Article

Schizofrenie en posttraumatische stress-stoornis

Dth 03/2002; 22:15-27. DOI: 10.1007/BF03060274

ABSTRACT

Schizofrenie en posttraumatische stress-stoornis (ptss) komen vaak samen voor. Onderzoeken tonen dat zo'n veertig procent van de patiënten met een psychose eveneens voldoet aan
de diagnose ptss. Een van de redenen is een overlap in symptomen. Een psychoserecidive en een traumatische herbeleving kunnen zich beide kenmerken
door hallucinaties. Negatieve symptomen tonen overeenkomst met de afgestomptheid van de gevoelens bij een chronische ptss. Oorzaak en gevolg zijn hier moeilijk te onderscheiden. Een secundaire ptss na een psychotische episode bij schizofrenie kan optreden door zowel de verschrikkingen van de psychose, als door de onbegrepen
gewelddadige bejegening door politie, hulpverleners of anderen. Een chronisch psychotisch beeld kan ook secundair zijn aan
een ernstige traumatisering. Ten slotte zien we vaak dat beide aandoeningen tegelijk voorkomen. Mensen met de kwetsbaarheid
voor psychotische ontregelingen zijn eveneens kwetsbaar in de sociale omgang. Zowel voor, tijdens, als na een psychose zijn
deze mensen vaker het slachtoffer van geweld en misbruik. Er ontstaat een vorm van circulaire causaliteit waarbij psychose
en ptss elkaar versterken. Voor de hulpverlening betekent dit dat zij nauwgezet moet diagnosticeren en behandeling van schizofrenie
en ptss moet overwegen. Als een alternatief voor dwang en opsluiting ontbreekt, moet een zorgvuldige begeleiding en uitleg steeds
plaatsvinden.

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