Pathomechanisms and Signatures in the Longitudinal Course of Psychosis

13.01.2015

2022-10-21

059_ The impact of early life stress on global functioning, quality of life and symptomatic burden in patients from the affective-to-psychotic spectrum and healthy controls

Research Question and Aims

Evidence indicates that in addition to genetic risk factors life events do influence the risk for psychiatric disorders and their clinical severity; especially the risk for psychotic 1-3 and affective disorders 4,5 may be dependent on early life stress. Furthermore, early life stress is considered to affect social functioning and cognitive performance in healthy controls Senner et al. under review. The PsyCourse Study allows us to elaborate cross-diagnostic analyses of the influence of early life stress on global functioning (GAF) and quality of life (WHOQoL). Thus we will try to predict these parameters in a group of patients with affective and psychotic disorders and healthy controls dependent on the experience of early adverse events.
Furthermore, we want to investigate whether certain subtypes of childhood trauma (physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect) attribute to specific symptomatic constellations. In patients with FEP (first-episode-psychosis), distinct effects of childhood trauma were observed on positive and negative symptom severity, global functioning, and depression 3. Emotional and physical abuse increased certain symptom constellations in patients with bipolar disorder 6. For affective disorders, especially emotional abuse is a risk factor to the occurrence of depressive symptoms 7. A meta-analysis showed that early life stress increases the likelihood of an admixture of affective, anxiety and psychotic symptoms across diagnostic boundaries. As certain early life stress patterns are apparently associated to specific changes on a symptom level, we want to analyze this phenomenon in a cross-diagnostic group of patients with affective and psychotic disorders and healthy controls. Therefore, we will try to predict the symptom severities as measured by PANSS, YMRS and IDS-C30 given the information of the CTS. Secondly, a cluster analysis on symptom level will be performed in order to find trends concerning co-occurrences of early life stress subtypes and their association with certain symptomatic constellations.

Analytic Plan

Hypothesis
1. We hypothesize that global functioning and quality of life (measured by GAF and WHOQoL; averaged over v1-4) in patients from the affective-to-psychotic spectrum and healthy controls can be predicted dependent on the early life stress level measured by CTS across diagnostic boundaries.
2. We hypothesize that symptom levels (measured by PANSSSpos, PANSSneg PANSSgen, YMRS and IDS-C30; averaged over v1-4) in patients from the affective-to-psychotic spectrum and healthy controls can be predicted dependent on the early life stress level across diagnostic boundaries.
3. We hypothesize that clusters of symptoms (independent of the clinical-control-status and diagnosis) exist and that the occurrence of the early life stress subtypes vary among these clusters.

Participants
Data from all participants in PsyCourse who have completed the "Childhood Trauma Screener" (CTS) will be included in this study.

Analytic methods
The analyses will be performed cross-diagnostically in patients and the healthy control group.

For H1
We will perform a machine learning based prediction for investigating the impact of early life stress on GAF and WHOQoL (averaged values from v1-v4).
Dependent variables: gaf, whoqol
Independent variables: cts
Covariates: age, sex, center, diagnosis, clinical-control-status

For H2
We will perform a machine learning based prediction for investigating the impact of early life stress on symptomatic burden measured by PANSSpos, PANSSneg, PANSSgen, YMRS and IDS-C30 (averaged values from v1-v4).
Dependent variables: PANSSpos, PANSSneg, PANSSgen, YMRS, IDS-C30
Independent variables: cts
Covariates: age, sex, center, diagnosis, clinical-control-status

For H3
Clusters on symptom levels (measured by PANSS, YMRS, and IDS-C30) will be built (corrected for the clinical-control-status and diagnosis) and investigated regarding the (co-)occurrence of different trauma subtypes.

