L8 - Environment and Mental Health

Question 1

What does FAS stand for?

Answer 1

Foetal alcohol syndrome

Question 2

What are the 4 features of FAS?

Answer 2

• exposure to alcohol during pregnancy
• craniofacial abnormalities
• growth retardation (shorter, slower growth)
• central nervous dysfunction (learning disabilities and low IQ)

Question 3

What are some examples of craniofacial abnormalities in FAS?

Answer 3

• small head/eye openings
• flat upper part of the nose
• short nose
• thin upper lip
• smooth area between nose and upper lip

Question 4

What are the instances of adverse life outcomes in FAS, found by Striessguth, (2004)?

Answer 4

• 61% had disrupted school experiences
• 60% juvenile delinquents
• 50% confinement (detention, jail, or a psychiatric inpatient setting)
• 49% inappropriate sexual behaviours on repeated occasions
• 35% drug/alcohol problems

Question 5

What does FAE stand for?

Answer 5

Fetal alcohol effects

Question 6

What did Fast et al., (1999) find about the prevalence of FAS or FAE in a youth forensic psychiatric service?

Answer 6

1% had FAS

22.3% had FAE

Question 7

What did Lancet’s (2016) meta-analysis show about the most common disorder comorbid with FAS?

Answer 7

• The disorder with the highest prevalence of FAS was CD (90%)
  Supports link between exposure to alcohol during pregnancy and developing antisocial behaviour later on.

Question 8

According to Sowell et al., (2008), what could be the mechanisms between FAS and ASVB outcomes?

Answer 8

Exposure to alcohol leads to:

• disruption of major white matter tracts
• damage to the hippocampus (which impairs learning)
• poor executive functioning
• widespread structural and functional impairments in later childhood.

Question 9

What is one of the most robust brain abnormalities in those with CD?

Answer 9

Abnormalities with the corpus callosum

Question 10

What is the definition of maltreatment according to the WHO?

Answer 10

All forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power.

Question 11

What are the 4 forms of maltreatment according to Radford et al., (2011)?

Answer 11

• Physical abuse
• emotional abuse
• Sexual abuse
• neglect

Question 12

What is the definition of physical abuse in relation to child maltreatment?

Answer 12

Acts such as hitting, kicking, baby-shaking or other physical aggression that is likely to hurt or cause significant harm to a child.

Question 13

What is the definition of emotional abuse in relation to child maltreatment?

Answer 13

The persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development.

Question 14

What is the definition of sexual abuse in relation to child maltreatment?

Answer 14

Forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening.

Question 15

What is the definition of neglect in relation to child maltreatment?

Answer 15

A persistent failure to meet a child’s basic physical and/or developmental needs.

Question 16

What is the least prevalent form of maltreatment?

Answer 16

Sexual abuse.

Question 17

What did Radford et al., (2011) find about the percentage of children that had experienced maltreatment?

Answer 17

U11s - nearly 10% reported that they were exposed to any form of maltreatment

Adolescents - almost 20% reported maltreatment

Majority of maltreated children experienced more than one kind of abuse. All forms of abuse in childhood were generally associated with poorer mental health and elevated delinquent behaviour.

Question 18

Maltreatment significantly increases the risk of what, during adolescence and adulthood?

Answer 18

• Depression
• Anxiety disorders/PTSD
• CD
• Personality disorders
• Substance misuse

Gilbert et al., (2009)

Question 19

What percentage of our genes is expressed in the brain?

Answer 19

70%

Question 20

Describe, in general, how genetics manifests in psychiatric disorders.

Answer 20

There are no genes for psychiatric disorders; but there are certain genetic variants which add small increments of risk or vulnerability

Such genetic variants bias the functioning of several brain and hormonal circuits, which mediate the body’s response to stress.

(Plomin et al., 1994)

Question 21

Which form of aggression is most associated with child maltreatment?

Answer 21

Reactive aggression, especially in response to threat.

Question 22

The amygdala and ACC act as what, respectively, for behaviour?

Answer 22

Amygdala - accelerator

ACC - brake

Question 23

What did Meyer-Lindenberg et al., (2006) find when comparing those with MAOA-low and MAOA-high, on their activation levels in response to emotional facial stimuli?

Answer 23

Compared 100 American men with MAOA-Low and MAOA alleles on their responses to emotional facial stimuli.

• those carrying MAOA-L had heightened responses to fearful faces compared to those with MAOA-H.
• those with MAOA-L had 8% reduction in gray matter volume in the ACC, compared to MAOA-H.
• men with MAOA-L had less deactivation (higher activation) of the ACC than those with MAOA-H and responses in the subgenual ACC were lower than that of the MAOA-H group. Also had greater activation in the amygdala than the MAOA-H group.

Those with MAOA-low have a heightened response in the basic threat response system (Amygdala), and less response in the region acting as regulatory brakes on the subcortical system (subgenual ACC).

Question 24

What did Holtz et al., (2014) find about sex differences in biosocial interactions?

Answer 24

Males - MAOA-low, increasingly positive amygdala response to emotional faces with increasing childhood life stress (CLS).

Greater amygdala response, greater the reactive aggression and aggression during later life.

