Lu Weili, Mueser Kim T, Rosenberg Stanley D, Yanos Philip T, Mahmoud Neisrein
Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Scotch Plains, NJ, United States.
Center for Psychiatric Rehabilitation, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States.
Front Psychiatry. 2017 Jul 19;8:129. doi: 10.3389/fpsyt.2017.00129. eCollection 2017.
The current study aimed to evaluate the potentially traumatic aspects of psychotic symptoms and psychiatric treatment of psychosis using qualitative methods. Participants included 63 people with first episode psychosis or multiple psychotic episodes recruited from an inpatient psychiatric unit and an urban state psychiatric hospital in the North East region of the United States. Quasi-structured interviews were used to explore those aspects of symptoms and treatment that were perceived as traumatic Emotional reactions to the most traumatic aspect of symptoms and treatment, during and after the event, were also examined. Participants described a number of traumatogenic aspects of psychotic symptoms, including frightening hallucinations; suicidal thought/attempts, thoughts/attempts to hurt others; paranoia/delusions and bizarre/disorganized behavior or catatonia. Traumatic aspects of psychosis elicited emotions including anger, sadness and confusion, anxiety, and numbness at the time of event. Furthermore, many participants found aspects of treatment to be traumatic, including: being forced to stay in the hospital for a long time; experiencing upsetting side-effects; coercive treatments, including involuntary hospitalization, use of restraints, and forced medication; being exposed to aggressive patients; and mistreatment by professionals. These experiences elicited emotions of anger, sadness, distrust, and a sense of helplessness. Study findings suggest that the experiences both of psychotic symptoms and psychiatric treatment, potentially traumatic, can be a powerful barrier to engaging people in mental health services and facilitating recovery. Clinical implications were discussed.
本研究旨在运用定性方法评估精神病性症状和精神病治疗中潜在的创伤性方面。参与者包括63名患有首次发作精神病或多次精神病发作的患者，他们是从美国东北部地区的一家住院精神科病房和一家城市州立精神病医院招募而来的。采用半结构化访谈来探究那些被视为创伤性的症状和治疗方面。还考察了事件期间及之后对症状和治疗中最具创伤性方面的情绪反应。参与者描述了精神病性症状的一些致创伤性方面，包括令人恐惧的幻觉、自杀想法/企图、伤害他人的想法/企图、偏执/妄想以及怪异/紊乱行为或紧张症。精神病的创伤性方面在事件发生时引发了包括愤怒、悲伤、困惑、焦虑和麻木在内的情绪。此外，许多参与者发现治疗的一些方面具有创伤性，包括：被迫长时间住院；经历令人不适的副作用；强制性治疗，包括非自愿住院、使用约束措施和强制用药；接触有攻击性的患者；以及受到专业人员的虐待。这些经历引发了愤怒、悲伤、不信任和无助感。研究结果表明，精神病性症状和精神病治疗的经历都可能具有创伤性，这可能成为人们参与心理健康服务和促进康复的强大障碍。文中讨论了临床意义。
