1
|
deMello RAF, Coimbra BM, Pedro BDM, Benvenutti IM, Yeh MSL, Mello AF, Mello MF, Poyares DR. Peri-Traumatic Dissociation and Tonic Immobility as Severity Predictors of Posttraumatic Stress Disorder After Rape. J Interpers Violence 2023; 38:4240-4266. [PMID: 35899768 DOI: 10.1177/08862605221114151] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Some individuals show abnormal reactions to extreme fear and life-threatening situations, including tonic immobility (TI) and peri-traumatic dissociation (PTD). We aimed to investigate the association of TI and PTD with posttraumatic stress disorder (PTSD) in women who experienced sexual violence and the risk factors for PTD occurrence. We compared PTSD severity in 86 young adult women with PTSD after a sexual violence exposure grouped according to the presence of PTD and TI. In addition, we investigated whether PTD is associated with depression and anxiety symptoms and assessed potential risk factors for PTD reaction. We found a significant positive correlation between PTSD severity and PTD occurrence (R2 = .132; p = .001). PTD was also positively correlated with all clusters of PTSD symptoms except the Clinician-Administered PTSD Scale avoidance cluster (p = .058). PTD was strongly correlated with anxiety (R2 = .619; p < .001) and depressive symptoms (R2 = .547; p < .001). Multiple logistic regression showed that history of physical abuse (odds ratio [OR]: 1.386; p = .011) and sexual abuse (OR: 1.947; p = .004) during childhood were associated with PTD occurrence. Other risk factors for PTD were having less years of study (OR: 0.216; p = .016) and lower income (OR: 7.403; p = .028). TI measures were available for a subsample of 29 women. We found no association between TI and PTSD severity. PTD, but not TI, is significantly associated with more severe PTSD, depressive, and anxiety symptoms. Less-educated women with a history of childhood abuse and a lower income are at risk of PTD occurrence during a sexual violence episode.
Collapse
Affiliation(s)
- Ricardo A F deMello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Bruno Messina Coimbra
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Bianca D M Pedro
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Isabella M Benvenutti
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mary S L Yeh
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea F Mello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcelo F Mello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Dalva R Poyares
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
2
|
D'Elia ATD, Juruena MF, Coimbra BM, Mello MF, Mello AF. Increased immuno-inflammatory mediators in women with post-traumatic stress disorder after sexual assault: 1-Year follow-up. J Psychiatr Res 2022; 155:241-251. [PMID: 36113394 DOI: 10.1016/j.jpsychires.2022.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/21/2022] [Accepted: 08/31/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Sexual violence is a traumatic event that can trigger post-traumatic stress disorder (PTSD) and generate biological responses to stress characterized by inhibiting the hypothalamic-pituitary axis (HPA), altering immune activity, and changing the structure and function of the brain. PTSD is associated with increased levels of inflammatory markers. This study aimed to measure differences in inflammatory markers and HPA hormone levels between women with PTSD due to sexual violence and controls at baseline and after 1-year follow-up. METHODS Fifty-eight women with PTSD resulting from sexual assault occurring up to 6 months prior were compared to 41 female controls. The patients were followed for 1 year. At baseline (T1), we measured inflammatory biomarkers. We also applied the Mini International Neuropsychiatric Interview (MINI), the Clinician-Administered Post-Traumatic Stress Disorder Scale-5, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Childhood Trauma Questionnaire. The patients were randomized to receive treatment with sertraline or interpersonal psychotherapy for 14 weeks (T2) and then continued the usual treatment if deemed necessary for 1 year. The same interviews and examinations were repeated after 1 year (T3). RESULTS At baseline, the patients had significantly higher adrenocorticotropic hormone levels, compared to controls; however, there was no baseline difference in inflammatory markers or cortisol. After 1 year, there were significantly higher levels of interleukin-1β (p < 0.0001), monocyte chemoattractant protein-1 (p < 0.0001), tumor necrosis factor-α (p < 0.0001), c-reactive protein (p < 0.0001), and cortisol (p = 0.046) in the patient group. In addition to PTSD, 56 patients presented with a major depressive episode at T1 (according to the MINI). At the end of 1 year, there was a significant improvement in depressive (p < 0.001), anxiety (p = 0.03), and PTSD symptoms (p < 0.001) regardless of the treatment received. DISCUSSION The increase of the inflammatory markers after 1 year, even with symptomatic improvement, may indicate that PTSD following sexual violence is associated with high depressive symptoms. This association may have a different pattern of immunoendocrine alterations than PTSD only. Furthermore, these alterations may persist in the long term, even with the improvement of the symptoms, probably generating an immunological imprint that can lead to future clinical consequences. This study adds to the current knowledge of PTSD neurobiology and contributes to broadening approaches to this disorder.
Collapse
Affiliation(s)
- Ana Teresa D D'Elia
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Mario F Juruena
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, Kings College London, London, United Kingdom
| | - Bruno M Coimbra
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands
| | - Marcelo F Mello
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Andrea F Mello
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
3
|
Mandlate F, Greene MC, Pereira LF, Sweetland AC, Kokonya D, Duarte CS, Cournos F, Oquendo MA, Wainberg ML, Sidat M, Sevene E, Mello MF. Lay HIV counselors' knowledge and attitudes toward depression: A mixed-methods cross-sectional study at primary healthcare centers in Mozambique. Front Public Health 2022; 10:919827. [PMID: 36249253 PMCID: PMC9554257 DOI: 10.3389/fpubh.2022.919827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/31/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Depression is the most common mental disorder among people living with HIV/AIDS and has a negative impact on HIV treatment outcomes. Training lay HIV counselors to identify and manage depression may contribute to improved patient access and adherence to treatment, and reduce stigma and discrimination among lay health workers toward both HIV and depression. The purpose of this study was to assess the current knowledge and attitudes of lay HIV counselors toward managing depression in primary care in Mozambique. Methods We conducted a mixed-methods cross-sectional study to assess depression-related knowledge and attitudes among lay HIV counselors in 13 primary healthcare facilities in Mozambique. We used the quantitative Depression Attitude Questionnaire (DAQ) scale, followed by open-ended questions to further explore three key DAQ domains: the nature of depression, treatment preferences, and professional attitudes or reactions. Results The sample included 107 participants (77.6% female, mean age: 32.3 years, sd = 7.4). Most (82.2%) had less than a high/technical school education. Findings suggested that some HIV counselors had knowledge of depression and described it as a cluster of psychological symptoms (e.g., deep sadness, anguish, apathy, isolation, and low self-esteem) sometimes leading to suicidal thoughts, or as a consequence of life stressors such as loss of a loved one, abuse, unemployment or physical illness, including being diagnosed with HIV infection. HIV counselors identified talking to trusted people about their problems, including family and/or counseling with a psychotherapist, as the best way for patients to deal with depression. While acknowledging challenges, counselors found working with patients with depression to be rewarding. Conclusion Lay health counselors identified HIV and psychosocial issues as key risk factors for depression. They believed that the treatment approach should focus on social support and psychotherapy.
Collapse
Affiliation(s)
- Flavio Mandlate
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - M. Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Luis F. Pereira
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Annika C. Sweetland
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Donald Kokonya
- School of Medicine, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Cristiane S. Duarte
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Francine Cournos
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Mohsin Sidat
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Esperança Sevene
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| |
Collapse
|
4
|
Hoffmann EV, Duarte CS, Matsuzaka CT, Milani ACC, Fossaluza V, Mello AF, Mello MF. The positive impact of maternal depression intervention on children's emotional and behavioral symptoms in a low-resource setting. Braz J Psychiatry 2022; 44. [PMID: 35816635 PMCID: PMC9851758 DOI: 10.47626/1516-4446-2022-2498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/02/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Children of depressed mothers are at risk of developing mental health problems. We sought to determine whether treatment for maternal depression delivered by community health workers (CHW) would decrease behavioral/emotional symptoms in their child. An intervention treating maternal depressive symptoms in a low-middle-income country can have a high global impact. METHODS CHW were trained to deliver a psychosocial intervention for mothers with depression in a primary care setting. 49 mothers and 60 children were assessed pre-intervention, post-intervention, and at a 6-months follow-up. Child behavioral/emotional symptoms were evaluated by type of change in maternal depressive symptoms: remission and response. RESULTS An overall decrease in maternal depressive symptoms from baseline to post-intervention and 6-month follow-up were found. Remission and response of maternal depression was associated with better outcomes related to child´s behavioral/emotional symptoms at the 6-month follow-up (p = 0.0247, Cohen's d: 0.76; p = 0.0224, Cohen's f: 0.44) but not at post-intervention (p = 0.1636, Cohen's d: 0.48; p = 0.0720, Cohen's f: 0.33). CONCLUSION Maternal depression improvement was related to their child's decreased behavioral/emotional symptoms. Our results suggest that interventions addressing maternal depression in primary care is a viable strategy to prevent behavioral/emotional symptoms in the next generation.
Collapse
Affiliation(s)
- Elis Viviane Hoffmann
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Cristiane S. Duarte
- Department of Child and Adolescent Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Camila T. Matsuzaka
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Victor Fossaluza
- Departamento de Matemática e Estatística, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Andrea F. Mello
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marcelo F. Mello
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, Faculdade de Medicina, São Paulo, SP, Brazil
| |
Collapse
|
5
|
Come AX, Polanco-Roman L, Dos Santos PF, Fumo W, Mutemba R, Pathare S, Wainberg ML, Oquendo MA, Duarte CS, Mello MF, Lovero KL. Social and Psychiatric Factors of Suicidal Thoughts and Behaviors in Mozambican Adolescents. J Am Acad Child Adolesc Psychiatry 2022; 61:841-844.e1. [PMID: 35452784 PMCID: PMC11013564 DOI: 10.1016/j.jaac.2022.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/02/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
Globally, suicide is the second leading cause of death for youth ages 10-24 years, and more than 75% of all deaths by suicide occur in low- and middle-income countries (LMIC).1 Suicidal thoughts (ST) and suicidal behaviors (SB), valuable signals for early detection and prevention of suicide deaths, have been associated with a number of different factors in adolescents, including gender and age, socioeconomic status, exposure to childhood adversity, and psychopathology.2 However, research has largely focused on Western, White populations from high-income countries (HIC).2 To lessen the suicide burden among adolescents in LMIC, there is an urgent need to identify contextually relevant risk identification and treatment targets. In Mozambique, the country with the highest suicide rate in southern Africa, this need is particularly dire, as there are fewer than 2 mental health specialists per 100,000 inhabitants,3 and limited resources must be efficiently targeted in youth suicide prevention efforts. We conducted a cross-sectional study at 2 secondary schools in the Mozambican capital Maputo City to identify the social and psychiatric factors associated with ST and SB in Mozambican adolescents.
