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Psychological and Physiological Trauma Research
Seize Your Journeys
_______________________ Traumatic stress is found in many competent, healthy, strong, good people. No one can completely protect themselves from traumatic experiences. Many people have long-lasting problems following exposure to trauma. Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy. What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences. Having symptoms after a traumatic event is NOT a sign of personal weakness. Given exposure to a trauma that is bad enough, probably all people would develop PTSD. By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment. _______________________
FUNCTIONAL NEUROANATOMY In order to best understand this atlas it is important to have a sense of the functional neuroanatomy of the brain. Over the next several pages there is a brief summary of the 5 major brain systems that relate to behavior, along with the general location seen on SPECT of these areas.
The Deep Limbic System
Functions
Problems
The Basal Ganglia System
Functions
Problems
The Prefrontal Cortex
Functions
Problems
The Cingulate Gyrus
Problems
The Temporal Lobes
Functions
Problems
Non-dominant Side (usually the right)
Secure Attachments as a Defense Against Trauma “All people mature and thrive in a social context that has profound effects on how they cope with life’s stresses. Particularly early in life, the social context plays a critical role in fuffering an individual against stressful situations, and in building the psychological and biological capacities to deal with further stresses. The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning, and resting—in short, by teaching them skills that will gradually help them modulate their own arousal. Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults (Finkelhor & Browne, 1984). In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long-term damage (McFarlane, 1988).” van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996. Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York and London: Guilford Press. .p. 185 _______________________
Sleep Disorders
“The sleep disorders are organized into four major sections according to presumed etiology. Primary Sleep Disorders are those in which none of the etiologies listed below (i.e., another mental disorder, a general medical condition, or a substance) is responsible. Primary Sleep Disorders are presumed to arise from endogenous abnormalities in sleep-wake generating or timing mechanisms, often complicated by conditioning factors. Primary Sleep Disorders in turn are divided into Dyssomnias (characterized by abnormalities in the amount, quality, or timing of sleep) and Parasomnias (characterized by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-awake transitions). Sleep Disorder Related to Another Mental Disorder involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder (often a Mood Disorder or Anxiety Disorder) but that is sufficiently severe to warrant independent clinical attention. Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-awake regulation. Sleep Disorder Due to a General Medical Condition involves a prominent complaint of sleep disturbance that results from the direct physiological effects of a general medical condition on the sleep-wake system. Substance-Induced Sleep Disorder involves prominent complaints of sleep disturbance that result from the concurrent use, or recent discontinuation of use, of a substance (including medications). That systematic assessment in individuals who present with prominent complaints of sleep disturbance includes an evaluation of the specific type of sleep complaint and a consideration of concurrent mental disorders, general medical conditions, and substance (including medication) use that may be responsible for the sleep disturbance. Five distinct sleep stages can be measured by polysomnography: rapid eye movement (REM) sleep and four stages of non-rapid eye movement (NREM) sleep (stages 1, 2, 3, and 4). Stage 1 NREM sleep is a transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults. Stage 2 NREM sleep, which is characterized by specific EEG waveforms (sleep spindles and K complexes), occupies about 50% of time spent asleep. Stages 3 and 4 NREM sleep (also known collectively as slow-wave sleep) are the deepest levels of sleep and occupy about 10%-20% of sleep time. REM sleep, during which the majority of typical storylike dreams occur, occupies about 20%-25% of total sleep. These sleep stages have a characteristic temporal organization across the night. NREM stages 3 and 4 tend to occur in the first one-third to one-half of the night and increase in duration in response to sleep deprivation. REM sleep occurs cyclically throughout the night, alternating with NREM sleep about every 80-100 minutes. REM sleep periods increase in duration toward the morning. Human sleep also varies characteristically across the life span. After relative stability with large amounts of slow-wave sleep in childhood and early adolescence, sleep continuity and depth deteriorate across the adult age range. This deterioration is reflected by increased wakefulness and stage 1 sleep and decreased stages 3 and 4 sleep. Because of this, age must be considered in the diagnosis of a Sleep Disorder in any individual. Polysomnography is the monitoring of multiple electrophysiological parameters during sleep and generally includes measurement of EEG activity, electroculographic activity, and electromyographic activity. Additional polysomnographic measures may include oral or nasal airflow, respiratory effort, chest and abdominal wall movement, oxyhemoglobin saturation, or exhaled carbon dioxide concentration; these measures are used to monitor respiration during sleep and to detect the presence and severity of sleep apnea. Measurement of peripheral electromyographic activity may be used to detect abnormal movements during sleep. Most polysomnographic studies are conducted during the person’s usual sleeping hours—that is, at night. However, daytime polysomnographic studies also are used to quantify daytime sleepiness. The most common daytime procedure is the Multiple Sleep Latency Test (MSLT), in which the individual is instructed to lie down in a dark room and not resist falling asleep; this protocol is repeated fives times during the day. Sleep latency (the amount of time required to fall asleep) is measured on each trial and is used as an index of physiological sleepiness. The converse of the MSLT is also used: In the Repeated Test of Sustained Wakefulness (RTSW), the individual is placed in a quiet, dimly lit room and instructed to remain awake; this protocol is repeated several times during the day. Again, sleep latency is measured, but is it used here as an index of the individual’s ability to maintain wakefulness. Standard terminology for polysomnographic measures is used throughout the test in this section. Sleep continuity refers to the overall balance of sleep and wakefulness during a night of sleep. “Better” sleep continuity indicates consolidated sleep and wakefulness; “worse” sleep continuity indicates disrupted sleep with more wakefulness. Specific sleep continuity measures include sleep latency—the amount of time required to fall asleep (expressed in minutes); intermittent wakefulness—the amount of awake time after initial sleep onset (expressed in minutes); and sleep efficiency—the ratio of actual time spent asleep to time spent in bed (expressed as a percentage, with higher numbers indicating better sleep continuity). Sleep architecture refers to the amount and distribution of specific sleep stages. Sleep architecture measures include absolute amount of REM sleep and each NREM sleep stage (in minutes), relative amount of REM seep and NREM sleep stages (expressed as a percentage of total sleep time), and latency between sleep onset and the first REM period (REM latency). The text for each of the Sleep Disorders contains a section describing its relationship to corresponding disorders in The International Classification of Sleep Disorders: (ICSD) diagnostic and Coding Manual, published in 1990 by the American Sleep Disorders Association. _________________
Substance Dependence “Features The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior. A diagnosis of Substance Dependence can be applied to every class of substances except caffeine. The symptoms of Dependence are similar across the various categories of substances, but for certain classes some symptoms are less salient, and in a few instances not all symptoms apply (e.g., withdrawal symptoms are not specified for Hallucinogenic Dependence). Although not specifically listed as a criterion item, “craving” (a strong subjective drive to use the substance) is likely to be experienced by most (if not all) individuals with Substance Dependence. Dependence is defined as a cluster of three or more of the symptoms listed below occurring at any time in the same 12-month-period. Tolerance (Criterion 1) is the need for greatly increased amounts of the substance to achieve intoxication (or the desired effect) or a markedly diminished effect with continued use of the same amount of the substance. The degree to which tolerance develops varies greatly across substances. Furthermore, for a specific drug, varied degrees of tolerance may develop for its different central nervous system effects. For example, for opioids, tolerance to respiratory depression and tolerance to analgesia develop at different rates. Individuals with heavy use of opioids and stimulants can develop substantial (e.g., 10-f0ld) levels of tolerance, often to a dosage that would be lethal to a nonuser. Alcohol tolerance can also be pronounced, but is usually less extreme than for amphetamine. Many individuals who smoke cigarettes consume more than 20 cigarettes a day, an amount that would have produced symptoms of toxicity when they first started smoking. Individuals with heavy use of cannabis or phencyclidine (PCP) are generally not aware of having developed tolerance (although it has been demonstrated in animal studies and in some individuals). Tolerance may be difficult to determine by history alone when the substance used is illegal and perhaps mixed with various diluents or with other substances. In such situations, laboratory tests may be helpful (e.g., high blood levels of the substance coupled with little evidence of intoxication suggest that tolerance is likely). Tolerance must also be distinguished from individual variability in the initial sensitivity to the effects of particular substances. For example, some first-time drinkers show very little evidence of intoxication with three or four drink, whereas others of similar weight and drinking histories had slurred speech and incoordination. Withdrawal (Criterion 2a) is a maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. After developing unpleasant withdrawal symptoms, the persons is likely to take the substance to relieve or to avoid those symptoms (Criterion 2b), typically using the substance throughout the day beginning soon after awakening. Withdrawal symptoms, which are generally the opposite of the acute effects of the substance, vary greatly across the calluses of substances, and separate criteria sets for Withdrawal are provided for most of the classes. Marked and generally easily measured physiological signs of withdrawal are common with alcohol, opioids, and sedatives, hypnotics, and anxiolytics. Withdrawal signs and symptoms are often present, but may be less apparent, with stimulants such as amphetamines and cocaine, as well as with nicotine and cannabis. No significant withdrawal is seen even after repeated use of hallucinogens. Withdrawal from phencyclidine and related substances has not yet been described in humans (although it has been demonstrated in animals). Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of Substance Dependence. However, for most classes of substances, a past history of tolerance or withdrawals is associated with a more severe clinical course (i.e., an earlier onset of Dependence, higher levels of substance intake, and a greater number of substance-related problems). Some individuals (e.g., those with Cannabis Dependence) show a pattern of compulsive use without obvious signs of tolerance or withdrawal. Conversely, some general medical and postsurgical patients without Opioid Dependence may develop a tolerance to prescribed opioids and experience withdrawal symptoms without showing any signs of compulsive use. The specifiers With Physiological Dependence and Without Physiological Dependence are provided to indicate the presence or absence of tolerance or withdrawal. The following items describe the pattern of compulsive substance use that is characteristic of Dependence. The individual may take the substance in larger amounts or over a longer period than was originally intended (e.g., continuing to drink until severely intoxicated despite having set a limit of only one drink) (Criterion 3). The individual may express a persistent desire to cut down or regulate substance use. Often, there have been many unsuccessful efforts to decrease or discontinue use (Criterion 4). The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects (Criterion 5). In some instances of Substance Dependence, virtually all of the person’s daily activities revolve around the substance. Important social, occupational, ore recreational activities may be given up or reduced because of substance use (Criterion 6). The individual may withdraw from family activities and hobbies in order to use the substance in private or to spend more time with substance-using friends. Despite recognizing the contributing role of the substance to a psychological or physical problem (e.g., sever depressive symptoms or damage to organ systems), the person continues to use the substance (Criterion 7). The key issue in evaluating this criterion is not eh existence of the problem, but rather the individual’s failure to abstain from using the substance despite having evidence of the difficulty it is causing.
Specifiers Tolerance and withdrawal may be associated with a higher risk for immediate general medical problems and a higher relapse rate. Specifiers are provided to note their presence or absence: With Physiological Dependence. This specifier should be used when Substance Dependence is accompanied by evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). Without Physiological Dependence. This specifier should be used when there is no evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). In these individuals, Substance Dependence is characterized by a pattern of compulsive use (at least three items from Criteria 3-7).”
Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. P. 193-195.
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PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com __________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373
Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association.
________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373 Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. ________________ DID-PTSD-EMDR Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com
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NeuroBiology of Trauma
ADHD and PTSD
Title: Cognitive therapy with children and adolescents: A casebook for clinical practice (2nd ed.). Author(s): Reinecke, Mark A. , (Ed), Northwestern U, Feinberg School of Medicine, Div of Psychology, Evanston, IL, US
Dattilio, Frank M. , (Ed), Harvard U Medical School, Dept of Psychiatry, Boston, MA, US
Freeman, Arthur , (Ed), Philadelphia Coll of Osteopathic Medicine, Dept of Psychology, Philadelphia, MA, US Source: New York, NY, US: Guilford Press, 2003. xviii, 476 pp. ISBN: 1-57230-853-2 (hardcover) Language: English Key Concepts: cognitive-behavioral therapy; psychotherapeutic processes; child psychology; adolescent psychology Abstract: (from the publicity materials) Now in a revised and updated second edition, this clinically oriented casebook and text presents empirically supported interventions for a wide range of child and adolescent problems. Leading cognitive-behavioral therapists demonstrate assessment and treatment approaches that have been carefully adapted--or specially designed--to meet the needs of young patients. Incorporating the latest, most innovative techniques, the volume reflects significant recent advances in knowledge about vulnerability and resilience, processes of change, and treatment effectiveness. Following a consistent format, each chapter reviews the relevant literature and presents an extended case example bringing to life what an experienced therapist might do, why, and how to do it. With new chapters on OCD, personality disorders, and social anxiety, the casebook also addresses oppositional behavior, ADHD, substance abuse and dependence, depression, sexual abuse, high-functioning autism, PTSD, and other frequently encountered clinical challenges. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Adolescent Psychology; *Child Psychology; *Cognitive Behavior Therapy Classification: Cognitive Therapy (3311) Population: Human (10) Age Group: Childhood (birth-12 yrs) (100)
Adolescence (13-17 yrs) (200) Intended Audience: Psychology: Professional & Research (PS) Publication Type: Edited Book (140); Print Release Date: 20031027 Accession Number: 2003-06804-000
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Record: 2
Title: Stimulant treatment in children and adolescents with and without Attention Deficit-Hyperactivity Disorder in a state mental health care system: Effects of caregiver functioning, comorbidity, and severity of symptoms. Author(s): Abraham, Melissa Ellen , Northwestern U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(4-B), Oct 2002. pp. 2047. Publisher: US: Univ Microfilms International
ISSN: 0419-4217 (Print) Order Number: AAI3050480 Language: English Key Concepts: stimulant treatment; ADHD; children; adolescents; caregiver functioning; psychiatric comorbidity; severity Abstract: Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood disorder that has engendered much media coverage and public debate. The primary focus of the public debate is whether stimulant medication is prescribed to children who do not need it, or not prescribed to children in whom it is indicated. The present study uses a stratified, randomly selected sample of 1592 children and adolescents in a statewide mental health system to examine the relationship of ADHD diagnosis, psychiatric comorbidity, caregiver functioning, and other measures, to stimulant medication prescribing patterns. The sample includes children and adolescents from a variety of program types, across a range of traditional and community-based care levels, who have diverse demographic and diagnostic profiles. Logistic regression stratified by program type demonstrated that children with ADHD who do not receive stimulant treatment for this disorder have fewer caregiver resources, are less likely to be in the custody of child welfare, and are less likely to have a comorbid diagnosis of PTSD than those who do receive stimulant medication. Children without ADHD but who receive stimulant treatment are more likely to be male, older, have indications of attention or impulsivity problems, have a diagnosis of oppositional defiant disorder or another disruptive behavior disorder, and have more difficulties in caregiver functioning than children who appropriately do not receive stimulant medications without a diagnosis of ADHD. The implications of these findings are discussed in terms of clinical decision-making and future research. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder with Hyperactivity; *Caregivers; *CNS Stimulating Drugs; *Comorbidity; *Severity (Disorders)
Classification: Health & Mental Health Treatment & Prevention (3300) Population: Human (10) Age Group: Childhood (birth-12 yrs) (100) Form/Content Type: Empirical Study (0800) Publication Type: Dissertation Abstract (350); Print
Format(s) Available: Print Release Date: 20030303 Accession Number: 2002-95020-209
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Record: 3
Title: Reliability and validity of the Turkish version of the Adolescent Dissociative Experiences Scale. Author(s): Zoroglu, Suleyman Salih , Gaziantep U Faculty of Medicine, Dept of Child & Adolescent Psychiatry, Gaziantep, Turkey, zoroglus@hotmail.com
Sar, Vedat , Istanbul U, Dept of Psychiatry, Clinical Psychotherapy Unit, Dissociative Disorders Program, Istanbul, Turkey
Tuzun, Umran , Istanbul U, Dept of Child & Adolescent Psychiatry, Istanbul, Turkey
Tutkun, Hamdi , Gaziantep U Faculty of Medicine, Dept of Psychiatry, Gaziantep, Turkey
Savas, Haluk Asuman , Gaziantep U Faculty of Medicine, Dept of Psychiatry, Gaziantep, Turkey Address: Zoroglu, Suleyman Salih, Gaziantep U, Tip Fakultesi, Cocuk ve Ergen Psikiyatrisi ABD, 27070, Gaziantep, Turkey, zoroglus@hotmail.com Source: Psychiatry & Clinical Neurosciences , Vol 56(5), Oct 2002. pp. 551-556.
