Alicia Picken

The subjective consequences of suffering a first episode psychosis: trauma and suicide behaviour

BackgroundThe subjective impact of a psychotic breakdown can be profound, potentially resulting in loss of social roles, hopes and aspirations and leading to stigmatisation, trauma and elevated suicide risk. This study aimed to assess the subjective effect and consequences of suffering a first episode of psychosis. It was hypothesised that suicide behaviour would be associated with the negative consequences of psychosis and co-morbid symptomatic-PTSD.MethodsPatients were assessed by means of a semi-structured interview on their reactions and experience of their psychotic episode and its treatment and by means of standardised methods for psychotic (PANSS) and trauma-related (CAPS) symptoms.ResultsA total of 35 patients suffering their first episode of psychosis were interviewed. As a result of the onset of their illness, 77% indicated they had suffered loss or disruption to their life, 60% had thwarted future aspirations, 38% had suffered violence or harassment, 53% had suffered stigma and 50% social exclusion. Totally, 80% felt they had been traumatised by their treatment and 38% were cases for symptomatic-PTSD. Symptomatic-PTSD was significantly associated with involuntary hospitalisation but not psychotic symptoms. Positive psychotic symptoms were associated with harassment, stigma and social exclusion. Suicidal ideation was reported by 40% and 31% reported attempting suicide. Suicidal behaviour was greater in those suffering symptomatic-PTSD but this was not significant, suicidal behaviour was significantly associated with the experience of trauma, but not the severity of that trauma, prior to the onset of their psychosis.ConclusionsThe negative consequences of a psychotic episode are significant. The potential iatrogenic effect of psychiatric care needs to be considered. Interventions need to be developed to reduce traumatisation and suicide risk.

Traumatic events, posttraumatic stress disorder, attachment style, and working alliance in a sample of people with psychosis.

There is a high incidence of trauma and posttraumatic stress disorder (PTSD) in people with a diagnosis of psychosis. Sequelae of trauma may affect the ability to engage in both attachment and therapeutic relationships. This study investigated associations between trauma histories, PTSD, attachment styles, and working alliance in a sample of 110 individuals with psychosis and substance misuse. Anxious attachment was associated with number of interpersonal traumas and PTSD reported, but there were no associations between trauma and alliance. There were discrepancies in number of traumatic events reported by care coordinators and patients. The findings of this study highlight the potential use of attachment theory in working with trauma and PTSD in psychosis.

Co-morbid PTSD and suicidality in individuals with schizophrenia and substance and alcohol abuse

BackgroundSuicide risk is high in schizophrenic patients and is further elevated in dual diagnosis patients. Suicide behaviour is a continuum from ideation, plans to attempts. Exposure to traumatic stress and co-morbid PTSD is elevated in schizophrenic patients. Suicide behaviour is also common in non-psychotic PTSD patients. This study aimed to investigate the effect of trauma and co-morbid PTSD on suicide behaviour in dual diagnosis patients and whether co-morbid PTSD would further elevate suicide risk.MethodThis was a cross-sectional study in which suicide behaviour was compared in those with and without co-morbid PTSD in 110 patients suffering schizophrenia and alcohol and/or substance abuse.Results100 (91%) reported at least one traumatic event with an average of 4.3 events. 31 (28%) patients met criteria for full PTSD. Current suicidal ideation was reported by 39 (35%) and 23 (21%) reported plans and ideation, 69 (63%) reported at least one previous suicide attempt. Suicide behaviour was significantly associated with an increasing number of traumatic events. Suicidality was significantly associated and elevated with co-morbid PTSD. Analysis indicated that the effect of trauma on suicide behaviour appeared to be mediated by hopelessness.ConclusionsSuicide behaviour was not associated with exposure to trauma per se but was associated with incremental exposure to traumatic experiences. Consistent with the study hypotheses, co-morbid PTSD further adds to the risk of suicide behaviour in an already vulnerable group.

Trauma and comorbid posttraumatic stress disorder in individuals with schizophrenia and substance abuse

OBJECTIVES The aim of this study was to investigate the occurrence of trauma and comorbid posttraumatic stress disorder (PTSD) in dual diagnosis patients and whether the trauma was related to the patients behavior or illness. METHOD One hundred ten patients with schizophrenia and comorbid substance or alcohol abuse were assessed for PTSD using self-report and structured interview. Traumatic events were classified as independent or dependent upon the patients behavior, illness, or symptoms. RESULTS One hundred patients (91%) reported at least 1 trauma (mean, 4.3). Sixty-three patients (57%) reported a traumatic event that met modified-criterion A for PTSD. Thirty-one patients (28%) met criteria for full PTSD, and 18 (16%) had a trauma directly related to their illness. Patients with PTSD had significantly higher scores on positive psychotic symptoms and depression. CONCLUSIONS Exposures to traumatic events and comorbid PTSD are high but are inflated by reactions to illness-related events such as hospitalization and psychotic symptoms.