الفهرس 
Childhood Trauma: Definitions, Types, Risk Factors and Impact on Brain & Mental HealthOnly 14 pages are availabe for public view
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Abstract
Traumatic experiences during childhood represent a major public health problem with approximately one to two thirds of the general population experience at least one form of CT as well as schizophrenia is among the world’s top ten causes of long-term disability. With many recent studies revealed a causal relationship between CT and psychosis in addition to many associations between different types of CT and specific symptom dimensions of schizophrenia.
The aim of this work was to compare the prevalence of CT between a sample of schizophrenic patients and healthy controls. And then to identify the impact of CT on symptom dimensions, symptom severity and personality profile of patients with schizophrenia.
This was conducted through a retrospective analytical case-control study done on 151 healthy controls and 166 patients with schizophrenia at outpatient clinics and inpatient department of the Institute of Psychiatry, Ain-Shams University hospitals over one and half year from the beginning of December 2016 to the end of June 2018.
All participants were subjected to a full neuropsychiatric history and examination then they were administered the Socio-Economic Status (SES) Scale to classify their socioeconomic level into very low, low, middle and high levels, the Arabic version of Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) to diagnose schizophrenia in patients and to exclude any psychiatric disorder among controls, the Arabic version of Structured Clinical Interview for DSM-IV-TR Axis II personality Disorders (SCID-II) to assess and diagnose personality disorders.
as well as two measures to assess 13 different type of CT which were the Arabic version of childhood trauma questionnaire (CTQ) and the Arabic version of childhood experience of care and abuse questionnaire (CECA -Q).
Then schizophrenic patients were subjected to the Positive and Negative Symptom Scale (PANSS) to assess the presence and severity of schizophrenia symptoms.
The study results showed that compared to controls, cases in our study were more often men, were older, were less likely to be married, were more likely to have a lower socioeconomic level and were more likely to have family history of mental illness. Yet these differences weren’t statistically significant except for having a family history of mental illness which was highly significant.
The study results showed that on inspecting both samples, it was evident that at the broad level, exposure to any childhood trauma was very common in both healthy controls and schizophrenia patients, but the severity of childhood trauma was much greater in the clinical sample. Also individuals exposed to more than one type of CT and severe degree of CT were vulnerable to schizophrenia. When research moves from this broad level to consider particular types of CT, patients with schizophrenia had a higher prevalence of physical abuse, sexual abuse, neglect, role reversal, house hold substance abuse and incarcerated household member with 77.1%, 41.6%, 41.6%, 41.6%, 30%, 28%, 21.6%of cases reported those types of childhood trauma compared to 37.1%, 13.2 %, 16.6%, 6.6%,14.5 %, 13%,11 % of controls respectively. While controls had a higher prevalence of parental loss or separation. Furthermore our findings indicated significantly higher levels of various forms of CT in the patient group relative to the control group.
To our knowledge, this was the first study from Egypt to explore the association between childhood trauma and schizophrenia. Our findings were consistent with reports linking the presence of a history of CT to nature, number and clinical levels of psychotic symptoms in patients with schizophrenia. As we found that CT appears to be associated with a specific symptom profile as well as personality profile in patients with schizophrenia. For example exposure to any childhood trauma was associated with hallucination, hostility, poor impulse control. Our findings didn’t only show the relationship between childhood trauma and schizophrenia symptoms, they also found a significant association CT and depression, anxiety, guilt feeling and suicidality in patients with schizophrenia. Moreover exposure to any childhood trauma was associated with a more severe symptoms in general and particularly positive symptoms and non- psychotic symptoms (but not negative symptoms). Also we found a negative association between exposure to any childhood trauma and premorbid or comorbid paranoid personality profile.
When we move to consider particular types of CT, there was also some evidence for some degree of specificity as different types of CT have a significant impact on symptomatology and personality profile of patients with schizophrenia. As we found that associations of CT with symptom domains weren’t consistent across different forms of CT. For example, sexual abuse (but not physical abuse) was associated particularly with hallucination, conceptual disorganization and hostility.
Also we demonstrated that emotional abuse, emotional neglect, physical neglect, domestic violence, house hold mental illness, incarcerated household member and house hold substance abuse exhibited associations with particular symptom dimensions of schizophrenia which were conceptual disorganization, grandiosity and hostility. These findings add further weight to the suggestion that there may be distinct pathways from specific forms of CT to particular types of psychotic symptoms.
Moreover sexual abuse, experience of parental separation or loss, role reversal and parent antipathy were associated with a more severe positive symptoms whereas role reversal and parent antipathy were additionally associated with a more severe negative symptoms.
Also we found that different types of CT appears to be associated with different personality profiles as we found that exposure to sexual abuse and parental loss or separation was associated with premorbid or comorbid antisocial personality profile, parent antipathy was associated with dependant personality profile, role reversal was associated with premorbid or comorbid schizotypal personality profile and witnessing mother treated violently (domestic violence) was associated with histrionic personality profile.
Moreover we found that the severity of CT was correlated with specific symptom dimensions (hallucination, conceptual disorganization, depression, anxiety and guilt feeling), symptom severity (dose response effect) and personality profile. As our study provided an evidence of a dose-response relationship between the cumulative number of traumatic experiences in childhood and the nature and number of symptoms in patients with schizophrenia but not the severity of symptoms except for negative correlation with severity of negative symptoms.
Thus our results were consistent with the concept that childhood trauma alters the presentation of schizophrenia. Our findings also didn’t only show the relationship between childhood trauma and schizophrenia symptoms, they also highlight the need to inquire about depression, anxiety, premorbid and comorbid personality profile and clinical features such as previous suicide attempts during clinical care of schizophrenia patients with a history of CT.
