Effects of body-oriented therapies on the negative symptoms in people with schizophrenia: A systematic review.

In a stabilized phase of schizophrenia, negative symptoms are evident, on which body-oriented therapies can act. This systematic review examines the scientific evidence of the effects of all body-oriented therapies on the negative symptoms in people with schizophrenia and the effects of each type of body-oriented therapies on the negative symptoms in people with schizophrenia. To carry out this systematic review, the PRISMA guidelines were followed. The research was carried out through Pubmed, Cochrane, Web of Science, APAPsycNet, Science Direct, Scopus and the VHL Regional Portal. The methodological quality of the studies was assessed using the PEDro scale and data synthesis was performed. There were included 18 studies with the following interventions: creative arts, mind-body interventions, and body psychotherapy. Negative symptoms (total value), affective blunting, anhedonia, avolition, alogia, asociality, and psychomotor slowing were studied. In conclusion, there is strong scientific evidence that: body-oriented therapies do not promote positive effects on avolition, when it is assessed using the SANS scale; and creative arts reduce the total value of negative symptoms, when assessed by PANSS.

The associations of cannabis and methamphetamine use with cognitive performance over the first 2 years of treatment in schizophrenia spectrum disorders.

AIM: Cognitive deficits are a core feature of schizophrenia, and comorbid substance use may be a contributory factor. Methamphetamine use has been associated with cognitive impairment in schizophrenia, while associations with cannabis use are less clear-cut. This study aimed to investigate the associations of cannabis and methamphetamine use with cognitive performance in first-episode schizophrenia spectrum disorders over the first 2 years of treatment. METHODS: This was a longitudinal cohort study in 81 patients treated with flupenthixol decanoate according to a standardized protocol over 24 months. Cognitive performance was assessed with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Cognitive Consensus Battery at four time points, and urine testing for cannabis and methamphetamine was conducted at six time points. We used linear mixed-effect models for repeated measures to assess visit-wise changes in composite cognitive scores in patients (n = 91) compared to matched controls without psychiatric or medical disorders (n = 100). Linear regression models were constructed to examine pre-treatment and end-point effects in patients. RESULTS: Compared to controls, patients exhibited greater cognitive impairments at baseline, which improved with treatment, but remained significantly lower throughout. The number of positive methamphetamine, but not cannabis, tests predicted less cognitive improvement in patients. CONCLUSIONS: Our findings suggest a negative association between methamphetamine and cognition, but not cannabis.

Duration of untreated psychosis and pathways to care in Suriname: a qualitative study among patients, relatives and general practitioners.

PURPOSE: Psychosis is a severe mental health problem and is responsible for poor health outcomes, premature mortality and morbidity, especially in low- and middle-income countries. The duration of untreated psychosis (DUP), that is the time period between onset of symptoms until initiation of appropriate treatment by a healthcare professional, is one of the main determinants for successful treatment in western settings. This study aims to explore the factors related to the DUP among Surinamese patients using the perspectives from patients, their families and first-line healthcare professionals in Suriname. METHODS: Semi-structured interviews were conducted with patients having a history of psychosis, family members and general practitioners between February 2019 and April 2019 in Suriname. Interviews were tape-recorded and transcribed verbatim. Data were analysed using a thematic analysis for which an inductive and deductive approach was applied. RESULTS: In total, 28 patients, 13 family members and 8 general practitioners were interviewed. Five patients were excluded from the study. A median DUP of 4 months was found (IQR 1-36). Identified themes related to DUP included presentation of symptoms and illness awareness, help-seeking behaviour and alternative medicine, social support and stigma, financial and practical factors. CONCLUSION: Multiple factors were related to DUP, of which poor illness awareness, traditional medicine, stigma and social support were predominant. Poor illness awareness and use of alternative medicine were related to a longer DUP. Stigma was often an obstacle for patients and their families. Social and family support was important in helping patients to get medical help sooner. Other explored factors including financial and practical factors did not contribute to DUP.

Mental imagery-based episodic simulation amplifies motivation and behavioural engagement in planned reward activities.

