I n v o l u n t a r y A d m i s s i o na n d P o s t t r a u m a t i cS t r e s sD i s o r d e r
S y m p t o m si n S c h i z o p h r e n i aP a t i e n t s
Stefan Pfiebe, Matthias Ardker, and Stefan Gunkel
In . empl€ of 105 codmunitY-@te p.tients suffering
from schizophrenia,the r€latioNhip botwoen reports
oainvoluntary ldmission in th. past, curent posttrau-
matic stress disordd IPTSDI symptoms. and other
aspects ol Fychopathology w.s examined. PTSD
symptons wereobt.ined onrhe PTSD interyiew, and
psychopathology was rat€d on th€ Bri€f Psychiatric
nating ScaleIBPRSIand onthe PresntStatoExamina-
rioo {PSEI.Fifty-sevenperce.t ol the p.tienb reported
th€y had experienced itrvoluntary admissions in the
DOs |l RAU\,{ATIC STRESS DISORDFR
I rPTSD/,rsdcfinrrJrnDS l lM
l , rD S \ 4 I I I R , -
r n d D 5 M l V , ' h r ' b ( ( n r u L n , lr o o . . u r f u l l " q r n S
diffcrc.t traumrlic experiences,including naluitl
catastrophcs.nccidenls, combat stress. polilical
persecudon.and torture.le Someauthorssuggested
r h d r , u l l c r i n Bl r o m . c h i / o p k e n i r m a ) b < : r $ o c i
atcd with lruumaticeventsthal subscqucntltled k)
' y m p r i ' m \ " i P I S D T r b u m . r r i c{ \ p { r i r n r c . i n
schizophr€niamay be causedby symptoms of rhe
psychotic illness, by lreltmcnt mcasures,o. by a
combination of bolh.rlrr In a casc rcpon. Shaner
r n d E ' h ' p u i n r ( d r o r h c p o r < n r i J l l )r ' r u m J I i .
naiurc of teniiying delusions and hallucinrlbDs
during the acutestlgc of schizophrcDia. Stanpfe.'"
proposed x theory that negative sympbms of
schizophreniamay be "manifestationsof r lrru
matic stress disorder lhat is fundamentally similar
i q r e m , o l r h ec l r n r c opl h e n o m e nr0n d p h o p h y c r -
ologicrl distu.bmce to chronic PTSD." Williams'
Kcelcr ci Nl.Ljrl$ noted r similarity bctween the
cxperienceofschizophrenir and that of PISD as a
result of combrt strcss.ud outlined implications
lbr psychosocialLrcahcnt of psrchotic patients.
In spile of ftese theoretical suggestions.litde
systemadcernpiricalresearchonthe relationshipof
schizophreniaand PTSD synptoms has been pub-
lished so far Mccorry e! al.'6examined24 schizo-
phrenia patientsand assessedthe level of PISD 4
I t.n th. D.purtnent ol lnn:tu] PD(hiutd, F.eie Unirtrtrtul
A.hres Epnn rcqrcns h PnJ Dr St4ar l,nebe, D.paa-
mentd Pst.h.lotittL MediLineSt Aaiho|new ! and thz
R.fal London S.h..l Dl Metli.ine, We! SnithJleu, IrtuLn
Copyisht 't 1998b, ll E. SuatuletsCon],a4y
a0I 0-110x9u3qu Nql 3aJ @n
Compt en"nsL e P" cn,Btr \ at.
paBt. Th. dsgreo of PTSD 3ymptoms was high-51%
lullilled the criteria tor a PTSD diagnosk. PTSDsymp-
toms w6re not correlated with repons of iovoluntary
admisions, fhey were, however, significantly co.re-
lated with the BPRSsubscaleanxiety/d.pre*ion, and
with PSE sub*ores lor sp.cific .nd nonspscilic nsu-
roric syndromes. Aecaose of an ovorlap ol iymptom
scor€s,. diagnGisot PTSD accordingto DSM criteri.
appearsto be very difiic!lt in schizophreni€parients.
Copvighta 199Aby WB. Saundeb Compah'r
nonths lnd I I months after dischrge from rcu€
hospital rrcatment. A total of46% and 35% of the
patjents, respectively, reported synptoms that ftrl
filled the diagnostic crileria of PTSD. A P'TSD
diagnosisand the level of PTSD symptoms werc
correlated wilh self-raled depressivesymptoms.
bu! not with .cgative symploms or the mode of
adnission. i.e., voluntary versus involuntary. Re
grding the intnsion symptoms, som€ palients
, l r ' c n b L d l h e i r r e r u l l < L L i oonf u e m e n r e \ ( m ' i n
nightmarei.suchds forced sedalionor seclusion.
This study is baied on the assumprion rhrt
involuntaryadmissionmay fulfiU the A criterbn of
PISD as defined in DSM. It can include forced
m c J r J I i o n .' c c l u . i u n .: l n du ' h u rc o m p u l ' u r yr e d r -
A..o'Jints r" rh. J.finitiun in
DSMJII'R i t i s o u t s ; d et h e . a n g eo f u s u r l h u m a n
experience and would be mdkedly dist.essingto
0lrnn.r J n y n n c A c c u r J i n gr " r h c D S \ ' r I V J c f i n i
tion of lhe A criterioD. involuntrry ldmissio. rnay
involve a threatto the physical integ.ity ofthe self,
and causean 'intensefbar,helptessness or honor"
In a srrnple of cornmunity-care paiients sufiering
f.om schizophrcnia,we investigabd(1) how nany.
i n d $ h i . h .p r r i H n r r. c p u ' l < dr ( p c r i L n r cu i i n ! u l u n -
tary admissxln in the p!st. (2) the lcvel of PISD
, y m p r o m .r n , l r ' r ef r e q u e n ( yn f P T S D , l i J g n ' ^ e 'i n
the whol€ sanple, (3) the associadonbelweenthe
experienceof involuntary adnnssionsin i\e past
and currem PTSD symploms, and (,1) the correla-
tion between PISD symploms and other aspectsof
psychopathology.
METHOD
The $udy w.s perfom€d in a comuniry{are system
seNinganinnerdistnctoi Be.lin,CemanyTte stsen i! run
 PTSOSYMPIOMS IN SCHIZOPHFEN
A 221

