LIST REFERENCES LIST REFERENCES A) PTSD 76 Q) AGGRESSION 10672 B) STRESS DISORDERS, P... 1588 R) BATTERED CHILD SYND... 358 C) *SUM AB 1664 S) CHILD ABUSE 5317 D) PSYCHOSIS 2667 T) CHILD ABUSE, SEXUAL 1233 E) PARANOID BEHAVIOR 45 U) RAPE 1434 F) PARANOID DISORDERS 2312 V) SEX OFFENSES 1272 G) PSYCHOTIC DISORDERS 10478 W) *SUM QRSTUV 20286 H) *SUM DEFG 15502 X) *ON H&I&W 100 I) ABSTRACT ONLINE 2697862 Y) SEX OFFENSES /MX 886 J) 1990...91 570592 Z) RAPE /MX 865 K) 1985...91 2287221 1A) CHILD ABUSE, SEXUAL/MX 970 L) DRUG ANTAGONISM 3354 1B) CHILD ABUSE /MX 4084 M) DRUG INTERACTIONS 26747 1C) BATTERED CHILD S.../MX 227 N) DRUG SYNERGISM 24967 1D) *SUM YZ1A1B1C 7032 O) *SUM LMN 55068 1E) *ON H&I&1D 8 P) *ON C&H&I 11 *** *** *****AMERICAN JOURNAL OF PSYCHIATRY***** (REFERENCE 1 OF 13) 84151366 Varley CK Schizophreniform psychoses in mentally retarded adolescent girls following sexual assault. Am J Psychiatry 1984 Apr;141(4):593-5 Three mildly retarded adolescent girls developed schizophreniform psychoses following sexual assault. The assault was not identified until the psychoses had cleared. The vulnerability of this population to sexual assault and psychosis is discussed. (REFERENCE 2 OF 13) 88047129 Beck JC van der Kolk B Reports of childhood incest and current behavior of chronically hospitalized psychotic women. Am J Psychiatry 1987 Nov;144(11):1474-6 Of the female patients (N = 26) on a state hospital unit who remained chronically institutionalized and actively psychotic despite psychopharmacologic and psychosocial treatment, 12 (46%) reported histories of childhood incest. These 12 patients were more likely than the others to engage socially with ward staff. A higher proportion had sexual delusions, affective symptoms, substance abuse, suspected organicity, and major mental problems, and they spent more time in seclusion than other patients. The authors acknowledge the difficulty of assessing the accuracy of reports of incest. They discuss the implications of a possible relationship between incest and severe, intractable psychotic disorder. Institutional address: Department of Psychiatry Cambridge Hospital MA 02139. *****ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY***** (REFERENCE 3 OF 13) 79213266 Findji F Harrison-Covello A Lairy GC Long duration EEG studies in the case of a psychotic child. Electroencephalogr Clin Neurophysiol 1979 May;46(5):592-600 Three biotelemetric examinations and a whole night sleep recording were carried out in an 8-year-old child whose behaviour alternated between excitation and autism with stereotypes. The EEG showed 5 c/sec temporo-parietal sharp wave discharges lasting from 1 sec to 20 min. These discharges were at times unilateral and predominantly right sided, at other times bilateral, without any clinical sign of epilepsy. The chronological distribution of right, left and bilateral discharges during the successive 1 min epochs was computed and related to corresponding 'behavioural states' of the child. The paroxysmal discharges predominated when the child was awake but not involved in any relational activity; during sleep, they mostly appeared during light NREM sleep (stage I) and paradoxical sleep. The significance of these paroxysmal discharges is discussed in relation to stereotyped behaviour, vigilance and early disorganization of biological rhythms. *****JOURNAL OF NERVOUS AND MENTAL DISEASE***** (REFERENCE 4 OF 13) 91217689 McGorry PD Chanen A McCarthy E Van Riel R McKenzie D Singh BS Posttraumatic stress disorder following recent-onset psychosis. An unrecognized postpsychotic syndrome. J Nerv Ment Dis 1991 May;179(5):253-8 Clinical experience with psychotic patients early in the course of their illness suggested that symptoms of posttraumatic stress disorder (PTSD) may not be uncommon after recovery from an acute psychotic episode. Thirty-six patients recovering from an acute psychotic episode within 2 to 3 years of onset of their illness were assessed as inpatients and followed up on two occasions during the year after discharge. The prevalence of PTSD was found to be 46% at 4 months and 35% at 11 months, measured by a questionnaire linked to DSM-III criteria. The relationships between negative symptomatology and PTSD symptoms and between depressive symptomatology and PTSD symptoms were also examined; a significant correlation was found only for the latter. The psychopathological, preventive, and therapeutic implications of these findings are discussed, and future research strategies are proposed. Institutional address: National Health and Medical Research Council Schizophrenia Research Unit Royal Park Hospital Parkville Victoria Australia. *****SOUTHERN MEDICAL JOURNAL***** (REFERENCE 5 OF 13) 83275988 Baskett SJ Henager J Differentiating between post-Vietnam syndrome and preexisting psychiatric disorders. South Med J 1983 Aug;76(8):988-90 The scientific literature and the news media have suggested that the symptoms of post-Vietnam syndrome are being overlooked by society and mental health workers. The literature relating to psychiatric problems in Vietnam combat troops and veterans was confusing, and reporting of