Machine learning applied to fMRI patterns of brain activation in response to mutilation pictures predicts PTSD symptoms.

BACKGROUND: The present study aimed to apply multivariate pattern recognition methods to predict posttraumatic stress symptoms from whole-brain activation patterns during two contexts where the aversiveness of unpleasant pictures was manipulated by the presence or absence of safety cues. METHODS: Trauma-exposed participants were presented with neutral and mutilation pictures during functional magnetic resonance imaging (fMRI) collection. Before the presentation of pictures, a text informed the subjects that the pictures were fictitious ("safe context") or real-life scenes ("real context"). We trained machine learning regression models (Gaussian process regression (GPR)) to predict PTSD symptoms in real and safe contexts. RESULTS: The GPR model could predict PTSD symptoms from brain responses to mutilation pictures in the real context but not in the safe context. The brain regions with the highest contribution to the model were the occipito-parietal regions, including the superior parietal gyrus, inferior parietal gyrus, and supramarginal gyrus. Additional analysis showed that GPR regression models accurately predicted clusters of PTSD symptoms, nominal intrusion, avoidance, and alterations in cognition. As expected, we obtained very similar results as those obtained in a model predicting PTSD total symptoms. CONCLUSION: This study is the first to show that machine learning applied to fMRI data collected in an aversive context can predict not only PTSD total symptoms but also clusters of PTSD symptoms in a more aversive context. Furthermore, this approach was able to identify potential biomarkers for PTSD, especially in occipitoparietal regions.

Relationship between epileptic seizures and criminal behavior: a systematic literature review / Relação entre crises epilépticas e comportamento criminoso: uma revisão sistemática da literatura

Objective: The principal objective aims to assess a possible relationship between epilepsy and aggressive behavior. Secondarily, we intend to study how epilepsy relates to criminal liability. Methods: A systematic literature review was performed, using the Web of Science,United States National Library of Medicine (PubMed),and Scielo databases. The searches were conducted in May-June 2022 and covered the period from 2000 to 2022. Eligibility criteria consisted on original articles in English and Portuguese that were interested in the association of epilepsy, criminal behavior (with aggression directed to others), criminal liability in adults with epilepsy. Results: The search yielded 921 results, 794 of which in PubMed, 115 in Web of Science, and 12 in Scielo. Articles that failed to meet the inclusion criteria (206) and duplicates (201) were excluded. Conclusion: There were no findings to indicate a significant increase in aggressive behaviors in individuals with epilepsy. However, it was possible to identify a higher prevalence of aggressive acts in males with epilepsy, besides the presence of comorbidities with mental disorders and substance use. In addition, the results suggest that in criminal offenders with epilepsy, the seizures originated in the temporal and frontal cerebral lobes. Further researchis necessary on the relationship between epilepsy, criminality, and criminal liability in order to produce more robust data to support legal proceedings.

Objetivo: O objetivo principal visa avaliar uma possível relação entre epilepsia e comportamento agressivo. Secundariamente, pretendemos estudar a relação entre epilepsia e responsabilidade penal. Método: Foi realizada uma revisão sistematizada da literatura, utilizando as bases de dados Web of Science, United States National Libraryof Medicine (PubMed) e Scielo. As buscas ocorreram no período de maio e junho de 2022, verificando o período de 2000 à 2022. Os critérios de elegibilidade consistiram em artigos originais em inglês e português, com interesse na associação entre epilepsia, comportamento criminoso (com violência direcionada a outros) e responsabilidade penal em adultos com epilepsia. Resultados: Foram encontrados 921 resultados na busca, sendo 794 na base de dados PubMed, 115 na Web of Science, e 12 na Scielo.Aqueles que não preencheram os critérios de inclusão (206) e duplicados (201) foram excluídos. Conclusão: Não houveram achados suficientes que indicassem um aumento significativo de comportamentos agressivos na população epiléptica. Entretanto, em relação a esse aspecto, foi possível estabelecer maior prevalência no sexo masculino, presença de comorbidades com transtornos mentais, além de uso de substâncias. Além disso, os resultados sugerem que, em infratores epilépticos, as crises foram provenientes das regiões temporo-frontais do cérebro. Em suma, é importante que a relação entre comportamento criminoso, epilepsia e imputabilidade penal continue sendo estudada, de modo a trazer dados mais sólidos para embasar procedimentos judiciais.

