Adaptación y validación del Cuestionario de Trastorno de Estrés Postraumático (COVID-19-PTSD) en población peruana / Adaptation and Validation of the Questionnaire on Posttraumatic Stress Disorder in a Peruvian Population

Introducción: La alta prevalencia de trastornos mentales como el estrés, en situaciones estresantes prolongadas inducidas por una pandemia, demanda su detección y valoración oportuna; para ello se requieren instrumentos contextualizados y con adecuadas propiedades métricas. Objetivo: Validar el Cuestionario sobre el Trastorno de Estrés Postraumático y Prevalencia de Sintomatología de Estrés Postraumático en población peruana. Métodos: Estudio de tipo instrumental, realizado en la región Ica del Perú, de junio a noviembre del 2021, en 412 participantes adultos. El proceso incluyó traducción al español, evaluación del contenido por jueces y prueba piloto. La validez de constructo se evaluó mediante el Análisis Factorial Exploratorio y el ajuste con Análisis Factorial Confirmatorio, que incluyó el Método de Estimación de Mínimos Cuadrados no Ponderados Robustos; se evaluó la confiabilidad con el Omega de McDonald y comparó la sintomatología del trastorno de estrés postraumático con variables generales. Resultados: Se obtuvo una versión de dieciocho ítems, agrupados en cuatro factores que explicaron el 70,78 por ciento de la varianza total y un ajuste aceptable [x2/gl = 1,54; NFI y CFI = 0,99; SRMR = 0,052; RMSEA = 0,036 (IC90 por ciento: 0,26-0,46)]. Los ítems discriminan de forma satisfactoria; así como la escala según variable sexo, estado civil y los que tienen familiar fallecido por COVID-19. La consistencia interna fue adecuada para la escala global (ω = 0,924) y sus dimensiones (EDA = 0,740; IEAN = 0,882; A = 0,786 y CE = 0,811). Conclusión: La nueva versión peruana del instrumento posee propiedades métricas aceptables; por tanto, se recomienda su uso para valorar el trastorno de estrés postraumático y estudios de validación(AU)

Introduction: The high prevalence of mental disorders such as stress, in prolonged stressful situations induced by a pandemic, demands their timely identification and assessment; in order to do this, contextualized instruments with adequate metric properties are required. Objective: To validate the Questionnaire on Posttraumatic Stress Disorder and Prevalence of Posttraumatic Stress Symptomatology in a Peruvian population. Methods: An instrumental study was conducted in the region of Ica, in Peru, from June to November 2021, with 412 adult participants. The process included translation into Spanish, content assessment by judges, and pilot testing. Construct validity was evaluated by exploratory factor analysis; and fit, with confirmatory factor analysis, which included the robust unweighted least squares estimation method. Reliability was evaluated with McDonald's Omega, while the posttraumatic stress disorder symptomatology was compared with general variables. Results: The obtained version included 18 items, grouped into four factors that explained 70.78 percent of the total variance. Also, an acceptable fit was obtained [x2/gl=1.54; NFI and CFI=0.99; SRMR=0.052; RMSEA=0.036 (90 percent CI: 0.26-0.46)]. The items discriminate satisfactorily, as does the scale according to sex, marital status and those with a family member who died from COVID-19. Internal consistency was adequate for the global scale (ω = 0.924) and its dimensions (EDA=0.740; IEAN = 0.882; A=0.786 and CE=0.811). Conclusion: The new Peruvian version of the instrument has acceptable metric properties; therefore, its use is recommended for assessing posttraumatic stress disorder and validation studies(AU)

Leitura Psicodramática dos conceitos de Transtorno de Estresse Pós-Traumático (TEPT) e Resiliência / Psychodramatic Reading of the concepts of Posttraumatic Stress Disorder (PTSD) and resilience / Lectura Psicodramática de los conceptos de Trastorno de Estrés Postraumático (TEPT) y resiliencia

Com a presente pesquisa os autores objetivam realizar uma leitura psicodramática dos conceitos de Resiliência e de Transtorno do Estresse Pós-Traumático (TEPT) na literatura científica. Para tal, foi realizada uma revisão sistemática em seis bases de dados, nos idiomas inglês, português e espanhol, com oito descritores distintos, nos últimos dez anos. Foram encontrados 1.154 artigos para aplicar os critérios de exclusão, resultando 19 para análise. Em conclusão, foi constatado que não há consenso na literatura sobre os constructos e que é possível formular uma compreensão psicodramática sobre o tema.

