A systematic review and meta-analysis of the traumatogenic phenotype hypothesis of psychosis
Franca Onyeama,
Eirini Melegkovits,
Nicole Yu,
Ameerah Parvez,
Artur Rodrigues,
Jo Billings,
Ian Kelleher,
Mary Cannon,
Michael A. P. Bloomfield
Affiliations
Franca Onyeama
Division of Psychiatry, University College London, UK; and Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK
Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK
Nicole Yu
Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK
Ameerah Parvez
Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK; and UCL Medical School, University College London, UK
Artur Rodrigues
Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK; and Department of Biology, Faculdade de Ciências da Universidade do Porto, Portugal
Division of Psychiatry, University College London, UK
Ian Kelleher
School of Medicine and Medical Sciences, University College Dublin, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Ireland; and Lucena Clinic, St John of God Community Mental Health Services, Dublin, Ireland
Mary Cannon
Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK; Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, UK; National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK; and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
Background Developmental trauma increases psychosis risk and is associated with poor prognosis. It has been proposed that psychosis in survivors of developmental trauma gives rise to a distinct ‘traumatogenic’ phenotype. Aims Given the implications for personalised treatment, we sought to explore the traumatogenic psychosis phenotype hypothesis in a systematic review and meta-analysis of studies comparing psychotic presentations between adults with and without developmental trauma histories. Method We registered the systematic review on PROSPERO (CRD42019131245) and systematically searched EMBASE, Medline and PsycINFO. The outcomes of interests were quantitative and qualitative comparisons in psychotic symptom expression (positive, negative, cognitive) and other domains of psychopathology, including affect regulation, sleep, depression and anxiety, between adults with and without experience of developmental trauma. Results Of 34 studies included (N = 13 150), 11 were meta-analysed (n = 2842). A significant relationship was found between developmental trauma and increased symptom severity for positive (Hedge's g = 0.27; 95% CI 0.10–0.44; P = 0.002), but not negative symptoms (Hedge's g = 0.13; 95% CI −0.04 to 0.30; P = 0.14). Developmental trauma was associated with greater neurocognitive, specifically executive, deficits, as well as poorer affect, dissociation and social cognition. Furthermore, psychotic symptom content thematically related to traumatic memories in survivors of developmental trauma. Conclusions Our findings that developmental trauma is associated with more severe positive and affective symptoms, and qualitative differences in symptom expression, support the notion that there may be a traumatogenic psychosis phenotype. However, underdiagnosis of post-traumatic stress disorder may also explain some of these findings. More research is needed to explore this further.
