Trauma e literalidade: a razão psicodinâmica no espírito da traumatização neurocientífica / Trauma and literality: psychodynamic reason in the spirit of neuroscientific traumatization

Resumo Desde o seu nascimento na medicina cirúrgica do século XVII, a pesquisa do trauma admitiu interpretações múltiplas e associadas ora às lesões visíveis de órgãos e tecidos, ora à influência de agentes psíquicos patogênicos sobre a memória, a consciência e a personalidade. Com o aprofundamento do papel dos sistemas classificatórios desde DSM-III, o fenômeno do trauma será incorporado ao prisma psiquiátrico através do Transtorno de Estresse Pós-Traumático e destinado, finalmente, à circunscrição da pesquisa neurocientífica. A partir de revisão narrativa, este artigo abordará uma das premissas epistemológicas fundamentais para essa transição, que informa como o trauma psicológico ganhou autonomia sobre as descrições anatômicas para ser, cerca de um século depois, por ela reanexado enquanto fenômeno essencialmente corporal e aderido à gramática das neurociências.

Abstract Since its origin in the surgical medicine of the 17th century, trauma research has had multiple interpretations and has been associated either with visible injuries to organs and tissues, or with the influence of pathogenic psychic agents on memory, consciousness and personality. With the intensification of the role of classification systems since DSM-III, the phenomenon of trauma came to be incorporated into the psychiatric realm through Post-Traumatic Stress Disorder and destined finally to the constraints of neuroscientific research. Based on a narrative review, this article will address one of the fundamental epistemological premises for this transition, which informs how psychological trauma gained autonomy over anatomical descriptions to be reclassified, around a century later, as an essentially bodily phenomenon and incorporated into the jargon of neurosciences.

Prévalence et facteurs prédicteurs des troubles post-traumatiques chez les accidentés de la voie publique / Prevalence and predictors of post-traumatic stress disorder in road traffic accidents

Introduction: les troubles post-traumatiques survenant à la suite d'un accident de la route ont un impact tant sanitaire qu'économique. Méthodes: notre étude prospective, vise à déterminer la prévalence de ces troubles, et de dégager leurs facteurs de risque auprès de sujets victimes d'accidents de la route et hospitalisés au service de chirurgie orthopédique et de traumatologie du Centre Hospitalo-Universitaire de Sfax-Tunisie. Résultats: soixante-dix sujets ont été inclus dans notre étude. La prévalence de l'état de stress aigu était de 37,1% et il a été associé au sexe féminin, au niveau scolaire bas, à la présence d'antécédents médicochirurgicaux, à la passivité au cours de l'accident, à la sévérité des lésions, et à la présence d'une symptomatologie anxieuse et dépressive. Le trouble stress post traumatique était constaté chez 40% des sujets et il a été associé au milieu de résidence urbain, à la passivité au cours de l'accident, et à la symptomatologie anxieuse et dépressive. Des scores faibles des stratégies de coping fonctionnelles et des scores élevés des stratégies de coping dysfonctionnelles ont été significativement associés à ces deux troubles. Le niveau scolaire bas, la résidence en milieu urbain, un niveau élevé d'anxiété et de dépression et la stratégie de coping de déni apparaissent comme des facteurs de risque indépendants de l'état de stress aigu et du trouble stress post traumatique. Conclusion: il s'avère ainsi important de déterminer un profil de personnes plus exposées aux troubles post-traumatique afin de permettre un dépistage précoce par les médecins avec lesquels les accidentés pourraient avoir des contacts dans les suites de leurs accidents.

ntroduction: Post-traumatic stress disorder following a road accident has both a health and an economic impact. Methods: we conducted a prospective study to determine the prevalence of this disorder, and to identify risk factors in subjects victims of road accidents and hospitalized in the Department of Orthopedic Surgery and Traumatology of the University Hospital Center of Sfax-Tunisia. Results: a total of sixty-ten subjects were included in this study. The prevalence of acute stress was 37.1% and was associated with female sex, low educational level, previous medical and surgical history, passivity during the accident, severity of injuries and the presence of anxious and depressive symptoms. Post-traumatic stress disorder was observed in 40% of subjects and was associated with urban residential environment, passivity during the accident and anxious and depressive symptoms. Low scores for functional coping strategies and high scores for dysfunctional coping strategies were significantly associated with both disorders. Low educational level, urban residential environment, high levels of anxiety and depression, and denial coping strategy appear to be independent risk factors for acute stress and post-traumatic stress disorder. Conclusion: It is therefore important to determine the profile of people at greater risk of post-traumatic stress disorder, to enable early diagnosis in victims of road accidents.

Is post-traumatic stress disorder related to the severity of physical trauma?

SUMMARY OBJECTIVE: Trauma can cause physical morbidity and even result in death. Besides, it can lead to serious mental problems as well. The most well-known mental health problem is post-traumatic stress disorder. Through this study, it was primarily aimed to find out whether the severity of physical trauma is effective on post-traumatic stress disorder and other risk factors if any. METHODS: The reports of the patients who were transferred to the Turkish Council of Forensic Medicine Third Speciality Board between January 01, 2019, and December 31, 2020, for post-traumatic invalidity or disability evaluation and whose psychiatric examinations were performed were retrospectively analyzed in the electronic environment. RESULTS: It was found that 34 (26.4%) of the patients had a diagnosis of post-traumatic stress disorder (under treatment for at least 6 months), while 76 (58.9%) of them did not have a psychiatric disease and 19 (14.7%) of them had mental disorders not associated with trauma (i.e., affective disorder, anxiety disorder, etc.). No significant correlation was found between trauma scores and post-traumatic stress disorder (p>0.05). CONCLUSION: Based on the results of our study, post-traumatic stress disorder and the severity of physical trauma are not significantly correlated. Being of female gender, sustaining a non-accidental injury, and witnessing a fatal event stand out as significant risk factors.