Blumenau, April 5, 2023: The point of view of psychiatry / Blumenau, 5 de abril de 2023: O ponto de vista da psiquiatria

ABSTRACT The goal of this editorial is to analyse a recent case of mass murder under the psychiatric perspective.

RESUMO O objetivo do presente editorial é o de analisar, sob a perspectiva da psiquiatria, um caso recente de homicídio em massa.

Post-traumatic stress disorder as a predictor for incident hypertension: a 3-year retrospective cohort study.

BACKGROUND: The goal of the present study was to investigate the association between PTSD and the onset of hypertension in previously normotensive individuals in a population living in the stressful environment of the urban slums while controlling for risk factors for cardiovascular disease (CVD). METHODS: Participants were 320 normotensive individuals who lived in slums and were attending a family doctor program. Measurements included a questionnaire covering sociodemographic characteristics, clinical status and life habits, the Posttraumatic Stress Disorder Checklist - Civilian Version, and the Beck Depression Inventory. Incident hypertension was defined as the first occurrence at the follow-up review of the medical records of (1) systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, (2) the participant started taking antihypertensive medication, or (3) a new diagnosis of hypertension made by a physician. Differences in sociodemographic, clinical, and lifestyle characteristics between hypertensive and non-hypertensive individuals were compared using the χ2 and t tests. Multivariate Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: Six variables - age, educational level, body mass, smoking, diabetes, and PTSD diagnosis - showed a statistically significant (p ≤ 0.20) association with the hypertensive status. In the Cox regression, only PTSD diagnosis was significantly associated with incident hypertension (multivariate HR = 1.94; 95% CI 1.11-3.40). CONCLUSIONS: The present findings highlight the importance of considering a diagnostic hypothesis of PTSD in the prevention and treatment of cardiovascular diseases.

The top-100 cited articles on post-traumatic stress disorder: a historical bibliometric analysis.

This is a bibliometric analysis of the most-cited articles on post-traumatic stress disorder (PTSD) with the objective of identifying citation patterns for researchers, journals, centers, periods, topics, and nations. A search was conducted in Thomson Reuters' WoS Core Collection employing the expression TI = (posttraumatic stress disorder OR post-traumatic stress disorder OR PTSD). The 100 most-cited articles were downloaded, and the relevant data were extracted and analyzed. These studies had a total of 69,649 citations, ranging from a minimum of 360 to a maximum of 6029 citations, with an average of 696.49, a standard deviation of 720.92, mode of 369, and a median of 512. Eighty-eight percent of the most-cited articles on PTSD originated from the USA, with just six cities accounting for 52% of the publications and the Boston area alone responsible for almost one-fifth of the total output. The universities of Yale and Harvard headed the ranking of institutions with larger numbers of highly-cited articles. Female researchers represented 42.3% of all authors, 51% of the first authors, and 48% of the corresponding authors. The proportion of M.D. authors decreased significantly between the 1980-1999 (42%) and the 2000-2019 (27.2%) periods while that of Ph.D. authors increased from 44% to 57.4%. The most studied population was military veterans (28%). Female victims of sexual or physical violence, traumatized children, and adult survivors of childhood abuse were assessed in only 6-7% of the most-cited publications. Ten clinical trials evaluated psychological interventions but only three investigated pharmacotherapy. We concluded that influential research on PTSD remains centralized in the USA. A balanced gender representation in publications was found. There was a heavy reliance on combat veterans as the study population. Few highly-cited studies on the pharmacotherapy for PTSD were identified. Focused efforts are needed to address these challenges.

Tonic immobility is associated with posttraumatic stress symptoms in healthcare professionals exposed to COVID-19-related trauma.

The Coronavirus Disease 2019 (COVID-19) pandemic has exposed healthcare workers (HCW) to traumatic situations that might lead to the development of posttraumatic stress disorder (PTSD). An important vulnerability factor for PTSD is the peritraumatic tonic immobility (TI) reaction, an involuntary and reflexive defensive response evoked by an intense and inescapable threat. TI is largely understudied in humans and has not been investigated during trauma related to COVID-19. For HCW, the pandemic context might be experienced as an intense and potentially inescapable threat, i.e., an overwhelming situation. Here, we investigated if TI response occurred during traumatic events related to the pandemic and its association with posttraumatic stress symptoms (PTSS). An online survey of 1001 HCW investigated COVID-19-related traumatic experiences, TI and PTSS. TI was reported for all types of traumatic events, and multivariate regression models revealed that TI was significantly associated with PTSS severity. HCW who reported high TI scores exhibited an increase of 9.08 times the probability of having a probable diagnosis of PTSD. Thus, TI was evoked by pandemic-related traumatic situations and associated with PTSS severity and higher odds of a PTSD diagnosis. Tonic immobility occurrence should be screened, and psychoeducation about its reflexive biological nature should be introduced.

