Bio

Clinical Focus


  • Brain Development
  • Early Life Stress
  • Child and Adolescent Psychiatry

Academic Appointments


Professional Education


  • Medical Education:Mt Sinai School of Medicine (1991) NY
  • Residency:University of Pennsylvania Health System (1995) PA
  • Fellowship:Stanford University School of Medicine (1997) CA
  • Board Certification: Child and Adolescent Psychiatry, American Board of Psychiatry and Neurology (1999)
  • Internship:University of Pennsylvania Health System (1992) PA

Community and International Work


  • Mental Health Services Oversight and Accountability Commission

    Location

    California

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • The Tipping Point Community

    Location

    Bay Area

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Ravenswood Family Health Center, East Palo Alto, Menlo Park, Redwood City

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Center for Youth Wellness

    Location

    Bay Area

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Student Mental Health Policy Workgroup

    Location

    California

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

Research & Scholarship

Current Research and Scholarly Interests


Examines the interplay between brain development and stress vulnerability via a multi-method approach that includes psychophysiology, neuroimaging, neuroendocrinology and phenomenology. Treatment development that focuses on individual and community-based interventions for stress related conditions in children and adolescents that experience traumatic stress.

Teaching

2013-14 Courses


Postdoctoral Advisees


Publications

Journal Articles


  • Cue-Centered Treatment for Youth Exposed to Interpersonal Violence: A Randomized Controlled Trial JOURNAL OF TRAUMATIC STRESS Carrion, V. G., Kletter, H., Weems, C. F., Berry, R. R., Rettger, J. P. 2013; 26 (6): 654-662

    Abstract

    This study provides preliminary evidence of the feasibility and efficacy of the Stanford cue-centered treatment for reducing posttraumatic stress, depression, and anxiety in children chronically exposed to violence. Sixty-five youth aged 8?17 years were recruited from 13 schools. Participants were randomly assigned to cue-centered treatment or a waitlist control group. Assessments were conducted at 4 discrete time points. Self-report measures assessed youth symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression.Self-report ratings of caregiver anxiety and depression as well as caregiver report of child PTSD were also obtained. Therapists evaluated participants? overall symptom improvement across treatment sessions. Hierarchal linear modeling analyses showed that compared to the waitlist group, the cue-centered treatment group had greater reductions in PTSD symptoms both by caregiver and child report, as well as caregiver anxiety. Cue-centered treatment, a hybrid trauma intervention merging diverse theoretical approaches, demonstrated feasibility,adherence, and efficacy in treating youth with a history of interpersonal violence.

    View details for DOI 10.1002/jts.21870

    View details for Web of Science ID 000328566900002

    View details for PubMedID 24490236

  • Integrated Behavioral Health Services: A Collaborative Care Model for Pediatric Patients in a Low-Income Setting CLINICAL PEDIATRICS Aguirre, J., Carrion, V. G. 2013; 52 (12): 1178-1180

    View details for DOI 10.1177/0009922812470744

    View details for Web of Science ID 000326576300015

    View details for PubMedID 23299835

  • Developmental Variation in Amygdala Volumes Among Children With Posttraumatic Stress DEVELOPMENTAL NEUROPSYCHOLOGY Weems, C. F., Scott, B. G., Russell, J. D., Reiss, A. L., Carrion, V. G. 2013; 38 (7): 481-495

    Abstract

    This article examined associations between indices of maturation (age and Tanner stage) and amygdala volumes in 24 youth (aged 7-14) with posttraumatic stress disorder symptoms and a matched control group. Fifteen of the youth with exposure to trauma were also re-evaluated one year later. A positive association between maturation and right amygdala volumes was observed in the trauma group but not in controls. Associations with maturation remained when controlling for a number of possible covariates and over time. Developmentally younger youth (Tanner stage 1 and 2) showed increases and older (Tanner stage 3 and 4) decreases in right amygdala volumes.

    View details for DOI 10.1080/87565641.2013.820307

    View details for Web of Science ID 000326069700004

    View details for PubMedID 24138217

  • Helping Children Exposed to War and Violence: Perspectives from an International Work Group on Interventions for Youth and Families CHILD & YOUTH CARE FORUM Kletter, H., Rialon, R. A., Laor, N., Brom, D., Pat-Horenczyk, R., Shaheen, M., Hamiel, D., Chemtob, C., Weems, C. F., Feinstein, C., Lieberman, A., Reicherter, D., Song, S., Carrion, V. G. 2013; 42 (4): 371-388
  • Introduction to a Special Issue on Research with Youth Exposed to Disasters and Violence CHILD & YOUTH CARE FORUM Carrion, V. G., Weems, C. F. 2013; 42 (4): 257-259
  • A Prospective Study on the Association Between Caregiver Psychological Symptomatology and Symptom Clusters of Pediatric Posttraumatic Stress Disorder JOURNAL OF TRAUMATIC STRESS Wong, S. S., Kletter, H., Wong, Y., Carrion, V. G. 2013; 26 (3): 385-391

    Abstract

    This study investigated the influence of caregiver psychological symptoms on posttraumatic stress disorder (PTSD) symptoms in traumatized children. One-hundred eleven children and caretakers were assessed in this study. Children (N = 59) with a history of exposure to interpersonal violence were evaluated for reexperiencing, avoidance/numbing, and hyperarousal symptom clusters using the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). The 52 primary caregivers were evaluated using the Symptom Checklist-90-Revised (SCL-90-R) on 9 domains of psychological symptomatology: anxiety, depression, hostility, interpersonal sensitivity, obsessive-compulsive disorder, paranoid ideation, phobic anxiety, psychoticism, and somatization. At 14-month follow-up, 45 of the children were re-evaluated with the CAPS-CA. Caregiver psychological symptoms in the domains of anxiety, depression, interpersonal sensitivity, obsessive-compulsive disorder, and paranoid ideation were associated with less improvement in total pediatric PTSD symptoms. Analysis of PTSD symptoms by cluster showed that greater caregiver symptomatology in the domains of anxiety, depression, interpersonal sensitivity, and obsessive-compulsive disorder were associated with less improvement in the hyperarousal symptom cluster. These results suggest caregiver symptomatology may be specifically associated with hyperarousal symptoms in pediatric trauma.

