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Letters to the Editor
March 2001

Causes of Posttraumatic Stress Disorder in Psychotic Patients

Arch Gen Psychiatry. 2001;58(3):305-306. doi:

The recognition of posttraumatic stress disorder (PTSD) within psychosis has been suggested to be important; it may avoid inappropriate use of antipsychotic medication, clarify professional understanding, and stimulate the design, implementation, and evaluation of more effective interventions for psychosis1,2; it may also have a beneficial effect on a wide range of problems, including depression, anxiety, substance abuse, and suicide among people with psychosis.3 Despite these important clinical implications, there is little research into the occurrence of PTSD within psychosis. To date, there are only 2 empirical investigations of PTSD within acute psychosis.2,3 One of these found that 52% of their sample (n = 45) qualified for the DSM-III-R diagnosis of PTSD while in the hospital.2 Of the sample (n = 36) in the other study, 46% and 35% qualified for a DSM-III diagnosis of PTSD at 4 and 11 months, respectively, after discharge from the hospital.3 These studies implicated the experience of psychosis and psychiatric hospitalization as precipitating PTSD within psychosis, but did not establish the differential contribution of such stressors. In addition, there is a growing body of literature that is consistent with the view that psychosis may actually be a response to trauma; one recent study found that 98% of a large sample (n = 275) reported exposure to at least 1 traumatic event.4 Therefore, it is likely that there will be various different causes of PTSD within psychosis that fall across the 3 categories of trauma considered above (psychotic symptoms, hospitalization, and other traumas).

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