Zusammenfassung
In den vergangenen Jahren ist der Zusammenhang von Posttraumatischen Belastungsstörungen (PTBS) und schizophrenen Erkrankungen v. a. unter 3 Aspekten näher beforscht worden: (a) Einmal kann PTBS als Folge der Erfahrung psychotischer Positivsymptome und von ungünstigen Behandlungserfahrungen auftreten. (b) Weiter kann sich eine PTBS als Vulnerabilitätsfaktor für Ausbruch und Rückfall schizophrener Erkrankungen auswirken. (c) Schließlich kann sich eine PTBS als Chronifizierungsfaktor schizophrener Symptome auswirken; die mit PTBS assoziierte Meidung der Auseinandersetzung mit erkrankungsbezogenen oder biografischen traumatisierenden Erfahrungen begünstigt einen auf Leugnung der Erkrankung ausgerichteten „Sealing over”-Stil der Krankheitsverarbeitung; hierdurch kann eine PTBS damit indirekt zu unzureichender Compliance und Inanspruchnahme psychiatrischer Hilfsangebote sowie zur Entwicklung sekundärer Suchterkrankungen und Depressionen beitragen. Vorhandene empirische Befunde zu diesen Aspekten werden zusammengefasst, ihre methodischen Schwächen diskutiert, einschließlich der Kontroverse um eine Erweiterung des DSM IV A1-Trauma-Kriteriums und die möglichen Implikationen für (Früh-)Diagnostik, Therapie und Verlauf konkretisiert, um künftige Forschung anzuregen.
Abstract
More recently research has focused on post-traumatic stress disorder (PTSD) as comorbide condition of schizophrenia. Current literature focussing the relationship between PTSD and schizophrenia is reviewed. Evidence is found in support of psychosis as a precondition for development of PTSD, PTSD as vulnerability factor for psychosis as well as psychosis and PTSD both as part of a spectrum of responses to a traumatic event. PTSD may be regarded as risk factor for worse outcome in schizophrenia: Internal stress of reexperiencing the trauma may enhance vulnerability to relapse of illness and proneness to anxiety avoiding coping style with psychosis by adoption of a “sealing over” style, lowering service utilization and compliance. Risk for development of alcohol misuse, cannabis misuse or benzodiazepine misuse and depression may be higher, also worsening the course of schizophrenia. Methodological shortcomings of current studies, ongoing debates on extending DSM-IV criterion A1 definition to psychotic or treatment experiences and implications for clinical assessment and cognitive-behavioural treatment of PTSD in schizophrenia are discussed.
Schlüsselwörter
Posttraumatische Belastungsstörung - Schizophrenie - Ersterkrankung - Trauma - Behandlung - Compliance - Epidemiologie - Kognitive Verhaltenstherapie - A-Kriterium
Key words
schizophrenia - Post Traumatic Stress Disorder - PTSD - recovery - psychosocial adaptation - first episode psychosis - compliance - cognitive-behaviour therapy - criterion A1
Literatur
-
1
Arenz D, Dudova K, Traxler S, Sieg J.
[Post-traumatic stress disorder and delusions. A case report].
Psychiatr Prax.
2000;
27 (8)
412-413
-
2
Seedat S, Stein M B, Oosthuizen P P, Emsley R A, Stein D J.
Linking Posttraumatic Stress Disorder and Psychosis: A Look at Epidemiology, Phenomenology, and Treatment.
Journal of Nervous & Mental Disease.
2003;
191
675-681
-
3
Sautter F J, Brailey K, Uddo M M, Hamilton M F, Beard M G, Borges A H.
PTSD and comorbide psychotic disorder: Comprehension with veterans diagnosed with PTSD or psychotic disorder.
Journal of Traumatic Stress.
1999;
12
73-88
-
4
Frueh B C, Hamner M B.
Apparent symptom overreporting in combat veterans evaluated for PTSD.
Clinical Psychology Review.
2000;
20
853-885
-
5
Hamner M B, Frueh B C, Ulmer H G, Huber M G, Twomey T J, Tyson C, Arana G W.
Psychotic features in chronic posttraumatic stress disorder and schizophrenia: comparative severity.
J Nerv Ment Dis.
2000;
188 (4)
217-221
-
6
Stein M B, Walker J, Hazen A L, Forde D R.
Full and partial posttraumatic stress disorder. Findings from a community survey.
Am J Psychiatry.
