Hypervigilant State Research Articles

Lost at sea: Impact of an ocean survival experience on psychological, physiological and cognitive abilities (RAD'LÔ)

Survival in an extreme environment places high physiological and cognitive demands on the individual. These environments are characterized by specific stimuli, including unusual sensory stimulation and uncertainty, which induce intense stress. Thus, the aims of this study are: i) to evaluate the impact of a five-day survival at sea simulation on human adaptive capacities, based on the assessment of psychological, cognitive, physiological, and sensorial measures; and ii) to assess recovery. Twenty-one healthy participants were enrolled in a 5-day simulation onboard a lifeboat or an inflatable raft. Psychological, physiological, sensory, and cognitive measurements were recorded before leaving (baseline), at the end of the experiment (post) and during the week that followed (recovery). Our results are unequivocal. The harshness of the environment affected the majority of the organism's responses. On the cognitive level, performance significantly deteriorated. On the psychological level, there was low mood, a decrease in subjective exteroceptive acuity and sleep disorders, increased energy, and less perceived stress. On the physiological level, a decline was recorded with respect to autonomous nervous system measurements. On the sensory level, we observed a state of hypervigilance and hypersensitivity to stimuli from the external environment. Proprioception was deeply impacted. Moreover, at recovery, many individuals did not fully recover or deteriorated further, especially regarding sleep, interoceptive abilities and sensory distortion. It appears that participants entered a state of psychological hibernation, associated with increased physical and cognitive load, and sensory hypervigilance. These results raise the question of the risks that may be incurred during future long-term space missions, as astronauts will have to maintain their cognitive performance at a high level to be able to respond to environmental demands and remain alive. It is essential to continue to explore countermeasures that will support adaptation in future spacecraft crew.

Atypical attention and saccade vigor in post-traumatic stress disorder

Effective attention control is essential for behavioral adaptation to different environmental contexts. In Post-traumatic Stress Disorder (PTSD) altered attention has been described in trauma-related and other emotional contexts. Nevertheless, atypical attention is also seen with neutral stimuli. The mechanisms of attention alterations in PTSD associated with neutral stimuli are poorly understood.The present study investigates alerting and orienting responses in PTSD participants using emotionally neutral stimuli in a saccade eye movement task incorporating both spatially predictable and temporally unpredictable conditions. We studied 23 PTSD patients and 27 Non-PTSD controls, using repeated-measures mixed modeling to estimate group and task condition differences in behavioral and psychophysiological measures. We explored the relationships among saccade characteristics, pupil size, and PTSD symptoms, including CAPS hypervigilance scores. PTSD, compared to Non-PTSD, participants showed differences in their saccade ‘main sequence’, reflected by higher peak velocities adjusted for amplitude. PTSD participants had smaller primary position errors in the unpredictable saccade condition. They also exhibited greater hyperarousal, reflected by larger pupil size during fixation that was greater in the unpredictable condition.Our results suggest that a heightened state of arousal and hypervigilance in PTSD leads to a state of atypical attention bias, even in emotionally neutral contexts. These differences may reflect higher saccade vigor. The observed differences suggest atypical attention in PTSD, which goes beyond possible distraction associated with emotional or threat-related stimuli.

The Existential Challenges of Stress, Trauma, and Psychopathology and Their Integration to the Self: A Self-Determination Theory Perspective

