Operational Stress Injuries: Impact on Family Mental Health and Well-being

This study was part of a larger scoping review and environmental scan conducted for Veterans Affairs Canada on the effects of operational stress injuries (OSIs) on the mental health and wellbeing of Veterans’ families. This paper focuses broadly on the relationships between combat (and/or deployment more generally), OSIs (primarily post-traumatic stress disorder (PTSD)), and the family. Based on the scoping review, the paper finds that existing research investigates the impacts of a Veteran’s OSI on the family, but also how various aspects of the family (such as family functioning, family support, etc.) can impact a Veteran living with an OSI.

Vivre avec un syndrome de stress post-traumatique : l'expérience et l'impact du diagnostic pour des militaires français

Ce mémoire de maitrise porte sur deux axes principaux : la mise en diagnostic et les enjeux que cela représente pour l’individu ainsi que la question du syndrome de stress post-traumatique (SSPT) dans une population particulière, celle des militaires français. À travers une étude de différents concepts anthropologiques tels que la sous-culture militaire, l’anthropologie du corps, de la mémoire et du discours, le travail de terrain a permis de mettre de l’avant l’expérience et l’impact du diagnostic du syndrome de stress post-traumatique. Les différentes étapes de la mise en diagnostic sont présentées afin de découvrir comment est vécue l’officialisation de ce trouble. Il est alors expliqué le paradoxe propre à ce diagnostic qui est posé, peu importe le type de choc traumatique à l’origine du SSPT. Cela permet de comprendre pourquoi le diagnostic du syndrome de stress post-traumatique reste un véritable enjeu lorsqu’il est question de la population militaire. Bien que de plus en plus de recherches existent sur le sujet au Canada ou aux États-Unis, la question en France reste encore en développement. C’est pourquoi cette recherche permet de découvrir la perception du trouble pour l’individu atteint et ses proches, la prévention et la prise en charge du stress post-traumatique à travers le diagnostic proposé actuellement.

A review of the dissociative disorders: from multiple personality disorder to the posttraumatic stress

In this paper we review the idea of dissociation, dissociative disorders and their relationship with the processes of consciousness. We will deal specifically with multiple personality disorder and posttraumatic stress disorder. Both polarize the discussion of diagnostic categories with dissociative symptoms. This review compares the initial ideas (one century old) with the current scenario and emerging trends in research, which are relating cognitive processes and dissociative phenomena and disorders from a neuroscientific approach. We discuss the ideas on dissociation, hypnosis and suicide associated with these disorders. There seems to be a lack of consensus as to the nature of dissociation with theoretical, empirical and clinical implications.

Como esquecer aquilo que não queremos?: Esquecimento dirigido na PPST – a doença dos cuidadores de doenças

Dissertação de Mestrado apresentada no ISPA – Instituto Universitário para obtenção de grau de Mestre na especialidade de Psicocriminologia

The deep trauma of secondary victimisation : parents of sex offenders

The publication of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) introduced the notion that a life-threatening illness can be a stressor and catalyst for Posttraumatic Stress Disorder (PTSD). Since then a solid body of research has been established investigating the post-diagnosis experience of cancer. These studies have identified a number of short and long-term life changes resulting from a diagnosis of cancer and associated treatments. In this chapter, we discuss the psychosocial response to the cancer experience and the potential for cancer-related distress. Cancer can represent a life-threatening diagnosis that may be associated with aggressive treatments and result in physical and psychological changes. The potential for future trauma through the lasting effects of the disease and treatment, and the possibility of recurrence, can be a source of continued psychological distress. In addition to the documented adverse repercussions of cancer, we also outline the recent shift that has occurred in the psycho-oncology literature regarding positive life change or posttraumatic growth that is commonly reported after a diagnosis of cancer. Adopting a salutogenic framework acknowledges that the cancer experience is a dynamic psychosocial process with both negative and positive repercussions. Next, we describe the situational and individual factors that are associated with posttraumatic growth and the types of positive life change that are prevalent in this context. Finally, we discuss the implications of this research in a therapeutic context and the directions of future posttraumatic growth research with cancer survivors. This chapter will present both quantitative and qualitative research that indicates the potential for personal growth from adversity rather than just mere survival and return to pre-diagnosis functioning. It is important to emphasise however, that the presence of growth and prevalence of resilience does not negate the extremely distressing nature of a cancer diagnosis for the patient and their families and the suffering that can accompany treatment regimes. Indeed, it will be explained that for growth to occur, the experience must be one that quite literally shatters previously held schemas in order to act as a catalyst for change.

