Abstract
BackgroundPatients with a first episode psychosis (FEP) who are admitted for the first time to a psychiatric hospital frequently have experienced prior psychological trauma. Additionally, 40–80% develop posttraumatic stress symptoms, which are summarized as a post-psychotic post-traumatic syndrome (PPS). Eye Movement Desensitization and reprocessing (EMDR) therapy could be an effective psychotherapy to treat a PPS and prior psychological traumas in this population.ObjectivesTo assess if EMDR therapy leads to: 1) a reduction of relapses after intervention, 2) an improvement of trauma-related, psychotic and affective symptoms, 3) an improvement of overall functioning, and 4) an improvement in quality of life.MethodsThis is a multicenter phase II rater-blinded randomized controlled trial in which 80 FEP patients with a history of psychological trauma will be randomly assigned to EMDR (n = 40) or to TAU (n = 40). Traumatic events will be measured by the Global Assessment of Posttraumatic Stress Questionnaire, the Cumulative Trauma Screening, the Impact of Event Scale-Revised, the Dissociative Experiences Scale, the Childhood Trauma Scale, the Holmes–Rahe Life Stress Inventory, and the Dissociative Experiences Questionnaire. Clinical symptomatology will be evaluated using the Suicide and Drug Consumption module of the International Neuropsychiatric Interview, Structured Clinical Interview for Positive and Negative Syndrome Scale, Young’s Scale for Mania Evaluation, and Beck Depression II Questionnaire. Functionality will be assessed with the Global Assessment of Functioning and the Quality of Life with the Standardized Instrument developed by the EuroQol Group. The cognitive insight and adherence to the treatment will be assessed with the Beck Cognitive Insight Scale and the Drug Attitude Inventory. All variables will be measured at baseline, post-treatment and at 12-month follow-up.ConclusionThis study will provide evidence of whether EMDR therapy is effective in reducing trauma and clinical symptoms, reducing relapses and in improving functionality and quality of life in patients with FEP and a history of trauma.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03991377
Highlights
Outcomes in patients with schizophrenia spectrum disorders and bipolar disorder have remained suboptimal [1, 2]
The results for specific early interventions in early phase psychosis are more effective than treatment as usual [65], but usually do not include assessment and treatment of the presence of comorbid prior or current psychological trauma
Patients with psychosis have a high prevalence of psychological trauma during their lifetime which has an important negative impact on the course and prognosis of the disease [3]
Summary
Outcomes in patients with schizophrenia spectrum disorders and bipolar disorder have remained suboptimal [1, 2]. A range of issues are potentially traumatic for FEP patients, from the experience of suffering psychotic symptoms, such as auditory hallucinations involving hearing voices, persecutory delusions or disorganized behavior, to the experience of being admitted to a psychiatric unit for the first time. This experience can involve involuntary hospitalizations and/or drug treatment, or other restrictive measures such as mechanical restraints, and is an important risk factor for traumatization [10], and is associated with feelings of anger, sadness, distrust or impotence. Eye Movement Desensitization and reprocessing (EMDR) therapy could be an effective psychotherapy to treat a PPS and prior psychological traumas in this population
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