For a diagnosis of PTSD, there needs to be at least two “negative alterations in cognitions and mood”. These include negative thoughts or feelings that began or worsened after the trauma, an inability to recall key features of the trauma, overly negative thoughts and assumptions about oneself or the world, exaggerated blame of self or others for causing the trauma, negative affect (e.g., fear, horror, anger, guilt, or shame), decreased interest in activities, feeling isolated, and difficulty experiencing positive affect.

What is the evidence for negative thoughts and mood in PTSD?

Moderate to high quality evidence found a strong relationship between increased dysfunctional appraisals of the trauma and increased PTSD symptoms in children and adolescents. Increased shame was related to increased PTSD symptoms in adults. There was also a relationship between increased symptoms and increased guilt, particularly feelings of wrongdoing and self-blame. In veterans, poor mental health in general, poor social functioning, more substance use and more aggression were related to more emotional numbing. However, more treatment initiation and better treatment retention were also related to more emotional numbing in veterans.

Moderate to low quality evidence found decreased reward functioning in people with PTSD, being a reflection of an inability to feel pleasure. There was less anticipation and approach reward functioning, and also decreased hedonic responses.

Moderate to low quality evidence finds five clusters of items relating to negative alterations in cognition and mood. These are;

Decreased interest items

I lost interest in activities which used to mean a lot to me. I lost interest in my usual activities. I lost interest in free time activities that used to be important to me. I lost interest in social activities. I lost interest in activities that I used to enjoy.

Detachment items

I felt distant or cut off from people. No one, not even my family, understood how I felt.

Restricted affect items

I was not able to feel normal emotions. It seemed as if I have no feelings. I felt emotionally numb. I felt unemotional about everything. I was unable to have loving feelings for people who are close to me.

Foreshortened future items

I felt as if my plans for the future would not come true. I felt that I had no future. Making long term plans seemed meaningless to me. I felt as if I don’t have a future. I felt as if my future would somehow be cut short.

Guilt items

I felt guilty. I felt ashamed of the traumatic events that happened to me. I blamed myself. I felt guilt over things I did around the time of the event. I felt guilty for having survived.

August 2021

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Memory involves encoding, storage and retrieval of information. Short-term memory is the ability to remember information after several seconds or minutes; and long-term memory is the ability to remember information over a longer duration. Semantic memory is memory for general facts, episodic memory is memory for personal events, prospective memory is memory for future actions, and retrospective memory is memory for past events. Working memory involves information being temporarily held as well as manipulated.

What is the evidence for memory in PTSD?

Moderate quality evidence finds small to medium-sized effects of poorer memory in people with the disorder than in controls. This was found for both episodic and prospective memory. There were also medium to large effects of poorer verbal episodic and working memory, with similar effects found in children and adults. Visual episodic memory was impaired only in children.

Moderate to low quality evidence finds large deficits in autobiographical memory in people with PTSD. Review authors explain an autobiographical memory deficit in PTSD as having difficulty recalling specific details of personal events and a tendency to recall an overall, general impression of events instead.

August 2021

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Intrusions are core symptoms of PTSD, with at least one intrusion symptom being required for a diagnosis. Intrusion symptoms include unwanted and upsetting memories, nightmares, flashbacks, and emotional distress and/or physical reactivity after exposure to reminders.

What is the evidence for intrusions in people with PTSD?

Moderate to low quality evidence finds five clusters of intrusion symptoms; distressing memories, distressing dreams, flashbacks, emotional cue distress, and physiological cue reactivity.

Items relating to distressing memories

Disturbing memories kept coming into my mind. I found myself remembering bad things that happened to me. Upsetting thoughts kept coming back to me over and over again. Memories of the trauma kept entering my mind. Upsetting thoughts or memories came into my mind against my will.

Items relating to distressing dreams

I had bad dreams about terrible things that have happened to me. My dreams were so real that I woke up and forced myself to stay awake. I had dreams about the trauma. I had bad dreams or nightmares about the trauma. I had disturbing dreams of a traumatic experience from the past.

Items relating to flashbacks

Being in certain situations made me feel as if I am back when the trauma occurred. I acted as if the trauma were happening again. I acted as though the event were happening again. I had flashbacks (sudden, vivid, distracting memories) of the trauma. I felt as though the trauma was happening again. I felt I was reliving the traumatic event.

Items relating to emotional cue distress

I felt upset when I was reminded of the trauma. Reminders of the trauma made me feel nervous. I became distressed and upset when something reminded me of the event. Any reminder brought back feelings about the trauma. I felt scared when something reminded me of the trauma. I felt upset by reminders of the event. I felt nervous when something reminded me of the trauma.

Items relating to physiological cue reactivity

I had sweating or dizziness when something reminded me of my experiences. I got an upset stomach when reminded of bad things that happened to me. When something reminded me of something bad that happened to me, I felt shaky. I had trouble breathing when something reminded me of a stressful experience from the past. Reminders of the trauma made me shake. Reminders of the trauma made my heart beat really fast.

