Mental health markers and protective factors in students with symptoms of physical pain across WEIRD and non-WEIRD samples - a network analysis

BACKGROUND

Studies conducted in Western societies have identified variables associated with chronic pain, but few have done so across cultures. Our study aimed to clarify the relationship between specific mental health markers (i.e., depression, anxiety, posttraumatic stress disorder [PTSD], perceived stress) as well as specific protective factors (i.e., social support and self-efficacy) related to physical pain among university students across non-WEIRD and WEIRD samples.

METHOD

A total of 188 university students (131 women and 57 men) were included in the study. We used network analysis to ascertain mental health markers especially central to the experience of physical pain.

RESULTS

No statistically significant difference was found between mental health markers (i.e., depression, anxiety, perceived stress, and PTSD) and protective factors (i.e., social support and self-efficacy) associated with physical pain symptoms for Swiss students versus Indian students (M = 0.325, p = .11). In addition, networks for Swiss versus Indian students did not differ in global strength (S = 0.29, p = .803). Anxiety was the most central mental health marker, and social support was the most important protective factor related to physical pain in both countries. However, for Swiss students, perceived stress, and for Indian students, PTSD symptoms were central mental health markers related to physical pain.

CONCLUSION

Our results identify factors that may serve as important treatment targets for pain interventions among students of both countries before it becomes chronic.

Perceived Acceptability of Child Maltreatment as a Moderator of the Association Between Experiences of Child Maltreatment and Post-Traumatic Symptoms: A Cross-Cultural Study

Despite the well-documented link between child maltreatment (CM) and mental health, evidence suggests substantial variability in the post-traumatic sequelae of CM across cultures. The perceived acceptability of CM in one's community might moderate the association between CM and mental health, but little research has been conducted on it so far. This study examined how the perceived acceptability of CM may influence the relationship between CM experiences and post-traumatic symptoms in individuals from four different continents and if the pattern of associations is the same across countries. We recruited a sample of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122). We administered online questionnaires and performed multiple group moderation analyses for total CM, neglect, physical abuse, emotional maltreatment, sexual abuse, and exposure to domestic violence (DV). A significant positive main effect of CM on post-traumatic symptoms was found in the overall sample and in Cameroon; in Germany, only neglect and emotional maltreatment were positively associated to post-traumatic symptoms. Moderation effects were identified; the perceived acceptability of neglect in Cameroon and Germany and of exposure to DV in Cameroon had a dampening effect on the relationship between CM experiences and post-traumatic symptoms. Our findings confirm that CM experiences entail long-term post-traumatic sequelae that can vary across cultures and CM subtypes and further our understanding of this issue by showing that the perceived acceptability of CM may be an understudied moderator.

How are experiences and acceptability of child maltreatment related to resilience and posttraumatic growth: a cross cultural study

Background: Post-traumatic growth (PTG) and resilience, regarded as positive psychological change following a traumatic experience, are under-researched across cultures in people exposed to child maltreatment (CM).Objective: We investigated how experiences and the perceived acceptability of CM are related to resilience and PTG in countries with different cultures, living standards, and gross national income.Method: A total of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122) completed an online survey with self-reported questionnaires, including the Brief Resilience Scale and the Post Traumatic Growth Inventory-Short Form.Results: Across countries, self-reported male gender and age were positively associated with resilience, while experiences of physical abuse and emotional maltreatment were negatively associated with resilience. Experiences of emotional maltreatment were positively associated with PTG. Higher levels of PTG and resilience were found amongst Cameroonian participants as compared to other countries.Conclusion: Our results suggest that positive changes following CM can vary significantly across cultures and that experiences of specific CM subtypes, but not the perceived acceptability of CM, may be important for a deeper understanding of how individuals overcome trauma and develop salutogenic outcomes. Our findings may inform CM intervention programmes for an enhanced cultural sensitivity.

A pilot study of cerebral metabolism and serotonin 5-HT2A receptor occupancy in rats treated with the psychedelic tryptamine DMT in conjunction with the MAO inhibitor harmine

Rationale: The psychedelic effects of the traditional Amazonian botanical decoction known as ayahuasca are often attributed to agonism at brain serotonin 5-HT2A receptors by N,N-dimethyltryptamine (DMT). To reduce first pass metabolism of oral DMT, ayahuasca preparations additionally contain reversible monoamine oxidase A (MAO-A) inhibitors, namely β-carboline alkaloids such as harmine. However, there is lacking biochemical evidence to substantiate this pharmacokinetic potentiation of DMT in brain via systemic MAO-A inhibition. Objectives: We measured the pharmacokinetic profile of harmine and/or DMT in rat brain, and tested for pharmacodynamic effects on brain glucose metabolism and DMT occupancy at brain serotonin 5-HT2A receptors. Methods: We first measured brain concentrations of harmine and DMT after treatment with harmine and/or DMT at low sub-cutaneous doses (1 mg/kg each) or harmine plus DMT at moderate doses (3 mg/kg each). In the same groups of rats, we also measured ex vivo the effects of these treatments on the availability of serotonin 5-HT2A receptors in frontal cortex. Finally, we explored effects of DMT and/or harmine (1 mg/kg each) on brain glucose metabolism with [18F]FDG-PET. Results: Results confirmed that co-administration of harmine inhibited the formation of the DMT metabolite indole-3-acetic acid (3-IAA) in brain, while correspondingly increasing the cerebral availability of DMT. However, we were unable to detect any significant occupancy by DMT at 5-HT2A receptors measured ex vivo, despite brain DMT concentrations as high as 11.3 µM. We did not observe significant effects of low dose DMT and/or harmine on cerebral [18F]FDG-PET uptake. Conclusion: These preliminary results call for further experiments to establish the dose-dependent effects of harmine/DMT on serotonin receptor occupancy and cerebral metabolism.

Validation of the French version of the Revised Diagnostic Interview for Borderlines (DIB-R) for assessing the psychopathology of borderline personality disorder

BACKGROUND

Borderline personality disorder (BPD) is frequently subject to misdiagnosis or underdiagnosis. As a matter of fact, its evaluation poses several challenges, highlighting the importance of having validated evaluation instruments. The Revised Diagnostic Interview for Borderlines (DIB-R) is widely used and recognized for its validity when it comes to assessing the psychopathology of BPD, but, as for now, no French version of the interview exists. The aim of the current work is to validate a French version of the DIB-R.

METHODS

The sample consists of N = 65 patients with borderline personality disorder (BPD) and N = 57 treatment seeking patients (non-BPD comparison group). For inter-rater reliability, a subsample of N = 84 interviews will be assessed by two raters, n = 47 for the BPD group and n = 37 for the non-BPD comparison group.

RESULTS

To assess reliability, we conducted analyses of internal consistency and inter-rater reliability. The results were good for the overall interview as well as for the four domains of the DIB-R. To assess validity, we calculated the receiver operating characteristic (ROC) curve, sensitivity, specificity, predictive values, convergent and discriminative validity. The optimal cutoff was found to be 7. Regarding convergent validity, we found strong convergence between the Borderline Symptom List (BSL-23) and the DIB-R total score. Additionally, the two groups statistically differed on all the DIB-R scores, which indicates that the interview discriminates between the two groups.

CONCLUSIONS

Our results indicate good psychometric properties of the French version of the DIB-R. This has important implications as the interview is useful both in clinical settings and for research purposes. Additionally, the present paper aims to contribute to the more general effort of demonstrating generalizability and transportability of the scale.

Associations between experiences of childhood maltreatment and perceived acceptability of child maltreatment: A cross-cultural and exploratory study

BACKGROUND

Acceptable parental behaviors and practices toward a child vary across countries and may impact the risk of exposure to maltreatment. Conversely, prior experiences of maltreatment as a child may influence the acceptability of child maltreatment (CM) behaviors.

OBJECTIVE

This exploratory study examined the association between CM experiences and perceived acceptability of CM using data from four countries representing different cultures, living standards, and gross national income.

PARTICIPANTS AND SETTING

We recruited a convenience sample of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122) through online postings on social media.

METHODS

We administered questionnaires and conducted a three-stage hierarchical multiple regression with perceived acceptability of CM subscales as the dependent variable.

RESULTS

In all countries, higher scores of childhood neglect were associated with greater perceived acceptability of neglect in one's community (p < .001). Equally, our results showed that higher scores of childhood neglect or sexual abuse were associated with greater perceived acceptability of sexual abuse (p < .044). However, we did not find a significant relationship between other forms of CM (i.e., physical abuse, emotional maltreatment, exposure to domestic violence), and their perceived acceptability.