b] rhe Deprnmert ofsdit Prychi!ry athe FEie umvenitat T.ble r . Sociodemo s raphic a.d Clinic.l Ch.r.d€ridics ot
Bcrlini its featurcs have been described in mo.e d.tait clse Pdienrs Panicipatins inth.study.nd ol P.ri€d D'o9-oub
*here.rr All patienn eh. net rhe diqnostic crireia lbr
s.hl^phrcnir rcodrng to DsM III R, lnd *ho weE teared ir
tne cxE sysc wilhin I poiod ol I led, were !!ked io
panr.'pte nr the srudy. All patienu !.ve inlomdd consnr
b€Ibrc lnclusion in rhe study t l d P
S(r\lenroaraphic dxu. patients' history ind derrils lrom
pEvrou: psychiaric ftrthenL\ {cre ohlined i. a $rndddird
,nterview Pltienr werc rsked in derail abonr rvolunory
552v" 52.9% 62 l
,"ln' non! JnJ neB.ir.e. o rcl' 6 D.n"!r rFaune i e\p.n
33.6I 9.4 39.1r 115 ?3134 NS
P . v , h , ' o d h o l o . Lq J . , h . e F e r m r e d o n ' 1 . B n l P t t h r J " c
Rltiry Scrle (BPRSlre and on the PrcseniShre Examinahon
(PSE).ruPTSD synrprors r.rD asessd by the PISD l[e.
21Vh 251% .29 2
v'ew.:Ll. this inreNies. ihe scverityd litquency ofeach PTSD
synpton. as defined in DSM-]II-R, is nred on a scale irom l
(no ornever)to I (crtEnely or rlwayt Fordi.gnorins PISD,
elcb sldpkm rari.g wN dich,nonized using ir Godrwhxr or
cdnmo t) xs a curofr ponf A stmpbn Ns regtrdcd d
exNtent if rhe icore was >,1i rhc di.gdosis $as rhen nidc
rccodlng to DsM III R critena.The traunaric cv.nt wN ei6er
xn nvolun.rry adnsstun..r in cas patienB did nor toprh my
'nvoludtdr) adftssion. orhdr negativeaspectsoi hdJnenr rhlr
the pxiiena had erpenenced in Lhe psr according to the
stmdadized interiew. The imerviewer wd nor involved in rhe

