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Kalebic N, Crole-Rees C, Tomlin J, Berrington C, Popovic I, Forrester A. Variations in services and intervention pathways for traumatic stress in Welsh prisons: A national survey. Med Leg J 2024; 92:50-53. [PMID: 38334710 PMCID: PMC10916347 DOI: 10.1177/00258172231214432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Both Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder are prevalent in prison settings. Both often go undetected and untreated, while prisoners who already suffered previous trauma may be re-traumatised upon imprisonment. The current study aimed to conduct a national survey of all Welsh prisons to gather information about existing services and treatments for traumatic stress. The survey identified variation within Welsh prisons with regard to NICE-recommended evidence-based therapies. It is therefore recommended that there needs to be development of a pathway of Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder in the prison system which should be achieved through a consensus process of both frontline staff and experts in the field.
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Affiliation(s)
- Natasha Kalebic
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Clare Crole-Rees
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Jack Tomlin
- School of Law and Criminology, University of Greenwich, London, UK
| | - Claudia Berrington
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Isidora Popovic
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Andrew Forrester
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
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Salome G, Vignaud P, Galia P, Prieto N, Chauliac N. Determinants of Care Pathways for C-PTSD Patients in French Psychotrauma Centers: A Qualitative Study. Int J Environ Res Public Health 2023; 20:6278. [PMID: 37444125 PMCID: PMC10341220 DOI: 10.3390/ijerph20136278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/05/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
In 2018, the International Classification of Diseases (ICD-11) established a novel nosographic category within the stress-specific disorders known as complex post-traumatic stress disorder (C-PTSD). Characterized by distinctive clinical attributes and a limited response to conventional PTSD treatments, C-PTSD has prompted the reconsideration of care methods. Our study's purpose was to explore the intricate factors shaping the care pathways for individuals suffering from C-PTSD. We used a grounded theorization technique involving professionals across a range of specialized French psychotraumatology institutions. The resulting comprehensive theoretical model offers valuable insights into the constitution mechanisms of these pathways, helping elucidate the varying care options. Interestingly, we found that differences in clinical perspectives were determined by the care provider's viewpoint on clinical guidelines, screening tools, and treatment options, but also by structural and organizational factors. The distinctive dynamics and interrelationships identified in our research reveal potential areas of focus for incorporating C-PTSD care more effectively into specialized French trauma centers. This investigation offers a path toward improved understanding and management of C-PTSD, ultimately advancing patient outcomes.
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Affiliation(s)
- Germain Salome
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Philippe Vignaud
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, F-69008 Lyon, France
| | - Perrine Galia
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Nathalie Prieto
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Nicolas Chauliac
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290 & Université Claude Bernard Lyon 1, Domaine Rockefeller, F-69008 Lyon, France
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Oehen P, Gasser P. Using a MDMA- and LSD-Group Therapy Model in Clinical Practice in Switzerland and Highlighting the Treatment of Trauma-Related Disorders. Front Psychiatry 2022; 13:863552. [PMID: 35546928 PMCID: PMC9082273 DOI: 10.3389/fpsyt.2022.863552] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
The Swiss Federal Act on Narcotics allows for the restricted medical use of scheduled psychotropic drugs in cases of resistance to standard treatment, and preliminary evidence of efficacy of the scheduled drug for the particular condition. Since 2014, the authors have obtained 50 licenses on a case-by-case basis and developed a psychedelic-assisted group therapy model utilizing MDMA and LSD. The majority of the patients taking part in the psychedelic group therapy suffered from chronic complex post-traumatic stress disorder (c-PTSD), dissociative, and other post-traumatic disorders. Treatment modalities, typical developments and problems encountered during and after the psychedelic experiences are described. Recurrent depression poses a frequent problem, and requires special attention. Symptoms of c-PTSD predominantly addressed by the psychedelic experiences are the regulation of emotions and impulses, negative self-perception, alterations in relationships to others, as well as meaning, recall, and processing of traumatic memories. C-PTSD needs a larger number of psychedelic experiences in contrast to PTSD resulting from single trauma. In this model MDMA was most often used in the first phase to enhance motivation to change, strengthen the therapeutic alliance, allowing it to become more resilient, stress-relieved and less ambivalent. When emotional self-regulation, negative self-perception and structural dissociation had also begun to improve and trauma exposure was better tolerated, LSD was introduced to intensify and deepen the therapeutic process. The majority of participants improved by clinical judgement, and no serious adverse events occurred. A short case vignette describes a typical process. The experiences with this model can serve to further develop the method of psychedelic-assisted psychotherapy (PAP) and to give directions for future research.
