Abstract
BackgroundPsychosis can be a sufficiently traumatic event to lead to post-traumatic stress disorder (PTSD). Previous research has focussed on the trauma of first episode psychosis (FEP) and the only review to date of PTSD beyond the first episode period was not systematic and is potentially outdated.MethodsWe searched electronic databases and reference lists using predetermined inclusion criteria to retrieve studies that reported prevalence rates and associated factors of psychosis-related PTSD across all stages of the course of psychosis. Studies were included if they measured PTSD specifically related to the experience of psychosis. Risk of bias was assessed using an adapted version of the Newcastle Ottawa Scale. Results were synthesised narratively.ResultsSix papers met inclusion criteria. Prevalence estimates of psychosis-related PTSD varied from 14 to 47%. Studies either assessed first-episode samples or did not specify the number of episodes experienced. Depression was consistently associated with psychosis-related PTSD. Other potential associations included treatment-related factors, psychosis severity, childhood trauma, and individual psychosocial reactions to trauma.ConclusionsPsychosis-related PTSD is a common problem in people with psychosis. There is a lack of published research on this beyond first episode psychosis. Further research is needed on larger, more generalizable samples. Our results tentatively suggest that prevalence rates of psychosis-related PTSD have not reduced over the past decade despite ambitions to provide trauma-informed care.Prospero registration number: CRD42019138750.
Highlights
Psychosis can be a sufficiently traumatic event to lead to post-traumatic stress disorder (PTSD)
Seven papers were assessed as eligible; one paper was excluded during data extraction as the PTSD prevalence included cases of PTSD from non-psychosisrelated events
In our narrative synthesis we examined differences in the conceptualisation, definition and assessment of psychosis-related PTSD between the included studies and it is likely that these factors can provide some explanation for variations in prevalence rates across all three reviews [20]
Summary
Psychosis can be a sufficiently traumatic event to lead to post-traumatic stress disorder (PTSD). Previous research has focussed on the trauma of first episode psychosis (FEP) and the only review to date of PTSD beyond the first episode period was not systematic and is potentially outdated. The experience of psychotic symptoms such as distressing hallucinations or persecutory delusions, and associated treatment responses, including involuntary hospitalisation, Psychosis-related PTSD can be difficult to detect. Many symptoms of psychosis and PTSD share similarities [5] and people with psychosis are often not assessed for trauma disorders [6]. Research has suggested that those with comorbid PTSD and psychosis have more severe positive symptoms, independent of other factors [9]
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