Childhood maltreatment and depressive disorders have both been associated with a dysregulation of the hypothalamic-pituitary-adrenal axis. The FKBP5 gene codes for a co-chaperone regulating the ...glucocorticoid-receptor sensitivity. Previous evidence suggests that subjects carrying the TT genotype of the FKBP5 gene single-nucleotide polymorphism (SNP) rs1360780 have an increased susceptibility to adverse effects of experimental stress. We therefore tested the hypothesis of an interaction of childhood abuse with rs1360780 in predicting adult depression. In all, 2157 Caucasian subjects from the Study of Health in Pomerania (German general population) completed the Beck Depression Inventory (BDI-II) and Childhood Trauma Questionnaire. The DSM-IV diagnosis of major depressive disorder (MDD) was assessed by interview. Genotypes of rs1360780 were taken from the Affymetrix Human SNP Array 6.0. Significant interaction (p=0.006) of physical abuse with the TT genotype of rs1360780 was found increasing the BDI-II score to 17.4 (95% confidence interval (CI)=12.0-22.9) compared with 10.0 (8.2-11.7) in exposed CC/CT carriers. Likewise, the adjusted odds ratio for MDD in exposed TT carriers was 8.2 (95% CI=1.9-35.0) compared with 1.3 (0.8-2.3) in exposed subjects with CC/CT genotypes. Relative excess risk due to interaction (RERI) analyses confirmed a significant additive interaction effect (RERI=6.8; 95% CI=0.64-33.7; p<0.05). In explorative analyses, the most severe degree of sexual and emotional abuse also yielded significant interaction effects (p<0.05). This study revealed interactions between physical abuse and rs1360780 of the FKBP5 gene, confirming its role in the individual susceptibility to depression. Given the large effect sizes, rs1360780 could be included into prediction models for depression in individuals exposed to childhood abuse.
Background A general emotional vulnerability (intense, easily triggered affective reactions) is considered a core symptom in borderline personality disorder (BPD), but evidence from ...psychophysiological studies for this hypothesis is not very consistent. Given the high comorbidity of posttraumatic stress disorder (PTSD) in BPD patients, current comorbid PTSD might also modulate emotional reactivity. In the present study using a script-driven imagery paradigm, idiographic aversive, disorder-specific (scenes about rejection and abandonment), and standard unpleasant, neutral, and pleasant scripts were presented to investigate emotional reactivity in patients with BPD. Methods Forty nonmedicated BPD patients and 32 healthy control subjects first read and then imagined the scripts. Acoustic startle probes were presented during reading and imagery and the eye-blink responses, as well as changes in heart rate and skin conductance level were recorded. Results Imagery of disorder-specific scripts resulted in a clear potentiation of the startle responses and increased autonomic arousal in BPD patients but not in control subjects. Borderline personality disorder patients with current comorbid PTSD ( n = 26 out of 40) showed attenuated startle potentiation during aversive imagery that was not the case in BPD patients without current PTSD. This effect was most pronounced in BPD patients with severe PTSD. Conclusions Scenes about rejection and abandonment are specifically able to activate defensive response mobilization in BPD patients. These findings suggest that BPD patients are not more physiologically reactive to emotional cues in general but show increased emotional vulnerability if borderline-specific schemas are activated. Moreover, emotional reactivity is attenuated in BPD patients with PTSD.
To determine in a general population sample the differential impact on physical health of exposure to traumatic experiences and posttraumatic stress disorder (PTSD). Trauma exposure and PTSD have ...been associated with physical illness in specific populations, such as veterans.
Medical histories including cardiovascular, endocrine, pulmonary, and other chronic diseases were obtained from 3171 adults living in the community. They were administered the PTSD module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and were assigned to three groups: no trauma (n = 1440); trauma, but no PTSD (n = 1669); and trauma with subsequent PTSD (n = 62).
After adjustments for sociodemographic factors, smoking, body mass index, blood pressure, depression, and alcohol use disorders, subjects with trauma history had higher odds ratios (ORs) for angina pectoris and heart failure (OR = 1.2; 95% Confidence Interval CI = 1.1-1.3), stroke (OR = 1.2; 95 CI = 1.0-1.5), bronchitis, asthma, renal disease, and polyarthritis (ORs between 1.1 and 1.3) compared with nontraumatized participants. The PTSD positive subsample had increased ORs for angina (OR = 2.4; 95% CI = 1.3-4.5), heart failure (OR = 3.4; 95% CI = 1.9-6.0), bronchitis, asthma, liver, and peripheral arterial disease (ORs, range = 2.5-3.1).
Our findings suggest a strong association between PTSD and cardiovascular and pulmonary diseases. Particular diagnostic and treatment attention should be paid to physical illness in PTSD positive patients in primary care, medical, and mental health settings.
