Endocrine modulation of the adolescent brain: a review

Adolescent exposure to bisphenol-a antagonizes androgen regulation of social behavior in male mice

Social behavior is sexually dimorphic, which is regulated by gonadal hormones in the brain. Our recent study found that exposure to low doses of bisphenol-A (BPA) during adolescence, permanently alters social behavior in adult male mice, but the underlying mechanisms remain unclear. Using adolescent gonadectomy (GDX) male mice with testosterone propionate (TP, 0.5 mg/kg) supplement (TP-GDX), this study showed that BPA antagonized promoting effects of TP on social interaction, sexual behavior, and aggression in GDX mice. BPA eliminated the reversal effects of TP on GDX-induced decrease in the number of immunoreactive to arginine vasopressin (AVP-ir) neurons in the medial amygdala (MeA) and the levels of AVP receptor 1a (V1aR) in the MeA and the nucleus accumbens (NAc). In addition, BPA removed down-regulation in the levels of dopamine (DA) transporter (DAT) and DA receptor 1 (DR1) in the NAc of TP-GDX mice. BPA exposure reduced testosterone (T) levels in the brain and serum and the expression of androgen receptor (AR) protein in the amygdala and striatum of sham-operated and TP-GDX males. These results suggest that adolescent exposure to BPA inhibits regulation of androgen in AVP and DA systems of the brain regions associated with social behavior, and thus alters social behaviors of adult male mice.

Neuroactive hormones and personal growth: associations in Chilean adolescents (ages 12-25) with ovulatory dysfunction

Introduction

Hormones produced by the hypothalamic-pituitary-adrenal-gonadal (HPAG) axis are crucial for modulating central nervous system (CNS) function and development throughout a person's life. Disruptions in HPAG function can impact psychological development, particularly during adolescence-a period marked by psychological growth and the maturation of the HPAG axis. An early indicator of HPAG alterations is ovulatory dysfunction (OD), a common condition among adolescents.

Methods

This study explored the associations between neuroactive hormones and personal growth in adolescents with OD. Female participants aged 12-25 years with OD were recruited, and assessments were conducted to profile their basic hormonal levels and various dimensions of individual development, including self-concept clarity, sense of coherence, self-esteem, perfectionism, self-control, and mood states.

Results

Adolescents with OD (n = 117) had lower self-concept clarity and self-esteem compared to reference data. A significant portion of the sample displayed elevated levels of tension (71.25%), confusion (62.5%), fatigue (58.22%), and depression (52.6%). Self-esteem scores were negatively correlated with DHEAS (r = -0.224; p = 0.026) and glucose (r = -0.249; p = 0.010). Higher levels of free testosterone were associated with increased depression scores (coef = 0.2398; p = 0.002), whereas higher estradiol levels were linked to lower aggressiveness scores (coef = -0.0648; p = 0.001).

Discussion

These findings indicate that hormonal imbalances in adolescents with OD could affect personal growth. Further research is needed to establish causal relationships between the variables considered.

Women's health, hormonal balance, and personal autonomy

Hormone-based contraception disrupts hormonal balance, creating artificial states of anovulation and threatening women's health. We reviewed its main adverse effects and mechanisms on accelerated ovarian aging, mental health (emotional disruptions, depression, and suicide), sexuality (reduced libido), cardiovascular (brain stroke, myocardial infarction, hypertension, and thrombosis), and oncological (breast, cervical, and endometrial cancers). Other "collateral damage" includes negative effects on communication, scientific mistrust, poor physician-patient relationships, increased patient burden, economic drain on the healthcare system, and environmental pollution. Hormone-sensitive tumors present a dilemma owing to their potential dual effects: preventing some cancers vs. higher risk for others remains controversial, with denial or dismissal as non-relevant adverse effects, information avoidance, and modification of scientific criteria. This lack of clinical assessment poses challenges to women's health and their right to autonomy. Overcoming these challenges requires an anthropological integration of sexuality, as the focus on genital bodily union alone fails to encompass the intimate relational expression of individuals, complete sexual satisfaction, and the intertwined feelings of trust, safety, tenderness, and endorsement of women's femininity.

The Synergetic Impact of Physical Activity and Fruit and Vegetable Consumption on the Risk of Depression in Taiwanese Adults

BACKGROUND

This research focused on the association between physical activity and fruit-vegetable intake and the risk of depression in middle aged and older Taiwanese adults.

METHODS

Data were obtained from the 1999 to 2015 datasets of the Taiwan Longitudinal Survey on Aging (TLSA), and 4400 participants were included in 1999 (aged ≥53 years). Descriptive statistics provided all of the basic characteristic variables. A chi-square test analyzed the association between sex, age, years of education, marriage, hypertension, drinking, smoking, and the incidence of depression. Logistic regression analysis was used to determine significant associations between physical activity and fruit-vegetable intake, and the presence or absence of depression after 16 years.

RESULTS

Combined high physical activity and fruit-vegetable intake reduced the risk of depression by 80% (OR = 0.20, 95% CI = 0.10-0.45, p = 0.001) compared to low physical activity and fruit-vegetable intake; high physical activity and moderate or low fruit-vegetable intake caused a 70% reduction (OR = 0.30, 95% CI = 0.15-0.63, p = 0.005). High fruit-vegetable intake and low physical activity caused a 65% reduction (OR = 0.35, 95% CI = 0.15-0.63, p = 0.005), compared to low physical activity and low fruit-vegetable intake. High physical activity alone caused a 40% reduction, which is the same as by high fruit-vegetable intake alone.

