Psychosocial impacts among adolescents disengaged from Colombian illegal armed groups and challenges to their attention.

OBJECTIVES: Our study focused on the impacts on health among adolescents who became members of illegal armed groups in Colombia and their attention within the specialized government programme as seen by the professionals who work directly with them. Previous research indicates that those victims of armed violence are usually highly affected on their emotional and social health, but with appropriate and timely support more serious mental health problems can be prevented. Therefore, the care provided to them should be based on broader and holistic approaches. METHODS: This cross-sectional study used the qualitative method based on semi-structured interviews with 42 professionals, and internal reports on the health condition of 165 adolescents, 57 (34.5%) females and 108 (65.5%) males, as a secondary source of information. All information was anonymous and confidential. RESULTS: The interviews with professionals and their reports demonstrated that about a half of the 165 adolescents, 35 of 57 (61.4%) females and 48 of 108 (44.4%) males, suffered from serious symptoms requiring therapeutic and psychiatric attention. About 20% of the adolescents presented clinically important post-traumatic stress symptoms, 27% admitted sexual abuse and 29% psychoactive substance abuse. The professionals stressed various obstacles to the attention of these multiple impacts related both to the administrative and institutional issues and the particular characteristics of this population. CONCLUSIONS: Our findings show the complexity of the psychosocial impacts among adolescent victims of the Colombian armed conflict and their attention. Highly trained professionals and alternative strategies including active listening, observation and art therapy activities seem to be vital for an effective care. The lessons learned from the Colombian reintegration programme serve as important inputs to be considered when attending children and adolescents from conflict-stricken areas also in other contexts.

APPLICATION OF ART THERAPY FOR CORRECTION OF PERSONAL DISORDERS OF PSYCHOEMOTIONAL STATE OF CHILDREN - INHABITANTS OF RADIATION POLLUTED TERRITORIES AND CHILDREN DISPLACED FROM THE ARMED CONFLICT ON THE SOUTHERN EAST OF UKRAINE. / ZASTOSUVANNIa ART-TERAPIÏ DLIa KOREKTsIÏ PORUShEN' PSYKhOEMOTsIY̆NOGO STANU DITEY̆-MEShKANTsIV RADIOAKTYVNO ZABRUDNENYKh TERYTORIY̆ TA DITEY̆, PEREMIShchENYKh IZ ZONY ZBROY̆NOGO KONFLIKTU NA PIVDENNOMU SKhODI UKRAÏNY.

OBJECTIVE: to identify the psycho-emotional state of children - residents of radioactively contaminated territories and children displaced from the zone of armed conflict in the south-east of Ukraine, and evaluate the effectiveness of art therapy application to correct its disturbances. MATERIALS AND METHODS: The psycho-emotional state was determined in 113 children, of which 57 children from radioactively contaminated territories with 137Cs content in the body from 269 Bq to 7024 Bq (group I) and 56 chil- dren displaced from the zone of military conflict in the Southeast of Ukraine (group II). The age of children ranged from 10 to 17 years. The children were hospitalized to the childrens' clinics of the NRCRM because of functional dis- orders and chronic somatic pathology. The psycho-emotional state of children was evaluated using the «non-exis- tent animal¼ test. It was analyzed for three symptoms - anxiety, aggressiveness and neuropsychiatric exhaustion and was evaluated by scoring points. Correction of the psychoemotional condition was carried out by the method of art therapy in the form of a serial drawing. Psychological testing was performed twice: at admission to the hospital and after the end of the art therapy. RESULTS: The results of the primary examination of the psycho-emotional state of children by the «non-existent ani- mal¼ test showed that in children - residents of radioactively contaminated territories the state of anxiety was reg- istered in all 57 children (100 %), the state of aggression - in 38 children (66.7%); exhaustion - in 37 children (64.9 %). In children who have been displaced from the zone of armed conflict in the south-east of Ukraine, the state of anxiety was also registered in all 56 children (100 %), the status of aggression was determined in 53 chil- dren (94.6 %), and the state of exhaustion - in 44 children (78.6 %). It was established that in children displaced from the combat zone in the Southeast of Ukraine, the quantitative indices of anxiety and aggression states were sig- nificantly higher than in children living in radioactively contaminated territories (p < 0.001), whereas nor by frequen- cy, nor by the degree of severity of exhaustion state they did not clearly differ (p > 0.05). Correlation analysis with the definition of Spearman's criterion did not reveal likely association between the content of 137Cs in the body of children - residents of radioactively contaminated territories and the peculiarities of their psycho-emotional state. CONCLUSIONS: The use of the art therapy method in the form of a serial drawing for children - residents of radioac- tively contaminated territories and children moved from the combat zone in the south-east of Ukraine, led to a sig- nificant positive effect, which was characterized by a decrease in the manifestations of symptoms of anxiety and aggressiveness. The state of exhaustion was less well corrected and its indices only had a tendency to improve. Thus, the method of art therapy in the form of a serial drawing is characterized by efficiency, simplicity of execution, low cost, it can be widely used in children's teams to correct disorders of the psycho-emotional state.