    View details for DOI 10.1002/jts.21816

    View details for Web of Science ID 000319882800011

    View details for PubMedID 23737297

  • Adverse childhood experiences among at-risk youth: The interrelation of ACES within a pediatric sample Journal of Child & Adolescent Trauma Scott, B. G., Burke, N. J., Weems, C. F., Hellman, J. L., Carrion, V. G. 2013
  • The interrelation of adverse childhood experiences within an at-risk pediatric sample Journal of Child & Adolescent Trauma G, S. B., J, B. N., F, W. C., L, H. J., G, C. V. 2013; 6: 217-229
  • Sleep Disturbance in Pediatric PTSD: Current Findings and Future Directions. Journal of clinical sleep medicine Kovachy, B., O'Hara, R., Hawkins, N., Gershon, A., Primeau, M. M., Madej, J., Carrion, V. 2013; 9 (5): 501-510

    Abstract

    Many studies have provided strong evidence of a fundamental and complex role for sleep disturbances in adult posttraumatic stress disorder (PTSD). Investigations of adult PTSD using subjective and objective measures document sleep architecture abnormalities and high prevalence of sleep disordered breathing, periodic limb movement disorder, nightmares, and insomnia. PTSD treatment methods do appear to significantly improve sleep disturbance, and also studies suggest that treatments for sleep disorders often result in improvements in PTSD symptoms. Further, the most recent evidence suggests sleep abnormalities may precede the development of PTSD. Given the importance of sleep disorders to the onset, course, and treatment of adult PTSD, examination of sleep disturbances far earlier in the life course is imperative. Here we review the literature on what we know about sleep disturbances and disorders in pediatric PTSD. Our review indicates that the extant, empirical data examining sleep disturbance and disorders in pediatric PTSD is limited. Yet, this literature suggests there are significantly higher reports of sleep disturbances and nightmares in children and adolescents exposed to trauma and/or diagnosed with PTSD than in non-trauma-exposed samples. Sleep questionnaires are predominantly employed to assess sleep disorders in pediatric PTSD, with few studies utilizing objective measures. Given the important, complex relationship being uncovered between adult PTSD and sleep, this review calls for further research of sleep in children with PTSD using more specific subjective measures and also objective measures, such as polysomnography and eventually treatment trial studies. CITATION: Kovachy B; O'Hara R; Hawkins N; Gershon A; Primeau MM; Madej J; Carrion V. Sleep disturbance in pediatric PTSD: current findings and future directions. J Clin Sleep Med 2013;9(5):501-510.

    View details for DOI 10.5664/jcsm.2678

    View details for PubMedID 23674943

  • Update on Neuroimaging and Cognitive Functioning in Maltreatment-Related Pediatric PTSD: Treatment Implications JOURNAL OF FAMILY VIOLENCE Carrion, V. G., Wong, S. S., Kletter, H. 2013; 28 (1): 53-61
  • Clinical Report: Psychological Maltreatment (vol 130, pg 372, 2012) PEDIATRICS Hibbard, R., BARLOW, J., MacMillan, H. 2012; 130 (4): 765-765
  • Can Traumatic Stress Alter the Brain? Understanding the Implications of Early Trauma on Brain Development and Learning JOURNAL OF ADOLESCENT HEALTH Carrion, V. G., Wong, S. S. 2012; 51 (2): S23-S28

    Abstract

    Youth who experience traumatic stress and develop post-traumatic symptoms secrete higher levels of the glucocorticoid cortisol than youth with no trauma history. Animal research suggests that excess corticosterone secretion can lead to neurotoxicity in areas of the brain rich in glucocorticoid receptors such as the hippocampus and the prefrontal cortex (PFC). These two areas of the brain are involved in memory processing and executive function, both critical functions of learning.In this article, we summarize findings presented at the National Summit for Stress and the Brain conducted at Johns Hopkins University's Department of Public Health in April 2011. The presentation highlighted structural and functional imaging findings in the hippocampus and PFC of youth with post-traumatic stress symptoms (PTSS).Youth with PTSS have higher levels of cortisol. Prebedtime cortisol levels predict decreases in hippocampal volume longitudinally. Cortisol levels are negatively correlated with volume in the PFC. Functional imaging studies demonstrate reduced hippocampal and PFC activities on tasks of memory and executive function in youth with PTSS when compared with control subjects.Effective interventions for youth with PTSS should target improved function of frontolimbic networks. Treatment outcome research using these potential markers can help develop more focused interventions that target the impaired learning of vulnerable youth experiencing traumatic stress.

    View details for DOI 10.1016/j.jadohealth.2012.04.010

    View details for Web of Science ID 000306374100005

    View details for PubMedID 22794529

  • Posttraumatic Stress Disorder Shifting Toward a Developmental Framework CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA Carrion, V. G., Kleffer, H. 2012; 21 (3): 573-?

    Abstract

    This article reviews the current classification of posttraumatic stress disorder and its limitations when applied to youth. Distinctions are made between single-event and multiple-event traumas. Diagnosis, neurobiology, treatment development, and treatment outcomes are presented. A summary of current empirical interventions is provided. The authors present implications for future research and for clinical practice.

    View details for DOI 10.1016/j.chc.2012.05.004

    View details for Web of Science ID 000307601700008

    View details for PubMedID 22800995

  • BRAIN ACTIVATION TO FACIAL EXPRESSIONS IN YOUTH WITH PTSD SYMPTOMS DEPRESSION AND ANXIETY Garrett, A. S., Carrion, V., Kletter, H., Karchemskiy, A., Weems, C. F., Reiss, A. 2012; 29 (5): 449-459

    Abstract

    This study examined activation to facial expressions in youth with a history of interpersonal trauma and current posttraumatic stress symptoms (PTSS) compared to healthy controls (HC).Twenty-three medication-naive youth with PTSS and 23 age- and gender-matched HC underwent functional magnetic resonance imaging (fMRI) while viewing fearful, angry, sad, happy, and neutral faces. Data were analyzed for group differences in location of activation, as well as timing of activation during the early versus late phase of the block. Using SPM5, significant activation (P < .05 FWE [Family-Wise Error] corrected, extent = 10 voxels) associated with the main effect of group was identified. Activation from selected clusters was extracted to SPSS software for further analysis of specific facial expressions and temporal patterns of activation.The PTSS group showed significantly greater activation than controls in several regions, including the amygdala/hippocampus, medial prefrontal cortex, insula, and ventrolateral prefrontal cortex, and less activation than controls in the dorsolateral prefrontal cortex (DLPFC). These group differences in activation were greatest during angry, happy, and neutral faces, and predominantly during the early phase of the block. Post hoc analyses showed significant Group × Phase interactions in the right amygdala and left hippocampus.Traumatic stress may impact development of brain regions important for emotion processing. Timing of activation may be altered in youth with PTSS.

