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1.
Med Pr ; 75(1): 45-56, 2024 Mar 22.
Artigo em Polonês | MEDLINE | ID: mdl-38523500

RESUMO

BACKGROUND: There are several techniques to diagnose post-traumatic stress disorder (PTSD) symptoms that correspond to the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification of mental disorders. This study aimed at testing the reliability and construct validity of the Polish version of the PTSD-8. The results obtained in four professional groups of healthcare workers (physicians, nurses, paramedics, other occupations) were compared. MATERIAL AND METHODS: The PTSD-8 questionnaire includes questions on stress reactions manifested by intrusion (4 items), avoidance (2 items), or hypervigilance (2 items). Respondents were asked about their reactions to the traumatic work-related experiences occurring during the COVID-19 pandemic. The nationwide survey conducted in 2022 included 2303 employees, among whom 746 had such an experience and completed the PTSD-8 questionnaire. RESULTS: Based on confirmatory factor analysis (CFA) results, it was shown that a single-factor model is acceptable, but under the condition of modification by correlation of random errors at selected observable variables. The reliability of this scale is very good (McDonald's Ω = 0.890), and the goodness-of-fit of the overall CFA model is confirmed by: CMIN/DF = 3.969, NFI = 0.982, RFI = 0.964, IFI = 0.986, TLI = 0.983, RMSEA = 0.063. The model estimated for female nurses has the best psychometric properties. In the study group of 2303 respondents, 16.76% met the criteria for PTSD, accounting for 52.74% of those who were traumatized by a work-related event. The PTSD-8 index is M±SD 20.01±5.55 pts (range: 8-32 pts). The PTSD-8 index is significantly higher in women than in men, and higher in nurses compared to other professions. However, the differences between professional groups are significant only for women, and the largest when comparing female physicians and nurses. CONCLUSIONS: The analyses confirmed the rationale of further implementation of the PTSD-8 questionnaire in Poland, both as a tool for identifying PTSD and for studying the severity of the syndrome, its determinants and health effects. Med Pr Work Health Saf. 2024;75(1):45-56.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Masculino , Humanos , Feminino , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Polônia , Reprodutibilidade dos Testes , Pandemias , Inquéritos e Questionários
2.
J Psychiatr Pract ; 30(2): 104-118, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38526398

RESUMO

OBJECTIVE: In 2021, 89.3 million refugees were vulnerable to posttraumatic stress disorder (PTSD) after exposure to multiple and repeated traumatic experiences. The recent war in Ukraine provoked 7 million refugees to flee their homes. Specific clinical presentations of PTSD in refugee populations may not be familiar to most physicians. The goal of this review is to describe the diagnosis and specific clinical features of PTSD in refugees. METHODS: This narrative review of 263 articles explores 3 PTSD diagnoses that are frequently described in refugee populations and that have been observed in our clinical practices: complex PTSD, PTSD with psychotic symptoms, and PTSD with somatic symptoms. RESULTS: While complex PTSD does not seem to be related to individuals' culture and origin, the other 2 diagnoses have been specifically described in refugee populations. PTSD with somatic manifestations appears to be the most frequently described and commonly acknowledged form in refugee populations, whereas PTSD with psychotic symptoms remains more controversial due to its clinical variability and association with comorbid disorders. CONCLUSIONS: The difficulty of identifying PTSD with psychotic symptoms and PTSD with somatic symptoms in refugee populations may lead to misdiagnosis and explain the moderate effectiveness of care delivered to these populations. Appropriate diagnosis is essential to provide optimal psychiatric care to refugee populations.


Assuntos
Sintomas Inexplicáveis , Médicos , Refugiados , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Psicoterapia
3.
Eur J Psychotraumatol ; 15(1): 2324631, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38511498

RESUMO

Background: Maladaptive trauma appraisal plays an important role in the development and maintenance of posttraumatic stress disorder (PTSD). While studies have demonstrated the effectiveness of exposure and cognitive treatments for PTSD symptomatology, the effect of such treatments on specific trauma appraisals is still not well understood.Objective: The study investigated the effect of an exposure and a cognitive restructuring internet-based treatment on specific trauma appraisals in Arabic-speaking participants with PTSD.Method: 334 participants received either an exposure (n = 167) or a cognitive restructuring (n = 167) internet-based treatment. PTSD symptom severity (PCL-5) and specific trauma appraisals (TAQ) were assessed at pre- and post-treatment. Changes in specific trauma appraisals within and between the two treatments were analyzed using multi-group change modelling. Associations between changes in PTSD symptom severity and changes in trauma appraisals were evaluated using Pearson product-moment correlation. For both treatments, participants with versus without reliable improvement were compared regarding changes in specific trauma appraisals using Welch tests. Analyses were performed on 100 multiple imputed datasets.Results: Both treatments yielded significant changes in shame, self-blame, fear, anger, and alienation (all ps < .001). Changes in betrayal were only significant in the cognitive restructuring treatment (p < .001). There was no evidence of differences between treatments for any specific trauma appraisal. Changes in PTSD symptom severity were significantly associated with changes in trauma appraisals (all ps < .001). In both treatments, participants who experienced reliable improvement in PTSD symptom severity showed significantly larger pre- to post-treatment changes in specific trauma appraisals compared to those without reliable improvement. Again, differences in betrayal were only significant in the cognitive restructuring treatment.Conclusions: The findings indicate that both treatments are effective in reducing trauma appraisals in Arabic-speaking people with PTSD. Changes in trauma appraisal seem to be associated with changes in PTSD symptomatology.Trial registration: German Clinical Trials Register identifier: DRKS00010245.


