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Childhood trauma as a risk factor for psychosis: A sib-pair study
... Three other studies related sexual abuse in childhood with a higher probability of presenting a diagnosis of SSD (Ding et al., 2014;Houston et al., 2011;Tomassi et al., 2017). Barrigon et al. (2015) and Harley et al. (2010) found that the chances of suffering psychosis were 7.3 and 5.2 times higher, respectively, for those who had suffered childhood trauma than for those who had not experienced it, and both works had moderate methodological quality. Additionally, with moderate quality, the Morkved study examined two different patient samples: a sample of patients with SSD and a sample of patients with substance abuse. ...
... The work of Saddichha et al. (2015) examined whether there were differences between those who used cannabis and those who used stimulants with regard to SSD, and they found that cannabis users had higher rates of lifetime SSD than stimulant users. Barrigón et al., found that the odds of developing psychosis were 16.5 times higher for subjects who used cannabis than for those who did not use cannabis (Barrigon et al., 2015). The last two described works that presented a moderate methodological quality. ...
... Finally, it is necessary to highlight that one of the seven studies did not find a significant interaction among the studied variables (Barrigon et al., 2015). ...
Background: Schizophrenia spectrum disorders (SSD) are mental diseases caused by a combination of genetic susceptibility and a number of environmental factors. Among these factors, the role of traumatic events suffered in childhood, as well as that of substance use, have been of particular research interest.
Objectives: To conduct a systematic review to clarify whether there is an interaction between childhood trauma and substance use related to the diagnosis or symptoms of SSD. It was also the objective of this review to collate the associations that may exist between the three variables of the study (trauma, substance use and psychosis).
Methods: We conducted a systematic search resulting in 240 articles. We considered all of the original articles that explored childhood trauma and substance use in patients suffering from SSD.
Results: Twenty-three articles were selected for this review. Several of the reviewed papers found associations between childhood trauma and substance use with SSD, as well as interactions between trauma and drug use on SSD.
Conclusions: The results suggest that childhood trauma and substance use may be present at the basis of psychosis. This double hit on the pathogenesis could have clinical implications, since each of these impacts could be considered a window of opportunity for the primary prevention of SSD.
... Childhood trauma is defined as "events that occur before the age of 16" (Bernstein et al., 2003;Mansueto and Faravelli, 2017;Plant et al., 2016), life events are defined as "situations or occurrences that bring about a positive or negative change in personal circumstances and involve an element of threat" (Beards et al., 2013); and recent events are defined as "life events that occur generally within 6-12 months before the onset of a disorder" (Brown and Birley, 1968). While there is accumulated evidence that childhood trauma might be Schizophrenia Research xxx (2018) xxx-xxx an independent risk factor for psychosis (Barrigón et al., 2015;Lataster et al., 2012;Morgan et al., 2014c;Read et al., 2005;Varese et al., 2012), the role of recent events as an independent risk factor has been less consistent (Kraan et al., 2015). ...
... We found that nearly half of the ROP group reported at least one kind of moderate-to-extreme childhood trauma. The prevalence of childhood trauma we reported accords with that of a study conducted in Spain by Barrigón et al. (2015), who reported 43% of childhood trauma in a sample of patients with a first psychotic episode. Among the various types of childhood trauma, exposure to physical abuse or neglect were most associated with psychosis, which is highly consistent with published data (Smeets et al., 2015;Varese et al., 2012). ...
... Fifty per cent of the ROP group reported at least moderate exposure to recent events, similar to the 55% prevalence reported by Mansueto and Faravelli (2017), assessed with different instruments. Focusing on the pattern of cannabis use, we found that nearly 50% were regular smokers, similar to the rates described in other first episode studies (Barbeito et al., 2013;Barrigón et al., 2015;Núñez et al., 2016). ...
Background:
There is a lack of studies investigating the dose-response effect of childhood trauma, recent events and cannabis use on recent psychosis. This study aims to determine the relationship between the level of exposure to stress factors and cannabis use with psychosis and to determine the combination effect among these factors in predicting a psychotic disorder.
Methods:
146 recent onset psychotic (ROP) patients and 61 healthy controls were included. Childhood trauma was evaluated using the childhood trauma questionnaire (CTQ) and recent events using the Holmes-Rahe social readjustment scale. The pattern of cannabis use was assessed by a detailed interview. A hierarchical multiple regression was run in order to determine both the cumulative and independent contribution of each factor in predicting a psychotic disorder.
Results:
The highest levels of exposure to childhood trauma and cannabis were associated with psychosis while neither low nor high recent event exposure was associated. The combined effect of risk factors yielded a significant association with psychosis (×2 = 86.76, p < .001) explaining the 49% of its variation. ROP were more likely to be exposed to one, two or three environmental factors than HC. Exposed to two or all factors were 7.5-fold and 26.7-fold more likely to have a diagnosis of psychosis, respectively.
Conclusions:
Our study provides evidence for a cumulative and a dose-response effect of environmental factors on recent psychosis. Considering that cannabis use and stress are highly prevalent in the population with psychosis, investigations of their relationships are needed to implement targeted prevention and treatment strategies.
... Adults who experience childhood trauma develop many psychopathologies, such as mood disorders [11] and anxiety disorders [12]. Childhood trauma also increases the likelihood of post-traumatic stress disorder (PTSD) [13], obsessive-compulsive disorder [14], personality disorders [15], and psychotic symptoms [16]. Individuals with childhood trauma have a higher risk of suicide, suicide attempts and self-harming behaviors [17]. ...
... Childhood trauma positively predicted psychopathology, and the sensory processing sensitivity and alexithymia had a mediating role in this association. According to the literature, childhood traumas can be a predisposition or risk factor for different psychopathology (e.g. ( [11,16,18,20])). In this study, the relationship between childhood traumas and psychopathology (depression, anxiety, negative self, somatization and hostility) was supported, and it was seen that the two variables mediating this relationship were sensory processing sensitivity and alexithymia. ...
Background
There is overwhelming evidence for a strong association between childhood trauma and adult psychopathology. This study aimed to investigate the mediation roles of alexithymia, sensory processing sensitivity, and emotional-mental processes in the relationship between childhood traumas and adult psychopathology.
Methods
The sample consisted of 337 people (78.9% female, 21.1% male) aged between 20 and 64 years. Participants filled the scales online via a Google form. Reading Mind in the Eyes (EYES), Sensory Processing Sensitivity Scale (SPS), Toronto Alexithymia Scale (TAS-26), Childhood Trauma Questionnaire (CTQ), and the Brief Symptom Inventory (BSI) were used. PROCESS (Model 4) macro was used to examine the mediating role of sensory processing sensitivity, alexithymia, and the EYES test results in the relationship between childhood trauma and psychopathology.
Results
The results of mediation analysis demonstrated that sensory processing sensitivity and alexithymia mediated the relationship between childhood trauma and adult psychopathology. However, the EYES test (mentalization) did not mediate in this relationship.
Conclusion
This study shows that childhood traumas may relate to more psychological symptoms in individuals with high sensory processing sensitivity and alexithymia. Our study may contribute to the understanding of what may lead to a person’s vulnerability to experiencing psychological symptoms after childhood trauma. It may be crucial that future treatment and intervention programs should include sensory sensitivity and alexithymia. Sensory processing sensitivity and alexithymia can be examined in the treatment of psychological problems of individuals who have experienced childhood trauma.
... In the present study, the adjustment for general psychopathology explained a substantial part of the association between TLE with intention to harm and PE. Previous studies used mediation analysis and identified various mediators in the association between TLE and PE: neuroticism (Barrigon et al. 2015), high levels of anxiety and depression (Mackie et al. 2011;Fisher et al. 2013), substance misuse (Harley et al. 2010;Mackie et al. 2011;Barrigon et al. 2015) and certain characteristics related to social defeat (van Nierop et al. 2014b). Indeed, Guloksuz & colleagues (2015) recently provided evidence that the presence of PE in nonpsychotic disorders is environment-dependent and mediated by severity of non-psychotic psychopathology. ...
... In the present study, the adjustment for general psychopathology explained a substantial part of the association between TLE with intention to harm and PE. Previous studies used mediation analysis and identified various mediators in the association between TLE and PE: neuroticism (Barrigon et al. 2015), high levels of anxiety and depression (Mackie et al. 2011;Fisher et al. 2013), substance misuse (Harley et al. 2010;Mackie et al. 2011;Barrigon et al. 2015) and certain characteristics related to social defeat (van Nierop et al. 2014b). Indeed, Guloksuz & colleagues (2015) recently provided evidence that the presence of PE in nonpsychotic disorders is environment-dependent and mediated by severity of non-psychotic psychopathology. ...
Background
Previous work showed traumatic life events (TLE) with intention to harm, like bullying and abuse, to be more strongly associated with psychotic experiences (PE) than other types of trauma, like accidents. However, this association is subject to reporting bias and can be confounded by demographic characteristics and by differences in dose of exposure across different trauma categories. We studied the association between TLE with and without intention to harm and PE, taking into account potential confounders and biases.
Methods
A total of 2245 children and adolescents aged 6–14 years were interviewed by psychologists. The interview included the presence of 20 PE (both self-report and psychologist evaluation). In addition, parents provided information on child exposure to trauma, mental health and PE.
Results
Results showed no significant association between TLE without intention to harm only and PE for the three methods of assessment of PE ( self-report , parent report and psychologist rating ). On the other hand, there was a positive association between PE and TLE in groups exposed to traumatic experiences with intention to harm ( with intention to harm only and with and without intention to harm). Results remained significant after controlling for demographic and clinical confounders, but this positive association was no longer significant after adjusting for the number of TLE.
Conclusions
TLE with intention to harm display a stronger association with PE than TLE without intention to harm, and this difference is likely reducible to a greater level of traumatic exposure associated with TLE with intention to harm.
... It is important to investigate childhood trauma in adults. Recently, there has been increasing evidence that childhood trauma experiences (physical, emotional, or sexual abuse and emotional or physical neglect) are related to neurobiological changes and long-term adverse effects, such as an increase in the likelihood of psychiatric disorders in adulthood (Barrigón et al., 2015;Mathews, Kaur, & Stein, 2008). Reduced health-related quality of life was reported in individuals with a history of childhood trauma experience (Corso, Edwards, Fang, & Mercy, 2008). ...
... Childhood traumas affect child development in the emotional, physical, cognitive, behavioral and social realms (Carr, Martins, Stingel, Lemgruber, & Juruena, 2013). Such traumas have been associated with depression, generalized anxiety, social phobia, obsessive-compulsive disorder, adult attention deficit and hyperactivity disorder, psychosis and reduced psychosocial functioning in the later period of life (Barrigón et al., 2015;Lochner et al., 2002;Mandelli, Petrelli, & Serretti, 2015;Mathews et al., 2008). In addition, they are strongly associated with posttraumatic stress disorder and cluster B personality disorder, particularly borderline personality disorder (Oquendo et al., 2005). ...
Aim
There has been increasing evidence that childhood traumas are related to reduced health-related quality of life, neurobiological changes and long-term adverse effects, such as an increase in the likelihood of psychiatric disorders in adulthoods. The aim of this study was to investigate the relationships between childhood traumas and type D personality.
