3049 — Reactions to Exposure Therapy for PTSD among Patients with Schizophrenia

Grubaugh AL, Charleston VAMC COIN; Knapp RG, Medical University of SC; Ellis C, East Carolina University; Veronee K, Charleston VAMC COIN;

Objectives:
There are few empirical data regarding effective treatment of trauma-related symptoms among individuals with a psychotic disorder. This lack of data is significant because rates of trauma and PTSD are notably higher among individuals with severe forms of mental illness (SMI) relative to the general population, and there are sufficient data to suggest that PTSD symptoms exacerbate the overall course and prognosis of SMI. The objectives of the current project are to examine the feasibility and efficacy of Prolonged Exposure (PE) for PTSD in a sample of Veterans with a psychotic disorder.

Methods:
As part of a larger study, and using mixed qualitative and quantitative methods, 14 Veterans with a psychotic disorder (i.e., schizophrenia or schizoaffective disorder) were enrolled to receive prolonged exposure (PE) for PTSD using an open trial study design. Pre- and post-intervention quantitative outcomes included measures of PTSD, depression, and quality of life. Post-intervention qualitative data were obtained using a semi-structured interview that was designed to better understand Veterans' perceptions of the intervention, including any perceived benefits obtained and difficulties encountered with PE.

Results:
Study data suggest that PE is feasible to implement, well-tolerated, and results in clinically significant decreases in PTSD severity in patients with a psychotic disorder. Reactions to the intervention obtained through interview further suggest that PE in this patient population is feasible to implement, clinically beneficial, and does not result in SMI-related de-compensation or produce undue distress.

Implications:
Parallel to PTSD treatment outcome studies using civilian and Veteran samples, including those with other forms of SMI, the current study data suggest that individuals with psychotic disorders can both tolerate and benefit from exposure-based interventions for PTSD. These data also support the use of PE for more complicated patient populations and highlight the need for large scale efficacy trials investigating the short and long term impact of treating PSTD in this patient population.

Impacts:
1. Veterans with a psychotic disorder can tolerate and benefit from exposure-based interventions for PTSD 2. Contrary to some concerns, participation in PE does not appear to result in exacerbations of the primary symptoms of SMI in patients with a psychotic disorder 3. Study data provide support for the use of PE for PTSD in more complicated patient populations that have historically been excluded from clinical trial participation.