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1.
Psychol Trauma ; 12(S1): S243-S244, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32538661

RESUMO

During the COVID-19 pandemic, Spain ranked 1st in number of infected health workers. Despite the fact that up to 75% of them were women, psychological interventions to prevent distress usually lacked a gender perspective and a biopsychosocial approach. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Adaptação Psicológica , Infecções por Coronavirus , Pessoal de Saúde , Doenças Profissionais , Pandemias , Pneumonia Viral , Psicoterapia/normas , Transtornos de Estresse Traumático , Mulheres , Adulto , Feminino , Humanos , Doenças Profissionais/terapia , Espanha , Transtornos de Estresse Traumático/terapia
2.
Am J Psychoanal ; 80(2): 119-132, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32493939

RESUMO

The coronavirus pandemic, which apparently began in Wuhan in December 2019, and has persisted to the present day, has had several psychological effects in China. The real danger has produced prolonged stress. Large-group phenomena have been stimulated. Overwhelming affects generated by the real danger have led to regression in the stimulus barrier (or "filter"). The COVID-19 has also triggered unconscious defensive reactions, including obsessional cleaning, counterphobic behavior, humor, and denial. The nationally imposed home quarantine of millions of families has caused in-home conflicts and neurotic repetitions of unresolved childhood issues. Prior psychiatric illnesses have been exacerbated. Health workers, including psychiatrists, psychologists, and psychoanalysts, have experienced emotional depletion. Finally, in families where there has been infection or death, delayed mourning and post-traumatic phenomena have been observed. In each of these situations, different interventions based on psychoanalytic principles have been useful.


Assuntos
Sintomas Comportamentais/psicologia , Esgotamento Profissional/psicologia , Infecções por Coronavirus/psicologia , Conflito Familiar/psicologia , Pessoal de Saúde/psicologia , Pandemias , Pneumonia Viral/psicologia , Terapia Psicanalítica , Quarentena/psicologia , Transtornos de Estresse Traumático/psicologia , Sintomas Comportamentais/terapia , Esgotamento Profissional/terapia , China , Humanos , Transtornos de Estresse Traumático/terapia
3.
Artigo em Inglês | MEDLINE | ID: mdl-32161213

RESUMO

Memory retrieval is not a passive process. When a memory is retrieved, the retrieved memory is destabilized, similar to short-term memory just after learning, and requires memory reconsolidation to re-stabilize the memory. Recent studies characterizing destabilization and reconsolidation showed that a retrieved memory is not always destabilized and that there are boundary conditions that determine the induction of destabilization and reconsolidation according to certain parameters, such as the duration of retrieval and the memory strength and age. Moreover, the reconsolidation of contextual fear memory is not independent of memory extinction; rather, these memory processes interact with each other. There is an increasing number of findings suggesting that destabilization following retrieval facilitates the modification, weakening, or strengthening of the original memory, and the resultant updated memory is stabilized through reconsolidation. Reconsolidation could be targeted therapeutically to improve emotional disorders such as post-traumatic stress disorder and phobia. Thus, this review summarizes recent findings to understand the mechanisms and function of reconsolidation.


Assuntos
Extinção Psicológica/fisiologia , Consolidação da Memória/fisiologia , Animais , Encéfalo , Medo , Humanos , Transtornos da Memória/metabolismo , Transtornos Mentais/metabolismo , Transtornos Fóbicos/metabolismo , Transdução de Sinais , Transtornos de Estresse Traumático/metabolismo
4.
BMJ ; 367: l5784, 2019 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-31645334