Preliminary evidence suggests mental imagery-based episodic simulation of planned reward activities may amplify motivation and promote greater behavioural engagement, particularly for activities with high motivational barriers (Renner, Murphy, Ji, Manly, & Holmes, 2019). This study conducted a conceptual replication and extension of Renner et al. (2019). N = 81 first-year university students self-selected and scheduled two reward activities (one hedonic, one mastery) for the following week before being randomly allocated to either an Imagery-Experiential elaboration condition (n = 27), a Verbal-Reasoning elaboration condition (n = 28), or a Scheduling-only Control condition (n = 26). Following the lab session, all participants received standardized daily prompts to complete daily activity diaries online for seven days. The Imagery-Experiential condition reported greater increases in anticipatory pleasure (state mood), anticipated pleasure, and self-reported motivation compared to the Scheduling-only Control condition, and greater increases in anticipatory pleasure (state mood), but not anticipated pleasure or motivation, relative to the Verbal-Reasoning condition. Consistent with Renner et al. (2019), the Imagery-Experiential condition, but not the Verbal-Reasoning condition, reported more frequent engagement in high motivational barrier activities than the Scheduling-only Control condition. Exploratory mediational analyses suggested that mental imagery may exert unique motivational impacts via its impact on anticipatory pleasure (state mood), although indirect effects were only observed for self-reported motivation change in the lab, with real world behavioural effects falling short of statistical significance.

Improving Clinical, Cognitive, and Psychosocial Dysfunctions in Patients with Schizophrenia: A Neurofeedback Randomized Control Trial.

Objectives: The aim of this study was to use neurofeedback (NF) training as the add-on therapy in patients with schizophrenia to improve their clinical, cognitive, and psychosocial condition. The study, thanks to the monitoring of various conditions, quantitative electroencephalogram (QEEG) and brain-derived neurotrophic factor (BDNF), was supposed to give an insight into mechanisms underlying NF training results. Methods: Forty-four male patients with schizophrenia, currently in a stable, incomplete remission, were recruited into two, 3-month rehabilitation programs, with standard rehabilitation as a control group (R) or with add-on NF training (NF). Pre- and posttherapy primary outcomes were compared: clinical (Positive and Negative Syndrome Scale (PANSS)), cognitive (Color Trails Test (CTT), d2 test), psychosocial functioning (General Self-Efficacy Scale (GSES), Beck Cognitive Insight Scale (BCIS), and Acceptance of Illness Scale (AIS)), quantitative electroencephalogram (QEEG), auditory event-related potentials (ERPs), and serum level of BDNF. Results. Both groups R and NF improved significantly in clinical ratings (Positive and Negative Syndrome Scale (PANSS)). In-between analyses unveiled some advantages of add-on NF therapy over standard rehabilitation. GSES scores improved significantly, giving the NF group of patients greater ability to cope with stressful or difficult social demands. Also, the serum-level BDNF increased significantly more in the NF group. Post hoc analyses indicated the possibility of creating a separate PANSS subsyndrome, specifically related to cognitive, psychosocial, and BDNF effects of NF therapy. Conclusions: Neurofeedback can be effectively used as the add-on therapy in schizophrenia rehabilitation programs. The method requires further research regarding its clinical specificity and understanding mechanisms of action.

Effects of maternal folic acid supplementation on nuclear methyltransferase activity of adult rats subjected to an animal model of schizophrenia.

INTRODUCTION: Schizophrenia is considered one of the most disabling and severe human diseases worldwide. The etiology of schizophrenia is thought to be multifactorial and evidence suggests that DNA methylation can play an important role in underlying pivotal neurobiological alterations of this disorder. Some studies have demonstrated the effects of dietary supplementation as an alternative approach to the prevention of schizophrenia, including folic acid. However, no study has ever investigated the role of such supplementation in altering the DNA methylation system in the context of schizophrenia. OBJECTIVES: The present study aims to investigate the effects of maternal folic acid supplementation at different doses on nuclear methyltransferase activity of adult rat offspring subjected to an animal model schizophrenia induced by ketamine. METHODS: Adult female Wistar rats, (60 days old) received folic acid-deficient diet, control diet, or control diet plus folic acid supplementation (at 5, 10, or 50 mg/kg) during pregnancy and lactation. After reaching adulthood (60 days), the male offspring of these dams were subjected to the animal model of schizophrenia induced by 7 days of ketamine intraperitoneal injection (25 mg/kg). After the 7-day protocol, the activity of nuclear methyltransferase was evaluated in the brains of the offspring. RESULTS: Maternal folic acid supplementation at 50 mg/kg increased methyltransferase activity in the frontal cortex, while 10 mg/kg increased methyltransferase activity in the hippocampus. In the striatum of offspring treated with ketamine, maternal deficient diet, control diet, and folic acid supplementation at 5 mg/kg decreased methyltransferase activity compared to the control group. The folic acid supplementation at 10 and 50 mg/kg reversed this ketamine effect. CONCLUSIONS: Maternal FA deficiency could be related to schizophrenia pathophysiology, while FA supplementation could present a protective effect since it demonstrated persistent effects in epigenetic parameters in adult offspring.

