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1.
Psychiatr Danub ; 32(Suppl 3): 320-336, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33030447

RESUMEN

The war in Bosnia and Herzegovina (1992-1995) was an extremely hard traumatic event with different losses, separations of people, injuries, hard physical and psychical suffering of everyone. Children were especially in difficult conditions. One of the most remarkable things about children, as anyone who works with them soon finds out, is their resilience. While children are vulnerable to psychic damage and, if the damage is deep enough, to delays in emotional and even physical growth, they also have an astonishing capacity to bounce back. This is one of the most rewarding things about treating traumatized children. For many children, it takes very little, perhaps only some words of understanding, to help them tap into their own ability to heal. Taking care of child war psycho-trauma was a difficult task for me, as the war-time head of Department of psychiatry, without enough knowledge in child psycho-trauma and as person with a high responsibility, to organize together with other psychological caretakers of children, especially refugee children. This presentation will be some kind of my remembrance of period of 20-25 years ago when we, I think did good work of what we could and what we knew.


Asunto(s)
Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/terapia , Guerra/psicología , Adolescente , Adulto , Anciano , Bosnia y Herzegovina , Niño , Familia/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Refugiados/psicología , Resiliencia Psicológica , Trastornos por Estrés Postraumático/rehabilitación , Adulto Joven
2.
Psychiatr Danub ; 32(Suppl 3): 367-370, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33030455

RESUMEN

Although family should be the basis for the development and formation of a child's personality, violence is mostly done in the family, and remains undiscovered for a long time. The real number of abused children is much more than that displayed in the registered cases. The secrecy of the problem is an important feature of this phenomenon. Families in which abuse takes place are mostly isolated. Social isolation does not come about by chance; secrecy is usually encouraged by an abuser to control over famoly members. In most cases, social reaction to violence is late, inadequate and focused on the consequences, but not on the causes. "Abuse implies an act of execution that directly inflicts damage, while neglect implies an act of non-fulfillment of something that is necessary for the well-being of a child". The most common forms of domestic violence are physical, emotional abuse in the presence of violence against the mother, and in a lesser extent sexual abuse. In addition, there is physical, emotional, educational and medical neglect. The presence of violence against the mother and the feeling of impotence leave the same consequences as the endured violence. It is considered that children living in violent families are likely to live under cumulative stress. Traumatic responses include a wide range of conditions from acute stress reactions through post-traumatic stress disorder to complex long-lasting, repeated trauma syndrome. All children will not react to this kind of experience in the same way, with the protective and risk factors in developmental psychopathology having a significant role to play. Because of their developmental vulnerability and dependency, children are at greater risk of violence than adults. Researches point to the need for a multidisciplinary approach to treatment and prevention of child abuse, with greater interaction between health institutions, relevant centers for social work, police, court, government and non-governmental sector, and the existence of adequate family and criminal laws.


Asunto(s)
Maltrato a los Niños/psicología , Violencia Doméstica/psicología , Trauma Psicológico/psicología , Adulto , Niño , Maltrato a los Niños/legislación & jurisprudencia , Maltrato a los Niños/prevención & control , Maltrato a los Niños/terapia , Violencia Doméstica/legislación & jurisprudencia , Violencia Doméstica/prevención & control , Femenino , Humanos , Masculino , Madres/psicología , Trauma Psicológico/prevención & control , Trauma Psicológico/terapia , Factores de Riesgo , Instituciones Académicas , Trastornos por Estrés Postraumático/prevención & control , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/terapia
3.
JMIR Mhealth Uhealth ; 8(9): e22079, 2020 09 21.
Artículo en Inglés | MEDLINE | ID: mdl-32955456

RESUMEN

BACKGROUND: A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. OBJECTIVE: This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. METHODS: Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military & Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. RESULTS: A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. CONCLUSIONS: Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted.


