The eMergency Medical Treatment and Active Labor Act of 1985: federal law, an Oklahoma experience relevant to the psychiatric patient.

The Emergency Medical Treatment and Active Labor Act of 1985 (EMTALA) was enacted to encourage emergency departments and physicians through fines and practice limitations to provide the same quality of care to all patients seeking medical assistance. Despite these penalties, violations continue to occur in all states including Oklahoma. One of the proposed reasons cited for this behavior is a physician's limited knowledge of the standard of care encompassed by the Act.

Using a filter to improve the chatroom experience in interactive medical education.

A computer chatroom exercise between faculty and students was used in a Human Behavior course for first-year medical students to provide an interactive exam review learning exercise. Two conditions were compared--one that filtered out all irrelevant student comments, and one without the filter that permitted all student comments. Four one-hour chatroom sessions, each with eight groups of five students, were conducted with all comments recorded.

Efficacy and safety of topiramate monotherapy in civilian posttraumatic stress disorder: a randomized, double-blind, placebo-controlled study.

Objective: This double-blind, placebo-controlled trial assessed efficacy and safety of topiramate monotherapy in civilian posttraumatic stress disorder (PTSD).

Method: Outpatients (18-64 years) with DSM-IV non-combat-related PTSD and Clinician-Administered PTSD Scale (CAPS) scores >or= 50 were eligible. Topiramate was started at 25 mg/day and titrated by 25-50 mg/week to 400 mg/day or maximum tolerated dose.

Physiologic reactivity despite emotional resilience several years after direct exposure to terrorism.

Objective: Six and a half to 7 years after the 1995 terrorist bombing in Oklahoma City, the authors assessed autonomic reactivity to trauma reminders and psychiatric symptoms in adults who had some degree of direct exposure to the blast.

Method: Sixty survivors who were listed in a state health department registry of persons exposed to the bombing and 60 age- and gender-matched members of the Oklahoma City metropolitan area community were assessed for symptoms of PTSD and depression and for axis I diagnoses. Heart rate and systolic, diastolic, and mean arterial blood pressures were measured before, during, and after bombing-related interviews.

Neuroimmune and cortisol changes in selective serotonin reuptake inhibitor and placebo treatment of chronic posttraumatic stress disorder.

Background: To explore relations between neuroimmune and neuroendocrine systems relative to posttraumatic stress disorder (PTSD) treatment, cortisol and cytokine changes in response to selective serotonin reuptake inhibitor (SSRI) and placebo treatment of chronic PTSD were assessed prospectively.

Methods: Baseline measures of PTSD, depression, salivary 8 am and 4 pm cortisol, and serum interleukin-1beta (IL-1beta; pro-inflammatory) and soluble interleukin-2 receptors (IL-2R; cell-mediated immunity) were obtained for 58 PTSD and 21 control subjects. The PTSD subjects participated in a 10-week, double-blind treatment with citalopram (n = 19), sertraline (n = 18), or placebo (n = 7).

Effects of prior trauma and age on posttraumatic stress symptoms in Asian and Middle Eastern immigrants after terrorism in the community.

Forty-five adult Asian and Middle Eastern immigrants living in Oklahoma City at the time of the 1995 bombing were surveyed 114 to 2 years later as part of a disaster mental health outreach program. Demographic variables, physical and interpersonal exposure, initial physiologic and emotional responses to the bombing, and posttraumatic stress symptoms associated with this disaster and with earlier trauma were measured. Most participants had experienced prior trauma in their homeland.

The effect of loss and trauma on substance use behavior in individuals seeking support services after the 1995 Oklahoma City bombing.

In this study, we examined the effect of trauma exposure on substance use behaviors, specifically tobacco and alcohol use, in a group of 84 individuals who sought supportive services after the 1995 Oklahoma City bombing. A self-report instrument was used to assess demographics, sensory exposure, injury, interpersonal exposure through relationship with victims, peritraumatic reaction, grief, posttraumatic stress, worry about safety, functional impairment, and changes in smoking and drinking. Those who reported increased smoking had higher scores on peritraumatic reaction, grief, posttraumatic stress, worry about safety, and trouble functioning.