David P G van den Berg1, Paul A J M de Bont2, Berber M van der Vleugel3, Carlijn de Roos4, Ad de Jongh5, Agnes van Minnen6, Mark van der Gaag7. 1. Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN Den Haag, The Netherlands; d.vandenberg@parnassia.nl. 2. Mental Health Organization (MHO) GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer, The Netherlands; 3. Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; 4. MHO Rivierduinen, Leiden, The Netherlands; 5. Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands; School of Health Sciences, Salford University, Manchester, UK; 6. Behavioural Science Institute, NijCare, Radboud University Nijmegen, Nijmegen, The Netherlands; MHO Pro Persona, Centre for Anxiety Disorders Overwaal, Nijmegen, The Netherlands; 7. Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN Den Haag, The Netherlands; Department of Clinical Psychology, VU University Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
Abstract
OBJECTIVES: Most clinicians refrain from trauma treatment for patients with psychosis because they fear symptom exacerbation and relapse. This study examined the negative side effects of trauma-focused (TF) treatment in patients with psychosis and posttraumatic stress disorder (PTSD). METHODS: Analyses were conducted on data from a single-blind randomized controlled trial comparing TF treatment (N = 108; 8 sessions prolonged exposure or eye movement desensitization) and waiting list (WL; N = 47) among patients with a lifetime psychotic disorder and current chronic PTSD. Symptom exacerbation, adverse events, and revictimization were assessed posttreatment and at 6-month follow-up. Also investigated were symptom exacerbation after initiation of TF treatment and the relationship between symptom exacerbation and dropout. RESULTS: Any symptom exacerbation (PTSD, paranoia, or depression) tended to occur more frequently in the WL condition. After the first TF treatment session, PTSD symptom exacerbation was uncommon. There was no increase of hallucinations, dissociation, or suicidality during the first 2 sessions. Paranoia decreased significantly during this period. Dropout was not associated with symptom exacerbation. Compared with the WL condition, fewer persons in the TF treatment condition reported an adverse event (OR = 0.48, P = .032). Surprisingly, participants receiving TF treatment were significantly less likely to be revictimized (OR = 0.40, P = .035). CONCLUSIONS: In these participants, TF treatment did not result in symptom exacerbation or adverse events. Moreover, TF treatment was associated with significantly less exacerbation, less adverse events, and reduced revictimization compared with the WL condition. This suggests that conventional TF treatment protocols can be safely used in patients with psychosis without negative side effects.
RCT Entities:
OBJECTIVES: Most clinicians refrain from trauma treatment for patients with psychosis because they fear symptom exacerbation and relapse. This study examined the negative side effects of trauma-focused (TF) treatment in patients with psychosis and posttraumatic stress disorder (PTSD). METHODS: Analyses were conducted on data from a single-blind randomized controlled trial comparing TF treatment (N = 108; 8 sessions prolonged exposure or eye movement desensitization) and waiting list (WL; N = 47) among patients with a lifetime psychotic disorder and current chronic PTSD. Symptom exacerbation, adverse events, and revictimization were assessed posttreatment and at 6-month follow-up. Also investigated were symptom exacerbation after initiation of TF treatment and the relationship between symptom exacerbation and dropout. RESULTS: Any symptom exacerbation (PTSD, paranoia, or depression) tended to occur more frequently in the WL condition. After the first TF treatment session, PTSD symptom exacerbation was uncommon. There was no increase of hallucinations, dissociation, or suicidality during the first 2 sessions. Paranoia decreased significantly during this period. Dropout was not associated with symptom exacerbation. Compared with the WL condition, fewer persons in the TF treatment condition reported an adverse event (OR = 0.48, P = .032). Surprisingly, participants receiving TF treatment were significantly less likely to be revictimized (OR = 0.40, P = .035). CONCLUSIONS: In these participants, TF treatment did not result in symptom exacerbation or adverse events. Moreover, TF treatment was associated with significantly less exacerbation, less adverse events, and reduced revictimization compared with the WL condition. This suggests that conventional TF treatment protocols can be safely used in patients with psychosis without negative side effects.
Authors: Amélie M Achim; Michel Maziade; Eric Raymond; David Olivier; Chantal Mérette; Marc-André Roy Journal: Schizophr Bull Date: 2009-12-03 Impact factor: 9.306
Authors: M Alexandra Kredlow; Kristin L Szuhany; Stephen Lo; Haiyi Xie; Jennifer D Gottlieb; Stanley D Rosenberg; Kim T Mueser Journal: Psychiatry Res Date: 2017-01-04 Impact factor: 3.222
Authors: Lauren C Ng; Liana J Petruzzi; M Claire Greene; Kim T Mueser; Christina P C Borba; David C Henderson Journal: J Nerv Ment Dis Date: 2016-08 Impact factor: 2.254
Authors: Jaël S van Bentum; Marit Sijbrandij; Marcus J H Huibers; Annemiek Huisman; Arnoud Arntz; Emily A Holmes; Ad J F M Kerkhof Journal: Int J Environ Res Public Health Date: 2017-06-30 Impact factor: 3.390
Authors: Maria B A Niemantsverdriet; Christina W Slotema; Jan Dirk Blom; Ingmar H Franken; Hans W Hoek; Iris E C Sommer; Mark van der Gaag Journal: Sci Rep Date: 2017-10-24 Impact factor: 4.379
Authors: David P G van den Berg; Berber M van der Vleugel; Paul A J M de Bont; Gwen Thijssen; Carlijn de Roos; Rianne de Kleine; Tamar Kraan; Helga Ising; Ad de Jongh; Agnes van Minnen; Mark van der Gaag Journal: Eur J Psychotraumatol Date: 2016-09-06