Korean Journal of Biological Psychiatry (생물정신의학)

The Korean Society of Biological Psychiatry (대한생물정신의학회)
권호 표지

Comorbidity of Posttraumatic Stress Disorder and Its Effect on Treatment Outcomes in Patients with Schizophrenia : One-Year Prospective Follow-Up Study

외상 후 스트레스 장애 동반 여부에 따른 정신분열병 환자의 임상증상과 치료효과의 비교 : 1년간의 전향적 추적연구

  • Park, Sung-Jong (Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital) ;
  • Kim, Nam Hee (Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital) ;
  • Jeong, Jae-Yeol (Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital) ;
  • Lee, Sunny (Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital)
  • 박성종 (서울특별시 은평병원 정신과) ;
  • 김남희 (서울특별시 은평병원 정신과) ;
  • 정재열 (서울특별시 은평병원 정신과) ;
  • 이선이 (서울특별시 은평병원 정신과)
  • Published : 2009.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives : The aims of this study were to assess a) the prevalence of trauma and posttraumatic stress disorder(PTSD) in schizophrenic patients and b) the differences in symptomatology and outcome after 1year treatment between those with and without PTSD. Methods : Twenty eight schizophrenia and schizoaffective disorder patients completed the Positive and Negative Syndrome Scale(PANSS), Life Stressor Checklist-Revised(LSCL-R), Clinician-Administered PTSD Scale(CAPS), Dissociative Experiences Scale(DES), Hamilton Psychiatry Rating Scale for Depression(HAM-D), and Rosenberg Self-Esteem Scale(RSE). Results : Twenty six patients(92.9%) had at least one trauma in their life time. Eleven patients(39.3%) were diagnosed with PTSD. PTSD group had significantly higher scores on HAM-D and DES but lower scores on RSE. PTSD group also had significantly lower score in the baseline PANSS Negative score. Higher CAPS scores were significantly correlated with lower baseline PANSS Negative score and greater change after 1year of PANSS Negative score. Conclusion : These results showed that the prevalences of trauma and PTSD are high in schizophrenic patients and suggested that PTSD and trauma-related symptoms affected the symptomatology and treatment outcome. More research is warranted to better understand the effects of PTSD in schizophrenic patients.