Journal URL: http://www.blackwell-science.com/~cgilib/jnlpage.asp?Journal=xpcn&File=x pcn Publisher: United Kingdom: Blackwell Publishing
Publisher URL: http://www.blackwellpublishing.com ISSN: 1323-1316 (Print) Digital Object Identifier: 10.1046/j.1440-1819.2002.01053.x Language: English Key Concepts: Adolescent Dissociative Experiences Scale-Turkish version; adolescents; reliability; validity; psychometrics; posttraumatic stress & anxiety & mood & attention-deficit hyperactivity disorders Abstract: The Adolescent Dissociative Experiences Scale (A-DES) is designed to measure dissociation in adolescents. The present study aimed to assess the reliability, validity, and psychometric characteristics of the Turkish version of the A-DES. The Turkish version of the A-DES was administered to 20 patients with a dissociative disorder, 24 patients with post-traumatic stress disorder (PTSD), 31 patients with anxiety disorder, 31 patients with mood disorder, 24 patients with attention deficit-hyperactivity disorder (ADHD), and 201 non-clinical participants. The internal consistency and the test-retest correlation of the A-DES were excellent. The mean total score of A-DES was 6.2 in dissociative disorder, 3.9 in PTSD, 2.1 in anxiety disorder, 2.4 in mood disorder, 2.5 in ADHD groups and 2.4 in non-clinical participants. There was a statistically significant difference between dissociative patients and other diagnostic groups on the A-DES total score. The good psychometric characteristics of the A-DES among Turkish participants support its cross-cultural validity. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Adolescent Psychiatry; *Dissociative Disorders; *Posttraumatic Stress Disorder; *Test Reliability; *Test Validity; Affective Disorders; Anxiety Disorders; Attention Deficit Disorder with Hyperactivity; Dissociation; Foreign Language Translation; Psychometrics; Test Forms Classification: Clinical Psychological Testing (2224)
Psychological Disorders (3210) Population: Human (10)
Male (30)
Female (40) Location: Turkey Age Group: Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800) Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print; Electronic Release Date: 20020911 Accession Number: 2002-04012-010 Number of Citations in Source: 18
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Record: 4
Title: The relationship of adolescent personality and family environment to psychiatric diagnosis. Author(s): Halloran, Elizabeth C. , Medical Coll of Ohio, Toledo, OH, US, lhalloran@mco.edu
Ross, Gloria J. , Wright State U, Celina, OH, US
Carey, Michael P. , Medical Coll of Ohio, Toledo, OH, US Address: Halloran, Elizabeth C., Medical Coll of Ohio, Kobacker Ctr, 3130 Glendale Avenue, Toledo, OH, US, lhalloran@mco.edu Source: Child Psychiatry & Human Development , Vol 32(3), Spr 2002. pp. 201-216.
Journal URL: http://www.wkap.nl/journalhome.htm/0009-398X Publisher: Netherlands: Kluwer Academic Publishers
Publisher URL: http://www.wkap.nl ISSN: 0009-398X (Print) Digital Object Identifier: 10.1023/A:1017904722137 Language: English Key Concepts: adolescent personality; family environment; psychiatric diagnosis; inpatients; mental disorders Abstract: This study examined the relationship of adolescent personality and family environment to psychiatric diagnosis in 170 adolescents admitted to a psychiatric inpatient unit. Patients were administered the Child Assessment Schedule, the Family Environment Scale, and the Millon Adolescent Personality Inventory. Adolescent personality and/or family environment were related to (1) major depression, conduct disorder, and attention deficit hyperactivity disorder (ADHD) disorder in both boys and girls; (2) oppositional defiant disorder, posttraumatic stress disorder (PTSD) and overanxious disorder in girls; and (3) dysthymic disorder and alcohol use in boys. The study empirically shows the relationship of both personality and family environment in psychiatric diagnoses. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Adolescent Development; *Family Relations; *Mental Disorders; *Personality; Diagnosis Classification: Psychological Disorders (3210) Population: Human (10)
Male (30)
Female (40)
Inpatient (50) Age Group: Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800) Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print; Electronic Release Date: 20020410 Accession Number: 2002-02329-003 Number of Citations in Source: 19
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Database: PsycINFO _____
Record: 5
Title: An overview of coexisting conditions for women with AD/HD. Author(s): Nadeau, Kathleen G. , Chesapeake Ctr for Attention & Learning Disorders, Silver Spring, MD, US
Quinn, Patricia O. Source: Understanding women with AD/HD. Nadeau, Kathleen G. (Ed); Quinn, Patricia O. (Ed); pp. 152-176. Silver Spring, MD, US: Advantage Books, 2002. vii, 465 pp. ISBN: 0-96609366-4-6 (paperback) Language: English Key Concepts: comorbidity; ADHD; women; depression; bipolar mood disorder; anxiety disorders; PTSD; addiction; eating disorders; sleeping problems; learning disabilities. Abstract: (from the chapter) Notes that a broad range of conditions commonly coexist with attention deficit hyperactivity disorder (ADHD) in women. This chapter outlines the following comorbid conditions: depression, bipolar mood disorder, anxiety disorders, posttraumatic stress disorder (PTSD), addiction, eating disorders, sleeping problems, and learning disabilities. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder with Hyperactivity; *Comorbidity; *Human Females; Addiction; Anxiety Disorders; Bipolar Disorder; Eating Disorders; Learning Disabilities; Major Depression; Posttraumatic Stress Disorder; Sleep Disorders Classification: Developmental Disorders & Autism (3250) Population: Human (10)
Female (40) Intended Audience: Psychology: Professional & Research (PS) Publication Type: Chapter (160); Print Release Date: 20020731 Accession Number: 2002-12830-009 Number of Citations in Source: 61
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Record: 6
Title: Future directions. Author(s): Quinn, Patricia O.
Nadeau, Kathleen G. , Chesapeake Ctr for Attention & Learning Disorders, Silver Spring, MD, US Source: Understanding women with AD/HD. Nadeau, Kathleen G. (Ed); Quinn, Patricia O. (Ed); pp. 444-456. Silver Spring, MD, US: Advantage Books, 2002. vii, 465 pp. ISBN: 0-96609366-4-6 (paperback) Language: English Key Concepts: future directions; ADHD; gender differences; research Abstract: (from the chapter) Explores future directions for research and clinical interests in gender issues in attention deficit hyperactivity disorder (ADHD). Proposed research directions include the following: new diagnostic tools, gender appropriate diagnostic criteria, gender differences in age of onset, gender differences in the life course of ADHD, gender differences in behavior, cognitive/neurological differences, gender differences in coexisting conditions, and gender appropriate treatment considerations. Additional ADHD research issues, including posttraumatic stress disorder (PTSD), motherhood, substance abuse, and eating disorders, are also described. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder with Hyperactivity; *Experimentation; *Human Sex Differences; Human Females Classification: Developmental Disorders & Autism (3250) Population: Human (10)
Male (30)
Female (40) Intended Audience: Psychology: Professional & Research (PS) Publication Type: Chapter (160); Print Release Date: 20020731 Accession Number: 2002-12830-024
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Database: PsycINFO _____
Record: 7
Title: Cultivating resiliency in youth. Author(s): Bell, Carl C. , U Illinois, Dept of Public & Community Psychiatry, Chicago, IL, US Address: Bell, Carl C., Community Mental Health Council, 8704 S. Constance, Chicago, IL, US Source: Journal of Adolescent Health , Vol 29(5), Nov 2001. pp. 375-381.
