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

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.