Narrowing the focus on the assessment of psychosis-related PTSD: a methodologically orientated systematic review

Posttraumatic stress disorder (PTSD) in response to psychosis and associated experiences (psychosis-related PTSD, or PR-PTSD) is the subject of a growing field of research. However, a wide range of PR-PTSD prevalence rates has been reported. This may be due to definitional and methodological inconsistencies in the assessment of PR-PTSD. The focus of the review is two-fold. (1) To identify factors that enhance, or detract from, the robustness of PR-PTSD assessment and (2) to critically evaluate the evidence in relation to these identified criteria, including the impact on PR-PTSD prevalence rates. Four quality criteria, whose development was informed by mainstream PTSD research, were selected to evaluate findings on PR-PTSD prevalence. Two criteria related to assessment of psychosis-related stressors (participant identification of worst moments of discrete threat events; psychometrically robust trauma measure) and two focussed on PR-PTSD symptom measurement (adequate time elapsed since trauma; use of validated PTSD interview) in the context of psychosis. Twenty-one studies of PR-PTSD, with prevalence rates ranging from 11 to 51%, were evaluated. Fourteen studies (67%) used robust PTSD measures but PR-trauma was not specifically defined or assessed with validated measures. Eleven studies (52%) assessed PTSD before sufficient time had elapsed since the trauma. Due to significant methodological limitations, it was not possible to review PR-PTSD rates and provide a revised estimate of prevalence. Methodological limitations are common in existing studies of PR-PTSD prevalence. Specific recommendations for improving assessment of psychosis-related trauma are made to guide the development of this new and emerging field. The review concludes with a proposed conceptualisation of PR-PTSD in the context of current diagnostic systems. The utility of the PR-PTSD term and its theoretical underpinnings are discussed. “Overall, robust measures of PTSD were employed but psychosis-related trauma was not specifically defined and time since trauma was not consistently recorded Given the above methodological limitations in the assessment of PR-PTSD, a revised prevalence rate is not provided A new conceptualisation of PR-PTSD in relation to the type of stressor is proposed in the context of current diagnostic systems

针对精神病性症状及相关经历的创伤后应激障碍（Posttraumatic stress disorder，简称PTSD），即精神病相关创伤后应激障碍（psychosis-related PTSD，简称PR-PTSD），正成为日益受到关注的研究领域。然而，现有研究报道的PR-PTSD患病率跨度极大，这可能源于PR-PTSD评估中存在的定义与方法学层面的不一致问题。本综述的核心目标分为两点：其一，识别能够提升或削弱PR-PTSD评估稳健性的影响因素；其二，批判性评估与上述已识别标准相关的证据，包括其对PR-PTSD患病率的影响。研究选取了四项基于主流PTSD研究制定的质量标准，用于评估PR-PTSD患病率的相关研究成果。其中两项标准针对精神病性应激源的评估：即参与者能够识别离散威胁事件的最严重时刻、采用心理测量学性能稳健的创伤评估工具；另外两项聚焦于PR-PTSD的症状评估：即创伤后已经过足够的时间间隔、针对精神病性背景下的经过效度验证的PTSD结构化访谈工具。本次综述共纳入并评估了21项PR-PTSD相关研究，其报道的患病率范围为11%至51%。其中14项研究（占总研究数的67%）采用了性能稳健的PTSD评估工具，但未对精神病性创伤进行明确界定，也未采用经过效度验证的工具开展相关评估；另有11项研究（占总研究数的52%）在创伤后尚未经过足够时间间隔的情况下即开展了PTSD症状评估。由于现有研究存在显著的方法学局限，本次综述无法对PR-PTSD患病率数据进行系统梳理，也无法给出修正后的患病率估算值。现有PR-PTSD患病率相关研究普遍存在方法学局限。本综述针对优化精神病性创伤的评估流程提出了具体建议，以期为这一新兴研究领域的发展提供指导。综述最后结合当前主流诊断系统，提出了PR-PTSD的概念化框架，并讨论了PR-PTSD术语的应用价值及其理论基础。“总体而言，相关研究虽采用了性能稳健的PTSD评估工具，但未对精神病性创伤进行明确界定，且创伤后时间间隔未被统一记录。鉴于PR-PTSD评估中存在上述方法学局限，本次综述未提供修正后的患病率估算值。结合当前主流诊断系统，本研究提出了基于应激源类型的PR-PTSD新的概念化框架。”