e32 Abstracts / Comprehensive Psychiatry 54 (2013) e15e40
selected from a stratified multistage clustered area probability sample of
households within the 39 municipalities of So Paulo, Brazil. Analyses used
weighted simple and multiple logistic regression models with childhood
neglect, physical abuse, sexual abuse, and family violence as exposures and
heart disease and hypertension as outcomes, adjusted for socio-demographic
variables and early onset of major depressive disorder.
Results: In models adjusted for socio-demographic factors and early onset of
depression, physical abuse (OR = 1.64, 95% CI: 1.302.07) and family
violence (OR = 1.37, 95% CI: 1.101.71) were associated with hypertension.
Physical abuse was a significant risk factor for heart disease (OR = 1.74, 95%
CI: 1.062.85) when controlling for socio-demographic variables, but this
association lost significance when controlling for early onset of depression.
When additionally controlling for other childhood adversities simultaneously,
physical abuse remained associated with adult hypertension (OR = 1.68, 95%
CI: 1.282.20; OR = 1.59, 95% CI: 1.222.07 with and without adjusting for
depression, respectively). Physical abuse lost significance when also adjusting
for the other childhood adversities simultaneously.
Conclusions: Results suggest a positive association between childhood
physical abuse and hypertension in adulthood, even when adjusting for other
childhood adversities, onset of depression and socio-demographic risk factors.
Efforts to curb child physical abuse could potentially reduce subsequent
hypertension, and morbidity and mortality due to cardiovascular disease.
http://dx.doi.org/10.1016/j.comppsych.2013.07.050
Social cognition in schizophrenia and comorbid antisocial
personality disorder
E. Payne a,b, T. Deliberto a,b, M. Serper a,b,c
a arousal symptoms were most strongly prospectively linked to re-experiencing
Hempstead, NY
b symptoms, while dysphoric arousal symptoms predominantly drove numbing
Far Rockaway, NY
c symptoms over time. In both groups of responders, avoidance symptoms drove
New York, NY
Prior research theorizes that individuals with schizophrenia (SZ) have difficulty
relating to others, because of poor social cognitive functioning. Yet high
comorbidity between schizophrenia and antisocial personality disorder (APD)
confound these findings. It remains unclear as to whether social deficits found
in SZ are inherent to the illness, or due to the presence of comorbid APD.
Previous studies comparing individuals with APD traits and a schizophrenia-
spectrum disorder to patients having SZ alone have shown significant structural
and functioning differences on neuroimaging tasks. Additionally, the two
diagnostic groups differ in terms of neurocognitive ability, with comorbid
APD + SZ patients demonstrating lower intellectual functioning and poorer
memory skills than individuals with SZ without APD. The present study will
examine differences in empathetic functioning in SZ patients with high vs. low
antisocial traits. We hypothesize that individuals with SZ and high APD traits
will have greater empathetic deficits than uncomplicated SZ. We also
hypothesize that individuals with SZ that are high in APD traits will have
lower IQ scores and demonstrate poorer working memory performance than
SZ low in APD trait comorbidity.
http://dx.doi.org/10.1016/j.comppsych.2013.07.051
Dimensional structure and prospective evolution of posttraumatic
stress symptomatology in World Trade Center responders
Robert H. Pietrzak a,b,c, Adriana Feder c, Ritika Singh c,
Clyde B. Schechter d, Jill L. Barron b, Steven M. Southwick a,b,c
a
National Center for Posttraumatic Stress Disorder, VA Connecticut
Healthcare System, West Haven, CT, USA
b
Department of Psychiatry, Yale University School of Medicine,
New Haven, CT, USA
c
Department of Psychiatry, Mount Sinai School of Medicine, New York,
NY, USA
d
Department of Family and Social Medicine, Albert Einstein College of
Medicine of Yeshiva University, Bronx, NY, USA
Background: Posttraumatic stress disorder (PTSD) is an anxiety disorder
characterized by heterogeneous clusters of re-experiencing, avoidance,
numbing, and hyperarousal symptoms. A large body of confirmatory factor
analytic (CFA) studies has demonstrated that four-factor dysphoria and
emotional numbing models provide a better representation of PTSD
symptom dimensionality compared to the three-factor DSM-IV model.
Recently, CFA studies of various trauma-exposed samples have found that a
novel five-factor model, which separates the DSM-IV hyperarousal
symptom cluster into distinct dysphoric and anxious arousal clusters,
provides a superior representation of PTSD symptom dimensionality. To
date, however, no study of which we are aware has evaluated the best
dimensional representation of PTSD symptoms in World Trade Center
(WTC) responders, or how symptom clusters from this model are
prospectively related.
Methods: Confirmatory factor analyses (CFAs) were used to examine the
factor structure of the PTSD Checklist in a cohort of 10,835 WTC
responders, including 4,035 police responders and 6,800 non-traditional
responders, who were evaluated an average of 3, 6, and 8 years after the
WTC attacks. An autoregressive cross-lagged panel regression analysis was
then conducted to evaluate interrelationships among PTSD symptom
clusters over time.
Results: CFAs revealed that a five-factor model comprised of intercorrelated
clusters of re-experiencing, avoidance, emotional numbing, dysphoric arousal,
and anxious arousal symptoms provided the best representation of PTSD
symptoms in police and non-traditional WTC responders. In police responders,
anxious arousal symptoms were most strongly prospectively linked to re-
experiencing symptoms, and dysphoric arousal to numbing symptoms in the
intermediate-term, while re-experiencing symptoms predominantly drove
numbing symptoms in the long-term. In non-traditional responders, anxious
re-experiencing symptoms over time.
Conclusions: A novel 5-factor model comprised of re-experiencing, avoidance,
numbing, dysphoric arousal, and anxious arousal symptoms best represented
PTSD symptomatology in both traditional and non-traditional disaster
responders. Prospective interrelationships among these symptom clusters
suggest that targeting hyperarousal and avoidance symptoms early after disaster
exposure may help reduce later symptoms of re-experiencing and numbing in
disaster responders.
http://dx.doi.org/10.1016/j.comppsych.2013.07.052
Early life adversity is associated with anxiety and depressive disorders in
young adulthood: a prospective longitudinal investigation over 25 years
D.T. Plant, S. Pawlby, C.M. Pariante
Institute of Psychiatry, King's College London, United Kingdom
Background: The etiological pathways for anxiety and depressive disorders
are not fully understood. Adverse childhood experiences such as exposure to
maltreatment and maternal depression have been found to predict later
depression and anxiety. In this study, we investigate the impact of very early
life adversity (exposure to maternal depression in utero) on young adulthood
psychopathology.
Method: The sample comprised a subgroup (n = 50) of participants from
the South London Child Development Study. A prospective longitudinal
design was employed. Data on offspring exposure to depression in utero (20
and 36 weeks gestation), exposure to childhood maltreatment (11 years) and
adulthood depression and anxiety (25 years) were obtained from parents and
offspring through clinical interview.
Results: At 25 years, 26% (13) of offspring met criterion for an anxiety
disorder diagnosis (panic disorder/posttraumatic stress disorder/social
phobia) and 26% (13) of offspring had experienced at least one depressive
episode as an adult. Offspring exposed to depression in utero were
significantly more likely to have an anxiety disorder or major depressive