Narrative Exposure Therapy for Posttraumatic Stress Disorder associated with repeated interpersonal trauma in patients with Severe Mental Illness: a mixed methods design

Background: In the Netherlands, most patients with severe mental illness (SMI) receive flexible assertive community treatment (FACT) provided by multidisciplinary community mental health teams. SMI patients with comorbid posttraumatic stress disorder (PTSD) are sometimes offered evidence-based trauma-focused treatment like eye movement desensitization reprocessing or prolonged exposure. There is a large amount of evidence for the effectiveness of narrative exposure therapy (NET) within various vulnerable patient groups with repeated interpersonal trauma. Some FACT-teams provide NET for patients with comorbid PTSD, which is promising, but has not been specifically studied in SMI patients. Objectives: The primary aim is to evaluate NET in SMI patients with comorbid PTSD associated with repeated interpersonal trauma to get insight into whether (1) PTSD and dissociative symptoms changes and (2) changes occur in the present SMI symptoms, care needs, quality of life, global functioning, and care consumption. The second aim is to gain insight into patients’ experiences with NET and to identify influencing factors on treatment results. Methods: This study will have a mixed methods convergent design consisting of quantitative repeated measures and qualitative semi-structured in-depth interviews based on Grounded Theory. The study population will include adult SMI outpatients (n=25) with comorbid PTSD and receiving NET. The quantitative study parameters will be existence and severity of PTSD, dissociative, and SMI symptoms; care needs; quality of life; global functioning; and care consumption. In a longitudinal analysis, outcomes will be analyzed using mixed models to estimate the difference in means between baseline and repeated measurements. The qualitative study parameters will be experiences with NET and perceived factors for success or failure. Integration of quantitative and qualitative results will be focused on interpreting how qualitative results enhance the understanding of quantitative outcomes. Discussion: The results of this study will provide more insight into influencing factors for clinical changes in this population

Time-varying differences in evoked potentials elicited by high versus low spatial frequencies: a topographical and source analysis

Objective: To investigate time-varying differences in visual-evoked potentials (VEPs) and dipoles elicited by high versus low spatial frequencies. The main question was whether different spatial frequencies are processed in distinct cortical areas, especially after 100 ms. An additional question was whether and how a hemispheric balance in spatial frequency processing develops over time. Methods: Stimuli were square-wave gratings, with spatial frequencies of 0.75, 1.5, and 6 c/d. VEPs and dipole models were analyzed at various latencies. Results: For the time-window of. 80-100 ms, spatial frequency-related differences in VEPs and dipoles in posterior regions as reported previously were replicated: lower spatial frequencies were associated with more positivity in the VEP and with more anterior and radial sources than high frequencies. However, after 100 ms differences in amplitude, but not in topography and dipoles, were found between the different spatial frequencies. Between 180-200 ms a right hemisphere dominance was found for all frequencies. Conclusions: After 100 ms, VEPs in response to different spatial frequencies seem to be generated in the same cortical areas. Also, no evidence for frequency-related hemispheric lateralization was found. Significance: Insight is provided into the functional-anatomical basis of longer-latency frequency-related differences in processing

Abnormal spatial frequency processing in high-functioning children with pervasive developmental disorder (PDD)

Objective: Basic abnormalities in visual information processing could be associated with the local visual bias often found in subjects with PDD. Therefore, the present study investigated the existence of deficits in spatial frequency processing at an early sensory level in children with PDD. Methods: Visual evoked potentials (VEPs) and VEP dipole sources elicited by high and low spatial frequency gratings were analyzed in high-functioning children with PDD and matched controls. Results: Around 80 ms (N80-latency) children with PDD did not show the same robust differences between high and low spatial frequencies in VEP amplitude and VEP brain sources as controls, because of atypical processing of high frequencies. Analyses at the P1-latency (130 ms) revealed that, although similar inferior-medial brain sources were activated for the processing of both spatial frequencies in the PDD and control group, source strength in response to both frequencies was weaker in the PDD compared to control group. Moreover, additional superior-lateral brain sources were activated during the processing of both frequencies in the PDD group. Conclusions: Decreased specialized processing of high and low spatial frequencies might be a robust characteristic of PDD, Early in processing abnormalities in high spatial frequency processing seem to occur in PDD. At a later phase in processing there seems to be both atypical high and low spatial frequency processing. Considering that the processing of specific spatial frequencies plays an important role in the processing of global and local aspects of hierarchical stimuli and faces and of emotions, present data suggest that peculiarities in PDD subjects with respect to these stimuli might be related to an abnormality in more fundamental visual processes. Significance: A basic abnormality in visual frequency processing is established in children with PDD

