Measuring Resilience in Adult Women Using the 10-Items Connor-Davidson Resilience Scale (CD-RISC). Role of Trauma Exposure and Anxiety Disorders

International audiencePURPOSE: Resilience is the ability of individuals to adapt positively in the face of trauma. Little is known, however, about lifetime factors affecting resilience. METHODS: We assessed the effects of psychiatric disorder and lifetime trauma history on the resilience self-evaluation using the Connor-Davidson Resilience Scale (CD-RISC-10) in a high-risk-women sample. Two hundred and thirty eight community-dwelling women, including 122 participants in a study of breast cancer survivors and 116 participants without previous history of cancer completed the CD-RISC-10. Lifetime psychiatric symptoms were assessed retrospectively using two standardized psychiatric examinations (Mini International Neuropsychiatric Interview and Watson's Post-Traumatic Stress Disorder Inventory). RESULTS: Multivariate logistic regression adjusted for age, education, trauma history, cancer, current psychiatric diagnoses, and psychoactive treatment indicated a negative association between current psychiatric disorder and high resilience compared to low resilience level (OR = 0.44, 95% CI [0.21-0.93]). This was related to anxiety and not mood disorder. A positive and independent association with a trauma history was also observed (OR = 3.18, 95% CI [1.44-7.01]). CONCLUSION: Self-evaluation of resilience is influenced by both current anxiety disorder and trauma history. The independent positive association between resilience and trauma exposure may indicate a "vaccination" effect. This finding need to be taken into account in future studies evaluating resilience in general or clinical populations

Etude des principales cibles moleculaires de la phencyclidine dans le systeme nerveux central : leurs implications dans un modele d'epilepsie experimentale, l'embrasement limbique

SIGLECNRS T Bordereau / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Implication de la réponse de peur dans le développement précoce du trouble de stress post-traumatique (TSPT)

International audiencePost-traumatic stress disorder (PTSD) is a psychiatric disorder that can develop following exposure to a traumatic event, in approximately 10% of individuals exposed. This disorder is characterized by an exacerbation of the fear response that can be explained by dysfunctional learning and memory in vulnerable individuals. Over the years, Pavlovian fear conditioning has emerged as a powerful paradigm for studying the neural foundations of aversive associative memory formation and has provided a better understanding of the underlying neurobiological changes in PTSD.In the first part of this article, we present a summary of the vulnerability factors associated with the early development of PTSD, focusing on the role of stress hormones in the formation and consolidation of traumatic memories. We show that dysfunctions at different levels of the glucocorticoid-signaling cascade are present in vulnerable individuals and that treatment with hydrocortisone, a glucocorticoid agonist, given during the first hours after traumatic exposure, protects against the development of PTSD in a modest but significant way.We then discuss the limitations of the fear conditioning model and its biological correlates (neuroendocrinology of stress) to explain the etiology of PTSD, a heterogeneous disorder in both its symptomatic expression and the variety of pathways associated with its development. The fear-conditioning model, while having the advantage of being translational, only explains one facet of the complex neurobiology of PTSD and does not appear to provide a sufficient conceptual framework to result in improved treatments for PTSD in an afflicted population

Persistence of abnormal cortisol levels in elderly persons after recovery from major depression.

International audienceBACKGROUND: Cortisol hypersecretion is characteristic of acute clinical depression, but little is known in fully recovered, non-treated elderly persons with a lifetime history of depression. This study was designed to examine patterns of diurnal cycle of cortisol in an elderly cohort without current depression or treatment for depression according to whether the person has or has not experienced a previous episode of depression or co-morbid depression with anxiety. METHODS: Cortisol secretion was evaluated in 162 community-dwelling elderly on a stressful and a non-stressful day (basal level). Past depression and anxiety disorders were assessed using a standardized psychiatric examination based on DSM-IV criteria (the Mini International Neuropsychiatric Interview). RESULTS: Antidepressant-free persons with a history of non-co-morbid major depression (6.8% of the sample) showed basal cortisol hypersecretion compared to those with depression and anxiety (8.6%) or controls. Several hours after exposure to a stressful situation, controls showed a sustained increase in cortisol secretion, which was not observed in persons with a history of depression. Persons with a history of depression with anxiety showed a similar cortisol secretion at baseline to controls but a heightened response to stressful situation; a pattern comparable to that observed in subjects with pure anxiety disorders (16.7%). CONCLUSION: An abnormal HPA response persists even after effective treatment for depression. A history of co-morbid depression and anxiety gives rise to changes characteristic of anxiety alone. Our findings suggest that cortisol abnormalities may be trait markers for vulnerability to depression and for the differentiation of depression and depression with co-morbid anxiety

Angiotensin-converting enzyme gene variants are associated with both cortisol secretion and late-life depression.

