Exploring Complex PTSD and Psychosis

Scientific research on cptsd

Interesting stuff coming out of the UK about Complex PTSD.

The North West United Kingdom mental health services conducted a unique study looking into the relationship of trauma, particularly complex trauma, with psychosis.

In short, they had 144 people who suffer from psychosis answer questions. The questions were designed to help assess the trauma the person suffered, the prevalence of PTSD and Complex-PTSD symptoms, as well as their symptoms of psychosis.

What the researchers found was –
10% of the study participants suffered from PTSD, but 40% of the sample suffered from cPTSD.

That in itself is a remarkable finding, but wait, there’s more.

The following sentence from the summary carries more meaning than you might initialy attatch to it.

PTSD and DSOs mediated the relationship between trauma and positive symptoms, controlling for dataset membership.

Let’s start with the definition of ‘positive symptoms’ –
In psychology ‘positive symptoms’ are defined as : highly exaggerated ideas, perceptions, or actions that show the person can’t tell what’s real from what isn’t. Here the word “positive” means the presence of symptoms. Which, in itself is not a positive thing. (Sorry, couldn’t resist the word play.)

The second term to parse out is DSOs. This is short hand for ‘disturbances in self-organization’ (DSOs) – which is a recognized attribute of Complex-PTSD in the International Classification of Diseases-11th Edition. Thank you Europe. You are so far ahead of the DSM.

Putting those terms together the sentence is telling us that PTSD and DSOs (aka cPTSD) were present in people who had suffered trauma and were now suffering psychosis. In addition there was also a relationship to exist between cPTSD and affective disorders (illnesses that affect the way a person thinks and feels).  

However, the relationship did not carry over to explain significant differences in the presence of negative sypmtoms. Remember, a ‘negative symptom’ doesn’t mean that there isn’t a problem. In psychology, a negative symptom denotes a loss of something. Negative symptoms include the inability to show emotions, apathy, difficulties talking, and withdrawing from social situations and relationships.

The summary of the article includes two important sentences:
1. Traumatic experiences and post-traumatic stress are highly prevalent in people with psychosis, increasing symptom burden, decreasing quality of life and moderating treatment response.
2. The prevalence and impact of cPTSD and DSOs in psychosis remains to be explored.

So, what I’m reading here is that trauma that results in cPTSD does have some linkage to some symptoms of psychosis. BUT, we don’t know what that particular mechanism is yet.

They end the study summary with this line: “These findings indicate the possible value of adjunct therapies to manage cPTSD symptoms in people with psychosis, pending replication in larger epidemiological samples and longitudinal studies.”

In other words – people who suffer from psychosis might also benefit from therapies for cPTSD — as long as a future study doesn’t toss all this in the proverbial bin.

The Role and Clinical Correlates of Complex Post-traumatic Stress Disorder in People With Psychosis [https://www.frontiersin.org/articles/10.3389/fpsyg.2022.791996/full]

Conformity

curled, twisted
broke and bent
pulled and pushed
torn and rent
pieces dropped
limbs lopped
all to shape
a perfect figment
of feminine
accomplishment

Research: Brain Activity Patterns After Trauma

Scientific research on cptsd

From October 2021 – The U.S. National Institutes of Health reported on a study that might demonstrate a link between post-trauma brain activity and symptoms of anxiety and PTSD.

The study doesn’t directly address the long term factors that contribute to Complex PTSD. Instead the study focuses on short-term instances of trauma, single event situations. Still, the information might allow researchers to being to detect the mental activity patterns that are prevalent in Complex PTSD. That could lead to a discernable physical marker for diagnosis?

Brain activity patterns after trauma may predict long-term mental health

Good News on Psilocybin for Major Depression

Scientific research on cptsd

Not that anyone following me on Twitter will be surprised to hear this – but – in case you haven’t, there is research coming out of Johns Hopkins Medicine that is good news for sufferers of major depression.

From the article –

The findings of a small study of adults with major depression, published Nov. 4, 2020, in JAMA Psychiatry, suggest that psilocybin may prove effective in a larger population of patients with intractable depression than previously appreciated.

This is great news. Do remember that it is only a very small study. Only 24 participants. But, the findings mean that there could be more trials and greater acceptance (and knowledge) of using psilocybin to treat major depression.

