Annals of Clinical Psychiatry最新文献

Background: Dissociation is a serious psychological condition that is characterized as a pathological outcome of trauma-related experience. Thus, dissociation could be expected to develop in survivors of disaster trauma and to be associated with trauma exposure and psychopathology.

Methods: A sample of 278 disaster-affected Kenyans was assessed 8 to 10 months after the 1998 terrorist bombing of the US Embassy in Nairobi for a study of trauma-related psychopathology and dissociation in the context of personality and culture. Instruments of assessment were the Diagnostic Interview Schedule, the Dissociative Experiences Scale, and the Temperament and Character Inventory.

Results: Dissociation appeared to represent a largely nonpathological response to the disaster experience that reflected personality variables and a cultural context.

Conclusions: These findings suggest that dissociation encountered in disaster-exposed groups in this cultural setting does not necessarily represent psychopathology, but attention to dissociative responses might help clinicians identify and provide interventions for individuals experiencing distressing intrusive and hyperarousal symptoms.

Background: Catatonic signs were first described by 19th- and 20th-century researchers. An important concept known as "Krankheitsreste," or the residual signs of catatonia, was described by Kraepelin in 1896. Modern researchers describe patients who demonstrate "partial response to the treatment of catatonia with residual signs." Kraepelin observed that these signs occurred between catatonic episodes as part of the natural course of illness. Modern psychiatrists see residual signs after intervention or treatment. The determination of residual signs of catatonia is necessary to evaluate the most effective treatment approach to the patient.

Methods: In this case series, we describe 3 patients whose catatonia improved with treatment, but each exhibited continued residual signs of the syndrome. Appropriate consent was obtained from the patients and we identified the varying levels of catatonic signs using the Bush-Francis Catatonia Rating Scale (BFCRS) and the KANNER scale.

Results: Scores on both the BFCRS and KANNER scale decreased on followup in all 3 patients, with varying levels of success. The BFCRS score for the patient in Case 1 dropped 4 points upon follow-up, and their score on Part 2 of the KANNER scale decreased 12 points. The patient in Case 2 experienced a 5-point drop in their BFCRS score at follow-up and their score on Part 2 of the KANNER scale decreased 4 points. In Case 3, the patient's BFCRS score dropped 10 points at follow-up and their score on Part 2 of the KANNER scale decreased 20 points.

Conclusions: These 3 patients demonstrate Krankheitsreste, or "partial response to the treatment of catatonia with residual signs." Each patient had a developmental disorder and 2 had autism spectrum disorder. They exhibited improved self-care and greater independence and required less restrictive living environments.

Background: Systematic data regarding long-term neurobehavioral effects of maternal antidepressant use during pregnancy are sparse. The aim of this study was to evaluate the impact of gestational exposure to antidepressants on later neurodevelopmental function.

Methods: This study describes a cohort of mother-child dyads (44 mothers, 54 children) in which maternal depressive symptoms and medication exposures were prospectively collected across pregnancy and the postpartum period. Children age 6 to 17 were assessed using validated instruments across domains of childhood behavior and executive memory and functioning.

Results: No associations were found between maternal use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy and atypical neurodevelopment of children. Borderline clinical or clinical ranges of internalizing symptoms were associated with exposure to a higher maternal depressive symptom burden during pregnancy compared with those in the normal range. Compared with age- and sex-matched controls, the SSRI-exposed group showed superior performance on executive function tasks; findings did not demonstrate elevated risk for abnormal neurodevelopment in children age 6 to 17 exposed to SSRIs in utero. Deviations from the norm were instead associated with higher in utero exposure to maternal depression burden.

Conclusions: This study highlights the need for rigorous studies of long-term outcomes after fetal antidepressant exposure.