Trauma predicts conversion to psychosis in high-risk

Melbourne psychiatrists have confirmed that a history of trauma is common in people deemed to be at ‘ultra-high risk’ (UHR) of psychosis. The study of almost 100 UHR patients found that nearly 70% had experienced a traumatic event. Furthermore, patients who had experienced a sexual trauma (36%) were almost three times as likely to convert to first time psychosis. Dr Andreas Bechdolf and colleagues from the University of Melbourne aimed to replicate the findings of a study by Thompson et al. published last year that found a high prevalence of trauma history in patients at ‘ultra high risk’ of psychotic disorder. Writing in Acta Psychiatrica Scandinavica the study authors noted that a key finding of their study was that history of sexual trauma predicted conversion to psychotic disorder in these patients. “If replicated, it leads to the question of why experience of sexual abuse might be more of a risk factor than other types of trauma for conversion to full-threshold psychotic disorder”. They suggested that as sexual abuse is often a repeated form of abuse it could be more likely than other traumas to lead to psychiatric morbidity. Noting some limitations of the study, the authors said that patients were offered CBT and this could have confounded the relationship between history of trauma and development of psychotic disorder. A high proportion of females in their sample compared with other UHR samples may also make their findings less generalisable. Nevertheless, the authors said their findings highlighted the importance of asking UHR patients about trauma history. Physicians could also consider the role of post-traumatic treatments as a way of delaying or preventing conversion to FEP. The study authors are currently conducting a larger scale retrospective study with a UHR cohort to confirm and refine their findings. Acta Psychiatrica Scandinavica 2010; published online before print...