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Mollon, Josephine, Emma Knowles, Samuel Mathias, Amanda Rodrigue, Marinka Koenis, Godfrey Pearlson, and David Glahn. "T67. TRAUMA IN AFFECTIVE AND NONAFFECTIVE PSYCHOSIS: ASSOCIATIONS AND DISSOCIATIONS WITH COGNITIVE FUNCTIONING IN CHILDHOOD AND ADULTHOOD." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S256—S257. http://dx.doi.org/10.1093/schbul/sbaa029.627.
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Abstract Background Childhood trauma and cognitive impairment are important risk factors for psychotic disorders. However, the relationship between trauma and psychosis throughout the lifespan, as well as between lifetime trauma and cognitive functioning, remain unclear. Methods Using data from a case-control study of African-American adults with psychotic disorders, we examined childhood and adult trauma, as well as their interaction with cognitive functioning, in adults with affective psychotic disorders (n=101), nonaffective psychotic disorders (n=109), non-psychotic psychiatric disorders (n=105), compared to controls (n=211). Childhood trauma was measured using the Childhood Trauma Questionnaire (CTQ), which produces dimensional measures of physical neglect, emotional neglect, physical abuse, emotional abuse, and sexual abuse. Adult trauma was measured using the Trauma History Questionnaire (THQ), which ascertains the presence of death-, and personal-related traumas throughout adulthood. Cognitive functioning was measured using a comprehensive computerized battery (‘Charlie’, https://github.com/sammosummo/Charlie). Results All three psychiatric groups showed greater childhood trauma compared to controls, but the affective psychosis group showed the most trauma (Cohen d=0.97–1.29, p<0.001), followed by the nonaffective psychosis group (d=0.54–0.72, p<0.001), and then the non-psychotic group (d=0.05–0.16, p<0.04). Despite the fact that childhood trauma was significantly associated with adult trauma (OR=0.67–2.08,p<0.002), only the affective psychosis group showed a significantly increased likelihood of experiencing both death- and personal-related traumas in adulthood (OR=0.86–2.14, p<0.01), while the nonaffective psychosis group showed an increased likelihood of experiencing personal-related traumas (OR=1.00, p=0.003). Significant childhood-trauma-by-group interactions on cognitive functioning showed that greater childhood neglect was associated with better performance in the affective psychosis group on measures of processing speed (d=0.52, p=0.011), social processing (d=0.57, p=0.020), and executive functioning (d=0.50–0.71,p<0.020). A similar pattern emerged in the affective psychosis group with both death- and personal-related adult traumas on measures of processing speed (d=0.67–0.74, p<0.010), memory (d=0.67–0.68, p<0.014), and emotional processing (d=0.79, p=0.008). In the domain of complex reasoning, on the other hand, increased childhood sexual abuse in the affective psychosis group, and personal-related adult traumas in the psychosis group, showed a deleterious effect (d=–0.44, p=0.025; d=–0.65, p=0.010). Discussion Individuals with psychotic disorders, especially affective psychoses, experienced more childhood and adult trauma than controls, and also individuals with non-psychotic psychiatric disorders. However, both childhood neglect and adult trauma were associated with better cognitive functioning in the affective psychosis group. One explanation for this seemingly paradoxical finding may be that traumatic experiences in childhood and adulthood lead to increased cognitive vulnerability, as typically seen in psychotic disorders. Thus, individuals who experience more lifetime trauma may follow a different pathway to psychosis, involving less neurodevelopmental impairment, but greater environmental stress, leading to more affective, rather than nonaffective, manifestations of psychosis.
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Spauwen, Janneke, Lydia Krabbendam, Roselind Lieb, Hans-Ulrich Wittchen, and Jim Van Os. "Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness." British Journal of Psychiatry 188, no. 6 (June 2006): 527–33. http://dx.doi.org/10.1192/bjp.bp.105.011346.
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BackgroundThe reported link between psychological trauma and onset of psychosis remains controversial.AimsTo examine associations between self-reported psychological trauma and psychotic symptoms as a function of prior evidence of vulnerability to psychosis (psychosis proneness).MethodAt baseline, 2524 adolescents aged 14–24 years provided self-reports on psychological trauma and psychosis proneness, and at follow-up (on average 42 months later) participants were interviewed for presence of psychotic symptoms.ResultsSelf-reported trauma was associated with psychotic symptoms, in particular at more severe levels (adjusted OR 1.89, 95% CI 1.16–3.08) and following trauma associated with intense fear, helplessness or horror. The risk difference between those with and without self-reported trauma at baseline was 7% in the group with baseline psychosis proneness, but only 1.8% in those without (adjusted test for difference between these two effect sizes: χ2=4.6, P=0.032).ConclusionsExposure to psychological trauma may increase the risk of psychotic symptoms in people vulnerable to psychosis.
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Ered, Arielle, and Lauren M. Ellman. "Specificity of Childhood Trauma Type and Attenuated Positive Symptoms in a Non-Clinical Sample." Journal of Clinical Medicine 8, no. 10 (September 25, 2019): 1537. http://dx.doi.org/10.3390/jcm8101537.
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Background: Childhood traumatic experiences have been consistently associated with psychosis risk; however, the specificity of childhood trauma type to interview-based attenuated positive psychotic symptoms has not been adequately explored. Further, previous studies examining specificity of trauma to specific positive symptoms have not accounted for co-occurring trauma types, despite evidence of multiple victimization. Methods: We examined the relationship between childhood trauma (Childhood Trauma Questionnaire) with type of attenuated positive symptom, as measured by the Structured Interview for Psychosis-risk Syndromes (SIPS) among a non-clinical, young adult sample (n = 130). Linear regressions were conducted to predict each attenuated positive symptom, with all trauma types entered into the model to control for co-occurring traumas. Results: Results indicated that childhood sexual abuse was significantly associated with disorganized communication and childhood emotional neglect was significantly associated with increased suspiciousness/persecutory ideas, above and beyond the effect of other co-occurring traumas. These relationships were significant even after removing individuals at clinical high-risk (CHR) for psychosis (n = 14). Conclusions: Our results suggest that there are differential influences of trauma type on specific positive symptom domains, even in a non-clinical sample. Our results also confirm the importance of controlling for co-occurring trauma types, as results differ when not controlling for multiple traumas.
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Veling, W., J. Counotte, R. Pot-Kolder, J. van Os, and M. van der Gaag. "Childhood trauma, psychosis liability and social stress reactivity: a virtual reality study." Psychological Medicine 46, no. 16 (September 13, 2016): 3339–48. http://dx.doi.org/10.1017/s0033291716002208.
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BackgroundChildhood trauma is associated with higher risk for mental disorders, including psychosis. Heightened sensitivity to social stress may be a mechanism. This virtual reality study tested the effect of childhood trauma on level of paranoid ideations and distress in response to social stress, in interaction with psychosis liability and level of social stress exposure.MethodSeventy-five individuals with higher psychosis liability (55 with recent onset psychotic disorder and 20 at ultra-high risk for psychosis) and 95 individuals with lower psychosis liability (42 siblings and 53 controls) were exposed to a virtual café in five experiments with 0–3 social stressors (crowded, other ethnicity and hostility). Paranoid ideation was measured after each experiment. Subjective distress was self-rated before and after experiments. Multilevel random regression analyses were used to test main effects of childhood trauma and interaction effects.ResultsChildhood trauma was more prevalent in individuals with higher psychosis liability, and was associated with higher level of (subclinical) psychotic and affective symptoms. Individuals with a history of childhood trauma responded with more subjective distress to virtual social stress exposures. The effects of childhood trauma on paranoia and subjective distress were significantly stronger when the number of virtual environmental stressors increased. Higher psychosis liability increased the effect of childhood trauma on peak subjective distress and stress reactivity during experiments.ConclusionsChildhood trauma is associated with heightened social stress sensitivity and may contribute to psychotic and affective dysregulation later in life, through a sensitized paranoid and stress response to social stressors.
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Coughlan, Helen, and Mary Cannon. "Does childhood trauma play a role in the aetiology of psychosis? A review of recent evidence." BJPsych Advances 23, no. 5 (September 2017): 307–15. http://dx.doi.org/10.1192/apt.bp.116.015891.
