Disorder Symptoms Research Articles

A multi-centre prospective cohort study investigating the roles of psychological flexibility and self-compassion in appearance concerns after burn injuries.

Appearance concerns following burn injuries are common. Psychological factors are important in maintaining such concerns. However, there is a lack of longitudinal or prospective research investigating their development. This study investigated whether psychological flexibility and self-compassion at hospital admission predicted subsequent appearance concerns. A multi-centre prospective cohort study across six burn services. Adults (n = 175; 67% male) in hospital following burn injuries were recruited. Questionnaires measuring appearance concerns, psychological flexibility, self-compassion, post-traumatic stress disorder symptoms and perceived noticeability were completed during hospital admission and two- and six-months later. Demographic and burn injury information was collected. Correlational analyses showed that increased psychological flexibility and self-compassion at admission were associated with decreased appearance concerns cross-sectionally and prospectively at two- and six-month follow-up. These associations remained significant when controlling for key covariates (i.e. gender, age, ethnicity, percentage total body surface area burnt, perceived noticeability, PTSD symptoms). Multiple linear regression analyses revealed that psychological flexibility and self-compassion predicted appearance concerns during hospital admission. Although psychological flexibility significantly predicted appearance concerns over time, it became non-significant when controlling for baseline appearance concerns. Psychological flexibility has a protective role against appearance concerns soon after burn injuries, although this protective role is reduced when accounting for baseline appearance concerns. Early interventions targeting psychological flexibility (i.e. acceptance and commitment therapy) may be beneficial after burns if adapted to address appearance-related concerns.

The Relationship Between Specific Adult Attention-Deficit/Hyperactivity Disorder Symptoms and Anxiety Using Self-Report Diagnostic Scales.

The Relationship Between Specific Adult Attention-Deficit/Hyperactivity Disorder Symptoms and Anxiety Using Self-Report Diagnostic Scales.

Investigating Attention Deficit Hyperactivity Disorder Symptoms, Emotional Dysregulation and Family Functioning in Children: A Community-Based Study in Elementary Schools in Surabaya, Indonesia.

Research on emotional dysregulation related to attention deficit hyperactivity disorder (ADHD) symptoms and its effects on family functioning in children is scarce. This is the first study conducted in Indonesia to examine the intricate relationships between ADHD symptoms, emotional regulation, and family functioning in children. A cross-sectional survey was conducted involving primary caregivers of children aged 9-13 years old across three elementary schools in Surabaya, using validated questionnaires comprising the Indonesian ADHD Rating Scale, Emotion Regulation Checklist, and Family APGAR scale. The findings revealed a positive association between ADHD features and the emotional lability/negativity subscale (ERLN) (r=0.528; p<0.001), but not the emotion regulation subscale (EREG). Moreover, family functioning positively correlated with ERLN (r= -0.269; p=0.003) and negatively correlated with EREG (r=0.331; p<0.001). Parental education emerged as a significant demographic factor, with higher education levels linked to better emotion regulation (r=0.297; p=0.001). These findings underscore the importance of addressing ADHD symptoms and emotional dysregulation in children in order to enhance family functioning and overall well-being. Implications for future research and interventions targeting emotion regulation, especially in children with ADHD and their families, are also discussed.

Delving into the role of reward and punishment sensitivity in anorexia nervosa: Punishment responsivity as the only predictor of eating disorder symptom persistence in adolescents.

This study differentiated between self-reported punishment responsivity (PR) and motivation to avoid punishment (MP) and examined their relationship with anorexia nervosa (AN) and its course in a combined cross-sectional and longitudinal approach. We explored whether inconsistent findings regarding reward sensitivity may be explained by previous research not differentiating between reward responsivity (RR) and motivation to approach reward (MR). Participants were 69 adolescents with AN and 69 adolescents without AN matched on age, sex and educational level. Eating disorder (ED) symptom severity, PR, MP, RR, and MR were assessed at the start of treatment and 1year later. Only PR was higher in patients with AN than in the comparison group. Both PR and MP decreased over the course of 1year, however, only the reduction in PR was related to the reduction in ED symptoms. Lastly, only higher baseline PR was independently related to less improvement in ED symptoms over the course of 1year. There was no support for the involvement of RS or its specific dimensions in AN. Most critical, the findings suggest that specifically the PR dimension of punishment sensitivity is related to the persistence of AN and could be an important target for treatment.

