Relationship satisfaction among spouse caregivers of service members and veterans with comorbid mild traumatic brain injury and post-traumatic stress disorder.

This study examined relationship satisfaction and health-related quality of life (HRQOL) among spouse caregivers assisting service members and veterans (SMV) with comorbid uncomplicated mild traumatic brain injury (MTBI) and post-traumatic stress disorder (PTSD). Spouse caregivers (N = 205) completed the Couples Satisfaction Index (CSI), 12 HRQOL measures, and the Mayo-Portland Adaptability Inventory 4th Edition (MPAI-4). T-scores were classified as "clinically elevated" using a cutoff of ≥60T. The sample was also classified into "Satisfied" (≥13.5, n = 113, 55.0%) or "Dissatisfied" (<13.5, n = 92, 44.0%) relationship categories. Using stepwise regression analysis, Anxiety, Family Disruption, Vigilance, Emotional Support, Feeling Trapped, and MPAI-4 Adjustment were identified as the strongest predictors of CSI total scores (p < 0.001), accounting for 41.6% of the variance. Squared semi-partial correlations revealed that 18.1% of the variance was shared across all six measures, with 7.8% to 1.5% of unique variance accounted for by each measure separately. When comparing the number of clinically elevated measures simultaneously, the Dissatisfied group consistently had a higher number of clinically elevated scores compared to the Satisfied group (e.g., 3-or-more clinically elevated scores: Dissatisfied = 40.2%, Satisfied = 8.8%, OR = 6.93, H = 0.76). Caring for a SMV with comorbid TBI and PTSD can have a profound impact on the spouse caregiver's HRQOL, relationship satisfaction, and family functioning. The findings from the current study continue to support the need for family involvement in the SMV's treatment plan, but more effort is needed to integrate behavioral health treatment that focuses on the family member's own issues into military TBI and PTSD systems of care.

En este estudio se analizó la satisfacción con la relación y la calidad de vida relacionada con la salud entre cónyuges cuidadores que asisten a miembros del servicio militar y veteranos con lesión cerebral traumática leve sin complicaciones concomitante con trastorno por estrés postraumático. Los cónyuges cuidadores (N=205) completaron el Índice de satisfacción de las parejas (Couples Satisfaction Index, CSI), la Encuesta de 12 ítems sobre la calidad de vida relacionada con la salud (12 HRQQL) y la Encuesta de Adaptabilidad Mayo-Portland 4.ª edición (Mayo-Portland Adaptability Inventory 4th Edition, MPAI-4). Los puntajes T se clasificaron en "clínicamente elevados" usando un valor de corte de ≥60T. La muestra también se clasificó en categorías de relaciones "satisfechas" (>13.5, n=113, 55.0%) o "insatisfechas" (<13.5, n=92, 44.0%). Utilizando un análisis de regresión paso a paso, se identificaron la ansiedad, la interrupción familiar, la vigilancia, el apoyo emocional, la sensación de estar atrapado y la adaptación de la MPAI-4 como los factores pronósticos más fuertes de los puntajes totales del CSI (p<.001), que representaron el 41.6% de la varianza. Las correlaciones semiparciales al cuadrado revelaron que el 18.1% de la varianza se compartió entre las seis medidas, con una varianza única de 7.8% a 1.5% representada por cada medida separadamente. Cuando se comparó el número de medidas clínicamente elevadas de manera simultánea, el grupo insatisfecho tuvo sistemáticamente un número más alto de puntajes clínicamente elevados en comparación con el grupo satisfecho (p. ej.: 3 o más puntajes clínicamente elevados: insatisfecho=40.2%, satisfecho=8.8%, OR=6.93, H=.76). cuidar a un miembro del servicio militar o a un veterano con lesión cerebral traumática leve y trastorno por estrés postraumático concomitantes puede afectar enormemente la calidad de vida relacionada con la salud del cónyuge cuidador, la satisfacción con la relación y el funcionamiento familiar. Los resultados del presente estudio continúan respaldando la necesidad de la participación familiar en el plan de tratamiento del miembro del servicio militar o veterano, pero se necesita más esfuerzo para integrar un tratamiento de salud conductual que se centre en los problemas propios del familiar en los sistemas de atención de militares con lesión cerebral traumática leve y trastorno por estrés postraumático.

Associations of Army Fathers' PTSD Symptoms and Child Functioning: Within- and Between-Family Effects.

This study examined the within-family and between-family associations between fathers' military-related PTSD symptoms and parent ratings of children's behavioral and emotional problems. The sample included married couples (N = 419) with children composed of a civilian wife and an active-duty husband serving in the U.S. Army. Results indicate that changes in fathers' PTSD symptoms over time were associated with corresponding changes in both mothers' and fathers' reports of child behavioral and emotional problems. These within-family findings were independent from between-family effects, which showed that higher average PTSD symptomatology was associated with more overall behavioral and emotional problems for children. This study uses advances in statistical methodologies to increase knowledge about how PTSD symptoms and child problems are related, both across different families and over time within families.

Psychological interventions for post-traumatic stress disorder in people living with HIV in Resource poor settings: a systematic review.

OBJECTIVE: Post-traumatic stress disorder is pervasive in low- and middle-income countries. There is evidence to suggest that post-traumatic stress disorder is more common among people living with HIV than non-infected matched controls. We carried out a systematic review of interventions for adult post-traumatic stress disorder from resource poor settings with a focus on people living with HIV. METHODS: We included all studies that investigated interventions for adult post-traumatic stress disorder from resource poor settings with a focus on interventions that were either randomised controlled trials or observational cohort studies carried out from 1980 to May 2015. RESULTS: Of the 25 articles that were identified for full review, two independent reviewers identified seven studies that met our study inclusion criteria. All randomised controlled trials (RCT) (n = 6) used cognitive behavioural therapy-based interventions and focused on people living with HIV in resource poor settings. There was only one study focusing on the use of lay counsellors to address post-traumatic stress disorder but core competencies were not described. There were no intervention studies from Africa, only an observational cohort study from Rwanda. CONCLUSION: Rigorously evaluated interventions for adult post-traumatic stress disorder in people living with HIV are rare. Most were undertaken in resource poor settings located in high-income countries. There is a need for research on the development and implementation of appropriate interventions for post-traumatic stress disorder in people living with HIV in low- and middle-income countries.