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SummaryThere has been a resurgence of interest in the role of childhood trauma in the aetiology of psychosis. In this review, recent findings on the association between childhood trauma and a continuum of psychotic symptoms are presented. Evidence of the association between specific childhood trauma subtypes and psychotic symptoms is examined, with a brief discussion of some current hypotheses about the potential mechanisms underlying the associations that have been found. Some practice implications of these findings are also highlighted.Learning Objectives• Identify findings from recent meta-analyses on the association between childhood trauma and a range of psychotic outcomes, from non-clinical psychotic experiences to psychotic disorders• Consider which childhood traumas are the most potent in the context of psychotic outcomes• Recognise that the relationships between childhood trauma, psychotic symptoms and other psychopathology are complex, dynamic and multidimensional
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Folk, Tully, Blacker, Liles, Bolden, Tryon, Botello, and Niendam. "Uncharted Waters: Treating Trauma Symptoms in the Context of Early Psychosis." Journal of Clinical Medicine 8, no. 9 (September 12, 2019): 1456. http://dx.doi.org/10.3390/jcm8091456.
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Psychosis is conceptualized in a neurodevelopmental vulnerability-stress framework, and childhood trauma is one environmental factor that can lead to psychotic symptoms and the development of psychotic disorders. Higher rates of trauma are associated with higher psychosis risk and greater symptom frequency and severity, resulting in increased hospitalization rates and demand on outpatient primary care and mental health services. Despite an estimated 70% of individuals in the early stages of psychosis reporting a history of experiencing traumatic events, trauma effects (post-traumatic anxiety or depressive symptoms) are often overlooked in psychosis treatment and current interventions typically do not target commonly comorbid post-traumatic stress symptoms. We presented a protocol for Trauma-Integrated Cognitive Behavioral Therapy for Psychosis (TI-CBTp), an approach to treating post-traumatic stress symptoms in the context of early psychosis care. We provided a brief summary of TI-CBTp as implemented in the context of Coordinated Specialty Care and presented preliminary data supporting the use of TI-CBTp in early psychosis care. The preliminary results suggest that individuals with comorbid psychosis and post-traumatic stress symptoms can be appropriately and safely treated using TI-CBTp within Coordinated Specialty Care.
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Lincoln, T. M., N. Marin, and E. S. Jaya. "Childhood trauma and psychotic experiences in a general population sample: A prospective study on the mediating role of emotion regulation." European Psychiatry 42 (May 2017): 111–19. http://dx.doi.org/10.1016/j.eurpsy.2016.12.010.
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AbstractBackgroundThe causal role of childhood trauma for psychosis is well established, but the mechanisms that link trauma to psychosis are largely unknown. Since childhood trauma is known to cause difficulties in emotion regulation (ER) and patients with psychosis show impaired ER, we hypothesize that impaired ER explains why people with a background of trauma are prone to psychotic experiences.MethodsThe study used a longitudinal cohort design based on a community sample (N = 562) from Germany, Indonesia, and the United States. Childhood trauma was assessed at baseline. ER and psychotic experiences (defined as positive symptom frequency and related distress) were measured repeatedly at a 4-, 8-, and 12-month follow-up. Cross-lagged panel and longitudinal mediation analyses with structural equation modeling were used to test the predictive value of ER on psychotic experiences and its mediating role in the association of childhood trauma and psychotic experiences.ResultsThe cross-lagged paths from impaired ER to symptom distress (but not frequency) were significant. However, there was also evidence for the reverse causation from symptom frequency and distress to impaired ER. ER partially mediated the significant prospective paths from childhood trauma to symptom distress.ConclusionThe findings demonstrate that ER plays a role in translating childhood trauma into distressing psychotic experiences in later life. Moreover, the findings point to a maintenance mechanism in which difficulties in ER and symptom distress exacerbate each other. Thus, ER could be a promising target for interventions aimed at prevention of psychosis.
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Matthews, Paul R. L. "Schizophrenia is not a kind of PTSD." BJPsych Advances 23, no. 5 (September 2017): 318–20. http://dx.doi.org/10.1192/apt.bp.117.017202.
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SummaryCoughlan & Cannon's article provides a helpful review of the current state of evidence regarding the connection between childhood trauma and psychotic-like symptoms. This commentary focuses on the clinical implications by noting that much of the data comes from studies in non-patient populations and to some extent depends on the underlying assumption of the continuum model of psychosis. I reconsider the presented data focusing purely on clinical diagnoses of psychosis, and consider the implications of the association between trauma and psychosis by looking at the evidence base for specific trauma-focused therapies in psychosis.
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van Dam, D. S., M. van Nierop, W. Viechtbauer, E. Velthorst, R. van Winkel, R. Bruggeman, W. Cahn, et al. "Childhood abuse and neglect in relation to the presence and persistence of psychotic and depressive symptomatology." Psychological Medicine 45, no. 7 (July 17, 2014): 1363–77. http://dx.doi.org/10.1017/s0033291714001561.
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BackgroundThe association between childhood trauma and psychotic and depressive symptomatology is well established. However, less is known about the specificity and course of these symptoms in relation to childhood trauma.MethodIn a large sample (n = 2765) of patients with psychosis (n = 1119), their siblings (n = 1057) and controls (n = 589), multivariate (mixed-effects) regression analyses with multiple outcomes were performed to examine the association between childhood trauma and psychotic and depressive symptomatology over a 3-year period.ResultsA dose–response relationship was found between childhood trauma and psychosis. Abuse was more strongly associated with positive symptoms than with negative symptoms whereas the strength of the associations between neglect and positive and negative symptoms was comparable. In patients, similar associations between childhood trauma and psychotic or depressive symptoms were found, and in siblings and controls, stronger associations were found between trauma and depressive symptomatology. Childhood trauma was not related to a differential course of symptoms over a 3-year time period.ConclusionsIn congruence with earlier work, our findings suggest that childhood trauma, and abuse in particular, is associated with (subthreshold) psychosis. However, childhood trauma does not seem to be associated with a differential course of symptoms, nor does it uniquely heighten the chance of developing (subthreshold) psychotic symptomatology. Our results indicate that trauma may instead contribute to a shared vulnerability for psychotic and depressive symptoms.
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Shevlin, Mark, Jamie Murphy, and John Read. "Testing complex hypotheses using secondary data analysis: is the association between sexual abuse and psychosis moderated by gender in a large prison sample?" Journal of Criminal Psychology 5, no. 2 (May 5, 2015): 92–98. http://dx.doi.org/10.1108/jcp-02-2015-0009.
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Purpose – There have been many studies that demonstrated an association between sexual trauma and psychotic disorders or psychotic symptoms. Limited attention has been paid to gender differences regarding this association. A recent study evidenced that the trauma-psychosis association may be moderated by gender and that the effect may be specific for females. However, there have been many methodological limitations, particularly that low prevalence of psychosis and sexual trauma for males leads to low statistical power, that have made this hypothesis difficult to test. The paper aims to discuss these issues. Design/methodology/approach – This study sought to estimate the association between sexual trauma and psychosis, and to determine if the association was moderated by gender using data from the Survey of Psychiatric Morbidity among Prisoners in England and Wales (n=3,142). Findings – Bivariate analysis showed that sexual trauma predicted probable psychosis for both females (OR=4.13) and males (OR=4.72). After controlling for confounding variables the odds ratios for males and females did not differ significantly (the shared odds ratio was 2.60) indicating that the association was not moderated by gender. Originality/value – The relationship between sexual abuse and psychosis may neither be specific to, nor moderated by, gender.
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Bloomfield, Michael, Mustapha Modaffar, Franca Onyeama, Ting-Yun Chang, Joseph Dickson, and Jo Billings. "M98. IS THERE A DEVELOPMENTAL TRAUMAGENIC PHENOTYPE OF PSYCHOSIS?" Schizophrenia Bulletin 46, Supplement_1 (April 2020): S172. http://dx.doi.org/10.1093/schbul/sbaa030.410.