Predictors of response to cognitive-behavioral therapy in patients with posttraumatic stress disorder: a systematic review / Preditores de resposta à terapia cognitivo-comportamental em pacientes com transtorno de estresse pós-traumático: uma revisão sistemática

OBJETIVO: O transtorno de estresse pós-traumático (TEPT) é um transtorno altamente prevalente e incapacitante. Mesmo quando tratado com uma intervenção de primeira linha, terapia cognitivo-comportamental (TCC), 45% dos pacientes continuam sofrendo desse transtorno. Portanto, conhecer os fatores que podem prever quem responderá à TCC seria de grande valor no tratamento desses pacientes. Por esse motivo, revisamos sistematicamente a literatura para identificar as variáveis que poderiam predizer a resposta à TCC em pacientes que sofrem de TEPT. MÉTODOS: Seguindo as diretrizes do PRISMA 2020, pesquisamos em banco de dados eletrônico como ISI Web of Science, Scopus, PsycINFO, MEDLINE e PTSDpubs até novembro de 2021. Dois autores conduziram independentemente a seleção do estudo e a extração de dados. Estudos que examinaram possíveis preditores de resposta à terapia, com amostra de adultos (18-65 anos) de ambos os sexos, com e sem comorbidades, foram considerados elegíveis. As características dos estudos foram sintetizadas em uma tabela. O risco de viés foi avaliado pela ferramenta de avaliação de qualidade de risco de viés da Cochrane. RESULTADOS: Vinte e oito estudos envolvendo 15 variáveis foram selecionados. Desses, oito mostraram baixo risco de viés, 19 mostraram algumas preocupações e um mostrou alto risco potencial de viés. A relação terapêutica foi a única variável considerada um preditor de boa resposta à terapia. Todas as outras variáveis apresentaram resultados conflitantes. CONCLUSÕES: A variável mais promissora, embora muito fraca cientificamente, é a relação terapêutica. Ensaios clínicos randomizados adicionais devem ser conduzidos para esclarecer o papel dessa variável como um preditor de resposta da TCC em pacientes com TEPT.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a highly prevalent and disabling disorder. Even when treated with the first-line intervention, cognitive-behavioral therapy (CBT), 45% of the patients continue suffering from this disorder. Therefore, knowing the factors that could foresee who will respond to CBT would be of great value to the treatment of these patients. Thus, we have systematically reviewed the literature to identify the variables that could predict response to CBT in patients suffering from PTSD. METHODS: Following the PRISMA 2020 guidelines, we searched the electronic databases ISI Web of Science, Scopus, PsycINFO, MEDLINE, and PTSDpubs until November 2021. Two authors have independently conducted study selection and data extraction. Studies that examined possible predictors of response to therapy on a sample of adults (18-65 years), both genders, with and without comorbidities were considered eligible. The characteristics of the studies were synthesized in a table. The risk of bias was assessed by the Cochrane risk of bias quality assessment tool. RESULTS: Twenty- -eight studies comprising 15 variables were selected. Among those, eight showed a low risk of bias, 19 showed some concerns, and one showed a high potential risk of bias. The therapeutic relationship was the only variable considered to be a predictor of a good response to therapy. All other variables showed conflicting results. CONCLUSIONS: The most promising variable, although scientifically weak, is the therapeutic relationship. Additional randomized clinical trials should be conducted to clarify the role of this variable as a predictor of response to CBT in patients with PTSD.

To BDZ or not to BDZ? That is the question! Is there reliable scientific evidence for or against using benzodiazepines in the aftermath of potentially traumatic events for the prevention of PTSD? A systematic review and meta-analysis.

