Form Of Post-traumatic Stress Disorder Research Articles

Post-traumatic Stress Disorder: The Influence of the Environmental Context and Analysis of Oxidative Stress and Inflammatory and Glycemic Markers in Women Living in Kurdistan Regional Government-Iraq.

Background Internally displaced persons (IDP) camps are still home to a large number of female survivors of the Yazidi genocide carried out in Iraq in 2014 by the Islamic organization known as the Islamic State of Iraq and Syria (ISIS). Many of these women suffer from a persistent form of post-traumatic stress disorder (PTSD), which can last for many years. On the other hand, little is known about the intricate etiology of PTSD. Objectives In this observational cross-sectional study, the biochemical parameters, including inflammatory and oxidative stress (OXS) markers, were evaluated in two groups: the case group (women with newly diagnosed PTSD) and the control group (apparently healthy women). Furthermore, how the environment impacts the biochemical and OXS parameters of people not diagnosed with PTSD but living in IDP camps was also analyzed. Materials and methods The PTSD group (n=55, age=30.0 years) was made up of women survivors of genocide-related events living in IDP camps in the Kurdistan region of Iraq. The studied parameters in the PTSD group have been compared to two healthy control groups: (1) internal control group (n=55, age=28.1 years): healthy women living inside the IDP camps; and (2) external control group (n=55, age=28.3 years): healthy women living outside the IDP camps. The diagnosis of PTSD was conducted using a validated Kurdish version of the PTSD Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PCL-5) scale. Blood samples were collected to determine the level of glycated hemoglobin (HbA1c) and the concentrations of fasting serum glucose (FSG), C-reactive protein (CRP), ceruloplasmin (CP), 8-hydroxydeoxyguanosine (8-OHdG), glutathione (GSH), malondialdehyde (MDA), protein carbonyls (PC), and catalase (CAT) activity. Results Women with PTSD presented increased values of FSG (4.41%, p<0.05), HbA1c (4.74%, p<0.05), and CRP (114.29%, p<0.05), as well as increased levels of 8-OHdG (185.97%, p<0.001), CP (27.08%, p<0.001), MDA (141.97%, p<0.001), and PC (63.01%, p<0.001), besides increased CAT activity (121.5%, p<0.001), when compared with the control groups. A significant reduction of GSH (-20.33%, p<0.05) was observed in PTSD patients as compared to the external control group. In relation to the internal control group, women diagnosed with PTSD presented significantly increased levels of FSG (3.88%, p<0.05), HbA1c (2.83%, p<0.05), CRP (77.97%, p<0.05), and PC (41.3%, p<0.05), as well as increased levels of 8-OHdG (118.84%, p<0.001), CP (22.72%, p<0.001), MDA (90.67%, p<0.001), and CAT activity (55.31%, p<0.001). Healthy individuals residing in IDP camps, compared with external healthy control, presented significantly elevated levels of 8-OHdG (30.68%, p<0.001), MDA (26.91%, p<0.001), PC (15.37%, p<0.001), and CAT activity (42.62%, p<0.001). Conclusion Our findings indicate that PTSD significantly influences glycemic, inflammatory, oxidant, and antioxidant parameters, as evidenced by increased levels of FSG, HbA1C, CRP, PC, MDA, 8-OHdG, and CP, as well as increased CAT activity and a reduced GSH concentration in the PTSD group in comparison to the external control group. Additionally, our results suggest that the environmental context in IDP camps by itself can potentially affect oxidant and antioxidant parameters, as evidenced by the increased concentrations of 8-OHdG, MDA, and PC and increased CAT activity found in individuals not diagnosed with PTSD but living inside the camps.

Neurobiology and systems biology of stress resilience.

