Abstract
Background
Bipolar disorder (BD) is a severe mental disorder related to neurocognitive deficits. Exposure to childhood trauma is associated with worse cognitive performance. Different compositions of childhood trauma in BD and their impacts on cognition are rarely reported.
Methods
We used the Brief Assessment of Cognition in Affective Disorders (BAC-A) to assess cognitive performance and the Chinese version of the Short Form of the Childhood Trauma Questionnaire (C-CTQ-SF) to assess childhood trauma experience among 55 euthymic BD patients. Cluster analysis was applied to dissect their childhood trauma experiences, which revealed three distinct clusters: a low trauma group, neglect-focus group, and multiple-trauma-experience group. We compared the cognitive function between the three clusters and used a generalized linear model to evaluate the impact of childhood neglect on cognitive domains.
Results
The neglect-focus cluster showed prominent exposures to physical and emotional neglect (41.8%). BD patients in this cluster performed worse in BAC-A compared with patients in the multiple trauma cluster, especially in working memory and processing speed. The neglect-focus group revealed a significant negative effect on the composite score (ß = -0.904, p = 0.025) and working memory (ß = -1.150, p = 0.002) after adjusting sex, age, education year, BMI and total psychotropic defined daily dose.
Conclusions
Distinct patterns of childhood trauma experience are seen in BD patients and are related with different cognitive profiles. Early exposure of neglect-focus trauma was associated with the worst cognitive performance in current study. Further studies investigating the intensity of the neglect, as well as individual resilience and co** mechanisms in BD, are warranted.
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Introduction
Bipolar disorder (BD) is a chronic mental illness with features of fluctuations in mood state and has a lifetime prevalence ranging between 0.1 and 2.4% (Grande et al. 2016; Rowland and Marwaha 2018). It is also one of the most disabling conditions, causing high days out of role and disability-adjusted life years (Alonso et al. 2011; He et al. 2020). Among patients, impairment crosses neurocognitive domains, including attention, verbal learning and memory, and executive functions had been noted (Solé et al. 2017). Although there is no specific intervention with pro-cognitive effects so far, multiple factors such as age, education level, illness duration, and clinical course are associated with the cognitive impairment (Mann-Wrobel et al. 2011; Tamura et al. 2021). Adverse childhood experiences are not uncommon in BD patients, and studies have revealed an association between childhood adversities and poor cognitive presentation among individuals (Poletti et al. 2014; Rokita et al. 2018). A previous study targeting major depression and BD patients also highlighted that cognitive impairment is especially observed in subjects exposed to great childhood adversities, indicating the importance of early experience in the cognitive functions in mood disorders (Poletti et al. 2017).
Exposure to childhood adversity has been noticed as a risk factor of poor health outcomes, including both physical and mental health (Hustedde 2021; Petruccelli et al. 2019; Sonu et al. 2019). Studies also suggested that childhood trauma experience and its impact on outcomes may differ between genders (** working memory-specific dysfunction using a transdiagnostic approach. Neuroimage Clin. 2021;31:102747." href="/article/10.1186/s40345-024-00335-w#ref-CR76" id="ref-link-section-d156332386e2803">2021). More specifically, in BD, poor working memory performance has been noted with a thinner prefrontal cortex and parietal cortices (Cho and Goghari 2020), functional abnormality in the dorsolateral prefrontal cortex (DLPFC) and ventromedial prefrontal cortex (VMPFC) (Saldarini et al. 2022), and attenuated neural activation in the prefrontal cortex and posterior parietal cortex (Townsend et al. 2010). In addition, functional Val158Met polymorphism of the catechol-O-methyltransferase (COMT) gene, which mediates the degradation of dopamine, may also influence the aberrant activity of DLPFC during working memory performance in BD (Miskowiak et al. 2017). On the other hand, a study investigating post-institutionalized Romanian orphans showed that early deprivation with neglect could cause metabolism changes in many brain regions, including the orbital frontal gyrus, infra-limbic prefrontal cortex, medial temporal structures, lateral temporal cortex, and brain stem (Chugani et al. 2001). A study specifically focused on BD also showed that both physical and emotional neglect are associated with a dysregulated frontoparietal circuit, and physical neglect may specifically impact the functional connectivity of the left-caudate-seed to the frontoparietal network (Hsieh et al. 2021). Therefore, we notified that the brain network involved in subjects with childhood neglect corresponds to the brain area for working memory in BD. Furthermore, research has suggested that in a deprived early environment, there may be excessive synaptic pruning and problems with myelination, causing reductions in cortical thickness and white matter integrity (McLaughlin et al. 2017). In addition, other mechanisms also link early life stress to cognitive outcomes, including interaction with genotypes, epigenetic modification, behavioral adaptation, and the impact on the HPA axis, immune system, oxidative stress, and alteration in neurotrophin factors (Aas et al. 2019; Deighton et al. 2018; Grillault Laroche et al. 2020; Horn et al. 2019; Jaworska-Andryszewska and Rybakowski 2019; Jiang et al. 2019; Maes et al. 2022; Tyrka et al. 2013).
