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Huang CY, Zhao YF, Zhang ZX, Liu RB, Liu JL, Li XZ, Luo J, Yue L, Zhang C. Psychotherapeutic and pharmacological agents for post-traumatic stress disorder with sleep disorder: network meta-analysis. Ann Med 2024; 56:2381696. [PMID: 39061119 DOI: 10.1080/07853890.2024.2381696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/21/2023] [Accepted: 02/26/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE The current guidelines and canonical norms of diagnosis or treatment for Post-traumatic stress disorder (PTSD) with sleep disorder are still conflicting and have not yet reached a consensus. This study aimed to unravel the most effective countermeasures between two categories (psychotherapy and pharmacotherapy) put forward by the National Institute for Health and Clinical Excellence (NICE) and World Federation of Societies of Biological Psychiatry (WFSBP) respectively to treat PTSD individuals co-exist with sleep disorders. METHODS Four databases, including PubMed, EMBASE, Cochrane Library, and APA PsyNet, were searched from inception to February 02, 2023. RESULTS Twenty articles with 24 Randomized controlled trials (RCTs) and a total number of 1,647 participants were included. As demonstrated in the network meta-analysis comparison results, CBT-I (standardized mean differences (SMD) = -1.51,95% confidence interval (CI):-2.55 to -0.47), CBT-I plus IRT (SMD = -1.71, 95%CI:-3.39, -0.03), prazosin (SMD = -0.87,95%CI:-1.59 to -0.16) and hydroxyzine (SMD = -1.06, 95%CI: -1.94 to -0.19) significantly reduced PTSD symptoms compared with placebo. In contrast to placebo, CBT-I (SMD = -5.61,95%CI:-8.82 to -2.40) significantly improved sleep quality. For nightmare severity, IRT (SMD =-0.65, 95%CI:-1.00 to -0.31), prazosin (SMD = -1.20,95%CI:-1.72 to -0.67) and hydroxyzine (SMD = -0.98,95%CI:-1.58 to -0.37) significantly reduced nightmare severity in comparison with placebo. CONCLUSIONS This study suggested that under most circumstances, psychotherapy namely CBT-I had a favorable profile, but pharmacotherapy with prazosin was effective in managing nightmare severity. The sole avail of CBT-I was recommended to improving sleep quality while CBT-I and CBT-I plus IRT showed excellent management of PTSD symptom severity. Exposure to CBT-I isrecommended for depression. The relevant clinical guidelines for the management of individuals with PTSD and sleep disorders may regard this as a reference. PROSPERO CRD42023415240.
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Affiliation(s)
- Cheng-Yang Huang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yi-Fan Zhao
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Zhi-Xin Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Run-Ben Liu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Jia-Ling Liu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xiao-Zheng Li
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Jie Luo
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Center for Neurological Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Li Yue
- Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
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Nejadghaderi SA, Mousavi SE, Fazlollahi A, Motlagh Asghari K, Garfin DR. Efficacy of yoga for posttraumatic stress disorder: A systematic review and meta-analysis of randomized controlled trials. Psychiatry Res 2024; 340:116098. [PMID: 39191128 DOI: 10.1016/j.psychres.2024.116098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 04/24/2024] [Accepted: 07/21/2024] [Indexed: 08/29/2024]
Abstract
Yoga is an increasingly popular complementary intervention to reduce posttraumatic stress disorder (PTSD) symptoms and related comorbidities, but its safety and treatment efficacy are not firmly established. We conducted a systematic review and meta-analysis of existing randomized control trials (RCTs) of yoga interventions for PTSD and related secondary outcomes (e.g., depression). Initial search results found over 668 potential papers. Twenty met inclusion criteria (e.g., RCTs on adult participants with PTSD that evaluated safety or efficacy outcomes). Meta-analysis indicated that, compared to control interventions, participation in yoga interventions significantly improved self-report PTSD (standardized mean difference [SMD]: -0.51; 95 % confidence interval [CI]: -0.68, -0.35) and immediate (SMD: -0.39; 95 % CI: -0.56, -0.22) and long-term (SMD: -0.44; 95 % CI: -0.74, -0.13) depression symptoms. However, using clinician-reported assessments, yoga interventions were not associated with improved PTSD symptoms. Type of yoga differentially predicted outcomes. Sensitivity analysis showed consistent effect sizes when omitting each study from main analyses. Six studies reported whether any serious adverse events occurred. None were indicated. No publication bias was found, although individual intervention studies tended to be high in bias. Results suggest yoga is likely a safe and effective complementary intervention for reducing PTSD and depressive symptoms in individuals with PTSD. More rigorous RCTs are warranted.
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Affiliation(s)
- Seyed Aria Nejadghaderi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Systematic Review and Meta‑analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Seyed Ehsan Mousavi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Asra Fazlollahi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kimia Motlagh Asghari
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Dana Rose Garfin
- Community Health Sciences, Fielding School of Public Health, University of California, 560 Charles E Young Drive South, Box 951772, Los Angeles, CA 90095, USA.
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Tonon AC, Ramos-Lima LF, Kuhathasan N, Frey BN. Early Life Trauma, Emotion Dysregulation and Hormonal Sensitivity Across Female Reproductive Life Events. Curr Psychiatry Rep 2024; 26:530-542. [PMID: 39187611 DOI: 10.1007/s11920-024-01527-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE OF REVIEW To explore the relationship between early life trauma, hormonal sensitivity, and psychiatric disorders across female-reproductive life events, with a focus on the neurobiological mechanisms. RECENT FINDINGS Childhood trauma significantly increases the risk of subsequent mood disorders during periods of intense hormonal fluctuation such as premenstrual, pregnancy, postpartum, and perimenopause. Neurobiological changes resulting from early trauma influence emotion regulation, which emerges as a key predisposing, exacerbating, and perpetuating factor to hormonal sensitivity and subsequent psychiatric symptoms. We identified altered stress response and allopregnanolone imbalance, bias in cognitive processing of emotions, neuroimage correlates and sleep disturbances as potential underlying neurobiological mechanisms. This review integrates cumulative findings supporting a theoretical framework linking early life trauma to hormonal sensitivity and mood disorders. We propose that some women might be more susceptible to such hormonal fluctuations because of emotion dysregulation following significant early life trauma.
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Affiliation(s)
- André C Tonon
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Luis Francisco Ramos-Lima
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Nirushi Kuhathasan
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Benicio N Frey
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.
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He YY, Yang Y, Hu JH, Zhou Y, Wang SB, Jia FJ, Hou CL. Psychometric properties of International Trauma Questionnaire (ITQ) and symptom structure of complex post-traumatic stress disorder among Chinese patients with MDD. J Psychiatr Res 2024; 178:283-290. [PMID: 39180987 DOI: 10.1016/j.jpsychires.2024.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/27/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
AIMS To assess the validity and internal reliability of the International Trauma Questionnaire (ITQ) among patients diagnosed with major depressive disorder (MDD) and to explore the network structure of Complex post-traumatic stress disorder (CPTSD) among MDD patients in China. METHODS Eligible individuals were recruited from a large tertiary hospital in Guangdong Province. Trained researchers conducted in-person interviews and administered self-report questionnaires, including demographics, medical information, and psychological assessments. Confirmatory factor analyses (CFA) and network analysis were performed, with calculations of Average Variance Extracted (AVE), Cronbach's α, and composite reliability. RESULTS A total of 113 patients with MDD participated in this study. The correlated six-factor one-order model was a good representation of the latent structure of ITQ (χ2= 60.114, df = 39, P = 0.017, SRMR = 0.070, RMSEA = 0.050, TLI = 0.952, CFI = 0.972, BIC = 175.508). All ITQ subscales possessed acceptable convergent validity and internal reliability, except for affective dysregulation and re-experiencing. The square root of AVE for affective dysregulation was lower than its correlations with other clusters. Network analysis revealed that node C4 ('I feel worthless'), as a core symptom, was significantly associated with the development of CPTSD. CONCLUSIONS The clinical applicability of the ITQ was demonstrated by its overall validity and reliability among patients with MDD. However, the affective dysregulation and re-experiencing clusters still need to be revised and enhanced. Timely screening, recognition, and diagnosis are critical due to the worse clinical outcomes seen in comorbid patients.
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Affiliation(s)
- Yong-Yi He
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yuan Yang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jia-Hui Hu
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yun Zhou
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Fu-Jun Jia
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Cai-Lan Hou
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Vonderlin R, Priebe K, Müller-Engelmann M, Fydrich T, Steil R, Resick PA, Schmahl C, Lindauer P, Kleindienst N, Bohus M. Long-term effects of dialectical behaviour therapy for posttraumatic stress disorder and cognitive processing therapy 9 months after treatment termination. Eur J Psychotraumatol 2024; 15:2393061. [PMID: 39221987 PMCID: PMC11370672 DOI: 10.1080/20008066.2024.2393061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
Background: The complexity of posttraumatic stress disorder (PTSD) symptoms related to childhood abuse (CA) present challenges for effective psychotherapeutic treatment. Consequently, there is great interest in the long-term effectiveness of psychological treatments for this population.Objective: This study aims to investigate the long-term outcomes of Dialectical Behaviour Therapy for PTSD (DBT-PTSD) and Cognitive Processing Therapy (CPT) 9 months after treatment termination.Method: This is a long-term analysis from a randomised-controlled trial of DBT-PTSD versus CPT (registration number DRKS00005578). Initially, 193 individuals with CA-related PTSD were randomly allocated to receive either DBT-PTSD (n = 98) or CPT (n = 95). The primary outcome the Clinician-administered PTSD-Scale for DSM-5 (CAPS-5) was administred at baseline, treatment completion (15 months post-randomization) and at the 9-month follow-up. Secondary outcomes included self-reported PTSD severity (PCL-5), dissociation (DSS), severity of borderline symptoms (BSL-23), and psychosocial functioning (GAF).Results: No significant changes were observed in the primary (CAPS) and all other outcomes from post-intervention to 9-months follow-up in both the DBT-PTSD (CAPS: Mpost = 15.60, Mfollow-up = 14.93) and CPT group (CAPS: Mpost = 18.80, Mfollow-up = 17.41). Between-group analyses at 9-months follow-up were significantly in favour of DBT-PTSD compared to CPT with small to medium effect sizes on all outcomes ranging from d = 0.35 on the CAPS to d = 0.57 on the BSL-23 and GAF.Conclusions: Our results indicate that treatment effects of psychotherapy addressing complex presentations of PTSD persist 9 months after treatment termination. In addition, the superiority of DBT-PTSD as compared to CPT found at treatment termination, was confirmed at 9-months follow-up.Trial registration: German Clinical Trials Register identifier: DRKS00005578..
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Affiliation(s)
- Ruben Vonderlin
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Kathlen Priebe
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Meike Müller-Engelmann
- Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt, Germany
- Department Psychology, Medical School Hamburg, Hamburg, Germany
| | - Thomas Fydrich
- Department of Psychology, Faculty of Life Sciences, Humboldt University, Berlin, Germany
| | - Regina Steil
- Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Petra Lindauer
- Department of Economics and Media, Hochschule Fresenius University of Applied Sciences, Cologne, Germany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- McLean Hospital, Harvard Medical School, Boston, MA, USA
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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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Fung HW, Lam SKK, Wong JYH. DSM-5 BPD and ICD-11 complex PTSD: Co-occurrence and associated factors among treatment seekers in Hong Kong. Asian J Psychiatr 2024; 101:104195. [PMID: 39236529 DOI: 10.1016/j.ajp.2024.104195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/17/2024] [Accepted: 08/18/2024] [Indexed: 09/07/2024]
Abstract
There is an ongoing debate regarding whether ICD-11 complex PTSD and DSM-5 borderline personality disorder (BPD) are the same syndrome. Little is known about the extent to which these two conditions overlap and whether they exhibit distinct clinical correlates in Asian cultures. This study examined the co-occurrence of ICD-11 complex PTSD and DSM-5 BPD in a sample of treatment seekers in Hong Kong (N = 220). Participants completed validated self-report measures which assessed if they met the respective diagnostic criteria. In this sample, 30.9 % met the ICD-11 criteria for complex PTSD only, 10.0 % met the DSM-5 criteria for BPD only, and 28.2 % met the criteria for both conditions. Complex PTSD symptoms were most strongly associated with depressive symptoms (β =.347, p <.001) and trauma-related maladaptive beliefs (β =.337, p <.001), while BPD symptoms were most strongly associated with dissociative symptoms (β =.281, p <.001). This study is the first to show that ICD-11 complex PTSD and DSM-5 BPD commonly co-occurred but were not the same construct in the Asian context, and their symptoms were associated with different sets of demographic and clinical factors. Future editions of DSM and ICD should not merge the two conditions into a single diagnosis.
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Affiliation(s)
- Hong Wang Fung
- School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong.
| | - Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Janet Yuen-Ha Wong
- School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong.
