Startle habituation, sensory, and sensorimotor gating in trauma-affected refugees with posttraumatic stress disorder.

BACKGROUND: Impairments in mechanisms underlying early information processing have been reported in posttraumatic stress disorder (PTSD); however, findings in the existing literature are inconsistent. This current study capitalizes on technological advancements of research on electroencephalographic event-related potential and applies it to a novel PTSD population consisting of trauma-affected refugees. METHODS: A total of 25 trauma-affected refugees with PTSD and 20 healthy refugee controls matched on age, gender, and country of origin completed the study. In two distinct auditory paradigms sensory gating, indexed as P50 suppression, and sensorimotor gating, indexed as prepulse inhibition (PPI), startle reactivity, and habituation of the eye-blink startle response were examined. Within the P50 paradigm, N100 and P200 amplitudes were also assessed. In addition, correlations between psychophysiological and clinical measures were investigated. RESULTS: PTSD patients demonstrated significantly elevated stimuli responses across the two paradigms, reflected in both increased amplitude of the eye-blink startle response, and increased N100 and P200 amplitudes relative to healthy refugee controls. We found a trend toward reduced habituation in the patients, while the groups did not differ in PPI and P50 suppression. Among correlations, we found that eye-blink startle responses were associated with higher overall illness severity and lower levels of functioning. CONCLUSIONS: Fundamental gating mechanisms appeared intact, while the pattern of deficits in trauma-affected refugees with PTSD point toward a different form of sensory overload, an overall neural hypersensitivity and disrupted the ability to down-regulate stimuli responses. This study represents an initial step toward elucidating sensory processing deficits in a PTSD subgroup.

How Danes evaluate moral claims related to abortion: a questionnaire survey.

OBJECTIVE: To investigate how Danish citizens evaluate four moral claims related to abortion issues, regarding the moral status of the fetus, autonomy, harm and possible negative consequences of allowing abortion and to explore the association between moral beliefs and attitudes towards abortion for different reasons and at different gestational weeks. METHOD: A questionnaire was mailed to 1000 Danish citizens aged 18-45 years randomly drawn from the Danish Central Personal Register. A significance level of 0.05 was used for statistical estimations. RESULTS: Four hundred and sixty-two responded to at least one moral claim. Two hundred and fifty-eight responded to all four claims without using the option 'neither agree nor disagree' and were classified as 'morally engaged responders'. A majority of these had a pro-abortion moral. The general relationship between moral beliefs and attitudes towards abortion was morally sound. Being 'morally engaged' did not increase the likelihood of reaching moral judgement on whether requests for abortion should be permitted. Education, religion and parenthood were statistically associated with the investigated issues. DISCUSSION: The direction of causality is discussed with reference to both moral reasoning and moral intuitions. The relationship between normative social behaviour and abortion attitudes is considered.

Attitudes among Danes toward termination of pregnancy for social reasons and fetal abnormality.

OBJECTIVE: To investigate attitude among Danes toward termination of pregnancy (TOP) for social reasons and fetal abnormality (Down's syndrome, cystic fibrosis, adult polycystic kidney disease and the missing of one upper extremity) at different gestational ages. METHOD: A questionnaire was mailed to 1000 Danish citizens aged 18 to 45 years randomly drawn from the Danish Central Personal Register. A significance level of 0.05 was used for statistical estimations. RESULTS: Response rate was 49%. Eighty-two percent supported TOP for social reasons < 18-week gestation. Apart from polycystic kidney disease and the missing of an extremity < week 18 gestation, the support for TOP varied significantly between each condition and decreased with increasing gestational age (non-overlapping confidence intervals, p < 0.05), with termination of Down's syndrome receiving the most support (85% < week 18 and 18% at week 26). Fewer would personally opt for termination. Preimplantation diagnostic was supported by a majority. Ninety percent gave consistent responses, and among these, a majority had a gradualistic approach to TOP. Religion and political affiliations were statistically associated with the investigated issues. CONCLUSION: Internationally compared Danes are less supportive of selective terminations. Their attitudes continue to be dominated by a gradualistic view on terminations.

Mixing Job Training with Nature-Based Therapy Shows Promise for Increasing Labor Market Affiliation among Newly Arrived Refugees: Results from a Danish Case Series Study.

The unemployment rate among newly arrived refugees in European countries is high and many experience mental health problems. This has negative consequences on integration and mental well-being. In this case series study we investigated the effect of a 30-week program that included horticulture activities, nature-based therapy, and traditional job training on job market affiliation and mental well-being. Fifty-two refugees met initial screening criteria and twenty-eight met all inclusion criteria and were enrolled. The program took place in a small community and consisted of informal therapeutic conversations, exercises aimed at reducing psychological stress, increasing mental awareness and physical wellbeing. At the end of the program traditional job market activities were led by social workers. Provisionary psychiatric interviews showed that at baseline 79% met criteria for either an anxiety, depression, or PTSD diagnosis. After the program, statistical analyses revealed an increase in the one-year incidence of job market affiliation (n = 28) and an increase in mental health according to two of four questionnaire measures (nrange = 15-16). The results strengthen the hypothesis that horticulture and nature-based therapy can help refugees enter the job market. However, the small sample size emphasizes the need for methodologically stronger studies to corroborate these preliminary findings.

Therapeutic Nature Activities: A Step Toward the Labor Market for Traumatized Refugees.

