Child and Adolescent Psychiatric Clinics of North America, 1998
A drunk driver slammed into and overturned their grandfather's truck as two-year-old Jane and her... more A drunk driver slammed into and overturned their grandfather's truck as two-year-old Jane and her six-year-old sister, Emily, drove from church with their grandparents. Their parents arrived at the scene later. Luckily, physical injuries were slight, and all family members were released from the local emergency room. Seven months later, however, Jane still panics whenever her grandfather says the word "truck." She is generally cooler to him and refuses to ride with him in his new truck. Recently, she played in his truck but panicked when he approached. Jane rides with him in his car and in her father's truck, however, no matter who drives. Emily, on the other hand, has not mentioned the accident and has been asymptomatic except for infrequent, brief, mild, frontal headaches. Emily clung to her mother as Jane played out and talked about the accident during their initial visit to the psychiatrist's office; but recently Emily began drawing about the accident. The grandmother was severely bruised and now meets the Diagnostic and Statistical Manual (DSM-IV) criteria for posttraumatic stress disorder (PTSD). Although the grandfather has had no other PTSD symptoms, his pulse rate increases dramatically while discussing the accident. The mother has some symptoms but not the full-blown disorder. Both parents' pulse rates rise when discussing the accident. The adults and their attorney are alarmed about Jane, especially about her
IRegardless of the setting of his practice, the psychiatrist must often prescribe psychotropic me... more IRegardless of the setting of his practice, the psychiatrist must often prescribe psychotropic medication for patients. Traditionally that complex function requires that the psychiatrist Shave expertise in the science of diagnosis and management, and in the art of allaying patients' anxiety, maximizing placebo effect, and ensuring that the patient will take medication. Today the psychiatrist's art must also include educating patients about his science so that they can exercise informed judgment in giving or withholding consent for treatment. He must also document the process for his own protection from allegations of malpractice. Ideally, after conducting his diagnostic assessment and obtaining a pertinent medical history but before asking the patient to consent to treatment with medication, the psychiatrist would orient the patient to the role of the psychiatrist, define his own expectations for cooperation, and inform the patient of alternate treatments and of the consequences of not consenting to the recommended treatment. In addition, the psychiatrist would review the expected benefits, appropriate warnings, possible sideeffects, and risks of the treatment recommended, and would encourage the patient to exercise his own judgment. Only then would the psychiatrist ask the patient to give consent to treatment, and then make a detailed summary of the process part of the clinical record. Practically, however, such thorough documentation of the process of obtaining informed consent could so markedly distort the clinical interview, so tax the patience of both physician and patient, and so encumber the clinical record that many physicians might resign
The purpose ofthe study was to investigate the effect ofsymptom threshold and criteria set select... more The purpose ofthe study was to investigate the effect ofsymptom threshold and criteria set selections on the diagnosis ofposttraumatic stress disorder (PTSD) in adults and children exposed to a man-made disaster and determine how well DSM-III and its successors agree. Method: Data gathered in the course ofa voluntary clinical screening for PTSD in 66 adults and 64 children 6 to 14 months after exposure to a school shooting were analyzed according to DSM-III, DSM-III-R, and proposed DSM-IV criteria for PTSD diagnosis and cluster endorsement using liberal (occurring at least a little ofthe time), moderate (occurring at least some of the time), and conservative (occurring at least much or most of the time) symptom thresholds. Results: Within DSM-III, DSM-III-R, and proposed DSM-IV, selection of liberal, moderate, and conservative symptom thresholds had robust effects on rates of diagnoses; liberal thresholds allowed the greatest frequencies of diagnosis. Compared with DSM-III and proposed DSM-IV, DSM-III-R generally diagnosed the fewest cases. Agreements between DSM-III-R and proposed DSM-IV were good, while agreements between DSM-III and its successors varied for children and adults. Conclusions: Diagnostic rates and agreements were complexly influenced by interactions among thresholds and revisions in symptom clusters. The present study suggests that attempts to refine PTSD classification consider specification of symptom threshold intensity and supports the view that modification of criteria sets be undertaken with caution.