Neural Circuitry and Therapeutic Targeting of Depressive Symptoms in Schizophrenia Spectrum Disorders.

Conceptual similarities between depressive and negative symptoms complicate biomarker and intervention development. This study employed a data-driven approach to delineate the neural circuitry underlying depressive and negative symptoms in schizophrenia spectrum disorders (SSDs). Data from three studies were analyzed (157 participants with SSDs) to assess brain-behavior relationships: two neuroimaging studies and a randomized trial of repetitive transcranial magnetic stimulation (rTMS). Partial least squares correlation (PLSC) was used to investigate associations between resting-state functional connectivity and depressive and negative symptoms. Secondary analyses of rTMS trial data (active, N=37; sham, N=33) were used to assess relationships between PLSC-derived symptom profiles and treatment outcomes. PLSC identified three latent variables (LVs) relating functional brain circuitry with symptom profiles. LV1 related a general depressive symptom factor with positive associations between and within the default mode network (DMN), the frontoparietal network (FPN), and the cingulo-opercular network (CON). LV2 related negative symptoms (no depressive symptoms) via negative associations, especially between the FPN and the CON, but also between the DMN and the FPN and the CON. LV3 related a guilt and early wakening depression factor via negative rather than positive associations with the DMN, FPN, and CON. The secondary visual network had a positive association with general depressive symptoms and negative associations with guilt and negative symptoms. Active (but not sham) rTMS applied bilaterally to the dorsolateral prefrontal cortex (DLPFC) reduced general depressive but not guilt-related or negative symptoms. The results clearly differentiate the neural circuitry underlying depressive and negative symptoms, and segregated across the two-factor structure of depression in SSDs. These findings support divergent neurobiological pathways of depressive symptoms and negative symptoms in people with SSDs. As treatment options are currently limited, bilateral rTMS to the DLPFC is worth exploring further for general depressive symptoms in people with SSDs.

Impact of Vertigo on Quality of Life

Abstract Vertigo is a dynamic symptom that can evolve over time and can represent a sign of complex and or serious diseases. Vertigo is a frequent medical symptom in the population where an individual needs an urgent consultation with the clinician. Vertigo is a symptom of vestibular disorders that may lead to physical disability and poor quality of life (QoL). There is a wide range of pathologies for manifesting vertigo. The patient who suffers from vertigo often consults several clinicians before getting a final diagnosis and effective treatment. There is limited knowledge regarding vestibular illnesses, which cause disruptions in daily activities, despite the fact that some particular problems are connected to sleep, work, leisure, and emotional impairment. Patients with vertigo often present psychological manifestations such as panic attacks, postural phobic vertigo, agoraphobia, anxiety, and depression. A vicious cycle may happen, in which vertigo acts as a source of anxiety, which in turn causes dizziness, even after vertigo has disappeared. In this review paper, we analyze the most recent research on the link between vertigo and life quality, as well as its effects and impending difficulties. Different articles related to the impact of vertigo on QoL were analyzed for this review. The objective of this review article is to provide awareness among general practitioners, otolaryngologists, neurologists, and neuro-otologists about QoL affected by vertigo symptoms.

Hypocretin-1/Hypocretin Receptor 1 Regulates Neuroplasticity and Cognitive Function through Hippocampal Lactate Homeostasis in Depressed Model.

