PTSD treatment in times of COVID-19:A systematic review of the effects of online EMDR

COVID-19 affects many societies by measures as “social distancing”, forcing mental health care professionals to deliver treatments online or via telephone. In this context, online Eye Movement Desensitization and Reprocessing (EMDR) is an emerging treatment for patients with Posttraumatic Stress Disorder (PTSD). We performed a systematic review of studies investigating online EMDR for PTSD. Only one trial was identified. That uncontrolled open trial showed promising results. There is an urgent need to further examine the effects of online EMDR for PTSD, before its wider dissemination is warranted. Remotely delivered cognitive behavioural therapy seems the preferred PTSD-treatment in times of COVID-19

Online treatment of persistent complex bereavement disorder, posttraumatic stress disorder, and depression symptoms in people who lost loved ones during the COVID-19 pandemic:study protocol for a randomized controlled trial and a controlled trial

Background: Losing a loved one during the COVID-19 pandemic is a potentially traumatic loss that may result in symptoms of persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression. To date, grief-specific cognitive-behavioural therapy (CBT) has mostly been delivered through individual face-to-face formats, while studies have shown that online treatment also yields promising results. Offering treatment online is now more than ever relevant during the pan demic and may offer important benefits compared with face-to-face CBT, such as lower costs and higher accessibility. Our expectation is that grief-specific online CBT is effective in reducing PCBD, PTSD, and depression symptoms. Objective: Our aim is to evaluate the short-term and long-term effectiveness of grief-specific online CBT in reducing PCBD, PTSD, and depression symptom-levels for adults who lost a loved one during the COVID-19 pandemic. Method: This study consists of two parts. In part 1, a two-armed (unguided online CBT versus waitlist controls) randomized controlled trial will be conducted. In part 2, a two-armed (guided online CBT versus unguided online CBT) controlled trial will be conducted. Symptoms of PCBD, PTSD, and depression will be assessed via telephone interviews at pre-treatment/pre-waiting period, post-treatment/post-waiting period, and six months post-treatment. Potential participants are people who lost a loved one at least three months earlier during the COVID-19 pandemic with clinically relevant levels of PCBD, PTSD, and/or depression. Analysis of covariance and multilevel modelling will be performed. Discussion: This is one of the first studies examining the effectiveness of online grief-specific CBT. More research is needed before implementing online grief-specific CBT into clinical practice

Assessing DSM-5-TR and ICD-11 prolonged grief disorder in children and adolescents:development of the Traumatic Grief Inventory - Kids - Clinician-Administered

BACKGROUND: Around 10% of bereaved youths experience symptoms of prolonged grief disorder (PGD). Recently, PGD was included in the two main classification systems for mental disorders: the ICD-11 and DSM-5-TR. Assessing PGD symptoms in youth is currently hindered by the lack of instruments for ICD-11 and DSM-5-TR criteria. To fill this gap, we developed an instrument to assess PGD symptoms in children and adolescents, the Traumatic Grief Inventory - Kids - Clinician-Administered (TGI-K-CA), based on input of grief experts and bereaved children.METHODS: Five experts rated the items on alignment with DSM-TR and ICD-11 PGD symptoms and comprehensibility. The adjusted items were then presented to seventeen bereaved youths ( Mdn age  = 13.0 years, range = 8-17 years). Using the Three-Step Test Interview (TSTI), children were asked to verbalize their thoughts while answering the items. RESULTS: Issues raised by experts were mostly related to alignment with the DSM-5-TR/ICD-11 symptom, ambiguous formulation of the items, or low comprehensibility for children and adolescents. Items raising fundamental issues according to experts were adjusted. The TSTI showed that children encountered relatively few problems with the items. Frequently reported problems with some of the items (e.g. regarding comprehensibility) led to final adjustments.CONCLUSION: With input from grief experts and bereaved youths, an instrument to assess PGD symptoms as defined in DSM-5-TR and ICD-11 in bereaved youths was finalized. Further quantitative research is currently undertaken to evaluate the instrument's psychometric qualities.</p

Valid measurement of DSM-5 persistent complex bereavement disorder and DSM-5-TR and ICD-11 prolonged grief disorder:The Traumatic Grief Inventory-Self Report Plus (TGI-SR+)

