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Adrien V, Bosc N, Peccia Galletto C, Diot T, Claverie D, Reggente N, Trousselard M, Bui E, Baubet T, Schoeller F. Enhancing Agency in Posttraumatic Stress Disorder Therapies Through Sensorimotor Technologies. J Med Internet Res 2024; 26:e58390. [PMID: 38742989 PMCID: PMC11250045 DOI: 10.2196/58390] [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: 03/14/2024] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
Posttraumatic stress disorder (PTSD) is a significant public health concern, with only a third of patients recovering within a year of treatment. While PTSD often disrupts the sense of body ownership and sense of agency (SA), attention to the SA in trauma has been lacking. This perspective paper explores the loss of the SA in PTSD and its relevance in the development of symptoms. Trauma is viewed as a breakdown of the SA, related to a freeze response, with peritraumatic dissociation increasing the risk of PTSD. Drawing from embodied cognition, we propose an enactive perspective of PTSD, suggesting therapies that restore the SA through direct engagement with the body and environment. We discuss the potential of agency-based therapies and innovative technologies such as gesture sonification, which translates body movements into sounds to enhance the SA. Gesture sonification offers a screen-free, noninvasive approach that could complement existing trauma-focused therapies. We emphasize the need for interdisciplinary collaboration and clinical research to further explore these approaches in preventing and treating PTSD.
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Affiliation(s)
- Vladimir Adrien
- Department of Infectious and Tropical Diseases, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
- Institute of Psychiatry and Neuroscience of Paris, Inserm UMR-S 1266, Université Paris Cité, Paris, France
- Department of Psychopathology, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Nicolas Bosc
- Department of Psychopathology, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | | | - Thomas Diot
- Department of Adult Psychiatry, Impact, Mondor Hospital, AP-HP, Université Paris-Est Créteil, Créteil, France
| | - Damien Claverie
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
| | - Nicco Reggente
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States
| | - Marion Trousselard
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
- INSPIIRE, Inserm UMR 1319, Université de Lorraine, Nancy, France
- ADES, CNRS UMR 7268, Aix-Marseille Université, Marseille, France
| | - Eric Bui
- Department of Psychiatry, Caen Normandy University Hospital, Normandie Université, Caen, France
- Physiopathology and Imaging of Neurological Disorders, UNICAEN, Inserm UMR-S 1237, Normandie Université, Caen, France
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Thierry Baubet
- Department of Psychopathology, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
- Unité Transversale de Psychogénèse et Psychopathologie, Université Sorbonne Paris Nord, Villetaneuse, France
- Centre National de Ressources et de Résilience, Lille, France
| | - Félix Schoeller
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
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Russell SE, Wrobel AL, Ashton MM, Turner A, Mohebbi M, Berk M, Cotton S, Dodd S, Ng CH, Malhi GS, Dean OM. Does Post-traumatic Stress Disorder Impact Treatment Outcomes within a Randomised Controlled Trial of Mitochondrial Agents for Bipolar Depression? CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:457-465. [PMID: 37424414 PMCID: PMC10335917 DOI: 10.9758/cpn.22.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 07/11/2023]
Abstract
Objective Bipolar disorder often co-occurs with post-traumatic stress disorder, yet few studies have investigated the impact of post-traumatic stress disorder in bipolar disorder on treatment outcomes. The aim of this sub-analysis was to explore symptoms and functioning outcomes between those with bipolar disorder alone and those with comorbid bipolar disorder and post-traumatic stress disorder. Methods Participants (n = 148) with bipolar depression were randomised to: (i) N-acetylcysteine alone; (ii) a combination of nutraceuticals; (iii) or placebo (in addition to treatment as usual) for 16 weeks (+4 weeks discontinuation). Differences between bipolar disorder and comorbid bipolar disorder and post-traumatic stress disorder on symptoms and functioning at five timepoints, as well as on the rate of change from baseline to week 16 and baseline to week 20, were examined. Results There were no baseline differences between bipolar disorder alone and comorbid bipolar disorder and post-traumatic stress disorder apart from the bipolar disorder alone group being significantly more likely to be married (p = 0.01). There were also no significant differences between bipolar disorder alone and comorbid bipolar disorder and post-traumatic stress disorder on symptoms and functioning. Conclusion There were no differences in clinical outcomes over time within the context of an adjunctive randomised controlled trial between those with bipolar disorder alone compared to those with comorbid bipolar disorder and post-traumatic stress disorder. However, differences in psychosocial factors may provide targets for areas of specific support for people with comorbid bipolar disorder and post-traumatic stress disorder.
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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, Geelong, VIC, Australia
| | - Anna L. Wrobel
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Melanie M. Ashton
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
| | - Alyna Turner
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Mohammadreza Mohebbi
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
- Deakin University, Faculty of Health, Biostatistics Unit, Geelong, VIC, Australia
| | - Michael Berk
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
- Orygen, Parkville, VIC, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, University of Melbourne, The Melbourne Clinic, Richmond, VIC, Australia
| | - Sue Cotton
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Seetal Dodd
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Chee H. Ng
- Department of Psychiatry, University of Melbourne, The Melbourne Clinic, Richmond, VIC, Australia
| | - Gin S. Malhi
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Department of Psychiatry, The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Sydney, NSW, Australia
- Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Olivia M. Dean
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
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Russell SE, Wrobel AL, Skvarc D, Kavanagh BE, Ashton MM, Dean OM, Berk M, Turner A. The Impact of Posttraumatic Stress Disorder on Pharmacologic Intervention Outcomes for Adults With Bipolar Disorder: A Systematic Review. Int J Neuropsychopharmacol 2023; 26:61-69. [PMID: 36037522 PMCID: PMC9850655 DOI: 10.1093/ijnp/pyac057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/05/2022] [Accepted: 08/25/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The prevalence of posttraumatic stress disorder (PTSD) co-occurring in people with bipolar disorder (BD) is high. People with BD and PTSD may experience different outcomes and quality of life after pharmacologic treatment than those with BD alone. This review systematically explores the impact of PTSD on pharmacologic treatment outcomes for adults with BD. METHODS We conducted a systematic search up to November 25, 2021, using MEDLINE Complete, Embase, American Psychological Association PsycInfo, and the Cochrane Central Register of Controlled Trials to identify randomized and nonrandomized studies of pharmacologic interventions for adults with BD that assessed for comorbid PTSD. We used the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool to assess the risk of bias. RESULTS The search identified 5093 articles, and we reviewed 62 full-text articles. Two articles met inclusion criteria (N = 438). One article was an observational study, and the other was a randomized comparative effectiveness trial. The observational study examined lithium response rates and found higher response rates in BD alone compared with BD plus PTSD over 4 years. The randomized trial reported more severe symptoms in the BD plus PTSD group than in those with BD alone following 6 months of quetiapine treatment. There was no significant difference in the lithium treatment group at follow-up. CONCLUSIONS Comorbid PTSD may affect quetiapine and lithium treatment response in those with BD. Because of the high risk of bias and low quality of evidence, however, these results are preliminary. Specific studies exploring comorbid BD and PTSD are required to inform pharmacotherapy selection and guidelines appropriately. (International Prospective Register of Systematic Reviews ID: CRD42020182540).
