
Childhood Trauma and Outcomes With Lithium or Quetiapine in Outpatients With Bipolar Disorder
Does childhood trauma affect outcomes in bipolar disorder? Researchers analyzed the impact of childhood trauma on outcomes in outpatients with bipolar disorder treated with lithium or quetiapine in a randomized clinical trial.
RESEARCH UPDATE
CASE VIGNETTE
“Mrs Gee” is a 58-year-old Native American female with a history of bipolar disorder with psychotic features and
In the past month, she has worsening of chronic auditory hallucinations of men who sexually abused her in the past. Sometimes the voices tell her to harm herself, which she is able to ignore, and she denies current suicidal ideation. She was violently raped at age 7, and was sexually assaulted by her uncle and several of her mother’s boyfriends as a teenager. She was also emotionally and physically abused by her mother. After discussing the risks and benefits of various medications, Mrs Gee is agreeable to a trial of quetiapine, which she has not taken previously.
Childhood trauma is associated with the clinical course of bipolar disorder, including earlier age of onset, a greater number of mood episodes, psychotic symptoms, and psychiatric comorbidity.1 Furthermore,
The Current Study
Wrobel and colleagues studied the association between childhood trauma and symptomatic and functional treatment outcomes in outpatients with bipolar disorder randomized to
Data at baseline were analyzed using logistic regression, based on participants with and without a history of any childhood trauma. Differences in treatment outcomes based on childhood trauma were analyzed using mixed effects and linear regression models.
Of the 482 participants in the trial, 6 were excluded due to “Other” abuse. Of the 476 included participants, 53% were exposed to at least 1 type of childhood trauma, including 49% for physical abuse, 6% for sexual abuse, and 76% for emotional abuse. Mean participant age was 39, and 59% were female. Participants with a history of trauma were likely to be female (odds ratio [OR]=2.0); have an earlier age of onset, more depressive episodes, a history of suicide attempts (OR=2.7), and history of psychiatric hospitalization; higher rates of PTSD (OR=2.9) and
Participants with childhood trauma had significantly higher BISS and CGI scores at each study visit except the week 24 endpoint. However, there were no differences in the rate of improvement/symptom reduction in participants based on childhood trauma status. Participants with childhood trauma also had significantly higher functional impairment scores at week 12 and 24, but there were no differences in the rate of improvement/reduction of functional impairment in participants based on childhood trauma status. In secondary analyses, the pattern of findings for rates of symptomatic and functional improvement was similar when considering lithium and quetiapine, and different types of childhood trauma, separately.
Study Conclusions
The authors concluded that childhood trauma was related to several indicators of a worse clinical course and prognosis in
The Bottom Line
The present study found that a history of childhood trauma does not inhibit improvements in symptoms or functional impairment in outpatients with bipolar disorder treated with lithium or quetiapine.
Dr Miller is professor in the Department of Psychiatry and Health Behavior, Augusta University, Augusta, Georgia. He is on the Editorial Board and serves as the schizophrenia section chief for Psychiatric TimesTM. The author reports that he receives research support from Augusta University, the National Institute of Mental Health, and the Stanley Medical Research Institute.
References
1. Agnew-Blais J, Danese A.
2. Etain B, Lajnef M, Brichant-Petitjean C, et al.
3. Cakir S, Tasdelen Durak R, Ozyildirim I, et al.
4. Wrobel AL, Köhler-Forsberg O, Sylvia LG, et al.
5. Nierenberg AA, Sylvia LG, Leon AC, et al.
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