The study explores changes in retrospective reports of experiences after a manmade disaster. Six ... more The study explores changes in retrospective reports of experiences after a manmade disaster. Six and 18 months after a school shooting, 12 school personnel recalled in identical self‐report questionnaires their proximity to the site, and emotional, including life threat, and sensory experiences the day of the incident. All changed some aspect of their recall on retest. Those close to the shooting increased and those far decreased their reported proximity to the site; and most respondents both enlarged and diminished at the same time reports of specific emotional, life threat, and sensory experiences. Enlargement on retest appeared associated with PTSD symptoms, while diminishment with lessening of anxiety and depression and increase in self confidence. The authors offer these preliminary findings for further inquiry into the biopsychological basis of post‐traumatic memory.
Myostatin (MSTN) is a negative regulator of skeletal muscle growth. The objective of the present ... more Myostatin (MSTN) is a negative regulator of skeletal muscle growth. The objective of the present study was to express yak (Bos grunniens) recombinant MSTN protein in E. coli and study its characteristics of immunogenicity. cDNA encoding yak MSTN mature peptide was amplified by reverse-transcription PCR, and cloned into pET28a(þ) vector and expressed in E. coli. The expressed recombinant MSTN was purified by affinity chromatography and used to prepare rabbit anti yak MSTN antibody. The results showed that yak MSTN mature peptide gene contained 330 bp nucleotides coding 109 amino acids. Content of the target protein accounted for 21% of the total expression products when MSTN-pET28a(þ)-BL21(DE3) bacterium was incubated in LB medium with 0.1 mM IPTG for 6 hours. The molecular weight of the purified yak MSTN recombinant protein was 16.5 kDa, exhibiting excellent immunogenicity as shown by ELISA. The obtained recombinant MSTN of yak is suitable for further analysis of yak MSTN functions.
The purpose ofthe study was to investigate the effect ofsymptom threshold and criteria set select... more The purpose ofthe study was to investigate the effect ofsymptom threshold and criteria set selections on the diagnosis ofposttraumatic stress disorder (PTSD) in adults and children exposed to a man-made disaster and determine how well DSM-III and its successors agree. Method: Data gathered in the course ofa voluntary clinical screening for PTSD in 66 adults and 64 children 6 to 14 months after exposure to a school shooting were analyzed according to DSM-III, DSM-III-R, and proposed DSM-IV criteria for PTSD diagnosis and cluster endorsement using liberal (occurring at least a little ofthe time), moderate (occurring at least some of the time), and conservative (occurring at least much or most of the time) symptom thresholds. Results: Within DSM-III, DSM-III-R, and proposed DSM-IV, selection of liberal, moderate, and conservative symptom thresholds had robust effects on rates of diagnoses; liberal thresholds allowed the greatest frequencies of diagnosis. Compared with DSM-III and proposed DSM-IV, DSM-III-R generally diagnosed the fewest cases. Agreements between DSM-III-R and proposed DSM-IV were good, while agreements between DSM-III and its successors varied for children and adults. Conclusions: Diagnostic rates and agreements were complexly influenced by interactions among thresholds and revisions in symptom clusters. The present study suggests that attempts to refine PTSD classification consider specification of symptom threshold intensity and supports the view that modification of criteria sets be undertaken with caution.
The purpose ofthe study was to investigate the effect ofsymptom threshold and criteria set select... more The purpose ofthe study was to investigate the effect ofsymptom threshold and criteria set selections on the diagnosis ofposttraumatic stress disorder (PTSD) in adults and children exposed to a man-made disaster and determine how well DSM-III and its successors agree. Method: Data gathered in the course ofa voluntary clinical screening for PTSD in 66 adults and 64 children 6 to 14 months after exposure to a school shooting were analyzed according to DSM-III, DSM-III-R, and proposed DSM-IV criteria for PTSD diagnosis and cluster endorsement using liberal (occurring at least a little ofthe time), moderate (occurring at least some of the time), and conservative (occurring at least much or most of the time) symptom thresholds. Results: Within DSM-III, DSM-III-R, and proposed DSM-IV, selection of liberal, moderate, and conservative symptom thresholds had robust effects on rates of diagnoses; liberal thresholds allowed the greatest frequencies of diagnosis. Compared with DSM-III and proposed DSM-IV, DSM-III-R generally diagnosed the fewest cases. Agreements between DSM-III-R and proposed DSM-IV were good, while agreements between DSM-III and its successors varied for children and adults. Conclusions: Diagnostic rates and agreements were complexly influenced by interactions among thresholds and revisions in symptom clusters. The present study suggests that attempts to refine PTSD classification consider specification of symptom threshold intensity and supports the view that modification of criteria sets be undertaken with caution.
