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Biomedical subjects

David M Benedek

Publications and source records attributed to David M Benedek.

11 recordsLinked to original sources
PubMed2003

Terrorism and weapons of mass destruction: managing the behavioral reaction in primary care.

Any terrorist attack using weapons of mass destruction will result in substantial psychological trauma and stress. Primary care and emergency clinics will likely see patients who have stress-related emotional or physical symptoms, or exacerbations of preexisting health concerns. Significant psychological and behavioral reactions to an attack with weapons of mass destruction are certain, include both group and individual reactions, and will follow a predictable course. Possible group reactions include mass panic, acute outbreaks of medically unexplained symptoms, and chronic cases of medically unexplained physical symptoms. Possible individual reactions include psychiatric disorders such as posttraumatic stress disorder, which occurs in approximately 30% of people exposed to extreme trauma. Most people have symptoms of arousal that are normal reactions to abnormal events and that resolve with rest, reassurance, support, and education. Mandatory debriefings are not recommended, and medications may be used when more conservative measures are not sufficient.

Humans↗
PubMed2003

Concealment of psychopathology in forensic evaluations: a pilot study of intentional and uninsightful dissimulators.

Dissimulation is the concealment of genuine psychiatric symptoms in an attempt to present a picture of psychiatric health. In this pilot study, the authors set out to demonstrate that defendants may conceal psychiatric illness even in forensic settings, contrary to their apparent self-interest. They reviewed their records for forensic assessments of dissimulators and malingerers and classified dissimulators as "intentional" or "uninsightful" depending on whether their concealment of symptoms appeared to be a volitional act or driven by a lack of insight. Although there were obvious diagnostic differences, the only other significant difference between malingerers and dissimulators was that malingerers were more likely to be facing charges related to financial crimes. Uninsightful dissimulators were significantly older than were intentional dissimulators. Uninsightful dissimulators were also more likely to be psychotic, particularly delusional and schizophrenic, than were intentional dissimulators. While forensic psychiatrists are vigilant in attempts to detect malingering, these data suggest that they should be equally vigilant regarding the possibility of dissimulation. Although further study is indicated, it appears that dissimulators are a heterogeneous group.

Adult↗
PubMed2002

Emergency mental health management in bioterrorism events.

The United States has not suffered significant psychosocial or medical consequences from the use of biological weapons within its territories. This has contributed to a "natural" state of denial at the community level. This denial could amplify the sense of crisis, anxiety, fear, chaos, and disorder that would accompany such a bioterrorist event. A key part of primary prevention involves counteracting this possibility before an incident occurs. Doing so will require realistic information regarding the bioterrorism threat followed by the development of a planned response and regular practice of that response. Unlike in natural disasters or other situations resulting in mass casualties, emergency department physicians or nurses and primary care physicians (working in concert with epidemiologic agencies), rather than police, firemen, or ambulance personnel, will be most likely to first identify the unfolding disaster associated with a biological attack. Like community leaders, this group of medical responders must be aware of its own susceptibility to mental health sequelae and performance decrement as the increasing demands of disaster response outpace the availability of necessary resources. A bioterrorist attack will necessitate treatment of casualties who experience neuropsychiatric symptoms and syndromes. Although symptoms may result from exposure to infection with specific biological agents, similar symptoms may result from the mere perception of exposure or arousal precipitated by fear of infection, disease, suffering, and death. Conservative use of psychotropic medications may reduce symptoms in exposed and uninfected individuals, as may cognitive-behavioral interventions. Clear, consistent, accessible, reliable, and redundant information (received from trusted sources) will diminish public uncertainty about the cause of symptoms that might otherwise prompt persons to seek unnecessary treatment. Training and preparation for contingencies experienced in an attack have the potential to enhance delivery of care. Initiating supportive social, psychotherapeutic, and psychopharmacologic treatments judiciously for symptoms and syndromes known to accompany the traumatic stress response can aid the efficient treatment of some patients and reduce long-term morbidity in affected individuals. Preventive strategies and planning must take into account the idea that specific groups within the population are at higher risk for psychiatric morbidity. First responders comprise one group at psychologic risk in this situation, and healthcare providers comprise another. These and other high-risk groups will benefit from the same supportive interventions developed for the community as a whole.

Bioterrorism↗
PubMed2002

Pharmacologic treatment of hospitalized patients with schizoaffective disorder.

This study examined changes in the pharmacologic treatment of 70 patients who were hospitalized with a diagnosis of schizoaffective disorder at some time during a six-year period. An increasing use of divalproex sodium and atypical antipsychotics instead of lithium and conventional antipsychotics was observed. The use of a combination of an antipsychotic and a thymoleptic medication was more common than monotherapy, and physicians tended to continue antidepressants if patients had a history of depression. Patients with a new diagnosis of schizoaffective disorder were stabilized less quickly than those with a previous diagnosis. The use of divalproex sodium and newer antipsychotics did not reduce the time to stabilization in routine clinical practice.

Adult↗
PubMed2002

"I could tell you, but then I'd have to kill you": classified information in the psychiatric evaluation.

Psychiatrists and other mental health professionals are presented with special challenges when their patients are involved in covert operations or other matters of national security. The patients' involvement may, by legal necessity, limit disclosures during the evaluation. Such situations may be encountered with varying degrees of frequency by military psychiatrists or consultants to various federal or law enforcement agencies involved in classified or undercover activities. The need to assess relevant psychosocial stressors while avoiding prohibited disclosure, the legal requirements to report potentially adverse information, or the procedure to gain legal permission to discuss classified details may present novel challenges for therapists in such evaluations. In this article, we present a case report illustrating these challenges and review applicable regulations and public law governing the disclosure of classified information. We also discuss common pitfalls and strategies for handling such situations.

Access to Information↗
PubMed2002

Occupational psychiatry services in a military setting.

Occupational psychiatry services have become increasingly important since the passage of the Americans with Disabilities Act and the recent growth of workers' compensation mental health claims. Delivery of such services within the military is complicated by interagency financial relationships, recent implementation of a comprehensive managed care program, and military regulations governing medical services. In this article, we describe the provision of occupational psychiatry services in a large military medical system and present the results of a feasibility study of establishing a regular clinic to improve them. The results of the study highlighted the importance of having occupational psychiatry services available within the medical center, although it did not establish the necessity of a specific clinic to provide these services. Case material is presented that illustrates our approach and the range of services encompassed.

District of Columbia↗
PubMed1987

Juvenile homicide: prior adjustment and a proposed typology.

Studies of juvenile homicide have been limited to small samples and have arrived at widely varying clinical formulations. The present study of 72 juvenile murderers uses a three-group typology based on the circumstances of the offense. Group differences in prior adjustment suggest distinct developmental pathways to adolescent violence. Implications for research and for legal decision-making are discussed.

Adolescent↗