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1.
Med Clin North Am ; 107(1): 85-99, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36402502

RESUMO

Post-traumatic stress disorder (PTSD) is characterized by symptoms of re-experiencing, avoidance, negative alterations in cognition and mood, and marked alterations in arousal and reactivity following exposure to a traumatic event. PTSD can be assessed by structured interviews and screening measures in psychiatric and nonpsychiatric settings. Evidence-based psychotherapies are the first-line treatment of PTSD, with cognitive behavioral therapies, such as prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing having the largest body and highest quality of evidence. Serotonin reuptake inhibitors are the first-line pharmacologic treatments for PTSD and are often used in conjunction with other therapeutic interventions.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/terapia , Cognição
2.
J Affect Disord ; 320: 108-116, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36162665

RESUMO

BACKGROUND: Pregnancy is a time of increased risk for intimate partner violence (IPV), yet there is a dearth of prospective research examining the relationship between IPV and posttraumatic stress symptoms (PTSS) in the perinatal period. Further, relationships among different types of IPV and perinatal PTSS remain understudied. METHODS: Latent class and transition analyses were used to examine classes of PTSS in pregnancy and postpartum, the longitudinal patterns of transitions across these classes, and the role of IPV types, childhood adversity, and depressive symptoms in PTSS presentation. Participants (N = 238) were drawn from two longitudinal studies of high-risk perinatal women. RESULTS: Four latent PTSS classes emerged: High, Avoidant, Hypervigilant, and Low. Childhood adversity (χ2(3) = 13.09, p = .004), prenatal depression (χ2(3) = 17.58, p = .001), and psychological IPV (χ2(3) = 10.51, p = .01) were associated with membership in High, Avoidant, and Hypervigilant classes. Women with low prenatal PTSS continued to have low levels at postpartum. Women in higher severity classes during pregnancy tended to transition into classes with adjacent, and often lower, levels of symptom severity postpartum. Women in the High PTSS class in pregnancy with elevated levels of depression were significantly more likely to remain in the High PTSS class or transition into the Avoidant class at postpartum, compared to the Low PTSS class, χ2(3) = 11.84, p = .008. LIMITATIONS: Relatively modest sample size precluded examination of a broader range of symptoms consistent with PTSD. CONCLUSIONS: Findings highlight the importance of individualized approaches to assessing, monitoring, and treating perinatal PTSS.


Assuntos
Violência por Parceiro Íntimo , Transtornos de Estresse Pós-Traumáticos , Humanos , Gravidez , Feminino , Transtornos de Estresse Pós-Traumáticos/psicologia , Estudos Prospectivos , Parto , Violência por Parceiro Íntimo/psicologia , Ansiedade
3.
J Affect Disord ; 320: 450-460, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36174789

RESUMO

OBJECTIVE: Sleep disruption is a common complaint among patients with post-traumatic stress disorder (PTSD). Modern technology of activity monitoring (actigraphy) enables extended, objective, unobtrusive recording and measuring of daytime and nighttime activity. We conducted a meta-analysis to investigate the actigraphic sleep patterns in PTSD compared with healthy controls. METHODS: We searched through seven electronic databases from inception to July 2022. Only case-control studies comparing rest-activity variables measured by actigraphy devices between clinically diagnosed PTSD patients and healthy individuals were included. RESULTS: We identified 12 eligible studies comparing 323 PTSD patients and 416 healthy controls. Using a random-effects model, we showed that PTSD patients have significantly lower sleep efficiency (SMD: -0.26, 95 % CI = -0.51 to -0.004, p < .05, I2 = 29.31 %), more fragmented sleep (SMD: 0.52, 95 % CI = 0.17 to 0.87, p < .01, I2 = 0 %), and longer time in bed (SMD: 0.41, 95 % CI = 0.07 to 0.74, p < .05, I2 = 0 %) compared to healthy controls. LIMITATIONS: This study included a limited number of studies. Publication bias was not examined on all variables, which could lead to an overestimation of effect size. Four studies involved veterans, which likely differ from civilians regarding traumatic exposure. CONCLUSION: This meta-analytic review highlighted a pattern of sleep disturbances in PTSD patients compared with non-PTSD individuals. High-quality, large-scale studies are necessary to draw a definitive conclusion regarding the distinctive sleep profile in PTSD. Future research can pay attention to sleep-specific mechanisms underlying PTSD and explore the momentary interactions between sleep-wake variables.


