Psychological impact of COVID-19 in a refugee camp in Iraq

The worldwide spread of COVID‐19 is especially causing a humanitarian catastrophe in refugee camps in crisis regions.1 For example, currently over 350 000 survivors of Islamic State of Iraq and Syria (ISIS) terrorism in the Kurdistan region of Iraq live in more than 20 refugee camps. These communities, which had already been traumatized, are now confronted with further adversities that exacerbate the ongoing psychological suffering and lead to increased suicide rates2; however, medical and psychological care is limited,3 and the work of humanitarian actors is restricted.4 Moreover, social distancing is almost impossible in high‐density camps, and hygiene practices are often simply not applicable.5 The objective of our pilot study was to briefly examine for the very first time the development of mental health of a cohort of Yazidis in a refugee camp in Iraq using selective psychometric measures before and shortly after the COVID‐19 outbreak. The participants were aged between 18 and 58 years (N = 68; mean age = 45.72 years, SD = 3.52 years; 38 females). They had fled from ISIS in 2014 and have since been living in a refugee camp near the city of Duhok, Iraq. This cohort was interviewed in October 2019 prior to the COVID‐19 pandemic and, having adapted the study to challenging circumstances, again in April 2020 during the spread of COVID‐19 through demographic questionnaires, the revised Impact of Event Scale (IES‐R),6 and the Composite International Diagnostic Interview (CIDI).7 Descriptive data are illustrated as the mean values of the standard deviation, and categorical parameters are presented as percentages. The presented comparison of both investigated groups was calculated with χ2‐tests, t‐tests, and a univariate two‐factor analysis of variance. Questionnaires in Kurdish were read by native Kurdish interviewers who had been trained by the research team at the Institute for Psychotherapy and Psychotraumatology at the University of Duhok under the leadership of the first author of this correspondence. The investigation was approved by the University Review Board of the University of Duhok; all subjects gave informed consent. The refugees had not been taken captive but had friends or family members who had been murdered. They lived in small tents together with 8–12 other people and their educational level ranged from 0 to 12 years of school attendance (mean = 6.8 years, SD = 2.61 years). Approximately 88% of the respondents were victims of a terror attack, 34% had witnessed a person being beaten or tortured, and 69% had lost at least one sibling. The mean initial IES‐R total score for females was 9.2/15 (SD = 2.6, Mdn = 11, range = 10–15) and that for males was 6.2/15 (SD = 2.4, Mdn = 10, range = 10–15). Yazidi who had individually experienced rape or torture were excluded from this investigation because they evidenced markedly high post‐traumatic stress disorder (PTSD) rates and comorbidities even before the COVID‐19 pandemic.8 The different psychometric prevalence rates of mental disorders in October 2019 and April 2020 according to CIDI were calculated and then sex‐matched compared (Table 1). (...

Transgenerational Transmission of Trauma across Three Generations of Alevi Kurds

Background: Thus far, most researchers on genocide and transgenerational transmissions have focused on the National Socialist Holocaust as the most abhorrent example of this severe human rights violation. Few data have been published on other ethnic or religious groups affected by genocidal actions in this context. Methodology: Using a mixed-method approach integrating qualitative interviews with standardized instruments (SCID and PDS), this study examines how individual and collective trauma have been handed down across three generations in an Alevi Kurd community whose members (have) suffered genocidal perpetrations over a longer time period (a “genocidal environment”). Qualitative, open-ended interviews with members of three generations answering questions yielded information on (a) how their lives are shaped by the genocidal experiences from the previous generation and related victim experiences, (b) how the genocidal events were communicated in family narratives, and (c) coping strategies used. The first generation is the generation which directly suffered the genocidal actions. The second generation consists of children of those parents who survived the genocidal actions. Together with their family (children, partner, relatives), this generation suffered forced displacement. Members of the third generation were born in the diaspora where they also grew up. Results: Participants reported traumatic memories, presented in examples in this publication. The most severe traumatic memories included the Dersim massacre in 1937–1938 in Turkey, with 70,000–80,000 victims killed, and the enforced resettlement in western Turkey. A content analysis revealed that the transgenerational transmission of trauma continued across three generations. SCID and PDS data indicated high rates of distress in all generations. Conclusions: Genocidal environments such as that of the Kurdish Alevis lead to transgenerational transmission mediated by complex factors

