Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients
Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients
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DOI：
10.1017/s0033291715000690
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发表时间：
2015-10-01
影响因子：
6.9
通讯作者：
Conus, P.
中科院分区：
文献类型：
--
作者：
Alameda, L.;Ferrari, C.;Conus, P.
背景有证据表明，儿童时期暴露于创伤与精神病患者的功能障碍之间存在关系。然而，在早期精神病（EP）患者中，暴露时年龄的影响尚未得到充分研究。在基线和治疗2、6、18、24、30和36个月后评估了225例年龄为18-35岁的患者。暴露于性和/或身体虐待（SPA）的患者根据首次暴露时的年龄进行分类（早期SPA：11岁之前;晚期SPA：12至15岁），然后与未暴露于此类创伤的患者（非SPA）进行比较。随访期间采用病前适应量表（PAS）、总体功能评定量表（GAF）和社会与职业功能评定量表（SOFAS）评定患者病前功能水平。有24.8%的患者有记录的SPA病史。晚期SPA患者更可能是女性（p = 0.010）。与非SPA患者比较发现：（1）早期和晚期SPA患者在青春期早期的病前社会功能均较差;（2）早期SPA患者在随访时的功能水平较差，GAF评分较低（p = 0.025），SOFAS评分较低（p = 0.048），而晚期SPA患者则没有。我们的研究结果表明，暴露于SPA和疾病发作前的社会功能障碍之间存在联系。在12岁之前暴露于SPA的EP患者可能会出现长期的功能障碍，而在较晚年龄暴露的患者可能会在这方面有所改善，并具有更好的功能结局。
Background. Evidence suggests a relationship between exposure to trauma during childhood and functional impairments in psychotic patients. However, the impact of age at the time of exposure has been understudied in early psychosis (EP) patients.Method. Two hundred and twenty-five patients aged 18-35 years were assessed at baseline and after 2, 6, 18, 24, 30 and 36 months of treatment. Patients exposed to sexual and/or physical abuse (SPA) were classified according to age at the time of first exposure (Early SPA: before age 11 years; Late SPA: between ages 12 and 15 years) and then compared to patients who were not exposed to such trauma (Non-SPA). The functional level in the premorbid phase was measured with the Premorbid Adjustment Scale (PAS) and with the Global Assessment of Functioning (GAF) scale and the Social and Occupational Functioning Assessment Scale (SOFAS) during follow-up.Results. There were 24.8% of patients with a documented history of SPA. Late SPA patients were more likely to be female (p = 0.010). Comparison with non-SPA patients revealed that: (1) both Early and Late SPA groups showed poorer premorbid social functioning during early adolescence, and (2) while patients with Early SPA had poorer functional level at follow-up with lower GAF (p = 0.025) and lower SOFAS (p = 0.048) scores, Late SPA patients did not.Conclusion. Our results suggest a link between exposure to SPA and the later impairment of social functioning before the onset of the disease. EP patients exposed to SPA before age 12 may present long-lasting functional impairment, while patients exposed at a later age may improve in this regard and have a better functional outcome.