Cognitive dysfunction is not only a common symptom of major depressive disorder, but also a more common residual symptom after antidepressant treatment and a risk factor for chronic and recurrent disease. The disruption of hypocretin regulation is known to be associated with depression, however, their exact correlation is remains to be elucidated. Hypocretin-1 levels are increased in the plasma and hypothalamus from chronic unpredictable mild stress (CUMS) model mice. Excessive hypocretin-1 conducted with hypocretin receptor 1 (HCRTR1) reduced lactate production and brain-derived neurotrophic factor (BDNF) expression by hypoxia-inducible factor-1α (HIF-1α), thus impairing adult hippocampal neuroplasticity, and cognitive impairment in CUMS model. Subsequently, it is found that HCRTR1 antagonists can reverse these changes. The direct effect of hypocretin-1 on hippocampal lactate production and cognitive behavior is further confirmed by intraventricular injection of hypocretin-1 and microPET-CT in rats. In addition, these mechanisms are further validated in astrocytes and neurons in vitro. Moreover, these phenotypes and changes in molecules of lactate transport pathway can be duplicated by specifically knockdown of HCRTR1 in hippocampal astrocytes. In summary, the results provide molecular and functional insights for involvement of hypocretin-1-HCRTR1 in altered cognitive function in depression.

Prevalence and co-occurrence of symptoms of mental and substance use disorders among people with HIV age 40 and older in low- and middle-income countries: a cross-sectional study.

Due to the increased effectiveness of and access to antiretroviral therapy (ART), people with HIV (PWH) are living longer. As a result, the population of older PWH has increased. Mental and substance use disorders (MSDs) are common and frequently co-occurring among PWH and are associated with poor HIV care outcomes. Research into the prevalence and co-occurrence of MSDs among ageing PWH remains limited, particularly in low- and middle-income countries (LMICs). We analysed data collected between 2020 and 2022 from the International epidemiology Databases to Evaluate AIDS (IeDEA) Sentinel Research Network cohort of PWH aged 40 years or older on ART at 11 HIV clinics in Brazil, Côte d'Ivoire, India, Kenya, Mexico, Uganda, Rwanda, Togo, Vietnam, Zambia and Zimbabwe. We estimated the prevalence and co-occurrence of unhealthy alcohol use (AUDIT-C ≥3 for women, ≥4 for men), unhealthy drug use (ASSIST >3 for cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens and/or opioids), and moderate to severe symptoms of depression (PHQ-9 ≥10), anxiety (GAD-7 ≥10) and post-traumatic stress disorder (PTSD) (PCL-5 ≥33). Psychiatric multimorbidity was defined as having symptoms of two or more disorders assessed. Log binomial models assessed the association between socio-demographic and HIV care characteristics and symptoms of anxiety, depression, PTSD or unhealthy substance use. Of 2821 participants, the prevalence of unhealthy alcohol and drug use was 21% and 5%, respectively. The prevalence of moderate to severe symptoms of depression, anxiety and PTSD was 14%, 9% and 6%, respectively. Overall, the prevalence of psychiatric multimorbidity was 11%. Among those with symptoms of at least one mental health or substance use outcome assessed (n = 1036), the prevalence of psychiatric multimorbidity was 31%. In binomial models, the prevalence of symptoms of depression and anxiety was higher, while the prevalence of unhealthy alcohol and drug use was lower among women than men. Unhealthy alcohol use and symptoms of depression were most commonly reported, among this cohort of PWH aged 40 or older across 11 LMICs. Integration of MSD screening and treatment into HIV care should be prioritized. The effectiveness and implementation of transdiagnostic or multi-focus mental health treatment approaches in HIV care settings should be examined.