Terapia de extinción y estimulación magnética transcraneal para el tratamiento de trastornos de ansiedad / Extinction therapy and transcranial magnetic stimulation for the treatment of anxiety disorders

Resumen Objetivo: Describir los factores que pueden determinar la reducción de los síntomas en el trastorno de ansiedad generalizada y trastorno por estrés postraumático, mediante estimulación magnética transcraneal en combinación con terapia de extinción. Material y Métodos: Se realizó una búsqueda en bases de datos (Cochrane, EBSCO, Pubmed, Sciencedirect y Wiley), con las palabras clave "transcranial magnetic stimulation", "human", "fear extinction". Los criterios de selección incluyen estudios en humanos, tratamientos con terapia de extinción y EMT, en donde se registre la conductancia de la piel como variable de respuesta. Resultados: Existe poca investigación que cumpla con los criterios de la presente revisión bibliográfica. Se obtuvieron 5 artículos enfocados en el tratamiento de síntomas como el miedo y la recurrencia de recuerdos traumáticos. Los protocolos de estimulación son heterogéneos, la frecuencia de estimulación va de 1 Hz a 30 Hz. La estimulación de alta frecuencia fue la más utilizada. La duración máxima de los efectos reportados fue de 1 mes. Conclusiones: La EMT junto con la terapia de extinción como tratamiento para TEPT y TAG es un campo de estudio que requiere de más investigación. Los resultados sobre su eficacia no son concluyentes, el tamaño de muestra es pequeño y es necesario identificar qué protocolos son eficaces a largo plazo. Los estudios clínicos con pacientes que presenten estos trastornos son relevantes para conocer los efectos de aquellos protocolos que han sido exitosos en pacientes sanos (condicionados al miedo).

Abstract Objective: To describe the factors that can determine the reduction of symptoms in generalized anxiety and posttraumatic stress disorders by transcranial magnetic stimulation in combination with extinction therapy. Material and methods: A bibliographic review was conducted in databases (Cochrane, EBSCO, PubMed, ScienceDirect y Wiley), using the keywords: "transcranial magnetic stimulation", "human" and "fear extinction". A selection of clinical trials that used extinction therapy plus TMS and the skin conductance as variable quantified was made. Results: Five articles focused on the treatment of symptoms, like fear and recurrence of traumatic memories were obtained. There is little research on the topic. Stimulation protocols are heterogeneous between studies (stimulation frequency ranges from 1 to 30 Hz). Most of the studies reviewed reported the use of high-frequency stimulation. The maximum duration of therapeutic effects reported was one month. Conclusions: TMS and extinction therapy as a treatment for PTSD and GAD has a growing research field. Effectiveness results are not conclusive, sample sizes are small, and studies do not focus on which protocols are effective in the long-term. New studies that include patients with diagnosed PTSD and GAD are relevant to assess the protocols that have already been successful in healthy patients (fear-conditioned).

Treating post-traumatic stress disorder in survivors of community and domestic violence using narrative exposure therapy: a case series in two public health centers in Rio de Janeiro/Brazil / Terapia de exposição narrativa para o tratamento do transtorno de estresse pós-traumático com pessoas que passaram por violência doméstica e comunitária: estudo de série de casos em dois centros de saúde no Rio de Janeiro, Brasil

Abstract Prevalence of violence in Brazil is high, which contributes to an increasing number of trauma-related disorders, especially post-traumatic stress disorder (PTSD). This study aims to present a case series of PTSD patients treated with narrative exposure therapy (NET) in two public health centers in Rio de Janeiro (Brazil). Health professionals were trained in a two-week workshop to deliver NET. Exposure to violence and other potentially traumatic events, as well as PTSD were assessed by interviewers before treatment and six months later in follow-up interviews conducted by blind assessors. Multiple traumatic events, including different types of childhood and sexual abuse, intimate partner violence and community violence were reported. Five patients were exposed to community violence, and one to domestic violence, during or after NET treatment. Treatment delivery was integrated into the routine of health centers. Eight patients completed NET and presented a substantial reduction in PTSD severity at six-month follow-up. NET is a feasible and effective treatment for PTSD patients exposed to ongoing violence, and can be integrated into established public health services.

