Franca Onyeama, Eirini Melegkovits, Nicole Yu, Ameerah Parvez, Artur Rodrigues, Jo Billings, Ian Kelleher, Mary Cannon, Michael A P Bloomfield
{"title":"精神病创伤表型假说的系统回顾和荟萃分析。","authors":"Franca Onyeama, Eirini Melegkovits, Nicole Yu, Ameerah Parvez, Artur Rodrigues, Jo Billings, Ian Kelleher, Mary Cannon, Michael A P Bloomfield","doi":"10.1192/bjo.2024.52","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Developmental trauma increases psychosis risk and is associated with poor prognosis. It has been proposed that psychosis in survivors of developmental trauma gives rise to a distinct 'traumatogenic' phenotype.</p><p><strong>Aims: </strong>Given the implications for personalised treatment, we sought to explore the traumatogenic psychosis phenotype hypothesis in a systematic review and meta-analysis of studies comparing psychotic presentations between adults with and without developmental trauma histories.</p><p><strong>Method: </strong>We registered the systematic review on PROSPERO (CRD42019131245) and systematically searched EMBASE, Medline and PsycINFO. The outcomes of interests were quantitative and qualitative comparisons in psychotic symptom expression (positive, negative, cognitive) and other domains of psychopathology, including affect regulation, sleep, depression and anxiety, between adults with and without experience of developmental trauma.</p><p><strong>Results: </strong>Of 34 studies included (<i>N</i> = 13 150), 11 were meta-analysed (<i>n</i> = 2842). A significant relationship was found between developmental trauma and increased symptom severity for positive (Hedge's <i>g</i> = 0.27; 95% CI 0.10-0.44; <i>P</i> = 0.002), but not negative symptoms (Hedge's <i>g</i> = 0.13; 95% CI -0.04 to 0.30; <i>P</i> = 0.14). Developmental trauma was associated with greater neurocognitive, specifically executive, deficits, as well as poorer affect, dissociation and social cognition. Furthermore, psychotic symptom content thematically related to traumatic memories in survivors of developmental trauma.</p><p><strong>Conclusions: </strong>Our findings that developmental trauma is associated with more severe positive and affective symptoms, and qualitative differences in symptom expression, support the notion that there may be a traumatogenic psychosis phenotype. However, underdiagnosis of post-traumatic stress disorder may also explain some of these findings. More research is needed to explore this further.</p>","PeriodicalId":9038,"journal":{"name":"BJPsych Open","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A systematic review and meta-analysis of the traumatogenic phenotype hypothesis of psychosis.\",\"authors\":\"Franca Onyeama, Eirini Melegkovits, Nicole Yu, Ameerah Parvez, Artur Rodrigues, Jo Billings, Ian Kelleher, Mary Cannon, Michael A P Bloomfield\",\"doi\":\"10.1192/bjo.2024.52\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Developmental trauma increases psychosis risk and is associated with poor prognosis. It has been proposed that psychosis in survivors of developmental trauma gives rise to a distinct 'traumatogenic' phenotype.</p><p><strong>Aims: </strong>Given the implications for personalised treatment, we sought to explore the traumatogenic psychosis phenotype hypothesis in a systematic review and meta-analysis of studies comparing psychotic presentations between adults with and without developmental trauma histories.</p><p><strong>Method: </strong>We registered the systematic review on PROSPERO (CRD42019131245) and systematically searched EMBASE, Medline and PsycINFO. The outcomes of interests were quantitative and qualitative comparisons in psychotic symptom expression (positive, negative, cognitive) and other domains of psychopathology, including affect regulation, sleep, depression and anxiety, between adults with and without experience of developmental trauma.</p><p><strong>Results: </strong>Of 34 studies included (<i>N</i> = 13 150), 11 were meta-analysed (<i>n</i> = 2842). A significant relationship was found between developmental trauma and increased symptom severity for positive (Hedge's <i>g</i> = 0.27; 95% CI 0.10-0.44; <i>P</i> = 0.002), but not negative symptoms (Hedge's <i>g</i> = 0.13; 95% CI -0.04 to 0.30; <i>P</i> = 0.14). Developmental trauma was associated with greater neurocognitive, specifically executive, deficits, as well as poorer affect, dissociation and social cognition. Furthermore, psychotic symptom content thematically related to traumatic memories in survivors of developmental trauma.