BACKGROUND: Most international guidelines suggest that benzodiazepines (BDZs) may be inefficient or iatrogenic in the aftermath of a potentially traumatic event (PTE). The goal of this study was to assess the strength of the evidence on whether the use of BDZs in the aftermath of a PTE negatively affects the incidence and severity of post-traumatic stress disorder (PTSD). METHODS: We systematically scrutinized the ISI Web of Knowledge, MEDLINE, SCOPUS, and PTSDpubs electronic databases in addition to citation searching. We included original studies providing data about the development of PTSD in adults after BDZ administration in the aftermath of a PTE. We screened 387 abstracts and selected eight studies for the qualitative synthesis and seven for the meta-analysis. We performed two separate meta-analyses, one for randomized clinical trials (RCTs) and the other for cohort studies. Heterogeneity between studies was evaluated with Higgins I² statistic and tested using the χ². This study was registered at PROSPERO (number 127170). RESULTS: The meta-analysis of the cohort studies showed an increased risk of PTSD in patients who received BDZs compared to those who did not (risk ratio (RR) = 1.53; 95% confidence interval (CI): 1.05-2.23) with a modest heterogeneity among studies (I2 = 41.8, p = 0.143). Regarding the RCTs, the combined measure revealed a tendency toward an increased severity of the PTSD symptoms (standardized mean difference (SMD): 0.24; 95% CI: 0.32-0.79). CONCLUSION: The studies reviewed showed a possible harmful effect of BDZs when used immediately after a PTE. However, these conclusions were based on a small number of studies of poor to moderate methodological quality.

The growth and development of research on personality disorders: A bibliometric study.

This study objective was to investigate publication trends on personality disorders (PD) and to identify patterns of historical development. Publication rates were determined using the Results by Year Timeline feature of PubMed. Time series autoregressive integrated moving average models were used to analyse the publication rates for PDs in quinquennial periods beginning in 1980 and ending in 2019 and to predict the number of publications in the 2024-2029 period. More than 300 articles on antisocial and borderline PD are being published each year, and the models suggest an accelerating growth rate. Approximately 100 articles are being published on average every year on schizotypal PD, and the regression model indicates linear growth in the near future. The mean number of publications per year for obsessive-compulsive, narcissistic and avoidant PDs is in the range of 10-30 with the corresponding models indicating linear growth. Fewer than 10 articles are being published each year on dependent, paranoid, histrionic and schizoid PD, whereas dependent PD shows modest growth and paranoid PD rates tended to stability, histrionic and schizoid PD exhibit declining rates. Personality disorders are a group of conditions with diverse etiological, prognostic, therapeutic, legal, research, social and cultural implications that influence publication rates.

The Jornal Brasileiro de Psiquiatria: a bibliometric survey of the one hundred most cited articles in the last 15 years / Jornal Brasileiro de Psiquiatria: uma pesquisa bibliométrica sobre os 100 artigos mais citados nos últimos 15 anos

OBJECTIVE: Bibliometrics is a group of statistical and mathematical methods employed to measure and analyze the quantity and the quality of scientific articles, books, and other forms of publications. The objective of the present study was to conduct a bibliometric analysis of the Jornal Brasileiro de Psiquiatria (JBP) by listing its 100 most highly cited articles in the scientific literature and identifying their main characteristics in terms of authorship and research topics and design. METHODS: The 100 topcited references in the JBP were identified through a search with Google Scholar. The main author, last author, corresponding author, the total number of authors, gender of the authors, year of publication, research institution, geographic origin, language, and the research design and subject of each reference were recorded and analyzed. RESULTS: A marked increase in the number of citations in the last 15 years, a relatively balanced distribution of publications among the Brazilian states and research centers, absence of gender bias among authors, and a varied range of published topics suggest a good current editorial performance by the JBP. Relative lack of systematic reviews and longitudinal studies, dearth of articles published in the English language, and modest participation of foreign authors were points requiring improvement. CONCLUSION: The present study suggests that a survey of the 100 most cited articles in the JBP can provide a historical overview of the progress of this journal, as well as highlight the main obstacles, constraints, and challenges faced by its editors and authors.

OBJETIVO: Bibliometria é um grupo de métodos estatísticos e matemáticos empregados para medir e analisar a quantidade e a qualidade de artigos científicos, livros e outras formas de publicações. O objetivo do presente estudo foi realizar uma análise bibliométrica do Jornal Brasileiro de Psiquiatria (JBP), relacionando seus 100 artigos mais citados na literatura científica e identificando suas principais características em termos de autoria e questões de pesquisa e delineamento experimental. MÉTODOS: As 100 referências mais citadas no JBP foram identificadas por meio de uma busca no Google Scholar. Foram registradas e analisadas as seguintes informações: autor principal, último autor, autor correspondente, número total de autores, gênero dos autores, ano de publicação, instituição de pesquisa, origem geográfica e idioma de cada referência e seu tema de investigação e delineamento metodológico. RESULTADOS: O aumento acentuado no número de citações nos últimos 15 anos, a boa distribuição das publicações entre os estados e centros de pesquisa brasileiros, a ausência de viés de gênero entre os autores e a variada gama de tópicos publicados sugerem um bom desempenho editorial atual do JBP. A relativa falta de revisões sistemáticas e estudos longitudinais, os poucos artigos publicados em inglês e a pequena participação de autores estrangeiros são pontos que requerem melhorias. CONCLUSÃO: O presente estudo sugere que o levantamento dos 100 artigos mais citados no JBP pode fornecer um panorama histórico da evolução dessa revista, bem como destacar os principais obstáculos, restrições e desafios enfrentados por seus editores e autores.

