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AAPI 2003. Neurobiología en Estrés y Trauma. Dr. Enrique De Rosa Informes@consultapsi.com www.consultapsi.com www.estrestraumatico.com. Fuentes de estrés:. Gastos, la falta de dinero, la persistente recensión económica, Desocupación,

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neurobiolog a en estr s y trauma

AAPI 2003

Neurobiología en Estrés y Trauma

Dr. Enrique De Rosa

Informes@consultapsi.com

www.consultapsi.com

www.estrestraumatico.com

fuentes de estr s
Fuentes de estrés:
  • Gastos, la falta de dinero, la persistente recensión económica,
  • Desocupación,
  • Desbordes sociales, Incremento del delito, Inseguridad
  • Demandas y frustraciones de la escuela,
  • Cambios en sus cuerpos,
  • Problemas con sus amigos
  • el vivir en un ambiente/vecindario poco seguro,
  • Peleas frecuentes entre los padres
  • Separación o divorcio de sus padres,
  • Enfermedad crónica o problemas severos en la familia,
  • Muerte de un ser querido- (Hoy suicidios, víctimas v. urbana etc)
  • Mudarse o cambiar de escuela
  • Llevar a cabo demasiadas actividades o tener expectativas demasiado altas

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trauma
Trauma.

1.Lesión duradera producida por un agente mecánico, generalmente externo.

2. Choque emocional que produce un daño duradero en el inconsciente.

3. Emoción o impresión negativa, fuerte y duradera.

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espectro de las reacciones al estr s
Trastorno por estrés agudo

Psicosis reactiva breve

Trastornos disociativos

fuga disociativa

amnesia disociativa

personalidad múltiple

Trastornos conversivos

Trastornos adaptativos

Trastornos fóbicos

Trastornos depresivos

depresión reactiva

depresión postraumática

Trastorno de despersonalización

Trastornos del sueño

Trastornos por somatización

Trastornos de personalidad

borderline

antisocial

depresiva

Cambio de personalidad

catastrófica

TEENE

DESNOS (trastorno de estrés extremo no especificado)

Espectro de las reacciones al estrés

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patolog a psiqui trica postraum tica
Patología psiquiátrica postraumática
  • Trastornos de ansiedad
    • Síndrome de Stress postraumático
    • Trastorno por estrés agudo
  • Trastornos del estado de ánimo
    • Síndromes depresivos
  • Trastornos adaptativos
  • Trastornos disociativos
  • Psicosis
  • Trastornos Psiquiátricos debidos a una condición médica
    • Epilepsia
    • Demencia
    • Síndrome Postconmocional de los traumatizados de cráneo
  • Trastornos relacionados con abuso de sustancias
  • Trastornos Somatoformes
    • Dismorfofobia
    • Somatizaciones o enfermedades psicosomáticas
    • Síndromes Conversivos
ptsd s ntomas nucleares
PTSD: Síntomas nucleares

Aumento de la respuesta autónomica (H)

Reexperiencia del hecho traumático (I)

Evitamiento (A)

Anestesia efectiva

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slide7

SNV.

  • Eje Hipotálamo-Hipófisis-Suprarrenal
  • Locus Coeruleus.
  • Amígdala/hipocampo
  • Corteza prefrontal

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slide8

gustativa

auditiva

olfativa

Cortex

Pre-frontal

visual

kinestética

TÁLAMO

HIPOCAMPO

Cognitive map

Amígdala

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slide9
Prenatal stress produces learning deficits associated with an inhibition of neurogenesis in the hippocampus

Lemaire,Koehl, Le Moal & AbrousBordeaux II

Early experiences such as prenatal stress significantly influence the development of the brain and the organization of behavior. In particular, prenatal stress impairs memory processes but the mechanism for this effect is not known. Hippocampal granule neurons are generated throughout life and are involved in hippocampal-dependent learning. Here, we report that prenatal stress in rats induced lifespan reduction of neurogenesis in the dentate gyrus and produced impairment in hippocampal-related spatial tasks. Prenatal stress blocked the increase of learning-induced neurogenesis. These data strengthen pathophysiological hypotheses that propose an early neurodevelopmental origin for psychopathological vulnerabilities in aging.

slide10
TEPT

Cuadros clínicos que se estructuran

posteriormente a un trauma real o imaginario único o repetido y de alta o baja intensidad.

