The long-term costs of traumatic stress: intertwined physical and psychological consequences

Relation between lifespan polytrauma typologies and post-trauma mental health

BACKGROUND

Most individuals experience more than one trauma. Hence, it is important to consider the count and types of traumas (polytraumatization) in relation to post-trauma mental health.

METHOD

The current study examined the relation of polytraumatization patterns to PTSD clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], and alterations in arousal and reactivity [AAR]), depression, and impulsivity facets (lack of perseverance, lack of premeditation, negative urgency, sensation seeking) using a web-based sample of 346 participants. Age, gender, race, and ethnicity were covariates.

RESULTS

Results of latent class analyses indicated a three-class solution: Low Experience, Moderate Experience - Predominent Threat/Indirect PTEs (Moderate Experience), and High Experience - Predominant Interpersonal PTEs (High/Interpersonal). Multinomial logistic regression results indicated that ethnicity and gender were significant covariates in predicting Low versus High/Interpersonal Class, and Moderate Experience versus High/Interpersonal Class membership, respectively. The High/Interpersonal Class had higher scores on most PTSD clusters, depression, and the impulsivity facets of lack of perseverance and negative urgency compared to the other classes. The Low and Moderate Experience Classes differed on PTSD's avoidance and AAR clusters (lower in the former).

CONCLUSIONS

Individuals exposed to multiple PTE types, particularly interpersonal traumas, may be at risk for more severe post-trauma symptoms.

The Evolutionary Life History Model of Externalizing Personality: Bridging Human and Animal Personality Science to Connect Ultimate and Proximate Mechanisms Underlying Aggressive Dominance, Hostility, and Impulsive Sensation Seeking

The present work proposes an evolutionary model of externalizing personality that defines variation in this broad psychobiological phenotype resulting from genetic influences and a conditional adaptation to high-risk environments with high extrinsic morbidity-mortality. Due to shared selection pressure, externalizing personality is coadapted to fast life history strategies and maximizes inclusive fitness under adverse environmental conditions by governing the major trade-offs between reproductive versus somatic functions, current versus future reproduction, and mating versus parenting efforts. According to this model, externalizing personality is a regulatory device at the interface between the individual and its environment that is mediated by 2 overlapping psychobiological systems, that is, the attachment and the stress-response system. The attachment system coordinates interpersonal behavior and intimacy in close relationships and the stress-response system regulates the responsivity to environmental challenge and both physiological and behavioral reactions to stress. These proximate mechanisms allow for the integration of neuroendocrinological processes underlying interindividual differences in externalizing personality. Hereinafter I further discuss the model's major implications for personality psychology, psychiatry, and public health policy.

Genetic predisposition toward suicidal ideation in patients with acute coronary syndrome

The genetic predisposition toward suicidal ideation has been explored to identify subgroups at high risk and to prevent suicide. Acute coronary syndrome (ACS) is associated with an increased risk of suicide, but few studies have explored the genetic predisposition toward suicide in ACS populations. Therefore, this longitudinal study explored the genetic predisposition toward suicidal ideation in ACS patients. In total, of 969 patients within 2 weeks after ACS, 711 were followed at 1 year after ACS. Suicidal ideation was evaluated with the relevant items on the Montgomery-Åsberg Depression Rating Scale. Ten genetic polymorphisms associated with serotonergic systems, neurotrophic factors, carbon metabolism, and inflammatory cytokines were examined. Associations between genetic polymorphisms and suicidal ideation within 2 weeks and 1 year of ACS were investigated using logistic regression models. The 5-HTTLPR s allele was significantly associated with suicidal ideation within 2 weeks of ACS after adjusting for covariates and after the Bonferroni correction. TNF-α -308G/A, IL-1β -511C/T, and IL-1β + 3953C/T were significantly associated with suicidal ideation within 2 weeks after ACS, but these associations did not reach significance after the Bonferroni correction in unadjusted analyses and after adjusting for covariance. However, no significant association between genetic polymorphisms and suicidal ideation was found at 1 year. Genetic predisposition, 5-HTTLPR s allele in particular, may confer susceptibility to suicidal ideation in ACS patients during the acute phase of ACS.

The impact of antecedent trauma exposure and mental health symptoms on the post-deployment mental health of Afghanistan-deployed Australian troops

BACKGROUND

Both traumatic deployment experiences and antecedent traumas increase personnel's risk of developing PTSD and depression. However, only cross-sectional studies have assessed whether antecedent trauma moderates stress reactions to deployment experiences. This study prospectively examines whether antecedent trauma moderates the association between deployment trauma and post-deployment PTSD and depressive symptoms after accounting for antecedent mental health problems, in a large Australian Defence Force (ADF) sample.

METHODS

In the ADF Middle East Area of Operations Prospective Study, currently-serving military personnel deployed to Afghanistan across 2010-2012 (n = 1122) completed self-reported measures at pre-deployment and post-deployment.

RESULTS

Within multivariable regressions, associations between deployment trauma and PTSD and depressive symptoms at post-deployment were stronger for personnel with greater antecedent trauma. However, once adjusting for antecedent mental health problems, these significant interaction effects disappeared. Instead, deployment-related trauma and antecedent mental health problems showed direct associations with post-deployment mental health problems. Antecedent trauma was also indirectly associated with post-deployment mental health problems through antecedent mental health problems. Similar associations were seen with prior combat exposure as a moderator.

LIMITATIONS

Antecedent and deployment trauma were reported retrospectively. Self-reports may also suffer from social desirability bias, especially at pre-deployment.

CONCLUSIONS

Our main effects results support the pervasive and cumulative negative effect of trauma on military personnel, regardless of its source. While antecedent trauma does not amplify personnel's psychological response to deployment trauma, it is indirectly associated with increased post-deployment mental health problems. Antecedent mental health should be considered within pre-deployment prevention programs, and deployment-trauma within post-operational screening.

The AIP Model of EMDR Therapy and Pathogenic Memories

Eye Movement Desensitization and Reprocessing (EMDR) therapy has been widely recognized as an efficacious treatment for post-traumatic stress disorder (PTSD). In the last years more insight has been gained regarding the efficacy of EMDR therapy in a broad field of mental disorders beyond PTSD. The cornerstone of EMDR therapy is its unique model of pathogenesis and change: the adaptive information processing (AIP) model. The AIP model developed by F. Shapiro has found support and differentiation in recent studies on the importance of memories in the pathogenesis of a range of mental disorders beside PTSD. However, theoretical publications or research on the application of the AIP model are still rare. The increasing acceptance of ideas that relate the origin of many mental disorders to the formation and consolidation of implicit dysfunctional memory lead to formation of the theory of pathogenic memories. Within the theory of pathogenic memories these implicit dysfunctional memories are considered to form basis of a variety of mental disorders. The theory of pathogenic memories seems compatible to the AIP model of EMDR therapy, which offers strategies to effectively access and transmute these memories leading to amelioration or resolution of symptoms. Merging the AIP model with the theory of pathogenic memories may initiate research. In consequence, patients suffering from such memory-based disorders may be earlier diagnosed and treated more effectively.

