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O'Donald F, Gunter E, Castle A, Warner R, Moore F. An evaluation of survive and thrive: a 10-week group psychoeducational course for adult interpersonal trauma survivors in Scotland. Cogn Behav Ther 2024; 53:490-507. [PMID: 38525889 DOI: 10.1080/16506073.2024.2333961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
Emerging evidence supports a phased approach to trauma treatment, including manualised group-based interventions, to facilitate symptom reduction resulting from complex trauma sequelae. This study investigates the efficacy of Survive and Thrive, a 10-week group psychoeducational course for adult survivors of interpersonal trauma. Between August 2019 and February 2022, participants were enrolled on the course. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and Difficulties in Emotion Regulation Scale-Short Form (DERS-SF) were administered pre-intervention and immediately post-intervention. In addition, thematic analysis was applied to qualitative feedback. Results revealed significant reductions in CORE-OM and DERS-SF scores post-intervention, with minimal variability in scores attributed to group delivery (either face-to-face or online). The thematic analysis demonstrated that normalising trauma symptoms and providing coping skills positively impacted participants' experiences. At the same time, the breadth and nature of the content were observed to be an occasional barrier to engagement. In summary, this study proposes that group-based psychoeducational interventions are generally effective for those with mild-to-moderate symptoms of complex trauma. However, further evidence is needed to offer more nuanced recommendations for identifying individuals who may benefit the most from these interventions.
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Affiliation(s)
- Frederick O'Donald
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
- School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Elise Gunter
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
| | - Ailie Castle
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
| | - Rachel Warner
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
| | - Fhionna Moore
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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2
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Shevorykin A, Hyland BM, Robles D, Ji M, Vantucci D, Bensch L, Thorner H, Marion M, Liskiewicz A, Carl E, Ostroff JS, Sheffer CE. Tobacco use, trauma exposure and PTSD: a systematic review. Health Psychol Rev 2024:1-32. [PMID: 38711288 DOI: 10.1080/17437199.2024.2330896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.
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Affiliation(s)
- Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bridget M Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Daniel Robles
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, Canada
| | - Mengjia Ji
- Department of Psychology, The City College of New York (CUNY), New York, NY, USA
| | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hannah Thorner
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Marion
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amylynn Liskiewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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3
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Poggi G, Klaus F, Pryce CR. Pathophysiology in cortico-amygdala circuits and excessive aversion processing: the role of oligodendrocytes and myelination. Brain Commun 2024; 6:fcae140. [PMID: 38712320 PMCID: PMC11073757 DOI: 10.1093/braincomms/fcae140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/27/2023] [Accepted: 04/16/2024] [Indexed: 05/08/2024] Open
Abstract
Stress-related psychiatric illnesses, such as major depressive disorder, anxiety and post-traumatic stress disorder, present with alterations in emotional processing, including excessive processing of negative/aversive stimuli and events. The bidirectional human/primate brain circuit comprising anterior cingulate cortex and amygdala is of fundamental importance in processing emotional stimuli, and in rodents the medial prefrontal cortex-amygdala circuit is to some extent analogous in structure and function. Here, we assess the comparative evidence for: (i) Anterior cingulate/medial prefrontal cortex<->amygdala bidirectional neural circuits as major contributors to aversive stimulus processing; (ii) Structural and functional changes in anterior cingulate cortex<->amygdala circuit associated with excessive aversion processing in stress-related neuropsychiatric disorders, and in medial prefrontal cortex<->amygdala circuit in rodent models of chronic stress-induced increased aversion reactivity; and (iii) Altered status of oligodendrocytes and their oligodendrocyte lineage cells and myelination in anterior cingulate/medial prefrontal cortex<->amygdala circuits in stress-related neuropsychiatric disorders and stress models. The comparative evidence from humans and rodents is that their respective anterior cingulate/medial prefrontal cortex<->amygdala circuits are integral to adaptive aversion processing. However, at the sub-regional level, the anterior cingulate/medial prefrontal cortex structure-function analogy is incomplete, and differences as well as similarities need to be taken into account. Structure-function imaging studies demonstrate that these neural circuits are altered in both human stress-related neuropsychiatric disorders and rodent models of stress-induced increased aversion processing. In both cases, the changes include altered white matter integrity, albeit the current evidence indicates that this is decreased in humans and increased in rodent models. At the cellular-molecular level, in both humans and rodents, the current evidence is that stress disorders do present with changes in oligodendrocyte lineage, oligodendrocytes and/or myelin in these neural circuits, but these changes are often discordant between and even within species. Nonetheless, by integrating the current comparative evidence, this review provides a timely insight into this field and should function to inform future studies-human, monkey and rodent-to ascertain whether or not the oligodendrocyte lineage and myelination are causally involved in the pathophysiology of stress-related neuropsychiatric disorders.
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Affiliation(s)
- Giulia Poggi
- Preclinical Laboratory for Translational Research into Affective Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, CH-8008 Zurich, Switzerland
| | - Federica Klaus
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA 92093, USA
| | - Christopher R Pryce
- Preclinical Laboratory for Translational Research into Affective Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, CH-8008 Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland
- URPP Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, 8057 Zurich, Switzerland
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4
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Zamir O, Yarns BC, Lagman-Bartolome AM, Jobanputra L, Lawler V, Lay C. Understanding the gaps in headache and migraine treatment with psychological and behavioral interventions: A narrative review. Headache 2023; 63:1031-1039. [PMID: 37638484 DOI: 10.1111/head.14624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE In this narrative review, we summarize relevant literature pertaining to psychosocial risk factors for headache and migraine progression, current behavioral and psychological treatments, and consider promising treatments. BACKGROUND Headache and migraine are common and associated with significant burden and disability. Current treatments targeting psychosocial risk factors show modest outcomes and do not directly address the impact of early life adversity, including the development of maladaptive emotional processing. An intervention that could address these factors and include components of current evidence-based interventions may lead to improved outcomes. METHODS We searched PubMed and Google Scholar for articles through December 2022. Search terms included headache, migraine, psychological interventions, behavioral interventions, cognitive-behavioral therapy, mindfulness, psychiatric comorbidities, adverse childhood experiences, trauma, and emotional processing. RESULTS Trauma and childhood adversity show a correlation with headache and migraine progression. Developmental adversity and trauma interfere with adaptive emotional processing, which may worsen headache and migraine symptoms, while adaptive ways of experiencing emotions are shown to improve symptoms. Current behavioral and psychological interventions, such as cognitive-behavioral and mindfulness therapies, are effective treatments for headache, but they produce small to medium effect sizes and do not directly address the impact of trauma and emotional conflicts-common factors that contribute to chronicity and disability, especially among certain subpopulations of headache patients such as those with migraine. Thus, there exists a gap in current treatment. CONCLUSION There is a gap in headache and migraine treatment for those patients who have a history of trauma, childhood adversity, and maladaptive emotional processing. We suggest that an integrated psychological treatment that includes components of current evidence-based interventions and addresses gaps by focusing on processing trauma-related emotions may improve chronic and debilitating symptoms.
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Affiliation(s)
- Orit Zamir
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
- Wasser Pain Medicine Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Brandon C Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ana Marissa Lagman-Bartolome
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Neurology, Children's Hospital, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Lina Jobanputra
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Valerie Lawler
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christine Lay
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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5
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Helleman A, Rubin RT, Gardner W, Lourie A, Taylor AN, Cochran J, Dorn LD, Susman E, Barrowman N, Bijelić V, Leininger L, Pajer K. Circadian cortisol secretion in adolescent girls with conduct disorder. Psychoneuroendocrinology 2023; 148:105972. [PMID: 36462295 PMCID: PMC10038075 DOI: 10.1016/j.psyneuen.2022.105972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
Severe antisocial behavior in girls, best exemplified by conduct disorder (CD), is a serious clinical and public health problem. Treatment is difficult, particularly in girls with comorbid internalizing disorders. Identifying biological correlates may help to develop new treatments or diagnostic, prognostic, or treatment response biomarkers. Based on our earlier work and research from others occurring primarily in boys with severe antisocial behavior, it is possible that abnormalities in the hypothalamic pituitary adrenal (HPA) axis circadian cortisol cycle may be associated with female CD. Additionally, research suggests that the presence of comorbid internalizing disorders may be related to differences in cortisol secretion, compared to subjects who only have CD. Our study aimed: 1) to compare the circadian cortisol cycle in 98 girls with CD, 15-16 years of age to 47 girls without any psychiatric disorder (ND) and 2) to compare the cycle in girls with CD and comorbid internalizing disorders (CD + INT) to those without such comorbidity (CD Only). Salivary cortisol was collected over 24 h during weekdays at scheduled times, with protocol adherence measures in place. Unstructured covariance pattern modeling, controlling for effects of age, social class, IQ, and awakening time was used to analyze cortisol data. CD was associated with overall lower cortisol secretion (p = 0.03), but this difference was due to a lower volume of cortisol secreted 30 min after awakening (area under the curve with respect to ground, p = 0.01). Circadian cortisol secretion was no different in the CD+INT group compared to the CD Only group (p = 0.52). Our findings need to be replicated using current consensus guidelines for the assessment of the CAR. We also suggest two new avenues of research in this field.
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Affiliation(s)
| | - Robert T Rubin
- David Geffen School of Medicine at UCLA, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA
| | - William Gardner
- CHEO Research Institute, Ottawa, Ontario, Canada; The Research Institute at Nationwide Children's Hospital, The Ohio State University, Department of Pediatrics, Columbus, OH, USA
| | - Andrea Lourie
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Department of Pediatrics, Columbus, OH, USA
| | - Anna N Taylor
- David Geffen School of Medicine at UCLA, Department of Neurobiology, Los Angeles, CA, USA
| | - Justinn Cochran
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Department of Pediatrics, Columbus, OH, USA
| | - Lorah D Dorn
- Cincinnati Children's Hospital Medical Center, Division of Adolescent Medicine, Cincinnati, OH, USA
| | - Elizabeth Susman
- College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | | | - Vid Bijelić
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Lisa Leininger
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Department of Pediatrics, Columbus, OH, USA
| | - Kathleen Pajer
- CHEO Research Institute, Ottawa, Ontario, Canada; The Research Institute at Nationwide Children's Hospital, The Ohio State University, Department of Pediatrics, Columbus, OH, USA.
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6
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deMello RAF, Coimbra BM, Pedro BDM, Benvenutti IM, Yeh MSL, Mello AF, Mello MF, Poyares DR. Peri-Traumatic Dissociation and Tonic Immobility as Severity Predictors of Posttraumatic Stress Disorder After Rape. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4240-4266. [PMID: 35899768 DOI: 10.1177/08862605221114151] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Some individuals show abnormal reactions to extreme fear and life-threatening situations, including tonic immobility (TI) and peri-traumatic dissociation (PTD). We aimed to investigate the association of TI and PTD with posttraumatic stress disorder (PTSD) in women who experienced sexual violence and the risk factors for PTD occurrence. We compared PTSD severity in 86 young adult women with PTSD after a sexual violence exposure grouped according to the presence of PTD and TI. In addition, we investigated whether PTD is associated with depression and anxiety symptoms and assessed potential risk factors for PTD reaction. We found a significant positive correlation between PTSD severity and PTD occurrence (R2 = .132; p = .001). PTD was also positively correlated with all clusters of PTSD symptoms except the Clinician-Administered PTSD Scale avoidance cluster (p = .058). PTD was strongly correlated with anxiety (R2 = .619; p < .001) and depressive symptoms (R2 = .547; p < .001). Multiple logistic regression showed that history of physical abuse (odds ratio [OR]: 1.386; p = .011) and sexual abuse (OR: 1.947; p = .004) during childhood were associated with PTD occurrence. Other risk factors for PTD were having less years of study (OR: 0.216; p = .016) and lower income (OR: 7.403; p = .028). TI measures were available for a subsample of 29 women. We found no association between TI and PTSD severity. PTD, but not TI, is significantly associated with more severe PTSD, depressive, and anxiety symptoms. Less-educated women with a history of childhood abuse and a lower income are at risk of PTD occurrence during a sexual violence episode.