Medicolegal assessment of human trafficking victims. Descriptive study of a series of forensic cases in Catalonia (Spain). / Valoración médico-legal de las víctimas de trata de seres humanos. Estudio descriptivo de una serie de casos forenses en Cataluña (España).

BACKGROUND AND OBJECTIVE: Human trafficking or contemporary slavery is the recruitment and transfer of people by force or deception for sexual, labour or other types of exploitation. Although the violence, abuse and deprivation that trafficking entails are a threat to the health of its victims, in Spain the clinical or forensic data available in this regard is scarce. At the Institute of Legal Medicine and Forensic Sciences of Catalonia (IMLCFC), a unit specialized in the forensic assessment of these victims was created. The objective of this work was to describe a series of forensic cases of trafficking victims. MATERIAL AND METHOD: Retrospective study of victims in judicial cases opened for an alleged crime of human trafficking registered in the IMLCFC until 06/30/2023. RESULTS: 57 different victims were registered. The majority were women (71.9%). The average age was 30.5 years (s.d. 10.31). All the victims were foreigners, mostly from Latin America (45.5%). The exploitation was mainly sexual (61.4%). There were some sociodemographic differences and in the conditions and consequences of trafficking between victims of sexual exploitation and the rest. Mental health problems were very common in all victims at the time of the assessment (87.5%). CONCLUSIONS: The consequences of trafficking on health, especially mental health, are notable and the forensic assessment of victims is valuable in judicial proceedings. It is necessary to deepen our knowledge of the phenomenon in our environment.

Trauma exposure and psychometric properties of the life events checklist among adults in South Africa.

Background: Trauma exposure is widespread and linked to chronic physical and mental health conditions including posttraumatic stress disorder. However, there are major gaps in our knowledge of trauma exposure in Africa and on the validity of instruments to assess potentially life-threatening trauma exposure.Objective: The Life Events Checklist for the DSM-5 (LEC-5) is a free, widely used questionnaire to assess traumatic events that can be associated with psychopathology. As part of a case-control study on risk factors for psychosis spectrum disorders, we used the LEC-5 to examine the frequency of traumatic events and to assess the questionnaire's factor structure in South Africa (N = 6,765).Method: The prevalence of traumatic events was measured by individual items on the LEC-5 across the study sample, by case-control status, and by sex. Cumulative trauma burden was calculated by grouping items into 0, 1, 2, 3, and ≥4 traumatic event types. Psychometric properties of the LEC-5 were assessed through exploratory and confirmatory factor analyses.Results: More than 92% of the study sample reported experiencing ≥1 traumatic event; 38.7% reported experiencing ≥4 traumatic event types. The most endorsed item was physical assault (65.0%), followed by assault with a weapon (50.2%). Almost 94% of cases reported ≥1 traumatic event compared to 90.5% of controls (p < .001) and 94% of male participants reported ≥1 traumatic event compared to 89.5% of female participants (p < .001). Exploratory factor analysis revealed a 6-factor model. Confirmatory factor analyses of three models found that a 7-factor model based on the South African Stress and Health survey was the best fit (standardized root mean square residual of 0.024, root mean square error of approximation of 0.029, comparative fit index of 0.910).Conclusion: Participants reported very high exposure to traumatic events. The LEC-5 has good psychometric priorities and is adequate for capturing trauma exposure in South Africa.

Trauma exposure was extremely prevalent in this South African sample, with less than 8% of participants reporting zero exposure to traumatic events.This was the first time the factor structure of the LEC-5 was assessed in South Africa.A confirmatory factor analysis using a 7-factor model based on a previous study of trauma exposure, the South African Stress and Health study (SASH), was the best fit for the LEC-5.

Effects of oral contraceptives on intrusive memories: a secondary analysis of two studies using the trauma film paradigm in healthy women.

Background: Women are more likely to develop post-traumatic stress disorder (PTSD) than men. Recent research suggests an impact of oral contraceptive (OC) intake on PTSD and intrusive memories, a hallmark symptom of PTSD. Although a majority of women use OCs at some point in their lives, the effects on PTSD pathogenesis are only poorly understood.Objective: In the current paper, we aimed to investigate the impact of OC intake on the acquisition and consolidation of intrusive memories in healthy women after watching a trauma film paradigm.Methods: We performed a secondary analysis of a pooled dataset (N = 437) of two previously conducted and published studies investigating the effect of oxytocin on the development of intrusive memories.Results: Women taking OCs showed an attenuated decline of intrusive memories over time after having watched the trauma film compared to naturally cycling women (F(2.75, 1167) = 3.79, p = .03, ηp2 = .01).Conclusion: These findings indicate that the intake of OCs is associated with the development of intrusive memories after a trauma film paradigm. This indication emphasizes the need to further investigate the complex impact of OCs and gonadal hormones on fear learning processes and PTSD.

The objective of the current study was to analyze the effect of oral contraceptives on the development of intrusive memories after a trauma film paradigm by conducting a secondary analysis of previously published data.Women taking oral contraceptives show an attenuated decline of intrusive memories after watching a trauma film paradigm compared to naturally cycling women in the luteal phase.Women using oral contraceptives show higher basal saliva cortisol levels.

Investigating the frequency of intrusive memories after 24 hours using a visuospatial interference intervention: a follow-up and extension.