Seasonal Bushmeat Hunger in the Congo Basin

Unlike the Sudano-sahelian regions, which are confronted to severe periods of food shortage, tropical rainforests are known to provide a constant supply of a great diversity of food resources that mitigates the risk of food starvation for omnivorous humans. Nevertheless, several African forest ethnic groups suffer from a seasonal hunger induced by depletion in the procurement of bushmeat, which is a food of paramount importance. Although the diet remains well balanced and meets all the nutritional needs, the bushmeat cravers loose weight and experience a stress that affects their well-being. Bushmeat hunger is a psychocultural form of hunger that generates several mental disorders. We present results from nutritional anthropology studies carried out among various Congo Basin forest peoples, which regularly suffer from bushmeat hunger. We expose the physiological risks that result from this psychological unrest, we argue that this type of unsatisfied compiling desire for meat should be considered as a factor of food insecurity and we conclude on its incidence on bushmeat trade. The immoderate craving for bushmeat compromises the attempts to replace bushmeat by other sources of meat and is a persisting obstacle to conservation initiatives that fail to take the psychocultural values of bushmeat into consideration.

Fornix Structural Connectivity and Allostatic Load: Empirical Evidence From Schizophrenia Patients and Healthy Controls

OBJECTIVE

The fornix is a white matter tract carrying the fibers connecting the hippocampus and the hypothalamus, two essential stress-regulatory structures of the brain. We tested the hypothesis that allostatic load (AL), derived from a battery of peripheral biomarkers indexing the cumulative effects of stress, is associated with abnormalities in brain white matter microstructure, especially the fornix, and that higher AL may help explain the white matter abnormalities in schizophrenia.

METHODS

Using 13 predefined biomarkers, we tested AL in 44 schizophrenic patients and 33 healthy controls. Diffusion tensor imaging was used to obtain fractional anisotropy (FA) values of the fornix and other white matter tracts.

RESULTS

AL scores were significantly elevated in patients compared with controls (F(3,77) = 7.87, p = .006). AL was significantly and inversely correlated with FA of fornix in both controls (r = -.58, p = .001) and patients (r = -.36, p = .023). Several nominally significant (p < .05 but did not survive Bonferroni correction for multiple comparison) correlations were also observed between AL and FA of other white matter tracts in schizophrenic patients. However, the fornix was the only tract exhibiting a correlation with AL in both groups.

CONCLUSIONS

These results provide initial evidence that allostatic processes are linked to fornix microstructure in clinical participants.

The childhood maltreatment influences on breast cancer patients: A second wave hit model hypothesis for distinct biological and behavioral response

Stress and cancer are two complex situations involving different biological and psychological mechanisms. Their relationship have long been studied, and there is evidence of the impact stress has on both, development and disease progression. Furthermore, early stress has been studied as an important factor associated to this relationship, since its impacts on the immune, endocrine and cognitive development throughout life is already known. Therefore, understanding early stress as a first wave of stress in life is necessary in order to explore a possible second wave hit model. From this perspective, we believe that breast cancer can be understood as a second wave of stress during development and that, in addition to the first wave, can cause important impacts on the response to cancer treatment, such as increased chances of disease progression and distinct behavioral responses. In this article we propose a second wave hit hypothesis applied to breast cancer and its implications on the immune, endocrine and cognitive systems, through mechanisms that involve the HPA axis and subsequent activations of stress responses.

The implications of war captivity and long-term psychopathology trajectories for telomere length

BACKGROUND

Previous findings have demonstrated the link between trauma, its psychopathological aftermath and cellular aging, as reflected in telomere length. However, as long-term examinations of psychopathology following trauma are scarce, very little is known regarding the repercussions of depression and PTSD trajectories of psychopathology for telomeres. The current study examined the implications of war captivity and depression/PTSD trajectories on telomere length.

METHODS

Ninety-nine former prisoners of war (ex-POWs) from the 1973 Yom Kippur War were evaluated for depression and PTSD at 18, 30, 35 and 42 years after the war. Data on leukocyte telomere length of ex-POWs and 79 controls was collected 42 years after the war.

RESULTS

Ex-POWs had shorter telomeres compared to controls (Cohen's d=.5 indicating intermediate effect). Ex-POWs with chronic depression had shorter telomeres compared to those with delayed onset of depression (Cohen's d=4.89), and resilient ex-POWs (Cohen's d= 3.87), indicating high effect sizes. PTSD trajectories were not implicated in telomere length (Partial eta²=.16 and p=.11).

CONCLUSION

The findings suggest that the detrimental ramifications of war captivity are extensive, involving premature cellular senesces. These findings further point to the wear-and-tear effect of long-term depression, but not PTSD, on telomere length. Explanations for the findings are discussed.

The Amplification of Common Somatic Symptoms by Posttraumatic Stress Disorder in Firefighters

Posttraumatic stress disorder (PTSD) in emergency service personnel and other trauma-exposed populations is known to be associated with a variety of physical health problems. However, little attention has been paid to the health of ageing emergency service personnel, who may be forced into early medical retirement because of a combination of these issues. Currently employed (N = 274) Australian firefighters completed a cross-sectional survey using validated, self-report measures of PTSD and somatic symptoms. Analyses examined the association between probable PTSD and a range of common somatic symptoms, and whether any association differed depending on the age of the firefighters. Firefighters with PTSD reported greater levels of neurological (p = .024), gastrointestinal (p = .015), and cardiorespiratory (p = .027) symptoms compared to those without PTSD. After adjusting for sex, age, and rank, linear regression analysis demonstrated that PTSD was significantly associated with increased total somatic symptom severity (p = .024), with PTSD accounting for 9.8% of the variance in levels of somatic symptoms. There was no interaction between age and the association between PTSD and somatic symptom severity. These results suggest that PTSD is associated with a significant increase in a wide range of somatic symptoms among firefighters, regardless of age. The implications for the identification and treatment of PTSD are discussed.

