A Brief Overview of PTSD Symptoms

Based in Kentfield, CA, Stephen Raffle, MD, has spent more than 50 years as a clinical psychiatrist, forensic psychiatrist, and neuropsychiatrist managing his own private outpatient practice. He has performed numerous independent medical examinations and provided expert witness testimony over the course of his career. At his private Kentfield, CA, practice, Stephen Raffle, MD, regularly works in areas of emotional distress and post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD), is a health condition caused by witnessing or experiencing a highly traumatic event. An individual with PTSD may experience flashbacks, nightmares, and anxiety. In some cases, a similar event or certain physical location may trigger PTSD symptoms, but an individual’s fight-or-flight response may also be triggered by seemingly nothing at all.

Many symptoms of PTSD are linked directly to the triggering event, such as flashbacks and nightmares. Other symptoms are more generalized, ranging from reclusive behavior to emotional conditions comparable to those seen in clinical depression. PTSD can also negatively impact a person’s memory and ability to maintain relationships with family and friends.

These symptoms represent only a small portion of the experiences and feelings a person may encounter when dealing with PTSD. If a person is still feeling the effects of a traumatic event more than one month later, they should seek out support from a health services provider.

The APA's Two Medical Journals

Stephen Raffle, MD, is an experienced psychiatrist and forensic psychiatrist based in Kentfield, CA. In addition to managing Stephen M. Raffle, MD, & Associates in Kentfield, CA, he spends time engaging with a number of professional organizations, including the American Psychiatric Association.

The American Psychiatric Association (APA) maintains two monthly journals: The American Journal of Psychiatry and Psychiatric Services. The American Journal of Psychiatry stands as the most widely read journal of its kind in the world, exploring relevant psychiatric topics such as the impact of cardiovascular disease on individuals living with psychiatric disorders and improved treatment outcomes for alcohol use disorder, anorexia, opioid use disorder, and more. Recent articles include mental health perspectives on the discussion surrounding modern police reform.

Psychiatric Services, meanwhile, was established in 1950 and emphasizes research reports regarding the delivery of mental health services. The journal is particularly focused on individuals living with serious mental illnesses and the treatments they receive through community programs.

Both the American Journal of Psychiatry and Psychiatric Services are available to read online at www.psychiatry.org. The website features a variety of related services, ranging from psychiatric podcasts to Editor’s Choice, which is a collection of articles from around the web on a specific psychiatric topic.

A Brief Overview of Chronic Pain

Kentfield, CA, psychiatrist Stephen Raffle, MD, has made several presentations and lectures for law offices and firms. In his time as a psychiatrist, Stephen Raffle, MD, has also spoken to many patients with chronic pain to understand their experiences.

Chronic pain is one of the most common reasons a person decides to visit a medical professional. Some studies estimate that 20 percent of adults worldwide suffer from chronic pain, and 7 percent of American adults say that pain interferes with their daily life. Chronic pain increases opioid addiction and suicidal tendencies. Those with Lyme disease see a 28 percent increase in suicide and mental disorders post-infection.

To help chronic pain patients, doctors use pain maps. Pain maps are an anatomical diagram of the human body with many different common pain sites, such as the neck, lower back, and shoulders. The patient rates the pain intensity by site, giving doctors and psychiatrists an overview of the symptoms. Descriptions of pain are subjective, which leads to misdiagnoses.

Sometimes health data tracking algorithms exacerbate the problem. They automatically flag patients with large amounts of controlled substances. For example, cancer patients were flagged 20 percent of the time because they see multiple specialists. Therefore seem suspicious to the algorithm.

APA Annual Update on Structural Racism

Based in Kentfield, CA, Stephen Raffle, MD has worked as a psychiatrist and forensic psychiatrist for more than five decades. In addition to consulting with attorneys throughout the Kentfield, CA, region on a variety of medical-legal matters, Stephen Raffle, MD engages with professional organizations such as the American Psychiatric Association (APA).

In May 2021, the American Psychiatric Association hosted the fifth installment in the APA Addresses Structural Racism Town Hall series. The series launched in June of 2020, with the most recent installment serving as an annual update on the organization’s commitment to social justice issues. APA President Jeff Geller initiated the series, in part, as a response to the COVID-19 pandemic’s disproportionate impact on people of color, as well as other prominent social justice issues impacting the United States.

