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Cao P, Peng R, Yuan Q, Zhou R, Ye M, Zhou X. Predictors of non-suicidal self-injury in adolescents with depressive disorder: the role of alexithymia, childhood trauma, and body investment. Front Psychol 2024; 15:1336631. [PMID: 38638510 PMCID: PMC11024233 DOI: 10.3389/fpsyg.2024.1336631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/27/2024] [Indexed: 04/20/2024] Open
Abstract
Purpose This study analyzes the relationship of alexithymia, childhood trauma, and body investment to non-suicidal self-injury (NSSI) behaviors in adolescents with depressive disorder and whether they have predictive and diagnostic value for non-suicidal self-injury (NSSI) behaviors in adolescents with depressive disorder. Patients and methods A total of 225 patients with a diagnosis of adolescent depressive disorder were included in the study and were divided into two groups according to the DSM-5 criteria: 98 cases without NSSI and 127 cases with NSSI. Compare the demographic data, 24-item Hamilton Depression Scale (HAMD-24), 20-item Toronto Alexithymia Scale (TAS-20), Childhood Trauma Questionnaire-Short Form (CTQ-SF), and Body Investment Scale (BIS) scores between two groups. Binary logistic regression was used to analyze the independent risk factors contributing to NSSI behaviors in adolescents with depression, and establish four predictive models. Based on the models' predictive probability, the ROC curves were plotted to calculate the value of the predictive diagnostic effect. Results The group without NSSI had lower scores than the group with NSSI on HAMD-24 total score, TAS-20 total score, difficulty identifying feelings, difficulty describing feelings, and externally focused thinking, as well as lower scores on CTQ-SF total score, physical neglect, emotional neglect, physical abuse, and emotional abuse. In contrast, the BIS total score, body image feelings and attitudes, body care, and body protection factor scores were higher for the group without NSSI. The BIS body care factor score and the CTQ-SF emotional abuse factor score were significantly linked with adolescents diagnosed with depressive disorder who exhibited NSSI behaviors. These results provide a good diagnostic model for adolescents with depressive disorder. Conclusion Low levels of body care and childhood emotional abuse may independently contribute to the implementation of NSSI in adolescents with depressive disorder. Body investment and childhood trauma are valuable in diagnosing and predicting NSSI behaviors and should be considered as potentially important factors in clinical treatment.
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Affiliation(s)
- Panpan Cao
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Anhui Psychiatric Center, Hefei, China
| | - Ran Peng
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Anhui Psychiatric Center, Hefei, China
| | - Qiuyu Yuan
- Bengbu Mental Health Center, Anhui Veterans Hospital, Anmin Hospital Affiliated to Bengbu Medical College, Bengbu, China
| | - Ruochen Zhou
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Anhui Psychiatric Center, Hefei, China
| | - Mengting Ye
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Anhui Psychiatric Center, Hefei, China
| | - Xiaoqin Zhou
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Anhui Psychiatric Center, Hefei, China
- Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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2
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Luciani KR, Johal PK, Chao T, Thiessen KA, Schütz CG. Adult self-reported childhood maltreatment types are associated with treatment satisfaction and alcohol relapse in patients with comorbid substance use and mental health disorders. Am J Addict 2024. [PMID: 38504581 DOI: 10.1111/ajad.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Individuals with comorbid substance use and mental health disorders (concurrent disorders; CD) report poor treatment outcomes, high prevalence of childhood maltreatment, and mostly negative experiences with treatment. No studies to date have examined childhood maltreatment and treatment outcomes in CD. This study investigated self-reported childhood maltreatment as it relates to treatment satisfaction and substance use relapse among CD patients. METHODS The 258 CD inpatients completed a self-report questionnaire package, comprising the Childhood Trauma Questionnaire and the Inpatient Consumer Survey (ICS). Childhood maltreatment was assessed according to five subtypes and self-perceived treatment satisfaction was rated across six ICS domains. Psychiatric diagnoses, substance use status and relapse data were retrieved via patient medical charts. RESULTS Emotional neglect was associated with lower ratings across all ICS domains and physical neglect was associated with a lower rating for 'outcome of care'. Childhood sexual abuse was associated with a greater likelihood of alcohol relapse. No other relationships were statistically significant. DISCUSSION AND CONCLUSIONS The presence of childhood neglect (but not abuse) was more associated with overall treatment dissatisfaction, and sexual abuse alone increased the likelihood of alcohol relapse. These findings suggest some early adverse experiences in CD patients may increase negative experiences in treatment while others contribute to the risk of substance use. Broader longitudinal research is needed to examine the trajectory leading to negative outcomes. SCIENTIFIC SIGNIFICANCE This is the first study to report differential patterns of association by type of childhood maltreatment on negative outcomes in treatment among CD patients.
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Affiliation(s)
- Karling R Luciani
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Priya K Johal
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Chao
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karina A Thiessen
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian G Schütz
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- BC Mental Health & Substance Use Services Research Institute, PHSA, Vancouver, British Columbia, Canada
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3
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Boals A. Illusory posttraumatic growth is common, but genuine posttraumatic growth is rare: A critical review and suggestions for a path forward. Clin Psychol Rev 2023; 103:102301. [PMID: 37331153 DOI: 10.1016/j.cpr.2023.102301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023]
Abstract
Over the last 2.5 decades, trauma researchers have increasingly become interested in posttraumatic growth (PTG) - the concept that some people experience growth as a result of trauma exposure. I begin by reviewing extant research on PTG, with a focus on measurement and conceptual issues. Expanding on arguments made by others, I distinguish between three forms of PTG, 1) perceived PTG, which is an individual's beliefs about their own PTG, 2) genuine PTG, which is veridical growth following adversity, and 3) illusory PTG, which is motivated fabrications of PTG. Perceived PTG is extremely common, as over half of individuals exposed to a potentially traumatic event (PTE) report moderate or greater levels of PTG. I review evidence that most self-reports of PTG are greatly exaggerated and argue that perceived PTG is mostly illusory PTG. I propose five reasons for the disconnect between perceived PTG and genuine PTG, including design flaws in the current measurements, emotional biases that favor perceived PTG, the inherent appeal of PTG, cultural expectations, and problems of definition. I then review the empirical evidence concerning the prevalence rate of genuine PTG, coming to the bold conclusion that the occurrence of genuine PTG is very rare, contradicting current fundamental beliefs about PTG. I recommend researchers focus on the key areas of measurement and etiology of genuine PTG, which are necessary to create interventions that foster genuine PTG. I conclude by outlining a path to steer the scientific progression of PTG back in the right direction.
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Affiliation(s)
- Adriel Boals
- University of North Texas, United States of America.
