Providentia

The nature of posttraumatic stress disorder in treatment-seeking first responders.

Approximately 10% of first responders report posttraumatic stress disorder (PTSD). Although reports within first responders suggest that they have distinct symptom presentations, there is a need to understand how the clinical profiles of first responders may differ from others seeking treatment for PTSD. A new study in the European Journal of Psychotraumatology compared the PTSD symptom profiles of first responder and civilians seeking treatment for PTSD. Method: Participants self-referred to the Traumatic Stress Clinic (University of New South Wales, Sydney) for enrolment in out-patient treatment trials for PTSD. Participants comprised people of mean age 41.72 years (SD = 10.71) who met DSM-IV criteria for PTSD. The sample was composed of 128 first responders and 182 civilians. Clinician-administered interviews of PTSD (Clinician-Administered PTSD Scale) and depression were conducted, as well as measures of self-report measures of depression, alcohol use, posttraumatic appraisals, and anger. Results: First responders reported greater rates of dysphoric cluster of symptoms, including diminished interest, emotional numbing, and social detachment, and less psychological reactivity and avoidance of situations, than civilians with PTSD. Beyond PTSD symptoms, first responders also reported more severe levels of depression and suppressed anger. Conclusions: These findings indicate that treatment-seeking first responders present with a distinct clinical profile that is characterized by dysphoric symptoms. These symptoms can predict poor treatment response and require specific attention in treating PTSD in first responders. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

For the abstract

Massed cognitive processing therapy for posttraumatic stress disorder in women survivors of intimate partner violence.

Survivors of intimate partner violence (IPV) report significant trauma histories, high rates of posttraumatic stress disorder (PTSD), head injuries and comorbid disorders, and multiple barriers to treatment that often preclude the regular attendance and engagement required in typical therapy protocols. The significant challenges faced by IPV survivors needing treatment may be ameliorated by condensing effective treatments for PTSD, such as cognitive processing therapy (CPT), in an accelerated delivery timeline. A new research study published in the journal Psychological Trauma: Theory, Research, Practice, and Policy used a multiple subject, single case design of six matched pairs of 12 female IPV survivor.  Researchers preliminarily tested the relative effectiveness of individual massed CPT delivered over 5 days (mCPT) as compared with standard CPT (sCPT) delivery in women IPV survivors. Assessments included full psychiatric diagnostic interviews, clinical interviews assessing trauma history and head injury prior to treatment, symptom monitoring during treatment, and full repeat assessments at 1 month and 3 months following treatment. Results showed that no treatment group effect was found for PTSD severity between mCPT and sCPT among intention-to-treat, F(1, 10) = .01, p = .93. Both mCPT and sCPT were associated with significant improvement in PTSD, F(2, 20) = 45.05, p< .001, ds = 1.32–2.38). COverall, findings indicate mCPT appears effective in reducing psychological symptoms for women IPV survivors and suggest that condensed treatment is both palatable and feasible. Accelerated treatment delivery in this population may provide a necessary lifeline for women with IPV-related PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

For the abstract

Cyberbullying victimization among adolescencts: Results of the international self-report delinquency study 3.

A paper recently published in the International Journal of Adolescence and Youth further explores a wide international research study, the International Self-Report Delinquency Study 3 (ISRD-3), with the aim of understanding if there is a relationship between having lived traumatic intrafamily experiences and potentially being a victim of cyberbullying. The data have been collected by a questionnaire ISRD-3 administered to a 20 European country sample of 57.463 students from 7th to 9th grade. Results show a statistically significant relationship between traumatic intrafamilial experiences such as a serious illness of one of the parents, episodes of violence suffered and assisted, separation or divorce of the parents, and being victimized in adolescence of cyberbullying. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

For the abstract (open access)

PTSD in First Responders

Approximately 10% of first responders report posttraumatic stress disorder (PTSD). Although reports within first responders suggest that they have distinct symptom presentations, there is a need to understand how the clinical profiles of first responders may differ from others seeking treatment for PTSD.  A new study published in the European Journal of Psychotraumatology compared the PTSD symptom profiles of first responder and civilians seeking treatment for PTSD. Participants self-referred to the Traumatic Stress Clinic (University of New South Wales, Sydney) were recruited  for enrolment in out-patient treatment trials for PTSD. Participants comprised people of mean age 41.72 years (SD = 10.71) who met DSM-IV criteria for PTSD. The sample was composed of 128 first responders and 182 civilians. Clinician-administered interviews of PTSD (Clinician-Administered PTSD Scale) and depression were conducted, as well as measures of self-report measures of depression, alcohol use, posttraumatic appraisals, and anger. Results showed that first responders reported greater rates of dysphoric cluster of symptoms, including diminished interest, emotional numbing, and social detachment, and less psychological reactivity and avoidance of situations, than civilians with PTSD. Beyond PTSD symptoms, first responders also reported more severe levels of depression and suppressed anger. These findings indicate that treatment-seeking first responders present with a distinct clinical profile that is characterized by dysphoric symptoms. These symptoms can predict poor treatment response and require specific attention in treating PTSD in first responders.

