Childhood trauma does not hinder progress in patients treated for bipolar disorder (BD) according to a recent study published in Acta Psychiatrica Scandinavica. The study examined the effect of childhood trauma on outcomes in patients treated with either lithium or quetiapine.

Childhood trauma is an important factor in mood disorder treatment, as multiple studies show that people who experienced childhood trauma do not respond to treatment as well as those without traumatic childhood experiences. The researchers behind the current study wanted to more closely examine the association between childhood trauma and BD specifically, as previous studies focused on BD have produced conflicting results.

The researchers conducted secondary analyses using data from the Clinical Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder (Bipolar CHOICE) study. They focused on outpatients randomized to either lithium or quetiapine. A history of childhood trauma was reported in over half (52.7%) of the 476 patients included.


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The researchers found BD symptoms manifested at an earlier age in BD patients who experienced childhood trauma. They also experienced a higher number of depressive episodes, higher rates and number of suicide attempts, higher rates of prior psychiatric hospitalization, and higher rates of comorbidity with posttraumatic stress disorder and lifetime substance abuse than those without childhood trauma.

After 24 weeks of lithium or quetiapine treatment, patients who experienced childhood trauma had a mean Bipolar Inventory of Symptoms Scale (BISS) score of 31.3 (SD=22.8) and a mean Clinical Global Impression Scale for Bipolar Disorder (CGI-BP) score of 2.92 (SD=1.31). Those without trauma had a mean BISS score of 27.1 (SD = 21.0) and a mean CGI-BP score of 2.76 (SD=1.37). The patients with trauma had higher scores at individual study visits but those scores had lowered by the 24-week mark.

Patients with childhood trauma had a mean Range of Impaired Functioning (LIFERFT) score of 10.8 (SD=3.7) while people without that history had a mean LIFE-RIFT score of 9.9 (SD=3.8). While the type of medication did not impact improvement for BD patients with childhood trauma, those who experienced physical, emotional, and sexual abuse showed a greater improvement in symptom severity.

The researchers note the data were not collected using a validated questionnaire, which could have led to a measurement error. Also, the retrospective assessment could have been influenced by recall bias. They acknowledge, however, that the original study was conducted by highly trained clinicians with extensive BD experience.

The researchers suggest future studies across different settings as a way to further validate the impact of medication on BD patients with a history of childhood trauma.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Wrobel AL, Köhler-Forsberg O, Sylvia LG, et al. Childhood trauma and treatment outcomes during mood-stabilising treatment with lithium or quetiapine among outpatients with bipolar disorder. Acta Psychiatr Scand. 2022;10.1111/acps.13420. doi:10.1111/acps.13420