The
Hungarian Branch of WAPR, under de untiring leadership of Ida Kosza, has
organised a special session in the IX Annual Congress of the Hungarian
Association of Psychiatry (Magyar Pszichiátriai Társaság) January,
24-27 2018. The topic of the session was Postraumatic Stress Disorder and Psychosocial
Rehabilitation.
 |
| Panellists. |
The session included 6 presentations
and open discussion. It was an opportunity to revise the state of the art of
this topic. Presenters elaborated on different perspectives: current
psychiatric evidence (Zeb Taintor, WAPR Past President), alternative
approaches, sociologic approaches, psychologic approaches (focusing in CBT:
Shahid Quraishi, WAPR Dep. Secretary General), Transgenerational Trauma (Ida
Kosza, chair WAPR Hungarian Branch) and special aspects of trauma in relation
with severe mental illness (my presentation).
In my presentation I showed that in
the last 15 years there is an increasing number or papers exploring in
different ways the relation of PTSD and Schizophrenia spectrum disorders. In
this trend there is a number of core ideas that can be underlined. First, that
PTSD and schizophrenia spectrum disorders (SSD) show a clear relationship: most
patients meeting criteria for schizophrenia also meet criteria for PTSD (although
this is mostly ignored); second, severe traumatic antecedents are clearly
overrepresented in the biographic antecedents of those in the group of SSD, and
this relationship seems “dose dependent” (children with high level of severe
traumatic antecedents -i.e., incest, chronic sexual abuse or complex trauma-
have more that 40 times probability to receive diagnostic of SSP later in life,
different from those with “low level” of abuse), that only have twice
probability of the same(). Last, those with traumatic antecedents (abuse,
neglecting) have almost 5 times more probability to experience hallucinations.
Adding to my first conclusion
(trauma increases probability to suffer from SSP), I suggested that suffering
from – and being labelled of- mental illness is traumatic itself. And moreover,
that there is a big amount of testimonies that declare that sometimes, aspects
of treatment – coercion, forced treatment or side effects of meds- may be
traumatising by themselves.
Different to those that consider relationship
between PTDS and SSD as mere comorbidity, I joined those that suggest that the
interpretations of this findings in research may imply that PTSD and SSD may
share part of the pathogenic mechanisms, and that according to some literature,
the classic concept called “dissociation”, coined by Pierre Janet and recovered
by relational therapists among others, may be that core mechanism. This could
be quite compatible with the findings by neuropsychologists. This also suits
well with the trends that consider that the classic descriptive diagnostic
criteria may benefit form updates that focus more in a dimensional approach to
the clinical features of mental symptoms, similar to the diathesis – stress model.
My conclusions in this session were
that for as primary prevention in mental health -but also for many other
reasons- effort to protect children, women and families should never be
overlooked. Second, that as many stakeholders claim -including WHO´s Office for
Mental Health and Substance Abuse- globally speaking, psychiatry should make
efforts to reduce to the maximum extent non-consensual interventions (i.e.
detention, coercive pharmacological treatment). To what extent these
interventions may be reduced non-affecting health and security of the person
and others is today under big discussion. While users’ organisations claim that
these interventions should be banned, some family organisation and
professionals opine that taking it to an extent is unrealistic and that there
are situations where the person needs external control and direction in order
to recover control of his own mind and life and to preserve security. The more
balanced opinion may be that these kind interventions can and should be reduced
by improving professional training and procedures, and ensuring personal procedural
guaranties.
Last, I reported that research shows
that specific treatments for PTSD in SSD is effective in reducing specific
posttraumatic symptoms in SSD – as hyperarousal, flashing memories or insomnia-
and also – may be not surprisingly- some
symptoms of the SSD area, such as secondary negative symptoms.
Discussion focused in different
aspects. Why we could consider that trauma may operate as a factor of
developing SSD was discussed, on the basis of the Vulnerability Model. Some
statements were presented on how difficult it is that child abuse may be
properly detected, and how difficult it is that the health system may intervene
in a effective way. The need of more public commitment, information and
training for public servers was highlighted (not only mental health workers but
also social workers, policemen, and judges).
These approach of trauma as a
hypothetical contributor to de onset of SSDs, along with other social aspects
and hypothetical contributors, will be discussed in the WAPR World Congress in
a special symposium, “From genes to narrative”, proposed by Francisco Pulido
from Spain and other colleagues from the Spanish Association of Neuropsychiatry
(Asociación Española de Neuropsiquiatría).
