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Liu J, Mahendran R, Chong SA, Subramaniam M. Elucidating the Impact of Childhood, Adulthood, and Cumulative Lifetime Trauma Exposure on Psychiatric Symptoms in Early Schizophrenia Spectrum Disorders. J Trauma Stress 2021; 34:137-148. [PMID: 33096583 DOI: 10.1002/jts.22607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/18/2020] [Accepted: 08/31/2020] [Indexed: 12/30/2022]
Abstract
Cumulative lifetime trauma has a profound impact on the development of schizophrenia spectrum disorders. However, few studies have determined participants' most distressing (i.e., "worst") life event in childhood or adulthood or examined whether this event contributes to poorer clinical outcomes. The present study aimed to (a) determine the associations between the worst life event and demographic/clinical variables and (b) examine the associations between the worst life event and psychiatric symptoms (i.e., positive, negative, depressive, and anxiety symptoms). Participants (N = 150) were outpatients newly diagnosed with schizophrenia spectrum disorders who were assessed for lifetime trauma exposure, positive and negative symptoms of schizophrenia, and symptoms of depression and anxiety. Multinomial logistic regression analysis was conducted to examine the associations between demographic and clinical variables and worst life events (none, childhood, or adulthood). Multiple linear regression analyses were performed to examine the associations between worst life events and psychiatric symptoms. More participants reported that their worst life event occurred during adulthood (31.1%) than childhood (21.3%). Adulthood trauma was associated with male gender, older age, non-Chinese ethnicity, and psychiatric comorbidities; childhood trauma was associated with a family history of depression/anxiety. Adulthood trauma was significantly associated with more severe positive psychotic symptoms, f2 = 0.19, whereas childhood and adulthood trauma exposure were both significantly associated with more severe depressive and anxiety symptoms, f2 s = 0.19 and 0.25, respectively. Our findings underscore the importance of conducting assessments for worst life events and the associated risk factors to develop meaningful formulations and appropriate trauma-focused treatment plans.
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Affiliation(s)
- Jianlin Liu
- Research Division, Institute of Mental Health, Singapore.,Department of Psychological Medicine, National University of Singapore, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, National University of Singapore, Singapore.,Academic Development Department, Duke-National University of Singapore Medical School, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Effect of standardized post-coercion review session on symptoms of PTSD: results from a randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2021; 271:1077-1087. [PMID: 33231771 PMCID: PMC8354865 DOI: 10.1007/s00406-020-01215-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/07/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Post-coercion review is increasingly regarded as a mean to reduce the negative consequences of coercive interventions, including the development of posttraumatic symptoms. However, the efficacy of this intervention in preventing posttraumatic symptoms or PTSD has not been sufficiently studied. The objective of this study is to examine the influence of a single, standardized post-coercion review session on the development or exacerbation of PTSD symptoms in patients with psychotic disorders. METHODS In a multi-center, two-armed, randomized controlled trial, patients who experienced coercive interventions during current hospitalization were either randomized to standard treatment or an intervention group receiving a guideline-based, standardized reflecting review session. Factorial MANCOVA and subsequent ANCOVAs investigated the effects of the post-coercion reflecting review session on post-traumatic symptoms as measured by the subscales of the Impact of Events Scale-Revised (IES-R). Similarly, the effect of the intervention on the intensity of the peritraumatic reactions measured by the Peritraumatic Distress Inventory (PDI) was analyzed by conducting a factorial ANCOVA. RESULTS N = 82 patients were included in an intention-to-treat analysis. MANCOVA and post hoc ANCOVAs revealed a significant main effect of the intervention for the IES-R subscales intrusion and hyperarousal, when controlling for levels of peritraumatic distress, whereby intervention group participants presented lower respective mean scores. There was no significant difference regarding the intensity of the peritraumatic reaction. CONCLUSION Standardized post-coercion review contributes to a reduction of the burden of PTSD symptoms in patients with psychotic disorders experiencing coercive interventions in acute settings and shall be recommended as a measure of trauma-informed care. The trial was registered at ClinicalTrials.gov (ID NCT03512925) on 01/30/2018 (retrospectively registered).
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Lu W, Yanos PT, Waynor WR, Gao CE, Bazan C, Giacobbe G, Gill K, Bullock D, Prigerson HG. Trauma Exposure and Prolonged Grief Disorder Among Persons Receiving Community Mental Health Services: Rates and Correlates. Front Psychiatry 2021; 12:760837. [PMID: 35185633 PMCID: PMC8854856 DOI: 10.3389/fpsyt.2021.760837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Persons with serious mental illnesses (SMIs) are at increased risk for exposure to trauma and posttraumatic stress disorder (PTSD). Prolonged Grief Disorder (PGD) may also impact this population but has been seldom studied. AIMS The present study investigated the rate of both PTSD and PGD among clients receiving community mental health services, and the clinical correlates of co-occurring PTSD/PGD. METHODS Trauma history, PTSD and PGD were assessed among 536 individuals receiving community mental health services (Study 1). A subsample of 127 individuals from Study 1 who met DSM-5 criteria for PTSD based on diagnostic interview completed measures of psychiatric symptoms (Study 2). RESULTS In Study 1, 92.4% of participants receiving community mental health services had experienced a traumatic event, 49.6% met criteria for probable and provisional PTSD, 14.7% scored positive for probable PGD, and 11.9% met criteria for probable and provisional PTSD as well as probable PGD. In Study 2, participants meeting diagnostic DSM-5 criteria for PTSD and probable PGD had more self-reported PTSD symptoms, but did not differ on other outcomes. CONCLUSIONS Findings highlight the need for trauma informed services including grief counseling for persons with SMI.
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Affiliation(s)
- Weili Lu
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, New Brunswick, NJ, United States
| | - Philip T Yanos
- John Jay College, City University of New York, New York City, NY, United States
| | - William R Waynor
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, New Brunswick, NJ, United States
| | - Carol E Gao
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, New Brunswick, NJ, United States
| | - Carolyn Bazan
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, New Brunswick, NJ, United States
| | - Giovanna Giacobbe
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, New Brunswick, NJ, United States
| | - Kenneth Gill
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, New Brunswick, NJ, United States
| | - Deanna Bullock
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, New Brunswick, NJ, United States
| | - Holly G Prigerson
- Department of Medicine, Center for Research on End of Life Care, Cornell University, White Plains, NY, United States
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Mauritz MW, van Gaal BGI, Goossens PJJ, Jongedijk RA, Vermeulen H. Treating patients with severe mental illness with narrative exposure therapy for comorbid post-traumatic stress disorder. BJPsych Open 2020; 7:e12. [PMID: 33295271 PMCID: PMC7791562 DOI: 10.1192/bjo.2020.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Interpersonal trauma and post-traumatic stress disorder (PTSD) in patients with severe mental illness (SMI) negatively affect illness course. Narrative exposure therapy (NET) is effective in vulnerable patient groups, but its efficacy and applicability has not been studied in out-patients with SMI. AIMS We aimed to evaluate the efficacy and applicability of NET in SMI on changes in PTSD, dissociation, SMI symptoms, care needs, quality of life, global functioning and care consumption. METHOD The study had a single-group, pre-test-post-test, repeated-measures design and was registered in The Netherlands National Trial Register (identifier TR571). Primary outcomes were assessed at pre-treatment (T0), 1 month post-treatment (T1) and 7 months' follow-up (T2), with a structured interview for PTSD and dissociation screening. Secondary outcomes followed routinely SMI measurements and medical data. Mixed models were used for data analysis. RESULTS The majority of the 23 participants was female (82%). Mean age was 49.9 years (s.d. 9.8) and mean PTSD duration was 24.1 years (s.d. 14.5). Mean PTSD severity decreased from 37.9 at T0 to 31.9 at T1 (-6.0 difference, 95%CI -10.0 to -2.0), and decreased further to 24.5 at T2 (-13.4 difference, 95%CI -17.4 to -9.4). Dissociation, SMI symptoms, duration of contacts, and medication decreased; global functioning increased; and quality of life and perceived needs did not change. Eleven participants were in remission for PTSD at T2, of which five were also in remission for major depression. CONCLUSIONS NET appeared efficacious and applicable to out-patients with SMI and PTSD, and was well tolerated.
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Affiliation(s)
- Maria W Mauritz
- GGNet Center for Mental Health Care, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, The Netherlands
| | - Betsie G I van Gaal
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, The Netherlands; HAN University for Applied Sciences, Nursing Studies, Nijmegen, The Netherlands
| | - Peter J J Goossens
- Dimence Group, Center for Mental Health Care, Specialistisch Centrum Bipolaire Stoornissen, The Netherlands; and University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Ruud A Jongedijk
- ARQ Centrum '45; and ARQ National Psychotrauma Center, The Netherlands
| | - Hester Vermeulen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, The Netherlands; and HAN University for Applied Sciences, Nursing studies, Nijmegen, The Netherlands
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Trauma―Focused Treatment for PTSD With Comorbid Psychosis: A Case Report. Clin Case Stud 2020. [DOI: 10.1177/1534650120980069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Post-traumatic stress disorder is often a condition left untreated in patients also meeting criteria for psychotic disorders. While many clinicians who treat patients with these co-occurring conditions choose to avoid treatment targeting symptoms of PTSD for fear of de-stabilizing these individuals or exacerbating psychotic symptomatology, little is currently known about how patients respond to treatment for PTSD in the context of ongoing psychotic symptoms. Additionally, research is scarce regarding the clinical profile of individuals who develop psychotic symptoms secondary to a traumatic stressor, in the absence of any premorbid symptomatology. The purpose of this case report is to outline the case of an individual, “Mary” who developed psychotic symptoms secondary to a traumatic stressor in her middle age and to describe her response to treatment targeting her symptoms of PTSD. Mary presented with core symptoms of PTSD that emerged following a traumatic car crash. She developed psychotic symptoms (auditory and visual hallucinations) several weeks later. Mary underwent a treatment course of Prolonged Exposure targeting her symptoms of PTSD, with careful work done to monitor any changes in psychotic symptomatology while engaging in this treatment. Standardized measures such as the Post-traumatic Stress Disorder Checklist-5 (PCL-5) and the Psychotic Symptom Rating Scales were administered to assess Mary’s progress throughout treatment. This case report provides a comprehensive summary of Mary’s 16-week course of Prolonged Exposure therapy, which resulted in a significant reduction in PTSD symptomatology as demonstrated by a 72% decrease in scores on the PCL-5 from the initiation to the conclusion of treatment.