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Karstoft KI, Korchakova N, Koushede VJ, Morton TA, Pedersen AA, Power SA, Thøgersen MH. (Complex) PTSD in Ukrainian refugees: Prevalence and association with acts of war in the Danish refugee cohort (DARECO). J Affect Disord 2024; 366:66-73. [PMID: 39209278 DOI: 10.1016/j.jad.2024.08.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The Russian invasion of Ukraine has driven millions of Ukrainians away from their homes. Among these, the majority have likely experienced war-related potentially traumatic events, and some will experience symptoms of posttraumatic stress disorder (PTSD). The aims of the study are to estimate the prevalence of PTSD and Complex PTSD (CPTSD) in displaced Ukrainians and examine associations between war- and other potentially traumatic exposures and (C)PTSD. METHODS Questionnaires were distributed to all registered adult Ukrainians (18+) who arrived in Denmark between February 24th 2022 and February 15th 2023 (N = 18,389). We estimate the prevalence of war exposures, other potentially traumatic exposures, and (C)PTSD. In logistic regression analyses, we test if exposure to war and other potentially traumatic events are associated with PTSD and CPTSD. RESULTS The final sample size was 6993 (38.0 %). Responders were more likely to be female and younger than non-responders. Prevalence of PTSD and CPTSD was 15.9 % and 13.5 %, respectively. Female gender, high education, and loss of a relative due to the war were associated with (C)PTSD. Direct and indirect exposure to war and combat was related to PTSD but not CPTSD, while exposure to war prior to the 2022 invasion was related to CPTSD but not PTSD. LIMITATIONS The study is cross-sectional and based on self-report. CONCLUSION Close to one third of the sample fulfill the criteria of PTSD or CPTSD. War exposures are differentially related to PTSD and CPTSD. The findings illustrate that trauma-related psychopathology is a pertinent problem in displaced Ukrainians.
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Affiliation(s)
- K-I Karstoft
- Department of Psychology, University of Copenhagen, Denmark.
| | - N Korchakova
- Department of Psychology, University of Copenhagen, Denmark; Rivne State University of the Humanities, Rivne, Oblast, Ukraine
| | - V J Koushede
- Department of Psychology, University of Copenhagen, Denmark
| | - T A Morton
- Department of Psychology, University of Copenhagen, Denmark
| | - A A Pedersen
- Department of Psychology, University of Copenhagen, Denmark
| | - S A Power
- Department of Psychology, University of Copenhagen, Denmark
| | - M H Thøgersen
- Department of Psychology, University of Copenhagen, Denmark; Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Blithikioti C, Duek O, Gordon C, Krystal JH, Levy I, Harpaz-Rotem I, Schiller D, Perl O. Cerebellar Contributions to Traumatic Autobiographical Memory in People with Post-Traumatic Stress Disorder. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01731-9. [PMID: 39180693 DOI: 10.1007/s12311-024-01731-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 08/26/2024]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating mental health condition characterized by recurrent re-experiencing of traumatic events. Despite increasing evidence suggesting that the cerebellum is involved in PTSD pathophysiology, it remains unclear whether this involvement is related to symptoms directly resulting from previous trauma exposure, such as involuntary re-experiencing of the traumatic events, or reflects a broader cerebellar engagement in negative affective states. In this study, we investigated the specific role of the cerebellum in PTSD by employing a script reactivation paradigm with personalized traumatic and sad autobiographical memories in 28 individuals diagnosed with chronic PTSD. Functional magnetic resonance imaging (fMRI) data were collected while participants listened to their own autobiographical narratives recounted by a third person. Activation in the right cerebellar lobule VI was uniquely associated with traumatic autobiographical recall and was parametrically modulated by the severity of re-experiencing symptoms. In contrast, cerebellar Crus II showed increased activation during both traumatic and sad autobiographical recall, suggesting a broader involvement in processing negative emotions. Our findings highlight the unique contribution of the right cerebellar lobule VI in the processing of traumatic autobiographical memories, potentially through its engagement in low-level representation of sensory and emotional aspects of traumatic events.
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Affiliation(s)
- Chrysanthi Blithikioti
- Department of Psychiatry, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
- Nash Family Department of Neuroscience and the Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Or Duek
- Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Psychiatry, Yale University School of Medicine, New-Haven, CT, USA
- The National Center for PTSD, VA CT Healthcare System, West Haven, CT, USA
| | - Charles Gordon
- Department of Psychiatry, Yale University School of Medicine, New-Haven, CT, USA
- The National Center for PTSD, VA CT Healthcare System, West Haven, CT, USA
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New-Haven, CT, USA
- The National Center for PTSD, VA CT Healthcare System, West Haven, CT, USA
| | - Ifat Levy
- Departments of Comparative Medicine and Neuroscience, Yale University, New Haven, CT, USA
- Department of Psychology and the Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, New-Haven, CT, USA
- The National Center for PTSD, VA CT Healthcare System, West Haven, CT, USA
- Department of Psychology and the Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Daniela Schiller
- Nash Family Department of Neuroscience and the Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Computational Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ofer Perl
- Nash Family Department of Neuroscience and the Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Computational Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Inomata Silva BL, da Cunha Rodrigues FE, Tsukimata MY, Botelho BJS, Santos LCC, Dos Santos Pereira Neto G, Lima ACR, André NP, Galdino SM, Monteiro DC, Yoshikawa GT, Mendonça LT, do Amaral JLA, de Britto Pereira Cruz R, Onuma DO, Vallinoto ACR, de Carvalho Klemz BN, Vallinoto IMVC. Fibromyalgia in patients infected with HTLV-1 and HTLV-2. Front Med (Lausanne) 2024; 11:1419801. [PMID: 39247631 PMCID: PMC11377305 DOI: 10.3389/fmed.2024.1419801] [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: 05/13/2024] [Accepted: 08/15/2024] [Indexed: 09/10/2024] Open
Abstract
Background Reports on the association between HTLV-2 infection and the development of diseases in the human host are rare, which has led the scientific community to believe that HTLV-2 is not an important etiological agent of lymphoproliferative or neurodegenerative disorders, which is the case for HTLV-1. In the present study, we demonstrated cases of fibromyalgia in HTLV-1 carriers and, in an unprecedented finding, in two patients with confirmed HTLV-2 infection. Methods A total of 957 individuals visited the Virology Laboratory at the Federal University of Pará for screening and confirmation tests for HTLV-1/2 infection. Individuals with confirmed HTLV-1 and HTLV-2 infection were clinically evaluated for signs and symptoms associated with infection. Results Sixty-nine individuals (7.2%) were identified as positive for HTLV infection, with 56 confirmed cases of HTLV-1 infection (5.9%), 12 cases of HTLV-2 infection (1.2%) and one case classified as undetermined (0.1%). Sixteen (23.2%) of these patients presented with rheumatological signs and complained of diffuse pain throughout the body; 12 of whom were infected by HTLV-1 (75%) and 4 were infected by HTLV-2 (25%). After anamnesis and careful evaluation, four patients were diagnosed with fibromyalgia, two of whom were infected by HTLV-1 (16.7%; 2/12) and two by HTLV-2 (50%; 2/4). The clinical follow-up and laboratory analysis results are reported in detail in this paper. Conclusion Considering the clinical cases presented herein as the first reports of patients with HTLV-2 infection with clinical symptoms of fibromyalgia, the importance of further studies on the pathogenicity of HTLV-2, similar to what have already been performed for HTLV-1, is highlighted. Our results also confirm previous evidence of an association between HTLV-1 infection and fibromyalgia.
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Affiliation(s)
- Bianca Lumi Inomata Silva
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
- Faculdade de Medicina, Instituto de Ciências Médica, Universidade Federal do Pará, Belém, Brazil
| | - Francisco Erivan da Cunha Rodrigues
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
- Faculdade de Medicina, Instituto de Ciências Médica, Universidade Federal do Pará, Belém, Brazil
| | - Márcio Yutaka Tsukimata
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
- Faculdade de Medicina, Instituto de Ciências Médica, Universidade Federal do Pará, Belém, Brazil
| | | | - Luciana Cristina Coelho Santos
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
- Programa de Pós-graduação em Biologia de Agentes Infecciosos e Parasitário, Universidade Federal do Pará, Belém, Brazil
| | - Gabriel Dos Santos Pereira Neto
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
- Programa de Pós-graduação em Biologia de Agentes Infecciosos e Parasitário, Universidade Federal do Pará, Belém, Brazil
| | - Aline Cecy Rocha Lima
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
- Programa de Pós-graduação em Biologia de Agentes Infecciosos e Parasitário, Universidade Federal do Pará, Belém, Brazil
| | - Natália Pinheiro André
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
- Faculdade de Medicina, Instituto de Ciências Médica, Universidade Federal do Pará, Belém, Brazil
| | - Sarah Marques Galdino
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
- Faculdade de Medicina, Instituto de Ciências Médica, Universidade Federal do Pará, Belém, Brazil
| | - Danniele Chagas Monteiro
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
- Faculdade de Medicina, Instituto de Ciências Médica, Universidade Federal do Pará, Belém, Brazil
| | | | | | - Juliana Lasmar Ayres do Amaral
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
- Faculdade de Medicina, Instituto de Ciências Médica, Universidade Federal do Pará, Belém, Brazil
| | | | - Débora Oliveira Onuma
- Faculdade de Medicina, Instituto de Ciências Médica, Universidade Federal do Pará, Belém, Brazil
| | - Antonio Carlos Rosário Vallinoto
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
- Faculdade de Medicina, Instituto de Ciências Médica, Universidade Federal do Pará, Belém, Brazil
- Programa de Pós-graduação em Biologia de Agentes Infecciosos e Parasitário, Universidade Federal do Pará, Belém, Brazil
| | | | - Izaura Maria Vieira Cayres Vallinoto
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
- Faculdade de Medicina, Instituto de Ciências Médica, Universidade Federal do Pará, Belém, Brazil
- Programa de Pós-graduação em Biologia de Agentes Infecciosos e Parasitário, Universidade Federal do Pará, Belém, Brazil
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11
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Zhang J, Wu Z, Chen M, Gao Y, Liu Z, Long Y, Chen X. Factor analysis and evaluation of one-year test-retest reliability of the 33-item Childhood Trauma Questionnaire in Chinese adolescents. Front Psychol 2024; 15:1384807. [PMID: 39246309 PMCID: PMC11377256 DOI: 10.3389/fpsyg.2024.1384807] [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: 02/12/2024] [Accepted: 08/13/2024] [Indexed: 09/10/2024] Open
Abstract
The 33-item Childhood Trauma Questionnaire (CTQ-33) is a recently developed tool expanded from the 28-item Childhood Trauma Questionnaire (CTQ-28) to assess childhood trauma events, which showed good test-retest reliability over 2 weeks. However, little is known regarding the factor structure and long-term test-retest reliability of the CTQ-33. To fill such a gap, this study investigated the factorial validity of the CTQ-33 and test-retest reliability of the scale over a relatively long interval of 1 year. Data on demographics, the CTQ-33 scores, and mental health statuses such as depressive/anxiety symptoms were collected in Chinese adolescents (n = 188) twice across a one-year period. Results of the confirmatory factor analysis (CFA) revealed that the Chinese version of CTQ-33 has close factor validity when compared to the original CTQ-28 in college students. Furthermore, the total and most subscale scores of the CTQ-33 have fair to good test-retest reliability (intra-class correlation coefficients >0.6 for the total score, and > 0.4 for most subscales), except for the physical abuse subscale. Moreover, we replicated previous findings of significant positive relationships between levels of different childhood trauma subtypes using the CTQ-33. These findings provide initial evidence supporting that the CTQ-33 is overall reliable to assess childhood traumatic events in adolescents over relatively long intervals.
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Affiliation(s)
- Jiamei Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhipeng Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Min Chen
- School of Mental Health, Jining Medical University, Jining, China
| | - Yan Gao
- School of Mental Health, Jining Medical University, Jining, China
| | - Zhening Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yicheng Long
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xudong Chen
- Department of Psychiatry, The Second Xiangya Hospital, 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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12
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Popolo R, Dimaggio G, MacBeth A, Ottavi P, Centonze A. Management of the therapeutic relationship in a patient with Complex PTSD and Personality Disorder. J Clin Psychol 2024. [PMID: 39169871 DOI: 10.1002/jclp.23737] [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: 01/30/2023] [Revised: 06/01/2024] [Accepted: 08/10/2024] [Indexed: 08/23/2024]
Abstract
Individuals diagnosed with Complex PTSD (C-PTSD) have experienced repeated and often prolonged traumatic events. From a therapeutic perspective this can lead to difficulties in emotion regulation within-session, challenges with patient-therapist attunement, and impaired coregulation of emotions during therapeutic interactions. As a result, frequent therapeutic alliance ruptures can emerge, which in turn pose challenges for symptom-focused work. We describe a case study involving a 38-year-old woman presenting with C-PTSD, dissociation, anxiety and borderline and dependent personality disorder traits. We explore how difficulties in attunement and emotion regulation during therapy were mostly attributable to (i) maladaptive ideas regarding the self and others; and (ii) difficulties in recognizing both her own mental states and those of her therapist. For instance, the patient believed that the therapist was distant and critical; which she held to be fact rather than reflective of a mental state. We show how the therapist addressed these difficulties, incorporating repair of the therapeutic alliance, which enabled a return to symptom focused work. The case description offers guidance on how to maintain a dual focus on therapeutic alliance alongside symptoms when treating C-PTSD (with or without comorbidity).
