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Background: Global evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery. Methods: The setting is sub-cities of Addis Ababa and rural districts in south-central Ethiopia covering 1.1 million people and including rural, urban and homeless populations. SCOPE comprises (1) formative work to understand care pathways and community resources (resource mapping); examine family context and communication (ethnography); develop valid measures of family communication and personal recovery; and establish platforms for community engagement and involvement of people with lived experience; (2a) a population-based incidence study, (2b) a case-control study and (2c) a cohort study with 12 months follow-up involving 440 people with psychosis (390 rural/Addis Ababa; 50 who are homeless), 390 relatives and 390 controls. We will test hypotheses about incidence rates in rural vs. urban populations and men vs. women; potential aetiological role of khat (a commonly chewed plant with amphetamine-like properties) and traumatic exposures in psychosis; determine profiles of needs at first contact and predictors of outcome; (3) participatory workshops to develop programme theory and inform co-development of interventions, and (4) evaluation of the impact of early identification strategies on engagement with care (interrupted time series study). Findings will inform development of (5) a protocol for (5a) a feasibility cluster randomised controlled trial of interventions for people with recent-onset psychosis in rural settings and (5b) two uncontrolled pilot studies to test acceptability, feasibility of co-developed interventions in urban and homeless populations. [ABSTRACT FROM AUTHOR]

The article "Expanding Perspectives on Treatment Outcomes in Clinical High-Risk for Psychosis: The Role of Comorbidities and Individual Differences" discusses the influence of psychiatric comorbidities on treatment outcomes in individuals at clinical high-risk for psychosis (CHR-P). The authors highlight the importance of considering individual differences, such as cognitive, phenomenological, and trauma-related factors, in developing interventions for CHR-P individuals. They also emphasize the need for personalized interventions and the evaluation of potential biases in predictive models and clinical decision-making processes. [Extracted from the article]

Background: Despite experiencing high rates of trauma and trauma-related conditions, people with psychosis are seldomly asked about possible traumatic events. While there are some barriers to discussing trauma in clinical services, research has shown that disclosure is not only possible but also beneficial to both psychotic and traumatic symptoms. The current study is the first to evaluate service users' perception of the influence of trauma on the development and maintenance of their psychotic symptoms, as well as their views on how their life and mental health have been affected by traumatic events and their disclosure (or lack of). Methods: Eleven participants with experiences of psychosis and trauma took part in semi-structured interviews. Results: Consistently with previous literature, our participants reported high rates of interpersonal trauma, but had rarely had the opportunity to discuss any of these events. Using thematic analysis, we identified three major themes that have important implications for healthcare: factors that facilitate or hinder talking about trauma; consequences of talking or not; and relationship between trauma and psychosis. Participants generally benefited from talking about trauma and concerningly often associated the prolonged lack of opportunities to discuss traumatic events with negative feelings towards the self and with a deterioration of their mental health. Participants also recognised direct links between past traumas and the content and characteristics of their psychotic experiences. Conclusions: Our findings highlight the importance, as perceived by service users, of discussing trauma and looking at psychosis through a "trauma lens". These results stress the need to systematically assess trauma history and traumatic symptoms in psychosis and might potentially help to overcome clinicians' worries about discussing trauma with service users. Our findings underscore the need to change current practice and implement trauma-informed approaches to understand clients' difficulties and provide support. [ABSTRACT FROM AUTHOR]

Les conditions opérationnelles exposent les militaires à des situations potentiellement traumatisantes au plan psychique. Les troubles spécifiques et non spécifiques qui peuvent en résulter nécessitent des dispositifs de prise en charge relativement souples et adaptables aux circonstances. Premier « maillon de la chaîne », l'intervention du psychiatre sur un théâtre d'opérations permet l'amorce de soins psychiques de façon précoce, pouvant éventuellement déboucher sur une prise en charge au long cours. Cette communication a pour objet la mise en œuvre d'une intervention médico-psychologique après un accident aérien en opération extérieure au Mali. Operational conditions expose military personnel to potentially traumatic psychological situations. The specific and non-specific psychological disorders which can result require relatively flexible treatment tools which can be adapted to the circumstances. As the "first link in the chain", the intervention of a psychiatrist in a theatre of operations allows for the early initiation of psychological care to be followed by long-term treatment where necessary. This article focuses on the activation of a medical-psychological intervention after a plane crash during a military operation in Mali. [ABSTRACT FROM AUTHOR]

This essay gives a traumatic reading of Maurya's passivity. Traumatized by her sons' deaths, Maurya develops PTSD symptoms including hyperarousal, intrusion, and constriction, and through keening she moves towards a recovery. Synge's deft use of symbols, repetition, and imagery to stage trauma makes Riders a precursor to later trauma plays. [ABSTRACT FROM AUTHOR]

