Trauma and Psychosis by Larkin Warren. Morrison Anthony P

Author:Larkin, Warren.,Morrison, Anthony P. [WARREN LARKIN AND ANTHONY P. MORRISON]
Language: eng
Format: epub
Publisher: Taylor & Francis (CAM)
Published: 2011-10-19T04:00:00+00:00

Chapter 7

Childhood trauma and psychosis in the major depressive disorders

Paul Hammersley and Ruth Fox

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Introduction

The bulk of the content of this book is taken up with analysis of the importance of trauma in the context of a diagnosis of ‘schizophrenia’. This chapter is slightly different in that we turn our attention to the relationship between childhood trauma and psychotic symptom profile in the affective disorders, namely psychotic depression and bipolar disorder type-1.

The fact that childhood trauma, particularly sexual abuse, is a significant risk factor in the subsequent development of adult depression is viewed by many as no longer a subject of debate. There is not yet enough evidence to suggest that the relationship is causal; however, it is certainly robust (Beitchman et al. 1992; Mullen et al. 1993). One of the strongest findings was reported by Kendler et al. (2002), who found that in a group of 1942 female twins interviewed four times over a nine-year period, childhood sexual abuse was associated with depression even after controlling for parental loss and adverse family environment. In addition, Hill et al. (2000), in a questionnairebased population study of 862 women, found childhood sexual abuse by a non-relative to be strongly associated with depression.

Despite these findings little is known of the relationship (if any) between childhood trauma and depressive disorders in which psychotic symptoms (hallucinations and delusions) are present. There are a number of reasons why such an analysis may be important. Of these the most important is suicide. The best efforts of health care providers on both sides of the Atlantic since the mid 1980s have done little to slow the incidence of suicide, particularly in young men. Increasing suicide rates are becoming something of an emergency. Childhood trauma is known to be associated with attempted suicide (Read et al. 2001), and there is also strong evidence that the presence of psychotic symptoms in depression significantly increases risk of suicide (Black et al. 1988; Vythilingam et al. 2003). As such an examination of the possible relationship between childhood traumas, psychotic symptoms in depression and the consequences of any such relationship in terms of suicidality may offer important insights in this crucial area.

The presence of psychotic symptoms in unipolar depression may negatively affect course of illness in other areas such as severity of symptoms, poorer prognosis, poor treatment response (Schatzburg 2003), or less time between episodes, and fewer weeks with minimal symptoms (Coryell et al. 1996). The presence of psychotic symptoms in bipolar disorder can have similar negative consequences and have been associated with earlier onset of illness (Rosen et al. 1983a), greater global severity (Rosen et al. 1983b) and both more admissions to hospital and less time between episodes. Keck et al. (2002) have questioned these findings: in their study of hallucinations in 353 patients with bipolar disorder, psychotic symptoms had no effect on prognosis or illness course. However, they state that this may be due to the high morbidity and poor functional outcome of a large percentage of their cohort.

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