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1.
J Acquir Immune Defic Syndr ; 85(4): 475-482, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33136748

RESUMO

BACKGROUND: The spread of severe acute respiratory syndrome coronavirus 2, causative agent of the coronavirus disease 2019 (COVID-19), has necessitated widespread lockdown to mitigate the pandemic. This study examines the influence of resilience on the impact of COVID-related stress and enforced lockdown on mental health, drug use, and treatment adherence among people living with HIV (PLWH) in Argentina. SETTING: PLWH residing predominantly in Buenos Aires Metropolitan Area and urban regions of Argentina were identified from a private clinic electronic database. METHODS: Participants completed an anonymous online survey to evaluate the impact of COVID-19 on economic disruption, resilience, mental health outcomes (depression, anxiety, stress, and loneliness), adherence to HIV treatment, and substance use. We performed ordinary least squares and logistic regressions to test whether resilient coping buffered the impact of economic disruption on mental health and drug use during quarantine. RESULTS: A total of 1336 PLWH aged 18-82 were enrolled. The impact of economic disruption on mental health ΔF(1,1321) = 8.86, P = 0.003 and loneliness ΔF(1,1326) = 5.77, P = 0.016 was buffered by resilience. A 3-way interaction between resilient buffering, stress, and sex was significant ΔF(1,1325) = 4.76, P = 0.029. Participants reported less than excellent adherence to medication (33%), disruption to mental health services (11%), and disruption to substance abuse treatment (1.3%) during lockdown. DISCUSSION: The impact of COVID-stress and lockdown on emotional distress seemed mitigated by resilience coping strategies, and the buffering impact of resilience on perceived stress was greater among women. Results highlight PLWH's capacity to adhere to treatment in challenging circumstances and the importance of developing resilience skills for better coping with stress and adversity.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Infecções por HIV/psicologia , Saúde Mental/tendências , Pneumonia Viral/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Infecções por Coronavirus/complicações , Infecções por Coronavirus/economia , Infecções por Coronavirus/prevenção & controle , Feminino , Infecções por HIV/complicações , Humanos , Violência por Parceiro Íntimo/tendências , Análise dos Mínimos Quadrados , Modelos Logísticos , Solidão , Masculino , Serviços de Saúde Mental/normas , Pessoa de Meia-Idade , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/economia , Pneumonia Viral/prevenção & controle , Resiliência Psicológica , Fatores Sexuais , Isolamento Social/psicologia , Apoio Social , Transtornos de Estresse Traumático Agudo/etiologia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento , Adulto Jovem
2.
Psychiatr Q ; 91(4): 1121-1133, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32803472

RESUMO

As cases of the coronavirus disease (COVID-19) continue to rise, psychological endurance is a challenge many people will face. For mental health, heightened stress responses to the pandemic, is likely to manifest in three ways: 1) development of a new episode of a disorder in those with a predisposition to a major psychiatric disorder or an acute exacerbation in those who already have such a disorder, 2) development of a trauma or stressor related disorder, such as acute stress disorder, Post Traumatic Stress Disorder (PTSD), or adjustment disorders, and 3) development of a symptomatic stress response that does not meet the diagnostic criteria of a psychiatric disorder. The authors reviewed existing literature on past epidemics, natural disasters, and COVID-19 with a focus on psychiatry and mental health. Psychological effects of past epidemics (Severe Acute Respiratory Syndrome CoV-1, Ebola, Middle East Respiratory Syndrome, the Anthrax threat), past natural disasters, and current COVID-19 data suggest numerous psychological effects following the pandemic. Alcohol use, PTSD, anxiety, anger, fear of contagion, perceived risk, uncertainty, and distrust are a few of the immediate and long-term effects that are likely to result from the COVID-19 pandemic. Identifying people in need of mental health care and determining the appropriate psychiatric services and therapy needed will be important. Increasing the use and availability of telehealth, group meetings, and online resources are some ways that health care workers can prepare for the increasing demand of psychiatric services during and following the pandemic.


