Childhood trauma in schizophrenia spectrum disorders as compared to substance abuse disorders

Association between rumination and drug craving in Chinese male methamphetamine use disorder patients with childhood trauma

BACKGROUND

In China, males make up the majority of methamphetamine (MA) dependent individuals and the majority of treatment seekers. Childhood trauma (CT) and rumination are associated with an increased risk of MA use. However, the association between CT, rumination, and drug craving remains largely unknown.

OBJECTIVE

The present study aims to explore the association between rumination and drug craving in methamphetamine use disorder (MAUD) patients with CT.

PARTICIPANTS AND SETTING

This study recruited 404 male participants with MAUD from a male drug rehabilitation center in Southwest China.

METHODS

Patients with CT were identified by the short form of Childhood Trauma Questionnaire (CTQ-SF). Rumination and drug craving were assessed by the Ruminative Responses Scale (RRS) and the Obsessive Compulsive Drug Use Scale (OCDUS), respectively.

RESULTS

188 patients (46.5 %) experienced CT. Patients who had experienced CT showed significantly higher RRS symptom rumination score and OCDUS total score than those who had not. In patients with CT, RRS total and all subscale scores were positively associated with OCDUS interference of drug. Furthermore, the RRS brooding (β = 0.34, p < 0.001) and total scores (β = 0.38, p < 0.001) were determined to be separate contributors to the OCDUS total score in patients with CT.

CONCLUSIONS

Our study suggests that CT is common in male MAUD patients, and those who have suffered CT may exhibit higher levels of rumination and drug craving. Moreover, CT may play an influential role in the association between rumination and drug craving in patients with MAUD.

Prevalence and correlates of suicide attempts in high-risk populations: a cross-sectional study among patients receiving opioid agonist therapy in Norway

BACKGROUND

Death by suicide in patients enrolled in opioid agonist therapy (OAT) is a major clinical concern. However, little knowledge exists regarding suicide attempts in this patient group. This study presents the lifetime prevalence of suicide attempts and the associations between suicide attempts and clinical and sociodemographic variables such as education, sex, early onset of substance use (< 13 years of age), substance use patterns, and injecting substance use among patients receiving OAT.

METHODS

We used data from a cohort of OAT patients in Norway obtained from a health assessment of self-reported suicide attempts and sociodemographic and clinical factors. A total of 595 patients receiving OAT were assessed from 2016 to 2020. A binary logistic regression analysis was performed and reported with an unadjusted odds ratio and 95% confidence intervals (OR). The purpose of this assessment was to analyze associations between suicide attempts and substance use patterns as well as the injection of substances during the 30 days leading up to the health assessment. A negative binomial regression analysis with an incidence rate ratio and 95% confidence intervals (IRR) was performed to investigate sex, education, early onset of substance use, and the number of suicide attempts.

RESULTS

Forty-one percent of the OAT patients had attempted to die by suicide at least once during their lifetime. An early onset of substance use was strongly associated with the suicide attempts (IRR: 1.7, 1.3-2.2). No significant association was found between suicide attempts and sex (IRR: 1.2, 0.9-1.6) or education (IRR: 0.6, 0.2-2.1). Likewise, no association was identified between suicide attempts and injecting substance use (OR: 0.9, 0.6-1.3), nor using alcohol (OR: 0.9, 0.7-1.3), amphetamines (OR: 1.0, 0.7-1.3), benzodiazepines (OR: 1.0, 0.7-1.4), cannabis (OR: 1.2, 0.9-1.7), cocaine (OR: 1.3, 0.6-3.0), or opioids (OR: 1.4, 0.9-2.0).

CONCLUSION

The lifetime prevalence of suicide attempts was alarmingly high in the OAT population. An early onset of substance use seemed to be an important risk factor for suicide attempts. There was a non-significant association to more current use of opioids among OAT patients with previous suicide attempts.

Dropout Rates in Psychosocial Interventions for People With Both Severe Mental Illness and Substance Misuse: A Systematic Review and Meta-Analysis

INTRODUCTION

Over the years, many psychosocial interventions for individual having both a psychotic spectrum disorder and a substance use disorder diagnoses have been developed and studied. However, there is a high dropout rate among this clinical population.

