Screening for Sexual Trauma, Intimate Partner Violence and Mental Health Symptoms among HIV Positive South African Women

Background: The psychological sequelae of sexual trauma and physical intimate partner violence (IPV) exposure can lead to poor HIV care outcomes, including poor treatment adherence. This study aimed to estimate the prevalence of and factors associated with mental health symptoms and trauma among HIV positive women. Additionally, the study aimed to assess the feasibility and acceptability of screening for trauma and mental health symptoms among HIV positive South African women. Finally, the study aimed to elicit healthcare workers’ perceptions related to sexual trauma and the provision of care and services for HIV positive women with trauma histories.

Methods: The study utilized a mixed-methods approach that included a cross-sectional survey of 70 HIV positive women recruited through referral sampling and key informant interviews with seven healthcare workers (HCWs). A study-screening instrument consisting of 24 items from standard measures was used to screen women for sexual trauma, physical intimate partner violence (IPV), depression and PTSD. Sexual trauma and IPV were assessed across the lifetime, while depression and PTSD were current assessments. Logistic regression models were used to explore the relationship between trauma exposure and mental health symptoms, while controlling for age and education. Interview transcripts were coded and analyzed for emergent themes on HCWs perceptions on sexual trauma and HIV care.

Results: Among participants, 51% had sexual trauma experience and 75% had intimate partner violence (IPV) experience. Among participants, 36% met screening criteria for major depression; among those with traumatic experiences (n=57), 70% met screening criteria for post-traumatic stress disorder (PTSD). Compared to having no sexual trauma or IPV exposure, having both sexual trauma and IPV was significantly associated with higher odds of depression (OR = 8.11; 95% CI 1.48-44.34), while having either IPV or sexual trauma individually was not significantly associated with increased odds of depression. Compared to having either IPV or sexual trauma, having both sexual trauma and IPV was not significantly associated with PTSD. Responses from participants’ feedback on screening process suggest that screening was feasible and acceptable to participants. Some of the health care workers (HCWs) did not perceive dealing with trauma to be part of their duties, but instead viewed social workers or psychologists as the appropriate health cadre to provide care related to trauma and mental health.

Conclusions: High levels of sexual trauma, IPV and mental health distress were reported among HIV positive women in this setting. Screening for trauma and mental health symptoms was acceptable to the participants, but several challenges were encountered in implementing screening. Given the potential impact of trauma and mental health on HIV care engagement, interventions to address trauma and its psychological sequelae are needed.

A Scoping Review of Psychological Interventions for PTSD in Military Personnel and Veterans.

Post-traumatic stress disorder (PTSD) has emerged as a key concern for military and veteran populations. This article describes what is being done programmatically and therapeutically to treat PTSD in military personnel and veterans returning from deployment. This scoping review demonstrates that (1) research published in this area has been rapidly increasing since its inception in the 1980s; (2) the vast majority of articles focus on cognitive-behavioral approaches to treatment, and this area of the literature presents strong evidence for these approaches; and (3) there is a lack of randomized controlled trials for treatments, such as art therapies and group therapies.

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.

Neurobiology and clinical implications of lucid dreaming

Several lines of evidence converge to the idea that rapid eye movement sleep (REMS) is a good model to foster our understanding of psychosis. Both REMS and psychosis course with internally generated perceptions and lack of rational judgment, which is attributed to a hyperlimbic activity along with hypofrontality. Interestingly, some individuals can become aware of dreaming during REMS, a particular experience known as lucid dreaming (LD), whose neurobiological basis is still controversial. Since the frontal lobe plays a role in self-consciousness, working memory and attention, here we hypothesize that LD is associated with increased frontal activity during REMS. A possible way to test this hypothesis is to check whether transcranial magnetic or electric stimulation of the frontal region during REMS triggers LD. We further suggest that psychosis and LD are opposite phenomena: LD as a physiological awakening while dreaming due to frontal activity, and psychosis as a pathological intrusion of dream features during wake state due to hypofrontality. We further suggest that LD research may have three main clinical implications. First, LD could be important to the study of consciousness, including its pathologies and other altered states. Second, LD could be used as a therapy for recurrent nightmares, a common symptom of depression and post-traumatic stress disorder. Finally, LD may allow for motor imagery during dreaming with possible improvement of physical rehabilitation. In all, we believe that LD research may clarify multiple aspects of brain functioning in its physiological, altered and pathological states.

