STRUCTURAL AND BIOCHEMICAL CHANGES IN CHILDREN VICTIMS OF CHILD ABUSE: A NARRATIVE REVIEW

Abstract

Introduction: Humans are defenseless in the first years of life due to the long period necessary for the complete development of the brain, which is shaped by the environment through the neuroplasticity process, and may undergo negative changes according to disastrous experiences. Abuse/violence and child neglect are acts or omissions of care, respectively, potentially capable of causing physical and/or mental harm, actual or potential, against minors under the age of 18. As Brazil reaches alarming levels of violence and child abuse, according to international data linked to the World Health Organization and nationals originating from the Notifiable Diseases Information System (SINAN), the identification of these victims and the adoption of preventive and therapeutic measures make the role of the doctor in society even more fundamental. Children who are subjected to maltreatment have potential risks of attending with structural and biochemical brain alterations which will have a negative impact, and may even be permanent, distinct intensity and vary according to the patient’s age group. Method: A study was carried out at the FMABC University Center through a narrative literature review in the PubMed database, applying the descriptors ”Child Abuse” and ”Brain Development”, with boleano ”and”. The search time was 2016 to 2022. Thirty-five articles were selected based on the reading of the abstracts of each article and listed in order of relevance. RESULTS: Imaging and population studies allowed the relationship of cases of child abuse with structural, volumetric, biochemical and clinical alterations of patients. Thus, although a mandatory causal effect cannot be traced, the relationship between psychopathology and child abuse is well established. In general, the main structural changes seen in victims of child abuse are the reduction of hippocampus, callous body, anterior cingulate cortex, frontal orbit cortex and dorsolateral prefrontal cortex. Furthermore, alterations in the amygdala, cerebellar vermis and hypothalamus-pituitary-adrenal axis give basis to the main clinics of these patients. Another point to consider is the hypothesis that certain polymorphisms can together determine how malleable a person is for both positive and negative experiences (phenotypic plasticity). In genetically susceptible people, epigenetic changes induced by maltreatment that, in turn, alter brain development trajectories can, in many cases, represent the beginning of a crucial chain of events that lead to psychopathology and risk of substance abuse, for example. Therefore, in a country like Brazil where child violence reaches alarming levels, it is mandatory to elucidate the influence of violence imposed on the phases of neurological development (structural and biochemical) on psychopathologies, substance abuse and the perpetuation of violence. This devastating scenario determines that public intervention policies should be widely discussed, developed and implemented. Physicians are responsible for the warning to act as early as possible in the diagnosis, both in educational, preventive measures and at the same time of the adoption of appropriate drug and non-drug therapies not only at the time of violence, but over time so that it can identify possible deviations and, thus, act appropriately. Conclusion: According to the information presented, we have that combating this abuse in childhood and the proper monitoring of these people may cause a reduction in the presentation of the clinical conditions of psychopathy and antisocial personality disorder, which tend, according to the history of these patients, to present problems of a social nature regarding violence and crime perpetration.