Increase of precuneus metabolism correlates with reduction of PTSD symptoms after EMDR therapy in military veterans: an 18F-FDG PET study during virtual reality exposure to war.

PURPOSE: The prevalence of posttraumatic stress disorder (PTSD) is higher among veterans, and can lead to disastrous consequences such as suicide. Eye movement desensitization and reprocessing (EMDR) is recommended in first-line psychotherapies for PTSD. Virtual reality exposure (VRE) coupled with 18F-FDG PET imaging can highlight the activated brain regions during stress exposure. The objective of this study is to identify, after EMDR therapy, the regions of brain metabolism that evolve during the stress exposure of a war scene with symptomatic remission in a group of military veterans suffering from PTSD, and to secondarily search for predictive metabolic features. METHODS: We recruited 15 military veterans suffering from PTSD who performed an 18F-FDG PET sensitized by the exposure to a virtual war scene, before (T0) and after (T1) EMDR therapy. Statistical parametric mapping was used to compare brain metabolism before and after treatment and to study correlations between metabolism and evolution scores on PTSD clinical scales (PTSD Checklist Scale, PCLS; Clinician-Administered PTSD Scale, CAPS). RESULTS: The metabolic activity of the precuneus was increased after EMDR therapy (p < 0.005 uncorrected, k > 180) and correlated with clinical improvement with the CAPS scale (r = -0.73 and p < 0.001). Moreover, the precuneus metabolic value before therapy predicted the clinical improvement on the PCLS scale (T1-T0) after EMDR (r = -0.667 and p < 0.006). CONCLUSION: The clinical improvement in military patients with PTSD after EMDR is related to increased precuneus metabolism upon VR stress exposure.

Psychological therapies for the treatment of mental disorders in low- and middle-income countries affected by humanitarian crises.