Neurobiology and clinical implications of lucid dreaming

Several lines of evidence converge to the idea that rapid eye movement sleep (REMS) is a good model to foster our understanding of psychosis. Both REMS and psychosis course with internally generated perceptions and lack of rational judgment, which is attributed to a hyperlimbic activity along with hypofrontality. Interestingly, some individuals can become aware of dreaming during REMS, a particular experience known as lucid dreaming (LD), whose neurobiological basis is still controversial. Since the frontal lobe plays a role in self-consciousness, working memory and attention, here we hypothesize that LD is associated with increased frontal activity during REMS. A possible way to test this hypothesis is to check whether transcranial magnetic or electric stimulation of the frontal region during REMS triggers LD. We further suggest that psychosis and LD are opposite phenomena: LD as a physiological awakening while dreaming due to frontal activity, and psychosis as a pathological intrusion of dream features during wake state due to hypofrontality. We further suggest that LD research may have three main clinical implications. First, LD could be important to the study of consciousness, including its pathologies and other altered states. Second, LD could be used as a therapy for recurrent nightmares, a common symptom of depression and post-traumatic stress disorder. Finally, LD may allow for motor imagery during dreaming with possible improvement of physical rehabilitation. In all, we believe that LD research may clarify multiple aspects of brain functioning in its physiological, altered and pathological states.

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

Alcohol use disorders and psychiatric diseases in Colombia

Background: An accurate understanding of co-occurrence and comorbidity of alcohol use disorders (AUD) in Colombia is crucial for public health. Objective: A secondary analysis was conducted, using a 2003/2004 government´s population database to determine the lifetime associations between AUD and other mental and addictive disorders in people of Colombia aged 18-65 years. Methods: Several statistical analysis were performed: testing prevalence difference in mental disorders by whether the individual had an AUD; a stratified analysis by gender and logistic regression analyses accounting for differences in demographic, socio-economic, behavioral and self-reported health status variables. Results: People with AUD comprised 9% of the population, of which 88% were males and on average 37 years old. They were more likely to be males, be working, and be current smokers; and less likely to be at home or retired. The population with AUD had greater chance to comply with criteria for all disorders but minor depressive disorder, post-traumatic stress disorder, nicotine dependence, and oppositional defiant disorder. Conclusion: This study demonstrates a high prevalence of mental disorders in the adult population with AUD in Colombia. The findings highlight the importance of comorbidity as a sign of disease severity and impact on public health and supports the need for training of more professionals and developing appropriate interventions and services.

Electrochemical Immunosensing of Cortisol in an Automated Microfluidic System Towards Point-of-Care Applications