CONCLUSIONS

Fruit-vegetable intake combined with physical activity was negatively correlated with the risk of depression. More fruit-vegetable intake and physical activity might reduce this risk. The results highlight the importance of physical activity and fruit-vegetable consumption for middle-aged and older adults to prevent depression.

When pharmaceutical drugs become environmental pollutants: Potential neural effects and underlying mechanisms

Pharmaceutical drugs have become consumer products, with a daily use for some of them. The volume of production and consumption of drugs is such that they have become environmental pollutants. Their transfer to wastewater through urine, feces or rinsing in case of skin use, associated with partial elimination by wastewater treatment plants generalize pollution in the hydrosphere, including drinking water, sediments, soils, the food chain and plants. Here, we review the potential effects of environmental exposure to three classes of pharmaceutical drugs, i.e. antibiotics, antidepressants and non-steroidal anti-inflammatory drugs, on neurodevelopment. Experimental studies analyzing their underlying modes of action including those related to endocrine disruption, and molecular mechanisms including epigenetic modifications are presented. In addition, the contribution of brain imaging to the assessment of adverse effects of these three classes of pharmaceuticals is approached.

Physical Activity and Depression in Adolescents: Evidence from China Family Panel Studies

Depression in adolescents is a major public health disorder. The relationship between physical activity and risk of depression in adolescents was examined using three waves of data from the China Family Panel Studies in 2020. The risk of depression was significantly higher among adolescents who reported lower frequency and shorter duration of physical exercise than those who reported physical exercise more frequently and for a longer duration. The risk of depression was significantly higher among adolescents who reported intense physical exercise than those who reported little or no intense physical exercise. The amount of time spent on housework by adolescents is inversely associated with depression. These results provide somewhat stronger evidence for an activity−depression link than previous studies and suggest a differential role for different types of physical activity, such as exercise and housework. The overall model predicting depression in adolescents (LR chi-squared = 95.974, p < 0.001, Nagelkerke R-square = 0.183) was statistically significant. To effectively control depression in adolescents, the government, schools and parents need to act together to guide adolescents towards participation in appropriate physical activities. The appropriate level of physical activity is for adolescents to experience breathing, rapid heartbeat, and slight perspiration.

Sociability, but not spatial memory, is correlated with regional brain volume variation in the striped mouse Rhabdomys spp

Local environmental conditions associated with different geographic areas may elicit variations in behavioural responses in animals, leading to concomitant differences in functional brain region volumes. We investigated the behavioural correlates of hippocampus and amygdala volumes in three sister taxa of the murid rodent genus Rhabdomys, occurring in different environments. We used a Barnes maze to test spatial memory, dyadic encounters to test social behaviour, and histological brain sections to calculate hippocampus and amygdala volumes. Arid-occurring R. pumilio made fewer errors and had shorter latencies in locating the escape tunnel compared to moist grassland-occurring R. d. dilectus and R. d. chakae in two probe trials, 48 and 96 h after the last learning trial. R. pumilio was more amicable than the R. dilectus subspecies in intra-specific dyadic encounters. R. pumilio had larger hippocampus and amygdala volumes than the other species. Smaller amygdala volumes were correlated with longer latencies in females for probe trial 1, but males showed similar latencies regardless of taxon. Higher amicability scores were correlated with larger amygdala volumes in all taxa. Higher amicability scores were correlated with larger hippocampus volumes in R. pumilio and R. d. chakae but smaller hippocampus volumes in R. d. dilectus. Correlative relationships between spatial memory and amygdala volume appeared 48 h, but not 96 h, after the last learning trial. Local environmental conditions may influence spatial navigation, but social correlates drive regional brain size within cryptic striped mouse taxa.

Sex-specific responses of the pubertal neuroimmune axis in CD-1 mice

The mechanistic relationship between the sexually dimorphic neuroimmune system and the sex-specific outcomes of a pubertal immune challenge is unclear. Therefore, we examined sex differences in the progression of cytotoxic microglial responses and blood-brain barrier (BBB) disruption to a peripubertal lipopolysaccharide (LPS) treatment in brain regions relevant to stress responses and cognitive function. Six-week-old (i.e., stress-sensitive pubertal period) male and female CD-1 mice were treated with LPS (1.5 ​mg/kg body weight, ip) or 0.9% saline (LPS-matched volume, ip). Sex and treatment differences in microglial (Iba1⁺) and apoptotic neuronal (caspase-3⁺/NeuN⁺) and non-neuronal (caspase-3⁺/NeuN⁻) expression were examined in the hippocampus, medial prefrontal cortex (mPFC), and paraventricular nucleus 24 ​h (sickness), one week (symptomatic recovery) and four weeks (early adulthood) post-treatment (n ​= ​8/group). Microglial morphology was quantified with fractal analyses. Group differences in BBB permeability to ¹⁴C-sucrose were examined 24 ​h (whole-brain, hippocampus, prefrontal cortex, hypothalamus, and cerebellum) and one week (whole-brain) post-treatment. The acute effects of pubertal LPS were specific to females (i.e., global BBB disruption, altered microglial expression and morphology in the mPFC and hippocampus, increased hippocampal apoptosis). The residual effects of pubertal LPS-induced sickness observed in microglia persisted into adulthood in a sex- and region-specific manner. In addition to highlighting these sex-specific responses of the pubertal neuroimmune system, we report baseline region-specific sex differences in microglia spanning puberty through adulthood. We propose that these sex differences in neuroimmune-neurovascular interactions during the stress-sensitive pubertal period create sex biases in stress-related disorders of brain and behaviour.

•

Pubertal LPS alters baseline sex differences in microglial numbers and morphology.

•

Pubertal CD-1 mice mount sexually dimorphic neuroimmune responses to systemic LPS.

