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Strigo IA, Craig ADB, Simmons AN. Expectation of pain and relief: A dynamical model of the neural basis for pain-trauma co-morbidity. Neurosci Biobehav Rev 2024; 163:105750. [PMID: 38849067 DOI: 10.1016/j.neubiorev.2024.105750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/09/2024]
Abstract
Posttraumatic Stress Disorder (PTSD) is highly co-morbid with chronic pain conditions. When present, PTSD significantly worsens chronic pain outcomes. Likewise, pain contributes to a more severe PTSD as evidenced by greater disability, more frequent use of harmful opioid analgesics and increased pain severity. The biomechanism behind this comorbidity is incompletely understood, however recent work strongly supports the widely-accepted role of expectation, in the entanglement of chronic pain and trauma symptoms. This work has shown that those with trauma have a maladaptive brain response while expecting stress and pain, whereas those with chronic pain may have a notable impairment in brain response while expecting pain relief. This dynamical expectation model of the interaction between neural systems underlying expectation of pain onset (traumatic stress) and pain offset (chronic pain) is biologically viable and may provide a biomechanistic insight into pain-trauma comorbidity. These predictive mechanisms work through interoceptive pathways in the brain critically the insula cortex. Here we highlight how the neural expectation-related mechanisms augment the existing models of pain and trauma to better understand the dynamics of pain and trauma comorbidity. These ideas will point to targeted complementary clinical approaches, based on mechanistically separable neural biophenotypes for the entanglement of chronic pain and trauma symptoms.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA.
| | | | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA; Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Drive, MC 151-B, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
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2
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Kratzer L, Tschöke S, Schröder J, Shevlin M, Hyland P, Eckenberger C, Heinz P, Karatzias T. Severe Dissociative Experiences beyond Detachment in a Large Clinical Sample of Inpatients with Post-Traumatic Stress Disorder: Diagnostic and Treatment Implications. Psychopathology 2024:1-9. [PMID: 39038445 DOI: 10.1159/000539740] [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: 08/22/2023] [Accepted: 02/12/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) contains a dissociative subtype of post-traumatic stress disorder (PTSD) characterized by depersonalization and derealization. Yet, there is evidence that dissociative symptoms in PTSD go beyond this kind of detachment dissociation and that some patients present with additional compartmentalization dissociation in the form of auditory-verbal hallucination, amnesia, and identity alteration. METHODS Hence, in this study, we examined latent profiles of childhood trauma (Childhood Trauma Questionnaire), PTSD (Impact-of-Event Scale-Revised), and pathological dissociation (Dissociative Experiences Scale-Taxon; DES-T) in a large sample of severely traumatized inpatients with PTSD (N = 1,360). RESULTS Results support a three-class solution of the latent profile analysis with a PTSD class, a dissociative subtype class, and a third class characterized by more complex and more severe dissociative symptoms. Importantly, in our inpatient sample of patients with severe PTSD, the latter class was found to be the most prevalent. Both the exploratory character of our retrospective analysis of clinical routine data and the use of the DES-T limit the generalizability of our findings, which require methodologically more rigorous replication. CONCLUSION In severe PTSD, dissociative symptoms beyond detachment are highly prevalent. Diagnostic and treatment implications are discussed.
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Affiliation(s)
- Leonhard Kratzer
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany,
| | - Stefan Tschöke
- Clinic for Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ulm, Germany
- Centre for Psychiatry Südwürttemberg, Ravensburg, Germany
| | - Johanna Schröder
- Department for Psychology, Medical School Hamburg, Institute for Clinical Psychology and Psychotherapy, Hamburg, Germany
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, UK
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Peter Heinz
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
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Vatanparast A, Shakiba S, Momeni F, Kamrani A. The relationship between childhood maltreatment and self-harm: the mediating roles of alexithymia, dissociation, internalizing and posttraumatic symptoms. Eur J Psychotraumatol 2024; 15:2378642. [PMID: 39028641 PMCID: PMC11262236 DOI: 10.1080/20008066.2024.2378642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 07/04/2024] [Indexed: 07/21/2024] Open
Abstract
Background: Although childhood maltreatment is associated with later self-harm, the mechanism through which it might lead to self-harm is not completely understood. The purpose of this study was to examine the roles of alexithymia, dissociation, internalizing and posttraumatic symptoms in the association between exposure to childhood maltreatment and subsequent self-harm.Methods: A total of 360 adolescents were asked to complete the Childhood Trauma Questionnaire, the Toronto Alexithymia Scale, the Dissociative Experience Scale, the Somatoform Dissociation Questionnaire-20, the Posttraumatic Stress Checklist for DSM-5, and the Deliberate Self-Harm Inventory.Results: Results of structural equation modelling analysis revealed the significant mediation effects of alexithymia and dissociative symptoms in the relationship between childhood maltreatment and self-harm, while internalizing and posttraumatic symptoms did not significantly mediate.Conclusion: The findings indicate that alexithymia and dissociative symptoms may be proximal mechanisms linking maltreatment exposure and adolescence self-harm.
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Affiliation(s)
- Amin Vatanparast
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shima Shakiba
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fereshte Momeni
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Kamrani
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Ireton R, Hughes A, Klabunde M. A Functional Magnetic Resonance Imaging Meta-Analysis of Childhood Trauma. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:561-570. [PMID: 38311289 DOI: 10.1016/j.bpsc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Traumatic experiences during childhood significantly impact the developing brain and contribute to the development of numerous physical and mental health problems. To date, however, a comprehensive understanding of the functional impairments within the brain associated with childhood trauma histories does not exist. Previous functional magnetic resonance imaging (fMRI) meta-analytical tools required homogeneity of task types and the clinical populations studied, thus preventing the comprehensive pooling of brain-based deficits present in children who have trauma histories. We hypothesized that the use of the novel, data-driven Bayesian author-topic model approach to fMRI meta-analyses would reveal deficits in brain networks that span fMRI task types in children with trauma histories. METHODS To our knowledge, this is the first study to use the Bayesian author-topic model approach to fMRI meta-analyses within a clinical population. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we present data-driven results obtained by combining activation patterns across heterogeneous tasks from 1428 initially screened studies and combining data from 14 studies that met study criteria (285 children with trauma histories, 297 healthy control children). RESULTS Altered brain activity was revealed within 2 clusters in children with trauma histories compared to control children: the default mode/affective network/posterior insula and the central executive network. Our identified clusters were associated with tasks pertaining to cognitive processing, emotional/social stress, self-referential thought, memory, unexpected stimuli, and avoidance behaviors in youths who have experienced childhood trauma. CONCLUSIONS Our results reveal disturbances in children with trauma histories within the modulation of the default mode and central executive networks-but not the salience network-regardless of whether children also presented with posttraumatic stress symptoms.
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Affiliation(s)
- Rebecca Ireton
- Department of Psychology and Centre for Brain Sciences, University of Essex, Wivenhoe, United Kingdom
| | - Anna Hughes
- Department of Psychology and Centre for Brain Sciences, University of Essex, Wivenhoe, United Kingdom
| | - Megan Klabunde
- Department of Psychology and Centre for Brain Sciences, University of Essex, Wivenhoe, United Kingdom.
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5
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Callus E, Gallina E, Fernandez I. EMDR: dispelling the false memory creation myth in response to Otgaar et al. (2022a). Front Psychol 2024; 15:1366137. [PMID: 38689725 PMCID: PMC11058937 DOI: 10.3389/fpsyg.2024.1366137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
- Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Eugenio Gallina
- Centro di Ricerca e Studi in Psicotraumatologia (CRSP), Milan, Italy
| | - Isabel Fernandez
- Centro di Ricerca e Studi in Psicotraumatologia (CRSP), Milan, Italy
- Associazione EMDR Italia, Varedo, Italy
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Martinez BS, Rowland JA, Shura RD, Magnante AT, Morey RA, Martindale SL. Influence of affective instability on suicidal ideation beyond traumatic brain injury and posttraumatic stress disorder in veterans. J Psychiatr Res 2024; 172:411-419. [PMID: 38458113 DOI: 10.1016/j.jpsychires.2024.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Mild traumatic brain injury (TBI) is associated with long-term consequences, including greater risk for posttraumatic stress disorder (PTSD) and suicidal ideation. Affective instability is also independently related to PTSD and suicidality, which may explain why some individuals continue to experience chronic psychiatric complaints following mild TBI. The purpose of the present study was to evaluate affective instability as a key factor for PTSD and suicidal ideation among Veterans with and without TBI. METHOD Participants (N = 299 Veterans; 86.96% male) completed the Personality Assessment Inventory (PAI) and structured clinical interviews for TBI and psychiatric diagnoses. Hierarchical linear regression was used to evaluate main and interaction effects. RESULTS There were no significant differences in affective instability (p = 0.140) or suicidal ideation (p = 0.453) between Veterans with or without TBI. Individuals with TBI were more likely to have a PTSD diagnosis (p = 0.001). Analyses evaluating PTSD diagnosis as an outcome indicated a main effect of affective instability (p < 0.001), but not TBI (p = 0.619). Analyses evaluating suicidal ideation as an outcome demonstrated an interaction effect between PTSD and affective instability beyond the effects of TBI (p = 0.034). CONCLUSIONS Severe Affective instability appears to be a key factor in suicidal ideation among Veterans beyond TBI or PTSD history. PTSD was more strongly associated with suicidality at lower and moderate levels of affective instability. At severe levels of affective instability, however, Veterans with and without PTSD experienced suicidal ideation at similar rates. Findings suggests that high levels of affective instability not better explained by other psychiatric conditions confers similar suicidality risk to that of PTSD in a Veteran population.
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Affiliation(s)
- Brandy S Martinez
- Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA; VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA.
| | - Jared A Rowland
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robert D Shura
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna T Magnante
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rajendra A Morey
- Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA; VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
| | - Sarah L Martindale
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Physiology & Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Aarts I, Thorsen AL, Vriend C, Planting C, van den Heuvel OA, Thomaes K. Effects of psychotherapy on brain activation during negative emotional processing in patients with posttraumatic stress disorder: a systematic review and meta-analysis. Brain Imaging Behav 2024; 18:444-455. [PMID: 38049598 DOI: 10.1007/s11682-023-00831-0] [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] [Accepted: 11/20/2023] [Indexed: 12/06/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating condition which has been related to problems in emotional regulation, memory and cognitive control. Psychotherapy has a non-response rate of around 50% and understanding the neurobiological working mechanisms might help improve treatment. To integrate findings from multiple smaller studies, we performed the first meta-analysis of changes in brain activation with a specific focus on emotional processing after psychotherapy in PTSD patients. We performed a meta-analysis of brain activation changes after treatment during emotional processing for PTSD with seed-based d mapping using a pre-registered protocol (PROSPERO CRD42020211039). We analyzed twelve studies with 191 PTSD patients after screening 3700 studies. We performed systematic quality assessment both for the therapeutic interventions and neuroimaging methods. Analyses were done in the full sample and in a subset of studies that reported whole-brain results. We found decreased activation after psychotherapy in the left amygdala, (para)hippocampus, medial temporal lobe, inferior frontal gyrus, ventrolateral prefrontal cortex, right pallidum, anterior cingulate cortex, bilateral putamen, and insula. Decreased activation in the left amygdala and left ventrolateral PFC was also found in eight studies that reported whole-brain findings. Results did not survive correction for multiple comparisons. There is tentative support for decreased activation in the fear and cognitive control networks during emotional processing after psychotherapy for PTSD. Future studies would benefit from adopting a larger sample size, using designs that control for confounding variables, and investigating heterogeneity in symptom profiles and treatment response.
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Affiliation(s)
- Inga Aarts
- Sinai Centrum, Arkin, Amstelveen, The Netherlands.
