Treating PTSD in Psychotic Patients
Steven Dubovsky, MD reviewing van den Berg DPG et al. JAMA Psychiatry 2015 Jan 21.
Two therapies, prolonged exposure and eye movement desensitization and reprocessing, seem to help, despite some study weaknesses.
Prolonged exposure (PE) and eye movement desensitization and reprocessing (EMDR) are commonly used for post-traumatic stress disorder (PTSD). To determine whether these work as well in patients with psychotic disorders, Dutch investigators conducted an 8-week comparison of these treatments in 155 adults with PTSD and schizophrenia (n=95), schizoaffective disorder (n=45), psychotic mood disorders (n=10), or other psychoses (n=5).
Participants continued treatment as usual for the psychotic disorder and were randomized to PE, EMDR, or waiting-list control. Assessments with a PTSD rating scale, but not treatments, were blinded.
At 8 weeks, both active treatments were significantly more effective than the waiting list in reducing PTSD ratings, with a mean decrease of around 45%; effect sizes were clinically meaningful and moderate to large. The two active treatments were statistically equivalent, except that only PE was associated with higher rates of full remission compared with the waiting list. Improvement was maintained over 6 months of follow-up. Psychosis did not worsen.
Citation(s):
van den Berg DPG et al. Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder: A randomized clinical trial. JAMA Psychiatry 2015 Jan 21; [e-pub ahead of print].
