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Schaal S, Koebach A, Hinkel H, Elbert T. Posttraumatic stress disorder according to DSM-5 and DSM-IV diagnostic criteria: a comparison in a sample of Congolese ex-combatants. Eur J Psychotraumatol 2015; 6:24981. [PMID: 25720994 PMCID: PMC4342502 DOI: 10.3402/ejpt.v6.24981] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 01/15/2015] [Accepted: 01/22/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Compared to DSM-IV, the criteria for diagnosing posttraumatic stress disorder (PTSD) have been modified in DSM-5. OBJECTIVE The first aim of this study was to examine how these modifications impact rates of PTSD in a sample of Congolese ex-combatants. The second goal of this study was to investigate whether PTSD symptoms were associated with perpetrator-related acts or victim-related traumatic events. METHOD Ninety-five male ex-combatants in the eastern Democratic Republic of Congo were interviewed. Both the DSM-IV and the DSM-5 PTSD symptom criteria were assessed. RESULTS The DSM-5 symptom criteria yielded a PTSD rate of 50% (n=47), whereas the DSM-IV symptom criteria were met by 44% (n=42). If the DSM-5 would be set as the current "gold standard," then DSM-IV would have produced more false negatives (8%) than false positives (3%). A minority of participants (19%, n=18) indicated an event during which they were involved as a perpetrator as their most stressful event. RESULTS of a regression analysis (R (2)=0.40) showed that, after accounting for the number of types of traumatic events, perpetrated violent acts were not associated with the symptom severity of PTSD. CONCLUSIONS The findings demonstrate that more diagnostic cases were produced with the DSM-5 diagnostic rules than were dropped resulting in an increase in PTSD rates compared to the DSM-IV system. The missing association between PTSD symptoms and perpetrated violent acts might be explained by a potential fascinating and excited perception of these acts.
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Affiliation(s)
- Susanne Schaal
- Department of Psychology, University of Ulm, Ulm, Germany;
| | - Anke Koebach
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | | | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany
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Hecker T, Hermenau K, Maedl A, Hinkel H, Schauer M, Elbert T. Does perpetrating violence damage mental health? Differences between forcibly recruited and voluntary combatants in DR Congo. J Trauma Stress 2013; 26:142-8. [PMID: 23319373 DOI: 10.1002/jts.21770] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As a consequence of the ongoing conflict in the Democratic Republic of the Congo (DRC), combatants are constantly involved in various forms of violence. Findings concerning the impact of perpetrating violence on mental health are contradictory, ranging from increasing to buffering the risk for mental ill health. The present study investigated the impact of perpetrating violence on mental health. In total, 204 forcibly recruited and voluntary male combatants (mean age = 24.61 years) from different armed groups in the eastern DRC took part in the study. In a semistructured interview, respondents were questioned about appetitive aggression and posttraumatic stress disorder (PTSD) as well as self-experienced violence and self-perpetrated violent offending. A multivariate analysis of variance (η(2) = .23) revealed that voluntary combatants perpetrated more violent acts (η(2) = .06) and showed higher appetitive aggression η(2) = .03). A moderated multiple regression analysis (R(2) = .20) showed that perpetrating violence was positively related to PTSD in forcibly recruited combatants, but not in voluntary combatants. Thus, perpetrating violence may not necessarily qualify as a traumatic stressor. Further studies might consider assessing the combatant's perception of committing violent acts.
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Affiliation(s)
- Tobias Hecker
- Department of Psychology, University of Konstanz, Konstanz, Germany.
