Causes of Posttraumatic Stress Disorder in Psychotic Patients

The recognition of posttraumatic stress disorder (PTSD) within psychosis has been suggested to be important; it may avoid inappropriate use of antipsychotic medication, clarify professional understanding, and stimulate the design, implementation, and evaluation of more effective interventions for psychosis^1- 2; it may also have a beneficial effect on a wide range of problems, including depression, anxiety, substance abuse, and suicide among people with psychosis.³ Despite these important clinical implications, there is little research into the occurrence of PTSD within psychosis. To date, there are only 2 empirical investigations of PTSD within acute psychosis.^2- 3 One of these found that 52% of their sample (n = 45) qualified for the DSM-III-R diagnosis of PTSD while in the hospital.² Of the sample (n = 36) in the other study, 46% and 35% qualified for a DSM-III diagnosis of PTSD at 4 and 11 months, respectively, after discharge from the hospital.³ These studies implicated the experience of psychosis and psychiatric hospitalization as precipitating PTSD within psychosis, but did not establish the differential contribution of such stressors. In addition, there is a growing body of literature that is consistent with the view that psychosis may actually be a response to trauma; one recent study found that 98% of a large sample (n = 275) reported exposure to at least 1 traumatic event.⁴ Therefore, it is likely that there will be various different causes of PTSD within psychosis that fall across the 3 categories of trauma considered above (psychotic symptoms, hospitalization, and other traumas).