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Farooq S, Hattle M, Kingstone T, Ajnakina O, Dazzan P, Demjaha A, Murray RM, Di Forti M, Jones PB, Doody GA, Shiers D, Andrews G, Milner A, Nettis MA, Lawrence AJ, van der Windt DA, Riley RD. Development and initial evaluation of a clinical prediction model for risk of treatment resistance in first-episode psychosis: Schizophrenia Prediction of Resistance to Treatment (SPIRIT). Br J Psychiatry 2024:1-10. [PMID: 39101211 DOI: 10.1192/bjp.2024.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND A clinical tool to estimate the risk of treatment-resistant schizophrenia (TRS) in people with first-episode psychosis (FEP) would inform early detection of TRS and overcome the delay of up to 5 years in starting TRS medication. AIMS To develop and evaluate a model that could predict the risk of TRS in routine clinical practice. METHOD We used data from two UK-based FEP cohorts (GAP and AESOP-10) to develop and internally validate a prognostic model that supports identification of patients at high-risk of TRS soon after FEP diagnosis. Using sociodemographic and clinical predictors, a model for predicting risk of TRS was developed based on penalised logistic regression, with missing data handled using multiple imputation. Internal validation was undertaken via bootstrapping, obtaining optimism-adjusted estimates of the model's performance. Interviews and focus groups with clinicians were conducted to establish clinically relevant risk thresholds and understand the acceptability and perceived utility of the model. RESULTS We included seven factors in the prediction model that are predominantly assessed in clinical practice in patients with FEP. The model predicted treatment resistance among the 1081 patients with reasonable accuracy; the model's C-statistic was 0.727 (95% CI 0.723-0.732) prior to shrinkage and 0.687 after adjustment for optimism. Calibration was good (expected/observed ratio: 0.999; calibration-in-the-large: 0.000584) after adjustment for optimism. CONCLUSIONS We developed and internally validated a prediction model with reasonably good predictive metrics. Clinicians, patients and carers were involved in the development process. External validation of the tool is needed followed by co-design methodology to support implementation in early intervention services.
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Affiliation(s)
- Saeed Farooq
- School of Medicine, Keele University, Newcastle-under-Lyme, UK; National Institute for Health and Care Research (NIHR), UK; and St George's Hospital, Midlands Partnership University NHS Foundation Trust, Stafford, UK
| | - Miriam Hattle
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; and National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
| | - Tom Kingstone
- School of Medicine, Keele University, Newcastle-under-Lyme, UK; National Institute for Health and Care Research (NIHR), UK; and St George's Hospital, Midlands Partnership University NHS Foundation Trust, Stafford, UK
| | - Olesya Ajnakina
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; and Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Arsime Demjaha
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; and Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Gillian A Doody
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - David Shiers
- School of Medicine, Keele University, Newcastle-under-Lyme, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK; and University of Manchester, Manchester, UK
| | - Gabrielle Andrews
- St George's Hospital, Midlands Partnership University NHS Foundation Trust, Stafford, UK
| | - Abbie Milner
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; and National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
| | - Maria Antonietta Nettis
- South London and Maudsley NHS Foundation Trust, London, UK; and Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrew J Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Danielle A van der Windt
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; and National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
| | - Richard D Riley
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; and National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
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2
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Sideli L, Aas M, Quattrone D, La Barbera D, La Cascia C, Ferraro L, Alameda L, Velthorst E, Trotta G, Tripoli G, Schimmenti A, Fontana A, Gayer-Anderson C, Stilo S, Seminerio F, Sartorio C, Marrazzo G, Lasalvia A, Tosato S, Tarricone I, Berardi D, D'Andrea G, Arango C, Arrojo M, Bernardo M, Bobes J, Sanjuán J, Santos JL, Menezes PR, Del-Ben CM, Jongsma HE, Jones PB, Kirkbride JB, Llorca PM, Tortelli A, Pignon B, de Haan L, Selten JP, Van Os J, Rutten BP, Bentall R, Di Forti M, Murray RM, Morgan C, Fisher HL. The relationship between genetic liability, childhood maltreatment, and IQ: findings from the EU-GEI multicentric case-control study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1573-1580. [PMID: 37335320 PMCID: PMC10460355 DOI: 10.1007/s00127-023-02513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
This study investigated if the association between childhood maltreatment and cognition among psychosis patients and community controls was partially accounted for by genetic liability for psychosis. Patients with first-episode psychosis (N = 755) and unaffected controls (N = 1219) from the EU-GEI study were assessed for childhood maltreatment, intelligence quotient (IQ), family history of psychosis (FH), and polygenic risk score for schizophrenia (SZ-PRS). Controlling for FH and SZ-PRS did not attenuate the association between childhood maltreatment and IQ in cases or controls. Findings suggest that these expressions of genetic liability cannot account for the lower levels of cognition found among adults maltreated in childhood.
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Affiliation(s)
- Lucia Sideli
- Department of Human Science, LUMSA University, Piazza delle Vaschette, 101, 00193, Rome, Italy.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England.
- Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy.
| | - Monica Aas
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- NORMENT Centre for Psychosis Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- Department of Behavioural Sciences, OsloMet, Oslo Metropolitan University, Oslo, Norway
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Laura Ferraro
- Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
- Centro Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Seville, Spain
- Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, Departamento de Psiquiatria, Universidad de Sevilla, Seville, Spain
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Eva Velthorst
- Department of Research, Mental Health Service Organization 'GGZ Noord-Holland-Noord', Hoorn, The Netherlands
| | - Giulia Trotta
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
| | - Giada Tripoli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
- Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE - Kore University of Enna, Enna, Italy
| | - Andrea Fontana
- Department of Human Science, LUMSA University, Piazza delle Vaschette, 101, 00193, Rome, Italy
| | - Charlotte Gayer-Anderson
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Simona Stilo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
- Department of Mental Health and Addiction Services, ASP Crotone, Crotone, Italy
| | - Fabio Seminerio
- Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Crocettarachele Sartorio
- Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Giovanna Marrazzo
- Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Domenico Berardi
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Giuseppe D'Andrea
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, ISGM, CIBERSAM, Madrid, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques, August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, ISPA, INEUROPA, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain
| | - Julio Sanjuán
- Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental, Valencia, Spain
| | - Jose Luis Santos
- Department of Psychiatry, Hospital "Virgen de La Luz", Cuenca, Spain
| | | | | | - Hannah E Jongsma
- PsyLife Group, Division of Psychiatry, University College London, London, England
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Peter B Jones
- CAMEO Early Intervention Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, England
- EA 7280 Npsydo, Université Clermont Auvergne, Clermont-Ferrand, France
| | - James B Kirkbride
- PsyLife Group, Division of Psychiatry, University College London, London, England
| | | | - Andrea Tortelli
- Establissement Public de Santé, Maison Blanche, Paris, France
| | - Baptiste Pignon
- AP-HP, Groupe Hospitalier "Mondor", Pôle de Psychiatrie, Créteil, France
- Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France
- Fondation FondaMental, Créteil, France
| | - Lieuwe de Haan
- Early Psychosis Section, Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jean-Paul Selten
- Institute for Mental Health, GGZ Rivierduinen, Leiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim Van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department Psychiatry, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Bart P Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Richard Bentall
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT, UK
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
| | - Craig Morgan
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Helen L Fisher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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3
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Tonini E, Watkeys O, Quidé Y, Whitford TJ, Cairns MJ, Green MJ. Polygenic risk for schizophrenia as a moderator of associations between childhood trauma and schizotypy. Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110612. [PMID: 35961623 DOI: 10.1016/j.pnpbp.2022.110612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 10/15/2022]
Abstract
Recent evidence shows that genetic and environmental risk factors for psychotic disorders are associated with higher levels of schizotypy (or psychosis proneness) in the general population. However, little is known about how these risk factors interact. We specifically examined whether genetic loading for schizophrenia moderates the association between childhood trauma severity and schizotypy. Schizotypy was measured using the Schizotypal Personality Questionnaire (SPQ), and childhood trauma severity was measured with the Childhood Trauma Questionnaire (CTQ) among a total of 168 participants (comprising 51 healthy individuals, 56 diagnosed with schizophrenia, and 61 with bipolar disorder). Polygenic risk scores (PRS) for schizophrenia were calculated for all participants and examined as a potential moderator of associations between total scores on the CTQ and schizotypy total scores and dimensions (i.e., cognitive-perceptual, interpersonal, disorganised). Multiple linear regression models revealed associations between childhood trauma and all dimensions of schizotypy, but no associations between PRS and schizotypy. A significant interaction between PRS and childhood trauma was evident for the interpersonal and disorganised dimensions of schizotypy, as well as the total score, reflecting positive associations between childhood trauma severity and these two schizotypal dimensions, only for individuals with low or average PRS for schizophrenia. This suggests that trauma may be able to increase risk for psychosis independently of any genetic vulnerability. The present findings are consistent with the idea of several risk pathways for the development of psychotic disorders.
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Affiliation(s)
- Emiliana Tonini
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales (UNSW), Kensington, NSW, Australia; Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia
| | - Oliver Watkeys
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales (UNSW), Kensington, NSW, Australia; Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia
| | - Yann Quidé
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales (UNSW), Kensington, NSW, Australia; Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia; School of Psychology, University of New South Wales (UNSW), Kensington, NSW, Australia
| | - Thomas J Whitford
- School of Psychology, University of New South Wales (UNSW), Kensington, NSW, Australia
| | - Murray J Cairns
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Melissa J Green
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales (UNSW), Kensington, NSW, Australia; Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia.
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4
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Ajnakina O, Agbedjro D, Lally J, Forti MD, Trotta A, Mondelli V, Pariante C, Dazzan P, Gaughran F, Fisher HL, David A, Murray RM, Stahl D. Predicting onset of early- and late-treatment resistance in first-episode schizophrenia patients using advanced shrinkage statistical methods in a small sample. Psychiatry Res 2020; 294:113527. [PMID: 33126015 DOI: 10.1016/j.psychres.2020.113527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/18/2020] [Indexed: 01/09/2023]
Abstract
Evidence suggests there are two treatment-resistant schizophrenia subtypes (i.e. early treatment resistant (E-TR) and late-treatment resistant (L-TR)). We aimed to develop prediction models for estimating individual risk for these outcomes by employing advanced statistical shrinkage methods. 239 first-episode schizophrenia (FES) patients were followed-up for approximately 5 years after first presentation to psychiatric services; of these, n=56 (25.2%) were defined as E-TR and n=24 (12.6%) were defined as L-TR. Using known risk factors for poor schizophrenia outcomes, we developed prediction models for E-TR and L-TR using LASSO and RIDGE logistic regression models. Models' internal validation was performed employing Harrell's optimism-correction with repeated cross-validation; their predictive accuracy was assessed through discrimination and calibration. Both LASSO and RIDGE models had high discrimination, good calibration. While LASSO had moderate sensitivity for estimating an individual risk for E-TR and L-TR, sensitivity estimated for RIDGE model for these outcomes was extremely low, which was due to having a very large estimated optimism. Although it was possible to discriminate with sufficient accuracy who would meet criteria for E-TR and L-TR during the 5-year follow-up after first contact with mental health services for schizophrenia, further work is necessary to improve sensitivity for these models.