Assuntos
Transtornos de Adaptação/psicologia , Infecções por Coronavirus/epidemiologia , Epidemias/história , Saúde Mental , Pneumonia Viral/epidemiologia , Transtornos de Estresse Traumático/psicologia , Estresse Psicológico/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Antraz , Betacoronavirus , Bioterrorismo/psicologia , Progressão da Doença , Doença pelo Vírus Ebola/epidemiologia , História do Século XXI , Humanos , Transtornos Mentais/psicologia , Desastres Naturais , Pandemias , Síndrome Respiratória Aguda Grave/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Traumático Agudo/psicologia
3.
Am J Geriatr Psychiatry ; 28(10): 1040-1045, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32718855

RESUMO

BACKGROUND: We aim to assess COVID-19 outbreak-related emotional symptoms, identify gender differences, and study the relationship between the emotional state and environmental features in the elderly. METHODS: We conducted a cross-sectional study starting on March 29 to April 5, 2020 based on a national online survey using snowball sampling techniques. Symptoms of anxiety (Hamilton Anxiety Scale), depression (Beck Depression Inventory) and acute stress (Acute Stress Disorder Inventory) were compared between people over and under 60 years old. Gender differences and the relationship of loneliness, regular exercise, economic losses and use of anxiolytics on the mental state were evaluated. RESULTS: One thousand six hundred thirty-nine (150 [9.2%] aged ≥60) participants completed the survey. The greater than or equal to 60 group showed lower mean (SD) BDI levels than the less than 60 group (3.02 [3.28] versus 4.30 [4.93]); and lower mean (SD) acute stress disorder inventory scores than the less than 60 group (3.68 [3.20] versus 4.45 [3.06]). There were no gender differences in any of the clinical measures. The presence of economic losses as well as the increase in the use of anxiolytics was significantly associated with higher emotional distress in the elderly compared to the younger group. CONCLUSIONS: Older people have shown less emotional distress, with no differences between men and women. Economic loss and substance use should be monitored to guarantee the emotional well-being of the elderly.


Assuntos
Ansiedade/epidemiologia , Infecções por Coronavirus/epidemiologia , Depressão/epidemiologia , Pneumonia Viral/epidemiologia , Transtornos de Estresse Traumático Agudo/epidemiologia , Fatores Etários , Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Ansiedade/psicologia , Betacoronavirus , Depressão/psicologia , Surtos de Doenças , Status Econômico , Exercício Físico/psicologia , Feminino , Humanos , Renda , Solidão/psicologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pandemias , Angústia Psicológica , Espanha/epidemiologia , Transtornos de Estresse Traumático Agudo/tratamento farmacológico , Transtornos de Estresse Traumático Agudo/psicologia
4.
Gen Hosp Psychiatry ; 66: 1-8, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32590254

RESUMO

OBJECTIVE: The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. We characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic. METHODS: This was a cross-sectional web survey of physicians, advanced practice providers, residents/fellows, and nurses, conducted during a peak of inpatient admissions for COVID-19 in NYC (April 9th-April 24th 2020) at a large medical center in NYC (n = 657). RESULTS: Positive screens for psychological symptoms were common; 57% for acute stress, 48% for depressive, and 33% for anxiety symptoms. For each, a higher percent of nurses/advanced practice providers screened positive vs. attending physicians, though housestaff's rates for acute stress and depression did not differ from either. Sixty-one percent of participants reported increased sense of meaning/purpose since the COVID-19 outbreak. Physical activity/exercise was the most common coping behavior (59%), and access to an individual therapist with online self-guided counseling (33%) garnered the most interest. CONCLUSIONS: NYC HCWs, especially nurses and advanced practice providers, are experiencing COVID-19-related psychological distress. Participants reported using empirically-supported coping behaviors, and endorsed indicators of resilience, but they also reported interest in additional wellness resources. Programs developed to mitigate stress among HCWs during the COVID-19 pandemic should integrate HCW preferences.


