Cérebro, estresse e defesa: elementos para uma teoria neurocientífica do trauma psicológico / Brain, stress and defense: elements for a neuroscientific theory of psychological trauma / Cerebro, estrés y defensa: elementos para una teoría neurocientífica del trauma psicológico / Cerveau, stress et défense: éléments pour une théorie neuroscientifique du trauma psychologique

As condições psicopatológicas decorrentes de acontecimentos traumáticos vêm progressivamente recebendo interpretações de natureza neurocientífica. Com isso, experiências humanas devastadoras são reduzidas ao funcionamento perturbado de sistemas neurofisiológicos atribuídos às respostas de estresse. Através de revisão narrativa, este artigo procura explorar algumas das condições epistemológicas elementares ao surgimento de uma teoria neurocientífica do estresse traumático, demonstrando a solidariedade que ela conserva com a teoria evolucionária e com a pesquisa do condicionamento clássico em animais. Espera-se que este trabalho possa salientar algumas das repercussões éticas da negligência dos fatores sociais e culturais nas interpretações dos fenômenos secundários ao traumatismo

Psychopathological conditions resulting from traumatic events have increasingly received neuroscientific interpretations, reducing the complexity of devastating human experiences to the disturbed functioning of neurophysiological systems attributed to stress responses. This narrative review explores some epistemological conditions essential to fashioning a neuroscientific theory of traumatic stress, showing the solidarity it maintains with evolutionary theory and with research on classical conditioning in animals. We hope this work can highlight some of the ethical repercussions in neglecting social and cultural factors when interpreting secondary trauma phenomena

Las condiciones psicopatológicas resultantes de eventos traumáticos han recibido progresivamente interpretaciones neurocientíficas. Como resultado, las devastadoras experiencias humanas vieron reducidas su complejidad al funcionamiento perturbado de los sistemas neurofisiológicos atribuidos a las respuestas al estrés. A partir de una revisión narrativa, este artículo buscará explorar algunas de las condiciones epistemológicas esenciales para el surgimiento de una teoría neurocientífica del estrés traumático, demostrando la solidaridad que mantiene con la teoría evolutiva y con la investigación sobre el condicionamiento clásico en animales. Se espera que este trabajo pueda resaltar algunas de las repercusiones éticas de descuidar los factores sociales y culturales en la interpretación de los fenómenos secundarios de trauma

Les conditions psychopathologiques résultant d'événements traumatiques ont progressivement reçu des interprétations neuroscientifiques, en réduisant la complexité des expériences humaines dévastatrices au fonctionnement perturbé des systèmes neurophysiologiques attribué aux réponses au stress. Cette revue narrative explore quelques conditions épistémologiques essentielles pour élaborer une théorie neuroscientifique du stress traumatique, démontrant la solidarité qu'elle entretient avec la théorie évolutionniste et avec les recherches sur le conditionnement classique. On espère que ce travail pourra mettre en évidence certaines des répercussions éthiques associées à la négligence des facteurs sociaux et culturels dans l'interprétation des phénomènes traumatiques secondaires

Defibulation can recall the trauma of female genital mutilation/cutting: a case report.

BACKGROUND: Women with female genital mutilation/cutting are known to have psychological sequelae from the cutting and other traumatic experiences. However, very few studies report immediate psychological sequelae of genital reconstructive surgery in this population. The present case is the first to our knowledge to report post-traumatic stress disorder symptoms immediately following defibulation, a procedure common in women with female genital mutilation/cutting type III. CASE PRESENTATION: We present the case of a 31-year-old Sudanese nulliparous woman in the second trimester of pregnancy with female genital mutilation/cutting type IIIa who was referred for antepartum defibulation to facilitate a vaginal birth. Immediately after an uncomplicated surgery under local anesthesia and just before the first micturition, she developed post-traumatic stress disorder symptoms and suddenly recalled the traumatic experience of her first micturition after female genital mutilation/cutting when she was a child in Sudan. The woman was offered psychiatric follow-up with psychotherapy for 4 months and a short course of benzodiazepines. She had fully recovered by the time of delivery, 4 months after surgery. CONCLUSIONS: We discuss the possibility of recall of a past traumatic experience of female genital mutilation/cutting during defibulation or other genital surgeries. We review the benefits and risks of defibulation, the impact of this procedure, and the setting and timing in which it is performed, focusing on women's mental health and psychological support.

The moderation of maternal parenting on the association of trauma, dissociation, and psychosis in depressive inpatients.