Aim: Traumatic events are involved in the development and maintenance of psychotic symptoms. There are few trials exploring trauma‐focused treatments as interventions for psychotic symptoms, especially in individuals with early psychosis. This trial will evaluate the feasibility and acceptability of conducting a definitive trial of Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) in people with early psychosis. Methods: Sixty participants with first episode psychosis and a history of a traumatic/adverse life event(s)will be recruited from early intervention services in the North West of England and randomized to receive16 sessions of EMDRp + Treatment as Usual (TAU) or TAU alone. Participants will be assessed at baseline, 6 and 12 months post‐randomization using several measures of psychotic symptoms, trauma symptoms, anxiety, depression, functioning, service‐user defined recovery, health economics indicators and quality of life. Two nested qualitative studies to assess participant feedback of therapy and views of professional stakeholders on the implementation of EMDRp into services will also be conducted. The feasibility of a future definitive efficacy and cost‐effectiveness evaluation of EMDRp will be tested against several outcomes, including ability to recruit and randomize participants, trial retention at 6‐ and 12‐month follow‐up assessments, treatment engagement and treatment fidelity. Conclusions: If it is feasible to deliver a multi‐site trial of this intervention, it will be possible to evaluate whether EMDRp represents a beneficial treatment to augment existing evidence‐based care of individuals with early psychosis supported by early intervention services. [ABSTRACT FROM AUTHOR]

The Dark Triad (DT) consists of three personality traits (machiavellianism, narcissism, and psychopathy). This is considered relevant for understanding the development of undesirable characteristics for society, frequently observed in young people and adults with antisocial and delinquent behaviours. Aversive personality traits have only recently aroused interest in researchers as a cohesive set of factors. The aim of this study was to analyse the associations of the DT (machiavellianism, narcissism, and psychopathy) with juvenile delinquency, conduct disorder (CD), and trauma. For this, a total sample of Portuguese adolescents (n=601; Mage=15.95 years, SD=1.05 years, range=13-18 years) was used, subdivided into a male forensic group, male school group, and female school group. After the elaboration of multiple linear regression models, the results indicated that the psychopathy dimension was the one with the greatest association with juvenile delinquency and CD, while the narcissism dimension was the one with the greatest association with trauma. In future studies, the associations of the DT with juvenile delinquency, CD, and trauma in Portuguese adolescents should continue to be explored in the forensic and school contexts, to further clarify these relationships and contribute to the development and implementation of prevention and intervention programs for Youth with these characteristics. [ABSTRACT FROM AUTHOR]

Introduction: Psychosis resulting from traumatic brain injury (TBI) is a relatively uncommon but potentially severe and disabling outcome. The complex relationship between TBI and the onset of psychosis is marked by significant scientific uncertainty and differing opinions. Objectives: To investigate the occurrence of psychosis following traumatic brain injury (TBI) and explore the intricate relationship between TBI and the development of psychosis. Methods: A comprehensive case report was conducted on a 38-year-old patient who, after a severe TBI at the age of 23, exhibited signs of psychosis. Developmental history, family background, clinical assessments, magnetic resonance imaging (MRI), and electroencephalogram (EEG) results were analyzed. Results: The patient, at the time of writing aged 38, was born at full term with a regular presentation and uneventful delivery, with no indications of perinatal or obstetric complications. Developmentally, he reached all milestones within the expected range, and there were no significant premorbid characteristics. There was no family history of schizophrenia in a first- or second-degree relative; a paternal cousin had had psychosis-like symptoms, but reportedly remained well without any medication. At the age of 23, the patient was knocked from his motorcycle by a car and sustained a severe traumatic brain injury (TBI), with initial loss of consciousness and was in a coma state for approximatively a month, with later sequelae of cerebellar syndrome and predominant right-sided pyramidal syndrome. Magnetic resonance imaging (MRI) a year following the TBI showed sequelae of bifrontal and temporal contusion lesions. An EEG did not indicate any evidence of epilepsy, and a repeat EEG 14 years later revealed no diagnostic abnormality. A year after the accident, his surroundings have noticed social withdrawal, a turning inward with a religious fervor, and persecutory remarks focused on his brother. At the age of 26, he presented to a psychiatric service having auditory hallucinations. He was deluded, believing himself to be a prophesied redeemer figure who is expected to appear and bring justice and righteousness to the world. He had an inappropriate affect. A diagnosis of schizophrenia was made, and neuroleptics prescribed. His auditory hallucinations faded, but the subsequent course was of repeated episodes of florid psychosis requiring maintenance neuroleptic treatment, eventually haloperidol decanoate (150mg monthly). Conclusions: Psychosis following TBI is an uncommon yet potentially severe consequence, carrying the risk of significant debilitation. The relationship between TBI and psychosis is complex, but notable distinctions exist in clinical, epidemiological, and neurobiological aspects when compared to primary psychotic disorders. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Literature suggests that the occurrence of psychological trauma (PT) from various negative life experiences beyond events mentioned in the DSM-criterion A, receives little to no attention when comorbid with psychosis. In fact, despite research indicating the intricate interplay between PT and psychosis, and the need for trauma-focused interventions (TFI), there continue to be mixed views on whether treating PT would worsen psychosis, with many practitioners hesitating to initiate treatment for this reason. This study, therefore, aimed to understand patient perspectives on the role of PT in psychosis and related treatment options. A qualitative exploratory approach was adopted using in-depth interviews with individuals experiencing psychosis. The Global Assessment of Functioning (GAF) scale was administered on a predetermined maximum variation sample resulting in two groups of participants- those with moderate-mild disability (GAF 54–80; n = 10) and those experiencing moderate-severe disability (GAF 41–57; n = 10). With the former group, a semi-structured interview schedule was used, while with the latter, owing to multiple symptoms and difficulty in cognitive processing, a structured interview schedule was used. Results from interpretative phenomenological analysis (IPA) indicated that traumatic loss was central to experienced PT, but received no attention; this often contributed to the psychotic experience and/or depression, through maintenance factors such as cognitive distortions and attenuated affective responses. Further, the experience of loss seems to be more consequential to trauma-related symptoms than the event itself. Participants opined strongly the need for TFI and the role of it in promoting recovery from psychosis. [ABSTRACT FROM AUTHOR]

