[Trauma and psychosis]

Abstract

Introduction: Since the 1990's a vast amount of research has been done on early traumatic experiences leading to serious psychopathology in adults. At the same time, several researchers started to assume a relationship between posttraumatic stress disorder (PTSD) and psychotic states. Patients suffering from PTSD often experience intrusive flashback memories which at the time seem quite present, real, absorbing and uncontrollable to them. From this point of view they have quite similar experiences as psychotic patients do when experiencing a hallucination. As with psychotic patients, people suffering from PTSD often reduce their outside contacts, become isolated and oversensitive or have nightmares. At the same time, psychotic patients are often traumatized as children, and go through further traumatic experiences during their hallucinations and hospital treatments. Trauma history can often contribute to therapy-resistance. Psychotic patients who suffered an early trauma usually need psychiatric treatment at a younger age, have more severe symptoms and need to be hospitalized more often than those who have not experienced early traumatisation. Our pilot study was designed to find out if there is a comorbidity of PTSD and psychosis in a small sample of hospitalized psychotic patients. We hypothesised that PTSD comorbidity is especially strong in patients with predominantly positive symptoms.

Method: A total of 24 hospitalized patients and 25 controls were assessed using the normal Brief Psychometric Rating Scale (Overall and Gorham, 1962), Scale for Assessment of Negative and Positive Symptoms (Andreasen, 1983, 1984), short version of Paykel's Life Event Scale (1970), Posttraumatic Diagnostic Scale (Foa, 1995), short version of Beck Depression Inventory (1972), short version of Hopelessness Scale (Beck et al, 1974) and SCID II.

Results: A significant comorbidity of PTSD and mainly positive psychotic symptoms was found. Furthermore, the present results showed that psychotic patients with mainly negative symptoms were more likely to be traumatized to a lesser degree.

Conclusions: Exploring trauma-related memories and applying trauma-related intervention can be an important therapeutic tool in certain, therapy-resistant cases of psychotic disorders.