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Dumas LE, Fernandez A, Auby P, Askenazy F. Relationship between social cognition and emotional markers and acoustic-verbal hallucination in youth with post-traumatic stress disorder: Protocol for a prospective, 2-year, longitudinal case-control study. PLoS One 2024; 19:e0306338. [PMID: 38954699 PMCID: PMC11218996 DOI: 10.1371/journal.pone.0306338] [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: 08/23/2023] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Auditory-verbal hallucinatory experiences (AVH) have a 12% prevalence in the general pediatric population. Literature reports a higher risk of developing AVH in post-traumatic stress disorder (PTSD). The persistence of AVHs during adolescence represents a risk of evolution into psychotic disorders. Social cognition and emotional markers could be considered prodromes markers of this evolution. The objectives of this prospective observational study are to observe social cognition and emotional markers correlation with the presence and persistence of AVH over two years and with the evolution of PTSD and psychotic diagnosis. METHODS AND ANALYSIS This prospective case-control study, longitudinal over two years (with an interim reassessment at six months and one year), will include 40 participants aged 8 to 16 years old with a diagnosis of PTSD and without a diagnosis of psychosis according to the criteria of DSM-5 (K-SADS-PL). Subjects included are divided into two groups with AVH and without AVH matched by gender, age and diagnosis. The primary outcome measure will be the correlation between social cognition and emotional makers and the presence of AVH in the PTSD pediatric population without psychotic disorders. The social cognition marker is assessed with the NEPSY II test. The emotional marker is assessed with the Differential Emotion Scale IV and the Revised Beliefs About Voices Questionnaire. The secondary outcome measures are the correlation of these markers with the persistence of AVH and the evolution of the patient's initial diagnosis two years later. DISCUSSION The originality of our protocol is to explore the potential progression to psychosis from PTSD by cognitive biases. This study supports the hypothesis of connections between PTSD and AVH through sensory, emotional and cognitive biases. It proposes a continuum model from PTSD to psychotic disorder due to impaired perception like AVH. TRIAL REGISTRATION Clinical trial registration: ClinicalTrials.gov Identifier: NCT03356028.
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Affiliation(s)
- Louise-Emilie Dumas
- University Department of Child and Adolescent Psychiatry, Pediatric Hospitals of Nice CHU-Lenval, Nice, France
- Université Côte d’Azur, CoBTek, FRIS, Nice, France
| | - Arnaud Fernandez
- University Department of Child and Adolescent Psychiatry, Pediatric Hospitals of Nice CHU-Lenval, Nice, France
- Université Côte d’Azur, CoBTek, FRIS, Nice, France
- Expert Center for Psychotrauma Paca Corse, Nice, France
| | - Philippe Auby
- University Department of Child and Adolescent Psychiatry, Pediatric Hospitals of Nice CHU-Lenval, Nice, France
- Université Côte d’Azur, CoBTek, FRIS, Nice, France
| | - Florence Askenazy
- University Department of Child and Adolescent Psychiatry, Pediatric Hospitals of Nice CHU-Lenval, Nice, France
- Université Côte d’Azur, CoBTek, FRIS, Nice, France
- Expert Center for Psychotrauma Paca Corse, Nice, France
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Aoki S, Nozawa E. Pilot Study on Classification of Sensory Symptoms in PTSD. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:283-293. [PMID: 38938954 PMCID: PMC11199429 DOI: 10.1007/s40653-023-00602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 06/29/2024]
Abstract
PTSD treatment that focused on a sensory symptoms is increasing. The study aimed to explore symptoms and abnormalities in the five senses exhibited by persons with PTSD and to examine whether there are any differences depending on type of traumatic experience. Questionnaire was followed by interviews to clinical psychologists involved in the treatment of PTSD. 249 PTSD symptoms exhibited in the sensory organs were collected. Sensory symptoms were classified into three categories according to the type of symptoms and the type of traumatic events. Cluster 1 is a group formed by child abuse and violence together with audition, tactile, and hyperarousal. Cluster 2 is made up of natural disaster, accident, and sexual assault together with vision, olfaction and intrusion. Cluster 3 is made up of multiple traumas together with gustation and dissociation. It is speculated that the survivors of Child abuse and violence are hypersensitive to sounds, the presence of others, and physical contact because they try to quickly sense when a perpetrator is approaching. Natural disasters, accidents, and sexual assault are events with strong smell and severe visual impact, it is possible that they may easily cause reliving of the event in the form of shocking visual images and smells in flashbacks. Dissociation symptoms were related with complex trauma and taste. The mouth is the site of first contact between mother and child, and it is possible that gustatory dissociation may occur mainly in cases of severe and repeated trauma since early childhood.