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Affiliation(s)
- Ricardo A F deMello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Bruno Messina Coimbra
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Bianca D M Pedro
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Isabella M Benvenutti
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mary S L Yeh
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea F Mello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcelo F Mello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Dalva R Poyares
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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7
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Modeling integrated stress, sleep, fear and neuroimmune responses: Relevance for understanding trauma and stress-related disorders. Neurobiol Stress 2023; 23:100517. [PMID: 36793998 PMCID: PMC9923229 DOI: 10.1016/j.ynstr.2023.100517] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/30/2022] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Sleep and stress have complex interactions that are implicated in both physical diseases and psychiatric disorders. These interactions can be modulated by learning and memory, and involve additional interactions with the neuroimmune system. In this paper, we propose that stressful challenges induce integrated responses across multiple systems that can vary depending on situational variables in which the initial stress was experienced, and with the ability of the individual to cope with stress- and fear-inducing challenges. Differences in coping may involve differences in resilience and vulnerability and/or whether the stressful context allows adaptive learning and responses. We provide data demonstrating both common (corticosterone, SIH and fear behaviors) and distinguishing (sleep and neuroimmune) responses that are associated with an individual's ability to respond and relative resilience and vulnerability. We discuss neurocircuitry regulating integrated stress, sleep, neuroimmune and fear responses, and show that responses can be modulated at the neural level. Finally, we discuss factors that need to be considered in models of integrated stress responses and their relevance for understanding stress-related disorders in humans.
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8
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Serfioti D, Murphy D, Greenberg N, Williamson V. Effectiveness of treatments for symptoms of post-trauma related guilt, shame and anger in military and civilian populations: a systematic review. BMJ Mil Health 2022:e002155. [PMID: 36442888 DOI: 10.1136/military-2022-002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Individuals who have been exposed to a traumatic event can develop profound feelings of guilt, shame and anger. Yet, studies of treatments for post-traumatic stress disorder (PTSD) have largely investigated changes in PTSD symptoms relating to a sense of ongoing fear or threat and the effectiveness of such treatments for post-trauma related guilt, shame or anger symptom reduction is comparatively not well understood. METHODS This review systematically examined the effectiveness of existing treatment approaches for three symptoms associated with exposure to traumatic events: guilt, shame and anger. Studies included had to be published after 2010 with a sample size of n=50 or greater to ensure stable treatment outcome estimates. RESULTS 15 studies were included, consisting of both civilian and (ex-) military population samples exposed to a wide range of traumatic events (eg, combat-related, sexual abuse). Findings indicated a moderate strength of evidence that both cognitive-based and exposure-based treatments are similarly effective in reducing symptoms. Cognitive-based treatments were found to effectively reduce post-trauma related guilt and anger, while exposure-based treatments appeared effective for post-trauma related guilt, shame and anger. CONCLUSIONS The findings suggest the importance of confronting and discussing the traumatic event during therapy, rather than using less directive treatments (eg, supportive counselling).Nonetheless, while these results are promising, firm conclusions regarding the comparative effectiveness and long-term impact of these treatments could not be drawn due to insufficient evidence. Further empirical research is needed to examine populations exposed to traumatic events and investigate which treatment approaches (or combination thereof) are more effective in the long-term.
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Affiliation(s)
- Danai Serfioti
- University of Derby, Derby, UK
- KCMHR, Institute of Psychiatry Psychology and Neuroscience Department of Basic and Clinical Neuroscience, London, UK
- Nottingham Trent University, Nottingham, UK
| | | | - N Greenberg
- Academic Department for Military Mental Health, King's College London, London, UK
| | - V Williamson
- KCMHR, Institute of Psychiatry Psychology and Neuroscience Department of Basic and Clinical Neuroscience, London, UK
- University of Oxford, Oxford, UK
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9
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Hogg B, Gardoki-Souto I, Valiente-Gómez A, Rosa AR, Fortea L, Radua J, Amann BL, Moreno-Alcázar A. Psychological trauma as a transdiagnostic risk factor for mental disorder: an umbrella meta-analysis. Eur Arch Psychiatry Clin Neurosci 2022; 273:397-410. [PMID: 36208317 DOI: 10.1007/s00406-022-01495-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/27/2022] [Indexed: 01/08/2023]
Abstract
This umbrella review is the first to systematically examine psychological trauma as a transdiagnostic risk factor across psychiatric conditions. We searched Pubmed, Scopus, and PsycNET databases from inception until 01/05/2021 for systematic reviews/meta-analyses evaluating the association between psychological trauma and at least one diagnosed mental disorder. We re-calculated the odds ratio (OR), then classified the association as convincing, highly suggestive, suggestive, or weak, based on the number of cases and controls with and without psychological trauma, random-effects p value, the 95% confidence interval of the largest study, heterogeneity between studies, 95% prediction interval, small-study effect, and excess significance bias. Additional outcomes were the association between specific trauma types and specific mental disorders, and a sensitivity analysis for childhood trauma. Transdiagnosticity was assessed using TRANSD criteria. The review was pre-registered in Prospero CRD42020157308 and followed PRISMA/MOOSE guidelines. Fourteen reviews met inclusion criteria, comprising 16,277 cases and 77,586 controls. Psychological trauma met TRANSD criteria as a transdiagnostic factor across different diagnostic criteria and spectra. There was highly suggestive evidence of an association between psychological trauma at any time-point and any mental disorder (OR = 2.92) and between childhood trauma and any mental disorder (OR = 2.90). Regarding specific trauma types, convincing evidence linked physical abuse (OR = 2.36) and highly suggestive evidence linked sexual abuse (OR = 3.47) with a range of mental disorders, and convincing evidence linked emotional abuse to anxiety disorders (OR = 3.05); there were no data for emotional abuse with other disorders. These findings highlight the importance of preventing early traumatic events and providing trauma-informed care in early intervention and psychiatric services.
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Affiliation(s)
- Bridget Hogg
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, C/Llull 410, 08019, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,PhD Programme, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
| | - Itxaso Gardoki-Souto
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, C/Llull 410, 08019, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,PhD Programme, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Valiente-Gómez
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, C/Llull 410, 08019, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
| | - Adriane Ribeiro Rosa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Department of Pharmacology, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil.,Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Lydia Fortea
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain.,Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Joaquim Radua
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain.,Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, King's College London, Psychology & Neuroscience, London, UK.,Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Benedikt L Amann
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, C/Llull 410, 08019, Barcelona, Spain. .,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain. .,Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain. .,Department of Psychiatry and Psychotherapy, Klinikum Der Universität München, Munich, Germany.
| | - Ana Moreno-Alcázar
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, C/Llull 410, 08019, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
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10
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Poggi G, Albiez J, Pryce CR. Effects of chronic social stress on oligodendrocyte proliferation-maturation and myelin status in prefrontal cortex and amygdala in adult mice. Neurobiol Stress 2022; 18:100451. [PMID: 35685682 PMCID: PMC9170777 DOI: 10.1016/j.ynstr.2022.100451] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/13/2022] [Accepted: 04/16/2022] [Indexed: 10/26/2022] Open
Abstract
Stress-related neuropsychiatric disorders present with excessive processing of aversive stimuli. Whilst underlying pathophysiology remains poorly understood, within- and between-regional changes in oligodendrocyte (OL)-myelination status in anterior cingulate cortex and amygdala (ACC-AMY network) could be important. In adult mice, a 15-day chronic social stress (CSS) protocol leads to increased aversion responsiveness, accompanied by increased resting-state functional connectivity between, and reduced oligodendrocyte- and myelin-related transcript expression within, medial prefrontal cortex and amygdala (mPFC-AMY network), the analog of the human ACC-AMY network. In the current study, young-adult male C57BL/6 mice underwent CSS or control handling (CON). To assess OL proliferation-maturation, mice received 5-ethynyl-2'-deoxyuridine via drinking water across CSS/CON and brains were collected on day 16 or 31. In mPFC, CSS decreased the density of proliferative OL precursor cells (OPCs) at days 16 and 31. CSS increased mPFC myelin basic protein (MBP) integrated density at day 31, as well as increasing myelin thickness as determined using transmission electron microscopy, at day 16. In AMY, CSS increased the densities of total CC1+ OLs (day 31) and CC1+/ASPA+ OLs (days 16 and 31), whilst decreasing the density of proliferative OPCs at days 16 and 31. CSS was without effect on AMY MBP content and myelin thickness, at days 16 and 31. Therefore, CSS impacts on the OL lineage in mPFC and AMY and to an extent that, in mPFC at least, leads to increased myelination. This increased myelination could contribute to the excessive aversion learning and memory that occur in CSS mice and, indeed, human stress-related neuropsychiatric disorders.
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Affiliation(s)
- Giulia Poggi
- Preclinical Laboratory for Translational Research Into Affective Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Jamie Albiez
- Preclinical Laboratory for Translational Research Into Affective Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Christopher R. Pryce
- Preclinical Laboratory for Translational Research Into Affective Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland
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11
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Norman SB, Capone C, Panza KE, Haller M, Davis BC, Schnurr PP, Shea MT, Browne K, Norman GJ, Lang AJ, Kline AC, Golshan S, Allard CB, Angkaw A. A clinical trial comparing trauma-informed guilt reduction therapy (TrIGR), a brief intervention for trauma-related guilt, to supportive care therapy. Depress Anxiety 2022; 39:262-273. [PMID: 35075738 DOI: 10.1002/da.23244] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Trauma-related guilt is common, associated with posttraumatic mental health problems, and can persist after posttraumatic stress disorder (PTSD) treatment. We compared the efficacy of two six-session psychotherapies, Trauma-Informed Guilt Reduction (TrIGR) and Supportive Care Therapy (SCT), for reducing trauma-related guilt. TrIGR helps patients accurately appraise their role in the trauma and re-engage in values. In SCT, patients guide session content. METHODS A total of 184 veterans seeking VA mental health services were enrolled across two sites; 145 veterans (mean age: 39.2 [8.1]; 92.4% male; 84.8% with PTSD) who endorsed guilt related to a traumatic event that occurred during a post 9/11 Iraq or Afghanistan deployment were randomized and assessed at baseline, posttreatment, 3- and 6-month follow-up. RESULTS Linear mixed models using intent-to-treat analyses showed guilt decreased in both conditions with a greater decrease for TrIGR (treatment × time, -0.22; F 1, 455.2 = 18.49, p = .001; d = 0.92) than supportive therapy. PTSD and depressive symptoms showed the same pattern. TrIGR had significantly higher likelihood of PTSD treatment response (67% vs. 40%), loss of PTSD diagnosis (50% vs. 14%), and meaningful change in depression (54% vs. 27%) than supportive therapy. Psychological distress and trait shame improved in both conditions. Quality of life did not change. CONCLUSIONS Targeting guilt appears to be an effective means for reducing posttraumatic symptoms and distress.
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Affiliation(s)
- Sonya B Norman
- Executive Division, National Center for PTSD, Hartford, Vermont, USA.,Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Clinical Research Division, VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Christy Capone
- Department of Mental Health, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Kaitlyn E Panza
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Moira Haller
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Brittany C Davis
- Department of Mental Health, James A. Haley Veterans Hospital, Tampa, Florida, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
| | - Paula P Schnurr
- Executive Division, National Center for PTSD, Hartford, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - M Tracie Shea
- Department of Mental Health, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Kendall Browne
- Department of Research, Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Gregory J Norman
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ariel J Lang
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Clinical Research Division, VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Alexander C Kline
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Shahrokh Golshan
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Carolyn B Allard
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Clinical Psychology, California School of Professional Psychology at Alliant International University, San Diego, California, USA
| | - Abigail Angkaw
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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12
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Brandl F, Weise B, Mulej Bratec S, Jassim N, Hoffmann Ayala D, Bertram T, Ploner M, Sorg C. Common and specific large-scale brain changes in major depressive disorder, anxiety disorders, and chronic pain: a transdiagnostic multimodal meta-analysis of structural and functional MRI studies. Neuropsychopharmacology 2022; 47:1071-1080. [PMID: 35058584 PMCID: PMC8938548 DOI: 10.1038/s41386-022-01271-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/28/2021] [Accepted: 01/05/2022] [Indexed: 12/21/2022]
Abstract
Major depressive disorder (MDD), anxiety disorders (ANX), and chronic pain (CP) are closely-related disorders with both high degrees of comorbidity among them and shared risk factors. Considering this multi-level overlap, but also the distinct phenotypes of the disorders, we hypothesized both common and disorder-specific changes of large-scale brain systems, which mediate neural mechanisms and impaired behavioral traits, in MDD, ANX, and CP. To identify such common and disorder-specific brain changes, we conducted a transdiagnostic, multimodal meta-analysis of structural and functional MRI-studies investigating changes of gray matter volume (GMV) and intrinsic functional connectivity (iFC) of large-scale intrinsic brain networks across MDD, ANX, and CP. The study was preregistered at PROSPERO (CRD42019119709). 320 studies comprising 10,931 patients and 11,135 healthy controls were included. Across disorders, common changes focused on GMV-decrease in insular and medial-prefrontal cortices, located mainly within the so-called default-mode and salience networks. Disorder-specific changes comprised hyperconnectivity between default-mode and frontoparietal networks and hypoconnectivity between limbic and salience networks in MDD; limbic network hyperconnectivity and GMV-decrease in insular and medial-temporal cortices in ANX; and hypoconnectivity between salience and default-mode networks and GMV-increase in medial temporal lobes in CP. Common changes suggested a neural correlate for comorbidity and possibly shared neuro-behavioral chronification mechanisms. Disorder-specific changes might underlie distinct phenotypes and possibly additional disorder-specific mechanisms.
