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  • 2005-10
    Pictures taken from various Earthwatch expeditions over the years. Learn more about Earthwatch at http://www.earthwatch.org.

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PTSD

August 21, 2008

Does Borderline Personality Disorder Affect Pain Sensitivity?

A research study published in the January 2008 issue of the World Journal of Biological Psychiatry compared pain sensitivity in patients with different psychiatric diagnoses under baseline and stress conditions. The study used a sample of 76 female subjects: 16 patients with borderline personality disorder (BPD), 16 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa and 24 healthy controls. Using a contact thermal probe, heat and cold pain thresholds were determined under baseline and stress conditions while mental stress was induced with a cognitive task (Paced Auditory Serial Addition Task). The results showed that pain thresholds in patients with BPD were significantly higher compared to healthy controls under baseline conditions. Patients with PTSD and bulimia nervosa did not show significant differences in pain thresholds compared to healthy controls. Under stress conditions, the difference between BPD patients and healthy controls became even more prominent, whereas the results in the other patient groups remained insignificant. The authors conclude that reduced pain sensitivity is a prominent feature of BPD, which may differentiate this disorder from other stress-related psychiatric conditions.

Click here for the abstract.

July 29, 2008

Doctors Remove Eight-Centimeter Long Nail Following Bizarre Suicide Attempt

Surgeons at a hospital in Meerut, India successfully removed an eight-centimeter-long nail from the skull of a 24-year old patient following an apparent suicide attempt. The patient had reportedly been suffering from post-traumatic stress disorder after witnessing a fire in 2005 that had killed more than 50 people. After seeing the charred bodies he had expressed a desire to die as well. “He had earlier attempted suicide by consuming poison,” said his father, a local resident. On the evening of July 22, he had rammed the rusted nail into his skull using a wooden board lying in the bathroom and then went to bed assuming that he would die in his sleep. The family saw the nail sticking out of his skull on the following morning when he came down to the ground floor.

After being rushed to Lala Lajpat Rai Medical College, doctors operated upon him and removed the nail. Pradeep Bharti, head of the neurosurgery department at the hospital, said: “The nail damaged certain parts of the youth’s brain. The operation was performed successfully. A team of eight medical and paramedical professionals took two and a half hours to take out the nail. The youth is fully conscious and well, but we are keeping him under observation.” Sona Kaushal Bharti, a psychiatrist, said the patient was under treatment of psychologists but did not receive counseling after he went into depression in 2005.

Click here for more information.

July 03, 2008

Disaster Mental Health Workers and the Anniversary Effect

A study published in the April 2008 issue of Journal of Traumatic Stress examined anniversary reactions in mental health disaster relief workers following traumatic exposure at the site of the World Trade Center terrorist attacks. Despite relatively low levels of symptom reporting, workers endorsed an increase in both negative mood symptoms and functional impairment at the one-year anniversary of their traumatic exposure (compared to 6 months postexposure). For individuals who met at least some of the criteria for posttraumatic stress disorder (PTSD) immediately following exposure, overall self-reported PTSD symptoms tended to increase from 6 to 12 months. This tendency resulted specifically from an increase in hyperarousal symptoms. Although only a few of the participants had severe PTSD, the results demonstrated that disaster relief workers may experience an increase in symptomatology at the anniversary of their traumatic exposure.

Click here for the abstract.

May 25, 2008

The Great Lisbon Earthquake

It was one of the most destructive earthquakes on record and, quite possibly, changed the course of European history.

The epicenter of the earthquake was in the North Atlantic about 200 kilometers southwest of the Portuguese coast and geologists now estimate the magnitude at almost 9 on the Richter scale. There was no warning when the tremors came in three devastating jolts on November 1, 1755 (All Saint's Day) beginning at 9:30 in the morning (local time). Although the earthquake subsided after only ten minutes, the devastation 340px1755_lisbon_earthquake was only just beginning.

In the city of Lisbon, fires raged out of control for days and destroyed large sections of the city. People fleeing the city attempted to escape any way that they could including aboard ships that were still moored on the Tagus river. Unfortunately, the tsunami that followed the earthquake battered the coast and rushed up the river thirty minutes after the tremors ended. Many of the low-lying areas were swamped by three great waves that washed people, buildings, and ships out to sea. The maximum height of the waves was later estimated at thirty meters in some places. Boats were capsized, buildings were drenched, and almost all the coastal areas of Algarve were heavily damaged.