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
| | - A L Thorsen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - C Vriend
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, The Netherlands
| | - C Planting
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, University Library, Amsterdam, The Netherlands
| | - O A van den Heuvel
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, The Netherlands
| | - K Thomaes
- Sinai Centrum, Arkin, Amstelveen, The Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
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Scalabrini A, Cavicchioli M, Benedetti F, Mucci C, Northoff G. The nested hierarchical model of self and its non-relational vs relational posttraumatic manifestation: an fMRI meta-analysis of emotional processing. Mol Psychiatry 2024:10.1038/s41380-024-02520-w. [PMID: 38514803 DOI: 10.1038/s41380-024-02520-w] [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] [Received: 10/13/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
Different kinds of traumatic experiences like natural catastrophes vs. relational traumatic experiences (e.g., sex/physical abuse, interpersonal partner violence) are involved in the development of the self and PTSD psychopathological manifestations. Looking at a neuroscience approach, it has been proposed a nested hierarchical model of self, which identifies three neural-mental networks: (i) interoceptive; (ii) exteroceptive; (iii) mental. However, it is still unclear how the self and its related brain networks might be affected by non-relational vs relational traumatic experiences. Departing from this background, the current study aims at conducting a meta-analytic review of task-dependent fMRI studies (i.e., emotional processing task) among patients with PTSD due to non-relational (PTSD-NR) and relational (PTSD-R) traumatic experiences using two approaches: (i) a Bayesian network meta-analysis for a region-of-interest-based approach; (ii) a coordinated-based meta-analysis. Our findings suggested that the PTSD-NR mainly recruited areas ascribed to the mental self to process emotional stimuli. Whereas, the PTSD-R mainly activated regions associated with the intero-exteroceptive self. Accordingly, the PTSD-R compared to the PTSD-NR might not reach a higher symbolic capacity to process stimuli with an emotional valence. These results are also clinically relevant in support of the development of differential treatment approaches for non-relational vs. relational PTSD.
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Affiliation(s)
- Andrea Scalabrini
- Department of Human and Social Sciences, University of Bergamo, P.le S. Agostino, 2, Bergamo, 24129, Italy.
| | - Marco Cavicchioli
- University Vita- Salute San Raffaele, Milan, Via Olgettina, 58, Milan, 20132, Italy.
| | - Francesco Benedetti
- University Vita- Salute San Raffaele, Milan, Via Olgettina, 58, Milan, 20132, Italy
- Psychiatry & Clinical Psychobiology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Clara Mucci
- Department of Human and Social Sciences, University of Bergamo, P.le S. Agostino, 2, Bergamo, 24129, Italy
| | - Georg Northoff
- The Royal's Institute of Mental Health Research & University of Ottawa. Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K412, Canada
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Mazinan RG, Dudek C, Warkentin H, Finkenstaedt M, Schröder J, Musil R, Kratzer L, Fuss J, Biedermann SV. Borderline personality disorder and sexuality: causes and consequences of dissociative symptoms. Borderline Personal Disord Emot Dysregul 2024; 11:8. [PMID: 38500169 PMCID: PMC10949637 DOI: 10.1186/s40479-024-00251-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/05/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Sexual risk behavior in patients diagnosed with borderline personality disorder (BPD) is supposed to be associated with traumatic experiences and dissociative symptoms. Nevertheless, scientific research thereon is scarce which might be due to the high prevalence of sexual trauma and fear of overwhelming patients with explicit sexual content. METHODS We investigated a clinical sample of patients diagnosed with BPD (n = 114) and compared them to a sample of matched healthy controls (HC) (n = 114) concerning the dissociative symptoms derealization, depersonalization, and conversion in sexual situations. In a subgroup of patients with BPD (n = 41) and matched HC (n = 40) dissociative symptoms after exposure to an acoustically presented erotic narrative were assessed in the lab. Regression analyses were used to examine the associations between sexual trauma, post-traumatic stress disorder (PTSD), dissociation in sexual situations, and risky sexual behavior. RESULTS Patients diagnosed with BPD endorsed higher dissociative symptoms in sexual situations retrospectively and in the lab compared to HC. Regression analyses revealed that depersonalization and conversion symptoms in sexual situations were explained by severity of BPD, while derealization was explained by PTSD symptomatology. Impulsive and sexual behavior with an uncommitted partner were higher in the BPD group and explained by derealization, while conversion showed an inverse association. CONCLUSION Our findings highlight the importance of addressing distinct dissociative symptoms in sexual situations when counselling and treating women with BPD. In the long term, this could contribute to a reduction in sexual risk behavior in patients with BPD. TRIAL REGISTRATION This analysis is part of a larger ongoing study and was registered prior to accessing the data (Registration trial DRKS00029716).
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Affiliation(s)
- Rose Gholami Mazinan
- Social and Emotional Neuroscience Group, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg- Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christina Dudek
- Department of Psychiatry and Psychotherapy, Psychiatric Clinic of LMU, Munich Ludwig Maximilians-Universität München, München, Germany
| | - Hannah Warkentin
- Social and Emotional Neuroscience Group, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg- Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Maja Finkenstaedt
- Social and Emotional Neuroscience Group, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg- Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Johanna Schröder
- Institute for Clinical Psychology and Psychotherapy, Department for Psychology, Medical School Hamburg, Hamburg, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, Psychiatric Clinic of LMU, Munich Ludwig Maximilians-Universität München, München, Germany
- Oberberg Fachklinik Bad Tölz, Bad Tölz, Germany
| | - Leonhard Kratzer
- Department of Psychotraumatology, Clinic St Irmingard, Osternacher Strasse 103, 83209, Prien am Chiemsee, Germany
| | - Johannes Fuss
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Sarah V Biedermann
- Social and Emotional Neuroscience Group, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg- Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Mohammadi Z, Dehghani M, Fathali Lavasani F, Farahani H, Ashouri A. A network analysis of ICD-11 Complex PTSD, emotional processing, and dissociative experiences in the context of psychological trauma at different developmental stages. Front Psychiatry 2024; 15:1372620. [PMID: 38532985 PMCID: PMC10963615 DOI: 10.3389/fpsyt.2024.1372620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Abstract
Objective Traumatic experiences are a significant risk factor for psychological disturbances, including disorders such as complex posttraumatic stress disorder, emotion-processing problems, and trauma-related dissociative experiences. The present investigation examined the coexistence of these symptoms using a network analysis model. Method This study included a sample of 406 people referred to comprehensive health centers in Tehran from September to December 2023 with psychopathological syndromes. Variables were assessed using The International Trauma Questionnaire, International Measurement of Exposure to Traumatic Event checklist, Baker Emotional Processing Questionnaire, and Dissociative Experiences. A regularized partial correlation network and Glasso algorithm, in combination with Extended Bayesian information criteria, were applied to estimate the network structure. Results Signs of unprocessed emotions and disturbance in self-organization symptoms were the most important symptoms in the symptom network, forming strong connections with other nodes. Thereby, these two symptoms can be regarded as the most important clinical manifestations in the symptom network following traumatic experiences. Three distinct symptom communities were identified: the community of traumatic experiences (childhood, adolescence, adulthood), the community of dissociative experiences (amnesia, depersonalization/derealization, and absorption), and the community of emotional processing (suppression, unpleasant emotional experience, Signs of unprocessed emotions, avoidance, and emotional control, posttraumatic stress disorder symptoms and disturbance in self-organization symptoms). The strongest edges observed were between childhood trauma-adolescence trauma (0.473) in the community of traumatic experiences, between amnesia and depersonalization/derealization (0.644) in the community of dissociative experiences, and between disturbance in self-organization symptoms and unprocessed emotions (0.324) in the community of emotional processing, indicating the recurrent occurrence of these symptoms. Conclusion In this study, disturbance in self-organization symptoms was identified as the central psychopathologic symptom in individuals experiencing traumas at different developmental stages. It seems that adolescent trauma and not childhood trauma plays a more decisive role in the symptoms that a person manifests after traumatic experiences. Also, posttraumatic stress disorder symptoms and disturbance in self-organization symptoms were recognized in the cluster of emotional processing symptoms and can have substantial roles in prioritizing therapeutic measures.
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Affiliation(s)
- Zahra Mohammadi
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood Dehghani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Fathali Lavasani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | | | - Ahmad Ashouri
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
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Purcell JB, Brand B, Browne HA, Chefetz RA, Shanahan M, Bair ZA, Baranowski KA, Davis V, Mangones P, Modell RL, Palermo CA, Robertson EC, Robinson MA, Ward L, Winternitz S, Kaufman ML, Lebois LAM. Treatment of dissociative identity disorder: leveraging neurobiology to optimize success. Expert Rev Neurother 2024; 24:273-289. [PMID: 38357897 PMCID: PMC10950423 DOI: 10.1080/14737175.2024.2316153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Dissociative identity disorder (DID) is a treatable mental health condition that is associated with a range of psychobiological manifestations. However, historical controversy, modern day misunderstanding, and lack of professional education have prevented accurate treatment information from reaching most clinicians and patients. These obstacles also have slowed empirical efforts to improve treatment outcomes for people with DID. Emerging neurobiological findings in DID provide essential information that can be used to improve treatment outcomes. AREAS COVERED In this narrative review, the authors discuss symptom characteristics of DID, including dissociative self-states. Current treatment approaches are described, focusing on empirically supported psychotherapeutic interventions for DID and pharmacological agents targeting dissociative symptoms in other conditions. Neurobiological correlates of DID are reviewed, including recent research aimed at identifying a neural signature of DID. EXPERT OPINION Now is the time to move beyond historical controversy and focus on improving DID treatment availability and efficacy. Neurobiological findings could optimize treatment by reducing shame, aiding assessment, providing novel interventional brain targets and guiding novel pharmacologic and psychotherapeutic interventions. The inclusion of those with lived experience in the design, planning and interpretation of research investigations is another powerful way to improve health outcomes for those with DID.
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Affiliation(s)
- Juliann B Purcell
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- b Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Bethany Brand
- Department of Psychology, Towson University, Towson, MD, USA
| | - Heidi A Browne
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, USA
| | | | - Meghan Shanahan
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, USA
| | - Zoe A Bair
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Kim A Baranowski
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Vona Davis
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, USA
| | - Patricia Mangones
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, USA
| | - Rebecca L Modell
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Cori A Palermo
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Emma C Robertson
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Smith College, Northampton, MA, USA
| | - Matthew A Robinson
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- b Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Laura Ward
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Sherry Winternitz
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- b Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Milissa L Kaufman
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- b Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- b Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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12
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Danböck SK, Duek O, Ben-Zion Z, Korem N, Amen SL, Kelmendi B, Wilhelm FH, Levy I, Harpaz-Rotem I. Effects of a dissociative drug on fronto-limbic resting-state functional connectivity in individuals with posttraumatic stress disorder: a randomized controlled pilot study. Psychopharmacology (Berl) 2024; 241:243-252. [PMID: 37872291 PMCID: PMC10806226 DOI: 10.1007/s00213-023-06479-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 10/07/2023] [Indexed: 10/25/2023]
Abstract
RATIONALE A subanesthetic dose of ketamine, a non-competitive N-methyl-D-aspartate glutamate receptor (NMDAR) antagonist, elicits dissociation in individuals with posttraumatic stress disorder (PTSD), who also often suffer from chronic dissociative symptoms in daily life. These debilitating symptoms have not only been linked to worse PTSD trajectories, but also to increased resting-state functional connectivity (RSFC) between medial prefrontal cortex (mPFC) and amygdala, supporting the conceptualization of dissociation as emotion overmodulation. Yet, as studies were observational, causal evidence is lacking. OBJECTIVES The present randomized controlled pilot study examines the effect of ketamine, a dissociative drug, on RSFC between mPFC subregions and amygdala in individuals with PTSD. METHODS Twenty-six individuals with PTSD received either ketamine (0.5mg/kg; n = 12) or the control drug midazolam (0.045mg/kg; n = 14) during functional magnetic resonance imaging (fMRI). RSFC between amygdala and mPFC subregions, i.e., ventromedial PFC (vmPFC), dorsomedial PFC (dmPFC) and anterior-medial PFC (amPFC), was assessed at baseline and during intravenous drug infusion. RESULTS Contrary to pre-registered predictions, ketamine did not promote a greater increase in RSFC between amygdala and mPFC subregions from baseline to infusion compared to midazolam. Instead, ketamine elicited a stronger transient decrease in vmPFC-amygdala RSFC compared to midazolam. CONCLUSIONS A dissociative drug did not increase fronto-limbic RSFC in individuals with PTSD. These preliminary experimental findings contrast with prior correlative findings and call for further exploration and, potentially, a more differentiated view on the neurobiological underpinning of dissociative phenomena in PTSD.
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Affiliation(s)
- Sarah K Danböck
- Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria.
