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

Abstract

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.

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

“…Accordingly, our findings showing mediation by PTSD symptoms in clinical samples (Choi et al, 2015;Hardy et al, 2016;Peach et al, 2019) are consistent with reports suggesting that similar mechanisms could be involved in psychotic experiences and symptoms of PTSD. For instance, it has been suggested that some hallucinations represent a dissociated type of posttraumatic intrusion, which may not be recognised as such by people with psychosis (Allen et al, 1997;Moskowitz et al, 2009).…”

“…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.…”

“…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, Eurelings-Bontekoe, & Selten, 2019; Styła, Stolarski, & Szymanowska, 2019; Van Dam, Korver-Nieberg, Velthorst, Meijer, & de Haan, 2014; Varese, Barkus, & Bentall, 2012a; Weijers et al, 2018; Wickham & Bentall, 2016) 27 in GP (Ashford, Ashcroft, & Maguire, 2012; Bortolon & Raffard, 2018; Bortolon, Seillé, & Raffard, 2017; Boyda & McFeeters, 2015; Boyda, McFeeters, Dhingra, & Rhoden, 2018; Cole, Newman-Taylor, & Kennedy, 2016; Fisher, Appiah-Kusi, & Grant, 2012, 2013; Gawęda, Göritz, & Moritz, 2019; Gibson, Reeves, Cooper, Olino, & Ellman, 2019; Goodall, Rush, Grünwald, Darling, & Tiliopoulos, 2015; Jaya, Ascone, & Lincoln, 2017; Lincoln, Marin, & Jaya, 2017; Marwaha & Bebbington, 2015; Marwaha, Broome, Bebbington, Kuipers, & Freeman, 2014; McCarthy-Jones, 2018; Mętel et al, 2020; Murphy, Murphy, & Shevlin, 2015; 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.…”

A Systematic Review on Psychological and Biological Mediators Between Adversity and Psychosis: Potential Targets for Treatment

“…Twenty-one studies were conducted in clinical samples (four in First Episode of Psychosis (FEP) or early psychosis patients [33][34][35][36] , three in Ultra High Risk (UHR) patients [37][38][39] , 14 in non-FEP patients 40-53 26 This total number of analyses excludes two studies with an extremely high number of analyses ((one used a network based approach exploring multiple connections between adversity and symptoms 80 , the other included up to 28 54 ). These studies would have distorted the numerical summaries and therefore are described in the text only.…”

“…53% of analyses overall showed evidence of mediation in this category. In terms of papers, 15/20 were supportive of mediation 33,35,37,38,54,55,57,60,62,64,69,71,76,86,87 , 5/20 were not 34,59,70,78,88 . Results were more likely to show evidence of mediation when conducted in the general population, compared with clinical samples (65% versus 38% of analyses were supportive of mediation respectively, see Table 1).…”