T184. THE ROLE OF ADVERSE CHILDHOOD EXPERIENCES IN THE DEVELOPMENT OF A MORE SEVERE TYPE OF SCHIZOPHRENIA
Authors: Prokopez Cintia , Vallejos Miguel , Fuentes Pamela , Caporusso Gabriela , Alberio German , Cozzarin Linda , Farinola Romina , Chiapella Luciana , Daray Federico 
Published: May 2020

Abstract

Background
The prevalence of Adverse Childhood Experiences (ACEs) in psychotic patients ranges from 45 to 91%. Some authors argue that the risk of developing psychosis is higher in subjects who were exposed to multiple types of ACEs and that trauma multiplicity has a negative clinical impact in psychosis, while others argue that specific types of trauma are related to specific features of disease, taking away importance at the dose-response hypothesis.
Most of the studies about ACEs and schizophrenia have been conducted in North America or Western Europe and there is a lack of information on this topic in developing regions, excluding the possibility of finding regional differences in ACEs frequency and its consequences. The present research provides information about the prevalence of ACEs in schizophrenic patients and in a control sample, and explores the clinical impact of trauma multiplicity in a schizophrenic adult population of Argentina.

Methods
An observational, multicentric and cross-sectional study was conducted at three different hospitals located in Buenos Aires. One hundred patients with schizophrenia and 50 subjects without a mental disease were recruited. Information about adverse childhood experiences was obtained from the Spanish version of the Adverse Childhood Experiences questionnaire (ACE-Q). Clinical severity of schizophrenia was measured with the Positive and Negative Syndrome Scale (PANSS) and with the hallucination subscale of the Psychotic Symptom Rating Scale (PSYRATS), suicidal behavior with the Columbia-Suicide Severity Rating Scale (C-SSRS), treatment adherence with the Drug Attitude Inventory (DAI-10), global functioning with the Global Assessment Functioning Scale (GAF), theory of mind with the Hinting Task test and emotional processing with the Reading the mind in the eyes test.
To analyze the impact of trauma multiplicity on clinical variables of schizophrenia, the patient sample was divided into 2 groups according to the number of ACEs suffered. As a cut-off point, a statistical criterion corresponding to the median number of ACEs was chosen and the sample was divided between those who suffered 0–4 ACEs and those with 5 or more ACEs. Statistical analysis was carried out using SAS software.

Results
The prevalence of at least one ACE in schizophrenic patients was almost double in comparison with the control group (92% vs 54%). Patients with trauma multiplicity showed a PANSS-N score lower than the group with lower number of ACEs (0–4 ACEs= 24.51 ± 5.17 vs. ≥ 5 ACEs= 21.04 ± 4.22; p= &lt;0.001). PSYRATS score was higher in patients with 5 or more ACEs (0–4 ACEs= 6 points, Q1-Q3: 3–18 vs. ≥ 5 ACEs= 12 points, Q1-Q3: 5–23; p= 0.042). Patients with 5 or more ACEs scored higher in death ideation (0–4 ACEs= 22 (40.00%) vs. ≥ 5 ACEs= 28 (62.22%); p= 0.027). The prevalence of suicidal attempts was also higher (0–4 ACEs= 22 (40.00%) vs. ≥ 5 ACEs= 27 (60.00%); p= 0.047), as well as the median number of suicide attempts (0–4 ACEs= 0 (0–1) vs. ≥ 5 ACEs= 1 (0–2); p= 0.039). Also, women with 5 or more ACEs showed higher suicidal ideation score (0–4 ACEs= 0 (0–1) vs. ≥ 5 ACEs= 2 (0–4); p= 0.035). No other clinical variables under study showed differences between the groups.

Discussion
Trauma multiplicity is associated with less negative symptoms, greater suicidal behavior and auditory hallucinations resistant to antipsychotic therapy. Further studies should be done to determine if this might be a specific endophenotype of schizophrenia. The high prevalence of ACEs in our study could be explained by the questionnaire applied, as it includes a large number of ACEs in comparison with others and it could also be linked to regional and cultural characteristics, as there is little information about ACEs prevalence of in South America.