Es diametralmente diferente a un cuadro por estrés

La sintomatología se estructura alrededor de 3 ejes:

alerta (arousal)

evitamiento

revivir el hecho traumático

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tept en los ni os dsm iv
TEPT en los niñosDSM IV

A - Si ha vivido o presenciado, acontecimientos de muerte o amenazas para su integridad física o de su entorno

(violencia familiar, abuso sexual).

  • Pueden manifestarse con trast. Del comportamiento o agitación psicomotriz

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tept en los ni os dsm iv12
TEPT en los niñosDSM IV

B

  • El trauma es reexperimentado
    • En niños pequeños:
      • juegos y dibujos repetitivos donde aparecen temas o aspectos del trauma
      • Sueños terroríficos (pesadillas)
      • Dramatización del acontecimiento traumático
      • Malestar psicológico intenso (Llantos, temores obsesivos, fobias)
      • Quejas psicosomáticas

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tept en los ni os dsm iv13
TEPT en los niñosDSM IV

C

  • Evitación ante estímulos asociados al trauma.
    • El niño no cuenta lo sucedido
    • Evita los lugares asociados al hecho traumático
    • Temor ante el abusador
    • Sensación de desapego
    • Aislamiento
    • Incapacidad para expresar afectos
    • Sensación de culpabilidad por lo sucedido

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tept en los ni os dsm iv14
TEPT en los niñosDSM IV

D

  • Síntomas persistentes de aumento de activación ( arousal )
    • Dificultad para conciliar o mantener el sueño
    • Irritabilidad y ataques de ira
    • Menor concentración
    • Hipervigilancia
    • Respuestas exageradas de sobresalto

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tept en los ni os dsm iv15
TEPT en los niñosDSM IV

E

  • Las alteraciones se prolongan por más de 1 mes (Criterios B-C-D)

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cuadros cl nicos de estr s post traum ticos m s habituales en ni os para el dsm iv
Cuadros clínicos de estrés post traumáticos más habituales en niños para el DSM IV
  • Estrés agudo
    • Menos de 1 mes
  • TEPT
    • Más de 1 mes
  • Trastorno Disociativo

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tipos de trauma
Tipos de trauma
  • Directo
  • Indirecto
    • Presencial (violencia doméstica)
    • Ser testigo (accidente de tránsito)
    • Ser informado (relatos)
    • (virtual) imágenes por TV, PC
    • Transgeneracional
    • Vicario (“contagio del trauma”)
    • Varios: desgaste laboral en menores

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s ntomas comunes en los ni os
Síntomas comunes en los niños
  • Temores obsesivos
  • Alteraciones del sueño
  • Hipervigilancia
  • Tendencia al llanto
  • Falta de entusiasmo
  • Impulsividad
  • Agresividad excesiva
  • Conflicto con compañeros
  • Quejas psicosomáticas
  • Enfermedad o accidentes frecuentes

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abuso infantil
Abuso Infantil
  • Son fenómenos con altísima incidencia socio-cultural
  • Es un concepto que continúa en evolución según investigaciones médicas, sociológicas y psicológicas
  • Incluye negligencia, daño emocional abusos físicos, explotación y abuso sexual.
  • Es un área de abordaje escencialmente interdisciplinaria

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s ntomas de abuso infantil seg n la edad
Síntomas de abuso Infantil según la edad
  • Preescolar:
    • Ansiedad
    • Retraimiento
    • Culpabilidad
    • Quejas somáticas
    • Alteración del apetito
    • Ansiedad de separación
    • Alteraciones del sueño
    • Pesadillas
    • Hiperactividad
    • Mentiras
    • Falta de confianza
    • Fobias
    • Regresiones
    • Conocimiento sexual inapropiado para la edad
    • Agresividad
    • Ausencia de síntomas

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slide21
Edad escolar y adolescentes.
    • Ansiedad
    • Retraimiento
    • Culpabilidad
    • Quejas somáticasAlteración del apetito
    • Alteraciones del sueño
    • Enuresis encopresis
    • Pesadillas
    • Depresión
    • Fobias
    • Dificultades escolares
    • Crisis de angustia
    • Mala relación con los compañeros
    • Huida del hogar
    • Intentos de suicidio
    • Tics
    • Hostilidad y negativismo
    • Agresividad
    • Pasividad
    • Delincuencia
    • Conducta sexual
    • Obsesiones Psicosis
    • Ausencia de síntomas

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secuelas
Secuelas
  • Mayor cantidad de síntomas psiquiátricos en los adultos
  • Menor cociente intelectual a expensas del CI verbal en los test estandarizados
  • Mayor incidencia de intentos de suicidio
  • En los estudios neurocognitivos
  • Alteraciones de la memoria, sensopercepción y conducta
  • Alteraciones del eje hipotálamo-hipófiso suprarrenal-amígdalo-hipocámpico-corteza frontal contralateral.