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany.
| | - Or Duek
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
- Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Ben-Gurion University of The Negev, Be'er-Sheva, Israel
| | - Ziv Ben-Zion
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
- Departments of Comparative Medicine and Neuroscience, School of Medicine, Yale University, New Haven, CT, USA
| | - Nachshon Korem
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
| | - Shelley L Amen
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
| | - Ben Kelmendi
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
| | - Frank H Wilhelm
- Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Ifat Levy
- Departments of Comparative Medicine and Neuroscience, School of Medicine, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
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13
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Jamieson G, Cardeña E, de Pascalis V. A spontaneous dissociative episode during an EEG experiment. Brain Cogn 2024; 174:106121. [PMID: 38142536 DOI: 10.1016/j.bandc.2023.106121] [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: 09/05/2023] [Revised: 11/14/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
A depersonalization episode occurred unexpectedly during an electroencephalogram (EEG) recording for a study. Experience reports tracked the time course of this event and, in conjunction, with EEG data, were analyzed. The source activity across canonical frequency bands was analyzed across four periods ended by retrospective experience reports (depersonalization was reported in the 2nd period). Delta and theta decreases occurred across all time periods with no relation to reported events. Theta and alpha increases occurred in right secondary visual areas following depersonalization, which also coincided with surges in beta and gamma. The largest increases occurred in bilateral fronto-polar and medial prefrontal cortex, followed by inferior left lateral fronto-insula-temporal cortices and right secondary visual cortex. A high frequency functional network with a principal hub in left insula closely overlapped inferior left cortical gamma band-power increases. Bilateral frontal increases in gamma are consistent with studies of dissociation. We interpret gamma and later beta, alpha, and theta band increases as arising from the generation of visual priors, in the absence of precise visual signals, which constrain interoceptive and proprioceptive predictions to reestablish a stable sense of physiological-self. Beta showed local increases following the pattern of gamma but showed no changes in functional connectivity.
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Affiliation(s)
| | - Etzel Cardeña
- CERCAP, Department of Psychology, Lund University, Sweden.
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14
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Seitz KI, Sicorello M, Schmitz M, Valencia N, Herpertz SC, Bertsch K, Neukel C. Childhood Maltreatment and Amygdala Response to Interpersonal Threat in a Transdiagnostic Adult Sample: The Role of Trait Dissociation. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00016-8. [PMID: 38280631 DOI: 10.1016/j.bpsc.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Childhood maltreatment (CM) confers risk for different mental disorders as well as transdiagnostic symptoms such as dissociation. Aberrant amygdala response to interpersonal threat may link CM to transdiagnostic psychopathology and has recently been shown to depend on type and developmental timing of CM experiences. Still, most studies on CM and threat-related amygdala response employ categorical disorder-specific perspectives and fail to consider type and timing of CM exposure. We aimed to investigate associations between CM, amygdala response to interpersonal threat, and dimensional psychopathological symptoms including trait dissociation in a transdiagnostic adult sample, specifically considering type, timing, and duration of CM. METHODS We conducted a cross-sectional neuroimaging study in 141 participants with varying levels of CM, including mostly female participants with major depressive disorder (n = 36), posttraumatic stress disorder (n = 34), and somatic symptom disorder (n = 35) and healthy volunteers (n = 36). Participants underwent functional magnetic resonance imaging during an emotional face-matching task, completed the brief German interview version of the Maltreatment and Abuse Chronology of Exposure scale, and answered self-report measures of transdiagnostic CM-related symptoms including trait dissociation. Data were analyzed using a machine learning-based model comparison procedure. RESULTS In our transdiagnostic sample, neither type nor timing or duration of CM predicted amygdala response to interpersonal threat. Instead, trait dissociation predicted blunted bilateral amygdala response and emerged as a possible mediator between CM and amygdala function. CONCLUSIONS Trait dissociation may be an important confounder in the widely documented association between CM and threat-related amygdala response, which should be considered in future longitudinal studies.
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Affiliation(s)
- Katja I Seitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany; German Center for Mental Health (DZPG), partner site Mannheim, Heidelberg, Ulm, Germany.
| | - Maurizio Sicorello
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marius Schmitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Noel Valencia
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany; German Center for Mental Health (DZPG), partner site Mannheim, Heidelberg, Ulm, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany; Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany; Department of Psychology, Julius-Maximilians-University Wuerzburg, Wuerzburg, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany; German Center for Mental Health (DZPG), partner site Mannheim, Heidelberg, Ulm, Germany
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15
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Manfield PE, Taylor G, Dornbush E, Engel L, Greenwald R. Preliminary evidence for the acceptability, safety, and efficacy of the flash technique. Front Psychiatry 2024; 14:1273704. [PMID: 38260782 PMCID: PMC10801180 DOI: 10.3389/fpsyt.2023.1273704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024] Open
Abstract
Objectives This study reports on four similar studies intended to explore the acceptability, safety, and efficacy of the flash technique (FT), a method of rapidly reducing the intensity of a disturbing memory or image, with minimal subjective disturbance for subjects during the process. Of the four studies, two were conducted during FT trainings in the United States, one in Australia, and one in Uganda. Methods The studies involve pre-, post-, and follow-up repeated-measures design to determine the effectiveness of a 15-min FT intervention. A total of 654 subjects were asked to think of a disturbing memory and then participate in a structured experience of an FT. The purpose of this investigation was to determine whether a brief application of an FT would be safe and effective in significantly reducing their disturbance. In each study, subjects rated their disturbing memories on a 0-to-10 scale, with zero representing no disturbance at all and 10 representing the worst they could imagine. Then, they took part in a 15-min group practicum where they were guided in a self-administering FT with no individual supervision or support. Results In all four studies, the mean reduction in disturbance exceeded two-thirds, the results were significant (p < 0.001), and the effect size was very large. Of the 813 sessions (654 subjects) represented in these studies, only two subjects reported slight increases in disturbances, and both of these subjects reported reductions in disturbance in their second FT experiences 2 h later. At a 4-week follow-up, mean disturbance levels in all four studies indicated maintenance of benefit or slightly further reduction of mean disturbance levels. An 18-month follow-up study with a subgroup of subjects who initially reported a high level of memory-related distress found similar maintenance of gains as well as symptom reduction. Conclusion These findings provide preliminary evidence of acceptability, safety, and efficacy of FT; therefore, further study is warranted.
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Affiliation(s)
| | | | | | - Lewis Engel
- Independent Practice, San Francisco, CA, United States
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16
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Burback L, Brémault-Phillips S, Nijdam MJ, McFarlane A, Vermetten E. Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. Curr Neuropharmacol 2024; 22:557-635. [PMID: 37132142 PMCID: PMC10845104 DOI: 10.2174/1570159x21666230428091433] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 05/04/2023] Open
Abstract
This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.
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Affiliation(s)
- Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | | | - Mirjam J. Nijdam
- ARQ National Psychotrauma Center, Diemen, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, New York University Grossman School of Medicine, New York, USA
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Sigurvinsdottir R, Skúladóttir H, Antonsdóttir HF, Cardenas P, Georgsdóttir MT, Írisardóttir Þórisdóttir M, Jónsdóttir EK, Konop M, Valdimarsdóttir HB, Vilhjálmsson HH, Ásgeirsdóttir BB. A Virtual Reality Courtroom for Survivors of Sexual Violence: A Mixed-Method Pilot Study on Application Possibilities. Violence Against Women 2024; 30:249-274. [PMID: 37801610 DOI: 10.1177/10778012231205589] [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] [Indexed: 10/08/2023]
Abstract
This mixed-method pilot study examined the application possibilities of a virtual courtroom to support survivors of sexual violence who may experience courtroom-associated distress. Female sexual violence survivors (n = 13) who had testified in court following victimization entered an interactive virtual courtroom replica. Their reactions were measured quantitatively and qualitatively. The virtual courtroom evoked both subjective and physiological stress. Participants perceived the virtual reality environment as similar to the real-life courtroom. Most reported negative experiences from interacting with the criminal justice system. The virtual courtroom is a possible future strategy to support survivors when reporting violence to the justice system.
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Affiliation(s)
| | | | | | - Paola Cardenas
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | | | | | | | - Magdalena Konop
- Department of Psychotherapy, Jagiellonian University Medical College, Krakow, Poland
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18
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Zaretsky TG, Jagodnik KM, Barsic R, Antonio JH, Bonanno PA, MacLeod C, Pierce C, Carney H, Morrison MT, Saylor C, Danias G, Lepow L, Yehuda R. The Psychedelic Future of Post-Traumatic Stress Disorder Treatment. Curr Neuropharmacol 2024; 22:636-735. [PMID: 38284341 PMCID: PMC10845102 DOI: 10.2174/1570159x22666231027111147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 01/30/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) is a mental health condition that can occur following exposure to a traumatic experience. An estimated 12 million U.S. adults are presently affected by this disorder. Current treatments include psychological therapies (e.g., exposure-based interventions) and pharmacological treatments (e.g., selective serotonin reuptake inhibitors (SSRIs)). However, a significant proportion of patients receiving standard-of-care therapies for PTSD remain symptomatic, and new approaches for this and other trauma-related mental health conditions are greatly needed. Psychedelic compounds that alter cognition, perception, and mood are currently being examined for their efficacy in treating PTSD despite their current status as Drug Enforcement Administration (DEA)- scheduled substances. Initial clinical trials have demonstrated the potential value of psychedelicassisted therapy to treat PTSD and other psychiatric disorders. In this comprehensive review, we summarize the state of the science of PTSD clinical care, including current treatments and their shortcomings. We review clinical studies of psychedelic interventions to treat PTSD, trauma-related disorders, and common comorbidities. The classic psychedelics psilocybin, lysergic acid diethylamide (LSD), and N,N-dimethyltryptamine (DMT) and DMT-containing ayahuasca, as well as the entactogen 3,4-methylenedioxymethamphetamine (MDMA) and the dissociative anesthetic ketamine, are reviewed. For each drug, we present the history of use, psychological and somatic effects, pharmacology, and safety profile. The rationale and proposed mechanisms for use in treating PTSD and traumarelated disorders are discussed. This review concludes with an in-depth consideration of future directions for the psychiatric applications of psychedelics to maximize therapeutic benefit and minimize risk in individuals and communities impacted by trauma-related conditions.
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Affiliation(s)
- Tamar Glatman Zaretsky
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathleen M. Jagodnik
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Barsic
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josimar Hernandez Antonio
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip A. Bonanno
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carolyn MacLeod
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charlotte Pierce
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hunter Carney
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Morgan T. Morrison
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles Saylor
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Danias
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren Lepow
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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19
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Aarts I, Vriend C, van den Heuvel OA, Thomaes K. Brain activation during an emotional task in participants with PTSD and borderline and/or cluster C personality disorders. Neuroimage Clin 2023; 41:103554. [PMID: 38128160 PMCID: PMC10777111 DOI: 10.1016/j.nicl.2023.103554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Although comorbidity of post-traumatic stress disorder (PTSD) with borderline personality disorder (BPD) and/or cluster C personality disorders (CPD) is common, neural correlates of this comorbidity are unknown. METHODS We acquired functional MRI scans during an emotional face task in participants with PTSD + CPD (n = 34), PTSD + BPD (n = 24), PTSD + BPD + CPD (n = 18) and controls (n = 30). We used ANCOVAs and Bayesian analyses on specific ROIs in a fearful vs. scrambled faces contrast. We also investigated associations with clinical measures. RESULTS There were no robust differences in brain activation between the groups with ANCOVAs. Transdiagnostically, we found a negative association between severity of dissociation and right insula and right dmPFC activation, and emotion regulation problems with right dmPFC activation. Bayesian analyses showed credible evidence for higher activation in all ROIs in the PTSD + BPD + CPD group compared to PTSD + BPD and PTSD + CPD. DISCUSSION Our Bayesian and correlation analyses support new dimensional conceptualizations of personality disorders.
