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Salloum A, Boedeker P, Morris C, Storch EA. Suicidal Ideation, Clinical Worsening and Outcomes among Child Participants in Trauma-Focused Treatment. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01242-5. [PMID: 39325087 DOI: 10.1007/s10802-024-01242-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2024] [Indexed: 09/27/2024]
Abstract
Research on clinical trajectories of children with suicidal ideation (SI) and clinical worsening (CW) during cognitive behavioral therapy (CBT) for childhood trauma is limited. The current study utilized secondary data from a randomized clinical trial comparing Trauma-Focused CBT versus Stepped care CBT to examine (1) clinical profile and outcomes of children with SI, recurrent thoughts of death/dying, and past attempts; and (2) clinical worsening during treatment and difference in outcomes. Children (ages 4-12) and their parents (N = 183) participated and 132 completed treatment. Interviews assessing SI, thoughts of death/dying, past attempts, and number/type of trauma were conducted with children (ages 7-12) and parents. Outcome measures (baseline and post-treatment) completed by parents included child posttraumatic stress symptoms, impairment, and internalizing and externalizing problems and an independent evaluator rated overall severity. Children (ages 7-12), parents and therapists completed ratings during treatment that indicated CW. Results did not differ by treatment group; thus, the pooled sample was used. Children with SI at baseline had higher severity than children without. For completers, no children (n = 14) with SI at baseline had SI at post-treatment. Child (n = 3) and therapist (n = 5) ratings of CW were low. Eighteen children (13.64%) were rated as CW by parents. Most ratings occurred at the beginning of treatment. Children with therapist ratings of CW had higher internalizing problems. Findings suggest that children with SI and CW can improve from trauma-focused CBT. More research is needed on the clinical trajectory of children with SI and trauma, and on clinical tools to monitor CW. Clinical trial registration information: https://clinicaltrials.gov : NCT02537678.
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Affiliation(s)
- Alison Salloum
- School of Social Work, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL, MHC 1400, USA.
| | - Peter Boedeker
- Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, TX, USA
| | - Cleo Morris
- College of Behavioral and Community Sciences, Cleo Morris, University of South Florida, Tampa, FL, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Riaz K, Suneel S, Hamza Bin Abdul Malik M, Kashif T, Ullah I, Waris A, Di Nicola M, Mazza M, Sani G, Martinotti G, De Berardis D. MDMA-Based Psychotherapy in Treatment-Resistant Post-Traumatic Stress Disorder (PTSD): A Brief Narrative Overview of Current Evidence. Diseases 2023; 11:159. [PMID: 37987270 PMCID: PMC10660711 DOI: 10.3390/diseases11040159] [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: 09/06/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating mental health disorder that causes significant dysfunction in individuals. Currently, there are many approved pharmacotherapy and psychotherapy treatment options for PTSD, but unfortunately, half of the patients do not respond to traditional therapies. In this article, we review clinical trials and research on 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in PTSD patients, its pharmacokinetics, and current treatment guidelines for PTSD. Our findings are based on the results of the efficacy of MDMA-assisted psychotherapy from six phase II randomized controlled trials. MDMA-assisted psychotherapy for PTSD has received the "breakthrough therapy" designation from the FDA. MDMA can reduce PTSD symptoms even in treatment-resistant cases by increasing certain neurohormones, i.e., dopamine, serotonin, norepinephrine, and oxytocin. It also modulates activities in the brain regions involved in fear and anxiety. Future research is needed to show whether the advantages outweigh the disadvantages and whether its use can be integrated into available treatment options for PTSD.
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Affiliation(s)
- Kainat Riaz
- Dow Medical College, Dow University of Health Sciences, Karachi 75700, Pakistan; (K.R.); (S.S.)
| | - Sejal Suneel
- Dow Medical College, Dow University of Health Sciences, Karachi 75700, Pakistan; (K.R.); (S.S.)
| | | | - Tooba Kashif
- Jinnah Sindh Medical University, Karachi 75510, Pakistan;
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar 25120, Pakistan; (I.U.); (A.W.)
| | - Abdul Waris
- Kabir Medical College, Gandhara University, Peshawar 25120, Pakistan; (I.U.); (A.W.)
| | - Marco Di Nicola
- Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.D.N.); (M.M.); (G.S.)
| | - Marianna Mazza
- Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.D.N.); (M.M.); (G.S.)
| | - Gabriele Sani
- Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.D.N.); (M.M.); (G.S.)
