Sexual offending in schizophrenia - a comparative trial

Studies suggest a complex relationship between schizophrenia and sexually offensive behaviour. The mental disorder itself, antisocial personality traits, drug abuse and adverse childhood experiences are suggested to have an impact on sexual offending in mentally disordered offenders. Similarities in psychosexual variables for schizophrenic and sexual offenders in general are found. This study aimed to preserve first findings of sex offence features and behaviours exhibited by psychotic men in Germany. Furthermore a typology of the schizophrenic offenders was developed. Records of 64-male restricted hospital order in-patients (32 patients with and 32 patients without an ICD-10 psychotic disorder) examined at the Institute for Forensic Psychiatry or resident in the Department of Psychiatry and Psychotherapy of the prisons in Berlin from 1980 - 2006 with an index conviction for a contact sex offence against a woman provided the material for research. A comparative trial design was used to differentiate the psychotic and non psychotic offender group. A check list which based on the method of a content analysis containing items related to the offender and the index offence was developed and applied to the records of men. A similar extent of social isolation, psychosexual variables and adverse childhood experiences are found for schizophrenic and non schizophrenic offenders. Negative symptoms of schizophrenia as well as antisocial traits had a great impact on schizophrenic sexual offending. Solely the occurrence of bizarre behaviour was influenced by positive symptoms. Different offence characteristics appeared in the four outlined schizophrenic subgroups such as bizarre behaviour of the psychotic, assaultive behaviour of the dissocial, chaotic behaviour of the substance abusive and negative childhood experiences of the sadistic schizophrenic offenders. The partly controversial findings underline the need for further studies to understand sexual offending in the heterogeneous group of schizophrenic men.     

Does a parent-report measure of behavioral problems enhance prediction of conversion to psychosis in clinical high-risk adolescents?

Recent research on risk for psychosis has focused on youth who manifest subclinical signs that are often associated with the prodrome to psychosis. Standardized measures of prodromal symptoms have been shown to significantly enhance prediction of risk for conversion to an Axis I psychotic disorder. In the present study, a widely used parent-report measure of behavioral problems, the Child Behavior Checklist (CBCL) was administered to examine the clinical and diagnostic utility of the measure as an adjunctive screening instrument in the identification of at-risk youth. The CBCL, the Structured Interview for Prodromal Syndromes (SIPS), and other diagnostic measures were administered at baseline and at one year follow-up assessments to adolescents (n=41) at clinical high-risk for the development of a psychotic disorder. Analyses were conducted to compare the 14 at-risk adolescents who subsequently converted to psychosis to the 27 who did not. Conversion to psychosis was defined as conversion to an Axis I psychotic disorder or affective disorder with psychotic features. Consistent with expectations, at one year follow-up, compared to the Non-Converted participants, the Converted participants manifested significantly higher scores on the prodromal symptom scales of the SIPS. There were, however, no differences in CBCL social and behavioral ratings as a function of conversion status. It is concluded that the CBCL does not show promise as an alternative or adjunctive predictor of conversion to psychosis in at-risk adolescents.     

Psychotic reactivity in borderline personality disorder

Glaser J‐P, Van Os J, Thewissen V, Myin‐Germeys I. Psychotic reactivity in borderline personality disorder. Objective: To investigate the stress relatedness and paranoia specificity of psychosis in borderline personality disorder (BPD). Method: Fifty‐six borderline patients, 38 patients with cluster C personality disorder, 81 patients with psychotic disorder and 49 healthy controls were studied with the experience sampling method (a structured diary technique) to assess: i) appraised subjective stress and ii) intensity of psychotic experiences. Results: All patient groups experienced significantly more increases in psychotic experiences in relation to daily life stress than healthy controls, borderline patients displaying the strongest reactivity. Borderline patients, moreover, reported significantly more hallucinatory reactivity than healthy controls and subjects with cluster C personality disorder. Paranoid reactivity to daily life stress did not differ between the patient groups. Conclusion: These results are the first to ecologically validate stress‐related psychosis in BPD. However, psychotic reactivity was not limited to expression of paranoia but involved a broader range of psychotic experiences including hallucinations.     

