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tồn tại từ trước rối loạn tâm thần có thể làm tăng tính dễ tổn thương đến sự xuất hiện hoặc chronicity các triệu chứng posttraumatic sau đây tiếp xúc. Nghiên cứu cho đến nay hỗ trợ đóng góp khả năng này, và cơ chế có thể khác | 448 VI. SPECIAL POPULATIONS AND PROBLEMS preexisting psychiatric disorder may increase vulnerability to the emergence or chronicity of posttraumatic symptoms following exposure. Research to date supports the likely contribution of these and other possible mechanisms linking trauma exposure schizophrenia and PTSD. Several other contributory factors have also been hypothesized. For example psychosis and associated treatment experiences e.g. involuntary commitment may themselves represent DSM-IV-TR Criterion A traumas. The potential symptom overlap between schizophrenia and PTSD e.g. flashbacks being misinterpreted as hallucinations extreme avoidance and anhedonia interpreted as negative symptoms may conflate the apparent rates of PTSD in those diagnostic groups. Alternatively PTSD associated with psychotic symptoms may be misdiagnosed as a primary psychotic disorder. Clients and advocacy groups often point to posttraumatic symptoms as among the most troubling of these individuals life problems and many U.S. states have prioritized the development of trauma-sensitive services as a key reform to mental health and substance abuse service systems. Major elements of trauma-sensitive services include 1 increased awareness by providers about trauma history and sequelae among clients 2 better understanding of special requirements of survivors and 3 knowledge of traumaspecific interventions for persons requiring such services. We discuss these three topics in this chapter and provide tools and useful references to increase mental health providers knowledge and competence in regard to trauma-related issues. Posttraumatic stress disorders are among the most treatable of psychiatric syndromes and it is important to recognize and treat PTSD symptoms in clients with schizophrenia. DEFINITIONS Psychological trauma refers to the experience of an uncontrollable event perceived to threaten a person s sense of integrity or survival. A traumatic event is defined by DSM-IV-TR as an event