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Childhood Adversity, Proximal Stressors and PTSD Among People with Severe Mental Illness: An Exploratory Study. Community Ment Health J 2020; 56:1557-1565. [PMID: 32170520 DOI: 10.1007/s10597-020-00607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
The purpose of this exploratory study is to: (1) assess prevalence of childhood adversities and posttraumatic stress disorder (PTSD); (2) assess their association, and; (3) explore whether proximal sources of stress affect this relationship and/or have an association with PTSD among people with severe and persistent psychological disorders. Using data from 141 respondents, we assess the extent to which individuals in this population experienced 17 PTSD symptoms, various correlates to probable PTSD, and the most relevant of these factors in a multivariate logistic regression. Overall, 27% of the participants met study criteria for probable PTSD and each symptom was reported by at least 18% of the sample. Multivariate logistic regression models indicated that interpersonal conflict and being a victim of a crime were significantly related to probable PTSD. We discuss these findings in relation to treatment and course of disease for people suffering from severe and persistent mental illness experiencing a traumatic event.
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Prokopez CR, Vallejos M, Farinola R, Alberio G, Caporusso GB, Cozzarin LG, Chiapella LC, Fuentes P, Daray FM. The history of multiple adverse childhood experiences in patients with schizophrenia is associated with more severe symptomatology and suicidal behavior with gender-specific characteristics. Psychiatry Res 2020; 293:113411. [PMID: 32890864 DOI: 10.1016/j.psychres.2020.113411] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022]
Abstract
The current study aims to compare the prevalence of adverse childhood experiences (ACEs) between patients with schizophrenia and non-psychiatric control group, and to analyze the association of having suffered multiple ACEs with clinical symptoms of schizophrenia and suicidal behavior. A multicenter, cross-sectional study was conducted across three facilities in Buenos Aires, Argentina. One-hundred patients with schizophrenia and 50 healthy subjects were assessed with the Adverse Childhood Experiences questionnaire (ACE-Q), the Positive and Negative Syndrome Scale (PANSS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). We observed that the prevalence of at least one ACE in schizophrenic patients was almost double in comparison with the non-psychiatric control group. Multiple ACEs were associated with persistent auditory hallucinations and lower negative symptoms in both sexes. Higher frequency of death ideation and a higher number of suicide attempts were reported among women. The strength of this study is the possibility of comparing the presence of ACEs between schizophrenic patients and non-psychiatric control using the same questionnaire in an under-reported sample of low socio-economic patients assisted in public hospitals. A limitation is that the history of ACEs relied on the retrospective assessment of childhood experiences, and adults could over-report ACEs because of recall bias.
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Affiliation(s)
- Cintia R Prokopez
- Braulio A. Moyano Neuropsychiatric Hospital, City of Buenos Aires, Argentina; University of Buenos Aires, School of Medicine, Institute of Pharmacology, Argentina
| | - Miguel Vallejos
- José Tiburcio Borda Hospital, City of Buenos Aires, Argentina
| | - Romina Farinola
- José Tiburcio Borda Hospital, City of Buenos Aires, Argentina
| | - Germán Alberio
- Braulio A. Moyano Neuropsychiatric Hospital, City of Buenos Aires, Argentina
| | | | | | - Luciana C Chiapella
- National Scientific and Technical Research Council (CONICET). Ciudad Autónoma de Buenos Aires, Argentina; Pharmacology Area, Faculty of Biochemical and Pharmaceutical Sciences, National University of Rosario, Argentina
| | - Pamela Fuentes
- Braulio A. Moyano Neuropsychiatric Hospital, City of Buenos Aires, Argentina
| | - Federico M Daray
- University of Buenos Aires, School of Medicine, Institute of Pharmacology, Argentina; National Scientific and Technical Research Council (CONICET). Ciudad Autónoma de Buenos Aires, Argentina.
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Pathways to aggression and violence in psychosis without longstanding antisocial behavior: A review and proposed psychosocial model for integrative clinical interventions. Psychiatry Res 2020; 293:113427. [PMID: 32866792 DOI: 10.1016/j.psychres.2020.113427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 11/22/2022]
Abstract
There is a need for a clearer understanding of the factors associated with increased risk of aggression and violence (AV) among people with psychosis and other severe mental illness (SMI) to guide effective prevention and intervention. The current article (1) reviews the literature regarding psychosocial factors associated with AV among individuals with psychosis and other SMI who do not have longstanding antisocial behaviors, (2) proposes an integrative psychosocial model of AV that can be practically applied, and (3) proposes appropriate evidence-based clinical interventions to reduce AV and facilitate recovery. We propose that increased risk for AV among people with psychosis is driven by anger, which is affected by a range of factors including victimization and situational stressors, social rejection or experiences of discrimination, anxious arousal, and hostile attribution bias related to psychosis. The cumulative effect of these systems is exacerbated by co-occurring substance misuse and increased impulsivity, particularly negative urgency. In consideration of the current psychosocial model and existing evidence-based interventions for AV in individuals with psychosis, we propose that trauma-informed interventions that integrate skills training in emotion regulation, social and interpersonal situations, cognitive restructuring and remediation, and modified prolonged exposure may demonstrate the most promise for this population.
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From trauma-blind to trauma-informed: re-thinking criminalization and the role of trauma in persons with serious mental illness. CNS Spectr 2020; 25:577-583. [PMID: 32372740 DOI: 10.1017/s1092852920001169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Trauma-informed approaches offer a new perspective for understanding how and why individuals with serious mental illness (SMI) become entangled in the criminal justice system. There is growing awareness that many individuals with SMI have experienced significant life trauma, and factors beyond SMI that contribute to criminalization are being identified; however, the role of trauma continues to be overlooked in many formulations. In trauma-blind systems, trauma-related behaviors are often misunderstood and met with responses that exacerbate psychiatric and behavioral problems. Trauma-informed approaches provide a richer understanding of underlying drivers of behavior, and view trauma as an integral component of risk management, case formulation, relationship-based care, and referral. Embedding trauma-informed principles across organizations promotes continuity of care, safety, and more compassionate cultures that help reduce the flow of individuals with SMI into the criminal justice system. An expanded view of the criminalization hypothesis is offered, which incorporates all factors addressed in current research.
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Liu J, Lim MSM, Ng BT, Chong SA, Subramaniam M, Mahendran R. Global emotion dysregulation and maladaptive cognitive emotion regulation strategies mediate the effects of severe trauma on depressive and positive symptoms in early non-affective psychosis. Schizophr Res 2020; 222:251-257. [PMID: 32473932 DOI: 10.1016/j.schres.2020.05.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/06/2020] [Accepted: 05/16/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous research has shown that childhood trauma contributes to the onset and maintenance of psychosis. However, few studies have accounted for the effects of lifetime trauma and post-traumatic stress disorder (PTSD), and none have examined the mediating role of emotion dysregulation in symptom maintenance after severe trauma. The purpose of this study is to determine whether maladaptive cognitive emotion regulation strategies (CERS) and global emotion dysregulation mediate the effects of probable PTSD on depressive symptoms, and whether this pathway extends to influence positive symptoms in patients with early non-affective psychotic disorders. METHODS A total of 150 outpatients with early non-affective psychosis were assessed for trauma exposure, DSM-5 PTSD symptoms, CERS, global emotion dysregulation, and current depressive and positive symptoms. Parallel and serial mediation analyses based on ordinary least squares regressions were used to test the hypothesized models. RESULTS Mediation analyses controlling for gender, psychiatric comorbidities, antipsychotic medication dosage, duration of untreated psychosis (DUP), family history of mental illness, and cumulative trauma revealed that maladaptive CERS (rumination, catastrophic thinking, and self-blame) and global emotion dysregulation mediated the effects of probable PTSD on depressive symptoms (R2 = 41%), while maladaptive CERS, global emotion dysregulation, and depressive symptoms mediated the effects of probable PTSD on positive symptoms (R2 = 30%). CONCLUSIONS Our results demonstrate the indirect effects of maladaptive CERS and global emotion dysregulation on maintaining depressive and positive symptoms. Emotion dysregulation may be a potential transdiagnostic treatment target to alleviate depressive and positive symptoms in traumatized patients with early non-affective psychosis.
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Affiliation(s)
- Jianlin Liu
- Department of Psychological Medicine, National University of Singapore, Singapore; Research Division, Institute of Mental Health, Singapore.
| | | | - Boon Tat Ng
- Pharmacy Department, Institute of Mental Health, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
| | | | - Rathi Mahendran
- Department of Psychological Medicine, National University of Singapore, Singapore; Academic Development Department, Duke-NUS Medical School, Singapore
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Discharge and post-discharge outcomes of psychiatric inpatients with a lifetime history of exposure to interpersonal trauma: A population-based study. Gen Hosp Psychiatry 2020; 65:82-90. [PMID: 32544716 DOI: 10.1016/j.genhosppsych.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine discharge and post-discharge outcomes for psychiatric inpatients with a history of exposure to physical, sexual, or emotional trauma. METHODS In this population-based cohort study using health-administrative data, adult psychiatric inpatients in Ontario, Canada (2009-2016) with and without self-reported lifetime exposure to interpersonal trauma were compared on their likelihood of: discharge against medical advice; post-discharge outpatient follow-up; and post-discharge emergency department (ED) visits, rehospitalization, deliberate self-harm and suicide. Modified Poisson regressions generated relative risks (aRR) and 95% confidence intervals (CI), adjusted for age, sex, income, medical comorbidities, and psychiatric diagnosis. RESULTS Psychiatric inpatients with a history of interpersonal trauma (n = 50,832/160,436, 31.7%) were at elevated risk for discharge against medical advice (5.6% vs. 4.6%; aRR = 1.27, 1.21-1.33), and for 1-year post-discharge psychiatric ED visits (31.0% vs. 28.3%, aRR = 1.04, 1.02-1.06), and deliberate self-harm (5.5% vs. 3.7%, aRR = 1.30, 1.23-1.36). Post-discharge 30-day follow-up with primary care was slightly more common among those with a trauma history (37.6% vs. 34.5%, aRR = 1.06, 1.04-1.08); psychiatrist follow-up was less common (35.1% vs. 37.1%, aRR = 0.87, 0.86-0.89). Elevations in risk were observed for those with primary diagnoses of psychotic, mood and anxiety disorders, but not for those with a primary diagnosis of substance-related disorders. Risk elevations were specifically observed in those without a diagnosis of post-traumatic stress disorder. CONCLUSION Implementing supports and services during and after inpatient hospitalization that take into account a history of interpersonal trauma may help reduce certain undesirable discharge and post-discharge outcomes in this slightly higher-risk group.
