SYMPOSIA

Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Abstracts of the Invited Speakers
Individuals with CT have both an overall increased risk for depression and a substantially increased sensitivity to the depressogenic
effects of stressful life events. The relation between CT and stressful life events is dose dependent and correlated with the intensity of the
neuroticism. It has been shown that the severity of CT predicts an early age of onset and the number of life time depressive episodes,
and that it is associated with more comorbidity. Increased rates of emotional CT, depressive symptoms and anxiety have been reported
in treatment resistant group of patients.
Childhood adverse life events are associated with various neuroendocrine and neuroanotomical changes. There is a 6 times larger ACTH
response to stress in depressive female patients who reported CT. These patients also have an increased cortisol response and heart
rate response to psychosocial stress. Women, who have reported CT but were not depressed, have exhibited normal cortisol responses,
despite having increased an ACTH response. This can be interpreted as resilience against depression, an adrenal adaptation to central
sensitization. It has been reported that decreased hippocampal volume (18%) in depression is related to CT and that the hippocampal
volumes of depresssive patiens who did not report CT were equal to those of the control group. Repeated bursts of CRF in response to
stress during development and increased cortisol reactivity over the course of time may contribute to smaller hippocampi after childhood
trauma exposure, leading to further sensitization of the stress responses. These results would suggest that there are biologically distinct
subtypes of depression as a function of childhood trauma.
The effect of CT on predisposition to illness is associated with genotype. The s/s allele of the serotonin transporter gene, the gene
polymorphism of BDNF and the CRF-1 gene have been shown to be related to vulnerability to trauma effects.
CT is associated to decreased response to pharmacological treatment. Among chronically depressed patients with no history of early
trauma, combination treatment was most effective in attaining remission compared to pharmacotherapy and psychotherapy. In contrast,
in chronically depressed patients with early-life trauma, remission rates were significantly higher for psychotherapy alone versus
pharmacotherapy. Combination treatment did not have any further advantage over psychotherapy alone. Improved effects of cognitive
and behavioral therapies, group therapies and EMDR have been reported in various studies. Questioning about CT in MD patients seems
to be important for treatment planning, assessment of risks and prophylactic interventions.
Key words: Childhood trauma, mood disorders
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S78-9
Trauma and psychotic disorders
Selma Bozkurt Zincir
Erenkoy Mental Health and Diseases Training and Research Hospital, Istanbul, Turkey
E-mail: sbozkurtzincir@yahoo.com
In recent years, there has been a growing awareness of the importance of abuse or trauma in shaping the course of people’s lives. There
is growing literature to indicate that trauma is also linked with more severe psychiatric disturbances, including symptoms indicative of
psychosis in general and schizophrenia in particular. Several lines of evidence suggest an association between trauma and psychosis with
a dose-response effect. First, studies have demonstrated a high incidence of trauma in the lifetimes of patients with psychosis. Abused
patients are particularly likely to experience positive symptoms, such as paranoid ideation, thought insertion, visual hallucinations, ideas
of reading someone else’s mind, ideas of reference, and hearing voices making comments. Secondly, it has been suggested that of all
diagnostic categories, psychosis displays the strongest association with child abuse. Thirdly, according to some researchers childhood
sexual abuse is the most powerful predictor of later psychiatric symptoms and disorders after controlling for significant demographic
variables.
It has been suggested that the experience of abuse may create a biological or psychological vulnerability for the development of
psychotic symptoms, including sub-clinical psychotic experiences such as low-grade delusional ideation, suicidal thinking and isolated
auditory hallucinations. Exposure to psychological trauma worsens the prognosis of expression of psychosis, in terms of greater likelihood
of transition to a more severe psychotic state. According to recent cognitive models of psychosis early adverse experiences such as
social marginalization, childhood loss or severe childhood trauma may create an enduring cognitive vulnerability characterized by less
subjective control over these experiences, negative schematic models of the self and a world that facilitates external attributions. This
tendency to externally attribute events may lie beneath paranoid ideation.
Current ideas about biological consequences of early adversities lend even more credibility to the notion of an enduring psychological
vulnerability. It has been suggested that adverse life events or significant losses might be able to mould the neurodevelopmental
abnormalities that underlie sensitivity to stressors, if they occur early enough or are sufficiently severe. Thus abnormal neurodevelopmental
processes may originate from traumatic events in childhood. Specifically, when exposure to stressors persists and heightened stress-
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