Memantine for Disruptive Behavior in Autistic Disorder

Field: Medicine (Health Sciences)

Sir: Studies from the United States suggest that the lifetime prevalence of both severe traumatic events and posttraumatic stress disorder (PTSD) is higher in people with schizophrenia than in the general population. 1 It has been suggested that comorbidity with PTSD is characterized by more severe schizophrenic symptoms and could be associated with poorer outcome. 2 Psychiatric inpatient treatment under some circumstances can be experienced as traumatic and can cause PTSDlike symptoms, particularly if compulsory interventions such as involuntary treatment, seclusion, and restraint are necessary.Patients with schizophrenic disorders are the patients most frequently exposed to such interventions.We have compared treatment outcome and adverse experiences during hospital stay in inpatients with schizophrenic disorders with and without a history of trauma.Method.The study was conducted from October 1, 2004, to March 31, 2005.We interviewed consecutively admitted patients with schizophrenic disorders (ICD-10 F2) with the Posttraumatic Diagnostic Scale. 3 We inquired also for traumatic experiences during previous psychiatric treatment, but we did not include them as criterion A events (DSM-IV) of lifethreatening character and thus did not take them into account in making PTSD diagnoses.Baseline and outcome measures (Positive and Negative Syndrome Scale [PANSS] 4 score, Global Assessment of Functioning [GAF] 5 score, length of stay) and adverse experiences during treatment (suicide attempts, seclusion, restraint) were recorded prospectively.One hundred seventy-three subjects were screened; of these, 118 subjects (56 males and 62 females) gave informed consent and participated in the interview.Results.Subjects who were and were not included did not differ in age, nationality, length of stay, number of previous admissions, GAF and PANSS score at admission, or frequency of adverse experiences.The percentage of men was lower among included subjects.A lifetime history of criterion A events was reported by 58 subjects (49.2%; 43.3% among females), and a PTSD diagnosis could be established in 33 subjects (28.0%; 32.3% among females).The most frequently reported traumatic experiences were violent assault (28.8% of all subjects), witnessing violent assault (15.2%), and sexual assault by nonfamily members (10.2%).In tune with the literature, 6 violent assaults were more frequent among men and sexual assaults were more frequent among women.Subjects with and without lifetime history of trauma did not differ with respect to age, length of stay, number of previous admissions, GAF and PANSS score at admission and discharge, or suicide attempts, nor were these differences found between subjects with and without comorbid diagnosis of PTSD or between genders.However, seclusion and restraint (including the index admission, the mean number of previous admissions was 8.9) were experienced by 16.6% of the individuals without history of trauma but in 56.1% of those with a history of trauma (p < .0001).This difference applied for both females (11.8% vs. 51.9%,p < .01)and males (23.1% vs. 60%, p < .01).During index admission, 10.2% of patients without history of trauma but 22.8% of those with such history underwent seclusion or restraint (p = .06).The prevalence of PTSD among our sample of patients with schizophrenia was similar to that reported in available U.S.studies, but the prevalence of lifetime traumatic experiences was considerably lower.We suggest that traumatic experiences can be reactualized during inpatient treatment and may lead to an unhappy cycle of adverse experiences of compulsory intervention and retraumatization.