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Affiliation(s)
- Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Rome, Italy
- DSM ASL Roma 1, Rome, Italy
| | | | - Angus MacBeth
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Paolo Ottavi
- Center for Metacognitive Interpersonal Therapy, Rome, Italy
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Rohde J, Hickmann E, Buchmann M, Kronenberg G, Vetter S, Seifritz E, Kleim B, Olbrich S. Combined Effects of Nasal Ketamine and Trauma-Focused Psychotherapy in Treatment-Resistant Post-Traumatic Stress Disorder: A Pilot Case Series. Behav Sci (Basel) 2024; 14:717. [PMID: 39199113 PMCID: PMC11351759 DOI: 10.3390/bs14080717] [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: 06/22/2024] [Revised: 07/24/2024] [Accepted: 08/08/2024] [Indexed: 09/01/2024] Open
Abstract
OBJECTIVE This pilot case series investigated the feasibility and efficacy of an eight-week therapy program, combining nasally administered ketamine (0.5 mg/kg) with trauma-focused psychotherapy, for individuals with chronic, treatment-resistant post-traumatic stress disorder (PTSD). METHOD Three patients with chronic, treatment-resistant PTSD underwent the eight-week therapy program. Clinical assessments included the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Hamilton Depression Rating Scale (HAMD) at baseline, post-assessment, and follow-up assessment, along with additional measures assessing other relevant symptoms and side effects. RESULTS The results demonstrated clinically relevant reductions in PTSD symptoms, indicated by a change in the CAPS-5 score at post-assessment (M = -18.00; SE = 6.48) and follow-up assessment (M = -25.33, SE = 5.58). Additionally, depressive symptoms showed notable improvement, with changes in HAMD scores at post-assessment (M = -8.33, SE = 3.07) and follow-up assessment (M = -9.00, SE = 3.77). Positive effects were also observed in anxiety reduction, decreased dissociations, and improvements in emotion regulation and disturbances of self-organization. CONCLUSIONS Despite potential variations in clinical profiles among the patients, the therapy program demonstrated positive outcomes for all participants. Nasally administered ketamine was well tolerated and resulted in immediate symptom reduction in tension, anxiety, and common PTSD symptoms. However, to validate these findings and compare treatment efficacy, future randomized controlled trials are warranted, especially in comparison with trauma-focused therapy alone.
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Affiliation(s)
- Judith Rohde
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland; (E.H.); (G.K.); (S.V.); (E.S.); (B.K.); (S.O.)
- Department of Psychology, University of Zurich, Binzmuehlestrasse 14, CH-8050 Zurich, Switzerland;
| | - Elena Hickmann
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland; (E.H.); (G.K.); (S.V.); (E.S.); (B.K.); (S.O.)
| | - Marco Buchmann
- Department of Psychology, University of Zurich, Binzmuehlestrasse 14, CH-8050 Zurich, Switzerland;
| | - Golo Kronenberg
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland; (E.H.); (G.K.); (S.V.); (E.S.); (B.K.); (S.O.)
| | - Stefan Vetter
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland; (E.H.); (G.K.); (S.V.); (E.S.); (B.K.); (S.O.)
| | - Erich Seifritz
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland; (E.H.); (G.K.); (S.V.); (E.S.); (B.K.); (S.O.)
| | - Birgit Kleim
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland; (E.H.); (G.K.); (S.V.); (E.S.); (B.K.); (S.O.)
- Department of Psychology, University of Zurich, Binzmuehlestrasse 14, CH-8050 Zurich, Switzerland;
| | - Sebastian Olbrich
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland; (E.H.); (G.K.); (S.V.); (E.S.); (B.K.); (S.O.)
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14
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Wyssen A, Lerch S, Reichl C, Mürner-Lavanchy I, Sigrist C, Schär S, Cavelti M, Koenig J, Kaess M. Comparing the new concept of impairment in personality functioning with borderline personality disorder: differential psychosocial and psychopathological correlates in a clinical adolescent sample. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02555-y. [PMID: 39150466 DOI: 10.1007/s00787-024-02555-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
Borderline personality disorder (BPD) is an established diagnosis in adolescence with high comorbidity and psychosocial impairment. With the introduction of the alternative model for personality disorders in DSM-5 (AMPD), personality functioning is operationalized using the Level of Personality Functioning Scale (LPFS), which has been shown to be associated with severity of personality pathology. The present study aimed at examining differential psychopathological and psychosocial correlates of LPFS and BPD. A total of 526 adolescent in- and outpatients were interviewed with the STiP-5.1 (LPFS) and the SCID-II. Mixed linear regression was used to investigate the associations between the two interviews with measures of psychopathology and psychosocial impairment. 11.4% met the diagnostic threshold of both interviews, 16.1% only of the LPFS, and 64.1% were below the diagnostic threshold in both interviews (no PD). The BPD only group was larger than expected-8.4% of patients who met criteria for BPD did not fulfill criteria for significant impairment in the LPFS. The highest burden was found in individuals concurrently showing significant impairment in LPFS and fulfilling BPD diagnosis (LPFS + BPD). Differences between the LPFS only group and the BPD only group were found in risk behavior and traumatic experiences, with higher prevalence in the BPD group. Findings confirm the high psychopathological burden and psychosocial impairment associated with both BPD and LPFS. Those exceeding the diagnostic threshold of LPFS in combination with a BPD diagnosis are characterized by greatest disability. Not all adolescents fulfilling formal BPD diagnosis showed a clinically significant impairment in LPFS, which may refer to a distinct diagnostic group.
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Affiliation(s)
- Andrea Wyssen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christine Sigrist
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Selina Schär
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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Yang XJ, Meng XX, Zhang LB, Wang LL, Deng H, Yang YC, Zhou SJ. Mediating effects of insomnia and resilience on COVID-19-related post-traumatic stress disorder and quality of life in adolescents. Sci Rep 2024; 14:17969. [PMID: 39095413 PMCID: PMC11297128 DOI: 10.1038/s41598-024-69093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 07/31/2024] [Indexed: 08/04/2024] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has impaired the quality of life (QoL) for many due to its extensive impacts. However, few studies have addressed the specific impact of COVID-19 on the mental health of adolescents, particularly post-traumatic stress disorder (PTSD). This study considered the impact of COVID-19-related PTSD on the QoL of adolescents in China, the mediating effects of insomnia, and the moderating effects of resilience. Participants included 50,666 adolescents aged 12-18 years selected using a comprehensive sampling method. We performed data collection from January 8th to January 18th, 2023, using the Children's Revised Impact of Event Scale, Pittsburgh Sleep Quality Index, Ten-item Connor-Davidson Resilience Scale, and Screening for and Promotion of Health-related QoL in Children and Adolescents Questionnaire for data collection. Male adolescents exhibited significantly lower levels of PTSD and insomnia compared to females and scored significantly higher in psychological resilience and overall QoL. Insomnia played a mediating role between PTSD and QoL. Psychological resilience moderated the impact of COVID-19-related stress on adolescents' QoL through its influence on insomnia. PTSD resulting from the COVID-19 pandemic affects the QoL of adolescents through the presence of insomnia. Psychological resilience plays a moderating role in this process. Cultivating psychological resilience in adolescents can effectively enhance their ability to cope with the impacts of sudden public events.
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Affiliation(s)
- Xing-Jie Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China
| | - Xue-Xue Meng
- School of Psychology and Mental Health, North China University of Science and Technology, Hebei, China
| | - Li-Bin Zhang
- Collaborative Innovation Center of Assessment for Basic Education Quality, Beijing Normal University, Beijing, China
| | - Lei-Lei Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China
| | - Hu Deng
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China
| | - Yu-Chun Yang
- Faculty of Education, Beijing Normal University, Beijing, 100875, China.
| | - Shuang-Jiang Zhou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China.
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Levenson JS, Harris DA. The Ripple Effects of Post-Conviction Traumatic Stress in People Required to Register as Sex Offenders and their Families. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2024; 36:572-602. [PMID: 37487051 DOI: 10.1177/10790632231191116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Post-Conviction Traumatic Stress (PCTS) describes the cognitive, psychological, and physiological symptoms of trauma that result from a range of experiences with the criminal justice system. This pilot study aimed to empirically validate the construct of PCTS utilizing the Post-Traumatic Checklist (PCL-5), an existing measure of Post-Traumatic Stress Disorder (PTSD) according to DSM-5 diagnostic criteria. Using mixed methods, the survey asked about the traumagenic impact of arrests, court proceedings, incarceration, probation/parole supervision, and sex offender registration requirements in a sample of people required to register as sexual offenders (RSOs; n = 290) and their family members (n = 126). The PCL-5 was used to estimate the prevalence of PTSD and to explore the unique presentation of symptoms. Findings indicated that 69% of registrants and 62% of family members reported clinically significant indicators of PTSD. Examples of specific symptom presentations are illustrated through qualitative responses. Implications for clinical treatment, policy, and future research related to PCTS are discussed.
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Affiliation(s)
- Jill S Levenson
- School of Social Work, Barry University, Miami Shores, FL, USA
| | - Danielle Arlanda Harris
- Griffith Youth Forensic Service | Griffith Criminology Institute, School of Criminology and Criminal Justice, Griffith University, Mt Gravatt, QLD, Australia
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Zheng H, Rong H, Meng L, Wang S, Nie C, Gu X. Effects of proof-of-concept training on reducing work stress and anxiety of junior medical staff: a randomized controlled trial proof-of-concept. Acta Neurol Belg 2024; 124:1273-1279. [PMID: 38668999 DOI: 10.1007/s13760-024-02504-1] [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: 08/24/2023] [Accepted: 02/08/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Psychological stress and anxiety have seriously affected the ability of new clinicians to adapt and coordinate their clinical work. Traditional pre-job training is often not very good at assisting new recruits to regulate their emotional problems. METHODS This study is a randomized controlled study. A total of 435 newly recruited clinicians participated in the study. 428 clinicians were randomized into a control group (n = 214) and an intervention group (n = 214). The control group conducted regular pre-job training. Doctors of the intervention group attend a themed course every two weeks on the basis of regular induction training. Their physiological status was evaluated by Perceived Stress Scale (PPS-10), Generalized Anxiety Scale (GAD-7) and Psychological Resilience Scale (CD-RISC-10) 3 months later. Participants in the intervention group received a training satisfaction questionnaire. RESULTS After entering the clinic for 3 months, the PSS-10 and GAD-7 scores of the intervention group were significantly lower than that of the control group. Consistently, the CD-RISC-10 score of new clinicians who received proof-of-concept pre-job training was significantly higher than that of new doctors in the control group. CONCLUSION New doctors received the proof-of-concept group experienced alleviation in stress and anxiety.
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Affiliation(s)
- Hanjing Zheng
- Departments of Emergency, Shijiazhuang Fourth Hospital, No.16 Tangubei Street, Shijiazhuang, 050000, Hebei, China
| | - Huijuan Rong
- Nursing Department, Shijiazhuang Fourth Hospital, No.16 Tangubei Street, Shijiazhuang, 050000, Hebei, China
| | - Lei Meng
- Department of Anesthesia, People's Hospital of Hebei Province, Heping Road, Shijiazhuang, 050000, Hebei, China
| | - Sha Wang
- Departments of Emergency, Shijiazhuang Fourth Hospital, No.16 Tangubei Street, Shijiazhuang, 050000, Hebei, China
| | - Chunxue Nie
- Departments of Emergency, Shijiazhuang Fourth Hospital, No.16 Tangubei Street, Shijiazhuang, 050000, Hebei, China
| | - Xiaoxu Gu
- Departments of Emergency, Shijiazhuang Fourth Hospital, No.16 Tangubei Street, Shijiazhuang, 050000, Hebei, China.
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Aprigio I, Gauer G. The Centrality of Humiliation in Complex Posttraumatic Stress Disorder. J Trauma Dissociation 2024:1-17. [PMID: 39052588 DOI: 10.1080/15299732.2024.2383182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
Victims of traumatic events that involve repeated interpersonal aggression and low or no chance of escape frequently report intense Self-Conscious Emotions (SCEs), such as Shame, Guilt, and Humiliation. Humiliation is the reaction to a forced loss of status and is hypothesized to have unique contributions to the development and maintenance of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD). However, previous studies did not include humiliation or did not simultaneously probe the relative contribution of each SCE to posttraumatic symptoms. This study aimed to investigate the dynamics between specific SCEs and trauma-related symptomatology in the general population who suffered a form of complex trauma. Four hundred forty-nine people (77.11% women) exposed to domestic violence and sexual abuse answered an online survey. We investigated whether each emotion would accurately predict probable PTSD and CPTSD levels above the proposed cutoff. We estimated a network model to understand the dynamics of their interactions and whether the traumatic event type would moderate relationships between SCEs and posttraumatic stress symptoms, comparing networks of two types of complex trauma. No SCE predicted PTSD, but humiliation was a predictor of CPTSD while controlling for Shame and Guilt. Humiliation was also the most central SCE domain in the networks of both traumatic events. Our results stress the relevance of Humiliation to understanding posttraumatic stress symptoms and the necessity to consider humiliation when studying the emotional processing in complex trauma.
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Affiliation(s)
- Isabelle Aprigio
- Department of Psychology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gustavo Gauer
- Department of Psychology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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19
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Meier M, Kantelhardt S, Gurri L, Stadler C, Schmid M, Clemens V, O’Donovan A, Boonmann C, Bürgin D, Unternaehrer E. Childhood trauma is linked to epigenetic age deceleration in young adults with previous youth residential care placements. Eur J Psychotraumatol 2024; 15:2379144. [PMID: 39051592 PMCID: PMC11275517 DOI: 10.1080/20008066.2024.2379144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024] Open
Abstract
Background: Early adversity increases the risk for mental and physical disorders as well as premature death. Epigenetic processes, and altered epigenetic aging in particular, might mediate these effects. While the literature that examined links between early adversity and epigenetic aging is growing, results have been heterogeneous.Objective: In the current work, we explored the link between early adversity and epigenetic aging in a sample of formerly out-of-home placed young adults.Method: A total of N = 117 young adults (32% women, age mean = 26.3 years, SD = 3.6 years) with previous youth residential care placements completed the Childhood Trauma Questionnaire (CTQ) and the Life Events Checklist (LEC-R) and provided blood samples for the analysis of DNA methylation using the Illumina Infinium MethylationEPIC BeadChip Microarray. Epigenetic age was estimated using Hovarth's and Hannum's epigenetic clocks. Furthermore, Hovarth's and Hannum's epigenetic age residuals were calculated as a proxy of epigenetic aging by regressing epigenetic age on chronological age. The statistical analysis plan was preregistered (https://osf.io/b9ev8).Results: Childhood trauma (CTQ) was negatively associated with Hannum's epigenetic age residuals, β = -.23, p = .004 when controlling for sex, BMI, smoking status and proportional white blood cell type estimates. This association was driven by experiences of physical neglect, β = -.25, p = .001. Lifetime trauma exposure (LEC-R) was not a significant predictor of epigenetic age residuals.Conclusion: Childhood trauma, and physical neglect in particular, was associated with decelerated epigenetic aging in our sample. More studies focusing on formerly institutionalized at-risk populations are needed to better understand which factors affect stress-related adaptations following traumatic experiences.
