Mayo Danessa, Corey Sarah, Kelly Leah H, Yohannes Seghel, Youngquist Alyssa L, Stuart Barbara K, Niendam Tara A, Loewy Rachel L
Imaging Research Center, Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA.
Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
Front Psychiatry. 2017 Apr 20;8:55. doi: 10.3389/fpsyt.2017.00055. eCollection 2017.
The experience of childhood trauma (CT) and stressful life events (SLEs) is associated with subsequent development of a variety of mental health conditions, including psychotic illness. Recent research identifying adolescents and young adults at clinical high risk (CHR) for psychosis allows for prospective evaluation of the impact of trauma and adverse life events on psychosis onset and other outcomes, addressing etiological questions that cannot be answered in studies of fully psychotic or non-clinical populations. This article provides a comprehensive review of the current emerging literature on trauma and adverse life events in the CHR population. Up to 80% of CHR youth endorse a lifetime history of childhood traumatic events and victimization (e.g., bullying). Several studies have shown that the experience of CT predicts psychosis onset among CHR individuals, while the literature on the influence of recent SLEs (e.g., death of a loved one) remains inconclusive. Multiple models have been proposed to explain the link between trauma and psychosis, including the stress-vulnerability and stress-sensitivity hypotheses, with emphases on both cognitive processes and neurobiological mechanisms (e.g., the hypothalamic-pituitary-adrenal axis). Despite the preponderance of CHR individuals who endorse either CT or SLEs, no clinical trials have been conducted evaluating interventions for trauma in CHR youth to date. Furthermore, the current process of formal identification and assessment of trauma, SLEs, and their impact on CHR youth is inconsistent in research and clinical practice. Recommendations for improving trauma assessment, treatment, and future research directions in the CHR field are provided.
童年创伤（CT）和应激性生活事件（SLEs）的经历与随后多种心理健康状况的发展相关，包括精神病性疾病。最近对处于精神病临床高危（CHR）的青少年和年轻人的研究，使得对创伤和不良生活事件对精神病发作及其他结果的影响进行前瞻性评估成为可能，解决了在完全精神病性或非临床人群研究中无法回答的病因学问题。本文全面综述了当前关于CHR人群中创伤和不良生活事件的新兴文献。高达80%的CHR青年认可有童年创伤事件和受侵害（如欺凌）的终生经历。多项研究表明，CT经历可预测CHR个体的精神病发作，而关于近期SLEs（如亲人死亡）影响的文献尚无定论。已提出多种模型来解释创伤与精神病之间的联系，包括应激易感性和应激敏感性假说，重点在于认知过程和神经生物学机制（如下丘脑-垂体-肾上腺轴）。尽管有大量认可CT或SLEs的CHR个体，但迄今为止尚未进行评估针对CHR青年创伤干预措施的临床试验。此外，目前在研究和临床实践中，对创伤、SLEs及其对CHR青年影响的正式识别和评估过程并不一致。本文还提供了关于改进CHR领域创伤评估、治疗及未来研究方向的建议。