Background: There is a need for effective, low-cost, readily available measures for reducing trauma symptoms so that people exposed to potentially traumatic events can receive help more quickly. A previous study reported that performing an intervention including a visuospatial task shortly after a reminder of a series of unpleasant film clips seen 24 hours earlier reduced the number of intrusive memories over the following week. Objective: This study reports a follow-up and extension of the earlier promising finding. The prediction was that participants performing the visuospatial task immediately after the reminder would report fewer intrusions compared to three other groups who 1) performed no task, and novel conditions who 2) performed the task before the reminder, and 3) performed the task 90 minutes after the reminder. Method: A trauma-analogue method was used, where students (N = 200) watched a series of short films with unpleasant material. Over the following week, they were asked to write down any intrusive memories they experienced in a diary. On the second day they returned to the lab and saw static reminders of the films. They were then randomly allocated to condition, recorded intrusive memories over the following days and returned to the lab for final testing on Day 8. Results: A total of 49 participants did not report any intrusions and were excluded from the analyses. Two more participants were excluded as outliers, leaving a final sample of n = 149. Despite using largely the same materials as the original study there were no significant differences in the number of intrusive memories between the four groups post intervention. Conclusions: Possible explanations include the effect not being as robust as expected, a low number of intrusions across groups, baseline differences in attention, and minor but potentially important differences in procedure between this and the original study.

Antecedentes: Existe la necesidad de medidas efectivas de bajo costo y fácilmente disponibles para reducir los síntomas del trauma, de modo que las personas expuestas a eventos potencialmente traumáticos puedan recibir ayuda más rápidamente. James y cols. (2015) reportaron que realizar una intervención que incluye una tarea viso-espacial poco después de un recordatorio consistente en una serie de clips de películas desagradables vistos 24 horas antes, redujo el número de recuerdos intrusivos durante la semana siguiente.Objetivo: Este estudio reporta un seguimiento y extensión del prometedor hallazgo de James y cols. La predicción fue que los participantes que realizaran la tarea viso-espacial inmediatamente después del recordatorio reportarían menos intrusiones en comparación con otros tres grupos que: 1) no realizaron ninguna tarea, y en condiciones novedosas que 2) realizaron la tarea antes del recordatorio y 3) realizaron la tarea 90 minutos después del recordatorio.Método: Se utilizó un método analógico de trauma, donde los estudiantes (N = 200) vieron una serie de cortometrajes con material desagradable. Durante la semana siguiente, se les pidió que escribieran cualquier recuerdo intrusivo que experimentaran en un diario. El segundo día regresaron al laboratorio y vieron recordatorios estáticos de las películas. Luego fueron asignados aleatoriamente a la condición, registraron recuerdos intrusivos durante los días siguientes y regresaron al laboratorio para la prueba final el día 8.Resultados: Un total de 49 participantes no reportó ninguna intrusión y fueron excluidos de los análisis. Se excluyeron dos participantes adicionales como valores atípicos, dejando una muestra final de n = 149. A pesar de utilizar en gran parte los mismos materiales que el estudio original, no hubo diferencias significativas en el número de recuerdos intrusivos entre los cuatro grupos después de la intervención.Conclusiones: Las posibles explicaciones incluyen que el efecto no es tan robusto como se esperaba, un número bajo de intrusiones entre los grupos, diferencias basales de atención y diferencias menores pero potencialmente importantes en el procedimiento entre éste y el estudio original.

Genetic Advances in Post-traumatic Stress Disorder. / Avances genéticos en el trastorno por estrés postraumático.

Post-traumatic stress disorder, or PTSD, is a condition that affects a subgroup of individuals that have suffered a previous traumatic event capable of generating changes at a psychological and behavioural level. These changes affect the personal, family, and social environment of those who suffer from this condition. Different genes have been identified as risk markers for development of this disorder. The population heterogeneity and individual differences (genetic and environmental) of each subject have made it difficult to identify valid markers in previous studies. For this reason, studies of Gene x Environment (G×E) have gathered importance in the last two decades, with the aim of identifying of the phenotypes of a particular disease. These studies have included genes such as SLC64A, FKBP5, and ADCYAP1R1, among others. Little is known about the interaction between the genes, pathways, and the molecular and neural circuitry that underlie PTSD. However their identification and association with stimuli and specific environments that stimulate the development of PTSD makes it focus of interest for identify genomic variations in this disorder. In turn, the epigenetic modifications that regulate the expression of genes involved in the hypothalamic-pituitary-adrenal (HPA) axis and the amygdala- hippocampal-medial prefrontal cortex circuits play a role in the identification of biomarkers and endophenotypes in PTSD. In this review, the advances in genetic and epigenetic that have occurred in the genomic era in PTSD are presented.

25 years of Eye Movement Desensitization and Reprocessing (EMDR): The EMDR therapy protocol, hypotheses of its mechanism of action and a systematic review of its efficacy in the treatment of post-traumatic stress disorder. / 25 años de Eye Movement Desensitization and Reprocessing: protocolo de aplicación, hipótesis de funcionamiento y revisión sistemática de su eficacia en el trastorno por estrés postraumático.

Eye movement desensitization and reprocessing (EMDR) is a relatively new psychotherapy that has gradually gained popularity for the treatment of post-traumatic stress disorder. In the present work, the standardised EMDR protocol is introduced, along with current hypotheses of its mechanism of action, as well as a critical review of the available literature on its clinical effectiveness in adult post-traumatic stress disorder. A systematic review of the published literature was performed using PubMed and PsycINFO databases with the keywords «eye movement desensitization and reprocessing¼ and «post-traumatic stress disorder¼ and its abbreviations «EMDR¼ and «PTSD¼. Fifteen randomised controlled trials of good methodological quality were selected. These studies compared EMDR with unspecific interventions, waiting lists, or specific therapies. Overall, the results of these studies suggest that EMDR is a useful, evidence-based tool for the treatment of post-traumatic stress disorder, in line with recent recommendations from different international health organisations.