•

Treatment effects on microglial expression and morphology differ by sex and region.

•

The acute LPS-induced effects were specific to females.

Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward

Neuroendocrine dysfunction can occur as a consequence of traumatic brain injury (TBI), and disruptions to the hypothalamic-pituitary axis can be especially consequential to children. The purpose of our review is to summarize current literature relevant to studying sex differences in pediatric post-traumatic hypopituitarism (PTHP). Our understanding of incidence, time course, and impact is constrained by studies which are primarily small, are disadvantaged by significant methodological challenges, and have investigated limited temporal windows. Because hormonal changes underpin the basis of growth and development, the timing of injury and PTHP testing with respect to pubertal stage gains particular importance. Reciprocal relationships among neuroendocrine function, TBI, adverse childhood events, and physiological, psychological and cognitive sequelae are underconsidered influencers of sexually dimorphic outcomes. In light of the tremendous heterogeneity in this body of literature, we conclude with the common path upon which we must collectively arrive in order to make progress in understanding PTHP.

Predictive factors for time to cessation of urinary incontinence in primiparous adolescents after vaginal delivery

OBJECTIVE

To investigate predictive factors for the time to cessation of urinary incontinence (UI) and estimate the median time for its cessation in primiparous adolescents after vaginal delivery.

METHODS

A cohort study with 102 adolescents aged 10-19 years with UI after vaginal delivery was developed in the Physical Therapy Laboratory for Women's Health and Pelvic Floor at the Federal University of Pernambuco between June 2017 and December 2019. Participants responded to the assessment form, providing information on the outcome of interest and possible predictive factors. For statistical analysis, the Cox regression model and the Kaplan-Meier method were used.

RESULTS

Risk factors identified for the outcome of interest were: age 15-19 years (adjusted hazard ratio [HR_a ] 1.37, 95% confidence interval [CI] 0.11-2.8); non-instrumental delivery (HR_a 2.95. 95% CI 1.19-7.53); adoption of vertical position during the expulsion stage of delivery (HR_a 2.19, 95% CI 1.28-3.84); and absence of episiotomy (HR_a 2.01, 95% CI 1.2-3.44). The median time to cessation of UI was 16 months (10-29).

CONCLUSION

Health professionals should reflect on obstetric practices adopted during delivery in adolescents, especially among 10-14-year-olds, regarding the use of episiotomy, instrumental delivery, and parturient position during the expulsion stage of delivery.

Sexual Dimorphism of Heart Rate Variability in Adolescence: A Case-Control Study on Depression, Anxiety, Stress Levels, Body Composition, and Heart Rate Variability in Adolescents with Impaired Fasting Glucose

Prediabetes in the form of impaired fasting glucose, impaired glucose tolerance, or both is considered as a preliminary stage for the onset of diabetes and diabetic complications. Hormonal fluctuations in adolescence are accompanied by body composition modifications, which are associated with insulin resistance and subclinical inflammation. Bioimpedance (BIA) accurately evaluates body composition, and heart rate variability (HRV) assesses cardiac autonomic function, which are frequently afflicted by insulin resistance. We aimed at evaluating the effect of glycemic status on mental stress, anxiety, and depression status in adolescents with impaired fasting glucose, body composition, and HRV parameters. This is a case-control study to evaluate the effect of the hyperglycemia on depression, anxiety, and stress levels (DASS21 questionnaire), body composition (BIA-ACC-BIOTEKNA©), and HRV (PPG Stress Flow-BIOTEKNA©), between euglycemic adolescents (euglycemic group) and adolescents with impaired fasting glucose (prediabetic group), aged 12-20 years. No differences were found between the prediabetic (n = 13) and the euglycemic (n = 16) groups in the outcome measures, possibly due to the number of participants. Interestingly, females, irrespective of their glycemic status, exhibited altered sympathovagal function as revealed by impaired HRV. In the euglycemic group, HRV parameters were significantly correlated and in line with the DASS21 scores, but in the prediabetic group, similarities to those of adults were observed. Impaired fasting glucose had no impact on mental health, body composition, or HRV parameters in adolescents. HRV parameters were impaired in females, irrespective of their glycemic status. This finding implies that females seem to be more prone to stress disorders, even from a young age. Future studies are needed to confirm these findings.

The effects of pubertal exposure to bisphenol-A on social behavior in male mice

Puberty is a crucial developmental period for structural modifications of brain and activation of the neural circuits underlying sex differences in social behavior. It is possible that pubertal exposure to bisphenol-A (BPA), a common EED with a weak estrogenic activity, influences social behavior. After being exposed to BPA at 0.04, 0.4, 4 mg kg^-1 for 18 days, the 7-week-old male mice were tested with social play and three-chamber. The results showed that pubertal BPA exposure decreased social play between adolescent males and sociability of adolescent males. Further, pubertal BPA exposure reduced sociability and inhibited social novel preferences of adult males. BPA inhibited social interactions with opposite sex but improved socio-sexual exploration and the low-intensity mating behavior (mounting) with same sex in adult males. In residential-intruder test, BPA-exposed adult males showed a decrease in aggressiveness and an enhancement in prosocial behavior with intruder. Western blot analysis showed that BPA (especially at 4 mg/kg/d) down-regulated the levels of AR in the amygdala and the striatum but up-regulated the levels of DR1 and DAT proteins in the striatum of adult males. BPA at 4 mg kg^-1 decreased the levels of T in the serum and the brain. These results suggest that pubertal BPA exposure affects social play and sociability of adolescent males and even results in long-term effects on social behavior of adult males. BPA-induced down-regulations of the levels of AR in the amygdala and the striatum and up-regulation of the levels of DR1 and DAT in the striatum may be involved.