The Need to Take a Staging Approach to the Biological Mechanisms of PTSD and its Treatment

Despite the substantial body of neurobiological research, no specific drug target has been developed to treat PTSD and there are substantial limitations with the available interventions. We propose that advances are likely to depend on the development of better classification of the heterogeneity of PTSD using a staging approach of disease. A primary rationale for staging is to highlight the probability that distinct therapeutic approaches need to be utilised according to the degree of biological progression of the disorder. Prospective studies, particularly of military populations, provide substantial evidence about the emerging biological abnormalities that precede the full-blown disorder. These need to be targeted with tailored interventions to prevent disease progression. Equally, the neurobiology of chronic unremitting PTSD needs to be differentiated from the acute disorder which emerges across a spectrum of severity, and this range of presentations correspondingly needs to be addressed with differing therapeutic strategies. The staging approach also needs to take account of the range of somatic pathological outcomes that are being identified as a consequence of traumatic stress exposure. PTSD should be conceptualised as a systemic disorder underpinned a range of biological dysregulation, including metabolic and altered immune function, reflected in the increased rates of cardiovascular and autoimmune disease. The effectiveness of novel treatments needs to be judged across their effectiveness in addressing the spectrum of trauma-related pathology.

Evaluating the EMDR Group Traumatic Episode Protocol With Refugees: A Field Study

In 2015, more than 1.5 million refugees arrived in Germany, many severely traumatized. Eye movement desensitization and reprocessing (EMDR) therapy has been proven to be an effective treatment for acute and chronic traumatic stress symptoms. A modification for provision in group settings was developed by E. Shapiro: the EMDR Group Traumatic Episode Protocol (G-TEP). In this field study, we investigated the effectiveness of 2 sessions of EMDR G-TEP in treating traumatized refugees. After receiving a psychoeducation session, 18 Arabic-speaking refugees from Syria and Iraq who had come to Germany during the previous 5 months were assigned to treatment and/or waitlist. The Impact of Event Scale-Revised (IES-R) and Beck Depression Inventory (BDI) were administered at pre- and posttreatment. Analysis was conducted using the Mann–Whitney U test and planned Kolmogorov–Smirnov tests. Results showed significant differences between the treatment and the waitlist groups, indicating a significant decline in IES-R scores (p < .05). Although differences in BDI scores did not reach significance (p = .06), a large decline in BDI scores was seen in the treatment group. These results provide preliminary evidence that it might be effective to treat groups of traumatized refugees with EMDR G-TEP.

EMDR, Community Psychology, and Innovative Applications of a Trauma Recovery Network as a Tool for Social Change

This article discusses the need for and ways to implement novel applications of early eye movement desensitization and reprocessing (EMDR) interventions (EEIs) at the community level for marginalized groups. Trauma Recovery Networks (locally based groups of licensed EMDR clinicians volunteering to provide pro bono disaster services, also known as TRNs) are an underused and insufficiently tapped tool when it comes to addressing the sequelae of disasters in our communities. We propose expanding our concept of and work with disasters beyond the traditional, legally recognized definition of Disaster (big D) to include ongoing stressful and traumatic community events or “little d” disasters. By serving those affected by little d disasters, the field of disaster response can be broadened in powerful ways. Marginalized communities typically suffer more and receive fewer services in the wake of traditional Disasters, threatening their civil rights and increasing the allostatic load on their collective health. Attending to the ongoing little d disasters, in these communities can be an important tool for social change, and various proposals for local TRNs are discussed.

Post-traumatic stress disorder moderates the relationship between trauma exposure and chronic pain

Background: Trauma exposure and post-traumatic stress disorder (PTSD) are risk factors for chronic pain. Objective: This study investigated how exposure to intentional and non-intentional traumatic events and PTSD are related to pain severity and outcome of treatment in chronic pain patients. Methods: We assessed exposure to potentially traumatizing events, psychiatric diagnosis with structured clinical interview, and pain severity in 63 patients at a secondary multidisciplinary pain clinic at the beginning of treatment, and assessed level of pain at follow up. Exposure to potentially traumatizing events and PTSD were regressed on pain severity at the initial session and at follow up in a set of multiple regression analysis. Results: The participants reported exposure to an average of four potentially traumatizing events, and 32% had PTSD. Exposure to intentional traumatic events and PTSD were significantly associated with more severe pain, and PTSD significantly moderated the relationship between trauma exposure and pain (all p < .05). The treatment programme reduced pain moderately, an effect that was unrelated to trauma exposure and PTSD. Conclusions: Trauma exposure is related to chronic pain in the same pattern as to mental disorders, with intentional trauma being most strongly related to pain severity. PTSD moderated the relationship between trauma exposure and pain. While pain patients with PTSD initially report more pain, they responded equally to specialist pain treatment as persons without PTSD.

Cannabis use among Canadian Armed Forces Veterans

Introduction: Despite rapidly changing cannabis use regulations in Canada, including health care support for Canadian Armed Forces (CAF) Veterans, the prevalence of and reasons for cannabis use in this population have not been studied. Methods: An online 28-item anonymous survey was used to examine the prevalence of cannabis use among CAF Veterans who reported undergoing treatment of PTSD ( N=120). We aimed to estimate the prevalence of cannabis use among CAF Veterans, as well as to explore the reasons for cannabis use in this population. We also examined the relationships between cannabis use and other aspects of health in CAF Veterans, namely other substance use, PTSD symptom severity, and chronic pain severity. Results: Approximately half of the respondents reported a history of cannabis use. Of these, approximately 35.5% reported beginning cannabis use before a military-related trauma, 23% reported beginning after a traumatic event, and 42% reported beginning after release. Participants stated that they used cannabis primarily for relaxation and emotional calm, and for pain management. Only 10% reported its use specifically for PTSD-related symptoms and anxiety. Chronic cannabis users (i.e., one or more years) endorsed a greater number of cannabis abuse symptoms than acute users (i.e., one time to less than three months). Cannabis users were also more likely to use both prescription and non-prescription drugs. No relationships were found between cannabis use and military-related PTSD symptom severity or pain severity. Discussion: Cannabis use, along with other substance use, is common among CAF Veterans, and the reasons for cannabis use vary greatly. Cannabis use does not appear to have an impact on PTSD- and pain-related symptom expression; however, further study is recommended.

Predicting the Transition From Acute Stress Disorder to Posttraumatic Stress Disorder in Children With Severe Injuries

INTRODUCTION

The purpose of this study was to examine predictors of risk for and the transition between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in a longitudinal sample of youth with severe injuries admitted to the hospital. These data would assist with treatment and discharge planning.

METHODS

Youth were assessed for ASD during the initial hospital stay and were followed-up over an 18-month period for PTSD (n = 151). Youth were classified into four groups, including Resilient (ASD-, PTSD-), ASD Only (ASD+, PTSD-), PTSD Only (ASD-, PTSD+), and Chronic (ASD+, PTSD+). Demographic, psychiatric, social context, and injury-related factors were examined as predictors of diagnostic transition.