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4
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Im H, George N, Swan LE. Born in displacement: Psychosocial and mental health impacts of country of birth among urban Somali refugee youth. Glob Public Health 2022; 17:3426-3439. [DOI: https:/doi.org/10.1080/17441692.2022.2106378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 07/18/2022] [Indexed: 06/22/2023]
Affiliation(s)
- Hyojin Im
- Ph.D., MA, MSW, Associate Professor, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Nicole George
- MSW, Doctoral Student, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Laura E.T. Swan
- Ph.D., LCSW, Postdoctoral Research Associate, Department of Population Health Sciences, University of Wisconsin - Madison, Madison, WI, USA
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5
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Im H, George N, Swan LET. Born in displacement: Psychosocial and mental health impacts of country of birth among urban Somali refugee youth. Glob Public Health 2022; 17:3426-3439. [PMID: 35923097 DOI: 10.1080/17441692.2022.2106378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Urban refugees often face tremendous adversities during displacement that exacerbate mental health and psychosocial outcomes. Given the lack of research on how extended displacement affects mental health in urban refugee youth, this study examines the differential effects of country of birth on trauma exposure and psychosocial factors that influence mental health experiences among Somali refugee youth in urban Kenya (n = 303). Findings reveals that childhood trauma and impeded social functioning predicted mental health outcomes. Being born in Kenya was a significant predictor of poor mental health despite there being no significant difference in trauma exposures and psychosocial factors between Somali-born and Kenya-born youth. This difference can be attributed to prolonged displacement, disrupted development of cultural identity, and discrimination experienced in the host country. Given the widely devastating effects of childhood trauma and community violence, mental health interventions need to be two-prolonged: addressing and preventing intergenerational trauma sequelae through family-based interventions; and community-level programs and advocacy for safety and protection for the displaced. Our findings also emphasize that future interventions for urban refugee communities should be inclusive to all community members, considering shared vulnerability to community violence as well as intergenerational transmission of traumas through childhood adversities and lacking support.
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Affiliation(s)
- Hyojin Im
- Ph.D., MA, MSW, Associate Professor, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Nicole George
- MSW, Doctoral Student, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Laura E T Swan
- Ph.D., LCSW, Postdoctoral Research Associate, Department of Population Health Sciences, University of Wisconsin - Madison, Madison, WI, USA
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KULACAOĞLU F, İZCİ F, YİLDİRİM YE, DIŞPINAR Nİ, CESUR MS. Bipolar bozukluğu olan hastalarda çocukluk çağı travması, çift uyumu ve cinsel işlevler arasındaki ilişki. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1137578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: This study aimed to investigate the dyadic adjustment and sexual functions in patients with bipolar disorder (BD) during the remission period, and examine the effect of a history of childhood trauma on these.
Materials and Methods: This cross-sectional study is consisted of 80 (46 female, 34 male) patients with bipolar disorder-1 and 40 (25 female, 15 male) healthy controls. The Dyadic Adjustment Scale (DAS), Childhood Trauma Questionnaire (CTQ-28), Arizona Sexual Questionnaire (ASEX) were administered to the participants.
Results: The patient group showed significantly higher trauma scores in all subscales and total scores of the CTQ-28, and lower scores in the subscales and total score of DAS compared to the control group. 82.5% of bipolar patients and 57.5% of healthy controls were found to have sexual dysfunction (SED). According to the results of linear regression and multiple regression analyses, age and DAS-total score predicted SED, and male gender, absence of SED and CTQ-total score predicted DAS score.
Conclusion: Patients with BD have more dyadic problems, sexual dysfunction, and trauma history than healthy controls. Sexual function and dyadic adjustment affect each other in two ways and a history of childhood trauma has a negative effect on both sexual function and dyadic adjustment.
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Affiliation(s)
- Filiz KULACAOĞLU
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ERENKÖY APPLICATION AND RESEARCH CENTER FOR PSYCHIATRIC AND NERVE DISEASES
| | - Filiz İZCİ
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ERENKÖY APPLICATION AND RESEARCH CENTER FOR PSYCHIATRIC AND NERVE DISEASES
| | | | - Nazmiye İlayda DIŞPINAR
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ERENKÖY APPLICATION AND RESEARCH CENTER FOR PSYCHIATRIC AND NERVE DISEASES
| | - Merve Sinem CESUR
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ERENKÖY APPLICATION AND RESEARCH CENTER FOR PSYCHIATRIC AND NERVE DISEASES
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7
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Zhao J, Lu XH, Liu Y, Wang N, Chen DY, Lin IA, Li XH, Zhou FC, Wang CY. The Unique Contribution of Past Bullying Experiences to the Presence of Psychosis-Like Experiences in University Students. Front Psychiatry 2022; 13:839630. [PMID: 35573375 PMCID: PMC9096161 DOI: 10.3389/fpsyt.2022.839630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Both bullying and psychosis-like experiences (PLEs) have gained much attention in recent years, but their interactions are not fully unraveled. The aim of the current study was to validate the Chinese version of Bullying Scale for Adults (C-BSA), and to investigate whether past bullying experiences independently predict the presence of PLEs in university students. METHODS The validity and reliability of the C-BSA were determined in two independent samples. A battery of psychological inventories was also administered to assess the presence of PLEs, maltreatment history in the family, and current depression and anxiety, including the 15-item positive subscale of the community assessment of psychic experiences (CAPE-p15), the Chinese version of the Childhood Trauma Questionnaire (CTQ), Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS). RESULTS In the construction sample (N = 629), a Cronbach's α of 0.921 indicated a good internal consistency of C-BSA. The exploratory factor analysis (EFA) yielded a four-factor model and a three-factor model, and both were verified by using the confirmatory factorial analysis (CFA) in the validation sample (N = 629). The total scores of C-BSA were significantly correlated with that of CTQ, CAPE-p15, SDS, and SAS. Multivariate logistic regression revealed that bullying was associated with 2.0 or 3.7 times of risk for the presence of PLEs (numbers of bullying types < = 3 or > 3, respectively) after controlling for CTQ, SDS, and SAS scores. CONCLUSIONS C-BSA has shown good psychometric properties in college students. The contribution of past bullying experiences to the present PLEs seems to be independent of other childhood trauma, current depression, and anxiety.
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Affiliation(s)
- Jie Zhao
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Xiao-Hua Lu
- Psychological Consulting Center, Beijing Jiaotong University, Beijing, China
| | - Yuan Liu
- Nursing Department, National University Polyclinic, Singapore, Singapore
| | - Nan Wang
- Department of General Psychiatry, Central Region, Institute of Mental Health, Singapore, Singapore
| | - Dong-Yang Chen
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Iun-An Lin
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Xiao-Hong Li
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Fu-Chun Zhou
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Chuan-Yue Wang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
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8
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Chaiyachati BH, Gur RE. Effect of child abuse and neglect on schizophrenia and other psychotic disorders. Pharmacol Biochem Behav 2021; 206:173195. [PMID: 33961909 PMCID: PMC10961915 DOI: 10.1016/j.pbb.2021.173195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 12/25/2022]
Abstract
Childhood experiences impact long-term physical and behavioral health outcomes including potential risk for schizophrenia and psychosis. Negative experiences, such as child abuse and neglect, have been specifically associated with risk for schizophrenia and psychosis. This review provides a brief overview of child abuse and neglect, including its position within the larger field of trauma and adversity and its long term consequences. The link to schizophrenia is then explored. Principles of treatment and outcomes for schizophrenia with antecedent child abuse and neglect are then reviewed. Finally, next steps and points of prevention are highlighted.