Sex influences in the preventive effects of peripubertal supplementation with N-3 polyunsaturated fatty acids in mice exposed to the two-hit model of schizophrenia.

Schizophrenia is a devastating neurodevelopmental disorder. The animal model based on perinatal immune activation, as first-hit, combined with peripubertal stress, as a second hit, has gained evidence in recent years. Omega-3 polyunsaturated fatty acids (n3-PUFAs) is being a promise for schizophrenia prevention. Nevertheless, the influence of sex in schizophrenia neurobiology and prevention has been neglected. Thus, the present study evaluates the preventive effects of n3-PUFAs in both sexes' mice submitted to the two-hit model and the participation of oxidative changes in this mechanism. The two-hit consisted of polyI:C administration from postnatal days (PNs) 5-7, and unpredictable stress from PNs35-43. n3-PUFAs were administered from PNs30-60. Prepulse inhibition of the startle reflex (PPI), social interaction, and Y-maze tests were conducted between PNs70-72 to evaluate positive-, negative-, and cognitive-like schizophrenia symptoms. We assessed brain oxidative changes in brain areas and plasma. Both sexes' two-hit mice presented deficits in PPI, social interaction, and working memory that were prevented by n3-PUFAs. In two-hit females, n3-PUFAs prevented increments in nitrite levels in the prefrontal cortex (PFC), hippocampus, striatum, and plasma TBARS levels. In two-hit males, n3-PUFAs prevented the increase in TBARS in the PFC, hippocampus, and striatum. Notably, male mice that received only n3-PUFAs without hit exposure presented impairments in working memory and social interaction. These results add further preclinical evidence for n3-PUFAs as an accessible and effective alternative in preventing behavioral and oxidative changes related to schizophrenia but call attention to the need for precaution in this indication due to hit- and sex-sensitive issues.

Ascorbic acid supplementation attenuates schizophrenia-like symptoms in an animal model induced by ketamine.

Schizophrenia is a chronic neuropsychiatric disorder with a poorly understood pathophysiology. The theories about the disorder are mainly about dysregulation in one or more systems of neurotransmitters, and the progression triggers the presence of inflammatory markers indicates the possibility that the disorder is initially an inflammatory disease. The objective was to evaluate the ascorbic acid supplementation in an animal model of schizophrenia, on behavioral parameters, and cytokines involved in inflammation IL-1ß, IL-10. Wistar rats with 60 days of age were used which were supplemented with ascorbic acid at 0.1, 1, and 10 mg/kg or saline for 14 days via orogastric gavage. Subsequently, four groups were given ketamine (25 mg/kg) and four groups received intraperitoneal saline from the 9th-15th day of the experiment. After 30 min of the last administration of ketamine/saline, and behavioral test, rats were killed by guillotine decapitation and the brain structures were carefully dissected for biochemical analysis. Results showed that ascorbic acid supplementation prevented motor sensory loss but nor alter other parameters evaluated. We concluded that ascorbic acid may be used as a therapeutic adjuvant in schizophrenia and may help to improve the schizophrenic patient's life quality.

No Effect of Coenzyme Q10 on Cognitive Function, Psychological Symptoms, and Health-related Outcomes in Schizophrenia and Schizoaffective Disorder: Results of a Randomized, Placebo-Controlled Trial.