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Affiliation(s)
- Maria Meier
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics Basel (UPK), University of Basel, Basel, Switzerland
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Sina Kantelhardt
- Department of Psychology, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Laura Gurri
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics Basel (UPK), University of Basel, Basel, Switzerland
| | - Christina Stadler
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics Basel (UPK), University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics Basel (UPK), University of Basel, Basel, Switzerland
| | - Vera Clemens
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Aoife O’Donovan
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA, USA
- Mental Health Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics Basel (UPK), University of Basel, Basel, Switzerland
- Department of Child and Adolescent Psychiatry (LUMC Curium), Leiden University Medical Center, Leiden, The Netherlands
| | - David Bürgin
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics Basel (UPK), University of Basel, Basel, Switzerland
| | - Eva Unternaehrer
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics Basel (UPK), University of Basel, Basel, Switzerland
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Behdinan T, Truuvert AK, Adekunte A, McCallum N, Vigod SN, Butt A, Rojas D, Soklaridis S, Ross DC. The Trauma PORTAL-A Blended e-Health Intervention for Survivors of Childhood Interpersonal Trauma: An Open-Label Pilot Study. TELEMEDICINE REPORTS 2024; 5:195-204. [PMID: 39081455 PMCID: PMC11286000 DOI: 10.1089/tmr.2024.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 08/02/2024]
Abstract
Background Adults with mental health symptoms stemming from childhood interpersonal trauma require specialized trauma-focused psychological interventions. Limitations in accessing treatment interventions for this population necessitate innovative solutions. This study explored the feasibility of a protocol for a blended e-health psychoeducational treatment intervention for this population called the Trauma PORTAL (Providing Online tRauma Therapy using an Asynchronous Learning platform), combining asynchronous online modules and weekly live virtual group sessions. Method From October 2021 to February 2022, this prospective, single-arm study recruited participants who were waitlisted for trauma therapy at an academic hospital. The primary outcome was protocol feasibility, including recruitment, adoption, and intervention acceptability. Secondary outcomes were pre- and post-intervention post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for DSM-5 [PCL-5]), depression/anxiety/stress (Depression and Anxiety Stress Scale [DASS-21]), and emotion regulation (Difficulties in Emotion Regulation Scale [DERS-18]), which were compared using paired t-tests and presented as mean differences (MDs) and 95% confidence intervals (CIs). Results A total of 66 participants (median age = 37, female = 61) were enrolled, and they completed on average 53.5% of the online modules. There were 51 (77%) participants who completed post-intervention questionnaires. Acceptability was very high, with 49 respondents (98%) reporting that the intervention increased their access to health care. There were reductions from pre- to post-intervention on the PCL-5 (49.1 vs. 36.7, MD -12.4, 95% CI 8.3-16.5), DERS-18 (51.8 vs. 48.8, MD -3.3, 95% CI 0.2-6.4), and DASS-21 (60.1 vs. 50.7, MD -9.4, 95% CI 2.3-16.6). Conclusion The Trauma PORTAL intervention was feasible to implement, well-adopted, and highly acceptable in an ambulatory trauma therapy program. The findings show promising evidence for symptom reduction. Further evaluation of the Trauma PORTAL's efficacy in a randomized trial is warranted.
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Affiliation(s)
- Tina Behdinan
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Aishat Adekunte
- Women’s College Hospital and Research Institute, Toronto, Canada
| | - Nancy McCallum
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women’s College Hospital and Research Institute, Toronto, Canada
| | - Simone N. Vigod
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women’s College Hospital and Research Institute, Toronto, Canada
| | - Aysha Butt
- Women’s College Hospital and Research Institute, Toronto, Canada
| | - David Rojas
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre, University of Toronto, Toronto, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre, University of Toronto, Toronto, Canada
- Centre for Addictions and Mental Health, Toronto, Canada
| | - Dana C. Ross
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women’s College Hospital and Research Institute, Toronto, Canada
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21
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Steil R, Maercker A, Jaworski L, Bachem R, Eberle D. [Evidence-based psychotherapy of posttraumatic stress syndrome-An update]. DER NERVENARZT 2024; 95:616-621. [PMID: 38906997 DOI: 10.1007/s00115-024-01694-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND The aim of this article is to summarize the current state of research on the effectiveness of psychotherapeutic treatment of posttraumatic stress disorder (PTSD). METHODS The results of current meta-analyses and trend-setting individual studies are summarized and the most important forms of intervention are explained. RESULTS The psychotherapeutic treatment methods for PTSD are very effective, the effect sizes are large and superior to those of pharmacotherapy. Trauma exposure and cognitive restructuring are most effective. Trauma-focused procedures are generally superior to other forms of psychotherapy. A range of different cognitive behavioral procedures as well as eye movement desensitization and reprocessing are recommended. The most recent initial findings confirm a very good effectiveness for imagery rescripting methods as protective interventions without a formal confrontation with trauma. Individual therapy works better than group psychotherapy. In the group setting cognitive processing therapy has proven to be the best intervention. Trauma-focused treatment should also be used when comorbid conditions such as schizophrenia, bipolar disorder or addiction are present. DISCUSSION Trauma-focused psychotherapy in an individual setting is the treatment of choice for PTSD. A large selection of effective methods and well-reviewed manuals are available. The German language S3 guidelines are currently being updated.
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Affiliation(s)
- Regina Steil
- Institut für Psychologie, Goethe-Universität Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Deutschland.
| | | | - Lena Jaworski
- Institut für Psychologie, Goethe-Universität Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Deutschland
| | - Rahel Bachem
- Psychologisches Institut, Universität Zürich, Zürich, Schweiz
| | - David Eberle
- Psychologisches Institut, Universität Zürich, Zürich, Schweiz
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22
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Bohus M, Vonderlin R. [Dialectical behavioral therapy for complex posttraumatic stress disorder (DBT-PTSD): an evidence-based disorder-specific treatment program]. DER NERVENARZT 2024; 95:630-638. [PMID: 38874612 DOI: 10.1007/s00115-024-01680-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/15/2024]
Abstract
Dialectical behavioral therapy for complex posttraumatic stress disorders (DBT-PTSD) is a modular treatment program that was developed at the Central Institute for Mental Health at the University of Heidelberg, Germany in 2005-2021. DBT-PTSD is designed to meet the needs of patients with complex PTSD related to sexual or physical trauma in childhood and adolescence. It is specifically designed for patients suffering from severe emotional dysregulation, persistent self-injury, chronic suicidal ideation, severe dissociative symptoms and a markedly negative self-concept with a high level of guilt, shame, self-loathing and interpersonal problems. To address these different core symptoms, DBT-PTSD combines evidence-based therapeutic strategies: principles, rules, and skills of DBT, trauma-specific cognitive and exposure-based techniques, imaginative interventions and procedures for behavioral change. The treatment program is designed to be carried out in an outpatient (45 weeks) or residential (12 weeks) setting. The results from two randomized controlled trials showed large effect sizes across very different symptom domains and a significant superiority of DBT-PTSD over Cognitive Processing Therapy (CPT). Based on these results, DBT-PTSD is currently a promising evidence-based treatment program for all features of a complex PTSD after sexual abuse in childhood and adolescence.
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Affiliation(s)
- Martin Bohus
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland.
- McLean Hospital, Harvard Medical School, Boston, MA, USA.
- Forschungs- und Behandlungszentrum für Psychische Gesundheit, Abteilung für Klinische Psychologie und Psychotherapie, Ruhr Universität Bochum, Bochum, Deutschland.
| | - Ruben Vonderlin
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
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23
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Jahan R, Amin R, Arafat SMY. Practical challenges for mental health services among Rohingya refugee in Bangladesh. Asian J Psychiatr 2024; 97:104069. [PMID: 38788321 DOI: 10.1016/j.ajp.2024.104069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/26/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Rohingya Muslims have been forcefully displaced from their mother land, Rakhaine State, Myanmar to Bangladesh, a country with about 170 million population with a treatment gap of more than 90% for standard mental health care. Due to the experienced trauma and displacement, high prevalence of depression, anxiety and post-traumatic tress disorders has been identified among Rohingya refugees in addition to the enduring mental health burden of Bangladesh. Very little has been known regarding the practical challenges of mental health services among Rohingya refugees in Bangladesh. In this commentary, we aimed to highlight the practical challenges for mental health services in Rohingya camps in Bangladesh along with our speculative ways forward based on available evidence, work experience, and informal communications. We highlighted the available mental health services, several major challenges including awareness, perception and belief towards mental health, language and cultural barriers, dearth of skilled service providers, inadequate services for severe mental illness, dearth of mental health services for children, inadequate provision of supervision and 'Care for Caregivers' program, and privacy and confidentiality of the clients. Although significant improvements have been made in the mental health field in the emergency crisis sector in Cox's Bazar over the past years, concentrated efforts are urgently required to actualize proposed solutions in this paper.
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Affiliation(s)
- Rubina Jahan
- Head of Clinical Services, Mental Health Program, SAJIDA Foundation, Dhaka, Bangladesh.
| | - Rizwana Amin
- Department of Psychology, Effat University, Jeddah, Saudi Arabia.
| | - S M Yasir Arafat
- Department of Psychiatry, Bangladesh Specialized Hospital, Dhaka 1207, Bangladesh; Senior Research Fellow, Biomedical Research Foundation, Dhaka, Bangladesh.
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24
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Mu C, Dang X, Luo XJ. Mendelian randomization analyses reveal causal relationships between brain functional networks and risk of psychiatric disorders. Nat Hum Behav 2024; 8:1417-1428. [PMID: 38724650 DOI: 10.1038/s41562-024-01879-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 04/03/2024] [Indexed: 05/19/2024]
Abstract
Dysfunction of brain resting-state functional networks has been widely reported in psychiatric disorders. However, the causal relationships between brain resting-state functional networks and psychiatric disorders remain largely unclear. Here we perform bidirectional two-sample Mendelian randomization (MR) analyses to investigate the causalities between 191 resting-state functional magnetic resonance imaging (rsfMRI) phenotypes (n = 34,691 individuals) and 12 psychiatric disorders (n = 14,307 to 698,672 individuals). Forward MR identified 8 rsfMRI phenotypes causally associated with the risk of psychiatric disorders. For example, the increase in the connectivity of motor, subcortical-cerebellum and limbic network was associated with lower risk of autism spectrum disorder. In adddition, increased connectivity in the default mode and central executive network was associated with lower risk of post-traumatic stress disorder and depression. Reverse MR analysis revealed significant associations between 4 psychiatric disorders and 6 rsfMRI phenotypes. For instance, the risk of attention-deficit/hyperactivity disorder increases the connectivity of the attention, salience, motor and subcortical-cerebellum network. The risk of schizophrenia mainly increases the connectivity of the default mode and central executive network and decreases the connectivity of the attention network. In summary, our findings reveal causal relationships between brain functional networks and psychiatric disorders, providing important interventional and therapeutic targets for psychiatric disorders at the brain functional network level.
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Affiliation(s)
- Changgai Mu
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Advanced Institute for Life and Health, Southeast University, Nanjing, China
| | - Xinglun Dang
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Advanced Institute for Life and Health, Southeast University, Nanjing, China
| | - Xiong-Jian Luo
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Advanced Institute for Life and Health, Southeast University, Nanjing, China.
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25
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Brenner L, Chrysanthou S, Rothermund E, Köllner V. [Effects of complex trauma disorder on the workplace: a scoping review]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:833-842. [PMID: 38890155 DOI: 10.1007/s00103-024-03908-3] [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: 01/02/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The "International Classification of Diseases 11th Revision" (ICD-11) introduces complex post-traumatic stress disorder (CPTSD) as a separate diagnosis to account for the effects that persistent or repetitive trauma can have. In CPTSD, disorders of self-organization are added to the core symptoms of PTSD. It can be assumed that those affected are impaired in their professional lives as a result. The aim of this paper is to provide an overview of the effects of CPTSD on work-related functioning and to present possible consequences for therapeutic and rehabilitative treatment. METHOD A scoping review with a literature search in the MEDLINE, APA PsycArticles, and APA PsycInfo databases was conducted in February 2024. RESULTS Of 2378 studies on KPTBS, five studies were included, of which only three dealt more specifically with the impact on the world of work. Those affected appear to have a poorer prognosis for maintaining their ability to work and are therefore to be regarded as a socio-medical risk group with regard to long-term maintenance of participation in working life. DISCUSSION The current state of research on the effects of the CPTSD symptom complex on the world of work is surprisingly limited. In comparison, the results indicate that CPTSD has a greater negative impact on the ability to function in the world of work than PTSD and other mental disorders. It is still unclear which psychopathological mechanisms mediate the connection. Only basic findings on the psychopathology of CPTSD are available. Treatment approaches that address the disorders of self-organization in addition to PTSD symptoms appear necessary.