Personality traits in early psychosis: relationship with symptom and coping treatment outcomes

Aims: This study aimed to determine personality profiles of individuals with early psychosis based on the Five Factor Model of personality and assess the predictive value of personality traits or profiles on therapeutic outcomes of two group treatments for recent onset psychosis: cognitive behaviour therapy or skills training for symptom management. Methods: One hundred and twenty‐nine individuals with early psychosis were recruited to participate in a randomized controlled trial. The participants were randomized to one of two group treatments or to a wait‐list control group. Measures included a personality inventory (NEO Five Factor Inventory) and outcome measures of symptomatology (Brief Psychiatric Rating Scale‐Expanded) and coping strategies (Cybernetic Coping Scale). Results: Cluster analyses revealed three different personality profiles (based on the Five Factor Model) – none specifically linked to psychotic symptoms. No links were revealed between personality traits and symptom change scores. Personality traits were linked to therapeutic improvements in active coping strategies, with extraversion accounting for 17% of the variance. Neuroticism was linked to increased use of passive coping strategies. Active coping strategies were also predicted by profile 1 (holding the highest openness score) with 26% of the variance explained and by profile 3 (the highest extraversion score), with 14% of the variance explained. Conclusions: Individuals with early psychosis can present with distinct personality profiles as would be expected in a non‐clinical population. Personality traits do not appear to influence symptomatic treatment outcomes but are linked to behavioural changes, such as the use of coping strategies.     

Dermatoglyphic asymmetries and fronto-striatal dysfunction in young adults reporting non-clinical psychosis

Mittal VA, Dean DJ, Pelletier A. Dermatoglyphic asymmetries and fronto‐striatal dysfunction in young adults reporting non‐clinical psychosis. Objective: Growing evidence indicates that non‐clinical psychotic‐like experiences occur in otherwise healthy individuals, suggesting that psychosis may occur on a continuum. However, little is known about how the diathesis for formal psychosis maps on to individuals at the non‐clinical side of this continuum. Our current understanding of the pathophysiology of schizophrenia implicates certain key factors such as early developmental abnormalities and fronto‐striatal dysfunction. To date, no studies have examined these core factors in the context of non‐clinical psychosis. Method: A total of 221 young adults were assessed for distressing attenuated positive symptoms (DAPS), dermatoglyphic asymmetries (a marker of early developmental insult), and procedural memory (a proxy for fronto‐striatal function). Results: Participants reporting DAPS (n = 16; 7.2%) and no‐DAPS (n = 205; 92.7%) were split into two groups. The DAPS group showed significantly elevated depression, elevated dermatoglyphic asymmetries, and a pattern of procedural learning consistent with other studies with formally psychotic patients. Conclusion: The results indicate that the non‐clinical side of the psychosis continuum also shares key vulnerability factors implicated in schizophrenia, suggesting that both early developmental disruption and abnormalities in fronto‐striatal function are core aspects underlying the disorder.     

Diagnostic stability in adolescent onset psychotic disorders

The purpose was to examine the long-term stability of a diagnosis of psychotic disorder in adolescence and to focus on diagnostic change over time. A total of 88 patients with a first episode of early onset psychosis (before 19 years) were followed up an average of 10.5 years (range 5.1-18.2) after admission. This report includes the 68 patients who could be traced and interviewed with the Positive and Negative Symptom Scale and lifetime Structured Clinical Interview for DSM-IV diagnosis. An initial diagnostic split between schizophrenia spectrum and affective disorder had a good (> 80 %) Positive Predictive Validity and Sensitivity. The main diagnostic shift was an influx to schizophrenia spectrum disorder (n = 6). These patients resembled the stable affective group (n = 27) in premorbid and prodromal aspects but changed over time to resemble the poor outcome of the stable schizophrenia spectrum group (n = 28) albeit with fewer negative symptoms and a better social function. Family history of nonaffective psychosis in first or second degree relatives was often found in the "change to schizophrenia group". A diagnosis in adolescence of schizophrenia spectrum or affective psychotic disorder is usually stable over time. A subgroup of non-schizophrenia patients go on to develop a schizophrenia spectrum disorder.     

