Maus-tratos na infância e psicopatologia no adulto: caminhos para a disfunção do eixo hipotálamo-pituitária-adrenal

Abstract

Objective The aim of this paper was to examine the relationship between childhood maltreatment and adult psychopathology, as reflected in hypothalamic-pituitary-adrenal axis dysfunction. Method A selective review of the relevant literature was undertaken in order to identify key and illustrative research findings. Results There is now a substantial body of preclinical and clinical evidence derived from a variety of experimental paradigms showing how early-life stress is related to hypothalamic-pituitary-adrenal axis function and psychological state in adulthood, and how that relationship can be modulated by other factors. Discussion The risk for adult psychopathology and hypothalamic-pituitary-adrenal axis dysfunction is related to a complex interaction among multiple experiential factors, as well as to susceptibility genes that interact with those factors. Although acute hypothalamic-pituitary-adrenal axis responses to stress are generally adaptive, excessive responses can lead to deleterious effects. Early-life stress alters hypothalamic-pituitary-adrenal axis function and behavior, but the pattern of hypothalamic-pituitary-adrenal dysfunction and psychological outcome in adulthood reflect both the characteristics of the stressor and other modifying factors. Conclusion Research to date has identified multiple determinants of the hypothalamic-pituitary-adrenal axis dysfunction seen in adults with a history of childhood maltreatment or other early-life stress. Further work is needed to establish whether hypothalamic-pituitary-adrenal axis abnormalities in this context can be used to develop risk endophenotypes for psychiatric and physical illnesses.

Association between child maltreatment indicators and developmental problems in early childhood education

“…13 Anxiety (in different levels) can also have important maladjusted responses mainly if this condition triggers high levels of stress for a long period, which will also affect the aforementioned structuring and organization process of the neurophysiologic responses. 16,17,32 There were no significant differences between the groups in Adaptive Functioning. It is important to consider that this function includes an assessment of school performance, levels of joy and dedication shown in the school setting according to the perception the teachers who participated in this study.…”

“…These data corroborate results found in previous studies that have indicated that the sequelae in different individuals vary from a few worrying symptoms to clinically relevant levels of maltreatment symptoms, and to the presence of severe psychiatric disorders. [14][15][16][17] Significant differences were also found in Internalizing Problems. For Externalizing Problems, there were no differences between the groups, even though the p value was close to significant.…”

“…Interference in this process can trigger significant anatomic and physiological changes, which would become the basis of certain psychopathologies and disorders later in life. 16,17 Throughout childhood, the phase that coincides with the start of formal schooling for children, usually at age 6, is a very sensitive time of their development, not only due to the changes in the brain, but also to the importance attributed to the adaptive experiences that occur at that time. Social relationships change dramatically when children enter school.…”

O desempenho executivo em pacientes que apresentam automutilação

“…O desenvolvimento das funções executivas depende do amadurecimento do córtex pré-frontal, que ocorre ao longo do crescimento da criança e continua na adolescência (Casey et al, 2000) e é precursor do funcionamento adulto Anderson, 2004 (Giedd et al, 1999;Sowell et al, 1999;Shaw et al, 2008), o que pode ter limitado o achado de diferenças, uma vez que são funções ainda em desenvolvimento na adolescência. Outra questão é a falta de instrumento que avalia gravidade da automutilação, além dos estudos que envolvem a automutilação se incluirem em um grupo heterogêneo, o que pode interferir nos resultados (Lloyd-Richardson et al, 2007;Whitlock et al, 2008 (Noll et al, 2006;Fergusson et al, 2008;Mello et al, 2009;Oliveira, 2013 -Uma vez que preencheu critérios para o transtorno, por exemplo, automutilação, o paciente é encaminhado para uma fila de espera para passar pela triagem.…”

Diagnóstico diferencial entre transtorno afetivo bipolar e transtorno de personalidade borderline fundamentado na história de estresse precoce e em avaliação psiconeuroendócrina

“…Existem evidências que indicam uma associação do abuso sexual com a hiperativação do eixo HHA , e do abuso emocional com reatividade diminuída do cortisol (CARPENTER et al, 2009;MELLO et al, 2009), além de relatos de associação entre negligência emocional e abuso físico e baixos níveis de cortisol (FLORY et al, 2009;. De acordo com esses dados da literatura, nossos achados são concordantes quanto ao papel do abuso sexual na hiperativação do eixo HHA nas pacientes borderline.…”