Asunto(s)
Socorristas/psicología , Personal Militar/psicología , Trastornos por Estrés Postraumático/terapia , Telemedicina , Veteranos/psicología , Infecciones por Coronavirus/epidemiología , Humanos , Pandemias , Neumonía Viral/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
4.
J Trauma Stress ; 33(4): 380-390, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32881116

RESUMEN

Leveraging technology to provide evidence-based therapy for posttraumatic stress disorder (PTSD), such as prolonged exposure (PE), during the COVID-19 pandemic helps ensure continued access to first-line PTSD treatment. Clinical video teleconferencing (CVT) technology can be used to effectively deliver PE while reducing the risk of COVID-19 exposure during the pandemic for both providers and patients. However, provider knowledge, experience, and comfort level with delivering mental health care services, such as PE, via CVT is critical to ensure a smooth, safe, and effective transition to virtual care. Further, some of the limitations associated with the pandemic, including stay-at-home orders and physical distancing, require that providers become adept at applying principles of exposure therapy with more flexibility and creativity, such as when assigning in vivo exposures. The present paper provides the rationale and guidelines for implementing PE via CVT during COVID-19 and includes practical suggestions and clinical recommendations.


Asunto(s)
Infecciones por Coronavirus , Servicios de Salud Mental , Pandemias , Neumonía Viral , Trastornos por Estrés Postraumático , Comunicación por Videocoferencia , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Medicina Basada en la Evidencia , Humanos , Terapia Implosiva , Neumonía Viral/epidemiología , Trastornos por Estrés Postraumático/terapia , Telemedicina
5.
Cochrane Database Syst Rev ; 9: CD013458, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32885850

RESUMEN

BACKGROUND: Migrants who have been forced to leave their home, such as refugees, asylum seekers, and internally displaced persons (IDP), are likely to experience stressors which may lead to mental health problems. The efficacy of interventions for mental health promotion, prevention, and treatment may differ in this population. OBJECTIVES: With this overview of systematic reviews, we will map the characteristics and methodological quality of existing systematic reviews and registered systematic review protocols on the promotion of mental health and prevention and treatment of common mental disorders among refugees, asylum seekers, and IDPs. The findings from this overview will be used to prioritise and inform future Cochrane reviews on the mental health of involuntary migrants. METHODS: We searched Ovid MEDLINE (1945 onwards), Ovid Embase (1974 onwards), Ovid PsycINFO, ProQuest PTSDpubs, Web of Science Core Collection, Cochrane Database of Systematic Reviews, NIHR Journals Library, CRD databases (archived), DoPHER, Epistemonikos, Health Evidence, 3ie International Initiative for Impact Evaluation, and PROSPERO, to identify systematic reviews of mental health interventions for involuntary migrants. We did not apply any restrictions on date, language, or publication status to the searches. We included systematic reviews or protocols for systematic reviews of interventions aimed at refugees, asylum seekers, and internally displaced persons. Interventions must have been aimed at mental health promotion (for example, classroom-based well-being interventions for children), prevention of mental health problems (for example, trauma-focussed Cognitive Behavioural Therapy to prevent post-traumatic stress disorder), or treatment of common mental disorders and symptoms (for example, narrative exposure therapy to treat symptoms of trauma). After screening abstracts and full-text manuscripts in duplicate, we extracted data on the characteristics of the reviews, the interventions examined in reviews, and the number of primary studies included in each review. Methodological quality of the included systematic reviews was assessed using AMSTAR 2. MAIN RESULTS: The overview includes 23 systematic reviews and 15 registered systematic review protocols. Of the 23 published systematic reviews, meta-analyses were conducted in eight reviews. It was more common for the search strategy or inclusion criteria of the reviews to state that studies involving refugees were eligible for inclusion (23/23), than for asylum seekers (14/23) or IDPs (7/23) to be explicitly mentioned. In most reviews, study eligiblity was either not restricted by participant age (9/23), or restricted to adults (10/23). Reviews commonly reported on studies of diagnosis or symptoms of post-traumatic stress disorder or trauma (11/23) and were less likely to report on depression or anxiety (6/23). In 15 reviews the intervention of interest was focused on/ specific to psychological therapy. Across all 23 reviews, the interventions most commonly identified from primary studies were general Cognitive Behavioural Therapy, Narrative Exposure Therapy, and a range of different integrative and interpersonal therapies. Even though many reviews included studies of participants without a diagnosis of a mental health problem, they often assessed mental health treatments and did not usually distinguish between promotion, prevention, and treatment in the review aims. Together the 23 systematic reviews included 336 references, of which 175 were unique primary studies. Limitations to the methodological quality of reviews most commonly related to reporting of selection criteria (21/23), absence of a protocol (19/23), reporting of study design (20/23), search strategy (22/23), and funding sources of primary studies (19/23). AUTHORS' CONCLUSIONS: Gaps exist in the evidence on mental health interventions for refugees, asylum seekers, and internally displaced persons. Most reviews do not specify that internally displaced persons are included in the selection criteria, even though they make up the majority of involuntary migrants worldwide. Reviews specific to mental health promotion and prevention of common mental disorders are missing, and there is more evidence available for adults or mixed populations than for children. The literature is focused on post-traumatic stress disorder and trauma-related symptoms, with less attention for depression and anxiety disorders. Better quality systematic reviews and better report of review design and methods would help those who may use these reviews to inform implementation of mental health interventions.