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging, and Clinical Sciences, University G. D’Annunzio, 66100 Chieti-Pescara, Italy;
| | - Domenico De Berardis
- Department of Psychiatry, Azienda Sanitaria Locale 4, 64100 Teramo, Italy
- School of Nursing, University of L’Aquila, 67100 L’Aquila, Italy
- International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, 443100 Samara, Russia
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Brewerton TD. The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines. Front Psychiatry 2023; 14:1149433. [PMID: 37252137 PMCID: PMC10213703 DOI: 10.3389/fpsyt.2023.1149433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
Psychiatric comorbidity is the norm in the assessment and treatment of eating disorders (EDs), and traumatic events and lifetime PTSD are often major drivers of these challenging complexities. Given that trauma, PTSD, and psychiatric comorbidity significantly influence ED outcomes, it is imperative that these problems be appropriately addressed in ED practice guidelines. The presence of associated psychiatric comorbidity is noted in some but not all sets of existing guidelines, but they mostly do little to address the problem other than referring to independent guidelines for other disorders. This disconnect perpetuates a "silo effect," in which each set of guidelines do not address the complexity of the other comorbidities. Although there are several published practice guidelines for the treatment of EDs, and likewise, there are several published practice guidelines for the treatment of PTSD, none of them specifically address ED + PTSD. The result is a lack of integration between ED and PTSD treatment providers, which often leads to fragmented, incomplete, uncoordinated and ineffective care of severely ill patients with ED + PTSD. This situation can inadvertently promote chronicity and multimorbidity and may be particularly relevant for patients treated in higher levels of care, where prevalence rates of concurrent PTSD reach as high as 50% with many more having subthreshold PTSD. Although there has been some progress in the recognition and treatment of ED + PTSD, recommendations for treating this common comorbidity remain undeveloped, particularly when there are other co-occurring psychiatric disorders, such as mood, anxiety, dissociative, substance use, impulse control, obsessive-compulsive, attention-deficit hyperactivity, and personality disorders, all of which may also be trauma-related. In this commentary, guidelines for assessing and treating patients with ED + PTSD and related comorbidity are critically reviewed. An integrated set of principles used in treatment planning of PTSD and trauma-related disorders is recommended in the context of intensive ED therapy. These principles and strategies are borrowed from several relevant evidence-based approaches. Evidence suggests that continuing with traditional single-disorder focused, sequential treatment models that do not prioritize integrated, trauma-focused treatment approaches are short-sighted and often inadvertently perpetuate this dangerous multimorbidity. Future ED practice guidelines would do well to address concurrent illness in more depth.
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Sexual violence as a precipitator of chronic pain in young adults with sickle cell disease. Blood Adv 2022; 6:4831-4833. [PMID: 35816686 PMCID: PMC9631675 DOI: 10.1182/bloodadvances.2022007600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
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Du J, Diao H, Zhou X, Zhang C, Chen Y, Gao Y, Wang Y. Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention. MEDICAL REVIEW (BERLIN, GERMANY) 2022; 2:219-243. [PMID: 37724188 PMCID: PMC10388753 DOI: 10.1515/mr-2022-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/21/2022] [Indexed: 09/20/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a severe and heterogenous psychiatric disorder that was first defined as a mental disorder in 1980. Currently, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and the International Classification of Diseases 11th Edition (ICD-11) offer the most widely accepted diagnostic guidelines for PTSD. In both diagnostic categories, experiencing a traumatic event (TE) is the necessary criterion for diagnosing PTSD. The TEs described in the DSM-5 include actual or threatened death, serious injury, sexual violence, and other extreme stressors, either directly or indirectly. More than 70% of adults worldwide are exposed to a TE at least once in their lifetime, and approximately 10% of individuals develop PTSD after experiencing a TE. The important features of PTSD are intrusion or re-experiencing fear memories, pervasive sense of threat, active avoidance, hyperarousal symptoms, and negative alterations of cognition and mood. Individuals with PTSD have high comorbidities with other psychiatric diseases, including major depressive disorder, generalized anxiety disorder, and substance use disorder. Multiple lines of evidence suggest that the pathophysiology of PTSD is complex, involving abnormal neural circuits, molecular mechanisms, and genetic mechanisms. A combination of both psychotherapy and pharmacotherapy is used to treat PTSD, but has limited efficacy in patients with refractory PTSD. Because of the high prevalence, heavy burden, and limited treatments, PTSD is a psychiatric disorder that requires urgent attention. In this review, we summarize and discuss the diagnosis, prevalence, TEs, pathophysiology, and treatments of PTSD and draw attention to its prevention.