As part of the first Town Hall event, Geller established the APA Presidential Task Force to Address Structural Racism Throughout Psychiatry, a committee tasked with analyzing structural racism as it appears throughout the world of psychiatry and developing strategies to redress these issues. Members of the Task Force help facilitate effective conversations at Town Hall events, while also providing educational resources that psychiatric professionals can utilize during their day-to-day activities.

Prior to the annual update, the series focused on structural racism in psychiatric residency training environments and how to improve in areas of recruitment, retention, and overall program development. For new APA members or those who have missed past editions of the series, the complete Structural Racism Town Hall Archives are accessible at www.psychiatry.org.

The American Psychiatric Association Presents the DSM-5

Based in Kentfield, CA, Stephen Raffle, MD, is a clinical and forensic psychiatrist with more than five decades of experience. He engages and consults with attorneys, insurers, and employers in venues and cases ranging from civil and criminal to administrative and employment. In addition to his professional responsibilities, Stephen Raffle, MD, belongs to various professional organizations, including the American Psychiatric Association.

The American Psychiatric Association (APA) manages the development and implementation of the Diagnostic and Statistical Manual of Mental Disorders. The current edition of the text, DSM-5, is the result of more than a decade of concentrated efforts by countless mental health professionals from around the globe. Through their work, the DSM-5 functions as a definitive resource for mental disorder classification and definition. Furthermore, the DSM-5 frames this information with a goal of optimizing diagnoses, treatment options, and ongoing research.

The DSM-5 is ubiquitous among American health professionals, as well as many international care providers. The text not only offers in-depth insight into symptoms and criteria for making diagnoses, but assists mental health professionals in conveying relevant information to individuals using common language.

Despite the authoritative nature of the DSM-5, the APA continues to improve its educational and professional offerings whenever possible. For example, a 2018 update took into account changes made to ICD-10-CM medical codes. Both a comprehensive breakdown and quick-reference overview to these changes are available at psychiatry.org.

Understanding the Pain of a Relationship Breakup

A clinical psychiatrist with decades of experience in areas ranging from forensic psychiatry to neuropsychiatry, Stephen Raffle, MD, maintains a private practice in Kentfield, CA. Through his practice, Stephen Raffle, MD, treats conditions ranging from posttraumatic stress disorder (PTSD) to emotional distress.

Often a romantic breakup can cause serious enough emotional distress that it presents similarly to PTSD. Those not responsible for the breakup tend to suffer more and may find themselves reliving the experiences, avoiding circumstances that trigger memories of their partners, numbing their emotions, and living in an aroused state, making them more anxious and irritable. They may also have trouble sleeping.

Studies show that such heartache has a neurological basis. Brain scans with functional magnetic resonance imaging (fMRI) indicate activity in certain areas of the brain similar to the activity in response to a hot probe placed on the arm. Hence, neurologically it seems that people experience emotional pain similarly to physical pain.

That fact has led psychologist Alain Brunet of McGill University in Montreal to explore treatment combining physiological suppression of the pain with the beta-blocker propanolol with therapy. He proposes this treatment to allow people to process through their memories, storing them without the associated pain.

The Daubert Standard for Admitting Expert Testimonies in Court

Court Room Photo by David Veksler on Unsplash

Stephen Raffle, MD, is a clinical psychiatrist and neuropsychiatrist in Kentfield, CA. While Dr. Raffle’s work as an MD covers several fields, the bulk is related to tort cases in civil litigation in which he acts as an expert witness.

For an expert witness’ testimony to be admissible in court, it must meet either the Daubert standard or, in some states, the Frye test. The Daubert standard is used in all federal jurisdictions and some state jurisdictions to establish whether an expert witness’ testimony is grounded in scientific reasoning that is appropriately applied to the facts at issue.

The Daubert standard originated from the 1993 Supreme Court case of Daubert v. Merrell Dow Pharmaceuticals, in which the court listed five factors to guide judges in determining whether an expert witness' testimony should be admissible. Per the court, a testimony is admissible if its theory or technique:

1. has been tested,

2. is subjected to peer review and publication,

3. has a known potential error rate,

4. has standards controlling its operation, and

5. is widely accepted within the scientific community.

Before Daubert, the standard for admissible testimony was the Frye test. The Frye test required that testimony be founded on methods generally accepted by experts in that field. The Frye test is still used in some states, including California.