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BACKGROUND: Psilocybin is being studied for use in treatment-resistant depression. METHODS: In this phase 2 double-blind trial, we randomly assigned adults with treatment-resistant depression to receive a single dose of a proprietary, synthetic formulation of psilocybin at a dose of 25 mg, 10 mg, or 1 mg (control), along with psychological support. The primary end point was the change from baseline to week 3 in the total score on the Montgomery-Åsberg Depression Rating Scale (MADRS; range, 0 to 60, with higher scores indicating more severe depression). Secondary end points included response at week 3 (≥50% decrease from baseline in the MADRS total score), remission at week 3 (MADRS total score ≤10), and sustained response at 12 weeks (meeting response criteria at week 3 and all subsequent visits). RESULTS: A total of 79 participants were in the 25-mg group, 75 in the 10-mg group, and 79 in the 1-mg group. The mean MADRS total score at baseline was 32 or 33 in each group. Least-squares mean changes from baseline to week 3 in the score were -12.0 for 25 mg, -7.9 for 10 mg, and -5.4 for 1 mg; the difference between the 25-mg group and 1-mg group was -6.6 (95% confidence interval [CI], -10.2 to -2.9; P<0.001) and between the 10-mg group and 1-mg group was -2.5 (95% CI, -6.2 to 1.2; P = 0.18). In the 25-mg group, the incidences of response and remission at 3 weeks, but not sustained response at 12 weeks, were generally supportive of the primary results. Adverse events occurred in 179 of 233 participants (77%) and included headache, nausea, and dizziness. Suicidal ideation or behavior or self-injury occurred in all dose groups. CONCLUSIONS: In this phase 2 trial involving participants with treatment-resistant depression, psilocybin at a single dose of 25 mg, but not 10 mg, reduced depression scores significantly more than a 1-mg dose over a period of 3 weeks but was associated with adverse effects. Larger and longer trials, including comparison with existing treatments, are required to determine the efficacy and safety of psilocybin for this disorder. (Funded by COMPASS Pathfinder; EudraCT number, 2017-003288-36; ClinicalTrials.gov number, NCT03775200.).
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Antidepressivos , Transtorno Depressivo Maior , Transtorno Depressivo Resistente a Tratamento , Psilocibina , Adulto , Humanos , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Método Duplo-Cego , Psilocibina/efeitos adversos , Psilocibina/uso terapêutico , Resultado do Tratamento , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/psicologiaRESUMO
While inflammatory markers have been implicated in the link between PTSD and poor health outcomes, there is a paucity of research investigating C-reactive protein (CRP) and psychotherapy treatment response for posttraumatic stress disorder (PTSD). The present study utilized a large, well-characterized sample of veterans and service members (N = 493) engaged in intensive psychotherapy to investigate the associations between CRP, trauma exposure, related variables, and PTSD and depression, as well as investigating if CRP was associated with PTSD psychotherapy treatment response. Bivariate correlation results indicate that CRP was significantly associated with BMI (r = 0.48) and severity of experiences of childhood physical and sexual abuse (r = 0.14 and 0.15, respectively) and was not significantly associated with baseline PTSD total symptom severity, PTSD symptom clusters, or depression symptom severity (rs ranging from -0.03 to 0.04). In multivariate regression models investigating if CRP and related variables were associated with PTSD baseline symptom severity, CRP was not a significant predictor (ß = -0.03). Hierarchical linear modeling did not identify CRP as a significant predictor of PTSD psychotherapy outcome. Given that findings indicate that CRP was broadly elevated in this treatment seeking sample but not associated with PTSD and depression symptom severity, results suggest CRP may not be a specific biomarker for PTSD or depression but may be elevated in psychiatric disease more generally.