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Affiliation(s)
- Barbara H Chaiyachati
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; The University of Pennsylvania, Lifespan Brain Institute of Penn-Medicine and CHOP, Philadelphia, PA, United States of America; The Center for Pediatric Clinical Effectiveness and Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; The Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Raquel E Gur
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; The University of Pennsylvania, Lifespan Brain Institute of Penn-Medicine and CHOP, Philadelphia, PA, United States of America
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9
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Chen J, Zhang C, Wang Y, Liu X, Xu W. A longitudinal study of childhood trauma impacting on negative emotional symptoms among college students: a moderated mediation analysis. PSYCHOL HEALTH MED 2021; 27:571-588. [PMID: 33550834 DOI: 10.1080/13548506.2021.1883690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The present study investigated the possible mediation of resilience in the relationship between childhood trauma and negative emotional symptoms (depression, anxiety, and stress) and whether this mediation depends on the levels of trait mindfulness. A total of 629 college students (female: 189, 30.0%; age: M= 18.43, SD = .90) completed the childhood trauma questionnaire (CTQ), the Connor-Davidson resilience scale (CD-RISC), and the mindful attention awareness scale (MAAS) at baseline assessment (T1), and completed the depression anxiety stress scale (DASS) three months later (T2). After controlling for age and gender, the moderated mediation analysis with longitudinal data suggested that resilience mediated the link between childhood trauma and negative emotional symptoms, and the indirect effect of childhood trauma on negative emotional symptoms was moderated by trait mindfulness. Specifically, the indirect effect was weaker among individuals with a high level of mindfulness compared to those with a low level of mindfulness. The findings suggested that trait mindfulness significantly influenced the indirect effect of childhood trauma on negative emotional symptoms via resilience. However, when the model was analyzed for males and females, respectively, the results suggested that the moderated mediating effects were only found for males, but not for females.
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Affiliation(s)
- Jing Chen
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Beijing Normal University, Beijing, P. R. China.,School of Psychology, Nanjing Normal University, Nanjing, P. R. China
| | - Chunyang Zhang
- Chongqing Vocational College of Transportation, Chongqing, P. R. China
| | - Yi Wang
- Department of linguistics, University of Victoria, Victoria, Canada
| | - Xiaoyan Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Beijing Normal University, Beijing, P. R. China
| | - Wei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Beijing Normal University, Beijing, P. R. China.,School of Psychology, Nanjing Normal University, Nanjing, P. R. China
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10
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Rodriguez V, Aas M, Vorontsova N, Trotta G, Gadelrab R, Rooprai NK, Alameda L. Exploring the Interplay Between Adversity, Neurocognition, Social Cognition, and Functional Outcome in People With Psychosis: A Narrative Review. Front Psychiatry 2021; 12:596949. [PMID: 33762975 PMCID: PMC7982734 DOI: 10.3389/fpsyt.2021.596949] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/10/2021] [Indexed: 12/14/2022] Open
Abstract
History of adversity is associated with subsequent psychosis, and with a spectrum of cognitive alterations in individuals with psychosis. These cognitive features go from neurocognitive aspects as working memory and attention, to complex social cognitive processes as theory of mind and emotional perception. Difficulties in these domains impact patients' social and occupational functioning, which has been shown to be more impaired in those previously exposed to childhood trauma. However, the interplay between adversity, neurocognition, and functioning is yet poorly understood. This narrative review aims to explore the evidence on whether deficits in neurocognitive and social cognitive domains may act as possible putative mechanism linking adversity with functioning in people with psychosis. We show available evidence supporting the link between adversity and poorer functioning in psychosis, especially in chronic stages; and replicated evidence suggesting associations of social cognition and, to a lesser extent, neurocognition with impairment in functioning in patients; although there is still an important gap in the literature testing particularly deficits in social cognition as mediator of the link between adversity and functional decline in psychosis. Targeting interventions focusing on neurocognition and social cognition in individuals with adversity and psychosis seems important, given the severe deterioration of these patients in these domains, although more research is needed to test whether such treatments can specifically improve functioning in individuals with psychosis and adversity. Literature aiming to understand the determinants of functional outcome should consider the pervasive impact of childhood adversity, and its related effects on cognition.
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Affiliation(s)
- Victoria Rodriguez
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Monica Aas
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,NORMENT Centre for Psychosis Research, Oslo University Hospital, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Department of Mental Health Research and Development, Vestre Viken Hospital Trust, Drammen, Norway
| | - Natasha Vorontsova
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Giulia Trotta
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Romayne Gadelrab
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Navneet Kaur Rooprai
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Departamento de Psiquiatría, Centro Investigación Biomedica en Red de Salud Mental (CIBERSAM), Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
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11
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The association between childhood trauma and treatment outcomes in schizophrenia spectrum disorders. Psychiatry Res 2020; 289:113004. [PMID: 32387789 DOI: 10.1016/j.psychres.2020.113004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 11/22/2022]
Abstract
Childhood trauma exposure has been associated with poorer treatment outcomes in schizophrenia. Most studies to date have been conducted in naturalistic settings in which the outcome may have been mediated by factors such as poor adherence and substance abuse. We compared the effects of high vs low childhood trauma exposure on the treatment response over 24 months in 78 patients with first-episode schizophrenia spectrum disorders who received standardised treatment with a long acting injectable antipsychotic. Compared to the low childhood trauma group (n = 37), the high childhood trauma group (n = 41) received higher doses of antipsychotic medication and were less likely to achieve remission. When age, sex and cannabis use were controlled for, patients with high levels of childhood trauma had a slower treatment response for positive and disorganized symptom domains, although differences did not differ significantly at 24 months. While there were no differences in functional outcomes, self-rated quality of life was the domain that most clearly differentiated the high and low childhood trauma groups. High childhood trauma exposure was associated with lower quality of life scores at baseline, a lesser degree of improvement with treatment, and lower quality of life scores at 24 months.
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12
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Thomas S, Höfler M, Schäfer I, Trautmann S. Childhood maltreatment and treatment outcome in psychotic disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 2019; 140:295-312. [PMID: 31357235 DOI: 10.1111/acps.13077] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Childhood maltreatment (CM) plays an important role in the aetiology and course of psychotic disorders and is associated with characteristics that could be relevant for treatment. We aimed to conduct a systematic review and meta-analysis on the association between CM and treatment outcome in psychotic disorders. METHODS Treatment outcome was defined as change in psychotic symptoms or in social or occupational functioning between first and last reported measurement in the course of a pharmacological and/or psychological treatment. RESULTS Twelve treatment results from seven studies (636 patients, average treatment duration: 59.2 weeks) were included. CM was related to poorer treatment outcomes in psychotic disorders (OR = 1.51, 95% CI = [1.08, 2.10]). There is evidence that this association might increase with illness duration and increasing age and might be stronger in schizophrenia samples. CONCLUSIONS Childhood maltreatment is highly understudied with regard to treatment outcome in psychotic disorders. The need for more studies is emphasized by the fact that this meta-analysis reveals evidence for a poorer treatment response in patients with CM. If this association is confirmed, the identification of patients with CM and the consideration of associated clinical and biological conditions could contribute to improve treatment outcome in psychotic disorders.