Collapse
Affiliation(s)
| | | | | | - Wilza Fumo
- Mozambican Ministry of Health of Maputo, Mozambique
| | | | - Soumitra Pathare
- Centre for Mental Health Law and Policy of Indian Law Society, Pune, India
| | - Milton L Wainberg
- New York State Psychiatric Institute and the Columbia University Vagelos College of Physicians and Surgeons of New York, New York
| | - Maria A Oquendo
- University of Pennsylvania Perelman School of Medicine of Philadelphia, Pennsylvania
| | - Cristiane S Duarte
- New York State Psychiatric Institute and the Columbia University Vagelos College of Physicians and Surgeons of New York, New York
| | | | - Kathryn L Lovero
- Columbia University Mailman School of Public Health of New York, New York.
| |
Collapse
|
6
|
Karyotaki E, Araya R, Kessler RC, Waqas A, Bhana A, Rahman A, Matsuzaka CT, Miguel C, Lund C, Garman EC, Nakimuli-Mpungu E, Petersen I, Naslund JA, Schneider M, Sikander S, Jordans MJD, Abas M, Slade P, Walters S, Brugha TS, Furukawa TA, Amanvermez Y, Mello MF, Wainberg ML, Cuijpers P, Patel V. Association of Task-Shared Psychological Interventions With Depression Outcomes in Low- and Middle-Income Countries: A Systematic Review and Individual Patient Data Meta-analysis. JAMA Psychiatry 2022; 79:430-443. [PMID: 35319740 PMCID: PMC8943620 DOI: 10.1001/jamapsychiatry.2022.0301] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/02/2022] [Indexed: 01/14/2023]
Abstract
Importance Task sharing, the training of nonspecialist workers with no formal experience in counseling, is a promising strategy for addressing the large gap in treatment for depression in low- and middle-income countries (LMICs). Objective To examine the outcomes and moderators of task-shared psychological interventions associated with depression severity, response, and remission. Data Sources Systematic literature searches in PubMed, Embase, PsycINFO, and Cochrane Library up to January 1, 2021. Study Selection Randomized clinical trials (RCTs) of task-shared psychological interventions compared with control conditions for adults with depressive symptoms in LMICs were included. Data Extraction and Synthesis Two researchers independently reviewed the titles, abstracts, and full text of articles from an existing generic meta-analytic database that includes all RCTs on psychotherapy for depression. A systematic review and individual patient data (IPD) meta-analysis was used to estimate the outcomes of task-shared psychological interventions across patient characteristics using mixed-effects models. Procedures for abstracting data and assessing data quality and validity followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Main Outcomes and Measures Primary outcome was reduction in depression symptom severity measured by the 9-item Patient Health Questionnaire (PHQ-9). Response and remission rates were also estimated. Results Of 13 eligible trials, 11 (4145 participants) contributed IPD. Task-shared psychological interventions were associated with a greater decrease in depressive symptom severity than control conditions (Hedges g, 0.32; 95% CI, -0.26 to -0.38). Participants in the intervention groups had a higher chance of responding (odds ratio, 2.11; 95% CI, 1.60 to 2.80) and remitting (odds ratio, 1.87; 95% CI, 1.20 to 1.99). The presence of psychomotor symptoms was significantly associated with the outcomes of task-shared psychological interventions (β [SE], -1.21 [0.39]; P = .002). No other significant associations were identified. Heterogeneity among the trials with IPD was 74% (95% CI, 53%-86%). Conclusions and Relevance In this meta-analysis of IPD, task-shared psychological interventions were associated with a larger reduction in depressive symptom severity and a greater chance of response and remission than control conditions. These findings show potential for the use of task-sharing of psychological interventions across different groups of patients with depression. Further research would help identify which people are most likely to benefit and strengthen larger-scale implementation of this strategy to address the burden of depression in LMICs.
Collapse
Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Ricardo Araya
- Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ahmed Waqas
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Arvin Bhana
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Camila T. Matsuzaka
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Clara Miguel
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Crick Lund
- Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Emily C. Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan
- Health Services Academy, Islamabad, Pakistan
| | - Mark J. D. Jordans
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Pauline Slade
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stephen Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Traolach S. Brugha
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Toshi A. Furukawa
- Departments of Health Promotion and Human Behaviour and of Clinical Epidemiology, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yagmur Amanvermez
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Albert Einstein Israelite Hospital, Medicine School, São Paulo, Brazil
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York
| | - Pim Cuijpers
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| |
Collapse
|
7
|
Proença CR, Markowitz JC, Coimbra BM, Cogo-Moreira H, Maciel MR, Mello AF, Mello MF. Interpersonal psychotherapy versus sertraline for women with posttraumatic stress disorder following recent sexual assault: a randomized clinical trial. Eur J Psychotraumatol 2022; 13:2127474. [PMID: 36267873 PMCID: PMC9578463 DOI: 10.1080/20008066.2022.2127474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Sexual assault often triggers posttraumatic stress disorder (PTSD), a potentially chronic severe mental disorder. Most guidelines recommend selective serotonin reuptake inhibitors (SSRIs) and trauma-focused psychotherapies as treatment options. Interpersonal Psychotherapy (IPT), adapted for PTSD (IPT-PTSD), focuses on interpersonal consequences of trauma rather than confronting the trauma itself. Studies have found IPT-PTSD efficaciously reduced PTSD symptoms with limited attrition. No efficacy trials have compared IPT-PTSD and SSRI. We hypothesized IPT would reduce PTSD, anxiety, and depressive symptoms more than sertraline among women with PTSD following a recent sexual assault. Objectives: To compare the efficacy of IPT-PTSD to SSRI sertraline in a 14-week randomized clinical trial for women with PTSD following a recent sexual assault. Methods: Seventy-four women with PTSD who had suffered sexual assault in the last six months were randomly assigned to 14 weeks of IPT-PTSD (n = 39) or sertraline (n = 35). Instruments assessed PTSD, anxiety, and depressive symptoms. This randomized clinical trial was conducted in São Paulo, Brazil, using the Clinician-Administered PTSD Scale-5 (CAPS-5) as the primary outcome measure. Results: Both treatments significantly reduced PTSD, anxiety, and depressive symptoms, without between-group outcome differences. CAPS-5 mean decreased from 42.5 (SD = 9.4) to 27.1 (SD = 15.9) with sertraline and from 42.6 (SD = 9.1) to 29.1 (SD = 15.5) with IPT-PTSD. Attrition was high in both arms (p = .40). Conclusions: This trial showed within-group improvements without differences between IPT-PTSD and sertraline treatment of PTSD. Our findings suggest that non-exposure-based psychotherapies may benefit patients with PTSD, although we did not directly compare these treatments to an exposure therapy. Brazilian Clinical Trials Registry RBR-3z474z.
Collapse
Affiliation(s)
- Cecília R Proença
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - John C Markowitz
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Bruno M Coimbra
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Hugo Cogo-Moreira
- Department of Education, ICT and Learning, Østfold University College, Halden, Norway
| | - Mariana R Maciel
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea F Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcelo F Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
8
|
D'Elia ATD, Juruena MF, Coimbra BM, Mello MF, Mello AF. Posttraumatic stress disorder (PTSD) and depression severity in sexually assaulted women: hypothalamic-pituitary-adrenal (HPA) axis alterations. BMC Psychiatry 2021; 21:174. [PMID: 33789596 PMCID: PMC8010966 DOI: 10.1186/s12888-021-03170-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sexual assault is implicated in several adverse psychological and physical health outcomes, including posttraumatic stress disorder (PTSD) and depression. Neurobiological research has shown variations related to the hypothalamic-pituitary-adrenal (HPA) axis, immune alterations, metabolic function, and brain circuitry. Although these mechanisms have been extensively studied, the results have demonstrated different outcomes in PTSD. METHODS We compared the plasma adrenocorticotropin (ACTH) and salivary cortisol levels of fifty-eight women with PTSD developed after sexual assault to those of forty-four female controls with no history of trauma. We also evaluated the psychiatric diagnosis and symptom severity of PTSD and depression. The participants' clinical conditions were associated with their hormonal levels to assess whether symptom severity was related to hormonal imbalance. RESULTS A large percentage of sexually assaulted women had PTSD and comorbid depression. The ACTH levels were higher in the PTSD group than the control group and increased as PTSD severity increased, considering depressive symptoms, measured by the Beck Depression Inventory (BDI) (p < 0.0001), as well as PTSD symptoms, measured by subscale D of the Clinician-Administered PTSD Scale (CAPS-5) (p = 0.045) and the CAPS-5 total scale (p = 0.026). Cortisol levels measured at 10 pm were higher for the PTSD group than the control group (p = 0.045, p = 0.037, respectively), and the cortisol awakening response showed elevated cortisol levels for the PTSD group. CONCLUSIONS These results show a correlation between symptom severity and HPA axis imbalance in patients with PTSD. Elevated ACTH and an elevated cortisol response in patients with comorbid depressive symptoms were the opposite of the expected response for patients with PTSD only. This association leads to the hypothesis that the neurobiological alterations of PTSD are related to the type of symptoms presented and their severity. These manifestations likely influence the disease course, prognosis and response to treatment. These outcomes highlight the need to discuss particular neurobiological alterations in patients with PTSD developed after sexual assault, mainly those with severe depressive symptoms.
Collapse
Affiliation(s)
- Ana Teresa D D'Elia
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil.
| | - Mario F Juruena
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, Kings College London, London, UK
| | - Bruno M Coimbra
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil
| | - Andrea F Mello
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil
| |
Collapse
|
9
|
Wainberg ML, Gouveia ML, Stockton MA, Feliciano P, Suleman A, Mootz JJ, Mello M, Fiks Salem A, Greene MC, Bezuidenhout C, Ngwepe P, Lovero KL, Fortunato Dos Santos P, Schriger SH, Mandell DS, Mulumba R, Neves Anube A, Mabunda D, Mandlate F, Cournos F, Alves-Bradford JM, Nicholson T, Kann B, Fumo W, Duarte CS, de Jesus Mari J, Mello MF, Mocumbi AO, Oquendo MA, Weissman MM. Technology and implementation science to forge the future of evidence-based psychotherapies: the PRIDE scale-up study. Evid Based Ment Health 2021; 24:19-24. [PMID: 33177149 PMCID: PMC8025148 DOI: 10.1136/ebmental-2020-300199] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the interim results from the training of providers inevidence-based psychotherapies (EBPs) and use of mobile applications. DESIGN AND SETTING The Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence (PRIDE) study is a cluster-randomised hybrid effectiveness-implementation trial comparing three delivery pathways for integrating comprehensive mental healthcare into primary care in Mozambique. Innovations include the use of EBPs and scaling-up of task-shifted mental health services using mobile applications. MAIN OUTCOME MEASURES We examined EBP training attendance, certification, knowledge and intentions to deliver each component. We collected qualitative data through rapid ethnography and focus groups. We tracked the use of the mobile applications to investigate early reach of a valid screening tool (Electronic Mental Wellness Tool) and the roll out of the EBPs PARTICIPANTS: Psychiatric technicians and primary care providers trained in the EBPs. RESULTS PRIDE has trained 110 EBP providers, supervisors and trainers and will train 279 community health workers in upcoming months. The trainings improved knowledge about the EBPs and trainees indicated strong intentions to deliver the EBP core components. Trained providers began using the mobile applications and appear to identify cases and provide appropriate treatment. CONCLUSIONS The future of EBPs requires implementation within existing systems of care with fidelity to their core evidence-based components. To sustainably address the vast mental health treatment gap globally, EBP implementation demands: expanding the mental health workforce by training existing human resources; sequential use of EBPs to comprehensively treat mental disorders and their comorbid presentations and leveraging digital screening and treatment applications.
Collapse
Affiliation(s)
- Milton L Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Maria Lídia Gouveia
- Mental Health Department, Ministry of Health of Mozambique, Maputo, Mozambique
| | - Melissa Ann Stockton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Paulino Feliciano
- Mental Health Department, Ministry of Health of Mozambique, Nampula, Mozambique
| | - Antonio Suleman
- Mental Health Department, Ministry of Health of Mozambique, Nampula, Mozambique
| | - Jennifer J Mootz
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Milena Mello
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Andre Fiks Salem
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - M Claire Greene
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Charl Bezuidenhout
- Research Unit, Foundation for Professional Development, Pretoria, South Africa
| | - Phuti Ngwepe
- Research Unit, Foundation for Professional Development, Pretoria, South Africa
| | - Kathryn L Lovero
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | | | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Anibal Neves Anube
- Docente da Faculdade de Ciências de Saúde-UniLúrio, Hospital Psiquiátrico de Nampula, Nampula, Mozambique
| | | | - Flavio Mandlate
- Mental Health Department, Ministry of Health of Mozambique, Maputo, Mozambique
| | - Francine Cournos
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jean-Marie Alves-Bradford
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Terriann Nicholson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Bianca Kann
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Wilza Fumo
- Mental Health Department, Ministry of Health of Mozambique, Maputo, Mozambique
| | - Cristiane S Duarte
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Jair de Jesus Mari
- Department of Psychiatry and Medical Psychology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, São Paulo, Brazil
| | | | - Ana O Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Doenças Não Transmissíveis, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Myrna M Weissman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| |
Collapse
|
10
|
Martinez D, Yeh M, Oliveira L, Coimbra B, Mello AF, Poyares D, Tufik S, Mello MF. 1079 Is PTSD In Young Women Associated With Rem Sleep Abnormalities? Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The increase in violence against young women has a high impact on the prevalence of Posttraumatic stress disorder (PTSD). The lifetime prevalence of PTSD is twice as high in women. However, most studies assessing sleep disturbances in PTSD were conducted predominantly in male samples and combat veterans. Objective: To analyze the sleep of young women with and without PTSD. Hypothesis: Women with PTSD have worse sleep quality, higher arousability, and higher muscle activity during REM sleep.