Unnecessarily prolonged suffering: a case of missed diagnosis of post-traumatic stress disorder in a teaching hospital / Sofrimento desnecessariamente prolongado: um caso de diagnóstico perdido de transtorno de estresse pós-traumático em um hospital de ensino

ABSTRACT We described a case in which a heavily-traumatized patient had been under psychiatric treatment for seven years (five of them in a university mental health clinic) but was never diagnosed with PTSD and, therefore, did not receive the proper treatment for a very long period. After the correct diagnosis was made and personalized treatment instituted, the patient has shown marked improvement in functionality and wellbeing. The key element in this case, was the adequacy of psychiatric training. Our report suggests that psychiatrists are not being adequately trained to identify traumatic events and to diagnose atypical cases of PTSD. With that in mind, we emphasize that theoretical modules on trauma and trauma-related disorders and practical training in specialized PTSD clinics should be incorporated into the psychiatric residency training programs wherever they may be missing, particularly in countries most impacted by violence. Furthermore, continuing medical education on trauma and PTSD should be provided by medical associations and journals to keep physicians updated on recent progress in the field.

RESUMO Descrevemos o caso de um paciente gravemente traumatizado que estava em tratamento psiquiátrico há sete anos (cinco deles em uma clínica universitária de saúde mental), mas nunca foi diagnosticado com transtorno de estresse pós-traumático (TEPT) e, portanto, não recebeu o tratamento adequado por muito tempo. Após o diagnóstico correto e o tratamento personalizado instituído, o paciente mostrou melhora acentuada na funcionalidade e no bem-estar. O elemento-chave, neste caso, foi a adequação do treinamento psiquiátrico. Nosso relatório sugere que os psiquiatras não estão sendo treinados adequadamente para identificar eventos traumáticos e diagnosticar casos atípicos de TEPT. Com isso em mente, enfatizamos que os módulos teóricos sobre eventos traumáticos e transtornos relacionados ao trauma e treinamento prático em clínicas especializadas de TEPT devem ser incorporados aos programas de treinamento em residência psiquiátrica onde quer que ainda estejam ausentes, particularmente nos países mais afetados pela violência. Além disso, a educação médica continuada sobre trauma e TEPT deve ser fornecida por associações médicas e periódicos científicos para manter os médicos atualizados sobre os avanços recentes na área.

The invisible scars of emotional abuse: a common and highly harmful form of childhood maltreatment.

BACKGROUND: Childhood maltreatment (CM) is unfortunately widespread globally and has been linked with an increased risk of a variety of psychiatric disorders in adults, including posttraumatic stress disorder (PTSD). These associations are well established in the literature for some maltreatment forms, such as sexual and physical abuse. However, the effects of emotional maltreatment are much less explored, even though this type figures among the most common forms of childhood maltreatment. Thus, the present study aims to investigate the impact of each type of childhood maltreatment, both individually and conjointly, on revictimization and PTSD symptom severity using a nonclinical college student sample. METHODS: Five hundred and two graduate and undergraduate students participated in the study by completing questionnaires assessing lifetime traumatic experiences in general, maltreatment during childhood and PTSD symptoms. Bivariate and multivariate negative binomial regressions were applied to examine the associations among childhood maltreatment, revictimization, and PTSD symptom severity. RESULTS: Our results showed that using bivariate models, all types of CM were significantly associated with revictimization and PTSD symptom severity. Multivariate models showed that emotional abuse was the type of maltreatment associated with the highest incidence rates of revictimization and PTSD symptom severity. CONCLUSIONS: These data provide additional evidence of the harmful effects of childhood maltreatment and its long-term consequences for individuals' mental health. Notably, the findings highlight the importance of studying the impacts of emotional abuse, which seems to be a highly prevalent, understudied, and chronic form of maltreatment that is as toxic as other maltreatment forms.