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Abstract Background Developmental trauma (DT) induces vulnerability to psychosis in adulthood. Adult survivors of DT with psychosis (ASDTP) have worse prognosis across a range of outcomes compared to individuals with psychosis without DT exposure. It has been suggested that this may reflect a developmental ‘traumatogenic’ psychosis phenotype, distinct from idiopathic schizophrenia. Given the implications for precision medicine, we therefore sought to test this hypothesis by conducting systematic reviews and meta-analyses of the literature comparing psychotic symptoms and neuroimaging findings between adults with psychosis diagnoses with and without developmental trauma. Methods We registered our search protocols in PROSPERO (CRD42018105021 and CRD42019131245). We systematically searched literature databases for relevant studies published up to July 2019. “Embase”, “MEDLINE”, and “PsychINFO” were systematically searched. Reference lists, OpenGrey, and Google scholar were hand-searched. Phenomenological outcomes of interests were quantitative and/or qualitative differences in psychotic symptom expression (primary outcome) and other domains of psychopathology (secondary outcome) between ASDTP and people with psychosis who did not report developmental trauma. Neuroimaging outcomes of interest including markers of brain volume and function (e.g. task-induced blood-oxygen dependent signal). Results Seventeen studies of symptomatology were included. Of these, four were meta-analysed. There was a relationship between DT and greater positive (Hedges g=0.53; p<0.001) and negative (Hedges g =0.41; p=0.001) symptom severity. ASDTP had greater neurocognitive deficits and symptom severity in other domains of psychopathology compared to individuals without DT. There was evidence that psychotic symptom content related to traumatic memories in those with experiences of DT. We identified twenty-seven imaging studies (n = 1,438 psychosis patients, n = 1,114 healthy controls or healthy siblings). DT was associated with global and regional differences in grey matter; corticolimbic structural dysconnectivity; a potentiated threat detection system; dysfunction in regions associated with mentalization; and elevated striatal dopamine synthesis capacity. Meta-analysis indicated that developmental trauma is associated with reductions of cortical thickness, global grey matter volume, and hippocampal volumes in patients with psychosis. Discussion Adult survivors of developmental trauma have more severe psychotic symptoms than those without developmental trauma histories. Alongside findings of differences in symptom expression and neuroimaging, the evidence suggests that there may be developmental traumatogenic psychosis phenotype. However, a key mechanistic gap remains how clinical and neuroimaging findings relate to each other. Nonetheless, alternative interpretations, such as an underdiagnosis of post-traumatic stress disorder, could also be plausible. These findings warrant further research to elucidate vulnerability and resilience mechanisms for psychosis in adult survivors of developmental trauma.
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Laugharne, Richard, Deborah Marshall, Jon Laugharne, and Alan Hassard. "A Role for EMDR in the Treatment of Trauma in Patients Suffering From a Psychosis: Four Vignettes." Journal of EMDR Practice and Research 8, no. 1 (2014): 19–24. http://dx.doi.org/10.1891/1933-3196.8.1.19.
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Many patients with a functional psychosis are likely to have a history of trauma and symptoms of posttraumatic stress disorder (PTSD); some may be traumatized by their psychotic symptoms. We present a series of vignettes to describe eye movement desensitization and reprocessing (EMDR) treatment of 4 patients suffering from a functional psychotic illness who had a significant history of trauma. After receiving EMDR, each patient showed an improvement in their PTSD symptoms and reported an improvement in the quality of their lives. Follow-up at 3–6 years indicated that the treatment effects were maintained, with changes evident in elimination of trauma-related delusions, reduction in anxiety and depression, fewer hospital admissions, and overall improved quality of life. Because a history of trauma and PTSD symptoms are more frequent in patients with a psychosis, and trauma may be an etiological component of psychosis, EMDR treatment needs to be researched and explored as a treatment opportunity.
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Daly, Oscar. "Trauma and psychosis." Psychiatry 8, no. 8 (August 2009): 315–18. http://dx.doi.org/10.1016/j.mppsy.2009.04.013.
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Collip, Dina, Inez Myin-Germeys, Marieke Wichers, Nele Jacobs, Catherine Derom, Evert Thiery, Tineke Lataster, et al. "FKBP5 as a possible moderator of the psychosis-inducing effects of childhood trauma." British Journal of Psychiatry 202, no. 4 (April 2013): 261–68. http://dx.doi.org/10.1192/bjp.bp.112.115972.
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BackgroundFK506 binding protein 5 (FKBP5) has repeatedly been shown to be a critical determinant of post-traumatic stress disorder (PTSD) and depression following childhood trauma.AimsTo examine the role of FKBP5-trauma interactions in the partly stress-related psychosis phenotype.MethodIn 401 general population twins, four functional polymorphisms were examined in models of psychosis and Cortisol, and followed up in models of psychosis in three samples at different familial liability (175 controls, 200 unaffected siblings and 195 patients with a psychotic disorder).ResultsThe most consistent finding was an interaction between childhood trauma and rs9296158/rs4713916 on psychotic symptoms and Cortisol in the twin sample, combined with a directionally similar interaction in siblings (rs4713916) and patients (rs9296158), A-allele carriers at both polymorphisms being most vulnerable to trauma.ConclusionsTrauma may increase the risk of psychosis through enduring changes in the Cortisol feedback loop, similar to that for PTSD, suggesting comparable biological mechanisms for psychosis across diagnostic boundaries.
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Richter, Anja, Evangelos Vassos, Matthew J. Kempton, Mark van der Gaag, Lieuwe de Haan, Barnaby Nelson, Anita Riecher-Rössler, et al. "S175. CLINICAL OUTCOMES IN PEOPLE AT HIGH RISK FOR PSYCHOSIS RELATED TO INTERACTIONS BETWEEN POLYGENIC RISK SCORES AND CHILDHOOD ADVERSITY." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S104. http://dx.doi.org/10.1093/schbul/sbaa031.241.
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Abstract Background Genetic vulnerability to psychosis is polygenic, involving multiple genes with small individual effects (Psychiatric Genomics Consortium (PGC), 2014). The risk of psychosis is also related to environmental factors, such as childhood trauma (Lardinois et al, 2011). Although the onset of psychosis is thought to result from the interaction of genetic and environmental risk factors (Walker & Diforio, 1997), the extent to which the influence of childhood trauma depends on genetic susceptibility remains unclear. We sought to address this issue in a large prospective study of people at clinical high risk (CHR) for psychosis. These individuals present with psychotic and affective symptoms, and are at increased risk of developing both schizophreniform and affective psychoses. Methods We studied subjects of European ancestry, drawn from EU-GEI, a large multi-centre prospective study of people at CHR for psychosis. At baseline, DNA was obtained from subjects who met the CAARMS criteria for the CHR state (n=266) and healthy controls (HC; n=42). Childhood trauma was assessed using the childhood trauma questionnaire (CTQ), which comprises 5 subdomains: emotional abuse, physical abuse, sexual abuse, physical neglect, and emotional neglect. Polygenic risk scores (PRSs) for schizophrenia (SCZ), bipolar disorder (BD) and major depressive disorder (MDD) were constructed separately, using results from meta-analyses by the corresponding Disorder Working Groups of the PGC. The CHR subjects were clinically monitored for up to 5 years and clinical outcomes were assessed in terms of transition to psychosis (as defined by the CAARMS), remission from the CHR state (subject no longer meets CAARMS inclusion criteria) and level of functioning (GAF Disability Scale). Logistic regression models were used to investigate the association between each PRSs and childhood trauma as predictors of transition and remission, adjusted by population stratification using the first 10 principal components, age, sex and site. All findings are reported at p<0.017, Bonferroni-corrected for the 3 PRSs. Results Within the CHR sample, the onset of psychosis during follow up was related to interactions between the BD PRS and the total childhood trauma score (OR=0.959, 95% CI 0.930–0.988, p=0.006), and between the BD PRS and physical abuse (OR=0.787, 95% CI 0.689–0.900, p<0.001). Remission from the CHR state was related to an interaction between the SCZ PRS and childhood sexual abuse (OR: 1.110, 95% CI 1.004–1.226, p=0.041). Discussion These data indicate that clinical outcomes in CHR subjects are related to interactions between the polygenic risk for psychotic disorders and childhood adversity. The measurement of interactions between genomic and environmental risk factors may help to predict individual outcomes in people at high risk in a clinical setting.
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Quidé, Y., N. O'Reilly, O. J. Watkeys, V. J. Carr, and M. J. Green. "Effects of childhood trauma on left inferior frontal gyrus function during response inhibition across psychotic disorders." Psychological Medicine 48, no. 9 (October 10, 2017): 1454–63. http://dx.doi.org/10.1017/s0033291717002884.
