講演情報
[SY-10-03]The ethics of treating trauma in forensic settings: EMDR for people with PTSD and psychosis receiving inpatient and prison-based forensic care
*Susanna Every-Palmer1 (1. Department of Psychological Medicine, University of Otago, Wellington (New Zealand))
キーワード：
Forensic psychiatry、Ethics、PTSD、Trauma、Eye Movement Desensitisation and Reprocessing
AIM: A substantial proportion of people in forensic care experience post-traumatic stress disorder (PTSD) related to traumatic life experiences but this is often left untreated. We discuss the ethics of treating PTSD and present the results from the first randomised controlled trial of Eye Movement Desensitisation and Reprocessing (EMDR) conducted in prison and forensic care.
METHOD: To: (i) review the literature on PTSD among people with psychotic disorders; (ii) present our randomised controlled trial on the effectiveness and safety of EMDR treatment for people with psychosis in forensic care; and (iii) described a qualitative study on the impact of trauma and the lived experiences of people with psychotic disorders receiving PTSD treatment in secure settings.
RESULTS: Untreated PTSD is common among people with psychosis and has significant costs to individuals, their families, and society. Mean (± standard deviation) Clinician-Administered PTSD Scale (CAPS) scores were reduced in the EMDR group compared with the control group after 6 months (21.8 ± 13.3 and 31.5 ± 20.7 respectively). The averaged point estimate difference was a reduction of 11.4 on the CAPS favouring EMDR (p = 0.028). Self-esteem increased in the EMDR group alongside some evidence of reduced depressive symptoms and overall disability. EMDR was regarded with Early Scepticism with most participants initially doubtful it could work. The therapy itself was initially emotionally taxing and Not Easy but participants generally felt safe and persevered. Fourth, they were often surprised and delighted by results (And it Worked!), describing significant symptom reduction and personal transformation. Lastly, EMDR Fits the Forensic Setting, bringing empowerment in a place perceived as disempowering. People reported changes that increased their hope in a violence-free future.
CONCLUSION: PTSD is often overlooked in forensic settings but the potential for symptoms to impede recovery is well established. More attention should be paid to this common comorbidity. EMDR seems to be an effective, safe and acceptable treatment for people with psychotic illness in the community, inpatient, forensic and custodial settings.
METHOD: To: (i) review the literature on PTSD among people with psychotic disorders; (ii) present our randomised controlled trial on the effectiveness and safety of EMDR treatment for people with psychosis in forensic care; and (iii) described a qualitative study on the impact of trauma and the lived experiences of people with psychotic disorders receiving PTSD treatment in secure settings.
RESULTS: Untreated PTSD is common among people with psychosis and has significant costs to individuals, their families, and society. Mean (± standard deviation) Clinician-Administered PTSD Scale (CAPS) scores were reduced in the EMDR group compared with the control group after 6 months (21.8 ± 13.3 and 31.5 ± 20.7 respectively). The averaged point estimate difference was a reduction of 11.4 on the CAPS favouring EMDR (p = 0.028). Self-esteem increased in the EMDR group alongside some evidence of reduced depressive symptoms and overall disability. EMDR was regarded with Early Scepticism with most participants initially doubtful it could work. The therapy itself was initially emotionally taxing and Not Easy but participants generally felt safe and persevered. Fourth, they were often surprised and delighted by results (And it Worked!), describing significant symptom reduction and personal transformation. Lastly, EMDR Fits the Forensic Setting, bringing empowerment in a place perceived as disempowering. People reported changes that increased their hope in a violence-free future.
CONCLUSION: PTSD is often overlooked in forensic settings but the potential for symptoms to impede recovery is well established. More attention should be paid to this common comorbidity. EMDR seems to be an effective, safe and acceptable treatment for people with psychotic illness in the community, inpatient, forensic and custodial settings.