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Affiliation(s)
- Felix Brandl
- Technical University of Munich, School of Medicine, Department of Psychiatry, 81675, Munich, Germany. .,Technical University of Munich, School of Medicine, Department of Neuroradiology, 81675, Munich, Germany. .,Technical University of Munich, School of Medicine, TUM-NIC Neuroimaging Center, 81675, Munich, Germany.
| | - Benedikt Weise
- grid.6936.a0000000123222966Technical University of Munich, School of Medicine, Department of Neuroradiology, 81675 Munich, Germany ,grid.6936.a0000000123222966Technical University of Munich, School of Medicine, TUM-NIC Neuroimaging Center, 81675 Munich, Germany
| | - Satja Mulej Bratec
- grid.6936.a0000000123222966Technical University of Munich, School of Medicine, Department of Neuroradiology, 81675 Munich, Germany ,grid.6936.a0000000123222966Technical University of Munich, School of Medicine, TUM-NIC Neuroimaging Center, 81675 Munich, Germany ,grid.8647.d0000 0004 0637 0731University of Maribor, Faculty of Arts, Department of Psychology, Koroska cesta 160, 2000 Maribor, Slovenia
| | - Nazia Jassim
- grid.6936.a0000000123222966Technical University of Munich, School of Medicine, Department of Neuroradiology, 81675 Munich, Germany ,grid.6936.a0000000123222966Technical University of Munich, School of Medicine, TUM-NIC Neuroimaging Center, 81675 Munich, Germany
| | - Daniel Hoffmann Ayala
- grid.6936.a0000000123222966Technical University of Munich, School of Medicine, Department of Neuroradiology, 81675 Munich, Germany ,grid.6936.a0000000123222966Technical University of Munich, School of Medicine, TUM-NIC Neuroimaging Center, 81675 Munich, Germany
| | - Teresa Bertram
- grid.6936.a0000000123222966Technical University of Munich, School of Medicine, Department of Psychiatry, 81675 Munich, Germany ,grid.6936.a0000000123222966Technical University of Munich, School of Medicine, Department of Neuroradiology, 81675 Munich, Germany ,grid.6936.a0000000123222966Technical University of Munich, School of Medicine, TUM-NIC Neuroimaging Center, 81675 Munich, Germany
| | - Markus Ploner
- grid.6936.a0000000123222966Technical University of Munich, School of Medicine, TUM-NIC Neuroimaging Center, 81675 Munich, Germany ,grid.6936.a0000000123222966Technical University of Munich, School of Medicine, Department of Neurology, 81675 Munich, Germany
| | - Christian Sorg
- grid.6936.a0000000123222966Technical University of Munich, School of Medicine, Department of Psychiatry, 81675 Munich, Germany ,grid.6936.a0000000123222966Technical University of Munich, School of Medicine, Department of Neuroradiology, 81675 Munich, Germany ,grid.6936.a0000000123222966Technical University of Munich, School of Medicine, TUM-NIC Neuroimaging Center, 81675 Munich, Germany
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13
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Bonde JPE, Jensen JH, Smid GE, Flachs EM, Elklit A, Mors O, Videbech P. Time course of symptoms in posttraumatic stress disorder with delayed expression: A systematic review. Acta Psychiatr Scand 2022; 145:116-131. [PMID: 34523121 PMCID: PMC9293462 DOI: 10.1111/acps.13372] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the hypothesis that PTSD with delayed expression in some cases occurs without subthreshold PTSD symptoms above background levels bridging the gap between the traumatic exposure(s) and the clinical diagnosis. METHODS We performed systematic searches of peer-reviewed papers in English referenced in Pubmed, Embase, or PsycINFO and ascertained 34 prospective studies of PTSD symptom trajectories identified by latent class growth statistical modeling. Studies with delayed and low-stable trajectories provided appropriate data for this study. We computed the difference between the delayed trajectory PTSD symptom sumscore and the low-stable PTSD sumscore at the observed points in time after the traumatic event(s). RESULTS In 29 study populations, the latent class growth analyses displayed delayed trajectories, and in these, we identified 110 data points (% PTSD sumscore difference/months since traumatic exposure). The median PTSD symptom sumscore was 25% higher during the initial 6 months among individuals in the delayed trajectory compared to those in low-stable trajectory. From this level, the difference widened and reached a plateau of 40-50% higher. The variation was large, and the baseline participation rate and loss to follow-up were exceeding 25% in the majority of the studies. Heterogeneity of populations, measures, and analyses precluded formal meta-analysis. CONCLUSION Delayed PTSD is preceded by PTSD symptoms during the first year in most cases. Still, few individuals may experience an asymptomatic delay. The results underpin the rationale for monitoring PTSD symptoms and may inform forensic assessments in that delayed PTSD without symptoms bridging the traumatic event is rare.
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Affiliation(s)
- Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental MedicineBispebjerg and Frederiksberg HospitalCopenhagenDenmark,Institute of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Johan Høy Jensen
- Department of Occupational and Environmental MedicineBispebjerg and Frederiksberg HospitalCopenhagenDenmark,Copenhagen Stress Research CenterCopenhagenDenmark
| | - Geert E. Smid
- Department of Humanist Chaplaincy StudiesUniversity of Humanistic StudiesUtrechtthe Netherlands,ARQ National Psychotrauma CenterDiementhe Netherlands
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental MedicineBispebjerg and Frederiksberg HospitalCopenhagenDenmark
| | - Ask Elklit
- Danish National Centre for PsychotraumatologyUniversity of Southern DenmarkOdenseDenmark
| | - Ole Mors
- Psychosis Research UnitAarhus University Hospital – PsychiatryAarhusDenmark
| | - Poul Videbech
- Centre for Neuropsychiatric Depression ResearchMental Health Centre Glostrup and Clinical InstituteUniversity of CopenhagenCopenhagenDenmark
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14
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Grillo L. A Possible Anti-anxiety Effect of Appetitive Aggression and a Possible Link to the Work of Donald Winnicott. Scand J Child Adolesc Psychiatr Psychol 2022; 10:102-113. [PMID: 36133733 PMCID: PMC9454322 DOI: 10.2478/sjcapp-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Various pleasant sensations that give a particularly intense pleasure are able to improve anxiety. In the present study I consider the possibility that their anti-anxiety action depends on the strong pleasure they provide, and I propose a possible mechanism of this action. According to some studies, also appetitive aggression (an aggression that provokes a strong pleasure and that is performed only for the pleasure it provides) can improve anxiety, and in this article I consider the possibility that the pleasure of appetitive aggression is able to reduce anxiety by the same mechanism I have proposed for other intense pleasurable sensations. The aggression performed by a child against the mother or against a substitute for the mother in the first period of life (a period in which this aggression is not dangerous) is a recurring theme throughout the work of of Donald Winnicott. Winnicott stresses that this aggression is necessary for the normal development of the child, and that the child must be free to practise it. According to Winnicott, this aggression is highly pleasurable and is not a response to unpleasant or hostile external situations. For these characteristics it seems to correspond to appetitive aggression in the adult that has been found to be able to reduce anxiety. Consequently, aggression performed by the child in the first period of life may also relieve anxiety, in the same way that appetitive aggression helps against anxiety in the adult. In his writings, Winnicott returns several times to an unthinkable or archaic anxiety that children experience when they feel abandoned by their mother for a period that is too long for them, and all children, according to Winnicott, live on the brink of this anxiety. In this study I propose the hypothesis that aggression in the early period of life may be necessary for children because the intense pleasure it provides may help them against this continuously impending anxiety.
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Affiliation(s)
- Luigi Grillo
- San Giorgio su Legnano via Ragazzi del 99Milano MI, Italy
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15
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Hangai M, Piedvache A, Sawada N, Okubo Y, Sampei M, Yamaoka Y, Tanaka K, Hosozawa M, Morisaki N, Igarashi T. Children's daily lives and well-being: Findings from the CORONA-CODOMO survey 1st wave. Pediatr Int 2022; 64:e14981. [PMID: 34480819 PMCID: PMC8662137 DOI: 10.1111/ped.14981] [Citation(s) in RCA: 1] [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] [Received: 12/23/2020] [Revised: 07/04/2021] [Accepted: 07/26/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has changed people's lives dramatically. Few data on the acute effects of the pandemic on children's daily lives and well-being have been published to date. This study aimed to capture its effects on Japanese children during the first peak of the outbreak. METHODS We conducted a web-based, anonymous cross-sectional survey targeting Japanese children aged 7-17 years and parents/guardians of children aged 0-17 years. Eligible individuals were invited to participate in the survey from April 30 to May 31, 2020. This self-report questionnaire examined daily life and behaviors, psychological symptoms, well-being, quality of life, and positive parenting or abusive behaviors at the very beginning of the outbreak. RESULTS A total of 2,591 children and 6,116 parents/guardians participated in our survey. Sixty-two percent of children reported screen time exceeding 2 h. Twenty percent of children reported abusive behaviors by family members. Nine in ten parents/guardians of school-aged children reported that their child had at least one acute stress symptom in the past month. Average mental health subscale scores from KINDLR questionnaire on quality of life were lower than the national average for all grades. Nearly half of parents/guardians refrained from seeking medical care for the child's symptoms. CONCLUSIONS The COVID-19 pandemic had serious acute impacts on Japanese children's daily lives, well-being, family relationships, and health-care utilization, including some impacts that are potentially long-lasting; thus, proactive interventions and services are needed, as well as longitudinal surveys.
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Affiliation(s)
- Mayumi Hangai
- Department of Social Medicine, National Center for Child Health and Development, Setagaya-ku, Japan.,Department of Pediatrics, The University of Tokyo, Bunkyo-ku, Japan
| | - Aurelie Piedvache
- Department of Social Medicine, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Naomi Sawada
- Department of Social Medicine, National Center for Child Health and Development, Setagaya-ku, Japan.,School of Public Health, The University of Tokyo, Bunkyo-ku, Japan
| | - Yusuke Okubo
- Department of Social Medicine, National Center for Child Health and Development, Setagaya-ku, Japan.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Makiko Sampei
- Department of Social Medicine, National Center for Child Health and Development, Setagaya-ku, Japan.,Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Yui Yamaoka
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Kyoko Tanaka
- Department of Psychosocial Medicine, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Mariko Hosozawa
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Shinjuku-ku, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Takashi Igarashi
- National Center for Child Health and Development, Setagaya-ku, Japan
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16
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Guo Z, Li S, Wu J, Zhu X, Zhang Y. Maternal Deprivation Increased Vulnerability to Depression in Adult Rats Through DRD2 Promoter Methylation in the Ventral Tegmental Area. Front Psychiatry 2022; 13:827667. [PMID: 35308874 PMCID: PMC8924051 DOI: 10.3389/fpsyt.2022.827667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Early life adversity is a risk factor for depression in adulthood; however, the underlying mechanisms are not well understood. This study aims to investigate the effect of DNA methylation of DRD2 gene on early life stress-induced depression in adult rats. METHODS Newborn Sprague-Dawley rats were randomly assigned to four groups: maternal deprivation group (MD), chronic unpredictable stress (CUS) group, maternal deprivation plus chronic unpredictable stress (MD/CUS) group, and normal control group (NOR). Behaviors were measured by open field test (OFT), sucrose preference test (SPT), and Original Research Article forced swimming test (FST). Fecal CORT level was detected by ELISA. Bisulfite amplicon sequencing PCR was used to assess methylation levels of DRD2 promoter. RESULTS CUS and MD/CUS rats had a significantly shorter total distance, longer immobility time, and higher CORT level, while MD and MD/CUS rats had a significantly lower percentage of central distance, more feces, lower rate of sucrose preference, and lower levels of DRD2 protein and mRNA in the VTA than NOR rats. CUS rats showed a significantly higher DRD2 mRNA and protein levels in the VTA than NOR rats. CUS, MD, and MD/CUS rats showed a significantly higher level of DRD2 promoter methylation than NOR rats. CORT level was significantly correlated with the sucrose preference rate in SPT, the immobility time in FST, the total distance, and the number of fecal pellets in OFT. DRD2 protein level was significantly correlated with the sucrose preference rate and the number of fecal pellets. DRD2 mRNA level was significantly correlated with the percentage of central distance and the number of fecal pellets in OFT. The level of DRD2 promoter methylation was significantly correlated with the sucrose preference rate, immobility time, total distance, the percentage of central distance, and the number of fecal pellets. CONCLUSIONS Early life MD increased vulnerability to stress-induced depressive-like behavior in adult rats. Enhanced DRD2 promoter methylation in the VTA may increase the susceptibility to depression.