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Konya J, Perôt C, Pitt K, Johnson E, Gregory A, Brown E, Feder G, Campbell J. Peer-led groups for survivors of sexual abuse and assault: a systematic review. J Ment Health 2020:1-13. [PMID: 32529864 DOI: 10.1080/09638237.2020.1770206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 04/07/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
Background: There are current concerns about whether appropriate support is provided for sexual abuse and assault survivors. We reviewed the published evidence for peer-led groups in the care of survivors.Aims: To determine the health and wellbeing outcomes of peer-led, group-based interventions for adult survivors who have experienced sexual abuse and assault and describe the experiences of participants attending these groups.Method: Systematic review. The following databases were searched: Medline, PsycINFO, Embase, Cochrane Library, Web of Science, Sociological Abstracts, IBSS. Papers focusing on adults using any research methodology were included. Quality appraisal was completed using the Mixed Methods Appraisal Tool (MMAT). Thematic analysis was undertaken using methods of constant comparison.Results: Initial, and updated searches identified 16,724 potentially eligible articles. Of these, eight were included. Thematic analysis revealed that peer-led group-based interventions have positive impact on participants' psychological, physical and interpersonal well-being. Participation also presents challenges for survivors. However, there is a mutuality and interconnected benefit between the triggering of difficult emotions due to participation and the healing experiences gained.Conclusions: Scientific evidence of peer-led, group-based, approaches for adult survivors of sexual abuse and assault is limited, although generally suggestive of benefits to such individuals.
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Affiliation(s)
- Judit Konya
- Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK
| | - Concetta Perôt
- Centre for Academic Primary Care (CAPC), University of Bristol, Bristol, UK
| | - Katherine Pitt
- Centre for Academic Primary Care (CAPC), University of Bristol, Bristol, UK
| | - Emma Johnson
- Centre for Academic Primary Care (CAPC), University of Bristol, Bristol, UK
| | - Alison Gregory
- Centre for Academic Primary Care (CAPC), University of Bristol, Bristol, UK
| | - Emily Brown
- Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK
| | - Gene Feder
- Centre for Academic Primary Care (CAPC), University of Bristol, Bristol, UK
| | - John Campbell
- Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK
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Perlini C, Donisi V, Rossetti MG, Moltrasio C, Bellani M, Brambilla P. The potential role of EMDR on trauma in affective disorders: A narrative review. J Affect Disord 2020; 269:1-11. [PMID: 32217337 DOI: 10.1016/j.jad.2020.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/19/2020] [Accepted: 03/01/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapeutic approach that has originally been developed to treat post-traumatic stress disorder (PTSD). Recently it has been suggested as a complementary therapy in a wide range of clinical conditions. In particular, affective disorders as bipolar disorder (BD) and major depressive disorder (MDD) have a higher lifetime prevalence of traumatic or stressful life events (SLEs) compared to the general population, which makes them good candidates for the application of EMDR. METHODS A bibliographic search on PUBMED, Scopus, and ScienceDirect of studies applying EMDR to people with a primary diagnosis of bipolar disorder (BD) and major depressive disorder (MDD) (with or without a comorbid PTSD) was conducted. RESULTS Literature search retrieved 15 studies, of which 3 were focused on BD and 12 on MDD. Overall, they suggest EMDR as an effective tool in reducing trauma-related but also manic and depressive symptoms, with few effect sides and high adherence rates. LIMITATIONS Few small studies exist with heterogeneous and not gold-standard methodology, especially for BD. CONCLUSIONS Overall, retrieved studies can be considered as first attempts at investigating the applicability of EMDR in affective disorders. Although far to be conclusive, preliminary evidence suggests EMDR as a useful adjunctive approach in the treatment of BD and MDD, especially when other treatments have failed. It is now the time to implement such trauma-focused therapy to larger samples of patients using more rigorous methods.
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Affiliation(s)
- Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Valeria Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Maria Gloria Rossetti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy; Department of Neuroscience and Mental Health, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Moltrasio
- Department of Neuroscience and Mental Health, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marcella Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.
| | - Paolo Brambilla
- Department of Neuroscience and Mental Health, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Møller L, Augsburger M, Elklit A, Søgaard U, Simonsen E. Traumatic experiences, ICD-11 PTSD, ICD-11 complex PTSD, and the overlap with ICD-10 diagnoses. Acta Psychiatr Scand 2020; 141:421-431. [PMID: 32049369 PMCID: PMC7317379 DOI: 10.1111/acps.13161] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study investigated the frequency of traumatic experiences, prevalence rates of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD), and overlap with ICD-10 classified disorders in outpatient psychiatry. METHOD Overall, 165 Danish psychiatric outpatients answered the International Trauma Questionnaire, the Life Event Checklist, and the World Health Organization Well-being Index. ICD-10 diagnoses were extracted from the hospital record. Chi-square analysis, t-tests, and conditional probability analysis were used for statistical analysis. RESULTS Nearly, all patients (94%) had experienced at least one traumatic event. CPTSD (36%) was more common than PTSD (8%) and had considerable overlap with ICD-10 affective, anxiety, PTSD, personality, adjustment and stress-reaction disorders, and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. ICD-11 PTSD overlapped with ICD-10 anxiety, PTSD, adjustment and stress-reaction disorders, and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. A subgroup of patients with ICD-10 PTSD (23%) did not meet criteria for ICD-11 PTSD or CPTSD. CONCLUSION Traumatic experiences are common. ICD-11 CPTSD is a highly prevalent disorder in psychiatric outpatients. One quarter with ICD-10 PTSD did not meet criteria for either ICD-11 PTSD or CPTSD. PTSD and CPTSD had considerable overlap with ICD-10 disorders.
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Affiliation(s)
- L. Møller
- Psychiatric Research Unit, Region ZealandSlagelseDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Clinic for Traumatized Refugees, Region ZealandSlagelseDenmark
| | - M. Augsburger
- Division of PsychopathologyDepartment of PsychologyUniversity of ZurichZurichSwitzerland
| | - A. Elklit
- Department of PsychologyNational Centre of PsychotraumatologyUniversity of Southern DenmarkOdenseDenmark
| | - U. Søgaard
- Psychiatric Research Unit, Region ZealandSlagelseDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - E. Simonsen
- Psychiatric Research Unit, Region ZealandSlagelseDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Winders S, Murphy O, Looney K, O'Reilly G. Self‐compassion, trauma, and posttraumatic stress disorder: A systematic review. Clin Psychol Psychother 2020; 27:300-329. [DOI: 10.1002/cpp.2429] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sarah‐Jane Winders
- Department of Clinical PsychologyUniversity College Dublin Dublin Ireland
| | - Orlagh Murphy
- Department of Clinical PsychologyUniversity College Dublin Dublin Ireland
| | - Kathy Looney
- Department of Clinical PsychologyUniversity College Dublin Dublin Ireland
| | - Gary O'Reilly
- Department of Clinical PsychologyUniversity College Dublin Dublin Ireland
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66
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Wright A, Browne J, Mueser KT, Cather C. Evidence-Based Psychosocial Treatment for Individuals with Early Psychosis. Child Adolesc Psychiatr Clin N Am 2020; 29:211-223. [PMID: 31708048 DOI: 10.1016/j.chc.2019.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Coordinated specialty care (CSC) first-episode models are an evidence-based practice in the treatment of first-episode psychosis. Group, individual, and family therapies in CSC aim to help the client and family understand and cope with the experience of psychosis, promote symptomatic and functional recovery and improve quality of life, and support the pursuit of personally meaningful goals of the client. Common elements to these interventions include building a therapeutic alliance, recovery orientation, education, and skills training, which can be directed to a range of targets, including problem-solving, communication, social skills, and social cognition.
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Affiliation(s)
- Abigail Wright
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, USA
| | - Corinne Cather
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
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67
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Stanton AE, Rose SJ. The Mental Health of Mothers Currently and Formerly Incarcerated in Jails and Prisons: An Integrative Review on Mental Health, Mental Health Treatment, and Traumatic Experiences. JOURNAL OF FORENSIC NURSING 2020; 16:224-231. [PMID: 32947439 DOI: 10.1097/jfn.0000000000000302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
UNLABELLED Most incarcerated women in the United States are mothers who report high rates of mental health issues and traumatic experiences, yet their needs are often overlooked because they comprise a smaller proportion of the incarcerated population compared with men. OBJECTIVE This integrative review aimed to synthesize the literature on the mental health, mental health treatment, and traumatic experiences of currently and formerly incarcerated mothers. METHODS We searched PsychINFO, CINAHL, and Criminal Justice Abstracts for all research articles that were written in English; included adult mothers who were incarcerated or incarcerated and released; and contained findings related to mental health, mental health treatment, or traumatic experiences. RESULTS Thirty-four articles met the inclusion criteria. Mothers had high rates of moderate-to-severe mental health problems and high childhood and adult trauma rates, especially intimate partner violence. Mothers faced barriers to treatment yet showed psychological resilience and active coping skills. IMPLICATIONS Nurses can recognize risk factors for women's incarceration and assess mental health symptoms and trauma, especially interpersonal violence. Nurses can use assessment findings to refer mothers to treatment and community resources and support their reuniting with their children. Nurses can also provide trauma-informed care and education about mental health topics and advocate for mental health treatment prerelease and postrelease. Staff education and organizational interventions to reduce burnout may remove additional barriers to care.