Schizophrenia and bipolar disorder are characterized by a high disease burden. Antipsychotic medication is an essential part of the treatment. However, non-adherence is a major problem. Our aim was ...to examine potential determinants of non-adherence for patients with severe mental disorders.
Baseline data of the study "Post stationary telemedical care of patients with severe psychiatric disorders" (Tecla) were used. Medication adherence was assessed with the Medication Adherence Report Scale German version (MARS-D). A logistic regression was calculated with age, sex, education, employment status, level of global functioning, social support and intake of typical and atypical antipsychotics as predictors.
N = 127 participants were included in the analysis (n = 73 men, mean age 42 years). The mean MARS-D Score was 23.4 (SD 2.5). The most common reason for non-adherence was forgetting to take the medicine. Significant positive determinants for adherence were older age (OR 1.02, 95% CI 1.011-1.024, p < 0.0001), being employed (OR 2.46, 95% CI 1.893-3.206, p < 0.0001), higher level of global functioning (overall measure of how patients are doing) (OR 1.02, 95% CI 1.012-1.028, p < 0.0001), having social support (OR 1.02, 95% CI 1.013-1.026, p < 0.0001), and intake of typical antipsychotics (OR 2.389, 95% CI 1.796-3.178, p < 0.0001). A negative determinant was (female) sex (OR 0.73, 95% CI 0.625-0.859, p = 0.0001).
Especially employment, functioning and social support could be promising targets to facilitate adherence in patients with schizophrenia or bipolar disorder.
This study is retrospectively registered at the German Clinical Trials Register with the trial registration number DRKS00008548 at 21/05/2015.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Background Public stigma and self-stigma are two facets of mental illness stigma. Self-stigma denotes the internalization of negative public perceptions by persons with mental illness and ...has been shown to decrease general self-efficacy. To date, self-stigma has not been examined in people suffering from alcohol dependence, a particularly severely stigmatized mental disorder. Methods By adopting the Self-Stigma in Mental Illness Scale (SSMI), we developed the Self-Stigma in Alcohol Dependence Scale (SSAD). The scale is based on a focus-group derived list of 16 negative stereotypes about alcohol dependent persons. It consists of four 16-item subscales measuring four hypothetical stages of self-stigma, stereotype awareness (aware), stereotype agreement (agree), self-concurrence (apply), and self-esteem decrement (harm). We employed the SSAD in a cross-sectional study of 153 patients hospitalized for alcohol detoxification to examine its reliability and validity. Results The four stages of self-stigma could be reliably measured with the SSAD (Cronbach's alpha, 0.86–0.93). Each step in the process of self-stigmatization was most closely associated with its preceding step. Other significantly related independent variables in multiple regression analyses included desire for social distance (associated with agree ), duration of drinking problems (associated with apply ) and depressive symptoms (associated with apply and harm ). Both apply and harm were significantly related to reduced drinking-refusal self-efficacy in analyses controlling for depressive symptoms and variables related to duration and severity of the drinking problem. Discussion The SSAD showed good validity and reliability measuring the stages of self-stigma in this group. Self-stigma appears to be associated with lower drinking-refusal self-efficacy.
Previous studies suggested that exposure to traumatic events during childhood and adulthood and post-traumatic stress disorder (PTSD) are associated with a dysregulation of different neuroendocrine ...systems. However, the activity of the renin-angiotensin-aldosterone-system (RAAS) in relation to trauma/PTSD has been largely neglected.
Traumatization, PTSD, and plasma concentrations of renin and aldosterone were measured in 3092 individuals from the general population. Subgroups according to the status of traumatization ('without trauma'; 'trauma, without PTSD', 'PTSD') were formed and compared regarding renin and aldosterone concentrations. Additionally, we calculated the associations between the number of traumata, renin, and aldosterone concentrations. Finally, associations of PTSD with renin/aldosterone levels were controlled for the number of traumata ('trauma load').
Levels of renin, but not aldosterone, were increased in traumatized persons without PTSD (p = 0.02) and, even stronger, with PTSD (p < 0.01). Moreover, we found a dose-response relation between the number of traumata and renin levels (β = 0.065; p < 0.001). Regression analyses showed PTSD as a significant predictor of renin (β = 0.38; p < 0.01). This effect was only slightly attenuated when controlled for trauma load (β = 0.32; p < 0.01).
Our results suggest that traumatization has lasting and cumulative effects on RAAS activity. Finding elevated renin levels in PTSD independent from trauma load supports the concept of PTSD as a disorder with specific neuroendocrine characteristics. Alternatively, elevated renin levels in traumatized persons may increase the risk for developing PTSD. Our findings contribute to explain the relationship between traumatic stress/PTSD and physical disorders.