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Transtornos de Estresse Pós-Traumáticos , Veteranos , Biomarcadores , Proteína C-Reativa/metabolismo , Depressão/psicologia , Depressão/terapia , Humanos , Psicoterapia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologiaRESUMO
Posttraumatic stress disorder (PTSD) is a debilitating syndrome with substantial morbidity and mortality that occurs in the aftermath of trauma. Symptoms of major depressive disorder (MDD) are also a frequent consequence of trauma exposure. Identifying novel risk markers in the immediate aftermath of trauma is a critical step for the identification of novel biological targets to understand mechanisms of pathophysiology and prevention, as well as the determination of patients most at risk who may benefit from immediate intervention. Our study utilizes a novel approach to computationally integrate blood-based transcriptomics, genomics, and interactomics to understand the development of risk vs. resilience in the months following trauma exposure. In a two-site longitudinal, observational prospective study, we assessed over 10,000 individuals and enrolled >700 subjects in the immediate aftermath of trauma (average 5.3 h post-trauma (range 0.5-12 h)) in the Grady Memorial Hospital (Atlanta) and Jackson Memorial Hospital (Miami) emergency departments. RNA expression data and 6-month follow-up data were available for 366 individuals, while genotype, transcriptome, and phenotype data were available for 297 patients. To maximize our power and understanding of genes and pathways that predict risk vs. resilience, we utilized a set-cover approach to capture fluctuations of gene expression of PTSD or depression-converting patients and non-converting trauma-exposed controls to find representative sets of disease-relevant dysregulated genes. We annotated such genes with their corresponding expression quantitative trait loci and applied a variant of a current flow algorithm to identify genes that potentially were causal for the observed dysregulation of disease genes involved in the development of depression and PTSD symptoms after trauma exposure. We obtained a final list of 11 driver causal genes related to MDD symptoms, 13 genes for PTSD symptoms, and 22 genes in PTSD and/or MDD. We observed that these individual or combined disorders shared ESR1, RUNX1, PPARA, and WWOX as driver causal genes, while other genes appeared to be causal driver in the PTSD only or MDD only cases. A number of these identified causal pathways have been previously implicated in the biology or genetics of PTSD and MDD, as well as in preclinical models of amygdala function and fear regulation. Our work provides a promising set of initial pathways that may underlie causal mechanisms in the development of PTSD or MDD in the aftermath of trauma.
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Transtorno Depressivo Maior , Transtornos de Estresse Pós-Traumáticos , Depressão , Transtorno Depressivo Maior/genética , Genômica , Humanos , Estudos Prospectivos , Transtornos de Estresse Pós-Traumáticos/genética , Transcriptoma/genéticaRESUMO
Posttraumatic stress disorder (PTSD) is prevalent and associated with significant morbidity. Mild traumatic brain injury (mTBI) concurrent with psychiatric trauma may be associated with PTSD. Prior studies of PTSD-related structural brain alterations have focused on military populations. The current study examined correlations between PTSD, acute mTBI, and structural brain alterations longitudinally in civilian patients (N = 504) who experienced a recent Criterion A traumatic event. Participants who reported loss of consciousness (LOC) were characterized as having mTBI; all others were included in the control group. PTSD symptoms were assessed at enrollment and over the following year; a subset of participants (n = 89) underwent volumetric brain MRI (M = 53 days posttrauma). Classes of PTSD symptom trajectories were modeled using latent growth mixture modeling. Associations between PTSD symptom trajectories and cortical thicknesses or subcortical volumes were assessed using a moderator-based regression. mTBI with LOC during trauma was positively correlated with the likelihood of developing a chronic PTSD symptom trajectory. mTBI showed significant interactions with cortical thickness in the rostral anterior cingulate cortex (rACC) in predicting PTSD symptoms, r = .461-.463. Bilateral rACC thickness positively predicted PTSD symptoms but only among participants who endorsed LOC, p < .001. The results demonstrate positive correlations between mTBI with LOC and PTSD symptom trajectories, and findings related to mTBI with LOC and rACC thickness interactions in predicting subsequent chronic PTSD symptoms suggest the importance of further understanding the role of mTBI in the context of PTSD to inform intervention and risk stratification.
