Anxiety Disorders: Weine S

Eisenman D, Weine S, Green B, de Jong J, Rayburn N, Ventevogel P, Keller A, Agani F. · RAND, Santa Monica, California and David Geffen School of Medicine, UCLA, USA. · J Trauma Stress. · Pubmed #16568460 No free full text.

Abstract: Mental health care for trauma-exposed populations in conflict-affected developing countries often is provided by primary healthcare providers (PHPs), including doctors, nurses, and lay health workers. The Task Force on International Trauma Training, through an initiative sponsored by the International Society for Traumatic Stress Studies and the RAND Corporation, has developed evidence- and consensus-based guidelines for the mental health training of PHPs in conflict-affected developing countries. This article presents the Guidelines, which provide a conceptual framework and specific principles for improving the quality of mental health training for PHPs working with trauma-exposed populations.

Weine S, Danieli Y, Silove D, Van Ommeren M, Fairbank JA, Saul J, Anonymous00062. · University of Illinois at Chicago, Task Force on International Trauma Training, c/o Stevan M. Weine, M.D., Health Research and Policy Centers, Suite 400, 850 W. Jackson Street, Chicago, IL 60607, USA. · Psychiatry. · Pubmed #12108139 No free full text.

Abstract: OBJECTIVE: To develop consensus-based guidelines for training in mental health and psychosocial interventions for trauma-exposed populations in the international arena. PARTICIPANTS: The Task Force on International Trauma Training of the International Society for Traumatic Stress Studies. EVIDENCE: The Task Force engaged in a 1-year dialogue on the practice of international training, drawing upon field experience, literature review, and consultation with key informants. CONSENSUS PROCESS: This statement was prepared on the basis of shared dialogue, consensus decision making, and a writing process involving all Task Force members. It was then disseminated for review to more than 200 professionals of more than 60 service and academic organizations. Written and oral suggestions from over 80 persons were incorporated and revisions made on the basis of consensus. CONCLUSIONS: The generated guidelines addresses four dimensions: (1) values, (2) contextual challenges in societies during or after conflicts, (3) core curricular elements, and (4) monitoring and evaluation. The guidelines can improve international training.

Smajkic A, Weine S, Djuric-Bijedic Z, Boskailo E, Lewis J, Pavkovic I. · The Project on Genocide, Psychiatry and Witnessing, Department of Psychiatry, University of Illinois at Chicago, and Chicago Health Outreach, Heartland Alliance, 60612-7327, USA. · J Trauma Stress. · Pubmed #11534876 No free full text.

Abstract: Three new antidepressants were used in treating posttraumatic stress disorder (PTSD) and symptoms of depression in Bosnian refugees. Thirty-two Bosnian refugees seeking treatment at a mental health clinic participated in a case series study. All received open trials of Sertraline (n = 15), Paroxetine (n = 12), or Venlafaxine (n = 5), with standard clinical doses. Overall, Sertraline and Paroxetine produced statistically significant improvement at 6 weeks in PTSD symptom severity in depression, and in Global Assessment of Functioning. Venlafaxine produced improvement in PTSD symptom severity and in Global Assessment of Functioning, did not yield improvement in symptoms of major depressive disorder; and had a high rate of side effects. Notwithstanding improvement of symptoms, all 32 refugees remained PTSD positive at the diagnostic level at the 6-week follow-up.

Weine S, Kulauzovic Y, Klebic A, Besic S, Mujagic A, Muzurovic J, Spahovic D, Sclove S, Pavkovic I, Feetham S, Rolland J. · Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA. · J Marital Fam Ther. · Pubmed #18412823 No free full text.

Abstract: The purpose of this study was to analyze the effects of a multiple-family group in increasing access to mental health services for refugees with posttraumatic stress disorder (PTSD). This study investigated a nine-session multiple-family group called Coffee and Families Education and Support with refugee families from Bosnia-Herzegovina in Chicago. Adults with PTSD (n = 197) and their families were randomly assigned to receive either the intervention or a control condition. The results indicated that a multiple-family group was effective in increasing access to mental health services and that depression and family comfort with discussing trauma mediated the intervention effect. Further well-designed studies of family interventions are needed for developing evidence-based interventions for refugee families.