Vulnerability and Protective Factors for PTSD and Depression Symptoms Among Healthcare Workers During COVID-19: A Machine Learning Approach.

Background: Healthcare workers are at high risk for developing mental health problems during the COVID-19 pandemic. There is an urgent need to identify vulnerability and protective factors related to the severity of psychiatric symptoms among healthcare workers to implement targeted prevention and intervention programs to reduce the mental health burden worldwide during COVID-19. Objective: The present study aimed to apply a machine learning approach to predict depression and PTSD symptoms based on psychometric questions that assessed: (1) the level of stress due to being isolated from one's family; (2) professional recognition before and during the pandemic; and (3) altruistic acceptance of risk during the COVID-19 pandemic among healthcare workers. Methods: A total of 437 healthcare workers who experienced some level of isolation at the time of the pandemic participated in the study. Data were collected using a web survey conducted between June 12, 2020, and September 19, 2020. We trained two regression models to predict PTSD and depression symptoms. Pattern regression analyses consisted of a linear epsilon-insensitive support vector machine (ε-SVM). Predicted and actual clinical scores were compared using Pearson's correlation coefficient (r), the coefficient of determination (r2), and the normalized mean squared error (NMSE) to evaluate the model performance. A permutation test was applied to estimate significance levels. Results: Results were significant using two different cross-validation strategies to significantly decode both PTSD and depression symptoms. For all of the models, the stress due to social isolation and professional recognition were the variables with the greatest contributions to the predictive function. Interestingly, professional recognition had a negative predictive value, indicating an inverse relationship with PTSD and depression symptoms. Conclusions: Our findings emphasize the protective role of professional recognition and the vulnerability role of the level of stress due to social isolation in the severity of posttraumatic stress and depression symptoms. The insights gleaned from the current study will advance efforts in terms of intervention programs and public health messaging.

PTSD Predicts Smoking Cessation Failure in a Trauma-Exposed Population.

OBJECTIVE: The objective of the study was to investigate whether a diagnosis of posttraumatic stress disorder (PTSD; full or partial) or specific PTSD symptom clusters predicted failure in quitting smoking in a trauma-exposed population. Methods: Participants were 310 smokers who attempted quitting smoking, either successfully (quitters, n = 213) or not (relapsers, n = 97), who lived in slums and were attending a family doctor program. Measurements included a general questionnaire covering sociodemographic characteristics, clinical status and life habits, and the Posttraumatic Stress Disorder Checklist - Civilian Version. Differences in sociodemographic, clinical and lifestyle characteristics between quitters and relapsers were compared using a chi-square test. Because of the small sample size, full and partial PTSD were collapsed into a single category. Results: Significant differences (p ≤ .15) between quitters and relapsers were found in age, body mass index (BMI), income, alcohol consumption, and in the presence of full/partial PTSD diagnosis and of all three symptom clusters separately. Four logistic regression models predicting smoking cessation were modeled to control for confounding factors and included as independent variables a full/partial PTSD diagnosis and the three posttraumatic symptom clusters. The avoidance/numbing cluster presented the strongest association with relapse status (ORa 2.04, 95% CI [1.15, 3.63], p = .015), followed by the full/partial PTSD (ORa 1.80, 95% CI [1.04, 3.14], p = .038). The re-experiencing and the hyperarousal clusters were non-significantly associated with smoking cessation (ORa 1.34, 95% CI [0.80, 2.31], ns and ORa 1.65, 95% CI [0.96, 2.84], ns, respectively). Conclusions: Full/partial PTSD and posttraumatic symptom clusters uniquely predict risk for smoking relapse and thus may be a useful therapeutic target in trauma-exposed smokers.

Possible outcomes of cumulative trauma in mental-health: a case report / Possíveis desfechos para trauma cumulativo na saúde mental: um relato de caso

ABSTRACT To discuss the resilience factors that may have prevented a patient from developing post-traumatic stress disorder (PTSD) after exposure to a variety of severe potentially traumatic events. A thirty-eight-year-old civilian has been exposed to at least ten dramatic situations of violence in his work and personal life. He developed only a few mild post-traumatic symptoms after being exposed to a particularly gruesome incident during work. Even though the number and severity of potentially traumatic events may be alarming, this does not determine that the patient will inexorably develop PTSD, or other disorders. The study of protective factors is mandatory so that we can acknowledge and develop more effective ways to prevent and treat disorders.