Face processing in Pervasive Developmental Disorder (PDD): the roles of expertise and spatial frequency

Both a reduced face expertise and a basic abnormality in visual information, e.g. spatial frequency, processing have been proposed as possible causes of the abnormal face processing in Pervasive Developmental Disorder (PDD). This study investigated both the roles of expertise and spatial frequency for face processing in PDD. Event-related potentials (ERPs) and dipole sources were measured in response to (upright/inverted) high- and low-pass filtered faces, houses, and stimuli for which children with PDD were experts. ERP analyses for specific posterior electrodes showed no differences between children with PDD and matched controls, but source analyses did. These showed that controls activated specialized brain sources for the processing of faces, which was dependent on low spatial frequency content. However, children with PDD did not. Importantly, present results argue against the idea that this is due to a reduced face expertise on the part of the children with PDD, but instead support an abnormality in spatial frequency processing

The relationship between local and global processing and the processing of high and low spatial frequencies studied by event-related potentials and source modeling

The processing of global and local elements and of low- and high-spatial frequencies are thought to be interrelated. Evidence for this stems from findings showing that brain localizations for global/local elements and for low/high spatial frequencies seem to overlap. the present study aimed to provide direct evidence that topographical differences between the processing of. global and local visual elements can directly be explained by their spatial frequency content, and to study at which point in time this relation is present. This was done by studying the event-related potentials (ERPs) and source models elicited by unfiltered, low- or high-pass filtered hierarchical stimuli. Results showed that performance for global and local targets was affected by removing low and high spatial frequencies, respectively. ERP data indicated that at 250 ins, there was an interaction between the processing of global/local targets and of spatial frequencies because at this time-point removal of low spatial frequencies decreased activity associated with the processing of global targets. When localizing this effect, we found evidence implying that spatial frequency content indeed affected the brain region in which local/ global targets were processed. Results implicated that the processing of global information depended on its low spatial frequency content, which was processed more laterally. Instead, processing of local information seemed to depend on its high spatial frequency content, which was processed more medially. Thereby, present results extend former results showing that global and local processing is dependent on spatial frequency and mapped retinotopically in the visual cortex

Predicting Mortality in Patients with Diabetes Starting Dialysis

Nephrolog

Development and evaluation of the Dutch Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)

Contains fulltext : 198351.pdf (publisher's version ) (Open Access)Background: In 2013, the Clinician-Administered PTSD Scale, the golden standard to assess PTSD, was adapted to the DSM-5 (CAPS-5). Objective: This project aimed to develop a clinically relevant Dutch translation of the CAPS-5 and to investigate its psychometric properties. Method: We conducted a stepped translation including Delphi rounds with a crowd of 44 Dutch psychotrauma experts and five senior psychotrauma experts. Using partial crowd-translations, two professional translations and the official Dutch translation of the DSM-5, each senior expert aggregated one independent translation. Consensus was reached plenary. After back-translation, comparison with the original CAPS-5 and field testing, a last round with the senior experts resulted in the final version. After implementation clinicians conducted CAPS-5 interviews with 669 trauma-exposed individuals referred for specialized diagnostic assessment. Reliability of the Dutch CAPS-5 was investigated through internal consistency and interrater reliability analyses, and construct validity through confirmatory factor analysis (CFA). Results: CAPS-5 total severity score showed high internal consistency (alpha = .90) and interrater reliability (ICC = .98, 95% CI: .94-.99). CAPS-5 diagnosis showed modest interrater reliability (kappa = .59, 95% CI: .20-.98). CFA with alternative PTSD models revealed adequate support for the DSM-5 four-factor model, but a six-factor (Anhedonia) model fit the data best. Conclusions: The Dutch CAPS-5 is a carefully translated instrument with adequate psychometric properties. Current results add to the growing support for more refined (six and seven) factor models for DSM-5 PTSD indicating that the validity and clinical implications of these models should be objective of further research.14 p