Griffiths and his colleagues reported that two doses of psilocybin during medically supervised treatment — supplemented by supportive psychotherapy — produced rapid and large reductions in depressive symptoms.

Milestone Study Shows Psychedelic Treatment with Psilocybin Relieves Major Depression

Tragedy

My Brother

My brother
A name
I simply moved
From
One column
To another.

Another Day

The fight to live

Another day
Another ten rounds
Even when you can’t
You don’t want
To fight.

Any more.

No mas. No mas.

Those are the days
To fight the hardest.

We fight to live.

An Analogy: the Wetsuit

When you grow up in a minefield, it seems normal.

People often find it difficult to explain, or to understand Complex PTSD. I often find myself falling into metaphor or analogy to explain the experience. The reason for using an abstraction is because in Complex PTSD the particulars from one person to another vary – greatly. I have found that trying to paint a detailed picture often results in becoming lost in the need for exactitude. It is impossible to be be ‘exact’ for everyone. Enter the analogy.

One question I have seen repeatedly about Complex PTSD is “Why am I having to deal with all this NOW? Why not when it was happening? Why 10/20/30/40 years after the fact?”

In the past I have often explained that when disfunction is your norm – you don’t see it as dysfunction.

Recently I thought this idea needed to grow. While comparing the environment to a minefield works it doesn’t go far enough. The minefield only addresses the environment, while Complex PTSD is the product of how we adapted to that environment.

Think of all those adaptations we learned or created to keep us safe as a wetsuit. See it in your mind and make it as thick or detailed as you like. Maybe you have one of those ‘survival suits’ for the North Sea, light blinking on the top and bright orange. Perhaps your wet suit is more like the body glove of neoprene we often visualize on Navy Seals and Frogmen.*

No matter how you envision your suit to look it all served one purpose – to preserve your life in a hostile environment. By ‘hostile environment’ any diver will tell you – you don’t need sharks to make the water dangerous. The water itself – everything surrounding you – is quite capable of ending you.

That is the mental state in which many of us grew up. Life itself, our most immediate environment posed an imminent threat to our survival. Perhaps there was a shark – a person(s) with the ability to harm you. Perhaps there was not – but your surroundings were as cold as Arctic waters. And some of us endured both.**

To survive we adapted. Those adaptations became the ‘wetsuit’ we wore to help us survive.

Our ‘wetsuit’ served us while we were in those dangerous places. But as we grow, age, we leave the environment(s) that caused us to make those adaptations.

When we no longer need that wetsuit because we have left the freezing water we don’t abandon it. Primarily because we are unaware of it. Those adaptations are integrated. Our ‘wetsuit’ is an intrinsic part of who we are.

Over time, out of that hostile environment, that wetsuit – our adaptations – no longer serve us. The neoprene becomes hot, binding, restrictive, and could even become more than an impairment, but a danger. ***

It is not a sudden appearance of Complex PTSD. We have carried it with us since we entered that hostile place. The reason for the sudden appearance is not because the wetsuit has changed, but because they have changed their environment and no longer need it.

Now – comes the work of peeling that sucker off. And that’s part of the reason you always have a dive buddy. It is easier to get out of the wetsuit when you have help.

At least, that’s one way to think about it.


*Note: I met one of the original ‘frogmen’, once, years ago. His stories were beyond impressive.
**Note: Just imagine a shark wearing a wooly knit jumper.
***Note: Good friend went to a Halloween party dressed as a ‘diver’ – full suit 5mm – almost cooked himself into heat stroke.

New class of antidepressants?

Scientific research on cptsd

Source C&E News February 7, 2022

How do you know if a mouse is hallucinating?

Apparently mice on LSD and psilocybin twich their heads. Fascinating. But then, if I was a mouse and my world had gone all psychotropic I suspect there would be some head twitching, too.

So what do tripping mice have to do with Complex PTSD?

As many readers may already know LSD and psilocybin are two controlled substances that have been demonstraated to help alleviate mood disorders. In light of CPTSD these mood disorders may include depression, major depression, persistent depression and psychotic depression. (yes, we are such a fun bunch. </sarcasm>)

Why do these drugs help with Complex PTSD?

The simple answer is ‘brain chemistry’.