BACKGROUND: Globally, the number of refugees is growing. For many refugees, entering the labor market in their new country of residence is challenging. Some remain forever dependent on welfare services, and this not only weakens their chances of integration, but also harms their health and well-being. METHODS: This qualitative single case study focused on a group of war-stricken refugees in Denmark. The study investigated the impact of an eight-month horticultural vocational program aimed at improving their ability to complete an education program or to work. A total of 29 interviews were conducted and analyzed using the interpretative phenomenological analysis (IPA) method. RESULTS: The natural environment in the eco-village evoked a feeling of safety as well as positive memories in the participants, in contrast to the traumatic memories they had of their flight. Horticultural activities and the positive and respectful attitude from staff initiated a recovery process. New skills were achieved at an individual pace, and feelings of isolation decreased. These findings can be implicated in future interventions.

Associations of neural processing of reward with posttraumatic stress disorder and secondary psychotic symptoms in trauma-affected refugees.

Background: Psychological traumatic experiences can lead to posttraumatic stress disorder (PTSD). Secondary psychotic symptoms are not common but may occur. Objectives: Since psychotic symptoms of schizophrenia have been related to aberrant reward processing in the striatum, using the same paradigm we investigate whether the same finding extends to psychotic and anhedonic symptoms in PTSD. Methods: A total of 70 male refugees: 18 PTSD patients with no secondary psychotic symptoms (PTSD-NSP), 21 PTSD patients with secondary psychotic symptoms (PTSD-SP), and 31 healthy controls (RHC) were interviewed and scanned with functional magnetic resonance imaging (fMRI) during a monetary incentive delay task. Using region of interest analysis of the prefrontal cortex and ventral striatum, we investigated reward-related activity. Results: Compared to RHC, participants with PTSD had decreased neural activity during monetary reward. Also, participants with PTSD-SP exhibited decreased activity in the associative striatum relative to participants with PTSD-NSP during processing of motivational reward anticipation which correlated with severity of psychotic symptoms. However, the difference between the two PTSD groups disappeared when PTSD severity and trauma exposure were accounted for. Conclusions: Anhedonia and secondary psychotic symptoms in PTSD are characterized by dysfunctional reward consumption and anticipation processing, respectively. The latter may reflect a mechanism by which abnormal reward signals in the basal ganglia facilitates psychotic symptoms across psychiatric conditions.

Antecedentes: Las experiencias traumáticas psicológicas pueden conducir al trastorno de estrés postraumático (TEPT). Los síntomas psicóticos secundarios no son comunes, pero pueden ocurrir.Objetivos: Dado que los síntomas psicóticos de la esquizofrenia se han relacionado con el procesamiento aberrante de recompensas en el cuerpo estriado, utilizando el mismo paradigma, investigamos si el mismo hallazgo se extiende a los síntomas psicóticos y anhedónicos en el TEPT.Método: Un total de 70 refugiados varones: 18 pacientes con TEPT sin síntomas psicóticos secundarios (TEPT-NSP), 21 pacientes con TEPT con síntomas psicóticos secundarios (TEPT-SP) y 31 controles sanos (RHC) fueron entrevistados y escaneados con Imagen por resonancia magnética funcional (fMRI en su sigla en inglés) durante una tarea de retraso de incentivo monetario. Mediante el análisis de la región de interés de la corteza prefrontal y el estriado ventral, investigamos la actividad relacionada con la recompensa.Resultados: En comparación con los RHC, los participantes con TEPT habían disminuido la actividad neuronal durante la recompensa monetaria. Además, los participantes con TEPT-SP exhibieron disminución de la actividad en el estriado asociativo en relación con los participantes con TEPT-NSP durante el procesamiento de la anticipación de recompensa motivacional, lo cual estuvo correlacionado con la gravedad de los síntomas psicóticos. Sin embargo, la diferencia entre los dos grupos de TEPT desapareció cuando se controlaron la gravedad del TEPT y la exposición al trauma.Conclusiones: La anhedonia y los síntomas psicóticos secundarios en el TEPT se caracterizan por un consumo de recompensa disfuncional y un procesamiento de anticipación, respectivamente. Este último puede reflejar un mecanismo por el cual las señales de recompensa anormales en los ganglios basales facilitan los síntomas psicóticos a través de afecciones psiquiátricas.

[Knowledge and perceptions of complementary and alternative medicine among medical students in Copenhagen]. / Københavnske medicinstuderendes kendskab og holdninger til komplementaer og alternativ medicin.

INTRODUCTION: Medical faculties worldwide are integrating courses on complementary and alternative medicine (CAM), accepting that knowledge of population's health behaviour, including CAM, increases physicians' ability to communicate, council and treat their patients. The aim of this survey was to assess attitudes towards and knowledge of CAM, and to determine if medical students at the University of Copenhagen perceived a need for education on CAM. MATERIAL AND METHODS: Self-administered questionnaires were distributed among 508 students on 1st, 2nd, 4th, 6th, 8th and 10th semester. A total of 470 questionnaires were included. RESULTS: In all, 94% reported knowledge of one or more CAM modalities, 34% reported knowledge of more than five. Most were acquainted with, had tried and would recommend the modalities herbal medicine/supplements, acupuncture and reflexology. Females were more CAM-positive than males and older students were less positive than the aggregate average. The students showed poor knowledge of the general population's use of CAM. CONCLUSION: A surprisingly large part of the medical students in Copenhagen reported knowledge and use of CAM compared with other countries, and with the general population, and the students are generally positive towards CAM. The majority agrees that physicians need to possess basic knowledge of CAM, and that courses on CAM should form part of the curriculum.