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Biomedical subjects

B Pfefferbaum

Publications and source records attributed to B Pfefferbaum.

At least 37 records · Page 2Linked to original sources

Posttraumatic stress disorder in children: implications for assessment, prevention, and referral in primary care.

Posttraumatic Stress Disorder (PTSD) has been described in children exposed to a variety of traumatic experiences. It is relatively common and is often accompanied by comorbid conditions. A number of factors influence the development of symptoms including those related to the traumatic event, the individual child, the family, and the sociocultural environment. Primary care physicians should routinely assess trauma exposure and response in the children they treat.

Adolescent↗

Oklahoma City: disaster challenges mental health and medical administrators.

Mental health and medical administrators responded to the Oklahoma City bombing with cooperative and overlapping efforts to meet community needs in the wake of terrorism. The major agencies assisted in the immediate rescue response, organized crisis hotlines, prepared mental health professionals to counsel bereaved families and victims, organized debriefing of rescuers, assessed mental health needs of local school children, planned for longer term treatment, and coordinated research efforts to learn from the disaster. Implications to mental health administrators responding to significant acts of terrorism are discussed.

Adult↗

Caring for children affected by disaster.

The child and adolescent psychiatrist must play an essential role in the wake of disaster. The focus of the community and the world understandably turns to the physical devastation wrought, and emergency and medical efforts take center stage. Physical evidence of the past may be lost, but the child psychiatrist is able to maintain focus on what cannot be seen. He or she may be the only one to advocate the child's emotional needs. It may be too difficult for others who lack the specialized expertise of mental health training to attend to both the child's physical and emotional needs, and it may be impossible for those without medical training to impress on medical personnel the importance of emotional issues. The child and adolescent psychiatrist, with his or her understanding of medical, mental health, and developmental concerns, is well positioned to support the child, the child's community, and the helpers whose own responses may complicate recovery.

Adolescent↗

Bereavement and loss in childhood.

This article examines the process of bereavement, its clinical presentation, and developmental influences. Family bereavement issues are outlined, pathologic and traumatic bereavement are described, and treatment strategies are suggested.

Adaptation, Psychological↗

Stress in children exposed to violence. Reenactment and rage.

Violence is a major public health problem that increasingly involves children and adolescents as both victims and witnesses. Exposure to violence is now implicated in the development of stress conditions. This article uses Terr's typology to describe responses to various kinds of violence and suggests that the posttraumatic stress model adds a unique dimension to our understanding of the effects of violence on children and adolescents.

Adolescent↗

What if Astyanax had survived? War, children, and youth.

What, then, might have happened to Astyanax had he survived? He might have become a Greek slave and accepted his lot, or he might have felt loyalty and an obligation to his Trojan ancestry and organized acts of revenge. Depending on his personal characteristics and the people and the community that raised him, a number of outcomes are possible. The fact that after 3000 years we know little more than did the Homeric bards, however, gives us reason to be humble. There is evidence that each experience of loss or violence is additive and reduces coping ability. Although the psychologic disturbances of children and youth exposed to war do appear less intense than might have been expected, as Garmezy and Rutter noted in 1985, it is impossible to know the cost, the vulnerabilities that have been veiled, and what might have been. Perhaps the most remarkable thing is how some children seem able to transcend their misfortunes and even to be steeled by them. Coles has recorded how a 6-year-old, African-American girl, initiating school desegregation in New Orleans in the face of mob violence and daily threats to her life, told him that if she managed to get through with some success, she had an explanation: "It will be because there is more to me than I ever realized."

Adolescent↗

Contagion in stress. An infectious disease model for posttraumatic stress in children.

Posttraumatic stress responses involve the development of characteristic symptoms of reexperiencing, arousal, and avoidance following exposure to a traumatic event. This article uses an infectious disease model to describe exposure and transmission of posttraumatic stress responses, individual susceptibility and resilience, onset of symptoms, and prevention and control.

Adolescent↗

Posttraumatic stress disorder in children: a review of the past 10 years.

OBJECTIVE: To review current knowledge about the clinical presentation, assessment, and treatment of posttraumatic stress disorder (PTSD) in children. METHOD: The literature on PTSD in children is examined. RESULTS: Over the past 10 years, PTSD has been described in children exposed to a variety of traumatic experiences. Little is known about the epidemiology of the disorder in children. Partial symptomatology and comorbidity are common. A variety of factors influence response to trauma and affect recovery. They include characteristics of the stressor and exposure to it; individual factors such as gender, age and developmental level, and psychiatric history; family characteristics; and cultural factors. Since the condition is likely to occur after disaster situations, much of the literature describes the child's response to disaster and interventions tend to include efforts within schools and/or communities. A number of clinical approaches have been used to treat the condition. CONCLUSIONS: While assessment has been studied extensively, the longitudinal course of PTSD and treatment effectiveness have not been. Biological correlates of the condition also warrant greater attention.

Age Factors↗

Traumatic reactions as predictors of posttraumatic stress six months after the Oklahoma City bombing.

