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To what extent psychotic symptoms in first-episode psychosis (FEP) with a history of childhood interpersonal trauma (CIT) are less responsive to antipsychotic medication is not known. In this longitudinal study, we compare symptom trajectories and remission over the first 2 years of treatment in FEP with and without CIT and examine if differences are linked to the use of antipsychotics.
FEP (N = 191) were recruited from in- and outpatient services 1997–2000, and assessed at baseline, 3 months, 1 and 2 years. Inclusion criteria were 15–65 years, actively psychotic with a DSM-IV diagnosis of psychotic disorder and no previous adequate treatment for psychosis. Antipsychotic medication is reported as defined daily dosage (DDD). CIT (<18) was assessed with the Brief Betrayal Trauma Survey, and symptomatic remission based on scores from the Positive and Negative Syndrome Scale.
CIT (n = 63, 33%) was not associated with symptomatic remission at 2 years follow-up (71% in remission, 14% in relapse), or time to first remission (CIT 12/ no-CIT 9 weeks, p = 0.51). Those with CIT had significantly more severe positive, depressive, and excited symptoms. FEP with physical (N = 39, 20%) or emotional abuse (N = 22, 14, 7%) had higher DDD at 1 year (p < 0.05). Mean DDD did not excerpt a significant between-group effect on symptom trajectories of positive symptoms.
Results indicate that antipsychotic medication is equally beneficial in the achievement of symptomatic remission in FEP after 2 years independent of CIT. Still, FEP patients with CIT had more severe positive, depressive, and excited symptoms throughout.
This chapter delineates the developmental trauma disorder (DTD) diagnosis proposed by the National Child Traumatic Stress DSM-V Taskforce. The numerous clinical expressions of the damage resulting from childhood interpersonal trauma are currently relegated to a whole variety of seemingly unrelated comorbidities, such as conduct disorder, attention-deficit hyperactivity disorder (ADHD) and separation anxiety. The chapter discusses the effects of childhood interpersonal trauma on brain activity, self-awareness and social functioning. Several large-sample studies have examined the causal relationship between childhood interpersonal trauma and DTD symptoms. These studies have documented the correlations of age of first trauma exposure, trauma severity and duration of exposure with DTD symptoms. Contemporary neuroscience research suggests that effective treatment needs to involve learning to modulate arousal, learning to tolerate feelings and sensations by increasing the capacity for interoception and learning that, after confrontation with physical helplessness, it is essential to engage in taking effective action.
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