Asunto(s)
Promoción de la Salud , Trastornos Mentales/terapia , Salud Mental , Refugiados/psicología , Revisiones Sistemáticas como Asunto , Humanos , Trastornos Mentales/prevención & control , Metaanálisis como Asunto , Refugiados/clasificación , Trastornos por Estrés Postraumático/terapia
6.
BMJ Case Rep ; 13(9)2020 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-32943446

RESUMEN

The global threat posed by the COVID-19 pandemic has highlighted the need to accurately identify the immediate and long-term postdisaster impacts on disaster-relief workers. We examined the case of a local government employee suffering from post-traumatic stress disorder (PTSD) and bipolar II disorder following the Great East Japan Earthquake. The complex and harsh experience provoked a hypomanic response such as elated feelings with increased energy, decreased need for sleep and an increase in goal-directed activity, which allowed him to continue working, even though he was adversely affected by the disaster. However, 3.5 years later, when he suffered further psychological damage, his PTSD symptoms became evident. In addition to treating mood disorders, trauma-focused psychotherapy was required for his recovery. Thereafter, we considered the characteristics of mental health problems that emerge in disaster-relief workers, a long time after the disaster, and the conditions and treatments necessary for recovery.


Asunto(s)
Trastorno Bipolar/psicología , Terremotos , Accidente Nuclear de Fukushima , Sistemas de Socorro , Trastornos por Estrés Postraumático/psicología , Tsunamis , Adulto , Betacoronavirus , Trastorno Bipolar/terapia , Infecciones por Coronavirus , Desastres , Humanos , Terapia Implosiva , Masculino , Pandemias , Neumonía Viral , Trastornos por Estrés Postraumático/terapia
7.
Artículo en Inglés | MEDLINE | ID: mdl-32898346

RESUMEN

Objective: To investigate the impact of reminder-focused positive psychiatry (RFPP) on attention-deficit/hyperactive disorder (ADHD) and posttraumatic stress disorder (PTSD) symptoms, vascular-function, inflammation and well-being of adolescents with comorbid ADHD and PTSD. Methods: After obtaining informed-consent, 11 adolescents were randomized to RFPP (n = 5) or trauma-focused cognitive-behavioral therapy (TF-CBT) (n = 6). Eight participants (RFPP: n = 4, TF-CBT: n = 4) completed the twice-weekly intervention for a 6-week trial. The RFPP intervention was inclusive of positive psychiatry interventions on (1) traumatic reminders and (2) avoidance and negative cognition. Vascular function measured as temperature rebound, C-reactive protein, homocysteine, ADHD Swanson, Nolan, and Pelham (SNAP) Questionnaire, Clinician-Administered PTSD Scale for DSM-5-Child/Adolescent Version (CAPS-CA), and neuropsychiatric-measures were measured at baseline and 6 weeks. Subjects were followed for 12 months. The study was conducted from September 2016 to June 2018. Results: A significant improvement in CAPS-CA, SNAP scores, and vascular function of both RFPP and TF-CBT groups was noted at follow-up, but was more-robust in the RFPP group (P < .05). At the sixth week, a significant increase in PERMA, gratitude, resilience, and Posttraumatic Growth Inventory scores and a significant decrease in homocysteine and C-reactive protein levels in the RFPP group, but not the TF-CBT group, were noted (P < .05). At 12-month follow-up, there was no psychiatry hospitalization or suicide ideation reported in either group. A continuation of significant improvement in CAPS-CA and SNAP scores in both groups was noted but was more robust in the RFPP group (P < .05). Similarly, a continuation of significant increase in PERMA, gratitude, resilience and Posttraumatic Growth Inventory scores was noted in the RFPP group but not in the TF-CBT group (P < .05). Conclusions: RFPP is associated with improvement in core PTSD and ADHD symptoms, decrease in inflammation, and increase in well-being, vascular function, and posttraumatic growth, as well as a favorable long-term clinical outcome. This finding highlights the importance of the dual role of RFPP in addressing vulnerability symptoms as well as enhancing well-being in youth with comorbid ADHD and PTSD. Trial Registration: ClinicalTrials.gov identifier: NCT04336072.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/complicaciones , Trastorno por Déficit de Atención con Hiperactividad/terapia , Psicoterapia , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/terapia , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Niño , Comorbilidad , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastornos por Estrés Postraumático/fisiopatología , Resultado del Tratamiento
8.
Z Kinder Jugendpsychiatr Psychother ; 48(5): 369-379, 2020 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-32880227