Analysis of kinase gene expression in the frontal cortex of suicide victims: Implications of fear and stress

Suicide is a serious public health issue that results from an interaction between multiple risk factors including individual vulnerabilities to complex feelings of hopelessness, fear, and stress. Although kinase genes have been implicated in fear and stress, including the consolidation and extinction of fearful memories, expression profiles of those genes in the brain of suicide victims are less clear. Using gene expression microarray data from the Online Stanley Genomics Database 1 and a quantitative PCR, we investigated the expression profiles of multiple kinase genes including the calcium calmodulin-dependent kinase (CAMK), the cyclin-dependent kinase, the mitogen-activated protein kinase (MAPK), and the protein kinase C (PKC) in the prefrontal cortex (PFC) of mood disorder patients died with suicide (N = 45) and without suicide (N = 38). We also investigated the expression pattern of the same genes in the PFC of developing humans ranging in age from birth to 49 year (N = 46). The expression levels of CAMK2B, CDK5, MAPK9, and PRKCI were increased in the PFC of suicide victims as compared to non-suicide controls (false discovery rate, FDR-adjusted p < 0.05, fold change >1.1). Those genes also showed changes in expression pattern during the postnatal development (FDR-adjusted p < 0.05). These results suggest that multiple kinase genes undergo age-dependent changes in normal brains as well as pathological changes in suicide brains. These findings may provide an important link to protein kinases known to be important for the development of fear memory, stress associated neural plasticity, and up-regulation in the PFC of suicide victims. More research is needed to better understand the functional role of these kinase genes that may be associated with the pathophysiology of suicide

Barbara's story : a thematic analysis of a relative's reflection of being in the intensive care unit

Aim The aim of this reflective account is to provide a view of the intensive care unit (ICU) relative’s experiences of supporting and being supported in the ICU. Background Understanding the relatives’ experiences of ICU is important especially because a recent work has identified the potential for this group to develop post-traumatic stress disorder, a condition that is normally equated with the ICU survivor. Design A thematic analysis was used in identifying emerging themes that would be significant in an ICU nursing context. Setting The incident took place in two 8-bedded ICUs (Private and National Health Service) in October. Results Two emergent themes were identified from the reflective story – fear of the technological environment and feeling hopeless and helpless. Conclusion The use of relative stories as an insight into the live experiences of ICU relatives may give a deeper understanding of their life-world. The loneliness, anguish and pain of the ICU relative extends beyond the walls of the ICU, and this is often negated as the focus of the ICU team is the patient. Relevance to clinical practice: Developing strategies to support relatives might include the use of relative diaries used concurrently with patient diaries to support this groups recovery or at the very least a gaining a sense of understanding for their ICU experience. Relative follow-up clinics designed specifically to meet their needs where support and advice can be given by the ICU team, in addition to making timely and appropriate referrals to counselling services and perhaps involving spiritual leaders where appropriate.

The influence of injury cause, contact-sport participation, and personal knowledge on expectation of outcome from mild traumatic brain injury

Objective: This study investigated the influence of injury cause, contact-sport participation, and prior knowledge of mild traumatic brain injury (mTBI) on injury beliefs and chronic symptom expectations of mTBI. Method: A total of 185 non-contact-sport players (non-CSPs) and 59 contact-sport players (CSPs) with no history of mTBI were randomly allocated to one of two conditions in which they read either a vignette depicting a sport-related mTBI (mTBIsport) or a motor-vehicle-accident-related mTBI (mTBIMVA). The vignettes were otherwise standardized to convey the same injury parameters (e.g., duration of loss of consciousness). After reading a vignette, participants reported their injury beliefs (i.e., perceptions of injury undesirability, chronicity, and consequences) and their expectations of chronic postconcussion syndrome (PCS) and posttraumatic stress disorder (PTSD) symptoms. Results: Non-CSPs held significantly more negative beliefs and expected greater PTSD symptomatology and greater PCS affective symptomatology from an mTBIMVA vignette thann mTBIsport vignette, but this difference was not found for CSPs. Unlike CSPs, non-CSPs who personally knew someone who had sustained an mTBI expected significantly less PCS symptomatology than those who did not. Despite these different results for non-CSPs and CSPs, overall, contact-sport participation did not significantly affect injury beliefs and symptom expectations from an mTBIsport. Conclusions: Expectations of persistent problems after an mTBI are influenced by factors such as injury cause even when injury parameters are held constant. Personal knowledge of mTBI, but not contact sport participation, may account for some variability in mTBI beliefs and expectations. These factors require consideration when assessing mTBI outcome.