Borderline personality features and development of psychosis in an 'ultra high risk' (UHR) population: a case control study

Aims: There is clinical uncertainty as to whether borderline personality disorder (BPD) traits in those with an ‘at risk mental state’ have an effect on the risk of ‘transition’ to psychosis. We aimed to investigate the relationship between baseline BPD features, risk of transition and type of psychotic disorder experienced. Method: This is a case‐control study of ‘Ultra High Risk’ (UHR) for psychosis patients treated at the clinic, between 2004 and 2007. ‘Cases’ were UHR individuals who made the ‘transition’ to full threshold psychotic disorder within 24 months; ‘Control’ group was a matched UHR sample who had not developed a psychotic disorder at 24 months. Individuals were matched on time of entry to the clinic, age and gender. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) BPD features were assessed from clinical assessments using a structured instrument (Structured Clinical Interview for DSM‐IV Axis II Disorder for BPD (SCID‐II BPD) ). Psychosis diagnosis following transition was rated from the clinical files using the operational criteria in studies of psychotic illness (OPCRIT) computer algorithm. The number of BPD traits and number with full threshold BPD were compared in those who developed psychosis and those who did not. Results: We analysed data from 48 cases and 48 controls. There was no statistically significant difference in the rate of transition to psychosis for those with baseline full‐threshold BPD, compared with those without BPD. The number of BPD traits or number with full threshold BPD did not differ by psychosis diagnosis grouping. Conclusions: Co‐occurring BPD or BPD features does not appear to strongly influence the risk of short‐term transition to psychosis or the risk of developing a non‐affective psychotic disorder in this population.     

Premorbid functioning in early-onset psychotic disorders

OBJECTIVE: To examine the premorbid characteristics of youths with early-onset psychotic disorders. METHOD: Subjects with early-onset psychotic disorders received an extensive diagnostic evaluation upon entry into the study, including a historic review of premorbid functioning using the Premorbid Adjustment Scale. RESULTS: Youths with schizophrenia (n = 27), bipolar disorder (n = 22), and psychosis not otherwise specified (NOS) (n = 20) were included. High rates of premorbid behavioral problems and academic difficulties were noted across all subjects. Youths with schizophrenia had higher rates of premorbid social withdrawal and global impairment. They also tended to have fewer friends. The psychosis NOS group had significantly higher rates of abuse histories and posttraumatic stress disorder. CONCLUSIONS: Premorbid abnormalities are common features of early-onset psychotic disorders. The social withdrawal and peer problems specific to youths with schizophrenia likely represent early manifestations of negative symptoms. The abuse histories in the psychosis NOS group may explain the atypical nature of their reported psychotic symptoms, which in many cases are likely posttraumatic phenomena.     

Comorbid personality disorders and substance use disorders of mentally ill homicide offenders: a structured clinical study on dual and triple diagnoses

Comorbid substance use disorders (SUDs) increase the risk of homicide by persons with major mental disorders (MMDs). However, there are no published data from clinical interviews or lifetime objective documents on the prevalence of lifetime personality disorder (PD) or SUD among a comprehensive sample of mentally ill homicide offenders. Therefore, a nationally representative sample of men with MMD (n = 90) who had committed or attempted homicide was assessed using the research version of the Structured Clinical Interview for DSM-IV Axis I and Axis II Disorders. Lifetime documents, records, and questionnaires from persons who knew the subjects since childhood were used. Seventy-eight percent of the mentally ill homicide offenders were diagnosed with schizophrenia, 17 percent with schizoaffective disorder, and 5 percent with other psychosis. A lifetime SUD was detected in 74 percent and alcohol use disorder in 72 percent. PD accounted for 51 percent, in 47 percent as antisocial personality disorder (APD). All subjects diagnosed with PD had SUD. Only 25 percent of the subjects had neither SUD nor PD. Among persons with dual diagnoses (MMD and SUD), about two-thirds had PD or APD. These results indicated that there were two-thirds major diagnostic categories of psychotic homicide offenders: about one-half had triple diagnosis (APD + SUD + MMD), one-quarter had "pure" dual diagnosis (SUD + MMD), and one-quarter had "pure" MMD. The fourth possible category, "APD + MMD but no SUD," was not found. The prevention of severe violence by persons with MMD necessitates effective treatments for those with dual diagnosis who also have a history of APD.     