    View details for DOI 10.1002/da.21892

    View details for Web of Science ID 000303440700010

    View details for PubMedID 22553009

  • Treatment of Traumatic Stress Disorder in Children and Adolescents Psychiatric Times Carrion, V. G., Kletter, H. 2012; 29: 1-8
  • Development of a Child Psychopharmacology Trial Scale Current Psychopharmacology Wilkinson, J. M., Glick, I. D., Carrion, V. G. 2012; 1 (1): 9-13
  • The impact of adverse childhood experiences on an urban pediatric population CHILD ABUSE & NEGLECT Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., Carrion, V. G. 2011; 35 (6): 408-413

    Abstract

    The goal of this study was to investigate the adverse childhood experiences (ACEs) in youth in a low-income, urban community.Data from a retrospective chart review of 701 subjects from the Bayview Child Health Center in San Francisco are presented. Medical chart documentation of ACEs as defined in previous studies were coded and each ACE criterion endorsed by a traumatic event received a score of 1 (range=0-9). This study reports on the prevalence of various ACE categories in this population, as well as the association between ACE score and two pediatric problems: learning/behavior problems and body mass index (BMI)?85% (i.e., overweight or obese).The majority of subjects (67.2%, N=471) had experienced 1 or more categories of adverse childhood experiences (ACE?1) and 12.0% (N=84) had experienced 4 or more ACEs (ACE?4). Increased ACE scores correlated with increased risk of learning/behavior problems and obesity.There was a significant prevalence of endorsed ACE categories in this urban population. Exposure to 4 or greater ACE categories was associated with increased risk for learning/behavior problems, as well as obesity.Results from this study demonstrate the need both for screening of ACEs among youth in urban areas and for developing effective primary prevention and intervention models.

    View details for DOI 10.1016/j.chiabu.2011.02.006

    View details for Web of Science ID 000292351200004

    View details for PubMedID 21652073

  • Reply to: Cortisol and Brain: Beyond the Hippocampus Biological Psychiatry Carrion, V. G., Weems, C. F., Richert, K., Hoffman, B. C., Reiss, A. L. 2011; 69 (4): e11
  • Decreased Prefrontal Cortical Volume Associated with Increased Bedtime Cortisol in Traumatized Youth BIOLOGICAL PSYCHIATRY Carrion, V. G., Weems, C. F., Richert, K., Hoffman, B. C., Reiss, A. L. 2010; 68 (5): 491-493

    Abstract

    The purpose of this study was to investigate prefrontal cortex (PFC) volumes in youth with posttraumatic stress symptoms (PTSS) and explore the relationship between cortisol secretion and PFC volumes.Total brain tissue volumes, segmented areas of the PFC, and diurnal cortisol secretion were examined in a sample of 33 youth aged 10 to 16 years. Cerebral volumes were available for 45 subjects (30 PTSS and 15 control subjects).Youth with PTSS had significantly decreased total brain tissue and total cerebral gray volumes in comparison with healthy control subjects. While controlling for total cerebral gray volume, the PTSS group demonstrated decreased left ventral and left inferior prefrontal gray volumes. A significant negative association was found between prebedtime cortisol levels and left ventral PFC gray volumes for the full sample.Findings suggest associations between posttraumatic stress and PFC neurodevelopment. Findings also suggest a link between PFC development and cortisol secretion.

    View details for DOI 10.1016/j.biopsych.2010.05.010

    View details for Web of Science ID 000281126800013

    View details for PubMedID 20579974

  • Reduced Hippocampal Activity in Youth with Posttraumatic Stress Symptoms: An fMRI Study JOURNAL OF PEDIATRIC PSYCHOLOGY Carrion, V. G., Haas, B. W., Garrett, A., Song, S., Reiss, A. L. 2010; 35 (5): 559-569

    Abstract

    Youth who experience interpersonal trauma and have posttraumatic stress symptoms (PTSS) develop cognitive deficits that impact their development. Our goal is to investigate the function of the hippocampus in adolescents with PTSS during a memory processing task.Twenty-seven adolescents between the ages of 10-17 years (16 with PTSS and 11 healthy controls) encoded and retrieved visually presented nouns (Verbal Declarative Memory Task) while undergoing fMRI scanning.The PTSS group demonstrated reduced activation of the right hippocampus during the retrieval component of the task. Further, severity of symptoms of avoidance and numbing correlated with reduced left hippocampal activation during retrieval.Decreased activity of the hippocampus during a verbal memory task may be a neurofunctional marker of PTSS in youth with history of interpersonal trauma. The results of this study may facilitate the development of focused treatments and may be of utility when assessing treatment outcome for PTSS.

    View details for DOI 10.1093/jpepsy/jsp112

    View details for Web of Science ID 000278614700012

    View details for PubMedID 19995868

  • Treatment manual for trauma-exposed youth: case studies. Clinical child psychology and psychiatry Carrion, V. G., Hull, K. 2010; 15 (1): 27-38

    Abstract

    Witnessing community violence and experiencing abuse in the home are two examples of interpersonal trauma that can have a devastating impact on children and adolescents. Recent research on the treatment of children exposed to interpersonal violence has focused on cognitive-behavioral interventions, often delivered in school settings. We describe the application of a new manual-based psychotherapy protocol for treating pediatric trauma in a middle school. Two case studies illustrate the protocol application to children from an inner-city neighborhood. The Stanford Cue-Centered Therapy (CCT) is a short-term, multimodal therapy for youths who have experienced trauma, focusing primarily on exposure to trauma-related cues. These cases provide early data on the feasibility and effectiveness of providing CCT for high-risk youth within a school setting and training of school mental-health personnel in the use of the Stanford CCT Manual.

