The best of two worlds: Combining the DSM-5 and ICD-11 clusters of symptoms for posttraumatic stress disorder in a single screening scale

Objectives: The most recent DSM-5 (2013) and ICD-11 (2018) diagnostic criteria for posttraumatic stress disorder (PTSD) encompass 20 and six symptoms, respectively, organized in different structures. This study aimed to investigate the dimensions of the Posttraumatic Stress Disorder Checklist 5 (PCL-5) according to the DSM-5's broader definition of PTSD and the ICD-11's narrower approach, as well as to explore an alternative restricted model that retains the core symptoms explicitly related to traumatic experiences. Methods: Data were gathered from Brazilian employees (n=1,101) who had directly experienced traumatic life events or had been exposed to them because of their work activities. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to evaluate the configural and metric structures of the models. Results: We estimated seven models of the latent structure of PTSD including the four-factor DSM-5 and three-factor ICD-11 PTSD models. Given the lack of evidence of their validity, an alternative 10-symptom model was tested. The final seven-item PTSD model considerably improved estimation of the PTSD construct. This solution showed reliable items with non-redundant content, acceptable fit indices, and satisfactory configural and metric properties. Conclusion: The more parsimonious one-dimensional model comprising the core PTSD symptoms has the potential to improve assessment of PTSD.

Constituição psíquica e linguística de um sujeito com transtorno do espectro do autismo imerso em uma família vulnerável pela imigração no pós-guerra / Psychic and linguistic constitution of a subject with autism spectrum disorder immersed in a family vulnerable by post-war immigration / Constitución psíquica y lingüística de un sujeto con trastorno del espectro autismo inmerso en una familia vulnerable por inmigración de posguerra

Introdução: este artigo apresenta a constituição psíquica e linguística de um jovem autista, proveniente de uma família de imigrantes em situação de pós-guerra, em que entram em questão temas como o luto, a constituição psíquica transgeracional, e a presença de angústias no processo de desenvolvimento da criança em uma situação singular que é a presença do autismo. Objetivo: analisar os efeitos singulares da imigração e multiculturalismo em um caso de autismo e sua evolução terapêutica. Método: estudo de caso longitudinal, que utilizou diário clínico e filmagens de sessões com observações do desenvolvimento de Rafael, desde os dezoito meses até a idade adulta. Como abordagem terapêutica e análise dos resultados, foram utilizados aportes da constituição psíquica da teoria psicanalítica, e sobre o desenvolvimento linguístico em uma perspectiva enunciativa. Resultados: O multiculturalismo acarretava um desafio maior ao processo de aquisição da linguagem por parte da criança com autismo, enquanto o silêncio consequente da dor do luto, presente nos adultos, dificultava a troca verbal e atrasava sua constituição psíquica. O autismo, por sua vez, apresentou-se como transtornos qualitativos na comunicação, necessitando maior investimento por parte de seus cuidadores para que a aquisição da linguagem se desse, pois o paciente precisou ser fisgado para a nossa cultura. Conclusão: Diante de todo esse quadro, o caso clínico demonstra a importância do suporte terapêutico à família e do investimento contínuo na subjetivação, considerando e valorizando os diferentes códigos culturais que compõem o núcleo familiar. (AU)

Introduction: this article presents the psychic and linguistic constitution of an autistic young man, from a post-war immigrant family, in which themes such as mourning, the transgenerational psychic constitution, and the presence of anxieties in the process come into question of the child development in a unique situation that is the presence of autism. Objective: to analyze the unique effects of immigration and multiculturalism in a case of autism and its therapeutic evolution. Method: longitudinal case study, which used a clinical diary and footage of sessions with observations of the development of R. from eighteen months to adulthood. As a therapeutic approach and analysis of results, contributions from the psychic constitution of psychoanalytic theory, and on linguistic development in an enunciative perspective, were used. Results: Multiculturalism posed a greater challenge to the process of language acquisition by the child with autism, while the consequent silence of the pain of grief, present in adults, hindered verbal exchange and delayed their psychic constitution. Autism, in turn, presented itself as qualitative disorders in communication, requiring greater investment on the part of its caregivers for the acquisition of language to take place, as it needed to be hooked for our culture. Conclusion: Given this situation, this clinical case demonstrates the importance of therapeutic support to the family and the continuous investment in subjectivity, considering and valuing the different cultural codes that make up the family nucleus. (AU)

Introducción: este artículo presenta la constitución psíquica y lingüística de un joven autista, proveniente de una familia inmigrante de posguerra, en la que se cuestionan temas como el luto, la constitución psíquica transgeneracional y la presencia de ansiedades en el proceso del desarrollo del niño en una situación única que es la presencia del autismo. Objetivo: analizar los efectos singulares de la inmigración y la multiculturalidad en un caso de autismo y su evolución terapéutica. Método: estudio de caso longitudinal, que utilizó un diario clínico y metraje de sesiones con observaciones del desarrollo de R. desde los dieciocho meses hasta la edad adulta. Como abordaje terapéutico y análisis de resultados se utilizaron aportes desde la constitución psíquica de la teoría psicoanalítica y sobre el desarrollo lingüístico en perspectiva enunciativa. Resultados: El multiculturalismo supuso un mayor desafío al proceso de adquisición del lenguaje por parte del niño con autismo, mientras que el consiguiente silencio del dolor del duelo, presente en los adultos, dificultó el intercambio verbal y retrasó su constitución psíquica. El autismo, a su vez, se presentó como un trastorno cualitativo en la comunicación, requiriendo una mayor inversión por parte de sus cuidadores para que se produjera la adquisición del lenguaje, pues necesitaba engancharse a nuestra cultura. Conclusión: Ante esta situación, este caso clínico demuestra la importancia del apoyo terapéutico a la familia y la continua inversión en la subjetividad, considerando y valorando los diferentes códigos culturales que conforman el núcleo familiar. (AU)

