Patterns of childhood adverse events are associated with clinical characteristics of bipolar disorder

BMC Psychiatry

Steinar Lorentzen¹  Ole A Andreassen²  Ingrid Melle²  Jan Ivar Røssberg²  Trine V Lagerberg⁵  Elizabeth A Barrett²  Nils Eiel Steen²  Erlend Mork³  Ingrid Agartz⁴  Ole Klungsøyr²  Monica Aas⁵  Sara Larsson⁵ 

[1] Institute of Clinical Medicine, Clinic of Health and Addiction, University of Oslo, 1039, Blindern, Oslo, N-0315, Norway;Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway;Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway;Institute of Clinical Medicine, University of Oslo, Oslo, Norway

关键词: Clinical characteristics;    Bipolar disorder;    Childhood trauma;   

Others  :  1124097
DOI  :  10.1186/1471-244X-13-97

 received in 2012-02-14, accepted in 2013-03-04,  发布年份 2013

【 摘 要 】

Background

Previous studies in bipolar disorder investigating childhood trauma and clinical presentations of the illness have mainly focused on physical and sexual abuse. Our aim was to explore further the relationship between childhood trauma and disease characteristics in bipolar disorder to determine which clinical characteristics were most strongly associated with childhood trauma total score, as well as subtypes of adverse childhood events, including physical, sexual, emotional abuse and neglect.

Methods

141 Patients with bipolar disorder were consecutively recruited, and disease history and clinical characteristics were assessed. History of childhood abuse was obtained using the Childhood Trauma Questionnaire (CTQ). Statistical methods used were factor analysis, Poisson and linear regression, and generalized additive modeling (GAM).

Results

The factor analysis of CTQ identified three factors: emotional abuse/neglect, sexual abuse and physical abuse. There were significant associations between CTQ total score and earlier onset of illness, reduced level of psychosocial functioning (GAF; Global Assessment of Functioning) and decreased number of hospitalization, which mainly were due to the factor emotional abuse/neglect. Physical abuse was significantly associated with lower GAF scores, and increased number of mood episodes, as well as self-harm. Sexual abuse was significantly associated with increased number of mood episodes. For mood episodes and self-harm the associations were characterized by great variance and fluctuations.

Conclusions

Our results suggest that childhood trauma is associated with a more severe course of bipolar illness. Further, childhood abuse (physical and sexual), as well as emotional abuse and neglect were significantly associated with accelerating staging process of bipolar disorder. By using specific trauma factors (physical abuse, sexual abuse and emotional abuse/neglect) the associations become both more precise, and diverse.

