Thunderclap headache as the presenting symptom of myocardial infarction.

Posted on May 18, 2007 by Maurice Preter MD
Headache. 2007 May;47(5):724-5. Related Articles, Links
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Thunderclap headache as the presenting symptom of myocardial infarction.

Broner S, Lay C, Newman L, Swerdlow M.

The Headache Institute, New York, USA.

Headache as the presenting symptom of myocardial ischemia has been reported in more than 20 cases. These headaches have been described as of gradual onset, associated with exertion and with EKG changes. We present herein the first case of thunderclap headache occurring at rest as the sole symptom of an acute myocardial infarction.

PMID: 17501856 [PubMed – in process]

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Feeling bad in more ways than one: comorbidity patterns of medically unexplained and psychiatric conditions.

Posted on May 18, 2007 by Maurice Preter MD
J Gen Intern Med. 2007 Jun;22(6):818-21. Related Articles, Links
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Feeling bad in more ways than one: comorbidity patterns of medically unexplained and psychiatric conditions.

Schur EA, Afari N, Furberg H, Olarte M, Goldberg J, Sullivan PF, Buchwald D.

Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. ellschur@u.washington.edu

BACKGROUND: Considerable overlap in symptoms and disease comorbidity has been noted among medically unexplained and psychiatric conditions seen in the primary care setting, such as chronic fatigue syndrome, low back pain, irritable bowel syndrome, chronic tension headache, fibromyalgia, temporomandibular joint disorder, major depression, panic attacks, and posttraumatic stress disorder. OBJECTIVE: To examine interrelationships among these 9 conditions. DESIGN: Using data from a cross-sectional survey, we described associations and used latent class analysis to investigate complex interrelationships. PARTICIPANTS: 3,982 twins from the University of Washington Twin Registry. MEASUREMENTS: Twins self-reported a doctor’s diagnosis of the conditions. RESULTS: Comorbidity among these 9 conditions far exceeded chance expectations; 31 of 36 associations were significant. Latent class analysis yielded a 4-class solution. Class I (2% prevalence) had high frequencies of each of the 9 conditions. Class II (8% prevalence) had high proportions of multiple psychiatric diagnoses. Class III (17% prevalence) participants reported high proportions of depression, low back pain, and headache. Participants in class IV (73% prevalence) were generally healthy. Class I participants had the poorest markers of health status. CONCLUSIONS: These results support theories suggesting that medically unexplained conditions share a common etiology. Understanding patterns of comorbidity can help clinicians care for challenging patients.

Publication Types:

PMID: 17503107 [PubMed – in process]

Posted in Psychiatry/Neurology |

Childhood Trauma in Film: Undzere Kinder (Our Children) at the 30th International Congress on Law and Mental Health, Padua

Posted on May 17, 2007 by Maurice Preter MD

On the Occasion of the 30th International Congress on Law and Mental Health

(University of Padua 2007, June 25-30)

 

Co-chaired and Discussed by:

 

Maurice Preter, M.D., Columbia University

and

Harold J. Bursztajn, M.D., Harvard Medical School

         

Childhood Trauma in Film: Undzere Kinder (Our Children)

אינדזערע  קינדער

Poland 1948. In Yiddish language with English subtitles

 

Date: Tuesday, June 26, 2007 (Please refer to final program for exact time)

         

Place: Congress Venue

 

In what has become a tradition during medical-psychiatric and psychoanalytic conferences around the world, Drs. Preter (www.psychiatryneurology.com) and Bursztajn (www.forensic-psych.com) continue their exploration of post-Shoah psychological trauma and its representation in film.

 

As in previous years (e.g., World Psychiatric Association, Istanbul 2006; International Psychoanalytic Association, Rio de Janeiro 2005; International Society for Traumatic Stress Studies, Buenos Aires 2004 and American Psychiatric Association, Philadelphia 2002), this workshop will screen and discuss the last Yiddish-language movie made in Poland, Undzere Kinder (Our Children), 1948.

From the program:

In 1945, after the end of World War II and the slaughter of the European Jews, some 250,000 Jewish survivors temporarily returned to Poland, where actors Shimon Dzigan and Yisroel Schumacher, director Natan Gross and producer Shaul Goskind teamed up to make Our Children. In this last Yiddish-language feature made in Poland, part docu-drama, part melancholic comedy, famous Yiddish comedians Dzigan and Schumacher visit the Helanowek orphanage near the city of Lodz to perform for an audience of Jewish orphans who survived the Holocaust. Their theatrical performance, however well-intentioned, stirs up painful memories of recent events, but also offends the children by the sentimentalized and naïve depiction of wartime conditions. Having all lived through the reality of separation and loss, the children take over the stage, outdo the performers, and tell their stories…

The little actors in Our Children were all residents of the Helanowek orphanage, many of them the sole survivors of their families.

