Psychotic symptoms in combat-related post-traumatic stress disorder.
ABSTRACT The presence of psychotic symptoms in post-traumatic stress disorder (PTSD) has already been recognized. Using the Structured Clinical Interview Diagnostic and Statistical Manual, we searched for and assessed psychotic symptoms in 91 males suffering from combat-related PTSD. Hallucinations and delusions were present in 20% of patients. We divided all patients into three groups: the group with hallucinations and delusions, the group without these symptoms, and the group with "subthreshold" psychotic symptoms. Using the Harvard Trauma Questionnaire, Clinician-Administered PTSD Scale, and Structured Clinical Interview Diagnostic and Statistical Manual, we investigated differences between groups in the intensity of traumatization, severity of PTSD symptoms, and the frequency of depression. There were no significant differences between groups; however, there was one exception: severity of hyperarousal symptoms was positively correlated with occurrence of psychotic symptoms.
Journal of clinical psychopharmacology 08/2013; DOI:10.1097/JCP.0b013e3182a11622 · 5.09 Impact Factor
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ABSTRACT: Depression with psychotic features afflicts a substantial number of people and has been characterized by significantly greater impairment, higher levels of dysfunctional beliefs, and poorer response to psychopharmacologic and psychosocial interventions than nonpsychotic depression. Those with psychotic depression also experience a host of co-occurring disorders, including posttraumatic stress disorder (PTSD), which is not surprising given the established relationships between trauma exposure and increased rates of psychosis and between PTSD and major depression. To date, there has been very limited research on the psychosocial treatment of psychotic depression; and even less is known about those who also suffer from PTSD. The purpose of this study was to better understand the rates and clinical correlates of psychotic depression in those with PTSD. Clinical and symptom characteristics of 20 individuals with psychotic depression and 46 with nonpsychotic depression, all with PTSD, were compared before receiving cognitive-behavioral therapy for PTSD treatment or treatment as usual. Patients with psychotic depression exhibited significantly higher levels of depression and anxiety, a weaker perceived therapeutic alliance with their case managers, more exposure to traumatic events, and more negative beliefs related to their traumatic experiences, as well as increased levels of maladaptive cognitions about themselves and the world, compared with participants without psychosis. Implications for cognitive-behavioral therapy treatment aimed at dysfunctional thinking for this population are discussed.Comprehensive psychiatry 01/2011; 52(1):41-9. DOI:10.1016/j.comppsych.2010.04.012 · 2.08 Impact Factor
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ABSTRACT: Evidence is accumulating that borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) ares related to small hippocampal and amygdala size, and to impaired cognition. We report results from several recent empirical studies on female BPD patients with childhood abuse and PTSD and female BPD patients with childhood abuse and a dissociative disorder (dissociative amnesia, DA, or dissociative identity disorder, DID). BPD patients with PTSD presented with small hippocampal and amygdala size and impaired cognition. However, BPD patients with DA or DID showed normal hippocampal and amygdala size, and normal cognition. Further investigation into the structure of superior parietal cortices, being crucial for psychological processes regarding the self, yielded increased superior parietal cortex volumes in BPD patients with DA or DID, but not PTSD. It may be concluded that high-level dissociation may protect the brain from stress-related deteriorating influences on hippocampus and amygdala. On the other hand, it may be possible that trauma-exposed persons with pre-existing small hippocampal and amygdala size are at risk for developing PTSD, but not DA or DID. Furthermore, it may be speculated that high-level dissociation during childhood makes an unusual or abnormal superior parietal cortex development more likely. Abnormal superior parietal cortex size may in turn lead to chronic and dominant dissociative behaviors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)