1995 00 00 Journal of the American Academy of Child & Adolescent Psychiatry - Vol 34 No 8 - 974-975 - Takhar and Fisman

Magazine Overview

Title: J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY
Issue: 34:8
Volume: 34
Date: August 1995

This issue of the Journal of the American Academy of Child and Adolescent Psychiatry features two letters to the editor, addressing distinct clinical topics relevant to child and adolescent psychiatry.

Letter 1: Alien Abduction in PTSD

This letter, authored by Josephine Elia, M.D., and colleagues, reports on a unique case of a 15-year-old male referred for assessment of a possible psychotic disorder. The patient presented with a constellation of fears, including alien abduction, drowning, water, heights, and insects, accompanied by panic symptoms, insomnia, reexperiencing flashbacks, and intrusive nightmares. While formal mental status examination did not reveal psychotic symptomatology, the patient was guarded and mistrustful.

During a 2-week hospitalization, the patient disclosed "early childhood trauma," recalling multiple contacts with aliens beginning at age 3. These experiences involved themes of physical and sexual abuse aboard a spaceship, with descriptions of invasion of privacy and intrusive procedures. He reported intense terror, fear, and helplessness, reexperiencing these events in nightmares and recurrent images, with his symptomatology triggered by watching the movie "Fire in the Sky."

The patient's childhood history revealed antenatal, perinatal, and neonatal difficulties, with repeated hospitalizations. He had separation anxiety disorder at school entry. Between ages 5 and 8, he experienced several episodes of sexual abuse by a male neighbor, a history verified by his mother. The frequency and nature of this abuse were unknown. His parents separated traumatically when he was 8, leading to no contact with his father for 5 years.

Physical status and laboratory investigations were normal. Attempts at CT scans and EEG were aborted due to the patient's reexperiencing trauma and numbing. Treatment involved a short-term course of alprazolam, individual and group therapy, and school and social interventions.

The authors link the patient's responses to repeated early childhood trauma to a delayed onset of PTSD. They note that numbing is a predictor of later PTSD symptomatology, and dissociative defenses develop more readily in childhood, possibly linked to hypnotizability. The child's schizotypal personality traits may have contributed to the incorporation of trauma into alien beliefs, using visual imagery defensively to detach from terror, pain, and helplessness. Children exposed to multiple traumas are more likely to use dissociative defense mechanisms. The alien beliefs were seen as symbolic of his emotional and cognitive perspective of his traumatic childhood experiences, and the child eventually became insightful into their use as a coping strategy.

The case highlights the importance of considering patients' symptom presentations within cross-sectional, longitudinal, and sociocultural contexts, cautioning against overdiagnosing psychotic disorders.

Letter 2: CPR and Psychiatric Treatment

This letter, from Elizabeth M. Tully, M.D., Stephen Frei, and Mark Giles, reports on a novel approach to group activity programming for adolescent inpatients and partially hospitalized patients: cardiopulmonary resuscitation (CPR) training.

Initiated by an author conducting CPR classes for staff, adolescent patients expressed curiosity. Basic CPR training, based on American Heart Association guidelines, was then offered to selected patients aged 12-18 with various psychiatric diagnoses. The 4-hour course proved highly successful as a combined educational and psychosocial exercise for groups of 6-10 adolescents.

Patients are selected based on their ability to sustain attention and willingness to participate. The course includes introductory reading material, 2 hours of lectures with visual aids, a written test, and a hands-on demonstration of adult CPR using a mannequin. Patients assist in teaching peers the rescue sequence.

Motivations for participation varied, including interest in skills seen on television, family history of CPR use, and a desire for CPR certification for future employment (e.g., as a lifeguard). The ability to respond to emergencies is particularly appealing to patients in challenging environments. One patient reportedly used his CPR training to save a neighbor's life.

All participants successfully completed the course and obtained certification. The authors were impressed by the patients' curiosity, initiative, and pride in earning their cards. The CPR course is viewed as a positive learning experience for adolescents who often face chronic failure in academic settings, providing a sense of mastery and self-esteem.

The educational material stimulates discussion on prevention, including exercise, healthy diet, and avoidance of substance abuse. The authors note that CPR training is becoming part of high school curricula in some areas and that teaching it to adolescent patients confirms their access to mainstream education.

In an era of program downsizing and cost containment, the CPR course is presented as a readily available, inexpensive, and safe group activity that promotes prosocial behavior, personal responsibility, and positive accomplishment. The authors encourage other clinicians working with adolescents to explore CPR training for its numerous benefits.

Recurring Themes and Editorial Stance

The "Letters to the Editor" section serves as a platform for preliminary ideas, controversy, and reader comments on published articles or issues of concern in child and adolescent psychiatry. The journal reserves the right to edit and publish letters, with the understanding that statements made are those of the authors and do not necessarily reflect the journal's opinions. The section emphasizes the importance of reader engagement and the sharing of novel clinical approaches and case observations.

This issue highlights two distinct areas: the complex interplay of trauma, dissociation, and symptom presentation in adolescents (as seen in the alien abduction case), and innovative therapeutic interventions that leverage practical skills to enhance patient well-being and self-efficacy (as demonstrated by the CPR training program).