RESUMEN
Early-life stress (ELS) is associated with a higher risk of psychopathologies in adulthood, such as depression, which may be related to persistent changes in the hypothalamic-pituitary-adrenal (HPA) axis. This study aimed to evaluate the effects of ELS on the functioning of the HPA axis in clinical and experimental situations. Clinically, patients with current depressive episodes, with and without ELS, and healthy controls, composed the sample. Subjects took a capsule containing placebo, fludrocortisone, prednisolone, dexamethasone or spironolactone followed by an assessment of plasma cortisol the morning after. Experimentally, male Wistar rats were submitted to ELS protocol based on variable, unpredictable stressors from postnatal day (PND)1 to PND21. On PND65 animals were behaviorally evaluated through the forced-swimming test (FST). At PND68, pharmacological challenges started, using mifepristone, dexamethasone, spironolactone, or fludrocortisone, and corticosterone levels were determined 3 h after injections. Cortisol response of the patients did not differ significantly from healthy subjects, regardless of their ELS history, and it was lower after fludrocortisone, prednisolone, and dexamethasone compared with placebo, indicating the suppression of plasma cortisol by all these treatments. Animals exposed to ELS presented altered phenotype as indicated by an increased immobility time in the FST when compared with control, but no significant long-lasting effects of ELS were observed on the HPA axis response. Limitations on the way the volunteers were sampled may have contributed to the lack of ELS effects on the HPA axis, pointing out the need for further research to understand these complex phenomena.
Asunto(s)
Experiencias Adversas de la Infancia , Sistema Hipófiso-Suprarrenal , Adulto , Animales , Depresión/tratamiento farmacológico , Depresión/etiología , Humanos , Sistema Hipotálamo-Hipofisario , Masculino , Ratas , Ratas Wistar , Estrés PsicológicoRESUMEN
Numerous studies have researched the aggravating and maintainer effect of Early Life Stress in patients adults with psychiatric disorders. This study examined the relationship between depression and subtypes of early life stress among 81 psychiatric patients treated at the inpatient Day Hospital Unit of a University General Hospital. Psychiatric diagnosis was confirmed according to the MINI International Neuropsychiatric Interview (MINI). The Childhood Trauma Questionnaire (CTQ) was used for evaluating as retrospective assessment of the presence of ELS on these patients, and we also evaluated the severity of hopelessness with the Beck Hopelessness Scale (BHS). Our results suggested that the occurrence of depression in adulthood is related to situations of emotional abuse, sexual, and physical neglect during childhood. The analysis between depression and childhood emotional abuse was significant after a multiple logistic regression analysis OR (IC 95%): 4.4 (1.7-11.2), even accounting for gender adjusted OR [AOR] 4.0; (IC 1.5-10.5); psychiatry family history AOR 3.8 (1.4-10.5); previous suicide attempted AOR 3.7; (1.4-10.5) and Hopelessness AOR 3.2 (1.11-9.4). Thus, these findings demonstrate emotional abuse as a significant risk factor to be part of the mechanism involved in the pathogenesis of depression related to early life stress.
RESUMEN
Os Transtornos relacionados a traumas e a estressores são quadros psiquiátricos relacionados a exposi- ção a um evento traumático ou estressante, resultando em sofrimento psicológico relevante, prejuízo social, profissional e em outras áreas importantes da vida do indivíduo. A apresentação clínica de tais transtornos é caracterizada por sintomas de ansiedade e de medo, anedonia, disforia, externalizações da raiva, agressividade e sintomas dissociativos. De acordo com a 5ª edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-5), as categorias diagnósticas inclusas nesse espectro são Transtorno de Apego Reativo, Transtorno de Interação Social Desinibida, Transtorno de Estresse PósTraumático, Transtorno de Estresse Agudo e os Transtornos de Adaptação. O objetivo desta revisão é introduzir o debate sobre a conceituação clínica e as diretrizes terapêuticas dos Transtornos Relacionados a Traumas e a Estressores, direcionando a escolha do profissional pelas práticas terapêuticas adequadas relacionadas a tais categorias diagnósticas. Além disso, os autores discutem as consequências do Estresse Precoce (situações traumáticas ocorridas na infância e adolescência) na vida adulta. (AU)
Trauma and Stressor-Related Disorders are psychiatric conditions related to exposure to a traumatic or stressful event, resulting in significant psychological distress social, professional and other relevant areas of the individual's life. The clinical presentation of these disorders is characterized by symptoms of anxiety and fear, anhedonia, dysphoria, externalizations of anger, aggressiveness and dissociative symptoms. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic categories included in this spectrum are Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder and Adjustment Disorders. The objective of this review is to introduce the debate on clinical conceptualization and therapeutic guidelines of Trauma and Stressor-Related Disorders, directing professional's choice for proper therapeutic practices related to such diagnostic categories. Also, the authors discuss the consequences of early life stress (traumatic situations that occur in childhood and adolescence) in adulthood. (AU)