It is interesting to note that in this study, the multi-trauma cluster unexpectedly did not show the worst cognitive performance. These findings indicated that the impact of adverse childhood experience on cognition does not simply rely on the cumulative effect of different childhood traumas, and some cluster characteristics need to be mentioned. For example, in the current study, we excluded BD patients with substance use disorder, and the cluster with multi-trauma showed trend of older onset age, fewer total episodes, and shorter duration of the illness. Those who could remain stable could be a special subpopulation in this multi-trauma cluster, which may be protected from some other biological or psychological factors. For example, they could have larger gray and whiter matter volume in the hippocampus and greater connectivity between the central executive network and the limbic regions, as shown in the population with resilience remaining after exposure to childhood maltreatment (Moreno-López et al. 2020).
With a clustering method instead of a categorical method, the current study provides further understanding of common distributions of childhood trauma experience in BD and the unique profile of their cognitive performance. The results allowed us to evaluate the impact of a certain combination of childhood trauma subtypes and provided a more realistic point of view. But there are several limitations that should be considered in this study. First, childhood trauma experience was assessed via self-report, which inevitably faces the issue of recall bias and is often questioned for the possible influence of patients’ psychopathology. However, CTQ scales have proven validity and reliability in both psychotic patients (Fisher et al. 2011) and a BD population (Hosang et al. 2023). Second, more detailed information is lacking about the childhood trauma, such as the actual frequency and duration, which may lead to an over-simplified model for the understanding of trauma experience. Third, all of the participants were recruited from a single tertiary psychiatric hospital. Therefore, the patients likely had a more severe degree of illness and cognitive dysfunction, causing uncertainty about generalizability of the study. Fourth, the sample size in our study was small, leading to limited sizes for each cluster. Only 10% of the patients clustered into the multi-trauma group, making it difficult to demonstrate differences in performance of cognitive domains due to small sample size. A larger sample size of multi-trauma cluster might reveal a cognitive profile different from both low trauma cluster and neglect-focused trauma cluster. Fifth, while assessing cognitive performances, it’s important to consider the impact of medications. However, the effects of different categories of pharmacological treatment on cognitive deficits in BD have shown mixed results in previous studies (Sanches et al. 2015; Wingo et al. 2009; Xu et al. 2020; Yatham et al. 2017). Although there was no significant difference in psychotropic DDD between clusters, we noted a relatively low proportion of subjects receiving lithium treatment in the neglect-focus group, while the long-term beneficial effect of lithium to BD on their cognition compared with other anticonvulsants still needed more research for precise conclusions (Sabater et al. 2016). Lastly, we did not have longitudinal cognitive profiles to ensure the cognitive stability of the patients.