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AbstractBackgroundChildhood trauma is a risk factor for psychosis. Deficits in response inhibition are common to psychosis and trauma-exposed populations, and associated brain functions may be affected by trauma exposure in psychotic disorders. We aimed to identify the influence of trauma-exposure on brain activation and functional connectivity during a response inhibition task.MethodsWe used functional magnetic resonance imaging to examine brain function within regions-of-interest [left and right inferior frontal gyrus (IFG), right dorsolateral prefrontal cortex, right supplementary motor area, right inferior parietal lobule and dorsal anterior cingulate cortex], during the performance of a Go/No-Go Flanker task, in 112 clinical cases with psychotic disorders and 53 healthy controls (HCs). Among the participants, 71 clinical cases and 21 HCs reported significant levels of childhood trauma exposure, while 41 clinical cases and 32 HCs did not.ResultsIn the absence of effects on response inhibition performance, childhood trauma exposure was associated with increased activation in the left IFG, and increased connectivity between the left IFG seed region and the cerebellum and calcarine sulcus, in both cases and healthy individuals. There was no main effect of psychosis, and no trauma-by-psychosis interaction for any other region-of-interest. Within the clinical sample, the effects of trauma-exposure on the left IFG activation were mediated by symptom severity.ConclusionsTrauma-related increases in activation of the left IFG were not associated with performance differences, or dependent on clinical diagnostic status; increased IFG functionality may represent a compensatory (overactivation) mechanism required to exert adequate inhibitory control of the motor response.
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Harley, M., I. Kelleher, M. Clarke, F. Lynch, L. Arseneault, D. Connor, C. Fitzpatrick, and M. Cannon. "Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence." Psychological Medicine 40, no. 10 (December 9, 2009): 1627–34. http://dx.doi.org/10.1017/s0033291709991966.
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BackgroundAdolescent cannabis use has been shown in many studies to increase the risk of later psychosis. Childhood trauma is associated with both substance misuse and risk for psychosis. In this study our aim was to investigate whether there is a significant interaction between cannabis use and childhood trauma in increasing the risk for experiencing psychotic symptoms during adolescence.MethodPsychiatric interviews using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) semi-structured instrument were carried out with 211 adolescents aged between 12 and 15 years and their parents as part of a population-based study. The interview enquired about early traumatic events, cannabis use and psychiatric symptoms in adolescence.ResultsIn separate analyses both cannabis use and childhood trauma were significantly associated with risk of experiencing psychotic symptoms. However, the presence of both childhood trauma and early cannabis use significantly increased the risk for psychotic symptoms beyond the risk posed by either risk factor alone, indicating that there was a greater than additive interaction between childhood trauma and cannabis use.ConclusionOur finding of a greater than additive interaction between childhood trauma and cannabis use may have implications for the identification of individuals at high risk of experiencing psychotic symptoms. For example, measures to actively discourage or intensively treat cannabis use in children and adolescents who have experienced abuse may help to prevent the development of psychosis in this vulnerable group. Our findings require replication in larger samples to confirm this interaction effect.
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Berg, A. O., M. Aas, S. Larsson, M. Nerhus, E. Hauff, O. A. Andreassen, and I. Melle. "Childhood trauma mediates the association between ethnic minority status and more severe hallucinations in psychotic disorder." Psychological Medicine 45, no. 1 (May 20, 2014): 133–42. http://dx.doi.org/10.1017/s0033291714001135.
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BackgroundEthnic minority status and childhood trauma are established risk factors for psychotic disorders. Both are found to be associated with increased level of positive symptoms, in particular auditory hallucinations. Our main aim was to investigate the experience and effect of childhood trauma in patients with psychosis from ethnic minorities, hypothesizing that they would report more childhood trauma than the majority and that this would be associated with more current and lifetime hallucinations.MethodIn this cross-sectional study we included 454 patients with a SCID-I DSM-IV diagnosis of non-affective or affective psychotic disorder. Current hallucinations were measured with the Positive and Negative Syndrome Scale (P3; Hallucinatory Behaviour). Lifetime hallucinations were assessed with the SCID-I items: auditory hallucinations, voices commenting and two or more voices conversing. Childhood trauma was assessed with the Childhood Trauma Questionnaire, self-report version.ResultsPatients from ethnic minority groups (n = 69) reported significantly more childhood trauma, specifically physical abuse/neglect, and sexual abuse. They had significantly more current hallucinatory behaviour and lifetime symptoms of hearing two or more voices conversing. Regression analyses revealed that the presence of childhood trauma mediated the association between ethnic minorities and hallucinations.ConclusionsMore childhood trauma in ethnic minorities with psychosis may partially explain findings of more positive symptoms, especially hallucinations, in this group. The association between childhood trauma and these first-rank symptoms may in part explain this group's higher risk of being diagnosed with a schizophrenia-spectrum diagnosis. The findings show the importance of childhood trauma in symptom development in psychosis.
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Masters, Kim J. "ENVIRONMENTAL TRAUMA AND PSYCHOSIS." Journal of the American Academy of Child & Adolescent Psychiatry 34, no. 10 (October 1995): 1258. http://dx.doi.org/10.1097/00004583-199510000-00006.
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Caplan, Rochelle. "ENVIRONMENTAL TRAUMA AND PSYCHOSIS." Journal of the American Academy of Child & Adolescent Psychiatry 34, no. 10 (October 1995): 1258–59. http://dx.doi.org/10.1097/00004583-199510000-00007.
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Dvir, Yael, Brian Denietolis, and Jean A. Frazier. "Childhood Trauma and Psychosis." Child and Adolescent Psychiatric Clinics of North America 22, no. 4 (October 2013): 629–41. http://dx.doi.org/10.1016/j.chc.2013.04.006.
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Stanton, Kate J., Brian Denietolis, Brien J. Goodwin, and Yael Dvir. "Childhood Trauma and Psychosis." Child and Adolescent Psychiatric Clinics of North America 29, no. 1 (January 2020): 115–29. http://dx.doi.org/10.1016/j.chc.2019.08.004.
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de Bont, Paul, Ad de Jongh, and David van den Berg. "Psychosis: An Emerging Field for EMDR Research and Therapy." Journal of EMDR Practice and Research 13, no. 4 (November 1, 2019): 313–24. http://dx.doi.org/10.1891/1933-3196.13.4.313.
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It has only been in this last decade that trauma-focused treatments (TFT) have been studied in patients with psychotic disorders. Before, the paradigm stated that TFT was contraindicated in these patients because clinicians and researchers assumed the risk of exacerbation of symptoms was too high. The purpose of this article is to examine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy in the treatment of psychosis. To this end, we will present a brief narrative review of the current state of research in this particular field. The results suggest that, contrary to the “no-TFT-in-psychosis” paradigm, TFTs such as EMDR therapy can successfully be used to reduce trauma-related symptoms in patients with psychosis. Moreover, there are now provisional indications that psychotic symptoms such as delusions and hallucinations can be targeted directly and indirectly using EMDR therapy.
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Appiah-Kusi, E., R. Wilson, M. Colizzi, E. Foglia, E. Klamerus, A. Caldwell, M. G. Bossong, P. McGuire, and S. Bhattacharyya. "Childhood trauma and being at-risk for psychosis are associated with higher peripheral endocannabinoids." Psychological Medicine 50, no. 11 (August 19, 2019): 1862–71. http://dx.doi.org/10.1017/s0033291719001946.
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AbstractBackgroundEvidence has been accumulating regarding alterations in components of the endocannabinoid system in patients with psychosis. Of all the putative risk factors associated with psychosis, being at clinical high-risk for psychosis (CHR) has the strongest association with the onset of psychosis, and exposure to childhood trauma has been linked to an increased risk of development of psychotic disorder. We aimed to investigate whether being at-risk for psychosis and exposure to childhood trauma were associated with altered endocannabinoid levels.MethodWe compared 33 CHR participants with 58 healthy controls (HC) and collected information about previous exposure to childhood trauma as well as plasma samples to analyse endocannabinoid levels.ResultsIndividuals with both CHR and experience of childhood trauma had higher N-palmitoylethanolamine (p < 0.001) and anandamide (p < 0.001) levels in peripheral blood compared to HC and those with no childhood trauma. There was also a significant correlation between N-palmitoylethanolamine levels and symptoms as well as childhood trauma.ConclusionsOur results suggest an association between CHR and/or childhood maltreatment and elevated endocannabinoid levels in peripheral blood, with a greater alteration in those with both CHR status and history of childhood maltreatment compared to those with either of those risks alone. Furthermore, endocannabinoid levels increased linearly with the number of risk factors and elevated endocannabinoid levels correlated with the severity of CHR symptoms and extent of childhood maltreatment. Further studies in larger cohorts, employing longitudinal designs are needed to confirm these findings and delineate the precise role of endocannabinoid alterations in the pathophysiology of psychosis.