RESUMO

OBJECTIVE: To assess whether severe psychiatric reactions to trauma and other adversities are associated with subsequent risk of life threatening infections. DESIGN: Population and sibling matched cohort study. SETTING: Swedish population. PARTICIPANTS: 144 919 individuals with stress related disorders (post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions) identified from 1987 to 2013 compared with 184 612 full siblings of individuals with a diagnosed stress related disorder and 1 449 190 matched individuals without such a diagnosis from the general population. MAIN OUTCOME MEASURES: A first inpatient or outpatient visit with a primary diagnosis of severe infections with high mortality rates (ie, sepsis, endocarditis, and meningitis or other central nervous system infections) from the Swedish National Patient Register, and deaths from these infections or infections of any origin from the Cause of Death Register. After controlling for multiple confounders, Cox models were used to estimate hazard ratios of these life threatening infections. RESULTS: The average age at diagnosis of a stress related disorder was 37 years (55 541, 38.3% men). During a mean follow-up of eight years, the incidence of life threatening infections per 1000 person years was 2.9 in individuals with a stress related disorder, 1.7 in siblings without a diagnosis, and 1.3 in matched individuals without a diagnosis. Compared with full siblings without a diagnosis of a stress related disorder, individuals with such a diagnosis were at increased risk of life threatening infections (hazard ratio for any stress related disorder was 1.47 (95% confidence intervals1.37 to 1.58) and for PTSD was 1.92 (1.46 to 2.52)). Corresponding estimates in the population based analysis were similar (1.58 (1.51 to 1.65) for any stress related disorder, P=0.09 for difference between sibling and population based comparison, and 1.95 (1.66 to 2.28) for PTSD, P=0.92 for difference). Stress related disorders were associated with all studied life threatening infections, with the highest relative risk observed for meningitis (sibling based analysis 1.63 (1.23 to 2.16)) and endocarditis (1.57 (1.08 to 2.30)). Younger age at diagnosis of a stress related disorder and the presence of psychiatric comorbidity, especially substance use disorders, were associated with higher hazard ratios, whereas use of selective serotonin reuptake inhibitors in the first year after diagnosis of a stress related disorder was associated with attenuated hazard ratios. CONCLUSION: In the Swedish population, stress related disorders were associated with a subsequent risk of life threatening infections, after controlling for familial background and physical or psychiatric comorbidities.


Assuntos
Infecções Bacterianas/epidemiologia , Suscetibilidade a Doenças/imunologia , Transtornos de Estresse Traumático/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/imunologia , Criança , Feminino , Seguimentos , Humanos , Incidência , Masculino , Anamnese , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença , Irmãos , Transtornos de Estresse Traumático/imunologia , Taxa de Sobrevida , Suécia/epidemiologia , Adulto Jovem
5.
Perspect Psychol Sci ; 14(5): 797-815, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31412219

RESUMO

Empirical evidence demonstrates that racism is a source of traumatic stress for racial/ethnic minorities, particularly African Americans. Like race and racism, skin tone and experiences of colorism-an often overlooked form of discrimination that privileges lighter skinned over darker skinned individuals, although not uniformly, may also result in traumatic stress. This article proposes a new conceptual model of skin-tone trauma. The model depicts how historical and contemporary underpinnings of colorism lead to colorist incidents that may directly and indirectly, by eliciting traumatic stress reactions, lead to negative effects on the health and interpersonal relationships of African Americans. Key tenets of critical race and intersectionality theories are used to highlight the complexities of skin-tone trauma as a result of intersectional identities on the basis of existing social hierarchies. Last, we present suggestions for researchers, as well as recommendations and strategies for practitioners, to unmask "skin-tone wounds" and promote healing for individuals, families, and communities that suffer from skin-tone trauma. Skin-tone trauma should be acknowledged by researchers, scholars, and practitioners to better understand and assess the widespread scope of trauma in the African American community.


Assuntos
Afro-Americanos/psicologia , Relações Interpessoais , Racismo/etnologia , Pigmentação da Pele , Transtornos de Estresse Traumático/etnologia , Afro-Americanos/etnologia , Direitos Civis , Corte/etnologia , Corte/psicologia , Escravização/etnologia , Escravização/psicologia , Relações Familiares , Feminino , Humanos , Masculino , Saúde Mental , Racismo/psicologia , Transtornos de Estresse Traumático/psicologia , Estresse Psicológico/etnologia , Estresse Psicológico/psicologia , Estados Unidos/etnologia
7.
Psychiatry Res ; 279: 15-22, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31279246