Partner relations and the development of alcoholism in female psychiatric patients

Sixty four consecutive female alcoholic psychiatric patients were interviewed about the causes to which they attributed the start of the abuse and the interaction between lifetime drinking career and partnerships. Thirty-three (51%) attributed the start to problems with partners (P-group): 21 drank to keep their partners, 12 drank when they were abandoned. Among the others (non P-group) four subgroups were identified: the social stigmatized group (n = 4), the parent abandoned group (n = 6), the teenage acting out group (n = 13), and the psychotic group (n = 7). Those who attributed the causes to a certain partnership (n = 33) were significantly older when the abuse started, more often divorced/separated, had more often had more than one alcoholic partner, less often a schizophrenic psychosis and more often a pure borderline personality disorder.     

Older criminals: a descriptive study of psychiatrically examined offenders in Sweden

OBJECTIVE: We retrospectively examined psychiatric diagnoses of older offenders referred by court for psychiatric assessment in Sweden, and compared them with younger offenders. METHOD: In Sweden, structured court-ordered forensic psychiatric evaluations are undertaken by a forensic psychiatric team. Data on age, sex, citizenship, psychiatric diagnoses, offences, and legal insanity declarations were obtained for the years 1988-2000 (n = 7297). RESULTS: There were 210 forensic psychiatric evaluations in those aged 60 and over. 7% had a diagnosis of dementia, 32% psychotic illness, 8% depressive or anxiety disorder, 15% substance abuse or dependence, and 20% personality disorder. Older offenders were significantly less likely to be diagnosed with schizophrenia or a personality disorder, and more likely to have dementia or an affective psychosis compared to younger ones. Logistic regression analyses suggested that of the studied factors, the ones most typical of older offenders were a diagnosis of dementia and being charged with a sexual offence. CONCLUSION: There appear to be important differences in psychiatric morbidity between older offenders and younger ones who come into contact with forensic psychiatric services. This research may assist in the planning of forensic and therapeutic services for the increasing number of older adults passing through the criminal justice system.     

The continuity of psychopathology from early childhood to preadolescence

Objective To study the continuity of psychopathology from the age of 3–12 years. Methods In a population-based birth cohort, children’s emotional and behavioral problems were assessed at age 3 using the Child Behavior Checklist 2–3 (CBCL 2–3), and at age 12 by parents using the CBCL 11–18, and the Youth Self Report (YSR) completed by the children. Behavioral ratings were obtained from 800 subjects at both time points. Results externalizing problems at age 3 predicted both externalizing and internalizing problems among both genders in preadolescence. In girls, internalizing behavior at age 3 predicted parent-reported internalizing behavior, and associated negatively with externalizing behavior in self-reports at age 12. Aggressive behavior was found to be remarkably stable, and both aggressive and destructive behavior independently predicted a wide range of later externalizing and internalizing problems. Parent ratings of withdrawal showed stability from early childhood to preadolescence in both genders. Somatic complaints of 3-year-old girls independently predicted both externalizing and internalizing problems. Conclusions The results show the complexity of pathways in psychopathology from early childhood to preadolescence. In particular, aggressive and destructive behaviors in very early childhood predict later problems and necessitate early recognition and possible intervention at an early age. An instrument like the CBCL 2–3 is valuable in the early detection of children at risk of long-term problems.     

A descriptive study of 'non-cases' and referral rates to an early intervention for psychosis service

Aim: Despite there being approximately 200 early intervention services for psychosis worldwide, little is known about the referral rates to these services, the diagnoses and needs of individuals found not to have a first episode of psychosis (FEP). Firstly, we aimed to describe the diagnoses for individuals who were found not to have a FEP (non‐cases) following an assessment using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV (SCID). We then aimed to examine the referral rates of cases and non‐cases to an early intervention service. Methods: All individuals referred to the early intervention service underwent a clinical assessment using the SCID. Results: In a 4‐year period, there were 632 referrals to the early intervention service for psychosis, and of these, 53% (n = 338) were found to have a FEP, 5% (n = 34) were found to have an at‐risk mental state for psychosis and 41% (n = 260) were found to be ‘non‐cases’. This represents a ratio of 1.9:1 of referrals to cases, or approximately 2:1. Of the non‐cases, 27% (n = 62) satisfied criteria for a mood disorder, with major depressive disorder the commonest diagnosis. A further 18% (n = 42) of non‐cases satisfied criteria for an anxiety disorder and nearly half of these were diagnosed with social phobia. The ratio of referrals to cases was not consistent over time and rose from 1.3:1 in the first year to 2:1 in the fourth year. Conclusion: A large proportion of individuals referred to an early intervention for psychosis service were found not to have psychotic disorder, however they still have significant needs regarding their mental health.     