Trastorno por Estrés Postraumático Complejo y Trastorno Límite de la Personalidad: El Debate Continúa. Propuesta de Diagnóstico Diferencial / Complex Posttraumatic Stress Disorder and Borderline Personality Disorder: The Debate Continues. Differential Diagnosis Proposal

Tras la inclusión en la CIE-11 del diagnóstico de trastorno por estrés postraumático complejo (TEPTc) en 2020, se han sucedido las publicaciones que debaten sobre la pertinencia o no de tal entidad y sobre su distinción del trastorno límite de la personalidad (TLP). En el presente artículo de reflexión se persigue: 1. conocer si el TEPTc y el TLP son entidades distintas; 2. conocer el estado de la cuestión respecto a este tema; y 3. proponer un diagnóstico diferencial que ayude a su discriminación. Para dar cuenta de las dos primeras cuestiones, se ha realizado una revisión bibliográfica (no sistemática) de tipo cualitativo entre los años 2020 y 2022 (tiempo de vigencia del TEPTc en la CIE-11). En función de la información teórica y empírica hallada, y cumpliendo con el tercer objetivo, se propone un diagnóstico diferencial con el fin de arrojar luz a la distinción nosológica entre ambos constructos.(AU)

Following the inclusion in the ICD-11 of the diagnosis of complex post-traumatic stress disorder (cPTSD) in 2020, there has been a succession of publications debating the relevance or not of this entity and regarding its distinction from borderline personality disorder (BPD). The present reflection article aims to: 1. to understand whether c-PTSD and BPD are different entities; 2. to understand the state of the art regarding this issue; and 3. to propose a differential diagnosis that will help to distinguish between the two. To account for the first two questions, a qualitative (non-systematic) literature review was carried out between 2020 and 2022 (the period of validity of cPTSD in the ICD-11). Based on the theoretical and empirical information found, and achieving the third objective, a differential diagnosis is proposed in order to shed light on the nosological distinction between the two constructs.(AU)

Post-traumatic Stress Disorder after the first wave of the Pandemic in Hospitalized COVID-19 Patients and Health Professionals in a Front-line Spanish Tertiary Hospital: a retrospective observational study / Trastorno por estrés postraumático tras la primera ola de la pandemia en pacientes hospitalizados por COVID-19 y profesionales sanitarios de primera línea en un hospital terciario español: un estudio observacional retrospectivo

The COVID-19 pandemic had a serious impact on mental health, associated with Post Traumatic Stress Disorder (PTSD) after infection and within healthcare professionals. We propose to compare the semiology, evolution and trauma-associated variables between both groups in a sample of patients. An observational retrospective study was performed, including 42 hospitalized COVID-19 patients and 31 health professionals, treated at the Mental Health Service of the Hospital 12 de Octubre, between June 2020/21, with a diagnosis of PTSD. Mental state evaluation was performed through a standard clinical interview. Additionally, the 8-item treatment-outcome post-traumatic stress disorder scale (TOP-8) was administered. Demographic data, variables related to hospital stay and pre/peri/post-trauma variables considered of interest were collected. All analyses were performed using the Stata 16 program. Health professionals showed higher levels of recovery, however no significant differences were found in the initial severity of the PTSD. Regarding the symptom pattern it was similar between both groups, except that professionals presented more dissociation during the traumatic event. In general, the subjects presented mainly intrusive symptoms, hyperarousal and sleep-related difficulties. Having witnessed suffering or death, and the gypsy ethnic group, were the variables with the greatest impact in the PTSD severity. These results suggest that the COVID-19 leaves important psychological sequelae such as PTSD, both in infection survivors and in health professionals. Differences found could be due to dissimilarities in coping resources and therapeutic adherence styles. We consider that knowing the variables involved can help improve intervention in these vulnerable groups.(AU)

La pandemia por COVID-19 ha tenido grave impacto sobre la salud mental, asociándose con Trastorno por estrés postraumático (TEPT) tras la infección y en profesionales sanitarios. Nos proponemos comparar la semiología, evolución y variables asociadas al trauma entre ambos grupos en una muestra de pacientes. Se realizó un estudio observacional retrospectivo, incluyendo 42 pacientes hospitalizados por COVID-19 y 31 profesionales sanitarios, tratados en el Servicio de Psiquiatría del Hospital 12 de Octubre, entre junio 2020/21, con diagnóstico de TEPT. Se realizó entrevista clínica estándar. Adicionalmente, se pasó la Escala de 8 ítems para los resultados del tratamiento del TEPT (TOP-8). Se recogieron datos demográficos, variables relacionadas con la estancia hospitalaria y variables pre/peri/post-trauma. Se analizaron los datos usando el programa Stata 16. Los profesionales sanitarios mostraron mayores niveles de recuperación, sin embargo, no hubo diferencias significativas en la severidad inicial del TEPT. El patrón sintomático fue similar entre ambos grupos, excepto que los profesionales presentaron más disociación durante el evento traumático. Todos presentaron principalmente síntomas intrusivos, hiperactivación y dificultades de sueño. Haber presenciado sufrimiento o muerte, y la etnia gitana, fueron las variables con mayor impacto en la severidad del TEPT. Estos resultados sugieren que la COVID-19 deja importantes secuelas psicológicas como el TEPT, tanto en supervivientes de la infección como en profesionales sanitarios. Las diferencias encontradas podrían ser debidas a disimilitudes en recursos de afrontamiento y estilos de adherencia terapéutica. Consideramos que conocer las variables involucradas puede ayudar a mejorar la intervención en estos grupos vulnerables.(AU)

Overlap of obsessive and posttraumatic symptoms: A systematic review / Superposición de síntomas obsesivos y postraumáticos: Una revisión sistemática

