Thomas W. Miller

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.

Effects of trazodone on sleep in patients diagnosed with post-traumatic stress disorder (PTSD)

Trauma victims frequently report nightmares with experiences of reliving the stressful event in catastrophic dreams. The following day there are exaggerated startle responses and psychic numbing, followed that evening by a reluctance to go to sleep and insomnia. This study found trazodone to be effective in veteran patients with a diagnosis or symptoms of PTSD including sleep disturbance. Among this group of veterans, 20 of the 21 under 60 and 24 out of 27 over 60 had positive responses to bedtime trazodone doses, in that they slept better, including going to sleep more quickly, having fewer nightmares,and had less anger the next day. These benefits may be due to deepened non-REM sleep early in the night as well as delayed REM-sleep onset.Trauma victims frequently report nightmares with experiences of reliving the stressful event in catastrophic dreams. The following day there are exaggerated startle responses and psychic numbing, followed that evening by a reluctance to go to sleep and insomnia. This study found trazodone to be effective in veteran patients with a diagnosis or symptoms of PTSD including sleep disturbance. Among this group of veterans, 20 of the 21 under 60 and 24 out of 27 over 60 had positive responses to bedtime trazodone doses, in that they slept better, including going to sleep more quickly, having fewer nightmares,and had less anger the next day. These benefits may be due to deepened non-REM sleep early in the night as well as delayed REM-sleep onset.

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.

Cost Effective Assessment Models in Providing Patient-Matched Psychotherapy

Examined are various models of assessing cost-effectiveness in the use of psychological measures employed for screening patient pathology through psychological testing as a precursor to providing psychotherapy. Actual and simulated quality assurance studies are provided. The authors caution that cost-containment limited to financial incentives may have negative consequences for patient care. Systems analysis and program restructuring designed to better balance the service system through levels of care may be more clinically sound, and less costly. Clinical algorithms and critical pathways are discussed, as are recommendations that incorporate psychological testing services as an ingredient in providing contemporary psychotherapy.

Alcohol and Substance Use Disorders: Algorithms and Critical Pathways for Healthcare Delivery

Contemporary health care delivery is being driven by a changing health care market environments as well as by the availability of enhanced models of service delivery. Providers are using clinical algorithms and critical pathways to standardize clinical care and improve clinical services to patients. The article highlights the application of contemporary clinical models and demonstrates their utility in the context of substance use and abuse disorders. Clinical algorithms and critical pathways are advanced as guidelines in diagnostic and therapeutic processes for the delivery of quality health care to patients. Specific recommendations for the development and implementation of such initiatives are discussed in detail.

Transitioning the Impact of Divorce on Children Throughout the Life Cycle

It is unfortunate that despite an alarming, worldwide increase in the rate of divorce in recent decades, there has been a general paucity of mental health literature written with the express purpose of focusing on and discussing the many and varied deleterious effects of parental divorce on child and adolescent populations in society at large. In addition to this dearth of available literature, there have been even fewer publications written to address potential treatment protocols and clinical “pearls,” which may be useful to mental health professionals working with affected youth from these disrupted home environments resulting from parental divorce.