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1.
Addict Biol ; 25(1): e12681, 2020 01.
Article in English | MEDLINE | ID: mdl-30307081

ABSTRACT

Childhood maltreatment (CM) is a strong risk factor for alcohol dependence (AD) and is associated with a more severe course of the disease. Alterations of the hypothalamic-pituitary-adrenal (HPA) axis may play an important role in this relationship. The aim of the present study was to systematically investigate potential alterations in HPA functioning associated with AD diagnosis and CM. Four study groups were recruited: AD patients with (n = 29; 10♀) and without (n = 33; 8♀) CM and healthy controls with (n = 30; 20♀) and without (n = 38; 15♀) CM. Cumulative cortisol secretion was measured by hair cortisol concentration (HCC). To measure HPA axis response to the Trier social stress test (TSST), saliva and blood samples were analysed for adrenocorticotropic hormone (ACTH) and cortisol. In the AD groups, the period of hair growth covered acute alcohol consumption and withdrawal. The TSST was scheduled after completion of withdrawal. Irrespective of CM, higher HCCs and reduced ACTH and cortisol levels before and after TSST were observed in AD patients. The analyses did not reveal any differences between AD patients with and without CM. Healthy controls with CM had lower plasma cortisol levels compared with those without CM. The results suggest that AD is strongly related to HPA axis functioning, which may superimpose possible differences between AD patients with and without CM. Future studies should investigate whether biologically different subtypes of AD with and without CM can be identified in earlier stages or before the development of AD.


Subject(s)
Adult Survivors of Child Abuse/statistics & numerical data , Alcoholism/metabolism , Hydrocortisone/metabolism , Hypothalamo-Hypophyseal System/metabolism , Pituitary-Adrenal System/metabolism , Stress, Psychological/metabolism , Adult , Alcoholics/statistics & numerical data , Female , Hair/metabolism , Humans , Male , Middle Aged
2.
Psychopharmacology (Berl) ; 234(12): 1901-1909, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28314952

ABSTRACT

RATIONALE: Alcohol-dependent (AD) patients with a history of childhood maltreatment (CM) have shown a more severe clinical profile and a higher risk of relapse than those without CM. It was hypothesized that stress responsivity plays an important role in moderating the relationship between CM and AD. Surprisingly, systematic investigations about the stress responsivity in AD patients with CM are rare. OBJECTIVE: This study compared physiological and subjective stress responses in AD patients with and without CM as well as in healthy controls with and without CM. METHODS: A total of 130 participants performed the Trier Social Stress Test (TSST). Physiological stress reactivity related to the noradrenergic system was assessed by salivary alpha-amylase (sAA) activity. Subjective ratings of anxiety, nervousness, distress, and mood were rated on visual analogue scales. RESULTS: AD patients showed significantly lower stress-related sAA activity than healthy controls (p ≤ 0.024; z ≥ 1.97). A different pattern was found in the subjective ratings. In particular, anticipatory anxiety revealed a clear effect of CM (p ≤ 0.005; z ≥ 2.43) but no difference between AD patients and healthy controls (p > 0.05). After the TSST, distress ratings differed between AD patients with CM and AD patients without CM (p ≤ 0.009; z ≥ 2.61). CONCLUSION: The discrepancy between physiological responsivity and subjective stress experiences may account for an increased inability to cope with stressful situations, which in turn might explain the enhanced risk of relapse in AD patients with a history of CM during early abstinence.


Subject(s)
Alcoholism/enzymology , Alcoholism/psychology , Child Abuse/psychology , Salivary alpha-Amylases/metabolism , Stress, Psychological/enzymology , Stress, Psychological/psychology , Adult , Affect/physiology , Alcoholism/diagnosis , Child, Preschool , Female , Humans , Male , Middle Aged , Salivary alpha-Amylases/analysis , Stress, Physiological/physiology , Stress, Psychological/diagnosis , Surveys and Questionnaires
3.
Psychother Psychosom Med Psychol ; 67(2): 83-90, 2017 Feb.
Article in German | MEDLINE | ID: mdl-28288498

