These guidelines have been replaced by British Guideline on the Management of Asthma. A national clinical guideline. Superseded By 2012 Revision Of 2008 Guideline: British Guideline on the Management of Asthma. Thorax 2008 May; 63(Suppl 4): 1–121.

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British guideline on the management of asthma: A national clinical guideline

Traumatic experiences are relatively common. More than two thirds of persons in the general population may experience a significant traumatic event at some point in their lives, and up to one fifth of people in the United States may experience such an event in any given year (1–5). Although comparable international data are limited, large proportions of populations in many countries have been exposed to terrorism, forced relocation, and violence, which suggests that the overall prevalence of exposure to traumatic events worldwide may be even higher than that in the United States (6, 7).

Disasters (e.g., floods, transportation accidents) are traumatic events that are experienced by many people and may result in a wide range of mental and physical health consequences (8). In one survey of US residents, 13 percent of the sample reported a lifetime exposure to natural or human-generated disaster (9). In the National Comorbidity Survey, 18.9 percent of men and 15.2 percent of women reported a lifetime experience of a natural disaster (4). Post-traumatic stress disorder (PTSD) is the most commonly studied and probably the most frequent and debilitating psychological disorder that occurs after traumatic events and disasters (8, 10).

The growing threat of terrorism worldwide has heightened our awareness of disasters as a potentially important determinant of population health and suggests a pressing need both to identify key areas of consensus in postdisaster research and to highlight areas that require additional study (11). It is our purpose in this review to contribute to this overall goal by comprehensively and systematically assessing the epidemiologic evidence about PTSD after disasters.

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The Epidemiology of Post-Traumatic Stress Disorder after Disasters

On the basis of the literature reviewed in Part I of this two-part series (Norris, Friedman, Watson, Byrne, Diaz, and Kaniasty, this volume), the authors recommend early intervention following disasters, especially when the disaster is associated with extreme and widespread damage to property, ongoing financial problems for the stricken community, violence that resulted from human intent, and a high prevalence of trauma in the form of injuries, threat to life, and loss of life. Meeting the mental health needs of children, women, and survivors in developing countries is particularly critical. The family context is central to understanding and meeting those needs. Because of the complexity of disasters and responses to them, inter-agency cooperation and coordination are extremely important elements of the mental health response. Altogether, the research demands that we think ecologically and design and test societal- and community-level interventions for the population at large and conserve scarce clinical resources for those most in need.

60,000 Disaster Victims Speak: Part II. Summary and Implications of the Disaster Mental Health Research

http://europepmc.org/articles/PMC3051041?pdf=render

Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.

Cosponsoring associations The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society. Objective To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity. Participants The participants include an Endocrine Society-appointed Task Force of 6 experts, a methodologist, and a medical writer. Evidence This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus process One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline. Conclusion Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.

Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline.

Objective To evaluate the type and frequency of psychiatric disorders in obese children and adolescents; to assess the correlation between psychopathology and severity of obesity; to explore the relationship between psychiatric disorders in obese children and obesity and psychopathology in their parents. Methods One hundred fifty-five children referred and followed for obesity were evaluated (98 girls and 57 boys; age, 5 to 17 years). Psychiatric disorders were assessed through a standardized diagnostic interview schedule (K-SADS R) and self-report questionnaires completed by the child (STAIC Trait-anxiety and CDI for depression) or his (her) parents (CBCL or GHQ). These obese children were compared with insulin-dependent diabetic (IDDM) outpatient children (N = 171) on questionnaire data. Results Eighty-eight obese children obtained a DSM-IV diagnosis, most often an anxiety disorder (N = 63). Psychological disorders were particularly pronounced in those obese children whose parents were disturbed. There was no correlation between severity of obesity in the child or his (her) parents and frequency of psychiatric disorders. Compared with diabetic children, they displayed significantly higher internalized and externalized questionnaire scores and poorer social skills. Conclusion These results highlight the importance of including a child psychiatric component in the treatment of obesity, which must engage the whole family.

Mental Disorders in Obese Children and Adolescents

Objective

The authors describe binge eating and psychopathology in severely obese adolescents who are seeking treatment for obesity and search for specific psychological features that may be associated with binge eating.



Method

Obese adolescents (n = 102) were assessed with the Binge Eating Scale (BES), the State–Trait Anxiety Inventory for Children (STAIC), the Beck Depression Inventory (BDI), Coopersmith's Self-Esteem Inventory (SEI), and the Body-Esteem subscale from the Piers–Harris Children's Self-Concept Scale (PHCSS). They were also evaluated with the Montgomery and Asberg Depression Rating Scale (MADRS) and the Brief Scale for Anxiety (BSA). Two subgroups (i.e., binge eaters and non-binge eaters) were then established according to the BES score.



Results

Binge eating symptoms were frequent in this population and the binge eating dimension was related to high levels of anxiety and depression, as well as to low levels of self-esteem and body-esteem. The dimensions of anxiety and depression were associated specifically with binge eaters.



Discussion

As observed in the obese adult population, binge eating symptoms were found frequently in severely obese adolescents seeking treatment and were related strongly to studied parameters. Obese adolescents who binge eat are a subgroup with high psychopathologic distress. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: 235–243, 2003.

Binge eating and psychopathology in severely obese adolescents

Prevalence of DSM IV anxiety and affective disorders in a pediatric population of asthmatic children and adolescents.

Psychopathology and quality of life for adolescents with asthma and their parents.

OBJECTIVE: The objective of our investigation was to study the course of direct and indirect posttraumatic disorders over 18 months in children after they were taken hostage in their school. METHODS: Twenty-six young hostages were evaluated by using standardized clinical interviews and self-administered questionnaires (State and Trait Anxiety Inventory for Children [STAIC]and Revised Impact of Event Scale [IES]) 2, 4, 7, and 18 months after the event. They were compared with 21 children from the same school who were not taken hostage (indirect exposure). RESULTS: Symptoms of acute stress were observed in 25 (96%) of the children who were directly involved in the traumatic event. After 2 months, 18 children had developed disorders according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, including 7 cases of full posttraumatic stress disorder (PTSD), 11 cases of subclinical PTSD, 3 cases of separation anxiety, 1 case of specific phobia, and 2 cases of major depressive disorder. Anxiety scores (STAIC) decreased between 2 and 4 months and then stabilized, whereas symptoms of avoidance (IES-avoidance) decreased gradually throughout the follow-up period, and symptoms of repetition (IES-intrusion) decreased less markedly. Children who were indirectly exposed to the trauma also manifested protracted posttraumatic symptomatology (two full cases of PTSD and six cases of subclinical PTSD), but their IES-intrusion scores were significantly lower at 7 months than those of children who were directly exposed, and the severity of their symptoms diminished over time. Girls tended to show a higher level of anxiety and more features of intrusion than boys. Psychological debriefing did not prevent occurrence of the disorders, but children who were not debriefed had the worst outcomes. CONCLUSIONS: Even after a short event and even if they are not directly exposed, children under the age of 9 years can develop high rates of posttraumatic disorders that follow a protracted course despite early intervention and careful monitoring. Language: en

G. Vila

Papers

Mental Disorders in Obese Children and Adolescents

Binge eating and psychopathology in severely obese adolescents

Prevalence of DSM IV anxiety and affective disorders in a pediatric population of asthmatic children and adolescents.

Psychopathology and quality of life for adolescents with asthma and their parents.

An 18-month longitudinal study of posttraumatic disorders in children who were taken hostage in their school.