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D C Silverman

Publications and source records attributed to D C Silverman.

10 recordsLinked to original sources
PubMed1993

Psychosocial impact of HIV-related caregiving on health providers: a review and recommendations for the role of psychiatry.

OBJECTIVE: The author considers current knowledge about the stresses of HIV-related care and assesses available evidence for the presence of major occupational, physical, and psychiatric morbidity in health care providers involved in intensive HIV-related caregiving. METHOD: The review is based on anecdotal reports of AIDS-care-related psychosocial distress and the literature concerning caregivers' attitudes toward people with HIV illness and HIV-related caregiving, the psychosocial impact of HIV work, and stress related to the ethical and philosophical challenges facing HIV caregivers. RESULTS: Few of the current publications concerning HIV caregiver stress come from the psychiatric literature. Psychiatry appears to lack a strong clinical, educational, research, or policy presence regarding psychosocial stress in HIV care providers. The numerous studies in the nursing, medical, public health, and health education literature do not include any controlled investigations documenting the incidence and prevalence of physical, psychological, occupational, or interpersonal symptoms or disorders in health care professionals who devote a substantial amount of their clinical activities to patients with HIV illness. CONCLUSIONS: Major HIV-related stress in conjunction with other psychiatric morbidity, such as mood disorders, anxiety disorders, substance abuse, and relationship and occupational problems, seems likely in susceptible caregivers. Decisions about the structure and form of delivery of HIV-related care and programs for caregivers must be based on more carefully controlled psychiatric observations of occupational, physical, psychological, and social adaptation to HIV-related work. The author suggests several areas in which psychiatric clinicians, educators, researchers, and policy experts can make major contributions.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Blitz rape and confidence rape: implications for clinical intervention.

Corroborating a typology of rape proposed 10 years earlier, a recent demographic study of 1,000 incidents of rape concluded that the two predominant types of assault were blitz and confidence rape. Blitz rape is characterized by sudden surprise attack by an unknown assailant using force or the threat of violence to gain control over the victim. In confidence rape, the assailant is known to some degree, however slight, and gains control over his victim by winning her trust. The characteristic details that differentiate one type of rape from the other suggest that the psychological impact on the victim will differ according to the type of rape. Specific clinical approaches for the mental health care of each victim group need to be provided. The immediate concerns of blitz rape victims center around their sense of safety, their fear that the rapist may return, and their dismay at having failed to ward off their attacker. They may respond like typical trauma victims with nightmares, flashbacks, sleep and appetite disturbances, heightened startle responses, anxiety, and depression. Treatment--usually sought soon after the rape--may include psychotherapy, medication, and behavioral desensitization. The confidence rape victims' chief concerns are guilt and self-blame. The rape may be revealed only years later. There is often significant delay between the rape and the victims' request for help. The victims need to be assured that they are deserving of help and need the meaning and definition of rape clarified. Providing services may require active and sustained involvement on the part of clinicians. Confidence rape victims will have strong doubts about their ability to discern who is truly trustworthy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Blitz rape and confidence rape: a typology applied to 1,000 consecutive cases.

The case records of 1,000 consecutive rape victims seen at a crisis center were analyzed to identify important categories of rape victimization. The most noteworthy finding was a replication and extension of the blitz rape and confidence rape typology. The distinction between these two types of rape corresponded to a series of significant differences in the victims' characteristics, the rape settings, the victims' activities before they were raped, the assailants' characteristics, and the victims' immediate responses to the assaults. The authors discuss the implications of these differences with respect to specific strategies of outreach and treatment for victims of different types of rape.

Adaptation, Psychological↗
PubMedDate not supplied

A pilot study of women's attitudes towards breast-conserving surgery with primary radiation therapy for breast cancer.

Breast-conserving surgery ("lumpectomy") with primary radiation therapy is gaining acceptance as an alternative to mastectomy for breast cancer. Currently, little is known about the specific immediate and long-range biopsychosocial effects of breast-conserving therapy as compared to more traditional mastectomy procedures. Physicians' speculations about the women who chose breast-conserving treatment as opposed to mastectomy seem to have been influenced by the scientific debate concerning the efficacy of this procedure. This study is a preliminary investigation of the attitudes and experiences of women receiving breast-saving therapy for carcinoma of the breast.

Adult↗
PubMedDate not supplied

The electronic medical record system: health care marvel or morass?

The author considers the potential advantages and disadvantages, as well as possible unintended consequences, of introducing electronic medical record systems in health care organizations. Special consideration is given to the issues such information systems raise concerning privacy, confidentiality, and quality of care from both patient and provider perspectives. The potential gains from computerizing medical records include the benefit of instantaneous availability of patients' medical history, treatment regimes, and current health status in routine and emergency clinical situations. Ease of access to this information should reduce adverse outcomes. The added value of a complete and up-to-date medical record immediately available to medical caregivers seems undeniable. The potential disadvantages include issues around patient confidentiality and unauthorized access to records, the enormous capital investment for computer hardware, and system maintenance.

Boston↗