Abstract
Purpose
This study assessed the distribution of posttraumatic stress disorder (PTSD) symptoms and psychosis indicators among a large sample of individuals with a lifetime diagnosis of PTSD. The identification of a psychotic PTSD subtype was also predicted.
Method
Using data from the National Comorbidity Survey a latent class analysis was conducted on the PTSD symptoms of intrusion, avoidance, and hyperarousal and the psychosis hallucination and delusion indicators.
Results
Results indicated four latent classes, two of which had relatively high probabilities of endorsing the hallucination and delusion indicators. These classes were associated with a broad range of traumatic experiences. One particular class had high probabilities of endorsing both the psychosis indicators and the PTSD symptoms and was associated with a broad range of comorbid psychiatric disorders.
Conclusion
There was a candidate class that met the characteristics expected to be evident in a psychotic PTSD subtype.
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References
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington
Bebbington PE, Kuipers L (1992) Social causation of schizophrenia. In: Bhugra D, Leff JP (eds) Principles of social psychiatry. Blackwell, Oxford
Janssen I, Krabbendam L, Bak M, Hanssen M, Vollebergh W, de Graaf R et al (2004) Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatr Scand 109:38–45
Shevlin M, Dorahy M, Adamson G (2007) Childhood traumas and hallucinations: an analysis of the National Comorbidity Survey. J Psychiatr Res 41:222–228
Shevlin M, Dorahy MJ, Adamson G (2007) Trauma and psychosis: an analysis of the National Comorbidity Survey. Am J Psychiatry 164:166–169
Elklit A, Shevlin M (2010) Female sexual victimization predicts psychosis: a case-control study based on the Danish registry system. Schizophr Bull. doi:10.1093/schbul/sbq048
Hamner MB, Frueh BC, Ulmer HG, Arana GW (1999) Psychotic features and illness severity in combat veterans with chronic posttraumatic stress disorder. Biol Psychiatry 45:846–852
Hamner MB, Fossey MD (1993) Psychotic symptoms associated with posttraumatic-stress-disorder. Neuropsychopharmacology 9:S121–S122
Hamner MB (1997) Psychotic features and combat-associated PTSD. Depress Anxiety 5:34–38
Morrison APSC, Read J, Turkington D (2005) Trauma and psychosis: theoretical and clinical implications. Acta Psychiatr Scand 112:327–329
Seedat S, Stein MB, Oosthuizen PP, Emsley RA, Stein DJ (2003) Linking posttraumatic stress disorder and psychosis—a look at epidemiology, phenomenology, and treatment. J Nerv Ment Dis 191:675–681
Sautter FJ, Brailey K, Uddo MM, Hamilton MF, Beard MG, Borges AH (1999) PTSD and comorbid psychotic disorder: comparison with veterans diagnosed with PTSD or psychotic disorder. J Trauma Stress 12:73–88
Ivezic S, Bagaric A, Oruc L, Mimica N, Ljubin T (2000) Psychotic symptoms and comorbid psychiatric disorders in a Croation combat related posttraumatic stress disorder sample. Croat Med J 41:179–183
Sareen J, Cox BJ, Goodwin RD, Asmundson GJG (2005) Co-occurrence of posttraumatic stress disorder with positive psychotic symptoms in a nationally representative sample. J Trauma Stress 18:313–322
Braakman MH, Kortman FAM, van den Brink W (2009) Validity of ‘posttraumatic stress disorder with secondary psychotic features’: a review of the evidence. Acta Psychiatr Scand 199:15–24
David D, Kutcher GS, Jackson EI, Mellman TA (1999) Psychotic symptoms in combat-related posttraumatic stress disorder. J Clin Psychiatry 60:29–32
Kastelan A, Franciskovic T, Moro L, Roncevic-Grzeta I, Grkovic J, Jurcan V et al (2007) Psychotic symptoms in combat-related post-traumatic stress disorder. Mil Med 172:273–277
Kessler RC (1994) The National Comorbidity Survey of the United States. Int Rev Psychiatry 6:365–376
American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd edn, revised (DSM-III-R). American Psychiatric Association, Washington
World Health Organization (1990) Composite International Diagnostic Interview (CIDI), version 1.0. World Health Organization
Simms LJ, Watson D, Doebbeling BN (2002) Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. J Abnorm Psychol 111:637–647
Elklit A, Armour C, Shevlin M (2010) Testing alternative factor models of PTSD and the robustness of the dysphoria factor. J Anxiety Disord 24:147–154
