ABSTRACT
The Journal of Child and Family Studies states that there have been more mass shootings within the last 18 years than in the entire 20th century combined, with 77% carried out by adolescents. This case study aims to evaluate the clinical presentation of post-traumatic stress disorder (PTSD) in an adolescent by highlighting the clinical course of a school shooting survivor. Here, we present the case of a 15-year-old female who presented to the emergency department (ED) of the University Hospital Medical Center (UHMC) under the Baker Act by the police for self-injury and self-harm. She had been admitted three times to the psychiatric hospital, all following the trauma of surviving the shooting. She met the criteria for PTSD and was triggered by graphics in the news outlets and social media. As clinicians working with PTSD adolescents, we must be cognizant of these factors as we think about prognosis and create a comprehensive treatment plan. This case study brings to our attention how complex and multifaceted PTSD patients can be in this day and age where social media, news outlets, and television are so pervasive. Three clinical pearls to take home from this patient encounter are: understanding the importance of news and media in modern-day PTSD diagnosis, how certain avoidance behaviors can delay remission, and how uncontrolled re-exposure can lead to poorer outcomes in children and adolescents specifically. It is no longer a rare occurrence to have a patient who has survived a mass school shooting. As a result of this unfortunate reality, clinicians need to be able to recognize and treat symptoms of PTSD in adolescent patients. We must be equipped to expect the interplay of modern triggers such as social media and news media and how it may affect adolescent patients.
ABSTRACT
The DNA hypomethylation that occurs when embryonic stem cells (ESCs) are directed to the ground state of naive pluripotency by culturing in two small molecule inhibitors (2i) results in redistribution of polycomb (H3K27me3) away from its target loci. Here, we demonstrate that 3D genome organization is also altered in 2i, with chromatin decompaction at polycomb target loci and a loss of long-range polycomb interactions. By preventing DNA hypomethylation during the transition to the ground state, we are able to restore to ESC in 2i the H3K27me3 distribution, as well as polycomb-mediated 3D genome organization that is characteristic of primed ESCs grown in serum. However, these cells retain the functional characteristics of 2i ground-state ESCs. Our findings demonstrate the central role of DNA methylation in shaping major aspects of 3D genome organization but caution against assuming causal roles for the epigenome and 3D genome in gene regulation and function in ESCs.
