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Biomedical subjects

E D Schwarz

Publications and source records attributed to E D Schwarz.

13 recordsLinked to original sources
PubMed1998

The trauma response of children and adolescents. Future directions in research.

Although trauma research in children lags behind that of adults and is often preliminary or unreplicated, current work promises rich understanding of the neurobiologic and psychologic mechanisms underlying the trauma response of the young. Epidemiologic and longitudinal, prospective, controlled studies sensitive to cultural and developmental differences are needed to illuminate the natural history of posttraumatic stress disorder and to show how trauma and its response interact with family, school, and community factors. Promising profound implications for society, such data would enable mental health professionals, educators, and policy makers to develop standards for prevention, detection, and intervention to optimize children's developmental trajectory.

Adolescent↗
PubMed1996

Liver biopsy findings in 501 patients infected with human immunodeficiency virus (HIV).

Patients infected with human immunodeficiency virus (HIV) are at risk for a variety of liver diseases. We undertook a retrospective study of 501 HIV-seropositive patients to assess the yield of percutaneous liver biopsy. The most common indications for liver biopsy were liver test abnormalities (89.5%), fever for 2 weeks (71.9%), and hepatomegaly (52.0%). The most common biopsy-derived diagnosis was Mycobacterium avium complex (MAC), seen in 87 (17.4%) biopsies. Mycobacterium tuberculosis was found in 13 biopsies (2.6%). In 28 biopsies (5.6%) mycobacteria was seen, but speciation of the organism was not possible. Chronic active viral hepatitis was seen in 60 biopsies (12.0%). Opportunistic hepatic infection from other organisms was found in 14 biopsies (2.8%). The most common neoplasm was lymphoma, which was seen in 12 biopsies (2.4%). MAC infection of the liver was associated with elevated alkaline phosphatase (p = 0.01). Among patients with fever for 2 weeks after an extensive negative workup including bone marrow biopsy, 58.2% had a diagnosis by liver biopsy. Overall, 64.3% of liver biopsies yielded a histopathological diagnosis, 45.7% of which were potentially treatable. We could not evaluate whether liver biopsy had a positive effect on patient outcome and survival, nor did we attempt to prove that liver biopsy resulted in a change in treatment or a change in preprocedure clinical diagnosis. Thus, questions about the efficacy of liver biopsy cannot be answered. Liver biopsy may be a helpful diagnostic tool in HIV-positive patients with fever, liver test abnormalities or hepatomegaly.

Adolescent↗
PubMed1994

The post-traumatic response in children and adolescents.

Mental health professionals are becoming increasingly aware of how violence--be it in the home, media, street, school, genocide, or war--can leave an indelible signature on the human psyche and on brain function and structure. They have challenging roles to play in preventing malignant memories and subduing their pernicious effects as well as examining the dramatic cascade of interactions among environment, brain, and behavior initiated by trauma.

Adolescent↗
PubMed1992

Malignant memories. Reluctance to utilize mental health services after a disaster.

This report describes the reluctance of individuals exposed to a man-made disaster to utilize formal mental health services. Measures were obtained in an initial screening 6 months after a shooting for 24 exposed school personnel. Data from the initial screening were compared for those who did not participate in a follow-up screening 12 months later (N = 11) and those who did (N = 13). Follow-up nonparticipants reported: more posttraumatic stress disorder symptoms, especially avoidance; recall of life threat during the event; feeling depressed; and an increase in positivity toward victims but not about their work or mental health professionals. The authors conclude that some individuals may avoid formal mental health services because they serve as cues for malignant memory retrieval and discuss implications for service delivery.

Adult↗
PubMed1991

Malignant memories: PTSD in children and adults after a school shooting.

Sixty-four children and 66 adults were screened for post-traumatic stress disorder 6 to 14 months after a school shooting. Although there were no differences in overall frequencies of DSM-III-R diagnoses or cluster endorsements, there were developmental influences. Post-traumatic stress disorder was associated more with emotional states recalled from the disaster than with proximity. Emotional states mediated the formation of malignant memories leading to symptomatology, suggesting that postdisaster intervention be offered on the basis of degree of emotional reaction as well as proximity.

Adult↗
PubMed1991

Posttraumatic stress disorder after a school shooting: effects of symptom threshold selection and diagnosis by DSM-III, DSM-III-R, or proposed DSM-IV.

OBJECTIVE: The purpose of the study was to investigate the effect of symptom threshold and criteria set selections on the diagnosis of posttraumatic stress disorder (PTSD) in adults and children exposed to a man-made disaster and determine how well DSM-III and its successors agree. METHOD: Data gathered in the course of a voluntary clinical screening for PTSD in 66 adults and 64 children 6 to 14 months after exposure to a school shooting were analyzed according to DSM-III, DSM-III-R, and proposed DSM-IV criteria for PTSD diagnosis and cluster endorsement using liberal (occurring at least a little of the time), moderate (occurring at least some of the time), and conservative (occurring at least much or most of the time) symptom thresholds. RESULTS: Within DSM-III, DSM-III-R, and proposed DSM-IV, selection of liberal, moderate, and conservative symptom thresholds had robust effects on rates of diagnoses; liberal thresholds allowed the greatest frequencies of diagnosis. Compared with DSM-III and proposed DSM-IV, DSM-III-R generally diagnosed the fewest cases. Agreements between DSM-III-R and proposed DSM-IV were good, while agreements between DSM-III and its successors varied for children and adults. CONCLUSIONS: Diagnostic rates and agreements were complexly influenced by interactions among threshold and revisions in symptom clusters. The present study suggests that attempts to refine PTSD classification consider specification of symptom threshold intensity and supports the view that modification of criteria sets be undertaken with caution.

Adult↗
PubMed1980

A revised checklist to obtain consent to treatment with medication.

A checklist to obtain patient consent for treatment with medication was developed by the author in 1976. The one-page form documents the process of obtaining consent from patients and certifies that the physician has discussed the benefits, side-effects, and risks of medication. A revised checklist now in use better equips the physician to deal with cases in which the patient's condition reduces his capacity to give fully informed, valid, and voluntary consent. On the checklist the physician assesses the patient's clinical condition as shock, denial, distress, dependency, or recovery and accordingly indicates the patient's capacity to give fully valid consent. The checklist procedure allows the physician to withhold certain information for good medical reasons. Like its predecessor, the revised checklist is thought to provide the physician with reasonable protection from prosecution and has been shown to enhance the therapeutic relationship when used properly.

Anxiety↗