This dissertation describes the development of a label-free, electrochemical immunosensing platform integrated into a low-cost microfluidic system for the sensitive, selective and accurate detection of cortisol, a steroid hormone co-related with many physiological disorders. Abnormal levels of cortisol is indicative of conditions such as Cushing’s syndrome, Addison’s disease, adrenal insufficiencies and more recently post-traumatic stress disorder (PTSD). Electrochemical detection of immuno-complex formation is utilized for the sensitive detection of Cortisol using Anti-Cortisol antibodies immobilized on sensing electrodes. Electrochemical detection techniques such as cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS) have been utilized for the characterization and sensing of the label-free detection of Cortisol. The utilization of nanomaterial’s as the immobilizing matrix for Anti-cortisol antibodies that leads to improved sensor response has been explored. A hybrid nano-composite of Polyanaline-Ag/AgO film has been fabricated onto Au substrate using electrophoretic deposition for the preparation of electrochemical immunosening of cortisol. Using a conventional 3-electrode electrochemical cell, a linear sensing range of 1pM to 1µM at a sensitivity of 66µA/M and detection limit of 0.64pg/mL has been demonstrated for detection of cortisol. Alternately, a self-assembled monolayer (SAM) of dithiobis(succinimidylpropionte) (DTSP) has been fabricated for the modification of sensing electrode to immobilize with Anti-Cortisol antibodies. To increase the sensitivity at lower detection limit and to develop a point-of-care sensing platform, the DTSP-SAM has been fabricated on micromachined interdigitated microelectrodes (µIDE). Detection of cortisol is demonstrated at a sensitivity of 20.7µA/M and detection limit of 10pg/mL for a linear sensing range of 10pM to 200nM using the µIDE’s. A simple, low-cost microfluidic system is designed using low-temperature co-fired ceramics (LTCC) technology for the integration of the electrochemical cortisol immunosensor and automation of the immunoassay. For the first time, the non-specific adsorption of analyte on LTCC has been characterized for microfluidic applications. The design, fabrication technique and fluidic characterization of the immunoassay are presented. The DTSP-SAM based electrochemical immunosensor on µIDE is integrated into the LTCC microfluidic system and cortisol detection is achieved in the microfluidic system in a fully automated assay. The fully automated microfluidic immunosensor hold great promise for accurate, sensitive detection of cortisol in point-of-care applications.

Enhanced noradrenergic activity in the amygdala contributes to hyperarousal in an animal model of PTSD

Increased activity of the noradrenergic system in the amygdala has been suggested to contribute to the hyperarousal symptoms associated with post-traumatic stress disorder (PTSD). However, only two studies have examined the content of noradrenaline or its metabolites in the amygdala of rats previously exposed to traumatic stress showing inconsistent results. The aim of this study was to investigate the effects of an inescapable foot shock (IFS) procedure 1) on reactivity to novelty in an open-field (as an index of hyperarousal), and 2) on noradrenaline release in the amygdala during an acute stress. To test the role of noradrenaline in amygdala, we also investigated the effects of microinjections of propranolol, a β-adrenoreceptor antagonist, and clenbuterol, a β-adrenoreceptor agonist, into the amygdala of IFS and control animals. Finally, we evaluated the expression of mRNA levels of β-adrenoreceptors (β1 and β2) in the amygdala, the hippocampus and the prefrontal cortex. Male Wistar rats (3 months) were stereotaxically implanted with bilateral guide cannulae. After recovering from surgery, animals were exposed to IFS (10 shocks, 0.86 mA, and 6 seconds per shock) and seven days later either microdialysis or microinjections were performed in amygdala. Animals exposed to IFS showed a reduced locomotion compared to non-shocked animals during the first 5 minutes in the open-field. In the amygdala, IFS animals showed an enhanced increase of noradrenaline induced by stress compared to control animals. Bilateral microinjections of propranolol (0.5 μg) into the amygdala one hour before testing in the open-field normalized the decreased locomotion observed in IFS animals. On the other hand, bilateral microinjections of clenbuterol (30 ng) into the amygdala of control animals did not change the exploratory activity induced by novelty in the open field. IFS modified the mRNA expression of β1 and β2 adrenoreceptors in the prefrontal cortex and the hippocampus. These results suggest that an increased noradrenergic activity in the amygdala contributes to the expression of hyperarousal in an animal model of PTSD.

Person-centred information to parents in paediatric oncology (the PIFBO study) : A study protocol of an ongoing RCT

Background: Parents of children with cancer experience a demanding situation and often suffer from psychological problems such as stress. Trying to coping with the complex body of information about their child's disease is one factor that contributes to this stress. The aim of this study is to evaluate an intervention for person-centred information to parents of children with cancer that consists of four sessions with children's nurses trained in the intervention method. Methods/Design: This is a multi-centre RCT with two parallel arms and a 1:1 allocation ratio. The primary outcome is illness-related parental stress. Secondary outcomes are post-traumatic stress symptoms, anxiety, depression, satisfaction with information, expected and received knowledge, and experiences with health care providers. A process evaluation is performed to describe experiences and contextual factors. Data are collected using web questionnaires or paper forms according to the parents' preference, audio recording of the intervention sessions, and qualitative interviews with parents and the intervention nurses. Discussion: Few studies have evaluated information interventions for parents of children with cancer using large multi-centre RCTs. This intervention is designed to be performed by regular staff children's nurses, which will facilitate implementation if the intervention proves to be effective. Trial registration: Clinical trials NCT02332226 (December 11, 2014).