ABSTRACT

Background: History of childhood abuse and neglect is considered to be a relevant risk factor for adult psychopathology. A functional emotion regulation (ER) can account for resilience despite of traumatic experiences in childhood. Materials & Methods: This study compares the habitual use of specific ER strategies among mentally healthy individuals with (n=61) and without (n=52) experience of childhood abuse and neglect by using the self-rating instrument Heidelberg Form for Emotion Regulation Strategies (H-FERST). SCID-I, ADP-IV, SCL-27, and BDI-II were used for assessment of psychopathological distress. Results: We found no group difference in the habitual use of ER strategies. Healthy individuals with childhood abuse and neglect showed significantly more subjective distress symptoms. Discussion & Conclusion: Considering the significantly higher psychopathological distress reported by the trauma group, the functional habitual use of ER strategies could serve as a path to explain the resilient development of adult individuals after childhood abuse and neglect.


Subject(s)
Adult Survivors of Child Abuse/psychology , Emotional Adjustment , Mental Disorders/psychology , Resilience, Psychological , Stress Disorders, Post-Traumatic/psychology , Adolescent , Adult , Child , Defense Mechanisms , Female , Humans , Male , Mental Disorders/diagnosis , Middle Aged , Psychometrics , Psychopathology , Stress Disorders, Post-Traumatic/diagnosis , Surveys and Questionnaires
4.
Dev Psychopathol ; 29(3): 737-749, 2017 08.
Article in English | MEDLINE | ID: mdl-27292103

ABSTRACT

Childhood abuse and neglect (CAN) is considered as a risk factor for substance use disorder (SUD). Based on the drinking to cope model, this study investigated the association of two trauma-relevant emotions (shame and sadness) and substance use. Using ecological momentary assessment we compared real-time emotion regulation in situations with high and low intensity of shame and sadness in currently abstinent patients with CAN and lifetime SUD (traumaSUD group), healthy controls with CAN (traumaHC group), and without CAN (nontraumaHC group). Multilevel analysis showed a positive linear relationship between high intensity of both emotions and substance use for all groups. The traumaSUD group showed heightened substance use in low, as well as in high, intensity of shame and sadness. In addition, we found an interaction between type of emotion, intensity, and group: the traumaHC group exhibited a fourfold increased risk for substance use in high intense shame situations relative to the traumaSUD group. Our findings provide evidence for the drinking to cope model. The traumaSUD group showed a reduced distress tolerance for variable intensity of negative emotions. The differential effect of intense shame for the traumaHC group emphazises its potential role in the development of SUD following CAN. In addition, shame can be considered a relevant focus for therapeutic preinterventions and interventions for SUD after CAN.


Subject(s)
Adult Survivors of Child Abuse/psychology , Emotions/physiology , Shame , Substance-Related Disorders/psychology , Adult , Ecological Momentary Assessment , Female , Humans , Male , Middle Aged , Risk Factors , Young Adult
5.
Eur Addict Res ; 22(6): 292-300, 2016.
Article in English | MEDLINE | ID: mdl-27438781

ABSTRACT

BACKGROUND/AIMS: Maltreatment in childhood and adolescence is a risk factor for substance use disorders (SUDs) in adulthood. This association has rarely been investigated in the light of emotion dysregulation. To fill this gap, this study examines emotion dysregulation and SUDs among adults with a history of early maltreatment. METHODS: Comparison of emotion dysregulation in adults with a history of early abuse and neglect who developed either an SUD (n = 105) or no mental disorder (n = 54). Further, a mediation model for the association between the severity of early maltreatment and SUDs was tested. Participants completed research diagnostic interviews for psychopathology, the Difficulties in Emotion Regulation Scale, and the Childhood Trauma Questionnaire. RESULTS: By using hierarchical regression techniques and mediational analyses controlling for age and gender, it was possible to provide evidence for the mediating role of emotion dysregulation between early emotional and physical maltreatment and later SUDs. CONCLUSIONS: Emotion dysregulation is a potential mechanism underlying the relationship between early emotional and physical maltreatment and the development of SUDs. In light of these findings, focusing on the early training of adaptive emotion regulation strategies after childhood maltreatment might be of considerable relevance to prevent the development of SUDs.