Identifying and monitoring neurons that undergo metamorphosis-regulated cell death (metamorphoptosis) by a neuron-specific caspase sensor (Casor) in Drosophila melanogaster

Activation of caspases is an essential step toward initiating apoptotic cell death. During metamorphosis of Drosophila melanogaster, many larval neurons are programmed for elimination to establish an adult central nervous system (CNS) as well as peripheral nervous system (PNS). However, their neuronal functions have remained mostly unknown due to the lack of proper tools to identify them. To obtain detailed information about the neurochemical phenotypes of the doomed larval neurons and their timing of death, we generated a new GFP-based caspase sensor (Casor) that is designed to change its subcellular position from the cell membrane to the nucleus following proteolytic cleavage by active caspases. Ectopic expression of Casor in vCrz and bursicon, two different peptidergic neuronal groups that had been well-characterized for their metamorphic programmed cell death, showed clear nuclear translocation of Casor in a caspase-dependent manner before their death. We found similar events in some cholinergic neurons from both CNS and PNS. Moreover, Casor also reported significant caspase activities in the ventral and dorsal common excitatory larval motoneurons shortly after puparium formation. These motoneurons were previously unknown for their apoptotic fate. Unlike the events seen in the neurons, expression of Casor in non-neuronal cell types, such as glial cells and S2 cells, resulted in the formation of cytoplasmic aggregates, preventing its use as a caspase sensor in these cell types. Nonetheless, our results support Casor as a valuable molecular tool not only for identifying novel groups of neurons that become caspase-active during metamorphosis but also for monitoring developmental timing and cytological changes within the dying neurons.

The components of the adolescent brain and its unique sensitivity to sexually explicit material

INTRODUCTION

The focus of this brief literature review is to explore whether there is a relationship between the unique anatomical and physiological paradigms of the adolescent brain and an increased sensitivity to sexually explicit material.

METHODS

The EBSCO Research Data bases were searched using the following key terms: adolescence, adolescent brain development, neuroplasticity, sexually explicit material, sexualization, and pornography.

RESULTS

The literature highlighted several components of the adolescent brain that are different than the mature brain. These include: an immature prefrontal cortex and over-responsive limbic and striatal circuits, heightened period for neuroplasticity, overactive dopamine system, a pronounced HPA axis, augmented levels of testosterone, and the unique impact of steroid hormones. The physiological response to sexually explicit material is delineated. The overlap of key areas associated with the unique adolescent brain development and sexually explicit material is noteworthy. A working model summary that compares the response of the adult and adolescent brain to the same sexually explicit stimulus is outlined.

CONCLUSIONS

The literature suggests that the adolescent brain may indeed be more sensitive to sexually explicit material, but due to a lack of empirical studies this question cannot be answered definitively. Suggestions for future research are given to further advance the work in this applicable field of today.

Impact of neuroimmune activation induced by alcohol or drug abuse on adolescent brain development

Evidence obtained in recent decades has demonstrated that the brain still matures in adolescence. Changes in neural connectivity occur in different regions, including cortical and subcortical structures, which undergo modifications in white and gray matter densities. These alterations concomitantly occur in some neurotransmitter systems and hormone secretion, which markedly influence the refinement of certain brain areas and neural circuits. The immaturity of the adolescent brain makes it more vulnerable to the effects of alcohol and drug abuse, whose use can trigger long-term behavioral dysfunction. This article reviews the action of alcohol and drug abuse (cannabis, cocaine, opioids, amphetamines, anabolic androgenic steroids) in the adolescent brain, and their impact on both cognition and behavioral dysfunction, including predisposition to drug abuse in later life. It also discusses recent evidence that indicates the role of the neuroimmune system response and neuroinflammation as mechanisms that participate in many actions of ethanol and drug abuse in adolescence, including the neurotoxicity and alterations in neurocircuitry that contribute to the dysfunctional behaviors associated with addiction. The new data suggest the therapeutic potential of anti-inflammatory targets to prevent the long-term consequences of drug abuse in adolescence.

Factors Associated with Urinary Incontinence in Pregnant Adolescents: A Case-Control Study

STUDY OBJECTIVE

To evaluate the factors associated with urinary incontinence (UI) in pregnant adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A case-control study was conducted in 3 Brazilian public hospitals. Adolescents between the ages of 10 and 19 years with gestational age of 27 weeks or more were included. The sample size was calculated using the Open-epi (http://www.openepi.com/Menu/OE_Menu.htm) 3.01 program considering gestational obesity as an associated factor. The resulting sample consisted of 658 volunteers, 329 in the case group (with UI) and 329 in the control group (without UI). The subjects responded to the evaluation form containing information about the outcome of interest and possible associated factors. Stata 14.0 software (StataCorp) was used to perform multivariate logistic analysis.

RESULTS

The variables age between 10 and 14 years (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.13-5.35; P = .023), previous UI (OR, 1.9; 95% CI, 1.36-2.75; P < .001), and constipation (OR, 1.7; 95% CI, 1.23-2.42; P = .002) were associated with UI in pregnant adolescents. Multigravida was not a factor associated (OR, 0.5; 95% CI, 0.31-0.66; P < .001) for UI in pregnant adolescents.

CONCLUSION

Attention must be given to primigravidae between the ages of 10 and 14 years who report previous UI and/or constipation to ensure referral to the appropriate health care professional for early prevention of UI.