Assuntos
Adaptação Psicológica , Infecções por Coronavirus/psicologia , Pessoal de Saúde/psicologia , Preferência do Paciente/psicologia , Pneumonia Viral/psicologia , Angústia Psicológica , Transtornos de Estresse Traumático Agudo/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
5.
Eur Heart J Acute Cardiovasc Care ; 9(3): 241-247, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32342698

RESUMO

The COVID-19 pandemic is an unprecedented challenge for society. Supporting the mental health of medical staff and affiliated healthcare workers (staff) is a critical part of the public health response. This paper details the effects on staff and addresses some of the organisational, team and individual considerations for supporting staff (pragmatically) during this pandemic. Leaders at all levels of health care organisations will find this a valuable resource.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/psicologia , Pessoal de Saúde/psicologia , Corpo Clínico/psicologia , Saúde Mental/normas , Pneumonia Viral/psicologia , Comunicação , Infecções por Coronavirus/epidemiologia , Intervenção na Crise/organização & administração , Cuidados Críticos/psicologia , Cuidados Críticos/estatística & dados numéricos , Assistência à Saúde/organização & administração , Empoderamento , Pessoal de Saúde/estatística & dados numéricos , Humanismo , Humanos , Controle de Infecções/métodos , Relações Interpessoais , Liderança , Corpo Clínico/estatística & dados numéricos , Pandemias , Médicos/psicologia , Pneumonia Viral/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Traumático Agudo/epidemiologia , Transtornos de Estresse Traumático Agudo/psicologia
8.
Psychiatry Res ; 280: 112525, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31445423

RESUMO

Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are developed from exposure to traumatic events including war, interpersonal violence and natural disasters. We investigated prevalence and trauma-related information in patients from an outpatient psychiatric unit in Brazil among 2014-2017. A prevalence of ASD/PTSD of 40.8% was found in 179 patients. Female, Caucasian, married, mostly educated during 10-12 years long and employed patients composed a main profile. The presence of any previous trauma in adulthood and childhood were related to ASD/PTSD with longer follow-up time. This study provides evidence of stress-related disorders in a heterogeneous environment.


Assuntos
Ambulatório Hospitalar/economia , Pobreza/economia , Transtornos de Estresse Pós-Traumáticos/economia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Traumático Agudo/economia , Transtornos de Estresse Traumático Agudo/epidemiologia , Adulto , Brasil/epidemiologia , Feminino , Seguimentos , Humanos , Renda/tendências , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/tendências , Pacientes Ambulatoriais/psicologia , Pobreza/psicologia , Pobreza/tendências , Prevalência , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Fatores de Tempo , Violência/economia , Violência/psicologia , Violência/tendências
9.
Psychoneuroendocrinology ; 104: 238-242, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30903990

RESUMO

Although a majority of people will be exposed to a traumatic event over the course of their lifespan, only a minority will develop post-traumatic stress disorder. Better understanding the factors contributing to the development of this psychopathology is of high importance and could significantly reduce the societal and human costs associated with PTSD. Acute stress disorder symptoms, which refers to clinical manifestations experienced in the aftermath of a traumatic event, have been shown to be associated with subsequent PTSD symptoms. Yet, many people who develop PTSD do not meet criteria for acute stress disorder in the first place, highlighting the need to refine the predictors of PTSD. The secretion of the stress hormone cortisol is dysregulated in PTSD patients. Whether combining clinical and biological measures in the aftermath of trauma could help to better explain subsequent PTSD symptoms remains to be tested. The current prospective study recruited 51 adults who were exposed to a traumatic event in their work setting, i.e. a psychiatric hospital. Acute stress disorder symptoms and cortisol awakening responses were assessed one to five weeks following trauma exposure (Time 1). PTSD symptoms were measured two months following trauma exposure. Results revealed a significant interaction between acute stress disorder symptoms and cortisol awakening response in predicting later PTSD symptoms. The results suggest that higher cortisol awakening response is a protective factor in that it abolishes the relationship between acute stress disorder symptoms and subsequent PTSD symptoms. These results point to the importance of considering multi-level information in the aftermath of trauma, such as clinical and biological measures, in order to better identify individuals who are at higher risk of developing PTSD.