Assuntos
Transtornos do Sono-Vigília , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Actigrafia , Polissonografia , Sono , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia
4.
Behav Brain Res ; 437: 114128, 2023 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-36174841

RESUMO

While SSRIs are the current first-line pharmacotherapies against post-traumatic stress disorder (PTSD), they suffer from delayed onset of efficacy and low remission rates. One solution is to combine SSRIs with other treatments. Neuronal nitric oxide synthase (nNOS) has been shown to play a role in serotonergic signaling, and there is evidence of synergism between nNOS modulation and SSRIs in models of other psychiatric conditions. Therefore, in this study, we combined subchronic fluoxetine (Flx) with 7-nitroindazole (NI), a selective nNOS inhibitor, and evaluated their efficacy against anxiety-related behavior in an animal model of PTSD. We used the underwater trauma model to induce PTSD in rats. Animals underwent the open field (OFT) and elevated plus maze tests on days 14 (baseline) and 21 (post-treatment) after PTSD induction to assess anxiety-related behaviors. Between the two tests, the rats received daily intraperitoneal injections of 10 mg/kg Flx or saline, and were injected intraperitoneally before the second test with either 15 mg/kg NI or saline. The change in behaviors between the two tests was compared between treatment groups. Individual treatment with both Flx and NI had anxiogenic effects in the OFT. These effects were associated with modest increases in cFOS expression in the hippocampus. Combination therapy with Flx + NI did not show any anxiogenic effects, while causing even higher expression levels of cFOS. In conclusion, addition of NI treatment to subchronic Flx therapy accelerated the abrogation of Flx's anxiogenic properties. Furthermore, hippocampal activity, as evidenced by cFOS expression, was biphasically related to anxiety-related behavior.


Assuntos
Ansiolíticos , Inibidores Enzimáticos , Óxido Nítrico Sintase Tipo I , Inibidores de Captação de Serotonina , Transtornos de Estresse Pós-Traumáticos , Animais , Ratos , Ansiedade/metabolismo , Modelos Animais de Doenças , Fluoxetina/farmacologia , Fluoxetina/uso terapêutico , Hipocampo/metabolismo , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase Tipo I/antagonistas & inibidores , Óxido Nítrico Sintase Tipo I/metabolismo , Inibidores de Captação de Serotonina/farmacologia , Inibidores de Captação de Serotonina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/metabolismo , Quimioterapia Combinada , Inibidores Enzimáticos/farmacologia , Inibidores Enzimáticos/uso terapêutico , Ansiolíticos/farmacologia , Ansiolíticos/uso terapêutico
5.
J Intensive Care Med ; 38(1): 11-20, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35593071