RESUMEN

Effectiveness of stabilization training for adolescent refugees with trauma-induced disorders: A randomized controlled trial Abstract. Unaccompanied minor refugees (UMR) are a group particularly vulnerable to mental illness. They pose a great challenge not only for child and youth psychiatric and psychotherapeutic care, but also for youth-welfare institutions. The study examines the effectiveness of Stabilization Training for Adolescent Refugees with Trauma Induced Disorders in inpatient youth-welfare facilities. Methods: We conducted a randomized controlled trial with pre-post design in a naturalistic setting, randomly assigning 9 housing groups for UMRs to the intervention or waiting control condition. The mental stress of 46 UMRs was assessed by both self-report and educational staff-report. Two educational staff members conducted the Stabilization Training for Adolescent Refugees with Trauma Induced Disorders as an intervention in each of the respective residential groups. Results: Participation in training led to a reduction in subjective general psychological stress. At the end of the training, psychological stress in self-judgment was significantly lower in the intervention group than in the waiting control condition. The effectiveness of the training is apparently not reflected by educational staff assessments. Conclusions: Stabilization training is a suitable instrument for the preclinical care of UMR and thus an essential basis for further psychotherapy.


Asunto(s)
Psicoterapia , Refugiados/psicología , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/terapia , Estrés Psicológico/psicología , Estrés Psicológico/terapia , Adolescente , Humanos , Resultado del Tratamiento
10.
FP Essent ; 495: 23-30, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32757563

RESUMEN

Posttraumatic stress disorder (PTSD) has a lifetime incidence of approximately 6.1% in the US population. However, studies of patients receiving regular primary care have shown a higher point prevalence, ranging from 11.1% to 24.5%. Multiple factors have been implicated in the etiology of PTSD, including genes, epigenetic regulation, neuroendocrine factors, inflammatory markers, autonomic risk and resilience, and sleep disturbances. There are many risk factors for PTSD, including exposure to trauma at a younger age, a high number of adverse childhood experiences, and a previous diagnosis of a mental disorder. Military personnel, police officers, and first responders who experience repeated or extreme exposure to traumatic events are at increased risk of PTSD. The National Institute for Health and Care Excellence (NICE) recommends that clinicians in the primary care setting consider screening for PTSD in patients with unexplained physical symptoms that may be associated with PTSD. Multiple evidence-based screening tools are available. If the patient is willing, psychotherapy is the treatment of choice, followed by combined psychotherapy and pharmacotherapy. PTSD is associated with many significant comorbidities and mortality.


Asunto(s)
Trastornos por Estrés Postraumático , Niño , Comorbilidad , Epigénesis Genética , Humanos , Psicoterapia , Factores de Riesgo , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/terapia
11.
Community Ment Health J ; 56(7): 1202-1203, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32734311

RESUMEN

Mobile health apps are becoming increasingly popular amongst users who are turning to digital platforms to aid their mental wellbeing. As a result of the current COVID-19 pandemic, healthcare staff as well as recovering patients may suffer from PTSD. We have therefore suggested to Reyes et al. ("Promoting Resilience Among College Student Veterans Through an Acceptance-and-Commitment-Therapy App: An Intervention Refinement Study", 2020) the importance of repurposing their app to help these users to improve their emotional resilience and subsequently their ability to cope with the trauma of their experience. We have also discussed the most pertinent barriers to mobile health app uptake including data privacy concerns and the role of stigma.


