Influence of childhood trauma on diagnosis and substance use in first-episode psychosis.

BackgroundChildhood trauma has been significantly associated with first-episode psychosis, affective dysfunction and substance use.AimsTo test whether people with first-episode psychosis who had experienced childhood trauma, when compared with those who had not, showed a higher rate of affective psychosis and an increased lifetime rate of substance use.MethodThe sample comprised 345 participants with first-episode psychosis (58% male, mean age 29.8 years, s.d. = 9.7).ResultsSevere sexual abuse was significantly associated with a diagnosis of affective psychosis (χ2 = 4.9, P = 0.04) and with higher rates of lifetime use of cannabis (68% v 41%; P = 0.02) and heroin (20% v 5%; P = 0.02). Severe physical abuse was associated with increased lifetime use of heroin (15% v 5%; P = 0.03) and cocaine (32% v 17%; P = 0.05).ConclusionsPatients with first-episode psychosis exposed to childhood trauma appear to constitute a distinctive subgroup in terms of diagnosis and lifetime substance use.

Headache in pediatric and neuropsychiatric primary care. A pilot study.

BACKGROUND: To evaluate the prevalence of headache in primary health care for children (child neuropsychiatry and pediatric primary care), detecting possible differences among areas, showing the number of patients with headache with a clinical significance that had not been communicated to a physician and studying the clinical features of cases. METHODS: A questionnaire is administered to all consecutive patients of 3 child neuropsychiatrists of a primary health care unit during a period of 20 days and of 2 family pediatricians during a period of 10 days. Data are collected on 259 children, between 5 and 14 years. RESULTS: 17.76% of examined children have recurrent headache. The percentage is significantly different (p < 0.05) in neuropsychiatry (22.78%) and pediatrics (9.90%). 63.04% of parents with children affected by headache have never reported the disease to a physician and 28.26% of affected children should follow a preventive therapy, but do not. Among all children, 6.56% have migraine and 8.49% have a tension-type headache, according to ICD-10 criteria. CONCLUSIONS: The higher frequency of headache in child neuropsychiatric primary care is probably due to a comorbidity with psychiatric diseases. The high number of non-reported cases of headache is in agreement with data reported in the literature about adults and suggests that it is important to ask standard questions about headache in the course of the anamnesis in all primary health care for children.