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tipos de abuso infantil
Tipos de Abuso Infantil
  • Negligencia
  • Abuso emocional
  • Abuso físico
  • Abuso sexual

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memoria
Memoria

Áreas de importancia

Diencéfalo:

- Núcleos :

- dorsomedial

- medial

- Hipocampo

- Núcleo dentado

- Hipocampo

- Gyrus parahipocámpico

Núcleos Amígdalinos

Talámico medial

Mediales lóbulo temporal

slide31

External Medullary Lamina (EML)

  • Reticular Nucleus (R) and Zona Incerta (ZI)
  • Subthalamic Nucleus (STN)
  • Internal Capsule (IC)
  • Extreme Capsule (ExmC)
  • Claustrum (Cl)
  • External Capsule (ExlC)
  • Putamen (P)
  • Globus Pallidus (GP)
  • Optic Tract (OT)
  • Amygdala
  • Lenticular Fasciculus (LF)
  • Thalamic Fasciculus (TF, Mammillothalamic Tract (MTT)
  • Tuber cinereum (TC,)
  • Corpus Callosum (CC)
  • Lateral Ventricle (LV)
  • Fornix (F, both dorsally and ventrally)
  • Body of Caudate (C)
  • Stria Terminalis (ST)
  • Stria Medullaris Thalami (SMT)
  • Choroid Plexus forming roof of (3V)
  • Mediodorsal N (MD)
  • Lateral Dorsal N (LD)
  • Internal Medullary Lamina (IML)
  • Ventral Lateral N (VL)
  • External Medullary Lamina (EML)
  • Reticular Nucleus (R) and Zona Incerta (ZI)
slide32
Estrés:  cortisol  hipocampo(pérdida neuronal-overpruning)

Trauma  cortisol 

 aguda

 crónica

  • Sensibilidad a los receptores de glucocorticóides  atrofia hipocámpica
  • Depresión resistencia a los glucocort. No hay atrofia

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slide33
Psicofisiológicos

+++ respuesta autónoma a est.traumáticos

++ resp.est. Neutros > intens. (pérdida discriminación).

  • No habituación startle response
  • Resp. debajo umbral en + sonoros (timbre, teléfono)

Neuroanatómicos

 volumen hipocámpico

Activación áreas sensitivas y amigdala

Menor actividad de Broca

Mayor act. Hemisferio no dominante

Est., como respuesta física, emocional y no verbal

slide34
Janet 1889 - Emoción intensa disocia de la conciencia y se guarda como sensaciones . Cuando las emociones son intensas, no pueden ser integradas en una narrativa
  • Fragmentarias-
  • L'Automatisme Psychologique.

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slide35
La naturaleza disociartiva de la memoria traumática es lo que la distingue de la experoencia cotidiana

La D. En el momento del trauma se transformó en el predictor más importante de desarrollo de PTSD

slide36
Freud fijación tuviera base biológica

Introduction to Psychoanalysis and the War Neuroses

Pavlov CR. Los eventos ocurren una y otra vez ( recuerdos)

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slide37

gustativa

auditiva

olfativa

Cortex

Pre-frontal

visual

kinestética

TÁLAMO

HIPOCAMPO

Cognitive map

Amígdala

PsyGnos – Centro de Estudios y Terapias Cognitivas

slide38
Más temprano el trauma, mayor elemento disociativo, más amnesia, más temprano
  • Alteración en el proceso de plasticidad neuronal Attachment

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estr s trauma ptsd espectro cl nico
Estrés-Trauma-PTSD: Espectro clínico
  • Conjunto de Elementos y respuestas
      • Cognitivas
  • Comportamentales
    • Emocionales
  • Fisiológicos
  • Anatómicos
  • -----------------------
  • Sociales

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organizaci n de la experiencia auditiva miedo

Corteza Auditiva

Hipocampo

Tálamo auditivo

Amigdala

Organización de la experiencia auditiva Miedo

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trauma47
Trauma.
  • 1. m. Lesión duradera producida por un agente mecánico, generalmente externo.
  • 2. m. Choque emocional que produce un daño duradero en el inconsciente.
  • 3. m. Emoción o impresión negativa, fuerte y duradera.

