Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges

Abstract

Trauma exposure leads to various psychiatric disorders including depression, anxiety, bipolar disorders, personality disorders, psychotic disorders, and trauma related disorders, especially posttraumatic stress disorder (PTSD). There are some overlapping symptoms of both PTSD and psychosis that make diagnosis challenging. Despite this overlap, the evidence of PTSD with comorbid psychosis as a distinct entity lies in the research showing biologic, genetic and treatment management differences between psychotic PTSD, non-psychotic PTSD, psychotic disorders and healthy controls. There is emerging evidence that PTSD with secondary psychotic features (PTSD-SP) might be a discrete entity of PTSD with known risk factors that increase its prevalence. This review has presented evidence for individuals with PTSD-SP being distinct in genetics and neurobiological factors. Individuals with PTSD and comorbid psychosis can benefit from evidence based psychotherapy (EBT). There is not enough evidence to recommend second generation antipsychotics (SGA) for PTSD-SP given that risperidone and quetiapine are the only SGAs studied in randomized controlled trials. Hence, developing an operational diagnostic criteria and treatment framework for clinical and research use is critical.

Associations of neural processing of reward with posttraumatic stress disorder and secondary psychotic symptoms in trauma-affected refugees

“…While 15-64% of veterans with PTSD from Western countries have been reported to have PTSD-SP (David, Kutcher, Jackson, & Mellman, 1999;Kaštelan et al, 2007;Kozarić-Kovačić & Borovečki, 2005), a prevalence of 41% was found in a recent study among trauma-affected refugees with PTSD (Nygaard, Sonne, & Carlsson, 2017). It is still unclear whether PTSD-SP is related to a complex or chronic form of PTSD or indicative of severe PTSD (Compean & Hamner, 2019) and the diagnostic concept is not recognized in current nosological systems.…”

“…PTSD is a diagnosis characterized by intrusive thoughts, avoidance, negative mood, and cognitive alterations, as well as arousal and reactivity in response to a psychologically traumatic experience (DSM-5) (APA, 2013). Secondary psychotic symptoms (PTSD-SP) may occur, and suggested criteria include, among others, that PTSD symptoms precede the onset of psychotic symptoms and that the criteria for another psychotic psychiatric condition are not met (Compean & Hamner, 2019). Estimates of PTSD-SP varies across studies, possibly reflecting variations in the PTSD-SP criteria.…”

“…To identify PTSD-SP participants, we adhered to the research criteria for PTSD-SP proposed by Compean & Hamner (2019). These include a score of minimum moderate (>3) on at least one positive item on the Positive and Negative Syndrome Scale (PANSS) (Kay, Flszbeln, & Qpjer, 1987).…”

“…These include a score of minimum moderate (>3) on at least one positive item on the Positive and Negative Syndrome Scale (PANSS) (Kay, Flszbeln, & Qpjer, 1987). The criteria also include that the participant has preserved reality testing, that the psychotic symptoms are not limited to flashbacks, that PTSD symptoms precede the psychotic symptoms, and that the participants do not meet the criteria for another psychiatric diagnosis with psychotic features (Compean & Hamner, 2019). All participants with psychotic symptoms were evaluated by a second psychiatrist to assure the exclusion of participants with primary psychotic disorders.…”

The Role of Therapeutic Landscape in Improving Mental Health of People with PTSD

“…Trauma exposure leads to various psychiatric disorders including depression, anxiety, bipolar disorders, personality disorders, psychotic disorders, and traumarelated disorders, especially post-traumatic stress disorder [3]. Post-traumatic stress disorder is classified in the new class of traumatic and stress disorder [4].…”