La co-occurrence entre symptômes post-traumatiques et symptômes psychotiques est classiquement décrite dans les suites immédiates d’un traumatisme psychique. Cette comorbidité peut également devenir chronique à distance de l’événement traumatisant aigu. Une telle co-occurrence symptomatique est le plus souvent abordée sous l’angle unique de l’état de stress post-traumatique ou de la psychose sans volonté de faire le lien entre les deux entités nosographiques. À la lumière de la littérature, nous proposons dans ce travail des articulations théoriques entre ces deux cadres nosologiques. Une structure psychotique favorise le risque d’être exposé à un évènement potentiellement traumatique, d’une part, et un traumatisme psychique peut venir révéler une psychose latente, d’autre part. Si un état de stress post-traumatique (ESPT) s’établit chez un sujet à la personnalité de structure névrotique, les symptômes psychotiques secondaires constituent un facteur de gravité. Certains auteurs ont retrouvé une analogie entre l’épisode dépressif mélancolique et l’ESPT avec caractéristiques psychotiques. L’ESPT favorise également la consommation de substances psycho-actives pourvoyeuses de symptômes psychotiques. Dans les suites d’un traumatisme cérébral et psychique intriqué, il convient de différencier l’expression schizophréniforme des séquelles neurologiques d’une schizophrénie post-traumatique, où le traumatisme cérébral est un cofacteur de risque du développement de la maladie chez un sujet prédisposé.

The co-occurrence between post-traumatic symptoms and psychotic symptoms is well described in the immediate suites of a trauma but can also be chronic. This symptomatic co-occurrence, rarely studied in the literature, is often approached under the sole angle of a primary post-traumatic stress disorder (PTSD) or of a primary psychosis, without federative will to unify the psychotic and post-traumatic symptoms within the same nosological framework. Individuals with schizophrenia or schizoaffective disorder report higher rates of trauma and assault than the general population.

High rates of PTSD have been noted in severe mental illness cohorts. Psychotic phenomena may be a relatively common manifestation in patients with chronic PTSD.

The purpose of this paper is to expose the various theorical psychopathological aspects between the symptoms of psychosis and PTSD. In populations of veterans, positive and negative symptoms of psychosis in PTSD are described as delusional thoughts and hallucinations often combat-specific.

When a PTSD becomes established at a subject to the personality of neurotic structure, the intensity of the PTSD’s symptoms lead to a psychotic expression which constitutes a factor of seriousness. Besides, PTSD often induces a risk of substance use disorder supplying psychotic symptoms. Cannabis increases the hallucinations, cocaine strengthens an underlying paranoid tone, and alcohol implies withdrawal hallucinosis. Moreover, such consumption could be a risk factor for the future development of chronic psychosis. From another point of view, by basing themselves on the plasma dopamine beta-hydroxylase activity, some authors made the analogy between psychotic major depression and PTSD with psychotic features (also characterized as a distinct psychotic subtype of PTSD). However, other studies found no correlation between PTSD with psychotic features and family predisposition for schizophrenia or schizoaffective disorder.

The determination of the structure of personality seems fundamental in the understanding of the symptoms. A personality of psychotic structure increases the risk of traumatization and PTSD. At the same time, the fragility of this structure causes an increased sensitivity to the trauma, which takes on a particular echo. Moreover, a trauma can test a latent psychotic structure to reveal its existence. The experience of psychosis may be traumatic in itself for patients with, notably, seclusion and sedation during hospitalization. Lastly, the symptoms of this post-traumatic psychosis will be differentiated from neurological confusion caused by a traumatic brain injury. Clinicians often fail to screen routinely for trauma and PTSD symptoms in patients with severe mental illness because few systematic guidelines exist for the identification and treatment of this comorbidity.

The links between psychotic and psycho-traumatic symptoms are complex and multidirectional; this co-occurrence is a factor of seriousness. The clinician, while paying attention to these symptoms, has to distinguish the structure of the personality of the subject to articulate the psychotherapy and the pharmacological treatment. Further investigational studies may determine whether antipsychotics will enhance treatment response in PTSD patients with psychotic features.