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Affiliation(s)
- S Thomas
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - M Höfler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - I Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Trautmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychology, Medical School Hamburg, Hamburg, Germany
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13
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Hörberg N, Kouros I, Ekselius L, Cunningham J, Willebrand M, Ramklint M. Early Trauma Inventory Self-Report Short Form (ETISR-SF): validation of the Swedish translation in clinical and non-clinical samples. Nord J Psychiatry 2019; 73:81-89. [PMID: 30900487 DOI: 10.1080/08039488.2018.1498127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Childhood trauma in an important public health concern, and there is a need for brief and easily administered assessment tools. The Early Trauma Inventory (ETI) is one such instrument. The aim of this paper is to test the psychometric properties of the Swedish translation of the short, self-rated version (ETISR-SF), and to further validate the instrument. MATERIALS AND METHODS In this cross-sectional study, 243 psychiatric patients from an open care unit in Sweden and 56 controls were recruited. Participants were interviewed and thereafter completed the ETISR-SF. Internal consistency was calculated using Cronbach's alpha, a confirmatory factor analysis (CFA) was performed and goodness-of-fit was determined. Intra Class Correlation (ICC) was used to calculate test-retest reliability. Discriminant validity between groups was gauged using the Mann-Whitney U-test. RESULTS Cronbach's alpha varied between 0.55 and 0.76, with higher values in clinical samples than in controls. Of the four domains, general trauma showed a lower alpha than the other domains. The CFA confirmed the four-factor model previously seen and showed good to acceptable fit. The ICC value was 0.93, indicating good test-retest reliability. According to the Mann-Whitney U-test, the non-clinical sample differed significantly from the clinical sample, as did those with PTSD or borderline diagnosis from those without these diagnoses. CONCLUSIONS The Swedish translation of the ETISR-SF was found to have similar psychometric properties as both the original version and translations. ETISR-SF scores could also distinguish between different diagnostic groups associated with various degrees of trauma, which supports its discriminant validity.
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Affiliation(s)
- Niklas Hörberg
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Ioannis Kouros
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Lisa Ekselius
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Janet Cunningham
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Mimmie Willebrand
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Mia Ramklint
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
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Choudhry V, Dayal R, Pillai D, Kalokhe AS, Beier K, Patel V. Child sexual abuse in India: A systematic review. PLoS One 2018; 13:e0205086. [PMID: 30300379 PMCID: PMC6177170 DOI: 10.1371/journal.pone.0205086] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 09/19/2018] [Indexed: 01/06/2023] Open
Abstract
Objective Child Sexual Abuse (CSA) is a pressing human right issue and public health concern. We conducted a systematic review of quantitative and qualitative studies published in the past decade on CSA in India to examine the distribution of the prevalence estimates for both genders, to improve understanding of the determinants and consequences of CSA and identify gaps in the current state of research. Methods For this systematic review, we searched electronic literature databases (PubMed, POPLINE, and PsycINFO) for articles published in English on Child Sexual Abuse in India between January 1, 2006 and January 1, 2016 using 55 search terms. Data were extracted from published articles only. Findings Fifty-one studies met inclusion criteria for the review. The review indicates that prevalence rates of CSA is high among both boys and girls in India. Due to heterogeneity of study designs and lack of standardised assessments, reported prevalence estimates varied greatly among both genders in different studies. There is a need to conduct representative studies using a validated instrument to obtain valid epidemiological estimates. Commercial sex workers, men who have sex with men, and women with psychiatric disorders were at higher risks for sexual abuse during childhood. In addition, the synthesis of qualitative data across studies included in the review suggests that exposure and perpetration of CSA is a multifaceted phenomenon grounded in the interplay between individual, family, community, and societal factors. The review indicates poor physical, behavioural, social, and mental health outcomes of CSA in India. We conclude with a research agenda calling for quantitative and qualitative studies to explore the determinants and perpetration of child sexual abuse in India from an ecological lens. This research agenda may be necessary to inform the development of a culturally tailored primary prevention and treatment strategy for CSA victims in India.
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Affiliation(s)
- Vikas Choudhry
- Public Health Foundation of India, Institutional Area, Gurugram, Haryana, India
- Sambodhi Research and Communications Pvt. Ltd., Noida, Uttar Pradesh, India
- * E-mail:
| | - Radhika Dayal
- Public Health Foundation of India, Institutional Area, Gurugram, Haryana, India
| | - Divya Pillai
- Public Health Foundation of India, Institutional Area, Gurugram, Haryana, India
| | - Ameeta S. Kalokhe
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
- Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, United States of America
| | - Klaus Beier
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstraße, Berlin, Germany
| | - Vikram Patel
- Public Health Foundation of India, Institutional Area, Gurugram, Haryana, India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
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Brazeau N, Reisz S, Jacobvitz D, George C. UNDERSTANDING THE CONNECTION BETWEEN ATTACHMENT TRAUMA AND MATERNAL SELF-EFFICACY IN DEPRESSED MOTHERS. Infant Ment Health J 2018; 39:30-43. [PMID: 29281747 PMCID: PMC5814850 DOI: 10.1002/imhj.21692] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Maternal self-efficacy predicts sensitive and responsive caregiving. Low maternal self-efficacy is associated with a higher incidence of postpartum depression. Maternal self-efficacy and postpartum depression can both be buffered by social support. Maternal self-efficacy and postpartum depression have both been linked independently, albeit in separate studies, to the experience of violent trauma, childhood maltreatment, and spousal abuse. This study proposed a model in which postpartum depression mediates the relation between attachment trauma and maternal self-efficacy, with emotional support as a moderator. Participants were 278 first-time mothers of infants under 14 months. Cross-sectional data were collected online. Mothers completed questionnaires on attachment trauma, maternal self-efficacy, postpartum depression, and emotional support. A moderated mediation model was tested in a structural equation modeling framework using Mplus' estimate of indirect effects. Postpartum depression fully mediated the relation between trauma and maternal self-efficacy. Emotional support moderated only the pathway between postpartum depression and maternal self-efficacy. Attachment trauma's implications for maternal self-efficacy should be understood in the context of overall mental health. Mothers at the greatest risk for low maternal self-efficacy related to attachment trauma also are those suffering from postpartum depression. Emotional support buffered mothers from postpartum depression, though, which has implications for intervention and future research.
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Petterson LJ, VanderLaan DP, Vasey PL. Sex, Sexual Orientation, Gender Atypicality, and Indicators of Depression and Anxiety in Childhood and Adulthood. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1383-1392. [PMID: 26919841 DOI: 10.1007/s10508-016-0690-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/21/2015] [Accepted: 01/02/2016] [Indexed: 06/05/2023]
Abstract
The current study evaluated the possibility that greater negative mental health outcomes reported among gay, lesbian, and gender-atypical individuals, compared to gender-typical individuals, are present in childhood and persist into adulthood. Sex and sexual orientation differences in self-reported adulthood and recalled childhood indicators of depression and anxiety and their association with current and retrospectively reported gender (a)typicality were examined in a non-clinically recruited community sample of Canadian heterosexual men (n = 98), heterosexual women (n = 142), gay men (n = 289), and lesbian women (n = 69). Indicators of depression and anxiety were constructed based on diagnostic criteria for generalized anxiety disorder, major depression, agoraphobia, social anxiety disorder, panic disorder, obsessive-compulsive disorder, and specific phobias. Factor reduction analyses yielded three factors: (1) indicators of childhood separation anxiety, (2) indicators of childhood depression and anxiety, and (3) indicators of adulthood depression and anxiety. Lesbian women scored higher on childhood separation anxiety than all other groups. Heterosexual men scored lower on indicators of childhood separation anxiety than gay men and lower on indicators of childhood and adulthood depression and anxiety than all other groups. No other significant group differences were observed. Correlational analysis suggested that for men, but not for women, gender-atypical behavior was associated with negative mental health. The current study indicated that childhood should be considered a critical time period during which the noted sexual orientation-related mental health discrepancies manifest and that childhood gender atypicality is a key factor for understanding the emergence of such discrepancies.