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Schmidt, T., S. W. Uldall, J. Carlsson, P. Munk-Jørgensen, and K. Andersen. "Differences in Psychiatrists’ and Psychologists’ Classification of Trauma-Related Changes of Consciousness in PTSD." European Psychiatry 33, S1 (March 2016): S514. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1899.
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IntroductionMental trauma may precede persistent changes in a person's mental health in the form of psychosis and dissociation. Presently, there are no subtypes to the diagnosis of PTSD. A psychotic subtype of PTSD has been proposed, and studies show that these patients differ as well in symptoms as biologically from patients with non-psychotic PTSD. Dissociation and psychosis are generally viewed as different phenomena. Where dissociation is understood as a disintegration of the mind, psychosis is viewed as a neurodegenerative disorder on a mainly biological/genetic basis. The delineation of psychotic and dissociative symptoms is not clear however.ObjectivesOur objective is to clarify, whether psychologists and psychiatrists describe trauma-related changes of consciousness (TCC) differently as dissociative or psychotic. Furthermore, we wish to compare scientific journals, and look for differences in how psychiatrists’ and psychologists’ make use of the terms dissociation and psychosis in relation to TCC.AimsWe aim to investigate whether TCC are interpreted differently among psychiatrists and psychologists.MethodsThis study is a systematic critical review of the literature. The databases PubMed, Embase and PsychInfo will be used. Articles involving PTSD with TCC will be included. Studies will be classified as viewing TCC's as either psychotic or dissociative, based on the terms the authors use to describe the observed phenomena.ResultsThe results will be presented at the EPA in March 2016 in Madrid.ConclusionThe study will reveal differences in how psychiatrists and psychologists classify TCC's in PTSD.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Vargas, Teresa, Phoebe H. Lam, Matilda Azis, K. Juston Osborne, Amy Lieberman, and Vijay A. Mittal. "Childhood Trauma and Neurocognition in Adults With Psychotic Disorders: A Systematic Review and Meta-analysis." Schizophrenia Bulletin 45, no. 6 (October 30, 2018): 1195–208. http://dx.doi.org/10.1093/schbul/sby150.
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Abstract Background Characterizing the link between childhood trauma and adult neurocognitive function in psychosis is crucial for improving the fields understanding of how early environmental risk factors impact the presentation of the disorder. To date, the literature has been inconsistent: meta-analytic synthesis is lacking, and it is unclear whether specific cognitive functions are affected. Methods A meta-analysis was performed on a total of 3315 subjects with a psychotic disorder. The links between childhood trauma, overall neurocognitive function, and four cognitive subdomains (working memory, executive function, verbal/visual memory, and attention/processing speed) were examined. Relevant sample characteristics and methodological moderators were tested. The strength of the association between trauma and overall neurocognition in individuals with psychotic disorders was also compared to that of healthy controls. Results Among individuals with psychotic disorders, there was a significant association between overall cognition and childhood trauma, r = −.055; 95% CI = −0.09, −0.02, P = .002. There was also a modest, negative relationship between childhood trauma and working memory, r = −.091; 95% CI = −0.15, −0.03, P = .002. Moderators did not have a significant effect on these analyses. Further, the association between childhood trauma and neurocognition was significantly stronger in healthy controls compared to patients with a psychotic disorder. Conclusion A small negative association was found between overall cognition and childhood trauma in individuals with psychotic disorders. Results suggest the association is less strong for individuals with a psychotic disorder compared to healthy populations. Findings are informative for prominent etiological models of psychosis.
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Reininghaus, U., C. Gayer-Anderson, L. Valmaggia, M. J. Kempton, M. Calem, A. Onyejiaka, K. Hubbard, et al. "Psychological processes underlying the association between childhood trauma and psychosis in daily life: an experience sampling study." Psychological Medicine 46, no. 13 (July 12, 2016): 2799–813. http://dx.doi.org/10.1017/s003329171600146x.
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BackgroundEvidence has accumulated that implicates childhood trauma in the aetiology of psychosis, but our understanding of the putative psychological processes and mechanisms through which childhood trauma impacts on individuals and contributes to the development of psychosis remains limited. We aimed to investigate whether stress sensitivity and threat anticipation underlie the association between childhood abuse and psychosis.MethodWe used the Experience Sampling Method to measure stress, threat anticipation, negative affect, and psychotic experiences in 50 first-episode psychosis (FEP) patients, 44 At-Risk Mental State (ARMS) participants, and 52 controls. Childhood abuse was assessed using the Childhood Trauma Questionnaire.ResultsAssociations of minor socio-environmental stress in daily life with negative affect and psychotic experiences were modified by sexual abuse and group (all pFWE < 0.05). While there was strong evidence that these associations were greater in FEP exposed to high levels of sexual abuse, and some evidence of greater associations in ARMS exposed to high levels of sexual abuse, controls exposed to high levels of sexual abuse were more resilient and reported less intense negative emotional reactions to socio-environmental stress. A similar pattern was evident for threat anticipation.ConclusionsElevated sensitivity and lack of resilience to socio-environmental stress and enhanced threat anticipation in daily life may be important psychological processes underlying the association between childhood sexual abuse and psychosis.
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Morrison, Anthony P. "A cognitive behavioural perspective on the relationship between childhood trauma and psychosis." Epidemiology and Psychiatric Sciences 18, no. 4 (December 2009): 294–98. http://dx.doi.org/10.1017/s1121189x00000245.
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AbstractThis editorial reviews the relationship between childhood trauma and the development of psychosis in adulthood. There are numerous studies, including large, prospective studies, which clearly support a link between childhood adversity and experience of psychosis later in life. There is also evidence that there is a dose response relationship, and that childhood trauma is particularly associated with the experience of hallucinations and delusional ideas. It is possible that psychosis is a relatively understandable response to the experience of severe trauma, and recent cognitive models of psychosis can help to explain the underlying mechanisms in such a causal relationship. There are obvious treatment implications, which include the need to assess histories of childhood trauma in people with psychosis, the incorporation of trauma in shared understandings of psychosis with service users, the incorporation of change strategies in cognitive behaviour therapy for psychosis that are derived from evidence-based approaches to the treatment of trauma and PTSD, and the prevention of traumatisation by mental health services.Declaration of Interest: None.
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Díaz-Caneja, Covadonga, Marcos González-Iglesias, Victoria Del Amo, Ignacio García-Cabeza, Celso Arango, and Enrique De Portugal. "S80. CHILDHOOD TRAUMA AND SOCIAL COGNITION IN DELUSIONAL PSYCHOSES." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S64—S65. http://dx.doi.org/10.1093/schbul/sbaa031.146.
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Abstract Background Deficits in social cognition could be involved in the pathogenesis of delusions in psychotic disorders (Bentall et al., 2009). Childhood trauma (CT) has been associated with an increased risk for psychosis (Varese et al., 2012). Neurocognitive and social cognition deficits could mediate in the association between CT and psychosis (Mansueto et al., 2019). Social cognition and childhood trauma have been understudied so far in delusional disorder (DD). We aimed to assess social cognition in a sample of patients with delusional psychoses (i.e., DD and schizophrenia) and healthy controls (HC) and to explore the potential effect of childhood trauma on social cognition and delusion. Methods This cross-sectional, transdiagnostic study included 69 patients with a DSM-IV-TR-confirmed diagnosis of DD (mean age 44.06 ± 11.39 years, 53.6% female), 77 with DSM-IV-TR-confirmed schizophrenia (mean age 38.12 ± 9.27 years, 27.3% female), and 63 HC (mean age 43.6 ± 13.0 years, 68.3% female). Attributional bias was assessed with the “Internal, Personal, and Situational Attributions Questionnaire.” Theory of Mind (ToM) performance was assessed with the “Reading the Mind in the Eyes Test” and the “Faux Pas Recognition Test.” Childhood trauma was measured with the “Childhood Trauma Questionnaire.” Neuropsychological functioning was measured with a comprehensive battery assessing attention, verbal learning, working memory, and executive function. We used ANCOVAs and linear regression analyses to assess the association between the three measures of social cognition and i) diagnosis, ii) dimensional measures of delusion proneness (Peters Delusion Inventory, PDI) and intensity (Maudsley Assessment of Delusion Schedule, MADS), and iii) childhood trauma; after controlling for potential confounders (age, sex, socioeconomic status, and estimated premorbid intelligence quotient). Results Patients with DD showed significantly poorer performance on the “Eyes Test” than HC (Cohen’s d=-0.44, p=0.037), after controlling for potential confounding variables. The difference was no longer significant after controlling for verbal memory. Patients with schizophrenia (d=-1.54, p<0.001) and DD (Cohen’s d=-0.60, p=0.002) showed significantly poorer performance than HC on the “Faux Pas Test,” after controlling for potential confounders. The difference between patients with schizophrenia and HC remained significant after controlling for neuropsychological functioning (Cohen’s d=-1.09, p<0.001), while differences between patients with DD and HC were no longer significant after controlling for executive function and working memory performance (Cohen’s d=-0.23, p=0.596). No significant differences were found between diagnostic groups in externalizing or personalizing attributional bias. In the fully adjusted models, intensity of the delusional idea was significantly associated with performance in the “Faux Pas Test” in DD, and with externalizing and personalizing attributional bias in schizophrenia. A positive history of CT was significantly associated with lower performance on the “Faux Pas Test” (Cohen’s d=-0.40, p=.022) and higher delusional proneness scores in the delusional psychosis samples (Cohen’s d=-0.49, p=.006), but not in HC. Discussion Social cognition deficits are associated with delusional intensity in delusional psychoses. Childhood trauma could increase the risk of psychosis through its effect on social cognition.
