Childhood adversities and psychotic symptoms: The potential mediating or moderating role of neurocognition and social cognition

Abstract

Introduction

Childhood abuse and neglect are risk factors for psychotic symptoms. Early adversities may contribute to alterations in neuro/social cognition, which in turn is associated with psychosis. This study explored the possible mediating/moderating role of neuro/social cognition between childhood abuse and neglect on the one hand, and psychotic symptoms on the other.

Method

The sampling frame was 1.119 patients with a psychotic disorder. Childhood adversity was evaluated with the Dutch version of the Childhood Trauma Questionnaire. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale. Verbal learning-memory, attention-vigilance, working memory, information processing speed, reasoning-problem solving were evaluated as measures of neurocognition using the Word Learning Task, the Continuous Performance Test, the Wechsler Adult Intelligence Scale 3rd. Mentalization was evaluated as a measure of social cognition using the Hinting Task. Correlation, mediation, moderation, 95% Bias Corrected and accelerated (BCaCI) bootstrapped analyses were performed, considering possible sex differences.

Results

In male psychotic patients, attention and vigilance mediated the association between childhood neglect and negative symptoms (indirect effect: 0.18, BCaCI: 0.03–0.54), disorganization (indirect effect: 0.26, BCaCI: 0.05–0.61), excitement (indirect effect: 0.07, BCaCI: 0.004–0.23); mentalization mediated the association between childhood neglect and negative symptoms (indirect effect: 0.21, BCaCI: 0.02–0.51), excitement (indirect effect: 0.07, BCaCI: 0.01–0.20) disorganization (indirect effect: 0.29, BCaCI: 0.02–0.64); working memory mediated the association between childhood abuse and disorganization (indirect effect: 0.28, BCaCI: 0.05–0.57), excitement (indirect effect: 0.08, BCaCI: 0.01–0.20), emotional distress (indirect effect: 0.10, BCaCI: 0.01–0.27).

Discussion

In psychotic disorder, sex-specific mediation of neurocognition and mentalization may exist in the association between childhood adversity and psychotic symptoms.

Introduction

The association between childhood adversities and psychosis is well known (Mansueto and Faravelli, 2017; Trotta et al., 2015; Varese et al., 2012a) with some evidence (Beards and Fisher, 2014; Bentall et al., 2014; Morgan and Gayer-Anderson, 2016) that specific subtypes of childhood adversities may predict later development of psychosis. Childhood abuse and childhood neglect may lead to a 2- to 3-fold increased risk of psychosis while childhood loss events may not (Ajnakina et al., 2016; Shevlin et al., 2015; Trauelsen et al., 2015; Varese et al., 2012a). Childhood adversities with intention to harm seem to be a stronger predictor of psychotic experiences than childhood adversities without intention to harm (van Nierop et al., 2014). Furthermore, childhood physical abuse increases the vulnerability to psychosis (Fisher et al., 2010) as does sexual abuse involving penetration (Cutajar et al., 2010).

It has been suggested that specific kinds of childhood adversities may lead to specific psychotic symptoms. Exposure to childhood abuse was found to be a strong predictor of positive symptoms (Aas et al., 2016; Ajnakina et al., 2016; Bentall et al., 2014; Chae et al., 2015; Cristóbal-Narváez et al., 2016; Gallagher and Jones, 2013; Heins et al., 2011; Lysaker et al., 2001; Schalinski et al., 2015; Shevlin et al., 2015; Sitko et al., 2014; Van Dam et al., 2015) while results on disorganization, excitement, and emotional distress are mixed (Aas et al., 2016; Chae et al., 2015; Schalinski et al., 2015). Experiences of childhood neglect have been associated with paranoia and negative symptoms (Bentall et al., 2014; Cristóbal-Narváez et al., 2016; Gallagher and Jones, 2013; Gibson et al., 2016; Sitko et al., 2014; Van Dam et al., 2015; Vogel et al., 2011) as well as with disorganization, excitement, and emotional distress (Aas et al., 2016; Chae et al., 2015; Schalinski et al., 2015).

Neurocognition (which involves attention, memory, processing speed, and executive functions) (de Gracia Dominguez et al., 2009) and social cognition (which involves perception, encoding, storage and regulation of information about people as well as the ability to think about and imagine mental states) (Fonagy et al., 2002; Green et al., 2015) may mediate in part the association between childhood adversities and psychosis (van Os et al., 2010; van Os et al., 2017).

Childhood adversities may induce a hypothalamic-pituitary-adrenal axis dysregulation that, through glucocorticoid receptors, diminishes hippocampal neurogenesis leading to altered neurocognition (Read et al., 2014). The exposure to childhood adversities may also cause deprivation of early social interactions, cognitive biases such as ‘jumping to conclusions’ and disrupted attachment, which in turn may affect the development of social cognitive abilities (Gibson et al., 2016; Jacobsen et al., 2015; van Os et al., 2010). Childhood adversity contributes to functional alterations of brain regions such as the temporoparietal junction (TPJ), the posterior cingulate cortex (PCC), and dorsomedial prefrontal cortex (dmPFC), which are essential for effective mental state inference (Quidé et al., 2017). Neurocognitive impairments were found in patients with psychotic disorder with a history of childhood abuse (Lysaker et al., 2001; Üçok et al., 2015) and poorer social cognition was observed in those exposed to childhood neglect if compared to those not exposed to childhood adversities (Garcia et al., 2016). In turn, impairments in neurocognition and social cognition were strongly associated with disorganization and negative symptoms, and were weakly associated with positive symptoms (de Gracia Dominguez et al., 2009; Fett et al., 2013; Ventura et al., 2013).

Guided by these findings, it may be hypothesized that patients with psychosis with early adversity may show poorer neuro- and social cognitive functioning which, in turn, is associated with psychotic symptoms. Mediation analyses, that attempt to identify the intermediary process between the independent (e.g. childhood adversities) and the dependent variables (e.g. psychotic symptoms) (Baron and Kenny, 1986; Muller et al., 2005) are a suitable model to evaluate whether neurocognition and social cognition represent a mediating factor between childhood adversities and psychotic symptoms. Moderation analysis (Baron and Kenny, 1986; Muller et al., 2005), in turn, may address the question to what degree neuro- and social cognitive functioning may enhance or reduce the susceptibility to psychotic symptoms in subjects who have been exposed to childhood adversities. Thus, the mediating and moderating role of neurocognition and social cognition in the association between childhood abuse/childhood neglect and psychotic symptoms were explored, using the Baron and Kenny (1986) criteria.