Shrivastava Amresh K, Karia Sagar B, Sonavane Sushma S, De Sousa Avinash A
Department of Psychiatry, The University of Western Ontario, Lawson Health Research Institute, London, Canada.
Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India.
Ind Psychiatry J. 2017 Jan-Jun;26(1):4-12. doi: 10.4103/ipj.ipj_38_15.
Child sexual abuse (CSA) is an important public health problem with long-standing neurobiological, developmental, and psychiatric abnormalities. The present review analyzes the long-term effects of CSA from a developmental, psychiatric morbidity, neurochemical and neurobiological perspective and then tries to posit a developmental neurobiological trajectory from CSA to the genesis of psychopathology in later life. The role of various neurotransmitters such as serotonin and dopamine affected by CSA are discussed. Serotonin abnormalities have been reported in various studies among participants exposed to CSA. Structures such as the prefrontal cortex, superior temporal gyrus, corpus callosum, parietal lobes, hippocampus, and cerebellum all demonstrate volumetric and structural changes in response to the trauma of CSA. Neurocognitive studies demonstrate memory and spatial awareness as well as decrements in general cognitive performance and memory when compared to normal individuals. The hypothalamic-pituitary-adrenal axis has also been implicated in CSA, and there is an alteration in corticotropin-releasing hormone response due to the continuous cumulative trauma of CSA. This paper also reviews a section on the role of genetic and epigenetic factors in the development of psychiatric disorders as a result of exposure to episodes of CSA where studies have demonstrated changes in DNA methylation in response to CSA. This review tries to hypothesize a developmental trajectory framework which is individual for every case where exposure to CSA may lead to psychopathology and psychiatric morbidity later in life. Rapid and emerging fields such as developmental traumatology in relation to CSA are also discussed.
儿童性虐待（CSA）是一个重要的公共卫生问题，会导致长期的神经生物学、发育和精神异常。本综述从发育、精神疾病发病率、神经化学和神经生物学角度分析了CSA的长期影响，然后试图提出一条从CSA到晚年精神病理学发生的发育神经生物学轨迹。讨论了受CSA影响的各种神经递质如血清素和多巴胺的作用。在接触CSA的参与者的各种研究中都报告了血清素异常。诸如前额叶皮层、颞上回、胼胝体、顶叶、海马体和小脑等结构在对CSA创伤的反应中均表现出体积和结构变化。神经认知研究表明，与正常个体相比，受CSA影响者存在记忆和空间意识问题，以及一般认知能力和记忆力下降。下丘脑-垂体-肾上腺轴也与CSA有关，由于CSA的持续累积创伤，促肾上腺皮质激素释放激素反应发生改变。本文还综述了遗传和表观遗传因素在因接触CSA事件而导致的精神疾病发展中的作用，研究表明DNA甲基化因CSA而发生变化。本综述试图假设一个发育轨迹框架，该框架因每个CSA案例而异，接触CSA可能导致晚年精神病理学和精神疾病发病率。还讨论了与CSA相关的快速发展的新兴领域，如发育创伤学。
