Childhood Trauma and Premenstrual Symptoms: The Role of Emotion Regulation.

BACKGROUND: Women with Premenstrual Dysphoric Disorder (PMDD) are more likely to have a history of childhood trauma, and may experience more severe premenstrual symptomatology. However, the pathway in which childhood trauma affects the prevalence and severity of premenstrual symptoms remains largely unclear. OBJECTIVE: To determine whether childhood trauma is associated with increased premenstrual symptoms, and if so, whether emotional dysregulation mediates or moderates this relationship. PARTICIPANTS AND SETTINGS: A total of 112 women were recruited for the study among students at the Hebrew University of Jerusalem. METHODS: Participants completed the Premenstrual Symptoms Screening Tool (PSST), the Childhood Trauma Questionnaire (CTQ) and the Difficulties in Emotion Regulation Scale (DERS). To test the mediation hypothesis, direct and indirect effects of childhood trauma on premenstrual symptoms were calculated. To test moderation, we performed multiple regression, including the interaction term between childhood trauma and emotion dysregulation RESULTS: Twenty-two women (18.6%) met criteria for premenstrual syndrome (PMS) and sixteen (13.6 %) for PMDD. The number and severity of premenstrual symptoms increased with more childhood trauma (r = .282), and this relationship was completely mediated by emotion regulation difficulties. Specifically, exposure to Sexual abuse (r = .243) and Emotional neglect (r = .198) were significantly associated with premenstrual symptoms. Abuse predicted greater emotion dysregulation (r = .33), whereas, neglect did not. CONCLUSIONS: This study contributes to the current knowledge on the long-term effects of childhood trauma. Promoting use of adaptive emotion regulation strategies for women with a history of childhood trauma, could improve their capability to confront and adapt to premenstrual changes.

Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists.

OBJECTIVE: Psychiatry is a low-risk specialisation; however, there is a steady increase in malpractice claims against psychiatrists. Defensive psychiatry (DP) refers to any action undertaken by a psychiatrist to avoid malpractice liability that is not for the sole benefit of the patient's mental health and well-being. The objectives of this study were to assess the scope of DP practised by psychiatrists and to understand whether awareness of DP correlated with defensive behaviours. METHODS: A questionnaire was administered to 213 Israeli psychiatry residents and certified psychiatrists during May and June 2015 regarding demographic data and experience with malpractice claims, medicolegal literature and litigation. Four clinical scenarios represented defensive behaviours and reactions (feelings and actions) to malpractice claims. RESULTS: Forty-four (20.6%) certified psychiatrists and four (1.9%) residents were directly involved in malpractice claims, while 132 (62.1%) participants admitted to practising DP. Residents acknowledged the practice of DP more than did senior psychiatrists (p=0.038).Awareness of DP correlated with unnecessary hospitalisation of suicidal patients, increased unnecessary follow-up visits and prescribing smaller drug dosages than required for pregnant women and elderly patients. CONCLUSIONS: This study provides evidence that DP is well established in the routine clinical daily practice of psychiatrists. Further studies are needed to reveal whether DP effectively protects psychiatrists from malpractice suits or, rather, if it impedes providing quality psychiatric care and represents an economic burden that leads to more harm for the patient.

Dynamic psychotherapy or dialectical behavioral therapy-- which is better for borderline personality disorder?

Clinical dilemma: A 20-year-old female patient, diagnosed as suffering from borderline personality disorder, is referred to your clinic. Her disorder is characterized by unstable personal relationships, impulsivity, suicidal behavior, emotional instability and pan-anxiety. After initiation of pharmacological treatment which you have chosen, you meet with her parents who ask you which is better for their daughter dynamic-analytic psychotherapy or dialectical behavioral therapy.

Stepwise repolarization from Ca2+ plateaus in neocortical pyramidal cells: evidence for nonhomogeneous distribution of HVA Ca2+ channels in dendrites.

Although cortical dendrites have classically been thought of as passive structures, recent evidence suggests that active conductances, including Ca2+ conductance, are also present in the dendritic membrane. To investigate this, we have recorded intracellularly in slices of rat neocortex bathed in 24 mM tetraethylammonium chloride and 1 microM TTX. Under these conditions, pyramidal neurons generated prolonged Ca2+ spikes. In computer simulations, the breakpoint voltage from which the plateau level began to repolarize was closely related to a specific region on the voltage/activation curve of the high-voltage-activated Ca2+ conductance underlying the spike. This modeling result was supported by the experimental observation that substituting Ba2+ for Ca2+ caused a hyperpolarizing shift in breakpoint voltage by 8-10 mV. Often there was stepwise repolarization from the Ca2+ spike to one or more additional plateau levels. In compartmental computer models, this could be simulated by two different mechanisms: (1) the presence of multiple, electrotonically separated sites of Ca2+ spike electrogenesis in the dendritic tree, and (2) the presence of Ca2+ channels with different voltage dependencies in the same compartment. In experiments, brief hyperpolarizing pulses could cut short the high-amplitude plateau without terminating the smaller "steps." This result could be simulated by both computer models. However, only the multicompartmental model could simulate effects of prolonged depolarizing and hyperpolarizing currents on the breakpoint. Thus, the more depolarized the breakpoint, and hence the closer the spike initiation zone to the recording site, the less it was affected by the injected current. In experiments, the ratio of the breakpoint voltages for the different plateau levels was equal to the ratio of the highest repolarization rates. These data indicate that the breakpoint voltage and the time course of repolarization were the same at all the sites of Ca2+ electrogenesis. Our findings provide strong evidence that Ca2+ spike initiation occurs at electrotonically separated "hot spots" in the dendrites, and that voltage dependence of the Ca2+ channels that underlie the spikes is the same at all sites.