Lucia Sideli

Do Child Abuse and Maltreatment Increase Risk of Schizophrenia

Introduction IntroductionaaAlthough childhood abuse is a recognised risk factor for depression, post-traumatic stress disorder, and substance misuse, its role in the aetiology of psychotic disorder remained controversial. This is in part because the putative effect of childhood trauma on psychosis has been mostly evaluated by small, cross sectional, uncontrolled studies that raised methodological issues. Methods Papers concerning the association between childhood trauma and psychotic disorders (to November, 2011) were identified using a comprehensive search of PubMed, Psychinfo, and Scopus and analysing reference list of relevant papers. A narrative synthesis was used to summarise results. Results An association between childhood abuse and psychotic symptoms was consistently reported by large cross sectional surveys with an effect ranging from 1.7 to 15. However, we cannot conclude that the relationship is causal as lack of longitudinal studies prevent us from fully excluding alternative explanations such as reverse causality. Gender, cannabis use, and depressive and post-traumatic stress disorder symptoms appear to moderate the effect of childhood trauma on psychotic disorders. However, specificity of childhood abuse in psychotic disorders and, particularly, in schizophrenia has not been demonstrated. Conclusion Although the association between childhood abuse and psychosis has been replicated, the etiological role of such early adversity has yet to be fully clarified. So far none of the studies reported support the hypothesis that childhood abuse is either sufficient or necessary to develop a psychotic disorder. It seems likely that any effect of childhood abuse on schizophrenia needs to be understood in terms of genetic susceptibility and interaction with other environmental risk factors.

Substance use, medication adherence and outcome one year following a first episode of psychosis

Both substance use and poor medication adherence are associated with poor outcome in psychosis. To clarify the contributions of substance use and poor medication adherence to poor outcome in the year following a first episode of psychosis, 205 patients were evaluated for use of tobacco, alcohol, cannabis and stimulants at their psychosis onset, and in a 1-year follow-up. Data on medication adherence and symptom remission were also collected. Patients had high rates of overall substance use before (37-65%) and after psychosis onset (45-66%). 44% showed poor medication adherence and 55% did not reach remission from psychosis. Nicotine dependence and cannabis use after psychosis onset significantly predicted both poor medication adherence and non-remission, and poor medication adherence mediated the effects of these substances on non-remission. In conclusion, medication adherence lies on the causal pathway between nicotine dependence and cannabis on the one hand and non-remission on the other.

Are there specific neuropsychological deficits underlying poor insight in first episode psychosis

Insight in psychosis is a multi-dimensional phenomenon, and has been hypothesised to have some sort of neuropsychological basis. It is unclear to what extent specific neuropsychological abilities are able to predict insight beyond the effect of generalised cognitive ability. We aimed to test this association, alongside the relationship of insight with illness duration and diagnosis, in a sample of first episode psychosis patients. 110 first episode psychosis patients were recruited and a comprehensive assessment was administered, including insight, symptoms, diagnosis and neuropsychological function. Low insight was related to worse performance in a variety of neuropsychological tasks. Regression analysis tested whether any specific tasks were related to insight (or dimensions of insight) beyond the effect of IQ. Verbal memory had an effect on total insight and all dimensions of insight (except compliance) beyond the effect of IQ. Insight appeared to vary with diagnosis, with those diagnosed with depressive affective psychoses having better insight than those with manic affective psychoses. There was no relationship between insight and DUP, but there was a relationship between time spent in treatment before assessment and insight, even after controlling for severity of symptoms. These results suggest a model of insight in early psychosis with a significant neuropsychological component, particularly with verbal memory but also with generalised cognitive ability. There is likely to be a social component to insight affected by initial time spent in contact with treatment, helping patients to understand and come to terms with their illness.

Failure to find association between childhood abuse and cognition in first-episode psychosis patients

This study investigated the relationship between severe childhood abuse and cognitive functions in first-episode psychosis patients and geographically-matched controls. Reports of any abuse were associated with lower scores in the executive function domain in the control group. However, in contrast with our hypothesis, no relationships were found amongst cases.

Interaction between cannabis consumption and childhood abuse in psychotic disorders: preliminary findings on the role of different patterns of cannabis use

Several studies have suggested that lifetime cannabis consumption and childhood abuse synergistically contribute to the risk for psychotic disorders. This study aimed to extend existing findings regarding an additive interaction between childhood abuse and lifetime cannabis use by investigating the moderating role of type and frequency of cannabis use.

Eating disorders on the web: risks and resources.

Our work is aimed at exploring the recent literature data on web sites, forums, and blogs, which promote eating disorders as normal life styles and their implication in the changes of the psychopatology of such disorders. We also want to understand whether new technologies have an impact in the course of the disorders or, on the other hand, whether they can also represent an instrument for searching help or information about them. The search strategy included a search of PsycINFO, Medline, and Ovid databases to identify research reports about pro-ana sites and their implication on the course of anorexia using the following key words: pro-ana, thinspiration, anorexia-web, online help eating disorders, anorexia nation.