Child and Adolescent Psychiatric Clinics of North America, 1998
A drunk driver slammed into and overturned their grandfather's truck as two-year-old Jane and her... more A drunk driver slammed into and overturned their grandfather's truck as two-year-old Jane and her six-year-old sister, Emily, drove from church with their grandparents. Their parents arrived at the scene later. Luckily, physical injuries were slight, and all family members were released from the local emergency room. Seven months later, however, Jane still panics whenever her grandfather says the word "truck." She is generally cooler to him and refuses to ride with him in his new truck. Recently, she played in his truck but panicked when he approached. Jane rides with him in his car and in her father's truck, however, no matter who drives. Emily, on the other hand, has not mentioned the accident and has been asymptomatic except for infrequent, brief, mild, frontal headaches. Emily clung to her mother as Jane played out and talked about the accident during their initial visit to the psychiatrist's office; but recently Emily began drawing about the accident. The grandmother was severely bruised and now meets the Diagnostic and Statistical Manual (DSM-IV) criteria for posttraumatic stress disorder (PTSD). Although the grandfather has had no other PTSD symptoms, his pulse rate increases dramatically while discussing the accident. The mother has some symptoms but not the full-blown disorder. Both parents' pulse rates rise when discussing the accident. The adults and their attorney are alarmed about Jane, especially about her
IRegardless of the setting of his practice, the psychiatrist must often prescribe psychotropic me... more IRegardless of the setting of his practice, the psychiatrist must often prescribe psychotropic medication for patients. Traditionally that complex function requires that the psychiatrist Shave expertise in the science of diagnosis and management, and in the art of allaying patients' anxiety, maximizing placebo effect, and ensuring that the patient will take medication. Today the psychiatrist's art must also include educating patients about his science so that they can exercise informed judgment in giving or withholding consent for treatment. He must also document the process for his own protection from allegations of malpractice. Ideally, after conducting his diagnostic assessment and obtaining a pertinent medical history but before asking the patient to consent to treatment with medication, the psychiatrist would orient the patient to the role of the psychiatrist, define his own expectations for cooperation, and inform the patient of alternate treatments and of the consequences of not consenting to the recommended treatment. In addition, the psychiatrist would review the expected benefits, appropriate warnings, possible sideeffects, and risks of the treatment recommended, and would encourage the patient to exercise his own judgment. Only then would the psychiatrist ask the patient to give consent to treatment, and then make a detailed summary of the process part of the clinical record. Practically, however, such thorough documentation of the process of obtaining informed consent could so markedly distort the clinical interview, so tax the patience of both physician and patient, and so encumber the clinical record that many physicians might resign
The purpose ofthe study was to investigate the effect ofsymptom threshold and criteria set select... more The purpose ofthe study was to investigate the effect ofsymptom threshold and criteria set selections on the diagnosis ofposttraumatic stress disorder (PTSD) in adults and children exposed to a man-made disaster and determine how well DSM-III and its successors agree. Method: Data gathered in the course ofa voluntary clinical screening for PTSD in 66 adults and 64 children 6 to 14 months after exposure to a school shooting were analyzed according to DSM-III, DSM-III-R, and proposed DSM-IV criteria for PTSD diagnosis and cluster endorsement using liberal (occurring at least a little ofthe time), moderate (occurring at least some of the time), and conservative (occurring at least much or most of the time) symptom thresholds. Results: Within DSM-III, DSM-III-R, and proposed DSM-IV, selection of liberal, moderate, and conservative symptom thresholds had robust effects on rates of diagnoses; liberal thresholds allowed the greatest frequencies of diagnosis. Compared with DSM-III and proposed DSM-IV, DSM-III-R generally diagnosed the fewest cases. Agreements between DSM-III-R and proposed DSM-IV were good, while agreements between DSM-III and its successors varied for children and adults. Conclusions: Diagnostic rates and agreements were complexly influenced by interactions among thresholds and revisions in symptom clusters. The present study suggests that attempts to refine PTSD classification consider specification of symptom threshold intensity and supports the view that modification of criteria sets be undertaken with caution.