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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, Geelong, Victoria, Australia
| | - Anna L Wrobel
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - David Skvarc
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- School of Psychology, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
| | - Bianca E Kavanagh
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Melanie M Ashton
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Olivia M Dean
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Alyna Turner
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, NSW, Australia
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Jaffe AE, Tao R, Page SC, Maynard KR, Pattie EA, Nguyen CV, Deep-Soboslay A, Bharadwaj R, Young KA, Friedman MJ, Williamson DE, Shin JH, Hyde TM, Martinowich K, Kleinman JE. Decoding Shared Versus Divergent Transcriptomic Signatures Across Cortico-Amygdala Circuitry in PTSD and Depressive Disorders. Am J Psychiatry 2022; 179:673-686. [PMID: 35791611 PMCID: PMC10697016 DOI: 10.1176/appi.ajp.21020162] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a debilitating neuropsychiatric disease that is highly comorbid with major depressive disorder (MDD) and bipolar disorder. The overlap in symptoms is hypothesized to stem from partially shared genetics and underlying neurobiological mechanisms. To delineate conservation between transcriptional patterns across PTSD and MDD, the authors examined gene expression in the human cortex and amygdala in these disorders. METHODS RNA sequencing was performed in the postmortem brain of two prefrontal cortex regions and two amygdala regions from donors diagnosed with PTSD (N=107) or MDD (N=109) as well as from neurotypical donors (N=109). RESULTS The authors identified a limited number of differentially expressed genes (DEGs) specific to PTSD, with nearly all mapping to cortical versus amygdala regions. PTSD-specific DEGs were enriched in gene sets associated with downregulated immune-related pathways and microglia as well as with subpopulations of GABAergic inhibitory neurons. While a greater number of DEGs associated with MDD were identified, most overlapped with PTSD, and only a few were MDD specific. The authors used weighted gene coexpression network analysis as an orthogonal approach to confirm the observed cellular and molecular associations. CONCLUSIONS These findings provide supporting evidence for involvement of decreased immune signaling and neuroinflammation in MDD and PTSD pathophysiology, and extend evidence that GABAergic neurons have functional significance in PTSD.
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Affiliation(s)
- Andrew E. Jaffe
- Lieber Institute for Brain Development, Baltimore, MD
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Genetic Medicine, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Center for Computational Biology, Johns Hopkins University, Baltimore, MD
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ran Tao
- Lieber Institute for Brain Development, Baltimore, MD
| | | | | | | | | | | | | | - Keith A. Young
- Department of Psychiatry and Behavioral Sciences, Texas A&M College of Medicine, Bryan TX
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
- Central Texas Veterans Health Care System, Temple, TX, 76504, USA
- Baylor Scott & White Psychiatry, Temple, TX
| | - Matthew J. Friedman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth Hanover, NH
- National Center for PTSD, U.S. Department of Veterans Affairs
| | - Douglas E. Williamson
- Duke Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 300 North Duke St, Durham, North Carolina
- Durham VA Healthcare System, 508 Fulton St, Durham, North Carolina
| | | | - Joo Heon Shin
- Lieber Institute for Brain Development, Baltimore, MD
| | - Thomas M. Hyde
- Lieber Institute for Brain Development, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Keri Martinowich
- Lieber Institute for Brain Development, Baltimore, MD
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Joel E. Kleinman
- Lieber Institute for Brain Development, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
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Olgiati P, Serretti A. Post-traumatic stress disorder and childhood emotional abuse are markers of subthreshold bipolarity and worse treatment outcome in major depressive disorder. Int Clin Psychopharmacol 2022; 37:1-8. [PMID: 34686642 PMCID: PMC9648980 DOI: 10.1097/yic.0000000000000380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
Post-traumatic stress disorder (PTSD) and childhood maltreatment (CMT: parental neglect; emotional, physical and sexual abuse) have been linked to bipolar disorder but they are also common in major depressive disorder (MDD). Our objective was to investigate their association with the bipolar spectrum and antidepressant treatment outcome in 482 outpatients with DSM-IV MDD treated in the Combining Medications to Enhance Depression Outcomes trial for 28 weeks Bipolar spectrum score included age of onset <21 years, subthreshold hypomania (a period of elated or irritable mood with at least two concurrent hypomanic symptoms, which did not fulfill DSM criteria for hypomanic/manic episode) and depressive mixed state (DMX). PTSD subjects (n = 107; 22%) had more severe depression (P < 0.0001), work and social impairment (P = 0.0031), comorbid anxiety disorders (P < 0.0001) and increased suicidality (P = 0.0003). Bipolar spectrum score was higher with PTSD comorbidity (P = 0.0063) and childhood emotional abuse (P = 0.0001). PTSD comorbidity was associated with residual suicidality (P = 0.0218) after 6 weeks of antidepressant use whereas childhood emotional abuse [odds ratio (OR), 1.01-2.22], subthreshold hypomania (OR, 1.04-4.09) and DMX (OR, 1.00-4.19) were predictors of mood switch. These results corroborate the role of PTSD and childhood emotional abuse as markers of bipolar spectrum and prognostic factors during antidepressant treatment.