Childhood trauma is linked to an increased risk of developing psychosis in adulthood. The extent and severity of trauma experienced is known to correlate with the intensity or presence of specific psychotic symptoms. The relative impact of types of abuse and neglect (sexual, physical, emotional) is unknown. Cluster analysis was used to create natural groupings of similarity based on Childhood Trauma Questionnaire Scores (CTQ) in a sub-sample of 51 anti-psychotic-free patients with diagnoses of Schizophrenia Spectrum Disorders from the ACTION trial. The derived clusters were compared on the Positive and Negative Syndrome Scale (PANSS) scores. Two clusters emerged: one characterized by abuse and the other by neglect. The abuse group was found to have significantly higher positive symptoms scores (p < 0.05). This is the first investigation of this concept in an un-medicated cohort that distinguished between trauma types using natural groupings in the data, and therefore, a more ecologically valid means of exploring the existence of a traumatic psychosis subgroup. [ABSTRACT FROM AUTHOR]

Background: Co-occurrence of psychosis and posttraumatic stress disorder (PTSD) symptoms has been demonstrated, but the ICD-11 marks a significant divergence in the formulation of PTSD with a focus on the core symptoms and the addition of complex PTSD (CPTSD). Objective: To evaluate the distribution of psychosis and traumatic stress symptoms using the ICD-11 conceptualisation of PTSD and CPTSD. Method: A latent class analysis was conducted on psychosis symptoms, PTSD and CPTSD among a random adult sample from the UK general population with a history of traumatic events (N = 1,051). Results: Six classes were identified; a low-symptom class, a PTSD-class, a CPTSD-class, a class characterized by disturbances in self-organization alone as well as two classes characterized by CPTSD and various levels of psychosis symptom endorsement. Cumulative childhood adversity predicted membership of the PTSD, CPTSD and comorbid classes in a dose-response manner with the strongest effects observed for classes characterised by comorbid symptoms. Conclusion: The present study confirms the co-occurrence of psychosis symptoms and ICD-11 PTSD and CPTSD. Psychosis symptoms did not emerge in isolation from traumatic stress symptoms, underpinning the need for a greater recognition of psychosis symptoms as part of the broader clinical picture among trauma-exposed populations. [ABSTRACT FROM AUTHOR]

Bullying is an adverse childhood experience that is more common among youth with special needs and is associated with increased psychopathology throughout the lifespan. Individuals with chromosome 22q11.2 deletion syndrome (22q) represent one group of special needs youth who are at increased risk for bullying due to co-occurring genetically-mediated developmental, physical, and learning difficulties. Furthermore, individuals with 22q are at increased risk for developing psychotic disorders such as schizophrenia. However, there is a paucity of research exploring the impact of bullying on individuals with 22q and the possible impact this has on risk for psychosis in this population. To explore this relationship using existing research the goals of the review are: (i) to explore the nature of bullying among youth with special needs, and (ii) to discuss its potential role as a specific risk factor in the development of adverse outcomes, including psychosis symptoms. We reviewed the relationship between bullying and its short and long-term effects on the cognitive, social, and developmental functioning of typically developing individuals and those with special needs. We propose an interactive relationship between trauma, stress, and increased psychosis risk among youth with 22q with a history of bullying. The early childhood experience of trauma in the form of bullying promotes an altered developmental trajectory that may elevate the risk for maladaptive functioning and subsequent psychotic disorders, particularly in youth with genetic vulnerabilities. Therefore, we conclude the experience of bullying among individuals with 22q should be more closely examined. [ABSTRACT FROM AUTHOR]