Abstract Background Current medical literature suggests a symptomatic overlap between posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), which makes understanding their impact on the treatment process a challenging undertaking. Objective The key aim of this work was to deliver a comprehensive overview of empirical and observational studies concerning the overlap between both psychopathologies. Method Two independent authors searched PubMed, PsycINFO, and Web of Science databases between April and July 2020 utilizing relevant MeSH terms. Subsequently, a systematic scoping review was undertaken according to the PRISMA-ScR Statement to identify all relevant publications concerning the overlap of OCD and PTSD symptomatology. We included peer reviewed studies published in any language that contributed quantitative or qualitative data that addressed the relationship between OCD and PTSD symptoms as the main aim or outcome of the study. Non-peer-reviewed articles, studies that did not address this phenomenon of interest, and gray literature documents were excluded. This review was not registered into the International Prospective Register of Systematic Reviews, since, according to the National Institute of Health Research, scoping reviews are ineligible for registration into PROSPERO. Results Twenty-five relevant studies were included (11 cross-sectional studies, 5 longitudinal-prospective studies, 4 case series, 4 case studies and 1 retrospective study). We did not conduct any statistical analysis due to the diversity of the included studies, thus proceeding to realize a thematic synthesis of the obtained data. Discussion and conclusion A symptomatic overlap exists between both comorbidities in some clinical populations, and this relationship may hamper treatment outcomes.

Resumen Antecedentes La literatura médica sugiere la existencia de una superposición sintomática entre el trastorno por estrés postraumático (TEPT) y el trastorno obsesivo-compulsivo (TOC), situación que puede comprometer el tratamiento de esta población clínica. Objetivo El objetivo clave de este trabajo consiste en ofrecer una visión general de estudios empíricos y observacionales sobre la superposición entre ambas psicopatologías. Método Dos autores independientes buscaron en las bases de datos PubMed, PsycINFO y Web of Science entre abril y julio de 2020 utilizando DeCS relevantes. Se realizó una revisión sistemática exploratoria de acuerdo con la Declaración PRISMA-ScR para identificar todas las publicaciones relevantes sobre esta superposición sintomática. Se incluyeron estudios revisados por pares publicados en cualquier idioma que aportaron datos cuantitativos o cualitativos, que abordaron la relación entre los síntomas de TOC y TEPT. Se excluyeron los artículos no revisados por pares, aquellos que no abordaron este fenómeno de interés y la literatura gris. Esta revisión no se registró en el Registro Prospectivo Internacional de Revisiones Sistemáticas, ya que acorde al Instituto Nacional de Investigación en Salud, las revisiones sistemáticas exploratorias no son elegibles para su registro en PROSPERO. Resultados Se incluyeron 25 estudios relevantes (11 estudios transversales, 5 estudios longitudinales-prospectivos, 4 series de casos, 4 estudios de casos y 1 estudio retrospectivo). No se realizó ningún análisis estadístico debido a la diversidad de los estudios incluidos, por lo que se procedió a realizar una síntesis temática. Discusión y conclusión Existe una superposición sintomática entre ambas comorbilidades y esta relación puede obstaculizar el tratamiento.

Signos radiológicos en la neuroimagen de pacientes pediátricos con trastorno por estrés postraumático / Radiological signs in neuroimaging of pediatric patients with posttraumatic stress disorder

RESUMEN Introducción: El trastorno por estrés postraumático afectan la salud mental de los pacientes pediátricos, se considera muy común en estos pacientes. Estudios científicos apoyados en la resonancia magnética han fundamentado una estrecha relación entre el estrés postraumático y cambios estructurales en el cerebro. Se realizó una revisión bibliográfica en el periodo de abril a mayo de 2021, en los recursos disponibles en MEDLINE, SciELO, Pubmed y Elsevier. Del total de consultas se citaron 25 referencias. Objetivo: Describir los signos radiológicos en la neuroimagen de pacientes pediátricos con estrés postraumático. Desarrollo: Los estudios de neuroimagen en niños y adolescentes con trastorno por estrés postraumático se han centrado en estructuras anormales y la funcionalidad de algunas regiones individuales del cerebro; estas implican las regiones cerebrales asociadas con la fisiopatología, ellas son: la corteza prefrontal medial y dorsolateral; la corteza orbitofrontal; ínsula; núcleo lentiforme; amígdala; hipocampo y el parahipocampo; la corteza cingulada anterior y posterior; el precúneo; cúneo; el giro fusiforme y lingual y los tractos de materia blanca que conectan estas regiones cerebrales. Conclusiones: Los signos radiológicos en la neuroimagen de pacientes pediátricos con trastorno por estrés postraumático son: reducción de los volúmenes del hipocampo; del volumen cerebral e intracraneal y del volumen de la amígdala, así como una disminución del área total del cuerpo calloso. Además se observa que el volumen hipofisario y los volúmenes de materia gris cerebral fueron menores en los pacientes con estrés postraumático.

ABSTRACT Introduction: Post-traumatic stress disorder affects the mental health of pediatric patients; it is considered very common in these patients. Scientific studies supported by magnetic resonance imaging have established a close relationship between post-traumatic stress and structural changes in the brain. A bibliographic review was carried out in the period from April to May 2021, in the resources available in MEDLINE, SciELO, Pubmed and Elsevier. Of the total of consultations, 25 references were cited. Objective: To describe the radiological signs in the neuroimaging of pediatric patients with post-traumatic stress disorder. Development: Neuroimaging studies in children and adolescents with post-traumatic stress disorder have focused on abnormal structures and the functionality of some individual brain regions; these involve the brain regions associated with pathophysiology, they are: the medial and dorsolateral prefrontal cortex; the orbitofrontal cortex; insula; lentiform nucleus; amygdala; hippocampus and parahippocampus; the anterior and posterior cingulate cortex; the precuneus; cuneus; the fusiform and lingual gyrus and the white matter tracts that connect these brain regions. Conclusions: The radiological signs in the neuroimaging of pediatric patients with post-traumatic stress disorder are: reduction of the volumes of the hippocampus; brain and intracranial volume and amygdala volume, as well as a decrease in the total area of ​​the corpus callosum. In addition, it is observed that the pituitary volume and the volumes of cerebral gray matter were lower in patients with post-traumatic stress.

