Does dissociation mediate the relationship between childhood trauma and hallucinations, delusions in first episode psychosis?

Sun, Pamela; Álvarez‐Jiménez, Mario; Simpson, Katrina; Lawrence, Katherine; Peach, Natalie; Bendall, Sarah

doi:10.1016/j.comppsych.2018.04.004

Cited by 29 publications

(27 citation statements)

References 51 publications

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“…Twenty-one studies were conducted in clinical samples [four in First Episode of Psychosis (FEP) or early psychosis patients (Evans, Reid, Preston, Palmier-Claus, & Sellwood, 2015;Morgan et al, 2014;Peach, Alvarez-Jimenez, Cropper, Sun, & Bendall, 2019;Sun et al, 2018), three in Ultra High Risk (UHR) patients (Appiah-Kusi et al, 2017;McDonnell, Stahl, Day, McGuire, & Valmaggia, 2018;Thompson et al, 2016), 14 in non-FEP patients (Cancel et al, 2015;Chatziioannidis et al, 2019;Choi et al, 2015;Hardy et al, 2016;Isvoranu et al, 2017;Perona-Garcelán et al, 2012;Quidé, O'Reilly, Watkeys, Carr, & Green, 2018;Schalinski et al, 2019;Steenkamp, Weijers, Gerrmann Perona-Garcelán et al, 2014;Pinto-Gouveia, Matos, Castilho, & Xavier, 2014;Rössler, Ajdacic-Gross, Rodgers, Haker, & Müller, 2016;Sheinbaum, Kwapil, & Barrantes-Vidal, 2014;Shevlin, McElroy, & Murphy, 2015;Sitko, Bentall, Shevlin, O'Sullivan, & Sellwood, 2014;van Nierop et al, 2014;Wolke, Lereya, Fisher, Lewis, & Zammit, 2014;Yamasaki et al, 2016)]. Our review included 82 352 subjects from the GP and 3189 subjects from clinical studies.…”

Section: Resultsmentioning

confidence: 99%

“…As illustrated in Fig. 1, most of the studies showing evidence of mediating effects used hallucinations as an outcome and explored trauma as a composite score (Bortolon et al, 2017;Cole et al, 2016;Gibson et al, 2019;Perona-Garcelán et al, 2012Varese et al, 2012a;Yamasaki et al, 2016), while only two (Cole et al, 2016;Sun et al, 2018) studies found positive effects with delusions as an…”

Section: Dissociationmentioning

confidence: 99%

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A systematic review on mediators between adversity and psychosis: potential targets for treatment

et al. 2020

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Various psychological and biological pathways have been proposed as mediators between childhood adversity (CA) and psychosis. A systematic review of the evidence in this domain is needed. Our aim is to systematically review the evidence on psychological and biological mediators between CA and psychosis across the psychosis spectrum. This review followed PRISMA guidelines. Articles published between 1979 and July 2019 were identified through a literature search in OVID (PsychINFO, Medline and Embase) and Cochrane Libraries. The evidence by each analysis and each study is presented by group of mediator categories found. The percentage of total effect mediated was calculated. Forty-eight studies were included, 21 in clinical samples and 27 in the general population (GP) with a total of 82 352 subjects from GP and 3189 from clinical studies. The quality of studies was judged as ‘fair’. Our results showed (i) solid evidence of mediation between CA and psychosis by negative cognitive schemas about the self, the world and others (NS); by dissociation and other post-traumatic stress disorder symptoms; and through an affective pathway in GP but not in subjects with disorder; (iii) lack of studies exploring biological mediators. We found evidence suggesting that various overlapping and not competing pathways involving post-traumatic and mood symptoms, as well as negative cognitions contribute partially to the link between CA and psychosis. Experiences of CA, along with relevant mediators should be routinely assessed in patients with psychosis. Evidence testing efficacy of interventions targeting such mediators through cognitive behavioural approaches and/or pharmacological means is needed in future.

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Section: Resultsmentioning

confidence: 99%

Section: Dissociationmentioning

confidence: 99%

A systematic review on mediators between adversity and psychosis: potential targets for treatment

et al. 2020

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“…We consider biases potentially introduced through the sampling method and the use of the retrospective self-report measure of childhood trauma, which risks inaccurate reporting of past traumatic experiences, to be minimal. In particular, the reliability and validity of retrospective childhood trauma self-reporting have been adequately demonstrated in people with psychosis (Fisher et al, 2011;Simpson et al, 2018). Our measurement of hallucinations and delusions was limited to the use of a small number of items on the PANSS scale (one item for hallucinations, two for delusions); more thorough measures of these symptoms would be preferable.…”

