The British Journal of Psychiatry (2017)

211, 151-156. doi:

10.1192/bjp.bp.116.194019

Childhood trauma has been associated strength of this association was

with first-episode psychosis,1'2 affective found to be dose-dependent, with
dysfunction,3-6 and substance use.2-9 In higher rates of psychosis
a recent case-control study patients occurring as the frequency and

Influence of childhood trauma on diagnosis

with first-episode psychosis severity of traumatic experiences
showed a prevalence of physical increased.9 We therefore aimed to

and substance use in first-episode psychosis

abuse of 14-15% and a prevalence verify, in a large,
of sexual abuse of 18%.' In a epidemiologically representative
similar sample two-fold higher sample of people with first-episode
rates of S. Tomassi,trauma
childhood S. Tosato,
were V.psychosis,
Mondelli, whether
C. Faravelli,
people A. who
Lasalvia, G. Fioravanti, C. Bonetto, A. Fioritti,
reported C. in Cremonese,
cases compared R. LowithParrino, K. De Santi,
had experienced A. Meneghelli,
childhood trauma S. Torresani, G. De Girolamo, E. Semrov,
controls.2M.Exposure
Pratelli,toD.childhood
Cristofalo,(when M. Ruggeri
compared andwiththe those
GET UP whoGroup
trauma was found to be had not) showed a psychosis onset
associated with a two-fold risk of characterised by a higher rate of
Background
both recurrent and persistent affective psychosis, and second,
depression;Childhood
3 trauma has
it predicts been significantly
lifetime had an associated
increasedwith first- rate higher
lifetime of rates of lifetime use of cannabis (68% v. 41%; P =0.02)
episode psychosis, affective dysfunction and substance use. and heroin (20% v. 5%; P=0.02). Severe physical abuse was
suicide attempts in patients with substance use.
associated with increased lifetime use of heroin (15% v. 5%;
Aims
treatment-resistant depression P= 0.03) and cocaine (32% v. 17%; P =0.05).
(OR= 2.79, To test95% whether people with first-episode psychosis who had
CI 1.14-6.84), 4

and hasexperienced
been related childhood
to trauma,
the when compared with those
Method Conclusions
who had not, showed
presence of psychotic features in a higher rate of affective psychosis
Patients with first-episode psychosis exposed to childhood
and an5increased lifetime rate of substance use.
mood disorders. Finally, childhood This study was conducted within trauma appear to constitute a distinctive subgroup in terms
trauma has Method been associated with the framework of the Genetics of diagnosis and lifetime substance use.
a higherThe risksample compriseduse
of substance Endophenotypes
345inparticipants and Treatment:
with first-episode
adolescencepsychosis (58%
and early male, mean
adulthood in age early PsychosisDeclaration
29.8 years, s.d.=9.7).
Understanding - of interest
the general population (OR= 3.83, Psychosis early Intervention None.
and
Results
95% CI Severe 1.29-11.30), 2
and was
sexual abuse may Assessment
significantly associated of withNeeds
a and
Copyright and usage
also havediagnosis
a role inof and Outcome
affective psychosis
modulating (x2=4.9, P(GET
=0.04) UPandPIANO)
with trial. The Royal College of Psychiatrists 2017.
moderating the association This is a large, multicentre,
between cannabis use and the randomised controlled trial
later development of psychosis.' comparing an add-on multi-
The risk of psychosis is higher in element psychosocial early
those who have been exposed to intervention with routine care for
both childhood trauma and people affected by first-episode
cannabis use compared with those psychosis and their relatives,
exposed to only one of the two. The provided within Italian public

