Childhood adverseties and mental ill health: Studies on associations between reported childhood adverse and trauma experiences and adult perceived attitudes of others, mental disorders and suicidality

Several studies have indicated that childhood adversities and trauma (CAT) are not uncommon and that they are often associated with physical illnesses, mental problems and disturbed behaviour in adulthood. We have no standardised Finnish instrument for assessment of CAT, and our knowledge of the association between CAT and mental wellbeing is still sporadic. In particular, knowledge of specific associations of CAT with mental problems and gender differences is sparse. The aims of this study programme were to evaluate the feasibility of a new Finnish CAT instrument and the associations of CAT experiences with adult individuals’ perceived attitudes of other people, and the associations of CAT with suicidality and psychiatric disorders. The study samples comprise 692 adult individuals from the general population, 250 patients attending primary care, 160 patients attending psychiatric outpatient care, and 245 patients with clinical high risk (CHR) of psychosis. The three first samples were recruited from South-West Finland. The CHR sample was available from the European Prediction of Psychosis Study (EPOS). In each sample, CAT was assessed with the Trauma and Distress Scale (TADS) which was translated into Finnish. TADS and its five sub-scale domains indicated good psychometric properties in terms of internal consistency, content, inter-method reliability and concurrent validity for adults from a Finnish community sample. TADS appeared to be a useful instrument for the assessment of retrospectively reported childhood adversity and trauma in the general population and clinical samples. In the general population, nearly three fourths (72.3%) of individuals reported at least one and nearly a half (48.1%) two or more CAT experiences. In primary care, the corresponding figures were 76.9% and 57.7%, and in psychiatric outpatient care, 94.4% and 80.6%. Childhood adverse and trauma experiences in general and emotional neglect specifically associated with negative perceived attitude of others in adulthood. The effects of CAT experiences on adult perceived negative attitude of others seem to be stronger in males than in females. All CAT domains associated significantly with reported alcohol problems. In females, sexual abuse and physical abuse had a direct effect on alcohol problems, while in males the corresponding effects were mainly mediated via depressive mood. Emotional abuse and neglect and physical abuse associated most strongly with current mood and anxiety disorders. However, there were considerable inter¬correlations within the CAT domains, as well as comorbidity between clinical diagnoses. When these inter-correlations were taken into account, physical abuse and emotional neglect had the strongest specific association with adult psychiatric disorders and might transmit main effects of other CAT domains onto mental disorders. In a random clinical sample, most psychiatric disorders and CAT domains associated with suicide risk. However, when the effect of co-morbidity and overlap of CAT domains was controlled, major depression, social phobia, alcohol, drug dependency and emotional abuse seemed to increase the risk of suicide. This risk profile varied between the genders. In clinical high risk to psychosis patients, all CAT domains except physical neglect predicted suicidal ideations. The effect of CAT on suicidal ideation was mediated via clinical depression and concurrent depression symptoms. Gender proved to be a central moderating factor in effects of CAT experiences on mental wellbeing. Therefore, in addition to controlling for the effect of gender in the analyses, it is also important to carry out analyses for females and males separately. Emotional neglect and physical abuse proved to be associated specifically with adult psychiatric disorders and, emotional neglect also with perceived negative attitude of other people. These both CAT domains touche on child’s and adolescent’s basic needs of safety and love, and may consequently damage their psychic integrity and self¬esteem, predisposing him/her to a distrusting attitude towards other people and making him/her vulnerable to adult mental problems and disorders. The majority of childhood adverse and trauma experiences are family-centred. Parents’ mental health and their mutual interaction, i.e. family function, form a central basis for the children’s undisturbed development. Therefore, early family¬centred therapeutic and educational interventions directed to improving parents’ and children’s mental health, and to supporting parents in their parenthood can protect children from adverse and traumatic experiences. Societal measures to help families facing economic and other difficulties can contribute to the same goal. At the level of the whole society, it is a question of valuation of family life. Societal actions should be taken to support a stable and harmonious family life, and to really value children and their wellbeing. Moreover, the public media have an important role to play in these actions.Lukuisat tutkimukset ovat osoittaneet, että lapsuuden kaltoinkohtelu ja traumat (KT) eivät ole