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Affiliation(s)
- Lanna J Petterson
- Department of Psychology, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada.
| | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
- Underserved Populations Research Program, Child, Youth and Family Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Paul L Vasey
- Department of Psychology, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
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Early-Life Trauma in Hospitalized Patients With Mood Disorders and Its Association With Clinical Outcomes. J Psychiatr Pract 2017; 23:36-43. [PMID: 28072643 DOI: 10.1097/pra.0000000000000202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of childhood trauma and its impact on clinical outcomes in hospitalized patients with mood disorders is unknown. We studied the frequency of childhood trauma among inpatient adults with mood disorders and its association with clinical outcomes. METHODS Patients admitted to our hospital with a primary diagnosis of mood disorders completed the short form of the Early Trauma Inventory-Self-Report (ETISR-SF), the Sheehan Disability Scale, and the Clinician-Rated Dimensions of Psychosis Symptom Severity scale. A regression model adjusted for multiple comparisons was used to examine the association between scores on the ETISR-SF and clinical outcomes. RESULTS Subjects were 167 patients, all of whom reported ≥1 types of childhood trauma: 90% general trauma, 75% physical abuse, 71% emotional abuse, 50% sexual abuse, and 35% all 4 types of abuse. The subtypes of abuse did not differ by sex or race. Diagnoses in the sample were bipolar disorder 56%, major depressive disorder 24%, schizoaffective disorder 14%, and substance-induced mood disorder 5%. The mean age in the sample was 35±11.5 years, 53% were male, and 64% also had substance abuse disorders. Higher scores on the ETISR-SF were associated with longer hospital stays [odds ratio (OR)=1.13; 95% confidence interval (CI), 1.05-1.22], and greater disruption of work/school life (OR=1.12; 95% CI, 1.04-1.21). There was also a trend for higher ETISR-SF scores to be associated with more severe psychotic symptoms (OR=1.13; 95% CI, 1.01-1.27) and more disruption in social (OR=1.14; 95% CI, 1.06-1.22) and family life (OR=1.09; 95% CI, 1.02-1.17). CONCLUSION Childhood trauma was reported by all of the 167 patients, with general trauma the most common and approximately half reporting sexual abuse. Childhood trauma was associated with poor clinical outcomes. Early recognition of trauma and trauma-related therapeutic interventions may improve outcomes.
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18
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Aas M, Andreassen OA, Aminoff SR, Færden A, Romm KL, Nesvåg R, Berg AO, Simonsen C, Agartz I, Melle I. A history of childhood trauma is associated with slower improvement rates: Findings from a one-year follow-up study of patients with a first-episode psychosis. BMC Psychiatry 2016; 16:126. [PMID: 27146044 PMCID: PMC4855869 DOI: 10.1186/s12888-016-0827-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 04/22/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate whether childhood trauma was associated with more severe clinical features in patients with first-episode psychosis, both at the initial assessment and after one year. METHODS Ninety-six patients with a first-episode of a DSM-IV diagnosis of psychosis, in addition to 264 healthy controls from the same catchment area, were recruited to the TOP NORMENT study. A history of childhood trauma was obtained using the Childhood Trauma Questionnaire (CTQ). Function and symptom severity were measured using the Global Assessment of Functioning (GAF) Scale divided into function (GAF-F) and symptoms (GAF-S), the Positive and Negative Syndrome Scale (PANSS) and the Young Mania Rating Scale (YMRS). All clinical assessments were completed at two time points: At an initial assessment within the first year of initiating treatment for psychosis and after one year. RESULTS Childhood trauma was associated with significantly reduced global functioning and more severe clinical symptoms at both baseline and follow-up, whereas emotional neglect was associated with a significantly reduced improvement rate for global functioning (GAF-F) over the follow-up period. CONCLUSION Our data indicate that patients with first-episode psychosis who report a history of childhood trauma constitute a subgroup characterized by more severe clinical features over the first year of treatment, as well as slower improvement rates.
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Affiliation(s)
- Monica Aas
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT K.G Jebsen Centre for Psychosis Research, TOP study group, University of Oslo and Oslo University Hospital, Bygg 49, Ullevål sykehus, PO Box 4956, Nydalen, 0424, Oslo, Norway.
| | - Ole A. Andreassen
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT K.G Jebsen Centre for Psychosis Research, TOP study group, University of Oslo and Oslo University Hospital, Bygg 49, Ullevål sykehus, PO Box 4956, Nydalen, 0424 Oslo Norway
| | - Sofie R. Aminoff
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT K.G Jebsen Centre for Psychosis Research, TOP study group, University of Oslo and Oslo University Hospital, Bygg 49, Ullevål sykehus, PO Box 4956, Nydalen, 0424 Oslo Norway ,Department of Specialized Inpatient Treatment, Division of Mental Health Services, Akershus University Hospital, Oslo, Norway
| | - Ann Færden
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT K.G Jebsen Centre for Psychosis Research, TOP study group, University of Oslo and Oslo University Hospital, Bygg 49, Ullevål sykehus, PO Box 4956, Nydalen, 0424 Oslo Norway
| | - Kristin L. Romm
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT K.G Jebsen Centre for Psychosis Research, TOP study group, University of Oslo and Oslo University Hospital, Bygg 49, Ullevål sykehus, PO Box 4956, Nydalen, 0424 Oslo Norway
| | - Ragnar Nesvåg
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Akiah O. Berg
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT K.G Jebsen Centre for Psychosis Research, TOP study group, University of Oslo and Oslo University Hospital, Bygg 49, Ullevål sykehus, PO Box 4956, Nydalen, 0424 Oslo Norway
| | - Carmen Simonsen
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT K.G Jebsen Centre for Psychosis Research, TOP study group, University of Oslo and Oslo University Hospital, Bygg 49, Ullevål sykehus, PO Box 4956, Nydalen, 0424 Oslo Norway
| | - Ingrid Agartz
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT K.G Jebsen Centre for Psychosis Research, TOP study group, University of Oslo and Oslo University Hospital, Bygg 49, Ullevål sykehus, PO Box 4956, Nydalen, 0424 Oslo Norway ,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT K.G Jebsen Centre for Psychosis Research, TOP study group, University of Oslo and Oslo University Hospital, Bygg 49, Ullevål sykehus, PO Box 4956, Nydalen, 0424 Oslo Norway
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Trotta A, Murray RM, David AS, Kolliakou A, O’Connor J, Di Forti M, Dazzan P, Mondelli V, Morgan C, Fisher HL. Impact of Different Childhood Adversities on 1-Year Outcomes of Psychotic Disorder in the Genetics and Psychosis Study. Schizophr Bull 2016; 42:464-75. [PMID: 26373540 PMCID: PMC4753600 DOI: 10.1093/schbul/sbv131] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
While the role of childhood adversity in increasing the risk of psychosis has been extensively investigated, it is not clear what the impact of early adverse experiences is on the outcomes of psychotic disorders. Therefore, we investigated associations between childhood adversity and 1-year outcomes in 285 first-presentation psychosis patients. Exposure to childhood adversity prior to 17 years of age was assessed using the Childhood Experience of Care and Abuse Questionnaire. Data on illness course, symptom remission, length of psychiatric hospitalization, compliance with medication, employment, and relationship status were extracted from clinical records for the year following first contact with mental health services for psychosis. Seventy-one percent of patients reported exposure to at least 1 type of childhood adversity (physical abuse, sexual abuse, parental separation, parental death, disrupted family arrangements, or being taken into care). No robust associations were found between childhood adversity and illness course or remission. However, childhood physical abuse was associated with almost 3-fold increased odds of not being in a relationship at 1-year follow-up compared to patients who did not report such adverse experiences. There was also evidence of a significant association between parental separation in childhood and longer admissions to psychiatric wards during 1-year follow-up and 2-fold increased odds of noncompliance with medication compared to those not separated from their parents. Therefore, our findings suggest that there may be some specificity in the impact of childhood adversity on service use and social functioning among psychosis patients over the first year following presentation to mental health services.