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Concussão Encefálica , Militares , Transtornos de Estresse Pós-Traumáticos , Encéfalo/diagnóstico por imagem , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico por imagem , Concussão Encefálica/psicologia , Humanos , Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/diagnóstico por imagem , Transtornos de Estresse Pós-Traumáticos/psicologia , Inconsciência/diagnóstico por imagem , Inconsciência/etiologia , Inconsciência/psicologiaRESUMO
BACKGROUND: Many reports have documented the relationship between previous traumatic experiences, including childhood trauma, and the development of later life psychopathology, including posttraumatic stress disorder (PTSD). Identification of individuals at greatest risk for the development of PTSD could lead to preventative interventions. The present study examined the developmental course of PTSD after trauma exposure, using histories of previous traumatic experiences and the severity of the reaction to the trauma as predictors. METHODS: Participants (N = 713) were recruited from Emergency Departments in Miami and Atlanta immediately following a traumatic experience. Histories of previous traumatic experiences and the immediate reaction to the new trauma were examined at baseline. Follow-up assessments of PTSD severity were conducted at 1, 3, and 6 months. RESULTS: Histories of child abuse and pre-existing trauma symptoms predicted the immediate response to stress (R2 = .21, p < .001) and the initial trauma reaction (p < .005).) A mixed-model repeated-measures analysis of variance found that immediate stress response and a history of prior trauma (p < .001) significantly predicted the course of PTSD symptoms. Area under the curve (AUC) analyses suggested that the presence of PTSD at each successive assessment was predicted most substantially by the severity of PTSD at the immediately prior follow-up assessment (AUC > 0.86). CONCLUSIONS: The current findings suggest that previous traumatic experiences lead to a greater immediate reaction to trauma and combine to predict the development of PTSD, the maintenance of which is not moderated by these earlier experiences. The identification of people likely to develop PTSD may be aided by the assessment of prior experiences and immediate reactions.
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Maus-Tratos Infantis , Transtornos de Estresse Pós-Traumáticos , Criança , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologiaRESUMO
In the current study, we used a sample of predominantly African-American women with high rates of trauma exposure (N = 434) to examine psychometric properties of the Personality Inventory for DSM-5-Brief Form (PID-5-BF). We compared model fit between a model with five correlated latent factors and a higher-order model in which the five latent factors were used to estimate a single "general pathology" factor. Additionally, we computed estimates of internal consistency and domain interrelations and examined indices of convergent/discriminant validity of the PID-5-BF domains by examining their relations to relevant criterion variables. The expected five-factor structure demonstrated good fit indices in a confirmatory factor analysis, and the more parsimonious, higher-order model was retained. Within this higher-order model, the first-order factors accounted for more variance in the criterion variables than the general pathology factor in most instances. The PID-5-BF domains were highly interrelated (rs = .38 to .66), and convergent/discriminant validity of the domains varied: Negative Affectivity and Detachment generally showed the hypothesized pattern of relations with external criteria, while Antagonism and Disinhibition displayed less consistent and discriminant relations. Results are discussed in terms of the costs and benefits of using brief pathological trait measures in samples characterized by high levels of psychopathology.
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Negro ou Afro-Americano/psicologia , Vítimas de Crime/psicologia , Transtornos da Personalidade/diagnóstico , Inventário de Personalidade/normas , Adulto , Testes Diagnósticos de Rotina , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Comportamento Problema , Psicometria , Reprodutibilidade dos Testes , Estresse Psicológico/diagnósticoRESUMO
Evidence-based psychotherapies such as prolonged exposure therapy (PE) are recommended by clinical practice guidelines as first-line treatments for post-traumatic stress disorder (PTSD) and are safe and acceptable for use with older adults. One third to one half of all patients do not achieve a clinically meaningful response to standard outpatient PE and recent research suggests that older adults in particular may experience barriers to full engagement and response. Standard treatment may be challenging in older adults due to cognitive, medical, and psychosocial barriers. This article reviews the current state of the evidence on adjunctive and second-tier interventions that show promise for increasing response and/or engagement in evidence-based psychotherapy for PTSD, including medications such as d-cycloserine and 3,4-methylenedioxy-methamphetamine, neuromodulation techniques such as repetitive transcranial magnetic stimulation, and augmentations to the structure and content of psychotherapy, such as intensive outpatient formats. A case illustration of successful application of multiple augmentations to PE with an initially nonresponsive older adult patient is presented. A creative interdisciplinary approach based in available research may be beneficial for older adults who do not respond to first-line treatments.
