Association of childhood trauma with cognitive function in healthy adults: a pilot study

BACKGROUND: Animal and human studies suggest that stress experienced early in life has detrimental consequences on brain development, including brain regions involved in cognitive function. Cognitive changes are cardinal features of depression and posttraumatic stress disorder. Early-life trauma is a major risk factor for these disorders. Only few studies have measured the long-term consequences of childhood trauma on cognitive function in healthy adults. METHODS: In this pilot study, we investigated the relationship between childhood trauma exposure and cognitive function in 47 healthy adults, who were identified as part of a larger study from the general population in Wichita, KS. We used the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Wide-Range-Achievement-Test (WRAT-3) to examine cognitive function and individual achievement. Type and severity of childhood trauma was assessed by the Childhood Trauma Questionnaire (CTQ). Data were analyzed using multiple linear regression on CANTAB measures with primary predictors (CTQ scales) and potential confounders (age, sex, education, income). RESULTS: Specific CTQ scales were significantly associated with measures of cognitive function. Emotional abuse was associated with impaired spatial working memory performance. Physical neglect correlated with impaired spatial working memory and pattern recognition memory. Sexual abuse and physical neglect were negatively associated with WRAT-3 scores. However, the association did not reach the significance level of p < 0.01. CONCLUSIONS: Our results suggest that physical neglect and emotional abuse might be associated with memory deficits in adulthood, which in turn might pose a risk factor for the development of psychopathology

Re-examination of the Controversial Coexistence of Traumatic Brain Injury and Posttraumatic Stress Disorder: Misdiagnosis and Self-Report Measures

The coexistence of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) remains a controversial issue in the literature. To address this controversy, we focused primarily on the civilian-related literature of TBI and PTSD. Some investigators have argued that individuals who had been rendered unconscious or suffered amnesia due to a TBI are unable to develop PTSD because they would be unable to consciously experience the symptoms of fear, helplessness, and horror associated with the development of PTSD. Other investigators have reported that individuals who sustain TBI, regardless of its severity, can develop PTSD even in the context of prolonged unconsciousness. A careful review of the methodologies employed in these studies reveals that investigators who relied on clinical interviews of TBI patients to diagnose PTSD found little or no evidence of PTSD. In contrast, investigators who relied on PTSD questionnaires to diagnose PTSD found considerable evidence of PTSD. Further analysis revealed that many of the TBI patients who were initially diagnosed with PTSD according to self-report questionnaires did not meet the diagnostic criteria for PTSD upon completion of a clinical interview. In particular, patients with severe TBI were often misdiagnosed with PTSD. A number of investigators found that many of the severe TBI patients failed to follow the questionnaire instructions and erroneously endorsed PTSD symptoms because of their cognitive difficulties. Because PTSD questionnaires are not designed to discriminate between PTSD and TBI symptoms or determine whether a patient's responses are accurate or exaggerated, studies that rely on self-report questionnaires to evaluate PTSD in TBI patients are at risk of misdiagnosing PTSD. Further research should evaluate the degree to which misdiagnosis of PTSD occurs in individuals who have sustained mild TBI

Racial and Ethnic Diagnostic Patterns in Schizophrenia Spectrum Disorders

The literature on racial and ethnic diagnostic patterns (as these pertain to schizophrenia spectrum disorders) is reviewed in this chapter. The chapter begins with a review of the literature on the diagnostic patterns among racial and ethnic minorities in the USA and abroad, followed by a review of racial/ethnic differences in symptom severity, symptom expression, and prevalence rates. This is then followed by a review of the empirical literature that offers explanations about why differential diagnostic patterns are observed. This review explores the question of whether differential patterns are due to inherent differences between racial/ethnic groups or if clinician biases and/or decision-making processes are contributing to differential diagnostic practices. Finally, literature that points to cultural mistrust, paranoia, and other environmental factors (e.g., stress) as potential variables that may contribute to the differential diagnostic patterns among racial/ethnic groups is reviewed. These reviews suggest that Black patients are three to four times more likely to receive a schizophrenia spectrum diagnosis. Findings also suggest that racial/ethnic variations may exist on a symptom level, with greater differences observed among positive symptom profiles. This review suggests that unawareness of cultural differences in symptom expression, cultural mistrust, and environmental factors (e.g., low SES) may be related to greater likelihood of receiving a schizophrenia spectrum diagnosis but do not fully account for the diagnostic discrepancies observed among racial/ethnic groups. To better understand these relationships, we conclude with recommendations to improve diagnostic accuracy and cultural competence (e.g., greater reliance on the Cultural Formulation Interview) and suggestions for future research that may further clarify the racial/ethnic diagnostic conundrum (e.g., using analog research studies)