Elderly survivors of the Lockerbie air disaster

Thirty-one elderly people were examined in Lockerbie and compared with 24 younger survivors of the disaster which took place in December 1988. Examination took place within one year of the disaster, but was timed to avoid the anniversary period. All subjects were in Lockerbie at the time the aeroplane exploded in mid-air. Examinations were conducted for purposes of medico-legal assessment. The elderly had similar responses to the younger disaster victims, the majority of whom met DSM-III-R criteria for PTSD. The elderly, however, had a very high incidence of coexisting major depression, unlike the younger population. Loss or injury to friends and the witnessing of human remains was positively correlated with a diagnosis of post-traumatic stress disorder in the elderly but not in the younger subjects. Neither material nor personal loss, nor the witnessing of human remains, was associated with a diagnosis of depression in the elderly, although significant material loss was associated with depression in the younger patients.     

Psychiatric-legal considerations in providing mental health assistance to disaster survivors.

This article describes psychiatric/legal issues encountered by those providing emergent care to disaster survivors.     

A meta-review of school-based disaster interventions for child and adolescent survivors

Background: Children and adolescents are among the most vulnerable groups affected by natural and man-made disaster. To better understand research and practice concerning mental health and psychosocial support efforts in humanitarian settings, the authors conducted a comprehensive review of all intervention programmes within the past decade that universally targeted children and adolescents who were exposed to a natural and/or man-made disaster.

Methods: We searched PubMed, PsychINFO, Cochrane Library and CINAHL for mental health and psychosocial interventions (MHPSS) involving children and adolescents. A total of 11 studies, 4 from natural disasters and 7 from conflict-affected areas met the inclusion criteria. Effect sizes were calculated using a random effects model for studies in post-natural disaster and war/terrorist-affected settings separately.

Results: The weighted mean effect sizes for interventions in both settings were statistically significant: ?0.308, 95% CI=?0.54– ?0.07, z=?2.58, p=0.010 after a natural disaster, and ?0.514, 95% CI=?0.80 to ?0.23, z=?3.57, p<0.001 in conflict areas. This indicates that MHPSS interventions in both disaster settings resulted in a reduction in PTSD symptoms compared to the control.

Conclusions: This review suggests that school-based, universal programmes that are conducted by teachers or local paraprofessionals are effective in reducing PTSD symptoms in children and adolescents. The few studies meeting the inclusion criteria of this study demonstrate the need for further expansion of statistical methods and study designs to test for the effects of interventions in challenging humanitarian settings.     

Psychotherapeutic approaches with survivors of childhood trauma

The development and evaluation of psychotherapeutic approaches for survivors of childhood trauma has been complicated by numerous conceptual and methodological challenges. Randomized controlled clinical trials are rare, and most of these test cognitive behavioral therapy with sexually abused children. This article reviews psychosocial (nonpharmacological) treatment approaches with child and adult survivors of childhood trauma, highlighting methodologically sound studies of treatment efficacy. Implications of efficacy data for clinical practice and future research are discussed.     

Therapeutic approaches to projection

Summary Four cases are presented which attempt to show other possible therapeutic approaches to projection than the classical one and how the use in clinical practice of the classical concept may tend to limit one's therapeutic effectiveness. The first two cases are not cases of projection, but are rather cases which could easily be misdiagnosed as projection by too mechanical an application of the traditional theory, with the result that important psychopathology may be missed.The last two cases are clinical examples of projection in which other therapeutic approaches than the classical one were illustrated. If the traditional approach had been used, there would have been a strong tendency to have attributed the distortions in perception to a mere transposition of affects while the more important reasons for the distortions would most probably have been overlooked.     

Acute disaster exposure and mental health complaints of Norwegian tsunami survivors six months post disaster

The objective was to investigate the relationship between possible disaster stressors and subsequent health problems among tourists experiencing the 2004 South-East Asia tsunami. A cross-sectional study was performed as a postal survey concerning the experiences of the disaster exposure in retrospect and the presence of psychological symptoms (GHQ-28) in Norwegian tsunami victims 6 months post disaster. The strongest predictors of health complaints were danger of death, witness impressions, and bereavements. Aggravated outcomes were also seen in those who helped others in the acute phase or had sole responsibility for children when the tsunami struck. Having a family member or close friend who was injured was reversely associated with health problems. Women reported more psychological distress than men, but the difference disappeared with increasing degree of danger exposure. Dose-response relationships to psychological distress were found for single exposure factors as well as for the cumulative effects of being exposed to several exposure variables.     

Therapeutic education, approaches in psychiatry

Therapeutic patient education offers people suffering from chronic illnesses new therapies as well as an appropriation of knowledge of the disease. It has a special place in psychiatric nursing care provision. However, programmes offered by nursing teams or pharmaceutical laboratories are struggling to define themselves.     

Therapeutic approaches to age-associated neurocognitive disorders

The United Nations projects that the number of individuals with dementia in developed countries alone will be approximately 36,7 million by the year 2050. International recognition of the significant emotional and economic burden of Alzheimer's disease has been matched by a dramatic increase in the development of pharmacological and nonpharmacological approaches to this illness in the past decade. Changing demographics have underscored the necessity to develop similar approaches for the remediation of the cognitive impairment associated with more benign syndromes, such as mild cognitive impairment (MCI) and age-associated cognitive decline (AACD). The present article aims to provide an overview of the most current therapeutic approaches to age-associated neurocognitive disorders. Additionally, it discusses the conceptual and methodological issues that surround the design, implementation, and interpretation of such approaches.     