harvinaisia ja että ne usein yhdistyvät aikuisiän fyysisiin sairauksiin, mielenterveyden ongelmiin ja häiriintyneeseen käyttäytymiseen. Meillä ei ole vielä standardoitua suomenkielistä mittaria lapsuuden KT:n arviointiin ja tietomme KT:n ja psyykkisen hyvinvoinnin välisistä yhteyksistä on edelleen satunnaista. Varsinkin tietomme KT:n ja psyykkisten ongelmien välisistä spesifisistä yhteyksistä ja sukupuolieroista ovat niukkoja. Tässä tutkimuskokonaisuudessa pyrittiin arvioimaan uuden suomenkielisen lapsuuden KT-instrumentin käyttökelpoisuutta, KT:n yhteyksiä koettuun, muiden taholta tulevaan asennoitumiseen sekä KT:n yhteyksiä itsetuhoisuuteen ja psykiatrisiin häiriöihin. Tutkimusaineistot käsittävät 692 yleisväestön aikuista, 250 terveyskeskukseen ja 160 psykiatriseen avohoitoon tullutta sekä 245 psykoosiriskissä olevaa potilasta. Kolme ensiksi mainittua otosta kerättiin Lounais-Suomesta. Psykoosiriskiaineisto tuli European Prediction of Psychosis study’stä (EPOS). Kaikissa aineistoissa lapsuuden kaltoinkohtelu ja traumat arvioitiin Trauma and Distress Scale:lla (TADS), joka oli käännetty englannista suomeksi. TADS:n ja sen viiden komponentin psykometriset ominaisuudet: sisäinen konsistenssi, sisältö, menetelmällinen reliabiliteetti, samanaikaisvaliditeetti, osoit¬tautuivat hyviksi suomalaisessa väestöotoksessa. TADS osoittautui käyttökelpoi¬seksi instrumentiksi, kun takautuvasti raportoituja lapsuuden kaltoinkohtelua ja traumoja arvioidaan yleisväestössä ja kliinisissä aineistoissa. Yleisväestöstä lähes kolme neljäsosaa (72.3%) raportoi vähintään yhden ja lähes puolet (48.1) kaksi tai useamman lapsuuden KT-kokemuksen. Terveyskeskuksen potilailla vastaava osuudet olivat 76.7% ja 57.7% ja psykiatrisilla avohoitopotilailla 94.4% ja 80.6%. Lapsuuden kaltoinkohtelu ja traumakokemukset yleisesti ja emotionaalinen laiminlyönti spesifisesti yhdistyivät aikuisiässä koettuun, toisten ihmisten nega¬tiiviseen asenteeseen. KT-kokemusten vaikutukset aikuisiässä koettuun, toisten ihmisten negatiiviseen asenteeseen näyttivät olevan miehillä voimakkaampia kuin naisilla. Kaikki KT:n komponentit yhdistyivät merkitsevästi raportoituihin alkoholiongelmiin. Naisilla seksuaalinen hyväksikäyttö ja fyysinen kaltoinkohtelu yhdistyivät suoraan alkoholiongelmien esiintymiseen; miehillä vastaavat yhteydet välittyivät pääasiassa masentuneen mielialan kautta. Emotionaalinen kaltoinkohtelu ja laiminlyönti sekä fyysinen kaltoinkohtelu yhdistyivät vahvimmin ajankohtaisiin mieliala-ja ahdistuneisuushäiriöihin. KT:n komponentit kuitenkin korreloivat huomattavasti keskenään, samoin kliinisten diagnoosien kesken ilmeni samanaikaisesiintymistä. Kun nämä samanaikais¬korrelaatiot otettiin huomioon, fyysinen kaltoinkohtelu ja emotionaalinen laiminlyönti yhdistyivät spesifisesti aikuisiän psykiatrisiin häiriöihin ja saattoivat siten välittää KT:n muiden komponenttien pääasialliset vaikutukset mielenterveyden häiriöihin. Satunnaisessa kliinisessä aineistossa useimmat psykiatriset häiriöt ja lapsuuden KT:n komponentit yhdistyivät itsemurhariskiin. Kuitenkin kun oheissairaudet ja KT:n komponenttien päällekkäisyys oli kontrolloitu, masennustila, sosiaalinen fobia, alkoholi-ja huumeriippuvuus sekä emotionaalinen kaltoinkohtelu näyttivät lisänneen itsemurhariskiä. Tämä riskiprofiili vaihteli sukupuolten välillä. Psykoosi¬riskipotilailla kaikki KT:n komponentit paitsi fysikaalinen laiminlyönti ennustivat seuranta-aikaisia itsetuhoisia ajatuksia. KT:n vaikutus itsetuhoisiin ajatuksiin välittyi perusvaiheen kliinisen masennushäiriön ja samanaikaisen masentuneisuuden kautta. Sukupuoli osoittautui keskeiseksi muovaavaksi tekijäksi, kun tarkasteltiin lapsuuden KT:n vaikutusta psyykkiseen hyvinvointiin. Niinpä sen lisäksi, että sukupuolen vaikutus analyyseissä kontrolloidaan, on tärkeää myöskin suorittaa analyysit naisilla ja miehille erikseen. Emotionaalinen laiminlyönti ja fyysinen kaltoinkohtelu osoittautuivat yhdis¬tyvän spesifisti psykiatrisiin häiriöihin ja emotionaalinen laiminlyönti myös negatiiviseksi koettuun toisten ihmisten asenteeseen. Nämä molemmat KT:n muodot koskettavat lapsen ja nuoren perustavaa laatua olevia turvallisuuden ja rakastettuna olemisen tarpeita ja voivat siten vahingoittaa hänen psyykkistä eheyttään ja itsetuntoaan altistaen hänet aikuisiässä epäluottamuksen sävyttämälle asenteelle toisia ihmisiä kohtaan sekä mielenterveyden ongelmille ja häiriöille. Enemmistö lapsuuden kaltoinkohtelusta ja traumakokemuksista liittyy perheisiin. Vanhempien mielenterveys ja heidän keskinäinen vuorovaikutuksensa, ts. perhefunktio, muodostaa keskeisen pohjan lasten häiriöttömälle kehitykselle. Tämän vuoksi varhaiset vanhempien ja lasten mielenterveyttä tukevat perhekes¬keiset terapeuttiset ja neuvontatoimenpiteet sekä vanhempien tukeminen heidän vanhemmuuden tehtävässään voivat suojata lapsia ja nuoria kaltoinkohtelulta ja traumakokemuksilta. Sosiaalipoliittiset toimenpiteet, jotka suunnataan perheisin niiden kohdatessa taloudellisia ja muita vaikeuksia, voivat vaikuttaa samaan tavoitteeseen. Koko yhteiskunnan taholla kyse on perhe-elämän arvostamisesta. Yhteiskunnan tuleekin ryhtyä toimenpiteisiin stabiilin ja tasapainoisen perhe-elämän tukemiseksi sekä suhtautua todella arvostavasti lapsiin ja heidän hyvinvointiinsa. Myös julkisella medialla on tärkeä rooli näissä toimenpiteissä