【 授权许可】

   
2013 Larsson et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Fisher HL, Jones PB, Fearon P, Craig TK, Dazzan P, Morgan K, Hutchinson G, Doody GA, McGuffin P, Leff J, Murray RM, Morgan C: The varying impact of type, timing and frequency of exposure to childhood adversity on its association with adult psychotic disorder. Psychol Med 2010, 24:1-12.
• [2]Mondelli V, Dazzan P, Hepgul N, Di FM, Aas M, D’Albenzio A, Di NM, Fisher H, Handley R, Marques TR, Morgan C, Navari S, Taylor H, Papadopoulos A, Aitchison KJ, Murray RM, Pariante CM: Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: the role of stress and of antipsychotic treatment. Schizophr Res 2010, 116(2–3):234-42.
• [3]Aas M, Dazzan P, Mondelli V, Toulopoulou T, Reichenberg A, Di FM, Fisher HL, Handley R, Hepgul N, Marques T, Miorelli A, Taylor H, Russo M, Wiffen B, Papadopoulos A, Aitchison KJ, Morgan C, Murray RM, Pariante CM: Abnormal cortisol awakening response predicts worse cognitive function in patients with first-episode psychosis. Psychol Med 2010, 9:1-14.
• [4]Read J, Van OJ, Morrison AP, Ross CA: Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatr Scand 2005, 112(5):330-50.
• [5]Etain B, Mathieu F, Henry C, Raust A, Roy I, Germain A, Leboyer M, Bellivier F: Preferential association between childhood emotional abuse and bipolar disorder. J Trauma Stress 2010, 23(3):376-83.
• [6]Garno JL, Goldberg JF, Ramirez PM, Ritzler BA: Impact of childhood abuse on the clinical course of bipolar disorder. Br J Psychiatry 2005, 186:121-5.
• [7]Bebbington PE, Bhugra D, Brugha T, Singleton N, Farrell M, Jenkins R, Lewis G, Meltzer H: Psychosis, victimisation and childhood disadvantage: evidence from the second british national survey of psychiatric morbidity. Br J Psychiatry 2004, 185:220-6.
• [8]Janssen I, Krabbendam L, Bak M, Hanssen M, Vollebergh W, De GR, Van OJ: Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatr Scand 2004, 109(1):38-45.
• [9]Shevlin M, Dorahy MJ, Adamson G: Trauma and psychosis: an analysis of the national comorbidity survey. Am J Psychiatry 2007, 164(1):166-9.
• [10]Brown GR, McBride L, Bauer MS, Williford WO: Impact of childhood abuse on the course of bipolar disorder: a replication study in U.S. veterans. J Affect Disord 2005, 89(1–3):57-67.
• [11]Nemeroff CB: Neurobiological consequences of childhood trauma. J Clin Psychiatry 2004, 65(Suppl 1):18-28.
• [12]Weber K, Rockstroh B, Borgelt J, Awiszus B, Popov T, Hoffmann K, Schonauer K, Watzl H, Propster K: Stress load during childhood affects psychopathology in psychiatric patients. BMC Psychiatry 2008, 8:63. BioMed Central Full Text
• [13]Alvarez MJ, Roura P, Oses A, Foguet Q, Sola J, Arrufat FX: Prevalence and clinical impact of childhood trauma in patients with severe mental disorders. J Nerv Ment Dis 2011, 199(3):156-61.
• [14]Daruy-Filho L, Brietzke E, Lafer B, Grassi-Oliveira R: Childhood maltreatment and clinical outcomes of bipolar disorder. Acta Psychiatr Scand 2011, 124(6):427-34.
• [15]Etain B, Henry C, Bellivier F, Mathieu F, Leboyer M: Beyond genetics: childhood affective trauma in bipolar disorder. Bipolar Disord 2008, 10(8):867-76.
• [16]Fisher HL, Craig TK, Fearon P, Morgan K, Dazzan P, Lappin J, Hutchinson G, Doody GA, Jones PB, McGuffin P, Murray RM, Leff J, Morgan C: Reliability and comparability of psychosis patients’ retrospective reports of childhood abuse. Schizophr Bull 2011, 37(3):546-53.
• [17]Carballo JJ, Harkavy-Friedman J, Burke AK, Sher L, Baca-Garcia E, Sullivan GM, Grunebaum MF, Parsey RV, Mann JJ, Oquendo MA: Family history of suicidal behavior and early traumatic experiences: additive effect on suicidality and course of bipolar illness? J Affect Disord 2008, 109(1–2):57-63.
• [18]Coulston CM, Tanious M, Mulder RT, Porter RJ, Malhi GS: Bordering on bipolar: the overlap between borderline personality and bipolarity. Aust N Z J Psychiatry 2012, 46(6):506-21.
• [19]Ringen PA, Lagerberg TV, Birkenaes AB, Engn J, Faerden A, Jonsdottir H, Nesvag R, Friis S, Opjordsmoen S, Larsen F, Melle I, Andreassen OA: Differences in prevalence and patterns of substance use in schizophrenia and bipolar disorder. Psychol Med 2008, 38(9):1241-9.
• [20]Kay SR, Fiszbein A, Opler LA: The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987, 13(2):261-76.
• [21]Shrout PE, Fleiss JL: Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979, 86(2):420-8.
• [22]Pedersen G, Hagtvet KA, Karterud S: Generalizability studies of the global assessment of functioning-split version. Compr Psychiatry 2007, 48(1):88-94.
• [23]Simonsen C, Sundet K, Vaskinn A, Birkenaes AB, Engh JA, Faerden A, Jonsdottir H, Ringen PA, Opjordsmoen S, Melle I, Friis S, Andreassen OA: Neurocognitive dysfunction in bipolar and schizophrenia spectrum disorders depends on history of psychosis rather than diagnostic group. Schizophr Bull 2011, 37(1):73-83.
• [24]Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, Sapareto E, Ruggiero J: Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 1994, 151(8):1132-6.
• [25]Aas M, Djurovic S, Athanasiu L, Steen NE, Agartz I, Lorentzen S, Sundet K, Andreassen OA, Melle I: Serotonin transporter gene polymorphism, childhood trauma, and cognition in patients with psychotic disorders. Schizophr Bull 2012, 38(1):15-22.
• [26]Heim C, Mletzko T, Purselle D, Musselman DL, Nemeroff CB: The dexamethasone/corticotropin-releasing factor test in men with major depression: role of childhood trauma. Biol Psychiatry 2008, 63(4):398-405.
• [27]Bremner JD: The relationship between cognitive and brain changes in posttraumatic stress disorder. Ann N Y Acad Sci 2006, 1071:80-6.
• [28]Lupien SJ, Maheu F, Tu M, Fiocco A, Schramek TE: The effects of stress and stress hormones on human cognition: implications for the field of brain and cognition. Brain Cogn 2007, 65(3):209-37.
• [29]Heim C, Newport DJ, Heit S, Graham YP, Wilcox M, Bonsall R, Miller AH, Nemeroff CB: Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA 2000, 284(5):592-7.
• [30]Kooiman CG, Van RV, Spinhoven P, Trijsburg RW DN, Rooijmans HG: Childhood adversities as risk factors for alexithymia and other aspects of affect dysregulation in adulthood. Psychother Psychosom 2004, 73(2):107-16.
• [31]Shaffer A, Huston L, Egeland B: Identification of child maltreatment using prospective and self-report methodologies: a comparison of maltreatment incidence and relation to later psychopathology. Child Abuse Negl 2008, 32(7):682-92.
• [32]Teicher MH, Anderson CM, Polcari A: Childhood maltreatment is associated with reduced volume in the hippocampal subfields CA3, dentate gyrus, and subiculum. Proc Natl Acad Sci USA 2012, 109(9):E563-E572.
• [33]Andersen SL, Teicher MH: Stress, sensitive periods and maturational events in adolescent depression. Trends Neurosci 2008, 31(4):183-91.
• [34]Andersen SL, Tomada A, Vincow ES, Valente E, Polcari A, Teicher MH: Preliminary evidence for sensitive periods in the effect of childhood sexual abuse on regional brain development. J Neuropsychiatry Clin Neurosci 2008, 20(3):292-301.
• [35]Andersen SL, Teicher MH: Delayed effects of early stress on hippocampal development. Neuropsychopharmacology 2004, 29(11):1988-93.
• [36]Tomoda A, Navalta CP, Polcari A, Sadato N, Teicher MH: Childhood sexual abuse is associated with reduced gray matter volume in visual cortex of young women. Biol Psychiatry 2009, 66(7):642-8.
• [37]Hubel DH, Wiesel TN: Early exploration of the visual cortex. Neuron 1998, 20(3):401-12.