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Review
. 2019 Jan 10:88:265-275.
doi: 10.1016/j.pnpbp.2018.08.001. Epub 2018 Aug 6.

Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges

Ebele Compean  1 , Mark Hamner  2
Affiliations
Review

Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges

Ebele Compean et al. Prog Neuropsychopharmacol Biol Psychiatry. .

Abstract

Trauma exposure leads to various psychiatric disorders including depression, anxiety, bipolar disorders, personality disorders, psychotic disorders, and trauma related disorders, especially posttraumatic stress disorder (PTSD). There are some overlapping symptoms of both PTSD and psychosis that make diagnosis challenging. Despite this overlap, the evidence of PTSD with comorbid psychosis as a distinct entity lies in the research showing biologic, genetic and treatment management differences between psychotic PTSD, non-psychotic PTSD, psychotic disorders and healthy controls. There is emerging evidence that PTSD with secondary psychotic features (PTSD-SP) might be a discrete entity of PTSD with known risk factors that increase its prevalence. This review has presented evidence for individuals with PTSD-SP being distinct in genetics and neurobiological factors. Individuals with PTSD and comorbid psychosis can benefit from evidence based psychotherapy (EBT). There is not enough evidence to recommend second generation antipsychotics (SGA) for PTSD-SP given that risperidone and quetiapine are the only SGAs studied in randomized controlled trials. Hence, developing an operational diagnostic criteria and treatment framework for clinical and research use is critical.

Keywords: Antipsychotics; Genetics; PTSD; Phenomenology; Psychosis.

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Figures

Figure 1.
Figure 1.
Proposed Diagnostic Criterion for PTSD with Secondary Psychotic Features (PTSD-SP)
Figure 2.
Figure 2.. Diagnostic and Management Framework for PTSD-SP
To facilitate clinical decisions and research, the illustration provides guidance in identifying, diagnosing and treating PTSD-SP. PCL-5: PTSD Checklist for DSM-5; BPRS: Brief Psychiatric Rating Scales; PANSS: Positive and Negative Syndrome Scale; C-RDPSS: Clinician-Rated Dimensions of Psychosis Symptom Severity; BDI-II: Beck Depression Inventory version 2; BAI: Beck Anxiety Inventory; SCID-5: Structured Clinical Interview for DSM-5; MINI: Mini-International Neuropsychiatric Interview; CAPS: Clinician Administrated PTSD Scale; HTQ: Harvard Trauma Questionnaire; HAM-D: Hamilton Depression Rating Scale; HAM-A: Hamilton Anxiety Rating Scale; CGI: Clinician Global Impressions; DES: Dissociative Experience Scale
See this image and copyright information in PMC

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