In the present research, the authors aim to do a psychodramatic reading of the concepts of Resilience and Posttraumatic Stress Disorder (PTSD) in the scientific literature. For that, a systematic review was carried out in six databases, in English, Portuguese and Spanish, with eight distinct descriptors, in the last ten years. One thousand one hundred and fifty four (1,154) articles were found to apply the exclusion criteria resulting in 19 articles for analysis. The conclusion is that there is no consensus in the literature on the constructs and that it is possible to formulate a psychodramatic understanding on the subject.

Con la presente investigación, los autores objetivan realizar una lectura psicodramática de los conceptos de Resiliencia y de Trastorno del estrés postraumático (TEPT) en la literatura científica. Con este fin, se realizó una revisión sistemática en seis bases de datos, en los idiomas inglés, portugués y español, con ocho descriptores distintos, en los últimos diez años. Se encontraron 1.154 artículos para aplicar los criterios de exclusión resultando 19 para el análisis. En conclusión, se constató que no hay consenso en la literatura sobre los constructos y que es posible formular una comprensión psicodramática sobre el tema.

Assessment and Treatment of Pain in Adult Intensive Care Unit Patients / 대한구급학회지

In most cases, patients admitted to an intensive care unit (ICU) have suffered from severe trauma, undergone major surgery or been treated for a serious medical illness. Although they often experience more intense pain than general ward patients, they are frequently unable to communicate their experiences to health care providers, thus preventing accurate assessment and treatment of their pain. If appropriate measures are not taken to treat pain in critically ill patients, stress response or sympathetic overstimulation can lead to complications. The short-term consequences of untreated pain include higher energy expenditure and immunomodulation. Longer-term, untreated pain increases the risk of post-traumatic stress disorder. Because pain is quite subjective, the accurate assessment of pain is very difficult in the patients with impaired communication ability. The current most valid and reliable behavioral pain scales used to assess pain in adult ICU patients are the Behavioral Pain Scale and the Critical-Care Pain Observation Tool. Once pain has been accurately assessed using these methods, various pharmacologic and non-pharmacologic therapies should be performed by the multidisciplinary care team. Accurate assessment and proper treatment of pain in adult ICU patients will improve patients outcome, which reduces the stress response and decreases the risk of post-traumatic stress disorder.

Impact of Childhood Trauma on Post-traumatic Stress Symptoms and Dissociation: Mediating Effect of Bullying / 정신간호학회지

PURPOSE: The purposes of the study were to determine whether specific forms of childhood traumatic experience predicts post traumatic stress symptoms and dissociation and to investigate the mediating effects of bullying experience on forms of childhood trauma and post traumatic stress symptoms or dissociation. METHODS: Participants were patients (n=90) from "S" clinic for psychological trauma. Data were collected from January 2012 to January 2013 through semi-structured interviews and self-reports using a modified Lifetime Incidence of Traumatic Events, Korean Version of Impact of Event Scale-Revised, and Dissociative Experience Scale. RESULTS: The participants showed high rates for childhood trauma and high scores on post traumatic stress symptoms and dissociation, and 38.9% of participants self-reported experiencing more than three types of trauma. Physical abuse was found to be a significant predictor of post traumatic stress symptoms and dissociation. It was also found that bullying experience partially mediated the association between physical abuse and post traumatic stress symptoms or dissociation. CONCLUSION: Future interventions for patients with childhood trauma should focus on assessing the possibility of dissociation. As boys and girls who experienced physical abuse in childhood are likely to be victims of bullying, school counselors should assess their support system and refer to mental health professionals as necessary.

