Posttraumatic stress disorder comorbidity and clinical implications in patients with severe mental illness.

Traumatic experiences and posttraumatic stress disorder (PTSD) are more frequent in patients with serious mental illness than in the general population. This study included 102 patients with schizophrenia, bipolar disorder, and schizoaffective disorder, according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Epidemiological and clinical data were collected using the Brief Psychiatric Rating Scale and Traumatic Life Events and Distressing Event questionnaires. We found a high number of traumatic experiences, and 15.1% of the patients met all criteria for PTSD. We found no differences based on diagnosis or sex, although there was a nonsignificant trend toward greater PTSD comorbidity in women. Among patients with serious mental illness and PTSD, 64.3% had made some attempt at suicide at some point in life, compared with 37.4% of patients without PTSD.

Prevalence and clinical impact of childhood trauma in patients with severe mental disorders.

A high prevalence of childhood abuse has been reported in patients with severe mental illness. We conducted a cross-sectional study of 102 patients with schizophrenia, bipolar disorder, or schizoaffective disorder. Social, demographic, and clinical data were obtained. Patients were evaluated using Brief Psychotic Relative Scale, and Traumatic Life Events and Distressing Event questionnaires. Almost half (47.5%) of these patients had suffered some kind of child abuse, and our results confirmed a relationship between a history of childhood abuse and more severe psychosis. Diagnosis of schizophrenia was determined 4.1 years earlier in victims of childhood abuse. Hospital admissions were twice as high in victims of psychological abuse. Patients with a history of sexual abuse were more than twice as likely to attempt suicide (68% vs. 28.9%).

Impacto psicológico inicial e incidencia de trastorno mental en torno a las interrupciones voluntarias del embarazo (IVE): un estudio piloto en población general / Initial psychological impact and incidence of mental disorders Around voluntary terminations of pregnancy (vtp): a pilot Study in the general population

Introducción/Antecedentes: Existe todavía una insuficiente evidencia científica sobre los efectos psicológicos/psicopatológicos y emocionales de las interrupciones voluntarias del embarazo (IVE), especialmente en nuestro entorno. Los estudios previos sobre el tema se caracterizan por 1) ofrecer resultados dispares, 2) estudiar depresión, ansiedad, trastorno por estrés postraumático y abuso de sustancias, pero al mismo tiempo 3) existen cuestiones metodológicas que limitan la generalización de los resultados. Objetivos: Describir una muestra de mujeres de población general que realizaron una IVE en un servicio público de Atención a la Sexual y Reproductiva (ASSIR) de Catalunya. Métodos: Estudio piloto de pacientes provenientes de población general y atendidas en nuestras consultas de Ginecología del Servicio de Atención a la Salud Sexual y Reproductiva (ASSIR) de Osona a Vic (Barcelona). Las pacientes fueron evaluadas siguiendo escalas estandarizadas, incluyendo la MINI (Mini Psychiatric Interview) y la Escala de Depresión de Hamilton. El seguimiento fue durante cuatro meses. Se realizó una estadística descriptiva. Resultados: Hasta 23 mujeres fueron incluidas en la muestra piloto. La edad media era joven (31.4 años). La mayoría (62.5%) estaban activas laboralmente y tenías estudios equivalentes al bachillerato o superiores (52.2%). El 26.1% habían tenido IVE previas. La IVE actual fue mayoritariamente farmacológica (73.9%). El principal motivo fue su voluntad (86.9%). Tres mujeres puntuaron más de 7 puntos en la Escala de Depresión de Hamilton. La entrevista diagnóstica MINI identificó diez mujeres con criterios para enfermedad mental en ese momento. De estas diez mujeres, seis no tenían antecedentes familiares ni personales de enfermedad mental, mientras que cuatro ya tenían antecedentes personales de alguna patología mental y ya habían consultado anteriormente en alguna ocasión al Servicio de Psiquiatría...(AU)