For the abstract

Insomnia in survivors 8.5 years after the Utøya Island terrorist attack: Transition from late adolescence to early adulthood-the Utøya study

Insomnia is a global health concern, associated with many mental and physical health conditions. Prevalence of insomnia is reported to increase during adolescence and early adulthood. High levels of insomnia are also reported in adolescents up to 2.5 years after a traumatic event. What is less well understood is the prevalence of insomnia in a trauma exposed population transitioning from adolescence to adulthood. A new study in the European Journal of Psychotraumatology examined insomnia in the survivors in the 2011 Utøya Island terrorist attack, 2.5 years and 8.5 years after the attack when the majority of survivors were transitioning from late adolescence to early adulthood. Participants were 336 survivors of the Utøya Island attack who completed the Utøya Study 2.5 years (T3) and 8.5 years (T4) after the attack. Participants completed a face-to-face interview including the Bergen Insomnia Scale (BIS), which was used to assess insomnia symptoms and prevalence of meeting diagnostic criteria for insomnia. Results showed that insomnia was indicated in 47.7% of survivors 8.5 years after the attack. Insomnia prevalence did not significantly change from 2.5 to 8.5 years after the attack, though insomnia symptoms (BIS sum score) were found to increase. Age was negatively associated with insomnia at T4, with older age being associated with less insomnia. No significant sex difference was found in insomnia prevalence at T4.  Almost a decade after the Utøya Island terrorist attack, nearly a half of the young survivors in our study reported insomnia and typical age- and sex-related differences in sleep were not always seen. This rate is almost double what is reported in the general population (20–30%) indicating a high level of unmet need in this population. The implications of such sleep disruption during a critical time for physical, mental, social and cognitive development are far reaching. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

For the abstract

The nature of posttraumatic stress disorder in treatment-seeking first responders.

Approximately 10% of first responders report posttraumatic stress disorder (PTSD). Although reports within first responders suggest that they have distinct symptom presentations, there is a need to understand how the clinical profiles of first responders may differ from others seeking treatment for PTSD.   A new study published in the European Journal of Psychotraumatology compared the PTSD symptom profiles of first responders and civilians seeking treatment for PTSD. Participants self-referred to the Traumatic Stress Clinic (University of New South Wales, Sydney) for enrolment in out-patient treatment trials for PTSD. Participants comprised people of mean age 41.72 years (SD = 10.71) who met DSM-IV criteria for PTSD. The sample was composed of 128 first responders and 182 civilians. Clinician-administered interviews of PTSD (Clinician-Administered PTSD Scale) and depression were conducted, as well as measures of self-report measures of depression, alcohol use, posttraumatic appraisals, and anger. Results showed that first responders reported greater rates of dysphoric cluster of symptoms, including diminished interest, emotional numbing, and social detachment, and less psychological reactivity and avoidance of situations, than civilians with PTSD. Beyond PTSD symptoms, first responders also reported more severe levels of depression and suppressed anger. CThese findings indicate that treatment-seeking first responders present with a distinct clinical profile that is characterized by dysphoric symptoms. These symptoms can predict poor treatment response and require specific attention in treating PTSD in first responders. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

For the abstract

Are There Biomarkers for Child Abuse?

Child maltreatment (CM) is a widespread problem associated with poor mental and physical health outcomes. The underlying mechanisms of this link are not always well understood, however certain biological changes observed in maltreated individuals may play a role in connecting experience and outcome. A new review published in Psychological Trauma: Theory, Research, Practice, and Policy  specifically focuses on 2 markers of biological embedding, DNA methylation (DNAm) and telomere length (TL) in maltreated children and youth. As biomarker changes are not uniform among maltreated children, we additionally discuss biological and environmental resilience factors that may contribute to variability. Method: We conducted a systematic review of Medline, Embase and PsycINFO databases for studies examining DNAm and/or TL in maltreated children and youth. Methodological quality of the included studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) checklists for cohort studies and randomized control trials. Data extraction focused on various factors including population and CM (type, chronicity, severity, and duration) characteristics. Results: The initial search returned 1,688 nonduplicate results, with 417 full text articles reviewed. Twenty-six articles from 16 studies were ultimately included of which 8 examined telomere length and 18 examined DNA methylation. Conclusions: While some heterogeneity of findings was found, evidence supports differential changes in both biomarkers associated with CM. This review enhances understanding of the constellation of biological changes related to CM and consideration of the important role of resilience factors in mitigating risk. Elucidating these factors may highlight targets for future study and intervention development. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