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Affiliation(s)
- Zhenli Guo
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shansi Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jialing Wu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiongzhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute of Central South University, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute of Central South University, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
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17
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Shah NN, Schwandt ML, Hobden B, Baldwin DS, Sinclair J, Agabio R, Leggio L. The validity of the state-trait anxiety inventory and the brief scale for anxiety in an inpatient sample with alcohol use disorder. Addiction 2021; 116:3055-3068. [PMID: 33861887 DOI: 10.1111/add.15516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/11/2021] [Accepted: 03/31/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The Brief Scale for Anxiety (BSA) and the State-Trait Anxiety Inventory Form Y-2 (STAI-Y-2) are self-report scales used to gauge anxiety symptoms in clinical settings. Co-occuring anxiety is common in alcohol use disorder (AUD); however, no studies have assessed the validity of the BSA and STAI-Y-2 compared with a clinical diagnostic tool of anxiety in alcohol treatment programs. We aimed to examine the validity of the BSA and STAI-Y-2 to predict a clinical diagnosis of an anxiety disorder (via the Structured Clinical Interview for DSM [SCID]) in AUD patients. DESIGN Participants were administered the BSA (n = 1005) on day 2 and the STAI-Y-2 (n = 483) between days 2 and 10 of the detoxification program. SCID-based clinical diagnoses of AUD and anxiety were made approximately on day 10. SETTING AND PARTICIPANTS Individuals seeking treatment for AUD admitted to an inpatient unit at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD, USA (n = 1010). MEASUREMENTS Inclusion criteria included a current diagnosis of alcohol dependence (AD) according to DSM-IV-TR or moderate to severe AUD according to DSM-5-RV, as well as available baseline BSA and/or STAI Y-2 data. Empirical receiver operating characteristic (ROC) curves were generated using estimates of sensitivity, 1-specificity and positive and negative predictive values for each cut-point to determine the accuracy of scale outcomes in relation to SCID diagnoses. FINDINGS The BSA demonstrated low accuracy relative to a clinical diagnosis of anxiety with an area under the curve (AUC) of 0.67 at the optimal cut-point of ≥ 10. The STAI-Y-2 had moderate accuracy relative to a clinical diagnosis of anxiety with an AUC of 0.70 at the optimal cut-point of ≥ 51. The accuracy of the STAI-Y-2 increased (AUC = 0.74) when excluding post-traumatic stress disorder and obsessive-compulsive disorder from anxiety disorder classification. CONCLUSIONS Use of the Brief Scale for Anxiety (BSA) and/or State-Trait Anxiety Inventory Form Y-2 (STAI-Y-2) does not appear to be a reliable substitute for clinical diagnoses of anxiety disorder among inpatients with alcohol use disorder. The BSA and STAI-Y-2 could serve as a screening tool to reject the presence of anxiety disorders rather than for detecting an anxiety disorder.
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Affiliation(s)
- Navan N Shah
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD, USA
| | - Melanie L Schwandt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Bethesda, MD, USA
| | - Breanne Hobden
- Health Behaviour Research Group, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre in Health Behaviour and Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,University Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Julia Sinclair
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD, USA.,Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, USA.,Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA.,Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Neuroscience, Georgetown University Medical Center, Washington, DC, USA
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18
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Henry M, Sargi E, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Black M, MacDonald C, Richardson K, Chartier G, Sadeghi N, Rosberger Z. Longitudinal study indicating antecedent psychosocial vulnerability as predictor of anxiety disorders post-treatment in people with head and neck cancer. Psychooncology 2021; 30:1910-1919. [PMID: 34190381 DOI: 10.1002/pon.5760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/11/2021] [Accepted: 06/23/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to: (1) determine the contribution of pre-cancer psychosocial vulnerability as an independent predictor of anxiety disorder (AD) onset immediately post-treatment in patients diagnosed with a first occurrence of head and neck cancer (HNC), controlling for sociodemographics and medical variables; and (2) estimate prevalence of AD and identify trajectories from the moment of diagnosis to the immediate post-treatment (i.e., over a period of 3 months) in this population. METHODS Two-hundred twenty-four consecutive patients (participation rate = 72%) newly diagnosed with a primary HNC were assessed with a structured clinical interview for a mental disorder, validated psychometric measures, and medical chart reviews. RESULTS Twenty-five percent of patients presented a lifetime AD, 19.4% within 2 weeks of HNC diagnosis, and 16.6% immediately post-treatment; representing 26.7% of patients with AD at any timepoint from the moment of diagnosis to immediately post-treatment. Patients were more likely to present an AD immediately post-treatment when they: were diagnosed with advanced-stage cancer (OR = 3.40, p = 0.006), presented a upon cancer diagnosis AD (OR = 2.45, p = 0.008) and/or experienced childhood abuse (OR = 1.96, p = 0.03). CONCLUSIONS Several AD trajectories may arise when patients are diagnosed with primary HNC. Health professionals should address AD and screen for risk factors (i.e., advanced stage cancer, AD upon cancer diagnosis, history of childhood abuse) as early as possible to assure optimal mental health care in this vulnerable population.
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Affiliation(s)
- Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Segal Cancer Centre, Jewish General Hospital, Montreal, Quebec, Canada
| | - Elyonora Sargi
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Saul Frenkiel
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Karen Kost
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Martin Black
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Christina MacDonald
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Nursing, Jewish General Hospital, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Gabrielle Chartier
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Nursing, Jewish General Hospital, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Zeev Rosberger
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Montreal, Quebec, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada
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Buchnik-Daniely Y, Vannikov-Lugassi M, Shalev H, Soffer-Dudek N. The path to dissociative experiences: A direct comparison of different etiological models. Clin Psychol Psychother 2021; 28:1091-1102. [PMID: 33527536 DOI: 10.1002/cpp.2559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/24/2021] [Indexed: 12/15/2022]
Abstract
Severe dissociation is trauma-related, but a range of dissociative experiences are also prevalent in clinical populations that are not necessarily trauma-based (e.g., depression, anxiety disorders, and obsessive-compulsive disorders). These remain poorly understood as the dominant etiological model for dissociation relies on trauma. Importantly, dissociation in such samples predicts poor prognosis and high drop-out rates. We set out to better understand the aetiology of dissociative experiences in a mixed clinical (anxiety and depression) and community sample by exploring between- and within-subjects effects of two domains: psychological distress or negative affectivity (operationalized as anxiety and depression symptoms), and poor sleep quality, including disturbed dreaming. The idea that negative affectivity triggers dissociation (Distress Model) is inspired by the trauma model. The idea that poor sleep and unusual dreaming underlie dissociation (Sleep Model) has been suggested as a competing theory. We examined both models by exploring which domains oscillate alongside dissociative experiences. N = 98 adults, half of them diagnosed with depression and anxiety and half community controls, underwent a structured clinical interview and completed questionnaires monthly for 6 months. Support was found for both models in that each domain had a unique explanatory contribution. Distress evinced consistent effects that could not be explained by sleep or dreaming, both between individuals and across time. Oscillations in dissociation across months, when taking psychological distress into account, were better explained by unusual dreaming than traditional sleep quality measures. These findings cannot be generalized to highly-traumatized samples. A complex, integrated etiological model for dissociative experiences is warranted.
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Affiliation(s)
| | | | - Hadar Shalev
- Department of Psychiatry, Soroka Medical Center, Beer-sheva, Israel
| | - Nirit Soffer-Dudek
- Department of Psychology, Ben-Gurion University of the Negev, Beer-sheva, Israel
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20
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Coimbra BM, Yeh M, D'Elia AT, Maciel MR, Carvalho CM, Milani AC, Mozzambani A, Juruena M, Belangero SI, Jackowski AP, Poyares D, Mello AF, Mello MF. Posttraumatic Stress Disorder and Neuroprogression in Women Following Sexual Assault: Protocol for a Randomized Clinical Trial Evaluating Allostatic Load and Aging Process Acceleration. JMIR Res Protoc 2020; 9:e19162. [PMID: 33206061 PMCID: PMC7710442 DOI: 10.2196/19162] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/20/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a prevalent, chronic, and severe disorder related to traumatic events. Women are disproportionately affected by PTSD than men and are more at risk in the occurrence of sexual assault victimization. Estimates suggest that 50% of women develop PTSD following sexual assault and successful clinical management can be challenging. Growing evidence has implicated neural, immune, and endocrine alterations underpinning PTSD, but only few studies have assessed the evolution of acute PTSD in women. OBJECTIVE This study aims to measure whether the onset of PTSD is associated with accelerated aging in women following sexual assault. We hypothesize that the increase of allostatic load caused by PTSD leads to neuroprogression. We will implement a randomized clinical trial to compare responses to treatment with either interpersonal psychotherapy adapted for PTSD (IPT-PTSD) or the selective serotonin reuptake inhibitor sertraline. METHODS We will include women between 18 and 45 years of age, who experienced sexual assault from 1 to 6 months before the initial evaluation, and present with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnosis of PTSD. Baseline evaluation will comprise clinical and psychometric assessments, structural and functional magnetic resonance imaging, neuropsychological testing, polysomnography, evaluation of immune and endocrine parameters, and genetic analyses. Age-matched female healthy controls will be included and subjected to the same evaluation. Patients will be randomized for treatment in 1 of the 2 arms of the study for 14 weeks; follow-up will continue until 1 year after inclusion via treatment as usual. The researchers will collect clinical and laboratory data during periodic clinical assessments up to 1-year follow-up. RESULTS Data collection started in early 2016 and will be completed by the end of the first semester of 2020. Analyses will be performed soon afterward, followed by the elaboration of several articles. Articles will be submitted in early 2021. This research project has obtained a grant from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2014/12559-5). CONCLUSIONS We expect to provide insight into the consequences of recent sexual assault exposure in women by investigating the degree of neuroprogression developing from an early stage of PTSD. We also expect to provide important evidence on the efficacy of a non-exposure psychotherapy (IPT-PTSD) to mitigate PTSD symptoms in recently sexually assaulted women. Further, we aim to obtain evidence on how treatment outcomes are associated with neuroprogression measures. TRIAL REGISTRATION Brazilian Clinical Trials Registry RBR-3z474z; http://www.ensaiosclinicos.gov.br/rg/RBR-3z474z/. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/19162.
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Affiliation(s)
- Bruno Messina Coimbra
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mary Yeh
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana Teresa D'Elia
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mariana Rangel Maciel
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carolina Muniz Carvalho
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
- Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana Carolina Milani
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Adriana Mozzambani
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mario Juruena
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College, London, United Kingdom
| | - Sintia Iole Belangero
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
- Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Andrea Parolin Jackowski
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Dalva Poyares
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Andrea Feijo Mello
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Feijo Mello
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD, Universidade Federal de São Paulo, São Paulo, Brazil
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21
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Henschel AV, Williams JL, Hardt MM. The Role of Experiential Avoidance and Emotion Regulation in DSM-5 Posttraumatic Stress Symptomatology. JOURNAL OF LOSS & TRAUMA 2020. [DOI: 10.1080/15325024.2020.1841506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Aisling V. Henschel
- Department of Psychology, University of Missouri – Kansas City, Kansas City, Missouri, USA
| | - Joah L. Williams
- Department of Psychology, University of Missouri – Kansas City, Kansas City, Missouri, USA
| | - Madeleine M. Hardt
- Department of Psychology, University of Missouri – Kansas City, Kansas City, Missouri, USA
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22
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Chin WS, Liao SC, Pan SC, Guo YLL. Occupational and non-occupational injuries can result in prolonged augmentation of psychiatric disorders. J Epidemiol 2020; 32:12-20. [PMID: 33041319 PMCID: PMC8666318 DOI: 10.2188/jea.je20200374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The long-term effects of occupational injury (OI) on psychiatric diseases are unclear. This study assessed and compared the effects of OI, no injury (control), and non-OI (NOI) on the development of psychiatric diseases. Methods We used Taiwan’s National Health Insurance Research Database to investigate the incidence of psychiatric disorders in OI, NOI, and control groups. The subjects were aged 20–50 years, actively employed in 2000, and did not have history of injury or psychiatric disorders. All subjects were followed from 2000 and were classified into OI, NOI, and control groups according to occurrence of target injury later on. Individuals in each group were matched by age, sex, insurance premium before the index date, and year of the index date. Psychiatric disease-free days were compared among the groups using survival analysis and Cox regression. Results We included a total of 12,528 patients for final analysis, with 4,176 in each group. Compared with the control group, the OI group had an increased occurrence of trauma and stress-related disorder, depressive disorders, anxiety disorders, and alcohol and other substance dependence. These increases were similar to those in the NOI group. Elevated cumulative incidence rate of any psychiatric disorders was observed among those with OI or NOI up to 10 years after injury. Conclusion We confirmed that OI and NOI induced psychiatric disorders. These findings highlight the need for workers’ compensation mechanisms to consider long-term psychological care among injured workers.