Methods
Case-controlled study with young women. Seventy-four women who suffered sexual assault and developed PTSD (DSM-5); and 64 women from the community without PTSD. Women were recruited from the PTSD outpatient clinic (Universidade Federal de São Paulo, Brazil).Clinician-Administered Posttraumatic Stress Scale (CAPS 5), Beck Depression and Anxiety Inventories (BDI) (BAI), full in-lab Polysomnography (PSG), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Índex (PSQI), Fatigue Impact Scale (FIS), and Insomnia Severity Índex (ISI) were applied to all participants. Analysis of variance, regression models, and general linear modeling were used.
Results
Patients mean age was 28 vs 24 for the control group (p=0.004). CAPS mean score in PTSD-group was 42.5±9.1. BDI, BAI, FIS, PSQI, ISI scores were worse in PTSD-group (p<0.05, all). Pittsburgh Sleep Quality Index (PSQI) score was significantly associated with CAPS 5 independently of depression, fatigue, and sleep fragmentation.
The PTSD women had lower total sleep time (p= 0.01) and lower REM sleep percentage (p=0.04). However, the control group had higher arousal index (p=.0.01) and had higher muscle activity during REM sleep (p=0.03) than PTSD.
Conclusion
Women with PTSD had significantly worse score in PSQI, FIS, and ISI. PSQI score was associated with PTSD severity. However, when PSG results are concerned, we found higher sleep fragmentation in the control group. We speculate that women with PTSD may have felt safer and taken care of in the lab, which might explain the difference between objective and subjective measures of sleep quality in PTSD.
Support
Acknowledgments: FAPESP: Fundação de Apoio à pesquisa de São Paulo, AFIP: Associação Incentivo a Pesquisa
Collapse
Affiliation(s)
- D Martinez
- Psychobiology Department, Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - M Yeh
- Psychiatry Department, Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - L Oliveira
- Psychobiology Department, Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - B Coimbra
- Psychiatry Department, Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - A F Mello
- Psychiatry Department, Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - D Poyares
- Psychobiology Department, Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - S Tufik
- Psychobiology Department, Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| | - M F Mello
- Psychiatry Department, Universidade Federal de Sao Paulo, Sao Paulo, BRAZIL
| |
Collapse
|
11
|
Proença CR, Markowitz JC, Prado EA, Braga R, Coimbra BM, Mello TF, Maciel MR, Pupo M, Póvoa J, Mello AF, Mello MF. Attrition in Interpersonal Psychotherapy Among Women With Post-traumatic Stress Disorder Following Sexual Assault. Front Psychol 2019; 10:2120. [PMID: 31572281 PMCID: PMC6753915 DOI: 10.3389/fpsyg.2019.02120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/02/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND An estimated 16.9% of adult Brazilian women experience sexual assault in their lifetime. Almost half of women who suffer such trauma develop post-traumatic stress disorder (PTSD). Markowitz et al. (2015) found that an affect-focused non-exposure therapy, Interpersonal Psychotherapy (IPT), adapted to treat PTSD (IPT-PTSD) had similar efficacy to and lower dropout rates than Prolonged Exposure (PE), the "gold standard," most studied exposure therapy for PTSD. OBJECTIVE To assess attrition rates in IPT of sexually assaulted women recently diagnosed with PTSD. METHODS The current study derives from a two-arm, randomized controlled clinical trial of sexually assaulted women with PTSD who received 14 weeks of standardized treatment with either IPT-PTSD or sertraline. Sample: The 32 patients in the IPT treatment arm were analyzed. RESULTS Overall attrition was 29%. One patient was withdrawn because of suicidal risk; four dropped out pre-treatment, and five dropped out during IPT-PTSD. If the excluded patient is considered a dropout, the rate increases to 31%. DISCUSSION This is the first formal study of IPT for PTSD specifically due to sexual assault. IPT attrition approximated dropout rates in PE studies, which are often around 30%, and to the sertraline group in our study (34.5%). Further research should compare IPT and PE among sexually assaulted women to clarify our hypothesis that IPT could be an attractive alternative approach for this patient group.
Collapse
Affiliation(s)
- Cecília R. Proença
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - John C. Markowitz
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Euthymia A. Prado
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Rosaly Braga
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Bruno M. Coimbra
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Thays F. Mello
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Mariana R. Maciel
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Mariana Pupo
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Juliana Póvoa
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea F. Mello
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
12
|
Fillenbaum GG, Blay SL, Mello MF, Quintana MI, Mari JJ, Bressan RA, Andreoli SB. Use of mental health services by community-resident adults with DSM-IV anxiety and mood disorders in a violence-prone area: São Paulo, Brazil. J Affect Disord 2019; 250:145-152. [PMID: 30856491 PMCID: PMC7391382 DOI: 10.1016/j.jad.2019.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/01/2019] [Accepted: 03/03/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND While under-use of mental health services by adults with anxiety and/or depression is well established, use in a violence-prone area, and as a function of diagnosis and personality characteristics such resilience, is little known. We examine the sociodemographic and personality characteristics (specifically resilience), associated with use of mental health services in a violence-prone city by those with anxiety, depression, and their comorbidity. METHODS The structured Composite International Diagnostic Interview was used to identify 12-month DSM-IV- and ICD-10-defined anxiety and depression in a cross-sectional, representative, community-resident sample age 15-75y (N = 2536) in São Paulo, Brazil, and their use of mental health services. Resilience was determined by the Wagnild and Young scale. Analyses, using weighted, design-corrected statistical tests, included frequency measures and multivariable logistic regression. RESULTS Mental health services were used by 10% with only anxiety, 22% with only depression, and 34% with comorbidity, with odds of use in controlled analyses doubling from anxiety to depression to comorbidity. Use was significantly higher among those who were white, older (age >30 years, with substantial social support, low resilience, living in low homicide rate areas; use was not affected by experience of traumatic events. Psychiatrists, general practitioners, and psychologists were the primary providers. LIMITATIONS Cross-sectional design CONCLUSIONS: Contrary to expectation, use was greater among residents of lower homicide areas, and was not associated with personal traumatic experience. This may reflect increased immunity to violence in higher homicidal rate areas, lower resilience, and poorer access to services. Increased access to mental health services is needed.
Collapse
Affiliation(s)
- Gerda G. Fillenbaum
- Center for the Study of Aging and Human Development, Duke
University Medical Center, Durham, NC, USA.,Corresponding author: Gerda G.
Fillenbaum, PhD, Center for the Study of Aging and Human Development, Box 3003,
Duke University Medical Center, Durham, NC 27710, USA,
| | - Sergio L Blay
- Department of Psychiatry, Federal University of Sao Paulo,
Sao Paulo, Sao Paulo, Brazil (Escola Paulista de Medicina - UNIFESP)
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of Sao Paulo,
Sao Paulo, Sao Paulo, Brazil (Escola Paulista de Medicina - UNIFESP)
| | - Maria I. Quintana
- Department of Psychiatry, Federal University of Sao Paulo,
Sao Paulo, Sao Paulo, Brazil (Escola Paulista de Medicina - UNIFESP)
| | - Jair J. Mari
- Department of Psychiatry, Federal University of Sao Paulo,
Sao Paulo, Sao Paulo, Brazil (Escola Paulista de Medicina - UNIFESP)
| | - Rodrigo A. Bressan
- Department of Psychiatry, Federal University of Sao Paulo,
Sao Paulo, Sao Paulo, Brazil (Escola Paulista de Medicina - UNIFESP)
| | - Sergio B. Andreoli
- Department of Psychiatry, Federal University of Sao Paulo,
Sao Paulo, Sao Paulo, Brazil (Escola Paulista de Medicina - UNIFESP)
| |
Collapse
|
13
|
Oliveira-Watanabe TT, Ramos-Lima LF, Santos RC, Mello MF, Mello AF. The Clinician-Administered PTSD Scale (CAPS-5): adaptation to Brazilian Portuguese. ACTA ACUST UNITED AC 2019; 41:92-93. [PMID: 30758463 PMCID: PMC6781712 DOI: 10.1590/1516-4446-2018-0136] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/21/2018] [Indexed: 11/22/2022]
Affiliation(s)
| | - Luis F Ramos-Lima
- Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Roberta C Santos
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marcelo F Mello
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Andrea F Mello
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
14
|
Cividanes GC, Mello AF, Mello MF. Revictimization as a high-risk factor for development of posttraumatic stress disorder: a systematic review of the literature. ACTA ACUST UNITED AC 2018; 41:82-89. [PMID: 30328955 PMCID: PMC6781702 DOI: 10.1590/1516-4446-2017-0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 02/19/2018] [Indexed: 11/22/2022]
Abstract
Objective: Much research has been published on the role of sexual revictimization in the emergence of mental disorders in adulthood, but findings have sometimes been contradictory. The present systematic review sought to assess the state of the evidence on revictimization as a potential factor for the emergence of posttraumatic stress disorder (PTSD). Methods: Electronic searches were conducted in five databases (MEDLINE/PubMed, Cochrane Library, Campbell Library, PsycINFO, and LILACS), using the terms PTSD, posttraumatic stress disorder, child abuse, and rape. Results: We identified nine articles that established a connection among childhood sexual abuse (CSA), sexual revictimization in adulthood, and development of PTSD. Eight of the nine papers included were classified as having strong methodological quality (grade VI). One was classified as IV, with an average quality-of-evidence rating. The mean methodological quality score of the articles was 5.5, and the quality of evidence was deemed strong. Conclusion: In the included studies, PTSD symptoms were most prevalent in the CSA + adult sexual assault groups, providing further evidence for the revictimization hypothesis.
Collapse
Affiliation(s)
- Giuliana C Cividanes
- Serviço de Atendimento e Pesquisa em Violência e Estresse Pós-Traumático (PROVE), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Andrea F Mello
- Serviço de Atendimento e Pesquisa em Violência e Estresse Pós-Traumático (PROVE), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marcelo F Mello
- Serviço de Atendimento e Pesquisa em Violência e Estresse Pós-Traumático (PROVE), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
15
|
Oquendo MA, Duarte C, Gouveia L, Mari JJ, Mello MF, Audet CM, Pinsky I, Vermund SH, Mocumbi AO, Wainberg ML. Building capacity for global mental health research: challenges to balancing clinical and research training. Lancet Psychiatry 2018; 5:612-613. [PMID: 29628365 PMCID: PMC6402326 DOI: 10.1016/s2215-0366(18)30097-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/27/2018] [Accepted: 02/20/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Maria A Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Cristiane Duarte
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | | | - Jair J Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | | | - Ilana Pinsky
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Sten H Vermund
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Ana O Mocumbi
- Instituto Nacional de Saúde, Maputo, Mozambique; Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Milton L Wainberg
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, Columbia University, New York, NY, USA
| |
Collapse
|
16
|
Martins Scalabrin J, Mello MF, Swardfager W, Cogo-Moreira H. Risk of Bias in Randomized Clinical Trials on Psychological Therapies for Post-Traumatic Stress Disorder in Adults. Chronic Stress (Thousand Oaks) 2018; 2:2470547018779066. [PMID: 32440583 PMCID: PMC7219943 DOI: 10.1177/2470547018779066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/04/2018] [Indexed: 12/01/2022]
Abstract
Objective To evaluate the factorial validity and internal consistency of a measurement
model underlying risk of bias as endorsed by Cochrane for use in systematic
reviews; more specifically, how the risk of bias tool behaves in the context
of studies on psychological therapies used for treatment of post-traumatic
stress disorder in adults. Methods We applied confirmatory factor analysis to a systematic review containing 70
clinical trials entitled “Psychological Therapies for Chronic Post-Traumatic
Stress Disorder in Adults” under a Bayesian estimator. Seven observed
categorical risk of bias items (answered categorically as low, unclear, or
high risk of bias) were collected from the systematic review. Results A unidimensional model for the Cochrane risk of bias tool items returned poor
fit indices and low factor loadings, indicating questionable validity and
internal consistency. Conclusion Although the present evidence is restricted to psychological interventions
for post-traumatic stress disorder, it demonstrates that the way risk of
bias has been measured in this context may not be adequate. More broadly,
the results suggest the importance of testing the risk of bias tool, and the
possibility of rethinking the methods used to assess risk of bias in
systematic reviews and meta-analyses.
