Publications by authors named "Anna Fuchs"

52 Publications

Early Parenting Stress Links Obstetric Complications and Child Psychopathology in Middle Childhood in an At-Risk Sample.

J Dev Behav Pediatr 2021 Apr 27. Epub 2021 Apr 27.

Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Psychology, Pennsylvania State University, University Park, PA; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Saarland, Homburg, Germany.

Objective: Obstetric complications (OCs) are adverse events during pregnancy, birth, or immediately after birth. Evidence on cumulative OC and longitudinal associations with child psychopathology is sparse. Prospective studies testing mediating pathways such as parenting stress are needed. This study aimed to investigate the impact of OC on child psychopathology in middle childhood and to highlight whether and which type of parenting stress specifically mediates this association.

Methods: We investigated n = 54 mother-child dyads from 5 months to 8 years of age. Child psychopathology at 8 years and parenting stress at 12 months were assessed using the Child Behavior Checklist (CBCL) and the Parenting Stress Index. OCs were evaluated by the Steinhausen Questionnaire and through access to official pregnancy records at the 5-month visit. Half of the mothers had experienced early-life maltreatment (ELM), assessed with the Childhood Trauma Questionnaire.

Results: There was a significant indirect effect of maternal parenting stress at 12 months mediating the association between OC and child psychopathology at 8 years (β = 0.26; p < 0.01; 95% [0.35-1.83]). A significant proportion of 35% of CBCL-variance was explained. The significant effect remained even when maternal ELM and maternal psychological distress were controlled for. On the subscale level, only the "Difficult Child" subscale was a significant mediator.

Conclusion: Our findings suggest that parenting stress should be targeted to prevent adverse effects of OC on child psychopathology. More research focusing on families subjected to OC is needed to highlight how maternal parenting stress and child regulatory functioning interact to affect child development longitudinally.
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http://dx.doi.org/10.1097/DBP.0000000000000960DOI Listing
April 2021

Individual differences in parent and child average RSA and parent psychological distress influence parent-child RSA synchrony.

Biol Psychol 2021 Mar 19;161:108077. Epub 2021 Mar 19.

Department of Psychology, Pennsylvania State University, University Park, United States.

Parent-child synchrony of respiratory sinus arrhythmia (RSA) varies by risk, but novel approaches are needed to capture individual contributions to synchrony. Multilevel state-trait modeling was applied to examine how parental psychological distress and parent and child average RSA during challenge (reflecting individual regulatory capacities) shaped RSA synchrony in mother-child (n = 71) and father-child (n = 47) interactions. RSA synchrony was curvilinear such that greater in-the-moment RSA reactivity in one partner prompted greater reactivity in the other. Higher risk (lower average RSA; higher distress) predicted in-the-moment RSA withdrawal to partner RSA changes, whereas lower risk (higher average RSA; lower distress) predicted in-the-moment RSA augmentation. In some models, one's higher average RSA prompted the partner's greater reactivity and thus synchrony when parental distress was higher. However, the presence and direction of synchrony was not consistently adaptive nor maladaptive across models, suggesting its meaning relies on theory and the parent and risk factors in question.
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http://dx.doi.org/10.1016/j.biopsycho.2021.108077DOI Listing
March 2021

Illness Anxiety Disorder: A Case Report and Brief Review of the Literature.

Cureus 2021 Jan 25;13(1):e12897. Epub 2021 Jan 25.

Critical Care Medicine, Boston Children's Hospital, Boston, USA.

Illness anxiety disorder (IAD) is defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) as the preoccupation with having or acquiring a serious illness, in the absence of somatic symptoms (or, if present, symptoms that are only mild in severity). Patients with IAD experience persistent anxiety or fear of having or acquiring a serious illness, which adversely affects their daily life. They remain unsatisfied with their physician's reassurances to the contrary, mainly because their distress is created by the anxiety of the meaning, significance, and cause of the complaints and not necessarily due to the physical presentations. IAD remains a huge burden on both the health facility and for the managing healthcare provider. In this report, we present the case of a patient with IAD, which has been managed for the past five years with recurrent visits to the physician with no resolution of signs and symptoms. Despite extensive medical workup over this period, which repeatedly showed normal test results, the patient continued to have anxiety over his ill health and complained of recurrent mild somatic symptoms. After his most recent appointment, he got very upset and booked a flight to his home country to have a second opinion to validate his illness. Physicians are encouraged to build a therapeutic alliance with patients with IAD, rather than ordering expensive or unnecessary diagnostic tests or treatment.
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http://dx.doi.org/10.7759/cureus.12897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903926PMC
January 2021

The impact of motherhood on sexuality.

Ginekol Pol 2021 ;92(1):1-6

Chair and Department of Gynecology, Obstetrics and Oncological Gynecology, School of Health Science in Katowice, Medical University of Silesia, Poland.

Objectives: Motherhood is a beautiful, extremely satisfying time ina woman's life, but also very challenging at the same time. Forty weeks of pregnancy, delivery, postpartum and breastfeeding periods affect physiological and mental functions that may unfortunately hinder women sexuality.

Material And Methods: A longitudinal study was carried out. The questionnaire was developed to include a validated tool as wells as socio-demographic and medical data. The completely self-administered questionnaire was provided to patients twice - before pregnancy and postpartum. Finally, 398 women were included in the study and filled out the survey.