15
mental health services. Detailed
information on the study design,
sample recruitment and clinical
assessment has been reported
elsewhere.'9 The trial was
proposed to all community mental
health centres (CMHCs) located
across two northern Italian regions
(Veneto and Emilia-Romagna) and
the urban areas of Florence, Milan
and Bolzano, covering an area with
9 951 306 inhabitants." Of 126
CMHCs, 117 (93%, covering 9
304 093 inhabitants) participated.
The trial was approved by the
ethics committees of the
coordinating centre (Azienda
Ospedaliera Universitaria
Integrata di Verona) and each
participating unit, and was
registered with ClinicalTrials.gov
(NCT01436331).
Participants
All CMHC professionals were
asked to refer potential psychosis
cases at first contact during the
index period (1 April 2010 to 31
March 2011) to the study team.
Immediately thereafter, a
screening questionnaire for
psychosis was administered.12 The
inclusion criteria were:
age 18-54 years;
residence within the
catchment areas of CMHCs;
presence of at least one of
the following symptoms:
hallucinations, delusions,
qualitative speech disorder,
qualitative psychomotor
disorder or bizarre or grossly
inappropriate behaviour; or
two of the following symptoms:
loss of interest, initiative and
drive; social withdrawal; episodic
severe excitement; purposeless
destructiveness; overwhelming
fear or marked self-neglect
first lifetime contact with
CMHCs, prompted by these
symptoms.
 Tomassi et al
Exclusion criteria were
antipsychotic medication ( >3
months) prescribed for an identical
or similar mental disorder; mental
disorders due to a general medical
condition; moderate to severe
mental retardation assessed by
clinical functional assessment;
and psychiatric diagnosis other
than ICD-10 for psychosis. Since a
first psychotic episode is generally a
phase of high diagnostic instability,
the specific ICD-10 codes for
psychosis (Flx.4; Flx.5; Flx.7; F20-
29; F30.2, F31.2, F31.5, F31.6,
F32.3, F33.3) were assigned at 9
months. The best-estimate ICD-10
diagnoses were made by consensus
by a panel of clinicians by taking
into account all available
information gathered in the 9-
month follow-up period, as required
to apply the Item Group Checklist
of the Schedule for Clinical
Assessment in Neuropsychiatry
(SCAN) 13
Eligible patients,
identified as those who were
sufficiently clinically stable, gave
written informed consent!'
Assessment
Participants were assessed by a team
of 17 independent researchers who
underwent specific training on the
use of the standardised instruments
and an interrater reliability exercise
to determine consistency of
evaluations between investigators.
Information about childhood
trauma and substance use was
collected using the Childhood
Experience of Care and Abuse
Questionnaire (CECA-Q) and the
Cannabis Experiences
Questionnaire respectively.14"5
Severe sexual abuse has been
defined as an experience that:
had to meet at least two of the following
criteria: the perpetrator was known to the
individual; the perpetrator was a relative; the
perpetrator lived in the same household; the
unwanted sexual experience occurred more
than once; the perpetrator touched the child's
genitals; the perpetrator forced the child to
touch the perpetrator's genitals; the abuse
involved sexual intercourse.16
Severe physical abuse has been
defined as a repeated exposure to
physical violence from parental
figures before age 16:
that had to meet at least two of the following
criteria: the abuse consisted of being hit with
a belt or stick or being punched or kicked; the
abuse resulted in an injury, including broken
limbs, black eyes or bruising; the
perpetrator was considered to be out of
control.16
Separation has been defined as a
detachment from at least one living
relative longer than 6 months within
152
the first 17 years of life; loss was
defined as the death of one or both
parents during the participant's
childhood. Participants were defined
as 'traumatised' if they had
experienced at least one trauma:
severe sexual abuse, severe physical
abuse, separation, and/or loss.
Lifetime substance use, including
several types of drugs, was
assessed using the Cannabis
Experiences Questionnaire." The
sample was stratified into two
groups: those who had never used
substances and those who had
used substances at least once in
their life.
Statistical analysis
The association between
categorical variables was evaluated
by chi-squared or Fisher's exact
test, where appropriate. Adjustment
for gender was performed in
univariate logistic regression models,
with specific types of traumas as
dependent variables and diagnosis
and substance misuse as
independent variables. Interaction
between gender and trauma was
controlled for in all models. All
tests were bilateral at P <0.05.
Analyses were performed using
SPSS version 22.0 for Windows.
R
esults
Descri
ption
of the
sampl
e
Within the GET UP PIANO trial,
444 patients identified at intake
with a confirmed ICD-10 diagnosis
of psychosis at 9 months were
assessed. Of these, 345 (78%)
individuals (58% male, mean
age 29.8 years, s.d. = 9.7) agreed to
be interviewed about their
childhood traumatic experiences
and represented the sample of this
study. No significant difference was
found with regard to
sociodemographic or clinical
characteristics between participants
who completed the CECA-Q and
those who did not (data available
from the authors), with the
exception of non-Italian nationality,
which was more frequent among
those who did not complete the
questionnaire (P= 0.01). Among
the 345 persons who completed
the CECA-Q, 80 (23%) received
an ICD-10 code for affective
psychoses, whereas 265 (77%)
received an ICD-10 code for non-
affective psychoses (schizophrenia
n=96, 28%; non-affective, non-
schizophrenic psychosis n= 169,
49%). Regarding childhood trauma,
of the 345 people with first-episode
psychosis 8% experienced severe
sexual abuse during their
childhood, 14% reported severe
physical abuse and 20% were
separated for more than 6 months
from at least one of the parental
figures and/or lost one of their
parents. Overall, 37% had had at
least one traumatic experience
during their childhood. In terms of
lifetime substance use, 43% of the
345 participants reported cannabis
use, 20% recalled cocaine use and
6% reported heroin use. When
looking at combined lifetime use
we found, as expected, that all
participants (100%) who reported
a lifetime use of heroin had both
cocaine and cannabis lifetime
use. Similarly, those who reported
a lifetime use of cocaine also had a
lifetime cannabis use in 96% of
cases Finally, among those with a
cannabis lifetime use, 52% reported
an exclusive use of cannabis.
Sociodemographic features and
clinical characteristics of the sample
are shown in Table 1.
Childhood trauma and
diagnosis
The overall rate of affective psychosis
detected in traumatised and non-
traumatised participants was
around 24% in both groups (Fig.
1). Analysing the specific types of
traumas, we found a significant
association between severe
childhood sexual abuse and
affective psychosis (x2 = 4.9, P=
0.04). In particular, 42% of those
who reported severe sexual abuse had
an affective psychosis compared
with 22% of the non-sexually
abused group; this finding
remained significant after
adjusting for gender (OR = 2.2,
95% CI 1.1-6.2; P= 0.03). The
interaction between gender and
trauma was not significant. In
contrast, the percentage of affective
psychosis was lower in
participants with severe physical
abuse than in those without it
(16% v. 24%; P= 0.25),
Table 1 Sociodemographic profile of the sample (n=345)
Sociodemographic factor n (%)
Gender, male: n (%) 199 (57.7)
Age at first contact with services, years: mean (s.d.) 29.8 (9.7)
Educational level, n (%)8
Low (primary-middle school) 125 (37.2)
High (secondary school, university) 211 (62.8)
Marital status, n (%)b
Single 251 (75.4)
In a relationship/married 62 (18.6)
Widowed/separated/divorced 20 (6.0)
Working status, n (%)8
Unemployed 107 (31.8)
Employed 126 (37.5)
Student/homemaker/retired 103 (30.7)
Nationality, n (%)b
Italian 311 (91.2)
Other 30 (8.8)

a. Data missing for 9 participants.

b. Data missing for 12 participants.
c. Data missing for 4 participants.
 Pa
rti
ci
pa
nt
s
wi
th
af
fe
cti
ve
ps
yc
h
os
is,
%

Pa
rti
ci
pa
nt
s
wi
th
lif
eti
m
e
ca
n
na
bi
s
us
e,
%
Tomassi et al

between loss/separation and lifetime heroin use (8%

in exposed v. results confirm at least a two-fold
increase and are consistent with 6% in non-exposed
groups; P= 0.71). findings shown previously.2

