Metabolic syndrome and childhood trauma: Also comorbidity and complication in mood disorder

Studies for prevalence and causal relationship established that addressing comorbidities of mental illnesses with medical disease will be another revolution in psychiatry. Increasing number of evidence shows that there is a bidirectional connection between mood disorders and some medical diseases. Glucocorticoid/insulin signal mechanisms and immunoenflammatory effector systems are junction points that show pathophysiology between bipolar disorder and general medical situations susceptible to stress. A subgroup of mood disorder patients are under risk of developing obesity and diabetes. Their habits and life styles, genetic predisposition and treatment options are parameters that define this subgroup. Medical disease in adults had a significant relationship to adverse life experiences in childhood. This illustrates that adverse experiences in childhood are related to adult disease by two basic etiologic mechanisms:(1) conventional risk factors that actually are compensatory behaviors, attempts at selfhelp through the use of agents and foods; and(2) the effects of chronic stress.

Antidepressants combined with psychodrama improve the coping style and cognitive control network in patients with childhood trauma-associated major depressive disorder

BACKGROUND The use of antidepressant therapy alone has a limited efficacy in patients with childhood trauma-associated major depressive disorder(MDD).However,the effectiveness of antidepressant treatment combined with psychodrama in these patients is unclear.AIM To evaluate the effectiveness of antidepressant treatment combined with psychodrama.METHODS Patients with childhood trauma-associated MDD treated with antidepressants were randomly assigned to either the psychodrama intervention(observation group)or the general health education intervention(control group)and received combination treatment for 6 mo.The observation group received general health education given by the investigator together with the“semi-structured group intervention model”of Yi Shu psychodrama.A total of 46 patients were recruited,including 29 cases in the observation group and 17 cases in the control group.Symptoms of depression and anxiety as well as coping style and resting-state functional magnetic resonance imaging were assessed before and after the intervention.RESULTS Symptoms of depression and anxiety,measured by the Hamilton Depression Scale,Beck Depression Inventory,and Beck Anxiety Inventory,were reduced after the intervention in both groups of patients.The coping style of the observation group improved significantly in contrast to the control group,which did not.In addition,an interaction between treatment and time in the right superior parietal gyrus node was found.Furthermore,functional connectivity between the right superior parietal gyrus and left inferior frontal gyrus in the observation group increased after the intervention,while in the control group the connectivity decreased.CONCLUSION This study supports the use of combined treatment with antidepressants and psychodrama to improve the coping style of patients with childhood trauma-associated MDD.Functional connectivity between the superior parietal gyrus and inferior frontal gyrus was increased after this combined treatment.We speculate that psychodrama enhances the internal connectivity of the cognitive control network and corrects the negative attention bias of patients with childhood trauma-associated MDD.Elucidating the neurobiological features of patients with childhood trauma-associated MDD is important for the development of methods that can assist in early diagnosis and intervention.

Childhood trauma,addiction&a modernized approach to treatment

This review serves to analyze the relationship between childhood trauma and addiction;provide an overview of the science behind addiction;analyze issues with current addiction treatment methods and protocols;as well as to provide a list of proposed changes to modernize addiction treatment to a level of quality which will prove much more successful in the treatment of addicts.

Childhood trauma: the cause that needs a cure

Children from all walks of life are subjected to traumatic experiences.Having one traumatic experience,while unfortunate,generally does not have much impact on the child’s future,as one might expect.This review examines the long-term psychoneuroendocrinologocal implications of repeated or prolonged exposure to traumatic events during childhood,particularly during the formative years which include chronic illnesses,terminal illnesses,psychological disorders,neurological disorders,and more which has resulted in an average reduced life expectancy of 20-years.Proposed modifications for screening tools,prevention,and interventions are explained and introduced.In conclusion,this review proposes a modified and universal approach to screening,prevention,and treatment for those at high risk and those already afflicted by childhood trauma based on the latest in evidence-based research.