    View details for DOI 10.1177/1359104509338150

    View details for PubMedID 19914939

  • Natural disasters and the neurodevelopmental response to trauma in childhood: a brief overview and call to action Future Neurology Carrion, V., Weems, C. F., Bradley, T. 2010; 5: 667-674

    View details for DOI DOI 10.2217/fnl.10.42

  • Converging evidence for abnormalities of the prefrontal cortex and evaluation of midsagittal structures in pediatric posttraumatic stress disorder: An MRI study PSYCHIATRY RESEARCH-NEUROIMAGING Carrion, V. G., Weems, C. F., Watson, C., Eliez, S., Menon, V., Reiss, A. L. 2009; 172 (3): 226-234

    Abstract

    Volumetric imaging research has shown abnormal brain morphology in posttraumatic stress disorder (PTSD) when compared with control subjects. We present results on a study of brain morphology in the prefrontal cortex (PFC) and midline structures, via indices of gray matter volume and density, in pediatric PTSD. We hypothesized that both methods would demonstrate aberrant morphology in the PFC. Further, we hypothesized aberrant brainstem anatomy and reduced corpus callosum volume in children with PTSD. Twenty-four children (aged 7-14) with history of interpersonal trauma and 24 age- and gender-matched controls underwent structural magnetic resonance imaging (sMRI). Images of the PFC and midline brain structures were first analyzed using volumetric image analysis. The PFC data were then compared with whole brain voxel-based techniques using statistical parametric mapping (SPM). The PTSD group showed significantly increased gray matter volume in the right and left inferior and superior quadrants of the PFC and smaller gray matter volume in the pons and posterior vermis areas by volumetric image analysis. The voxel-by-voxel group comparisons demonstrated increased gray matter density mostly localized to ventral PFC as compared with the control group. Abnormal frontal lobe morphology, as revealed by separate-complementary image analysis methods, and reduced pons and posterior vermis areas are associated with pediatric PTSD. Voxel-based morphometry may help to corroborate and further localize data obtained by volume of interest methods in PTSD.

    View details for DOI 10.1016/j.pscychresns.2008.07.008

    View details for Web of Science ID 000266580800010

    View details for PubMedID 19349151

  • Brief Report: Diurnal Salivary Cortisol in YouthClarifying the Nature of Posttraumatic Stress Dysregulation JOURNAL OF PEDIATRIC PSYCHOLOGY Weems, C. F., Carrion, V. G. 2009; 34 (4): 389-395

    Abstract

    The purpose of this study was to clarify the nature of diurnal salivary cortisol dysregulation in youth who experience posttraumatic stress (PTS).Diurnal trends in salivary cortisol secretion were examined in a sample of 41 youth aged 10-16 years (26 youth exposed to interpersonal traumas and 15 control participants with no PTS) using hierarchical linear modeling.Cortisol levels were characterized by curvilinear trends in secretion (i.e., sharp declines from prebreakfast to prelunch followed by smaller decreases from prelunch to predinner with a leveling-off or slight increase from predinner to prebed assessment). Results further indicated that youth with PTS had sharper morning declines and relatively higher evening levels (i.e., a greater curve in the daily trend) than nontraumatized youth.Findings help to elucidate the physiological basis for altered arousal patterns in youth with PTS. Traumatized youth showed wider daily fluctuations in cortisol levels when these trends were modeled in a curvilinear fashion. The findings help to describe the nature of stress dysregulation in trauma-exposed youth and may have implications for clarifying some of the apparent inconsistencies in the literature.

    View details for DOI 10.1093/jpepsy/jsn087

    View details for Web of Science ID 000265525600006

    View details for PubMedID 18689854

  • Loss and the Experience of Emotional Distress in Childhood JOURNAL OF LOSS & TRAUMA Taylor, L. K., Weems, C. F., Costa, N. M., Carrion, V. G. 2009; 14 (1): 1-16
  • Guilt and posttraumatic stress symptoms in child victims of interpersonal violence. Clinical child psychology and psychiatry Kletter, H., Weems, C. F., Carrion, V. G. 2009; 14 (1): 71-83

    Abstract

    Our objective was to examine the relationship between guilt and posttraumatic stress disorder (PTSD) symptoms in children with a history of interpersonal violence. Eighty-seven children between the ages of 5 and 16 years (mean age = 11.70 years) were administered the Clinician-Administered PTSD Scale for Children and Adolescents to assess for PTSD symptoms and associated features. Multiple regression analysis found that guilt over acts of commission or omission (behaviors the child performed or failed to perform during the event or to prevent it) was highly associated with PTSD severity. Derealization and changes in attachment were also significantly related to PTSD symptoms. Findings suggest that it may be important for clinicians to assess for associated features in traumatized children as these are associated with greater PTSD severity. Posttraumatic interventions may benefit from targeting these symptoms.

    View details for DOI 10.1177/1359104508100137

    View details for PubMedID 19103706

  • Posttraumatic stress symptoms and brain function during a response-inhibition task: An fMRI study in youth DEPRESSION AND ANXIETY Carrion, V. G., Garrett, A., Menon, V., Weems, C. F., Reiss, A. L. 2008; 25 (6): 514-526

    Abstract

    Youth who experience interpersonal trauma and have posttraumatic stress symptoms (PTSS) can exhibit difficulties in executive function and physiological hyperarousal. Response inhibition has been identified as a core component of executive function. In this study, we investigate the functional neuroanatomical correlates of response inhibition in youth with PTSS. Thirty right-handed medication-naïve youth between the ages of 10 and 16 years underwent a 3-Tesla Functional Magnetic Resonance Imaging scan during a response-inhibition (Go/No-Go) task. Youth with PTSS (n = 16) were age and gender matched to a control group of healthy youth (n = 14). Between-groups analyses were conducted to identify brain regions of greater activation in the No/Go-Go contrasts. PTSS and control youth performed the task with similar accuracy and response times. Control subjects had greater middle frontal cortex activation when compared with PTSS subjects. PTSS subjects had greater medial frontal activation when compared with control subjects. A sub-group of youth with PTSS and a history of self-injurious behaviors demonstrated increased insula and orbitofrontal activation when compared with those PTSS youth with no self-injurious behaviors. Insula activation correlated positively with PTSS severity. Diminished middle frontal activity and enhanced medial frontal activity during response-inhibition tasks may represent underlying neurofunctional markers of PTSS.

