T4. CHILDHOOD TRAUMA AND ITS RELATIONSHIP WITH PREMORBID ADJUSTMENT, COGNITION AND TREATMENT OUTCOMES IN FIRST EPISODE SCHIZOPHRENIA

Abstract

Background: Childhood trauma is likely to interfere with normal neurodevelopment. Evidence is also accumulating for the effect of childhood trauma on cognitive functioning and treatment outcomes. Firstly, to investigate the relationship between childhood trauma and neurodevelopment we studied the association between childhood trauma and premorbid adjustment, which may be a manifestation of neurodevelopmental compromise. We also explored the moderating role of a family history of schizophrenia/ psychiatric illness, substance abuse, obstetric complications, and neurological soft signs. Next, we assessed the impact of childhood trauma on cognitive functioning, as little is known about the relationship between social cognition and childhood trauma. Lastly, we studied the effect of childhood trauma on clinical outcomes and functionality over the course of 2 years. Schizophrenia is an illness characterized by poor outcomes and this may be ascribed to a history of childhood adversity. Method(s): Our sample consisted of First Episode Schizophrenia (FES) patients and healthy controls. Patients received a fixed treatment regimen of long-acting decanoate injections. We used hierarchical regression to assess the relationship between childhood trauma and premorbid adjustment in 77 patients. We included interaction terms in the model. We also used hierarchical regression to explore the relationship between childhood trauma and cognition in patients (n = 56) and controls (n = 52). We used linear mixed effect models for continuous repeated measures to assess changes in clinical outcomes and functionality in 78 patients. Result(s): We found a relationship between childhood trauma and premorbid adjustment from childhood to late adolescence. There were no moderating effects for family history of schizophrenia/psychiatric disorder. History of obstetric complications, substance abuse and poor motor coordination weakened the association between childhood trauma and premorbid adjustment, while poor sequencing of motor acts strengthened the association. Childhood neglect was a predictor of poor social cognition in both patients and controls. Neglect was also a significant predictor of poorer verbal learning in patients and of attention/vigilance in controls. Childhood abuse did not predict cognitive impairments in either group. Then we found no pronounced differences pre-treatment when comparing patients with high and low childhood trauma. Over time patients with high childhood trauma scores had more severe positive and disorganized symptoms and at the end of 2 years they had higher overall symptom severity and disorganized symptoms and poorer social and occupational functioning and quality of life. Discussion(s): Our results confirm an association between childhood trauma and premorbid adjustment and indicate a general rather than specific association, apparent with different types of trauma, and affecting both social and academic premorbid adjustment. Our results suggest an interplay of risk factors, supporting the notion of different pathways to psychosis. We found that childhood adversity is associated with cognitive impairment. It seems that the association between neglect and social cognition is not illness- specific and found in both patients and controls. Although we did not find pronounced differences pre-treatment, the effect of early adversity was clearly visible over time and at the end of the 2-year follow-up period. Our findings regarding the effect of childhood trauma on premorbid adjustment, cognitive functioning, and treatment outcomes suggest that early adversity is an important environmental factor that can no longer be ignored when we treat patients with schizophrenia.