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Psychiatric aspects of trauma
BOOK REVIEWS
Although this review book is, in general, complete and well written, some weaknesses can be identified. The chapter on facial trauma is not very representative of the injuries frequently seen in the emergency department. Facial fractures and dislocations as well as certain specific soft tissue injuries are not included. Also, some of the questions are somewhat irrelevant to the emergency management of patients. For example, posttraumatic impotence may be of interest at least to the patient, but it is not my first priority when assessing the multiply injured patient. Some questions have insufficient or no explanations for the answers given. For example, the chapter on fever gives no explanation for the five questions asking the reader to match the causes of elevated temperature with their associated pathophysiologic mechanism. The section on headaches is also guilty of incomplete answers. Some typographical errors are scattered throughout the book, due, in part, to the time frame given the authors to publish. Also, pictures of key radiographs pertinent to the question would have been easier to interpret had they been printed on glossy paper. All in all, I found this book to be potentially a very useful tool in the teaching of emergency medicine to residents in training, as well as a means of assessing one’s knowledge in preparing for the written board examination. This is the only question-and-answer review book in emergency medicine that I am aware of at present, and I believe it has met the objectives it set out to achieve. Word has it that a new review book is soon to be released that will be more complete and have less errors. It will be a nice adjunct to the new edition of Rosen et al.‘s Emergency Medicine: Concepts and Clinical Practice. We anxiously await its inception. KATHLEENM. HARGARTEN,MD
Medical College of Wisconsin Milwaukee, Wisconsin
Psychiatric Aspects of Trauma, Vol 16. Edited by Peterson LG, O’Shanick GJ. New York, Karger, 1986. The series Advances in Psychosomatic Medicine has provided a much-needed bridge between the body and the mind. This 16th volume of that series contains chapters on a wide variety of topics that are likely to affect the practice of the emergency physician. The chapters are organized under the general subheadings “Factors Determining Trauma Vulnerability,” “ Behavioral Responses to Trauma,” and “‘Il-auma Treatment in Practice: The Head-injured Patient.” The first section sets the stage by describing the ways in which the impact of external trauma is modified and interpreted by the social and personal circumstances of the victim. Although it is unlikely a Western physician would really be called on to recognize a behavior in a New Guinean out of context, the first chapter shows the multiple faces of trauma -the impact of an individual’s trauma on a social network and, conversely, the social context in which an individual reacts to or interprets a traumatic event. This significant message should remind us not to draw premature conclusions about anyone’s reaction to domestic violence, rape, child abuse, or physical illness. Two excellent chapters on
abuse and trauma in children also underscore the multidimensional problem of injury and illness in children, who are so much at the mercy of their social network. The second section of chapters summarizes much of what is known about three populations of “normal” patients who may come to the attention of psychiatrists because of external events that affect them in very significant ways, sometimes preventing them from going on with their lives. These populations-the grieving patient, the patient with posttraumatic stress disorder, and the patient with chronic pain -comprise the bulk of the practice of consultation-liaison psychiatry. The contribution on grief response in trauma patients is especially noteworthy for its extensive bibliography, as well as for its discussion of the problems that occur among the helpers in major trauma, including health care personnel and family members. There is also a very interesting section on major civil disasters, which describes the psychological support systems that were established in response to these. The third section of the book deals with the specific trauma problem of head injury. These chapters detail the statistical information (“[From] 1970- 1976 more than one million major head injuries per year were reported for the . . . United States”), the demographics (the majority of head injury patients are male), and the dire consequences (in one study, only one third of victims survived long enough to receive inpatient care). A chilling quote begins the chapter on the neuropsychiatric complications of head injury: “A good outcome to the doctor may be a disaster to the patient and family” (Bryan Jennett). There follows a well-organized description of the biological and psychological course of head injury, with attention paid to the impact on care-givers and family. An extensive bibliography is given for each of the chapters in this section. This book is an unusual collection of papers around a central theme, but unique in that it is unlikely any one group of physicians would find all sections relevant to their practice. Nonetheless, the emergency physician, pediatrician, psychiatrist, and trauma surgeon would each find much in this volume, as would state legislators and lobbyists concerned with mandatory seat-belts laws, speed limits, child care, and disability. The book is a useful reference that will enhance our understanding of the complex nature of trauma. BEVERLYJ. FAUMAN, MD
Sinai Hospital Detroit, Michigan
Emergency Medicine: A Quick Reference for Primary Care. By Hocutt JE. East Norwalk, Connecticut, Appleton & Lange, 1982,439 pages. ISBN O-668-04983-9, $21.95. Because this text was written by a family practitioner, I would assume its audience is the generalist physician. The contents is broken into three categories; the first is treatment in the office, the second, treatment in the street (I assume by the physician rather than the paramedic), and the last, treatment in the emergency department. On first glance, this book would appear to fill a valuable function. It is an orientation to family practitioners without 75