RESULTS

The results of multivariate analysis of variance and pairwise comparisons found that peritraumatic dissociation, gender, and socioeconomic status were significant predictors after controlling for multiple testing.

DISCUSSION

Results suggest that both within-child and contextual factors contribute to the longitudinal response to trauma in children. Clinicians should consider early screening and discharge planning, particularly for children most at risk.

Hypertension after injury among burned combat veterans: A retrospective cohort study

BACKGROUND

The long-term health effects of burn are poorly understood. We sought to evaluate the relationship between burn and the subsequent development of hypertension.

METHODS

Retrospective cohort study of patients admitted to our burn center from 2003 to 2010. Data collected included demographic variables, burn size, injury severity score, presence of inhalation injury, serum creatinine, need for renal replacement therapy, as well as days spent in the hospital, in the intensive care unit and on mechanical ventilation. Data for the subsequent diagnosis of hypertension was obtained from medical records. Cox proportional hazard regression models were performed to determine what factors were associated with hypertension.

RESULTS

Of the 711 patients identified, 670 were included for analysis after exclusions. After adjustment, only age (HR 1.06 per one year increase, 95% confidence interval 1.03-1.08; p<0.001), percentage of total body surface area burned (HR 1.11 per 5% increase, 95% confidence interval 1.04-1.19; p=0.002) and acute kidney injury (HR 1.68, 95% confidence interval 1.05-2.69; p=0.03) were associated with hypertension.

CONCLUSION

Burn size is independently associated with the subsequent risk of hypertension in combat casualties. Clinical support for primary prevention techniques to reduce the incidence of hypertension specific to burn patients may be warranted.

The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews

BACKGROUND

First generation migrants are reportedly at higher risk of mental ill-health compared to the settled population. This paper systematically reviews and synthesizes all reviews on the mental health of first generation migrants in order to appraise the risk factors for, and explain differences in, the mental health of this population.

METHODS

Scientific databases were searched for systematic reviews (inception-November 2015) which provided quantitative data on the mental ill-health of first generation migrants and associated risk factors. Two reviewers screened titles, abstracts and full text papers for their suitability against pre-specified criteria, methodological quality was assessed.

RESULTS

One thousand eight hundred twenty articles were identified, eight met inclusion criteria, which were all moderate or low quality. Depression was mostly higher in first generation migrants in general, and in refugees/asylum seekers when analysed separately. However, for both groups there was wide variation in prevalence rates, from 5 to 44 % compared with prevalence rates of 8-12 % in the general population. Post-Traumatic Stress Disorder prevalence was higher for both first generation migrants in general and for refugees/asylum seekers compared with the settled majority. Post-Traumatic Stress Disorder prevalence in first generation migrants in general and refugees/ asylum seekers ranged from 9 to 36 % compared with reported prevalence rates of 1-2 % in the general population. Few studies presented anxiety prevalence rates in first generation migrants and there was wide variation in those that did. Prevalence ranged from 4 to 40 % compared with reported prevalence of 5 % in the general population. Two reviews assessed the psychotic disorder risk, reporting this was two to three times more likely in adult first generation migrants. However, one review on the risk of schizophrenia in refugees reported similar prevalence rates (2 %) to estimates of prevalence among the settled majority (3 %). Risk factors for mental ill-health included low Gross National Product in the host country, downward social mobility, country of origin, and host country.

CONCLUSION

First generation migrants may be at increased risk of mental illness and public health policy must account for this and influencing factors. High quality research in the area is urgently needed as is the use of culturally specific validated measurement tools for assessing migrant mental health.

Associations between lifetime potentially traumatic events and chronic physical conditions in the South African Stress and Health Survey: a cross-sectional study

BACKGROUND

This study examined the association between the type, and cumulative number of lifetime potentially traumatic events (PTEs), and chronic physical conditions, in a South African sample. PTE exposures have been associated with an increased risk for a wide range of chronic physical conditions, but it is unclear whether psychiatric disorders mediate this association. Given the established differences in trauma occurrence, and the epidemiology of posttraumatic stress disorder (PTSD) in South Africa relative to other countries, examining associations between PTEs and chronic physical conditions, particularly while accounting for psychiatric comorbidity is important.

METHODS

Data were drawn from the South African Stress and Health Study, a cross-sectional population-representative study of psychological and physical health of South African adults. Twenty-seven PTEs, based on the World Health Organization Composite International Diagnostic Interview Version 3.0, DSM-IV PTSD module were grouped into seven PTE types (war events, physical violence, sexual violence, accidents, unexpected death of a loved one, network events, and witnessing PTEs). Five clusters of physical conditions (cardiovascular, arthritis, respiratory, chronic pain, and other health conditions) were examined. Logistic regressions assessed the odds of reporting a physical condition in relation to type and cumulative number of PTEs. Cochran-Armitage test for trend was used to examine dose-response effect of cumulative PTEs on physical conditions.

RESULTS

After adjusting for sociodemographic variables and psychiatric disorders, respondents with any PTE had increased odds of all assessed physical conditions, ranging between 1.48 (95 % CI: 1.06-2.07) for arthritis and 2.07 (95 % CI: 1.57-2.73) for respiratory conditions, compared to those without PTE exposure. Sexual violence, physical violence, unexpected death of a loved one, and network PTEs significantly increased the odds of all or nearly all the physical conditions assessed. There was a dose-response relationship between number of PTEs and increased odds of all physical conditions.

CONCLUSIONS

Results from this study, the first in an African general population, are consistent with other population-based studies; PTEs confer a broad-spectrum risk for chronic physical conditions, independent of psychiatric disorders. These risks increase with each cumulative PTE exposure. Clinically, comprehensive evaluations for risk of mental and physical health morbidities should be considered among PTE survivors.

Resilient Coping Moderates the Effect of Trauma Exposure on Depression

Posttraumatic depression rates are increasing in the United States, and there is a great need to identify malleable factors that could moderate posttraumatic depression levels. The purpose of this study was to examine whether resilient coping moderates the effects of trauma exposure on depression, while controlling for neuroticism-an established predictor of depressive symptoms. This study used data from 3,734 pairs of twins from the community-based University of Washington Twin Registry. Each twin pair was randomized with twin A in one subsample and twin B in the second subsample. The four-item Brief Resilient Coping Scale measured resilient coping. The two-item Patient Health Questionnaire measured depression. Multiple linear regression analyses were performed on each subsample, controlling for neuroticism. In addition to significant effects of neuroticism and trauma exposure on depression (p < .001), the effect of the interaction of resilient coping and trauma exposure on depression was significant in both subsamples (p < .01). High levels of resilient coping were associated with lower depression scores in the context of previous trauma exposure. Individuals high in resilient coping who experienced significant life traumas were less depressed after trauma exposure, even after controlling for neuroticism. Because coping skills may be learned, interventions that teach resilient coping to individuals with traumatic histories merit investigation. © 2016 Wiley Periodicals, Inc.