Weine S, Muzurovic N, Kulauzovic Y, Besic S, Lezic A, Mujagic A, Muzurovic J, Spahovic D, Feetham S, Ware N, Knafl K, Pavkovic I. · International Center on Responses to Catastrophes, Department of Psychiatry, College of Medicine, University of Illinois at Chicago, 60612, USA. · Fam Process. · Pubmed #15603500 No free full text.

Abstract: OBJECTIVE: To construct a model on the consequences of political violence for refugee families based upon a qualitative investigation. METHODS: This study used a grounded-theory approach to analyze qualitative evidence from the CAFES multi-family support and education groups with Bosnian refugee families in Chicago. Textual coding and analysis was conducted using ATLAS/ti for Windows. RESULTS: A grounded-theory model of Family Consequences of Refugee Trauma (FAMCORT) was constructed that describes Displaced Families of War across four realms of family life: (1) changes in family roles and obligations, (2) changes in family memories and communications, (3) changes in family relationships with other family members; and (4) changes in family connections with the ethnic community and nation state. In each realm, the model also specifies family strategies, called Families Rebuilding Lives, for managing those consequences. CONCLUSIONS: Political violence leads to changes in multiple dimensions of family life and also to strategies for managing those changes. Qualitative family research is useful in better understanding refugee families and in helping them through family-oriented mental health services.

Smajkić A, Weine S, Durić-Bijedić Z, Boskailo E, Lewis J, Pavković I. · Project on Genocide, Psychiatry and Witnessing, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA. · Med Arh. · Pubmed #11795192 No free full text.

Abstract: The authors describe the use of three new antidepressants: Sertralilne, Paroxetine and Venlafaxine in treating Posttraumatic Stress Disorder and symptoms of Depression in adult Bosnian refugees victims of ethnic cleansing. 32 Bosnian refugees with PTSD and symptoms of Depression presenting for treatment of the mental health consequences of surviving ethnic cleansing, participated in a case series study. All subjects completed open trials of Sertraline (15), Paroxetine (12) or Venlafaxine (5), with standard clinical doses. Overall, Sertraline and Paroxetine yielded statistically significant improvement at 6 weeks in the total PTSD symptom severity, in each symptom cluster, in Beck Depression Inventory and in Global Assessment of Functioning. Venlafaxine produced statistically significant improvement at 6 weeks in the total PTSD symptom severity, in each symptom cluster and in Global Assessment of Functioning but did not yield significant improvement in symptoms of depression and had a high rate of side effects.

Weine S. · University of Illinois College of Medicine at Chicago, USA. · JAMA. · Pubmed #11231756 links to  free full text

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Smajkić A, Weine S, Durić-Bijedić Z, Lacević A, Lewis J, Pavković I. · Department of Psychiatry, University of Illinois at Chicago, USA. · Med Arh. · Pubmed #10934842 No free full text.

Abstract: OBJECTIVE: To conduct a preliminary study on the discontinuation of SSRI's in a population of traumatized refugees from Bosnia. SUBJECTS: Subjects were the 33 Bosnian refugees being treated in our clinical program who had discontinued SSRI's over a six month period. All had been on SSRI's for over one year and had shown a therapeutic response. The discontinuations were either planned with their clinician or self-initiated. Their age were ranged between 36 and 64, with a means of 56. Ten were men and twenty three were women. Standardized assessments were done approximately 2 months after discontinuation. RESULTS: Upon reassessment after discontinuation, fourteen (43%) met symptom criteria for PTSD. He means PTSD severity rating was 16.0 and the BDI score was 8.5. Seven persons (21%) restarted SSRI's and twenty-six (79%) did not. Statistical analysis showed that the group that restarted differed from the others in terms of lower age, higher PTSD diagnosis and severity, higher BDI score, poorer sleep, and higher subjective with either PTSD or BDI scores. CONCLUSION: This preliminary study suggests that when traumatized refugees discontinue SSRI's, still they have significant PTSD and depressive symptoms, indicating chronicity. The choice of discontinue or restart SSRI's is in part related to symptom severity, but other psychosocial factors appear entering into the equation. There is a need for further research.