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Title:Samopoškodovalno vedenje brez samomorilnega namena (NSSI) pri mladostnikih - vpliv genetskih polimorfizmov, travmatiziranosti, impulzivnosti in duševnih motenj
Authors:ID Bunderla, Teja (Author)
ID Gregorič Kumperščak, Hojka (Mentor) More about this mentor... New window
ID Potočnik, Uroš (Co-mentor)
Files:.pdf DOK_Bunderla_Teja_2021.pdf (2,49 MB)
MD5: 5B618402838F975FE83C0240741722FA
 
Language:Slovenian
Work type:Doctoral dissertation (mb31)
Typology:2.08 - Doctoral Dissertation
Organization:MF - Faculty of Medicine
Abstract:Samopoškodovalno vedenje brez samomorilnega namena (»Nonsuicidal Self-Injury« – NSSI) se vedno bolj pojmuje kot samostojna psihiatrična motnja. Odkar je bil NSSI leta 2013 v najnovejši izdaji ameriške klasifikacije duševnih motenj (»Diagnostic and Statistical Manual of Mental Disorders« – DSM-5) prvič opredeljen kot samostojna diagnoza v sekciji III – pod motnjami za prihodnje raziskovanje, se je znanje na tem področju bistveno povečalo, vendar pa etiologija tega vedenja še zmeraj ni pojasnjena. Obstajajo številne psihološke razlage nastanka in vzdrževanja NSSI. Identificirane so najpogostejše komorbidnosti (depresija, mejna osebnostna motnja, anksioznost). Vzroki za nastanek NSSI niso poznani, dosedanje raziskave pa nakazujejo tako dedni dejavnik kot dejavnike okolja. V raziskavi smo zbrali 95 mladostnikov z NSSI, diagnosticiranih po raziskovalnih kriterijih DSM-5, 21 kontrol brez NSSI in 118 posameznikov iz splošne populacije, ki smo jih dodali kot dodatno kontrolno skupino za genetske preiskave. Pri vseh smo opravili genotipizacijo polimorfizmov v genih TPH1 (rs4537731, rs1799913, rs7933505), SLC6A4 (VNTR STin2), OPRM1 (rs1799971), GNβ3 (rs5443) in DRD2/ANKK1 (rs1800497). Preiskovanci z NSSI in kontrolna skupina brez NSSI so izpolnili prevedene vprašalnike Barratt Impulsiveness Scale (BIS-11), State-Trait Anxiety Inventory for Adults (STAI), MacLean Screening Instrument for BPD (MSI-BPD) in Early Trauma Inventory Self Report-Short Form (ETISR-SF), preiskovanci z NSSI pa še dodatno Inventory of Statements about Self-Injury (ISAS) in Self-Injury Craving Questionnaire (SICQ). Opravili smo asociacijsko analizo in analize interakcij med izbranimi kandidatnimi geni in okolijskimi dejavniki za nastanek NSSI. Ugotovili smo statistično značilno povezavo polimorfizma rs4537731 v genu TPH 1 s starostjo ob prvem pojavu NSSI. Prisotnost STin2.10 je bila skupaj s celokupno travmatiziranostjo povezana z večjo verjetnostjo za NSSI. Alel G polimorfizma rs1799971 v genu OPRM1 se je izkazal kot varovalni alel, povezan z nižjim hlepenjem po NSSI. Z multivariantnim modelom smo pokazali povezavo mejne osebnostne motnje in dednega dejavnika z nastankom NSSI, pri čemer sta k dednemu dejavniku za nastanek NSSI prispevala predvsem polimorfizma rs1799913 in rs7933505. Polimorfizem rs1799913 je bil statistično značilno povezan z nastankom NSSI v modelu skupaj z anksioznostjo kot osebnostno potezo. NSSI v našem vzorcu je bil močno povezan s celokupno travmatiziranostjo, čustveno zlorabo in spolno zlorabo. Dokazali smo tudi pomembno povezavo z impulzivnostjo. Mladostniki z NSSI iz našega vzorca so izpostavili hlepenje po NSSI, ki je primerljivo hlepenju po kokainu. Hlepenje je bilo v močni premo sorazmerni korelaciji s številom NSSI v življenju. Anksioznost je bila pri posameznikih z NSSI zelo povišana, bistveno pa je bila povezana tudi s povišanjem hlepenja po NSSI. Mladostniki so v večinskem deležu poročali o spremenjenem zaznavanju bolečine med NSSI, a povezave z genetiko nismo uspeli potrditi. NSSI je v analizah povezav med dednimi in okoljskimi dejavniki pokazal povezanost predvsem s kandidatnimi polimorfizmi serotoninskega sistema in s sistemom endogenih opioidov. Ugotovili smo povezavo NSSI z visokim hlepenjem. Nujno je nadaljevanje raziskovanja NSSI v smislu vedenjske odvisnosti. NSSI je bil močno povezan s travmatiziranostjo in izkušnjami predvsem čustvene in spolne zlorabe. Z anksioznostjo je verjetno povezan veliko bolj, kot smo do sedaj predvidevali.
Keywords:samopoškodovalno vedenje brez samomorilnega namena, NSSI, mladostniki, anksioznost, mejna osebnostna motnja, travmatiziranost, impulzivnost, odvisnost, zaznavanje bolečine, genetski polimorfizmi, serotoninski sistem, endogeni opioidi, dopaminergični sistem
Year of publishing:2021
Source:Maribor
COBISS.SI-ID:55708675 New window
NUK URN:URN:SI:UM:DK:HMCWQWNK
Publication date in DKUM:18.03.2021
Views:402
Downloads:65
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Licences

License:CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Link:http://creativecommons.org/licenses/by-nc-nd/4.0/
Description:The most restrictive Creative Commons license. This only allows people to download and share the work for no commercial gain and for no other purposes.
Licensing start date:10.05.2020

Secondary language

Language:English
Title:Nonsuicidal Self-Injury (NSSI) in Adolescents – The Influence of Genetic Polymorphisms, Trauma, Impulsivity and Mental Disorders
Abstract:Nonsuicidal Self-Injury – NSSI is being increasingly regarded as a separate psychiatric disorder. Since the latest Diagnostic and Statistical Manual of Mental Disorders – DSM-5 from 2013 defined NSSI as a separate diagnosis under section III – Conditions for Further Study, the knowledge about this field has increased considerably; however, the aetiology of this behaviour has still not been explained. There are many psychological explanations for the development and the continuation of NSSI. Researchers have identified the most common comorbidities (depression, borderline personality disorder, anxiety). The causes of NSSI are not known, although studies that have been carried out so far indicate both genetic and environmental factors. The research included 95 adolescents with NSSI who were diagnosed based on the DSM-5 criteria, a control group consisting of 21 people without NSSI, and 118 individuals from the general population as an additional control group for genetic research. For all participants we carried out the genotyping of polymorphisms for the TPH1 (rs4537731, rs1799913, rs7933505), SLC6A4 (VNTR STin2), OPRM1 (rs1799971), GNβ3 (rs5443) and DRD2/ANKK1 (rs1800497) genes. The participants with NSSI and the control group without NSSI completed translated questionnaires for the Barratt Impulsiveness Scale (BIS-11), State-Trait Anxiety Inventory for Adults (STAI), MacLean Screening Instrument for BPD (MSI-BPD) and the Early Trauma Inventory Self Report-Short Form (ETISR-SF). The participants with NSSI also completed the questionnaire for the Inventory of Statements about Self-Injury (ISAS), and the Self-Injury Craving Questionnaire (SICQ). We carried out an association analysis and G x E analyses. There was a statistically significant association between polymorphism rs4537731 in the gene TPH 1 and age at first episode of NSSI. Together with overall trauma, the presence of Stin2.10 was associated with increased probability of NSSI. The allele of the G polymorphism rs1799971 in the OPRM1 gene proved to be a protective allele associated with lower NSSI cravings. Using a multivariate model, we proved the association both of borderline personality disorder and of the genetic factor with the development of NSSI, where the genetic factor for the development of NSSI can be attributed particularly to the polymorphisms rs1799913 and rs7933505. The polymorphism rs1799913 was statistically significantly associated with the development of NSSI together with anxiety as a personality trait. In our sample, NSSI was strongly associated with overall trauma, and emotional and sexual abuse. We also proved that there is an important correlation with impulsivity. The adolescents with NSSI from our sample demonstrated a craving for NSSI that is comparable to cocaine craving. There was a strong proportional correlation between craving and the number of NSSI episodes during their lifetime. In individuals with NSSI, the level of anxiety was very high and it was also significantly associated with increased NSSI cravings. The majority of adolescents reported an altered pain perception during NSSI; however, we could not confirm a link to genetics. Analysis of the influence of genetic and environmental factors showed an association between NSSI and the candidate polymorphisms both of the serotonin system and of the endogenous opioid system. We established a correlation between NSSI and high cravings. It is essential to conduct further research into NSSI in terms of behavioural addiction. NSSI was strongly correlated with trauma and experience of emotional and sexual abuse. It is probably far more correlated to anxiety than we predicted.
Keywords:nonsuicidal self-injury, NSSI, adolescents, anxiety, borderline personality disorder, trauma, impulsivity, addiction, pain perception, genetic polymorphisms, serotonergic system, endogenous opioids, dopaminergic system


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