CONCLUSIONS

Our findings suggest that experiences of some CM types, namely neglect and sexual abuse, may be associated with the perception that these are more acceptable within one's community. Perceived acceptability of CM might be a driver that can either prevent or perpetuate CM. Therefore, intervention and prevention programs could incorporate a deeper cross-cultural understanding and assessment of these social norms in order to foster meaningful behavioral changes.

Disrupted longitudinal restoration of brain connectivity during weight normalization in severe anorexia nervosa

Altered intrinsic brain connectivity of patients with anorexia nervosa has been observed in the acute phase of the disorder, but it remains unclear to what extent these alterations recover during weight normalization. In this study, we used functional imaging data from three time points to probe longitudinal changes in intrinsic connectivity patterns in patients with severe anorexia nervosa (BMI ≤ 15.5 kg/m²) over the course of weight normalization. At three distinct stages of inpatient treatment, we examined resting-state functional connectivity in 27 women with severe anorexia nervosa and 40 closely matched healthy controls. Using network-based statistics and graph-theoretic measures, we examined differences in global network strength, subnetworks with altered intrinsic connectivity, and global network topology. Patients with severe anorexia nervosa showed weakened intrinsic connectivity and altered network topology which did not recover during treatment. The persistent disruption of brain networks suggests sustained alterations of information processing in weight-recovered severe anorexia nervosa.

Indigenous-Amazonian Traditional Medicine's Usage of the Tobacco Plant: A Transdisciplinary Ethnopsychological Mixed-Methods Case Study

Harmful usage of tobacco is a global public health problem associated with adverse health effects and addiction. Yet, in the Peruvian Amazon, the native region of Nicotiana rustica L., this plant is used in remarkably different manners: it is considered a potent medicinal plant, applied in liquid form for oral ingestion to treat mental health problems, a common and ancient healing practice in this region. Using a transdisciplinary field research approach with mixed ethnopsychological methods, this work aimed to report for the first time a case study in this context. The intervention took place in the Peruvian Amazon (Loreto) and involved ritual tobacco ingestion in a weeklong retreat-like frame, administered by a specialized traditional Amazonian healer. The patient was a 37-year-old woman with diagnosed mood, anxiety, and attention deficit disorders, as well as a chronic somatic condition. We applied qualitative experience-sampling during and quantitative symptom assessments pre- and post-treatment. Our findings offer a detailed description of the experiential therapeutic process during the treatment week and suggest clinically relevant improvements in patient well-being. This work is significant in view of the globally prevalent harmful uses of tobacco and the current scientific trend of revisiting herbal psychoactives (e.g., cannabis, psilocybin) for their therapeutic potentials.

The first session matters: Therapist responsiveness and the therapeutic alliance in the treatment of borderline personality disorder

OBJECTIVES

The focus of the present research is to investigate the impact of therapist responsiveness at the very first session of therapy on the evaluation of therapeutic alliance from the therapist's perspective and from patient's perspective in the context of guideline-based treatment for borderline personality disorder.

DESIGN

The study has a correlational and longitudinal design applied to a 10-session therapy in a naturalistic setting.

METHODS

A total of four trained raters evaluated therapist responsiveness during the first session of therapy. After each therapy session, therapists and patients filled out the short form of the Working Alliance Inventory measuring working alliance; the sample included 13 therapists and 47 patients. Correlational analysis as well as hierarchical linear modelling exploring the relationship between first session therapist responsiveness and working alliance were performed.

RESULTS

The global evaluation of responsiveness revealed a significant relationship with the temporal evolution of the alliance rated from the therapists' perspective.

DISCUSSION

There is the necessity to further explore therapist appropriate responsiveness which could potentially explain several psychotherapy research results. Moreover, it could help in finding alternatives in order to facilitate patients' early engagement in therapy as well as facilitating the building process of therapeutic alliance. Finally, an effort should be made in order to study more individualized operationalization of responsiveness.

Methylation of the glucocorticoid receptor gene (NR3C1) in dyads mother-child exposed to intimate partner violence in Cameroon: Association with anxiety symptoms

BACKGROUND

The glucocorticoid receptor (GR), which is encoded by the NR3C1 (Nuclear Receptor Subfamily 3 Group C Member 1) gene plays an important role in the modulation of the hypothalamic-pituitary-adrenal (HPA) axis activity by providing feedback regulation which allows termination of the stress response. Little is known about epigenetic programming at the level of NGFI-A (nerve growth factor-inducible protein A) putative binding site (CpG) of the NR3C1 exon 1F in dyads mother-child exposed to intimate partner violence (IPV) more specifically in an unstudied region such as the sub-Saharan Africa where levels of violence are very high.

OBJECTIVE

Examine NR3C1 exon 1F methylation in response to IPV and possible association with cortisol concentration and mental health.

METHOD

We recruited 20 mother-child dyads exposed to IPV and a control group of 20 mother-child dyads not exposed to IPV. We administered self-reported questionnaires to measure mother's mental health and collected saliva samples for cortisol dosage and bisulfite sequencing of DNA methylation.

RESULTS

Regarding the mothers, our results showed a significant difference in methylation level at CpG 16-21 sites of the NR3C1 exon 1F promoter region between the groups. In the exposed group as compared to the control group, there was a significant positive association between the level of methylation at CpG 16-21 sites and mother's mental health in particular anxiety symptoms. However, we did not find any significant correlation between methylation level and cortisol concentration. In children, we did not find any significant results.

CONCLUSION

This study highlights a NGFI-A putative binding site (CpG 16-21) that is more methylated in mothers exposed to IPV and which may have the potential to confer vulnerability for psychopathologies.

Relationship between behavioral and mood responses to monetary rewards in a sample of Indian students with and without reported pain

Physical pain has become a major health problem with many university students affected by it worldwide each year. Several studies have examined the prevalence of pain-related impairments in reward processing in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries but none of the studies have replicated these findings in a non-western cultural setting. Here, we aimed to investigate the prevalence of physical pain symptoms in a sample of university students in India and replicate our previous study conducted on university students in Switzerland, which showed reduced mood and behavioral responses to reward in students with significant pain symptoms. We grouped students into a sub-clinical (N = 40) and a control group (N = 48) to test the association between pain symptoms and reward processes. We used the Fribourg reward task and the pain sub-scale of the Symptom Checklist (SCL-27-plus) to assess physical symptoms of pain. We found that 45% of the students reported high levels of physical symptoms of pain and interestingly, our ANOVA results did not show any significant interaction between reward and the groups either for mood scores or for outcomes related to performance. These results might yield the first insights that pain-related impairment is not a universal phenomenon and can vary across cultures.

Can working memory account for EMDR efficacy in PTSD?

BACKGROUND

Although eye movement desensitization and reprocessing (EMDR) has been shown to be effective in the treatment of PTSD for years, it remains controversial due to the lack of understanding of its mechanisms of action. We examined whether the working memory (WM) hypothesis -the competition for limited WM resources induced by the dual task attenuates the vividness and emotionality of the traumatic memory - would provide an explanation for the beneficial effect induced by bilateral stimulation.

METHODS

We followed the Prisma guidelines and identified 11 articles categorized in two types of designs: studies involving participants with current PTSD symptoms and participants without PTSD diagnosis.

RESULTS

Regardless of the types of studies, the results showed a reduction of vividness and emotionality in the recall of traumatic stimuli under a dual-task condition compared to a control condition, such as recall alone. However, two studies used a follow-up test to show that this effect does not seem to last long.

CONCLUSION

Our results provide evidence for the WM hypothesis and suggest that recalling a traumatic memory while performing a secondary task would shift the individual's attention away from the retrieval process and result in a reduction in vividness and emotionality, also associated with the reduction of symptoms.

Estimation of meal portions in bulimia nervosa compared to anorexia nervosa and healthy controls

PURPOSE

Bulimia nervosa (BN) and anorexia nervosa (AN) are potentially life-threatening eating disorders (ED) that primarily affect young people, mostly women. The central common pathology is linked to the relationship with food and with abnormalities in food intake. A previous study indicated that individuals with AN tend to overestimate food portion sizes compared to healthy controls (HC), but no study has investigated these patterns in BN, which was the objective of this study.

METHODS

Women with BN (27), AN (28), and HC (27) were asked to rate different meal portion sizes in two conditions: as if they were supposed to eat them (intent-to-eat condition) or in general (general condition). BN results were compared to HC and AN using mixed model analyses.

RESULTS

BN showed larger estimations compared to HC, while smaller estimations compared to AN. These differences were found mostly for intermediate portion sizes. No difference for conditions (intent-to-eat; general) was found between groups.

CONCLUSION

When estimating food portion sizes, individuals with BN seem to fall intermediately between HC and AN. ED symptoms in BN were most strongly associated with higher portion estimation. This might therefore reflect one aspect of the cognitive distortions typically seen also in AN. A therapeutic option could include the frequent visual exposure to increasing portions of food, what may serve to recalibrate visual perceptions of what a "normal-sized" portion of food looks like.