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Affiliation(s)
- Jun Du
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Huapeng Diao
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Xiaojuan Zhou
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Chunkui Zhang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yifei Chen
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yan Gao
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yizheng Wang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
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Watson P. Stress, PTSD, and COVID-19: the Utility of Disaster Mental Health Interventions During the COVID-19 Pandemic. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2022; 9:14-40. [PMID: 35223372 PMCID: PMC8860255 DOI: 10.1007/s40501-021-00253-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 02/08/2023]
Abstract
Purpose of review In the context of an ongoing, highly uncertain pandemic, disaster mental health measures can increase community capacity for resilience and well-being, support formal mental health treatment, and help address the risk for mental health reactions in high-stress occupations. The purpose of this review is to summarize the literature on disaster mental health interventions that have been helpful both prior to and during the pandemic in a broad range of applications, including for use with high-stress occupations in an effort to mitigate risk for post-traumatic stress disorder (PTSD) and other mental health sequelae. Recent findings Evidence-based and evidence-informed disaster mental health interventions, frameworks, and treatments have been studied in pilot studies, non-randomized trials, and randomized clinical trials prior to and in the context of the current COVID-19 pandemic. The studies have demonstrated feasibility and acceptability of these modalities and improved perceived support, as well as significant reductions in distress, and mental health symptoms such as depression, anxiety, and PTSD. Summary A disaster mental health approach to the COVID-19 pandemic can generate opportunities for prevention and support at multiple levels with timely interventions tailored for different concerns, cultures, and available resources.
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Park DH, Meltendorf T, Kahl KG, Kamp JC, Richter MJ, Gall H, Ghofrani HA, Hoeper MM, Olsson KM, Fuge J. Childhood Trauma in Patients With PAH-Prevalence, Impact on QoL, and Mental Health-A Preliminary Report. Front Psychiatry 2022; 13:812862. [PMID: 35222119 PMCID: PMC8866231 DOI: 10.3389/fpsyt.2022.812862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/OBJECTIVE Child maltreatment is associated with increased risk of psychological consequences, contributes to morbidity and has long lasting effects on mental health and quality of life. Child maltreatment has not been assessed in patients with pulmonary arterial hypertension (PAH). We examined the prevalence of child maltreatment and determined their impact on disease severity in patients with PAH. METHODS A cross-sectional observational multicenter study at two PH centers in Germany was conducted. Patients with a confirmed diagnosis of PAH were given a self-administered questionnaire. Child maltreatment using the Childhood Trauma Questionnaire (CTQ), quality of life (QoL), anxiety, depression, and lifestyle factors were assessed and enhanced by clinical parameters 6-min walk distance (6MWD), WHO functional class (WHO FC), and serum levels of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP). Prevalence rates of child maltreatment were compared to the general population and impact of child maltreatment on disease severity was calculated by logistic regression analysis. RESULTS Two-hundred and seventeen patients, 71% female and a median age of 56 years were enrolled in this study. Patients with PAH had higher rates of emotional abuse and lower rates of physical neglect compared to the German population while rates of emotional neglect, physical abuse, and sexual abuse did not differ between patients and German population. Patients with any form of child maltreatment were more likely to be active smokers, had a worse QoL and more anxiety or depression. Moderate associations between child maltreatment, mental health, QoL, lifestyle factors and clinical parameters could be observed. Logistic regression analysis showed a significant impact of CTQ-total score on disease severity with an OR of 1.022 (95%-CI: 1.001-1.042, p = 0.035). CONCLUSION We found a higher rate of child maltreatment in patients with PAH in comparison to the German population. Correlations suggest moderate associations between CTQ-scores and mental health as well as QoL. Child maltreatment had significant impact on disease severity. However, effects were moderate. We conclude that child maltreatment has effects on mental health and quality of life in patients with PAH and may have limited effect on disease severity.
