Early Life Stress Affects Volume of the Hippocampus

December 12, 2016 · Posted in Risk Factors · Comment 

early life stressors affect hippocampal volume

New research shows that there are crucial periods of early life in which a stressful event can reduce hippocampal volume in adolescence. In a study presented at the 2016 meeting of the Society of Biological Psychiatry, Kathryn L. Humphreys and colleagues found that children who experienced a significant stressor before age 8 had smaller hippocampi in early adolescence than children who did not have a significant stressor early in life.

The severity of the stressors that occurred when children were between the ages of 0 and 2 predicted the volume of the hippocampus later in life. This was true to a lesser extent for stressful events that occurred between the ages of 3 and 5. No effect was seen for stressful events that took place between the ages of 6 and 8.

The period of sensitivity to stressful events between ages 0 and 2 and its effects on hippocampal volume could influence a variety of psychiatric outcomes in conditions such as depression and post-traumatic stress disorder (PTSD).

Emotional Abuse Increases Inflammation

December 5, 2016 · Posted in Risk Factors · Comment 

emotional abuse increases inflammation

Trauma in childhood is a risk factor for depression, and both childhood trauma and depression have been linked to increased inflammation. In a study presented at the 2016 meeting of the Society of Biological Psychiatry, Sarah R. Horn and colleagues found that emotional abuse in childhood predicted high levels of inflammation measured in the blood in adulthood.

Horn and colleagues took blood samples from 35 people with treatment-resistant depression and 28 healthy control subjects. The researchers measured inflammatory markers in the blood and also interviewed the participants about any physical, sexual, or emotional abuse they experienced in childhood. Among all the participants, emotional abuse was linked to elevated levels of several inflammatory markers, including interleukin-6, interleukin-10, interleukin-1a, interleukin-15, and fractalkine.

The researchers suggest that more research is needed to clarify the link between early trauma, depression, and inflammation. How elevated inflammation in people with a history of abuse may influence the effectiveness of different psychotherapies and medications for depression remains to be determined.

Psychiatric Symptoms in Childhood Linked to Struggles in Adulthood

December 31, 2015 · Posted in Risk Factors · Comment 

psychiatric symptoms in childhood

Psychiatric illness is one of the most common health problems among children. A study by William E. Copeland and colleagues in the journal JAMA Psychiatry indicates that psychiatric symptoms and diagnoses in childhood can lead to struggles with health, the legal system, personal finances, and social functioning in early adulthood, even if the psychiatric symptoms themselves do not last.

The study included 1420 participants from 11 mostly rural counties in North Carolina, who participated in structured interviews up to six times between the ages of 9 and 16 to determine the existence of psychiatric symptoms and diagnoses. Of these, 1273 were assessed three times during young adulthood, at the ages of 19, 21, and 24–26, for any evidence of social, legal, financial, or health problems.

Participants who had had a childhood psychiatric disorder were six times more likely to have at least one adverse outcome in adulthood compared to participants with no history of psychiatric problems, and nine times more likely to have two or more adverse outcomes in adulthood. Those participants who had psychiatric symptoms that were not sufficient for a particular diagnosis were still three times more likely to have at least one adverse outcome in adulthood, and five times more likely to have at least 2 adverse outcomes. The cumulative number of psychiatric disorders to which a participant was exposed was the best predictor of adverse outcomes in adulthood.

Even moderate psychiatric problems in childhood can disrupt a person’s transition to adulthood. However, early treatment and prevention can help reduce the long-term impact of psychiatric illness. Parents of children (aged 2–12) with mood and behavioral symptoms are welcome to join the Child Network, a system for collecting weekly ratings of their children’s symptoms and displaying them longitudinally for the child’s doctor.

Childhood Maltreatment Associated with Suicide Attempts

December 30, 2015 · Posted in Risk Factors · Comment 

child abuse

A history of childhood maltreatment increases the risk that a person will attempt suicide. Different types of maltreatment, such as physical abuse, emotional abuse, sexual abuse, and neglect, often overlap. In a 2015 study in the Journal of Clinical Psychiatry, researcher Nicolas Hoertel and colleagues used data from an epidemiological survey of 34,653 Americans to clarify the mechanism by which maltreatment is linked to suicide risk.

Hoertel and colleagues found that childhood maltreatment in general was associated with an increased risk of attempting suicide and an earlier age at first suicide attempt. The analysis controlled for demographic characteristics and psychiatric diagnoses. Most of the risk came from effects that were shared across all the types of maltreatment. However, sexual abuse directly conferred an additional risk of suicide attempt.