Subjects and methods
In total, 187 university students (64 males and 123 females; mean age = 21.69 ± 2.00) were included in the study. All participants were evaluated using the Type D Personality Scale (DS-14), Childhood Trauma Questionnaire (CTQ-28) and Beck Depression Inventory (BDI). The participants were divided into the two groups according to the presence of type D personality. Then, statistical analyses were performed.
Results
The frequency of type D personality in participants was 43.3% (n = 81). The emotional neglect, physical neglect, emotional abuse component of the CTQ-28, total CTQ-28 scores and BDI scores were higher in the group with type D personality than in the group without type D personality (p < .001, p = .003, p = .001, p < .001 and p < .001, respectively). There were significantly positive correlations between the type D personality scores and BDI scores, emotional neglect, physical neglect, emotional abuse and childhood trauma total scores (p < .05, for all). Linear regression analyses showed that the significant and independent predictors of the score of DS-14 were total score of CTQ-28 and BDI score.
Conclusion
Childhood trauma may be associated with type D personality, and there is predictive value of the childhood trauma on the scores of type D personality.
... Considerable evidence suggests that developmental trauma is a risk factor across the psychosis spectrum, including psychotic experiences, at-risk mental states and psychotic disorder. 1 Developmental trauma is associated with a twofold increase in the likelihood of developing psychosis, and may account for a third of cases of psychosis. 2 Furthermore, there is evidence of a causal relationship between developmental trauma and psychosis, including clear temporal sequences between exposure and outcome, plausible mechanisms and dose-response relationships. ...
Background
Developmental trauma increases psychosis risk and is associated with poor prognosis. It has been proposed that psychosis in survivors of developmental trauma gives rise to a distinct ‘traumatogenic’ phenotype.
Aims
Given the implications for personalised treatment, we sought to explore the traumatogenic psychosis phenotype hypothesis in a systematic review and meta-analysis of studies comparing psychotic presentations between adults with and without developmental trauma histories.
Method
We registered the systematic review on PROSPERO (CRD42019131245) and systematically searched EMBASE, Medline and PsycINFO. The outcomes of interests were quantitative and qualitative comparisons in psychotic symptom expression (positive, negative, cognitive) and other domains of psychopathology, including affect regulation, sleep, depression and anxiety, between adults with and without experience of developmental trauma.
Results
Of 34 studies included ( N = 13 150), 11 were meta-analysed ( n = 2842). A significant relationship was found between developmental trauma and increased symptom severity for positive (Hedge's g = 0.27; 95% CI 0.10–0.44; P = 0.002), but not negative symptoms (Hedge's g = 0.13; 95% CI −0.04 to 0.30; P = 0.14). Developmental trauma was associated with greater neurocognitive, specifically executive, deficits, as well as poorer affect, dissociation and social cognition. Furthermore, psychotic symptom content thematically related to traumatic memories in survivors of developmental trauma.
Conclusions
Our findings that developmental trauma is associated with more severe positive and affective symptoms, and qualitative differences in symptom expression, support the notion that there may be a traumatogenic psychosis phenotype. However, underdiagnosis of post-traumatic stress disorder may also explain some of these findings. More research is needed to explore this further.
... His anxiety, particularly social anxiety, like his insomnia, never abated. His painted self-portraits and portraits, which he saw, like all his painting, as a means of expressing himself, reflect empirically the transitions in his state of mind: growing brighter, more colourful, and more numerous as his symptoms became more severe while maintaining a high, rigid 26 measure of complexity throughout his life. This suggests that his childhood experience of both physiological and psychological distress caused him to acquire neurological traits including lasting morphological, neurobiological, and functional changes particularly affecting perception of contrast, context, motion, and facial emotion. ...
Edvard Munch, a founder of Expressionism was pre-occupied with depicting his subjective experience and the most prolific painter of self-portraits since Rembrandt. Based on evidence that faces and self-related images are more salient than other objects it is plausible that self-portraits, in which the subject and object are the same, reflect the artist’s state of mind. Although he suffered from a variety of physical and psychological illness Munch was not diagnosed with any specificity in his lifetime. Posthumous diagnoses include schizophrenia, anxiety, bipolar and other disorders. Recent research has revealed altered visual perception in such patients. The present study empirically analysed three stylistic elements of Munch’s painted self-portraits and portraits: contrast, colour and fractal dimension and his painted productivity, to determine if variations correlate with critical life events and if so whether they indicate states of mind. It found significant increases in contrast and colour brightness and persistent high complexity during critical periods supporting the conclusion that Munch is diagnostically best described as suffering from early onset schizophrenia and comorbid social anxiety disorder.
... should be noted that our prevalence rate (54.7%) was similar to the almost 50% prevalence reported in studies of FEP in Spain (Alameda et al., 2015;Arranz et al., 2018;Barrigón et al., 2015). Additionally, we found that 62.9% of patients with schizophrenia experienced moderate to severe adversity, a figure similar to the 56.1% reported by Struck et al. (2020) using the childhood trauma questionnaire. ...
Background
Evidence suggests a possible relationship between exposure to childhood adversity (CA) and functional impairment in psychosis. However, the impact of CA on long-term outcomes of psychotic disorders remains poorly understood.
Methods
Two hundred and forty-three patients were assessed at their first episode of psychosis for CA and re-assessed after a mean of 21 years of follow-up for several outcome domains, including symptoms, functioning, quality of life, cognitive performance, neurological dysfunction, and comorbidity. The unique predictive ability of CA exposure for outcomes was examined using linear regression analysis controlling for relevant confounders, including socioeconomic status, family risk of schizophrenia, and obstetric complications.
Results
There were 54% of the patients with a documented history of CA at mild or higher levels. CA experiences were more prevalent and severe in schizophrenia than in other psychotic disorders ( p < 0.001). Large to very large effect sizes were observed for CA predicting most role functioning variables and negative symptoms (Δ R ² between 0.105 and 0.181). Moderate effect sizes were observed for positive symptoms, personal functioning, impaired social cognition, impaired immediate verbal learning, poor global cognition, internalized stigma, poor personal recovery, and drug abuse severity (Δ R ² between 0.040 and 0.066). A dose–response relationship was observed between levels of CA and severity of outcome domains.
Conclusion
Our results suggest a strong and widespread link between early adversity exposure and outcomes of psychotic disorders. Awareness of the serious long-term consequences of CA should encourage better identification of those at risk and the development of effective interventions.
... Studies investigating CT histories in patients with SCZ and their siblings report more CT in patients compared to siblings (Barrigón et al., 2015;Heins et al., 2011). In a recent meta-analysis, it has been reported that all kinds of childhood abuse and neglect were related to three subtypes of schizotypy, and strongest relationship was found between emotional abuse and schizotypal symptoms in non-clinical populations (Toutountzidis, Gale, Irvine, Sharma, & Laws, 2022). ...
Background
The relationship between childhood trauma (CT) and psychotic symptoms in patients with schizophrenia (SCZ), and subthreshold psychotic experiences in non-clinical populations is well-established. However, little is known about the relationship between subtypes of trauma and specific symptoms in patients, their siblings, and controls. It is also not clear which variables mediate the relationship between trauma and psychotic symptoms.
Methods
Seven hundred and forty-two patients with SCZ, 718 of their unaffected siblings and 1039 controls from three EU-GEI sites were assessed for CT, symptom severity, and cognitive schemas about self/others. CT was assessed with the Childhood Trauma Questionnaire, and cognitive schemas were assessed by The Brief Core Schema Scale.
Results
Patients with psychosis were affected by CT more than their siblings and controls in all domains. Childhood emotional abuse and neglect were more common in siblings than controls. CT was related to negative cognitive schemas toward self/others in patients, siblings, and controls. We found that negative schemas about self-mediated the relationship between emotional abuse and thought withdrawal and thought broadcasting. Approximately 33.9% of the variance in these symptoms was explained by the mediator. It also mediated the relationship between sexual abuse and persecutory delusions in SCZ.
Conclusions
Our findings suggest that childhood abuse and neglect are more common in patients with schizophrenia than their siblings and healthy controls, and have different impacts on clinical domains which we searched. The relationship between CT and positive symptoms seems to be mediated by negative cognitive schemas about self in schizophrenia.
... In child sexual abuse, ecchymosis in different parts of the body, hematomas and incoherence, enuresis, genital and anal tears, sexually transmitted diseases, and pregnancy, deterioration in child-parent relations (Kamiye et al. 2016, Blakemore et al. 2017, social relations, physical and mental problems such as difficulty in developing selfesteem, low self-esteem, hopelessness, introversion, and behavioral disorders are observed (Ucuz et al. 2022). Also, the sexually abused individual during childhood is associated with several long-term psychological, physical, and behavioral problems in adulthood, such as depression, suicidal thoughts and attempts, substance abuse, post-traumatic stress disorder, sexually risky behaviors, and increased use of health services for physical health problems (Barrigón et al. 2015, Hébert et al. 2018. As reported in the literature, sexual abuse negatively affects the childhood and adulthood of children physically, emotionally, and mentally in terms of personality development (Bahali et al. 2010, Alpay et al. 2017, Hébert et al. 2018. ...
This study aimed to compare parents' knowledge and attitudes of children with special needs and normally developing children about child sexual abuse. The study was cross-sectional, descriptive, and correlational design, and the sample consisted of 228 parents, including 153 parents of normal children and 75 parents of children with special needs. Personal Information Form and Child Abuse Knowledge/Attitude Scale for Parents were used to collect the data. The only independent variable with explanatory power on the level of Child Abuse Knowledge and Attitude was found to be educational status. In the model created with this variable, educational status explained 2.9% of the variation on the total score of the Child Abuse Knowledge and Attitude Scale. Ninety-four point eight percent of the parents had no previous education about sexual abuse against children but were informed about it. Parents' knowledge and attitudes towards sexual abuse were significantly affected by the educational status of the parents. In this context, awareness should be increased through school-based programs organized by mental health professionals.
... FFM personality traits can heighten susceptibility to psychotic disorders. Elevated levels of neuroticism denote a susceptibility to experiencing anxiety and distress, and this personality trait has been discovered to be a risk factor for developing schizophrenia [34][35][36], In contrast, a study has shown that increased levels of extraversion can diminish this risk [37]. ...
Background
Many mental problems lead to the occurrence of physical diseases, causing worse consequences of diseases. Despite many studies in the field of personality types and types of mental disorders, this relationship and the mediating role of coping styles in cardiovascular patients are still not well known. Therefore, the present study was conducted to investigate the mediating role of coping styles in the relationship between personality types and mental disorders in cardiovascular patients.
Method
The present study is a cross-sectional study that was conducted on 114 cardiovascular patients at the heart center in Bushehr, Iran. The sampling method is simple random sampling. Demographic information form, MCMI-III questionnaire, NEO-FFI questionnaire, and Lazarus and Folkman coping styles questionnaire were used to collect data. Data were analyzed using SPSS 22 and Amos 24 software. Descriptive statistics methods (mean, variance and percentage), Pearson correlation, and structural equation model (SEM) were applied to analyze the data.
Results
The findings showed that the two variables of personality types and problem-oriented explain 15.2% of the variable of mental disorders, of which 10.7% is related to the variable of personality types and 4.5% is related to the intermediate variable of problem-oriented. Among the personality types, the neurotic personality type has the biggest role (0.632) and has a direct and significant effect on mental disorders. Also, the personality types of extroversion (-0.460), agreeableness (-0.312), and responsibility (-0.986) exert inverse and significant effects on mental disorders.
