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. Presenters of this session 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.

**This content was captured at the 2019 APA Annual Meeting and may reference information from various sources and terminology from previous editions of the DSM.

Course References

• Gould, F. et al. The effects of child abuse and neglect on cognitive functioning in adulthood. J Psychiatr Res. 2012 Apr;46(4):500-6.
• Neigh, G., Gillespie, C., & Nemeroff, C. The neurobiological toll of child abuse and neglect. Trauma Violence Abuse. 2009 Oct;10(4):389-410.
• Nemeroff, C. & Binder, E. The preeminent role of childhood abuse and neglect in vulnerability to major psychiatric disorders: toward elucidating the underlying neurobiological mechanisms. J Am Acad Child Adolesc Psychiatry. 2014 Apr;53(4):395-7.

Learning Objectives

• Discuss how genetic polymorphisms and epigenetics effect psychiatric disease vulnerability
• Explain how a gene variation effects brain development and function so that the risk of a depressive episode or PTSD is increased
• Describe how early life experience produces persistent CNS alterations and its implications

Target Audience

Psychiatrists, Residents/Fellows

Estimated Time to Complete

Estimated Duration: 60 minutes
Begin Date: December 1, 2020
End Date: December 1, 2023

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit ™ or a certificate of participation may do so by completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The APA designates this enduring CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Program Presenters

• Charles B. Nemeroff, M.D., Ph.D., Chair and Professor, Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School. Disclosures - Consultant/Advisory: Bracket Pharmaceuticals, Intracellular Therapies, Janssen, Magstim, Other Navitor, Sumitomo, Sunovion Pharmaceuticals Inc., Taisho Toyama Pharmaceutical Co., Ltd., Takeda Pharmaceuticals, Xhale; Grant/Research: Other NIH, Stanley Medical Research Institute; Stock: AbbVie Pharmaceutical, Celgene Corporation, Corcept Therapeutics, Inc., Other Seattle Genetics, OPKO Health, Antares, BI Gen Holdings, Xhale

Program Planners

• Tristan Gorrindo, M.D., Director of Education, American Psychiatric Association. Reports no financial relationships with commercial interests.

Accessibility for Participants with Disabilities

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Technical Requirements

This internet-based CME activity is best experienced using any of the following:

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• Internet Explorer 11+

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