AbstractIn much current research on stress, trauma, and psychopathology, there is a converging interest in the role of the stress response in engendering trauma, emotional dysregulation, and mental illness. Both the acute stressors known from post-traumatic stress disorder (PTSD) and the early-life, persistent stressors involved in complex PTSD, may create a stress response that is not properly downregulated. This leaves the person in a permanent state of high arousal and hypervigilance, common characteristics of many psychiatric disorders. It is suggested that such stressors are examples of the challenges that confront everyone: trivial, optimal, or overwhelming. Trivial challenges are mundane, optimal challenges invite learning and development, and overwhelming challenges may lead to trauma and mental ill-being. For a promising perspective on life’s challenges, we turn to Self-Determination Theory (SDT). In SDT, mental health and human flourishing derive from the satisfaction of three basic psychological needs: for autonomy, competence and relatedness, as well as from the integration of experiences and challenges to the self. It is proposed in this paper that the overwhelming challenges involved in trauma and psychopathology are experiences that frustrate or thwart psychological needs and thus fail to integrate to the self. Such experiences may still be internalized, albeit as “introjects”—“thrown in,” swallowed whole, not digested properly. They remain outside of the self, exerting pressure on it through guilt, shame, ego-involvement, pride, etc., in the process producing much anguish and mental pain. Thus, as challenges are part and parcel of the human experience, trauma and psychopathology appear as outcomes of human development, rather than as essentially incomprehensible aberrations.

Developmental age and fatty acid amide hydrolase genetic variation converge to mediate fear regulation in female mice.

Anxiety disorders are more prevalent in females than in males, yet a majority of basic neuroscience studies are performed in males. Furthermore, anxiety disorders peak in prevalence during adolescence, yet little is known about neurodevelopmental trajectories of fear expression, particularly in females. To examine these factors, we fear conditioned juvenile, adolescent, and adult female mice and exposed them to fear extinction and a long-term recall test. For this, we used knock-in mice containing a common human mutation in the gene for fatty acid amide hydrolase (FAAH), the primary catabolic enzyme for the endocannabinoid anandamide (FAAH-IN). This mutation has been shown to impart a low-anxiety phenotype in humans, and in rodents relative to their wild-type littermates. We find an impact of the FAAH polymorphism on developmental changes in fear behavior. Specifically, the FAAH polymorphism appears to induce a state of hypervigilance (increased fear) during adolescence. We also used markerless pose estimation software to classify alternative behaviors outside of freezing. These analyses revealed age differences in vigilance to indicators of threat and in the propensity of mice to explore an aversive environment, though genotypic differences were minimal. These findings address a gap in the literature regarding developmental patterns of fear learning and memory as well as the mechanistic contributions of the endocannabinoid system in females.

Patient violence towards their family carers: A qualitative exploration of carers’ experiences in psychosis

Introduction Compared to the general population, people living with schizophrenia spectrum disorders (SSD) are more likely to perpetrate acts of violence. When this happens, family members (informal carers) are most commonly the victims. However, family violence by people with SSD is often a taboo topic and largely neglected within public discourse, research, and clinical domains. Consequently, our understanding of families’ experiences and support needs are limited.ObjectivesTo develop a detailed understanding of the subjective experiences, and impact, of patient violence towards family carers.MethodsIndividual semi-structured interviews were held with family carers of adults with SSD and a history of violence perpetration towards their family carer. Interview data were subject to thematic analyses using NVivo software.ResultsTwenty-one UK based carers that were predominately White British (90%) and female (81%) were interviewed. Key themes highlight the range of physical and mental injuries endured by carers following patient violence, and speak to carers’ experiences of suffering, living in a constant state of hypervigilance, as well as social isolation in the context of shame, stigma, and an absence of professional and informal support.Conclusions Family violence by people living with SSD can and does happen. Yet, too often, carers are left with no option but to continue supporting their relative in the absence of support, even in contexts where this compromises their own safety. The devastating impact of violence is far-reaching, across all levels of the family-system. The findings highlight the danger of neglecting family violence by people with SSD in research and clinical fields.DisclosureNo significant relationships.