Resumo A prevalência de exposição à violência é alta no Brasil, contribuindo para o aumento do número de transtornos relacionados a traumas, especialmente o transtorno de estresse pós-traumático (TEPT). Este estudo tem por objetivo apresentar uma série de casos de pacientes com TEPT que passaram pela terapia de exposição narrativa (NET) em dois centros de saúde do Rio de Janeiro. Os profissionais de saúde receberam duas semanas de treinamento NET. A exposição à violência e a outros eventos potencialmente traumáticos, bem como o TEPT, foram avaliados por entrevistadores antes do tratamento e seis meses depois em entrevistas de acompanhamento conduzidas por avaliadores sob condição cega. O tratamento foi integrado à rotina dos serviços. Oito pacientes completaram a NET e apresentaram redução substancial na severidade do TEPT. Todos reportaram exposição a eventos traumáticos múltiplos, incluindo diferentes tipos de abuso infantil, sexual, violência por parceiro íntimo e comunitária. Cinco pacientes foram expostos à violência comunitária e um à violência doméstica durante ou após o tratamento. Esta série de casos mostra que a NET é um tratamento eficaz para pacientes com TEPT expostos a violências contínuas e pode ser integrado nos serviços públicos de saúde.

Validation Spanish of the Post-Traumatic Stress Disorder Scale in the Postpartum - City BITS / Validación al castellano de la Escala de Trastorno de Estrés Postraumático en el Postparto - City BITS

Background: Postpartum post-traumatic stress disorder (PTSD) has a prevalence of 3-4% in women, rising to 15-19% in the presence of risks during pregnancy or childbirth, and reaching 39% in the case of neonatal death. Perinatal complications can trigger a real or perceived threat to maternal or neonatal life, which can evoke intense emotional reactions equivalent to a traumatic stressor according to PTSD criteria. Four symptom clusters have been identified: re-experiencing, avoidance, negative cognitions and mood, and hyperarousal symptoms. Despite its high comorbidity with depression and anxiety, postpartum PTSD remains underdiagnosed in maternal settings. The Postpartum Posttraumatic Stress Disorder Scale, originally developed in England, is in the process of translation and global validation. Objective: To validate the Spanish adaptation of the City Birth Trauma Scale. Methods: Quantitative, nonexperimental, cross-sectional, descriptive-correlational study in a sample of 677 Argentine women with children under 12 months of age. Results: Exploratory factor analysis revealed two dimensions that explained 49.56% of the total variance. Confirmatory factor analysis supported the two-factor structure. The scale showed high internal consistency (total α = .903), with α = .872 for 'birth-related symptoms' and α = .886 for 'general symptoms'. Construct validity of the City BiTS was demonstrated by moderate associations with the DASS-21 subscales and a negative correlation with the BIEPS-A. Conclusions: The Spanish adaptation of the City Birth Trauma Scale is confirmed as a reliable and valid instrument, consistent with original research findings and subsequent validations, articulating postpartum PTSD in two symptom categories: birth-related and general.

Introducci�n: El Trastorno de Estr�s Postraum�tico (TEPT) posparto tiene una prevalencia del 3�4% en mujeres, incrementando al 15-19% en presencia de riesgos durante la gestaci�n o parto, y alcanzando un 39% en caso de fallecimiento neonatal. Las complicaciones perinatales pueden desencadenar una amenaza real o interpretada sobre la vida materna o neonatal, lo cual puede suscitar intensas respuestas emocionales equivalentes a un estresor traum�tico seg�n los criterios de TEPT. Se identifican cuatro grupos sintom�ticos: reexperimentaci�n, evitaci�n, cogniciones y estado de �nimo negativos y s�ntomas de hiperactivaci�n. A pesar de su alta comorbilidad con depresi�n y ansiedad, el TEPT posparto permanece subdiagnosticado en contextos maternales. La Escala de Trastorno de Estr�s Postraum�tico en el Postparto, originalmente dise�ada en ingl�s en Inglaterra, est� en proceso de traducci�n y validaci�n global. Objetivo: Validar la adaptaci�n al castellano de The City Birth Trauma Scale. M�todo: Estudio cuantitativo, no experimental, transversal y descriptivo-correlacional en una muestra de 677 mujeres argentinas con hijos menores de 12 meses. Resultados: El an�lisis factorial exploratorio revel� dos dimensiones que explican el 49.56% de la varianza total. El an�lisis factorial confirmatorio respald� esta estructura bifactorial. La escala demostr� una alta consistencia interna (α total = 0.903), siendo α = 0.872 para "S�ntomas relacionados con el parto" y α = 0.886 para "S�ntomas generales". La validez de constructo de City BiTS se evidenci� a trav�s de asociaciones moderadas con las subescalas de DASS-21 y una correlaci�n negativa con BIEPS-A. Conclusi�n: La adaptaci�n al castellano de The City Birth Trauma Scale se confirma como un instrumento confiable y v�lido, alineado con hallazgos de la investigaci�n original y validaciones subsiguientes, articulando el TEPT posparto en dos categor�as sintom�ticas: las relacionadas al parto y las generales.

Effect of early intervention with electroacupuncture on behavior and gut microbiota in mice with post-traumatic stress disorder / 中华行为医学与脑科学杂志