For the abstract

Australian Psychiatrist Goes to Court For Right to Treat Patient with MDMA

Melbourne psychiatrist Eli Kotler has launched a court battle against the state of Victoria for permission to treat a severely ill patient with MDMA (better known as "ecstasy").   According to Dr. Kotler, his patient (who cannot be named) suffers from numerous mental health issues for which conventional psychiatric medication have been ineffective.    Since MDMA is listed as a prohibited substance in Australia, it can only be administered for medical or scientific research.  Earlier this year, the Victorian health department rejected Dr. Kotler's application to use the drug for treating his patient.  A letter sent at the time by Stefan Tulloch, the acting chief officer of medicines and poisons regulation at the Department of Health,  informed the psychiatrist that ""There is insufficient data to establish the safety and efficacy … with regards to the safe use of a Schedule 9 poison in clinical practice."

As a result, Dr. Kotler has gone forward with a court challenge that sets a legal precedent in Australia.  While Australia's  Therapeutic Goods Administration, which regulates medicines, is considering making MDMA a controlled drug, it is still unclear how long this will take and whether it will resolve Dr. Kotler's challenge.  In the meantime, both sides are gearing up for what is expected to be a protracted legal battle with expert witnesses being called in from California and the United Kingdom where MDMA has already been used successfully in medical treatment.

Despite the controversy surrounding MDMA-assisted therapy in many places, research has already suggested that MDMA-assisted psychotherapy may be beneficial in treating posttraumatic stress disorder (PTSD), and depression though most researchers call for more studies given the potential dangers associated with its use.

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Post-infection depressive, anxiety and post-traumatic stress symptoms: A prospective cohort study in patients with mild COVID-19.

It remains unclear whether COVID-19 is associated with psychiatric symptoms during or after the acute illness phase. Being affected by the disease exposes the individual to an uncertain prognosis and a state of quarantine. These factors can predispose individuals to the development of mental symptoms during or after the acute phase of the disease. There is a need for prospective studies assessing psychiatric symptoms in COVID-19 patients in the post-infection period. In a prospective cohort study recently published in the journal Progress in Neuro-Psychopharmacology & Biological Psychiatry, nasopharyngeal swabs for COVID-19 tests were collected at patients' homes under the supervision of trained healthcare personnel. Patients who tested positive for COVID-19 and were classified as mild cases (N = 895) at treatment intake were further assessed for the presence of psychiatric symptoms (on average, 56.6 days after the intake). We investigated the association between the number of COVID-19 symptoms at intake and depressive, anxiety and post-traumatic symptoms approximately two months later, adjusting for previous mental health status, time between baseline and outcome, and other confounders. Multivariate logistic regression and generalized linear models were employed for categorical and continuous outcomes, respectively. Results: A clinically significant level of depressive, anxiety and post-traumatic stress symptoms were reported by 26.2% (N = 235), 22.4% (N = 201), and 17.3% (N = 155) of the sample. Reporting an increased number of COVID-related symptoms was associated with the presence of clinically significant levels of depressive (aOR = 1.059;95%CI = 1.002–1.119), anxiety (aOR = 1.072;95%CI = 1.012–1.134), and post-traumatic stress (aOR = 1.092;95%CI = 1.024–1.166) symptoms. Sensitivity analyses supported findings for both continuous and categorical measures. Conclusion: Exposure to an increased number of COVID-19 symptoms may be associated with depressive, anxiety and post-traumatic symptoms after the acute phase of the disease. These patients should be monitored for the development of psychiatric symptoms after COVID-19 treatment discharge. Early interventions, such as brief interventions of psychoeducation on coping strategies, could benefit these individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

For the abstract

How Does PTSD Affect People in the Workplace?

Objective: There is evidence that posttraumatic stress disorder (PTSD) is a hidden barrier to employment among individuals with serious mental illnesses (SMI) among whom PTSD is highly prevalent.  A new study published in the Psychiatric Rehabilitation Journal aimed to explore how PTSD interferes with achieving employment outcomes among persons with SMI. Methods: Participants included 119 individuals with SMI and co-occurring PTSD receiving Supported Employment services. Responses to the question, “In what ways are PTSD symptoms interfering with your work during the past month?” were analyzed. Results: Six themes emerged: (a) I don’t like being around people, (b) I feel frozen and unable to get started, (c) troubling negative affect, (d) mind is scattered and all over the place, (e) feeling fatigued all the time, and (f) flashbacks and triggers can happen whenever. Conclusions and Implications for Practice: Findings provide insight into how PTSD symptoms impact work outcomes and suggest that there is a need for Supported Employment providers to screen clients for trauma exposure to identify those in need of additional support in order to improve work outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

For the abstract