LEVEL OF EVIDENCE

Level II: Evidence obtained from well-designed controlled trials without randomization.

Social Functioning in Individuals Affected by Childhood Maltreatment: Establishing a Research Agenda to Inform Interventions

Childhood maltreatment (CM) is linked to impairments in various domains of social functioning. Here, we argue that it is critical to identify factors that underlie impaired social functioning as well as processes that mediate the beneficial health effects of positive relationships in individuals exposed to CM. Key research recommendations are presented, focusing on: (1) identifying attachment-related alterations in specific inter- and intrapersonal processes (e.g., regulation of closeness and distance) that underlie problems in broader domains of social functioning (e.g., lack of perceived social support) in individuals affected by CM; (2) identifying internal (e.g., current emotional state) and external situational factors (e.g., cultural factors, presence of close others) that modulate alterations in specific social processes; and (3) identifying mechanisms that explain the positive health effects of intact social functioning. Methodological recommendations include: (1) assessing social processes through interactive and (close to) real-life assessments inside and outside the laboratory; (2) adopting an interdisciplinary, lifespan perspective to assess social processes, using multi-method assessments; (3) establishing global research collaborations to account for cultural influences on social processes and enable replications across laboratories and countries. The proposed line of research will contribute to globally develop and refine interventions that prevent CM and further positive relationships, which - likely through buffering the effects of chronic stress and corresponding allostatic load - foster resilience and improve mental and physical health, thereby reducing personal suffering and the societal and economic costs of CM and its consequences. Interventions targeting euthymia and psychological well-being are promising therapeutic concepts in this context.

Teacher plants - Indigenous Peruvian-Amazonian dietary practices as a method for using psychoactives

ETHNOPHARMACOLOGICAL RELEVANCE

Indigenous groups of the Amazon have developed intricate methods for the application of psychoactives, among which particularly the dieta or diet method of Peruvian-Amazonian traditional medicine stands out. It is a retreat-like intervention involving lengthy periods of social, behavioural, and alimentary restrictions, while ingesting specially prepared plant substances. The interplay of the dietary conditions and plants ingested sensitizes the dieter to receive healing, strength, guidance, and knowledge. From a clinical scientific point of view, the method has remained largely underexplored, but seems more pertinent than ever given the increasing interest in Amazonian psychoactive preparations including ayahuasca (Banisteriopsis caapi) and the burgeoning field of psychedelic-assisted therapies in general.

AIM OF THE STUDY

This study offers a descriptive account and emic interpretation of the Peruvian-Amazonian dieta. More specifically we document in detail the procedure, its context and purpose of application, effects, modes of action, adverse effects, and risks, from the perspectives of a sample of Peruvian traditional healers. The Peruvian-Amazonian dieta is a multi-purpose method for making use of medicinal plants, many of which (but not all), are psychoactive; the current work especially focuses on its therapeutic applications in conjunction with psychoactives.

METHODS

We interviewed 16 healers working in the Ucayali, San Martín, and Loreto provinces of Peru using a semi-structured interview approach. Interviews were audio-recorded and transcribed verbatim. The extensive data derived from these interviews were analysed by means of computer-assisted manifest qualitative content analysis using a theory-advancing approach. Over 500 coded text segments were categorized, resulting in 7 main theme clusters and corresponding sub-themes.

RESULTS

The interviewed healers described a complex intervention with multifaceted applications (treatment, prevention, training) and effects in various domains (body, mind, spirit, energy). The process was portrayed as transformative, with benefits attributed to the effects of the so-called teacher plants in conjunction with the diet's conditions, along with the skill of the healer guiding the intervention. Further, a detailed risk assessment revealed sophisticated safety measures and tools designed to address adverse responses. The importance of adequate training of the healer that administers the diet was particularly highlighted in this context.

CONCLUSIONS

The dieta is a central therapeutic concept and tool in Peruvian-Amazonian traditional medicine and a unique method for using psychoactive plants. Multidisciplinary health research that includes traditional treatment methods from Indigenous cultures, Amazonian and other, should not be neglected in the current global interest in psychedelic therapies; such research may in the long-term contribute to a more inclusive psychedelic research paradigm as well as healthcare practice in countries where rich traditional healing systems exist, and perhaps beyond. It may also contribute to the recognition of the Indigenous healers as not only historical forerunners, but also current leading experts in psychedelic medicine.

From the Mother to the Child: The Intergenerational Transmission of Experiences of Violence in Mother-Child Dyads Exposed to Intimate Partner Violence in Cameroon

Intimate partner violence (IPV) is a widespread social problem with serious consequences for the health of both women and their children. However, little is known about the combined effect of maternal childhood abuse and current exposure to IPV with respect to the psychopathological symptoms of the mother-child dyad. In a Cameroonian cultural setting, where IPV affects more than half of women, we aimed to better understand how mother's childhood abuse and current IPV co-occur to lead to psychopathological symptoms in the mother-child dyad. With the help of a non-governmental organization in Cameroon, we recruited 49 mother-child dyads exposed to IPV, along with 25 mother-child dyads who had not been exposed, and who functioned as a control group. All mothers completed a set of questionnaires, including the Revised Conflict Tactics Scale to assess IPV; the Child Trauma Questionnaire to examine their childhood trauma; the Child Behavior Checklist to assess their children's psychopathological traits; the Hospital Anxiety and Depression Scale; and the Symptom Checklist. We found that physical abuse experienced by mothers during childhood was associated with IPV in adulthood, and specifically sexual abuse, p = .001. In addition, we found that the accumulation of maternal childhood abuse and current IPV was related to anxiety and depression symptoms in mothers, all R² ≥ .18, all ps ≤ .015, as well as to externalized symptoms in children, all R² ≥ .27, all ps ≤ .017. Our results suggest the intergenerational transmission of experiences of childhood abuse and current IPV, which calls for the development of interventions and care strategies for the mother-child dyad.

Child maltreatment and NR3C1 exon 1F methylation, link with deregulated hypothalamus-pituitary-adrenal axis and psychopathology: A systematic review

BACKGROUND

Epigenetics offers one promising method for assessing the psychobiological response to stressful experiences during childhood. In particular, deoxyribonucleic acid (DNA) methylation has been associated with an altered hypothalamus-pituitary-adrenal (HPA) axis and the onset of mental disorders. Equally, there are promising leads regarding the association between the methylation of the glucocorticoid receptor gene (NR3C1-1_F) and child maltreatment and its link with HPA axis and psychopathology.

OBJECTIVE

The current study aimed to assess the evidence of a link among child maltreatment, NR3C1-1_F methylation, HPA axis deregulation, and symptoms of psychopathology.

METHODS

We followed the Prisma guidelines and identified 11 articles that met our inclusion criteria.

RESULTS

We found that eight studies (72.72%) reported increased NR3C1-1_F methylation associated with child maltreatment, specifically physical abuse, emotional abuse, sexual abuse, neglect, and exposure to intimate partner violence, while three studies (27.27%) found no significant association. Furthermore, a minority of studies (36.36%) provided additional measures of symptoms of psychopathology or cortisol in order to examine the link among NR3C1-1_F methylation, HPA axis deregulation, and psychopathology in a situation of child maltreatment. These results suggest that NR3C1-1_F hypermethylation is positively associated with higher HPA axis activity, i.e. increased production of cortisol, as well as symptoms of psychopathology, including emotional lability-negativity, externalizing behavior symptoms, and depressive symptoms.

CONCLUSION

NR3C1-1_F methylation could be one mechanism that links altered HPA axis activity with the development of psychopathology.

Does local cerebellar volume predict treatment success in anorexia nervosa?

Anorexia nervosa (AN) is difficult to treat with up to half of patients failing to gain weight during treatment. Neurobiological factors predicting treatment response in AN are poorly understood. In this longitudinal study, we aimed to identify morphological characteristics in the grey matter which predict treatment success in patients with AN. Fifty patients with severe AN participated in an eating disorder-specific inpatient treatment. On admission, T1-weighted magnetic resonance images were acquired from all patients. Half of the patients successfully gained weight, reaching a body-mass index ≥ 17.5 kg/m². Using voxel-based morphometry, local grey matter volumes were compared between the two groups of patients who gained weight and those who did not. This approach allowed us to identify anatomical characteristics which predict treatment success in terms of post-treatment weight status. Patients who did not reach the weight threshold at discharge had a smaller volume in the right cerebellar crus I at the time of admission. In this group, smaller volume was associated with a greater alexithymia score. The findings suggest that a trophic state within the cerebellum before treatment might be prognostic for treatment success. Consistent with previous reports, this result further substantiates the possible role of the cerebellum in the psychopathology of AN.

