Complex PTSD in asylum-seekers living in a humanitarian setting in Africa: A latent class analysis

[Correction Notice: An Erratum for this article was reported online in Psychological Trauma: Theory, Research, Practice, and Policy on May 08 2023 (see record 2023-69929-001). In the original article, paragraphs 1 through 3 of the main text and the first paragraph under "PTSD and CPTSD Symptoms" in the Methods section were rewritten to avoid text similarity with that of a previously published article "Evidence of Distinct Profiles of ICD-11 Post-Traumatic Stress Disorder (PTSD) and Complex PTSD in a South African Sample," by James Rink and Gosia Lipinska (European Journal of Psychotraumatology, 2020, Vol. 11, No. 1, Article 1818965, https:// doi.org/10.1080/20008198.2020.1818965). All versions of this article have been corrected.] Objective: This study investigated ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) symptom profiles and their premigration, postmigration, and demographic predictors in a treatment-seeking sample of asylum-seekers in Agadez (Niger).

METHOD

Participants were 126 asylum-seekers hosted in a large, isolated reception camp in the desert surroundings of Agadez (humanitarian site) or in a number of small urban hosting facilities (cases de passages) who completed measures of trauma exposure and PTSD/CPTSD symptoms. Latent class analysis (LCA) was used to identify symptom profiles, and predictors of class membership were identified via multinomial logistic regression.

RESULTS

More asylum seekers met the criteria for CPTSD (74.6%) than PTSD (19.8%) and no gender differences were observed. LCA results identified two distinct groups: (a) a CPTSD class (69.0%); and (b) a PTSD class (31.0%). Membership in the CPTSD class was significantly predicted by the early age of the first traumatic event, levels of functional impairment and reception conditions. Specifically, those in the CPTSD class were more likely to live in the humanitarian site compared with those in the PTSD class.

CONCLUSION

This study supported the validity of the ICD-11 construct of CPTSD in an asylum-seeker sample living in a low-income country. Moreover, the findings suggest that not only premigration factors (i.e., the early age of the first trauma) but also postmigration stressors (i.e., precarious reception conditions in large, isolated facilities) are important predictors of CPTSD symptoms with important implications regarding reception policies and the prevention of trauma-related mental disorders in asylum seekers and refugees. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Voice hearing in refugees survivors of traumatic events

The term voice hearing (VH) refers to the experience of hearing voices in the absence of corresponding external stimuli and is considered a hallucinatory experience. According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association [APA], 2013), hallucinations are perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control. Specifically, auditory hallucinations involve the perception of sound, most frequently of voices (i.e., auditory verbal hallucinations- AVHs) but sometimes of clicks or other noises, that are not restricted to the period of awakening or the onset of sleep. AVHs are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual's own thoughts.

A Schema Therapy approach to complex dissociative disorder in a cross-cultural setting: a single case study

Complex dissociative disorders (CDD) include dissociative identity disorder (DID) and the most common other specified dissociative disorder (OSDD, type 1). While consensus-based treatments for CDD are lacking in several international guidelines, patients suffering from CDD show high levels of impairment, treatment utilization and costs. Migrants and refugees often present risk factors for trauma-related and dissociative disorders and need effective and culturally adapted treatments. Schema Therapy (ST) is an integrative psychotherapy that has been recently proposed as a treatment for CDD. This case study examined the process of individual ST, in a three phases-based approach, with a 38-year-old male Yemeni refugee with OSDD, type 1, posttraumatic stress disorder and borderline personality disorder. The treatment was provided in a Western country and the setting included two Western therapists (co-therapy) and an Arabic interpreter/cultural mediator. We assessed the patient's change by using self-report assessments of dissociative and PTSD symptoms, cognitive schemas over 2-year and 4-months treatment periods and a 6-months follow-up. Posttreatment and follow-up reliable change analyses showed significant improvements in dissociative and PTSD symptoms as well as in some cognitive schemas. Despite any firm conclusion cannot be drawn due to the limitations of this study (i.e., single case study), the findings suggest that ST integrated in a phase-oriented approach may be an effective treatment for CDD. Additionally, our study provides some preliminary elements about cross-cultural validity of the schema modes construct as well as cross-cultural effectiveness of ST. More research based on larger samples and specific cross-cultural focused design is needed to confirm these assumptions.

Patterns and predictors of PTSD in treatment-seeking African refugees and asylum seekers: A latent class analysis

BACKGROUND

Despite the empirical and clinical relevance of understanding posttraumatic stress disorder (PTSD) heterogeneity in refugees and asylum-seekers, very few studies have examined the manner in which PTSD symptoms manifest in such populations.

AIMS

This study sought to investigate patterns and predictors of DSM-5 PTSD in a treatment-seeking sample of African refugees.