Bullying victimization has been recognized as a risk factor for social, physical, and psychological problems in adolescence. One promising resource that seems to protect adolescents from adversity and traumatic events is gratitude. However, no analysis of the specific role of gratitude in bullying context has been performed as yet. Thus, the aim of this research was to explore the associations between bullying victimization, gratitude and suicide risk (i.e., depressive symptoms and suicidal thoughts and behaviors) and gender-based differences. We also investigated whether levels of gratitude moderated the relationship between victimization and suicide risk for girls and boys. A convenience sample of 1,617 adolescents (50.5% girls; M age = 14.02) participated in this research. Adolescents completed a paper-and-pencil questionnaire about their bullying victimization, gratitude, depressive symptoms and suicidal thoughts and behaviors. Gratitude was found to be negatively related to victimization and suicide risk. While no gender differences were found in gratitude, it was observed that girls reported higher levels of suicide risk. However, the victimization × gratitude interaction contributed to variance in suicide risk, but only for girls: Those girls who were victims of bullying with high gratitude scores reported lower suicide risk than their counterparts who showed less gratitude. Thus, the findings from this present cross-sectional study suggest that gratitude is related to suicide risk in the context of bullying victimization, especially among adolescent girls. Finally, the theoretical and practical implications of our novel contributions to the understanding of gratitude as a protective factor against consequences of bullying victimization are discussed. [ABSTRACT FROM AUTHOR]

Alcohol use disorder (AUD) evidences high rates of comorbidity with a range of psychiatric disorders, particularly within high-risk populations, such as individuals exposed to physical or sexual violence. Increasing efforts are focused on understanding the role of early alcohol use (e.g., during adolescence) on emotional and psychiatric functioning over time, as well as sex differences in these associations. The aim of the current study was to evaluate patterns of association between age of initiation of regular alcohol use and posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms as a function of sex. Participants were 269 college students with a history of interpersonal trauma and alcohol use who completed a battery of questionnaires regarding alcohol use and emotional health. Neither bivariate correlations nor results from structural equation models covarying for key factors showed a relationship between age of alcohol use initiation and current psychiatric symptoms among men (n = 63). Results of a structural equation model supported an association between earlier age of alcohol use initiation and greater levels of current PTSD (β = -0.14), anxiety (β = -0.15), and depression symptoms (β = -0.16) in the female sub-sample (n = 202), after controlling for covariates, as well as intercorrelations among criterion variables. Statistical support for sex as a moderator of these associations was not detected. The current study provides preliminary evidence for potential sex differences in the role of early alcohol use in the development of psychiatric symptoms and highlights the need for systematic longitudinal research. [ABSTRACT FROM AUTHOR]

Numerous studies have demonstrated that genetic and environmental factors interact to influence alcohol problems. Yet prior research has primarily focused on samples of European descent and little is known about gene–environment interactions in relation to alcohol problems in non-European populations. In this study, we examined whether and how genetic risk for alcohol problems and peer deviance and interpersonal traumatic events independently and interactively influence trajectories of alcohol use disorder symptoms in a sample of African American students across the college years (N = 1,119; Mage = 18.44 years). Data were drawn from the Spit for Science study where participants completed multiple online surveys throughout college and provided a saliva sample for genotyping. Multilevel growth curve analyses indicated that alcohol dependence genome-wide polygenic risk scores did not predict trajectory of alcohol use disorder symptoms, while family history of alcohol problems was associated with alcohol use disorder symptoms at the start of college but not with the rate of change in symptoms over time. Peer deviance and interpersonal traumatic events were associated with more alcohol use disorder symptoms across college years. Neither alcohol dependence genome-wide polygenic risk scores nor family history of alcohol problems moderated the effects of these environmental risk factors on alcohol use disorder symptoms. Our findings indicated that peer deviance and experience of interpersonal traumatic events are salient risk factors that elevate risk for alcohol problems among African American college students. Family history of alcohol problems could be a useful indicator of genetic risk for alcohol problems. Gene identification efforts with much larger samples of African descent are needed to better characterize genetic risk for alcohol use disorders, in order to better understand gene–environment interaction processes in this understudied population. [ABSTRACT FROM AUTHOR]

While the concept of moral injury has been embraced in academic, clinical and public discourses, it is still nascent and needs development regarding the ‘moral’ in ‘moral injury’. When questions about the complex nature of morality go unaddressed, clinical practice is based on unsubstantiated and possibly reductive assumptions about the moral dimensions of traumas. Current conceptualizations of moral injury approach morality implicitly as a harmonious belief system. However, people always have multiple moral commitments that may co-exist in tension. What are the implications of moral tension in the experience of distress, and what are the implications of the complex nature of morality for the theoretical understanding of moral injury? This article addresses these questions, drawing on relevant literature from the fields of philosophy and social sciences, and on 80 in-depth qualitative interviews with Dutch veterans, thus contributing to a refined, interdisciplinary concept of moral injury. [ABSTRACT FROM AUTHOR]