The study explores changes in retrospective reports of experiences after a manmade disaster. Six ... more The study explores changes in retrospective reports of experiences after a manmade disaster. Six and 18 months after a school shooting, 12 school personnel recalled in identical self‐report questionnaires their proximity to the site, and emotional, including life threat, and sensory experiences the day of the incident. All changed some aspect of their recall on retest. Those close to the shooting increased and those far decreased their reported proximity to the site; and most respondents both enlarged and diminished at the same time reports of specific emotional, life threat, and sensory experiences. Enlargement on retest appeared associated with PTSD symptoms, while diminishment with lessening of anxiety and depression and increase in self confidence. The authors offer these preliminary findings for further inquiry into the biopsychological basis of post‐traumatic memory.
Myostatin (MSTN) is a negative regulator of skeletal muscle growth. The objective of the present ... more Myostatin (MSTN) is a negative regulator of skeletal muscle growth. The objective of the present study was to express yak (Bos grunniens) recombinant MSTN protein in E. coli and study its characteristics of immunogenicity. cDNA encoding yak MSTN mature peptide was amplified by reverse-transcription PCR, and cloned into pET28a(þ) vector and expressed in E. coli. The expressed recombinant MSTN was purified by affinity chromatography and used to prepare rabbit anti yak MSTN antibody. The results showed that yak MSTN mature peptide gene contained 330 bp nucleotides coding 109 amino acids. Content of the target protein accounted for 21% of the total expression products when MSTN-pET28a(þ)-BL21(DE3) bacterium was incubated in LB medium with 0.1 mM IPTG for 6 hours. The molecular weight of the purified yak MSTN recombinant protein was 16.5 kDa, exhibiting excellent immunogenicity as shown by ELISA. The obtained recombinant MSTN of yak is suitable for further analysis of yak MSTN functions.
The purpose ofthe study was to investigate the effect ofsymptom threshold and criteria set select... more The purpose ofthe study was to investigate the effect ofsymptom threshold and criteria set selections on the diagnosis ofposttraumatic stress disorder (PTSD) in adults and children exposed to a man-made disaster and determine how well DSM-III and its successors agree. Method: Data gathered in the course ofa voluntary clinical screening for PTSD in 66 adults and 64 children 6 to 14 months after exposure to a school shooting were analyzed according to DSM-III, DSM-III-R, and proposed DSM-IV criteria for PTSD diagnosis and cluster endorsement using liberal (occurring at least a little ofthe time), moderate (occurring at least some of the time), and conservative (occurring at least much or most of the time) symptom thresholds. Results: Within DSM-III, DSM-III-R, and proposed DSM-IV, selection of liberal, moderate, and conservative symptom thresholds had robust effects on rates of diagnoses; liberal thresholds allowed the greatest frequencies of diagnosis. Compared with DSM-III and proposed DSM-IV, DSM-III-R generally diagnosed the fewest cases. Agreements between DSM-III-R and proposed DSM-IV were good, while agreements between DSM-III and its successors varied for children and adults. Conclusions: Diagnostic rates and agreements were complexly influenced by interactions among thresholds and revisions in symptom clusters. The present study suggests that attempts to refine PTSD classification consider specification of symptom threshold intensity and supports the view that modification of criteria sets be undertaken with caution.
The purpose ofthe study was to investigate the effect ofsymptom threshold and criteria set select... more The purpose ofthe study was to investigate the effect ofsymptom threshold and criteria set selections on the diagnosis ofposttraumatic stress disorder (PTSD) in adults and children exposed to a man-made disaster and determine how well DSM-III and its successors agree. Method: Data gathered in the course ofa voluntary clinical screening for PTSD in 66 adults and 64 children 6 to 14 months after exposure to a school shooting were analyzed according to DSM-III, DSM-III-R, and proposed DSM-IV criteria for PTSD diagnosis and cluster endorsement using liberal (occurring at least a little ofthe time), moderate (occurring at least some of the time), and conservative (occurring at least much or most of the time) symptom thresholds. Results: Within DSM-III, DSM-III-R, and proposed DSM-IV, selection of liberal, moderate, and conservative symptom thresholds had robust effects on rates of diagnoses; liberal thresholds allowed the greatest frequencies of diagnosis. Compared with DSM-III and proposed DSM-IV, DSM-III-R generally diagnosed the fewest cases. Agreements between DSM-III-R and proposed DSM-IV were good, while agreements between DSM-III and its successors varied for children and adults. Conclusions: Diagnostic rates and agreements were complexly influenced by interactions among thresholds and revisions in symptom clusters. The present study suggests that attempts to refine PTSD classification consider specification of symptom threshold intensity and supports the view that modification of criteria sets be undertaken with caution.
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