An Ecological Monitoring and Management App (EMMA) for Older Adults With Chronic Pain: Protocol for a Design and Feasibility Study

Background

Chronic pain is a complex problem for many older adults that affects both physical functioning and psychological well-being. Mobile health (mHealth) technologies have shown promise in supporting older persons in managing chronic conditions. Cognitive behavior therapy is recommended for older people with chronic pain. However, web-based treatment programs for chronic pain are not aimed at the needs of older people and offer standard therapies without providing tailored treatment for this population.

Objective

To address this problem, we aim to develop a psychological web-based intervention for ecological monitoring of daily life experiences with chronic pain called EMMA to support self-management of chronic pain in older adults.

Methods

The key clinical and engagement features of the intervention were established through the integration of evidence-based material from cognitive behavioral therapy for the treatment of chronic pain in older adults. The development process uses a co-design approach and actively involves end-users in the design process by incorporating feedback from focus groups with older adults in order to inform a user-centered intervention design. For the co-design process, we will include 10 older adults with chronic pain, who will discuss the requirements for the app in workshops in order to ensure suitability of the app for older adults with chronic pain. In order to test the feasibility and acceptability of the intervention, we will include a sample of 30 older adults with chronic pain who will test all features of the intervention for a period of 8 consecutive weeks. After the trial period, validated instruments will be used to assess usability and acceptability, as well as influence on pain levels and associated physical and psychological symptoms. Participants will be invited to take part in a semistructured telephone interviews after the trial period to explore their experiences using the app.

Results

Digitalization of the pain diary and psychotherapeutic content has started. Recruitment of participants for the co-design workshops will start as soon as we have a functioning prototype of the electronic pain diary and EMMA intervention, which is expected to be in September 2021. The feasibility study will start as soon as the co-design process is finished and required changes have been implemented into the pain diary and the EMMA intervention. We expect to start the feasibility study early in 2022.

Conclusions

Required changes to assure usability and acceptability will be directly implemented in the app. EMMA brings together a strong body of evidence using cognitive behavioral and self-management theory with contemporary mHealth principles, allowing for a cost-effective intervention that can be used to target chronic pain anywhere and anytime by older adults. Given the ubiquity of mHealth interventions for chronic conditions, the results of this study may serve to inform the development of tailored self-management interventions.

International Registered Report Identifier (IRRID)

PRR1-10.2196/26930

Molecular and Functional Imaging Studies of Psychedelic Drug Action in Animals and Humans

Hallucinogens are a loosely defined group of compounds including LSD, N,N-dimethyltryptamines, mescaline, psilocybin/psilocin, and 2,5-dimethoxy-4-methamphetamine (DOM), which can evoke intense visual and emotional experiences. We are witnessing a renaissance of research interest in hallucinogens, driven by increasing awareness of their psychotherapeutic potential. As such, we now present a narrative review of the literature on hallucinogen binding in vitro and ex vivo, and the various molecular imaging studies with positron emission tomography (PET) or single photon emission computer tomography (SPECT). In general, molecular imaging can depict the uptake and binding distribution of labelled hallucinogenic compounds or their congeners in the brain, as was shown in an early PET study with N1-([11C]-methyl)-2-bromo-LSD ([11C]-MBL); displacement with the non-radioactive competitor ketanserin confirmed that the majority of [11C]-MBL specific binding was to serotonin 5-HT2A receptors. However, interactions at serotonin 5HT1A and other classes of receptors and pleotropic effects on second messenger pathways may contribute to the particular experiential phenomenologies of LSD and other hallucinogenic compounds. Other salient aspects of hallucinogen action include permeability to the blood-brain barrier, the rates of metabolism and elimination, and the formation of active metabolites. Despite the maturation of radiochemistry and molecular imaging in recent years, there has been only a handful of PET or SPECT studies of radiolabeled hallucinogens, most recently using the 5-HT2A/2C agonist N-(2[11CH3O]-methoxybenzyl)-2,5-dimethoxy- 4-bromophenethylamine ([11C]Cimbi-36). In addition to PET studies of target engagement at neuroreceptors and transporters, there is a small number of studies on the effects of hallucinogenic compounds on cerebral perfusion ([15O]-water) or metabolism ([18F]-fluorodeoxyglucose/FDG). There remains considerable scope for basic imaging research on the sites of interaction of hallucinogens and their cerebrometabolic effects; we expect that hybrid imaging with PET in conjunction with functional magnetic resonance imaging (fMRI) should provide especially useful for the next phase of this research.

Increased Reward-Related Activation in the Ventral Striatum During Stress Exposure Associated With Positive Affect in the Daily Life of Young Adults With a Family History of Depression. Preliminary Findings

Background: Being the offspring of a parent with major depression disorder (MDD) is a strong predictor for developing MDD. Blunted striatal responses to reward were identified in individuals with MDD and in asymptomatic individuals with family history of depression (FHD). Stress is a major etiological factor for MDD and was also reported to reduce the striatal responses to reward. The stress-reward interactions in FHD individuals has not been explored yet. Extending neuroimaging results into daily-life experience, self-reported ambulatory measures of positive affect (PA) were shown to be associated with striatal activation during reward processing. A reduction of self-reported PA in daily life is consistently reported in individuals with current MDD. Here, we aimed to test (1) whether increased family risk of depression is associated with blunted neural and self-reported reward responses. (2) the stress-reward interactions at the neural level. We expected a stronger reduction of reward-related striatal activation under stress in FHD individuals compared to HC. (3) the associations between fMRI and daily life self-reported data on reward and stress experiences, with a specific interest in the striatum as a crucial region for reward processing. Method: Participants were 16 asymptomatic young adults with FHD and 16 controls (HC). They performed the Fribourg Reward Task with and without stress induction, using event-related fMRI. We conducted whole-brain analyses comparing the two groups for the main effect of reward (rewarded > not-rewarded) during reward feedback in control (no-stress) and stress conditions. Beta weights extracted from significant activation in this contrast were correlated with self-reported PA and negative affect (NA) assessed over 1 week. Results: Under stress induction, the reward-related activation in the ventral striatum (VS) was higher in the FHD group than in the HC group. Unexpectedly, we did not find significant group differences in the self-reported daily life PA measures. During stress induction, VS reward-related activation correlated positively with PA in both groups and negatively with NA in the HC group. Conclusion: As expected, our results indicate that increased family risk of depression was associated with specific striatum reactivity to reward in a stress condition, and support previous findings that ventral striatal reward-related response is associated with PA. A new unexpected finding is the negative association between NA and reward-related ventral striatal activation in the HC group.

HPA-axis activity and the moderating effect of self-esteem in the context of intimate partner violence in Cameroon

BACKGROUND

The experience of intimate partner violence (IPV) is stressful. One objective way to monitor it is to assess victims' stress response by measuring the concentration of their salivary cortisol, the major stress hormone released by the hypothalamic-pituitary-adrenal axis.

OBJECTIVE

We investigated how the IPV experienced by women in Cameroon affects their stress levels and those of their children.

METHOD

We recruited 50 mother-child dyads exposed to IPV and a control group of 25 mother-child dyads. All mothers completed questionnaires, including the Revised Conflict Tactics Scale to assess IPV, the Sense of Coherence Scale, and the Self-Esteem Scale, to assess their psychological resources. Mothers were asked to collect 3 saliva samples from themselves and 3 from their children on a single weekday: immediately after waking up, 30 minutes after waking up, and 45 minutes after waking up. The total cortisol secretion over the first hour after awakening was determined by calculating the area under the curve with respect to the ground (AUCg).

RESULTS

Mothers exposed to IPV exhibited higher total post-awakening cortisol concentrations compared with those in the control group. However, no significant difference was found between exposed and non-exposed children. In addition, higher IPV, specifically injuries, was significantly and positively associated with greater AUCg among mothers exhibiting lower self-esteem. When self-esteem was high, however, no significant effect of IPV on AUCg was observed.

CONCLUSIONS

Of particular clinical significance is that self-esteem can modulate the stress levels of women exposed to IPV, a valuable insight into the development of effective psychosocial interventions to support IPV victims in sub-Saharan Africa.

