Tietjen Gretchen E
University of Toledo, Toledo, OH.
Neurol Clin Pract. 2012 Mar;2(1):5-13. doi: 10.1212/CPJ.0b013e31824c6c8a.
Domestic violence is an enormous public health problem that is frequently encountered in health care settings, but often not recognized. In addition to physical injuries directly related to maltreatment, there is a growing scientific literature demonstrating that abuse and neglect, particularly when beginning early in life, results in brain functional, structural, and even epigenetic changes that have enduring effects. This article reviews the definitions and prevalence of domestic violence, summarizes the known neurobiological effects, and describes the fundamentals of office assessment for abuse and the management of the battered patient. Ethical challenges with regards to abuse assessment and reporting, particularly in states with mandatory reporting laws, are discussed. Comprehensive resources for both patients and clinicians are included.
家庭暴力是一个巨大的公共卫生问题，在医疗环境中经常遇到，但往往未被识别。除了与虐待直接相关的身体伤害外，越来越多的科学文献表明，虐待和忽视，尤其是在生命早期开始时，会导致大脑功能、结构甚至表观遗传变化，并产生持久影响。本文回顾了家庭暴力的定义和患病率，总结了已知的神经生物学影响，并描述了办公室对虐待的评估基础以及受虐患者的管理。还讨论了与虐待评估和报告相关的伦理挑战，特别是在有强制报告法律的州。文中还包括了为患者和临床医生提供的综合资源。