Muito além do trauma: uma investigação sobre o papel das reações peritraumáticas sobre o transtorno de estresse pós-traumático / Beyond the trauma: an investigation of the role of peritraumatic reactions on posttraumatic stress disorder

O Transtorno de Estresse Pós-Traumático (TEPT) é uma condição debilitante que impacta significativamente a qualidade de vida dos seus portadores. Dentre vários fatores de risco para o TEPT, as reações peritraumáticas (RP), como a imobilidade tônica peritraumática (ITP), dissociação (DP) e reações físicas de pânico (RFP), estão entre as mais investigadas. No entanto, a maioria dos estudos avaliou essas RP separadamente, e o elo entre elas e o TEPT ainda não foi bem compreendido. Portanto, essa tese teve como objetivos: (i) estimar simultaneamente o efeito das três RP sobre o TEPT utilizando um instrumento validado; e (ii) avaliar se há efeito indireto da ITP sobre o TEPT mediado pelo sentimento de culpa/vergonha. Utilizamos modelagem de equações estruturais para analisar dados de 3211 participantes do Rio de Janeiro e de São Paulo. Tratamos as RP como variáveis latentes, selecionando desconfundidores específicos para cada reação. Nossas exposições foram as RP, sendo TEPT o desfecho. Calculamos odds ratios e intervalos de confiança de 95%. Utilizamos o Bayesian Information Criterion para comparar o ajuste de modelos não aninhados. Quando analisadas separadamente, todas as RP alcançaram significância estatística. No entanto, apenas DP (ORDP=1,8; IC95%:1,3-2,4) e RFP (ORRFP=2,5; IC95%:1,8-3,4) permaneceram estatisticamente significativas quando incluímos as três reações em um modelo com seus respectivos desconfundidores e correlações entre elas. Os resultados sugeriram um possível efeito da ITP sobre o TEPT (ORITP=1,4; IC95%:1,0-1,9). As interações entre as RP não foram estatisticamente significativas. Ao investigarmos o sentimento de culpa/vergonha como mediador entre ITP e TEPT, o efeito indireto alcançou apenas significância estatística limítrofe (ORITP(TNIE)=1,1; IC95%:1,0-1,2). Os efeitos direto (ORITP(PNDE)=1,3; IC95%: 0,8-1,8) e total (ORITP(TE)=1,4; IC95%:0,9-1,9) para ITP perderam significância quando todas as RP, seus desconfundidores e correlações entre elas fizeram parte do mesmo modelo. As demais RP, no entanto, permaneceram estatisticamente significativas (ORDP=1,7; IC95%:1,3-2,3 e ORRFP=2,5; IC95%:1,8-3,4). Nossos resultados mostraram que a DP e as RFP aumentaram o risco de TEPT mesmo quando consideradas em conjunto. A ITP pode ter efeito sobre o risco de TEPT, mas esse achado deve ser interpretado com cautela devido a significância limítrofe dessa RP em nosso modelo final. Também não identificamos uma mediação significativa entre ITP e TEPT pelos sentimentos de culpa/vergonha. Contudo, a significância limítrofe encontrada para o efeito indireto demanda investigações adicionais. Nossos achados reforçam a ideia de que as reações peritraumáticas devem ser analisadas e compreendidas como ocorrências simultâneas. Também seria oportuno que estudos envolvendo culpa/vergonha, ITP e TEPT focalizassem traumas caracterizados por aprisionamento e impossibilidade de escapar, dado que estas experiências são apontadas como mais susceptíveis para desencadear a ITP. (AU)

Posttraumatic stress disorder (PTSD) is a debilitating condition that greatly impacts quality of life. Among several PTSD risk factors, peritraumatic reactions (PR) such as peritraumatic tonic immobility (PTI), dissociation (PD) and physical panic reactions (PPR) are some of the most investigated. However, several studies have assessed these PR separately, and the pathway connecting them to PTSD is not well understood. Therefore, this thesis aimed to: (i) simultaneously estimate the effect of the three PR on PTSD using a validated instrument; and (ii) assess if there is an indirect effect of PTI on PTSD mediated by feelings of guilt/shame. We used structural equation modelling to analyse data from 3211 participants from Rio de Janeiro and São Paulo. We treated the PR as latent variables and selected specific confounders for each reaction. Our exposures were the PR, and PTSD was the outcome. We calculated odds ratios and 95% confidence intervals for each analysis. We also employed the Bayesian Information Criterion to compare the goodness of fit between non-nested models. Separately, all PR achieved statistically significant results. However, only PD (ORPD=1.8; 95%CI:1.3-2.4) and PPR (ORPPR=2.5; 95%CI:1.8-3.4) remained statistically significant when all three were included in a model with their respective confounders and correlations among all PR. Our findings suggested a possible effect of PTI on PTSD (ORPTI=1.4; 95%CI:1.0-1.9). Interactions between the PR were not statistically significant. When we investigated feelings of guilt/shame as the mediator between PTI and PTSD, the indirect effect achieved a borderline statistical significance (ORPTI(TNIE)=1.1; 95%CI:1.0-1.2). Direct (ORPTI(PNDE)=1.3; 95%CI:0.8-1.8) and total (ORPTI(TE)=1.4; 95%CI:0.9-1.9) effects lost their significance when all PR, their confounders and correlations were included in the same model. The other PR remained statistically significant (ORPD=1.7; 95%CI:1.3-2.3 and ORPPR=2.5; 95%CI:1.8-3.4). Our findings showed PD and PPR to increase the risk of PTSD even when considered in tandem. PTI could have an effect on PTSD, but this must be considered cautiously, as this PR only reached borderline significance in our final model. Feelings of guilt/shame did not significantly mediate PTI's effect on PTSD. However, a borderline statistical significance in the indirect effects warrants further investigation. Our findings reinforce the hypothesis that peritraumatic reactions should be analysed and understood as simultaneous occurrences, not as separate entities. It would also be appropriate for studies concerning guilt/shame, PTI and PTSD to focus on traumas characterized by imprisonment and feelings of inescapability, given that these experiences are allegedly more likely to trigger PTI. (AU)