OBJECTIVES

This meta-analysis aims to replicate a previous meta-analysis on the effects of psychosocial treatment for dual disorders, while including and determining the dropout rates in those type of interventions.

METHOD

Based on a Cochrane systematic review conducted in 2019, we conducted a meta-analysis including 40 randomized clinical trials on psychosocial treatment among persons suffering from schizophrenia spectrum disorder and substance use disorder.

RESULTS

A dropout rate of 27,2% was obtained. Stimulants use significantly affected dropout rates. Age, gender, diagnosis, alcohol and cannabis abuse, and duration of treatment did not affect dropout rates.

CONCLUSION

The 27,2% rate of dropout from psychosocial treatment highlights the need to engage participants having a dual diagnosis from the start by focusing on therapeutic alliance and motivation for treatment.

Linking childhood emotional neglect to adolescents' parent-related loneliness: Self-other differentiation and emotional detachment from parents as mediators

BACKGROUND

The detrimental role of childhood emotional neglect (CEN) on long-term affective and social development has received increasing attention in the literature. Individuals who were emotionally neglected during their childhood are more prone to feeling isolated and excluded by their parent during adolescence. However, little is known about the mediating processes underlying this association.

OBJECTIVE

This study investigated whether self-other differentiation (SOD) and emotional detachment from parents mediate the link between CEN and parent-related loneliness.

METHOD AND PARTICIPANTS

A sample of 535 high school students aged 13-18 years (63.6% female; M_age = 16.21; SD = 1.40) completed questionnaires regarding demographics, CEN, SOD, emotional detachment, and parent-related loneliness.

RESULTS

After controlling for demographic covariates, structural equation modeling (SEM) showed that (a) CEN was positively associated with parent-related loneliness (β = 0.64, p < .001), (b) SOD did not mediate the relationship between CEN and parent-related loneliness (β = -0.01, p = .142), (c) emotional detachment partially mediated the relationship between CEN and parent-related loneliness (β = 0.16, p < .001), and (d) SOD and emotional detachment partially and sequentially mediated the link between CEN and parent-related loneliness, albeit with a small effect size (β = 0.02, p = .027).

CONCLUSIONS

The findings underscore the significance of the link between CEN and parent-related loneliness in adolescence. Moreover, our results suggest that some adolescents with a history of CEN have difficulties in establishing clear boundaries between "self" and "other" and tend to engage in emotionally detached relationships with their parents, which may lead them to feel more parent-related loneliness. Clinical implications and directions for future research are discussed.

Childhood physical abuse and subsequent violent victimization among people who use illegal drugs in Vancouver, Canada

Background

Violent victimization is common among people who use illegal drugs (PWUD) and is a source of significant health-related harm. However, little attention has been paid to how antecedent childhood trauma among PWUD may contribute to the risk of victimization in adulthood.

Objective

This study sought to examine the relationship between childhood physical abuse and victimization by physical assault among adult PWUD.

Participants and setting

Data were derived from three prospective cohorts of PWUD in Vancouver, Canada between 2005 and 2018.

Methods

Childhood physical abuse was assessed using the Childhood Trauma Questionnaire. Generalized linear mixed modeling was used to estimate the relationship between childhood physical abuse and subsequent violent victimization, after adjustment for potential confounders.

Results

Among 2960 PWUD, including 1018 (34.39%) female participants, 1030 (34.8%) participants reported a history of moderate to severe childhood physical abuse, and 949 (32.06%) participants reported recent violent victimization at baseline. In a multivariate analysis, childhood physical abuse (Adjusted Odds Ratio [AOR] = 1.34, 95% confidence interval [CI]: 1.23–1.46) remained independently associated with violent victimization after adjustment for potential confounders.

Conclusions

This study found a high prevalence of childhood physical abuse and that this was associated with a higher risk of subsequent violent victimization among PWUD in this setting. Greater support for PWUD with a history of childhood physical abuse is needed to decrease existing vulnerability to violence, including screening for and treatment of childhood trauma and related violence prevention.

Childhood emotional abuse and problematic social networking sites use in a sample of Italian adolescents: The mediating role of deficiencies in self-other differentiation and uncertain reflective functioning

OBJECTIVE

Childhood emotional abuse (CEA) is associated with various negative mental health outcomes. This study aimed to investigate the association between CEA and problematic social networking site (SNS) use in a sample of Italian adolescents.

