneration, and organization). Activities were very diverse, and a step-by-step implementation was recommended by all authors. Peer-support interventions might be a potential resource for those anxious parents and improve their NICU experiences. These challenges are described by SOS Préma in France. This article brings together recent studies on partnership in the NICU. It is an innovative topic in neonatology with vast issues to explore.
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10
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Krámská L, Hrešková L, Krámský D, Vojtěch Z. Attachment style of patients diagnosed with psychogenic non-epileptic seizures at a tertiary Epilepsy Center in the Czech Republic. Front Psychiatry 2022; 13:1065201. [PMID: 36465292 PMCID: PMC9712441 DOI: 10.3389/fpsyt.2022.1065201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Quality and type of early relationships with primary caregivers is considered one of the key factors in the etiopathogenesis of many mental disorders including depression, anxiety, and conversion disorders. This study focused on the type and quality of attachment style in adult patients with psychogenic non-epileptic seizures (PNES). MATERIALS AND METHODS We evaluated the demographic data and profiles of PNES patients (n = 262) and group of healthy volunteers (n = 51) measured by the Parental Bonding Inventory (PBI) and Experiences in Close Relationships (ECR) and Experiences in Close Relationships-Relationship Structure (ECR-RS). RESULTS Significant differences in measured values between the two groups were identified; specifically, differences in the caregiver style-father and mother overprotection (PBI) was higher in the PNES group. The most frequent type of attachment in PNES was type 2 (preoccupied). Correlations between the PBI and ECR results were also found. CONCLUSION This study highlighted certain attachment styles in patients with PNES and statistically significant differences between patients with PNES and a healthy sample. Some correlations between the results of the questionnaires with socio-demographic factors were found. The identification of specific patterns in attachment may be useful for further use in reaching a differential diagnosis and administering tailored psychotherapy of patients with PNES.
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Affiliation(s)
- Lenka Krámská
- Department of Clinical Psychology, Na Homolce Hospital, Prague, Czechia.,Epilepsy Center, Na Homolce Hospital, Prague, Czechia
| | - Lucia Hrešková
- Kúpele pre dušu, s.r.o., Bardejov Spa, Bardejov, Slovakia
| | - David Krámský
- Department of Social Science, Police Academy, Prague, Czechia
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11
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Granados AV, Sabogal JC, Muñoz P, Caicedo JC, Martínez-Cotrina J, Aponte Canencio M. Ethogram of non-verbal behaviours associated with emotional regulation and stress response in children and adolescents with complex trauma. BEHAVIOUR 2021. [DOI: 10.1163/1568539x-bja10124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
Complex trauma is a clinical concept developed to address the nature and effects of interpersonal traumatic experiences over the development of children and adolescents. To contribute to the development of ecologically valid diagnostic tools and a better understanding of the effects of complex trauma, an ethogram of emotional regulation and stress response behaviours was proposed and used as the main instrument in the Crossed-Puzzles Game. In total 84 children and adolescents aged 6–14 (50% of children with complex trauma in state protective care) were selected from institutions and the community. Both groups were matched by age, sex, and socioeconomic status. PCA, PERMANOVA, Mann-Whitney’s U, Pearson correlations, and logistic regression analyses were performed. The ethogram’s category ‘Externalising of frustration’ was identified as one of the strongest predictors for the complex trauma group. The ethogram’s validity as a research and assessment instrument from a clinical ethology perspective of complex trauma in psychology was discussed.