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Terapia Implosiva , Transtornos de Estresse Pós-Traumáticos , Idoso , Humanos , Transtornos de Estresse Pós-Traumáticos/terapia , Estimulação Magnética TranscranianaRESUMO
BACKGROUND: Posttraumatic stress disorder (PTSD) is linked to a specific event, providing the opportunity to intervene in the immediate aftermath of trauma to prevent the development of this disorder. A previous trial demonstrated that trauma survivors who received three sessions of modified prolonged exposure therapy demonstrated decreased PTSD and depression prospectively compared to assessment only. The present study investigated the optimal dosing of this early intervention to test one versus three sessions of exposure therapy in the immediate aftermath of trauma. METHODS: Participants (n = 95) recruited from a Level 1 Trauma Center were randomly assigned in a 1.5:1.5:1 ratio in a parallel-group design to the three conditions: one-session exposure therapy, three-session exposure therapy, and assessment only. Follow-up assessments were conducted by study assessors blind to study condition. RESULTS: Mixed-effects model results found no significant differences in PTSD or depression symptoms between the control condition and those who received one or three exposure therapy sessions across 1-12-month follow-up assessment. Results indicate that the intervention did not interfere with natural recovery. Receiver operating characteristic curve analyses on the screening measure used for study inclusion (Predicting PTSD Questionnaire; PPQ) in the larger sample from which the treatment sample was drawn (n = 481) found that the PPQ was a poor predictor of likely PTSD at all follow-up time points (Area under the curve's = 0.55-0.62). CONCLUSIONS: This likely impacted study results as many participants demonstrated natural recovery. Recommendations for future early intervention research are reviewed, including strategies to identify more accurately those at risk for PTSD and oversampling more severe trauma types.
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Terapia Implosiva/métodos , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sobreviventes , Resultado do TratamentoRESUMO
Food addiction (FA) describes a group of disordered eating behaviors. Childhood trauma has been associated with adult FA and trauma has known effects on the endocrine system, but it is unclear whether FA is associated with insulin resistance. We hypothesized that severity of childhood trauma will be associated with FA and higher insulin resistance (HOMA-IR) in a sample of obese women with type 2 diabetes mellitus (T2DM), and that FA will mediate the association between childhood trauma and HOMA-IR. Women with a diagnosis of T2DM (Nâ¯=â¯73; MBMIâ¯=â¯35.86, SDBMIâ¯=â¯7.72; Mageâ¯=â¯50.59, SDageâ¯=â¯9.72) were recruited from a diabetes clinic at a county hospital. Participants completed the Childhood Trauma Questionnaire and the Yale Food Addiction Scale. Fasting blood samples were obtained from 64 participants to assess plasma hemoglobin A1c (HbA1c), insulin and glucose (used to calculate HOMA-IR); Oral Glucose Tolerance Test (OGTT) was performed to measure change in glucose and insulin secretion. 48% of the sample met diagnostic criteria for FA. Women with FA reported significantly higher HOMA-IR (Fâ¯=â¯25.692, pâ¯<â¯0.001, dfâ¯=â¯1,62), HbA1c (Fâ¯=â¯4.358, pâ¯=â¯0.041, dfâ¯=â¯1,62), and OGGT glucose (Fâ¯=â¯5.539, pâ¯=â¯0.022, dfâ¯=â¯1,62) as well as severity of childhood trauma (Fâ¯=â¯10.453, pâ¯=â¯0.002, dfâ¯=â¯1,71). In a hierarchical linear regression controlling for BMI, income level, and T2DM treatment, the severity of childhood trauma did not contribute to the prediction of HOMA-IR (ßâ¯=â¯-0.011, pâ¯=â¯0.942) whereas FA did (ßâ¯=â¯0.422, pâ¯=â¯0.007). In a bootstrapped mediation analysis, the association between childhood trauma and HOMA-IR was mediated by FA severity (bâ¯=â¯0.596, pâ¯=â¯0.020). Understanding the psychological factors that contribute to HOMA-IR in an underserved population of African American women may lead to more effective diabetes management and prevention strategies.
