Single-session visuospatial task procedure to prevent childbirth-related posttraumatic stress disorder: a multicentre double-blind randomised controlled trial.

Preventive evidence-based interventions for childbirth-related posttraumatic stress disorder (CB-PTSD) are lacking. Yet, 18.5% of women develop CB-PTSD symptoms following an unplanned caesarean section (UCS). This two-arm, multicentre, double-blind superiority trial tested the efficacy of an early single-session intervention including a visuospatial task on the prevention of maternal CB-PTSD symptoms. The intervention was delivered by trained maternity clinicians. Shortly after UCS, women were included if they gave birth to a live baby, provided consent, and perceived their childbirth as traumatic. Participants were randomly assigned to the intervention or attention-placebo group (allocation ratio 1:1). Assessments were done at birth, six weeks, and six months postpartum. Group differences in maternal CB-PTSD symptoms at six weeks (primary outcomes) and six months postpartum (secondary outcomes) were assessed with the self-report PTSD Checklist for DSM-5 (PCL-5) and by blinded research assessors with the Clinician-administered PTSD scale for DSM-5 (CAPS-5). Analysis was by intention-to-treat. The trial was prospectively registered (ClinicalTrials.gov, NCT03576586). Of the 2068 women assessed for eligibility, 166 were eligible and 146 were randomly assigned to the intervention (n = 74) or attention-placebo control group (n = 72). For the PCL-5, at six weeks, a marginally significant intervention effect was found on the total PCL-5 PTSD symptom count (ß = -0.43, S.E. = 0.23, z = -1.88, p < 0.06), and on the intrusions (ß = -0.73, S.E. = 0.38, z = -1.94, p < 0.0525) and arousal (ß = -0.55, S.E. = 0.29, z = -1.92, p < 0.0552) clusters. At six months, a significant intervention effect on the total PCL-5 PTSD symptom count (ß = -0.65, S.E. = 0.32, z = -2.04, p = 0.041, 95%CI[-1.27, -0.03]), on alterations in cognition and mood (ß = -0.85, S.E. = 0.27, z = -3.15, p = 0.0016) and arousal (ß = -0.56, S.E. = 0.26, z = -2.19, p < 0.0289, 95%CI[-1.07, -0.06]) clusters appeared. No group differences on the CAPS-5 emerged. Results provide evidence that this brief, single-session intervention carried out by trained clinicians can prevent the development of CB-PTSD symptoms up to six months postpartum.

Prenatal insomnia and childbirth-related PTSD symptoms: A prospective population-based cohort study.

BACKGROUND: Certain populations are at high risk of experiencing a traumatic event and developing post-traumatic stress disorder (PTSD). Yet, primary preventive interventions against PTSD are lacking. It is therefore crucial to identify pre-traumatic risk factors, which could be targeted with such interventions. Insomnia may be a good candidate, but studies on civilians are sparse. Furthermore, the mechanisms at stake in the relationship between pre-traumatic insomnia and PTSD symptoms are unclear. METHODS: This prospective population-based cohort study (n = 1,610) examined the relationship between insomnia symptoms at 32 weeks of pregnancy and childbirth-related PTSD (CB-PTSD) symptoms at eight weeks postpartum. Postnatal insomnia symptoms, prenatal psychological symptoms (depression, anxiety, PTSD, fear of childbirth), subjective birth experience (SBE) and birth medical severity were included as covariates in the analyses, which were based on a Piecewise Structural Equation Modelling approach. RESULTS: The relationship between prenatal insomnia and CB-PTSD symptoms was mediated by negative SBE and postnatal insomnia symptoms. All relationships involving insomnia symptoms had small or very small effect sizes. LIMITATIONS: This study used self-report questionnaires. Postnatal insomnia and CB-PTSD symptoms were concurrently measured. CONCLUSION: Prenatal insomnia symptoms may impair the ability to cope with a difficult birth experience and contribute to postnatal insomnia, a risk factor for CB-PTSD. Thus, prenatal insomnia symptoms may be a promising target for CB-PTSD primary preventive interventions, although other prenatal psychological symptoms could also be considered. Even beyond the perinatal context, future studies on pre-traumatic insomnia and PTSD should include post-traumatic insomnia as a covariate.

Beyond WEIRD: Associations between socioeconomic status, gender, lifetime stress exposure, and depression in Madagascar.