RESULTS
Chdr.lcteristics oJ he Slmple
One hundredlolry p,Iicnls ful6lled dle inclusDn
criteria. Of these, 15 cilher did Dot agree ro
participatcin this study orcould notbe inrerviewed
bccause tbeir psychoparhologywas roo severe.
Sociodemographicdat4 the mern durarion since
d r s r h . \ p r t J l a J n , r . n o n .J n d h e n u m b e 'o f p r e rF Abbreviarion:NS, nonsignificant.
ous hospitalizntionsof those 35 padentsand the
remaiDing 105 patients thal w€re eJemined are
q ali6cadrn. living situation.occupationalshrus),
Patientsin fic study group had. on average,a clinical va.iables(fiequency of prcvious hospital,
b€tler school educationthan drop-outs, bur orhcr izations.duration since first adrnission,dosageof
difierenceslailed to reach sratisticalsignificlDce. currenr neurclepticmedicarion).or degreeof psy
The mcm BPRS roral scorc in rhe 105 srudied chopathologicalsymploms (BPRS total score and
patienlswas 32.0 (a8.6). The ne.rn PSEtoral score subscales. PSE toial scoreand subscores).
r 1 6 . ) n d r o m e5 c o r e J' g g r e 8 a r e $
J )a \ 2 2 2 r t a All palients,including thosewho did nor repon
involuntary admissions.did, however. repoft that
Invohoiart Almission they had experiencedncgativeasp€ctsoftreatment
Experienceof one or more involuntffy admrs- ; n r h ( p J . r . T h c ' . n e g J r i \ ea | e c r . I n c l u d e dt l o -
s'ons in the pasl wls reponed by 60 parienls.The lence:noiseiovercrowdingand monotonyon wards:
trnre e]lpsed sinc€ the last involunhry admission u*ind. risid, and fomal treatmenL and lack ot'
rMged from I to l59months (i11.4t 40.7 monhs) empathy and suppon in staff members. Patients
These60p.uients,and the other45 patien$ who did wi.h involunt:iryddmissionsreponedmore ofthese
not repofl rny involuntary addssions, showedno ncgaliveexperiencesthan patienrswithout involun-
statistically significant difference in sociodeno- t a r y a d m i s s i o n s( 9 . ' 7 | 4 . 1 , t - 6 . 6 4 , d f : 1 O 3 ,
graphic drh (age, gender,education.ptufcssional P < .001).
 PCifBE, BROKTq AND GUN<FI
222

Tabl.2, Co.i.|arions Stu en BPRS ScoB ftortl scort and

PTSD Sfmqtons .ub*.lerl, PSE Scor.s lloial $oE andsub*ore'l' 'nd PrsD
=
The tohl scorctbr PISD svmpfoms,as assessed Svfltlomt llotal score .nd .ub$or6) ln 105)

in thc inrervicw, ranged from 17 io 108

(56.1 1 18.9).By the symptomrutings,54 pahents
receivedthe diasnosisol FISD Patienrswith and
without involontary admissions in fte past hardl'\'
diffcr€d in their |otal score of T'ISD svmploms NS NS NS NS

