“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

Abstract

© 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