Trauma and dissociation among inpatients diagnosed with schizophrenia spectrum disorders in Taiwan

Background: The overlapping symptoms of schizophrenia and dissociation have been increasingly recognized. This paper explains why it is reasonable to expect that there would be a substantial subgroup of patients diagnosed with schizophrenia spectrum disorders (SSDs) who suffer from pathological dissociation.

Objective: As little is known about the prevalence of dissociative disorders and symptoms among patients with SSDs, we investigated the prevalence of dissociative disorders and symptoms among patients with SSDs. Method: We used both self-report measures and structured interviews to examine dissociative disorders and symptoms in a randomly recruited sample of inpatients with a clinical diagnosis of SSDs in Taiwan (N = 100).

Results: Over 60% of participants exhibited pathological dissociation, and 54% had a dissociative disorder according to structured interview data; three participants met the DSM-5 diagnostic criteria for dissociative identity disorder. The concurrent validity of pathological dissociation in this sample was similar to that of depression among patients with schizophrenia reported in the literature. Participants with a dissociative disorder were more likely to report high-betrayal traumas and meet DSM-5 criteria for post-traumatic stress disorder; they also reported more psychotic symptoms than those without a dissociative disorder.

Conclusions: This was one of very few studies that used structured interviews to examine pathological dissociation in patients with SSDs. The results indicate that pathological dissociation in SSDs is not uncommon. Clinical assessment should include measures of dissociation to facilitate early identification.

背景: 思覺失調症和解離在症狀上之重疊漸漸為人所關注。本文解釋為何我們預料不少被診斷患有思覺失調類群障礙症(SSD)之患者可能有病態解離。

目的: 由於我們對解離症狀及解離症在SSD患者之盛行率知之甚少，我們探討SSD患者中解離症狀及解離症之普遍性。

方法: 我們隨機招募台灣臨床診斷為SSD之住院患者(N = 100)，以自評問卷及結構性晤談來探討他們的解離症狀及解離症。

結果: 根據結構性晤談的數據，超過60% 的參加者呈現病態解離，54%患有解離症；三名參加者符合DSM-5 解離性身份障礙之診斷標準。在我們的樣本中，病態解離的效度與文獻中思覺失調症患者的抑鬱之效度相近。跟沒有解離症的參加者相比，有解離症的參加者更有可能報告高度背叛創傷，並更大機會符合創傷後壓力症之診斷標準，而他們也報告更多精神病症狀。

結論: 這是少數使用結構式晤談來探討SSD 患者之病態解離的研究。結果表明SSD患者之病態解離並不罕見，臨床評估應該包括解離的評估工具，以助及早識別相關狀況。