Self-Contempt, the Working Alliance and Outcome in Treatments for Borderline Personality Disorder: An Exploratory Study

Objective. We examined the role of expressed self-contempt in therapy for borderline personality disorder (BPD). Based on previous literature on BPD, we assumed an association between the self-contempt and the core symptoms of BPD. We also studied the progression of expressed self-contempt during the treatment and its effect on the alliance and the outcomes of treatment.Method. We rated the expressed self-contempt in 148 tape-recorded sessions with patients with BPD (N = 50), during a brief psychiatric treatment. We rated self-contempt at three time-points, using an observer-rate scale. Self-reported questionnaires were used to assess symptoms and the working alliance.Results. There are some associations between self-contempt and BPD symptoms. Expressed self-contempt did not change during the treatment. One measure of self-contempt was associated with a weaker alliance rated by the patients and with a stronger alliance rated by the therapists. The expression of high self-contempt was not predictive of outcomes when the initial level of problems was controlled for.Conclusions. The results highlight the importance to examine the complex effects of self-contempt in BPD undergoing treatment in a differentiated manner and suggest to clinicians and researchers to be attentive to this specific emotional state, and change therein, in psychotherapy.Keywords: Self-contempt; Borderline Personality Disorder; Brief Treatment; Therapeutic Alliance; EmotionTrial registration: ClinicalTrials.gov identifier: NCT01896024.

"Tobacco Is the Chief Medicinal Plant in My Work": Therapeutic Uses of Tobacco in Peruvian Amazonian Medicine Exemplified by the Work of a Maestro Tabaquero

Introduction

Harmful usage of tobacco is a public health problem of global concern and, in many countries, the main risk factor for non-communicable diseases. Yet, in the Peruvian Amazon, the geographical region believed to be tobacco’s historical birthplace, this plant is associated with a strikingly different usage and repute: Tobacco (especially Nicotiana rustica L.) in this area is described as a potent medicinal plant, used topically or via ingestion to treat a variety of health conditions. The goal of this transdisciplinary field study was to investigate clinical applications of the tobacco plant as per Amazonian medicine exemplified in the practice of a reputed Maestro Tabaquero, an Amazonian traditional healer whose medical specialization focuses on tobacco-based treatments.

Methods

Using a transdisciplinary clinical approach, we conducted in-depth interviews with the tabaquero applying the systematizing expert interview method, in order to map modes of preparation and administration, indications, contraindications, effects, risks, adverse effects, and systemic aspects of tobacco-based remedies.

Results

The informant’s descriptions revealed refined knowledge on this plant’s therapeutic properties and scope, safety profile, and application techniques. The main indications mentioned included “problems of the mind,” of the respiratory system, parasitic illnesses (intestinal/skin), gout, and Amazonian epistemic conditions described as spiritual-energetic in nature. A liquid remedy taken orally was his most commonly used preparation, with acute/sub-acute effects involving a pronounced psychoactive component (altered state of consciousness) and physiological response (emesis, nausea). A skilled tabaquero that knows how to dose, administer, and intervene in case of adverse effects was considered imperative for safe treatment delivery.

Conclusions

To our knowledge, this is the first study employing a transdisciplinary clinical approach to examine therapeutic applications of tobacco by an Amazonian tabaquero. Our findings significantly contribute to the growing research literature on Amazonian medicine and emergent psychedelic-assisted therapies and could, in the long-term, open new treatment avenues in several domains. Forthcoming studies should assess toxicity/safety and clinical outcomes of patients receiving Amazonian tobacco-based treatment.

Who Turns to Amazonian Medicine for Treatment of Substance Use Disorder? Patient Characteristics at the Takiwasi Addiction Treatment Center

OBJECTIVE

Complementary medicines are an emergent field in the treatment of substance use disorders (SUDs) and include Amazonian medicines, such as ayahuasca. The aim of this multimodal cross-sectional study was to investigate characteristics of people who seek treatment for SUDs at an accredited healthcare facility that applies Amazonian medicines along with conventional psychotherapy.

METHOD

We collected clinical and sociodemographic data of consecutive admissions at the Takiwasi Addiction Treatment Center (Tarapoto, Peru) using structured questionnaires, interviews, and letters submitted upon program application describing motivation for treatment.

RESULTS

The sample of 50 male participants admitted between 2014 and 2016 was culturally heterogeneous, including patients from Peru (42%), other Latin American countries (34%), and North America/Europe (24%). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria indicated dependencies on cannabis (72%), alcohol (52%), cocaine/base paste (48%), and others; multiple substance use was common (84%). Self-reported depression and anxiety scores showed moderate elevation. Comparison of Addiction Severity Index composite scores to a large U.S. sample suggested somewhat more severe problems in the drug and psychiatric domains. Common motives for selecting the program included interest in Amazonian medicine, the Takiwasi concept of treatment, and unfavorable experiences with past treatments. Being motivated by family, a desire for self-transformation, and spiritual/existential motives were common themes for treatment initiation.

CONCLUSIONS

Our results suggest that the Amazonian medicine-based therapy attracts a diverse patient group not limited to regional residents and may be particularly appealing to more impaired SUD patients with a history of unsuccessful treatment. The sample's cultural diversity suggests an existing interest in such therapies among international SUD treatment-seeking patients. These findings are relevant in light of the need for improved SUD therapies and contribute to the emergent research literature on ayahuasca-based treatments.

Effects of hunger on mood and affect reactivity to monetary reward in women with obesity - A pilot study

Worldwide, nearly 3 million people die every year because of being overweight or obese. Although obesity is a metabolic disease, behavioral aspects are important in its etiology. Hunger changes the rewarding potential of food in normal-weight controls. In obesity, impairments related to reward processing are present, but it is not clear whether these are due to mental disorders more common among this population. Therefore, in this pilot study, we aimed at investigating whether fasting influence mood reactivity to reward in people with obesity. Women with obesity (n = 11, all mentally healthy) and normal weight controls (n = 17) were compared on a computerized monetary reward task (the wheel of fortune), using self-reports of mood and affect (e.g., PANAS and mood evaluation during the task) as dependent variables. This task was done in 2 satiety conditions, during fasting and after eating. Partially, in line with our expectation of a reduced affect and mood reactivity to monetary reward in participants with obesity accentuated by fasting, our results indicated a significant within-group difference across time (before and after the task), with monetary gains significantly improving positive affect in healthy controls (p>0.001), but not in individuals with obesity (p = 0.32). There were no significant between-group differences in positive affect before (p = 0.328) and after (p = 0.70) the task. In addition, women with obesity, compared to controls, reported more negative affect in general (p < 0.05) and less mood reactivity during the task in response to risky gains (p < 0.001) than healthy controls. The latter was independent of the level of satiety. These preliminary results suggest an impairment in mood reactivity to monetary reward in women with obesity which is not connected to the fasting state. Increasing the reinforcing potential of rewards other than food in obesity may be one target of intervention in order to verify if that could reduce overeating.

Age influences structural brain restoration during weight gain therapy in anorexia nervosa

Neuroimaging studies on anorexia nervosa (AN) have consistently reported globally reduced gray matter in patients with acute AN. While first studies on adolescent AN patients provide evidence for the reversibility of these impairments after weight gain, longitudinal studies with detailed regional analysis for adult AN patients are lacking and factors associated with brain restitution are poorly understood. We investigated structural changes in anorexia nervosa using T1-weighted magnetic resonance images with surface-based morphometry. The sample consisted of 26 adult women with severe AN and 30 healthy controls. The longitudinal design comprised three time points, capturing the course of weight-restoration therapy in AN patients at distinct stages of weight gain (BMI ≤ 15.5 kg/m²; 15.5 < BMI < 17.5 kg/m²; BMI ≥ 17.5 kg/m²). Compared to controls, AN patients showed globally decreased cortical thickness and subcortical volumes at baseline. Linear mixed effect models revealed the reversibility of these alterations, with brain restoration being most pronounced during the first half of treatment. The restoration of cortical thickness of AN patients negatively correlated with age, but not duration of illness. After weight restoration, residual group differences of cortical thickness remained in the superior frontal cortex. These findings indicate that structural brain alterations of adult patients with severe AN recuperate independently of the duration of illness during weight-restoration therapy. The temporal pattern of brain restoration suggests a decrease in restoration rate over the course of treatment, with patients' age as a strong predictor of brain restitution, possibly reflecting decreases of brain plasticity as patients grow older.

Striatal reactivity to reward under threat-of-shock and working memory load in adults at increased familial risk for major depression: A preliminary study

INTRODUCTION

Anhedonia, a core symptom of Major Depressive Disorder (MDD), manifests as a lack or loss of motivation as reflected by decreased reward responsiveness, at both behavioral and neural (i.e., striatum) levels. Exposure to stressful life events is another important risk factor for MDD. However, the mechanisms linking reward-deficit and stress to MDD remain poorly understood. Here, we explore whether the effects of stress exposure on reward processing might differentiate between Healthy Vulnerable adults (HVul, i.e., positive familial MDD) from Healthy Controls (HCon). Furthermore, the well-described reduction in cognitive resources in MDD might facilitate the stress-induced decrease in reward responsiveness in HVul individuals. Accordingly, this study includes a manipulation of cognitive resources to address the latter possibility.