the posttraumatic stress syndrome was slow. However, the Veterans Administration accepts the diagnostic entity of posttraumatic stress disorder as potentially compensable. We report a case that demonstrates many of the complex issues faced when treating a Vietnam combat veteran. We believe the time has come for a large- scale study of Vietnam veterans to identify the risk factors involved in postwar psychiatric problems. *** *** *****AMERICAN JOURNAL OF PSYCHOTHERAPY***** (REFERENCE 6 OF 13) 84176276 Hendin H Combat never ends: the paranoid adaptation to posttraumatic stress. Am J Psychother 1984 Jan;38(1):121-31 Among Vietnam veterans with posttraumatic stress disorder, a frequently observed adaptation can be described as "paranoid". This adaptation, reflected in mistrust, proneness to take offense, and restricted affectivity, is integrally related to the meanings that combat experiences have had for these veterans. Both in combat and in their postwar civilian lives, rage and the readiness to counterattack serve to repress fear and vulnerability and to deny guilt. The case of one such veteran is presented to illuminate the relationship between combat and postcombat adaptations and to illustrate how understanding the meanings of combat for the veteran is necessary for successful psychotherapy with such patients. *****ANNALES MEDICO-PSYCHOLOGIQUES***** (REFERENCE 7 OF 13) 76229984 Poinso Y Mouren MC [Post emotional syndromes (author's transl)] Les syndromes post-emotionnels Ann Med Psychol (Paris) 1976 Feb;1(2):185-218 (Published in French) On the basis of ten clinical cases of post emotional shock, the following aspects are discussed: the causal emotion and its characteristics, its psychological repercussions and the mechanisms involvent, the clinical patterns observed, both somatic and psychic, and their interpretation. Attention is called to the consequences of such emotions from the forensic view-point and the need to ascertain and specify the nature and intensity of the emotional trauma and the actual state of anxiety. Emphasis is laid on the difficulty of making expert appraisals and fixing equitable compensations, as experts differ and their approaches to the problem and also because of the functional character of sequela and their varying degree of severity. *****BIOLOGICAL PSYCHIATRY***** (REFERENCE 8 OF 13) 89105633 Southwick S Mason JW Giller EL Kosten TR Serum thyroxine change and clinical recovery in psychiatric inpatients. Biol Psychiatry 1989 Jan;25(1):67-74 Serum free thyroxine (FT4), total thyroxine (TT4), and Brief Psychiatric Rating Scale (BPRS) measurements were obtained following hospital admission and at 2-week intervals during hospitalization in 80 male psychiatric inpatients with a variety of major psychotic and affective disorders. A strong correlation between the range values for BPRS sum and for FT4 (p less than 0.005) and TT4 (p less than 0.001) levels indicated that change in overall symptom severity was linked to change in thyroxine levels during clinical recovery. We found the relationship not to be a simple one, but to require definition of criteria for three patient subgroups for each hormone, taking into account the initial absolute thyroxine level, as well as the direction and magnitude of hormonal change during recovery. The hormonally defined "good recovery" subgroup included patients with high initial thyroxine levels that then fell substantially, patients with low initial thyroxine levels that then rose substantially, and patients with initial thyroxine levels in the middle range that subsequently changed substantially. The hormonally defined "poor recovery" subgroup included those patients not meeting these criteria. The degree of clinical improvement in the hormonally defined good recovery group was significantly greater by almost twofold than the poor recovery group both for FT4 (p less than 0.04) and TT4 (p less than 0.02). These findings suggest that a "normalizing" principle underlies the relationship between clinical recovery and thyroxine levels and that both FT4 and TT4 levels within the normal range appear to have clinical significance in either reflecting or contributing to the course of a variety of psychiatric disorders and possibly having a role in pathogenesis. Institutional address: Department of Psychiatry Yale University School of Medicine West Haven VA Medical Center CT 06516. *****BRITISH JOURNAL OF PSYCHIATRY***** (REFERENCE 9 OF 13) 86188466 Shalev A Munitz H Conversion without hysteria: a case report and review of the literature. Br J Psychiatry 1986 Feb;148:198-203 The term 'conversion' implies a correlation between conversion symptoms, hysteria, and hysterical personality. A clinical case of conversion related to chronic post-traumatic disorder, with paranoid features, was successfully treated by anti-psychotic drugs; it illustrates the non-specific nature of conversion symptoms. Mechanic's concept of 'illness behaviour' is a frame-work that meets the need for a broader understanding of conversion symptoms. *****JOURNAL OF CLINICAL PSYCHOLOGY***** (REFERENCE 10 OF 13) 90270456 Koretzky MB Peck AH Validation