Trauma and Treatment Resistance: A Case of PTSD and Schizophrenia
Location
Center for Advanced Learning and Simulation (CALS)
Publication Date
April 2025
Start Date
17-4-2025 8:00 AM
Description
Introduction: There is growing evidence linking trauma exposure to increased severity of psychotic symptoms and treatment resistance in schizophrenia1,2. Studies indicate that comorbid PTSD in schizophrenic patients is associated with higher rates of non-remission and treatment failure2. In addition, comorbid PTSD and schizophrenia can present unique symptomology, such as dissociative reactions3,4. Delusions of possessions have also been noted in cases of schizophrenia where patients have a history of trauma, particularly traumas where they felt a lack of control1. This case highlights the importance of trauma screening and tailored intervention strategies in first-episode psychosis. Case: A 20-year-old female presented with first-episode psychosis and was admitted to the inpatient BHU for symptom management. The patient reported auditory and visual hallucinations, insomnia, delusion of persecution, delusion of possession and negative symptoms such as flattened affect and psychomotor retardation. Unique characteristics of her psychosis became apparent early in her treatment, such as worsening psychosis at night and after family visitation, ineffectiveness of multiple antipsychotics, dissociation with loss of time and memories, and delusions of possession by specific family members. Initial treatment with multiple second-generation antipsychotics yielded no improvement, necessitating an escalation to first-generation antipsychotics late in her hospital stay. Further evaluation revealed a history of childhood abuse by multiple family members, some of which had been visiting her. She was diagnosed with comorbid PTSD and followed with psychology for trauma-focused psychotherapy. We theorize that earlier screening for PTSD could have modified our treatment course and improved clinical outcomes. Conclusion: This case underscores the need for systematic trauma screening in patients presenting with first-episode psychosis. The complex interplay between PTSD and schizophrenia can contribute to treatment resistance and necessitate a multidisciplinary approach. Earlier involvement of psychological support, stringent control of environmental triggers (e.g., restricting abusive family members), and earlier initiation of first-generation antipsychotics may improve prognosis.
Recommended Citation
Henderson, Ashley L3 and Backes, Gregory MD, "Trauma and Treatment Resistance: A Case of PTSD and Schizophrenia" (2025). Dept. of Psychiatry Research Symposium. 30.
https://digitalscholar.lsuhsc.edu/psych_rd/2025/presentations/30
Trauma and Treatment Resistance: A Case of PTSD and Schizophrenia
Center for Advanced Learning and Simulation (CALS)
Introduction: There is growing evidence linking trauma exposure to increased severity of psychotic symptoms and treatment resistance in schizophrenia1,2. Studies indicate that comorbid PTSD in schizophrenic patients is associated with higher rates of non-remission and treatment failure2. In addition, comorbid PTSD and schizophrenia can present unique symptomology, such as dissociative reactions3,4. Delusions of possessions have also been noted in cases of schizophrenia where patients have a history of trauma, particularly traumas where they felt a lack of control1. This case highlights the importance of trauma screening and tailored intervention strategies in first-episode psychosis. Case: A 20-year-old female presented with first-episode psychosis and was admitted to the inpatient BHU for symptom management. The patient reported auditory and visual hallucinations, insomnia, delusion of persecution, delusion of possession and negative symptoms such as flattened affect and psychomotor retardation. Unique characteristics of her psychosis became apparent early in her treatment, such as worsening psychosis at night and after family visitation, ineffectiveness of multiple antipsychotics, dissociation with loss of time and memories, and delusions of possession by specific family members. Initial treatment with multiple second-generation antipsychotics yielded no improvement, necessitating an escalation to first-generation antipsychotics late in her hospital stay. Further evaluation revealed a history of childhood abuse by multiple family members, some of which had been visiting her. She was diagnosed with comorbid PTSD and followed with psychology for trauma-focused psychotherapy. We theorize that earlier screening for PTSD could have modified our treatment course and improved clinical outcomes. Conclusion: This case underscores the need for systematic trauma screening in patients presenting with first-episode psychosis. The complex interplay between PTSD and schizophrenia can contribute to treatment resistance and necessitate a multidisciplinary approach. Earlier involvement of psychological support, stringent control of environmental triggers (e.g., restricting abusive family members), and earlier initiation of first-generation antipsychotics may improve prognosis.