Acoso laboral y sus efectos en la salud del trabajador : revisión de la literatura

Introducción: Desde los años 80 se viene haciendo énfasis en el acoso laboral, conocido en otros países como Mobbing, describiéndose como una forma de abuso y violencia psicológica en el lugar de trabajo, realizado ya sea por una sola persona o por un grupo de personas y que por sus implicaciones se estima de alto impacto para los trabajadores, y las organizaciones. Considerando la importancia y prevalencia del mobbing en la sociedad actual, se convierte en un tema relevante para el área de salud ocupacional. Objetivo: El objetivo de este estudio fue identificar los efectos del acoso laboral generados en la salud del trabajador. Metodología: Se realizó una revisión sistemática utilizando el método PRISMA, de las publicaciones vigentes entre los años 2006 a 2016 sobre los efectos del acoso laboral en la salud del trabajador. En la búsqueda se obtuvieron 778 artículos de los cuales 27 cumplían con los criterios de inclusión. Resultados: se encontró que la prevalencia del acoso laboral puede ser diferente de acuerdo a la definición utilizada, instrumento de medida y población estudiada, la cual fluctúa entre el 7% al 88% según el estudio analizado. Además se evidenció que la prevalencia también difiere dependiendo de quién sea el perpetrador del acoso, si el líder o jefe es el acosador es mayor (60,3%) que cuando es causado por colegas o por clientes (41,5%). El impacto del acoso laboral, según la mayoría de los estudios, es que provoca efectos negativos en la salud emocional del trabajador siendo la depresión una de las principales consecuencias con una relación estadísticamente significativa (p<0,001). Las enfermedades del aparato respiratorio y del sistema musculo esquelético y del tejido conectivo fueron las que se presentaron con mayor frecuencia en los trabajadores que sufren de acoso con un 43,5% y un 37.8% respectivamente. Conclusiones: éstos resultados demuestran que el acoso laboral no solamente es un problema desde el punto de vista organizacional, sino que conlleva consecuencias en la salud mental y física de los trabajadores que lo sufren. Palabras clave: Mobbing, workplace, acoso laboral, acoso psicológico, bullying, harassment, salud ocupacional, occupational health.

Memory in posttraumatic stress disorder: properties of voluntary and involuntary, traumatic and nontraumatic autobiographical memories in people with and without posttraumatic stress disorder symptoms.

One hundred fifteen undergraduates rated 15 word-cued memories and their 3 most negatively stressful, 3 most positive, and 7 most important events and completed tests of personality and depression. Eighty-nine also recorded involuntary memories online for 1 week. In the first 3-way comparisons needed to test existing theories, comparisons were made of memories of stressful events versus control events and involuntary versus voluntary memories in people high versus low in posttraumatic stress disorder (PTSD) symptom severity. For all participants, stressful memories had more emotional intensity, more frequent voluntary and involuntary retrieval, but not more fragmentation. For all memories, participants with greater PTSD symptom severity showed the same differences. Involuntary memories had more emotional intensity and less centrality to the life story than voluntary memories. Meeting the diagnostic criteria for traumatic events had no effect, but the emotional responses to events did. In 533 undergraduates, correlations among measures were replicated and the Negative Intensity factor of the Affect Intensity Measure correlated with PTSD symptom severity. No special trauma mechanisms were needed to account for the results, which are summarized by the autobiographical memory theory of PTSD.