Factor structure, internal consistency and reliability of the Posttraumatic Stress Disorder Checklist (PCL): an exploratory study / Estrutura fatorial, consistência interna e confiabilidade do Posttraumatic Stress Disorder Checklist (PCL): um estudo exploratório

INTRODUCTION: Posttraumatic stress disorder (PTSD) is an anxiety disorder resulting from exposure to traumatic events. The Posttraumatic Stress Disorder Checklist (PCL) is a self-report measure largely used to evaluate the presence of PTSD. OBJECTIVE: To investigate the internal consistency, temporal reliability and factor validity of the Portuguese language version of the PCL used in Brazil. METHODS: A total of 186 participants were recruited. The sample was heterogeneous with regard to occupation, sociodemographic data, mental health history, and exposure to traumatic events. Subjects answered the PCL at two occasions within a 15 days'; interval (range: 5-15 days). RESULTS: Cronbach's alpha coefficients indicated high internal consistency for the total scale (0.91) and for the theoretical dimensions of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (0.83, 0.81, and 0.80). Temporal reliability (test-retest) was high and consistent for different cutoffs. Maximum likelihood exploratory factor analysis (EFA) was conducted and oblique rotation (Promax) was applied. The Kaiser-Meyer-Olkin (KMO) index (0.911) and Bartlett's test of sphericity (χ² = 1,381.34, p < 0.001) indicated that correlation matrices were suitable for factor analysis. The analysis yielded three symptom clusters which accounted for 48.9% of the variance, namely, intrusions, avoidance, and numbing-hyperarousal. CONCLUSION: Our findings provide additional data regarding the psychometric properties of the PCL, including internal consistency, test-retest reliability, and factor validity. Results are discussed in relation to PTSD theoretical models (AU)

INTRODUÇÃO: O transtorno do estresse pós-traumático (TEPT) é um transtorno de ansiedade decorrente da exposição a eventos traumáticos. Entre as medidas de avaliação dos sintomas, destaca-se o Posttraumatic Stress Disorder Checklist (PCL). OBJETIVO: Investigar a consistência interna, a confiabilidade temporal e a validade fatorial da versão do PCL em português, utilizada no Brasil. MÉTODOS: Participaram do estudo 186 indivíduos heterogêneos em relação a ocupação, características sociodemográficas, histórico de saúde mental e exposição a eventos traumáticos. O PCL foi aplicado em dois momentos considerando um intervalo máximo de 15 dias (intervalo: 5-15 dias). RESULTADOS: A consistência interna (alfa de Cronbach) foi adequada para a escala total (0,91) e para as dimensões teóricas do Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (0,83, 0,81 e 0,80). A confiabilidade temporal foi alta e consistente para diferentes pontos de corte. A análise fatorial exploratória pelo método da máxima verossimilhança, com rotação oblíqua (Promax), foi realizada. O índice Kaiser-Meyer-Olkin (KMO) (0,911) e o teste de esfericidade de Bartlett (χ² = 1.381,34, p < 0,001) indicaram que a matriz de correlações era adequada para análise fatorial. Os resultados indicaram três conglomerados de sintomas que explicaram 48,9% da variância, a saber, revivecência, esquiva e entorpecimento-hiperexcitabilidade. CONCLUSÃO: Nossos achados fornecem informações adicionais sobre as características psicométricas do PCL, incluindo consistência interna, confiabilidade teste-reteste e validade fatorial. Os resultados são discutidos em relação a modelos teóricos de TEPT (AU)

Risk of posttraumatic stress disorder and depression in survivors of the floods in Bihar, India.