Stress resilience is the phenomenon that some people maintain their mental health despite exposure to adversity or show only temporary impairments followed by quick recovery. Resilience research attempts to unravel the factors and mechanisms that make resilience possible and to harness its insights for the development of preventative interventions in individuals at risk for acquiring stress-related dysfunctions. Biological resilience research has been lagging behind the psychological and social sciences but has seen a massive surge in recent years. At the same time, progress in this field has been hampered by methodological challenges related to finding suitable operationalizations and study designs, replicating findings, and modeling resilience in animals. We embed a review of behavioral, neuroimaging, neurobiological, and systems biological findings in adults in a critical methods discussion. We find preliminary evidence that hippocampus-based pattern separation and prefrontal-based cognitive control functions protect against the development of pathological fears in the aftermath of singular, event-type stressors [as found in fear-related disorders, including simpler forms of posttraumatic stress disorder (PTSD)] by facilitating the perception of safety. Reward system-based pursuit and savoring of positive reinforcers appear to protect against the development of more generalized dysfunctions of the anxious-depressive spectrum resulting from more severe or longer-lasting stressors (as in depression, generalized or comorbid anxiety, or severe PTSD). Links between preserved functioning of these neural systems under stress and neuroplasticity, immunoregulation, gut microbiome composition, and integrity of the gut barrier and the blood-brain barrier are beginning to emerge. On this basis, avenues for biological interventions are pointed out.

Do relationships with parents determine citizens’ reactions to war trauma?

BackgroundThe article concerns the psychology of trauma: the intensity of the experienced threats and reactions to the trauma in the form of post-traumatic stress disorder (PTSD), defenses and post-traumatic growth (PTG) in Ukrainian immigrants in Poland. The issues of trauma psychology were studied in connection with the relationships with parents.Participants and procedureThe methods used mainly concerned the specifics of experiencing strong threats (trauma) and responding to them (PCL-5 questionnaire, Psycho-Social and Psychic Defenses Questionnaire, Post-Traumatic Growth Inventory), determination of closeness to parents (Scale of Closeness to Biological Parents) and secure and non-secure attachment style (Attachment Style Questionnaire). The subjects were 178 people (including 147 women and 31 men), citizens of Ukraine, who arrived in Poland after the outbreak of war on February 24, 2022, and at the time of the study were living in and around Krakow, Wroclaw, Lublin, or Warsaw. The mean age of the subjects was 38 years (SD = 12.57).ResultsThe results of the study indicate that non-secure attachment styles (anxious-avoidant and anxious-ambivalent), along with frustration of the need for competence and intensity of threats, are predictors of PTSD and non-constructive defenses. In contrast, a secure attachment style, along with frustration of the need for competence and intensity of threats, is a predictor of constructive defenses, while a secure attachment style is a predictor of PTG. Statistical analyses show that closeness to the mother is not significantly associated with any of the explained variables.ConclusionsThe accumulation of risks associated with war trauma and the necessity to cope with them are strongly associated with the ongoing war. Attachment styles support or hinder the process of adaptation. The absence of closeness to the mother among the predictors in the models tested represents the most intriguing result, to be confirmed in further research.

Addressing Secondary Traumatic Stress Among Nurses: A Brief Unit-Based Group Program

The nursing profession requires constant adaptation to change, along with resilience and unwavering provision of excellent patient care. Secondary traumatic stress (STS) challenges this adaptive process and provision of patient care, leaving nurses with impairment in several well-being domains critical to resilience, including emotional, physical, spiritual, and professional well-being. STS is described as experiencing a patient’s trauma, resulting in a form of posttraumatic stress disorder with hyperarousal, avoidance, sleep disturbance, intrusive thoughts, mood disturbance, and impaired performance. Currently there is a nationwide paradigm shift among national and state nursing associations about how to address stress in nursing and support the well-being of nursing professionals. However, many nurses often do not recognize the signs of stress in themselves or colleagues, and they tend not to utilize strategies for prevention or intervention. Also, it is difficult for busy nursing professionals providing direct patient care to leave their units to engage in stress management programs offered by their institutions. This article addresses this gap and presents a short-term, four-session unit-based group model that integrates cognitive behavioral strategies and mindfulness practice for stress reduction, which has been implemented at a large, busy, urban academic medical center in the Northeast. The short-term unit-based group model aims to assist nursing professionals with recognition, prevention, and mitigation of stress. Such an intervention supports the emotional well-being of nursing professionals, which in turn contributes to a resilient and engaged workforce, a high-functioning team, and improved patient care.