Asunto(s)
Infecciones por Coronavirus/psicología , Coronavirus , Personal de Salud/psicología , Aplicaciones Móviles/estadística & datos numéricos , Neumonía Viral/psicología , Trastornos por Estrés Postraumático/terapia , Telemedicina/métodos , Adaptación Psicológica , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud , Humanos , Salud Mental , Pandemias , Neumonía Viral/epidemiología , Resiliencia Psicológica
12.
Gen Hosp Psychiatry ; 66: 96-102, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32763640

RESUMEN

BACKGROUND: Psychological morbidity in both patients and family members related to the intensive care unit (ICU) experience is an often overlooked, and potentially persistent, healthcare problem recognized by the Society of Critical Care Medicine as Post-intensive Care Syndrome (PICS). ICU diaries are an intervention increasingly under study with potential to mitigate ICU-related psychological morbidity, including ICU-related post-traumatic stress disorder (PTSD), depression and anxiety. As we encounter a growing number of ICU survivors, in particular in the wake of the coronavirus pandemic, clinicians must be equipped to understand the severity and prevalence of significant psychiatric complications of critical illness. METHODS: We compared the efficacy of the ICU diary, written by family and healthcare workers during the patient's intensive care course, versus education alone in reducing acute PTSD symptoms after discharge. Patients with an ICU stay >72 h, who were intubated and mechanically ventilated over 24 h, were recruited and randomized to either receive a diary at bedside with psychoeducation or psychoeducation alone. Intervention patients received their ICU diary within the first week of admission into the intensive care unit. Psychological symptom screening with IES-R, PHQ-8, HADS and GAD-7 was conducted at baseline within 1 week of ICU discharge and at weeks 4, 12, and 24 after ICU discharge. Change from baseline in these scores was assessed using Wilcoxon rank sum tests. RESULTS: From September 26, 2017 to September 25, 2018, our team screened 265 patients from the surgical and medical ICUs at a single large academic urban hospital. 60 patients were enrolled and randomized, of which 35 patients completed post-discharge follow-up, (n = 18) in the diary intervention group and (n = 17) in the education-only control group. The control group had a significantly greater decrease in PTSD, hyperarousal, and depression symptoms at week 4 compared to the intervention group. There were no significant differences in other measures, or at other follow-up intervals. Both study groups exhibited clinically significant PTSD symptoms at all timepoints after ICU discharge. Follow-up phone interviews with patients revealed that while many were interested in getting follow-up for their symptoms, there were many barriers to accessing appropriate therapy and clinical attention. CONCLUSIONS: Results from psychological screening tools demonstrate no benefit of ICU diaries versus bedside education-alone in reducing PTSD symptoms related to the intensive care stay. However, our study finds an important gap in clinical practice - patients at high risk for PICS are infrequently connected to appropriate follow-up care. Perhaps ICU diaries would prove beneficial if utilized to support the work within a program providing wrap-around services and close psychiatric follow up for PICS patients. This study demonstrates the high prevalence of ICU-related PTSD in our cohort of survivors, the high barrier to accessing care for appropriate treatment of PICS, and the consequence of that barrier-prolonged psychological morbidity. TRIAL REGISTRATION: NCT04305353. GRANT IDENTIFICATION: GH-17-022 (Arnold P. Gold Foundation).