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Odenwald M, Hinkel H, Schauer E, Schauer M, Elbert T, Neuner F, Rockstroh B. Use of khat and posttraumatic stress disorder as risk factors for psychotic symptoms: A study of Somali combatants. Soc Sci Med 2009; 69:1040-8. [DOI: 10.1016/j.socscimed.2009.07.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Indexed: 11/15/2022]
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Odenwald M, Lingenfelder B, Schauer M, Neuner F, Rockstroh B, Hinkel H, Elbert T. Screening for posttraumatic stress disorder among Somali ex-combatants: a validation study. Confl Health 2007; 1:10. [PMID: 17822562 PMCID: PMC2020457 DOI: 10.1186/1752-1505-1-10] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 09/06/2007] [Indexed: 11/22/2022] Open
Abstract
Background In Somalia, a large number of active and former combatants are affected by psychological problems such as Posttraumatic Stress Disorder (PTSD). This disorder impairs their ability to re-integrate into civilian life. However, many screening instruments for Posttraumatic Stress Disorder used in post-conflict settings have limited validity. Here we report on development and validation of a screening tool for PTSD in Somali language with a sample of ex-combatants. Methods We adapted the Posttraumatic Diagnostic Scale (PDS) to reflect linguistic and cultural differences within the Somali community so that local interviewers could be trained to administer the scale. For validation purposes, a randomly selected group of 135 Somali ex-combatants was screened by trained local interviewers; 64 of them were then re-assessed by trained clinical psychologists using the Composite International Diagnostic Interview (CIDI) and the Self-Report Questionnaire (SRQ-20). Results The screening instrument showed good internal consistency (Cronbach's α = .86), convergent validity with the CIDI (sensitivity = .90; specificity = .90) as well as concurrent validity: positive cases showed higher SRQ-20 scores, higher prevalence of psychotic symptoms, and higher levels of intake of the local stimulant drug khat. Compared to a single cut-off score, the multi-criteria scoring, in keeping with the DSM-IV, produced more diagnostic specificity. Conclusion The results provide evidence that our screening instrument is a reliable and valid method to detect PTSD among Somali ex-combatants. A future Disarmament, Demobilization and Reintegration Program in Somalia is recommended to screen for PTSD in order to identify ex-combatants with special psycho-social needs.
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Affiliation(s)
- Michael Odenwald
- University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany
- vivo international, Ancona, Italy
| | - Birke Lingenfelder
- University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany
| | - Maggie Schauer
- University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany
- vivo international, Ancona, Italy
| | - Frank Neuner
- University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany
- vivo international, Ancona, Italy
| | - Brigitte Rockstroh
- University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany
- vivo international, Ancona, Italy
| | - Harald Hinkel
- GTZ International Services, Addis Abbeba, Ethiopia, and The World Bank MDRP (Multi-Country Demobilization and Reintegration Program of the Greater Great Lakes Region in Africa), Goma, Democratic Republic of Congo
| | - Thomas Elbert
- University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany
- vivo international, Ancona, Italy
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Odenwald M, Neuner F, Schauer M, Elbert T, Catani C, Lingenfelder B, Hinkel H, Häfner H, Rockstroh B. Khat use as risk factor for psychotic disorders: a cross-sectional and case-control study in Somalia. BMC Med 2005; 3:5. [PMID: 15707502 PMCID: PMC554104 DOI: 10.1186/1741-7015-3-5] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Accepted: 02/12/2005] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of khat-induced psychotic disorders in East African countries, where the chewing of khat leaves is common. Its main psycho-active component cathinone produces effects similar to those of amphetamine. We aimed to explore the prevalence of psychotic disorders among the general population and the association between khat use and psychotic symptoms. METHODS In an epidemiological household assessment in the city of Hargeisa, North-West Somalia, trained local interviewers screened 4,854 randomly selected persons from among the general population for disability due to severe mental problems. The identified cases were interviewed based on a structured interview and compared to healthy matched controls. Psychotic symptoms were assessed using the items of the WHO Composite International Diagnostic Interview and quantified with the Positive and Negative Symptoms Scale. Statistical testing included Student's t-test and ANOVA. RESULTS Local interviewers found that rates of severe disability due to mental disorders were 8.4% among males (above the age of 12) and differed according to war experiences (no war experience: 3.2%; civilian war survivors: 8.0%; ex-combatants: 15.9%). The clinical interview verified that in 83% of positive screening cases psychotic symptoms were the most prominent manifestations of psychiatric illness. On average, cases with psychotic symptoms had started to use khat earlier in life than matched controls and had been using khat 8.6 years before positive symptoms emerged. In most cases with psychotic symptoms, a pattern of binge use (> two 'bundles' per day) preceded the onset of psychotic symptoms, in contrast to controls of the same age. We found significant correlations between variables of khat consumption and clinical scales (0.35 to 0.50; p < 0.05), and between the age of onset of khat chewing and symptom onset (0.70; p <0.001). CONCLUSION Evidence indicates a relationship between the consumption of khat and the onset of psychotic symptoms among the male population, whereby not the khat intake per se but rather early onset and excessive khat chewing seemed to be related to psychotic symptoms. The khat problem must be addressed by means other than prohibition, given the widespread use and its role in Somali culture.