Results: Pregnancy and childbirth significantly (p < 0.001) reduce female sexual activity by lowering FSFI score. A similar relationship occurs in the six domains included in the FSFI scale.The number of women who received ≤ 26 points (which may indicate sexual dysfunctions) before pregnancy is 34 (8.54%) and after giving birth it is 167 (41.96%) CONCLUSIONS: Pregnancy and childbirth significantly reduce female sexual activity by lowering FSFI score. The number of women who with sexual dysfunctions increases fivefold after giving birth, and may even reach the value of 40% of young mothers. The role of the medical personnel in maintain women's sexual health is extremely important.
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http://dx.doi.org/10.5603/GP.a2020.0162DOI Listing
January 2021

Maternal bonding impairment predicts personality disorder features in adolescence: The moderating role of child temperament and sex.

Personal Disord 2021 Feb 11. Epub 2021 Feb 11.

Research has shown associations between adverse parenting experiences and (borderline) personality disorder ([B]PD). A biopsychosocial model suggests that child characteristics and the environment interact in the development of symptoms. However, prospective data in this aspect are limited. This study focused on maternal bonding impairment (MBI; 2 weeks postpartum) and its interactions with child temperament (age 5) and child sex as predictors of BPD symptoms and general personality dysfunction in adolescence. Participants were 64 mother-child dyads from a community sample who took part in a 14-year longitudinal study. Higher MBI was a significant predictor of general personality dysfunction as defined in Criterion A of the alternative model for PD of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Interactions showed that the effect of MBI on general personality dysfunction was decreased for children higher in harm avoidance and increased for children higher in novelty seeking. There was also a negative main effect of harm avoidance on (B)PD features. Regarding BPD symptoms, the MBI × Child Sex interaction indicated differential susceptibility. Girls' but not boys' BPD symptoms were dependent on maternal bonding. Our results indicate that children at risk of developing personality pathology can be identified early in life. They stress the importance of early relationship disturbances in the development of personality pathology and refine the understanding of differential susceptibility factors in the context of MBI and PD symptom development. Our findings can be applied to target at-risk dyads for selective early prevention based on temperament and maternal bonding. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/per0000433DOI Listing
February 2021

Differences in mother-child and father-child RSA synchrony: Moderation by child self-regulation and dyadic affect.

Dev Psychobiol 2021 Jan 9. Epub 2021 Jan 9.

The Pennsylvania State University, University Park, PA, USA.

Parents and preschoolers show respiratory sinus arrhythmia (RSA) synchrony, but it is unclear how child self-regulation and the dyadic affective climate shape RSA synchrony and how synchrony differs for mothers and fathers. We examined child average RSA, externalizing problems, and dyadic positive affect as moderators of the synchrony of dynamic, within-epoch child and parent RSA reactivity during a challenging task. Mothers (N = 82) and fathers (N = 60) oversampled for familial risk participated with their 3-year-olds. For mothers, when children showed either higher externalizing or lower average RSA, negative RSA synchrony was observed as dynamic coupling of maternal RSA augmentation and child RSA withdrawal, suggesting inadequate support of the child during challenge. However, when children showed both higher externalizing and lower average RSA, indicating greater regulatory difficulties overall, positive synchrony was observed as joint RSA withdrawal. The same patterns were found for father-child RSA synchrony but instead with respect to the moderators of higher externalizing and lower dyadic positive affect. Findings suggest moderators of RSA synchrony differ by parent and shared positive affect plays a robust role in fathers' RSA reactivity and synchrony. Mothers may be more attuned to children's regulatory capacities, whereas fathers may be more influenced by the immediate behavioral context.
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http://dx.doi.org/10.1002/dev.22080DOI Listing
January 2021

Is weight just a number? Relationship between overweight, obesity and domains of sexual functioning among young women.

Ginekol Pol 2020;91(10):595-599

Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.

Objectives: Being overweight and obesity, one of the biggest health problems in developing countries, is known to affect reproductive health problems. More and more Polish women are struggling with infertility and sexual dysfunctions. Such complications are often diagnosed to be linked directly with patients' excess weight. The main objectives of the study were to assess the influence of increased BMI (≥ 25.0) on sexual activity and the prevalence of sexual dysfunctions in overweight and obese women in Upper Silesia. Additionally, the occurrence of health problems existing along with obesity was analyzed.

Material And Methods: The study was carried out at the Department of Pregnancy Pathology, Department of Woman's Health, School of Health Sciences in Katowice of Medical University of Silesia in Poland. From 526 examined patients, 38% had normal BMI (18.5-24.9), 27% were overweight (BMI 25-29.9) and 35% were obese (BMI score ≥ 30). The patients answered a completely self-administered questionnaire, which was divided into two parts. The first part consisted of general questions about the patient and her past medical history. The second part was the Polish version FSFI questionnaire. The results obtained from FSFI were analyzed using the STATISTICA program.

Results: Statistically significant (p < 0.001) reduction in the level of satisfaction was found in the group of obese women when compared to patients with BMI < 30. Also among obese patients the occurrence of sexual dysfunction (FSFI ≤ 26) was significantly increased (p < 0.05). A significantly higher number of patients from an average socio-economic situation suffered from sexual dysfunctions, when compared with patients from good a socio-economic group.

Conclusions: Obesity and being overweight lead to more frequent sexual dysfunctions, especially through prevalence of decreased level of sexual satisfaction. Sexual activity problems may be exacerbated by increased body weight in combination with its comorbidities such as insulin resistance, PCOS, obstetric difficulties and irregular menstruation. What is more, a worse socio-economic situation of women predisposes them to the occurrence of sexual dysfunctions.
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http://dx.doi.org/10.5603/GP.2020.0162DOI Listing
January 2020

Is weight just a number? Relationship between overweight, obesity and domains of sexual functioning among young women.