1997;
154
1114-1119
-
7
Resnick S G, Bond G R, Mueser K T.
Trauma and posttraumatic stress disorder in people with schizophrenia.
J Abnorm Psychol.
2003;
112 (3)
415-423
-
8
Cascardi M, Mueser K T, DeGiralomo J, Murrin M.
Physical aggression against psychiatric inpatients by family members and partners.
Psychiatric Services.
1996;
47
531-533
-
9
Mueser K T, Bond G R, Drake R E, Resnick S G.
Models of community care for severe mental illness: a review of research on case management.
Schizophr Bull.
1998;
24 (1)
37-74
-
10
Switzer G E, Dew M A, Thompson K, Goycoolea J M, Derricott T, Mullins S D.
Posttraumatic stress disorder and service utilization among urban mental health center clients.
Journal of Traumatic Stress.
1999;
12
25-39
-
11
Meyer H, Taiminen T, Vuori T, Aeijaelae A, Helenius H.
Posttraumatic stress disorder symptoms related to psychosis and acute involuntary hospitalization in schizophrenic and delusional patients.
Journal of Nervous & Mental Disease.
1999;
187 (6)
343-352 US: Lippincott Williams and Wilkins
-
12
Braga R J, Mendlowicz M V, Marrocos R P, Figueira I L.
Anxiety disorders in outpatients with schizophrenia: prevalence and impact on the subjective quality of life.
J Psychiatr Res.
2005;
39 (4)
409-414
-
13
Mueser K T, Salyers M P, Rosenberg S D, Goodman L A, Trumbetta S L.
Interpersonal trauma and posttraumatic stress disorder in persons with severe mental illness: Demographic, clinical and health correlates.
Schizophr Bull.
2004;
30 (1)
45-57
-
14
Harrison C L, Fowler D.
Negative symptoms, trauma, and autobiographical memory: an investigation of individuals recovering from psychosis.
J Nerv Ment Dis.
2004;
192 (11)
745-753
-
15
Kennedy B L, Dhaliwal N, Pedley L, Sahner C, Greenberg R, Manshadi M S.
Post-Traumatic Stress Disorder in subjects with schizophrenia and bipolar disorder.
J Ky Med Assoc.
2002;
100 (9)
395-399
-
16
Jackson C, Knott C, Skeate A, Birchwood M.
The trauma of first episode psychosis: the role of cognitive mediation.
Aust N Z J Psychiatry.
2004;
38 (5)
327-333
-
17
Shaw K, McFarlane A C, Bookless C, Air T.
The aetiology of postpsychotic posttraumatic stress disorder following a psychotic episode.
Journal of Traumatic Stress.
2002;
15 (1)
39-47
-
18
Morrison A P, Frame L, Larkin W.
Relationships between trauma and psychosis: a review and integration.
Br J Clin Psychol.
2003;
42 (Pt 4)
331-353
-
19
Bebbington P, Kuipers L.
The clinical utility of expressed emotion in schizophrenia. [Review] [74 refs].
Acta Psychiatr Scand Suppl.
1994;
382
46-53
-
20
Norman R MG, Malla A.
Stressful life events and schizophrenia: I A review of the research.
British Journal of Psychiatry.
1993;
162
161-166
-
21
Goodman L A, Dutton M A, Harris M.
The relationship between violence dimensions and symptom severity among homeless, mentally ill women.
Journal of Traumatic Stress.
1997;
10
51-70
-
22
Mueser K T, Rosenberg S D, Goodman L A, Trumbetta S L.
Trauma, PTSD, and the course of severe mental illness: An interactive model.
Schizophr Res.
2002;
53
123-143
-
23
Bremner D J, Vermetten E.
Stress and development: Behavioral and biological consequences.
Dev Psychopathol.
2001;
1 (3)
473-489
-
24
Brewin C R, Andrews B, Valentine J D.
Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.
Journal of Consulting and Clinical Psychology.
2000;
68
748-766
-
25
Read J, Perry B D, Moskowitz A, Connolly J.
The contribution of early traumatic events to schizophrenia in some patients: a traumagenic neurodevelopmental model.
Psychiatry.
2001;
64 (4)
319-345
-
26
Ryan M C, Sharifi N, Condren R, Thakore J H.
Evidence of basal pituitary-adrenal overactivity in first episode, drug naive patients with schizophrenia.
Psychoneuroendocrinology.
