Rates of Exposure to Traumatic Events and Development of PTSD among PSMD in Treatment

Rates of Exposure to Traumatic Events and Development of PTSD among PSMD in Treatment

Principal Investigators: Mary Jane Alexander, Ph.D., Kristina Muenzenmaier, M.D., Lew Opler, M.D., Ph.D., Shang Lin, Ph.D.

GOALS

To examine the relationship of trauma exposure to the clinical profiles of persons with severe mental disorder (PSMD),
To examine their contacts with health, welfare and criminal justice systems in the five years prior to admission,
The original project goals have been revised to adapt existing measures of psychosis to include elements of complex post-traumatic stress disorder (PTSD) that co-occur with psychosis.

RESEARCH ACTIVITIES AND RESULTS

Methods: In order to understand the phenomenology of the flashback/numbing/dissociative continuum that appears to characterize PTSD that co-occurs with psychosis, we held two advisory meetings with consumer survivor advocates who had severe dissociative histories, and four focus groups with state hospital inpatients who had histories of childhood sexual abuse and current severe dissociative symptoms. Issues of clinical support for the fragile study population were raised by the IRBs and were addressed by making clinical support available during and between groups. This was important as some participants became dissociative or upset during group discussions.

Results: This population experiences very high levels of ongoing dissociation that they can distinguish from flashbacks, they develop strategies to cope with dissociation, and they are eager to discuss their service system encounters. We have presented several workshops based on this work, and developed a cognitive-behavioral group intervention to help inpatients with psychosis to cope with severe dissociation.

POLICY IMPLICATIONS

PSMD with trauma histories are more severely ill than those without and they tell us that existing mental health services do not adequately address their needs. This study will provide a systematic understanding of the clinical profiles and service use patterns associated with trauma histories and complex PTSD in a public sector tertiary care population, to aid in the development of effective services.

PLANS

In the next phase we will work with focus group transcripts to develop items assessing dissociation and flashbacks to enhance the PANSS, originally developed by Dr. Opler to measure positive and negative symptoms of psychosis. We will describe the service system use and clinical profiles of patients with and without trauma histories. The dissociation intervention will be implemented and manualized by project clinical collaborators. We have submitted a workshop proposal on dissociation, psychosis and the intervention to the International Society for Studies of Dissociative Disorders

INCLUSION OF GENDER AND MINORITY SUBJECTS

	Amer Ind Alaska Nat	Asian, Pacific Islander	Black, not Hispanic	Hispanic	White, not Hispanic	Unknown Origin	TOTAL
Female	-	-	6	1	-	-	7
Male	-	-	6	1	-	-	7
TOTAL	-	-	12	2	-	-	14

PRESENTATION:

Workshop on Trauma, Psychosis and Dissociation, 2001 Key Connection Conference, April 2001

Muenzenmaier K, Shelley AM. Alexander MJ. Psychosis, Dissociation, Complex PTSD and Severe Mental Illness. ISSD International Fall Conference (joint session with ISTSS), Baltimore MD, 2002.

Muenzenmaier K, Shelley AM. Alexander MJ.Complex PTSD, Psychosis and Dissociation. NYS Office of Mental Health 15th Annual Research Conference, Albany NY, December 2002.

Muenzenmaier K, Shelley AM.Best Practices for Trauma Treatment: A Sympton-Specific Group for Complex PTSD. Bronx (NY) Psychiatric Center, 2003.

Opler LA, Alexander MJ, Muenzenmaier K, Shelley AM. Schizophrenia and PTSD: Assessment and Treatment. American Psychiatric Association, San Francisco CA, 2003.

Entered: July 7, 2001
Updated: June 10, 2002

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