</p><p><strong>Conclusions: </strong>Our findings that developmental trauma is associated with more severe positive and affective symptoms, and qualitative differences in symptom expression, support the notion that there may be a traumatogenic psychosis phenotype. However, underdiagnosis of post-traumatic stress disorder may also explain some of these findings. More research is needed to explore this further.</p>\",\"PeriodicalId\":9038,\"journal\":{\"name\":\"BJPsych Open\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2024-08-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BJPsych Open\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1192/bjo.2024.52\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHIATRY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJPsych Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1192/bjo.2024.52","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0
摘要
背景:发育创伤会增加患精神病的风险,并与不良预后有关。目的:鉴于这对个性化治疗的影响,我们试图通过一项系统性综述和荟萃分析来探讨创伤致精神病表型假说:我们在 PROSPERO (CRD42019131245) 上注册了该系统综述,并系统检索了 EMBASE、Medline 和 PsycINFO。研究结果是对有和无发育创伤经历的成年人在精神病症状表现(积极、消极、认知)和其他精神病理学领域(包括情感调节、睡眠、抑郁和焦虑)方面的定量和定性比较:在纳入的 34 项研究(N = 13 150)中,有 11 项进行了元分析(N = 2842)。研究发现,成长创伤与积极症状(Hedge's g = 0.27;95% CI 0.10-0.44;P = 0.002)严重程度的增加有明显关系,但与消极症状(Hedge's g = 0.13;95% CI -0.04-0.30;P = 0.14)严重程度的增加无明显关系。发育创伤与更大的神经认知(特别是执行力)缺陷以及更差的情感、分离和社会认知有关。此外,发展性创伤幸存者的精神病症状内容在主题上与创伤记忆有关:我们的研究结果表明,发育创伤与更严重的积极和情感症状以及症状表达的质的差异有关,这支持了可能存在创伤性精神病表型的观点。然而,创伤后应激障碍的诊断不足也可以解释其中的一些发现。需要进行更多的研究来进一步探讨这个问题。
A systematic review and meta-analysis of the traumatogenic phenotype hypothesis of psychosis.
Background: Developmental trauma increases psychosis risk and is associated with poor prognosis. It has been proposed that psychosis in survivors of developmental trauma gives rise to a distinct 'traumatogenic' phenotype.
Aims: Given the implications for personalised treatment, we sought to explore the traumatogenic psychosis phenotype hypothesis in a systematic review and meta-analysis of studies comparing psychotic presentations between adults with and without developmental trauma histories.
Method: We registered the systematic review on PROSPERO (CRD42019131245) and systematically searched EMBASE, Medline and PsycINFO. The outcomes of interests were quantitative and qualitative comparisons in psychotic symptom expression (positive, negative, cognitive) and other domains of psychopathology, including affect regulation, sleep, depression and anxiety, between adults with and without experience of developmental trauma.
Results: Of 34 studies included (N = 13 150), 11 were meta-analysed (n = 2842). A significant relationship was found between developmental trauma and increased symptom severity for positive (Hedge's g = 0.27; 95% CI 0.10-0.44; P = 0.002), but not negative symptoms (Hedge's g = 0.13; 95% CI -0.04 to 0.30; P = 0.14). Developmental trauma was associated with greater neurocognitive, specifically executive, deficits, as well as poorer affect, dissociation and social cognition. Furthermore, psychotic symptom content thematically related to traumatic memories in survivors of developmental trauma.
Conclusions: Our findings that developmental trauma is associated with more severe positive and affective symptoms, and qualitative differences in symptom expression, support the notion that there may be a traumatogenic psychosis phenotype. However, underdiagnosis of post-traumatic stress disorder may also explain some of these findings. More research is needed to explore this further.
期刊介绍:
Announcing the launch of BJPsych Open, an exciting new open access online journal for the publication of all methodologically sound research in all fields of psychiatry and disciplines related to mental health. BJPsych Open will maintain the highest scientific, peer review, and ethical standards of the BJPsych, ensure rapid publication for authors whilst sharing research with no cost to the reader in the spirit of maximising dissemination and public engagement. Cascade submission from BJPsych to BJPsych Open is a new option for authors whose first priority is rapid online publication with the prestigious BJPsych brand. Authors will also retain copyright to their works under a creative commons license.