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Early trauma as a risk factor for future psychotic disorder. Part II. Research data, cause-effect mechanisms and clinical implications

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Streszczenie

Several studies provide ample evidence supporting association of early trauma (ET) with various non-psychotic mental disorders. Authors of this paper review recently published papers on correlations between ET and subsequent development of psychotic disorders. Pertinent data are largely inconsistent. Most investigators agree that an ET experience may lead to the development of the positive symptoms of a psychosis in the future, mainly hallucinations and delusions. No association was demonstrated between ET and negative symptoms, nor with disturbances of cognitive functions or thought disorganization, considered typical for schizophrenic psychosis. This suggests that association of ET and psychosis is diagnostically non-specific and rather indicates the possibility of development of psychotic symptoms, present in other mental disorders. The mechanism of development of ET-associated psychotic disorders is explained both in biological and psychological aspects. Biological mechanisms include the impact of stress on brain development, derangement of the hypothalamus-pituitary-adrenals axis and of the dopaminergic system. According to the cognitive model of psychosis, traumatic experience results in development of negative cognitive patterns, promoting external attributions and construction of delusions and hallucinations. The issue has several clinical implications, thereof the most important is the need to include ET in medical history and accounting for a possible traumatic experience when planning the therapeutic process. Cognitive-behavioural therapy is recommended as primary or adjuvant form of therapy in persons with a history of ET.

Słowa kluczowe
early trauma, physical/sexual abuse, psychotic disorder, mechanisms of development of psychosis, clinical implications