Adverse Childhood Experiences among Men with Schizophrenia

Adverse childhood experiences among people with schizophrenia at comprehensive specialized hospitals in Bahir Dar, Ethiopia: a comparative study

Background

People who have encountered adverse childhood experiences (ACEs) are predisposed to developing schizophrenia, experiencing exacerbated symptoms, and facing an elevated risk of disease relapse. It is imperative to evaluate the prevalence of ACEs to comprehend the specific attributes of this condition and enable the implementation of suitable interventions.

Aims

The aim of this study was to assess the prevalence of ACEs and its determinants among people with schizophrenia and the patient attendants in Bahir Dar, Ethiopia.

Method

A comparative cross-sectional study was carried out at the Comprehensive Specialized Hospitals in Bahir Dar, Ethiopia, from April 26 to June 10, 2023. A total of 291 individuals with schizophrenia and 293 individuals from the patient attendants were selected using a systematic random sampling method. A proportional odds model ordinal logistic regression analysis was used to identify the factors associated with ACEs.

Results

The occurrence of at least one ACE among individuals diagnosed with schizophrenia was 69.4%, while patient attendants had a 46.8%, as indicated by the Chi-square test, which showed a significant difference at p <0.05. The study findings indicated that individuals with schizophrenia who have encountered four or more ACEs are more inclined to have lower educational attainment (AOR: 4.69 [1.94 - 11.61]), low resilient coping mechanisms (AOR: 2.07 [1.11 - 3.90]), and poor social support (AOR: 3.93 [2.13 - 7.32]). Conversely, factors such as rural residency, illiteracy, and heightened attachment-related anxiety were found to be notably associated with the patient attendants.

Conclusion

In this study, the substantial prevalence of ACEs emphasized the necessity for ACE screening and the implementation of evidence-based interventions to address and alleviate the overall burden of ACEs.

The association between psychosocial stress, interpersonal sensitivity, social withdrawal and psychosis relapse: a systematic review

Psychosis is associated with a high risk of relapse, with 67% of clients relapsing within one year following a first episode. In light of the high personal, social, and healthcare costs of the illness, it is paramount to understand the risk factors associated with psychosis relapse. The current systematic review aims to critically review the role of psychosocial stress in psychosis relapse in individuals with an established psychotic disorder. This review systematically searched Ovid (PsycINFO, EMBASE, MEDLINE) literature databases from inception until 28th February 2022. Sixteen studies were eligible for inclusion. Most studies found that individuals with psychosis demonstrate high levels of psychosocial stress and are more likely to be socially withdrawn compared to healthy controls or other clinical presentations. Most studies reported a statistically significant association between psychosocial stress and psychosis relapse, as well as between social withdrawal and psychosis relapse. However, no studies examined the association between high levels of interpersonal sensitivity and psychosis relapse. Individuals with psychosis tend to experience high levels of psychosocial stress and social withdrawal, and these appear to increase the risk of psychosis relapse. Due to high levels of heterogeneity within the literature, we could only conduct a narrative synthesis of the findings. Future studies would benefit from employing a meta-analytic approach.

The Impact of ACEs on BMI: An Investigation of the Genotype-Environment Effects of BMI

Adverse Childhood Experiences are stressful and traumatic events occurring before the age of eighteen shown to cause mental and physical health problems, including increased risk of obesity. Obesity remains an ongoing national challenge with no predicted solution. We examine a subset of the Healthy Nevada Project, focusing on a multi-ethnic cohort of 15,886 sequenced participants with recalled adverse childhood events, to study how ACEs and their genotype-environment interactions affect BMI. Specifically, the Healthy Nevada Project participants sequenced by the Helix Exome+ platform were cross-referenced to their electronic medical records and social health determinants questionnaire to identify: 1) the effect of ACEs on BMI in the absence of genetics; 2) the effect of genotype-environment interactions on BMI; 3) how these gene-environment interactions differ from standard genetic associations of BMI. The study found very strong significant associations between the number of adverse childhood experiences and adult obesity. Additionally, we identified fifty-five common and rare variants that exhibited gene-interaction effects including three variants in the CAMK1D gene and four variants in LHPP; both genes are linked to schizophrenia. Surprisingly, none of the variants identified with interactive effects were in canonical obesity-related genes. Here we show the delicate balance between genes and environment, and how the two strongly influence each other.

