Presentation Jiwo

7/31/2019 Presentation Jiwo

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Relationship Between Childhood Adversity AndClinical And Cognitive Features In Schizophrenia

Presented By:

Redha Cipta Utama, S.Ked

Arini Rafiqoh Asri, S.Ked

Yudha Fadhol Arafah, S.Ked

Kathryn L. McCabe , Elizabeth A. Maloney , Helen J. Stain , Carmel M. Loughland , Vaughan J. Carr

Journal of Psychiatric Research 46 (2012) 600e607

Kepaniteraan Klinik Ilmu Kedokteran Jiwa

Fakultas Kedokteran

Universitas Muhammadiyah Surakarta

Pembimbing:

dr Ana Yuliani


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Elevated risk for a wide range of adult psychiatric

disorders , negative effects on adult behavioural,

personality disorder, & social functioning

In schizophrenia, CA earlier first admissions, longer and more

frequent hospitalizations, more medication, increased likelihood of self

harm and higher global symptom severity

Severity of psychotic clinical symptoms is increased in schizophreniapatients who report abuse in childhood

Associations between childhood adversity and both IQ and symptom

ratings are reported.

Childhood

Adversity (CA)

Physical or emotional acts

that are potentially

harmful, or insensitive to

a childs development


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People with schizophrenia would report a greater number of

childhood adversities than healthy controls

Experience of childhood adversity would be associated with

increased positive symptoms in schizophrenia, but not negative

symptoms

CA would be associated with greater intellectual impairmet

CA higher rates in cluster A and cluster B personality

(schizophrenia and controls)

Hypotheses

To assess rates of retrospectively reported childhood adversity

among adults with schizophrenia and to examine the

relationship between childhood adversity and clinical and

cognitive features.


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Included

Sz & HC 18-65 years old

Sz Dx.psychosis from Diagnostic

Interview Of Psychosis

Excluded

Control participants were excluded from

the study if they reported a family history

of schizophrenia or bipolar disorder and a

personal history of psychosis.


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Sampels 675 adults (18 - 65 yrs)

408 schizophrenia participants (Sz) (males 268)

267 healthy control (HC) (males 116)

Assessments of medical and family history,

& neurocognitive function

Diagnostic interview of psychosis

(DIP), ICD-10 criteria (WHO1992)

Schizophrenia Healthy Control

Childhood Adversity Questionnaire (CAQ) CAQ 20 items: 6 Measure lack of parental (affection,

nervous, emotional or depressive,substance

abuse problems;

2 Record household conflict and

tension,parental divorce or separation;

9 measure abuse, neglect and authoritarian

upbringing;

3 items assess aspects of parental

indifference

The International Personality Disorder Examination (IPDE)

Scale for the Assessment of Negative Symptoms (SANS)

Global Assessment of Functioning (GAF)

Asses with:

Statistical Analyses


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Socio-Demographic And Cognitive Characteristics Of The Sample


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Prevalence Of Childhood Adversity Items For

Schizophrenia Participants (Sz) And Controls (C).


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Contd.... Prevalence Of Childhood Adversity Items For Schizophrenia

Participants (Sz) And Controls (C).


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Comparison Of Proportion Of Schizophrenia Participants

And Controls For Each Childhood Adversity Factor


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IQ, Personality Disorders And Childhood Adversity Among

Schizophrenia Participants And Controls.


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First Hypothesis The result of research concluded that

Sz associated with increased reporting

of CA events compared to HC

Increased Of CA psychiatric disorder (Johnson et.al 1999),

depression (Spinhoven et.al 2010), substance abuse (Conroy,2009)

Childhood adversity (CA)

1. Sc with positive symptomps2. Increased risk of a range of psychopathologies


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Demographic associations and factor structure of the

childhood adversity questionnaire

Conflicting gender evidence is reported from developing countries with a

slightly higher risk of child abuse for male children (Akmatov, 2011)

Childhood adversity did not influence the likelihood of being married or

having gained employment; however, being female (and older)wasassociated with more childhood adversity in both groups

the data reported here does not show support for a differential influence by

gender or age on rates of childhood adversity in schizophrenia.

