The relationship between childhood trauma, psychotic symptoms, and cognitive schemas in patients with schizophrenia, their siblings, and healthy controls: results from the EU-GEI study.

BACKGROUND: The relationship between childhood trauma (CT) and psychotic symptoms in patients with schizophrenia (SCZ), and subthreshold psychotic experiences in non-clinical populations is well-established. However, little is known about the relationship between subtypes of trauma and specific symptoms in patients, their siblings, and controls. It is also not clear which variables mediate the relationship between trauma and psychotic symptoms. METHODS: Seven hundred and forty-two patients with SCZ, 718 of their unaffected siblings and 1039 controls from three EU-GEI sites were assessed for CT, symptom severity, and cognitive schemas about self/others. CT was assessed with the Childhood Trauma Questionnaire, and cognitive schemas were assessed by The Brief Core Schema Scale. RESULTS: Patients with psychosis were affected by CT more than their siblings and controls in all domains. Childhood emotional abuse and neglect were more common in siblings than controls. CT was related to negative cognitive schemas toward self/others in patients, siblings, and controls. We found that negative schemas about self-mediated the relationship between emotional abuse and thought withdrawal and thought broadcasting. Approximately 33.9% of the variance in these symptoms was explained by the mediator. It also mediated the relationship between sexual abuse and persecutory delusions in SCZ. CONCLUSIONS: Our findings suggest that childhood abuse and neglect are more common in patients with schizophrenia than their siblings and healthy controls, and have different impacts on clinical domains which we searched. The relationship between CT and positive symptoms seems to be mediated by negative cognitive schemas about self in schizophrenia.

Obsessive compulsive symptoms are related to lower quality of life in patients with Schizophrenia.

BACKGROUND: The aim of this study is to investigate the effects of obsessive-compulsive symptoms (OCS) on quality of life (QoL) and to identify the OCS with a particular effect on QoL, and whether there are any such symptoms for patients with schizophrenia. METHODS: We studied three groups of patients with schizophrenia. One group of patients (n = 45) without OCS or obsessive-compulsive disorder (OCD), one group with OCS, not fulfilling the diagnostic criteria for OCD (n = 31), and one group with OCD as a comorbid condition (n = 24). Severity of clinical symptoms was evaluated with the Positive and Negative Symptom Scale and OCS was examined using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist. We also administered the Y-BOCS. The patients' QoL was assessed using the Quality of Life Scale (QLS). RESULTS: QLS interpersonal relationships subscale scores of those with OCS were lower than those without OCS. There was no difference among OCS, non-OCS, and OCD groups in terms of QoL. There was no relationship between QLS scores and symmetry, contamination and causing harm obsessions, but those with cleaning and repeating compulsions had lower QoL. CONCLUSIONS: Questioning of comorbid OCS and treatment with specific medication in schizophrenia patients may increase QoL.

Cognitive deficits in clinical and familial high risk groups for psychosis are common as in first episode schizophrenia.

The aim of this study is to compare the neurocognitive functions in individuals with clinical or genetic risk for psychosis, in patients with first-episode schizophrenia (FES) and in healthy controls. We compared cognitive functions of 52 individuals at ultra high risk (UHR) for psychosis, 53 patients with FES, their 30 healthy siblings (familial high risk group, FHR) and controls. FES group had worse neuropsychological performance than controls in all of the domains. UHR group had worse performance in verbal learning, attention, and working memory than controls. Additionally, individuals at UHR with familial risk had worse performance on executive functions than the control group. FES group had lower global composite score than UHR group, and worse sustained attention than FHR group. FHR group had worse performance on executive functions and attention than controls. We found no difference in cognitive performances of UHR and FHR groups. Cognitive deficits in UHR and FHR groups were largely similar to those with FES. These findings support that cognitive deficits may arise before the first episode of schizophrenia.

Anticipated discrimination is related to symptom severity, functionality and quality of life in schizophrenia.