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Affiliation(s)
- Inga Aarts
- Sinai Centrum, Arkin, Amstelveen, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neurosciences, Boelelaan 1117, Amsterdam, the Netherlands.
| | - Chris Vriend
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neurosciences, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, the Netherlands
| | - Odile A van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neurosciences, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, the Netherlands
| | - Kathleen Thomaes
- Sinai Centrum, Arkin, Amstelveen, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neurosciences, Boelelaan 1117, Amsterdam, the Netherlands
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Brueggemann AD, Ekwonye AU. Perceived Benefits of Magdalena Energy Healing Sessions: An Exploratory Study of Clients' Perspectives. Healthcare (Basel) 2023; 11:3087. [PMID: 38063655 PMCID: PMC10871104 DOI: 10.3390/healthcare11233087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/17/2023] [Accepted: 11/30/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Energy healing techniques are associated with many physical and mental benefits. A qualitative study was conducted to understand clients' experiences of a new energy healing modality called Magdalena Energy Healing. METHODS Semi-structured qualitative interviews were conducted after clients experienced 60 min Magdalena energy healing session(s). Twenty-five adults participated in the study. All participants received Magdalena energy healing from a certified, trained practitioner. Thematic analysis was conducted to determine clients' perceived benefits of the Magdalena energy healing session(s). RESULTS Four themes emerged from the data: Physical, Mental, Social, and Spiritual Benefits. Physical health benefits included relief from a variety of medical symptoms, improved sleep quality, and physical body awareness. Mental Health benefits included relaxation and peace, decision-making clarity, relief of mental health symptoms, and an increased ability to cope with life. Social Benefits included improved attitudes in relationships. Spiritual Benefits included optimism, gratitude, self-acceptance, and increased spiritual connection. CONCLUSIONS Participants' perceptions are that Magdalena energy healing sessions offer peace, symptom relief, and gratitude. Magdalena energy healing can address priorities of The National Center for Complementary and Integrative Health (NCCIH). Sessions can be seamlessly integrated into traditional medical care as a useful complementary/integrative healing option to improve physical, mental, and/or spiritual wellbeing across a variety of diseases.
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Affiliation(s)
- Alvina D. Brueggemann
- Department of Holistic Health Studies, St. Catherine University, St. Paul, MN 55105, USA
| | - Angela U. Ekwonye
- Department of Public Health, St. Catherine University, St. Paul, MN 55105, USA;
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21
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Strachan LP, Paulik G, Preece DA, McEvoy PM. Pathways from trauma to unusual perceptual experiences: Modelling the roles of insecure attachment, negative affect, emotion regulation and dissociation. Psychol Psychother 2023; 96:934-951. [PMID: 37493351 DOI: 10.1111/papt.12486] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND A range of traumas have been linked to voices (auditory verbal hallucinations) and unusual perceptual experiences (UPEs) in other perceptual-sensory domains. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the relationship between trauma and voices. The trauma-related voices (TRV) model was developed to generate novel research in this area. AIMS This study aimed to investigate pathways from trauma to the frequency of UPEs based on a subset of hypothesised relationships in the TRV model. MATERIALS The PTSD Diagnostic Scale for DSM-5, State Adult Attachment Measure, Depression Anxiety and Stress Scales-21, Perth Emotion and Regulation Competency Inventory, Dissociative Experiences Measure Oxford, and Multi-modality Unusual Perceptual Experiences Questionnaire. METHODS We used path analysis in a non-clinical sample (N = 528) to model indirect effects from diverse trauma experiences to the frequency of multi-sensory UPEs via a subset of mediators within the TRV model: insecure attachment, emotion regulation deficits, negative affect and dissociation. RESULTS Our model was an excellent fit to the data and accounted for 37.1% of variance in UPE frequency, and all direct (βs = .14-.61) and indirect pathways (βs = .01-.08) were significant (ps < .001). DISCUSSION Our findings suggest that insecure attachment may link diverse trauma experiences to emotion regulation deficits and negative affect, which are linked to UPE frequency via dissociation. CONCLUSION Our findings provide preliminary evidence for a subset of relationships within the TRV model. Future studies are needed to gather stronger evidence of temporality and causation between these factors, and to test broader pathways within the TRV model.
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Affiliation(s)
- Laura P Strachan
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Perth, Western Australia, Australia
- Perth Voices Clinic, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - David A Preece
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Peter M McEvoy
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- Centre for Clinical Interventions, Perth, Western Australia, Australia
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22
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Kimonis ER. The Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) Model for the Development of Secondary Psychopathic Traits. Clin Child Fam Psychol Rev 2023; 26:1097-1114. [PMID: 37735279 PMCID: PMC10640461 DOI: 10.1007/s10567-023-00455-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Abstract
Understanding and treatment of antisocial behavior have improved through efforts to subtype individuals based on similar risk factors and outcomes. In particular, the presence of psychopathic traits is associated with distinct etiological factors and antisocial behavior that begins early in life, is aggressive, persistent, and less likely to normalize with traditional treatments, relative to individuals low on psychopathy or its childhood precursor, callous-unemotional (CU) traits. However, important distinctions can be made within individuals with CU/psychopathic traits according to the presence of elevated anxiety symptoms and/or adverse childhood experiences, known as secondary psychopathy/CU traits. This paper provides a broad and brief overview of theory and empirical literature supporting the existence of secondary psychopathy/CU variants as a distinct subtype of childhood antisocial behavior. It outlines the Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) model for the developmental psychopathology of secondary psychopathic/CU traits and discusses research and theory supporting this perspective. Future research directions for testing this conceptual model and its implications for assessing and treating high-risk individuals with secondary CU/psychopathic traits are discussed.
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Affiliation(s)
- Eva R Kimonis
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, NSW, 2052, Australia.
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23
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Shafie M, Shahmohamadi E, Cattarinussi G, Sanjari Moghaddam H, Akhondzadeh S, Sambataro F, Moltrasio C, Delvecchio G. Resting-state functional magnetic resonance imaging alterations in borderline personality disorder: A systematic review. J Affect Disord 2023; 341:335-345. [PMID: 37673288 DOI: 10.1016/j.jad.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a severe psychiatric disorder characterized by emotion dysregulation, impulsivity, and interpersonal disturbances. Several structural and functional neuroimaging abnormalities have been described in BPD. In particular, resting-state functional magnetic resonance imaging (rs-fMRI) studies have recently suggested various connectivity alterations within and between large-scale brain networks in BPD. This review aimed at providing an updated summary of the evidence reported by the available rs-fMRI studies in BPD individuals. METHODS A search on PubMed, Scopus, and Web of Science was performed to identify rs-fMRI alterations in BPD. A total of 15 studies met our inclusion criteria. RESULTS Overall, aberrant resting-state functional connectivity (rs-FC) within and between default mode network (DMN), salience network (SN), and central executive network (CEN) were observed in BPD compared to healthy controls, as well as selective functional impairments in bilateral amygdala, anterior and posterior cingulate cortex, hippocampus, and prefrontal cortex. LIMITATIONS The observational design, small sample size, prevalence of females, high rates of concurrent comorbidities and medications, and heterogeneity across imaging methodologies limit the generalizability of the results. CONCLUSIONS The identification of altered patterns of rs-FC within and between selective brain networks, including DMN, SN, and CEN, could further our knowledge of the clinical symptoms of BPD, and therefore, future studies with multimodal methodologies and longitudinal designs are warranted to further explore the neural correlates of this disorder.
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Affiliation(s)
- Mahan Shafie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Giulia Cattarinussi
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Hossein Sanjari Moghaddam
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fabio Sambataro
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Chiara Moltrasio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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24
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Chaudhary IS, Shyi GCW, Huang STT. A systematic review and activation likelihood estimation meta-analysis of fMRI studies on arousing or wake-promoting effects in Buddhist meditation. Front Psychol 2023; 14:1136983. [PMID: 38022985 PMCID: PMC10646186 DOI: 10.3389/fpsyg.2023.1136983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Conventional Buddhist texts illustrate meditation as a condition of relaxed alertness that must fend against extreme hypoarousal (sleep, drowsiness) and extreme hyperarousal (restlessness). Theoretical, neurophysiological, and neuroimaging investigations of meditation have highlighted the relaxing effects and hypoarousing without emphasizing the alertness-promoting effects. Here we performed a systematic review supported by an activation-likelihood estimate (ALE) meta-analysis in an effort to counterbalance the surfeit of scholarship emphasizing the hypoarousing and relaxing effects of different forms of Buddhist meditation. Specifically, the current systematic review-cum-meta-analytical review seeks to highlight more support for meditation's wake-promoting effects by drawing from neuroimaging research during wakefulness and meditation. In this systematic review and meta-analysis of 22 fMRI studies, we aim to highlight support for Buddhist meditation's wake-promoting or arousing effects by identifying brain regions associated with alertness during meditation. The most significant peaks were localized medial frontal gyrus (MFG) and precuneus. We failed to determine areas ostensibly common to alertness-related meditation such as the medial prefrontal cortex (mPFC), superior parietal lobule, basal ganglia, thalamus, most likely due to the relatively fewer fMRI investigations that used wakefulness-promoting meditation techniques. Also, we argue that forthcoming research on meditation, related to alertness or wakefulness, continues to adopt a multi-modal method to investigate the correlation between actual behaviors and neural networks connected to Buddhist meditation. Moreover, we recommend the implementation of fMRI paradigms on Buddhist meditation with clinically diagnosed participants to complement recent trends in psychotherapy such as mindfulness-based cognitive therapy (MBCT).
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Affiliation(s)
- Inder S. Chaudhary
- PhD Program in Cognitive Sciences, National Chung Cheng University, Chiayi City, Taiwan
- Center for Research in Cognitive Sciences, National Chung Cheng University, Chiayi City, Taiwan
- Department of Psychology, National Chung Cheng University, Chiayi City, Taiwan
| | - Gary Chon-Wen Shyi
- PhD Program in Cognitive Sciences, National Chung Cheng University, Chiayi City, Taiwan
- Center for Research in Cognitive Sciences, National Chung Cheng University, Chiayi City, Taiwan
- Department of Psychology, National Chung Cheng University, Chiayi City, Taiwan
| | - Shih-Tseng Tina Huang
- PhD Program in Cognitive Sciences, National Chung Cheng University, Chiayi City, Taiwan
- Center for Research in Cognitive Sciences, National Chung Cheng University, Chiayi City, Taiwan
- Department of Psychology, National Chung Cheng University, Chiayi City, Taiwan
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25
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Andrews K, Lloyd CS, Densmore M, Kearney BE, Harricharan S, McKinnon MC, Théberge J, Jetly R, Lanius RA. 'I am afraid you will see the stain on my soul': Direct gaze neural processing in individuals with PTSD after moral injury recall. Soc Cogn Affect Neurosci 2023; 18:nsad053. [PMID: 37897804 PMCID: PMC10612569 DOI: 10.1093/scan/nsad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/20/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023] Open
Abstract
Direct eye contact is essential to understanding others' thoughts and feelings in social interactions. However, those with post-traumatic stress disorder (PTSD) and exposure to moral injury (MI) may exhibit altered theory-of-mind (ToM)/mentalizing processes and experience shame which precludes one's capacity for direct eye contact. We investigated blood oxygenation level-dependent (BOLD) responses associated with direct vs averted gaze using a virtual reality paradigm in individuals with PTSD (n = 28) relative to healthy controls (n = 18) following recall of a MI vs a neutral memory. Associations between BOLD responses and clinical symptomatology were also assessed. After MI recall, individuals with PTSD showed greater activation in the right temporoparietal junction as compared to controls (T = 4.83; pFDR < 0.001; k = 237) during direct gaze. No significant activation occurred during direct gaze after neutral memory recall. Further, a significant positive correlation was found between feelings of distress and right medial superior frontal gyrus activation in individuals with PTSD (T = 5.03; pFDR = 0.049; k = 123). These findings suggest that direct gaze after MI recall prompts compensatory ToM/mentalizing processing. Implications for future interventions aimed at mitigating the effects of PTSD on social functioning are discussed.
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Affiliation(s)
- Krysta Andrews
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
- Homewood Research Institute, Guelph, ON N1E 6K9, Canada
| | - Chantelle S Lloyd
- Homewood Research Institute, Guelph, ON N1E 6K9, Canada
- Department of Psychiatry, Western University, London, ON N6C 0A7, Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Maria Densmore
- Department of Psychiatry, Western University, London, ON N6C 0A7, Canada
- Imaging Division, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Breanne E Kearney
- Department of Neuroscience, Western University, London, ON N6A 3K7, Canada
| | - Sherain Harricharan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
- Homewood Research Institute, Guelph, ON N1E 6K9, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, London, ON N6C 0A7, Canada
- Imaging Division, Lawson Health Research Institute, London, ON N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, ON N6A 5C1, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, ON K1A 0S2, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Ruth A Lanius
- Homewood Research Institute, Guelph, ON N1E 6K9, Canada
- Department of Psychiatry, Western University, London, ON N6C 0A7, Canada
- Imaging Division, Lawson Health Research Institute, London, ON N6A 4V2, Canada
- Department of Neuroscience, Western University, London, ON N6A 3K7, Canada
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26
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van der Linde RPA, Huntjens RJC, Bachrach N, Rijkeboer MM, de Jongh A, van Minnen A. The role of dissociation-related beliefs about memory in trauma-focused treatment. Eur J Psychotraumatol 2023; 14:2265182. [PMID: 37846662 PMCID: PMC10583636 DOI: 10.1080/20008066.2023.2265182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/16/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms. METHOD Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (n = 111) or the dissociative subtype of PTSD (n = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated. RESULTS Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome. CONCLUSION The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.
