Phenomenology of PTSD and psychotic symptoms.

It is well established that PTSD may develop following a traumatic experience such as war combat. In addition it has been noted that such trauma may lead to symptoms of psychosis. Childhood psychological abuse and sexual abuse have also been linked to psychosis. It may be the case that trauma predisposes to the development of psychosis and this can be compared to psychosis of neurodevelopmental origin (schizophrenia). Most widely explored is psychosis following trauma alongside PTSD. This has been well documented following trauma in Wartime situations. PTSD groups of combat veterans were found to manifest a significant increase in psychotic symptoms over control groups (Butler 1996, Kozaric-Kovacic 2005). Not only have positive psychotic symptoms been recorded in PTSD but also negative symptoms (Hamner 2000). PTSD and psychosis following childhood related and other trauma have also been reported (Neria 2003). A review of data shows 30-40% of combat veterans with PTSD report auditory or visual hallucinations and/or delusions (Lindley 2000). Much debate surrounds the nature of the relationship between PTSD and psychosis. Morrison et al. (2003) discusses three main alternatives. The first is that psychosis may cause PTSD for which there is evidence that 46% of those recovering from an acute psychotic episode developed PTSD after 4 months (McGorry 1991). Secondly it is suggested that trauma may cause psychosis and lastly that PTSD and psychosis are part of a spectrum of disorders that can occur in response to trauma. Other traumatic life events including childhood psychological and sexual abuse have been linked to the onset of future psychosis (Read 1997). A study found 70% of hallucinations to develop following a traumatic event (Romme & Escher 1989). Additionally, chronic auditory hallucinations were commonly preceded by an episode of trauma or an event that activated a memory of past trauma (Honig 1998). Trauma also appears to predispose to subsequent 'borderline personality disorder' and depression. Co-morbidity is common in sufferers of PTSD with psychotic symptoms (Hamner 1999, David 1999, Ivezic 2000). Of particular interest is the pattern of development of psychosis following trauma in comparison to that of psychosis of neurodevelop-mental origin (schizophrenia). Brain functional and anatomical changes have been implicated in the development of schizophrenia. Similar abnormalities have also been observed in PTSD. The structure of the brain leading up to and following the onset of neurodevelopmental psychosis (schizophrenia) has been extensively studied using MRI. There has been particular focus on the hippocampus, …