In conclusion, this study confirmed that neglect-focused trauma experience in BD may cause a negative impact on working memory function. There might be a unique influence of the neglect cluster over childhood abuse. Findings from this study suggest that in clinical practice, history of childhood trauma experiences, not only abuse but also neglect, should be assessed in BD population as it may be associated with cognitive deficits and require further attention while managing the patients. Further research is warranted for understanding the linking mechanisms of childhood neglect, such as disturbed neurodevelopmental process, neurocircuits, immune and inflammatory system. Specific interventions focusing on preventing cognitive deterioration are also required in this cluster of patients.
Data availability
The data that support the findings of this study are available on request from the corresponding author.
References
Aas M, Pizzagalli DA, Laskemoen JF, Reponen EJ, Ueland T, Melle I, et al. Elevated hair cortisol is associated with childhood maltreatment and cognitive impairment in schizophrenia and in bipolar disorders. Schizophr Res. 2019;213:65–71.
Agnew-Blais J, Danese A. Childhood maltreatment and unfavourable clinical outcomes in bipolar disorder: a systematic review and meta-analysis. Lancet Psychiatry. 2016;3(4):342–9.
Alonso J, Petukhova M, Vilagut G, Chatterji S, Heeringa S, Üstün TB, et al. Days out of role due to common physical and mental conditions: results from the WHO World Mental Health surveys. Mol Psychiatry. 2011;16(12):1234–46.
Barboza GE. Latent classes and cumulative impacts of adverse childhood experiences. Child Maltreat. 2018;23(2):111–25.
Bauer IE, Keefe RS, Sanches M, Suchting R, Green CE, Soares JC. Evaluation of cognitive function in bipolar disorder using the brief Assessment of Cognition in Affective disorders (BAC-A). J Psychiatr Res. 2015;60:81–6.
Begemann MJH, Sommer IE, Brand RM, Oomen PP, Jongeneel A, Berkhout J, et al. Auditory verbal hallucinations and childhood trauma subtypes across the psychosis continuum: a cluster analysis. Cogn Neuropsychiatry. 2022;27(2–3):150–68.
Bernstein DP, Fink L. Childhood Trauma Questionnaire: a retrospective Self-report: Manual. Psychological Corporation; 1998.
Bernstein DP, Ahluvalia T, Pogge D, Handelsman L. Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population. J Am Acad Child Adolesc Psychiatry. 1997;36(3):340–8.
Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003;27(2):169–90.
Bruni A, Carbone EA, Pugliese V, Aloi M, Calabrò G, Cerminara G, et al. Childhood adversities are different in Schizophrenic Spectrum disorders, bipolar disorder and major depressive disorder. BMC Psychiatry. 2018;18(1):391.
Carbone EA, Pugliese V, Bruni A, Aloi M, Calabrò G, Jaén-Moreno MJ, et al. Adverse childhood experiences and clinical severity in bipolar disorder and schizophrenia: a transdiagnostic two-step cluster analysis. J Affect Disord. 2019;259:104–11.
Caruso D, Palagini L, Miniati M, Massa L, Marazziti D, Geoffroy PA, et al. Early life stress and chronobiological rhythms desynchronization: possible impact on Mood symptoms and suicidal ideation in bipolar disorder. J Nerv Ment Dis. 2021;209(7):518–24.
Chen RA, Lee CY, Lee Y, Hung CF, Huang YC, Lin PY, et al. Defining cognitive profiles of depressive patients using the brief Assessment of Cognition in Affective disorders. PeerJ. 2019;7:e7432.
Cho IYK, Goghari VM. The relationship between maintenance and manipulation components of working memory and prefrontal and parietal brain regions in bipolar disorder. J Affect Disord. 2020;264:519–26.
Chugani HT, Behen ME, Muzik O, Juhász C, Nagy F, Chugani DC. Local brain functional activity following early deprivation: a study of postinstitutionalized Romanian orphans. NeuroImage. 2001;14(6):1290–301.
Cotter J, Yung AR. Exploring the impact of adverse childhood experiences on symptomatic and functional outcomes in adulthood: advances, limitations and considerations. Ir J Psychol Med. 2018;35(1):5–7.
