Effects of Childhood Trauma on the Lipid Profile of First-Episode Psychosis Patients.
Background: Patients with schizophrenia and associated psychosis-spectrum disorders have abnormally higher mortality rates (up to three times) and reduced life expectancies (15 years on average) when compared to the general population. Furthermore, the mortality gap seems to be worsening over time. A substantial proportion of these premature deaths is secondary to cardiovascular disease (e.g. myocardial infarction) and associated metabolic disorders (e.g. dyslipidemia, diabetes). The current theories explaining this association point to the psychopathological nature of psychosis-spectrum disorders and its relationship with unhealthy behaviours such as smoking (nicotine self-medication hypothesis) and sedentary lifestyles (resulting from negative symptoms). Moreover, most of the currently available antipsychotic medications have frequent metabolic side effects. However, the high comorbidity between schizophrenia and diabetes was documented long before the introduction of the first antipsychotics. In addition, recent meta-analytical evidence indicates that metabolic anomalies are already present in first-episode psychosis patients, whom have not been chronically exposed to the negative effects of sedentary lifestyle changes or antipsychotics. As such, other risk factors might responsible for the increased rates of metabolic and cardiovascular disease in psychosis. Thus, other risk factors might account for this relationship. One of the most pervasive influences of health is childhood abuse. Since childhood abuse has been documented to increase the incidence rates for obesity, diabetes and psychosis, it placing itself as a possible etiological link. Objectives: The main objective of the present study is to determine the influence of childhood abuse on cardiometabolic risk markers in first-episode psychosis patients. The secondary objective is to provide indirect evidence that childhood abuse could account for a proportion of the cardiometabolic comorbidity in psychosis-spectrum disorders. Methods: Participants consisted of patients accepted to PEPP-Montréal between 2003 and 2014, aged 14-35 years, participated in the study (N=167, 49 women, 118 men). Participants completed the Childhood Trauma Questionnaire (CTQ), which consists of 28 items, 25 pertaining to trauma exposures during childhood (5 questions per trauma type). A dichotomous predictor variable indicating exposure over minimum threshold for trauma was calculated following the CTQ authors’ guidelines. Blood levels of total cholesterol, HDL, LDL, and triglyceride levels at admission were used to as indicators of cardiovascular risk (outcome variables). Results: A history of childhood trauma significantly predicted higher levels of HDL in women (t=3.10, df=49, p<0.01), but not in men (t=0.38, df=118, p<0.70). Other lipid levels showed a non-significant trend towards decrease in women, and no relationship in men. Discussion and Implications: While the presence of a sexual dimorphism is not surprising (given the differential influence of childhood abuse by sex), finding higher HDL levels in women with a history of abuse is contradictory, as it is associated with lower cardiovascular risk. While it cannot be tested in the present sample, childhood trauma in women could lead to drastic dietary behaviors such as anorexia, potentially explaining their paradoxically better (and statistically robust) levels of HDL, at least in the present sample.