Journal URL: http://www.elsevier.com/inca/publications/store/5/0/5/7/6/5/ Publisher: United Kingdom: Elsevier Science
Publisher URL: http://www.elsevier.com ISSN: 1054-139X (Print) Digital Object Identifier: 10.1016/S1054-139X(01)00306-8 Language: English Key Concepts: resilience; adolescents; youth; neuropsychiatry; traumatic stress; resiliency building; psychological resiliency Abstract: Discusses characteristics of resiliency in adolescents and young people, and the importance of strengthening resiliency and how to build it. The neuropsychiatry of traumatic stress is discussed, including effects on the catecholamine system, the hypothalamic-pituitary-adrenal axis, the hypothalamic-pituitary-gonadal axis, and the relationship with posttraumatic stress disorder (PTSD) and attention deficit hyperactivity disorder (ADHD). Esoteric resiliency-building activities are discussed, including cultivating a sense of "Atman" (a true or real self), the meditative practice of attending, developing a fighting spirit ("building heart"), building physiologic resiliency (exercise and adrenocorticotrophic hormone (ACTH) building), and building psychological resiliency through Chi Kung exercises. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Psychological Endurance; *Psychological Stress; *Resilience (Psychological); Adolescent Psychiatry; Emotional Trauma; Human Potential Movement; Neuropsychiatry; Posttraumatic Stress Disorder
Classification: Psychosocial & Personality Development (2840)
Promotion & Maintenance of Health & Wellness (3365) Population: Human (10) Age Group: Adolescence (13-17 yrs) (200) Form/Content Type: Conference Proceedings/Symposia (0600) Conference: Society for Adolescent Medicine annual meeting, Mar, 2001, San Diego, CA, US Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print; Electronic Release Date: 20020109 Accession Number: 2001-09202-008 Number of Citations in Source: 63
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Record: 8
Title: Adderall, the atypicals, and weight gain. Author(s): Horrigan, Joseph P. , U North Carolina, Developmental Neuropharmacology Clinic, Chapel Hill, NC, US
Barnhill, L. Jarrett
Kohli, R. Robin Source: Journal of the American Academy of Child & Adolescent Psychiatry , Vol 40(6), Jun 2001. pp. 620.
Journal URL: http://www.jaacap.com/ Publisher: US: Lippincott Williams & Wilkins
Publisher URL: http://www.lww.com ISSN: 0890-8567 (Print) Language: English Key Concepts: amphetamine Adderall; appetite suppression; weight control; ADHD; PTSD; behavior problems; atypical neuroleptics; drug side effects Abstract: Although atypical neuroleptics are increasingly used in child and adolescent psychiatric populations, the high probability of increased appetite and subsequent weight gain associated with their use is problematic. A number of palliative strategies have been proposed to combat these phenomena, including the use of amphetamines. The case is presented of an 11-yr-old boy with attention deficit hyperactivity disorder (ADHD), chronic posttraumatic stress disorder (PTSD), intermittent explosive disorder, and conduct disorder who was prescribed olanzapine and Adderall (a combination of amphetamine salts). His behavior improved, but his appetite increased and he gained weight. A shift in the Adderall dosing schedules from immediately after meals to 45 min before meals resulted in a normalization of appetite and velocity of weight gain. It is suggested that careful psychopharmacology often requires an appreciation of the utility of a medication's side effects. In this instance, the Adderall appeared to buffer the detrimental effects of olanzapine following a subtle shift in the dosing schedule. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Amphetamine; *Attention Deficit Disorder with Hyperactivity; *Behavior Problems; *Neuroleptic Drugs; *Posttraumatic Stress Disorder; Appetite Depressing Drugs; Drug Therapy; Side Effects (Drug); Weight Control Classification: Clinical Psychopharmacology (3340) Population: Human (10)
Male (30) Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180) Form/Content Type: Empirical Study (0800)
Clinical Case Report (0820)
Journal Letter (5500) Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print; Electronic Release Date: 20010620 Accession Number: 2001-17985-019 Number of Citations in Source: 5
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Database: PsycINFO _____
Record: 9
Title: The toy theater. Author(s): Palumbo, A. J. Source: 101 more favorite play therapy techniques. Kaduson, Heidi Gerard (Ed); Schaefer, Charles E. (Ed); pp. 252-254. Northvale, NJ, US: Jason Aronson, Inc, 2001. xix, 457 pp. ISBN: 0-7657-0299-1 (hardcover) Language: English Key Concepts: puppetry; therapists; chidren; play therapy; treatment process; adhd; ptsd; poverty; homelessness; depression; abuse; neglect; familial dysfunction; aggression; isolation Abstract: (from the chapter) Puppetry is widely used by professionals who treat children. Puppetry uses "toy theaters," simple tri-part, wooden screens with crudely painted and decorated panel that can be set up on a table. Therapists, court psychologists, teachers, and nurses who work with children under stress are integrating puppet play and craft into their treatment process. Puppetry can be adapted to suit the constraints of therapy, such as limited resources and the restricted parameters. This technique can be used with children who are diagnosed with attention deficit hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD), stressed by poverty, homelessness, depression, abuse and neglect, who are unable to adjust to schooling or foster care, histories of familial dysfunction and those who are isolated or aggressive. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Play Therapy; *Psychologists; *Psychotherapeutic Processes; *Toys; *Treatment; Aggressive Behavior; Attention Deficit Disorder with Hyperactivity; Depression (Emotion); Dysfunctional Family; Foster Care; Homeless; Isolation (Defense Mechanism); Posttraumatic Stress Disorder; Therapists Classification: Psychotherapy & Psychotherapeutic Counseling (3310) Population: Human (10) Age Group: Childhood (birth-12 yrs) (100) Intended Audience: Psychology: Professional & Research (PS) Publication Type: Chapter (160); Print Release Date: 20020626 Accession Number: 2002-01308-057
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Database: PsycINFO _____
Record: 10
Title: Firesetting. Author(s): Jones, Russell T. , Virginia Polytechnic Inst, Dept of Psychology, Blacksburg, VA, US
Langley, Audra K. , U California, Neuropsychiatric Inst, Los Angeles, CA, US
Penn, Carrie , Virginia Polytechnic Inst, Dept of Psychology, Blacksburg, VA, US Source: Handbook of conceptualization and treatment of child psychopathology. Orvaschel, Helen (Ed); Faust, Jan (Ed); et al; pp. 355-378. Amsterdam, Netherlands: Pergamon/Elsevier Science Inc, 2001. xiv, 486 pp. ISBN: 0-08-043362-6 (hardcover) Language: English Key Concepts: firesetting; arson; PTSD; psychopathology; risk factor model; cognitive behavioral treatment Abstract: (from the chapter) It is estimated that at least 100,000 fires are set yearly by children. Among juveniles, prevalence of firesetting is higher for males than females and there is a higher incidence rate of firesetting between the ages of 12 and 14. Among psychiatric samples, D. J. Kolko (1999) found that outpatients and inpatients had a higher prevalence for both matchplay and firesetting. Developmental considerations have indicated that the struggle to develop autonomy and independence, and the feeling of powerlessness and anxiety found during the adolescent stage of development are key symptoms. A risk factor model for firesetting is proposed, and a general description of two treatment approaches (cognitive-behavioral and an alternative intervention curriculum proffered by J. Richardson and Pinsonneault [1996] are delineated within the context of a case illustration with a male 15-yr-old with posttraumatic stress disorder (PTSD), conduct disorder and attention deficit hyperactivity disorder (ADHD). (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Arson; *Cognitive Therapy; *Conduct Disorder; *Posttraumatic Stress Disorder; Adolescent Development; Epidemiology; Risk Factors Classification: Cognitive Therapy (3311) Population: Human (10)