Objective:To investigate the effect of early intervention with electroacupuncture (EA) on the gut microbiota in a mouse model of post-traumatic stress disorder(PTSD).Methods:Totally 32 C57BL/6 mice were randomly assigned to the following 4 groups ( n=8 for each group): Control group, EA group, PTSD group and PTSD+ EA group.After 7 days acclimation, mice in the PTSD group and PTSD+ EA group were subjected to modified single prolonged stress (mSPS). Mice in the EA group and PTSD+ EA group received EA (2/15 Hz, 1 mA, dilatational wave, 30 min/d) on "Baihui" for 7 days. Mice in the Control group and PTSD group received false stimulation (stimulated the same acupiont without electricity) for 7 days. Seven days after the last stimulation, elevated plus maze test and fear conditioning test were conducted to observe the effect of EA on PTSD-like behavior of mice. At the same time, feces of the mice were collected for gut microbiota detection by 16S rRNA sequencing.SPSS 19.0 was used for statistical analysis.One-way ANOVA was used for multiple group comparison and Bonferrani test was done for further pairwise comparision. Results:(1) There were statistically differences in the open arm activity time of the elevated plus maze test and the immobility time in contextual and cued fear conditioning test among the four groups ( F=6.93, 5.26, 14.51, all P<0.01). In the elevated plus maze test, mice in PTSD group ((60.17±15.52) s) showed significant less time in the open arms than mice in Control group((96.37±14.62) s) and PTSD+ EA group ((86.89±15.02) s) (both P<0.05). In the fear conditioning test, mice in PTSD group ((121.99±29.67) s, (130.82±29.11) s) showed significant increased immobility time both in contextual and cued fear conditioning tests than mice in Control group((74.50±26.65) s, (39.50±23.52) s) and PTSD+ EA group ((76.77±22.60) s, (102.17±3.39) s)(both P<0.05). (2) There were no significant differences among the four groups in the alpha diversity of gut microbiota ( F=0.79-2.45, all P>0.05). (3)Correlation analysis showed that 13 gut microbiotas were negatively correlated with the immobility time in contextual fear conditioning test, 2 gut microbiotas were positively correlated with it; 7 gut microbiotas were negatively correlated with the immobility time in cued fear conditioning test, 1 gut microbiota was positively correlated with it; 3 gut microbiotas were positively correlated with time spent in open arms of elevated plus maze test. Conclusion:Early intervention with EA can improve anxiety-fear like behaviors and gut microflora disorder in PTSD model mice.

Using machine learning algorithm to predict the risk of post-traumatic stress disorder among firefighters in Changsha / 中南大学学报(医学版)

OBJECTIVES@#Firefighters are prone to suffer from psychological trauma and post-traumatic stress disorder (PTSD) in the workplace, and have a poor prognosis after PTSD. Reliable models for predicting PTSD allow for effective identification and intervention for patients with early PTSD. By collecting the psychological traits, psychological states and work situations of firefighters, this study aims to develop a machine learning algorithm with the aim of effectively and accurately identifying the onset of PTSD in firefighters, as well as detecting some important predictors of PTSD onset.@*METHODS@#This study conducted a cross-sectional survey through convenient sampling of firefighters from 20 fire brigades in Changsha, which were evenly distributed across 6 districts and Changsha County, with a total of 628 firefighters. We used the synthetic minority oversampling technique (SMOTE) to process data sets and used grid search to finish the parameter tuning. The predictive capability of several commonly used machine learning models was compared by 5-fold cross-validation and using the area under the receiver operating characteristic curve (ROC-AUC), accuracy, precision, recall, and F1 score.@*RESULTS@#The random forest model achieved good performance in predicting PTSD with an average AUC score at 0.790. The mean accuracy of the model was 90.1%, with an F1 score of 0.945. The three most important predictors were perseverance, forced thinking, and reflective deep thinking, with weights of 0.165, 0.158, and 0.152, respectively. The next most important predictors were employment time, psychological power, and optimism.@*CONCLUSIONS@#PTSD onset prediction model for Changsha firefighters constructed by random forest has strong predictive ability, and both psychological characteristics and work situation can be used as predictors of PTSD onset risk for firefighters. In the next step of the study, validation using other large datasets is needed to ensure that the predictive models can be used in clinical setting.

Relationship between kinesiophobia and somnipathy among inpatients with lumbar degenerative disease after surgery and its impact pathway / 中国实用护理杂志

Objective:To explore the relationship between kinesiophobia and somnipathy among inpatients with lumbar degenerative disease after surgery, and analyze the mediating effects of post-traumatic stress disorder and family care.Methods:A cross-sectional survey method was adopted, from July 2020 to July 2022, a total of 130 lumbar degenerative disease patients from Wuhan Dongxihu District People′s Hospital were enrolled as research object by convenience sampling method. General information questionnaire, Tampa Scale for Kinesiophobia, Pittsburgh Sleep Quality Index, Posttraumatic Stress Checklist-civilian version and Family APGAR index were used for investigation. A structural equation model was established to evaluate the mediating effect of post-traumatic stress disorder, family care on kinesiophobia and somnipathy.Results:The scores of kinesiophobia, somnipathy, post-traumatic stress disorder and family care were (39.95 ± 3.90), (7.63 ± 0.46), (25.99 ± 4.99), (5.67 ± 1.76) points, respectively. There were significant differences in the scores of somnipathy in terms of age, monthly income, course of disease and pain degree ( F values were 3.21 to 10.12, all P<0.05). The dimensions and total scores of somnipathy were positively correlated with kinesiophobia ( r values were 0.347 to 0.800, all P<0.05) and post-traumatic stress disorder ( r values were 0.385 to 0.825, all P<0.05), negatively correlated with the scores of family care ( r values were - 0.653 to - 0.282, all P<0.05); the scores of family care was negatively correlated with kinesiophobia and post-traumatic stress disorder ( r = - 0.695, - 0.637, both P<0.05); the scores of kinesiophobia was positively correlated with post-traumatic stress disorder ( r = 0.773, P<0.05). The indirect effect of kinesiophobia on somnipathy was identified, and the total indirect effect value was 0.44; the indirect effect value of family care and post-traumatic stress disorder was 0.09, which accounted for 12.0% of the total effect. Conclusions:Post-traumatic stress disorder and family care play a multiple mediating role on the relationship between kinesiophobia and somnipathy in patients with lumbar degenerative disease after surgery.

