The trauma of first episode psychosis: the role of cognitive mediation

Abstract

The results call into question whether it is possible to make claims for a simple causal link between psychosis and PTSD. Instead patients' appraisals of potentially traumatic events and their coping styles may mediate the traumatic impact of a first episode of psychosis.

Family interventions in early psychosis: specificity and effectiveness

“…The literature suggests that the first 5 years constitute a critical period for treatment and outcomes (Birchwood, Todd & Jackson, 1998;Lieberman & Fenton, 2000). We know, for example, there are high levels of trauma, depression and anxiety in people presenting to early psychosis services (Koreen et al 1993;Birchwood, Spencer & McGovern, 2000;Birchwood, 2003;Mueser & Rosenberg, 2003;Jackson et al 2004). Suicide levels are elevated in psychosis, but particularly so in the early illness years (Caldwell & Gottesman, 1990;Robinson et al 2010).…”

Trauma, posttraumatic stress disorder and psychosis: etiopatho­genic and nosological implications

“…Concerning the first factor, there are partially consistent findings to establish a positive relationship between presence or severity of positive symptoms and PTSD 82,85,87,88 . As for the kind of admission and/or treatment, the association is less conclusive 82,84,85,87 . Together, these data have posed the question of what variables could be modulating the relationship between these variables and PTSD.…”

“…Together, these data have posed the question of what variables could be modulating the relationship between these variables and PTSD. In this sense, current findings suggest that the presence of PTSD in subjects with first psychotic episodes is higher if 1) they have a previous history of trauma, 2) use dysfunctional assessment and coping strategies in front of stress (e.g., experience of uncontrollability), and 3) show comorbid depressive symptoms 4,[82][83][84][88][89][90] .…”

“…On this issue, many studies with clinical samples of subjects with first psychotic episodes showed that the prevalence of PTSD ranges from 11% to 67%, being diagnosed in a third of patients assessed on average 4,[82][83][84][85][86][87][88] . Two variables have been identified as potential precursors of this post-traumatic condition: positive symptoms and the type of psychiatric admission (e.g., voluntary vs. involuntary).…”

The efficacy of psychotherapy in reducing post-psychotic trauma

“…There is no simple cause and effect relationship between psychosis and trauma (Larkin & Morrison, 2006). Rather, there is an array of mediating and moderating variables such as cognitive appraisals coping style and shame proneness that influences the degree to which the experience of psychosis influences PTSD-type symptoms (Jackson et al 2004). Such mediating and moderating variables will ultimately influence the phenomenology, course and treatment of such symptoms.…”