RESUMO

The theory and practice of psychiatric diagnosis are central yet contentious. This paper examines the heterogeneous nature of categories within the DSM-5, how this heterogeneity is expressed across diagnostic criteria, and its consequences for clinicians, clients, and the diagnostic model. Selected chapters of the DSM-5 were thematically analysed: schizophrenia spectrum and other psychotic disorders; bipolar and related disorders; depressive disorders; anxiety disorders; and trauma- and stressor-related disorders. Themes identified heterogeneity in specific diagnostic criteria, including symptom comparators, duration of difficulties, indicators of severity, and perspective used to assess difficulties. Wider variations across diagnostic categories examined symptom overlap across categories, and the role of trauma. Pragmatic criteria and difficulties that recur across multiple diagnostic categories offer flexibility for the clinician, but undermine the model of discrete categories of disorder. This nevertheless has implications for the way cause is conceptualised, such as implying that trauma affects only a limited number of diagnoses despite increasing evidence to the contrary. Individual experiences and specific causal pathways within diagnostic categories may also be obscured. A pragmatic approach to psychiatric assessment, allowing for recognition of individual experience, may therefore be a more effective way of understanding distress than maintaining commitment to a disingenuous categorical system.


Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Mentais/diagnóstico , Técnicas Psicológicas/classificação , Transtornos de Ansiedade/diagnóstico , Transtornos Bipolares e Relacionados/diagnóstico , Transtorno Depressivo/diagnóstico , Humanos , Transtornos Mentais/classificação , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Transtornos de Estresse Traumático/diagnóstico
9.
Pediatr Ann ; 48(7): e257-e261, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31305942

RESUMO

Addressing adverse childhood experiences (ACEs) in primary care pediatric practice is riddled with potential pitfalls that prevent most providers from implementing ACE or toxic stress screening in their practices. However, the growing body of literature and clinician experience about ACE screening shows how this practice is also ripe with possibilities beyond just the treatment of trauma-related diagnoses and for the prevention of intergenerational transmission of toxic stress. This article reviews the current state of screening for ACEs and toxic stress in practice, describes how pediatricians and clinics have overcome pitfalls during implementation of practice-based screening initiatives, and discusses possibilities for the future of primary care-based screening. [Pediatr Ann. 2019;48(7):e257-e261.].


Assuntos
Experiências Adversas da Infância , Pediatria/métodos , Atenção Primária à Saúde/métodos , Transtornos de Estresse Traumático/diagnóstico , Cuidadores/psicologia , Criança , Trauma Histórico/diagnóstico , Trauma Histórico/prevenção & controle , Humanos , Poder Familiar/psicologia , Pais/psicologia , Relações Profissional-Família , Encaminhamento e Consulta , Transtornos de Estresse Traumático/psicologia , Transtornos de Estresse Traumático/terapia
10.
Pediatr Ann ; 48(7): e262-e268, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31305943

RESUMO

Pediatric practitioners are called upon to identify adverse childhood experiences and social determinants of health, given the growing evidence of the prevalence, lifelong risk, and potentially preventable impact of adversities. Caregivers serve as a strong mediator of how adversities affect children, with toxic stress resulting from the lack of a buffering caregiver in the context of prolonged stress activation. In the context of family centered care, pediatric practitioners who identify adversities or diagnose related health conditions, will need to be adept at modifying treatment plans to respect the caregiver's circumstances. Pediatric practitioners will need to consider how adversities affect the caregiver's well-being and capacity to provide protective, buffering relationships to prevent toxic stress, and access to recommended treatments. This article proposes a reconsideration of traditional treatment planning to be adversity-informed to provide family centered care. [Pediatr Ann. 2019;48(7):e262-e268.].