2004;
29 (8)
1065-1070
-
27 Yehuda R. Neuroendocrinology of trauma and posttraumatic stress disorder. Yehuda R. Psychological trauma. Washington, DC: American Psychiatric Press 1998: 97-131
-
28
McFarlane A C.
Avoidance and intrusion in posttraumatic stress disorder.
Journal of Nervous & Mental Disease.
1992;
180
439-445
-
29
Shaw K, McFarlane A, Bookless C.
The phenomenology of traumatic reactions to psychotic illness.
Journal of Nervous & Mental Disease.
1997;
185
434-441 US: Lippincott Williams and Wilkins
-
30
Adams N HS, Hafner J R.
Attitude of patients and their relatives to involuntary treatment.
Australian and New Zealand Journal of Psychiatry.
1991;
25
231-237
-
31
Kane J M, Quitkin F, Rifkin A, Wegner J, Rosenberg G, Borenstein M.
Attitudinal changes of involuntary committed patients following treatment.
Archives of General Psychiatry.
1983;
40
374-377
-
32
Priebe S, Broker M, Gunkel S.
Involuntary admission and posttraumatic stress disorder symptoms in schizophrenia patients.
Compr Psychiatry.
1998;
39 (4)
220-224
-
33
Ehlers A, Clark D M, Hackmann A, McManus F, Fennell M.
Cognitive therapy for post-traumatic stress disorder: development and evaluation.
Behav Res Ther.
2005;
43 (4)
413-431
-
34
Priebe S, Kaiser W, Huxley P J, Roderwanner U U, Rudolf H.
Do different subjective evaluation criteria reflect distinct constructs.
Journal of Nervous & Mental Disease.
1998;
186 (7)
385-392
-
35
Shaner A, Eth S.
Can schizophrenia cause post-traumatic stress disorder?.
American Journal of Psychotherapy.
1989;
43
588-597
-
36
McGorry P, Chanen A, McCarthy E.
Posttraumatic stress disorder following recent onset psychosis: an unrecognized postpsychotic syndrome.
Journal of Nervous and Mental Diseases.
1991;
179
253-258
-
37
Frame L, Morrison A P.
Causes of posttraumatic stress disorder in psychotic patients.
Archives of General Psychiatry.
2001;
58
305-306
-
38
Kessler R C, Sonnega A, Bromet E, Hughes M, Nelson C B.
Posttraumatic stress disorder in the National Comorbidity Survey.
Archives of General Psychiatry.
1995;
52
1048-1060
-
39
Greenfield S F, Strakowski S M, Tohen M, Batson S C, Kolbrener M L.
Childhood abuse in first-episode psychosis.
British Journal of Psychiatry.
1994;
164
831-834
-
40
Ross C A, Anderson G, Clark P.
Childhood abuse and the positive symptoms of schizophrenia.
Hospital & Community Psychiatry.
1994;
45
489-491
-
41
Rusch N, Angermeyer M C, Corrigan P W.
[The stigma of mental illness: concepts, forms, and consequences.].
Psychiatr Prax.
2005;
32 (5)
221-232
-
42
Janssen I, Krabbendam L, Bak M, Hanssen M, Vollebergh W, de Graaf R, Os J van.
Childhood abuse as a risk factor for psychotic experiences.
Acta Psychiatr Scand.
2004;
109 (1)
38-45
-
43
Sautter F J, Barley K, Uddo M M, Hamilton M F, Beard M G, Borges A H.
PTSD and comorbide psychotic disorder: Comparison with veterans diagnosed with PTSD or psychotic disorder.
Journal of Traumatic Stress.
1999;
12
73-88
-
44
Hamner M B, Frueh B C, Ulmer H G, Arana G W.
Psychotic features and illness severity in combat veterans with chronic posttraumatic stress disorder.
Biol Psychiatry.
1999;
45
846-852
-
45
Hamner M B.
Psychotic features and combat-associated PTSD.
Depression and Anxiety.
1997;
5
34-38
-
46
Hamner M B, Frueh B C, Ulmer H G, Huber M G, Twomey T J, Tyson C, Arana G W.
Psychotic features in chronic posttraumatic stress disorder and schizophrenia: Comparative severity.
Journal of Nervous & Mental Disease.
2000;
188
217-221
-
47
Erickson D H, Beiser M, Iacono W G, Fleming J A, Lin T Y.
The role of social relationships in the course of first episode schizophrenia and affective disorders.
Am J Psychiatry.
