They suggest that PTSD, major depressive disorder and psychotic symptoms are somehow interconnected. proposes that 44 to 84% of patients with PTSD have co-morbid major depressive disorder, and that the comorbidity is probably higher in PTSD-SP patients. The symptoms described primarily consist of hallucinations and delusions, and are generally related to the patients’ trauma. Studies concerning PTSD-SP show that the psychotic features do not exclusively occur in relation to flashbacks, and that they are chronic. PTSD with Secondary Psychotic features (PTSD-SP) has similarly been discussed as a separate diagnostic entity in which PTSD is followed by the appearance of psychotic features. Evidence for the support of the diagnosis complex PTSD is mixed and, although it has not been included in DMS-5 or ICD-10, it will most probably be included in ICD-11. The discussion addresses the current PTSD formulations’ ability to capture these diverse clusters of symptoms. The symptoms reported in the literature are, for example, emotional regulation difficulties, dissociative and psychotic symptoms and somatic distress. In the literature, a diagnostic entity called complex PTSD has long been discussed as survivors of prolonged and repeated trauma often report additional symptoms alongside their PTSD. Refugees have often been exposed to prolonged and repeated traumas and have been described to present with a more complex symptomatology than is captured by the ICD-10/DSM-V diagnosis of PTSD. Studies on the prevalence of PTSD in refugees and post-conflict populations worldwide have found a prevalence between 10–30%. In addition to the PTSD diagnosis, ICD-10 has introduced a separate diagnostic entity called enduring personality change after catastrophic experience (DF62.0) that includes a hostile understanding of the surroundings, social withdrawal and a sensation of being under constant threat. PTSD is commonly associated with depression, anxiety disorders, alcohol/drug dependency and personality disorders. Post-Traumatic Stress Disorder (PTSD) is a mental disorder that arises from the experience of a traumatic event of an exceptionally threatening character, which is likely to cause distress in almost anyone as defined in ICD-10. This implies that most refugees have been exposed to traumatic events such as persecution, imprisonment, torture, violence and loss of family members, and additionally traumas due to fleeing from their countries of origin.
The United Nations 1951 Refugee Convention defines a refugee as “ someone who is unable or unwilling to return to their country of origin owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion”. An inevitable consequence is that people have to flee their homes and become refugees. The study points to the difficulties distinguishing psychotic features from flashbacks and the authors call for attention to psychotic features in PTSD patients in order to improve documentation and understanding of the disorder.ĭisasters and wars take place continuously. This study provides an estimation of PTSD-SP prevalence in a clinical refugee population with PTSD. Furthermore the PTSD-SP group included significantly more patients exposed to torture ( P = 0.001) and imprisonment ( P = 0.005). There were significantly more patients diagnosed with enduring personality change after catastrophic experience in the PTSD-SP group than in the PTSD group ( P = 0.009).
The majority of symptoms identified were auditory hallucinations (66.2%) and persecutory delusions (50.0%).
One hundred eighty-one patients were diagnosed with PTSD among which psychotic symptoms were identified in 74 (40.9, 95% CI 33.7–48.1%). A categorisation and description of the secondary psychotic features was undertaken. Psychiatric records from 220 consecutive patients at Competence Centre for Transcultural Psychiatry (CTP) were examined, and all the PTSD patients were divided into two groups one group with secondary psychotic features (PTSD-SP group) and one without (PTSD group). The aim of this study was to illustrate the characteristics and estimate the prevalence of psychotic features in a clinical population of trauma-affected refugees with PTSD. A previously published case report from such a facility in Denmark shows that some patients suffer from secondary psychotic symptoms alongside their PTSD. In Denmark there are different facilities specialised in psychiatric treatment of trauma-affected refugees. A substantial amount of refugees (10–30%) suffer from Post-Traumatic Stress Disorder (PTSD).
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