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Affiliation(s)
- Da-Hee Park
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Tanja Meltendorf
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jan C. Kamp
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Manuel J. Richter
- Department of Internal Medicine, Justus Liebig University Giessen, Giessen, Germany
- German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine, Justus Liebig University Giessen, Giessen, Germany
- German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Hossein A. Ghofrani
- Department of Internal Medicine, Justus Liebig University Giessen, Giessen, Germany
- German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Karen M. Olsson
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
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Crum KI, Flanagan JC, Vaughan B, Aloi J, Moran-Santa Maria MM, Back SE, Brady KT, Joseph JE. Oxytocin, PTSD, and sexual abuse are associated with attention network intrinsic functional connectivity. Psychiatry Res Neuroimaging 2021; 316:111345. [PMID: 34371478 PMCID: PMC8478844 DOI: 10.1016/j.pscychresns.2021.111345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022]
Abstract
Childhood maltreatment is linked to Posttraumatic Stress Disorder (PTSD) in adulthood. Neural attention network function contributes to resilience against PTSD following maltreatment; oxytocin administration alters functional connectivity differentially among resilient to PTSD groups. The present study examined intrinsic connectivity between ventral and dorsal neural attention networks (VAN and DAN) to clarify the nature of dysfunction versus resilience in the context of maltreatment-related PTSD, and to explore differential dysfunction related to varied aspects of maltreatment. Oxytocin administration was examined as a factor in these relationships. Resting-state functional connectivity data were collected from 39 adults with maltreatment histories, with and without PTSD, who were randomly assigned to receive oxytocin or placebo. We found that PTSD and sexual abuse (SA) were associated with reduced VAN-DAN connectivity. There were no significant effects with regard to physical abuse. Oxytocin was associated with greater VAN-DAN connectivity strength. These preliminary findings suggest dysfunction within attentional systems in PTSD, as well as following SA. Further, oxytocin may help ameliorate attentional neurocircuitry dysfunction in individuals with PTSD and those with maltreatment histories.
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Affiliation(s)
- Kathleen I Crum
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA; Department of Psychiatry, Indiana University School of Medicine, 1002 Wishard Blvd, Suite 4110, Indianapolis, 46202, IN, USA.
| | - Julianne C Flanagan
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veteran's Affairs Medical Center, Charleston, SC, USA
| | - Brandon Vaughan
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph Aloi
- Department of Psychiatry, Indiana University School of Medicine, 1002 Wishard Blvd, Suite 4110, Indianapolis, 46202, IN, USA; Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA; MD/PhD Scholars Program, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Sudie E Back
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veteran's Affairs Medical Center, Charleston, SC, USA
| | - Kathleen T Brady
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Jane E Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
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Proskynitopoulos PJ, Heitland I, Glahn A, Bauersachs J, Westhoff-Bleck M, Kahl KG. Prevalence of Child Maltreatment in Adults With Congenital Heart Disease and Its Relationship With Psychological Well-Being, Health Behavior, and Current Cardiac Function. Front Psychiatry 2021; 12:686169. [PMID: 34381388 PMCID: PMC8350035 DOI: 10.3389/fpsyt.2021.686169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The prevalence of child maltreatment in adults with congenital heart disease (ACHD) has not been assessed so far. Child maltreatment is a major risk factor for unfavorable behavioral, mental, and physical health outcomes and has been associated with decreased quality of life. Given the increased survival time of ACHD, it is essential to assess factors that may worsen the quality of life and interact with classical cardiovascular risk factors and mental well-being. Methods: In a cross-sectional study, 196 ACHD (mean age 35.21 ± 11.24 y, 44,4% female, 55.6% male) completed a thorough psychiatric and cardiac evaluation. Child maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ) and rates were compared to already existing data from the German general population. Further psychological measurements included the WHO Quality of Life Questionnaire, Hospital Anxiety and Depression Scale (HADS) and assessment of lifestyle factors (exercise, smoking, alcohol consumption, body mass index). To identify a relationship between current cardiac function and child maltreatment, we used logistic regression. Results: ACHD reported significantly higher rates of emotional neglect and emotional abuse and sexual abuse and lower rates of physical neglect when compared to the general German population. In addition, total CTQ-scores, emotional abuse, emotional neglect, physical abuse, and sexual abuse correlated with symptoms of depression, anxiety, and negatively correlated with QoL. Furthermore, CTQ scores contributed significantly in predicting higher New York Heart Association (NYHA) scores (p = 0.009). Conclusion: Child maltreatment is more common in ACHD and associated with decreased quality of life and depression and anxiety. Furthermore, we found evidence that self-reported child maltreatment is associated with decreased cardiac function. Given the longer survival time of patients with ACHD, identifying factors that may negatively influence the disease course is essential. The negative consequences of child maltreatment may be the subject of psychosocial interventions that have demonstrated efficacy in treating posttraumatic stress disorders.