Compulsive buying disorder: Conceptualization based on addictive, impulsive, and obsessive-compulsive features and comorbidity

BackgroundThis study sought to examine the conceptualization of compulsive buying disorder in a sample of adults drawn from the community and its associated mental health correlates. MethodsAn online survey of “Personality, Mental Health, and Well-Being” was distributed to 300 adults aged 18–75 years. The survey measured a range of behaviors, such as buying behavior, alcohol and drug use, impulse control disorders, and dimensional constructs of impulsivity and obsessive-compulsiveness. ResultsA total of 294 participants (54.7% female) completed the survey and were included in the analysis. The overall frequency of probable compulsive buying disorder was 5.4% (n = 16). Compared to adults without compulsive buying disorder, those with probable compulsive buying disorder were significantly less likely to identify as heterosexual and were significantly more likely to endorse attention-deficit hyperactivity disorder, drug use problems, symptoms of borderline personality disorder, binge eating disorder, and had higher levels of compulsivity plus impulsivity. ConclusionCompulsive buying disorder appears to be fairly common in adults and appears to have symptom or diagnostic overlap with obsessive-compulsive problems, addictive disorders, and impulse control disorders. Findings highlight the need for careful clinical screening to identify often overlooked comorbidities and treat them on an individual patient basis, as well as the need to conduct high-quality clinical trials for compulsive buying disorder itself and to explore its presentation longitudinally at large scale.

Change processes associated with functional improvement in a web-based version of Skills Training in Affective and Interpersonal Regulation (webSTAIR) for trauma-exposed veterans.

In spite of the evidence that both symptom reduction and functional improvement are important for supporting recovery from trauma, psychotherapy process research has largely focused on mechanisms of symptom reduction. A better understanding of how change occurs in treatments that emphasize functional improvement rather than trauma processing is critical for optimizing effective, patient-centered care. This study involved secondary analysis of data collected in three multisite trials of a 10-module web-based version of Skills Training in Affective and Interpersonal Regulation, a skills-focused transdiagnostic intervention. The sample included 314 trauma-exposed veterans (38% male; 64% non-Hispanic White) who screened positive for elevated symptoms of posttraumatic stress disorder and/or depression. Latent change score modeling examined prospective relationships between changes from pre-to-mid and mid-to-post treatment in four potential mechanisms (emotion regulation, interpersonal problems, posttraumatic stress disorder symptoms, and depression symptoms) and the association of these changes with overall functional improvement (at posttreatment and follow-up). Emotion regulation change during the first half of treatment predicted interpersonal and symptom improvements during the second half of treatment, but not vice versa. Changes in each potential mechanism were uniquely associated with functional improvement and together statistically accounted for 78% additional variance in functional improvement beyond what was associated with baseline functioning and covariates. Results support emotion regulation as an early mechanism of transdiagnostic therapeutic change in web-based version of Skills Training in Affective and Interpersonal Regulation and highlight the relevance of all four potential mechanisms to functional improvement. The study contributes to an understanding of how change occurs in skills-focused interventions for trauma-exposed individuals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reducing COVID-19-Induced Educational Slumps—Training Preservice Teachers to Be Children Coaches: An Evaluation of Effects in Elementary Schools

The school closures due to the COVID-19 pandemic have had significant side effects, particularly on the psychological well-being of pupils. This situation poses great challenges for teachers in schools. At the same time, teacher education students have to be prepared for this situation by being trained to deal with difficult situations and pupils with symptoms of psychological disorders. Furthermore, they need to adequately address the increasing heterogeneity in terms of their pupils’ learning standards. To meet these challenges, the teaching project “CaBire” was called into being. As part of this project, teacher education students first receive theoretical input to act as socio-psychological coaches for children. After the training phase, students offer support to pupils at schools. This practical phase is accompanied by coaching-supervision seminars led by psychology teachers at the university. Both the practical phase, as well as the accompanying seminars at the university can be credited to teacher education students’ studies. Here we report a good-practice example and an evaluation of this teaching concept based on data of a mixed-method design. The results are promising and point towards a beneficial program for both teacher education students and pupils.