Therapeutic approaches to anxiety--a holistic view

This then, briefly provides an example of how a number of different techniques can be woven into the treatment process, and how relaxation approaches particularly can be used. Practitioners who can be flexible in their approach, providing both mind and body techniques to help the client explore their anxiety, will find a deeper dimension to their work.     

Therapeutic boundary issues in working with childhood sexual-abuse survivors

The article describes a study of therapists involved in treating survivors of childhood sexual abuse. The authors focus on what induces participants to change their usual therapeutic boundaries. Through qualitative research utilizing extensive interviews, written questionnaires, and a focus-group discussion, the authors gathered information from therapists related to situations that influence them to change their own boundaries. Emergent themes are discussed and the information is integrated with the authors' experience of supervision and psychotherapy. Concern for client safety is the commonly recurrent issue that pushes therapists to change their boundaries. Other intense feelings, such as resentment of the client, worry about the client's feelings, a wish to connect and imbue hope are also strong influences. Self-disclosure boundaries of the therapist are challenged by the wish to balance power within the relationship. Supervision provides an opportunity to examine what influences therapists to make subtle boundary shifts before they become harmful boundary crossings.     

Therapeutic approaches in patients with inflammatory myopathies

Among the group of inflammatory myopathies, dermatomyositis (DM) remains the most treatable subset responding, in the majority of the cases, to steroids, intravenous immunoglobulin (IVIg), or immunosuppressants. Inclusion-body myositis (IBM) remains the most difficult disease to treat; in uncontrolled studies immunosuppressants and steroids have not helped, and controlled trials with IVIg have been disappointing. Polymyositis (PM) is a very uncommon, although still overdiagnosed, disorder and its rarity poses difficulties in performing large-scale therapeutic studies; based on small series, however, PM seems to variably respond to immunotherapeutic interventions. The most consistent problem in the treatment of inflammatory myopathies remains the distinction of true PM from the difficult-to-treat cases of IBM, or from necrotizing myopathies and dystrophic processes where secondary endomysial inflammation may be prominent. The future in the management of PM, DM, and IBM seems promising because of the availability of new agents directed at T-cell activation molecules, cytokines, chemokines, and adhesion receptors. In IBM, the use of such immunomodulatory drugs may be combined with agents that block cytokine-enhancing amyloid or with agents that inhibit the formation and polymerization of amyloid fibrils.     

Therapeutic approaches to inflammation in neurodegenerative disease

PURPOSE OF REVIEW: According to the neuroinflammatory hypothesis of neurodegenerative diseases, drugs with an anti-inflammatory mode of action should slow the disease progression. Here we review recent advances in our understanding of one such disorder, Parkinson's disease, in which anti-inflammatory drugs are now becoming a new therapeutic focus. RECENT FINDINGS: The involvement of inflammatory mechanisms in Parkinson's disease has been revealed through in-vitro and in-vivo experimental studies supported by pathological and epidemiological findings. Several of the demonstrated inflammatory mechanisms are shared by other neurodegenerative disorders but some Parkinson's disease-specific mechanisms have also emerged. These include inflammatory stimulation by interaction of alpha-synuclein with microglia and astrocytes and a suppressive action by nonsteroidal anti-inflammatory drugs on dopamine quinone formation. SUMMARY: It can be anticipated that a more detailed understanding of neuroinflammatory mechanisms in Parkinson's disease will lead to new cellular and molecular targets, which may, in turn, permit design of Parkinson's disease modifying drugs. Future treatment may involve combination therapies with drugs directed at both inflammatory and non-inflammatory mechanisms.     

Therapeutic approaches and advances in pediatric stroke

Evidence-based therapeutic interventions for pediatric ischemic cerebrovascular disease are beginning to emerge. The primary therapeutic target is usually the pathological prothrombotic disturbance that underlies the majority of pediatric stroke. A battle between anticoagulation and anti-platelet therapies continues to provide controversy and is the inspiration for upcoming randomized trials. Supportive care and neuroprotective strategies are an important consideration in children with stroke. Attempts to determine the safety of acute thrombolytic interventions are also underway. Finally, unique medical and surgical treatments for specific diseases leading to stroke in children continue to evolve. After briefly summarizing the epidemiology, pathophysiology, diagnosis, and outcomes of ischemic strokes in children, treatment approaches and alternatives will be reviewed in detail with emphasis placed on current areas of controversy and future directions for clinical research.     

Prevalence and duration of PTSD in survivors 6 years after a natural disaster

The present study aimed to examine the prevalence of posttraumatic stress disorder (PTSD) in survivors with low levels of risk factors for PTSD. The sample included 142 adults (58% women, 54% university education, 93% employed/students/retired) on vacation in Southeast Asia during the 2004 Indian Ocean disaster. Semi-structured clinical interviews (SCID-I) were performed after 6 years including PTSD, depression, specific phobia, and alcohol abuse. The 6-year prevalence of PTSD was 11.3% and the current prevalence was 4.2%, with onset mainly within 1 month and remission within 3 years post-disaster. Suicidal ideation and comorbidity were common in PTSD cases. Lifetime prevalence of depression was 19%, specific phobia 7%, and alcohol abuse 4%. The findings suggest elevated levels of PTSD but not other disorders as compared with general population samples, but still lower levels than other disaster samples. Despite benign circumstances, however, the course and burden of PTSD were comparable to similar studies.