Swan Sarah, Keen Nadine, Reynolds Nicola, Onwumere Juliana
South London and Maudsley NHS Foundation Trust London, UK.
South London and Maudsley NHS Foundation TrustLondon, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondon, UK.
Front Psychol. 2017 Mar 14;8:341. doi: 10.3389/fpsyg.2017.00341. eCollection 2017.
Individuals with severe mental health problems, such as psychosis, are consistently shown to have experienced high levels of past traumatic events. They are also at an increased risk of further traumatisation through victimization events such as crime and assault. The experience of psychosis itself and psychiatric hospitalization have also been recognized to be sufficiently traumatic to lead to the development of post-traumatic stress (PTS) symptoms. Rates of post-traumatic stress disorder (PTSD) are elevated in people with psychosis compared to the general population. The current guidance for the treatment of PTSD is informed by an evidence base predominately limited to populations without co-morbid psychiatric disorders. The systematic review therefore sought to present the current available literature on the use of psychological treatments targeting PTS symptoms in a population with a primary diagnosis of a psychotic disorder. The review aimed to investigate the effect of these interventions on PTS symptoms and also the effect on secondary domains such as psychotic symptoms, affect and functioning. Fifteen studies were identified reporting on cognitive behavior therapy, prolonged exposure, eye movement desensitisation and reprocessing and written emotional disclosure. The review provides preliminary support for the safe use of trauma-focused psychological interventions in groups of people with severe mental health problems. Overall, the interventions were found to be effective in reducing PTS symptoms. Results were mixed with regard to secondary effects on additional domains. Further research including studies employing sufficiently powered methodologically rigorous designs is indicated.
患有严重心理健康问题（如精神病）的个体，一直被证明经历过高水平的过往创伤事件。他们还因犯罪和袭击等受害事件而面临更高的再次受创伤风险。精神病发作本身以及精神病住院治疗的经历也被认为具有足够的创伤性，会导致创伤后应激（PTS）症状的出现。与普通人群相比，患有精神病的人创伤后应激障碍（PTSD）的发病率更高。目前针对PTSD的治疗指南主要依据的是仅限于没有共病精神疾病人群的证据。因此，这项系统评价旨在呈现目前关于在原发性诊断为精神障碍的人群中使用针对PTS症状的心理治疗方法的现有文献。该评价旨在研究这些干预措施对PTS症状的影响，以及对诸如精神病症状、情感和功能等次要领域的影响。共确定了15项关于认知行为疗法、延长暴露疗法、眼动脱敏再处理疗法和书面情绪宣泄的研究报告。该评价为在患有严重心理健康问题的人群中安全使用以创伤为重点的心理干预措施提供了初步支持。总体而言，这些干预措施被发现对减轻PTS症状有效。关于对其他领域的次要影响，结果喜忧参半。表明需要进一步开展研究，包括采用方法严谨、样本量充足的设计的研究。