    View details for DOI 10.1002/da.20346

    View details for Web of Science ID 000257017000007

    View details for PubMedID 17598145

  • The association between PTSD symptoms and salivary cortisol in youth: The role of time since the trauma JOURNAL OF TRAUMATIC STRESS Weems, C. F., Carrion, V. G. 2007; 20 (5): 903-907

    Abstract

    This study examined the direction of association between symptoms of posttraumatic stress disorder (PTSD) and cortisol levels among youth with recent and distal traumas (N = 50; mean age = 10.7 years). Each had a clinical interview for PTSD symptoms, a cortisol assessment, and the time since the child's most recent trauma was assessed. Results indicated that the time since the most recent trauma moderated the association between cortisol and PTSD symptoms and comparisons indicated that there were significant differences in the size of the correlations across the recent and distal trauma groups. The results point to a potentially important role of the time since trauma in understanding the relationship between PTSD symptoms and cortisol.

    View details for DOI 10.1002/jts.20251

    View details for Web of Science ID 000250736400024

    View details for PubMedID 17955527

  • Divalproex sodium for the treatment of PTSD and conduct disordered youth: A pilot randomized controlled clinical trial CHILD PSYCHIATRY & HUMAN DEVELOPMENT Steiner, H., Saxena, K. S., Carrion, V., Khanzode, L. A., Silverman, M., Chang, K. 2007; 38 (3): 183-193

    Abstract

    We examined the efficacy of divalproex sodium (DVP) for the treatment of PTSD in conduct disorder, utilizing a previous study in which 71 youth were enrolled in a randomized controlled clinical trial. Twelve had PTSD. Subjects (all males, mean age 16, SD 1.0) were randomized into high and low dose conditions. Clinical Global Impression (CGI) ratings for core PTSD symptoms (Intrusion, avoidance and hyper arousal) were primary outcome measures, weekly slopes of impulsivity secondary ones. Intent-to-treat analyses showed significant positive associations between receiving high dose of DVP CGI's. Parallel analyses comparing outcome by drug level achieved strengthened the results.

    View details for DOI 10.1007/s10578-007-0055-8

    View details for Web of Science ID 000248055300002

    View details for PubMedID 17570057

  • The psychosocial impact of Hurricane Katrina: Contextual differences in psychological symptoms, social support, and discrimination BEHAVIOUR RESEARCH AND THERAPY Weems, C. F., Watts, S. E., Marsee, M. A., Taylor, L. K., Costa, N. M., Cannon, M. F., Carrion, V. G., Pina, A. A. 2007; 45 (10): 2295-2306

    Abstract

    This study tested a contextual model of disaster reaction by examining regional differences in the psychosocial impact of Hurricane Katrina. A total of 386 individuals participated in this study. All were recruited in the primary areas affected by Hurricane Katrina and included residents of metropolitan New Orleans (Orleans Parish, Louisiana), Greater New Orleans (i.e., Metairie, Kenner, Gretna), and the Mississippi Gulf Coast (i.e., cities along the coast from Waveland to Ocean Springs, Mississippi). Participants were assessed for posttraumatic stress disorder (PTSD) symptoms, other psychological symptoms, perceptions of discrimination, perceptions of social support, evacuation distance, and the extent to which they experienced hurricane-related stressful events. Results were consistent with previous research on the impact of disasters on mental health symptoms. Findings extended research on individual differences in the response to trauma and indicated that regional context predicted unique variance in the experience of discrimination, social support, and emotional symptoms consistent with the theoretical model presented.

    View details for DOI 10.1016/j.brat.2007.04.013

    View details for Web of Science ID 000250038600004

    View details for PubMedID 17568560

  • State and trait emotions in delinquent adolescents CHILD PSYCHIATRY & HUMAN DEVELOPMENT Plattner, B., Karnik, N., Jo, B., Hall, R. E., Schallauer, A., Carrion, V., Feucht, M., Steiner, H. 2007; 38 (2): 155-169

    Abstract

    To examine the structure of emotions and affective dysregulation in juvenile delinquents.Fifty-six juvenile delinquents from a local juvenile hall and 169 subjects from a local high school were recruited for this study. All participants completed psychometric testing for trait emotions followed by measurements of state emotions under two conditions (free association and stress condition). Finally, delinquent participants completed a detailed assessment of past trauma using the Childhood Trauma Interview (CTI).Delinquents exhibit significantly higher levels of negative state and trait emotions when compared to a high school sample. In the delinquent sample chronicity of physical trauma affects the longstanding variable of trait emotionality and severity of trauma, specifically emotional abuse and witnessing violence, shapes negative emotional outcomes in state emotionality. In addition, delinquents appear to experience a wider range of emotions than the comparison sample and were more likely to experience a confluence of state emotions of sadness and anger under stressed conditions.Adolescent delinquents appear to have a different experience of negative emotions than comparison adolescents. The experience of emotions appears to differ in state and trait conditions. These emotions may be related to childhood experiences of trauma.

    View details for Web of Science ID 000247265400006

    View details for PubMedID 17417724

  • Stress predicts brain changes in children: A pilot longitudinal study on youth stress, posttraumatic stress disorder, and the hippocampus PEDIATRICS Carrion, V. G., Weems, C. F., Reiss, A. L. 2007; 119 (3): 509-516

    Abstract

    Does stress damage the brain? Studies of adults with posttraumatic stress disorder have demonstrated smaller hippocampal volumes when compared with the volumes of adults with no posttraumatic stress disorder. Studies of children with posttraumatic stress disorder have not replicated the smaller hippocampal findings in adults, which suggests that smaller hippocampal volume may be caused by neurodevelopmental experiences with stress. Animal research has demonstrated that the glucocorticoids secreted during stress can be neurotoxic to the hippocampus, but this has not been empirically demonstrated in human samples. We hypothesized that cortisol volumes would predict hippocampal volume reduction in patients with posttraumatic symptoms.We report data from a pilot longitudinal study of children (n = 15) with history of maltreatment who underwent clinical evaluation for posttraumatic stress disorder, cortisol, and neuroimaging.Posttraumatic stress disorder symptoms and cortisol at baseline predicted hippocampal reduction over an ensuing 12- to 18-month interval.Results from this pilot study suggest that stress is associated with hippocampal reduction in children with posttraumatic stress disorder symptoms and provide preliminary human evidence that stress may indeed damage the hippocampus. Additional studies seem to be warranted.