Autobiographical Memory for Stressful Events, Traumatic Memory and Posttraumatic Stress Disorder: A Systematic Review

Stressors and traumatic events may contribute to the development of many psychopathologies, PTSD among them. People with this disorder can present significant cognitive impairments and losses in memory, particularly autobiographical memory (AM).This paper aims to present a systematic review of literature considering changes on autobiographical memory in people exposed to potentially traumatic stressors. Therefore, we performed a computerized search in databases PsycINFO, PubMed, Web of Science and Pilots in March 2012.A total of 29 articles were selected and grouped into three categories: studies comparing Trauma X PTSD, studies comparing PTSD X Trauma X Control and comparison studies according to post-traumatic symptoms. Results demonstrate that people with PTSD presents alterations in a larger number of AM components compared to the cases in which PTSD did not developed. In the same way, subjects never exposed to trauma did not demonstrate significant alterations on  AM when compared to the other groups. The results of this study allowed concluding that changes of some components of the AM are primarily associated with PTSD, but it was not possible to clarify whether such changes are related to the timely development of the disorder, or if they are also observed in traumatic memories even in the absence of disorder.

Le stress post-traumatique chez l'agresseur – intérêt pour le clinicien

Introduction : Cet article présente un cas de psychothérapie de stress post-traumatique chez l’agresseur. Ce syndrome clinique est bien décrit dans la littérature, mais notre recherche ne nous a permis de trouver que 2 rapports de cas témoignant de son traitement en psychothérapie. Le traitement de cette population présente plusieurs défis. Un effort a dû être déployé pour réviser une littérature complexe. D’autres contraintes à notre démarche touchaient l’identification d’un sujet éligible, l’adaptation du protocole de psychothérapie à ce sujet et à au contexte de la pratique clinique, ainsi que l’administration du protocole en tenant compte de contraintes organisationnelles spécifiques. Méthode : Toutes les étapes du projet ont été dirigées par le premier auteur. Une revue de la littérature sur l’état de stress post-traumatique chez l’agresseur a été réalisée sous la supervision du deuxième auteur. Elle a été présentée au congrès annuel de l’Association des Médecins Psychiatres du Québec (AMPQ) de 2011. Cette expérience a permis une sensibilisation aux manifestations de ce syndrome clinique dans la pratique psychiatrique. Grâce à cela, un sujet hospitalisé a été identifié comme présentant des symptômes suggestifs d’état de stress post-traumatique chez l’agresseur. Une psychothérapie a été planifiée et administrée, à partir des connaissances acquises lors de la revue de la littérature, sous la supervision du troisième auteur. Le sujet a été sélectionné par échantillon de convenance. Les données colligées concernant l’évolution clinique du sujet sont de nature qualitative. La méthode d’intervention est une thérapie cognitivo-comportementale intensive, chez un patient hospitalisé. Une attention particulière a été portée au vécu subjectif de l’agresseur, tel que suggéré par la littérature. Un suivi a eu lieu en clinique externe par la suite, permettant de colliger des données supplémentaires. Résultats : L’évolution du sujet a été positive, se concluant par le désir de devenir un membre productif de la société. Conclusion : Un protocole de thérapie cognitivo-comportementale visant l’état de stress post-traumatique en général peut être adapté à la situation de l’agresseur. L’exercice d’être attentif à l’expérience subjective de l’agresseur permet de dépasser certains défis que présente son traitement. La psychothérapie peut être adaptée à la situation du patient hospitalisé en psychiatrie. L’ensemble de la démarche illustrée dans cet article représente un exemple concret d’application de principes scientifiques au traitement d’un sujet dont la présentation clinique ne correspond pas à un diagnostic pour lequel il existe un traitement bien établi. Nous invitons le lecteur clinicien à aborder les défis présentés par un cas clinique en formulant une question de recherche pertinente, qui pourra être mise à l’épreuve pendant la phase de traitement du patient. De plus, nous croyons que la rédaction d’une histoire de cas, organisée en fonction de ce principe, constitue un outil didactique précieux dans la formation en psychiatrie.