Exposure and cognitive restructuring treatment in Arabic-speaking individuals with PTSD yield significant changes in shame, self-blame, fear, anger, and alienation.Changes in PTSD symptoms are positively associated with changes in specific trauma appraisals.There is no evidence of differences between both treatments for any specific trauma appraisal.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Terapia de Reestruturação Cognitiva
4.
Eur J Psychotraumatol ; 15(1): 2328506, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38516952

RESUMO

Background: The outbreak of war in Israel on 7 October and the unique events of that day have presented unprecedented challenges to first responders (FRs), who are professionally trained to engage in providing assistance in such circumstances. Moreover, while research demonstrates the long-term psychological consequences of FRs, little is known regarding how FR's engagement in providing assistance relates to stress and resilience levels as events continue to unfold.Objective: The current study examined the relationship between traumatic stress symptoms (TSS) and resilience levels among FRs and controls during the first weeks of the Iron Swords war, while focusing on the moderating role of active engagement in providing assistance.Method: Data were collected during the first month of the Iron Swords war from 374 participants living in Southern Israel, of whom 77 (20.6%) were FRs. All participants filled out scales assessing TSS and resilience and provided relevant background information.Results: High TSS levels were associated with reduced resilience in FRs and non-FRs. Moreover, both the study group and active engagement were significant moderators for the TSS-resilience link, which was insignificant among FRs who provided assistance and for civilians who did not provide assistance. However, the TSS-resilience association remained significant for FRs who did not engage in providing assistance and for civilians who did.Conclusions: Our findings highlight the importance of examining the extent to which FRs act in line with their duties during times of adverse stress. Clinical interventions aimed towards FRs who did not engage in providing assistance are needed and should focus on the extent to which their moral values, beliefs and expectations are met, as these appear critical parameters in preserving resilience.


First responders report increased traumatic stress and reduced resilience.Active engagement moderated first responders' traumatic stress­resilience link.Findings are discussed in the context of potentially morally injurious events.


Assuntos
Socorristas , Resiliência Psicológica , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Surtos de Doenças , Ferro
5.
Eur J Psychotraumatol ; 15(1): 2320993, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38445477

RESUMO

Background: Women have twice the lifetime prevalence of posttraumatic stress disorder (PTSD) relative to men, and PTSD is a known risk factor for cardiovascular disease (CVD). Two sex hormones - estradiol and progesterone - have been found to impact both PTSD and CVD symptomatology, but the way in which sex hormones influence cardiovascular physiology among individuals with PTSD is not well understood.Objective: This study sought to clarify the association between sex hormones, PTSD, and CVD among trauma-exposed women.Method: Sixty-six trauma-exposed women (M age = 31.45, SD = 8.92) completed a clinical interview for PTSD and self-reported CVD symptoms; estradiol and progesterone were assayed from blood samples. The association between each sex hormone and CVD symptoms was analyzed, controlling for age, systolic blood pressure (BP), and diastolic BP.Results: Neither estradiol nor the PTSD-by-estradiol interaction was significantly associated with CVD symptoms. Higher progesterone and, relatedly, progesterone-to-estradiol ratio (PE ratio) were each significantly associated with greater CVD symptom severity, but only for individuals with lower relative PTSD severity.Conclusions: The findings indicate that PTSD moderates the relationship between progesterone and CVD symptoms, and further research is warranted to reconcile findings in existing literature regarding the direction of and mechanisms behind this relationship.


Posttraumatic stress disorder (PTSD) is a risk factor for cardiovascular disease (CVD) and sex hormones have been implicated in their link.The current study examined associations between sex hormones, PTSD, and CVD symptoms among 66 trauma-exposed women.Estradiol was not significantly associated with CVD symptoms, but higher progesterone was significantly associated with greater CVD symptom severity, but only for individuals with lower relative PTSD severity.