RESUMO

OBJECTIVE: To examine medical and psychosocial risk factors associated with the development of acute stress in parents of patients unexpectedly admitted to the PICU. DESIGN: Cross-sectional observational study. SETTING: Two tertiary care children's hospitals with mixed medical/surgical/cardiac PICU. PATIENTS: Parents of patients unexpectedly admitted to the PICU. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: 265 parents of 188 children were enrolled of whom 49 parents (18%) met ASD qualification and 108 (41%) parents developed ASD symptoms as determined by the ASDS-5 scale. Risk factors making parents likely to meet ASD qualification include parents from area served by Penn State (p < 0.001), prior psychiatric illness (p < 0.01), and female gender (p < 0.05), while graduating college was protective (p < 0.05). In the multivariate analysis, parents from area served by Penn State (OR 3.00 (1.49-6.05) p < 0.01) and parents with prior psychiatric illness (OR 2.16 (1.03-4.52) p < 0.05) were associated with ASD qualification. Parents who graduated college or had prior medical problems were not significant.Risk factors making parents more likely to develop ASD symptoms (significant symptoms that do not meet ASD qualification) include patients with higher PRISM-III scores (p < 0.01), patients receiving cardiovascular support (p < 0.05), parents with a history of prior physical/sexual abuse (p < 0.01), parental involvement in the past with a major disaster/accident (p < 0.01), a family member admitted to an ICU in the past (p < 0.05) and preexisting parental psychiatric/medical disorders (p < 0.001). In a multivariate analysis, prior parental psychiatric disorder (OR 4.11 (1.80-6.42) p < 0.001), history of parental abuse (OR 3.11 (1.14-5.08) p < 0.05), and parental prior medical problem (OR 2.03 (1.01-3.05) p < 0.05) were associated with the development of ASD symptoms. However, PRISM-III score and prior involvement in major disaster were not significant. CONCLUSIONS: A combination of psychosocial parental risk factors and patient factors were associated with acute stress in parents. Further studies evaluating targeted hospital interventions towards parents most at-risk are needed.


Assuntos
Unidades de Terapia Intensiva Pediátrica , Pais , Criança , Humanos , Feminino , Estudos Transversais , Pais/psicologia , Hospitalização , Fatores de Risco
6.
J Interpers Violence ; 38(1-2): NP1654-NP1689, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35483029

RESUMO

High-quality video and audio recordings of violent crimes, captured using now ubiquitous digital technologies, play an increasingly important role in the administration of justice. However, the effects of exposure to gruesome material presented in this form on criminal justice professionals who analyze, evaluate, and use this potentially traumatic content in the context of their work, are largely unknown. Using long interviews and constructivist grounded theory, this qualitative study sought to explore experiences of exposure to video evidence of violent crime among Canadian criminal justice professionals. Sixteen individuals including police, lawyers, judges, psychiatrists, law clerks, and court reporters volunteered to participate in qualitative long interviews asking about workplace exposures to violent videos. Themes identified address the ubiquity of video evidence of violent crime; proximity to violence through video; being blindsided through lack of preparedness for violent content; repeated exposures through multiple and protracted viewings; insufficient customary methods for self-protection; and the enduring impact of exposure to videoed violence. We determine that criminal justice professionals are increasingly and repeatedly presented with deeply disturbing imagery that was once imperceptible or unknowable and thus previously held at a greater distance. Elements of what is newly visible and audible in video evidence of violent crime create a new emotional proximity to violence that potentially increases the risks of secondary trauma and underscores the need for improved safety measures.


Assuntos
Crime , Direito Penal , Humanos , Crime/psicologia , Local de Trabalho , Canadá , Violência/psicologia
7.
J Interpers Violence ; 38(1-2): NP2048-NP2067, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35487239

RESUMO

The development of posttraumatic stress symptoms (PTSS) due to sexual trauma is complex. Various mechanisms have been studied to explain the relationship between sexual trauma and PTSS. Other studies have looked at the impact of the victim-perpetrator relationship on the relationship between sexual trauma and PTSS with mixed results. Lacking from the literature is the possible mediating effect of peritraumatic schemas for the relationship between sexual trauma and PTSS. Additionally, the impact of the type of victim-perpetrator relationship may have on the development of peritraumatic schemas has also been unaddressed. This study seeks to close the gap in the literature by asking if peritraumatic schemas mediate the relationship between sexual trauma, specifically attempted and completed rape, and PTSS. The moderating role of the victim-perpetrator relationship on the association between sexual trauma and peritraumatic schemas was also examined. Using a college student sample that had endorsed experiencing at least one sexual trauma in their life, this study examined path analysis model explaining the mediating effects of peritraumatic schemas and the moderating effects of the victim-perpetrator relationship. Results indicated that peritraumatic schemas partially mediated the relationship between attempted rape and PTSS when controlling for completed rape. This effect was not found for the relationship between completed rape and PTSS when controlling for attempted rape. The interaction between attempted rape and the acquaintance perpetrator relationship was significant, indicating that peritraumatic schemas increased more severely for those that experienced attempted rape by an acquaintance. Recognizing that PTSS partially results from the peritraumatic schemas experienced, which are impacted by the victim-perpetrator relationship, helps increase understanding of the experience of attempted rape.