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Affiliation(s)
- Paolo Olgiati
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Batchelder AW, Fitch C, Feinstein BA, Thiim A, O'Cleirigh C. Psychiatric, Substance Use, and Structural Disparities Between Gay and Bisexual Men with Histories of Childhood Sexual Abuse and Recent Sexual Risk Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2861-2873. [PMID: 34676467 PMCID: PMC8761038 DOI: 10.1007/s10508-021-02037-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 06/13/2023]
Abstract
Sexual minority men disproportionately experience childhood sexual abuse (CSA) compared to heterosexual men, resulting in greater risk of psychiatric and substance use diagnoses, sexual risk taking, and HIV acquisition later in life. However, little is known about psychiatric and substance use disparities between gay and bisexual men who have experienced CSA. We recruited a purposive convenience sample in Boston and Miami, involving self-report and clinical interview data from 290 sexual minority men (M age = 38.0 years) who reported CSA, defined as unwanted sexual contact before 13 years of age with an adult or person five years older, or unwanted sexual contact between 13 and 16 years of age with a person 10 years older (or any age with the threat of force or harm). We compared those who self-identified as gay (n = 199) versus bisexual (n = 64) on demographic and structural variables (i.e., government benefits, unstable housing, and neighborhood crime) as well as psychiatric and substance use diagnoses. Across 15 unique diagnoses, three were more common in bisexual men than gay men in unadjusted models: bipolar disorder (OR = 2.90, 95% CI: 1.01-8.34), obsessive compulsive disorder (OR = 2.22, 95% CI: 1.01-4.88), and alcohol use disorder (OR = 1.86, 95% CI: 1.03-3.38). Bisexual men were also more likely to meet criteria for "any substance use disorder" than were gay men (OR = 1.99, 95% CI: 1.10-3.59). However, when race, education, and income were included as covariates, the odds ratios reduced significantly (bipolar disorder: aOR = 1.98, 95% CI: 0.59-6.61; obsessive compulsive disorder: aOR = 1.56, 95% CI: 0.64-3.77; alcohol use disorder, aOR = 1.54, 95% CI: 0.80-2.98; any substance use disorder, aOR = 1.79, 95% CI: 0.93-3.45, respectively). Our results highlight the mental health needs, including problematic substance use, of bisexual men with histories of CSA, as well as the importance of accounting for potential confounding demographic variables that may influence disparities in mental health and substance use.
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Affiliation(s)
- Abigail W Batchelder
- Harvard Medical School, Boston, MA, USA.
- Behavioral Medicine Program, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
- The Fenway Institute, Boston, MA, USA.
| | - Calvin Fitch
- Harvard Medical School, Boston, MA, USA
- Behavioral Medicine Program, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- The Fenway Institute, Boston, MA, USA
| | - Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Conall O'Cleirigh
- Harvard Medical School, Boston, MA, USA
- Behavioral Medicine Program, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- The Fenway Institute, Boston, MA, USA
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Affective and Psychotic Disorders in War-Torn Eastern Part of the Democratic Republic of the Congo: A Cross-Sectional Study. PSYCHIATRY JOURNAL 2020; 2020:9190214. [PMID: 32775401 PMCID: PMC7397443 DOI: 10.1155/2020/9190214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is lack of information about prevalence of affective and psychotic disorders triggered by traumatic events among people living in war-affected regions. This study is aimed at determining the prevalence rate of affective and psychotic disorders and the associated factors in a war-torn eastern part of Democratic Republic of the Congo. METHODS This epidemiological cross-sectional descriptive study was carried out from 1st January 2019 to 31st December 2019 at Cepima and Muyisa health centers. This study enrolled 344 patients that had experienced traumatic events in Eastern Democratic Republic of the Congo from the 1119 participants, of whom 229 had positive bipolar affective disorder and 115 patients had psychotic disorders. RESULTS The results revealed that bipolar affective disorders were two times more than psychotic disorders. Sexual abuse, sudden death of a relative, kidnapping, the physical torture, and childhood trauma were the psychological factors correlated to the occurrence of bipolar affective and psychotic disorders. CONCLUSIONS It was concluded that the traumatic experiences were precursors for the occurrence of bipolar affective and psychotic spectrum disorders.
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Carmassi C, Bertelloni CA, Dell'Oste V, Foghi C, Diadema E, Cordone A, Pedrinelli V, Dell'Osso L. Post-traumatic stress burden in a sample of hospitalized patients with Bipolar Disorder: Which impact on clinical correlates and suicidal risk? J Affect Disord 2020; 262:267-272. [PMID: 31732278 DOI: 10.1016/j.jad.2019.10.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/05/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing evidence suggests Bipolar Disorder (BD) to be frequently associated to a history of traumatic experiences and Post-traumatic Stress Disorder (PTSD), with consequent greater symptoms severity, number of hospitalizations and worsening in quality of life. The aim of the present study was to investigate the lifetime exposure to traumatic events and PTSD rates in-patients with BD and to analyze the relationships between PTSD symptoms, clinical characteristics and severity of the mood disorder. METHODS A consecutive sample of 212 in-patients with a DSM-5 diagnosis of BD was enrolled at the psychiatric unit of a major University hospital in Italy and assessed by the SCID-5 and MOOD Spectrum-Self Report lifetime version (MOODS-SR). Socio-demographic characteristics, clinical features, substance or alcohol abuse, history of suicide related behaviors were also collected. RESULTS Lifetime trauma exposure emerged in 72.3% subjects, with a DSM-5 PTSD diagnosis reported by 35.6%. Patients with PTSD showed more frequently a (hypo)manic episode at onset, alcohol or substance abuse, psychotic features, suicide behaviors, higher scores in almost all the MOODS-SR domains, compared to those without PTSD. LIMITATIONS Cross sectional study. Lack of data about the time since trauma exposure or PTSD onset. CONCLUSIONS Our findings show a history of multiple traumatic experiences in hospitalized patients with BD besides high rates of PTSD, with the co-occurrence of these conditions appearing to be related to a more severe BD. Detailed investigation of post-traumatic stress symptoms is recommended for the relevant implications on the choice of a tailored treatment and the prognosis assessment.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Claudia Foghi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Elisa Diadema
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Annalisa Cordone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
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Childhood maltreatment is associated with attachment insecurities, dissociation and alexithymia in bipolar disorder. Psychiatry Res 2018; 260:391-399. [PMID: 29253803 DOI: 10.1016/j.psychres.2017.12.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/10/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022]
Abstract
Child maltreatment is a public health issue that is a well-established risk factor for many psychological conditions, including bipolar disorder. The current study is one of the first to investigate associations among child maltreatment, dissociative symptomatology, alexithymia, anxiety, depression, and attachment insecurities. 40 patients with bipolar disorder-I and 40 healthy subjects matched for age, gender, and education participated in the study. The Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), Childhood Trauma Questionnaire (CTQ-28), Toronto Alexithymia Scale (TAS-20), Depression Anxiety Stress Scale (DASS-21), and Experiences in Close Relationships-Revised (ECR-R) were completed by participants. In comparison to control participants, patients with bipolar disorder-I reported significantly more frequent abusive experiences in childhood, higher levels of attachment insecurities, more severe pathological and somatoform dissociation, as well as higher scores on measures of alexithymia, anxiety, depression and psychological stress. Reports of psychopathology among first-degree relatives (OR = 102.169, 95%IC = 4.596-2271.255; P < 0.01) and childhood emotional trauma (OR = 1.032; 95%CI = 0.782-1.363, P = 0.05) significantly contributed to bipolar disorder-I diagnosis. In contrast, absorption was negatively associated with bipolar illness (OR = 0.852; 95% CI = 0.747-0.973, P < 0.05). Our results showed significant associations between childhood trauma exposure and risk of bipolar disorder. Moreover, the results demonstrate that emotional abuse exposure predicts bipolar illness.
