Trauma okresu rozwojowego jako czynnik ryzyka rozwoju zaburzeń psychotycznych. Część II. Wyniki badań, mechanizmy przyczynowo-skutkowe, implikacje kliniczne

• Authors: Magdalena Kotlicka-Antczak , Jolanta Rabe-Jabłońska

Title variants

EN

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

• Languages of publication: EN PL

Abstracts

EN

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 implicadooewiadtions, 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.

PL

Wiele badań przynosi dowody na istnienie związku pomiędzy przeżyciem wczesnej traumy (WT) a różnorodnymi niepsychotycznymi zaburzeniami psychicznymi. Autorki pracy dokonują przeglądu współczesnego piśmiennictwa dotyczącego relacji WT z późniejszym rozwojem zaburzeń psychotycznych. Dane na ten temat pozostają w dużym stopniu niespójne. Większość badaczy jest zgodna, że doznanie WT może skutkować wystąpieniem w przyszłości tzw. objawów pozytywnych psychozy, zwłaszcza halucynacji i urojeń. Nie wykazano związku WT z występowaniem uznanych za charakterystyczne dla psychoz schizofrenicznych objawów negatywnych, zaburzeń funkcji poznawczych czy cech dezorganizacji myślenia. Sugeruje to, że związek pomiędzy WT a psychozą jest niespecyficzny diagnostycznie i dotyczy raczej możliwości wystąpienia objawów psychotycznych obecnych w różnych zaburzeniach psychicznych. Mechanizm rozwoju objawów psychotycznych związanych z WT znajduje swoje wyjaśnienie zarówno w paradygmacie biologicznym, jak i psychologicznym. Mechanizmy biologiczne obejmują między innymi wpływ stresu na rozwój mózgu, dysregulację osi podwzgórze - przysadka - nadnercza lub układu dopaminergicznego. Zgodnie z modelem poznawczym psychozy przeżycie traumy prowadzi do powstawania negatywnych schematów poznawczych, co sprzyja zewnętrznym atrybucjom i formowaniu urojeń i halucynacji. Omawiany problem przynosi wiele implikacji klinicznych, z których podstawowymi są konieczność przeprowadzania wywiadu w kierunku WT i uwzględnianie faktu jej doznania w procesie terapeutycznym. Najbardziej polecaną jako podstawowa lub dodatkowa forma leczenia osób z WT w wywiadzie jest terapia poznawczo-behawioralna.

Keywords

EN

clinical implications; early trauma; implikacje kliniczne; mechanisms of development of psychosis; mechanizmy rozwoju psychozy; nadużycie fizyczne/seksualne; physical/sexual abuse; psychotic disorder; wczesna trauma; zaburzenia psychotyczne

Discipline

• MEDICINE: MEDICINE

• Journal: Psychiatria i Psychologia Kliniczna
• Year: 2008
• Volume: 8
• Issue: 2
• Pages: 76-92

Contributors

author

Magdalena Kotlicka-Antczak

• Klinika Zaburzeń Afektywnych i Psychotycznych Uniwersytetu Medycznego w Łodzi. Kierownik: prof. dr hab. n. med. Jolanta Rabe-Jabłońska

author

Jolanta Rabe-Jabłońska

• Klinika Zaburzeń Afektywnych i Psychotycznych Uniwersytetu Medycznego w Łodzi. Kierownik: prof. dr hab. n. med. Jolanta Rabe-Jabłońska

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• Document Type: article