The trauma of psychosis: Posttraumatic stress disorder and recent onset psychosis

Mueser, Kim T.; Lu, Weili; Rosenberg, Stanley D.; Wolfe, Rosemarie

doi:10.1016/j.schres.2009.10.025

Cited by 122 publications

(134 citation statements)

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“…Likewise, the co-occurrence of PTSD and psychosis is again associated with more severe psychopathology and reduced treatment adherence (Schenkel et al 2005;Mueser et al 2010). However, childhood trauma may influence treatment outcome via mechanisms that go over and above the presence of PTSD.…”

Section: Implications For Clinical Managementmentioning

confidence: 99%

Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature

Cotter

Kaess

Yung

2014

Ir. j. psychol. Med.

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Objectives. We aimed to examine the association between childhood trauma and functional impairment in psychotic disorders, bipolar disorder and borderline personality disorder, to speculate on possible mechanisms that underlie this association and discuss the implications for clinical work.Methods. Narrative review of the peer-reviewed English language literature in the area.Results. High rates of childhood trauma in psychotic disorders, bipolar disorder and borderline personality disorder were identified. This was associated with impaired social and occupational functioning in both the premorbid and established phases of each of these psychiatric disorders over and above the deficits typically observed in these populations. Possible mechanisms mediating this relationship include neurocognitive deficits, insecure attachment, higher rates of comorbidities and problems with adherence and response to treatment. Conclusions.Routine clinical inquiry about childhood maltreatment should be adopted within mental health settings. This has potentially important treatment implications for identifying those individuals at elevated risk of functional disability. While there is no clear guidance currently available on how to target childhood trauma in the treatment of psychotic disorders, bipolar disorder or borderline personality disorder, there are several promising lines of enquiry and further research is warranted.

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Section: Implications For Clinical Managementmentioning

confidence: 99%

Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature

Cotter

Kaess

Yung

2014

Ir. j. psychol. Med.

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“…Psychosis (behaviours)59.1017. Treatment and hospitalization84.6.62** p < 0.01; ** p < 0.05 a Unable to compute kappa because variables are constant a Green, 1996. b Bernstein et al, 2003. c Mueser et al, 2010. …”

Section: Resultsmentioning

confidence: 99%

“…In addition to the TALE, trauma event exposure was assessed by completing the Trauma History Questionnaire (THQ; Green, 1996), CTQ-SF (Bernstein et al, 2003) and the PATS (Mueser et al, 2010). …”

Section: Methodsmentioning

confidence: 99%

“…Where necessary, scores were converted to the same rating scale to aid validation. Specifically, the CTQ-SF and PATS (Mueser et al, 2010) were collapsed down to dichotomous responses (‘no’ or ‘yes’) to allow for comparison against like items on the TALE. The THQ (Green, 1996) already had a dichotomous scale so no conversions were necessary.…”

Section: Methodsmentioning

confidence: 99%

“…To date, only two measures have been designed to assess trauma in people with psychosis. The PTSD Assessment Tool for Schizophrenia (PATS; Mueser, Lu, Rosenberg, & Wolfe, 2010) assesses lifetime, symptom and treatment-related trauma, but is a semi-structured research interview unsuitable for routine clinical use. The Trauma Experience Checklist (TEC; Cristofaro et al, 2013) is relatively more suitable for clinical practice and was developed to assess abuse, neglect and stressful life events.…”

Section: Introductionmentioning

confidence: 99%

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The Trauma and Life Events (TALE) checklist: development of a tool for improving routine screening in people with psychosis