Psychosocial aspects of coping that predict post-traumatic stress disorder for African American survivors of homicide victims

African Americans disproportionately experience homicide, and the psychological consequence of experiencing this traumatic event interferes with daily function, often in the form of post-traumatic stress disorder (PTSD). According to the Model of Coping for African American Survivors of Homicide Victims (MCAASHV), African Americans coping with the traumatic impact of homicide are influenced by: the violent nature of the death itself, racial- and cultural-bound experiences (e.g., cultural trauma, the culture of homicide including stigma, blame, shame, and lack of justice) and psychological processes including racial appraisal and coping strategies (e.g., spiritual, collective, meaning making). This study examined the direct and indirect effects racial- and cultural-bound experiences have on PTSD through coping strategies among 304 African American survivors of homicide victims across the United States using Qualtrics Panel collected in March–May 2018. The path analysis model demonstrated strong model fit, and the variables in the model accounted for 34% variance in PTSD. Coping (β = −0.38, p < .001) and culture of homicide (β = −0.27, p < .001) were negatively related to PTSD. Cultural trauma (β = 0.11, p < .014), culture of homicide (β = 0.43, p < .001), reactions to homicide (β = 0.11, p < .006) and racial appraisal (β = 0.32, p < .001) were positively associated with coping (R2 = 52%), and all were indirectly associated with PTSD through coping. Findings provide strong support for the MCAASHV and highlight the direct and indirect effects of racial and cultural experiences of coping that explain PTSD among African Americans chronically exposed to homicide.

Phagophobia in A 6-Year-Old Child : Case Report

Introduction: Photophobia or swallowing phobia is a rarely studied clinical entity. Classified as a specific phobia by the DSM-V. Through our clinical case, we highlight the diagnosis difficulty of this clinical entity and the interest of early therapeutic management appropriate to the age of the child. Clinical observation: A 6-year-old female patient was hospitalized in pediatric surgery for esophageal caustic stenosis that required esophageal replacement. Thereafter, the persistence of swallowing disorders was observed while the organic etiological assessment was negative. Manifestations of phobic anxiety were identified starting the first psychiatric consultation. These manifestations were found to be linked to the memory of traumatic events that the patient experienced during the gastro esophageal fibro copy. The diagnosis of phobic disorder was retained and the treatment was essentially based on behavioral therapy. The evolution was globally favorable. Discussion: Photophobia, or swallowing phobia, is an uncommon phobic disorder listed in the 11th edition of the International Classification of Mental Disorders and the DSM-5. The important question before diagnosing this disorder is to determine its psychogenic basis. In most cases, the onset of the disorder follows a swallowing accident, which leads to swallowing phobia, which in turn is considered a particular form of post-traumatic stress disorder. It can also be associated with separation anxiety in children as in our case. Conclusion: Swallowing phobia is considered a specific, non-developmental phobia. Swallowing phobia and other childhood anxiety disorders are closely correlated. Cognitive behavioural therapies have shown favourable responses in most cases.

Provider's Perception of Parental Anxiety in the Pediatric Intensive Care Unit.

Parents of critically ill children in the Pediatric Intensive Care Unit (PICU) commonly experience new or worsening anxiety, which can lead to long-term sequelae in the form of post-traumatic stress disorder (PTSD). To investigate how well the PICU providers recognize and assess parental anxiety, we assessed the acute and baseline anxiety level of 30 parents in the PICU with the State-Trait Anxiety Inventory (STAI) and compared the results with the PICU physician's and nurses' assessments. All but four parents experienced higher acute anxiety scores compared to baseline, with a 34% increase in the number of parents with moderate and high anxiety scores. All PICU providers performed poorly in recognizing and assessing parental anxiety, with a tendency to underestimate the level of anxiety. Proper screening tools and strategies are essential to recognize and help parents in distress and potentially prevent long-term psychological sequelae.