Conclusion
The results of the present study showed the frequency of personality disorders and other mental disorders among heart patients. Problem-oriented coping style plays a mediating role between personality types and mental disorders.
... More recently, there has been an increase in empirical findings accounting for the relationship between CM and psychotic experience. Adults who have experienced CM are 7.3 times more likely than their counterparts to experience psychosis (Barrigón et al., 2015). In other words, there is a wellsupported link between the high stress of CM and psychosis, and such symptoms are shown to be CHILDHOOD MALTREATMENT AND PSYCHOSIS a result of structural changes in those that experience CM as a result of traumatic experiences. ...
... The growing interest in the role of childhood traumatic experiences in mental health has revealed that people with mental health problems experience a higher prevalence of traumatic events (Goh and Agius, 2010;Van Os et al., 2010;Zannas and West, 2014), which is specially true for people suffering from psychosis (Barrigón et al., 2015:Misiak et al., 2017. In fact, a recent systematic review found that people who have experienced a first-episode of psychosis (FEP) have a prevalence of childhood traumatic experiences between 52 and 73% (Vila-Badia et al., 2021). ...
Objective
To study the prevalence and the type of childhood trauma (CT) in a first-episode psychosis (FEP) cohort and in a healthy control (HC) sample. To study which clinical and sociodemographic variables in the onset of the FEP are related to having suffered some traumatic experience in childhood.
Method
100 FEP patients and 94 HC participated in the study. The Childhood Traumatic Questionnaire (CTQ) was used to evaluate CT. The Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance (PSP), the Suicide Risk Scale of Plutchik (SRSP), and the Perceived Stress Scale (PSS) were also administered.
Results
61% of FEP patients and 17% of HC reported having experienced some kind of CT. FEP showed more CT than controls in all subscales, except in sexual abuse. The most frequent CT was emotional abuse. For the FEP group, younger age, more years of education, have a first-degree family history, more positive and negative symptoms, more perceived stress and more personal and social functioning were the variables more influenced by having suffered some kind of CT.
Conclusions
There is a high prevalence of CT in FEP patients. Having a first-degree family history of mental illness, more positive symptoms, and more perception of stress at the time of hospital admission were related to having suffered CT. More research is needed to find out the best way to detect CT and its role in psychosis to be able to implement interventions to improve the evolution of these patients.
... Finally, a study conducted in Spain among 60 patient-sibling pairs, constituted by subjects with functional psychosis in the first five years of their illness matched with a non-psychotic sibling, demonstrated that after controlling for cannabis use and neuroticism, the odds of suffering psychosis for individuals who were afflicted with a childhood trauma were 7.3 times higher than the odds for persons who did not experience a childhood trauma (95% confidence interval = 1.06 -50.01; p = 0.04) [45]. American Journal of Plant Sciences Of note, some researchers illustrated that neither lifetime cannabis use nor reported exposure to childhood trauma was correlated to psychotic disorders when the other risk factor was taken into account [39] [161]. ...
... Neurotic personality also contributed independently to this risk. These findings might help to improve the prevention of psychosis and aid in the development of specific treatment strategies [36]. ...
Psychosis is a syndrome characterized by features of reality distortion such as delusions and hallucinations. It may occur as a primary mental disorder or secondary to a medical or neurological illness or substance abuse. Several genetic, environmental, and protective risk factors have been identified and require further study. Neurobiological damage at the onset of schizophrenia is the most active and destructive. Therefore, it is important to detect the prodromal phase of psychosis so that interventions can be started early and the onset of psychosis delayed. Herein, we review the relevant epidemiological data on psychosis, particularly in Saudi Arabia. In addition, the risk and protective factors of psychosis will be discussed.
Recent findings have shown that psychosis development is affected by genetic and environmental factors. Psychotic disorders are considered a cause of disability and are, therefore, a substantial economic burden. Consequently, it is important to try and detect the psychosis in its prodromal stage, where intervention may slow its progression and improve general wellbeing. Several tools have been identified to screen for the prodrome of psychosis, one of which is the prodromal questionnaire-brief version. This has been shown to be a promising tool that can be self-administered by the patient in contrast to long interview-based tools, which are time-consuming and require a physician to perform. Despite the limited evidence in the literature, there have been significant improvements in the outcomes of patients with psychosis when treated in the prodromal period.
In summary, this article provides psychiatrists and researchers with an overview of psychosis, its risk factors, the prodromal stage of psychosis, tools to detect the prodromal phase, and potential treatments during this phase.
... 41 The GRANAD P Psychosis Study 7 psychological wellbeing but also inhibits domains of social development that, in turn, have been found to predate the onset of psychosis. 42,43 Furthermore, some studies have demonstrated a dose---response association between childhood maltreatment and psychosis in both prospective and cross-sectional studies. 41,42 In addition to this, synergistic pathways of risk have recently been defined showing that childhood trauma, bullying and experience of discrimination do associate with PS. 19 Our finding that child abuse is a robust risk correlates for PS favours the view that child trauma may indeed increase risk for psychosis. ...
Background and objectives
Psychotic symptoms (PS) can be ascertained in the general population suggesting the existence of a wide psychosis phenotype. We aim to investigate the prevalence and correlates of PS in the province of Granada (Spain) in the absence of previous data. Our objectives were to establish the prevalence of PS, i.e. delusions and hallucinations, and identifying correlates with PS in search of plausible risk factors.
Methods
This is a cross-sectional study (GRANAD∑P study) including assessments of 809 individuals who were selected randomly from the Unified Database of the Andalusian Health System, a census covering about 98% of the entire regional population. PS were assessed by the MINI Neuropsychiatric International Interview Psychosis Subscale. A variety of potential risk factors for PS were also assessed including socio-demographics, cognitive function, psychiatric comorbidity and physical health issues.
Results
The prevalence of any PS in the province of Granada was 10.3% (hallucinations were detected in 6.1% of the sample and delusions in 7.4%). PS was correlated with increased suicide risk, lower functionality, having suffered childhood abuse, cannabis use, lower working memory and higher impulsivity.
Conclusions
The prevalence of PS in this Southern Spanish sample is similar to that found in other European populations. This may indicate that an extended subclinical psychotic phenotype can be detectable on general populations and that it associates to a variety of cognitive deficits, personality traits and environmental factors upon which we can direct preventative measures to prevent transition from subclinical non-cases to clinical cases states.
... However, there are evidences implicating that physical childhood trauma experiences can lead to long-term adverse impacts owing to neurological changes. 37 Moreover, one recent study has revealed the presence of positive correlation between childhood traumas and personality D prevalence. 33 In the third part of this study, we evaluated the effect of type-D personality on OHRQoL in CLP patients. ...
The purpose of this study was to investigate the oral health-related quality of life and type-D personality in cleft lip/palate (CLP) patients and the relationship between type-D personality and oral health-related quality of life (OHRQoL) in CLP patients. Fifty patients with CLP within age range from 8 to 15 years were chosen and asked to complete both Child Oral Health Impact Profile (COHI) and Type-D scale (DS14) questionnaire. Moreover, the participants of a control group matched with CLP patients were asked to complete the DS14 questionnaire. A significant difference between boys and girls on the subscale "emotional well-being" of COHIP (P = 0.001) and a positive significant correlation between "oral symptoms" and age (P = 0.029) were found among CLP patients. The prevalence of type-D personality was equal between clefts and nonclefts groups. However, there was a significant relationship between type-D personality and OHRQoL in CLP patients regarding mean scores of overall COHIP and its subscales (P < 0.05). This study has shown that the personality type remains unchanged among cleft patients and a meaningful relationship exists between type-D personality and OHRQoL.
... growing up in an urban setting) (Haddad et al., 2015), but in particular childhood trauma which is reported in up to 73% of patients (Bendall et al., 2008). Childhood trauma is (1) associated with GM volume reductions and cortical thinning in the general population (Carrion et al., 2009;Edmiston et al., 2011;Hanson et al., 2010;Kelly et al., 2013), (2) linked with increased risk of psychosis (Barrigon et al., 2015;Thompson et al., 2014) and (3) has been found to be a predictor of left hippocampal and right amygdala volumes in FEP (Hoy et al., 2012). Evidence further suggests that smaller amygdala volume acts as a mediator between childhood trauma and poor cognitive functioning in FEP (Aas et al., 2012). ...
Objective:
This review critically examines the structural neuroimaging evidence in psychotic illness, with a focus on longitudinal imaging across the first-episode psychosis and ultra-high-risk of psychosis illness stages.
Methods:
A thorough search of the literature involving specifically longitudinal neuroimaging in early illness stages of psychosis was conducted. The evidence supporting abnormalities in brain morphology and altered neurodevelopmental trajectories is discussed in the context of a clinical staging model.
Results:
In general, grey matter (and, to a lesser extent, white matter) declines across multiple frontal, temporal (especially superior regions), insular and parietal regions during the first episode of psychosis, which has a steeper trajectory than that of age-matched healthy counterparts. Although the ultra-high-risk of psychosis literature is considerably mixed, evidence indicates that certain volumetric structural aberrations predate psychotic illness onset (e.g. prefrontal cortex thinning), while other abnormalities present in ultra-high-risk of psychosis populations are potentially non-psychosis-specific (e.g. hippocampal volume reductions).
Conclusion:
We highlight the advantages of longitudinal designs, discuss the implications such studies have on clinical staging and provide directions for future research.
Background
There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.
Objective
The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.
Methods
Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.
Results
From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.
Conclusion
This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.
Background
The diathesis-stress paradigm and the cannabinoid-hypothesis have been proposed as possible pathophysiological models of schizophrenia. However, they have historically been studied independently of each other.
Objective
This PRISMA 2020-compliant systematic review aimed at reappraising the interplay be- tween the hypothalamic-pituitary-adrenal (HPA) axis and the endocannabinoid (eCB) system in psy- chosis-spectrum disorder risk and outcome.
Methods
All pathophysiological and outcome clinical studies, concomitantly evaluating the two sys- tems in psychosis-spectrum disorder risk and different stages of illness, were gathered from electronic databases (Pubmed, Web of Science, and Scopus), and discussed.
Results
41 eligible outputs were extracted, focusing on at least a biological measure (9 HPA-related studies: 4 eCB-interventional, 1 HPA-interventional, 1 both HPA-interventional and non-interventional, 3 non-interventional; 2 eCB-related studies: non-interventional), environmental measures only (29 studies: 1 eCB- interventional, 28 non-interventional), and genetic measures (1 study: non-interventional). In- dependent contributions of aberrancies in the two systems to the physiopathology and outcome of psy- chosis were confirmed. Also, concomitant alterations in the two systems, either genetically defined (e.g., CNR1 genetic variation), biologically determined (e.g., dysfunctional HPA axis or endocanna- binoid signaling), or behaviorally imputed (e.g., cannabis use, stress exposure, and response), were consistently reported in psychosis. Further, a complex biobehavioral perturbation was revealed not on- ly within each system (e.g., cannabis use affecting the eCB tone, stress exposure affecting the HPA ax- is), but also across the two systems (e.g., THC affecting the HPA axis, childhood trauma affecting the endocannabinoid signaling).
Conclusion
There is a need to concomitantly study the two systems’ mechanistic contribution to psychosis in order to establish more refined biological relevance.