Cocaine been widely described

No significant difference in before. Methodological
lifetime cocaine use (23% issues such as
v. 16%; P=0.30) was found heterogeneity of
between traumatised and definition, sample size and
non-traumatised demographic and social
participants. In particular, context issues have been
no significant association identified as possible
was found between severe reasons for this
sexual abuse or variability." The use of a
loss/separation and 'severe' abuse category,
lifetime use of cocaine. instead of the 'abuse' one,
Conversely, severely might account for
physically abused differences with other
participants showed studies. Rates of sexual
higher lifetime cocaine use and physical abuse in our
in comparison with non- sample were 11% and 29%
physically abused patients respectively. Regarding
(32% v. 17%; P=0.05). This sexual abuse, our rate
finding gained significance remains substantially
after adjusting for gender lower than that found by
(OR = 2.3, 95% CI 1.1-4.9; others;'" however, the
P = 0.04). The interaction prevalence of physical
between gender and abuse is broadly in line
trauma was not with other research. The
significant. surge in the rate of
physical abuse in our
sample might depend on
Discussion the inclusion in this
category of physical
This is the first study to punishments (i.e. open-
investigate the handed smacks) and
relationship between maltreatments (such as
childhood trauma and punches and kicks), even
affective psychosis in a when occurring once in a
large sample with first- lifetime. The social
episode psychosis acceptability of corporal
recruited in a 'real world' punishments as a method
setting. As predicted, we of education and their
found a significant consequent high frequency
association between within Italian families might
affective psychosis and therefore explain the data.
severe sexual abuse and Overall, the lower
between drug misuse and percentage of abused
both severe sexual and participants in our sample
severe physical abuse. We is consistent with a survey
found the frequency of carried out in the Italian
sexual and physical abuse general population, in
to be substantially lower which 8 children out of
than in previous studies 1000 were reported to be
of first-episode victims of maltreatments;
psychosis." In fact, severe specifically, among minors
sexual abuse was reported under the care of child
in 8% of our sample v. 15- services, 4% were sexually
18% in previous studies; abused whereas 7%
similarly, severe physical experienced physical
abuse was reported in maltreatment.19 When
14% v. 15-22%."7 compared with rates from
Variability in the the World Health
prevalence of abuse has Organization (WHO)
 Global Status Violence
Prevention, a discrepancy
comes to light with Italian
rates, which are
substantially lower than
rates in other high-income
countries.20 In the USA the
prevalence rates of sexual
abuse and physical
maltreatment were 7% and
10% respectively; in
Canada the respective
rates were 7% and 23%,
and in Australia 10% and
28%. These differences
might be due to a more
cohesive family and an
enhanced social support
network, which are
common in southern
European countries," or it
could reflect the proneness
to silence, connected with
the feelings of shame and
stigma, related to the
experience of trauma."
Nonetheless, comparing
trauma rates in our
sample (sexual abuse 11%,
physical abuse 29%) with
those of the Italian general
population (sexual abuse
4%, physical abuse 7%),
the
Affective psychosis and
childhood trauma
In our study severely
sexually abused people
with first-episode psychosis
had a five-fold higher
likelihood of receiving a
diagnosis of affective
psychosis. Our results are
in line with previous
studies, which showed an
increased presence of
psychotic features in both
major depressive disorder
and bipolar affective
disorder when the person
had been abused.5'6'23
Affective symptoms could
mediate the victimisation
psychosis association. Our
data are consistent with
previous studies,24'25 which
advocate a significant role
of negative beliefs about
self and others and of
depression and anxiety
within the pathway from
early trauma to psychosis.
Most interestingly, only
sexual abuse not physical
abuse has been proved to
be a strong and specific risk
factor for mental disorders,
including major depression
and anxiety disorder," once
more supporting our
154
results. A recent study
described a significant
association between sexual
abuse and depressive
symptoms in women but
not in men, suggesting
that maltreatments may
have a gender effect on
the development of
maladaptive self-images
and depression,'
mediated by a gender
difference in stress
reactivity. Women have
been shown to be more
susceptible to the
negative consequences of
stress in general," and of
early traumatic
experiences in particular."
In contrast, we did not find
any effect of gender on the
association between severe
sexual abuse and affective
psychosis. Our study did
not investigate the
presence of depressive
symptoms but focused on
diagnostic category; issues
other than gender might
therefore be involved and
explain the discrepancy
with previous evidence.
Substance use and childhood
trauma
In our sample, drug use
was found to be associated
with both severe sexual
and severe physical abuse.
Traumatised participants
in particular, those
reporting severe childhood
sexual abuse showed
significantly higher lifetime
cannabis use. The trauma-
cannabispsychosis
association could involve
several psychosocial
elements, contributing to an
enhanced vulnerability,8 and
various biological factors,
including the dopamine
neurotransmitter system,3
and the hypothalamic
pituitaryadrenal (HPA)
axis.2 First, childhood
trauma has been
significantly associated
with depression, which
usually precedes the
onset of substance
dependence among
traumatised people.31
Consistent with this,
abused individuals in our
sample more frequently
received a diagnosis of
affective psychosis when
compared with those who
were not abused. We may
therefore propose the role
of affective symptoms as
mediators or modulators of
the traumacannabis-
psychosis association.
Abused people tend to
become more frequently
depressed and thus might
more frequently use
cannabis to alleviate
depressive symptoms, or
could develop dysfunctional
coping strategies such as
self-medication to reduce
trauma-related stress.8
Second, social factors might
have a meaningful
influence: disadvantaged
environments, where it is
easier to become
entrapped in substance
dependence, and social
adversities, such as a low
socioeconomic status and
unemployment, have been
shown to be significantly
associated with both
psychosis and childhood
trauma.32 Finally, it is a
reasonable hypothesis that
abused and non-abused
individuals have similar
drug use patterns but that
only the former develop
psychosis owing to their pre-
existing enhanced
vulnerability.8'33
Biological factors may
also be involved. First, and
in line with the
'sensitisation' hypothesis,
genetically predisposed
individuals, whether
exposed to environmental
risk factors (as childhood
 Childhood trauma and substance use in first-episode psychosis
trauma and cannabis use) or not,
have been proved to show an
increased dopaminergic response
to social stressors. It may lead to
stable changes in the stress-related
dopaminergic response system,34
and eventually to a subsequent
enhanced vulnerability for
psychosis. Second, animal studies
have shown an influence of
environmental stressors on a rat's
delta-tetrahydrocannabinol (ATHC)
response:35 under stressful
housing conditions (i.e. isolation
and food deprivation) ATHC
administration resulted in an
increased dopamine uptake and
significant behavioural
abnormalities not observed in control
group rats.36 Finally, early traumatic
experiences have been associated
with permanent HPA axis
overreactivity (higher levels of
cortisol) to stressors and changes
in brain structures.37 Moreover, we
found that both sexual and physical
severe abuse experiences were
significantly associated with heroin
lifetime use, whereas cocaine lifetime
use appeared to be associated only
with severe physical abuse, which
is to some degree in line with
results for other psychiatric
disorders (anxiety, mood and
borderline personality disorders)."
Our findings seem to contrast
with a recent study that found no
association between childhood
trauma and use of cannabis or
other illicit drugs.39 This
inconsistency might be partially
explained by the different time
frame used when investigating
substance use: we explored lifetime
use, whereas the other study
investigated substance use in the
preceding month.
Strengths and limitations
The GET UP PIANO trial is the first
trial in first-episode psychosis
patients performed in a large
catchment area, corresponding to
nearly 10 million inhabitants.
Over 90% of CMHCs completed
the study, demonstrating that the
participants were highly