Armour C, Shevlin M (2010) Testing the dimensionality of PTSD and the specificity of the dysphoria factor. J Loss Trauma 15:11–27
Ford JD, Elhai JD, Ruggiero KJ, Frueh BC (2009) Refining posttraumatic stress disorder diagnosis: evaluation of symptom criteria with the National Survey of Adolescents. J Clin Psychiatry 70:748–755
Spitzer RL, First MB, Wakefield JC (2007) Saving PTSD from itself in DSM-V. J Anxiety Disord 21:233–241
Morrison AP, Frame L, Larkin W (2003) Relationships between trauma and psychosis: a review and integration. Br J Clin Psychol 42:331–353
Spitzer RL, Williams JBW, Gibbon M, First MB (1992) The Structured Clinical Interview for DSM-III-R (SCID) I: history, rationale, and description. Arch Gen Psychiatry 49:624–629
Kessler RC, Borges G, Walters EE (1999) Prevalence of and risk factors for lifetime suicide attempts in the national comorbidity survey. Arch Gen Psychiatry 56:17–626
Wittchen HU, Robins LN, Cottler LB, Sartorius N, Burke JD, Regier D (1991) Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). Br J Psychiatry 159:645–653
Cottler LB, Robins LN, Grant BF, Blaine J, Towle LH, Wittchen HU et al (1991) The CIDI-core substance-abuse and dependence questions—cross-cultural and nosological issues. Br J Psychiatry 159:653–658
Wacker HR, Battegay R, Muellejans R, Schloesser C (1990) Using the CIDI-C in the general-population. Psychiatry: A World Perspective 900:138–143
Janca A, Robins LN, Bucholz KK, Early TS, Shayka JJ (1992) Comparison of Composite International Diagnostic Interview and Clinical DSM-III-R Criteria Checklist Diagnoses. Acta Psychiatr Scand 85:440–443
Schafer JL, Graham JW (2002) Missing data: our view of the state of the art. Psychol Methods 7:147–177
Akaike H (1987) Factor analysis and AIC. Psychometrika 52:317–332
Scwartz G (1978) Estimating the dimension of a model. Ann Stat 6:461–464
Sclove SL (1987) Application of model selection criteria to some problems in multivariate analysis. Psychometrika 52:333–343
McLachlan GJ, Peel D (2000) Finite mixture models. New York, Wiley-Interscience
Ramaswamy V, DeSarbo W, Reibstein D, Robinson W (1993) An empirical pooling approach for estimating marketing mix elasticities with PIMS data. Marketing Sci 12:103–124
Nylund KL, Asparoutiov T, Muthen BO (2007) Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Model 14:535–569
Muthen BO, Muthen L (1998–2007) Mplus Users Guide, 5th edn. Muthen & Muthen, Los Angeles
Scott J, Welham J, Martin G, Bor W, Najman J, O’Callaghan M et al (2008) Demographic correlates of psychotic-like experiences in young Australian adults. Acta Psychiatr Scand 118:230–237
Johns LC, Hemsley D, Kuipers E (2002) A comparison of auditory hallucinations in a psychiatric and non-psychiatric group. Br J Clin Psychol 41:81–86
Bebbington PE, Bhugra D, Brugha T, Singleton N, Farrell M, Jenkins R et al (2004) Psychosis, victimisation and childhood disadvantage—evidence from the second British National Survey of Psychiatric Morbidity. Br J Psychiatry 185:220–226
Mueser KT, Essock SM, Haines M, Wolfe R, Xie HY (2004) Posttraumatic stress disorder, supported employment, and outcomes in people with severe mental illness. CNS Spectr 9:913–925
Shaw K, McFarlane AC, Bookless C, Air T (2002) The aetiology of postpsychotic posttraumatic stress disorder following a psychotic episode. J Trauma Stress 15:39–47
Bendall S, McGorry P, Krstev H (2006) The trauma of being psychotic: an analysis of posttraumatic stress disorder in response to acute psychosis. In: Larkin W, Morrison AP (eds) Trauma and psychosis: new directions for theory and therapy. Routledge, London, pp 58–74
Cresswell CM, Kuipers L, Power MJ (1992) Social networks and support in long-term psychiatric-patients. Psychol Med 22:1019–1026
Bebbington PE, Kuipers L (1994) The social management of long standing schizophrenia: the deployment of service resources. Clinician 12:17–29
Butzlaff RL, Hooley JM (1998) Expressed emotion and psychiatric relapse—a meta-analysis. Arch Gen Psychiatry 55:547–552
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Shevlin, M., Armour, C., Murphy, J. et al. Evidence for a psychotic posttraumatic stress disorder subtype based on the National Comorbidity Survey. Soc Psychiatry Psychiatr Epidemiol 46, 1069–1078 (2011). https://doi.org/10.1007/s00127-010-0281-4
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DOI: https://doi.org/10.1007/s00127-010-0281-4