Jaworska-Andryszewska Paulina, Rybakowski Janusz
Klinika Psychiatrii Dorosłych UM w Poznaniu.
Psychiatr Pol. 2016 Oct 31;50(5):989-1000. doi: 10.12740/PP/61159.
The aim of this paper is to review the effects of negative childhood experiences on the development and course of bipolar disorder (BD) and to discuss the involved mechanisms. The negative childhood experiences that may play a role in BD are critical or traumatic events including all kinds of abuse, loss of a parent or parents resulting from death, suicide, separation, divorce or prolonged separation. Previous studies indicate that in BD patients negative childhood events are more frequent than in control group. In BD patients these events are associated with an earlier onset and more severe course of the illness, including more frequent relapses, suicidal behavior, substance abuse and somatic diseases. This paper presents the possibility of the specific impact of individual events on the clinical outcome of BD. Mechanisms explaining the impact of negative childhood events on the development and course of BD include the interaction between biological predisposition and stress factors, the concept of kindling and activation of negative cognitive schemas. Early negative experiences cause a modification of the expression of the mediators of stress and neurotransmitters in certain areas of the brain. The interaction of these mediators with the development of neural networks may lead to long-lasting structural and functional changes. Molecular genetic studies indicate the possibility of interactions between environmental factors (stress) and the polymorphisms of serotonin transporter, brain-derived neurotrophic factor (BDNF) and toll-like receptor (TLR2). It has also been hypothesized that childhood experiences affect DNA methylation, acting as a form of molecular memory and modifying brain activity over the next decade.
本文旨在综述童年负面经历对双相情感障碍（BD）发展及病程的影响，并探讨其中涉及的机制。可能在双相情感障碍中起作用的童年负面经历是重大或创伤性事件，包括各种虐待、因死亡、自杀、分居、离婚或长期分离导致的父母一方或双方丧失。先前的研究表明，双相情感障碍患者童年负面事件的发生频率高于对照组。在双相情感障碍患者中，这些事件与疾病的更早发病和更严重病程相关，包括更频繁的复发、自杀行为、物质滥用和躯体疾病。本文阐述了个体事件对双相情感障碍临床结局产生特定影响的可能性。解释童年负面事件对双相情感障碍发展及病程影响的机制包括生物易感性与应激因素之间的相互作用、点燃效应以及负面认知模式的激活。早期负面经历会导致大脑某些区域应激介质和神经递质表达的改变。这些介质与神经网络发育的相互作用可能导致长期的结构和功能变化。分子遗传学研究表明，环境因素（应激）与血清素转运体、脑源性神经营养因子（BDNF）和Toll样受体（TLR2）的多态性之间可能存在相互作用。也有人推测，童年经历会影响DNA甲基化，作为一种分子记忆形式，并在未来十年改变大脑活动。
