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Clinical Practice
Care of the Adult Patient after Sexual Assault
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 20-year-old…
- September 1, 2011
- Linden J.A.
- N Engl J Med 2011; 365:834-841
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This article reviews the treatment of patients presenting for care after sexual assault, including guidance for evidence collection in case of prosecution, psychological support for the victim, and prevention of pregnancy and sexually transmitted infections.
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Review Article
Current Concepts: The Gulf Oil Spill
One year after the Gulf oil spill (also known as the Deepwater Horizon oil spill, the BP oil spill, or the Gulf of Mexico oil spill), the full magnitude of the environmental, economic, and human health effects of this major disaster remain unknown. Despite a growing literature describing the impact…
- April 7, 2011
- Goldstein B.D., Osofsky H.J., Lichtveld M.Y.
- N Engl J Med 2011; 364:1334-1348
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The 2010 Gulf Oil spill was an occupational, environmental, and community health disaster. This review summarizes the contaminants of concern, toxicologic consequences for humans and the ecosystem, lessons for worker safety, and mental health consequences in the community.
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Perspective
Haiti Earthquake Relief, Phase Two — Long-Term Needs and Local Resources
A month and a half after January's devastating earthquake in Haiti, the National Organization for the Advancement of Haitians, a U.S.-based nonprofit organization with a division dedicated to improving health care in Haiti, sent in teams of U.S. physicians and other health care professionals,…
- May 20, 2010
- Bayard D.
- N Engl J Med 2010; 362:1858-1861
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Dr. Dominique Bayard worked in a makeshift hospital in Tabarre, a northeast section of Port-au-Prince, where the hospital staff treated more than 800 patients a day for infections, disabilities, complications from delayed treatment, respiratory illness, ...
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Original Article
Morphine Use after Combat Injury in Iraq and Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is an important and well-documented mental health outcome among seriously injured civilian and military survivors of trauma.– Increasing recognition of the profound and prolonged detrimental effects on general health status and quality of life when PTSD…
- January 14, 2010
- Holbrook T.L., Galarneau M.R., Dye J.L., Quinn K., Dougherty A.L.
- N Engl J Med 2010; 362:110-117
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In this study of injured U.S. military personnel, the use of morphine during trauma care was associated with a reduced risk of post-traumatic stress disorder (PTSD) after injury. This finding suggests that optimal control of pain after serious injury may help prevent PTSD.
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Editorial
Prevention of Psychiatric Problems among Military Personnel and Their Spouses
It is always important to capture information generated from clinical databases to advance theory and practice. This is certainly the case with two articles in this issue of the Journal. One article addresses the secondary prevention of post-traumatic stress disorder (PTSD) by the administration of…
- January 14, 2010
- Friedman M.J.
- N Engl J Med 2010; 362:168-170
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It is always important to capture information generated from clinical databases to advance theory and practice. This is certainly the case with two articles in this issue of the Journal. One article addresses the secondary prevention of post-traumatic ...
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Editorial
Disentangling Mild Traumatic Brain Injury and Stress Reactions
The study by Hoge and colleagues in this issue of the Journal provides an important profile of the sequelae of mild traumatic brain injury in military personnel after combat. The findings demonstrate that mild traumatic brain injury results in increased rates of psychological, health, and…
- January 31, 2008
- Bryant R.A.
- N Engl J Med 2008; 358:525-527
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The study by Hoge and colleagues in this issue of the Journal provides an important profile of the sequelae of mild traumatic brain injury in military personnel after combat.¹ The findings demonstrate that mild traumatic brain injury results in increased ...
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Original Article
Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq
More than 1.5 million U.S. military personnel have deployed to Iraq or Afghanistan since the start of military operations in 2001. Because of improved protective equipment, a higher percentage of soldiers are surviving injuries that would have been fatal in previous wars. Head and neck injuries,…
- January 31, 2008
- Hoge C.W., McGurk D., Thomas J.L., et al.
- N Engl J Med 2008; 358:453-463
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In this survey of soldiers who served in Iraq, about 15% reported concussions, also known as mild traumatic brain injuries (injuries resulting in brief loss of consciousness or confusion). Soldiers who had mild traumatic brain injuries were more likely to have post-traumatic stress disorder and physical health problems than were soldiers with other injuries.