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Affiliation(s)
| | | | - Pablo Muñoz
- Department of Psychology, National University of Colombia, Bogota, Colombia
| | - Juan Carlos Caicedo
- Area of Health, Medical Knowledge and Society from the Research Center on Social Dynamics (CIDS), Externado University of Colombia, Bogota, Colombia
| | - Jorge Martínez-Cotrina
- Area of Health, Medical Knowledge and Society from the Research Center on Social Dynamics (CIDS), Externado University of Colombia, Bogota, Colombia
- Interdisciplinary Laboratory of Sciences and Human Processes (LINCIPH), Externado University of Colombia, Bogota, Colombia
| | - Mauricio Aponte Canencio
- Area of Health, Medical Knowledge and Society from the Research Center on Social Dynamics (CIDS), Externado University of Colombia, Bogota, Colombia
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12
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Potter-Dickey A, Letourneau N, Silveira PP, Ntanda H, Giesbrecht GF, Hart M, Dewell S, de Koning APJ. Associations Among Parental Caregiving Quality, Cannabinoid Receptor 1 Expression-Based Polygenic Scores, and Infant-Parent Attachment: Evidence for Differential Genetic Susceptibility? Front Neurosci 2021; 15:704392. [PMID: 34385904 PMCID: PMC8353245 DOI: 10.3389/fnins.2021.704392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Attachment is a biological evolutionary system contributing to infant survival. When primary caregivers/parents are sensitive and responsive to their infants’ needs, infants develop a sense of security. Secure infant attachment has been linked to healthy brain and organ-system development. Belsky and colleagues proposed the term differential susceptibility to describe context-dependent associations between genetic variations and behavioral outcomes as a function of parenting environments. Variations in the Cannabinoid Receptor Gene 1 (CNR1) are associated with memory, mood, and reward and connote differential susceptibility to more and less optimal parental caregiving quality in predicting children’s behavioral problems.
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Affiliation(s)
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Owerko Centre, Child Development Centre, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Department Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Patricia P Silveira
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Henry Ntanda
- Owerko Centre, Child Development Centre, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Gerald F Giesbrecht
- Owerko Centre, Child Development Centre, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Department Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Martha Hart
- Owerko Centre, Child Development Centre, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Sarah Dewell
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - A P Jason de Koning
- Department of Biochemistry & Molecular Biology, University of Calgary, Calgary, AB, Canada.,Department of Medical Genetics, University of Calgary, Calgary, AB, Canada
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13
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Işik M, Demir M. The relationship between overactive bladder and attachment: A preliminary study. Neurourol Urodyn 2021; 40:1175-1181. [PMID: 33846996 DOI: 10.1002/nau.24675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/12/2021] [Accepted: 03/27/2021] [Indexed: 12/29/2022]
Abstract
AIM There are strong relationships between overactive bladder (OAB) and psychological factors. The aim of this study was to examine the relationship between OAB and attachment. METHODS Patients who presented with OAB symptoms and were first diagnosed with OAB were included in the study. Patient and control groups were matched in terms of age and gender. A urological and psychiatric examination was performed on each participant. The severity of patients' OAB symptoms was assessed using the Overactive Bladder-V8 Questionnaire (OAB-v8). The characteristics of attachment patterns were evaluated using The Close Relationships Scale Revised. RESULTS The OAB and control groups included 41 and 43 participants, respectively. No significant difference was found between the two groups with regard to alcohol abuse, daily cigarette consumption, marital status, and gender. The prevalence of anxious attachment was significantly higher in the OAB group than in the control group (p < 0.001), whereas no significant difference was found with regard to avoidant attachment (p = 0.18). A significant relationship was found between the OAB-v8 score and anxious attachment in OAB patients (r = 0.50; p < 0.001). CONCLUSIONS Our findings suggest that insecure attachment, especially anxious attachment is associated with OAB and the severity of OAB symptoms. More extensive and longitudinal studies can better show the relationship between attachment and OAB. Future research may focus on the possibility of causality between attachment and OAB.
