Post-traumatic stress disorder in psychosis

The diagnosis of schizophrenia spectrum disorders often overshadows other psychopathological issues, such as post-traumatic stress disorder (PTSD), which has a significantly higher lifetime prevalence in individuals with psychosis, ranging from 14% to 53%, compared to the general population. The experience of psychosis and its treatment, particularly during the first episode, can be traumatic and frequently leads to PTSD, which may present with a specific clinical profile. Recognising PTSD in individuals with psychosis is challenging for several reasons: difficulties in gathering a trauma history, diagnostic challenges arising from the similarity between PTSD and psychosis symptoms, and systemic barriers in healthcare. An additional complication is the structure of PTSD diagnostic criteria in the DSM-5 classification, which can make it difficult to classify psychosis-related experiences as traumatic. The diagnosis of complex PTSD, as introduced in the ICD-11, is poorly studied among individuals with psychosis, though initial research indicates its high prevalence in this group. Screening tools can be helpful in identifying traumatic experiences, while self-report questionnaires and diagnostic interviews are useful in accurately diagnosing PTSD in individuals with psychosis. Psychotherapy for PTSD in the context of psychosis is both effective and safe, and it also contributes to improved treatment outcomes for psychosis itself. The most well-researched methods are trauma-focused cognitive behavioural therapy and eye movement desensitisation and reprocessing (EMDR).