Associations of oxytocin receptor gene (
OXTR) variants and autism spectrum disorders (ASD) have been reported in earlier studies; in one of the studies associations with IQ and daily living skills ...were found additionally. Variations of the oxytocin receptor gene might also regulate affect, attachment and separation beyond the diagnostic borders of autism. We tested hypotheses of associations between positive and negative affects and social and emotional loneliness (285 adults), IQ (117 adolescents) and polymorphisms of the oxytocin receptor gene (
OXTR rs53576, rs2254298 and rs2228485) in normal subjects. Individuals with the oxytocin
OXTR rs53576 A/A genotype showed lower positive affect scores (
F
=
5.532, df
=
1;
p
=
0.019). This effect was restricted to males (
F
=
13.098, df
=
1;
p
=
0.00047). Haplotypes constructed with the three markers were associated with positive affect (
p
=
0.0012), negative affect (
p
<
0.0001) and emotional loneliness (
p
<
0.0001). Non-verbal intelligence was significantly reduced in rs53576 A/A adolescents (
T
=
2.247,
p
=
0.027). Our findings support a role for the oxytocin receptor haplotypes in the generation of affectivity, emotional loneliness and IQ.
In the present study, we investigated whether inter-individual differences in vagally mediated heart rate variability (vmHRV) would be associated with inter-individual differences in empathy and ...alexithymia. To this end, we determined resting state HF-HRV in 90 individuals that also completed questionnaires assessing inter-individual differences in empathy and alexithymia. Our categorical and dimensional analyses revealed that inter-individual differences in HF-HRV were differently associated with inter-individual differences in empathy and alexithymia. We found that individuals with high HF-HRV reported more empathy and less alexithymia than individuals with low HF-HRV. Moreover, we even found that an increase in HF-HRV was associated with an increase in empathy and a decrease in alexithymia across all participants. Taken together, these findings indicate that individuals with high HF-HRV are more empathetic and less alexithymic than individuals with low HF-HRV. These differences in empathy and alexithymia may explain why individuals with high HF-HRV are more successful in sharing and understanding the mental and emotional states of others than individuals with low HF-HRV.
Abstract Background Posttraumatic stress disorder (PTSD) has been associated with several somatic diseases, and low-grade inflammation may be one psychobiological mechanism mediating this ...relationship. We assessed the association between PTSD and elevated serum levels of C-reactive protein (CRP; >3 mg/L) in a large general population sample. Methods About 3049 adults living in the community were included in the present study. CRP, lipoproteins and triglycerides were determined. Participants were also examined with regard to blood pressure, body mass index (BMI), physical activity, comorbid somatic diseases, medication, daily alcohol intake, and depression. Results PTSD was diagnosed in 55 participants (1.8%), and low-grade inflammation (i.e. CRP >3 mg/L) was found in 701 subjects (23.0%). PTSD positive participants had significantly higher odds for elevated CRP values than those without PTSD (OR = 2.27; 95% CI: 1.32–3.93). Even after adjusting for sex, age, other sociodemographic factors, BMI, blood pressure, lipoproteins and triglycerides, physical activity, comorbid somatic diseases, daily alcohol intake, and trauma exposure, there were almost twofold higher odds for elevated CRP levels in participants with PTSD compared to those without PTSD (OR = 1.87; 95% CI: 1.05–3.35). Conclusions Our findings suggest a close relationship between PTSD and low-grade inflammation possibly representing one psychobiological pathway from PTSD to poor physical health, particularly with respect to cardiovascular and pulmonary disease as well as diabetes.
Abstract Background The role of stigma in help-seeking for depression is unclear. We hypothesize that in persons experiencing symptoms of depression, personal stigmatizing attitudes impair appraisal ...of the present condition as mental health problem and thus reduce the perceived need for professional help. Methods We recruited a sample of 25 currently untreated depressed persons from the general population using local newspaper articles and emails that listed symptoms of depression avoiding the term “depression” or any other potentially stigma-associated term. We elicited personal stigmatizing attitudes, appraisal of the present problem as mental health problem, and perceived need for any medical or therapeutic help. Results In linear regression analyses controlling for depression severity and previous help-seeking, high personal stigma was related to lower problem appraisal (beta, − 0.38; p < 0.05) and to lower perceived need (beta, − 0.59, p < 0.01). Lower problem appraisal was associated with lower perceived need. Regressing need on both problem appraisal and stigma reduced the direct influence of stigma on need, indicating a partial mediation of this relationship by problem appraisal. Limitations Our small sample prohibited the use of path models. Conclusions Personal stigmatizing attitudes in persons suffering from a depressive syndrome pose an important barrier to help, impairing appraisal of depressive symptoms as potential mental health problem and decreasing perceived need for professional help.
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