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Affiliation(s)
- Mesut Işik
- Department of Psychiatry, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Murat Demir
- Department of Urology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
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14
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Patterson DK, Pollock D, Carter CS, Chambers JE. Treating Opioid Use Disorder in Peripartum Mothers: A Look at the Psychodynamics, Neurobiology, and Potential Role of Oxytocin. Psychodyn Psychiatry 2021; 49:48-72. [PMID: 33635103 DOI: 10.1521/pdps.2021.49.1.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The peripartum period (pregnancy and postpartum) is a unique time filled with psychodynamic and biological changes that are critical in affecting the lives of mother and baby. Attachment, the biologically based emotional connection between a caregiver and infant, is critical to the development of the child. The early interactions in an infant's life shape their reward neuro-circuitry and the development of their internal working models and styles of attachment. Opioid use disorders in the mother affect the psychodynamics and neurobiology of attachment. There is significant overlap between the neurobiology of attachment and that of opioid use disorders. In this article, we hope to describe how opioid use disorders affect mother-infant attachment and how psychodynamic psychotherapy that is informed by attachment theory may be a potential treatment for mothers with opioid use disorders. Further, oxytocin plays a role in the attachment process and may function abnormally in mothers with opioid use disorders. As oxytocin affects attachment, administration of oxytocin during postpartum mother-infant interactions in the setting of psychotherapy may facilitate bonding and promote recovery from opioid use disorders in the peripartum population.
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Affiliation(s)
- Danielle K Patterson
- Assistant Professor of Clinical Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | | | - C Sue Carter
- Distinguished University Research Scientist, Executive Director, Emerita, The Kinsey Institute, Indiana University, Bloomington, IN
| | - Joanna E Chambers
- Associate Professor of Clinical Psychiatry and OB/GYN, Indiana University School of Medicine
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15
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Abstract
Zombie films and shows have accelerated in popularity through the decades, and the genre is produced the world over. The Walking Dead, one such show, has been rated among the most popular cable network television programs since its inception. When watching a herd of zombie walkers, the viewer faces some important questions. In some ways, many can identify with the experience of the zombie, as it reflects the psychological state of inner deadness. The psychodynamic literature has a rich history describing this experience. A review of these ideas and the metaphor of the zombie help guide us in the treatment of our patients who do not experience themselves as truly living. The Walking Dead also provides a glimpse into the response of detachment to a viral pandemic, and how we might discover our best self during such times while helping our patients to do the same.
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Affiliation(s)
- Jeffrey Katzman
- Professor and Vice Chair Academic, Education, and Clinical Affairs, University of New Mexico, Department of Psychiatry
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16
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D'Amato FR. Evaluation of μ-Opioid System Functionality in Mouse Pups: Ultrasonic Vocalizations as an Index of Infant Attachment. Methods Mol Biol 2021; 2201:259-265. [PMID: 32975807 DOI: 10.1007/978-1-0716-0884-5_24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The evaluation of ultrasonic vocalizations (USVs) during isolation in 6-8-day-old mouse pups can give an indication of the perception of pups' discomfort and need for caretaker presence to overcome the unpleasant condition. Time spent vocalizing changed according to opioid activation, stress exposure, and genetic profile of pups. Deficits in attachment suggest altered opioid functioning and predisposal for long-term defective social behaviors and reward processes.
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Affiliation(s)
- Francesca R D'Amato
- Institute of Biochemistry and Cellular Biology, National Research Council, Rome, Italy.
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17
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Goh KK, Lu ML, Jou S. Childhood Trauma and Aggression in Persons Convicted for Homicide: An Exploratory Study Examines the Role of Plasma Oxytocin. Front Psychiatry 2021; 12:719282. [PMID: 34484006 PMCID: PMC8415833 DOI: 10.3389/fpsyt.2021.719282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Evidence has demonstrated the association between childhood trauma and criminality in adulthood, however, less is known about how best to explain the route from childhood trauma to adulthood aggression. Results from both human and animal studies have generated the hypothesis that dysfunction of the oxytocinergic system may correlate with pathological aggression. The current study represents a first exploratory examination to investigate the trajectory from childhood trauma to aggression, specifically, plasma oxytocin's role in this association. We assessed the childhood trauma experiences in a total of 108 participants, including 33 persons convicted for homicide and 75 non-offending healthy participants, using the Childhood Trauma Questionnaire, with in-depth clarification interviews for cross-validation. All participants were checked for aggression using the Modified Overt Aggression Scale and their plasma oxytocin levels were obtained. Results indicated that persons convicted for homicide had higher childhood trauma scores and lower plasma oxytocin levels than healthy controls. The plasma oxytocin levels were inversely correlated with childhood trauma in all participants. Further mediation models were constructed to explore these associations, in the best-fit model, the relationship between childhood trauma and aggression is mediated by plasma oxytocin levels in persons convicted for homicide. In conclusion, the association between childhood trauma and aggression of persons convicted for homicide is mediated by their plasma oxytocin levels. With leading to further theoretical consideration in the causality on how best to explain the interaction between childhood trauma and aggression, the current study may assist in developing further research and preventive strategies for aggression, particularly the importance of early identification of childhood trauma.