representative of the patients treated
in the community psychiatric
services. We used reliable,
internationally validated
instruments and adopted
conservative cut-off points,
previously applied, to identify only
the most severe forms of abuse.
Moreover, we systematically
performed adjustments excluding the
gender effect, known to represent a
potential confounder on the
association between trauma and
psychosis.'
However, some limitations
should also be considered. Reliance
on the retrospective reporting of
abuse might increase the risk of
recall bias. However, the
reliability of patients affected by
psychosis in referring trauma has
been clearly demonstrated;" their
reports were independent of
symptoms, stable over time and
generally consistent with other
sources of information. It has also
been proved that retrospective recall
yields an underestimation of the
phenomenon, rather than an
overestimation." Despite clear
evidence of association between
trauma, cannabis and psychosis,
our data do not elucidate whether
childhood traumatic experiences
and drug misuse represent
vulnerability factors for psychosis or
environmental stressors that trigger
the disorder acting on a pre-
existing vulnerability. Traumatic
experiences and drug misuse could
both be vulnerability agents,
decreasing the individual's resilience
in response to other stressors such
as migration, and leading to
psychosis. They might represent two
different environmental stressors,
acting in an additive or
multiplicative way on another
type of vulnerability (possibly
genetic). Childhood trauma could
enhance vulnerability and
cannabis use acts as an
exacerbating agent or vice versa.
Finally, because of the relative rarity
of abusive experiences, resulting in
small numbers, no further
adjustments for social factors
(such as employment or
socioeconomic status) and/or
genetic vulnerability (familiality)
have been carried out in the
analysis.
Future research
In addition to clarifying whether
cannabis and childhood trauma
represent vulnerability factors or
stressors triggering psychosis,
studies should also analyse this
association, taking into account
other environmental variables
and/or biological markers. A
population-based, longitudinal
prospective study design, with
long-term follow-up (from
155
infancy to adulthood) would be Funding
most appropriate." Overall, our
study suggests that patients with The study was funded by the Ministry of Health, Italy
Ricerca Sanitaria Finalizzata, Code
first-episode psychosis exposed to H61.108000200001.
childhood trauma constitute a
distinctive subgroup characterised
Acknowledgements
by diverse features in terms of
nosology and drug use. It has We thank all members of the Genetics
elucidated, albeit partially, to what Endophenotypes and Treatment: Understanding
early Psychosis (GET UP) group; see online
extent the presence of childhood supplement DS1 for full details of the group.
trauma affects features of first-
episode psychosis Finally, this
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results from the cluster-randomized
controlled GET UP PIANO Trial in a
catchment area of 10 million inhabitants.
Schizophr Bull 2015; 41: 1192-203.
12 Jablensky A, Sartorius N, Ernberg G,
Anker M, Korten A, Cooper JE, et al.
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13 Wing JK, Babor T, Brugha T, Burke J,
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14 Bifulco, A, Bernazzani 0 Moran PM,
Jacobs C. The childhood experience of
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15 Barkus EJ, Stirling J, Hopkins RS, Lewis S.
Cannabis-induced psychosis-like
experiences are associated with high
schizotypy. Psychopathology 2006; 39:
175-8.
16 Aas M, Navari S, Gibbs A, Mondelli V,
Fisher HL, Morgan C, et al. Is there a
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and amygdala and hippocampus volume
in first-episode psychosis? Schizophr
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17 Neria Y, Bromet EJ, Sievers S. Trauma
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18 Fisher HL, Craig T. Childhood
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19 Bollini A, Giannotta F, Angeli A.
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quante le vittime in Italia? Prima
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bambini-maltrattati-tdh-cismai.pdf).
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21 Bertani M, Lasalvia A, Bonetto C,
Tosato S, Cristofalo D, Bissoli S, et al.
The influence of gender on clinical and
social characteristics of patients at
psychosis onset a report from the
Psychosis Incident Cohort Outcome Study
(PICOS). Psycho! Med 2012; 42: 769-
80.
22 Taylor TF. The influence of shame on
post trauma disorders: have we failed
to see the obvious? Fur J
Psychotraumatol 2015; 6: 28847.
23 Hammersley P, Dias A, Todd G,
Bowen-Jones K, Reilly B, Bentall RP.
Childhood trauma and hallucinations in
bipolar affective disorder: preliminary
investigation. Br J Psychiatry 2003;
182: 543-7.
24 Garety PA, Bebbington P, Fowler D,
Freeman D, Kuipers E. Implications for
neurobiological research of cognitive
models of psychosis: a theoretical
paper. Psycho! Med 2007; 37: 1377-91.
25 Gracie A, Freeman D, Green S, Garety PA,
Kuipers E, Hardy A, et al. The association
between traumatic experience, paranoia
and hallucinations: a test of the
predictions of psychological models. Acta
Psychiatr Scand 2007; 116: 280-9.
26 Fergusson DM, McLeod GF, Norwood U.
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developmental outcomes: findings from a
30-year longitudinal study in New Zealand.
Child Abuse Negl 2013; 37: 664-74.
27 Haug E, Oie M, Andreassen OA,
Bratlien U, Nelson B, Aas M, et al.
Anomalous self-experience and
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schizophrenia. Compr
Psychiatry 2015; 56: 35-41.
28 Myin-Germeys I, Krabbendam L,
 Delespaul PA, Van Os J. Sex differences in
emotional reactivity to daily life stress in
psychosis. J Clin Psychiatry 2004; 65:
805-9.
29 Myin-Germeys I, Van Os J. Stress-
reactivity in psychosis: evidence for an
affective pathway to psychosis. Clin
Psycho! Rev 2007; 27: 409-24.
30 Kaufman J, Plotsky PM, Nemeroff CB,
Charney DS. Effects of early adverse
experiences on brain structure and
function: clinical implications. Biol
Psychiatry 2000; 48: 778-90.
31 Douglas KR, Chan G, Gelernter J, Arias Al,
Anton RF, Weiss RD. Adverse childhood
events as risk factors for substance
dependence: partial mediation by mood
and anxiety disorders. Addict Behav
2010; 35: 7-13.
32 Wicks S, Hjern A, Gunnell D, Lewis G,
Delman C. Social adversity in
childhood and the risk of developing
psychosis: a national cohort study.
Am J Psychiatry 2005; 162: 1652-7.
33 Tosato S, Lasalvia A, Bonetto C,
Mazzoncini R, Cristofalo D, De Santi K,
et al. The impact of cannabis use on
age of onset and clinical characteristics
in first-episode psychotic patients. Data
from the Psychosis Incident Cohort
Outcome Study (PICOS). J Psychiatr Res
2013; 47: 438-44.
34 Collip D, Myin-Germeys I, Van Os J.
Does the concept of 'sensitization'
provide a plausible mechanism for the
putative link between the
environment and schizophrenia?
Schizophr Bull 2008; 34: 220-5.
35 Suplita RL, Eisenstein SA, Neely MH,
Moise AM, Hohmann AG. Cross-
sensitization and cross-tolerance
between exogenous cannabinoid
antinociception and endocannabinoid
mediated stress-induced analgesia.
Neuropharmaco/ 2008; 54: 161-71.
36 MacLean KI, Littleton JM. Environmental
stress as a factor in the response of rat
brain catecholamine metabolism to
delta8-tetrahydrocannabinol. Eur J
Pharmacol 1977; 41: 171-82.
37 Read J, Perry BD, Moskowitz A,
Connolly J. The contribution of
early traumatic events to
schizophrenia in some patients: a
traumagenic neurodevelopmental
model. Psychiatry 2001; 64:
319-45.
38 Banducci AN, Hoffman E, Lejuez
CW, Koenen KC. The relationship
between child abuse and negative
outcomes among substance users:
psychopathology, health, and
comorbidities. Addict Behav 2014;
39: 1522-7.
39 Duhig M, Patterson S, Connell M,
Foley S, Capra C, Dark F, et al. The
prevalence and correlates of
childhood trauma in patients with
early psychosis. Aust NZ!
Psychiatry 2015; 49: 651-9.
40 Fisher HL, Morgan C, Dazzan P, Craig
TK, Morgan K, Hutchinson G, et al.
Gender differences in the association
between childhood abuse and
psychosis. Br! Psychiatry 2009; 194:
319-25.
41 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: 546-53.
42 Hardt J, Rutter M. Validity of adult
retrospective reports of adverse childhood
experiences: review of the evidence. J
Child Psycho! Psychiatry 2004; 45:
260-73.
43 Poulton R, Moffitt TE, Silva PA. The Dunedin
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an eye to the future. Soc Psychiatry
Psychiatr Epidemiol 2015; 50: 679-93.
Data supplement to Tomassi et al. Influence of childhood trauma on diagnosis and substance
use in first-episode psychosis Br J Psychiatry doi: 10.1192/bjp.bp.116.194019
.

