Schizophrenia Bulletin Advance Access published online on April 21, 2009
Schizophrenia Bulletin, doi:10.1093/schbul/sbp009
Pretreatment and Outcome Correlates of Sexual and Physical Trauma in an Epidemiological Cohort of First-Episode Psychosis Patients
2 Treatment and early Intervention in Psychosis Program (TIPP), Département de Psychiatrie Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland
3 Department of Psychiatry, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville Victoria, Melbourne, VIC, Australia
4 Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
5 Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany
1 To whom correspondence should be addressed; tel: 041-21-643-61-11, fax: 041-21-643-64-69, e-mail: philippe.conus{at}chuv.ch.
Objectives: High prevalence of trauma has been reported in psychosis. While role of trauma as a risk factor for developing psychosis is still debated, its negative impact on outcome has been described. Few studies have explored this issue in first-episode psychosis (FEP) patients. We assessed rate of stressful events, as well as premorbid and outcome correlates of past sexual and/or physical abuse (SPA) in an epidemiological FEP patients cohort. Methods: The Early Psychosis Prevention and Intervention Centre admitted 786 FEP patients between 1998 and 2000. Data were collected from patients' files using a standardized questionnaire. A total of 704 files were available, 43 excluded because of a nonpsychotic diagnosis at end point and 3 due to missing data regarding past stressful events; 658 patients were analyzed. Results: A total of 83% patients had been exposed to at least one stressful event and 34% to SPA. SPA patients were more likely to have presented other psychiatric disorders before psychosis onset (posttraumatic stress disorder, substance use disorder), to have made suicide attempts in the past, and to have had poorer premorbid functional levels. Additionally, SPA patients had higher rate of comorbid diagnosis at program entry and were more likely to attempt suicide during treatment. Conclusions: SPA prevalence is high in FEP patients and must be explored by clinicians considering its durable impact on psychological balance and link with long-lasting suicidal risk. More research is warranted to better understand mechanisms involved between trauma and its potential consequences, as well as to develop psychological interventions adapted to this very sensitive and complex issue.
Keywords: sexual abuse / physical abuse / early psychosis / outcome