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Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients

  • L. Alameda (a1) (a2), C. Ferrari (a2), P. S. Baumann (a1) (a2), M. Gholam-Rezaee (a3), K. Q. Do (a1) and P. Conus (a2)...

Abstract

Background

Evidence suggests a relationship between exposure to trauma during childhood and functional impairments in psychotic patients. However, the impact of age at the time of exposure has been understudied in early psychosis (EP) patients.

Method

Two hundred and twenty-five patients aged 18–35 years were assessed at baseline and after 2, 6, 18, 24, 30 and 36 months of treatment. Patients exposed to sexual and/or physical abuse (SPA) were classified according to age at the time of first exposure (Early SPA: before age 11 years; Late SPA: between ages 12 and 15 years) and then compared to patients who were not exposed to such trauma (Non-SPA). The functional level in the premorbid phase was measured with the Premorbid Adjustment Scale (PAS) and with the Global Assessment of Functioning (GAF) scale and the Social and Occupational Functioning Assessment Scale (SOFAS) during follow-up.

Results

There were 24.8% of patients with a documented history of SPA. Late SPA patients were more likely to be female (p = 0.010). Comparison with non-SPA patients revealed that: (1) both Early and Late SPA groups showed poorer premorbid social functioning during early adolescence, and (2) while patients with Early SPA had poorer functional level at follow-up with lower GAF (p = 0.025) and lower SOFAS (p = 0.048) scores, Late SPA patients did not.

Conclusion

Our results suggest a link between exposure to SPA and the later impairment of social functioning before the onset of the disease. EP patients exposed to SPA before age 12 may present long-lasting functional impairment, while patients exposed at a later age may improve in this regard and have a better functional outcome.

Copyright

Corresponding author

* Address for correspondence: Dr L. Alameda, Department of Psychiatry, Lausanne University Hospital (CHUV), rue de Caroline 2, 1003 Lausanne, Switzerland. (Email: Luis.alameda-fernandez@chuv.ch)