Causal determinants of complex PTSD in Syrian refugee children living in informal settlements in Lebanon

IntroductionDisplaced refugee children with a history of war exposure are at risk of developing complex and severe forms of post-traumatic stress disorder (PTSD).ObjectivesSearch for the most relevant causal predictors of complex PTSD in a prospective cohort of Syrian refugee children living in informal settlements in Lebanon (N=1007).Methods A latent class unsupervised analysis was carried out to determine clusters with complex PTSD presentation at the follow-up assessment. A new exploratory causal discovering modelling approach was applied using 97 multilevel psychosocial variables as predictors (Biazoli et al., 2021). Associations between discovered candidate causal factors assessed at baseline with a presumed diagnosis of complex PTSD one year later were calculated using a multiple logistic regression model.Results Several putative causal factors emerged: perceived social coherence of the neighbourhood (Positive Predictive Value increase: 1.22); impulsivity (1.25), self-efficacy (1.23) and depressive symptoms (1.15) at the parental level; positive home experiences (1.16) at the family level; and child-level factors such as being forced to work (1.22), being a victim of verbal or physical bullying (1.19), loneliness (1.17) and well-being (1.18). In further confirmatory multiple logistic regression analysis and after correction for multiple comparisons, verbal or physical bullying victimization (p=.005) and caregiver depressive symptoms (p=.0004) at baseline were associated with complex PTSD presentations one year later.Conclusions Our results support the need for a multi-level psychosocial care model to prevent psychological distress and promote mental health in refugee children. Specifically, our results suggest that programs tackling caregiver’s mental health and children’s exposure to violence might effectively prevent complex PTSD.DisclosureNo significant relationships.

PTSD As Portrayed in Finn’s The Woman in The Window and Murakami’s Colorless Tsukuru Tazaki and His Years of Pilgrimage: A Comparative Literature

This thesis is entitled “Post-Traumatic Stress Disorder as Portrayed in A.J. Finn’s Novel The Woman in the Window and Haruki Murakami’s Novel Colorless Tsukuru Tazaki and His Years of Pilgrimage: A Comparative Literature Analysis”. The writer is interested in analyzing the two novels because they have the same motive is Post-Traumatic Stress Disorder. In this thesis the writer uses two novels as the object, there is The Woman in the Window (2018) from England and Colorless Tsukuru Tazaki and His Years of Pilgrimage (2013) from Japan. This study aims to find out how Post-Traumatic Stress Disorder is portrayed in the two literary works and to find the affinities and differences regarding the issue in forms of Post-Traumatic Stress Disorder that the main characters are suffering from using Post-Traumatic Stress Disorder‘s theory by American Psychiatric Association through the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Both main characters of the two literary works, Anna Fox and Tsukuru Tazaki are suffering from Post-Traumatic Stress Disorder. The study also involves looking at the intrinsic elements to look at the affinities and differences found in the two literary works. In completing the analysis, the writer uses the descriptive qualitative method which represents all the data in the forms of words and sentences. The writer collects data from various sources including The Woman in the Window by A.J. Finn, Colorless Tsukuru Tazaki, and His Years of Pilgrimage by Haruki Murakami, relevant books, articles, and journals to support the analysis. Based on the results of the analysis it can be concluded that the two literary works show affinities and differences regarding Post-Traumatic Stress Disorder that is experienced by the two main characters of both literary works.

PTSD symptoms and coping mechanism of nurses in Poland before the COVID-19 pandemic. A cross-sectional study

Abstract Introduction. Secondary traumatic stress (STS) is a consequence of the indirect experience of trauma. The symptoms of STS are similar to those experienced by people who directly experience traumatic events in the form of posttraumatic stress disorder (PTSD). Aim. The aim of the study was to determine the frequency of the symptoms of PTSD and to establish the role of coping strategies in the development of PTSD symptoms among Polish nurses. The study was conducted before the COVID-19 pandemic. Material and methods. The study was conducted in the Podkarpackie Province (Poland) in clinical hospitals and hospital out-patient clinics. The results of studies conducted among 509 nurses were analyzed. The mean age of the respondents was 35 years, and the mean work seniority was 11 years. The IES-R scale and Mini-COPE were used in the study. Results. At least moderate PTSD symptoms were found in 42.4% of the surveyed nurses. The results showed that maladaptive stress coping strategies played a major role in the development of PTSD symptoms in the group of nurses. Conclusion. Nurses are a professional group exposed to a high risk of traumatic encounters that may result in PTSD/STS, therefore this professional group should be targeted at prophylactic programs and training in dealing with traumatic stress. The COVID pandemic and the related restrictions, organizational chaos, constant fear and a sense of danger are serious traumatizing factors and can seriously contribute to the increase in stress disorders among nurses and other medical professionals.