The aim of this study is to evaluate a possible relationship between the level of anticipated discrimination with severity of symptoms and functionality. We included 103 patients with schizophrenia. Severity of symptoms was measured by PANSS and Calgary Depression Scale for Schizophrenia. Quality of life (QL) and functionality were measured by using QLS, PSP and Functional Remission of General Schizophrenia Scale (FROGS). Anticipated/experienced discrimination was evaluated with four selected items from Discrimination and Stigma Scale. First, variables related to each item were determined by using t-test and later the variables that have an independent contribution to anticipated discrimination subscale of DISC were evaluated with linear regression analysis. Results showed that those who stated that they felt the need to conceal their diagnosis more had shorter duration of illness, lower PANNS scores, higher scores on professional performance subscale of QLS, a lower number of suicide attempts and higher current employment rates. Participants who reported that they had been avoided or shunned more had higher depression scores. While patients with lower level of functionality tended to stop themselves more, patients with high level of functionality tended to conceal their diagnosis.

The history of childhood trauma among individuals with ultra high risk for psychosis is as common as among patients with first-episode schizophrenia.

AIM: Childhood trauma (CT) is more common in patients with psychosis than in general population and is found to be related to the severity of symptoms. The objective of this study was to investigate the severity of CT, and its relationship with clinical features in two different groups: first-episode schizophrenia (FES) and ultra high risk for psychosis (UHR) groups. METHODS: In this cross-sectional study, 83 patients with FES, 41 individuals with UHR and 69 healthy controls were included. Clinical features were evaluated with the Brief Psychiatric Rating Scale, the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms (SAPS). We evaluated CT with the Childhood Trauma Questionnaire (CTQ). UHR group was also assessed with the Calgary Depression Scale for Schizophrenia. RESULTS: The emotional and physical abuse, physical and emotionalneglect subscale scores and CTQ total score of both the UHR group and FES group were higher than the control group. However, the CTQ total score and subscale scores did not differ between FES and UHR groups. UHR group had more Schneiderian symptoms in terms of both number and severity, and severity of sexual abuse was found to be correlated with SAPS scores especially for the 'commenting voices' item. The CTQ emotional abuse and neglect scores were correlated with the severity of depression. FES patients with higher CTQ scores obtained higher total scores on SAPS and higher total scores on Schneiderian items. CONCLUSION: We found that CT is related to the severity of psychotic symptoms in both FES and UHR groups. Therefore, it is possible that interventions aimed at preventing CT in children would reduce the manifestation of psychosis among young people.

Relationship of symptomatic remission with quality of life and functionality in patients with schizophrenia.

OBJECTIVE: The aim of this study was to investigate the relationship between remission and quality of life (QoL) of patients with schizophrenia. METHOD: Quality of life was investigated with the Quality-of-Life Scale, the Personal and Social Performance Scale (PSP), and the Evaluation of Functional Remission Scale in 102 outpatients with schizophrenia. Positive and Negative Syndrome Scale and Calgary Depression Scale for Schizophrenia (CDSS) were used to assess symptom severity. Remission was defined based on the Andreasen et al criteria (2005). RESULTS: The remission group had higher levels of QoL and functionality as measured by the Quality-of-Life Scale (P = .001), PSP (P = .001), and Evaluation of Functional Remission Scale (P = .001). The remission group also had higher employment rates, lower smoking rates, and less depressive symptoms. We found that negative (P = .001) and positive symptoms of the Positive and Negative Syndrome Scale (P = .05) and CDSS score (P = .005) independently contributed to PSP score in a linear regression analysis. Years of education and positive symptoms were related to CDSS score. All of the 3 scales that we used to assess QoL and functionality were highly correlated with each other. In addition, the opinions of patients or relatives/partners about functionality of the patient was highly correlated with all of the scales. CONCLUSION: We found significant differences between patients with schizophrenia with and without remission for QoL and functionality. Relative/partner's evaluation of functional status provides a reliable measure of QoL as well.