Background: The effect of dissociation and parenting style on the relationship between psychological trauma and psychotic symptoms has not previously been investigated. Objective: The aim of this study was to develop a moderated mediation model to assess whether the association between psychological trauma and psychotic symptoms is mediated by dissociation and moderated by parental maltreatment. Methods: Inpatients with major depressive disorder (MDD) and bipolar depression (BP) were recruited. Self-reported and clinical rating scales were used to measure the level of dissociation, psychotic symptoms, history of psychological trauma and parental maltreatment. The PROCESS macro in SPSS was used to estimate path coefficients and adequacy of the moderated mediation model. High betrayal trauma (HBT), low betrayal trauma (LBT), paternal maltreatment, and maternal maltreatment were alternatively entered into the conceptual model to test the adequacy. Results: A total of 91 patients (59 with MDD and 32 with BP) were recruited, with a mean age of 40.59 ± 7.5 years. After testing with different variables, the moderated mediation model showed that the association between LBT and psychotic symptoms was mediated by dissociation and moderated by maternal maltreatment. A higher level of maternal maltreatment enhanced the effect of LBT on dissociation. Conclusions: Healthcare workers should be aware of the risk of developing psychotic symptoms among depressive patients with a history of LBT and maternal maltreatment.

Antecedentes: El efecto de disociación y el estilo parental en la relación entre el trauma psicológico y los síntomas psicóticos no se han investigado previamente.Objetivo: El objetivo de este estudio fue desarrollar un modelo de mediación moderada para evaluar si la asociación entre trauma psicológico y síntomas psicóticos es mediada por la disociación y moderada por el maltrato de los padres.Métodos: Fueron reclutados pacientes hospitalizados con trastorno depresivo mayor (TDM) y depresión bipolar (DB). Se utilizaron escalas clínicas y de auto-reporte para medir el nivel de disociación, síntomas psicóticos, antecedentes de trauma psicológico y maltrato de los padres. La macro PROCESS en SPSS se utilizó para estimar los coeficientes de ruta y adecuación del modelo de mediación moderada. Alto exposición al trauma de traición (HET), baja exposición al trauma de traición (BET), maltrato paterno y maltrato materno fueron alternativamente ingresados en el modelo conceptual para probar la adecuación.Resultados: Se reclutaron un total de 91 pacientes (59 con TDM y 32 con DB), con una edad media de 40,59 ± 7,5 años. Después de probar con diferentes variables, el modelo moderado de mediación mostró que la asociación entre BET y síntomas psicóticos estuvo mediada por la disociación y moderada por el maltrato materno. Un nivel superior del maltrato materno aumentó el efecto de BET sobre la disociación.Conclusiones: Los trabajadores del área de la salud deben ser conscientes del riesgo del desarrollo de síntomas psicóticos entre los pacientes depresivos con antecedentes de BET y maltrato materno.

Disparities, desperation, and divisiveness: Coping with COVID-19 in India.

India enforced one of the world's largest lockdowns in the last quarter of March 2020 to minimize the impact of the COVID-19 pandemic. This commentary focuses on the mental health implications of the ongoing pandemic as well as the lockdown that lasted for more than two months and is still in place in certain areas. Whereas loneliness, stress, anxiety, and depression have been widespread, vulnerable sections of the population, including daily wage workers, migrant laborers, religious minorities, women and children, and the elderly, have been facing various forms of economic, sociopolitical, and familial stigma, racism, and violence. By and large, the COVID-19 pandemic has widened all forms of societal disparities in India. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Unseen Costs: The Direct and Indirect Impact of U.S. Immigration Policies on Child and Adolescent Health and Well-Being.

Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child-parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents who were separated from their parents, detained, and placed in the custody of the United States following the implementation of the 2018 Zero Tolerance Policy. Economic modeling techniques, including a Markov process and Monte Carlo simulation, based on data from the National Child Traumatic Stress Network's Core Data Set (N = 458 migrant youth) and published studies were used to estimate economic costs associated with three immigration policies: No Detention, Family Detention, and Zero Tolerance. Clinical evaluation data on mental health symptoms and disorders were used to estimate the initial health state and risks associated with additional trauma exposure for each scenario. The total direct and indirect costs per child were conservatively estimated at $33,008, $33,790, and $34,544 after 5 years for No Detention, Family Detention, and Zero Tolerance, respectively. From a health system perspective, annual estimated spending increases ranged from $1.5 million to $14.9 million for Family Detention and $2.8 million to $29.3 million for Zero Tolerance compared to baseline spending under the No Detention scenario. Border control policies that increase the likelihood of child and adolescent trauma exposure are not only morally troubling but may also create additional economic concerns in the form of direct health care costs and indirect societal costs.

Emotional impact of the COVID-19 pandemic on U.S. health care workers: A gathering storm.

The COVID-19 pandemic is placing enormous stress on U.S. health care workers. Prior studies of infectious disease outbreaks and other catastrophic events have shown the damaging mental health impacts caused by these events. Implications for the policy and treatment of health care workers facing the COVID-19 crisis are discussed in this commentary. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Moral and mental health challenges faced by maternity staff during the COVID-19 pandemic.