References

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Aas, M, Dazzan, P, Fisher, HL, Morgan, C, Morgan, K, Reichenberg, A, Zanelli, J, Fearon, P, Jones, PB, Murray, RM, Pariante, CM (2011). Childhood trauma and cognitive function in first-episode affective and non-affective psychosis. Schizophrenia Research 129, 1219.
Addington, J, Addington, D (2000). Neurocognitive and social functioning in schizophrenia: a 2.5 year follow-up study. Schizophrenia Research 44, 4756.
Allen, DN, Kelley, ME, Miyatake, RK, Gurklis, JA Jr., van Kammen, DP (2001). Confirmation of a two-factor model of premorbid adjustment in males with schizophrenia. Schizophrenia Bulletin 27, 3946.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.
APA (2000). DSMIV-TR. American Psychiatric Association: Washington, DC.
Arseneault, L, Cannon, M, Fisher, HL, Polanczyk, G, Moffitt, TE, Caspi, A (2011). Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. American Journal of Psychiatry 168, 6572.
Baumann, PS, Crespi, S, Marion-Veyron, R, Solida, A, Thonney, J, Favrod, J, Bonsack, C, Do, KQ, Conus, P (2013). Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne): implementation of an early intervention programme for psychosis in Switzerland. Early Intervention Psychiatry 7, 322328.
Bebbington, PE, Bhugra, D, Brugha, T, Singleton, N, Farrell, M, Jenkins, R, Lewis, G, Meltzer, H (2004). Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity. British Journal of Psychiatry 185, 220226.
Berry, K, Barrowclough, C, Wearden, A (2008). Attachment theory: a framework for understanding symptoms and interpersonal relationships in psychosis. Behaviour Research and Therapy 46, 12751282.
Bora, E, Eryavuz, A, Kayahan, B, Sungu, G, Veznedaroglu, B (2006). Social functioning, theory of mind and neurocognition in outpatients with schizophrenia; mental state decoding may be a better predictor of social functioning than mental state reasoning. Psychiatry Research 145, 95103.
Brill, N, Reichenberg, A, Weiser, M, Rabinowitz, J (2008). Validity of the premorbid adjustment scale. Schizophrenia Bulletin 34, 981983.
Cabungcal, JH, Steullet, P, Kraftsik, R, Cuenod, M, Do, KQ (2013 a). Early-life insults impair parvalbumin interneurons via oxidative stress: reversal by N-acetylcysteine. Biological Psychiatry 73, 574582.
Cabungcal, JH, Steullet, P, Morishita, H, Kraftsik, R, Cuenod, M, Hensch, TK, Do, KQ (2013 b). Perineuronal nets protect fast-spiking interneurons against oxidative stress. Proceedings of the National Academy of Sciences of the United States of America 110, 91309135.
Cannon-Spoor, HE, Potkin, SG, Wyatt, RJ (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470484.
Chandola, T, Jenkinson, C (2000). The new UK National Statistics Socio-Economic Classification (NS-SEC); investigating social class differences in self-reported health status. Journal of Public Health Medicine 22, 182190.
Chang, WC, Yee Man Tang, J, Lai Ming Hui, C, Hoi Yan Wong, G, Kit Wa Chan, S, Ho Ming Lee, E, Yu Hai Chen, E (2013). The relationship of early premorbid adjustment with negative symptoms and cognitive functions in first-episode schizophrenia: a prospective three-year follow-up study. Psychiatry Research 3, 353360.
Colvert, E, Rutter, M, Kreppner, J, Beckett, C, Castle, J, Groothues, C, Hawkins, A, Stevens, S, Sonuga-Barke, EJ (2008). Do theory of mind and executive function deficits underlie the adverse outcomes associated with profound early deprivation?: findings from the English and Romanian adoptees study. Journal of Abnormal Child Psychology 36, 10571068.
Conus, P, Bonsack, C (2004). Early intervention for the initial phase of psychotic disorders in Lausanne: what problems and what solutions? Revue Médicale de la Suisse Romande 124, 221224.
Conus, P, Cotton, S, Schimmelmann, BG, McGorry, PD, Lambert, M (2010). Pretreatment and outcome correlates of sexual and physical trauma in an epidemiological cohort of first-episode psychosis patients. Schizophrenia Bulletin 36, 11051114.
Cornblatt, BA, Carrion, RE, Addington, J, Seidman, L, Walker, EF, Cannon, TD, Cadenhead, KS, McGlashan, TH, Perkins, DO, Tsuang, MT, Woods, SW, Heinssen, R, Lencz, T (2012). Risk factors for psychosis: impaired social and role functioning. Schizophrenia Bulletin 38, 12471257.