A critical evaluation of written discharge advice for people with mild traumatic brain injury : what should we be looking for?

Objective: To formally evaluate the written discharge advice for people with mild traumatic brain injury (mTBI). Methods: Eleven publications met the inclusion criteria: (1) intended for adults; (2) ≤two A4 pages; (3) published in English; (4) freely accessible; and (5) currently used (or suitable for use) in Australian hospital emergency departments or similar settings. Two independent raters evaluated the content and style of each publication against established standards. The readability of the publication, the diagnostic term(s) contained in it and a modified Patient Literature Usefulness Index (mPLUI) were also evaluated. Results: The mean content score was 19.18 ± 8.53 (maximum = 31) and the mean style score was 6.8 ± 1.34 (maximum = 8). The mean Flesch-Kincaid reading ease score was 66.42 ± 4.3. The mean mPLUI score was 65.86 ± 14.97 (maximum = 100). Higher scores on these metrics indicate more desirable properties. Over 80% of the publications used mixed diagnostic terminology. One publication scored optimally on two of the four metrics and highly on the others. Discussion: The content, style, readability and usefulness of written mTBI discharge advice was highly variable. The provision of written information to patients with mTBI is advised, but this variability in materials highlights the need for evaluation before distribution. Areas are identified to guide the improvement of written mTBI discharge advice.

The impact of personality and workplace belongingness on mental health workers’ professional quality of life

Objectives Mental health workers are constantly exposed to their clients’ stories of distress and trauma. While listening to these stories can be emotionally draining, professionals in this field still derive pleasure from their work. This study examined the role of personality and workplace belongingness in predicting compassion satisfaction, secondary traumatic stress, and burnout in mental health professionals. Methods Mental health staff (N = 156) working in a counselling service completed a questionnaire that included measures relating to professional quality of life, the Five-Factor Model of personality, workplace belongingness, as well as questions relating to the participants’ demographic profile, work roles and trauma history. Results The results indicated that, high levels of emotional stability (low neuroticism), extraversion, agreeableness, conscientiousness, and being connected at work, are essential factors that promote the professional quality of life of mental health workers. Specifically, workplace belongingness was the strongest predictor of compassion satisfaction and low levels of burnout, while neuroticism was the strongest predictor of secondary traumatic stress. Conclusions Important implications from this study include: (1) encouraging mental health staff to increase self-awareness of their dispositional characteristics and how their personalities affect their wellbeing at work, and; (2) encouraging management to facilitate practices where mental health workers feel connected, respected, and supported in their organisation.

Organisational belongingness mediates the relationship between sources of stress and post-trauma outcomes in fire-fighters

Previous research with emergency service workers has examined the relationship between operational and organisational stress and negative indicators of mental health, and generally found that organisational stress is more strongly related to pathology than operational stress. The current study aimed to create and test a model predicting both posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG) simultaneously in a sample of fire-fighters (N = 250). The results found that the model demonstrated good fit for the data. In contrast to previous research operational stress was directly related to PTSD symptoms, while organisational stress was not. Organisational stress was indirectly related to PTG, through the mediating role of organisational belongingness. This research identified organisational belongingness as a good target for psychosocial interventions aimed at promoting positive adaptation following the experience of trauma in emergency services.

Metamorfoses do humano: experimentações etnográficas em um laboratório de neurociência

Este trabalho tem como foco central a análise dos dilemas presentes na produção de conhecimento acerca das emoções e do comportamento humano nas neurociências. Para isso, realizou-se uma etnografia em um laboratório atuante na seara da psicofisiologia ou neurobiologia das emoções. Mais especificamente, trata-se de um centro de pesquisas que atualmente realiza experimentos com universitários, militares e pacientes psiquiátricos no intuito de investigar questões relativas ao chamado transtorno do estresse pós-traumático, o neuromarketing, entre outras questões relacionadas à violência urbana e situações aversivas de um modo geral. Para compreender a centralidade adquirida pelo corpo e em especial o cérebro na definição da Pessoa, buscou-se acompanhar o cotidiano de transformação e atualizações neurocientíficas de problemáticas já postas desde o delineamento histórico do fisicalismo moderno. Buscou-se atentar ainda para as trajetórias dos programas de pesquisas desenvolvidos e da vida acadêmica das/os pesquisadoras/os, assim como para as controvérsias intrínsecas a uma atividade científica que se propõe a discutir uma ontologia para o humano.