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slide48

Sucesos Vitales

Calidad

de

Vida

Soportes

Afectivos

Vulnerabilidad

Enfermedad

Gatillador

Zukerfeld R y Zukerfeld Z. Psicoanálisis Tercera tópica y vulnerabilidad somática. Lugar 1999: 47.

slide49
Stress-induced changes in cerebral metabolites, hippocampal volume, and cell proliferation prevented by tianeptine

Boldizsár Czéh, October 2, 2001, 10.1073 /pnas.211427898

Stress-induced structural remodeling in the adult hippocampus, involving debranching and shortening of dendrites and suppression of neurogenesis, provides a cellular basis for understanding the impairment of neural plasticity in the human hippocampus in depressive illness. Accordingly, reversal of structural remodeling may be a desirable goal for antidepressant therapy. Animals were subjected to a 7-day period of psychosocial stress to elicit stress-induced endocrine and central nervous alterations before the onset of daily oral administration of tianeptine (50 mg/kg).

Chronic psychosocial stress significantly decreased in vivo concentrations of N-acetyl-aspartate ( 13%), creatine and phosphocreatine ( 15%), and choline-containing compounds ( 13%). The proliferation rate of the granule precursor cells in the dentate gyrus was reduced ( 33%). These stress effects were prevented by the simultaneous administration of tianeptine.

In stressed animals treated with tianeptine, hippocampal volume increased above the small decrease produced by stress alone. These findings provide a cellular and neurochemical basis for evaluating antidepressant treatments with regard to possible reversal of structural changes in brain that have been reported in depressive disorders.

slide50
Prenatal stress produces learning deficits associated with an inhibition of neurogenesis in the hippocampus

Lemaire,Koehl, Le Moal & AbrousBordeaux II

Early experiences such as prenatal stress significantly influence the development of the brain and the organization of behavior. In particular, prenatal stress impairs memory processes but the mechanism for this effect is not known. Hippocampal granule neurons are generated throughout life and are involved in hippocampal-dependent learning. Here, we report that prenatal stress in rats induced lifespan reduction of neurogenesis in the dentate gyrus and produced impairment in hippocampal-related spatial tasks. Prenatal stress blocked the increase of learning-induced neurogenesis. These data strengthen pathophysiological hypotheses that propose an early neurodevelopmental origin for psychopathological vulnerabilities in aging.

Red PsyGnos.net- ConsultaPsi.com

slide51
Experimental diabetes in rats causes hippocampal dendritic and synaptic reorganization and increased glucocorticoid reactivity to stress

Magariños and McEwen The Rockefeller University

Chronic stressor that produces retraction and simplification of apical dendrites of hippocampal pyramidal neurons. Diabetes also induces morphological changes in the presynaptic mossy fiber terminals that form excitatory synaptic contacts with the proximal apical dendrites. One effect, synaptic vesicle depletion, occurs in diabetes as well as after repeated stress and Cort treatment. However, diabetes produced other MFT structural changes that differ qualitatively and quantitatively from other treatments. Furthermore, whereas 7 d of repeated stress was insufficient to produce dendritic or synaptic remodeling in nondiabetic rats, it potentiated both dendritic atrophy and MFT synaptic vesicle depletion in STZ rats. These changes occurred in concert with adrenal hypertrophy and elevated basal Cort release as well as hypersensitivity and defective shutoff of Cort secretion after stress. Thus, as an endogenous stressor, STZ diabetes not only accelerates the effects of exogenous stress to alter hippocampal morphology; it also produces structural changes that overlap only partially with those produced by stress and Cort in the nondiabetic state.

adptaci n eje
Adptación-Eje

Limbic-hypothalamic-pituitary-adrenal axis in depression: literature review Twardowska K; Rybakowski JKliniki Psychiatrii Dorosych w Poznaniu. Psychiatr Pol, 1996 Sep, 30:5, 741-55Increased cortisol concentration has until now been the best documented biochemical abnormality in depression. Pathological results of the Dexamethasone Suppression Test pointing to hyperactivity of LHPA axis are found in about half of depressive patients. According to most recent research, primary disturbance of LHPA axis concerns hypothalamus and limbic system. An association was found between disturbances of LHPA axis in depression and immune system abnormalities in this illness. Disturbances of serotonergic and noradrenergic neurotransmission in depression may also partially result from LHPA axis dysfunction. Influencing LHPA axis may underlie the mechanism of new antidepressant drug, tianeptine. Recently, it was found that classical tricyclic antidepressant drugs as well as electroconvulsive may also act on LHPA in regulatory way.