Assuntos
Doenças Cardiovasculares , Transtornos de Estresse Pós-Traumáticos , Masculino , Feminino , Humanos , Adulto , Doenças Cardiovasculares/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Progesterona , Hormônios Esteroides Gonadais , Estradiol
6.
BMC Health Serv Res ; 24(1): 277, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38454472

RESUMO

BACKGROUND: There is scarce knowledge on the health care follow-up of parents of terror attack survivors. This study focused on the mothers and fathers of survivors and examined (1) their perceived health care needs relative to their psychological reactions, physical health problems (unmet health care needs), and adaptation to work; (2) whether sociodemographic characteristics, health problems and social support were associated with unmet health care needs; and (3) how unmet health care needs, sociodemographic characteristics, and experiences with health services associated with overall dissatisfaction during the health care follow-up. METHODS: Interview and questionnaire data from three waves of the Utøya parent study were analyzed (n = 364). Chi-square tests and t- tests were used to compare unmet physical and psychological health care needs, sociodemographic factors and post-terror attack health reported by mothers and fathers. Logistic regression analyses were used to examine whether sociodemographic characteristics, unmet health care needs, and health care experiences were associated with overall dissatisfaction among mothers and fathers of the survivors during the health care follow-up. RESULTS: Among the mothers, 43% reported unmet health care needs for psychological reactions, while 25% reported unmet health care needs for physical problems. Among the fathers, 36% reported unmet health care needs for psychological reactions, and 15% reported unmet health care needs for physical problems. Approximately 1 in 5 mothers and 1 in 10 fathers reported "very high/high" needs for adaptation to work. Poorer self-perceived health, higher levels of posttraumatic stress and anxiety/depression symptoms, and lower levels of social support were significantly associated with reported unmet psychological and physical health care needs in both mothers and fathers. Parents with unmet health care needs reported significantly lower satisfaction with the help services received compared to parents whose health care needs were met. Low accessibility of help services and not having enough time to talk and interact with health care practitioners were associated with overall dissatisfaction with the help received. CONCLUSIONS: Our findings highlight that parents of terror-exposed adolescents are at risk of having unmet psychological and physical health care needs and thus need to be included in proactive outreach and health care follow-up programs in the aftermath of a terror attack.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Terrorismo , Feminino , Adolescente , Humanos , Estudos Longitudinais , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Terrorismo/psicologia , Atenção à Saúde , Pais/psicologia , Sobreviventes/psicologia
7.
Indian J Pharmacol ; 56(1): 20-27, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38454585

RESUMO

AIMS AND OBJECTIVES: Posttraumatic stress disorder (PTSD) is a complex neuropsychiatric pathophysiology with an unmet need for safe, effective, and sustainable therapeutic modalities. Thus, the present study evaluated the effects of Withaniasomnifera (WS, Ashwagandha) on an experimental model of PTSD in rats. MATERIALS AND METHODS: Wistar rats (200-250 g) were used and time-dependent sensitization (TDS) was used as the experimental model of PTSD. Standardized WS root extract (100 and 300 mg/kg, p.o. for 15 days) was administered with TDS and their effects were observed on neurobehavioral (anxiety) and brain cytokines, corticosterone, and oxidative stress markers. RESULTS: Exposure to TDS resulted in anxiogenic behavior in the elevated plus maze (EPM) test, i.e., reductions in open arm entries and open arm time, as compared to the control group. Pretreatment with WS extract (100 and 300 mg/kg × 14 days) attenuated the TDS-induced anxiogenic activity in a dose-related manner, and these WS effects were comparable to those seen after the comparator drug fluoxetine (10 mg/kg). Assay of brain homogenates showed that TDS also resulted in elevations in brain interleukin-6 and reduction in corticosterone levels in both the hippocampus and prefrontal cortex (PFC), which were reversed after WS pretreatments. Further, WS pretreatment also reversed the TDS-induced changes in brain oxidative stress markers, namely elevated malondialdehyde and reduced glutathione levels in both the hippocampus and PFC. CONCLUSION: These results suggest that WS could have potential as a therapeutic agent for treating PTSD by attenuating anxiogenesis, neuroimmune axis activation, and oxidative stress.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Withania , Ratos , Animais , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Ratos Wistar , Corticosterona , Antioxidantes/farmacologia
8.
Clin Epigenetics ; 16(1): 38, 2024 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-38431614

