The posttraumatic stress disorder diagnosis in preschool- and elementary school-age children exposed to motor vehicle accidents

Objective: Increasingly, children are being diagnosed with psychiatric disorders, including preschool-age children. These diagnoses in young children raise questions pertaining to 1) how diagnostic algorithms for individual disorders should be modified for young age groups, 2) how psychopathology is best detected at an early stage, and 3) how to make use of multiple informants. The authors examined these issues in a prospective longitudinal assessment of preschool- and elementary school-age children who were exposed to a traumatic event. Method: Participants were 114 children (age range: 2-10 years) who had experienced a motor vehicle accident. Parents and older children (age range: 7-10 years) completed structured interviews 2-4 weeks (initial assessment) and 6 months (6-month follow-up) after the traumatic event. A recently proposed alternative symptom algorithm for diagnosing posttraumatic stress disorder (PTSD) was utilized and compared with the standard DSM-IV algorithms for diagnosing PTSD and acute stress disorder. Results: At the 2- to 4-week assessment, 11.5% of the children met conditions for a diagnosis of PTSD based on the alternative algorithm criteria per parent report, and 13.9% met criteria for this diagnosis at the 6-month follow-up. These percentages were much higher than those for DSM-IV diagnoses of acute stress disorder and PTSD. Among 7- to 10-year-old subjects, the use of combined parent- and child-reported symptoms to derive a diagnosis resulted in an increased number of children in this age group who were identified with psychiatric illness relative to the use of parent report alone. Agreement between parent and child on symptoms for 1) a diagnosis of PTSD based on the alternative algorithm criteria and 2) diagnoses of DSM-IV acute stress disorder and PTSD in this age group was poor. Among 2- to 6-year-old subjects, the alternative algorithm PTSD diagnosis per parent report was a more sensitive predictor of later onset psychopathology relative to a diagnosis of DSM-IV acute stress disorder or PTSD per parent report. However, among 7- to 10-year-old subjects, a combined symptom report (from both parent and child) was optimal in predicting posttraumatic psychopathology. Conclusions: These findings support the use of the proposed alternative algorithm for assessing PTSD in young children and suggest that the diagnosis of PTSD based on the alternative algorithm criteria is stable from the acute phase onward. When both parent- and child-reported symptoms are utilized for the assessment of PTSD among 7- to 10-year-old children, the alternative algorithm and DSM-IV criteria have broad comparable validity. However, in the absence of child-reported symptoms, the alternative algorithm criteria per parent report appears to be an optimal diagnostic measure of PTSD among children in this age group, relative to the standard DSM-IV algorithm for diagnosing the disorder

Maladaptive Cognitive Appraisals Mediate the Evolution of Posttraumatic Stress Reactions:A 6-Month Follow-Up of Child and Adolescent Assault and Motor Vehicle Accident Survivors

A prospective longitudinal follow-up study (n = 59) of child and adolescent survivors of physical assaults and motor vehicle accidents assessed whether cognitive processes predicted posttraumatic stress symptomatology (PTSS) at 6 months posttrauma in this age group. In particular, the study assessed whether maladaptive posttraumatic appraisals mediated the relationship between initial and later posttraumatic stress. Self-report measures of PTSS, maladaptive appraisals, and other cognitive processes, as well as structured interviews assessing for acute stress disorder and posttraumatic stress disorder (PTSD), were completed at 2-4 weeks and 6 months posttrauma. PTSS and PTSD at 6 months were associated with maladaptive appraisals and other cognitive processes but not demographic or objective trauma severity variables. Only maladaptive appraisals were found to associate with PTSS/PTSD after partialing out initial symptoms/diagnosis and to mediate between initial and later PTSS. It was argued that, on this basis, maladaptive appraisals are involved in the development and maintenance of PTSS over time, whereas other cognitive processes (e.g., subjective threat, memory processes) may have an effect only in the acute phase. The implications of this study for the treatment of PTSS in youths are discussed

The role of the family in child and adolescent posttraumatic stress following attendance at an emergency department

Objective: To evaluate the role of family factors in posttraumatic stress symptomatology (PTSS) in children and adolescents who have attended an emergency department following assaults or motor vehicle accident. Methods: Children and their parents completed self-report questionnaires and semistructured interviews relating to their psychopathology and cognitive styles at 2-4 weeks and 6 months after trauma. Results: Parental depression was correlated with child PTSS at each assessment point. Less consistent findings were observed for family functioning. Parental endorsement of worry was a correlate of child PTSS at each assessment and a mediator between parental depression and child PTSS. Conclusions: A role for family factors, in particular parental depression and parental endorsement of worry, in the development of child PTSS is supported. Weaknesses of the study are discussed, and suggestions for future research are given

