Can the effects of maternal depression upon offspring development be extrapolated to the prebirth environment, making it the earliest of adverse life events? Increasing clinical and laboratory data indicate that maternal stress and depression during critical developmental windows carry a diverse array of harmful sequelae for the offspring. The effects witnessed in animal research include neurobiological and behavioral alterations that persist into adulthood. Paralleling the preclinical literature are human studies indicating similar acute effects. The clinical implications for the psychiatric treatment of depressed women who have children will be discussed.
{"title":"Maternal depression: a child's first adverse life event.","authors":"D. Newport, M. Wilcox, Z. Stowe","doi":"10.1053/SCNP.2002.31789","DOIUrl":"https://doi.org/10.1053/SCNP.2002.31789","url":null,"abstract":"Can the effects of maternal depression upon offspring development be extrapolated to the prebirth environment, making it the earliest of adverse life events? Increasing clinical and laboratory data indicate that maternal stress and depression during critical developmental windows carry a diverse array of harmful sequelae for the offspring. The effects witnessed in animal research include neurobiological and behavioral alterations that persist into adulthood. Paralleling the preclinical literature are human studies indicating similar acute effects. The clinical implications for the psychiatric treatment of depressed women who have children will be discussed.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 2 1","pages":"113-9"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58317995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Basic and clinical research documents associations between stress and a set of related psychobiologic perturbations, including dysfunction of the hypothalamic-pituitary-adrenal axis, alterations in the structure and function of the medial temporal lobe, and impairments in explicit memory. Although these associations are thought to emerge developmentally, insufficient clinical research elucidates the manner in which early trauma relates to these abnormalities. To gain a better understanding of relevant processes, we propose the use of a developmental and neurobiological approach, where data in animal models are used to inform studies in traumatized children who will be followed longitudinally. This approach will help clarify how early traumatic events have the capacity to lead to psychopathology or a healthy outcome.
{"title":"A developmental and neurobiological approach to early trauma research.","authors":"Christopher S. Monk, D. Pine, D. Charney","doi":"10.1053/SCNP.2002.31793","DOIUrl":"https://doi.org/10.1053/SCNP.2002.31793","url":null,"abstract":"Basic and clinical research documents associations between stress and a set of related psychobiologic perturbations, including dysfunction of the hypothalamic-pituitary-adrenal axis, alterations in the structure and function of the medial temporal lobe, and impairments in explicit memory. Although these associations are thought to emerge developmentally, insufficient clinical research elucidates the manner in which early trauma relates to these abnormalities. To gain a better understanding of relevant processes, we propose the use of a developmental and neurobiological approach, where data in animal models are used to inform studies in traumatized children who will be followed longitudinally. This approach will help clarify how early traumatic events have the capacity to lead to psychopathology or a healthy outcome.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 2 1","pages":"137-46"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58318244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A review dealing with the epidemiology of traumatic experiences in childhood and adolescence will be of limited use without some attention being devoted to various demanding issues of measurement that are involved. The relevant literature on such experience is now large, with most research based on the use of standardized questionnaires. Although this has by and large been good enough to open up the field as a research enterprise, the task of establishing causal mechanisms in areas such as psychopathology is unlikely to flourish without a much greater investment in interview-based instruments using investigator-based ratings. Here research on the causative role of life events in general in the onset and course of psychiatric and physical disorder in both childhood and adulthood has a good deal to offer. Within the context of this emphasis on the importance of measurement various issues are discussed, such as the need to take account of nonabusive experience, particularly of correlated experiences such as parental neglect, the importance of obtaining time-based data and the need to take a population perspective where issues of prevalence are concerned.
