Trauma And Violence

Research conducted over the past 30 years leads to the conclusion that televised violence does influence viewers' attitudes, values and behavior.

The obvious sometimes bears repeating: Sick people have trouble thinking. They may be suffering from a delirium, a dementia or a more subtle disturbance of cognition caused by fever, drugs, infection, inflammation, trauma, hypoxemia, metabolic derangement, hypotension, tumor, intracranial pathology, pain and so forth.

The following 3 cases illustrate the diagnostic challenges related to differentiating brain injury and posttraumatic stress disorder (PTSD) in patients presenting to the emergency department (ED) in the acute period following a traumatic injury. Such patients pose a dilemma for ED clinicians because of the interplay between head injury and PTSD in the clinical presentation of cognitive impairments in the aftermath of trauma.

The presentation of patients to the emergency department following trauma is often complicated by the behavioral reaction to the accident that brought them there. In some cases, the mental reaction to psychological trauma is the primary presenting phenomenon. ED physicians and staff often use medication to treat the acute effects of psychological trauma. However, there is little empiric evidence to support this practice.

Pilot studies show that preventing PTSD after vulnerable persons are exposed to extreme life-threatening trauma is possible, although we are in the very early stages of knowing exactly what to do.

The use of benzodiazepines in psychiatry and general medicine is fraught with controversy because of the potential for abuse and dependence. In daily practice, clinicians vary widely in their comfort level with prescribing this class of medications, whether for short-term relief of panic or for long-term prophylaxis of generalized anxiety. The use of benzodiazepines in acutely traumatized persons is particularly controversial.

Intimate partner violence is a common problem and a significant public health concern. Substance use is involved in 40% to 60% of IPV incidents. Several lines of evidence suggest that when substance use and IPV co-occur, substance use may play a facilitative role in IPV by precipitating or exacerbating violence. This article will review epidemiological, clinical and treatment research relevant to substance-abusing men with co-occurring domestic violence.

stress, trauma

Although public officials expressed surprise and outrage at the behavior of the some of the victims of Hurricane Katrina, research and history has shown that both altruism and violence are common after a disaster of this magnitude. Why is human behavior not a part of disaster preparedness planning?

Childhood Reactions to Terrorism-Induced Trauma by Wanda P. Fremont, M.D. The unpredictable, indefinite threat of terrorist events, the profound effect on adults and communities, and the effect of extensive terrorist-related media coverage can contribute to a continuous state of stress and anxiety in children. Current treatment strategies are discussed as well as direction for further research.

A team of neuroscientists from Purdue University and Nagoya University in Nagoya, Japan, has identified acrolein as a key neurotoxin in the neurodegenerative process that follows traumatic spinal cord injury. Acrolein, a toxic industrial by-product, naturally occurs in the body in negligible quantities as free radical molecules. However, it can quickly accrue to toxic levels in response to trauma, stress, or exposure to environmental carcinogens. Carriage

Youth gangs are a recognized risk factor for adolescent violence and delinquency. This article reviews recent research on these topics, including the prevalence, characteristics and influence of youth gangs, and discusses the implications of those findings for clinical practice.

Traumatic events affect individuals as well as entire communities. In this Special Report on trauma and violence, a number of often forgotten traumatic experiences are described. The individuals exposed to these events are at increased risk of several psychiatric disorders, as well as behavioral changes such as increased alcohol use or cigarette smoking.

Although a lot remains to be learned, much is already known about the early childhood characteristics that predispose children to antisocial behavior and violence in adolescence and early adulthood, an expert in psychopathology said recently at a National Institutes of Health conference.

Despite the image presented in films, books and television, prostitution places women and children at high risk for PTSD and other comorbid disorders. What experiences lead to this life?

Cognitive-behavioral therapy can be tailored for use with children who have experienced sexual abuse in order to relieve symptoms of PTSD.

Evidence is growing that trauma-focused cognitive-behavioral therapy (TF-CBT) is an effective treatment for sexually abused children, including those who have experienced multiple other traumatic events. This article reviews the research that has examined treatments for sexually abused children and suggests future research priorities in this regard.

Community awareness of traumatic events and their effects on individuals has increased in the last decade. The articles in the special report section of Psychiatric Times enhance our appreciation of the divergent research and clinical efforts being made assist those who have suffered from the consequences of trauma and its aftermath.

In the wake of the Columbine school shootings, it is of utmost importance for psychiatrists to be aware of the role they can play in preventing violence and bullying in our schools. What programs have been tried and how have they fared? What are the elements for a successful program?

The distress and functional impairment associated with PTSD may make it difficult for IPV victims to benefit from interventions to increase their safety and reduce their exposure to violence. Empirically supported PTSD treatments include pharmacotherapy and cognitive behavioral therapy. Incorporating these treatments into interventions to improve victims' safety and reduce exposure to violence may improve their effectiveness in protecting women from IPV.

How is it that anti-anxiety drugs can cause anxiety and insomnia, sometimes within the first day or two of treatment? These are not the soothing qualities we expect for anti-anxiety medications.

Little attention has been paid in the professional literature to a phenomenon that non-professionals have recognized since ancient times: Trauma can lead to personal growth. This article focuses on how traumatic events set processes in motion that produces new perspectives on the self, relationships and philosophy of life. Implications for clinical work with trauma survivors are discussed.

There is a long tradition in psychiatry, reaching at least back to World War I, of studying the response of people who are faced with traumatic circumstances and devising ways to restore them to psychological health. The main focus of this work has been on the ways in which traumatic events are precursors to psychological and physical problems.

With never-ending, ongoing conflict in the Middle East, trauma issues become of paramount importance. In some ways, trauma may even be considered to be continual. What are the unique challenges of psychological trauma at this level and how are people in this region coping?

This article reviews the Adverse Childhood Experiences (ACE) Study that examined the association between multiple childhood traumas and health outcomes in adults. These findings have significant public health implications for individuals exposed to childhood trauma, and the authors present a vision for a children's mental health care and wellness infrastructure in the United States derived from the Report of the Surgeon General's Conference on Children's Mental Health.

When it was announced that Michael Moore's documentary on the U.S. culture of fear and gun violence, Bowling for Columbine, had won the Academy Award for feature documentary, the Hollywood audience gave him a standing ovation.

Once the potential for violent behavior has been identified in a patient, how should it be dealt with? What steps can the clinician take to ensure the physical and legal safety of themselves and their patients? Furthermore, what are the clinician's legal and ethical responsibilities if the patient does commit a violence act?

In this introduction to our Trauma Special Report, Dr. Novac places the articles in historical perspective and reminds the reader of the importance of understanding trauma within today's global constructs and impending war.

The majority of people experience acute stress symptoms following trauma, but the development of posttraumatic stress disorder is the exception rather than the rule. Some investigators hypothesize that PTSD develops following increased nervous system response to trauma. Why only a minority of individuals experience this response, what their risk factors are and when should they be treated is the subject of ongoing research.

Parents who have witnessed traumatic events may pass dysfunctional life views on to their children. How much more vulnerable are these second-generation victims to PTSD and other psychiatric disorders?