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Affiliation(s)
- Wei-Shan Chin
- School of Nursing, College of Medicine, National Taiwan University (NTU) and NTU Hospital
| | - Shih-Cheng Liao
- Department of Psychiatry, College of Medicine, National Taiwan University (NTU) and NTU Hospital
| | - Shin-Chun Pan
- National Institute of Environmental Health Science, National Health Research Institutes
| | - Yue-Liang Leon Guo
- National Institute of Environmental Health Science, National Health Research Institutes.,Department of Environment and Occupational Medicine, College of Medicine, National Taiwan University and NTU Hospital
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23
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Abstract
There is increasing theoretical, clinical, and empirical support for the hypothesis that psychospiritual development, and more specifically, postconventional religious reasoning, may be related to moral injury. In this study, we assessed the contributions of exposure to potentially morally injurious events, posttraumatic stress symptoms, and psychospiritual development to moral injury symptoms in a sample of military veterans (N = 212). Psychospiritual development was measured as four dimensions, based on Wulff’s theory juxtaposing conventional vs. postconventional levels of religious reasoning, with decisions to be an adherent or a disaffiliate of faith. After controlling for exposure to potentially morally injurious events and severity of posttraumatic stress symptoms, veterans who were conventional disaffiliates reported higher scores on the Moral Injury Questionnaire than conventional adherents, postconventional adherents, or postconventional disaffiliates. We conclude that the role of psychospiritual development offers a theoretical approach to moral injury that invites collaboration between social scientists, philosophers, theologians, and medical professionals.
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24
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Reinhardt KM, Zerubavel N, Young AS, Gallo M, Ramakrishnan N, Henry A, Zucker NL. A multi-method assessment of interoception among sexual trauma survivors. Physiol Behav 2020; 226:113108. [PMID: 32721494 DOI: 10.1016/j.physbeh.2020.113108] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 06/01/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
It is well established that many female sexual trauma survivors experience dissociation, particularly disconnection from the body, in the aftermath of sexual trauma. This study aims to address the open question of how sexual trauma is associated with awareness of inner body sensations (i.e., interoception). Given the important role that interoception has in emotion regulation, a process with which survivors often struggle, it is important to understand the associations between interoception and PTSD symptoms among survivors. Through multi-methods, we assessed associations between interoception, dissociation, and PTSD symptoms among 200 female sexual trauma survivors. We assessed two components of interoception: interoceptive accuracy (IAc: accurately perceiving internal body sensations; via heartbeat perception task) and interoceptive sensibility (IS: self-report perception of sensitivity to interoceptive sensations). We hypothesized that IAc and IS would be positively correlated with PTSD, with interactions between IAc/dissociation and IS/dissociation qualifying those main effects, weakening them for survivors with higher dissociation. Results showed an opposite pattern than was predicted: although IAc did explain significant PTSD variance, as IAc increased, PTSD decreased. Although IAc did explain significant variance in PTSD symptoms, interestingly, IS did not. Consistent with extant literature, dissociation predicted significant variance in PTSD. These correlational results suggest that the ability to more accurately perceive inner body sensations is related to lower PTSD symptoms. Findings provide a foundation for future research that can assess if interventions (such as yoga or exercise) that target increasing interoceptive accuracy lead to decreases in PTSD symptoms. We discuss further clinical implications, limitations and future directions.
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Affiliation(s)
| | - Noga Zerubavel
- Department of Psychiatry and Behavioral Services, Duke University Medical Center
| | - Anna S Young
- University of Oregon; Oregon Health & Science University
| | | | | | | | - Nancy L Zucker
- Department of Psychology and Neuroscience, Duke University
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25
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Heeke C, O'Donald A, Stammel N, Böttche M. Same same but different? DSM-5 versus ICD-11 PTSD among traumatized refugees in Germany. J Psychosom Res 2020; 134:110129. [PMID: 32413613 DOI: 10.1016/j.jpsychores.2020.110129] [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: 09/09/2019] [Revised: 04/07/2020] [Accepted: 05/03/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The recent changes in diagnostic criteria for posttraumatic stress disorder (PTSD) in the 5th edition of the DSM and the 11th edition of the ICD marked a shift towards two perspectives on the same disorder. Previous studies indicate lower prevalence rates for the ICD-11-model as compared to the DSM-5 model. Main purpose of this study is to examine the concordance between ICD-11 and DSM-5 PTSD rates, and to assess the overlap of the two PTSD definitions with anxiety and depression among refugees. METHODS 167 traumatized refugees were assessed with the PCL-5 for the DSM-5 PTSD model. A subset of the items was used as criteria for the ICD-11 model. Depression and anxiety were measured with the HSCL-25. RESULTS The DSM-5-algorithm for PTSD identified significantly more cases (n = 147; 88%) than the ICD-11 algorithm (80%; n = 134). Level of agreement between the diagnostic systems was substantial (Κ = 0.67, p < .001) and 9% (n = 15) met criteria under one diagnostic system only. Overlap with depression and anxiety was high under both diagnostic systems. CONCLUSION PTSD rates indicated a highly distressed sample of survivors of war and trauma. Our data provide further evidence that the DSM-5 diagnoses a larger number of persons than the ICD-11. Although the level of agreement was substantial, the observed discrepancies represent a challenge for research and practice to reliably identify individuals with PTSD. Especially for refugees, this might affect their access to mental health care and appropriate treatment during an asylum procedure.
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Affiliation(s)
- Carina Heeke
- Freie University Berlin, Department of Clinical-Psychological Intervention, Habelschwerdter Allee 45, 14195 Berlin, Germany.
| | - Alicia O'Donald
- Freie University Berlin, Department of Clinical-Psychological Intervention, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Nadine Stammel
- Freie University Berlin, Department of Clinical-Psychological Intervention, Habelschwerdter Allee 45, 14195 Berlin, Germany; Center UEBERLEBEN gGmbH, Turmstr. 21, 10559 Berlin, Germany
| | - Maria Böttche
- Freie University Berlin, Department of Clinical-Psychological Intervention, Habelschwerdter Allee 45, 14195 Berlin, Germany; Center UEBERLEBEN gGmbH, Turmstr. 21, 10559 Berlin, Germany
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26
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Romero G, Huth-Bocks A, Puro-Gallagher E, Riggs J. Maternal prenatal depression, PTSD, and problematic parenting: the mediating role of maternal perceptions of infant emotion. J Reprod Infant Psychol 2020; 39:125-139. [PMID: 32320277 DOI: 10.1080/02646838.2020.1754371] [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] [Indexed: 10/24/2022]
Abstract
Background: Perinatal illness is alarmingly common and has negative effects on maternal and infant well-being. Depression and posttraumatic stress disorder (PTSD), specifically, are characterised by negative views of the self and others, which may impact a mother's perceptions of herself and her child. Objective: This study examined the relationship between depression and PTSD symptoms, maternal perceptions of infant emotions, and parenting behaviours. Methods: 120 pregnant, mostly low-income women and their infants (after birth) participated in a longitudinal study. Maternal depression and PTSD symptoms were assessed during pregnancy and 1 year postpartum; maternal perceptions of infant emotions and parenting quality were assessed at 1 year. Results: Correlation analyses revealed significant, negative associations between prenatal (but not postnatal) psychiatric symptoms and positive perceptions of infant emotions, as well as between positive perceptions of infant emotions and negative parenting. Results also revealed significant indirect effects of prenatal depressive and PTSD symptoms on negative parenting via perceptions of infant emotion (95% CIs:.0013 -.0200 and.0008 -.0083, respectively). Conclusion: Findings highlight that mothers should be routinely screened for psychiatric symptoms during the perinatal period, and perceptions of infant emotions may be an important target for parent-infant mental health interventions.
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Affiliation(s)
- Gloria Romero
- Department of Psychology, University of Tennessee-Knoxville , Knoxville, TN, USA
| | - Alissa Huth-Bocks
- Department of Pediatrics/Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center , Cleveland, OH, USA
| | | | - Jessica Riggs
- Department of Psychiatry, Michigan Medicine , Ann Arbor, MI, USA
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27
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Barger BT, Obedin-Maliver J, Capriotti MR, Lunn MR, Flentje A. Characterization of substance use among underrepresented sexual and gender minority participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Subst Abus 2020; 42:104-115. [PMID: 32032500 DOI: 10.1080/08897077.2019.1702610] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Profiles of substance use among less commonly described subgroups of sexual and gender minority (SGM) people (e.g., queer, genderqueer) remain largely unknown. Objective(s): To identify substance use differences among less commonly described SGM identity-based subgroups. Methods: The PRIDE Study is a national, online, longitudinal cohort study of self-identified SGM adults living in the U.S. Between 2015-2017, an iPhone application was used to administer three cross-sectional health questionnaires to participants, one of which included questions about binge alcohol, marijuana, and other drug use (substance use). This study was a secondary data analysis of participant responses to substance use survey items. Logistic regression and generalized linear modeling assessed relationships between sexual orientation or gender and use of or reported problems with substances within the past year. Results: Among the 1790 participants included in this study, 51.0% reported binge alcohol use, 39.8% reported marijuana use, and 19.7% reported other drug use (65.9% endorsed use of one or more of these) within the past year. Over 30% indicated substance use had been a problem in their life. Asexual individuals had lower odds of reporting past year binge alcohol and marijuana use (aOR: 0.27, 95% CI: 0.12-0.61; aOR: 0.38, 95% CI: 0.15-0.96, respectively), and queer participants had higher odds of reporting past year marijuana use (aOR: 2.52, 95% CI: 1.58-4.03) compared to lesbian participants. Gender nonbinary participants had lower odds of reporting past year binge alcohol use (aOR: 0.48, 95% CI: 0.32-0.71) and transmasculine participants had higher odds of reporting past year marijuana use (aOR: 2.18, 95% CI: 1.10-4.31) compared to cisgender women. Conclusions: Substance use heterogeneity exists between SGM groups. Comprehensive assessment of sexual orientation and gender may improve understanding of substance use and increase equity within support and treatment services for SGM populations. Highlights We examined substance use among less represented sexual and gender minority groups. Alcohol and other drug use were examined by both sexual orientation and gender identity. Analyses included identities such as queer, pansexual, genderqueer and nonbinary. Alcohol use differed across asexual, genderqueer and gender nonbinary groups. Marijuana use differed across queer, asexual and transmasculine groups.
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Affiliation(s)
- Branden T Barger
- Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, San Francisco, California, USA.,The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew R Capriotti
- Department of Psychology, San Jose State University, San Jose, California, USA.,Division of Nephrology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Department of Community Health Systems, University of California, San Francisco, School of Nursing, San Francisco, California, USA.,Alliance Health Project, Department of Psychiatry, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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28
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Gilbar O. Examining the boundaries between ICD-11 PTSD/CPTSD and depression and anxiety symptoms: A network analysis perspective. J Affect Disord 2020; 262:429-439. [PMID: 31744734 DOI: 10.1016/j.jad.2019.11.060] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/20/2019] [Accepted: 11/10/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Two newly identified sibling disorders - ICD-11 PTSD and CPTSD - have been well validated in the last few years. Although these trauma-related disorders are suggested to be neatly separated from depression and anxiety, no study has used a network analysis to examine those definitions' construct validity when they also interplay with symptoms of depression and anxiety. Additionally, no research has focused upon the specific boundaries between these four disorders' symptoms, the bridges between them, and the ways they influence each other among clinical populations. METHODS A sample of 234 men drawn randomly from a national sample of 1,600 Jewish men receiving treatment for domestic violence in Israel completed the ICD-11 International Trauma Questionnaire (ITQ) and Brief Symptom Inventory (BSI). RESULTS The ICD-11 CPTSD, depression and anxiety clustering network results revealed, within the EGA, a four-cluster solution in which PTSD and CPTSD symptoms are differentiated from two other distinct clusters of anxiety and depression symptoms. Feelings of worthlessness and avoiding internal reminders of the experience were the most central symptoms. LIMITATIONS Due to the use of a cross-sectional design, causal interpretation of the network correlation between symptoms should be made cautiously. CONCLUSIONS These findings strengthen the approach that ICD-11 PTSD and CPTSD have a distinct construct; however, they also reflect a strong positive connection to anxiety and depression symptoms and no clear boundaries between disorders. Specifically, dysphoria/avoidance-related symptoms act as a bridge between the disorders, which may be important targets for specific assessments and related interventions.