RESUMO

BACKGROUND: Large-scale cohort and epidemiological studies suggest that PTSD confers risk for dementia in later life but the biological mechanisms underlying this association remain unknown. This study examined this question by assessing the influences of PTSD, APOE ε4 genotypes, DNA methylation, and other variables on the age- and dementia-associated biomarkers Aß40, Aß42, GFAP, NfL, and pTau-181 measured in plasma. Our primary hypothesis was that PTSD would be associated with elevated levels of these markers. METHODS: Analyses were based on data from a PTSD-enriched cohort of 849 individuals. We began by performing factor analyses of the biomarkers, the results of which identified a two-factor solution. Drawing from the ATN research framework, we termed the first factor, defined by Aß40 and Aß42, "Factor A" and the second factor, defined by GFAP, NfL and pTau-181, "Factor TN." Next, we performed epigenome-wide association analyses (EWAS) of the two-factor scores. Finally, using structural equation modeling (SEM), we evaluated (a) the influence of PTSD, age, APOE ε4 genotype and other covariates on levels of the ATN factors, and (b) tested the mediating influence of the EWAS-significant DNAm loci on these associations. RESULTS: The Factor A EWAS identified one significant locus, cg13053408, in FANCD2OS. The Factor TN analysis identified 3 EWAS-significant associations: cg26033520 near ASCC1, cg23156469 in FAM20B, and cg15356923 in FAM19A4. The SEM showed age to be related to both factors, more so with Factor TN (ß = 0.581, p < 0.001) than Factor A (ß = 0.330, p < 0.001). Genotype-determined African ancestry was associated with lower Factor A (ß = 0.196, p < 0.001). Contrary to our primary hypothesis, we found a modest negative bivariate correlation between PTSD and the TN factor scores (r = - 0.133, p < 0.001) attributable primarily to reduced levels of GFAP (r = - 0.128, p < 0.001). CONCLUSIONS: This study identified novel epigenetic associations with ATN biomarkers and demonstrated robust age and ancestral associations that will be essential to consider in future efforts to develop the clinical applications of these tests. The association between PTSD and reduced GFAP, which has been reported previously, warrants further investigation.


Assuntos
Doença de Alzheimer , Demência , Transtornos de Estresse Pós-Traumáticos , Humanos , Epigenoma , Metilação de DNA , Apolipoproteína E4/genética , Transtornos de Estresse Pós-Traumáticos/genética , Biomarcadores , Demência/genética , Doença de Alzheimer/genética , Proteínas de Transporte/genética
9.
Eur J Psychotraumatol ; 15(1): 2320607, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38436944

RESUMO

Background: Trauma-focused cognitive behavioural therapy such as prolonged exposure is considered firsthand choice for treatment of posttraumatic stress disorder (PTSD) but is seldom available in regular care. Digital therapy is proposed to bridge this gap, but its effectiveness for severe and complex PTSD is uncertain. The primary objective of the current study was to examine the feasibility, acceptability, and preliminary effects of digital therapist-guided prolonged exposure (Huddinge Online Prolonged Exposure; HOPE).Method: Thirty participants with moderate to severe PTSD, with the majority self-reporting complex PTSD symptoms, received HOPE over a ten-week period. Eighty percent of participants had been diagnosed with other psychiatric comorbidity by a mental health professional. Primary outcome was the feasibility and acceptability of treatment. Participants were repeatedly assessed using clinician- and self-rated outcome measures at baseline, during the treatment period, post-treatment, and at 1-month and 6-month follow-ups to estimate preliminary treatment effects. The Clinician Administered PTSD Scale version 5 (CAPS-5), administered by independent assessors, evaluated PTSD symptom severity.Results: HOPE proved feasible and effective, delivering evidence-based treatment content in a psychiatric outpatient setting with reduced therapist time. The treatment was well-tolerated, with no severe adverse events and a 17% dropout rate. Sixty-four percent completed the exposure-based portion of the treatment, and overall satisfaction measured by the Client Satisfaction Questionnaire was moderate. Furthermore, significant reductions in PTSD symptoms as assessed with the CAPS-5 (Cohen's d = 1.30 [95% CI -1.79 to -0.82]) at the primary endpoint 1 month which were sustained at the 6-month follow up.Conclusion: Altogether, this study indicate feasibility of treating severe and complex PTSD through a digital PE intervention, thereby building upon and extending previous research findings. Large-scale controlled trials are needed to further validate the specific effect and long-term benefits of HOPE.Trial registration: ClinicalTrials.gov identifier: NCT05560854.


HOPE, a digital therapist-guided prolonged exposure programme, demonstrated feasibility and preliminary effects for severe and complex PTSD in a psychiatric outpatient setting, while requiring less therapist time.HOPE was well-tolerated by participants, with a relatively low dropout rate and average overall satisfaction.Significant reductions in PTSD symptoms were observed, and these benefits were sustained at the 6-month follow-up.


Assuntos
Terapia Cognitivo-Comportamental , Terapia Implosiva , Transtornos de Estresse Pós-Traumáticos , Humanos , Estudos de Viabilidade , Transtornos de Estresse Pós-Traumáticos/terapia , Pessoal de Saúde
10.
BMC Psychiatry ; 24(1): 171, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429677