Assuntos
Experiências Adversas da Infância , Cuidadores/psicologia , Planejamento de Assistência ao Paciente , Pediatria/métodos , Relações Profissional-Família , Determinantes Sociais da Saúde , Transtornos de Estresse Traumático/terapia , Criança , Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/terapia , Humanos , Relações Pais-Filho , Apoio Social , Transtornos de Estresse Traumático/diagnóstico , Transtornos de Estresse Traumático/psicologia
11.
Pediatr Ann ; 48(7): e269-e273, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31305944

RESUMO

Trauma in childhood is now understood to cause long-term effects on the brain and body. The pediatric provider, using a "trauma lens," which constitutes observing a child's attachment, resilience, and stress response, is well poised to identify and support children and families at risk. Fortunately, resilience is a dynamic process that can be learned, enhanced, and supported. Familiarity with the most common symptoms of traumatic stress will help the medical provider quickly recognize which children are impacted or FRAYED (Fits, Frets, and Fear; Regulation disorders; Attachment problems; Yawning and Yelling; Educational and developmental delays; Defeat and Dissociation). Once symptoms are identified, the caregiver can "focus" on attachment and resilience skills, the THREADS (Thinking & learning brain, with opportunity for continued growth; cognitive development; Hope, optimism, faith, belief in a future for one's self; Regulation [self-regulation, self-control]; Efficacy, or knowing one can impact their environment and situation; Attachment, secure; Development, or mastery of age-salient developmental tasks; Social context or the larger network of relationships in which one lives and learns) that can be woven together to promote resilience. Guiding families with empathy and positive regard, the medical provider can help the child and family rebuild resilience skills. Organizing practical guidance around the "3 R's"-Reassuring, Restoring routines, and Regulating-is a roadmap to recovery. [Pediatr Ann. 2019;48(7):e269-e273.].


Assuntos
Pediatria/métodos , Transtornos de Estresse Traumático/diagnóstico , Transtornos de Estresse Traumático/terapia , Experiências Adversas da Infância , Cuidadores/psicologia , Criança , Humanos , Recuperação da Saúde Mental , Relações Pais-Filho , Relações Profissional-Família , Relações Profissional-Paciente , Resiliência Psicológica , Transtornos de Estresse Traumático/fisiopatologia , Transtornos de Estresse Traumático/psicologia
12.
Pediatr Ann ; 48(7): e274-e279, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31305945

RESUMO

Adolescent relationship abuse and sexual violence are prevalent throughout adolescence and are associated with serious physical and mental health consequences. Trauma-informed approaches to care balance adolescent confidentiality, autonomy, and a young person's safety. The provision of trauma-informed care can include universal education and brief counseling about healthy relationships with all adolescent patients during clinical encounters to promote healthy adolescent sexual relationships, ensure youth know about resources for relationship abuse and sexual violence, and facilitate connections to advocates who serve survivors of abuse. Providers can integrate evidence-based relationship abuse and sexual violence prevention into their work with adolescents. [Pediatr Ann. 2019;48(7):e274-e279.].


Assuntos
Serviços de Saúde do Adolescente , Experiências Adversas da Infância , Maus-Tratos Infantis , Violência por Parceiro Íntimo/prevenção & controle , Serviços Preventivos de Saúde/métodos , Delitos Sexuais/prevenção & controle , Transtornos de Estresse Traumático , Adolescente , Criança , Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/terapia , Terapia Combinada , Confidencialidade , Aconselhamento/métodos , Feminino , Educação em Saúde/métodos , Promoção da Saúde/métodos , Humanos , Violência por Parceiro Íntimo/psicologia , Masculino , Segurança do Paciente , Assistência Centrada no Paciente/métodos , Delitos Sexuais/psicologia , Apoio Social , Transtornos de Estresse Traumático/diagnóstico , Transtornos de Estresse Traumático/psicologia , Transtornos de Estresse Traumático/terapia
13.
Pediatr Ann ; 48(7): e280-e285, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31305946

RESUMO

Sleep difficulties are a common challenge among children who have experienced trauma. Pediatricians are best positioned to work with families to address sleep challenges after traumatic events and help families return to healthy sleep patterns. In this article, we review the underlying concepts that connect trauma to disturbed sleep, types of sleep difficulties seen in children exposed to trauma, and explore ways in which pediatricians can support families as they help their child return to a normal sleep cycle, including the identification of co-occurring conditions and the use of medications. [Pediatr Ann. 2019;48(7):e280-e285.].