Discapacidad militar: revisión de recursos psicosociales en los ejércitos de nuestro entorno / Military disability: review of psychosocial resources in the armies of our environment

El avance legislativo y social respecto a los derechos e igualdad de oportunidades de las personas con discapacidad, no excluye a los contextos militares. Estados Unidos, Francia, Reino Unido o España, han desarrollado instrumentos para garantizar la protección legal, administrativa y económica de los militares con discapacidad, pero los proyectos y programas de recuperación social parecen insuficientes, por lo que este trabajo se centra en el objetivo de revisar los recursos psicosociales disponibles en los ejércitos de nuestro entorno.Los resultados muestran que la mayor parte de los estudios revisados se centran en la recuperación de militares con trastorno de estrés postraumático (TEPT), aunque también se recogen trabajos con lesionados medulares o con daño cerebral. Las temáticas abordadas, con relación al apoyo psicosocial y los recursos disponibles, se enfocan a la empleabilidad, las compensaciones económicas, los tratamientos y los factores que favorecen la integración social. Destacan los estudios sobre: (1) los beneficios aportados por los programas de empleo con apoyo para la salud, la integración social y la autoestima, (2) el uso de perros de servicio, que mejoran la calidad de vida y la producción laboral, y (3) los programas de deporte, que mejoran la autoestima y la calidad de vida, y favorecen el crecimiento postraumático.Como conclusión, se apunta la necesidad de establecer programas de recuperación integral, no solamente sanitaria, sino también psicosocial. Los militares y veteranos con discapacidad deben ser informados y asesorados acerca de los recursos que tienen a su disposición, pero también acompañados en la transición a la vida civil, iniciando proyectos laborales, sociales, deportivos y de ocio, que favorezcan su calidad de vida, su autoestima y su recuperación. (AU)

The legislative and social progress regarding the rights and equal opportunities of people with disabilities does not exclude military contexts. The United States, France, the United Kingdom and Spain have developed instruments to guarantee legal, administrative, and economic protection for military personnel with disabilities, although social recovery projects and programs seem insufficient. Therefore, this bibliographic review focuses on the objective of reviewing the psychosocial resources available in the Armies of our environment.The results show that most of the studies reviewed focus on the recovery of military personnel with post-traumatic stress disorder (PTSD), although there are also studies on spinal cord injury or brain damage. The topics addressed, in relation to psychosocial support and available resources, focus on employability, economic compensation, treatments and factors that favour social integration. Of note are studies on: (1) the benefits brought by supported employment programs, for health, social integration, and self-esteem, (2) the use of service dogs, that improve quality of life and work production, and (3) sports programs, which improve self-esteem and quality of life, and favour post traumatic growth.In conclusion, the need to establish comprehensive recovery programs, not only health, but also psychosocial, is pointed out. Military personnel and veterans with disabilities should be informed and advised about the resources available to them, and accompanied in the transition to civilian life, initiating work, social, sports and leisure projects that favour their quality of life, self-esteem, and recovery. (AU)

Guía de práctica clínica para el tratamiento farmacológico y psicológico de los pacientes adultos con un trastorno de ansiedad y un diagnóstico comórbido de trastorno por uso de sustancias / Clinical practice guideline on pharmacological and psychological management of adult patients with an anxiety disorder and comorbid substance use

Esta revisión resume las intervenciones farmacológicos y psicosociales que han sido llevadas a cabo en trastornos de ansiedad con un diagnóstico comórbido de trastorno por uso de sustancias y además proporciona recomendaciones clínicas respecto de cuáles elementos de intervención son útiles para hacer frente a los síntomas del uso de sustancias y los síntomas de ansiedad en pacientes con estas afecciones concurrentes. Se utilizó la mejor evidencia de ensayos controlados aleatorizados para evaluar las opciones de tratamiento. La fuerza de las recomendaciones se describió mediante el enfoque GRADE. Hay ensayos clínicos disponibles únicamente para el trastorno por estrés postraumático (TEPT) y para el trastorno de ansiedad. En cuanto al diagnóstico comórbido de trastorno por uso de sustancias, todos los estudios han incluido pacientes con consumo de alcohol, ninguno de ellos ha abordado el consumo de cocaína, cannabis o nicotina. Aunque algunos tratamientos han mostrado beneficios para los síntomas de ansiedad sin beneficios para el consumo de alcohol u otras sustancias, solo se han ensayado enfoques farmacológicos limitados (sertralina, desipramina, paroxetina, buspirona, naltrexona y disulfiram).(AU)

This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid anxiety disorders and SUDs while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus anxiety symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Clinical trials are only available for post-traumatic stress disorder (PTSD) and for social anxiety. Concerning the comorbid substance use, all the studies have included patients with alcohol use, none of them have dealt with cocaine, cannabis or nicotine use. Although some treatments have shown benefit for anxiety symptoms without benefits for alcohol or other substance use, only limited pharmacological approaches have been assayed (sertraline, desipramine, paroxetine, buspirone, naltrexone and disulfiram).(AU)

Psicodrama como terapia en trauma y estrés postraumático / Psychodrama as a Therapy in Trauma and Posttraumatic Stress

Resumen Objetivo: Evaluar la evidencia disponible de la eficacia del psicodrama como terapia para el manejo del trauma psicológico, trastorno por estrés agudo y postraumático. Método: Se realizó una búsqueda sistemática de la literatura en MEDLINE, EMBASE, Cochrane Central, Scopus, LILACS y Ovid hasta abril de 2019. Se incluyeron los términos: (1)Psychodrama, (2)Role-playing, (3)Stress disorders, Acute, posttraumatic, y (4)Psychological trauma (MeSH). Se seleccionaron revisiones sistemáticas de la literatura, metaanálisis, ensayos clínicos aleatorios, cuasi aleatorios y estudios observacionales en inglés y español. Se seleccionaron los trabajos que incluyeran una descripción de las intervenciones con técnicas del psicodrama. Resultados: 14 trabajos cumplieron criterios de inclusión. Conclusión: No se encontró una asociación fuerte de la eficacia del psicodrama ante los síntomas de estrés postraumático. Se requieren más investigaciones con diseño metodológico ajustado para este tipo de intervenciones.