Assuntos
Vítimas de Crime , Estupro , Humanos , Trauma Sexual , Amigos , Estudantes
8.
J Interpers Violence ; 38(1-2): NP1815-NP1841, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35499214

RESUMO

STUDY QUESTIONS: Although most women who are subjected to intimate partner violence attempt to leave their abusive partners, many return, and resultantly are at risk for even greater violence. Research to date has documented relations between several factors (income and economic dependence, frequency of intimate partner violence (IPV), fear of violence escalations, history of childhood abuse, and post-traumatic stress disorder symptoms) and women's returning to their abusive partners. Nevertheless, the contribution of women's emotional bonds with their violent partners, known as identification with the aggressor (IWA), in explaining their perceived likelihood of going back to the relationship, has remained unclear. SUBJECTS: The current study, conducted among 258 Israeli women who had left their violent partners, aimed to fill this void. METHODS: An online survey was conducted. Demographic variables, history of childhood abuse, frequency of IPV, economic dependence on former partner, fear of future violence escalation, post-traumatic stress disorder symptoms, IWA, and perceived likelihood of returning to the relationship, were assessed via self-report questionnaire. FINDINGS: Results indicated that two aspects of IWA-becoming hyper-sensitive to the perpetrator and adopting the perpetrator's experience-were related to women's perceived likelihood of returning to the relationship. Furthermore, a logistic regression analysis indicated that only two factors-income and becoming hyper-sensitive to the perpetrator-uniquely contributed to explaining the likelihood of returning to abusive partners. Major implications: The current findings suggest that women's tendency to be highly attuned to their partners' feelings and needs, as a part of IWA, may impede their ability to permanently leave abusive relationships.


Assuntos
Violência por Parceiro Íntimo , Transtornos de Estresse Pós-Traumáticos , Feminino , Humanos , Criança , Violência por Parceiro Íntimo/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Autorrelato , Medo , Parceiros Sexuais/psicologia
9.
J Interpers Violence ; 38(1-2): NP2135-NP2158, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35536767

RESUMO

Previous research has not assessed the association between intimate partner violence (IPV) and disordered eating (DE), nor the potential indirect effect through posttraumatic stress disorder (PTSD) symptoms, among residents of IPV shelters. Among 212 IPV survivors, this study examined these and the differential associations by PTSD symptom cluster and types of DE. In the current sample, 67.9% met criteria for probable PTSD, 20.3% met criteria for a probable eating disorder, and 18.4% had probable comorbid diagnoses. Consistent with escape theory, there was an indirect effect of IPV on DE through PTSD symptoms. Additionally, there was an indirect effect of IPV on weight/shape concerns and binge symptoms through PTSD symptoms. Although there was a significant total effect of IPV on compensatory behaviors, there was no indirect effect through PTSD symptoms. When PTSD symptom clusters were examined concurrently, the only indirect effect of IPV on weight/shape concerns was via the PTSD symptom cluster of negative alterations in cognition and mood. Although there was an indirect effect of IPV on binge symptoms via PTSD symptoms overall, no specific PTSD symptom cluster drove this association. Implications highlight the need for attention to DE within this population. Consistent with escape theory, survivors' DE might serve to distract from psychological distress.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Violência por Parceiro Íntimo , Transtornos de Estresse Pós-Traumáticos , Feminino , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Síndrome , Violência por Parceiro Íntimo/psicologia , Sobreviventes , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia
10.
Front Psychol ; 13: 1040935, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36438324