( 5 6 . 6a 1 9 . 2! 5 5 . 4 1 1 8 . 6 )n o r i n t h e s u b s c o r e s
NS NS
( i n l r u s i o n s y m p t o m8! .1 I 5 2 ' 7 6 I 5 l l a v o r d
a n c es y m p b m s , 1 6 . 81 8 8 v 1 6 . 0 1 8 8 i a r o u s a l NS NS
s y m p l o m s1. 4 . 6 1 8 4 v 1 4 8 1 8 6 i I = 0 0 9 l o
O.49ieach not signilicant tNSl) The frequencvof .21. NS NS NS

PISD diagnosis wlts also similar in both groups

(Darientswith involuntaryadNission,489'; patients
= 05'1,
without involuniarv admission,569': X'
J/ L NS).
Pxtients lulfilling the criEna for PTSD were
more ofien unemployed than those not fullilling rhe
= I' P <o0r)
c r i t e r i a( 8 7 9 0, 6 5 9 . . X ? : ' 1 2 l . d f
No sociodemographicdata or psvchialric historv
variablesshowedany other strlistictllv significanr
differcncebclwecnthe lwo grcups.
NoTE. PoaGon'scordlations,rwo ta eo
Patientsin this study had r similar level of C
(avoidance)and D (increrseddousal ) svmplomsas
a s a m p l eu f J a P r u e n r ss u f i e n n gl r o m r n d u r i n g
0
m e n t r l' e q u c l i r e, ' l t o n u r ei n l r a n S ( h i / o p h t e n i d
p a u e n r s l ' i ' w e d .h o $ e \ c r ' r . l e a r l ) l o $ e ' d e g r e (
-
u l B ( i n r r u ' i u nt ,m p l o r r s ' l l 8 5 I t l o
r - 4h &at patienls and psychiatric slltff do not 'lwavs
r = 5 0, P < 001). ln the ['TSD inrerYrew'more asree as to whelher m admission or trea|menl w's
l Some
than half of the Patienlsshowedsvmploms tulfiI]- ol-i*st"reA involunhrilv or voluntrilv
*irn miEhl
ins the B (intrusion). C (avoidance).and D
(n- D J n e n r \ ' . l a r c m e noln\ I n \ o l u n r a r ay J r
creased arousal) criteria of PTSD " , ' L r c f l e c rr h e \ r c $ o f t h e ' u r f I n t o r \ e d o r t l e
Table 2 summarizes th€ correlations betlveen actual tegal status of the admission Plrlients're'
vfSD score Jnd subscoresBPRS totd score and ports of iraumaric events might bc rnfluencedbv
subscales,and PSE lotai scoreand subscores' .voidance dnd denial, and lhc timc elapsedsmce
Thc total score ol PISD svmptoms is signifi rhe rdmis.ion rried I'eatl) fuanerm"rc' trcuiD
cantly conclated to both BPRS and PSE total of symptons w,rs not controlled, and potentiallv
*ore' ln BPRS srb'(ale\' dn\rct!/del'e'sx'n u a u m r t r c . \ p e n ( n c e \ i n d e p ( n d e nl r " m p r ) f t u J l
clerly show the highest correlation wift PISD ric treatment have not been investiSaEd Such
symptoms.ln PSE subscores.the highestcorfela- problems and shoncomingsshould.be taken rnio
tions were ibund for specilic and nonspecrnc ecount when the data afe tnterpreieo
neurotrc syndromes.ln general.PISD sttbscales The lelel of PTSD svnptoms was surpnsinglv
of
avoidance and arousal arc slighrlv more ckxelv high in this sa'nple md was sinilar to a sample
associaledwilh other aspecF ot psychopathology vietnam war combat veleraos whose symprcms
'
than fie intrusion sYmptoms. were assessedby the same method ln general'il
was also similar to a group of prtients suffenng
DISCUSSION fiom enduringnenlal sequ€laeof torture in lran''"
More lhan haLf of lhe palients examined in tb's althoughlower in intrusion svmPloms'which mav
sludy reportederQericnceof one or more involun- be reeirded as the mosl specific group of PTSD
tary admissionsin the past These r€pods are not svrnoioms. Using a ratbcr conservdive cur-off
poini of a for each svnptom raling in tbe PISD
objectivedata,,nd sornestudieshavedemonstrated
 PTSD SYMPTOMS IN SCHIZOPHRENIA