Assuntos
Transtornos de Estresse Pós-Traumáticos/metabolismo , Transtornos de Estresse Traumático Agudo/metabolismo , Violência no Trabalho/psicologia , Adulto , Exposição à Violência/psicologia , Feminino , Humanos , Hidrocortisona/análise , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Saliva/química , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Estresse Psicológico/metabolismo , Estresse Psicológico/psicologia , Local de Trabalho/psicologia
10.
J Pediatr Psychol ; 44(3): 311-322, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30615178

RESUMO

OBJECTIVE: In the aftermath of a child injury, children and parents can jointly experience acute stress symptoms. Optimism and self-efficacy might buffer against post-traumatic stress disorder. Knowing that children are innately receptive to parent modeling, we were interested in exploring how parent acute stress, optimism, and self-efficacy might transpire in parent-child interactions and whether any differences existed between mothers and fathers. METHODS: We recruited 71 families of seriously injured children who were hospitalized for at least 24 hr. Parents completed self-report measures of acute stress, optimism, and self-efficacy. Children wore the Electronically Activated Recorder (EAR(2)); Mehl, M. R. [2017]. The electronically activated recorder (EAR): A method for the naturalistic observation of daily social behavior. Current Directions in Psychological Science, 26, 184-190) for a 2-day period postdischarge. The EAR recorded ambient sounds for 30 s every 5 min. The audio recordings were transcribed and coded. We derived a percentage of time spent with each parent (interaction time), and average ratings of the emotional tone of voice for each speaker. RESULTS: Overall, parental acute stress and self-efficacy were not associated with interaction time or emotional tone, and parents generally spent less time with older children. Compared to fathers, mothers spent significantly more time with their child, particularly for daughters, but mothers did not differ from fathers in emotional tone, acute stress, optimism, or self-efficacy. For mothers, optimism may be associated with greater interaction time and more positive emotional tone. CONCLUSIONS: The present study highlighted parent gender differences in time spent with children and enabled the inclusion of more fathers using a naturalistic observational tool.


Assuntos
Pai , Mães , Otimismo , Relações Pais-Filho , Autoeficácia , Transtornos de Estresse Traumático , Ferimentos e Lesões , Adolescente , Adulto , Criança , Pré-Escolar , Pai/psicologia , Feminino , Humanos , Masculino , Mães/psicologia , Transtornos de Estresse Traumático/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Ferimentos e Lesões/psicologia
11.
Psychol Trauma ; 11(6): 563-570, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30570286

RESUMO

OBJECTIVE: Religious coping has been shown to relate to psychological adjustment in survivors of disasters months or even years afterward. However, because very few studies have assessed coping and well-being during the immediate crisis, little is known about the role of religiousness at this critical time. METHOD: We studied a sample of 132 Hurricane Katrina evacuees (56% male, 74.2% African American, mean age of 43 years) relocated to a Red Cross emergency shelter in Austin, Texas, within 19 days of Hurricane Katrina's landfall. RESULTS: Participants reported high levels of acute stress disorder (ASD) symptoms and functional impairment as well as high resource loss. Belief that God is in control and negative religious coping (perceiving punishment) were positively related to ASD symptoms while negative religious coping (perceiving abandonment) was related to higher functional impairment. The negative religious coping-ASD symptom relationship was moderated by resource loss, such that, for those with lower levels of resource loss, negative religious coping (perceiving punishment) related to even higher levels of ASD symptoms, an effect that diminished with higher resource loss. Neither positive religious coping nor pre-Katrina frequency of service attendance or private prayer related to ASD symptoms or functional impairment. CONCLUSIONS: At least in this sample at the height of disruption following a disaster, little evidence of salutary effects of religiousness were observed. It may be that such effects take time to emerge as people begin their recovery processes or that not all groups find help through their religious coping resources. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Adaptação Psicológica , Tempestades Ciclônicas , Punição/psicologia , Religião e Psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Sobreviventes/psicologia , Adulto , Afro-Americanos/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Traumático Agudo/fisiopatologia , Adulto Jovem
12.
Curr Psychiatry Rep ; 20(12): 111, 2018 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-30315408