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Affiliation(s)
- Michael Odenwald
- Department of Psychology, University of Konstanz, Fach D25, D-78476 Konstanz, Germany
- Outpatient Clinic for Refugees, University of Konstanz, Feursteinstr. 55, Haus 22, D-78479 Reichenau, Germany
| | - Frank Neuner
- Department of Psychology, University of Konstanz, Fach D25, D-78476 Konstanz, Germany
- Outpatient Clinic for Refugees, University of Konstanz, Feursteinstr. 55, Haus 22, D-78479 Reichenau, Germany
- Ctr. for Psychiatry Reichenau (ZPR), Feursteinstr.55, D-78479 Reichenau, Germany
| | - Maggie Schauer
- Department of Psychology, University of Konstanz, Fach D25, D-78476 Konstanz, Germany
- Outpatient Clinic for Refugees, University of Konstanz, Feursteinstr. 55, Haus 22, D-78479 Reichenau, Germany
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Fach D25, D-78476 Konstanz, Germany
- Outpatient Clinic for Refugees, University of Konstanz, Feursteinstr. 55, Haus 22, D-78479 Reichenau, Germany
- Ctr. for Psychiatry Reichenau (ZPR), Feursteinstr.55, D-78479 Reichenau, Germany
| | - Claudia Catani
- Outpatient Clinic for Refugees, University of Konstanz, Feursteinstr. 55, Haus 22, D-78479 Reichenau, Germany
| | - Birke Lingenfelder
- Department of Psychology, University of Konstanz, Fach D25, D-78476 Konstanz, Germany
| | - Harald Hinkel
- Worldbank, Multi-Country Demobilization and Reintegration Program in the greater Great Lakes Region of Africa, Goma, Democratic Republic of Congo
| | - Heinz Häfner
- AG Schizophrenieforschung, Zentralinstitut für Seelische Gesundheit, J5, D-68159 Mannheim, Germany
| | - Brigitte Rockstroh
- Department of Psychology, University of Konstanz, Fach D25, D-78476 Konstanz, Germany
- Outpatient Clinic for Refugees, University of Konstanz, Feursteinstr. 55, Haus 22, D-78479 Reichenau, Germany
- Ctr. for Psychiatry Reichenau (ZPR), Feursteinstr.55, D-78479 Reichenau, Germany
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Ben Khalifa R, Stankiewicz M, Pelhate M, Serrano-Hernandez SE, Possani LD, Hinkel H, Mebs D. Action of babycurus-toxin 1 from the east African scorpion Babycurus centrurimorphus on the isolated cockroach giant axon. Toxicon 1997; 35:1069-80. [PMID: 9248005 DOI: 10.1016/s0041-0101(96)00221-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A toxin named babycurus-toxin 1 (mol. wt 8191), from telson extracts of the scorpion Babycurus centrurimorphus, was found to depolarize the cockroach giant axon. It progressively blocked the evoked action potentials after a short period of limited repetitive activity and after 30 min of toxin action it became impossible to evoke responses to current stimulations. Voltage-clamp experiments on the sodium current indicated that the toxin in micromolar concentrations progressively decreased the transient inward peak sodium current, but also slowed the activation phase of this sodium current and maintained an inward current during the voltage pulses, which deactivated slowly. The toxin also induced in the insect axon a slowly activating-deactivating component of the sodium current. This suggests that the toxin modifies both activation and inactivation mechanisms of sodium channels. Thus there is some similarity in the electrophysiological effects between BcTx1 and the beta-toxins active on mammals.
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Affiliation(s)
- R Ben Khalifa
- Laboratory of Neurophysiology, CNRS EREA 120, Faculty of Medicine, University of Angers, France
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Nussbaum RA, Hinkel H. Revision of East African Caecilians of the Genera Afrocaecilia Taylor and Boulengerula Tornier (Amphibia: Gymnophiona: Caeciliaidae). COPEIA 1994. [DOI: 10.2307/1447192] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hinkel H. [On some connections between consequences of traffic accidents and the sex of the involved persons]. Dtsch Gesundheitsw 1968; 23:125-32. [PMID: 5682387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Hinkel H, Roth G. [On some connections between the consequences of traffic accidents and local factors]. Dtsch Gesundheitsw 1967; 22:1948-56. [PMID: 5601592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Lengwinat A, Hinkel H. [On the relationship between sequelae of accidents and the type of traffic involved]. Dtsch Gesundheitsw 1967; 22:1556-65. [PMID: 5596778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Hinkel H. [On the effect of temporal conditions on occurrence and results of traffic accidents]. Dtsch Gesundheitsw 1967; 22:466-72. [PMID: 5587078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Schöpf C, Benz G, Braun F, Hinkel H, Rokohl R. Die Kondensation von Δ1-Piperidein mit Acetondicarbonsäure und Formaldehyd. Angew Chem Int Ed Engl 1953. [DOI: 10.1002/ange.19530650605] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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