RESUMO

Objective: This study examined whether sleep disturbance was a mediator between alexithymic traits and post-traumatic stress disorder (PTSD) COVID-19 pandemic-related stress symptoms, and explored whether self-esteem moderated the alexithymic contribution to poor sleep and PTSD symptoms. Method: A representative sample of young adults (N = 2,485) from six universities in Southwest China completed online self-report surveys on alexithymia, sleep, PTSD, self-esteem, sociodemographic information, and health-related behaviors. Results: High alexithymic young adults were found to be more likely to have higher sleep problems and higher PTSD symptoms. The moderated mediation model showed that sleep problems mediated the associations between alexithymia and PTSD symptoms. Alexithymic people with lower self-esteem were more likely to have elevated PTSD symptoms and sleep problems than those with higher self-esteem. Conclusion: Targeted psychological interventions for young people who have difficulty expressing and identifying emotions are recommended as these could assist in reducing their post-traumatic psychophysical and psychological problems. Improving self-esteem could also offer some protection for trauma-exposed individuals.

11.
Soc Sci Med ; 315: 115529, 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-36427478

RESUMO

This paper examines key processes from the social identity model of traumatic identity change in the context of the aftermath of a natural disaster. It focuses on the roles of (i) group membership gain, (ii) group membership continuity, (iii) social identity revitalisation, and (iv) the severity of natural disaster exposure on post-traumatic growth (PTG) and post-traumatic stress (PTS). PARTICIPANTS: (N = 410, Mage = 53.24 years) comprised adult survivors of the Australian 2019-20 Black Summer bushfires, recruited to complete an online survey via geo-targeted Facebook advertisements. RESULTS: showed that group membership gain was positively correlated with PTG, whilst group membership continuity negatively correlated with PTS, highlighting the different roles played by group gain and continuity in post-trauma recovery. Preliminary evidence for the validity of a new author-developed social identity revitalisation measure was found, which mediated some relationships between group gain and continuity and PTG and PTS. Lastly, the extent that participants were affected by the fires moderated the relationship between group gain and PTS. Specifically, for those most affected, group gain was correlated with lower reported PTS, whilst for those less affected, group gain was correlated with higher reported PTS. We discuss implications for theory and draw attention to the concept of revitalisation, which shows promise as a potentially critical contributor to post-trauma recovery.

12.
Life (Basel) ; 12(11)2022 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-36362862

RESUMO

Individuals with posttraumatic stress disorder (PTSD) experience intrusions of vivid traumatic memories, heightened arousal, and display avoidance behavior. Disorders in identity, emotion regulation, and interpersonal relationships are also common. The cornerstone of PTSD is altered learning, memory, and remembering, regulated by a complex neuronal and molecular network. We propose that the essential feature of successful treatment is the modification of engrams in their unstable state during retrieval. During psychedelic psychotherapy, engrams may show a pronounced instability, which enhances modification. In this narrative review, we outline the clinical characteristics of PTSD, its multifaceted neuroanatomy, and the molecular pathways that regulate memory destabilization and reconsolidation. We propose that psychedelics, acting by serotonin-glutamate interactions, destabilize trauma-related engrams and open the door to change them during psychotherapy.

13.
Eat Weight Disord ; 2022 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-36401788

RESUMO

PURPOSE: Given data suggesting common co-occurrence and worse outcomes for individuals with eating disorders (EDs) and post-traumatic stress disorder (PTSD), it is critical to identify integrated treatment approaches for this group of patients. Past work has explored the feasibility and initial efficacy of intervention approaches that draw on evidence-based treatments for both EDs and PTSD; however, this work remains limited in scope. In the current study, we explored the feasibility and naturalistic outcomes of PTSD treatment delivered within the context of intensive ED treatment. METHOD: Participants were 57 adult men and women with DSM-5 EDs and comorbid PTSD who completed a course of either Prolonged Exposure (PE; n = 22) or Cognitive Processing Therapy (CPT; n = 35) (Msessions = 10.40; SD = 5.13) and weekly validated measurements of clinical symptoms while enrolled in ED programming. RESULTS: Multi-level models for PTSD symptoms indicated a significant linear effect of time, such that participants demonstrated significant decreases over time in PTSD symptoms, regardless of treatment modality. CONCLUSION: Our preliminary investigation provides support for the feasibility and efficacy of an integrated approach to treating EDs and PTSD. It is critical for future work to undertake randomized tests of this integrated approach using large, heterogeneous samples. LEVEL OF EVIDENCE: Level IV, multiple time series with intervention.