Abstract Objective: To evaluate the available evidence in regarding the efficacy of psychodrama in patients with acute and posttraumatic stress disorder and psychological trauma- Methods: Systematic review. Terms: (1)Psychodrama, (2)Role-playing, (3)Stress disorders, Acute, posttraumatic, and (4)Psychological trauma (Mesh), were searched in Pubmed, EMBASE, Cochrane Central, Scopus, Lillacs and OVID, until April 2019. Systematic reviews of the literature, meta-analysis, randomized clinical trials, quasi-randomized and observational studies in English and Spanish were selected. The works should have described interventions with psychodrama techniques. Results: 14 papers met the inclusion criteria. Conclusions: There is no evidence of the psychodrama response to the symptoms after traumatic stress. Research should be carried out with a more rigorous methodological design.

Psicología De Emergencias En España: Análisis Actual, Normativa Y Proposición Reguladora / Psychology Of Emergencies In Spain: Current Analysis, Norms And Regulatory Proposal

La psicología de emergencias en España ha tenido desde finales de los años noventa hasta la actualidad un desarrollo exponencial como nueva disciplina profesional del psicólogo. La demanda de psicólogos por parte de la sociedad en incidentes con múltiples víctimas, desastres, atentados terroristas, accidentes de tráfico, suicidios, etc., ha sido una constante en estos años. Por ello, se ha desarrollado numerosa normativa en la que se contempla la importancia de prestar esta asistencia a las personas afectadas por situaciones que, por su alto impacto, pueden resultar potencialmente traumáticas. En el presente trabajo, se realiza una revisión histórica de la evolución de la psicología de emergencias, la sintomatología más común presentada como consecuencia de estas vivencias, el impacto que ha supuesto a nuestra sociedad estos acontecimientos en cuanto a personas afectadas y la necesidad de prestar asistencia psicológica tanto en situaciones de emergencia cotidiana como en grandes catástrofes. Todo ello, nos lleva a la conclusión de la importancia de trabajar hacia una regulación de la psicología de emergencias que garantice la cualificación formativa de los profesionales de la psicología que van a ejercer esta actividad, así como su incorporación e integración en el sistema público asistencial. (AU)

Emergency psychology in Spain has experienced exponential development as a new professional discipline of the psychologist in the last decades. Society has shown a permanent demand for psychologists in mass casualty incidents, disasters, terrorist attacks, traffic accidents, suicides, etc. Consequently, numerous regulations have been developed regarding assistance in these situations which, due to their high impact, could be potentially traumatic. In the present work we present a historical review of the evolution of emergency psychology, the most common symptoms presented as a consequence of these experiences, the impact that these events have had on society, the people affected, and the necessity to provide psychological assistance, both in everyday emergency situations and in major catastrophes. We highlight the importance of emergency psychology regulation to guarantee the training qualification of the psychology professionals who will carry out this activity, as well as their incorporation and integration in the public healthcare system. (AU)

Psicología De Emergencias En España: Delimitación Conceptual, Ámbitos De Actuación Y Propuesta De Un Sistema Asistencial / Psychology Of Emergencies In Spain: Conceptual Delimitation, Action Areas And Healthcare System Proposal

La psicología de emergencias es un ámbito de aplicación de la psicología bastante reciente, lo que implica que no haya en laactualidad un consenso unificado sobre esta disciplina, su delimitación conceptual o campo de actuación. Tampoco queda reflejada su incursión en los itinerarios curriculares elaborados en nuestro país a partir del Espacio Europeo de Educación Superior,ni en la estructura sanitaria o de protección civil de cara a que los psicólogos de emergencias puedan intervenir en las situaciones de crisis, emergencias o desastres que se producen. Partimos en este trabajo de esta dificultad en la vertebración de este ámbito disciplinar para realizar una propuesta de sistema de asistencia psicológica que contribuya a clarificar la labor ycompetencias de los distintos servicios psicológicos implicados en estas situaciones de manera que facilite un sistema coordinadode actuación. Pretendemos generar un debate profesional y académico que nos lleve a encontrar el consenso necesario que impulse la consolidación de este específico perfil profesional, así como el reconocimiento y regulación de la Psicología de Emergencias que contribuya a afianzarla como disciplina dentro de la Psicología que permita ofrecer a la sociedad una actuaciónprofesional de calidad y adaptada a los retos actuales y futuros. (AU)

Emergency psychology is a recent area of application for psychology, which means that there is currently no unified consensus onthis discipline, its conceptual delimitation, or its field of action. Also not delimited are the curricular itineraries adapted to the European Higher Education Area, in either the health or civil protection structure, in order for emergency psychologists to be able tointervene in crisis situations, emergencies, and disasters. In the present work, we offer a proposal for a system of psychologicalassistance that contributes to clarifying the work and competences of the different psychological services involved in these situations, in a way that facilitates a coordinated system of action. We intend to generate a professional and academic debate to leadus to reach the necessary consensus to make it possible to consolidate this specific professional profile, as well as to recognizeand regulate emergency psychology in order to strengthen it as a discipline of psychology that allows us to offer a professionalperformance of quality, adapted to current and future challenges. (AU)

Trastorno de estrés postraumático en menores internados por maltrato en cinco instituciones ICBF - Pereira / Post-traumatic stress disorder in abused children that are hospitalized in five ICBF institutions in Pereira