Relationship between Assessed Emotion,Personality, Personality Disorder and Risk in Offenders with Intellectual Disability

In mainstream studies on offenders and on individuals with psychopathology, relationships have been found between personality characteristics, emotional problems and personality disorders. This study reviewed the relationships between the Emotional Problems Scale, two circumplex measures of personality, personality disorder assessments and risk assessments in 212 offenders with intellectual disability. Previous studies had established the reliability and validity of these measures with the client group. Strong relationships emerged between externalizing emotional problems and dominant and hostile personality dimensions with weaker but significant relationships between internalizing problems and submissive and hostile dimensions. Externalizing problems were strongly associated with risk for violence, while internalizing problems had a weaker but significant relationship with some historical and clinical risk scales. Dominant personality dimensions were associated with narcissistic personality disorder and nurturant personality dimensions negatively associated with anti-social personality disorder. It would seem that there are orderly, significant relationships among measures of personality, personality disorders, emotional problems and risk. We discuss the implications of emotional assessment for the evaluation of risk and prediction of treatment progress.     

The antecedents of non‐affective psychosis in a birth‐cohort,with a focus on measures related to cognitive ability,attentional dysfunction and speech problems

Welham J, Scott J, Williams GM, Najman JM, Bor W, O’Callaghan M, McGrath J. The antecedents of non‐affective psychosis in a birth‐cohort, with a focus on measures related to cognitive ability, attentional dysfunction, and speech problems. Objective: Adults with non‐affective psychosis show subtle deviations in a range of developmental trajectories as children and adolescents. Method: Based on a birth‐cohort (n = 3801), we examined the Peabody Picture Vocabulary Test (PPTV) at age 5, and Raven’s Standard Progressive Matrices (RSPM) and Wide Range Achievement Test reading scale (WRAT‐R) at age 14. Items related to speech problems and attentional dysfunction were available from maternal‐ or self‐report. At age 21, we identified 60 cohort members who were screen‐positive for non‐affective psychosis (SP‐NAP). Results: Impaired performance on the PPVT and RSPM (but not WRAT‐R) predicted SP‐NAP for males only. Male cohort members in the highest quartile for attentional dysfunction at ages 5 and 14 were about 5–8 times more likely to develop SP‐NAP. SP‐NAP in males was significantly associated with speech problems at age 14. Conclusion: Males who develop non‐affective psychoses have subtle impairments in cognitive capacity prior to the development of their psychotic disorder.     

Self-regulation in violent and non-violent offenders: a preliminary report

Background The functional role of self‐regulation in violent behaviour is not yet fully understood. Aim To test the hypothesis that violent offenders have more deficits in self‐regulation and self‐control than non‐violent offenders. Methods Self‐regulation and personality disorders were evaluated in a sample of 70 violent and non‐violent incarcerated offenders using the Volitional Components Questionnaire (VCQ) and the SCID‐II for DSM‐IV. Results The self‐report data indicate that violent offenders were no different from non‐violent offenders on either facilitatory or inhibitory modes of self‐regulation and self‐control. Compared with a sample of normal, healthy men, differences were found in all tested self‐regulation variables but not in self‐control. Except for antisocial personality, the groups were similar in personality features. Conclusions The proposed hypothesis was not sustained on this measure of self‐regulation. With regard to self‐regulation and self‐control, violent and non‐violent offenders were similar and treatment interventions to improve capacity in these respects are probably useful for both groups. Copyright © 2007 John Wiley & Sons, Ltd.     

