Psychiatric Unit, Odense University Hospital, Svendborg, Denmark.
Department of Psychology, University of Southern Denmark, Odense, Denmark.
Clin Psychol Psychother. 2024 Jul-Aug;31(4):e3027. doi: 10.1002/cpp.3027.
Trauma is a significant risk factor for developing psychosis. Nevertheless, psychosis is often considered grounds for not receiving trauma-focused therapy due to concerns of exacerbating psychotic symptoms. Prolonged exposure (PE) is a recognized and effective evidence-based therapy modality for the treatment of severe trauma.
To assess the available empirical evidence for PE as a feasible treatment programme for posttraumatic stress disorder (PTSD) in patients with psychotic symptoms.
A systematic literature search was conducted using the databases Scopus, PsycINFO (OVID) and PubMed MEDLINE in December 2023 with a priori defined eligibility criteria. The literature search identified 1226 articles, of which eight met the eligibility criteria. Five studies exploring the effects of PE treatment on patients diagnosed with PTSD and suffering from comorbid psychotic experiences were included. Three studies containing follow-up data or secondary analysis on PTSD and psychotic symptoms from original studies fulfilling the inclusion and exclusion criteria were included. Each study was assessed for quality to estimate the risk of bias.
Acknowledging the scarcity of available evidence, the results of the scoping review indicate that PE may be an effective treatment approach for reducing PTSD symptoms in patients with PTSD and comorbid psychotic symptoms. The reviewed studies found no iatrogenic effects, including no increase in psychotic symptoms.
PE appears to be a possibly effective PTSD treatment for patients suffering from PTSD and comorbid psychotic symptoms or disorders. However, the evidence is scarce, and larger confirmative trials are required for more conclusive evidence.
创伤是发展为精神病的一个重要危险因素。然而，由于担心加重精神病症状，精神病通常被认为是不接受创伤聚焦治疗的理由。延长暴露（PE）是一种公认的、有效的循证治疗模式，可用于治疗严重创伤。
评估 PE 作为一种可行的治疗方案，用于治疗有精神病症状的创伤后应激障碍（PTSD）患者的现有实证证据。
2023 年 12 月，使用 Scopus、PsycINFO（OVID）和 PubMed MEDLINE 数据库进行了系统的文献搜索，并使用预先定义的合格标准进行了筛选。文献搜索共确定了 1226 篇文章，其中 8 篇符合入选标准。有 5 项研究探讨了 PE 治疗对诊断为 PTSD 且伴有共病精神病体验的患者的影响。有 3 项研究包含了来自符合纳入和排除标准的原始研究的 PTSD 和精神病症状的随访数据或二次分析。对每一项研究进行质量评估，以评估偏倚风险。
鉴于现有证据的稀缺性，范围综述的结果表明，PE 可能是一种有效的治疗方法，可以减少 PTSD 患者共病精神病症状的 PTSD 症状。综述研究发现没有医源性影响，包括精神病症状没有增加。
PE 似乎是一种可能有效的 PTSD 治疗方法，适用于患有 PTSD 和共病精神病症状或障碍的患者。然而，证据稀缺，需要更大规模的验证性试验来提供更确凿的证据。