{"title":"Measurement and the epidemiology of childhood trauma.","authors":"George W. Brown","doi":"10.1053/SCNP.2002.31775","DOIUrl":"https://doi.org/10.1053/SCNP.2002.31775","url":null,"abstract":"A review dealing with the epidemiology of traumatic experiences in childhood and adolescence will be of limited use without some attention being devoted to various demanding issues of measurement that are involved. The relevant literature on such experience is now large, with most research based on the use of standardized questionnaires. Although this has by and large been good enough to open up the field as a research enterprise, the task of establishing causal mechanisms in areas such as psychopathology is unlikely to flourish without a much greater investment in interview-based instruments using investigator-based ratings. Here research on the causative role of life events in general in the onset and course of psychiatric and physical disorder in both childhood and adulthood has a good deal to offer. Within the context of this emphasis on the importance of measurement various issues are discussed, such as the need to take account of nonabusive experience, particularly of correlated experiences such as parental neglect, the importance of obtaining time-based data and the need to take a population perspective where issues of prevalence are concerned.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 2 1","pages":"66-79"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58317945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Numerous studies have shown that early life stress in nonhuman primates produces profound and long-lasting changes in behavior and biological function. We review several aspects of the neurobiology of early life stress, focusing on nonhuman primate experimental paradigms. There is experimental evidence that even prenatal stress can produce profound alterations in biological factors such as regulation of the hypothalamic-pituitary-adrenal (HPA) axis, biogenic amines, and immune function, as well as in behavioral measures of attention and sociability. An ongoing struggle in research studies is defining the relative contributions of nature and nurture in mediating the long-term effects of stress. Studies of social support contend that this has the capacity to buffer the deleterious effects of stressful early rearing environments, whereas social deprivations appear to have negative behavioral and medical outcomes, most notably deficits in immune function. From studies involving variable foraging demand (VFD)-reared nonhuman primates and other models, we suggest that many of the behavioral and biochemical changes produced resemble those seen in humans who suffer from depressive and anxiety conditions. Finally, there appears to be remarkable consistency of key neurobiological findings across species.
{"title":"Neurobiology of early life stress: nonhuman primate models.","authors":"J. Gorman, S. Mathew, J. Coplan","doi":"10.1053/SCNP.2002.31784","DOIUrl":"https://doi.org/10.1053/SCNP.2002.31784","url":null,"abstract":"Numerous studies have shown that early life stress in nonhuman primates produces profound and long-lasting changes in behavior and biological function. We review several aspects of the neurobiology of early life stress, focusing on nonhuman primate experimental paradigms. There is experimental evidence that even prenatal stress can produce profound alterations in biological factors such as regulation of the hypothalamic-pituitary-adrenal (HPA) axis, biogenic amines, and immune function, as well as in behavioral measures of attention and sociability. An ongoing struggle in research studies is defining the relative contributions of nature and nurture in mediating the long-term effects of stress. Studies of social support contend that this has the capacity to buffer the deleterious effects of stressful early rearing environments, whereas social deprivations appear to have negative behavioral and medical outcomes, most notably deficits in immune function. From studies involving variable foraging demand (VFD)-reared nonhuman primates and other models, we suggest that many of the behavioral and biochemical changes produced resemble those seen in humans who suffer from depressive and anxiety conditions. Finally, there appears to be remarkable consistency of key neurobiological findings across species.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"9 1","pages":"96-103"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58318433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This review focuses on child sexual abuse (CSA) as a prototype of childhood trauma and evaluates the evidence on psychiatric morbidity in adult survivors. An association between CSA and a wide range of psychiatric morbidity has been consistently documented in general population studies. The interpretation of this observed association is fraught with uncertainty that stems primarily from: (1) the retrospective nature of the data on CSA from adults' reports on their early experiences; (2) the adverse family context in which it occurs, which presents a major challenge for evaluating the effect of CSA per se; (3) the well documented lifetime comorbidity among psychiatric disorders, which leaves open questions about the specificity of CSA outcomes in adulthood. Twin study methods offer a solution to the problem of the familial context of CSA. Ascertainment of age of onset of adult disorders in future studies would increase the utility of findings for formulating psychological and biological causal models on the CSA-adult disorders connection. However, the retrospective nature of data on child abuse, because of legal and ethical restraints on research on children, is a formidable obstacle to advancing knowledge in this field.