Ginekol Pol 2020;91(10):595-599

Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.

Objectives: Being overweight and obesity, one of the biggest health problems in developing countries, is known to affect reproductive health problems. More and more Polish women are struggling with infertility and sexual dysfunctions. Such complications are often diagnosed to be linked directly with patients' excess weight. The main objectives of the study were to assess the influence of increased BMI (≥ 25.0) on sexual activity and the prevalence of sexual dysfunctions in overweight and obese women in Upper Silesia. Additionally, the occurrence of health problems existing along with obesity was analyzed.

Material And Methods: The study was carried out at the Department of Pregnancy Pathology, Department of Woman's Health, School of Health Sciences in Katowice of Medical University of Silesia in Poland. From 526 examined patients, 38% had normal BMI (18.5-24.9), 27% were overweight (BMI 25-29.9) and 35% were obese (BMI score ≥ 30). The patients answered a completely self-administered questionnaire, which was divided into two parts. The first part consisted of general questions about the patient and her past medical history. The second part was the Polish version FSFI questionnaire. The results obtained from FSFI were analyzed using the STATISTICA program.

Results: Statistically significant (p < 0.001) reduction in the level of satisfaction was found in the group of obese women when compared to patients with BMI < 30. Also among obese patients the occurrence of sexual dysfunction (FSFI ≤ 26) was significantly increased (p < 0.05). A significantly higher number of patients from an average socio-economic situation suffered from sexual dysfunctions, when compared with patients from good a socio-economic group.

Conclusions: Obesity and being overweight lead to more frequent sexual dysfunctions, especially through prevalence of decreased level of sexual satisfaction. Sexual activity problems may be exacerbated by increased body weight in combination with its comorbidities such as insulin resistance, PCOS, obstetric difficulties and irregular menstruation. What is more, a worse socio-economic situation of women predisposes them to the occurrence of sexual dysfunctions.
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http://dx.doi.org/10.5603/GP.2020.0162DOI Listing
January 2020

The Impact of COVID-19 on Female Sexual Health.

Int J Environ Res Public Health 2020 09 30;17(19). Epub 2020 Sep 30.

Chair and Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia in Katowice, Markiefki 87, 40-211 Katowice, Poland.

Introduction: Coronavirus disease (COVID-19), announced as a pandemic by the World Health Organization, recently has dominated people's lifestyle. The impact of COVID-19 seems to be relevant to the sexual health as well.

Methods: This prospective study was conducted on two occasions involving 764 female patients between March and April 2020-before and during the time of social quarantine. The sexual function was assessed using the Polish version of the Female Sexual Function Index (FSFI). Every patient filled out the survey concerning socio-demographic characteristics as well as the influence of SARS-CoV-2 pandemic on their lives.

Results: The overall FSFI score before the pandemic was 30.1 ± 4.4 and changed to 25.8 ± 9.7 during it. Scores of every domain: desire, arousal, lubrication, orgasm, satisfaction and pain decreased as well ( < 0.001). There was statistically significant association between the workplace and the change of FSFI scores before and during COVID-19 pandemic ( < 0.01). We noticed the biggest decrease in FSFI score in the group of women who did not work at all (5.2 ± 9.9). Religion had a statistically important impact on level of anxiety ( < 0.01).

Conclusion: The main finding of our study was the influence of COVID-19 pandemic on the quality of sexual lifestyle and frequency of intercourse among Polish women.
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http://dx.doi.org/10.3390/ijerph17197152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579227PMC
September 2020

The Cycle of Abuse: Emotional Availability in Resilient and Non-Resilient Mothers with Early Life Maltreatment.

Psychopathology 2020 16;53(5-6):298-305. Epub 2020 Sep 16.

Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.

Background: Early life maltreatment (ELM) has a high risk of transmission across generations, known as "the cycle of abuse." ELM is also an important risk factor for developing mental disorders, and having a mental disorder increases the risk of child abuse. Both the abuse potential in mothers with ELM and in mothers with a history of mental disorders might be associated with a disturbed mother-child interaction.

Objective: The current study examined differences in emotional availability between mothers with a history of ELM and previous or current mental disorders (non-resilient), mothers with ELM without mental disorders (resilient), and control mothers without ELM and without mental disorders.

Methods: Thirty-three non-resilient mothers, 18 resilient mothers, and 37 control mothers and their 5- to 12-year-old children participated in a standardized mother-child interaction task. Videotaped interactions were rated by three independent, trained raters based on the Emotional Availability Scales (EA Scales) and compared between the groups.

Results: The non-resilient mothers and their children showed reduced maternal sensitivity, structuring, non-intrusiveness, non-hostility, responsiveness, and involvement compared to the resilient mothers and their children and the control mothers and their children (p = 0.006, ηp2 = 0.12). No differences on any of the EA Scales were found between resilient mothers and control mothers.

Conclusions: These deficits in mother-child interaction in non-resilient mothers might contribute to mechanisms that could explain the cycle of abuse. Interestingly, resilient mothers, who did not develop a mental disorder despite having experienced ELM, did not show these deficits. Thus, prevention programs promoting resilience might be a key to break the cycle of abuse.
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http://dx.doi.org/10.1159/000509904DOI Listing
January 2021

Recommendations of the Group of Experts of the Polish Society of Gynecologists and Obstetricians regarding abnormal uterine bleeding in adolescents.

Ginekol Pol 2020;91(8):482-487

Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Poland.

