Exploring the effects of COVID-19-related traumatic events on the mental health of university students in Brazil: A cross-sectional investigation.

University students are vulnerable to mental health issues during their academic lives. During the COVID-19 pandemic, university students faced mental distress due to lockdowns and the transition to e-learning. However, it is not known whether these students were also affected specifically by COVID-19-related traumatic events. This study examined the impact of COVID-19-related traumatic events on 2277 university students from two federal institutions of higher education in Brazil. The university students completed an online questionnaire covering demographics, lifestyle habits, health characteristics, COVID-19-related traumatic events, and depression, anxiety, and stress symptoms. The results showed that an increased intensity of COVID-19-related traumatic events was positively associated with stress, anxiety, and depressive symptoms, and each specific type of event was associated with these symptoms. In addition, we found a negative association between these symptoms and male sex and age and a positive association with having or having had a history of cardiovascular, respiratory, neurological, or mental disorders or another disease diagnosed by a physician. In conclusion, this study emphasizes the heightened risk of mental health issues in university students in the face of COVID-19-related traumatic events. Women, young people and people who have or have had a history of disease were the most vulnerable to mental health issues during the COVID-19 pandemic.

Episodic memory training in elderly: A systematic review.

Introduction: Episodic memory is a cognitive process that allows the recall of experiences, learning, and the pursuit of future goals. During the aging process, episodic memory declines negatively, impacting social and psychological aspects in the elderly. Such intervention strategies as cognitive training are non-pharmacological ways of reducing these losses. Objective: We systematically reviewed studies of the cognitive training of episodic memory in healthy elderly individuals and elderly individuals with clinical conditions. Method: We systematically searched the PubMed, PsycNET, Web of Science, and SciELO databases using the descriptors "Episodic Memory" AND "Training" AND "Elderly" OR "Aging" OR "Dementia" in English and translated into Portuguese. Results: Of the 572 articles that were identified by the search, 23 were included in the final analysis. The main variables that comprised the intervention protocols (i.e., characteristics of the sample, type of control group, mode of episodic memory training, and duration of training) were investigated, as well as the outcome variables, efficacy, and risk of bias. The main results indicated effectiveness with regard to different forms of the cognitive training of episodic memory. Conclusion: Episodic memory training among the elderly can mitigate the negative effects of cognitive decline in dementia and healthy subjects promoting impacts at social, psychological, and economic levels. Although it is a widely studied topic, further empirical studies on the utility of episodic memory training in healthy elderly individuals and elderly individuals with clinical conditions are still needed.

Tonic Immobility in PTSD: Exacerbation of Emotional Cardiac Defense Response.

Among defensive behaviors, tonic immobility (TI) is considered the last defensive resort when life is at extreme risk. Post-Traumatic Stress Disorder (PTSD) is the main psychiatric consequence resulting from exposure to traumatic events. Increasing evidence indicate an association between peritraumatic tonic immobilility and severity of PTSD. Cardiac defense response, a reactivity to perceived danger or threat, has been studied by recording heart rate changes that follows the presentation of an unpredictable intense auditory aversive stimulus. The aim of this study was to investigate potential distinctiveness in cardiac defense response among PTSD patients who presented - compared to those that did not - TI reaction in the laboratory setting. Patients (N = 17) completed the TI questionnaire for signs of immobility elicited by passive listening to their autobiographical trauma script. After a while, they were exposed to an intense white noise, while electrocardiogram was recorded. The heart rate during the 80 s after the noise, subtracted from baseline, was analyzed. Higher reports of TI to the trauma script were associated with stronger and sustained heart rate accelerations after the noise. The effects on cardiac defense response add to increasing evidence that some PTSD patients are prone to repeated re-experiences of TI, which may implicate in a potentially distinct pathophysiology and even a new PTSD subtype.

AS VÍTIMAS DA VIOLÊNCIA: ENTRE DISCURSOS CIENTÍFICOS E BIOPOLÍTICAS DO CONTEMPORÂNEO / VÍCTIMAS DE LA VIOLENCIA: MIENTRE DISCURSOS CIENTÍFICOS Y LAS BIOPOLÍTICAS CONTEMPORÁNEAS / VICTIMS OF VIOLENCE: BETWEEN SCIENTIFIC DISCOURSES AND BIOPOLITICS OF CONTEMPORARY