{"title":"Psychiatric morbidity in adult survivors of childhood trauma.","authors":"N. Breslau","doi":"10.1053/SCNP.2002.31780","DOIUrl":"https://doi.org/10.1053/SCNP.2002.31780","url":null,"abstract":"This review focuses on child sexual abuse (CSA) as a prototype of childhood trauma and evaluates the evidence on psychiatric morbidity in adult survivors. An association between CSA and a wide range of psychiatric morbidity has been consistently documented in general population studies. The interpretation of this observed association is fraught with uncertainty that stems primarily from: (1) the retrospective nature of the data on CSA from adults' reports on their early experiences; (2) the adverse family context in which it occurs, which presents a major challenge for evaluating the effect of CSA per se; (3) the well documented lifetime comorbidity among psychiatric disorders, which leaves open questions about the specificity of CSA outcomes in adulthood. Twin study methods offer a solution to the problem of the familial context of CSA. Ascertainment of age of onset of adult disorders in future studies would increase the utility of findings for formulating psychological and biological causal models on the CSA-adult disorders connection. However, the retrospective nature of data on child abuse, because of legal and ethical restraints on research on children, is a formidable obstacle to advancing knowledge in this field.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 2 1","pages":"80-8"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58317538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Childhood abuse is a major public health problem affecting as many as a third of children in this country today at some point before their 18(th) birthday. The effects of childhood trauma on the brain are increasingly an area of interest. In trying to understand the effects of early stressors on the brain we use animal models of early stress to guide the development of hypotheses. An important potential tool in understanding the effects of abuse on the brain is neuroimaging. Neuroimaging studies in traumatized children are in a relative state of infancy. A number of methodological and ethical issues make this a difficult area for research, including problems ranging from patient motion during scanning to the ethical issues of the duty to report abuse and working with child protective services. Some studies have shown that adults abused as children have smaller volume of the hippocampus, a brain area involved in learning and memory, as measured with magnetic resonance imaging (MRI). One study in children with posttraumatic stress disorder (PTSD) did not find smaller hippocampal volume, but did find smaller brain volume and corpus callosum. Functional neuroimaging studies are consistent with alteration in function and structure of medial prefrontal cortex and hippocampus in patients with childhood sexual trauma and PTSD. These initial results suggest that childhood abuse in the setting of PTSD is associated with long-term changes in brain structure and function.
{"title":"Neuroimaging of childhood trauma.","authors":"Bremner Jd","doi":"10.1053/SCNP.2002.31787","DOIUrl":"https://doi.org/10.1053/SCNP.2002.31787","url":null,"abstract":"Childhood abuse is a major public health problem affecting as many as a third of children in this country today at some point before their 18(th) birthday. The effects of childhood trauma on the brain are increasingly an area of interest. In trying to understand the effects of early stressors on the brain we use animal models of early stress to guide the development of hypotheses. An important potential tool in understanding the effects of abuse on the brain is neuroimaging. Neuroimaging studies in traumatized children are in a relative state of infancy. A number of methodological and ethical issues make this a difficult area for research, including problems ranging from patient motion during scanning to the ethical issues of the duty to report abuse and working with child protective services. Some studies have shown that adults abused as children have smaller volume of the hippocampus, a brain area involved in learning and memory, as measured with magnetic resonance imaging (MRI). One study in children with posttraumatic stress disorder (PTSD) did not find smaller hippocampal volume, but did find smaller brain volume and corpus callosum. Functional neuroimaging studies are consistent with alteration in function and structure of medial prefrontal cortex and hippocampus in patients with childhood sexual trauma and PTSD. These initial results suggest that childhood abuse in the setting of PTSD is associated with long-term changes in brain structure and function.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 1","pages":"104-112"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58317980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The development and evaluation of psychotherapeutic approaches for survivors of childhood trauma has been complicated by numerous conceptual and methodological challenges. Randomized controlled clinical trials are rare, and most of these test cognitive behavioral therapy with sexually abused children. This article reviews psychosocial (nonpharmacological) treatment approaches with child and adult survivors of childhood trauma, highlighting methodologically sound studies of treatment efficacy. Implications of efficacy data for clinical practice and future research are discussed.
