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Published Online: 20 September 2019

The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders

Abstract

A large body of evidence has demonstrated that exposure to childhood maltreatment at any stage of development can have long-lasting consequences. It is associated with a marked increase in risk for psychiatric and medical disorders. This review summarizes the literature investigating the effects of childhood maltreatment on disease vulnerability for mood disorders, specifically summarizing cross-sectional and more recent longitudinal studies demonstrating that childhood maltreatment is more prevalent and is associated with increased risk for first mood episode, episode recurrence, greater comorbidities, and increased risk for suicidal ideation and attempts in individuals with mood disorders. It summarizes the persistent alterations associated with childhood maltreatment, including alterations in the hypothalamic-pituitary-adrenal axis and inflammatory cytokines, which may contribute to disease vulnerability and a more pernicious disease course. The authors discuss several candidate genes and environmental factors (for example, substance use) that may alter disease vulnerability and illness course and neurobiological associations that may mediate these relationships following childhood maltreatment. Studies provide insight into modifiable mechanisms and provide direction to improve both treatment and prevention strategies.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 20 - 36
PubMed: 31537091

History

Received: 4 January 2019
Revision received: 4 June 2019
Accepted: 8 July 2019
Published online: 20 September 2019
Published in print: January 01, 2020

Keywords

  1. Maltreatment
  2. Depression
  3. Bipolar Disorder
  4. Posttraumatic Stress

Authors

Details

Elizabeth T.C. Lippard, Ph.D.
Department of Psychiatry, Institute of Early Life Adversity Research, and Mulva Clinic for Neuroscience, Dell Medical School, University of Texas, Austin (Lippard, Nemeroff); Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin (Lippard, Nemeroff); and Department of Psychology, University of Texas, Austin (Lippard).
Charles B. Nemeroff, M.D., Ph.D. [email protected]
Department of Psychiatry, Institute of Early Life Adversity Research, and Mulva Clinic for Neuroscience, Dell Medical School, University of Texas, Austin (Lippard, Nemeroff); Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin (Lippard, Nemeroff); and Department of Psychology, University of Texas, Austin (Lippard).

Notes

Send correspondence to Dr. Nemeroff ([email protected] ).

Funding Information

Dr. Nemeroff has served as a consultant for Bracket (Clintara), Fortress Biotech, EMA Wellness, Gerson Lehrman Group, Intra-Cellular Therapies, Janssen Research and Development, Magstim, Navitor Pharmaceuticals, Sunovion Pharmaceuticals, Taisho Pharmaceutical, Takeda, TC MSO, and Xhale; he holds stock in AbbVie, Antares, BI Gen Holdings, Celgene, Corcept Therapeutics Pharmaceuticals Company, EMA Wellness, OPKO Health, Seattle Genetics, TC MSO, Trends in Pharma Development, and Xhale; he is a member of the scientific advisory boards of the Anxiety Disorder Association of America (ADAA), the American Foundation for Suicide Prevention (AFSP), Bracket (Clintara), the Brain and Behavior Research Foundation, the Laureate Institute for Brain Research, Skyland Trail, and Xhale and on the boards of directors of ADAA, AFSP, Gratitude America, and Xhale Smart; he has had income sources or equity of $10,000 or more from American Psychiatric Publishing, Bracket (Clintara), CME Outfitters, EMA Wellness, Intra-Cellular Therapies, Magstim, Takeda, TC-MSO, and Xhale; he holds patents on a method and devices for transdermal delivery of lithium (US 6,375,990B1), a method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitter by ex vivo assay (US 7,148,027B2), and compounds, compositions, methods of synthesis, and methods of treatment (CRF receptor binding ligand) (US 8,551,996 B2). Dr. Lippard reports no financial relationships with commercial interests.

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