Kapfhammer Hans-Peter
Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, 8036, Graz, Österreich,
Neuropsychiatr. 2012;26(4):171-8. doi: 10.1007/s40211-012-0030-x. Epub 2012 Oct 5.
A comprehensive literature stresses a high percentage of severe childhood maltreatment in the history of many psychotically ill patients treated in mental health services. Early childhood abuse seems to be associated among other things with a more severe clinical state, a more chronic course of illness and a more unfavourable psychosocial adaptation. In order not to jump to unwarranted causal conclusions, several conceptual und methodological problems have to be clarified before. From a conceptual perspective psychotic disorders diagnosed according to conventional criteria define only a minor subgroup within a much broader psychosis continuum in general population. Early childhood abuse has to be differentiated according to type, severity, timing, and context. The rates of early childhood abuse are high in general population. The methods of measurement of psychotic symptoms on the one side, of early trauma on the other side have to be critically evaluated. There is an empirically well founded association of childhood maltreatment and psychological and psychosomatic morbidity during adult years in general. In order to establish a potential conditional link also to psychotic disorders, clinical populations have to be compared to adequate control groups at least. A systematic literature search shows a very small number of studies including control groups at all. These studies underline that early childhood abuse may be significantly associated to the risk of psychosis indeed. The conditional role of early childhood abuse, however, has to be investigated only within a multifactorial biopsychosocial model of psychotic illness.
一项全面的文献强调，在心理健康服务机构接受治疗的许多精神病患者的病史中，有很大比例的人曾遭受过严重的童年虐待。儿童期早期受虐似乎与更严重的临床状态、更慢性的病程以及更不利的心理社会适应等诸多因素相关。为了避免得出毫无根据的因果结论，在此之前必须澄清几个概念和方法上的问题。从概念角度来看，根据传统标准诊断的精神障碍仅定义了普通人群中更广泛的精神病连续体中的一个较小亚组。儿童期早期受虐必须根据类型、严重程度、时间和背景进行区分。普通人群中儿童期早期受虐的发生率很高。一方面，精神病症状的测量方法，另一方面，早期创伤的测量方法都必须进行严格评估。一般来说，儿童期虐待与成年期的心理和身心疾病之间存在基于实证的良好关联。为了确定与精神障碍之间潜在的条件联系，至少必须将临床人群与适当的对照组进行比较。一项系统的文献检索显示，几乎没有研究纳入对照组。这些研究强调，儿童期早期受虐确实可能与患精神病的风险显著相关。然而，儿童期早期受虐的条件作用必须仅在精神病的多因素生物心理社会模型中进行研究。
