Psychiatric comorbidity for veterans with posttraumatic stress disorder (PTSD): A latent profile analysis and implications for treatment.

BACKGROUND AND OBJECTIVE: Psychiatric comorbidity is common among veterans with posttraumatic stress disorder (PTSD), but there is little known about the patterns of co-occurring mental health problems and implications for treatment. The aim of this study was to identify comorbidity profiles among veterans at treatment intake and assess associations with PTSD and quality of life (QOL) outcomes. METHOD: The study included 2,522 veterans accessing outpatient treatment for PTSD in Australia who self-completed measures of comorbid issues including depression, anger, alcohol use problems, guilt, and dissociation. Latent Profile Analysis (LPA) was used to identify subgroups based on comorbidity profiles, and their association with outcomes. RESULTS: LPA suggested 5 comorbidity profiles: (a) low comorbidity severity, (b) moderate comorbidity severity with low alcohol, (c) moderate comorbidity severity with high alcohol, (d) high comorbidity severity with low alcohol, and (e) high comorbidity severity with high alcohol. The absence of alcohol problems was associated with improved treatment outcomes when overall comorbidity severity was high but not moderate. While all profiles evidenced symptom improvement from intake to discharge and follow-up, this did not correspond to quality of life improvements equally across classes. The highest severity comorbidity class experienced no improvement on psychological quality of life. CONCLUSIONS: The comorbidity profiles of veterans in treatment for PTSD can be distinguished by levels of severity and the specific presence or absence of alcohol use problems. Alcohol use problems have discernible implications for treatment in the context of comorbidity. Group treatments for PTSD should consider tailoring interventions to comorbidity profiles. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prevalence and treatment implications of ICD-11 complex PTSD in Australian treatment-seeking current and ex-serving military members.

Background: Despite growing support for the distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as separate diagnoses within the ICD-11 psychiatric taxonomy, the prevalence and treatment implications of CPTSD among current and ex-serving military members have not been established. Objective: The study aims were to a) establish the prevalence of provisional ICD-11 CPTSD diagnosis relative to PTSD in an Australian sample of treatment-seeking current and ex-serving military members, and b) examine the implications of CPTSD diagnosis for intake profile and treatment response. Methods: The study analysed data collected routinely from Australian-accredited treatment programmes for military-related PTSD. Participants were 480 current and ex-serving military members in this programmes who received a provisional ICD-11 diagnosis of PTSD or CPTSD at intake using proxy measures. Measures of PTSD symptoms, disturbances in self-organisation, psychological distress, mental health and social relationships were considered at treatment intake, discharge, and 3-month follow-up. Results: Among participants with a provisional ICD-11 diagnosis, 78.2% were classified as having CPTSD, while 21.8% were classified as having PTSD. When compared to ICD-11 PTSD, participants with CPTSD reported greater symptom severity and psychological distress at intake, and lower scores on relationship and mental health dimensions of the quality of life measure. These relative differences persisted at each post-treatment assessment. Decreases in PTSD symptoms between intake and discharge were similar across PTSD (d RM  = -0.81) and CPTSD (d RM  = -0.76) groups, and there were no significant post-treatment differences between groups when controlling for initial scores. Conclusions: CPTSD is common among treatment-seeking current and ex-serving military members, and is associated with initially higher levels of psychiatric severity, which persist over time. Participants with CPTSD were equally responsive to PTSD treatment; however, the tendency for those with CPTSD to remain highly symptomatic post-treatment suggests additional treatment components should be considered.

