School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.
Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.
Early Interv Psychiatry. 2019 Dec;13(6):1366-1372. doi: 10.1111/eip.12773. Epub 2018 Dec 25.
Increasing evidence suggests that childhood trauma and dissociation are associated with psychotic symptoms and disorders. Significant rates of dissociative disorders and clinical levels of dissociative symptoms are found in chronic schizophrenia. To date, no studies have examined the prevalence of these in a first episode psychosis (FEP) group. This study aimed to investigate the prevalence of dissociative disorders and symptoms in a FEP sample as well as the prevalence of severe dissociative symptoms in those with or without experiences of childhood trauma.
Sixty-six young people with FEP completed a research interview which included the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders, Childhood Trauma Questionnaire and the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised.
Dissociative symptoms at clinical levels were found in 36.4% of the sample. Furthermore, 13.6% of the sample met diagnostic criteria for a lifetime dissociative disorder. Significant differences in the frequency of clinical dissociative symptoms between those with or without childhood trauma were also found.
Dissociative symptoms should be routinely assessed for in early intervention settings, especially in cases where childhood trauma is disclosed or suspected. Where present, dissociative symptoms should also be incorporated into subsequent case formulation and treatment planning.
越来越多的证据表明,儿童时期的创伤和分离与精神病症状和障碍有关。慢性精神分裂症中存在较高比例的分离性障碍和临床水平的分离症状。迄今为止,尚无研究在首发精神病(FEP)患者群体中检查这些疾病的患病率。本研究旨在调查 FEP 样本中分离性障碍和症状的患病率,以及那些有或没有儿童期创伤经历的患者中严重分离症状的患病率。
66 名患有 FEP 的年轻人完成了一项研究访谈,其中包括用于诊断和统计手册第四版(DSM-IV)轴 I 障碍的结构化临床访谈、儿童期创伤问卷和用于 DSM-IV 修订版的结构化临床访谈分离障碍。
该样本中有 36.4%的人出现了临床水平的分离症状。此外,该样本中有 13.6%的人符合终生分离障碍的诊断标准。在有或没有儿童期创伤的患者中,临床分离症状的发生频率也存在显著差异。
在早期干预环境中应常规评估分离症状,特别是在披露或怀疑存在儿童期创伤的情况下。如果存在分离症状,也应将其纳入后续的病例形成和治疗计划中。