A pilot randomised control study to investigate the effect of the South African Adolescence Group Sleep Intervention (SAASI) on adolescent sleep and PTSD.

Background: Trauma exposure prevalence and consequent post-traumatic stress disorder among South African adolescents are significant. Sleep disturbances are among the most frequently reported difficulties faced by those dealing with PTSD. The current study examined the feasibility and preliminary efficacy of the South African Adolescence Group Sleep Intervention on PTSD symptom severity and sleep disturbance.Method: Sixty-one adolescents with PTSD diagnoses and sleep disturbance were randomly assigned (1:1) to one individual and four group sessions of a sleep intervention (SAASI) or a control group. Participants completed the Child PTSD symptom scale for DSM5 (CPSS-5) and the Pittsburgh Sleep Quality Index (PSQI) among other sleep and psychiatric measures. The trial was registered on the Pan African Trial Registry (PACTR202208559723690).Results: There was a significant but similar decrease in PSQI scores in both groups over time indicating no overall intervention effect (Wald test = -2.18, p = .029), mean slope = -0.2 (95% CI: -0.37 to -0.02) (p = .583). On the CPSS-5, interaction between groups was also not significant (p = .291). Despite this overall finding, the mean difference in CPSS-SR-5 scores increased over time, with the difference between groups post-treatment -9.10 (95%CI: -18.00 to -0.21), p = .045 and the 1-month follow-up contrast - 11.22 (95%CI: -22.43 to -0.03), p = .049 suggesting that PTSD symptom severity decreased more in the intervention group than the control group. The dropout rate was higher than expected for both the intervention (n = 10; 32%) and control (n = 8; 26.7%) groups. Dropout were mostly school commitments or travel related.Conclusions: Early findings suggest a trend towards dual improvement in sleep quality and PTSD symptom severity in adolescents with a sleep disturbance and PTSD receiving a group sleep intervention (SAASI). Further investigation in a properly powered RCT with detailed retention planning is indicated.

A four-week group sleep intervention seems feasible in adolescents with PTSD and sleep disturbances in a low-resource South African setting.Utilising less specialised mental health resources such as nurses and counsellors in intervention delivery was feasible and effective.Preliminary results are promising and support further research to establish the efficacy of the intervention.

Effectiveness of abbreviated trauma-focused cognitive behavioural therapy for South African adolescents: a randomized controlled trial.

Background: In low- and middle- income countries (LMICs) trauma exposure among youth is high, but mental health services are critically under-resourced. In such contexts, abbreviated trauma treatments are needed.Objective: To evaluate the efficacy of an abbreviated eight-session version of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) for improving posttraumatic stress disorder (PTSD) and depression symptoms in a sample of South African adolescents.Method: 75 trauma-exposed adolescents (21 males, 54 females; mean age = 14.92, range = 11-19) with posttraumatic stress disorder (PTSD) symptoms were randomly assigned to eight sessions of TF-CBT or to usual services. At baseline, post-treatment and three-month follow-up, participants completed the Child PTSD Symptom Scale for DSM 5 (CPSS-5) and the Beck Depression Inventory II (BDI-II). The trial is registered on the Pan African Trial Registry (PACTR202011506380839).6.Results: 95% of TF-CBT participants completed treatment while only 47% of TAU participants accessed treatment. Intention-to-treat analyses found that the TF-CBT group had a significantly greater reduction in CPSS-5 PTSD symptom severity at post-treatment (Cohen's d = 0. 60, p < .01) and three-month follow-up (Cohen's d = 0.62, p < . 01), and a greater reduction in the proportion of participants meeting the CPSS-5 clinical cut-off for PTSD at both time points (p = .02 and p = .03, respectively). There was also a significantly greater reduction in depression symptom severity in the TF-CBT group at post-treatment (Cohen's d = 0.51, p = .03) and three-month follow-up (Cohen's d = 0.41, p = .05), and a greater reduction in the proportion of TF-CBT participants meeting the BDI clinical cut-off for depression at both time points (p = .02 and p = .03, respectively).Conclusion: The findings provide preliminary evidence of the efficacy of an abbreviated eight-session version of TF-CBT for reducing PTSD and depression symptoms in a LMIC sample of adolescents with multiple trauma exposure.

Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) is one of the leading evidence-based treatments for child and adolescent posttraumatic stress, but an abbreviated version has not been evaluated in low- and middle-income countries (LMICs).At post-treatment and three-month follow-up, eight sessions of TF-CBT were more effective than treatment-as-usual in reducing posttraumatic stress and depression symptoms in an LMIC sample of South African adolescents exposed to multiple traumas.Effect sizes were similar to those reported for standard length TF-CBT, indicating that abbreviated TF-CBT may be a suitable option for resource-constrained child and adolescent mental health services in LMICs.

Differences in Abuse, Neglect, and Exposure to Community Violence in Adolescents With and Without PTSD and Depression.

South African adolescents are exposed to high levels of violence and trauma, including community violence, abuse, and neglect. Violence and trauma are associated with negative mental health outcomes, including posttraumatic stress disorder (PTSD) and depression. Demographic characteristics, additional exposure to trauma, community violence, and types of childhood abuse and neglect may place adolescents at greater risk of developing PTSD. This study aimed to first assess the weighted contribution of demographic factors, trauma load, community violence, and types of abuse and neglect in predicting PTSD symptom severity. Second, we aimed to determine group differences in demographic factors, trauma load, community violence, and types of abuse and neglect among participants with no disorder, PTSD only, PTSD and depression, and depression only. Participants were 215 adolescents identified with emotional and/or behavioral problems and referred to an adolescent trauma clinic from schools in the Western Cape region of South Africa. Clinical assessments were undertaken to assess community violence exposure; physical, sexual, and emotional abuse; physical and emotional neglect; and a clinical diagnosis of PTSD and comorbidity. Trauma-exposed adolescents with PTSD and depression reported significantly higher levels of emotional abuse and community violence exposure in comparison with trauma-exposed adolescents without a disorder. Emotional abuse, community violence exposure, and female gender were significant predictors of PTSD in regression analysis. These findings underscore the contribution of different types of trauma in the development of PTSD. Interventions focused on preventing trauma, PTSD, and depression should be multifaceted and be targeted at various levels, for example, individual/interpersonal level (reduce abuse in the household and immediate environment) and community/societal level (reduce crime rates in communities and strengthen conviction policies). Traumatized youth should routinely be screened for a history of abuse and particularly exposure to community violence, given their strong association with PTSD.

Sexual abuse but not posttraumatic stress disorder is associated with neurocognitive deficits in South African traumatized adolescents.

OBJECTIVES: Neurocognitive impairments are commonly observed in adults suffering from posttraumatic stress disorder (PTSD). The picture is less clear in adolescents. Childhood sexual abuse (CSA) may have an independent influence on neuropsychological test performance and provide partial explanatory power of the inconsistent findings. We hypothesized that adolescents with PTSD who have also suffered sexual abuse would have most pronounced deficits on neurocognitive testing. METHODS: In a cross-sectional design, 105 traumatized South African adolescents, of whom 52 fulfilled criteria of PTSD and 34 reported CSA, were studied. A comprehensive neurocognitive battery including tests of memory, executive functioning, and language was used to analyze the associations of neurocognitive impairments with PTSD and CSA. RESULTS: Adolescents reporting CSA manifested impairments in proactive and retroactive interference tasks on the Rey Auditory Verbal Learning test and in the copy condition of the Rey Osterrieth figure test, indicating deficits in attention and working memory. Against our hypothesis, no independent effects of PTSD were found on neurocognitive performance. Results were independent of comorbid psychiatric diagnoses. CONCLUSIONS: Sexual abuse seems to have an independent influence on attention and working memory. This could be an early sign of hippocampal impairment.

Trauma type as a conditional risk factor for posttraumatic stress disorder in a referred clinic sample of adolescents.

