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This article discusses the forms of sexual abuse of female children and the psychosocial impact on the well-being of girls in India. Child sexual abuse statistics reveal an estimated 50% of girls being sexually abused before the age of 15 years. Girl children are abused and then are made to feel personally responsible, guilty, or persecuted. Girls are threatened with violence if they tell about the sexual abuse. Pregnancies arising from sexual abuse result in shame and early marriage. Male children are also abused but they are not made to feel punished. Child sexual abuse is technically any sexual activity (rape, fondling of genitalia, masturbation, forced oral sex, sodomy, or vaginal penetration) that is committed by someone in a position of authority, power, or trust over the child or by a stranger. The World Health Organization estimates that 1 in 10 children worldwide is sexually abused. Rape within the family is particularly difficult for the victim. In almost 60% of rape cases, the victim was unwilling to report the name of the abuser. Families remain silent about sexual offenses in order to protect the family image. Mothers remain silent if the abuser is the father, which interferes with a child's relationship to both parents. Sexual abuse can result in bed wetting, nightmares, sleep disorders, depression, anxiety, running away from home, multiple personality disorders, precocious sexual behavior, or sexual inhibition and low self-esteem. Parental responses tend to be inappropriate discipline or ignoring it. Children may experience flashbacks or other long-term effects. Girls who experience sexual abuse once tend to be more vulnerable to abuse in adult life. Healing is slow and systematic. The first aim is to restore a girl's ability to say no and to teach her to protect herself. Healing is about removing guilt and resolution of the conflict between blame and the grossness of the violation.
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PMID:Sexual violence and the girl child. 1215 3

Female genital mutilation is associated with immediate, long-term, pregnancy-related, and psychosexual complications. Immediate complications can cause death and include severe pain, shock, hemorrhage, tetanus or sepsis, urine retention, ulceration of the genital region, and injury to adjacent tissues. Long-term complications include formation of cysts, abscesses, and keloid scars, damage to the urethra resulting in incontinence, painful sexual intercourse, sexual dysfunction, recurrent urinary tract infections, chronic pelvic inflammatory disease, and infertility. During child birth, survivors of female genital mutilation may require Cesarean section or suffer obstructed labor leading to fetal death and/or vesico-vaginal fistulae and large perineal tears. The psychological consequences of female genital mutilation may involve loss of trust and confidence in care-givers, feelings of incompleteness, anxiety, depression, chronic irritability, and sexual problems. In many women, flashbacks of the infibulation process are triggered by touch. Deinfibulation must be accompanied by adequate pain relief, but the use of local or epidural anesthesia is not appropriate.
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PMID:Consequences of genital mutilation. 1222 23

There is abundant evidence to suggest that violence in healthcare settings, especially in emergency departments (EDs) and psychiatry, is escalating and that nurses are particularly vulnerable. The authors, therefore, investigated the prevalence and effects of violence against nurses in an ED in a general hospital setting in Kuwait. A 12-item frequency-weighted questionnaire was used to measure rates, frequency and severity of violence. The questions related to the experience of violent incidents during the past year. Seventy out of 81 nurses experienced verbal insults or threats of imminent violence and 13 were also physically attacked during the 1-year period. Sixty-seven out of 70 nurses suffered from one or more after-effects, including flashbacks, sleeplessness, fearfulness, depression or taking time off work. Violence in healthcare services often reflects the community in which service is provided. Our findings suggest that doctors experience more violence but nurses suffer from more after-effects of violence at work.
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PMID:Violence against nurses in hospitals: prevalence and effects. 1257 14