Les traitements hormonaux des mineurs transgenres, ou les obstacles de l’éthique médicale aujourd’hui

L’âge des mineurs qui réclament un traitement pour la dysphorie du genre (anciennement et encore couramment appelée « transgénérisme » ou « transsexualité ») ne cesse de reculer [1], mais un manque de consensus sur des traitements qui soient médicalement et éthiquement acceptables pour les individus prépubères, rend difficile leur prise en charge [2, 3]. Une étude des critères sur lesquels reposent les choix de traitement de ces patients, et plus particulièrement le blocage hormonal, révèle certains obstacles intrinsèques à l’éthique médicale qui empêchent l’élaboration d’une réponse claire et décisive. Nous verrons, dans cette revue, que les experts médicaux, les psychologues et les spécialistes de sciences humaines ne s’accordent pas sur l’origine et donc sur la définition du transgénérisme. Il est ainsi difficile de prendre en charge les individus concernés, l’éthique médicale tirant souvent aujourd’hui son autorité d’un accord général entre les experts. Nous analyserons également comment les risques du traitement proposé, ou les risques de refuser de donner ce traitement, peuvent également peser dans les débats d’éthique médicale, alors qu’ils sont évalués de plusieurs manières, certaines étant plus subjectives que d’autres. Finalement, reste la question difficile du consentement chez les mineurs. L’âge en deçà duquel le mineur ne peut prendre la responsabilité pour ses propres actes apparaît se modifier arbitrairement selon le thème abordé : avortements, traitements pour maladies sexuellement transmissibles, etc. Les débats autour du traitement hormonal des mineurs transgenres doivent donc tenir compte de ces considérations éthiques afin de pouvoir mieux les aider.

Mental health of the male adolescent and young man: the Copenhagen statement

BACKGROUND

Male adolescents and young men benefit when their mental health care is specialized to match their unique gendered and developmental needs. Sensitivity to the social circumstances of this population is important; additionally, the emerging ability to tailor care through knowledge gleaned from the intersection of psychiatry, neurology, and endocrinology informs care.

DATA SOURCES

This article summarized the views of six experts in the area of the adolescent and young adult male mental health. These experts were select members of the World Federation of Societies of Biological Psychiatry's Task Force on Men's Mental Health. They convened to present two symposia on the topic of men's mental health at the 13th World Congress of Biological Psychiatry (WCBP) in Copenhagen, Denmark in 2017.

RESULTS

In these works, a special focus is paid to addictive disorders, disruptive behavior disorders, aggression, and brain development. Collectively, the authors present an argument for the merits of a male-specific model of mental health care to advance the overall well-being of this population.

CONCLUSIONS

Men's mental health should be recognized as a social issue as much as a medical issue, with special attention paid to problems such as unemployment, familial disruption, and substance abuse. These problems, and especially those of major societal impact including violence and suicide which are much more frequently the product of male youth and men, should have more male-tailored options for service provision that respond to men's mental health needs.

Urinary incontinence in pregnant adolescents: A case series

AIMS

Determine the severity of urinary incontinence (UI) and its effect on the quality of life (QoL) of pregnant adolescents, as well as explore the strategies used to manage UI and the reporting/investigation of this condition by healthcare professionals.

METHODS

A case series was conducted in three Brazilian public hospitals that offer prenatal care. Inclusion criteria were: age between 10 and 19 years, gestational age of 27 weeks or more, and reported UI in the third trimester of pregnancy. All volunteers responded to the Incontinence Severity Index (to assess severity of UI) and the International Consultation on Incontinence Questionnaire for Urinary Incontinence-Short Form (to evaluate the effect of UI on QoL). A descriptive analysis of data were done.

RESULTS

A total of 329 incontinent pregnant adolescents with mean age of 17.09 years (95%CI 16.92-17.26), who reported voiding urgency (72.0%), increased daytime urinary frequency (75.1%), nocturia (96.7%), and mixed UI (44.1%) were included in the study. UI was considered moderate to severe (79.3%) and had a moderate effect on QoL (mean 9.84; 95%CI 9.40-10.28). The volunteers used UI management strategies (66.6%), with bladder emptying prior to activities (56.8%) and the use of sanitary pads (29.5%) most frequently reported. UI is not disclosed voluntarily (89.1%) or explored by healthcare professionals (91.2%).

CONCLUSION

UI can be moderate to severe and has a moderate effect on QoL in incontinent pregnant adolescents, who use strategies to manage this condition. Healthcare professionals do not identify this urinary symptom during prenatal care.

Prenatal environmental chemical exposures and longitudinal patterns of child neurobehavior

BACKGROUND

Prenatal chemical exposures may adversely affect neurodevelopment, but few studies have examined the persistence of these associations. We examined whether associations between prenatal bisphenol A (BPA) or polybrominated diphenyl ether (PBDE) exposures persist or resolve as children age.

METHODS

We followed 346 mother-child pairs (enrolled 2003-2006) from Cincinnati, OH from pregnancy until children were 8 years old. We measured BPA in urine collected at 16 and 26 weeks gestation and PBDE-47 in serum collected at 16 weeks gestation. We administered repeated measures of children's behavior, mental/psychomotor development, and IQ from ages 1-8 years. We determined if associations of BPA or PBDE-47 with child neurobehavior persisted or resolved as children aged using linear mixed models and estimated neurobehavioral measure reproducibility using intraclass correlation coefficients (ICCs).

RESULTS

Higher BPA in girls and higher PBDE-47 in both boys and girls were associated with more externalizing behaviors; these associations persisted from ages 2-8 years (exposure×age interaction p-values≥0.36). Higher PBDE-47 concentrations were associated with decreases in MDI from ages 1-3 years (PBDE-47x age interaction p-value=0.03) and persistently lower IQ at ages 5 and 8 years (PBDE-47×age interaction p-value=0.56). Mental/psychomotor abilities had fair reproducibility from ages 1-3 years (ICCs∼0.4), cognitive abilities from ages 5 to 8 years had excellent reproducibility (ICCs=0.7-0.8), and parent-reported behaviors from ages 2-8 years had poor to good reproducibility (ICCs=0.38-0.59).

