Workshop​​ 
W09 -​​ 
A Translational Approach to Understanding Childhood Maltreatment in Adult Depression: Lessons from the Canadian Biomarker Integration Network in Depression (CAN-BIND-1)​​ 

Saturday, 24 October​​ 

11:15 – 12:45 (1.5 hrs)
Trisha Chakrabarty*, MD; Kate Harkness, PhD, C Psych; Stefanie Hassel, PhD; Raymond Lam, MD, FRCPC

 

CanMEDS Roles:​​ 

  • Medical Expert​​ 

  • Scholar​​ 

  • Health Advocate​​ 

At the end of this session, participants will be able to:​​ 1) Describe the association between childhood maltreatment and clinical expression of adult major depressive disorder (MDD); 2) Describe the main structural and functional brain alterations common to childhood maltreatment and MDD, and how these might impact symptomatology; and 3) Describe the cognitive sequelae of childhood maltreatment.​​ 

Childhood maltreatment (CM) - encompassing emotional, physical, or sexual abuse - is the strongest developmental risk factor for major depressive disorder (MDD), and is associated with a more severe illness course. The mechanisms that drive the relationship of CM to MDD are complex. Findings from the Canadian Biomarker Integration Network in Depression (CAN-BIND-1) will be used to illustrate the pervasive behavioral and neurobiological impact of CM in adult MDD, and help clinicians develop an integrated understanding of this unique patient subgroup. We first review the clinical and neurobiological correlates of CM. We next describe the relationship between CM and cognition, as CM was found to be a significant contributor to cognitive dysfunction in acute and remitted MDD patients in CAN-BIND-1. We then turn to CM-associated alterations in glucocorticoid (GC) and inflammatory systems, and their impact on hippocampal neuroplasticity. We present data to test the hypothesis that CM is related to reduced hippocampal volume through increased peripheral inflammatory proteins, increased GC receptor mRNA expression, and increased expression of glucocorticoid-inducible genes. Finally, intrinsic connectivity networks (ICNs) are fundamental elements of human brain architecture and function, with alterations in resting state ICNs in both MDD patients and individuals with a history of CM observed. Our next presentation explores ICNs in MDD CAN-BIND-1 patients in relation to CM. We will end with a discussion of how these findings, in the context of the broader literature, can help develop a more nuanced understanding of MDD patients with CM and inform treatment approach.

References:

  • Nelson J, Klumparendt A, Doebler P,​​ Ehring T. Childhood maltreatment and characteristics of adult depression: A meta-analysis. Brit J Psychiatry 2017:210:96-104.

  • Cross D, Fani N, Powers A,​​ Bradley B. Neurobiological development in the context of childhood trauma. Clinical psychology: A publication of the division of clinical psychology of the American Psychological Association. 2017.

/ Virtual Conference 2020