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Experiências Adversas da Infância , Maus-Tratos Infantis , Diabetes Mellitus Tipo 2 , Dependência de Alimentos/psicologia , Resistência à Insulina , Adulto , Negro ou Afro-Americano , Criança , Feminino , Humanos , Pessoa de Meia-Idade , ObesidadeRESUMO
Background and Introduction: Comprehensive monitoring and follow-up after traumatic injury is important for psychological recovery. However, scalable services to facilitate this are limited. Automated text message-based symptom self-monitoring (SSM) may be a feasible approach. This study examined its implementation and utility in identifying patients at risk for mental health difficulties after traumatic injury.Materials and Methods: Five hundred two patients admitted to a Level I trauma center between June 20, 2016 and July 31, 2017 were offered enrollment in a text message-based SSM service. Patients who enrolled received daily text message prompts over 30 days and most participated in a mental health screening 30 days postbaseline.Results: Approximately 67% of patients enrolled in the service; of these, 58% responded to the text messages, with an average response rate of 53%. Younger patients and those with elevated peritraumatic distress were more likely to enroll. Patients with higher levels of mental health stigma, who were White, or had been in a motor vehicle collision were more likely to enroll and respond to text messages once enrolled. Patients' daily ratings of distress detected clinically elevated 30-day mental health screens with high sensitivity (83%) and specificity (70%).Discussion and Conclusions: Text message-based SSM can be implemented as a clinical service in Level I trauma centers, and patient participation may increase engagement in mental health follow-up. Further, it can inform the use of risk assessments in practice, which can be used to identify patients with poor psychological recovery who require additional screening.
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Depressão/psicologia , Programas de Rastreamento/métodos , Medição de Risco , Autocuidado , Transtornos de Estresse Pós-Traumáticos/psicologia , Envio de Mensagens de Texto , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , South Carolina , Centros de TraumatologiaRESUMO
Given advantages of freely available and modifiable measures, an increase in the use of measures developed from the International Personality Item Pool (IPIP), including the 300-item representation of the Revised NEO Personality Inventory (NEO PI-R; Costa & McCrae, 1992a ) has occurred. The focus of this study was to use item response theory to develop a 60-item, IPIP-based measure of the Five-Factor Model (FFM) that provides equal representation of the FFM facets and to test the reliability and convergent and criterion validity of this measure compared to the NEO Five Factor Inventory (NEO-FFI). In an undergraduate sample (n = 359), scores from the NEO-FFI and IPIP-NEO-60 demonstrated good reliability and convergent validity with the NEO PI-R and IPIP-NEO-300. Additionally, across criterion variables in the undergraduate sample as well as a community-based sample (n = 757), the NEO-FFI and IPIP-NEO-60 demonstrated similar nomological networks across a wide range of external variables (rICC = .96). Finally, as expected, in an MTurk sample the IPIP-NEO-60 demonstrated advantages over the Big Five Inventory-2 (Soto & John, 2017 ; n = 342) with regard to the Agreeableness domain content. The results suggest strong reliability and validity of the IPIP-NEO-60 scores.
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Determinação da Personalidade/estatística & dados numéricos , Transtornos da Personalidade/diagnóstico , Inventário de Personalidade/estatística & dados numéricos , Personalidade , Adolescente , Adulto , Coleta de Dados , Análise Fatorial , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Estudantes , Adulto JovemRESUMO
OBJECTIVE: The goal of the present study was to investigate whether having higher scores on maladaptive personality traits was related to rating these traits as more likable. METHOD: Two studies were conducted, one with personality disorder traits (N = 219; Mage = 19.4; 63.8% female; 76.6% Caucasian) and one with general personality traits (N = 198; Mage = 19.5; 69.7% female; 77.3% Caucasian). In each study, participants self-rated their own personality and separately provided ratings of how "likable" they considered those personality traits. RESULTS: As expected, participants rated maladaptive traits more favorably if they considered themselves to possess those traits as well. Also as expected, individuals with higher Antagonism scores (including self-rated Dark Triad constructs of narcissism, psychopathy, and Machiavellianism) rated Antagonism and its related facets as "tolerable"-not necessarily likable, but as less unlikable than the average participant. CONCLUSIONS: These findings have implications for the ways that individuals with personality pathology perceive the people around them, which may in turn impact their expectations and behaviors.