Davidson, G, Shannon, C, Mulholland, C, Campbell, J (2009). A longitudinal study of the effects of childhood trauma on symptoms and functioning of people with severe mental health problems. Journal of Trauma Dissociation 10, 5768.
De Bellis, MD (2002). Developmental traumatology: a contributory mechanism for alcohol and substance use disorders. Psychoneuroendocrinology 27, 155170.
Do, KQ, Cabungcal, JH, Frank, A, Steullet, P, Cuenod, M (2009). Redox dysregulation, neurodevelopment, and schizophrenia. Current Opinion in Neurobiology 19, 220230.
Drake, RE, Osher, FC, Noordsy, DL, Hurlbut, SC, Teague, GB, Beaudett, MS (1990). Diagnosis of alcohol use disorders in schizophrenia. Schizophrenia Bulletin 16, 5767.
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, 19671978.
Freeman, D, Fowler, D (2009). Routes to psychotic symptoms: trauma, anxiety and psychosis-like experiences. Psychiatry Research 169, 107112.
Freeman, D, Gittins, M, Pugh, K, Antley, A, Slater, M, Dunn, G (2008). What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation. Psychological Medicine 38, 11211132.
Frith, CD, Corcoran, R (1996). Exploring ‘theory of mind’ in people with schizophrenia. Psychological Medicine 26, 521530.
Gordon, HW (2002). Early environmental stress and biological vulnerability to drug abuse. Psychoneuroendocrinology 27, 115126.
Green, MF, Kern, RS, Braff, DL, Mintz, J (2000). Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119136.
Howard, LM (1993). Allegations of abuse in psychotic patients. American Journal of Psychiatry 150, 839840.
Janssen, I, Krabbendam, L, Bak, M, Hanssen, M, Vollebergh, W, de Graaf, R, van Os, J (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica 109, 3845.
Jones, SH, Thornicroft, G, Coffey, M, Dunn, G (1995). A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry 166, 654659.
Jovanović, AA, GaSic, MJ, Ivković, M, Milovanović, S, Damjanović, A (2008). Reliability and validity of DSM-IV Axis V scales in a clinical sample of veterans with posttraumatic stress disorder. Psychiatria Danubina 20, 286300.
Keiley, MK, Howe, TR, Dodge, KA, Bates, JE, Petti, GS (2001). The timing of child physical maltreatment: a cross-domain growth analysis of impact on adolescent externalizing and internalizing problems. Development and Psychopathology 13, 891912.
Lysaker, PH, Buck, KD, LaRocco, VA (2007). Clinical and psychosocial significance of trauma history in the treatment of schizophrenia. Journal of Psychosocial Nursing and Mental Health Services 45, 4451.
Lysaker, PH, Erickson, MA, Buck, B, Buck, KD, Olesek, K, Grant, ML, Salvatore, G, Popolo, R, Dimaggio, G (2011 a). Metacognition and social function in schizophrenia: associations over a period of five months. Cognitive Neuropsychiatry 16, 241255.
Lysaker, PH, Gumley, A, Brune, M, Vanheule, S, Buck, KD, Dimaggio, G (2011 b). Deficits in the ability to recognize one's own affects and those of others: associations with neurocognition, symptoms and sexual trauma among persons with schizophrenia spectrum disorders. Consciousness and Cognition 20, 11831192.
Lysaker, PH, Meyer, PS, Evans, JD, Clements, CA, Marks, KA (2001). Childhood sexual trauma and psychosocial functioning in adults with schizophrenia. Psychiatric Services 52, 14851488.
Lysaker, PH, Nees, MA, Lancaster, RS, Davis, LW (2004). Vocational function among persons with schizophrenia with and without history of childhood sexual trauma. Journal of Traumatic Stress 17, 435438.
Lysaker, PH, Outcalt, SD, Ringer, JM (2010). Clinical and psychosocial significance of trauma history in schizophrenia spectrum disorders. Expert Review of Neurotherapeutics 10, 11431151.
MacBeth, A, Gumley, A (2008). Premorbid adjustment, symptom development and quality of life in first episode psychosis: a systematic review and critical reappraisal. Acta Psychiatrica Scandinavica 117, 8599.
Menezes, NM, Arenovich, T, Zipursky, RB (2006). A systematic review of longitudinal outcome studies of first-episode psychosis. Psychological Medicine 36, 13491362.
Monin, A, Baumann, PS, Griffa, A, Xin, L, Mekle, R, Fournier, M, Butticaz, C, Klaey, M, Cabungcal, JH, Steullet, P, Ferrari, C, Cuenod, M, Gruetter, R, Thiran, JP, Hagmann, P, Conus, P, Do, KQ (2014). Glutathione deficit impairs myelin maturation: relevance for white matter integrity in schizophrenia patients. Molecular Psychiatry Published online: 26 08 2014 . doi:10.1038/mp.2014.88.