Psychological trauma and depression in recovered COVID-19 patients: a telecommunication based observational study

Abstract Introduction Coronavirus disease 2019 (COVID-19) is adversely affecting the mental health of patients infected with the virus and the psychological impact on recovered COVID-19 patients is unclear. Objectives The study aimed to assess posttraumatic stress disorder (PTSD) and depression among COVID-19 patients after recovery from the disease. Methods This cross-sectional study was conducted from November 9, 2020, to December 23, 2020. The study used a telemedicine model to enroll recovered COVID-19 patients from a database of patients provided by the health authorities. The National Stressful Events Survey PTSD Short Scale (NSESSS) for adults was used to assess PTSD symptoms and the Patient Health Questionnaire (PHQ-9) was used to assess depression. Results The study enrolled 503 recovered COVID-19 patients with a mean age of 41.90 years. The majority were asymptomatic (64.6%), while 21.5% had had moderate to severe forms of the disease. Prevalence rates of PTSD symptoms and depression were 56.9 and 29% respectively. COVID-19 patients with severe forms of the disease were significantly more affected by PTSD symptoms (vs. mild, odds ratio [OR] = 18.7, 95%confidence interval [CI] 9.9-35.5) and depression (vs. mild, OR = 19.8, 95% CI 9.9-39.5). Similarly, patients who required oxygen or ventilator support reported significantly higher rates of PTSD symptoms (vs. managed at home, OR = 17.4, 95% CI 8.3-36.4) and depression (vs. managed at home, OR = 22.0, 95% CI 10.1-47.7). Conclusion This study reports that recovered COVID-19 patients suffered from a significant amount of depression and experienced significant PTSD symptoms. It will help with addressing a major psychological concern among the recovered subjects.

Effect of Ganmai Dazao Decoction on ethology of rats with PTSD and its mechanism / 中国中药杂志

This study aimed to explore the effect of Ganmai Dazao Decoction on the ethology of rats with posttraumatic stress disorder(PTSD) and study the related mechanism through the changes in magnetic resonance imaging and protein expression. Sixty rats were randomly divided into 6 groups, namely the normal group, the model group, the low(1 g·kg~(-1)), medium(2 g·kg~(-1)), and high-dose Ganmai Dazao Decoction groups(4 g·kg~(-1)), and the positive control group(intragastric administration with 10.8 mg·kg~(-1) of fluoxetine), with 10 rats in each group. Two weeks after inducing PTSD by single-prolonged stress(SPS) in rats, the positive control group was given fluoxetine hydrochloride capsule by gavage, the low, medium, and high-dose groups were given Ganmai Dazao Decoction by gavage, and both the normal group and the model group were given the same volume of normal saline by gavage, each for 7 days. The open field experiment, elevated cross elevated maze, forced swimming experiment, and new object recognition test were carried out for the behavioral test. Three rats in each group were selected to detect the expression of neuropeptide receptor Y1(NPY1R) protein in the hippocampus by Western blot. Then, the other three rats in each group were selected to use the 9.4T magnetic resonance imaging experiment to observe the overall structural changes in the brain region and the anisotropy fraction of the hippocampus. The results of the open field experiment showed that the total distance and central distance of rats in the model group were significantly lower than those in the normal group, and the total distance and central distance of rats in the middle and high-dose Ganmai Dazao Decoction groups were higher than those in the model group. The results of the elevated cross maze test showed that medium and high-dose Ganmai Dazao Decoction remarkably increased the number of open arm entries and the residence time of open arm of rats with PTSD. The results of the forced swimming experiment showed that the immobility time in the water of the model group rats was significantly higher than that of the normal group, and Ganmai Dazao Decoction hugely reduced the immobility time in the water of rats with PTSD. The results of the new object recognition test showed that Ganmai Dazao Decoction significantly increased the exploration time of new objects and familiar objects in rats with PTSD. The results of Western blot showed that Ganmai Dazao Decoction significantly reduced the expression of NYP1R protein in the hippocampus of rats with PTSD. The 9.4T magnetic resonance examination found that there was no significant difference in the structural image among the groups. In the functional image, the fractional anisotropy(FA value) of the hippocampus in the model group was significantly lower than that in the normal group. The FA value of the hippocampus in the middle and high-dose Ganmai Dazao Decoction groups was higher than that in the model group. Ganmai Dazao Decoction reduces the injury of hippocampal neurons by inhibiting the expression of NYP1R in the hippocampus of rats with PTSD, thereby improving the nerve function injury of rats with PTSD and playing a neuroprotective role.