CONCLUSIONS

Prenatal BPA and PBDE-47 concentrations were persistently associated with more externalizing behaviors. PBDE-47 concentrations were inversely associated with cognitive abilities that strengthened over time.

Age at menarche and risk of developing migraine or non-migraine headaches by young adulthood: A prospective cohort study

Importance

Migraine is a highly prevalent and disabling primary headache disorder that is two to three times more prevalent in young women. Among females, there is a steep increase in incidence from puberty to young adulthood, but the mechanisms for the increase are unknown.

Objective

To determine if age of menarche is a risk factor for developing migraine headache vs. non-migraine headache by young adulthood.

Design

A prospective cohort study, The Growing Up Today Study (GUTS), of adolescents who have been followed since 1996, when they were nine, to 14 years of age. Headache questions were included on the 2007 and 2010 surveys.

Setting

Youth from across the United States who are offspring of women participating in the Nurses’ Health Study II.

Participants

6112 female participants who had provided data on headache symptoms, age at menarche and family history of migraine and were followed through 2007 or 2010 were included in this analysis.

Main outcomes

Migraine or non-migraine headache.

Results

Many females had a history of headaches, with approximately equal numbers reporting symptoms consistent with migraine (29.7%) and non-migraine headaches (25.3%). We found that, independent of age and family history of migraine, each one-year delay in onset of menarche decrease the odds of migraine by 7% (odds ratio (OR) = 0.93, 95% confidence interval (CI) 0.89–0.97), but was not related to non-migraine headaches.

Conclusions and relevance

The findings of this study suggest that early puberty increases the risk of developing migraines by young adulthood. As such, the study emphasizes the need for understanding the pathophysiological links between puberty and developmental changes that occur in the brain during that period and the mechanisms of onset of the migraine disease and its trajectory.

Migraine and Puberty: Potential Susceptible Brain Sites

Puberty is a sensitive and critical period for brain development. The relationship between developmental processes in the brain during puberty and the onset of migraine disease in relation to the potential sites of susceptibility in the brain remains largely unknown. There are few data on how such processes interact with each other in influencing the migraine onset during puberty or even later in adulthood. Focusing on the migraine brain during pubertal development may provide us with a "window of opportunity" both to better understand the mechanisms of the disease and, also more importantly, to effectively intervene.

The Role of Kisspeptin in the Onset of Puberty and in the Ovulatory Mechanism: A Mini-review

The onset of puberty has been a fascinating topic for reproductive endocrinologists for decades; however, its underlying physiological mechanisms have remained elusive until recently. The discovery and understanding of the effects exerted by the peptide hormone kisspeptin have shed light on this research area. This review is aimed to discuss the functions of kisspeptin, with special focus on its role in the onset of puberty and in the ovulatory mechanism. The points under discussion are (1) the characteristics of kisspeptin and its receptor, (2) the relevance of this hormone and its interaction with leptin in the onset of puberty, (3) the role of kisspeptin in the ovulatory mechanism based on its differential expression at hypothalamic nuclei, which is modulated by sex steroid hormones, and (4) the clinical relevance of kisspeptin and its antagonists in new therapeutic strategies for the treatment of various reproductive pathologies. All of this explains the revolution that kisspeptin has caused among researchers working in the field of gynecological endocrinology and reproductive biology.

Psychological, social, and spiritual effects of contraceptive steroid hormones

Governments and society have accepted and enthusiastically promoted contraception, especially contraceptive steroid hormones, as the means of assuring optimal timing and number of births, an undoubted health benefit, but they seldom advert to their limitations and side effects. This article reviews the literature on the psychological, social, and spiritual impact of contraceptive steroid use. While the widespread use of contraceptive steroid hormones has expanded life style and career choices for many women, their impact on the women's well-being, emotions, social relationships, and spirituality is seldom mentioned by advocates, and negative effects are often downplayed. When mentioned at all, depression and hypoactive sexual desire are usually treated symptomatically rather than discontinuing their most frequent pharmacological cause, the contraceptive. The rising incidence of premarital sex and cohabitation and decreased marriage rates parallel the use of contraceptive steroids as does decreased church attendance and/or reduced acceptance of Church teaching among Catholics. Lay summary: While there is wide, societal acceptance of hormonal contraceptives to space births, their physical side effects are often downplayed and their impact on emotions and life styles are largely unexamined. Coincidental to the use of "the pill" there has been an increase in depression, low sexual desire, "hook-ups," cohabitation, delay of marriage and childbearing, and among Catholics, decreased church attendance and reduced religious practice. Fertility is not a disease. Birth spacing can be achieved by natural means, and the many undesirable effects of contraception avoided.

