Hostname: page-component-5d84bcc8dc-kbj6t Total loading time: 0 Render date: 2026-09-07T19:21:18.245Z Has data issue: false hasContentIssue false
  • English
  • Français

Childhood maltreatment is associated with increased body mass index and increased C-reactive protein levels in first-episode psychosis patients

Published online by Cambridge University Press:  20 January 2012

N. Hepgul ,
C. M. Pariante ,
S. Dipasquale ,
M. DiForti ,
H. Taylor ,
T. R. Marques ,
C. Morgan ,
P. Dazzan ,
R. M. Murray  and
V. Mondelli
N. Hepgul
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK
C. M. Pariante
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK
S. Dipasquale
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK
M. DiForti
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, UK
H. Taylor
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, UK
T. R. Marques
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, UK
C. Morgan
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, UK
P. Dazzan
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, UK
R. M. Murray
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, UK
V. Mondelli*
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK
*
*Address for correspondence: V. Mondelli, Ph.D., Sections of Perinatal Psychiatry and Stress, Psychiatry and Immunology (SPI-Lab), Centre for the Cellular Basis of Behaviour, The James Black Centre, Institute of Psychiatry, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK. (Email: valeria.mondelli@kcl.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The high incidence of the metabolic syndrome in patients with psychosis is mainly attributed to antipsychotic treatment. However, it is also possible that psychological stress plays a role, inducing a chronic inflammatory process that may predispose to the development of metabolic abnormalities. We investigated the association between childhood maltreatment and inflammatory and metabolic biomarkers in subjects with first-episode psychosis and healthy controls.

Method

Body mass index (BMI), weight and waist circumference were measured in 95 first-episode psychosis patients and 97 healthy controls. Inflammatory and metabolic markers were measured in a subsample of 28 patients and 45 controls. In all the subjects we collected information on childhood maltreatment and recent stressors.

Results

Patients with childhood maltreatment had higher BMI [25.0 (s.e.=0.6) kg/m2] and C-reactive protein (CRP) levels [1.1 (s.e.=0.6) mg/dl] when compared with healthy controls [23.4 (s.e.=0.4) kg/m2, p=0.030 and 0.2 (s.e.=0.1) mg/dl, p=0.009, respectively]. In contrast, patients without childhood maltreatment were not significantly different from healthy controls for either BMI [24.7 (s.e.=0.6) kg/m2, p=0.07] or CRP levels [0.5 (s.e.=0.2) mg/dl, p=0.25]. After controlling for the effect of BMI, the difference in CRP levels across the three groups remained significant (F2,58=3.6, p=0.035), suggesting that the increase in inflammation was not driven by an increase in adipose tissue.

Conclusions

Childhood maltreatment is associated with higher BMI, and increased CRP levels, in patients with a first-episode psychosis. Further studies need to confirm the mechanisms underlying the putative causal relationship between childhood maltreatment and higher BMI, and whether this is indeed mediated by increased inflammation.