Estimates vary concerning the total loss of life on that fateful day and range from 60,000 to 100,000. Lisbon, which had been one of the most heavily populated cities in Europe, lost as many as 90,000 out of a total population of 275,000 and countless more were left homeless. Over eighty percent of all the buildings in the city were destroyed including priceless architecture and artwork. The Royal Hospital burned to the ground with hundreds of patients inside. Although the worst of the damage was in Portugal, there was also heavy loss of life in the Moroccan cities of Fez and Mequinez. The tremors were felt as far away as Spain, France, Switzerland and Italy.

While earthquakes were hardly uncommon in the region, nothing of that magnitude had ever been experienced before. Portuguese troops were overwhelmed with the task of clearing the rubble and dealing with the thousands of corpses left behind. They also dealt harshly with looters (with thirty-four public executions to deter others). To prevent the spread of disease, many corpses were loaded onto barges and buried at sea (to which the Church objected). Able-bodied citizens were drafted to aid in the reconstruction work.

Word about the earthquake spread and countries across Europe promptly sent aid (making it the first truly international relief effort). Due to transportation delays, months passed before that aid could reach Lisbon. Portugal's economy was strained to the breaking point dealing with the expense of feeding and housing the thousands left homeless by the earthquake. In discussing the aftermath of the disaster, the Marques de Pombal, then Portugal's chief minister, reportedly made the famous statement that their main task was to "bury the dead and to feed the living" (actually it was another prominent noble who said it first but Pombal, ever the politician, made the phrase his own).

The earthquake had a profound effect on European cultural thinking. Theologians agonized over why God had permitted such a disaster in a predominately Catholic country (and on a holy day no less). Many proclaimed that it was due to the "wrath of God" and further disasters were predicted. Philosophers across Europe debated the implications of what happened. Voltaire wrote a controversial work about the earthquake titled Poem on the Lisbon Disaster in which he openly condemned prevailing views about the nature of good and evil. Using the calamity as an example, he introduced readers to his own pessimistic philosophy (he would expand on this further in his better-known Candide).  Early researchers including Immanuel Kant and the Marques de Pombal himself studied the Lisbon earthquake in depth and their published findings are considered to mark the beginnings of the modern science of seismology.

The psychological impact of the earthquake is harder to determine but the Great Earthquake certainly had a lasting effect on the survivors. While the Royal family escaped unharmed (largely by chance since there were spending the holiday away from Lisbon), the Ribeira Palace was completely destroyed. King Joseph I never really recovered from the devastation and, for him, the trauma took a most peculiar form. Until his death in 1777, he would never allow himself to be inside a walled building and, at his urging, the entire royal court was moved to the "Real Barraca" (Royal Tent), a collection of tents and pavilions in the hills of Ajuda. It was there that he presided over the rebuilding of Lisbon for the rest of his life.  Only during the reign of his daughter, Maria I, was the new Ajuda National Palace built on the site where the Royal Tent had stood.

Restoring Lisbon to its former glory took decades and the rebuilt sections of the city marked the first examples of earthquake-proof architecture. The designs for the new buildings were tested in a most intriguing way. Scale models were built and troops were marched around them to simulate the effects of an earthquake (a low-tech solution to a practical problem). There were later earthquakes in the region with additional loss of life and property damage but nothing to the extent of what gone before (so far).

While many other natural disasters have occurred since the Lisbon earthquake, it remains a grim reminder of the enormous loss of life that can occur.  Improvements in transportation, communication and medicine may have enabled the rapid deployment of relief efforts but burying the dead and feeding the living is still a heartbreaking task for aid workers and survivors alike.

Click here for an eyewitness account of the earthquake.

May 18, 2008

Is There a Stockholm Syndrome?

On August 23, 1973, an escaped felon named Jan Erik Olsson walked into the Kreditbanken in central Stockholm and attempted to rob it at gunpoint. When Stockholm police arrived on the scene, Olsson180pxformer_kreditbanken_norrmalmst opened fire and injured one policeman before taking four bank employees hostage. He demanded that his fellow convict, Clark Olafsson, be brought to the bank along with a sizable ransom in exchange for his hostages' lives. The police went along with Olsson's demands and arranged for Olafsson to be brought to the bank and a communication link to be established with the police negotiators. Over the course of the next five days, Olsson and Olafsson continued to hold the hostages and threatened to kill them if their demands went unmet.

Finding the police negotiators to be too unreasonable, the hostage-takers even telephoned then-Prime Minister, Olaf Palme, and attempted to make their demands to him directly. After Palme refused their demands, he received a second call from hostage, Kristin Enmark, who expressed annoyance over his refusal to allow the robbers to leave with their hostages. The two robbers finally surrendered on August 28 after a gas attack on the bank itself. None of the hostages had been injured despite numerous threats of death.   Both Olsson and Olafsson were charged and convicted although Olafsson claimed to have simply gone along with Olsson to keep the hostages safe (his conviction was later overturned on appeal). Kristin Enmark maintained contact with Clark Olafsson during his trial and assisted in his defence. She also remained friends with him after his release.