High Prevalence of Post-Traumatic Stress Symptoms in Relation to Social Factors in Affected Population One Year after the Fukushima Nuclear Disaster

OBJECTIVE

This study investigated post-traumatic stress symptoms in relation to the population affected by the Fukushima Nuclear Disaster, one year after the disaster. Additionally, we investigated social factors, such as forced displacement, which we hypothesize contributed to the high prevalence of post-traumatic stress. Finally, we report of written narratives that were collected from the impacted population.

DESIGN AND SETTINGS

Using the Impact of Event Scale-Revised (IES-R), questionnaires were sent to 2,011 households of those displaced from Fukushima prefecture living temporarily in Saitama prefecture. Of the 490 replies; 350 met the criteria for inclusion in the study. Multiple logistic regression analysis was performed to examine several characteristics and variables of social factors as predictors of probable post-traumatic stress disorder, PTSD.

RESULTS

The mean score of IES-R was 36.15±21.55, with 59.4% having scores of 30 or higher, thus indicating a probable PTSD. No significant differences in percentages of high-risk subjects were found among sex, age, evacuation area, housing damages, tsunami affected, family split-up, and acquaintance support. By the result of multiple logistic regression analysis, the significant predictors of probable PTSD were chronic physical diseases (OR = 1.97), chronic mental diseases (OR = 6.25), worries about livelihood (OR = 2.27), lost jobs (OR = 1.71), lost social ties (OR = 2.27), and concerns about compensation (OR = 3.74).

CONCLUSION

Although there are limitations in assuming a diagnosis of PTSD based on self-report IES-R, our findings indicate that there was a high-risk of PTSD strongly related to the nuclear disaster and its consequent evacuation and displacement. Therefore, recovery efforts must focus not only on medical and psychological treatment alone, but also on social and economic issues related to the displacement, as well.

DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11)

BACKGROUND

Post-traumatic symptomatology is one of the signature effects of the pernicious exposures endured by responders to the World Trade Center (WTC) disaster of 11 September 2001 (9/11), but the long-term extent of diagnosed Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) and its impact on quality of life are unknown. This study examines the extent of DSM-IV PTSD 11-13 years after the disaster in WTC responders, its symptom profiles and trajectories, and associations of active, remitted and partial PTSD with exposures, physical health and psychosocial well-being.

METHOD

Master's-level psychologists administered sections of the Structured Clinical Interview for DSM-IV and the Range of Impaired Functioning Tool to 3231 responders monitored at the Stony Brook University World Trade Center Health Program. The PTSD Checklist (PCL) and current medical symptoms were obtained at each visit.

RESULTS

In all, 9.7% had current, 7.9% remitted, and 5.9% partial WTC-PTSD. Among those with active PTSD, avoidance and hyperarousal symptoms were most commonly, and flashbacks least commonly, reported. Trajectories of symptom severity across monitoring visits showed a modestly increasing slope for active and decelerating slope for remitted PTSD. WTC exposures, especially death and human remains, were strongly associated with PTSD. After adjusting for exposure and critical risk factors, including hazardous drinking and co-morbid depression, PTSD was strongly associated with health and well-being, especially dissatisfaction with life.

CONCLUSIONS

This is the first study to demonstrate the extent and correlates of long-term DSM-IV PTSD among responders. Although most proved resilient, there remains a sizable subgroup in need of continued treatment in the second decade after 9/11.

Posttraumatic stress symptoms in palliative care professionals seeking mindfulness training: Prevalence and vulnerability

BACKGROUND

Vicarious exposure to trauma is ubiquitous in palliative medicine. Repeated exposure to trauma may contribute to compassion fatigue and posttraumatic stress disorder symptoms in medical and supportive care professionals such as physicians, nurses, and social workers. These symptoms may be intensified among medical and supportive care professionals who use avoidant or rigid coping strategies.

AIM

This study aimed to provide an estimate of posttraumatic stress disorder symptoms in a sample of professionals who work in palliative care settings, and have already been enrolled in mindfulness-based communication training.

DESIGN

Palliative care providers provided self-reported ratings of posttraumatic stress disorder symptoms, depression, and coping strategies using validated measures including the Acceptance and Action Questionnaire, Cognitive Fusion Questionnaire, and the Posttraumatic Stress Disorder Checklist-Civilian Version.

SETTING/PARTICIPANTS

A total of 21 professionals working with palliative care patients completed assessments prior to beginning mindfulness-based communication training.

RESULTS

Posttraumatic stress disorder symptoms were prevalent in this sample of professionals; 42% indicated positive screens for significant posttraumatic stress disorder symptoms, and 33% indicated probable posttraumatic stress disorder diagnosis.

CONCLUSION

Posttraumatic stress disorder symptoms may be common among professionals working in palliative medicine. Professionals prone to avoidant coping and those with more rigid negative thought processes may be at higher risk for posttraumatic stress disorder symptoms.

Posttraumatic Stress Disorder-Related Hospitalizations in the United States (2002-2011): Rates, Co-Occurring Illnesses, Suicidal Ideation/Self-Harm, and Hospital Charges

The purpose of the present study was to evaluate posttraumatic stress disorder (PTSD)-related hospitalizations in the United States (2002-2011). Over this period, there were an estimated 1,477,944 hospitalizations (915,591 women) with either a primary (reason for hospitalization) or secondary PTSD diagnosis. Population-based hospitalization rates rose from 2002 to 2011; women in the age range of 20 to 44 years had the highest rates and the steepest rise. Most of the hospitalizations for men and women younger than 45 years had been assigned a primary diagnosis of mental illness (including PTSD). Mood and substance use disorders were among the most commonly co-occurring psychiatric diagnoses with PTSD. Suicidal ideation/suicide attempts declined with increasing age. The strongest predictor of this criterion was mood disorder, and its importance as a predictor increased as people aged. Total inflation-adjusted charges for all PTSD-related hospitalizations were $34.9 billion, with 36% being for hospitalizations where a mental illness (including PTSD) was the primary diagnosis.