Resumen Introducción: El trastorno de estrés postraumático (TEPT) aparece después de la exposición a un evento amenazante e incluye síntomas de evitación e intrusión del recuerdo, hiper-alerta e hiperreactividad , alteraciones negativas cognitivas y alteraciones en el estado de ánimo. Puede aparecer en más del 50% de los niños afectados por desastres de origen natural o humano, como el maltrato, afectando gravemente su calidad de vida presente y futura. Objetivo: Determinar la prevalencia de TEPT en niños internados por maltrato en cinco instituciones de Pereira vinculadas al ICBF. Materiales y métodos: Se construyó, validó y utilizó una escala graduada a partir de los criterios sintomáticos del DSM-5 de TEPT adaptada a población escolar. Se aplicó mediante entrevista personal, previa educación lúdica a los niños sobre los conceptos pertinentes. Resultados y conclusiones: La población de estudio fueron 46 hombres y 47 mujeres institucionalizados en el ICBF, con una media de edad de 11.6 (desviación estándar 2.0) y un tiempo de estadía máximo en el rango inferior de menos de 6 meses con tendencia a la baja y una escolaridad por debajo de lo esperado para la edad . La causa principal de ingreso fue por maltrato intrafamiliar con un 49% , seguido por el abandono o pobreza extrema con un 41%. En cuanto a los criterios para TEPT, el 60 (64.5%) de los menores de edad institucionalizados por vulneración de derechos, cumplían todos los criterios y el 8 (8.6%) cumplían todos menos un criterio sintomático (TEPT subclínico), este alto porcentaje concuerda con la literatura mundial y nacional. Finalmente, el 21.5% no presentaban síntomas y el 5.4% no habían estado expuestos a eventos traumáticos. Los diferentes criterios sintomáticos tenían un nivel similar de intensidad.

Abstract Introduction: Post-traumatic stress disorder (PTSD) appears after being exposed to a threatening event; it includes symptoms of avoidance and intrusion of memories, an increase of arousal and reactivity, and negative alterations in cognitions and mood. It can appear in more than 50% of children affected by disasters caused by nature or human beings, such as abuse; these experiences can seriously affect the children's present and future quality of life. Objective: This descriptive research aims to determine the prevalence of PTSD in hospitalized children for mistreatment in five Pereira institutions linked to the ICBF. Materials and Methods: A graded scale was constructed, validated, and used based on the symptomatic DSM-5 criteria of PTSD and was adapted to the school population. It was applied through a personal interview after giving some playful education about the relevant concepts to the children. Results and conclusions: The standard population was composed of 46 boys and 47 girls that were part of the ICBF. The main range of age was 11.6 (standard deviation 2.0), the maximum stay time in place was the lowest (less than six months) with a decreasing tendency, and a schooling level below to the expected according to the age. The most common cause of hospitalization was inter-family violence (49%) and 41% for abandonment or extreme poverty. According to the PTSD criteria, 60 youngers (64.5%) were hospitalized for violation of rights, and eight children (8.6%) fit with all but one symptomatic standard (subclinical PTSD). This high percentage tallies with the ones found in the world literature and Colombia. Finally, 21.5% had no symptoms, and 5.4% had not been exposed to traumatic events. The different symptomatic criteria had a similar level of intensity.

Post-traumatic stress disorder after subsequent birth to a gestational loss: An observational study / Trastorno de estrés postraumático tras una gestación posterior a una pérdida gestacional: Un estudio observacional

Abstract Introduction The loss of a pregnancy puts women at risk of suffering post-traumatic stress disorder. This circumstance can influence a subsequent pregnancy, and the link with the future baby. Objective The main objective of this work was to identify the prevalence of post-traumatic stress disorder (PTSD) among post-partum women who give birth after having suffered a previous gestational loss and to identify possible relationships between PTSD and the variables studied. Method An observational, descriptive, and cross-sectional study. A total of 115 puerperal women who had suffered a previous gestational loss completed questionnaires containing sociodemographic variables, obstetric history, and responses to the Davidson Trauma Scale. Results A score of 40 was established as a cut-off point in the Davidson Trauma Scale for the identification of PTSD. 21.7% of the participants scored 40 or above. Significant differences were found related to age (p = .030), number of pregnancies (p = .033), and number of gestational losses (p = .001). The probability of PTSD increases significantly in relation to the number of losses. Respondents are 2.55 times (β = .94 p = .027) more likely to suffer PTSD the higher the number of gestational losses suffered. Discussion and conclusion There are significant differences in the presence of PTSD among puerperal women in terms of age, number of pregnancies, and number of gestational losses. Post-partum women are more likely to suffer PTSD after a gestational loss the higher the number of gestational losses suffered.

Resumen Introducción La pérdida de un embarazo sitúa a las mujeres en riesgo de padecer un trastorno por estrés postraumático. Esta circunstancia puede influir en un embarazo posterior, y el vínculo con el futuro bebé. Objetivo El objetivo principal de este trabajo fue identificar la prevalencia de trastorno por estrés postraumático entre puérperas que dan a luz tras haber sufrido una pérdida gestacional previa e identificar posibles relaciones entre el trastorno por estrés postraumático y las variables estudiadas. Método Se trata de un estudio observacional, descriptivo y transversal. Un total de 115 puérperas que habían sufrido una pérdida gestacional anterior llenaron cuestionarios que contenían variables sociodemográficas, de la historia obstétrica y la Escala de Trauma de Davidson. Resultados Se estableció 40 como punto de corte en la Escala de Trauma de Davidson para identificar el trastorno por estrés postraumático. Se identificó en un 21.7% de las participantes. Se encontraron diferencias significativas relacionadas con la edad (p = .030), el número de embarazos (p = .033) y el número de pérdidas gestacionales (p = .001). La probabilidad de trastorno por estrés postraumático aumenta significativamente en relación con el número de pérdidas. Es 2.55 veces (β = .94 p = .027) más probable padecer un trastorno por estrés postraumático cuanto mayor sea el número de pérdidas gestacionales sufridas. Discusión y conclusión Existen diferencias significativas en la prevalencia de trastorno por estrés postraumático entre las puérperas en cuanto a la edad, el número de embarazos y el número de pérdidas gestacionales. Es más probable padecer trastorno por estrés postraumático tras una gestación posterior a una pérdida gestacional cuanto mayor sea el número de pérdidas gestacionales sufridas.