The Psychiatric clinics of North America
-
Psychiatr. Clin. North Am. · Jun 2002
ReviewPsychobiology of the acute stress response and its relationship to the psychobiology of post-traumatic stress disorder.
The literature to date that examines the biology of the acute stress reactions suggests that relatively lower baseline cortisol is associated with the development of PTSD. This is particularly informative because of the ongoing controversy surrounding baseline cortisol in PTSD. Studies have found low baseline cortisol, normal range, and elevated baseline cortisol in chronic PTSD, and it has been unclear whether this reflects methodologic differences across studies or true heterogeneity within the disorder. ⋯ The therapeutics literature supports this hypothesis, in that brief psychosocial interventions based on sophisticated cognitive-behavioral models have proven effective in reducing suffering, symptom severity, and chronicity in individuals presenting with acute PTSD symptoms [27-29]. No acutely administered pharmacologic treatment to date has been shown effective in accelerating the process of recovery or in preventing the development of chronic PTSD. However, pharmacologic interventions that would prevent sensitization of circuits related to context-dependent threat perception, dysregulation of affect, and/or dysregulation of normal circadian rhythms are of theoretical interest and deserve further study.
-
Psychiatr. Clin. North Am. · Jun 2002
ReviewFuture pharmacotherapy for post-traumatic stress disorder: prevention and treatment.
I have presented two complementary lines of speculation in this article. First, I have presented a public health model of resilience, prevention, acute intervention, and tertiary treatment to inform a pharmacotherapeutic strategy for PTSD in the future. Second, I have proposed a rational rather than an empirical approach to the clinical pharmacology of PTSD. Such an approach suggests that efforts be directed toward the development and testing of new classes of drugs designed to target the unique pathophysiology of PTSD.
-
Psychiatr. Clin. North Am. · Mar 2002
Case ReportsPsychiatry of the medically ill in the burn unit.
Clinical experience and burn survivor testimony show that the experience of being burned can be associated with catastrophic stress and lead to drastic permanent body image changes from scarring and limb-function loss. Close relatives, if not killed in the fire, often also experience clinically significant bystander stress. Closeness of relationships may be lost, and self-image may suffer. ⋯ The psychiatry consultant can positively affect both variables substantially using both pharmacologic and psychosocial measures. The important role of psychiatric issues both before and after burn injury support the need for more consistent and comprehensive medical insurance coverage for psychiatric consultation to burn units and clinics. Burn Support Groups are an invaluable asset.
-
This article has reviewed the potential complications of acute intoxication and withdrawal from some of the more commonly used club, or designer, drugs. Although limited, acute use of these drugs is claimed by users to be benign, in the context of crowded raves and circuit parties, where multiple drugs may be used, hyperthermia, dehydration, and life-threatening reactions may occur. In addition, mounting evidence of the long-term effects of continued use of these drugs is cause for great concern. Finally, awareness of a severe withdrawal syndrome from GHB and its precursors is particularly important to psychiatrists of the medically ill, who may be called on to help in the management of these patients.
-
Psychiatr. Clin. North Am. · Sep 2001
Comparative StudyMental health and illness in traditional India and China.
Biomedical knowledge underlies the science of all national systems of psychiatry and is integral to international psychiatry. It is grounded in Western systems of thought, values, and world views. ⋯ In reviewing salient characteristics of the approach to mental health and illness of India and China, one is provided with a vivid illustration of the interplay between culture and a system of psychiatric practice. The secular and essentially impersonal features of modern biomedical psychiatry contrast with the spiritual, value-laden, but also naturalistic basis of ancient traditions and approaches to mental health and illness.