Impact of childhood abuse on the clinical course of bipolar disorder

Long Island University, New York, New York, United States
The British Journal of Psychiatry (Impact Factor: 7.99). 03/2005; 186:121-5. DOI: 10.1192/bjp.186.2.121
Source: PubMed


Few investigations have examined the impact of childhood trauma, and domains of childhood abuse, on outcome in bipolar disorder.
To evaluate the prevalence and subtypes of childhood abuse reported by adult patients with bipolar disorder and relationship to clinical outcome.
Prevalence rates of childhood abuse were retrospectively assessed and examined relative to illness complexity in a sample of 100 patients at an academic specialty centre for the treatment of bipolar disorder.
Histories of severe childhood abuse were identified in about half of the sample and were associated with early age at illness onset. Abuse subcategories were strongly inter-related. Severe emotional abuse was significantly associated with lifetime substance misuse comorbidity and past-year rapid cycling. Logistic regression indicated a significant association between lifetime suicide attempts and severe childhood sexual abuse. Multiple forms of abuse showed a graded increase in risk for both suicide attempts and rapid cycling.
Severe childhood trauma appears to have occurred in about half of patients with bipolar disorder, and may lead to more complex psychopathological manifestations.

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Available from: Joseph Goldberg, Nov 02, 2014
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    • "Moreover, a family history of affective disorder is associated with a more severe course of BD, including an earlier onset, more episodes, more suicide attempts and lower quality of life (Antypa and Serretti, 2014; Berutti et al., 2014). In addition to hereditary factors, severe childhood abuse is also associated with an earlier onset of BD (Etain et al., 2008; Garno et al., 2005; Suppes et al., 2001). In younger adults with BD it was found that the Contents lists available at ScienceDirect journal homepage: "
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    ABSTRACT: The aim of this study is to explore the family history of psychiatric disorders, childhood abuse, and stressors in older patients with Bipolar Disorder (BD) and the association of these variables with the age at onset of BD. The Questionnaire for Bipolar Disorder (QBP) and the Mini International Neuropsychiatric Interview (MINI-Plus) were obtained from 78 patients aged 60 and over to determine diagnosis, age at onset of the first affective episode, childhood abuse, family history of psychiatric disorders and past and recent stressful life events. Increased family history of psychiatric disorders was the only factor associated with an earlier age at onset of BD. Less family history of psychiatric disorders and more negative stressors were significantly associated with a later age at onset of the first (hypo)manic episode. Age at onset, history of childhood abuse, and past stressful life events were assessed retrospectively. Family members of BD patients were not interviewed. Our findings suggest that age at onset can define distinct BD phenotypes. More specifically there was a stronger heredity of BD and other psychiatric disorders in patients with an early age of onset of BD. Negative stressors may play a specific role in patients with a late age at onset of a first (hypo)manic episode. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 09/2015; 184:249-255. DOI:10.1016/j.jad.2015.05.066 · 3.38 Impact Factor
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    • "Evidence suggests that early childhood stressors may contribute to the substantial morbidity associated with BD. In particular, individuals with BD and a history of physical and sexual abuse reportedly have an earlier age of onset (Daruy-Filho et al., 2011), worsened clinical presentation and psychosocial functioning (Daglas et al., 2014), higher rate of comorbid substance abuse (Garno et al., 2005), and a higher number of suicide attempts (Daruy-Filho et al., 2011). Experiencing emotional and sexual abuse may in part explain why certain individuals with BD express suicidal behavior while some do not (Etain et al., 2008). "
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    ABSTRACT: Background Psychiatric illnesses like bipolar disorder (BD) are increasingly understood to be neurodevelopmental disorders with clinical, psychological and biological indicators recognizable long before the emergence of the full-blown syndromes.Methods This paper is a selective review of findings from studies of high-risk children of affected parents that inform knowledge of illness risk and development markers of BD. We specifically focus on candidate clinical, biological and psychological risk indicators that could serve as targets for future early intervention and prevention studies.ResultsThere is convergent evidence from prospective studies that BD typically debuts as depressive episodes after puberty. In some high-risk children, sleep and anxiety disorders precede mood disorders by several years and reflect an increased vulnerability. An association between early exposure to adversity (e.g. exposure to parental illness, neglect from mother) and increased risk of psychopathology may be mediated through increased stress reactivity evident at both behavioural and biological levels. Inter-related psychological processes including reward sensitivity, unstable self-esteem, rumination and positive self-appraisal are risk factors for mood disorders. Disturbances in circadian rhythm and immune dysfunction are associated with mood disorders and may be vulnerability markers influenced by these other risk factors.Conclusions There is accruing evidence of a number of measurable and potentially modifiable markers of vulnerability and developing illness in youth at familial risk for BD. Longitudinal studies of multiple biological and psychological risk processes in high-risk offspring, both individually and together, will improve our understanding of illness onset and lead to the development of specific early interventions. © The Author 2014. Published by Oxford University Press on behalf of CINP.
    The International Journal of Neuropsychopharmacology 06/2015; DOI:10.1093/ijnp/pyv071 · 4.01 Impact Factor
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    • "This pattern highlights the need to better understand the predictors of illness course, including psychosocial factors, which received an increasing awareness lately. Considerable literature exists about the prevalence of life events prior to episodes and its role on the course of bipolar disorder (Ambelas, 1979; Christensen et al., 2003; Dunner et al., 1979; El Kissi et al., 2013; Ellicott et al., 1990; Garno et al., 2005; Gershon et al., 2013; Hosang et al., 2012; Hosang et al., 2010b; Joffe et al., 1989; Kennedy et al., 1983; Neria et al., 2005; Swendsen et al., 1995). Stressful life events are associated with lower socio-economic status, living with non-intact family, anxiety and disruptive behaviors (Romero et al., 2009) and occur frequently prior to affective episodes in bipolar patients (Ambelas, 1979; Dunner et al., 1979; El Kissi et al., 2013; Hosang et al., 2010a). "
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    ABSTRACT: Background Life events may very well increase the likelihood of affective episodes in bipolar disorder, but prospective data on survival are inconsistent. Methods The authors examined the prevalence of negative and goal-attainment life events within 6 months prior to the index episode and after the index episode and their impact on the risk of relapse. Two hundred twenty-two consecutively admitted ICD-10 bipolar I (n=126) and II (n=96) patients were followed-up naturalistically over a period of 4 years. Results One-hundred thirty-eight (62.2%) of the patients had at least one life event 6 month before the index episode. Seventy patients (31.5%) experienced one, 48 (21.6%) two, and 20 (9.0%) three (or more) life events. Regarding life events after the index episode, 110 (49.5%) patients had at least one life event. Fifty-four patients (24.3%) experienced one, 31 (14.0%) two, and 25 (11.3%) three (or more) life events. The number of life events was larger in patients with bipolar II disorder than in patients with bipolar I disorder (p=0.004). Using a Cox regression analysis, the risk of a depressive relapse in bipolar I patients was associated with the number of life events after the index episode (p=0.002). This was independent of the quality of the life event. Limitations Standardized life event scales, defined dosages of drugs or blood sampling during all visits were not performed. Conclusions Our data suggest a high and continuous number of life events prior to affective episodes. Life events after the index episode worsened the course of bipolar I patients with more depressive episodes. This underlines the importance of detection and treatment of emerging life events.
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