The longer answer goes like this:
There is a receptor in the central nervous system called 5-HT2A. This receptor is where serotonin binds to the cell. Serotonin in the brain is linked with mood, anxiety regulation, sexuality, memory, and some social fascets. In essence, your brain is bathing in serotonin. This is why SSRI – Selective Serotonin Reuptake Inhibitors – class drugs are often prescribed to people with symptoms of depression.
Simple logic – raise the level of serotonin in the brain –> lower the presence of depression symptoms.

Guess what else binds to 5-HT2A. If you said magic mushrooms (psilocybin) and LSD you are correct.

However, these drugs also induce hallucinations. Psilocybin is “a Schedule I controlled substance because it has no approved medical purpose and the potential for abuse.”** LSD is also a Schedule I controlled substance. ***

What scientists are trying to discover is – what is the difference between a compound that binds to 5-HT2A that causes hallucinations vs. one that does not. That discovery will open an area of research into new antidepressive medication. It could also prove valuable for people who need antipsychotic medication.

So far scientists have produced two compounds based on this research that demonstrate antidepressant activity without hallucinations in mice.

There is a long step between the lab and a safe effective human medication. The process can take years. But, there is hope, and growing proof, of a new way to help people who suffer from a chronic imbalance of brain chemistry.


Article is at : Hallucinogen Chemistry Guies Antidepressant Drug Discovery by Bethany Halford
[ https://pubs.acs.org/doi/pdf/10.1021/cen-10005-leadcon ] (Sorry, you need ACS membership.)

**(source: USDA [ https://www.usada.org/spirit-of-sport/magic-mushrooms-prohibited-status/ ] as of Feb. 16, 2022)
***(source: DEA [https://www.dea.gov/drug-information/drug-scheduling] as of Feb 16, 2022)

Counterpoint

Poetry Counterpoint Complex PTSD

Between the idea
And the reality
Between the motion
And the act
Falls the shadow
~TS Eliot
(The Hollow Men)

That space between
A point
Of precarious balance
Where we exist
Both alive and not.
~ M.Stewart
(on complex-ptsd)

By Jove – I think I finally get it.

white clouds and blue sky

This post is probably going to sound a lot like bragging – but I promise there is a point at the end…

I am challenging myself to do ‘one big thing a day’.

Why? Because I stand in amazement at what an ordinary human can accomplish in a morning. For decades I have watched friends (not so much family) just soar through their days. They get thing, after thing, after thing done. They just crank out the minor jobs of day-to-day living.

And I stand there stunned and mystified as to how they can do it.

HOW?

Then this morning…

I was up early.

Made my bed.

Ate breakfast.

Did a little social media.

Decided that my ‘one big thing’ challenge was going to be to clean my desk off.

So I went upstairs with my plastic grocery bag of cleaning supplies – and a bag to toss garbage into – and a bag for donates. A couple of rags to do some dusting. And my cup of water.

But that turned into –

You know I could use a chair in here.

(Into the spare room) (Look! A chair we aren’t using)

Moved the chair into my office space.

Went back to the spare room and moved my husband’s inversion table closer to the window. The mirror isn’t in danger now and I can get to the linen chest. And he has a window to look out of. Win-Win-Win.

Noticed the floor needed spot cleaning… grabbed a rag dumped some water on it from my cup, let it sit.

Felt like some music – had to clear my desk anyway – so set up a place for the computer and hit Pandora.

And on. And on. And on.

By lunch I had moved a set of shelves from the basement to my office. Reorganized my desk. Tamed all the cables. Danced. Made a bed for the cat on the shelves…

And I stopped dead in my tracks when I realized that I had been more than just ‘functional’. Damn, I rocked this morning.

The point to all this is I noticed WHY this morning was so productive.

I GOT OUT OF MY HEAD.

Everytime that little voice said… AUGH – I’m overwhelmed!

I would pause – and talk to myself.

“Really? We’re mopping a spot off the floor. This is a problem?”

And – that voice of being overwhelmed quieted a bit.

“OK, just this.”

Next time. AUGH – I’m overwhelmed!

“We are just brushing the dust off the shelves – nothing says we have to do anything else. Is this really a problem?”

A little quieter.

“OK, just this.”

I managed to “Ok, just this.” my way into having a bloomin’ productive morning. And it was all because I listened to that anxious little voice – responded to it – and just did one more little thing.

I’m guessing all my ‘productive’ friends don’t have that almost instant anxiety always in their heads stopping them from doing most anything.

I think/hope I have tamed mine a bit more this morning and more importantly – learned how to work around it.

I hope this helps someone else.