OBJECTIVE: Although research has examined associations between socioeconomic status (SES), gender, and acute and chronic life stressors in depression, most studies have been conducted in Western, educated, industrialized, rich, democratic (WEIRD) populations. METHOD: We addressed this issue by interviewing 65 adults (55 women, M age = 37) living in Madagascar, a typical low- and middle-income country. RESULTS: As hypothesized, women experienced more life stressors and depressive symptoms, on average, than men, as did those from lower (vs. higher) SES backgrounds. Additionally, lifetime stress exposure was associated with greater symptoms of depression, accounting for 19% of the variability in depressive symptom levels. These effects differed for acute versus chronic and distal versus recent stressors. Finally, stress exposure significantly mediated the relation between SES and gender on depressive symptoms, accounting for 24.0%-70.8% of the SES/gender-depression association depending on stressor type. CONCLUSION: These data extend prior research by describing how social stratification and gender relate to lifetime stress exposure and depressive symptoms in a non-WEIRD population.

The relationship between early administration of morphine or nitrous oxide gas and PTSD symptom development.

BACKGROUND: Posttraumatic Stress Disorder (PTSD) is a debilitating mental health disorder. Certain drugs, such as morphine and nitrous oxide gas (N2O), are administered to individuals who just experienced a traumatic event (e.g., soldiers, injured civilians). It is therefore crucial to understand if they incidentally affect PTSD symptom development. Furthermore, such observations could pave the way for the development of pharmacological prevention strategies of PTSD. METHODS: In this prospective population-based cohort study (n = 2,070), we examined the relationship between morphine or N2O administration during childbirth, and subsequent childbirth-related PTSD symptoms at eight weeks postpartum. Pain during labour, prior PTSD symptoms, and birth medical severity were included as covariates in the analyses. RESULTS: In women who developed PTSD symptoms, N2O administration during childbirth predicted reduced PTSD symptom severity (p < .001, small to medium effect size). A similar tendency was observed for morphine, but was not significant (p < .065, null to small effect size). Both drugs predicted increased PTSD symptoms when combined with severe pain during labour. LIMITATIONS: This study was observational, thus drug administration was not randomised. Additionally, PTSD symptoms were self-reported. CONCLUSIONS: Peritraumatic N2O administration may reduce subsequent PTSD symptom severity and thus be a potential avenue for PTSD secondary prevention. This might also be the case for morphine. However, the role of severe peritraumatic pain in context of drug administration deserves further investigation.

Spatialization in working memory: can individuals reverse the cultural direction of their thoughts?

A recent study based on the SPoARC effect (spatial position association response codes) showed that culture heavily shapes cognition and more specifically the way thought is organized; when Western adults are asked to keep in mind a sequence of colors, they mentally organize them from left to right, whereas right-to-left reading/writing adults spatialize them in the opposite direction. Here, we investigate if the spontaneous direction of spatialization in Westerners can be reversed. Lists of five consonants were presented auditorily at a rate of 3 s per item, participants were asked to mentally organize the memoranda from right to left. Each list was followed by a probe. Participants had to indicate whether the probe was part of the sequence by pressing a "yes" key or a "no" key with the left or right index finger. Left/right-hand key assignment was switched after half of the trials were completed. The results showed a reverse SPoARC effect that was comparable in magnitude to the spontaneous left-to-right SPoARC effect found in a previous study. Overall, our results suggest that individuals can reverse the cultural direction of their thoughts.

Spatialization in working memory is related to literacy and reading direction: Culture "literarily" directs our thoughts.

The ability to maintain arbitrary sequences of items in the mind contributes to major cognitive faculties, such as language, reasoning, and episodic memory. Previous research suggests that serial order working memory is grounded in the brain's spatial attention system. In the present study, we show that the spatially defined mental organization of novel item sequences is related to literacy and varies as a function of reading/writing direction. Specifically, three groups (left-to-right Western readers, right-to-left Arabic readers, and Arabic-speaking illiterates) were asked to memorize random (and non-spatial) sequences of color patches and determine whether a subsequent probe was part of the memorized sequence (e.g., press left key) or not (e.g., press right key). The results showed that Western readers mentally organized the sequences from left to right, Arabic readers spontaneously used the opposite direction, and Arabic-speaking illiterates showed no systematic spatial organization. This finding suggests that cultural conventions shape one of the most "fluid" aspects of human cognition, namely, the spontaneous mental organization of novel non-spatial information.