RESUMO

PURPOSE OF REVIEW: The aim of this review is to provide a summary of the current evidence pertaining to the course of acute and chronic posttraumatic stress, the diagnosis of acute stress disorder (ASD), and treatment of acute stress disorder and prevention of posttraumatic stress disorder (PTSD). RECENT FINDINGS: Although acute stress disorder was introduced partly to predict subsequent PTSD, longitudinal studies indicate that ASD is not an accurate predictor of PTSD. Recent analytic approaches adopting latent growth mixture modeling have shown that trauma-exposed people tend to follow one of four trajectories: (a) resilient, (b) worsening, (c) recovery, and (d) chronically distressed. The complexity of the course of posttraumatic stress limits the capacity of the ASD diagnosis to predict subsequent PTSD. Current evidence indicates that the treatment of choice for ASD is trauma-focused cognitive behavior therapy, and this intervention results in reduced chronic PTSD severity. Recent attempts to limit subsequent PTSD by early provision of pharmacological interventions have been promising, especially administration of corticosterone to modulate glucocorticoid levels. Although the ASD diagnosis does not accurately predict chronic PTSD, it describes recently trauma-exposed people with severe distress. Provision of CBT in the acute phase is the best available strategy to limit subsequent PTSD.


Assuntos
Transtornos de Estresse Traumático Agudo , Terapia Cognitivo-Comportamental , Humanos , Estudos Longitudinais , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Traumático Agudo/complicações , Transtornos de Estresse Traumático Agudo/diagnóstico , Transtornos de Estresse Traumático Agudo/psicologia , Transtornos de Estresse Traumático Agudo/terapia
13.
J Affect Disord ; 241: 15-21, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30089232

RESUMO

BACKGROUND: Victims of violent crime are at elevated risk of developing acute stress disorder (ASD) as well as subsequent post-traumatic stress disorder (PTSD), both of which are linked to severe psychological distress. The aim of this 12-month prospective study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) vs. cognitive-behavioral therapy with a significant other (CBT-SO), relative to usual care (UC), for the improvement of post-traumatic, depression and anxiety symptoms and the prevention of PTSD among victims of violent crime with ASD. METHODS: A total of 166 victims of violent crime with ASD were assigned to CBT (n = 54), CBT-SO (n = 52) or UC (n = 60). Self-report assessments and diagnostic interviews were completed at pre-treatment and post-treatment as well as at 6-month and 12-month follow-ups. RESULTS: CBT and CBT-SO participants had fewer depression symptoms than those in the UC group up to 12 months post-event. Significantly fewer participants in the CBT condition met criteria for PTSD than in the UC group up to 12 months post-event. The CBT group did not differ from the CBT-SO group on any variable at any assessment time. LIMITATIONS: Findings must be interpreted in light of the quasi-experimental nature of the study and limitations concerning the management of missing data. CONCLUSIONS: Further research is warranted in order to assess whether more extensive involvement of a significant other in therapy may lead to better outcomes for victims of violent crime with ASD.