Racial Differences in Posttraumatic Stress Disorder Vulnerability Following Hurricane Katrina Among a Sample of Adult Cigarette Smokers from New Orleans

Although blacks are more likely than whites to experience posttraumatic stress disorder (PTSD) after a natural disaster, the reasons for this disparity are unclear. This study explores whether race is associated with PTSD after adjusting for differences in preexisting vulnerabilities, exposure to stressors, and loss of social support due to Hurricane Katrina using a representative sample of 279 black and white adult current and past smokers who were present when Hurricane Katrina struck, and identified it as the most traumatic event in their lifetime. Multiple logistic regression models evaluated whether differential vulnerability (pre-hurricane physical and mental health functioning, and education level), differential exposure to hurricane-related stressors, and loss of social support deterioration reduced the association of race with PTSD. Blacks were more likely than whites to screen positive for PTSD (49 vs. 39 %, respectively, p = 0.030). Although blacks reported greater pre-hurricane vulnerability (worse mental health functioning and lower educational attainment) and hurricane-related stressor exposure and had less social support after the hurricane, only pre-hurricane mental health functioning attenuated the association of race with screening positive for PTSD. Thus, racial differences in pre-hurricane functioning, particularly poorer mental health, may partially explain racial disparities in PTSD after natural disasters, such as Hurricane Katrina. Future studies should examine these associations prospectively using representative cohorts of black and whites and include measures of residential segregation and discrimination, which may further our understanding of racial disparities in PTSD after a natural disaster.

Re-experiencing phenomena following a disaster: The long-term predictive role of intrusion symptoms in the development of post-trauma depression and anxiety

BACKGROUND

Contention in the literature regarding the diagnostic utility of intrusion symptoms highlights that they have high sensitivity but low specificity in predicting PTSD. They are highly prevalent following a range of traumatic events, and across a range of disorders. The prevalence of intrusion symptoms in the absence of PTSD suggests their relevance to the development of other psychopathology. Therefore, the predictive role of intrusion symptoms for other post-trauma psychopathology was examined using data from an epidemiological, longitudinal sample of adults recruited in childhood.

METHOD

From 5 phases of data collection for this sample, these analyses focused on the 20 year and 28 year follow-ups (n=583). Lifetime exposure to trauma was assessed using a modified set of 10 Criterion-A events from the Composite International Diagnostic Interview (CIDI), with PTSD assessed in reference to a self-nominated worst lifetime event, and other DSM-IV disorder also assessed using the CIDI.

RESULTS

Results showed that the presence of intrusion symptoms without PTSD at the 20 year follow-up was predictive of increased risk at 28 years for depressive but not anxiety disorders.

LIMITATIONS

There was limited psychopathology in the sample, reducing the power to examine many individual disorders. Furthermore, trauma history and psychiatric symptoms were retrospectively reported, introducing the possibility of recall bias.

CONCLUSION

Together the findings suggest that intrusion symptoms may play an aetiological role in the development and/or maintenance of disorders other than PTSD.

Associations between stress disorders and cardiovascular disease events in the Danish population

OBJECTIVES

Post-traumatic stress disorder (PTSD) is a well-documented risk factor for cardiovascular disease (CVD). However, it is unknown whether another common stress disorder-adjustment disorder--is also associated with an increased risk of CVD and whether gender modifies these associations. The aim of this study was to examine the overall and gender-stratified associations between PTSD and adjustment disorder and 4 CVD events.

DESIGN

Prospective cohort study utilising Danish national registry data.

SETTING

The general population of Denmark.

PARTICIPANTS

PTSD (n=4724) and adjustment disorder (n=64,855) cohorts compared with the general population of Denmark from 1995 to 2011.

PRIMARY OUTCOME MEASURES

CVD events including myocardial infarction (MI), stroke, ischaemic stroke and venous thromboembolism (VTE). Standardised incidence rates and 95% CIs were calculated.

RESULTS

Associations were found between PTSD and all 4 CVD events ranging from 1.5 (95% CI 1.1 to 1.9) for MI to 2.1 (95% CI 1.7 to 2.7) for VTE. Associations that were similar in magnitude were also found for adjustment disorder and all 4 CVD events: 1.5 (95% CI 1.4 to 1.6) for MI to 1.9 (95% CI 1.8 to 2.0) for VTE. No gender differences were noted.

CONCLUSIONS

By expanding beyond PTSD and examining a second stress disorder-adjustment disorder-this study provides evidence that stress-related psychopathology is associated with CVD events. Further, limited evidence of gender differences in associations for either of the stress disorders and CVD was found.

Symptom attribution and symptom reporting in Australian Gulf War veterans

OBJECTIVE

To better understand the consistent elevated symptom reporting by Gulf War veterans; we compared Australian Gulf War veterans and military-comparison group on symptom attributional styles and the relationship with total number and grouping of somatic and psychological symptoms.

METHOD

Postal questionnaires were completed by Australian Gulf War veterans (n=697) and military-comparison group (n=659) in 2000-2002 and 2011-2012. Data were collected on deployments, military-psychological stressors, symptom reporting, symptom factors and attributional style (normalising, psychologising, somatising, mixed-attribution).

RESULTS

Gulf War veterans did not differ in attributional style from comparison group (p>0.05); normalising was the predominant style. Groups were combined for analyses. Psychologisers reported the highest overall symptoms (mean(M)=10.95, standard deviation(SD)=9.15), the most psychophysiological (M=1.71, SD=2.82), cognitive (M=5.79, SD=5.09) and arthro-neuromuscular symptoms (M=1.53, SD=1.73). Psychologisers and somatisers reported significantly more symptoms across overall symptoms, all three symptom factors and psychological distress than normalisers. Normalisers consistently reported fewest overall symptoms (M=2.85, SD=4.49), psychophysiological (M=0.40, SD=0.98), cognitive (M=1.14, SD=2.22), and arthro-neuromuscular symptoms (M=0.72, SD=1.31). Persistent symptoms, rather than remitted, between baseline and follow-up were associated with increased rates of psychologising and mixed-attribution compared with normalising. For incident symptoms a similar pattern was observed, some symptoms also showed increased rates of somatising.

CONCLUSIONS

In veterans, psychologising was associated with higher symptom reporting, whilst somatisers and mixed-attribution also demonstrated higher reporting than normalisers. Symptom persistence and incidence were associated with symptom attribution. The findings indicate that attributional style is associated with patterns of symptom reporting and highlights both past and present symptoms may influence attributional style.

Sexual Behavior and Concerns in a Sample of Elderly, Former Indentured Swiss Child Laborers

Introduction

Past research suggests a link between post‐traumatic stress disorder (PTSD) and an increased risk for sexual problems. However, there is still no clear picture whether these higher rates are related to trauma exposure or to PTSD itself.

Aim

The aim of the present study was to complement existing knowledge on the relative impact of trauma and PTSD on sexuality in later life, considering different aspects of trauma exposure on both men and women.