14.
Int J Psychiatry Clin Pract ; : 1-10, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36369845

RESUMO

BACKGROUND: Post-traumatic stress disorder (PTSD) is a risk factor for suicidality (suicidal ideation, and suicide attempt). This study described the prevalence of suicidality amongst a representative sample of individuals with PTSD and the association between suicidality and receipt of five PTSD treatments. METHODS: We analysed deidentified data for patients being treated for PTSD at Camden and Islington NHS Foundation Trust between 2009 and 2017 obtained via the Clinical Record Interactive Search tool. We described the sample's sociodemographic and clinical characteristics and used stepwise logistic regression to investigate the association between suicidality and receipt of four, specific PTSD treatments: psychotherapy, antidepressant/antianxiety medication, antipsychotics, benzodiazepines. We used Cox proportional hazards regression to investigate the association between suicidality and hospital/crisis team admission. RESULTS: Of 745 patients diagnosed with PTSD, 60% received psychotherapy and 66% received psychotropic medication. Those who reported suicidality (6%) were no more likely than those who did not to be prescribed antidepressant/antianxiety medication, but were more likely to receive antipsychotics (AOR = 2.27, 95% CI 1.15 - 4.47), benzodiazepines (AOR 2.28, 95% CI 1.17 - 4.44), psychotherapy (AOR 2.60, 95% CI 1.18 - 5.73) and to be admitted to hospital/crisis team (AOR 2.84, 95% 1.82 - 4.45). CONCLUSION: In this sample, patients with PTSD and suicidality were more likely to receive psychiatric medication, psychotherapy and psychiatric admission than those who were not suicidal. Overall patients were more likely to receive psychotropic medication than psychotherapy. Adherence to clinical guidelines is important in this population to improve treatment outcomes and reduce the risk of suicide.KEY POINTSNICE guidelines recommend psychological therapy be first line treatment for PTSD, yet we identified that fewer people diagnosed with PTSD received therapy compared to psychotropic medication.Patients with suicidality were more likely to receive antipsychotics and benzodiazepines, yet not antidepressant/antianxiety medication although given that suicidality is characteristic of severe depression, it might be assumed from stepped care models that antidepressant/antianxiety medication be prescribed before antipsychotics.The high proportion of patients prescribed antipsychotics suggests a need for better understanding of psychosis symptoms among trauma-exposed populations.Identifying which combinations of symptoms are associated with suicidal thoughts could help tailor trauma-informed approaches to discussing therapy and medication.

15.
Asian J Psychiatr ; 78: 103304, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36327602

RESUMO

Posttraumatic mental health issues following traumatic limb amputations in children have been commonly reported worldwide. Traumatic limb amputationsarecatastrophic injuries/events and often have various long term psycho-social impacts on children. We report a case of 8 year-oldfemale child presenting with symptoms of post-traumatic stress disorder (PTSD) following a traumatic amputation of right hand. A non- directive approach in play therapy was used for management of her symptoms. At 12 months follow up, the child is doing well with no impairment in her overall functioning.