Antecedentes: A pesar del creciente apoyo para la distinción entre trastorno de estrés postraumático (TEPT) y trastorno de estrés postraumático complejo (TEPTC) como diagnósticos separados dentro de la taxonomía psiquiátrica de la CIE-11, la prevalencia y las implicaciones en el tratamiento del TEPTC dentro de miembros militares activos o en retiro no han sido establecidas.Objetivo: Los objetivos del estudio fueron a) establecer la prevalencia de TEPTC provisional según CIE-11 en relación al TEPT en una muestra australiana de miembros militares activos o en retiro en busca de tratamiento, y b) examinar las implicaciones del diagnóstico de TEPTC para el perfil de ingreso y respuesta a tratamiento.Método: El estudio analizó datos recolectados de forma rutinaria por programas de tratamiento australianos acreditados para TEPT relacionado a militares. Los participantes fueron 480 miembros activos o en retiro ingresados a este programa bajo el diagnóstico provisional de TEPT o TEPTC según CIE-11 a través de indicadores indirectos. Al ingreso, egreso y a los 3 meses de seguimiento, se consideraron mediciones de los síntomas de TEPT, alteraciones en la organización del Yo, estrés psicológico, salud mental y relaciones sociales.Resultados: Dentro de los participantes con un diagnóstico provisional según CIE-11, el 78,2% fue clasificado como portador de TEPTC, mientras que un 21,8% fue clasificado como portador de TEPT. Al ser comparados con TEPT según CIE-11, los participantes con TEPTC reportaron al ingreso una mayor severidad en la sintomatología y en el estrés psicológico, y menores puntajes en las dimensiones de medida de calidad de vida de salud mental y relaciones sociales. Estas diferencias relativas persistieron en cada seguimiento posterior al tratamiento. Las disminuciones en los síntomas de TEPT entre el ingreso y el egreso fueron similares entre los grupos con TEPT (d RM = -0.81) y TEPTC (d RM = -0.76), y no hubo diferencias significativas post-tratamiento entre los grupos al controlarlos según los puntajes iniciales. Conclusiones: El TEPTC es común dentro de miembros militares activos o en retiro en busca de tratamiento, y está asociado a mayores niveles de severidad psiquiátrica inicial, la cual persiste a lo largo del tiempo. Los participantes con TEPTC respondieron igualmente al tratamiento del TEPT; sin embargo, la tendencia de aquéllos con TEPTC de permanecer altamente sintomáticos tras el tratamiento sugiere componentes de tratamiento adicionales que deberían ser considerados.

Screening for consequences of trauma - an update on the global collaboration on traumatic stress.

This letter provides an update on the activities of "The Global Collaboration on Traumatic Stress" (GC-TS) as first described by Schnyder et al. in 2017. It presents in further detail the projects of the first theme, in particular the development of and initial data on the Global Psychotrauma Screen (GPS), a brief instrument designed to screen for the wide range of potential outcomes of trauma. English language data and ongoing studies in several languages provide a first indication that the GPS is a feasible, reliable and valid tool, a tool that may be very useful in the current pandemic of the coronavirus disease 2019 (COVID-19). Further multi-language and cross-cultural validation is needed. Since the start of the GC-TS, new themes have been introduced to focus on in the coming years: a) Forcibly displaced persons, b) Global prevalence of stress and trauma related disorders, c) Socio-emotional development across cultures, and d) Collaborating to make traumatic stress research data "FAIR". The most recent theme added is that of Global crises, currently focusing on COVID-19-related projects.

The global collaboration on traumatic stress.

Trauma is a global issue. The great majority of the global burden of disease arising from mental health conditions occurs in low- and middle-income countries (LMICs), among populations in political, economic, and/or cultural transition and those struck by forced migration. These mental health problems frequently arise as a result of traumatic events that adversely affect adults, children, and families, including war, mass violence, natural disasters, and accidents. In response to this, the International Society for Traumatic Stress Studies (ISTSS) launched the Global Initiative to have a stronger global impact on trauma-related issues. As part of this initiative, the Global Collaboration was established by representatives of eight professional organizations active in the field of traumatic stress. The group decided to focus on childhood abuse and neglect as its first collaboration. They collected guidelines worldwide, providing the basis for a synthesized core guide for prevention and treatment that can be customized for specific cultural contexts. The resulting 'Internet information on Childhood Abuse and Neglect' (iCAN) is a comprehensive guide for adults who have been affected by childhood abuse and neglect, as well as for the survivors' significant others. It is currently provided in eight languages, and is freely available at the homepage of ISTSS and other websites. A second achievement of the Global Collaboration is the validation of the Computerized Childhood Attachment and Relational Trauma Screen (CARTS), a self-report measure designed to measure occurrences of childhood maltreatment, and its translation into multiple languages, including Croatian, Dutch, French, Georgian, German, Italian, Japanese, Norwegian, Russian, and Spanish. A study is currently planned to collect normative responses to the questionnaire, and to conduct cross-cultural comparisons. The Global Collaboration's success may be seen as an encouraging step towards a truly global structure in the field of traumatic stress.