1989;
146
1456-1461
-
48
Perlick D, Stastny P, Mattis S, Teresi J.
Contribution of family, cognitive and clinical dimensions to longterm-outcome in schizophrenia.
Schizophr Res.
1992;
6 (3)
257-265
-
49
Rajkumar S, Thara R.
Factors affecting relapse in schizophrenia.
Schizophr Res.
1989;
2
403-409
-
50
Strauss B, Carpenter W T.
Prediction of outcome in schizophrenia: III. Five year outcome and its predictors.
Archives of General Psychiatry.
1977;
34
159-163
-
51
Larsen T K, Johannessen J O, Opjordsmoen S.
First-episode schizophrenia with long duration of untreated psychosis. Pathways to care.
Br J Psychiatry Suppl.
1998;
172 (33)
45-52
-
52
Buchanan R W.
Clozapine: efficacy and safety.
Schizophr Bull.
1995;
21 (4)
579-591
-
53
Stampfer H G.
“Negative symptoms”: a cumulative trauma stress disorder?.
Aust N Z J Psychiatry.
1990;
24 (4)
516-528
-
54
Scheller-Gilkey G, Moynes K, Cooper I, Kant C, Miller A H.
Early life stress and PTSD symptoms in patients with comorbid schizophrenia and substance abuse.
Schizophr Res.
2004;
69 (2 - 3)
167-174
-
55
Pitman R K, Delahanty D L.
Conceptually driven pharmacologic approaches to acute trauma.
CNS Spectr.
2005;
10 (2)
99-106
-
56
Turnbull G, Bebbington P.
Anxiety and the schizophrenic process: Clinical and epidemiological evidence.
Social Psychiatry & Psychiatric Epidemiology.
2001;
36
235-243
-
57
Jacobsen L K, Southwick S M, Kosten T R.
Substance use disorders in patients with posttraumatic stress disorder: A review of the literature.
Am J Psychiatry.
2001;
158
1184-1190
-
58
Lysaker P H, Clements C A, Wright D E, Evans J, Marks K A.
Neurocognitive correlates of helplessness, hopelessness, and well-being in schizophrenia.
Journal of Nervous & Mental Disease.
2001;
189 (7)
457-462
-
59
McGlashan T H.
Recovery style from mental illness and long-term outcome.
Journal of Nervous & Mental Disease.
1987;
175 (11)
681-685
-
60
Tait L, Birchwood M, Trower P.
Predicting engagement with services for psychosis: insight, symptoms and recovery style.
Br J Psychiatry.
2003;
182
123-128
-
61
Charney D S, Deutsch A Y, Krystal J H, Southwick S M, Davis M.
Psychobiologic mechanisms of posttraumatic stress disorder.
Archives of General Psychiatry.
1993;
50
294-305
-
62
Hamner M B, Faldowski R A, Ulmer H G, Frueh B C, Huber M G, Arana G W.
Adjunctive risperidone treatment in post-traumatic stress disorder: A preliminary controlled trial of effects on comorbid psychotic symptoms.
International Clinical Psychopharmacology.
2003;
18
1-8
-
63
Hamner M B, Ulmer H G, Faldowski R A, Frueh B C, Twomey T J, Tyson C, Lorberbaum J P, Teneback C C, Huber M G, Arana G W.
A randomized, controlled trial of risperidone for psychotic features in PTSD.
Biol Psychiatry.
2000;
47
158S-159S
-
64
Ahearn E P, Winston E, Mussey M, Howell T.
Atypical antipsychotics, improved intrusive symptoms in patients with posttraumatic stress disorder.
Mil Med.
2003;
168 (9)
x-xi
-
65
Hamner M B.
Clozapine treatment for a veteran with comorbid psychosis and PTSD.
Am J Psychiatry.
1996;
153
841
-
66
Izrayelit L.
Schizoaffective disorder and PTSD successfully treated with olanzapine and supportive psychotherapy.
Psychiatric Annals.
1998;
28
424-426
-
67
Sokolski K N, Denson T F, Lee R T, Reist C.
Quetiapine for treatment of refractory symptoms of combat-related post-traumatic stress disorder.
Mil Med.
2003;
168 (6)
486-489
-
68
Rosenberg S D, Mueser K T, Friedman M J, Gorman P G, Drake R E, Vidaver R M, Torrey W C, Jankowski M K.
Developing effective treatments for posttraumatic disorders among people with severe mental illness.