The recommendations present the current knowledge and procedures, which can be modified and changed in some cases, after careful analysis of a given clinical situation, which in the future may become the basis for their modification and updating.
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http://dx.doi.org/10.5603/GP.2020.0111DOI Listing
January 2020

Parenting and care: a complex role in the development of mental health.

Eur Child Adolesc Psychiatry 2020 09;29(9):1171-1173

Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.

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http://dx.doi.org/10.1007/s00787-020-01633-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497360PMC
September 2020

Hair cortisol moderates the association between obstetric complications and child wellbeing.

Psychoneuroendocrinology 2020 11 18;121:104845. Epub 2020 Aug 18.

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany.

Obstetric complications (OC) may have implications for later health outcomes. However, there is a lack of research examining the association between OC and behavior problems or quality of life (HRQoL). We aimed to close this gap and further investigate functioning of the hypothalamus-pituitary-adrenal (HPA)-axis as a potential physiological vulnerability moderating the association between OC and behavior problems and HRQoL. We investigated 232 mothers and their five to 12-year-old children. Presence of OC during the pre-, peri-, and postnatal phases was determined by interviewing mothers. Children's behavior problems (CBCL, TRF) and HRQoL (Kidscreen rated by mothers and children) were assessed. Children gave 3 cm strands of hair for analysis of hair cortisol (HC). Structural equation modeling analyses with a latent variable of child outcome ("distress"), OC as predictor and HC as a potential moderator were conducted. OC significantly predicted distress (β = .33, p < .01). The model showed a good fit to the data: χ2(14)=15.66, p < .33, CFI=.99, TLI=.99, RMSEA=.02, 90 %CI [.00, .06], SRMR=.04. In addition, HC moderated the association between OC and distress (β=-.32, p < .01). The moderation model also showed a good fit: χ2(14) =7.13, p = .93, CFI=1.00, TLI=1.06, RMSEA=.00, 90 %CI [.00, .02], SRMR=.03. Results indicated that the association between OC and distress was significant only when children had low HC-levels. This was also the case for both externalizing and internalizing behavior problems. Our results underline the notion of OC as a risk factor for child behavior problems and wellbeing and point to an important role of the children's physiological set-up such as HPA-functioning.
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http://dx.doi.org/10.1016/j.psyneuen.2020.104845DOI Listing
November 2020

Assisted reproductive technologies (ART) and placental abnormalities.

J Perinat Med 2020 Oct;48(8):825-828

Department of Obstetrics & Gynecology and Reproductive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.

Objectives Assisted reproductive technologies (ART) may be associated with placental abnormalities including placenta previa, umbilical cord abnormalities, and placental abruption. Our study evaluates the relationship between ART and placental abnormalities compared with spontaneously conceived controls. Methods An IRB-approved cohort study was conducted including women who delivered between January 2013 and December 2018. We excluded delivery prior to 23 weeks and known fetal anomalies. Patients were matched with controls (2:1) for parity, age, and mode of delivery. Controls were women who had spontaneously conceived and delivered immediately preceding and following the index delivery. The primary outcome was placental abnormalities found on both antenatal ultrasound and pathology in ART gestations compared with spontaneously conceived gestations. Results There were 120 ART pregnancies and 240 matched control pregnancies identified. The groups were similar for parity, BMI, comorbidities, number of multiples, mode of delivery, and female newborns. The ART group had a higher maternal age (37.1±5 y vs. 30.0±5 y; p<0.001), greater preterm birth (29 vs. 6%; p<0.001), and lower BW (2,928±803 g vs. 3,273±586 g; p<0.001). The ART group had a higher incidence of placenta previa on ultrasound (4.0 vs. 0.4%, p=0.01), adherent placentas at delivery (3 vs. 0% p=0.014), placental abruption (2 vs. 0%; p=0.04), as well as an increased rate of velamentous cord insertion (12 vs. 3%, p<0.001) and marginal cord insertion (28 vs. 15%, p=0.002). ART demonstrated a two-fold likelihood of abnormal placental pathology. Conclusions ART is associated with increased rate of placental abnormalities, including abnormal umbilical cord insertion and increased rates of adherent placentation. This information may be beneficial in planning and surveillance in patients with ART pregnancies.
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http://dx.doi.org/10.1515/jpm-2020-0141DOI Listing
October 2020

Early life maltreatment and depression: Mediating effect of maternal hair cortisol concentration on child abuse potential.

Psychoneuroendocrinology 2020 10 6;120:104791. Epub 2020 Jul 6.

Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Germany.

Introduction: Maternal early life maltreatment (ELM) and history of depression can bear a risk for adverse development in the child. One neurobiological pathway for the transmission of both maternal ELM and remitted depression (MDD) might be altered maternal cortisol levels. In the present study, we examine (1) main and interacting effects of maternal ELM and remitted MDD on hair cortisol concentration (HCC) in mothers, whether (2) maternal HCC explains the association between maternal ELM or remitted MDD and maternal child abuse potential, and (3) whether maternal child abuse potential as well as maternal HCC are associated with maternal report of child well-being.

Methods: The current study involved 127 mother-child dyads. Maternal history of ELM and psychopathology were assessed via the Mini International Neuropsychiatric Interview (M.I.N.I.) and Childhood Experience and Care (CECA) interview. The Child Abuse Potential Inventory (CAPI) was used to assess maternal child abuse and neglect potential. We applied the Kidscreen-27 parent report to study child well-being. To assess HCC, hair strands were taken from the mothers. To test the research questions, a two-factorial analysis of covariance, mediation analysis using ordinary least squares regressions with bootstrapping, and Pearson correlations were calculated.

