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Schizophr Res. 2019 Jun;208:90-96. doi: 10.1016/j.schres.2019.04.006. Epub 2019 Apr 23.

Relationship between childhood trauma and level of insight in schizophrenia: A path-analysis in the national FACE-SZ dataset.

Author information

1
Fondation Fondamental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France; Université Paris-Est Créteil (UPEC), AP-HP, DHU Pe-PSY, Créteil, France. Electronic address: baptiste.pignon@aphp.fr.
2
Fondation Fondamental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France.
3
Fondation Fondamental, Créteil, France.
4
Fondation Fondamental, Créteil, France; Université Claude Bernard Lyon 1/Centre Hospitalier Le Vinatier Pole Est BP 300 39 - 95 bd Pinel - 69678 BRON Cedex, France.
5
Fondation Fondamental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Inserm U894, Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, Colombes, France.
6
Fondation Fondamental, Créteil, France; Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; Laboratoire HandiRESP, EA4047, UFR des Sciences de la santé Simone Veil, Université de Versailles Saint-Quentin-En-Yvelines, 2 Avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux, France.
7
Fondation Fondamental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France; Université Paris-Est Créteil (UPEC), AP-HP, DHU Pe-PSY, Créteil, France.
8
Fondation Fondamental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France.
9
Fondation Fondamental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France.
10
Fondation Fondamental, Créteil, France; Centre Hospitalier Charles Perrens, F-33076 Bordeaux, France; Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, F-33000 Bordeaux, France; Université de Bordeaux, France.
11
Fondation Fondamental, Créteil, France; Centre Hospitalier Charles Perrens, F-33076 Bordeaux, France; CNRS UMR 5287-INCIA, France; Université de Bordeaux, France.
12
Fondation Fondamental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
13
Fondation Fondamental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France.
14
Fondation Fondamental, Créteil, France; Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France.
15
Fondation Fondamental, France.
16
Centre Hospitalier Charles Perrens, F-33076 Bordeaux, France; Fondation Fondamental, France; Université de Bordeaux, Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, F-33000 Bordeaux, France.
17
Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Fondation Fondamental, France.
18
CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France; Fondation Fondamental, France.
19
AP-HP, DHU Pe-PSY, Pôle de Psychiatrie et d'addictologie des Hôpitaux Universitaires H Mondor,INSERM U955, Eq 15 Psychiatrie Translationelle, Université Paris Est-Créteil, Créteil, France; Fondation Fondamental, France.
20
Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France; Fondation Fondamental, France.
21
Université Claude Bernard Lyon 1/Centre Hospitalier Le Vinatier Pole Est BP 300 39 - 95 bd Pinel - 69678 BRON Cedex, France; Fondation Fondamental, France.
22
Centre Hospitalier Charles Perrens, F-33076 Bordeaux, France; Fondation Fondamental, France; Université de Bordeaux, CNRS UMR 5287-INCIA, France.
23
Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France; Fondation Fondamental, France.
24
AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894 Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France; Fondation Fondamental, France.
25
Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France; Fondation Fondamental, France.
26
Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France; Fondation Fondamental, France.

Abstract

INTRODUCTION:

This study aimed was to investigate the relationship between different types of childhood trauma and the level of insight (i.e., awareness of having a psychiatric disorder) in subjects suffering from schizophrenia, as well as the putative role of clinical mediators.

METHODS:

294 community-dwelling subjects with stable schizophrenia were included into FACE-SZ, a multicentre cross-sectional study. All patients were assessed by specialized multidisciplinary teams. The level of insight was assessed by the Scale to assess Unawareness of Mental Disorder (SUMD), and childhood trauma by the Childhood Trauma Questionnaire (CTQ). Path analyses from the five CTQ subscales (physical abuse and neglect, emotional abuse and neglect, and sexual abuse) and the SUMD, with current symptomatology (i.e., positive, negative, global psychopathology and depression) as mediator, was performed.

RESULTS:

Physical neglect (β = 0.14) and abuse (β = 0.13) were significantly associated with poor insight. Negative symptoms were a clinical mediator of the relationship between physical neglect and poor insight. Moreover, positive (β = 0.21) and negative (β = 0.30) symptoms were associated with poor insight, whereas depression (β = -0.14) was associated with higher levels of insight.

DISCUSSION:

For the first time, this study shows a significant relationship between childhood trauma, specifically physical neglect and abuse, and poor insight. The level of insight was linked to different clinical dimensions. Among subjects with schizophrenia, these results provide support for a role of childhood trauma in poorer management outcomes, and the need to provide treatment, including psycho-education that better targets the consequences of childhood trauma.

KEYWORDS:

Childhood trauma; Insight; Negative symptoms; Path-analysis; Schizophrenia

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