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Affiliation(s)
- Ohad Gilbar
- Boston University, VA Medical Center, Boston, United States; The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel.
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29
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Abstract
BACKGROUND Almost all patients with familial adenomatous polyposis undergo abdominal surgery with a risk of disease and surgery-related complications. This, the familial nature of the syndrome, and its wide-ranging manifestations make patients prone to mental health symptoms. If this is true, patients need appropriate evaluation and treatment. OBJECTIVE The purpose of this study was to record the experience of mental health symptoms in a group of unselected patients with FAP. DESIGN We conducted an observational study using an anonymized mental health symptom survey for patients affected with familial adenomatous polyposis. SETTINGS The study was conducted using the Hereditary Colorectal Cancer Registry in a tertiary referral center. PATIENTS Patients affected with familial adenomatous polyposis were included. MAIN OUTCOME MEASURES Results of the mental health survey were measured. RESULTS Seventy nine of 100 patients completed the survey; 57 endorsed ≥1 psychosocial symptom (72.2%). with a mean of 4 per patient. Nine patients (11.4%) met all 4 of the American Psychiatric Association diagnostic criteria for posttraumatic stress disorder, and 8 (10.1%) endorsed partial posttraumatic stress disorder criteria (3/4 symptoms). Patients who met all of the criteria for posttraumatic stress disorder had an average of 9.3 psychosocial symptoms each compared with 8.3 for those who met 3 of 4 and 2.2 for those who met <3. Six patients endorsed suicidal thoughts, all of whom met 3 or 4 of the criteria for posttraumatic stress disorder. LIMITATIONS The study was limited by its referral bias toward severe cases and relatively small number of patients. Because of the limitations of an anonymous self-administered screening, no mental health diagnoses have been given. CONCLUSIONS Patients with familial adenomatous polyposis are at risk for mental health symptoms, which can be multiple and severe. Some patients need professional counseling. A correlation between familial adenomatous polyposis patients with posttraumatic stress disorder and suicidal ideation is important. See Video Abstract at http://links.lww.com/DCR/A995. SÍNTOMAS PSICOPATOLÓGICOS EN PACIENTES CON PÓLIPOSIS ADENOMATOSO FAMILIAR: UN ESTUDIO OBSERVACIONAL: Un mayoría de pacientes con póliposis adenomatoso familiar (PAF) se someten a cirugía abdominal con los riesgos de enfermedad propria y complicaciones relacionadas a cirugía. Estos factores, la relación familiar del síndrome y sus manifestaciones altamente variables hacen que los pacientes sean propensos a psicopatologías. Si estas consideraciones son validas, los pacientes requieren evaluación y tratamiento adecuado. OBJETIVO Documentar la experiencia de los síntomas psicopatológicos en un grupo de pacientes no seleccionados con PAF. DISEÑO:: Estudio observacional utilizando una encuesta anónima de síntomas psicopatológicos en pacientes afectados con póliposis adenomatoso familiar. AMBIENTE CLINICO Registro de cáncer colorrectal hereditario en un centro de referencia de tercer nivel. PACIENTES Individuos afectados con póliposis adenomatoso familiar. OBJETIVOS PRINCIPALES A VALORACIÓN:: Resultados de la encuesta de salud mental. RESULTADOS Setenta y nueve de 100 pacientes completaron la encuesta; 57 afirmaron uno o más síntomas psicosociales (72,2%) con un promedio de 4 por paciente. 9 (11,4%) pacientes cumplieron con los 4 criterios de diagnóstico de la Asociación Estadounidense de Psiquiatría para el trastorno por estrés postraumático, y 8 (10,1%) llenaron los criterios del trastorno de estrés postraumático parcial (3/4 síntomas). Los pacientes que cumplieron con todos los criterios para el trastorno por estrés postraumático tuvieron un promedio de 9.3 síntomas psicosociales cada uno, en comparación con 8.3 para los que cumplieron con 3/4 y 2.2 para los que cumplieron con <3. 6 pacientes afirmaron pensamientos de suicidio, todos los cuales cumplieron con 3 o 4 de los criterios para el trastorno por estrés postraumático. LIMITACIONES Sesgo de referencia hacia casos graves, y un número relativamente pequeño de pacientes. Debido a las limitaciones de un examen anónimo auto administrado, no se confirmaron diagnósticos de psicopatología. CONCLUSIONES Los pacientes con póliposis adenomatoso familiar tienen riesgo de síntomas de salud mental alterada que pueden ser múltiples y graves. Algunos pacientes necesitan asesoramiento profesional. La correlación entre los pacientes con póliposis adenomatoso familiar con trastorno por estrés postraumático y ideación suicida es importante. Vea el Resumen del Video en http://links.lww.com/DCR/A995.
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Dalgaard NT, Diab SY, Montgomery E, Qouta SR, Punamäki RL. Is silence about trauma harmful for children? Transgenerational communication in Palestinian families. Transcult Psychiatry 2019; 56:398-427. [PMID: 30702385 DOI: 10.1177/1363461518824430] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Style of family communication is considered important in the transgenerational transmission of trauma. This study had three aims: first, to identify the contents of family communication about past national trauma; second, to examine how parents' current war trauma is associated with transgenerational communication; and third, to analyze the associations between transgenerational communication and children's mental health, measured as posttraumatic stress disorder (PTSD), depression and psychological distress. The study sample consisted of 170 Palestinian families in Gaza Strip, in which both mothers (n = 170) and fathers (n = 170) participated, each with their 11-13-year-old child. Mothers and fathers responded separately to three questions: 1) what did their own parents tell them about the War of 1948, Nakba?; 2) what did they tell their own children about the Nakba?; and 3) What did they tell their own children about the 1967 Arab-Israeli War and military occupation? Current war trauma, as reported separately by mothers, fathers and their children, refers to the Gaza War 2008/09. Children reported their symptoms of PTSD, depression, and psychological distress. Results revealed seven communication content categories and one category indicating maintaining silence about the traumas. Fathers' high exposure to current war trauma was associated with a higher level of communicating facts, reasons, and meanings regarding the1948 and 1967 wars, and mothers' high exposure to current war trauma was associated with a lower level of maintaining silence. Family communication about facts, reasons, and meanings was significantly associated with children not showing PTSD and marginally with not showing psychological distress, while maintaining silence was not associated with children's mental health.
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Marshall GN, Jaycox LH, Engel CC, Richardson AS, Dutra SJ, Keane TM, Rosen RC, Marx BP. PTSD symptoms are differentially associated with general distress and physiological arousal: Implications for the conceptualization and measurement of PTSD. J Anxiety Disord 2019; 62:26-34. [PMID: 30496918 DOI: 10.1016/j.janxdis.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/14/2018] [Accepted: 10/17/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The primary purpose of this study was to examine the place of posttraumatic stress disorder (PTSD) vis-à-vis the external dimensions of general distress and physiological arousal. METHODS Using data collected from veterans of the wars in Iraq and Afghanistan (N = 1350), latent variable covariance structure modeling was employed to compare correlations of PTSD symptom clusters and individual PTSD symptoms with general distress and physiological arousal. RESULTS Each PTSD symptom cluster, and 17 of 20 individual PTSD symptoms were more strongly associated with general distress than with physiological arousal. However, moderate to strong associations were also found between physiological arousal and both PTSD clusters and symptoms. LIMITATIONS Findings are based on self-reported data elicited from a single sample of veterans with substantial PTSD symptoms. Replication, particularly by clinician interview, is necessary. Generalizability to other traumatized populations is unknown. CONCLUSIONS Results offer support, with caveats, for viewing PTSD as a distress disorder. Findings are not consistent with the position that PTSD is a hybrid disorder with some features reflecting hyperarousal and others indicative of general distress. Results have implications for the conceptualization and measurement of PTSD.
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Affiliation(s)
- Grant N Marshall
- RAND Corporation, 1776 Main Street, Santa Monica, CA, United States.
| | | | | | | | - Sunny J Dutra
- VA National Center for PTSD, Boston University School of Medicine, Boston, MA, United States; William James College, Newton MA, USA
| | - Terence M Keane
- VA National Center for PTSD, Boston University School of Medicine, Boston, MA, United States
| | - Raymond C Rosen
- New England Research Institutes, Watertown, MA, United States
| | - Brian P Marx
- VA National Center for PTSD, Boston University School of Medicine, Boston, MA, United States
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Do adding attachment, oppression, cumulative and proliferation trauma dynamics to PTSD Criterion “a” improve its predictive validity: Toward a paradigm shift? CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00206-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tomich PL, Tolich A. Life is a balancing act: Deviation from a balanced time perspective mediates the relationship between lifetime trauma exposure and optimism. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00191-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aslaner D, Solmaz M, Kulacaoglu F, Ardic FC, Balcioglu YH, Kose S. Lifetime post-traumatic stress disorders in female trauma victims in an outpatient sample from Turkey. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1556910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Dilek Aslaner
- Department of Psychiatry, Health Sciences University Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Mustafa Solmaz
- Department of Psychiatry, Health Sciences University Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Filiz Kulacaoglu
- Department of Psychiatry, Health Sciences University Bagcilar Research and Training Hospital, Istanbul, Turkey
- Department of Psychiatry, Cerkezkoy State Hospital, Tekirdag, Turkey
| | - Ferhat Can Ardic
- Department of Psychiatry, Health Sciences University Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Yasin Hasan Balcioglu
- Bakirkoy Prof. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Forensic Psychiatry Unit, Istanbul, Turkey
| | - Samet Kose
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
- Department of Psychiatry, University of Texas Medical School of Houston, Houston, USA
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Zhang Y, Zhang OR, Li R, Flores A, Selek S, Zhang XY, Xu H. Psychiatric stressor recognition from clinical notes to reveal association with suicide. Health Informatics J 2018; 25:1846-1862. [PMID: 30328378 DOI: 10.1177/1460458218796598] [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: 01/22/2023]
Abstract
Suicide takes the lives of nearly a million people each year and it is a tremendous economic burden globally. One important type of suicide risk factor is psychiatric stress. Prior studies mainly use survey data to investigate the association between suicide and stressors. Very few studies have investigated stressor data in electronic health records, mostly due to the data being recorded in narrative text. This study takes the initiative to automatically extract and classify psychiatric stressors from clinical text using natural language processing-based methods. Suicidal behaviors were also identified by keywords. Then, a statistical association analysis between suicide ideations/attempts and stressors extracted from a clinical corpus is conducted. Experimental results show that our natural language processing method could recognize stressor entities with an F-measure of 89.01 percent. Mentions of suicidal behaviors were identified with an F-measure of 97.3 percent. The top three significant stressors associated with suicide are health, pressure, and death, which are similar to previous studies. This study demonstrates the feasibility of using natural language processing approaches to unlock information from psychiatric notes in electronic health record, to facilitate large-scale studies about associations between suicide and psychiatric stressors.
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Affiliation(s)
- Yaoyun Zhang
- The University of Texas Health Science Center at Houston, USA
| | | | - Rui Li
- The University of Texas Health Science Center at Houston, USA
| | | | | | | | - Hua Xu
- The University of Texas Health Science Center at Houston, USA
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Schorr Y, Stein NR, Maguen S, Barnes JB, Bosch J, Litz BT. Sources of moral injury among war veterans: A qualitative evaluation. J Clin Psychol 2018; 74:2203-2218. [PMID: 29984839 DOI: 10.1002/jclp.22660] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 05/09/2018] [Accepted: 06/05/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Service members deployed to war are at risk for moral injury, but the potential sources of moral injury are poorly understood. The aim of this qualitative study was to explore the types of events that veterans perceive as morally injurious and to use those events to develop a categorization scheme for combat-related morally injurious events. METHOD Six focus groups with US war veterans were conducted. RESULTS Analysis based on Grounded Theory yielded two categories (and eight subcategories) of events that putatively cause moral injury. The two categories were defined by the focal attribution of responsibility for the event: Personal Responsibility (veteran's reported distress is related to his own behavior) versus Responsibility of Others (veteran's distress is related to actions taken by others). Examples of each type of morally injurious event are provided. CONCLUSIONS Implications for the further development of the moral injury construct and treatment are discussed.
