Severe post-traumatic disorder leading to failure of passing asylum interview—a case report

Background Asylum applicants can benefit from psychiatric evaluation which can explain how culture and mental health symptoms relate to perceived deficits in credibility. Case presentation Ms. B presented for psychiatric evaluation, seeking asylum in the USA after multiple threats on her life in Honduras. At initial evaluation, she was diagnosed with depression. On reevaluation, she was found to have panic attacks and post-traumatic stress disorder. Recommendations included an anxiolytic medication and the use of pre-written statements upon interview. However, Ms. B was sent back to her country of origin despite her severe mental symptoms. Conclusion Post-traumatic disorder scales should be used by mental health professionals especially with patients who are not forthcoming about past trauma history to avoid missing this diagnosis. There is a need to inform immigration officials and lawyers about the necessity of accommodating clients’ needs to appropriately present themselves in asylum interviews.

Psychological Impact of the COVID-19 Pandemic on Health Workers in Morocco: Results of a Cross Sectional Survey .

Background : This study aims to assess the psychological impact of the COVID-19 pandemic, in particular stress, depression, and Post-traumatic disorder, among health care workers in Oujda. Methods:We conducted a survey among 85 health care workers by using a google form questionnaire, during three months (from to). We assessed the work condition, fears, negative emotions, relationships, lifestyle, and coping of medical staff. We also evaluated stress, depression, and post- traumatic stress disorder through the Perceived Stress Scale (PSS), The World Health Organization- Five Well-Being Index (WHO-5), and Primary Care-Post Traumatic Disorder. Results: 65.8% work in front-line, and did between 4 to 15 shifts per month. 71.1% are in fear of COVID-19 infection. 97.6% are afraid to transmit the virus to relatives. More than two-thirds of responders describe negative feelings and exhaustion. 49.4% had a low level of well-being and probably depressed. 67% presented high perceived stress. Anxiety and depression were associated with fears, negative feelings, previous psychiatric disorder, poor sleep, and lack of family support. Conclusion: Our current study showed the high prevalence of depression and perceived stress among medical staff, hence the need to accompany and support all health workers. Keywords: COVID -19 impact; pandemic, Depression; Health care workers; Morocco. Perceived stress; style life.

Trauma and migration

This chapter explores the links between migration and trauma, drawing on research findings for traumatized asylum seekers and refugees to explore some of the controversies and debates with in the field, particularly in the area of therapeutic interventions. Interwoven with this is a description of a psychoanalytic understanding of trauma and migration. This is used to elaborate on the complexity of the experiences, as well as touching on the impact on the professional in working with traumatized people. The two themes running through this chapter are the complex interaction between migration and trauma, on the one hand, and managing traumatic experiences, on the other hand. Using case examples these features are illustrated to enable clinicians to offer the right therapeutic interventions. Complex post-traumatic disorder is not uncommon and requires focused and targeted interventions. Post-migration stress or culture shock need to be identified and managed.

Abstract 314: Cardiac Arrest Related Cognitive Activity

Background: Few studies have examined the psychological outcomes of cardiac arrest (CA) survivors. While some negative outcomes including post-traumatic disorder, anxiety and depression have been reported in ~50%, interestingly, ~10-20% of CA survivors have reported lucid, well-structured thought processes during CA associated with positive psychological outcomes and transformation post CA. We aimed to characterize the themes describing the cognitive experiences recalled by survivors. Method: In a qualitative study 118 self-reported cases were extracted from a CA survivor registry, coded the data using thematic analysis to identify emerging themes followed by descriptive statistics to identify frequencies of identified themes. Results: Analysis of 69 in-hospital and 45 out-of-hospital CA events led to identification of 10 major and 64 sub-themes describing the breadth of CA survivors’ cognitive experiences. Most predominate features included having no sense of pain during on-going CPR (18%), perception of being separate from the body (46%), observing the body from a point outside (40%), travelling through a tunnel towards a destination (16%) and having a life review (19%). Interestingly, in the life-review category 87% perceived the life-review to be an educational experience focused on their actions and intentions towards others, 38% described reliving of certain actions with a sense of shame, and 18% perceived to examine life events from others’ perspective. In addition, another category of cognitive experiences were also described that appeared to relate to events during recovery of consciousness around the time of return of spontaneous circulation (ROSC) where 14% of survivors sensed the pressure of CPR and 18% woke up with pain. Conclusion: CA survivor’s memories appear to reflect two categories: 1) a life review and perception of observing themselves during CPR without pain, which is felt to be educational, positive and peaceful and 2) memories related to the recovery phase around the time of ROSC. These include sensing CPR related events such as pain, chest pressure and distress. While the former category may explain the long-term positive transformation, the latter may explain the long-term occurrence of PTSD and anxiety in CA survivors.

What Diagnosis Is—And What It Isn’t

Diagnosis in psychiatry is not based on a deep understanding of disease mechanisms. Rather, it is a practical way of classifying what clinicians can observe and what patients can describe. Attempts to root diagnosis in neuroscience have all, up to now, failed. There are also no reliable biomarkers or genetic markers for mental disorders. Psychiatric categories can be overdiagnosed or underdiagnosed, but overdiagnosis is the more serious problem. The most frequently overdiagnosed categories these days are bipolar disorder, attention-deficit hyperactivity disorder, and post-traumatic disorder. A history of changes in the diagnosis of schizophrenia is presented to illustrate some of these problems.

Addressing the health care needs of people who identify as transgender: What do nurses need to know?

Being transgender (TG) is part of the natural spectrum of human diversity, and its visibility has increased with societal change. The TG population is comprised of individuals identifying themselves as the opposite gender to that which they were born. Adult TG people are calculated as a part of Australia’s non-heterosexual marginal population; therefore, exact numbers are unknown. As a result of not being recognised, TG people have faced multiple challenges, fairing worse in all socioeconomic and health measures, including not being able to afford and access appropriate healthcare. Many of these challenges arise from a lack of understanding resulting in social exclusion, bullying, and physical attacks. The isolation and physical assaults on this community creates anxiety and mental health conditions, including self-harm, suicide, depression, personality disorder, psychosis, post traumatic disorder, and eating disorders. To affirm a gender identity that is different from the gender a person was born to is referred to as “transition”. The lengths to which an individual will go to transition is varied with some people choosing to change only their dress and mannerisms and others to undertake medical interventions such as hormonal therapy and/or surgery. In Australia, there is limited capacity within the health system to support the needs of the trans and gender diverse (TGD) population. Initiatives such as nurse-led post-operative support service need to be created as a way to address this. This service could provide patients with nurse advocates working collaboratively with other health professionals to provide primary health solutions.