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Affiliation(s)
- Antonella Trotta
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Anthony S. David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Anna Kolliakou
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Jennifer O’Connor
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Marta Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK;,MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Craig Morgan
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Helen L. Fisher
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK;,*To whom correspondence should be addressed; MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 16 De Crespigny Park, London SE5 8AF, UK; tel: +44 (0)207-848-5430, fax: +44 (0)207-848-0866, e-mail:
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Alameda L, Ferrari C, Baumann PS, Gholam-Rezaee M, Do KQ, Conus P. Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients. Psychol Med 2015; 45:2727-2736. [PMID: 26350397 DOI: 10.1017/s0033291715000690] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Evidence suggests a relationship between exposure to trauma during childhood and functional impairments in psychotic patients. However, the impact of age at the time of exposure has been understudied in early psychosis (EP) patients. METHOD Two hundred and twenty-five patients aged 18-35 years were assessed at baseline and after 2, 6, 18, 24, 30 and 36 months of treatment. Patients exposed to sexual and/or physical abuse (SPA) were classified according to age at the time of first exposure (Early SPA: before age 11 years; Late SPA: between ages 12 and 15 years) and then compared to patients who were not exposed to such trauma (Non-SPA). The functional level in the premorbid phase was measured with the Premorbid Adjustment Scale (PAS) and with the Global Assessment of Functioning (GAF) scale and the Social and Occupational Functioning Assessment Scale (SOFAS) during follow-up. RESULTS There were 24.8% of patients with a documented history of SPA. Late SPA patients were more likely to be female (p = 0.010). Comparison with non-SPA patients revealed that: (1) both Early and Late SPA groups showed poorer premorbid social functioning during early adolescence, and (2) while patients with Early SPA had poorer functional level at follow-up with lower GAF (p = 0.025) and lower SOFAS (p = 0.048) scores, Late SPA patients did not. CONCLUSION Our results suggest a link between exposure to SPA and the later impairment of social functioning before the onset of the disease. EP patients exposed to SPA before age 12 may present long-lasting functional impairment, while patients exposed at a later age may improve in this regard and have a better functional outcome.
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Affiliation(s)
- L Alameda
- Unit for Research in Schizophrenia,Center for Psychiatric Neuroscience,Department of Psychiatry,Lausanne University Hospital (CHUV),Lausanne,Switzerland
| | - C Ferrari
- Service of General Psychiatry,Treatment and Early Intervention in Psychosis,Program (TIPP-Lausanne),Lausanne University Hospital (CHUV),Lausanne,Switzerland
| | - P S Baumann
- Unit for Research in Schizophrenia,Center for Psychiatric Neuroscience,Department of Psychiatry,Lausanne University Hospital (CHUV),Lausanne,Switzerland
| | - M Gholam-Rezaee
- Department of Psychiatry,Center for Psychiatric Epidemiology and Psychopathology,Lausanne University Hospital (CHUV),Lausanne,Switzerland
| | - K Q Do
- Unit for Research in Schizophrenia,Center for Psychiatric Neuroscience,Department of Psychiatry,Lausanne University Hospital (CHUV),Lausanne,Switzerland
| | - P Conus
- Service of General Psychiatry,Treatment and Early Intervention in Psychosis,Program (TIPP-Lausanne),Lausanne University Hospital (CHUV),Lausanne,Switzerland
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Dissociation in bipolar disorder: Relationships between clinical variables and childhood trauma. J Affect Disord 2015; 184:104-10. [PMID: 26074019 DOI: 10.1016/j.jad.2015.05.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 05/09/2015] [Accepted: 05/10/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The dissociative experiences of patients with bipolar disorder (BD) differ from those of patients with other psychiatric disorders with regard to certain features. The primary goal of this study was to evaluate the relationship between the clinical variables of BD and childhood trauma using the factor structure, psychometric features, and potential subdimensions of the Dissociative Experience Scale (DES). METHOD This study included 200 BD patients who were in a remission period and 50 healthy volunteers. The BD patients were recruited from two psychiatry clinic departments in Turkey. The sociodemographic data of the two groups and their scores on the DES and Childhood Trauma Questionnaire (CTQ)-28 were compared. RESULTS The overall DES scores and the scores for each DES item accurately and reliably measured dissociation in the BD patients (item-total correlation r scores: >0.20, Cronbach's alpha: 0.95), and a factor analysis revealed two subdimensions of the DES for BD: identity confusion/alteration (SubDES-1) and amnesia and depersonalization/derealization (SubDES-2). Although age at onset of BD was significantly correlated with both subdimensions, illness duration was significantly correlated only with the SubDES-2. Of all the subjects, 19.5% (39/200 patients) were identified as having dissociative experiences by the DES-Taxon (DES-T), and subjects in this subscale (DES-T-positive) had significantly higher total scores on the CTQ-28 as well as higher scores on each subgroup of this scale. The highest CTQ-28 subgroup score was emotional neglect, which was followed by emotional abuse and physical neglect and then sexual abuse and physical abuse. There was a significant correlation between total scores on the CTQ-28 and SubDES-2 but none of the CTQ-28 subscale scores was significantly correlated with either SubDES-1 or SubDES-2. CONCLUSION The DES sufficiently and reliably identified the experience of dissociative symptoms on the part of BD patients, and a factor analysis revealed two subdimensions of BD on this scale. In particular, DES-T-positive subjects experienced a greater amount of childhood trauma and, as a result, had an earlier age at onset of BD. Additionally, SubDES-2, which was associated with amnesia and depersonalization/derealization, was closely related to illness duration.
