S-18-01

Childhood trauma in patients with psychotic disorders

I. Schäfer, T. Harfst, P. Briken, V. Aderhold. Klinik für Psychiatrie Uni-Klinik HH-Eppendorf Hamburg, Germany

Objective: The role of traumatic life events in psychotic patients has received considerable attention over the past years. Crucial findings point to an increased prevalence of traumatic experiences over the life-span and differences with regard to symptoms and course of the illness in patients concemed.

Methods: In a pilot study, we examined 30 consecutively admitted female patients using the Childhood Trauma Questionnaire (CTQ) and the Early Sexual Experiences Checklist (ESEC). Diagnoses were based on the Structured Clinical Interview for DSM-IV (SCID), psychopathology was measured with the Positiv and Negativ Symptom Scale (PANSS), the Dissociative Experiences Scale (DES), the Posttraumatic Diagnostic Scale (PDS) and a purposed-designed interview.

Results: In our sample, we found a high prevalence of childhood sexual abuse (forcible bodycontact 36.7%, forcible intercourse 16.7%). All subscales of the CTQ were raised, especially in the case of „emotional abuse” (M=I 1.5, SD=5.6) and „emotional neglect” (M=13.0, SD=5.5). Symptoms of PTSD were not found to the same extent as in other studies, dissociative symptoms seemed to be state-dependend.

Conclusion: The results of our ongoing research suggest that childhood trauma in psychotic patients needs further investigation and emotional abuse and neglect might be of special interest.

S-18-02

Influence of Trauma on Axis I Disorders among a population of Khmer Refugees

P. Auby, L. Michel, A. Sebille, C. Netillard. Paris, France

Objective: The authors will share there clinical experience of psychiatry in South East Asian Refugee Camps early 90s. The influence of traumatic experiences on the clinical presentation of Axis I Disorders among a population of Khmer Refugees will be discussed.

Methods: The authors have been working as psychiatrists in different Refugee Camps in Thailand in the context of the French national military service. They were responsible of mental health consultations and in-patient units taking care of refugees from South East Asia mainly presenting DSM-III Axis I Disorders. The Khmer refugees' case reports will be the focus of the presentation as the extreme magnitude of the violence towards the Khmer population enables to describe some links between trauma and clinical features.

Results: The clinical data showing the influence of traumatic events on clinical presentations will be discussed and compared to the current published studies investigating the psychiatric consequences of mass trauma and disasters.

Conclusion: If the increase in the diagnosis of PTSD in society has been seen by some authors to be linked to cultural and socio economic shift, the situation of the Khmer refugees provides an interesting paradigm of how trauma can influence the clinical presentation of mental disorders.

S-18-03

A.-M. Pezous. ECIMUD Service de Psychiatrie, Paris, France

S-18-04

Trauma, PTSD and dissociation in alcohol dependent patients

W. Langeland en Gertjan Dijkstra. Department of Psychiatry Unive, Amsterdam, Netherlands

Objective: Alcoholic patients report high rates of adverse life events and exposure to trauma over the whole life-span. An important question is whether childhood and adult traumatic experiences are important factors in understanding clinical impairment in treated alcohol-dependent patients, in particular comorbid posttraumatic stress disorder. In this contribution, results of a study on the frequency and relevance of trauma and traumarelated disorders in alcohol-dependent patients in the Netherlands will be presented. The focus will be on the relationship between childhood abuse experiences and dissociation/posttraumatic stress disorder in treated alcoholics.

Methods: 155 treatment-seeking alcoholics were assessed using the Structured Trauma Interview, the Composite International Diagnostic Interview, and the Dissociative Experiences Scale. Results: Early trauma histories may be particularly relevant in the development of PTSD found in alcoholic patients. Furthermore, when PTSD is present, it is often embedded in a pattern of complex psychopathology. In addition, there may exist a specific - this is anxious - subtype of PTSD in early traumatized alcoholic patients, reporting profound phobic avoidance and little psychological dissociation.

Conclusion: All patients entering alcohol treatment services should be carefully screened and evaluated for trauma and traumarelated disorders. Comprehensive assessment of psychopathology is a necessary first step towards providing adequate care for alcoholic patients with a PTSD diagnosis.

S-18-05

Trauma therapeutic approach through associative process: “Algerian Experience”

B. Chawki. Tebessa, Algeria

Objective: The Purpose of our study which lasted four years through a concomitant psychological measures of two cases “P.T.S.D”, is to try to highlight, beyond their apparent similarity, the impact nature on their lives, by mean of plural therapeutic approach within a new care process, invented carefully almost daily by a group of young voluntary nursing auxiliaries within Psychological - Social and Medical Association of Tebessa which our patients joined voluntary at a crucial moment of their disorders where their existential prognostics seemed definitively compromised.

Methods: In order to carry out our study, we have deliberately chosen two patients: Khaled and Aziz, who shared, henceforth, a lot of common points: both were singles, former professionals of antiterrorist fight and victims of “P.T.S.D” with psychological manifestations; first punished then lately recognized and treated (exclusively by us), both living in weak social and economic conditions Furthermore, we adopted for them two distinct therapeutic strategies. Otherwise: Khaled was not directly involved in our associative approach, contrary to Aziz (apparently the most affected) who was close to the auxiliary nursing staff by virtue of his status of volunteer that we granted him at his request, allowing him to attend our weekly meetings at association's head office.

Results: respectively, concerning the table 1 and the table 2 TABLE 1:Thus, my co-therapist prepared herself to launch the final attack on a dangerous ground, but her possible fall will be broken by our immediate intervention… TABLE 2: at the end of 04 years of support, Aziz became one of the most essential members to the working of our association., everything was back to normal.

Conclusion: Thus, we can note the importance of our association in daily life of our patient and our fives by giving each time a new process, always based on concentration and dialogue between members of auxiliary nursing staff and patients themselves! Tebessa on August 08th, 2003.