International audienceAngiotensin-converting enzyme (ACE) is assumed to influence the activity of the hypothalamic-pituitary-adrenocortical (HPA) axis, which shows hyperactivity in depressed patients. ACE could thus be a promising candidate gene for late-life depression but this has not been examined previously. Depression was assessed in 1005 persons aged at least 65 years, at baseline and over the 10-year follow-up. A clinical level of depression (DEP) was defined as having a score of > or =16 on the Centre for Epidemiology Studies-Depression scale or a diagnosis of current major depression based on the Mini International Neuropsychiatric Interview and according to DSM-IV criteria. Seven single-nucleotide polymorphisms (SNPs) in the ACE gene were genotyped and diurnal cortisol secretion, as an index of HPA axis activity, was measured. Multivariable analyses were adjusted for socio-demographic and vascular factors, cognitive impairment, and apolipoprotein E. Strong significant associations were found between all seven SNPs and DEP and, in particular, first-onset DEP in persons without a past history of depression (P-values ranging from 0.005 to 0.0004). These associations remained significant after correction for multiple testing. The genotypes that were associated with an increased risk of DEP were also significantly associated with an increase in cortisol secretion under stress conditions. Variants of the ACE gene influence cortisol secretion and appear as susceptibility factors for late-life depression in the elderly population. Whether this could represent a common pathophysiological mechanism linking HPA axis and late-life depression remains to be explored

Biological underpinnings of trauma and post-traumatic stress disorder:Focusing on genetics and epigenetics

International audienceCertain individuals are more susceptible to stress and trauma, as well as the physical and mental health consequences following such exposure, including risk for post-traumatic stress disorder (PTSD). This differing vulnerability is likely to be influenced by genetic predisposition and specific characteristics of the stress itself (nature, intensity and duration), as well as epigenetic mechanisms. In this review we provide an overview of research findings in this field. We highlight some of the key genetic risk factors identified for PTSD, and the evidence that epigenetic processes might play a role in the biological response to trauma, as well as being potential biomarkers of PTSD risk. We also discuss important considerations for future research in this area

Resilience and mental health

International audienceThe relationship between disease and good health has received relatively little attention in mental health. Resilience can be viewed as a defence mechanism, which enables people to thrive in the face of adversity and improving resilience may be an important target for treatment and prophylaxis. Though resilience is a widely-used concept, studies vary substantially in their definition, and measurement. Above all, there is no common underlying theoretical construct to this very heterogeneous research which makes the evaluation and comparison of findings extremely difficult. Furthermore, the varying multi-disciplinary approaches preclude meta-analysis, so that clarification of research in this area must proceed firstly by conceptual unification. We attempt to collate and classify the available research around a multi-level biopsychosocial model, theoretically and semiotically comparable to that used in describing the complex chain of events related to host resistance in infectious disease. Using this underlying construct we attempt to reorganize current knowledge around a unitary concept in order to clarify and indicate potential intervention points for increasing resilience and positive mental health

Traumatisme et santé mentale chez les jeunes majeurs isolés étrangers arrivés en France en tant que Mineurs Non-Accompagnés

