Psychiatry

Biography

Biography: Charles B Nemeroff

Abstract

Brain imaging, neuroendocrine and neurotransmitter studies have revealed the many long-term biological consequences of child abuse and neglect. These changes underlie the increased vulnerability to mood and anxiety disorders in adulthood. Our group and others have demonstrated a number of long term neurobiological consequences of child abuse and neglect including structural and functional brain imaging changes, neuroendocrine and immune alterations. In particular, alterations in the hypothalamic-pituitary-adrenal (HPA) axis, the major mediator of the mammalian stress response, contribute to the long standing effects of early life trauma. However, not all exposed individuals demonstrate altered HPA axis physiology, suggesting that genetic variations influence the psychiatric consequences of trauma exposure. Variants in the genes encoding the CRF R1 receptor, FKBP5, PAC1, oxytocin receptor, and others interact with adverse early environmental factors to predict risk for stress-related psychiatric disorders. Epigenetic mechanisms have now been shown to play a seminal role in mediating the effects of early life stress. These studies have suggested new molecular targets for drug development, biological risk factors, and predictors of treatment response. Patients with a history of child abuse and neglect exhibit a more severe disease course in terms of earlier age of onset and symptom severity, and exhibit a poorer treatment response to both psychopharmacological and psychotherapeutic treatments. Recognition of the biological consequences and clinical impact of trauma has critical importance for clinical service delivery, treatment research, and public health policy.