CiteSpace-based visualization analysis of domestic and foreign researches on post-traumatic stress disorder in recent five years / 四川精神卫生

ObjectiveTo understand the research status of post-traumatic stress disorder （PTSD） at home and abroad in recent five years， and to grasp the research frontiers and hot spots in this field. MethodsTwo electronic databases， Web of Science and China National Knowledge Infrastructure （CNKI）， were retrieved for the literature published from January 1， 2017 to December 31， 2021. A total of 8 505 literatures were included， then the visualization analysis of the number of publications， authors， countries， institutions and keywords was conducted based on Microsoft Excel and CiteSpace software. Results① The number of publications in domestic and foreign showed an increasing trend in recent five years. ② In foreign literature， the top five countries in terms of the number of publications were the United States， the United Kingdom， China， Australia and Canada， with Canada having the highest centrality （0.18）. ③ Both domestic and foreign research institutions were dominated by universities. ④ In terms of the number of articles published， the top three foreign scholars were Bryant RA， Ressler KJ and Greenberg N， and the top three Chinese scholars were Wu Xinchun， Li Yuefeng， Yan Xingke and Zhang Guiqing （tied for the third place）. Compared with foreign authors， the number of articles published by Chinese scholars was relatively small. ⑤ In terms of research keywords， PTSD and depression were of more concern in both domestic and foreign. ConclusionIn recent five years， PTSD has been a hot topic at home and abroad， with both domestic and international studies focusing on PTSD and depression， and strengthening international exchanges may help promote progress in the field of PTSD research.

Relationship between childhood maltreatment and insomnia in middle school students： a moderated mediation model / 四川精神卫生

ObjectiveTo clarify the relationship between childhood maltreatment and insomnia in middle school students， and to explore the mediating role of post-traumatic stress disorder （PTSD） symptoms and the moderating role of mental resilience involvement. MethodsFrom April to May 2021， a total of 3 412 students in 3 middle schools in a city in western China were selected using convenient sampling method， and all students were assessed by Childhood Trauma Questionnaire （CTQ）， Post Traumatic Stress Disorder Scale （PCL）， Insomnia Severity Index （ISI） and mental resilience scale. The moderated mediating effect analysis was conducted using Process v3.4. ResultsAmong the middle school students， CTQ scores were positively correlated with PCL and ISI scores （r=0.540， 0.320， P<0.05）， and the scores of CTQ， PCL and ISI were negatively correlated with the score of mental resilience scale （r=-0.049， -0.193， -0.132， P<0.05）. PTSD symptoms exhibited a partial mediating effect on the relationship between general childhood maltreatment and insomnia （β=0.161， P<0.05）， accounting for 80.5% of the total effect. ConclusionAmong the middle school students， the relationship between childhood maltreatment and insomnia is partially mediated via PTSD symptoms， and mental resilience exerts a moderating role between childhood maltreatment and PTSD symptoms.

Phytochemical interventions for post-traumatic stress disorder: A cluster co-occurrence network analysis using CiteSpace / 中西医结合学报

OBJECTIVE@#This study investigated trends in the study of phytochemical treatment of post-traumatic stress disorder (PTSD).@*METHODS@#The Web of Science database (2007-2022) was searched using the search terms "phytochemicals" and "PTSD," and relevant literature was compiled. Network clustering co-occurrence analysis and qualitative narrative review were conducted.@*RESULTS@#Three hundred and one articles were included in the analysis of published research, which has surged since 2015 with nearly half of all relevant articles coming from North America. The category is dominated by neuroscience and neurology, with two journals, Addictive Behaviors and Drug and Alcohol Dependence, publishing the greatest number of papers on these topics. Most studies focused on psychedelic intervention for PTSD. Three timelines show an "ebb and flow" phenomenon between "substance use/marijuana abuse" and "psychedelic medicine/medicinal cannabis." Other phytochemicals account for a small proportion of the research and focus on topics like neurosteroid turnover, serotonin levels, and brain-derived neurotrophic factor expression.@*CONCLUSION@#Research on phytochemicals and PTSD is unevenly distributed across countries/regions, disciplines, and journals. Since 2015, the research paradigm shifted to constitute the mainstream of psychedelic research thus far, leading to the exploration of botanical active ingredients and molecular mechanisms. Other studies focus on anti-oxidative stress and anti-inflammation. Please cite this article as: Gao B, Qu YC, Cai MY, Zhang YY, Lu HT, Li HX, Tang YX, Shen H. Phytochemical interventions for post-traumatic stress disorder: A cluster co-occurrence network analysis using CiteSpace. J Integr Med. 2023; 21(4):385-396.