Assuntos
Pediatria/métodos , Transtornos do Sono-Vigília/etiologia , Transtornos de Estresse Traumático/complicações , Criança , Terapia Combinada , Humanos , Poder Familiar , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/psicologia , Transtornos do Sono-Vigília/terapia , Transtornos de Estresse Traumático/fisiopatologia , Transtornos de Estresse Traumático/psicologia
14.
Am J Addict ; 28(5): 376-381, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31242340

RESUMO

BACKGROUND AND OBJECTIVES: Prescription opioid (PO) misuse is increasing and is associated with overdose. Individuals who experienced a recent sexual assault are at risk for increased substance use, yet limited interventions target PO misuse after sexual assault. The current study examined the efficacy of video interventions on PO misuse after sexual assault. METHODS: Adolescent girls and women (n = 154) were recruited in the context of a sexual assault medical forensic exam in the emergency department. Effects of a prevention of post-rape stress (PPRS) video and a pleasant imagery and relaxation instruction (PIRI) video were compared with treatment as usual (TAU) during a sexual assault medical forensic exam on PO misuse. Participants reported if they had used POs for non-medical purposes since the sexual assault at 1.5 month follow-up. RESULTS: Results from a logistic regression analysis indicated that participants with a prior sexual assault were less likely to misuse prescription opioids 1.5 months after the assault in the PIRI condition compared with TAU. There were no main effects for video condition and no interactions for the PPRS condition on PO misuse. DISCUSSION AND CONCLUSIONS: Providing the PIRI video, or teaching other types of mindfulness or relaxation exercises, may be warranted as a secondary prevention for individuals during the sexual assault medical forensic exam for those with a prior sexual assault history. SCIENTIFIC SIGNIFICANCE: This research provides an initial examination of the impact of mindfulness skills recently after traumatic event exposure on PO misuse. (Am J Addict 2019;28:376-381).


Assuntos
Vítimas de Crime , Estupro , Transtornos de Estresse Traumático , Gravação em Vídeo , Adolescente , Adulto , Analgésicos Opioides/farmacologia , Vítimas de Crime/psicologia , Vítimas de Crime/reabilitação , Overdose de Drogas/prevenção & controle , Feminino , Humanos , Atenção Plena/métodos , Uso Indevido de Medicamentos sob Prescrição/efeitos adversos , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Uso Indevido de Medicamentos sob Prescrição/psicologia , Estupro/psicologia , Estupro/reabilitação , Transtornos de Estresse Traumático/etiologia , Transtornos de Estresse Traumático/prevenção & controle , Transtornos de Estresse Traumático/psicologia , Resultado do Tratamento
15.
Psychoneuroendocrinology ; 107: 251-260, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31174163

RESUMO

INTRODUCTION: Maternal gestational stress and immune activation have independently been associated with affective and neurodevelopmental disorders across the lifespan. We investigated whether rats exposed to prenatal maternal stressors (PNMS) consisting of psychological stress, interleukin (IL)-1ß or both (two-hit stress) during critical developmental windows displayed a behavioral phenotype representative of these conditions. METHODS: Long-Evans dams were exposed to psychological stressors consisting of restraint stress and forced swimming from gestational day (GD)12 to 18 or to no stress (controls). From GD17 until day of delivery, these same animals were injected with saline or IL-1ß as a second hit and immune stressor (5 µg/day, intraperitoneally). The behavior of F1 offspring adults was tested on the open field test, elevated plus maze and affective exploration task on postnatal days (P)90, 100 and 110 respectively. RESULTS: The effects of PNMS differed depending on the specific testing environment and potentially the age at assessment, especially in female offspring. Both locomotion and anxiety-like behavioral measures were susceptible to PNMS effects. In females, psychological stress increased anxiety-like behavior, whereas IL-1ß had an opposite effect, inducing exploration and risk-taking behavior on the open field test and the elevated plus maze. When present, interactions between both stressors limited the anxiogenic effect of psychological stress on its own. In contrast, prenatal psychological stress increased anxiety-like behavior in adult males overall. A similar anxiogenic effect of IL-1ß was only found on the open field test while the Stress*IL-1ß interaction appeared to limit the effect of either alone. Contrarily, the PNMS effects on anxiety-like behavior on the affective exploration task were highly similar between both sexes. Analysis of males and females together revealed an additive effect of Stress and IL-1ß on the number of exits from the refuge, a measure of risk assessment and thus correlated with anxiety. CONCLUSION: PNMS affected offspring adult behavior in a sex-dependent manner. Effects on females were more variable, whereas psychological stress mostly induced anxiety-like behavior in males. These data highlight the sexual dimorphism in vulnerability to prenatal stressors. Maternal or stress-induced programming of the stress response and neuroinflammation may play an important role in mediating stress effects on offspring adult behavior.