PARENTAL MODELS OF BEHAVIOR AS A FACTOR OF VULNERABILITY TO SOCIAL ANXIETY DISORDER: A LITERATURE REVIEW

Individuals characterize a social anxiety disordered by individuals to fear social situations in which they anticipate negative evaluations. The impact of social anxiety, as one of the widespread mental health disorders, characterize by onset at an early age and affecting functioning in various domains of life and general wellbeing. The aim of the article was to conduct a review of scientific data devoted to parental behavior patterns and emotional response to the child in the process of socialization on the pathogenesis of social phobia. It was found that the results of empirical studies considered the pathogenesis of social anxiety and social phobia in the context of neurobiological vulnerability, psychological aspects of attachment, social learning models, and cognitive-behavioral models. The analysis of recent research points out that parental styles, relationship support, and emotional response can be factors of vulnerability to mental pathology and social anxiety disorder. Summing up, three paths of were realizing the influence of parental models of behavior on the development of persistent distress due to social phobia as an independent disorder are distinguished. The first considers the mutual vulnerability of the emotional response to parents' anxiety signals in the relationship with the child, which increases the tendency to behavioral inhibition or avoidance of the child's emotional experience during social interaction. The second path considers social phobia as the result of social learning parental patterns of emotional response and behavior. These links mediated by the child's low self-esteem, avoidant strategies and controlling parenting style as a protective strategy on the part of significant others. The third model considers the impact of social punishment or other socially traumatic experiences in the relationship with parents or the community (as models of parental image). According to such a strategy, a state of hypervigilance to social evaluation and avoiding behavior strategies bring temporary relief against retraumatization due to "punishment." These strategies reinforce dysfunctional cognitive and behavioral patterns that impair social efficacy and strengthen the fear of rejection through condemnation or devaluation in the long term. The obtained results will make it possible to expand the conceptual model of the pathogenesis of social phobia, which will contribute to the provision of psychosocial assistance and substantiate the need for further empirical research.

Mind affects matter: Hindbrain GLP1 neurons link stress, physiology and behaviour.

What is the topic of this review? This Lecture covers the role of caudal brainstem GLP1 neurons in acute and chronic stress responses. What advances does it highlight? This Lecture focuses on the recent advances in our understanding of GLP1 neurons and their physiological role in many aspects of stress. Particular focus is given to the recent elucidation, in part, of the anatomical basis for recruitment of GLP1 neurons in response to acute stress. Finally, the potential, but at this time somewhat speculative, role of GLP1 neurons in chronic stress is discussed. The brain responds rapidly to stressful stimuli by increasing sympathetic outflow, activating the hypothalamic-pituitary-adrenal axis and eliciting avoidance behaviours to limit risks to safety. Stress responses are adaptive and essential but can become maladaptive when the stress is chronic, causing autonomic imbalance, hypothalamic-pituitary-adrenal axis hyper-reactivity and a state of hypervigilance. Ultimately, this contributes to the development of cardiovascular disease and affective disorders, including major depression and anxiety. Stress responses are often thought to be driven mainly by forebrain areas; however, the brainstem nucleus of the solitary tract (NTS) is ideally located to control both autonomic outflow and behaviour in response to stress. Here, I review the preclinical evidence that the NTS and its resident glucagon-like peptide-1 (GLP1)-expressing neurons are prominent mediators of stress responses. This Lecture introduces the reader to the idea of good and bad stress and outlines the types of stress that engage the NTS and GLP1 neurons. I describe in particular detail the recent studies by myself and others aimed at mapping sources of synaptic inputs to GLP1 neurons and consider the implications for our understanding of the role of GLP1 neurons in stress. This is followed by a discussion of the contribution of brain GLP1 and GLP1 neurons to behavioural and physiological stress responses. The evidence reviewed highlights a potentially prominent role for GLP1 neurons in the response of the brain to acute stress and reveals important unanswered questions regarding their role in chronic stress.

Attentive immobility in the face of inevitable distal threat-Startle potentiation and fear bradycardia as an index of emotion and attention.