223
i n l ( N r e $ .r n d i \ \ u m i n e L h r h e
A r n t e r i . , nr \ r l \ o rhecleveiopm€nt
r u t ' r I e dr $ h i \ h , , d , , L r b r f daJr. of SISD o.cudng after traumatic
l e : r , ri n r h o , ep a t r e n t \
":1 "A'1 inr'rrunra4 (suchascombarsrress),theseprocesscs
:"::li rdrru*ions
Lurju.r :v:nls
mnmly exptarnunspccificsympromsof
may
r t r g r r ' \ en s p ( , c lo\ l . r e J r m . n r ,<. oxiery ano
t o oo l . o n x r u n r D oepressron
c e .(tu_1ophretuaparcnr\ in ln schizophrenia.
rhi\ \rud! $,,ur.r Th€ rcsuks atso suggesrrtrat the
r q u f r J P I S D , t i a g n o , r .t , , , q j n g mture or rhe
fie uperuu.,ml. 'r 'n.:cli/oqh,en,J
rzcd cn icfla in DSM_III_R o ,fnr\,. crp,urer
byaI
'Thc (ll'r,'l
. r t e \ a p p l F di n
r r c q u c n c )o r p r s D , ) m p , o m . t h i \ . r u d ) .J n J n { g d t i \ e . } m p r o m s
1 5n o , r \ \ o c l are not correlaredwirtr anxiety as
rro u h reton\ ,,f Invo,unrr,\ ncasured r! m1s
rdmr\,ion. Uur
"r "" m(Jns
e\crude
rhepo,.ibrr
li:,]ilsl
lngre ma)
) rhlr h n , f t t u . r o r . , , 1 , r r i n d r n S sc o u l d
be reJJ ro
tdrrenr\ h J \ c d r r e t o p e d P T S L ,r \
r \ u o r I n r o j u n l J OJ d m r \ \ i o n , r d , t t i c a t r \ \ o r rdr _ su:ge{ lhrr hJi ut .he pJlr.nr,
. n d r j. 5tuu} oo
A (un<r trnm p']sD
i n \ o t u n l b r ya J r r u , j o n , n d c u r c n l p o . . , b J vb e c J U . co l l r a u m , , u J
h o q e \ . r h a , n , r l b e e nr u u n d . se,c n,,,criciredin,,uInrenn $.
:lr.rJ:n:\^,I!,
-' 'i* 'rmprom\in rhesep:r,(nrsub,e_
rnu .In\otuntrD ailm,\on\ :'-"
mr) n.l berepuoe,r quen ) inUuen.e
J \ c i u . r n g h c h i S ht e \ e l o f p T S D . ) m p r n m , - r n rh( \ore\ of BiRS dnd pJt
rhc lrven rh,,pre\Jlen.e ui mSD rnot}lcr\rmpt(\, /r
sampte
PTSD \)mprom ,.orc: Jre ,rgnrti.Jnri! 'r.'cem\unljtet)rh 5t." ot J .rmpk.ol
(urre_ .chzo
, prur\nrJ pdlenlsIn rommunrtr
*,1 *'., rrom.,!hrrp.yrhopr rh;r,,sr\ cdre do:uif.J fiDm
rlllll,
rlrng\. JI rhc c,,n(,p, or FrsD is,p€(rhcd
p a n r c u t d fw i r h r h e B p R S , u b * u l < :,,: :,1,:,,
Q lor
.rn