RESUMO

BACKGROUND: Despite the fact that studies indicate that earthquake trauma is associated with numerous psychological consequences, the mediating mechanisms leading to these outcomes have not been well-studied. Therefore, this study investigates the relationship between trauma exposure with substance use tendency, depression, and suicidal thoughts, with the mediating role of peritraumatic dissociation and experiential avoidance. METHODS: The descriptive-correlational approach was employed in this study. The participants were people who had experienced the Kermanshah earthquake in 2017. A total of 324 people were selected by convenient sampling method. The Traumatic Exposure Severity Scale, the Peritraumatic Dissociative Experiences Questionnaire, the Acceptance and Action Questionnaire, the Iranian Addiction Potential Scale, Beck's Depression Inventory [BDI-II], and Beck's Suicidal Thoughts Scale were used to collect data. The gathered data was analyzed| using structural equation modeling in |SPSS Ver. 24 and LISREL Ver. 24. RESULTS: The study findings indicated that the intensity of the trauma exposure is directly and significantly associated with depression symptoms, peritraumatic dissociation, and experiential avoidance. The severity of exposure to trauma had a significant indirect effect on the tendency to use substances through experiential avoidance. This is while the severity of the trauma experience did not directly correlate with substance use and suicidal thoughts. In addition, peritraumatic dissociation did not act as a mediator in the relationship between the severity of trauma exposure with substance use, depression, and suicidal thoughts. CONCLUSIONS: The severity of exposure to the earthquake was associated with symptoms of depression and these findings indicate the importance of experiential avoidance in predicting the tendency to use drugs. Hence, it is essential to design and implement psychological interventions that target experiential avoidance to prevent drug use tendencies and to establish policies that lower depression symptoms following natural disasters.


Assuntos
Terremotos , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Depressão/etiologia , Ideação Suicida , Irã (Geográfico)
11.
BMC Psychiatry ; 24(1): 170, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429751

RESUMO

BACKGROUND: To the best of our knowledge, the long term prevalence of symptoms of anxiety and depression in ICU admitted individuals after COVID-19 in Sweden during the first wave of the pandemic has not been investigated. Furthermore, no studies have exclusively investigated the risk factors for experiencing symptoms of anxiety and depression in this population. AIM: The aim of this study was to determine the prevalence of symptoms of anxiety and depression at one year after ICU admission for COVID-19. An additional aim was to identify any early predictors that are associated with symptoms of anxiety and depression, at one year following ICU admission for COVID-19. METHODS: This multicenter cohort study had a cross-sectional and a longitudinal design. The primary outcomes and dependent variables, symptoms of anxiety and depression, were assessed using the Hospital Anxiety and Depression Scale (HADS). The independent variables were related to demographic factors, comorbidities, and complications during COVID-19-related ICU admission. Logistic regression analyses were performed to identify any predictors of symptoms of anxiety and depression. RESULTS: Out of 182 eligible individuals, 105 participated in the study. Symptoms of anxiety was found in 40 (38.1%) and depression in 37 (35.2%) of the participants. Using univariable logistic regression analyses, female sex was identified as a predictor of depression as defined by HADS at one year following ICU admission for COVID-19 (odds ratio 2.53, 95% confidence intervals 1.01-6.34, p-value 0.048). CONCLUSIONS: The high prevalence of symptoms of anxiety and depression in ICU admitted individuals one year after COVID-19 is a public health issue of concern. Our findings imply that individuals who recovered after an ICU stay for COVID-19 may benefit from long-term follow-ups and continuous mental health support for more than a year following the ICU admission. For women specifically, this is true. TRIAL REGISTRATION: The study was registered at researchweb.org on 28 May 2020 (Project number: 274477).


Assuntos
COVID-19 , Transtornos de Estresse Pós-Traumáticos , Humanos , Feminino , Estudos de Coortes , Transtornos de Estresse Pós-Traumáticos/psicologia , Depressão/psicologia , Prevalência , Estudos Transversais , COVID-19/epidemiologia , Ansiedade/psicologia , Unidades de Terapia Intensiva
12.
J Clin Sleep Med ; 20(3): 345-351, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38426846

RESUMO

STUDY OBJECTIVES: The goal of this study was to examine the phenotypic expression of posttraumatic stress disorder (PTSD) symptoms in veterans with probable PTSD and clinical insomnia relative to those with probable PTSD alone. METHODS: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 4,069 US military veterans. RESULTS: A total of 3.9% of the full sample screened positive for probable PTSD and clinical insomnia and 3.2% for probable PTSD alone. Relative to veterans with probable PTSD alone, those with probable PTSD and clinical insomnia reported significantly greater severity of intrusions, avoidance, and anxious and dysphoric arousal symptoms. Post hoc analyses of individual symptoms revealed that trauma-related nightmares; flashbacks; trauma-related emotional and physiological reactivity; avoidance of trauma-related thoughts, feelings, and external reminders; exaggerated startle response; concentration difficulties; and trauma-related sleep difficulties differed between groups. A multivariable logistic regression analysis further revealed that trauma-related sleep difficulties, trauma-related physiological reactivity, and exaggerated startle response independently predicted probable PTSD and clinical insomnia relative to PTSD alone. CONCLUSIONS: Results of this study suggest that trauma-related reactivity and arousal symptoms differentiate veterans with probable PTSD and clinical insomnia from those with probable PTSD alone. They further underscore the importance of utilizing nuanced models of PTSD symptom expression as part of assessment and treatment planning efforts in this population. CITATION: DeViva JC, McCarthy E, Fischer I, Pietrzak RH. Differences in the phenotypic expression of posttraumatic stress disorder symptoms in US military veterans with and without clinical insomnia. J Clin Sleep Med. 2024;20(3):345-351.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/psicologia , Ansiedade , Fenótipo
13.
Eur J Psychotraumatol ; 15(1): 2320040, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38488137