Asunto(s)
Centros Médicos Académicos/organización & administración , Ansiedad , Cuidados Críticos , Enfermedad Crítica/psicología , Depresión , Unidades de Cuidados Intensivos/organización & administración , Trastornos por Estrés Postraumático , Cuidados Posteriores , Ansiedad/diagnóstico , Ansiedad/etiología , Ansiedad/terapia , Infecciones por Coronavirus/psicología , Cuidados Críticos/métodos , Cuidados Críticos/organización & administración , Cuidados Críticos/psicología , Depresión/diagnóstico , Depresión/etiología , Depresión/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/psicología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/terapia , Sobrevivientes
13.
Cogn Neuropsychiatry ; 25(5): 348-363, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32847486

RESUMEN

INTRODUCTION: One route to advancing psychological treatments is to harness mental health science, a multidisciplinary approach including individuals with lived experience and end users (e.g., Holmes, E. A., Craske, M. G., & Graybiel, A. M. (2014). Psychological treatments: A call for mental-health science. Nature, 511(7509), 287-289. doi:10.1038/511287a). While early days, we here illustrate a line of research explored by our group-intrusive imagery-based memories after trauma. METHOD/RESULTS: We illustrate three possible approaches through which mental health science may stimulate thinking around psychological treatment innovation. First, focusing on single/specific target symptoms rather than full, multifaceted psychiatric diagnoses (e.g., intrusive trauma memories rather than all of posttraumatic stress disorder). Second, investigating mechanisms that can be modified in treatment (treatment mechanisms), rather than those which cannot (e.g., processes only linked to aetiology). Finally, exploring novel ways of delivering psychological treatment (peer-/self-administration), given the prevalence of mental health problems globally, and the corresponding need for effective interventions that can be delivered at scale and remotely for example at times of crisis (e.g., current COVID-19 pandemic). CONCLUSIONS: These three approaches suggest options for potential innovative avenues through which mental health science may be harnessed to recouple basic and applied research and transform treatment development.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Imágenes en Psicoterapia/tendencias , Salud Mental/tendencias , Neumonía Viral/terapia , Trauma Psicológico/terapia , Trastornos por Estrés Postraumático/terapia , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Emociones/fisiología , Humanos , Imágenes en Psicoterapia/métodos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Trauma Psicológico/epidemiología , Trauma Psicológico/psicología , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Pensamiento/fisiología
14.
Nat Commun ; 11(1): 4220, 2020 08 24.
Artículo en Inglés | MEDLINE | ID: mdl-32839437

RESUMEN

Post-traumatic stress disorder (PTSD) is characterized by emotional hypermnesia on which preclinical studies focus so far. While this hypermnesia relates to salient traumatic cues, partial amnesia for the traumatic context can also be observed. Here, we show in mice that contextual amnesia is causally involved in PTSD-like memory formation, and that treating the amnesia by re-exposure to all trauma-related cues cures PTSD-like hypermnesia. These findings open a therapeutic perspective based on trauma contextualization and the underlying hippocampal mechanisms.


Asunto(s)
Amnesia/prevención & control , Amnesia/terapia , Condicionamiento Psicológico/fisiología , Memoria/fisiología , Trastornos por Estrés Postraumático/prevención & control , Trastornos por Estrés Postraumático/terapia , Amnesia/fisiopatología , Animales , Reacción de Prevención/fisiología , Señales (Psicología) , Emociones , Hipocampo/fisiopatología , Humanos , Masculino , Ratones Endogámicos C57BL , Trastornos por Estrés Postraumático/fisiopatología
15.
Health Psychol ; 39(9): 826-840, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32833484

RESUMEN

This study utilizes the Science of Behavior Change (SOBC) experimental medicine approach to evaluate the effects of a 3-month, individually prescribed progressive exercise training program on neurobiological, cognitive and motivational mechanisms by which our exercise-training paradigm may foster exercise maintenance. We will investigate hypothesized relationships between exercise-training associated augmentation of neuropeptide Y (NPY) system function and improvements in self-regulation and reward sensitivity-cognitive control and motivational processes posited to promote self-efficacy and intrinsic motivation, which have been shown to predict exercise maintenance. This study will recruit Veterans with chronic low back pain and posttraumatic stress disorder (PTSD). Procedures include a baseline, acute cardiopulmonary exercise challenge assessment that will inform the exercise prescription for a 12-week progressive exercise training program comprised of three 45-minute aerobic exercise sessions per week-all of which will be supervised by an exercise physiologist. Additionally, a week-7 and week-14 exercise challenge assessment will track changes in NPY system function and the variables of interest. We hypothesize that increases in the capacity to release NPY in response to acute exercise testing will be associated with improvements in self-regulation and reward sensitivity, which will in turn be associated with self-efficacy and intrinsic motivation to maintain regular exercise. Ninety participants will be randomized either to the "active exercise training condition" or to the "wait list symptom monitoring condition". The study aims to demonstrate the feasibility of procedures and elucidate mechanisms relevant to developing individually prescribed, motivationally based exercise regimens to reduce negative consequences of PTSD and low back pain over the long-term. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Terapia por Ejercicio/métodos , Dolor/rehabilitación , Trastornos por Estrés Postraumático/terapia , Femenino , Humanos , Masculino , Estudios Prospectivos
16.
Med Klin Intensivmed Notfmed ; 115(6): 511-518, 2020 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-32749505