Effects of childhood trauma on aggressive behaviors andhippocampal function:the modulation of COMT haplotypes

Background:Aggression is a commonly hostile behavior linked to the hippocampal activity.Childhood trauma(CT)exposure has been associated with altered sensitization of the hypothalamic-pituitary-adrenal(HPA)axis and hippocampal volumewhich could increase violent aggressive behaviors.Additionally,Catechol-O-methyltransferase(COMT),the major dopamine metabolism enzyme,is impli-cated in stress responsivity,including aggression.Hence,CT exposure may affect aggression through the effect on the hippocampal function,which might also be modulated by the COMT variations.Objectives:This study examined whether both CT and haplotypes of COMT moderate hippocampal function and thus affect human aggressive behavior.Methods:We obtained bilateral hippocampal functional connectivity maps using resting state functional magnetic resonance imag-ing(MRI)data.COMT haplotype estimation was performed using Haploview 4.2 and PHASE 2.1.Then we constructed a moderated mediation model to study the effect of the CTQ×COMT on aggressive behavior.Results:Three major haplotypes were generated from thirteen single nucleotide polymorphisms(SNPs)within the COMT gene and formed three haplotypes corresponding to high,medium,and low enzymatic activity of COMT.The results showed interactive re-lationships between the Childhood Trauma Questionnaire(CTQ)and COMT with respect to the functional connectivity(FC)of the bilateral hippocampus(HIP)-orbital frontal cortex(OFC).Specifically,CT experience predicted lower negative HIP-OFC coupling in the APS and HPS haplotypes corresponding to the medium and high enzymatic activity of COMT,but greater FC in the LPS haplotypes corresponding to the low enzymatic activity.We also observed a conditional mediation effect of the right HIP-OFC coupling in the link between COMT and aggressive behavior that was moderated by CT experience.Conclusions:These results suggest that CT and COMT have a combined effect on aggressive behavior through hippocampal function.This mediation analysis sheds light on the influence of childhood experience on aggressive behavior in different genetic backgrounds.

歧视知觉在高职生童年期创伤与攻击行为之间的中介作用

目的:了解高职生攻击行为、歧视知觉和童年期创伤的关系为相应的心理健康教育提供理论参考。方法:2021年10月,采用Buss-Perry攻击行为问卷、歧视知觉问卷和童年期创伤问卷对635名高职生进行问卷调查。结果:高职生攻击行为与知觉歧视(r=0.622,P<0.01)和童年期创伤(r=0.310,P<0.01)呈正相关。童年期创伤可以直接对高职生攻击行为产生正向预测作用,也可以通过歧视知觉间接影响攻击行为。结论:高职生歧视知觉在攻击行为和童年期创伤之间起部分中介效应。

童年创伤、亲子依恋对青少年问题行为的影响研究

为了探明童年创伤、亲子依恋对青少年问题行为的作用,采用儿童创伤问卷、依恋方式问卷和长处困难问卷对300名青少年进行调研。结果显示:童年创伤与安全型依恋显著负相关,与不安全型依恋显著正相关,与问题行为之间显著正相关;问题行为与安全型依恋之间显著负相关,与不安全型依恋之间显著正相关。结论:童年创伤可能破坏亲子依恋关系,进而导致青少年问题行为的发生。家长应该为子女创设良好的成长环境,良好的童年经历、高质量的亲子依恋关系意味着更少的问题行为。

儿童期创伤对成人抑郁的影响:功能失调性态度和人际关系的链式中介作用

目的:探讨功能失调性态度和人际关系在儿童期创伤与成年人抑郁关系中的链式中介效应。方法:采用儿童期创伤问卷简表、功能失调性态度量表、人际关系综合诊断量表、汉密尔顿抑郁量表对930名成年抑郁症患者进行调查。结果:儿童期创伤、功能失调性态度、人际关系及抑郁症状得分之间均呈两两显著性正相关;儿童期创伤可以对抑郁产生直接影响,也可以通过功能失调性态度和人际关系的独立中介作用及两者的链式中介作用间接影响抑郁,其中介效应分别占总效应的33.62%、5.88%、7.60%。结论:儿童期创伤不但可以直接影响成人抑郁,还可以通过功能失调性态度和人际关系的独立中介作用,以及功能失调性态度-人际关系之间的链式中介作用间接影响成人抑郁。

童年期创伤对大学生孤独感的影响:自尊和反刍思维的链式中介效应

为探讨童年期创伤与大学生孤独感的关系,采用童年期创伤问卷、自尊量表、反刍思维量表、孤独感量表对621名大学生进行调查.结果表明:(1)童年期创伤、反刍思维与孤独感显著正相关;自尊与童年期创伤、反刍思维、孤独感显著负相关;(2)自尊和反刍思维在童年期创伤与孤独感之间起链式中介作用.结论:童年期创伤不仅是触发大学生孤独感的重要外部因素,而且童年期创伤还会通过影响自尊和经由反刍思维对大学生孤独感产生间接作用.因此,减少和避免童年期创伤对大学生心理的负面影响,增强其自尊水平,调整其负性认知方式是改善和预防大学生孤独感的重要途径.

