Muehlhan Markus, Höcker Anja, Höfler Michael, Wiedemann Klaus, Barnow Sven, Schäfer Ingo
Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
Department of Psychology, Faculty of Human Science, Medical School Hamburg, Hamburg, Germany.
Psychopharmacology (Berl). 2017 Jun;234(12):1901-1909. doi: 10.1007/s00213-017-4595-8. Epub 2017 Mar 18.
Alcohol-dependent (AD) patients with a history of childhood maltreatment (CM) have shown a more severe clinical profile and a higher risk of relapse than those without CM. It was hypothesized that stress responsivity plays an important role in moderating the relationship between CM and AD. Surprisingly, systematic investigations about the stress responsivity in AD patients with CM are rare.
This study compared physiological and subjective stress responses in AD patients with and without CM as well as in healthy controls with and without CM.
A total of 130 participants performed the Trier Social Stress Test (TSST). Physiological stress reactivity related to the noradrenergic system was assessed by salivary alpha-amylase (sAA) activity. Subjective ratings of anxiety, nervousness, distress, and mood were rated on visual analogue scales.
AD patients showed significantly lower stress-related sAA activity than healthy controls (p ≤ 0.024; z ≥ 1.97). A different pattern was found in the subjective ratings. In particular, anticipatory anxiety revealed a clear effect of CM (p ≤ 0.005; z ≥ 2.43) but no difference between AD patients and healthy controls (p > 0.05). After the TSST, distress ratings differed between AD patients with CM and AD patients without CM (p ≤ 0.009; z ≥ 2.61).
The discrepancy between physiological responsivity and subjective stress experiences may account for an increased inability to cope with stressful situations, which in turn might explain the enhanced risk of relapse in AD patients with a history of CM during early abstinence.
有童年期虐待（CM）史的酒精依赖（AD）患者比没有CM史的患者表现出更严重的临床特征和更高的复发风险。据推测，应激反应性在调节CM与AD之间的关系中起重要作用。令人惊讶的是，关于有CM的AD患者应激反应性的系统研究很少。
本研究比较了有和没有CM的AD患者以及有和没有CM的健康对照者的生理和主观应激反应。
共有130名参与者进行了特里尔社会应激测试（TSST）。通过唾液α-淀粉酶（sAA）活性评估与去甲肾上腺素能系统相关的生理应激反应性。焦虑、紧张、痛苦和情绪的主观评分采用视觉模拟量表进行评定。
AD患者的应激相关sAA活性显著低于健康对照者（p≤0.024；z≥1.97）。主观评分中发现了不同的模式。特别是，预期焦虑显示出CM的明显影响（p≤0.005；z≥2.43），但AD患者与健康对照者之间没有差异（p>0.05）。TSST后，有CM的AD患者和没有CM的AD患者的痛苦评分存在差异（p≤0.009；z≥2.61）。
生理反应性与主观应激体验之间的差异可能导致应对压力情况的能力下降，这反过来可能解释了有CM史的AD患者在早期戒酒期间复发风险增加的原因。