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Trotta A, Murray RM, Fisher HL. The impact of childhood adversity on the persistence of psychotic symptoms: a systematic review and meta-analysis. Psychol Med 2015; 45:2481-2498. [PMID: 25903153 DOI: 10.1017/s0033291715000574] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Evidence suggests that childhood adversity is associated with the development of psychotic experiences (PE), psychotic symptoms and disorders. However, less is known regarding the impact of early adversity on the persistence of PE and clinically relevant psychosis. Thus we conducted a systematic review of the association between childhood adversity and the course of PE and symptoms over time. METHOD A systematic search of Medline, EMBASE and PsychINFO databases was undertaken to identify articles published between January 1956 and November 2014. We included studies conducted on general population samples, individuals at ultra-high risk (UHR) of psychosis, and patients with full-blown psychotic disorders. A meta-analysis was performed on a subgroup. RESULTS A total of 20 studies were included. Of these, 17 reported positive associations between exposure to overall or specific subtypes of childhood adversity and persistence of PE or clinically relevant psychotic symptoms. A meta-analysis of nine studies yielded a weighted odds ratio of 1.76 [95% confidence interval (CI) 1.19-2.32, p < 0.001] for general population studies and 1.55 (95% CI 0.32-2.77, p = 0.007) for studies conducted using clinical populations. CONCLUSIONS The available evidence is limited but tentatively suggests that reported exposure to adverse events in childhood is associated with persistence of PE and clinically relevant psychotic symptoms. This partially strengthens the case for addressing the consequences of early adversity in individuals presenting with psychotic phenomena to improve long-term outcomes. However, the heterogeneity of studies was high which urges caution in interpreting the results and highlights the need for more methodologically robust studies.
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Affiliation(s)
- A Trotta
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - R M Murray
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - H L Fisher
- MRC Social, Genetic and Developmental Psychiatry Centre,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
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Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature. Ir J Psychol Med 2014; 32:21-30. [DOI: 10.1017/ipm.2014.74] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
ObjectivesWe aimed to examine the association between childhood trauma and functional impairment in psychotic disorders, bipolar disorder and borderline personality disorder, to speculate on possible mechanisms that underlie this association and discuss the implications for clinical work.MethodsNarrative review of the peer-reviewed English language literature in the area.ResultsHigh rates of childhood trauma in psychotic disorders, bipolar disorder and borderline personality disorder were identified. This was associated with impaired social and occupational functioning in both the premorbid and established phases of each of these psychiatric disorders over and above the deficits typically observed in these populations. Possible mechanisms mediating this relationship include neurocognitive deficits, insecure attachment, higher rates of comorbidities and problems with adherence and response to treatment.ConclusionsRoutine clinical inquiry about childhood maltreatment should be adopted within mental health settings. This has potentially important treatment implications for identifying those individuals at elevated risk of functional disability. While there is no clear guidance currently available on how to target childhood trauma in the treatment of psychotic disorders, bipolar disorder or borderline personality disorder, there are several promising lines of enquiry and further research is warranted.
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Boyette LL, van Dam D, Meijer C, Velthorst E, Cahn W, de Haan L, Kahn R, de Haan L, van Os J, Wiersma D, Bruggeman R, Cahn W, Meijer C, Myin-Germeys I. Personality compensates for impaired quality of life and social functioning in patients with psychotic disorders who experienced traumatic events. Schizophr Bull 2014; 40:1356-65. [PMID: 24771304 PMCID: PMC4193722 DOI: 10.1093/schbul/sbu057] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Patients with psychotic disorders who experienced childhood trauma show more social dysfunction than patients without traumatic experiences. However, this may not hold for all patients with traumatic experiences. Little is known about the potential compensating role of Five-Factor Model personality traits within this group, despite their strong predictive value for social functioning and well-being in the general population. METHODS Our sample consisted of 195 patients with psychotic disorders (74% diagnosed with schizophrenia) and 132 controls. Cluster analyses were conducted to identify and validate distinct personality profiles. General linear model analyses were conducted to examine whether patients with different profiles differed in social functioning and quality of life (QoL), while controlling for possible confounders. Mediation models were tested to assess potential causal links. RESULTS In general, patients with higher levels of self-reported traumatic experiences (PT+) showed lower QoL and more social withdrawal compared with patients with lower traumatic experiences (PT-). Two clusters reflecting personality profiles were identified. PT+ with the first profile (lower neuroticism and higher extraversion, openness, agreeableness, and conscientiousness) presented higher levels of QoL and better social functioning in several areas, including less withdrawal, compared with both PT+ and PT- with the second profile. PT+ and PT- with the first personality profile did not differ in QoL and social functioning. Mediation analyses suggested that personality traits mediate the relation between traumatic experiences and QoL and social withdrawal. CONCLUSIONS Our findings indicate that personality may "buffer" the impact of childhood traumatic experiences on functional outcome in patients with psychotic disorders.
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Affiliation(s)
- Lindy-Lou Boyette
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands;
| | - Daniëlla van Dam
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
| | - Carin Meijer
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
| | - Eva Velthorst
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
| | - René Kahn
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
| | - Jim van Os
- Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, Maastricht, The Netherlands
| | - Durk Wiersma
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Carin Meijer
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
| | - Inez Myin-Germeys
- Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, Maastricht, The Netherlands
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26
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Karsten J, Penninx BWJH, Verboom CE, Nolen WA, Hartman CA. Course and risk factors of functional impairment in subthreshold depression and anxiety. Depress Anxiety 2013; 30:386-94. [PMID: 23165799 DOI: 10.1002/da.22021] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/18/2012] [Accepted: 10/13/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although persons with subthreshold depression or anxiety are known to be at risk for full-syndromal disorders, little is known about their functioning over time. In this study, we investigate the functional impairment of persons with subthreshold depression or anxiety over time, compared to that of controls. Furthermore, we evaluate which illness, personal, and environmental risk factors influence its course. METHODS Data come from the Netherlands Study of Depression and Anxiety (N = 1,266, aged 18-65). Linear mixed models were used to identify predictors of functional impairment at baseline, 1-, and 2-year follow-up. Risk factors were evaluated in their overall effect on functioning and on change in functioning over time, and whether they differed for respondents with and without subthreshold depression or anxiety. RESULTS Functional impairment in subthreshold respondents improved over time, but remained much higher than in controls. Prior anxiety disorder, high neuroticism, low conscientiousness, more somatic conditions, and more childhood trauma all predicted greater functional impairment. Older age predicted lower functioning only in subthreshold respondents, while the effect of neuroticism was stronger in subthreshold respondents relative to controls. CONCLUSIONS Functional impairment in subthreshold respondents improved over time, but remained elevated compared to that of controls. Given continuously elevated levels of impairment, preventive interventions should be focused on persons with subthreshold symptoms; in particular those with prior anxiety disorder, high neuroticism, low conscientiousness, somatic conditions, or childhood trauma.
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Affiliation(s)
- Julie Karsten
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Cotton SM, Lambert M, Berk M, Schimmelmann BG, Butselaar FJ, McGorry PD, Conus P. Gender differences in first episode psychotic mania. BMC Psychiatry 2013; 13:82. [PMID: 23497439 PMCID: PMC3602146 DOI: 10.1186/1471-244x-13-82] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 01/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this paper was to delineate the impact of gender on premorbid history, onset, and 18 month outcomes of first episode psychotic mania (FEPM) patients. METHODS Medical file audit assessment of 118 (male = 71; female = 47) patients with FEPM aged 15 to 29 years was undertaken on clinical and functional measures. RESULTS Males with FEPM had increased likelihood of substance use (OR = 13.41, p <.001) and forensic issues (OR = 4.71, p = .008), whereas females were more likely to have history of sexual abuse trauma (OR = 7.12, p = .001). At service entry, males were more likely to be using substances, especially cannabis (OR = 2.15, p = .047), had more severe illness (OR = 1.72, p = .037), and poorer functioning (OR = 0.96, p = .045). During treatment males were more likely to decrease substance use (OR = 5.34, p = .008) and were more likely to be living with family (OR = 4.30, p = .009). There were no gender differences in age of onset, psychopathology or functioning at discharge. CONCLUSIONS Clinically meaningful gender differences in FEPM were driven by risk factors possibly associated with poor outcome. For males, substance use might be associated with poorer clinical presentation and functioning. In females with FEPM, the impact of sexual trauma on illness course warrants further consideration.