Abstract: As I recount my own experience of having essentially been a refugee “twice” during World War II, the first time, when to escape what Jews experienced as a serious threat to life once the German army started its attack on its Western Europe neighbors we fled Brussels, Belgium to find safety in France. The second time occurred, when after a year in safety, by my mother's intentional action, I left France with 49 other, then for all intents and purposes family‐less refugees to come to America. As I narrate the ups and downs of my threat‐compelled meanderings I stop from time to time to reflect and comment on some of the experiences that confronted me and many other refugees – recognizing that side‐by‐side with some plausible generalizations one can make of such miserable experience, that there are as many individual narratives as there are refugees. [ABSTRACT FROM AUTHOR]

Evidence suggests that posttraumatic stress (PTS) disorder (PTSD) symptom presentations may vary as a function of index trauma type. Network analysis was employed in the present study to examine differences in PTS symptom centrality (i.e., the relative influence of a symptom on the network), and PTS symptom associations across three trauma types: motor vehicle accident (MVA), sexual assault (SA), and sudden accidental/violent death of a loved one (SAD). The final sample comprised 554 female undergraduates who had experienced a MVA ( n = 226), SA ( n = 222), or SAD ( n = 106) per Diagnostic Statistical Manual—Fifth Edition ( DSM-5 ) criteria. Within the pooled network, anhedonia and dysphoria emerged as the most central symptoms, while trauma-related amnesia was the least central. The SA network was largely consistent with the DSM-5 conceptualization of PTSD. In contrast, the SAD network was the least consistent with the DSM-5 conceptualization of PTSD, and centrality estimates for the SAD network were inconsistent with the MVA and SA networks. Findings of the current study suggest a need to consider index trauma type as an important factor in the ontology of PTSD. Findings also add to the ongoing discussions about the suitability of SAD as a PTSD-relevant trauma type and about the importance of trauma-related amnesia as a PTSD symptom. [ABSTRACT FROM AUTHOR]

While Freud’s account of melancholia stresses the role of a lost object, a Lacanian approach draws attention to the role of an intruding and excessive “real” object and the inability of the psychotic subject to adequately shield themselves from the traumatic jouissance associated with it. While initially these approaches seem to contradict one another, this short commentary argues that the loss of an imaginary (ego-supporting) object (as per Freud’s conceptualization of psychosis) may be coterminous with the invasive presence of an object of a different order—that of the Lacanian real. We are able to better appreciate the particularity of this invasive object by reference to Lacan’s notion—itself derived from Freud—of das Ding. Das Ding is that “object” of amassed primal jouissance, which—like a black hole—corresponds to its own absence and which, in its terrifying and sublime materializations, brings together the three crucial Freudian concepts of libidinal overproximity, unmodulated jouissance, and the death drive. [ABSTRACT FROM AUTHOR]

Objective: Attrition is a common problem in youth trauma treatment, but there is currently little knowledge of why so many youths drop out. In this study, treatment variables (caregiver attendance in the first session and exposure vs. non-exposure-based treatment) and first-session process variables (the therapeutic alliance and youths’ perceptions of parental treatment approval) were investigated as predictors of dropout.Method: Participants (N = 156, mean age = 15.1) were randomly assigned to trauma-focused cognitive behavioral therapy or therapy as usual in a community trial.Results: Dropout (n = 39, 25.0%) was predicted by a lack of caregiver attendance, lower rates of youth-perceived parental treatment approval, and weaker therapist-rated youth alliance. Neither type of treatment, youth-rated alliance or caregiver alliance, predicted dropout.Conclusions: The findings indicate that in addition to caregivers’ actual participation in the first session, youths’ perception of their parents’ approval of treatment seems to influence treatment attendance. This finding implies that therapists should engage caregivers in therapy and address possible discordance in treatment goals and tasks. Furthermore, consistent with adult studies, exposure-based treatments do not appear to increase dropout rates. [ABSTRACT FROM PUBLISHER]

Recent interest among criminologists on the construct of temperament has been fueled by DeLisi and Vaughn's (2014) temperament-based theory of antisocial behavior. Their theory suggests that core self-regulation capacity and negative emotionality are the most salient temperament features for understanding the emergence and maintenance of antisocial and violent behavior, even among offending populations. The present study tests the relative effects of these temperamental features along with psychopathic traits and trauma in their association with violent and non-violent delinquency in a sample of 252 juvenile offenders. Results from a series of negative binomial regression models indicate that temperament was uniformly more strongly associated with violent and non-violent delinquency than psychopathic traits and childhood traumatic events. Exploratory classification models suggested that temperament and psychopathy possessed similar predictive capacity, but neither surpassed prior history of violence and delinquency as a predictor of future offending. Overall, findings are supportive of DeLisi and Vaughn's temperament-based theory and suggest temperament as conceptualized and measured in the present study may play an important role as a risk factor for violent and non-violent delinquency. [ABSTRACT FROM AUTHOR]