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Affiliation(s)
- Olesya Ajnakina
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
| | - Deborah Agbedjro
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Psychiatry, St Vincent's Hospital Fairview, Dublin, Ireland
| | - Marta Di Forti
- Social, Genetic, & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Antonella Trotta
- Social, Genetic, & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Tony Hillis Unit, South London and Maudsley NHS Foundation Trust, London United Kingdom
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Carmine Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London United Kingdom
| | - Helen L Fisher
- Social, Genetic, & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Anthony David
- Institute of Mental Health, University College London, London, United Kingdom
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - Daniel Stahl
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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5
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Murray RM, Mondelli V, Stilo SA, Trotta A, Sideli L, Ajnakina O, Ferraro L, Vassos E, Iyegbe C, Schoeler T, Bhattacharyya S, Marques TR, Dazzan P, Lopez-Morinigo J, Colizzi M, O'Connor J, Falcone MA, Quattrone D, Rodriguez V, Tripoli G, La Barbera D, La Cascia C, Alameda L, Trotta G, Morgan C, Gaughran F, David A, Di Forti M. The influence of risk factors on the onset and outcome of psychosis: What we learned from the GAP study. Schizophr Res 2020; 225:63-68. [PMID: 32037203 DOI: 10.1016/j.schres.2020.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 01/05/2023]
Abstract
The GAP multidisciplinary study carried out in South London, recruited 410 first episode of psychosis patients and 370 controls; the aim was to elucidate the multiple genetic and environmental factors influencing the onset and outcome of psychosis. The study demonstrated the risk increasing effect of adversity in childhood (especially parental loss, abuse, and bullying) on onset of psychosis especially positive symptoms. Adverse life events more proximal to onset, being from an ethnic minority, and cannabis use also played important roles; indeed, one quarter of new cases of psychosis could be attributed to use of high potency cannabis. The "jumping to conclusions" bias appeared to mediate the effect of lower IQ on vulnerability to psychosis. We confirmed that environmental factors operate on the background of polygenic risk, and that genetic and environment act together to push individuals over the threshold for manifesting the clinical disorder. The study demonstrated how biological pathways involved in the stress response (HPA axis and immune system) provide important mechanisms linking social risk factors to the development of psychotic symptoms. Further evidence implicating an immune/inflammatory component to psychosis came from our finding of complement dysregulation in FEP. Patients also showed an upregulation of the antimicrobial alpha-defensins, as well as differences in expression patterns of genes involved in NF-κB signaling and Cytokine Production. Being of African origin not only increased risk of onset but also of a more difficult course of illness. The malign effect of childhood adversity predicted a poorer outcome as did continued use of high potency cannabis.
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Affiliation(s)
- R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy.
| | - V Mondelli
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - S A Stilo
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Division of Psychology and Language Sciences, University College London, London, UK
| | - A Trotta
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - L Sideli
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - O Ajnakina
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - L Ferraro
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - E Vassos
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - C Iyegbe
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - T Schoeler
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - S Bhattacharyya
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - T R Marques
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - J Lopez-Morinigo
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Colizzi
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - J O'Connor
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Neuropsychology, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
| | - M A Falcone
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - D Quattrone
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - V Rodriguez
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - G Tripoli
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - D La Barbera
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - C La Cascia
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - L Alameda
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - G Trotta
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - C Morgan
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - F Gaughran
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - A David
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Institute of Mental Health, University College London, London, UK
| | - M Di Forti
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
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6
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Morgan C, Gayer-Anderson C, Beards S, Hubbard K, Mondelli V, Di Forti M, Murray RM, Pariante C, Dazzan P, Craig TJ, Reininghaus U, Fisher HL. Threat, hostility and violence in childhood and later psychotic disorder: population-based case-control study. Br J Psychiatry 2020; 217:575-582. [PMID: 32778182 PMCID: PMC7525109 DOI: 10.1192/bjp.2020.133] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND A growing body of research suggests that childhood adversities are associated with later psychosis, broadly defined. However, there remain several gaps and unanswered questions. Most studies are of low-level psychotic experiences and findings cannot necessarily be extrapolated to psychotic disorders. Further, few studies have examined the effects of more fine-grained dimensions of adversity such as type, timing and severity. AIMS Using detailed data from the Childhood Adversity and Psychosis (CAPsy) study, we sought to address these gaps and examine in detail associations between a range of childhood adversities and psychotic disorder. METHOD CAPsy is population-based first-episode psychosis case-control study in the UK. In a sample of 374 cases and 301 controls, we collected extensive data on childhood adversities, in particular household discord, various forms of abuse and bullying, and putative confounders, including family history of psychotic disorder, using validated, semi-structured instruments. RESULTS We found strong evidence that all forms of childhood adversity were associated with around a two- to fourfold increased odds of psychotic disorder and that exposure to multiple adversities was associated with a linear increase in odds. We further found that severe forms of adversity, i.e. involving threat, hostility and violence, were most strongly associated with increased odds of disorder. More tentatively, we found that some adversities (e.g. bullying, sexual abuse) were more strongly associated with psychotic disorder if first occurrence was in adolescence. CONCLUSIONS Our findings extend previous research on childhood adversity and suggest a degree of specificity for severe adversities involving threat, hostility and violence.