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Affiliation(s)
- Kah Kheng Goh
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Susyan Jou
- Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate School of Criminology, National Taipei University, Taipei, Taiwan
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18
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Ouyang JX, Mayer JLW, Battle CL, Chambers JE, Inanc Salih ZN. Historical Perspectives: Unsilencing Suffering: Promoting Maternal Mental Health in Neonatal Intensive Care Units. Neoreviews 2020; 21:e708-e715. [PMID: 33139508 DOI: 10.1542/neo.21-11-e708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Mothers of infants in the NICU suffer higher rates of psychological distress, anxiety, and depression compared with the general population. Often, their mental health concerns remain underidentified and undertreated, which can have deleterious effects on the offspring, both in short-term outcomes while in the NICU as well as long-term neurodevelopmental and behavioral outcomes. In this review, we present an overview of existing empirical evidence about how maternal mental health affects the health of infants, special considerations regarding the mental health needs of NICU mothers, and the findings about existing and developing interventions to address mental health concerns in this vulnerable population.
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Affiliation(s)
- Jessica X Ouyang
- Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Jessica L W Mayer
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Cynthia L Battle
- Warren Alpert Medical School of Brown University, Butler Hospital, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Joanna E Chambers
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Zeynep N Inanc Salih
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
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19
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Lasheras G, Farré-Sender B, Porta R, Mestre-Bach G. Risk factors for postpartum depression in mothers of newborns admitted to neonatal intensive care unit. J Reprod Infant Psychol 2020; 40:47-61. [DOI: 10.1080/02646838.2020.1775793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Gracia Lasheras
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
| | - Borja Farré-Sender
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
| | - Roser Porta
- Department of Pediatrics, Dexeus University Hospital, Barcelona, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, La Rioja, Spain
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20
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Gerhardt C, Hamouda K, Irorutola F, Rose M, Hinkelmann K, Buchheim A, Senf-Beckenbach P. Insecure and Unresolved/Disorganized Attachment in Patients With Psychogenic Nonepileptic Seizures. J Acad Consult Liaison Psychiatry 2020; 62:337-344. [PMID: 33358452 DOI: 10.1016/j.psym.2020.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychogenic nonepileptic seizures (PNES) are still poorly understood and difficult to treat. Attachment theory could add new aspects to the understanding of the multifactorial genesis and maintenance of PNES and the therapeutic needs of this patient group. OBJECTIVE The aim of the present study is to systematically assess attachment in adult patients with PNES with a focus on the role of unresolved/disorganized attachment. METHODS A cross-sectional design was chosen to compare patients with confirmed PNES (n = 44) and healthy controls (n = 44) matched for gender, age, and education. Attachment was assessed using the Adult Attachment Projective Picture System. Psychometric questionnaires included the Childhood Trauma Questionnaire; Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) axis II disorders, Patient Questionnaire; the Somatoform Dissociation Questionnaire; and the Patient Health Questionnaire. RESULTS We found significantly less secure (P = 0.006) and more unresolved/disorganized (P = 0.041) attachment classifications in the PNES group. Among patients with PNES, 7% were classified secure and 43% were classified unresolved/disorganized. Patients with an unresolved attachment representation were significantly more likely to be screened positive for personality pathology in the Structured Clinical Interview for DSM-IV axis II disorders, Patient Questionnaire (P = 0.03) and to report more emotional abuse in the Childhood Trauma Questionnaire (P = 0.007) than patients with other attachment classifications. CONCLUSIONS Our findings suggest that unresolved/disorganized attachment might be the predominant attachment style in patients with PNES and might be associated with more severe personality pathology. This could be of therapeutic relevance. The present study is the first to assess adult attachment in patients with PNES using a semi-structured interview in comparison to matched healthy controls.