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Affiliation(s)
- Ann E Stanton
- Author Affiliations: Adult Crisis Mobile Team, Milwaukee County Behavioral Health Division
| | - Susan J Rose
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee
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68
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Out of the silence: towards grassroots and trauma-informed support for people who have experienced sexual violence and abuse. Epidemiol Psychiatr Sci 2019; 28:598-602. [PMID: 30977461 PMCID: PMC6998991 DOI: 10.1017/s2045796019000131] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
To experience sexual violence and abuse is to experience silence. This commentary explores some of the ways in which psychiatry reinforces the silencing of sexual violence survivors. We argue that current psychiatric responses to sexual violence typically constitute iatrogenic harm including through: a failure to provide services that meet survivors' needs, a failure to believe or validate disclosures; experiences of medicalisation and diagnoses which can delegitimise people's own knowledge and meaning; 'power over' relational approaches which can prevent compassionate responses and result in staff having to develop their own coping strategies; and poorly addressed and reported experiences of sexual violence within psychiatric settings. We argue that these multiple forms of silencing have arisen in part because of biomedical dominance, a lack of support and training in sexual violence for staff, inconsistent access to structured, reflective supervision, and the difficulties of facing the horror of sexual violence and abuse. We then describe community-based and grassroots responses, and consider the potential of trauma-informed approaches. Whilst this paper has a UK focus, some aspects will resonate globally, particularly given that Western psychiatry is increasingly being exported around the globe.
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69
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What is the relationship between post-traumatic stress disorder, extreme appraisals of internal state and symptoms in bipolar disorder? Behav Cogn Psychother 2019; 48:103-115. [PMID: 31637991 DOI: 10.1017/s1352465819000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is important to understand the factors associated with more severe mood symptoms in bipolar disorder. The integrative cognitive model of bipolar disorder proposes that extreme appraisals of changes to internal states maintain and exacerbate mood symptoms. AIMS The current study aimed to investigate if post-traumatic stress disorder (PTSD) is related to current depressive and manic bipolar symptoms, and whether this relationship is mediated by appraisals of internal state. METHOD Participants with bipolar disorder (n = 82) from a randomized controlled trial of cognitive therapy for bipolar disorder (the TEAMS trial) completed self-reported questionnaires assessing appraisals of internal state, generalized anxiety symptoms, and self-reported and observer-rated depressive and manic symptoms. Clinical interviews assessed PTSD co-morbidity. RESULTS Participants with bipolar and co-morbid PTSD (n = 27) had higher depressive symptoms and more conflicting appraisals than those without PTSD. Regression analyses found PTSD to be associated with depressive symptoms but not manic symptoms. Conflicting appraisals were found to be associated only with manic symptoms meaning that the planned mediation analysis could not be completed. CONCLUSIONS Findings provide partial support for the integrative cognitive model of bipolar disorder and highlight the need for transdiagnostic treatments in bipolar disorder due to the prevalence and impact of trauma and co-morbidity. Working on trauma experiences in therapy may impact on depressive symptoms for those with bipolar disorder and co-morbid PTSD.
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70
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Uncharted Waters: Treating Trauma Symptoms in the Context of Early Psychosis. J Clin Med 2019; 8:jcm8091456. [PMID: 31547447 PMCID: PMC6780072 DOI: 10.3390/jcm8091456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/05/2019] [Accepted: 09/08/2019] [Indexed: 12/27/2022] Open
Abstract
Psychosis is conceptualized in a neurodevelopmental vulnerability-stress framework, and childhood trauma is one environmental factor that can lead to psychotic symptoms and the development of psychotic disorders. Higher rates of trauma are associated with higher psychosis risk and greater symptom frequency and severity, resulting in increased hospitalization rates and demand on outpatient primary care and mental health services. Despite an estimated 70% of individuals in the early stages of psychosis reporting a history of experiencing traumatic events, trauma effects (post-traumatic anxiety or depressive symptoms) are often overlooked in psychosis treatment and current interventions typically do not target commonly comorbid post-traumatic stress symptoms. We presented a protocol for Trauma-Integrated Cognitive Behavioral Therapy for Psychosis (TI-CBTp), an approach to treating post-traumatic stress symptoms in the context of early psychosis care. We provided a brief summary of TI-CBTp as implemented in the context of Coordinated Specialty Care and presented preliminary data supporting the use of TI-CBTp in early psychosis care. The preliminary results suggest that individuals with comorbid psychosis and post-traumatic stress symptoms can be appropriately and safely treated using TI-CBTp within Coordinated Specialty Care.
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71
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McKenna G, Jackson N, Browne C. Trauma history in a high secure male forensic inpatient population. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 66:101475. [PMID: 31706394 DOI: 10.1016/j.ijlp.2019.101475] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/03/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
There is an increasing focus on trauma within forensic services. This study aimed to investigate exposure to trauma among a high secure male forensic population. Based on the Childhood Trauma Questionnaire (CTQ) and the Trauma History Questionnaire (THQ) data capture sheets were developed. Patients' own offending behaviour was included as a source of potential trauma. Records for all patients placed within the hospital (n = 194) were reviewed. All patients had been exposed to a traumatic event over the lifespan, with 75% having been exposed to trauma during childhood. Sixty-five percent of patients had experienced more than one type of trauma during childhood; the mean number of trauma types experienced during this period being 2.31. In adulthood 63% had been exposed to one trauma type while 29% had been exposed to two or more trauma types. No significant difference was found between those with and those without childhood trauma histories on hospital variables including admission length, seclusion and incidents. The implications of these results in the context of adopting a trauma informed care approach to treatment in forensic settings are discussed, and recommendations for future clinical and research directions are made.
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Affiliation(s)
- Gráinne McKenna
- High Secure Psychological Services Ashworth Hospital, Mersey Care NHS Foundation Trust, Parkbourn, Maghull, Merseyside L31 1HW, UK.
| | - Neil Jackson
- High Secure Psychological Services Ashworth Hospital, Mersey Care NHS Foundation Trust, Parkbourn, Maghull, Merseyside L31 1HW, UK
| | - Claire Browne
- High Secure Psychological Services Ashworth Hospital, Mersey Care NHS Foundation Trust, Parkbourn, Maghull, Merseyside L31 1HW, UK
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72
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Simpson S, Phillips L, Baksheev G, Garner B, Markulev C, Phassouliotis C, Alvarez-Jimenez M, McGorry P, Bendall S. Stability of retrospective self-reports of childhood trauma in first-episode psychosis. Early Interv Psychiatry 2019; 13:908-913. [PMID: 29968298 DOI: 10.1111/eip.12700] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 03/06/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
Abstract
AIM Childhood trauma (CT), abuse and neglect are commonly reported by individuals experiencing psychosis. However, there are concerns that acute psychotic symptoms, in particular delusions, may contribute to inaccurate reporting of CT. As a result, individuals experiencing psychosis may not be asked about their experiences of abuse when they are being seen in psychiatric settings. This lack of attention can directly impact on the tailoring of their clinical care. This study aimed to investigate the stability of reports of CT by young people experiencing a first psychotic episode (FEP) compared to healthy comparison subjects. METHODS Responses of 24 young people during the acute FEP and 3 months later to items on the Childhood Trauma Questionnaire (CTQ) were compared to 30 non-psychiatric controls. All participants were aged 15 to 25 years. RESULTS FEP participants reported higher CT than controls at both time points. Reliability analyses (interclass correlation coefficients [ICCs]) suggested strong agreement between CT reports at baseline and follow-up for FEP participants (.81) and controls (.91). Positive psychotic symptoms were unrelated to CT reports. Although the severity of CT reports fluctuated between assessments, complete retractions of severe abuse claims occurred rarely. CONCLUSIONS The results suggest that retrospective self-report can be used to reliably assess CT in young people experiencing acute psychosis.
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Affiliation(s)
- Samantha Simpson
- Melbourne Graduate School of Education, The University of Melbourne, Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Lisa Phillips
- School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | | | - Belinda Garner
- Translational Research Institute (TRI), Institute for Health and Biomedical Innovation (IHBI), School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Connie Markulev
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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73
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Grattan RE, Lara N, Botello RM, Tryon VL, Maguire AM, Carter CS, Niendam TA. A History of Trauma is Associated with Aggression, Depression, Non-Suicidal Self-Injury Behavior, and Suicide Ideation in First-Episode Psychosis. J Clin Med 2019; 8:E1082. [PMID: 31340527 PMCID: PMC6678563 DOI: 10.3390/jcm8071082] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022] Open
Abstract
The association between trauma and psychosis outcomes is well-established, and yet the impact of trauma on comorbid clinical symptoms-such as aggression, non-suicidal self-injury behavior (NSSIB), suicide ideation, and suicide behavior-for those with psychosis is unclear. To effectively treat those with first-episode psychosis (FEP) and a history of trauma, we need to understand the impact of trauma on their whole presentation. FEP participants were recruited from an Early Psychosis Program (N = 187, ages 12-35, 72.2% male). Clinicians gathered history of trauma, aggression, and suicide data, and rated current symptom severity and functioning. Data was coded using clinician rated measures, self-report measures, and retrospective clinical chart review. Regression analyses examined whether trauma was associated with a history of aggression, suicidal ideation, suicide behavior, NSSIB, symptoms, and functioning. Trauma was associated with aggression, aggression severity and type of aggression (aggression towards others). Trauma was also associated with depression severity, suicide ideation, most severe suicide ideation, and NSSIB. Trauma was not associated with suicide behavior, severity of suicide behavior or psychosocial functioning. Integrating trauma treatment into FEP care could reduce rates of depression, aggression, suicide ideation, and NSSIB for those with a history of trauma. To reduce suicide attempt occurrence and improve functioning, more research is needed.
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Affiliation(s)
- Rebecca E Grattan
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Natalia Lara
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Renata M Botello
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Valerie L Tryon
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Adrienne M Maguire
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Cameron S Carter
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Tara A Niendam
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA.
