A randomized multicentered trial of trauma focused treatment of psychotic patients with PTSD in the Netherlands; design and research questions

Objectives: The prevalence of postraumatic stress disorder (PTSD) in severe mental illness varies from 10 to 60% is the published literature. Probably between 10 to 20% of lifetime psychotic patients, also meet the criteria for having a PTSD. There is not much evidence for the efficacy and safeness of treatment in patients with a lifetime psychotic disorder who also meet the criteria for PTSD. Some pilot studies show promising results. Method: A study is designed to investigate whether treatment of PTSD is effective and safe in a group of people with a psychotic disorder? A multi-site randomised clinical trial with 80 patients Eye Movement Desensitisation and Reprocessing (EMDR) versus 80 patients Prolonged Exposure (PEx) versus 80 patients Treatment as Usual/Waiting list (TAU) is now being performed to answer these research questions. The outcome measures in this study are: Primary: Posttraumatic stress disorder (diagnose and severity) Secundary: psychosis, depression, adverse events. Moderators en mediators of treatment success. Cost-effectiveness will be assessed and expressed in Euro per gained Quality Adjusted Life Years. If no effectivity can be demonstrated, a costminimalisation calculation will be made. Results: Therapist have been trained in EMDR and in PEx during eight days. Therapies are closely supervised an monitored during the study. Fidelity measures are collected from a rond sample of sessions. Conclusions and Discussion: Pilots have been promising in showing effective treatment for PTSD without any adverse events or worsening of the condition in psychotic patients with a chronic course. If this study can demonstrate effectivesness and safety, this can change the treatment for many patients with severe mental illness and reduce suffering from symptoms of PTSD and probably also the burden of psychotic symptoms can be reduced in a subsample of the patients.

Conference

English

Mark van der Gaag
Berber van der Vleugel
David van den Berg
Paul de Bont
Ad de Jongh
Agnes van Minnen

van der Gaag, M., van der Vleugel, B., van den Berg, D., de Bont, P., de Jongh, A., & van Minnen, A. (2011, August-September). A randomized multicentered trial of trauma focused treatment of psychotic patients with PTSD in the Netherlands; design and research questions. In Treating PTSD in patients with psychotic disorders. Symposium conducted at the 41st EABCT Annual Congress, Reykjavk, Iceland