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Ladois-Do Pilar Rei A, Chraïbi S. [Patients assaulted in psychiatric institutions: Literature review and clinical implications]. Rev Epidemiol Sante Publique 2017; 66:53-62. [PMID: 29223515 DOI: 10.1016/j.respe.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/30/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The psychiatric ward is a place where all forms of violence are treated. Occasionally, this violence involves acts of aggression between patients in emergency psychiatric units or hospital wards. Such events can lead to the development or worsening of posttraumatic stress disorder. METHODS To establish the context, we first examined the epidemiology data concerning posttraumatic stress disorder in psychiatric patients who were frequently exposed to assaults. Secondly, we examined the issue of sexual and physical assaults between patients receiving treatment in a psychiatric ward. In this context, we studied possible occurrence of posttraumatic stress disorder associated with exposure to assaults of this kind. RESULTS In certain cases, potentially traumatic exposure to violence was unknown to the medical staff or not taken into consideration. This would induce a risk of later development of posttraumatic stress disorder that would not be treated during the stay in psychiatry. CONCLUSION To date, few scientific studies have focused on the proportion of patients assaulted by other patients during treatment in a psychiatric ward and the subsequent development of peritraumatic reactions and/or posttraumatic stress disorder associated with these assaults. We know that an insufficient number of public and private health institutions report the existence of such facts to the competent authorities. Also, a minority of clinicians and caregivers are trained in screening and management of trauma victims. Yet, these issues are particularly relevant in the scope of public health and health promotion.
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Affiliation(s)
- A Ladois-Do Pilar Rei
- Centre hospitalier de Lannemezan, CMP Théophile-Gautier, 1, rue Théophile-Gautier, 65000 Tarbes, France.
| | - S Chraïbi
- Laboratoire cliniques pathologique et interculturelle (LCPI), université Toulouse Jean-Jaurès, 5, allées Antonio-Machado, 31058 Toulouse, France
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Lex C, Bäzner E, Meyer TD. Does stress play a significant role in bipolar disorder? A meta-analysis. J Affect Disord 2017; 208:298-308. [PMID: 27794254 DOI: 10.1016/j.jad.2016.08.057] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/09/2016] [Accepted: 08/24/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is evidence that stressful life events (LE) play a crucial role in the etiology of bipolar affective disorder (BD). However, primary studies, as well as narrative reviews, have provided mixed results. The present meta-analysis combined and analyzed previous data in order to address these inconsistencies. METHOD Forty-two studies published in 53 records were identified by systematically searching MEDLINE, PsychINFO, and PSYCHINDEX using the terms "bipolar disorder" OR "manic-depressive" OR "bipolar affective disorder" OR "mania" AND "stress" OR "life event" OR "daily hassles" OR "goal attainment". Then, meta-analyses were conducted. RESULTS Individuals diagnosed with BD reported more LE before relapse when compared to euthymic phases. They also experienced more LE relative to healthy individuals and to physically ill patients. No significant difference in the number of LE was found when BD was compared to unipolar depression and schizophrenia. LIMITATIONS When interpreting the present meta-analytic findings one should keep in mind that most included studies were retrospective and often did not specify relevant information, e.g., if the LE were chronic or acute or if the individuals were diagnosed with BD I or II. We could not entirely rule out a publication bias. CONCLUSION The present meta-analyses found that individuals with BD were sensitive to LE, which corroborates recent theoretical models and psychosocial treatment approaches of BD. Childbirth, as a specific LE, affected individuals with BD more than individuals with unipolar depression. Future studies that investigate specific LE are warranted.
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Affiliation(s)
- Claudia Lex
- Villach General Hospital, Department of Psychiatry, Austria
| | - Eva Bäzner
- Eberhard Karls University, Tübingen, Germany
| | - Thomas D Meyer
- Eberhard Karls University, Tübingen, Germany; McGovern Medical School, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, USA.