Collapse
Affiliation(s)
| | - Marcelo F Mello
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Hugo Cogo-Moreira
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
17
|
Matsuzaka CT, Wainberg ML, Norcini Pala A, Mello MF. Discriminant analysis of caregivers' psychiatric symptoms according to offspring psychopathology. Braz J Psychiatry 2018; 40:226-227. [PMID: 29846469 PMCID: PMC6900770 DOI: 10.1590/1516-4446-2017-2505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/07/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Camila T Matsuzaka
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Milton L Wainberg
- Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Andrea Norcini Pala
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Marcelo F Mello
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
18
|
Blay SL, Fillenbaum GG, Mello MF, Quintana MI, Mari JJ, Bressan RA, Andreoli SB. 12-month prevalence and concomitants of DSM-IV depression and anxiety disorders in two violence-prone cities in Brazil. J Affect Disord 2018; 232:204-211. [PMID: 29499502 PMCID: PMC6039111 DOI: 10.1016/j.jad.2018.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/29/2018] [Accepted: 02/15/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Estimating 12-month prevalence of depression, anxiety, and comorbid anxiety/depression in noninstitutionalized adults (age 15-75) in two violence-prone cities. METHODS The Composite International Diagnostic Interview v2.1 (Portuguese), administered in population-representative surveys (age 15-75) in São Paulo (N = 2536) and Rio de Janeiro (N = 1208), yielded 12-month prevalence of violent events experienced, and DSM-IV diagnoses of depression and anxiety, which were classified into mutually exclusive groups: 1) no anxiety/depression; 2) anxiety only; 3) depression only; 4) comorbid anxiety/depression. Weighted analyses estimated 12-month prevalence, multinomial logistic regression compared the demographic characteristics of the diagnosis groups, and association with experienced violence. RESULTS Twelve-month prevalence of anxiety alone, depression alone, and comorbid anxiety/depression was 12.7% (of whom 24.9% were also depressed), 4.9% (of whom 46.2% had anxiety), and 4.2% respectively for São Paulo; and 12.1% (18.2% of whom were depressed), 4.6% (37.0% with anxiety), and 2.7% respectively for Rio de Janeiro. All conditions were approximately twice as prevalent in women than in men in both cities. In São Paulo, comorbidity was associated with age under 60, depression alone was more prevalent among 30-59 year olds, but in 23-29 year-olds in Rio de Janeiro. Exposure to violence increased the odds of anxiety, depression, and their comorbidity. With rare exception, marital status, education, and race/ethnicity were not associated with anxiety, depression, or their comorbidity. LIMITATIONS Cross-sectional design. CONCLUSIONS Prevalence rates for all conditions were high, and particularly associated with exposure to violence. Means to ameliorate violence, and its mental health effects, particularly for women, are needed.
Collapse
Affiliation(s)
- Sergio L Blay
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil.
| | - Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Marcelo F Mello
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil
| | - Maria I Quintana
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil
| | - Jair J Mari
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil
| | - Sergio B Andreoli
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
19
|
D'Elia ATD, Matsuzaka CT, Neto JBB, Mello MF, Juruena MF, Mello AF. Childhood Sexual Abuse and Indicators of Immune Activity: A Systematic Review. Front Psychiatry 2018; 9:354. [PMID: 30127754 PMCID: PMC6088139 DOI: 10.3389/fpsyt.2018.00354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/16/2018] [Indexed: 02/05/2023] Open
Abstract
Background: Childhood sexual abuse (CSA) is a prevalent subtype of early life stress associated with changes in immunological and neuroendocrine systems leading to inflammatory responses of the organism and increasing several inflammatory and immune markers. We aimed to conduct a systematic review concerning the association between CSA and indicators of immune activity. Methods: We conducted a search for articles in PubMed, Scopus, PsycINFO, and Web of Science, using the key words: ("Child sexual abuse" OR "childhood maltreatment" OR "sexual violence" OR "posttraumatic stress disorder" OR "rape") AND ("cytokines" OR "inflammatory markers" OR "interleukin" OR "tumor necrosis factor" OR "C-reactive protein"). PRISMA guidelines were used in order to improve the quality of this research, and MeSH terms were used in PubMed. Results: A total of 3,583 studies were found and, after application of the exclusion criteria, 17 studies were included in this review. Most studies reported an increase of inflammatory activity associated with the presence of early abuse. IL-6, TNF- α, and C-reactive protein were the most frequently analyzed markers and some studies showed higher levels in individuals that suffered CSA compared with controls, although the results were heterogeneous, as was the assessment of CSA, repeated trauma, and time of occurrence. It was not possible to perform a meta-analysis because the results were diversified. Conclusion: CSA is associated with changes in inflammatory markers levels. Improving the assessment of subtypes of trauma is important to further understand the complex correlations of CSA and its biological consequences such as psychiatric and physical illness in later life.
Collapse
Affiliation(s)
- Ana T. D. D'Elia
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Department of Medicine, Federal University of São Carlos, São Carlos, Brazil
- *Correspondence: Ana T. D. D'Elia
| | - Camila T. Matsuzaka
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Jair B. B. Neto
- Department of Medicine, Federal University of São Carlos, São Carlos, Brazil
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Mario F. Juruena
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, Kings College London, London, United Kingdom
- Department of Neurosciences and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Andrea F. Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
20
|
Carvalho CM, Coimbra BM, Ota VK, Mello MF, Belangero SI. Single-nucleotide polymorphisms in genes related to the hypothalamic-pituitary-adrenal axis as risk factors for posttraumatic stress disorder. Am J Med Genet B Neuropsychiatr Genet 2017; 174:671-682. [PMID: 28686326 DOI: 10.1002/ajmg.b.32564] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/30/2017] [Indexed: 01/12/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a common psychiatric disorder. The etiology of PTSD is multifactorial, depending on many environmental and genetic risk factors, and the exposure to life or physical integrity-threatening events. Several studies have shown significant correlations of many neurobiological findings with PTSD. Hypothalamic-pituitary-adrenal (HPA) axis dysfunction is strongly correlated with this disorder. One hypothesis is that HPA axis dysfunction may precede the traumatic event, suggesting that genes expressed in the HPA axis may be involved in the development of PTSD. This article reviews molecular genetic studies related to PTSD collected through a literature search performed in PubMed, MEDLINE, ScienceDirect, and Scientific Electronic Library Online (SciELO). The results of these studies suggest that several polymorphisms in the HPA axis genes, including FKBP5, NR3C1, CRHR1, and CRHR2, may be risk factors for PTSD development or may be associated with the severity of PTSD symptoms.
Collapse
Affiliation(s)
- Carolina M Carvalho
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Department of Morphology and Genetics, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,LINC-Interdisciplinary Laboratory of Clinical Neurosciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Bruno M Coimbra
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Vanessa K Ota
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Department of Morphology and Genetics, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,LINC-Interdisciplinary Laboratory of Clinical Neurosciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sintia I Belangero
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Department of Morphology and Genetics, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,LINC-Interdisciplinary Laboratory of Clinical Neurosciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
21
|
Blay SL, Laks J, Marinho V, Figueira I, Maia D, Coutinho ESF, Quintana IM, Mello MF, Bressan RA, Mari JJ, Andreoli SB. Prevalence and Correlates of Elder Abuse in São Paulo and Rio de Janeiro. J Am Geriatr Soc 2017; 65:2634-2638. [PMID: 28898387 DOI: 10.1111/jgs.15106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the prevalence of elder abuse and to investigate potential sociodemographic, health behavior, and medical correlates. DESIGN Cross-sectional data were collected in face-to-face assessments. SETTING São Paulo and Rio de Janeiro, Brazil. PARTICIPANTS Individuals aged 60 to 75. MEASUREMENTS Information on elder abuse was obtained using the Brazil-adapted, nine-item Hwalek-Sengstock Elder Abuse Screening Test. Sampling design-adjusted descriptive statistics and logistic regression were used in analyses. RESULTS The overall prevalence of abuse was 14.4% (n = 46/259, 95% confidence interval (CI) = 9.82-20.61) in São Paulo and 13.3% (n = 27/197, 95% CI = 8.76-19.74) in Rio de Janeiro. Unadjusted analyses indicated that poor education, low physical activity, unemployment, heart disease, and psychiatric problems were associated with abuse, but in adjusted analyses, self-reported elder abuse was significantly associated only with psychiatric problems (São Paulo: OR = 4.48, 95% CI = 1.75-11.45; Rio de Janeiro: OR = 21.61, 95% CI = 6.39-73.14). CONCLUSION Elder abuse is prevalent in São Paulo and Rio de Janeiro, but whether concomitants of abuse are cause, effect, or both is unclear because this was a cross-sectional study. These findings highlight the importance of the problem, as well as the need to develop measures to increase awareness, facilitate prevention, and fight against abuse of elderly adults.
Collapse
Affiliation(s)
- Sergio L Blay
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Postgraduation Program in Translational Biomedicine, Universidade do Grande Rio, Caxias, Brazil
| | - Valeska Marinho
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Deborah Maia
- National School of Public Health, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Ines M Quintana
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Jair J Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Sergio B Andreoli
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
22
|
Matsuzaka CT, Wainberg ML, Norcini Pala A, Hoffmann EV, Coimbra BM, Braga RF, Duarte CS, Sweetland AC, Mello MF. Correlations between caregiver psychiatric symptoms and offspring psychopathology in a low-resource setting. Rev Bras Psiquiatr 2017; 40:56-62. [PMID: 28700013 PMCID: PMC5756531 DOI: 10.1590/1516-4446-2016-1990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 03/08/2017] [Indexed: 11/22/2022]
Abstract
Objective: Methods: Results: Conclusion:
Collapse
Affiliation(s)
| | - Milton L. Wainberg
- New York State Psychiatric Institute, USA; Columbia University College, USA
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Milani ACC, Hoffmann EV, Fossaluza V, Jackowski AP, Mello MF. Does pediatric post-traumatic stress disorder alter the brain? Systematic review and meta-analysis of structural and functional magnetic resonance imaging studies. Psychiatry Clin Neurosci 2017; 71:154-169. [PMID: 27778421 DOI: 10.1111/pcn.12473] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 09/01/2016] [Accepted: 10/20/2016] [Indexed: 12/20/2022]
Abstract
Several studies have recently demonstrated that the volumes of specific brain regions are reduced in children and adolescents with post-traumatic stress disorder (PTSD) compared with those of healthy controls. Our study investigated the potential association between early traumatic experiences and altered brain regions and functions. We conducted a systematic review of the scientific literature regarding functional magnetic resonance imaging and a meta-analysis of structural magnetic resonance imaging studies that investigated cerebral region volumes in pediatric patients with PTSD. We searched for articles from 2000 to 2014 in the PsycINFO, PubMed, Medline, Lilacs, and ISI (Web of Knowledge) databases. All data regarding the amygdala, hippocampus, corpus callosum, brain, and intracranial volumes that fit the inclusion criteria were extracted and combined in a meta-analysis that assessed differences between groups. The meta-analysis found reduced total corpus callosum areas and reduced total cerebral and intracranial volumes in the patients with PTSD. The total hippocampus (left and right hippocampus) and gray matter volumes of the amygdala and frontal lobe were also reduced, but these differences were not significant. The functional studies revealed differences in brain region activation in response to stimuli in the post-traumatic stress symptoms/PTSD group. Our results confirmed that the pediatric patients with PTSD exhibited structural and functional brain abnormalities and that some of the abnormalities occurred in different brain regions than those observed in adults.
Collapse
Affiliation(s)
| | - Elis V Hoffmann
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Victor Fossaluza
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Andrea P Jackowski
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
24
|
Hoffmann EV, Duarte CS, Fossaluza V, Milani ACC, Maciel MR, Mello MF, Mello AF. Mental health of children who work on the streets in Brazil after enrollment in a psychosocial program. Soc Psychiatry Psychiatr Epidemiol 2017; 52:55-63. [PMID: 27866219 DOI: 10.1007/s00127-016-1316-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 11/15/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the mental health status of children working on the streets in Sao Paulo City, Brazil, two years after their participation in a psychosocial program, and to identify factors associated with their mental health status. METHODS From a total sample of 126 children working on the streets, 107 (85%) were re-evaluated two years after the initiation of a psychosocial program which aimed to cease their work on the streets. The focus was the presence of mental health problems, defined based on a screening instrument (Strengths and Difficulties Questionnaire). Logistic regression models tested factors related to the probability that a child would not present mental health problems at follow-up. RESULTS The likelihood of a child presenting mental health problems was higher at baseline compared to the two-year follow-up (67.5 and 56.1%, respectively). Absence of mental health problems two years after a psychosocial intervention was significantly correlated with the following baseline factors: lower level of caregiver's psychiatric symptoms as measured by the SRQ (Self-Report Questionnaire) (AOR = 0.84, p = 0.0065), absence of child physical neglect (AOR = 0.38, p = 0.0705) and parental Protestant religion affiliation, compared to other religions (AOR = 4.06; p = 0.0107). CONCLUSIONS Different factors are related to the absence of mental health problems of children working on the streets after enrollment in a two-year psychosocial program. Our findings suggest that interventions that aim to improve child mental health should consider the detection of psychiatric symptoms in caregivers, provide treatment when it is needed, and also assess other problems such as neglect in the family setting.