Amygdala subnucleus volumes in psychosis high-risk state and first-episode psychosis

Structural and functional abnormalities of the amygdala in schizophrenia have been well documented. Post-mortem studies suggest that the lateral nucleus is particularly affected in schizophrenia. It is not known whether the amygdala subnuclei are differently affected at the time of the first-episode psychosis or already at high-risk state.75 first-episode psychosis patients (FEP), 45 clinical high-risk patients (CHR) and 76 population controls participated in this cross-sectional case-control study. Participants underwent T1-weighted 3T MRI scans, from which the amygdala was segmented using a newly developed automated algorithm. Because early adverse events increase risk for psychosis and affect the amygdala, we also tested whether experiences of childhood maltreatment associate with the putative amygdala subnuclei abnormalities.Compared to the population controls, FEP had smaller volumes of the lateral, and basal nuclei. In CHR, only the lateral nucleus was significantly smaller compared to the control subjects. Experience of childhood maltreatment was inversely associated with lateral nucleus volumes in FEP but not in CHR.These results show that the lateral and basal nuclei of the amygdala are already affected in FEP. These volumetric changes may reflect specific cellular abnormalities that have been observed in post-mortem studies in schizophrenia in the same subnuclei. Decreased volume of the lateral nucleus in CHR suggest that a smaller lateral nucleus could serve as a potential biomarker for psychosis risk. Finally, we found that the lateral nucleus volumes in FEP may be sensitive to the effects of childhood maltreatment.</p