Objective
Childhood maltreatment is associated with mental health problems, but the extent to which this relationship is causal remains unclear. To strengthen causal inference, we conducted a systematic review and meta-analysis of quasi-experimental studies examining the relationship between childhood maltreatment and mental health problems.
Methods
We searched PubMed, PsycINFO, and Embase for peer-reviewed, English language articles from inception until January 1, 2022. Studies were included if they examined the association between childhood maltreatment and mental health problems using a quasi-experimental method (e.g., twin/sibling differences design, Children of Twins design, adoption design, fixed-effects design, random-intercept cross-lagged panel model, natural experiment, propensity score matching, or inverse probability weighting).
Results
We identified 34 quasi-experimental studies, including 54,646 independent participants. Before quasi-experimental adjustment for confounding, childhood maltreatment was moderately associated with mental health problems (Cohen’s d=0.56, 95% CI=0.41-0.71). Following quasi-experimental adjustment, a small association between childhood maltreatment and mental health problems remained (Cohen’s d=0.31, 95% CI=0.24-0.37). This adjusted association between child maltreatment and mental health was consistent across different quasi-experimental methods, and generalised across different psychiatric disorders.
Conclusion
These findings are consistent with a small, causal contribution of childhood maltreatment to mental health problems. Furthermore, the findings suggest that part of the overall risk of mental health problems in individuals exposed to maltreatment is due to wider genetic and environmental risk factors. Therefore, preventing childhood maltreatment and addressing wider psychiatric risk factors in individuals exposed to maltreatment could help to prevent psychopathology.
Background: Psychosis is a complex disorder that places a substantial burden on individuals and society. Despite decades of research, the precise origins of this multi-factorial condition remain obscure. Although perceived primarily as an organically occurring brain disease, it is becoming increasingly accepted that psychosocial factors play a significant role in its development. Objective: Since the bulk of existing research is biomedical in nature, the present study seeks to investigate the key psychosocial factors that are associated with the development of psychotic disorder; these include childhood abuse, urbanicity and ethnicity and migration. Method: A systematic review was conducted, based on relevant data published between 2000 and 2020. Identified studies were screened for eligibility and assessed for quality based on guidelines developed by the Critical Skills Appraisal Programme (CASP). Data was narratively summarised. Since only published data was included, risk of publication bias is high. Results: 62 studies were included. The majority reported significant effects for each of these three risk factors, independent of confounding variables. A dose-effect relationship was identified for each of these. The ‘social defeat’ model of psychosis may be a common explanatory mechanism underlying all three of these factors. Conclusions: Childhood abuse, ethnic minority and migrant status and urbanicity reliably and significantly increase an individual’s risk for psychotic disorder by influencing biological and cognitive processes that give rise to symptoms. Future research should a), investigate the replicability of these findings in diverse cultures; b) include multi-level analysis to understand the interaction of risk (and protective) factors; and c), further elucidate the mechanisms involved in order to develop more effective treatment interventions.
Background
There is overwhelming evidence for a strong association between childhood trauma and adult psychopathology. This study aims to investigate the mediation roles of alexithymia, sensory processing sensitivity, and emotional-mental processes in the relationship between childhood traumas and adult psychopathology.
Methods
337 people (78.9% female, 21.1% male) between the ages of 20–64 participated in this study. Participants filled the scales online via google form. Reading Mind in the Eyes (EYES), Sensory Processing Sensitivity Scale (SPS), Toronto Alexithymia Scale (TAS-26), Childhood Trauma Questionnaire (CTQ), and the Brief Symptom Inventory (BSI) were used. SPSS Process (Model 4) was used to examine the mediating role of sensory processing sensitivity, alexithymia and the eyes test results in the relationship between childhood trauma and psychopathology.
Results
Sensory processing sensitivity and alexithymia have been found to mediate the relationship between childhood trauma and adult psychopathology. The eyes test (mentalization) was not found to have a mediating effect on this relationship.
Conclusion
This study shows that childhood traumas may relate more psychopathology in individuals with high sensory processing sensitivity and alexithymia. Our study may contribute to the understanding of what may lead to a person's vulnerability to experiencing psychopathology after childhood trauma. It may be important that future treatment and intervention programs should include sensory sensitivity and alexithymia. Sensory processing sensitivity and alexithymic characteristics of individuals can be examined in the treatment of psychological problems of individuals who have experienced childhood trauma.
Psychotic experiences are common in the general population and have been reported in children, adolescents, and adults. Childhood trauma, i.e. maltreatment with the intention to harm, has been proposed to play a causal role in the etiology of psychosis. There is some evidence that this association cannot, at least not solely, be attributed to genetic risk. In other words, childhood trauma increases the risk for later psychopathology independent of genetic risk. Additionally, childhood trauma might mediate the association between genes linked with mechanisms possibly underlying psychosis (such as neuroplasticity and stress regulation) and the onset of psychosis. Another mechanism through which childhood trauma might increase the risk for psychotic symptoms is through its impact on the developing brain. The hippocampus and amygdala are two limbic structures that are densely populated with receptors for stress hormones, which make them particularly sensitive to early life trauma (i.e., early life stress). Main findings include hippocampal volume reductions and increased amygdala reactivity to emotional stimuli. Furthermore, early traumatic experiences may cause heightened sensitivity of the stress response system. For example, studies found that those with a trauma history report more paranoid ideation and subjective stress, even in neutral (social) situations. There is some evidence suggesting a role for the immune system in the association between childhood trauma and psychosis; however, more research needs to be done to unravel “how.” Moreover, there are a number of psychological mechanisms that might explain the association between childhood trauma and psychosis, including feelings of social defeat, cognitive biases, attachment style, and dissociative tendencies. In this chapter, we will review the evidence linking childhood trauma to the onset of psychosis.
There is a scarcity of studies investigating the effect of sex on the clinical and treatment characteristics of first-admitted patients with first-episode psychosis (FEP). The reasons for using cannabis and the effect of cannabis on clinical features have not received enough attention either. We aim therefore, to investigate sex differences in the reasons for cannabis use and to determine the effects of sex, cannabis use and their interaction on clinical variables at admission and at discharge from the inpatient unit.
204 first-admitted FEPs in two inpatient units in Spain were included. The reasons for using cannabis were determined using the Dixon questionnaire. Clinical variables were compared between sexes and between cannabis users and non-users.
Cannabis use was more frequent in males, but females were more likely to smoke cannabis to “feel relaxed”. There was a main effect of sex on positive psychotic symptoms and antipsychotics dose and an interaction effect of cannabis and sex on global functioning at discharge .Our findings show sex differences in the reasons for cannabis use and in some clinical and treatment characteristics among FEP patients. More studies focusing on gender perspectives are needed to develop more individualized treatments.
Life expectancy in patients with schizophrenia is reduced by 20 years for men and 15 years for women compared to the general population. About 60% of the excess mortality is due to physical illnesses, with cardiovascular disease being dominant. CHANGE was a randomized, parallel-group, superiority, multi-centre trial with blinded outcome assessment, testing the efficacy of an intervention aimed to improve cardiovascular risk profile and hereby potentially reduce mortality. A total of 428 patients with schizophrenia spectrum disorders and abdominal obesity were recruited and centrally randomized 1:1:1 to 12 months of lifestyle coaching plus care coordination plus treatment as usual (N=138), or care coordination plus treatment as usual (N=142), or treatment as usual alone (N=148). The primary outcome was 10-year risk of cardiovascular disease assessed post-treatment and standardized to age 60. At follow-up, the mean 10-year risk of cardiovascular disease was 8.4 ± 6.7% in the group receiving lifestyle coaching, 8.5 ± 7.5% in the care coordination group, and 8.0 ± 6.5% in the treatment as usual group (p=0.41). We found no intervention effects for any secondary or exploratory outcomes, including cardiorespiratory fitness, physical activity, weight, diet and smoking. In conclusion, the CHANGE trial did not support superiority of individual lifestyle coaching or care coordination compared to treatment as usual in reducing cardiovascular risk in patients with schizophrenia spectrum disorders and abdominal obesity.
There is a substantial body of research reporting evidence of associations between various forms of childhood adversity and psychosis, across the spectrum from experiences to disorder. This has been extended, more recently, to include studies of cumulative effects, of interactions with other factors, of specific effects, and of putative biological and psychological mechanisms. In this paper we evaluate this research and highlight the remaining methodological issues and gaps that temper, but do not dismiss, conclusions about the causal role of childhood adversity. We also consider the emerging work on cumulative, synergistic, and specific effects and on mechanisms; and discuss the broader implications of this line of research for our understanding of psychosis. We conclude that the current balance of evidence is that childhood adversities - particularly exposure to multiple adversities involving hostility and threat - do, in some people, contribute to the onset of psychotic experiences and psychotic disorders.
There is robust evidence that childhood adversity is associated with an increased risk of psychosis. There is, however, little research on intervening factors that might increase or decrease risk following childhood adversity.
To investigate main effects of, and synergy between, childhood abuse and life events and cannabis use on odds of psychotic experiences.
Data on psychotic experiences and childhood abuse, life events and cannabis use were collected from 1680 individuals as part of the South East London Community Health Study (SELCoH), a population-based household survey.
There was strong evidence that childhood abuse and number of life events combined synergistically to increase odds of psychotic experiences beyond the effects of each individually. There was similar, but weaker, evidence for cannabis use (past year).
Our findings are consistent with the hypothesis that childhood abuse creates an enduring vulnerability to psychosis that is realised in the event of exposure to further stressors and risk factors.
Research has shown that childhood sexual abuse and cannabis use below the age of 16 significantly increased the risk of psychosis. The aim of this study was to estimate the effects of the different temporal ordering of exposure to cannabis and sexual trauma on psychosis. Data from the National Comorbidity Survey were used to construct a variable representing different exposures (no sexual trauma or cannabis use, sexual trauma only, cannabis use only, sexual trauma preceded cannabis use, cannabis use preceded sexual trauma). A hierarchical binary logistic regression model was specified with a diagnosis of psychosis as the dependent variable, background variables entered in the first block and the sexual trauma and cannabis use variable entered in the second block. The results indicated that sexual trauma with no cannabis use increased the risk of psychosis (OR=2.45, p<.05), and the risk increased for cannabis use before (OR=4.39, p<.05) or after (OR=4.25, p<.05) sexual trauma. The findings are discussed with reference to the existing research literature on the development of psychosis symptoms.
BACKGROUND: Childhood adversity is a putative risk factor for schizophrenia, although evidence supporting this suggestion is inconsistent and controversial. The aim of this review was to pool and quality assess the current evidence pertaining to childhood adversity in people with schizophrenia compared to other psychiatric disorders and to non-psychiatric controls.Method
Included were case-control, cohort and cross-sectional studies. Medline, EMBASE and PsycINFO databases were searched. Study reporting was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and pooled evidence quality was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Twenty-five studies met inclusion criteria. Moderate to high quality evidence suggests increased rates of childhood adversity in schizophrenia compared to controls [odds ratio (OR) 3.60, p<0.00001]. Increased childhood adversity was also reported in schizophrenia compared to anxiety disorders (OR 2.54, p=0.007), although the effect was not significant in the subgroup analysis of five studies assessing only sexual abuse. No differences in rates of childhood adversity were found between schizophrenia and affective psychosis, depression and personality disorders whereas decreased rates of childhood adversity were found in schizophrenia relative to dissociative disorders and post-traumatic stress disorder (OR 0.03, p<0.0001). CONCLUSIONS: This is the first meta-analysis to report a medium to large effect of childhood adversity in people with schizophrenia and to assess specificity for schizophrenia. Further research is required that incorporates longitudinal design and other potentially causal variables to assess additive and/or interactive effects.
