Childhood trauma and treatment outcome in bipolar disorder
Childhood trauma and treatment outcome in bipolar disorder
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DOI：
10.1080/15299732.2015.1132489
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发表时间：
2016-01-01
影响因子：
3.3
通讯作者：
Sar, Vedat
中科院分区：
文献类型：
--
作者：
Cakir, Sibel;Durak, Rumeysa Tasdelen;Sar, Vedat
本研究的目的是调查儿童创伤对双相情感障碍的临床表现、精神共病和长期治疗结果的潜在影响。从一个正在进行的前瞻性随访项目中招募了135名连续的I型双相情感障碍患者。所有参与者都接受了儿童创伤问卷和DSM-IV轴I障碍结构化临床访谈。对长期治疗的反应是从前瞻性随访项目的生命表记录中确定的。在长期锂治疗反应良好和不良组之间，儿童创伤评分没有显著差异。然而，对长期抗惊厥治疗反应差的人，情感和身体虐待得分较高。终生诊断的创伤后应激障碍(PTSD)与锂治疗和抗抑郁药物的使用反应差有关，但与抗惊厥药物治疗的反应无关。童年创伤总分与终生共病精神障碍的总数、抗抑郁药物的使用以及精神病特征的存在有关。所有类型的儿童期虐待与终生共病精神病诊断的总数之间存在显著的相关性。身体上的忽视与情绪发作的平均严重程度和精神特征有关，而情感上的忽视与自杀企图有关。在双相情感障碍的长期治疗中，童年创伤或创伤后应激障碍的病史可能是一个不良的预后因素。虽然童年的虐待经历似乎会导致疾病的分裂(共病)，但童年的忽视往往会导致情绪发作的严重程度。
The aim of the present study was to investigate the potential influence of childhood trauma on clinical presentation, psychiatric comorbidity, and long-term treatment outcome of bipolar disorder. A total of 135 consecutive patients with bipolar disorder type I were recruited from an ongoing prospective follow-up project. The Childhood Trauma Questionnaire and the Structured Clinical Interview for DSM-IV Axis I Disorders were administered to all participants. Response to long-term treatment was determined from the records of life charts of the prospective follow-up project. There were no significant differences in childhood trauma scores between groups with good and poor responses to long-term lithium treatment. Poor responders to long-term anticonvulsant treatment, however, had elevated emotional and physical abuse scores. Lifetime diagnosis of posttraumatic stress disorder (PTSD) was associated with poor response to lithium treatment and antidepressant use but not with response to treatment with anticonvulsants. Total childhood trauma scores were related to the total number of lifetime comorbid psychiatric disorders, antidepressant use, and the presence of psychotic features. There were significant correlations between all types of childhood abuse and the total number of lifetime comorbid psychiatric diagnoses. Whereas physical neglect was related to the mean severity of the mood episodes and psychotic features, emotional neglect was related to suicide attempts. A history of childhood trauma or PTSD may be a poor prognostic factor in the long-term treatment of bipolar disorder. Whereas abusive experiences in childhood seem to lead to nosological fragmentation (comorbidity), childhood neglect tends to contribute to the severity of the mood episodes.