RT Book, Section
A1 Reus, Victor I.
A2 Jameson, J. Larry
A2 Fauci, Anthony S.
A2 Kasper, Dennis L.
A2 Hauser, Stephen L.
A2 Longo, Dan L.
A2 Loscalzo, Joseph
SR Print(0)
ID 1177607842
T1 Assessment and Evaluation of Violence
T2 Harrison's Principles of Internal Medicine, 20e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259644016
LK accesspharmacy.mhmedical.com/content.aspx?aid=1177607842
RD 2024/04/25
AB Primary  care  physicians  may  encounter  situations  in  which  family,  domestic,  or  societal  violence  is  discovered  or  suspected.  Such  an  awareness  can  carry  legal  and  moral  obligations;  many  state  laws  mandate  reporting  of  child,  spousal,  and  elder  abuse.  Physicians  are  frequently  the  first  point  of  contact  for  both  victim  and  abuser.  Approximately  2  million  older  Americans  and  1.5  million  U.S.  children  are  thought  to  experience  some  form  of  physical  maltreatment  each  year.  Spousal  abuse  is  thought  to  be  even  more  prevalent.  An  interview  study  of  24,000  women  in  10  countries  found  a  lifetime  prevalence  of  physical  or  sexual  violence  that  ranged  from  15  to  71%;  these  individuals  are  more  likely  to  suffer  from  depression,  anxiety,  and  substance  abuse  and  to  have  attempted  suicide.  In  addition,  abused  individuals  frequently  express  low  self-esteem,  vague  somatic  symptomatology,  social  isolation,  and  a  passive  feeling  of  loss  of  control.  Although  it  is  essential  to  treat  these  elements  in  the  victim,  the  first  obligation  is  to  ensure  that  the  perpetrator  has  taken  responsibility  for  preventing  any  further  violence.  Substance  abuse  and/or  dependence  and  serious  mental  illness  in  the  abuser  may  contribute  to  the  risk  of  harm  and  require  direct  intervention.  Depending  on  the  situation,  law  enforcement  agencies,  community  resources  such  as  support  groups  and  shelters,  and  individual  and  family  counseling  can  be  appropriate  components  of  a  treatment  plan.  A  safety  plan  should  be  formulated  with  the  victim,  in  addition  to  providing  information  about  abuse,  its  likelihood  of  recurrence,  and  its  tendency  to  increase  in  severity  and  frequency.  Antianxiety  and  antidepressant  medications  may  sometimes  be  useful  in  treating  the  acute  symptoms,  but  only  if  independent  evidence  for  an  appropriate  psychiatric  diagnosis  exists.