Subject(s)
Affective Symptoms/epidemiology , Affective Symptoms/psychology , Child Abuse/psychology , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychology , Surveys and Questionnaires , Adult , Affective Symptoms/diagnosis , Child , Emotions , Female , Germany/epidemiology , Humans , Male , Middle Aged , Substance-Related Disorders/diagnosis , Time Factors , Young Adult
6.
Psychother Psychosom Med Psychol ; 62(5): 185-94, 2012 May.
Article in German | MEDLINE | ID: mdl-22565336

ABSTRACT

Supportive care needs of family members of cancer patients are often overlooked within psychosocial care. A screening measure was sent to 132 family members and 362 cancer patients (response rate > 95 %) after telephone registration at a specialized outpatient clinic for psycho-oncology at the University Medical Center Hamburg-Eppendorf. The majority of participants was informed about the outpatient clinic for psycho-oncology through advice by third parties. More than 90 % of family members and cancer patients show high levels of distress; 49 % of family members and 59 % of patients had moderate to high levels of depression; 58 % of family members and 61 % of patients had moderate to high levels of anxiety. No gender differences were observed in both groups. Most frequent supportive care needs in both groups refer to fear of recurrence, dealing with uncertainty, sadness and keeping a positive outlook. Our findings emphasize the need for specific psycho-oncological interventions.


Subject(s)
Ambulatory Care/methods , Family/psychology , Neoplasms/psychology , Neoplasms/therapy , Social Support , Stress, Psychological/psychology , Stress, Psychological/therapy , Adult , Aged , Aged, 80 and over , Anxiety/epidemiology , Anxiety/psychology , Depression/epidemiology , Depression/psychology , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Patients/psychology , Sex Factors , Stress, Psychological/epidemiology , Young Adult
7.
J Pain Symptom Manage ; 42(5): 768-76, 2011 Nov.
Article in English | MEDLINE | ID: mdl-21592722

ABSTRACT

CONTEXT: The concept of demoralization has been widely used to describe states of existential distress and a self-perceived incapacity to deal effectively with a specific stressful situation. OBJECTIVES: To evaluate the psychometric properties of the German adaptation of the Demoralization Scale (DS) in patients with advanced cancer. METHODS: Participants with heterogeneous tumor sites were recruited in several treatment and rehabilitation facilities. Concurrent and divergent validity of the DS was analyzed through associations with and group differences between measures of distress, depression, anxiety, and meaning-related life attitudes. RESULTS: From a total sample of 1102 patients, 516 individuals (45%) with advanced cancer were enrolled (male 53%, median age 58 years [range 18-88], breast cancer 21%, prostate cancer 17%). The total mean score of the DS was 29.8 (SD=10.41). Four factors were extracted by exploratory factor analysis, which accounted for 59% of the variation (Cronbach α=0.84): loss of meaning and purpose (α=0.88), disheartenment (α=0.88), dysphoria (α=0.80), and sense of failure (α=0.76). DS dimensions shared between 12% and 62% of the variance. Demoralization was significantly associated with anxiety (r=0.71), depression (r=0.61), and distress (r=0.42). Fifty-seven percent of patients had high distress, 24% depression, and 11% high anxiety. According to different cutoff values, between 16% and 39% were seriously demoralized and 73% had moderate levels of demoralization. Between 5% and 20% of patients were seriously demoralized but not clinically depressed; 60% of patients with moderate levels of demoralization had no depression. CONCLUSION: Results provide further evidence that the DS is a valid and reliable instrument of high clinical relevance in patients with advanced cancer.


Subject(s)
Depression/psychology , Neoplasms/psychology , Neuropsychological Tests , Adolescent , Adult , Aged , Aged, 80 and over , Depression/etiology , Factor Analysis, Statistical , Female , Germany , Humans , Language , Male , Middle Aged , Psychometrics , Reproducibility of Results , Sense of Coherence , Socioeconomic Factors , Stress, Psychological/complications , Stress, Psychological/psychology , Young Adult
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