McCrory Eamon J, Gerin Mattia I, Viding Essi
Division of Psychology and Language Sciences, University College London, London, UK.
Anna Freud National Centre for Children and Families, London, UK.
J Child Psychol Psychiatry. 2017 Apr;58(4):338-357. doi: 10.1111/jcpp.12713. Epub 2017 Mar 13.
Childhood maltreatment is a potent predictor of poor mental health across the life span. We argue that there is a need to improve the understanding of the mechanisms that confer psychiatric vulnerability following maltreatment, if we are to progress from simply treating those with a manifest disorder, to developing effective preventative approaches that can help offset the likelihood that such disorders will emerge in the first place.
We review extant functional neuroimaging studies of children and adolescents exposed to early neglect and/or maltreatment, including physical, sexual and emotional abuse across four neurocognitive domains: threat processing, reward processing, emotion regulation and executive control. Findings are discussed in the context of 'latent vulnerability', where alterations in neurocognitive function are considered to carry adaptive value in early adverse caregiving environments but confer long-term risk.
Studies on threat processing indicate heightened as well as depressed neural responsiveness in maltreated samples, particularly in the amygdala, thought to reflect threat hypervigilance and avoidance respectively. Studies on reward processing generally report blunted neural response to anticipation and receipt of rewards, particularly in the striatum, patterns associated with depressive symptomatology. Studies on emotion regulation report increased activation of the anterior cingulate cortex (ACC) during active emotion regulation, possibly reflecting greater effortful processing. Finally, studies of executive control report increased dorsal ACC activity during error monitoring and inhibition.
An emerging body of work indicates that altered neurocognitive functioning following maltreatment: (a) is evident even in the absence of overt psychopathology; (b) is consistent with perturbations seen in individuals presenting with psychiatric disorder; (c) can predict future psychiatric symptomatology. These findings suggest that maltreatment leads to neurocognitive alterations that embed latent vulnerability to psychiatric disorder, establishing a compelling case for identifying those children at most risk and developing mechanistically informed models of preventative intervention. Such interventions should aim to offset the likelihood of any future psychiatric disorder.
童年期受虐待是一生中心理健康状况不佳的有力预测因素。我们认为，如果要从单纯治疗那些已出现明显疾病的人，转向开发有效的预防方法，以帮助降低此类疾病首先出现的可能性，就需要更好地理解虐待后导致精神疾病易感性的机制。
我们回顾了现存的关于遭受早期忽视和/或虐待的儿童和青少年的功能性神经影像学研究，这些虐待包括身体虐待、性虐待和情感虐待，涉及四个神经认知领域：威胁处理、奖励处理、情绪调节和执行控制。研究结果在“潜在易感性”的背景下进行讨论，即在早期不良照料环境中，神经认知功能的改变被认为具有适应性价值，但会带来长期风险。
关于威胁处理的研究表明，受虐待样本中的神经反应性增强和减弱，特别是在杏仁核，分别被认为反映了威胁过度警觉和回避。关于奖励处理的研究普遍报告，对奖励预期和获得的神经反应迟钝，特别是在纹状体，这种模式与抑郁症状相关。关于情绪调节的研究报告，在主动情绪调节过程中前扣带回皮质（ACC）的激活增加，这可能反映了更多的努力性加工。最后，关于执行控制的研究报告，在错误监测和抑制过程中背侧ACC活动增加。
一项新出现的研究表明，虐待后神经认知功能的改变：（a）即使在没有明显精神病理学症状的情况下也很明显；（b）与患有精神疾病的个体中观察到的扰动一致；（c）可以预测未来的精神症状。这些发现表明，虐待会导致神经认知改变，使个体对精神疾病具有潜在易感性，这为识别那些风险最高的儿童并开发基于机制的预防性干预模型提供了有力依据。此类干预应旨在降低未来患任何精神疾病的可能性。
