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Psychotic symptoms in refugees diagnosed with PTSD: A series of case reports

Background: In our clinical work, we treat refugees who have been exposed to trauma and who subsequently develop psychotic symptoms. However, the literature does not address the relationship between refugees with depression, post-traumatic stress disorder (PTSD) and psychotic symptoms. Therefore the aim of this study is firstly to present a series of cases showing how psychotic symptoms may present in refugees diagnosed with PTSD, and secondly to discuss the underlying explanations of the involved psychopathology. Methods: The study is based on a presentation of a series of cases. All six cases were selected as they fulfilled the following criteria for inclusion: 1) had a refugee background, 2) fulfilled the PTSD (F43.1) diagnosis upon treatment start and 3) revealed psychotic symptoms during treatment. All six were outpatients at the Psychiatric Trauma Clinic for Refugees at Psychiatric Centre Gentofte in Copenhagen during 2009. Results: Our cases were all characterized by having severe symptoms of depression and PTSD. Before treatment start they had a score on the Harvard Trauma Questionnaire between 2.9 and 3.8 (cut-off: 2.5), and a score on the Hopkins Symptom Checklist-25 between 2.8 and 3.6 (cut-off: 1.8). Additionally, all cases suffered from varying degrees of positive psychotic symptoms, including auditory hallucinations, olfactory and visual hallucinations, as well as persecutory delusions and delusions of reference. Conclusion: In conclusion, research is needed into the prevalence of psychotic symptoms among refugees with depression and PTSD, including the qualitative dimensions of the symptoms in order to optimize diagnosis and treatment among this group of psychiatric patients.