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Affiliation(s)
- Carola Gerhardt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany.
| | - Karim Hamouda
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
| | - Freddy Irorutola
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
| | - Matthias Rose
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
| | - Kim Hinkelmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
| | - Anna Buchheim
- Department of Psychology, Clinical Psychology, University of Innsbruck, Innsbruck, Austria
| | - Philine Senf-Beckenbach
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
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21
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Tronick E, Mueller I, DiCorcia J, Hunter R, Snidman N. A Caretaker Acute Stress Paradigm: Effects on behavior and physiology of caretaker and infant. Dev Psychobiol 2020; 63:237-246. [PMID: 32311073 DOI: 10.1002/dev.21974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 11/07/2022]
Abstract
While experimental stress paradigms of infants (arm restraint; the Still-Face) are powerful tools for infant research, no study has experimentally stressed mothers to observe its independent effects on infant stress regulation. Extant caretaker/maternal stress studies essentially are correlational and confounded by other conditions (e.g., depression). Here, we present a standard procedure, the Caregiver Acute Stress Paradigm (CASP), for stressing mothers during en face interactions with their infants. We hypothesized that infants of the stressed mothers would be more distressed than infants of non-stressed mothers. A total of 106 four-month-old infants and their mothers were randomly assigned to the experimental stress or non-stress manipulation. Confirming our hypothesis, infants of the stressed mothers were significantly more likely to become distressed and require terminating the procedure. While objective ratings of maternal behavior showed no difference between groups, mother in the stress condition self-rated the episode following the caretaker stress significantly lower than mothers in the non-stress group. The self-ratings in the maternal stress-group were reflected in infant cortisol. The findings indicate that CASP is an effective experimental paradigm for exploring the independent effects of an acute stress on caretakers, including effects of conditions, such as poverty or mental illness.
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Affiliation(s)
- Ed Tronick
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA.,Department of Newborn Medicine, Harvard Medical School, Boston, MA, USA
| | - Isabelle Mueller
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Jennifer DiCorcia
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Richard Hunter
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Nancy Snidman
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
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22
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Roder E, Koehler-Dauner F, Krause S, Prinz J, Rottler E, Alkon A, Kolassa IT, Gündel H, Fegert JM, Ziegenhain U, Waller C. Maternal separation and contact to a stranger more than reunion affect the autonomic nervous system in the mother-child dyad. Int J Psychophysiol 2020; 147:26-34. [DOI: 10.1016/j.ijpsycho.2019.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022]
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23
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Epigenetic Mechanisms in the Neurodevelopmental Theory of Depression. DEPRESSION RESEARCH AND TREATMENT 2020; 2020:6357873. [PMID: 32373361 PMCID: PMC7196148 DOI: 10.1155/2020/6357873] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/13/2020] [Accepted: 04/02/2020] [Indexed: 12/28/2022]
Abstract
The genome (genes), epigenome, and environment work together from the earliest stages of human life to produce a phenotype of human health or disease. Epigenetic modifications, including among other things: DNA methylation, modifications of histones and chromatin structure, as well as functions of noncoding RNA, are coresponsible for specific patterns of gene expression. This refers also to mental disorders, including depressive disorders. Early childhood experiences accompanied by severe stressors (considered a risk factor for depression in adult life) are linked with changes in gene expression. They include genes involved in a response to stress (hypothalamic-pituitary-adrenal axis, HPA), associated with autonomic nervous system hyperactivity and with cortical, and subcortical processes of neuroplasticity and neurodegeneration. These are, among others: gene encoding glucocorticoid receptor, FK506 binding protein 5 gene (FKBP5), gene encoding arginine vasopressin and oestrogen receptor alpha, 5-hydroxy-tryptamine transporter gene (SLC6A4), and gene encoding brain-derived neurotrophic factor. How about personality? Can the experiences unique to every human being, the history of his or her development and gene-environment interactions, through epigenetic mechanisms, shape the features of our personality? Can we pass on these features to future generations? Hence, is the risk of depression inherent in our biological nature? Can we change our destiny?