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Editorial
The Healing Power of Listening in the ICU
Critical care services are highly valued because they can often restore function in patients with acute life-threatening illnesses. In this context, advances in medical science have led to increased expectations for favorable outcomes of episodes of critical illness, even when the patient has…
- February 1, 2007
- Lilly C.M. and Daly B.J.
- N Engl J Med 2007; 356:513-515
Critical care services are highly valued because they can often restore function in patients with acute life-threatening illnesses. In this context, advances in medical science have led to increased expectations for favorable outcomes of episodes of ...
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Original Article
A Communication Strategy and Brochure for Relatives of Patients Dying in the ICU
Having a loved one die in the intensive care unit (ICU) is an extraordinarily stressful event. The patient is usually unable to communicate with the family or with ICU staff. Qualitative and quantitative studies of families in this situation have identified effective communication between…
- February 1, 2007
- Lautrette A., Darmon M., Megarbane B., et al.
- N Engl J Med 2007; 356:469-478
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The death of a loved one in an intensive care unit is an emotionally trying experience. These investigators compared a proactive end-of-life conference with family members, including the provision of an informational brochure, with a customary conference; outcomes were reported by family members 90 days after the loved one's death. Family members who participated in the intervention conference had improved outcomes, as compared with those who participated in the standard conference.
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Perspective
Reconstructing Lives — A Tale of Two Soldiers
Jason Pepper can't see the deer and wild turkeys that feed in the pasture in front of his new home, an hour's drive from Nashville. But when he sits and smokes on his front porch, he likes knowing they're out there — and even more, he savors the silence. Pepper, who was blinded by a bomb in Iraq…
- December 21, 2006
- Okie S.
- N Engl J Med 2006; 355:2609-2615
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As thousands of brain-injured veterans come home to recover and rebuild their lives, medical experts have expressed concern about the challenges of providing them with continuing medical care and vocational and emotional support. To see how two ...
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Perspective
Hurricane Katrina: Aftershocks
When Hurricane Katrina hit, my wife and I responded in a fashion common to many New Orleans residents: we "vertically evacuated" to the lower floors of one of the city's larger hotels. This had been a successful routine for many years. But when the storm blew out the windows in our hotel room, we…
- October 13, 2005
- Frohlich E.D.
- N Engl J Med 2005; 353:1545
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When Hurricane Katrina hit, my wife and I responded in a fashion common to many New Orleans residents: we “vertically evacuated” to the lower floors of one of the city's larger hotels. This had been a successful routine for many years. But when the storm ...
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Perspective
The London Attacks — Aftermath: Victimhood and Resilience
At least until the failed attacks of July 21, the gut-wrenching shock of the July 7 suicide bombings in London had been starting to dissipate, and the nonstop news coverage was slowing. Gradually, Londoners were beginning to get on with their lives. Three days after the bombings, I joined the…
- August 11, 2005
- Wessely S.
- N Engl J Med 2005; 353:548-550
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After the London attacks, many of the survivors and the bereaved are suffering intense mental anguish, an anguish that is painful for the rest of us even to witness. Dr. Simon Wessely explains that the events of July 7 demonstrate the sensible way in ...
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Case Records of the Massachusetts General Hospital
Case 19-2005 — A 17-Year-Old Girl with Respiratory Distress and Hemiparesis after Surviving a Tsunami
Editor's note: After the earthquake and tsunami in the Indian Ocean on December 26, 2004, the Massachusetts General Hospital formed a clinical-response team to work with Project HOPE (Health Opportunities for People Everywhere). Project HOPE volunteers worked with U.S. Navy and Public Health…
- June 23, 2005
- Kao A.Y., Munandar R., Ferrara S.L., et al.
- N Engl J Med 2005; 352:2628-2636
A 17-year-old Indonesian girl was swept up by a tsunami that followed a large earthquake. She aspirated salt water and mud but did not lose consciousness. Two days later, a cough developed; two weeks after the tsunami, she had headache, nausea, and vomiting. One week later, right-sided hemiparesis and aphasia developed, which worsened after several weeks in local hospitals. She was transferred to the U.S. Naval Ship Mercy for evaluation and treatment.
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Perspective
Mental Health Care Needs among Recent War Veterans
Fifteen percent or more of some populations of veterans of the Vietnam War and the 1991 Gulf War have received diagnoses of post-traumatic stress disorder (PTSD). Given this history and the fact that U.S. troops in Iraq and Afghanistan are serving for prolonged periods in a hazardous combat…
- March 31, 2005
- Kang H.K. and Hyams K.C.