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Affiliation(s)
- Sanae Aoki
- Faculty of Psychology, Department of Clinical Psychology, Rissho University, 4-2-16 Osaki, Shinagawa, Tokyo, 141-8602 Japan
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Jukić M, Malenica L, Đuričić V, Talapko J, Lukinac J, Jukić M, Škrlec I. Long-Term Consequences of War Captivity in Military Veterans. Healthcare (Basel) 2023; 11:1993. [PMID: 37510434 PMCID: PMC10379024 DOI: 10.3390/healthcare11141993] [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: 05/16/2023] [Revised: 07/02/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Numerous studies on the health and functioning of veterans and former prisoners of war have shown that the experience of war captivity is one of the most difficult human experiences. Captivity is often characterized by extremely difficult and inhumane conditions, as well as exposure to various forms of both psychological and physical abuse. Such traumatic experiences can lead to serious psychological consequences that can last for years, even decades after release from captivity. The aim of this paper is to present a brief overview of research that points to the specifics of wartime captivity and the long-term psychological consequences in veterans of former camp detainees, as well as the consequences suffered by their families and factors that, apart from the intensity of the trauma, contribute to the emergence and persistence of psychological disorders. From the presented research, it can be concluded that former prisoners of the camp represent an extremely vulnerable group of the social community and require long-term appropriate treatment, while the needs of veterans' families should not be neglected, with the necessity of including spouses and children in psychological and psychosocial treatments.
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Affiliation(s)
- Melita Jukić
- Department of Psychiatry, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Luka Malenica
- Department of Psychiatry, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Vanja Đuričić
- Department of Psychiatry, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia
| | - Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Jasmina Lukinac
- Faculty of Food Technology Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Marko Jukić
- Faculty of Food Technology Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Bajor LA, Balsara C, Osser DN. An evidence-based approach to psychopharmacology for posttraumatic stress disorder (PTSD) - 2022 update. Psychiatry Res 2022; 317:114840. [PMID: 36162349 DOI: 10.1016/j.psychres.2022.114840] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 01/04/2023]
Abstract
Algorithms for posttraumatic stress disorder were published by this team in 1999 and 2011. Developments since then warrant revision. New studies and review articles from January 2011 to November 2021 were identified via PubMed and analyzed for evidence supporting changes. Following consideration of variations required by special patient populations, treatment of sleep impairments remains as the first recommended step. Nightmares and non-nightmare disturbed awakenings are best addressed with the anti-adrenergic agent prazosin, with doxazosin and clonidine as alternatives. First choices for difficulty initiating sleep include hydroxyzine and trazodone. If significant non-sleep PTSD symptoms remain, an SSRI should be tried, followed by a second SSRI or venlafaxine as a third step. Second generation antipsychotics can be considered, particularly for SSRI augmentation when PTSD-associated psychotic symptoms are present, with the caveat that positive evidence is limited and side effects are considerable. Anti-adrenergic agents can also be considered for general PTSD symptoms if not already tried, though evidence for daytime use lags that available for sleep. Regarding other pharmacological and procedural options, e.g., transcranial magnetic stimulation, cannabinoids, ketamine, psychedelics, and stellate ganglion block, evidence does not yet support firm inclusion in the algorithm. An interactive version of this work can be found at www.psychopharm.mobi.