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Affiliation(s)
- Craig Morgan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London; and National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London; and Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, UK,Correspondence: Professor Craig Morgan.
| | - Charlotte Gayer-Anderson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London; and Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, UK
| | - Stephanie Beards
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Kathryn Hubbard
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Valeria Mondelli
- Institute of Psychiatry, Psychology & Neuroscience, King's College London; and National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, UK
| | - Marta Di Forti
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Robin M. Murray
- FRS, Institute of Psychiatry, Psychology & Neuroscience, King's College London; and National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, UK
| | - Carmine Pariante
- Institute of Psychiatry, Psychology & Neuroscience, King's College London; and National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, UK
| | - Paola Dazzan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London; and National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, UK
| | - Thomas J. Craig
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Ulrich Reininghaus
- Institute of Psychiatry, Psychology & Neuroscience, King's College London; and Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, UK
| | - Helen L. Fisher
- Institute of Psychiatry, Psychology & Neuroscience, King's College London; and Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, UK
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7
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Sideli L, Murray RM, Schimmenti A, Corso M, La Barbera D, Trotta A, Fisher HL. Childhood adversity and psychosis: a systematic review of bio-psycho-social mediators and moderators. Psychol Med 2020; 50:1761-1782. [PMID: 32624020 DOI: 10.1017/s0033291720002172] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The association between childhood adversity (CA) and psychosis has been extensively investigated in recent years. An increasing body of research has also focused on the mediating or moderating role of biological and psychological mechanisms, as well as other risk factors that might account for the link between CA and psychosis. We conducted a systematic search of the PsychINFO, Embase, Ovid, and Web of Science databases for original articles investigating the role of genetic vulnerabilities, environmental factors, psychological and psychopathological mechanisms in the association between CA and psychosis up to August 2019. We included studies with individuals at different stages of the psychosis continuum, from subclinical psychotic experiences to diagnosed disorders. From the 28 944 records identified, a total of 121 studies were included in this review. Only 26% of the studies identified met the criteria for methodological robustness. Overall, the current evidence suggests that CA may be associated with psychosis largely independently of genetic vulnerabilities. More consistent and robust evidence supports interaction between early and recent adversities, as well as the mediating role of attachment and mood symptoms, which is suggestive of an affective pathway between CA and psychosis across the continuum from subclinical experiences to diagnosable disorder. This review highlighted numerous methodological issues with the existing literature, including selection bias, heterogeneity of measurement instruments utilised, and lack of control for potential confounders. Future research should address these limitations to more accurately estimate mediation and moderation effects on the CA-psychosis association to inform the development of preventive interventions.
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Affiliation(s)
- Lucia Sideli
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Robin M Murray
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | | | - Mariangela Corso
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Antonella Trotta
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Tony Hillis Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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8
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Ayerbe L, Pérez-Piñar M, Foguet-Boreu Q, Ayis S. Psychosis in children of separated parents: A systematic review and meta-analysis. Eur Psychiatry 2020; 63:e3. [PMID: 32093793 PMCID: PMC7315852 DOI: 10.1192/j.eurpsy.2019.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Parental separation is a very common childhood adversity. The association between other adverse childhood experiences and an increased risk of psychosis has been reported. However, the evidence on the risk of psychosis for children of separated parents is limited. In this systematic review, cohort, case-control, and cross-sectional studies, comparing the risk of psychotic disorders for people with and without separated parents, were searched, critically appraised, and summarized. METHODS Studies were searched in PubMed, EMBASE, PsycINFO, and the Web of Science, from database inception to September 2019. A meta-analysis, using random-effects models, was undertaken to obtain pooled estimates of the risk of psychosis among participants with separated parents. RESULTS Twelve studies, with 305,652 participants from 22 countries, were included in the review. A significantly increased risk of psychosis for those with separated parents was observed, with a pooled odds ratio: 1.53 (95% confidence interval [CI]: 1.29-1.76), p < 0.001. The association remained significant when cohort, case-control, and cross-sectional studies were analyzed separately. The five cohort studies included in this review showed and increased risk of psychosis with odds ratio: 1.47 (95% CI: 1.26-1.69), p < 0.001. CONCLUSIONS Parental separation is a common childhood adversity associated with an increased risk of psychosis. Although the risk for an individual child of separated parents is still low, given the high proportion of couple that separate, the increased rates of psychosis may be substantial in the population. Further studies on the risk of psychosis in those with separated parents, and the explanatory factors for this association, are required.
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Affiliation(s)
- Luis Ayerbe
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Centre of Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
- Carnarvon Medical Centre, Southend-on-Sea, United Kingdom
| | | | - Quintí Foguet-Boreu
- Department of Psychiatry, Vic University Hospital, Vic, Spain
- Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Salma Ayis
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, South London at King’s College Hospital NHS Foundation Trust, London, United Kingdom
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9
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Söder E, Clamor A, Lincoln TM. Hair cortisol concentrations as an indicator of potential HPA axis hyperactivation in risk for psychosis. Schizophr Res 2019; 212:54-61. [PMID: 31455519 DOI: 10.1016/j.schres.2019.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 07/10/2019] [Accepted: 08/05/2019] [Indexed: 12/24/2022]
Abstract
A chronic hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis is assumed to be an important indicator of vulnerability for psychosis. Despite the considerable research on this topic, putative social origins of HPA axis hyperactivation have received little attention in the literature so far. Also, the inconsistency of previous findings calls for new and reliable methods in the assessment of HPA axis activation. To address these issues, we used hair cortisol concentrations as an indicator of chronic HPA axis activation in participants at elevated risk for psychosis (clinical risk: n = 43, familial risk: n = 32) and low-risk controls (n = 35), and assessed its relation with a variety of social stressors. We also tested the interaction effect between social stressors and familial risk status on hair cortisol concentrations (moderation analysis). Participants at elevated risk for psychosis did not show significantly higher hair cortisol concentrations than low-risk controls. However, severe social stressors (child abuse experiences, traumatic events) predicted hair cortisol concentrations in the total sample. This relationship was not significantly moderated by familial risk status (as a marker of genetic risk). The results challenge the assumption that HPA axis hyperactivation is an early vulnerability indicator for psychosis but leave the possibility that it manifests only at more severe risk stages. Furthermore, the findings suggest that acquired experiences contribute to the emergence of HPA axis hyperactivation, which might occur via a gene-environment correlation rather than via a gene-environment interaction.