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74
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Ng LC, Medhin G, Hanlon C, Fekadu A. Trauma exposure, depression, suicidal ideation, and alcohol use in people with severe mental disorder in Ethiopia. Soc Psychiatry Psychiatr Epidemiol 2019; 54:835-842. [PMID: 30788553 PMCID: PMC7343339 DOI: 10.1007/s00127-019-01673-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/12/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate exposure to traumatic and stressful events and their association with depression, suicidal ideation, and alcohol abuse in people with severe mental disorder (SMD) in Ethiopia. METHODS As part of the Programme for Improving Mental health carE, 300 people with SMD (84% primary psychosis, 11% bipolar disorder, and 16% depression with psychotic features) in a rural district were identified by psychiatric nurses. A cross-sectional assessment included clinical characteristics, experience of being restrained, exposure to stressful events as measured by an adapted version of the List of Threatening Experiences scale, traumatic events as measured by endorsement of 13 locally relevant potentially traumatic events that occurred since the onset of the participant's mental illness, depression symptoms measured by the Patient Health Questionnaire, the Suicidal Behavior Module of the Composite International Diagnostic Interview, and hazardous drinking which was calculated as a sum score of eight or higher on the Alcohol Use Disorders Identification Test. RESULTS Almost half of participants reported being restrained since becoming ill, which was associated with more suicidal ideation and less hazardous drinking. More than one-third experienced traumatic events since becoming ill, including being assaulted, beaten, or raped. Exposure to traumatic events was associated with hazardous drinking. CONCLUSIONS In this rural Ethiopian setting, people with SMD experienced high levels of traumatic and stressful events which were associated with co-morbid conditions. Greater attention needs to be given to trauma prevention and integration of treatment for trauma sequelae in efforts to expand integrated mental health care.
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Affiliation(s)
- Lauren C. Ng
- Boston University School of Medicine, Department of Psychiatry 720 Harrison Avenue, Boston, MA, 02118 USA
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
| | - Charlotte Hanlon
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK,College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Ethiopia
| | - Abebaw Fekadu
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK,College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Ethiopia
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75
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Relationale Wirksamkeit im präventiven Kinderschutz: Evaluation der modularen Gruppenintervention „Ressourcen psychisch kranker und suchtkranker Eltern stärken“. Prax Kinderpsychol Kinderpsychiatr 2019; 68:43-62. [DOI: 10.13109/prkk.2019.68.1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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76
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Nishith P, Mueser KT, Morse GA. Alcohol expectancies in persons with severe mental illness and posttraumatic stress disorder. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1635805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Pallavi Nishith
- Places for People: A human Approach to Mental Health+Healing, St. Louis, MO, USA
| | - Kim T. Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - Gary A. Morse
- Places for People: A human Approach to Mental Health+Healing, St. Louis, MO, USA
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77
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Implementing Transdiagnostic Cognitive Behavioral Psychotherapy in Adult Public Behavioral Health: A Pilot Evaluation of the Feasibility of the Common Elements Treatment Approach (CETA). J Behav Health Serv Res 2018; 46:249-266. [PMID: 30209716 DOI: 10.1007/s11414-018-9631-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Few evidence-based psychotherapies are provided in adult public behavioral health (PBH), despite the need for such treatments. The common elements treatment approach (CETA) was developed for use by lay providers in low- and middle-income countries and may have relevance in PBH given its unique application with individuals with multiple diagnoses including PTSD, depression, and anxiety. This study utilized data collected as part of the implementation of CETA in 9 PBH agencies in Washington State with 58 providers, including a 2-day workshop and 6 months of consultation. Outcomes included provider-perceived skill in CETA delivery, training and consultation completion rates, and perceived appropriateness of CETA for clients. Thirty-nine (67%) providers completed requirements for training and consultation, and delivered CETA to a total of 56 clients. Perceived competence in delivering CETA improved over time, as well as client symptom scores. CETA shows promise for feasible and effective implementation within US-based PBH systems.
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78
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Mangaoil RA, Cleverley K, Peter E. Immediate Staff Debriefing Following Seclusion or Restraint Use in Inpatient Mental Health Settings: A Scoping Review. Clin Nurs Res 2018; 29:479-495. [PMID: 30051734 DOI: 10.1177/1054773818791085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this scoping review is to synthesize the academic and gray literature on the use of immediate staff debriefing following seclusion or restraint events in inpatient mental health settings. Multiple electronic databases were searched to identify literature on the topic of immediate staff debriefing. The analysis identified several core components of immediate staff debriefing: terminology, type, critical reflection, iterative process, training, documentation, and monitoring. While these components were regarded as vital to the implementation of debriefing, they remain inconsistently described in the literature. Immediate staff debriefing is an important intervention not only to prevent future episodes of seclusion and restraint use, but as a forum for staff to support each other emotionally and psychologically after a potentially distressing event. The core components identified in this review should be incorporated into the organization's policies, practice guidelines, and training modules to ensure consistent conceptualization and implementation of the debriefing process.
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Affiliation(s)
- Remar A Mangaoil
- University of Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kristin Cleverley
- University of Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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79
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Kim H, Kim D, Kim SH. Association of types of delusions and hallucinations with childhood abuse and neglect among inpatients with schizophrenia in South Korea: A preliminary study. PSYCHOSIS 2018. [DOI: 10.1080/17522439.2018.1472627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hwigon Kim
- Department of Psychiatry, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Daeho Kim
- Department of Psychiatry, College of Medicine, Hanyang University, Seoul, Republic of Korea
- Trauma and Stress Program, Hanyang University Guri Hospital, Guri, Gyeonggido, Republic of Korea
| | - Seok Hyeon Kim
- Department of Psychiatry, College of Medicine, Hanyang University, Seoul, Republic of Korea
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80
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Lutton SS, Swank JM. The Importance of Intentionality in Untangling Trauma From Severe Mental Illness. ACTA ACUST UNITED AC 2018. [DOI: 10.17744/mehc.40.2.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Trauma has become entangled and largely lost in the conceptualization and treatment of severe mental illness (SMI). Practitioners conceptualize and treat SMI with medical-model ideals. While researchers support using treatment approaches developed from a medical model in treating the symptoms of SMI, these treatments can be problematic for an individual with SMI who has also experienced trauma. Thus, it is imperative that counselors consider trauma separately when working with individuals presenting with SMI. Additionally, counselors need to employ holistic measures to treat trauma. This article focuses on understanding how SMI and trauma have become entangled, what they look like when separated, and why it is important to disentangle them. The conceptualization for the disentanglement process is presented from a Jungian theoretical foundation.
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81
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Mihelicova M, Brown M, Shuman V. Trauma-Informed Care for Individuals with Serious Mental Illness: An Avenue for Community Psychology's Involvement in Community Mental Health. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:141-152. [PMID: 29266247 DOI: 10.1002/ajcp.12217] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Individuals with serious mental illness are at particularly high risk for trauma; however, service environments with which they interact may not always be trauma-informed. While community mental health and other human services settings are moving toward trauma-informed care (TIC) service delivery, a variety of TIC frameworks exist without consensus regarding operationalization, thereby leading to challenges in implementation. TIC is principle-driven and presents substantial overlap with community psychology values and competencies, including ecological frameworks, second-order change, empowerment, and citizen participation. One way to address barriers to TIC implementation is to draw on the strengths of the field of community psychology. With a particular emphasis on the applicability of TIC to individuals with serious mental illness, this paper identifies key implementation issues and recommends future directions for community psychologists in clarifying the service framework, its adaptation to specific service contexts, and improving delivery through consultation and evaluation. Community psychologists may work with various disciplines involved in the TIC field to together promote a more conscious, actionable shift in service delivery.
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Posttraumatic growth among people with serious mental illness, psychosis and posttraumatic stress symptoms. Compr Psychiatry 2018; 81:1-9. [PMID: 29175375 DOI: 10.1016/j.comppsych.2017.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/07/2017] [Accepted: 10/24/2017] [Indexed: 01/06/2023] Open
Abstract
Recent research has shown high rates of exposure to trauma among people with serious mental illness (SMI). In addition, studies suggest that psychosis and mental illness-related experiences can be extremely traumatic. While some individuals develop posttraumatic symptomatology related to these experiences, some appear to experience posttraumatic growth (PTG). Little is known, however, about PTG as a possible outcome among people who experienced psychosis as well as posttraumatic stress symptoms (PTSS). For further understanding of the relationship between PTSS and PTG among people with SMI who experienced psychosis, 121 participants were recruited from community mental health rehabilitation centers and administered trauma and psychiatric questionnaires. Results revealed that while high levels of traumatic exposure were common, most participants experienced some level of PTG which was contingent upon meaning making and coping self-efficacy. In addition, posttraumatic avoidance symptoms were found to be a major obstacle to PTG. The range of effect sizes for significant results ranged from η2=0.037 to η2=0.144. These findings provide preliminary evidence for the potential role of meaning making and coping self-efficacy as mediators of PTG in clinical, highly traumatized populations of people with SMI and psychosis. Implications of these findings for future research and clinical practice are discussed.
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83
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Lewis C, Raisanen L, Bisson JI, Jones I, Zammit S. Trauma exposure and undetected posttraumatic stress disorder among adults with a mental disorder. Depress Anxiety 2018; 35:178-184. [PMID: 29244901 DOI: 10.1002/da.22707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/26/2017] [Accepted: 10/08/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Trauma exposure and posttraumatic stress disorder (PTSD) are common among individuals with a mental disorder, but symptoms often go undetected and untreated. METHODS The aim of this study was to determine the prevalence of PTSD among a large sample of adults with psychiatric diagnoses and to establish factors associated with symptoms going undetected. Participants were 1,946 adults recruited by the National Centre for Mental Health. Structured interviews and validated self-report questionnaires were used to ascertain clinical and demographic information for analysis. RESULTS The prevalence of participants screening positive for PTSD that had not been detected by clinical services was 13.9% [12.4-15.5%, 95% confidence interval]). Factors associated with undetected PTSD were female gender, younger age of first contact with psychiatric services, and lower household income. Especially, poor rates of detection were observed after traumatic events, such as child abuse and sexual assault. CONCLUSIONS Our findings demonstrate the need for routine assessment of trauma histories and symptoms of PTSD among individuals with anymental disorder.
