Childhood Trauma Questionnaire (CTQ): Greek translation and psychometric validation in general and clinical population.

Exposure to childhood trauma experiences shows a high prevalence worldwide, with approximately two-thirds of the general population reporting traumatic experiences during childhood. The valid psychometric assessment of childhood trauma experience represents, however, a significant challenge in clinical research and practice. The Childhood Trauma Questionnaire - Short Form (CTQ-SF) embodies the most valid and internationally widely used tool for the retrospective assessment of traumatic experiences during childhood to date. The purpose of this study was the Greek translation of the questionnaire and its validation in both a general and clinical population. Participants completed electronically the Greek translation of the CTQ-SF, the Early Trauma Questionnaire (ETI-SR-SF), the Trauma Symptom Checklist (TSC-40), the Positive and Negative Affect Scale (PANAS- SF), the Well-Being Index (WHO-5) and the Patient Health Questionnaire (PHQ-4) to examine psychometric properties of the questionnaire (e.g., internal consistency, concurrent, convergent and divergent validity), but also to investigate the relationship between childhood trauma exposure and psychological well-being and symptoms of anxiety and depression. The total study sample (TS) consisted of 722 adults (606 women), of which 155 declared the existence of a psychiatric diagnosis (PD) and 567 constituted the general population (GP) sample. The most common trauma types reported were emotional abuse (29.1%), emotional neglect (23.7%), and physical abuse (24.6%). The CTQ-SF questionnaire showed high levels of internal consistency based on the Cronbach α coefficient (TS = 0.92, PD = 0.92, GP = 0.92), high concurrent and convergent validity and satisfactory convergent validity. In addition, self-reported childhood trauma was highly positively correlated to negative affect and anxiety and depression symptoms, as well as negatively to psychological well-being. Our results confirm that the Greek Version of Childhood Trauma Questionnaire (CTQ-SF) is a reliable and valid tool that can be used for the retrospective assessment of traumatic childhood experiences both in the general and in the clinical adult Greek population.

Immune Cell Ratios Are Higher in Bipolar Affective than Unipolar Depressive Disorder and Modulated by Mood Episode: A Retrospective, Cross-Sectional Study.

Immune dysregulation is implicated in the pathophysiology of both bipolar and major depressive disorder, while immune cell ratios (IRCs) have recently been proposed as clinically applicable immune biomarkers. We investigated IRCs differences in affective disorders and their association with current mood episodes and clinical features. This retrospective cohort study analyzed neutrophil-lymphocyte (NLR), monocyte-lymphocyte (MLR), and platelet-lymphocyte (PLR) ratios upon admission in 135 affective disorder in-patients with mania (MA, n = 36), bipolar depression (BiD, n = 38), and unipolar depression (MDD, n = 61). Demographic, clinical, and immune data were extracted from medical records. Monocyte count was significantly higher in BiD compared to MDD (p < 0.001). Multivariable regression models suggested higher NLR in MA compared to MDD (p = 0.039), higher MLR in both MA and BiD compared to MDD (p < 0.001 and p = 0.004 respectively), while we found neither group differences in PLR nor an effect of type and duration of hospitalization, current psychotic, or suicidal features and psychiatric history on IRCs. Here, we show that IRCs are elevated in bipolar disorder versus MDD and affected by mood episode, while MLR could be especially valuable in the differential diagnosis between bipolar and unipolar depression. IRCs represent inexpensive, routinely accessible and clinically applicable biomarkers with diagnostic validity in affective disorders that could be easily implemented as illness activity indicators, to better follow the course of illness and eventually predict relapse or treatment response and, thus, guide therapeutic targeting.

[Neurobiology of early life traumatic stress and trauma: Prolonged neuroendocrine dysregulation as a neurodevelopmental risk factor].