From epileptic hysteria to psychogenic non epileptic seizure: Continuity or discontinuity for contemporary psychiatry?

In the wake of Charcot, the École de la Salpêtrière became passionate about major crises or hysterical attacks: at the time, hysteria was not just about this great crisis, even if it represented an ideal heuristic model for a patient presentation that left a lasting impression on people's minds. The great attack is a framework for the study of hystero-epilepsy that opens the way to psychopathological explanation. The heirs of the Salpêtrière School's knowledge protesters each boast of imposing a universal model of hysteria seen from the perspective of its causes. If Babinski considers hysteria to be a purely psychogenic mechanism, it is of the subconscious mind or self-suggestion, the subject abandoning himself to his symptom. Unlike pithiatism, Freud and Breuer understand crisis as the cleavage of the content of consciousness that testifies to the return of a forgotten traumatic memory. These questions, partly eclipsed by modern psychiatry, are resurfacing with the description of a new clinical entity: the nonepileptic psychogenic seizure.Non-epileptic psychogenic seizures (PNES) can be defined as paroxysmal manifestations clinically suggestive of epileptic seizures but related to unconscious psychogenic processes. Clinical diagnosis is particularly difficult. Most patients with PNES incorrectly use anticonvulsant therapy, which is ineffective and has frequent side effects. To establish a diagnosis that discriminates between PNES and epilepsy, the electroencephalographic recording coupled with a video recording is the paraclinical examination of choice. The treatment of PNESs is complex: despite a diagnosis made by the patient and joint follow-up by a specialized team of neurologists and psychiatrists, the prognosis remains uncertain.We sought a phenomenal continuity between a major hysterical attack, hystero-epilepsy and a non-epileptic psychogenic seizure. From one time to another, the diagnosis of epileptic seizures is a diagnosis of clinical and paraclinical elimination. A reference to hysteria is found over time, currently confusing into dissociative and somatoform disorders. Consistent with ancient theories, the psychotraumatic dimension of the epileptoid phenomenon is found in recent epidemiological studies.Since hysteria was not just about major attacks, the entity called PNES is a group of clinical manifestations with heterogeneous etiologies. Some research teams consider PNESs to be the result of non-epileptic, normal electroencephalogram neuronal hyperexcitability. Other authors have adopted the etiological hypothesis of recurrent dissociative disorders and equivalent to a particular form of post-traumatic stress disorder.

Dissociative identity disorder: out of the shadows at last?

Dissociative identity disorder (DID) is a severely debilitating disorder. Despite recognition in the current and past versions of the DSM, DID remains a controversial psychiatric disorder, which hampers its diagnosis and treatment. Neurobiological evidence regarding the aetiology of DID supports clinical observations that it is a severe form of post-traumatic stress disorder.

Treating implicit trauma: a quasi-experimental study comparing the EMDR Therapy Standard Protocol with a \u2018Blind 2 Therapist\u2019 version within a trauma capacity building project in Northern Iraq

Psychological trauma is a silent epidemic which presents as a global public health issue, often in the form of post-traumatic stress disorder (PTSD). Eye Movement Desensitisation and Reprocessing (EMDR) Therapy is an empirically supported treatment intervention for PTSD and has been used as part of trauma-capacity building, particularly in low- and middle-income countries (LMIC). For some survivor’s, their trauma experiences cannot be spoken of: they may be alluded to, suggested and though not directly expressed. There are several factors as to why these implicit trauma experiences are ‘unspoken’, for example, when the trauma involves a deep-rooted sense of shame or guilt, a distorted sense of over-responsibility or when to speak of the trauma engenders fear of retribution, reprisal and consequence. This paper will explore the effectiveness of using two protocol variations of EMDR Therapy—standard versus a ‘Blind 2 Therapist’ protocol version as part of a quasi-experimental study which took place in Northern Iraq. The study contains two projects and subsequently tested several hypotheses regarding safety, effectiveness, efficiency and relevance of the ‘Blind 2 Therapist’ protocol within EMDR Therapy. Results indicated support for the B2T protocol intervention with various trauma populations including Yezidi survivors of Islamic State of Iraq and the Levant (ISIL)—also known as Daesh.