Evidence suggests that adverse experiences in childhood are associated with psychosis. To examine the association between childhood adversity and trauma (sexual abuse, physical abuse, emotional/psychological abuse, neglect, parental death, and bullying) and psychosis outcome, MEDLINE, EMBASE, PsychINFO, and Web of Science were searched from January 1980 through November 2011. We included prospective cohort studies, large-scale cross-sectional studies investigating the association between childhood adversity and psychotic symptoms or illness, case-control studies comparing the prevalence of adverse events between psychotic patients and controls using dichotomous or continuous measures, and case-control studies comparing the prevalence of psychotic symptoms between exposed and nonexposed subjects using dichotomous or continuous measures of adversity and psychosis. The analysis included 18 case-control studies (n = 2048 psychotic patients and 1856 nonpsychiatric controls), 10 prospective and quasi-prospective studies (n = 41,803) and 8 population-based cross-sectional studies (n = 35,546). There were significant associations between adversity and psychosis across all research designs, with an overall effect of OR = 2.78 (95% CI = 2.34-3.31). The integration of the case-control studies indicated that patients with psychosis were 2.72 times more likely to have been exposed to childhood adversity than controls (95% CI = 1.90-3.88). The association between childhood adversity and psychosis was also significant in population-based cross-sectional studies (OR = 2.99 [95% CI = 2.12-4.20]) as well as in prospective and quasi-prospective studies (OR = 2.75 [95% CI = 2.17-3.47]). The estimated population attributable risk was 33% (16%-47%). These findings indicate that childhood adversity is strongly associated with increased risk for psychosis.
Cannabis consumption continues to be identified as a causal agent in the onset and development of psychosis. However, recent findings have shown that the effect of cannabis on psychosis may be moderated by childhood traumatic experiences.
Using hierarchical multivariate logistic analyses the current study examined both the independent effect of cannabis consumption on psychosis diagnosis and the combined effect of cannabis consumption and childhood sexual abuse on psychosis diagnosis using data from the Adult Psychiatric Morbidity Survey 2007 (n=7403).
Findings suggested that cannabis consumption was predictive of psychosis diagnosis in a bivariate model; however, when estimated within a multivariate model that included childhood sexual abuse, the effect of cannabis use was attenuated and was not statistically significant. The multivariate analysis revealed that those who had experienced non-consensual sex in childhood were over six times [odds ratio (OR) 6.10] more likely to have had a diagnosis of psychosis compared with those who had not experienced this trauma. There was also a significant interaction. Individuals with a history of non-consensual sexual experience and cannabis consumption were over seven times more likely (OR 7.84) to have been diagnosed with psychosis compared with those without these experiences; however, this finding must be interpreted with caution as it emerged within an overall analytical step which was non-significant.
Future studies examining the effect of cannabis consumption on psychosis should adjust analyses for childhood trauma. Childhood trauma may advance existing gene-environment conceptualisations of the cannabis-psychosis link.
A number of studies have found that the use of cannabis and other psychoactive substances is associated with an earlier onset of psychotic illness.
To establish the extent to which use of cannabis, alcohol, and other psychoactive substances affects the age at onset of psychosis by meta-analysis.
Peer-reviewed publications in English reporting age at onset of psychotic illness in substance-using and non-substance-using groups were located using searches of CINAHL, EMBASE, MEDLINE, PsycINFO, and ISI Web of Science.
Studies in English comparing the age at onset of psychosis in cohorts of patients who use substances with age at onset of psychosis in non-substance-using patients. The searches yielded 443 articles, from which 83 studies met the inclusion criteria.
Information on study design, study population, and effect size were extracted independently by 2 of us.
Meta-analysis found that the age at onset of psychosis for cannabis users was 2.70 years younger (standardized mean difference = -0.414) than for nonusers; for those with broadly defined substance use, the age at onset of psychosis was 2.00 years younger (standardized mean difference = -0.315) than for nonusers. Alcohol use was not associated with a significantly earlier age at onset of psychosis. Differences in the proportion of cannabis users in the substance-using group made a significant contribution to the heterogeneity in the effect sizes between studies, confirming an association between cannabis use and earlier mean age at onset of psychotic illness.
The results of meta-analysis provide evidence for a relationship between cannabis use and earlier onset of psychotic illness, and they support the hypothesis that cannabis use plays a causal role in the development of psychosis in some patients. The results suggest the need for renewed warnings about the potentially harmful effects of cannabis.
Background
Childhood sexual abuse (CSA) has been shown to be a risk factor for personality disorder (PD). However, no previous studies have examined whether associations exist between sexual abuse and abnormal personality as measured both categorically and dimensionally. Such enquiry would more fully illuminate the impact of CSA on adult personality.
Method
Using a large nationally representative sample, we set out to examine associations between CSA and categorically defined PD. We also examined associations between CSA and the five dimensions of personality (openness to experience, conscientiousness, extraversion, agreeableness and neuroticism). A total of 1520 young adults were interviewed to determine the prevalence of sexual abuse occurring before age 16 years. A dimensional measure of personality was completed by 1469 participants, and 1145 had an informant-based PD assessment.
Results
PD was independently associated with repeated CSA [fully adjusted odds ratio (OR) 1.9, 95% confidence interval (CI) 1.1–3.4]. Repeated sexual abuse was also associated with higher neuroticism and lower agreeableness (p values for both <0.001). Adjusting for the effects of potential confounders and mediators, including earlier symptoms of anxiety and depression, had little impact on the strength of associations.
Conclusions
We conclude that repeated CSA is independently associated with categorically defined PD, and also with higher neuroticism and lower agreeableness. Our findings suggest that if a dimensional classification of PDs is adopted in future classification systems, there might be meaningful continuity with previous aetiological research conducted using the current categorical system.
Adolescent 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.
Psychiatric 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.
In 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.
Our 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.
An increasing number of studies are demonstrating an association between childhood abuse and psychosis. However, the majority
of these rely on retrospective self-reports in adulthood that may be unduly influenced by current psychopathology. We therefore
set out to explore the reliability and comparability of first-presentation psychosis patients’ reports of childhood abuse.
Psychosis case subjects were drawn from the Aetiology and Ethnicity of Schizophrenia and Other Psychoses (ÆSOP) epidemiological
study and completed the Childhood Experience of Care and Abuse Questionnaire to elicit abusive experiences that occurred prior
to 16 years of age. High levels of concurrent validity were demonstrated with the Parental Bonding Instrument (antipathy:
rs = 0.350–0.737, P < .001; neglect: rs = 0.688–0.715, P < .001), and good convergent validity was shown with clinical case notes (sexual abuse: κ = 0.526, P < .001; physical abuse: κ = 0.394, P < .001). Psychosis patients’ reports were also reasonably stable over a 7-year period (sexual abuse: κ = 0.590, P < .01; physical abuse: κ = 0.634, P < .001; antipathy: κ = 0.492, P < .01; neglect: κ = 0.432, P < .05). Additionally, their reports of childhood abuse were not associated with current severity of psychotic symptoms (sexual
abuse: U = 1768.5, P = .998; physical abuse: U = 2167.5, P = .815; antipathy: U = 2216.5, P = .988; neglect: U = 1906.0, P = .835) or depressed mood (sexual abuse: χ2 = 0.634, P = .277; physical abuse: χ2 = 0.159, P = .419; antipathy: χ2 = 0.868, P = .229; neglect: χ2 = 0.639, P = .274). These findings provide justification for the use in future studies of retrospective reports of childhood abuse obtained
from individuals with psychotic disorders.
It is unclear if research findings support clinical opinion that cannabis use leads to worse outcomes in people with psychosis, or whether this impression is confounded by other factors.
To systematically review the evidence pertaining to whether cannabis affects outcome of psychotic disorders.
We searched 10 relevant databases (to November 2006), reference lists of included studies and contacted experts. We included 13 longitudinal studies from 15,303 references. Data extraction and quality assessment were conducted independently and in duplicate.
Cannabis use was consistently associated with increased relapse and non-adherence. Associations with other outcome measures were more disparate. Few studies adjusted for baseline illness severity, and most made no adjustment for alcohol, or other potentially important confounders. Adjusting for even a few confounders often resulted in substantial attenuation of results.
Confidence that most associations reported were specifically due to cannabis is low. Despite clinical opinion, it remains important to establish whether cannabis is harmful, what outcomes are particularly susceptible, and how such effects are mediated. Studies to examine this further are eminently feasible.
This article reviews empirical studies of affective traits in individuals with schizophrenia spectrum disorders, population-based
investigations of vulnerability to psychosis, and genetic and psychometric high-risk samples. The review focuses on studies
that use self-report trait questionnaires to assess Negative Affectivity (NA) and Positive Affectivity (PA), which are conceptualized
in contemporary models of personality as broad, temperamentally-based dispositions to experience corresponding emotional states.
Individuals with schizophrenia report a pattern of stably elevated NA and low PA throughout the illness course. Among affected
individuals, these traits are associated with variability in several clinically important features, including functional outcome,
quality of life, and stress reactivity. Furthermore, evidence that elevated NA and low PA (particularly the facet of anhedonia)
predict the development of psychosis and are detectable in high-risk samples suggests that these traits play a role in vulnerability
to schizophrenia, though they are implicated in other forms of psychopathology as well. Results are discussed in terms of
their implications for treatment, etiological models, and future research to advance the study of affective traits in schizophrenia
and schizotypy.
The association between level of cannabis consumption and development of schizophrenia during a 15-year follow-up was studied in a cohort of 45,570 Swedish conscripts. The relative risk for schizophrenia among high consumers of cannabis (use on more than fifty occasions) was 6.0 (95% confidence interval 4.0-8.9) compared with non-users. Persistence of the association after allowance for other psychiatric illness and social background indicated that cannabis is an independent risk factor for schizophrenia.
We analyzed the psychometric properties of the Positive and Negative Syndrome Scale (PANSS) in a sample of 100 DSM-III-R schizophrenic patients. Our findings coincided with the results of Kay's group in the following points: (1) the PANSS scores were normally distributed; (2) the positive and negative scales showed good interrater reliability; (3) positive and negative syndromes are independent constructs; (4) the positive and negative scales held a high concurrent validity in relation to the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms; and (5) although positive and negative syndromes showed factorial validity, they were not sufficient to account for the whole of the schizophrenic symptoms. Unlike Kay's group, we found a modest internal consistency of the positive scale, indicating that it is composed of several independent components. The data suggest that the distinction between positive and negative symptoms is an oversimplification, and that schizophrenic symptoms can be better conceptualized as composed of, at least three dimensional syndromes: positive, disorganized, and negative.