Collapse
Affiliation(s)
- Elis Viviane Hoffmann
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil.
| | - Cristiane S Duarte
- Division of Child and Adolescent Psychiatry, Columbia University-NYSPI, New York, NY, USA
| | - Victor Fossaluza
- Department of Mathematics and Statistics, University of Sao Paulo (USP), Sao Paulo, SP, Brazil
| | - Ana Carolina C Milani
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil
| | - Mariana R Maciel
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil
| | - Marcelo F Mello
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil
| | - Andrea F Mello
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil
| |
Collapse
|
25
|
Luz MP, Coutinho ESF, Berger W, Mendlowicz MV, Vilete LMP, Mello MF, Quintana MI, Bressan RA, Andreoli SB, Mari JJ, Figueira I. Conditional risk for posttraumatic stress disorder in an epidemiological study of a Brazilian urban population. J Psychiatr Res 2016; 72:51-7. [PMID: 26540404 DOI: 10.1016/j.jpsychires.2015.10.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/17/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Conditional risk for PTSD is the risk of developing PTSD after exposure to traumatic events. This epidemiological study of the general urban population from the two largest cities in Brazil reports exposure to traumatic events; conditional risk for PTSD; and proportion/estimated number of PTSD cases secondary to each type of traumatic event. METHOD Cross-sectional study of general population (15-75 y.o.) from Rio de Janeiro and São Paulo. PTSD was assessed through Composite International Diagnostic Interview 2.1. RESULTS Our main findings, from 3744 participants, were: 1) high prevalence of traumatic events (86%), urban violence being the most common; 2) conditional risk for PTSD was 11.1%; 3) women (15.9%) have overall conditional risk 3 times higher than men (5.1%); 4) war-related trauma (67.8%), childhood sexual abuse (49.1%) and adult sexual violence (44.1%) had the highest conditional risks; 5) 35% of PTSD cases (estimated 435,970 individuals) were secondary to sudden/unexpected death of a close person, and 40% secondary to interpersonal violence. CONCLUSIONS Brazilian urban population is highly exposed to urban violence, and overall conditional risk for PTSD was 11.1%. Violence prevention and enhancement of resilience should be part of public policies, and mental health sequelae of trauma should be better recognized and treated.
Collapse
Affiliation(s)
- Mariana Pires Luz
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil.
| | - Evandro S F Coutinho
- National School of Public Health (ENSP/FIOCRUZ), Rua Leopoldo Bulhões 1480/823, Manguinhos, Rio de Janeiro, RJ 21041-210, Brazil
| | - William Berger
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil
| | - Mauro V Mendlowicz
- Fluminense Federal University (UFF), Rua Miguel de Frias 9, Icaraí, Niterói, RJ 24220-008, Brazil
| | - Liliane M P Vilete
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil
| | - Marcelo F Mello
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Maria Inês Quintana
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Sérgio B Andreoli
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Jair J Mari
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Ivan Figueira
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil
| |
Collapse
|
26
|
Mello AF, Maciel MR, Fossaluza V, Paula CSD, Grassi-Oliveira R, Cavalcante-Nóbrega LP, Cividanes GC, Soussumi Y, Soussumi SP, Perissinotti DNM, Bordin IA, Mello MF, Mari JJ. Exposure to maltreatment and urban violence in children working on the streets in São Paulo, Brazil: factors associated with street work. Braz J Psychiatry 2014; 36:191-8. [PMID: 24770654 DOI: 10.1590/1516-4446-2013-1185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 12/04/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To quantitatively study the exposure to childhood maltreatment and urban violence in children from families with at least one child working on the streets and to investigate the relationship between these factors and street work. METHODS Families who participated in a nongovernmental organization (NGO) program to eliminate child labor were included. Data concerning sociodemographic characteristics, punishment methods used in the family environment against the children, five types of abuse and neglect perpetrated by the caregivers, urban violence exposure and family functioning were collected. RESULTS The sample included 126 children who were working on the streets and 65 siblings who were not working on the streets. Caregivers reported high levels of severe physical punishment. The children reported high levels of abuse and neglect, and high levels of urban violence exposure. The families showed a predominance of dysfunctional and unsatisfactory relationships. A multiple logistic regression model showed that age older than 12 years and severe physical punishment at home were associated with street work. CONCLUSION Interventions to decrease the risk of child street work should be family-focused and should aim to reduce violence in the family environment.
Collapse
Affiliation(s)
- Andrea F Mello
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Mariana R Maciel
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Victor Fossaluza
- Mathematics and Statistics Institute, Universidade Estadual de São Paulo (UNESP), São Paulo, SP, Brazil
| | - Cristiane S de Paula
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Rodrigo Grassi-Oliveira
- Graduate Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | | | - Giuliana C Cividanes
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Yusaku Soussumi
- RUKHA Institute and Center for Studies and Research in Neuropsychoanalysis (CEINP), São Paulo, SP, Brazil
| | - Sonia P Soussumi
- RUKHA Institute and Center for Studies and Research in Neuropsychoanalysis (CEINP), São Paulo, SP, Brazil
| | - Dirce N M Perissinotti
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Isabel A Bordin
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Jair J Mari
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
27
|
Carvalho HWD, Andreoli SB, Lara DR, Patrick CJ, Quintana MI, Bressan RA, Mello MF, Mari JJ, Jorge MR. The joint structure of major depression, anxiety disorders, and trait negative affect. ACTA ACUST UNITED AC 2014; 36:285-92. [PMID: 25310205 DOI: 10.1590/1516-4446-2013-1329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/02/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Dimensional models of psychopathology demonstrate that two correlated factors of fear and distress account for the covariation among depressive and anxiety disorders. Nevertheless, these models tend to exclude variables relevant to psychopathology, such as temperament traits. This study examined the joint structure of DSM-IV-based major depression and anxiety disorders along with trait negative affect in a representative sample of adult individuals residing in the cities of São Paulo and Rio de Janeiro, Brazil. METHODS The sample consisted of 3,728 individuals who were administered sections D (phobic, anxiety and panic disorders) and E (depressive disorders) of the Composite International Diagnostic Interview (CIDI) 2.1 and a validated version of the Positive and Negative Affect Schedule. Data were analyzed using correlational and structural equation modeling. RESULTS Lifetime prevalence ranged from 2.4% for panic disorder to 23.2% for major depression. Most target variables were moderately correlated. A two-factor model specifying correlated fear and distress factors was retained and confirmed for models including only diagnostic variables and diagnostic variables along with trait negative affect. CONCLUSIONS This study provides support for characterization of internalizing psychopathology and trait negative affect in terms of correlated dimensions of distress and fear. These results have potential implications for psychiatric taxonomy and for understanding the relationship between temperament and psychopathology.
Collapse
Affiliation(s)
| | | | - Diogo R Lara
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | | | - Jair J Mari
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Miguel R Jorge
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
28
|
Barbosa Neto JB, Germain A, Mattos PF, Serafim PM, Santos RCM, Martini LC, Suchecki D, Mello MF. Psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A). ACTA ACUST UNITED AC 2014; 36:330-5. [PMID: 25310204 DOI: 10.1590/1516-4446-2013-1225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/28/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Sleep disturbances play a fundamental role in the pathophysiology posttraumatic stress disorder (PTSD), and are not only a secondary feature. The aim of this study was to validate and assess the psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A-BR), a self-report instrument designed to assess the frequency of seven disruptive nocturnal behaviors, in a sample of participants with and without PTSD. METHODS PSQI-A was translated into Brazilian Portuguese and applied to a convenience sample of 190 volunteers, with and without PTSD, who had sought treatment for the consequences of a traumatic event. RESULTS The PSQI-A-BR displayed satisfactory internal consistency (Cronbach's coefficient of 0.83 between all items) and convergent validity with the Clinician Administered PTSD Scale (CAPS), even when excluding sleep-related items (r = 0.52). Test-retest yielded high agreement in the global PSQI-A-BR, with good stability over time (r = 0.88). A global PSQI-A-BR cutoff score of 7 yielded a sensitivity of 79%, specificity of 64%, and a global score of 7 yielded a positive predictive value of 93% for discriminating participants with PTSD from those without PTSD. CONCLUSION The PSQI-A-BR is a valid instrument for PTSD assessment, applicable to both clinical and research settings.
Collapse
Affiliation(s)
- Jair B Barbosa Neto
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Patrícia F Mattos
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Paula M Serafim
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Roberta C M Santos
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Larissa C Martini
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Marcelo F Mello
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
29
|
Cividanes GC, Mello AF, Sallum JM, Fossaluza V, Medeiros MD, Maciel MR, Cavalcante-Nobrega LP, Mari JJ, Mello MF, Valentte NL. Lack of association between the 5-HTTLPR and positive screening for mental disorders among children exposed to urban violence and maltreatment. Rev Bras Psiquiatr 2014; 36:277-84. [DOI: 10.1590/1516-4446-2013-1150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 12/05/2013] [Indexed: 11/21/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Jair J. Mari
- Universidade Federal de São Paulo (UNIFESP), Brazil; King's College London, United Kingdom
| | | | | |
Collapse
|
30
|
Flaks MK, Malta SM, Almeida PP, Bueno OFA, Pupo MC, Andreoli SB, Mello MF, Lacerda ALT, Mari JJ, Bressan RA. Attentional and executive functions are differentially affected by post-traumatic stress disorder and trauma. J Psychiatr Res 2014; 48:32-9. [PMID: 24199652 DOI: 10.1016/j.jpsychires.2013.10.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/07/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Among the neurocognitive impairments observed in patients with Post-traumatic Stress Disorder (PTSD), attentional and executive dysfunctions appear to correlate with negative effects on education, work, daily life activities, and social relations, as well as the re-experiencing, avoidance, and hyperarousal symptoms of PTSD. However, there is no consensus regarding which aspects of attentional and executive functions are impaired in PTSD patients. METHODS Attentional and executive functions were assessed using the digit span (WAIS-III) and spatial span (WMS-III) tests under forward and backward recall conditions, the Stroop Test, and the Wisconsin Card Sorting Test (WCST). Our sample was composed of victims of urban violence who developed PTSD (PTSD+) (n = 81), victims of urban violence who did not develop PTSD (PTSD-) (n = 70), and healthy controls not exposed to trauma (HC) (n = 50). RESULTS The PTSD+ group had poorer performance on the spatial span forward subtest (p = 0.023; eta(2) = 0.038) and poorer execution time (p = 0.023; eta(2) = 0.042) and accuracy (p = 0.019; eta(2) = 0.044) on the Stroop Test compared to HC. CONCLUSIONS These data suggest that there are few differences between the PTSD+ and HC groups, which are restricted to less complex measures of attentional and executive functional processes (short term capacity, selective attention, processing speed, and inhibitory control) and are related to visual stimuli. Therefore, cognitive impairments directly correlated with the manifestation of PTSD.
Collapse
Affiliation(s)
- Mariana K Flaks
- LiNC - Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de São Paulo (UNIFESP), Brazil; PROVE - Programa de Atendimento e Pesquisa em Violência, Universidade Federal de São Paulo (UNIFESP), Brazil.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Schoedl AF, Costa MP, Fossaluza V, Mari JJ, Mello MF. Specific traumatic events during childhood as risk factors for posttraumatic stress disorder development in adults. J Health Psychol 2013; 19:847-57. [PMID: 23520354 DOI: 10.1177/1359105313481074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To evaluate differences in early life events (ELE) on adult victims of severe interpersonal violence among patients who developed posttraumatic stress disorder (PTSD) and control group. Adult victims of interpersonal violence were evaluated to diagnose the presence of PTSD and ELE. 308 subjects were included, 141 in patient's group (PTSD+) and 167 in control group (PSTD-). PTSD+ group had more severe PTSD, depressive symptoms and higher ETI scores than PTSD- group. Patients in PTSD+ group had a more frequent history of ELE. Some ELE were more significant for the development of this predisposition.
