Eine negative Geburtserfahrung: Einfluss auf Stresshormone und depressive Symptome?

Hintergrund: Eine negative Geburtserfahrung erhöht das Risiko, eine postpartale Depression (PPD) zu entwickeln. Veränderungen der Hypothalamus-Hypophysen-Nebennieren-Achse (HHNA) werden als ein zugrundeliegender Mechanismus diskutiert. Bisher gibt es nur wenig Forschung zu dem Zusammenhang zwischen negativen Geburtserfahrungen und langfristig integrierten Glukokortikoiden. Ziel der vorliegenden Arbeit war zu untersuchen, ob objektive und subjektive Geburtserfahrungen mütterliche Glukokortikoide, gemessen anhand der Haarsegmentanalyse, vor-hersagen können. Methoden: Acht Wochen nach der Geburt wurden Haarproben von 257 Müttern entnommen, die in der prospektiven Kohortenstudie DREAMHAIR teilnahmen. Die Haar-Glukokortikoide wurden in den kopfhautnahen 2cm Haarsegmenten mittels der Flüssigchromatographie-Massenspektrometrie quantifiziert. Die analysierten Haarsträhnen spiegeln die Stresshormonkonzentrationen von der Geburt bis zu zwei Monaten nach der Entbindung wider. Die objektive und subjektive Geburtserfahrung sowie die PPD-Symptome wurden mittels etablierter Fragebögen gemessen. Ergebnisse: Die Geburtserfahrung war kein signifikanter Prädiktor für Cortisol oder Cortisone und Letztere sagten PPD-Symptome nicht signifikant vorher. Allerdings sagte eine negative objektive und subjektive Geburtserfahrung eine signifikant höhere Cortisol/Cortisone Ratio voraus und die Cortisol/Cortisone Ratio wiederum war ein signifikanter Prädiktor von PPD-Symptomen. Der Zusammenhang zwischen einer subjektiven negativen Geburtserfahrung und PPD-Symptomen wurde teilweise durch die Cortisol/Cortisone Ratio erklärt. Schlussfolgerungen: Die Ergebnisse legen nahe, dass eine negative Geburtserfahrung mit einer höheren mütterlichen Cortisol/Cortisone Ratio assoziiert ist. Insbesondere die subjektive Geburtserfahrung ist ein wesentlicher Risikofaktor für Veränderungen des Glukokortikoid-Stoffwechsels, welche wiederum PPD-Symptome vorhersagen. Unsere Studie deutet darauf hin, dass die Cortisol/Cortisone Ratio ein vielversprechender Biomarker sein könnte, um Frauen mit einem erhöhten Risiko für die Entwicklung einer PPD zu identifizieren.:Theoretischer Hintergrund Methoden Diskussio

Is physiological glucocorticoid replacement important in children?

Cortisol has a distinct circadian rhythm with low concentrations at night, rising in the early hours of the morning, peaking on waking and declining over the day to low concentrations in the evening. Loss of this circadian rhythm, as seen in jetlag and shift work, is associated with fatigue in the short term and diabetes and obesity in the medium to long term. Patients with adrenal insufficiency on current glucocorticoid replacement with hydrocortisone have unphysiological cortisol concentrations being low on waking and high after each dose of hydrocortisone. Patients with adrenal insufficiency complain of fatigue, a poor quality of life and there is evidence of poor health outcomes including obesity potentially related to glucocorticoid replacement. New technologies are being developed that deliver more physiological glucocorticoid replacement including hydrocortisone by subcutaneous pump, Plenadren, a once-daily modified-release hydrocortisone and Chronocort, a delayed and sustained absorption hydrocortisone formulation that replicates the overnight profile of cortisol. In this review, we summarise the evidence regarding physiological glucocorticoid replacement with a focus on relevance to paediatrics

Conceptual Analysis: A Social Neuroscience Approach to Interpersonal Interaction in the Context of Disruption and Disorganization of Attachment (NAMDA)