Females - MAOA-high, positive relationship between CLS and positive amygdala response to threatening information. Positive relationship between amygdala response and reactive aggression & aggression during later life.

Sex may be important when considering the interactions between environmental and neurobiological risk factors in predicting aggression and ASB.

Question 25

What did Pollak et al., (2009) find about the sensitivity of abused children to emotional faces?

Answer 25

measured activity as faces changed from neutral to emotional (sad, angry, fearful, etc)

Children who had been physically abused were more sensitive at recognising threat, as faces changed from neutral to angry, compared to those who had not been physically abused.

Question 26

What did Pollak et al., (2001) find using EEG to measure responses to emotional faces

Answer 26

When the target was angry faces, children with physical abuse had an increased P3b component compared to the controls. This was the only emotion for which differences were found.

Suggests that physical maltreatment increases a child’s sensitivity to social cues associated with threat in the environment - allocating more attention to stimuli that might convey threat.

Question 27

What does the P3b component index?

Answer 27

Paying attention to a specific stimulus.

Question 28

What is the evidence supporting the impact of combat exposure on amygdala activity?

Answer 28

Wingen et al., (2011):

Soldiers exposed to combat showed increase amygdala and insular responses to threatening faces, compared to soldiers who remained at base camp.

Suggests that severe and long term stress exposure sensitised amygdala and insular reactivity to biologically salient stimuli in humans.

Question 29

What is the evidence for the effect of family violence on amygdala sensitivity?

Answer 29

McCrory, De Brito et al., (2011):

Children who had been exposed to family violence reported a tendency for higher trauma symptoms, and a higher level of CP, based on parents and teacher reports.

Those exposed to family violence showed increased amygdala response to angry faces and bilaterally in the interior insula, this was found when comparing angry and calm faces, but also angry and sad faces.

This implies that the exposure to family violence may indeed increase amygdala and insula sensitivity to stimuli which convey threat.

Question 30

Heightened amygdala sensitivity to threatening stimuli demonstrates a similarity in activity patterns with what other conditions?

Answer 30

Anxiety/PTSD

Reactive aggression

Question 31

The increased responsiveness of the anterior insula and amygdala in monitoring potential threats following exposure to family violence may what?

Answer 31

• act as a latent neural risk marker for psychopathology in adolescence and adulthood
• initially manifest as conduct problems with heightened response to threat cues

Question 32

What is the evidence that those experiencing maltreatment increase in sensitivity to all emotions?

Answer 32

McCrory, De Brito et al., (2013):

Found that maltreated children showed heightened sensitivity to angry compared to neutral faces, but also to happy compared to sad faces.

The younger they were emotionally abused, and the earlier they were exposed to neglect, the higher the amygdala reactivity to angry faces in maltreated children.

Question 33

What is the evidence for GMV differences in maltreated children?

Answer 33

De Brito et al., (2013)

Maltreated children showed a reduction in GMV in the medial orbitofrontal cortex (decision making) and the left middle temporal gyrus (autobiographical memory). Extremely strong effects. These regions are associated with neural changes for PTSD and depression.

Question 34

What did Kelly et al., (2015) show about the relationship between maltreatment and OFC volume, and a third factor that could be involved?

Answer 34

Childhood maltreatment was associated with peer problems. This relationship was mediated by changes in GMV of the left OFC.

Question 35

What is the evidence for a relationship between childhood abuse and cortical thickness?

Answer 35

Busso et al., (2017):

• abuse was associated with reduced cortical thickness in medial and lateral prefrontal and temporal regions.
• reduced cortical thickness of the left and right parahippocampal gyrus was associated with increased vulnerability with antisocial behaviour 2 years after.

Question 36

What did Andersen et al., (2008) show about the sensitive period with regards to the effects of childhood abuse?

Answer 36

Those females who had been exposed to sexual abuse:

• early on (3-5 years) showed a maximum effect of abuse in the hippocampus.
• showed a maximum effect in the frontal cortex during the adolescent period (14-16 years).
• showed a maximum effect on the corpus callosum from 9-10 years.

Question 37

Which higher order social cognitive skills are frontal lobes associated with?

Answer 37

• perspective taking
• empathy
• emotion regulation
• executive function

adolescence is a period of significant plasticity when new learning can occur.

Question 38

What is the prevalence of each version of the serotonin transporter gene?

Answer 38

SS - 17%
SL - 41%
LL - 42%

Question 39

What is the version of the serotonin transporter gene which leads to increased risk of antisocial outcomes?

Answer 39

SS - short version

Question 40

What is the interaction between allele of the serotonin transporter gene and maltreatment in predicting psychiatric outcomes?

Answer 40

Short version + maltreatment leads to greater risk of depression Caspi et al., (2003) Dunedin study.

Question 41

What is the evidence showing environmental factors can buffer the risk of genetics, specifically the risky allele of the serotonin transporter gene?

Answer 41

Kaufman et al., (2004)

Under normal parenting conditions, the allele of the transporter gene does not lead to any differences in symptoms of depression.

Under maltreatment conditions, those carrying the SS allele are significantly more likely to show symptoms of depression.

• replicated in children and adults.

HOWEVER, in those who had been maltreated, and had the SS allele, those who had regular contact with a trusted adult had their risk of depression HALVED.