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Affiliation(s)
- Eveline Söder
- Universität Hamburg, Clinical Psychology and Psychotherapy, Institute of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Annika Clamor
- Universität Hamburg, Clinical Psychology and Psychotherapy, Institute of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Tania M Lincoln
- Universität Hamburg, Clinical Psychology and Psychotherapy, Institute of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany
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10
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Lecei A, Decoster J, De Hert M, Derom C, Jacobs N, Menne-Lothmann C, van Os J, Thiery E, Rutten BPF, Wichers M, van Winkel R. Evidence that the association of childhood trauma with psychosis and related psychopathology is not explained by gene-environment correlation: A monozygotic twin differences approach. Schizophr Res 2019; 205:58-62. [PMID: 29793818 DOI: 10.1016/j.schres.2018.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/10/2018] [Accepted: 05/13/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Converging evidence supports childhood trauma as possible causal risk for psychosis and related psychopathology. However, studies have shown that baseline psychotic symptoms may actually increase risk for subsequent victimization, suggesting that exposure to CT is not random but may result from pre-existing vulnerability. Therefore, studies testing whether the association between CT and psychopathology persists when accounting for gene-environment correlation are much needed. METHODS A monozygotic (MZ) twin differences approach was used to examine whether differences in CT exposure among MZ twin pairs would be associated with MZ differences in symptoms. As MZ twins are genetically identical, within-pair correlations between CT exposure and psychopathology rule out the possibility that the association is solely attributable to gene-environment correlation. 266 monozygotic twins (133 pairs) from a larger general population study were available for analysis. RESULTS CT was associated with symptoms of psychosis (B = 0.62; SE = 0.08, p < .001) and overall psychopathology (B = 43.13; SE = 6.27; p < .001). There were measurable differences within pairs in CT exposure and symptoms, allowing for meaningful within-pair differences. Within-pair differences in CT exposure were associated with within-pair differences in symptoms of psychosis (B = 0.35; SE = 0.16; p = .024), as well as with overall psychopathology (B = 29.22; SE = 12.24; p = .018), anxiety (B = 0.65; SE = 0.21; p = .002) and depression (B = 0.37; SE = 0.18; p = .043). CONCLUSION While it is not unlikely that pre-existing vulnerability may increase the risk for traumatic exposures, such gene-environment correlation does not explain away the association between CT and psychopathology. The present findings thus suggest that at least part of the association between CT and psychopathology may be causal.
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Affiliation(s)
- Aleksandra Lecei
- KU Leuven, Dept. of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, Leuven, Belgium
| | | | - Marc De Hert
- KU Leuven, Dept. of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, Leuven, Belgium; UPC KU Leuven, Leuven, Belgium
| | - Catherine Derom
- Center of Human Genetics, University Hospital Leuven, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, Ghent University Hospitals, Ghent University, Ghent, Belgium
| | - Nele Jacobs
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, Netherlands; Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, Netherlands
| | - Claudia Menne-Lothmann
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom; Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Evert Thiery
- Department of Neurology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, Netherlands
| | - Ruud van Winkel
- KU Leuven, Dept. of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, Leuven, Belgium; UPC KU Leuven, Leuven, Belgium.
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11
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Trotta A, Iyegbe C, Yiend J, Dazzan P, David AS, Pariante C, Mondelli V, Colizzi M, Murray RM, Di Forti M, Fisher HL. Interaction between childhood adversity and functional polymorphisms in the dopamine pathway on first-episode psychosis. Schizophr Res 2019; 205:51-57. [PMID: 29653893 DOI: 10.1016/j.schres.2018.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/30/2018] [Accepted: 04/04/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is consistent evidence of a cumulative relationship between childhood adversity and psychosis, with number of adversities experienced increasing the probability of psychosis onset. It is possible that genetic factors moderate the association between childhood adversity and psychosis, potentially by influencing how an individual reacts biologically and/or psychologically following exposure to adversity, in such a way as to set them off on the path to psychosis. However, identifying the specific genetic variants involved and how they interact with childhood adversity remains challenging. We examined whether the association between cumulative exposure to childhood adversity and development of psychotic disorder was moderated by the COMT Val158Met, AKT1 rs2494732 or DRD2 rs1076560 polymorphisms, known to affect dopamine levels. METHODS Participants were 285 first-presentation psychosis cases and 256 geographically-matched controls drawn from the Genetics and Psychosis (GAP) study. Childhood adversity was assessed using the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and blood- and cheek-derived genotype data were collected. RESULTS Our findings revealed no main effect of COMT Val158Met, AKT1 rs2494732 and DRD2 rs1076560 polymorphisms on psychosis case status or reports of childhood adversity. Individuals reporting a history of multiple adversities were more likely to be psychosis patients than controls, regardless of their genetic risk. There was no evidence of candidate genotype by childhood adversity interactions in relation to psychosis onset. CONCLUSION These findings did not provide evidence of a possible role of COMT Val158Met, AKT1 rs2494732 or DRD2 rs1076560 genotypes in modifying the association between childhood adversity and onset of psychosis.