Contextual-compassion training for borderline personality disorder with long lasting symptoms: a randomized clinical trial

Long-term follow-up studies have shown that the symptoms of borderline personality disorder (BPD) tend to remit over time. However, many patients present long lasting symptoms (LLS), including low mood, emptiness, and persistent impairment in psychosocial adjustment. Given the high rate of LLS in BPD patients, new treatment strategies are needed. We conducted a randomized clinical trial (RCT) to evaluate the efficacy of a novel intervention that combines self-compassion and contextual-based skills for patients with persistent symptoms. Sixty BPD individuals with LLS who had received dialectical behavior therapy skills training (DBT-ST) in the previous six months were recruited and randomized to receive the experimental intervention or treatment as usual (TAU) for 12 weeks. All participants were evaluated pre- and post-intervention and at 3-months follow-up. The primary outcome measure was self-reported well-being. Other clinical variables were also evaluated, including depressive symptoms, BPD symptoms, functionality, self-compassion, and self-criticism. Participants in the experimental arm showed a significant increase in indicators of well-being (e.g., happiness and quality of life) and a significant decrease in depressive symptoms. These results were sustained—and even continued to improve—at the three-month follow-up. No significant changes were observed in BPD severity, self-criticism, or self-compassion. More RCTs are needed to test the efficacy of new interventions targeting this population with persistent symptoms, not only to reduce symptoms but also to promote well-being and personal recovery.

Differential impact of optogenetic stimulation of direct and indirect pathways from dorsolateral and dorsomedial striatum on motor symptoms in Huntington's disease mice

The alterations in the basal ganglia circuitry are core pathological hallmark in Huntington's Disease (HD) and traditionally linked to its sever motor symptoms. Recently it was shown that optogenetic stimulation of cortical afferences to the striatum is able to reverse motor symptoms in HD mice. However, the specific contribution of the direct and indirect striatal output pathways from the dorsolateral (DLS) and dorsomedial striatum (DMS) to the motor phenotype is still not clear. Here, we aim to uncover the contributions of these striatal subcircuits to motor control in wild type (WT) and HD mice by using the symptomatic R6/1 mice. We systematically evaluated locomotion, exploratory behavior, and motor learning effects of the selective optogenetic stimulation of D1 or A2A expressing neurons (direct and indirect pathway, respectively), in DLS or DMS. Bilateral optogenetic stimulation of the direct pathway from DLS and the indirect pathway from DMS resulted in subtle locomotor enhancements, while unaltering exploratory behavior. Additionally, bilateral stimulation of the indirect pathway from the DLS improved performance in the accelerated rotarod task, suggesting a role in motor learning. In contrast, in HD mice, stimulation of these pathways did not modulate any of these behaviors. Overall, this study highlights that selective stimulation of direct and indirect pathways from DLS and DMS have subtle impact in locomotion, exploratory activity nor motor learning. The lack of responses in HD mice also suggests that strategies involving cortico-striatal circuits rather than striatal output circuits might be a better strategy for managing motor symptoms in movement disorders.

Pain prevalence rates and the mediating role of negative affect in adults referred to personality disorder treatment: A cross-sectional study.

Personality disorders (PDs) are prevalent among individuals with chronic pain, but less is known about the prevalence of pain in the PD population. This study therefore sought to explore the prevalence of current or everyday pain among individuals referred to outpatient PD treatment, and further explore the mediating role of negative affect in the relationship between PD severity and current pain. Data was retrieved from the Norwegian Network for PDs' quality register which included 4361 participants. Pain was operationalized using the EQ-5D-3L "pain or discomfort" item and four SCL-90-R pain-related items ("pain bothersomeness"). Rates of self-reported pain were explored both pre and post treatment to determine the persistency of the pain-related symptoms. The role of negative affect in the relationship between PD severity and pain was investigated by linear regression analysis. A substantial burden of pain-related symptoms was demonstrated, as 71% and 80% reported moderate to extreme pain or discomfort and pain bothersomeness, respectively. Muscle soreness was the most common pain (59%) followed by headache (48%), low back pain (46%), and heart or chest pain (34%). Moderate to extreme pain or discomfort was persistent for 77% of the participants who provided end of treatment data (mean treatment duration was 82 weeks). Negative affect mediated the relationship between PD severity and pain. To our knowledge, this is the first large-scale study on everyday pain in patients with PDs. The findings reveal that moderate to extreme pain is prevalent among persons with PDs and that this co-occurrence is driven by negative affect. PERSPECTIVE: Pain is a prevalent and potentially underrecognized symptom in personality disorders and persists until treatment termination for a large group of patients. This co-occurrence may be driven by a susceptibility to negative affect that is enhanced by personality disorder features.

Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials: Antidepressants for Restricted and Repetitive Behaviors in Autism Spectrum Disorder.

In previously randomized controlled trials (RCTs) on the efficacy of antidepressants in restricted and repetitive behaviors (RRBs) in autism spectrum disorder (ASD), outcomes overwhelmingly showed no benefits of antidepressants studied in the larger multisite RCTs over placebo. However, the positive effect of antidepressants in the RRBs found in the small preliminary studies requires confirmation in larger trials. We aimed to systematically review the efficacy of antidepressants in the treatment of RRBs in ASD by including RCTs from the SCOPUS, PubMed, Embase, Cochrane Controlled Trials Register, Clinical Trials.gov, and other databases in January 2024. Analyzing data from 609 participants across nine RCTs showed no significant difference in the overall pooled mean-end score for RRBs between antidepressant- and placebo-treated groups [SMD (95% CI) of -0.25 (-0.53, 0.02), I2 = 54%, Tau2 = 0.10, prediction interval = -1.03, 0.53]. In small preliminary studies by one group, the clomipramine-treated group's pooled mean endpoint for obsessive-compulsive symptoms in ASD individuals showed a significantly better outcome than the desipramine-treated group, but in unconfirmed studies. Of the individual antidepressants investigated only clomipramine, and fluvoxamine illustrated some efficacy over placebo in small preliminary studies. These findings need confirmation in larger, multisite randomized controlled trials. There were no significant differences in the overall discontinuation rates or discontinuation due to adverse events between the antidepressant- and placebo-treated groups [RR (95% CI) of 1.30 (0.95, 1.78), I2 = 0%, and 1.33 (0.71, 2.47), I2=0%, respectively]. Common side effects included agitation, appetite disturbance, anorexia, gastrointestinal issues, and sleep disturbance, with no significant differences between the antidepressant and placebo groups. In conclusion, the results regarding the efficacy of antidepressants in the treatment of RRBs in ASD are inconsistent. Since previous evidence found a correlation between attention-deficit hyperactivity disorder (ADHD) symptoms including overactivity and impulsivity, and RRBs, further trials including the use of non-stimulants such as atomoxetine could be conducted.

Standardized weighted low-resolution electromagnetic tomography study of the amygdala activity in patients with comorbid major depressive disorder and anxiety symptoms

Major depressive disorder (MDD) often coexists with anxiety disorders or symptoms, as identified by previous functional magnetic resonance imaging (fMRI) studies. These studies have found abnormal amplitudes of low-frequency fluctuations (ALFF) in the amygdala, which serve as traits and state markers of MDD. This study used standardized weighted low-resolution electromagnetic tomography (swLORETA) technology to explore amygdala markers in patients with comorbid MDD and anxiety. Participants included patients with MDD comorbid with anxiety symptoms (MDD group) and healthy controls (HC group) who completed the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). EEG data collected under resting state, happiness recall, and depressive recall tasks were converted into current-source density (CSD) values using swLORETA to assess amygdala activation. The results indicated higher beta2, beta3, and high beta levels in both the left and right amygdalae during the resting state in the MDD group than in the HC group. Similarly, elevated levels of beta2, beta3, and high beta were observed in the left and right amygdalae of the MDD group during happiness and depressive recall tasks. These findings support the presence of hyperactivity in the amygdala under resting state and emotional tasks in patients with comorbid MDD and anxiety symptoms.