rnxrel)/'lepresron and tr iri rhr .p.crnc reot'nned Lh(..eparienr,.A u\erut,Ji;sno,r\^l)
dnd non.pe. j
r 5D..r.cordingr,,rhei,per.ru,rnatrzca
c r n cn e u r o l c , ) n d r u r n cr. s r - e \ \ c d cirr..,,,r
i n r h ep \ L t , uJvr r K. ,e(m,h ,lt) po\srbte
snm.e\renl.rhi\o\cfldtor.ymprorn\5.or(\r\ore rn.Jhr/ophreniJ
r)mcr,rctlh ric5Jnc.)mpr.,m\.e.g..deprc.\ion pjrUent\br(ru.e ot lhr 5ub5rrn,irt
overtJD!l
o n y p e r a r i ' u , r rl .r e r \ \ c j . c d " n v e r ) ed on e.tubti.h(d \ rrc,
rmrt;r i,em. Inr< ipptr(\. jn p3flrcutcr.
, , ,' , r r r r u I n r c n r . $l n d I n
r h r B P R So r p S F , when .chr/,,phrenrJ
r e . p e c l r \ e l JT h u \ . \ o m e s ) m p l o m s "'. dom,ndreJ b) anrrery. rrepie*ion,
rh nrat b,j llTfly'*
and ^rh(r
'nrerprcteJJ\ ff un\p€rInc .r8n un\peciitc .)mpr,,m,.Wh,teo;r \rudy
or d ,chi/onhrem! rocuscdon thc potentialy traumatic
'fln-es. mr) nece,.aril) tea,Jro impac. or
hgher.c,,re. on LrrL. Involunlrr)rdmr5ron,.iunher
r I J U i ) I n p ( o m . .k . h o u t db e {uJre. michr(^
n o l c d .h o s e \ e r r h : r r prure lh( efiecr of rhe cxperi.nc.
nc nrghev c"nelarinn\oi fie or a.:ur. ,,
PISD ,vmor,,m ctu-unr.p,ychoric,yn,prom\. tn dn) cr\e,:d-
{ r n l o p t u e n i Ja : t d a l h L } vrnceoconceprj JndmcrhoJs:rre
t J 5 , e $ e do n B p R s ne(dedroe{Ju_
r n d P S L .T h i \ h n d i n p i . i n , i n e rnc.huu\chi/ophrcniJ p uentsrea..l{.,rhepulcn-
",rl ,".uri, r,,rn IrJrt' lrJumrrjr.rp.n.n.. "r .o*.,r.
rrcuoT] et ut. rnd Jo<. n^r .upp,,n ,r.",,n.u,
sl.mpier
n y p , , m e s rr,h . t n e 8 . L j \ e . v m t l o m , , , t . c h i r o n t r (!- mer.ur<,:rndof rerrit)ing\!mprum..
hnq hrrr
n r Jr r e m f f r i r \ r J r o n \ o r J J r , u r d . r coprng pro(c\c\ ma] bc um,cred b! cDAnirr\e
lhlr i\ .rrni]r ,u sofrrlrmprrrmcnr,. r,u
c h r o n r cP r s D l t r l e r . r e , i r n ; t r r Jndh,,$rhccomptex re,po,N(
plci,togic,r rc rraum,rlrJ
p , n c . . . e {' n r h ec ( p r r . n ( e , , r , c h i r o ; n r . . t u i e!fnl\ lcadsro .p(crrifor unsoecfi.
r;d in p rem\ur slmproms.
REFERENCES
I Anm r. -h! 4.,eJ,rn.
- .
I *:;il;;r; , ",1t.;:,;5*:j:;11.1:t:*lu.:,
nii,t:l:jy.ilJii{,.;,j:.;;;
_P!r.h