Early life stressors display a high universal prevalence and constitute a major public health problem with two thirds of youth being exposed to potentially traumatic experiences by the age of 17. Traumatic stress exposure during critical periods of development may have essential and long-lasting effects on the physical and mental health of individuals and represents a developmental risk factor mediating risk for disease. Early-life stress (ELS) and childhood trauma (CT) can both have an impact on sensitive neuronal brain networks involved in stress reactions, and could exert a programming effect on glucocorticoid signaling leading to chronic hyper- or hypo-activation of the stress system. In addition, alterations in emotional and autonomic reactivity, circadian rhythm disruption, functional and structural changes in the brain, as well as immune and metabolic dysregulation have been lately identified as important risk factors for a chronically impaired homeostatic balance after ELS/CT. Furthermore, human genetic background and epigenetic modifications through stress-related gene expression could interact with these alterations and explain inter-individual variation in vulnerability or resilience to stress. This narrative review presents relevant evidence from mainly human research on the most acknowledged neurobiological allostatic pathways exerting enduring adverse effects of ELS/CT even decades later. Future studies should prospectively investigate potential confounders, their temporal sequence and combined effects at the biological level, while considering the potentially delayed time-frame for the expression of their effects. Finally, screening strategies for ELS/CT and trauma need to be improved. Information about ELS/CT history and the number of adverse experiences could help to better identify the individual risk for disease development, predict individual treatment response and design prevention strategies to reduce the negative effects of ELS/CT.

The relationship between early symptom severity, improvement and remission in first episode psychosis with jumping to conclusions.

It is suggested that Jumping To Conclusions (JTC) reasoning bias might contribute to the distortion of external reality. However, the association between psychotic manifestations and JTC is obscure, especially if general intelligence is considered as a mediator. The aim of this study is to investigate the relation between severity, early clinical improvement and remission of symptoms in First Episode Psychosis (FEP) with JTC as an explanatory factor. One hundred seventy-one FEP individuals were evaluated with the Positive and Negative Syndrome Scale (PANSS) at baseline and one month after treatment initiation. Clinical improvement was ascribed as symptom change one-month post-baseline measurements. Symptomatic remission was assessed with the Andreasen severity criteria and JTC with the Beads Task, operationalized through Draws To Decision (DTD) (the lower the number of DTD, the higher the JTC bias). Regarding symptoms severity, total psychotic, total positive psychotic, and hallucinations-item PANSS scores showed a negative association with JTC after controlling for IQ. Regarding early clinical improvement, the association with JTC was non-significant. No significant association was detected between one month remission status of FEP and JTC. Our findings indicate that severity of positive symptoms is not associated with hastiness in decision-making, but rather with a heightened conservatism in terms of increased data gathering. Further research is required to replicate the results and clarify the cognitive processes involved.

[Peripheral prognostic biomarkers of response in treatment-resistant depression].

Major depressive disorder is a serious mental health disorder of high prevalence and the leading cause of disability worldwide. While there are several classes of therapeutic agents with proven antidepressant efficacy, only about 40-60% of patients respond to initial antidepressant monotherapy, and 30-40% of patients may even show resistance to treatment even under optimal antidepressant pharmacotherapy. Despite the existence of international guidelines, there are still no clear and widely accepted treatment algorithms, no established predictive biomarkers of response to treatment, while the management treatment- resistant depression is usually based on clinical experience. The present article offers a brief narrative review of studies published so far on the predictive quality of various blood-based peripheral biomarkers with respect to response to pharmacological, stimulation or behavioral treatment in patients with treatment-resistant depression. To summarize the results, there does not yet appear to be any specific biomarker that has sufficient discriminative predictive validity and can be used in the routine clinical practice of treating resistant depression. Many factors are likely to account for the above-mentioned research findings, including the wide variety of treatment protocols and the non-uniformly accepted definition of resistant depression used by the various studies, the small number of patients with treatment-resistant depression included, and the existence of different pathophysiological phenotypes of the disorder. The ineffective treatment of major depressive disorder requires an immediate improvement of our therapeutic approach by establishing clinically useful and easily accessible predictive biomarkers of response with high accuracy. The discovery of new and better clinical characterization of known biomarkers in the treatment of treatment-resistant depression could support a better staging and classification of the disorder, the development of personalized treatment algorithms for specific patient subgroups, the achievement of higher rates of stable remission, and the development of new precision drugs with minimal side effects.