Orientation to bodily signals is defined as the way somatic sensations are attended, perceived and interpreted. Research suggests that trauma exposure, particularly the pathological reaction to trauma (i.e., PTSD), is associated with catastrophic and frightful orientation to bodily signals. However, little is known regarding the long-term ramifications of trauma exposure and PTSD for orientation to bodily signals. Less is known regarding which PTSD symptom cluster manifests in the ‘somatic route’ through which orientation to bodily signals is altered. The current study examined the long-term implications of trauma and PTSD trajectories on orientation to bodily signals. Fifty-nine ex-prisoners of war (ex-POWs) and 44 controls were assessed for PTSD along three time-points (18, 30 and 35 years post-war). Orientation to bodily signals (pain catastrophizing and anxiety sensitivity–physical concerns) was assessed at T3. Participants with a chronic PTSD trajectory had higher pain catastrophizing compared to participants with no PTSD. PTSD symptom severity at T2 and T3 mediated the association between captivity and orientation. Among PTSD symptom clusters, hyperarousal at two time-points and intrusion at three time-point mediated the association between captivity and orientation. These findings allude to the cardinal role of long-term PTSD in the subjective experience of the body following trauma. [ABSTRACT FROM AUTHOR]

Purpose: Examine to what extent adults affected by recent potentially traumatic events (PTE) with different PTSD-symptom levels are more at risk for post-event loneliness than non-affected adults are in the same study period.Methods: We extracted data from the Dutch longitudinal LISS panel to measure pre-event loneliness (2011) and post-event loneliness (2013 and 2014), pre-event mental health problems (2011), PTE and PTSD symptoms (2012). This panel is based on a traditional random sample drawn from the population register by Statistics Netherlands.Results: Results of the multinomial logistic regression analyses showed that affected adults with high levels of PTSD symptoms were more at risk for high levels of post-event loneliness than affected adults with very low PTSD-symptom levels and non-affected adults, while controlling for pre-event loneliness, pre-event mental health problems and demographics. However, affected adults with very low levels of PTSD symptoms compared to non-affected adults were less at risk for medium and high levels of post-event loneliness while controlling for the same variables. Yet, pre-event loneliness appeared to be the strongest independent predictor of loneliness at later stages: more than 80% with high pre-event levels had high post-event levels at both follow-ups.Conclusions: Remarkably, potentially traumatic events have depending on PTSD-symptom levels both negative and positive effects on post-event loneliness in favor of affected adults with very low PTSD symptoms levels. However, post-event levels at later stages are predominantly determined by pre-event loneliness levels. [ABSTRACT FROM AUTHOR]

Study Objective To evaluate the characteristics of girls with accidental genital trauma (AGT) who can be managed in the emergency department (ED) vs the operating suite (OS). Design Retrospective cohort. Setting ED at a children's hospital in a metropolitan area. Participants Girls aged 0-18 years with AGT. Interventions and Main Outcome Measures Factors associated with need for evaluation and repair of AGT in the OS. Results A total of 359 girls were included in the analysis. The mean age was 6 ± 3 years. Most girls presented with pain and bleeding, 321/359 (89%). Straddle injury was the most common mechanism, 258/355 (73%). The most commonly injured site was the labia, 225/358 (63%) and the most common type of injury was laceration, 308/357 (86%). Factors significantly associated with treatment in the OS included older age, transfer from another institution, penetrating injuries, injuries involving the hymen/vagina/urethra/anus, and injuries larger than 3 cm in size. The odds of requiring general anesthesia in the OS were 5.5 times higher for injuries larger than 3 cm (95% confidence interval, 2.8-10.9; P < .0001) and 4.1 times greater if the patient was transferred from another facility (95% confidence interval, 1.3-13.3; P < .02). Conclusion Most AGT can be managed expectantly. Penetrating injuries, injuries to the hymen/vagina/urethra/anus, and injuries with a maximal size of 3 cm should be considered as indications for management in the OS. With adequate procedural sedation, most girls with minor injuries as a result of AGT can undergo a thorough examination and repair of AGT in the ED. [ABSTRACT FROM AUTHOR]