Collapse
|
32
|
Maciel MR, Mello AF, Fossaluza V, Nobrega LP, Cividanes GC, Mari JJ, Mello MF. Children working on the streets in Brazil: predictors of mental health problems. Eur Child Adolesc Psychiatry 2013; 22:165-75. [PMID: 23073672 DOI: 10.1007/s00787-012-0335-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 09/29/2012] [Indexed: 02/04/2023]
Abstract
The objective of this study was to determine which factors predict higher risk for mental health problems in children working on the streets. We studied a sample of families that had at least one child working on the streets, from October 2008 to March 2009. The instruments applied were the parent version strengths and difficulties questionnaire (SDQ), the childhood trauma questionnaire (CTQ) for children and caregivers, the WorldSAFE core questionnaire, the global assessment of relational functioning scale (GARF), the schedule for affective disorders and schizophrenia for school-age children (K-SADS), and a socio-demographic questionnaire. 191 children between 7 and 14 years of age were analyzed; 126 (66%) were working on the streets, and 65 were siblings who did not work on the streets. Multivariate analysis showed that mental health problems in the caregivers, violent behaviors of the caregivers toward the children, absence of a partner living in the house, and lower levels of family functioning increased the risk of mental health problems in the children. Caregivers reported severe forms of physical punishment against their children in 62% of cases. Caregivers who had suffered sexual abuse and emotional negligence in childhood were more violent with their children. Factors that increased risk for mental health symptoms in these children were caregivers' psychopathology, physical punishment at home, single-parent structure, and poor family functioning. Work on the streets did not influence the children's mental health, when multiple risk factors were considered; family characteristics were the most significant in this sample.
Collapse
Affiliation(s)
- Mariana R Maciel
- Department of Psychiatry, Universidade Federal de Sao Paulo, PROVE/UNIFESP Rua Botucatu #431, São Paulo, SP, 04023-061, Brazil.
| | | | | | | | | | | | | |
Collapse
|
33
|
Baldaçara L, Borgio JGF, Araújo C, Nery-Fernandes F, Lacerda ALT, Moraes WADS, Montaño MBMM, Rocha M, Quarantini LC, Schoedl A, Pupo M, Mello MF, Andreoli SB, Miranda-Scippa A, Ramos LR, Mari JJ, Bressan RA, Jackowski AP. Relationship between structural abnormalities in the cerebellum and dementia, posttraumatic stress disorder and bipolar disorder. Dement Neuropsychol 2012; 6:203-211. [PMID: 29213799 PMCID: PMC5619331 DOI: 10.1590/s1980-57642012dn06040003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
New evidence suggests that the cerebellum has structural and functional abnormalities in psychiatric disorders. Objective In this research, the goal was to measure the volume of the cerebellum and its subregions in individuals with psychiatric disorders and to relate these findings to their symptoms. Methods Patients with different degrees of cognitive impairment (Epidemiology of the Elderly - UNIFESP) and patients with post-traumatic stress disorder (PTSD) from population studies were analyzed. Also, patients with bipolar disorder from an outpatient clinic (Center for the Study of Mood and Anxiety Disorders, Universidade Federal da Bahia) were recruited for this study. All subjects underwent a 1.5T structural magnetic resonance scan. Volumetric measures and symptom measurements, by psychometric scales, were performed and compared between patients and controls. Results The cerebellum volume was reduced in patients with cognitive impairment without dementia and with dementia, in patients with PTSD, and in patients with bipolar disorder compared to controls. In dementia and PTSD, the left cerebellar hemisphere and vermis volume were reduced. In bipolar disorder, volumes of both hemispheres and the vermis were reduced. In the first two studies, these cerebellar volumetric reductions correlated with symptoms of the disease. Conclusion The exact nature of cerebellar involvement in mental processes is still not fully understood. However, abnormalities in cerebellar structure and its functions have been reported in some of these diseases. Future studies with larger samples are needed to clarify these findings and investigate whether they are important for treatment and prognosis.
Collapse
Affiliation(s)
- Leonardo Baldaçara
- Federal University of São Paulo, SP, Brazil.,Federal University of Tocantins, TO, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Hoexter MQ, Fadel G, Felício AC, Calzavara MB, Batista IR, Reis MA, Shih MC, Pitman RK, Andreoli SB, Mello MF, Mari JJ, Bressan RA. Higher striatal dopamine transporter density in PTSD: an in vivo SPECT study with [(99m)Tc]TRODAT-1. Psychopharmacology (Berl) 2012; 224:337-45. [PMID: 22700036 DOI: 10.1007/s00213-012-2755-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/24/2012] [Indexed: 12/23/2022]
Abstract
RATIONALE Some evidence suggests a hyperdopaminergic state in posttraumatic stress disorder (PTSD). The 9-repetition allele (9R) located in the 3' untranslated region of the dopamine transporter (DAT) gene (SLC6A3) is more frequent among PTSD patients. In vivo molecular imaging studies have shown that healthy 9R carriers have increased striatal DAT binding. However, no prior study evaluated in vivo striatal DAT density in PTSD. OBJECTIVES The objective of this study was to evaluate in vivo striatal DAT density in PTSD. METHODS Twenty-one PTSD subjects and 21 control subjects, who were traumatized but asymptomatic, closely matched comparison subjects evaluated with the Clinician-Administered PTSD Scale underwent a single-photon emission computed tomography scan with [(99m)TC]-TRODAT-1. DAT binding potential (DAT-BP) was calculated using the striatum as the region of the interest and the occipital cortex as a reference region. RESULTS PTSD patients had greater bilateral striatal DAT-BP (mean ± SD; left, 1.80 ± 0.42; right, 1.78 ± 0.40) than traumatized control subjects (left, 1.62 ± 0.32; right, 1.61 ± 0.31; p = 0.039 for the left striatum and p = 0.032 for the right striatum). CONCLUSIONS These results provide the first in vivo evidence for increased DAT density in PTSD. Increases in DAT density may reflect higher dopamine turnover in PTSD, which could contribute to the perpetuation and potentiation of exaggerated fear responses to a given event associated with the traumatic experience. Situations that resemble the traumatic event turn to be interpreted as highly salient (driving attention, arousal, and motivation) in detriment of other daily situations.
Collapse
Affiliation(s)
- Marcelo Q Hoexter
- Instituto do Cérebro, Instituto de Ensino e Pesquisa do Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Miranda AM, Soares CN, Moraes ML, Fossaluza V, Serafim PM, Mello MF. Healthy maternal bonding as a resilience factor for depressive disorder. ACTA ACUST UNITED AC 2012. [DOI: 10.3922/j.psns.2012.1.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
36
|
Baldaçara L, Jackowski AP, Schoedl A, Pupo M, Andreoli SB, Mello MF, Lacerda ALT, Mari JJ, Bressan RA. Reduced cerebellar left hemisphere and vermal volume in adults with PTSD from a community sample. J Psychiatr Res 2011; 45:1627-33. [PMID: 21824628 DOI: 10.1016/j.jpsychires.2011.07.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/14/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Traumatic events exposure is a necessary condition for developing posttraumatic stress disorder (PTSD), but not all individuals exposed to the same trauma will develop PTSD. Human studies have suggested that the cerebellum is involved in human fear perception, anticipation, and recollection. In this context, the current study evaluated whether cerebellar volume is associated with PTSD. METHODS Eighty-four victims of violence, 42 who fulfilled the DSM-IV-TR criteria for PTSD and 42 resilient controls, were identified through an epidemiologic survey conducted in the city of São Paulo. Subjects were evaluated using the Clinician-Administered PTSD Scale (CAPS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Early Trauma Inventory (ETI). All subjects underwent a magnetic resonance imaging (MRI) scan to evaluate their cerebellar hemispheres and vermis. RESULTS PTSD subjects had relative smaller left hemisphere (p = 0.04) and vermis (p < 0.01) volumes persisted after controlling for gender, age, and brain volume. In PTSD group, left cerebellar hemisphere volume correlated negatively with PTSD (p = 0.01) and depressive symptoms (p = 0.04). Vermal volume correlated negatively with PTSD symptoms (p < 0.01), early traumatic life events (p < 0.01), depressive symptoms (p = 0.04) and anxiety (p = 0.01). CONCLUSION The cerebellum is involved in emotion modulation, and our results suggest that cerebellar volumetric reduction is associated with mood, anxiety and PTSD symptoms. Early traumatic life experiences are related to vermal volume reduction and may be a risk factor for future PTSD development.
Collapse
Affiliation(s)
- Leonardo Baldaçara
- Psychiatry, Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo (UNIFESP), Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Mello MF, Serafim PM, Moraes ML, Miranda AM, Soussumi Y, Mello AF. The Impact of Early Maternal Presence on Child Development and the Stress Response System. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/15294145.2011.10773673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
38
|
Mello MF, Faria AA, Mello AF, Carpenter LL, Tyrka AR, Price LH. [Childhood maltreatment and adult psychopathology: pathways to hypothalamic-pituitary-adrenal axis dysfunction]. Braz J Psychiatry 2010; 31 Suppl 2:S41-8. [PMID: 19967199 DOI: 10.1590/s1516-44462009000600002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this paper was to examine the relationship between childhood maltreatment and adult psychopathology, as reflected in hypothalamic-pituitary-adrenal axis dysfunction. METHOD A selective review of the relevant literature was undertaken in order to identify key and illustrative research findings. RESULTS There is now a substantial body of preclinical and clinical evidence derived from a variety of experimental paradigms showing how early-life stress is related to hypothalamic-pituitary-adrenal axis function and psychological state in adulthood, and how that relationship can be modulated by other factors. DISCUSSION The risk for adult psychopathology and hypothalamic-pituitary-adrenal axis dysfunction is related to a complex interaction among multiple experiential factors, as well as to susceptibility genes that interact with those factors. Although acute hypothalamic-pituitary-adrenal axis responses to stress are generally adaptive, excessive responses can lead to deleterious effects. Early-life stress alters hypothalamic-pituitary-adrenal axis function and behavior, but the pattern of hypothalamic-pituitary-adrenal dysfunction and psychological outcome in adulthood reflect both the characteristics of the stressor and other modifying factors. CONCLUSION Research to date has identified multiple determinants of the hypothalamic-pituitary-adrenal axis dysfunction seen in adults with a history of childhood maltreatment or other early-life stress. Further work is needed to establish whether hypothalamic-pituitary-adrenal axis abnormalities in this context can be used to develop risk endophenotypes for psychiatric and physical illnesses.
Collapse
Affiliation(s)
- Marcelo F Mello
- Instituto PROVE, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | | | | | | | | |
Collapse
|
39
|
Leite PH, Melo RC, Mello MF, Silva ED, Borghi-Silva A, Catai AM. Heart rate responses during isometric exercises in patients undergoing a phase III cardiac rehabilitation program. Rev Bras Fisioter 2010; 14:383-389. [PMID: 21180863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 12/21/2009] [Indexed: 05/30/2023]
Abstract
BACKGROUND the magnitude of cardiovascular responses is dependent on the static and dynamic components as well as the duration and intensity of the contraction performed. OBJECTIVE to evaluate the heart rate responses to different percentages of isometric contractions in 12 patients (63 ± 11.6 years) with coronary artery disease and/or risk factors for coronary artery disease that were participating in a phase III cardiac rehabilitation program. METHODS heart rate variation (ΔHR) was evaluated during maximum (MVC, five and ten seconds in duration) and submaximal (SMVC, 30 and 60% of MVC-5, until muscle exhaustion) voluntary contraction, using a handgrip dynamometer. Additionally, the representative index of cardiac vagal modulation (RMSSD index) was calculated at rest (pre-contraction), at the final 30 seconds of SMVC and during recovery (post-contraction). RESULTS ΔHR showed higher values in MVC-10 versus MVC-5 (17 ± 5.5 vs 12 ± 4.2 bpm, p<0.05) and the SMVC-60 vs SMVC-30 (19 ± 5.8 vs 15 ± 5.1 bpm, p<0.05). However, results for CVM-10 showed similar ΔHR compared to results for CVSM (p> 0.05). RICVM at rest decreased (p<0.05) during SMVC-30 (30% = 27.9 ± 17.1 vs 12.9 ± 8.5 ms) and SMVC-60 (60% =25.8 ± 18.2 vs 9.96 ± 4.2 ms), but returned to the baseline values when the contraction was interrupted. CONCLUSIONS in patients with coronary artery disease and/or risk factors for coronary heart disease, low intensity isometric contraction, maintained over long periods of time, presents the same effect on the responses of HR, compared to a high intensity or maximal isometric contraction of briefly duration.
