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

ABSTRACT 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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    • "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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    • "The CTQ has been used in both non-clinical (Scher et al., 2001) and clinical populations (Martinotti et al., 2009; Uçok and Bikmaz, 2007). It has a high degree of reliability (Bernstein et al., 1994) and it was also recently used to assess patients with affective disorders (Etain et al., 2010; Garno et al., 2005; Polanczyk et al., 2009). Psychopathology was rated using the Young Mania Rating Scale (YMRS) for mania symptom severity (Young et al., 1978), the 17-item Hamilton Rating Scale for Depression (HAMD) for depression symptom severity (Hamilton, 1960) and the Hamilton Rating Scale for Anxiety (HAMA) for anxiety symptom severity (Hamilton, 1959); all investigated the week prior to the assessment. "
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    ABSTRACT: Childhood trauma is an important environmental stressor associated with bipolar disorders (BD). It is still not clear if it is differently distributed between BD I and BD II. Therefore, the aim of this research was to investigate the distribution patterns of childhood trauma in BD I and BD II. In this perspective, we also studied the relationship between childhood trauma and suicidality. We assessed 104 outpatients diagnosed with BD I (n=58) or BD II (n=46) according to DSM-IV-TR criteria and 103 healthy controls (HC) matched for age, sex and education level. History of childhood trauma was obtained using the Childhood Trauma Questionnaire (CTQ). All patients with BD had had more severe traumatic childhood experiences than HC. Both BD I and BD II patients differed significantly from HC for trauma summary score and emotional abuse. BD I patients differed significantly from HC for sexual abuse, and BD II differed from HC for emotional neglect. BD I and BD II did not significantly differ for any type of trauma. Suicide attempts were linked to both emotional and sexual abuse in BD I and only to emotional abuse in BD II. Emotional abuse was an independent predictor of lifetime suicide attempts in BD patients. The reliability of the retrospective assessment of childhood trauma experiences with the CTQ during adulthood may be influenced by uncontrolled recall bias. The assessment of childhood trauma, which has great clinical importance because of its strong link with suicidality, can unveil slight differences between BD subtypes and HC. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 12/2014; 175C:92-97. DOI:10.1016/j.jad.2014.12.055 · 3.38 Impact Factor
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