METHODS

Participants were 122 African refugees and asylum-seekers living in Italy who completed measures of trauma exposure and PTSD symptoms. Latent class analysis (LCA) was used to identify PTSD symptom profiles, and predictors of class membership were identified via multinomial logistic regression.

RESULTS

Among participants, 79.5% had a probable diagnosis of PTSD. Three PTSD classes were identified by LCA: Pervasive (32.0%) with high probabilities of all symptoms, high-Threat (45.9%) with higher probabilities of intrusions and avoidance symptoms, moderate-Avoidance (22.1%) with high probability of thoughts/feelings avoidance. None of the examined variables (legal status, gender, age, education, months spent in Italy, number of traumatic events, employment) significantly predicted class membership with the relevant exception of reception conditions. Specifically, living in large reception centres (over 1,000 people) significantly predicted Pervasive PTSD class membership compared to high/Threat PTSD class and to moderate/Avoidance class.

CONCLUSION

This study provides evidence for distinct patterns of PTSD symptomatology in refugees and asylum seekers. We identified three classes which present both qualitative and quantitative differences in symptoms: Pervasive class, high-Threat class and a new moderate class, characterised by avoidance symptoms. Reception conditions contributed to the emergence of the Pervasive PTSD profile characterised by the symptoms highest severity. These findings highlight that stressors in the post-migration environment, as inadequate reception conditions in large facilities, may have detrimental effect on refugees' mental health. We emphasise the importance for host countries to implement reception models that provide effective protection and integration to this vulnerable population.

Depression in the Mirror: Depression Severity and Its Link to Negative Judgments of Symptoms

Background and Objectives: Depressive states represent a normal and physiological response to the experience of loss. However, it is possible to identify some elements that allow distinguishing physiological depressive states from pathological ones. Over the years, research has confirmed that a stable tendency to negative self-evaluation is a transdiagnostic factor that triggers and amplifies dysfunctional emotional reactivity, thus contributing to the shift from normal to pathological reaction. In this sense, the secondary problem, or meta-emotional problem, referring to the negative evaluation of one's depressive state and the consequent dysfunctional attempts to solve it, seems to play an important role. The aim of the present study is to investigate how dysfunctional beliefs and the evaluations of depressive symptoms (meta-emotional problems) are related to depression severity. Methods: We asked to a community sample to focus on the depressive symptoms they regard as most distressful and evaluate them through specific questionnaires. One-hundred and eighty nine participants were asked to complete a set of questionnaires: (1) the Meta-Emotional Problem Questionnaire; (2) the Center for Epidemiologic Studies Depression Scale; (3) the Beck Depression Inventory; (4) the Dysfunctional Attitude Scale-24 in order to investigate the relation between dysfunctional beliefs, meta-emotional problems, and depressive symptoms severity. Results: Our results show that higher levels of depression are associated both to more pervasive dysfunctional attitudes and increased evaluation of meta-emotional problem. In addition, we conduct a regression analysis to disentangle the impact of the two different measures of depressive symptoms (i.e., BDI-II and CES-D) with two explanatory variables (dysfunctional attitudes and meta-emotional problem). Results show that meta-emotional problem remains a significant and robust predictor of the severity of depressive symptomatology, while dysfunctional beliefs has a rather weak and non-significant relation with the criterion. In other words, meta-emotional problem consistently explains the higher variance of depressive symptoms than dysfunctional beliefs. In conclusion, our study shows a clear link between meta-emotional problem and depression severity. This is relevant for clinical practice, as it highlights the importance of specifically targeting beliefs about the depressive condition in cognitive-behavioral treatment of depression, since they represent crucial factors maintaining depressive symptomatologies.

[Efficacy of third wave cognitive therapies in the treatment of psychosis: a meta-review]

INTRODUCTION

The therapeutic approaches of the so-called "third wave" of clinical cognitivism have assumed increasing relevance in recent years alongside cognitive-behavioral therapy in the treatment of psychosis.

AIMS

To evaluate the efficacy of some of the most relevant third wave cognitive-behavioral approaches (metacognitive interventions and therapies based on mindfulness and acceptance) in the treatment of psychosis.

METHOD

A systematic research was carried out for systematic reviews and meta-analysis on the efficacy of metacognitive interventions and mindfulness- and acceptance-based therapies in the treatment of psychosis, published from 1 January 2009 to 31 December 2018. The selected studies were evaluated using AMSTAR 2, a valid and reliable tool composed of 16 items to measure the methodological quality of systematic reviews and meta-analysis.

RESULTS

7 meta-analysis were selected: 4 for metacognitive therapies (3 of low quality, 1 of critically low quality) and 3 for mindfulness- and acceptance-based therapies (1 of medium quality, 2 of low quality).