SOMATOFORM PAIN DISORDER – OVERVIEW

Somatoforme Schmerzen sind ein sowohl in der Primärals auch der fachsomatischen Versorgung häufiges Beschwerdebild. Neben somatisch nicht ausreichend zu erklärenden Schmerzen aller Lokalisationen treten häufig auch umschriebene Funktionsstörungen einzelner Organsysteme wie Schwindel, Herz- oder Verdauungsbeschwerden sowie Erschöpfungsbeschwerden auf. Gleichzeitig klagen viele Patienten über depressive oder Angstsymptome. Während psychodynamisch-interaktionelle Modelle eine frühe Beeinträchtigung der Körperbeziehung sowie eine ungenügende Affektdifferenzierung in den Vordergrund stellen, fokussieren kognitiv-behaviorale Modelle somatosensorische Amplifikationsprozesse. Die organische Ursachenüberzeugung der Patienten sowie die im Durchschnitt lange Anamnesedauer mit Enttäuschungen über die zahlreichen, meist unbefriedigenden Behandlungsversuchen bedingen nicht selten interaktionelle Schwierigkeiten in der Arzt-Patienten- Beziehung. Schulenübergreifende Handlungsempfehlungen betonen eine aktive Haltung des Therapeuten, Legitimation der Schmerzbeschwerden sowie Hilfe bei der Symptombewältigung. Psychodynamische Ansätze fokussieren zudem Affektdifferenzierung sowie die Bearbeitung von im Zusammenhang mit Schmerzerleben berichteten Beziehungsepisoden.Patients with severe and disabling pain and bodily distress which cannot be explained by underlying organic pathology are common in all levels of health care and are typically difficult to treat for physicians as well as for mental health specialists. Beside pain in different locations, not fully explained by specific somatic pathology, specific functional complaints such as dizziness, fatigue or vegetative disorders are common. A great proportion of patients with somatoform pain complain of comorbid depressive or anxiety disorder. Psychodynamic-interpersonal psychotherapy particularly emphasises interpersonal processes as well as disturbance of body awareness and self regulation already in childhood. Cognitive-behavioral models focus on the phenomenon of somatosensory amplification. The patients do have a strong believe in an underlying somatic illness, therefore seeking for further diagnostic and somatic therapy. This frequently leads to multiple but ineffective therapeutic attempts in the field of somatic medicine resulting in frustration of the patients and a difficult doctor-patient-relationship. General therapeutic recommendations include an active therapeutic approach with paying tribute for the patients’ suffering and giving support to cope with the pain. A specific psychodynamic approach furthermore focuses on improvement of affect differentiation and the interaction of somatoform pain and interpersonal relationships

A European research agenda for somatic symptom disorders, bodily distress disorders, and functional disorders: Results of an estimate-talk-estimate delphi expert study

Background: Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs and pose a substantial challenge to the population and health policy of Europe. To meet this challenge, a specific research agenda is needed as one of the cornerstones of sustainable mental health research and health policy for SSD, BDD, and FD in Europe. Aim: To identify the main challenges and research priorities concerning SSD, BDD, and FD from a European perspective. Methods: Delphi study conducted from July 2016 until October 2017 in 3 rounds with 3 workshop meetings and 3 online surveys, involving 75 experts and 21 European countries. EURONET-SOMA and the European Association of Psychosomatic Medicine (EAPM) hosted the meetings. Results: Eight research priorities were identified: (1) Assessment of diagnostic profiles relevant to course and treatment outcome. (2) Development and evaluation of new, effective interventions. (3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in this context. (4) Research into patients preferences for diagnosis and treatment. (5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes (6). Translational research exploring how psychological and somatic symptoms develop from somatic conditions and biological and behavioral pathogenic factors. (7) Development of new, effective interventions to personalize treatment. (8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital and specialty mental health settings. The general public and policymakers will benefit from the development of new, effective, personalized interventions for SSD, BDD, and FD, that will be enhanced by translational research, as well as from the outcomes of research into patient involvement, GP-patient communication, consultation-liaison models and implementation. Conclusion: Funding for this research agenda, targeting these challenges in coordinated research networks such as EURONET-SOMA and EAPM, and systematically allocating resources by policymakers to this critical area in mental and physical well-being is urgently needed to improve efficacy and impact for diagnosis and treatment of SSD, BDD, and FD across Europe

[Functional and Somatoform Disorders in the Mirror of ICD-10 Routine Data].