Does mindfulness based cognitive therapy prevent relapse of depression?

addresses: Mood Disorders Centre, University of Exeter, Exeter EX4 4QG, UK. [email protected]: Journal Article; Research Support, Non-U.S. Gov'tCopyright © 2012 by the BMJ Publishing Group LtdDepression typically runs a relapsing and recurrent course.1 Without ongoing treatment people with recurrent depression have a very high risk of repeated depressive relapses throughout their life, even after successful acute treatment. Major inroads into the substantial health burden attributable to depression could be offset through interventions that prevent depressive relapse among people at high risk of recurrent episodes.2 If the factors that make people vulnerable to depressive relapse can be attenuated, the relapsing course of depression could potentially be broken. Currently, most depression is treated in primary care, and maintenance antidepressants are the mainstay approach to preventing relapse.3 The UK’s National Institute for Health and Clinical Excellence (NICE) recommends that to stay well, people with a history of recurrent depression should continue taking antidepressants for at least two years. However, many patients experience side effects, and some express a preference for psychosocial interventions, which provide long term protection against relapse.4 Mindfulness based cognitive therapy (MBCT)5 was developed as a psychosocial intervention for teaching people with a history of depression the skills to stay well in the long term

Threat visibility modulates the defensive brain circuit underlying fear and anxiety

Recent theories distinguish anxiety from fear in the brain. Anxiety is associated with activation in ventromedial prefrontal cortex and hippocampus, while fear is associated with activation in periaqueductal gray, with amygdala involved in processing aspects of both emotional responses. These theories propose that the amount of information available about threat determines which of the two defensive responses is elicited, with fear and anxiety associated with well-defined and uncertain threats respectively. However, a direct test of this hypothesis is lacking. Here we provide such a test using fMRI to record participants’ brain activity while they performed a computer-based task which required to press a button to move an artificial agent to a target position while an artificial predator chased the agent. In one condition (associated with fear) the predator was visible, while in another condition (associated with anxiety) the predator was invisible. Ventromedial prefrontal cortex, hippocampus, and amygdala showed increased activity when the predator was invisible compared to visible, while the opposite effect was observed in periaqueductal gray. We also observed that participants with high but not low trait-anxiety showed an hippocampal activation with invisible threat at an earlier time stage during the trial. These findings help clarify the neural mechanisms that underlie different defensive emotions and shed light on how these mechanisms may contribute to exaggerated anxiety

Mitigating Coronavirus Induced Dysfunctional Immunity for At-Risk Populations in COVID-19: Trained Immunity, BCG and "New Old Friends".

The novel, highly contagious coronavirus SARS-CoV-2 spreads rapidly throughout the world, leading to a deadly pandemic of a predominantly respiratory illness called COVID-19. Safe and effective anti-SARS-CoV-2 vaccines are urgently needed. However, emerging immunological observations show hallmarks of significant immunopathological characteristics and dysfunctional immune responses in patients with COVID-19. Combined with existing knowledge about immune responses to other closely related and highly pathogenic coronaviruses, this could forebode significant challenges for vaccine development, including the risk of vaccine failure. Animal data from earlier coronavirus vaccine efforts indicate that elderly people, most at risk from severe COVID-19 disease, could be especially at risk from immunopathologic responses to novel coronavirus vaccines. Bacterial "new old friends" such as Bacille Calmette-Guérin (BCG) or Mycobacterium obuense have the ability to elevate basal systemic levels of type 1 cytokines and immune cells, correlating with increased protection against diverse and unrelated infectious agents, called "trained immunity." Here we describe dysfunctional immune responses induced by coronaviruses, representing potentially difficult to overcome obstacles to safe, effective vaccine development for COVID-19, and outline how trained immunity could help protect high risk populations through immunomodulation with BCG and other "new old friends.

Culture and the remembering of trauma

This research investigated the influence of culture and posttraumatic stress disorder (PTSD) on global autobiographical remembering (Study 1a) and on the phenomenological properties (Study 1b) and memory-content variables (Study 1c) of trauma-specific autobiographical remembering. Australian, British, and Iranian trauma survivors with and without PTSD completed the Autobiographical Memory Test, Self-Defining Memory Task, and Autobiographical Memory Questionnaire and provided trauma- and negative-memory narratives. We found that there were pan-cultural deficits and distortions in the global autobiographical remembering of participants with PTSD (Study 1a). In addition, the presence of PTSD moderated the usual effect of culture on the phenomenological properties of the trauma memory (Study 1b). Finally, participants with PTSD, regardless of cultural background, had significantly fewer expressions of autonomy and self-determination in their autobiographical remembering than did those without PTSD (Study 1c). The findings suggest that pan-culturally, individuals with PTSD have similar disruptions and distortions in their autobiographical remembering

