The role of acute cortisol and DHEAS in predicting acute and chronic PTSD symptoms

Background: Decreased activation of the hypothalamus-pituitary-adrenal (HPA) axis in response to stress is suspected to be a vulnerability factor for posttraumatic stress disorder (PTSD). Previous studies showed inconsistent findings regarding the role of cortisol in predicting PTSD. In addition, no prospective studies have examined the role of dehydroepiandrosterone (DHEA), or its sulfate form DHEAS, and the cortisol-to-DHEA(S) ratio in predicting PTSD. In this study, we tested whether acute plasma cortisol, DHEAS and the cortisol-to-DHEAS ratio predicted PTSD symptoms at 6 weeks and 6 months post-trauma. Methods: Blood samples of 397 adult level-1 trauma center patients, taken at the trauma resuscitation room within hours after the injury, were analyzed for cortisol and DHEAS levels. PTSD symptoms were assessed at 6 weeks and 6 months post-trauma with the Clinician Administered PTSD Scale. Results: Multivariate linear regression analyses showed that lower cortisol predicted PTSD symptoms at both 6 weeks and 6 months, controlling for age, gender, time of blood sampling, injury, trauma history, and admission to intensive care. Higher DHEAS and a smaller cortisol-to-DHEAS ratio predicted PTSD symptoms at 6 weeks, but not after controlling for the same variables, and not at 6 months. Conclusions: Our study provides important new evidence on the crucial role of the HPA-axis in response to trauma by showing that acute cortisol and DHEAS levels predict PTSD symptoms in survivors of recent trauma. © 2014 Elsevier Ltd

До питання про культурну атрибутацію шару ранньозалізного віку на городищі Теребовля І

У статті на основі досліджень І.Русанової, Р.Миська та М.Ягодинської проведено атрибутацію культурного шару ранньозалізного віку на городищі літописної Теребовлі. Висловлюється припущення, що перші оборонні споруди на городищі Теребовля І «Замкова Гора», вал 3-ій та 4-ий городища збудовані носіями висоцької культури у ІХ-VIII ст. до н.е

Editorial: Low-Intensity Interventions for Psychiatric Disorders.

Editorial

The association between childhood maltreatment and suicidal intrusions: A cross-sectional study

Childhood maltreatment may play an important role in the transition from suicidal ideation to suicidal behavior. Recently, research has begun evaluating the association between childhood maltreatment and involuntary and distressing intrusions about one's own suicide, also called suicidal intrusions. This cross-sectional, multicenter study aimed to investigate the association between childhood maltreatment and the severity of suicidal intrusions using online questionnaires. Participants were suicidal outpatients currently receiving treatment at a Dutch mental health institution (N = 149). The Childhood Trauma Questionnaire–Short Form and Suicidal Intrusions Attributes Scale were administered online. A simple linear regression was performed followed by a multiple linear regression with backward selection to separate the predictors of childhood maltreatment subscales. Next, significant predictor variables were used to perform an additional regression analysis with gender, age, posttraumatic stress disorder (PTSD) diagnosis, and depressive symptoms as potential covariates. The results showed that childhood maltreatment was significantly associated with suicidal intrusion scores, B =.22, t(147) = 2.010, p =.046. A multiple linear regression analysis showed that the only specific form of childhood maltreatment associated with suicidal intrusions was sexual abuse; the association remained after controlling for age, gender, PTSD diagnosis and depressive symptoms, F(5, 143) = 11.15, p <.001. In summary, the present study confirms the link between childhood maltreatment, particularly childhood sexual abuse, and suicidal intrusions. This finding implies that in the treatment of suicidal intrusions and suicidality, childhood sexual abuse should be identified and targeted with evidence-based treatments for PTSD

Mental health stigma at primary health care centres in Lebanon: qualitative study

&lt;jats:title&gt;Abstract&lt;/jats:title&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Background&lt;/jats:title&gt; &lt;jats:p&gt;Mental health-related stigma is a global public health concern and a major barrier to seeking care. In this study, we explored the role of stigma as a barrier to scaling up mental health services in primary health care (PHC) centres in Lebanon. We focused on the experiences of Healthcare Providers (HCPs) providing services to patients with mental health conditions (MHCs), the views of policy makers, and the perceptions of stigma or discrimination among individuals with MHCs. This study was conducted as part of INDIGO-PRIMARY, a larger multinational stigma reduction programme.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Methods&lt;/jats:title&gt; &lt;jats:p&gt;Semi-structured qualitative interviews (n = 45) were carried out with policy makers (n = 3), PHC management (n = 4), PHC staff (n = 24), and service users (SUs) (n = 14) between August 2018 and September 2019. These interviews explored mental health knowledge, attitudes and behaviour of staff, challenges of providing treatment, and patient outcomes. All interviews were coded using NVivo and a thematic coding framework.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Results&lt;/jats:title&gt; &lt;jats:p&gt;The results of this study are presented under three themes: (1) stigma at PHC level, (2) stigma outside PHC centres, and (3) structural stigma. SUs did not testify to discrimination from HCPs but did describe stigmatising behaviour from their families. Interestingly, at the PHC level, stigma reporting differed among staff according to a power gradient. Nurses and social workers did not explicitly report incidents of stigma but described patients with MHCs as uncooperative, underscoring their internalized negative views on mental health. General practitioners and directors were more outspoken than nurses regarding the challenges faced with mental health patients. Mental health professionals revealed that HCPs still hold implicitly negative views towards patients with MHCs however their attitude has improved recently. Our analysis highlights five layers of stigma affecting SUs.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Conclusion&lt;/jats:title&gt; &lt;jats:p&gt;This qualitative study reveals that stigma was still a key concern that affects patients with MHC. SUs reported experiencing overt stigmatising behaviour in the community but less explicit discrimination in a PHC setting. Our findings emphasise the importance of (1) combatting structural stigma through legal reform, (2) addressing interpersonal stigma, (3) committing PHC management to deliver high quality mental health integrated services, and (4) reducing intrapersonal stigma by building public empathy.&lt;/jats:p&gt; &lt;/jats:sec&gt

Self-report screening instruments for post-traumatic stress disorder (PTSD) in survivors of traumatic experiences (protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess and compare the diagnostic accuracy of different PTSD self-report instruments

Treatment of Intrusive Suicidal Imagery Using Eye Movements

Suicide and suicidal behavior are major public health concerns, and affect 3–9% of the population worldwide. Despite increased efforts for national suicide prevention strategies, there are still few effective interventions available for reducing suicide risk. In this article, we describe various theoretical approaches for suicide ideation and behavior, and propose to examine the possible effectiveness of a new and innovative preventive strategy. A model of suicidal intrusion (mental imagery related to suicide, also referred to as suicidal flash-forwards) is presented describing one of the assumed mechanisms in the etiology of suicide and the mechanism of therapeutic change. We provide a brief rationale for an Eye Movement Dual Task (EMDT) treatment for suicidal intrusions, describing techniques that can be used to target these suicidal mental images and thoughts to reduce overall behavior. Based on the available empirical evidence for the mechanisms of suicidal intrusions, this approach appears to be a promising new treatment to prevent suicidal behavior as it potentially targets one of the linking pins between suicidal ideation and suicidal actions