As raízes do trauma: uma revisão sobre a história do psicotraumatismo / The roots of trauma: a review of the history of psychotrauma

Resumo A percepção do papel do trauma psicológico na origem de problemas psiquiátricos aumentou e diminuiu ao longo da história da psiquiatria. Com a concepção do transtorno de estresse pós-traumático (TEPT), entretanto, as sociedades ocidentais presenciaram uma profunda expansão do discurso do traumatismo na interpretação de experiências humanas devastadoras, como catástrofes, genocídios, desastres e epidemias. A partir de revisão bibliográfica integrativa, este artigo analisa alguns dos determinantes históricos e epistemológicos que fundamentam o surgimento da memória traumática e o estabelecimento do trauma como campo semântico que orienta respostas clínicas e estratégias políticas no campo das ciências humanas e da saúde.

Abstract Perceptions of the importance of the role of psychological trauma in the origins of psychiatric problems have oscillated throughout the history of psychiatry. However, since the conception of post-traumatic stress disorder (PTSD), western societies have witnessed a marked expansion of the discourse of trauma in the interpretation of devastating human experiences like catastrophes, genocides, disasters, and epidemics. Through an integrative literature review, this article analyzes some of the historical and epistemological determinants behind the emergence of traumatic memory and the establishment of trauma as a semantic field that orients clinical responses and political strategies in the field of the humanities and the health sciences.

Symptoms of post-traumatic stress disorder and affects in healthcare workers during the COVID-19 pandemic / Sintomas de transtorno de estresse pós-traumático e afetos em profissionais da saúde durante a pandemia da COVID-19

Objective: This study aimed to evaluate symptoms of post-traumatic stress disorder and affects in health professionals during the COVID-19 pandemic. Method: Three hundred and seventy-four health professionals, among which 235 were front-line and 139 non-front-line workers, answered an online questionnaire consisting of socio-demographic data, identification of past mental disorders, personal experience facing the pandemic, the Impact of Event Scale, and the Positive and Negative Affect Schedule. The sample consisted mainly of physicians and nursing staff aged between 30 and 49 years. Results: The results demonstrate high scores of symptoms related to post-traumatic stress disorder, with greater expressiveness among front-line professionals, especially in the nursing staff, and a strong correlation of these results with negative affects. Conclusion: Psychological assistance and interventions directed to health professionals are urgent to mitigate the impacts caused by the COVID-19 pandemic.

Objetivo: Este estudo objetivou avaliar sintomas de transtorno de estresse pós-traumático e afetos em profissionais de saúde durante a pandemia da COVID-19. Método: Trezentos e setenta e quatro profissionais da área da saúde, dentre os quais 235 profissionais que estavam atuando na linha de frente e 139 que não estavam na linha de frente, responderam a um questionário online composto por dados sociodemográficos, identificação de transtornos mentais pregressos, experiência pessoal frente à pandemia e Escala do Impacto do Evento e Escala de Afetos Positivos e Afetos Negativos. A amostra foi composta majoritariamente de médicos e funcionários da equipe de enfermagem com idades entre 30 e 49 anos. Resultados: Os resultados demonstram altas pontuações de sintomas relativos ao transtorno de estresse pós-traumático, com maior expressividade nos profissionais da linha de frente, principalmente na equipe de enfermagem, e forte correlação desses resultados com afetos negativos. Conclusão: O atendimento e intervenções psicológicas direcionadas aos profissionais de saúde são urgentes para mitigar os impactos causados pela pandemia da COVID-19.

A soberania do visível: como a memória traumática se torna estresse traumático / The sovereignty of the visible: how traumatic memory becomes traumatic stress / La soberanía de lo visible: cómo la memoria traumática se convierte en estrés traumático

Desde o lançamento da terceira versão do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-III), a psiquiatria biológica vem sistematicamente aplicando seu raciocínio classificatório a fenômenos sociais de múltiplas naturezas. Nessa perspectiva, ganha relevância o discurso do trauma, pelo qual acontecimentos de magnitude devastadora passaram a receber interpretações neurocomportamentais e foram, finalmente, reconhecidos menos por seus impactos culturais e subjetivos que pelas alterações fisiológicas que propiciam. Apoiado em revisão narrativa, este artigo procurará explorar a transição da racionalidade traumática entre o século XIX, quando o trauma fora concebido em associação ao conceito cognitivo de memória, e o século XX, quando finalmente esse fenômeno foi anexado à pesquisa neurocientífica do estresse. A pluralidade de modelos conceituais e paradigmas determinísticos pode contribuir para que a pesquisa do trauma produza protocolos de enfrentamento multifatoriais mais adequados à experiência humana do sofrimento pós-traumático.

Since the release of the third version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), biological psychiatry has been systematically applying its classification reasoning to social phenomena of many natures. From this perspective, the discourse of trauma gained relevance and events of devastating magnitude began to receive neurobehavioral interpretations until finally being recognized less for their cultural and subjective effects than for the physiological changes they cause. By a narrative review, this study aims to analyze the transition of traumatic rationality from the 19th century, when trauma was associated with the cognitive concept of memory, to the 20th century, when this phenomenon was finally attached to neuroscientific research on stress. The plurality of conceptual models and deterministic paradigms can contribute to the fact that trauma research produces multifactorial coping protocols more appropriate to the human experience of post-traumatic suffering.