El trauma es un problema global. La gran mayoría de la carga mundial de enfermedades derivadas de las enfermedades de salud mental se produce en los países de ingresos medios y bajos (PIMB), entre las poblaciones en transición política, económica y/o cultural y las afectadas por la migración forzada. Estos problemas de salud mental suelen surgir como resultado de acontecimientos traumáticos que afectan de modo adverso a adultos, niños y familias, e incluyen guerras, violencia masiva, desastres naturales y accidentes. En respuesta a esto, la Sociedad Internacional de Estudios de Estrés Traumático (ISTSS) lanzó la Iniciativa Global para tener un impacto global más fuerte en los temas relacionados con el trauma. Como parte de esta iniciativa, la Colaboración Global fue establecida por representantes de ocho organizaciones profesionales activas en el campo del estrés traumático. El grupo decidió centrarse en el abuso y la negligencia infantil como primera colaboración. Recopilaron directrices de todo el mundo, proporcionando la base para un guía central sintetizada de prevención y tratamiento que se puede personalizar para contextos culturales específicos. La 'información de Internet sobre abuso y abandono infantil' (iCAN) resultante es una guía completa para adultos que se han visto afectados por abuso y negligencia en la infancia, así como para los seres queridos de los sobrevivientes. Actualmente, se ofrece en ocho idiomas y está disponible gratuitamente en la página de inicio de la ISTSS y otras páginas web. Un segundo logro de la Colaboración Global es la validación de la Detección Computarizada de Apego Infantil y Trauma Relacional (CARTS), una medida de autoinforme diseñada para medir las ocurrencias de maltrato infantil, y su traducción a múltiples idiomas, que incluyen croata, holandés, francés, georgiano, alemán, italiano, japonés, noruego, ruso y español. Actualmente se está planeando un estudio para recopilar respuestas normativas al cuestionario y realizar comparaciones interculturales. El éxito de la Colaboración Global puede verse como un paso estimulante hacia una verdadera estructura global en el campo del estrés traumático.

Optical properties of amyloid stained by Congo red: history and mechanisms.

Amyloid stained by Congo red has striking optical properties that generally have been poorly described and inadequately explained, although they can be understood from principles of physical optics. Molecules of Congo red are orientated on amyloid fibrils, and so the dye becomes dichroic and birefringent. The birefringence varies with wavelength in accordance with a fundamental property of all light-transmitting materials called anomalous dispersion of the refractive index around an absorption peak. The combination of this and absorption of light, with modification by any additional birefringence in the optical system, explains the various colours that can be seen in Congo red-stained amyloid between crossed polariser and analyser, and also when the polariser and analyser are progressively uncrossed. These are called anomalous colours.

Physical basis of colors seen in Congo red-stained amyloid in polarized light.

Amyloid stained by Congo red is traditionally said to show apple-green birefringence in polarized light, although in practice various colors may be seen between accurately crossed polarizing filters, called polarizer and analyzer. Other colors are seen as the polarizer and analyzer are uncrossed and sometimes when the slide is rotated. Previously, there has been no satisfactory explanation of these properties. Birefringence means that a material has two refractive indices, depending on its orientation in polarized light. Birefringence can change linearly polarized light to elliptically polarized, which allows light to pass a crossed analyzer. The birefringence of orientated Congo red varied with wavelength and was maximal near its absorption peak, changing from negative (slow axis of transmission perpendicular to smears or amyloid fibrils) on the shortwave side of the peak to positive (slow axis parallel) on the longwave side. This was explained by a property of any light-absorbing substance called anomalous dispersion of the refractive index around an absorption peak. Negative birefringence gave transmission of blue, positive gave yellow, and the mixture was perceived as green. This explains how green occurs in ideal conditions. Additional or strain birefringence in the optical system, such as in glass slides, partly or completely eliminated blue or yellow, giving yellow/green or yellow, and blue/green or blue, which are commonly seen in practice and in illustrations. With uncrossing of polarizer or analyzer, birefringent effects declined and dichroic effects appeared, giving progressive changes from green to red as the plane of polarization approached the absorbing axis and from green to colorless in the opposite way. This asymmetry of effects is useful to pathologists as a confirmation of amyloid. Rather than showing 'apple-green birefringence in polarized light' as often reported, Congo red-stained amyloid, when examined between crossed polarizer and analyzer, should more accurately be said to show anomalous colors.

Max Schultze (1865), G. Bizzozero (1882) and the discovery of the platelet.

Max Schultze published the first accurate and convincing description of platelets as part of a study devoted mainly to the white blood cells in 1865. He recognised them as a normal constituent of the blood and 'enthusiastically recommended' them as an object for further study by 'those concerned with the in-depth study of the blood of humans'. In 1882, Bizzozero demonstrated the value of this recommendation in his much more comprehensive study. He observed them microscopically in the circulating blood of living animals and in the blood removed from the blood vessels. In well-planned experiments, he showed that they were the first component of the blood to adhere to damaged blood vessel walls in vivo and, in vitro, that they were the first components of the blood to adhere to threads that subsequently became covered with fibrin.