Methods

The study was conducted on a unique population sample of former Swiss indentured child laborers (55 men, M_age 78, age range 60–95 years) who have repeatedly experienced a variety of severe childhood traumas.

Main Outcome Measures

Sexual outcomes were measured using two scales from the Trauma Symptom Inventory—Dysfunctional Sexual Behavior (DSB) and Sexual Concerns (SC). PTSD symptoms and trauma were assessed with the Short Screening Scale for PTSD and the Composite International Diagnostic Interview, respectively.

Results

Twenty‐two individuals showed PTSD symptoms, and 53 reported having experienced childhood trauma. Significant differences between men and women were reported for DSB and SC. Men reported a significantly higher prevalence of both SC and DSB compared with women.

Conclusions

This is the very first study investigating DSB and SC in a sample of older adults exposed to similar traumatic experiences and settings. However, some study limitations need to be considered such as the small sample size. Additional studies are needed to further explore the relative role of traumatization and PTSD on sexual behavior and well‐being, especially to improve sexual therapy for patients who experience trauma. Rechsteiner K, Burri A, and Maercker A. Sexual behavior and concerns in a sample of elderly, former indentured Swiss child laborers. Sex Med 2015;3:305–314.

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) occurs in 5-10% of the population and is twice as common in women as in men. Although trauma exposure is the precipitating event for PTSD to develop, biological and psychosocial risk factors are increasingly viewed as predictors of symptom onset, severity and chronicity. PTSD affects multiple biological systems, such as brain circuitry and neurochemistry, and cellular, immune, endocrine and metabolic function. Treatment approaches involve a combination of medications and psychotherapy, with psychotherapy overall showing greatest efficacy. Studies of PTSD pathophysiology initially focused on the psychophysiology and neurobiology of stress responses, and the acquisition and the extinction of fear memories. However, increasing emphasis is being placed on identifying factors that explain individual differences in responses to trauma and promotion of resilience, such as genetic and social factors, brain developmental processes, cumulative biological and psychological effects of early childhood and other stressful lifetime events. The field of PTSD is currently challenged by fluctuations in diagnostic criteria, which have implications for epidemiological, biological, genetic and treatment studies. However, the advent of new biological methodologies offers the possibility of large-scale approaches to heterogeneous and genetically complex brain disorders, and provides optimism that individualized approaches to diagnosis and treatment will be discovered.

Cumulative stress pathophysiology in schizophrenia as indexed by allostatic load

BACKGROUND

The etiopathophysiology of schizophrenia has long been linked to stress and the influence of stress is important in all stages of the illness. Previous examinations of perceived stress and acute stress responses may not capture this longitudinal stress pathophysiology. We hypothesized that the cumulative negative effects of stress, indexed by allostatic load (AL), would be elevated in schizophrenia, and that the AL paradigm would be relevant to our understanding of pathophysiology in schizophrenia.

METHODS

We assessed allostatic load in 30 patients with schizophrenia (SZ; mean age = 33; 17 males) and 20 healthy controls (HC; mean age = 35; 12 males) using 13 cardiovascular, metabolic, neuroendocrine and immune biomarkers. Participants' perceived stress over the past month, functional capacity and psychiatric symptoms were also measured.

RESULTS

Controlling for age, SZ had significantly higher AL as compared to HC (p = 0.007). Greater AL was present in both early course and chronic SZ, and was associated with reduced functional capacity (p = 0.006) and more psychotic symptoms (p = 0.048) in SZ. Current level of perceived stress was not significantly elevated in SZ or associated with AL in either group.

CONCLUSIONS

The higher AL found in SZ may reflect increased bodily "wear and tear", possibly caused by more chronic stress exposure or maladaptive responses to stress over time, although additional research is required to differentiate these causes. The higher AL is similarly present in early and chronic SZ, suggesting primary maladaptive stress physiology rather than secondary effects from medications or chronic illness.

Altered one-carbon metabolism in posttraumatic stress disorder

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with increased morbidity and mortality through somatic conditions, particularly cardiovascular disease. The one-carbon metabolism in connection with the hypothalamic-pituitary-adrenal (HPA)-axis may be an important mediator of this increased cardiovascular risk.

METHODS

In a mixed-gender sample of 49 PTSD patients and 45 healthy controls we therefore investigated: (1) alterations in the one-carbon metabolism as reflected in fasting plasma concentrations of homocysteine, folate, vitamins B6 and B12, and (2) associations of these one-carbon metabolites with the HPA-axis hormones cortisol, dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S).

RESULTS

After correction for confounders, PTSD patients had significantly elevated homocysteine (z = 2.963, p = .003) compared to controls, but normal levels of folate, vitamin B6 and B12. Comorbid depression did not explain the observed higher homocysteine levels. Patients showed increased risk for moderate hyperhomocysteinemia (OR = 7.0, χ(2) = 7.436, p = .006). Additionally, homocysteine was associated with PTSD severity (z = 2.281, p = .005). Moreover, all HPA-axis hormones were associated with folate in both patients and controls (all p's ≤ .011), while DHEA-S influenced folate in patients (z = 2.089, p = .037).

LIMITATIONS

Our clinical sample is relatively small and therefore small-sized effects may have remained undetected.

CONCLUSIONS

Our study indicates that: (1) the one-carbon metabolism is altered in PTSD patients, (2) earlier findings of higher homocysteine in male PTSD patients are generalized to female patients, (3) homocysteine is negatively associated with PTSD severity, and (4) HPA-axis alterations are associated with the one-carbon metabolism. Longitudinal studies are needed to determine whether elevated homocysteine levels reflect preexisting risk factors and/or consequences of psychological trauma.

Life Stressors and Posttraumatic Stress Disorder in a Seriously Mentally Ill Jail Population

Inmates represent a vulnerable population with increased rates of trauma and posttraumatic stress disorder (PTSD). However, little is known about the rates of trauma and PTSD among male inmates with acute psychiatric illness. This prospective, randomized study was conducted to assess the current rates of trauma and PTSD in this population. The sample consisted of 48 patients admitted to a hospital jail psychiatry service in New York City. Subjects were administered the Life Stressor Checklist-Revised and the Structured Clinical Interview for DSM-IV-TR Disorders, PTSD Module (SCID-I). The rate of PTSD diagnosis via SCID-I was 46.2% as compared to 2.1% diagnosis via clinical interview. All participants reported a history of at least one stressful and/or traumatic event, and many of these events occurred during incarceration. These results demonstrate that a great deal of trauma and PTSD goes unrecognized and untreated in this population, indicating the need for more effective treatment interventions.