A comparison of risk factors for habitual violence in pre-trial subjects

OBJECTIVE: Pre-trial referrals to the Valkenberg Hospital forensic unit over a 6-month period were studied. Habitually violent offenders were compared with those with no history of violence. METHODS: Risk factors known to be associated with violent behaviour were elicited, i.e. demographics, behaviour during index offence (such as impulsivity, identity of victim, use of weapon, accomplices, intoxication, psychotic symptoms), psychiatric and family histories, history of suicide attempts, past child abuse, head injury, criminal record, psychiatric diagnosis and presence of medical disorders. EEG's, Barratt's Impulsivity, Zuckerman's Sensation Seeking and Mini-Mental Scales were administered. Behaviour in the ward during the 30 days was also appraised. Logistic regression models were used to determine relative risks. RESULTS: There were 155 subjects; 89.7% were male, 71.6% were single and 58.7% were unemployed. For 44.5% the index offence was violent, and 9.7% had committed sexual offences; 61.9% had histories of habitual violence. A psychotic disorder was diagnosed in 32.3% and a personality disorder in 48.4%. Habitually violent subjects were distin- guished by a history of issuing threats (OR=3.68; CI=3.19-4.16; P=0.000), delusions of persecution (OR=3.43; CI=2.67-4.17; P=0.001), history of conduct disorder (OR=1.95; CI=1.70-2.19; P=0.006), alcohol/substance abuse (OR=2.08; CI=1.53-2.61; P=0.008) and violent index offence (OR=1.66; CI=1.54-2.61; P=0.035). CONCLUSION: This seems to confirm the relationship between threats, feeling threatened, psychosis, a history of antisocial behaviour and alcohol abuse.     

Neuropsychological functioning in early onset psychotic disorders

This paper examines whether neuropsychological profiles of youth with early onset psychotic disorders predicted diagnostic or clinical status. Youth with schizophrenia (n=27), bipolar disorder (n=22), and psychosis NOS (n=20) were included. Subjects received an extensive neuropsychological evaluation, including measures of general cognition, attention, memory, and executive functioning. Medication status was not controlled. No statistically significant neurocognitive differences across diagnostic groups were found. Compared to standardized norms, youth with schizophrenia demonstrated deficits in general cognition, verbal learning, recall, sustained effort, and social knowledge. Subjects with bipolar disorder and psychosis NOS exhibited deficits on measures of verbal learning, recall, and sustained effort similar to those of youth with schizophrenia. Neurocognitive deficits in memory and attention appeared to be common among youth with psychotic illnesses, regardless of diagnosis. Those with schizophrenia may have greater global cognitive deficits and problems with social knowledge. Across diagnoses, subjects demonstrated relative strengths on tests that provided them with immediate feedback, and performed most poorly on tests requiring delayed recall.     

The prevalence of DSM-III-R "prodromal" symptoms of schizophrenia in non-psychotic psychiatric outpatients

A cross-sectional point prevalence study of the DSM-III-R prodromal symptoms in non-psychotic (n = 501) consecutive outpatients from a catchment area with 260000 inhabitants is presented. The relationship between the three most psychosis-specific prodromal symptoms and the development of psychosis during the following 6 months was also explored. The prevalence of any prodromal symptom was 25%, the most prevalent being impairment of role functioning (14%), isolation and withdrawal (11%) and lack of initiative (8%). The most prevalent symptom in affective disorders was lack of initiative (14%); in personality disorders, it was impairment of role functioning (21%). The prevalences of the most psychosis-specific symptoms "peculiar behaviour", "magical thinking" and "unusual perceptual experiences" was 1-2%. At re-evaluation 6 months later, three of 20 patients (15%) with one or more such symptoms had become psychotic, two with schizoaffective disorder, one with affective psychosis. It was concluded that DSM-III prodromal symptoms are common among non-psychotic outpatients, but most such symptoms are non-specific for psychosis. Persistent peculiar behaviour, magical thinking and unusual perceptual experiences have a very low prevalence but may indicate an increased risk for psychosis. Such patients should be followed with that risk in mind.     

The relationship between childhood trauma history and the psychotic subtype of major depression

Gaudiano BA, Zimmerman M. The relationship between childhood trauma history and the psychotic subtype of major depression. Objective: Increasing evidence exists linking childhood trauma and primary psychotic disorders, but there is little research on patients with primary affective disorders with psychotic features. Method: The sample consisted of adult out‐patients diagnosed with major depressive disorder (MDD) at clinic intake using a structured clinical interview. Patients with MDD with (n = 32) vs. without psychotic features (n = 591) were compared as to their rates of different types of childhood trauma. Results: Psychotic MDD patients were significantly more likely to report histories of physical (OR = 2.81) or sexual abuse (OR = 2.75) compared with non‐psychotic MDD patients. These relationships remained after controlling for baseline differences. Within the subsample with comorbid post‐traumatic stress disorder, patients with psychotic MDD were significantly more likely to report childhood physical abuse (OR = 3.20). Conclusion: Results support and extend previous research by demonstrating that the relationship between childhood trauma and psychosis is found across diagnostic groups.