Male (30) Age Group: Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800)
Clinical Case Report (0820) Intended Audience: Psychology: Professional & Research (PS) Publication Type: Chapter (160); Print Release Date: 20020605 Correction Date: 20031124 Accession Number: 2002-01069-016 Number of Citations in Source: 22
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2002-01069-016&db=psyh">Fire setting.</A>
Database: PsycINFO _____
Record: 11
Title: Childhood communication disorders in mental health settings. Author(s): Giddan, Jane J. , Medical Coll Ohio, Dept of Psychiatry, Kobacker Ctr, Toledo, OH, US
Ross, Gloria J. , Miami Valley Hosp, Family Practice Residency Program, Dayton, OH, US Source: Austin, TX, US: PRO-ED, Inc, 2001. ix, 165 pp. ISBN: 0-89079-866-4 (paperback) Language: English Key Concepts: childhood communication disorders; mental health settings; multidisciplinary treatment team; speech-language therapists; treatment approaches; diagnostic details; evaluation Abstract: (from the cover) Offered as a resource to the speech-language pathologist (SLP) to help fellow members of a multidisciplinary team understand how a communicative disorder might affect the treatment of youngsters with emotional and behavioral disorders. Using case studies, specific treatment approaches, and diagnostic details, the authors guide the SLP, as well as treatment team members and other therapists, in the treatment of children and adolescents who have communication disorders and psychopathological disorders that include autism, pervasive developmental disorders, depression, ADHD, and PTSD. The children also might have disorders including schizophrenia, oppositional defiant disorder, selective mutism, anxiety, and conduct disorder. Besides a chapter detailing developmental, emotional, and behavioral disorders and treatment settings, this manual contains chapters on communication evaluation in psychopathology, communication in a multidisciplinary team assessment, intervention strategies, co-occurring disorders, and autism and related disorders, respectively. Contributing author, J. Wahl, details medical interventions, including an exhaustive table of medications. Completing the resource are an appendix of assessment forms, a glossary, and sources of additional reading. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Child Psychiatry; *Communication Disorders; *Interdisciplinary Treatment Approach; *Speech Therapy; Behavior Disorders; Mental Disorders; Psychodiagnosis Classification: Speech & Language Disorders (3270) Population: Human (10) Age Group: Childhood (birth-12 yrs) (100) Form/Content Type: Book Handbook/Manual (8200) Intended Audience: Psychology: Professional & Research (PS) Publication Type: Authored Book (120); Print Release Date: 20020717 Accession Number: 2002-01579-000 Number of Citations in Source: 115
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Database: PsycINFO _____
Record: 12
Title: Psychotherapy with young people in care: Lost and found. Author(s): Hunter, Margaret , Maudsley NHS Trust, England Source: New York, NY, US: Brunner-Routledge, 2001. xiv, 193 pp.
ISBN: 0-415-19190-4 (hardcover)
0-415-19191-2 (paperback) Language: English Key Concepts: psychotherapy; children; adolescents; residential care; foster care; ethical considerations; confidentiality; sexual abuse; ADHD; PTSD; identity crisis; trauma Abstract: (from the cover) Whilst there is wealth of literature on working with children and adolescents, very little focuses on those who are in residential or foster care. This book is a practical guide to working with this group from a psychoanalytic therapeutic perspective. The book examines the issues most relevant to all those working with children and adolescents: (1) the place of psychotherapy in residential/foster care, (2) ethical considerations (e.g. confidentiality and sexual abuse), and (3) particular problems faced by young people (e.g. attention deficit hyperactivity disorder (ADHD), trauma, identity crisis, and posttraumatic stress disorder (PTSD)). (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Adolescent Psychotherapy; *Child Psychotherapy; *Foster Care; *Residential Care Institutions; Attention Deficit Disorder with Hyperactivity; Identity Crisis; Posttraumatic Stress Disorder; Privileged Communication; Sexual Abuse Classification: Psychotherapy & Psychotherapeutic Counseling (3310) Population: Human (10)
Male (30)
Female (40) Age Group: Childhood (birth-12 yrs) (100)
Adolescence (13-17 yrs) (200) Form/Content Type: Book Handbook/Manual (8200) Intended Audience: Psychology: Professional & Research (PS) Publication Type: Authored Book (120); Print Release Date: 20010725 Accession Number: 2001-01563-000
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Database: PsycINFO _____
Record: 13
Title: Reward deficicency syndrome: A biogenetic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors. Author(s): Blum, Kenneth , U North Texas, Dept of Biological Sciences, Denton, TX, US
Braverman, Eric R.
Holder, Jay M.
Lubar, Joel F.
Monastra, Vincent J.
Miller, David
Lubar, Judith O.
Chen, Thomas J. H.
Comings, David E. Source: Journal of Psychoactive Drugs , Vol 32Suppl), Nov 2000. pp. 1-68. Publisher: US: Haight-Ashbury Publications
Publisher URL: http://www.hafci.org ISSN: 0279-1072 (Print) Language: English Key Concepts: dopamine as reward mechanism in biogenetic model for diagnosis & treatment of impulsive & addictive & compulsive behaviors Abstract: "The reward cascade" is the release of serotonin, which in turn at the hypothalamus stimulates enkephalin, which in turn inhibits gamma-aminobutyric acid (GABA) at the substantia nigra, which in turn fine tunes the amount of dopamine (DA) released at the nucleus accumbens or "reward site." When DA is released into the synapse, it stimulates a number of DA receptors which results in increased feelings of well-being and stress reduction. It is suggested that when there is a dysfunction in the brain reward cascade, especially in the DA system causing a hypodopaminergic trait, the brain of that person requires a DA fix to feel good. This trait leads to multiple drug-seeking behavior. This is so because alcohol, cocaine, heroin, marijuana, nicotine, and glucose all cause activation and neuronal release of brain DA, which could heal the abnormal cravings. The lack of D-sub-2 receptors causes individuals to have a high risk of multiple addictive, impulsive and compulsive behavioral propensities, such as severe alcoholism, cocaine, heroin, marijuana and nicotine use, glucose bingeing, pathological gambling, sex addiction, attention deficit hyperactivity disorder (ADHD), Tourette's syndrome, autism, chronic violence, posttraumatic stress disorder (PTSD), schizoid/avoidant cluster, conduct disorder, and antisocial behavior. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Addiction; *Dopamine; *Obsessive Compulsive Disorder; *Psychodiagnosis; *Treatment; Biochemistry; Genetics; Impulsiveness; Models; Rewards Classification: Psychopharmacology (2580) Population: Human (10) Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print Release Date: 20010117 Accession Number: 2000-14192-001 Number of Citations in Source: 635
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Database: PsycINFO _____
Record: 14
Title: Child maltreatment, other trauma exposure and posttraumatic symptomatology among children with oppositional defiant and attention deficit hyperactivity disorders. Author(s): Ford, Julian D. , U Connecticut, School of Medicine, Ctr for the Study of High Utilizers of Health Care, Farmington, CT, US
Racusin, Robert
Ellis, Cynthia G.