Background: Following a natural disaster, survivors are vulnerable to develop posttraumatic stress disorder (PTSD) and/ or depression. Objectives: (i) To screen survivors of the Bihar floods a month after the event to determine their scores in a screening questionnaire for PTSD and/ or depression and (ii) to correlate these scores with age and gender. Materials and Methods: One thousand two hundred eighty-nine persons (645 females) who had been directly exposed to the floods in Bihar, India, in August 2008 were assessed. The Screening Questionnaire for Disaster Mental Health (SQD) was used to screen for PTSD and depression. Statistical Analysis: Separate two-factor ANOVAs were used to compare persons of both sexes and 5 different age groups for PTSD and depression scores. This was followed by post-hoc analysis for multiple comparisons. Results: People over the age of 60 years had significantly higher scores for PTSD and depression compared to all groups (P< 0.05 for all comparisons). Conclusion: Following a natural disaster, older people appear more vulnerable to develop PTSD and depression. This should be taken into account in devising strategies for disaster relief.

Tratamiento de las pesadillas en el trastorno por estrés postraumático: farmacoterapia / Pharmacological treatment of posttraumatic stress disorder nightmares

Introducción: Las pesadillas son síntomas usuales y característicos del trastorno por estrés postraumático (TEPT). Su presencia se relaciona directamente con la gravedad del trastorno, suelen tener un impacto negativo en la calidad de vida de los pacientes y, como frecuentemente se convierten en un síntoma residual y refractario, requieren especial atención y tratamiento específico. Objetivo: Revisar y actualizar los conocimientos acerca del tratamiento farmacológico de las pesadillas en el TEPT. Método: Este artículo revisa y actualiza los tratamientos disponibles para el manejo de las pesadillas en el TEPT. Conclusión: Se han realizado muy pocos estudios acerca del tratamiento farmacológico específico para las pesadillas en el TEPT. La mayoría han sido de diseño abierto o reportes de casos, las muestras han sido pequeñas, con grupos heterogéneos y algunos de los resultados han sido contradictorios. La psicoterapia adquiere entonces gran relevancia en el tratamiento de las pesadillas, pues aunque aún no hay estudios que muestren la superioridad de una modalidad sobre la otra (farmacoterapia versus psicoterapia), la experiencia clínica muestra que la combinación es importante y benéfica para los pacientes...

Introduction: Nightmares are common and characteristic symptoms of Posttraumatic Stress Disorder (PTST). Their presence is directly related with the severity of the disorder, usually having a negative impact on the patient’s quality of life. They frequently become a refractory and residual symptom, and require special attention and specific treatment. Objective: To review and update current knowledge on the pharmacological treatment available for PTSD nightmares. Conclusion: Very few studies have been done addressing the pharmacological treatment for PTSD nightmares. Most have an open design or are case reports, the samples have been small with heterogeneous groups, and some of the results have been contradictory. Psychotherapy, then, acquires great relevance in the treatment of nightmares, since although no studies exist that show the superiority of one modality over another (pharmacotherapy versus psychotherapy), clinical experience shows that the combination is beneficial for patients...

Changes of nuclear receptors-glucocorticoid receptors in locus ceruleus neurons of posttraumatic stress disorder-like rat / 解剖学报

Objective To investigate expression changes of nuclear receptors-glucocorticoid receptors (GR) in the locus ceruleus neurons of posttraumatic stress disorder(PTSD)like rats. Methods Sixty adult healthy male Wistar rats were enrolled in the experiment. PTSD-like rat model was established by single prolonged stress (SPS). There was no SPS stimulation in the control group and the rats of the other five groups were undisturbedly raised for 24 hours, 4 days,7 days,14 days and 28 days respectively after SPS stimulation.The expressions of glucocorticoid receptors in the locus ceruleus nucleus of all groups were detected with Nissl staining, immunohistochemistry,Western blotting and PCR, and image analysis and statistical analysis were performed. Results GR was distributed in the nucleus of coeruleus neurons, GR expression was showed after 24 hours, 4 days, 7 days treatment and gradually increased, restorative downregulation was seen after 14 days and 28 days, but still high(P<0.05). Conclusion After SPS, the GR locus ceruleus temporarily increased and then lowered, suggesting that PTSD rat locus coeruleus neurons in nuclear receptor-GR expression changes may directly involve in the continuing spirit of PTSD symptoms occurred in the development process.