During the hostage crisis, criminologist and psychiatrist, Nils Bejerot served as an advisor to the police negotiators and interviewed the hostages after their release. He noted that the hostages reported considerable sympathy for their captors and stated that they had been mainly frightened over what the police might do to rescue them. It was Bejerot who first coined the term "Stockholm syndrome" and used it in a media interview.Although its actual clinical validity was suspect, the term took on a life of its own and entered the popular culture.

Also known as hostage identification syndrome (HIS), Stockholm Syndrome is apparently characterized by an emotional bond that forms between hostages and their captors which can manifest either unidirectionally (hostage towards captor only) or reciprocally (mutual emotional bond between hostage and captor). The formation of an emotional bond has even been observed going on the other direction with captors developing sympathy for hostages (also known as Lima Syndrome) although its occurrence is considerably rarer.

The existence of Stockholm Syndrome is often taken for granted by authority figures and hostage negotiators despite the lack of consistent evidence noted in released hostages. The Stockholm Sydrome has also been advanced to explain the formation of loyalty bonds in cases of domestic and child abuse (also known as identification with the aggressor) as well as in prisoners of war and concentration camp survivors.  It should be noted that the lack of clear correspondence between hostage situations to more long-term abusive relationships limits possible generalization. Famous cases (such as the Patty Hearst kidnapping) have lent a certain legitimacy to the existence of Stockholm Syndrome but actual research using simulated hostage situations and hostage debriefings tend not to be so straightforward.

In a classic 1985 paper by James T. Turner of the University of Tennessee, he identified specific factors believed to play a role in the formation of HIS. These factors include: face-to-face contact between hostage and captor, a common language (he described a 1977 incident in which only those hostages who spoke the same language as their captors developed HIS), pre-existing beliefs regarding the moral justification of the hostage-taker's goals, absence of unwarranted violence (deliberate mistreatment of hostages), and development of identification with the captor. The final factor that Turner identified was length of captivity with likelihood of positive interactions forming between hostages and captors increasing over time.

It was largely with the expectation of Stockholm Syndrome that hostage preparedness training programs have been developed to teach diplomatic and military personnel who are deemed to be at high risk of capture to cope effectively.  Despite the events of September 11, 2001, use of hostage preparedness training still focuses on awareness of potential emotional problems both during the hostage crisis and in coping with the aftermath.  Unfortunately, studies examining the validity of such training in actual hostages remains rare.

As for Jan Erik Olsson, the bank robber who had started it all? While serving his sentence, he received numerous letters from female admirers and later married one of them (contrary to popular belief, she was not one of the hostages). He returned to a life of crime after his release. In 2006, Olsson attempted to turn himself over to Swedish authorities believing that he was still a fugitive for crimes that he had committed. The police informed him that the charges had been dismissed and he was sent on his way. His current whereabouts are unknown (but his legacy remains).

April 17, 2008

The Children of War

A study focusing on the psychosocial effects chronic warfare among refugee children in Southern Darfur is presented in a recent issue of Omega. A sample of 331 children (aged 6-17) from three refugee camps were selected to be part of the study. Of those in the sample, 43 percent were girls and 57 per cent were boys with an average age of twelve years. All of the children in the study were interviewed and tested with measures of traumatic stress, depression, and grief.The study results indicate that there were no significant differences between genders in terms of exposure to traumatic experiences, including rape, but older children (13-17 years) experienced a larger number of traumatic exposures than younger children (6-12 years). Seventy-five percent of the children met the DSM-IV criteria for PTSD, and 38 per cent exhibited clinical symptoms of depression. Twenty per cent of the children sampled also reported significant levels of grief symptoms.

The authors found that increased exposure to war experiences led to higher levels of: (1) traumatic reactions; (2) depression; and (3) grief symptoms. Of the different war experiences examined, abduction, hiding to protect oneself, being raped, and being forced to kill or hurt family members were most predictive of traumatic reactions. Factors most likely to predict depressive symptoms included: being raped, seeing others raped, the death of a parent, being forced to fight, and having to hide to protect oneself. Similar findings were reported for grief reactions. While trauma, depression, and grief often occur together, the mechanisms and ways in which they interact are less understood. This is the first study examining the psychosocial effects of war experiences among refugee children currently living in Sudan's war-zone areas. The authors recognize the need for further research into war-related atrocities and their varying impact on the children's psychological well-being and overall adjustment. Implications for planning mental health interventions are also discussed.

Click here for the abstract.

