Combining Trauma Script Exposure With rTMS to Reduce Symptoms of Post-Traumatic Stress Disorder: Randomized Controlled Trial.

BACKGROUND: Innovative therapeutic interventions for post-traumatic stress disorder (PTSD) are required. We opted to facilitate fear extinction by combining trauma script exposure with repetitive transcranial magnetic stimulation (rTMS) to reduce symptoms of PTSD. OBJECTIVE: The efficacy and safety of 10 Hz rTMS of the right dorsolateral prefrontal cortex simultaneously with exposure to personal traumatic narrative were studied in patients with PTSD. MATERIALS AND METHODS: This trial was a single-center randomized controlled trial (NCT02584894). Patients were randomly assigned 1:1 to receive eight daily sessions of 110% of motor threshold high frequency (HF) 10 Hz rTMS (110% HF rTMS) or 70% low frequency (LF) 1 Hz rTMS (70% LF rTMS) with trauma script exposure in both groups. Severity of PTSD, depression, and anxiety were assessed before and after study treatment (one month, three months) by an assessor masked to the trial group assignment. The primary outcome was the severity of PTSD assessed by the Clinician Administered PTSD Scale (CAPS). We used mixed linear regression models for statistical comparisons. RESULTS: Thirty-eight patients (65.8% females) were randomly assigned to 110% HF rTMS (n = 18, 31.3 ± 10.0 years, 13 females) or 70% LF rTMS (n = 20, 33.5 ± 11.1 years, 12 females). From baseline to three months, mean CAPS scores decreased by 51% in the 110% HF rTMS group (from 83.7 ± 14.4 to 41.8 ± 31.9) and by 36.9% in the 70% LF rTMS group (from 81.8 ± 15.6 to 51.6 ± 23.7), but with no significant difference in improvement (time by treatment interaction -3.61 [95% confidence interval (CI), -9.70 to 2.47]; p = 0.24; effect size 0.53). One serious adverse event occurred during the study (psychogenic nonepileptic seizure). CONCLUSION: We found no evidence of difference in clinical improvement or remission rates between the 110% HF and 70% LF stimulation. These findings may reflect the importance of exposure procedure and that larger number of participants is needed.

COVID-19: urgency for distancing from domestic violence.

BACKGROUND: Although COVID-19 is a major worldwide health threat, there is another global public health emergency that is becoming a growing challenge. Domestic violence is a public health and human rights issue that primarily affects women and children worldwide. Several countries have reported a significant increase in domestic violence cases since the COVID-19-induced lockdowns and physical distancing measures were implemented. The COVID-19 health crisis is exacerbating another pre-existing public health problem by increasing the severity and frequency of domestic violence, thus demonstrating the need to adopt significant and long-term measures. OBJECTIVE: Therefore, it is urgently necessary to promote and increase actions and policies to guarantee the safety and dignity of all victims of domestic violence worldwide. METHODS: This paper describes preventive measures and action plans to combat violence against women and children during the COVID-19 pandemic. CONCLUSION: The prevention of domestic violence must indeed be every government's priority and every citizen's responsibility.

Antecedentes: Aunque el COVID-19 es una amenaza mayor de la salud a nivel mundial, existe otra emergencia de salud pública global la cual está llegando a ser un desafío creciente. La violencia doméstica es un problema de salud pública y de derechos humanos que afecta primordialmente a mujeres y niños en todo el mundo. Varios países han reportado un aumento significativo en los casos de violencia domestica desde que se implementaron los confinamientos inducidos por COVID-19 y las medidas de distanciamiento físico. La crisis de salud del COVID-19 está exacerbando otro problema de salud pública preexistente al aumentar la gravedad y frecuencia de la violencia doméstica, lo cual demuestra la necesidad de adoptar medidas significativas y a largo plazo.Objetivo: Por lo tanto, es urgentemente necesario promover y aumentar las acciones y políticas para garantizar la seguridad y la dignidad de todas las víctimas de violencia doméstica en todo el mundo.Método: Este artículo describe medidas preventivas y planes de acción para combatir la violencia en contra de mujeres y niños durante la pandemia de COVID-19.Conclusiones: La prevención de la violencia doméstica debe ser, de hecho, la prioridad de todos los gobiernos y la responsabilidad de todos los ciudadanos.

