Late-onset delirious mania: Does it ring a bell?

BACKGROUND: Bell's mania was first described in 1849, and other terms have been used to describe this condition, including delirious mania, mania with delirium, and excited delirium. However, no international diagnostic manual has included mania as an independent diagnostic tool. The criteria for delirious mania were proposed by Bond et al. METHODS: We present a case of a man without a personal or family psychiatric history who experienced his first manic episode of delirium and psychosis at 76 years old. CONCLUSIONS: The case described in this study is compatible with mood disorders, the original description of Bell's mania, and Bond's definition of delirious mania. Although rare, extremely late-onset primary mania can occur without personal or family psychiatric history. The initial clinical presentation of delirium requires a thorough medical investigation, including magnetic resonance imaging (MRI) and lumbar puncture with neuronal antibodies. The addition of delirious mania to the group of bipolar disorders in future editions of The International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM) has therapeutic and prognostic implications. The Bond criteria can provide valuable information in this respect. Further investigations are necessary to clarify the pathophysiology and epidemiology of delirious mania.

[Prevalence and intensity of nightmares in traumatized versus non-traumatized children and adolescents]. / Häufigkeit und Intensität von Alpträumen bei traumatisierten im Vergleich zu nicht traumatisierten Kindern und Jugendlichen.

OBJECTIVE: Nightmares may be seen as a symptom of traumatization in both children and adults. Nightmares are assumed to be more frequent and more distressing among traumatized children and adolescents than among those without trauma. A total of 38 traumatized and 40 nontraumatized children and adolescents were surveyed. METHOD: Nightmare-induced stress was measured with a questionnaire comprised of nine items (some of which concerned nightmare frequency and perceived intensity). RESULTS: Traumatized children and adolescents overall report a significantly higher number of nightmares, which they perceive in a more intense and frightening way than their control group counterparts. Traumatized children and adolescents reported an average of 9.7 nightmares per month compared to 1.7 in nontraumatized participants. The number of nightmares in traumatized girls was twice that in traumatized boys. CONCLUSIONS: Traumatized children and adolescents report fears of dream repetitions as well as feelings of helplessness during the nightmares and are thus influenced during the daytime significantly more often. Traumatized patients have more life-threatening and violent dreams. An increased frequency of nightmare and distress is also a specific feature in traumatized children and adolescents.

Short-term eye movement desensitization and reprocessing (EMDR) therapy to treat children with posttraumatic stress symptoms after single trauma: A case series.

BACKGROUND: Traumatic experiences can lead to posttraumatic stress disorder (PTSD). For young children, even minor, inconspicuous looking events can lead to posttraumatic stress symptoms. Trauma-focused treatment with Eye Movement Desensitization and Reprocessing (EMDR) offers children an age-adapted intervention to help them successfully process traumatic experiences. So far, there has been a lack of well evaluated trauma-focused treatments for young children. METHODS: These case series examine the effectiveness of a short-term treatment with EMDR therapy for children showing PTSD symptoms after experiencing a single incident induced trauma. Five children between 5 and 10 years of age who developed PTSD after a single incident trauma received a manualized EMDR treatment for 6 weeks (mean number of sessions: seven including a mean number of EMDR sessions: 3.4). Posttraumatic stress symptoms were assessed prior to treatment, following treatment and at a 3-month follow-up with standardized instruments for caregivers and children. RESULTS: PTSD symptoms decreased for all children after completing the treatment from clinical to non-clinical level. Reductions in vegetative hyperarousal, fears and clinging behaviour were achieved. Furthermore, reductions in the parental stress levels, as well as a recovery of everyday routine and everyday stability were observed. CONCLUSION: Short-term EMDR treatment appears to be a promising treatment for single incident trauma in young children providing a potentially successful quick and safe psychological treatment for children. Results contribute to the knowledge of feasibility and acceptability of short-term, trauma-focused treatments of children with EMDR. Replication of the results of these case series in larger samples using a randomized controlled design is warranted.

[Evaluation of outpatient treatment units according to the Crime Victims' Regulation Act]. / Evaluation der Traumaambulanzen nach dem Opferentschadigungsgesetz in Nordrhein-Westfalen.

OBJECTIVE: Over the past years, 35 trauma outpatient units have been established in accordance with the Crime Victims' Compensation Act in the federal state of North Rhine-Westphalia (Germany) for both children and adolescents as well as for adults. They are operated by the social welfare authorities and, since 2008, by the regional authorities of Westphalia-Lippe and Rhineland. They enable victims to receive qualified psychotraumatological help within the first few days after suffering violence. Since trauma units have now been set up across most parts of this federal state, the time has come to assess the effectiveness of their acute care provision to victims of violence. METHODS: In 2007, on the order of the Ministry of Labour, Health and Social Affairs of the federal state of North Rhine-Westphalia, trauma outpatient units were subjected to scientific evaluation. In 17 trauma outpatient units, a data assessment protocol was officially implemented that included repeat measurements (immediately before the initial contact, after completion of intervention, at follow-up six months after intervention) of traumatized subjects aged 14 and older. Socio-demographic data were gathered, and the scores of the Impact of Event Scale - Revised (IES-R), the Symptom Checkliste-27 (SCL-27), the simplified Beck Depressions Inventory (BDI-V), the Global Assessment of Functioning Scale (GAF) as well as the Cologne Risk Index (CRI) (expert rating) were collected. RESULTS: Nearly three-fourths (65.9 %) of the traumatic experiences of the 211 patients investigated can be characterized as type-1 traumatisation. 31.8 % of patients were victims of crimes involving violations of the right to sexual self-determination (94.0 % of sexual offences being committed against girls and women). Crimes against physical integrity, which according to crime statistics are the most frequent of crimes against individuals (88.8 %, 34.8 % females), were suffered by 36.0 % of all patients of the trauma outpatient units (63.2 % being females). In 57.1 % of the victims, the interval between the traumatic event and initial intervention was less than a month. In 51.7 % (n = 109), suspicion of PTBS (F43.1) was raised at the initial presentation. The average of all instruments yielded an effect size of d = 1.04 (SD = 0.28) in a pre-post comparison. Pair-wise comparison showed highly significant differences in averages between pre and post (that is, between initial and follow-up measurements) in the sense of marked symptom reduction for all scales. CONCLUSIONS: The services of the trauma outpatient units are utilized in a timely and targeted fashion. The calculated effects show that the trauma outpatient units offer highly effective services to crime victims seeking help there.