The ICD-10 offers the possibility of double coding of diagnoses in functional disorders on the one hand, somatoform disorders on the other side. The current S3 guideline for "dealing with patients with non-specific, functional and somatoform physical complaints" states that "[...] in most cases, the specialty of the (initial) examiner and not the clinical constellation seems to define how a diagnosis is made". Based on selective routine data of the Daimler BKK for the years 2008-2010 frequencies of specific functional diagnoses were compared with those of somatoform disorders, additional diagnoses analyzed and compared with epidemiological data from the Federal Health Monitoring System. The incidence found in epidemiological studies of somatoform disorders cannot be found in present routine data. Functional disorders were more frequently diagnosed than somatoform disorders. Certain additional diagnoses that may provide clues to etiological relations are rarely used. As the validity, reliability and purpose of ICD-10 invoicing diagnoses is debatable, there seems to be an imbalance relevant for the health care system. Non-adherence to the guidelines may prevent adequate quality and quantity of patient care

Entwicklungsabhängige Änderung neuronaler Kalziumsignale

Gegenstand vorliegender Arbeit sind Untersuchungen zu Aktionspotential-induzierten Kalzium-Signalen in unreifen Neuronen. In Widerspiegelung des hierzu gewählten zweigleisigen Vorgehens ist diese Dissertation in zwei Teile gegliedert: Im ersten Abschnitt wird die Entwicklung eines Softwarepaketes beschrieben, mit dem die Aufnahme und Analyse des für diese Arbeit relevanten Bilddatenteils erfolgte. Im zweiten Abschnitt wurden dann unter Anwendung dieser Software Experimente in heranreifenden Purkinje-Neuronen des Kleinhirns (Zerebellum) von Ratten und Mäusen durchgeführt. Besonderes Augenmerk galt in diesem Zusammenhang dem maturationsbedingt unterschiedlichen Grad der Ausprägung von intrazellulären Kalzium-Signalen infolge der Evozierung von somatischen Aktionspotentialen. Darauf aufbauend wurden Untersuchungen hinsichtlich der Bedeutung des intrazellulären Kalzium-Puffers Calbindin D28k (Calbindin) und dessen Rolle für das zeitliche wie räumliche Profil dieser Kalziumsignale durchgeführt

Neural correlates of deficits in pain-related affective meaning construction in patients with chronic pain disorder.

Psychological and neural mechanisms of the affective dimension of pain are known to be disturbed in patients with chronic pain disorder. The aim of this functional magnetic resonance imaging study was to assess the neurofunctional and behavioral measures underlying the ability to construct pain-related affective meaning in a painful situation by comparing 21 clinically and psychometrically well-characterized patients with persistent non-nociceptive somatoform pain with 19 healthy controls.The functional magnetic resonance imaging task involved viewing pictures depicting human hands and feet in different painful and nonpainful situations. Participants were asked to estimate the perceived pain intensity. These data were correlated with behavioral measures of depression, alexithymia, and general cognitive and emotional empathy.In a hypothesis-driven region-of-interest analysis, the healthy control group exhibited greater activation of the left perigenual anterior cingulate cortex than patients with pain (Montreal Neurological Institute coordinates (x y z)=-8 38 0; cluster extent=54 voxels; T=4.28; p=.006 corrected for multiple comparisons at cluster level). No group differences in the activation of the anterior insular cortex were found. Scores on self-assessment instruments (Beck Depression Inventory I, Interpersonal Reactivity Index, and 20-item Toronto Alexithymia Scale) did not influence neuroimaging results.Our results suggest that patients with chronic medically unexplained pain have an altered neural pain perception process owing to decreased activation of empathetic-affective networks, which we interpret as a deficit in pain-related affective meaning construction. These findings may lead to a more specific and detailed neurobiological understanding of the clinical impression of disturbed affect in patients with chronic pain disorder