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Bipolar I disorder with comorbid PTSD: Demographic and clinical correlates in a sample of hospitalized patients. Compr Psychiatry 2017; 72:13-17. [PMID: 27693886 DOI: 10.1016/j.comppsych.2016.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/12/2016] [Accepted: 08/13/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND According to data from epidemiological and clinical samples, there are elevated rates of posttraumatic stress disorder (PTSD) among patients with bipolar disorder (BD). However, little is known about the clinical correlates that may distinguish patients with BD and comorbid PTSD from those without comorbid PTSD. The present study sought to elucidate those differences and examine factors, such as psychosis, history of suicide attempts, and comorbid personality disorders, which may predict comorbid PTSD in patients with BD-I. METHODS We conducted a retrospective chart review of 230 psychiatric inpatients with BD-I. RESULTS Patients with BD-I and comorbid PTSD were significantly more likely to be female, to be depressed (vs. manic), to have a comorbid personality disorder, and to have a history of suicide attempt. Also, BD-I patients with PTSD were significantly less likely to present for their inpatient hospital stay with psychosis. These effects remained significant after controlling for mood episode polarity, suggesting that findings were not fully explained by the higher incidence of depression in the comorbid PTSD group. CONCLUSIONS Patients with BD-I and comorbid PTSD appear to be a high risk population with need for enhanced monitoring of suicidality. Clinical implications of these findings are discussed.
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Shannon C, Hanna D, Tumelty L, Waldron D, Maguire C, Mowlds W, Meenagh C, Mulholland C. Reliability of reports of childhood trauma in bipolar disorder: A test-retest study over 18 months. J Trauma Dissociation 2016; 17:511-9. [PMID: 26835747 DOI: 10.1080/15299732.2016.1141147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to explore the reliability of self-reported trauma histories in a population with a diagnosis of bipolar disorder using the Childhood Trauma Questionnaire. Previous studies in other populations suggest high reliability of trauma histories over time, and it was postulated that a similar high reliability would be demonstrated in this population. A total of 39 patients with a confirmed diagnosis (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria) were followed up and readministered the Childhood Trauma Questionnaire after 18 months. Cohen's kappa scores and intraclass correlations suggested reasonable test-retest reliability over the 18-month time period of the study for all types of childhood abuse, namely, emotional, physical, and sexual abuse and physical and emotional neglect. Intraclass correlations ranged from r = .50 (sexual abuse) to r = .96 (physical abuse). Cohen's kappas ranged from .44 (sexual abuse) to .76 (physical abuse). Retrospective reports of childhood trauma can be seen as reliable and are in keeping with results found with other mental health populations.
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Affiliation(s)
- Ciaran Shannon
- a School of Psychology , Queen's University Belfast , Belfast , Northern Ireland
| | - Donncha Hanna
- a School of Psychology , Queen's University Belfast , Belfast , Northern Ireland
| | - Leo Tumelty
- b Department of Psychiatry , Western Health and Social Care Trust , Derry , Northern Ireland
| | - Daniel Waldron
- a School of Psychology , Queen's University Belfast , Belfast , Northern Ireland
| | - Chrissie Maguire
- a School of Psychology , Queen's University Belfast , Belfast , Northern Ireland
| | - William Mowlds
- a School of Psychology , Queen's University Belfast , Belfast , Northern Ireland
| | - Ciaran Meenagh
- c Department of Psychiatry , Northern Health and Social Care Trust , Newtownabbey , Northern Ireland
| | - Ciaran Mulholland
- d School of Medicine , Queen's University Belfast , Belfast , Northern Ireland
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15
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Baldwin DV. Primitive mechanisms of trauma response: an evolutionary perspective on trauma-related disorders. Neurosci Biobehav Rev 2013; 37:1549-66. [PMID: 23792048 DOI: 10.1016/j.neubiorev.2013.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 05/23/2013] [Accepted: 06/03/2013] [Indexed: 01/09/2023]
Abstract
The symptoms we identify and the behaviors we recognize as defenses define which symptoms we see as trauma-related. Early conceptions of trauma-related disorders focused on physical signs of distress while current ones emphasize mental symptoms, but traumatizing experiences evoke psychobiological reactions. An evolutionary perspective presumes that psychophysical reactions to traumatizing events evolved to ensure survival. This theoretical review examines several primitive mechanisms (e.g., sensitization and dissolution) associated with responses to diverse stressors, from danger to life-threat. Some rapidly acquired symptoms form without conscious awareness because severe stresses can dysregulate mental and physical components within systems ensuring survival. Varied defensive options engage specialized and enduring psychophysical reactions; this allows for more adaptive responses to diverse threats. Thus, parasympathetically mediated defense states such as freeze or collapse increase trauma-related symptom variability. Comorbidity and symptom variability confuse those expecting mental rather than psychophysical responses to trauma, and active (sympathetically mediated flight and fight) rather than immobility defenses. Healthcare implications for stress research, clinical practice and diagnostic nosology stem from the broader evolutionary view.
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Mauritz MW, Goossens PJJ, Draijer N, van Achterberg T. Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness. Eur J Psychotraumatol 2013; 4:19985. [PMID: 23577228 PMCID: PMC3621904 DOI: 10.3402/ejpt.v4i0.19985] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 02/13/2013] [Accepted: 03/04/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. OBJECTIVE To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. METHODS We conducted a systematic review of four databases (1980-2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. RESULTS Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25-72%), sexual abuse 37% (range 24-49%), and posttraumatic stress disorder (PTSD) 30% (range 20-47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. CONCLUSIONS Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI.
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Affiliation(s)
- Maria W. Mauritz
- Community Mental Health Care Unit/Long Treatment, GGNet, Warnsveld, The Netherlands
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Peter J. J. Goossens
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Saxion University of Applied Sciences, Expertise Centre of Health, Social Work & Technology, Deventer, The Netherlands
- Specialist Centre for Bipolar Disorders, Dimence, Deventer, The Netherlands
| | - Nel Draijer
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Theo van Achterberg
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Brown R, Du Mont J, Macdonald S, Bainbridge D. A comparative analysis of victims of sexual assault with and without mental health histories: acute and follow-up care characteristics. JOURNAL OF FORENSIC NURSING 2013; 9:76-83. [PMID: 24158128 DOI: 10.1097/jfn.0b013e31828106df] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sexual assault is a common and serious health issue that is underreported and has low follow-up rates. The myriad of psychological sequelae of sexual assault are well documented; however, there is a dearth of literature on the prevalence of preexisting mental health issues in survivors of sexual assault. This exploratory study compares victims seen at a sexual assault treatment center with and without preexisting self-reported mental health histories. The rates of preexisting mental illness in sexual assault victims are significant. Implications for clinical practice and research are discussed.