Keywords

References

  1. Lysaker PH, Davis LW, Gatton MJ, Herman SM. Associations of anxiety-related symptoms with reported history of childhood sexual abuse in schizophrenia spectrum disorders. J Clin Psychiatry 2005;66:1279-1284. https://doi.org/10.4088/JCP.v66n1010
  2. Gearon JS, Kaltman SI, Brown C, Bellack AS. Traumatic life events and PTSD among women with substance use disorders and schizophrenia. Psychiatr Serv 2003;54:523-528. https://doi.org/10.1176/appi.ps.54.4.523
  3. Resnick SG, Bond GR, Mueser KT. Trauma and posttraumatic stress disorder in people with schizophrenia. J Abnorm Psychol 2003;112:415-423. https://doi.org/10.1037/0021-843X.112.3.415
  4. Bebbington PE, Bhugra D, Brugha T, Singleton N, Farrell M, Jenkins R, et al. Psychosis, victimization and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity. Br J Psychiatry 2004;185:220-226. https://doi.org/10.1192/bjp.185.3.220
  5. Lysaker PH, Beattie NL, Strasburger AM, Davis LW. Reported history of child sexual abuse in schizophrenia: associations with heightened symptom levels and poorer participations over four months in vocational rehabilitation. J Nerv Ment Dis 2005;193:790-795. https://doi.org/10.1097/01.nmd.0000188970.11916.76
  6. Garno JL, Goldberg JF, Ramirez PM, Ritzler BA. Impact of childhood abuse on the clinical course of bipolar disorder. Br J Psychiatry 2005;186:121-125. https://doi.org/10.1192/bjp.186.2.121
  7. Neria Y, Bromet EJ, Carlson GA, Naz B. Assaultive trauma and illness course in psychotic bipolar disorder: findings from the Suffolk county mental health project. Acta Psychiatr Scand 2005;111:380-383. https://doi.org/10.1111/j.1600-0447.2005.00530.x
  8. Neria Y, Bromet EJ, Sievers S, Lavelle J, Fochtmann LJ. Trauma exposure and posttraumatic stress disorder in psychosis: findings from a first-admission cohort. J Consult Clin Psychol 2002;70:246-251. https://doi.org/10.1037/0022-006X.70.1.246
  9. Kim D, Choi SK, Lee GW, Lee K, Nam J. Prevalence of traumatic events and posttraumatic stress disorder among inpatients with schizophrenia. J Korean Neuropsychiatr Assoc 2006;45:214-221.
  10. Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 1998;55: 626-632. https://doi.org/10.1001/archpsyc.55.7.626
  11. Fan X, Henderson DC, Nguyen DD, Cather C, Freudenreich O, Evins AE, et al. Posttraumatic stress disorder, cognitive function and quality of life in patients with schizophrenia. Psychiatry Res 2008;159:140-146. https://doi.org/10.1016/j.psychres.2007.10.012
  12. Spauwen J, Krabbendam L, Lieb R, Wittchen HV, van Os J. Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness. Br J Psychiatry 2006;188:527-533. https://doi.org/10.1192/bjp.bp.105.011346
  13. Ross CA, Anderson G, Clark P. Childhood abuse and the positive symptoms of schizophrenia. Hosp Community Psychiatry 1994;45:489-491.
  14. Lysaker PH, Meyer P, Evans JD, Marks KA. Neurocognitive and symptom correlates of self-reported childhood sexual abuse in schizophrenia spectrum disorders. Ann Clin Psychiatry 2001;13:89-92. https://doi.org/10.3109/10401230109148953
  15. Schafer I, Harfst T, Aderhold V, Briken P, Lehmann M, Moritz S, et al. Childhood trauma and dissociation in female patients with schizophrenia spectrum disorders: an exploratory study. J Nerv Ment Dis 2006;194:135-138. https://doi.org/10.1097/01.nmd.0000198199.57512.84
  16. Vogel M, Spitzer C, Barnow S, Freyberger HJ, Grabe HJ. The role of trauma and PTSD-related symptoms for dissociation and psychopathological distress in inpatients with schizophrenia. Psychopathology 2006;39:236-242. https://doi.org/10.1159/000093924
  17. Harrison CL, Fowler D. Negative symptoms, trauma, and autobiographical memory: an investigation of individuals recovering from psychosis. J Nerv Ment Dis 2004;192:745-753. https://doi.org/10.1097/01.nmd.0000144693.12282.11
  18. Scheller-Gilkey G, Thomas SM, Woolwine BJ, Miller AH. Increased early life stress and depressive symptoms in patients with comorbid substance abuse and schizophrenia. Schizophr Bull 2002;28:223-231. https://doi.org/10.1093/oxfordjournals.schbul.a006933
  19. Spence W, Mulholland C, Lynch G, McHugh S, Dempster M, Shannon C. Rates of childhood trauma in a sample of patients with schizophrenia as compared with a sample of patients with nonpsychotic psychiatric diagnoses. J Trauma Dissociation 2006;7:7-22.
  20. Calhoun PS, Bosworth HB, Stechuchak KA, Strauss J, Butterfield MI. The impact of posttraumatic stress disorder on quality of life and health service utilization among veterans who have schizophrenia. Trauma Stress 2006;19:393-397. https://doi.org/10.1002/jts.20114
  21. Mueser KT, Essock SM, Haines M, Wolfe R, Xie H. Posttraumatic stress disorder, supported employment, and outcomes in people with severe mental illness. CNS Spectr 2004;9:913-925. https://doi.org/10.1017/S1092852900009779
  22. Assion HJ, Brune N, Schmidt N, Aubel T, Edel MA, Basilowski M, et al. Trauma exposure and post-traumatic stress disorder in bipolar disorder. Soc Psychiatry Psychiatr Epidemiol;2009.
  23. Hahn OS, Ahn JH, Song SH, Cho MJ, Kim JK, Bae JN, et al. Development of Korean Version of Structured Clinical Interview Schedule for DSM-IV Axis I Disorder: Interrater Reliability. J Korean Neuropsychiatr Assoc 2000;39:362-372.
  24. Yi JS, Ahn YM, Shin HK, An SK, Joo YH, Kim SH, et al. Reliability and Validity of the Korean Version of the Positive and Negative Syndrome Scale. J Korean Neuropsychiatr Assoc 2001;40:1090-1105.
  25. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a Clinician-Administered PTSD Scale. J Trauma Stress 1995;8:75-90. https://doi.org/10.1002/jts.2490080106
  26. Lee BY, Kim Y, Yi SM, Eun HJ, Kim DI, Kim JY. A Reliability and Validity Study of A Clinician Administered PTSD Scale. J Korean Neuropsychiatr Assoc 1999;38:514-522.
  27. Wolfe J, Kimerling R. Gender issues in the assessment of Posttraumatic Stress Disorder: Assessing psychological trauma and PTSD. New York: Guilford;1997. p.192-238.
  28. Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986;174:727-735. https://doi.org/10.1097/00005053-198612000-00004
  29. Park JM, Choe BM, Kim MJ, Hahn HM, Yoo SY, Kim SH, et al. Standardization of Dissociative Experiences Scale - Korean Version. Kor J Psychopathol 1995;4:105-125.
  30. Yi JS, Bae SO, Ahn YM, Park DB, Noh KS, Shin HK, et al. Validity and Reliability of the Korean Version of the Hamilton Depression Rating Scale(K-HDRS). J Korean Neuropsychiatr Assoc 2005;44:456-465.
  31. Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University;1965.
  32. Jon BJ. Self-esteem: a test of its measurability. Yonsei Journal 1974;11:107-130.
  33. Mueser KT, Goodman LB, Trumbetta SL, Rosenberg SD, Osher C, Vivader R, et al. Trauma and posttraumatic stress disorder in severe mental illness. J Consult Clin Psychol 1998;66:493-499. https://doi.org/10.1037/0022-006X.66.3.493
  34. Conus P, Cotton S, Schimmelmann BG, McGorry PD, Lambert M. Pretreatment and Outcome Correlates of Sexual and Physical Trauma in an Epidemiological Cohort of First-Episode Psychosis Patients. Schizophr Bull;2009.
  35. Eun HJ, Lee SM, Kim TH. The epidemiological study of posttraumatic stress disorder in an urban area. J Korean Neuropsychiatr Assoc 2001;40:581-591.
  36. McGorry PD, Chanen A, McCarthy E, Van Riel R, McKenzie D, Singh BS. Posttraumatic stress disorder following recent-onset psychosis. An unrecognized postpsychotic syndrome. J Nerv Ment Dis 1991;179:253-258. https://doi.org/10.1097/00005053-199105000-00002
  37. Howgego IM, Owen C, Meldrum L, Yellowlees P, Dark F, Parslow R. Posttraumatic stress dis-order: an exploratory study examining rates of trauma and PTSD and its effect on client outcomes in community mental health. BMC Psychiatry 2005;26:5-21.
  38. Meyer H, Taiminen T, Vuori T, Aijala A, Helenius H. Posttraumatic stress disorder symptoms related to psychosis and acute involuntary hospitalization in schizophrenic and delusional patients. J Nerv Ment Dis 1999;187:343-352. https://doi.org/10.1097/00005053-199906000-00003