The role of attachment anxiety in the relationship between childhood trauma and schizophrenia-spectrum psychosis.

Childhood trauma (CT) is a comprehensive concept encompassing experiences of sexual, physical, and emotional abuse, and neglect during childhood and adolescence. Patients with schizophrenia-spectrum psychosis (SSP) display higher rates of CT than healthy controls. Among the potential mediators of this association, insecure attachment has gained attention and empirical validation. The present study aimed to extend existing knowledge on this field by exploring the role of the two attachment dimensions, attachment anxiety and attachment avoidance, in the CT-SSP association. A clinical sample of 63 SSP inpatients was compared to a healthy control group on CT and attachment style measures. Correlations between CT, attachment dimensions and psychopathology were sought. Mediation analyses were also performed to examine whether attachment anxiety and/or attachment avoidance mediated the CT-SSP association. Patients displayed higher rates of CT and insecure attachment than controls. Attachment anxiety and severity of Mother Antipathy were linked to severity of hallucinations. Attachment anxiety was recognized as the sole mediator of the CT-SSP association. Our findings suggest that individuals with severe CT and increased attachment anxiety represent a risk population warranting early clinical attention, regular monitoring and tailored therapeutic interventions aimed at reducing the psychological impact of trauma.

Multilevel Interactions of Stress and Circadian System: Implications for Traumatic Stress.

The dramatic fluctuations in energy demands by the rhythmic succession of night and day on our planet has prompted a geophysical evolutionary need for biological temporal organization across phylogeny. The intrinsic circadian timing system (CS) represents a highly conserved and sophisticated internal "clock," adjusted to the 24-h rotation period of the earth, enabling a nyctohemeral coordination of numerous physiologic processes, from gene expression to behavior. The human CS is tightly and bidirectionally interconnected to the stress system (SS). Both systems are fundamental for survival and regulate each other's activity in order to prepare the organism for the anticipated cyclic challenges. Thereby, the understanding of the temporal relationship between stressors and stress responses is critical for the comprehension of the molecular basis of physiology and pathogenesis of disease. A critical loss of the harmonious timed order at different organizational levels may affect the fundamental properties of neuroendocrine, immune, and autonomic systems, leading to a breakdown of biobehavioral adaptative mechanisms with increased stress sensitivity and vulnerability. In this review, following an overview of the functional components of the SS and CS, we present their multilevel interactions and discuss how traumatic stress can alter the interplay between the two systems. Circadian dysregulation after traumatic stress exposure may represent a core feature of trauma-related disorders mediating enduring neurobiological correlates of trauma through maladaptive stress regulation. Understanding the mechanisms susceptible to circadian dysregulation and their role in stress-related disorders could provide new insights into disease mechanisms, advancing psychochronobiological treatment possibilities and preventive strategies in stress-exposed populations.

Improved facial affect recognition in patients with first-episode psychosis.

AIM: The present study aimed at assessing whether impaired facial affect recognition (FAR) in patients with first-episode psychosis (FEP) would improve after a brief intervention targeting FAR specifically. METHODS: Thirty-five outpatients and 38 healthy controls were administered an intervention which involved training to recognize emotional information, conveyed by changes in facial features. Using a pre- and post-intervention design, two measurements of FAR were conducted using an experimental procedure with alternative sets of stimuli. RESULTS: We found improved overall FAR performance in both participant groups with marked effects in recognizing anger, disgust and fear. Patients' post-intervention performance was comparable to healthy participants' baseline performance. CONCLUSIONS: The present improvement in facial affects recognition in FEP patients, despite only somewhat impaired, emphasizes the importance of early targeted interventions for FAR in psychosis. Further research is needed to assess whether this improvement will generalize to global social functioning.