BACKGROUND: Cognitive impairments, negative symptoms, affective symptoms, and low energy are highly prevalent features of schizophrenia. Mitochondrial dysfunction has been hypothesized as one of the numerous factors to underlie the manifestation of these symptoms. The objective of this study was to evaluate whether Coenzyme Q10 (CoQ10) has a role in the treatment of schizophrenia and schizoaffective disorder. METHODS: A double-blind, randomized, placebo-controlled trial was conducted to assess the effects of CoQ10 supplementation (300 mg/day) on the co-primary outcomes of attention and working memory performance after 3 and 6 months. Secondary outcomes included plasma CoQ10 levels, mitochondrial function, energy, depression, anxiety, negative symptoms, and quality oflife. FINDINGS: In total, 72 patients were randomized to intervention groups. Overall, there was no effect of CoQ10 supplementation on the primary outcome measures at 3 or 6 months. Further, with the exception of plasma CoQ10 levels, CoQ10 supplementation also had no effect on the secondary outcomes. At 3 months, CoQ10 concentration was significantly higher in the CoQ10 group (3.85 µg/mL) compared with placebo (1.13 µg/mL); this difference was not present at 6 months. CONCLUSIONS: The results of the study suggest that CoQ10 supplementation at 300 mg/day for 6 months is unlikely to be beneficial for cognitive, psychological and health-related outcomes in schizophrenia and schizoaffective disorder. However, a number of limitations including low adherence, modest sample size, and attrition, likely reduce estimates of effects. As such, results should be considered preliminary.

Single-Session Dance/Movement Therapy for Thought and Behavioral Dysfunction Associated With Schizophrenia: A Mixed Methods Feasibility Study.

ABSTRACT: This purposes of this mixed methods feasibility study were to determine whether people with schizophrenia in an inpatient psychiatric facility were able to complete the research protocol, and to obtain preliminary treatment effects of a single-session dance/movement therapy (DMT) intervention versus verbal treatment as usual (TAU). Thirty-two participants were randomized to a 45-minute DMT or verbal TAU session. Data were collected quantitatively using the Brief Psychiatric Rating Scale (BPRS) and qualitatively through open-ended interviews. Results indicated that participants in the DMT group had statistically significant symptom reduction compared with those in the TAU group in overall BPRS scores (effect size [ES] = 0.67), psychological discomfort (ES = 0.64), negative symptoms (ES = 0.67), and positive symptoms (ES = 0.55). No statistical significance was shown for resistance. Qualitative findings substantiate the quantitative findings, however, show divergence regarding resistance. Participants in the DMT group expressed feeling in control, less angry, and motivated for treatment.

The effectiveness of adjunct music therapy for patients with schizophrenia: A meta-analysis.

To evaluate the efficacy of adjunct music therapy on patients with schizophrenia, we conducted a meta-analysis of currently available randomized controlled trials and controlled clinical trials. Eight electronic databases (CNKI, PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science, Psychology and behavioural Sciences Collection, and Medline) were systematically searched from inception to January 2020. Standard mean difference (SMD) with 95% confidence interval (CI) values were used to evaluate the effects of music therapy. Finally, we selected eighteen studies comprising 1,212 participants comparing with control conditions. The meta-analysis demonstrated that adjunct music therapy significantly improved total symptoms (SMD = -0.48, 95%CI: -0.74 to -0.22), negative symptoms (SMD=-0.56, 95%CI: -0.72 to -0.40), depression symptoms (SMD = -0.35, 95% CI: -0.54 to -0.17), and quality of life (SMD = 0.35, 95%CI: 0.07 to 0.62) in people with schizophrenia compared with the control group. In addition, the meta-analysis indicated no publication bias for total symptoms, negative symptoms, and positive symptoms. The sensitivity analysis showed that the result was reliable. But the quality of evidence is still low, more well-designed studies with larger sample size and high quality are needed to confirm the efficiency of adjunct music therapy in treating schizophrenia.

Application of electroencephalographic (EEG) biofeedback therapy in the rehabilitation of patients with chronic diseases.

Schizophrenia is one of the chronic mental disorders characterized by disturbances in thought, emotion, language, perception, and behavior. There is no cure for this disease, and most of the current treatments are palliative. In this study, we aimed to analyze the application of electroencephalographic (EEG) biofeedback therapy, an adjunctive treatment used for many psychiatric disorders, in the rehabilitation of schizophrenic patients. Schizophrenic patients were selected as the experimental subjects, and the initial diagnosis criteria were set accordingly. A primary and a secondary efficacy index was then developed for the evaluation of EEG biofeedback therapy rather than traditional drug treatment. Lastly, the effects of the two methods were compared. The findings indicate that traditional drugs could be used in the treatment of mild schizophrenia, but showed poor results for severe and moderate schizophrenia. EEG biofeedback therapy was effective for the treatment of various degrees of schizophrenia and improved patients' sleep quality and anxiety. These findings have significant practical implications for the rehabilitation of schizophrenic patients and patients with chronic diseases in general.