RESUMO Discutir fatores de resiliência que podem ter prevenido que um paciente desenvolvesse transtorno do estresse pós-traumático (TEPT) após a exposição a uma variedade de eventos potencialmente traumáticos severos. Um civil de 38 anos que foi exposto a, ao menos, 10 situações dramáticas de violência em seu trabalho e vida pessoal. Ele desenvolveu apenas alguns sintomas leves após o trauma de ter sido exposto a um evento particularmente desconcertante durante seu trabalho. Apesar de o número e a severidade dos eventos potencialmente traumáticos serem alarmantes, isso não determina que o paciente invariavelmente apresentará o TEPT ou outros transtornos. O estudo dos fatores protetivos é essencial para que possamos reconhecer e desenvolver maneiras efetivas de prevenir e tratar os transtornos mentais.

Translation and cross-cultural adaptation of the International Trauma Questionnaire for use in Brazilian Portuguese.

BACKGROUND: The most recent editions of diagnostic manuals have proposed important modifications in posttraumatic stress disorder (PTSD) criteria. The International Trauma Questionnaire (ITQ) is the gold-standard measurement for assessing PTSD and complex PTSD in accordance with the model of the 11th International Classification of Diseases (ICD-11). OBJECTIVE: The aim of this study was to adapt the ITQ for the Brazilian context. DESIGN AND SETTING: The translation and cross-cultural adaptation of the ITQ for use in Brazilian Portuguese was performed in trauma research facilities in Porto Alegre, Rio de Janeiro and Belo Horizonte, Brazil. METHODS: The adaptation followed five steps: (1) translation; (2) committee synthesis; (3) experts' evaluation through the content validity index (CVI) and assessment of interrater agreement though kappa statistics; (4) comprehension test with clinical and community samples (n = 35); and (5) final back-translation and authors' evaluation. RESULTS: Two independent translations were conducted. While working on a synthesis of these translations, the committee proposed changes in six items to adapt idiomatic expressions or to achieve a more accurate technical fit. Both the expert judges' evaluation (CVI > 0.7; k > 0.55) and the pretest in the target population (mean comprehension > 3) indicated that the adapted items were adequate and comprehensible. The final back-translation was approved by the authors of the original instrument. CONCLUSION: ITQ in its Brazilian Portuguese version achieved satisfactory content validity, thus providing a tool for Brazilian research based on PTSD models of the ICD-11.

Translation and cross-cultural adaptation of the International Trauma Questionnaire for use in Brazilian Portuguese

ABSTRACT BACKGROUND: The most recent editions of diagnostic manuals have proposed important modifications in posttraumatic stress disorder (PTSD) criteria. The International Trauma Questionnaire (ITQ) is the gold-standard measurement for assessing PTSD and complex PTSD in accordance with the model of the 11th International Classification of Diseases (ICD-11). OBJECTIVE: The aim of this study was to adapt the ITQ for the Brazilian context. DESIGN AND SETTING: The translation and cross-cultural adaptation of the ITQ for use in Brazilian Portuguese was performed in trauma research facilities in Porto Alegre, Rio de Janeiro and Belo Horizonte, Brazil. METHODS: The adaptation followed five steps: (1) translation; (2) committee synthesis; (3) experts' evaluation through the content validity index (CVI) and assessment of interrater agreement though kappa statistics; (4) comprehension test with clinical and community samples (n = 35); and (5) final back-translation and authors' evaluation. RESULTS: Two independent translations were conducted. While working on a synthesis of these translations, the committee proposed changes in six items to adapt idiomatic expressions or to achieve a more accurate technical fit. Both the expert judges' evaluation (CVI > 0.7; k > 0.55) and the pretest in the target population (mean comprehension > 3) indicated that the adapted items were adequate and comprehensible. The final back-translation was approved by the authors of the original instrument. CONCLUSION: ITQ in its Brazilian Portuguese version achieved satisfactory content validity, thus providing a tool for Brazilian research based on PTSD models of the ICD-11.

Pre-traumatic vs post-traumatic OCD in PTSD patients: Are differences in comorbidity rates and functional health status related to childhood abuse?

