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It is clinically imperative to better understand the relationship between trauma, auditory hallucinations and dissociation. The personal narrative of trauma has enormous significance for each individual and is also important for the clinician, who must use this information to decide on a diagnosis and treatment approach.
To better understand whether dissociation contributes in a significant way to hallucinations in individuals with and without trauma histories.
Three groups of participants with auditory hallucinations were recruited, with diagnoses of: schizophrenia (without trauma) (n = 18), post-traumatic stress disorder (PTSD, n = 27) and comorbid schizophrenia and PTSD (SCZ+PTSD), n = 26). Clinician-administered measures included the PTSD Symptoms Scale Interview (PSSI-5), the Clinician-Administered Dissociative States Scale (CADSS) and the Psychotic Symptom Rating Scales (PSYRATS).
Dissociative symptoms were significantly higher in participants with trauma histories (PTSD and SCZ+PTSD groups) and significantly correlated with hallucinations in trauma-exposed participants, but not in participants with schizophrenia (without trauma history). Hallucination severity was correlated with the CADSS amnesia subscale score, but depersonalisation and derealisation were not.
Dissociation may be a mechanism in trauma-exposed individuals who hear voices, but it does not explain all hallucinatory experiences. The SCZ+PTSD group were in an intermediary position between schizophrenia and PTSD on dissociative and hallucination measures. The PTSD and SCZ+PTSD groups experienced dissociative phenomena much more frequently than the schizophrenia group, with a significant trend towards the amnesia subtype of dissociation.
Grey matter and other structural brain abnormalities are consistently
reported in first-onset schizophrenia, but less is known about the extent
of neuroanatomical changes in first-onset affective psychosis
To determine which brain abnormalities are specific to (a) schizophrenia
and (b) affective psychosis
We obtained dual-echo (proton density/T2-weighted) magnetic resonance
images and carried out voxel-based analysis on the images of 73 patients
with first-episode psychosis (schizophrenia n=44,
affective psychosis n=29) and 58 healthy controls
Both patients with schizophrenia and patients with affective psychosis
had enlarged lateral and third ventricle volumes. Regional cortical grey
matter reductions (including bilateral anterior cingulate gyrus, left
insula and left fusiform gyrus) were evident in affective psychosis but
not in schizophrenia, although patients with schizophrenia displayed
decreased hippocampal grey matter and increased striatal grey matter at a
more liberal statistical threshold
Both schizophrenia and affective psychosis are associated with volumetric
abnormalities at the onset of frank psychosis, with some of these evident
in common brain areas
This chapter compares and contrasts the characteristics of patients presenting for the first time with a schizophrenia-like illness at the extremes of life. Unless otherwise stated, ‘childhood onset’ refers to illness onset in childhood (0-12 years) and ‘adolescent onset’ to onset roughly between ages 13 and 18 years (Werry, 1992). The term ‘early onset’ is used for both childhood- and adolescent-onset schizophrenia. Very-late-onset (or ‘late paraphrenia’) illness is taken as onset after the age of 60 years (Roth, 1955). The chapter details the epidemiology, gender differences, phenomenology, risk factors (including premorbid functioning), outcome and treatment for early- and very-late-onset schizophrenia in turn, pointing up areas of similarity as well as important differences in these domains. This is summarized in Tables 9.1 and 9.2. In the concluding section, we address the issue of whether the similarities outweigh the differences, how far the differences can be considered merely a reflection of the same illness impinging upon the individual at different developmental/degenerative phases of life, and to what extent the differences might point to early- and very-late-onset illnesses being, in fact, discrete entities.
Research into the prevalence and incidence of schizophrenia in early life has been infrequent and often incomplete. This is a consequence, in part, of the rarity of the disorder, particularly in childhood.
After having been very abundant in the Early Maastrichtian Globotruncana gansseri zone, Inoceramus remains disappear from five stratigraphic sections in the Basque region of France and Spain in the lower Abathomphalus mayaroensis zone, ~2.5 m.y. before the Cretaceous–Tertiary boundary. Several lines of evidence demonstrate that these shell fragments are preserved in place and accurately record the pattern of the decline and disappearance of the group. The dominant taphonomic process seems to have been passive disaggregation of the shell as shell proteins decayed. The resulting shell fragments were dispersed only locally by burrowing organisms. Shell fragments decline in abundance over tens of meters of section and there are subtle differences between sections which suggests Inoceramus was eliminated by gradual changes in ecological conditions that affected the basin roughly simultaneously but with some geographic variability.
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