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Affiliation(s)
- Lorena Brenner
- Forschungsgruppe Psychosomatische Rehabilitation, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Sophia Chrysanthou
- Reha-Zentrum Seehof der Deutschen Rentenversicherung, Lichterfelder Allee 55, 14513, Teltow, Deutschland
| | - Eva Rothermund
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Volker Köllner
- Forschungsgruppe Psychosomatische Rehabilitation, Charité Universitätsmedizin Berlin, Berlin, Deutschland.
- Reha-Zentrum Seehof der Deutschen Rentenversicherung, Lichterfelder Allee 55, 14513, Teltow, Deutschland.
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26
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Maercker A, Bachem R, Mutuyimana C, Eberle D. [Toward Cultural Scripts of Trauma Sequelae]. Psychother Psychosom Med Psychol 2024; 74:276-285. [PMID: 38580308 DOI: 10.1055/a-2276-4992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND The concept of cultural scripts has proven to be very useful for describing depression-like psychological complaints in different cultural regions of the world. The article presents the galaxy model and its implementation in the model of cultural scripts theoretically for the first time and connects these with cultural psychological value research. A new, extensive series of research projects aims to investigate post-trauma -related psychological complaints in various regions of the world. METHODS The work in two countries/regions began with focus groups in which elements of cultural scripts were collected by traumatized clients and/or by (therapeutic) experts. For this purpose, a theory-based framework of possible post-traumatic script elements was provided. In Switzerland, focus groups were conducted with patients and experts. Focus groups were conducted with genocide survivors and other trauma victims in Rwanda and three East African countries. The evaluation was semi-quantitative. RESULTS In Switzerland, around 50 symptoms and changes were mentioned as script elements (e. g. still having to function). Approximately 100 symptoms and changes were mentioned as script elements in East Africa (e. g. loss of dignity). The first temporal connections (i. e. strong scripts) were found for the Swiss scripts (e. g. self-devaluation - urge to function). In the East African study, cultural value orientations underlying the script groupings were also assessed (e. g. community reputation). DISCUSSION The illustrative results presented here demonstrate the galaxy model and the suitability of the cultural script concept for recording the effects of trauma. There are differences and similarities in the two world regions examined so far. Further steps at the two study sites will be the temporal connections and the relationships to value orientations. The studies will be started at the other study sites in the following years.
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Affiliation(s)
- Andreas Maercker
- Psychopathologie und Klinische Intervention, Universität Zürich, Schweiz
| | - Rahel Bachem
- Psychopathologie und Klinische Intervention, Universität Zürich, Schweiz
| | | | - David Eberle
- Psychopathologie und Klinische Intervention, Universität Zürich, Schweiz
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27
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Cassioli E, Tarchi L, Rossi E, Faldi M, Dani C, Giuranno G, Siviglia S, Baroncelli A, Maggi M, Vignozzi L, Giraldi A, Ricca V, Castellini G. Early traumatic experiences are linked to hypersexual behavior and erectile dysfunction in men through the mediation of body uneasiness and general psychopathology. J Sex Med 2024; 21:635-647. [PMID: 38778740 DOI: 10.1093/jsxmed/qdae058] [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: 06/13/2023] [Revised: 04/11/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Childhood traumatic experiences have been associated with hypersexuality and sexual dysfunctions. However, the mediators of the interactions between these variables should be clarified in men. AIM This study aimed to investigate the interaction of early traumatic experiences, psychopathology, and sexuality with respect to erectile dysfunction (ED) and hypersexual behavior. The hypothesized model expected that traumatic experiences would be associated with hypersexual behavior and reduced sexual functioning through the mediation of body uneasiness and psychological distress. METHODS The study was cross-sectional and observational. A total of 317 men were enrolled. Male patients with a primary complaint of ED and an indication for psychiatry referral represented the clinical sample (n = 116; mean ± SD age, 42.82 ± 16.89 years). Clinical classification was assessed with the Structured Interview on Erectile Dysfunction. The second sample (n = 201, 30.82 ± 11.94 years) was recruited from the general population. All participants were administered the following questionnaires: Brief Symptom Inventory, Childhood Trauma Questionnaire-Short Form, Hypersexual Behavior Inventory, Body Uneasiness Test-A, and 5-item International Index of Erectile Function. OUTCOMES Psychopathology and sexual functioning were assessed by a dimensional approach, and a multivariate model was computed by structural equation model analysis. RESULTS When compared with the sample from the general population, the clinical sample exhibited a higher prevalence of early traumatic experiences, as measured by scores on the Childhood Trauma Questionnaire-Short Form (45.08 ± 14.25 vs 39.03 ± 10.22, F = 17.63, P < .001), and a higher tendency to engage in hypersexual behaviors (34.63 ± 13.55 vs 30.79 ± 12.44, F = 6.97, P < .01). Structural equation model analysis showed excellent fit indices indicating that early traumatic experiences predicted hypersexual behaviors and ED through the exacerbating mediating effect of body uneasiness and psychopathology. CLINICAL IMPLICATIONS Clinicians should not limit their attention to the behavioral level when assessing sexual dysfunction in men; rather, they should also consider the complex psychopathologic consequences of childhood trauma. Integrated treatments that address the potential presence of childhood trauma with its wider psychological correlates (eg, emotion dysregulation, body uneasiness) might improve treatment response. STRENGTHS AND LIMITATIONS The study reports novel data on the relationship among childhood maltreatment, male sexuality, and psychopathologic mediators with a dimensional assessment. However, the assessment was cross-sectional, and causality was mainly derived from previous studies. CONCLUSION The present study enriches the current literature, strengthening the hypothesis that childhood traumatic experiences significantly shape development and sexuality. Body uneasiness and psychopathology can both tax sexual functioning, as assessed by erectile functioning or hypersexuality.
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Affiliation(s)
- Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Livio Tarchi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Marco Faldi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Cristiano Dani
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Gabriele Giuranno
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Serena Siviglia
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Andrea Baroncelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Mario Maggi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, 50100, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, 50100, Italy
| | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center Copenhagen, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, 2200, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
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Hofmann L, Wagner B. Understanding the complexity of suicide loss: PTSD, complex PTSD and prolonged grief disorder following suicide bereavement. DEATH STUDIES 2024:1-10. [PMID: 38913771 DOI: 10.1080/07481187.2024.2369858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Suicide-bereaved individuals are often confronted with profound grief reactions and have an increased risk for mental health disorders. Little is known about the development of complex post-traumatic stress disorder (CPTSD) following a loss by suicide. This paper aims to assess the prevalence of CPTSD, PTSD, prolonged grief disorder (PGD), and depression as well as to identify sociodemographic and loss-related factors regarding their development. A total of 161 suicide loss survivors (91.3% female) completed a questionnaire, which collected symptoms of grief (TGI-SR+), PTSD, CPTSD (ITQ), and depression (PHQ-D). In total, 12.4% met the diagnosis for CPTSD, 5.0% for PTSD. A total of 22.0% fulfilled the diagnosis for PGD. 41.6% showed at least moderate symptoms of depression. Pearson's correlation showed that time since loss was negatively associated with PG and PTSD symptoms, kinship to the deceased was associated with PG severity. The sample scored high on all disturbances in self-organization (DSO) symptom clusters typical for CPTSD. A focus on symptoms of CPTSD may be a necessary component in the care of survivors of suicide loss.
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Affiliation(s)
- Laura Hofmann
- Department of Clinical Psychology, Medical School Berlin, Berlin, Germany
| | - Birgit Wagner
- Department of Clinical Psychology, Medical School Berlin, Berlin, Germany
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29
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Navarra-Ventura G, Godoy-González M, Gomà G, Jodar M, Sarlabous L, Santos-Pulpón V, Xifra-Porxas A, de Haro C, Roca O, Blanch L, López-Aguilar J, Fernández-Gonzalo S. Occurrence, co-occurrence and persistence of symptoms of depression and post-traumatic stress disorder in survivors of COVID-19 critical illness. Eur J Psychotraumatol 2024; 15:2363654. [PMID: 38881386 PMCID: PMC11185090 DOI: 10.1080/20008066.2024.2363654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 05/22/2024] [Indexed: 06/18/2024] Open
Abstract
Background: Intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) are associated with psychological distress and trauma. The COVID-19 pandemic brought with it a series of additional long-lasting stressful and traumatic experiences. However, little is known about comorbid depression and post-traumatic stress disorder (PTSD).Objective: To examine the occurrence, co-occurrence, and persistence of clinically significant symptoms of depression and PTSD, and their predictive factors, in COVID-19 critical illness survivors.Method: Single-centre prospective observational study in adult survivors of COVID-19 with ≥24 h of ICU admission. Patients were assessed one and 12 months after ICU discharge using the depression subscale of the Hospital Anxiety and Depression Scale and the Davidson Trauma Scale. Differences in isolated and comorbid symptoms of depression and PTSD between patients with and without IMV and predictors of the occurrence and persistence of symptoms of these mental disorders were analysed.Results: Eighty-nine patients (42 with IMV) completed the 1-month follow-up and 71 (34 with IMV) completed the 12-month follow-up. One month after discharge, 29.2% of patients had symptoms of depression and 36% had symptoms of PTSD; after one year, the respective figures were 32.4% and 31%. Coexistence of depressive and PTSD symptoms accounted for approximately half of all symptomatic cases. Isolated PTSD symptoms were more frequent in patients with IMV (p≤.014). The need for IMV was associated with the occurrence at one month (OR = 6.098, p = .005) and persistence at 12 months (OR = 3.271, p = .030) of symptoms of either of these two mental disorders.Conclusions: Comorbid depressive and PTSD symptoms were highly frequent in our cohort of COVID-19 critical illness survivors. The need for IMV predicted short-term occurrence and long-term persistence of symptoms of these mental disorders, especially PTSD symptoms. The specific role of dyspnea in the association between IMV and post-ICU mental disorders deserves further investigation.Trial registration: ClinicalTrials.gov identifier: NCT04422444.
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Affiliation(s)
- Guillem Navarra-Ventura
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Godoy-González
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, International Excellence Campus, Bellaterra, Spain
| | - Gemma Gomà
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercè Jodar
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, International Excellence Campus, Bellaterra, Spain
- Neurology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Leonardo Sarlabous
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Verónica Santos-Pulpón
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Xifra-Porxas
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Candelaria de Haro
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Oriol Roca
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Lluís Blanch
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Josefina López-Aguilar
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Sol Fernández-Gonzalo
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, International Excellence Campus, Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Ding Y, Peng YY, Li S, Tang C, Gao J, Wang HY, Long ZY, Lu XM, Wang YT. Single-Cell Sequencing Technology and Its Application in the Study of Central Nervous System Diseases. Cell Biochem Biophys 2024; 82:329-342. [PMID: 38133792 DOI: 10.1007/s12013-023-01207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
The mammalian central nervous system consists of a large number of cells, which contain not only different types of neurons, but also a large number of glial cells, such as astrocytes, oligodendrocytes, and microglia. These cells are capable of performing highly refined electrophysiological activities and providing the brain with functions such as nutritional support, information transmission and pathogen defense. The diversity of cell types and individual differences between cells have brought inspiration to the study of the mechanism of central nervous system diseases. In order to explore the role of different cells, a new technology, single-cell sequencing technology has emerged to perform specific analysis of high-throughput cell populations, and has been continuously developed. Single-cell sequencing technology can accurately analyze single-cell expression in mixed-cell populations and collect cells from different spatial locations, time stages and types. By using single-cell sequencing technology to compare gene expression profiles of normal and diseased cells, it is possible to discover cell subsets associated with specific diseases and their associated genes. Therefore, scientists can understand the development process, related functions and disease state of the nervous system from an unprecedented depth. In conclusion, single-cell sequencing technology provides a powerful technology for the discovery of novel therapeutic targets for central nervous system diseases.
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Affiliation(s)
- Yang Ding
- College of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China
- State Key Laboratory of Trauma and Chemical Poisoning, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Yu-Yuan Peng
- College of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China
| | - Sen Li
- State Key Laboratory of Trauma and Chemical Poisoning, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Can Tang
- College of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China
| | - Jie Gao
- College of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China
| | - Hai-Yan Wang
- State Key Laboratory of Trauma and Chemical Poisoning, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Zai-Yun Long
- State Key Laboratory of Trauma and Chemical Poisoning, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Xiu-Min Lu
- College of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China.
| | - Yong-Tang Wang
- State Key Laboratory of Trauma and Chemical Poisoning, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Wang L, Fu H, Guo H, Liu P, Bi Y, Luo S, Han Y, Wang Y, Cao C. Complex posttraumatic stress disorder and dissociation in trauma-exposed Chinese adolescents: a latent class analysis. Eur J Psychotraumatol 2024; 15:2351292. [PMID: 38809665 PMCID: PMC11138217 DOI: 10.1080/20008066.2024.2351292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/24/2024] [Indexed: 05/31/2024] Open
Abstract
Background: Preliminary evidence provides support for the proposition that there is a dissociative subtype of Complex posttraumatic stress disorder (CPTSD). Research on this proposition would extend our knowledge on the association between CPTSD and dissociation, guide contemporary thinking regarding placement of dissociation in the nosology of CPTSD, and inform clinically useful assessment and intervention.Objectives: The present study aimed to investigate the co-occurring patterns of CPTSD and dissociative symptoms in a large sample of trauma exposed adolescents from China, and specify clinical features covariates of such patterns including childhood trauma, comorbidities with major depressive disorder (MDD) and generalized anxiety disorder (GAD), and functional impairment.Methods: Participants included 57,984 high school students exposed to the coronavirus disease 2019 (COVID-19) pandemic. CPTSD and dissociative symptoms, childhood traumatic experience, and functional impairment were measured with the Global Psychotrauma Screen for Teenagers (GPS-T). Major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Latent class analysis (LCA) was employed to test the co-occurring patterns of CPTSD and dissociative symptoms. Analysis of covariance (ANCOVA) and chi-square tests were respectively used to examine between-class differences in continuous and categorical clinical covariates.Results: A 5-class model emerged as the best-fitting model, including resilience, predominantly PTSD symptoms, predominantly disturbances in self-organization (DSO)symptoms, predominantly CPTSD symptoms, and CPTSD dissociative subtype classes. The CPTSD dissociative subtype class showed the lowest level of functioning and the highest rates of MDD, GAD and childhood trauma.Conclusions: Our findings provide initial empirical evidence supporting the existence of a dissociative subtype of CPTSD, and inform for further research and clinical practice on traumatized individuals.