Transtorno de Estresse Pós-traumático e funções executivas em adultos: uma revisão sistemática / Posttraumatic Stress Disorder and executive functions in adults: a systematic review / Trastorno de Estrés Postraumático y funciones ejecutivas en adultos: una revisión sistemática

O Transtorno do Estresse Pós-traumático (TEPT) é caracterizado por apresentar sintomas de desconforto e medo diante de situações diretas e/ou imaginadas em relação a experiências que ameaçam a integridade pessoal. As Funções Executivas (FE) são processos responsáveis pela análise de uma situação, tomada de decisão e ações voltadas à resolução de problemas. Sabe-se que o TEPT está associado a prejuízos em diferentes dimensões das FE. Deste modo, o presente estudo investigou a produção científica sobre o tema feita nos últimos 12 anos. Duzentos e três registros foram identificados e 18 deles cumpriram os critérios de inclusão. A avaliação das pesquisas incluídas nesta revisão apontou o comprometimento das funções executivas e a reabilitação neuropsicológica mostrou-se eficiente como estratégia de intervenção para adultos diagnosticados com TEPT. A ausência de informações sobre a intensidade dos sintomas presentes no TEPT foi uma limitação comum aos estudos encontrados nesta pesquisa.(AU)

Posttraumatic Stress Disorder (PTSD) is characterized by symptoms of uneasiness and fear when faced with direct and/or imagined situations related to experiences that threaten personal integrity. Executive Functions (EF) are processes defined by situational analysis, making decisions and taking actions to solve problems. It is known that PTSD is associated with dysfunctions in different dimensions of EF. Accordingly, the present study investigated the scientific production on the subject considering the last 12 years. A total of203 records were identified, with 18 of them meeting the inclusion criteria. The evaluation of the studies included in this review showed the impairment of EF and that neuropsychological rehabilitation has proven to be an efficient intervention strategy for adults diagnosed with PTSD. The absence of information about the intensity of symptoms present in PTSD was a common limitation of the studies found in this review.(AU)

El Trastorno de Estrés Postraumático (TEPT) se caracteriza por presentar síntomas de malestar y miedo ante situaciones directas y/o imaginadas en relación con experiencias que amenazan la integridad personal. Las Funciones Ejecutivas (FE) son procesos definidos por el análisis de una situación, toma de decisiones y acciones encaminadas a la resolución de problemas. Se sabe que el TEPT está asociado con disfunciones en diferentes dimensiones de la FE. De esta manera, el presente estudio investigó la producción científica sobre el tema en los últimos 12 años. Se identificaron 203 registros y 18 de ellos cumplieron los criterios de inclusión. La evaluación de los estudios incluidos en esta revisión mostró que el compromiso de las funciones ejecutivas, y la rehabilitación neuropsicológica, demostró ser eficiente como estrategia de intervención para adultos diagnosticados con TEPT. La ausencia de información sobre la intensidad de los síntomas presentes en el TEPT fue una limitación común de los estudios encontrados en esta investigación.(AU)

Predictors of response to cognitive-behavioral therapy in patients with posttraumatic stress disorder: a systematic review / Preditores de resposta à terapia cognitivo-comportamental em pacientes com transtorno de estresse pós-traumático: uma revisão sistemática

OBJETIVO: O transtorno de estresse pós-traumático (TEPT) é um transtorno altamente prevalente e incapacitante. Mesmo quando tratado com uma intervenção de primeira linha, terapia cognitivo-comportamental (TCC), 45% dos pacientes continuam sofrendo desse transtorno. Portanto, conhecer os fatores que podem prever quem responderá à TCC seria de grande valor no tratamento desses pacientes. Por esse motivo, revisamos sistematicamente a literatura para identificar as variáveis que poderiam predizer a resposta à TCC em pacientes que sofrem de TEPT. MÉTODOS: Seguindo as diretrizes do PRISMA 2020, pesquisamos em banco de dados eletrônico como ISI Web of Science, Scopus, PsycINFO, MEDLINE e PTSDpubs até novembro de 2021. Dois autores conduziram independentemente a seleção do estudo e a extração de dados. Estudos que examinaram possíveis preditores de resposta à terapia, com amostra de adultos (18-65 anos) de ambos os sexos, com e sem comorbidades, foram considerados elegíveis. As características dos estudos foram sintetizadas em uma tabela. O risco de viés foi avaliado pela ferramenta de avaliação de qualidade de risco de viés da Cochrane. RESULTADOS: Vinte e oito estudos envolvendo 15 variáveis foram selecionados. Desses, oito mostraram baixo risco de viés, 19 mostraram algumas preocupações e um mostrou alto risco potencial de viés. A relação terapêutica foi a única variável considerada um preditor de boa resposta à terapia. Todas as outras variáveis apresentaram resultados conflitantes. CONCLUSÕES: A variável mais promissora, embora muito fraca cientificamente, é a relação terapêutica. Ensaios clínicos randomizados adicionais devem ser conduzidos para esclarecer o papel dessa variável como um preditor de resposta da TCC em pacientes com TEPT.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a highly prevalent and disabling disorder. Even when treated with the first-line intervention, cognitive-behavioral therapy (CBT), 45% of the patients continue suffering from this disorder. Therefore, knowing the factors that could foresee who will respond to CBT would be of great value to the treatment of these patients. Thus, we have systematically reviewed the literature to identify the variables that could predict response to CBT in patients suffering from PTSD. METHODS: Following the PRISMA 2020 guidelines, we searched the electronic databases ISI Web of Science, Scopus, PsycINFO, MEDLINE, and PTSDpubs until November 2021. Two authors have independently conducted study selection and data extraction. Studies that examined possible predictors of response to therapy on a sample of adults (18-65 years), both genders, with and without comorbidities were considered eligible. The characteristics of the studies were synthesized in a table. The risk of bias was assessed by the Cochrane risk of bias quality assessment tool. RESULTS: Twenty- -eight studies comprising 15 variables were selected. Among those, eight showed a low risk of bias, 19 showed some concerns, and one showed a high potential risk of bias. The therapeutic relationship was the only variable considered to be a predictor of a good response to therapy. All other variables showed conflicting results. CONCLUSIONS: The most promising variable, although scientifically weak, is the therapeutic relationship. Additional randomized clinical trials should be conducted to clarify the role of this variable as a predictor of response to CBT in patients with PTSD.

