A JAMA THEME ISSUE
Edited by Annette Flanagin, RN, MA, and Thomas B. Cole, MD, MPH
Military veterans diagnosed as having posttraumatic stress disorder (PTSD) are often prescribed a serotonin reuptake inhibitor (SSRI). When PTSD symptoms persist despite an adequate medication trial, adjunctive treatment with a second-generation antipsychotic is common, although evidence supporting this practice is limited. In a randomized trial of individuals with military service–related and SSRI–resistant PTSD, Krystal and colleagues found that compared with placebo, 6 months' treatment with risperidone—a second-generation antipsychotic—added to ongoing pharmacologic and psychosocial treatment did not reduce PTSD symptoms.
Psychological rehabilitation and successful reintegration of former child soldiers into postconflict society is challenging. Ertl and colleagues assessed the efficacy of a community-based and lay therapist–delivered short-term intervention that targeted symptoms of posttraumatic stress disorder (PTSD) among 85 former Ugandan child soldiers who resided in camps for internally displaced persons. The authors report that compared either with assignment to a waiting list or with an academic catch-up program that included supportive counseling, the trauma-focused intervention was associated with greater reduction in PTSD symptoms.
Rees and colleagues analyzed data from women respondents to the 2007 Australian National Mental Health and Well-Being Survey to examine mental health correlates of violence against women. Among the authors' findings was that lifetime exposure to gender-based violence—specifically, intimate partner physical violence, rape, other sexual assault, and stalking—was associated with higher lifetime prevalence of anxiety, mood and substance use disorders, suicide attempts, and impaired psychosocial functioning.
Armed conflicts can result in displacement of persons to neighboring countries or secure areas of their own country. In Sri Lanka, where civil conflict occurred between 1983 and 2009, internal displacement of residents in one affected region—the Jaffna District—was estimated to be 23%. To assess the relationship between forced internal displacement and common war-related mental health conditions, Husain and colleagues conducted a cross-sectional cluster sample survey of 1517 Jaffna District households in 2009. The authors report that the prevalence of symptoms of posttraumatic stress disorder, anxiety, and depression among Jaffna District residents aged 15 years or older was substantial and significantly associated with displacement status and trauma exposure.
Mrs O, a 70-year-old woman with a history of alcoholism and recurrent falls, lives alone. In response to an anonymous referral to adult protective services, investigators found a filthy environment, unopened delivered meals, no food in the refrigerator, and multiple bottles of alcohol. Clinical examination of Mrs O documented extensive evidence of self-neglect and deficits in multiple living skills. Mosqueda and Dong discuss risk factors for and consequences of elder mistreatment and the role of health care professionals in its diagnosis and response.
“We all lose patients we care for and care about, but just not as frequently and with such a sense of helplessness as we did in those days.” From “You Have No Idea.”
Health care workers in Bahrain have been targeted for reprisals by the government for treating abused and tortured antigovernment protesters.
Government-imposed human rights barriers to professionalism
Treating PTSD via the Internet
Scientific publication and global security
Indirect sampling to measure conflict violence
Interventions for war-related PTSD
Should a healthy 42-year-old man at low risk of HIV infection undergo screening? Read the case at www.jama.com. Submit your response by August 7 for possible online posting.
Ms Flanagin and Dr Cole summarize and comment on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about elder abuse.
This Week in JAMA . JAMA. 2011;306(5):461. doi:10.1001/jama.2011.1081