Complex PTSD as mediator of psychosis after childhood trauma.
Complex PTSD as mediator of psychosis after childhood trauma.
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复杂的 PTSD 作为童年创伤后精神病的中介。
DOI：
10.1016/s2215-0366(23)00302-4
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Groenewold,NynkeA
中科院分区：
文献类型：
--
作者：
Groenewold,NynkeA
发展性创伤或童年创伤在全球非常普遍。这是一个普遍存在的问题，经常发生在封闭的家庭大门后面。暴露的儿童患精神病理的风险增加，如创伤后应激、抑郁和精神障碍。1精神病与精神障碍的关联一直存在争议，因为精神病状态下的回忆以前被认为是不可靠的，但越来越多的经验证据表明，童年创伤在精神障碍患者中非常普遍。Ava Mason及其同事在《柳叶刀精神病学》上发表的一项新研究调查了创伤后应激障碍（PTSD）和复杂创伤后应激障碍作为发展性创伤和精神病之间关系的中间产物。作者发现，在英国和韩国的两个独立的发育性创伤成人样本中，复杂的PTSD （β= 22.62 [SE 1.65]; p< 0.0001）与总精神病症状严重程度相关，而PTSD （β= -2·40 [SE 3.28]; p= 0.47）与总精神病症状严重程度无关，即使在调整了创伤暴露的严重程度之后也是如此。尽管作者最初假设创伤后应激障碍和复杂的创伤后应激障碍都与精神病症状的严重程度有关，但他们的研究结果并不支持这一假设。PTSD的效应量很小，提示无效效应，尽管由于样本量小，估计不确定（PTSD n= 64 [5%] vs复杂PTSD n= 528[42%]）。与复杂创伤后应激障碍相比，效应大小的差异以及在高度不同的环境下的独立复制表明，可能与复杂创伤后应激障碍有独特的联系。此外，在区分复杂和非复杂创伤后应激障碍的所有三个症状领域（即情感失调、消极自我概念和关系障碍）的研究结果的一致性显示了这种关联的稳健性。如果这一结论得到证实，那么复杂的创伤后应激障碍（而非单独的创伤后应激障碍）是精神病症状严重程度的驱动因素，可能有助于发现有发展性创伤史的个体的精神病早期表现，并确定可能的机制，如侵入、分离、消极的自我形象和社会关系的破裂，这些可能是干预的目标。先前在临床和人群样本中进行的几项调查已经确定PTSD是儿童创伤和成年期精神病发展之间的有效中介。考虑到最近ICD-11对复杂创伤后应激障碍的定义和专用测量仪器的相关验证，以及dsm - 5,8中对复杂创伤后应激障碍的遗漏，当前的研究很重要。在更大规模的纵向研究数据可用之前，这项横断面调查是建立复杂创伤后应激障碍作为中介的证据基础的第一步。从预防的角度来看，关键是要确定在复杂的PTSD患者中可以检测到发病前和前驱精神病症状，因为这意味着有机会进行干预，可以预防充分的创伤后应激障碍
Developmental trauma, or childhood trauma, is highly prevalent across the globe. It is an ubiquitous problem that often takes place behind closed family doors. Exposed children have an increased risk for developing psychopathology, such as post-traumatic stress, depressive, and psychotic disorders. 1 The association with psychotic disorders has been under debate as recollections in a psychotic state were previously deemed unreliable, but empirical evidence has been accumulating showing that childhood trauma is highly prevalent in individuals with psychotic disorders. 2, 3 A new study by Ava Mason and colleagues4 in The Lancet Psychiatry investigated post-traumatic stress disorder (PTSD) and complex PTSD as intermediates in the relationship between developmental trauma and psychosis. The authors found that complex PTSD (β= 22· 62 [SE 1· 65]; p< 0· 0001) but not PTSD (β=–2· 40 [SE 3· 28]; p= 0· 47) was associated with total psychotic symptom severity in two independent samples of adults with developmental trauma from the UK and South Korea, even after adjustment for severity of trauma exposure. Whereas the authors originally hypothesised that both PTSD and complex PTSD would be associated with total psychotic symptom severity, their findings did not support this. The effect size for PTSD was small and suggestive of a null effect, although the estimate was uncertain due to the small sample size (PTSD n= 64 [5%] vs complex PTSD n= 528 [42%]). The difference in effect size compared to complex PTSD and the independent replication in a highly different setting suggest that there might be a unique association with complex PTSD. Furthermore, the consistency in findings across all three symptom domains that discriminate complex from non-complex PTSD (ie, affective dysregulation, negative self-concept, and relationship disturbance) show the robustness of this association. If confirmed, the suggestion that complex PTSD but not PTSD alone is the driver of psychotic symptom severity could help to detect early manifestations of psychosis in individuals with a history of developmental trauma, and to identify possible mechanisms such as intrusions, dissociation, negative self-image, and the breakdown of social relationships, which can be targets for intervention. 5, 6 Several previous investigations in clinical and population samples have identified PTSD as a potent mediator between childhood trauma and the development of psychosis in adulthood. 5 Given the recent ICD-11 definition of complex PTSD and associated validation of dedicated measurement instruments, 7 as well as the omission of complex PTSD from DSM-5, 8 the current study is important. This crosssectional investigation is a first step in establishing an evidence base for complex PTSD as mediator before data from larger longitudinal studies become available. From a prevention perspective, it is key to establish that premorbid and prodromal psychotic symptoms can be detected in patients with complex PTSD, as these imply an opportunity for intervention that could prevent full
影响因子：
64.3
作者：
Mason，Ava J. C.;Jung，Paul;Bloomfield，Michael
通讯作者：
Bloomfield，Michael
对童年逆境与成人精神疾病之间关系的修订和扩展系统回顾和荟萃分析。
影响因子：
4.8
作者：
M. McKay;Leah Kilmartin;Alexandra Meagher;M. Cannon;C. Healy;M. Clarke
通讯作者：
M. Clarke
童年和青春期的创伤经历：评估精神病风险的前瞻性研究的荟萃分析
影响因子：
6.4
作者：
A. Pastore;G. de Girolamo;S. Tafuri;Aldo Tomasicchio;F. Margari
通讯作者：
F. Margari