Low-frequency oscillations reflect aberrant tone restoration during the auditory continuity illusion in schizophrenia.

Patients with schizophrenia (ScZ) often show impairments in auditory information processing. These impairments have been related to clinical symptoms, such as auditory hallucinations. Some researchers have hypothesized that aberrant low-frequency oscillations contribute to auditory information processing deficits in ScZ. A paradigm for which modulations in low-frequency oscillations are consistently found in healthy individuals is the auditory continuity illusion (ACI), in which restoration processes lead to a perceptual grouping of tone fragments and a mask, so that a physically interrupted sound is perceived as continuous. We used the ACI paradigm to test the hypothesis that low-frequency oscillations play a role in aberrant auditory information processing in patients with ScZ (N = 23). Compared with healthy control participants we found that patients with ScZ show elevated continuity illusions of interrupted, partially-masked tones. Electroencephalography data demonstrate that this elevated continuity perception is reflected by diminished 3 Hz power. This suggests that reduced low-frequency oscillations relate to elevated restoration processes in ScZ. Our findings support the hypothesis that aberrant low-frequency oscillations contribute to altered perception-related auditory information processing in ScZ.

Beneficial effects of omega-3 fatty acid supplementation in schizophrenia: possible mechanisms.

BACKGROUND: Schizophrenia is a serious long-term psychotic disorder marked by positive and negative symptoms, severe behavioral problems and cognitive function deficits. The cause of this disorder is not completely clear, but is suggested to be multifactorial, involving both inherited and environmental factors. Since human brain regulates all behaviour, studies have focused on identifying changes in neurobiology and biochemistry of brain in schizophrenia. Brain is the most lipid rich organ (approximately 50% of brain dry weight). Total brain lipids is constituted of more than 60% of phospholipids, in which docosahexaenoic acid (DHA, 22:6n-3) is the most abundant (more than 40%) polyunsaturated fatty acid (PUFA) in brain membrane phospholipids. Results from numerous studies have shown significant decreases of PUFAs, in particular, DHA in peripheral blood (plasma and erythrocyte membranes) as well as brain of schizophrenia patients at different developmental phases of the disorder. PUFA deficiency has been associated to psychotic symptoms and cognitive deficits in schizophrenia. These findings have led to a number of clinical trials examining whether dietary omega-3 fatty acid supplementation could improve the course of illness in patients with schizophrenia. Results are inconsistent. Some report beneficial whereas others show not effective. The discrepancy can be attributed to the heterogeneity of patient population. METHODS: In this review, results from recent experimental and clinical studies, which focus on illustrating the role of PUFAs in the development of schizophrenia were examined. The rationale why omega-3 supplementation was beneficial on symptoms (presented by subscales of the positive and negative symptom scale (PANSS), and cognitive functions in certain patients but not others was reviewed. The potential mechanisms underlying the beneficial effects were discussed. RESULTS: Omega-3 fatty acid supplementation reduced the conversion rate to psychosis and improved both positive and negative symptoms and global functions in adolescents at ultra-high risk for psychosis. Omega-3 fatty acid supplementation could also improve negative symptoms and global functions in the first-episode patients with schizophrenia, but improve mainly total or general PANSS subscales in chronic patients. Patients with low PUFA (particularly DHA) baseline in blood were more responsive to the omega-3 fatty acid intervention. CONCLUSION: Omega-3 supplementation is more effective in reducing psychotic symptom severity in young adults or adolescents in the prodromal phase of schizophrenia who have low omega-3 baseline. Omega-3 supplementation was more effective in patients with low PUFA baseline. It suggests that patients with predefined lipid levels might benefit from lipid treatments, but more controlled clinical trials are warranted.

[Melting-Pain Therapy for difficult mental health patients]. / L'activité Melting-pain therapy pour les malades mentaux difficiles.

The nurses in the unit for difficult patients at Cadillac hospital have developed an innovative art therapy concept: Melting-Pain Therapy. In this workshop patients produce a collective piece of art created through participants' individual sessions with a nurse. These patients are exclusively men, suffering mainly from schizophrenia, who have been or who are potentially dangerous. The photographs accompanying this article show some examples of these art brut creations.