and cross-validation of the PTSD subscale of the MMPI with civilian trauma victims. J Clin Psychol 1990 May;46(3):296-300 The 49-item MMPI PTSD Subscale, developed and validated with Vietnam combat veterans, was administered to validation and cross-validation samples of Posttraumatic Stress Disorder (PTSD) patients who had experienced non-military traumatic events and to psychiatric controls (total N = 69). Using a cutting score of 19, derived from the validation sample only, the PTSD subscale correctly classified 87% of all validation subjects and 88% of all cross-validation subjects. Results strongly support the utility of MMPI assessment of PTSD with civilian trauma victims as one component of a broad assessment strategy. Institutional address: Department of Veterans Affairs Medical Center Psychology Service Fort Howard MD 21052. (REFERENCE 11 OF 13) 90037629 Penk W Robinowitz R Black J Dolan M Bell W Roberts W Skinner J Co-morbidity: lessons learned about post-traumatic stress disorder (PTSD) from developing PTSD scales for the MMPI. J Clin Psychol 1989 Sep;45(5):709-17 Results from efforts to develop and validate PTSD measures are promising, but a "gold standard" has not been achieved. Keane, Malloy, and Fairbank (1984) have developed an MMPI PTSD subscale that has been cross-validated with clinicians' classification of PTSD at acceptable levels of agreement, specificity, and sensitivity. There is, however, room for improvement. Empirical evidence is presented that indicates that the next round of efforts to increase reliability and validity of PTSD measures must account for the presence/absence of co-morbidity (i.e., the simultaneous occurrence of other psychiatric disorders). For example, differences are noted in MMPI group profiles and PTSD scales between psychiatric patients and substance abusers. Second, different MMPI items emerge as indicative of PTSD; these vary as a function of the presence of other Axis I disorders among groups of Vietnam combat veterans who seek treatment for substance abuse. Results substantiate that different MMPI items for classifying PTSD occur with groups that differ in co-morbidity. Improvements in PTSD scale development are more likely when the contributions of pre-existing or subsequently co-occurring psychiatric disorders are taken in account, as well as variations in level of personality maturity. The evidence suggests that a "family" of PTSD scales need to be developed that take into account co- morbidity differences. Institutional address: Veterans Administration Medical Center Boston Massachusetts. *****JOURNAL OF PERSONALITY ASSESSMENT***** (REFERENCE 12 OF 13) 87198046 Vanderploeg RD Sison GF Jr Hickling EJ A reevaluation of the use of the MMPI in the assessment of combat- related posttraumatic stress disorder. J Pers Assess 1987 Spring;51(1):140-50 This study attempts to validate previously developed, empirically based Minnesota Multiphasic Personality Inventory (MMPI) decision rules (Keane, Malloy, & Fairbank, 1984) to aid in the diagnosis of combat-related posttraumatic stress disorder (PTSD). Four groups of 21 subjects each were identified: PTSD, psychotic, depressed, and chronic pain. A decision rule based on the standard clinical scales resulted in a correct classification rate (PTSD vs. non-PTSD) of 81% across the four-group sample. An empirically derived MMPI PTSD scale resulted in a correct classification rate of 77%. However, 43% of the PTSD subjects were incorrectly classified as non-PTSD by these rules. Independent, blind sorting of the 84 MMPI profiles by two doctoral- level clinical psychologists resulted in "hit rates" similar to the MMPI decision rules. The present results suggest that the previously derived, empirically based MMPI decision rules for PTSD do scarcely better than chance on correct classification of individuals with PTSD. We suggest that the differential diagnosis of PTSD is difficult because of the wide variety of symptoms in common with other diagnostic groups, and hence the variability of PTSD subjects on psychometric measures. We also suggest that the MMPI decision rules of Keane et al. (1984) may have utility in identifying subgroup(s) of combat-related PTSDs. *****PSYCHIATRY RESEARCH***** (REFERENCE 13 OF 13) 91319846 Goff DC Brotman AW Kindlon D Waites M Amico E Self-reports of childhood abuse in chronically psychotic patients. Psychiatry Res 1991 Apr;37(1):73-80 A heterogeneous sample of 61 chronically psychotic patients were subgrouped according to the presence or absence of a self-reported history of childhood abuse. Patients reporting childhood abuse (n = 27) had an earlier age of onset, scored higher on the Dissociative Experiences Scale, reported more amnesia, and relapsed more frequently than patients not reporting abuse histories. Histories of childhood abuse and of past stimulant abuse predicted the score on the Dissociative Experiences Scale. A history of childhood abuse may thus contribute to the symptomatology and course of illness in some chronically psychotic patients. Institutional address: Freedom Trail Clinic Erich Lindemann Mental Health Center Boston MA 02114.