The current diathesis-stress model of schizophrenia proposes that a genetic deficit creates a predisposing vulnerability in the form of oversenstivity to stress. This model positions all psychosocial events on the stress side of the diathesis-stress equation. As an example of hypotheses that emerge when consideration is given to repositioning adverse life events as potential contributors to the diathesis, this article examines one possible explanation for the high prevalence of child abuse found in adults diagnosed schizophrenic. A traumagenic neurodevelopmental (TN) model of schizophrenia is presented, documenting the similarities between the effects of traumatic events on the developing brain and the biological abnormalities found in persons diagnosed with schizophrenia, including overreactivity of the hypothalamic-pituitary-adrenal (HPA) axis; dopamine, norepinephrine, and serotonin abnormalities; and structural changes to the brain such as hippocampal damage, cerebral atrophy, ventricular enlargement, and reversed cerebral asymmetry. The TN model offers potential explanations for other findings in schizophrenia research beyond oversensitivity to stress, including cognitive impairment, pathways to positive and negative symptoms, and the relationship between psychotic and dissociative symptomatology. It is recommended that clinicians and researchers explore the presence of early adverse life events in adults with psychotic symptoms in order to ensure comprehensive formulations and appropriate treatment plans, and to further investigate the hypotheses generated by the TN model.
Cannabis use may increase the risk of psychotic disorders and result in a poor prognosis for those with an established vulnerability to psychosis. A 3-year follow-up (1997-1999) is reported of a general population of 4,045 psychosis-free persons and of 59 subjects in the Netherlands with a baseline diagnosis of psychotic disorder. Substance use was assessed at baseline, 1-year follow-up, and 3-year follow-up. Baseline cannabis use predicted the presence at follow-up of any level of psychotic symptoms (adjusted odds ratio (OR) = 2.76, 95% confidence interval (CI): 1.18, 6.47), as well as a severe level of psychotic symptoms (OR = 24.17, 95% CI: 5.44, 107.46), and clinician assessment of the need for care for psychotic symptoms (OR = 12.01, 95% CI: 2.24, 64.34). The effect of baseline cannabis use was stronger than the effect at 1-year and 3-year follow-up, and more than 50% of the psychosis diagnoses could be attributed to cannabis use. On the additive scale, the effect of cannabis use was much stronger in those with a baseline diagnosis of psychotic disorder (risk difference, 54.7%) than in those without (risk difference, 2.2%; p for interaction = 0.001). Results confirm previous suggestions that cannabis use increases the risk of both the incidence of psychosis in psychosis-free persons and a poor prognosis for those with an established vulnerability to psychotic disorder.
Improved management of mental illness and substance misuse comorbidity is a National Health Service priority, but little is known about its prevalence and current management.
To measure the prevalence of comorbidity among patients of community mental health teams (CMHTs) and substance misuse services, and to assess the potential for joint management.
Cross-sectional prevalence survey in four urban UK centres.
Of CMHT patients, 44% (95% CI 38.1-49.9) reported past-year problem drug use and/or harmful alcohol use; 75% (95% CI 68.2-80.2) of drug service and 85% of alcohol service patients (95% CI 74.2-93.1) had a past-year psychiatric disorder. Most comorbidity patients appear ineligible for cross-referral between services. Large proportions are not identified by services and receive no specialist intervention.
Comorbidity is highly prevalent in CMHT, drug and alcohol treatment populations, but may be difficult to manage by cross-referral psychiatric and substance misuse services as currently configured and resourced.
The lack of prospective studies and data on male victims leaves major questions regarding associations between child sexual abuse and subsequent psychopathology.
To examine the association between child sexual abuse in both boys and girls and subsequent treatment for mental disorder using a prospective cohort design.
Children (n=1612; 1327 female) ascertained as sexually abused at the time had their histories of mental health treatment established by data linkage and compared with the general population of the same age over a specified period.
Both male and female victims of abuse had significantly higher rates of psychiatric treatment during the study period than general population controls (12.4% v. 3.6%). Rates were higher for childhood mental disorders, personality disorders, anxiety disorders and major affective disorders, but not for schizophrenia. Male victims were significantly more likely to have had treatment than females (22.8% v.10.2%).
This prospective study demonstrates an association between child sexual abuse validated at the time and a subsequent increase in rates of childhood and adult mental disorders.
Exposure to early trauma may increase the risk of dysfunctional responses to anomalous psychotic experiences resulting in psychotic symptom formation.
In a three-wave longitudinal general population study, 4045 never-psychotic individuals exposed and non-exposed to trauma before the age of 16 years, according to baseline interview were interviewed for the onset of psychotic experiences 3 years later (T2). In 36 individuals with incident psychosis at T2, assessments were made, for each psychotic experience, of i) the amount of distress associated with and ii) the degree of coping and subjective control over the experience.
In the 16 observations of an incident psychotic experience, in the absence of distress, the baseline rate of early trauma was low (6%), whereas it was much higher in the 21 observations of an incident psychotic experience with distress [43%; odds ratio=10.0, 95% confidence interval (CI): 1.04, 96.3; P=0.046]. Similarly, coping attempts in the context of early trauma was associated with less control (reduction of 2 points on a seven-point scale, 95% CI: -4.0, -0.07).
Early experience of trauma may create lasting cognitive and affective vulnerabilities to develop clinical symptoms arising out of early, non-clinical psychotic experiences.
Substance use is implicated in the cause and course of psychosis.
To characterise substance and alcohol use in an epidemiologically representative treatment sample of people experiencing a first psychotic episode in south Cambridgeshire.
Current and lifetime substance use was recorded for 123 consecutive referrals to a specialist early intervention service. Substance use was compared with general population prevalence estimates from the British Crime Survey.
Substance use among people with first-episode psychosis was twice that of the general population and was more common in men than women. Cannabis abuse was reported in 51% of patients (n=62) and alcohol abuse in 43% (n=53). More than half (n=68, 55%) had used Class A drugs, and 38% (n=43) reported polysubstance abuse. Age at first use of cannabis, cocaine, ecstasy and amphetamine was significantly associated with age at first psychotic symptom.
Substance misuse is present in the majority of people with first-episode psychosis and has major implications for management. The association between age at first substance use and first psychotic symptoms has public health implications.
Previous research investigating the etiology of psychosis has identified risk factors such as childhood sexual abuse and cannabis use. This study investigated the multiplicative effect of these variables on clinically assessed diagnoses of psychosis based on a large community sample (the National Comorbidity Survey). Demographic variables (sex, age, urbanicity, ethnicity, education, employment, and living arrangements) and depression were used as predictors in the first block of a binary logistic regression. In the second block, the variables representing early cannabis use, childhood sexual trauma, and the interaction between these variables were entered. There was no significant main effect for early cannabis use or childhood sexual trauma. The interaction was statistically significant (odds ratio [OR] = 6.93, 95% confidence interval [CI] = 1.39-34.63, P = .02). The effect for the sexual trauma variable was statistically significant for those who used cannabis under 16 years (OR = 11.96, 95% CI = 2.10-68.22, P = .01) but not for those who had not used cannabis under 16 years (OR = 1.80, 95% CI = 0.91-3.57, P = .09). Many factors have been shown to be significant in the etiology of psychosis; however, the current research augments previous findings by examining psychosis in terms of an interaction between 2 of these factors.
We assessed normal personality traits and childhood trauma in approximately 1170 subjects from a general population-based community sample. In bivariate analyses emotional abuse was most pervasively related to personality, showing significant detrimental associations with neuroticism, extraversion, openness, conscientiousness, and agreeableness. Neuroticism was significantly related to emotional abuse and neglect, physical abuse and neglect, and sexual abuse. Emotional abuse was related to neuroticism in men more profoundly than in women (β = 0.095). Adjusting for the covariance between childhood maltreatment variables, neuroticism was mainly related to emotional abuse (β = 0.193), extraversion to emotional neglect (β = -0.259), openness to emotional abuse (β = 0.175), conscientiousness to emotional abuse (β = -0.110), and agreeableness to emotional neglect (β = -0.153). The proportion of variance explained was highest in neuroticism (5.6%) and lowest in openness (1.9%) and conscientiousness (1.8%). These findings help to understand the complex association between childhood maltreatment and both normal and pathological personality.
Cannabis use and childhood maltreatment are independent risk factors for the development of psychotic symptoms. These factors have been found to interact in some but not all studies. One of the reasons may be that childhood maltreatment and cannabis primarily induce psychotic symptoms in genetically susceptible individuals. In this context, an extensively studied psychosis vulnerability gene is catechol-methyl-transferase (COMT). Therefore, we aimed to examine whether the COMT Val(158)Met polymorphism (rs4680) moderates the interaction between childhood maltreatment and cannabis use on psychotic symptoms in the general population.
The discovery sample consisted of 918 individuals from a cross-sectional study. For replication we used an independent sample of 339 individuals from the general population.
A significant three-way interaction was found between childhood maltreatment, cannabis use, and the COMT genotype (rs4680) in the discovery sample (P=0.006). Val-homozygous individuals displayed increased psychotic experiences after exposure to both cannabis use and childhood maltreatment compared to Met-heterozygous and Met-homozygous individuals. Supportive evidence was found in the replication sample with similar effect and direction even though the results did not reach statistical significance (P=0.25).
These findings suggest that a functional polymorphism in the COMT gene may moderate the interaction between childhood maltreatment and cannabis use on psychotic experiences in the general population. In conclusion, the COMT Val(158)Met polymorphism may constitute a genetic risk factor for psychotic symptoms in the context of combined exposure to childhood maltreatment and cannabis use.
There is evidence from research based on self-report personality measures that schizophrenia patients tend to be lower in extraversion and higher in neuroticism than healthy individuals. Self-report personality measures assess aspects of the explicit self-concept. The Implicit Association Test (IAT) has been developed to assess aspects of implicit cognition such as implicit attitudes and implicit personality traits. The present study was conducted to investigate the applicability and reliability of the IAT in schizophrenia patients and test whether they differ from healthy individuals on implicitly measured extraversion and neuroticism. The IAT and the NEO-FFI were administered as implicit and explicit measures of extraversion and neuroticism to 34 schizophrenia patients and 45 healthy subjects. For all IAT scores satisfactory to good reliabilities were observed in the patient sample. In both study groups, IAT scores were not related to NEO-FFI scores. Schizophrenia patients were lower in implicit and explicit extraversion and higher in implicit and explicit neuroticism than healthy individuals. Our data show that the IAT can be reliably applied to schizophrenia patients and suggest that they differ from healthy individuals not only in their conscious representation but also in their implicit representation of the self with regard to neuroticism and extraversion-related characteristics.
Objective:
To test whether the association between childhood abuse, cannabis use and psychotic experiences (PEs) was moderated by the COMT (catechol-O-methyltransferase) gene.
Method:
Psychotic experiences (PEs), childhood abuse, cannabis use and COMT Val158Met genotypes were assessed in 533 individuals from the general population. Data were analysed hierarchically by means of multiple linear regression models.
Results:
Childhood abuse showed a significant main effect on both positive (β = 0.09; SE = 0.04; P = 0.047) and negative PEs (β = 0.11; SE = 0.05; P = 0.038). A significant three-way interaction effect was found among childhood abuse, cannabis use and the COMT gene on positive PEs (β = -0.30; SE = 0.11; P = 0.006). This result suggests that COMT genotypes and cannabis use only influenced PE scores among individuals exposed to childhood abuse. Furthermore, exposure to childhood abuse and cannabis use increased PE scores in Val carriers. However, in individuals exposed to childhood abuse but who did not use cannabis, PEs increased as a function of the Met allele copies of the COMT gene.
