Trauma, psychose, PTSS en de toepassing van EMDR

Samenvatting In dit artikel beschrijven wij drie interacties tussen trauma, psychose en PTSS:

  1. 1.

    Veel patiënten met psychosen hebben in hun leven traumatiserende ervaringen meegemaakt. Deze traumata spelen vaak een belangrijke rol in hun psychosen en in het ontstaan hiervan.

  2. 2.

    Het meemaken van een psychose en de psychiatrische behandeling zijn voor veel patiënten levensechte en traumatische ervaringen, die kunnen leiden tot posttraumatische stressklachten.

  3. 3.

    Vaak komen psychosen en een posttraumatische stressstoornis gezamenlijk voor, waarbij er sprake is van negatieve wederzijdse beïnvloeding en voortgaande traumatisering.

Deze drie interacties hebben een hoge klinische relevantie. Er is in de praktijk van de zorg voor patiënten met psychosen echter weinig aandacht voor traumatisering en comorbide PTSS. Eye Movement Desensitization and Reprocessing (EMDR) is een behandelmethode die effectief is bij de behandeling van traumata en PTSS. Wij beschrijven per genoemde interactie een behandeling waarbij EMDR is ingezet. Daarna bespreken wij een aantal factoren die een EMDR-behandeling bij patiënten met psychosen kunnen bemoeilijken, zoals doorlopende traumatisering door psychotische klachten, cognitieve beperkingen, moeite met oogbewegingen, belemmeringen door antipsychotische medicatie en verminderde affectieve expressie. Wij sluiten het artikel af met het advies om in de zorg voor mensen met psychosen aandacht te hebben voor trauma en comorbide PTSS, en patiënten hier ook voor te behandelen.

Abstract In this article we describe three interactions between trauma, psychosis and PTSD:

  1. 1.

    Many patients suffering from psychosis have been traumatized. This trauma often plays an important role in their psychosis and the onset thereof.

  2. 2.

    Having a psychosis and being treated in a psychiatric hospital are traumatic experiences for a lot of patients, and can lead to posttraumatic stress symptoms; and

  3. 3.

    Often psychoses and post-traumatic stress disorder occur jointly, reciprocally influencing one another and leading to ongoing traumatization.

These interactions have a great clinical relevance. In the practice of care for patients with psychosis however there is little attention for traumatization and co-morbid PTSD. EMDR is a treatment approach that is effective in treating traumas and PTSD. Per interaction mentioned above we describe a treatment in which EMDR was used. After this we discuss certain factors that may complicate an EMDR treatment in patients with psychosis, such as ongoing traumatization by psychotic symptoms, cognitive impairments, difficulty with eye movements, barriers due to anti-psychotic medication, and diminished emotional expression.

We end the article with the advise to be aware of the high prevalence of trauma and co-morbid PTSD in the care for patients with psychosis and to treat patients for these complaints.

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VAN DEN BERG, D., VAN DER VLEUGEL, B. & STARING, A. Trauma, psychose, PTSS en de toepassing van EMDR. DIRECT. THERAP. 30, 303–328 (2010). https://doi.org/10.1007/s12433-010-0242-9

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