Data supplement DS1

THE GET UP GROUP includes:
(update April 08 2013)

GET UP - Genetics, Endophenotypes, Treatment: Understanding early Psychosis

National Coordinator: Professor Mirella Ruggeri (Verona)

Leading Project: PIANO (Psychosis: Early Intervention and Assessment of Needs and Outcome)
Scientific Coordinator: Mirella Ruggeri (Verona)
Administrative Leading Institution: Azienda Ospedaliera Universitaria Integrata Verona, Regione
Veneto
Coordinating Centre: Mario Ballarin, Maria Elena Bertani, Sarah Bissoli, Chiara Bonetto, Doriana
Cristofalo, Katia De Santi, Antonio Lasalvia, Silvia Lunardi, Valentina Negretto, Sara Poli, Sarah
Tosato, Maria Grazia Zamboni

Project TRUMPET (TRaining and Understanding of Service Models for Psychosis Early Treatment)
Scientific Coordinator: Giovanni De Girolamo (Bologna and Brescia)
Administrative Leading Institution: Agenzia Sanitaria e Sociale Regionale, Regione Emilia
Romagna
Coordinating Centre: Angelo Fioritti, Giovanni Neri, Francesca Pileggi, Paola Rucci

Project GUITAR (Genetic data Utilization and Implementation of Targeted Drug Administration
in the Clinical Routine)
Scientific Coordinator: Massimo Gennarelli (Brescia)
Administrative Leading Institution: IRCCS Centro S.Giovanni di Dio Fatebenefratelli, Brescia
Coordinating Centre: Luisella Bocchio Chiavetto, Catia Scasselatti, Roberta Zanardini

Project CONTRABASS
COgnitive Neuroendophenotypes for Treatment and RehAbilitation of psychoses: Brain imaging,
InfAmmation and StreSS
Scientific Coordinator: Paolo Brambilla (Udine and Verona)
Administrative Leading Institution: Azienda Ospedaliera Universitaria Integrata, Verona, Regione
Veneto
Coordinating Centre: Marcella Bellani, Alessandra Bertoldo, Veronica Marinelli, Cinzia Perlini,
Gianluca Rambaldelli

1
ENROLLMENT AND TREATMENT RESEARCH UNITS:
RESEARCH UNIT Western Veneto:
Coordinator: Antonio Lasalvia (Verona).
Administrative Leading Institution: Azienda Ospedaliera Universitaria Integrata, Verona.
Coordinating Centre: Mariaelena Bertani, Sarah Bissoli, Lorenza Lazzarotto.
Participating MHCs: TAU Arm: Ulss 3 (Bassano), Ulss 4 Alto Vicentino (Thiene), Ulss 5 Montecchio
(Centro; Sud), Ulss 6 Vicenza ( Secondo), Ulss 18 Rovigo (Rovigo), Ulss 20 Verona ( II Servizio), Ulss 22
Bussolengo (Isola della Scala).
Experimental Arm: Ulss 5 Montecchio (Nord), Ulss 6 Vicenza (Primo; Noventa), Ulss 18 Rovigo ( Badia),
Ulss 19 Adria (Adria), Ulss 20 Verona (I Servizio; III Servizio; La Filanda),Ulss 21 Legnago (Il Tulipano; il
Girasole).
MHCs Reference Persons: Sonia Bardella, Francesco Gardellin, Dario Lamonaca, Antonio Lasalvia, Marco
Lunardon, Renato Magnabosco, Marilena Martucci, Stylianos Nicolau Francesco Nifosi, Michele
Pavanati, Massimo Rossi, Carlo Piazza, Gabriella Piccione, Annalisa Sala, Benedetta Stefani, Spyridon
Zotos.
CBT Staff: Mirko Balbo, Ileana Boggian, Enrico Ceccato, Rosa DallAgnola, Francesco Gardellin, Barbara
Girotto, Claudia Goss, Dario Lamonaca, Antonio Lasalvia, Alessia Mai, Annalisa Pasqualini, Michele
Pavanati, Carlo Piazza, Gabriella Piccione, Stefano Roccato, Alberto Rossi, Spyridon Zotos.
Family Intervention Staff: Flavia Aldi, Barbara Bianchi, Paola Cappellari, Raffaello Conti, Laura De Battisti,
Silvia Merlin,. Tecla Pozzan, Lucio Sarto.
Case Management Staff : Andrea Brazzoli, Antonella Campi, Roberta Carmagnani, Sabrina Giambelli,
Annalisa Gianella, Lino Lunardi, Davide Madaghiele, Paola Maestrelli, Lidia Paiola, Elisa Posteri, Loretta
Viola, Valentina Zamberlan, Marta Zenari.
Biological Sample processing and support to Brain Imaging precedures: Sarah Tosato, Martina Zanoni,
Giovanni Bonadonna, Mariacristina Bonomo.

