Combined psychopharmacological and psychosocial approaches and the relevance of therapeutic jurisprudence and religion in the successful management of battered woman's syndrome: A case report

INTRODUCTION: Although Battered Woman Syndrome is not listed in the DSM 5 and the ICD 10 as an official diagnosis, it is undeniable that women suffering Intimate Partner Violence (IPV) experience the same cycle of violence, suffer from a common range of symptoms, and have a predictable prognosis. While psychosocial guidelines and support are available, like in our Women and Child Protection Units (WCPU), there is also a gap in the clinical guidelines in treating and managing these cases, which might present with a combination of posttraumatic and depressive symptomatology. In this report, we discuss the case of a 32 year old woman who was subjected to severe physical and emotional abuse by her longtime romantic partner. She consulted at our center seeking help for a psychiatric evaluation for the case she was going to pursue in court but it was apparent she was suffering from posttraumatic, somatic, and depressive symptoms. Supportive therapy was initially done and she was started on Escitalopram and low dose Quetiapine for sleep problems. As her case started gathering steam, issues about the court process, possible setback with her church and possible retaliation from her partner weighed heavily on her. Possible issues were discussed beforehand and successfully faced up to her partner in a church related tribunal and in the fiscal's office. Using an Eye Movement Desensitization and Reprocessing(EMDR) variant, Unfinished Trauma Episode Protocol (U-TEP), her posttraumatic symptoms were eventually addressed. As she started having faith in the legal system and her church, she had restored self-esteem, was active in her social circle and become an advocate in helping other women get proper treatment and to fight for their rights. Besides the clinician advocated treatment along with the services delivered via the WCPU network, the perception of getting justice from social institutions like the judiciary and the church helped in the recovery of this patient. Clinicians dealing with Battered Woman Syndrome should be aware of issues the patient might go through the stages of her fight and that the process of seeking for justice is also a process of mental healing.

A Pilot Study of Brief Eye Movement Desensitization and Reprocessing(EMDR) for Treatment of Acute Phase Schizophrenia

OBJECTIVES: Eye movement desensitization and reprocessing(EMDR) is a novel, time-limited psychotherapy originally developed for treatment of psychological trauma. The effectiveness of this therapy has been validated only for posttraumatic stress disorder; however, EMDR is often applied to other psychiatric illnesses, including other anxiety disorders and depression. This pilot study tested the efficacy of EMDR added to the routine treatment for individuals with acute stage schizophrenia. METHODS: This study was conducted in the acute psychiatric care unit of a university-affiliated training hospital. Inpatients diagnosed with schizophrenia were randomly assigned to either three sessions of EMDR, three sessions of progressive muscle relaxation(PMR) therapy, or only treatment as usual(TAU). All the participants received concurrent typical treatments(TAU), including psychotropic medication, individual supportive psychotherapy and group activities in the psychiatric ward. The Positive and Negative Syndrome Scale(PANSS), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale were administered by a clinical psychologist who was blinded to the patients' group assignment. RESULTS: Forty-five patients enrolled and forty patients(89%) completed the post-treatment evaluation. There were no between-group differences in the withdrawal rates of patients during the treatment or at the three-month follow-up session. All three groups improved significantly across each of the symptomatic domains including schizophrenia, anxiety, and depressive symptoms. However, a repeated measures ANOVA revealed no significant differences among the groups over time. Effect size for change in total PANSS scores was also similar across treatment conditions, but effect size for negative symptoms was large for EMDR(0.60 for EMDR, 0.39 for PMR and 0.21 for TAU only). CONCLUSION: These findings supported the use of EMDR in treating the acute stage of schizophrenia but the results failed to confirm the effectiveness of the treatment over the two control conditions in three sessions. Further studies with longer courses of treatment, more focused target dimensions of treatment, and a sample of outpatients are necessary.

Eye Movement Desensitization and Reprocessing(EMDR) for Post-traumatic Stress Disorder / 신경정신의학

This article reviews existing Eye Movement Desensitization and Reprocessing (EMDR) literature concerning its effectiveness, theory, mechanism, and procedural aspects in the treatment of post-traumatic stress disorder (PTSD). Evidence from randomized clinical trials and meta-analyses indicates that EMDR is as effective as well established treatments such as exposure and cognitive behavior therapy. And moreover, EMDR may be more efficient in terms of unnecessary homework assignment and fewer treatment sessions. The current status of EMDR occupies one of legitimate and standard psychotherapeutic approaches in adult PTSD treatment. Mechanism for treatment efficacy is poorly understood at present and putative at most, however, there is a growing body of literature on neurobiological change after successful EMDR treatment.