Introduction/Background: There is still insufficient scientific evidence on the psychological/psychopathological and emotional effects of voluntary terminations of pregnancy (V.T.P.), especially in our setting. Previous studies on the subject are characterized by 1) mixed results, 2) studying depression, anxiety, post-traumatic stress disorder and substance abuse, but at the same time 3) there are methodological issues that limit the generalizability of the results. Objectives: To describe a sample of women from the general population who underwent an abortion in a public center of the Sexual and Reproductive Assistance Network (ASSIR) of Catalonia. Methodology: Pilot study of patients from the general population attended in our Sexual and Reproductive Health outpatient clinics at the ASSIR of Osona (Vic, Barcelona). Patients were assessed using standardized scales, including the MINI (Mini Psychiatric Interview) and the Hamilton Depression Scale. Follow-up was for four months. Descriptive statistics were performed. Results: Up to 23 women were included in the pilot sample. The average age was young (31.4 years). The majority (62.5%) were active in the labour market and had a high school education or higher (52.2%). 26.1% had had a previous VTP. The current abortion was mostly pharmacological (73.9%). The main reason was willingness (86.9%). Three women scored more than 7 points on the Hamilton Depression Scale. The MINI diagnostic interview identified ten women with criteria for mental illness at that time. Of these ten women, six had no family or personal history of mental illness, while four had a personal history of mental illness and had previously consulted the psychiatric service. After the abortion, during the following four months, only one patient consulted the psychology service and was subsequently discharged...(AU)

Stress and multiple sclerosis: A systematic review considering potential moderating and mediating factors and methods of assessing stress.

Research about the effects of stress on multiple sclerosis has yielded contradictory results. This study aims to systematically review the evidence focusing on two possible causes: the role of stress assessment and potential moderating and mediating factors. The Web of Knowledge (MEDLINE and Web of Science), Scopus, and PsycINFO databases were searched for relevant articles published from 1900 through December 2014 using the terms "stress*" AND "multiple sclerosis." Twenty-three articles were included. Studies focused on the effect of stress on multiple sclerosis onset (n = 9) were mostly retrospective, and semi-structured interviews and scales yielded the most consistent associations. Studies focused on multiple sclerosis progression (n = 14) were mostly prospective, and self-reported diaries yielded the most consistent results. The most important modifying factors were stressor duration, severity, and frequency; cardiovascular reactivity and heart rate; and social support and escitalopram intake. Future studies should consider the use of prospective design with self-reported evaluations and the study of moderators and mediators related to amount of stress and autonomic nervous system reactivity to determine the effects of stress on multiple sclerosis.

Esquizofrenia y disociación: el trauma infantil en la etiología de los síntomas / Schizophrenia and dissociation: childhood trauma in the etiology of symptoms

Introducción: En los últimos 10 años han surgido múltiples estudios que vinculan las experiencias traumáticas en la infancia con la esquizofrenia. Hay autores que postulan un subtipo de esquizofrenia de origen traumático cuyos síntomas estarían mediados por mecanismos disociativos. Observación: Presentamos el caso de una joven de 22 años con antecedentes de polivictimización durante la infancia. A los 14 años inició un cuadro clínico caracterizado por sintomatología ansiosa y depresiva y realizó un primer intento de suicidio. Posteriormente se instauraron conductas autolesivas acompañadas de síntomas disociativos, alucinaciones visuales y auditivas e ideación delirante. Actualmente, y a lo largo de los 8 años de evolución, los síntomas positivos se han mantenido a pesar de múltiples tratamientos antipsicóticos. La paciente cumple los criterios DSM IV para esquizofrenia y trastorno límite de la personalidad. Las pruebas psicométricas aplicadas indican elevada disociación; las capacidades cognitivas están preservadas, con ausencia de trastornos formales del pensamiento y de síntomas negativos, y presenta un aceptable ajuste social. Discusión: El trauma infantil se asocia a los síntomas psicóticos, al trastorno límite de personalidad y a los síntomas disociativos. Diversos estudios muestran la imposibilidad de distinguir las alucinaciones de origen psicótico de las disociativas o de las del trastorno por estrés postraumático Es necesario contemplar la posibilidad de que los síntomas que presentan los pacientes esquizofrénicos con antecedentes de trauma infantil tengan un componente disociativo. Enfatizamos el indagar sistemáticamente sobre los antecedentes de abusos en la infancia y la presencia de síntomas disociativos en los pacientes con esquizofrenia (AU)

We report the case of a 22-year-old woman with history of childhood trauma. At 14 years old, she began with a clinical syndrome, characterized by anxiety and depression and made the first suicide attempt. She continued with repeated self-harm behavior and suicide attempts, showing dissociative symptoms, visual and auditory hallucinations, and prejudiced elusions. The current examinations indicate high dissociation, preserved cognitive abilities, absence of formal thought disorder and negative symptoms, and acceptable social adjustment. Discussion: The childhood trauma has been associated with psychotic symptoms, with the borderline personality disorder and with the dissociative symptoms. Diverse studies showed the inability to distinguish the psychotic hallucinations from the dissociative hallucinations or from the post-traumatic flashbacks. Some of the symptoms of schizophrenic patients with a history of childhood abuse are likely to have a dissociative component. The childhood trauma history and the presence of dissociative symptoms should be explored in all patients with schizophrenia (AU)