    View details for DOI 10.1542/peds.2006-2028

    View details for Web of Science ID 000244579800011

    View details for PubMedID 17332204

  • IQ and posttraumatic stress symptoms in children exposed to interpersonal violence CHILD PSYCHIATRY & HUMAN DEVELOPMENT Saltzman, K. M., Weems, C. F., Carrion, V. G. 2006; 36 (3): 261-272

    Abstract

    The literature is mixed as to the relationship between intelligence quotient (IQ) and Posttraumatic Stress Disorder (PTSD) symptomatology in adult populations. Even less is known about the relationship in children who have been traumatized.Fifty-nine children and adolescents (mean age = 10.6) with a history of interpersonal violence were evaluated with respect to PTSD symptomatology, number of traumas, and estimated Verbal, Performance and Full scale IQ scores. PTSD symptomatology included symptom levels for cluster B (re-experiencing), cluster C (avoidance and numbing), and cluster D (Hypervigilance) and criterion F, functional impairment.Results indicated that Full scale and Verbal IQ were significantly associated with the number of traumas, re-experiencing symptoms, and impairment. Performance IQ was only associated with impairment. Regression analyses suggested that together PTSD symptomatology predicted Full scale and Verbal IQ but nor Performance IQ and impairment was the single best predictor of IQ generally.Findings provide support for an association between PTSD symptoms and IQ, particularly verbal IQ. Two possible reasons for this relationship are that higher levels of Verbal IQ may serve as a premorbid protective factor against the development of re-experiencing symptoms, or performance on post-trauma Verbal IQ measures may be negatively impacted by expression of PTSD symptoms. Longitudinal studies are needed to clarify which of these two possibilities explains the association.

    View details for DOI 10.1007/s10578-005-0002-5

    View details for Web of Science ID 000239459600002

    View details for PubMedID 16362242

  • Mixed lateral preference in posttraumatic stress disorder JOURNAL OF NERVOUS AND MENTAL DISEASE Saltzman, K. M., Weems, C. F., Reiss, A. L., Carrion, V. G. 2006; 194 (2): 142-144

    Abstract

    Recent research indicates that adults with posttraumatic stress disorder (PTSD) have a higher incidence of mixed laterality with respect to handedness than the rest of the population. To test if this relationship also occurs early in life, we evaluated children with history of interpersonal trauma. Fifty-nine traumatized children were evaluated with the Clinician Administered PTSD Scale for Children and Adolescents and the Edinburgh Handedness Inventory. Forty matched healthy controls were used for comparison. Increased mixed laterality was found in all children exhibiting symptoms of PTSD when compared with healthy controls, and children who met DSM-IV diagnostic criteria for PTSD had more mixed laterality than the subthreshold traumatized group (F = 7.71; df = 2,96; p = 0.001). Within the entire traumatized group, there was a positive correlation between PTSD symptom severity and mixed laterality. Mixed laterality was positively associated with PTSD symptoms in traumatized children, suggesting that neurological abnormalities may be related to degree of PTSD symptom expression.

    View details for DOI 10.1097/01.nmd.0000198201.59824.37

    View details for Web of Science ID 000235488700014

    View details for PubMedID 16477196

  • Regional differences of the prefrontal cortex in pediatric PTSD: an MRI study DEPRESSION AND ANXIETY Richert, K. A., Carrion, V. G., Karchemskiy, A., Reiss, A. L. 2006; 23 (1): 17-25

    Abstract

    Previous studies have revealed altered structural development of the frontal lobes and prefrontal cortex (PFC) in children with symptoms of posttraumatic stress disorder (PTSD). This study is the first to provide a detailed structural analysis of the PFC in children with and without PTSD symptoms. We compared gray and white matter volume in four subregions of the PFC between said groups, then explored whether volume was associated with PTSD symptom severity and functional impairment. PFC measurements were extracted from magnetic resonance imaging (MRI) data from a sample of 23 children (ages 7-14) with a history of trauma and symptoms of PTSD, who had undergone assessment for PTSD symptoms and functional impairment using the Child and Adolescent version of the Clinician-Administered PTSD Scale (CAPS-CA). These measurements were compared to data from an age-equivalent control group of 24 healthy children. Children with PTSD symptoms showed a significantly larger volume of gray matter in the delineated middle-inferior and ventral regions of the PFC than did control children. Decreased volume of gray matter in the dorsal PFC correlated with increased functional impairment scores. Results indicate that increased volume of the middle-inferior and ventral PFC may be associated with trauma and PTSD symptoms in children. Furthermore, the neuroanatomy of the dorsal PFC may influence the degree of functional impairment experienced by children with PTSD symptoms.

    View details for DOI 10.1002/da.20131

    View details for Web of Science ID 000235381900004

    View details for PubMedID 16247760

  • Development of anxiety disorders in a traumatized pediatric population: A preliminary longitudinal evaluation CHILD ABUSE & NEGLECT Cortes, A. M., Saltzman, K. M., Weems, C. F., Regnault, H. P., Reiss, A. L., Carrion, V. G. 2005; 29 (8): 905-914

    Abstract

    The current study was conducted to determine if post-traumatic stress disorder (PTSD) symptomatology predicted later development of non-PTSD anxiety disorders in children and adolescents victimized by interpersonal trauma.Thirty-four children with a history of interpersonal trauma and no initial diagnosis of anxiety disorder participated in the study. Children were assessed at time one (T1) and then 12-18 months later at time two (T2). At T1, the Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA) and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) were used to evaluate children's PTSD symptoms and comorbid non-PTSD anxiety disorder diagnosis. At T2, the CAPS-CA and the K-SADS-PL were repeated.The diagnosis of PTSD and PTSD symptoms in children exposed to interpersonal trauma at T1, particularly the symptoms associated with avoidance and constricted emotional expression (criteria C) as well as physiological hyperarousal (criteria D), predicted the development of other anxiety disorders at T2.Traumatized children with initial PTSD symptomatology may be at risk of later development of other anxiety disorders.

    View details for DOI 10.1016/j.chiabu.2004.12.010

    View details for Web of Science ID 000231777500005

    View details for PubMedID 16125233

  • Relationships of dissociation and childhood abuse and neglect with heart rate in delinquent adolescents JOURNAL OF TRAUMATIC STRESS Koopman, C., Carrion, V., Butler, L. D., Sudhakar, S., Palmer, L., Steiner, H. 2004; 17 (1): 47-54

    Abstract

    This study examined the relationship of dissociative symptoms, abuse and neglect, and gender to mean heart rate (HR) in two types of interviews. Participants were 25 female and 16 male delinquent adolescents. Dissociative symptoms and abuse and neglect were assessed by structured interviews. Participants were randomized to one of two conditions, to describe either their most stressful life experience or their free association thoughts. Greater dissociative symptoms were associated with lower mean HR, whereas abuse and neglect, being a girl, and participating in the free association task were associated with higher mean HR. The finding that high levels of dissociative symptoms may be related to a suppression of autonomic physiological responses to stress support Bremner's conceptualization (J. D. Bremner, 1999) that dissociative symptoms comprise one of two subtypes of the acute stress response, differing physiologically as well as subjectively from a predominantly hyperarousal or intrusive symptom response.