Resources needed

Demographic information
v1_sex
v1_ageBL
v1_yob
v1_center

Diagnosis
v1_scid_dsm_dx_cat
v1_stat

Medication Information
v1_Antidepressants
v2_Antidepressants
v3_Antidepressants
v4_Antidepressants
v1_Antipsychotics
v2_Antipsychotics
v3_Antipsychotics
v4_Antipsychotics
v1_Mood_stabilizers
v2_Mood_stabilizers
v3_Mood_stabilizers
v4_Mood_stabilizers
v1_Tranquilizers
v2_Tranquilizers
v3_Tranquilizers
v4_Tranquilizers
v1_Other_psychiatric
v2_Other_psychiatric
v3_Other_psychiatric
v4_Other_psychiatric

Treatment Status
v1_cur_psy_trm
v2_cur_psy_trm
v3_cur_psy_trm
v4_cur_psy_trm

Treatment Status
v1_cur_psy_trm
v2_cur_psy_trm
v3_cur_psy_trm
v4_cur_psy_trm

Genetic Risk
psyc_id
gsa_id

Childhood Trauma Screener
v3_cts_1
v3_cts_2
v3_cts_3
v3_cts_4
v3_cts_5
v3_cts_els_dic
v3_cts_1_dic
v3_cts_2_dic
v3_cts_3_dic
v3_cts_4_dic
v3_cts_5_dic

Quality of Life
v1_whoqol_itm1
v1_whoqol_itm2
v1_whoqol_itm3
v1_whoqol_itm4
v1_whoqol_itm5
v1_whoqol_itm6
v1_whoqol_itm7
v1_whoqol_itm8
v1_whoqol_itm9
v1_whoqol_itm10
v1_whoqol_itm11
v1_whoqol_itm12
v1_whoqol_itm13
v1_whoqol_itm14
v1_whoqol_itm15
v1_whoqol_itm16
v1_whoqol_itm17
v1_whoqol_itm18
v1_whoqol_itm19
v1_whoqol_itm20
v1_whoqol_itm21
v1_whoqol_itm22
v1_whoqol_itm23
v1_whoqol_itm24
v1_whoqol_itm25
v1_whoqol_itm26
v1_whoqol_dom_glob
v1_whoqol_dom_phys
v1_whoqol_dom_psy
v1_whoqol_dom_soc
v1_whoqol_dom_env
v2_whoqol_itm1
v2_whoqol_itm2
v2_whoqol_itm3
v2_whoqol_itm4
v2_whoqol_itm5
v2_whoqol_itm6
v2_whoqol_itm7
v2_whoqol_itm8
v2_whoqol_itm9
v2_whoqol_itm10
v2_whoqol_itm11
v2_whoqol_itm12
v2_whoqol_itm13
v2_whoqol_itm14
v2_whoqol_itm15
v2_whoqol_itm16
v2_whoqol_itm17
v2_whoqol_itm18
v2_whoqol_itm19
v2_whoqol_itm20
v2_whoqol_itm21
v2_whoqol_itm22
v2_whoqol_itm23
v2_whoqol_itm24
v2_whoqol_itm25
v2_whoqol_itm26
v2_whoqol_dom_glob
v2_whoqol_dom_phys
v2_whoqol_dom_psy
v2_whoqol_dom_soc
v2_whoqol_dom_env
v3_whoqol_itm1
v3_whoqol_itm2
v3_whoqol_itm3
v3_whoqol_itm4
v3_whoqol_itm5
v3_whoqol_itm6
v3_whoqol_itm7
v3_whoqol_itm8
v3_whoqol_itm9
v3_whoqol_itm10
v3_whoqol_itm11
v3_whoqol_itm12
v3_whoqol_itm13
v3_whoqol_itm14
v3_whoqol_itm15
v3_whoqol_itm16
v3_whoqol_itm17
v3_whoqol_itm18
v3_whoqol_itm19
v3_whoqol_itm20
v3_whoqol_itm21
v3_whoqol_itm22
v3_whoqol_itm23
v3_whoqol_itm24
v3_whoqol_itm25
v3_whoqol_itm26
v3_whoqol_dom_glob
v3_whoqol_dom_phys
v3_whoqol_dom_psy
v3_whoqol_dom_soc
v3_whoqol_dom_env
v4_whoqol_itm1
v4_whoqol_itm2
v4_whoqol_itm3
v4_whoqol_itm4
v4_whoqol_itm5
v4_whoqol_itm6
v4_whoqol_itm7
v4_whoqol_itm8
v4_whoqol_itm9
v4_whoqol_itm10
v4_whoqol_itm11
v4_whoqol_itm12
v4_whoqol_itm13
v4_whoqol_itm14
v4_whoqol_itm15
v4_whoqol_itm16
v4_whoqol_itm17
v4_whoqol_itm18
v4_whoqol_itm19
v4_whoqol_itm20
v4_whoqol_itm21
v4_whoqol_itm22
v4_whoqol_itm23
v4_whoqol_itm24
v4_whoqol_itm25
v4_whoqol_itm26
v4_whoqol_dom_glob
v4_whoqol_dom_phys
v4_whoqol_dom_psy
v4_whoqol_dom_soc
v4_whoqol_dom_env