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Emoções , Transtornos da Personalidade/psicologia , Personalidade , Adulto , Feminino , Humanos , Masculino , Narcisismo , Psicopatologia , Autorrelato , Sudeste dos Estados Unidos , Universidades , Adulto JovemRESUMO
OBJECTIVE: Increasing attention has been paid to the distinction between the dimensions of narcissistic grandiosity and vulnerability. We examine the degree to which basic traits underlie vulnerable narcissism, with a particular emphasis on the importance of Neuroticism and Agreeableness. METHOD: Across four samples (undergraduate, online community, clinical-community), we conduct dominance analyses to partition the variance predicted in vulnerable narcissism by the Five-Factor Model personality domains, as well as compare the empirical profiles generated by vulnerable narcissism and Neuroticism. RESULTS: These analyses demonstrate that the lion's share of variance is explained by Neuroticism (65%) and Agreeableness (19%). Similarity analyses were also conducted in which the extent to which vulnerable narcissism and Neuroticism share similar empirical networks was tested using an array of criteria, including self-, informant, and thin slice ratings of personality; interview-based ratings of personality disorder and pathological traits; and self-ratings of adverse events and functional outcomes. The empirical correlates of vulnerable narcissism and Neuroticism were nearly identical (MrICC = .94). Partial analyses demonstrated that the variance in vulnerable narcissism not shared with Neuroticism is largely specific to disagreeableness-related traits such as distrustfulness and grandiosity. CONCLUSIONS: These findings demonstrate the parsimony of using basic personality to study personality pathology and have implications for how vulnerable narcissism might be approached clinically.
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Narcisismo , Neuroticismo , Adolescente , Adulto , Idoso , Agressão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Personalidade , Escalas de Graduação Psiquiátrica , Estudantes , Inquéritos e Questionários , Universidades , Adulto JovemRESUMO
BACKGROUND: When a memory is recalled, it may again exist in a labile state and stored information becomes amenable to change, a psychobiological process known as reconsolidation. Exposure therapy for anxiety disorders involves accessing a fear memory and modifying it with less fearful information. A preclinical study reported that providing a reminder of a fear memory 10 min prior to extinction training in humans decreased fear up to 1 year later (Schiller et al., 2010). METHODS: For this pilot clinical study, we used virtual reality exposure therapy (VRE) for fear of flying (FoF) to determine if using a cue to reactivate the memory of the feared stimulus 10 min prior to exposure sessions leads to fewer anxiety-related behaviors and a more durable response compared to a neutral cue. FoF participants (N = 89) received four sessions of anxiety management training followed by four sessions of VRE. Participants were randomly assigned to receive an FoF cue (reactivation group) or a neutral cue (control group) prior to the VRE sessions. Heart rate (HR) and skin conductance levels (SCLs) were collected during posttreatment and 3-month follow-up assessments as objective markers of fear responding. RESULTS: Treatment was effective and all clinical measures improved equally between groups at posttreatment with maintained gains through follow-ups. Significant differences were identified with regard to HR and SCL indices. CONCLUSIONS: These results suggest that memory reactivation prior to exposure therapy did not have an impact on clinical measures but may enhance the effect of exposure therapy at the physiological level.
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Consolidação da Memória/fisiologia , Transtornos Fóbicos/terapia , Terapia de Exposição à Realidade Virtual/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Fóbicos/prevenção & controle , Projetos Piloto , Resultado do TratamentoRESUMO
A robust literature has emerged on the Dark Triad (DT) of personality-Machiavellianism (MACH), psychopathy, and narcissism. Questions remain as to whether MACH and psychopathy are distinguishable and whether MACH's empirical and theoretical networks are consistent. In Study 1 (N = 393; MTurk research participants), factor analyses were used to compare two-factor (MACH and psychopathy combined + narcissism) and three-factor models, with both fitting the data equally well. In Studies 1 and 2 (N = 341; undergraduate research participants), DT scores were examined in relation to a variety of external criteria, including self- and informant ratings of personality, adverse developmental experiences, and psychopathological symptoms/behaviors. In both studies, MACH and psychopathy manifested nearly identical empirical profiles and both were significantly related to disinhibitory traits thought to be antithetical to MACH. In Study 3 (N = 36; expert raters), expert ratings of the Five-Factor Model traits prototypical of MACH were collected and compared with empirically derived profiles. Measures of MACH yielded profiles that were inconsistent with the prototypical expert-rated profile due to their positive relations with a broad spectrum of impulsivity-related traits. Ultimately, measures of psychopathy and MACH appear to be measuring the same construct, and MACH assessments fail to capture the construct as articulated in theoretical descriptions.