SUBJECTIVE SLEEP PARAMETERS: A MARKER TO PTSD SYMPTOMS EVOLUTION? A 4-YEAR LONGITUGINAL STUDY

Disturbed sleep is a common feature after exposure to a traumatic event, especially when PTSD develops. However, although there is evidence suggesting a potential role of sleep disturbance in the progression of PTSD symptoms, the interrelationship between sleep and PTSD symptoms has yet to be determined. In order to address this knowledge gap, we have investigated the influence of initial sleep characteristics on the evolution of post-traumatic stress disorder (PTSD) symptoms over 4 years of follow-up among individuals exposed to the Brazilian Kiss nightclub fire. Participants were individuals exposed to the 2013 Kiss nightclub fire in Brazil. Sleep characteristics and PTSD symptoms were measured within the 4 years following the fire by self-report questionnaires, such as The Pittsburgh Sleep Quality Index (PSQI), and PTSD Checklist - Civilian version (PCL-C). Generalized estimating equations (GEE) models were used to examine the longitudinal associations (by estimating the relative effects of initial sleep problems on PTSD symptoms after adjusting for covariates). Comprehensive information concerning socio-demographic factors, health status, and sleep complaints were obtained. A total of 232 individuals were included. In GEE models, no significant interactions were observed between sociodemographic variables and PTSD symptoms in the follow-up period, however, associations were found between PTSD at baseline and the following factors: the female gender, the victim individuals and the existence of prior psychiatric disease. Initial subjective sleep parameters were strongly associated with PTSD symptoms over 4 years, mainly the presence of disturbed dreams (p=0.012), increased sleep latency (p=0.029), and reduced sleep duration (p=0.012). Sleep complaints and PTSD symptoms were common among individuals after the disaster. The current study has found that the presence of sleep complaints, especially increased sleep latency, presence of disturbed dreams and short sleep duration, in the initial presentation after the fire was consistently associated with the perpetration of PTSD symptoms in the next 4 years of follow-up. These findings suggest that interventions addressing these sleep complaints have the potential to reduce the persistence and/or severity of PTSD symptoms.

Understanding Intensive Care Unit Family Caregivers' Vulnerability to Post-Traumatic Stress Disorder: The Impact of Neurotic Personality Traits, Emotional Suppression, and Perceptions of Unexpected Death.

Rationale: Family members of patients who die in an intensive care unit (ICU) are at heightened risk of post-traumatic stress disorder (PTSD) symptoms. Not all surrogates develop these symptoms and heterogeneity exists in PTSD symptom clusters. Objectives: The study tested a personality model of PTSD symptoms in bereaved family caregivers of ICU patients. It was hypothesized that family members endorsing higher levels of neurotic personality traits would report higher levels of PTSD symptom clusters and that these associations would be explained by tendencies to view the patient's death as unexpected and to cope by suppressing their emotions. Methods: Participants were family members of ICU patients at an urban, academic medical center who either died or were discharged to an inpatient hospice unit. Participants were contacted for participation at least six months after the patient's death. Participants completed measures of personality, emotion regulation, and PTSD symptoms. Data were analyzed using path analysis. Results: Approximately one-third (35%) of the sample of 162 caregivers endorsed at-risk levels of PTSD. Individuals reporting higher levels of neurotic personality traits reported more PTSD symptoms (r = 0.53, p < 0.001). Perceptions that the patient death was unexpected partially explained the association of neuroticism with the intrusive re-experiencing PTSD symptoms (B = 0.45, p = 0.031). In contrast, emotional suppression partially explained the association of neuroticism with avoidance (B = 0.70, p = 0.010) and hyperarousal symptom clusters (B = 0.37, p = 0.041). Conclusions: Family vulnerability to PTSD after an ICU death can be conceptualized based on neurotic personality traits. Tendencies to view the patient's death as unexpected may contribute to intrusive thoughts and memories of the ICU experience. Individuals may avoid reminders and remain at heightened levels of arousal when they suppress their emotional experiences. Key Message: Family members who experience the death of a loved one following ICU treatment are vulnerable to PTSD symptoms. These reactions to ICU-related losses may be shaped by family members' personalities, expectations, and emotion regulation styles. Understanding these characteristics could inform family screening and intervention efforts in the ICU.

