Perceptions of clinicians treating young people with first-episode psychosis for post-traumatic stress disorder

Abstract

Aim: Evidence shows that approximately half of young people with first-episode psychosis have post-traumatic stress disorder. Yet, post-traumatic stress disorder is often left untreated in the presence of psychosis. To support the development of a post-traumatic stress disorder intervention for young people with first-episode psychosis, clinicians' perceptions of trauma-focused interventions were sought. Two research questions were explored: What treatment barriers were associated with treating young people with first-episode psychosis? What supports would be useful to implement post-traumatic stress disorder intervention?

Methods: A mixed-methods design incorporated quantitative and qualitative data from a questionnaire with qualitative data from two focus groups. Sixteen (of 20) case managers from an early psychosis intervention centre participated in the study (16 completed a questionnaire, eight participated in focus groups). Descriptive statistics were generated for quantitative data and qualitative material was examined using a grounded theory approach.

Results: The results showed that perceived barriers to delivering trauma-focused intervention were increased mental health risks for clients with psychosis, workload pressures and poor client engagement. Targeted training and formal professional guidance were thought to best scaffold an intervention.

Conclusions: Post-traumatic stress disorder intervention for first-episode psychosis clients should address engagement, make safeguarded provisions for family involvement and be sufficiently paced and flexible. Trauma-focused intervention is perceived with a degree of caution, is often not prioritized, lacks institutional support and requires more targeted training. It is important to conduct further research regarding the safety of trauma interventions alongside psychosis in order to address widespread concerns.

Keywords: first-episode psychosis; post-traumatic; psychotic disorder; stress disorder.