RESEARCH UNIT Eastern Veneto:

Coordinator: Paolo Santonastaso.
Administrative Leading Institution: University of Padua.
Coordinating Centre: Carla Cremonese, Paolo Scocco, Angela Veronese.
Participating MHCs: TAU Arm: Ulss 8 ( Castelfranco), Ulss 9 (Treviso Nord; Oderzo), Ulss 10 (San Don di
Piave), Ulss 12 (Venezia; Mestre sud), Ulss 13 (Dolo), Ulss 14 (Piove di Sacco), Ulss 15 ( Cittadella), Ulss
16 (II Servizio), Ulss 17 (Este; Montagnana).
Experimental Arm: Ulss 8 (Montebelluna; Valdobbiadene), Ulss 9 (Treviso; Mogliano Veneto), Ulss 10
(PortogReserach Unitaro), Ulss 12 (Mestre Centro), Ulss 13 (Mirano), Ulss 14 (Chioggia I ; Cavarzere),
Ulss 15 (Camposanpiero), Ulss 16 (I Srvizio; III Servizio), Ulss 17 (Monselice; Conselve).
MHCs Reference Persons: Patrizia Anderle, Andrea Angelozzi, Isabelle Amalric Gabriella Baron,, Enrico
Bruttomesso Fabio Candeago, Franco Castelli, Maria Chieco, Carla Cremonese, Enrico Di Costanzo,
Mario Derossi, Michele Doriguzzi, Osvaldo Galvano, Marcello Lattanzi, Roberto Lezzi, Marisa Marcato,
Alessandro Marcolin, Franco Marini, Stefano Marino, Manlio Matranga, Elisabetta Sabbadin, , Rossana
Riolo, Maria Zucchetto, Flavio Zadro.
CBT Staff: Daniela Argenti, Giovanni Austoni, Maria Bianco, Stefania Bordino, Linda Cibiniel, Maria Chieco,
Marco DallAsta, Filippo Dario, Francesca Dassi, Alessandro Di Risio, Aldo Gatto, Simona Gran,
Emanuele Favero, Anna Franceschini, Silvia Friederici, Vanna Marangon, Marisa Marcato, Stefano
Marino, Giorgio Martinelli, Michela Pascolo, Maya Piaia, Luana Ramon, Elisabetta Sabbadin, Paolo
Scocco, Mara Semenzin, Angela Veronese, Stefania Zambolin, Maria Zucchetto. Anna Dominoni.
2
Family Intervention Staff: Antonella Buffon, Carla Cremonese, Elena Di Bortolo, Silvia Friederici, Stefania
Fortin,Marisa Marcato, Francesco Matarrese, Simona Mogni, Novella Nicodemo, Alessio Russo,
Alessandra Silvestro, Elena Turella, Paola Viel.
Case Management Staff: Lorenzo Andreose, Mario Boenco, Daniela Bottega, Loretta Bressan, Arianno
Cabbia, Elisabetta Canesso, Romina Cian, Caludia Dal Piccol, Maria Dalla Pasqua, Cinzia De Gasperi,
Anna Di Prisco, Lorena Mantellato, Monica Luison, Sandra Morgante, Mirna Santi, Moreno Sacillotto,
Mauro Scabbio, Patrizia Sponga, MLuisa Sguotto, Flavia Stach, MGrazia Vettorato.
Biological Sample processing and support to Brain Imaging precedures: Oscar Cabianca, Amalia Valente,
Livio Caberlotto, Alberto Passoni, Patrizia Flumian, Luigino Daniel, Massimo Gion, Saverio Stanziale,
Flora Alborino, Vladimiro Bortolozzo, Lucio Bacelle, Leonarda Bicciato, Daniela Basso, Filippo Navaglia,
Fabio Manoni, Mauro Ercolin.

RESEARCH UNIT Emilia:

Coordinators: Giovanni Neri, Franco Giubilini.
Administrative Leading Institution: Azienda ULSS, Parma
Coordinating Centre: Massimiliano Imbesi, Emanuela Leuci, Fausto Mazzi, Enrico Semrov.
Participating MHCs: TAU Arm: Piacenza (Castel S.Giovanni), Parma (Parma Est; Sud Est; Valli Taro e
Ceno), Reggio Emilia (CastelNovo nei Monti; Montecchio), Modena (Mirandola; Polo Ovest; Sassuolo;
Pavullo).
Experimental Arm : Piacenza (Piacenza; Fiorenzuola), Parma (Nord; Ovest; Fidenza), Reggio Emilia
(Correggio; Guastalla; Reggio Emilia III; Reggio Emilia; Scandiano), Modena ( Carpi; Polo Est; Vignola).
MHCs Reference Persons: Silvio Anelli, Mario Amore, Laura Bigi, Welsch Britta, Giovanna Barazzoni Anna,
Rubes Bonatti, Maria Borziani, Stefano Crosato, Isabella Fabris, Raffaele Galluccio, Margherita Galeotti,
Mauro Gozzi, Vanna Greco, Emanuele Guagnini, Stefania Pagani, Silvio Maccherozzi, Raffaello Malvasi,
Francesco Marchi, Ermanno Melato, Elena Mazzucchi, Franco Marzullo, Pietro Pellegrini, Nicoletta
Petrolini, Donatella Silvia Rizzi, Paolo Volta.
CBT Staff: Silvio Anelli, Franca Bonara, Elisabetta Brusamonti, Roberto Croci, Ivana Flamia, Francesca
Fontana, Romina Losi, Fausto Mazzi, Roberto Marchioro, Stefania Pagani, Luigi Raffaini, Luca Ruju,
Antonio Saginario, Giulia Stabili, Grazia Tondelli.
Family Intervention Staff: Lucia Bernardelli, Federica Bonacini, Annaluisa Florindo, Marina Merli, Patrizia
Nappo, Lorena Sola, Ornella Tondelli, Matteo Tonna, MTeresa Torre, Morena Tosatti, Gloria Venturelli,
Daria Zampolli.
Case Management Staff: Antonia Bernardi, Cinzia Cavalli, Lorena Cigala, Cinzia Ciraudo, Antonia Di Bari,
Lorena Ferri, Fabiana Gombi, Sonia Leurini, Elena Mandatelli, Stefano Maccaferri, Mara Oroboncoide,
Barbara Pisa, Cristina Ricci.
Biological Sample processing and support to Brain Imaging precedures: Enrica Poggi, Mara
Oroboncoide, Corrado Zurlini, Monica Malpeli, Rossana Colla, Elvira Teodori, Luigi Vecchia, Rocco
D'Andrea, Tommaso Trenti , Paola Paolini