Este artigo apresenta reflexões em torno do papel social da vítima da violência na produção do medo e da insegurança, e sua influência no aumento dos mecanismos repressivos do estado penal brasileiro. Foi realizada uma pesquisa bibliográfica não sistemática buscando proposições acerca da criação de uma psicopatologia relacionada à vitimização, nesse caso o Transtorno de Estresse Pós-Traumático (TEPT). Indo além de uma proposta de caracterização do transtorno em si, o presente trabalho teve como objetivo entender as práticas que o engendram, quais contingências históricas o fizeram emergir em um determinado momento e quais efeitos têm produzido na medicalização da vida e nas atuais políticas públicas de segurança de nossa sociedade.(AU)

Este artículo presenta una reflexión sobre el papel social de las víctimas de la violencia en la génesis del miedo y la sensación de inseguridad, así como su influencia en el aumento de los mecanismos represivos del Estado penal brasileño. Se realizó una búsqueda no sistemática en la literatura sobre las propuestas de la creación de una psicopatología relacionada con la victimización, en este caso el Trastorno de Estrés Postraumático (TEPT). Más allá de una propuesta de caracterización del trastorno en sí, el objetivo de este estudio fue comprender las prácticas que lo causan, así como las contingencias históricas que lo hicieron surgir en un momento determinado y los efectos que han producido en la medicalización de la población y en las políticas públicas de seguridad de nuestra sociedad.(AU)

This article presents some reflections about the social role of the victims of violence in production of fear and insurance, and its influences in the repressive mechanisms in the state criminal justice. We performed a systematic literature search seeking proposals about the creation of a psychopathology related with the victimhood, the Posttraumatic Stress Disorder (PTSD). More than a simple characterization of the disorder, our aim was to investigate what practices create it, what effects produces in the medicalization of life and the actual public security policies in our society.(AU)

As vítimas da voolência: entre discursos científicos e biopolíticas do contemporâneo / Víctimas dela viiolencia: mientre discursos científicos y las biopolíticas contemporáneas / Vitims of violennce: between scienific discourses and biopoliticss of contemporary

Este artigo apresenta reflexões em torno do papel social da vítima da violência na produção do medo e da insegurança, e sua influência no aumento dos mecanismos repressivos do estado penal brasileiro. Foi realizada uma pesquisa bibliográfica não sistemática buscando proposições acerca da criação de uma psicopatologia relacionada à vitimização, nesse caso o Transtorno de Estresse Pós-Traumático (TEPT). Indo além de uma proposta de caracterização do transtorno em si, o presente trabalho teve como objetivo entender as práticas que o engendram, quais contingências históricas o fizeram emergir em um determinado momento e quais efeitos têm produzido na medicalização da vida e nas atuais políticas públicas de segurança de nossa sociedade...

Este artículo presenta una reflexión sobre el papel social de las víctimas de la violencia en la génesis del miedo y la sensación de inseguridad, así como su influencia en el aumento de los mecanismos represivos del Estado penal brasileño. Se realizó una búsqueda no sistemática en la literatura sobre las propuestas de la creación de una psicopatología relacionada con la victimización, en este caso el Trastorno de Estrés Postraumático (TEPT). Más allá de una propuesta de caracterización del trastorno en sí, el objetivo de este estudio fue comprender las prácticas que lo causan, así como las contingencias históricas que lo hicieron surgir en un momento determinado y los efectos que han producido en la medicalización de la población y en las políticas públicas de seguridad de nuestra sociedad...

This article presents some reflections about the social role of the victims of violence in production of fear and insurance, and its influences in the repressive mechanisms in the state criminal justice. We performed a systematic literature search seeking proposals about the creation of a psychopathology related with the victimhood, the Posttraumatic Stress Disorder (PTSD). More than a simple characterization of the disorder, our aim was to investigate what practices create it, what effects produces in the medicalization of life and the actual public security policies in our society...

They know their trauma by heart: an assessment of psychophysiological failure to recover in PTSD.