Keywords

Body mass indexchildhood maltreatmentinflammationmetabolic syndromepsychosis

Information

Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 9 , September 2012 , pp. 1893 - 1901
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Aas, M, Dazzan, P, Mondelli, V, Toulopoulou, T, Reichenberg, A, Di Forti, M, Fisher, HL, Handley, R, Hepgul, N, Marques, T, Miorelli, A, Taylor, H, Russo, M, Wiffen, B, Papadopoulos, A, Aitchison, KJ, Morgan, C, Murray, RM, Pariante, CM (2010). Abnormal cortisol awakening response predicts worse cognitive function in patients with first-episode psychosis. Psychological Medicine 41, 463–476.CrossRefGoogle ScholarPubMed
Allison, DB, Mentore, JL, Heo, M, Chandler, LP, Cappelleri, JC, Infante, MC, Weiden, PJ (1999). Antipsychotic-induced weight gain: a comprehensive research synthesis. American Journal of Psychiatry 156, 1686–1696.CrossRefGoogle ScholarPubMed
Bassuk, SS, Rifai, N, Ridker, PM (2004). High-sensitivity C-reactive protein: clinical importance. Current Problems in Cardiology 29, 439–493.Google ScholarPubMed
Bebbington, P, Nayani, T (1995). The Psychosis Screening Questionnaire. International Journal of Methods in Psychiatric Research 5, 11–19.Google Scholar
Bifulco, A, Bernazzani, O, Moran, PM, Jacobs, C (2005). The childhood experience of care and abuse questionnaire (CECA.Q): validation in a community series. British Journal of Clinical Psychology 44, 563–581.CrossRefGoogle Scholar
Black, PH (2003). The inflammatory response is an integral part of the stress response: implications for atherosclerosis, insulin resistance, type II diabetes and metabolic syndrome X. Brain, Behavior and Immunity 17, 350–364.CrossRefGoogle ScholarPubMed
Brown, S, Inskip, H, Barraclough, B (2000). Causes of the excess mortality of schizophrenia. British Journal of Psychiatry 177, 212–217.CrossRefGoogle ScholarPubMed
Brugha, TS, Cragg, D (1990). The List of Threatening Experiences: the reliability and validity of a brief life events questionnaire. Acta Psychiatrica Scandinavica 82, 77–81.CrossRefGoogle ScholarPubMed
Capuron, L, Poitou, C, Machaux-Tholliez, D, Frochot, V, Bouillot, JL, Basdevant, A, Laye, S, Clement, K (2010). Relationship between adiposity, emotional status and eating behaviour in obese women: role of inflammation. Psychological Medicine 41, 1517–1528.CrossRefGoogle ScholarPubMed
Cohen, S, Williamson, G (1988). Perceived stress in a probability sample of the United States. In The Social Psychology of Health: The Claremont Symposium on Applied Social Psychology (ed. Spacapan, S. and Oskamp, S.), pp. 64–65. Sage Publications, Inc.: Newbury Park, CA.Google Scholar
Crespo-Facorro, B, Carrasco-Marin, E, Perez-Iglesias, R, Pelayo-Teran, JM, Fernandez-Prieto, L, Leyva-Cobian, F, Vazquez-Barquero, JL (2008). Interleukin-12 plasma levels in drug-naive patients with a first episode of psychosis: effects of antipsychotic drugs. Psychiatry Research 158, 206–216.CrossRefGoogle ScholarPubMed
Dallman, MF, Pecoraro, NC, la Fleur, SE (2005). Chronic stress and comfort foods: self-medication and abdominal obesity. Brain, Behavior and Immunity 19, 275–280.CrossRefGoogle ScholarPubMed
Danese, A (2008). Genetic opportunities for psychiatric epidemiology: on life stress and depression. Epidemiologia e Psichiatria Sociale 17, 201–210.CrossRefGoogle ScholarPubMed
Danese, A, Moffitt, TE, Harrington, H, Milne, BJ, Polanczyk, G, Pariante, CM, Poulton, R, Caspi, A (2009). Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Archives of Pediatrics and Adolescent Medicine 163, 1135–1143.CrossRefGoogle ScholarPubMed
Danese, A, Moffitt, TE, Pariante, CM, Ambler, A, Poulton, R, Caspi, A (2008). Elevated inflammation levels in depressed adults with a history of childhood maltreatment. Archives of General Psychiatry 65, 409–415.CrossRefGoogle ScholarPubMed
Danese, A, Pariante, CM, Caspi, A, Taylor, A, Poulton, R (2007). Childhood maltreatment predicts adult inflammation in a life-course study. Proceedings of the National Academy of Sciences USA 104, 1319–1324.CrossRefGoogle Scholar
Dinan, TG (2004). Stress and the genesis of diabetes mellitus in schizophrenia. British Journal of Psychiatry Supplement 47, S72–S75.CrossRefGoogle ScholarPubMed
Fernandez-Egea, E, Bernardo, M, Donner, T, Conget, I, Parellada, E, Justicia, A, Esmatjes, E, Garcia-Rizo, C, Kirkpatrick, B (2009). Metabolic profile of antipsychotic-naive individuals with non-affective psychosis. British Journal of Psychiatry 194, 434–438.CrossRefGoogle ScholarPubMed
Fisher, H, Morgan, C, Dazzan, P, Craig, TK, Morgan, K, Hutchinson, G, Jones, PB, Doody, GA, Pariante, C, McGuffin, P, Murray, RM, Leff, J, Fearon, P (2009). Gender differences in the association between childhood abuse and psychosis. British Journal of Psychiatry 194, 319–325.CrossRefGoogle ScholarPubMed