DESIGN

Using structural equation modeling, the study examined whether the relationship between CEA and problematic SNS use was sequentially mediated by self-other differentiation and uncertain reflective functioning in 1308 Italian adolescents (628 males, age range 13-19 years).

RESULTS

A history of CEA was positively associated with problematic SNS use. Furthermore, deficiencies in self-other differentiation and uncertain reflective functioning partially mediated the relationship between CEA and problematic SNS use.

CONCLUSIONS

The present study provides additional insight into the psychological dynamics underpinning problematic SNS use among adolescents. The clinical implications of these findings are discussed.

Childhood Maltreatment in Individuals With Schizophrenia Spectrum Disorders: The Impact of Cut-Off Scores on Prevalence Rates

Childhood maltreatment is a common phenomenon in various psychiatric disorders. Accordingly, patients with disorders from the schizophrenia spectrum (SSD) appear to have high prevalence rates of childhood maltreatment. However, the interpretation and comparability of prevalence rates is impeded by methodological weaknesses and differences such as measures and thresholds used in previous studies. Therefore, we aimed to provide and compare systematically captured data on prevalence rates of all common types of childhood maltreatment in patients with SSD using a standardized and well-established questionnaire and the most frequently used thresholds. The sample consisted of 48 patients with a primary diagnosis of SSD. 58.3-77.1% of the sample experienced at least one type of childhood maltreatment. Prevalence rates for physical abuse, physical neglect, and emotional abuse were dependent on the thresholds used, while equal rates were found for emotional neglect and sexual abuse. Physical neglect (46-67%), and emotional abuse (44-48%) were most commonly reported, followed by emotional neglect (38%), physical abuse (25-38%), and sexual abuse (25%). Additionally, high levels of peer victimization were reported by SSD patients. It appears that childhood maltreatment is a common phenomenon in SSD, even though methodological details, especially cut-off scores, have a substantial impact on the prevalence rates that are determined. Therefore, the methodology of studies should be closely examined when drawing conclusions from presented prevalence rates.

Health-related quality of life of long-term patients receiving opioid agonist therapy: a nested prospective cohort study in Norway

Background

Opioid dependence carries the highest disease burden of all illicit drugs. Opioid agonist therapy (OAT) is an evidence-based medical intervention that reduces morbidity and mortality. There is limited knowledge on the health-related quality of life (HRQoL) of long-term patients in OAT. This study measures HRQoL and self-perceived health of long-term patients on OAT, compares the scores to a Norwegian reference population, and assesses changes in these scores at 1-year follow up.

Methods

We conducted a nested prospective cohort study among nine OAT outpatient clinics in Norway. 609 OAT patients were included, 245 (40%) followed-up one year later. Data on patient characteristics, HRQoL, and self-perceived health was collected. HRQoL was assessed with the EQ-5D-5L, which measures five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) on a five-point Likert scale (from “no problems” to “extreme problems”). An UK value set was applied to calculate index values (from 0 to 1) for the EQ-5D-5L and compare them to a Norwegian reference population. Self-perceived health was measured with EQ-VAS (from 0 to 100).

Results

Mean (standard deviation (SD)) EQ-5D-5L index value at baseline was 0.699 (0.250) and EQ-VAS 57 (22) compared to 0.848 (0.200) and 80(19) for the Norwegian reference population. There were large variations in EQ-5D-5L index values, where 43% had > 0.8 and 5% had < 0.2 at baseline. The lowest EQ-5D-5L index values were observed for female patients, age groups older than 40 years and for methadone users. At follow-up, improvements in HRQoL were observed across almost all dimensions and found significant for mobility and pain/discomfort. Mean (SD) overall index value and EQ-VAS at follow up were 0.729 (0.237) and 59 (22) respectively.

Conclusion

The average HRQoL and self-perceived health of OAT patients is significantly lower than that of the general population, and lower than what has been found among other severe somatic and psychiatric conditions. Around 34% had very good HRQoL, higher than average Norwegian values, and around 5% had extremely poor HRQoL.