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Affiliation(s)
- Sue M Cotton
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia.
| | - Martin Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Berk
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,School of Medicine, Deakin University, Geelong, Australia,Florey Institute for Neuroscience and Mental Health, Parkville, Australia
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Felicity J Butselaar
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick D McGorry
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, Prilly, Switzerland
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Carlton TG. The integration of science and practice in trauma and dissociation: a clinician's view. J Trauma Dissociation 2012; 13:1-8. [PMID: 22211438 DOI: 10.1080/15299732.2011.621016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Picken A, Tarrier N. Trauma and comorbid posttraumatic stress disorder in individuals with schizophrenia and substance abuse. Compr Psychiatry 2011; 52:490-7. [PMID: 21193183 DOI: 10.1016/j.comppsych.2010.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 10/19/2010] [Accepted: 10/27/2010] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the occurrence of trauma and comorbid posttraumatic stress disorder (PTSD) in dual diagnosis patients and whether the trauma was related to the patient's behavior or illness. METHOD One hundred ten patients with schizophrenia and comorbid substance or alcohol abuse were assessed for PTSD using self-report and structured interview. Traumatic events were classified as independent or dependent upon the patient's behavior, illness, or symptoms. RESULTS One hundred patients (91%) reported at least 1 trauma (mean, 4.3). Sixty-three patients (57%) reported a traumatic event that met modified-criterion A for PTSD. Thirty-one patients (28%) met criteria for full PTSD, and 18 (16%) had a trauma directly related to their illness. Patients with PTSD had significantly higher scores on positive psychotic symptoms and depression. CONCLUSIONS Exposures to traumatic events and comorbid PTSD are high but are inflated by reactions to illness-related events such as hospitalization and psychotic symptoms.
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Affiliation(s)
- Alicia Picken
- Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, Zochonis Building, Oxford Road, Manchester M13 9PL, UK
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Shannon C, Douse K, McCusker C, Feeney L, Barrett S, Mulholland C. The association between childhood trauma and memory functioning in schizophrenia. Schizophr Bull 2011; 37:531-7. [PMID: 19752010 PMCID: PMC3080678 DOI: 10.1093/schbul/sbp096] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Both neurocognitive impairments and a history of childhood abuse are highly prevalent in patients with schizophrenia. Childhood trauma has been associated with memory impairment as well as hippocampal volume reduction in adult survivors. The aim of the following study was to examine the contribution of childhood adversity to verbal memory functioning in people with schizophrenia. METHODS Eighty-five outpatients with a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis of chronic schizophrenia were separated into 2 groups on the basis of self-reports of childhood trauma. Performance on measures of episodic narrative memory, list learning, and working memory was then compared using multivariate analysis of covariance. RESULTS Thirty-eight (45%) participants reported moderate to severe levels of childhood adversity, while 47 (55%) reported no or low levels of childhood adversity. After controlling for premorbid IQ and current depressive symptoms, the childhood trauma group had significantly poorer working memory and episodic narrative memory. However, list learning was similar between groups. CONCLUSION Childhood trauma is an important variable that can contribute to specific ongoing memory impairments in schizophrenia.
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Affiliation(s)
- Ciaran Shannon
- School of Psychology, Queen’s University Belfast, Belfast, N. Ireland.
| | - Kate Douse
- Department of Clinical Psychology, Belfast Health and Social Care Trust, Belfast, N. Ireland
| | - Chris McCusker
- School of Psychology, Queen's University Belfast, Belfast, N. Ireland
| | - Lorraine Feeney
- Department of Clinical Psychology, Northern Health and Social Care Trust, Antrim, N. Ireland
| | - Suzanne Barrett
- Department of Psychiatry, Queen's University Belfast, Belfast, N. Ireland
| | - Ciaran Mulholland
- Department of Psychiatry, Queen's University Belfast, Belfast, N. Ireland
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Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: a critical review. Clin Psychol Rev 2011; 31:883-99. [PMID: 21596012 DOI: 10.1016/j.cpr.2011.04.003] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 03/16/2011] [Accepted: 04/19/2011] [Indexed: 11/21/2022]
Abstract
There is a great deal of research on the prevalence, correlates, and treatment of PTSD in the general population. However, we know very little about the manifestation and consequences of PTSD in more complicated patient populations. The purpose of the current paper is to provide a comprehensive review of PTSD within the context of severe mental illness (SMI; i.e., schizophrenia spectrum disorders, mood disorders). Extant data suggest that trauma and PTSD are highly prevalent among individuals with SMI relative to the general population, and both are associated with adverse clinical functioning and increased healthcare burden. However, trauma and PTSD remain overlooked in this population, with low recognition rates in public-sector settings. Additionally, there are few data on the clinical course and treatment of PTSD among individuals with SMI. Particularly lacking are longitudinal studies, randomized controlled treatment trials, and studies using ethno-racially diverse samples. Furthermore, there is a need to better understand the interplay between trauma, PTSD, and severe forms of mental illness and to further develop and disseminate evidence-based PTSD treatments in this population. The current state of the literature and future directions for practice are discussed.
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Hammer JH, Springer J, Beck NC, Menditto A, Coleman J. The relationship between seclusion and restraint use and childhood abuse among psychiatric inpatients. JOURNAL OF INTERPERSONAL VIOLENCE 2011; 26:567-579. [PMID: 20237391 DOI: 10.1177/0886260510363419] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Seclusion and restraint (S/R) is a controversial topic in the field of psychiatry, due in part to the high rates of childhood physical and sexual abuse found among psychiatric inpatients. The trauma-informed care perspective suggests that the use of S/R with previously abused inpatients may result in retraumatization due to mental associations between childhood trauma and the experience during S/R. Thus, though one would expect to see efforts on the part of inpatient psychiatric facilities to limit S/R of previously abused inpatients, research suggests that trauma victims may be more likely to experience S/R. The current study sought to clarify this possibility by examining whether presence or absence and chronicity of childhood sexual and physical abuse differed among three groups of adult inpatients (N = 622) residing at a mid-Western state psychiatric hospital. These groups are empirically derived on the basis of dramatic differences in the patterning of their exposure to S/R over the course of hospitalization. Results of Chi-square and Kruskal-Wallis tests suggest that the classes did not significantly differ in presence or absence and chronicity of childhood sexual or physical abuse when male and female inpatients were analyzed separately. However, among the class of inpatients who experienced the most instances of S/R, 70% of the members have histories of childhood abuse. Implications for inpatients, clinicians, and policy makers are discussed.
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