D’Esposito M, Postle BR. The cognitive neuroscience of working memory. Annu Rev Psychol. 2015;66:115–42.
Deighton S, Neville A, Pusch D, Dobson K. Biomarkers of adverse childhood experiences: a sco** review. Psychiatry Res. 2018;269:719–32.
Farias CA, Cardoso TA, Mondin TC, Souza LDM, da Silva RA, Kapczinski F, et al. Clinical outcomes and childhood trauma in bipolar disorder: a community sample of young adults. Psychiatry Res. 2019;275:228–32.
Fisher HL, Craig TK, Fearon P, Morgan K, Dazzan P, Lappin J, et al. Reliability and comparability of psychosis patients’ retrospective reports of childhood abuse. Schizophr Bull. 2011;37(3):546–53.
Grande I, Berk M, Birmaher B, Vieta E. Bipolar disorder. Lancet. 2016;387(10027):1561–72.
Grillault Laroche D, Curis E, Bellivier F, Nepost C, Courtin C, Etain B, et al. Childhood maltreatment and HPA axis gene expression in bipolar disorders: a gene network analysis. Psychoneuroendocrinology. 2020;120:104753.
Häuser W, Schmutzer G, Brähler E, Glaesmer H. Maltreatment in childhood and adolescence: results from a survey of a representative sample of the German population. Dtsch Arztebl Int. 2011;108(17):287–94.
He H, Hu C, Ren Z, Bai L, Gao F, Lyu J. Trends in the incidence and DALYs of bipolar disorder at global, regional, and national levels: results from the global burden of Disease Study 2017. J Psychiatr Res. 2020;125:96–105.
Hesselbrock V, Stabenau J, Hesselbrock M, Mirkin P, Meyer R. A comparison of two interview schedules. The schedule for affective disorders and Schizophrenia-Lifetime and the National Institute for Mental Health Diagnostic Interview Schedule. Arch Gen Psychiatry. 1982;39(6):674–7.
Higgins ESG, Mark S. The Neuroscience of Clinical Psychiatry. 3rd Ed. ed2018.
Hjelseng IV, Vaskinn A, Ueland T, Lunding SH, Reponen EJ, Steen NE, et al. Childhood trauma is associated with poorer social functioning in severe mental disorders both during an active illness phase and in remission. Schizophr Res. 2022;243:241–6.
Horn SR, Leve LD, Levitt P, Fisher PA. Childhood adversity, mental health, and oxidative stress: a pilot study. PLoS ONE. 2019;14(4):e0215085.
Hosang GM, Manoli A, Shakoor S, Fisher HL, Parker C. Reliability and convergent validity of retrospective reports of childhood maltreatment by individuals with bipolar disorder. Psychiatry Res. 2023;321:115105.
Hsieh YT, Wu R, Tseng HH, Wei SY, Huang MC, Chang HH, et al. Childhood neglect is associated with corticostriatal circuit dysfunction in bipolar disorder adults. Psychiatry Res. 2021;295:113550.
Hustedde C. Adverse childhood experiences. Prim Care. 2021;48(3):493–504.
Janiri D, Kotzalidis GD, De Chiara L, Koukopoulos AE, Aas M, Sani G. The Ring of Fire: Childhood Trauma, emotional reactivity, and mixed States in Mood disorders. Psychiatr Clin North Am. 2020;43(1):69–82.
Jaworska-Andryszewska P, Rybakowski JK. Childhood trauma in mood disorders: neurobiological mechanisms and implications for treatment. Pharmacol Rep. 2019;71(1):112–20.
Jiang S, Postovit L, Cattaneo A, Binder EB, Aitchison KJ. Epigenetic modifications in stress response genes Associated with Childhood Trauma. Front Psychiatry. 2019;10:808.
Jørgensen JL, Macoveanu J, Petersen JZ, Knudsen GM, Kessing LV, Jørgensen MB, et al. Association of childhood trauma with cognitive impairment and structural brain alterations in remitted patients with bipolar disorder. J Affect Disord. 2023;337:75–85.