Examining the shared and unique features of self-concept content and structure in Borderline Personality Disorder and Depression

AcceptedArticleCopyright © Springer Science+Business Media New York 2015The online version of this article (doi:10.1007/s10608-015-9695-3) contains supplementary material, which is available to authorized users.A number of clinical theories emphasise self-concept disturbance as central to borderline personality disorder (BPD). To date, however, there has been limited empirical examination of exactly how BPD changes the content and structure of self-concept. Moreover, it is unclear if patterns of self-concept disturbance are unique to BPD or are driven by axis-I comorbidities such as depression. To examine this issue, the present study adopted a dimensional design, examining how performance on a novel adaptation of a well-validated measure of self-concept (the Psychological Distance Scaling Task) was related to BPD and depression symptoms in a sample of 93 individuals with a wide range of symptom severity. While greater BPD severity was associated with less positive and more negative content of self-concept, this was driven by depression symptoms. Similarly, positive content was more diffuse and negative content more interconnected at higher levels of BPD severity, but for positive content, this was most clearly linked to comorbid depression features. In contrast, BPD severity (over and above depression symptoms) was uniquely associated with greater ‘clustering’ for positive and negative content (i.e. a more fragmented self-concept). This pattern of results lends support to clinical theories arguing that self-concept fragmentation is core to BPD and also supports the utility of dimensional analyses to identify patterns of cognitive-affective disturbance unique to BPD versus those shared with comorbid conditions like depression.MR

Ionised gas kinematics in bipolar H II regions

Stellar feedback plays a fundamental role in shaping the evolution of galaxies. Here we explore the use of ionised gas kinematics in young, bipolar H II regions as a probe of early feedback in these star-forming environments. We have undertaken a multiwavelength study of a young, bipolar H II region in the Galactic disc, G$316.81-0.06$, which lies at the centre of a massive ($\sim10^3$ M$_{\odot}$) infrared-dark cloud filament. It is still accreting molecular gas as well as driving a $\sim 0.2$ pc ionised gas outflow perpendicular to the filament. Intriguingly, we observe a large velocity gradient ($47.81 \pm 3.21$ km s$^{-1}$ pc$^{-1}$) across the ionised gas in a direction perpendicular to the outflow. This kinematic signature of the ionised gas shows a reasonable correspondence with the simulations of young H II regions. Based on a qualitative comparison between our observations and these simulations, we put forward a possible explanation for the velocity gradients observed in G$316.81-0.06$. If the velocity gradient perpendicular to the outflow is caused by rotation of the ionised gas, then we infer that this rotation is a direct result of the initial net angular momentum in the natal molecular cloud. If this explanation is correct, this kinematic signature should be common in other young (bipolar) H II regions. We suggest that further quantitative analysis of the ionised gas kinematics of young H II regions, combined with additional simulations, should improve our understanding of feedback at these early stages

Role of autobiographical memory in patient response to cognitive behavioural therapies for depression: protocol of an individual patient data meta-analysis.

This is the final version. Available from the publisher via the DOI in this record.INTRODUCTION: Cognitive behavioural therapies (CBTs) are one of the most effective treatments for major depression. However, ~50% of individuals do not adequately respond to intervention and of those who do remit from a depressive episode, over 50% will experience later relapse. Identification of patient-level factors which moderate treatment response may ultimately help to identify cognitive barriers that could be targeted to improve treatment efficacy. This individual patient data meta-analysis explores one such potential moderator-the ability to retrieve specific, detailed memories of the autobiographical past-as cognitive-based therapeutic techniques draw heavily on the ability to use specific autobiographical information to challenge the dysfunctional beliefs which drive depression. METHODS AND ANALYSIS: We have formed a collaborative network which will contribute known datasets. This will be supplemented by datasets identified through literature searches in Medline, PsycInfo, Web of Science, the Cochrane Central Register of Controlled Trials and WHO trials database between December 2018 and February 2019. Inclusion criteria are delivery of a cognitive or cognitive behavioural therapy for major depression, and measurement of autobiographical memory retrieval at preintervention. Primary outcomes are depressive symptoms and clinician-rated diagnostic status at postintervention, along with autobiographical memory specificity at postintervention. Secondary outcomes will consider each of these variables at follow-up. All analyses will be completed using random-effects models employing restricted maximum likelihood estimation. Risk of bias in included studies will be measured using the Revised Cochrane Risk of Bias Tool. ETHICS AND DISSEMINATION: The findings will be published in a peer-reviewed journal. Study results will contribute to better understanding of the role of autobiographical memory in patient response to CBTs, and may help to inform personalised medicine approaches to treatment of depression. PROSPERO REGISTRATION NUMBER: CRD42018109673.Economic and Social Research Council (ESRC