Results: Mothers with ELM had significantly increased HCC. There was no effect of remitted MDD on HCC, nor an interaction effect of both factors. HCC was a significant mediator of the association between maternal ELM and maternal child abuse potential. Maternal child abuse potential as well as HCC were significantly associated with reduced child well-being.

Discussion: Our data suggest that adverse experiences in childhood are associated with altered HPA-axis functioning reflected in increased levels of HCC. HPA-axis activity is not altered in mothers with remitted MDD. From a clinical point of view, one might speculate that the partially mediating effect of maternal HCC could indicate a starting point in the prevention of the intergenerational cycle of abuse.
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http://dx.doi.org/10.1016/j.psyneuen.2020.104791DOI Listing
October 2020

Maternal early life maltreatment and psychopathology affect the next generation: Alterations in post-awakening cortisol levels of primary school-aged children.

Dev Psychobiol 2021 Jan 4;63(1):98-107. Epub 2020 Jun 4.

Department of General Psychiatry, Heidelberg University, Heidelberg, Germany.

Early life maltreatment (ELM) has severe and lasting effects on the individual, which might also impact the next generation. On an endocrine level, the hypothalamus-pituitary-adrenal axis has been suggested to play an important role in the interplay between ELM and the development of mental disorders. Several studies have revealed that maternal post-awakening cortisol concentration, maternal sensitivity, maternal ELM and psychopathology are associated with children's cortisol levels. We investigated the post-awakening cortisol concentrations in 6- to 11-year-old children (N = 53) whose mothers either had experienced ELM and had developed a lifetime mental disorder (N = 15 ELM and disorder group), had experienced ELM without developing a mental disorder (N = 12 ELM-only group), or had neither experienced ELM nor developed a mental disorder (N = 26 HC-group). Furthermore, we assessed maternal post-awakening cortisol concentrations, maternal psychopathology, and sensitivity. Multilevel analysis revealed higher cortisol at awakening (S1) levels in children of mothers with ELM and disorder. Maternal cortisol at awakening (S1) also predicted the child's cortisol at awakening (S1), and no effect of maternal sensitivity could be found. The current results replicate an attunement of cortisol levels (S1) between mothers and children and suggest an association between the children's endocrine stress system and maternal factors such as ELM and psychopathology.
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http://dx.doi.org/10.1002/dev.21996DOI Listing
January 2021

Recommendations of the Group of Experts of the Polish Society of Gynecologists and Obstetricians in the field of gynecological and obstetric care of young women with physical and intellectual disabilities.

Ginekol Pol 2020 ;91(3):165-173

Department of Pregnancy Pathology, Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.

The recommendations present the current knowledge and procedures, which can be modified and changed in some cases, after careful analysis of a given clinical situation, which in the future may become the basis for their modification and updating.
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http://dx.doi.org/10.5603/GP.2020.0033DOI Listing
January 2020

Sexual Functioning in Pregnant Women.

Int J Environ Res Public Health 2019 10 30;16(21). Epub 2019 Oct 30.

Department of Pregnancy Pathology, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.

Sexual activity during pregnancy is determined by emotional, psychosocial, hormonal, and anatomical factors and varies during trimesters. This work aimed to establish women's sexual activity during each trimester of pregnancy. A total of 624 women were included in the study and filled in the questionnaire three times, once during each trimester of pregnancy. The first part of the survey included questions about socio-demographic characteristics, obstetric history, and medical details of a given pregnancy. The second part was the Polish version of the female sexual function index (FSFI) questionnaire. Comparison of the mean scores for the overall sexual function of each trimester revealed clinically relevant sexual dysfunction in the second and third trimesters (mean values 25.9 ± 8.7 and 22.7 ± 8.7, respectively; < 0.01). Women were most sexually active during their second trimester. In the first trimester of pregnancy, women were most likely to choose intercourse in the missionary position. Women with vocational education were characterized by the lowest and homogenous FSFI values. Total FSFI score depended on the martial status-the highest value pertained to married women (25.2 ± 6.9; = 0.02).
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http://dx.doi.org/10.3390/ijerph16214216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6862185PMC
October 2019

Anti-androgenic therapy in young patients and its impact on intensity of hirsutism, acne, menstrual pain intensity and sexuality - a preliminary study.

Ginekol Pol 2019 ;90(9):520-526

Department of Pregnancy Pathology, Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.

Objectives: Using anti-androgenic contraception is one of the methods of birth control. It also has a significant, non-contraceptiveimpact on women's body. These drugs can be used in various endocrinological disorders, because of their abilityto reduce the level of male hormones.The aim of our study is to establish a correlation between taking different types of anti-androgenic drugs and intensity ofhirsutism, acne, menstrual pain intensity and sexuality.

Material And Methods: 570 women in childbearing age that had been using oral contraception for at least three monthstook part in our research. We examined women and asked them about quality of life, health, direct causes and effects ofthat treatment, intensity of acne and menstrual pain before and after. Our research group has been divided according tothe type of gestagen contained in the contraceptive pill: dienogest, cyproterone, chlormadynone and drospirenone. Additionally,the control group consisted of women taking oral contraceptives without antiandrogenic component.

Results: The mean age of the studied group was 23 years ± 3.23. 225 of 570 women complained of hirsutism.The mean score for acne intensity before the use of contraception was 2.7 ± 1.34. The mean score for acne intensity after3 months of using contraception was 1.85 ± 1.02 (p < 0.001). 192 women reported excess hairiness in one or more areabefore treatment. Mean value based on Ferriman-Gallway scale before the treatment was 6.23 ± 6.21 and 5.39 ± 5.6 afterthe treatment (p < 0.001).

