Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.
Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy.
Bipolar Disord. 2020 Nov;22(7):749-756. doi: 10.1111/bdi.12923. Epub 2020 May 16.
Childhood maltreatment has been associated to an increased risk of developing bipolar disorder (BD). A role of the hypothalamus-pituitary-adrenal (HPA) axis in mediating trauma-related risk for adult psychopathology has been suggested but scarcely investigated in BD. Therefore, we explored the impact of childhood maltreatment on clinical features of BD and on the activity of the HPA axis.
One hundred and six patients participated in the study. On the basis of their history of childhood trauma, as assessed by the Childhood Trauma Questionnaire (CTQ), they were divided into a group with a history of childhood maltreatment (CM+) and a group without (CM-). Twenty-nine participants (16 with a history of childhood trauma and 13 without) underwent the cortisol awakening response (CAR) test.
Sixty-two patients had a history of childhood maltreatment and 44 had not. Maltreatment was significantly more frequent in females than males. CM+ patients showed a significant higher body mass index, a significant higher number of suicide attempts, and more severe mania symptoms than CM- ones. Logistic regression indicated a significant association between lifetime suicide attempts and any type of childhood maltreatment and between emotional abuse and the presence of psychotic symptoms or mixed mood episodes. CM+ individuals with BD exhibited a significantly reduced CAR with respect to CM- ones.
Our results add to literature findings showing a worse clinical course in BD patients with a history of childhood maltreatments and show for the first time that childhood trauma exposure is associated to an impaired CAR in adults with BD.
儿童期虐待与双相障碍（BD）发病风险增加有关。已有研究提示下丘脑-垂体-肾上腺（HPA）轴在介导创伤相关的成年精神病理学风险方面发挥作用，但在 BD 中研究甚少。因此，我们探讨了儿童期虐待对 BD 临床特征和 HPA 轴活性的影响。
106 名患者参与了这项研究。根据儿童期创伤问卷（CTQ）评估的儿童期创伤史，他们被分为有儿童期虐待史组（CM+）和无儿童期虐待史组（CM-）。29 名参与者（16 名有儿童期创伤史，13 名无）接受了皮质醇觉醒反应（CAR）测试。
62 名患者有儿童期虐待史，44 名患者没有。女性中虐待的发生率明显高于男性。CM+患者的体重指数明显更高，自杀未遂次数明显更多，躁狂症状也更严重。Logistic 回归分析表明，一生中的自杀企图与任何类型的儿童期虐待以及情感虐待与精神病症状或混合情绪发作的存在之间存在显著关联。与 CM-相比，BD 中的 CM+个体的 CAR 明显降低。
我们的结果增加了文献发现，即有儿童期虐待史的 BD 患者临床病程更差，并首次表明儿童期创伤暴露与 BD 成人中 CAR 受损有关。
