Psychopathology in children of Holocaust survivors: a review of the research literature

The literature on transgenerational transmission of Holocaust trauma has grown into a rich body of unique psychological knowledge with almost 400 publications. For the time being, however, the transgenerational effect of the Holocaust on the offspring remains a subject of considerable controversy. The main question involves the presence or absence of specific psychopathology in this population. Psychotherapists kept reporting various characteristic signs of distress while research failed to find significant differences between offspring and comparative groups. In an effort to settle this question, the present review of the research literature provides a summary of the findings of 35 comparative studies on the mental state of offspring of Holocaust survivors, published between 1973-1999. This extensive research indicates rather conclusively that the non-clinical population of children of Holocaust survivors does not show signs of more psychopathology than others do. Children of Holocaust survivors tend to function rather well in terms of manifest psychopathology and differences in the mental state of offspring and people in general are small according to most research. The clinical population of offspring, however, tend to present a specific "psychological profile" that includes a predisposition to PTSD, various difficulties in separation-individuation and a contradictory mix of resilience and vulnerability when coping with stress.     

Alcohol and violence: a current review

Violent behaviour under the influence of alcohol is a long-known phenomenon and causes great suffering in affected persons and enormous costs for society. While earlier studies considered alcohol-associated violence primarily to be due to alcohol's disinhibiting effects, recent scientific studies show a complex interaction of various bio-psycho-social factors. Including recent study results, the following review presents current data on the epidemiology of alcohol-associated violence, discusses possible contributing factors and causes, and possible resulting therapeutic implications. Based on these results, populations at risk such as binge drinkers, young adults and individuals with substance use disorders and comorbid psychiatric disorders can be identified, who often display a high burden of problems and therefore need a close network of medical, psychiatric and social services.     

Application of risk assessment for violence methods to general adult psychiatry: a selective literature review

OBJECTIVE: General adult psychiatrists are required to assess risk of violence as frequently as forensic psychiatrists. Yet most of the literature on risk assessment has originated from forensic settings, has been written by forensic psychiatrists, is applicable to forensic patients but may not apply to general psychiatric settings. Because the patient population and the nature of risk assessed may differ between the two settings, there is a need to consider the relevance of systems of assessment of risk of violence specific to the context of general adult psychiatry. METHODS: We searched the literature on the way risk has been conceptualized in different disciplines using Medline database from 1993 to 2003. Keywords used were violence and risk management and risk assessment. Additional papers were identified from cross-references and personal knowledge of authors. RESULTS: Seven hundred and nine key papers were identified. We identified three common key concepts that define risk: Uncertainty, weighing up the likelihood of different outcomes arising and, the possibility of benefits as well as harm due to risk assessment. The impact of safety culture - the collection of beliefs, norms, attitudes, roles and practices while making daily activities and management decisions - on psychiatric thinking is examined. We review the two main methods of risk assessment from forensic psychiatric literature (actuarial and clinical) with a view to examine their utility in general adult psychiatric context. CONCLUSIONS: In order to develop a system of risk assessment relevant to general adult psychiatry, we note the benefits of shifting from risk prediction to assessment, management and reduction of risk, the need to merge actuarial and clinical approaches, communication of risk and finally the need to involve patients in the process of risk assessment.     

Batterers: a review of violence and risk assessment tools

Batterers are often identified in the criminal justice system after they have inflicted significant abuse on their victims. The increasing public health initiatives surrounding intimate partner violence focus on identification of victims and their protection. Little emphasis is placed, however, on the batterers themselves. Forensic specialists become involved in risk assessment for violence only after a perpetrator has inflicted significant damage on his victim and entered the criminal justice system. This article serves to bring awareness of the many factors, including neurobiology and neuropsychology, that contribute to the development of a batterer. Two instruments useful in identifying violence risk will be highlighted, along with a proposal for future research that could broaden risk assessment applications to other noncriminal settings, allowing for early detection and prevention of violent acts.     

Psychoneuroimmunology: a literature review

Psychoneuroimmunology (PNI) examines the deleterious effects of chronic stress on the central nervous system, on the body's defense against infection of external origin, and on aberrant cell division. Empirical data concerning PNI are chronicled, revealing a rapidly emerging holistic model that implicates factors in the etiology and prevention of various disease states, as well as recovery from them.     

Effects of media violence on children. A review of the literature

The effects of media violence on the behavior of children are controversial. We examined and reviewed studies addressing this issue and identified many mediating variables. A small but genuine association appears to exist between media violence and aggression. However, many unanswered questions persist, and no interventions are clearly indicated.     

Exercise addiction: a literature review

Exercise in appropriate quantity and of proper quality contributes significantly to the preserve our health. On the contrary, excessive exercise may be harmful to health. The term 'exercise addiction' has been gaining increasing recognition to describe the latter phenomenon. The exact definition of exercise addiction and its potential associations with other disorders is still under study, although according to the authors this phenomenon can be primarily described as a behavioral addiction. Accordingly, exercise addiction, among other behavioral and mental disorders, can be well describe within the obsessive-compulsive spectrum suggested by Hollander (1993). There are several tools used to assess exercise addiction. The authors here present the Hungarian version of the Exercise Dependence Scale (Hausenblas és Downs, 2002) and the Exercise Addiction Inventory (Terry, Szabo és Griffiths, 2004). Exercise addiction has many symptoms in common and also shows a high comorbidity with eating disorders and body image disorders. It may be more closely associated with certain sports but more data is needed to demonstrate this specificity with more certainty. Sel-evaluation problems seem to have a central role in the etiology from a psychological aspect. The relevance of neurohormonal mechanisms is less clear. The authors emphasize the importance of further research on exercise addiction. One important question to be answered is if this disorder is an independent entity to be classified as a distinct clinical disorder or is it rather a subgroup of another disorder.     