Assuntos
Terapia Cognitivo-Comportamental , Vítimas de Crime , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Traumático Agudo/terapia , Adolescente , Adulto , Crime , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Psicoterapia de Grupo , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Traumático Agudo/psicologia
14.
Psychiatry Res ; 267: 461-466, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29980125

RESUMO

Identifying pathways through which environmental risk factors influence PTSD is important for understanding PTSD etiology. Here, we hypothesized that the physical proximity to threat influences PTSD risk by increasing ASD following trauma. One hundred six bank employees who had experienced a bank robbery participated in the study. A longitudinal design assessing ASD at day 2 and PTSD at day 30 was used to test the hypothesis. Participants also indicated their location in the bank at the time of the robbery. ASD was identified in 40 (38%) and PTSD in 16 (15%) of the robbery victims. Distance to the robber had a strong effect on ASD (OR 3.51, 95% CI 1.94-6.34) and a somewhat lesser effect on PTSD (OR 2.15, 95% CI 1.04-4.46), indicating that the effect of proximity to threat on PTSD 1 month following trauma could be mediated by its effect on ASD 2 days following trauma. Using structural equation modeling, we confirmed that the effect of distance on PTSD was fully mediated by ASD. These findings suggest that proximity to threat may increase PTSD risk by enhancing the acute stress response following trauma.


Assuntos
Vítimas de Crime/psicologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Traumático Agudo/etiologia , Roubo/psicologia , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Adulto Jovem
15.
Psychooncology ; 27(10): 2310-2316, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29980165

RESUMO

The human dimensions of medical care were highlighted by such pioneering figures as Cicely Saunders, Elizabeth Kubler-Ross, and Jimmie Holland and their tireless advocacy helped to build an evidence base for psychosocial and palliative interventions. In that spirit, we studied physical and psychological distress in advanced cancer and modeled pathways to distress in this population. We considered acute stress disorder as the prototype for psychological disturbances following the acute onset of life-threatening disorders, showing that it occurred in one-third of patients after the diagnosis of acute leukemia. To treat and prevent these symptoms, we developed Emotion and Symptom-focused Engagement (EASE), an integrated psychotherapeutic and early palliative intervention. We showed that EASE reduced both traumatic stress and physical suffering in these patients and a large multi-center trial is now underway. We also identified symptoms of depression and hopelessness n one quarter of patients with metastatic and advanced cancer, with worsening toward the end of life. To alleviate this distress, we developed a brief supportive-expressive therapy, referred to as Managing Cancer and Living Meaningfully (CALM). We showed in a large RCT that CALM improves depression, distress related to dying and death, and preparation for the end of life. We have now launched a global initiative involving 20 sites to date across North and South America, Europe, Australia, and Asia to have CALM implemented routinely in cancer care. Such initiatives are needed to move psychosocial care in cancer from evidence to implementation and to fulfill the dream of Jimmie Holland that cancer care be as humanistic as it is effective.


Assuntos
Depressão/terapia , Emoções , Neoplasias/terapia , Dor/psicologia , Psico-Oncologia , Psicoterapia/métodos , Transtornos de Estresse Traumático Agudo/terapia , Adulto , Afeto , Austrália , Depressão/complicações , Europa (Continente) , Humanos , Masculino , Neoplasias/complicações , Neoplasias/psicologia , Países Baixos , Manejo da Dor , Qualidade de Vida/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Estresse Psicológico/etiologia
16.
Medicine (Baltimore) ; 97(22): e10880, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29851807

RESUMO

Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) may occur after traumatic event and also cause significant life time impairment. P300 event-related potential (ERP) is a potential biological marker for PTSD and can reflect cognitive impairment in information processing and attention. Despite the usefulness of ERP, there are few attempts to reveal relationships between ASD and P300. In the present study, we aimed to determine if the P300 of the patients who were the victims of sexual abuse reflected the quantitative trait of ASD or if P300 is applicable as a state marker for predicting the risk of PTSD.Fifteen female victims of sexual abuse diagnosed with ASD and 18 healthy controls (HCs) without trauma exposure participated in this study. We investigated the P300 ERPs in patients with ASD to compare them with those of HCs. ERPs were acquired from female adults during an auditory oddball task. Between-group differences in amplitudes or latencies of P300 were investigated using repeated-measures analysis of variance.The ASD groups showed reduced P300 amplitudes at the midline centroparietal site as well as reduced accuracy rates during an auditory oddball task compared with the HCs.These results indicate that ASD have abnormalities in the P300 compared to those in HCs. Moreover, the reduction in P300 could be considered a candidate neurophysiological marker for ASD.