The current COVID-19 pandemic places maternity staff at risk of engaging in clinical practice that may be in direct contravention with evidence; professional recommendations; or, more profoundly, deeply held ethical or moral beliefs and values, as services attempt to control the risk of cross-infection. Practice changes in some settings include reduction in personal contacts for tests, treatments and antenatal and postnatal care, exclusion of birth partners for labor and birth, separation of mother and baby in the immediate postnatal period, restrictions on breastfeeding, and reduced capacity for hands-on professional labor support through social distancing and use of personal protective equipment. These enforced changes may result in increasing levels of occupational moral injury that need to be addressed at both an organizational and a personal level. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Home is not always a haven: The domestic violence crisis amid the COVID-19 pandemic.

The novel coronavirus (SARS-CoV-2) and the associated disease it causes, COVID-19, have caused unprecedented social disruption. Due to sweeping stay-at-home orders across the United States and internationally, many victims and survivors of domestic violence (DV), now forced to be isolated with their abusers, run the risk of new or escalating violence. Numerous advocates, organizations, and service centers anticipated this: Upticks in domestic violence were reported in many regions soon after stay-at-home directives were announced. In this commentary, we delineate some of the recent events leading up to the reported spike in DV; review literature on previously documented disaster-related DV surges; and discuss some of the unique challenges, dilemmas, and risks victims and survivors face during this pandemic. We conclude with recommendations to allocate resources to DV front-liners and utilize existing DV guidelines for disaster preparedness, response, and recovery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychotherapists' vicarious traumatization during the COVID-19 pandemic.

During the COVID-19, psychotherapists are often exposed to traumatic material in their sessions, potentially leading to vicarious traumatization. We surveyed 339 therapists about their professional practices and experiences during the pandemic. Results showed that on average therapists experienced moderate levels of vicarious trauma, whereas about 15% experienced high levels of vicarious trauma. A higher level of vicarious trauma was associated with younger age, less clinical experience, and negative online treatment experiences. The results imply a need for personal and professional support for therapists working remotely amid a global health crisis. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Collective trauma and community support: Lessons from Detroit.

The COVID-19 crisis can be defined as a collective trauma, which contributes to an upheaval of community connection and functioning. The current pandemic has also illuminated disparities in mental health supports. In this commentary, we highlight one community organization, located in metro Detroit, that has responded to the trauma by bolstering resources and supports for residents, many of whom are ethnoracial minorities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Mental health impact of the COVID-19 pandemic in Japan.

As of May 20, 2020, the COVID-19 death toll in Japan was 771. The 2020 Tokyo Olympics/Paralympics had to be postponed to 2021 because of the pandemic. Not only the infected patients but also health care workers have been affected from adverse societal dynamics because of COVID-19, such as discrimination and stigmatization. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Tending and mending: Affiliative responses to the COVID-19 pandemic by healthcare professionals in Italy.

The physical and social isolation measures associated with the 2019 novel coronavirus (COVID-19) outbreak, although certainly necessary to contain the spread of the virus, represent a particularly distressing aspect that might accentuate the fears and pain associated with the disease, especially for patients, their family members, and health-care professionals. Affiliative responses to the crises are emerging as ad hoc or formally endorsed practices within COVID-19 facilities in Italy, aimed at establishing links of communication between patients and family members by using new communication technologies. Tending to the emotional needs of patients and mending the affiliative connections interrupted by the disease are good examples of interdisciplinary cohesion and affiliative responses to the COVID-19 emergency. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Defining trauma and a trauma-informed COVID-19 response.

The ubiquitous exposure to COVID-19 argues for governments to use a trauma-informed response as a universal precaution, with the goal of promoting the recovery and resilience of their residents. How a system defines trauma will drive its administrative policies, research, and clinical services. The Substance Abuse and Mental Health Services Administration's Concept of Trauma and Guidance for a Trauma-Informed Approach offers governments a framework to define trauma and incorporate trauma-informed principles and tasks into their COVID-19 responses. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

LGBTQ populations: Psychologically vulnerable communities in the COVID-19 pandemic.

In the wake of the 2019 novel coronavirus (COVID-19) pandemic and the psychological consequences that will follow, it is critical to acknowledge and understand the unique vulnerabilities of lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) populations in order to provide equitable mental health intervention that reaches these highly at-risk groups. It is well established that LGBTQ persons face social disadvantages and mental health disparities, which may be exacerbated as a result of COVID-19 pandemic trauma and social isolation measures. This commentary highlights structural, social, and individual-level challenges among LGBTQ populations in the context of COVID-19 and proposes prevention recommendations to mitigate the psychological ramifications of COVID-19 pandemic-related trauma among LGBTQ persons. (PsycInfo Database Record (c) 2020 APA, all rights reserved).