Adverse Childhood Experiences and Socio-Emotional Outcomes of Children Born Very Preterm

ObjectiveTo examine whether adverse childhood experiences (ACEs) confer risk for socio-emotional problems in children born very preterm (VPT) Study designAs part of a longitudinal study, 96 infants born VPT at 23-30 weeks of gestation were recruited from a level III neonatal intensive care unit and underwent follow-up at ages 2 and 5 years. Eighty-three full-term (FT, 37-41 weeks gestation) children were recruited from an adjoining obstetric service and the local community. ACEs were assessed with the Child Life Events Scale at age 2 and Preschool Age Psychiatric Assessment at age 5. At age 5, internalizing, externalizing, and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms were assessed with the Child Behavior Checklist and Conner’s Rating Scale-Revised, respectively. Covariates including socioeconomic disadvantage, maternal distress, and parent ADHD symptoms were assessed at the 2- and/or 5-year follow-up. Mediation and moderation analysis, accounting for family clustering, examined associations between birth group, ACEs, and socio-emotional outcomes. ResultsAfter covariate adjustment, children born VPT experienced more ACEs (p<0.001), particularly medical ACEs (p<0.01), and had worse ADHD and internalizing outcomes (p<.05) than FT children. ACEs mediated the association between birth group and ADHD outcomes (95% CIs: 0.11 – 4.08). There was no evidence of mediation for internalizing outcomes. Higher parent ADHD symptoms (p<.001) and maternal distress (p<.05) were associated with poorer internalizing outcomes. ConclusionsScreening for childhood ACEs should be embedded in the follow-up care of children born VPT and their families. Strategies to screen for and address parent psychosocial functioning may be important to support children’s socio-emotional development.

Exploring the impact of biological sex on intrinsic connectivity networks in PTSD: A data-driven approach

IntroductionSex as a biological variable (SABV) may help to account for the differential development and expression of post-traumatic stress disorder (PTSD) symptoms among trauma-exposed males and females. Here, we investigate the impact of SABV on PTSD-related neural alterations in resting-state functional connectivity (rsFC) within three core intrinsic connectivity networks (ICNs): the salience network (SN), central executive network (CEN), and default mode network (DMN). MethodsUsing an independent component analysis (ICA), we compared rsFC of the SN, CEN, and DMN between males and females, with and without PTSD (n = 47 females with PTSD, n = 34 males with PTSD, n = 36 healthy control females, n = 20 healthy control males) via full factorial ANCOVAs. Additionally, linear regression analyses were conducted with clinical variables (i.e., PTSD and depression symptoms, childhood trauma scores) in order to determine intrinsic network connectivity characteristics specific to SABV. Furthermore, we utilized machine learning classification models to predict the biological sex and PTSD diagnosis of individual participants based on intrinsic network activity patterns. ResultsOur findings revealed differential network connectivity patterns based on SABV and PTSD diagnosis. Males with PTSD exhibited increased intra-SN (i.e., SN-anterior insula) rsFC and increased DMN-right superior parietal lobule/precuneus/superior occipital gyrus rsFC as compared to females with PTSD. There were also differential network connectivity patterns for comparisons between the PTSD and healthy control groups for males and females, separately. We did not observe significant correlations between clinical measures of interest and brain region clusters which displayed significant between group differences as a function of biological sex, thus further reinforcing that SABV analyses are likely not confounded by these variables. Furthermore, machine learning classification models accurately predicted biological sex and PTSD diagnosis among novel/unseen participants based on ICN activation patterns. ConclusionThis study reveals groundbreaking insights surrounding the impact of SABV on PTSD-related ICN alterations using data-driven methods. Our discoveries contribute to further defining neurobiological markers of PTSD among females and males and may offer guidance for differential sex-related treatment needs.