Psychotic Features in Chronic Posttraumatic Stress Disorder and Schizophrenia

Abstract

Psychotic features are frequent in combat veterans with chronic posttraumatic stress disorder (PTSD), may correlate with severity of PTSD symptoms, and may reflect a distinct subtype of the disorder. These psychotic features include auditory and visual hallucinations and delusional thinking that is usually paranoid in nature. Psychotic features may be under-recognized in chronic PTSD because patients are reluctant to report these symptoms and because they may not have overt changes in affect or bizarre delusions characteristic of other psychoses, e.g., schizophrenia. To further assess these phenomena, we compared clinical ratings on the Positive and Negative Syndrome Scale (PANSS) and other assessments, including the Clinical Global Impression Scale and the Structured Clinical Interview with Psychotic Screen, in veterans meeting DSM-IV criteria for chronic PTSD with well-defined comorbid psychotic features (N = 40) or chronic schizophrenia (N = 40). The patients with schizophrenia had modestly higher composite PANSS scores and positive symptom scores although average scores in both groups were moderate to severe in intensity. Negative symptom and general psychopathology subscale scores were comparable in both groups. Regarding specific positive symptoms, hallucinations were comparable between groups in severity; however, schizophrenia patients had slightly more intense delusions and conceptual disorganization. These data further validate the occurrence of positive as well as negative symptoms of psychosis in chronic PTSD in a range of severity that may approach that of patients with schizophrenia. Although meeting DSM-IV criteria for two different major psychiatric disorders, these two patient populations were remarkably similar with respect to not only positive but also negative symptoms.

Dimensions of Psychosis in Patients with Bipolar Mania as Measured by the Positive and Negative Syndrome Scale

“…The scale has since become a widely used symptom assessment tool that is used to measure symptoms of psychosis in studies of schizophrenia, but also schizoaffective disorder [19] , bipolar disorder [12,13] , dementia [20] , post-traumatic stress disorder [21] , and obsessive compulsive disorder [22] .…”

Psychotic Symptoms in an Urban General Medicine Practice

“…Third, no information was available on the rate of posttraumatic stress disorder. This disorder is common in low-income primary care populations (36) and is often complicated with psychotic symptoms (37,38), an association that appears to be higher among Hispanic than nonHispanic clinical samples (39,40). Information was also not available concerning histrionic personality disorder, which may contribute to psychotic response tendencies (41).…”

Decreased integrity of the fronto-temporal fibers of the left inferior occipito-frontal fasciculus associated with auditory verbal hallucinations in schizophrenia

“…To characterize the phenomenology of PTSD-AVH we drew on the three largest detailed studies of this phenomenon we were aware of (Scott et al, 2007, N = 20;Anketell et al, 2010, N = 20;Brewin and Patel, 2010, N = 30). In one instance where a notable aspect of the phenomenology of AVH was described in the PTSD-AVH studies but not SZ-AVH (and vice versa for another aspect of AVH phenomenology), we drew on smaller studies to gather information about this property of AVH (Kent and Wahass, 1996;Hamner et al, 2000). The resultant comparisons are shown in Table 1.…”

“…This was done with 100 people who heard voices (80% of who had received a (Anketell et al, 2010;Brewin and Patel, 2010) Present, more common than pleasant voices (Nayani and David, 1996;Corstens and Longden, 2013;McCarthy-Jones et al, 2014) Pleasant voices Present, but less common than negative voices (Anketell et al, 2010;Brewin and Patel, 2010) Present, but less common than negative voices (Nayani and David, 1996;Corstens and Longden, 2013;McCarthy-Jones et al, 2014) Voices issue commands? Yes (Scott et al, 2007;Anketell et al, 2010) Y e s ( Nayani and David, 1996;Corstens and Longden, 2013;McCarthy-Jones et al, 2014) Commands to hurt self Yes (Anketell et al, 2010) Y e s ( Kent and Wahass, 1996) Link to trauma Only 40% linked voices to earlier traumas (Anketell et al, 2010) Some but not all linked to trauma (Hardy et al, 2005;Corstens and Longden, 2013) Location Mostly internally located, but some external and some in both locations (Scott et al, 2007;Anketell et al, 2010) Approximately equal mix between internal, external, and both ( Unclear voices In addition to clear content, may include "garbled voices" (Hamner et al, 2000) In addition to clear content, may include "nonsense voices" (McCarthy-Jones et al, 2014) Experienced as manifestation of own thoughts Present in some (Brewin and Patel, 2010) Present in some (McCarthy-Jones et al, 2014) Gender Voices are mainly male (Brewin and Patel, 2010) Voices are mainly male (Corstens and Longden, 2013;McCarthy-Jones et al, 2014) Identity of voice Most recognized as being that of person known in the real world to the hearer (Anketell et al, 2010;…”