DISCUSSION AND CONCLUSIONS

Among metacognitive therapies, metacognitive training has shown promising results on positive symptoms and in particular on the psychopathology of delusions. Mindfulness- and acceptance-based therapies have shown mild to moderate effects on general and positive symptoms as well as some effects on negative symptoms, depressive symptoms, hospitalization rates and length. However, further research is needed to confirm overall the encouraging results of both metacognitive training and mindfulness- and acceptance-based therapies as the small number of randomized controlled trials and the low methodological quality of most meta-analysis realized up to date does not allow to draw yet sufficiently solid conclusions on their efficacy in the treatment of psychosis.

[Efficacy of cognitive behavioural therapy in the treatment of psychosis: a meta-review]

INTRODUCTION

Although cognitive behavioural therapy (CBT) for psychosis is recommended by the main international guidelines, its effective efficacy in the treatment of schizophrenia and psychosis is still debated.

AIMS

To evaluate the efficacy of cognitive behavioural therapy in the treatment of psychosis.

METHOD

A systematic research was carried out for systematic reviews and meta-analysis on the efficacy of CBT in the treatment of psychosis, published from 1 January 2009 to 31 December 2018. The selected studies were evaluated using AMSTAR 2, a valid and reliable tool composed of 16 items to measure the methodological quality of systematic reviews and meta-analysis.

RESULTS

20 meta-analysis were selected: 2 of high quality, 5 of moderate quality, 6 of low quality, 7 of critically low quality.

DISCUSSION AND CONCLUSION

CBT is an effective therapy compared to treatment as usual, for positive, negative and general symptoms of psychosis (with a particularly large number of studies in favour of positive symptoms), with effects of medium-small size. On the other hand, there is no clear and convincing advantage for CBT over other psychological and psychosocial therapies for symptoms, relapses, social functioning and quality of life in people with psychosis even if today the quality of the trials available is mostly of low or very low quality and further research is needed to reach reliable conclusions. Further and more rigorous research is certainly needed also to establish the effective efficacy of CBT on secondary symptoms, insight and non-symptomatic outcomes. CBT does not seem to produce significant effects in the prevention of psychotic relapses.

Complex trauma, PTSD and complex PTSD in African refugees

Background: The introduction of the diagnosis of complex posttraumatic stress disorder (CPTSD) by ICD-11 is a turning point in the field of traumatic stress studies. It's therefore important to examine the validity of CPTSD in refugee groups exposed to complex trauma (CT) defined as a repeated, prolonged, interpersonal traumatic event. Objective: The objective of this study was to compare DSM-5 and ICD-11 post-traumatic stress disorder diagnoses and to evaluate the discriminant validity of ICD-11 PTSD and CPTSD constructs in a sample of treatment-seeking refugees living in Italy. Method: The study sample included 120 treatment-seeking African refugees living in Italy. All participants were survivors of at least one CT. PTSD and CPTSD diagnoses were assessed according to both DSM-5 and ICD-11 criteria. Results: Findings revealed that 79% of the participants met the DSM-5 criteria for PTSD, 38% for ICD-11 PTSD and 30% for ICD-11 CPTSD. Generally, ICD-11 CPTSD items evidenced strong sensitivity and negative predictive power, low specificity and positive predictive power. Latent class analysis results identified two distinct groups: (1) a PTSD class, (2) a CPTSD class. None of the demographic and trauma-related variables analysed was significantly associated with diagnostic group. On the other hand, the months spent in Italy were significantly associated with PCL-5 score. Conclusions: Findings extend the current evidence base to support the discriminant validity of PTSD and CPTSD amongst refugees exposed to torture and other gross violations of human rights. The results suggest also that, in the post-traumatic phase, the time spent in a 'safe place' condition contributes to improve the severity of post-traumatic symptomatology, but neither this variable nor other socio-demographic factors seem to contribute to the emergence of complex PTSD. Further investigations are needed to clarify which specific vulnerability factors influence the development of PTSD or CPTSD in refugees exposed to complex trauma.

Social threat exposure in juvenile mice promotes cocaine-seeking by altering blood clotting and brain vasculature

Childhood maltreatment is associated with increased severity of substance use disorder and frequent relapse to drug use following abstinence. However, the molecular and neurobiological substrates that are engaged during early traumatic events and mediate the greater risk of relapse are poorly understood and knowledge of risk factors is to date extremely limited. In this study, we modeled childhood maltreatment by exposing juvenile mice to a threatening social experience (social stressed, S‐S). We showed that S‐S experience influenced the propensity to reinstate cocaine‐seeking after periods of withdrawal in adulthood. By exploring global gene expression in blood leukocytes we found that this behavioral phenotype was associated with greater blood coagulation. In parallel, impairments in brain microvasculature were observed in S‐S mice. Furthermore, treatment with an anticoagulant agent during withdrawal abolished the susceptibility to reinstate cocaine‐seeking in S‐S mice. These findings provide novel insights into a possible molecular mechanism by which childhood maltreatment heightens the risk for relapse in cocaine‐dependent individuals.