Traumatic experiences during childhood represent a major public health problem with approximately one to two thirds of the general population experience at least one form of CT as well as schizophrenia is among the world’s top ten causes of long-term disability. With many recent studies revealed a causal relationship between CT and psychosis in addition to many associations between different types of CT and specific symptom dimensions of schizophrenia.
The aim of this work was to compare the prevalence of CT between a sample of schizophrenic patients and healthy controls. And then to identify the impact of CT on symptom dimensions, symptom severity and personality profile of patients with schizophrenia.
This was conducted through a retrospective analytical case-control study done on 151 healthy controls and 166 patients with schizophrenia at outpatient clinics and inpatient department of the Institute of Psychiatry, Ain-Shams University hospitals over one and half year from the beginning of December 2016 to the end of June 2018.
All participants were subjected to a full neuropsychiatric history and examination then they were administered the Socio-Economic Status (SES) Scale to classify their socioeconomic level into very low, low, middle and high levels, the Arabic version of Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) to diagnose schizophrenia in patients and to exclude any psychiatric disorder among controls, the Arabic version of Structured Clinical Interview for DSM-IV-TR Axis II personality Disorders (SCID-II) to assess and diagnose personality disorders.
as well as two measures to assess 13 different type of CT which were the Arabic version of childhood trauma questionnaire (CTQ) and the Arabic version of childhood experience of care and abuse questionnaire (CECA -Q).
Then schizophrenic patients were subjected to the Positive and Negative Symptom Scale (PANSS) to assess the presence and severity of schizophrenia symptoms.
The study results showed that compared to controls, cases in our study were more often men, were older, were less likely to be married, were more likely to have a lower socioeconomic level and were more likely to have family history of mental illness. Yet these differences weren’t statistically significant except for having a family history of mental illness which was highly significant.
The study results showed that on inspecting both samples, it was evident that at the broad level, exposure to any childhood trauma was very common in both healthy controls and schizophrenia patients, but the severity of childhood trauma was much greater in the clinical sample. Also individuals exposed to more than one type of CT and severe degree of CT were vulnerable to schizophrenia. When research moves from this broad level to consider particular types of CT, patients with schizophrenia had a higher prevalence of physical abuse, sexual abuse, neglect, role reversal, house hold substance abuse and incarcerated household member with 77.1%, 41.6%, 41.6%, 41.6%, 30%, 28%, 21.6%of cases reported those types of childhood trauma compared to 37.1%, 13.2 %, 16.6%, 6.6%,14.5 %, 13%,11 % of controls respectively. While controls had a higher prevalence of parental loss or separation. Furthermore our findings indicated significantly higher levels of various forms of CT in the patient group relative to the control group.
To our knowledge, this was the first study from Egypt to explore the association between childhood trauma and schizophrenia. Our findings were consistent with reports linking the presence of a history of CT to nature, number and clinical levels of psychotic symptoms in patients with schizophrenia. As we found that CT appears to be associated with a specific symptom profile as well as personality profile in patients with schizophrenia. For example exposure to any childhood trauma was associated with hallucination, hostility, poor impulse control. Our findings didn’t only show the relationship between childhood trauma and schizophrenia symptoms, they also found a significant association CT and depression, anxiety, guilt feeling and suicidality in patients with schizophrenia. Moreover exposure to any childhood trauma was associated with a more severe symptoms in general and particularly positive symptoms and non- psychotic symptoms (but not negative symptoms). Also we found a negative association between exposure to any childhood trauma and premorbid or comorbid paranoid personality profile.
When we move to consider particular types of CT, there was also some evidence for some degree of specificity as different types of CT have a significant impact on symptomatology and personality profile of patients with schizophrenia. As we found that associations of CT with symptom domains weren’t consistent across different forms of CT. For example, sexual abuse (but not physical abuse) was associated particularly with hallucination, conceptual disorganization and hostility.
Also we demonstrated that emotional abuse, emotional neglect, physical neglect, domestic violence, house hold mental illness, incarcerated household member and house hold substance abuse exhibited associations with particular symptom dimensions of schizophrenia which were conceptual disorganization, grandiosity and hostility. These findings add further weight to the suggestion that there may be distinct pathways from specific forms of CT to particular types of psychotic symptoms.
Moreover sexual abuse, experience of parental separation or loss, role reversal and parent antipathy were associated with a more severe positive symptoms whereas role reversal and parent antipathy were additionally associated with a more severe negative symptoms.
Also we found that different types of CT appears to be associated with different personality profiles as we found that exposure to sexual abuse and parental loss or separation was associated with premorbid or comorbid antisocial personality profile, parent antipathy was associated with dependant personality profile, role reversal was associated with premorbid or comorbid schizotypal personality profile and witnessing mother treated violently (domestic violence) was associated with histrionic personality profile.
Moreover we found that the severity of CT was correlated with specific symptom dimensions (hallucination, conceptual disorganization, depression, anxiety and guilt feeling), symptom severity (dose response effect) and personality profile. As our study provided an evidence of a dose-response relationship between the cumulative number of traumatic experiences in childhood and the nature and number of symptoms in patients with schizophrenia but not the severity of symptoms except for negative correlation with severity of negative symptoms.
Thus our results were consistent with the concept that childhood trauma alters the presentation of schizophrenia. Our findings also didn’t only show the relationship between childhood trauma and schizophrenia symptoms, they also highlight the need to inquire about depression, anxiety, premorbid and comorbid personality profile and clinical features such as previous suicide attempts during clinical care of schizophrenia patients with a history of CT.