Karlsson Linnér R, Biroli P, Kong E, Meddens SFW, Wedow R, Fontana MA, et al. Genome-wide association analyses of risk tolerance and risky behaviors in over 1 million individuals identify hundreds of loci and shared genetic influences. Nat Genet. 2019;51(2):245–57.
Keefe RS, Fox KH, Davis VG, Kennel C, Walker TM, Burdick KE, et al. The brief Assessment of Cognition in Affective disorders (BAC-A):performance of patients with bipolar depression and healthy controls. J Affect Disord. 2014;166:86–92.
Lacey RE, Minnis H. Practitioner review: twenty years of research with adverse childhood experience scores - advantages, disadvantages and applications to practice. J Child Psychol Psychiatry. 2020;61(2):116–30.
Lee CY, Wang LJ, Lee Y, Hung CF, Huang YC, Lee MI, et al. Differentiating bipolar disorders from unipolar depression by applying the brief Assessment of Cognition in Affective disorders. Psychol Med. 2018;48(6):929–38.
Lucero MM, Satz S, Miceli R, Swartz HA, Manelis A. The effects of mood disorders and childhood trauma on fear of positive and negative evaluation. Acta Psychol (Amst). 2022;227:103603.
Lund JI, Toombs E, Radford A, Boles K, Mushquash C. Adverse childhood experiences and executive function difficulties in children: a systematic review. Child Abuse Negl. 2020;106:104485.
Lund JI, Boles K, Radford A, Toombs E, Mushquash CJ. A Systematic Review of Childhood Adversity and Executive functions outcomes among adults. Arch Clin Neuropsychol. 2022.
Maes M, Rachayon M, Jirakran K, Sodsai P, Klinchanhom S, Debnath M et al. Adverse childhood experiences predict the Phenome of Affective disorders and these effects are mediated by staging, neuroimmunotoxic and growth factor profiles. Cells. 2022;11(9).
Mann-Wrobel MC, Carreno JT, Dickinson D. Meta-analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables. Bipolar Disord. 2011;13(4):334–42.
Matsumoto M, Piersiak HA, Letterie MC, Humphreys KL. Population-based estimates of associations between child maltreatment types: a Meta-analysis. Trauma Violence Abuse. 2021:15248380211030502.
McLaughlin KA, Sheridan MA, Nelson CA. Neglect as a violation of species-expectant experience: neurodevelopmental consequences. Biol Psychiatry. 2017;82(7):462–71.
Mills R, Alati R, O’Callaghan M, Najman JM, Williams GM, Bor W, et al. Child abuse and neglect and cognitive function at 14 years of age: findings from a birth cohort. Pediatrics. 2011;127(1):4–10.
Miskowiak KW, Kjaerstad HL, Støttrup MM, Svendsen AM, Demant KM, Hoeffding LK, et al. The catechol-O-methyltransferase (COMT) Val158Met genotype modulates working memory-related dorsolateral prefrontal response and performance in bipolar disorder. Bipolar Disord. 2017;19(3):214–24.
Miskowiak KW, Hansen KB, Mariegaard J, Kessing LV. Association between childhood trauma, cognition, and psychosocial function in a large sample of partially or fully remitted patients with bipolar disorder and healthy participants. Int J Bipolar Disord. 2023;11(1):31.
Moreno-López L, Ioannidis K, Askelund AD, Smith AJ, Schueler K, van Harmelen AL. The resilient emotional brain: a sco** review of the Medial Prefrontal Cortex and Limbic structure and function in resilient adults with a history of Childhood Maltreatment. Biol Psychiatry Cogn Neurosci Neuroimaging. 2020;5(4):392–402.
Park YM, Shekhtman T, Kelsoe JR. Effect of the type and number of adverse childhood experiences and the timing of adverse experiences on clinical outcomes in individuals with bipolar disorder. Brain Sci. 2020;10(5).
Petruccelli K, Davis J, Berman T. Adverse childhood experiences and associated health outcomes: a systematic review and meta-analysis. Child Abuse Negl. 2019;97:104127.
