hpa axis activity in delinquent male adolescents arne popma department of child and adolescent...
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hpa axis activity hpa axis activity in delinquent male in delinquent male
adolescentsadolescents
arne popmadepartment of
child and adolescent
psychiatry vu amsterdam
outlineoutline
backgroundbackground literatureliterature
overall projectoverall project study 1study 1 study 2study 2 study 3study 3
conclusionconclusion discussiondiscussion
backgroundbackground
disruptive behaviour disorders (dbd): disruptive behaviour disorders (dbd): oppositional defiant disorder (odd)oppositional defiant disorder (odd) conduct disorder (cd)conduct disorder (cd)
- high prevalence - high prevalence - high risk for problems in adulthood- high risk for problems in adulthood - major public health problem- major public health problem
- resistant to treatment- resistant to treatment
theoretical frameworktheoretical framework
underarousalunderarousal
fearlessness sensation seekingfearlessness sensation seeking (zuckermann,1977) (raine, 1993)(zuckermann,1977) (raine, 1993)
biological parametersbiological parameters
biological parameters: the biological parameters: the ansans
autonomic nervous system activityautonomic nervous system activity in antisocial children:in antisocial children:
low basal heart rate (hr):low basal heart rate (hr): (ortiz & raine, 2004) (ortiz & raine, 2004)
smaller increase during stress:smaller increase during stress:(van goozen (van goozen al.al., 1998 & 2000), 1998 & 2000)
biological paramaters: biological paramaters: cortisolcortisol
cortisol cortisol in antisocial children:in antisocial children:
low basal cortisol (???)low basal cortisol (???) (Mc Burnett et al., 2000; Shoal et al., 2003)(Mc Burnett et al., 2000; Shoal et al., 2003)
blunted cortisol reaction during stressblunted cortisol reaction during stress (Van Goozen et al., 1998 & 2000; Moss al.,1995)(Van Goozen et al., 1998 & 2000; Moss al.,1995)
overall project: aimoverall project: aim
- non clinically referred groupnon clinically referred group- early in adolescence (follow-up)early in adolescence (follow-up)- study 1: diurnal cortisol cyclestudy 1: diurnal cortisol cycle- study 2: hpa/ans: psychosocial stress teststudy 2: hpa/ans: psychosocial stress test
- hpa/ans: frustrating stress testhpa/ans: frustrating stress test- interactions between hormones in relation to interactions between hormones in relation to
subtypes of aggressionsubtypes of aggression
overall project: study overall project: study populationpopulation
12-14 year old boys from (n = 110)12-14 year old boys from (n = 110)
delinquency diversion project (DP) in amsterdamdelinquency diversion project (DP) in amsterdam
(petty crime: shoplifting, vandalism, aggression)(petty crime: shoplifting, vandalism, aggression)
normal control boys (n = 35)normal control boys (n = 35)
matched group wise on age, ses, ethnicity, IQmatched group wise on age, ses, ethnicity, IQ
overall project: instrumentsoverall project: instruments
diagnostic interwiew schedule for diagnostic interwiew schedule for childrenchildren
child behavior checklistchild behavior checklist
wechsler intelligence scalewechsler intelligence scale
subjectssubjects
normal controls:normal controls: NCNC
diversion project without DBD:diversion project without DBD: DP-DP-
diversion project with DBD:diversion project with DBD: DP+DP+
DBD = ODD ór CDDBD = ODD ór CD
study 1: diurnal cycle of cortisol, incl. CAR
aimaim
measuring cortisol levels in saliva measuring cortisol levels in saliva
- in the first hour after waking up:in the first hour after waking up:
the cortisol awakening response (CAR)the cortisol awakening response (CAR)
- during the dayduring the day
hypotheses:hypotheses:
smaller CAR and lower cortisol levels over smaller CAR and lower cortisol levels over the day in DP+ compared to NCthe day in DP+ compared to NC
0
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14
7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00
time
co
rtis
ol (
nm
ol/l
)
NC (n = 32)
DP- (n = 61)
DP+ (n = 20)
study 1: diurnal cycle of cortisol, incl CAR
resultsresults
study 2: psychosocial stress test
aimaim
measuring salivary cortisol, HRmeasuring salivary cortisol, HR
hypotheses:hypotheses:
DP+DP+ lower basal cortisol and HR,lower basal cortisol and HR,
smaller increase cortisol and HRsmaller increase cortisol and HR
as compared with NCas compared with NC
study 2: psychosocial stress test
timeschedule timeschedule
initial resting period psychosocial stress test post-test resting period
t = -50 min t = -25 t = 0 t = 10 t = 15 t = 35 t = 55 t =75
HR and SCL saliva saliva saliva saliva saliva saliva saliva nms 1 nms nms nms nms nms nms 1 Von Zerssen negative mood scale
study 2: psychosocial stress test
salivary cortisolsalivary cortisol
0
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4
-40 -30 -20 -10 0 10 20 30 40 50 60 70 80
time
cort
iso
l (n
mo
l/l)
NC (n = 30)DP- (n = 45)DP+ (n = 21)
prepare speaking
study 2: psychosocial stress test
heartrateheartrate
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-40 -30 -20 -10 0 10 20 30 40 50 60 70 80time
hea
rtra
te (
bp
m)
NC (n = 30)
DP- (n = 49)
DP+ (n = 21)
prepare speaking
study 2: psychosocial stress test
negative affectnegative affect
0
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-40 -30 -20 -10 0 10 20 30 40 50 60 70 80