The Stress Barometer: Validation of a Bio-Psycho-Social Brief Screening Instrument of Pandemic Stress Reaction.

Background: To capture the psychosocial impact of the SARS-CoV-2 pandemic, a model based on the International Classification of Functioning, Disability, and Health (ICF) was developed during the first lockdown in Germany in April 2020. FACT-19, the questionnaire for the assessment of pandemic stress load, measures (1) pre-pandemic stress, (2) pandemic stress, and (3) contextual factors (functioning as facilitators or barriers). Derived from this model, the stress barometer as a brief screening instrument captures these factors. The purpose of this study is a preliminary validation of the instrument. Method: The stress barometer was applied in conjunction with the Symptom-Checklist SCL-90-S at the beginning of the first lockdown in psychosomatic and psychotraumatological care in two federal states in Germany. The sample consists of n = 341 (68.6% female) from 18-73 years of age (M = 49.36, SD = 11.4). Results: The structure of the short screening was examined in the overall sample using an exploratory factor analysis [Chi2 (78) = 875.720, KMO = 0.688]. The results indicate a four-factor-structure that explains 59.5% of the total cumulative variance. The factors of the stress barometer correlate with the Global Severity Index (GSI, measured by SCL-90-S) with moderate to weak effects: pre-pandemic stress (r s = 0.431, p < 0.001, n = 295), pandemic stress (r s = 0.310, p < 0.001, n = 298), distal facilitator (r s = -0.155, p < 0.001, n = 312), and proximal barriers (r s = 0.232, p < 0.001, n = 312). Discussion: The results indicate the suitability of the stress barometer to complement the measurement of the impact of pandemics with an ICF-oriented approach, taking into consideration pre-pandemic stress as well as interactions with facilitators and barriers. Further analysis will be necessary for a revision of the items of the scale.

European Commission project: European Guideline for Target Group-Oriented Psychosocial Aftercare-Implementation.

After disasters, the individual health and well-being of first responders and affected population are affected for years. Therefore, psychosocial help is needed. Although most victims recover on their own, a minority of survivors, members of rescue teams, or relatives develop long-term, disaster-related psychic disorders, such as post-traumatic stress disorder (PTSD). This subgroup especially should receive timely and appropriate psychosocial help. Many European countries offer post-disaster psychosocial care from a variety of caregivers (i.e., professionals and volunteers, non-governmental organizations, church or commercial organizations). Therefore, European standards for providing post-disaster psychosocial support currently is required. This article describes the project European Guideline for Target Group-Oriented Psychosocial Aftercare-Implementation, supported by the European Commission.

Equine-assisted psychotherapy with traumatized couples-Improvement of relationship quality and psychological symptoms.

Many traumatised individuals suffering from deployment related PTSD report severe problems in their relationships. Up until now, the therapeutic interventions used by the German Armed Forces have rarely targeted these problems through the integration of partners. For this reason, a Program designed specifically for couples was developed. In this prospective study equine-assisted psychotherapy was applied to soldiers and their spouses. The study population consisted of n = 36 couples, divided in n = 20 therapy group with a inpatient equine-assisted intervention and a 16-couples control group. After the intervention, numerous significant improvements occurred in the therapy group in the areas of current, somatic and communication problems, depressive symptoms and partnership quality but not in the control group. PTSD was reduced significantly on the sub-scale associated with negative thoughts. These results show that the intervention is an effective way to improve partnership quality and reduce the stressors that the partners of afflicted service members face.

Symptoms of posttraumatic stress disorder among targets of school bullying.

BACKGROUND: The aim of this study was to investigate whether bullying among students is associated with symptoms of posttraumatic stress disorder (PTSD), and whether associations are comparable to other traumatic events leading to PTSD. METHODS: Data were collected from 219 German children and adolescents: 150 students from grade six to ten and 69 patients from an outpatient clinic for PTSD as a comparison group. Symptoms of PTSD were assessed using the Children's Revised Impact of Event Scale (CRIES) and the Posttraumatic Symptom Scale (PTSS-10). A 2 × 5 factorial analysis of variance (ANOVA) with the factors gender (male, female) and group (control, conflict, moderate bullying, severe bullying, traumatized) was used to test for significant differences in reported PTSD symptoms. RESULTS: Results showed that 69 (46.0%) students from the school sample had experienced bullying, 43 (28.7%) in a moderate and 26 (17.3%) in a severe way. About 50% of the severe bullying group reached the critical cut-off point for suspected PTSD. While the scores for symptoms of PTSD were significantly higher in bullied versus non-bullied students, no significant differences were found between patients from the PTSD clinic and students who experienced severe bullying. CONCLUSIONS: Our findings suggest that bullying at school is highly associated with symptoms of PTSD. Thus, prevention of bullying in school may reduce traumatic experiences and consequent PTSD development.