Friday, September 18, 2015

Study Finds No Association Between Childhood Adversity and Course of Psychotic Illness

There does not appear to be any significant association between a history of childhood adversity and the course of psychotic illness during the first year after presentation to mental health services, according to a report published online in Schizophrenia Bulletin. However, childhood adversity was associated with several outcomes that the authors of the study suggest could impact service use and social functioning among psychosis patients.

Researchers at King’s College London investigated associations between childhood adversity and one-year outcomes in 285 first-presentation psychosis patients. Exposure to childhood adversity prior to 17 years of age was assessed using the Childhood Experience of Care and Abuse Questionnaire. Data on illness course, symptom remission, length of psychiatric hospitalization, compliance with medication, employment, and relationship status were extracted from clinical records for the year following first contact with mental health services for psychosis.

A total of 71% of patients reported exposure to at least one type of childhood adversity (physical abuse, sexual abuse, parental separation, parental death, disrupted family arrangements, or being taken into care). Despite the high prevalence of childhood adversity in the sample of patients, the researchers found no evidence that a history of adversity impacted either remission from psychotic symptoms or global functioning scores at one-year follow-up. There was no robust evidence of a dose-response effect for exposure to multiple adverse experiences on clinical course of psychosis, symptomatic remission, or global clinical functioning over one-year follow-up.

Psychosis patients who reported a history of physical abuse were almost three times more likely to be single at follow-up compared with patients who did not report this type of adversity. Moreover, there was evidence of an association between parental separation in childhood and a longer admission to a psychiatric ward during one-year follow-up, with cases reporting such adversity being approximately twice as likely to have longer hospital stays compared with those without such a history. Evidence of a two-fold increased odds of noncompliance with medications was also found among those patients who reported childhood exposure to parental separation or disrupted family arrangements, though the latter association fell just short of statistical significance.

“Given the high prevalence of childhood adversities reported by first-presentation psychosis cases in this sample, routine assessment of adversity history and psychotherapies focused on adverse childhood experiences should be considered by services providing treatment to psychosis patients,” the researchers wrote.

For related information, see the Psychiatric News article “Link Found Between Childhood Infections, Later Psychosis.”

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