Aberrant salience mediates the interplay between emotional abuse and positive symptoms in schizophrenia

• Published in: Comprehensive psychiatry Vol. 133; p. 152496
• Main Authors: de Filippis, Renato, Aloi, Matteo, Liuzza, Marco Tullio, Pugliese, Valentina, Carbone, Elvira Anna, Rania, Marianna, Segura-Garcia, Cristina, De Fazio, Pasquale
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2024; Elsevier Limited; Elsevier
• Subjects: Adult; Adverse childhood experiences; Adverse Childhood Experiences - psychology; Antipsychotics; Child & adolescent psychiatry; Cronbach's alpha; Cross-Sectional Studies; Discriminant analysis; Emotional abuse; Emotional Abuse - psychology; Ethics; Female; Humans; Hypotheses; Informed consent; Male; Mediation analysis; Middle Aged; Psychiatric Status Rating Scales; Psychiatrists; Psychopathology; Psychosis; Psychotic disorders; Psychotic Disorders - diagnosis; Psychotic Disorders - psychology; Psychotropic drugs; Quantitative psychology; Risk factors; Schizophrenia; Schizophrenia - diagnosis; Schizophrenia - physiopathology; Schizophrenia spectrum and other psychotic disorders; Schizophrenic Psychology; Sex crimes; Sexual abuse; Sociodemographics; Surveys and Questionnaires; Italy; Psychotic disorders; Schizophrenia spectrum and other psychotic disorders; Adverse childhood experiences; Emotional abuse; Risk factors; Mediation analysis
• ISSN: 0010-440X; 1532-8384; 1532-8384
• DOI: 10.1016/j.comppsych.2024.152496

Childhood trauma and adversities (CTA) and aberrant salience (AS) have a pivotal role in schizophrenia development, but their interplay with psychotic symptoms remains vague. We explored the mediation performed by AS between CTA and psychotic symptomatology in schizophrenia.
We approached 241 adults suffering from schizophrenia spectrum disorders (SSDs), who have been in the unit for at least 12 consecutive months, excluding the diagnosis of dementia, and recent substance abuse disorder, and cross-sectional evaluated through the Aberrant Salience Inventory (ASI), Childhood Trauma Questionnaire Short-Form (CTQ-SF), and Positive and Negative Symptom Scale (PANSS). We tested a path-diagram where AS mediated the relationship between CTA and psychosis, after verifying each measure one-dimensionality through confirmatory factor analysis.
The final sample comprised 222 patients (36.9% female), with a mean age of 42.4 (± 13.3) years and an average antipsychotic dose of 453.6 (± 184.2) mg/day (chlorpromazine equivalents). The mean duration of untreated psychosis was 1.8 (± 2.0) years while the mean onset age was 23.9 (± 8.2) years. Significant paths were found from emotional abuse to ASI total score (β = 0.39; p < .001) and from ASI total score to PANSS positive (β = 0.17; p = .019). Finally, a statistically significant indirect association was found from emotional abuse to PANSS positive mediated by ASI total score (β = 0.06; p = .041; CI 95% [0.01, 0.13]).
Emotional abuse has an AS-mediated effect on positive psychotic symptomatology. AS evaluation could allow a better characterization of psychosis as well as explain the presence of positive symptoms in adults with SSDs who experienced CTA.
•Aberrant salience (AS) is associated with psychotic symptoms in schizophrenia.•Childhood trauma and adversities (CTA) are particularly relevant in schizophrenia.•The relationship between AS, CTA and the development of psychosis is unclear.•AS could act as a mediator between CTA and positive symptoms in adulthood.•CTA early recognition may improve long-term prognosis in patients with higher AS.