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24
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Abstract
The ability to form attachments with other human beings is an essential skill that typically begins early in life. The parent/caregiver-child relationship is the first crucial relationship that an infant forms, and the health of this relationship has a profound effect on the child's social and emotional development. Children who form secure relationships with their parent or other primary caregiver have fewer internalizing and externalizing behaviors, are more socially competent, and have better-quality friendships. Conversely, children with attachment disorders exhibit a varying capacity to form and sustain relationships and demonstrate emotional depth, they and experience a higher level of peer conflict. Children with insecure attachments have a greater likelihood for physical health morbidities and impaired social, psychological, and neurobiological functioning extending into adulthood. It is crucial that pediatric nurse practitioners implement practice behaviors to better identify children at risk for attachment disorders and link them with appropriate interventions. This continuing education article will explore attachment; and attachment theory; and attachment disorders in terms of types, risk factors, consequences, and treatment and will also provide implications for practice.
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25
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Robinson-Drummer PA, Opendak M, Blomkvist A, Chan S, Tan S, Delmer C, Wood K, Sloan A, Jacobs L, Fine E, Chopra D, Sandler C, Kamenetzky G, Sullivan RM. Infant Trauma Alters Social Buffering of Threat Learning: Emerging Role of Prefrontal Cortex in Preadolescence. Front Behav Neurosci 2019; 13:132. [PMID: 31293398 PMCID: PMC6598593 DOI: 10.3389/fnbeh.2019.00132] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/04/2019] [Indexed: 11/13/2022] Open
Abstract
Within the infant-caregiver attachment system, the primary caregiver holds potent reward value to the infant, exhibited by infants' strong preference for approach responses and proximity-seeking towards the mother. A less well-understood feature of the attachment figure is the caregiver's ability to reduce fear via social buffering, commonly associated with the notion of a "safe haven" in the developmental literature. Evidence suggests this infant system overlaps with the neural network supporting social buffering (attenuation) of fear in the adults of many species, a network known to involve the prefrontal cortex (PFC). Here, using odor-shock conditioning in young developing rats, we assessed when the infant system transitions to the adult-like PFC-dependent social buffering of threat system. Rat pups were odor-shock conditioned (0.55 mA-0.6 mA) at either postnatal day (PN18; dependent on mother) or 28 (newly independent, weaned at PN23). Within each age group, the mother was present or absent during conditioning, with PFC assessment following acquisition using 14C 2-DG autoradiography and cue testing the following day. Since the human literature suggests poor attachment attenuates the mother's ability to socially buffer the infants, half of the pups at each age were reared with an abusive mother from PN8-12. The results showed that for typical control rearing, the mother attenuated fear in both PN18 and PN28 pups, although the PFC [infralimbic (IL) and ventral prelimbic (vPL) cortices] was only engaged at PN28. Abuse rearing completely disrupted social buffering of pups by the mother at PN18. The results from PN28 pups showed that while the mother modulated learning in both control and abuse-reared pups, the behavioral and PFC effects were attenuated after maltreatment. Our data suggest that pups transition to the adult-like PFC social support circuit after independence from the mother (PN28), and this circuit remains functional after early-life trauma, although its effectiveness appears reduced. This is in sharp contrast to the effects of early life trauma during infancy, where social buffering of the infant is more robustly impacted. We suggest that the infant social buffering circuit is disengaged by early-life trauma, while the adolescent PFC-dependent social buffering circuit may use a safety signal with unreliable safety value.