Trauma reactivation under propranolol among traumatized Syrian refugee children: preliminary evidence regarding efficacy.

Background: There is a dearth of therapeutic solutions for traumatized young patients. Trauma reactivation conducted under the influence of the reconsolidation blocker propranolol (Reconsolidation Therapy) is a simple, cost-effective treatment option that has some promising initial results in adults suffering from posttraumatic stress disorder (PTSD). Objective: To explore the usefulness of this novel treatment in children. The primary outcome was the reduction of PTSD symptoms at the end of treatment, while secondary outcomes included reduction in anxiety and in depressive symptoms. Method: An open-label clinical trial was conducted in a refugee camp in Syria, investigating the safety and efficacy of this therapeutic strategy in 117 children suffering from enduring PTSD symptoms. Participants received propranolol 90 minutes before briefly recalling (i.e. reactivating) a single personal traumatic memory, for 5 consecutive days. Self-reported anxiety, depressive, and PTSD symptoms were assessed at baseline, as well as 4 and 13 weeks after treatment. Results: A significant, clinically meaningful symptom reduction was observed at all post-treatment measurement times vs. baseline. More specifically, between baseline and the 13-week follow-up we observed a 64% PTSD symptoms reduction (d = 2.71). In a similar vein, we obtained a 39% symptoms reduction for depressive symptoms (d = 1.01). The general anxiety symptoms improved, but eventually returned to prior level, probably because of the deteriorating living conditions in the camp. Conclusions: This therapy appeared as a potentially safe and useful treatment strategy for children suffering from PTSD symptoms, warranting replication studies using stronger study designs. The social acceptability and ease of implementation of the treatment should also be noted.

Introducción: Existe una escasez de soluciones terapéuticas para pacientes jóvenes traumatizados. La reactivación del trauma conducida bajo los efectos del propanolol bloqueador de reconsolidación (Terapia de Reconsolidación) es una opción de tratamiento simple, costo-efectiva, que tiene algunos resultados iniciales prometedores en adultos que sufren del trastorno de estrés postraumático (TEPT).Objetivos: Explorar la utilidad de este novedoso tratamiento en niños. El resultado primario fue la reducción de los síntomas de TEPT al final del tratamiento, mientras que los resultados secundarios incluyeron la reducción de los síntomas ansiosos y depresivos.Métodos: Se condujo un estudio clínico abierto en un campo de refugiados en Siria, investigando la seguridad y eficacia de esta estrategia terapéutica en 117 niños que permanecían con síntomas de TEPT. Los participantes recibieron propranolol 90 minutos antes de recordar brevemente (es decir, reactivación) un único recuerdo personal traumático, por 5 días consecutivos. Se evaluó los síntomas de ansiedad, depresión y TEPT auto-reportados, tanto al inicio, como a las 4 y 13 semanas después del tratamiento.Resultados: Se observó una reducción sintomática significativa, clínicamente importante en todas las mediciones post tratamiento versus el nivel basal. Más específicamente, observamos un 64% de reducción de síntomas de TEPT entre el nivel basal y el seguimiento en la semana 13 (d = 2.71). De forma similar, obtuvimos un 39% de reducción de los síntomas depresivos (d =1.01). Los síntomas generales de ansiedad mejoraron, pero retornaron a sus niveles previos al final, probablemtente por las condiciones de vida deteriorantes en el campo de refugiados.Conclusiones: Esta terapia pareciera ser una estrategia de tratamiento potencialmente segura y útil en niños que sufren síntomas de TEPT, justificando estudios de replicación que usen diseños más estrictos. Se debería hacer notar también la aceptabilidad social y la fácil implementación del tratamiento.