童年创伤对青少年抑郁症患者自伤行为的影响: 抑郁和社会支持的中介作用

目的:探讨抑郁和社会支持在青少年抑郁症患者童年创伤经历和自伤行为之间的中介作用。方法:选取首次在河北医科大学第一医院就诊的214例青少年抑郁症患者作为研究对象,采用一般情况调查表、童年创伤问卷、青少年自我伤害问卷、抑郁自评量表、社会支持评定量表进行问卷调查,并分析童年创伤、抑郁、社会支持和自我伤害的关系。结果:(1)女性青少年抑郁症患者自我伤害评分显著高于男性,差异具有统计学意义(P<0.05)。(2)童年创伤总分与抑郁、自我伤害评分均呈正相关(r值分别为0.256、0.396,均P<0.05);抑郁与自我伤害评分呈正相关(r=0.477,P<0.05);社会支持评分与童年创伤、抑郁、自我伤害评分均呈负相关(r值分别为-0.340、-0.376、-0.523,均P<0.05)。(3)童年创伤总分、社会支持和抑郁评分对自我伤害有预测作用(F=46.972,P<0.001),可解释方差变异的39.3%。(4)抑郁和社会支持在童年创伤与自我伤害之间起到部分中介效应,分别占总效应的20.1%和40.2%。结论:抑郁和社会支持在青少年抑郁症患者童年创伤经历和自伤行为之间具有双重中介作用。

注意力损害与童年创伤及抑郁症临床症状的相关性研究

目的:探索抑郁症患者注意力与童年创伤及临床症状的相关性。方法:纳入抑郁症患者152例(研究组),健康对照组250名,分别采用剑桥神经心理自动化成套测试(CANTAB)中的快速视觉信息处理(RVP)、17项汉密尔顿抑郁量表(HAMD-17)、童年创伤量表简版(CTQ-SF)评估视觉持续注意力、抑郁症状、童年创伤,采用SPSS 26进行统计学分析。结果:与对照组相比,研究组快速视觉信息处理中总错过数更多,总正确拒绝数更少,命中率更低,平均反应时间更长(P均<0.01);童年创伤总分及各因子分均高于对照组(P均<0.01);在研究组中发现躯体忽视与快速视觉信息处理总错过数正相关(r=0.226,P=0.012),与反应灵敏度、总正确拒绝数、命中率负相关(r=-0.260、-0.230、-0.224,P均<0.05);HAMD-17总分与快速视觉信息处理总错过数、错击率、平均反应时间正相关(r=0.228、0.192、0.341,P均<0.05),与反应倾向性、总正确拒绝数、命中率负相关(r=-0.203、-0.324、-0.226,P均<0.05)。结论:抑郁症患者的童年可能遭受较多创伤事件,其注意力明显受损;抑郁症状与注意力下降有一定相关性,且抑郁程度越重,注意力越差。

伴有童年创伤的重症抑郁患者异常全脑功能连接:一项静息态功能磁共振研究

【目的】童年创伤(CT)被认为是成年后发展为重度抑郁(MDD)的主要危险因素之一。然而,伴有CT的MDD(CT-MDD)患者的神经基础仍然知之甚少。因此,本研究的目的是探讨CT-MDD患者静息态全脑功能连接(FC)。【方法】对34名CT-MDD患者和34名健康对照组进行静息态功能磁共振扫描。进行全脑体素水平度中心性(DC)分析,选取两组间显著差异的脑区作为感兴趣区(ROI),进一步计算全脑FC。随后,将异常脑区DC,FC值与临床量表进行相关性分析。【结果】CT-MDD组右侧额中回(MFG)的DC值高于健康对照组。基于种子点的脑功能连接分析发现,与健康对照组相比,CT-MDD组右侧MFG与右内侧前额叶和左侧楔前叶之间的FC增加(P<0.05)。此外,右侧MFG的DC值与CT严重程度相关。【结论】我们的结果表明,以右侧MFG作为ROI,其与默认网络(DMN)中的两个重要脑区右内侧前额叶和左侧楔前叶之间的FC增加,这可能表明CT-MDD患者的认知执行网络与DMN之间的同步性增加。这些发现可能为深入了解CT-MDD的病理生理机制提供了见解。