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Affiliation(s)
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Alexander Glahn
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Adult Congenital Heart Centre, Hanover, Germany
| | - Mechthild Westhoff-Bleck
- Department of Cardiology and Angiology, Hannover Medical School, Adult Congenital Heart Centre, Hanover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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Jamshidi F, Rajabi S, Dehghani Y. How to heal their psychological wounds? Effectiveness of EMDR therapy on post‐traumatic stress symptoms, mind‐wandering and suicidal ideation in Iranian child abuse victims. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Treating Posttraumatic Stress Disorder in the Presence of Acute Suicide Risk in Veterans and Active Duty Service Members: A Call for Research. J Nerv Ment Dis 2019; 207:611-614. [PMID: 31259796 DOI: 10.1097/nmd.0000000000001022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with increased risk for suicide, and clinicians often encounter acute suicide risk during the process of intervening upon PTSD. Although the Department of Veterans Affairs (VA) and the Department of Defense (DoD) have disseminated evidence-based treatments for PTSD, prior clinical trials have used inconsistent definitions and unclear assessment methods of suicide risk. Consequently, translating findings from PTSD treatment research to clinical practice remains challenging. This article describes challenges inherent to the current PTSD interventional research literature related to concurrent acute suicide risk among veterans and active duty service members. We reviewed prior trials and how their assessment methods and nomenclature compare with strategies and definitions mandated within the VA/DoD. Furthermore, we describe methodological recommendations for future research, including consistent use of mandated universal suicide nomenclature, standardization for classifying suicide risk, transparency in reporting assessment means and measures, and examination of current models of PTSD treatment in the context of acute suicide risk.
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Abstract
PURPOSE OF REVIEW This article reviews recent evidence related to public health epidemiology and intervention for traumatic stress and PTSD. Recent evidence is presented regarding incidence of traumatic stress worldwide, as well as most frequent types of traumas, indicators of the public health burden of PTSD, and prevalence, predictors, and correlates of PTSD. Public health perspectives on intervention and treatment are delineated, and innovations in both psychosocial and psychopharmacological interventions are highlighted. RECENT FINDINGS PTSD has been associated with substantial medical and economic burden. Recent public health preventive innovations include integrated medical/behavioral health care, acute CBT and attention interventions, modifications to CBT protocols, use of novel and augmentative psychopharmacological agents, and use of technology. Recent research regarding the scope and impact of traumatic stress, as well as prevention strategies for PTSD, have resulted in an improved understanding of its impact and more effective public health interventions.
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Affiliation(s)
- Patricia Watson
- Department of Veterans Affairs (116D), National Center for PTSD, Executive Division, 215 N. Main ST, White River Junction, VT, 05009, USA.
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Pivac N. Theranostic approach to PTSD. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:260-262. [PMID: 30707987 DOI: 10.1016/j.pnpbp.2019.01.018] [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: 11/30/2022]
Affiliation(s)
- Nela Pivac
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laboratory for Molecular Neuropsychiatry, Bijenicka cesta 54, 10000 Zagreb, Croatia.
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Compean E, Hamner M. Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:265-275. [PMID: 30092241 PMCID: PMC6459196 DOI: 10.1016/j.pnpbp.2018.08.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/13/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
Abstract
Trauma exposure leads to various psychiatric disorders including depression, anxiety, bipolar disorders, personality disorders, psychotic disorders, and trauma related disorders, especially posttraumatic stress disorder (PTSD). There are some overlapping symptoms of both PTSD and psychosis that make diagnosis challenging. Despite this overlap, the evidence of PTSD with comorbid psychosis as a distinct entity lies in the research showing biologic, genetic and treatment management differences between psychotic PTSD, non-psychotic PTSD, psychotic disorders and healthy controls. There is emerging evidence that PTSD with secondary psychotic features (PTSD-SP) might be a discrete entity of PTSD with known risk factors that increase its prevalence. This review has presented evidence for individuals with PTSD-SP being distinct in genetics and neurobiological factors. Individuals with PTSD and comorbid psychosis can benefit from evidence based psychotherapy (EBT). There is not enough evidence to recommend second generation antipsychotics (SGA) for PTSD-SP given that risperidone and quetiapine are the only SGAs studied in randomized controlled trials. Hence, developing an operational diagnostic criteria and treatment framework for clinical and research use is critical.
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Affiliation(s)
- Ebele Compean
- Medical University of South Carolina (MUSC) 169 Ashley Ave, RM 202 MUH MSC 333 Charleston SC 29425,Ralph H. Johnson VA Medical Center Department of Veterans Affairs 109 Bee Street Charleston, SC 29401-5799
| | - Mark Hamner
- Medical University of South Carolina (MUSC), 169 Ashley Ave, RM 202 MUH MSC 333, Charleston, SC 29425, United States; Ralph H. Johnson VA Medical Center, Department of Veterans Affairs, 109 Bee Street Charleston, SC 29401-5799, United States.
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Hinojosa CA, Kaur N, VanElzakker MB, Shin LM. Cingulate subregions in posttraumatic stress disorder, chronic stress, and treatment. HANDBOOK OF CLINICAL NEUROLOGY 2019; 166:355-370. [DOI: 10.1016/b978-0-444-64196-0.00020-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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