Does childhood trauma influence cognitive functioning in schizophrenia? The association of childhood trauma and cognition in schizophrenia spectrum disorders

Childhood trauma (CT) is a risk factor for schizophrenia spectrum disorders (SSDs), and cognitive impairment is a core feature and a vulnerability marker of SSDs. Studies of the relationship between CT and cognitive impairment in SSDs are inconclusive. In addition, few studies have examined differential effects of CT subtypes, e.g. physical, sexual or emotional abuse/neglect, on cognitive functioning. The present study therefore aimed to examine the effects of CT and CT subtypes on cognitive impairment in SSD. Participants (n = 78) with SSDs completed a comprehensive neuropsychological test battery and the Childhood Trauma Questionnaire Short-Form (CTQ-SF). We compared global cognitive performance as well as scores in seven subdomains (verbal abilities, visuospatial abilities, learning, memory, attention/working memory, executive abilities and processing speed) between participants reporting no CT and those reporting CT experiences using independent samples t-tests as well as linear regression analyses to control for possible confounders. CT subtype physical neglect was associated with attention and working memory after controlling for positive and negative psychosis symptoms, years of education, antipsychotics, gender and age, and adjustment of multiple testing. Our results indicate that the observed heterogeneity in cognitive impairment in SSDs, especially attention/working memory abilities, may in part be associated with childhood physical neglect.

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Research on childhood trauma and cognitive impairment in SSDs is inconclusive

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Few studies investigated if CT subtypes (abuse and neglect) could explain the heterogeneity in cognitive impairment in SSDs

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CT subtype physical neglect was associated with impairment in attention/working memory abilities

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The observed heterogeneity in cognitive impairment in SSDs may in part be associated with CT subtypes

Childhood trauma and substance use underlying psychosis: a systematic review

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 in Persons With Schizophrenia and a History of Interpersonal Violence

BACKGROUND

Childhood trauma is a risk factor for psychosis as well for violent behavior and offending later in life. Childhood trauma comprises subdomains of abuse and neglect that may be differently related to later violence among patients with schizophrenia. The aim of this study was to map the subdomains of childhood trauma associated with violent offending in schizophrenia.

METHODS

Information on childhood trauma from predominantly male patients with a DSM-IV diagnosis of schizophrenia and a history of violent offending (interpersonal violence) (SCZ-V, n = 19), schizophrenia patients without a history of violence (SCZ-NV, n = 34), and healthy controls (HC, n = 66) was obtained with the Childhood Trauma Questionnaire (CTQ). Differences between groups in total maltreatment scores and the five subdomains including physical, emotional, and sexual abuse, as well as physical and emotional neglect were analyzed.

RESULTS

SCZ-V had the highest median CTQ scores for all sub-domains. SCZ-V reported significantly higher total CTQ scores than SCZ-NV and HC. SCZ-V had significantly higher scores than HC on all subdomains, and significantly higher than SCZ-NV on physical and emotional neglect. SCZ-NV had higher scores on all domains except sexual abuse compared to HC.

CONCLUSION

SCZ-V patients had higher exposure to childhood trauma than SCZ-NV, and both schizophrenia groups had higher exposure than HC. The results suggest that childhood physical and emotional neglect may be of specific importance to later violence in schizophrenia.

Associations between adverse childhood experiences and adversities later in life. Survey data from a high-risk Norwegian sample

BACKGROUND

A history of childhood abuse and neglect (CAN) is associated with exposure to later negative life events. CAN at an early age, multiple cooccurring exposures (cumulative events), and a high severity and frequency of exposure have potential detrimental long-term effects.

OBJECTIVE

The present study examines the relationship between the severity of CAN and the prevalence of school difficulties and hardship at school, adult adversity and mental health.

PARTICIPANTS AND SETTINGS

Participants were recruited from in- and outpatient mental health or substance abuse treatment facilities, child protective services (CPS), and prisons (N = 809, age range = 13-66, mean age = 27.62, SD = 10.47).

METHODS

Exposure to childhood maltreatment was assessed by the Childhood Trauma Questionnaire Short Form (CTQ-SF). After adjusting for gender and age, we conducted a risk ratio regression analysis to investigate associations between severity of child abuse and neglect and hardship at school, adult adversity and adult mental health.

RESULTS

The moderate and severe level groups of CAN had statistically significant higher risk ratios for experiences of school difficulties, hardship at school, adult adversity and mental health problems. A robust dose-response was found between severity levels.