精神障碍患者童年创伤经历及其与文化智力的关联研究

目的:探究精神障碍患者的童年创伤经历及与其文化智力水平的关联。方法:纳入就诊于昆明医科大学第二附属医院精神科的203例精神障碍患者(包括抑郁障碍、焦虑障碍、目前为抑郁发作的双相情感障碍患者),采用童年创伤问卷简化版(CTQ-SF)、文化智商问卷(CIQ)进行调查。根据童年创伤类型对患者进行分组,比较各组间童年创伤和文化智商的关联。结果:忽视组与忽视+虐待组患者的童年创伤经历、文化智商量表总分及各因子分均低于不伴童年创伤组的患者(P均<0.05)。情感忽视与文化智商量表总分、认知因子得分负向关联(β=-0.3、-0.3);躯体忽视与元认知因子得分、行为因子得分负向关联(β=-0.2、-0.2)。结论:与不伴有童年创伤经历的精神障碍患者相比,伴有童年创伤经历的患者的文化智力水平低。情感忽视和躯体忽视与此类患者的文化智力水平有较强的关联性。

童年期创伤后亲子关系对青少年社会适应的影响:HPA轴系统多基因的调节

童年期的不良经历似乎增加了个体对压力刺激的敏感性,从而可能影响其终身的社会适应。许多研究表明,HPA轴系统基因可能在调节环境因素与社会适应之间发挥作用。然而,过去单个基因与环境相互作用对社会适应的影响存在争议。本研究针对青少年样本(14.15±0.63岁;N=700),采用多位点遗传谱评分(multilocus genetic profile scores,MGPS)计算HPA轴系统多基因得分,利用纵向数据探究其与童年期创伤和亲子关系之间的相互作用,并预测青少年的社会适应(包括抑郁症状、亲社会行为和自伤行为)。研究结果显示,青少年的社会适应(包括抑郁症状和亲社会行为)是遗传(HPA轴系统MGPS)、远端环境(童年期创伤)和近端环境(亲子关系)三者相互作用的结果。随着遗传风险评分的增加,童年期创伤和亲子关系之间的交互作用也增加,这意味着遭受过童年期创伤的个体,亲子关系对社会适应的影响会更加显著,符合差别易感性模型。行为学实验进一步揭示了遗传和环境因素对青少年社会适应的潜在机制。

早年创伤经历对高原军官创伤后应激障碍症状的影响:亲子疏离的中介作用

目的了解高原军官创伤后应激障碍(post-traumatic stress disorder,PTSD)症状的现状,探讨早年创伤经历对高原军官PTSD症状的影响以及亲子疏离的作用。方法本研究采用横断面研究设计方案。于2021年10月采用整群抽样法,使用童年期创伤问卷(childhood trauma question,CTQ)、亲子疏离感问卷(inventory of alienation toward parents,IAP)、PTSD自评量表(the post-traumatic stress disorder checklist-civilian version,PCL-C)对238名男性高原军官进行问卷调查,分析亲子疏离在早年创伤经历与PTSD症状间的中介效应。结果①高原军官PTSD症状阳性检出率为8.5%。②有早年创伤经历组的军官PTSD症状阳性检出率为15.6%,显著高于无早年创伤经历组(5.1%,χ^(2)=7.27,P<0.01)。③PTSD症状、早年创伤经历和亲子疏离之间呈显著正相关(r=0.35~0.76,P<0.01)。④早年躯体虐待经历(β=1.05,P<0.001)和亲子疏离(β=0.39,P<0.01)都正向预测高原军官PTSD症状的严重程度。⑤亲子疏离在早年躯体虐待经历与PTSD症状之间起部分中介作用(β=1.16,95%CI:0.54~1.75)。结论有早年创伤经历的高原军官PTSD症状阳性检出率更高、症状更重。早年躯体虐待经历不仅对PTSD症状有直接影响,还会通过亲子疏离间接影响其严重程度。

双相抑郁患者快感缺失与童年创伤经历的相关性

目的:探讨双相抑郁患者快感缺失与童年创伤经历的关联性。方法:采用斯奈思-汉密尔顿快感量表(Snaith-Hamilton pleasure scale,SHAPS)、中文版修订社会快感缺失量(revised social anhedonia scale-Chinese version,RSAS-C)、中文版修订躯体快感缺失量表(revised physical anhedonia scale-Chinese version,RPAS-C)、17项汉密尔顿抑郁量表(17-item Hamilton rating scale for depression,HAMD-17)、14项汉密尔顿焦虑量表(14-item Hamilton anxiety scale,HAMA-14)和童年创伤问卷(childhood trauma questionnaire,CTQ)对53例双相抑郁患者(观察组)和51名健康者(健康对照组)进行评估,通过偏相关分析探讨双相抑郁患者快感缺失与童年创伤的关系。结果:观察组SHAPS、RSAS-C、RPAS-C、CTQ的总分及其分量表情绪虐待、躯体虐待、情绪忽视和躯体忽视评分均高于健康对照组(P<0.05)。RPAS-C评分与CTQ总分及性虐待、躯体虐待评分呈正相关(P<0.05)。结论:童年创伤经历与双相抑郁患者快感缺失相关联,特别是早年的创伤经历影响个体对躯体快乐的体验能力。