Morgan, C, Fisher, H (2007). Environment and schizophrenia: environmental factors in schizophrenia: childhood trauma – a critical review. Schizophrenia Bulletin 33, 310.
Murphy, J, Shevlin, M, Adamson, G, Houston, JE (2013). From sexual abuse to psychosis: a pilot study exploring the social deafferentation hypothesis and the mediating role of avoidance. Psychosis: Psychological, Social and Integrative Approaches 5, 3647.
Neria, Y, Bromet, EJ, Sievers, S, Lavelle, J, Fochtmann, LJ (2002). Trauma exposure and posttraumatic stress disorder in psychosis: findings from a first-admission cohort. Journal of Consulting and Clinical Psychology 70, 246251.
Norman, RM, Malla, AK, Manchanda, R, Townsend, L (2005). Premorbid adjustment in first episode schizophrenia and schizoaffective disorders: a comparison of social and academic domains. Acta Psychiatrica Scandinavica 112, 3039.
Pinkham, AE, Penn, DL, Perkins, DO, Lieberman, J (2003). Implications for the neural basis of social cognition for the study of schizophrenia. American Journal of Psychiatry 160, 815824.
Read, J, Gumley, A (2008). Can attachment theory help explain the relationship between childhood adversity and psychosis? Attachment: New Directions in Psychotherapy and Relational Psychoanalysis 2, 135.
Read, J, van Os, J, Morrison, AP, Ross, CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica 112, 330350.
Ross, CA, Anderson, G, Clark, P (1994). Childhood abuse and the positive symptoms of schizophrenia. Hospital and Community Psychiatry 45, 489491.
Schenkel, LS, Spaulding, WD, DiLillo, D, Silverstein, SM (2005). Histories of childhood maltreatment in schizophrenia: relationships with premorbid functioning, symptomatology, and cognitive deficits. Schizophrenia Research 76, 273286.
Spauwen, J, Krabbendam, L, Lieb, R, Wittchen, HU, van Os, J (2006). Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness. British Journal of Psychiatry 188, 527533.
Stain, HJ, Bronnick, K, Hegelstad, WT, Joa, I, Johannessen, JO, Langeveld, J, Mawn, L, Larsen, TK (2013). Impact of interpersonal trauma on the social functioning of adults with first-episode psychosis. Schizophrenia Bulletin 40, 14911498.
Steullet, P, Cabungcal, JH, Kulak, A, Kraftsik, R, Chen, Y, Dalton, TP, Cuenod, M, Do, KQ (2010). Redox dysregulation affects the ventral but not dorsal hippocampus: impairment of parvalbumin neurons, gamma oscillations, and related behaviors. Journal of Neuroscience 30, 25472558.
Steullet, P, Cabungcal, JH, Monin, A, Dwir, D, O'Donnell, P, Cuenod, M, Do, KQ (2014). Redox dysregulation, neuroinflammation, and NMDA receptor hypofunction: a ‘central hub’ in schizophrenia pathophysiology? Schizophrenia Research Published online: 04 07 2014 . doi:http://dx.doi.org/10.1016/j.schres.2014.06.021.
Thornberry, TP, Ireland, TO, Smith, CA (2001). The importance of timing: the varying impact of childhood and adolescent maltreatment on multiple problem outcomes. Development and Psychopathology 13, 957979.
Ucok, A, Bikmaz, S (2007). The effects of childhood trauma in patients with first-episode schizophrenia. Acta Psychiatrica Scandinavica 116, 371377.
Ucok, A, Serbest, S, Kandemir, PE (2011). Remission after first-episode schizophrenia: results of a long-term follow-up. Psychiatry Research 189, 3337.
van der Vegt, EJ, van der Ende, J, Ferdinand, RF, Verhulst, FC, Tiemeier, H (2009). Early childhood adversities and trajectories of psychiatric problems in adoptees: evidence for long lasting effects. Journal of Abnormal Child Psychology 37, 239249.
Varese, F, Smeets, F, Drukker, M, Lieverse, R, Lataster, T, Viechtbauer, W, Read, J, van Os, J, Bentall, RP (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin 38, 661671.
Widom, CS, Czaja, SJ, Dutton, MA (2008). Childhood victimization and lifetime revictimization. Child Abuse and Neglect 32, 785796.
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, Francey, SM, Cosgrave, EM, Killackey, E, Stanford, C, Godfrey, K, Buckby, J (2005). Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States. Australian and New Zealand Journal of Psychiatry 39, 964971.
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