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Affiliation(s)
- Yonit Schorr
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
| | | | - Shira Maguen
- San Francisco VA Medical Center, San Francisco, California.,San Francisco School of Medicine, University of California, San Francisco, California
| | - J Ben Barnes
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Jeane Bosch
- San Francisco VA Medical Center, San Francisco, California
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts.,School of Medicine, Boston University, Boston, Massachusetts
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Knefel M, Lueger-Schuster B, Karatzias T, Shevlin M, Hyland P. From child maltreatment to ICD-11 complex post-traumatic stress symptoms: The role of emotion regulation and re-victimisation. J Clin Psychol 2018; 75:392-403. [PMID: 29931669 PMCID: PMC6686279 DOI: 10.1002/jclp.22655] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/24/2018] [Accepted: 06/05/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Complex post-traumatic stress disorder (CPTSD) will be introduced in ICD-11 and comprises symptoms of PTSD and disturbances in self-organisation (DSO). The association of trauma with PTSD and DSO is not yet fully understood. We investigated the path from child maltreatment to PTSD and DSO and examined the mediating role of emotion regulation (ER) and adult interpersonal re-victimisation. METHOD Adult patients (N = 193) from a Scottish National Health Service clinic participated in the project. Participants completed measures of life events, ICD-11 PTSD and CPTSD, and ER. Path analysis was used to assess possible direct and indirect effects from childhood trauma on current post-traumatic psychopathology. RESULTS Overall results indicate that the path from child maltreatment to PTSD is a direct one, while the path to DSO is indirectly mediated by ER. CONCLUSIONS Future research should address the potentially beneficial effect of treatment protocols for CPTSD explicitly aiming at reducing ER difficulties.
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Affiliation(s)
- Matthias Knefel
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Brigitte Lueger-Schuster
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.,NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, UK
| | - Phil Hyland
- School of Business, National College of Ireland, Dublin, Ireland
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Feingold D, Rehm J, Factor H, Redler A, Lev-Ran S. Clinical and functional outcomes of cannabis use among individuals with anxiety disorders: A 3-year population-based longitudinal study. Depress Anxiety 2018; 35:490-501. [PMID: 29486095 DOI: 10.1002/da.22735] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/09/2018] [Accepted: 01/29/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cannabis use has been reported to negatively affect the course and outcome of various psychiatric disorders, yet little is known on its effect on rates of remission from anxiety disorders and associated clinical and functional outcomes. METHODS In this study, data were drawn from Waves 1 and 2 of the National Epidemiologic survey on Alcohol and Related Conditions, focusing on individuals who qualified for a diagnosis of any anxiety disorder (social anxiety, panic disorder, generalized anxiety disorder, and specific phobias) at Wave 1 (N = 3,723). Cannabis users and individuals with cannabis use disorders (CUDs) throughout a 4-year period were compared to nonusers in rates of remission, suicidality, general functioning, and quality of life at Wave 2, while controlling for baseline confounders. RESULTS Although rates of remission decreased with level of cannabis use, this was not maintained in adjusted models. Aside from specific outcomes (individuals with CUDs were significantly more prone to report breaking up from a romantic relationship; adjusted odds ratio [AOR] = 3.85, 95% confidence interval [CI] = 1.66-8.97) and repeatedly quitting school (AOR = 6.02, 95% CI = 2.65-13.66)), following adjustment no additional differences were found in outcome measures. CONCLUSIONS These findings add to previous reports suggesting that poorer outcome of anxiety disorders among cannabis users may be attributed mainly to differences in baseline factors and not cannabis use.
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Affiliation(s)
- Daniel Feingold
- Psychology Department, Ariel University, Ariel, Israel.,Lev-Hasharon Medical Center, Pardesiya, Israel
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Klinische Psychologie & Psychotherapie, Technische Universität Dresden, Dresden, Germany
| | - Hagai Factor
- Masters Program, Psychology Department, Ariel University, Ariel, Israel
| | - Avigayil Redler
- Masters Program, Psychology Department, Ariel University, Ariel, Israel
| | - Shaul Lev-Ran
- Lev-Hasharon Medical Center, Pardesiya, Israel.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Silverstein MW, Dieujuste N, Kramer LB, Lee DJ, Weathers FW. Construct validation of the hybrid model of posttraumatic stress disorder: Distinctiveness of the new symptom clusters. J Anxiety Disord 2018; 54:17-23. [PMID: 29421368 DOI: 10.1016/j.janxdis.2017.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/31/2017] [Accepted: 12/13/2017] [Indexed: 11/29/2022]
Abstract
Despite the factor analytic support for the seven-factor hybrid model (Armour et al., 2015) of posttraumatic stress disorder (PTSD), little research has examined the degree to which newly established symptom clusters (i.e., negative affect, anhedonia, dysphoric arousal, anxious arousal, externalizing behavior) functionally and meaningfully differ in their associations with other clinical phenomena. The aim of the current study was to examine the degree to which newly established PTSD symptom clusters differentially relate to co-occurring psychopathology and related clinical phenomena through Wald testing using latent variable modeling. Participants were 535 trauma-exposed undergraduates who completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5; Weathers et al., 2013) and Personality Assessment Inventory (PAI; Morey, 1991). As expected and in line with results from previous studies, significant heterogeneity emerged for dysphoric arousal, anxious arousal, and externalizing behavior. However, there was less evidence for the distinctiveness of negative affect and anhedonia. Results indicate that only some of the newly established symptom clusters significantly differ in their associations with related clinical phenomena and that the hybrid model might not provide a meaningful framework for understanding which PTSD symptoms relate to associated features. Limitations include a non-clinical sample and reliance on retrospective self-report assessment measures.
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Affiliation(s)
| | - Nathalie Dieujuste
- VISN 19 Rocky Mountain MIRECC, Denver Veterans Affairs Medical Center, United States
| | | | - Daniel J Lee
- Veterans Affairs Boston Healthcare System, Boston University School of Medicine, United States
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Bachem R, Casey P. Adjustment disorder: A diagnosis whose time has come. J Affect Disord 2018; 227:243-253. [PMID: 29107817 DOI: 10.1016/j.jad.2017.10.034] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/06/2017] [Accepted: 10/19/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjustment disorder is among the most frequently diagnosed mental disorders in clinical practice although it has received little academic attention and been the subject of substantial criticism over the past decades. While those suffering with adjustment disorders are often treated by mental health professionals, research interest in the origin of the disorder or the effectiveness of psychotherapeutic and medical interventions has only recently begun to emerge. This article summarizes the empirical literature published on adjustment disorder and points out current diagnostic developments in DSM-5 and ICD-11. METHODS Literature for this review was identified through established online search tools, including publications in English, German, and Spanish. RESULTS This paper reviews literature on the evolution of adjustment disorder, and highlights the current state of research with regard to genesis and treatment. Importantly, for the first time ICD-11 intends to define adjustment disorder by explicit symptom groups, unlike DSM-5. LIMITATIONS Publications without an English abstract were not included. CONCLUSIONS Key directions for future research include investigating the concordance of the ICD-11 and DSM-5 concepts and the effect that the diverging conceptualizations may have. Risk and protective factors specific to AD should be identified and the biological underpinnings of the disorder should be explored. Finally, given the high prevalence of AD in certain clinical settings effective disorder-specific interventions should be developed and evaluated.
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Affiliation(s)
- Rahel Bachem
- Bob Shapell School of Social Work, Tel Aviv University, Chaim Levanon 30, Tel Aviv 699780, Israel.
| | - Patricia Casey
- University College Dublin, School of Medicine, Mater Misericordiae Hospital, 62/63 Eccles Street, Dublin 7, Ireland
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Nasanbuyan N, Yoshida M, Takayanagi Y, Inutsuka A, Nishimori K, Yamanaka A, Onaka T. Oxytocin-Oxytocin Receptor Systems Facilitate Social Defeat Posture in Male Mice. Endocrinology 2018; 159:763-775. [PMID: 29186377 DOI: 10.1210/en.2017-00606] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/14/2017] [Indexed: 11/19/2022]
Abstract
Social stress has deteriorating effects on various psychiatric diseases. In animal models, exposure to socially dominant conspecifics (i.e., social defeat stress) evokes a species-specific defeat posture via unknown mechanisms. Oxytocin neurons have been shown to be activated by stressful stimuli and to have prosocial and anxiolytic actions. The roles of oxytocin during social defeat stress remain unclear. Expression of c-Fos, a marker of neuronal activation, in oxytocin neurons and in oxytocin receptor‒expressing neurons was investigated in mice. The projection of oxytocin neurons was examined with an anterograde viral tracer, which induces selective expression of membrane-targeted palmitoylated green fluorescent protein in oxytocin neurons. Defensive behaviors during double exposure to social defeat stress in oxytocin receptor‒deficient mice were analyzed. After social defeat stress, expression of c-Fos protein was increased in oxytocin neurons of the bed nucleus of the stria terminalis, supraoptic nucleus, and paraventricular hypothalamic nucleus. Expression of c-Fos protein was also increased in oxytocin receptor‒expressing neurons of brain regions, including the ventrolateral part of the ventromedial hypothalamus and ventrolateral periaqueductal gray. Projecting fibers from paraventricular hypothalamic oxytocin neurons were found in the ventrolateral part of the ventromedial hypothalamus and in the ventrolateral periaqueductal gray. Oxytocin receptor‒deficient mice showed reduced defeat posture during the second social defeat stress. These findings suggest that social defeat stress activates oxytocin-oxytocin receptor systems, and the findings are consistent with the view that activation of the oxytocin receptor in brain regions, including the ventrolateral part of the ventromedial hypothalamus and the ventrolateral periaqueductal gray, facilitates social defeat posture.
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Affiliation(s)
- Naranbat Nasanbuyan
- Division of Brain and Neurophysiology, Department of Physiology, Jichi Medical University, Shimotsuke-shi, Tochigi-ken, Japan
| | - Masahide Yoshida
- Division of Brain and Neurophysiology, Department of Physiology, Jichi Medical University, Shimotsuke-shi, Tochigi-ken, Japan
| | - Yuki Takayanagi
- Division of Brain and Neurophysiology, Department of Physiology, Jichi Medical University, Shimotsuke-shi, Tochigi-ken, Japan
| | - Ayumu Inutsuka
- Division of Brain and Neurophysiology, Department of Physiology, Jichi Medical University, Shimotsuke-shi, Tochigi-ken, Japan
| | - Katsuhiko Nishimori
- Laboratory of Molecular Biology, Department of Molecular and Cell Biology, Graduate School of Agricultural Science, Tohoku University, Aoba-ku, Sendai-shi, Miyagi-ken, Japan
| | - Akihiro Yamanaka
- Department of Neuroscience II, Research Institute of Environmental Medicine, Nagoya University, Nagoya-shi, Aichi-ken, Japan
| | - Tatsushi Onaka
- Division of Brain and Neurophysiology, Department of Physiology, Jichi Medical University, Shimotsuke-shi, Tochigi-ken, Japan
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Mendoza C, Barreto GE, Iarkov A, Tarasov VV, Aliev G, Echeverria V. Cotinine: A Therapy for Memory Extinction in Post-traumatic Stress Disorder. Mol Neurobiol 2018; 55:6700-6711. [PMID: 29335846 DOI: 10.1007/s12035-018-0869-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/07/2018] [Indexed: 12/14/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a mental disorder that may develop after exposure to exceptionally threatening or unescapable horrifying events. Actual therapies fail to alleviate the emotional suffering and cognitive impairment associated with this disorder, mostly because they are ineffective in treating the failure to extinguish trauma memories in a great percentage of those affected. In this review, current behavioral, cellular, and molecular evidence supporting the use of cotinine for treating PTSD are reviewed. The role of the positive modulation by cotinine of the nicotinic acetylcholine receptors (nAChRs) and their downstream effectors, the protection of astroglia, and the inhibition of microglia in the PTSD brain are also discussed.
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Affiliation(s)
- Cristhian Mendoza
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia.,Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Alexandre Iarkov
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile
| | - Vadim V Tarasov
- Institute of Pharmacy and Translational Medicine, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
| | - Gjumrakch Aliev
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, Severniy Proezd, Chernogolovka, Moscow Region, 1142432, Russia. .,"GALLY" International Biomedical Research Consulting LLC, San Antonio, TX, 78229, USA. .,School of Health Sciences and Healthcare Administration, University of Atlanta, Johns Creek, GA, 30097, USA.
| | - Valentina Echeverria
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile. .,Bay Pines VA Healthcare System, Research and Development, Bay Pines, FL, 33744, USA.