RESUMO

Background: Posttraumatic stress disorder (PTSD) is considered an independent risk factor for dementia. Despite the (clinical) evidence that PTSD is associated with neuropsychiatric symptoms in people with dementia, studies on its prevalence and clinical manifestation are limited, and their quality is affected by the lack of a structured method to diagnose PTSD in this population. The primary aim of the current study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for PTSD in people with dementia and to test feasibility of EMDR treatment for people with PTSD and dementia.Methods: This prospective multi-centre study is divided into two parts. In study A, 90 participants with dementia will be included to test the criterion validity, inter-rater reliability and feasibility of the 'TRAuma and DEmentia' interview. In study B, 29 participants with dementia and PTSD will receive eye movement desensitisation and reprocessing therapy by a trained psychologist, and 29 participants with dementia and PTSD will be placed on the waiting list control group.Conclusion: This study aims to improve the diagnostic process of PTSD and to assess the effects of eye movement desensitisation and reprocessing treatment in people with dementia living in Dutch care facilities.Trial registration: NL70479.068.20 / METC 20-063 / OSF registration: https://doi.org/10.17605/OSF.IO/AKW4F.


This study protocol describes a two-part study on posttraumatic stress disorder in people with dementia in Dutch care facilities.The primary aim of the study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for posttraumatic stress disorder in people with dementia.This study aims to test the feasibility of an evidence-based treatment for people with dementia and posttraumatic stress disorder in the form of eye movement desensitisation and reprocessing therapy.


Assuntos
Demência , Dessensibilização e Reprocessamento através dos Movimentos Oculares , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Dessensibilização e Reprocessamento através dos Movimentos Oculares/métodos , Demência/epidemiologia , Demência/terapia , Demência/complicações , Estudos Multicêntricos como Assunto
14.
Isr Med Assoc J ; 26(3): 186-190, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38493331

RESUMO

BACKGROUND: Survivors of critical illness are at increased risk of long-term impairments, referred to as post-intensive care unit (ICU) syndrome (PICS). Post-traumatic stress disorder (PTSD) is common among ICU survivors with reported rates of up to 27%. The prevalence of PTSD among Israeli ICU survivors has not been reported to date. OBJECTIVES: To evaluate the prevalence of new onset PTSD diagnosed in a post-ICU clinic at a tertiary center in Israel. METHODS: We conducted a retrospective, single center, cohort study. Data were collected from medical records of all patients who visited the Tel Aviv Sourasky Medical Center post-ICU clinic between October 2017 and June 2020. New onset PTSD was defined as PTSD diagnosed by a certified board psychiatrist during the post-ICU clinic visit. Data were analyzed using descriptive statistics. RESULTS: Overall, 39 patients (mean age 51 ± 17 years, 15/39 females [38%]) attended the post-ICU clinic during the study period. They were evaluated 82 ± 57 days after hospital discharge. After excluding 7 patients due to missing proper psychiatric analysis, 32 patients remained eligible for the primary analysis. New PTSD was diagnosed in one patient (3%). CONCLUSIONS: We found lower incidence of PTSD in our cohort when compared to existing literature. Possible explanations include different diagnostic tools and low risk factors rate. Unique national, cultural, and/or religious perspectives might have contributed to the observed low PTSD rate. Further research in larger study populations is required to establish the prevalence of PTSD among Israeli ICU survivors.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Estudos de Coortes , Israel/epidemiologia , Estudos Retrospectivos , Prevalência , Unidades de Terapia Intensiva , Sobreviventes/psicologia , Estado Terminal
15.
Eur Psychiatry ; 67(1): e24, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38450651

RESUMO

BACKGROUND: Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians' treatment choices for post-traumatic stress disorder (PTSD). METHODS: The case-based analysis included 611 participants, who correctly classified the vignette as a case of PTSD, from Central/ Eastern Europe (CEE) (n = 279), Southern Europe (SE) (n = 92), Northern Europe (NE) (n = 92), and Western Europe (WE) (N = 148). RESULTS: About 82% woulduse antidepressants (sertraline being the most preferred one). Benzodiazepines and antipsychotics were significantly more frequently recommended by participants from CEE (33 and 4%, respectively), compared to participants from NE (11 and 0%) and SE (9% and 3%). About 52% of clinicians recommended trauma-focused cognitive behavior therapy and 35% psychoeducation, irrespective of their origin. In the latent class analysis, we identified four distinct "profiles" of clinicians. In Class 1 (N = 367), psychiatrists would less often recommend any antidepressants. In Class 2 (N = 51), clinicians would recommend trazodone and prolonged exposure therapy. In Class 3 (N = 65), they propose mirtazapine and eye movement desensitization reprocessing therapy. In Class 4 (N = 128), clinicians propose different types of medications and cognitive processing therapy. About 50.1% of participants in each region stated they do not adhere to recognized treatment guidelines. CONCLUSIONS: Clinicians' decisions for PTSD are broadly similar among European psychiatrists, but regional differences suggest the need for more dialogue and education to harmonize practice across Europe and promote the use of guidelines.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/psicologia , Europa (Continente) , Antidepressivos/uso terapêutico
16.
J Trauma Nurs ; 31(2): 82-89, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38484163