During fear conditioning, a cue (CS) signals an inevitable distal threat (US) and evokes a conditioned response that can be described as attentive immobility (freezing). The organism remains motionless and monitors the source of danger while startle responses are potentiated, indicating a state of defensive hypervigilance. Although in animals vagally mediated fear bradycardia is also reliably observed under such circumstances, results are mixed in human fear conditioning. Using a single-cue fear conditioning and extinction protocol, we tested cardiac reactivity and startle potentiation indexing low-level defensive strategies in a fear-conditioned (n=40; paired presentations of CS and US) compared with a non-conditioned control group (n=40; unpaired presentations of CS and US). Additionally, we assessed shock expectancy ratings on a trial-by-trial basis indexing declarative knowledge of the previous contingencies. Half of each group underwent extinction under sham or active transcutaneous vagus nerve stimulation (tVNS), serving as additional proof of concept. We found stronger cardiac deceleration during CS presentation in the fear learning relative to the control group. This learned fear bradycardia was positively correlated with conditioned startle potentiation but not with declarative knowledge of CS-US contingencies. TVNS abolished differences in heart rate changes between both groups and removed the significant correlation between late cardiac deceleration and startle potentiation in the fear learning group. Results suggest, fear-conditioned cues evoke attentive immobility in humans, characterized by cardiac deceleration and startle potentiation. Such defensive response pattern is elicited by cues predicting inevitable distal threat and resembles conditioned fear responses observed in rodents.

Reflections on My Early Career: Nearly Trampled by Trauma

Reflections on My Early Career: Nearly Trampled by Trauma

Workplace Violence in Healthcare: A Single-Center Study on Causes, Consequences and Prevention Strategies.

Workplace violence is one of the main risk factors in the professional world. Healthcare workers are at higher risk whencompared to other sectors. Our study aimed to characterize physical and verbal violence in a public hospital and to define occupationalhealth prevention and surveillance strategies. Single center observational cross-sectional study, carried amongst healthcare workers in a public hospital inLisbon. A qualitative survey was carried out through six in-depth interviews. A quantitative survey was carried through questionnairesdelivered to 32 workers. A significance level of 5% was accepted in the assessment of statistical differences. The Mann-Whitney testand the Fisher's exact test were used to calculate p values. The main results are: (1) 41 violence incidents were reported in the quantitative phase; (2) 5/21 [23.81%] victims notifiedthe incident to the occupational health department; (3) 18/21 [85.71%] victims reported a permanent state of hypervigilance; (4) 22/28[78.57%] participants self-reported poor or no familiarity with internal reporting procedures; (5) 24/28 [85.71%] participants believed itis possible to minimize workplace violence. Workplace violence is favored by unrestricted access to working areas, absence of security guards and police officersor scarce intervention. The low notification rate contributes to organizational lack of action. The state of hypervigilance reported in ourstudy reflects the negative effects of threatening occupational stressors on mental health. Our results show that workplace violence is a relevant risk factor that significantly impacts workers' health in a noxiousmanner, deserving a tailored occupational health approach whose priority areas and strategies have been determined.

The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray.

Post-traumatic stress disorder (PTSD), a diagnosis that may follow the experience of trauma, has multiple symptomatic phenotypes. Generally, individuals with PTSD display symptoms of hyperarousal and of hyperemotionality in the presence of fearful stimuli. A subset of individuals with PTSD; however, elicit dissociative symptomatology (i.e., depersonalization, derealization) in the wake of a perceived threat. This pattern of response characterizes the dissociative subtype of the disorder, which is often associated with emotional numbing and hypoarousal. Both symptomatic phenotypes exhibit attentional threat biases, where threat stimuli are processed preferentially leading to a hypervigilant state that is thought to promote defensive behaviors during threat processing. Accordingly, PTSD and its dissociative subtype are thought to differ in their proclivity to elicit active (i.e., fight, flight) versus passive (i.e., tonic immobility, emotional shutdown) defensive responses, which are characterized by the increased and the decreased expression of the sympathetic nervous system, respectively. Moreover, active and passive defenses are accompanied by primarily endocannabinoid- and opioid-mediated analgesics, respectively. Through critical review of the literature, we apply the defense cascade model to better understand the pathological presentation of defensive responses in PTSD with a focus on the functioning of lower-level midbrain and extended brainstem systems.