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Affiliation(s)
- Antonella Trotta
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Heather Close Rehabilitation Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Conrad Iyegbe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jenny Yiend
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Carmine Pariante
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Valeria Mondelli
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marco Colizzi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Marta Di Forti
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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12
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Ajnakina O, Trotta A, Forti MD, Stilo SA, Kolliakou A, Gardner-Sood P, Lopez-Morinigo J, Gaughran F, David AS, Dazzan P, Pariante C, Mondelli V, Murray RM, Fisher HL. Different types of childhood adversity and 5-year outcomes in a longitudinal cohort of first-episode psychosis patients. Psychiatry Res 2018; 269:199-206. [PMID: 30153597 DOI: 10.1016/j.psychres.2018.08.054] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 01/01/2023]
Abstract
Little is known about the impact of different forms of childhood adversity on outcomes in first-episode psychosis (FEP) patients beyond the first year of treatment. We investigated associations between different types of childhood adversity and outcomes of FEP patients over the 5 years following their first contact with mental health services for psychosis. 237 FEP cases aged 18-65 years were followed on average for 5 years after first presentation to psychiatric services in South London, UK. Childhood adversity prior to 17 years of age was assessed at baseline using the Childhood Experience of Care and Abuse Questionnaire (CECA.Q). The results showed that exposure to at least one type of childhood adversity was significantly associated with a lower likelihood of achieving symptomatic remission, longer inpatient stays, and compulsory admission over the 5-year follow-up. There was no evidence though of a dose-response effect. Some specificity was evident. Childhood parental separation was associated with significantly greater likelihood of non-compliance with antipsychotic medications, compulsory admission, and substance dependence. Institutional care was significantly associated with longer total length of inpatient stays; and parental death was significantly associated with compulsory admissions. Clinicians should screen FEP patients for childhood adversity and tailor interventions accordingly to improve outcomes.
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Affiliation(s)
- Olesya Ajnakina
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Antonella Trotta
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Marta Di Forti
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Simona A Stilo
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Anna Kolliakou
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Poonam Gardner-Sood
- Imaging Trials Unit, University College London and University College London Hospitals NIHR Biomedical Research Centre, London UK; Centre for Medical Imaging, University College London, Charles Bell House, London, UK
| | - Javier Lopez-Morinigo
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Fiona Gaughran
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, London, UK
| | - Anthony S David
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Paola Dazzan
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Carmine Pariante
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Valeria Mondelli
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Robin M Murray
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
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13
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Abstract
Schizophrenia and other types of psychosis incur suffering, high health care costs and loss of human potential, due to the combination of early onset and poor response to treatment. Our ability to prevent or cure psychosis depends on knowledge of causal mechanisms. Molecular genetic studies show that thousands of common and rare variants contribute to the genetic risk for psychosis. Epidemiological studies have identified many environmental factors associated with increased risk of psychosis. However, no single genetic or environmental factor is sufficient to cause psychosis on its own. The risk of developing psychosis increases with the accumulation of many genetic risk variants and exposures to multiple adverse environmental factors. Additionally, the impact of environmental exposures likely depends on genetic factors, through gene-environment interactions. Only a few specific gene-environment combinations that lead to increased risk of psychosis have been identified to date. An example of replicable gene-environment interaction is a common polymorphism in the AKT1 gene that makes its carriers sensitive to developing psychosis with regular cannabis use. A synthesis of results from twin studies, molecular genetics, and epidemiological research outlines the many genetic and environmental factors contributing to psychosis. The interplay between these factors needs to be considered to draw a complete picture of etiology. To reach a more complete explanation of psychosis that can inform preventive strategies, future research should focus on longitudinal assessments of multiple environmental exposures within large, genotyped cohorts beginning early in life.
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Affiliation(s)
- Alyson Zwicker
- Department of Pathology,Dalhousie University,Halifax,NS,Canada
| | | | - Rudolf Uher
- Department of Pathology,Dalhousie University,Halifax,NS,Canada
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14
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Kilian S, Burns JK, Seedat S, Asmal L, Chiliza B, Du Plessis S, Olivier MR, Kidd M, Emsley R. Factors Moderating the Relationship Between Childhood Trauma and Premorbid Adjustment in First-Episode Schizophrenia. PLoS One 2017; 12:e0170178. [PMID: 28107388 PMCID: PMC5249082 DOI: 10.1371/journal.pone.0170178] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/30/2016] [Indexed: 12/14/2022] Open
Abstract
Childhood trauma is a recognised risk factor for schizophrenia. It has been proposed that childhood trauma interferes with normal neurodevelopment, thereby establishing a biological vulnerability to schizophrenia. Poor premorbid adjustment is frequently a precursor to schizophrenia, and may be a manifestation of neurodevelopmental compromise. We investigated the relationship between childhood trauma and premorbid adjustment in 77 patients with first-episode schizophrenia spectrum disorders. We also investigated possible mediating roles for other selected risk factors in the relationship. We found several significant correlations between different trauma types and both social and academic premorbid adjustment from childhood to late adolescence. There were no significant moderating effects for family history of schizophrenia or family history of psychiatric disorder. History of obstetric complications, substance abuse and poor motor coordination weakened some of the associations between childhood trauma and premorbid adjustment, while poor sequencing of motor acts strengthened the association. Our results confirm previous studies indicating an association between childhood trauma and premorbid adjustment. Results indicate a general rather than specific association, apparent with different types of trauma, and affecting both social and academic components of premorbid adjustment across childhood, early and late adolescence. Further, our results suggest a complex interplay of various risk factors, supporting the notion of different pathways to psychosis.