RESEARCH UNIT Romagna:

Coordinators: Francesca Pileggi, Daniela Ghigi.
Administrative Leading Institution: Azienda ULSS, Rimini
Coordinating Centre: Mariateresa Gagliostro , Michela Pratelli, Paola Rucci
Participating MHCs: TAU Arm: Bologna (Zanolini; Scalo; Casalecchio; Vergato; San Giovanni), Ferrara (CSA
Ferrara; SIPI Ferrara Sud; Codigoro; Portomaggiore), Ravenna (Ravenna; Fenza), Forl (Forl), Cesena
(Cesena), Rimini (Riccione).
Experimental Arm: Bologna (Mazzacorati; Tiarini, Nani; S. Lazzaro; Budrio; San Giorgio), Imola
(UOT_Imola), Ferarra (Copparo; Ferrara Nord; Cento), Ravenna (Lugo), Cesena (Rubicone), Rimini
(Rimini).
3
MHCs Reference Persons: Antonio Antonelli, Luana Battistini, Francesca Bellini, Eva Bonini, Caterina
Bruschi Rossella Capelli, Cinzia Di Domizio, Chiara Drei, Giuseppe Fucci, Alessandra Gualandi, Maria
Rosaria Grazia, Anna M. Losi, Franca Mazzanti Paola Mazzoni, Daniela Marangoni, Giuseppe Monna,
Marco Morselli, Alessandro Oggioni, Silvio Oprandi, Walter Paganelli, Morena Passerini, Maria Piscitelli,
Gregorio Reggiani, Gabriella Rossi, Federica Salvatori, Simona Trasforini, , Carlo Uslenghi, Simona
Veggetti,
CBT Staff: Giovanna Bartolucci, Rosita Baruffa, Francesca Bellini, Raffaella Bertelli, Lidia Borghi, Patrizia
Ciavarella, Cinzia DiDomizio, Giuseppe Monna, Alessandro Oggioni, Elisabetta Paltrinieri, Maria
Piscitelli, Francesco Rizzardi, Piera Serra, Damiano Suzzi, Uslenghi Carlo.
Family Intervention Staff: Paolo Arienti, Fabio Aureli, Rosita Avanzi, Vincenzo Callegari, Alessandra
Corsino, Paolo Host, Rossella Michetti, Michela Pratelli,Francesco Rizzo, Paola Simoncelli, Elena Soldati,
Eraldo Succi.
Case Management Staff: Massimo Bertozzi, Elisa Canetti,Luca Cavicchioli, Elisa Ceccarelli, Stefano Cenni,
Glenda Marzola, Vanessa Gallina, Carla Leoni, Andrea Olivieri, Elena Piccolo, Sabrina Ravagli, Rosaria
Russo, Daniele Tedeschini.
Biological Sample processing and support to Brain Imaging precedures : Marina Verenini, Walter Abram,
Veronica Granata, Alessandro Curcio, Giovanni Guerra, Samuela Granini, Lara Natali, Enrica Montanari,
Fulvia Pasi, Umbertina Ventura, Stefania Valenti, Masi Francesca, Rossano Farneti, Paolo Ravagli,
Romina Floris, Otello Maroncelli, Gianbattista Volpones, Donatella Casali.

RESEARCH UNIT Firenze:

Coordinator: Maurizio Miceli.
Administrative Leading Institution: Azienda Sanitaria di Firenze
Coordinating Centre: Maurizio Miceli.
Participating MHCs: TAU Arm: MOM SMA 5; MOM SMA 8; MOM SMA 11; MOM SMA 12.
Experimental Arm: MOM SMA 3; MOM SMA 7; MOM SMA 9; MOM SMA 10.
MHCs Reference Persons: Andrea Bencini, Massimo Cellini, Luca De Biase, Leonardo Barbara, Liedl
Charles, Maurizio Miceli, Cristina Pratesi, Andrea Tanini, Roberto Leonetti.
CBT Staff: Massimo Cellini, Maurizio Miceli, Riccardo Loparrino, Cristina Pratesi, Cinzia Ulivelli,
Family Intervention Staff: Cristina Cussoto, Nico Dei, Enrico Fumanti, Manuela Pantani, Gregorio Zeloni.
Case Management Staff: Rossella Bellini, Roberta Cellesi, Nadia Dorigo, Patrizia Gull, Luisa Ialeggio,
Maria Pisanu.
Biological Sample processing and support to Brain Imaging precedures: Graziella Rinaldi, Angela Konze

RESEARCH UNIT Milano Niguarda:

Coordinator: Angelo Cocchi.
Administrative Leading Institution: Azienda Ospedaliera Ospedale Niguarda Ca Granda, Milano
Coordinating Centre: Anna Meneghelli
Participating MHCs: TAU Arm: corso Plebisciti; via Mario Bianco.
Experimental Arm: via Cherasco e via Livigno; via Litta Modignani.
MHC Reference Persons: Maria Frova , Emiliano Monzani, Alberto Zanobio, Marina Malagoli, Roberto
Pagani.
CBT Staff: Simona Barbera, Carla Morganti, Emiliano Monzani, Elisabetta Sarzi Amad.
Family Intervention Staff: Virginia Brambilla, Anita Montanari.
Case Management Staff: Giori Caterina, Carmelo Lopez.

