“It levels you out again but you're not dealing with the trauma”: An exploration into how people with a history of interpersonal childhood trauma and psychosis subjectively experience antipsychotic medications

© 2020 Ilias KamitsisAmong people diagnosed with psychotic disorders, those with a history of interpersonal childhood trauma (ICT) present with a more complex clinical profile. In addition to experiencing hallucinations/delusions, these individuals can experience a range of post-traumatic stress/trauma-related symptoms and, more specifically, the distress associated with remembering/re-experiencing traumatic events. There is also a high likelihood that people with trauma and psychosis will experience dissociation, depression, anxiety, suicidality, substance use and cognitive impairment. Irrespective of their symptomatic profile, these individuals are often prescribed an antipsychotic medication. Little is known about how these individuals experience the emotional, cognitive and physical effects of antipsychotics or how antipsychotics influence their trauma-related and other non-psychotic symptoms. Thus, this study aimed to explore how people with psychosis and a history of ICT subjectively experience the wide-ranging psychological and physical effects of antipsychotic medications. An embedded mixed-methods research design with a qualitative phenomenological priority was implemented. Nineteen people who were diagnosed with psychosis and had experienced ICT participated in semi-structured interviews. Participants were specifically asked about how antipsychotics influenced their 1) general emotional, cognitive and physical states, 2) trauma-related thoughts, emotions and physical responses and 3) dissociative symptoms (depersonalisation and derealisation). Participants’ interview transcripts were analysed using interpretative phenomenological analysis. The results demonstrated that, for most participants, antipsychotic medications altered the way they experienced their memories of childhood trauma. There were differences between participants in how antipsychotics altered their trauma memories. Some participants indicated that their medication alleviated the frequency and/or intensity of distressing trauma-related thoughts, emotions and/or physical symptoms, while others mentioned that their flashbacks and thoughts of past traumatic events intensified. Participants also reported that, by supressing trauma-related thoughts and emotions, antipsychotics prevented them from confronting or processing their childhood trauma. While participants considered this beneficial in the short term, they recognised that they would need to confront their trauma to heal. As such, having trauma memories supressed by the emotional and cognitive effects of antipsychotics was not considered beneficial in the long term by these participants. There was also a mixed response from participants about whether antipsychotic medications altered their dissociative symptoms. Many participants reported that antipsychotics supressed their emotions and/or impaired their cognitive functioning, while a few mentioned that they were able to think more clearly and concentrate for longer. Many participants also described varying adverse physical effects of antipsychotic medications. The most common were weight gain and movement difficulties. Participants reported that they had tried many different antipsychotics before finding a medication that was somewhat effective in alleviating their psychotic symptoms. This study’s findings suggest that the cognitive, emotional and physiological effects of antipsychotic medications can be experienced as beneficial or detrimental depending, in part, on how they influence trauma-related thoughts/emotions/physical responses and dissociative symptoms. These findings highlight the need for intervention studies that evaluate the effect of antipsychotic medication on the trauma-related/post-traumatic stress and dissociative symptoms of people with a history of childhood trauma and psychosis

A Culturally Responsive Trauma-Informed Public Health Emergency Framework for Aboriginal and Torres Strait Islander Communities in Australia, Developed during COVID-19

The Coronavirus Disease 2019 (COVID-19) pandemic impacted peoples’ livelihoods and mental wellbeing. Aboriginal and Torres Strait Islander peoples in Australia continue to experience intergenerational trauma associated with colonization and may experience trauma-related distress in response to government responses to public health emergencies. We aimed to develop a culturally responsive trauma-informed public health emergency response framework for Aboriginal and Torres Strait Islander peoples. This Aboriginal and Torres Strait Islander-led study involved: (i) a review of trauma-informed public health emergency responses to develop a draft framework (ii) interviews with 110 Aboriginal and Torres Strait Islander parents about how COVID-19 impacted their lives, and (iii) a workshop with 36 stakeholders about pandemic experiences using framework analysis to refine a culturally responsive trauma-informed framework. The framework included: an overarching philosophy (cultural humility, safety and responsiveness); key enablers (local leadership and Eldership); supporting strategies (provision of basic needs and resources, well-functioning social systems, human rights, dignity, choice, justice and ethics, mutuality and collective responsibility, and strengthening of existing systems); interdependent core concepts (safety, transparency, and empowerment, holistic support, connectedness and collaboration, and compassion, protection and caring); and central goals (a sense of security, resilience, wellbeing, self- and collective-efficacy, hope, trust, resilience, and healing from grief and loss)