time
neg
ativ
e m
oo
d NC (n = 30)DP- (n = 50)DP+ (n = 22)
prepare speaking
study 2: psychosocial stress test
resultsresults
in resting situation:in resting situation:
no differences cortisol, HR negative mood no differences cortisol, HR negative mood
during stress:during stress:
DP+DP+ smaller increase in cortisol and HR, smaller increase in cortisol and HR, but similar increase in negative mood but similar increase in negative mood during psychosocial stressorduring psychosocial stressor
as compared with NCas compared with NC
conclusionconclusion
delinquent boys with a disruptive behavior delinquent boys with a disruptive behavior disorder show differences in cortisol levels,disorder show differences in cortisol levels,
1 in the first hours after waking up 1 in the first hours after waking up
2 during a psychosocial stressor 2 during a psychosocial stressor
as compared with normal controlsas compared with normal controls
conclusionconclusion
when studying HPA activity when studying HPA activity
in relation to disruptive behavior in relation to disruptive behavior
it is important to take into account it is important to take into account
diurnal variation diurnal variation
and basal versus stress conditionsand basal versus stress conditions
testosterone and cortisoltestosterone and cortisol
evidence from studies in animals that evidence from studies in animals that
testosterone influences HPA-functioning testosterone influences HPA-functioning
(Luine 2002)(Luine 2002)
ánd cortisol influences testosterone ánd cortisol influences testosterone
levels (Viau 2002)levels (Viau 2002)
aggressionaggression
The Buss-Durkee Hostility Inventory (BDHI; The Buss-Durkee Hostility Inventory (BDHI; Buss-Durkee and Baer 1956) Buss-Durkee and Baer 1956)
- self-report questionnaire - self-report questionnaire - translated and validated for the - translated and validated for the Netherlands by Lange et al (1995)Netherlands by Lange et al (1995)
bdhi: itemsbdhi: items
overt aggression:overt aggression: feeling angry and displaying aggression, feeling angry and displaying aggression,
often impulsive and poorly controlledoften impulsive and poorly controlled
- ”When I am angry, I slam doors” - ”When I am angry, I slam doors” - “I have known people who pushed me - “I have known people who pushed me so far that we came to blows”so far that we came to blows” - “When I really lose my temper, I am - “When I really lose my temper, I am capable of slapping someone” capable of slapping someone”
behavioral measure: behavioral measure: itemsitems
covert aggression:covert aggression: feeling angry without expressing openly, feeling angry without expressing openly,
is more hidden and controlledis more hidden and controlled
- “I am irritated a great deal more than - “I am irritated a great deal more than people are aware of”people are aware of” - “Although I don’t show it, I am - “Although I don’t show it, I am sometimes eaten up with jealousy”sometimes eaten up with jealousy” - “If I let people see the way I feel, I’d be - “If I let people see the way I feel, I’d be considered a hard person to get along considered a hard person to get along with”with”
study populationstudy population
12-14 year old boys (12-14 year old boys (n = 103; m.a.13.68 ± n = 103; m.a.13.68 ± 0.74)0.74)
from delinquency diversion project in from delinquency diversion project in amsterdamamsterdam
(petty crime: shoplifting, vandalism, (petty crime: shoplifting, vandalism, aggression)aggression)
27 participants had a DBD diagnosis (26%)27 participants had a DBD diagnosis (26%)
instrumentsinstruments
linear regression analyses were performed linear regression analyses were performed
with aggression (overt and covert aggressionwith aggression (overt and covert aggression
respectively) as dependent variable and with respectively) as dependent variable and with
testosterone, cortisol and testosterone xtestosterone, cortisol and testosterone x
cortisol as independent variablescortisol as independent variables
testosteron x cortisol > overt testosteron x cortisol > overt aggressionaggression
6
8
10
12
14
0 50 100 150 200 250
Testosterone (pmol/l)
Ove
rt A
gg
ress
ion
Cortisol 1SD below mean
Cortisol mean
Cortisol 1 SD above mean
discussiondiscussion
how to understand this interaction?how to understand this interaction?
1: cortisol related to psychosocial factors 1: cortisol related to psychosocial factors
(social withdrawal, inhibition) that (social withdrawal, inhibition) that influence influence
the testosterone-aggression relationshipthe testosterone-aggression relationship
discussiondiscussion
2: high cortisol protective against aggression2: high cortisol protective against aggression (Shirtcliff 2005)(Shirtcliff 2005)
3: cortisol directly influences effects of 3: cortisol directly influences effects of
testosterone, for example on receptor leveltestosterone, for example on receptor level (Viau 2002)(Viau 2002)
future plansfuture plans
follow up:
do HPA and ANS (re)activity predict (persistency of) disruptive behavior?
how do environmental factors (ie traumatic events) interact with these biological factors in relation to disruptive behavior?
which subtypes op disruptive behavior correlate best with HPA activity
thank you!thank you!Theo Doreleijers
Herman van Engeland
Robert Vermeiren
Lucres Jansen
Stephanie van Goozen
Wim van den Brink
Thomas Rinne
Hans Steiner
Adrian Raine