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Affiliation(s)
- Rebecca Brown
- Author Affiliations: 1Faculty of Medicine, University of Toronto 2Women's College Research Institute, Women's College Hospital, 3Dalla Lana School of Public Health at the University of Toronto, 4 Sexual Assault/Domestic Violence Care Centre at Women's College Hospital, 5Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto, and 6Sexual Assault/Domestic Violence Treatment Centres in Ontario
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The prevalence of full and partial posttraumatic stress disorder among people with severe mental illness in Israel. J Nerv Ment Dis 2013; 201:244-50. [PMID: 23407211 DOI: 10.1097/nmd.0b013e3182848d1e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Research has shown higher rates of trauma exposure and posttraumatic stress disorder (PTSD) among persons with severe mental illness (SMI). The aim of this study was to assess the prevalence of traumatic events and full and partial PTSD among people with SMI and their associations with trauma-related cognitions and depressive symptoms. A total of 122 persons with SMI were assessed for trauma exposure and PTSD. A subsample of 40 participants, 20 with PTSD and 20 without PTSD, were randomly selected, and their posttraumatic cognitions and depressive symptoms were assessed. The prevalence of traumatic events was 90%, and 19% met full diagnostic criteria for PTSD, and 20% had partial PTSD. The people with PTSD had more depressive symptoms and negative cognitions. PTSD in SMI is highly prevalent and underdiagnosed.
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Cavalcanti-Ribeiro P, Andrade-Nascimento M, Morais-de-Jesus M, de Medeiros GM, Daltro-Oliveira R, Conceição JO, Rocha MF, Miranda-Scippa Â, Koenen KC, Quarantini LC. Post-traumatic stress disorder as a comorbidity: impact on disease outcomes. Expert Rev Neurother 2013; 12:1023-37. [PMID: 23002944 DOI: 10.1586/ern.12.77] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Post-traumatic stress disorder (PTSD) is associated with many psychiatric and nonpsychiatric comorbidities. Growing evidence suggests that PTSD as a comorbidity may impair drug adherence, quality of life and sleep quality, as well as increase rehospitalization rates, disease relapses, intensity of symptoms, morbidity and mortality. The aim of this article is to examine the literature regarding the effects of PTSD comorbidity on physical and mental health.
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[Bipolar disorders and comorbid anxiety: prognostic impact and therapeutic challenges]. Encephale 2012; 39:66-74. [PMID: 23095585 DOI: 10.1016/j.encep.2012.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 03/06/2012] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Anxiety disorders are among the main psychiatric conditions co-occuring with bipolar disorders. Many clinical and epidemiological studies have found much higher prevalence rates of generalized anxiety disorder, social phobia, obsessive-compulsive disorder, panic disorder and post-traumatic stress disorder in bipolar patients than in the general population, regardless of age. In the National Comorbidity Survey for instance, the diagnosis of at least one anxiety disorder was made for nearly 90% of bipolar subjects. Several issues arise from this high comorbidity, such as the way anxiety disorders alter the course and prognosis of the mood disorder, and challenge typical therapeutic strategies. This article reviews data on clinical and therapeutical significance of such comorbidity. LITERATURE FINDINGS Many studies point out the poorer outcome for bipolar patients with co-occurring anxiety symptoms: apart from the alarming increase of suicidal ideas and suicide attempts, authors have found a shorter duration of euthymia, more comorbid addictions, mixed states and rapid cycling, and lower response to treatments. This is the reason why monitoring the suicidal risk in those bipolar patients with co-occurring anxiety disorders is of critical importance. From a physiopathological standpoint, the precise links between both pathologies remains unclear. The frequency of this comorbidity and its significance on long term prognosis stands in sharp contrast with the very few therapeutic studies conducted in this indication so far. Pharmacological approaches are strongly limited by the risk of mood switching under antidepressants and drug dependence on anxiolytics such as benzodiazepines. Nevertheless, there is emerging evidence of the interest of atypical antipsychotics such as olanzapine and mood stabilisers such as lamotrigine to control anxiety symptoms in bipolar patients. There is weaker evidence for other molecules. Taking into account other therapeutic approaches than the pharmacological approach appears accurate. Psychosocial interventions such as cognitive-behavioral therapies or psychoeducation appear essential to improve in a correct way the global functioning and quality of life of these patients.
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Rakofsky JJ, Ressler KJ, Dunlop BW. BDNF function as a potential mediator of bipolar disorder and post-traumatic stress disorder comorbidity. Mol Psychiatry 2012; 17:22-35. [PMID: 21931317 PMCID: PMC3690922 DOI: 10.1038/mp.2011.121] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bipolar disorder (BD) and post-traumatic stress disorder (PTSD) frequently co-occur among psychiatric patients, leading to increased morbidity and mortality. Brain-derived neurotrophic factor (BDNF) function is associated with core characteristics of both BD and PTSD. We propose a neurobiological model that underscores the role of reduced BDNF function resulting from several contributing sources, including the met variant of the BDNF val66met (rs6265) single-nucleotide polymorphism, trauma-induced epigenetic regulation and current stress, as a contributor to the onset of both illnesses within the same person. Further studies are needed to evaluate the genetic association between the val66met allele and the BD-PTSD population, along with central/peripheral BDNF levels and epigenetic patterns of BDNF gene regulation within these patients.