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Affiliation(s)
- S. Kilian
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- * E-mail:
| | - J. K. Burns
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
- Institute for Health Research, University of Exeter, Exeter, United Kingdom
| | - S. Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - L. Asmal
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - B. Chiliza
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - S. Du Plessis
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - M. R. Olivier
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - M. Kidd
- Centre for Statistical Consultation, Stellenbosch University, Cape Town, South Africa
| | - R. Emsley
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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15
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Interplay between Schizophrenia Polygenic Risk Score and Childhood Adversity in First-Presentation Psychotic Disorder: A Pilot Study. PLoS One 2016; 11:e0163319. [PMID: 27648571 PMCID: PMC5029892 DOI: 10.1371/journal.pone.0163319] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022] Open
Abstract
A history of childhood adversity is associated with psychotic disorder, with an increase in risk according to number or severity of exposures. However, it is not known why only some exposed individuals go on to develop psychosis. One possibility is pre-existing genetic vulnerability. Research on gene-environment interaction in psychosis has primarily focused on candidate genes, although the genetic effects are now known to be polygenic. This pilot study investigated whether the effect of childhood adversity on psychosis is moderated by the polygenic risk score for schizophrenia (PRS). Data were utilised from the Genes and Psychosis (GAP) study set in South London, UK. The GAP sample comprises 285 first-presentation psychosis cases and 256 unaffected controls with information on childhood adversity. We studied only white subjects (80 cases and 110 controls) with PRS data, as the PRS has limited predictive ability in patients of African ancestry. The occurrence of childhood adversity was assessed with the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and the PRS was based on genome-wide meta-analysis results for schizophrenia from the Psychiatric Genomics Consortium. Higher schizophrenia PRS and childhood adversities each predicted psychosis status. Nevertheless, no evidence was found for interaction as departure from additivity, indicating that the effect of polygenic risk scores on psychosis was not increased in the presence of a history of childhood adversity. These findings are compatible with a multifactorial threshold model in which both genetic liability and exposure to environmental risk contribute independently to the etiology of psychosis.
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16
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Hardy A, Emsley R, Freeman D, Bebbington P, Garety PA, Kuipers EE, Dunn G, Fowler D. Psychological Mechanisms Mediating Effects Between Trauma and Psychotic Symptoms: The Role of Affect Regulation, Intrusive Trauma Memory, Beliefs, and Depression. Schizophr Bull 2016; 42 Suppl 1:S34-43. [PMID: 27460616 PMCID: PMC4960432 DOI: 10.1093/schbul/sbv175] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Evidence suggests a causal role for trauma in psychosis, particularly for childhood victimization. However, the establishment of underlying trauma-related mechanisms would strengthen the causal argument. In a sample of people with relapsing psychosis (n = 228), we tested hypothesized mechanisms specifically related to impaired affect regulation, intrusive trauma memory, beliefs, and depression. The majority of participants (74.1%) reported victimization trauma, and a fifth (21.5%) met symptomatic criteria for Posttraumatic Stress Disorder. We found a specific link between childhood sexual abuse and auditory hallucinations (adjusted OR = 2.21, SE = 0.74, P = .018). This relationship was mediated by posttraumatic avoidance and numbing (OR = 1.48, SE = 0.19, P = .038) and hyperarousal (OR = 1.44, SE = 0.18, P = .045), but not intrusive trauma memory, negative beliefs or depression. In contrast, childhood emotional abuse was specifically associated with delusions, both persecutory (adjusted OR = 2.21, SE = 0.68, P = .009) and referential (adjusted OR = 2.43, SE = 0.74, P = .004). The link with persecutory delusions was mediated by negative-other beliefs (OR = 1.36, SE = 0.14, P = .024), but not posttraumatic stress symptoms, negative-self beliefs, or depression. There was no evidence of mediation for referential delusions. No relationships were identified between childhood physical abuse and psychosis. The findings underline the role of cognitive-affective processes in the relationship between trauma and symptoms, and the importance of assessing and treating victimization and its psychological consequences in people with psychosis.
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Affiliation(s)
- Amy Hardy
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
| | - Richard Emsley
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Paul Bebbington
- UCL Mental Health Sciences Unit, University College London, London, UK
| | - Philippa A. Garety
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Elizabeth E. Kuipers
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
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17
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Morgan C, Gayer‐Anderson C. Childhood adversities and psychosis: evidence, challenges, implications. World Psychiatry 2016; 15:93-102. [PMID: 27265690 PMCID: PMC4911761 DOI: 10.1002/wps.20330] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
There is a substantial body of research reporting evidence of associations between various forms of childhood adversity and psychosis, across the spectrum from experiences to disorder. This has been extended, more recently, to include studies of cumulative effects, of interactions with other factors, of specific effects, and of putative biological and psychological mechanisms. In this paper we evaluate this research and highlight the remaining methodological issues and gaps that temper, but do not dismiss, conclusions about the causal role of childhood adversity. We also consider the emerging work on cumulative, synergistic, and specific effects and on mechanisms; and discuss the broader implications of this line of research for our understanding of psychosis. We conclude that the current balance of evidence is that childhood adversities - particularly exposure to multiple adversities involving hostility and threat - do, in some people, contribute to the onset of psychotic experiences and psychotic disorders.