Assuntos
Disfunção Cognitiva/psicologia , Potencial Evocado P300/fisiologia , Delitos Sexuais/psicologia , Transtornos de Estresse Traumático Agudo/fisiopatologia , Transtornos de Estresse Traumático Agudo/psicologia , Adulto , Percepção Auditiva/fisiologia , Biomarcadores/análise , Estudos de Casos e Controles , Eletroencefalografia , Feminino , Humanos , Estudos Prospectivos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Análise e Desempenho de Tarefas , Adulto Jovem
17.
Addict Behav ; 85: 120-124, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29902682

RESUMO

INTRODUCTION: Sexual assault (SA) is common, and recent sexual assault is associated with suicidal ideation and prescription opioid (PO) use. PO use is also associated with increased risk of suicidal ideation. The current study examined suicidal ideation among adults seeking medical and psychological follow-up care after a SA medical forensic examination based on PO use and prior SA. METHODS: Adults (n = 60) who received a SA medical forensic exam at the emergency room within 120 h of a SA were invited to receive medical and psychological follow-up care, which included a questionnaire about current mental health symptoms. RESULTS: Results from a linear regression model revealed that more acute stress symptoms were associated with higher suicidal ideation. Further, there was a significant association between PO use and suicidal ideation among those with a prior SA such that those with a prior SA and who used POs reported more severe suicidal ideation than those with a prior SA who did not use POs. CONCLUSIONS: Routine screening at the emergency department for PO use and prior SA may help prevention efforts for suicide among adults who recently experienced SA.


Assuntos
Analgésicos Opioides/uso terapêutico , Depressão/psicologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Delitos Sexuais/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Ideação Suicida , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Modelos Lineares , Programas de Rastreamento , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Questionário de Saúde do Paciente , Adulto Jovem
18.
Gen Hosp Psychiatry ; 53: 119-124, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29789141

RESUMO

OBJECTIVE: Prior posttraumatic stress disorder (PTSD) and elevated threat perceptions predict posttraumatic psychopathology after evaluation for acute coronary syndrome (ACS), but most research has measured threat retrospectively. We investigated how threat perceptions during ACS evaluation in the emergency department (ED) and upon recall were associated with posttraumatic psychopathology burden due to prior trauma and the suspected ACS. METHODS: Perceived threat was assessed in the ED, and ED threat recall was assessed upon inpatient transfer/discharge, along with acute stress disorder (ASD) symptoms due to suspected ACS and PTSD symptoms due to prior trauma. The sample comprised 894 participants (mean age = 60.7 ±â€¯13.1 years; 46.8% female; 56.3% Hispanic; 20.5% Black). One-way ANOVAs examined how those with consistent posttraumatic psychopathology (prior PTSD/ASD; 14.8%), prior posttraumatic psychopathology (prior PTSD/no ASD; 6.8%), new-onset posttraumatic psychopathology (no PTSD/ASD; 15.7%), or no posttraumatic psychopathology (no PTSD/no ASD; 62.8%) differed in threat perception, threat recall, and their discrepancy. RESULTS: Threat perception scores ranged from 6 to 24. Participants with consistent posttraumatic psychopathology had higher threat perceptions (M = 14.01) than those with prior posttraumatic psychopathology (M = 12.02) and new-onset posttraumatic psychopathology (M = 12.21) (ps ≤ 0.001); the latter two did not differ significantly but had higher threat perceptions than those with no posttraumatic psychopathology (M = 9.84) (p < .001). Similar results were observed for threat recall (p < .001). The new-onset posttraumatic psychopathology group also had a greater increase in perceived threat versus the no posttraumatic psychopathology group (p = .06). Results were similar adjusting for potential confounders. CONCLUSIONS: Assessing threat perceptions during ACS evaluation and hospitalization may help identify those at risk for emotional difficulties post-ACS.


