Anxiety Disorders: Lewis C

Benun J, Lewis C, Siegel M. · Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA. · Pediatr Rev. · Pubmed #18593756 No free full text.

This publication has no abstract.

Lewis C. · Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-2103, USA. · Psychiatr Clin North Am. · Pubmed #16904511 No free full text.

Abstract: Research on incarcerated women has shown they have a high degree of comorbid psychopathology, including substance dependence, posttraumatic stress disorder (PTSD), antisocial personality disorder (ASPD), and major depression. Incarcerated women differ from their community peers by having more symptoms related to addiction, ASPD, and PTSD. At the same time, incarcerated women are every bit as likely as incarcerated men to be dependent on drugs and almost as likely to be dependent on alcohol. What emerges is a picture of the incarcerated woman far more likely to have had traumatic experiences, including early sexual and physical abuse, than her male peers but every bit as likely to have substance dependence and, in some correctional populations (eg, sentenced felons), antisocial personality disorder. Central to the discussion of how best to treat female offenders is the need to address how programs would best be structured for women with severe substance dependence, substantial trauma histories, and personality pathology, including ASPD. Incarcerated women are a population with complex medical and mental health needs and are likely to be high users of services within the correctional system. This poses challenges to a system already stretched thin in caring for these complex inmates. This article emphasizes that gender differences need to be appreciated, and that service delivery to male and female inmates needs to be structured with gender in mind. The article recommends case management, treatment in highly structured therapeutic communities, and emphasizing abstinence from substances and development of skill sets to engage in healthy relationships.A major future challenge lies in researching treatment interventions for women in the correctional system. There are few existing trials of treatment efficacy and, as previously noted, the incarcerated female population differs from populations of incarcerated men and women in the community. Opiate-dependent women undergoing treatment in the community may prove to be a reasonable comparison group in beginning to develop evidence-based treatment for female offenders in prisons and jails. Ultimately, the development of services for incarcerated women will consider gender, race, and psychopathology in determining treatment setting and modalities. We are on new ground. It is a promising and exciting time to be involved with treatment of female offenders.

Thombs BD, Lewis C, Bernstein DP, Medrano MA, Hatch JP. · Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · J Psychosom Res. · Pubmed #17905047 No free full text.

Abstract: OBJECTIVE: A number of practice guidelines and recommendations call for an assessment of childhood abuse history among adult medical patients. The cultural sensitivity of screening instruments, however, has not been examined. High rates of childhood abuse history have been reported among adults who abuse substances. The objective of this study was to investigate the measurement invariance of the Childhood Trauma Questionnaire--Short Form (CTQ-SF) across groups defined by gender and race in a sample of substance-abusing adults. METHODS: This study performed a cross-sectional survey of 693 active intravenous drug abusers from San Antonio, TX. Structural equation modeling methods were used to evaluate the measurement invariance of the CTQ-SF between male and female subjects and between Black and Hispanic subjects. RESULTS: Evidence was found for the invariance of the five-factor structure of the CTQ-SF across groups and for a partial invariance model at the item level. Consistent with study hypotheses, two items that referred to "abuse," using the actual word, were more likely to be endorsed by women than by men, even after controlling for responses on similar items. In addition, compared to Hispanics, Blacks tended to report having been "punished with hard objects" at higher rates than expected from their responses on other items related to physical abuse. CONCLUSION: The amount of bias from nonmeasurement invariance in the CTQ-SF across groups was minimal at the total scale score level. Clinically, however, individual questions that use broad labeling terms are more likely to identify women as having a history of abuse, and individual questions that blend the constructs of physical discipline and physical abuse may overidentify Black Americans as having a history of abuse.

Semple WE, Goyer PF, McCormick R, Donovan B, Muzic RF, Rugle L, McCutcheon K, Lewis C, Liebling D, Kowaliw S, Vapenik K, Semple MA, Flener CR, Schulz SC. · Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA. · Psychiatry. · Pubmed #10855761 No free full text.

Abstract: Posttraumatic stress disorder (PTSD) patients with histories of cocaine and alcohol abuse (CA-PTSD) were compared with normal volunteers. Positron emission tomography (PET) scans with 15O-butanol were used to compare regional cerebral blood flow (rCBF) between the groups during rest and during an auditory continuous performance task (ACPT). CA-PTSD patients had significantly higher rCBF in right amygdala and left parahippocampal gyrus than normals during the ACPT. Normals had higher rCBF at frontal cortex during the resting scan and during the ACPT. The role of the amygdala in attention and fear conditioning suggests that increased amygdala rCBF may be related to clinical features of PTSD. Cocaine use may be associated with increased amygdala rCBF in PTSD patients. Amygdala and frontal cortex attention system components may be reciprocally related and their relative contributions to processing of neutral stimuli perturbed in CA-PTSD.