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Affiliation(s)
- Patrese A. Robinson-Drummer
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
| | - Maya Opendak
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
| | - Anna Blomkvist
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Stephanie Chan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Neural Science, New York University, New York, NY, United States
| | - Stephen Tan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Neural Science, New York University, New York, NY, United States
| | - Cecilia Delmer
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Neural Science, New York University, New York, NY, United States
| | - Kira Wood
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Aliza Sloan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Psychology, Florida Atlantic University, Boca Raton, FL, United States
| | - Lily Jacobs
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Biology, Yeshiva University, New York, NY, United States
| | - Eliana Fine
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Biology, Yeshiva University, New York, NY, United States
| | - Divija Chopra
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Neural Science, New York University, New York, NY, United States
| | - Chaim Sandler
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Department of Biology, Yeshiva University, New York, NY, United States
| | - Giselle Kamenetzky
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
- Instituto de Investigaciones Médicas A Lanari, IDIM-CONICET, Universidad de Buenos Aires, Combatientes de Malvinas 3150 (CP 1427), Buenos Aires, Argentina
| | - Regina M. Sullivan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States
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26
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Screening for postpartum depression: obligation and opportunity for pediatricians to improve the lives of children. Pediatr Res 2019; 85:923-924. [PMID: 30862959 DOI: 10.1038/s41390-019-0373-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 11/08/2022]
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27
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Porges SW, Davila MI, Lewis GF, Kolacz J, Okonmah‐Obazee S, Hane AA, Kwon KY, Ludwig RJ, Myers MM, Welch MG. Autonomic regulation of preterm infants is enhanced by Family Nurture Intervention. Dev Psychobiol 2019; 61:942-952. [DOI: 10.1002/dev.21841] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/10/2018] [Accepted: 12/23/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Stephen W. Porges
- Traumatic Stress Research Consortium Kinsey Institute, Indiana University Bloomington Indiana
- Department of Psychiatry University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Maria I. Davila
- Department of Psychiatry University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Gregory F. Lewis
- Traumatic Stress Research Consortium Kinsey Institute, Indiana University Bloomington Indiana
- Intelligent Systems Engineering Indiana University Bloomington Indiana
| | - Jacek Kolacz
- Traumatic Stress Research Consortium Kinsey Institute, Indiana University Bloomington Indiana
| | | | - Amie Ashley Hane
- Department of Psychology Williams College Williamstown Massachusetts
| | - Katie Y. Kwon
- Department of Pediatrics Columbia University Medical Center New York New York
| | - Robert J. Ludwig
- Department of Pediatrics Columbia University Medical Center New York New York
| | - Michael M. Myers
- Department of Pediatrics Columbia University Medical Center New York New York
- Department of Psychiatry Columbia University Medical Center New York New York
| | - Martha G. Welch
- Department of Pediatrics Columbia University Medical Center New York New York
- Department of Psychiatry Columbia University Medical Center New York New York
- Department of Anatomy and Cell Biology Columbia University Medical Center New York New York
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Zarse EM, Neff MR, Yoder R, Hulvershorn L, Chambers JE, Chambers RA. The adverse childhood experiences questionnaire: Two decades of research on childhood trauma as a primary cause of adult mental illness, addiction, and medical diseases. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1581447] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Emily M. Zarse
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Midtown Mental Health Center/Eskenazi Hospital, Indianapolis, IN, USA
| | - Mallory R. Neff
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Division of Child Psychiatry, Riley Hospital, IU School of Medicine, Indianapolis, IN, USA
| | - Rachel Yoder
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Division of Child Psychiatry, Riley Hospital, IU School of Medicine, Indianapolis, IN, USA
| | - Leslie Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Division of Child Psychiatry, Riley Hospital, IU School of Medicine, Indianapolis, IN, USA
| | - Joanna E. Chambers
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Midtown Mental Health Center/Eskenazi Hospital, Indianapolis, IN, USA
| | - R. Andrew Chambers
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Midtown Mental Health Center/Eskenazi Hospital, Indianapolis, IN, USA
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