Perinatal administration of aromatase inhibitors in rodents as animal models of human male homosexuality: similarities and differences

In this chapter we briefly review the evidence supporting the existence of biological influences on sexual orientation. We focus on basic research studies that have affected the estrogen synthesis during the critical periods of brain sexual differentiation in male rat offspring with the use of aromatase inhibitors, such as 1,4,6-androstatriene-3,17 (ATD) and letrozole. The results after prenatal and/or postnatal treatment with ATD reveal that these animals, when adults, show female sexual responses, such as lordosis or proceptive behaviors, but retain their ability to display male sexual activity with a receptive female. Interestingly, the preference and sexual behavior of these rats vary depending upon the circadian rhythm.Recently, we have established that the treatment with low doses of letrozole during the second half of pregnancy produces male rat offspring, that when adults spend more time in the company of a sexually active male than with a receptive female in a preference test. In addition, they display female sexual behavior when forced to interact with a sexually experienced male and some typical male sexual behavior when faced with a sexually receptive female. Interestingly, these males displayed both sexual behavior patterns spontaneously, i.e., in absence of exogenous steroid hormone treatment. Most of these features correspond with those found in human male homosexuals; however, the "bisexual" behavior shown by the letrozole-treated rats may be related to a particular human population. All these data, taken together, permit to propose letrozole prenatal treatment as a suitable animal model to study human male homosexuality and reinforce the hypothesis that human sexual orientation is underlied by changes in the endocrine milieu during early development.

Antecedents and sex/gender differences in youth suicidal behavior

Suicide is the second leading cause of death in youth globally; however, there is uncertainty about how best to intervene. Suicide rates are typically higher in males than females, while the converse is true for suicide attempts. We review this "gender paradox" in youth, and in particular, the age-dependency of these sex/gender differences and the developmental mechanisms that may explain them. Epidemiologic, genetic, neurodevelopmental and psychopathological research have identified suicidal behaviour risks arising from genetic vulnerabilities and sex/gender differences in early adverse environments, neurodevelopment, mental disorder and their complex interconnections. Further, evolving sex-/gender-defined social expectations and norms have been thought to influence suicide risk. In particular, how youth perceive and cope with threats and losses (including conforming to others' or one's own expectations of sex/gender identity) and adapt to pain (through substance use and help-seeking behaviours). Taken together, considering brain plasticity over the lifespan, these proposed antecedents to youth suicide highlight the importance of interventions that alter early environment(s) (e.g., childhood maltreatment) and/or one's ability to adapt to them. Further, such interventions may have more enduring protective effects, for the individual and for future generations, if implemented in youth.

Impacts of stress and sex hormones on dopamine neurotransmission in the adolescent brain

RATIONALE

Adolescence is a developmental period of complex neurobiological change and heightened vulnerability to psychiatric illness. As a result, understanding factors such as sex and stress hormones which drive brain changes in adolescence, and how these factors may influence key neurotransmitter systems implicated in psychiatric illness, is paramount.

OBJECTIVES

In this review, we outline the impact of sex and stress hormones at adolescence on dopamine neurotransmission, a signaling pathway which is critical to healthy brain function and has been implicated in psychiatric illness. We review normative developmental changes in dopamine, sex hormone, and stress hormone signaling during adolescence and throughout postnatal life, then highlight the interaction of sex and stress hormones and review their impacts on dopamine neurotransmission in the adolescent brain.

RESULTS AND CONCLUSIONS

Adolescence is a time of increased responsiveness to sex and stress hormones, during which the maturing dopaminergic neural circuitry is profoundly influenced by these factors. Testosterone, estrogen, and glucocorticoids interact with each other and have distinct, brain region-specific impacts on dopamine neurotransmission in the adolescent brain, shaping brain maturation and cognitive function in adolescence and adulthood. Some effects of stress/sex hormones on cortical and subcortical dopamine parameters bear similarities with dopaminergic abnormalities seen in schizophrenia, suggesting a possible role for sex/stress hormones at adolescence in influencing risk for psychiatric illness via modulation of dopamine neurotransmission. Stress and sex hormones may prove useful targets in future strategies for modifying risk for psychiatric illness.

Cortisol levels and risk for psychosis: initial findings from the North American prodrome longitudinal study

BACKGROUND

Studies of biomarkers of hypothalamic-pituitary-adrenal activity indicate that psychotic disorders are associated with elevated cortisol. This study examined cortisol levels in healthy control subjects and individuals who met clinical high-risk (CHR) criteria for psychosis. It was hypothesized that cortisol levels would be 1) elevated in the CHR group relative to control subjects, 2) positively correlated with symptom severity, and 3) most elevated in CHR patients who transition to psychotic level severity.

METHODS

Baseline assessments were conducted at eight centers in the North American Prodrome Longitudinal Study. The present CHR sample included 256 individuals meeting the Scale for Prodromal Symptoms criteria and 141 control subjects, all of whom underwent baseline assessment and measurement of salivary cortisol.

RESULTS

Consistent with previous reports, there was an effect of age on cortisol, with increases through the adolescent/early adult years. Analysis of covariance showed a main effect of diagnostic group, with the CHR group showing higher cortisol. There were modest, positive correlations of cortisol with baseline symptom severity, and analysis of covariance revealed higher baseline cortisol in those who transitioned to psychotic level symptoms when compared with healthy control subjects and CHR subjects who remitted.

CONCLUSIONS

The present findings add to accumulating evidence of heightened cortisol secretion in CHR individuals. The findings also indicate nonspecific associations between cortisol levels and symptom severity, as well as symptom progression. The role of hypothalamic-pituitary-adrenal activity in prediction of conversion to psychosis and its relation with other biomarkers of risk should receive attention in future research.

Autism as the Early Closure of a Neuroplastic Critical Period Normally Seen in Adolescence

The most severe cases of autism are diagnosed by extreme social dysfunction and other behavioral abnormalities. A number of genetic studies have been conducted to correlate behavioral phenotypes to genetic dysfunctions, but no "autism gene" has yet been discovered. In addition, environmental factors have been found to influence the development of autistic traits with high probability. This review will examine the role of a shortened period of neuroplasticity as a unifying feature of the autistic phenotype. The neuroplastic period of interest normally extends into adolescence, allowing for neural integration and the development of language and social skills. Early closure of this period may result in a shortened period of development, forcing the brain to rely on underdeveloped structures.