RESUMO

BACKGROUND: Approximately 90% of adults endorse psychological trauma exposure. However, barriers to assessment of psychological trauma and sequelae include limited access to care, lack of standardized assessments in nonpsychiatric settings, and comorbid diagnoses, such as traumatic brain injury (TBI), that may mimic psychiatric syndromes. OBJECTIVES: This study aims to assess the prevalence rates of psychological trauma exposure and TBI to understand the relationship of these experiences with current psychiatric symptoms. METHODS: This is a cross-sectional study of a convenience sample of adult patients (age 18 years and older) referred for outpatient evaluation at a neuropsychology clinic in the Western United States between September 2021 and October 2022. Patients completed a clinical interview to assess their history of psychological trauma, TBI, and current psychiatric symptoms. RESULTS: A total of 118 patients met inclusion criteria. Patients in the TBI group (n = 83) endorsed significantly higher rates of childhood trauma and prior physical, emotional, and sexual abuse compared with the No TBI group (n = 35). Psychological trauma exposure and TBI significantly predicted current anxiety and depressive symptoms, but there was no interaction between these experiences in predicting current psychiatric symptoms. CONCLUSIONS: Individuals with prior TBI experienced psychological trauma, particularly childhood trauma, at a significantly higher rate than those without TBI. Psychological trauma exposure and TBI independently predicted anxious and depressive symptoms, suggesting both may be viable treatment targets. Evaluation of prior psychological trauma exposure during evaluation of TBI may provide opportunities for trauma-informed care and may allow for improved outpatient treatment planning.


Assuntos
Lesões Encefálicas Traumáticas , Trauma Psicológico , Transtornos de Estresse Pós-Traumáticos , Adulto , Humanos , Adolescente , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/etiologia , Estudos Transversais , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/complicações , Trauma Psicológico/complicações , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia
17.
Crit Care ; 28(1): 77, 2024 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-38486304

RESUMO

BACKGROUND: Posttraumatic stress disorder (PTSD) after a stay in the intensive care unit (ICU) can affect one in five ICU survivors. At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, admission to the ICU for COVID-19 was stressful due to the severity of this disease. This study assessed whether admission to the ICU for COVID-19 was associated with a higher prevalence of PTSD compared with other causes of ICU admission after adjustment for pre-ICU psychological factors. METHODS: This prospective observational comparative cohort study included 31 ICUs. Eligible patients were adult ICU survivors hospitalized during the first wave of COVID-19 pandemic in France, regardless of the reason for admission. The prevalence of presumptive diagnosis of PTSD at 6 months was assessed using the PTSD Checklist for DSM-5 (PCL-5). Sociodemographics, clinical data, history of childhood trauma (Childhood Trauma Questionnaire [CTQ]), and exposure to potentially traumatic events (Life Events Checklist for DSM-5 [LEC-5]) were assessed. RESULTS: Of the 778 ICU survivors included during the first wave of COVID-19 pandemic in France, 417 and 361 were assigned to the COVID-19 and non-COVID-19 cohorts, respectively. Fourteen (4.9%) and 11 (4.9%), respectively, presented with presumptive diagnosis of PTSD at 6 months (p = 0.976). After adjusting for age, sex, severity score at admission, use of invasive mechanical ventilation, ICU duration, CTQ and LEC-5, COVID-19 status was not associated with presumptive diagnosis of PTSD using the PCL-5. Only female sex was associated with presumptive diagnosis of PTSD. However, COVID-19 patients reported significantly more intrusion and avoidance symptoms than non-COVID patients (39% vs. 29%, p = 0.015 and 27% vs. 19%, p = 0.030), respectively. The median PCL-5 score was higher in the COVID-19 than non-COVID-19 cohort (9 [3, 20] vs. 4 [2, 16], p = 0.034). CONCLUSION: Admission to the ICU for COVID-19 was not associated with a higher prevalence of PTSD compared with admission for another cause during the first wave of the COVID-19 pandemic in France. However, intrusion and avoidance symptoms were more frequent in COVID-19 patients than in non-COVID-19 patients. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT03991611, registered on June 19, 2019.


