Autor:innen:
Vivien Kraft, Hamburg (Germany)
Friederike Ruppelt, Hamburg (Germany)
Anja Christine Rohenkohl, Hamburg (Germany)
Romy Schröter, Hamburg (Germany)
Julia Gaianigo, Hamburg (Germany)
Mary Sengutta, Hamburg (Germany)
Linus Wittmann, Hamburg (Germany)
Daniel Schöttle, Hamburg (Germany)
Anne Karow, Hamburg (Germany)
Martin Lambert, Hamburg (Germany)
Recently, the harmful influence of childhood adversities (CAs) on psychotic disorders and psychiatric disorders in general, has been shown. One particularly adverse combination of childhood adversities consists of parental maladjustment (mental illness, substance abuse or family violence) plus parental maltreatment (neglect, physical or sexual abuse) and is called maladaptive family functioning. Here we assess the influence of maladaptive family functioning on combined symptomatic and functional remission over 6 months in young psychotic patients.
- Sample (ACCESS III study): 120 patients aged 12-29 years diagnosed with schizophrenia spectrum disorders, bipolar disorder or depression with psychotic symptoms
- Therapeutic assertive community treatment embedded in an integrated care program monitored every 3 to 6 months over 1 year on PANSS, GAF i.a. (ACCESS treatment model)
- Traumatic experiences and CAs recorded as part of the baseline interview
- Remission defined as PANSS items P1, P2, P3, N1, N4, N6, G5, G9 ≤3 points plus GAF ≥60 points for ≥ 6 months
The majority reported having experienced trauma (57%) or childhood adversities (83%).
64% displayed two or more childhood adversities, 45% maladaptive family functioning. Significantly more patients without maladaptive family functioning in the past reached combined remission (34 vs. 16, χ2(1)=5.9, p=0.016; in total 42%).
Using backward selection, the multivariable logistic regression resulted in only one predictive variable: maladaptive family functioning. The variables childhood adversities (≥ 2 vs. < 2), trauma (yes/no), sex (male/female) and diagnosis (affective vs. non-affective psychosis) did not predict remission.
Our data highlights the particular importance of maladaptive family functioning as a predictor of treatment outcome in terms of remission rates. Preventive measures and risk factor assessment as well as psychotherapy should incorporate adaptations accordingly.