Alcohol misuse is a common sequela of traumatic event experiences causing considerable morbidity and mortality. Although biological stress indicators have been identified as useful risk markers for the development of trauma-related disorders, no such biological indicators exist for the risk of increased alcohol use after trauma exposure. This is the first study to prospectively investigate the predictive value of long-term cortisol levels and acute stress reactivity for the risk of increased alcohol use following traumatic events. Male soldiers were examined before and 12 months following deployment using a standardized diagnostic interview. We analyzed the moderating role of baseline hair cortisol concentrations (HCCs, n = 153) as well as baseline salivary cortisol and alpha-amylase stress reactivity in response to a laboratory stressor (n = 145) in the association between new-onset traumatic events (according to the DSM-IV A1 criterion) and subsequent daily alcohol use. No main effects of pre-traumatic HCC or salivary stress markers on subsequent change in alcohol use were observed. However, we found that with decreasing HCC, the number of new-onset traumatic events was more strongly associated with subsequent alcohol use independent from changes in posttraumatic stress disorder symptoms. No such relation was seen for the acute stress reactivity data. Taken together, this study provides first evidence suggesting that individual differences in long-term cortisol regulation are involved in the association between traumatic experiences and subsequent alcohol use. HCC may thus serve as a potential target in the early identification of individuals vulnerable for increased alcohol use following traumatic events. [ABSTRACT FROM AUTHOR]

BackgroundChildhood trauma has been significantly associated with first-episode psychosis, affective dysfunction and substance use.AimsTo test whether people with first-episode psychosis who had experienced childhood trauma, when compared with those who had not, showed a higher rate of affective psychosis and an increased lifetime rate of substance use.MethodThe sample comprised 345 participants with first-episode psychosis (58% male, mean age 29.8 years, s.d. = 9.7).ResultsSevere sexual abuse was significantly associated with a diagnosis of affective psychosis (χ2 = 4.9, P = 0.04) and with higher rates of lifetime use of cannabis (68% v 41%; P = 0.02) and heroin (20% v 5%; P = 0.02). Severe physical abuse was associated with increased lifetime use of heroin (15% v 5%; P = 0.03) and cocaine (32% v 17%; P = 0.05).ConclusionsPatients with first-episode psychosis exposed to childhood trauma appear to constitute a distinctive subgroup in terms of diagnosis and lifetime substance use. [ABSTRACT FROM AUTHOR]

The aim of this work is to understand, from a developmental-relational perspective, the emotional nature of addictive symptoms. Many studies have shown that addictions are linked to traumatic emotions that, once activated, could cause a feeling of emotional confusion that in the most severe cases could be connected to the fear that the Self might disintegrate. Before understanding the relationship between dissociation and addictions, it is essential to distinguish disintegration (désagrégation, in the language of Pierre Janet) and dissociation. Indeed, if the disintegration is a structural and pathological condition of the personality caused by early and chronic emotional traumatic memories, the dissociation is a defensive reaction to a stress: this reaction can be normal (flexible and adequate) or pathological (rigid and inadequate). Thus, addictive behaviours could be associated to a dissociative reaction in individuals with a structural dissociation of the personality (désagrégation). This disintegration would be linked to traumatic emotions: unconscious and unsymbolised emotions. On the unconscious nature of these emotions, the author of this paper underlines the role of the unrepressed unconscious, which in addicts would seem to be impaired. [ABSTRACT FROM AUTHOR]

Background: Trauma remains a leading cause of death and long term-morbidity. We have shown that patients who sustain traumatic injuries are at increased risk for the development of infectious complications. Psychiatric illnesses (PIs) are also noted to occur frequently among the general population. The presence of a PI has been shown to be a risk factor for the development of infections. Despite the prevalence of both traumatic injuries and psychiatric diseases, there are little data relating the impact of PI on the outcome of patients with trauma. We hypothesize that the presence of a PI will be associated with an increased risk of an infection developing after injury.Patients and Methods: This is a five year retrospective chart review of all admitted patients with trauma age 18 years and older. Patients with and without a major psychiatric illness were compared. Demographic data, mechanism of injury and Injury Severity Score (ISS) were reviewed. Co-morbidities included diabetes mellitus, obesity, pre-injury steroid use, and International Classification of Diseases, 9th edition, based psychiatric illness. All infections were diagnosed by microbiologic criteria (urinary tract infection [UTI], ventilator-associated pneumonia) or Centers for Disease Control and Prevention criteria for clinically evident infections (surgical site infection).Results: Of the 11,147 admitted trauma patients, 14.5% had a pre-injury PI diagnosis. The PI patients were older (61.5 ± 0.5 vs. 54.3; p < 0.001), more often female (56% vs. 39.1%; p < 0.001), and had no difference in blunt mechanism rates (88.4% vs. 89.9%; p = 0.06) or median ISS (9 vs. 9; p = 0.06). There was no difference between PI and non-PI patients in pre-injury diabetes mellitus (13.4% vs. 12.7%; p = 0.4), steroid use (2.5% vs. 1.9%; p = 0.1), but patients with PI were more likely to be obese (15.7% vs. 13.6%; p = 0.03). Patients with PI were more likely to have an infection develop (10.4% vs. 7.5%; p < 0.001). The most common infection in both groups was UTI (6.9% vs. 4.2%; p < 0.001). Compared with non-PI patients, adjusting for age, gender, ISS, diabetes mellitus, and obesity, patients with PI were more likely to have an infection develop (odds ratio 1.3, 95% confidence interval = 1.1-1.5) Conclusions: Patients with an underlying PI are at increased risk of having a UTI after traumatic injury. This study identifies a previously unknown independent risk factor for UTIs in patients with trauma. This stresses the need for increased awareness and attention to this vulnerable population. [ABSTRACT FROM AUTHOR]

