Rates of current, PTSD in individuals with bipolar disorder range from 11 % to 24% (eg, refs 37,38). Psychotic patients with a history of childhood trauma and/or PTSD have a more severe clinical profile compared with those without these experiences. They report more current or lifetime substance abuse,39,40 higher levels of current depression and

anxiety,41,42 and more dissociative symptoms.43,44 Childhood sexual abuse has specifically been linked to hallucinations and delusions20,45 and the content of these positive symptoms may be related to Inhibitors,research,lifescience,medical patients’ traumatic experiences.46 Psychotic patients with a history of childhood trauma tend to present with a variety of additional problems, similar to that of other populations with childhood trauma. Victims of abuse report increased levels of suicidal ideation and more frequent Inhibitors,research,lifescience,medical suicide GSK1210151A mw attempts.40 They have also been reported to be less able to sustain intimacy, and to be more prone to emotional instability.47 Finally, a. history of childhood abuse is associated with worse overall social functioning,48,49 lower remission rates,50 and poorer compliance with treatment.40,51 Inhibitors,research,lifescience,medical Promising treatments for patients with childhood trauma Initial studies suggest that trauma-specific treatments are as beneficial for patients with psychosis as for other diagnostic groups. Psychotic patients with early and complex trauma can benefit,

from present-focused treatments with an emphasis on psychoeducation, stabilization, and the development of safe coping skills. Trappier and Newville,52 for instance, treated 24 patients with chronic schizophrenia and complex PTSD using the first phase of skills training in affect, and interpersonal regulation (STAIR).53 The Inhibitors,research,lifescience,medical first phase of this cognitive-behavioral therapy (CBT) program is focussing on skills training in affect, and interpersonal regulation. A control group of patients Inhibitors,research,lifescience,medical received supportive psychotherapy sessions. After 12 weeks of

treatment, the patients in the STAIR group showed significant reductions in Impact, of Events Scale scores and positive psychotic symptoms, while no improvement in these was observed in the control group. Furthermore, several case studies and open trials have reported that exposure-based interventions can also be used safely and effectively in patients with psychosis. Frueh et al54 treated because 20 patients with PTSD and either schizophrenia or schizoaffective disorder via an 11-week CBT intervention that, consisted of 14 sessions of psychoeducation, anxiety management, and social skills training, as well as 8 sessions of exposure therapy, provided at community mental health centers. Treatment completers showed significant. PTSD symptom improvement, maintained at 3-month followup. Moreover, significant improvements existed with regard to other targeted domains (eg, anger, general mental health).