Collapse
Affiliation(s)
- Poliana H Leite
- Physical Therapy Departament, Laboratory of Cardiovascular Physical Therapy, Nuclear Research in Physical Exercise, São Carlos, São Carlos, SP, Brasil
| | | | | | | | | | | |
Collapse
|
40
|
Campanini RFB, Schoedl AF, Pupo MC, Costa ACH, Krupnick JL, Mello MF. Efficacy of interpersonal therapy-group format adapted to post-traumatic stress disorder: an open-label add-on trial. Depress Anxiety 2010; 27:72-7. [PMID: 20013958 DOI: 10.1002/da.20610] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a highly prevalent condition, yet available treatments demonstrate only modest efficacy. Exposure therapies, considered by many to be the "gold-standard" therapy for PTSD, are poorly tolerated by many patients and show high attrition. We evaluated interpersonal therapy, in a group format, adapted to PTSD (IPT-G PTSD), as an adjunctive treatment for patients who failed to respond to conventional psychopharmacological treatment. METHODS Research participants included 40 patients who sought treatment through a program on violence in the department of psychiatry of Federal University of São Paulo (UNIFESP). They had received conventional psychopharmacological treatment for at least 12 weeks and failed to have an adequate clinical response. After signing an informed consent, approved earlier by the UNIFESP Ethics Review Board, they received a semi-structured diagnostic interview (SCID-I), administered by a trained mental health worker, to confirm the presence of a PTSD diagnosis according to DSM-IV criteria. Other instruments were administered, and patients completed out self-report instruments at baseline, and endpoint to evaluate clinical outcomes. RESULTS Thirty-three patients completed the trial, but all had at least one second outcome evaluation. There were significant improvements on all measures, with large effect sizes. CONCLUSIONS IPT-G PTSD was effective not only in decreasing symptoms of PTSD, but also in decreasing symptoms of anxiety and depression. It led to significant improvements in social adjustment and quality of life. It was well tolerated and there were few dropouts. Our results are very preliminary; they need further confirmation through randomized controlled clinical trials.
Collapse
Affiliation(s)
- Rosaly F B Campanini
- Program for Victims of Violence of the Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
41
|
Andreoli SB, Ribeiro WS, Quintana MI, Guindalini C, Breen G, Blay SL, Coutinho ESF, Harpham T, Jorge MR, Lara DR, Moriyama TS, Quarantini LC, Gadelha A, Vilete LMP, Yeh MSL, Prince M, Figueira I, Bressan RA, Mello MF, Dewey ME, Ferri CP, Mari JDJ. Violence and post-traumatic stress disorder in Sao Paulo and Rio de Janeiro, Brazil: the protocol for an epidemiological and genetic survey. BMC Psychiatry 2009; 9:34. [PMID: 19500422 PMCID: PMC2700799 DOI: 10.1186/1471-244x-9-34] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 06/07/2009] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND violence is a public health major concern, and it is associated with post-traumatic stress disorder and other psychiatric outcomes. Brazil is one of the most violent countries in the world, and has an extreme social inequality. Research on the association between violence and mental health may support public health policy and thus reduce the burden of disease attributable to violence. The main objectives of this project were: to study the association between violence and mental disorders in the Brazilian population; to estimate the prevalence rates of exposure to violence, post-traumatic stress disorder, common metal disorder, and alcohol hazardous use and dependence: and to identify contextual and individual factors, including genetic factors, associated with the outcomes. METHODS/DESIGN one phase cross-sectional survey carried out in Sao Paulo and Rio de Janeiro, Brazil. A multistage probability to size sampling scheme was performed in order to select the participants (3000 and 1500 respectively). The cities were stratified according to homicide rates, and in Sao Paulo the three most violent strata were oversampled. The measurements included exposure to traumatic events, psychiatric diagnoses (CIDI 2.1), contextual (homicide rates and social indicators), and individual factors, such as demographics, social capital, resilience, help seeking behaviours. The interviews were carried between June/2007 February/2008, by a team of lay interviewers. The statistical analyses will be weight-adjusted in order to take account of the design effects. Standardization will be used in order to compare the results between the two centres. Whole genome association analysis will be performed on the 1 million SNP (single nucleotide polymorphism) arrays, and additional association analysis will be performed on additional phenotypes. The Ethical Committee of the Federal University of Sao Paulo approved the study, and participants who matched diagnostic criteria have been offered a referral to outpatient clinics at the Federal University of Sao Paulo and Federal University of Rio de Janeiro.
Collapse
Affiliation(s)
| | | | - Maria Ines Quintana
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Camila Guindalini
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gerome Breen
- MRC Social, Institute of Psychiatry, King's College, London, UK
| | - Sergio Luis Blay
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Trudy Harpham
- London South Bank University, London, UK,London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Tais S Moriyama
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucas C Quarantini
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ary Gadelha
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Mary SL Yeh
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Martin Prince
- Centre for Public Mental Health, Health Services and Population Research Department, Institute of Psychiatry, King's College, University of London, London, UK
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB – UFRJ), Rio de Janeiro, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Michael E Dewey
- Centre for Public Mental Health, Health Services and Population Research Department, Institute of Psychiatry, King's College, University of London, London, UK
| | - Cleusa P Ferri
- Centre for Public Mental Health, Health Services and Population Research Department, Institute of Psychiatry, King's College, University of London, London, UK
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil,Centre for Public Mental Health, Health Services and Population Research Department, Institute of Psychiatry, King's College, University of London, London, UK
| |
Collapse
|
42
|
Bressan RA, Quarantini LC, Andreoli SB, Araújo C, Breen G, Guindalini C, Hoexter M, Jackowski AP, Jorge MR, Lacerda ALT, Lara DR, Malta S, Moriyama TS, Quintana MI, Ribeiro WS, Ruiz J, Schoedl AF, Shih MC, Figueira I, Koenen KC, Mello MF, Mari JJ. The posttraumatic stress disorder project in Brazil: neuropsychological, structural and molecular neuroimaging studies in victims of urban violence. BMC Psychiatry 2009; 9:30. [PMID: 19480721 PMCID: PMC2702374 DOI: 10.1186/1471-244x-9-30] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Accepted: 06/01/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Life trauma is highly prevalent in the general population and posttraumatic stress disorder is among the most prevalent psychiatric consequences of trauma exposure. Brazil has a unique environment to conduct translational research about psychological trauma and posttraumatic stress disorder, since urban violence became a Brazilian phenomenon, being particularly related to the rapid population growth of its cities. This research involves three case-control studies: a neuropsychological, a structural neuroimaging and a molecular neuroimaging study, each focusing on different objectives but providing complementary information. First, it aims to examine cognitive functioning of PTSD subjects and its relationships with symptomatology. The second objective is to evaluate neurostructural integrity of orbitofrontal cortex and hippocampus in PTSD subjects. The third aim is to evaluate if patients with PTSD have decreased dopamine transporter density in the basal ganglia as compared to resilient controls subjects. This paper shows the research rationale and design for these three case-control studies. METHODS AND DESIGN Cases and controls will be identified through an epidemiologic survey conducted in the city of São Paulo. Subjects exposed to traumatic life experiences resulting in posttraumatic stress disorder (cases) will be compared to resilient victims of traumatic life experiences without PTSD (controls) aiming to identify biological variables that might protect or predispose to PTSD. In the neuropsychological case-control study, 100 patients with PTSD, will be compared with 100 victims of trauma without posttraumatic stress disorder, age- and sex-matched controls. Similarly, 50 cases and 50 controls will be enrolled for the structural study and 25 cases and 25 controls in the functional neuroimaging study. All individuals from the three studies will complete psychometrics and a structured clinical interview (the Structured Clinical Interview for DSM-IV and the Clinician-Administered PTSD Scale, Beck Anxiety Inventory, Beck Depression Inventory, Global Assessment of Function, The Social Adjustment Scale, Medical Outcomes Study 36-Item Short-Form Health Survey, Early Trauma Inventory, Clinical global Impressions, and Peritraumatic Dissociative Experiences Questionnaire). A broad neuropsychological battery will be administered for all participants of the neuropsychological study. Magnetic resonance scans will be performed to acquire structural neuroimaging data. Single photon emission computerized tomography with [(99m)Tc]-TRODAT-1 brain scans will be performed to evaluate dopamine transporters. DISCUSSION This study protocol will be informative for researchers and clinicians interested in considering, designing and/or conducting translational research in the field of trauma and posttraumatic stress disorder.
Collapse
Affiliation(s)
- Rodrigo A Bressan
- Laboratório Interdisciplinar de Neurosciencias Clínicas - LiNC, São Paulo, Brazil.
| | - Lucas C Quarantini
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil,Department of Society, Human Development, and Health, Harvard School of Public Health, Cambridge, MA, USA,Depart of Psychiatry, Universidade Federal da Bahia, Bahia, Brazil
| | | | - Celia Araújo
- Laboratório Interdisciplinar de Neurosciencias Clínicas – LiNC, São Paulo, Brazil,Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Gerome Breen
- MRC Social, Genetic and Developmental Psychiatry Research Centre and NIHR Biomedical Research Centre for Mental Health at NHS South London, UK ,Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
| | - Camila Guindalini
- Laboratório Interdisciplinar de Neurosciencias Clínicas – LiNC, São Paulo, Brazil,Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Marcelo Hoexter
- Laboratório Interdisciplinar de Neurosciencias Clínicas – LiNC, São Paulo, Brazil,Department of Psychiatry, Universidade Federal de São Paulo, Brazil,Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Andrea P Jackowski
- Laboratório Interdisciplinar de Neurosciencias Clínicas – LiNC, São Paulo, Brazil,Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Miguel R Jorge
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Acioly LT Lacerda
- Laboratório Interdisciplinar de Neurosciencias Clínicas – LiNC, São Paulo, Brazil,Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | | | - Stella Malta
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil,Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Tais S Moriyama
- Laboratório Interdisciplinar de Neurosciencias Clínicas – LiNC, São Paulo, Brazil,Department of Psychiatry, Universidade Federal de São Paulo, Brazil,Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Maria I Quintana
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Wagner S Ribeiro
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Juliana Ruiz
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Aline F Schoedl
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Ming C Shih
- Laboratório Interdisciplinar de Neurosciencias Clínicas – LiNC, São Paulo, Brazil,Department of Psychiatry, Universidade Federal de São Paulo, Brazil,Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB – UFRJ), Rio de Janeiro, Brazil
| | - Karestan C Koenen
- Department of Society, Human Development, and Health, Harvard School of Public Health, Cambridge, MA, USA
| | - Marcelo F Mello
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Jair J Mari
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil,Centre for Public Mental Health, Health Services and Population Research Department, Institute of Psychiatry, King's College, University of London, London, UK
| |
Collapse
|
43
|
Braga LL, Fiks JP, Mari JJ, Mello MF. The importance of the concepts of disaster, catastrophe, violence, trauma and barbarism in defining posttraumatic stress disorder in clinical practice. BMC Psychiatry 2008; 8:68. [PMID: 18694520 PMCID: PMC2533004 DOI: 10.1186/1471-244x-8-68] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 08/12/2008] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Several terms in the scientific literature about posttraumatic stress disorder are used with different meanings in studies conducted by different authors. Words such as trauma, violence, catastrophe, disaster and barbarism are often used vaguely or confusingly, and their meanings change in different articles. The lack of conceptual references for these expressions complicates the organization of literature. Furthermore, the absence of clear concepts may be an obstacle to clinical treatment because the use of these words by the patients does not necessarily point to a diagnosis of posttraumatic stress disorder. DISCUSSION A critical review of scientific literature showed that stress can be divided in stages to facilitate specific terminological adjustments to the event itself, to the subject-event interaction and to psychological responses. Moreover, it demonstrated that the varying concept of trauma expands into fundamental psychotherapeutic definitions and that the meanings of violence associated with barbarism are an obstacle to resilience. Therefore, this study updates the etymological origins and applications of these words, connects them to the expansions of meanings that can be operated in the clinical care of patients with posttraumatic stress disorder, and analyzes them critically according to the criterion A of DSM-IV and ICD-10. SUMMARY The terminology in the literature about posttraumatic stress disorder includes a plethora of terms whose meanings are not fully understood, and that, therefore, limit this terminology. The analysis of these terms suggested that the transformation of the concept of trauma led to a broader understanding of this phenomenon in its psychic dimensions, that a barbarian type of violence constitutes an obstacle to resilience, and that the criterion A of the DSM-IV and ICD-10 shows imprecision and conceptual fragilities. METHODS To develop this debate article, a current specialized literature review was achieved by searching and retrieving the key terms from two major databases: PubMed and PsycINFO. The key terms included "disaster", "catastrophe", "barbarism", "terrorism", "trauma", "psychic trauma" and "violence", also in combination with the terms "PTSD", "concept" and "conceptual aspects". The data were captured specially from review articles. The included studies were those mostly identified by the authors as relevant by the presence of a conceptual approach in any part of the paper. Researches that relied solely on empirical indicators, like psychopathological, neurobiological or pharmacological aspects, were excluded. The focus here was in conceptual aspects, even when some few empirical studies were included. As it was noted a paucity of medical references related to conceptual aspects of these terms, a wider literature needed to be included, including chapters, books and articles proceeded from the Humanities areas. "Interdisciplinary research is needed in this area to include perspectives from a range of different disciplines" once that "to promote public health (...) new dimensions of such interactions and the implications thereof should be pursued in collaboration with researchers from broader areas" 1.