Assuntos
COVID-19 , Testes Psicológicos , Autorrelato , Transtornos de Estresse Pós-Traumáticos , Adulto , Humanos , Feminino , Transtornos de Estresse Pós-Traumáticos/psicologia , COVID-19/epidemiologia , COVID-19/complicações , Estudos de Coortes , Pandemias , Unidades de Terapia Intensiva , Sobreviventes
18.
Eur Psychiatry ; 67(1): e22, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38425211

RESUMO

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is highly heritable, though environmental factors also play a role. Prenatal maternal stress is suggested to be one such factor, including exposure to highly distressing events that could lead to post-traumatic stress disorder (PTSD). The aim of this study is to investigate whether prenatal maternal PTSD is associated with offspring ADHD. METHOD: A register-based retrospective cohort study linking 553 766 children born in Sweden during 2006-2010 with their biological parents. Exposure: Prenatal PTSD. Outcome: Offspring ADHD. Logistic regression determined odds ratios (ORs) with 95% confidence intervals (CIs) for ADHD in the offspring. Adjustments were made for potential covariates, including single parenthood and possible indicators of heredity measured as parental ADHD and maternal mental disorders other than PTSD. Subpopulations, excluding children with indicators of heredity, were investigated separately. RESULTS: In the crude results, including all children, prenatal PTSD was associated with offspring ADHD (OR: 1.79, 95% CI: 1.37-2.34). In children with indicators of heredity, the likelihood was partly explained by it. Among children without indicators of heredity, PTSD was associated with offspring ADHD (OR: 2.32, 95% CI: 1.30-4.14), adjusted for confounders. CONCLUSIONS: Prenatal maternal PTSD is associated with offspring ADHD regardless of indicators of heredity, such as parental ADHD or maternal mental disorder other than PTSD. The association is partly explained by heredity and socioeconomic factors. If replicated in other populations, preferably using a sibling design, maternal PTSD could be identified as a risk factor for ADHD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtornos de Estresse Pós-Traumáticos , Criança , Feminino , Gravidez , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Suécia/epidemiologia , Estudos de Coortes , Estudos Retrospectivos , Mães , Fatores de Risco
19.
Auton Neurosci ; 252: 103159, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38428324

RESUMO

In the field of psychiatry, biological markers are rarely, if ever, used in the diagnosis of mental health disorders. Clinicians rely primarily on patient histories and behavioral symptoms to identify specific psychopathologies, which makes diagnosis highly subjective. Moreover, therapies for mental health disorders are aimed specifically at attenuating behavioral manifestations, which overlooks the pathophysiological indices of the disease. This is highly evident in posttraumatic stress disorder (PTSD) where inflammation and immune system perturbations are becoming increasingly described. Further, patients with PTSD possess significantly elevated risks of developing comorbid inflammatory diseases such as autoimmune and cardiovascular diseases, which are likely linked (though not fully proven) to the apparent dysregulation of the immune system after psychological trauma. To date, there is little to no evidence that demonstrates current PTSD therapies are able to reverse the increased risk for psychological trauma-induced inflammatory diseases, which suggests the behavioral and somatic consequences of PTSD may not be tightly coupled. This observation provides an opportunity to explore unique mechanisms outside of the brain that contribute to the long-term pathology of PTSD. Herein, we provide an overview of neuroimmune mechanisms, describe what is known regarding innate and adaptive immunity in PTSD, and suggest new directions that are needed to advance the understanding, diagnosis, and treatment of PTSD moving forward.


Assuntos
Doenças Cardiovasculares , Transtornos de Estresse Pós-Traumáticos , Humanos , Encéfalo , Sistema Imunitário , Inflamação
20.
Psychiatry Res ; 334: 115819, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38430818

RESUMO

The purpose of this study was to develop the Complex Trauma Screener (CTS), a brief screener (seven items) of the ICD-11 trauma disorders that can be used in "quick-paced" facilities. We examined the factor structure of the CTS in two separate samples: civilian college students (N = 823) and military veterans (N = 130) who reported exposure to at least one traumatic event. Confirmatory factor analyses (CFAs) supported two highly-correlated factors (post-traumatic stress disorder [PTSD] and Disturbances in Self-Organization [DSO]) that loaded on the ICD-11-consistent items. The model fit indices indicated good to excellent model fit in both samples, and the internal consistencies for the scales were borderline to good (α = 0.68-0.86). Supplementary analyses supported the gender invariance of the CFA model in the civilian student sample, as well as convergent (with another trauma inventory) and discriminant validity (with borderline disorder features, depression, and mania) of the CTS in both samples. The CTS is, to our knowledge, the shortest instrument designed to measure the ICD-11 trauma disorders and is ideal for "fast-paced" facilities that have significant assessment time restraints. The CTS is, therefore, is a psychometrically-validated instrument that can help mental health professionals efficiently screen adults for ICD-11 trauma disorders.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Adulto , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Classificação Internacional de Doenças , Escalas de Graduação Psiquiátrica , Personalidade , Análise Fatorial
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