School of Psychological Sciences, Monash University, Wellington Road, Clayton 3800, Victoria, Australia.
Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville 3052, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville 3052, Victoria, Australia.
Compr Psychiatry. 2018 Jul;84:68-74. doi: 10.1016/j.comppsych.2018.04.004. Epub 2018 Apr 11.
Childhood trauma has been linked to the presence of delusions and hallucinations in psychosis, although the mechanisms underlying this relationship require elucidation. Dissociation, characterized by disruptions to the integrative functioning of several core mental domains, has emerged as a potential mechanism. There is a paucity of research using a clinician-rated measure of dissociation to test the indirect effect of dissociation on the relationship between childhood trauma and psychotic symptoms. This study aimed to investigate whether dissociation mediated both the relationships between childhood trauma and hallucinations, and childhood trauma and delusions utilizing a clinician-administered measure of dissociation, namely the Structured Clinical Interview for DSM-IV Dissociative Disorders - Revised (SCID-D-R).
Sixty-six first-episode psychosis (FEP) participants completed a research interview and questionnaires. Information about experiences of childhood trauma, psychosis, dissociation, general psychopathology and demographics were collected.
When using the SCID-D-R, childhood trauma positively correlated with dissociation. Further, dissociation mediated the relationship between childhood trauma and delusions. Contrary to previous findings, we found no relationship between dissociation and hallucinations and no mediating effect of dissociation on the association between childhood trauma and hallucinations. The results of the SCID-D-R differed significantly from those of the Dissociative Experiences Scale-II (DES-II) which were consistent with previous research.
Our findings are the first to use a clinician-rated measure to test the mediating effect of dissociation on the relationship between childhood trauma and positive symptoms (i.e., hallucinations and delusions). Given the discrepancies in results between the SCID-D-R and DES-II, how dissociation is measured in future research is an important consideration. The results add to a body of work that increasingly recognizes the importance of dissociative symptoms on the relationship between childhood trauma and psychosis. The results suggest that dissociative symptoms should be part of routine assessment in those with a history of trauma and present to FEP services.
童年创伤与精神病中的妄想和幻觉的存在有关，尽管这种关系的机制尚需阐明。分离，其特征是几个核心心理领域的整合功能受到破坏，已成为一种潜在的机制。使用临床医生评定的分离量表来测试分离对童年创伤与精神病症状之间关系的间接影响的研究很少。本研究旨在调查使用临床医生管理的分离量表，即 DSM-IV 修订版结构性临床访谈分离障碍（SCID-D-R），分离是否介导了童年创伤与幻觉以及童年创伤与妄想之间的关系。
66 名首发精神病（FEP）患者完成了研究访谈和问卷调查。收集了有关童年创伤经历、精神病、分离、一般精神病理学和人口统计学的信息。
当使用 SCID-D-R 时，童年创伤与分离呈正相关。此外，分离介导了童年创伤与妄想之间的关系。与之前的发现相反，我们没有发现分离与幻觉之间存在关系，也没有发现分离对童年创伤与幻觉之间关联的中介作用。SCID-D-R 的结果与 Dissociative Experiences Scale-II（DES-II）的结果有显著差异，后者与之前的研究结果一致。
我们的研究结果首次使用临床医生评定的量表来测试分离对童年创伤与阳性症状（即幻觉和妄想）之间关系的中介作用。鉴于 SCID-D-R 和 DES-II 之间的结果差异，在未来的研究中如何测量分离是一个重要的考虑因素。这些结果增加了越来越多的认识到分离症状在童年创伤与精神病之间关系中的重要性的工作。结果表明，在有创伤史和出现首发精神病的患者中，分离症状应成为常规评估的一部分。