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van Nierop, M., W. Viechtbauer, N. Gunther, C. van Zelst, R. de Graaf, M. ten Have, S. van Dorsselaer, M. Bak, and R. van Winkel. "Childhood trauma is associated with a specific admixture of affective, anxiety, and psychosis symptoms cutting across traditional diagnostic boundaries." Psychological Medicine 45, no. 6 (October 2, 2014): 1277–88. http://dx.doi.org/10.1017/s0033291714002372.
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Background.Meta-analyses link childhood trauma to depression, mania, anxiety disorders, and psychosis. It is unclear, however, whether these outcomes truly represent distinct disorders following childhood trauma, or that childhood trauma is associated with admixtures of affective, psychotic, anxiety and manic psychopathology throughout life.Method.We used data from a representative general population sample (NEMESIS-2, n = 6646), of whom respectively 1577 and 1120 had a lifetime diagnosis of mood or anxiety disorder, as well as from a sample of patients with a diagnosis of schizophrenia (GROUP, n = 825). Multinomial logistic regression was used to assess whether childhood trauma was more strongly associated with isolated affective/psychotic/anxiety/manic symptoms than with their admixture.Results.In NEMESIS-2, largely comparable associations were found between childhood trauma and depression, mania, anxiety and psychosis. However, childhood trauma was considerably more strongly associated with their lifetime admixture. These results were confirmed in the patient samples, in which it was consistently found that patients with a history of childhood trauma were more likely to have a combination of multiple symptom domains compared to their non-traumatized counterparts. This pattern was also found in exposed individuals who did not meet criteria for a psychotic, affective or anxiety disorder and who did not seek help for subclinical psychopathology.Conclusions.Childhood trauma increases the likelihood of a specific admixture of affective, anxiety and psychotic symptoms cutting across traditional diagnostic boundaries, and this admixture may already be present in the earliest stages of psychopathology. These findings may have significant aetiological, pathophysiological, diagnostic and clinical repercussions.
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Rodriguez, Victoria, Luis Alameda, Paolo Marino, Giulia Trotta, Edoardo Spinazzola, Sandra Matheson, Kristin Laurens, Robin Murray, and Evangelos Vassos. "O8.4. ENVIRONMENTAL RISK FACTORS IN BIPOLAR DISORDER AND PSYCHOTIC DEPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF PROSPECTIVE STUDIES." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S19—S20. http://dx.doi.org/10.1093/schbul/sbaa028.045.
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Abstract Background There is replicated evidence of a shared genetic load between affective and non-affective psychosis, but much less is known of whether affective psychosis is affected by the same environmental risk factors as well. The aim of this review and meta-analysis is to study the association between specific environmental risk factors of interest previously associated with schizophrenia and later affective psychoses (bipolar disorder and psychotic depression). Methods A systematic search of prospective studies was conducted in MEDLINE, EMBASE and PsycINFO databases, supplemented by hand searching. Selected exposures included: paternal age, maternal infection, obstetric and perinatal factors, childhood trauma, childhood infection, urbanicity, migration, stressful life events, head injury and cannabis or substance use. Relevant studies were selected systematically among those fulfilling inclusion criteria, and effect sizes were extracted. Pooled information was presented for those factors with enough number studies to combine extracted effect sizes, while the rest were presented in a narrative way. Results Approximately 60 studies addressing the associations between environmental risk factors of interest and later affective psychoses were identified. The compiled studies showed that paternal age, early gestational age, lifetime cannabis use, parental death during childhood and ethnic minority in UK are associated with future development of affective psychosis. Discussion These results show that, as per genetics, there may be some overlap in the environmental load between schizophrenia and affective psychosis, suggesting general risks for psychosis rather than diagnostic specific risks. Nonetheless, publish studies for some factors in this subgroup of patients are still scarce. More longitudinal studies addressing specific association between environmental risk factors and affective psychosis are warranted.
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Croft, Jazz, David Martin, Paul Madley-Dowd, Daniela Strelchuk, Jonathan Davies, Jon Heron, Christoph Teufel, and Stanley Zammit. "Childhood trauma and cognitive biases associated with psychosis: A systematic review and meta-analysis." PLOS ONE 16, no. 2 (February 25, 2021): e0246948. http://dx.doi.org/10.1371/journal.pone.0246948.
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Childhood trauma is associated with an increased risk of psychosis, but the mechanisms that mediate this relationship are unknown. Exposure to trauma has been hypothesised to lead to cognitive biases that might have causal effects on psychotic symptoms. The literature on whether childhood trauma is associated with psychosis-related cognitive biases has not been comprehensively reviewed. A systematic review and meta-analysis or narrative synthesis of studies examining the association between childhood trauma and the following biases: external locus of control (LOC), external attribution, probabilistic reasoning, source monitoring, top-down processing, and bias against disconfirmatory evidence. Studies were assessed for quality, and sources of heterogeneity were explored. We included 25 studies from 3,465 studies identified. Individuals exposed to childhood trauma reported a more external LOC (14 studies: SMD Median = 0.40, Interquartile range 0.07 to 0.52), consistent with a narrative synthesis of 11 other studies of LOC. There was substantial heterogeneity in the meta-analysis (I2 = 93%) not explained by study characteristics examined. Narrative syntheses for other biases showed weaker, or no evidence of association with trauma. The quality of included studies was generally low. Our review provides some evidence of an association between childhood trauma and a more external LOC, but not with the other biases examined. The low quality and paucity of studies for most of the cognitive biases examined highlights the need for more rigorous studies to determine which biases occur after trauma, and whether they mediate an effect of childhood trauma on psychosis.
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Savitz, Jonathan, Lize van der Merwe, Dan J. Stein, Mark Solms, and Rajkumar Ramesar. "Neuropsychological status of bipolar I disorder: impact of psychosis." British Journal of Psychiatry 194, no. 3 (March 2009): 243–51. http://dx.doi.org/10.1192/bjp.bp.108.052001.
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BackgroundThe presence of schizotypal personality traits in some people with bipolar disorder, together with reports of greater cognitive dysfunction in patients with a history of psychotic features compared with patients without such a history, raises questions about the nosological relationship between bipolar disorder with psychotic features and bipolar disorder without psychotic features.AimsTo test the impact of a history of DSM–IV-defined psychosis on the neuropsychological status of participants with bipolar disorder while statistically controlling for confounding factors such as mood, medication, alcohol misuse/dependence and childhood abuse, and to evaluate the impact of schizotypal personality traits (and thus potential vulnerability to psychotic illness) on the cognitive performance of people with bipolar disorder and their healthy relatives.MethodNeuropsychological data were obtained for 25 participants with type I bipolar disorder and a history of psychosis, 24 with type I bipolar disorder but no history of psychosis and 61 unaffected relatives. Schizotypal traits were measured with the Schizotypal Personality Scale (STA). Childhood trauma was measured with the Childhood Trauma Questionnaire.ResultsThe group with a history of psychosis performed significantly worse than the healthy relatives on measures of verbal working memory, cognitive flexibility and declarative memory. Nevertheless, the two bipolar disorder groups did not differ significantly from each other on any cognitive measure. Scores on the STA were negatively associated with verbal working and declarative memory, but positively associated with visual recall memory.Conclusions‘Psychotic’ and ‘non-psychotic’ subtypes of bipolar disorder may lie on a nosological continuum that is most clearly defined by verbal memory impairment.
