Robert F. Kraus

Exercise Dependence: Diagnostic and Therapeutic Issues for Patients in Psychotherapy

Health promotion and exercise is recognized as an important ingredient in health maintenance. Within the diagnostic category of obsessive-compulsive disorders has been the increased recognition by clinicians of a phenomena best described as “exercise dependence.” Reviewed herein is its definition, theoretical framework and a spectrum of factors often associated with exercise. Realizing that exercise dependence as a clinical entity is not yet recognized in either the International Classification of Disorders (ICD-9) or the Diagnostic and Statistical Manual (DSM-IV-R), proposed criteria for its inclusion are offered. Where a pattern of behavior shows the presence of symptoms consistent with “exercise dependence,” clinical diagnosis should be made to assure that appropriate treatment might be offered to manage the condition and continue to make exercise an important part of a healthy lifestyle. Diagnostic and therapeutic considerations are offered for the contemporary psychotherapist.

Character Education as a Prevention Strategy in School-Related Violence

Prevention education is seen as a key component in addressing school violence. Three hundred and three fourth grade students in 9 elementary schools in a predominantly rural community were provided a specialized program of character education as a prevention tool to reduce the potential for deviant behavior. Students in 3 schools were in the no treatment control condition. Students in the remaining 6 schools received a school-based and curriculum driven character education program; two of the schools were in the curriculum only condition while in four of the schools students were randomly selected to receive a protocol-driven summer academic (6 weeks) and experiential education/program. The intervention results suggest that the students who received the academic/camp intervention had the greatest increases in social competence, the largest gains in reading achievement, and the largest increase in parental interaction. Recommendations for prevention education are discussed at the primary, secondary and tertiary levels.

Clinical and Cultural Issues in Diagnosing and Treating Child Victims of Peer Abuse

Examined are clinical and cultural issues in assessing and treating child victims of peer abuse. Profiles for both victims and perpetrators are discussed as are clinical patterns that may emerge in adulthood. Clinical trauma accommodation is discussed to offer the processing and adaptation to peer victimization. A clinical algorithm is discussed to provide the clinician with a pathway for assessment, treatment and follow-up for children who experience peer victimization.

Telemedicine: A Child Psychiatry Case Report

The topic addressed is the use of telemedicine involving a rural health care setting and child clinical services provided through an innovative model of telehealth applications. Telehealth technology and services have gained the attention of both scientists and practitioners examining trends and models of health care delivery for underserved populations and in situations where consultation with a team of professionals may benefit service providers in rural communities. Examined is an innovative model of telehealth care delivery through a rural school system in an underserved regional setting. The goals of this model are offered, as are a number of applications within the broad spectrum of services utilizing telehealth. Changing patterns in clinically based health care delivery in a managed care environment are discussed.

School-Related Violence: Definition, Scope, and Prevention Goals

The purpose of this book is to provide a compendium of papers addressing school violence and the critical ingredients in prevention interventions that contribute to reducing and/or eliminating various forms of violence in the school setting. The Center for the Prevention of School Violence developed a research-based definition of “school violence” in 1997. The definition, which emerged from a detailed microanalysis, suggests that school violence is any behavior that violates a school’s educational mission or climate of respect or jeopardizes the intent of the school to be free of aggression against persons or property, drugs, weapons, disruptions, and disorder (Center for Prevention of School Violence, 2004). School violence involves a spectrum of crimes taking place within educational institutions. Ensuring safer schools requires establishing valid and reliable indicators of the current state of school crime and safety across the nation and periodically monitoring and updating such indicators. Two decades ago, the term “school violence” itself was widely used to describe violent and aggressive acts on school campuses. Today, the definition is much broader in scope.

Gambling as an addictive disorder among athletes: clinical issues in sports medicine.

AbstractThis article examines the role of gambling as an addictive disorder experienced by athletes, both college and professional. Gambling may often be seen as a comorbid factor with other addictions and with depression among athletes. The focus on addictions among athletes has gained considerable attention among sports medicine clinicians. Diagnostic indicators, risk and protective factors, and a stage model of addiction among athletes are addressed. An algorithm and pathway of care for athletes with an addictive disorder is offered as are recommendations that sports physicians, sports medicine specialists, coaches and counsellors need to address athletes who have an addictive disorder.

Post-traumatic stress disorder in children and adolescents of the Armenian earthquake

The impact of the Armenian earthquake of 1988 on children and adolescents screened through the National Mental Health Research Center in Spitak, Armenia, is discussed. The earthquake caused close to 20,000 deaths, almost two-thirds of which were children and adolescents. Clinical data which address advances in understanding the diagnostic indicators and resulting psychopathology in victims of the Armenian earthquake are presented. Current theory about the processing of trauma in children and adolescents is reviewed, with recommendations for future research in this area.

An adolescent vampire cult in rural America: clinical issues and case study.

The emergence of cult related activities in rural America are examined. Cults and their attraction to adolescents are addressed as are methods of cult indoctrination and a profile of cult members and their leader. Clinical management along with a rationale for the attraction of some adolescents to cults are discussed. A case study of a vampire cult and the psychopathology identified in the leader of the cult are provided. Import for clinicians is offered.

Drug use in very rural Alaska villages

The Alaska Native Preschool Project was centered in the Head Start Programs of two typical Alaska native villages near the Bering Sea. Data were collected over 5 years, 1990 to 1995, from preschool parents (N = 342) with surveys, a panel of villagers (N = 25 to 30) using qualitative interviews; villagers using participant observation; and a limited review of public records. The villages typify the changing life of Alaskan villagers who live in the Bering Straits area. Qualitative data indicated that a number of problems were associated with drug and alcohol use in the villages. The level of smokeless tobacco use from surveys in the previous month among preschool parents (41%) was self-reported to be almost 10 times greater than the national level reported in the 1995 National Household Survey. The use of marijuana reported by preschool parents in the previous month was almost 3 times higher than the 1995 National Household Survey estimates (19 vs 6.7%). Tobacco use in the previous month was reported at over 56%, a level that was over 1 1/2 times the level of use at 34.7% estimated from the 1995 National Household Survey. For 26-34 year olds, previous month alcohol use was lower for the village parents than estimated from the 1995 National Household Survey (38 vs 63%). The self-reported levels of other drug use among preschool parents were very low compared with overall United States rates.

Childhood trauma in victims of the Armenian earthquake.

Childhood victims of the Armenian earthquake have shown numerous diagnostic indicators of traumatization and stress. Examined are clinical data which address advances in understanding diagnostic indicators and resulting psychopathology in childhood victims of natural disasters. Presented is a review of current theory about the processing of traumatization in children, as well as case vignettes, and recommendations for further research.