Daviss, William B.
Reiser, Jessica
Fleischer, Amy
Thomas, Julie Source: Child Maltreatment: Journal of the American Professional Society on the Abuse of Children , Vol 5(3), Aug 2000. pp. 205-217. Publisher: US: Sage Publications
Publisher URL: http://www.sagepub.com ISSN: 1077-5595 (Print) Language: English Key Concepts: child maltreatment & other trauma & PTSD symptoms, 6-17 yr olds with ADHD & oppositional defiant disorder Abstract: 165 consecutive child psychiatric outpatient admissions (aged 6-17 yrs) with disruptive behavior or adjustment disorders were assessed by validated instruments for trauma exposure and posttraumatic stress disorder (PTSD) symptoms and other psychopathology. Four reliably diagnosed groups were defined in a retrospective case-control design: Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), comorbid ADHD-ODD, and adjustment disorder controls. ODD and (although to a lesser extent) ADHD were associated with a history of physical or sexual maltreatment. PTSD symptoms were most severe if (a) ADHD and maltreatment co-occurred or (b) ODD and accident/illness trauma co-occurred. The association between ODD and PTSD Criterion D (hyperarousal/hypervigilance) symptoms remained after controlling for overlapping symptoms, but the association of ADHD with PTSD symptoms was largely due to an overlapping symptom. These findings suggest that screening for maltreatment, other trauma and PTSD symptoms may enhance prevention, treatment and research concerning childhood disruptive behavior disorders. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder; *Child Abuse; *Emotional Trauma; *Hyperkinesis; *Oppositional Defiant Disorder; Posttraumatic Stress Disorder Classification: Psychological Disorders (3210) Population: Human (10)
Male (30)
Female (40)
Outpatient (60) Location: US Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180)
Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800) Publication Type: Peer Reviewed Journal (270); Print Release Date: 20000802 Accession Number: 2000-05031-001
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Database: PsycINFO _____
Record: 15
Title: Attention-deficit hyperactivity disorder and posttraumatic stress disorder: Differential diagnosis in childhood sexual abuse. Author(s): Weinstein, Dan , Pacific U, OR, US
Staffelbach, Darlene
Biaggio, Maryka Source: Clinical Psychology Review , Vol 20(3), Apr 2000. pp. 359-378.
Journal URL: http://www.elsevier.com/inca/publications/store/6/5/2/ Publisher: United Kingdom: Elsevier Science
Publisher URL: http://www.elsevier.com ISSN: 0272-7358 (Print) Digital Object Identifier: 10.1016/S0272-7358(98)00107-X Language: English Key Concepts: differential diagnosis of ADHD disorder & PTSD, sexually abused children Abstract: attention deficit hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD) are the most commonly diagnosed disorders in sexually abused children (SAC). There is a high degree of symptom overlap and comorbidity between these disorders, and differential diagnosis can be confusing. Current diagnostic criteria do not include PTSD as a differential diagnosis for ADHD, nor do existing assessment guidelines address these diagnostic similarities. This may have serious implications for SAC. This literature review describes the psychological impact of child sexual abuse and possible consequences for misdiagnosing ADHD in SAC. A comparison of criteria from the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for ADHD and PTSD is presented, and commonalities are discussed. On the basis of this comparison, recommendations are made for improving clinical decision-making and for facilitating differential diagnosis. The authors suggest routine inquiry about traumatic experiences in children presenting with ADHD symptoms, to increase accuracy in differential diagnosis. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder; *Differential Diagnosis; *Posttraumatic Stress Disorder; *Psychodiagnosis; *Sexual Abuse; Child Abuse; Hyperkinesis Classification: Behavior Disorders & Antisocial Behavior (3230) Population: Human (10) Age Group: Childhood (birth-12 yrs) (100) Form/Content Type: Literature Review (1300) Publication Type: Peer Reviewed Journal (270); Print Release Date: 20000501 Correction Date: 20031124 Accession Number: 2000-07445-004
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2000-07445-004&db=psyh">Atte ntion-deficit hyperactivity disorder and posttraumatic stress disorder: Differential diagnosis in childhood sexual abuse.</A>
Database: PsycINFO _____
Record: 16
Title: Stress, trauma, and PTSD in ADHD-diagnosed children: A biopsychosocial perspective. Author(s): Bennett, Edith Allison , California School Of Professional Psychology - Berkeley/Alameda, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(9-B), Apr 2000. pp. 4875. Publisher: US: Univ Microfilms International
ISSN: 0419-4217 (Print) Order Number: AAI9945881 Language: English Key Concepts: levels of stress & trauma & PTSD, 7-13 yr olds with vs without ADHD Abstract: Attention-Deficit Hyperactivity Disorder (ADHD) is a common childhood disorder with increasing prevalence rates that raise questions about overdiagnoses, misdiagnoses, and possible inadequate assessment of primary, comorbid, and differential diagnoses. The present study assumes that other factors influence or coexist with attention deficits: combinations of stresses, difficult life events, trauma history, and trauma symptoms. Stress and trauma, which are often characteristic of children with ADHD, may produce symptoms that present as attentional deficits. Distinguishing between ADHD and behaviors that result from severe stress or trauma poses a challenge for clinicians. Accurate assessment of ADHD and trauma-related attentional problems has important implications for diagnostic practices and treatment. This study investigated levels of stress, trauma, and PTSD in two groups of children ages 7 to 13 in a school district in a large metropolitan area: a group of children with existing ADHD diagnoses and a comparison group of children without ADHD. Participants were 41 children, their mothers, and the children's teachers. The study hypothesized that children with ADHD experience more significant life events, more family stress, more traumatic events, more trauma symptoms, and more PTSD diagnoses than children without ADHD. The procedures included the use of standardized instruments, adapted measures, and interviews. The instruments used were the Behavioral Assessment System for Children Developmental History Form, the Child Behavior Checklist, the Children's Life Events Inventory, the Life Chart, and the Structured Clinical Interview for DSM-IV. Statistical procedures included t tests and nonparametic tests. The results from quantitative analyses suggested that the ADHD group demonstrated more significant life events, more severe events, and more chronic traumas than the comparison group. The ADHD group did not report significantly more family stress, more trauma symptoms, or PTSD diagnoses. Exploratory analyses on demographics and medical history did not indicate significant differences between the groups. Qualitative data suggested some similar features among ADHD-diagnosed children with significant trauma, which included adoption, chronic trauma, difficulty with attachment, and foster home placement. The results underscore the need for further research to distinguish between ADHD and comorbid PTSD, ADHD with trauma features, and attentional problems that are secondary to trauma. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder; *Emotional Trauma; *Hyperkinesis; *Posttraumatic Stress Disorder; *Stress Classification: Health & Mental Health Treatment & Prevention (3300) Population: Human (10) Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180)
Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800) Publication Type: Dissertation Abstract (350); Print
Format(s) Available: Print Release Date: 20010110 Accession Number: 2000-95006-109
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Database: PsycINFO _____
Record: 17
Title: Eight month follow-up of delinquent adolescents: Predictors of short-term outcome. Author(s): Vermeiren, Robert , U Centrum Kinder-en Jeugdpsychiatrie, Algemeen Ziekenhuis Middleheim, Antwerpen, Belgium
de Clippele, Antoine
Deboutte, Dirk Source: European Archives of Psychiatry & Clinical Neuroscience , Vol 250(3), 2000. pp. 133-138.