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Transtorno da Personalidade Antissocial/fisiopatologia , Maquiavelismo , Narcisismo , Transtornos da Personalidade/fisiopatologia , Adulto , Transtorno da Personalidade Antissocial/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/classificação , Adulto JovemRESUMO
BACKGROUND: Alcohol use and sexual risk behaviors (SRBs) are significant problems on college campuses. College women are at particularly high risk for negative consequences associated with sexually transmitted infections (STIs) and unwanted pregnancy. METHODS: The current study (n = 160) examined the effect of a brief, web-based alcohol intervention (n = 53) for college women on reducing SRBs compared to an assessment only control (n = 107) with a randomized controlled trial. Outcome measures included condom use assertiveness and number of vaginal sex partners and data were collected at baseline and three-month follow-up. RESULTS: Regression analyses revealed that the alcohol intervention was associated with higher levels of condom use assertiveness at a three-month follow-up. Additionally, more alcohol use was associated with less condom use assertiveness for those with more significant sexual assault histories. CONCLUSIONS: These findings suggest that alcohol interventions may impact college women's beliefs but not behavior, and future interventions should more explicitly target both alcohol and sexual risk to decrease risky behaviors.
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This brief review article will describe treatment approaches for posttraumatic stress disorder (PTSD) based on findings from basic research. The focus of this review will be fear conditioning and extinction models, which provide a translational model of PTSD that can help translate basic research in nonhuman animals through well-controlled trials confirming the efficacy of treatment approaches in humans with PTSD such as prolonged exposure therapy. Specific cognitive aspects of fear extinction processes, including consolidation and reconsolidation, are reviewed along with behavioral and pharmacological treatment strategies based on basic research in these areas including attempts to prevent the development of PTSD as well as the treatment of chronic PTSD. Pharmacological, behavioral, and device-based augmentation strategies of PTSD treatment based in basic science findings are reviewed, including those that disrupt noradrenergic receptor processes, medications that act on NMDA receptors, physical exercise, cannabinoids, estradiol, dexamethasone, yohimbine, losartan, dopamine, and MDMA, along with the evidence for their efficacy in human clinical samples. While fear extinction provides an exciting translational opportunity to improve PTSD based on basic science findings, we review limitations and challenges of the extant literature as well as future directions.
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BACKGROUND: Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. OBJECTIVE: This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. METHODS: Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants' impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. RESULTS: Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, "It was realistic to my past surgical experiences"), impacting their degree of preparedness and expectations for surgery (eg, "The sounds and sights and procedures give you a test run; they prepare you for the actual day"), and having a calming or relaxing effect (eg, "You feel more relaxed for the surgery"). CONCLUSIONS: This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618.
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BACKGROUND: The Emory Healthcare Veterans Program (EHVP) is a multidisciplinary intensive outpatient treatment program for post-9/11 veterans and service members with invisible wounds, including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), substance use disorders (SUD), and other anxiety- and depression-related disorders. OBJECTIVE: This article reviews the EHVP. METHODS: The different treatment tracks that provide integrated and comprehensive treatment are highlighted along with a review of the standard, adjunctive, and auxiliary services that complement individualized treatment plans. RESULTS: This review particularly emphasizes the adjunctive neurorehabilitation service offered to veterans and service members with a TBI history and the EVHP data that indicate large reductions in PTSD and depression symptoms across treatment tracks that are maintained across 12 months follow up. Finally, there is a discussion of possible suboptimal treatment response and the pilot programs related to different treatment augmentation strategies being deploying to ensure optimal treatment response for all. CONCLUSION: Published data indicate that the two-week intensive outpatient program is an effective treatment program for a variety of complex presentations of PTSD, TBI, SUD, and other anxiety- and depression-related disorders in veterans and active duty service members.