Mourning stands among the early traumatic experiences that lead to narcissistic identity disorders. The separations that the child has experienced, regardless of their cause, are difficult to work-through and integrate within the child's psychic life, sometimes even impossible. The child's capacity to go through a process of mourning depends on his / her relationship to the mother, on the age at which this separation is experienced, but also on the relationship with the lost object. Sometimes, children are exposed to a mourning which the parents are unable to achieve, and which they displace upon their children, this having negative effects upon the narcissism of the latter. Throughout this paper, I set out to describe the consequences of such a mourning upon the child's subsequent development. I took into account the parents' loss of a child, either before the patient's birth or, a different situation, the loss having occurred when the patient was less than two years old and had no direct contact with the deceased sister. [ABSTRACT FROM AUTHOR]

The current study examined intergenerational transmission of trauma in grandchildren of Holocaust survivors. While many typically do not find evidence for such effects, careful reading of the relevant literature suggests conditions under which such effects may be obtained. Following, we made use of three factors. First, we took the number of grandparents exposed to the Holocaust into account. Second, we examined participants who were exposed to present terror and displayed posttraumatic stress disorder (PTSD) symptoms. Third, we measured anxiety of a future ISIS threat, which in its genocidal nature is reminiscent of the Holocaust. Results reveal that grandchildren having all four grandparents who survived the Holocaust in conjunction with them directly experiencing PTSD symptoms demonstrated greater ISIS anxiety than other groups. Results are discussed in reference to various conditions that may determine the likelihood of intergenerational transmission of trauma emerging. [ABSTRACT FROM AUTHOR]

This study explores the applicability of psychoanalytic trauma-centered perspectives and social psychological intergroup comparison perspectives to difficult histories of the Israeli context. The study describes 2 test cases of difficult histories in the Jewish-Israeli context at the levels of curriculum policy, teachers, and learners. The first is the Holocaust, a history of victimhood, and the second is the creation of the Palestinian refugee problem, a history of perpetrating harm onto others. Findings show engagement with Holocaust history is officially encouraged through an ever-expanding curriculum and arouses almost universal enthusiasm and pride. By contrast, engagement with Palestinian plight was hampered by erratic curricular policy. It has led to teachers hovering between evasion and risk-taking, incurring hostile student reactions as well as facilitating student openness to the other’s voice. These phenomena seemingly contradict the psychoanalytically inspired view of trauma as difficult history and may be better interpreted from a social psychological perspective. The implications of this study stress the potential of the psychoanalytically inspired “pedagogy of remembrance” in structuring engagement with trauma and point to the utility of social psychological theory in predicting and overcoming learner resistance. This study also illustrates the risks and promises difficult histories of perpetration may hold for educators. [ABSTRACT FROM PUBLISHER]

Affective films are often used in emotion research and negative films are frequently used as an analogue for trauma (trauma film paradigm). However, different films are used with possibly distinct consequences. We aimed to investigate specific effects of four negative films covering distinct themes (physical, sexual, traffic and food), and tested neutral and positive films with matching content. Self-reported emotional responses and heart rate during the films were examined (immediate responses) as well as intrusions of the films in the subsequent week (delayed responses). Within each theme, negative films were rated as more unpleasant than the positive and neutral counterparts. They also evoked more negative emotions and more intrusive memories. Across themes, the four negative films did not differ in terms of valence and arousal, but clearly differed on immediate (e.g., disgust, embarrassment, heart rate) and delayed (intrusions) effects. Thus, we urge researchers to carefully select negative films for their studies, as different films seem to evoke distinct emotional responses. In addition, using positive films within the same themes is recommended in order to control for effects of arousal. In general, the specific film material should be considered when comparing effects across studies. [ABSTRACT FROM AUTHOR]

Childhood cumulative trauma (CCT) refers to an amalgam of childhood maltreatment experiences that can lead to a range of symptoms and problems in adulthood. The current study examined an integrative model of CCT for its relevance to psychosexual adjustment in adult survivors. A total of 620 participants aged 18 years and over completed a questionnaire assessing early life experiences, affect dysregulation, sexual anxiety, and sexual satisfaction. Path analyses confirmed the hypothesis that CCT is associated with affect dysregulation and sexual anxiety that, in turn, predict lower levels of sexual satisfaction. The validity of this mediational model was demonstrated for different operationalizations of CCT. The results suggested that sex therapists, who are likely to encounter CCT survivors in their practice, should consider targeting affect dysregulation in their efforts to decrease sexual anxiety and increase sexual satisfaction. [ABSTRACT FROM PUBLISHER]