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Affiliation(s)
- Robin P. A. van der Linde
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
- GGZ Oost Brabant, Boekel, the Netherlands
| | - Rafaële J. C. Huntjens
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Nathan Bachrach
- GGZ Oost Brabant, Boekel, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Marleen M. Rijkeboer
- Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, the Netherlands
| | - Ad de Jongh
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
- School of Psychology, Queen’s University, Belfast, Northern Ireland
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
- School of Health Sciences, Salford University, Manchester, United Kingdom
| | - Agnes van Minnen
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Behavioural Science Institute (BSI), Radboud University, Nijmegen, the Netherlands
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27
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van de Kamp MM, Scheffers M, Emck C, Fokker TJ, Hatzmann J, Cuijpers P, Beek PJ. Body-and movement-oriented interventions for posttraumatic stress disorder: An updated systematic review and meta-analysis. J Trauma Stress 2023; 36:835-848. [PMID: 37702005 DOI: 10.1002/jts.22968] [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] [Received: 04/06/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 09/14/2023]
Abstract
This study is an update of the meta-analysis we published in 2019 on the effectiveness of body- and movement-oriented interventions (BMOIs) for adults with posttraumatic stress disorder (PTSD) in decreasing PTSD symptoms and secondary outcomes of depressive symptoms, sleep disturbance, and interoceptive awareness. Search terms for BMOIs and PTSD were combined to identify eligible studies in four bibliographical databases. Articles were selected if they included adult participants with a primary diagnosis of PTSD, included BMOI as one of the investigated therapies, were designed as a comparative outcome trial with any control condition, and involved a standardized outcome measure for PTSD symptom severity. This resulted in the addition of 14 new studies compared to the 2019 study. The meta-analysis, which included 29 studies in total, resulted in a mean Hedges' g effect size of 0.50, 95% CI [0.22, 0.79], in decreasing PTSD symptoms, with very high heterogeneity, I2 = 89%. Meta-analyses of secondary outcomes resulted in Hedges' g effect sizes of 0.37, 95% CI [0.08, 0.66] for depressive symptoms; 0.62, 95% CI [0.42, 0.81] for sleep quality; and -0.10, 95% CI [-0.23, 0.43] for interoceptive awareness. The risk of bias analysis resulted in some concerns or high risk of bias in almost all included studies; only one study had a low risk of bias. We conclude that BMOIs may be valuable for patients with PTSD. There is, however, still a lack of high-quality studies with proper control conditions and long-term follow-up periods from which to draw conclusions.
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Affiliation(s)
- Minke M van de Kamp
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Mia Scheffers
- School of Health, Movement & Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Claudia Emck
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Ties J Fokker
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Janneke Hatzmann
- School of Health, Movement & Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Pim Cuijpers
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Peter J Beek
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
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28
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İçin ZN, Koşe Ç, Şar V. Turkish Adaptation of Dissociative Subtype of Post Traumatic Stress Disorder Scale. J Trauma Dissociation 2023; 24:624-639. [PMID: 36994469 DOI: 10.1080/15299732.2023.2195396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/21/2023] [Indexed: 03/31/2023]
Abstract
After the changes in DSM-5, dissociative subtype was added to post-traumatic stress disorder. That caused a necessity for a scale to measure the mentioned change. A scale named Dissociative Subtype of Post-Traumatic Stress Disorder (DSPS) was developed to measure this subtype and help the diagnosis. The purpose of this study is to adapt the Dissociative Subtype of Post-Traumatic Stress Disorder to Turkish and examine its reliability and validity. The Dissociative Subtype of PTSD (DSPS) was translated into Turkish. DSPS, Turkish forms of The Posttraumatic Diagnostic Scale and Dissociative Experiences Scale were sent to participants via Google Forms and data from 279 people aged 18-45 were analyzed. Reliability tests and factor analysis were conducted. Factor analysis showed that scale has good model fit scores and items were loaded to the factors the same as the original study. Scales internal consistency was examined, and a good score was obtained (α=.84). Fit index values of confirmatory factor analysis were found as χ2/df = 2.51, GFI=.90, RMSEA=.07, RMR=.02. As a result of the high reliability scores and sufficient model fit scores, this scale is considered as a dependable measure to evaluate the dissociative subtype of PTSD.
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Affiliation(s)
- Zühre Neslihan İçin
- Institute of Forensic Sciences and Legal Medicine, Department of Social Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Çiğdem Koşe
- Department of Psychology, Topkapı University, Istanbul, Turkey
| | - Vedat Şar
- Department of Psychiatry, Koc University, Istanbul, Turkey
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29
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Lewis MW, Webb CA, Kuhn M, Akman E, Jobson SA, Rosso IM. Predicting Fear Extinction in Posttraumatic Stress Disorder. Brain Sci 2023; 13:1131. [PMID: 37626488 PMCID: PMC10452660 DOI: 10.3390/brainsci13081131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Fear extinction is the basis of exposure therapies for posttraumatic stress disorder (PTSD), but half of patients do not improve. Predicting fear extinction in individuals with PTSD may inform personalized exposure therapy development. The participants were 125 trauma-exposed adults (96 female) with a range of PTSD symptoms. Electromyography, electrocardiogram, and skin conductance were recorded at baseline, during dark-enhanced startle, and during fear conditioning and extinction. Using a cross-validated, hold-out sample prediction approach, three penalized regressions and conventional ordinary least squares were trained to predict fear-potentiated startle during extinction using 50 predictor variables (5 clinical, 24 self-reported, and 21 physiological). The predictors, selected by penalized regression algorithms, were included in multivariable regression analyses, while univariate regressions assessed individual predictors. All the penalized regressions outperformed OLS in prediction accuracy and generalizability, as indexed by the lower mean squared error in the training and holdout subsamples. During early extinction, the consistent predictors across all the modeling approaches included dark-enhanced startle, the depersonalization and derealization subscale of the dissociative experiences scale, and the PTSD hyperarousal symptom score. These findings offer novel insights into the modeling approaches and patient characteristics that may reliably predict fear extinction in PTSD. Penalized regression shows promise for identifying symptom-related variables to enhance the predictive modeling accuracy in clinical research.
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Affiliation(s)
- Michael W. Lewis
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Christian A. Webb
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Manuel Kuhn
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Eylül Akman
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
| | - Sydney A. Jobson
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
| | - Isabelle M. Rosso
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
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30
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Gecaite-Stonciene J, Rossetti MG, Brambilla P, Hughes BM, Mickuviene N, Bellani M. Psychophysiological responses to psychological stress exposure and neural correlates in adults with mental disorders: a scoping review. Front Psychiatry 2023; 14:1191007. [PMID: 37564245 PMCID: PMC10411511 DOI: 10.3389/fpsyt.2023.1191007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction The dysregulation of psychophysiological responses to mental stressors is a common issue addressed in individuals with psychiatric conditions, while brain circuit abnormalities are often associated with psychiatric conditions and their manifestations. However, to our knowledge, there is no systematic overview that would comprehensively synthesize the literature on psychophysiological responses during laboratory-induced psychosocial stressor and neural correlates in people with mental disorders. Thus, we aimed to systematically review the existing research on psychophysiological response during laboratory-induced stress and its relationship with neural correlates as measured by magnetic resonance imaging techniques in mental disorders. Methods The systematic search was performed on PubMed/Medline, EBSCOhost/PsycArticles, Web of Science, and The Cochrane Library databases during November 2021 following the PRISMA guidelines. Risk of bias was evaluated by employing the checklists for cross-sectional and case-control studies from Joanna Briggs Institute (JBI) Reviewers Manual. Results Out of 353 de-duplicated publications identified, six studies were included in this review. These studies were identified as representing two research themes: (1) brain anatomy and psychophysiological response to mental stress in individuals with mental disorders, and (2) brain activity and psychophysiological response to mental stress in individuals with mental disorders. Conclusions Overall, the evidence from studies exploring the interplay between stress psychophysiology and neural correlates in mental disorders is limited and heterogeneous. Further studies are warranted to better understand the mechanisms of how psychophysiological stress markers interplay with neural correlates in manifestation and progression of psychiatric illnesses.
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Affiliation(s)
- Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Maria G. Rossetti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Narseta Mickuviene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Marcella Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Zhang X, Bhatt RR, Todorov S, Gupta A. Brain-gut microbiome profile of neuroticism predicts food addiction in obesity: A transdiagnostic approach. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110768. [PMID: 37061021 PMCID: PMC10731989 DOI: 10.1016/j.pnpbp.2023.110768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 04/17/2023]
Abstract
Neuroticism is one of the most robust risk factors for addictive behaviors including food addiction (a key contributor to obesity), although the associated mechanisms are not well understood. A transdiagnostic approach was used to identify the neuroticism-related neuropsychological and gut metabolomic patterns associated with food addiction. Predictive modeling of neuroticism was implemented using multimodal features (23 clinical, 13,531 resting-state functional connectivity (rsFC), 336 gut metabolites) in 114 high body mass index (BMI ≥25 kg/m2) (cross-sectional) participants. Gradient boosting machine and logistic regression models were used to evaluate classification performance for food addiction. Neuroticism was significantly associated with food addiction (P < 0.001). Neuroticism-related features predicted food addiction with high performance (89% accuracy). Multimodal models performed better than single-modal models in predicting food addiction. Transdiagnostic alterations corresponded to rsFC involved in the emotion regulation, reward, and cognitive control and self-monitoring networks, and the metabolite 3-(4-hydroxyphenyl) propionate, as well as anxiety symptoms. Neuroticism moderated the relationship between BMI and food addiction. Neuroticism drives neuropsychological and gut microbial signatures implicated in dopamine synthesis and inflammation, anxiety, and food addiction. Such transdiagnostic models are essential in identifying mechanisms underlying food addiction in obesity, as it can help develop multiprong interventions to improve symptoms.
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Affiliation(s)
- Xiaobei Zhang
- G. Oppenheimer Center for Neurobiology of Stress & Resilience, at UCLA, United States of America; UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, United States of America; David Geffen School of Medicine at UCLA, United States of America; University of California, Los Angeles, United States of America
| | - Ravi R Bhatt
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, United States of America
| | - Svetoslav Todorov
- G. Oppenheimer Center for Neurobiology of Stress & Resilience, at UCLA, United States of America
| | - Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress & Resilience, at UCLA, United States of America; UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, United States of America; David Geffen School of Medicine at UCLA, United States of America; Goodman-Luskin Microbiome Center at UCLA, United States of America; University of California, Los Angeles, United States of America.
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Cassady M, Baslet G. Dissociation in patients with epilepsy and functional seizures: A narrative review of the literature. Seizure 2023; 110:220-230. [PMID: 37433243 DOI: 10.1016/j.seizure.2023.06.020] [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: 05/03/2023] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023] Open
Abstract
Dissociation is a "disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment" according to DSM-5. It is commonly seen in psychiatric disorders including primary dissociative disorders, post-traumatic stress disorder, depression, and panic disorder. Dissociative phenomena are also described in the context of substance intoxication, sleep deprivation and medical illnesses including traumatic brain injury, migraines, and epilepsy. Patients with epilepsy have higher rates of dissociative experiences as measured on the Dissociative Experiences Scale compared to healthy controls. Ictal symptoms, especially in focal epilepsy of temporal lobe origin, may include dissociative-like experiences such as déjà vu/jamais vu, depersonalization, derealization and what has been described as a "dreamy state". These descriptions are common in the setting of seizures that originate from mesial temporal lobe epilepsy and may involve the amygdala and hippocampus. Other ictal dissociative phenomena include autoscopy and out of body experiences, which are thought to be due to disruptions in networks responsible for the integration of one's own body and extra-personal space and involve the temporoparietal junction and posterior insula. In this narrative review, we will summarize the updated literature on dissociative experiences in epilepsy, as well as dissociative experiences in functional seizures. Using a case example, we will review the differential diagnosis of dissociative symptoms. We will also review neurobiological underpinnings of dissociative symptoms across different diagnostic entities and discuss how ictal symptoms may shed light on the neurobiology of complex mental processes including the subjective nature of consciousness and self-identity.
