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The Treatment of PTSD and Schizophrenia

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Updated January 29, 2012

PTSD and schizophrenia have been found to co-occur, and some people question how successful treatment of PTSD can be when a person also has schizophrenia. However, before the issues of treatment in the face of the co-occurrence of PTSD and schizophrenia can be discussed, it is important to familiarize ourself with the disorder of schizophrenia.

What is Schizophrenia?

Schizophrenia is one of the psychotic disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. To be diagnosed with schizophrenia, you need to meet the following criteria:

  • You must experience at least two of the following symptoms for a good amount of time for at least one month.
    • Delusions
    • Hallucinations
    • Disorganized speech (for example, speaking incoherently or being unable to stay on topic)
    • Disorganized or catatonic behavior (for example, being unable to move for long periods of time)
    • A reduction in speaking, motivation, or the ability to experience/express emotions (often called negative symptoms).

  • Experiencing major difficulties with social relationships, self-care, school, or your job.

  • Experience difficulties with the above symptoms for at least 6 months.

People with schizophrenia have been found to be more likely to have histories of traumatic exposure than people without schizophrenia. Therefore, it is not surprising that many people with schizophrenia also have PTSD. In addition, PTSD symptoms may worsen the symptoms of schizophrenia.

Despite this, many people are hesitant to treat PTSD in people with schizophrenia, especially when it comes to exposure therapy. This may stem from a lack of training on the part of the therapist when it comes to dealing with the co-occurrence of PTSD and schizophrenia or from concerns that exposure therapy may actually make the symptoms of schizophrenia worse.

Cognitive-Behavioral Therapy for PTSD in People with Schizophrenia

However, it is important that a person with schizophrenia also receives help for his PTSD symptoms. If PTSD symptoms remain untreated, they can influence the course and treatment of schizophrenia, as well as a person's quality of life.

In addition, there is some evidence that cognitive-behavioral therapy (including exposure therapy) for PTSD may be successful for people living with a diagnosis of schizophrenia.

Specifically, a group of researchers from a number of hospitals and universities across the country tested a time-limited group and individual cognitive-behavioral treatment for PTSD among people with a psychotic disorder (mostly schizophrenia). This brief treatment was received in addition to their usual treatment.

The treatment lasted 11 weeks with 2 sessions being held each week. It was made up of the following components:

  • Education: Patients were given basic information on PTSD and how it can negatively affect a person's life, as well as how it can be treated.

  • Anxiety Coping Skills: Patients were also taught how to manage their anxiety in healthy ways, such as relaxation and deep breathing.

  • Social Skills Training: Patients learned healthy basic social skills, as well as healthy ways of managing anger.

  • Managing Symptoms of Trauma: Patients were also aided in learning how to effectively talk with family members and friends about their past traumatic events, as well as how to be assertive in letting people know that they do not want to talk about their past traumatic events. Patients were also taught ways of reducing their risk for experiencing another traumatic event.

  • Exposure: Finally, at the end of the treatment, exposure therapy was conducted in eight individual sessions for each patient.

Approximately two-thirds of the patients completed the treatment. They found that PTSD symptoms improved by the end of the treatment, as well as 3 months after the treatment was completed. In fact, most patients no longer met criteria for a diagnosis of PTSD after the treatment. In addition, patients' anger reduced and their quality of social relationships improved.

Getting Help

This study shows that there is hope for people suffering from both PTSD and schizophrenia. If you are living with schizophrenia and have PTSD, it is important to seek out help. Getting treatment for your PTSD symptoms can also prevent a worsening of your schizophrenia symptoms.

You can find out more information about treatment providers in your area who might offer PTSD and schizophrenia treatment through UCompare HealthCare from About.com, the Anxiety Disorder Association of America, or the National Institutes of Mental Health.

Sources:

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th edition). Washington, DC: Author.

Frueh, B.C., Buckley, T.C., Cusak, K.J., Kimble, M.O., Grubaugh, A.L., Turner, S.M., & Keane, T.M. (2004). Cognitive behavioral treatment for PTSD among people with severe mental illness: A proposed treatment model. Journal of Psychiatric Practice, 10, 26-38.

Frueh, B.C., Cusack, K.J., Grubaugh, A.L., Sauvageot, J.A., & Wells, C. (2006). Clinician perspectives on cognitive behavioral treatment for PTSD among persons with severe mental illness. Psychiatric Services, 57, 1027-1031.

Frueh, B.C., Cousins, V.C., Hiers, T.G., Cavanaugh, S.D., Cusack, K.J., & Santons, A.B. (2002). The need for trauma assessment and related clinical services in a state public mental health system. Community Mental Health Journal, 38, 351-356.

Frueh, B.C., Grubaugh, A.L., Cusack, K.J., Kimble, M.O., Elhai, J.D., & Knapp, R.G. (in press). Exposure-based cognitive behavioral treatment of PTSD in adults with schizophrenia or schizoaffective disorder: A pilot study. Journal of Anxiety Disorders.

Hamner, M.B., Frueh, B.C., Ulmer, H.G., & Arana, G.W. (1999). Psychotic features and illness severity in combat veterans with chronic posttraumatic stress disorder. Biological Psychiatry, 45, 846-852.

Resnick, S.G., Bond, G.R., & Mueser, K.T. (2003). Trauma and posttraumatic stress disorder in people with schizophrenia. Journal of Abnormal Psychology, 112, 415-423.

Turkington, D., Dudley, R., Warman, D.M., & Beck, A.T. (2004). Cognitive behavior therapy for schizophrenia: A review. Journal of Psychiatric Practice, 10, 5-16.

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