Appiah-Kusi E, Fisher H L, Petros N, Wilson R, Mondelli V, Garety P A, Mcguire P, Bhattacharyya S
King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 67, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 80, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
J Psychiatr Res. 2017 May;88:89-96. doi: 10.1016/j.jpsychires.2017.01.003. Epub 2017 Jan 6.
Exposure to childhood trauma has been associated with psychotic symptoms, being at ultra-high risk for psychosis (UHR), and psychotic disorders such as schizophrenia. Negative self-beliefs have been shown to partially mediate the relationship between childhood trauma and paranoia and have been shown to be characteristic of patients with psychosis. However, whether the association between childhood trauma and being at high risk of developing psychosis (e.g., UHR) and paranoia symptoms is mediated by altered cognitive schema is unknown and warrants investigation to inform preventive interventions. Data was collected on 30 UHR patients from Outreach and Support in South London about exposure to childhood trauma, cognitive schema, paranoia and cannabis use. Relative to healthy controls (n = 38), UHR patients were significantly more likely to report exposure to various types of childhood trauma (emotional and sexual abuse, and emotional and physical neglect), had more negative schema and less positive schema about themselves and others, and were more likely to use cannabis more than once a month. Emotional neglect was found to be significantly associated with UHR status even after controlling for the effects of previous exposure to cannabis use (b = 0.262, 95% CI: 0.115-0.408), and this association was partially mediated by negative self-schema (b = 0.045, 95% CI: 0.004-0.159). Similarly, emotional neglect was significantly associated with paranoia (b = 1.354, 95% CI: 0.246-2.462), and this association was partially mediated by negative self-schema (b = 0.988, 95% CI: 0.323-1.895). These findings provide preliminary evidence about the cognitive mechanisms that may underlie the association between childhood trauma and later risk for psychosis.
童年期受创伤与精神病性症状、处于精神病超高风险状态（UHR）以及精神分裂症等精神病性障碍有关。消极的自我信念已被证明部分介导了童年期创伤与偏执之间的关系，并且已被证明是精神病患者的特征。然而，童年期创伤与处于精神病高风险状态（如UHR）及偏执症状之间的关联是否由认知模式改变所介导尚不清楚，需要进行调查以指导预防性干预措施。从伦敦南部外展与支持项目中收集了30名UHR患者关于童年期受创伤、认知模式、偏执及大麻使用情况的数据。与健康对照组（n = 38）相比，UHR患者更有可能报告遭受过各种类型的童年期创伤（情感和性虐待，以及情感和身体忽视），对自己和他人有更多消极模式和更少积极模式，并且更有可能每月使用大麻不止一次。即使在控制了既往大麻使用的影响后，仍发现情感忽视与UHR状态显著相关（b = 0.262，95%置信区间：0.115 - 0.408），并且这种关联部分由消极自我模式介导（b = 0.045，95%置信区间：0.004 - 0.159）。同样，情感忽视与偏执显著相关（b = 1.354，95%置信区间：0.246 - 2.462），并且这种关联部分由消极自我模式介导（b = 0.988，95%置信区间：0.323 - 1.895）。这些发现为童年期创伤与后期精神病风险之间关联可能潜在的认知机制提供了初步证据。