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Krabbendam, L. "Childhood psychological trauma and psychosis." Psychological Medicine 38, no. 10 (February 7, 2008): 1405–8. http://dx.doi.org/10.1017/s0033291708002705.
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Bloomfield, Michael. "41. DEVELOPMENTAL TRAUMA AND PSYCHOSIS." Schizophrenia Bulletin 45, Supplement_2 (April 2019): S155. http://dx.doi.org/10.1093/schbul/sbz022.168.
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Bower, Herbert. "Psychogenic trauma and transient psychosis." European Psychiatry 11 (January 1996): 294s. http://dx.doi.org/10.1016/0924-9338(96)88898-5.
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Wilcox, James A., and Henry A. Nasrallah. "Childhood head trauma and psychosis." Psychiatry Research 21, no. 4 (August 1987): 303–6. http://dx.doi.org/10.1016/0165-1781(87)90013-8.
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Gómez-Arnau, J., R. Puente-García, S. García-Jorge, M. Benítez-Alonso, H. Dolengevich-Segal, and J. Correas-Lauffer. "The old concept of psychogenic psychosis revisited from a transcultural approach: A case series." European Psychiatry 33, S1 (March 2016): S400—S401. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1440.
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IntroductionThe concept of psychogenic psychosis was introduced by Wimmer in 1916 and subsequently extended by Strömgren in the mid twentieth century. It typically describes a polymorphic psychotic episode of abrupt onset and which follows a trauma or stressful life situation. The duration of the episode is usually brief and remission occurs ad integrum. In recent decades, the notion has fallen into disuse in clinical psychiatry and international classifications. This could be due to a general improvement in living conditions, with less exposure to traumatic situations.ObjectiveWe intend to study the characteristics of psychogenic psychosis in immigrants. We believe that the condition could be observed better in this population, given their greater vulnerability to trauma. For this purpose, we chose a sample of Romanian patients, who nevertheless have considerable cultural affinity with the Spanish population.MethodsWe collected the clinical and biographical data of four cases of psychogenic psychosis admitted to our clinic between 2012 and 2015.ResultsFour Romanian women aged 25 to 42 were diagnosed with psychogenic psychosis in this period. Mean length of hospitalization was 5, 0 days. All patients reported familiar or occupational stress prior to the onset of symptoms. Psychotic symptoms remitted quickly with low doses of medication, despite being initially intense.ConclusionsReported cases fit remarkably well with the original description of Wimmer. The concept of psychogenic psychosis, along with similar brief psychotic entities, could be useful in describing the psychopathology derived from new social models and crises.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Van den Berg, David P. G., Berber M. Van der Vleugel, Anton B. P. Staring, Paul A. J. De Bont, and Ad De Jongh. "EMDR in Psychosis: Guidelines for Conceptualization and Treatment." Journal of EMDR Practice and Research 7, no. 4 (2013): 208–24. http://dx.doi.org/10.1891/1933-3196.7.4.208.
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A significant proportion of clients with psychosis have experienced childhood trauma and suffer from comorbid posttraumatic stress disorder. Research indicates that exposure to distressing early life events plays an important role in the emergence and persistence of psychotic symptoms—either directly or indirectly. The Two Method Approach of EMDR conceptualization and recent findings on reprocessing of psychosis-related imagery fit with the existing cognitive models of psychosis. This article presents a series of preliminary guidelines for conceptualizing EMDR treatment in psychosis, which are based on both theory and clinical experience and are illustrated with case examples. Several obstacles and related treatment strategies for using EMDR in psychosis are described. EMDR in psychosis can very well be combined with other standard interventions such as psychotropic medication and cognitive behavioral therapy.
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Holttum, Sue. "Research watch: trauma-informed mental health care and avoiding exclusion of people with a psychosis diagnosis from trauma therapies." Mental Health and Social Inclusion 25, no. 2 (May 7, 2021): 109–16. http://dx.doi.org/10.1108/mhsi-02-2021-0006.
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Purpose This paper aims to highlight emerging research relating to the need to recognise and address trauma in mental health service users. Design/methodology/approach The author searched for papers on trauma-informed care, published in the past two years. Findings One paper reports ideas of service users and family members for trauma-informed mental health services. A second paper describes an online survey seeking agreement between staff and service users of early intervention services for psychosis about practices of trauma-informed care. Both papers feature themes about safety and staff having training and support for asking about and responding to trauma. A third paper reports on specific therapies for trauma with people who experience psychosis. It found some evidence for talking therapies but noted that people with a psychosis diagnosis are rarely offered such therapies. Originality/value These papers highlight an emerging consensus about essential components of trauma-informed care and the need for staff training and support to realise it. The exclusion of people with a psychosis diagnosis from specific trauma therapies might begin to be addressed if services were more able to recognise trauma. There is some evidence that talking therapies for childhood trauma can be helpful for people who have a psychosis diagnosis. However, evidence reviews should be broadened to include a range of distressing experiences recognised to follow childhood trauma irrespective of whether the person has a psychosis diagnosis.
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Freeman, Daniel, and David Fowler. "Routes to psychotic symptoms: Trauma, anxiety and psychosis-like experiences." Psychiatry Research 169, no. 2 (September 2009): 107–12. http://dx.doi.org/10.1016/j.psychres.2008.07.009.
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Ntlantsana, Vuyokazi, Yusuf Asmal, Usha Chhagan, Bonginkosi Chiliza, Enver Karim, Musa Sibiya, and Saeeda Paruk. "T148. FIRST EPISODE PSYCHOSIS, TRAUMA AND SUBSTANCE USE IN A HIGH HIV PREVALENCE SETTING IN SUB-SAHARAN AFRICA." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S287. http://dx.doi.org/10.1093/schbul/sbaa029.708.
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Abstract Background HIV, substance use and trauma are associated with more severe symptoms and poorer outcomes in psychosis. We aim to describe the profile of adults with first episode psychosis (FEP) and associations with substance use and trauma in a cohort of patients in a low resource, high HIV prevalence setting in South Africa. Methods We recruited all adult patients (18–45 years) presenting with FEP to five psychiatric units in the eThekwini Municipality, KwaZulu-Natal Province. Psychiatric diagnosis was made using the MINI. We used the PANSS for psychotic symptoms, WHO ASSIST for substance use and CTQ for early childhood trauma. HIV status was confirmed by ELISA. Results Sixty participants were recruited, mean age 26 years (SD 8, IQR 19–33), 68% (n=41) were male. Mean age at presentation was 24 and 31 years for males and females respectively, with males being significantly younger than females (p=0.0003). Duration of untreated psychosis (DUP) was 12.5 months (IQR 1–10.3 months). Lifetime tobacco, alcohol and cannabis use was reported at 57%, 55%, and 47% respectively. Substance use was more prevalent among males compared to females, p=0.10, 0.13 and 0.0001 for tobacco, alcohol and cannabis respectively. Lifetime cannabis use was associated with higher negative PANSS scores (mean score 32, SD 10) compared to non-users (mean score 17, SD 7), p=0.05. Sixty eight percent (n=41) reported any traumatic event. Sixty-two percent (n=37) experienced trauma before 18 years and 35% (n=21) reported traumatic experiences in adulthood. Individuals who reported trauma in adulthood had higher hostility scores in the PANSS compared to those who experienced no trauma in adulthood (p=0.05). Fifteen (25%) of the cohort was HIV infected. Females were more likely to be HIV infected (58% HIV infected females compared to 9.8% HIV infection in males, p=0.0001). Eleven of the 15 HIV infected patients had been on antiretroviral treatment prior to the psychosis onset and four were newly diagnosed at the time of psychosis presentation. Of the 11 individuals on antiretroviral treatment, 6 (45%) were virologically suppressed. There was no significant difference in PANSS scores by HIV status (p=0.5) and childhood trauma (p=0.5). Discussion The study found participants with FEP had a high prevalence of HIV, particularly in females, and high prevalence of tobacco, alcohol and cannabis use. This suggests that these individuals are particularly vulnerable to the triple burden of psychosis, substance use and HIV. In addition, they had long DUP suggesting delay in accessing treatment, which all serve as poorer prognostic indicators in an already overwhelmed health care setting. The high rates of trauma (more than half the sample reporting childhood trauma) is another major public health concern as trauma exposure has been associated with poorer physical and mental health outcomes. In this study the lack of association between childhood trauma and psychosis severity is inconsistent with literature and needs to be further explored. The association between adult exposure to trauma and increased hostility scores suggests the need to include psychological treatment strategies to address the trauma exposure to improve outcomes.