Assuntos
Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Caracteres Sexuais , Estresse Psicológico/fisiopatologia , Animais , Ansiedade/etiologia , Ansiedade/fisiopatologia , Comportamento Animal/fisiologia , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Comportamento Exploratório/fisiologia , Feminino , Hipocampo/efeitos dos fármacos , Interleucina-1beta/metabolismo , Interleucina-1beta/farmacologia , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/psicologia , Ratos , Ratos Long-Evans , Fatores Sexuais , Transtornos de Estresse Traumático/etiologia , Transtornos de Estresse Traumático/fisiopatologia , Estresse Psicológico/complicações
16.
J Affect Disord ; 254: 49-58, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31103906

RESUMO

BACKGROUND: Early childhood trauma is known to independently increase adverse outcome risk in coronary artery disease (CAD) patients, although the neurological correlates are not well understood. The purpose of this study was to examine whether early childhood trauma alters neural responses to acute mental stress in CAD patients. METHODS: Participants (n = 152) with CAD underwent brain imaging with High Resolution Positron Emission Tomography and radiolabeled water during control (verbal counting, neutral speaking) and mental stress (mental arithmetic, public speaking). Traumatic events in childhood were assessed with the Early Trauma Inventory (ETI-SR-SF) and participants were separated by presence (ETI+) or absence (ETI-) of early childhood trauma. Brain activity during mental stress was compared between ETI+ and ETI-. RESULTS: Compared to ETI-, ETI+ experienced greater (p < 0.005) activations during mental stress within the left anterior cingulate, bilateral frontal lobe and deactivations (p < 0.005) within the left insula, left parahippocampal gyrus, right dorsal anterior cingulate, bilateral cerebellum, bilateral fusiform gyrus, left inferior temporal gyrus, and right parietal lobe. Significant (p < 0.005) positive correlations between brain activation and ETI-SR-SF scores were observed within the left hippocampus, bilateral frontal lobe, left occipital cuneus, and bilateral temporal lobe. LIMITATIONS: Results in non-CAD samples may differ and ETI may be subject to recall bias. CONCLUSION: Early childhood trauma exacerbated activations in stress-responsive limbic and cognitive brain areas with direct and indirect connections to the heart, potentially contributing to adverse outcomes in CAD patients.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Transtornos de Estresse Traumático/complicações , Estresse Psicológico/fisiopatologia , Adulto , Encéfalo/fisiopatologia , Cerebelo/fisiopatologia , Córtex Cerebral/fisiopatologia , Criança , Pré-Escolar , Feminino , Lobo Frontal/fisiopatologia , Giro do Cíngulo/fisiopatologia , Hipocampo/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Rememoração Mental/fisiologia , Pessoa de Meia-Idade , Giro Para-Hipocampal/fisiopatologia , Lobo Parietal/fisiopatologia , Tomografia por Emissão de Pósitrons
17.
Obstet Gynecol ; 133(4): e296-e302, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30913202

RESUMO

Sexual violence continues to be a major public health problem affecting millions of adults and children in the United States. Medical consequences of sexual assault include sexually transmitted infections; mental health conditions, including posttraumatic stress disorder; and risk of unintended pregnancy in reproductive-aged survivors of sexual assault. Obstetrician-gynecologists and other women's health care providers play a key role in the evaluation and management of sexual assault survivors and should screen routinely for a history of sexual assault. When sexual violence is identified, individuals should receive appropriate and timely care. A clinician who examines sexual assault survivors in the acute-care setting has a responsibility to comply with state and local statutory or policy requirements for the use of evidence-gathering kits. This document has been updated to include model screening protocols and questions, relevant guidelines from other medical associations, trauma-informed care, and additional guidance regarding acute evaluation of survivors and evidence-gathering kits.