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Affiliation(s)
- Catrin Lewis
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Lawrence Raisanen
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Ian Jones
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Stan Zammit
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK.,Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
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84
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Mueser KT, McGurk SR, Xie H, Bolton EE, Jankowski MK, Lu W, Rosenberg SD, Wolfe R. Neuropsychological predictors of response to cognitive behavioral therapy for posttraumatic stress disorder in persons with severe mental illness. Psychiatry Res 2018; 259:110-116. [PMID: 29040946 PMCID: PMC5742038 DOI: 10.1016/j.psychres.2017.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/22/2017] [Accepted: 10/04/2017] [Indexed: 11/29/2022]
Abstract
This study examined whether cognitive functioning was related to treatment outcomes in persons with severe mental illness who received a cognitive behavioral therapy (CBT) program for co-occurring posttraumatic stress disorder (PTSD). The study sample was drawn from a larger controlled trial of 108 persons with severe mental illness and PTSD comparing the effects of CBT with treatment as usual on PTSD and related outcomes, with assessments conducted at baseline, post-treatment, and 3- and 6-month follow-ups. Among the 54 persons in CBT, 49 were administered a neuropsychological battery at baseline and 40 were exposed to the CBT program. Statistical analyses of these 40 participants were conducted to evaluate whether cognitive functioning was related to participation in the CBT program, completion of homework assignments, and improvements in PTSD, and other outcomes. Cognitive functioning was not related to participation in CBT or completion of homework. Lower cognitive functioning predicted less learning of information about PTSD at post-treatment and follow-up, but not less clinical benefit from CBT in PTSD diagnosis or symptoms, other symptoms, or health. The results suggest that cognitive impairment does not attenuate response to the CBT for PTSD program in persons with severe mental illness. Clinical Trials.gov Identifier: NCT00053690.
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Affiliation(s)
- Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychological and Brain Sciences, and Psychiatry, Boston University, Boston, MA, USA.
| | - Susan R McGurk
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychological and Brain Sciences, and Psychiatry, Boston University, Boston, MA, USA
| | - Haiyi Xie
- Departments of Biomedical Data Science and Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Elisa E Bolton
- Counseling Center, University of New Hampshire, Durham, NH, USA
| | - M Kay Jankowski
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Weili Lu
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Scotch Plains, NJ, USA
| | - Stanley D Rosenberg
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Rosemarie Wolfe
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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85
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Slade EP, Gottlieb JD, Lu W, Yanos PT, Rosenberg S, Silverstein SM, Minsky SK, Mueser KT. Cost-Effectiveness of a PTSD Intervention Tailored for Individuals With Severe Mental Illness. Psychiatr Serv 2017; 68:1225-1231. [PMID: 28712353 PMCID: PMC5711573 DOI: 10.1176/appi.ps.201600474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the cost-effectiveness of a cognitive-behavioral therapy (CBT) intervention for posttraumatic stress disorder (PTSD) that is tailored for adults with a co-occurring severe mental illness. METHODS Data were from a randomized trial involving 183 adult clients of two outpatient clinics and three partial hospitalization programs. All had a severe mental illness diagnosis (major mood disorder, schizophrenia, or schizoaffective disorder) and severe PTSD. Participants were randomly assigned to the tailored 12- to 16-session CBT intervention for PTSD (CBT-P) or a three-session breathing retraining and psychoeducation intervention (BRF). Cost estimates included intervention costs for training, supervision, fidelity assessment, personnel, and overhead and related mental health care costs for outpatient, inpatient, and emergency department services and for medications. The incremental cost-effectiveness ratio comparing CBT-P with BRF measured the added cost or savings per remission from PTSD at 12 months postintervention. Generalized linear models were used to estimate intervention effects on annual mental health care costs and the likelihood of a remission from PTSD. Ten thousand bootstrap replications were used to assess uncertainty. RESULTS Annual mean mental health care costs were $25,539 per client (in 2010 dollars) for BRF participants and $29,530 per client for CBT-P participants, a nonsignificant difference. The mean incremental cost-effectiveness ratio was $36,893 per additional PTSD remission yielded by CBT-P compared with BRF (95% confidence interval=-$33,523 to $158,914). Remissions were associated with improvements in quality of life and functioning. CONCLUSIONS An effective CBT intervention tailored for adults with severe mental illness and PTSD was not found to be more cost-effective than a brief three-session intervention.
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Affiliation(s)
- Eric P Slade
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Jennifer D Gottlieb
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Weili Lu
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Philip T Yanos
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Stanley Rosenberg
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Steven M Silverstein
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Shula K Minsky
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Kim T Mueser
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
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86
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Lewine R, Martin M, Hart M. Sex versus gender differences in schizophrenia: The case for normal personality differences. Schizophr Res 2017; 189:57-60. [PMID: 28215470 PMCID: PMC5559345 DOI: 10.1016/j.schres.2017.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/07/2017] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
Abstract
Schizophrenia has generally been viewed as having a unique preschizophrenia personality or destructive to the personality post-onset. This view is reflected in the scarcity of studies of personality in schizophrenia with the exception of schizotypal personality considered by many as an endophenotype of schizophrenia. What is missing is the study of personality as independent of schizophrenia and as a potential source of schizophrenia heterogeneity. In this study we examine sex versus gender as an initial effort to introduce personality as a normal variant that influences how schizophrenia is expressed. Gender, a personality construct, was associated with the presence of depression in a large sample of schizophrenia patients controlling for sex, age of onset, severity of disorder, and education. The results suggest that gender, rather than sex, as a representative personality trait may yield important insights into how schizophrenia is expressed.
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Affiliation(s)
- Richard Lewine
- Department of Psychological and Brain Sciences, University of Louisville, Belknap Campus, Louisville, KY 40292, USA.
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87
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Quan L, Zhen R, Yao B, Zhou X, Yu D. The Role of Perceived Severity of Disaster, Rumination, and Trait Resilience in the Relationship Between Rainstorm-related Experiences and PTSD Amongst Chinese Adolescents Following Rainstorm Disasters. Arch Psychiatr Nurs 2017; 31:507-515. [PMID: 28927516 DOI: 10.1016/j.apnu.2017.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/27/2017] [Accepted: 06/01/2017] [Indexed: 11/27/2022]
Abstract
This study examined the mediating role of perceived severity of trauma and rumination in the relationship between traumatic experiences and PTSD, and assessed the moderated role of resilience in this mediating process. Nine hundred and fifty-one adolescents were selected to complete a self-report questionnaire involving rainstorm-related experiences, perceived severity of trauma, rumination, resilience, and PTSD. The results found that rainstorm-related experiences had a positive effect on PTSD by perceived severity of disaster, or by rumination via perceived severity of disaster. Resilience buffered the relationship between rainstorm-related experiences and PTSD, but did not buffer the relation of rainstorm-related experiences to perceived severity of disaster and rumination. These findings indicated that rainstorm-related experiences may have an indirect effect on PTSD via cognitive activities, and these indirect paths were not buffered by resilience. A buffering effect only occurred in the direct paths from rainstorm-related experiences to PTSD.
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Affiliation(s)
- Lijuan Quan
- College of Educational Science, Anhui Normal University, Anhui, Wuhu 241000, China
| | - Rui Zhen
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing 100875, China
| | - Benxian Yao
- College of Educational Science, Anhui Normal University, Anhui, Wuhu 241000, China
| | - Xiao Zhou
- I-Core Research Center for Mass Trauma, School of Social Work, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Dapeng Yu
- Department of Geography, Loughborough University, Loughborough, Leicestershire, UK
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88
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O'Hare T, Shen C, Sherrer MV. Post-traumatic Stress and Trauma-Related Subjective Distress: Comparisons Among Hispanics, African-Americans, and Whites with Severe Mental Illness. Community Ment Health J 2017; 53:778-781. [PMID: 28168433 DOI: 10.1007/s10597-017-0097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Abstract
We tested the hypothesis with a sample of community mental health clients (N = 132) that Hispanic clients would report significantly greater post-traumatic stress symptoms than African-American or white clients when controlling for gender, psychiatric symptoms of SMI, and subjective distress from six of the most commonly reported trauma in the SMI literature. Results supported our main hypothesis: being self-identified as Hispanic was significantly associated with greater post-traumatic stress symptoms. Subjective distress from having been sexually abused along with being "Hispanic" were the only two significant variables left in the equation. Limitations of this study include its modest sample size.
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Affiliation(s)
- Thomas O'Hare
- Graduate School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Ce Shen
- Graduate School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Margaret V Sherrer
- Department of Psychology and Human Services, Lyndon State College, 1001 College Rd., Lyndonville, VT, 05851, USA
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89
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Lapid Pickman L, Greene T, Gelkopf M. Sense of Threat as a Mediator of Peritraumatic Stress Symptom Development During Wartime: An Experience Sampling Study. J Trauma Stress 2017; 30:372-380. [PMID: 28696543 DOI: 10.1002/jts.22207] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 03/16/2017] [Accepted: 04/19/2017] [Indexed: 01/08/2023]
Abstract
Exposure and sense of threat have been associated with stress symptoms, yet these relationships have not been clarified during the peritraumatic period. We investigated the mediating role of sense of threat in the link between exposure to rocket warning sirens and stress symptoms during wartime, and the effect of severe mental illness (SMI) status and gender on this mediation. A 30-day twice-daily smartphone-based intensive assessment of exposure to sirens, sense of threat, and peritraumatic stress symptoms was performed during the 2014 Israel-Gaza conflict. Participants included 182 highly exposed individuals with or without SMI. Multilevel structural equation modeling analysis was performed, with SMI status and gender as confounders. Exposure affected the level of peritraumatic stress symptoms both directly, b = 1.07, p < .001, 95% CI [0.32, 1.82], and indirectly, b = 0.78, p < .001, 95% CI [0.24, 1.33], through sense of threat. The effect of sense of threat on stress symptoms was larger in the SMI group, b = 0.86, p < .001, 95% CI [0.31, 1.40]. Gender did not have a significant effect. Sense of threat has a key role in symptom development during the peritraumatic timeframe. Intervention and prevention efforts should start early and focus on promoting a sense of safety, particularly with people with SMI.