    View details for Web of Science ID 000188745900007

    View details for PubMedID 15027793

  • An ecological-transactional model of significant risk factors for child psychopathology in outer Mongolia CHILD PSYCHIATRY & HUMAN DEVELOPMENT Kohrt, H. E., Kohrt, B. A., Waldman, I., Saltzman, K., Carrion, V. G. 2004; 35 (2): 163-181

    Abstract

    The present study examined significant risk factors, including child maltreatment, for child psychopathology in a cross-cultural setting. Ninety-nine Mongolian boys, ages 3-10 years, were assessed. Primary caregivers (PCG) completed structured interviews including the Emory Combined Rating Scale (ECRS) and the Mood and Feelings Questionnaire (MFQ). Structural equation modeling identifies eight risk factors affecting child psychopathology: Three with direct effects (severity of physical punishment, PCG's MFQ score, and PCG's education), three with indirect effects (cultural acceptance of violence as discipline, presence of community violence, and contact with extended family), and two with direct and indirect effects (quality of marriage/presence of spousal abuse, and household size). Results support the ecological-transactional theory of developmental psychopathology in a cross-cultural setting. Structural equation modeling provides a useful technique to isolate specific sites for intervention, while maintaining a comprehensive perspective of risk factor interaction.

    View details for Web of Science ID 000226068300005

    View details for PubMedID 15577280

  • Pathways to dissociation: Intrafamilial versus extrafamilial trauma in juvenile delinquents JOURNAL OF NERVOUS AND MENTAL DISEASE Plattner, B., Silvermann, M. A., Redlich, A. D., Carrion, V. G., Feucht, M., Friedrich, M. H., Steiner, H. 2003; 191 (12): 781-788

    Abstract

    Dissociation is postulated to occur as a function of particular types of child abuse or chronic abuse. Additionally, there is an ongoing controversy examining the perpetrator's relationship to the victim in the development of dissociation. In this study, reports of traumatic events experienced both in the family environment and in the community were used to examine the relationship between dissociative disorder as defined by DSM-IV (pathological dissociation), and dissociation as a defense mechanism. The first objective was to identify whether the site of the trauma or the quantity of trauma correlated more significantly with symptoms of dissociation. The second objective was to explore a potential correlation between topics that participants choose to disclose during a standardized Stress Inducing Speech Task (SIST), and symptoms of dissociation. The third objective was to examine the relationship between the age of occurrence, the duration of trauma, and symptoms of dissociation. Fifty-two delinquent juveniles completed measures (including the SCID-D, REM-71, CTQ, CTI, SIST) assessing traumatic experiences, psychopathological dissociation, and dissociation as defense mechanism. Blind raters scored the SIST for intrafamilial and extrafamilial trauma. The perpetrator's relationship to the victim, site of the trauma, quantity of the trauma, age of occurrence, and duration of the trauma were analyzed by descriptive statistics and Pearson partial correlations. Significant correlations were found between symptoms of pathological dissociation and intrafamilial trauma. Significant correlations were not found between extrafamilial trauma and pathological dissociation and dissociation as defense mechanism. All these correlations held constant the chronicity of traumas reported. The results obtained in this study through blind and independent assessment suggest that special trauma characteristics (i.e., childhood trauma perpetrated by a family member) rather than sheer cumulative effects of trauma may have greater implications for the development of pathological dissociation. The relationships to dissociation as a defense were much weaker.

    View details for DOI 10.1097/01.nmd.0000105372.88982.54

    View details for Web of Science ID 000187438200003

    View details for PubMedID 14671454

  • Dissociative symptoms in posttraumatic stress disorder: diagnosis and treatment CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA Steiner, H., Carrion, V., Plattner, B., Koopman, C. 2003; 12 (2): 231-?

    Abstract

    This article explores the complex relationship between dissociation and psychiatric trauma. Dissociation is described as a defense reaction, a risk factor for the development of posttraumatic stress disorder, and as a set of syndromal disturbances. The authors discuss various models proposed for the relationship between these. They outline developmental considerations in diagnosis and treatment and end by discussing further needed research.

    View details for DOI 10.1016/S1056-4993(02)00103-7

    View details for Web of Science ID 000182120400006

    View details for PubMedID 12725010

  • A prospective test of the association between hyperarousal and emotional numbing in youth with a history of traumatic stress JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY Weems, C. F., Saltzman, K. M., Reiss, A. L., Carrion, V. G. 2003; 32 (1): 166-171

    Abstract

    Investigated the hypothesis that emotional numbing may develop as a result of hyperarousal using a prospective design. Forty-two children between the ages of 7 and 14 with a history of trauma and posttraumatic stress disorder (PTSD) symptoms were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA; Nader et al., 1996) and were reassessed 1 year later. Results indicated that hyperarousal symptoms were concurrently positively correlated with emotional numbing at both time points. Moreover, Time 1 hyperarousal symptoms were associated with emotional numbing at Time 2 and predicted Time 2 emotional numbing even when controlling for each of the other symptom clusters of PTSD at Time 1 as well as other concurrent (i.e., Time 2) PTSD symptoms. Results are discussed in terms of the implications of the findings for enhancing the understanding of PTSD symptoms in youth.

    View details for Web of Science ID 000180579800015

    View details for PubMedID 12573941

  • The treatment of separation anxiety disorder employing attachment theory and cognitive behavior therapy techniques Clin Case Studies Weems CF, Carrion VG 2003; 2 (3): 188-198
  • Diurnal salivary cortisol in pediatric posttraumatic stress disorder BIOLOGICAL PSYCHIATRY Carrion, V. G., Weems, C. F., Ray, R. D., Glaser, B., Hessl, D., Reiss, A. L. 2002; 51 (7): 575-582

    Abstract

    The hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the pathophysiology of posttraumatic stress disorder (PTSD). Additional information on basal cortisol levels in children exposed to trauma and experiencing PTSD symptoms may contribute to the understanding of the role of this axis in PTSD.Fifty-one children (30 boys and 21 girls, mean age 10.7 years) with a history of exposure to trauma and PTSD symptoms were compared with 31 age- and gender-matched healthy control subjects. Salivary cortisol was obtained from participants during home measurements and was collected four times a day (prebreakfast, prelunch, predinner, and prebed) for up to 3 consecutive days.The clinical group demonstrated significantly elevated cortisol levels when compared with the control group. In addition, exploratory analyses revealed that girls with PTSD symptoms had significantly elevated cortisol levels when compared with boys with PTSD symptoms.The physiologic response of children with history of trauma and with PTSD symptoms may be characterized by heightened adrenal activity.