Fisher, HL, Jones, PB, Fearon, P, Craig, TK, Dazzan, P, Morgan, K, Hutchinson, G, Doody, GA, McGuffin, P, Leff, J, Murray, RM, Morgan, C (2010). The varying impact of type, timing and frequency of exposure to childhood adversity on its association with adult psychotic disorder. Psychological Medicine 40, 1967–1978.CrossRefGoogle ScholarPubMed
Freeman, LM, Gil, KM (2004). Daily stress, coping, and dietary restraint in binge eating. International Journal of Eating Disorders 36, 204–212.CrossRefGoogle ScholarPubMed
Heim, C, Newport, DJ, Heit, S, Graham, YP, Wilcox, M, Bonsall, R, Miller, AH, Nemeroff, CB (2000). Pituitary–adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. Journal of the American Medical Association 284, 592–597.CrossRefGoogle ScholarPubMed
Heiskanen, T, Niskanen, L, Lyytikainen, R, Saarinen, PI, Hintikka, J (2003). Metabolic syndrome in patients with schizophrenia. Journal of Clinical Psychiatry 64, 575–579.CrossRefGoogle ScholarPubMed
Hotamisligil, GS (2006). Inflammation and metabolic disorders. Nature 444, 860–867.CrossRefGoogle ScholarPubMed
Lehman, BJ, Taylor, SE, Kiefe, CI, Seeman, TE (2005). Relation of childhood socioeconomic status and family environment to adult metabolic functioning in the CARDIA study. Psychosomatic Medicine 67, 846–854.CrossRefGoogle ScholarPubMed
Mallett, R, Leff, J, Bhugra, D, Pang, D, Zhao, JH (2002). Social environment, ethnicity and schizophrenia. A case–control study. Social Psychiatry and Psychiatric Epidemiology 37, 329–335.CrossRefGoogle ScholarPubMed
McGuffin, P, Farmer, A, Harvey, I (1991). A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Archives of General Psychiatry 48, 764–770.CrossRefGoogle ScholarPubMed
Miller, AH (2008). Inflammation versus glucocorticoids as purveyors of pathology during stress: have we reached the tipping point? Biological Psychiatry 64, 263–265.CrossRefGoogle ScholarPubMed
Mondelli, V, Cattaneo, A, Belvederi Murri, M, Di Forti, M, Handley, R, Hepgul, N, Miorelli, A, Navari, S, Papadopoulos, A, Aitchison, KJ, Morgan, C, Murray, RM, Dazzan, P, Pariante, CM (2011). Stress and inflammation reduce brain-derived neurotrophic factor expression in first-episode psychosis: a pathway to smaller hippocampal volume. Journal of Clinical Psychiatry. Published online: 18 May 2011. doi:10.4088/JCP.10m06745.CrossRefGoogle ScholarPubMed
Mondelli, V, Dazzan, P, Hepgul, N, Di Forti, M, Aas, M, D'Albenzio, A, Di Nicola, M, Fisher, H, Handley, R, Marques, TR, Morgan, C, Navari, S, Taylor, H, Papadopoulos, A, Aitchison, KJ, Murray, RM, Pariante, CM (2010 a). Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: the role of stress and of antipsychotic treatment. Schizophrenia Research 116, 234–242.CrossRefGoogle ScholarPubMed
Mondelli, V, Pariante, CM, Navari, S, Aas, M, D'Albenzio, A, Di Forti, M, Handley, R, Hepgul, N, Marques, TR, Taylor, H, Papadopoulos, AS, Aitchison, KJ, Murray, RM, Dazzan, P (2010 b). Higher cortisol levels are associated with smaller left hippocampal volume in first-episode psychosis. Schizophrenia Research 119, 75–78.CrossRefGoogle ScholarPubMed
Pearson, TA, Mensah, GA, Alexander, RW, Anderson, JL, Cannon, RO, Criqui, M, Fadl, YY, Fortmann, SP, Hong, Y, Myers, GL, Rifai, N, Smith, SC, Taubert, K, Tracy, RP, Vinicor, F (2003). Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107, 499–511.CrossRefGoogle Scholar
Potvin, S, Stip, E, Sepehry, AA, Gendron, A, Bah, R, Kouassi, E (2008). Inflammatory cytokine alterations in schizophrenia: a systematic quantitative review. Biological Psychiatry 63, 801–808.CrossRefGoogle ScholarPubMed
Ryan, MC, Collins, P, Thakore, JH (2003). Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia. American Journal of Psychiatry 160, 284–289.CrossRefGoogle ScholarPubMed
Ryan, MC, Flanagan, S, Kinsella, U, Keeling, F, Thakore, JH (2004). The effects of atypical antipsychotics on visceral fat distribution in first episode, drug-naive patients with schizophrenia. Life Sciences 74, 1999–2008.CrossRefGoogle ScholarPubMed
Shah, T, Newcombe, P, Smeeth, L, Addo, J, Casas, JP, Whittaker, J, Miller, MA, Tinworth, L, Jeffery, S, Strazzullo, P, Cappuccio, FP, Hingorani, AD (2010). Ancestry as a determinant of mean population C-reactive protein values: implications for cardiovascular risk prediction. Circulation Cardiovascular Genetics 3, 436–444.CrossRefGoogle ScholarPubMed
Sperner-Unterweger, B, Whitworth, A, Kemmler, G, Hilbe, W, Thaler, J, Weiss, G, Fleischhacker, WW (1999). T-cell subsets in schizophrenia: a comparison between drug-naive first episode patients and chronic schizophrenic patients. Schizophrenia Research 38, 61–70.CrossRefGoogle ScholarPubMed
Thomas, C, Hyppönen, E, Power, C (2008). Obesity and type 2 diabetes risk in midadult life: the role of childhood adversity. Pediatrics 121, e1240–e1249.CrossRefGoogle ScholarPubMed
Williamson, DF, Thompson, TJ, Anda, RF, Dietz, WH, Felitti, V (2002). Body weight and obesity in adults and self-reported abuse in childhood. International Journal of Obesity and Related Metabolic Disorders 26, 1075–1082.CrossRefGoogle ScholarPubMed
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.Google Scholar