Assuntos
Síndrome Coronariana Aguda/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Síndrome Coronariana Aguda/epidemiologia , Idoso , Estudos de Coortes , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Traumático Agudo/diagnóstico , Transtornos de Estresse Traumático Agudo/epidemiologia
19.
J Affect Disord ; 235: 467-473, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29679899

RESUMO

BACKGROUND: The birth of a preterm infant can be stressful and traumatic for parents and may cause posttraumatic stress symptoms and disorders. There is a dearth of data from controlled studies regarding level, prevalence, risk, and predictors of these symptoms in parents after preterm birth. METHODS: As part of the longitudinal HaFEn-study, data from parents of infants with very low birth weight (VLBW), and term infants were cross-sectionally analyzed. We recruited parents at the three largest perinatal care centers in Hamburg, Germany. Posttraumatic stress symptoms were assessed with a standardized questionnaire, and acute and posttraumatic stress disorders with a clinical interview one month postpartum. Stress during birth, lifetime psychiatric diagnoses, social support, pregnancy risks, and mode of delivery were also evaluated. To examine predictors of posttraumatic stress symptoms in both parents simultaneously, we constructed multiple random coefficient models. RESULTS: 230 mothers and 173 fathers were included. The risk for acute stress disorder was increased in mothers with VLBW infants but not in fathers. While the risk for posttraumatic stress disorder was not elevated, the level of posttraumatic stress symptoms was higher in both parents with VLBW infants. Predictors for posttraumatic stress symptoms were stress during birth, low social support, psychiatric lifetime diagnoses, the birth of a VLBW infant, and female parent sex. LIMITATIONS: Results reported here are cross-sectional. Thus, no temporal relationships can be established. CONCLUSIONS: Although posttraumatic stress disorders were rare, our results suggest that posttraumatic stress symptoms and acute stress disorders are common in parents of VLBW infants.


Assuntos
Pai/psicologia , Recém-Nascido de muito Baixo Peso/psicologia , Mães/psicologia , Período Pós-Parto/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Alemanha , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Parto , Gravidez , Nascimento Prematuro , Prevalência , Estudos Prospectivos , Apoio Social , Inquéritos e Questionários
20.
J Anxiety Disord ; 55: 8-13, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29549879

RESUMO

Peritraumatic distress is defined as the emotional and physiological distress experienced during and/or immediately after a traumatic event and is associated with the development and severity of posttraumatic stress disorder (PTSD) and related psychological difficulties. The Peritraumatic Distress Inventory (PDI) is a widely-used self-report measure for which psychometric evaluation has been limited. This study sought to assess the factor structure and predictive validity of the PDI with a clinical sample of 600 traumatically injured patients admitted to a Level I trauma center, 271 of whom completed a phone-based PTSD screening ∼30-days post-injury. The results confirmed previously proposed one- and two-factor solutions for the PDI. PDI scores predicted PTSD severity and positive PTSD screens (i.e., clinically elevated vs. non-elevated). Data suggested an optimal cutoff score of 23 (sensitivity = 71%; specificity = 73%) for predicting clinically elevated PTSD 30-days post-injury. This study provides further evidence supporting the PDI as a valid and reliable measure of peritraumatic distress and a useful clinical tool with significant prognostic value.


Assuntos
Hospitalização , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Traumático Agudo/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Psicometria , Sensibilidade e Especificidade , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Centros de Traumatologia , Adulto Jovem
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