ABSTRACT
OBJECTIVE: To review the evidence from empirical studies regarding the validity of 'post-traumatic stress disorder with secondary psychotic features' (PTSD-SP) as a separate diagnostic entity. METHOD: The authors performed a review tracing publications between 1980 and January 2008. RESULTS: Twenty-four comparative studies were included. These studies indicate that PTSD-SP is a syndrome that comprises PTSD-symptoms followed in time by the additional appearance of psychotic features. The psychotic features are not confined to episodes of re-experiencing, but remain present continuously. PTSD-SP seems to have some biological features differentiating it from schizophrenia and PTSD, e.g. there are differences in smooth pursuit eye movement patterns, concentrations of corticotropin-releasing factor and dopamine beta-hydroxylase activity. CONCLUSION: There is currently not yet full support for PTSD-SP as a nosological entity. However, the delineation of PTSD-SP from other psychiatric syndromes is notable and biological studies seem to support the validity as a separate diagnostic entity.
Subject(s)
Psychotic Disorders/diagnosis , Stress Disorders, Post-Traumatic/diagnosis , Chronic Disease , Comorbidity , Delusions/classification , Delusions/diagnosis , Delusions/psychology , Diagnosis, Differential , Evidence-Based Medicine , Hallucinations/classification , Hallucinations/diagnosis , Hallucinations/psychology , Humans , Psychiatric Status Rating Scales , Psychotic Disorders/classification , Psychotic Disorders/psychology , Reality Testing , Risk Factors , Stress Disorders, Post-Traumatic/classification , Stress Disorders, Post-Traumatic/psychologyABSTRACT
Until the 1970's the universality hypothesis was the leading theory in transcultural psychiatry. Kleinman argued in favour of a more anthropological approach. This was reflected in Appendix I of the DSM IV (Cultural Formulation). More recently the focus of attention has broadened to include interethnic differences and social and community factors that induce and perpetuate mental disorders in various ethnic groups. The individualistic anthropologically orientated approach of the 1970's is moving more and more in the direction of social psychiatry.
Subject(s)
Culture , Ethnicity/psychology , Psychiatry/trends , Humans , NetherlandsABSTRACT
The use of coercive measures in the care for the addicted has changed over the past 20 years. Laws that have adopted the "dangerousness" criterion in order to secure patients' rights to non-intervention are increasingly subjected to critique as many authors plead for wider dangerousness criteria. One of the most salient moral issues at stake is whether addicts who are at risk of causing danger to themselves should be involuntarily admitted and/or treated. In this article, it is argued that the dilemma between coercion on the one hand and abandonment on the other cannot be analysed without differentiated perspectives on the key notions that are used in these debates. The ambiguity these notions carry within care practice indicates that the conflict between the prevention of danger and respect for autonomy is not as sharp as the legal systems seem to imply. Some coercive measures need not be interpreted as an infringement of autonomy--rather, they should be interpreted as a way to provide good care.
