Gerra G, Leonardi C, Cortese E, Zaimovic A, Dell'agnello G, Manfredini M, Somaini L, Petracca F, Caretti V, Raggi M A, Donnini C
UNODC, Global Challenges Section, Division for Operations, P.O. Box 500, A-1400 Vienna, Austria.
Neurosci Biobehav Rev. 2009 Apr;33(4):601-10. doi: 10.1016/j.neubiorev.2007.08.002. Epub 2007 Aug 29.
Childhood neglect and poor child-parent relationships have been reported to increase substance use disorders susceptibility. Stressful environmental factors, including emotional neglect, could affect individual personality traits and mental health, possibly inducing stable changes in hypothalamic-pituitary-adrenal (HPA) axis and brain mono-amine function, in turn involved in addictive behavior vulnerability. Therefore, we decided to investigate homovanillic (HVA) and prolactin (PRL) plasma levels, as expression of possible changes in dopamine function, ACTH and cortisol plasma levels, as measures of HPA axis function, and concomitant psychiatric symptoms profile in abstinent cocaine addicts, in relationship to their childhood history of neglect and poor parental care perception.
Fifty abstinent cocaine dependent patients, and 44 normal controls, matched for age and sex, were submitted to a detailed psychiatric assessment (DSM IV criteria). All patients and controls completed the Symptoms Check List-90 (SCL-90) and the Buss Durkee Hostility Inventory (BDHI), to evaluate psychiatric symptoms frequency and aggressiveness levels. The Childhood Experience of Care and Abuse-Questionnaire (CECA-Q) and Parental Bonding Instrument (PBI) have been used to retrospectively investigate parent-child relationships. Blood samples were collected to determine HVA, PRL, ACTH and cortisol basal plasma levels.
Cocaine addicted individuals in general showed significantly lower HVA, and higher PRL, ACTH and cortisol basal levels respect to controls. In particular, neuroendocrine changes characterized cocaine addicts with childhood history of neglect and low perception of parental care. Obsessive-compulsive, depression and aggressiveness symptoms have been found related to poor parenting, inversely associated to HVA levels and directly associated to PRL, ACTH and cortisol levels.
These findings suggest the possibility that childhood experience of neglect and poor parent-child attachment may partially contribute to a complex neurobiological derangement including HPA axis and dopamine system dysfunctions, playing a crucial role in addictive and affective disorders susceptibility.
据报道，童年期受忽视以及不良的亲子关系会增加物质使用障碍的易感性。包括情感忽视在内的压力性环境因素可能会影响个体的人格特质和心理健康，可能会引起下丘脑 - 垂体 - 肾上腺（HPA）轴和脑单胺功能的稳定变化，进而与成瘾行为易感性有关。因此，我们决定研究高香草酸（HVA）和催乳素（PRL）的血浆水平，作为多巴胺功能可能变化的指标；促肾上腺皮质激素（ACTH）和皮质醇的血浆水平，作为HPA轴功能的指标；以及戒断的可卡因成瘾者的伴随精神症状概况，与他们童年期受忽视的历史以及对父母照顾的不良感知之间的关系。
50名戒断的可卡因依赖患者和44名年龄和性别匹配的正常对照者接受了详细的精神评估（DSM-IV标准）。所有患者和对照者都完成了症状自评量表90（SCL-90）和布斯-杜克敌意量表（BDHI），以评估精神症状的频率和攻击水平。童年期关爱与虐待问卷（CECA-Q）和父母教养方式问卷（PBI）被用于回顾性调查亲子关系。采集血样以测定HVA、PRL、ACTH和皮质醇的基础血浆水平。
一般而言，可卡因成瘾个体的HVA水平显著低于对照组，而PRL、ACTH和皮质醇的基础水平高于对照组。特别是，神经内分泌变化是童年期受忽视且对父母照顾感知度低的可卡因成瘾者的特征。强迫、抑郁和攻击症状与不良养育方式有关，与HVA水平呈负相关，与PRL、ACTH和皮质醇水平呈正相关。
这些发现表明，童年期受忽视和不良亲子依恋的经历可能部分导致包括HPA轴和多巴胺系统功能障碍在内的复杂神经生物学紊乱，在成瘾和情感障碍易感性中起关键作用。
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