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Affiliation(s)
- JJ Rakofsky
- Mood and Anxiety Disorders Program/Bipolar Disorders Clinic, Emory University Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - KJ Ressler
- Department of Psychiatry and Behavioral Sciences, Center for Behavioral Neuroscience, Yerkes Research Center, Emory University, Atlanta, GA, USA
| | - BW Dunlop
- Mood and Anxiety Disorders Program/Bipolar Disorders Clinic, Emory University Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
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Shannon C, Maguire C, Anderson J, Meenagh C, Mulholland C. Enquiring about traumatic experiences in bipolar disorder: a case note and self- report comparison. J Affect Disord 2011; 133:352-5. [PMID: 21596441 DOI: 10.1016/j.jad.2011.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 04/22/2011] [Accepted: 04/23/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study examined: (i) the prevalence of lifetime trauma, childhood trauma and trauma related to civil unrest in a Bipolar Disorder sample, and (ii) the agreement between rates of disclosure of trauma in case notes and self-report questionnaires. METHODS The case notes of sixty participants, recruited from a geographically well-defined mental health service in Northern Ireland, were examined for reports of experiences of lifetime, childhood and traumatic events related to civil conflict. The participants also completed self-report measures of trauma. RESULTS Considerable differences were found between the prevalence of trauma as measured by self-report questionnaires and case notes reports. The prevalence of lifetime trauma as measured by the Trauma History Questionnaire was 61.7% (compared to case notes prevalence of 33.3%). The prevalence of moderate and severe levels of childhood trauma as measured by the Childhood Trauma Questionnaire was 65% (case notes 21.7%). Rates of trauma related to civil unrest were 35% (case notes 3.3%). Poor levels of agreement were found between all self-report trauma measures and case notes reports. Agreement on two categories of trauma (childhood emotional neglect and childhood physical neglect) reached statistical significance but kappa scores suggest this agreement was poor (κ=.14, p<.05; κ=.127, p<.05). CONCLUSIONS It is probable that the increased rate of trauma disclosed in the self-report questionnaire arises because clinicians during initial assessment and subsequent treatment do not consistently enquire about trauma. The need for staff training is discussed.
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Affiliation(s)
- Ciaran Shannon
- School of Psychology, The Queens University of Belfast, Belfast, Northern Ireland, UK.
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Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: a critical review. Clin Psychol Rev 2011; 31:883-99. [PMID: 21596012 DOI: 10.1016/j.cpr.2011.04.003] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 03/16/2011] [Accepted: 04/19/2011] [Indexed: 11/21/2022]
Abstract
There is a great deal of research on the prevalence, correlates, and treatment of PTSD in the general population. However, we know very little about the manifestation and consequences of PTSD in more complicated patient populations. The purpose of the current paper is to provide a comprehensive review of PTSD within the context of severe mental illness (SMI; i.e., schizophrenia spectrum disorders, mood disorders). Extant data suggest that trauma and PTSD are highly prevalent among individuals with SMI relative to the general population, and both are associated with adverse clinical functioning and increased healthcare burden. However, trauma and PTSD remain overlooked in this population, with low recognition rates in public-sector settings. Additionally, there are few data on the clinical course and treatment of PTSD among individuals with SMI. Particularly lacking are longitudinal studies, randomized controlled treatment trials, and studies using ethno-racially diverse samples. Furthermore, there is a need to better understand the interplay between trauma, PTSD, and severe forms of mental illness and to further develop and disseminate evidence-based PTSD treatments in this population. The current state of the literature and future directions for practice are discussed.
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Positive aspects of mental illness: a review in bipolar disorder. J Affect Disord 2011; 128:185-90. [PMID: 20471692 DOI: 10.1016/j.jad.2010.03.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/16/2010] [Accepted: 03/23/2010] [Indexed: 11/22/2022]
Abstract
INTRODUCTION There is growing interest to understand the role of positive psychological features on the outcomes of medical illnesses. Unfortunately this topic is less studied in relation to mental health, and almost completely neglected in relation to one of the most common severe psychiatric illnesses, bipolar disorder. Certain specific psychological characteristics, that are generally viewed as valuable and beneficial morally or socially, may grow out of the experience of having this affective disorder. OBJECTIVE We describe the sources, research and impact of these positive psychological traits in the lives of persons with bipolar disorder based on the few published literature available to date. These include, but are not limited to: spirituality, empathy, creativity, realism, and resilience. METHODS After an extensive search in the literature, we found 81 articles that involve descriptions of positive psychological characteristics of bipolar disorder. RESULTS We found evidence for enhancement of the five above positive psychological traits in persons with bipolar disorder. CONCLUSIONS Bipolar disorder is associated with the positive psychological traits of spirituality, empathy, creativity, realism, and resilience. Clinical and research attention to preserving and enhancing these traits may improve outcomes in bipolar disorder.
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Quarantini LC, Netto LR, Andrade-Nascimento M, Almeida AGD, Sampaio AS, Miranda-Scippa A, Bressan RA, Koenen KC. [Comorbid mood and anxiety disorders in victims of violence with posttraumatic stress disorder]. BRAZILIAN JOURNAL OF PSYCHIATRY 2010; 31 Suppl 2:S66-76. [PMID: 19967202 DOI: 10.1590/s1516-44462009000600005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review studies that have evaluated the comorbidity between posttraumatic stress disorder and mood disorders, as well as between posttraumatic stress disorder and other anxiety disorders. METHOD We searched Medline for studies, published in English through April, 2009, using the following keywords: 'posttraumatic stress disorder', 'PTSD', 'mood disorder', 'major depressive disorder', 'major depression', 'bipolar disorder', 'dysthymia', 'anxiety disorder', 'generalized anxiety disorder', 'agoraphobia', 'obsessive-compulsive disorder', 'panic disorder', 'social phobia', and 'comorbidity'. RESULTS Major depression is one of the most frequent comorbid conditions in posttraumatic stress disorder individuals, but individuals with posttraumatic stress disorder are also more likely to present with bipolar disorder, other anxiety disorders and suicidal behaviors. These comorbid conditions are associated with greater clinical severity, functional impairment, and impaired quality of life in already compromised individuals with posttraumatic stress disorder. Depression symptoms also mediate the association between posttraumatic stress disorder and severity of pain among patients with chronic pain. CONCLUSION Available studies suggest that individuals with posttraumatic stress disorder are at increased risk of developing affective disorders compared with trauma-exposed individuals who do not develop posttraumatic stress disorder. Conversely, pre-existing affective disorders increase a person's vulnerability to the posttraumatic stress disorder--inducing effects of traumatic events. Also, common genetic vulnerabilities can help to explain these comorbidity patterns. However, because the studies addressing this issue are few in number, heterogeneous and based on a limited sample, more studies are needed in order to adequately evaluate these comorbidities, as well as their clinical and therapeutic implications.
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Affiliation(s)
- Lucas C Quarantini
- Serviço Psiquiátrico, Hospital-Escola, Universidade Federal da Bahia, Salvador, BA, Brasil.
