Co-Occurring Posttraumatic Stress Disorder and Depression Among Young Children

Efficacy of traumatic memory reactivation with or without propranolol in PTSD with high dissociative experiences

Background: Post-traumatic stress disorder (PTSD) with dissociative symptoms is now a full-fledged subtype of this disorder. The dissociative subtype is associated with a greater number of psychiatric comorbidities. To date, the impact of dissociation on the efficacy of PTSD treatment remains unclear.Objective: The aim of this study was to compare the efficacy of a traumatic memory reactivation procedure with the administration of propranolol or a placebo once a week for six consecutive weeks in reducing PTSD and MDE symptoms between PTSD subjects with or without high dissociative symptoms.Method: For that, we conducted a randomized clinical trial in 66 adults diagnosed with longstanding PTSD and measured the SCID PTSD module, the PTSD Checklist (PCL-S), Beck's Depression Inventory-II (BDI-II), and the Dissociative Experiences Scale (DES).Results: Patients with and without high dissociative experience had significant improvement in their PCL-S scores over the 6 treatment sessions, and PCL-S scores continued to decline in all patients during the post-treatment period. However, there was no correlation between the presence/absence of high dissociative experiences and no specific effect of propranolol treatment. We found exactly the same results for MDE symptoms. Interestingly, patients with high dissociative experiences before treatment exhibited very significant improvement in their DES scores after the 6 treatment sessions, and patients maintained this improvement 3 months post-treatment.Conclusions: The traumatic memory reactivation procedure is an effective way to treat dissociative symptoms in patients with PTSD, and improvement of these dissociative symptoms was associated with a decrease in both PTSD and depression severity.

Influence of earthquake exposure and left-behind status on severity of post-traumatic stress disorder and depression in Chinese adolescents

In the Longmenshan seismic fault zone in the Sichuan province of China, many children and adolescents have been exposed to the 2008 Wenchuan earthquake and/or the 2013 Lushan earthquake, and many are left alone for extended periods by parents who migrate to larger cities for work. We wished to examine how these two kinds of trauma-earthquake exposure and left-behind status-influence severity of post-traumatic stress disorder (PTSD) and depressive reactions. A cross-sectional survey of 2447 adolescents aged 13-18 at 11 schools in three cities in the Longmenshan fault zone was conducted in 2016. Potential relationships of scores on the Children's Revised Impact of Event Scale (CRIES-13) and the Depression Self-Rating Scale (KADS-6) with severity of PTSD and depression symptoms were explored using ANOVA and multiple hierarchical linear regression. Prevalence of post-traumatic stress and depression symptoms were higher among left-behind children than among those not left behind, and both types of symptoms were more severe in children exposed to both earthquakes than in children exposed only to the Lushan earthquake. Our results suggest that earthquake exposure is a strong risk factor for PTSD, whereas being left behind is a strong risk factor for depression.