Prevalence and clinical implication of adverse childhood experiences and their association with substance use disorder among patients with schizophrenia

Background

Adverse childhood experiences (ACEs) and substance use disorder (SUD) are well-known risk factors for psychosis and dramatically affect schizophrenia. In this research, we aimed to measure the prevalence of adverse childhood experiences and substance use disorder in patients with schizophrenia and assess the effect of ACEs on the clinical presentation and overall functioning and the association between them and SUD in patients with schizophrenia. A cross-sectional study included a random sample of 165 schizophrenic patients who were examined by doing drug screen in urine, structured questionnaire to collect Socioeconomic characteristics, history of schizophrenia, structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-fifth edition, Positive and Negative Syndrome Scale (PANSS), Adverse Childhood Experiences International Questionnaire (ACE-IQ), World Health Organization Disability Assessment Schedule 2.0, compliance rating scale, addiction severity index fifth edition (ASI) for individuals with positive urine drug screen.

Results

Only 14.4% of the studied patients had no adverse childhood experiences. The prevalence of positive substance abuse screening was 18.2%. There were statistically significant negative correlations between total ACE score and educational level, socioeconomic level, and the onset of schizophrenia. On the other hand, statistically significant positive correlations were found between the total ACE score and PANSS score and ASI score. The first most frequent ACE was significantly associated with female gender, lower education levels, low and middle socioeconomic classes, lifetime substance use, smokers, and positive drug screening. Emotional neglect and contact sexual abuse were significantly associated with positive drug screening. At the same time, Physical abuse was significantly associated with both lifetime substance use and positive drug screening.

Conclusion

The current study’s findings indicate that childhood adverse experiences and substance abuse are prevalent problems in patients with schizophrenia. Given that there is an association between both issues, they may affect the symptomatology of the disorder, the prognosis, and the therapeutic plan. It is advised that a greater emphasis on and identification of childhood trauma and drug use disorder may be a necessary step in assessing patients with schizophrenia.

Using phenome-wide association studies and the SF-12 quality of life metric to identify profound consequences of adverse childhood experiences on adult mental and physical health in a Northern Nevadan population

In this research, we examine and identify the implications of Adverse Childhood Experiences (ACEs) on a range of health outcomes, with particular focus on a number of mental health disorders. Many previous studies observed that traumatic childhood events are linked to long-term adult diseases using the standard Adverse Childhood Experience Questionnaire. The study cohort was derived from the Healthy Nevada Project, a volunteer-based population health study in which each adult participant is invited to take a retrospective questionnaire that includes the Adverse Childhood Experience Questionnaire, the 12-item Short Form Survey measuring quality of life, and self-reported incidence of nine mental disorders. Using participant's cross-referenced electronic health records, a phenome-wide association analysis of 1,703 phenotypes and the incidence of ACEs examined links between traumatic events in childhood and adult disease. These analyses showed that many mental disorders were significantly associated with ACEs in a dose-response manner. Similarly, a dose response between ACEs and obesity, chronic pain, migraine, and other physical phenotypes was identified. An examination of the prevalence of self-reported mental disorders and incidence of ACEs showed a positive relationship. Furthermore, participants with less adverse childhood events experienced a higher quality of life, both physically and mentally. The whole-phenotype approach confirms that ACEs are linked with many negative adult physical and mental health outcomes. With the nationwide prevalence of ACEs as high as 67%, these findings suggest a need for new public health resources: ACE-specific interventions and early childhood screenings.

The history of multiple adverse childhood experiences in patients with schizophrenia is associated with more severe symptomatology and suicidal behavior with gender-specific characteristics

The current study aims to compare the prevalence of adverse childhood experiences (ACEs) between patients with schizophrenia and non-psychiatric control group, and to analyze the association of having suffered multiple ACEs with clinical symptoms of schizophrenia and suicidal behavior. A multicenter, cross-sectional study was conducted across three facilities in Buenos Aires, Argentina. One-hundred patients with schizophrenia and 50 healthy subjects were assessed with the Adverse Childhood Experiences questionnaire (ACE-Q), the Positive and Negative Syndrome Scale (PANSS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). We observed that the prevalence of at least one ACE in schizophrenic patients was almost double in comparison with the non-psychiatric control group. Multiple ACEs were associated with persistent auditory hallucinations and lower negative symptoms in both sexes. Higher frequency of death ideation and a higher number of suicide attempts were reported among women. The strength of this study is the possibility of comparing the presence of ACEs between schizophrenic patients and non-psychiatric control using the same questionnaire in an under-reported sample of low socio-economic patients assisted in public hospitals. A limitation is that the history of ACEs relied on the retrospective assessment of childhood experiences, and adults could over-report ACEs because of recall bias.

