A systematic review on comorbid post-traumatic stress disorder in schizophrenia

doi:10.1016/j.schres.2016.05.004

Schizophrenia Research

Volume 176, Issues 2–3, October 2016, Pages 441-451

https://doi.org/10.1016/j.schres.2016.05.004 Get rights and content

Abstract

Post-traumatic stress disorder (PTSD) appears to commonly co-occur with schizophrenia, which is widely considered the most disabling mental illness. Both conditions share neurological risk factors, and present with symptoms that are superficially similar, complicating diagnostic accuracy. The presence of comorbid PTSD is also of concern as additional diagnoses tend to worsen functioning and quality of life. In the current review, EMBASE, Medline, and PsycINFO were searched for articles pertaining to PTSD comorbidity in schizophrenia spectrum disorders. Articles went through two stages of review prior to inclusion – one at the abstract level and another at the full-text level. Thirty-four articles were ultimately included in the present review. Prevalence of PTSD in schizophrenia ranged from 0 to 57%, likely due to study heterogeneity. Findings generally indicated that comorbid PTSD was associated with higher levels of positive symptoms, general psychopathology, and neurocognitive impairment, as well as worse functioning and quality of life. As such, it is important for clinicians to differentiate between psychotic and PTSD symptoms, and to pay attention to the associated features of comorbid PTSD in order to provide the most appropriate intervention. Unfortunately, epidemiological and longitudinal studies in this area are lacking.

Section snippets

A systematic review on comorbid post-traumatic stress disorder in schizophrenia

Psychiatric comorbidities are common among individuals with mental disorders; in particular, post-traumatic stress disorder (PTSD) has been found to frequently co-occur with schizophrenia (Buckley et al., 2009, Young et al., 2013). Schizophrenia is a chronic mental disorder characterized by positive (i.e., delusions, hallucinations, disorganized speech and behaviours) and negative symptoms (i.e., affective flattening, alogia, avolition). PTSD is a condition of persistent mental and emotional

Database search

The current review was conducted in line with the PRISMA statement (Moher et al., 2015). An electronic search of articles published between 1995 and 2014 was performed on EMBASE, Medline and PsycINFO by the authors MM, SS, and VS. Each database was searched using free-text keywords to cover all possible synonyms for schizophrenia and PTSD. Terms relating to the schizophrenia spectrum disorders were searched using “schizo*”, combined with the following keywords for PTSD: AND (“posttraumatic

Literature search

The combined search returned a total of 383 items and 190 remained after removal of duplicates. A further 162 were removed after abstract and full-text reviews. 6 other relevant studies that were incidental or identified as references in those obtained through the electronic search were added, resulting in a total of 34 studies being included in the final review. The search process is outlined in Fig. 1. Table 1 provides an overview of the 34 studies included in the review, including details of

Discussion

This review paper summarized findings across 34 studies with respect to the prevalence and factors associated with PTSD in individuals with schizophrenia spectrum disorders. Several aspects of the findings were mixed, indicating complexity in the relationship between the two conditions. Nonetheless, these conflicting results may be influenced by heterogeneous factors such as sample type, methodological variance, type of trauma experienced, and pre-existing illness severity.

Conclusions

Our findings indicate that comorbid PTSD in schizophrenia is associated with worse outcomes in various aspects of the individual's presentation, including symptom severity, neurocognitive functioning, general psychopathology, suicidality, and quality of life. As such, clinicians should be vigilant with regard to detecting comorbid PTSD in schizophrenia patients, rather than simply attributing PTSD symptoms to a variant presentation of schizophrenia. Differential diagnosis of the two conditions

Abbreviations

BASIS

Behavior and Symptom Identification Scale

BHS

Beck Hopelessness Scale

BPD

bipolar disorder

BORI

Bell Object Relations Inventory

BPRS

Brief Psychiatric Rating Scale

BSS

Beck Suicide Scale

CAPS

Clinician-Administered PTSD Scale

CDS

Calgary Depression Scale

CTES

Childhood Traumatic Events Scale

DEQ

Distressing Event Questionnaire

DIS

Diagnostic Interview Schedule

GAF

Global Assessment of Functioning

GHQ

General Health Questionnaire

HTQ

Harvard Trauma Questionnaire

IAMs

Involuntary Autobiographic Memories

IES-R

Impact of

Role of funding source

There is no funding source for this manuscript.

Contributors

Esmond Seow: Wrote the first draft of the article and reviewed articles.

Clarissa Ong: Contributed to the results and discussion of the article.

Mithila Mahesh: Consolidated search from EMBASE and reviewed articles.

Vathsala Sagayadevan: Consolidated search from PsycINFO and reviewed articles.

Saleha Shafie: Consolidated search from Medline and reviewed articles.

Mythily Subramaniam: Provided intellectual input on the article.

Chong Siow Ann: Provided intellectual input on the article, particular on

Acknowledgements

There is no acknowledgement to be made for this manuscript.

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A systematic review on comorbid post-traumatic stress disorder in schizophrenia

Abstract

Section snippets

A systematic review on comorbid post-traumatic stress disorder in schizophrenia

Database search

Literature search

Discussion

Conclusions

Abbreviations

Role of funding source

Contributors

Acknowledgements

Compr. Psychiatry

J. Psychiatr. Res.

Psychiatry Res.

Schizophr. Res.

Biol. Psychiatry

Compr. Psychiatry

Psychiatry Res.

Psychiatry Res.

J. Clin. Epidemiol.

Schizophr. Res.

Schizophr. Res.

Neurosci. Biobehav. Rev.

Schizophr. Res.

Asian J. Psychiatr.

Schizophr. Res.

Neurobiol. Learn. Mem.

Compr Psychiatry.

Schizophr. Res.

Schizophr. Res.

Compr. Psychiatry

Schizophr. Res.

Posttraumatic stress disorder comorbidity and clinical implications in patients with severe mental illness

J. Nerv. Ment. Dis.

Chronic PTSD in Vietnam combat veterans: course of illness and substance abuse

Am. J. Psychiatry

Psychiatric comorbidities and schizophrenia

Schizophr. Bull.

The impact of posttraumatic stress disorder on quality of life and health service utilization among veterans who have schizophrenia

J. Trauma. Stress.

Schizophrenia: from dopamine to glutamate and back

Curr. Med. Chem.

Glutamate and post-traumatic stress disorder: toward a psychobiology of dissociation

Semin. Clin. Neuropsychiatry

The relationship between post-traumatic symptom severity and object relations deficits in persons with schizophrenia

Br. J. Clin. Psychol.

Discovering the neural basis of human social anxiety: a diagnostic and therapeutic imperative

Am. J. Psychiatry

Disability associated with mental disorders

Indian J. Psychiatry

Posttraumatic stress disorder among substance users from the general population

Am. J. Psychiatry

Neurocognitive function in schizophrenia with comorbid posttraumatic stress disorder

J. Clin. Exp. Neuropsychol.

Obese people who seek treatment have different characteristics than those who do not seek treatment

Health Psychol.

Traumatic life events and PTSD among women with substance use disorders and schizophrenia

Psychiatr. Serv.

The association of PTSD with physical and mental health functioning and disability (VA Cooperative Study #569: the course and consequences of posttraumatic stress disorder in Vietnam-era veteran twins)

Qual. Life Res.

Neurocognitive deterioration in elderly chronic schizophrenia patients with and without PTSD

J. Nerv. Ment. Dis.

Temporolimbic volume reductions in schizophrenia

Arch. Gen. Psychiatry