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Affiliation(s)
- Laura A Bajor
- James A. Haley VA Hospital, Tampa, FL, United States; University of South Florida Morsani School of Medicine, Tampa, FL, United States; VA Boston Healthcare System and Harvard South Shore Psychiatry Residency Training Program, Brockton, MA, United States.
| | - Charmi Balsara
- HCA Healthcare East Florida Division GME/HCA FL Aventura Hospital, United States
| | - David N Osser
- VA Boston Healthcare System and Harvard South Shore Psychiatry Residency Training Program, Brockton, MA, United States
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Qi R, Cao Z, Surento W, Zhang L, Qiu L, Xia Z, Ching CRK, Xu Q, Yin Y, Zhang LJ, Li L, Luo Y, Lu GM. RORA rs8042149 polymorphism moderates the association between PTSD symptom severity and transverse temporal gyrus thickness in Han Chinese adults who lost their only child. J Affect Disord 2022; 314:318-324. [PMID: 35878841 DOI: 10.1016/j.jad.2022.07.044] [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: 05/18/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The G allele in retinoid-related orphan receptor alpha (RORA, rs8042149) gene is associated with post-traumatic stress disorder (PTSD) diagnosis and more severe symptoms, reported in the first genome-wide association study of PTSD and subsequent replication studies. Although recent MRI studies identified brain structural deficits in RORA rs8042149 risk G allele carriers, the neural mechanism underlying RORA-related brain structural changes in PTSD remains poorly understood. METHODS This study included 227 Han Chinese adults who lost their only child. Cortical thickness and subcortical volume were extracted using FreeSurfer, and PTSD severity was assessed using the Clinician-Administered PTSD Scale. Hierarchical linear regression was used to assess the interaction effect between RORA genotypes (T/T, G/T, and G/G) and PTSD severity on cortical and subcortical structures. RESULTS Significant genotype × PTSD symptom severity interaction effects were found for bilateral transverse temporal gyrus thickness. For individuals with the homozygous T/T genotype, current PTSD symptom severity was positively associated with bilateral transverse temporal gyrus thickness. For individuals with heterozygous G/T genotype, current PTSD symptom severity was negatively associated with the left transverse temporal gyrus thickness. No significant main or interaction effects were found in any subcortical regions. LIMITATION Cross-sectional design of this study. CONCLUSION These findings suggest that the non-risk T/T genotype - but not the risk G allele carriers - has a potentially protective or compensatory role on temporal gyrus thickness in adults who lost their only child. These results highlight the moderation effect of RORA polymorphism on the relationship between PTSD symptom severity and cortical structural changes.
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Affiliation(s)
- Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Zhihong Cao
- Department of Radiology, the Affiliated Yixing Hospital of Jiangsu University, Wuxi, 75 Tongzhenguan Road, 214200 Wuxi, China
| | - Wesley Surento
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Marina del Rey, CA 90292, USA
| | - Li Zhang
- Mental Health Institute, the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan 410011, China
| | - Lianli Qiu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Zhuoman Xia
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Christopher R K Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Marina del Rey, CA 90292, USA
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Yan Yin
- Hangzhou Seventh People's Hospital, Mental Health Center of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310013, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Lingjiang Li
- Mental Health Institute, the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan 410011, China
| | - Yifeng Luo
- Department of Radiology, the Affiliated Yixing Hospital of Jiangsu University, Wuxi, 75 Tongzhenguan Road, 214200 Wuxi, China.
