Article 1b: The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders (Lippard & Nemeroff, 2020)

Question 1

Persistent alterations of the body due to childhood maltreatment (as a predisposition for medical and mental diseases)

Answer 1

• HPA dysregulation
• Inflammatory cytokines
• Epigenetic changes
• Biological embedding
• Negative health behaviour

Question 2

HPA dysregulation

Answer 2

Responsible for stress regulation, which can result in chronic stress, increased risk for stress-related disorder, anxiety and cardiovascular diseases.

Question 3

Inflammatory cytokines

Answer 3

Cytokines regulate the immune response. Inflammatory cytokines can contribute to disease vulnerability and a more pernicious (kwaadaardige) disease course.

Question 4

Epigenetic changes

Answer 4

Can alter gene expression without changing the DNA sequence. These changes can affect the functioning of various biological systems and increase vulnerability to disease.

Question 5

Biological embedding

Answer 5

Early adverse experiences become embedding in the body’s biological systems, leading to long-term changes in brain function, neuroendocrine responses and immune system dysfunction.

Question 6

Negative health behaviour

Answer 6

Childhood maltreatment is associated with poor mental health behaviours like smoking, drinking and unhealthy diet, which causes a predisposition to medical diseases and mood disorders.

Question 7

Substance use disorder (SUD)

Answer 7

People who experience childhood maltreatment have a higher risk of developing SUD. The trauma and stress from the maltreatment can lead to self-medication as a coping mechanism. SUD can worsen the symptoms of mood disorders and often complicates treatment (while people with a history of maltreatment often already have a bad response to treatment).

Question 8

Recommendations for treatment strategies after childhood maltreatment

Answer 8

• Integrated treatment programs: to adres the disorder itself and the co-occurring conditions (like SUD). Combination of medication, therapy and social support.
• Trauma-informed care: to ensure that treatments are sensitive to the histories of trauma patients.
• Personalised intervention: consider an individuals genetic predispositions, environmental influences and specific experiences of maltreatment.
• Supportive therapies: focus on rebuilding resilience and coping skills.