Introduction: When grief reactions after bereavement are so intense that they impair daily functioning, a diagnosis of disturbed grief may apply. Slightly differing criteria-sets for disturbed grief are included in the ICD-11, the DSM-5, and its forthcoming text revision, DSM-5-TR. We examined psychometric properties of a new self-report measure, the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+), that assesses these criteria sets for Persistent Complex Bereavement Disorder (PCBD) as per DSM-5, and Prolonged Grief Disorder (PGD) as defined in ICD-11 and DSM-5-TR. Material and methods: We examined the: i) factor structure, ii) internal consistency, iii) temporal stability, iv) convergent validity, v) known-groups validity, vi) probable caseness, and vii) optimal clinical cut-off scores in two Dutch bereaved samples. Sample 1 consisted of 278 adults, bereaved by various causes. Sample 2 included 270 adults who lost loved ones in a traffic accident. Results: We found support for a 3-factor PCBD model, 1-factor DSM-5-TR model, and 1-factor ICD-11 PGD model. The DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD items demonstrated good internal consistency and temporal stability. Associations between disturbed grief symptoms and posttraumatic stress and depression levels supported convergent validity. Associations between demographic/loss-related variables and disturbed grief symptoms supported known-groups validity. Optimal clinical cut-offs for the TGI-SR+ total score were ≥ 75, ≥71, and ≥ 75 for probable caseness of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD, respectively. Discussion: While replication of our findings in diverse bereaved samples is needed, we conclude that the TGI-SR+ is a reliable and valid measure to assess symptoms of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD

PO-033 Identification and functional evaluation of monoclonal antibodies specifically targeting human carbonic anhydrase IX

Introduction Poor vascularisation of solid tumours leads to inadequate nutrient and oxygen supplies which forces tumour cells to reprogram their metabolism. As a consequence the tumour cell's environment becomes acidic and hypoxic. This, in turn, triggers signalling cascades involving for example heterodimeric hypoxia-inducible factor (HIF). Activation of this hypoxia-induced transcriptional program is crucial for the survival of tumour cells in their hostile microenvironment but also their ability to metastasize. One of the genes upregulated through the HIF pathway is carbonic anhydrase (CA)-IX (CAIX, gene G250/MN-encoded transmembrane protein). CA-IX catalyses carbon dioxide (CO2) thereby generating a proton (H+) and bicarbonate (HCO3-), the latter of which is transported back into the cell and utilised to help safeguard intracellular pH (pHi) stability. Except for the stomach and the gallbladder, CA-IX expression is negligible in normal tissues. In contrast, a broad range of tumours express high levels of CA-IX, where the protein can serve as a biomarker for the early stages of tumour development but also as tumour marker of hypoxia associated with resistance to chemotherapy and radiotherapy. Material and methods Preclinical and clinical studies have shown that CA-IX is a promising therapeutic target for detection and therapy for several cancer types. To date only a limited number of ant-CAIX monoclonal antibodies (mAbs) have been available for clinical testing as therapeutic and imaging agents. In the current study, we generated and functionally categorised a panel of 51 mouse mAbs that specifically bind to human CA-IX. Results and discussions Characterisation of the mAbs revealed that of the mAbs with the best biophysical characteristics, three3 mAbs are suitable as an antibody-drug conjugate (ADC), two2 mAbs inhibit the CA-IX enzyme activity, and one1 mAb that is suitable for CA-IX imaging purposes. Conclusion These preliminary data presented here could thus form the basis for the development of novel CA-IX targeted immunotherapies and diagnostic tools for the treatment of cancer

Stability Analysis of Galerkin/Runge-Kutta Navier-Stokes Discretisations on Unstructured Grids

This paper presents a timestep stability analysis for a class of discretisations applied to the linearised form of the Navier-Stokes equations on a 3D domain with periodic boundary conditions. Using a suitable definition of the `perturbation energy' it is shown that the energy is monotonically decreasing for both the original p.d.e. and the semi-discrete system of o.d.e.'s arising from a Galerkin discretisation on a tetrahedral grid. Using recent theoretical results concerning algebraic and generalised stability, sufficient stability limits are obtained for both global and local timesteps for fully discrete algorithms using Runge-Kutta time integration