RESUMEN

In the context of intensive care medicine, patients, their relatives, and more infrequently members of the ICU team can be affected by potential trauma. Acute stress disorder often results. Psychological symptoms of critically ill patients should therefore be regularly screened in a standardized manner in order to be able to identify and treat patients with a high symptom burden. Some traumatic stressors in intensive care medicine can be reduced using trauma-sensitive communication. Psychological and psychotherapeutic interventions can complement this basic care. High quality communication with relatives contributes to a risk reduction with regard to their subsequent psychological stress. On the part of the ICU team, stress should be differentiated from potentially traumatizing events and both problem areas should be dealt with preventively. After experiencing a traumatic event during work, a procedure analogous to physical work accidents is recommended.


Asunto(s)
Unidades de Cuidados Intensivos , Trastornos por Estrés Postraumático/terapia , Cuidados Críticos , Enfermedad Crítica , Humanos , Estrés Psicológico
17.
J Music Ther ; 57(3): 353-378, 2020 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-32651585

RESUMEN

Patients diagnosed with both substance use disorder (SUD) and posttraumatic stress disorder (PTSD) often experience hypervigilance, increased fear, and difficulties regulating emotions. This dual diagnosis increases treatment complexity. Recently, a short-term music therapy intervention for arousal and attention regulation (the SMAART intervention) was designed based on neurobiological findings. Twelve patients with SUD and PTSD (50% females) in outpatient treatment participated in six weekly one-hour sessions of the SMAART intervention. Six patients completed the study. PTSD symptom severity was evaluated with the Posttraumatic Stress Disorder Symptom Scale Interview for DSM-5 (PSSI-5) pre- and post-intervention, and sustained attention was evaluated with the Bourdon-Wiersma (BW) test. A significant difference in measurements for the PSSI-5 overall symptom severity was found pre- and post-intervention. Furthermore, participants showed significant improvement on subscales of hyperarousal, mood and cognition, and attention. The BW test completion time decreased significantly. Two participants dropped out before the end of the intervention due to craving. Concerning future research, it is recommended to define the role of the music more explicitly and to change the design to a randomized controlled trial. A risk for future larger studies is a high dropout rate (50%). Several limitations of the study are discussed.


Asunto(s)
Nivel de Alerta/fisiología , Atención/fisiología , Musicoterapia , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/terapia , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/terapia , Adulto , Emociones , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos por Estrés Postraumático/psicología , Trastornos Relacionados con Sustancias/psicología , Resultado del Tratamiento
18.
Medicine (Baltimore) ; 99(28): e21142, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-32664144

RESUMEN

BACKGROUND: Post-traumatic stress disorder (PTSD) is a psychiatric disorder. While bringing psychologic pain to patients, it also damages their social function, which is a great threat to people's life and health. Complementary and alternative medicine (CAM) therapies have been used clinically to treat PTSD; however, the selection strategies of different CAM interventions in clinical practice is still uncertain, and the purpose of this study is to evaluate the efficacy and acceptability of different CAM therapies using systematic review and network meta-analysis. METHODS: According to the strategy, the authors will retrieve a total of 7 electronic databases by June 2020. After a series of screening, the 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from randomized controlled trials of CAM therapies for the PTSD. Finally, the evidence grade of the results will be evaluated. RESULTS: This study will provide a reliable evidence for the selection of CAM therapies for PTSD. CONCLUSION: The results of this study will provide references for evaluating the influence of different CAM therapies for PTSD, and provide decision-making references for clinical research.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Terapias Complementarias/métodos , Metaanálisis en Red , Trastornos por Estrés Postraumático/terapia , Humanos
19.
Fam Process ; 59(3): 883-897, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32621761