METHODS

16 HVul (12 females) and 16 gender- and age-matched HCon completed an fMRI study, during which they performed a working memory reward task. Three factors were manipulated: reward (reward, no-reward), cognitive resources (working memory at low and high load), and stress level (no-shock, unpredictable threat-of-shock). Only the reward anticipation phase was analyzed. Imaging analyses focused on striatal function.

RESULTS

Compared to HCon, HVul showed lower activation in the caudate nucleus across all conditions. The HVul group also exhibited lower stress-related activation in the nucleus accumbens, but only in the low working memory (WM) load condition. Moreover, while stress potentiated putamen reactivity to reward cues in HVul when the task was more demanding (high WM load), stress blunted putamen reactivity in both groups when no reward was at stake.

CONCLUSION

Findings suggest that HVul might be at increased risk of developing anhedonic symptoms due to weaker encoding of reward value, higher difficulty to engage in goal-oriented behaviors and increased sensitivity to negative feedback, particularly in stressful contexts. These findings open new avenues for a better understanding of the mechanisms underlying how the complex interaction between the systems of stress and reward responsiveness contribute to the vulnerability to MDD, and how cognitive resources might modulate this interaction.

5'UTR polymorphism in the serotonergic receptor HTR3A gene is differently associated with striatal Dopamine D2/D3 receptor availability in the right putamen in Fibromyalgia patients and healthy controls-Preliminary evidence

BACKGROUND

Extensive literature has investigated the role of serotonin (5-HT) in the control of the central dopamine (DA) systems, and their dysfunction in the pathological conditions. 5-HT stimulates the local DA release in striatal regions via activation of various receptors including serotonin receptor-3 (5-HT3). Several studies have related polymorphisms (SNPs) in the serotonin receptor-3 (HTR3) genes to be associated with the pain modulation and endogenous pain suppression. A few studies suggested a functional role of 5'UTR SNP in the serotonergic receptor HTR3A gene (rs1062613) in the development of the chronic pain and Fibromyalgia syndrome (FMS) in particular. Here, we investigated the effect of a 5'UTR SNP in the serotonergic receptor HTR3A gene (rs1062613) on striatal dopamine D2/D3 receptor (DRD2) availability and reward-associated DA release in response to unpredictable monetary rewards in 23 women with FMS and 17 age-matched healthy female controls. Furthermore, we aimed to examine if SNP rs1062613 is associated with thermal pain and pain tolerance thresholds.

METHODS

We used PET and [¹¹ C]raclopride to assess the DRD2 availability. In the same participants we used the [¹¹ C]raclopride PET bolus-plus-infusion method to measure the [¹¹ C]raclopride receptor binding potential (ΔBP) between an unpredictable reward condition and a sensorimotor control condition. DRD2 availability and ΔBP were assessed in MRI-based striatal regions of interest. Thermal pain and pain tolerance thresholds were assessed outside the scanner.

RESULTS

The frequency of SNP rs1062613 genotype differed significantly between groups, indicating that CC homozygotes were more frequent in FMS patients (82.6%) than in healthy controls (41.3%). Our results showed a significant main effect of SNP rs1062613 on [¹¹ C]raclopride binding potential in the right caudate nucleus indicating a higher DRD2 receptor availability for CC-genotype of this SNP. Furthermore, we found a significant group × SNP interaction on [¹¹ C]raclopride binding potential in the right putamen, indicating a higher DRD2 availability in T-carriers compared to CC genotype of SNP rs1062613 in FMS patients, whereas this effect was not present in healthy controls. However, we did not find an influence of SNP rs1062613 on reward-related DA release. In addition, there was no association between SNP rs1062613 and pain threshold or pain tolerance threshold in our data.

CONCLUSION

These preliminary results indicate that SNP rs1062613 in the serotonergic receptor HTR3A gene possibly modulates the DRD2 receptor availability.

Behavioral Responses to Uncertainty in Weight-Restored Anorexia Nervosa - Preliminary Results

Impaired decision-making under conditions of uncertainty seems to contribute to the expression and maintenance of anorexia nervosa (AN), but it is not clear whether this impairment is a disease state that would remit with treatment, or a persisting trait in patients with AN. To examine this question, a longitudinal study was conducted in 12 female inpatients with AN (age M = 22.2, SE = 1.36), before (Time-1) and after reaching a body mass index of >17.5 kg/m² (Time-2). Intolerance of uncertainty (IU) was assessed via a decision-making task, the wheel of fortune (WOF). Weight gain at Time-2 was accompanied with significant changes in uncertainty-related performance compared to Time-1 [(Time × Uncertainty), p < 0.05]. At Time-1, reaction times (RTs) varied in function of uncertainty, while at Time-2, uncertainty did not modulate RTs. These findings support a change in decision-making under uncertainty with successful weight-rehabilitation in AN. While IU was present in underweight patients, it became non-significant after weight restoration.

Altered circulating endocannabinoids in anorexia nervosa during acute and weight-restored phases: A pilot study

Anorexia nervosa (AN) is an eating disorder characterized by a low food intake and often exceeding exercise, leading to a particularly low body × weight proportion. Patients with AN usually report less hunger than healthy controls. Endogenous endocannabinoids (eCBs), specifically the anandamide, have been associated to hunger, as a meal initiator, but research regarding AN and eCB and inconclusive. In this pilot study, we investigated plasma levels of eCB in inpatients with AN during fasting and after eating, both during the acute AN phase and after weight recovery. After an 8-hr fasting period, blood sample was collected from all participants. After that, participants were given a muffin test meal. Blood samples for the investigation of endogenous eCBs anandamide (N-arachidonoylethanolamide [AEA]) and 2-arachidonoylglycerol (2-AG) were then collected after 120 and 240 min. Participants were only allowed to eat and drink what was offered them during the research. AN reported less hunger than controls during fasting and at the end of the experiment. Also, plasma levels of AEA were significantly smaller in AN in comparison with controls in all time points. No significant difference was found for 2-AG plasma levels. After recovery, no significant difference was found for eCB levels. These findings could be interpreted as an AEA deregulation in AN before and after food intake, which persists after weight recovery. These findings may have implications to the pharmacological treatment of AN and to relapse occurring in the disorder.

Striatal responsiveness to reward under threat-of-shock and working memory load: A preliminary study

INTRODUCTION

Reward and stress are important determinants of motivated behaviors. Striatal regions play a crucial role in both motivation and hedonic processes. So far, little is known on how cognitive effort interacts with stress to modulate reward processes. This study examines how cognitive effort (load) interacts with an unpredictable acute stressor (threat-of-shock) to modulate motivational and hedonic processes in healthy adults.

MATERIALS AND METHODS

A reward task, involving stress with unpredictable mild electric shocks, was conducted in 23 healthy adults aged 20-37 (mean age: 24.7 ± 0.9; 14 females) during functional magnetic resonance imaging (fMRI). Manipulation included the use of (a) monetary reward for reinforcement, (b) threat-of-shock as the stressor, and (c) a spatial working memory task with two levels of difficulty (low and high load) for cognitive load. Reward-related activation was investigated in a priori three regions of interest, the nucleus accumbens (NAcc), caudate nucleus, and putamen.

RESULTS

During anticipation, threat-of-shock or cognitive load did not affect striatal responsiveness to reward. Anticipated reward increased activation in the ventral and dorsal striatum. During feedback delivery, both threat-of-shock and cognitive effort modulated striatal activation. Higher working memory load blunted NAcc responsiveness to reward delivery, while stress strengthened caudate nucleus reactivity regardless reinforcement or load.

CONCLUSIONS

These findings provide initial evidence that both stress and cognitive load modulate striatal responsiveness during feedback delivery but not during anticipation in healthy adults. Of clinical importance, sustained stress exposure might go along with dysregulated arousal, increasing therefore the risk for the development of maladaptive incentive-triggered motivation. This study brings new insight that might help to build a framework to understand common stress-related disorders, given that these psychiatric disorders involve disturbances of the reward system, cognitive deficits, and abnormal stress reactivity.

Short-Term Treatment Effects of a Substance Use Disorder Therapy Involving Traditional Amazonian Medicine

Chronic illness management today commonly involves alternative medicines. Substance use disorder (SUD), as a chronic psychosomatic illness, might benefit from a similar approach. The accredited Takiwasi Center offers such an SUD treatment program involving Amazonian medicine combined with psychotherapy. The current study assessed this integrative program's short-term therapeutic effects. We measured baseline data from 53 dependence-diagnosed males admitted to treatment (T1) and repeated clinical outcome variables at treatment completion (T2). Paired samples t-tests were used to assess changes between T1 and T2 (n = 36). Nearly all participants (age M= 30.86, SD= 8.17) were dependent on multiple substances, most prominently cannabis, alcohol, and cocaine-related drugs. A significant decrease (T1 to T2) was found for addiction severity outcomes drug use (p < .001), alcohol use (p < .001), psychiatric status (p < .001), and social/familial relationships (p < .001). Emotional distress also diminished significantly (p < .001), as did substance craving (p < .001). Quality of life increased significantly from T1 to T2 (p < .001). Our results provide first indications for significantly improved SUD symptoms after the Amazonian medicine-based treatment. These findings are preliminary given the design, but strongly encourage further investigation of this therapy, which in the long term may open new therapeutic avenues for SUDs.

