Por qué, cuándo y cómo preguntar sobre el abuso infantil / Why, When and how to aks about childhood abuse / Per què, quan i com preguntar sobre l’abús infantil

Cuando partimos de que el modelo médico enfatiza el papel de la genética en la causa de la locura y el sufrimiento, podemos subestimar gravemente el impacto de los sucesos traumáticos en el desarrollo de la mente. Este sesgo persiste a pesar de la sabiduría popular universal de que la enfermedad mental aparece cuando ocurren cosas malas a la gente. El maltrato infantil físico y sexual y la negligencia son experiencias extremadamente comunes en aquellos que desarrollan problemas graves de salud mental. Por desgracia, las víctimas suelen ser reacias a revelar sus historias de abuso y los profesionales suelen ser reacios a buscarlas. Exploramos la naturaleza y el alcance del problema y las razones aparentes para el descuido generalizado de esta importante área de la atención. Luego, sobre la base de nuestra experiencia en Nueva Zelanda, proporcionamos directrices para preguntar a los pacientes sobre el abuso infantil y describir una iniciativa en curso en el Reino Unido para seguir avanzando en nuestra comprensión del impacto del maltrato y nuestras habilidades para detectar y tratar a los supervivientes

Subscribers to the medical model of the causation of madness and distress emphasize the role of genes and can severely underestimate the impact of traumatic events on the development of the human mind. This bias persists despite the worldwide popular wisdom that mental illness arises when bad things happen to people. Childhood physical and sexual abuse and neglect are extremely common experiences among those who develop serious mental health problems. Unfortunately, victims are typically reluctant to disclose their histories of abuse and practitioners are often reluctant to seek it. We explore the nature and extent of the problem and the apparent reasons for the pervasive neglect of this important area of care. Then, on the basis of our experience in New Zealand, we provide guidelines on asking patients about childhood abuse and describe an ongoing initiative in the United Kingdom to further advance our understanding of the impact of abuse and our skills to detect it and treat survivors

Quan partim de que el model mèdic emfatitza el paper de la genètica en la causa de la bogeria i el patiment, podem subestimar greument l’impacte dels successos traumàtics en el desenvolupament de la ment. Aquest biaix persisteix, malgrat la saviesa popular que la malaltia mental apareix quan passen coses dolentes a la gent. L’abús infantil físic i sexual i la negligència són experiències extremadament comunes en aquells que desenvolupen problemes greus de salut mental. Malauradament, les víctimes acostumen a estar poc disposades a revelar les seves històries d’abús i els professionals acostumen a estar poc disposats a buscar-les. Explorem la naturalesa i l’abast del problema i les raons aparents del descuit genera­litzat d’aquesta important àrea d’atenció. Després, sobre la base de la nostra experiència a Nova Zelanda, proporcionem directrius per preguntar als pacients sobre l’abús infantil i descriure una iniciativa en curs al Regne Unit per seguir avançant en la nostra com­prensió de l’impacte del maltractament i en les nostres habilitats per detectar i tractar els supervivents

Attributions for hallucinations in bipolar affective disorder.

BACKGROUND: Attributions for hallucinations in the "schizophrenia" spectrum disorders have been subject to extensive investigation; however, in comparison very little is known about attributions for hallucinations in the bipolar disorders spectrum. AIMS: This preliminary study is an attempt to investigate attributions for hallucinations in bipolar disorder with regard to prevalence, modality and mood state. METHOD: Forty participants were recruited from a larger randomized control trial into CBT for bipolar disorder and asked to provide information related to attributions for hallucinations both in and out of episode. Data was collected using a specially designed instrument based on the Belief about Voices Questionnaire (BAVQ). RESULTS: Just under half of the participants reported experiencing true hallucinations during their illness. Participants tended to report visual hallucinations in mania and auditory hallucinations in depression. The vast majority of participants attributed hallucinations to illness when out of episode, and unlike in previously reported analyses of attributions for hallucinations in the schizophrenia spectrum, malevolent/omnipotent attributions were comparatively rare. CONCLUSIONS: Attributions for hallucinations in bipolar disorder may be clinically distinct from attributions previously observed in the schizophrenia spectrum, and CBT aimed at reducing the distress associated with these attributions may have to be tailored accordingly.

Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation.

BACKGROUND: Strong evidence exists for an association between childhood trauma, particularly childhood sexual abuse, and hallucinations in schizophrenia. Hallucinations are also well-documented symptoms in people with bipolar affective disorder. AIMS: To investigate the relationship between childhood sexual abuse and other childhood traumas and hallucinations in people with bipolar affective disorder. METHOD: A sample of 96 participants was drawn from the Medical Research Council multi-centre trial of cognitive-behavioural therapy for bipolar affective disorder. The trial therapists recorded spontaneous reports of childhood sexual abuse made during the course of therapy. Symptom data were collected by trained research assistants masked to the hypothesis. RESULTS: A significant association was found between those reporting general trauma (n=38) and auditory hallucinations. A highly significant association was found between those reporting childhood sexual abuse (n=15) and auditory hallucinations. CONCLUSIONS: The relationship between childhood sexual abuse and hallucinations in bipolar disorder warrants further investigation.