RESUMEN

The Witness to Witness Program (W2W), based on Weingarten's witnessing model (2000, 2003, 2004), began in July 2018 and originally was established to support healthcare workers and attorneys (our partners) who were experiencing empathic distress working with people involved in various stages of the detention process. The W2W program evolved to offer four primary components: clinician listening sessions geared to deep understanding of the person's story of their work and its challenges; an inventory of the person's current internal and external resources both in the present and in the past; help with removal of barriers to those resources; and development of a personal toolkit to handle stress. Additional services available to partners and their organizations included psycho-educational webinars, facilitated peer support groups, and organizational consultations to foster trauma-sensitive and resilience-hardy work environments. In March, after lockdowns due to the coronavirus pandemic, W2W pivoted to focus on handouts and webinars addressing how to cope with distress and moral injury, maintaining resilience, coping with grief, and dealing with multiple losses caused by the pandemic. Disaster sparked collaboration and innovation. A train the trainer model was developed to reach more community health workers providing services to the Latinx community dealing with losses similar to those experienced by the clients they serve. W2W continues to create virtual communities of support. In doing so we practice doing reasonable hope together (Weingarten, Family Process, 2010, 49, 5).


Asunto(s)
Infecciones por Coronavirus/psicología , Personal de Salud/psicología , Enfermedades Profesionales/terapia , Neumonía Viral/psicología , Psicoterapia/métodos , Trastornos por Estrés Postraumático/terapia , Adaptación Psicológica , Adulto , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Femenino , Pesar , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/psicología , Pandemias , Neumonía Viral/epidemiología , Evaluación de Programas y Proyectos de Salud , Resiliencia Psicológica , Trastornos por Estrés Postraumático/psicología , Estados Unidos/epidemiología , Lugar de Trabajo/psicología
20.
J Clin Psychiatry ; 81(4)2020 07 07.
Artículo en Inglés | MEDLINE | ID: mdl-32659874

RESUMEN

OBJECTIVE: A recent randomized controlled trial of repetitive transcranial magnetic stimulation (TMS) for major depressive disorder (MDD) in veterans raised the question of whether comorbid posttraumatic stress disorder (PTSD) negatively impacted the outcome of TMS in veterans. To address this, a quality database was analyzed to compare outcomes of MDD treated with TMS in veterans with and without comorbid PTSD. METHODS: The clinical outcomes of all consecutive veterans with MDD treated with TMS at the James A. Haley Veterans' Hospital as outpatients from October 2013 through September 2018 were included. Patients were initially evaluated by an experienced psychiatrist, and the diagnosis of MDD was made by clinical evaluation per DSM-IV-TR/DSM-5 criteria. At the start of treatment, after every 5 treatments, and at the end of treatment, patients were assessed with self-report and clinician-rated scales of depression. All data were abstracted from an existing quality database. RESULTS: Among the 118 patients treated with TMS for depression, 55 (47%) had comorbid PTSD and 63 (53%) had no comorbid PTSD. Response and remission rates by score on the Montgomery-Asberg Depression Rating Scale were similar between patients with PTSD (52.5% and 40.9%, respectively) and without PTSD (53.8% and 35.6%, respectively). No seizures or persistent adverse effects were observed or reported in either group. CONCLUSIONS: Comorbid PTSD did not impact the outcome of TMS for depression in this sample of veterans. Future studies should include formal ratings of PTSD to determine if the severity of PTSD affects the outcome.


Asunto(s)
Trastorno Depresivo Mayor/terapia , Trastornos por Estrés Postraumático/terapia , Estimulación Magnética Transcraneal , Veteranos/psicología , Adulto , Anciano , Terapia Combinada/métodos , Bases de Datos Factuales , Trastorno Depresivo Mayor/complicaciones , Trastorno Depresivo Mayor/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicotrópicos/uso terapéutico , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/tratamiento farmacológico , Estimulación Magnética Transcraneal/efectos adversos , Resultado del Tratamiento , Adulto Joven
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