Kayrouz Rony, Vrklevski Lila Petar
Provisionally Registered Psychologist, Sydney Local Health District, Concord Centre for Mental Health, Concord, NSWCentre For Emotional Health, Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, NSW, Australia
Principal Psychologist, Director of Psychology for Sydney Local Health District (SLHD), Professional Senior Psychology SLHD Mental Health Service, Head of Department Psychology, Concord Centre for Mental Health, Sydney, NSWDoctoral Candidate, School of Business and Management, University of Tasmania, Hobart, TAS, Australia.
Australas Psychiatry. 2015 Feb;23(1):54-8. doi: 10.1177/1039856214563850. Epub 2014 Dec 15.
This paper presents the case of a forensic inpatient who was found 'Not Guilty by Reason of Mental Illness' for the murder of his mother and illustrates how psychotic symptoms can mask trauma symptoms, leading to neglect in the treatment of trauma in psychotherapy with forensic inpatients.
A case study of a forensic inpatient diagnosed with schizophrenia that as part of his rehabilitation program received 19 sessions of therapy (i.e. grief counselling, Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and imagery rescripting). The following measures were administered pre- and post-treatment: (a) The Depression Anxiety Stress Scale (DASS), to measure symptoms of depression, anxiety and stress; (b) The Impact of Events Scale-Revised (IES-R), to measure post-traumatic stress symptoms; and (c) The Trauma Attachment and Beliefs Scale (TABS), to measure disruption in beliefs about self and others.
At completion of therapy, he showed a reduction in Post-Traumatic Stress Disorder (PTSD), depression, anxiety and stress symptoms.
Trauma and PTSD-related symptoms in the forensic inpatient population must be assessed and treated alongside psychotic symptoms, where relevant. TF-CBT was effective in reducing PTSD symptoms in this current case study and should be considered as an intervention in forensic inpatient populations.
本文介绍了一名法医住院患者的案例，该患者因谋杀其母亲而被判定“因精神疾病无罪”，并说明了精神病症状如何掩盖创伤症状，导致在对法医住院患者的心理治疗中忽视创伤治疗。
对一名被诊断为精神分裂症的法医住院患者进行案例研究，作为其康复计划的一部分，该患者接受了19次治疗（即悲伤辅导、创伤聚焦认知行为疗法（TF-CBT）和意象改写）。在治疗前后进行了以下测量：（a）抑郁焦虑压力量表（DASS），用于测量抑郁、焦虑和压力症状；（b）事件影响量表修订版（IES-R），用于测量创伤后应激症状；（c）创伤依恋和信念量表（TABS），用于测量对自我和他人信念的破坏。
治疗结束时，他的创伤后应激障碍（PTSD）、抑郁、焦虑和压力症状有所减轻。
在相关情况下，法医住院患者群体中的创伤和与PTSD相关的症状必须与精神病症状一起进行评估和治疗。在本案例研究中，TF-CBT在减轻PTSD症状方面有效，应被视为法医住院患者群体的一种干预措施。