One hundred years of lessons about the impact of war on mental health; two steps forward, one step back

OBJECTIVE

This paper outlines the substantial stigmatization of soldiers who suffered psychiatric disorders during World War I, and how there was little acceptance of the enduring impact of prolonged combat exposure once the war ended.

CONCLUSION

Recent decades of research highlight the delayed impact of combat exposure and its long-term neurobiological consequences.

Paradoxical Pain Perception in Posttraumatic Stress Disorder: The Unique Role of Anxiety and Dissociation

Posttraumatic stress disorder (PTSD) and chronic pain often co-occur and exacerbate each other. Elucidating the mechanism of this co-occurrence therefore has clinical importance. Previously, patients with PTSD with chronic pain were found to demonstrate a unique paradoxical pain profile: hyperresponsiveness together with hyposensitivity to pain. Our aim was to examine whether 2 seemingly paradoxical facets of PTSD (anxiety and dissociation) underlie this paradoxical profile. Patients with PTSD (n = 32) and healthy control individuals (n = 43) underwent psychophysical testing and completed questionnaires. Patients with PTSD had higher pain thresholds and higher pain ratings to suprathreshold stimuli than control individuals. Pain thresholds were positively associated with dissociation levels and negatively associated with anxiety sensitivity levels. Experimental pain ratings were positively associated with anxiety sensitivity and negatively related to dissociation levels. Chronic pain intensity was associated with anxiety, anxiety sensitivity, and pain catastrophizing. It appears that reduced conscious attention toward incoming stimuli, resulting from dissociation, causes delayed response in pain threshold measurement, whereas biases toward threatening stimuli and decreased inhibition, possibly caused by increased anxiety, are responsible for the intensification of experimental and chronic pain. The paradoxical facets of PTSD and their particular influences over pain perception seem to reinforce the coexistence of PTSD and chronic pain, and should be considered when treating traumatized individuals.

PERSPECTIVE

This article provides new information regarding the underlying mechanism of the coexistence of PTSD and chronic pain. This knowledge could help to provide better management of PTSD and chronic pain among individuals in the aftermath of trauma.

Is Post-Traumatic Stress Disorder Associated with Premature Senescence? A Review of the Literature

OBJECTIVE

Post-traumatic stress disorder (PTSD) has major public health significance. Evidence that PTSD may be associated with premature senescence (early or accelerated aging) would have major implications for quality of life and healthcare policy. We conducted a comprehensive review of published empirical studies relevant to early aging in PTSD.

METHOD

Our search included the PubMed, PsycINFO, and PILOTS databases for empirical reports published since the year 2000 relevant to early senescence and PTSD, including: 1) biomarkers of senescence (leukocyte telomere length [LTL] and pro-inflammatory markers), 2) prevalence of senescence-associated medical conditions, and 3) mortality rates.

RESULTS

All six studies examining LTL indicated reduced LTL in PTSD (pooled Cohen's d = 0.76). We also found consistent evidence of increased pro-inflammatory markers in PTSD (mean Cohen's ds), including C-reactive protein = 0.18, Interleukin-1 beta = 0.44, Interleukin-6 = 0.78, and tumor necrosis factor alpha = 0.81. The majority of reviewed studies also indicated increased medical comorbidity among several targeted conditions known to be associated with normal aging, including cardiovascular disease, type 2 diabetes mellitus, gastrointestinal ulcer disease, and dementia. We also found seven of 10 studies indicated PTSD to be associated with earlier mortality (average hazard ratio: 1.29).

CONCLUSION

In short, evidence from multiple lines of investigation suggests that PTSD may be associated with a phenotype of accelerated senescence. Further research is critical to understand the nature of this association. There may be a need to re-conceptualize PTSD beyond the boundaries of mental illness, and instead as a full systemic disorder.

Bimodal Modulation of Ipsilateral Spinal-Coeruleo-Spinal Pathway in CRPS: A Novel Model for Explaining Different Clinical Features of the Syndrome

OBJECTIVE

The objective is to present a hypothesis to explain the sensory, autonomic, and motor disturbances associated with complex regional pain syndrome (CRPS) syndrome.

METHODS

The author reviewed the available and relevant literature, which was supplemented with research on experimental animal models, with a focus on how they may translate into humans, particularly in areas about pathophysiologic mechanisms of CRPS.

RESULTS

We propose that different CRPS subtypes may result from facilitative or inhibitory influences exerted by the spinal-coeruleo-spinal pathway in three sites at the spinal cord: the dorsal horn (DH), intermediolateral cell column (IML) and ventral horn (VH). A facilitatory influence over DH may have a pronociceptive effect that explains exacerbated pain, sensory disturbances, and spreading sensitization and neuroinflammation. Conversely, a facilitatory influence over preganglionic neurons located in IML cell column may increase sympathetic outflow with peripheral vasoconstriction, which leads to cold skin, ipsilateral limb ischaemia, and sympathetically maintained pain (SMP). For patients presenting with these symptoms, a descending inhibitory influence would be predicted to result in decreased sympathetic outflow and warm skin, as well as impairment of peripheral vasoconstrictor reflexes. Finally, a descending inhibitory influence over VH could explain muscle weakness and decreased active range of motion, while also facilitating motor reflexes, tremor and dystonia.

CONCLUSIONS

The proposed model provides a mechanistically based diagnostic scheme for classifying and explaining the sensory, autonomic and motor disturbances associated with CRPS syndrome.

Eye movement desensitization and reprocessing (EMDR) therapy in the treatment of depression: a matched pairs study in an inpatient setting

BACKGROUND

Depression is a severe mental disorder that challenges mental health systems worldwide as the success rates of all established treatments are limited. Eye Movement Desensitization and Reprocessing (EMDR) therapy is a scientifically acknowledged psychotherapeutic treatment for PTSD. Given the recent research indicating that trauma and other adverse life experiences can be the basis of depression, the aim of this study was to determine the effectiveness of EMDR therapy with this disorder.

METHOD

In this study, we recruited a group of 16 patients with depressive episodes in an inpatient setting. These 16 patients were treated with EMDR therapy by reprocessing of memories related to stressful life events in addition to treatment as usual (TAU). They were compared to a group of 16 controls matched regarding diagnosis, degree of depression, sex, age and time of admission to hospital, which were receiving TAU only.

RESULTS

Sixty-eight percent of the patients in the EMDR group showed full remission at end of treatment. The EMDR group showed a greater reduction in depressive symptoms as measured by the SCL-90-R depression subscale. This difference was significant even when adjusted for duration of treatment. In a follow-up period of more than 1 year the EMDR group reported less problems related to depression and less relapses than the control group.

CONCLUSIONS

EMDR therapy shows promise as an effective treatment for depressive disorders. Larger controlled studies are necessary to replicate our findings.