Effects of childhood and adolescence physical activity patterns on psychosis risk—a general population cohort study

Schizophrenia spectrum disorders are associated with high morbidity and mortality in somatic diseases. The risk factors of this excess mortality include, e.g., obesity, dietary factors, and physical inactivity, especially after the onset of psychosis, but there are limited early developmental data on these factors in individuals who later develop psychosis. A population-based cohort study “Cardiovascular Risk of Young Finns” started in 1980 with 3596 children and adolescents from six different age groups (3, 6, 9, 12, 15, and 18 years). Cardiovascular health parameters, including questionnaire of physical activity before first hospitalization (≤18 years), were studied in 1980, 1983, and 1986. All psychiatric diagnoses of the participants were derived from the Finnish Hospital Discharge Register up to the year 2012. We identified diagnostic groups of non-affective psychosis (n = 68, including a schizophrenia subgroup, n = 41), personality disorders (n = 43), affective disorders (n = 111), and substance-related disorders (n = 49), based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Groups were compared with controls with no psychiatric diagnoses (n = 3325). Sex, age, body mass index, birth weight, non-preterm birth, and mother’s mental disorders were included in the statistical model. Low physical activity in childhood and adolescence (9–18 years) independently predicted later development of non-affective psychosis. Lower physical activity index (relative risk 1.26 [1.1–1.5]), lower level of common activity during leisure time (relative risk 1.71 [1.2–2.5]), and non-participation in sports competitions (relative risk 2.58 [1.3–5.3]) were associated with a higher risk for later non-affective psychosis (expressed as increase in relative risk per physical activity unit). The findings were even stronger for schizophrenia, but no such link was observed for other diagnoses. The cause of low physical activity in premorbid/prodromal phase is likely to be multifactorial, including deviant motor and cognitive development. The results provide a rationale for including exercise and physical activity interventions as a part of psychosis prevention programs.</p

Extrapyramidal symptoms predict cognitive performance after first-episode psychosis

Extrapyramidal (EP) symptoms such as tremor, rigidity, and bradykinesia are common side effects of most antipsychotics, and may associate with impaired performance in neurocognitive testing. We studied EP symptoms in first-episode psychosis (FEP; n = 113). Cognitive testing and EP symptoms (three items of the Simpson-Angus Scale) were assessed at baseline and follow-up (mean follow-up time 12 months). Mild EP symptoms were present at treatment onset in 40% of the participants. EP symptoms were related with lower performance in neurocognitive testing at baseline and at follow-up, especially among those with nonaffective psychotic disorder, and especially in tasks requiring speed of processing. No associations between EP symptoms and social cognition were detected. In linear regression models, when positive and negative symptom levels and chlorpromazine equivalents were accounted for, baseline EP symptoms were associated with worse baseline global neurocognition and visuomotor performance. Baseline EP symptoms also longitudinally predicted global, verbal, and visuomotor cognition. However, there were no cross-sectional associations between EP symptoms and cognitive performance at follow-up. In sum, we found both cross-sectional and longitudinal associations between EP symptoms and neurocognitive task performance in the early course of psychosis. Those without EP symptoms at the start of treatment had higher baseline and follow-up neurocognitive performance. Even mild EP symptoms may represent early markers of long-term neurocognitive impairment.</p

Short-term functional outcome in psychotic patients: results of the Turku early psychosis study (TEPS)