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
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Volpato E, Cavalera C, Castelnuovo G, Molinari E, Pagnini F. The "common" experience of voice-hearing and its relationship with shame and guilt: a systematic review. BMC Psychiatry 2022; 22:281. [PMID: 35443637 PMCID: PMC9022353 DOI: 10.1186/s12888-022-03902-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite Auditory Verbal Hallucinations (AVHs) having been long associated with mental illness, they represent a common experience also in the non-clinical population, yet do not exhibit distress or need for care. Shame and guilt are emotions related to one's perception of oneself and one's responsibility. As such, they direct our attention to aspects of AVHs that are under-researched and elusive, particularly about the status of voices as others, their social implications and the constitution and conceptualisation of the self. OBJECTIVES This paper aims to provide a systematic review of studies that investigated the relationship between auditory hallucinations, shame, and guilt in people without relevant signs of psychiatric issues. METHODS We searched studies reporting information about voices characteristics, the relationship between voices and hearers, hearer's reactions, and beliefs, paying peculiar attention to shame and guilt issues. Included papers were evaluated for risk of bias. RESULTS Eleven studies that explored the relationship between AVHs, shame and guilt, were extracted. Phenomenological, pragmatic, as well as neuropsychological features of hearing voices in non-clinical populations, allowed us to note a dynamic relationship and the constellation of subjective experiences that can occur. The role of guilt was characterized by few studies and mixed results, while shame was mainly common. CONCLUSIONS Due to the high heterogeneity detected and the scarce sources available, further studies should focus on both the aetiology and the bidirectional relationship between hearing voices, shame, and guilt in non-clinical people. This can be helpful in therapies for non-clinical populations who are distressed by their voices (e.g., psychotherapy), and for whom shame, and guilt may contribute to negative consequences such as isolation, anxiety or future depression. Moreover, it might favour the development and implication of different treatments considering emotion regulation, distress tolerance and interpersonal sensitivity on the clinical populations.
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Affiliation(s)
- E. Volpato
- grid.8142.f0000 0001 0941 3192Present Address: Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123 Milan, Italy ,grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - C. Cavalera
- grid.8142.f0000 0001 0941 3192Present Address: Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123 Milan, Italy
| | - G. Castelnuovo
- grid.8142.f0000 0001 0941 3192Present Address: Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123 Milan, Italy ,grid.418224.90000 0004 1757 9530Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory , Verbania , Italy
| | - E. Molinari
- grid.8142.f0000 0001 0941 3192Present Address: Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123 Milan, Italy ,grid.418224.90000 0004 1757 9530Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - F. Pagnini
- grid.8142.f0000 0001 0941 3192Present Address: Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123 Milan, Italy ,grid.38142.3c000000041936754XDepartment of Psychology, Harvard University, Cambridge, MA USA
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Hallucinations: diagnosis, neurobiology and clinical management. Int Clin Psychopharmacol 2020; 35:293-299. [PMID: 32324611 DOI: 10.1097/yic.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hallucinations are important diagnostic symptoms in schizophrenia, but also occur in other medical and neuropsychiatric conditions. Not all patients with hallucinations are psychotic. There has been a surge of interest in the topic of hallucinations, as new research data have begun to reveal their neurobiology. Hallucinogenic molecules may also serve as new scaffolds for the development of new psychotropic drugs. We searched and reviewed recent literature, focusing on the refinement of clinical management, which was inspired by new data regarding the neurobiology of hallucination subtypes. We concluded that the successful management of hallucinations depends on accurate differential diagnosis to identify subtypes, which would then determine the most appropriate treatment.
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Shinn AK, Wolff JD, Hwang M, Lebois LAM, Robinson MA, Winternitz SR, Öngür D, Ressler KJ, Kaufman ML. Assessing Voice Hearing in Trauma Spectrum Disorders: A Comparison of Two Measures and a Review of the Literature. Front Psychiatry 2020; 10:1011. [PMID: 32153431 PMCID: PMC7050446 DOI: 10.3389/fpsyt.2019.01011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022] Open
Abstract
Voice hearing (VH) can occur in trauma spectrum disorders (TSD) such as posttraumatic stress disorder (PTSD) and dissociative disorders. However, previous estimates of VH among individuals with TSD vary widely. In this study, we sought to better characterize the rate and phenomenology of VH in a sample of 70 women with TSD related to childhood abuse who were receiving care in a specialized trauma program. We compared the rate of VH within our sample using two different measures: 1) the auditory hallucination (AH) item in the Structured Clinical Interview for DSM-IV-TR (SCID), and 2) the thirteen questions involving VH in the Multidimensional Inventory of Dissociation (MID), a self-report questionnaire that comprehensively assesses pathological dissociation. We found that 45.7% of our sample met threshold for SCID AH, while 91.4% met criteria for MID VH. Receiver operating characteristics (ROC) analyses showed that while SCID AH and MID VH items have greater than chance agreement, the strength of agreement is only moderate, suggesting that SCID and MID VH items measure related but not identical constructs. Thirty-two patients met criteria for both SCID AH and at least one MID VH item ("unequivocal VH"), 32 for at least one MID VH item but not SCID AH ("ambiguous VH"), and 6 met criteria for neither ("unequivocal non-VH"). Relative to the ambiguous VH group, the unequivocal VH group had higher dissociation scores for child voices, and higher mean frequencies for child voices and Schneiderian voices. Our findings suggest that VH in women with TSD related to childhood abuse is common, but that the rate of VH depends on how the question is asked. We review prior studies examining AH and/or VH in TSD, focusing on the measures used to ascertain these experiences, and conclude that our two estimates are consistent with previous studies that used comparable instruments and patient samples. Our results add to growing evidence that VH-an experience typically considered psychotic or psychotic-like-is not equivalent to having a psychotic disorder. Instruments that assess VH apart from psychotic disorders and that capture their multidimensional nature may improve identification of VH, especially among patients with non-psychotic disorders.