Poletti S, Colombo C, Benedetti F. Adverse childhood experiences worsen cognitive distortion during adult bipolar depression. Compr Psychiatry. 2014;55(8):1803–8.
Poletti S, Aggio V, Brioschi S, Dallaspezia S, Colombo C, Benedetti F. Multidimensional cognitive impairment in unipolar and bipolar depression and the moderator effect of adverse childhood experiences. Psychiatry Clin Neurosci. 2017;71(5):309–17.
Richard-Lepouriel H, Kung AL, Hasler R, Bellivier F, Prada P, Gard S, et al. Impulsivity and its association with childhood trauma experiences across bipolar disorder, attention deficit hyperactivity disorder and borderline personality disorder. J Affect Disord. 2019;244:33–41.
Rokita KI, Dauvermann MR, Donohoe G. Early life experiences and social cognition in major psychiatric disorders: a systematic review. Eur Psychiatry. 2018;53:123–33.
Rosa M, Scassellati C, Cattaneo A. Association of childhood trauma with cognitive domains in adult patients with mental disorders and in non-clinical populations: a systematic review. Front Psychol. 2023;14:1156415.
Rowland TA, Marwaha S. Epidemiology and risk factors for bipolar disorder. Ther Adv Psychopharmacol. 2018;8(9):251–69.
Sabater A, García-Blanco AC, Verdet HM, Sierra P, Ribes J, Villar I, et al. Comparative neurocognitive effects of lithium and anticonvulsants in long-term stable bipolar patients. J Affect Disord. 2016;190:34–40.
Saldarini F, Gottlieb N, Stokes PRA. Neural correlates of working memory function in euthymic people with bipolar disorder compared to healthy controls: a systematic review and meta-analysis. J Affect Disord. 2022;297:610–22.
Sanches M, Bauer IE, Galvez JF, Zunta-Soares GB, Soares JC. The management of cognitive impairment in bipolar disorder: current status and perspectives. Am J Ther. 2015;22(6):477–86.
Schilling C, Weidner K, Brähler E, Glaesmer H, Häuser W, Pöhlmann K. Patterns of childhood abuse and neglect in a Representative German Population Sample. PLoS ONE. 2016;11(7):e0159510.
Sheridan MA, Peverill M, Finn AS, McLaughlin KA. Dimensions of childhood adversity have distinct associations with neural systems underlying executive functioning. Dev Psychopathol. 2017;29(5):1777–94.
Solé B, Jiménez E, Torrent C, Reinares M, Bonnin CDM, Torres I, et al. Cognitive impairment in bipolar disorder: treatment and Prevention Strategies. Int J Neuropsychopharmacol. 2017;20(8):670–80.
Sonu S, Post S, Feinglass J. Adverse childhood experiences and the onset of chronic disease in young adulthood. Prev Med. 2019;123:163–70.
Strathearn L, Giannotti M, Mills R, Kisely S, Najman J, Abajobir A. Long-term cognitive, psychological, and Health outcomes Associated with child abuse and neglect. Pediatrics. 2020;146(4).
Sun D, Zhang R, Ma X, Sultana MS, Jiao L, Li M, et al. The association between childhood trauma and the age of onset in drug-free bipolar depression. Psychiatry Res. 2022;310:114469.
Sussman N, Mullen J, Paulsson B, Vågerö M. Rates of remission/euthymia with quetiapine in combination with lithium/divalproex for the treatment of acute mania. J Affect Disord. 2007;100(Suppl 1):S55–63.
Tamura JK, Carvalho IP, Leanna LMW, Feng JN, Rosenblat JD, Mansur R et al. Management of cognitive impairment in bipolar disorder: a systematic review of randomized controlled trials. CNS Spectr. 2021:1–22.
Townsend J, Bookheimer SY, Foland-Ross LC, Sugar CA, Altshuler LL. fMRI abnormalities in dorsolateral prefrontal cortex during a working memory task in manic, euthymic and depressed bipolar subjects. Psychiatry Res. 2010;182(1):22–9.