童年创伤与强迫症关系的研究进展

童年创伤包括躯体虐待、性虐待、情感虐待以及忽视。作为影响强迫症(OCD)的重要社会心理因素,童年创伤既可以直接影响OCD的发生和发展,也可以通过与生物、遗传、社会心理等多种因素发生交互作用间接影响OCD。本文对童年创伤和OCD的关系进行综述,以期更深入理解童年创伤与OCD之间的内在机制,为OCD的治疗提供新的思路。

女性童年创伤经历对孕产期抑郁的影响研究

目的探讨女性童年创伤经历对孕产期抑郁的影响,并检验可能的中介因素,为孕产期抑郁的防治提供新思路。方法本研究于2021年10月至2022年4月采用三阶段抽样的方式抽取甘肃省8个市907例孕产妇为调查对象。采用问卷调查的方法收集资料,通过爱丁堡产后抑郁量表(EPDS)评估孕产期抑郁,使用反刍思维量表(RRS)评估反刍思维水平,采用童年创伤问卷(CTQ)评估女性童年创伤经历。利用Spearman相关分析童年创伤与孕产妇抑郁症状的相关性,使用SPSS 22.0 Process插件分析反刍思维水平在童年创伤经历与孕产期抑郁之间所起的中介作用。结果Spearman相关分析结果表明,孕产妇抑郁与童年创伤、反刍思维均正相关(r值分别为0.315、0.707,P<0.001),童年创伤与反刍思维正相关(r=0.379,P<0.001);童年创伤对孕产妇抑郁、反刍思维均有显著的预测作用(β值分别为0.131、0.362,P<0.001),将反刍思维作为中介变量放入模型后,童年创伤对孕产妇抑郁的直接预测作用不显著(β=0.005,P>0.05),反刍思维对孕产妇抑郁的预测作用仍然显著(β=0.347,P<0.001)。结论女性童年创伤经历可以通过提高反刍思维水平而增加其孕产期抑郁的发生。因此,针对有童年创伤经历的孕产妇可重点评估其反刍思维水平,提供及时、综合的干预,预防其孕产期抑郁的发生,以提高孕产期女性的生活质量。

童年创伤对负性自动思维及手机成瘾的影响:感戴的保护作用

目的:探讨感戴在童年创伤对大学生负性思维和手机成瘾的影响中的保护机制。方法:采用童年创伤问卷、感戴量表、手机成瘾倾向量表和负性自动思维自评量表对1839名大学生进行问卷施测。结果:相关分析表明,童年创伤与手机成瘾(r=0.24;P<0.01)、负性自动思维(r=0.35;P<0.01)呈显著正相关关系,与感戴(r=-0.52;P<0.01)呈显著负相关;感戴与手机成瘾(r=-0.40;P<0.01)和负性自动思维(r=-0.54;P<0.01)呈显著的负相关。回归分析表明,童年创伤可显著负向预测感戴,童年创伤可显著正向预测负性自动思维和手机成瘾,同时感戴可显著负向预测负性自动思维与手机成瘾。中介效应分析表明,感戴在童年创伤对负性自动思维和童年创伤对手机成瘾的影响中均起部分中介作用,中介效应量分别为72.58%和78.41%。结论:童年创伤直接对大学生负性自动思维与手机成瘾起消极作用,感戴在童年创伤对大学生负性自动思维与手机成瘾的影响中起保护作用。

童年期创伤对大学生网络态度的影响:认知共情的中介作用

本研究采用《人际反应指数量表》《网络态度量表》和《童年期创伤问卷》,考察大学生(n=201)童年期创伤对其网络态度的影响。结果显示:(1)男性大学生的童年期创伤得分高于女性大学生,城镇来源的大学生童年期创伤得分高于农村来源的大学生,且独生子女大学生对网络使用有更高的偏好;(2)童年期创伤能够正向预测网络喜欢、网络焦虑和网络行为倾向。认知共情能够正向预测网络效能感、网络有用性认知,负向预测网络焦虑;(3)认知共情在童年期创伤和网络焦虑间起遮掩效应,所以认为认知共情能够弱化童年期创伤对网络焦虑的影响,其中观点采择发挥了重要作用。想象在童年期创伤和网络喜欢间起部分中介作用。