Journal URL: http://link.springer.de/link/service/journals/00406/index.htm Publisher: Germany: Springer Verlag
Publisher URL: http://www.springer.de ISSN: 0940-1334 (Print)
1433-8491 (Electronic) Digital Object Identifier: 10.1007/s004060070029 Language: English Key Concepts: psychiatric assessment, predictability of recidivism, 12-17 yr old juvenile delinquents Abstract: Investigated whether psychiatric assessment can help to predict recidivism in delinquent adolescents. By means of semi-structured psychiatric assessment (Child Assessment Schedule), developmental interview of the parents, and self-report instruments, the authors assessed the psychiatric status of 72 12-17 yr old juvenile delinquents. A follow-up of criminal status after 8 months was conducted. Self-report questionnaires by the Ss did not differentiate recidivists from non-recidivists, while parent questionnaires did. Through semi-structured interviews, the authors found that a diagnosis of conduct disorder significantly predicts recidivism, while Ss with attention deficit hyperactivity disorder (ADHD) and substance abuse show a tendency towards more recidivism. The authors were unable, however, due to the small number of Ss showing a psychiatric disorder (e.g. ADHD and posttraumatic stress disorder (PTSD)) unrelated to conduct disorder, to assess the relative contribution of these disorders to the recidivism rate. This study found that psychiatric assessment of delinquent adolescents could be of help in predicting recidivism. The necessity of gathering information from parents and teachers is demonstrated. Future research should include a more extensive group of delinquent adolescents and should focus on the effect of therapeutic interventions. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Juvenile Delinquency; *Prediction; *Psychological Assessment; *Recidivism Classification: Criminal Behavior & Juvenile Delinquency (3236) Population: Human (10)
Male (30)
Female (40) Location: Belgium Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180)
Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800) Publication Type: Peer Reviewed Journal (270); Print Release Date: 20000816 Accession Number: 2000-08872-003
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Database: PsycINFO _____
Record: 18
Title: The ADHD response-inhibition deficit as measured by the stop task: Replication with DSM-IV combined type, extension, and qualification. Author(s): Nigg, Joel T. , Michigan State U, Psychology Dpt, East Lansing, MI, US Source: Journal of Abnormal Child Psychology , Vol 27(5), Oct 1999. pp. 393-402.
Journal URL: http://www.wkap.nl/journalhome.htm/0091-0627 Publisher: Netherlands: Kluwer Academic Publishers
Publisher URL: http://www.wkap.nl ISSN: 0091-0627 (Print) Digital Object Identifier: 10.1023/A:1021980002473 Language: English Key Concepts: response inhibition, 1st-6th graders with ADHD Abstract: Although response inhibition has been proposed as a core element of child attention deficit hyperactivity disorder (ADHD), the literature is heavily reliant on studies using Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) diagnostic criteria, older methods of measuring response inhibition, samples of boys, and failing to control thoroughly for comorbid problems--both as diagnoses and as subclinical variation. The present study replicated a deficit in response inhibition in the ADHD combined type using samples of 1st-6th graders matched on age and sex. The study replicated an effect size in boys with ADHD, and observed an even larger effect size for girls, although the Sex * Group interaction was nonsignificant. Children with ADHD also had problems with response output, shown by variable responding. Excluding comorbid conduct disorder, reading disorder, generalized anxiety disorder, obsessive-compulsive disorder, major depression, and posttraumatic stress disorder (PTSD) from the sample did not alter the results. Correlations indicated that response inhibition was associated with both attentional problems and reading level. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder; *Hyperkinesis; *Inhibition (Personality); *Response Parameters Classification: Developmental Disorders & Autism (3250) Population: Human (10)
Male (30)
Female (40) Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180) Form/Content Type: Empirical Study (0800)
Experimental Replication (0830) Publication Type: Peer Reviewed Journal (270); Print Release Date: 20000101 Correction Date: 20031124 Accession Number: 1999-15082-006 Number of Citations in Source: 47
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Database: PsycINFO _____
Record: 19
Title: Brain imaging correlates. Author(s): Krishnan, K. Ranga , Duke U, Medical Ctr, Dept of Psychiatry, Durham, NC, US Source: Journal of Clinical Psychiatry Monograph Series , Vol 17(2), Apr 1999. pp. 36-39. Publisher: US: Physicians Postgraduate Press
Publisher URL: http://www.psychiatrist.com ISSN: 0742-1915 (Print) Language: English Key Concepts: brain imaging data on neuroanatomical circuitry related to aggression symptom prevalence in psychiatric disorders Abstract: The aggression complex of symptoms is important to understand, because it is present in a variety of psychiatric disorders, including posttraumatic stress disorder (PTSD), bipolar disorder, depression, dementia, schizophrenia, and attention deficit hyperactivity disorder (ADHD). This paper discusses the neuroanatomical circuitry potentially implicated in aggression (probably similar in many ways to any other affective regulation), and examines data from a rhesus monkey study and a human study with single photon emission computed tomography (SPECT) to follow the direction of current research. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Aggressive Behavior; *Mental Disorders; *Neuroanatomy; *Tomography Classification: Psychological Disorders (3210) Population: Human (10) Form/Content Type: Conference Proceedings/Symposia (0600) Conference: "Phenomenology and Treatment of Aggression Across Psychiatric Illnesses", Aug, 1998, Chicago, IL, US Publication Type: Journal (250); Print Release Date: 19990801 Accession Number: 1999-05506-010
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Database: PsycINFO _____
Record: 20
Title: Risperdal(R) and parkinsonian tremor. Author(s): Roberts, Malcolm D. , Halifax Behavioral Services, Daytona Beach, FL, US Source: Journal of the American Academy of Child & Adolescent Psychiatry , Vol 38(3), Mar 1999. pp. 230.
Journal URL: http://www.jaacap.com/ Publisher: US: Lippincott Williams & Wilkins
Publisher URL: http://www.lww.com ISSN: 0890-8567 (Print) Language: English Key Concepts: risperidone, development of parkinsonian tremor, 12-yr-old male with ADHD & conduct disorder & PTSD Abstract: Reports the case of parkinsonian tremor developing during the treatment of a prepubertal boy (aged 12 yrs, 5 mo) with the neuroleptic risperidone. The S had a family history that was positive for Parkinson disease. He was being treated for ADHD, childhood-onset conduct disorder, and PTSD. Following discontinuation of risperidone, the tremor was not observed. This case emphasizes the need to be wary of the use of neuroleptics in pediatric patients, even with agents with a lesser known rate of such side effects as reported here. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Drug Therapy; *Parkinsonism; *Risperidone; *Side Effects (Drug); Attention Deficit Disorder; Conduct Disorder; Hyperkinesis; Posttraumatic Stress Disorder Classification: Clinical Psychopharmacology (3340) Population: Human (10)
Male (30) Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180) Form/Content Type: Empirical Study (0800)
Clinical Case Report (0820)
Journal Letter (5500) Publication Type: Peer Reviewed Journal (270); Print Release Date: 19990501 Accession Number: 1999-10534-004
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Database: PsycINFO _____
Record: 21
Title: Antecedents and complications of trauma in boys with ADHD: Findings from a longitudinal study. Author(s): Wozniak, Janet , Massachusetts General Hosp, Pediatric Psychopharmacology Unit, Boston, MA, US
Crawford, Margaret Harding
Biederman, Joseph
Faraone, Stephen V.
Spencer, Thomas J.
Taylor, Andrea
Blier, Heather K. Source: Journal of the American Academy of Child & Adolescent Psychiatry , Vol 38(1), Jan 1999. pp. 48-56.