Exogenous attention and memory for faces following contextual behavioral immune system activation

The behavioral immune system (BIS) is characterized by affective, cognitive and behavioral processes that work in an articulated manner to prevent the occurrence of infections. Attention and memory evolved to enhance the organism's chances of survival and have been proposed to play an important role in the BIS. The present study investigated the effects of attention and memory for neutral faces after a contextual activation of the BIS. Participants were primed, by the use of film clips, either with infectious disease concerns or non-infectious disease concerns. They performed an exogenous attentional task involving the discrimination of target letters, with face stimuli presented as distractors, which was then followed by a surprise recognition task for the faces. The results showed that participants in the infectious disease condition were more accurate in the attentional task than participants in the control condition. No significant difference between groups was found in the response times during the attention task nor in memory performance. Overall, these results suggest that the BIS might be associated with a hypervigilant state towards cues in general and that BIS activation through this type of priming may not be sufficient to clearly activate mnemonic mechanisms.

Experts Search for Meds to Help Youth With DMDD

Experts Search for Meds to Help Youth With DMDD

Sex Hormones and Processing of Facial Expressions of Emotion: A Systematic Literature Review.

Background: We systematically reviewed the literature to determine the influence of sex hormones on facial emotion processing (FEP) in healthy women at different phases of life.Methods: Searches were performed in PubMed, Web of Science, PsycINFO, LILACS, and SciELO. Twenty-seven articles were included in the review and allocated into five different categories according to their objectives and sample characteristics (menstrual cycle, oral contraceptives, pregnancy/postpartum, testosterone, and progesterone).Results: Despite the limited number of studies in some categories and the existence of inconsistencies in the results of interest, the findings of the review suggest that FEP may be enhanced during the follicular phase. Studies with women taking oral contraceptives showed reduced recognition accuracy and decreased responsiveness of different brain structures during FEP tasks. Studies with pregnant women and women in the postpartum showed that hormonal changes are associated with alterations in FEP and in brain functioning that could indicate the existence of a hypervigilant state in new and future mothers. Exogenous administration of testosterone enhanced the recognition of threatening facial expressions and the activation of brain structures involved in the processing of emotional stimuli.Conclusions: We conclude that sex hormones affect FEP in women, which may have an impact in adaptive processes of the species and in the onset of mood symptoms associated with the premenstrual syndrome.

Experiencing violence in a psychiatric setting: Generalized hypervigilance and the influence of caring in the fear experienced.

Exposure to violence in the mental health sector both affects employees and has implications for the quality of care provided. This phenomenological study aims to describe and understand the ways in which acts of aggression from a patient might affect workers in a psychiatric institute, their relationships with the patients and the services offered. Two semi-structured interviews were conducted with each of the 15 participants from various professions within a psychiatric hospital. Our analysis reveals four themes: hypervigilance, caring, specific fear toward the aggressor and generalized fear of all patients. A state of hypervigilance is found among all participants. An emphasis on caring is present among the majority and unfolds as a continuum, ranging from being highly caring to showing little or no caring. A feeling of fear is expressed and is influenced by the participant's place on the caring continuum. Caring workers developed a specific fear of their aggressor, whereas those showing little or no caring developed a generalized fear of all patients. Following a violent event, caring participants maintained this outlook, whereas those demonstrating little to no caring were more inclined to disinvest from all patients. Hypervigilance and fear caused by experiences of violence impact the quality of care provided. Considerable interest should thus be paid to caring, which can influence fear and its effects.