Social cognition in the course of psychosis and its correlation with biomarkers in a male cohort.

INTRODUCTION: Patients diagnosed with schizophrenia display deficits in Theory of Mind (ToM) and Emotion Perception (EP) even before the appearance of full-blown symptomatology. METHODS: We evaluated ToM and EP in a male cohort consisting of 25 First Episode Psychosis (FEP) and 16 relapsed schizophrenic patients (CHRON) compared to 12 subjects in Ultra-high Risk (UHR) and 23 healthy controls (CTR). Furthermore, we measured the levels of Cortisol, Insulin like Growth Factor (IGF-1), TNF-a, TNF-b and several interleukins as potential biomarkers. RESULTS: Deficits in EP and ToM were found in FEP, CHRON patients and UHR subjects compared to CTR. The impairments in these two domains seem to follow different patterns in the course of psychosis. EP was more impaired in subjects with a longer history of symptomatology whereas there was no statistically significant difference regarding ToM. On the other hand IL-4 was the only biomarker correlated to ToM and EP scores in two different samples of our study. CONCLUSION: Social Cognition (SC) domains are impaired in patients with psychosis as well as in UHR subjects compared to healthy controls. There are differences in the progress of ToM and EP deficits in the course of psychosis. Interleukins as IL-4 could correlate to SC.

Emotional perception and theory of mind in first episode psychosis: the role of obsessive-compulsive symptomatology.

The aim of the present study was to investigate the effects of comorbid obsessive-compulsive symptoms on emotional perception and theory of mind (ToM) in patients with first-episode psychosis. Participants were 65 patients with non-affective first episode psychosis (FEP) and 47 healthy controls. The patient group was divided into two subgroups, those with (FEP+; n=38) and those without obsessive-compulsive symptomatology (FEP-; n=27). Emotion perception and ToM were assessed with the Perception of Social Inference Test. Severity of psychotic and obsessive-compulsive symptoms was assessed with the Positive and Negative Syndrome Scale (PANSS) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), respectively. Deficits in emotion recognition and theory of mind were confirmed in patients with non-affective first-episode psychosis compared to healthy controls. In patients, comorbidity with obsessive-compulsive symptoms was associated with worse performance on certain aspects of social cognition (ToM 2nd order) compared to FEP- patients. Our findings of impaired emotion perception and ToM in patients with first-episode psychosis support the hypothesis that deficits are already present at illness onset. Presence of OCS appears to have further deleterious effects on social cognition, suggesting that these patients may belong to a schizo-obsessive subtype of schizophrenia characterized by more extensive neurobiological impairment.

Comorbidity of obsessive-compulsive disorder with obsessive-compulsive personality disorder: Does it imply a specific subtype of obsessive-compulsive disorder?

The present study examined whether the comorbidity of obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD) constitute a specific subtype of OCD. The study sample consisted of 146 consecutive outpatients with a DSM-IV diagnosis of OCD. Diagnoses were established using MINI, IPDE, YBOCS and YBOCS-SC. OCD patients with comorbid OCPD were compared with OCD patients without OCPD on various sociodemographic and clinical variables. Almost one third of the OCD subjects met criteria for comorbid OCPD. OCD+OCPD patients had a significantly earlier age at onset of initial OC symptoms, earlier age at onset of OCD and more obsessions and compulsions than pure obsessions compared to the patients with OCDOCPD. OCD+OCPD patients also had a higher rate of comorbidity with avoidant personality disorder and showed more impairment in global functioning. There were not differences between the two sub-groups on severity of OCD symptoms and also on type of OCD onset. Our results indicate that the comorbidity of OCD with OCPD is associated with a number of specific clinical characteristics of OCD. These findings in conjunction with of current clinical, family and genetic studies provide some initial evidence that OCD comorbid with OCPD constitute a specific subtype of OCD.