Journal URL: http://www.jaacap.com/ Publisher: US: Lippincott Williams & Wilkins
Publisher URL: http://www.lww.com ISSN: 0890-8567 (Print) Language: English Key Concepts: ADHD & increased risk for trauma or PTSD or trauma-associated psychopathology, 6-17 yr old males Abstract: Examined the relationship between trauma and attention-deficit hyperactivity disorder (ADHD) and evaluated whether ADHD increases the risk for trauma, the risk for posttraumatic stress disorder (PTSD), or the risk for trauma-associated psychopathology. Data from a longitudinal sample of 260 male children and adolescents (aged 6-17 yrs) with and without ADHD were examined. All were evaluated comprehensively with assessments in multiple domains of functioning including systematic assessments of trauma and PTSD. Comparisons were made between traumatized and nontraumatized youths with and without ADHD. No meaningful differences were detected in comparisons between ADHD and control children, either in the rate of trauma exposure or in the development of PTSD. Although trauma was associated with the development of major depression, this effect was independent of ADHD status. In contrast, bipolar disorder at baseline assessment was a significant risk factor for subsequent trauma exposure. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder; *Emotional Trauma; *Posttraumatic Stress Disorder; *Psychopathology; *Risk Analysis; Human Males; Hyperkinesis Classification: Developmental Disorders & Autism (3250) Population: Human (10)
Male (30) Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180)
Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800)
Longitudinal Study (0850) Publication Type: Peer Reviewed Journal (270); Print Release Date: 19990301 Accession Number: 1999-00128-017
Persistent link to this record: http://search.epnet.com/direct.asp?an=1999-00128-017&db=psyh
Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=1999-00128-017&db=psyh">Ante cedents and complications of trauma in boys with ADHD: Findings from a longitudinal study.</A>
Database: PsycINFO _____
Record: 22
Title: A comparative analysis of the memory functioning of stress-exposed youth with and without posttraumatic stress disorder. Author(s): Yasik, Anastasia Elizabeth , City U New York, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 59(4-B), Oct 1998. pp. 1873. Publisher: US: Univ Microfilms International
ISSN: 0419-4217 (Print) Order Number: AAM9830778 Language: English Key Concepts: A comparative analysis of the memory functioning of stress-exposed youth with and without posttraumatic stress disorder Abstract: This study compared the Wide Range Assessment of Memory and Learning (WRAML) scores of urban youth with PTSD to the WRAML scores of stress-exposed urban youth without PTSD. A total of 131 youths were referred from Bellevue Hospital clinics subsequent to exposure to a variety of traumatic events (e.g., physical assaults, sexual assaults, motor vehicle accidents, fires). Youth with a positive history for child abuse or neglect were excluded. In order to control for the potentially confounding effects of comorbidity, youth meeting criteria for ADHD, conduct disorder, major depression, substance dependence, and schizophrenia were excluded. Similarly, youth with a documented head trauma, use of psychopharmacological agents, or mental retardation were also excluded. This process led to the identification of 16 youth with PTSD and 19 youth without PTSD. Statistical analyses revealed that there were no significant differences between comparison groups with regard to gender, ethnicity, age, and SES. Separate ANOVAs for the four WRAML Index scores were performed. These analyses revealed significant group differences on the General Memory and Verbal Memory Indexes. Youth with PTSD scored significantly lower on the General Memory and Verbal Memory Indexes compared to stress-exposed youth without PTSD. Whereas statistically significant differences were not observed on the Visual Memory and Learning Indexes, clinically significant impairment of these Indexes was observed among youth with PTSD. Finally, three separate MANOVAs were performed to examine for group differences across the WRAML subtests. These analyses failed to reveal significant group differences across the nine WRAML subtests. As such, this study indicates that PTSD is associated with discrete patterns of memory impairment in youth. A discussion of the observed results with reference given to clinical and theoretical implications is presented. Finally, the potential limitations with reference given to implications for future research are addressed. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Early Experience; *Memory; *Posttraumatic Stress Disorder; *Stress Classification: Health & Mental Health Treatment & Prevention (3300) Population: Human (10) Age Group: Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800) Publication Type: Dissertation Abstract (350); Print Release Date: 19980101 Accession Number: 1998-95020-231
Persistent link to this record: http://search.epnet.com/direct.asp?an=1998-95020-231&db=psyh
Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=1998-95020-231&db=psyh">A comparative analysis of the memory functioning of stress-exposed youth with and without posttraumatic stress disorder.</A>
Database: PsycINFO _____
Record: 23
Title: Nightmares treated with cyproheptadine. Author(s): Gupta, Sanjay , State U New York, Health Science Ctr, Syracuse, NY, US
Austin, Rene
Cali, Lee Anne
Bhatara, Vinod Source: Journal of the American Academy of Child & Adolescent Psychiatry , Vol 37(6), Jun 1998. pp. 570-571.
Journal URL: http://www.jaacap.com/ Publisher: US: Lippincott Williams & Wilkins
Publisher URL: http://www.lww.com ISSN: 0890-8567 (Print) Language: English Key Concepts: cyproheptadine, nightmares, 9 yr old male with ADHD & PTSD & oppositional defiant disorder Abstract: Describes the remission of nightmares following treatment with cyproheptadine after previous unsuccessful trials of diphenhydramine and trazodone in a 9-yr-old boy with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and posttraumatic stress disorder (PTSD). Within a month of starting cyproheptadine, the S reported a complete remission of the nightmares and significant improvement in sleep. At 6-mo follow-up, the nightmares were in remission. At this point the authors are unable to suggest what the maximum dosage in children might be. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder; *Drug Therapy; *Nightmares; *Oppositional Defiant Disorder; *Serotonin Antagonists; Hyperkinesis; Posttraumatic Stress Disorder Classification: Clinical Psychopharmacology (3340) Population: Human (10)
Male (30) Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180) Form/Content Type: Empirical Study (0800)
Clinical Case Report (0820)
Journal Letter (5500) Publication Type: Peer Reviewed Journal (270); Print Release Date: 19980801 Accession Number: 1998-04167-003
Persistent link to this record: http://search.epnet.com/direct.asp?an=1998-04167-003&db=psyh
Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=1998-04167-003&db=psyh">Nigh tmares treated with cyproheptadine.</A>
Database: PsycINFO _____
Record: 24
Title: "Nightmares treated with cyproheptadine": Comment. Author(s): Perry, Bruce D. , Baylor Coll of Medicine, Dept of Psychiatry & Behavioral Sciences, Houston, TX, US Source: Journal of the American Academy of Child & Adolescent Psychiatry , Vol 37(6), Jun 1998. pp. 571-572.
Journal URL: http://www.jaacap.com/ Publisher: US: Lippincott Williams & Wilkins
Publisher URL: http://www.lww.com ISSN: 0890-8567 (Print) Language: English Key Concepts: cyproheptadine, nightmares, 9 yr old male with ADHD & PTSD & oppositional defiant disorder, commentary, importance of clinical observations Abstract: Comments on an article by S. Gupta et al (see record 1998-04167-003) about the remission of nightmares following treatment with cyproheptadine after previous unsuccessful trials of diphenhydramine and trazodone in a 9-yr-old boy with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and posttraumatic stress disorder (PTSD). The author discusses the important role of the skilled clinician's observations in the furthering of knowledge. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder; *Drug Therapy; *Nightmares; *Oppositional Defiant Disorder; *Serotonin Antagonists; Hyperkinesis; Observational Learning; Posttraumatic Stress Disorder Classification: Clinical Psychopharmacology (3340) Form/Content Type: Comment (0500)
Journal Letter (5500) Publication Type: Peer Reviewed Journal (270); Print Release Date: 19980801 Accession Number: 1998-04167-004
Persistent link to this record: http://search.epnet.com/direct.asp?an=1998-04167-004&db=psyh
Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=1998-04167-004&db=psyh">"Nig htmares treated with cyproheptadine": Comment.</A>
Database: PsycINFO _____
Record: 25
Title: A comparative analysis of WISC-III performance of traumatized and non-traumatized children. Author(s): Samet, Mitchell Jay , City U New York, US Source: Dissertation Abstracts International Section A: Humanities & Social Sciences , Vol 58(9-A), Mar 1998. pp. 3419. Publisher: US: Univ Microfilms International
ISSN: 0419-4209 (Print) Order Number: AAM9807995 Language: English Key Concepts: performance on WISC-III, PTSD positive vs stress exposed PTS |
