[Post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) - a clinical update of knowledge]. / Posttraumatiskt stressyndrom (PTSD) och komplex PTSD (CPTSD).

Post-traumatic stress disorder, PTSD, is a psychiatric diagnosis that describes a condition where one or more very traumatic events, that include life-threatening or extreme psychological stress, have left permanent traces of distress that induce sustained suffering.  In this clinical overview, we present current updates in diagnostic criteria and a new diagnosis of complex PTSD, and discuss the problems caused by the new PTSD diagnosis criteria partially differing in the DSM-5 and ICD-11 diagnostic manuals. Diagnostic challenges caused by symptom variations is discussed, as well as the high degree of comorbidity with other psychiatric and somatic illnesses. Combined forms of treatment that reduce both psychological PTSD and somatic symptoms is underscored, as well as the clinical value of early discovery of PTSD and treatment of comorbidity. Furthermore, the article illuminates knowledge about resilience and social support as protective factors.

[PTSD and Complex PTSD - Assessment, management and treatment]. / Utredning, handläggning och behandling av PTSD och CPTSD.

Post-traumatic stress disorder (PTSD) is a disruptive condition associated with great suffering. Fortunately, effective treatments are available. Assessment of children and adolescents with symptoms of PTSD is done within the child and adolescent mental health services. Adults are assessed in primary healthcare settings. In complex conditions with psychiatric comorbidity, assessment is conducted in specialist psychiatric services. Trauma-focused psychotherapy is the treatment of choice for both children and adults. Trauma-focused psychotherapy is also recommended for treating complex PTSD, despite a weaker evidence base. PTSD-specific treatment should normally be offered even in the presence of psychiatric comorbidities. Treatment of children and adolescents with PTSD and CPTSD is provided by child and adolescent mental health services. Adults can receive treatment both in primary and secondary healthcare settings, depending on symptomatology and comorbidities.

[A human rights-based approach improves the mental health care for migrants]. / Människorättsbaserat arbetssätt ger vårdpersonal viktiga verktyg.

The increasing number of displaced persons and the high proportion of refugees with traumatic background and psychiatric symptoms affect the mental health care offered. Sweden has been criticized by the United Nations for the unsatisfactory fulfilment of the right to health for migrants. This article on human rights in mental health care practice, with a focus on migrants, describes the right to the enjoyment of the highest attainable standard of physical and mental health and what this right implies for mental health care services, including the responsibilities of medical staff. The right to a dignified and equal treatment, integrity and participation is required by medical ethics and legislation, but is ultimately also a matter of human rights. The importance of social determinants for health, the right to individually adapted information and participation are discussed. The argued discrimination of undocumented migrants and other patients is exemplified. A human rights-based approach, HRBA, improves the mental health care for migrants by increased participation and empowerment of the rights-holders, and can contribute to realizing the human rights in a transcultural mental health care context. A model for implementation of HRBA methods is introduced.

Overrepresentation of unaccompanied refugee minors in inpatient psychiatric care.

BACKGROUND: Unaccompanied refugee minors (URMs) have high levels of psychiatric symptoms, and concerns for their access to mental health services have been raised. From the mid-2000s, an increasing number of asylum-seeking URMs, mainly adolescent boys from Afghanistan, have been referred to the Child & Adolescent Psychiatry emergency unit in Malmö, Sweden. The aim of the study was to compare inpatient psychiatric care between URMs and non-URMs. FINDINGS: All admissions in 2011 at the emergency unit were identified and divided into URMs (n = 56) and non-URMs (n = 205). On the basis of unique patients' first treatment occasion, a group level analysis was performed on gender, age, treatment duration, additional treatment occasions/patient, involuntary care, involuntary care by gender, and ICD-10 principal diagnosis. To retrieve further sample characteristics, a questionnaire was administered to the physicians responsible for admitting patients in 2011. More URMs than non-URMs exhibited self-harm or suicidal behaviour in conjunction with referral. 86% of URMs were admitted with symptoms relating to stress in the asylum process. In the catchment area, 3.40% of the URM population received inpatient care and 0.67% inpatient involuntary care, compared to 0.26% and 0.02% respectively of the non-URM population, both comparisons p < 0.001. There were more boys in the URM group (95%) compared to the non-URM group (29%). A difference in use of involuntary care disappeared after adjusting for gender. No differences were found in diagnoses except for neurotic disorders (F40-48), which were more common in the URM group. CONCLUSION: From an epidemiological perspective, URMs were overrepresented in inpatient psychiatric care.

[Crisis of the scientific communication]. / Den videnskabelige kommunikation i krise.

Scientific communication is undergoing radical changes. The increasingly high prices of scientific journals and other barriers limiting their accessibility are important reasons. On the internet, it is possible to archive and publicize articles with open access, thereby speeding up scientific communication and achievements. Thousands of researchers around the world and many institutions are in favour of open access, while commercial publishers fear losing their profits. The new open-access journals have a low impact factor, which is impending the transformation of the publication system.