- N Engl J Med 2005; 352:1289
Fifteen percent or more of some populations of veterans of the Vietnam War and the 1991 Gulf War have received diagnoses of post-traumatic stress disorder (PTSD).¹,² Given this history and the fact that U.S. troops in Iraq and Afghanistan are serving for ...
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Perspective
Veterans' Mental Health in the Wake of War
Some aspects of the psychological experiences of war bind veterans together across temporal and national boundaries. Consider Hotspur's traumatic nightmares in Shakespeare's King Henry IV, Part I, the challenges confronting Homer's Odysseus on his return home from Troy, the alienation and reentry…
- March 31, 2005
- Friedman M.J.
- N Engl J Med 2005; 352:1287-1290
Some aspects of the psychological experiences of war bind veterans together across temporal and national boundaries. Dr. Matthew Friedman states that while new treatments have changed the landscape of hope, we must prepare for some unprecedented ...
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Editorial
Acknowledging the Psychiatric Cost of War
The data presented by Hoge and associates in this issue of the Journal about members of the Army and the Marine Corps returning from Operation Iraqi Freedom or Operation Enduring Freedom in Afghanistan force us to acknowledge the psychiatric cost of sending young men and women to war. It is…
- July 1, 2004
- Friedman M.J.
- N Engl J Med 2004; 351:75-77
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The data presented by Hoge and associates in this issue of the Journal ¹ about members of the Army and the Marine Corps returning from Operation Iraqi Freedom or Operation Enduring Freedom in Afghanistan force us to acknowledge the psychiatric cost of ...
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Original Article
Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care
The recent military operations in Iraq and Afghanistan, which have involved the first sustained ground combat undertaken by the United States since the war in Vietnam, raise important questions about the effect of the experience on the mental health of members of the military services who have been…
- July 1, 2004
- Hoge C.W., Castro C.A., Messer S.C., et al.
- N Engl J Med 2004; 351:13-22
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Most members of the military services returning from combat duty in Iraq and Afghanistan have experienced traumatic events such as being shot at, killing someone, and knowing someone who was injured or killed. Almost 20 percent of respondents to a survey of soldiers and Marines returning from Iraq suffered from post-traumatic stress disorder, but most had not sought or received treatment. Perceived barriers to treatment included concern about the stigma associated with mental illness and about possible harm to a career.
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Perspective
Global Health: Surviving Torture
The shocking, unfiltered images from the Abu Ghraib prison in Iraq have focused the world's attention on the plight of torture survivors. Physicians in the United States are confronted as never before with the need to identify and treat the physical and psychological sequelae of extreme violence…
- July 1, 2004
- Mollica R.F.
- N Engl J Med 2004; 351:5-7
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Dr. Richard F. Mollica and his colleagues have cared for many torture survivors. He explains that medical professionals must take the lead in healing the wounds inflicted by the most extreme acts of human aggression.
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Special Article
Psychological Sequelae of the September 11 Terrorist Attacks in New York City
The attacks of September 11, 2001, represented the largest act of terrorism in U.S. history. Approximately 3000 people were killed in New York City alone. Severe lasting psychological effects are generally seen after disasters causing extensive loss of life, property damage, and widespread…
- March 28, 2002
- Galea S., Ahern J., Resnick H., et al.
- N Engl J Med 2002; 346:982-987
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This telephone survey of Manhattan residents was performed five to nine weeks after the terrorist attacks on the World Trade Center. The prevalence of acute post-traumatic stress disorder (PTSD) was 7.5 percent, and the prevalence of depression was 9.7 percent. Among residents living close to the World Trade Center, the prevalence of PTSD was 20.0 percent.
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Correspondence
Reactions to the Events of September 11
To the Editor: Schuster et al. (Nov. 15 issue) report an increased incidence of distress after the events of September 11 and advise clinicians to be prepared to assist people with trauma-related symptoms. Using national workload data from the Department of Veterans Affairs, I compared the average…
- February 21, 2002
- N Engl J Med 2002; 346:629-630
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To the Editor: Schuster et al. (Nov. 15 issue)¹ report an increased incidence of distress after the events of September 11 and advise clinicians to be prepared to assist people with trauma-related symptoms. Using national workload data from the ...
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