CONCLUSION

At an individual level the findings highlight the association between exposure to abuse and adult adversity, underscoring the importance of targeting individuals with high risk of exposure to CAN to reduce the negative long-term risk for Polyvictimization.

Childhood trauma and the likelihood of increased suicidal risk in schizophrenia

The aims of the present study were to investigate the dimensions of childhood trauma (CT) in patients with schizophrenia, and to predict suicidal risk (e.g., current suicidal ideation and lifetime suicide attempts) by CT dimensions and clinical factors (positive and negative symptoms and depression). Eighty-two inpatients with schizophrenia completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Beck Depression Inventory-II (BDI-II), and the Beck Scale for Suicide Ideation (BSSI); they were also administered the Positive and Negative Syndrome Scale (PANSS).The presence of lifetime suicide attempts was assessed by structured diagnostic clinical interview. Patients with lifetime suicide attempts scored higher on sexual abuse than those without attempts after controlling for depression severity. Patients with high suicidal risk had higher scores on physical neglect than those without high risk after controlling for depression severity. Patients with high CT had higher scores on negative and positive symptoms, current suicidal ideation, and depression than those with low CT. Logistic regression analyses indicated that sexual abuse was a unique predictor of lifetime suicide attempts, and that physical neglect and depression were unique predictors of current suicidal ideation. These findings indicate that patients with schizophrenia who have experienced CT may be at increased risk for suicide.

Early maladaptive schemas in patients with schizophrenia and non-patients with high and low schizotypal traits and their differences based on depression severity

BACKGROUND

The aims of this study were to predict positive and negative symptoms of psychosis via early maladaptive schemas (EMSs) in patients with schizophrenia (SZ); to compare EMSs among SZ patients, non-patients with high schizotypal traits, and non-patients with low schizotypal traits; and to compare EMSs among subgroups concerning depression severity.

METHODS

We applied three groups of participants including SZ patients (n = 105), non-patients with low schizotypal traits (n = 90), and non-patients with high schizotypal traits (n = 90). Participants completed the Young Schema Questionnaire-Short Form (YSQ-SF), the Positive and Negative Syndrome Scale (PANSS), the Schizotypal Personality Scale (STA), and the Beck Depression Inventory-II (BDI-II).

RESULTS

The results indicated that the mistrust/abuse and social isolation schemas were significant predictors of positive and negative symptoms in SZ patients respectively. SZ patients and non-patients with high schizotypal traits exceeded non-patients with low schizotypal traits on all EMSs. There were no differences between SZ patients and non-patients with high schizotypal traits regarding EMSs. In the subgroups with high depression, SZ patients showed higher levels of EMSs than non-patients with low and high schizotypal traits. In the subgroups with low depression, both SZ patients and non-patients with high schizotypal traits had higher scores on EMSs than non-patients with low schizotypal traits.

CONCLUSION

The findings suggest that mistrust/abuse and social isolation may be specific to psychosis symptoms. Also, SZ and schizotypal traits may overlap in relation to EMSs. In addition, the activated EMSs may contribute to high depression in SZ.

Parental style and Cloninger's model in psychosis

Parental style and Cloninger's dimensions are associated with psychosis, but it is still unclear whether temperament, character and parenting variables are linked to specific psychotic symptoms. This study extends previous research exploring these issues. 78 patients with psychosis and 156 control subjects were recruited. Parental style was evaluated using the Measure of Parental Style. Temperament and character were evaluated using the Temperament and Character Inventory-Revised. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale. T-tests, correlations and moderation and mediation analyses were performed. Patients reported dysfunctional parenting and had higher scores for harm avoidance (HA) and self transcendence (ST), and lower scores for self directedness (SD) and cooperativeness (CO) than controls. Maternal indifference, abuse and overcontrol were correlated with positive symptoms (PS). Novelty seeking (NS), reward dependence, SD, CO were correlated with PS; HA and ST were correlated with negative symptoms. After adjusting for age, gender and family history of psychopathology lower CO partially mediated the relationship between maternal abuse and PS; the positive NS-maternal abuse interaction was associated with PS. Different parenting and personality variables may be associated with different psychotic symptoms. NS and CO may be part of a pathway between maternal abuse and PS.