Skadelige barndomserfaringer og psykose

Time to abandon the bio-bio-bio model of psychosis: Exploring the epigenetic and psychological mechanisms by which adverse life events lead to psychotic symptoms

John Read, Richard P. Bentall, Roar Fosse

British children raised in economic deprivation were found to be four times more likely to develop ‘non-schizophrenic’ disorders but eight times more likely to grow-up to be ‘schizophrenic’.

Patients abused as children have earlier first admissions and longer and more frequent hospitalisations, spend longer in seclusion, receive more medication, self-mutilate more, have higher global symptom severity and try to kill themselves more often.

Even within samples diagnosed psychotic or ‘schizophrenic’, child abuse is related to longer duration of untreated psychosis, poorer premorbid functioning, substance abuse, other diagnoses (especially depression and PTSD), unemployment, poor engagement with services, low medication compliance, low satisfaction with diagnosis and treatment, and, most importantly, suicidality.

Most genetic and brain researchers, however, have either ignored the psychosocial causes of psychosis or relegated them to the role of triggers or exacerbators of a vulnerability which they assumed to be genetic.

The President of the American Psychiatric Association recently warned: “If we are seen as mere pill pushers and employees of the pharmaceutical industry, our credibility as a profession is compromised. As we address these Big Pharma issues, we must examine the fact that as a profession, we have allowed the bio-psycho-social model to become the bio-bio-bio model”.

2 kommentarer:

  1. Publiceret i : Epidemiologia e psichiatria sociale - så typisk!

  2. Per Son11.2.10

    Veldig bra artikklel! Den sier blant annet:

    "The hypothesis that there is a specific genetic predisposition for schizophrenia may be one of the costliest blind alleys in the history of medical research."


    "A recent paper in the American Journal of Psychiatry (Sanders et al., 2008), described by the editor as “The most comprehensive genetic association study of genes previously reported to contribute to the susceptibility to schizophrenia” (Hamilton, 2008), found that “none of the polymorphisms were associated with the schizophrenia phenotype at a reasonable threshold for statistical significance’ and ‘of the 69 SNPs(single nucleotide polymorphisms)... only four showed even nominal association. ... The distribution of test statistics suggests nothing outside of what would be expected by chance” (p. 421)."

    Den sier også:

    "Ten out of eleven recent large-scale general population studies have found, even after controlling for other factors including family history of psychosis, that child maltreatment is significantly related to psychosis (Table II). For example, a prospective Netherlands study controlled for both family mental health care and history of hallucinations or delusions in first-degree relatives and found that people who had been abused as children were nine times more likely than non-abused people to experience pathology-level psychosis (Janssen et al., 2004). Nine of the 11 studies tested for, and found, a doseresponse relationship."

    "Doseresponse" ("jo mer, jo verre") er en meget sterk indikator for årsakssammenheng.


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