Tyrka AR, Burgers DE, Philip NS, Price LH, Carpenter LL. The neurobiological correlates of childhood adversity and implications for treatment. Acta Psychiatr Scand. 2013;128(6):434–47.
Wang LJ, Huang YC, Hung CF, Chen CK, Chen YC, Lee PY, et al. The Chinese Version of the brief Assessment of Cognition in Schizophrenia: data of a large-scale Mandarin-speaking Population. Arch Clin Neuropsychol. 2017;32(3):289–96.
Wingo AP, Wingo TS, Harvey PD, Baldessarini RJ. Effects of lithium on cognitive performance: a meta-analysis. J Clin Psychiatry. 2009;70(11):1588–97.
**ao D, Wang T, Huang Y, Wang W, Zhao M, Zhang WH, et al. Gender differences in the associations between types of childhood maltreatment and sleep disturbance among Chinese adolescents. J Affect Disord. 2020;265:595–602.
Xu N, Huggon B, Saunders KEA. Cognitive impairment in patients with bipolar disorder: impact of pharmacological treatment. CNS Drugs. 2020;34(1):29–46.
Yaple ZA, Tolomeo S, Yu R. Map** working memory-specific dysfunction using a transdiagnostic approach. Neuroimage Clin. 2021;31:102747.
Yatham LN, Mackala S, Basivireddy J, Ahn S, Walji N, Hu C, et al. Lurasidone versus treatment as usual for cognitive impairment in euthymic patients with bipolar I disorder: a randomised, open-label, pilot study. Lancet Psychiatry. 2017;4(3):208–17.
Ying-Chih Cheng C-HC, Chou K-R, Kuo P-H, Huang M-C. Reliability and factor structure of the Chinese Version of Childhood Trauma Questionnaire-short form in in patients with Substance Use Disorder. Taiwan J Psychiatry (Taipei). 2018;32:52–62.
Yue Y, Wang Y, Yang R, Zhu F, Yang X, Lu X, et al. Gender difference in the associations of childhood maltreatment and non-suicidal self-injury among adolescents with mood disorders. Front Psychiatry. 2023;14:1162450.
Zhao Y, Wu C. Childhood maltreatment experiences and emotion perception in young Chinese adults: sex as a moderator. Stress Health. 2022;38(4):666–78.
Zietz S, Kajula L, McNaughton Reyes HL, Moracco B, Shanahan M, Martin S, et al. Patterns of adverse childhood experiences and subsequent risk of interpersonal violence perpetration among men in Dar Es Salaam, Tanzania. Child Abuse Negl. 2020;99:104256.
Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K. Severity classification on the Hamilton Depression Rating Scale. J Affect Disord. 2013;150(2):384–8.
Zuo X, Zhang Z, Yan L, Lian Q, Yu C, Tu X, et al. Childhood adversity subtypes and violence victimization and perpetration among early adolescents in Shanghai, China. BMC Pediatr. 2021;21(1):381.
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This work was supported by the Ministry of Science and Technology (MOST 110-2314-B-532-007) and National Science and Technology Council (NSTC 112-2314-B-532 -002 -MY3). The funders played no role in the study design; collection, analysis, and interpretation of data; manuscript writing; or the decision to submit the paper for publication.
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YZH formatted the tables and figures and also wrote the original draft of the manuscript. CYH, MCH, PYC, and CJK performed the investigation and obtained resources. CCC and YCC suggested the investigation and completed resource and data curation. PHK participated in methodology and statistical analysis. WYC completed study conceptualization, funding acquisition, project administration and revised the manuscript. All authors read and approved the final manuscript.
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Hsueh, YZ., Huang, CY., Kuo, PH. et al. Cluster analysis exploring the impact of childhood neglect on cognitive function in patients with bipolar disorder. Int J Bipolar Disord 12, 13 (2024). https://doi.org/10.1186/s40345-024-00335-w
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DOI: https://doi.org/10.1186/s40345-024-00335-w