Contextualizing migration and mental health in the post-COVID era

Background: The population of migrants all over the world is progressively rising. The major reasons for migration include the desire for self-actualization, moving to a place with more opportunities, tourism, and education, and escaping hardship and political unrest in the home country. In recent times climate change, insecurity, and economic hardship are top of the list. The global economy has suffered a major blow from the multiple waves of the lingering COVID-19 pandemic. To lessen the scourge of inflation and to restore economic stability, several countries are being forced to liberalize their immigration policies and therefore immigrants are welcomed in these nations. This review attempts to investigate how migration in the post-pandemic era affects migrants' mental health. Main Text: Migration and the COVID-19 epidemic both have beneficial and durable effects on the mental health of migrants and immigration laws have a direct impact on several health-related issues. Mental health disorders may develop at any point from the pre-migration phase to the post-migration settlement in the host nations. Factors such as host community, racism, marginalization, political climate, poor support, loss of social status, language barriers, undocumented status, climate change, mode of dressing in the host country, and several others may lead to mental health disorders among migrants. Unfortunately, there is limited access to care, and the services provided may not be culturally sensitive. Conclusion: Despite the benefits gotten from migration like financial benefits and economic development of the native country and the left behind family members, migration has enormous psychological complications which have to be attended to. Access to specialists who are trained to provide culturally sensitive interventions and implement outreach programs to introduce the services to the migrants' community should be encouraged.

Mental health and influencing factors of military medical students during the normalization period of the epidemic prevention and control / 中华医学教育探索杂志

Objective:To investigate the level of psychological stress, anxiety and posttraumatic stress disorder (PTSD) of military medical students under the condition of normalized prevention and control of the epidemic.Methods:A total of 225 students from a military university were selected by random sampling method. Chinese perceived stress scale (CPSS), Perceived social support scale (PSSS), Self-rating anxiety scale (SAS) and PTSD Checklist-5 (PCL-5) were used to measure the mental health of the subjects and influencing factors. SPSS 26.0 was used to conduct independent sample t test and ANOVA analysis. Pearson correlation analysis was conducted, and multiple regression equation was used to further analyze the relationship between psychometric factors. Results:The SAS scores of 22.2% (50/225) of the subjects and PCL-5 scores of 30.7% (69/225) of the subjects reached the positive standard. The results of correlation analysis showed that the total score of PSSS was negatively correlated with CPSS ( r=-0.315, P<0.01), SAS ( r=-0.336, P<0.01) and PCL-5 ( r=-0.137, P<0.05) scores. The score of family support negatively predicted the level of psychological stress ( B=-0.595, P<0.001), anxiety ( B=-0.635, P<0.001) and PTSD level ( B=-0.769, P=0.006) of the students. Conclusion:Social support, especially family support, has a significant protective effect on psychological stress, anxiety and PTSD during the period of normalized prevention and control of the epidemic.

Contributions from functional neuroimaging studies to the comprehension of traumatic child experiences: preliminary findings / Aportes de los estudios de neuroimagen funcional a la comprensión del trauma infantil: estudio preliminar

Abstract This study aimed to describe the cerebral activation patterns using fMRI (Functional Magnetic Resonance Imaging) technology in a sample of 15 children with Posttraumatic Stress Disorder (PTSD) and 7 with no PTSD. The study used a Quasi-experimental methodology where two experimental tasks were applied: an emotional face task and a version of an emotional Stroop task. The results point out differences in the group of PTSD on the processing of negative stimuli and changes in their frontal lobe activation. These preliminary results suggest that early traumatic experiences affect typical brain development patterns. And explicit and implicit variables involved in the traumatic experiences are discussed as a part of any intervention process.

Resumen El presente estudio tuvo como objetivo describir patrones de activación cerebral mediante una técnica de Imagen por resonancia magnética funcional -fMRI- (abreviatura en inglés de Functional Magnetic Resonance Imaging) en una muestra de niños con Trastorno de estrés postraumático (TEPT) y compararlos con un grupo de controles. Estudio cuasi-experimental en el que se tomó un grupo de 15 niños con TEPT y se comparó con un grupo de 7 niños sin TEPT. Se emplearon dos tareas experimentales: una prueba de caras y una versión del Stroop emocional. Los resultados preliminares, señalan diferencias en el procesamiento de estímulos, principalmente de carácter negativo en los niños con TEPT y cambios en los patrones de activación a nivel de estructuras frontales. Se concluye que el trauma a edad temprana afecta el curso normal del desarrollo cerebral y se evidencia la importancia de abordar los aspectos explícitos e implícitos asociados a la experiencia traumática como parte de la intervención.

Psicodrama como terapia en trauma y estrés postraumático / Psychodrama as a Therapy in Trauma and Posttraumatic Stress

Resumen Objetivo: Evaluar la evidencia disponible de la eficacia del psicodrama como terapia para el manejo del trauma psicológico, trastorno por estrés agudo y postraumático. Método: Se realizó una búsqueda sistemática de la literatura en MEDLINE, EMBASE, Cochrane Central, Scopus, LILACS y Ovid hasta abril de 2019. Se incluyeron los términos: (1)Psychodrama, (2)Role-playing, (3)Stress disorders, Acute, posttraumatic, y (4)Psychological trauma (MeSH). Se seleccionaron revisiones sistemáticas de la literatura, metaanálisis, ensayos clínicos aleatorios, cuasi aleatorios y estudios observacionales en inglés y español. Se seleccionaron los trabajos que incluyeran una descripción de las intervenciones con técnicas del psicodrama. Resultados: 14 trabajos cumplieron criterios de inclusión. Conclusión: No se encontró una asociación fuerte de la eficacia del psicodrama ante los síntomas de estrés postraumático. Se requieren más investigaciones con diseño metodológico ajustado para este tipo de intervenciones.