Global Functioning
v1_gaf
v2_gaf
v3_gaf
v4_gaf

Symptom Rating Scales
v1_panss_p1
v1_panss_p2
v1_panss_p3
v1_panss_p4
v1_panss_p5
v1_panss_p6
v1_panss_p7
v1_panss_sum_pos
v1_panss_n1
v1_panss_n2
v1_panss_n3
v1_panss_n4
v1_panss_n5
v1_panss_n6
v1_panss_n7
v1_panss_sum_neg
v1_panss_g1
v1_panss_g2
v1_panss_g3
v1_panss_g4
v1_panss_g5
v1_panss_g6
v1_panss_g7
v1_panss_g8
v1_panss_g9
v1_panss_g10
v1_panss_g11
v1_panss_g12
v1_panss_g13
v1_panss_g14
v1_panss_g15
v1_panss_g16
v1_panss_sum_gen
v1_panss_sum_tot
v1_ymrs_itm1
v1_ymrs_itm2
v1_ymrs_itm3
v1_ymrs_itm4
v1_ymrs_itm5
v1_ymrs_itm6
v1_ymrs_itm7
v1_ymrs_itm8
v1_ymrs_itm9
v1_ymrs_itm10
v1_ymrs_itm11
v1_ymrs_sum
v1_idsc_itm1
v1_idsc_itm2
v1_idsc_itm3
v1_idsc_itm4
v1_idsc_itm5
v1_idsc_itm6
v1_idsc_itm7
v1_idsc_itm8
v1_idsc_itm9
v1_idsc_itm9a
v1_idsc_itm9b
v1_idsc_itm10
v1_idsc_itm11
v1_idsc_itm12
v1_idsc_itm13
v1_idsc_itm14
v1_idsc_itm15
v1_idsc_itm16
v1_idsc_itm17
v1_idsc_itm18
v1_idsc_itm19
v1_idsc_itm20
v1_idsc_itm21
v1_idsc_itm22
v1_idsc_itm23
v1_idsc_itm24
v1_idsc_itm25
v1_idsc_itm26
v1_idsc_itm27
v1_idsc_itm28
v1_idsc_itm29
v1_idsc_itm30
v1_idsc_sum
v2_panss_p1
v2_panss_p2
v2_panss_p3
v2_panss_p4
v2_panss_p5
v2_panss_p6
v2_panss_p7
v2_panss_sum_pos
v2_panss_n1
v2_panss_n2
v2_panss_n3
v2_panss_n4
v2_panss_n5
v2_panss_n6
v2_panss_n7
v2_panss_sum_neg
v2_panss_g1
v2_panss_g2
v2_panss_g3
v2_panss_g4
v2_panss_g5
v2_panss_g6
v2_panss_g7
v2_panss_g8
v2_panss_g9
v2_panss_g10
v2_panss_g11
v2_panss_g12
v2_panss_g13
v2_panss_g14
v2_panss_g15
v2_panss_g16
v2_panss_sum_gen
v2_panss_sum_tot
v2_ymrs_itm1
v2_ymrs_itm2
v2_ymrs_itm3
v2_ymrs_itm4
v2_ymrs_itm5
v2_ymrs_itm6
v2_ymrs_itm7
v2_ymrs_itm8
v2_ymrs_itm9
v2_ymrs_itm10
v2_ymrs_itm11
v2_ymrs_sum
v2_idsc_itm1
v2_idsc_itm2
v2_idsc_itm3
v2_idsc_itm4
v2_idsc_itm5
v2_idsc_itm6
v2_idsc_itm7
v2_idsc_itm8
v2_idsc_itm9
v2_idsc_itm9a
v2_idsc_itm9b
v2_idsc_itm10
v2_idsc_itm11
v2_idsc_itm12
v2_idsc_itm13
v2_idsc_itm14
v2_idsc_itm15
v2_idsc_itm16
v2_idsc_itm17
v2_idsc_itm18
v2_idsc_itm19
v2_idsc_itm20
v2_idsc_itm21
v2_idsc_itm22
v2_idsc_itm23
v2_idsc_itm24
v2_idsc_itm25
v2_idsc_itm26
v2_idsc_itm27
v2_idsc_itm28