A SPoARC in the Dark: Spatialization in Verbal Immediate Memory.

In 2011, van Dijck and Fias described a positional SNARC (Spatial-Numerical Association of Response Codes) effect: the SPoARC (Spatial-Positional Association of Response Codes). To-be-remembered items (e.g., numbers, words) presented centrally on a screen seemed to acquire a left-to-right spatial dimension. If confirmed, this spatialization could be crucial for immediate memory theories. However, given the intricate links between visual and spatial dimensions, this effect could be due to the visual presentation (on a computer screen), which could have probed the left-to-right direction of reading/writing. To allow a generalization of this effect, we adapted van Dijck and Fias's (2011) task using an auditory version of Sternberg's paradigm. Lists of five consonants were auditorily presented at a rate of 3 s/item. A SPoARC effect was observed. The consequences are discussed first from an immediate memory perspective, putting forward the view that order could be coded through spatialization, and then in terms of similarities between SPoARC and SNARC.

A beta unfolding model for continuous bounded responses.

An unfolding model for continuous bounded responses is proposed, derived both from a hypothetical interpolation response mechanism and from the hypothesis of two opposite sources of item refusal being collapsed. These two sources of refusal are made explicit in a three-component Dirichlet response model and then collapsed to obtain a (two-component) beta response model. The two natural parameters of the beta are interpreted as acceptance and refusal parameters and expressed as functions of person-item distances on a latent continuum. The potentially bimodal shape of the beta is exploited to model chaotic response choices among ambivalent subjects.

The effect of long-term working memory through personalization applied to free recall: uncurbing the primacy-effect enthusiasm.

In this study, a personalization method (Guida, Tardieu, & Nicolas, European Journal of Cognitive Psychology, 21: 862-896 2009) was applied to a free-recall task. Fifteen pairs of words, composed of an object and a location, were presented to 93 participants, who had to mentally associate each pair and subsequently recall the objects. A 30-s delay was introduced on half of the trials, the presentation rate was manipulated (5 or 10 s per item), and verbal and visuospatial working memory tests were administered to test for their effects on the serial curve. Two groups were constituted: a personalized group, for whom the locations were well-known places on their university campus, and a nonpersonalized group, for whom the locations did not refer to known places. Since personalization putatively operationalizes long-term working memory (Ericsson & Kintsch, Psychological Review, 102: 211-245 1995)-namely, the capacity to store information reliably and rapidly in long-term memory-and if we take a dual-store approach to memory, the personalization advantage would be expected to be greater for pre-recency than for recency items. Overall, the results were compatible with long-term working memory theory. They contribute to validating the personalization method as a methodology to characterize the contribution of long-term memory storage to performance in working memory tasks.

Deficits in decoding emotional facial expressions in Parkinson's disease.

INTRODUCTION: The basal ganglia have numerous connections not only with the motor cortex but also with the prefrontal and limbic cortical areas. Therefore, basal ganglia lesions can disturb motor function but also cognitive function and emotion processing. The aim of the present study was to assess the consequences of Parkinson's disease (PD) on ability to decode emotional facial expressions (EFEs)-a method commonly used to investigate non-verbal emotion processing. METHODS: Eighteen PD patients participated in the study, together with 18 healthy subjects strictly matched with respect to age, education and sex. The patients were early in the course of the disease and had not yet received any antiparkinsonian treatment. Decoding of EFEs was assessed using a standardized, quantitative task where the expressions were of moderate intensity, i.e. quite similar to those experienced in everyday life. A set of tests also assessed executive function. Visuospatial perception, depression and anxiety were measured. RESULTS: Early in the course of the disease, untreated PD patients were significantly impaired in decoding EFEs, as well as in executive function. The deficits were significantly interrelated, although neither was significantly related to severity of the motor symptoms. Visuospatial perception was not impaired, and the patients' impairment was related neither to their depression nor to their anxiety score. The PD patients' impairment in decoding EFEs was related to a systematic response bias. CONCLUSION: Early in the course of PD, non-verbal emotional information processing is disturbed. This suggests that in PD, nigrostriatal dopaminergic depletion leads not only to motor and cognitive disturbances but also to emotional information processing deficits. The observed correlation pattern does not enable adoption of a clear-cut position in the debate over totally or partially segregated functional organization of the basal ganglia circuits.