Although this review book is, in general, complete and well written, some weaknesses can be identified. The chapter on facial trauma is not very representative of the injuries frequently seen in the emergency department. Facial fractures and dislocations as well as certain specific soft tissue injuries are not included. Also, some of the questions are somewhat irrelevant to the emergency management of patients. For example, posttraumatic impotence may be of interest at least to the patient, but it is not my first priority when assessing the multiply injured patient. Some questions have insufficient or no explanations for the answers given. For example, the chapter on fever gives no explanation for the five questions asking the reader to match the causes of elevated temperature with their associated pathophysiologic mechanism. The section on headaches is also guilty of incomplete answers. Some typographical errors are scattered throughout the book, due, in part, to the time frame given the authors to publish. Also, pictures of key radiographs pertinent to the question would have been easier to interpret had they been printed on glossy paper. All in all, I found this book to be potentially a very useful tool in the teaching of emergency medicine to residents in training, as well as a means of assessing one’s knowledge in preparing for the written board examination. This is the only question-and-answer review book in emergency medicine that I am aware of at present, and I believe it has met the objectives it set out to achieve. Word has it that a new review book is soon to be released that will be more complete and have less errors. It will be a nice adjunct to the new edition of Rosen et al.‘s Emergency Medicine: Concepts and Clinical Practice. We anxiously await its inception. KATHLEENM. HARGARTEN,MD
Medical College of Wisconsin Milwaukee, Wisconsin
Psychiatric Aspects of Trauma, Vol 16. Edited by Peterson LG, O’Shanick GJ. New York, Karger, 1986. The series Advances in Psychosomatic Medicine has provided a much-needed bridge between the body and the mind. This 16th volume of that series contains chapters on a wide variety of topics that are likely to affect the practice of the emergency physician. The chapters are organized under the general subheadings “Factors Determining Trauma Vulnerability,” “ Behavioral Responses to Trauma,” and “‘Il-auma Treatment in Practice: The Head-injured Patient.” The first section sets the stage by describing the ways in which the impact of external trauma is modified and interpreted by the social and personal circumstances of the victim. Although it is unlikely a Western physician would really be called on to recognize a behavior in a New Guinean out of context, the first chapter shows the multiple faces of trauma -the impact of an individual’s trauma on a social network and, conversely, the social context in which an individual reacts to or interprets a traumatic event. This significant message should remind us not to draw premature conclusions about anyone’s reaction to domestic violence, rape, child abuse, or physical illness. Two excellent chapters on
abuse and trauma in children also underscore the multidimensional problem of injury and illness in children, who are so much at the mercy of their social network. The second section of chapters summarizes much of what is known about three populations of “normal” patients who may come to the attention of psychiatrists because of external events that affect them in very significant ways, sometimes preventing them from going on with their lives. These populations-the grieving patient, the patient with posttraumatic stress disorder, and the patient with chronic pain -comprise the bulk of the practice of consultation-liaison psychiatry. The contribution on grief response in trauma patients is especially noteworthy for its extensive bibliography, as well as for its discussion of the problems that occur among the helpers in major trauma, including health care personnel and family members. There is also a very interesting section on major civil disasters, which describes the psychological support systems that were established in response to these. The third section of the book deals with the specific trauma problem of head injury. These chapters detail the statistical information (“[From] 1970- 1976 more than one million major head injuries per year were reported for the . . . United States”), the demographics (the majority of head injury patients are male), and the dire consequences (in one study, only one third of victims survived long enough to receive inpatient care). A chilling quote begins the chapter on the neuropsychiatric complications of head injury: “A good outcome to the doctor may be a disaster to the patient and family” (Bryan Jennett). There follows a well-organized description of the biological and psychological course of head injury, with attention paid to the impact on care-givers and family. An extensive bibliography is given for each of the chapters in this section. This book is an unusual collection of papers around a central theme, but unique in that it is unlikely any one group of physicians would find all sections relevant to their practice. Nonetheless, the emergency physician, pediatrician, psychiatrist, and trauma surgeon would each find much in this volume, as would state legislators and lobbyists concerned with mandatory seat-belts laws, speed limits, child care, and disability. The book is a useful reference that will enhance our understanding of the complex nature of trauma. BEVERLYJ. FAUMAN, MD
Sinai Hospital Detroit, Michigan
Emergency Medicine: A Quick Reference for Primary Care. By Hocutt JE. East Norwalk, Connecticut, Appleton & Lange, 1982,439 pages. ISBN O-668-04983-9, $21.95. Because this text was written by a family practitioner, I would assume its audience is the generalist physician. The contents is broken into three categories; the first is treatment in the office, the second, treatment in the street (I assume by the physician rather than the paramedic), and the last, treatment in the emergency department. On first glance, this book would appear to fill a valuable function. It is an orientation to family practitioners without 75