International audienceObjectifs : La santé mentale des mineurs non accompagnés a été largement étudiée mais peu d’études se sont intéressées à leur devenir au sortir de la protection de l’enfance, souvent caractérisé par l’incertitude et l’angoisse quant à leur statut et droit de rester dans le pays d’accueil. Notre objectif était d'étudier auprès de cette population de jeunes majeurs isolés étrangers (JMIE) la prévalence des troubles psychiatriques courants à l’aide d’instruments de recherche standardisés et validés, et d’examiner les associations entre la présence de ces troubles et leur histoire traumatique.Méthodes : 110 JMIE (92,7% hommes, âge médian 19,7 ans [18,1-22,8]) de Chambéry, Montpellier et La Rochelle, ont participé à une étude transversale exploratoire. Le recrutement a été effectué par l’intermédiaire d’intervenants travaillant dans les centres d’accueil de l’Aide Sociale à l‘Enfance où ils avaient séjourné. Au cours d’un entretien en face à face, les troubles probables somatoformes, anxieux et dépressifs ont été évalués avec le Patient Health Questionnaire (PHQ ; score≥10) et le trouble de stress post-traumatique (TSPT) avec le PTSD Checklist for DSM-5 (PCL-5 ; score≥33). Les associations entre ces quatre troubles et le nombre et type d’évènements de vie traumatiques mesurés avec le Life Events Checklist (LEC-5) ont été analysées à l’aide de modèles de régression logistique, avec un seuil de significativité fixé à p≤0,0125 pour prendre en compte les comparaisons multiples.Résultats : 19,3% des JMIE présentaient des troubles somatoformes, 17,6% une anxiété, 28,7% une dépression et 20% un TSPT. Le nombre médian d’évènements traumatiques vécus personnellement sur les 15 types investigués était de 5 [min-max : 0-10]. Les plus fréquents étaient : exposition à la mort accidentelle d'un proche (67,8%), agression physique (66,1%), attaque à main armée (47,7%) et captivité (45,9%). Le nombre d'événements de vie traumatiques augmentait le risque de dépression (OR (95%CI) ajusté : 1,56 (1,25-1,96)), de TSPT (1,60 (1,23-2,08)), de troubles somatoformes (1,41 (1,10-1,82), avec, après correction pour comparaisons multiples, une tendance pour l'anxiété (1,33 (1,02-1,72)). L’agression physique était le type d’évènement associé positivement au plus grand nombre de troubles psychiatriques (p≤0,01, pour tous les troubles sauf l’anxiété), suivi par l’exposition comme témoin à mort violente (p≤0,01 pour la dépression et le TSPT) et par l’agression sexuelle (p=0,002 pour le TSPT).Conclusion : les JMIE présentaient une prévalence élevée de troubles psychiatriques, comparée à des valeurs normatives pour les catégories d’âge les plus proches. Malgré les difficultés à établir des comparaisons, les prévalences par catégorie diagnostique étaient proches de celles trouvés dans d’autres études de migrants, mineurs non accompagnés ou adultes. Nous avons mis en évidence un effet cumulatif du nombre d’évènements de vie traumatiques sur ces troubles, qui était robuste aux ajustements pour les facteurs de confusion potentiels. Nous avons aussi constaté une augmentation des troubles, en particulier le TSPT, avec des évènements de type interpersonnels (agressions) et violents. Une évaluation régulière des symptômes psychiatriques avec une prise en charge rapide et adaptée est préconisée, en vue des troubles potentiellement traumatiques vécus dans les pays d’accueil qui viendraient s’ajouter aux évènements subis avant et pendant le parcours migratoire

Abnormal reactions to environmental stress in elderly persons with anxiety disorders: Evidence from a population study of diurnal cortisol changes.

International audienceBACKGROUND: Cortisol secretion in elderly persons with anxiety disorders exposed to common stressful situations has not been evaluated. METHODS: Salivary-free cortisol levels were evaluated at 8, 15, and 22 h, in 201 elderly subjects during stressful and non-stressful days. Psychiatric symptomatology was assessed by a standardized psychiatric examination (MINI). RESULTS: Elderly subjects without psychiatric disorder showed a sustained increase in cortisol secretion several hours after the exposure to a stressful situation. In comparison, subjects with anxiety disorders showed a greater increase in cortisol secretion in the stressful situation, with lowered recuperation capacity. This effect was dose-dependent as a function of anxiety co-morbidity. Persons reporting lifetime major trauma with intrusions exhibited lowered continuous basal cortisol associated with efficient recuperation capacity. Independently of psychopathology, women appeared more reactive to stressful environmental conditions. LIMITATIONS: Exclusion of institutionalized persons and benzodiazepine users may have led to sampling of less severe anxiety symptoms. CONCLUSIONS: Dysregulation of the hypothalamic-pituitary-adrenal axis was observed in elderly persons with anxiety disorders experiencing environmental stress. A common pattern of up-regulated diurnal cortisol secretion was observed in anxious subjects with lifetime and current anxiety disorder irrespective of sub-type (generalized anxiety, phobias) suggesting a stable trait and a common "core" across disorders. Elderly persons who had experienced trauma with subsequent intrusions showed a distinct pattern with down-regulated activity