4
Biological Sample processing and support to Brain Imaging precedures: Alessandro Marocchi, Andrea
Moletta, Maurizio Sberna

RESEARCH UNIT Milano S. Paolo:

Coordinator: Silvio Scarone.
Administrative Leading Institution: Azienda ULSS San Paolo, Milano
Coordinating Centre: Maria Laura Manzone
Participating MHCs: TAU Arm: CPS Zona 14 (Barabino).
Experimental Arm: Rozzano; Zona 15 (Conca del Naviglio); Zona 16 (San Vigilio).
MHC Reference Persons: Barbera Barbara, Luisa Mari, Maria L. Manzone, Edoardo Razzini.
CBT Staff: Yvonne Bianchi, MRosa Pellizzer, Antonella Verdecchia.
Family Intervention Staff: MGabriella Sferrazza, MLaura Manzone, Carmine Pismataro.
Case Management Staff: Benedetta Cerrai, Alessandra Gambino, Rosa Panarello.
Biological Sample processing and support to Brain Imaging precedures: Gian Vico Melzi D'Eril,
Alessandra Barassi, Rosana Pacciolla, Gloria Faraci

RESEARCH UNIT Bolzano:

Coordinator: Stefano Torresani (Bolzano).
Administrative Leading Institution: Azienda Sanitaria,, Bolzano
Participating MHCs: TAU Arm: none
Experimental Arm: Bolzano Rossini; Bolzano del Ronco.
MHC Reference Persons: Fabio Carpi, Soelva Margit.
CBT Staff: Monica Anderlan, Michele De Francesco, Efi Duregger, Stefano Torresani, Carla Vettori.
Family Intervention Staff: Carpi Fabio, Doimo Sabrina, Kompatscher Erika, Soelva Margit, Stefano
Torresani
Case Management Staff: Forer Michael, Kerschbaumer Helene.
Biological Sample processing and support to Brain Imaging precedures: Anna Gamper, Maira Nicoletti

PSYCHOTHERAPISTS SUPPORTING TREATMENTS IN THE EXPERIMENTAL ARM:

Chiara Acerbi, Daniele Aquilino, Silvia Azzali, Luca Bensi, Sarah Bissoli, Davide Cappellari, Elisa Casana,
Nadia Campagnola, Elisa Dal Corso, Elisabetta Di Micco, Erika Gobbi, Laura Ferri, Erika Gobbi, Laura
Mairaghi, Sara Malak, Luca Mesiano, Federica Paterlini, Michela Perini, Elena Maria Puliti, Rosaria Rispoli,
Elisabetta Rizzo, Chiara Sergenti, Manuela Soave, Elisabetta Di Micco, Rosaria Rispoli.

EXPERTS SUPERVISING TREATMENTS IN THE EXPRERIMENTAL ARM:

Andrea Alpi, Laura Bislenghi, Tiziana Bolis, Francesca Colnaghi, Simona Fascendini, Silvia Grignani, Anna
Meneghelli, Giovanni Patelli.

SPECIFIC TOPICS RESEARCH UNITS:

RESEARCH UNIT Life Events Firenze - Coordinator: Carlo Faravelli
Coordinating Centre: Silvia Casale
Administrative Leading Institution: University of Florence

RESEARCH UNIT Communications Skills - Coordinator: Christa Zimmermann

5
Coordinating Centre: Giuseppe Deledda, Claudia Goss, Mariangela Mazzi, Michela Rimondini.
Administrative Leading Institution: University of Verona

RESEARCH UNIT Genetics-IRCCS, FBF Brescia Coordinator: Massimo Gennarelli

Coordinating Centre: Catia Scassellati, Cristian Bonvicini, Sara Longo
 Administrative Leading Institution: IRCCS Centro S.Giovanni di Dio Fatebenefratelli, Brescia

RESEARCH UNIT Neu ropsicopha rmacology-I RCCS, FBF Brescia Coordinator: Luisella Bocchio Chiavetto
Coordinating Centre: Roberta Zanardini
Administrative Leading Institution: IRCCS Centro S.Giovanni di Dio Fatebenefratelli, Brescia

RESEARCH UNIT Molecular Biology, AFaR, FBF, Roma Coordinator: Mariacarla Ventriglia

Coordinating Centre: Rosanna Squitti

Administrative Leading Institution: Department of Neuroscience, AFaR-Fatebenefratelli Hospital, Rome,

Italy

RESEARCH UNIT LENITEM - IRCCS, FBF Brescia Coordinator: Giovanni Frisoni

Coordinating Centre: Michela Pievani

Administrative Leading Institution: IRCCS Centro S.Giovanni di Dio Fatebenefratelli, Brescia

RESEARCH UNIT RUBIN, Udine-Verona Coordinator: Matteo Balestrieri

Coordinating Centre: Paolo Brambilla, Cinzia Perlini, Veronica Marinelli, Marcella Bellani, Gianluca
Rambaldelli, Alessandra Bertoldo, Paolo Carpeggiani, Alberto Beltramello, Franco Alessandrini,
Francesca Pizzini, Giada Zoccatelli, Maurizio Sberna, Angela Konze
Administrative Leading Institution: DISM, Universit di Udine, Udine (Signora Marina Dorligh)

RESEARCH UNIT STRESS, University of Pavia Coordinator: Pierluigi Politi

Coordinating Centre: Enzo Emanuele, Natascia Brondino.

RESEARCH UNIT Neuroimmunologiy-IRCCS S. Raffaele, Milano Coordinator: Gianvito Martino

Coordinating Centre: Alessandra Bergami e Roberto Zarbo

RESEARCH UNIT Animal Models, Univ. Milano Coordinator: Marco Andrea Riva

Coordinating Centre: Fabio Fumagalli, Raffaella Molteni, Francesca Calabrese, Gianluigi Guidotti,
AlessiaLuoni, Flavia Macchi.

INDEPENDENT EVALUATORS AND RESEARCHERS SUPPORTING THE ONSITE DATA COLLECTION :

Stefania Artioli, Marco Baldetti, Milena Bizzocchi, Donatella Bolzon, Elisa Bonello, Giorgia Cacciari, Claudia
Carraresi, MTeresa Cascio, Gabriele Caselli, Karin Furlato, Sara Garlassi, Alessandro Gavarini, Silvia
Lunardi, Fabio Macchetti, Valentina Marteddu, Giorgia Plebiscita, Sara Poli, Stefano Totaro.

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BJP2017, 211:151-156.
Access the most recent version at DOI: 10.1192/bjp.bp.116.194019

Supplementary material can be found at:

http://bjp.rcpsych.org/content/suppl/2017/07/17/bjp.bp.116.194019.DC1

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http://bjp.rcpsych.org/content/211/3/151#BIBL
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