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Affiliation(s)
- Maureen Cassady
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Heekerens JB, Gross JJ, Kreibig SD, Wingenfeld K, Roepke S. The temporal dynamics of dissociation: protocol for an ecological momentary assessment and laboratory study in a transdiagnostic sample. BMC Psychol 2023; 11:178. [PMID: 37287088 DOI: 10.1186/s40359-023-01209-z] [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: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Dissociation is a ubiquitous clinical phenomenon. Dissociative disorders (DD) are primarily characterized by dissociation, and dissociative states are also a criterion for borderline personality disorder (BPD) and the dissociative subtype of post-traumatic stress disorder (PTSD). Dissociative reactions (e.g., depersonalization/derealization or gaps in awareness/memory) across diagnostic categories are believed to be affect contingent and theorized to serve affect regulation functions. What is not clear, however, is how self-reported affect and physiological reactivity unfold within dissociative episodes. To address this issue, the present project aims to investigate the hypothesis (1) whether self-reported distress (as indicated by arousal, e.g., feeling tense/agitated, and/or valence, e.g., feeling discontent/unwell) and physiological reactivity increase before dissociative episodes and (2) whether self-reported distress and physiological reactivity decrease during and after dissociative episodes in a transdiagnostic sample of patients with DD, BPD, and/or PTSD. METHODS We will use a smartphone application to assess affect and dissociation 12 times per day over the course of one week in everyday life. During this time, heart and respiratory rates will be remotely monitored. Afterwards, participants will report affect and dissociative states eight times in the laboratory before, during, and after the Trier Social Stress Test. During the laboratory task, we will continuously record heart rate, electrodermal activity, and respiratory rate, as well as measure blood pressure and take salivary samples to determine cortisol levels. Our hypotheses will be tested using multilevel structural equation models. Power analyses determined a sample size of 85. DISCUSSION The project will test key predictions of a transdiagnostic model of dissociation based on the idea that dissociative reactions are affect contingent and serve affect regulation functions. This project will not include non-clinical control participants. In addition, the assessment of dissociation is limited to pathological phenomena.
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Affiliation(s)
- Johannes B Heekerens
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, 12203, Berlin, Germany.
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, 94305, USA
| | - Sylvia D Kreibig
- Department of Psychology, Stanford University, Stanford, CA, 94305, USA
| | - Katja Wingenfeld
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, 12203, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, 12203, Berlin, Germany
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Lathan EC, Guelfo A, La Barrie DL, Teer A, Powers A, Siegle G, Fani N. Differing associations of depersonalization with physiological response during rest and breath-focused mindfulness in a trauma-exposed female population. J Psychiatr Res 2023; 162:193-199. [PMID: 37172509 PMCID: PMC10305839 DOI: 10.1016/j.jpsychires.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/10/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Dissociative and posttraumatic stress disorder (PTSD) symptoms are commonly co-occurring responses to psychological trauma. Yet, these two groups of symptoms appear to be related to diverging patterns of physiological response. To date, few studies have examined how specific dissociative symptoms, namely, depersonalization and derealization, relate to skin conductance response (SCR), a marker of autonomic function, within the context of PTSD symptoms. We examined associations among depersonalization, derealization, and SCR during two conditions - resting control and breath-focused mindfulness - in the context of current PTSD symptoms. METHODS Sixty-eight trauma-exposed women (82.4% Black; Mage = 42.5, SDage = 12.1) were recruited from the community for a breath-focused mindfulness study. SCR data were collected during alternating resting control and breath-focused mindfulness conditions. Moderation analyses were conducted to examine relations among dissociative symptoms, SCR, and PTSD for these different conditions. RESULTS Moderation analyses revealed that depersonalization was linked to lower SCR during resting control, B = 0.0005, SE = 0.0002, p = .006, in participants low-to-moderate PTSD symptoms; however, depersonalization was associated with higher SCR during breath-focused mindfulness, B = -0.0006, SE = 0.0003, p = .029, in individuals with similar levels of PTSD symptoms. No significant interaction between derealization and PTSD symptoms on SCR was observed. CONCLUSIONS Depersonalization symptoms may associate with physiological withdrawal during rest, but greater physiological arousal during effortful emotion regulation in individuals with low-to moderate levels of PTSD, which has significant implications for barriers to treatment engagement as well as treatment selection in this population.
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Affiliation(s)
- Emma C Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Alfonsina Guelfo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | | | - Andrew Teer
- Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Massachusetts General Hospital, Charlestown, MA, USA; Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA.
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Greg Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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Mertens YL, Manthey A, Sierk A, de Jong P, Walter H, Daniels JK. A pharmacological challenge paradigm to assess neural signatures of script-elicited acute dissociation in women with post-traumatic stress disorder. BJPsych Open 2023; 9:e78. [PMID: 37128866 DOI: 10.1192/bjo.2023.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND There is limited experimentally controlled neuroimaging research available that could explain how dissociative states occur and which neurobiological changes are involved in acute post-traumatic dissociation. AIMS To test the causal hypothesis that acute dissociation is triggered bottom-up by a selective noradrenergic-mediated increase in amygdala activation during the processing of autobiographical trauma memories. METHOD Women with post-traumatic stress disorder (n = 47) and a history of interpersonal childhood trauma underwent a within-participant, placebo-controlled pharmacological challenge paradigm (4.0 mg reboxetine versus placebo) employing script-driven imagery (traumatic versus neutral autobiographical memory recall). Script-elicited brain activation patterns (measured via functional magnetic resonance imagery) were analysed by means of whole-brain analyses and a pre-registered region of interest (i.e. amygdala). RESULTS Self-reported acute dissociation increased significantly during trauma (versus neutral) recall but did not differ between pharmacological conditions. The pharmacological manipulation was also unsuccessful in eliciting increased amygdala activation following script-driven imagery in the reboxetine (versus placebo) condition. In the reboxetine condition, trauma retrieval resulted in similar activation patterns as in the placebo condition (e.g. elevated brain activation in the middle occipital gyrus and supramarginal gyrus), albeit with different peaks. CONCLUSIONS Current (null) findings cast doubt on the suggested role of the amygdala in subserving dissociative processing of trauma memories. Alternative pharmacological manipulation approaches (e.g. ketamine) and analysis techniques (e.g. event-related independent component analysis) might provide better insight into the spatiotemporal dynamics and network shifts involved in dissociative experiences and autobiographical trauma memory recall.
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Affiliation(s)
- Yoki L Mertens
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Antje Manthey
- Charité University Clinic Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health), Berlin, Germany
| | - Anika Sierk
- Charité University Clinic Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health), Berlin, Germany
| | - Peter de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Henrik Walter
- Charité University Clinic Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health), Berlin, Germany
| | - Judith K Daniels
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
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Wolf EJ, Hawn SE, Sullivan DR, Miller MW, Sanborn V, Brown E, Neale Z, Fein-Schaffer D, Zhao X, Logue MW, Fortier CB, McGlinchey RE, Milberg WP. Neurobiological and genetic correlates of the dissociative subtype of posttraumatic stress disorder. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:409-427. [PMID: 37023279 PMCID: PMC10286858 DOI: 10.1037/abn0000795] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Approximately 10%-30% of individuals with posttraumatic stress disorder (PTSD) exhibit a dissociative subtype of the condition defined by symptoms of depersonalization and derealization. This study examined the psychometric evidence for the dissociative subtype of PTSD in a sample of young, primarily male post-9/11-era Veterans (n = 374 at baseline and n = 163 at follow-up) and evaluated its biological correlates with respect to resting state functional connectivity (default mode network [DMN]; n = 275), brain morphology (hippocampal subfield volume and cortical thickness; n = 280), neurocognitive functioning (n = 337), and genetic variation (n = 193). Multivariate analyses of PTSD and dissociation items suggested a class structure was superior to dimensional and hybrid ones, with 7.5% of the sample comprising the dissociative class; this group showed stability over 1.5 years. Covarying for age, sex, and PTSD severity, linear regression models revealed that derealization/depersonalization severity was associated with: decreased DMN connectivity between bilateral posterior cingulate cortex and right isthmus (p = .015; adjusted-p [padj] = .097); increased bilateral whole hippocampal, hippocampal head, and molecular layer head volume (p = .010-.034; padj = .032-.053); worse self-monitoring (p = .018; padj = .079); and a candidate genetic variant (rs263232) in the adenylyl cyclase 8 gene (p = .026), previously associated with dissociation. Results converged on biological structures and systems implicated in sensory integration, the neural representation of spatial awareness, and stress-related spatial learning and memory, suggesting possible mechanisms underlying the dissociative subtype of PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Sage E. Hawn
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Danielle R. Sullivan
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Victoria Sanborn
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
| | - Emma Brown
- Translational Research Center for TBI and Stress Disorders and Geriatric Research Educational and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - Zoe Neale
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | | | - Xiang Zhao
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Mark W. Logue
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
- Department of Biostatistics, Boston University School of Public Health Boston, MA
- Biomedical Genetics, Boston University School of Medicine, Boston, MA
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders and Geriatric Research Educational and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Regina E. McGlinchey
- Translational Research Center for TBI and Stress Disorders and Geriatric Research Educational and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - William P. Milberg
- Translational Research Center for TBI and Stress Disorders and Geriatric Research Educational and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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Li J, Tong L, Schock BC, Ji LL. Post-traumatic Stress Disorder: Focus on Neuroinflammation. Mol Neurobiol 2023; 60:3963-3978. [PMID: 37004607 DOI: 10.1007/s12035-023-03320-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/09/2023] [Indexed: 04/04/2023]
Abstract
Post-traumatic stress disorder (PTSD), gaining increasing attention, is a multifaceted psychiatric disorder that occurs following a stressful or traumatic event or series of events. Recently, several studies showed a close relationship between PTSD and neuroinflammation. Neuroinflammation, a defense response of the nervous system, is associated with the activation of neuroimmune cells such as microglia and astrocytes and with changes in inflammatory markers. In this review, we first analyzed the relationship between neuroinflammation and PTSD: the effect of stress-derived activation of the hypothalamic-pituitary-adrenal (HPA) axis on the main immune cells in the brain and the effect of stimulated immune cells in the brain on the HPA axis. We then summarize the alteration of inflammatory markers in brain regions related to PTSD. Astrocytes are neural parenchymal cells that protect neurons by regulating the ionic microenvironment around neurons. Microglia are macrophages of the brain that coordinate the immunological response. Recent studies on these two cell types provided new insight into neuroinflammation in PTSD. These contribute to promoting comprehension of neuroinflammation, which plays a pivotal role in the pathogenesis of PTSD.
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Affiliation(s)
- Jimeng Li
- Department of 2nd Clinical College, China Medical University, Shenyang, Liaoning, China
| | - Lei Tong
- Department of Anatomy, College of Basic Sciences, China Medical University, Shenyang, Liaoning, China
| | - Bettina C Schock
- The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
| | - Li-Li Ji
- Department of Anatomy, College of Basic Sciences, China Medical University, Shenyang, Liaoning, China.
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Sosnowski DW, Rojo-Wissar DM, Smail EJ, Musci RJ, Wilcox HC, Johnson SB. Expanding on Threat and Deprivation: Empirical Examination of Adversity Dimensions and Psychiatric Outcomes Among Emerging Adults. EMERGING ADULTHOOD (PRINT) 2023; 11:431-443. [PMID: 36969950 PMCID: PMC10038124 DOI: 10.1177/21676968221114260] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Dimensional models of adversity, whereby experiences lie along dimensions of threat and deprivation, are increasingly popular; however, their empirical validation is limited. In a sample of emerging adults (N=1,662; M age =20.72; 53% female; 72% Black), we conducted exploratory factor analyses using adversities derived from items probing family relationships and a validated assessment of traumatic events. Resulting factors were used to test associations with odds of lifetime diagnosis of a substance use disorder, other mental health disorders, and suicide attempt. Results supported a four-factor solution: threat (non-betrayal), emotional deprivation, sexual assault, and threat (betrayal). Threat (betrayal) summary scores were most strongly associated with increased odds of substance use and other disorders, whereas sexual assault was most strongly associated increased odds of lifetime suicide attempt. Findings provide some empirical support for categorizing adversity along dimensions of threat and deprivation. However, it also suggests the possibility of further divisions within these dimensions.