Section: Discussionmentioning

confidence: 99%

“…This study was part of a larger study investigating relationships between psychotic symptoms, dissociation, PTSD, and symptom content in a group with first episode psychosis (Sun et al, 2018). The data reported here form part of the primary analyses.…”

Section: Methodsmentioning

confidence: 99%

Testing models of post‐traumatic intrusions, trauma‐related beliefs, hallucinations, and delusions in a first episode psychosis sample

Peach

Álvarez‐Jiménez

Cropper

et al. 2018

British J Clinic Psychol

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Objective There is increasing evidence that childhood trauma may play a role in the aetiology of psychosis. Cognitive models implicate trauma‐related symptoms, specifically post‐traumatic intrusions and trauma‐related beliefs as primary mechanisms, but these models have not been extensively tested. This study investigated relationships between childhood trauma, psychotic symptoms (hallucinations and delusions), post‐traumatic intrusions, and trauma‐related beliefs while accounting for comorbid symptoms. Methods Sixty‐six people with first episode psychosis aged between 15 and 24 years were assessed for hallucinations, delusions, childhood trauma, post‐traumatic intrusions, post‐traumatic avoidance, and trauma‐related beliefs. Results Fifty‐three per cent of the sample had experienced childhood trauma, and 27% met diagnostic criteria for post‐traumatic stress disorder. Both post‐traumatic intrusions and trauma‐related beliefs mediated the relationships between childhood trauma and hallucinations, and childhood trauma and delusions. Multiple regression analyses revealed that post‐traumatic intrusions (but not childhood trauma, post‐traumatic avoidance, or trauma‐related beliefs) were independently associated with hallucination severity (β = .53, p = .01). Post‐traumatic intrusions and trauma‐related beliefs (but not childhood trauma or post‐traumatic avoidance) were independently associated with delusion severity (β = .67, p < .01 and β = .34, p < .01, respectively). Conclusions These findings support cognitive models that implicate post‐traumatic intrusions in hallucination aetiology, and post‐traumatic intrusions and trauma‐related beliefs in delusion aetiology. The results suggest that trauma and post‐traumatic stress disorder, including trauma‐related beliefs, should be addressed in the assessment and treatment of people with early psychosis. Practitioner points Trauma and post‐traumatic stress disorder, including trauma‐related beliefs, should be addressed in the assessment and treatment of people with early psychosis. Routine assessment of childhood trauma and PTSD in clinical services dealing with young people with first episode psychosis is needed. These findings support cognitive models of trauma and hallucinations and delusions.

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“…Traumatic experiences in childhood are now an acknowledged risk factor for psychotic symptoms and disorders (Bailey et al, 2018;Varese et al, 2012). In those with a psychotic disorder, associations between dissociative experiences and childhood adversity is a common finding (Braehler et al, 2013;Ross & Keyes, 2004;Sun et al, 2018). Those with psychosis and a history of childhood trauma experienced significantly more severe dissociative symptoms on a selfreport measure of dissociation than those without a trauma history (Perona-Garcelán et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Investigating the prevalence of dissociative disorders and severe dissociative symptoms in first episode psychosis

Sun

Álvarez‐Jiménez

Lawrence

et al. 2018

Early Intervention Psych

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Aim Increasing evidence suggests that childhood trauma and dissociation are associated with psychotic symptoms and disorders. Significant rates of dissociative disorders and clinical levels of dissociative symptoms are found in chronic schizophrenia. To date, no studies have examined the prevalence of these in a first episode psychosis (FEP) group. This study aimed to investigate the prevalence of dissociative disorders and symptoms in a FEP sample as well as the prevalence of severe dissociative symptoms in those with or without experiences of childhood trauma. Methods Sixty‐six young people with FEP completed a research interview which included the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) Axis I Disorders, Childhood Trauma Questionnaire and the Structured Clinical Interview for DSM‐IV Dissociative Disorders‐Revised. Results Dissociative symptoms at clinical levels were found in 36.4% of the sample. Furthermore, 13.6% of the sample met diagnostic criteria for a lifetime dissociative disorder. Significant differences in the frequency of clinical dissociative symptoms between those with or without childhood trauma were also found. Conclusions Dissociative symptoms should be routinely assessed for in early intervention settings, especially in cases where childhood trauma is disclosed or suspected. Where present, dissociative symptoms should also be incorporated into subsequent case formulation and treatment planning.

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Does dissociation mediate the relationship between childhood trauma and hallucinations, delusions in first episode psychosis?

Cited by 29 publications

References 51 publications

A systematic review on mediators between adversity and psychosis: potential targets for treatment

A systematic review on mediators between adversity and psychosis: potential targets for treatment

Testing models of post‐traumatic intrusions, trauma‐related beliefs, hallucinations, and delusions in a first episode psychosis sample

Investigating the prevalence of dissociative disorders and severe dissociative symptoms in first episode psychosis

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