The development of psychotic disorders in adolescence: a potential role for hormones

This article is part of a Special Issue "Puberty and Adolescence". The notion that adolescence is characterized by dramatic changes in behavior, and often by emotional upheaval, is widespread and longstanding in popular western culture. In recent decades, this notion has gained increasing support from empirical research showing that the peri- and post-pubertal developmental stages are associated with a significant rise in the rate of psychiatric symptoms and syndromes. As a result, interest in adolescent development has burgeoned among researchers focused on the origins of schizophrenia and other psychotic disorders. Two factors have fueled this trend: 1) increasing evidence from longitudinal research that adolescence is the modal period for the emergence of "prodromal" manifestations, or precursors of psychotic symptoms, and 2) the rapidly accumulating scientific findings on brain structural and functional changes occurring during adolescence and young adulthood. Further, gonadal and adrenal hormones are beginning to play a more prominent role in conceptualizations of adolescent brain development, as well as in the origins of psychiatric symptoms during this period (Walker and Bollini, 2002; Walker et al., 2008). In this paper, we begin by providing an overview of the nature and course of psychotic disorders during adolescence/young adulthood. We then turn to the role of hormones in modulating normal brain development, and the potential role they might play in the abnormal brain changes that characterize youth at clinical high-risk (CHR) for psychosis. The activational and organizational effects of hormones are explored, with a focus on how hormone-induced changes might be linked with neuropathological processes in the emergence of psychosis.

[Puberty, fertility and chronic diseases]

The onset of puberty is the sum of complex and multifactorial mechanisms resulting from the action of both activating and inhibiting factors, leading to the maturation of the gonads and the ability to reproduce. Many contributors to pubertal development are involved in fat mass acquisition and their action is relayed through the hypothalamus. It is therefore easy to understand how chronic diseases can affect the development of puberty and fertility apart from the specific impact of their molecular alteration. We have chosen cystic fibrosis and chronic renal disease as examples of chronic disorders affecting puberty through distinct mechanisms. As drugs are undistinguishable from chronic diseases, we also describe the impact of corticosteroids and chemotherapy on reproductive function. Last, we describe the surveillance and care of pubertal delay and its consequences (growth and bone mineralization) of patients affected with chronic disorders during adolescence.

Social and emotional predictors of the tempo of puberty in female rhesus monkeys

A cascade of neuroendocrine events regulates the initiation and progression of female puberty. However, the factors that determine the timing of these events across individuals are still uncertain. While the consequences of puberty on subsequent emotional development and adult behavior have received significant attention, what is less understood are the social and environmental factors that actually alter the initiation and progression of puberty. In order to more fully understand what factors influence pubertal timing in females, the present study quantified social and emotional behavior; stress physiology; and growth and activity measures in juvenile female rhesus monkeys to determine what best predicts eventual puberty. Based on previous reports, we hypothesized that increased agonistic behavior resulting from subordinate status in their natal group, in combination with slowed growth, reduced prosocial behavior, and increased emotional reactivity would predict delayed puberty. The analyses were restricted to behavioral and physiological measures obtained prior to the onset of puberty, defined as menarche. Together, our findings indicate that higher rates of aggression but lower rates of submission received from group mates; slower weight gain; and greater emotional reactivity, evidenced by higher anxiety, distress and appeasing behaviors, and lower cortisol responsivity in response to a potentially threatening situation, predicts delayed puberty. Together the combination of these variables accounted for 58% of the variance in the age of menarche, 71% in age at first ovulation, and 45% in the duration of adolescent sterility. While early puberty may be more advantageous for the individual from a fertility standpoint, it presents significant health risks, including increased risk for a number of estrogen dependent cancers and as well as the emergence of mood disorders during adulthood. On the other hand, it is possible that increased emotional reactivity associated with delayed puberty could persist, increasing the risk for emotional dysregulation to socially challenging situations. The data argue for prospective studies that will determine how emotional reactivity shown to be important for pubertal timing is affected by early social experience and temperament, and how these stress-related variables contribute to body weight accumulation, affecting the neuroendocrine regulation of puberty.

Gray matter volumetric abnormalities associated with the onset of psychosis

Patients with psychosis display structural brain abnormalities in multiple brain regions. The disorder is characterized by a putative prodromal period called ultra-high-risk (UHR) status, which precedes the onset of full-blown psychotic symptoms. Recent studies on psychosis have focused on this period. Neuroimaging studies of UHR individuals for psychosis have revealed that the structural brain changes observed during the established phases of the disorder are already evident prior to the onset of the illness. Moreover, certain brain regions show extremely dynamic changes during the transition to psychosis. These neurobiological features may be used as prognostic and predictive biomarkers for psychosis. With advances in neuroimaging techniques, neuroimaging studies focusing on gray matter abnormalities provide new insights into the pathophysiology of psychosis, as well as new treatment strategies. Some of these novel approaches involve antioxidants administration, because it is suggested that this treatment may delay the progression of UHR to a full-blown psychosis and prevent progressive structural changes. The present review includes an update on the most recent developments in early intervention strategies for psychosis and potential therapeutic treatments for schizophrenia. First, we provide the basic knowledge of the brain regions associated with structural abnormalities in individuals at UHR. Next, we discuss the feasibility on the use of magnetic resonance imaging (MRI)-biomarkers in clinical practice. Then, we describe potential etiopathological mechanisms underlying structural brain abnormalities in prodromal psychosis. Finally, we discuss the potentials and limitations related to neuroimaging studies in individuals at UHR.