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Affiliation(s)
- David W Sosnowski
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | | | - Emily J Smail
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Rashelle J Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Sara B Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
- Department of Pediatrics, School of Medicine, Johns Hopkins University
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Danböck SK, Franke LK, Miedl SF, Liedlgruber M, Bürkner PC, Wilhelm FH. Experimental induction of peritraumatic dissociation: The role of negative affect and pain and their psychophysiological and neural correlates. Behav Res Ther 2023; 164:104289. [PMID: 36934622 DOI: 10.1016/j.brat.2023.104289] [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: 04/13/2022] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023]
Abstract
While research has elucidated processes underlying dissociative symptoms in patients with posttraumatic stress disorder, little is known about the circumstances under which trauma-related dissociation initially arises. To experimentally investigate causes and concomitants of peritraumatic dissociation, we subjected sixty-nine healthy women to aversive-audiovisual and painful-electrical stimulation in a 2(aversive/neutral film) x 2(pain/no pain) within-subject design while recording psychophysiological and fMRI-BOLD responses. Afterwards, participants rated negative-affect, pain, and dissociation for each condition. Using Bayesian multilevel regression models, we examined (1) whether aversive-audiovisual and painful-electrical stimulation elicit higher dissociation-levels than control conditions and (2) whether stronger negative-affect and pain responses (operationalized via self-report, psychophysiological, and neural markers) correlate with higher dissociation-levels. Several key findings emerged: Both aversive-audiovisual and painful-electrical stimulation elicited dissociation. Dissociation was linked to higher self-reported negative-affect, but we did not find enough evidence linking it to psychophysiological and neural negative-affect markers. However, dissociation was associated with higher levels of self-reported pain, a skin-conductance-response-based pain marker, and the fMRI-BOLD-based Neurologic-Pain-Signature. Results indicate that both aversive-audiovisual and painful stimuli can independently cause dissociation. Critically, pain responses captured via self-report, psychophysiological, and neural markers were consistently linked to higher dissociation-levels suggesting a specific, evolutionary meaningful, contribution of pain to the rise of dissociation.
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Affiliation(s)
- Sarah K Danböck
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria.
| | - Laila K Franke
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
| | - Stephan F Miedl
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
| | - Michael Liedlgruber
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
| | - Paul-Christian Bürkner
- Cluster of Excellence SimTech, University of Stuttgart, Universitätsstraße 32, 70569, Stuttgart, Germany
| | - Frank H Wilhelm
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
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Burback L, Dhaliwal R, Reeson M, Erick T, Hartle K, Chow E, Vouronikos G, Antunes N, Marshall T, Kennedy M, Dennett L, Greenshaw A, Smith-MacDonald L, Winkler O. Trauma focused psychotherapy in patients with suicidal ideation: A scoping review. CURRENT RESEARCH IN BEHAVIORAL SCIENCES 2023. [DOI: 10.1016/j.crbeha.2023.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
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Killeen TK, Brewerton TD. Women with PTSD and Substance Use Disorders in a Research Treatment Study: A Comparison of those with and without the Dissociative Subtype of PTSD. J Trauma Dissociation 2023; 24:229-240. [PMID: 36266949 PMCID: PMC9905299 DOI: 10.1080/15299732.2022.2136327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 07/14/2022] [Accepted: 08/12/2022] [Indexed: 02/07/2023]
Abstract
Significant differences in clinical features have been reported in women with substance use disorders (SUDs) between those with the dissociative subtype of posttraumatic stress disorder (D-PTSD) compared to those without, namely more severe trauma histories, PTSD symptoms, and general psychopathology. This presentation reports on a group of 88 women with PTSD and SUD taking part in a research treatment study. All women were assessed using the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and were categorized into those with (n = 23, 26%) and without (n = 65, 74%) D-PTSD. Assessments for SUDs were via the Multi-International Neuropsychiatric Inventory, Seventh Version (MINI-7). Compared to those without D-PTSD, those with D-PTSD had significantly higher CAPS-5 scores (50.5 ± 9.9 v. 39.6 ± 8.8), greater number of PTSD symptoms (16.4 ± 2.6 v. 14.2 ± 2.4), more alcohol use disorder (AUD) (65.2% v. 30.8%), and more non-cocaine stimulant use disorder (34.8% v. 12.3%). No significant differences were found for other SUDs. These women with SUDs and D-PTSD have higher degrees of PTSD severity as well as unique clinical presentations. Future research is needed to explore the significance of these findings for clinical assessment and treatment.
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Affiliation(s)
- Therese K. Killeen
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - Timothy D. Brewerton
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
- Timothy D. Brewerton, MD, LLC, Mt. Pleasant, SC 29464
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Emotion Regulation Strategies as Risk Factors for Developmental Psychopathology: a Meta-analytic Review of Longitudinal Studies based on Cross-lagged Correlations and Panel Models. Res Child Adolesc Psychopathol 2023; 51:295-315. [PMID: 36208360 DOI: 10.1007/s10802-022-00980-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 02/09/2023]
Abstract
Cross-sectional relationships between emotion regulation strategies (ERSs) and several psychopathological conditions among children and adolescents have been well-demonstrated. However, the longitudinal associations of ERSs on psychopathological manifestations during development remain unclear, especially considering their reciprocal influences over time. This meta-analytic review was based on a set of ERSs referring to a comprehensive evidence-based model of ER processes. Three hundred thirty-five studies were screened. The meta-analytic procedures were based on 60 studies (N = 20, 191; age: M [SD] = 10.27 [4.36]; years of follow-up: M [SD] = 2.23 [2.76]), which primarily assessed prospective associations between ERt1 and internalizing/externalizing psychopathology (PSY)t2. The cross-lagged correlations among these variables were also considered. Results showed: i) a small prospective association between ERt1 and PSY t2, which was independent of age and length of follow-up period. Adaptive and maladaptive domains of ER were significant moderators. Deficits in adaptive ER seemed more associated to externalizing PSY, whereas maladaptive ER was more associated to internalizing PSY; ii) cross-lagged correlations were comparable with ERt1 - PSY t2 associations. Nevertheless, the detrimental effects of PSY t1 on levels of adaptive ERt2 were larger than the protective effects of adaptive ERt1 on PSYt2. iii) When the other cross-lagged correlations were controlled for, the meta-analytic cross-lagged panel model demonstrated that maladaptive ERt1 was a significant predictor of PSYt2. ER processes should be considered transdiagnostic risk factors for psychopathology during development. Homotypic and heterotypic continuity of psychopathological conditions might reflect the stability or dynamic organization of adaptive and maladaptive ERSs over time.
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43
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Iffland B, Eilers R, Rosner R, Renneberg B, Steil R, Neuner F. Differentiated processing of emotional cues in adolescents and young adults with ICD-11 PTSD and complex PTSD after child abuse. Brain Behav 2023; 13:e2904. [PMID: 36749180 PMCID: PMC10013947 DOI: 10.1002/brb3.2904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 01/09/2023] [Accepted: 01/15/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The recent update of the International Classification of Diseases 11th revision (ICD-11) introduced the diagnosis of complex posttraumatic stress disorder (CPTSD) as a distinct entity from posttraumatic stress disorder (PTSD). Because psychophysiological alterations are a core diagnostic feature of PTSD and CPTSD, the aim of the current study was to examine potential distinctive patterns in cortical and cardiac responses to emotional words in adolescent and young adult patients with PTSD and CPTSD. METHOD Event-related potentials and heart rate responses were studied in 81 adolescent and young adult participants, of which 17 individuals were diagnosed with ICD-11 PTSD and 32 individuals with CPTSD, each after childhood sexual and/or physical abuse. Thirty-two individuals served as healthy controls. The paradigm consisted of a passive reading task with neutral, positive, physically threatening, and socially threatening words. RESULTS Differentiated early processing of emotional words was indicated by differences on P1 and left EPN components. Additionally, PTSD and CPTSD patients presented with specific patterns of heart rate responses to emotional words. In CPTSD patients, heart rate reactions to emotional words were more variable than in PTSD patients. CONCLUSIONS These findings provide early evidence of differentiated cortical and cardiac response patterns in adolescent and young adult patients with CPTSD and PTSD, supporting a nosological distinction between PTSD and complex PTSD. However, due to small and unequal sample sizes, findings presented in the current study are preliminary and require future research.
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Affiliation(s)
- Benjamin Iffland
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Rebekka Eilers
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Berlin, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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44
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Lieberman JM, Rabellino D, Densmore M, Frewen PA, Steyrl D, Scharnowski F, Théberge J, Neufeld RWJ, Schmahl C, Jetly R, Narikuzhy S, Lanius RA, Nicholson AA. Posterior cingulate cortex targeted real-time fMRI neurofeedback recalibrates functional connectivity with the amygdala, posterior insula, and default-mode network in PTSD. Brain Behav 2023; 13:e2883. [PMID: 36791212 PMCID: PMC10013955 DOI: 10.1002/brb3.2883] [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: 09/06/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Alterations within large-scale brain networks-namely, the default mode (DMN) and salience networks (SN)-are present among individuals with posttraumatic stress disorder (PTSD). Previous real-time functional magnetic resonance imaging (fMRI) and electroencephalography neurofeedback studies suggest that regulating posterior cingulate cortex (PCC; the primary hub of the posterior DMN) activity may reduce PTSD symptoms and recalibrate altered network dynamics. However, PCC connectivity to the DMN and SN during PCC-targeted fMRI neurofeedback remains unexamined and may help to elucidate neurophysiological mechanisms through which these symptom improvements may occur. METHODS Using a trauma/emotion provocation paradigm, we investigated psychophysiological interactions over a single session of neurofeedback among PTSD (n = 14) and healthy control (n = 15) participants. We compared PCC functional connectivity between regulate (in which participants downregulated PCC activity) and view (in which participants did not exert regulatory control) conditions across the whole-brain as well as in a priori specified regions-of-interest. RESULTS During regulate as compared to view conditions, only the PTSD group showed significant PCC connectivity with anterior DMN (dmPFC, vmPFC) and SN (posterior insula) regions, whereas both groups displayed PCC connectivity with other posterior DMN areas (precuneus/cuneus). Additionally, as compared with controls, the PTSD group showed significantly greater PCC connectivity with the SN (amygdala) during regulate as compared to view conditions. Moreover, linear regression analyses revealed that during regulate as compared to view conditions, PCC connectivity to DMN and SN regions was positively correlated to psychiatric symptoms across all participants. CONCLUSION In summary, observations of PCC connectivity to the DMN and SN provide emerging evidence of neural mechanisms underlying PCC-targeted fMRI neurofeedback among individuals with PTSD. This supports the use of PCC-targeted neurofeedback as a means by which to recalibrate PTSD-associated alterations in neural connectivity within the DMN and SN, which together, may help to facilitate improved emotion regulation abilities in PTSD.