Le développement de paradigmes psycholinguistiques devient nécessaire à l’espace de la psychotraumatologie. Analyse critique de la littérature anglophone et des premiers travaux francophones. Vers un nouveau modèle du traumatisme psychique

Resume Objectifs Si l’interet pour la psychotraumatologie s’est progressivement generalise au cours de la derniere decennie, faute de reperage diagnostique, de nombreux patients restent sans soins tandis que parallelement, l’offre de psychotherapies differenciees s’est majoree. Notons egalement que si les recherches en neurosciences ont explose en nombre, leurs applications concretes utiles a la pratique quotidienne semblent plus tenues, notamment au plan pharmacologique. De tels achoppements seraient-ils causes par une preeminence de la reference au « stress » au detriment de la consideration du « trauma » ? Au-dela des picrocholines querelles d’ecoles, il apparait aujourd’hui necessaire de construire une nouvelle phase d’analyse. Methodes Nous exposons une revue critique de la litterature de langue anglaise avant de focaliser sur les quelques etudes francophones existantes. Resultats La majorite des etudes anglophones referencees se rattachent aux protocoles de deux travaux princeps sans que les paradigmes linguistiques en soutenant le design apparaissent tres structures. L’analyse linguistique s’y avere en fait limitee, sans mention des richesses apportees par les ecoles de semantique et de pragmatique. Il apparait toutefois une lente complexification des methodes d’analyse textuelle dans le temps. Pour l’espace francophone, seules deux etudes existent : l’une de Louis Crocq datant des annees 1960, et une autre de Ribeton & Auxemery mettant en evidence le syndrome psycholinguistique post-traumatique (anomie traumatique, repetitions linguistiques et desorganisation discursive). Conclusion Les troubles psychiques post-traumatiques beneficient d’un renouveau d’interet pour la psychiatrie et la psychologie contemporaines. La densification de la description du trouble de stress post-traumatique dans le DSM-5 pourrait encore se completer des differentes formes cliniques specifiques constituant les troubles psychiques post-traumatiques. Aussi, a l’heure ou differents protocoles psychotherapeutiques apparaissent concurrents (protocoles comportementaux et cognitifs, traitements par l’hypnose, therapies par mouvements oculaires, therapies psychodynamiques, therapies narratives, etc.), l’analyse de la restauration du langage pourrait permettre d’unifier une conception specifique du traumatisme psychique et de ses consequences cliniques. Le paradigme que nous proposons developpe la recherche clinique a l’aide de marqueurs psycholinguistiques offrant d’evaluer l’efficacite des psychotherapies.

The Most Important Mental Health Issue You’ve Never Heard Of

The Most Important Mental Health Issue You’ve Never Heard Of

Alcohol use and coping in a cross-sectional study of African American homicide survivors

The loss of a loved one to homicide is associated with considerable distress, often in the form of posttraumatic stress disorder (PTSD) and complicated grief (CG), and alcohol misuse. Yet alcohol-related problems and loss from a homicide are issues that disproportionally affect African Americans. The present study investigated alcohol use in a sample of 54 African American homicide survivors. Although there was a low prevalence of hazardous drinking, alcohol use was associated with higher levels of PTSD, complicated grief, and depression severity. In addition, scores on the Alcohol Use Disorders Identification Test (AUDIT) were correlated with active emotional coping and avoidant emotional coping. In analyses of PTSD symptom clusters, emotional numbing and hyperarousal symptoms were significantly correlated with AUDIT total score.

Using fMRI connectivity to define a treatment-resistant form of post-traumatic stress disorder.