Narrativas médicas do medo: do coração ao cérebro

Desde a síndrome do coração irritável, passando pelas diversas síndromes do fin de siècle e chegando ao triunfo das teorias neurocientíficas sobre a hipersensibilidade dos centros cerebrais de resposta ao alarme e sufocação, a Medicina buscou teorias para explicar a experiência de pavor. Investiga-se o modo como ocorreram, ao longo da história, as transformações da atenção médica sobre o medo e os estados mórbidos que o acompanham. Ao se buscar na literatura médica vestígios de análises científicas sobre o mal-estar intenso, do meio do século XIX ao fim do XX, não se pretendeu construir uma história triunfalista, de modo que as teorias atuais pudessem ganhar status de superioridade em relação às do passado. Evidenciou-se, sim, a importância cultural e a força histórica de cada uma delas, salientando as possíveis continuidades e rupturas de sentido que elas assumiram.

A Terapia de Exposição com Realidade Virtual para pacientes com TEPT controlada por um Sistema de Lógica Fuzzy

Nos últimos anos, a área da saúde vem explorando o potencial das novas tecnologias para diagnóstico e tratamentos de muitos distúrbios. Em especial, a tecnologia de Realidade Virtual se destaca por oferecer novas perspectivas de tratamento para diferentes distúrbios neuropsiquiátricos. Por outro lado, a ocorrência de problemas causados por situações traumáticas vem crescendo em todo o mundo. Nesse contexto, o Transtorno de Estresse Pós-Traumático (TEPT) é classificado como um transtorno de ansiedade que se caracteriza por gerar uma classe de comportamentos inadequados a situações que não representam perigo real. Em geral, este transtorno está relacionado à ocorrência de algum evento traumático de grande magnitude no passado. Vários trabalhos foram desenvolvidos utilizando ambientes virtuais tridimensionais (3D) para tratar e diagnosticar este distúrbio. Entretanto, percebe-se uma carência de sistemas que consigam controlar o nível de dificuldade das atividades desenvolvidas nesses ambientes. Nesse caso, esta dissertação tem por objetivo descrever o desenvolvimento e avaliar o potencial de utilização de dois sistemas: um que explora a Realidade Virtual (ARVET) para oferecer cenas virtuais que simulem os estímulos geradores de ansiedade similares aqueles da vida real; e outro que explora a Lógica Fuzzy (SAPTEPT) para classificar os níveis de ansiedade do paciente, possibilitando a análise quali-quantitativa de dados psicofisiológicos e psicométricos. As avaliações realizadas com especialistas na área mostraram que o ARVET pode proporcionar um alto grau de estímulos ansiogênicos e a integração com o SAPTEPT ocorreu de forma satisfatória mostrando o potencial que os sistemas têm de serem utilizados em pacientes reais.

Sociologia do trauma: elementos sociogenéticos e psicogenéticos

O presente trabalho investiga os diferentes processos sociais relacionados ao surgimento do transtorno de estresse pós-traumático (TEPT) no contexto brasileiro. Categoria diagnóstica norte-americana instituída na década de 1980 pela terceira edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (Diagnostic and Statistical Manual of Mental Disorders DSM-III) uma publicação da Associação Americana de Psiquiatria (American Psychiatric Association APA) o TEPT tornou-se, desde a sua aparição, uma das categorias nosológicas mais difundidas, estudadas e diagnosticadas da psiquiatria contemporânea. A partir do cotidiano de um laboratório de pesquisa e tratamento do TEPT, de análises conversacionais dos atendimentos médicos, de um estudo das diferentes escalas psiquiátricas utilizadas no acompanhamento dos pacientes e de pesquisas sobre a mídia relacionada às experiências traumáticas buscou-se entender os entrelaçamentos entre os processos de difusão e a construção da legitimidade da categoria diagnóstica do TEPT. A abordagem aqui proposta pretende ir além do aparente dilema entre uma concepção medicalizada que assumem a existência o TEPT como um fenômeno natural e as abordagens sócio-antropológicas que veem o TEPT como uma experiência culturalmente construída. Por fim, pretendo mostrar, pela investigação dos alicerces políticos e culturais dos denominados transtornos mentais, que o estatuto social dos diagnósticos e dos tratamentos da moderna psiquiatria só pode ser compreendido tendo como referência as dinâmicas de longo prazo nas sociedades contemporâneas.