Assuntos
Amputação Traumática , Transtornos de Estresse Pós-Traumáticos , Humanos , Criança , Feminino , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Amputação Traumática/cirurgia , Amputação Traumática/psicologia , Ludoterapia , Amputação/psicologia
16.
J Psychiatr Res ; 156: 467-475, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36347106

RESUMO

In vivo exposures (IVEs) are a key component of exposure-based treatments, during which patients approach fear-provoking, yet safe, situations in "real life." This pilot study assessed the use of a wearable technology (Bio Ware) during IVEs to enhance Prolonged Exposure (PE) therapy for PTSD. Bio Ware provides a clinician dashboard with real-time physiological and subjective data for clinicians to use for virtually guided IVEs. Participants (N = 40) were randomized to a Guided group that received standard PE and virtual, clinician-guided IVEs with the Bio Ware device, or a Non-Guided group that received standard PE and used the Bio Ware device on their own for IVEs. Multilevel linear models with bootstrapping were completed on the intent-to-treat (ITT; N = 39) and per-protocol samples (PP; n = 23), defined as completing at least eight sessions of PE and using the Bio Ware system during ≥ 1 IVEs. In the PP sample, there were significant effects of treatment condition (b = -14.55, SE = 1.47, 95% CI [-17.58, -11.78], p < .001) and time (b = -1.98, SE = 0.25, 95% CI [-2.47, -1.48], p < .001). While both groups showed reductions in PTSD symptoms, the Guided group evidenced significantly greater reductions than the Non-Guided group. These findings demonstrate the feasibility and safety of leveraging Bio Ware for virtual, clinician-guided IVEs during PE therapy for PTSD and suggest that virtual, clinician-guided exposures may enhance treatment outcomes. CLINICAL TRIAL REGISTRATION: NCT04471207.

17.
BMC Psychol ; 10(1): 245, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36320044

RESUMO

BACKGROUND: Although eye movement desensitization and reprocessing (EMDR) has been shown to be effective in the treatment of PTSD for years, it remains controversial due to the lack of understanding of its mechanisms of action. We examined whether the working memory (WM) hypothesis -the competition for limited WM resources induced by the dual task attenuates the vividness and emotionality of the traumatic memory - would provide an explanation for the beneficial effect induced by bilateral stimulation. METHODS: We followed the Prisma guidelines and identified 11 articles categorized in two types of designs: studies involving participants with current PTSD symptoms and participants without PTSD diagnosis. RESULTS: Regardless of the types of studies, the results showed a reduction of vividness and emotionality in the recall of traumatic stimuli under a dual-task condition compared to a control condition, such as recall alone. However, two studies used a follow-up test to show that this effect does not seem to last long. CONCLUSION: Our results provide evidence for the WM hypothesis and suggest that recalling a traumatic memory while performing a secondary task would shift the individual's attention away from the retrieval process and result in a reduction in vividness and emotionality, also associated with the reduction of symptoms.


Assuntos
Dessensibilização e Reprocessamento através dos Movimentos Oculares , Transtornos de Estresse Pós-Traumáticos , Humanos , Dessensibilização e Reprocessamento através dos Movimentos Oculares/métodos , Memória de Curto Prazo/fisiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Movimentos Oculares , Rememoração Mental/fisiologia
18.
Front Digit Health ; 4: 974668, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36329832

RESUMO

Although well-established therapies exist for post-traumatic stress disorder (PTSD), barriers to seek mental health care are high. Technology-based interventions may play a role in improving the reach of efforts to treat, especially when therapist availability is low. The goal of the current randomized controlled trial was to pilot the efficacy of a computer-based trauma intervention with elements of virtual reality (VR; 3MR system) and limited therapist involvement for the treatment of PTSD in a childhood sexual abuse (CSA) and war veteran sample and to compare this to "treatment as usual" (TAU). TAU consisted of evidence-based approaches such as imaginal exposure, EMDR, or narrative exposure therapy. A total of 44 patients with PTSD were included and randomly assigned to 12 sessions of 3MR intervention or TAU (completer n 3MR = 12, TAU = 18). Several measures (PCL-5, BDI-II, OQ-45-2, and the M.I.N.I. 5.0.0.) were administered to measure symptoms of PTSD and depression and scores of overall well-being at pre, post, and a three-month follow-up measurement. Analyses suggest that symptoms of PTSD and depression in the 3MR condition decreased, and overall well-being increased between pre and post measurements. Results did not indicate any clear differences between the treatment conditions over time which suggests that treatment gains of the 3MR intervention seem no less than those of TAU. Finally, both treatment conditions produced similar remission rates of PTSD and depression. Therefore, the 3MR intervention could possibly constitute an appropriate treatment alternative. The small sample size as well as evident drop-out rates in the 3MR condition (45%) do warrant further research. The procedures of this study were approved by the Medical Ethical Research Committee (MERC) of the Erasmus Medical Center in Rotterdam (MEC-NL46279.078.13) and pre-registered via ClinicalTrials.gov (Protocol Record CI1-12-S028-1).