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Affiliation(s)
- Li Wang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People’s Republic of China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Haibo Fu
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People’s Republic of China
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
| | - Hengjia Guo
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People’s Republic of China
- Department of Psychology, Skidmore College, Saratoga Springs, NY, USA
| | - Ping Liu
- People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Yajie Bi
- People’s Hospital of Deyang City, Deyang, People’s Republic of China
- School of Psychology, Guizhou Normal University, Guiyang, People’s Republic of China
| | - Shu Luo
- People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Yuwei Han
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People’s Republic of China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Yuxuan Wang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People’s Republic of China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Chengqi Cao
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People’s Republic of China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
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Riedl D, Kampling H, Nolte T, Kirchhoff C, Kruse J, Sachser C, Fegert JM, Gündel H, Brähler E, Grote V, Fischer MJ, Lampe A. Utilization of Mental Health Provision, Epistemic Stance and Comorbid Psychopathology of Individuals with Complex Post-Traumatic Stress Disorders (CPTSD)-Results from a Representative German Observational Study. J Clin Med 2024; 13:2735. [PMID: 38792277 PMCID: PMC11121826 DOI: 10.3390/jcm13102735] [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: 03/20/2024] [Revised: 05/02/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Complex post-traumatic stress disorder (CPTSD) is a severely debilitating recently added symptom cluster in the International Classification of Diseases (ICD-11). So far, only limited information on mental health treatment-uptake and -satisfaction of individuals with CPTSD is available. The aim of this study is to investigate these aspects in a representative sample of the German general population. Methods: Participants completed the International Trauma Questionnaire (ITQ) to identify participants with CPTSD, as well as questionnaires on mental health treatment uptake and satisfaction, adverse childhood experiences, anxiety, depression, working ability, personality functioning, and epistemic trust. Results: Of the included n = 1918 participants, n = 29 (1.5%) fulfilled the criteria for CPTSD. Participants with CPTSD had received mental health treatment significantly more often than participants with PTSD or depression (65.5% vs. 58.8% vs. 31.6%; p = 0.031) but reported significantly less symptom improvement (52.9% vs. 78.0% vs. 80.0%; p = 0.008). Lower levels of epistemic trust were associated with higher CPTSD symptoms (p < 0.001). Conclusions: Our study shows that while the vast majority of individuals with CPTSD had received mental health treatment, subjective symptom improvement rates are not satisfactory. CPTSD was associated with a broad number of comorbidities and impairments in functioning. Lower levels of epistemic trust may partially explain worse treatment outcomes.
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Affiliation(s)
- David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35392 Giessen, Germany
| | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London N1 9JH, UK
- Research Department for Clinical, Educational and Heath Psychology University College London, London WC1E 6BT, UK
| | - Christina Kirchhoff
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35392 Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, 35037 Marburg, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, 89075 Ulm, Germany
- German Center for Mental Health (DZPG), Partner Site Ulm, 89075 Ulm, Germany
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, 89075 Ulm, Germany
- German Center for Mental Health (DZPG), Partner Site Ulm, 89075 Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University Ulm Medical Center, 89081 Ulm, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, 55131 Mainz, Germany
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
- VAMED Rehabilitation Center Kitzbuehel, 6370 Kitzbuehel, Austria
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
- VAMED Rehabilitation Montafon, 6780 Schruns, Austria
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Scott R, Freckelton I. Vicarious trauma among legal practitioners and judicial officers. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2024; 31:500-522. [PMID: 38899325 PMCID: PMC11185848 DOI: 10.1080/13218719.2024.2339323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/06/2024] [Indexed: 06/21/2024]
Abstract
The term 'vicarious trauma' refers to a range of cumulative and harmful effects from exposure to the trauma of others and is now recognised as a category of causation in the diagnostic criteria of post-traumatic stress disorder. Legal practitioners may be exposed to the risk of harm from vicarious trauma in a number of occupational contexts. This article reviews recent case authority, including a 2023 prosecution of Court Services Victoria for failing to provide a safe workplace in the Coroners Court of Victoria and the High Court decision in Kozarov v Victoria (2022) and the Victoria Court of Appeal decision in Bersee v Victoria (2022). It considers measures that should be taken to provide a workplace for both legal practitioners and judicial officers that is as safe and without risks to health as is reasonably practicable.
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Affiliation(s)
- Russ Scott
- West Moreton Prison Mental Health Service, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Ian Freckelton
- Castan Chambers, Melbourne, VIC, Australia
- Law Faculty, University of Melbourne, Parkville, VIC, Australia
- Department of Forensic Medicine, Monash University, Melbourne, VIC, Australia
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Tschoeke S, Steinert T, Knoblauch H. Forensic aspects of dissociative positive symptoms in trauma-related disorders and borderline personality disorder. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 94:101973. [PMID: 38460238 DOI: 10.1016/j.ijlp.2024.101973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
A psychotically motivated act or an act committed under impaired insight and control of action in the midst of an acute psychosis is the standard for lack of criminal responsibility. There is now increasing evidence that positive symptoms, particularly in the form of hallucinations and delusions, in trauma-related disorders and borderline personality disorder (BPD) are comparable to positive symptoms in psychotic disorders, posing a challenge for differential diagnosis and forensic assessment of the relevance of positive symptoms to insight and self-control. Due to the indistinguishability of the phenomena, there is both a risk of misdiagnosis of a psychotic disorder and also trivialization with the use of pseudo-hallucinations or quasi-psychotic labels. Essential phenomenological differences that may be helpful in forensic assessments are the usually preserved reality testing in trauma-related disorders and BPD, as well as differences in psychopathological symptom constellations. Because of these differences relevant to forensic assessments, it seems useful to distinguish trauma-related disorders and BPD with positive symptoms from psychotic disorders.
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Affiliation(s)
- Stefan Tschoeke
- Clinic for Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ulm, Germany; Centres for Psychiatry Suedwuerttemberg, Ravensburg, Germany.
| | - Tilman Steinert
- Clinic for Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ulm, Germany; Centres for Psychiatry Suedwuerttemberg, Ravensburg, Germany
| | - Hans Knoblauch
- Clinic for Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ulm, Germany; Centres for Psychiatry Suedwuerttemberg, Ravensburg, Germany
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Bachem R, Maercker A, Levin Y, Köhler K, Willmund G, Bohus M, Koglin S, Roepke S, Schoofs N, Priebe K, Wülfing F, Schmahl C, Stadtmann MP, Rau H, Augsburger M. Assessing complex PTSD and PTSD: validation of the German version of the International Trauma Interview (ITI). Eur J Psychotraumatol 2024; 15:2344364. [PMID: 38687289 PMCID: PMC11062267 DOI: 10.1080/20008066.2024.2344364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
Background: With the introduction of the ICD-11 into clinical practice, the reliable distinction between Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) becomes paramount. The semi-structured clinician-administered International Trauma Interview (ITI) aims to close this gap in clinical and research settings.Objective: This study investigated the psychometric properties of the German version of the ITI among trauma-exposed clinical samples from Switzerland and Germany.Method: Participants were 143 civilian and 100 military participants, aged M = 40.3 years, of whom 53.5% were male. Indicators of reliability and validity (latent structure, internal reliability, inter-rater agreement, convergent and discriminant validity) were evaluated. Confirmatory factor analysis (CFA) and partial correlation analysis were conducted separately for civilian and military participants.Results: Prevalence of PTSD was 30% (civilian) and 33% (military) and prevalence of CPTSD was 53% (civilians) and 21% (military). Satisfactory internal consistency and inter-rater agreement were found. In the military sample, a parsimonious first-order six-factor model was preferred over a second-order two-factor CFA model of ITI PTSD and Disturbances in Self-Organization (DSO). Model fit was excellent among military participants but no solution was supported among civilian participants. Overall, convergent validity was supported by positive correlations of ITI PTSD and DSO with DSM-5 PTSD. Discriminant validity for PTSD symptoms was confirmed among civilians but low in the military sample.Conclusions: The German ITI has shown potential as a clinician-administered diagnostic tool for assessing ICD-11 PTSD and CPTSD in primary care. However, further exploration of its latent structure and discriminant validity are indicated.
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Affiliation(s)
- Rahel Bachem
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Yafit Levin
- School of Social Work, Ariel University, Ariel, Israel
| | - Kai Köhler
- Bundeswehr Center for Military Mental Health, Berlin, Germany
| | - Gerd Willmund
- Bundeswehr Center for Military Mental Health, Berlin, Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Stefanie Koglin
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Nikola Schoofs
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Kathlen Priebe
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Wülfing
- Department of Psychiatry and Neurosciences, Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Manuel P. Stadtmann
- Eastern Switzerland University of Applied Sciences, Competence Centre for Mental Health, St. Gallen, Switzerland
| | - Heinrich Rau
- Bundeswehr Center for Military Mental Health, Berlin, Germany
| | - Mareike Augsburger
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
- Klenico Health AG, University of Zurich startup, Zürich, Switzerland
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Drožđek B, Rodenburg J. Healing wounded trees: clinicians' perspectives on treatment of complex posttraumatic stress disorder. Front Psychiatry 2024; 15:1356862. [PMID: 38654731 PMCID: PMC11035878 DOI: 10.3389/fpsyt.2024.1356862] [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: 12/16/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
While treatment guidelines agree on the first-line interventions for the treatment of posttraumatic stress disorder (PTSD), there is an ongoing debate between experts regarding the treatment of complex posttraumatic stress disorder (C-PTSD). As scientific research is slowly emerging, different treatment approaches are used in clinical practice This article aims to provide a set of treatment options for C-PTSD in adult survivors of repeated exposure to severe violence and abuse, both in childhood and later on in life. The developmental-contextual perspective on mental health forms the basis of this approach. This perspective is elaborated using the tree metaphor. Then, several treatment strategies are suggested. The presented strategies are a combination of the existing evidence-based approaches for the treatment of PTSD and personality disorders. They target psychological damage in survivors while taking their developmental trajectories and ecological environments into consideration. The treatment model presented is based on longstanding clinical practice and it may be a promising framework for treating C-PTSD. However, it still needs to be scientifically examined for acceptability and effectiveness.
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Lampe A, Riedl D, Kampling H, Nolte T, Kirchhoff C, Grote V, Fischer MJ, Kruse J. Improvements of complex post-traumatic stress disorder symptoms during a multimodal psychodynamic inpatient rehabilitation treatment - results of an observational single-centre pilot study. Eur J Psychotraumatol 2024; 15:2333221. [PMID: 38577992 PMCID: PMC11000601 DOI: 10.1080/20008066.2024.2333221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
Background: Complex post-traumatic stress disorder (CPTSD) describes chronic disturbances in self-organization (i.e. affect dysregulation; negative self-concept; severe difficulties in relationships) which are frequently observed in survivors of prolonged, repeated or multiple traumatic stressors. So far, evidence of psychodynamic treatment approaches for CPTSD is scarce.Methods: In this single-centre observational pilot study, symptom change during a 6-week psychodynamic inpatient treatment in a multimodal psychosomatic rehabilitation centre was evaluated using repeated measures analyses of variance (ANOVAs). Patients completed questionnaires on PTSD and CPTSD symptoms (ITQ), anxiety, depression and somatization (BSI-18), functional impairment (WHODAS) and epistemic trust, mistrust and credulity (ETMCQ) before (T1) and at the end of treatment (T2). A hierarchical linear regression analysis was calculated to identify factors associated with improved CPTSD symptoms.Results: A total of n = 50 patients with CPTSD were included in the study, of whom n = 40 (80%) completed treatment. Patients reported a significant reduction of CPTSD symptoms during treatment with a large effect size (-3.9 points; p < .001; η2 = .36), as well as a significant reduction of psychological distress (p < .001; η2 = .55) and functional impairment (p < .001; η2 = .59). At the end of treatment, 41.0% of patients no longer fulfilled the diagnostic criteria for CPTSD. Changes in epistemic stance included improved epistemic trust (β = -.34, p = .026) and decreased epistemic credulity (β = .37, p = .017), which together with lower age (β = .43, p = .012) and lower depression levels at baseline (β = .35, p = .054) were significantly associated with baseline adjusted mean change of CPTSD symptoms during therapy and explained 48% of its variance.Discussion: In our study, patients reported a significant reduction of CPTSD symptoms and comorbid symptoms during a multimodal psychodynamic inpatient rehabilitation treatment. Improved epistemic trust may facilitate the establishment of a trusting therapeutic relationship, thus fostering an environment of openness for knowledge transfer (i.e. social learning) and the exploration of diverse viewpoints and perspectives in the therapeutic process.