An Internet-Based Intervention for the Relatives of People with Mental Illnesses

Abstract. Relatives of individuals with mental illness are exposed to an elevated level of burden. Consequently, it is important to provide them with coping strategies. We explored the benefits of an online skills-training intervention. This open, uncontrolled interventional pilot study included 104 relatives of individuals with a mental illness. They participated either in a face-to-face group ( n = 60) or online intervention ( n = 44); participants were free to choose the type of intervention. Depressive symptoms and emotion regulation were assessed before and after the interventions. The analysis was based on an intention-to-treat model. About one-third of both samples did not complete the posttest assessments. The results of a multivariate analysis of variance revealed a significant effect of the interaction between time and intervention type, F(2,101) = 11.77, p < .01. Reductions in depressive symptoms, F(1,102) = 9.41, p < .01, ε2p = .08, and emotion-regulation difficulty, F(1,102) = 8.01, p < .01, ε2p = .07, following the online intervention were greater relative to the group intervention. Despite the limitations of this study because of group differences, the results demonstrated the benefits of an online intervention for the relatives. These encouraging initial results require further confirmation using a randomized controlled trial.

Effects of Institutionalization and Parental Living Status on Children's Self-Esteem, and Externalizing and Internalizing Problems in Rwanda

The negative effects of institutionalization on children's wellbeing and psychological adjustment have been extensively documented. Throughout the world, particularly in developing countries, many children in residential child care institutions known as orphanages have parents, and it is not clear how this situation affects the psychological adjustment of institutionalized children. This study aimed at investigating specifically whether institutionalization impacts negatively children's psychological adjustment defined in terms of externalizing and internalizing behavior problems and self-esteem and whether having living parents or not has an additional influence. Children were recruited in Rwanda from seven registered institutions and six primary schools. Ninety-six institutionalized children (48 orphans, who lost at least one parent, and 46 non-orphans, who had both parents living) and 84 non-institutionalized children, who lived in a family (28 orphans and 56 non-orphans) aged 9 to 16 participated. The caregivers or parents assessed externalizing and internalizing behavior problems using the Child Behavior Checklist. Children completed the Coopersmith Self-Esteem Inventory. Controlling for gender, age, and residential area, analyses of covariance revealed that institutionalized children had significantly more externalizing behavior problems than had non-institutionalized children. In addition, non-orphans had more externalizing behavior problems than had orphans, regardless of whether they lived in an institution or not. There were no group differences in internalizing behavior problems, but there was a significant main effect of the parental living status (orphans vs. non-orphans) and a significant interaction effect between parental living status and institutionalization on self-esteem. Self-esteem of non-orphans in families was significantly higher than self-esteem of the other groups. This should be considered when making the decision to place a child in an institution, especially when her or his parents are still living, and when developing supportive programs for children without adequate parental care.

Short-Term Effects of a Multidimensional Stress Prevention Program on Quality of Life, Well-Being and Psychological Resources. A Randomized Controlled Trial

It is well-documented that university students have an increased risk in developing psychological problems because they face multiple stressors. Cognitive, behavioral, and mindfulness-based stress prevention programs were shown to reduce symptoms of anxiety, depression, and perceived stress in university students. However, little is known of their effect on resource activation. Additionally, most validated interventions are unidimensional, i.e., including one stress-coping approach. In this study, we investigated the short-term effects of a multidimensional stress prevention program on students' quality of life, psychological symptoms and resources, and resilience factors against stress. Using an experimental design, 64 healthy undergraduate students (56 women), between 18 and 34 years old (M = 21.34, SD = 2.53), from the University of Fribourg, Switzerland, were randomly allocated either to the intervention or the wait-list control group. The intervention group participated in a multidimensional stress prevention program, integrating mindfulness-based activities, cognitive and behavioral strategies, social skills, and emotional regulation exercises. The program consisted of eight 2-h weekly sessions. Before and after the intervention, participants completed self-reported questionnaires evaluating quality of life; psychological symptoms such as depression, anxiety, social anxiety, and interpersonal problems; as well as psychological resources like self-efficacy, sense of coherence, self-compassion, and social support, presented online. A standardized clinical interview was performed at pre- and post-measurement times. To analyze the sort-term effects of the program, we used mixed, two-factorial ANOVAs (per-protocol analyses). In accordance with our hypotheses, our results showed significant reduction of psychological symptoms, including anxiety, interpersonal problems, and symptoms of pain; a significant increase in quality of life, sense of coherence, and self-compassion in students who participated in the intervention program compared to the control group, (all p < 0.05). No significant results were found for symptoms of depression, social anxiety, self-efficacy, and social support. These preliminary findings indicate specific short-term effects of our multidimensional stress prevention program on psychological symptoms and on quality of life as well as promising effects on psychological resources and factors associated with resilience against stress. Future studies should investigate the long-term effects of the intervention as well as the effects in clinical samples.

Trauma exposure and the mediating role of posttraumatic stress on somatic symptoms in civilian war victims

BACKGROUND

It has been well documented that the exposure to war has a negative effect on the psychological health of civilian. However, little is known on the impact of war exposure on the physical health of the civilian population. In addition, the link between trauma exposure and somatic symptoms remain poorly understood. This cross-sectional study examined levels of somatic symptoms in the aftermath of war, and the mediating role of posttraumatic stress symptoms in the relationship between trauma exposure and somatic symptoms.

METHODS

Civilian war survivors (N = 142) from Kosovo were assessed for potentially traumatic events, posttraumatic stress symptoms, and somatic symptoms. Data were analyzed using mediation analyses. Posttraumatic stress disorder (PTSD) symptoms were categorized based on King's four factor model (Psychol Assessment. 10: 90-96, 1998).

RESULTS

Participants reported on average more than 5 types of traumatic exposure. The cut-off indicative for PTSD was exceeded by 26.1% of participants. Symptom levels of PTSD were associated with somatic symptoms. The relationship between trauma exposure and somatic symptoms was partly mediated by the active avoidance and hyperarousal symptom clusters of PTSD.

CONCLUSION

Active avoidance and hyperarousal symptoms seem to play a key role in traumatized people suffering from somatic symptoms.

Burnout, Psychological Symptoms, and Secondary Traumatic Stress Among Midwives Working on Perinatal Wards: A Cross-Cultural Study Between Japan and Switzerland

The aim of this study was to explore cross-cultural differences in symptoms of burnout, anxiety, depression, general psychological distress, and secondary traumatic stress between Asian (Japan) and European (Switzerland) midwives. One hundred seventy midwives participated in the study. There were significant differences in age group [χ²(3) = 24.2, p < 0.01], marital or relationship status [χ²(2) = 28.4, p < 0.01], and years of experience [χ²(2) = 17.8, p < 0.01] between the two countries. The Japanese staff were younger, more often unmarried, and had less experience than the Swiss staff. The mean score of depersonalization was significantly higher in Switzerland (4.8 ± 3.8) than in Japan (3.2 ± 3.7; |z| = 2.71, p < 0.01). The mean score of general psychological distress in the Swiss sample (12.8 ± 6.5) was significantly higher than that in the Japanese sample (10.3 ± 6.2; |z| = 2.04, p = 0.04). In addition, the mean score of secondary traumatic stress was higher in the Swiss sample (31.8 ± 9.7) than in the Japanese sample (24.1 ± 8.6; |z| = 4.56, p < 0.01). These results may reflect cultural differences such as working conditions or family environment between Japan and Switzerland.

Conceptions and practices of an integrative treatment for substance use disorders involving Amazonian medicine: traditional healers' perspectives

Objective:

The harmful use of psychoactive substances represents one of today’s largest public health problems. Yet, in spite of its global relevance, current treatment for substance use disorders (SUDs) is still not entirely successful. The purpose of this study was to investigate alternative treatments and conceptions from traditional Amazonian medicine adapted to SUDs.

Methods:

We conducted semi-structured interviews with 13 practicing experts at a well-established addiction treatment center in the Peruvian Amazon and performed qualitative content analysis on the collected data. Main categories were deductively defined and corresponding subcategories inductively developed.