Background Functional recovery of patients with clinical and subclinical psychosis is associated with clinical, neuropsychological and developmental factors. Less is known about how these factors predict functional outcomes in the same models. We investigated functional outcomes and their predictors in patients with first-episode psychosis (FEP) or a confirmed or nonconfirmed clinical high risk of psychosis (CHR-P vs. CHR-N). Methods Altogether, 130 patients with FEP, 60 patients with CHR-P and 47 patients with CHR-N were recruited and extensively examined at baseline (T0) and 9 (T1) and 18 (T2) months later. Global Assessment of Functioning (GAF) at T0, T1 and T2 and psychotic, depression, and anxiety symptoms at T1 and T2 were assessed. Functional outcomes were predicted using multivariate repeated ANOVA. Results During follow-up, the GAF score improved significantly in patients with FEP and CHR-P but not in patients with CHR-N. A single marital status, low basic education level, poor work situation, disorganization symptoms, perceptual deficits, and poor premorbid adjustment in patients with FEP, disorganization symptoms and poor premorbid adjustment in patients with CHR-P, and a low basic education level, poor work situation and general symptoms in patients with CHR-N predicted poor functional outcomes. Psychotic symptoms at T1 in patients with FEP and psychotic and depression symptoms at T1 and anxiety symptoms at T2 in patients with CHR-P were associated with poor functioning. Conclusions In patients with FEP and CHR-P, poor premorbid adjustment and disorganization symptomatology are common predictors of the functional outcome, while a low education level and poor work situation predict worse functional outcomes in patients with FEP and CHR-N. Interventions aimed at improving the ability to work and study are most important in improving the functioning of patients with clinical or subclinical psychosis.</p

Psykoosipotilaiden toimintakyvyn ennuste ja sitä ennustavat tekijät

TAUSTA. Tavoitteenamme oli tutkia luonnollisessa tutkimusasetelmassa psykoosin ja psykoosiriskin vuoksi ensi kertaa hoitoon tulleiden potilaiden toimintakyvyn ennustetta ja siihen vaikuttavia tekijöitä.AINEISTO JA MENETELMÄT. Tutkimusaineisto koostui 130 psykoosi- ja 107 psykoosiriskipotilaasta, joille tehtiin alkuhaastattelun jälkeen seurantahaastattelu yhdeksän ja 18 kuukauden kuluttua. Seurannan perusteella muodostettiin hyvän ja huonon ennusteen ryhmät, joita selitettiin logistisella regressioanalyysillä.TULOKSET JA PÄÄTELMÄT. Psykoosi- ja riskipotilaiden toimintakyvyn ennusteissa ei ollut eroa. Hyvä ennuste yhdistyi naissukupuoleen, lapsuuden sosiaalisuuteen, koulumenestykseen ja vähäisiin traumakokemuksiin sekä hyvään koulutustasoon ja työtilanteeseen. Oireista tunneköyhyys ja ajattelun hajanaisuus liittyvät huonoon ennusteeseen. Monimuuttuja-analyysissä naimattomuus, lapsuuden traumakokemukset ja heikko koulumenestys, huono työtilanne sekä tunneköyhyys ja ajattelun hajanaisuus ennustivat huonoa toimintakykyä. Koulutuksen ja työteon tukemiseen liittyvät kuntoutustoimenpiteet ovat keskeisiä pyrittäessä parantamaan psykoosipotilaiden ja psykoosiriskissä olevien potilaiden toimintakykyä.</p

Association between age of cannabis initiation and gray matter covariance networks in recent onset psychosis

Cannabis use during adolescence is associated with an increased risk of developing psychosis. According to a current hypothesis, this results from detrimental effects of early cannabis use on brain maturation during this vulnerable period. However, studies investigating the interaction between early cannabis use and brain structural alterations hitherto reported inconclusive findings. We investigated effects of age of cannabis initiation on psychosis using data from the multicentric Personalized Prognostic Tools for Early Psychosis Management (PRONIA) and the Cannabis Induced Psychosis (CIP) studies, yielding a total sample of 102 clinically-relevant cannabis users with recent onset psychosis. GM covariance underlies shared maturational processes. Therefore, we performed source-based morphometry analysis with spatial constraints on structural brain networks showing significant alterations in schizophrenia in a previous multisite study, thus testing associations of these networks with the age of cannabis initiation and with confounding factors. Earlier cannabis initiation was associated with more severe positive symptoms in our cohort. Greater gray matter volume (GMV) in the previously identified cerebellar schizophrenia-related network had a significant association with early cannabis use, independent of several possibly confounding factors. Moreover, GMV in the cerebellar network was associated with lower volume in another network previously associated with schizophrenia, comprising the insula, superior temporal, and inferior frontal gyrus. These findings are in line with previous investigations in healthy cannabis users, and suggest that early initiation of cannabis perturbs the developmental trajectory of certain structural brain networks in a manner imparting risk for psychosis later in life

Prevalence of cognitive impairments and strengths in the early course of psychosis and depression.