BACKGROUND: Depressive and anxiety disorders are highly prevalent in the primary care setting. There is evidence that patients with depression and comorbid anxiety are more severely impaired than patients with depression alone and require aggressive mental health treatment. The goal of this study was to assess the impact of comorbid anxiety in a primary care population of depressed patients. METHOD: 342 subjects diagnosed with a DSM-IV-defined major depressive episode, dysthymia, or both were asked 2 questions about the presence of comorbid anxiety symptoms (history of panic attacks and/or flashbacks). Patient groups included depression only (N = 119), depression and panic attacks (N = 51), depression and flashbacks (N = 97), and depression and both panic attacks and flashbacks (N = 75). Groups were compared on demographics, mental health histories, and health-related quality-of-life variables. Data were gathered from January 1998 to March 1999. RESULTS: Those patients with depression, panic attacks, and flashback symptoms as compared with those with depression alone were more likely to be younger, unmarried, and female. The group with depression, panic attacks, and flashbacks was also more likely to have more depressive symptoms, more impaired health status, worse disability, and a more complicated and persistent history of mental illness. Regression analysis revealed that the greatest impact on disability, presence of depressive symptoms, and mental health outcomes was associated with panic attacks. CONCLUSION: By asking 2 questions about comorbid anxiety symptoms, primary care providers evaluating depressed patients may be able to identify a group of significantly impaired patients at high risk of anxiety disorders who might benefit from collaboration with or referral to a mental health specialist.
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PMID:Identifying Depressed Patients With a High Risk of Comorbid Anxiety in Primary Care. 1515 20

Repeated vivid recalls or flashbacks of traumatic memories and memory deficits are the cardinal features of post-traumatic stress disorder (PTSD). The underlying mechanisms are not fully understood yet. Here, we examined the effects of very strong fear conditioning (20 pairings of a light with a 1.5-mA, 0.5-s foot shock) and subsequent reexposure to the conditioning context (chamber A), a similar context (chamber B), and/or to the fear conditioned stimulus (CS) (a light) on synaptic plasticity in the hippocampal CA1 area in anesthetized Sprague-Dawley rats. The conditioning procedure resulted in very strong conditioned fear, as reflected by high levels of persistent freezing, to both the contexts and to the CS, 24 h after fear conditioning. The induction of long-term potentiation (LTP) was blocked immediately after fear conditioning. It was still markedly impaired 24 h after fear conditioning; reexposure to the conditioning chamber A (CA) or to a similar chamber B (CB) did not affect the impairment. However, presentation of the CS in the CA exacerbated the impairment of LTP, whereas the CS presentation in a CB ameliorated the impairment so that LTP induction did not differ from that of control groups. The induction of long-term depression (LTD) was facilitated immediately, but not 24 h, after fear conditioning. Only reexposure to the CS in the CA, but not reexposure to either chamber A or B alone, or the CS in chamber B, 24 h after conditioning, reinstated the facilitation of LTD induction. These data demonstrate that unconditioned and conditioned aversive stimuli in an intense fear conditioning paradigm can have profound effects on hippocampal synaptic plasticity, which may aid to understand the mechanisms underlying impairments of hippocampus-dependent memory by stress or in PTSD.
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PMID:Effects of unconditioned and conditioned aversive stimuli in an intense fear conditioning paradigm on synaptic plasticity in the hippocampal CA1 area in vivo. 1601 21

Admission to critical care can have far-reaching psychological effects because of the distinct environment. Critical care services are being re-shaped to address long-term sequelae, including post-traumatic stress disorder, anxiety and depression. The long-term consequences of critical illness not only cost the individual, but also have implications for society, such as diminished areas of health-related quality-of-life in sleep, reduced ability to return to work and enjoy recreational activities (Audit Commission, 1999; Hayes et al, 2000). The debate around the phenomenon of intensive care unit (ICU) syndrome is discussed with reference to current thinking. After critical care, patients may experience amnesia, continued hallucinations or flashbacks, anxiety, depression, and dreams and nightmares. Nursing care for patients while in the critical care environment can have a positive effect on psychological well-being. Facilitating communication, explaining care and rationalizing interventions, ensuring patients are oriented as to time and place, reassuring patients about transfer, providing patients,where possible, with information about critical care before admission and considering anxiolytic use, are all practices that have a beneficial effect on patient care. Follow-up services can help patients come to terms with their experiences of critical illness and provide the opportunity for them to access further intervention if desired. Working towards providing optimal psychological care will have a positive effect on patients' psychological recovery and may also help physical recuperation after critical care.
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PMID:Psychological implications of admission to critical care. 1611 71