SSRIs and pregnancy: a review of the literature

Objective

A review of the consequences of maternal depression on fetal and infant development and the risk and benefits of SSRI use.

Method

We have reviewed the literature published on PubMed between January 1980 and February 2009 using the following keywords: SSRI, depression, pregnancy, abnormality, teratogenic effect.

Results

Pregnancies complicated by the onset or recurrence of a major depressive disorder constitute a complex medical situation. The management of such situations is based on the principle of avoiding, as far as possible, the exposure of the developing foetus to both the maternal illness and the potential teratogenic effects of psychotropic drugs. Epidemiological studies show that maternal depression is a very frequent disease: 10 to 16% of pregnant women fulfill major depressive disorder diagnostic criteria and 15% suffer from postpartum depression. The consequences of such exposure on fetal and infant development are so harmful that a pharmacological treatment is highly recommended. Nowadays, the information available on the safety of SSRI use in pregnancy is abundant and these molecules are probably the most studied drugs in pregnant women. Their beneficial effects largely prevail over their potential fetal/neonatal risks and it is unlikely that any marked teratogenic effect occurs, with the possible exception of an increased risk for cardiovascular defects after maternal use of paroxetine. However, transient neonatal symptoms are common after SSRI use in late pregnancy. These include transient autonomic, gastrointestinal, somatic, and clinical respiratory manifestations in the immediate neonatal period.

Conclusion

Treatment of maternal depression during pregnancy and immediate neonatal period is uniformly recommended despite the potential side effects on the fetus and newborn. With a possible exception for paroxetine, maternal treatment with SSRIs during pregnancy is not associated with significantly increased risks of congenital defects.     

Driving and dementia: a review of the literature

The purpose of this article is to review the literature on the ability of individuals with dementia to drive an automobile. Based on a review of the literature, several factors were identified that may be useful in differentiating between people with dementia who presently remain safe drivers from those who have progressed to impaired driving. These factors include disease duration and severity, sex, patient self-assessment, family assessment, neuropsychological measures, findings on road evaluations, and driving simulator testing. The approach of the physician to driving and dementia is addressed, including in-office screening, referral for on-road driving assessments, and the potential for physician reporting to state agencies.     

Immunizations and autism: a review of the literature

Because of a temporal correlation between the first notable signs and symptoms of autism and the routine childhood vaccination schedule, many parents have become increasingly concerned regarding the possible etiologic role vaccines may play in the development of autism. In particular, some have suggested an association between the Measles-Mumps-Rubella vaccine and autism. Our literature review found very few studies supporting this theory, with the overwhelming majority showing no causal association between the Measles-Mumps-Rubella vaccine and autism. The vaccine preservative thimerosal has alternatively been hypothesized to have a possible causal role in autism. Again, no convincing evidence was found to support this claim, nor for the use of chelation therapy in autism. With decreasing uptake of immunizations in children and the inevitable occurrence of measles outbreaks, it is important that clinicians be aware of the literature concerning vaccinations and autism so that they may have informed discussions with parents and caregivers.     

Seclusion and restraint: a review of recent literature

An October 1998 Hartford Courant investigative series highlighted alleged cases of brutality and death suffered by involuntarily secluded, restrained, and/or emergently medicated patients. The resulting public and professional furor prompted a spate of new federal regulations and legislative initiatives setting national standards for reporting and clinical oversight. These events provide stimulus for this literature review. Rates, duration, and methods of seclusion and restraint still vary widely. Little evidence is available to guide clinical practice regarding relative benefits and risks of various methods to control acute adult patient aggression; even less evidence exists in child and adolescent populations. Further efficacy and effectiveness studies are needed to address this issue. Various programmatic efforts successfully reduce seclusion and restraint-at times dramatically-and can be used as examples of systematic quality improvement so "best practices" may evolve and spread throughout psychiatric inpatient settings.     

Sensate focus: a critical literature review

Masters and Johnson's Sensate Focus techniques have informed the sex therapy field for over four decades. However, two problems continue to plague the understanding and application of these techniques. First, clear and detailed information about the underlying concepts, original intent, and specific implementation associated with Sensate Focus has been limited primarily to private presentations within professional gatherings. Controversies and difficulties with interpretations among the general sexological community have resulted. Second, the application of Sensate Focus to diverse populations, and efficacy research on these interventions, has been limited. In addition to surveying the literature, this article addresses the primary confusions about the original concepts and technical applications of Sensate Focus. It also reviews the efficacy of this approach with populations other than the physically able-bodied, well-educated, heterosexual couples investigated by Masters and Johnson. Finally, this article concludes with an emphasis on the need for additional, detailed research and publication on the conceptual intention, practical application, and efficacy results of Sensate Focus across different population groups. This research would especially benefit sexually marginalized populations whose needs are not adequately addressed in current sexological literature and practice.     

The pharmacological management of violence in schizophrenia: a structured review

Although the increased risk of violent behavior in individuals with schizophrenia is now well-established, there is considerable uncertainty in pharmacological strategies to reduce this risk. In this review, we performed a systematic search of three electronic databases from January 2000 to March 2010 of treatment research on the management of violence in schizophrenia. We identified eight randomized controlled trials. The main findings included the association of nonadherence to antipsychotic medication to violent outcomes, a specific anti-aggressive effect of clozapine and short-term benefits of adjunctive β-blockers. There was little evidence on the efficacy of adjunctive mood stabilizers, depot medication or electroconvulsive therapy. Future research should use validated outcomes, longer follow-up periods and investigate patients with comorbid substance misuse.