Childhood Adversities in Men with Schizophrenia : Dose-Response vs . Trauma Specific Hypothesis

Introduction: Multiple studies have found that suffering from adverse experiences during childhood is associated with the development of mental diseases, substance abuse, poor physical health and negative repercussions in social functioning. Patients diagnosed with schizophrenia have higher rates of traumatic experiences during childhood than the general population. The current study aims to determine the clinical repercussion of adverse childhood experiences in a male schizophrenic sample and to compare different clinical characteristics among patients who suffered a specific trauma versus those who were victims of multiple types of adverse experiences during childhood. 1.2. Methods An observational descriptive cross-sectional study was conducted at Jose T. Borda Hospital, in Buenos Aires, Argentina. Participants included 51 male patients between 18 63 years with a diagnosis of schizophrenia. Semi-structured interviews were taken, including SCID I and II to assess psychiatric diagnosis, a socio-demographic questionnaire and the Adverse Childhood Experiences (ACE) Questionnaire to evaluate the presence of adverse childhood experiences. Results: We found that 94% of participants had experienced at least one adverse childhood experience. Sixty three percent of the sample suffered from four or more disruptive child events. We observed that sexual abuse and physical neglect increase the risk of substance abuse and auditory hallucinations, respectively. We also found a statistically significant relationship between patients who suffered from multiple adverse events and the presence of auditory hallucinations and the abuse of substances. INTRODUCTION Childhood adversity in patients with schizophrenia Suffering adverse experiences during childhood increase the risk of developing physical diseases, aggressive behavior and psychiatric disorders in adulthood [1,2]. Given its high prevalence, it is likely that child abuse is a major factor in developing mental pathologies [1,2]. Several authors argue that individuals with a history of traumatic events in childhood rarely experience a single traumatic event, being more likely to suffer several traumatic episodes [3]. Numerous investigations show that 69% of children suffering from child abuse experience an average of three different types of adverse events in childhood [4]. Several studies show a higher prevalence of childhood traumatic events among psychotic patients in comparison with the general population. The rates varies between 4590% among schizophrenic patients [5-13]. Two hypotheses try to explain how child abuse influences on the psychic structuring and on the onset of clinical and mental diseases. The first one postulates that the greater the number of types of trauma suffered, the greater the clinical and social repercussion [2,14,15]. People who were exposed numerous times to different severe events have a higher risk of developing psychosis, suggesting a dose-response relationship among trauma/ psychosis instead of a trauma specific hypothesis [5,8,11,16-18]. Supporting this hypothesis, Feletti et al. created the Adverse Childhood Experiences questionnaire (ACE) [2]. The Central Bringing Excellence in Open Access   Prokopez et al. (2017) Email: Arch Paediatr Dev Pathol 1(1): 1002 (2017) 2/5 ACE score has been framed by its creators as “a measure of the cumulative exposure to traumatic stress during childhood” and they emphasize the importance of cumulative burden and downplay the importance of exposure to specific types of maltreatment [14,19]. Moreover, many studies have linked the presence of multiple adverse childhood events in schizophrenic patients with an increase in substance abuse, psychotic symptoms, hospitalizations and a poor outcome [5,9,11,13,20-22]. On the other hand, the second hypothesis proposes that susceptibility is strongly dependent on the type and timing of maltreatment with a maximum vulnerability emerging to a specific type of abuse during a narrow sensitive exposure period. These authors argue that the exposure to a specific type of maltreatment at a certain age is a more relevant predictor than its multiplicity. Several studies also suggest a particularly deleterious role for a very early or lengthy exposure [23-25]. Some studies found that the exposure to a specific type of maltreatment during a narrow developmental stage is better as a predictor than over-all measures of exposure, such as severity, duration, or multiplicity [25]. A significant number of studies, using unbiased whole brain analyses, have shown that exposure to specific types of maltreatment selectively target sensory systems most involved in perceiving the experience [26-29]. A few studies have shown evidence that one type of maltreatment may be a stronger risk factor in comparison with others for a specific outcome, both in general population and in patients with mental disorder. However, there is no agreement in which type of trauma is associated with a specific outcome [5,10,11,24,30-32]. The aim of this study is 1) to determine the prevalence of each subtype of trauma in a men sample diagnosed with schizophrenia 2) to determine the prevalence of those individuals who suffered 4 or more types of adverse events 3) to correlate both groups with clinical variables. METHOD Study design The present study is a descriptive-observational, crosssectional study conducted at Dr. Tiburcio Borda Hospital. This is a male’s neuropsychiatric hospital and serves a large urban catchment area in Buenos Aires, Argentina, and predominantly uninsured patients. All procedures performed in studies involving human participants are in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. The present study was approved by the ethics committee of José T. Borda Hospital.