BACKGROUND: People living in humanitarian settings in low- and middle-income countries (LMICs) are exposed to a constellation of stressors that make them vulnerable to developing mental disorders. Mental disorders with a higher prevalence in these settings include post-traumatic stress disorder (PTSD) and major depressive, anxiety, somatoform (e.g. medically unexplained physical symptoms (MUPS)), and related disorders. A range of psychological therapies are used to manage symptoms of mental disorders in this population. OBJECTIVES: To compare the effectiveness and acceptability of psychological therapies versus control conditions (wait list, treatment as usual, attention placebo, psychological placebo, or no treatment) aimed at treating people with mental disorders (PTSD and major depressive, anxiety, somatoform, and related disorders) living in LMICs affected by humanitarian crises. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), the Cochrane Central Register of Controlled Trials (Wiley), MEDLINE (OVID), Embase (OVID), and PsycINFO (OVID), with results incorporated from searches to 3 February 2016. We also searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov to identify any unpublished or ongoing studies. We checked the reference lists of relevant studies and reviews. SELECTION CRITERIA: All randomised controlled trials (RCTs) comparing psychological therapies versus control conditions (including no treatment, usual care, wait list, attention placebo, and psychological placebo) to treat adults and children with mental disorders living in LMICs affected by humanitarian crises. DATA COLLECTION AND ANALYSIS: We used standard Cochrane procedures for collecting data and evaluating risk of bias. We calculated standardised mean differences for continuous outcomes and risk ratios for dichotomous data, using a random-effects model. We analysed data at endpoint (zero to four weeks after therapy); at medium term (one to four months after therapy); and at long term (six months or longer). GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) was used to assess the quality of evidence for post-traumatic stress disorder (PTSD), depression, anxiety and withdrawal outcomes. MAIN RESULTS: We included 36 studies (33 RCTs) with a total of 3523 participants. Included studies were conducted in sub-Saharan Africa, the Middle East and North Africa, and Asia. Studies were implemented in response to armed conflicts; disasters triggered by natural hazards; and other types of humanitarian crises. Together, the 33 RCTs compared eight psychological treatments against a control comparator.Four studies included children and adolescents between 5 and 18 years of age. Three studies included mixed populations (two studies included participants between 12 and 25 years of age, and one study included participants between 16 and 65 years of age). Remaining studies included adult populations (18 years of age or older).Included trials compared a psychological therapy versus a control intervention (wait list in most studies; no treatment; treatment as usual). Psychological therapies were categorised mainly as cognitive-behavioural therapy (CBT) in 23 comparisons (including seven comparisons focused on narrative exposure therapy (NET), two focused on common elements treatment approach (CETA), and one focused on brief behavioural activation treatment (BA)); eye movement desensitisation and reprocessing (EMDR) in two comparisons; interpersonal psychotherapy (IPT) in three comparisons; thought field therapy (TFT) in three comparisons; and trauma or general supportive counselling in two comparisons. Although interventions were described under these categories, several psychotherapeutic elements were common to a range of therapies (i.e. psychoeducation, coping skills).In adults, psychological therapies may substantially reduce endpoint PTSD symptoms compared to control conditions (standardised mean difference (SMD) -1.07, 95% confidence interval (CI) -1.34 to -0.79; 1272 participants; 16 studies; low-quality evidence). The effect is smaller at one to four months (SMD -0.49, 95% CI -0.68 to -0.31; 1660 participants; 18 studies) and at six months (SMD -0.37, 95% CI -0.61 to -0.14; 400 participants; five studies). Psychological therapies may also substantially reduce endpoint depression symptoms compared to control conditions (SMD -0.86, 95% CI -1.06 to -0.67; 1254 participants; 14 studies; low-quality evidence). Similar to PTSD symptoms, follow-up data at one to four months showed a smaller effect on depression (SMD -0.42, 95% CI -0.63 to -0.21; 1386 participants; 16 studies). Psychological therapies may moderately reduce anxiety at endpoint (SMD -0.74, 95% CI -0.98 to -0.49; 694 participants; five studies; low-quality evidence) and at one to four months' follow-up after treatment (SMD -0.53, 95% CI -0.66 to -0.39; 969 participants; seven studies). Dropout rates are probably similar between study conditions (19.5% with control versus 19.1% with psychological therapy (RR 0.98 95% CI 0.82 to 1.16; 2930 participants; 23 studies, moderate quality evidence)).In children and adolescents, we found very low quality evidence for lower endpoint PTSD symptoms scores in psychotherapy conditions (CBT) compared to control conditions, although the confidence interval is wide (SMD -1.56, 95% CI -3.13 to 0.01; 130 participants; three studies;). No RCTs provided data on major depression or anxiety in children. The effect on withdrawal was uncertain (RR 1.87 95% CI 0.47 to 7.47; 138 participants; 3 studies, low quality evidence).We did not identify any studies that evaluated psychological treatments on (symptoms of) somatoform disorders or MUPS in LMIC humanitarian settings. AUTHORS' CONCLUSIONS: There is low quality evidence that psychological therapies have large or moderate effects in reducing PTSD, depressive, and anxiety symptoms in adults living in humanitarian settings in LMICs. By one to four month and six month follow-up assessments treatment effects were smaller. Fewer trials were focused on children and adolescents and they provide very low quality evidence of a beneficial effect of psychological therapies in reducing PTSD symptoms at endpoint. Confidence in these findings is influenced by the risk of bias in the studies and by substantial levels of heterogeneity. More research evidence is needed, particularly for children and adolescents over longer periods of follow-up.

"In the Sport I Am Here": Therapeutic Processes and Health Effects of Sport and Exercise on PTSD.

Current evidence suggests positive effects of exercise on posttraumatic stress symptoms; however, knowledge about how these effects are achieved is limited. Thus, this study aims to contribute to a more holistic understanding of these effects. We performed a single case study of a war and torture survivor, who was diagnosed with posttraumatic stress disorder (PTSD) and depression, and who was participant of the sport and exercise therapy program Movi Kune. Participant observation was conducted as well as semi-structured interviews with the participant and his psychotherapist. Data analysis resulted in the proposal of different processes: The focus on bodily sensations related to an exposure effect, contributing to improvements in body awareness, coping behavior, and affect regulation, whereas the focus on playing related to an improved performance, presence, enjoyment, and mastery experiences, pointing toward distraction and motivational-restorative effects. The findings also advice to be cautious as participants may be exposed to negative sensations and trauma-related triggers.

Oil, Gas and Conflict: A Mathematical Model for the Resource Curse.

Oil and natural gas are highly valuable natural resources, but many countries with large untapped reserves suffer from poor economic and social-welfare performance. This conundrum is known as the resource curse. The resource curse is a result of poor governance and wealth distribution structures that allow the elite to monopolize resources for self-gain. When rival social groups compete for natural resources, civil unrest soon follows. While conceptually easy to follow, there have been few formal attempts to study this phenomenon. Thus, we develop a mathematical model that captures the basic elements and dynamics of this dilemma. We show that when resources are monopolized by the elite, increased exportation leads to decreased domestic production. This is due to under-provision of the resource-embedded energy and industrial infrastructure. Decreased domestic production then lowers the marginal return on productive activities, and insurgency emerges. The resultant conflict further displaces human, built, and natural capital. It forces the economy into a vicious downward spiral. Our numerical results highlight the importance of governance reform and productivity growth in reducing oil-and-gas-related conflicts, and thus identify potential points of intervention to break the downward spiral.