adptaci n eje53
Adptación-Eje

Watanabe Y, Gould E, Daniels DC, Cameron H, McEwen BS.Laboratory of Neuroendocrinology, Rockefeller University, New York, NY 10021.Repeated 6-h daily restraint stress over 21 days reduces length and number of branch points of hippocampal CA3c pyramidal dendrites in the hippocampal formation of adult male rats. This effect is mimicked by daily injections of 40 mg/kg corticosterone. Daily treatment with tianeptine (15 mg/kg) prior to stress sessions or the corticosterone treatment prevented these effects of stress or corticosterone, respectively. Tianeptine treatment did not prevent the effects of stress to increase adrenal/body weight ratio, nor did it prevent the effects of stress to decrease body weight gain, indicating that its actions are not mediated solely by effects on stress-induced secretion of corticosterone. Because tianeptine is known to enhance neural uptake of serotonin, these results suggest that the serotonergic system may be involved in modulating stress and corticosterone effects on dendritic morphology.

adptaci n eje54
Adptación-Eje

Delbende C, Contesse V, Mocaer E, Kamoun A, Vaudry H.European Institute for Peptide Research, CNRS URA 650.The possible effect of tianeptine, a novel antidepressant agent, on the neuroendocrine response to stress was investigated in adult male rats. Tube restraint stress for 30 min induced a marked increase of plasma ACTH and corticosterone. A single i.p. injection of tianeptine (10 mg/kg), 120 min before stress caused a significant decrease of ACTH and corticosterone levels. In order to investigate the kinetics of the effect of tianeptine, the drug was injected at various times (from 15 min to 12 h) before restraint stress. The inhibitory effect of tianeptine on stress-induced elevations of plasma ACTH and corticosterone occurred from 1 to 3 h after the injection. Administration of increasing doses of tianeptine revealed that only the highest doses (10 and 20 mg/kg) had a significant effect on stress-evoked stimulation of ACTH and corticosterone secretion. These results show that the antidepressant, tianeptine, reduces the activation of the hypothalamo-pituitary-adrenal (HPA) axis induced by restraint stress. Since depressed patients generally exhibit an elevated cortisol level, the present data suggest that part of the therapeutic properties of tianeptine could be accounted for by the effect of this antidepressant to modulate the activity of the HPA axis.

slide55
Stress facilitates classical conditioning in males, but impairs classical conditioning in females through ovarian hormones

Gwendolyn E. Wood and Tracey J. Shors Princeton University

Exposure to restraint and brief intermittent tailshocks facilitates associative learning of the classical conditioned eyeblink response in male rats. Based on evidence of sex differences in learning and responses to stressful events, we investigated sexually dimorphic effects of a stressor of restraint and intermittent tailshock on classical eyeblink conditioning 24 h after stressor cessation. Our results indicate that exposure to the acute stressor had diametrically opposed effects on the rate of acquisition of the conditioned response in male vs. female rats. Exposure to the stressor facilitated acquisition of the conditioned response in males, whereas exposure to the same stressful event dramatically impaired acquisition in females. We further demonstrate that the stress-induced impairment in female conditioning is dependent on the presence of ovarian hormones. Conditioning of stressed sham-ovariectomized females was significantly impaired relative to the unstressed controls, whereas conditioning in stressed ovariectomized females was not impaired. We present additional evidence that estrogen mediates the stress-induced impairment in female acquisition. Females administered sesame oil vehicle and then stressed were significantly impaired relative to their unstressed controls, whereas females administered the estrogen antagonist tamoxifen prior to stress were not impaired. In summary, these results indicate that exposure to the same aversive event can induce opposite behavioral responses in males vs. females. These effects underscore sex differences in associative learning and emotional responding, and implicate estrogen in the underlying neuronal mechanism

referencias
Referencias
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  • Polyakova I, Knobler HY, Ambrumova A, Lerner V: Characteristics of suicidal attempts in major depression versus adjustment reactions. J Affect Disord 1998 Jan; 47(1-3): 159-67[Medline].
slide57

Preguntas ???

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