Department of Psychiatry, Dartmouth Medical School, Hanover, NH, USA.
Schizophr Res. 2010 Feb;116(2-3):217-27. doi: 10.1016/j.schres.2009.10.025. Epub 2009 Nov 24.
Clinical investigators have argued that the experience of a recent onset of psychosis is an event of such severity that it can lead to posttraumatic stress disorder (PTSD), or at least to PTSD symptoms. The traumagenic elements of the psychotic experience may relate to the distressing nature of psychotic symptoms, components of treatment, or both. However, this hypotheses has not been fully empirically evaluated. In particular, the importance of the DSM-IV A1 (perception of threat) and A2 (negative emotion at time of event) criteria for a traumatic event due to a psychotic episode has not been assessed. To address this question, 38 clients in treatment for recent onset of psychosis were interviewed to identify distressing experiences related to the episode, with PTSD assessed (including A1/A2 criteria) related to those events. More than one-half of the participants reported intense distress related to psychotic symptoms or treatment experiences, with 66% meeting symptom criteria for the PTSD syndrome (regardless of A1/A2), and 39% meeting full diagnostic criteria for PTSD (including A1/A2). Both participants with the PTSD syndrome and full PTSD reported more problems in daily functioning and more severe symptoms than those without PTSD. Participants with the PTSD syndrome were also more likely to have an integrative rather than sealing over coping style compared to those without the PTSD syndrome. The results suggest that individuals with PTSD symptoms related to a recent onset of psychosis may benefit from intervention designed to help them integrate their experience into their lives and address potentially stigmatizing beliefs that could contribute to distress and impaired functioning.
临床研究人员认为，最近出现的精神病症状是一种非常严重的事件，可能导致创伤后应激障碍（PTSD），或者至少会出现 PTSD 症状。精神病体验的创伤因素可能与精神病症状的痛苦性质、治疗的组成部分或两者都有关。然而，这一假设尚未得到充分的实证评估。特别是，精神病发作引起的创伤性事件的 DSM-IV A1（感知威胁）和 A2（事件发生时的负面情绪）标准的重要性尚未得到评估。为了解决这个问题，对 38 名正在接受近期精神病发作治疗的患者进行了访谈，以确定与发作相关的痛苦经历，并评估与这些事件相关的 PTSD（包括 A1/A2 标准）。超过一半的参与者报告与精神病症状或治疗经历相关的强烈痛苦，66%的参与者符合 PTSD 综合征的症状标准（无论 A1/A2 标准如何），39%的参与者符合 PTSD 的完整诊断标准（包括 A1/A2）。患有 PTSD 综合征和完整 PTSD 的参与者在日常生活功能方面的问题和更严重的症状都比没有 PTSD 的参与者多。与没有 PTSD 综合征的参与者相比，患有 PTSD 综合征的参与者更有可能采用整合而不是封闭的应对方式。研究结果表明，与近期精神病发作相关的 PTSD 症状的个体可能会受益于旨在帮助他们将其经历融入生活并解决可能导致痛苦和功能受损的潜在污名化信念的干预措施。