BACKGROUND Studies investigating cognitive impairments in psychosis and depression have typically compared the average performance of the clinical group against healthy controls (HC), and do not report on the actual prevalence of cognitive impairments or strengths within these clinical groups. This information is essential so that clinical services can provide adequate resources to supporting cognitive functioning. Thus, we investigated this prevalence in individuals in the early course of psychosis or depression. METHODS A comprehensive cognitive test battery comprising 12 tests was completed by 1286 individuals aged 15-41 (mean age 25.07, s.d. 5.88) from the PRONIA study at baseline: HC (N = 454), clinical high risk for psychosis (CHR; N = 270), recent-onset depression (ROD; N = 267), and recent-onset psychosis (ROP; N = 295). Z-scores were calculated to estimate the prevalence of moderate or severe deficits or strengths (>2 s.d. or 1-2 s.d. below or above HC, respectively) for each cognitive test. RESULTS Impairment in at least two cognitive tests was as follows: ROP (88.3% moderately, 45.1% severely impaired), CHR (71.2% moderately, 22.4% severely impaired), ROD (61.6% moderately, 16.2% severely impaired). Across clinical groups, impairments were most prevalent in tests of working memory, processing speed, and verbal learning. Above average performance (>1 s.d.) in at least two tests was present for 40.5% ROD, 36.1% CHR, 16.1% ROP, and was >2 SDs in 1.8% ROD, 1.4% CHR, and 0% ROP. CONCLUSIONS These findings suggest that interventions should be tailored to the individual, with working memory, processing speed, and verbal learning likely to be important transdiagnostic targets

The heterogeneity of attenuated and brief limited psychotic symptoms: association of contents with age, sex, country, religion, comorbidities, and functioning

INTRODUCTION The Attenuated Psychosis Symptoms (APS) syndrome mostly represents the ultra-high-risk state of psychosis but, as does the Brief Intermittent Psychotic Symptoms (BIPS) syndrome, shows a large variance in conversion rates. This may be due to the heterogeneity of APS/BIPS that may be related to the effects of culture, sex, age, and other psychiatric morbidities. Thus, we investigated the different thematic contents of APS and their association with sex, age, country, religion, comorbidity, and functioning to gain a better understanding of the psychosis-risk syndrome. METHOD A sample of 232 clinical high-risk subjects according to the ultra-high risk and basic symptom criteria was recruited as part of a European study conducted in Germany, Italy, Switzerland, and Finland. Case vignettes, originally used for supervision of inclusion criteria, were investigated for APS/BIPS contents, which were compared for sex, age, country, religion, functioning, and comorbidities using chi-squared tests and regression analyses. RESULT We extracted 109 different contents, mainly of APS (96.8%): 63 delusional, 29 hallucinatory, and 17 speech-disorganized contents. Only 20 contents (18.3%) were present in at least 5% of the sample, with paranoid and referential ideas being the most frequent. Thirty-one (28.5%) contents, in particular, bizarre ideas and perceptual abnormalities, demonstrated an association with age, country, comorbidity, or functioning, with regression models of country and obsessive-compulsive disorders explaining most of the variance: 55.8 and 38.3%, respectively. Contents did not differ between religious groups. CONCLUSION Psychosis-risk patients report a wide range of different contents of APS/BIPS, underlining the psychopathological heterogeneity of this group but also revealing a potential core set of contents. Compared to earlier reports on North-American samples, our maximum prevalence rates of contents were considerably lower; this likely being related to a stricter rating of APS/BIPS and cultural influences, in particular, higher schizotypy reported in North-America. The various associations of some APS/BIPS contents with country, age, comorbidities, and functioning might moderate their clinical severity and, consequently, the related risk for psychosis and/or persistent functional disability