Effect of Korean folk music intervention on schizophrenia inpatients' emotional behavior and interpersonal relationship functioning.

Schizophrenia can lead to inappropriate emotional behavior and issues with interpersonal relationship functioning as it becomes chronic. This study aimed to determine the effects of a Korean folk music therapy program on the emotional behavior and interpersonal relationship functioning of patients with schizophrenia. Twenty inpatients with schizophrenia in a psychiatric ward in Daegu and North Gyeongsang Province were included in the experimental group, and 24 in the control group. The experimental group participated in a 15-session music therapy program, with two 50-minute sessions per week. For hypothesis testing, Wilks' Lambda based on sphericity testing was used to perform repeated measures ANOVA. The experimental group showed statistically significantly higher levels of emotional behavior (F = 5.814, p < .020) and interpersonal relationship functioning (F = 21.72, p < .001) than the control group, indicating that the Korean folk music therapy program was an effective intervention.

[Development and implementation of clozapine protocol in patients with schizophrenia in Greece].

Clozapine is an atypical antipsychotic used for the treatment of resistant schizophrenia, exhibiting significant advantages over other antipsychotic agents. Clozapine efficacy is well established in people diagnosed with schizophrenia via reducing both positive and negative symptoms. Also, is associated with a low risk of extrapyramidal side effects compared to other antipsychotics. Despite the above, clozapine is an unpopular therapeutic option for patients not previously responded to other antipsychotics, because of adverse side effects, such as hyper-salivation and weight gain or critical side effects, i.e., risk for developing neutropenia and agranulocytosis and the need for a systematic and vigilant patients' monitoring, causing discomfort to them and increased expenses to the healthcare system. The aim of the present article is to describe (a) the development of a "clozapine treatment monitoring protocol", and (b) the monitoring process applied at the Department of Psychiatry of Aghioi Anargyroi Cancer Hospital in patients under clozapine treatment. For the protocol development a systematic review of the existing literature was conducted. An advanced search in Medline, CINAHL, Scopus and Google Scholar was conducted, as well as at the National Organization of Greece for Medicines database, with the following key- words: "clozapine", "clozapine protocol", "clozapine monitoring", "clozapine guidelines". Based on this procedure, the Victorian Consensus View protocol applied in Australia was evaluated as the most appropriate since it encompasses: (a) monitoring of multiple systems based on a holistic healthcare approach towards patients, and (b) Intense cardiovascular functioning monitoring, highly relevant to the Greek population due to increased incidence of myocarditis. Overall, the necessary interventions prior and after clozapine treatment initiation are, monitoring of heamatological and cardiovascular function and related side effects, metabolic monitoring and related side effects, monitoring of metabolic adverse effects, gastrointestinal and neurological adverse effects, hepatic function monitoring and related side effects. Clozapine treatment monitoring protocol applied at special settings, e.g., Clozapine Clinics, is highly beneficial, since the risk of neutropenia, agronulocytosis is minimized, while suicidal behavior and substance use are reduced along with risky health behaviors, i.e., nicotine use and sedentary lifestyle. The current protocol may be applied by mental healthcare professionals aiming to empower individuals with schizophrenia through promoting their independency and quality of life.

The association between childhood trauma and treatment outcomes in schizophrenia spectrum disorders.

Childhood trauma exposure has been associated with poorer treatment outcomes in schizophrenia. Most studies to date have been conducted in naturalistic settings in which the outcome may have been mediated by factors such as poor adherence and substance abuse. We compared the effects of high vs low childhood trauma exposure on the treatment response over 24 months in 78 patients with first-episode schizophrenia spectrum disorders who received standardised treatment with a long acting injectable antipsychotic. Compared to the low childhood trauma group (n = 37), the high childhood trauma group (n = 41) received higher doses of antipsychotic medication and were less likely to achieve remission. When age, sex and cannabis use were controlled for, patients with high levels of childhood trauma had a slower treatment response for positive and disorganized symptom domains, although differences did not differ significantly at 24 months. While there were no differences in functional outcomes, self-rated quality of life was the domain that most clearly differentiated the high and low childhood trauma groups. High childhood trauma exposure was associated with lower quality of life scores at baseline, a lesser degree of improvement with treatment, and lower quality of life scores at 24 months.