Neuroendocrine mechanisms involved in the physiological effects caused by skin-to-skin contact – With a particular focus on the oxytocinergic system

The positive clinical effects caused by skin-to-skin contact immediately after birth or after repeated skin-to-skin contact of premature infants (kangaroo care) or fullterm infants are well documented in the literature. However, information regarding the physiological mechanisms mediating these effects are surprisingly scarce and incomplete. In this article the oxytocinergic system and the cutaneous sensory pathways by which the oxytocinergic system is activated in response to skin-to-skin contact are presented in more detail. In addition, we discuss how the effects of skin-to-skin treatment can be attributed to different aspects of the effect spectrum of the oxytocinergic or calm and connection system.The structure of the oxytocinergic system, comprising the peripheral (circulating, hormonal) and the central (neurotransmitter) components, as well as, the pathways and mechanisms by which these functions are coordinated are described. Also the various effects induced by the oxytocinergic system (the calm and connection system) are reviewed.The sensory pathways, which include visual, auditory, olfactory and tactile stimuli, given and received by both mother and newborn and which activate the oxytocinergic system in response to skin-to-skin contact, are reviewed. A special emphasis is placed on the role of cutaneous sensory nerves and their activation by touch, light pressure and in particular warmth. The important role of the rise and the pulsatility of maternal temperature in mediating the positive effects of skin-to-skin contact in the newborn is highlighted. The concept of maternal giving of warmth and its possible link to the experience of trust and safety in the newborn is discussed from an evolutionary perspective.The effects induced by skin-to-skin contact can be attributed to the different functions of the oxytocinergic system. Ameliorated social interaction (e.g., more tactile and auditory interaction, more sensitive and synchronous interaction between mother and baby, the baby’s crawling behavior) are expressions of oxytocin’s ability to stimulate social interaction. The decreased levels of fear and stress are expressions of oxytocin’s ability to reduce the activity of the amygdala and of the stress system, e.g. the activity in the HPA-axis and the sympathetic nervous system. Increased HRV, increased activity in endocrine system of the gastrointestinal tract as well as stimulation of growth and maturation are examples of oxytocin’s ability to stimulate the activity of the parasympathetic nervous system and other peripheral and central mechanisms related to restoration and growth.The propensity of different types of treatment with skin-to-skin contact to induce long-term effects is also highlighted. We propose that the sustained effects caused by skin-to-skin contact are induced by an enduring shift in the balance between the oxytocinergic system (the calm and connection system) and the stress system (fight flight reaction) in favor of the oxytocinergic system. This shift leads to a sustained decrease in the HPA-axis and the sympathetic nervous system probably involving alpha 2-adrenoceptors.It is of clinical importance to be aware of the mechanisms by which skin-to-skin contact induces short and longterm positive effects in parents and newborns. If ward routines are adapted to ascertain a maximal stimulation of these mechanisms, the function of the oxytocinergic system will be optimized, which will be linked to a better clinical outcome for parents and newborns.     

A hermeneutic study of integrating psychotherapist competence in postnatal Child Health Care: Parents’ perspectives

A child's emotional and social development depends on the parents’ provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents’ experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists’ technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified.     

The intersectionality of race/ethnicity and socioeconomic status on social and emotional skills

The intersectionality of race/ethnicity and socioeconomic status (SES) in predicting social and emotional (SE) skills was examined for 81,950 6th–8th graders. At low levels of SES, White students tended to have the lower SE scores. However, as SES increased, they tended to have higher scores relative to minority groups. Across SES levels, Asian students showed higher Academic Discipline and Self-Regulation scores. The SES and SE skill relationship was less pronounced for underserved minority groups. This may be among the first reports where a measure of SE skills has documented different relationships with SES as a function of race/ethnicity. Possible explanations for these findings, as well as implications for designing culturally responsive programs that focus on SE skills, are discussed.     

