The pattern of development of psychotic symptoms after trauma

Abstract

Background and Aims:Psychotic symptoms may develop after traumatic experiences. This is documented in Wartime situations. Childhood Abuse is linked with psychosis in later life. PTSD, and ‘Borderline’ symptoms are often linked with a past history of childhood trauma.We hypothesise that the development of psychotic symptoms related to trauma may occur in a different pattern than the development of psychosis of neuro-developmental origin [schizophrenia].Methods:We present a series of Vigniettes, all of whom have developed psychosis. Three have experienced major trauma, in Early Adulthood, Two have experienced a major trauma related to a war situation., and two, have developed psychotic illness of a neuro-developmental type [schizophrenia].Results:As expected, the cases of neuro-developmental psychosis developed psychosis over a long prodromal period, in which symptoms developed from non-specific depression and anxiety to a gradual increase of positive psychotic symptoms over time, until full psychosis developed.The five cases where psycho-trauma occurred in adulthood [including the two wartime cases and the three other cases] showed sudden development of symptoms at the time of the trauma including PTSD and borderline symptoms. The psychotic symptoms developed, also suddenly, some time later, after a subsequent episode of psycho-trauma.Conclusion:These different patterns of development of psychotic symptoms suggest different mechanisms of causation. Nonetheless, in all these cases, a full blown psychotic illness may result. In cases of psycho-trauma, the illness may continue to be accompanied by ongoing symptoms of PTSD and Borderline features, making these patients difficult to treat.