Abstract Objective: To evaluate the available evidence in regarding the efficacy of psychodrama in patients with acute and posttraumatic stress disorder and psychological trauma- Methods: Systematic review. Terms: (1)Psychodrama, (2)Role-playing, (3)Stress disorders, Acute, posttraumatic, and (4)Psychological trauma (Mesh), were searched in Pubmed, EMBASE, Cochrane Central, Scopus, Lillacs and OVID, until April 2019. Systematic reviews of the literature, meta-analysis, randomized clinical trials, quasi-randomized and observational studies in English and Spanish were selected. The works should have described interventions with psychodrama techniques. Results: 14 papers met the inclusion criteria. Conclusions: There is no evidence of the psychodrama response to the symptoms after traumatic stress. Research should be carried out with a more rigorous methodological design.

Protocolos de terapia cognitivo-comportamental culturalmente adaptados para tratamento de tept: uma revisão sistemática da literatura / Cognitive-behavioral therapy protocols culturally adapted for PTSD treatment: a systematic review of the literature

Imigrantes e refugiados são uma população de risco para transtornos mentais, como o Transtorno de Estresse Pós-Traumático (Tept), e a psicoterapia com indivíduos provenientes de diferentes contextos culturais pode ser desafiadora, porém, a Terapia Cognitivo-Comportamental (TCC) vem se mostrando uma abordagem eficaz com essa população. O presente estudo de revisão sistemática tem como objetivo descrever os protocolos culturalmente adaptados de TCC para imigrantes e refugiados com diagnóstico ou sintomas de Tept, seguindo as recomendações do método PRISMA. Foram realizadas buscas nas bases de dados PubMed/Medline e PsycInfo, nos últimos 15 anos, sendo incluídos 11 artigos. As principais adaptações realizadas pelos estudos foram: o uso da língua mãe dos participantes, uso de imagens relativas ao país de origem ou à religião e modificações na exposição usual. As informações descritas neste estudo podem auxiliar no desenvolvimento de futuros estudos ou na prática clínica com essa população.

Immigrants and refugees are a population at risk for mental disorders, such as Posttraumatic Stress Disorder (PTSD), and psychotherapy with individuals from different cultural contexts can be challenging, however, Cognitive-Behavioral Therapy (CBT) has shown to be an effective approach with this population. This systematic review study aims to describe the culturally adapted protocols of CBT for immigrants and refugees with diagnosis or symptoms of PTSD, following the recommendations of the PRISMA method. Searches were conducted in the PubMed/Medline and PsycInfo databases, in the last 15 years, and 11 articles were included. The main adjustments made by the studies were: the use of the participant's mother tongue, use of images related to the country of origin or religion and modifications in the usual exposure. The information described in this study may help in the development of future studies or in clinical practice with this population.

Effect of attention and interpretation therapy on posttraumatic stress disorder and perceived stress of parents with children having developmental dislocation of the hip / 中国实用护理杂志

Objective:To investigate the effect of attention and interpretation therapy on posttraumatic stress disorder and perceived stress of parents with children having developmental dislocation of the hip.Methods:Totally 96 parents with children having developmental dislocation of the hip from women and children hospital of Hubei province were divided into experimental group ( n=46) and control group ( n=46) according to the random number table method. The control group received routine postoperative DDH care. On the basis of this, the experimental group was given attention and interpretation therapy for 8 weeks. Before intervention and at the end of intervention, the effects were assessed by Posttraumatic Stress Checklist-Civilian Version (PCL-C) and Chinese Perceived Stress Scale (CPSS). Results:After intervention, the scores of arousal symptoms, avoidance/numbing, re-experiencing symptoms and total PCL-C scores were 8.47±2.30, 10.67±2.67, 7.49±2.63, 26.62±4.10, in addition, the scores of sense of tension, sense of out of control and total scores of CPSS were 11.71±2.21, 11.27±2.95, 22.98±3.77, which were significantly lower than those in the control group (9.45±2.33, 12.39±2.43, 8.93±2.79, 30.77±5.30, 12.86±3.05, 13.09±3.46, 25.95±4.52), the difference was statistically significant ( t value was 2.013-4.135, P<0.05). Conclusion:Attention and interpretation therapy can effectively relieve posttraumatic stress disorder symptom and alleviate perceived stress level of parents with children having developmental dislocation of the hip.

Military-related posttraumatic stress disorder and mindfulness meditation: A systematic review and meta-analysis / 中华创伤杂志(英文版)

PURPOSE@#Posttraumatic stress disorder (PTSD) is a significant global mental health concern, especially in the military. This study aims to estimate the efficacy of mindfulness meditation in the treatment of military-related PTSD, by synthesizing evidences from randomized controlled trials.@*METHODS@#Five electronic databases (Pubmed, EBSCO Medline, Embase, PsychINFO and Cochrane Library) were searched for randomized controlled trials focusing on the treatment effect of mindfulness meditation on military-related PTSD. The selection of eligible studies was based on identical inclusion and exclusion criteria. Information about study characteristics, participant characteristics, intervention details, PTSD outcomes, as well as potential adverse effects was extracted from the included studies. Risk of bias of all the included studies was critically assessed using the Cochrane Collaboration's tool. R Statistical software was performed for data analysis.@*RESULTS@#A total of 1902 records were initially identified and screened. After duplicates removal and title & abstract review, finally, 19 articles in English language with 1326 participants were included through strict inclusion and exclusion criteria. The results revealed that mindfulness meditation had a significantly larger effect on alleviating military-related PTSD symptoms compared with control conditions, such as treatment as usual, present-centered group therapy and PTSD health education (standardized mean difference (SMD) = -0.33; 95% CI [-0.45, -0.21]; p < 0.0001). Mindfulness interventions with different control conditions (active or non-active control, SMD = -0.33, 95% CI [-0.46, -0.19]; SMD = -0.49, 95% CI [-0.88, -0.10], respectively), formats of delivery (group-based or individual-based, SMD = -0.30, 95% CI [-0.42, -0.17], SMD = -0.49, 95% CI [-0.90, -0.08], respectively) and intervention durations (short-term or standard duration, SMD = -0.27, 95% CI [-0.46, -0.08], SMD = -0.40, 95% CI [-0.58, -0.21], respectively) were equally effective in improving military-related PTSD symptoms.@*CONCLUSION@#Findings from this meta-analysis consolidate the efficacy and feasibility of mindfulness meditation in the treatment of military-related PTSD. Further evidence with higher quality and more rigorous design is needed in the future.