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Affiliation(s)
- A. Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Montafon, Schruns, Austria
| | - D. Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - H. Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - T. Nolte
- Anna Freud National Centre for Children and Families, London, UK
- Research Department for Clinical, Educational and Heath Psychology, UCL, London, UK
| | - C. Kirchhoff
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - V. Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - M. J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Center Kitzbuehel, Kitzbuehel, Austria
| | - J. Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
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Ross DC, McCallum N, Truuvert AK, Butt A, Behdinan T, Rojas D, Soklaridis S, Vigod S. The development and evaluation of a virtual, asynchronous, trauma-focused treatment program for adult survivors of childhood interpersonal trauma. J Ment Health 2024:1-10. [PMID: 38572918 DOI: 10.1080/09638237.2024.2332797] [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: 03/10/2023] [Accepted: 08/05/2023] [Indexed: 04/05/2024]
Abstract
BACKGROUND The long-term mental and physical health implications of childhood interpersonal trauma on adult survivors is immense, however, there is a lack of available trauma-focused treatment services that are widely accessible. This study, utilizing a user-centered design process, sought feedback on the initial design and development of a novel, self-paced psychoeducation and skills-based treatment intervention for this population. AIMS To explore the views and perspectives of adult survivors of childhood interpersonal trauma on the first two modules of an asynchronous trauma-focused treatment program. METHODS Fourteen participants from our outpatient hospital service who completed the modules consented to provide feedback on their user experience. A thematic analysis of the three focus groups was conducted. RESULTS Four major themes emerged from the focus groups: (1) technology utilization, (2) module content, (3) asynchronous delivery, and (4) opportunity for interactivity. Participants noted the convenience of the platform and the use of multimedia content to increase engagement and did not find the modules to be emotionally overwhelming. CONCLUSIONS Our research findings suggest that an asynchronous virtual intervention for childhood interpersonal trauma survivors may be a safe and acceptable way to provide a stabilization-focused intervention on a wider scale.
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Affiliation(s)
- Dana C Ross
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nancy McCallum
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Annie K Truuvert
- Women's College Hospital and Research Institute, Toronto, ON, Canada
| | - Aysha Butt
- Women's College Hospital and Research Institute, Toronto, ON, Canada
| | - Tina Behdinan
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Rojas
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Simone Vigod
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Kazlauskas E, Kairyte A, Zelviene P. Complex posttraumatic stress disorder in adolescence: A two-year follow-up study. Clin Child Psychol Psychiatry 2024; 29:466-478. [PMID: 37402474 PMCID: PMC10945978 DOI: 10.1177/13591045231187975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Complex posttraumatic stress disorder is a new diagnosis in the 11th edition of the International Classification of Diseases (ICD-11). There is a need for a better understanding of complex PTSD in children and adolescents. OBJECTIVE The study aimed to estimate the factors associated with chronic complex PTSD versus recovery of complex PTSD in adolescents in a 2-year follow-up study. METHOD In total, 66 adolescents, mean age 14.5, 73% female, identified as having complex PTSD using self-report at baseline recruited from a general population sample, were included in the study. The International Trauma Questionnaire - Child and Adolescent Version (ITQ-CA) was used for the assessment of complex PTSD. RESULTS Overall, 36% of the study sample has been identified as having chronic complex PTSD over 2 years, 10% met the criteria for PTSD at a 2-year follow-up, and 54% recovered. A higher risk for chronic complex PTSD was associated with exposure to more traumatic events and more life-stressors over the 2 years, low social network, low positive social support, bullying at school, and loneliness. CONCLUSION The study found that around one-third of the traumatized youth had a prolonged trajectory of complex PTSD symptoms, which were associated with negative life experiences and social difficulties.
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Affiliation(s)
- Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Agniete Kairyte
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Paulina Zelviene
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
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Cloitre M, Lovelund AA, Jackson C, Edward D, Baker M. STAIR Narrative Therapy for complex posttraumatic stress disorder: Treating sexual and gender minority trauma. J Clin Psychol 2024; 80:836-854. [PMID: 37566386 DOI: 10.1002/jclp.23572] [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: 01/03/2023] [Revised: 05/02/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Complex PTSD is a recent addition to the ICD-11 diagnostic system. AIMS This case study describes the delivery of Skills Training in Affective and Interpersonal Regulation and Narrative Therapy (SNT), a flexible, multi-component therapy that addresses the symptoms of complex posttraumatic stress disorder. SNT balances interventions that address current-day stressors with those that reappraise the meaning of traumatic past events. This paper outlines 16 sessions of SNT with a 55-year-old gay man. DISCUSSION The case analysis describes the ways in which SNT is relevant and effective in addressing the client's mulitple concerns. The skills work helped the client effectively manage ongoing minority stress, discrimination, and micro-aggressions related to his identity as a gay man. Review and re-appraisal of his traumatic memories, which focused on the sudden death of his partner from AIDS along with discussion of events from his childhood that shaped his reactions to this loss, allowed the client to create a more integrated sense of self as well as a more compassionate view of himself. Implications regarding the relevance of SNT for sexual and gender minority individuals are discussed.
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Affiliation(s)
- Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Adrienne A Lovelund
- University of California San Francisco Alliance Health Project, San Francisco, California, USA
| | - Christie Jackson
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Donovan Edward
- Psychology Department of Georgia Southern University, Statesboro, Georgia, USA
| | - Michelanne Baker
- University of California San Francisco Alliance Health Project, San Francisco, California, USA
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Chiu HTS, Low DCW, Chan AHT, Meiser-Stedman R. Relationship between anxiety sensitivity and post-traumatic stress symptoms in trauma-exposed adults: A meta-analysis. J Anxiety Disord 2024; 103:102857. [PMID: 38507961 DOI: 10.1016/j.janxdis.2024.102857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/21/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
Given the high rate of trauma exposure among the general population, it is important to delineate the risk factors for post-traumatic stress disorder (PTSD). While historically implicated in panic disorder, anxiety sensitivity is increasingly found to play a role in PTSD. The present review investigated the size of the relationship between anxiety sensitivity and PTSD symptoms among trauma exposed adults. A systematic search on multiple electronic databases (PTSDpubs, CINAHL, MEDLINE and PsycINFO) generated a total of 1025 records, among which 52 (n = 15173) met study inclusion criteria and were included in our random effects meta-analysis. Our results indicated a medium effect size (r = .46, 95% CI =.41,.50) for the relationship between anxiety sensitivity and PTSD symptoms. There was significant between-study heterogeneity. Furthermore, sub-group analyses revealed that study design (cross-sectional vs. longitudinal) may significantly moderate the association between anxiety sensitivity and PTSD severity. No moderation effect was found for assessment of PTSD through interview versus questionnaire, interpersonal versus non-interpersonal trauma, or low versus high study quality. Such patterns of results are consistent with cognitive models of PTSD. Clinical implications, strengths and limitations of the review were discussed.
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Affiliation(s)
- Henry Tak Shing Chiu
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
| | - Debbie Chi Wing Low
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Angel Hiu Tung Chan
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Iazzolino AM, Valenza M, D'Angelo M, Longobardi G, Di Stefano V, Luca S, Scuderi C, Steardo L. How effective are mood stabilizers in treating bipolar patients comorbid with cPTSD? Results from an observational study. Int J Bipolar Disord 2024; 12:9. [PMID: 38530497 DOI: 10.1186/s40345-024-00330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Multiple traumatic experiences, particularly in childhood, may predict and be a risk factor for the development of complex post-traumatic stress disorder (cPTSD). Unfortunately, individuals with bipolar disorder (BP) are more likely to have suffered traumatic events than the general population. Consequently, cPTSD could be comorbid with BD, and this may negatively affect psychopathological manifestations. To date, no one has explored whether such comorbidity also affects the response to treatment with mood stabilizers in BD patients. RESULTS Here, a cross-sectional study was carried out by comparing the response to treatment, measured by the Alda scale, in a cohort of 344 patients diagnosed with BD type I and II, screened for the presence (or absence) of cPTSD using the International Trauma Questionnaire. The main result that emerged from the present study is the poorer response to mood stabilizers in BD patients with comorbid cPTSD compared with BD patients without cPTSD. CONCLUSIONS The results collected suggest the need for an add-on therapy focused on trauma in BD patients. This could represent an area of future interest in clinical research, capable of leading to more precise and quicker diagnoses as well as suggesting better tailored and more effective treatments.
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Affiliation(s)
- Anna Maria Iazzolino
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, 88100, Italy
| | - Marta Valenza
- Department of Physiology and Pharmacology "Vittorio Erspamer", SAPIENZA University of Rome, Rome, Italy
| | - Martina D'Angelo
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, 88100, Italy
| | - Grazia Longobardi
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, 88100, Italy
| | - Valeria Di Stefano
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, 88100, Italy
| | - Steardo Luca
- Department of Physiology and Pharmacology "Vittorio Erspamer", SAPIENZA University of Rome, Rome, Italy
- Università Giustino Fortunato, Benevento, 82100, Italy
| | - Caterina Scuderi
- Department of Physiology and Pharmacology "Vittorio Erspamer", SAPIENZA University of Rome, Rome, Italy
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, 88100, Italy.
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Gründer G, Brand M, Mertens LJ, Jungaberle H, Kärtner L, Scharf DJ, Spangemacher M, Wolff M. Treatment with psychedelics is psychotherapy: beyond reductionism. Lancet Psychiatry 2024; 11:231-236. [PMID: 38101439 DOI: 10.1016/s2215-0366(23)00363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/17/2023]
Abstract
Treatment of psychiatric disorders with psychedelic substances represents one of the most promising current treatment approaches in psychiatry. Since its inception in the 1950s, therapy with psychedelics has been conceptualised as psychedelic-assisted psychotherapy-ie, a form of psychotherapy that uses the profound biological effects of this class of substances as a catalyst for changing thinking, emotions, and behaviour. In this view, the psychotherapy component of the treatment is considered as being of the utmost importance for both the safety and efficacy of the therapy. This conceptualisation has been challenged by the idea that the latest clinical studies suggest that the potential therapeutic effects of psychedelics must be attributed solely to the substance itself, with no role for psychotherapy. Here, accompaniment by therapists is understood as mere psychological support, to maintain the safety of the substance administration. In this Personal View, we contrast these two views and argue that the characterisation of treatment with psychedelics as a biological intervention (with psychological support as a purely safety-related component) represents an outdated and reductionistic dualism that has dominated psychiatric treatment and research for far too long. This discussion has important implications for the study and the regulation of these compounds.
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Affiliation(s)
- Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; OVID Health Systems, Berlin, Germany.
| | - Manuela Brand
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lea J Mertens
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Henrik Jungaberle
- MIND Foundation, Berlin, Germany; OVID Health Systems, Berlin, Germany
| | - Laura Kärtner
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dennis J Scharf
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Moritz Spangemacher
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Max Wolff
- MIND Foundation, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
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Tschöke S, Knauer Y, Flammer E, Usemann P, Uhlmann C. Psychotic Experiences and Daily Functioning in Borderline Personality Disorder and Schizophrenia. J Nerv Ment Dis 2024; 212:187-189. [PMID: 38412244 DOI: 10.1097/nmd.0000000000001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT Psychotic experiences have been shown to be comparable in borderline personality disorder (BPD) and schizophrenia. Preliminary evidence suggests differences in the impact of psychotic experiences on daily functioning. Therefore, in this study, we aimed to investigate the role of psychotic experiences in daily functioning in BPD compared with schizophrenia. We performed post hoc analyses on data from 23 inpatients with BPD and 21 inpatients with schizophrenia, for whom results from the Psychotic Symptom Rating Scales were available. No differences were found in frequency, intensity, and disruption of life in relation to auditory verbal hallucinations and the amount of preoccupation and conviction with regard to delusions. Significant differences were found in the disruption of life due to delusions. The results emphasize that the quality of psychotic experiences in BPD and schizophrenia is comparable, but the impact of delusions on daily life is different, which may improve differential diagnosis.
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Russell SE, Wrobel AL, Lotfaliany M, Ashton MM, Kaur R, Yocum AK, Duval ER, Diaz-Byrd C, Ehrlich TJ, Marshall DF, Berk M, McInnis MG, Dean O, Turner A. Trauma and comorbid post-traumatic stress disorder in people with bipolar disorder participating in the Heinz C. Prechter Longitudinal Study. J Affect Disord 2024; 348:275-282. [PMID: 38163569 DOI: 10.1016/j.jad.2023.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/06/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND It is estimated that up to 50 % of people with bipolar disorder (BD) also have comorbid post-traumatic stress disorder (PTSD). However, little is known about the presentation and treatment of people with this comorbidity. METHODS Data from 577 individuals diagnosed with bipolar disorder participating in the Heinz C. Prechter Longitudinal Study of BD were explored at baseline, year two and four. Three trauma groups were created: (i) one trauma (n = 75), (ii) multiple traumas (n = 417), and comorbid PTSD (n = 85). Measures of depression, mania, sleep, number of hospitalisations, suicide attempts, and medication use were analysed using regression modelling to determine differences between the three trauma groups. RESULTS There was an increase in depression, mania, and sleep scores and a higher number of hospitalisations in participants with comorbid PTSD compared to those experiencing one trauma. Additionally, increased mania and depression scores were reported in participants experiencing multiple traumas compared to those with one trauma. There was no difference in medication use between those who experienced one trauma compared to those with comorbid PTSD. LIMITATIONS The trauma groups may include confounding with more participants experiencing PTSD than reported in this study due to screening processes. Additionally, the severity of trauma was not recorded, therefore number of traumas was utilised as a proxy. CONCLUSION Comorbid BD and PTSD is associated with worse symptom scores compared to participants reporting one trauma. Clinical implications include the addition of trauma-informed care to clinical settings to identify PTSD to provide appropriate treatments.