19.
G Ital Med Lav Ergon ; 44(1): 22-31, 2022 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-36346296

RESUMO

SUMMARY: Occupational stress can exceed the workers' individual capacity to adapt, and cause psychopathological conditions, including adjustment disorder (AD) and post-traumatic stress disorder (PTSD), for which medico-legal reporting is mandatory by law. Since the early 2000s, an interdisciplinary diagnostic protocol has been in use at our Institute to address patients towards an appropriate therapeutic path, in order to promote their psychological well-being and work reintegration. In 2017, the protocol was updated and expanded. The current version (MaSD-2) includes: occupational medicine examination, psychological counselling, psychiatric interview, and psychodiagnostic testing: Short-Negative Acts Questionnaire (S-NAQ), Cognitive Behavioral Assessment 2.0 (CBA-2.0), SCID (Structured Clinical Interview for DSM: Diagnostic and Statistical Manual of Mental Disorders), Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), Maugeri Stress Index - Reduced form (MASI-R). Between 2017 and 2019, we used the MaSD-2 to assess, for suspected psychopathological work-related problems, 198 patients (120 women and 78 men; mean age SD: 47.9 9.0 years). Nine (4.5%), already examined with the original version of the protocol, received diagnostic confirmation (2 cases of paranoid personality disorder, 7 of work-related anxiety-depressive disorder). Of the other 189 subjects, three (1.6%) were not affected by psychiatric disease, 12 (6.3%) had a psychiatric disorder (e.g., anxiety disorder, mood disorder, personality disorder) independent of work, 160 (84.7%) a work-related anxiety and/or depressive disorder. DA was identified in 12 cases (6.3%), and two patients (1.1%) were diagnosed with DA in pre-existent DPTS, for a total of 14 medico-legal reports of occupational disease. Compared to the past, the case record presents a much higher percentage of psychiatric disorders related to occupational stress. This may be due to a greater sensitivity of the new diagnostic protocol, and to a better selection of the patients referred to us. Women and tertiary workers continue to be at greater risk, with significant involvement of health professionals. Diagnoses of DA and DPTS remain rare, confirming the need for a rigorous and cautious interdisciplinary approach, aimed at selecting the cases for which to start medico-legal procedures. Finally, the study calls for adequate preventive measures.


Assuntos
Bullying , Estresse Ocupacional , Transtornos de Estresse Pós-Traumáticos , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Ocupacional/diagnóstico , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/complicações
20.
Health Psychol Res ; 10(4): 40321, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36425233

RESUMO

This review aims to assess the relationship between interstitial cystitis (IC) and significant traumatic events or PTSD. It was shown that there is a strong correlation between past trauma and the development of interstitial cystitis, as well as a much higher incidence of PTSD in patients diagnosed with IC. It was also established that for individuals with early traumatic experiences, the more likely the development of IC later in life, and with more severe symptoms and adverse effects on quality of life. We describe three distinct hypotheses for the possible physiologic mechanism for development of IC with relation to mental health and trauma, although definitive evidence in this area is still lacking, which poses interesting avenues for further research. This review also revealed an apparent lack of, and need for, trauma informed care and screening for PTSD in patients diagnosed with IC or other chronic pain syndromes.

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