March 2017

Derek K. Tracy, Dan W. Joyce, Sukhwinder S. Shergill

Full textThe British Journal of Psychiatry Mar 2017, 210 (3) 237-238; DOI: 10.1192/bjp.210.3.237

There’s been a zombie outbreak in Gotham City. Before you yell for Batman, the culprit is a novel psychoactive substance (‘legal high’ to use the incorrect but problematically enduring term). The law in the UK changed in 2016, banning all psychoactive agents, including those not yet synthesised. How effective this will be has yet to be seen. So-called ‘headshops’ are shutting down; do you regard that as good news? Well, now if young people want to purchase legal highs, they’ve to go back to meeting a guy on a BMX bike with a knife in his pocket in a field at night – a pyrrhic victory perhaps. Problematically, with over 500 novel agents, science and clinical practice are only coming to terms with NPS, and some of the novel cannabis-like variants are being identified as ‘ultra-potent’. Kaleidoscope picks up on a paper that describes a so-called ‘zombie outbreak’ in New York, named after the highly depressant effects of a specific new agent identified, with drug consumers looking like the evil dead as they stagger along the streets. Long term concerns about potential impact on younger users continue.

Which factors predict the development of post-traumatic stress disorder (PTSD) following exposure to a trauma? There are growing data that interpersonal traumas, such as a sexual assault, are more damaging than non-interpersonal ones, such as road traffic accidents. The issue of individual predisposition has also attracted much attention: why, when faced with a similar trauma, do some but not others develop this condition? Problematically, much of the existing literature has had quite small sample sizes. Now a large study has utilised data from almost 35,000 participants in a World Health Organisation survey. Fitting with precipitating trauma data, a past history of violent traumas – but not other types – sensitises one to having later life PTSD triggered by subsequent events. The work also found an unexpectedly low prevalence of PTSD after natural disasters, and the authors argue that some past smaller studies suffered unintentional biases by focusing primarily on highly traumatised subpopulations. Fascinatingly, taking part in sectarian violence was associated with a reduced risk of developing PTSD. Before you take to the streets rampaging and pillaging, telling the police that we said it would ‘help your mental health’, the data support what is known as a ‘healthy warrior’ effect: in other words, the type of meat-head who engages in violence in the first place seems to be more immune to developing the condition. I’m sure they’ll face other karmic repayments.