OBJECTIVE: This study attempted to identify remembered reactions of Oklahoma City residents at the time of the April 1995 terrorist bombing that predicted later development of posttraumatic stress symptoms. METHODS: Eighty-six adults who sought help for distress related to the bombing six months after it occurred completed a survey about demographic characteristics, level of exposure to the event, symptoms of grief, retrospective reports of reactions at the time of the trauma, current posttraumatic stress symptoms, and coping strategies. To identify immediate bombing reactions predictive of later distress, retrospective reports of reactions to the trauma were correlated with current posttraumatic stress symptoms. Multiple regression analysis was used to determine which reactions predicted the emergence of posttraumatic stress symptoms. RESULTS: Reactions of being nervous and being upset by how other people acted when the bombing occurred accounted for about one-third of the total variation in posttraumatic stress symptom scores and thus were major predictors of posttraumatic stress. CONCLUSIONS: These results differ from those of other studies in which peritraumatic dissociation, or dissociation at the time of the event, was more predictive than anxiety for developing later distress. The results suggest that persons who experience significant anxiety at the time of the traumatic event may continue to experience distress. Those who are overly concerned about others' actions may be showing diminished interpersonal trust, evidence of terrorism's ability to erode social harmony.

Adult↗

Child witnesses in Oklahoma.

Children are often required to testify in court about physical and sexual abuse. This article examines the literature related to their testifying and reports the experiences of children who were interviewed regarding those experiences. In general, the children did not appear to be unduly traumatized by their court experiences.

Adaptation, Psychological↗

Adolescent suicide: implications for primary care.

A number of factors associated with teen suicide have been elucidated in recent years. Relevant clinical and research issues are reviewed: victim characteristics including psychopathology and warning signs; social influences including the effects of music and the media, the role of imitation and access to firearms; prevention programs; and implications for practice including professional education, primary care interventions, response to threats, commitment, and post-intervention.

Adolescent↗

Self-report study of impulsive and delinquent behavior in college students.

PURPOSE: This self-report study of college students sought to examine the relationship between risk-taking and delinquent behavior, to develop reliable measures of impulsiveness and attraction to thrill-seeking and risk-taking, and to measure the relationships among conventional correlates of delinquent behavior, personality factors, and delinquent behavior itself. METHODS: A sample of 296 undergraduate college students completed questionnaires pertaining to delinquent behavior and other activities, identification with educational goals and behavior, and attraction to thrill-seeking and risk-taking behavior, as well as items from the Self-Control and Socialization scales of the California Personality Inventory. RESULTS: Males who measured high in thrill-seeking behavior and low in self-control reported significantly more property delinquency. Interpersonal delinquency was most influenced by a lack of self-control. There was a negative correlation between substance abuse and socialization. The reasons most often given for property and substance delinquency were "fun/thrills" while those most often given for interpersonal delinquency involved "anger/revenge." CONCLUSION: Variables representing conventional sociological theories have often been treated as the immediate causal factors in juvenile delinquency, but their impact may be mediated through factors such as impulsiveness and an attraction to thrill-seeking and risk-taking.

Adolescent↗

Pharmacological management of pain in children.

This article examines the use of analgesics and psychopharmacological adjuvants in children experiencing pain. Peripheral analgesics are effective for mild to moderate pain. Narcotics are effective but may produce dependence and tolerance as well as untoward side effects. Major tranquilizers, minor tranquilizers, tricyclic antidepressants, and stimulants have all been used as adjuvants in pain management. Major tranquilizers are now discouraged because of potential serious adverse effects. Benzodiazepines are relatively safe and decrease anxiety accompanying pain. Tricyclics may be used with caution. Stimulants have received little attention but may be useful in treating both pain and depression in the physically ill.

Analgesics↗

The influence of culture on pain in Anglo and Hispanic children with cancer.

This study sought to determine if cultural heritage and acculturation influence the perception and expression of pain and anxiety. The study was based on self-report and observation of Anglo and Hispanic children with cancer undergoing invasive procedures. Seventy-eight children between the ages of 3 and 15 participated. Thirty-five were Anglo and 43 were Hispanic. A significant inverse relationship between age and observed and reported distress was noted in both ethnic groups. The Anglo and Hispanic children had remarkably similar behavioral responses. Hispanic parents, however, reported significantly higher levels of anxiety than Anglo parents.

Acculturation↗

The use of methylphenidate in a depressed adolescent with AIDS.

Stimulants once used to treat depression have been overshadowed by tricyclic antidepressants and monoamine oxidase inhibitors. Recently, their use has been reported in the treatment of depression in medically ill adults in whom tricyclics are contraindicated, or for whom a rapid response is critical. This report documents the successful use of methylphenidate in a depressed adolescent with AIDS.

Acquired Immunodeficiency Syndrome↗

Monoamine oxidase inhibitor toxicity.

Monoamine oxidase inhibitor (MAOI) drugs are used in the treatment of depressive and anxiety disorders in adults. MAOIs are also used in high doses for the treatment of lymphomas and of central nervous system (CNS) tumors in children. Toxic effects resulted when procarbazine, a drug of this class, was used in treating a child with a CNS tumor. Psychotic reaction in the child may have been triggered by any of several factors, but arguments are for an organic cause. The implication of the MAOI procarbazine must be seriously considered. The case highlights potential serious problems associated with MAOIs and the interaction of this agent with other drugs.

Brain Neoplasms↗

A comparison of depressed and nondepressed disturbed children on measures of attributional style, hopelessness, life stress, and temperament.

Upon admission to a hospital treatment program, clinically depressed and nondepressed children (aged 9-17 years) were assessed on measures of attributional style, hopelessness, depression, life stress, and child temperament. The depressed group tended to attribute positive events to specific and unstable factors when compared with the nondepressed sample. Group differences also were found on child temperament measures. However, no differences were reported between the diagnostic groups on self-reported depression, hopelessness, or life stress. The findings suggested that there may not be a unique constellation of cognitive characteristics in depressed children when compared with a nondepressed clinical sample. For both depressed and nondepressed groups, treatment did appear to affect self-reported depression and overall ratings of depressogenic attributional style.

Adjustment Disorders↗