Three factors comprising abuse or neglect items (Green et al., 2010).

1. Maladaptive family functioning

2. Loss and economic adversity, and

3. Divorce and economic adversity


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In the current study, Sz participants, relative to

controls, were significantly more likely to report

experiences of childhood adversity for factors

Abusive Parenting, Neglectful Parenting and

Dysfunctional Parenting.

This is consistent with the findings of Green et al.

(2010) who found most adversity items loaded on

the first factor termed maladaptive family

functioning (e.g., parental substance abuse,criminality, domestic violence, abuse and neglect).


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Childhood adversity, symptoms and IQ

Van OS (2009), Lardinois et.al (2011),

Dominguez (2009)Traumatic experience (CA)

Greater odds of prevalent and incident experiences of

psychotic and sub-clinical psychotic experiences

Increased sensitivity to stress is a likely consequence of

childhood adversity

Vulnerability marker for the development of psychosis

Anomalies in early development and impaired cognition& neurodevelopmental dysfunction

(Meyer-Lindenberg et al., 2001),

(Dominguez et al., 2009a)


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Previous studies...

Severe childhood abuse linked with lower IQ and cognitive deficits

(Koenen et al., 2003; Pears and Fisher, 2005; Nolin and Ethier, 2007; Mills et al., 2011; Ritchie et al., 2011).

Early adversity is associated with lower cognitive ability in childhood, is

sustained to midlife and is independent of social background

(Richards and Wadsworth, 2004)

Prolonged childhood trauma has been shown to cause structural andneurochemical abnormalities in the brain and nervous system (Anda et

al., 2006), linking childhood adversity with dysfunction in brain regions

implicated in learning and memory (Bremner et al., 2003); (Pluck et al.,

2010) and structural brain alterations in hypothalamic-pituitary-adrenal

(HPA) axis functioning (Heim et al., 2000) and glucocorticoid

dysregulation.


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No inverse relationship between childhood adversity and intellectual

function in participants with this diagnosis.

This reserach conclude...

Others also report no association between IQ (Schenkel et al., 2005) or

cognitive functioning (Aas et al., 2011) and childhood adversity in

schizophrenia samples.

Aas et al. (2011) found an association between childhood trauma and

cognitive function in first episode affective psychosis but not in first

episode schizophrenia, notwithstanding the fact that the latter group

reported the highest frequency of childhood trauma. It is likely that our

findings and those of others reflect a floor effect in schizophrenia in which

any effects of childhood adversity on intellectual functioning are maskedby the magnitude of the cognitive deficits inherent in schizophrenia itself.


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Childhood adversity and personality traits

Personality clusters A, B and C were all significantly associated withincreased rates of childhood adversity in schizophrenia and controls.

Predominantly related to

Abusive Parenting (Factor 1),

Neglectful Parenting (Factor 3)

and, Dysfunctional Parenting

(Factor 4)

CLUSTER C

The association of Cluster A personality

traits with Abusive Parenting (Factor 1)in schizophrenia partially confirmed our

fifth hypothesis, but the absence of an

association between this factor and

Cluster A in controls was contrary to our

prediction.


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Among participants with schizophrenia, positive symptom

severity and fewer years of education were associated with

childhood adversity. Lower IQ scores and personality traits

were associated with reporting a greater number of

childhood adversities and with adversity sub-types of abusive,

neglectful and dysfunctional parenting. The rate of childhoodadversity reported in this sample was high which suggests

greater exposure to adverse childhood events among

participants with schizophrenia in comparison with healthy

controls. We identified unique groups amongst CAQ itemsthat provided a salient framework from which to investigate

the connection between childhood adversity and clinical and

cognitive features.

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