{"title":"Psychotherapeutic approaches with survivors of childhood trauma.","authors":"M. Celano, B. Rothbaum","doi":"10.1053/SCNP.2002.31791","DOIUrl":"https://doi.org/10.1053/SCNP.2002.31791","url":null,"abstract":"The development and evaluation of psychotherapeutic approaches for survivors of childhood trauma has been complicated by numerous conceptual and methodological challenges. Randomized controlled clinical trials are rare, and most of these test cognitive behavioral therapy with sexually abused children. This article reviews psychosocial (nonpharmacological) treatment approaches with child and adult survivors of childhood trauma, highlighting methodologically sound studies of treatment efficacy. Implications of efficacy data for clinical practice and future research are discussed.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 2 1","pages":"120-8"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58318071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A burgeoning number of clinical studies have evaluated the immediate and long-term neurobiological effects of early developmental stress, eg, child abuse and neglect or parental loss, in the past years. This review summarizes and discusses the available findings from neuroendocrine (hypothalamic-pituitary-adrenal axis, other neuroendocrine axes), neurochemical (catecholamines, serotonin, other neurotransmitters), psychophysiological (autonomic function, startle reactivity, brain electrical activity) and neuroimaging studies (brain structure, function) conducted in children or adults with a history of early life stress, with or without psychiatric disorders. Early developmental stress in humans appears to be associated with neurobiological alterations that are similar to many findings in animal models of early life stress, and likely represent the biological basis of an enhanced risk for psychopathology. Clinical studies are now beginning to explore potentially differential neurobiological effects of different types of early life stress and the existence of critical developmental periods, which may be sensitive to the neurobiological effects of specific stressors. In addition, the role of a multitude of moderating and mediating factors in the determination of individual vulnerability or resilience to the neurobiological effects of early life stress should be addressed. Findings from such studies may ultimately help to prevent the deleterious neurobiological and psychopathological consequences in the unacceptably high number of children exposed to early life stress in modern society.
{"title":"Neurobiology of early life stress: clinical studies.","authors":"C. Heim, C. Nemeroff","doi":"10.1053/SCNP.2002.33127","DOIUrl":"https://doi.org/10.1053/SCNP.2002.33127","url":null,"abstract":"A burgeoning number of clinical studies have evaluated the immediate and long-term neurobiological effects of early developmental stress, eg, child abuse and neglect or parental loss, in the past years. This review summarizes and discusses the available findings from neuroendocrine (hypothalamic-pituitary-adrenal axis, other neuroendocrine axes), neurochemical (catecholamines, serotonin, other neurotransmitters), psychophysiological (autonomic function, startle reactivity, brain electrical activity) and neuroimaging studies (brain structure, function) conducted in children or adults with a history of early life stress, with or without psychiatric disorders. Early developmental stress in humans appears to be associated with neurobiological alterations that are similar to many findings in animal models of early life stress, and likely represent the biological basis of an enhanced risk for psychopathology. Clinical studies are now beginning to explore potentially differential neurobiological effects of different types of early life stress and the existence of critical developmental periods, which may be sensitive to the neurobiological effects of specific stressors. In addition, the role of a multitude of moderating and mediating factors in the determination of individual vulnerability or resilience to the neurobiological effects of early life stress should be addressed. Findings from such studies may ultimately help to prevent the deleterious neurobiological and psychopathological consequences in the unacceptably high number of children exposed to early life stress in modern society.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 2 1","pages":"147-59"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58318310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Research over the past decade and a half has established the efficacy of pharmacotherapy as an important adjunctive treatment for trauma in conjunction with either cognitive behavior therapy or psychoanalytic psychotherapy. Medication is often effective in reducing post-traumatic stress symptoms as well as treating a number of commonly comorbid conditions such as depressive and anxiety disorders. The current medications of choice are the selective serotonin reuptake inhibitors (SSRI), which are beneficial for posttraumatic reexperiencing, hyperarousal, and avoidant symptoms. Other medication classes including non-SSRI antidepressants, mood stabilizers, anticonvulsants, and anti-adrenergic agents have shown efficacy for some trauma symptoms. Because beneficial responses may be slow to appear, pharmacotherapy of trauma requires a medication trial of adequate length and dose to determine effectiveness. Partial responders may require the addition of a second class of medication. Positive responders should be maintained on medication for at least 6 months after remission of acute PTSD and at least 12 months after remission of chronic PTSD. The initial successes of pharmacotherapy for trauma are spurring further research and more effective medications can be anticipated in the foreseeable future.