Conclusions: All groups of drugs effectively reduced pain and acne severity. Cyproterone and drospirenone turned outas the most effective drugs in treating hirsutism. Surprisingly, according to our research, dienogest does not have anyimpact on body hairiness.
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http://dx.doi.org/10.5603/GP.2019.0091DOI Listing
May 2020

Could problems in the bedroom come from our intestines? A preliminary study of IBS and its impact on female sexuality.

Psychiatr Danub 2019 Sep;31(Suppl 3):561-567

Department of Psychiatric Rehabilitation, Medical School of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland,

Introduction: Female sexuality may be affected by many somatic and psychological factors. Somatic conditions have impact on psychological well-being. We assumed that chronic disease like Irritable Bowel Syndrome (IBS), when producing the long-term distress, may greatly influence sexual functioning.

Aim: The aim of this study was to determine whether the severity of IBS influences sexual functions of women and take into consideration other factors like Small Intestinal Bacterial Overgrowth (SIBO) comorbidity and duration of IBS.

Subjects And Methods: Study patients were recruited by contacting IBS patients at Gastroenterology Ward of Clinical University Centre in Katowice. The survey consisted of 3 parts. The first part were socio-demographic questions. The second part was polish translation of Female Sexuality Functions Index (FSFI) questionnaire. The third part consisted of questions about the patient condition, pharmacotherapy and Irritable Bowel Syndrome Severity Score (IBSSS) questionnaire. 307 women were included in the study and completed the questionnaire. 143 participants were diagnosed with IBS. The mean age of participants was 27 (IQR=23-33). 29% of the patients (n=41) had severe, 47% (n=68) moderate and 24% (n=34) mild IBS.

Results: The prevalence of sexual dysfunctions was greater in women with IBS (48%) than in healthy control group (23%) (p<0.001). The median of FSFI was: 30.1 (26.3-32.8) for healthy control group, 30 (23.5-32.6) for mild IBS, 26.2 (22.2-31.6) for moderate and 24.4 (20.1-28.9) for severe.

Conclusion: IBS decreases all domains of women sexual activity. Severity of sexual dysfunctions relate to intensity of IBS symptoms. All physicians treating IBS-patients should take sexual dysfunctions into their clinical consideration.
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September 2019

Symptomatic uterine fibroids in pregnancy - wait or operate? Own experience.

Ginekol Pol 2019 ;90(6):320-324

Department of Pregnancy Pathology, Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.

Objectives: Uterine fibroids are one of the most common benign tumors of the female genital tract. The major complication of myomas in pregnancy is a recurrent pain, however the misscariage is the main threat. The negative impact of myomas on the course of pregnancy may also result in i.e. uterine bleeding, higher incidence of a maternal-fetal incommunicability, an incorrect position of the fetus and its deformities.

Material And Methods: The patient aged 31 was admitted to Mother and Child Health Center in Zabrze due to the threatened miscarriage. The primigravid at 19 weeks' gestation was previously diagnosed with myoma. On admission the ultrasonography revealed one alive fetus in the uterus and a nodular change on the right side of the uterine fundus, 13 x 11 cm in size and non-homogenous echo.

Results: The patient was qualified to the conservative myomectomy. 11 days after the enucleation of 25 cm in diameter myoma, patient in good condition, with the maintained, alive foetus was discharged from the hospital. Patient at 34 weeks' gestation was re-admitted due to the beginning of uterine contraction. After one week of observation within the ward, with tocolytic drugs and steroids administered, at 35th week of pregnancy the patient gave birth to a live daughter via the Ceasarian section.

Conclusions: Prenatal myomectomy can be safely performed in the first and second trimester of pregnancy, however it is recommended to deliver the baby via Caesarean section, due to fear of intrauterine rupture of the uterus.
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http://dx.doi.org/10.5603/GP.2019.0058DOI Listing
March 2020

Alterations of empathy in mothers with a history of early life maltreatment, depression, and borderline personality disorder and their effects on child psychopathology.

Psychol Med 2020 05 22;50(7):1182-1190. Epub 2019 May 22.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Berlin, Germany.

Background: Early life maltreatment (ELM), borderline personality disorder (BPD), and major depressive disorder (MDD) have been associated with empathy deficits in different domains. Lack of maternal empathy has also been related to child behavioral problems. As ELM, BPD, and MDD often co-occur, we aimed to identify dissociable effects on empathy due to these three factors. In addition, we aimed to investigate their indirect effects via empathy on child psychopathology.

Methods: We included 251 mothers with and without MDD (in remission), BPD and ELM and their children, aged 5-12. We used the Interpersonal Reactivity Index as a measure of empathy on four different dimensions (personal distress, empathic concern, perspective taking, and fantasy) and the Child Behavior Checklist as a measure of child psychopathology.

Results: Having included all three factors (ELM, MDD, BPD) in one analysis, we found elevated personal distress in MDD and BPD, and lower levels of perspective-taking in BPD, but no effects from ELM on any empathy subscales. Furthermore, we found indirect effects from maternal BPD and MDD on child psychopathology, via maternal personal distress.

Conclusion: The present study demonstrated the dissociable effects of maternal ELM, MDD, and BPD on empathy. Elevated personal distress in mothers with BPD and MDD may lead to higher levels of child psychopathology.
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http://dx.doi.org/10.1017/S0033291719001107DOI Listing
May 2020

Childhood adversity and parenting behavior: the role of oxytocin receptor gene polymorphisms.