Regulation of nucleus accumbens transcript levels in mice by early-life social stress and cocaine

Much interest has been piqued regarding the quality of one's environment at early ages in modulating the susceptibility to drug addiction in adulthood. However, the molecular mechanisms that are engaged during early trauma and mediate the risk for drug addiction are poorly understood. In rodents, exposure to early-life stress alters the rewarding effects of cocaine, amphetamine, and morphine in adulthood. Recently, we demonstrated that the exposure of juvenile mice to social threat (Social Stress, S-S) promoted cocaine-seeking behavior and relapse of cocaine-seeking after periods of withdrawal, compared with unhandled controls (UN) and with juvenile mice that experienced only daily isolation in a novel environment (no social stress, NS-S). Interestingly, while the exposure to NS-S slightly increased cocaine-seeking behavior compared with UN, the same was not sufficient to promote cocaine reinstatement. In this study, we examined the long-term transcriptional changes that are induced by S-S compared to NS-S and linked the increased susceptibility of S-S mice to cocaine reinstatement. To this end, we performed genome-wide RNA sequencing analysis in the nucleus accumbens (NAC), which revealed that 89 transcripts were differentially expressed between S-S and NS-S mice. By Gene Ontology classification, these hits were enriched in genes that mediate cell proliferation, neuronal differentiation, and neuron/forebrain development. Eleven of these genes have been reported to be involved in substance use disorders, and the remaining genes are novel candidates in this area. We characterized 4 candidates with regard to their significant neurobiological relevance (ZIC1, ZIC2, FABP7, and PRDM12) and measured their expression in the NAC by immunohistochemistry. These findings provide insights into novel molecular mechanisms in NAC that might be associated with the risk of relapse in cocaine-dependent individuals.

Adversity in childhood and depression: linked through SIRT1

Experiencing an adverse childhood and parental neglect is a risk factor for depression in the adult population. Patients with a history of traumatic childhood develop a subtype of depression that is characterized by earlier onset, poor treatment response and more severe symptoms. The long-lasting molecular mechanisms that are engaged during early traumatic events and determine the risk for depression are poorly understood. In this study, we altered adult depression-like behavior in mice by applying juvenile isolation stress. We found that this behavioral phenotype was associated with a reduction in the levels of the deacetylase sirtuin1 (SIRT1) in the brain and in peripheral blood mononuclear cells. Notably, peripheral blood mRNA expression of SIRT1 predicted the extent of behavioral despair only when depression-like behavior was induced by juvenile--but not adult--stress, implicating SIRT1 in the regulation of adult behavior at early ages. Consistent with this hypothesis, pharmacological modulation of SIRT1 during juvenile age altered the depression-like behavior in naive mice. We also performed a pilot study in humans, in which the blood levels of SIRT1 correlated significantly with the severity of symptoms in major depression patients, especially in those who received less parental care during childhood. On the basis of these novel findings, we propose the involvement of SIRT1 in the long-term consequences of adverse childhood experiences.

Timing and communication of parietal cortex for visuomotor control

In both monkeys and humans, motor cognition emerges from a parietal-frontal network containing discrete dominant domains of visual, eye and hand signals, where neurons are responsible for goal and effector selection. Within these domains, the combination of different inputs shape the tuning properties of neurons, while local and long cortico-cortical connections outline the architecture of the distributed network and determine the conduction time underlying eye-hand coordination, necessary for visually guided operations in the action space. The analysis of the communication timing between parietal and frontal nodes of the network helps understanding the sensorimotor cortical delays associated to different functions, such as online control of movement and eye-hand coordination, and opens a new perspective to the study of the parieto-frontal interactions.

Impairment of online control of hand and eye movements in a monkey model of optic ataxia

The parietal mechanisms for online control of hand trajectory were studied by combining single-cell recording and reversible inactivation of superior parietal area 5 (PE/PEc; SPL) of monkeys while these made reaches and saccades to visual targets, when the target position changed unexpectedly. Neural activity was modulated by hand position, speed, and movement direction, and by pre- and/or postsaccadic signals. After bilateral muscimol injection, an increase in the hand reaction- and movement-time toward both the first and second targets was observed. This caused an increase in the time necessary for the trajectory correction, and therefore an elongation of the hand-path toward the first target location. Furthermore, hand trajectories were different in shape than control ones. An elongation of the eye reaction time to both first and second targets was also observed, which could partially explain the deficit of planning and correction of hand movement. These results identify the superior parietal lobule as a crucial node in the online control of hand and eye movement and highlight the role of the eye impairment in the emergence of the reaching disorder so far regarded as the hallmark of optic ataxia.