The impact of the COVID-19 pandemic and associated control measures on the mental health of the general population

Background: To what extent the COVID-19 pandemic and its containment measures influenced mental health in the general population is still unclear. Purpose: To assess the trajectory of mental health symptoms during the first year of the pandemic and examine dose-response relations with characteristics of the pandemic and its containment. Data sources: Relevant articles were identified from the living evidence database of the COVID-19 Open Access Project, which indexes COVID-19-related publications from MEDLINE via PubMed, Embase via Ovid, and PsycInfo. Preprint publications were not considered. Study selection: Longitudinal studies that reported data on the general population's mental health using validated scales and that were published before 31 March 2021 were eligible. Data extraction: An international crowd of 109 trained reviewers screened references and extracted study characteristics, participant characteristics, and symptom scores at each timepoint. Data were also included for the following country-specific variables: days since the first case of SARS-CoV-2 infection, the stringency of governmental containment measures, and the cumulative numbers of cases and deaths. Data synthesis: In a total of 43 studies (331 628 participants), changes in symptoms of psychological distress, sleep disturbances, and mental well-being varied substantially across studies. On average, depression and anxiety symptoms worsened in the first 2 months of the pandemic (standardized mean difference at 60 days, -0.39 [95% credible interval, -0.76 to -0.03]); thereafter, the trajectories were heterogeneous. There was a linear association of worsening depression and anxiety with increasing numbers of reported cases of SARS-CoV-2 infection and increasing stringency in governmental measures. Gender, age, country, deprivation, inequalities, risk of bias, and study design did not modify these associations. Limitations: The certainty of the evidence was low because of the high risk of bias in included studies and the large amount of heterogeneity. Stringency measures and surges in cases were strongly correlated and changed over time. The observed associations should not be interpreted as causal relationships. Conclusion: Although an initial increase in average symptoms of depression and anxiety and an association between higher numbers of reported cases and more stringent measures were found, changes in mental health symptoms varied substantially across studies after the first 2 months of the pandemic. This suggests that different populations responded differently to the psychological stress generated by the pandemic and its containment measures

The impact of the COVID-19 pandemic and associated control measures on the mental health of the general population: a systematic review and dose-response meta-analysis

Background: to what extent the COVID-19 pandemic and its containment measures influenced mental health in the general population is still unclear.Purpose: to assess the trajectory of mental health symptoms during the first year of the pandemic and examine dose–response relations with characteristics of the pandemic and its containment.Data Sources: relevant articles were identified from the living evidence database of the COVID-19 Open Access Project, which indexes COVID-19–related publications from MEDLINE via PubMed, Embase via Ovid, and PsycInfo. Preprint publications were not considered.Study Selection: longitudinal studies that reported data on the general population's mental health using validated scales and that were published before 31 March 2021 were eligible.Data Extraction: an international crowd of 109 trained reviewers screened references and extracted study characteristics, participant characteristics, and symptom scores at each timepoint. Data were also included for the following country-specific variables: days since the first case of SARS-CoV-2 infection, the stringency of governmental containment measures, and the cumulative numbers of cases and deaths.Data Synthesis: in a total of 43 studies (331 628 participants), changes in symptoms of psychological distress, sleep disturbances, and mental well-being varied substantially across studies. On average, depression and anxiety symptoms worsened in the first 2 months of the pandemic (standardized mean difference at 60 days, −0.39 [95% credible interval, −0.76 to −0.03]); thereafter, the trajectories were heterogeneous. There was a linear association of worsening depression and anxiety with increasing numbers of reported cases of SARS-CoV-2 infection and increasing stringency in governmental measures. Gender, age, country, deprivation, inequalities, risk of bias, and study design did not modify these associations.Limitations: the certainty of the evidence was low because of the high risk of bias in included studies and the large amount of heterogeneity. Stringency measures and surges in cases were strongly correlated and changed over time. The observed associations should not be interpreted as causal relationships.Conclusion: although an initial increase in average symptoms of depression and anxiety and an association between higher numbers of reported cases and more stringent measures were found, changes in mental health symptoms varied substantially across studies after the first 2 months of the pandemic. This suggests that different populations responded differently to the psychological stress generated by the pandemic and its containment measures.Primary Funding Source: Swiss National Science Foundation. (PROSPERO: CRD42020180049