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Affiliation(s)
- Peter Oehen
- Private Practice of Psychiatry and Psychotherapy, Biberist, Switzerland
| | - Peter Gasser
- Private Practice of Psychiatry and Psychotherapy, Solothurn, Switzerland
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Dokkedahl S, Kristensen TR, Murphy S, Elklit A. The complex trauma of psychological violence: cross-sectional findings from a Cohort of four Danish Women Shelters. Eur J Psychotraumatol 2021; 12:1863580. [PMID: 34992746 PMCID: PMC8725710 DOI: 10.1080/20008198.2020.1863580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Psychological trauma has only recently been considered a traumatic event. Therefore, research on Posttraumatic Stress Disorder (PTSD) and Complex-PTSD following exposure to psychological violence, is less studied compared with physical and sexual violence. Objectives: This study aimed to establish the prevalence of PTSD and C-PTSD of among female victims of partner violence (IPV) and examine the unique association between different subtypes of IPV (i.e. physical, psychological and sexual IPV) and the traumatic response. Methods: The study includes a shelter-based sample of female victims of IPV (N = 147). Validated measures were used to estimate IPV exposure and mental health outcomes. Partial Correlation and Hierarchical Regression was used to examine the association between IPV and PTSD and C-PTSD, respectively. Results: The study found a high prevalence of both PTSD (56.5%) and C-PTSD (21.1%) in the sample. Overall, when controlling for the other types of violence, psychological violence correlated with PTSD, C-PTSD, negative affect and somatization. When controlling for psychological violence, neither physical nor sexual violence correlated with any of the mental health outcomes. Hierarchical regression models helped explain 23.5% and 29.7% of the variance in symptoms of PTSD and C-PTSD, respectively. Conclusion: A relatively large subgroup of the women had symptoms of C-PTSD, which demonstrate a potentially unmet need for trauma-informed treatment services in Danish Women Shelters. Psychological violence was found to be the strongest risk factor for all mental health outcomes and thus, it is important to acknowledge the severity of this IPV subtype.
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Affiliation(s)
- Sarah Dokkedahl
- Danish National Center of Psychotraumatology, Odense, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark.,Dannercenterfonden, Copenhagen, Denmark
| | - Trine Rønde Kristensen
- Centre for Persons Subjected to Violence, Center of Social Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Siobhan Murphy
- Danish National Center of Psychotraumatology, Odense, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark.,Queen's University Belfast, Centre for Public Health, Belfast, N. Ireland
| | - Ask Elklit
- Danish National Center of Psychotraumatology, Odense, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
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Giarratano P, Ford JD, Nochajski TH. Gender Differences in Complex Posttraumatic Stress Symptoms, and Their Relationship to Mental Health and Substance Abuse Outcomes in Incarcerated Adults. J Interpers Violence 2020; 35:1133-1157. [PMID: 29294660 DOI: 10.1177/0886260517692995] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Complex trauma (CT; for example, childhood abuse) has been associated with significant behavioral health problems (i.e., mental health and substance use disorders) and symptoms that are consistent with complex posttraumatic stress disorder (C-PTSD). CT is prevalent in adult forensic populations, and particularly important for women as they tend to report more adverse consequences of exposure to traumatic stressors and are entering the criminal justice system at a heightened rate compared with men. However, no studies have empirically tested the relationship among CT, C-PTSD, and behavioral health problems with gender among incarcerated adults. The present study examined the relationship between gender and childhood abuse history, C-PTSD symptom severity, and behavioral health problems in 497 incarcerated adults. Findings indicate that women were more likely to report a history of childhood abuse, and more severe C-PTSD symptoms and behavioral health problems than men. Childhood abuse history significantly accounted for the gender difference observed in C-PTSD symptom severity. C-PTSD partially mediated the gender difference in psychiatric morbidity and in risk of hard drug use. Implications for trauma-informed and gender-responsive services and research in the adult criminal justice system are discussed.
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Abstract
DSM-5 significantly changed the diagnostic criteria for Posttraumatic Stress Disorder (PTSD) relative to DSM-IV/DSM-IV-TR. These changes do not alter its basic approach to diagnosing mental disorders, which treats each disorder as a separate category. This article analyzes the strengths and weaknesses of the categorical approach, and reviews empirical evidence regarding the impact of changes within it on the ease or difficulty of receiving the PTSD diagnosis. It especially analyzes the impact of newly included symptoms that are meant to identify cases in which trauma exposure was associated with changes in more serious PTSD cases, known as Complex PTSD (C-PTSD). It proposes some effects that the changes could have on psychological injury claims. Many changes could support plaintiffs' claims while others could support defense claims. Some changes could support either. Overall, DSM-5 PTSD diagnosis is more responsive to individual differences in symptom presentations and appears able to diagnose some C-PTSD cases. The thesis throughout the article is that PTSD diagnostic accuracy could be improved further, especially for C-PTSD cases, by complementing its current exclusive reliance on behavioral symptoms that are characteristic of victims in general with assessment of the meaning that the symptoms have for individual victims. The article proposes some principles to guide interpretation of the individualized meaning of victims' symptoms, which help make the reasoning behind the interpretations explicit.
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