August 2021

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Memory involves encoding, storage and retrieval of information. Short-term memory is the ability to remember information after several seconds or minutes; and long-term memory is the ability to remember information over a longer duration. Working memory involves information being temporarily held as well as manipulated. Semantic memory is memory for general facts, episodic memory is memory for personal events, prospective memory is memory for future actions, and retrospective memory is memory for past events. Most memory tasks assess retrospective memory by measuring recall and recognition.

What is the evidence regarding memory in people with bipolar disorder?

Moderate to high quality evidence shows medium-sized effects of poorer working and episodic memory in people with bipolar I compared to controls. There were smaller effects of poorer working and episodic memory in people with bipolar II compared to controls. Comparing people with bipolar I disorder directly with people with bipolar II disorder, small effects of poorer working memory and episodic memory in people with bipolar I disorder were found.

In people with either bipolar I or bipolar II, there were medium-sized effects of poorer prospective and digit span memory compared to controls, with the effect for digit span backward being larger than for digit span forward.

In people with first-episode bipolar disorder and youth with bipolar disorder (aged 13 years), there were small to medium-sized effects of poorer verbal, visual and working memory compared to controls. Compared to people with first-episode schizophrenia, people with first-episode bipolar disorder showed better verbal and working memory, with no differences in visual memory.

In elderly people with bipolar disorder, moderate quality evidence found a medium-sized effect of poorer memory than in controls matched for age and years of education. Poor delayed recall was significant only during depression phases, while poor digit span was significant only during manic phases.

Compared to people with major depression, moderate quality evidence found a medium-sized effect of poorer verbal memory in people with bipolar disorder during euthymia but not during a depressive phase.

High quality evidence found small effects of poorer verbal and working memory with no differences in visual memory in people with bipolar disorder and a history of psychotic symptoms compared to people with bipolar disorder without a history of psychotic symptoms.

High quality evidence found small effects of poorer verbal and visual memory in young first-degree relatives of people with bipolar disorder (aged 10 to 25 years) compared to controls. Compared to first-degree relatives of people with schizophrenia, moderate to high quality evidence found first-degree relatives of people with the disorder had small to medium-sized effects of better verbal and working memory, with no differences in visual memory.

High quality evidence suggests a small association between poorer memory and poorer general functioning.

Moderate quality evidence suggests no changes in memory over time (~4-5 years) in people with the disorder.

October 2021

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Memory involves encoding, storage and retrieval of information. Short-term memory is the ability to remember information after several seconds or minutes and long-term memory is the ability to remember information over a longer duration. Working memory involves information being temporarily held as well as manipulated. Episodic memory is long-term memory for autobiographical events. Semantic memory involves memory for general facts, prospective memory involves memory for future actions, and retrospective memory is memory for past events.

What is the evidence for memory?

Compared to controls, moderate to high quality evidence found medium to large effects of poorer short-term, long-term, working, episodic, prospective, and memory binding in people with schizophrenia. Compared to people with affective psychoses (e.g., bipolar I disorder), high quality evidence shows a medium-sized effect of poorer visual and verbal delayed memory, and verbal immediate memory, while moderate quality evidence finds poorer verbal working memory in people with schizophrenia. A small effect suggests people with schizophrenia showed impaired performance on working memory tasks compared to people with schizoaffective disorder.

Moderate to high quality evidence shows small to medium-sized associations between more severe negative and disorganised symptoms and poorer visual and verbal memory, with moderate quality evidence also suggesting a weak association with poorer executive working memory. There were small to medium-sized associations between poorer prospective memory and more severe general psychopathology, increased medication dose, longer duration of illness, increasing age, and lower education and IQ.

Moderate quality evidence suggests more impaired working memory in people with schizophrenia and an alcohol use disorder compared to people with schizophrenia without any substance use disorder. High quality evidence also found a small impairment in working memory in smokers vs. non-smokers with schizophrenia.

Moderate quality evidence suggests people taking olanzapine or risperidone show improvement in working memory after treatment, while people taking clozapine or quetiapine show no improvement. Moderate quality evidence suggests people taking olanzapine or risperidone show improvement on working memory with treatment, while people taking clozapine or quetiapine show no improvement. People taking olanzapine, clozapine, risperidone or haloperidol show improvement on delayed recall with treatment, while people taking quetiapine show no improvement.

High quality evidence found people at clinical high-risk of psychosis or familial high-risk of psychosis are similarly impaired on verbal and visual memory, showing small to medium-sized effects compared to controls. People at clinical high-risk of psychosis were more impaired on visuospatial working memory than those at familial risk of psychosis. There is a medium-sized effect of better working memory in people at clinical high-risk of psychosis than in people with first-episode psychosis.

March 2022

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