Major Depression with Delusional Prevalence and Fixation in Neurotransmitters

Making a differential diagnosis between schizoaffective disorder with major depressive episode and paranoid schizophrenia is difficult. The patient is at the threshold of neurotic versus psychotic, the intensity of ideation phenomenon being very high and specific to both disorders, it is required an assessment based on life and disorder history information, but also the emotional presence of the patient in the clinical interview. In this case study we suggest a literature comparison but also an evaluation profile of the disorder, marked by a psychiatric illness in which the person shows both affective symptoms (depressive or maniac) and symptoms of schizophrenia (such as delusions, hallucinations). Hypothesis: symptoms of the patient are oscillating between paranoid elements (paranoid schizophrenia) and affective elements (schizoaffective disorder). These oscillations are based on a fragile Ego structure with cognitive rigidity. The study outlines an immature-dependent personality profile, based on interpretativity, with passive-aggressive elements, hypersensitivity, psychotic operation and through psychotic elements manifested in the past (auditory hallucinations, as voices). Also, the basis of the transfer and counter-transference elements identified, the emotional resonance is low, with a risk of psychotic decompensation. Conclusions: Depressive schizoaffective disorder is characterized by presence of both depressive and schizophrenia symptoms in the same time period. Depressive symptoms includes: depressed mood, reduced interest, sluggishness, low energy, difficulty concentrating, insomnia, feelings of despair. During the same episode are present symptoms of schizophrenia: hallucinations, delusions of control, state of hyper-vigilance, delusions injury. Clinical examination cannot be a chance encounter because the history of mental suffering tight interfere with subject's essential history in that it creates a gap and that subjectivity psychiatric symptoms inferred immense emotional and personal participation of the subject.

A Qualitative Exploration of the Premigration Victimization Experiences of Sexual and Gender Minority Refugees and Asylees in the United States and Canada

Progress in analyzing and interpreting the concepts of sexual orientation and gender identity in the context of refugee law has contributed to a rise in individuals seeking asylum in such countries as the United States and Canada. However, few studies have examined the victimization experiences of sexual- and gender-identity forced migrants prior to their arrival in North America. This qualitative study used thematic analysis to explore the premigration adult victimization experiences of 26 lesbian, gay, and transgender individuals who obtained refugee, asylee, or withholding-of-removal status in the United States or Canada based on persecution for their sexual orientation and/or gender identity. Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. Analysis revealed the following themes: living on the edge, adopting concealment strategies, routine victimization, and protectors as perpetrators. Participants described living in a constant state of hypervigilance, and they adopted numerous strategies to protect themselves from victimization. Despite the use of such strategies, participants experienced victimization by community members and state actors, leaving them no choice but to flee to ensure their safety and well-being. Findings are discussed using the ecological framework outlined by the World Health Organization (WHO). The discussion concludes with implications for international policy and clinical practice.

Gangs and Knife crime: which comes first?

An 18 year old man was brought by ambulance to the hospital with multiple stab wounds to his limbs. His life was clearly in danger but his response to the medical team and paramedics who were trying to help him was one of extreme agitation, verbal aggression and generally being uncooperative. This young British man of Afro/Caribbean ethnicity had been in care since a young age. His brother was in prison and it soon became clear that he lived in a state of hyper-vigilance, fearing for his safety and was unable to articulate his high levels of anxiety and insecurity. This was clearly manifested in his aggressive and constant questioning of the medical teams around him. It was evident that settings such as the hospital, which was located in an area of London where he didn’t feel safe, made him very anxious; in this state of anxiety he was unable to manage his anger. Fortunately for this young man and indeed for the medical and nursing team who needed to focus on stabilizing his condition, there was a youth worker from an organization called Redthread (http://www.redthread.org.uk) present who was able to stay with him offering the support and reassurance which allowed the medical and nursing staff to

Shame: A Disowned Part of the Self

The patterns of our default mechanisms are laid down by the age of 3. This is the place we will default to in times of crisis later in life and for most of us this is a mostly stable place. But what if it’s not, what if we are defaulting to a very unstable and frightening place every time we experience emotional stress/crisis in our adult lives? Trauma, especially early childhood trauma, would cause this and even if we do not consciously know the trauma the mnemic memory trace of it would be enough to cause a disturbance in our default mechanisms. The result is that we would exist in a hypervigilant state, always waiting for the next traumatic event and, as per Freud’s pleasure/pain principle, that pressure will build to an unsustainable level meaning we will either explode and act out on/with others or implode and act in on ourselves. This is the motivation behind my exploration of the themes in the movie Shame and in particular the perceived childhood trauma of Brandon and his relationship with his sister Sissy.

The fast and the slow sides of cortisol's effects on emotional interference and sustained attention.

The fast and the slow sides of cortisol's effects on emotional interference and sustained attention.