An integrated approach to providing care for people who have been trafficked.

People who have been trafficked often have complex medical and psychiatric needs. Integrated care is a treatment approach that may be used to improve the care of this population. The authors describe the integrated care model and how it may be applied to this population. They also describe some of the benefits and challenges of using an integrated care model with this population.

Child abuse and neglect in complex dissociative disorder, abuse-related chronic PTSD, and mixed psychiatric samples.

Only a select number of studies have examined different forms of child maltreatment in complex dissociative disorders (DDs) in comparison to other groups. Few of these have used child abuse-related chronic posttraumatic stress disorder (C-PTSD) and mixed psychiatric (MP) patients with maltreatment as comparison groups. This study examined child sexual, physical, and emotional abuse as well as physical and emotional neglect in DD (n = 39), C-PTSD (n = 13), and MP (n = 21) samples, all with abuse and neglect histories. The predictive capacity of these different forms of maltreatment across the 3 groups was assessed for pathological dissociation, shame, guilt, relationship esteem, relationship anxiety, relationship depression, and fear of relationships. All forms of maltreatment differentiated the DD from the MP group, and sexual abuse differentiated the DD sample from the C-PTSD group. Childhood sexual abuse was the only predictor of pathological dissociation. Emotional abuse predicted shame, guilt, relationship anxiety, and fear of relationships. Emotional neglect predicted relationship anxiety and relationship depression. Physical neglect was associated with less relationship anxiety. Different forms of abuse and neglect are associated with different symptom clusters in psychiatric patients with maltreatment histories.

Dissociation, shame, complex PTSD, child maltreatment and intimate relationship self-concept in dissociative disorder, chronic PTSD and mixed psychiatric groups.

BACKGROUND: Whilst a growing body of research has examined dissociation and other psychiatric symptoms in severe dissociative disorders (DDs), there has been no systematic examination of shame and sense of self in relationships in DDs. Chronic child abuse often associated with severe DDs, like dissociative identity disorder, is likely to heighten shame and relationship concerns. This study investigated complex posttraumatic stress disorder (PTSD), borderline and Schneiderian symptoms, dissociation, shame, child abuse, and various markers of self in relationships (e.g., relationship esteem, relationship depression, fear of relationships). METHODS: Participants were assessed via clinical interview with psychometrically sound questionnaires. They fell into three diagnostic groups, dissociative disorder (n=39; primarily dissociative identity disorder), chronic PTSD (Chr-PTSD; n=13) or mixed psychiatric presentations (MP; n=21; primarily mood and anxiety disorders). All participants had a history of child abuse and/or neglect, and the groups did not differ on age and gender. RESULTS: The DD group was higher on nearly all measured variables than the MP group, and had more severe dissociative, borderline and Schneiderian symptoms than the Chr-PTSD sample. Shame and complex PTSD symptoms fell marginally short of predicting reductions in relationship esteem, pathological dissociative symptoms predicted increased relationship depression, and complex PTSD symptoms predicted fear of relationships. LIMITATIONS: The representativeness of the samples was unknown. CONCLUSION: Severe psychiatric symptoms differentiate DDs from chronic PTSD, while dissociation and shame have a meaningful impact on specific markers of relationship functioning in psychiatric patients with a history of child abuse and neglect.

Auditory middle latency responses in individuals with debilitating tinnitus.

Many researchers have investigated the possibility of using auditory evoked potentials (AEPs) to objectively diagnose tinnitus. Published AEP studies suggest differences in neural activity in individuals with tinnitus compared to control groups, but the results are not consistent. There is a great deal of variability seen in auditory evoked- and event-related potentials in the tinnitus population, which reflects AEP variability in general. At the present time, there is not a specific AEP measure able to objectively diagnose tinnitus. The auditory middle latency response (AMLR) has not been extensively examined to determine its potential as an objective measure of tinnitus; therefore, this study examined the AMLR in fourteen individuals with and without severe tinnitus to determine its potential as a diagnostic measure of tinnitus. The data from this study revealed similar AMLR results between groups. This outcome suggests that this AMLR protocol may not be specific enough to detect neurophysiological changes associated with tinnitus.

Effects of chronic and acute smoking on AMLRs in older and younger listeners.

Chronic and acute smoking effects on the auditory middle latency response (AMLR) were studied in older (55-81 years) and younger (19-30 years) normal-hearing listeners. Forty healthy participants were selected for one of four groups: older smokers, older nonsmokers, younger smokers, or younger nonsmokers. Biochemical urine analyses confirmed participant categorization as smoker or nonsmoker. Click-evoked AMLRs were acquired once from nonsmokers and twice (chronic condition, acute condition) from smokers. Waveform latency (V, Na, Pa) and relative amplitude (V-Na, Na-Pa) were examined with two independent variables (age, smoking) using MANOVA. Results (n=40) revealed no chronic effect of smoking in the AMLR from smokers compared to nonsmokers. However, in both older and younger smokers (n=20), Na-Pa amplitude was significantly larger in the acute compared to the chronic smoking condition, indicating an acute smoking effect. There was no interaction of smoking and aging. This is a first study describing long-term, chronic and acute smoking effects on AMLRs in older compared to younger listeners. Results suggest that cigarette smoking is an important variable for AMLR research and clinical practice.

Neurophysiology of cochlear implant users I: effects of stimulus current level and electrode site on the electrical ABR, MLR, and N1-P2 response.

OBJECTIVE: As the need for objective measures with cochlear implant users increases, it is critical to understand how electrical potentials behave when stimulus parameters are systematically varied. The purpose of this study was to record and evaluate the effects of implanted electrode site and stimulus current level on latency, amplitude, and threshold measures of electrically evoked auditory potentials, representing brainstem and cortical levels of the auditory system. DESIGN: The electrical auditory brainstem response (EABR), electrical auditory middle latency response (EAMLR), and the electrical late auditory response (ELAR) were recorded from the same experimental subjects, 11 adult Clarion cochlear implant users. The Waves II, III, and V of the EABR, the Na-Pa complex of the EAMLR and the N1-P2 complex of the ELAR were investigated relative to electrode site (along the intra-cochlear electrode array) and stimulus current level. Evoked potential measures were examined for statistical significance using analysis of variance (ANOVA) for repeated measures. RESULTS: For the EABR, Wave V latency was significantly longer for the basal electrode (7) compared with the mid (4) and apical (1) electrodes. For the EAMLR and ELAR, there were no significant differences in latency by electrode site. For all subjects and each of the evoked potentials, the apical electrodes tended to have the largest amplitude and the basal electrodes the smallest amplitude, although amplitude differences did not reach statistical significance. In general, decreases in stimulus current level resulted in statistically significant decreases in the amplitude of Wave V, Na-Pa and N1-P2. The evoked potential thresholds for Wave V, Na-Pa, and N1-P2 were significantly higher for the basal Electrode 7 than for Electrodes 4 and 1. CONCLUSIONS: Electrophysiologic responses of Waves II, III, and V of the EABR, Na-Pa of the EAMLR, and N1-P2 of the ELAR were characterized as functions of current level and electrode site. Data from this study may serve as a normative reference for expected latency, amplitude and threshold values for the recording of electrically evoked auditory brainstem and cortical potentials. Responses recorded from cochlear implant users show many similar patterns, yet important distinctions, compared with auditory potentials elicited with acoustic signals.