A mechanistic understanding of the pathology of psychiatric disorders has been hampered by extensive heterogeneity in biology, symptoms, and behavior within diagnostic categories that are defined subjectively. We investigated whether leveraging individual differences in information-processing impairments in patients with post-traumatic stress disorder (PTSD) could reveal phenotypes within the disorder. We found that a subgroup of patients with PTSD from two independent cohorts displayed both aberrant functional connectivity within the ventral attention network (VAN) as revealed by functional magnetic resonance imaging (fMRI) neuroimaging and impaired verbal memory on a word list learning task. This combined phenotype was not associated with differences in symptoms or comorbidities, but nonetheless could be used to predict a poor response to psychotherapy, the best-validated treatment for PTSD. Using concurrent focal noninvasive transcranial magnetic stimulation and electroencephalography, we then identified alterations in neural signal flow in the VAN that were evoked by direct stimulation of that network. These alterations were associated with individual differences in functional fMRI connectivity within the VAN. Our findings define specific neurobiological mechanisms in a subgroup of patients with PTSD that could contribute to the poor response to psychotherapy.

Secondary traumatic stress among physiatrists treating trauma patients

Secondary traumatic stress is a form of posttraumatic stress disorder resulting from exposure to others’ acute serious physical harm or death, regardless of mechanism. However, the incidence of secondary traumatic stress among physiatrists remains unexplored. This study examined relationships with secondary traumatic stress among physiatrists. Surveys were distributed to members of the Association of Academic Physiatry and local physiatrists. Surveys included measures of secondary traumatic stress, resilience, personality factors, demographics, and work-related factors. Of 102 surveys returned, 88 were complete and included for analysis. The sample was 42 ± 11 years and included 45 women (51%). Moderate to severe levels of secondary traumatic stress were found in 26 (30%) respondents, and 45% reported clinical levels of at least one symptom cluster. Higher resilience, higher extraversion, and higher emotional stability were associated with significantly lower odds of positive secondary traumatic stress screens and lower symptom severity (all P < 0.023). In conclusion, a third of responding physiatrists reported moderate to severe symptoms of secondary traumatic stress—a rate consistent with previous research among clinicians in a trauma setting and higher than the rate of posttraumatic stress disorder in the general population. Resilience-building interventions for secondary traumatic stress are likely to improve the well-being of physiatrists.

Neuromodulation Strategies in Post-Traumatic Stress Disorder: From Preclinical Models to Clinical Applications.

Post-traumatic stress disorder (PTSD) is an often debilitating disease with a lifetime prevalence rate between 5–8%. In war veterans, these numbers are even higher, reaching approximately 10% to 25%. Although most patients benefit from the use of medications and psychotherapy, approximately 20% to 30% do not have an adequate response to conventional treatments. Neuromodulation strategies have been investigated for various psychiatric disorders with promising results, and may represent an important treatment option for individuals with difficult-to-treat forms of PTSD. We review the relevant neurocircuitry and preclinical stimulation studies in models of fear and anxiety, as well as clinical data on the use of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and deep brain stimulation (DBS) for the treatment of PTSD.

Biased emotional attention in patients with dental phobia.

Biased motivated attention towards phobia‐relevant pictures is a typical finding in specific phobia. In the visual system, the allocation of motivated attention is indexed by two event‐related potential components – the Early Posterior Negativity and the Late Positive Potential. Enhanced Early Posterior Negativity and Late Positive Potential amplitudes are reliably observed in specific phobia such as, for instance, snake, spider, or blood‐injection‐injury phobia and to some extent also in dental phobia. However, regarding dental phobia results are sparse and its theoretical concept is not undisputed. To further elucidate the electrophysiological characteristics of dental phobia, we investigated visual emotional processing in dental phobia patients and controls. Subjects viewed neutral, phobia‐irrelevant and phobia‐relevant pictures while magnetoencephalographic and behavioural measures were recorded. All patients reported a history of traumatic experiences and depressive and anxiety symptoms, as well as dissociative and posttraumatic symptoms. In the magnetoencephalography, patients showed generally less evoked neural activation at parietal and temporal regions and a reduced differentiation between picture categories compared to controls. At the behavioural level, patients rated phobia‐relevant pictures as clearly more negative as did controls. In contrast to previous reports, our results suggest that dental phobia cannot be associated with the typical effects of biased motivated attention seen in other specific phobias. Instead, results indicate that dental phobia shares typical characteristics with mild forms of posttraumatic stress disorder.