Symonds on fear and Post Traumatic Stress Disorder (PTSD)

Prominent English neurologist Sir Charles Symonds, during World War II service with the Royal Air Force, published a series of articles emphasizing the role of fear initiating psychological breakdown in combat airmen (termed Lack of Moral Fibre). Having served in a medical capacity in the previous war, Symonds re-presented the phylogenetic conceptualizations formed by his colleagues addressing 'shell shock'. In 2013, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) re-classified Post Traumatic Stress Disorder (PTSD), removing the diagnosis from the category of Anxiety Disorders. This was the view introduced a century ago by the trench doctors of World War I and affirmed by Symonds' clinical experience and studies in World War II.

Euthanasia and physician-assisted death

Medical practitioners do not have the knowledge and expertise to participate competently and reliably in selecting those fit to be offered euthanasia and assisted suicide. Issues relating to the clinically assessment of such requests by the terminally ill, diagnostic errors, prognosis, competency, and mental health status are, as yet, not adequately scientifically resolved.

Post concussion syndrome: the attraction of the psychological by the organic

Post concussion symptoms following mild traumatic brain injury are a difficult clinical state to conceptualise. The constellation of symptoms include those with an organic signature (and presumed organic aetiology), and those with overt psychological features. A seemingly trivial head injury may result in enduring symptoms. The validity of post concussion syndrome (PCS) has been the focus of much medico-legal debate, as has its cause. Whether PCS is 'neurogenic' or 'psychogenic' in aetiology remains contestable. Babinski, in 1918, hypothesised that an organic factor initiated the symptoms of the disorder now known as PCS, and that this acted as a 'bait', or attractor, for pre-existing and post-injury psychological influences. This hypothesis, which has been neither proven nor disproven over the subsequent nearly one hundred years, deserves reconsideration for it is an appealing model of PCS.

Demoralisation--a useful conceptualisation of non-specific psychological distress among refugees attending mental health services

BACKGROUND

While it is recognised that many refugee and migrant clients present at mental health services with non-specific psychological distress little is known about successful intervention strategies.

AIMS

The aim of this study was to systematically review clinical files to determine the degree of 'demoralisation' symptoms among a sample of refugee and migrant clients attending a community-based mental health service.

METHOD

Sixty-four closed cases were reviewed using a specifically designed case review sheet as a checklist which included diagnostic criteria for a Demoralisation Syndrome.

RESULTS

The findings indicated that while many of the refugee and migrant clients had attracted a diagnosis of major depressive disorder, in the main they did not benefit from a normal course of treatment. Further analysis suggested that demoralisation may be a preferable concept for many of these clients rather than affective disorder. This finding suggests that demoralisation may be a different construct than low mood or depression.

CONCLUSIONS

The findings add support to the concept that demoralisation could be a distinct diagnostic entity in its own right that may be useful to clinicians attending refugee and migrant clients.