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Pretreatment and outcome correlates of past sexual and physical trauma in 118 bipolar I disorder patients with a first episode of psychotic mania

Authors

  • Philippe Conus,

    1. Treatment and Early Intervention in Psychosis Program, Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, Prilly, Switzerland
    2. Early Psychosis Prevention and Intervention Centre, Orygen Youth Health Clinical Program
    3. Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
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  • Sue Cotton,

    1. Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
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  • Benno G Schimmelmann,

    1. Department of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
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  • Michael Berk,

    1. Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
    2. Department of Clinical and Biomedical Sciences, Barwon Health, University of Melbourne, Geelong
    3. Mental Health Research Institute, Parkville, Australia
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  • Rothanthi Daglas,

    1. Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
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  • Patrick D McGorry,

    1. Early Psychosis Prevention and Intervention Centre, Orygen Youth Health Clinical Program
    2. Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
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  • Martin Lambert

    1. Psychosis Early Detection and Intervention Centre, Centre for Psychosocial Medicine, Department for Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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  • The authors of this paper have no competing or financial interests in the results reported. Full disclosure of all potential conflicts of interest, even though unrelated to this work, has been provided to Bipolar Disorders, as required.

Corresponding author:
Philippe Conus, M.D. Treatment and Early Intervention in Psychosis Program Département Psychiatrie CHUV Université Lausanne Clinique de Cery 1008 Prilly, Switzerland
Fax: +41-21-643-64-69
E-mail: philippe.conus@chuv.ch

Abstract

Conus P, Cotton S, Schimmelmann BG, Berk M, Daglas R, McGorry PD, Lambert M. Pretreatment and outcome correlates of past sexual and physical trauma in 118 bipolar I disorder patients with a first episode of psychotic mania.
Bipolar Disord 2010: 12: 244–252. © 2010 The Authors.
Journal compilation © 2010 John Wiley & Sons A/S.

Objectives:  To assess the prevalence and correlates of childhood and adolescent sexual and/or physical abuse (SPA) in bipolar I disorder (BDI) patients treated for a first episode of psychotic mania.

Methods:  The Early Psychosis Prevention and Intervention Centre admitted 786 first-episode psychosis patients between 1998 and 2000. Data were collected from patients’ files using a standardized questionnaire. A total of 704 files were available; 43 were excluded because of a nonpsychotic diagnosis at endpoint and 3 due to missing data regarding past stressful events. Among 658 patients with available data, 118 received a final diagnosis of BDI and were entered in this study.

Results:  A total of 80% of patients had been exposed to stressful life events during childhood and adolescence and 24.9% to SPA; in particular, 29.8% of female patients had been exposed to sexual abuse. Patients who were exposed to SPA had poorer premorbid functioning, higher rates of forensic history, were less likely to live with family during treatment period, and were more likely to disengage from treatment.

Conclusions:  SPA is highly prevalent in BDI patients presenting with a first episode of psychotic mania; exposed patients have lower premorbid functional levels and poorer engagement with treatment. The context in which such traumas occur must be explored in order to determine whether early intervention strategies may contribute to diminish their prevalence. Specific psychological interventions must also be developed.

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