In an earlier study of 648 outpatients with bipolar disorder by this editor Robert Post and colleagues (led by Gabriele Leverich), 34% had a history of suicide attempts, and these participants had a higher incidence of traumatic stressors in childhood and more stresses at illness onset than those without a history of suicide attempts. A history of sexual abuse in childhood was also linked to an increased risk of a serious suicide attempt in the earlier study, which appeared in the Journal of Clinical Psychiatry in 2003.

Link Between Childhood Trauma and Difficult Course of Bipolar Disorder Clarified

November 9, 2015 · Posted in Genetics, Risk Factors · Comment 

Trauma in childhood linked to course of bipolar disorder

A collaboration between Norwegian and French researchers led by Bruno Etain has clarified the pathway by which childhood trauma is linked to worse outcomes among people with bipolar disorder. The researchers, who presented their work in a poster at the 2015 meeting of the Society of Biological Psychiatry, replicated earlier findings by this editor (Robert Post) that patients who experienced trauma as a child had a more adverse course of bipolar disorder. Etain and colleagues found a link between childhood trauma and an earlier age of onset of bipolar disorder, rapid cycling, suicide attempts, and cannabis misuse.

The researchers identified more than 550 patients with bipolar disorder, who answered questionnaires about their history of bipolar disorder and childhood trauma. Their DNA was also analyzed, and the researchers found that the effect of childhood trauma on age of onset was mediated by the presence of common genetic variants in proteins related to stress (the serotonin transporter) and immune function (Toll-like receptors). They also found that the traits of mood lability (or moodiness) and impulsivity mediated the effects of trauma on clinical outcomes.

The lasting epigenetic effects of child maltreatment and adversity noted in the above abstract are consistent with a large literature showing more epigenetic effects in these individuals than in controls. While genetics are important, the impact of the environment is also substantial.

Verbal Abuse in Childhood, Like Physical and Sexual Abuse, Linked to Earlier Onset and More Difficult Course of Bipolar Disorder

July 22, 2015 · Posted in Course of Illness, Risk Factors · Comment 

verbal abuse

Earlier research has shown that childhood adversity is linked to earlier age of onset of bipolar disorder and more difficult course of illness. Physical and sexual abuse are associated with both earlier age of onset and more difficulties such as anxiety disorders and substance abuse. Now, new research by this editor (Robert M. Post) and colleagues links verbal abuse (even in the absence of physical and sexual abuse) to earlier onset of bipolar disorder and to more severe and complicated course of illness.

The study, published in the journal Bipolar Disorders, was based on the self-reports of 634 adult outpatients with bipolar disorder at four sites in the US. These participants were interviewed about their history of illness and the frequency of adverse events they experienced in childhood, adolescence, and adulthood, including physical, sexual, and verbal abuse. Twenty-four percent of these participants reported having experienced verbal abuse occasionally or frequently in childhood, but not other forms of abuse, while another 35% had a history of verbal abuse as well as physical or sexual abuse, for a total of 59% with a history of verbal abuse.

The greater the frequency of verbal abuse in childhood, the earlier the average age of onset of bipolar disorder. Participants with no history of abuse had a mean age of onset of 20.6 years, but verbal abuse by itself reduced the mean age of onset to 16.5 years, and verbal abuse plus sexual abuse reduced the mean age of onset to 15.3 years. (The mean age of onset for participants who experienced sexual abuse alone was 17.5 years.) It was impossible to determine the combined effect of verbal and physical abuse because verbal abuse was almost always present when physical abuse occurred. For the 14% of the participants who had experienced verbal, physical, and sexual abuse in childhood, the mean age of onset of bipolar disorder was 13.1 years.

Those who were verbally (but not physically or sexually) abused in childhood had more anxiety disorders, drug abuse, and rapid cycling than those who were not abused, but not more alcohol abuse. Those who were verbally abused also showed increasing severity of illness, including increased frequency of cycling.

Genetics can also play a role. Having a parent with a mood disorder also contributed to an earlier age of onset of bipolar disorder.

Editor’s Note: Researcher David J. Miklowitz and colleagues have shown that family focused therapy (FFT), which emphasizes illness education and communication enhancement within the family, is more effective than treatment as usual for children with a family history of bipolar disorder and a diagnosis of depression, cyclothymia, or bipolar not otherwise specified (BP NOS).

FFT was particularly effective in reducing symptoms in children from families with high expressed emotion, suggesting that this kind of family-based intervention could reduce levels of verbal abuse.