J Neural Transm (Vienna) 2019 06 16;126(6):777-787. Epub 2019 May 16.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany.

Previous research revealed experiences of childhood adversity (CA) to be related to less favorable parenting behavior. It can further be expected that maternal oxytocin receptor (OXTR) genes may influence parenting behavior and moderate relationships between CA and parenting behavior. Moreover, associations between the OXTR gene and plasma oxytocin (OT) have been discussed. The present study investigated main effects of the OXTR gene on parenting behavior and plasma OT of mothers, and moderating effects of the OXTR gene on the relationship between mothers' experiences of CA and parenting behavior. We relied on a sample of 193 mothers and their on average 8-year-old children. Maternal experiences of CA were assessed using a standardized interview. A questionnaire for the assessment of child abuse potential and observations of mother-child interaction were used as indicators of parenting behavior. For mothers, we analyzed three polymorphisms (rs53576, rs1042778, rs2254298) of the OXTR gene and plasma OT. Only the rs53576 was associated with mothers' parenting behavior, specifically with maternal sensitivity. The rs2254298 significantly moderated relations between mothers' experiences of CA and parenting behavior. Significant relations could be found only for mothers who were homozygous for the G allele. The G allele of the rs2254298 was further related to increased plasma OT levels. Our findings underline the importance of considering genetic variation when investigating consequences of CA and developing intervention programs that are adapted to an individual's needs.
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http://dx.doi.org/10.1007/s00702-019-02009-9DOI Listing
June 2019

Pharmacological and Non-Pharmacological Methods of Labour Pain Relief-Establishment of Effectiveness and Comparison.

Int J Environ Res Public Health 2018 12 9;15(12). Epub 2018 Dec 9.

Department of Pregnancy Pathology, Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.

: To evaluate the effectiveness of pharmacological and non-pharmacological pain relief methods and to compare them. : 258 women were included in the study and interviewed using a questionnaire and the visual analogue scale for pain. They were divided into six groups depending on chosen method of labour pain relief: epidural anaesthesia (EA; = 42), water immersion and water birth (WB; = 40), nitrous oxide gas for pain control (G; = 40), transcutaneous electrical nerve stimulation (TENS) ( = 50), multiple management (MM; = 42), none (N; = 44). : The average age of the women was 29.4 ± 3.74 years and 60.47% of them were nulliparous ( = 156). Mean values of labour pain intensity were 6.81 ± 2.26 during the first stage of labour; 7.86 ± 2.06 during the second stage, and 3.22 ± 2.46 during the third stage. There was no significant difference in pain level between epidural analgesia and gas groups in the first stage of labour ( = 0.74). Nevertheless, epidural analgesia reduced pain level during the second and third stage (both < 0.01). The highest satisfaction level pertains to water immersion ( = 38; 95%). : Epidural analgesia is the gold standard of labour pain relief, however water birth was found to be associated with the highest satisfaction level of the parturient women. The contentment of childbirth depends not only on the level of experienced pain, but also on the care provided to the parturient during pregnancy and labour.
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http://dx.doi.org/10.3390/ijerph15122792DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313325PMC
December 2018

Impact of Maternal Early Life Maltreatment and Maternal History of Depression on Child Psychopathology: Mediating Role of Maternal Sensitivity?

Child Psychiatry Hum Dev 2019 04;50(2):278-290

Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.

The study addresses the impact of maternal early life maltreatment (ELM) and maternal history of depression (HoD) on offspring's mental health. Maternal sensitivity was examined as a potential mediator explaining the relationship between maternal ELM, maternal HoD and child psychopathology. Participants were 194 mothers with and without HoD and/or ELM as well as their children between 5 and 12 years. Maternal sensitivity was assessed using the Emotional Availability Scales. Parent and teacher ratings were utilized to assess child psychopathology. Path analyses showed an indirect effect of maternal HoD on parents' ratings of child psychopathology with maternal sensitivity as mediating variable. In contrast, maternal ELM was directly linked to teachers' ratings of child psychopathology; this effect was not mediated by maternal sensitivity. Our results indicate that the impact of maternal HoD, maternal ELM, and maternal sensitivity on offspring psychopathology might vary depending on the context in which child psychopathology is assessed.
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http://dx.doi.org/10.1007/s10578-018-0839-zDOI Listing
April 2019

Preliminary Study on Antinuclear Antibodies in Patients With Chronic Dilatory Eustachian Tube Dysfunction.

Otol Neurotol 2018 09;39(8):e612-e617

Department of Otolaryngology.

Background And Hypothesis: There are some known reasons for chronic dilatory Eustachian tube dysfunction (chronic D-ETD, also known as chronic obstructive tube dysfunction), for example infections, hyperplastic adenoids, or tumors. In many cases though, none of these reasons apply. The question arises whether there might be an autoimmune pathogenesis in patients with idiopathic chronic D-ETD.

Methods: The study includes 31 consecutive patients with chronic D-ETD and 92 consecutive blood donors (BD, comparative cohort). The production of antinuclear antibodies (ANA), as an indicator for autoimmune pathologies, was measured in the serum of patients and BD.

Results: ANA titers were significantly higher in patients with chronic D-ETD, compared with BD (p = 0.0027). The results weighted clearly toward higher ANA titers in younger patients. A comparison of ANA titers in patients and BD aged less than 40 years showed a significant difference (p = 0.0062), whereas it was not significant between patients and BD aged ≥ 40 years (p = 0.19).