Assuntos
Vítimas de Crime , Delitos Sexuais , Vítimas de Crime/legislação & jurisprudência , Vítimas de Crime/psicologia , Vítimas de Crime/reabilitação , Feminino , Humanos , Gravidez , Delitos Sexuais/legislação & jurisprudência , Delitos Sexuais/psicologia , Doenças Sexualmente Transmissíveis/etiologia , Transtornos de Estresse Traumático/diagnóstico , Transtornos de Estresse Traumático/terapia , Estados Unidos
18.
Psychoneuroendocrinology ; 103: 219-224, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30711899

RESUMO

Prenatal stress (PS) has been related to altered hypothalamic-pituitary-adrenal (HPA) axis activity later in life. So far, studies in children assessing HPA axis functioning have focused on salivary cortisol, reflecting daytime activity. The present work is part of a prospective study and aims to extend knowledge about the association between PS and HPA axis regulation in children. To do so, we investigated cortisol, cortisone, and the ratio cortisone/(cortisone + cortisol) in the first morning urine of 45-month-old children in relation to several measures of maternal stress during pregnancy. Urinary cortisol and cortisone were measured by online turbulent flow chromatography coupled with high performance liquid chromatography-tandem mass spectrometry. PS was defined as: perceived stress for aim 1 (Perceived Stress Scale; n = 280); presence of self-reported (n = 371) and expert-rated psychopathology for aim 2 (Mini International Neuropsychiatric Interview; n = 281); continuous measures of anxiety and depression for exploratory aim 3 (State-Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale; n = 280). Aim 1: Perceived maternal PS showed negative associations with cortisol and cortisone levels. Aim 2: The presence of expert-rated maternal psychopathology was associated with reduced morning cortisone. Aim 3: Continuous measures of anxiety and depression showed negative associations with cortisol and cortisone levels. After correcting for multiple testing, perceived maternal PS (aim 1) and prenatal level of anxiety (aim 3) were significant predictors of children's urinary cortisol and cortisone in the morning (and, in the case of cortisone, also prenatal level of depression). The ratio cortisone/(cortisone + cortisol) as a global marker for the balance between the enzymes metabolizing cortisol to cortisone and vice versa (11ß-hydroxysteroid dehydrogenases type 1 and 2; 11ß-HSD1 and 2) was not associated with any measure of maternal PS (aims 1-3). The present study provides insight into possible programming effects of PS on nocturnal HPA axis activity and a proxy of 11ß-HSD in a large sample. The results suggest that the nocturnal rate of cortisol production is lower in children exposed to PS, but do not support the hypothesis of divergent 11ß-HSD activity.


Assuntos
Efeitos Tardios da Exposição Pré-Natal/metabolismo , Estresse Psicológico/metabolismo , Ansiedade/psicologia , Pré-Escolar , Cromatografia Líquida de Alta Pressão/métodos , Ritmo Circadiano/fisiologia , Cortisona/análise , Cortisona/urina , Depressão/metabolismo , Depressão/psicologia , Transtorno Depressivo/metabolismo , Transtorno Depressivo/psicologia , Feminino , Humanos , Hidrocortisona/análise , Hidrocortisona/urina , Sistema Hipotálamo-Hipofisário/metabolismo , Masculino , Espectrometria de Massas/métodos , Sistema Hipófise-Suprarrenal/metabolismo , Gravidez , Estudos Prospectivos , Transtornos de Estresse Traumático
19.
Psychiatry ; 82(2): 113-127, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30735480