March 27, 2008

Casualties of War

The Winter issue of Perspectives in Biology and Medicine presents a thoughtful overview on war and its casualties. Throughout America's first 145 years of war, far more of the country's military personnel died from infectious diseases than from combat injuries. This only began to change in World War II due to better methods of disease prevention and treatment. The authors suggested that soldier deaths throughout U.S. history can be divided into a Disease Era (1775-1918), during which infectious diseases were the major killer of America's armed forces, and a Trauma Era (1941-present), in which combat-related injuries were the major cause of fatalities. Using the 3,400 U.S. military fatalities in Iraq as a comparison, suicide deaths have become more prevalent than deaths from infectious disease.  Given the rising rate of suicides in U.S. soldiers posted overseas, this trend is not expected to change.

Click here for the abstract.

March 11, 2008

Seeking Refuge

The International Organization for Migration (IOM) has released a report indicating that Iraqi refugees in Lebanon are experiencing high levels of emotional distress and post-traumatic symptoms. The report outlines the results of a study carried out between November 2007 and January 2008 on 800 Iraqi refugees in Lebanon and Jordan. More than half of the refugees studied reported post-traumatic symptoms such as panic attacks, anger, fatigue, anxiety and sleep disorders. For the 34 per cent of study participants who reported experiencing direct violence, including attacks on themselves or family members, the emotional distress was particularly acute. In addition to the effects of recent trauma, factors relating to their uncertain existence as refugees are sources of added distress. Economic difficulties relating to lack of employment, poor living conditions and limited access to health and social resources and educational opportunities has led to physical expressions of anger and frustration. Domestic violence, behavioural and learning problems in children, and isolation are common experiences in refugee families.

"The level of instability is very high among the refugees. We see humanitarian agencies and governments responding to the basic needs of displaced Iraqis at home and abroad, and we need to see a similar response in dealing with their equally important psychological well-being," said Guglielmo Schinina, head of IOM's psychosocial office in the Middle East.

The study was carried out in partnership with international and non-governmental organizations such as the Iraqi Youth League and the Jordanian Women's Union, as well as UNICEF, which provided financial assistance.

Click here for more information.

March 06, 2008

Surviving the Holocaust

The January 2008 issue of the Journal of the American Geriatric Society presents that results of a longitudinal study examining the long-term effects of Holocaust exposure during young adulthood. A sample of four hundred fifty-eight subjects of European origin (aged 70 at baseline and 77 at follow-up) were assessed in the study. Information taken included biographical history of concentration camp internment, exposure to Nazi occupation during World War II, or lack thereof (the control subjects), and 7-year mortality data from the National Death Registry. The results indicated that the 93 survivors of the internment camps and the 129 survivors who experienced the occupation first-hand were more likely to differ from the 236 control subjects in terms of being male, being less educated, and having poorer social support. They were also found to report being less physically active, to experience greater difficulty in activities of daily living, to have poorer self-rated health, and to have greater usage of psychiatric medication. No other differences in health parameters or physical illnesses were found. Holocaust survivors and control subjects had similar rates of deterioration in health issues over the follow-up period, and 7-year mortality rates were identical. The authors conclude that while Holocaust survivors displayed significant psychosocial and functional impairment, there was no evidence found to support the hypothesis that the delayed effects of the trauma of the Holocaust influence physical health or mortality.

Click here for the abstract.

March 04, 2008

Mitigating Factors Citied in Restaurant Murder

An Australian judge cited mitigating factors raised in a psychological report to sentence restaurant owner Khanh Vo to seven years in prison for the manslaughter of 56-year old Anh Dung Nguyen. Vo stabbed Nguyen with a small kitchen knife after a fight broke out at the Bon Mua restaurant and karaoke bar in Richmond, Australia on the night of April 16, 2006. Justice Kevin Bell said in passing sentence that Vo, a father of two with no previous convictions, showed remorse by pleading guilty to the crime. In making his sentencing decision, Justice Bell took account of a psychologist's report that said Vo's violent childhood experiences as a refugee from Vietnam in the mid-1980s could have led him to overreact. He lived for a time in a refugee camp described in court as "violent and dangerous", especially for children. The report also suggested that Vo met many criteria depicting a major depressive episode and post-traumatic stress disorder.

Sources state that the fight began within half an hour of Mr Nguyen complaining about the length of time it took for Vo's wife and restaurant co-owner, Vy Huynh, to bring food to his table. After Ms Huynh complained to her husband, Vo recognised Mr Nguyen from a previous occasion in which Mr Nguyen allegedly said he would get a gun and shoot somebody if that person caused him trouble. Following the stabbing, Mr Nguyen was helped from the restaurant but died the next day, Justice Bell said.

Vo has served about 22 months in pre-sentence detention, making him eligible to seek release on parole in 2010.

Click here for more information.

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