Early Life Stress as Factor for Use of Psychoactive Substances: Integrative Review

Purpose: To identify, analyze and synthetize the scientific evidences that support Early Life Stress (ELS) diagnosis using the Childhood Trauma Questionnaire (CTQ), since it assumes the use of psychoactive substances later in adolescence and adulthood. Individuals that experienced some form of childhood stress may present, in adulthood, consequences that manifest into mental disorders such as problematic use of psychoactive substances. Methods: An integrative review of the literature on the subject in the databases: PubMed, Web of Science, LILACS and Psycinfo, regards studies that have been indexed in the last ten years (2003-2014). Combination of controlled and uncontrolled factors in the use and abuse of psychoactive substances, CTQ and ELS adapted to each database. Findings: The alcohol was the most used drug by the participating subjects of these research;mostly, the use of psychoactive drugs, started when they were still in adolescence;ELS and the later use of psychoactive drugs can be found more frequently in female;the lack of internal resources for dealing with stress in adulthood after ELS occurrence may have as a consequence the use of psychoactive drugs as a coping mechanism. Conclusions: It was possible to identify scientific evidences that support the ELS diagnosis, measured by the CTQ, as a determining factor for the use and abuse of alcohol and/or other psychoactive drugs in adolescence and adulthood. Implications: Investigate the ELS as a strategy to improve the therapeutic project of patients in nursing care, which will be built based on scientific evidence, so it can be more effective.

Music in depression: Neural correlates of emotional experience in remitted depression

AIM: To investigate neural and behavioral correlates of emotional experiences as potential vulnerability markers in remitted depression. METHODS: Fourteen remitted participants with a history of major depression and fourteen closely matched healthy control participants took part in the study. We used two psychiatric interviews(Hamilton Depression Rating Scale, Montgomery-Asberg Depression Rating Scale) and one self-report scale(Beck Depression Inventory) to assess remission. Healthy control participants were interviewed by an experienced psychiatrist to exclude those who showed any current or lifetime psychiatric or neurological disorders. To explore psychosocialand cognitive-interpersonal underpinnings of potential vulnerability markers of depression, early life stress, coping styles and alexithymia were also assessed. We induced pleasant and unpleasant emotional states using congruent combinations of music and human emotional faces to investigate neural and behavioral correlates of emotional experiences; neutral stimuli were used as a control condition. Brain responses were recorded using functional magnetic resonance imaging. Behavioral responses of pleasantness, arousal, joy and fear were measured via button-press inside the resonance imaging scanner. RESULTS: The mean age of the sample was 54.9(± 11.3) years. There were no differences between remitted depressed(RD)(n = 14; 9 females and 5 males) and healthy participants(n = 14; 8 females and 6 males) regarding age, current degree of depression, early life stress, coping styles and alexithymia. On a neural level, RD participants showed reduced activations in the pregenual anterior cingulate cortex(pg ACC) in response to pleasant [parameter estimates:-0.78 vs 0.32; t(26) =-3.41, P < 0.05] and unpleasant [parameter estimates:-0.88 vs 0.56; t(26)=-4.02, P < 0.05] emotional stimuli. Linear regression analysis revealed that pg ACC activity was modulated by early life stress [β =-0.48; R2 = 0.23, F(1,27) = 7.83, P < 0.01] and taskoriented coping style [β = 0.63; R2 = 0.37, F(1,27) = 16.91, P < 0.001]. Trait anxiety modulated hippocampal responses to unpleasant stimuli [β = 0.62; R2= 0.38, F(1,27) = 15.95, P < 0.001]. Interestingly, in their reported experiences of pleasantness, arousal, happiness and fear in response to pleasant, unpleasant and neutral stimuli, RD participants did not differ significantly from healthy control participants. Adding trait anxiety or alexithymia as a covariate did not change the results.CONCLUSION: The present study indicates that, in euthymic individuals, depression history alters neural correlates, but not the subjective dimension of pleasant and unpleasant emotional experiences.