群体认同对群际敏感效应及其行为表现的影响

通过实验研究了群际互动中个体对不同来源身份的消极群体评价的情绪反应及群体认同的调节作用, 并从情绪-行为反应的连续性视角探索群际敏感效应的行为表现及内在机制。结果发现:(1)相比内群体的消极群体评价, 外群体的消极群体评价更能引起消极情绪反应; (2)群体认同对群际敏感效应起调节作用, 高群体认同者对来自外群体消极评价的情绪反应更加负面, 而低群体认同者这种趋势并不明显; (3)高群体认同者在经历外群体的消极群体评价后会表现出更多的内群体积极行为, 且消极情绪反应对此起中介作用。研究扩展了群际敏感效应的适用范围, 并为探讨其内部机制和后续影响提供了新的研究思路。     

左侧眶额皮层在自动情绪调节下注意选择中的作用：来自经颅直流电刺激的证据

前人研究表明自动情绪调节能够自上而下地影响情绪及情绪性注意过程。近来有研究提示自动情绪调节与眶额皮层(orbitofrontal cortex, OFC)有关。也有研究表明左侧OFC的激活影响负性注意偏向。本研究采用经颅直流电刺激技术, 考察阈下启动情绪控制目标条件下, 抑制左侧眶额皮层兴奋性是否影响负性注意偏向。结果发现, 使用阴极刺激抑制左侧OFC活动可以加快被试对与恐惧刺激位置一致的探测点的反应。该结果提示左侧眶额皮层是自动情绪调节下情绪性注意选择相关的重要脑区。     

The association between risky decision making and attention-deficit/hyperactivity disorder symptoms: A preregistered assessment of need for cognition as underlying mechanism

Attention-Deficit/Hyperactivity Disorder (ADHD) is related to suboptimal decision making in experimental tasks and to real-life risk-taking behavior (RTB) such as substance abuse and unsafe traffic conduct. In this preregistered study, we tested whether these associations are mediated by need for cognition—the extent to which one tends towards, and enjoys, analytical thought. In a large sample of young adults (N = 463, M_age = 19.7 years), we tested whether need for cognition mediated the association between self-reported ADHD symptoms on the one hand and decision-making strategy complexity on an experimental gambling task and self-reported real-life RTB on the other hand. Preregistered confirmatory analyses indicated first that ADHD symptoms were positively associated with real-life RTB, but the association was not mediated by need for cognition. Second, ADHD symptoms were not related to decision-making strategy complexity, and need for cognition was not a significant mediator. Explorative analyses revealed that (a) need for cognition was associated with higher decision-making accuracy and slower reaction time; (b) need for cognition was related to inattentive but not to hyperactive/impulsive ADHD symptoms; (c) need for cognition was associated with health-related RTB but not interpersonal RTB; and (4) only the association between inattention and health-related RTB was mediated by need for cognition. We conclude that need for cognition is not a mediator in the association between ADHD symptoms and RTB. Additionally, we conclude that neither ADHD symptoms nor need for cognition predict decision-making strategy complexity. Implications for both future research and clinical practice are discussed.     

L’annonce d’un décès en milieu hospitalier

Announcing a death is always a delicate moment for close familial members but also for caregivers. Law gives some precisions about how this information must be delivered. Recently the state council judged that the lack of empathy from caregivers and the late of the death announcement can create a damage. This judgement gives more precisions about how a death announcement must be in a hospital. This topic is pretty similar with the information which must be given to close familial members about organ donation. This latter is definitely more exceptional and the procedure is a way more regulated. There are much rules which explain how this information must be delivered.     

La responsabilité pénale du psychiatre du fait de son patient

If the criminal liability remains personal, recent case law has tended to broaden the hypotheses for the doctor's criminal liability in the case of unintentional offenses. The question particularly concerns the psychiatrist, because of acts committed by his patient, on the basis of articles 221-6 or 222-19 of the French penal code. However, judicial assessment of the fault and its causal link with the damage does not impose on the psychiatrist an obligation of result, insofar as only serious professional misconduct, manifestly not in accordance with the rules of medical art, are sanctioned.     

Utilisation de l’engagement pour limiter la valorisation des fumeurs chez les adolescents

IntroductionSocial psychology research about commitment has demonstrated that it is possible to change one people's cognition and behavior.ObjectiveThe aim of the present article is to show that commitment can be used as a reduction strategy of smokers’ valorization and smoking normativity in order to reduce smoking.MethodStudents have been followed into a longitudinal study from end of elementary school to 8th grade class. They have been divided into different groups representing the smoking prevention's degree of commitment.ResultsRsults suggest that the sooner they are engaged in schooling, the better is the prevention. Commitment intervention made later in schooling has no influence on students smoking valorization.ConclusionResults will be discussed in terms of commitment theory by highlighting that an intervention using commitment is efficient only if the target is not already committed in an opposite behavior.