○ Exposure to actual or threatened death, serious injury, or sexual violation. ○ Directly experiencing the traumatic events. ○ Witnessing, in person, the traumatic events. ○ Learning that the traumatic events occurred to a close family member or close friend (cases of actual or threatened death must have been violent or accidental). ○ Experiencing repeated or extreme exposure to aversive details of the traumatic events (i.e., first responders collecting human remains, police officers repeatedly exposed to details of child abuse). Note : This does not apply to exposure through electronic media, television, movies or pictures, unless exposure is work-related. ● Criterion B : One of the following intrusive symptoms: ○ Spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic events. ( Note : In children, repetitive play may occur in which themes or aspects of the traumatic events are expressed.) ○ Recurrent distressing dreams in which the content or affect (i.e., feeling) of the dream is related to the events ( Note : In children, there may be frightening dreams without recognizable content.) ○ Flashbacks or other dissociative reactions in which the individual feels or acts as if the traumatic events are recurring. ( Note : In children trauma-specific reenactment may occur in play.) ○ Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events. ○ Physiological reactions to reminders of the traumatic events. ● Criterion C : One symptom of anxious avoidance of trauma- relevant stimuli: ○ Persistent avoidance of distressing memories, thoughts or feelings about, or closely associated with, the traumatic events. ○ Avoidance of external reminders such as people, places, conversations, activities, objects and/or situations associated with the trauma. ● Criterion D : Two or more of the following affective responses following the trauma: ○ Inability to remember an important aspect of the traumatic events (not due to head injury, alcohol or drugs). ○ Persistent and exaggerated negative beliefs or expectations about oneself, others or the world (e.g., Schizophrenia Rates of suicide among individuals diagnosed with schizophrenia have varied among recent research from 5 to 10% compared with past numbers. The differences seem to involve the age at onset and the prevalence of substance use disorders and other co-occurring, diagnosed mental disorders. Suicide is a relevant leading cause of death among patients affected by schizophrenia (Ventriglio et al., 2016). The rate of attempted suicide in patients affected by schizophrenia- spectrum disorders and psychotic patients ranges from 10 to 50%. Of individuals affected by schizophrenia, 40 to 79% have had suicidal ideation at least once during the course of illness. The estimated lifetime risk of suicidal death is 5.6%. In a review of research, the researchers noted even if suicidal ideation is present in different stages of disease, some differences have been described between the risk of suicide in patients experiencing first episode of psychosis and those with long-term schizophrenia. It is particularly higher during the first year of illness and reaches a steady decline over the following years. Suicidal ideation and attempts may also be common among subjects
“I am bad,” “No one can be trusted,” “The world is completely dangerous”). ○ Persistent, distorted blame of self or others about the cause or consequences of the traumatic events. ○ Persistent fear, horror, anger, guilt or shame. ○ Markedly diminished interest or participation in significant activities. ○ Feelings of detachment or estrangement from others. ○ Persistent inability to experience positive emotions. ● Criterion E : Two or more of the following marked changes in arousal and reactivity: ○ Irritable or aggressive behavior. ○ Reckless or self-destructive behavior. ○ Hypervigilance. ○ Exaggerated startle response. ○ Problems with concentration. ○ Difficulty falling or staying asleep or restless sleep. These symptoms must last for at least one month or longer in duration. Also, clinically significant distress or impairment in social, occupational, or other important areas of functioning not attributed to the direct physiological effects of medication, drugs, or alcohol, or another medical condition, such as traumatic brain injury, are common symptoms of patients with PTSD. It is well-known that traumatic life events may lead to anxiety, depression, and psychotic symptoms and can contribute to the development of an at- risk state for psychosis (Ventriglio, et al., 2016). These researchers found that 83% of patients reporting psychotic episodes were exposed to at least one stressful event during their lifetime and 34% of them reported physical and/or sexual abuse (especially females). PTSD patients who attempted suicide in the past and during the treatment were more likely to report sexual and physical abuse and substance use disorder before the onset of the first psychotic episode. The effects of trauma and co-morbid PTSD may increase risk of suicide in patients after the first psychotic episode. Post- traumatic stress symptoms and trauma associated with the psychotic onset influenced suicidal behavior. Among those suffering from PTSD, 40% of the sample reported suicidal ideation, and 31% reported attempted suicides associated with the experience of trauma that occurred before the onset of psychosis. Finally, recent research evaluating the relationship between PTSD and dissociation has suggested that there is a dissociative subtype of PTSD, defined primarily by symptoms of derealization such as feeling like the world is not real, “out of body” experiences, depersonalization, and feeling as if oneself is not real; dissociative PTSD also has elevated risk for suicidal behavior (Herzog et al., 2020). with subthreshold psychotic experiences. Factors associated with the risk of suicide in the early phase of schizophrenia are previous suicidal attempts and social aspects, such as a lack of social support and stable relationships, social drift after the first episode, and social impairment. Antipsychotic treatment remains crucial for reducing the risk of suicide among patients in the first episode of psychosis (FEP). Clozapine, an antipsychotic medication, has shown superiority in reducing suicide risk among schizophrenia patients (Wimberley et al., 2017). Further studies are required to identify specific psychotherapeutic and psychosocial interventions that may offer more benefits for preventing suicidal behaviors in such patients. Specialized multidisciplinary early psychosis teams, psychiatrist, psychotherapist, social worker, and other mental health professionals could provide the interventions needed for supporting FEP patients and their family in a comprehensive manner. Suspiciousness, paranoid delusions, mental disintegration and agitation, negative symptoms, depression and hopelessness, command hallucinations, and substance abuse are associated
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Book Code: PYCA1423
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