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Murphy, Jamie, James Edward Houston, Mark Shevlin, and Gary Adamson. "Childhood sexual trauma, cannabis use and psychosis: statistically controlling for pre-trauma psychosis and psychopathology." Social Psychiatry and Psychiatric Epidemiology 48, no. 6 (September 29, 2012): 853–61. http://dx.doi.org/10.1007/s00127-012-0592-8.
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van Nierop, M., I. Myin-Germeys, and R. van Winkel. "Clinic risk associated with comorbidity of (subclinical) psychosis, anxiety and depressive symptoms: A case for stratified medicine in psychiatry." European Psychiatry 33, S1 (March 2016): S49. http://dx.doi.org/10.1016/j.eurpsy.2016.01.913.
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BackgroundMeta-analyses link childhood trauma to depression, mania, anxiety, and psychosis. It is unclear, however, whether these outcomes truly represent distinct disorders following childhood trauma, or that childhood trauma is associated with admixtures of affective, psychotic, anxiety and manic psychopathology throughout life.AimTo investigate the impact of trauma on psychopathological phenotype, functional outcome, and daily life stress reactivity.MethodsWe used data from a representative general population sample (NEMESIS-2; n = 6646), of whom respectively 1577 and 1120 had a lifetime diagnosis of mood or anxiety disorder, as well as from a sample of patients with a diagnosis of schizophrenia (GROUP; n = 825). Multinomial logistic regression was used to assess whether childhood trauma was more strongly associated with isolated affective/psychotic/anxiety/manic symptoms than with their admixture. Additionally, we examined these groups in terms of social functioning, clinical severity, and quality of life. In a separate sample (n = 621), daily life (emotional and cortisol) stress reactivity was assessed, using ambulatory assessment.ResultsIn all samples, childhood trauma was considerably more strongly associated with an admixture of symptoms of depression, anxiety, psychosis, and mania, rather than with these symptoms in isolation. Individuals exposed to childhood trauma, who also had an admixture of symptoms, had a lower quality of life, more help-seeking behaviour, higher prevalence of substance use disorders, and lower social functioning, compared with individuals not exposed to trauma, without an admixture of symptoms, or neither. Furthermore, trauma-exposed individuals with an admixed psychopathological phenotype show a higher daily emotional stress reactivity.ConclusionChildhood trauma increases the likelihood of a specific admixture of affective, anxiety and psychotic symptoms cutting across traditional diagnostic boundaries. Stratifying according to childhood trauma exposure thus identifies an admixed phenotype, possibly induced by continuous daily life stress reactivity, that has important clinical relevance. Identification of functionally meaningful aetiological subgroups may aid clinical practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Grattan, Rebecca E., Natalia Lara, Renata M. Botello, Valerie L. Tryon, Adrienne M. Maguire, Cameron S. Carter, and Tara A. Niendam. "A History of Trauma is Associated with Aggression, Depression, Non-Suicidal Self-Injury Behavior, and Suicide Ideation in First-Episode Psychosis." Journal of Clinical Medicine 8, no. 7 (July 23, 2019): 1082. http://dx.doi.org/10.3390/jcm8071082.
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The association between trauma and psychosis outcomes is well-established, and yet the impact of trauma on comorbid clinical symptoms—such as aggression, non-suicidal self-injury behavior (NSSIB), suicide ideation, and suicide behavior—for those with psychosis is unclear. To effectively treat those with first-episode psychosis (FEP) and a history of trauma, we need to understand the impact of trauma on their whole presentation. FEP participants were recruited from an Early Psychosis Program (N = 187, ages 12–35, 72.2% male). Clinicians gathered history of trauma, aggression, and suicide data, and rated current symptom severity and functioning. Data was coded using clinician rated measures, self-report measures, and retrospective clinical chart review. Regression analyses examined whether trauma was associated with a history of aggression, suicidal ideation, suicide behavior, NSSIB, symptoms, and functioning. Trauma was associated with aggression, aggression severity and type of aggression (aggression towards others). Trauma was also associated with depression severity, suicide ideation, most severe suicide ideation, and NSSIB. Trauma was not associated with suicide behavior, severity of suicide behavior or psychosocial functioning. Integrating trauma treatment into FEP care could reduce rates of depression, aggression, suicide ideation, and NSSIB for those with a history of trauma. To reduce suicide attempt occurrence and improve functioning, more research is needed.
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Fišeković, Saida, and Lejla Burnazović. "Epileptic Psychoses – Evaluation of Clinical Aspects." Bosnian Journal of Basic Medical Sciences 7, no. 2 (May 20, 2007): 140–43. http://dx.doi.org/10.17305/bjbms.2007.3069.
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Epileptic psychoses as the most complex psychopathological phenomena represent unexplored states for prognosis. Clinical trials, conveyed in order to found risk factors still are not consistent in their conclusions. By this research results of all biological, clinical, psychological and social, as well as demographic factors will contribute to opportunity to find variables which could finally prevent these conditions. In this study we tried to evaluate clinical variables which could foresee manifestation of interictal and postictal psychosis. This research study is epidemiological, clinical, retrospective and analytical. In total 567 patients were included in this study, which belonged to the diagnostic criteria F 0.6 according to ICD-10 classification, among which 14 patients with the diagnosed epileptic psychosis (06,8) were followed. All patients were hospitalized and evaluated at the Psychiatric Clinic in University of Sarajevo Clinics Centre, during time period between 01.01.2000 - 31.08.2006. Within baseline all relevant clinical and demographic variables were evaluated. Among patients most dominant form of behavior was expansive, with emphasized paranoid ideations and perception of auditory hallucinations. A correlation between intensive psychological trauma as an exacerbation factor and prolonged illness is determined, as well as between expression of psychotic symptoms and forced normalization by antiepileptic medications. Also is proven that among postictal psychosis more dominant are suicide attempts and aggressive behavior.
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Tomassi, S., S. Tosato, V. Mondelli, C. Faravelli, A. Lasalvia, G. Fioravanti, C. Bonetto, et al. "Influence of childhood trauma on diagnosis and substance use in first-episode psychosis." British Journal of Psychiatry 211, no. 3 (September 2017): 151–56. http://dx.doi.org/10.1192/bjp.bp.116.194019.
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BackgroundChildhood trauma has been significantly associated with first-episode psychosis, affective dysfunction and substance use.AimsTo test whether people with first-episode psychosis who had experienced childhood trauma, when compared with those who had not, showed a higher rate of affective psychosis and an increased lifetime rate of substance use.MethodThe sample comprised 345 participants with first-episode psychosis (58% male, mean age 29.8 years, s.d.=9.7).ResultsSevere sexual abuse was significantly associated with a diagnosis of affective psychosis (χ2=4.9, P=0.04) and with higher rates of lifetime use of cannabis (68% v. 41%; P = 0.02) and heroin (20% v. 5%; P=0.02). Severe physical abuse was associated with increased lifetime use of heroin (15% v. 5%; P = 0.03) and cocaine (32% v. 17%; P = 0.05).ConclusionsPatients with first-episode psychosis exposed to childhood trauma appear to constitute a distinctive subgroup in terms of diagnosis and lifetime substance use.
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Hardy, Amy, David Fowler, Daniel Freeman, Ben Smith, Craig Steel, Jane Evans, Philippa Garety, Elizabeth Kuipers, Paul Bebbington, and Graham Dunn. "Trauma and Hallucinatory Experience in Psychosis." Journal of Nervous and Mental Disease 193, no. 8 (August 2005): 501–7. http://dx.doi.org/10.1097/01.nmd.0000172480.56308.21.
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Garrett, Michael. "Psychosis, Trauma, and Ordinary Mental Life." American Journal of Psychotherapy 70, no. 1 (January 2016): 35–62. http://dx.doi.org/10.1176/appi.psychotherapy.2016.70.1.35.
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Frounfelker, Rochelle. "Review of Psychosis, trauma and dissociation." Psychiatric Rehabilitation Journal 33, no. 3 (2010): 246–47. http://dx.doi.org/10.1037/h0094653.
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