v2_idsc_itm29
v2_idsc_itm30
v2_idsc_sum
v3_panss_p1
v3_panss_p2
v3_panss_p3
v3_panss_p4
v3_panss_p5
v3_panss_p6
v3_panss_p7
v3_panss_sum_pos
v3_panss_n1
v3_panss_n2
v3_panss_n3
v3_panss_n4
v3_panss_n5
v3_panss_n6
v3_panss_n7
v3_panss_sum_neg
v3_panss_g1
v3_panss_g2
v3_panss_g3
v3_panss_g4
v3_panss_g5
v3_panss_g6
v3_panss_g7
v3_panss_g8
v3_panss_g9
v3_panss_g10
v3_panss_g11
v3_panss_g12
v3_panss_g13
v3_panss_g14
v3_panss_g15
v3_panss_g16
v3_panss_sum_gen
v3_panss_sum_tot
v3_ymrs_itm1
v3_ymrs_itm2
v3_ymrs_itm3
v3_ymrs_itm4
v3_ymrs_itm5
v3_ymrs_itm6
v3_ymrs_itm7
v3_ymrs_itm8
v3_ymrs_itm9
v3_ymrs_itm10
v3_ymrs_itm11
v3_ymrs_sum
v3_idsc_itm1
v3_idsc_itm2
v3_idsc_itm3
v3_idsc_itm4
v3_idsc_itm5
v3_idsc_itm6
v3_idsc_itm7
v3_idsc_itm8
v3_idsc_itm9
v3_idsc_itm9a
v3_idsc_itm9b
v3_idsc_itm10
v3_idsc_itm11
v3_idsc_itm12
v3_idsc_itm13
v3_idsc_itm14
v3_idsc_itm15
v3_idsc_itm16
v3_idsc_itm17
v3_idsc_itm18
v3_idsc_itm19
v3_idsc_itm20
v3_idsc_itm21
v3_idsc_itm22
v3_idsc_itm23
v3_idsc_itm24
v3_idsc_itm25
v3_idsc_itm26
v3_idsc_itm27
v3_idsc_itm28
v3_idsc_itm29
v3_idsc_itm30
v3_idsc_sum
v4_panss_p1
v4_panss_p2
v4_panss_p3
v4_panss_p4
v4_panss_p5
v4_panss_p6
v4_panss_p7
v4_panss_sum_pos
v4_panss_n1
v4_panss_n2
v4_panss_n3
v4_panss_n4
v4_panss_n5
v4_panss_n6
v4_panss_n7
v4_panss_sum_neg
v4_panss_g1
v4_panss_g2
v4_panss_g3
v4_panss_g4
v4_panss_g5
v4_panss_g6
v4_panss_g7
v4_panss_g8
v4_panss_g9
v4_panss_g10
v4_panss_g11
v4_panss_g12
v4_panss_g13
v4_panss_g14
v4_panss_g15
v4_panss_g16
v4_panss_sum_gen
v4_panss_sum_tot
v4_ymrs_itm1
v4_ymrs_itm2
v4_ymrs_itm3
v4_ymrs_itm4
v4_ymrs_itm5
v4_ymrs_itm6
v4_ymrs_itm7
v4_ymrs_itm8
v4_ymrs_itm9
v4_ymrs_itm10
v4_ymrs_itm11
v4_ymrs_sum
v4_idsc_itm1
v4_idsc_itm2
v4_idsc_itm3
v4_idsc_itm4
v4_idsc_itm5
v4_idsc_itm6
v4_idsc_itm7
v4_idsc_itm8
v4_idsc_itm9
v4_idsc_itm9a
v4_idsc_itm9b
v4_idsc_itm10
v4_idsc_itm11
v4_idsc_itm12
v4_idsc_itm13
v4_idsc_itm14
v4_idsc_itm15
v4_idsc_itm16
v4_idsc_itm17
v4_idsc_itm18
v4_idsc_itm19
v4_idsc_itm20
v4_idsc_itm21
v4_idsc_itm22
v4_idsc_itm23
v4_idsc_itm24
v4_idsc_itm25
v4_idsc_itm26
v4_idsc_itm27
v4_idsc_itm28
v4_idsc_itm29
v4_idsc_itm30
v4_idsc_sum