Interaction between cannabis consumption and childhood abuse in psychotic disorders

Several studies have suggested that lifetime cannabis consumption and childhood abuse synergistically contribute to the risk for psychotic disorders. This study aimed to extend existing findings regarding an additive interaction between childhood abuse and lifetime cannabis use by investigating the moderating role of type and frequency of cannabis use.

Validation of the Italian version of the Burn Specific Health Scale-Brief

INTRODUCTION A growing awareness of psychological and functional impairment due to burns have led to the development of specific instruments to evaluate Quality of Life in this population, such as the Burn Specific Health Scale - Brief (BSHS-B), whose psychometric properties have been consistently verified. The aim of this study was to translate the BSHS-B into Italian and to investigate its reliability and validity. METHODS Translation procedures were carried out according to accepted standards. Internal reliability was assessed using Cronbachs alpha coefficient. Concurrent validity was evaluated through correlations between the BSHS-B and the Short-Form 36 Health Survey (SF-36), the Self-report Clinical Inventory (SCL-90), and the Body Uneasiness Test (BUT). RESULTS The overall Cronbachs alpha value for the scale was 0.887. Significant correlations were found between the Italian BSHS-B domains, the SF-36 subscales (Spearmans rho: 0.184-0.414), and several SCL-90 subscales (Spearmans rho: -0.173 to -0.477). Furthermore, the affect and relationship domain and the skin domain of the BSHS-B negatively correlated with the compulsive self-monitoring and depersonalization subscales of the BUT. CONCLUSION The Italian translation of BSHS-B has shown satisfactory internal consistency, criterion validity, and convergent validity, supporting its application in routine clinical practice as well as in international studies.

Searching for the truth about schizophrenia requires the application of similarly high standards of proof to biological and social risk factors

In their provocative paper, Bentall and Varese (2012) criticize our review on child abuse and schizophrenia (Sideli, Mulè, La Barbera, & Murray, 2012) and suggest that we have a biological bias which causes us to apply more stringent criteria when evaluating causality in psychosocial than bio-genetic research. This critique surprises us, as of the review’s two senior authors, one (RMM) has recently coauthored a paper on a “sociodevelopmental model of schizophrenia” (Morgan, Charalambides, Hutchinson, & Murray, 2010) while the other (DLB) has a proud record in psychosocial and therapeutic aspects of psychiatry – we are hardly a troupe of hard-line reductionists! Furthermore, not only did our review recognize the significant association between child abuse and positive psychotic symptoms, but our group has also contributed to the literature on this subject (Aas et al., 2011; Fisher et al., 2009; Fisher et al., 2010; Mondelli et al., 2010; Schäfer et al., 2011; Sideli et al., in press); indeed, while complaining about our review, Bentall and Varese (2012) quote our group’s research in support of the reliability of patients’ accounts of abuse (Fisher et al., 2011). Bentall and Varese criticize us for saying that “none of the studies reported indicate that child abuse is either necessary or sufficient to develop a psychotics disorder”. They do not, however, contest this statement which is, of course, true not only for child abuse but for all putative causes of psychosis including other risk factors which our group has investigated, e.g. susceptibility genes, obstetric factors and cannabis abuse. Bentall and Varese complain that “shockingly, the Sideli review concludes that ‘the possibility cannot be excluded that a child destined to develop schizophrenia may show characteristics in childhood that increase the risk of abuse’”. In response, we would gently remind them that developmental anomalies and childhood psychopathology, which often precede schizophrenia (Welham, Isohanni, Jones, &

Alexithymia and personality traits of patients with inflammatory bowel disease

Psychological factors, specific lifestyles and environmental stressors may influence etiopathogenesis and evolution of chronic diseases. We investigate the association between Chronic Inflammatory Bowel Diseases (IBD) and psychological dimensions such as personality traits, defence mechanisms, and Alexithymia, i.e. deficits of emotional awareness with inability to give a name to emotional states. We analyzed a survey of 100 patients with IBD and a control group of 66 healthy individuals. The survey involved filling out clinical and anamnestic forms and administering five psychological tests. These were then analyzed by using a network representation of the system by considering it as a bipartite network in which elements of one set are the 166 individuals, while the elements of the other set are the outcome of the survey. We then run an unsupervised community detection algorithm providing a partition of the 166 participants into clusters. That allowed us to determine a statistically significant association between psychological factors and IBD. We find clusters of patients characterized by high neuroticism, alexithymia, impulsivity and severe physical conditions and being of female gender. We therefore hypothesize that in a population of alexithymic patients, females are inclined to develop psychosomatic diseases like IBD while males might eventually develop behavioral disorders.