Psychiatric Services.
2001;
52
1453-1461
-
69
Frueh B C, Buckley T C, Cusack K J, Kimble M O, Grubaugh A L, Turner S M, Keane T M.
Cognitive-behavioral treatment for PTSD among people with severe mental illness: a proposed treatment model.
J Psychiatr Pract.
2004;
10 (1)
26-38
-
70
Herz M I, Lamberti J S, Mintz J, Scott R, O'Dell S P, McCartan L, Nix G.
A program for relapse prevention in schizophrenia: a controlled study.
Archives of General Psychiatry.
2000;
57 (3)
277-283
-
71
Gumley A, O'Grady M, McNay L, Reilly J, Power K, Norrie J.
Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy.
Psychol Med.
2003;
33 (3)
419-431
-
72
Griffin M G, Resick P A, Waldrop A E, Mechanic M B.
Participation in trauma research: is there evidence of harm?.
J Trauma Stress.
2003;
16 (3)
221-227
-
73 Vauth R, Stieglitz R-D. Chronisches Stimmenhören und persistierender Wahn. im Druck Göttingen: Hogrefe 2005
-
74
Green M F, Kern R S, Braff D L, Mintz J.
Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “right stuff”?.
Schizophr Bull.
2000;
26 (1)
119-136
-
75
Gaudiano B A, Herbert J D.
Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: Pilot results.
Behav Res Ther.
2006;
44 (3)
415-437
-
76
Iqbal Z, Birchwood M, Chadwick P, Trower P.
Cognitive approach to depression and suicidal thinking in psychosis. 2. Testing the validity of a social ranking model.
Br J Psychiatry.
2000;
177
522-528
-
77
Jackson C T, Fein D, Essock S M, Mueser K T.
The effects of cognitive impairment and substance abuse on psychiatric hospitalizations.
Community Mental Health Journal.
2001;
37 (4)
303-312
-
78
McNally R J.
Psychological mechanisms in acute response to trauma.
Biol Psychiatry.
2003;
53 (9)
779-788
-
79
Priebe S, Nowak M, Schmiedebach H P.
[Trauma and Psyche in German Psychiatry since 1889].
Psychiatr Prax.
2002;
29 (1)
3-9
-
80
Gold S D, Marx B P, Soler-Baillo J M, Sloan D M.
Is life stress more traumatic than traumatic stress?.
J Anxiety Disord.
2005;
19 (6)
687-698
-
81
Creamer M, McFarlane A C, Burgess P.
Psychopathology following trauma: the role of subjective experience.
J Affect Disord.
2005;
86 (2 -3)
175-182
-
82
Roemer L, Orsillo S M, Borkovec T D, Litz B T.
Emotional response at the time of a potentially traumatizing event and PTSD symptomatology: a preliminary retrospective analysis of the DSM-IV Criterion A-2.
J Behav Ther Exp Psychiatry.
1998;
29 (2)
123-130
-
83
Reynolds M, Mezey G, Chapman M, Wheeler M, Drummond C, Baldacchino A.
Co-morbid post-traumatic stress disorder in a substance misusing clinical population.
Drug Alcohol Depend.
2005;
77 (3)
251-258
-
84
Tennant C.
Psychological trauma: psychiatry and the law in conflict.
Aust N Z J Psychiatry.
2004;
38 (5)
344-347
-
85
Gearon J S, Bellack A S, Tenhula W N.
Preliminary reliability and validity of the Clinician-Administered PTSD Scale for schizophrenia.
J Consult Clin Psychol.
2004;
72 (1)
121-125
-
86
Goodman L A, Thompson K M, Weinfurt K, Corl S, Acker P, Mueser K T, Rosenberg S D.
Reliability of reports of violent victimization and PTSD among men and women with SMI.
Journal of Traumatic Stress.
1999;
12
587-599
-
87
Uddo M, Sautter F J, Pardue L.
Treatment of PTSD with psychotic symptoms.
NC-PTSD Clin Q.
1998;
8
1418
-
88
Bradley R, Greene J, Russ E, Dutra L, Westen D.
A multidimensional meta-analysis of psychotherapy for PTSD.
Am J Psychiatry.
2005;
162 (2)
214-227
PD Dr. med. Dipl.-Psych. Roland Vauth
Psychiatrische Poliklinik des Universitätsspitals Basel
Claragraben 95
CH-4005 Basel, Schweiz
Email: rvauth@uhbs.ch