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Bachem R, Perkonigg A, Stein DJ, Maercker A. Measuring the ICD-11 adjustment disorder concept: Validity and sensitivity to change of the Adjustment Disorder - New Module questionnaire in a clinical intervention study. Int J Methods Psychiatr Res 2017; 26:e1545. [PMID: 27862575 PMCID: PMC6877162 DOI: 10.1002/mpr.1545] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/19/2016] [Accepted: 09/23/2016] [Indexed: 11/07/2022] Open
Abstract
Adjustment disorder (AjD) is a frequent but under-researched diagnosis due in part to a lack of specific symptom criteria and adequate tools of measurement. The ICD-11 for the first time proposes a positive symptom catalogue to define AjD. This study presents a validation of the Adjustment Disorder - New Module (ADNM), the first symptom severity measure for AjD according to the ICD-11 concept. Validity and sensitivity to change were investigated in a sample of 190 individuals with a DSM-IV diagnosis of AjD. The ADNM scales demonstrated convergent and discriminant validity for anxiety symptoms (Hamilton Anxiety Scale; psychic anxiety r = 0.18-0.31), functional impairment (Sheehan Disability Scale; r = 0.18-0.47), and depression (Montgomery-Asberg Depression Scale; r = 0.13-0.30). At baseline 78% of the individuals with a DSM-IV diagnosis of AjD were also classified so by the ADNM. Repeated-measures ANOVA indicated significant ADNM-symptom decrease during treatment, replicating the patterns of the Hamilton Anxiety Scale, Sheehan Disability Scale, and Clinical Global Impression Scale. This article presents the first use of the ADNM as a measure for ICD-11 AjD in a randomized-controlled intervention study of AjD. It provides support for the construct validity and sensitivity to symptom change of this scale during pharmacological treatment.
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Affiliation(s)
- Rahel Bachem
- Department of Psychology, Psychopathology and Clinical Intervention Unit, University of Zurich, Zurich, Switzerland
| | - Axel Perkonigg
- Department of Psychology, Psychopathology and Clinical Intervention Unit, University of Zurich, Zurich, Switzerland
| | - Dan J Stein
- Department of Psychiatry, Groote Schuur Hospital J2, University of Cape Town and MRC Unit on Anxiety & Stress Disorders, Cape Town, South Africa
| | - Andreas Maercker
- Department of Psychology, Psychopathology and Clinical Intervention Unit, University of Zurich, Zurich, Switzerland
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Mordeno IG, Hall BJ. DSM-5-based latent PTSD models: Assessing structural relations with GAD in Filipino post-relocatees. Psychiatry Res 2017; 258:1-8. [PMID: 28964957 DOI: 10.1016/j.psychres.2017.09.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/12/2017] [Accepted: 09/22/2017] [Indexed: 12/28/2022]
Abstract
An increasing number of studies investigated the latent factor structure of posttraumatic stress disorder (PTSD) symptomatology following the new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To date, there is no consensus on the best representation of PTSD. This study examined six latent PTSD models in a sample of Filipino post-disaster relocatees (N = 523). Further investigation on the relationship of the best-fitting model to generalized anxiety disorder (GAD) in the latent level was conducted. The seven-factor hybrid model consisting of intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal, was the best fitting model. Latent associations between the factors in the hybrid model and GAD suggest there are core and transdiagnostic features of PTSD. These findings have implications for understanding the underlying mechanism of PTSD and can inform the development of trauma-related interventions, particularly among post-disaster relocatees.
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Affiliation(s)
- Imelu G Mordeno
- College of Education, Mindanao State University, Iligan Institute of Technology, Philippines
| | - Brian J Hall
- Global and Community Mental Health Research Group, Faculty of Social Sciences (E21), University of Macau, Avenida da Universidade, Taipa, Macau, Hong Kong Special Administrative Region; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Muris P, Mannens J, Peters L, Meesters C. The Youth Anxiety Measure for DSM-5 (YAM-5): Correlations with anxiety, fear, and depression scales in non-clinical children. J Anxiety Disord 2017; 51:72-78. [PMID: 28668214 DOI: 10.1016/j.janxdis.2017.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 06/04/2017] [Accepted: 06/11/2017] [Indexed: 10/19/2022]
Abstract
The Youth Anxiety Measure for DSM-5 (YAM-5) is a newly developed rating scale for assessing anxiety disorder symptoms of children and adolescents in terms of the contemporary classification system. In the present study, 187 children aged 8-12 years completed the new measure as well as the trait version of the State-Trait Anxiety Inventory for Children (STAIC), the Short Form of the Fear Survey Schedule for Children-Revised (FSSC-R-SF), the Spence Children's Anxiety Scale (SCAS), the Selective Mutism Questionnaire (SMQ), and the Children's Depression Inventory (CDI). Results indicated that part one of the YAM-5, which measures symptoms of the major anxiety disorders, was most substantially linked with the trait anxiety scale of the STAIC, whereas part two, which measures phobic symptoms, was most clearly associated with the FSSC-R-SF. The correlation between the YAM-5 and the SCAS was also robust, and particularly strong correlations were found between subscales of both questionnaires that assessed similar symptoms. Further, the selective mutism subscale of the YAM-5 was most clearly linked to the SMQ. Finally, the YAM-5 was also significantly correlated with depression symptoms as indexed by the CDI. These findings provide further support for the concurrent validity of the YAM-5.
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Affiliation(s)
- Peter Muris
- Maastricht University, The Netherlands; Stellenbosch University, South Africa; Virenze-RIAGG Maastricht, The Netherlands.
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Farnsworth JK, Drescher KD, Evans W, Walser RD. A functional approach to understanding and treating military-related moral injury. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017. [DOI: 10.1016/j.jcbs.2017.07.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Norton PJ, Paulus DJ. Transdiagnostic models of anxiety disorder: Theoretical and empirical underpinnings. Clin Psychol Rev 2017; 56:122-137. [DOI: 10.1016/j.cpr.2017.03.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/07/2017] [Accepted: 03/21/2017] [Indexed: 01/18/2023]
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Delaparte L, Yeh FC, Adams P, Malchow A, Trivedi MH, Oquendo MA, Deckersbach T, Ogden T, Pizzagalli DA, Fava M, Cooper C, McInnis M, Kurian BT, Weissman MM, McGrath PJ, Klein DN, Parsey RV, DeLorenzo C. A comparison of structural connectivity in anxious depression versus non-anxious depression. J Psychiatr Res 2017; 89:38-47. [PMID: 28157545 PMCID: PMC5374003 DOI: 10.1016/j.jpsychires.2017.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/16/2016] [Accepted: 01/19/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) and anxiety disorders are highly co-morbid. Research has shown conflicting evidence for white matter alteration and amygdala volume reduction in mood and anxiety disorders. To date, no studies have examined differences in structural connectivity between anxious depressed and non-anxious depressed individuals. This study compared fractional anisotropy (FA) and density of selected white matter tracts and amygdala volume between anxious depressed and non-anxious depressed individuals. METHODS 64- direction DTI and T1 scans were collected from 110 unmedicated subjects with MDD, 39 of whom had a co-morbid anxiety disorder diagnosis. Region of interest (ROI) and tractography methods were performed to calculate amygdala volume and FA in the uncinate fasciculus, respectively. Diffusion connectometry was performed to identify whole brain group differences in white matter health. Correlations were computed between biological and clinical measures. RESULTS Tractography and ROI analyses showed no significant differences between bilateral FA values or bilateral amygdala volumes when comparing the anxious depressed and non-anxious depressed groups. The diffusion connectometry analysis showed no significant differences in anisotropy between the groups. Furthermore, there were no significant relationships between MRI-based and clinical measures. CONCLUSION The lack of group differences could indicate that structural connectivity and amygdalae volumes of those with anxious-depression are not significantly altered by a co-morbid anxiety disorder. Improving understanding of anxiety co-morbid with MDD would facilitate development of treatments that more accurately target the underlying networks.
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Affiliation(s)
- Lauren Delaparte
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA; Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pittsburgh
| | - Phil Adams
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ashley Malchow
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Maria A. Oquendo
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, New York
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Todd Ogden
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Crystal Cooper
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melvin McInnis
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Benji T. Kurian
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Myrna M. Weissman
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, New York
| | - Patrick J. McGrath
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, New York
| | - Daniel N. Klein
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Ramin V. Parsey
- Department of Psychiatry, Stony Brook University, Stony Brook, New York,Department of Radiology, Stony Brook University, Stony Brook, New York
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Sekhon B. Concept Analysis of Posttraumatic Stress Disorder. Int J Nurs Knowl 2017; 29:176-183. [PMID: 28544554 DOI: 10.1111/2047-3095.12177] [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: 11/30/2022]
Abstract
PURPOSE Mental health nursing is not the same as psychiatry, so it is important for nurses to have an understanding of the defining attributes, antecedents, consequences, model cases, and empirical referents of post-traumatic stress disorder (PTSD). METHOD Walker and Avant's (2005) method is used to guide this concept analysis of PTSD. FINDINGS Four attributes arise from this concept analysis, which are addressed through both the DSM-IV and DSM-5 (American Psychiatric Association, /): triggering event or events, re-experiencing, fear, and helplessness. Though a majority of the defining attributes are addressed through both versions of the DSM, a key fifth attribute arises through this concept analysis: a disruption of meaning. CONCLUSIONS A better understanding of PTSD from a nursing perspective will help inform appropriate nursing interventions and prevention strategies, while expanding the knowledge synthesis and contribution of the nursing profession. PRACTICE IMPLICATIONS A model case, borderline case, and contrary case of PTSD are provided. Discussion of the importance of a lack or loss of meaning in PTSD is included, along with exploration of transformative learning theory to inform clinical practice for nurses addressing a disruption of meaning.
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Affiliation(s)
- Bikram Sekhon
- Bikram Sekhon, is a graduate student in the Masters of Nursing thesis-based program at the Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Cascella M, Fusco R, Caliendo D, Granata V, Carbone D, Muzio MR, Laurelli G, Greggi S, Falcone F, Forte CA, Cuomo A. Anesthetic dreaming, anesthesia awareness and patient satisfaction after deep sedation with propofol target controlled infusion: A prospective cohort study of patients undergoing day case breast surgery. Oncotarget 2017; 8:79248-79256. [PMID: 29108303 PMCID: PMC5668036 DOI: 10.18632/oncotarget.17238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/21/2017] [Indexed: 12/17/2022] Open
Abstract
Background Anesthetic dreaming and anesthesia awareness are well distinct phenomena. Although the incidence of intraoperative awareness is more common among patients who reported a dream after surgery, the exact correlation between the two phenomena remains an unsolved rebus. The main purpose of this study was to investigate anesthetic dreaming, anesthesia awareness and psychological consequences eventually occurred under deep sedation. Intraoperative dreaming experiences were correlated with dream features in natural sleep. Methods Fifty-one patients, undergoing surgical excision of fibroadenomas under a Bispectral index-guided deep sedation anesthesia with propofol target controlled infusion, were enrolled into this prospective study. Psychological assessment was performed through the State Trait Anxiety Inventory. A questionnaire was adopted to register dreaming and anesthesia awareness. Data were collected after emergence (t0), 24 hours (t1), 1 month (t2), 6 months (t3). Results Six patients (12%) reported anesthetic dreaming at t0 confirming the response at each subsequent evaluation. One patient (2%) confirmed dreaming during anesthesia in all, but denied it at t0. There was a high correlation between the intraoperative dream contents and the features of dreams in natural sleep. No cases of anesthesia awareness were detected. A similar level of satisfaction was observed in dreaming and no-dreaming patients. Conclusions Anesthetic dreaming does not seem to influence satisfaction of patients undergoing deep sedation with propofol target controlled infusion. A psychological assessment would seem to improve the evaluation of possible psychological consequences in dreamer patient.
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Affiliation(s)
- Marco Cascella
- Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Roberta Fusco
- Department of Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Domenico Caliendo
- Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Vincenza Granata
- Department of Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Domenico Carbone
- Department of Emergency Medicine, Umberto I Hospital, Nocera Inferiore, Salerno, Italia
| | - Maria Rosaria Muzio
- Division of Infantile Neuropsychiatry, UOMI, Maternal and Infant Health, Torre del Greco, Napoli, Italia
| | - Giuseppe Laurelli
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Stefano Greggi
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Francesca Falcone
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Cira Antonietta Forte
- Psychology, Division of Pain Medicine, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Arturo Cuomo
- Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
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