Collapse
Affiliation(s)
- Luciana L Braga
- Graduate Program in Psychiatry - Department of Psychiatry, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Jose P Fiks
- Department of Psychiatry, Escola Paulista de Medicina – Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Jair J Mari
- Department of Psychiatry, Escola Paulista de Medicina – Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Escola Paulista de Medicina – Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| |
Collapse
|
44
|
Rikhye K, Tyrka AR, Kelly MM, Gagne GG, Mello AF, Mello MF, Price LH, Carpenter LL. Interplay between childhood maltreatment, parental bonding, and gender effects: impact on quality of life. Child Abuse Negl 2008; 32:19-34. [PMID: 18082260 PMCID: PMC4469467 DOI: 10.1016/j.chiabu.2007.04.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 03/22/2007] [Accepted: 04/18/2007] [Indexed: 05/22/2023]
Abstract
OBJECTIVE The aim of this study was to examine associations between childhood adversity, parental bonding, gender, depressive symptoms, and quality of life in non-treatment-seeking adults from the community. METHOD Effects of differential parental rearing were compared in adults who reported a high degree of childhood maltreatment (n=72) and those who reported no significant adverse events in childhood (n=69). Subjects completed retrospective measures of childhood maltreatment and perceived parenting style, as well as measures of current depressive symptoms and quality of life. RESULTS The subjects without childhood maltreatment were younger and endorsed less current depressive symptomatology than did subjects with childhood maltreatment. While the subjects without a history of maltreatment reported more "optimal" bonding experiences with their parents, the maltreatment group members were more likely to characterize their early parental bonding experiences in terms of "affectionless control" (p<.001 for both maternal and paternal parenting), "affectionate constraint" (p=.025 for maternal parenting and p=.004 for paternal parenting), or "weak or absent" bonding (p<.001 for both maternal and paternal parenting). Results of a multiple regression analysis revealed that overall quality of paternal care (p=.015) and current level of depressive symptoms (p<.001) were significant independent predictors of adult quality of life. Gender effects between subjects providing parental bonding data were limited to the group with childhood maltreatment. CONCLUSION These findings extend previous work documenting a relationship between early life maltreatment and suboptimal parental bonding, suggesting gender-specific effects of maternal and paternal care. Effects of childhood maltreatment on quality of life in adulthood appear to be linked with the quality of childhood paternal care and the occurrence of depressive symptomatology in adulthood, suggesting possible targets for primary or secondary prevention.
Collapse
Affiliation(s)
- Kobita Rikhye
- Mood Disorders Research Program, Butler Hospital, Department of Psychiatry and Human Behavior, Brown Medical School, 345 Blackstone Boulevard., Providence, RI 02906, USA
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Carpenter LL, Carvalho JP, Tyrka AR, Wier LM, Mello AF, Mello MF, Anderson GM, Wilkinson CW, Price LH. Decreased adrenocorticotropic hormone and cortisol responses to stress in healthy adults reporting significant childhood maltreatment. Biol Psychiatry 2007; 62:1080-7. [PMID: 17662255 PMCID: PMC2094109 DOI: 10.1016/j.biopsych.2007.05.002] [Citation(s) in RCA: 394] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 04/25/2007] [Accepted: 05/02/2007] [Indexed: 12/18/2022]
Abstract
BACKGROUND Preclinical research findings suggest that exposure to stress and concomitant hypothalamus-pituitary-adrenal (HPA) axis activation during early development can have permanent and potentially deleterious effects. A history of early-life abuse or neglect appears to increase risk for mood and anxiety disorders. Abnormal HPA response to stress challenge has been reported in adult patients with major depressive disorder and posttraumatic stress disorder. METHODS Plasma adrenocorticotropin hormone (ACTH) and cortisol reactivity to the Trier Social Stress Test were examined in healthy adults (n = 50) without current psychopathology. Subjects with a self-reported history of moderate to severe childhood maltreatment (MAL) (n = 23) as measured by the Childhood Trauma Questionnaire were compared with subjects without such a history (CTL) (n = 27). RESULTS Compared with CTLs, MAL subjects exhibited significantly lower cortisol and ACTH baseline-to-peak deltas. A significant group effect was seen in the (repeated measures) cortisol response to the stress challenge, reflecting lower concentrations among MAL subjects. A significant group x time effect characterized the relatively blunted ACTH response of the MAL group. Emotional neglect (-.34, p = .02) and sexual abuse (.31, p = .03) strongly predicted maximal cortisol release. CONCLUSIONS In adults without diagnosable psychopathology, childhood maltreatment is associated with diminished HPA axis response to a psychosocial stressor. Possible explanations for the finding are discussed.
Collapse
Affiliation(s)
- Linda L Carpenter
- Mood Disorders Research Program, Butler Hospital, Brown Medical School, Providence, Rhode Island 02906, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
This study assessed personality disorder symptomatology in a community sample of healthy adults without diagnosable DSM-IV-TR Axis I psychiatric disorders who reported a history of childhood abuse. Twenty-eight subjects with a history of moderate to severe physical, sexual, and/or emotional abuse according to the Childhood Trauma Questionnaire were compared to 33 subjects without an abuse history on symptoms of personality disorders. Subjects in the Abuse group were more likely to report subclinical symptoms of paranoid, narcissistic, borderline, antisocial, obsessive compulsive, passive-aggressive, and depressive personality disorders. These findings link reports of childhood abuse with symptoms of personality disorders in the absence of Axis I psychiatric disorders in a community sample of healthy adults.
Collapse
Affiliation(s)
- Kelly E Grover
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Butler Hospital, Providence, RI 02906, USA
| | | | | | | | | | | | | |
Collapse
|
47
|
Tyrka AR, Mello AF, Mello MF, Gagne GG, Grover KE, Anderson GM, Price LH, Carpenter LL. Temperament and hypothalamic-pituitary-adrenal axis function in healthy adults. Psychoneuroendocrinology 2006; 31:1036-45. [PMID: 16908106 PMCID: PMC4469475 DOI: 10.1016/j.psyneuen.2006.06.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 05/10/2006] [Accepted: 06/22/2006] [Indexed: 12/16/2022]
Abstract
BACKGROUND Traits such as behavioral inhibition and neuroticism have been linked to the development of mood and anxiety disorders. Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, a manifestation of the stress response, is often seen in major depression and has also been demonstrated in animals and humans with inhibited temperaments. A recent study found HPA hyperactivity in adults with high levels of neuroticism. The present study investigated associations of temperament and HPA function in 31 healthy adults. METHODS AND MATERIALS Subjects completed diagnostic interviews, questionnaires, and the dexamethasone-/corticotropin-releasing hormone (Dex/CRH) test. Temperament was assessed using the Tridimensional Personality Questionnaire (TPQ). RESULTS Novelty Seeking was inversely related to plasma cortisol concentrations in the Dex/CRH test. Harm Avoidance and Reward Dependence were not significantly associated with cortisol responses in the Dex/CRH test. The results were not accounted for by psychiatric symptoms or a history of stress or childhood maltreatment. CONCLUSIONS These findings are consistent with previous reports associating temperament factors with HPA axis hyperactivity. Further work is needed to replicate these observations and determine whether HPA axis dysfunction might account for some of the previously reported association of personality factors with mood and anxiety disorders.
Collapse
Affiliation(s)
- Audrey R Tyrka
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Butler Hospital, 345 Blackstone Road, Providence, RI 02906, USA.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Numerous studies in the past three decades have characterised 'psychotic major depression', a subtype of major depression which is accompanied by delusions or other psychotic features. Evidence from phenomenological and neurobiological investigations indicates that this is a unique disorder with clinical and biological characteristics that are distinct from those of nonpsychotic depression and from other psychotic disorders. Treatment studies have provided evidence of small placebo effects and good responses to electroconvulsive therapy or combination treatment with an antidepressant plus an antipsychotic agent. However, until recently, there were only a few small, prospective, double-blind, controlled trials investigating the efficacy of antidepressant-antipsychotic combination pharmacotherapy, yet this constitutes the currently accepted and most universally applied 'standard of care' for psychotic depression. Treatment guidelines have been based largely on uncontrolled investigations of electroconvulsive therapy and studies using tricyclic antidepressants and first-generation antipsychotic drugs, which are not frequently chosen as first-line agents today because of concerns regarding tolerability and risks. However, recent open-label studies and large controlled trials of newer antidepressants and antipsychotics have yielded very divergent results thus far, so that the best treatment approach remains elusive. This review discusses the phenomenology and treatment of psychotic depression with a focus on the benefits and risks of various treatment approaches. Problems with this literature are highlighted, and strategies for future research are suggested.
Collapse
Affiliation(s)
- Audrey R Tyrka
- Mood Disorders Research Program, and the Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, Rhode Island 02906, USA.
| | | | | | | | | |
Collapse
|
49
|
Abstract
OBJECTIVE Gamma-aminobutyric acid (GABA) plays a key role in the pathophysiology and treatment of depression and anxiety. Tiagabine, a selective GABA reuptake inhibitor (SGRI) that enhances normal GABA tone, was evaluated for its efficacy and safety in the treatment of depression comorbid with significant anxiety. METHOD In this 8-week, single-center, open-label study, adults with DSM-IV-diagnosed major depressive disorder and significant anxiety (i.e., "anxious depression") received tiagabine monotherapy, initiated at 4 mg/day and titrated for optimum response as tolerated to a maximum dose of 20 mg/day. Symptoms, function, and adverse events were assessed at regular intervals. Patients were entered from April 2002 to February 2003. RESULTS Nineteen patients entered the study and 15 met criteria for intent-to-treat analyses. Of those, 6 (40%) discontinued treatment and 9 (60%) completed the 8-week protocol. Tiagabine significantly improved depression, as shown by a reduction in mean +/- SD Hamilton Rating Scale for Depression scores from baseline (31.9 +/- 6.1) to endpoint (17.0 +/- 12.4; p = .002). Categorical response rate was 47% (N = 7). Tiagabine also significantly improved anxiety (Hamilton Rating Scale for Anxiety baseline score of 22.7 +/- 4.9 vs. endpoint score of 12.5 +/- 8.8; p = .002). The mean +/- SD final daily dose was 12.8 +/- 5.8 mg. The most commonly reported adverse events were dizziness, headache, and gastrointestinal upset/nausea. CONCLUSION These results suggest the potential of the SGRI tiagabine in the treatment of depression with anxiety. Large, placebo-controlled trials are needed.
Collapse
Affiliation(s)
- Linda L Carpenter
- Mood Disorders Research Program, Butler Hospital, Brown Medical School, 345 Blackstone Boulevard, Providence, R.I. 02906, USA.
| | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
UNLABELLED We studied the meaning given to the terms "death" and "suicide" among psychiatric inpatients. Forty-four patients who had been admitted in a psychiatric inpatient unit following a suicide attempt underwent a qualitative interview, using a "general guide interview" approach. The results were analyzed systematically to investigate the relationship between attempted suicide and mental disorder. In 6 cases there was no correlation between the attempted suicide and psychopathological symptoms. One of these patients had a psychiatric diagnosis, but this did not seem to be related to the suicide attempt. All of them made a rational a deliberate suicidal act. CONCLUSION even in a psychiatric inpatient setting, suicide attempts are not always a behavioural expression of underlying psychopathological disturbances - individual and social factors also play a decisive role.
Collapse
Affiliation(s)
- M F Mello
- Hospital do Servidor Público Estadual de São Paulo, Rua Urussuí, 71 conj. 133, Itaim Bibi, São Paulo, SP 04542-050, Brasil
| |
Collapse
|