Carr

Hardy

Fornells-Ambrojo

2018

European Journal of Psychotraumatology

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Background: Best practice guidelines recommend traumatic events should be assessed in psychosis to support the identification and, when indicated, treatment of post-traumatic stress reactions. However, routine assessment in frontline services is rare, and available tools are not tailored to psychosis. Assessment obstacles include lengthy measures, a focus on single, physically threatening events, and the exclusion of psychosis-related traumas. Objective: To develop and validate a brief trauma screening tool for the identification of clinically significant traumas in people with psychosis. Method: The Trauma and Life Events (TALE) checklist was developed in conjunction with people with lived experience of trauma and psychosis, and specialist clinicians and researchers. The psychometric properties (i.e. test-retest reliability, content validity, construct validity) of the TALE were evaluated in a sample of 39 people with psychosis diagnoses. Results: The TALE displayed moderate psychometric acceptability overall, with excellent reliability and convergent validity for sexual abuse. High rates of psychosis-related trauma and childhood adversity were reported, in particular bullying and emotional neglect. A dose–response relationship between cumulative trauma, post-traumatic stress and psychosis was found. Conclusions: The TALE is the first screening tool specifically designed to meet the needs of routine trauma screening in psychosis services. The psychometric limitations highlight the challenge of developing a measure that is both sufficiently brief to be useful in clinical settings and comprehensive enough to identify all relevant adverse events. Validation of the TALE is now required across the spectrum of psychosis.

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Prolonged Exposure vs Eye Movement Desensitization and Reprocessing vs Waiting List for Posttraumatic Stress Disorder in Patients With a Psychotic Disorder

et al. 2015

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The efficacy of posttraumatic stress disorder (PTSD) treatments in psychosis has not been examined in a randomized clinical trial to our knowledge. Psychosis is an exclusion criterion in most PTSD trials. OBJECTIVE To examine the efficacy and safety of prolonged exposure (PE) therapy and eye movement desensitization and reprocessing (EMDR) therapy in patients with psychotic disorders and comorbid PTSD. DESIGN, SETTING, AND PARTICIPANTS A single-blind randomized clinical trial with 3 arms (N = 155), including PE therapy, EMDR therapy, and waiting list (WL) of 13 outpatient mental health services among patients with a lifetime psychotic disorder and current chronic PTSD. Baseline, posttreatment, and 6-month follow-up assessments were made. INTERVENTIONS Participants were randomized to receive 8 weekly 90-minute sessions of PE (n = 53), EMDR (n = 55), or WL (n = 47). Standard protocols were used, and treatment was not preceded by stabilizing psychotherapeutic interventions. MAIN OUTCOMES AND MEASURES Clinician-rated severity of PTSD symptoms, PTSD diagnosis, and full remission (on the Clinician-Administered PTSD Scale) were primary outcomes. Self-reported PTSD symptoms and posttraumatic cognitions were secondary outcomes. RESULTS Data were analyzed as intent to treat with linear mixed models and generalized estimating equations. Participants in the PE and EMDR conditions showed a greater reduction of PTSD symptoms than those in the WL condition. Between-group effect sizes were 0.78 (P < .001) in PE and 0.65 (P = .001) in EMDR. Participants in the PE condition (56.6%; odds ratio [OR], 3.41; P = .006) or the EMDR condition (60.0%; OR, 3.92; P < .001) were significantly more likely to achieve loss of diagnosis during treatment than those in the WL condition (27.7%). Participants in the PE condition (28.3%; OR, 5.79; P = .01), but not those in the EMDR condition (16.4%; OR, 2.87; P = .10), were more likely to gain full remission than those in the WL condition (6.4%). Treatment effects were maintained at the 6-month follow-up in PE and EMDR. Similar results were obtained regarding secondary outcomes. There were no differences in severe adverse events between conditions (2 in PE, 1 in EMDR, and 4 in WL). The PE therapy and EMDR therapy showed no difference in any of the outcomes and no difference in participant dropout (24.5% in PE and 20.0% in EMDR, P = .57). CONCLUSIONS AND RELEVANCE Standard PE and EMDR protocols are effective, safe, and feasible in patients with PTSD and severe psychotic disorders, including current symptoms. A priori exclusion of individuals with psychosis from evidence-based PTSD treatments may not be justifiable. TRIAL REGISTRATION isrctn.com Identifier: ISRCTN79584912

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The trauma of psychosis: Posttraumatic stress disorder and recent onset psychosis

Cited by 122 publications

References 58 publications

Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature

Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature

The Trauma and Life Events (TALE) checklist: development of a tool for improving routine screening in people with psychosis

Prolonged Exposure vs Eye Movement Desensitization and Reprocessing vs Waiting List for Posttraumatic Stress Disorder in Patients With a Psychotic Disorder

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