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Affiliation(s)
- Liron Lapid Pickman
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,NATAL: Israel Trauma Center for Victims of Terror and War, Tel Aviv, Israel
| | - Talya Greene
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,NATAL: Israel Trauma Center for Victims of Terror and War, Tel Aviv, Israel
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90
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Grubaugh AL, Veronee K, Ellis C, Brown W, Knapp RG. Feasibility and Efficacy of Prolonged Exposure for PTSD among Individuals with a Psychotic Spectrum Disorder. Front Psychol 2017; 8:977. [PMID: 28701969 PMCID: PMC5488794 DOI: 10.3389/fpsyg.2017.00977] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/28/2017] [Indexed: 12/01/2022] Open
Abstract
Objective: Few empirical studies have examined the feasibility of trauma-focused treatment among individuals with schizophrenia. This lack of research is important given the substantial overlap of trauma exposure and subsequent PTSD with psychotic spectrum disorders, and the potential for PTSD to complicate the course and prognosis of schizophrenia and other variants of severe mental illness. Method: As part of a larger study, 14 veterans with a psychotic spectrum disorder were enrolled to receive prolonged exposure (PE) for PTSD within a single arm open trial study design. Patient reactions and responses to PE were examined using feasibility indices such as attrition, survey reactions, and treatment expectancy; pre and post-changes in PTSD severity and diagnostic status; and thematic interviews conducted post-intervention. Results: Quantitative and qualitative data indicate that implementation of PE is feasible, subjectively well-tolerated, and may result in clinically significant reductions in PTSD symptoms in patients with psychotic spectrum disorders. Conclusion: Consistent with treatment outcome data in clinical populations with a broader range of severe mental illnesses, the current results support the use of PTSD exposure-based interventions, such as PE, for individuals with psychotic spectrum disorders.
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Affiliation(s)
- Anouk L Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, CharlestonSC, United States.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, CharlestonSC, United States
| | - Kimberly Veronee
- Ralph H. Johnson Veterans Affairs Medical Center, CharlestonSC, United States.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, CharlestonSC, United States
| | - Charles Ellis
- Department of Communication Sciences and Disorders, East Carolina University, GreenvilleNC, United States
| | - Wilson Brown
- Ralph H. Johnson Veterans Affairs Medical Center, CharlestonSC, United States.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, CharlestonSC, United States
| | - Rebecca G Knapp
- Department of Public Health Sciences, Medical University of South Carolina, CharlestonSC, United States
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91
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Steel C, Doukani A, Hardy A. The PCL as a brief screen for posttraumatic stress disorder within schizophrenia. Int J Psychiatry Clin Pract 2017; 21:148-150. [PMID: 28150512 DOI: 10.1080/13651501.2016.1271897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the utility of using the posttraumatic checklist (PCL) as a screening measure for identifying posttraumatic stress disorder (PTSD) in individuals diagnosed with a psychotic disorder. METHODS The PCL was administered to 165 participants as part of a clinical trial. Those scoring 44 or above on the PCL underwent further assessment using the clinician administered PTSD scale (CAPS). RESULTS Overall 18.2% of the sample exhibited a diagnostic level of PTSD symptoms, as indicated by the CAPS assessment. Only 29.7% of those who scored above the PCL threshold were diagnostic of PTSD. CONCLUSIONS The use of PCL for identifying PTSD within this population is not recommended.
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Affiliation(s)
- Craig Steel
- a Department of Psychology , School of Psychology and Clinical Language Sciences, University of Reading, Reading , UK
| | - Asmae Doukani
- b Department of Population Health , London School of Hygiene & Tropical Medicine , London , UK
| | - Amy Hardy
- c Department of Psychology , Institute of Psychiatry, Psychology & Neuroscience , London , UK
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92
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Keen N, Hunter ECM, Peters E. Integrated Trauma-Focused Cognitive-Behavioural Therapy for Post-traumatic Stress and Psychotic Symptoms: A Case-Series Study Using Imaginal Reprocessing Strategies. Front Psychiatry 2017; 8:92. [PMID: 28620323 PMCID: PMC5451497 DOI: 10.3389/fpsyt.2017.00092] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/04/2017] [Indexed: 12/14/2022] Open
Abstract
Despite high rates of trauma in individuals with psychotic symptoms, post-traumatic stress symptoms are frequently overlooked in clinical practice. There is also reluctance to treat post-traumatic symptoms in case the therapeutic procedure of reprocessing the trauma exacerbates psychotic symptoms. Recent evidence demonstrates that it is safe to use reprocessing strategies in this population. However, most published studies have been based on treating post-traumatic symptoms in isolation from psychotic symptoms. The aims of the current case series were to assess the acceptability, feasibility, and preliminary effectiveness of integrating cognitive-behavioural approaches for post-traumatic stress and psychotic symptoms into a single protocol. Nine participants reporting distressing psychotic and post-traumatic symptoms were recruited from a specialist psychological therapies service for psychosis. Clients were assessed at five time points (baseline, pre, mid, end of therapy, and at 6+ months of follow-up) by an independent assessor on measures of current symptoms of psychosis, post-traumatic stress, emotional problems, and well-being. Therapy was formulation based and individualised, depending on presenting symptoms and trauma type. It consisted of five broad, flexible phases, and included imaginal reprocessing strategies (reliving and/or rescripting). The intervention was well received, with positive post-therapy feedback and satisfaction ratings. Unusually for this population, no-one dropped out of therapy. Post therapy, all but one (88% of participants) achieved a reliable improvement compared to pre-therapy on at least one outcome measure: post-traumatic symptoms (63%), voices (25%), delusions (50%), depression (50%), anxiety (36%), and well-being (40%). Follow-up assessments were completed by 78% (n = 7) of whom 86% (n = 6) maintained at least one reliable improvement. Rates of improvements following therapy (average of 44% across measures post therapy; 32% at follow-up) were over twice those found during the waiting list period (19%). No participant indicated a reliable worsening of any symptoms during or after therapy. The study shows that an integrative therapy incorporating reprocessing strategies was an acceptable and feasible intervention for this small sample, with promising effectiveness. A randomised controlled trial is warranted to test the efficacy of the intervention for this population.
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Affiliation(s)
- Nadine Keen
- South London and Maudsley NHS Foundation Trust, Psychological Interventions Clinic for outpatients with Psychosis (PICuP), London, United Kingdom
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Elaine C. M. Hunter
- South London and Maudsley NHS Foundation Trust, Psychological Interventions Clinic for outpatients with Psychosis (PICuP), London, United Kingdom
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Emmanuelle Peters
- South London and Maudsley NHS Foundation Trust, Psychological Interventions Clinic for outpatients with Psychosis (PICuP), London, United Kingdom
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
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93
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Van Dorn RA, Grimm KJ, Desmarais SL, Tueller SJ, Johnson KL, Swartz MS. Leading indicators of community-based violent events among adults with mental illness. Psychol Med 2017; 47:1179-1191. [PMID: 27998319 DOI: 10.1017/s0033291716003160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The public health, public safety and clinical implications of violent events among adults with mental illness are significant; however, the causes and consequences of violence and victimization among adults with mental illness are complex and not well understood, which limits the effectiveness of clinical interventions and risk management strategies. This study examined interrelationships between violence, victimization, psychiatric symptoms, substance use, homelessness and in-patient treatment over time. METHOD Available data were integrated from four longitudinal studies of adults with mental illness. Assessments took place at baseline, and at 1, 3, 6, 9, 12, 15, 18, 24, 30 and 36 months, depending on the parent studies' protocol. Data were analysed with the autoregressive cross-lag model. RESULTS Violence and victimization were leading indicators of each other and affective symptoms were a leading indicator of both. Drug and alcohol use were leading indicators of violence and victimization, respectively. All psychiatric symptom clusters - affective, positive, negative, disorganized cognitive processing - increased the likelihood of experiencing at least one subsequent symptom cluster. Sensitivity analyses identified few group-based differences in the magnitude of effects in this heterogeneous sample. CONCLUSIONS Violent events demonstrated unique and shared indicators and consequences over time. Findings indicate mechanisms for reducing violent events, including trauma-informed therapy, targeting internalizing and externalizing affective symptoms with cognitive-behavioral and psychopharmacological interventions, and integrating substance use and psychiatric care. Finally, mental illness and violence and victimization research should move beyond demonstrating concomitant relationships and instead focus on lagged effects with improved spatio-temporal contiguity.
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Affiliation(s)
- R A Van Dorn
- Behavioral and Urban Health Program, RTI International,Research Triangle Park, NC,USA
| | - K J Grimm
- Department of Psychology,Arizona State University,Tempe, AZ,USA
| | - S L Desmarais
- Department of Psychology,North Carolina State University,Raleigh, NC,USA
| | - S J Tueller
- Behavioral and Urban Health Program, RTI International,Research Triangle Park, NC,USA
| | - K L Johnson
- Behavioral and Urban Health Program, RTI International,Research Triangle Park, NC,USA
| | - M S Swartz
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham, NC,USA
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94
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Jansen JE, Morris EM. Acceptance and Commitment Therapy for Posttraumatic Stress Disorder in Early Psychosis: A Case Series. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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95
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Swan S, Keen N, Reynolds N, Onwumere J. Psychological Interventions for Post-traumatic Stress Symptoms in Psychosis: A Systematic Review of Outcomes. Front Psychol 2017; 8:341. [PMID: 28352239 PMCID: PMC5348513 DOI: 10.3389/fpsyg.2017.00341] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/22/2017] [Indexed: 11/19/2022] Open
Abstract
Individuals with severe mental health problems, such as psychosis, are consistently shown to have experienced high levels of past traumatic events. They are also at an increased risk of further traumatisation through victimization events such as crime and assault. The experience of psychosis itself and psychiatric hospitalization have also been recognized to be sufficiently traumatic to lead to the development of post-traumatic stress (PTS) symptoms. Rates of post-traumatic stress disorder (PTSD) are elevated in people with psychosis compared to the general population. The current guidance for the treatment of PTSD is informed by an evidence base predominately limited to populations without co-morbid psychiatric disorders. The systematic review therefore sought to present the current available literature on the use of psychological treatments targeting PTS symptoms in a population with a primary diagnosis of a psychotic disorder. The review aimed to investigate the effect of these interventions on PTS symptoms and also the effect on secondary domains such as psychotic symptoms, affect and functioning. Fifteen studies were identified reporting on cognitive behavior therapy, prolonged exposure, eye movement desensitisation and reprocessing and written emotional disclosure. The review provides preliminary support for the safe use of trauma-focused psychological interventions in groups of people with severe mental health problems. Overall, the interventions were found to be effective in reducing PTS symptoms. Results were mixed with regard to secondary effects on additional domains. Further research including studies employing sufficiently powered methodologically rigorous designs is indicated.