Results:

Our findings revealed characteristic features and consequences, causes and antecedents, and treatment methods of SUDs as the main categories. Overall, concepts of disease etiology bore resemblance with contemporary biopsychosocial models of SUDs. The Amazonian therapeutic means however differed markedly from current Western ones. The main methods involved dietary retreats, healing ceremonies, and purging rituals. The integral application of Amazonian methods, as well as their traditional implementation according to prescribed ritual protocols, were emphasized by the experts as crucial for efficacy and safety of treatment delivery.

Conclusion:

We suggest further scientific attention to these therapies, including clinical studies, for which our results provide conceptual underpinnings. Findings from this research expand the cross-cultural understanding of SUDs and, in the long run, may enhance its treatment options.

Discriminative evaluative conditioning in the long-term after severe accidental injury

Impairments in classical fear conditioning and deficits in discriminative learning are observed in posttraumatic stress disorder (PTSD). However, it is unknown whether similar impairments can be found with types of discriminative learning other than classical conditioning, such as evaluative conditioning (EC), in which the valence of a stimulus can be transferred to other stimuli. In this study, we investigated whether EC is also influenced by traumatic experiences independently of presence of PTSD. We tested 14 accident survivors with remitted PTSD, 14 survivors without PTSD, and 16 non-trauma controls. We used behavioral measures, psychophysiological indicators, and subjective ratings for tasks. General effects of learning were observed across groups and conditioning/extinction. Trauma controls had slower reaction times (RTs) to the aversive conditioned stimulus compared to appetitive conditioned and neutral stimuli, as well as slower RTs and increased accuracy during conditioning than during extinction. Remitted PTSD participants showed opposite results, demonstrating decreased accuracy and slower RTs during conditioning as compared to during extinction. No discriminative effect was found in the non-trauma controls and the remitted PTSD participants. These results suggest that a traumatic experience influences EC, and that this influence differs between individuals who have and have not developed PTSD after traumatic exposure.

Post-transplant outcome-clusters of psychological distress and health-related quality of life in lung transplant recipients

QUESTIONS UNDER STUDY

To (1) assess distinct clusters of psychological distress and health-related quality of life during the first 6 months following lung transplantation; (2) identify patients with poor psychosocial outcomes; and (3) determine potential predictors regarding psychological distress and health-related quality (HRQoL) of life at 6 months post-transplant.

METHODS

A total of 40 patients were examined for psychological distress (Symptom Checklist short version-9) and quality of life (EuroQOL five-dimension health-related quality of life questionnaire) during their first 6 months post-transplant. Hierarchical cluster analyses were performed to identify specific types of post-transplant outcomes in terms of psychological distress and HRQoL over the first six post-transplant months. Correlational analyses examined medical and psychosocial predictors of the outcome at 6 months post-transplant.

RESULTS

Three distinctive clusters were identified, summarizing either groups of patients with (1) optimal (35%), (2) good (42%), and (3) poor outcome-clusters (23%). The latter tended to be older, to suffer from more severe disease, to have more co-morbidities, to have had a prolonged intensive care unit and/or hospital stay, to have more hospital admissions and were more frequently treated with antidepressants post-transplant. Disease severity, length of stay, quality of life two weeks post-transplant, hospital admissions and use of antidepressants were strong predictors of psychological distress and impaired health-related quality of life at six months of follow-up.

CONCLUSION

Almost a quarter of the investigated patients suffered from elevated distress and substantially impaired HRQoL, with no improvements over time. Results underscore the psychosocial needs of patients with poor post-transplant outcomes.

Use of inpatient rehabilitation for cancer patients in Switzerland: who undergoes cancer rehabilitation?

QUESTION UNDER STUDY

Rehabilitation for cancer patients aims to reduce physical disability and mental distress resulting from the disease and its treatment. However, little is known about the use of cancer inpatient rehabilitation in Switzerland in relation to sociodemographic and medical characteristics. The main purpose of this study was to evaluate whether there are differences in sociodemographic and medical characteristics between patients who underwent inpatient rehabilitation (users) and those who did not (nonusers).

METHODS

A total of 238 cancer patients from the University Hospital Zurich were included. The sociodemographic and medical characteristics of inpatient rehabilitation users were assessed and compared with those of nonusers. We analysed the differences between inpatient rehabilitation users and nonusers.

RESULTS

Of the patients included, 101 (42.4%) used inpatient rehabilitation. They were less likely to be employed (p = 0.029), stayed longer in hospital (p <0.001), and were more likely to have semiprivate or private supplementary health insurance (p = 0.030) than nonusers. There were differences in cancer site (p = 0.001). Patients with tumours of the digestive organs or of the thoracic organs were more likely to use rehabilitation, whereas breast cancer patients were less likely to use it. Stratified analyses showed that male patients with semiprivate or private supplementary health insurance (p = 0.037), lower education (p = 0.039), and lower likelihood of employment (p = 0.051) were more likely to use rehabilitation. Women with an advanced tumour stage used inpatient rehabilitation more often (p = 0.012).

CONCLUSIONS

Findings show the influence of duration of hospitalisation, insurance type, cancer site, employment status, and gender on the use of inpatient cancer rehabilitation. The results indicate the need of structured standardised procedures for medical referral to be implemented based on screening.

Acoustic Emotional Processing in Patients With Borderline Personality Disorder: Hyper- or Hyporeactivity?

Earlier studies have demonstrated emotional overreactions to affective visual stimuli in patients with borderline personality disorder (BPD). However, contradictory findings regarding hyper- versus hyporeactivity have been reported for peripheral physiological measures. In order to extend previous results, the authors investigated emotional reactivity and long-term habituation in the acoustic modality. Twenty-two female BPD patients and 19 female nonclinical controls listened to emotionally negative, neutral, and positive sounds in two identical sessions. Heart rate, skin conductance, zygomaticus/corrugator muscle, and self-reported valence/arousal responses were measured. BPD patients showed weaker skin conductance responses to negative sounds than controls. The elevated zygomaticus activity in response to positive sounds observed in controls was absent in BPD patients, and BPD patients assigned lower valence ratings to positive sounds than controls. In Session 2, patients recognized fewer positive sounds than controls. Across both groups, physiological measures habituated between sessions. These findings add to growing evidence toward partial affective hyporeactivity in BPD.

Blunted responses to reward in remitted post-traumatic stress disorder

BACKGROUND

Recent evidence suggests blunted responses to rewarding stimuli in patients with post-traumatic stress disorder (PTSD). However, it is not clear whether these alterations in reward processing normalize in remitted PTSD patients.

METHODS

We tested behavioral and physiological responses to monetary reward in a spatial memory task in 13 accident survivors with remitted PTSD, 14 accident survivors who never had PTSD, and 16 nontrauma-exposed subjects. All accident survivors were recruited from two samples of severely physically injured patients, who had participated in previous prospective studies on the incidence of PTSD after accidental injury approximately 10 years ago. Reaction time, accuracy, skin conductance responses, and self-reported mood were assessed during the task.

RESULTS

Accident survivors who never had PTSD and nontrauma exposed controls reported significantly higher positive mood in the reinforced versus nonreinforced condition (P < 0.045 and P < 0.001, respectively), while there was no effect of reinforcement in remitted PTSD subjects.

CONCLUSIONS

Our findings suggest an alteration of the reward system in remitted PTSD. Further research is needed to investigate whether altered reward processing is a residual characteristic in PTSD after remission of symptoms or, alternatively, a preexisting risk factor for the development of PTSD after a traumatic event.

A systematic review of health-related quality of life and psychological outcomes after lung transplantation

BACKGROUND

Lung transplantation (LTx) aims to reduce physical disability and mental distress, extend survival, and improve health-related quality of life (HRQoL). In this systematic review we aimed to: (1) augment evidence regarding measures to assess HRQoL and psychological outcomes after LTx; and (2) summarize HRQoL and psychological outcomes after LTx.

METHODS

Validated and standardized instruments with well-known psychometric properties used for assessing HRQoL and psychological outcomes after LTx were identified by means of comprehensive literature searches of PsychINFO and Medline/PubMed, up through March 2014, using the following search terms in various combinations: lung transplantation; physical functioning; symptom experience; mental health; anxiety; depression; distress; social functioning; life satisfaction; and health-related quality of life.

RESULTS

The search strategy identified 371 titles and abstracts. Of these, 279 were retrieved for further assessment and 63 articles selected for final review. Thirty-nine studies were found for HRQoL, 15 for physical functioning, 5 for mental health and 4 for social functioning. A total of 50 psychometric instruments were encountered.

CONCLUSIONS

Considerable heterogeneity exists in methodology, operational concepts and applied outcome measures in the existing literature on HRQoL and psychological outcomes after LTx. Nevertheless, the studies generally point to significant improvements in both mental health and HRQoL post-transplant. Further research is warranted utilizing consistent outcome measures, including LTx-specific measures and longitudinal study designs.