Desde la publicación de la tercera versión del Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-III), la psiquiatría biológica ha aplicado sistemáticamente su razonamiento clasificatorio a fenómenos sociales de múltiple naturaleza. Desde esta perspectiva cobra relevancia el discurso del trauma, a través del cual eventos muy devastadores pasaron a tener interpretaciones neuroconductuales y finalmente fueron reconocidos menos por sus impactos culturales y subjetivos que por los cambios fisiológicos que provocan. A partir de una revisión narrativa, este artículo busca explorar la transición del razonamiento traumático entre el siglo XIX, cuando el trauma se concibe en asociación con el concepto cognitivo de memoria, y el siglo XX, cuando este fenómeno se vincula a la investigación neurocientífica sobre estrés. La diversidad de modelos conceptuales y paradigmas deterministas puede contribuir a que la investigación del trauma produzca protocolos de afrontamiento multifactoriales más adecuados a la experiencia humana del sufrimiento postraumático.

Psychopathological intersection between obsessive-compulsive disorder and post-traumatic stress disorder: scoping review of similarities and differences

Abstract Introduction Although post-traumatic stress disorder and obsessive-compulsive disorder have distinct diagnostic criteria, some psychopathological phenomena seem to be shared, which may lead to misdiagnosis and erroneous treatment decisions. This scoping review explores the psychopathological similarities and differences between these two disorders. Method The review complies with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and included articles published in Portuguese, English, or Spanish in the last 50 years indexed in the PubMed database. Case-reports were excluded. Results Fifty-three studies with different designs were included (30 [56.5%] were cross-sectional studies; eight [15.1%] were case-control studies; one [1.9%] was a cohort study; three [5.7%] were clinical trials; nine [17%] were reviews/systematic reviews; and two [3.8%] were meta-analyses). The main psychopathological aspects described by the studies included were flashbacks x obsessions; avoidant behavior (AB); depressive, anxious, and somatic symptoms; sexuality, sleep, and appetite; psychiatric comorbidities; and suicidality. The intersection between clinical features seems to occur in the extrinsic psychopathological dimension. Conclusion The disorders' core psychopathological symptoms (intrinsic characteristics) are distinctly different, since flashbacks and obsessions are consequences of different predominant defective mental functions: the former derives from defective memory, the latter from defective thought. Along the same lines, the ABs observed in the two disorders are products of different purposes and inner necessities.

Trauma and Coping in Battling the COVID-19 Pandemic Among Malaysian Healthcare Workers

@#Introduction: Prolonged COVID-19 pandemic with high morbidity and mortality may cause traumatic events to Healthcare Workers (HCW), resulting in Post-Traumatic Stress Disorder (PTSD) symptoms. Hence, this study aims to determine the prevalence of PTSD symptoms and its association with coping strategies among HCW in managing COVID-19 pandemic at Klang Valley Public Hospitals in Malaysia. Methods: A cross-sectional study with total of 424 eligible respondents were recruited through stratified random sampling. Data was collected from 6th May until 6th June 2021 using a self-administered online questionnaire adopted from MPCL-5 and Brief COPE instruments. IBM Statistical Package for Social Sciences Version 26 was used to analyse data. Result: 25% of the respondents demonstrated PTSD symptoms. Respondents who are single (aOR=3.319, 95% CI: 1.912, 5.762, p-value <0.001) and had history of positive COVID-19 (aOR= 2.563, 95% CI:1.058, 6.209, p-value=0.037) were more likely to experience PTSD symptoms. Frequently coping with self-blaming (aOR= 7.804, 95% CI: 3.467, 17.568, p-value < 0.001), behavioural disengagement (aOR= 7.262, 95% CI: 1.973, 26.723, p-value =0.003), humour (aOR= 5.303, 95% CI: 1.754, 16.039, p-value =0.003), venting emotion (aOR= 3.287, 95% CI: 1.521, 7.105, p-value =0.002) and less planning (aOR= 2.006, 95% CI:1.154, 3.487 p-value =0.014) are significant predictors for PTSD symptoms. Conclusion: One in four HCW managing COVID-19 in Klang Valley public hospitals experienced PTSD symptoms. Therefore, urgent interventional program targeting HCW who are single with history of positive COVID-19 is beneficial to prevent PTSD. Maladaptive coping strategies like self-blaming, venting emotion, humour and behavioural disengagement should be replaced with more adaptive coping strategies like planning, self-compassion, self-care and self-reflection.

Estresse, coping e estados afetivos em profissionais da saúde durante a pandemia / Distress, coping and affective statesin healthcare workers durig the COVID-19 pandemic / Estrés, afrontamiento y estados afectivos em profissionales de la salud durante la pandemia de COVID-19

A pandemia da COVID-19 configurou um período de crise mundial com impactos na saúde mental de toda a população, notadamente dos profissionais de saúde da linha de frente. Objetivou-se rastrear a presença de sintomas de Transtorno de Estresse Pós-Traumático em profissionais de saúde da linha de frente e verificar sua associação com estratégias de coping e estados afetivos durante a pandemia da COVID-19 no Brasil. Realizou-se um estudo longitudinal on-line com 51 profissionais da saúde da linha de frente residentes nas cinco regiões do Brasil que responderam aos instrumentos: Escala do Impacto do Evento, Escala de Afetos Positivos e Afetos Negativos, Escala de Coping Ocupacional e questionário sobre a experiência pessoal frente à pandemia. Por meio de análises de comparação de proporções e médias, bem como análise de correlações, verificou-se alto índice de sintomas relacionados ao Transtorno de Estresse Pós-Traumático nos três momentos de coleta com correlações significativas com afetos negativos, mas não com estratégias de coping. Destaca-se o risco aumentado para o desenvolvimento ou agravo de transtornos mentais nesses profissionais, particularmente quadros de estresse pós-traumático e dificuldades de regulação emocional, que exigem ações urgentes de cuidado psicológico (AU).