Evolucionismo e genética do transtorno de estresse pós-traumático: [revisão] / Evolutionism and genetics of posttraumatic stress disorder: [revision]

Os autores discutem, a partir do conceito evolutivo, como a resposta de estresse, nas suas possibilidades de fuga e luta e de imobilidade tônica, pode levar a uma nova compreensão etiológica do transtorno de estresse pós-traumático. Através da análise dos agrupamentos de sintomas desse diagnóstico - revivência, evitação e hiperexcitação -, procuram correlacionar os achados neurobiológicos e evolutivos. As descobertas atuais sobre a genética do transtorno de estresse pós-traumático são resumidas e colocadas nessa perspectiva evolutiva, dentro de conceitos que possibilitam o entendimento da interação gene/ambiente, como a epigenética. Propõem que a pesquisa dos fatores de risco do transtorno de estresse pós-traumático deva ser investigada do ponto de vista fatorial, onde a somatória destes aumenta o risco de desenvolvimento do quadro, não sendo possível a procura da causa do transtorno de forma única. A pesquisa de genes candidatos no transtorno de estresse pós-traumático deve levar em consideração todos os sistemas associados aos processos de respostas ao estresse, sistemas dos eixos hipotálamo-hipofisário-adrenal e simpático, mecanismos de aprendizado, formação de memórias declarativas, de extinção e esquecimento, da neurogênese e da apoptose, que envolvem vários sistemas de neurotransmissores, neuropeptídeos e neuro-hormônios.

The authors discuss, from the evolutionary concept, how flight and fight responses and tonic immobility can lead to a new understanding of posttraumatic stress disorder. Through the analysis of symptom clusters (revivals, avoidance and hyperexcitation), neurobiological and evolutionary findings are correlated. The current discoveries on posttraumatic stress disorder genetics are summarized and analyzed in this evolutionary perspective, using concepts to understand the gene-environment interaction, such as epigenetic. The proposal is that the research of susceptibility factors in posttraumatic stress disorder must be investigated from the factorial point of view, where their interactions increase the risk of developing the disorder, preventing a unique search of the cause of this disorder. The research of candidate genes in posttraumatic stress disorder must take into consideration all the systems associated with processes of stress response, such as the hypothalamus-pituitary-adrenal and sympathetic axes, mechanisms of learning, formation and extinguishing of declarative memories, neurogenesis and apoptosis, which involve many systems of neurotransmitters, neuropeptides and neurohormones.

A Case Series of Eye Movement Desensitization and Reprocessing (EMDR) in 30 Psychiatric Patients: Korean Experience / 신경정신의학

OBJECTIVES: Eye Movement Desensitization and Reprocessing (EMDR) is an emerging psychotherapeutic technique for posttraumatic stress disorder and other conditions associated with psychological trauma. The effectiveness of this technique has been reported among North American and European populations; however, research on it's effectiveness among other ethnocultural groups is sparse. This is the first clinical study of EMDR in Korea with 30 Korean psychiatric patients in two clinical settings. METHODS: Diagnostically heterogeneous group of 30 psychiatric patients underwent a mean of 3.13 (95%CI=2.54-3.73) sessions of EMDR. The Clinical Global Impression-Change scale (CGI-C) was administered one week and six months after the termination of treatment. RESULTS: Participants had a mean CGI-C score of 1.80 (95%CI=1.44-2.16). We designated as 'responders' those who were 'very much improved' or 'much improved' on the CGI-C, 23 (77%) After six months, 19/23 (83%) still characterized as remaimed responders. All the patients with posttraumatic stress disorder, phobia, and grief reaction were responders, and those with personality disorder nonresponders. Results for depressive and other disorders were mixed. CONCLUSION: Despite methodological limitations, results from this study suggest that the EMDR can be applied to Korean psychiatric patients.