Neuropsychological issues in the assessment of refugees and victims of mass violence

Department of Psychiatry, Beth Israel-Deaconess Hospital-East Boston, Massachusetts 02115, USA.
Neuropsychology Review (Impact Factor: 4.59). 10/2001; 11(3):131-41. DOI: 10.1023/A:1016650623996
Source: PubMed


Brain injury, stressor severity, depression, premorbid vulnerabilities, and PTSD are frequently intertwined in trauma populations. This interaction is further complicated when the neuropsychologist evaluates refugees from other cultures. In addition, the observed psychiatric symptoms reported in refugees and victims of mass violence may in fact not be the primary features of PTSD and depression but psychiatric symptoms secondary to the effects of traumatic brain injury. This paper reviews the occurrence of starvation, torture, beatings, imprisonment, and other head injury experiences in refugee and POW populations to alert treators to the presence of chronic and persistent neuropsychiatric morbidity, with implications for psychosocial adjustment. The concept of fixed neural loss may also interact with environmental and emotional stresses, and a model of neuropsychological abnormalities triggered by traumatic events and influenced by subsequent stress will also be considered. Neuropsychologists working with refugees play an important role in assessing the possibility of traumatic brain injury with tools that are relatively culture-fair.

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    ABSTRACT: Abstract S√łndergaard, Hans Peter (2002): Post-traumatic stress disorder and life events among recently resettled refugees. Stockholm, Sweden. Karolinska Institutet, Department of Public Health Sciences, Division of Psychosocial Factors and Health. ISBN 91-7349-318-X. Background In refugee health, one topic is the importance of posttraumaticstress disorder (PTSD) from a public health point of view. The present study was initiated in order to study the prevalence of PTSD through structured assessment in a group of recently resettled refugees, and to study important classes of present life events and their interaction with health by means of qualitative and quantitative methods as well as hormonal markers. Further, associations between traumatisation, PTSD and alexithymia were of interest. Subjects and methods Participants eligible for the study were every fourth 18-48 years old recently resettled
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    ABSTRACT: Purpose of review: In recent years, sequels to torture as a specific and frequent form of social violence have become a major focus of research and clinical practice. A shift in attention from physical to short and long-term sequels has been followed by a large number of studies that have demonstrated sequels to be highly prevalent in different populations and that the scale of the problem has been underestimated before. The review focuses on forensic aspects of political torture. Recent findings: Studies published over the last years are characterized by the increasing use of structured criteria and interviews, but also by a growing understanding of torture as a phenomenon that is embedded in other negative live events and culture-dependent reactions that might contribute to the severe suffering of many survivors. This makes forensic evaluation but also rehabilitation a complex challenge. Epidemiological studies underline that torture and persecution-related sequels are partly covered by the post-traumatic stress disorder concept, but a too narrow focus on the combination of this causal link and torture as an isolated act might not do justice to all factors. The lack of integration of psychological with psychophysiological imaging and somatic findings reflects the present focus on epidemiological approaches that are necessary for a culture-sensitive and community-oriented approach to support the victims, but require an additional focus in future forensic research. Summary: Forensic evaluation of sequels to torture is still a developing field in spite of excellent recent studies. Psychiatrists must be careful to avoid retraumatization and respect the survivor, while following an open approach to the possible complex physical and psychological sequels that cannot be reduced to a simple universal model.
    Current Opinion in Psychiatry 10/2002; 15(6):611-615. DOI:10.1097/00001504-200211000-00009 · 3.94 Impact Factor
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