;1t1".."
D\M t D,a:1

2. An 4nn p\)chuhr A\d

I.n. DSM tll R Dron.

ili;:'il'lI;;;:J;{ai:;.;l;i;::;'";":'T:
r uli*'";l,l;i,i;i1.l;l*r,1".1:"::#tr
\ h e r i .n p r d , . r n c A . . , . r J , i o .
; ;, ;; ,;;.,",l,i:ilj:
j,:l l; I:;;1,:;H:^"; DsMt\ D,,".

+ van puner T. Emor, $H J;:;:,;i;#{.itl:t :)# 1ti:tflIt:;

TiJUmirr nturo.es,n \kh
\'{sokrdkru,. 3 F"rr.'c\' Ln,e lM pJ.,ua,md,roo)
A , . ; ; . ; ; . ; l ; : ; ' , : : ; ' 1 1. rrypJF..
:;fi; in po.,!..,nd,,.
.,_...rio r,.^ rr
ffi;:..;i''
 B F O T T qA N DC , \ f T /
PqIEAF

9 Pnebes,EsnailiS Longtrm menralaquelaeoltonuE P T q D . r n e i o nq . A n , I p r . h i " . D I ' r q . i r ) t 6 4 . . . 6 0 :/ e r

,nl' 'n \ lu .ee\"Frne." r \,.1 V.. Di l@1185.-
18 PriebeS. Cruyte6 T. The role of hdlpinsrlliancem
l0 JeffnesJJ The tiNrna oi b.in8 psychdtic: A oeglsted psychiatficcomuniry caG-A prcsp€crivenudr J Nen Meni
dl€nont tn. .Dnag.ment of ctuonic schizophtunia.Can D i s1 9 9 3 : l 8 l : 5 5525 7 .
PsychiatAssocI 1977i:2:199-205. 19 Overlll JE. Grhan DR. The Bnet PsychialrrRating
l l . A r n d cR - l . \ ' l c a o \S V . A i , l ' o f p . . c n , i r u a l . \ . J r e r . t , \ , i R c t 0 6 l . t 0 - o oq t r
r o $ - r op l - . cf . n ' r ' , e c l u , o r H o . o . o m L r P . . h .' r ) 20. \'ine JK. Coot€r JE, Sdrius N. Thc MeasuEmentand
1983i3.r:1052'105a. Ctrsihcntionof Psy.hixdcStnpbds. Crlbridge. MA,lln,
II H rriIK V,r,, ) lPKo.,lH.SJ\niJer:1.Hv,pi'J.
& , 1 , h i p h ' d i . p : ' : . n '\ . u . ' b o r - c l d , i J nr a l F P . . r h . r :1. wa6on CC, JubaMB Mmlfold v. Kucrh T, Andcson
PED The I4SD incwiew: Rdn,mld.de$ripron, reliability.
l 1 S h r n cA' E r h< . r , h i , " p \ ' e n L c c u . rp o qr ' L n r ' ind conc0nentvalidnyof a DSM III basedtechnique. J Chn
stEssdisorder? Am J Psychorher 1939:41:588 597 Psy.holl99Li,17rl79-133.
1.1.Sunpfer HG. Ncgdivc sydrpronx': A cunulahve 22. lrrik$n Kl, we$rnrC-C.Ccrciveneuues in psycn!
u.un'J u.J dn rdrr 4rr \ 7J Pyh dO loon.?!.16':8 atric care. Repons md rcactioosof patientJ rnd oiher pcople
l ( w i l i J " . K r . l . ' L \ , {l i l e r H . I o r ' . B P . ) . \ , , . n a . involved.Actr P,sychiltrScand1995:92:245234
pr*rpnatin8 taum Ior PISD: A tEarnent staregy.Am J 2l BreslnuN. Davis CC. Andreskiq Petersoi E. Traunatic
Orthopsycbiat_v 1994i64:a9i r98. crenarnd postaunat. shss disord.ri..n Drbanpopulatron
16 Mccorry PD, Chdcn A, Mccdrihy E, Van Rrel R, of you.Bidults.ArchGenPsychi.q l99li48:218-222.
McKcMicD, SnrghAS.Posftraunatic sftss disorde.following 2.1. Nonis !N The epnGniology of taumr Frequencymd
recer!onserpsychosis. I NeryMentDis l99l;I19253 253 inprl .f differenrpotenrixllttuhrti. rven6 o. dftere
L _ .P n e b e s . B J u eMr l r r l l ' n r o . : c h o o p . ! . , 1 ' o n lf d.no8raphicgioups.J coNultctn Psychol192i60r409118