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Electronic Letters to:

Articles: Helen McColl, Kwame McKenzie, and Kamaldeep Bhui Mental healthcare of asylum-seekers and refugees Adv Psychiatr Treat 2008; 14: 452-459 [Abstract] [Full text] [PDF]

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Electronic letters published:

The failed asylum seeker: lessons from two encounters

Adeniyi S. Adetoki   (18 November 2008)

The natural history of PTSD in asylum seekers and refugees

Alexandra L Pitman   (21 January 2009)

The failed asylum seeker: lessons from two encounters 18 November 2008
Adeniyi S. Adetoki, CT1 Trainee Psychiatrist Birmingham and Solihull Mental Health Trust, Birmingham. Send letter to journal: Re: The failed asylum seeker: lessons from two encounters niyiadetoki{at}yahoo.co.uk Adeniyi S. Adetoki	Within the last 6 weeks I have been directly involved in the management of two young female failed asylum seekers who presented with psychiatric problems. Both had children for partners who were themselves asylum seekers, and one had spent some time in a detention camp. Both had reasons for seeking asylum which would appear difficult to prove, as they fell more within the realm of personal experiences of persecution rather than such issues as war or political upheaval. The severity of the impact of the asylum seeking process on these two individuals and the implications of this for their partners and the children involved further highlights the need for improvement in the approach to mental health care for asylum seekers. This includes full and careful assessment of their claims for seeking refugee status. I believe that training in trans-cultural aspects of psychiatric care should be introduced early in the curriculum for psychiatric training. Declaration of interest: None. References 1.Helen McColl, Kwame McKenzie, and Kamaldeep Bhui Mental healthcare of asylum-seekers and refugees. Adv Psychiatr Treat 2008; 14: 452-459
The natural history of PTSD in asylum seekers and refugees 21 January 2009
Alexandra L Pitman, Academic Clinical Fellow (ST4) in Psychiatry Barnet Enfield & Haringey Mental Health NHS Trust Send letter to journal: Re: The natural history of PTSD in asylum seekers and refugees a.pitman{at}medsch.ucl.ac.uk Alexandra L Pitman	This review of the epidemiology of mental illness in asylum seekers and refugees highlights the role of post- migration adversities in patients diagnosed with post traumatic stress disorder (PTSD), applying this to diagnostic formulation and the prioritisation of appropriate interventions. This focuses attention on a patient’s individual circumstances rather than considering them as part of a homogeneous group. As a relatively recent diagnostic entity the natural history of PTSD may not yet be clear, and although the ICD-10 clearly describes the symptoms characteristic at the time of diagnosis, it gives no sense of how those symptoms might subsequently evolve (WHO, 1992). It is possible that the course of the illness may diverge according to index trauma or experiences of post- trauma adversity. If so clinical guidelines may need to take a longer-term perspective, structured using a decision-tree approach. Clinical experience in the asylum seeker and refugee population suggests that although initial diagnosis of the disorder is characterised by hypervigilence, flashbacks, and nightmares, these give way over a period of years to a ‘burnt-out’ form of the illness. Patients subsequently report predominant symptoms of chronic depression and anxiety, often with psychotic features and suicidality. The emergence of such features often necessitates divergence from the evidence-based prescribing advice provided by NICE (NICE, 2005), which relates only to the anti-depressants mirtazapine, amitriptyline and phenelzine. One adjunctive anti-psychotic (olanzapine) is suggested in the event of non- response to anti-depressants. No mention is made of psychotic symptoms or how to manage them, leaving clinicians to use their own judgement according to experience and skills. The lack of evidence-based guidance in these situations predicts substantial geographical variations in practice, and the potential for sub-optimal care. It is hoped that the updated NICE guideline for PTSD, planned for 2009, will reflect an evolution in our thinking about this disorder and use any available research to provide more evidence-based approaches. REFERENCES: NICE (2005) Post-traumatic stress disorder (PTSD): The management of PTSD in adults and children in primary and secondary care. CG26. NICE, London. World Health Organisation (1992) The ICD-10 Classification of Mental and Behavioural Disorders. WHO, Geneva.