PTSD: Past, present and future implications for China / 中华创伤杂志(英文版)

There has been a long history since human beings began to realize the existence of post-traumatic symptoms. Posttraumatic stress disorder (PTSD), a diagnostic category adopted in 1980 in the Diagnostic and Statistical Manual of Mental Disorders-Ⅲ, described typical clusters of psychiatric symptoms occurring after traumatic events. Abundant researches have helped deepen the understanding of PTSD in terms of epidemiological features, biological mechanisms, and treatment options. The prevalence of PTSD in general population ranged from 6.4% to 7.8% and was significantly higher among groups who underwent major public traumatic events. There has been a long way in the studies of animal models and genetic characteristics of PTSD. However, the high comorbidity with other stress-related psychiatric disorders and complexity in the pathogenesis of PTSD hindered the effort to find specific biological targets for PTSD. Neuroimage was widely used to elucidate the underlying neurophysiological mechanisms of PTSD. Functional MRI studies have showed that PTSD was linked to medial prefrontal cortex, anterior cingulate cortex and sub-cortical structures like amygdala and hippocampus, and to explore the functional connectivity among these brain areas which might reveal the possible neurobiological mechanism related to PTSD symptoms. For now, cognitive behavior therapy-based psychotherapy, including combination with adjunctive medication, showed evident treatment effects on PTSD. The emergence of more effective PTSD pharmacotherapies awaits novel biomarkers from further fundamental research. Several natural disasters and emergencies have inevitably increased the possibility of suffering from PTSD in the last two decades, making it critical to strengthen PTSD research in China. To boost PTSD study in China, the following suggestions might be helpful: (1) establishing a national psychological trauma recover project, and (2) exploring the mechanisms of PTSD with joint effort and strengthening the indigenized treatment of PTSD.

Oxytocin receptor variant rs53576 genotype is associated with dysphoric arousal symptoms of DSM-5 posttraumatic stress disorder in Chinese earthquake survivors / 中华创伤杂志(英文版)

PURPOSE@#Evidence suggests that the oxytocin receptor (OXTR) gene may be involved in the psychopathology of posttraumatic stress disorder (PTSD). This study aimed to investigate the effects of OXTR rs53576 genotype on PTSD symptoms introduced in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5).@*METHODS@#This study was a cross-sectional study conducted among 1140 adults who had personally experienced the Wenchuan earthquake. PTSD symptoms were measured with the PTSD checklist for DSM-5. A custom-by-design 2 × 48-Plex SNPscan@*RESULTS@#The results revealed that the rs53576 genotype could significantly predict PTSD symptoms (β = 0.055, p = 0.045). Further analysis showed that the rs53576 genotype was only significantly associated with dysphoric arousal symptoms of PTSD (β = 0.080, p = 0.005). The rs53576 genotype × earthquake exposure interaction had no significant effect on different symptom clusters (p > 0.05).@*CONCLUSION@#This study showed that the rs53576 genotype was only associated with the dysphoric arousal symptoms but not with other symptom clusters of PTSD. These findings support the role of the OXTR on the psychopathology of PTSD and help us to understand the genetic basis of PTSD.

Psychological Impact of Covid-19 Pandemic on Mental Health Among Medical Students in Malaysia

@#Introduction: The Coronavirus disease-2019 impacted the governments and public health systems worldwide, with the psychological impact including an increase in the level of stress, anxiety and depression. We determine the prevalence of depression, anxiety and stress using the Depression Anxiety Stress Scales (DASS-21), and to determine the psychological impact of COVID-19 pandemic amongst medical students in Sarawak, Malaysia using the revised Impact of Event Scale (IES-R). Methods: We analysed 355 medical student’s data obtained from an online survey. All the undergraduate medical students were the sample population. IBM SPSS version 22.0 was used for data analysis. A p-value of ≤.05 was considered statistically significant. Results: Analysis indicated that three-fourths of the students had no mental health issues. More than one-tenth of the students were moderately depressed (12.4%) and 4.3% severely depressed. A similar pattern of prevalence of anxiety was noted with 10% reported moderate anxiety, and 6.8% had severe anxiety. 15.8% of the students had mild stress, 4.2% moderately stressed, and 2% severely stressed. A hierarchical multiple linear regression analysis showed that hyperarousal appeared to be a predictor of depression (β=.466, p<.001), anxiety (β=.481, p<.001) and stress β=.508, p<.001). Along with hyperarousal, intrusion (β=.148, p<.05) predicts stress among the students. Conclusion: Our analysis revealed that hyperarousal symptoms related to the global pandemic of COVID-19 led to significant mental health issues among students. Therefore, urgent strategies to support the students’ psychosocial wellbeing and self-care and to strengthen their coping skills and resilience need to be implemented.