Conclusion: The significant results of elevated ANA titers in chronic D-ETD make an autoimmune pathogenesis highly probable, at least in some of the patients concerned. Further research with higher numbers of patients is needed to confirm the hypothesis of an autoimmune chronic D-ETD. A better understanding of etiology and pathogenesis of chronic D-ETD might open up new and perhaps even causal therapeutic strategies.
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http://dx.doi.org/10.1097/MAO.0000000000001918DOI Listing
September 2018

Neural processing of the own child's facial emotions in mothers with a history of early life maltreatment.

Eur Arch Psychiatry Clin Neurosci 2019 Mar 28;269(2):171-181. Epub 2018 Jul 28.

Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, 69115, Heidelberg, Germany.

Early life maltreatment (ELM) has long-lasting effects on social interaction. When interacting with their own child, women with ELM often report difficulties in parenting and show reduced maternal sensitivity. Sensitive maternal behavior requires the recognition of the child's emotional state depicted in its facial emotions. Based on previous studies, it can be expected that ELM affects the neural processing of facial emotions by altering activation patterns in parts of the brain's empathy and mentalizing networks. However, so far studies have focused on the processing of standardized, adult facial emotions. Therefore, the current study investigated the impact of ELM on the processing of one's own child's facial emotions using functional magnetic resonance imaging. To achieve this, 27 mothers with and 26 mothers without a history of ELM (all without current mental disorders and psychopharmacological treatment) took part in an emotional face recognition paradigm with happy, sad, and neutral faces of their own and an unknown primary school-aged child of the same age and sex. We found elevated activations in regions of the mentalizing (superior temporal sulcus, precuneus) and mirror neuron (inferior parietal lobule) networks as well as in the visual face processing network (cuneus, middle temporal gyrus) in mothers with ELM compared to the non-maltreated mothers in response to happy faces of their own child. This suggests a more effortful processing and cognitive empathic mentalizing of the own child's facial happiness in mothers with ELM. Future research should address whether this might indicate a compensatory recruitment of mentalizing capacities to maintain maternal sensitivity.
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http://dx.doi.org/10.1007/s00406-018-0929-8DOI Listing
March 2019

Students' Motivation for Sport Activity and Participation in University Sports: A Mixed-Methods Study.

Biomed Res Int 2018 12;2018:9524861. Epub 2018 Jun 12.

Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Straße 7-11, 68167 Mannheim, Germany.

Background: Physical activity among students is essential for complimenting sedentary behavior and for individuals' future health. This study investigates reasons for sport engagement among students and addresses the utilization of university sports programs (USP) by employing a mixed-methods approach.

Methods: The NuPhA-Study consists of a quantitative online survey (n=689) followed by qualitative interviews (n=20). In the survey, we assessed reasons for sport activity using a 24-item battery and USP utilization. Quantitative results were further explored using qualitative data to check for completeness of the predefined items (content validity) and to identify opportunities to improve participating in USP.

Results: A factor analysis grouped the 24 items into five factors (life balance/fitness/body image/contact with others/fun). Our qualitative study explained these in more detail and revealed missing aspects. 47.6% of students participated in USP. Potential improvements for USP include program maintenance during the semester break and temporal harmonization with the classes.

Discussion: The qualitative component identified additional reasons for sport activity that were not addressed by the item battery, which provides critical implications for developing item batteries for future research. Our results may help to generate a more target-group-oriented approach to increase physical activity among students, which will reduce sedentary behavior and future disease burden.
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http://dx.doi.org/10.1155/2018/9524861DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020653PMC
January 2019

The maternal brain in women with a history of early-life maltreatment: an imagination-based fMRI study of conflictual versus pleasant interactions with children.

J Psychiatry Neurosci 2018 07;43(4):273-282

From the Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Neukel, Zietlow, Reck, Herpertz); the Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Fuchs, Brunner); the Department of Psychology, Faculty of Psychology and Educational Science, Ludwig-Maximilian University of Munich, Germany (Reck); the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, SHG Hospital, Kleinblittersdorf, Germany (Moehler); and the Department of Psychiatry and Psychotherapy, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany (Bermpohl).

Background: Early-life maltreatment has severe consequences for the affected individual, and it has an impact on the next generation. To improve understanding of the intergenerational effects of abuse, we investigated the consequences of early-life maltreatment on maternal sensitivity and associated brain mechanisms during mother-child interactions.

Methods: In total, 47 mothers (22 with a history of physical and/or sexual childhood abuse and 25 without, all without current mental disorders) took part in a standardized real-life interaction with their 7- to 11-year-old child (not abused) and a subsequent functional imaging script-driven imagery task.

Results: Mothers with early-life maltreatment were less sensitive in real-life mother-child interactions, but while imagining conflictual interactions with their child, they showed increased activation in regions of the salience and emotion-processing network, such as the amygdala, insula and hippocampus. This activation pattern was in contrast to that of mothers without early-life maltreatment, who showed higher activations in those regions in response to pleasant mother-child interactions. Mothers with early-life maltreatment also showed reduced functional connectivity between regions of the salience and the mentalizing networks.

Limitations: Region-of-interest analyses, which were performed in addition to whole-brain analyses, were exploratory in nature, because they were not further controlled for multiple comparisons.

Conclusion: Results suggest that for mothers with early-life maltreatment, conflictual interactions with their child may be more salient and behaviourally relevant than pleasant interactions, and that their salience network is poorly modulated by the brain regions involved in mentalizing processes. This activation pattern offers new insights into the mechanisms behind the intergenerational effects of maltreatment and into options for reducing these effects.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019349PMC
July 2018