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27-03-2013 | Mental health | Article

Sexual trauma predicts psychosis transition


Free abstract

medwireNews: Sexual trauma in childhood may significantly increase the risk for frank psychosis in patients at "ultra high risk" (UHR) for the condition, study findings indicate.

The findings showed that UHR patients who were sexually abused as children were two to four times more likely to develop full blown psychosis than those not sexually abused.

"We should be routinely assessing pervious sexual trauma in the 'at-risk' population because it may pose an increased risk for transition to a psychotic disorder," say Andrew Thompson (Mill View Hospital, Hove, UK) and colleagues.

"It has been reported that previous abuse is often not well assessed in psychiatric clinics and this should be an important part of the overall assessment process."

By contrast, other types of childhood trauma and trauma as a whole did not significantly increase the risk for transition to psychosis.

The effects of trauma were studied in 233 individuals who were participating in research studies at a Personal Assessment and Clinical Evaluation (PACE) clinic in Melbourne, Australia, when aged between 15 and 30 years.

At baseline, the participants had an average Childhood Trauma Questionnaire (CTQ) score of 47.8, with an average score for sexual abuse of 7.5.

Over an average follow-up period of 7 years, 55 patients were diagnosed with a psychotic disorder.

Sexual abuse was the only trauma to significantly increase the risk for transition to psychosis, even after taking into account other risk factors including year of entry to PACE, baseline Global Assessment of Functioning score, and time between symptom onset and first contact with PACE.

Patients with a CTQ sexual abuse score of 15 out of a possible 25 were twice as likely to transition to psychosis as those with a score of 5 (no sexual abuse), while a score of 25 increased the risk for transition fourfold, compared with a score of 5.

Thompson et al say that addressing the sequelae of sexual trauma may be a focus of early intervention strategies to prevent the development of psychosis.

"Examples of approaches might be working directly with the dissociative experiences in response to trauma using psychological techniques such as coping strategies, body awareness/mindfulness techniques, and stress management," they write in Schizophrenia Bulletin.

"Challenging any externalized attributional biases, which may have been developed or exacerbated by previous trauma, may also reduce the risk of symptom development of entrenchment."

By Lucy Piper, Senior medwireNews Reporter

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