Providentia

How Prevalent is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD) is a mental disorder involving excessive preoccupation with imagined or minor bodily imperfections. It has been linked to OCD-spectrum disorders and can manifest itself in s range of ways including anorexia nervosa, substance abuse and suicide. Estimates of actual prevalence vary widely. The April 2008 issue of CNS Spectrums presented the results of a national survey to estimate the prevalence of BDD in the United States. Using a random sample national household telephone survey conducted in 2004, 2,513 adults were contacted, of whom 2,048 qualified for administration of computer-assisted, structured interviews, addressed DSM-IV criteria for BDD. Information on psychological, financial and demographic factors was also collected. Respondents included a higher percentage of women and people >55 years of age than in the US adult population, and a lower percentage of Hispanics. Results showed an estimated prevalence of DSM-IV BDD among respondents as 2.4% (49/2,048) (by gender: 2.5% for women, 2.2% for men), exceeding the prevalence of schizophrenia and bipolar disorder type I and about that of generalized anxiety disorder. BDD prevalence decreased after 44 years of age, and a larger proportion of BDD respondents were never married. Of those meeting DSM-IV criteria for BDD, 90% (45/49) met the DSM-IV distress criterion, and 51% (25/49) met the interference-with-functioning criterion. The researchers concluded that further research is needed to evaluate these results and to determine more effective treatment approaches.

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Is There a Link Between Brain Injury and Psychiatric Problems?

An interesting analysis in the December 2007 issue of Brain Injury looks at the role of traumatic brain injuries (TBI) in the development of severe, long-term psychiatric disorders.

While a clear causal link remains unclear, the authors found that psychiatric syndromes are consistently present at an elevated rate following TBI. Survivors of TBI are particularly susceptible to major depression, generalized anxiety disorder and post-traumatic stress disorder. While evidence of a direct link is lacking, the authors suggest that there may be consistent critical periods for the post-injury development of psychiatric disorders that have yet to be identified. There is evidence, however, that TBI cases remain at risk for years following injury. Non-organic factors, including pre-morbid personality traits and post-injury psychological reactions to disability and trauma, seem to play a role in the development of post-TBI psychiatric disorders. Treatment professionals dealing with TBI cases needed to be aware of the potential for the development of post-TBI psychiatric problems.

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Ten Years After Traumatic Brain Injury

A research study published in the March 2008 issue of the Journal of the International Neuropsychological Society presents the results of a 10-year study examining the long-term effects of traumatic brain injury (TBI). Previous research investigating long-term has yielded mixed results linking severity of injury, demographic factors, and psychiatric problems. In the present study, a sample of 60 participants who had sustained TBI 10 years previously was used. Participants were tested with the Extended Glasgow Outcome Scale (GOSE) as well as neuropsychological measures of attention, speed of processing, memory and executive function and a measure of anxious affect. Outcome on the GOSE ranged from upper good recovery (32%) to lower severe disability (2%). Factors associated with poorer outcome on the GOSE included duration of posttraumatic amnesia, level of education, poor performance on cognitive measures of information processing speed, attention, memory, and executive function as well as showed higher levels of tested anxiety.

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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.

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How Families of Organ Donors Deal with Grief

A study published in the February 2008 issue of Clinical Transplantation examines the effect of the organ donation process on families dealing with grief. Using the British Columbia Transplant Society (BCTS) database, the authors mailed test packages to families of deceased organ donors. Each package contained three standardized, validated questionnaires (including scales of depression, post-traumatic stress, and bereavement). Seventy-three completed packages were received (an overall response rate of 46%) and the responses were analyzed. The results of the study showed that grief varied in terms of age of the deceased and length of time since donation. Donor families reporting negative aspects about the donation process were also more likely to experience post-traumatic stress. Based on their findings, the authors concluded that organ donation can have a beneficial effect on the grief process providing that donor families receive proper counseling and support before and after donation.

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Does Mild Traumatic Brain Injury Cause Cognitive Problems?

A study reported in the December 2007 Journal of Psychosomatic Research examined cognitive complaints in head-injured patients referred to the emergency department of a level 1 trauma center in the Netherlands.  A sample of 79 patients (ranging in age from 18 to 60) who had been admitted for mild traumatic brain injury were followed up over six months post-admission. In addition to a battery of neuropsychological tests and use of the Rivermead Postconcussional Symptoms Questionnaire (RPSQ), patients were also asked to self-monitor their cognitive and memory problems over a 12-day period. Results indicated that 39 per cent of the sample self-reported cognitive problems. These complaints were strongly related to lower educational levels, emotional distress, personality, and poorer physical functioning (especially fatigue) but not to actual extent of injury.  Severity of self-reported cognitive complaints was found not to be associated with the patients' daily observations of cognitive problems or with outcome on a range of neuropsychological tests.  The researchers concluded that self-reported cognitive complaints were more strongly related to preexisting personality factors, as well as physical and emotional problems rather than actual cognitive impairments. This would suggest that treatment of emotional distress and fatigue may also reduce cognitive complaints. They also concluded that neuropsychological screening and daily monitoring of complaints is a useful method to gather information about the frequency and pattern of cognitive problems in regular life.

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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.

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Psychotic Symptoms In The Elderly

A study in the December 2007 issue of the American Journal of Geriatric Psychiatry examines the prevalence of psychotic symptoms and schizophrenia in nondemented 95-year-olds over a one-year period. A sample of 338 95-year-olds living in Göteborg, Sweden (individuals with dementia were excluded leaving 163 subjects for this study) received psychiatric and physical examinations as well as cognitive tests and interviews with close informants. The results indicated that the one-year prevalence of any psychotic symptom was 7.4% overall (hallucinations 6.7% and delusions 0.6% ). Four of the study participants met DSM-III-R criteria for schizophrenia (2.4%). No differences in cognitive functioning were found between individuals with psychotic symptoms and individuals without these symptoms. Individuals with hallucinations and paranoid ideation also had an increased frequency of paranoid personality traits. The authors concluded that there was evidence of a higher than expected prevalence of psychotic symptoms, paranoid ideation, and schizophrenia in the very old.

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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.

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Head Injury and Substance Use in Teenagers

A paper published in the January 2008 issue of Journal of Pediatric Surgery contains the results of a study examining the role of drug and alcohol use in adolescents suffering from traumatic brain injuries. Using trauma registry data to identify adolescent blunt trauma victims between 2000 and 2005, demographic information, injury severity, length of hospital stay, and clinical outcomes were evaluated. Of the total number of adolescent patients sampled, 9.3% tested positive for drug and/or alcohol use (the mean age of toxicology-positive patients was 17.2 years). The most commonly detected drugs were cannabis (40%), alcohol (30%), and polysubstances (23%). Substance-positive patients were more likely to be comatose, to have more significant injuries, and require emergency operations than adolescent patients who did not test positive for substance use. Length of hospital stay was was also significantly longer. In terms of outcome, mortality was found to be significantly higher and functional independence was lower. The authors conclude that substance abuse was linked to injury severity, need for medical care, and poor medical outcome for adolescent blunt trauma victims.

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