Posttraumatic growth indicators in Brazilian and Pakistani samples / Indicadores de crecimiento postraumático en una muestra brasileña y pakistaní / Indicadores de crescimento pós-traumático em amostra brasileira e paquistanesa

We investigated indicators of posttraumatic growth (PTG) in victims of disasters. Six hypotheses were tested: the symptoms of re-experiencing and avoidance, typical of posttraumatic stress disorder (PTSD), would be positive predictors of PTG (h1); the Pakistanis would have lower PTG rates when compared to Brazilians (h2); higher number of traumatic events (h3), bombings and terrorism (h4) and pathological personality traits (h5) would be negative predictors of PTG; and the religiosity factor would be a positive indicator of PTG (h6). Participants included 202 subjects, 64.9% male with age ranges between 18 and 66 years (M = 28.07; SD = 8.82). Instruments used included the Posttraumatic Growth Inventory, the PTSD Checklist for DSM-5 and the Clinical Dimensional Personality Inventory-Screening. All hypotheses were partially corroborated. We discuss the implications of the transposition of Western evaluation methods and the posttraumatic perspective to Non-Western contexts.

Investigou-se indicadores de crescimento pós-traumático (CPT) em vítimas de desastres por meio de seis hipóteses: os sintomas de reexperimentação e evitação, típicos do transtorno de estresse pós-traumático (TEPT), seriam preditores positivos de CPT (h1); os paquistaneses teriam menores taxas de CPT quando comparados a brasileiros (h2), maior número de eventos traumáticos (h3), bombardeios e terrorismo (h4) e traços patológicos de personalidade (h5) seriam preditores negativos de CPT e o fator religiosidade seria um indicador positivo do CPT (h6). Participaram do estudo 202 indivíduos, 64,9% homens com idades entre 18 e 66 anos (M = 28,07; DP = 8,82). Os instrumentos utilizados incluíram o Inventário de Crescimento Pós-Traumático, o PTSD Checklist for DSM-5 e o Inventário Dimensional Clínico da Personalidade-Versão Triagem. As hipóteses foram parcialmente corroboradas. Se discute a transposição de métodos de avaliação ocidentais e perspectiva pós-traumática para contextos orientais.

Se han investigado indicadores de crecimiento postraumático (CPT) en víctimas de desastres a través de seis hipótesis: los síntomas de re experimentación y evitación, típicos del trastorno de estrés postraumático (TEPT), serían predictores positivos de CPT (h1); los paquistaníes tendrían menores tasas de CPT cuando comparados a brasileños (h2), mayor número de eventos traumáticos (h3), bombardeos y terrorismo (h4) y rasgos patológicos de personalidad (h5) serían predictores negativos de CPT y el factor religiosidad sería un indicador positivo del CPT (h6). Participaron 202 individuos, 64,9% hombres con edades entre 18 y 66 años (M = 28,07, DP = 8,82). Los instrumentos utilizados incluyeron el Inventario de Crecimiento Post-traumático, la lista de verificación del PTSD para el Checklist for DSM-5 y el Inventario Dimensional Clínico de la Personalidad - Versión EvaluaciónTriage. Las hipótesis fueron parcialmente corroboradas. Se discute la transposición de métodos de evaluación occidentales y perspectiva post-traumática para contextos orientales.

Possible outcomes of cumulative trauma in mental-health: a case report / Possíveis desfechos para trauma cumulativo na saúde mental: um relato de caso

ABSTRACT To discuss the resilience factors that may have prevented a patient from developing post-traumatic stress disorder (PTSD) after exposure to a variety of severe potentially traumatic events. A thirty-eight-year-old civilian has been exposed to at least ten dramatic situations of violence in his work and personal life. He developed only a few mild post-traumatic symptoms after being exposed to a particularly gruesome incident during work. Even though the number and severity of potentially traumatic events may be alarming, this does not determine that the patient will inexorably develop PTSD, or other disorders. The study of protective factors is mandatory so that we can acknowledge and develop more effective ways to prevent and treat disorders.

RESUMO Discutir fatores de resiliência que podem ter prevenido que um paciente desenvolvesse transtorno do estresse pós-traumático (TEPT) após a exposição a uma variedade de eventos potencialmente traumáticos severos. Um civil de 38 anos que foi exposto a, ao menos, 10 situações dramáticas de violência em seu trabalho e vida pessoal. Ele desenvolveu apenas alguns sintomas leves após o trauma de ter sido exposto a um evento particularmente desconcertante durante seu trabalho. Apesar de o número e a severidade dos eventos potencialmente traumáticos serem alarmantes, isso não determina que o paciente invariavelmente apresentará o TEPT ou outros transtornos. O estudo dos fatores protetivos é essencial para que possamos reconhecer e desenvolver maneiras efetivas de prevenir e tratar os transtornos mentais.

Long-term posttraumatic stress disorder in mine workers after a coalmining disaster

Abstract Background A coalmine disaster has occurred in Turkey on 13 May 2014, which caused the death of 301 miners. Objective This study aimed to determine the prevalence of posttraumatic stress disorder (PTSD) symptoms and the risk factors for PTSD among mine workers, 2 years after the coalmining disaster. Methods This was a cross-sectional survey conducted between June 2016 and July 2016 among mine workers who were the employees of either the mine where the accident occurred or three other mines in the same area. Sociodemographic data form and PTSD Symptom-Scale Self-Report (PSS-SR) were used to collect data. Results 672 mine workers participated in the study. At the time of the accident, 23.7% (n = 159) of them were in the mine where the accident occurred. The mean score on total PSS-SR was 4.27 (SD: ±4.49). Eighteen (2.7%) participants screened positive for PTSD. Logistic regression analysis revealed the significant risk factors for PTSD are: being single/divorced/widowed, having a chronic disease, having a family history of psychiatric illness and previously experiencing traumatic events more than one. Discussion Coalmining workers have considerably high prevalence rate of PTSD symptoms after a coalmining disaster. Assessing PTSD and associated risks is important for preventive mental health services.