Hard routes of mental health in Portugal: what can we offer to an adolescent with serious mental illness and multiple social risk factors?

Worldwide, millions of children and adolescents are suffering due to a lack of efficient mental healthcare. Although some progress has been made to address the mental health problems in this age group, currently, even developed countries fail in providing psychiatric patients with the best practice care. We present a case of a Portuguese adolescent with a first episode of psychosis in whom multiple social and environmental risk factors were identified as triggers to his clinical presentation, as well as fundamental determinants of prognosis in the short and long term. In this case, we demonstrate how social determinants, including poverty, family dysfunction and difficulties in accessing appropriate mental healthcare, strongly influence the development, maintenance and prognosis in early psychosis during adolescence. Furthermore, we consider the implications of an absence of community-based mental healthcare and rehabilitation services and reasons for why this may complicate the management and limit opportunities to this patient population.

Adverse Childhood Experiences are Associated with High-Intensity Binge Drinking Behavior in Adulthood and Mediated by Psychiatric Disorders

AIM

High-intensity binge drinking (HIBD), defined as two or more times the gender-specific binge threshold, is rapidly increasing in the USA; however, the underlying contributing factors are poorly understood. This study investigated the relationship of adverse childhood experiences (ACEs) and HIBD.

METHODS

Two independent, cross-sectional samples were analysed: (a) past 12-month drinkers in the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III; n = 25,552) and (b) the National Institute on Alcohol Abuse and Alcoholism (NIAAA) clinical sample (n = 1303). Multinomial logistic regressions were utilized to estimate adjusted odds ratios (AORs) of ACEs on HIBD. Mediation analysis was performed to examine the relationship between the past 12-month psychiatric disorders, ACEs, and HIBD.

RESULTS

In the NESARC-III sample, prevalence of ACEs increased across all binge levels with the highest prevalence in extreme HIBD; ACEs were associated with higher odds for HIBD (level II, odds ratio (OR) = 1.2-1.4; P = 0.03-0.001; level III, OR = 1.3-1.9; P < 0.001). Prevalence of DSM-5 diagnoses also increased across all binge levels. Substance use disorders (SUD), mood, personality and post-traumatic stress disorders (PTSD) conferred the highest odds with extreme HIBD (SUD: OR = 21.32; mood: 1.73; personality: 2.84; PTSD: 1.97; all Ps < 0.001). Mediation analyses showed that the association between ACEs and HIBD was fully mediated through SUD (proportion mediated: 70-90%) and partially through other psychiatric disorders (20-80%). In the NIAAA sample, ACEs were 2-5 times more prevalent in extreme HIBD with higher odds (ORs = 3-8, P < 0.001) compared with non-bingers.

CONCLUSION

ACEs were associated with significantly increased odds of HIBD and the relationship may be mediated by psychiatric disorders.

Attachment Style and Insight in Schizophrenia: a Cross-Sectional Study

Attachment theory provides a model for understanding impairments in social and interpersonal functioning. Schizophrenia is a neuropsychiatry disorder frequently associated with compromised social functioning and limited social support networks. However, the relationship between attachment style and psychopathology dimensions, including insight, isn't fully understood To determine whether there is a relationship between the attachment style and markers for severity of schizophrenia and insight. We conducted a cross-sectional study of 41 patients with schizophrenia and 34 patients with non-psychotic disorders used as a control group. Patients were assessed using semi-structured diagnostic interviews and self-reporting questionnaires, including Adult Attachment Scale-Revised. The schizophrenia group was also given the Positive and Negative Syndrome Scale and the Markova and Berrios Insight Scale. Insecure attachment was overrepresented in the schizophrenic group, and this difference was mainly accounted for lower levels of dependence, representing a moderate effect size (Cohen's d = 0.32). In the schizophrenia group, the closeness and the dependence subscale were negatively correlated with psychopathology severity. Using a multiple regression analysis, the insight was predicted by attachment anxiety, accounting for 20% of the total variance (R² = 0.199, p <0.05). Our data confirm previous evidence that insecure attachment is associated with schizophrenia and suggest that the less comfortable the patient is with closeness and intimacy the greater the severity of symptoms. Furthermore, our findings indicate that higher separation anxiety might predict a better insight.