Prevalence of Traumatic Events and PTSD in Immigrant and Non-immigrant Patients With Psychotic Disorder

Study Overview
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Brief Summary
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Higher rates of psychosis are described in migrant population. Likewise, this populations could suffer several adversities during migration process that could lead to higher exposure to traumatic events and higher rates of posttraumatic stress disorder (PTSD). There is a growing evidence that trauma is associated with psychosis onset. The aim of this research is to study the association between psychosis and traumatic events exposure/PTSD in immigrant population. Our hypothesis is that the higher incidence of psychosis described in immigrant population is associated to higher trauma exposure. A case-control observational study is performed. Patients who presented at least one psychotic episode are recruited from acute and chronic units at Parc Salut Mar (Barcelona). Estimated total sample is 196 individuals. Trauma exposure is assessed by validated trauma scales. Known factors associated with psychosis are controled during the statistic analysis.

Official Title
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Prevalence of Traumatic Events and Post-traumatic Stress Disorder in Immigrant and Non-immigrant Patients With Psychotic Disorder

Conditions
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Psychotic Disorders, Psychological Trauma, Stress, Psychological, Cross-Cultural Comparison

Intervention / Treatment
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* Diagnostic Test: Psychological trauma evaluation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: To present history of one or more psychotic episodes defined according to DSM-5 criteria, including patients with diagnoses of Schizophrenia, Schizoaffective Disorder and non-specific psychotic disorders. Patients of non-local origins who have undergone a migration process along the life line (as case individuals) and autochthonous patients (as control individuals). Age between 18 and 65 years. Exclusion Criteria: Patients who have not clinical stability. Important cognitive limitations to understand informed consent nor applied questionnaires. Language barrier that limits understanding informed consent nor applied questionnaires.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Case-Immigrants psychotic patients<br>Individuals who have presented at least one non-affective psychotic episode with an immigrant status, defined as a person who migrates to another country, usually for permanent residence | Diagnostic Test: Psychological trauma evaluation<br>* Psychological trauma exposure is assessed by validated scales: Childhood Trauma Questionnaire (CTQ) Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) Cumulative Trauma Scale. The Holmes and Rahe Stress Scale. Other clinical scales used: Positive and Negative Syndrome Scale (PANSS). Dissociative Experiences Scale (DES) Mini-Mental State Examination (MMSE).<br>|
| Control-Non immigrants psychotic patients<br>Individuals who have presented at least one non-affective psychotic episode who do not have an immigrant status. | Diagnostic Test: Psychological trauma evaluation<br>* Psychological trauma exposure is assessed by validated scales: Childhood Trauma Questionnaire (CTQ) Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) Cumulative Trauma Scale. The Holmes and Rahe Stress Scale. Other clinical scales used: Positive and Negative Syndrome Scale (PANSS). Dissociative Experiences Scale (DES) Mini-Mental State Examination (MMSE).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Childhood Trauma exposure | Assessed by Childhood Trauma Questionnaire (CTQ): is a self-administered 28-item scale to measure abuse and neglect suffered in childhood on five subscales: emotional, physical or sexual abuse, and emotional or physical neglect, each subscale scored on a 5-point Likert scale. The score for each subscale classifies the severity of the abuse and neglect as: none to minimal, low to moderate, moderate to severe and severe to extreme. | From birth to age 18 (216 months) | 
| Global Trauma exposure by Cumulative Trauma Scale | Cumulative Trauma Scale (CTS): Assesses exposure and emotional involvement to 33 traumatic events, especially oriented to minority groups such as refugees, prisoners or mental health patients. Each item on a 7-point Likert scale (from 1-extremely positive to 7-extremely negative). Higher scores show more cumulative lifetime traumatic events exposure. | From birth to study evaluation, assessed up to 250 months. | 
| The Holmes and Rahe Stress Scale | The Holmes and Rahe Stress Scale (Holmes & Rahe): is used to determine which common stressful life events a patient has experienced in the last 12 months, with each life event scored according to a standardized measure of their impact and a total score provided by summing all those applicable to the patient. Scores <150 are correlated with low stress, 150-299 scores are correlated with moderate stress and >300 scores are correlated with high level of stress. | 1 year (previous to study evaluation) . | 
| PTSD prevalence | Clinician-Administered PTSD Scale for Diagnostic and statistical manual of mental disorders 5th edition (DSM-V), (CAPS-5): is a 55-item clinician-applied scale to determine PTSD diagnosis, based on the current DSM-V criteria. This scale consists of three sections: events, symptoms and functioning. | From birth to study evaluation, assessed up to 250 months. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Positive and Negative Syndrome Scale (PANSS) | Psychotic symptoms are measured with the Positive and Negative Syndrome Scale (PANSS) for schizophrenia an 30-item clinician administered scale which measures positive, negative and general psychopathological symptoms on a scale of 1-7, based on the severity of the symptom (1=absent, 2=minimal, 3=mild, 4=moderate, 5=moderate severe, 6=severe, and 7=extreme). The higher scores are correlated with more severe symptomatology. A total score of 58 indicates moderate severity, while a PANSS score of 75 represents marked severity. A PANSS total score of 95 corresponds to severe severity, and a score of 116 signifies very severe severity. | 1 week (previous to study evaluation) | 
| Dissociative symptoms prevalence | Dissociative Experiences Scale (DES): is a 28-item self-report scale which measures the frequency with which an individual experiences a range of dissociative experiences, from normal to pathological. An overall mean score ranges from 0 to 100, and there are subscales for amnesia, dissociation and depersonalization. A total score of over 30 indicate high levels of dissociation | 1 week (previous to study evaluation) | 
| Substance use disorder prevalence. | A diagnosis of substance use disorder (alcohol or other illicit substances) will be made according to Diagnostic and statistical manual of mental disorders 5th edition (DSM-V) criteria. | From birth to study evaluation, assessed up to 250 months. |