INTRODUCTION: Traumatic experiences that are varied in type and severity may lead to the development of Posttraumatic Stress Disorder (PTSD). Some trauma types present a higher conditional risk for PTSD owing to their nature and impact on growth and functioning. Few studies have investigated the conditional risk of PTSD in clinic referred adolescents in low- and middle-income countries. The aim of the study was to determine the conditional risk for PTSD based on various trauma types (car accidents, other serious accidents, fires, witnessing a natural disaster, witnessing a violent crime, being confronted with traumatic news, witnessing domestic violence, physical abuse and sexual abuse) and to stratify risk by gender. METHOD: Adolescents exposed to at least one Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) qualifying trauma were referred to a research clinic in Cape Town, South Africa (n = 216). PTSD status was assessed using a clinician administered interview. Conditional risk was determined using backwards stepwise multiple logistic regression analysis for 1) the whole sample, 2) females only and 3) males only. Gender differences in exposure to trauma types were determined using chi-square tests and cross-tabulation. RESULTS: The prevalence of PTSD was 48.1% in the whole sample. Age (ß = .16, p = .048, OR 1.17), fire exposure (ß = 2.32, p = .036, OR 10.12) and sexual abuse (ß = .93, p = .001, OR 2.54) were significant predictors of PTSD in the whole sample with the model explaining 12.4% of the variance in PTSD status. Age (ß = .22, p = .041, OR 1.24) and sexual abuse (ß = .87, p = .018, OR 2.39) were significant predictors of PTSD in female participants and explained 9.8% of the variance in PTSD status. Being a victim of a violent crime (ß = .78 p = .100, OR 2.19) was the only remaining predictor of PTSD in male participants and showed a trend towards significance. The model explained 7% of the variance in PTSD status. CONCLUSIONS: The findings underscore the importance of timely identification of trauma, particularly, sexual abuse and violence. Longitudinal tracking of adolescents exposed to different trauma types may identify those in need of treatment and enhance our understanding of the lasting impact of trauma.

Neuropsychological manifestations in children with Sydenham's chorea after adjunct intravenous immunoglobulin and standard treatment.

This was an exploratory study comparing neuropsychological manifestations of Sydenham's chorea (SC), 6 months after initiation of treatment, in children who had received intravenous immunoglobulins as an adjunct to standard treatment, with those who had received standard treatment. We included a non-SC control group for comparison. We hypothesized that compared to controls, children with SC who had received prior intravenous immunoglobulins would demonstrate less pronounced impairments compared to those who had received standard care. We conducted a cross-sectional analysis of 17 children with -SC who had received treatment 6 months previously (9 treated with standard of care and 8 augmented with intravenous immunoglobulins) and 17 non-SC, medically well controls. The standard treatment group (n = 9) exhibited significant behavioral difficulties, including significantly poorer co-operation (p = 0.009) compared with the other augmented immunoglobulins and non-SC control groups, and increased impulsivity (p = 0.016) compared with non-SC controls. The standard treatment group scored significantly lower than the other two groups on a measure of executive functioning (p = 0.03). Children with SC may be more at risk for neuropsychological difficulties than non-SC, medically well children. Intravenous immunoglobulins may mitigate some of these impairments.

Differential effects of escitalopram challenge on disgust processing in obsessive-compulsive disorder.

INTRODUCTION: Literature on the ability of patients with obsessive-compulsive disorder (OCD) to recognize static facial expressions of disgust is not consistent. We aimed to investigate whether OCD is associated with deficits in the recognition of disgust in a dynamic task, and if so, whether the acute administration of the selective serotonin reuptake inhibitor (SSRI) escitalopram would result in the normalization of such deficits. METHODS: OCD patients (n=20) and matched healthy controls (n=20) received a single dose of escitalopram 20mg on one day, and a single dose of placebo on another day, in randomized order, under double-blind conditions. Accuracy (i.e. the percentage of correct answers) and sensitivity to disgust stimuli (defined as the lowest level of emotional intensity expressed on the photo image after which no errors were made in the recognition of disgust for subsequent trials of increasing intensity) were compared in OCD patients and controls, with a repeated measures analysis of variance using a mixed model approach. RESULTS: On placebo, the accuracy of, and sensitivity to, disgust stimuli were similar across groups. OCD patients had more accurate and more sensitive recognition of disgust after acute SSRI administration than after placebo, while controls had less accurate recognition and less sensitive recognition of disgust after acute SSRI administration than after placebo. CONCLUSIONS: The use of a dynamic facial recognition task demonstrated altered responses to disgust in OCD patients compared to healthy controls after a pharmacological challenge with escitalopram. These findings suggest that the serotonergic system plays a role in disgust recognition.