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Affiliation(s)
- Ann K. Shinn
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jonathan D. Wolff
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
| | - Melissa Hwang
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
| | - Lauren A. M. Lebois
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
- Neurobiology of Fear Laboratory, McLean Hospital, Belmont, MA, United States
| | - Mathew A. Robinson
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
| | - Sherry R. Winternitz
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Neurobiology of Fear Laboratory, McLean Hospital, Belmont, MA, United States
| | - Milissa L. Kaufman
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
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Abstract
Objectives: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas: 1) assessment and diagnosis and 2) non-pharmacological treatment of PTSD in late life. Methods: We performed a search using PubMed and Academic Search Premier (EBSCO) databases and reviewed reference sections of selected papers. We also drew on our own clinical perspectives and reflections of seven expert mental health practitioners. Results: Rates of PTSD are lower in older compared with younger adults. The presence of sub-syndromal/partial PTSD is important and may impact patient functioning. Assessment requires awareness and adaptation for potential differences in PTSD experience and expression in older adults. Psychotherapies for late-life PTSD appear safe, acceptable and efficacious with cognitively intact older adults, although there are relatively few controlled studies. Treatment adaptations are likely warranted for older adults with PTSD and co-morbidities (e.g., chronic illness, pain, sensory, or cognitive changes). Conclusions: PTSD is an important clinical consideration in older adults, although the empirical database, particularly regarding psychotherapy, is limited. Clinical Implications: Assessment for trauma history and PTSD symptoms in older adults is essential, and may lead to increased recognition and treatment.
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Affiliation(s)
- Anica Pless Kaiser
- National Center for PTSD at VA Boston Healthcare System, Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Joan M. Cook
- Department of Psychiatry, Yale School of Medicine and National Center for PTSD, West Haven, CT, USA
| | | | - Jennifer Moye
- New England Geriatric Research Education and Clinical Center and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Abstract
Research into the causes of "hearing voices," formally termed auditory verbal hallucinations (AVH), has primarily focused on cognitive mechanisms. A potentially causative role for emotion has been relatively neglected. This paper uses historical and contemporary case studies of AVH to tentatively generate the hypothesis that shame can be a causal factor in the onset of AVH. Other sources of support for the generation of this hypothesis are then sought. First, evidence is examined for a role of shame in the etiology of post-traumatic stress disorder, a condition that is characterized by phenomena related to AVH (intrusions and dissociation) and in which a substantial minority of sufferers report AVH. Second, the effect on AVH of a psychological therapy specifically designed to counteract shame (Compassion Focused Therapy) is noted. The hypothesis generation process is then expanded to propose mechanisms that could mediate a relation between shame and AVH. It is proposed that employing absorbed or avoidant strategies to deal with shame may lead to AVH through mediating mechanisms such as rumination, suppression, and dissociation. Evolutionary reasons for a relation between shame and AVH are also proposed, including that AVH may be an evolved mechanism to encourage self-protective behaviors in the wake of trauma. It is concluded that existing research supports the generation of this paper's hypothesis, which is now worthy of dedicated empirical testing.
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