Posttraumatic stress disorder (PSTD), classified as an anxiety disorder, has become increasingly important because of wars overseas, natural disasters, and domestic violence. After trauma exposes the victim to actual or threatened death or serious injury, 3 dimensions of PTSD unfold: (1) reexperiencing the event with distressing recollections, dreams, flashbacks, and/or psychologic and physical distress; (2) persistent avoidance of stimuli that might invite memories or experiences of the trauma; and (3) increased arousal. Traumatic events sufficient to produce PTSD in susceptible subjects may reach a lifetime prevalence of 50% to 90%. The actual lifetime prevalence of PTSD among US citizens is approximately 8%, with the clinical course driven by pathophysiologic changes in the amygdala and hippocampus. Comorbid depression and other anxiety disorders are common. General principles of treatment include the immediate management of PTSD symptoms and signs; management of any trauma-related comorbid conditions; nonpharmacologic interventions including cognitive behavioral treatment; and psychopharmacologic agents including antidepressants (selective serotonin reuptake inhibitors most commonly), antianxiety medications, mood stabilizing drugs, and antipsychotics. This review of PTSD will provide the reader with a clearer understanding of this condition, an increased capacity to recognize and treat this syndrome, and a greater appreciation for the role of the internist in PTSD.
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PMID:Posttraumatic stress disorder: clinical features, pathophysiology, and treatment. 1665 Oct 48

Combat-related Post-traumatic Stress Disorder (PTSD) is often highly debilitating and affects nearly all areas of psychosocial functioning. Veterans with PTSD re-experience their traumas in the form of haunting intrusive memories, nightmares and flashbacks, and have chronic difficulty modulating arousal. As a way to cope with these symptoms, many survivors live isolated and avoidant lives, self-medicate with alcohol and substances of abuse, and numb themselves to emotional experiences and relationships with family and friends. Additionally, many combat veterans report survivor guilt, depression, affect dysregulation, and an altered world view in which fate is seen as uncontrollable and life is viewed as devoid of meaning. In this report we describe the use of logotherapy (healing through meaning) for the treatment of combat-related PTSD
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PMID:Logotherapy as an adjunctive treatment for chronic combat-related PTSD: a meaning-based intervention. 1689 52

Setting oneself ablaze is an uncommon method of attempting suicide. Ten patients with deliberate thermal injuries had been evaluated by a consultation psychiatry service over a 15-year period. Schizophrenia and major depression were the more common diagnoses, and most patients had prior psychiatric histories. When compared to 1,864 people who attempted suicide by other means, the burn subjects were older, comprised a larger percentage of African Americans, and resembled those who had jumped from high places. Stresses encountered by recovering burn patients involved dependency, body image concerns, exacerbation of pre-existing depression, pain, flashbacks of the incident, and guilt intensified by their proximity to accidentally burned victims. Problems for burn unit staff included feelings of discomfort with difficult, potentially suicidal individuals, and responsibilities to perform painful procedures. Recommendations for psychiatric care include pharmacotherapy for depression or psychosis, visitation by previously self-burned individuals who serve as role models, patients' visualization of their injuries, and behavioral techniques to diminish reliance on analgesic drugs and to increase a personal sense of control. Suggestions for assisting staff include liaison support, personnel debriefing sessions, and inservice presentations on emotional aspects of burn management.
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PMID:Suicide attempts by burning. 1708 43

Ketamine is a new party drug, which is easy to obtain. For this reason, it is possible that physicians will be increasingly confronted with users that have medical problems. Relatively few cases of ketamine intoxication with a fatal outcome have been reported thus far. Ketamine is very hallucinogenic; people can experience unpleasant flashbacks even weeks after the drug has been eliminated from the body. Ketamine has a short half-life; the elimination half-life is about 2.5 h. A serious intoxication can lead to aspiration, acidosis, rhabdomyolysis, epileptic seizures, respiratory depression, and cardiac arrest. Ketamine is frequently used as a party drug in combination with other substances. As a result, the chance of untoward effects is increased. Anaesthetists use ketamine for short surgical procedures, sedation and analgesia. It is also used more and more often as an analgesic in patients who do not respond well to opioids.
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PMID:[Ketamine as a party drug]. 1792 12


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