RESUMO

Objective: To evaluate potential differences in therapeutic outcomes between youths who completed a full course of treatment as planned compared to youths who terminated treatment prematurely. Method: Using longitudinal data from the National Child Traumatic Stress Network (NCTSN) Core Data Set, the present study examined demographic characteristics, trauma history, scores on standardized measures, and ratings of functional impairment and behavior problems in a large clinical sample of children and adolescents exposed to trauma who received treatment at NCTSN centers across the United States. Baseline and follow-up data were used to compare treatment completers (n= 3,108) and noncompleters (n = 4,029). Results: Both treatment completers and noncompleters received benefits from treatment by NCTSN mental health providers in that both groups showed significant decreases in mean scores from baseline to follow-up on all standardized measures. However, compared to noncompleters, treatment completers showed three types of significantly greater benefit at follow-up. These included: (a) greater rates of decline (i.e., steeper slopes) on all outcome measures; (b) greater reductions in the odds of falling within the clinical range on standardized measures; and (c) greater reductions in the odds of exhibiting functional impairment and behavior problems at follow-up. In contrast, compared to treatment completers, noncompleters reported significantly higher rates of lifetime exposure to community violence, psychological maltreatment, physical abuse, neglect, sexual abuse, and sexual assault. Conclusion: These findings underscore the value of incorporating engagement and retention strategies in treatments for traumatized youths to maximize therapeutic benefit and raise the standard of care.


Assuntos
Terapia Cognitivo-Comportamental/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Transtornos de Estresse Traumático/terapia , Adolescente , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Estados Unidos
20.
Child Abuse Negl ; 90: 43-51, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30738238

RESUMO

BACKGROUND: Nearly a third of adults report childhood trauma in their youth and approximately 700,000 cases of child maltreatment were reported in 2016. Both history of childhood trauma and current trauma symptoms in adults are linked to child maltreatment, although many trauma-exposed individuals are warm and nurturing parents. Identifying resiliency factors in adults with risk factors for harsh parenting may illuminate new pathways to sensitive parenting. Mindfulness is reported to improve trauma and mental health symptoms but the relationship between mindfulness, trauma, and child abuse potential is not yet understood. OBJECTIVE: This cross-sectional study investigated the relationship between mindfulness, childhood trauma experiences, trauma symptoms and child abuse potential. PARTICIPANTS AND SETTING: Our participants were 102 expectant parents recruiting from obstetric clinics and agencies Detroit, MI (58.8% African American, 27.5% Caucasian). METHOD: Bivariate correlations were examined using validated, self-report questionnaires. Significant variables were included in a hierarchical linear regression to identify predicting factors that contribute to child abuse potential scores. RESULTS: Significant correlations between child abuse potential with current trauma symptoms (r = .53, p < .01) and mindfulness (r = -.32, p < .01) were found, but no link with past childhood trauma experiences and child abuse potential were identified. The model significantly predicts child abuse potential (ΔR2 = .10, F(5, 96), = 12.48, p < .001). Trauma symptoms (B = .09, p < .001, 95% confidence interval [CI][-.40, -.07]) and mindfulness nonreactivity (B = -.24, p < .01, 95% CI[.05, .14]) predicted higher potential for child abuse scores. CONCLUSION: Findings suggest increased mindfulness, especially nonreactivity to one's own thoughts, may be an important factor to protect against child abuse potential. Interventions to increase parental mindfulness may reduce child abuse potential and improve child well-being, but further mechanistic research is needed to determine this.


Assuntos
Maus-Tratos Infantis/psicologia , Atenção Plena , Complicações na Gravidez/psicologia , Transtornos de Estresse Traumático/psicologia , Adolescente , Adulto , Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Sobreviventes Adultos de Maus-Tratos Infantis/estatística & dados numéricos , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Michigan/epidemiologia , Pessoa de Meia-Idade , Poder Familiar/psicologia , Pais/psicologia , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de Risco , Autorrelato , Inquéritos e Questionários , Adulto Jovem
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