Childhood maltreatment and clinical response to mood stabilizers in patients with bipolar disorder

Abstract

Objective The association between childhood maltreatment (CM) and clinical response to mood stabilizers has been scarcely investigated in bipolar disorder (BD). Therefore, we assessed whether CM affects the response to lithium or anticonvulsant treatments in BD patients. Methods A retrospective assessment of clinical response to mood stabilizers was conducted in 97 euthymic patients with BD by means of the Alda scale. History of CM was investigated through the Childhood Trauma Questionnaire. Results Thirty‐seven patients (24 with a history of CM and 13 without CM) were on stable lithium treatment while sixty (35 with a history of CM and 25 without CM) were on stable anticonvulsant treatment. Clinical response to drug treatment did not differ between BD with CM and those without CM in the whole sample as well as in the anticonvulsant‐treated subgroup. In the lithium‐treated subgroup, a significant negative correlation emerged between childhood physical abuse and clinical response and patients with CM showed a significantly reduced Alda score. Conclusions In BD patients, CM did not influence the clinical response to anticonvulsant mood stabilizers whereas it was associated with a poorer response to lithium with childhood physical abuse playing a major role in this effect.

Childhood trauma and treatment outcomes during mood‐stabilising treatment with lithium or quetiapine among outpatients with bipolar disorder

“…Our findings are consistent with two observational studies that were unable to demonstrate an association between participants’ history of any childhood trauma and response to lithium treatment 13,14 . Our findings are discordant with a recent study by Cascino et al 15 In a sample of 37 outpatients with bipolar disorder, participants with a history of childhood trauma ( n = 24) responded more poorly to lithium (i.e., showed less symptom improvement). However, studies with small sample sizes need to be interpreted cautiously.…”

“…Methodological differences may partly explain the inconsistent results. Etain et al 13 and Cascino et al 15 conducted observational studies in which they retrospectively assessed response to lithium treatment among currently euthymic patients. In contrast, in Bipolar CHOICE, the treatment outcomes of symptomatic patients were prospectively monitored over the course of 24 weeks in the context of a randomised trial of lithium and quetiapine.…”

“…Our null result pertaining to the type of childhood trauma (physical, sexual or emotional abuse) is surprising in the context of previously published research. 13,15 Both Etain et al 13 and Cascino et al 15 suggested that physical abuse-not sexual or emotional abuse-was negatively associated with treatment outcome after treatment with lithium. Unlike these studies, we were unable to provide evidence of the specific implication of one childhood trauma type.…”

“…7,8 Several studies have demonstrated an association between childhood trauma and poorer response to pharmacotherapy in both adolescent and adult samples diagnosed with major depressive disorder. [9][10][11][12] Although there are only few small-scale studies that examined a similar association in bipolar disorder, [13][14][15][16][17] initial findings highlight that childhood trauma might also moderate treatment outcomes in this population.…”

Attachment insecurity partially mediates the relationship between childhood trauma and depression severity in bipolar disorder

“…Although it is a retrospective instrument, evidence of reasonable correlations between the CTQ and prospective measures of childhood trauma is emerging. 38 Consistent with previous research, [39][40][41] participants with a score of moderate severity on at least one subscale of the CTQ (physical abuse ≥10, sexual abuse ≥8, emotional abuse ≥13, physical neglect ≥10, emotional neglect ≥15) 42 were coded as having a history of childhood trauma.…”