Conclusion:
Cannabis use after exposure to childhood abuse may have opposite effects on the risk of PEs, depending on the COMT genotypes providing evidence for a qualitative interaction. Val carriers exposed to childhood abuse are vulnerable to the psychosis-inducing effects of cannabis.
Recent studies have provided robust evidence for an association between childhood trauma (CT) and psychosis. Meta-analyses have quantified the association, pointing to odds ratios in the order of around 3, and prospective studies have shown that reverse causation is unlikely to explain the association. However, more work is needed to address the possibility of a gene-environment correlation, that is, whether genetic risk for psychosis predicts exposure to CT. Nevertheless, multiple studies have convincingly shown that the association between CT and psychosis remains strong and significant when controlling for genetic risk, in agreement with a possible causal association. In addition, several studies have shown plausible psychological and neurobiological mechanisms linking adverse experiences to psychosis, including induction of social defeat and reduced self-value, sensitization of the mesolimbic dopamine system, changes in the stress and immune system, and concomitant changes in stress-related brain structures, such as the hippocampus and the amygdala, findings that should be integrated, however, in more complex models of vulnerability. It is currently unclear whether genetic vulnerability plays a role in conferring the mental consequences of adversity, and which genes are likely to be involved. The current, limited evidence points to genes that are not specifically involved in psychosis but more generally in regulating mood (serotonin transporter gene), neuroplasticity (brain-derived neurotrophic factor), and the stress-response system (FKBP5), in line with a general effect of CT on a range of mental disorders, rather than suggesting specificity for psychosis.
Purpose:
Recurring evidence seems to suggest that sexual trauma in childhood may moderate associations between cannabis consumption and psychosis. It has also been suggested, however, that poor childhood mental health may explain linkages between these phenomena.
Methods:
The current study, using data from the National Comorbidity Survey-Replication (N = 2,355), sought to revaluate the stability of the childhood trauma-cannabis interaction while statistically controlling for pre-trauma psychotic experiences and psychopathology in childhood.
Results:
Psychotic experiences that occurred before childhood sexual trauma significantly influenced adult psychosis symptomatology (psychosis pre-rape B = 0.10; psychosis pre-sexual assault B = 0.23). Social phobia (B = 0.07) also conferred risk for adult psychosis. Pre-trauma childhood psychopathology, however, did not account for the interaction between childhood sexual trauma and cannabis consumption in a multivariate model. Childhood experiences of rape (B = 0.15) and an interaction between cannabis use and childhood sexual assault (B = 0.05) independently contributed to adult psychosis. Cannabis use conferred no independent risk.
Conclusions:
With specific regard to research methodology, the current findings offer further justification for the inclusion of childhood sexual trauma in analyses investigating associations between cannabis use and psychosis.
Aim:
Traumatic childhood experiences are associated with psychotic illness and are frequently reported in patients at clinical high risk (CHR) for psychosis. Moreover, deteriorating premorbid functioning from childhood, and through adolescence, is related to greater severity of overall symptomatology and poorer outcomes in patients with psychosis. We studied the prevalence of traumatic childhood experiences and premorbid adjustment and their association with each other in patients at CHR for psychosis and normal control subjects (NCSs).
Methods:
A total of 20 CHR patients for psychosis and 30 NCSs aged 14 to 35 participated in the present study. The CHR patients were identified as prodromal to psychosis using the Structured Interview for Prodromal Syndromes/Scale of Prodromal Symptoms. Premorbid adjustment was assessed by using the premorbid adjustment scale (PAS), and self-reported childhood trauma was assessed with the Trauma and Distress Scale (TADS).
Results:
In CHR patients, TADS and PAS scores were higher than in NCSs. In CHR patients, TADS correlated significantly with the PAS general section and observably, but not significantly, with adolescence and adulthood sections.
Conclusion:
CHR patients reported more childhood trauma experiences and poorer premorbid adjustment than NCSs. In CHR patients, traumatic childhood experiences are associated with poor general premorbid adjustment.
Data are reported on a series of short-form (SF) screening scales of DSM-III-R psychiatric disorders developed from the World Health Organization's Composite International Diagnostic Interview (CIDI). A multi-step procedure was used to generate CIDI-SF screening scales for each of eight DSM disorders from the US National Comorbidity Survey (NCS). This procedure began with the subsample of respondents who endorsed the CIDI diagnostic stem question for a given disorder and then used a series of stepwise regression analyses to select a subset of screening questions to maximize reproduction of the full CIDI diagnosis. A small number of screening questions, between three and eight for each disorder, was found to account for the significant associations between symptom ratings and CIDI diagnoses. Summary scales made up of these symptom questions correctly classify between 77% and 100% of CIDI cases and between 94% and 99% of CIDI non-cases in the NCS depending on the diagnosis. Overall classification accuracy ranged from a low of 93% for major depressive episode to a high of over 99% for generalized anxiety disorder. Pilot testing in a nationally representative telephone survey found that the full set of CIDI-SF scales can be administered in an average of seven minutes compared to over an hour for the full CIDI. The results are quite encouraging in suggesting that diagnostic classifications made in the full CIDI can be reproduced with excellent accuracy with the CIDI-SF scales. Independent verification of this reproduction accuracy, however, is needed in a data set other than the one in which the CIDI-SF was developed. Copyright © 1998 Whurr Publishers Ltd.
There may be biological plausibility to the notion that cannabis use and childhood trauma or maltreatment synergistically increase the risk for later development of psychotic symptoms. To replicate and further investigate this issue, prospective data from two independent population-based studies, the Greek National Perinatal Study (n=1636) and The Netherlands Mental Health Survey and Incidence Study (NEMESIS) (n=4842), were analyzed.
Two different data sets on cannabis use and childhood maltreatment were used. In a large Greek population-based cohort study, data on cannabis use at age 19 years and childhood maltreatment at 7 years were assessed. In addition, psychotic symptoms were assessed using the Community Assessment of Psychic Experiences (CAPE). In NEMESIS, the Composite International Diagnostic Interview (CIDI) was used to assess psychotic symptoms at three different time points along with childhood maltreatment and lifetime cannabis use.
A significant adjusted interaction between childhood maltreatment and later cannabis use was evident in both samples, indicating that the psychosis-inducing effects of cannabis were stronger in individuals exposed to earlier sexual or physical mistreatment [Greek National Perinatal Study: test for interaction F(2, 1627)=4.18, p=0.02; NEMESIS: test for interaction χ2(3)=8.08, p=0.04].
Cross-sensitivity between childhood maltreatment and cannabis use may exist in pathways that shape the risk for expression of positive psychotic symptoms.
Associations among maltreatment and traumatic experiences in childhood and adolescence, later substance use, and subsequent mental health outcomes for individuals with schizophrenia-spectrum disorders have been initially explored in previous studies; however, research on these factors in socially disadvantaged patients with first-episode psychosis is unavailable. This exploratory, correlational analysis examined associations between maltreatment and trauma-related variables (e.g., traumatic experiences, parental harsh discipline, violence exposure) and: social variables (years of education attained and extent of Axis IV psychosocial problems at initial hospitalization), substance abuse (age at initiation of alcohol and cannabis use, as well as estimates of lifetime intake of both), and positive and negative symptom severity. Rates of childhood abuse and traumatic events were remarkably high in the sample. Years of educational attainment and number of Axis IV psychosocial problems were substantially correlated with several domains of childhood abuse/traumatic events. Age at initiation of alcohol and cannabis use, and lifetime alcohol and cannabis intake, were correlated with a number of trauma domains. Whereas positive symptom severity was correlated with four of the trauma variables, negative symptom severity was correlated only with prior emotional neglect. These results provide insights into the relations among childhood traumatic events, substance use, and clinical features of first-episode psychosis, creating hypotheses for future research.
Research suggests that low-grade psychotic experiences in the general population are a common but transitory developmental phenomenon. Using two independent general population samples, the hypothesis was examined that common, non-clinical developmental expression of psychosis may become abnormally persistent when synergistically combined with developmental exposures that may impact on behavioural and neurotransmitter sensitization such as cannabis, trauma and urbanicity.
The amount of synergism was estimated from the additive statistical interaction between baseline cannabis use, childhood trauma and urbanicity on the one hand, and baseline psychotic experiences on the other, in predicting 3-year follow-up psychotic experiences, using data from two large, longitudinal, random population samples from the Netherlands [The Netherlands Mental Health Survey and Incidence Study (NEMESIS)] and Germany [The Early Developmental Stages of Psychopathology (EDSP) study].
The 3-year persistence rates of psychotic experiences were low at 26% in NEMESIS and 31% in EDSP. However, persistence rates were progressively higher with greater baseline number of environmental exposures in predicting follow-up psychotic experiences (chi2=6.9, df=1, p=0.009 in NEMESIS and chi2=4.2, df=1, p=0.04 in EDSP). Between 21% and 83% (NEMESIS) and 29% and 51% (EDSP) of the subjects exposed to both environmental exposures and psychotic experiences at baseline had persistence of psychotic experiences at follow-up because of the synergistic action of the two factors.
The findings suggest that environmental risks for psychosis act additively, and that the level of environmental risk combines synergistically with non-clinical developmental expression of psychosis to cause abnormal persistence and, eventually, need for care.
We analyzed the association of age at onset of psychosis treatment (AOPT) with having a history of cannabis use in patients with a first episode of non-affective psychosis. We also investigated the impact on the AOPT of exposure to cannabis in adolescence, compared with young adulthood, and of the additional exposure to cocaine.
We recruited 112 consecutive patients (66 men and 46 women; age range, 18-57years) with a first psychotic episode. The composite international diagnostic interview (CIDI) was used to assess drug use and to define the age at onset of heaviest use (AOHU) of a drug, defined as the age when drug was used the most for each patient. The effect of cannabis and cocaine AOHU on AOPT was explored through Kruskal-Wallis and Mann-Whitney tests, and logistic regression. Sex-adjusted cumulative hazard curves and Cox regression models were used to compare the AOPT of patients with and without a history of cannabis use, or associated cocaine use.
We found that the AOPT was significantly associated with the use of cannabis, independently of sex, use of cocaine, tobacco smoking or excessive alcohol consumption. There was a dose-response relationship between cannabis AOHU and AOPT: the earlier the AOHU the earlier the AOPT. Hazard curves showed that patients with a history of cannabis use had a higher hazard of having a first-episode psychosis than the rest of the patients (sex-adjusted log-rank chi(2)=23.43, df=1, p<0.001). Their respective median AOPT (25th, 75th percentiles) were 23.5 (21, 28) and 33.5years (27, 45) (for log-transformed AOPT, t=5.6, df=110, p<0.001). The sex-adjusted hazard ratio of psychosis onset comparing both groups was 2.66 (95% CI, 1.74-4.05).
Our results are in favor of a catalytic role for cannabis use in the onset of psychosis.
Studies demonstrating an association between childhood trauma and psychosis in adulthood have not systematically explored gender differences.
To investigate gender differences in the prevalence of childhood sexual and physical abuse among people with psychosis in comparison with healthy controls.
The Childhood Experiences of Care and Abuse Questionnaire was completed to elicit experiences of sexual and physical abuse during childhood in first-episode psychosis cases and population-based controls.