{"title":"Pharmacotherapy for survivors of childhood trauma.","authors":"F. Putnam, Jaclyn E. Hulsmann","doi":"10.1053/SCNP.2002.31792","DOIUrl":"https://doi.org/10.1053/SCNP.2002.31792","url":null,"abstract":"Research over the past decade and a half has established the efficacy of pharmacotherapy as an important adjunctive treatment for trauma in conjunction with either cognitive behavior therapy or psychoanalytic psychotherapy. Medication is often effective in reducing post-traumatic stress symptoms as well as treating a number of commonly comorbid conditions such as depressive and anxiety disorders. The current medications of choice are the selective serotonin reuptake inhibitors (SSRI), which are beneficial for posttraumatic reexperiencing, hyperarousal, and avoidant symptoms. Other medication classes including non-SSRI antidepressants, mood stabilizers, anticonvulsants, and anti-adrenergic agents have shown efficacy for some trauma symptoms. Because beneficial responses may be slow to appear, pharmacotherapy of trauma requires a medication trial of adequate length and dose to determine effectiveness. Partial responders may require the addition of a second class of medication. Positive responders should be maintained on medication for at least 6 months after remission of acute PTSD and at least 12 months after remission of chronic PTSD. The initial successes of pharmacotherapy for trauma are spurring further research and more effective medications can be anticipated in the foreseeable future.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 2 1","pages":"129-36"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58318209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is now clear that early experience influences the long-term development of behavioral, neuroendocrine, and cognitive systems in a number of animal species. This article examines the effects of early life stress on the development of the rodent. Postnatal maternal separation is often used as a potent early life stressor, and some of the major findings from these studies are discussed. A majority of these studies have shown that early life stress can lead to a heightened stress response when maternally deprived rodents are tested as adults. The effects of early life stress on the development of brain structures involved in regulating the stress response as adults are also discussed. Finally the influence of both genetics and maternal style are mentioned in relation to their ability to alter the effects of early life stress.
{"title":"Neurobiology of early life stress: rodent studies.","authors":"D. Gutman, C. Nemeroff","doi":"10.1053/SCNP.2002.31781","DOIUrl":"https://doi.org/10.1053/SCNP.2002.31781","url":null,"abstract":"It is now clear that early experience influences the long-term development of behavioral, neuroendocrine, and cognitive systems in a number of animal species. This article examines the effects of early life stress on the development of the rodent. Postnatal maternal separation is often used as a potent early life stressor, and some of the major findings from these studies are discussed. A majority of these studies have shown that early life stress can lead to a heightened stress response when maternally deprived rodents are tested as adults. The effects of early life stress on the development of brain structures involved in regulating the stress response as adults are also discussed. Finally the influence of both genetics and maternal style are mentioned in relation to their ability to alter the effects of early life stress.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 2 1","pages":"89-95"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58318331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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