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Affiliation(s)
- Samantha E Russell
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia
| | - Anna L Wrobel
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia; Orygen, Parkville, Victoria, Australia
| | - Mojtaba Lotfaliany
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia
| | - Melanie M Ashton
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia
| | - Ravleen Kaur
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anastasia K Yocum
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Claudia Diaz-Byrd
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tobin J Ehrlich
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - David F Marshall
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Berk
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia; Orygen, Parkville, Victoria, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville 3052, Australia; University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Olivia Dean
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville 3052, Australia
| | - Alyna Turner
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia; School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan 2308, Australia.
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Shi H. The effect of social support on home isolation anxiety and depression among college students in the post-pandemic era: the mediating effect of perceived loss of control and the moderating role of family socioeconomic status. Front Public Health 2024; 12:1288848. [PMID: 38406501 PMCID: PMC10884108 DOI: 10.3389/fpubh.2024.1288848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/30/2024] [Indexed: 02/27/2024] Open
Abstract
Background There is an escalating concern about the rising levels of anxiety and depression among college students, especially during the post-pandemic era. A thorough examination of the various dimensions of social support and their impact on these negative emotions in college students is imperative. Aim This study aimed to determine if a perceived loss of control mediates the relationship between social support and levels of anxiety and depression among college students during the post-pandemic era. Additionally, it examined whether family socioeconomic status moderates this mediated relationship. Methods We administered an online cross-sectional survey in China, securing responses from 502 participants. The sample comprised home-isolated college students impacted by COVID-19. Established scales were employed to assess social support, anxiety, depression, perceived loss of control, and family socioeconomic status. Analytical techniques included descriptive statistics, correlation analysis, and a bootstrap method to investigate mediating and moderating effects. Results Social support was found to negatively affect anxiety and depression in college students, with perceived loss of control partially mediating this relationship. In addition, family socio-economic status was shown to moderate this moderating process. Furthermore, family socioeconomic status influenced this mediation, with higher socioeconomic families exhibiting a stronger moderating effect on perceived loss of control across different dimensions of social support. Conclusion This study may help to develop strategies to mitigate the impact of anxiety and depression in the lives and studies of university students during unexpected public health crises, and to promote better mental health among college students.
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Affiliation(s)
- Hui Shi
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
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Blay M, Duarte M, Dessouli MA, Durpoix A, Rüfenacht E, Weibel S, Speranza M, Perroud N. Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles. Front Psychiatry 2024; 15:1260138. [PMID: 38384590 PMCID: PMC10879599 DOI: 10.3389/fpsyt.2024.1260138] [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: 07/17/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Emotion dysregulation (ED) has primarily been described in patients suffering from borderline personality disorder (BPD) and is an integral part of this diagnosis, but it is also a transdiagnostic construct that can be found in several other psychiatric disorders. The strong relationships between ED and BPD may lead clinicians to underestimate ED associated to other clinical contexts. This can lead to difficulties in diagnostic and treatment orientation, especially in the context of comorbidities. In this article, after reviewing the literature on the development and functioning of emotion dysregulation, and on the evidence for emotion dysregulation in eight disorders (borderline personality disorder, pathological narcissism with/without narcissistic personality disorder, obsessive-compulsive personality disorder, antisocial personality disorder, bipolar disorder, autism spectrum disorder, complex post-traumatic stress disorder, and adult attention deficit hyperactivity disorder), we present a transdiagnostic processual model of emotion dysregulation based on core triggers and interpersonal styles to try to address this issue and to provide a simple but technical tool to help clinicians in their diagnostic assessment and treatment orientation. By focusing more on typical patterns and interpersonal dynamics than only on categories, we believe that this model may contribute to the actual need for improvement of our current psychiatric classifications, alongside other well-studied and under-used dimensional models of psychopathology (e.g., HiTOP, AMPD), and may be useful to build more specific treatment frameworks for patients suffering from ED.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Addictology and Psychiatry Outpatient Center, Santé Basque Développement Group, Lyon, France
- Centre de recherche en Epidemiologie et Sante des Populations Team ‘DevPsy’, INSERM, Universite Paris-Saclay, UVSQ, Villejuif, France
| | - Miguel Duarte
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Marie-Alix Dessouli
- Department of Emergency Psychiatry, University Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Amaury Durpoix
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
| | - Eva Rüfenacht
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Sébastien Weibel
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
- U1114, INSERM, Strasbourg, France
| | - Mario Speranza
- Centre de recherche en Epidemiologie et Sante des Populations Team ‘DevPsy’, INSERM, Universite Paris-Saclay, UVSQ, Villejuif, France
- University Department of Child and Adolescent Psychiatry, Versailles Hospital Center, Le Chesnay-Rocquencourt, France
| | - Nader Perroud
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
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48
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Iazzolino AM, Valenza M, D’Angelo M, Longobardi G, Stefano VD, Visalli G, Steardo L, Scuderi C, Steardo L. The Impact of Complex PTSD on Suicide Risk in Patients with Bipolar Disorder: A Cross-Sectional Study. J Clin Med 2024; 13:673. [PMID: 38337367 PMCID: PMC10856776 DOI: 10.3390/jcm13030673] [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: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Patients with bipolar disorder (BD) are more likely than the general population to experience traumatic events, particularly during childhood, and these may predict and be a risk factor for the development of complex PTSD (cPTSD). The presence of multiple traumas plays a relevant role from a psychopathological point of view, but little is known about the effect this may have on suicide attempts in patients with BD. METHODS A cross-sectional study was conducted comparing socio-demographic and clinical characteristics, recruiting 344 patients diagnosed with BD I and II, screened for the presence (or absence) of cPTSD using the International Trauma Questionnaire (ITQ). Suicide attempts were assessed directly during the clinical interview and from the patient's medical record. RESULTS The results emerging from the study indicate that cPTSD can be considered a risk factor for suicide attempts in patients with BD. Furthermore, evidence is provided to support the idea that cPTSD is highly prevalent in patients with BD and is related to a higher psychopathological burden. CONCLUSIONS The results recommend an urgent and comprehensive assessment of suicidal risk in patients with comorbidity of both bipolar disorder and cPTSD. There is a crucial demand for early intervention initiatives and proactive prevention strategies to address the intricate intersection of these mental health challenges.
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Affiliation(s)
- Anna Maria Iazzolino
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (M.D.); (G.L.); (V.D.S.); (G.V.); (L.S.J.)
| | - Marta Valenza
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (L.S.); (C.S.)
| | - Martina D’Angelo
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (M.D.); (G.L.); (V.D.S.); (G.V.); (L.S.J.)
| | - Grazia Longobardi
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (M.D.); (G.L.); (V.D.S.); (G.V.); (L.S.J.)
| | - Valeria Di Stefano
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (M.D.); (G.L.); (V.D.S.); (G.V.); (L.S.J.)
| | - Giulia Visalli
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (M.D.); (G.L.); (V.D.S.); (G.V.); (L.S.J.)
| | - Luca Steardo
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (L.S.); (C.S.)
- University Giustino Fortunato, 82100 Benevento, Italy
| | - Caterina Scuderi
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (L.S.); (C.S.)
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (M.D.); (G.L.); (V.D.S.); (G.V.); (L.S.J.)
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49
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Rusmir M, Rohner SL, Maercker A, Salas Castillo AN, Thoma MV. Predictors and (in-)stability of ICD-11 complex posttraumatic stress disorder in older adults: findings from a longitudinal study in Switzerland. Eur J Psychotraumatol 2024; 15:2299618. [PMID: 38258813 PMCID: PMC10810634 DOI: 10.1080/20008066.2023.2299618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Objective: There is a lack of research on complex post-traumatic stress disorder (CPTSD) in older individuals, with little known about the temporal course of CPTSD. Therefore, this study assessed and compared the demographic characteristics, adverse childhood experiences (ACE), and well-being of Swiss older adults with and without probable CPTSD. The (in-)stability of probable CPTSD was also examined in relation to the predictive value of various emotion-related factors.Methods: A longitudinal study was conducted in Switzerland with N = 213 participants (Mage = 69.98 years, SD = 10.61; 45.5% female). Data was collected via face-to-face assessments at baseline and follow-up, 21 months apart. The German version of the International Trauma Questionnaire was used to screen for (C)PTSD. Standardized instruments were used to assess ACE as well as the predictors anger, embitterment, emotion regulation, and meaning in life.Results: From the total sample, n = 16 participants (7.5%) were identified as having probable CPTSD, with only five of these (31.25%) having probable CPTSD at both baseline and follow-up. Individuals with and without probable CPTSD differed significantly regarding age and employment status. Significant predictors of probable CPTSD were anger (β = 0.16), embitterment (β = 0.06), cognitive reappraisal (β = -0.41), and the presence of meaning in life (β = -0.10).Conclusions: Probable CPTSD appears to be relatively unstable over the course of a 21-month period in older individuals. The links between CPTSD and emotion-related predictors highlight potential targets for intervention.
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Affiliation(s)
- Milan Rusmir
- Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Shauna L. Rohner
- Competence Centre for Mental Health, Department of Health, OST – University of Applied Sciences of Eastern Switzerland, St. Gallen, Switzerland
- University Research Priority Program ‘Dynamics of Healthy Aging’, University of Zurich, Zurich, Switzerland
| | - Andreas Maercker
- Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland
- University Research Priority Program ‘Dynamics of Healthy Aging’, University of Zurich, Zurich, Switzerland
| | - Aileen N. Salas Castillo
- Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Myriam V. Thoma
- Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland
- University Research Priority Program ‘Dynamics of Healthy Aging’, University of Zurich, Zurich, Switzerland
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50
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Aksan N, Guzick AG, Taylor L, Richmond R, Liberzon I, Cross J, Garza C, Rousseau J, Shahidullah JD, Clark SL, Rathouz PJ, Dodd CG, Cisler J, Newport DJ, Wagner KD, Nemeroff CB. Evaluating traumatic event scoring schemas for their predictive value to concurrent diagnostic profiles: Texas Childhood Trauma Research Network. J Affect Disord 2024; 345:94-102. [PMID: 37848091 DOI: 10.1016/j.jad.2023.10.092] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND To prospectively chart pathways of risk and resiliency following childhood trauma studies need to address three limitations of prior work: 1) recruit beyond social service/ treatment settings; 2) include broad spectrum of trauma types and 3) cast a broad longitudinal measurement framework of both clinical diagnoses and traumatic exposures. The Texas-Childhood Trauma Research Network (TX-CTRN) is a multi-site collaboration that addresses these limitations. In this baseline-only report, we examined domains of trauma and evaluated the concurrent predictive validity of various traumatic event scoring schemas for clinical diagnoses. METHODS Broad-base recruitment of 8-20 year-olds (N = 1289) included trauma centers, emergency departments, pediatric and primary care clinics, and other community settings. Assessments were comprehensive and based on clinical interviews by trained research interviewers. RESULTS Factor analyses supported a five-factor solution of trauma domains including unintentional/acute, intentional/interpersonal, bullying, in-home versus community witnessed interpersonal harms. Trauma burden scoring schemas were examined for their predictive superiority. Domain-specific counts of traumas that met DSM-5 post-traumatic-stress disorder (PTSD) Criterion-A was the best overall schema in distinguishing among youth with no diagnosis, comorbidities, those with depression, suicidality, substance misuse, and PTSD. LIMITATIONS There were no assessments of neglect. CONCLUSIONS Findings largely aligned with earlier studies on the relative importance of intentional interpersonal traumas and showed bullying may be an important source of traumatic stress that independently adds to prediction of several diagnoses and should be considered in clinical practice.
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Affiliation(s)
- Nazan Aksan
- Dept of Population Health, Dell Medical School, University of Texas at Austin, United States of America.
| | - Andrew G Guzick
- Dept of Psychiatry, Baylor College of Medicine, University of Pennsylvania, United States of America
| | - Leslie Taylor
- Dept of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, Houston, United States of America
| | - Robyn Richmond
- Dept of Surgery, Texas Tech University Lubbock, United States of America
| | - Israel Liberzon
- Dept of Psychiatry, Texas A&M University, United States of America
| | - Jeremyra Cross
- Dept of Psychiatry, University of Texas Health Science Center, San Antonio, United States of America
| | - Cynthia Garza
- Adult Primary Care University of Texas Health Science Center Rio Grande Valley, United States of America
| | - Justin Rousseau
- Dept of Population Health, Dell Medical School, University of Texas at Austin, United States of America; Dept of Neurology, Dell Medical School, University of Texas at Austin, United States of America
| | - Jeffrey D Shahidullah
- Dept of Psychiatry, Dell Medical School, University of Texas at Austin, United States of America
| | - Shaunna L Clark
- Dept of Psychiatry, Texas A&M University, United States of America
| | - Paul J Rathouz
- Dept of Population Health, Dell Medical School, University of Texas at Austin, United States of America
| | - Cody G Dodd
- Dept of Psychiatry & Behavioral Sciences, University of Texas Medical Branch, United States of America
| | - Josh Cisler
- Dept of Psychiatry, Dell Medical School, University of Texas at Austin, United States of America
| | - D Jeffrey Newport
- Dept of Psychiatry, Dell Medical School, University of Texas at Austin, United States of America
| | - Karen D Wagner
- Dept of Psychiatry & Behavioral Sciences, University of Texas Medical Branch, United States of America
| | - Charles B Nemeroff
- Dept of Psychiatry, Dell Medical School, University of Texas at Austin, United States of America
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