 

For more background on the history of this workshop, and contact information, go to:

www.psychiatryneurology.com (Dr. Preter)

www.forensic-psych.com (Dr. Bursztajn)

 

Co-sponsored by the Harvard Medical School Program in Psychiatry & the Law

Posted in Health |

PTSD rates dropped 3 years postwar and rose again 17 years later; 23% of veterans without combat stress reaction reported delayed PTSD.

Posted on May 15, 2007 by Maurice Preter MD
 
Am J Psychiatry. 2006 Apr;163(4):659-66.
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Trajectories of PTSD: a 20-year longitudinal study.

Solomon Z, Mikulincer M.

Bob Shappel School of Social Work, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel. solomon@post.tau.ac.il

OBJECTIVE: This study assessed the psychopathological effects of combat in veterans with and without combat stress reaction. METHOD: Veterans (N=214) from the 1982 Lebanon War were assessed in a prospective longitudinal design: 131 suffered from combat stress reaction during the war, and 83 did not. They were evaluated 1, 2, 3, and 20 years after the war. RESULTS: Combat stress reaction is an important vulnerability marker. Veterans with combat stress reaction were 6.6 times more likely to endorse posttraumatic stress disorder (PTSD) at all four measurements, their PTSD was more severe, and they were at increased risk for exacerbation/reactivation. A qualitative analysis of the profile of PTSD symptoms revealed some time-related changes in the symptom configuration of veterans who did not suffer from combat stress reaction. In both groups, the course fluctuated; PTSD rates dropped 3 years postwar and rose again 17 years later; 23% of veterans without combat stress reaction reported delayed PTSD. CONCLUSIONS: These findings suggest that the detrimental effects of combat are deep and enduring and follow a complex course, especially in combat stress reaction casualties. The implications of aging and ongoing terror in impeding recovery from the psychological wounds of war are discussed.

Publication Types:

PMID: 16585441 [PubMed – indexed for MEDLINE]

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Dissociative disorders were highly prevalent in this clinical population and typically had not been previously diagnosed clinically.

Posted on May 15, 2007 by Maurice Preter MD
 
Am J Psychiatry. 2006 Apr;163(4):623-9. Related Articles, Links
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Comment in:

Prevalence of dissociative disorders in psychiatric outpatients.

Foote B, Smolin Y, Kaplan M, Legatt ME, Lipschitz D.

Klau-1 Psychiatric Outpatient Department, Montefiore Medical Center, 111 E. 210th St., Bronx, NY 10467, USA. jbfoote@aol.com

OBJECTIVE: The purpose of the study was to assess the prevalence of DSM-IV dissociative disorders in an inner-city outpatient psychiatric population. METHOD: Subjects were 231 consecutive admissions (84 men and 147 women, mean age=37 years) to an inner-city, hospital-based outpatient psychiatric clinic. The subjects completed self-report measures of dissociation (Dissociative Experiences Scale) and trauma history (Traumatic Experiences Questionnaire). Eighty-two patients (35%) completed a structured interview for dissociative disorders (Dissociative Disorders Interview Schedule). RESULTS: The 82 patients who were interviewed did not differ significantly on any demographic measure or on the self-report measures of trauma and dissociation from the 149 patients who were not interviewed. Twenty-four (29%) of the 82 interviewed patients received a diagnosis of a dissociative disorder. Dissociative identity disorder was diagnosed in five (6%) patients. Compared to the patients without a dissociative disorder diagnosis, patients with a dissociative disorder were significantly more likely to report childhood physical abuse (71% versus 27%) and childhood sexual abuse (74% versus 29%), but the two groups did not differ significantly on any demographic measure, including gender. Chart review revealed that only four (5%) patients in whom a dissociative disorder was identified during the study had previously received a dissociative disorder diagnosis. CONCLUSIONS: Dissociative disorders were highly prevalent in this clinical population and typically had not been previously diagnosed clinically. The high prevalence of dissociative disorders found in this study may be related to methodological factors (all patients were offered an interview rather than only those who had scored high on a screening self-report measure) and epidemiological factors (extremely high prevalence rates for childhood physical and sexual abuse were present in the overall study population).

Publication Types:

PMID: 16585436 [PubMed – indexed for MEDLINE]

Posted in Psychiatry/Neurology | Tagged |