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Quarantini LC, Miranda-Scippa A, Nery-Fernandes F, Andrade-Nascimento M, Galvão-de-Almeida A, Guimarães JL, Teles CAS, Netto LR, Lira SB, de Oliveira IR, Post RM, Kapczinski F, Koenen KC. The impact of comorbid posttraumatic stress disorder on bipolar disorder patients. J Affect Disord 2010; 123:71-6. [PMID: 19732957 DOI: 10.1016/j.jad.2009.08.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 08/06/2009] [Accepted: 08/06/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Available data regarding posttraumatic stress disorder (PTSD) in bipolar disorder (BD) are scarce and usually from a limited sample size. The present report was carried out using the Brazilian Research Consortium for Bipolar Disorders and aimed to examine whether patients with BD and comorbid PTSD are at an increased risk for worse clinical outcomes. METHODS A consecutive sample of bipolar I outpatients from two teaching hospitals in Brazil was recruited. Patients were assessed using the Structured Clinical Interview for DSM-IV, Young Mania Rating Scale, 17-item Hamilton Rating Scale for Depression, and quality of life instrument WHOQOL-BREF. Participants were divided into three groups: a. bipolar patients with PTSD, b. bipolar patients exposed to trauma without PTSD, and c. bipolar patients with no trauma exposure. RESULTS Of the 405 patients who consented to participate, 87.7% completed the survey. All three groups were similar in terms of demographic parameters. The group with comorbid PTSD reported worse quality of life, more rapid cycling, higher rates of suicide attempts, and a lower likelihood of staying recovered. LIMITATIONS The cross-sectional design excludes the opportunity to examine causal relationships among trauma, PTSD, and BD. CONCLUSIONS The findings indicate that PTSD causes bipolar patients to have a worse outcome, as assessed by their lower likelihood to recover, elevated proportion of rapid cycling periods, increased risk of suicide attempts, and worse quality of life.
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Affiliation(s)
- Lucas C Quarantini
- Teaching Hospital- Psychiatry Service, Universidade Federal da Bahia, Salvador, BA, Brazil.
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Conus P, Cotton S, Schimmelmann BG, Berk M, Daglas R, McGorry PD, Lambert M. Pretreatment and outcome correlates of past sexual and physical trauma in 118 bipolar I disorder patients with a first episode of psychotic mania. Bipolar Disord 2010; 12:244-52. [PMID: 20565431 DOI: 10.1111/j.1399-5618.2010.00813.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the prevalence and correlates of childhood and adolescent sexual and/or physical abuse (SPA) in bipolar I disorder (BDI) patients treated for a first episode of psychotic mania. METHODS The Early Psychosis Prevention and Intervention Centre admitted 786 first-episode psychosis patients between 1998 and 2000. Data were collected from patients' files using a standardized questionnaire. A total of 704 files were available; 43 were excluded because of a nonpsychotic diagnosis at endpoint and 3 due to missing data regarding past stressful events. Among 658 patients with available data, 118 received a final diagnosis of BDI and were entered in this study. RESULTS A total of 80% of patients had been exposed to stressful life events during childhood and adolescence and 24.9% to SPA; in particular, 29.8% of female patients had been exposed to sexual abuse. Patients who were exposed to SPA had poorer premorbid functioning, higher rates of forensic history, were less likely to live with family during treatment period, and were more likely to disengage from treatment. CONCLUSIONS SPA is highly prevalent in BDI patients presenting with a first episode of psychotic mania; exposed patients have lower premorbid functional levels and poorer engagement with treatment. The context in which such traumas occur must be explored in order to determine whether early intervention strategies may contribute to diminish their prevalence. Specific psychological interventions must also be developed.
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Affiliation(s)
- Philippe Conus
- Treatment and Early Intervention in Psychosis Program, Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, Prilly, Switzerland.
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Baker DG, Nievergelt CM, Risbrough VB. Post-traumatic stress disorder: emerging concepts of pharmacotherapy. Expert Opin Emerg Drugs 2009; 14:251-72. [PMID: 19453285 DOI: 10.1517/14728210902972494] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Post-traumatic stress disorder (PTSD) can result from a traumatic experience that elicits emotions of fear, helpless or horror. Most individuals remain asymptomatic or symptoms quickly resolve, but in a minority intrusive imagery and nightmares, emotional numbing and avoidance, and hyperarousal persist for decades. PTSD is associated with psychiatric and medical co-morbidities, increased risk for suicide, and with poor social and occupational functioning. Psychotherapy and pharmacotherapy are common treatments. Whereas, research supports the efficacy of the cognitive behavioral psychotherapies, there is insufficient evidence to unequivocally support the efficacy of any specific pharmacotherapy. Proven effective pharmacologic agents are sorely needed to treat core and targeted PTSD symptoms, and for prevention. This review describes current and emerging pharmacotherapies that advance these goals.
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Affiliation(s)
- Dewleen G Baker
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0603V), La Jolla, California 92093, USA.
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Coleman PK, Coyle CT, Shuping M, Rue VM. Induced abortion and anxiety, mood, and substance abuse disorders: isolating the effects of abortion in the national comorbidity survey. J Psychiatr Res 2009; 43:770-6. [PMID: 19046750 DOI: 10.1016/j.jpsychires.2008.10.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 10/19/2008] [Accepted: 10/21/2008] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to examine associations between abortion history and a wide range of anxiety (panic disorder, panic attacks, PTSD, Agoraphobia), mood (bipolar disorder, mania, major depression), and substance abuse disorders (alcohol and drug abuse and dependence) using a nationally representative US sample, the national comorbidity survey. Abortion was found to be related to an increased risk for a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without hierarchy), and substance abuse disorders after statistical controls were instituted for a wide range of personal, situational, and demographic variables. Calculation of population attributable risks indicated that abortion was implicated in between 4.3% and 16.6% of the incidence of these disorders. Future research is needed to identify mediating mechanisms linking abortion to various disorders and to understand individual difference factors associated with vulnerability to developing a particular mental health problem after abortion.
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Affiliation(s)
- Priscilla K Coleman
- Human Development and Family Studies, Bowling Green State University, Bowling Green, OH 43403, USA.
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