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The article by Peleikis and colleagues in this issue of Acta Psychiatrica Scandinavica [1] draws attention to the importance of the poorly recognized problem of trauma and post-traumatic stress disorder (PTSD) in people with schizophrenia. Extensive research documents that people with schizophrenia are more likely to experience trauma over the course of their lifetime, including both before and following the onset of their illness, than those in the general population [2, 3]. However, it is also well established that people with schizophrenia and other serious mental illnesses are more likely to underreport their trauma exposure than to overreport it[4], necessitating assessments that systematically review exposure to a broad range of different traumatic events. The lower rate of trauma exposure reported by participants in the study by Peleikis et al. [1] (26%)than most other studies (>70–80%) may partly reflect the method for assessing trauma, which involved asking a broad question about exposure to traumatic events, not specific questions about specific types of events.

PTSD is the most common consequence of trauma exposure, both in the general population as well as in people with serious psychiatric disorders such as schizophrenia. However, PTSD is rarely assessed in people with schizophrenia, and therefore rarely treated [5]. There are multiple clinical implications for the failure to adequately assess and treat PTSD in individuals with schizophrenia.

Although, contrary to their hypothesis, Peleikis et al. did not find that trauma exposure and PTSD were associated with more severe cognitive impairments in people with schizophrenia, they did find that the diagnosis of PTSD was associated with more severe depression. This finding is consistent with multiple other studies of PTSD in people with schizophrenia or other serious mental illnesses [4]. Furthermore, the strong association between PTSD and depression is consistent with findings in the general population, in which major depression is the most common comorbid disorder with schizophrenia [6].

The routine evaluation of exposure to different traumatic events and the presence of PTSD in people with schizophrenia could reduce the burden of anxiety and depression, and contribute to better long-term outcomes. A variety of effective treatments have been established for PTSD in the general population [7]. There is also growing evidence that treatment models adapted for people with schizophrenia and other major mental illnesses may also be beneficial [8-10].This study by Peleikis et al. serves as an important reminder of the significant and long-term consequences of trauma in people with a serious mental illness, and should galvanize mental health service providers to evaluate trauma exposure and PTSD in all their clients, and to begin to explore what treatment options may be available for relieving their suffering.

References

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  2. References
  • 1
    Peleikis DE, Varga M, Sundet K, Lorentzen S, Agartz I, Andreassen OA. Schizophrenia patients with and without posttraumatic stress disorder (PTSD) have different mood symptom levels but same cognitive functioning. Acta Psychiatr Scand 2013;127:455463.
  • 2
    Goodman LA, Rosenberg SD, Mueser KT, Drake RE. Physical and sexual assault history in women with serious mental illness: Prevalence, correlates, treatment and future research directions. Schizophr Bull 1997;23:685696.
  • 3
    Varese F, Smeets F, Drukker M et al. Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophr Bull 2012;38:661671.
  • 4
    Grubaugh AL, Zinzow HM, Paul L, Egede LE, Frueh BC. Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: A critical review. Clin Psychol Rev 2011;31:883899.
  • 5
    Mueser KT, Rosenberg SD, Goodman LA, Trumbetta SL. Trauma, PTSD and the course of schizophrenia: An interactive model. Schizophr Res 2002;53:123143.
  • 6
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995;52:10481060.
  • 7
    Foa EB, Keane TM, Friedman MJ, Cohen JA eds. Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. 2nd edn. New York: Guilford Press, 2009.
  • 8
    Frueh BC, Grubaugh AL, Cusack KJ, Kimble MO, Elhai JD, Knapp RG. Exposure-based cognitive-behavioral treatment of PTSD in adults with schizophrenia or schizoaffective disorder: A pilot study. J Anxiety Disord 2009;23:665675.
  • 9
    Mueser KT, Rosenberg SD, Rosenberg HJ. Treatment of Posttraumatic Stress Disorder in Special Populations: A Cognitive Restructuring Program. Washington, DC: American Psychological Association, 2009.
  • 10
    Mueser KT, Rosenberg SR, Xie H et al. A randomized controlled trial of cognitive-behavioral treatment of posttraumatic stress disorder in severe mental illness. J Consult Clin Psychol 2008;76:259271.