    View details for Web of Science ID 000174959100006

    View details for PubMedID 11950459

  • Toward an empirical definition of pediatric PTSD: The phenomenology of PTSD symptoms in youth JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Carrion, V. G., Weems, C. F., Ray, R., Reiss, A. L. 2002; 41 (2): 166-173

    Abstract

    To examine the frequency and intensity of posttraumatic stress disorder (PTSD) symptoms and their relation to clinical impairment, to examine the requirement of meeting all DSM-IV symptom cluster criteria (i.e., criteria B, C, D), and to examine the aggregation of PTSD symptom clusters across developmental stages.Fifty-nine children between the ages of 7 and 14 years with a history of trauma and PTSD symptoms were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents.Data support the utility of distinguishing between the frequency and the intensity of symptoms in the investigation of the phenomenology of pediatric PTSD. Children fulfilling requirements for two symptom clusters did not differ significantly from children meeting all three cluster criteria with regard to impairment and distress. Reexperience (cluster B) showed increased aggregation with avoidance and numbing (cluster C) and hyperarousal (cluster D) in the later stages of puberty.Frequency and intensity of symptoms may both contribute to the phenomenology of pediatric PTSD. Children with subthreshold criteria for PTSD demonstrate substantial functional impairment and distress.

    View details for Web of Science ID 000173451400010

    View details for PubMedID 11837406

  • Attenuation of frontal asymmetry in pediatric posttraumatic stress disorder BIOLOGICAL PSYCHIATRY Carrion, V. G., Weems, C. F., Eliez, S., Patwardhan, A., BROWN, W., Ray, R. D., Reiss, A. L. 2001; 50 (12): 943-951

    Abstract

    Volumetric imaging research has shown abnormal brain morphology in adults with posttraumatic stress disorder (PTSD) when compared with matched control subjects. In this article, we present brain imaging findings from a study of children with PTSD symptoms.Twenty-four children between the ages of 7 and 14 with a history of trauma and PTSD symptoms were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). The sample underwent magnetic resonance imaging in a 1.5 T scanner. Brain images were analyzed by raters blind to diagnostic status using well-standardized methods, and images were compared with age- and gender-matched healthy control subjects.The clinical group demonstrated attenuation of frontal lobe asymmetry and smaller total brain and cerebral volumes when compared with the control group. There were no statistically significant differences in hippocampal volume between clinical and control subjects.Frontal lobe abnormalities may occur as a result of PTSD in children or, alternatively, be a risk factor for the development of the syndrome in this age group. The implications of the findings and their consistency with previous research are discussed.

    View details for Web of Science ID 000172841300003

    View details for PubMedID 11750890

  • Trauma and dissociation in delinquent adolescents JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Carrion, V. G., Steiner, H. 2000; 39 (3): 353-359

    Abstract

    To assess history of trauma and dissociation in a group of juvenile delinquents and to assess how adolescents would respond to a structured interview for dissociative symptoms.Sixty-four adolescents in juvenile probation hall participated in 2 investigational sessions in 1996-1997. For session 1 they answered the Childhood Trauma Questionnaire (CTQ), the Response Evaluation Measure for Youth-71 (REMY-71), and the Weinberger Adjustment Inventory. For session 2 they were given the Childhood Trauma Interview (CTI) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D).In this sample 28.3% met criteria for a dissociative disorder and 96.8% endorsed a history of traumatic events. There were significant positive correlations between CTI and CTQ trauma scores and SCID-D and REMY-71 dissociative symptoms. All dissociative symptoms were endorsed, but depersonalization was the most common experience. There was a lack of congruence between the different methods of assessing dissociation.This study provides support for an early link between history of trauma and dissociation. Adolescents were able to answer questions from a structured interview assessing dissociation.

    View details for Web of Science ID 000085580800018

    View details for PubMedID 10714056

  • The coming out process: developmental stages for sexual minority youth Clin Child Psychol and Psychiatry Carrion VG, Lock J 1997; 2 (3): 369-377
  • NALTREXONE FOR THE TREATMENT OF TRICHOTILLOMANIA - A CASE-REPORT JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Carrion, V. G. 1995; 15 (6): 444-445

    View details for Web of Science ID A1995TK56700014

    View details for PubMedID 8748437

  • ROADBLOCKS TO DO-NOT-RESUSCITATE ORDERS - A STUDY IN POLICY IMPLEMENTATION ARCHIVES OF INTERNAL MEDICINE Paris, B. E., Carrion, V. G., Meditch, J. S., Capello, C. F., Mulvihill, M. N. 1993; 153 (14): 1689-1695

    Abstract

    Cardiopulmonary resuscitation, a potentially lifesaving procedure, is initiated on hospitalized patients who have an arrest in the absence of a written do-not-resuscitate (DNR) order. New York State Law specifies that attending physicians may write a DNR order on an adult patient either with his/her consent or that of a surrogate. Under specified circumstances, concurring physician and witness signatures are also required. This study examines potential obstacles physicians may encounter when implementing a DNR order for a hospitalized patient.Sixty house staff officers and 45 attending physicians at two New York City medical centers responded to a questionnaire listing 18 potential problems in obtaining a DNR order. Using a Likert scale, respondents rated the prevalence of each problem.Analysis of the data indicates that attending physician's failure to discuss DNR issues with patients and situations involving surrogate decision making are considered major obstacles to obtaining a DNR order. Procedural regulations, including abundant paperwork and witnessed signatures, are not identified as major obstacles.This study suggests a need for improved communication among physicians, patients, and surrogates about advance directives, when feasible, either prior to hospitalization or early in its course, in an effort to comply with DNR legislation in a manner that reflects the patient's wishes and best interests.

    View details for Web of Science ID A1993LP29900007

    View details for PubMedID 8333806

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