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Affiliation(s)
- Craig Morgan
- Society and Mental Health Research Group, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College LondonLondonUK
| | - Charlotte Gayer‐Anderson
- Society and Mental Health Research Group, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College LondonLondonUK
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18
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Trotta A, Murray RM, David AS, Kolliakou A, O’Connor J, Di Forti M, Dazzan P, Mondelli V, Morgan C, Fisher HL. Impact of Different Childhood Adversities on 1-Year Outcomes of Psychotic Disorder in the Genetics and Psychosis Study. Schizophr Bull 2016; 42:464-75. [PMID: 26373540 PMCID: PMC4753600 DOI: 10.1093/schbul/sbv131] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
While the role of childhood adversity in increasing the risk of psychosis has been extensively investigated, it is not clear what the impact of early adverse experiences is on the outcomes of psychotic disorders. Therefore, we investigated associations between childhood adversity and 1-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. Seventy-one percent of patients reported exposure to at least 1 type of childhood adversity (physical abuse, sexual abuse, parental separation, parental death, disrupted family arrangements, or being taken into care). No robust associations were found between childhood adversity and illness course or remission. However, childhood physical abuse was associated with almost 3-fold increased odds of not being in a relationship at 1-year follow-up compared to patients who did not report such adverse experiences. There was also evidence of a significant association between parental separation in childhood and longer admissions to psychiatric wards during 1-year follow-up and 2-fold increased odds of noncompliance with medication compared to those not separated from their parents. Therefore, our findings suggest that there may be some specificity in the impact of childhood adversity on service use and social functioning among psychosis patients over the first year following presentation to mental health services.
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Affiliation(s)
- Antonella Trotta
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Anthony S. David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Anna Kolliakou
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Jennifer O’Connor
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Marta Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK;,MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Craig Morgan
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Helen L. Fisher
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK;,*To whom correspondence should be addressed; MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 16 De Crespigny Park, London SE5 8AF, UK; tel: +44 (0)207-848-5430, fax: +44 (0)207-848-0866, e-mail:
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19
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Ajnakina O, Trotta A, Oakley-Hannibal E, Di Forti M, Stilo SA, Kolliakou A, Gardner-Sood P, Gaughran F, David AS, Dazzan P, Pariante C, Mondelli V, Morgan C, Vassos E, Murray RM, Fisher HL. Impact of childhood adversities on specific symptom dimensions in first-episode psychosis. Psychol Med 2016; 46:317-326. [PMID: 26383785 DOI: 10.1017/s0033291715001816] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The relationship between childhood adversity (CA) and psychotic disorder is well documented. As the adequacy of the current categorical diagnosis of psychosis is being increasingly questioned, we explored independent associations between different types of CA and specific psychotic symptom dimensions in a well-characterized sample of first-episode psychosis (FEP) patients. METHOD This study involved 236 FEP cases aged 18-65 years who presented for the first time to psychiatric services in South London, UK. Psychopathology was assessed with the Positive and Negative Syndrome Scale and confirmatory factor analysis was used to evaluate the statistical fit of the Wallwork/Fortgang five-factor model of psychosis. CA prior to 17 years of age (physical abuse, sexual abuse, parental separation, parental death, and being taken into care) was retrospectively assessed using the Childhood Experience of Care and Abuse Questionnaire. RESULTS Childhood sexual abuse [β = 0.96, 95% confidence interval (CI) 0.40-1.52], childhood physical abuse (β = 0.48, 95% CI 0.03-0.93) and parental separation (β = 0.60, 95% CI 0.10-1.11) showed significant associations with the positive dimension; while being taken into care was associated with the excited dimension (β = 0.36, 95% CI 0.08-0.65), independent of the other types of CA. No significant associations were found between parental death and any of the symptom dimensions. CONCLUSIONS A degree of specificity was found in the relationships between different types of CA and psychosis symptom dimensions in adulthood, suggesting that distinct pathways may be involved in the CA-psychosis association. These potentially different routes to developing psychosis merit further empirical and theoretical exploration.
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Affiliation(s)
- O Ajnakina
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - A Trotta
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - E Oakley-Hannibal
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - M Di Forti
- MRC Social, Genetic & Developmental Psychiatry Centre,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - S A Stilo
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - A Kolliakou
- Department of Psychological Medicine,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - P Gardner-Sood
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - F Gaughran
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - A S David
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - P Dazzan
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - C Pariante
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London,London,UK
| | - V Mondelli
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London,London,UK
| | - C Morgan
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London,London,UK
| | - E Vassos
- MRC Social, Genetic & Developmental Psychiatry Centre,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - R M Murray
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - H L Fisher
- MRC Social, Genetic & Developmental Psychiatry Centre,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
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20
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Bhui K, Malhi GS, Kaufman KR. Open Sesame: a new generation journal. BJPsych Open 2015; 1:e1-e2. [PMID: 27703732 PMCID: PMC5000493 DOI: 10.1192/bjpo.bp.115.001263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/17/2015] [Indexed: 11/23/2022] Open
Abstract
SUMMARY The Royal College of Psychiatrists welcomes you to its newest peer-reviewed research journal, British Journal of Psychiatry Open (BJPsych Open), which has been created to maximise the College's efforts to publish and disseminate the most exciting and progressive research in psychiatry and allied disciplines. BJPsych Open will maintain the same high quality standards established by the British Journal of Psychiatry (BJPsych). As an online journal without print restrictions, BJPsych Open will be able to publish many more excellent articles and article types not currently accommodated within BJPsych. The breadth of BJPsych Open is outlined in 'What we publish' and its strength is realised in our first issue, 'Powerful papers'. As editors, we welcome both your submissions and comments as our new generation journal grows. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Kamaldeep Bhui
- , Editor in Chief, Professor of Cultural Psychiatry and Epidemiology at Queen Mary University of London, Honorary Consultant Psychiatrist, East London Foundation Trust, London, UK
| | - Gin S Malhi
- , Deputy Editor, Chair of Psychiatry, University of Sydney, Australia
| | - Kenneth R Kaufman
- , Deputy Editor, Professor of Psychiatry, Neurology and Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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