The COVID-19 pandemic forgeda period of global crisis with impacts on the mental health of the entire population, notably frontline health professionals.The study aimed to track the presence of Post-Traumatic Stress Disorder symptoms in frontline healthcare workers and verify its association with coping strategies and affective states during the COVID-19 pandemic in Brazil. A longitudinal onlinestudy was carried out with 51 frontline healthcare professionalsfrom the fiveregions of Brazilwho responded to the following instruments: Impact of Event Scale, Positive Affect and Negative Affect Scale, Occupational Coping Scale, and questionnaire about personal experience during the pandemic. Comparison of proportions and means, as well as correlationanalysis,revealeda high rate of symptoms related to Post-Traumatic Stress Disorder in the three point of data collection, with significant correlations with negative affects, but not with coping strategies. The increased risk for the development or worsening of mental disorders in these professionals is highlighted, particularly post-traumatic stress and emotional regulation difficulties, which require urgent psychological care actions (AU).

La pandemia de COVID-19 estableció un período de crisis global con impactos en la salud mental de toda la población, en particular de los profesionales de la salud de primera línea. El objetivo fue rastrear la presencia de síntomas de Trastorno de Estrés Postraumático en profesionales de salud de primera línea y verificar su asociación con estrategias de afrontamiento y estados afectivos durante la pandemia de COVID-19 en Brasil. Se realizó un estudio longitudinal onlinecon 51 profesionales de salud de primera línea residentes de las cincoregiones de Brasil que respondieron los siguientes instrumentos: Escala de Impacto de Evento, Escala de Afectos Positivos y Negativos, Escala de Afrontamiento Ocupacional y cuestionario sobre experiencia personal frente ala pandemia.Los análisisde comparación de proporciones y medias, así como análisis de correlaciones, mostró una alta tasa de síntomas relacionados con el Trastorno de Estrés Postraumático en los tres momentos de recolección de datos, con correlaciones significativas con los afectos negativos, pero no con las estrategias de afrontamiento. Se destaca el mayor riesgo para el desarrollo o empeoramiento de trastornos mentales en estos profesionales, en particular el estrés postraumático y las dificultades (AU).

Asociación entre abuso sexual y distrés psicológico en adolescentes escolarizados de Santa Marta, Colombia / Association between sexual abuse and psychological distress in high-school adolescents in Santa Marta, Colombia

Resumen. El abuso sexual es un estresor que incrementa el riesgo de distrés psicológico. El objetivo de la investigación fue cuantificar la asociación entre abuso sexual y distrés psicológico (estrés postraumático, depresión y riesgo suicida) en estudiantes adolescentes en Santa Marta, Colombia. Se diseñó un estudio transversal. Participaron 1.462 estudiantes entre 13 y 17 años (M = 15,98; DE = 0,83). El abuso sexual se indagó mediante un ítem único del Cuestionario de Victimización Juvenil y el distrés con la Escala Breve de Davidson para estrés postraumático, la escala de ideación suicida del Centro de Estudios Epidemiológicos y el Índice de Bienestar General (WHO-5). La prevalencia de abuso sexual fue 17,37%; riesgo de estrés postraumático, 19,36%; riesgo de depresión, 7,05%; y alto riesgo suicida, 13,27%. La historia de abuso sexual se asoció a estrés postraumático (Ajustado OR = 2,41; IC 95% 1,77 -3,28), depresión (AOR = 2,48; IC 95% 1,59-3,88), y riesgo suicida (AOR = 2,51; IC 95% 1,77 -3,56). Se concluye que el abuso sexual es un estresor que incrementa significativamente el riesgo de distrés psicológicos en estudiantes adolescentes en Santa Marta, Colombia. Se necesitan estudios de cohorte para controlar posibles variables de confusión para estas asociaciones.

Abstract. Sexual abuse is a stressor that increases the risk of psychological distress. The research objective was to quantify the association between sexual abuse and psychological distress (post-traumatic stress, depression, and suicide risk) in adolescent students in Santa Marta, Colombia. A cross-sectional, correlational study was designed. One thousand four hundred sixty-two students between the ages of 13 and 17 participated (M = 15.98, SD = 0.83). Sexual abuse was investigated using a single item of the Juvenile Victimization Questionnaire. Psychological distress was evaluated with the SPAN (post-traumatic symptoms, suicidal ideation scale of the Center for Epidemiological Studies and Well-being Index (WHO-5). The prevalence of sexual abuse was 17.37%; post-traumatic stress, 19.36%; depression, 7.05%; and suicide risk, 13.27%. The sexual abuse history was associated with post-traumatic stress (Adjusted OR = 2.41, 95% CI 1.77 - 3.28), depression (AOR = 2.48, 95% CI 1.59 - 3.88), and suicide risk (AOR = 2.51, 95% CI 1.77 - 3.56). It is concluded that sexual abuse is a stressor that significantly increases the risk of psychological distress in adolescent students in Santa Marta, Colombia. Cohort studies are needed to control for possible confounding variables for these associations.