OBJECTIVE: The goal of this study was to compare the clinical and functional status and the trauma-related characteristics of PTSD patients with comorbid OCD whose onset predated the index traumatic event (pre-traumatic OCD) with those of PTSD patient whose comorbid OCD only emerged after the exposure to the traumatic event (post-traumatic OCD). METHODS: Sixty-three individuals with PTSD and comorbid OCD were evaluated with the Structured Clinical Interview for DSM-IV AXIS I Disorders and completed the Posttraumatic Stress Disorder Checklist - Civilian Version, the Beck Depression Inventory, the Beck Anxiety Inventory, the Trauma History Questionnaire and the 36-Item Short-Form Health Survey. RESULTS: A history of childhood abuse was significantly more frequent among PTSD patients with pre-traumatic OCD (45.2%) than among their counterparts with post-traumatic OCD (16%). PTSD patients with pre-traumatic OCD had higher rates of psychiatric comorbidity in general and showed a lower functional health status in a physical domain (SF-36 Role Limitation due to Physical Health). In contrast, PTSD patients with post-traumatic OCD had a decreased functional health status in a psychological domain (SF-36 Emotional Well Being). The effect sizes were in the medium to large range. CONCLUSIONS: A history of child abuse may be an important, but often neglected, factor accounting for clinical, functional, and trauma-related differences between pre-traumatic and posttraumatic OCD in PTSD patients.

Métodos de rastreamento da depressão em pacientes ambulatoriais com insuficiência cardíaca / Methods of screening for depression in outpatients with heart failure

A depressão é uma condição clínica sindrômica subdiagnosticada em pacientes com insuficiência cardíaca. Uma variedade de instrumentos é atualmente aplicada no rastreamento da depressão. Determinar a prevalência da depressão e a concordância entre os métodos de rastreamento para depressão em pacientes com insuficiência cardíaca. Estudo transversal realizado entre março de 2015 e janeiro de 2017 com 76 pacientes ambulatoriais acompanhados em uma clínica especializada de insuficiência cardíaca. A depressão foi rastreada pela Escala de Avaliação de Depressão de Hamilton (HAM-D), pelo Inventário de Depressão de Beck-II (BDI-II) e pelo Patient Health Questionnaire-9 (PHQ-9). A concordância entre os três instrumentos foi analisada pelo coeficiente kappa de Fleiss (kF), coeficiente alfa de Krippendorff (Ck) e coeficiente alfa de Cronbach. Foram calculadas a acurácia, sensibilidade, especificidade e as taxas de resultados falso-positivos e falso-negativos dos instrumentos HAM-D e PHQ-9, considerando o instrumento BDI-II como padrão-ouro no diagnóstico da depressão. As prevalências de depressão foram de 72,4% (n = 55) pela escala HAM-D, 67,1% (n = 51) pela escala BDI-II e 40,8% (n = 31) pelo PHQ-9. A prevalência de depressão pelos três instrumentos simultaneamente foi de 28,9% (n = 22) e a concordância diagnóstica entre os três instrumentos (sobre a presença ou ausência de depressão) foi de 47,4% (n = 36). A análise revelou uma concordância superficial (kF = Ck = 0,27) e consistência moderada (↓C = 0,602, significativamente não nulo, p = 0,000). As variáveis sociodemográficas e clínicas não constituíram fatores de riscos para a depressão na amostra avaliada. Os métodos de rastreamento analisados apresentaram concordância e foram úteis na detecção da depressão entre pacientes ambulatoriais com insuficiência cardíaca

Depression is a syndromic clinical condition underdiagnosed in patients with heart failure. Several instruments are currently applied to screen for depression. To determine the prevalence of depression and the agreement among screening methods for depression in patients with heart failure. Cross-sectional study conducted between March 2015 and January 2017 including 76 outpatients following up at a clinic specialized in heart failure. Depression was screened with the Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory-II (BDI-II), and Patient Health Questionnaire-9 (PHQ-9). The agreement among the three instruments was analyzed with Fleiss' kappa coefficient (kF), Krippendorff's alpha coefficient (Ck) and Cronbach's alpha coefficient. The accuracy, sensitivity, and specificity, as well as false-positive and false-negative results of the HAM-D and PHQ-9 were calculated considering the BDI-II as the gold-standard instrument in the diagnosis of depression. The prevalence rates of depression were 72.4% (n = 55) with the HAM-D, 67.1% (n = 51) with the BDI-II, and 40.8% (n = 31) with the PHQ-9 scales. The prevalence of depression simultaneously identified by all three instruments was 28.9% (n = 22) and the diagnostic agreement (presence or absence of depression) was 47.4% (n = 36). The analysis revealed a superficial agreement (kF = Ck = 0.27) and moderate consistency ((↓C = 0.602, significantly not null, p = 0.000). Sociodemographic and clinical variables were not risk factors for depression in the evaluated sample. The screening methods analyzed showed agreement and were useful in detecting depression among outpatients with heart failure