Involuntary Admission and Posttraumatic Stress Disorder Symptoms in Schizophrenia Patients Stefan Priebe, Matthias Br6ker, and Stefan Gunkel In a sample of 105 community-care patients suffering from schizophrenia, the relationship between reports of involuntary admission in the past, current posttrau- matic stress disorder (PTSD) symptoms, and other aspects of psychopathology was examined. PTSD symptoms were obtained on the PTSD interview, and psychopathology was rated on the Brief Psychiatric Rating Scale (BPRS) and on the Present State Examina- tion (PSE). Fifty-seven percent of the patients reported they had experienced involuntary admissions in the past. The degree of PTSD symptoms was high--51% fulfilled the criteria for a PTSD diagnosis. PTSD symp- toms were not correlated with reports of involuntary admissions. They were, however, significantly corre- lated with the BPRS subscale anxiety/depression, and with PSE subscores for specific and nonspecific neu- rotic syndromes. Because of an overlap of symptom scores, a diagnosis of PTSD according to DSM criteria appears to be very difficult in schizophrenia patients. Copyright © 1998 by W.B. Saunders Company p OSTTRAUMATIC STRESS DISORDER (PTSD), as defined in DSM-III, l DSM-III-R, 2 and DSM-IV? has been found to occur following different traumatic experiences, including natural catastrophes, accidents, combat stress, political persecution, and torture. 4-9 Some authors suggested that suffering from schizophrenia may be associ- ated with traumatic events that subsequently lead to symptoms of PTSD. Traumatic experiences in schizophrenia may be caused by symptoms of the psychotic illness, by treatment measures, or by a combination of both. 10-12 In a case report, Shaner and Eth ~3 pointed to the potentially traumatic nature of terrifying delusions and hallucinations during the acute stage of schizophrenia. Stampfer TM proposed a theory that negative symptoms of schizophrenia may be "manifestations of a trau- matic stress disorder that is fundamentally similar in terms of the clinical phenomena and pathophysi- ological disturbance to chronic PTSD." Williams- Keeler et al. 15 also noted a similarity between the experience of schizophrenia and that of PTSD as a result of combat stress, and outlined implications for psychosocial treatment of psychotic patients. In spite of these theoretical suggestions, little systematic empirical research on the relationship of schizophrenia and PTSD symptoms has been pub- lished so far. McGorry et al.16 examined 24 schizo- phrenia patients and assessed the level of PTSD 4 From the Department of Social Psychiatry, Freie Universitiit Berlin, Berlin, Germany. Address reprint requests to Prof Dr. Stefan Priebe, Depart- ment of Psychological Medicine, St. Bartholomew's and the Royal London School of Medicine, West Smithfield, London ECIA 7BE, UK. Copyright © 1998 by W.B. Saunders Company 0010-440X/98/3904-0003503.00/0 months and 11 months after discharge from acute hospital treatment. A total of 46% and 35% of the patients, respectively, reported symptoms that ful- filled the diagnostic criteria of PTSD. A PTSD diagnosis and the level of PTSD symptoms were correlated with self-rated depressive symptoms, but not with negative symptoms or the mode of admission, i.e., voluntary versus involuntary. Re- garding the intrusion symptoms, some patients described their recollection of treatment events in nightmares, such as forced sedatiort or seclusion. This study is based on the assumption that involuntary admission may fulfill the A criterion of PTSD as defined in DSM. It can include forced medication, seclusion, and other compulsory treat- ment measures. According to the definition in DSM-III-R it is "outside the range of usual human experience and would be markedly distressing to almost anyone." According to the DSM-IV defini- tion of the A criterion, involuntary admission may involve a threat to the physical integrity of the self, and cause an "intense fear, helplessness or horror" in the patient. 17 In a sample of community-care patients suffering from schizophrenia, we investigated (1) how many, and which, patients reported experience of involun- tary admission in the past, (2) the level of PTSD symptoms and the frequency of PTSD diagnoses in the whole sample, (3) the association between the experience of involuntary admissions in the past and current PTSD symptoms, and (4) the correla- tion between PTSD symptoms and other aspects of psychopathology. METHOD The study was performed in a community-care system serving an inner district of Berlin, Germany. The system is run 220 Comprehensive Psychiatry, Vol. 39, No. 4 (July/August), 1998: pp 220-224