Humans are strongly dependent upon social resources for allostasis and emotion regulation. This applies especially to early childhood because humans – as an altricial species – have a prolonged period of dependency on support and input from caregivers who typically act as sources of co-regulation. Accordingly, attachment theory proposes that the history and quality of early interactions with primary caregivers shape children’s internal working models of attachment. In turn, these attachment models guide behavior, initially with the set goal of maintaining proximity to caregivers, but eventually paving the way to more generalized mental representations of self and others. Mounting evidence in nonclinical populations suggests that these mental representations coincide with differential patterns of neural structure, function, and connectivity in a range of brain regions previously associated with emotional and cognitive capacities. What is currently lacking, however, is an evidence-based account of how early adverse attachment-related experiences and/or the emergence of attachment disorganization impact the developing brain. While work on early childhood adversities offers important insights, we propose that how these events become biologically embedded crucially hinges on the context of the child-caregiver attachment relationships in which the events take place. Our selective review distinguishes between direct social neuroscience research on disorganized attachment and indirect maltreatment-related research, converging on aberrant functioning in neurobiological systems subserving aversion, approach, emotion regulation, and mental state processing in the wake of severe attachment disruption. To account for heterogeneity of findings, we propose two distinct neurobiological phenotypes characterized by hyper- and hypo-arousal primarily deriving from the caregiver serving either as a threatening or as an insufficient source of co-regulation, respectively

Hydrocortisone as an adjunct to brief cognitive-behavioural therapy for specific fear: endocrine and cognitive biomarkers as predictors of symptom improvement

Background: Glucocorticoid (GC) administration prior to exposure-based cognitive-behavioural therapy (CBT) has emerged as a promising approach to facilitate treatment outcome in anxiety disorders. Further components relevant for improved CBT efficacy include raised endogenous GCs and reductions in information-processing biases to threat. Aims: To investigate hydrocortisone as an adjunct to CBT for spider fear and the modulating role of threat bias change and endogenous short-term and long-term GCs for treatment response. Methods: Spider-fearful individuals were randomized to receiving either 20 mg of hydrocortisone (n = 17) or placebo (n = 16) one hour prior to single-session predominantly computerised exposure-based CBT. Spider fear was assessed using self-report and behavioural approach measures at baseline, 1-day and 1-month follow-up. Threat processing was assessed at baseline and 1-day follow-up. Cortisol and cortisone were analysed from hair and saliva samples at baseline. Results/outcomes: Self-report, behavioural and threat processing indices improved following CBT. Hydrocortisone augmentation resulted in greater improvement of self-report spider fear and stronger increase in speed when approaching a spider, but not on threat bias. Neither threat bias nor endogenous GCs predicted symptom change, and no interactive effects with hydrocortisone emerged. Preliminary evidence indicated higher hair cortisone as predictor of a stronger threat bias reduction. Conclusions/interpretation: Our data extend earlier findings by suggesting that GC administration boosts the success of exposure therapy for specific fear even with a low-level therapist involvement. Future studies corroborating our result of a predictive hair GC relationship with threat bias change in larger clinical samples are needed

Hair cortisol and cognitive performance in working age adults

It has been hypothesized that prolonged exposure to high cortisol levels results in cognitive impairment. However, previous research into the relationship between cortisol and cognition has produced mixed results, most likely due to difficulties achieving valid estimates of long-term cortisol exposure based on salivary or plasma cortisol assessments at a single time point. Furthermore, there has been little research on the cognitive effects of long-term cortisol exposure in working-age adults. In the present study, hair samples were collected from 246 nurses (89.8% female) aged from 21 to 62 (M = 42.0, SD = 11.2). Hair cortisol concentrations (HCC) in the proximal 3-cm hair segment were analyzed providing an estimate of integrated cortisol secretion over the 3 month-period prior to hair sampling. Cognition was measured using a battery of 15 neuropsychological tests, measuring core dimensions of memory, inductive reasoning, processing speed, crystalized intelligence and major aspects of executive functioning. HCC was not significantly related to any of the cognitive abilities measured, either before or after controlling for potential moderators such as age, sex, education, health, well-being, work ability and burnout. Tests for nonlinear relationships also yielded non-significant results. Thus, despite the study being well powered, long term cortisol exposure did not appear to be related to cognitive performance in this sample of working-age adults, suggesting that long term cortisol exposure may be less relevant to cognition in younger and middle-aged adults than was previously thought

Predictors of Hair Cortisol Levels.

<p>Results of the conditioned random forest regression as well as scatterplots for each important variable. Hair cortisol levels are displayed in original units (in pg/mg). Filled circles = patient group member. CAPS = Clinician-Administered PTSD Scale.</p

Schematic Description of the Interview Design.

<p>Schematic Description of the Interview Design.</p