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Affiliation(s)
- Jonathan M Lieberman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Imaging, Lawson Health Research Institute, London, Ontario, Canada
| | - Daniela Rabellino
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Neuroscience, Western University, London, Ontario, Canada
| | - Maria Densmore
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
| | - Paul A Frewen
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada
| | - David Steyrl
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Frank Scharnowski
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Jean Théberge
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Diagnostic Imaging, St. Joseph's Healthcare, London, Ontario, Canada
| | - Richard W J Neufeld
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada.,Department of Psychology, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Heidelberg, Germany
| | - Rakesh Jetly
- The Institute of Mental Health Research, University of Ottawa, Royal Ottawa Hospital, Ontario, Canada
| | - Sandhya Narikuzhy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Ruth A Lanius
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Andrew A Nicholson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,The Institute of Mental Health Research, University of Ottawa, Royal Ottawa Hospital, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada.,Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
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45
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Dyball D, Bennett AN, Schofield S, Cullinan P, Boos CJ, Bull AMJ, Stevelink SA, Fear NT. The underlying mechanisms by which PTSD symptoms are associated with cardiovascular health in male UK military personnel: The ADVANCE cohort study. J Psychiatr Res 2023; 159:87-96. [PMID: 36696788 DOI: 10.1016/j.jpsychires.2023.01.010] [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: 10/30/2022] [Revised: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
Post-Traumatic Stress Disorder (PTSD) has been identified as an independent risk factor for cardiovascular disease, but the mechanisms of this relationship are not well understood. This study investigates the associations between PTSD symptom clusters (hyperarousal, intrusive thoughts, avoidance behaviours and emotional numbing) and mechanisms of cardiovascular disease including cardiometabolic effects, inflammation, and haemodynamic functioning. In the ADVANCE study cohort of UK male military personnel, 1111 participants were assessed for PTSD via questionnaire and cardiovascular risk via venous blood sampling, pulse wave analysis and dual energy x-ray absorptiometry between 2015 and 2020. Variable selection procedures were conducted to assess which of the symptom clusters if any were associated with cardiovascular risk outcomes. Associations were confirmed via robust regression modelling. Avoidance behaviours were associated with greater systolic Blood Pressure (BP) (Adjusted Coefficient (AC) 0.640 (95% Confidence Interval (CI) 0.065, 1.149). Emotional numbing was associated with greater estimated glucose disposal rate (AC -0.021 (95%CI -0.036, -0.005). Hyperarousal was associated with greater levels of (log)triglycerides (exponentiated-AC 1.009 (95%CI 1.002, 1.017). Intrusive thoughts were associated with greater visceral adipose tissue (AC 0.574 (95%CI 0.020, 1.250). Nonlinear relationships were observed between emotional numbing with heart rate and intrusive thoughts with systolic BP. Limited evidence is present for symptom associations with lipoproteins and pulse wave velocity. No associations were observed between PTSD symptom clusters and high sensitivity c-reactive protein, diastolic BP, total cholesterol, or haemoglobin fasting glucose. In conclusion, symptom clusters of PTSD were associated with increased cardiovascular risk via cardiometabolic and haemodynamic functioning mechanisms, but not inflammation.
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Affiliation(s)
- Daniel Dyball
- King's Centre for Military Health Research, King's College London, SE5 9RJ, UK.
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Near Loughborough, Nottinghamshire, LE12 5BL, UK
| | - Susie Schofield
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, SW3 6LR, UK
| | - Paul Cullinan
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, SW3 6LR, UK
| | - Christopher J Boos
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, BH1 3LT, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, SW7 2AZ, UK
| | - Sharon Am Stevelink
- King's Centre for Military Health Research, King's College London, SE5 9RJ, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8AF, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, SE5 9RJ, UK; Academic Department of Military Mental Health, King's College London, SE5 9RJ, UK
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46
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Crapanzano C, Damiani S, Casolaro I, Amendola C. Quetiapine Treatment for Post-traumatic Stress Disorder: A Systematic Review of the Literature. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:49-56. [PMID: 36700311 PMCID: PMC9889892 DOI: 10.9758/cpn.2023.21.1.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 01/27/2023]
Abstract
Paroxetine and Sertraline are the only medications approved in posttraumatic stress disorder (PTSD). However, about 60% of traumatized patients fail to show an adequate clinical response. Second generation antipsychotics are recommended as second-line monotherapy or third-line augmentation strategies and quetiapine appears as one of the most used and promising agents. Up to date, no reviews assessed the efficacy of quetiapine in the treatment of PTSD. We aimed to assess the effectiveness and general safety of quetiapine on PTSD. A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, selecting studies that evaluated the efficacy of quetiapine on global or specific PTSD symptomatology. Ten studies (n = 894) were considered eligible for qualitative synthesis: one case report, one case series, one prospective cohort study, 3 open-label trials, 3 retrospective studies, one randomized controlled trial. Quetiapine was effective on global PTSD symptomatology assessed in 6 studies as well as on re-experiencing (4/4 studies), avoidance (4/3 studies) and hyperarousal (4/4 studies), flashbacks (2/2 studies), depressive (4/4 studies), anxiety (1/1 studies), psychotic (3/3 studies), insomnia (4/5 studies), nightmares (3/3 studies) specific symptoms and PTSD domains. Sedation was among the most frequently observed adverse effects and the main cause of drug discontinuation. Preliminary findings support the efficacy of quetiapine in ameliorating symptoms relative to PTSD and its overall safety. However, quetiapine use in PTSD cannot be recommended yet as studies mainly rely on open-label, retrospective studies or case series.
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Affiliation(s)
- Calogero Crapanzano
- Azienda Sanitaria Provinciale di Agrigento, Centro Salute Mentale Licata, Licata, Italy,Address for correspondence: Calogero Crapanzano Azienda Sanitaria Provinciale di Agrigento, Centro Salute Mentale Licata, C/da Cannavecchia c/o Ospedale San Giacomo D’Altopasso, 92027 Licata, Italy, E-mail: , ORCID: https://orcid.org/0000-0001-6006-1268
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ilaria Casolaro
- Azienda Socio Sanitaria Territoriale Ovest Milanese, Milano, Italy
| | - Chiara Amendola
- Azienda Unità Sanitaria Locale Toscana Centro, Centro Salute Mentale Scandicci, Firenze, Italy
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47
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Zukerman G, Pinhas M, Icht M. Hypervigilance or shutdown? Electrophysiological processing of trauma-unrelated aversive stimuli after traumatic life events. Exp Brain Res 2023; 241:1185-1197. [PMID: 36847844 DOI: 10.1007/s00221-023-06578-w] [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: 08/30/2022] [Accepted: 02/17/2023] [Indexed: 03/01/2023]
Abstract
Post-Traumatic Stress Disorder (PTSD) research indicates that hyper-reactivity to trauma-related stimuli reflects reduced prefrontal cortex (PFC) modulation of amygdala reactivity. However, other studies indicate a dissociative "shutdown" reaction to overwhelming aversive stimuli, possibly reflecting PFC over-modulation. To explore this, we used an Event-Related Potential (ERP) oddball paradigm to study P3 responses in the presence of the following: 1. Trauma-unrelated morbid distractors (e.g., "injured bear") related to the Rorschach inkblot test, and 2. Negative distractors (e.g., "significant failure"), among participants with high post-traumatic stress symptoms (PTS; n = 20), low PTS (n = 17), and controls (n = 15). Distractors were presented at 20% frequency amongst the more frequent (60%) neutral standard stimuli (e.g., "desk lamp") and the equally frequent (20%) neutral trauma-unrelated target stimulus ("golden fish"). P3 amplitudes were high in the presence of morbid distractors and low in the presence of negative distractors only amongst the control group. Possible mechanisms underlying the lack of P3 amplitude modulation after trauma are discussed.
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Affiliation(s)
- Gil Zukerman
- Department of Communication Disorders, School of Health Sciences, Ariel University, 40700, Ariel, Israel.
| | - Michal Pinhas
- Department of Psychology, Ariel University, Ariel, Israel
| | - Michal Icht
- Department of Communication Disorders, School of Health Sciences, Ariel University, 40700, Ariel, Israel
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48
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Jo Y, Choi H. Factor Structure and Clinical Correlates of The Dissociative Symptoms Scale (DSS) Korean Version Among Community Sample With Adverse Childhood Experiences. J Trauma Dissociation 2023; 24:380-394. [PMID: 36809920 DOI: 10.1080/15299732.2023.2181474] [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] [Indexed: 02/24/2023]
Abstract
This study examined the factor structure and psychometric properties of the Dissociative Symptoms Scale (DSS) among the Korean community adult population with adverse childhood experiences (ACE). Data were drawn from community sample data sets collected from an online panel investigating the impact of ACE and ultimately consisted of data from a total of 1304 participants. A confirmatory factor analysis revealed a bi-factor model with a general factor and four sub-factors such as depersonalization/derealization, gaps in awareness and memory, sensory misperceptions, and cognitive behavioral reexperiencing, which are the four factors that correspond to the original DSS. The DSS showed good internal consistency as well as convergent validity with clinical correlates such as posttraumatic stress disorder, somatoform dissociation, and emotion dysregulation. The high-risk group with more ACE was associated with increased DSS. These findings support the multidimensionality of dissociation and the validity of Korean DSS scores in a general population sample.
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Affiliation(s)
- Yoonhyoung Jo
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
| | - Hyunjung Choi
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
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49
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Sauer KS, Wendler-Bödicker C, Boos A, Niemeyer H, Palmer S, Rojas R, Hoyer J, Hitzler M. Treatment of Comorbid Disorders, Syndromes, and Symptoms of Posttraumatic Stress Disorder Related to Childhood Maltreatment with STAIR-NT. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2023. [DOI: 10.1026/1616-3443/a000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Abstract. Background: Early interpersonal traumatic events, such as childhood maltreatment, increase the risk of developing complex posttraumatic stress symptoms. The biphasic treatment program STAIR-NT (Skills Training for Affective and Interpersonal Regulation with Narrative Therapy), developed specifically for this patient group, combines interventions to improve emotion regulation and interpersonal skills with narrative therapy. Objective: Many affected patients with PTSD after childhood maltreatment also suffer from various comorbid mental disorders and symptoms that can affect and impede the course and outcome of treatment with STAIR-NT. Method: Based on experience from a current treatment study, we provide recommendations for integrating treatment of comorbid mental symptoms into STAIR-NT. Results / Conclusion: Training affective and interpersonal regulation skills in the first treatment phase offers various interventions to efficiently adapt transdiagnostic mechanisms such as emotion dysregulation. In cases of severe comorbid mental disorders or symptoms, adding disorder-specific interventions to STAIR-NT may be indicated.
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Affiliation(s)
- Karoline Sophie Sauer
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Germany
| | | | - Anne Boos
- Psychotherapy Practice in Großhartau, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Sebastian Palmer
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Gießen, Germany
| | - Roberto Rojas
- University Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Melissa Hitzler
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Germany
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50
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Jafarian AA, Khatibi A, Mesbah Kiaei M, Alebouyeh MR, Alimian M, Habibi A, Amniati S. Comparison of Effects of Stress and Midazolam on Retrograde and Anterograde Amnesia in Patients Undergoing General Anesthesia. Anesth Pain Med 2023; 13:e134300. [PMID: 37404263 PMCID: PMC10317029 DOI: 10.5812/aapm-134300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 07/20/2023] Open
Abstract
Background The identification of different factors affecting anesthesia and physiological changes during anesthesia can be effective in improving the quality of anesthesia. Midazolam is a benzodiazepine that has been used for many years for sedation under anesthesia. Stress is also an important factor affecting memory and other physiological changes, such as blood pressure and heart rate. Objectives his study aimed to investigate the effects of stress on retrograde and anterograde amnesia among patients undergoing general anesthesia. Methods This multi-center, parallel, stratified, randomized controlled trial was performed on patients undergoing non-emergency abdominal laparotomy. The patients were divided into high- and low-stress groups according to the Amsterdam Preoperative Anxiety and Information Scale. Then, both groups were randomly divided into three subgroups receiving 0, 0.02, or 0.04 mg/kg of midazolam. Recall cards were shown to patients at 4 minutes, 2 minutes, and immediately before injection to determine retrograde amnesia and at 2 minutes, 4 minutes, and 6 minutes after injection to determine anterograde amnesia. Hemodynamic changes were recorded during intubation. The chi-square and multiple regression tests were used to analyze the data. Results Midazolam injection was associated with the development of anterograde amnesia in all groups (P < 0.05); however, it had no effect on the development of retrograde amnesia (P < 0.05). Midazolam could decrease the systolic and diastolic blood pressure and heart rate during intubation (P < 0.05). Stress also caused retrograde amnesia in patients (P < 0.05); nevertheless, it had no effect on anterograde amnesia (P > 0.05). Stress and midazolam injection could not affect the oxygen levels during intubation. Conclusions The results showed that midazolam injection could induce anterograde amnesia, hypotension, and heart rate; nonetheless, it had no effect on retrograde amnesia. Stress was associated with retrograde amnesia and increased heart rate; however, it was not associated with anterograde amnesia.
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Affiliation(s)
- Ali Akbar Jafarian
- Department of Anesthesiology and Pain Medicine, Motahari Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Khatibi
- Firouzgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Mesbah Kiaei
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood-Reza Alebouyeh
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahzad Alimian
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Habibi
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saied Amniati
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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