Among women, those in the cases group were twice as likely to report either physical or sexual abuse compared with controls following adjustment for all confounders. In particular, the effect of physical abuse in women was stronger and more robust than that for sexual abuse. A similar trend was found for psychotic-like experiences in the female control group. No association was found in men.
Reports of severe childhood physical or sexual abuse were associated with psychosis in women but not in men.
Although neurological soft signs (NSS) have been consistently associated with schizophrenia and a variety of risk factors, few studies have focused on the association between NSS and environmental factors such as cannabis use, particularly in patients with first episode psychosis.
We administered the Neurological Evaluation Scale (NES) to 92 patients during their first episode of functional psychosis. Psychopathology was assessed with the Positive And Negative Syndrome Scale (PANSS) and the family history of psychotic disorder was established on the basis of the Family Interview for Genetic Studies (FIGS). We also assessed lifetime cannabis and cocaine use utilizing that specific section of the Composite International Diagnostic Interview. The outcome variable was the presence of high NSS, defined by a score above the median split of the NES score (>21).
Most patients (80/92, 87%) presented a non-affective psychosis. The presence of high NSS showed a significant independent association with not having been a heavy cannabis user (OR=8.3; 95% CI, 2.4-33.3), family history of psychosis (OR=4.3; 95% CI, 1.2-14.9), male sex (OR=4.0; 95% CI, 1.2-14.0), lower score in verbal fluency and higher score in negative symptoms (both p<0.01).
Our cross-sectional results support the hypothesis that potentially different pathways associated with the emergence of first episode psychosis may exist, including neurological premorbid alteration and environmental cannabis abuse.
The aim of this study was to investigate the relationship between age and cannabis use in patients with a first psychotic episode, and to analyze the mediating effect of comorbid use of other drugs and sex on age at onset of psychosis.
All consenting patients (aged 15 to 65 years) with a first psychotic episode needing inpatient psychiatric treatment during a 2-year period between February 1997 and January 1999 were considered, confirming a total of 131 patients. Subjects were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders, and clinical and demographic data were collected. We used general linear models with age at onset as the response variable and survival Cox models to confirm the results. Both a multivariate linear model and the corresponding Cox model were fitted with a covariate that summarizes the most significant contributors that seemed to decrease age at onset.
Regarding the effect of cannabis use, a significant gradual reduction on age at onset was found as dependence on cannabis increased, consisting in a decrement of 7, 8.5, and 12 years for users, abusers, and dependents, respectively, with respect to nonusers (p = .004, p < .001, and p < .001, respectively). Multivariate analysis showed a clear effect of cannabis use on age at onset, which was not explained by the use of other drugs or by gender. The finding was similar in the youngest patients, suggesting that this effect was not due to chance.
The major contribution of this investigation is the independent and strong link between cannabis use and early age at onset of psychosis, and the slight or nonexistent effect of sex and comorbid substance abuse in this variable. These results point to cannabis as a dangerous drug in young people at risk of developing psychosis.
The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized
measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale
(PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS
was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative
symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring
positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the
four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely
correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually
exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with
antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both
typological and dimensional assessment.
Previous twin studies have supported a genetic contribution to the major categories of psychotic disorders, but few of these have employed operational diagnostic criteria, and no such study has been based on a sample that included the full range of functional psychotic disorders.
A total of 224 twin probands (106 monozygotic, 118 dizygotic) with a same-sex co-twin and a lifetime history of psychosis was ascertained from the service-based Maudsley Twin Register in London, England. Research Diagnostic Criteria psychotic diagnoses were made on a lifetime-ever basis. Main-lifetime diagnoses of DSM-III-R and International Statistical Classification of Diseases, 10th Revision schizophrenia were also made. Probandwise concordance rates and correlations in liability were calculated, and biometrical model fitting applied.
A substantial genetic contribution to variance in liability was confirmed for the major diagnostic categories except Research Diagnostic Criteria depressive psychosis and unspecified functional psychosis, where familial transmission was confirmed, but the relative contribution of genetic and common environmental factors was unclear. Heritability estimates for Research Diagnostic Criteria schizophrenia, schizoaffective disorder, mania, DSM-III-R schizophrenia, and International Statistical Classification of Diseases, 10th Revision schizophrenia were all between 82% and 85%. None of the estimates differed significantly from any other.
Heritability estimates for schizophrenia, schizoaffective disorder, and mania were substantial and similar. Population morbid risk estimates were inferred rather than directly measured, but the results were very similar to those from studies where morbid risks were directly estimated.
We review case-control designs for studying gene associations in which relatives of case patients are used as control subjects. These designs have the advantage that they avoid the problem of population stratification that can lead to spurious associations with noncausal genes. We focus on designs that use sibling, cousin, or pseudosibling controls, the latter formed as the set of genotypes not transmitted to the case from his or her parents. We describe a common conditional likelihood framework for use in analyzing data from any of these designs and review what is known about the validity of the various design and analysis combinations for estimating the genetic relative risk. We also present comparisons of efficiency for each of the family-based designs relative to the standard population-control design in which unrelated controls are selected from the source population of cases. Because of overmatching on genotype, the use of sibling controls leads to estimates of genetic relative risk that are approximately half as efficient as those obtained with the use of population controls, while relative efficiency for cousin controls is approximately 90%. However, we find that, for a rare gene, the sibling-control design can lead to improved efficiency for estimating a G x E interaction effect. We also review some restricted designs that can substantially improve efficiency, e.g., restriction of the sample to case-sibling pairs with an affected parent. We conclude that family-based case-control studies are an attractive alternative to population-based case-control designs using unrelated control subjects.
Neuroticism has been shown to increase the risk of depression whereas extraversion is associated with a reduction of risk. These personality traits play a central role in aetiological theories of affective disorder but their role in schizophrenia is unclear. In this study, the risk for schizophrenia associated with neuroticism and extraversion was examined and quantified.
Neuroticism and extraversion rated at the age of 16 years were examined in relation to adult schizophrenia in a national birth cohort of 5362 individuals.
Neuroticism increased the risk of later schizophrenia independent of the level of affective symptoms in adult life (odds ratio over three levels: 1.93, 95% CI 1.09-3.43), whereas extraversion reduced the risk (OR: 044, 95% CI 0.23-0.84).
Depression and schizophrenia may share personality risk-increasing and risk-reducing factors. Coping styles associated with particular personality traits may determine whether isolated symptoms progress to full-blown illness.
To examine the hypothesis that individuals from the general population who report childhood abuse are at increased risk of developing positive psychotic symptoms.
Data were derived from a general population sample of 4045 subjects aged 18-64 years. First ever onset of positive psychotic symptoms at 2-year follow-up were assessed using the Composite International Diagnostic Interview and additional clinical interviews if necessary. Childhood abuse was assessed at baseline.
Baseline reported childhood abuse predicted development of positive psychotic symptoms associated with need for care [odds ratio (OR) = 11.5, 95% CI 2.6-51.6]. This association remained after adjustment for demographic variables, reported risk factors and presence of any lifetime psychiatric diagnosis at baseline (OR = 7.3, 95% CI 1.1-49.0).
The results suggest that early childhood trauma increases the risk for positive psychotic symptoms. This finding fits well with recent models that suggest that early adversities may lead to psychological and biological changes that increase psychosis vulnerability.
Adverse early circumstances may be more common in people who later develop psychotic disorders.
To use data from the second British National Survey of Psychiatric Morbidity to examine associations between psychotic disorders and a number of early victimisation experiences.
Psychiatric disorders were identified through structured assessment of adults resident in private households in Britain (n=8580). Respondents were asked whether they had experienced selected events displayed on cards.
Compared with respondents with other psychiatric disorders or with none, the prevalence of every experience bar one was significantly elevated in those with definite or probable psychosis. The largest odds ratio was for sexual abuse. Controlling for depressed mood somewhat reduced the odds ratios for the individual experiences.
In people with psychosis, there is a marked excess of victimising experiences, many of which will have occurred during childhood. This is suggestive of a social contribution to aetiology.
Cannabis dependence is a prevalent comorbid substance use disorder among patients early in the course of a schizophrenia-spectrum disorder. Determining risk factors for substance abuse may be helpful in designing interventions to reduce the psychosocial morbidity associated with substance abuse among this population. This study aimed to determine whether or not African American, socially disadvantaged, first-episode schizophrenia-spectrum patients with cannabis dependence experienced greater levels of childhood abuse and neglect compared to similar patients without comorbid cannabis dependence. Among 29 eligible patients, 18 participated in this pilot study. First-episode patients with comorbid cannabis dependence (n = 8) reported significantly greater childhood physical and sexual abuse compared to those without comorbid cannabis dependence (n = 10). This represents preliminary evidence of an association between childhood maltreatment and cannabis dependence among this especially vulnerable population. Childhood physical and sexual abuse may be a risk factor for the initiation of cannabis dependence and other substance use disorders in the early course of schizophrenia.
Influential studies have cast doubt on the validity of retrospective reports by adults of their own adverse experiences in childhood. Accordingly, many researchers view retrospective reports with scepticism.
A computer-based search, supplemented by hand searches, was used to identify studies reported between 1980 and 2001 in which there was a quantified assessment of the validity of retrospective recall of sexual abuse, physical abuse, physical/emotional neglect or family discord, using samples of at least 40. Validity was assessed by means of comparisons with contemporaneous, prospectively obtained, court or clinic or research records; by agreement between retrospective reports of two siblings; and by the examination of possible bias with respect to differences between retrospective and prospective reports in their correlates and consequences. Medium- to long-term reliability of retrospective recall was determined from studies in which the test-retest period extended over at least 6 months.
Retrospective reports in adulthood of major adverse experiences in childhood, even when these are of a kind that allow reasonable operationalisation, involve a substantial rate of false negatives, and substantial measurement error. On the other hand, although less easily quantified, false positive reports are probably rare. Several studies have shown some bias in retrospective reports. However, such bias is not sufficiently great to invalidate retrospective case-control studies of major adversities of an easily defined kind. Nevertheless, the findings suggest that little weight can be placed on the retrospective reports of details of early experiences or on reports of experiences that rely heavily onjudgement or interpretation.
Retrospective studies have a worthwhile place in research, but further research is needed to examine possible biases in reporting.
To explore the association between cannabis and personality scores when genetic background and shared environment are controlled for.
The co-twin control design. This design provides a powerful method for controlling for the effects of potentially confounding familial factors that may act to predispose subjects both to cannabis use and a particular personality profile.
118 monozygotic twin pairs discordant for cannabis use.
Data on personality and cannabis use were obtained through a questionnaire survey. The Dutch Sensation Seeking List was used to assess various aspects of sensation seeking. The Amsterdamse Biografische Vragenlijst assessed extraversion, neuroticism, somatic complaints and test attitude.
The affected twins scored higher on all scales than their unaffected co-twins, especially on experience seeking (P = 0.004), total sensation seeking score (P = 0.004) and neuroticism (P = 0.039). Differences were also observed when items on drug use were removed from the experience seeking scale (P = 0.037) and total sensation seeking score (P = 0.009) although these differences were no longer significant after Bonferoni correction (P < 0.005).
Cannabis use is associated with a higher score on personality scales. This result was obtained in a sample of monozygotic twins discordant for cannabis use. Thus, at least part of the association between cannabis use and experience seeking cannot be attributed to underlying genetic or shared environmental factors that influence both personality and cannabis use and must be explained by unique environmental influences.