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Affiliation(s)
- Sarah Swan
- South London and Maudsley NHS Foundation Trust London, UK
| | - Nadine Keen
- South London and Maudsley NHS Foundation TrustLondon, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondon, UK
| | - Nicola Reynolds
- South London and Maudsley NHS Foundation TrustLondon, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondon, UK
| | - Juliana Onwumere
- South London and Maudsley NHS Foundation TrustLondon, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondon, UK
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96
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Kostaras P, Bergiannaki JD, Psarros C, Ploumbidis D, Papageorgiou C. Posttraumatic stress disorder in outpatients with depression: Still a missed diagnosis. J Trauma Dissociation 2017; 18:233-247. [PMID: 27636557 DOI: 10.1080/15299732.2016.1237402] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Comorbidity between major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) is a well-established fact but has been studied little among MDD patients and even less among outpatients. We assessed the prevalence and characteristics of comorbid MDD-PTSD patients in a sample of MDD outpatients in an effort to elucidate possible causes of MDD-PTSD comorbidity. A semistructured clinical interview was applied to 101 outpatients with MDD. Sociodemographic factors, psychiatric history, the presence of PTSD, and MDD-PTSD comorbidity were recorded. The prevalence of MDD-PTSD comorbidity was 38.6%, with 26.7% suffering currently from PTSD. The average duration of PTSD was 16 years, and in most cases (79.5%) PTSD started earlier than or simultaneously with MDD. Only 28.8% of patients with PTSD had a documented diagnosis in their medical record. The most significant factors predicting MDD-PTSD comorbidity were found to be chronic depression, a history of prolonged or repeated trauma, male gender, a younger age at onset of psychological symptoms, lower education, and a lower level of functioning. Our findings indicate that MDD-PTSD comorbidity still remains an overlooked fact. Prolonged trauma seems to be a major risk factor for MDD-PTSD comorbidity, predisposing subjects to PTSD and later on or simultaneously to comorbidity with MDD.
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Affiliation(s)
- Panagiotis Kostaras
- a 1st Department of Psychiatry, Eginition Hospital , University of Athens Medical School , Athens , Greece
| | - Joanna-Despina Bergiannaki
- a 1st Department of Psychiatry, Eginition Hospital , University of Athens Medical School , Athens , Greece.,b University Mental Health Research Institute , Athens , Greece
| | - Constantin Psarros
- a 1st Department of Psychiatry, Eginition Hospital , University of Athens Medical School , Athens , Greece
| | - Dimitrios Ploumbidis
- a 1st Department of Psychiatry, Eginition Hospital , University of Athens Medical School , Athens , Greece
| | - Charalambos Papageorgiou
- a 1st Department of Psychiatry, Eginition Hospital , University of Athens Medical School , Athens , Greece.,b University Mental Health Research Institute , Athens , Greece
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97
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Steel C. Psychological Interventions for Working with Trauma and Distressing Voices: The Future Is in the Past. Front Psychol 2017; 7:2035. [PMID: 28127290 PMCID: PMC5226958 DOI: 10.3389/fpsyg.2016.02035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/15/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Craig Steel
- School of Psychology and Clinical Language Sciences, University of Reading Reading, UK
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98
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An examination of sleep quality in veterans with a dual diagnosis of PTSD and severe mental illness. Psychiatry Res 2017; 247:15-20. [PMID: 27863313 DOI: 10.1016/j.psychres.2016.07.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/25/2016] [Accepted: 07/12/2016] [Indexed: 11/21/2022]
Abstract
Poor sleep quality is one of the most frequently reported symptoms by veterans with Posttraumatic Stress Disorder (PTSD) and by veterans with severe mental illness (SMI; i.e., schizophrenia spectrum disorders, bipolar disorder, major depression with or without psychotic features). However, little is known about the compounding effects of co-occurring PTSD/SMI on sleep quality in this population. Given the high rates of comorbidity and poor functional outcomes associated with sleep dysfunction, there is a need to better understand patterns of poor sleep quality in this population. The present study provides a description of sleep quality in veterans with a dual diagnosis of PTSD/SMI relative to veterans with PTSD only. Results indicated that, despite similar reports of PTSD symptom severity between the groups, veterans with PTSD/SMI reported higher levels of poor sleep quality than veterans only diagnosed with PTSD. Specifically, veterans with PTSD/SMI reported significantly greater difficulties with sleep onset and overall more sleep disturbance than their non-SMI counterparts. Implications of the findings are discussed within the context of an existing model of insomnia and suggest that more comprehensive sleep assessment and the provision of targeted sleep interventions may be helpful for those with a dual diagnosis of PTSD/SMI.
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99
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Steel C, Hardy A, Smith B, Wykes T, Rose S, Enright S, Hardcastle M, Landau S, Baksh MF, Gottlieb JD, Rose D, Mueser KT. Cognitive-behaviour therapy for post-traumatic stress in schizophrenia. A randomized controlled trial. Psychol Med 2017; 47:43-51. [PMID: 27650432 DOI: 10.1017/s0033291716002117] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is limited evidence for effective interventions in the treatment of post-traumatic stress symptoms within individuals diagnosed with schizophrenia. Clinicians have concerns about using exposure treatments with this patient group. The current trial was designed to evaluate a 16-session cognitive restructuring programme, without direct exposure, for the treatment of post-traumatic stress symptoms specifically within individuals diagnosed with schizophrenia. METHOD A multicentre randomized controlled single-blinded trial with assessments at 0 months, 6 months (post-treatment) and 12 months (follow-up) was conducted. A total of 61 participants diagnosed with schizophrenia and exhibiting post-traumatic stress symptoms were recruited. Those randomized to treatment were offered up to 16 sessions of cognitive-behaviour therapy (CBT, including psychoeducation, breathing training and cognitive restructuring) over a 6-month period, with the control group offered routine clinical services. The main outcome was blind rating of post-traumatic stress symptoms using the Clinician Administered PTSD Scale for Schizophrenia. Secondary outcomes were psychotic symptoms as measured by the Positive and Negative Symptom Scale and the Psychotic Symptom Rating Scale. RESULTS Both the treatment and control groups experienced a significant decrease in post-traumatic stress symptoms over time but there was no effect of the addition of CBT on either the primary or secondary outcomes. CONCLUSIONS The current trial did not demonstrate any effect in favour of CBT. Cognitive restructuring programmes may require further adaptation to promote emotional processing of traumatic memories within people diagnosed with a psychotic disorder.
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Affiliation(s)
- C Steel
- School of Psychology and Clinical Language Sciences, University of Reading,Reading,UK
| | - A Hardy
- Department of Psychology,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - B Smith
- North East London NHS Foundation Trust,UK
| | - T Wykes
- Department of Psychology,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - S Rose
- Berkshire Healthcare NHS Foundation Trust,UK
| | - S Enright
- Berkshire Healthcare NHS Foundation Trust,UK
| | | | - S Landau
- Department of Biostatistics,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - M F Baksh
- Department of Mathematics and Statistics,University of Reading,Reading,UK
| | - J D Gottlieb
- Center for Psychiatric Rehabilitation, Boston University,Boston, MA,USA
| | - D Rose
- Health Services Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - K T Mueser
- Department of Mathematics and Statistics,University of Reading,Reading,UK
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100
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Cragin CA, Straus MB, Blacker D, Tully LM, Niendam TA. Early Psychosis and Trauma-Related Disorders: Clinical Practice Guidelines and Future Directions. Front Psychiatry 2017; 8:33. [PMID: 28321193 PMCID: PMC5337515 DOI: 10.3389/fpsyt.2017.00033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/16/2017] [Indexed: 11/13/2022] Open
Abstract
Despite high rates of trauma-related disorders among individuals with early psychosis, no clinical practice guidelines for the treatment of comorbid early psychosis and trauma-related disorders exist to date. Indeed, the routine exclusion of individuals with past and current psychosis from participation in trauma research and practice has limited the accumulation of research that could support such clinical practice guidelines. While preliminary research evidence suggests that traditional, evidence-based treatments for trauma-related disorders can be safely and effectively employed to reduce symptoms of posttraumatic stress and chronic psychosis, it remains unclear whether such treatments are appropriate for individuals in the early stages of psychotic illness. Clinical experts (N = 118) representing 121 early psychosis programs across 28 states were surveyed using the expert consensus method. Forty-nine clinical experts responded and reached consensus on 46 of 49 expert consensus items related to the treatment of comorbid early psychosis and trauma-related disorders. Conjoint or family therapy and individual therapy were rated as treatment approaches of choice. Anxiety or stress management and psychoeducation were rated as treatment interventions of choice for addressing both trauma symptoms and psychotic symptoms. In addition, case management was rated as a treatment intervention of choice for addressing psychotic symptoms. No consensus was reached on expert consensus items regarding the appropriateness of a parallel treatment approach exposure interventions for addressing psychotic symptoms, or sensorimotor or movement interventions for addressing trauma symptoms. In areas where expert consensus exists and is supported by current research, preliminary clinical practice guidelines for the treatment of comorbid early psychosis and trauma-related disorders are offered. In areas where expert consensus does not exist, recommendations for future research are offered. The results of this study are intended to serve as a launching point for scientists and practitioners interested in advancing appropriate treatment for high-risk and underserved individuals with comorbid early psychosis and trauma-related disorders.
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Affiliation(s)
- Casey A Cragin
- Department of Clinical Psychology, Antioch University New England , Keene, NH , USA
| | - Martha B Straus
- Department of Clinical Psychology, Antioch University New England , Keene, NH , USA
| | - Dawn Blacker
- CAARE Diagnostic and Treatment Center, Department of Pediatrics, University of California , Davis, Sacramento , USA
| | - Laura M Tully
- UC Davis Imaging Research Center, Department of Psychiatry and Behavioral Sciences, University of California , Davis, Sacramento , USA
| | - Tara A Niendam
- UC Davis Imaging Research Center, Department of Psychiatry and Behavioral Sciences, University of California , Davis, Sacramento , USA
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