BACKGROUND: Posttraumatic stress disorder (PTSD) develops following exposure to atraumatic event and is characterized by persistent intense reactivity to trauma related cues. Equally important, but less studied, is the failure to restore physiological homeostasis after these excessive reactions. This study investigates psychophysiological markers of sustained cardiac activity after exposure to reminders of traumatic event in PTSD patients. METHODS: Participants passively listened to neutral and personal traumatic event while electrocardiogram was continuously recorded. Heart rate (HR) and heart rate variability (HRV) were analyzed in 19 PTSD patients and 16 trauma-exposed controls. RESULTS: Both PTSD patients and trauma exposed controls exhibited a significant increase in HR to the exposure of their personal trauma. PTSD patients sustained the increase of HR while controls recovered to basal levels. In PTSD patients, sustained HR was positively associated with re-experiencing symptoms. The PTSD group also showed a reduced HRV (a measure of parasympathetic influence on the heart) during personal trauma exposure and lack of recovery. LIMITATIONS: The sample size was small and PTSD patients were under medication. CONCLUSIONS: Our findings provide an experimental account of the failure of PTSD patients to exhibit physiological recovery after exposure to trauma-related stimuli. PTSD patients exhibited a sustained tachycardia with attenuation of HRV that persisted even after cessation of the stressor. Re-experiencing symptoms facilitated engagement in the trauma cues, suggesting that, in their daily-life, patients most likely present repeated episodes of sustained over-reactivity, which may underpin the emotional dysregulation characteristic of PTSD.

Impacto da terapia cognitivo-comportamental nos fatores neurobiológicos relacionados à resiliência / Impact of cognitive-behavior therapy on resilience-related neurobiological factors

A resiliência, como uma variável de desfecho, tem sido largamente negligenciada no campo terapêutico. Nosso objetivo foi investigar os efeitos da terapia cognitivo-comportamental (TCC) nos marcadores neurobiológicos de resiliência em pacientes com transtorno de estresse pós-traumático (TEPT). Nesta pesquisa experimental de caso único, foram acessadas variáveis fisiológicas (frequência cardíaca, frequência respiratória, tônus vagal cardíaco, balanço simpático e condutância da pele) e neuroendócrinas (cortisol e de-hidroepiandrosterona - DHEA) e medidas psicométricas de autorrelato (afeto negativo, resiliência, sintomas de TEPT, depressão, ansiedade e apoio social). Foram medidas as respostas fisiológicas, neuroendócrinas e psicométricas em repouso antes e após quatro meses de TCC. O paciente era um homem de 45 anos que sofreu dois assaltos com arma de fogo e não respondeu adequadamente ao tratamento farmacológico com paroxetina. A TCC levou a uma redução da frequência cardíaca, frequência respiratória, balanço simpático, condutância da pele e cortisol, bem como a um aumento no tônus vagal e DHEA. Além disso, a TCC promoveu redução na pontuação dos sintomas de TEPT, depressão, ansiedade e afeto negativo e aumento da pontuação de resiliência e apoio social. Nossos dados sugerem que a TCC aumenta os fatores relacionados à resiliência (DHEA, tônus vagal, autorrelato de resiliência e apoio social). Isso não é somente "antipatológico", mas também pode ser considerado "pró-bem-estar". Adicionalmente, nossos resultados mostram a relevância da investigação dos efeitos do tratamento psicológico em múltiplos sistemas neurobiológicos no mesmo paciente com TEPT, visando desvendar as bases neurobiológicas dos fatores de resiliência.

Resilience, as an outcome variable, has been largely neglected in the field of therapeutics. Our aim was to investigate the effects of cognitive behavioral therapy (CBT) on neurobiological markers of resilience in posttraumatic stress disorder (PTSD) patients. In this single-case experimental research, we assessed physiological (heart rate, respiratory rate, cardiac vagal tone, sympathetic balance and skin conductance) and neuroendocrine (cortisol and dehydroepiandrosterone - DHEA) variables; and psychometric self-report measures (negative affect, resilience, PTSD symptoms, depression, anxiety and social support). Physiological, neuroendocrine and psychometric responses at rest were measured before and after four months of CBT. The patient was a 45-year-old man who had suffered two armed robberies and failed to respond adequately to pharmacological treatment with paroxetine. CBT led to a reduction in heart rate, respiratory rate, sympathetic balance, skin conductance and cortisol. It also led to an increase in cardiac vagal tone and DHEA. Furthermore, CBT promoted reduction of PTSD symptoms, depression, anxiety and negative affect scores and enhancement of resilience and social support scores. CBT in this single case enhanced resilience-related factors such as DHEA, vagal tone, self-reported resilience and social support suggesting that this therapeutic strategy not only contributed to 'anti' pathology effects but to 'pro' well-being. Additionally, our results show the relevance of investigating the effects of psychological treatments in multiple neurobiological systems in the same PTSD patients to unveil the neurobiological underpinnings of resilience factors.

Marcadores neurobiológicos e psicométricos da eficácia da terapia cognitivo-comportamental no transtorno de estresse pós-traumático associado a sintomas dissociativos: relato de caso / Neurobiological and psychometric markers of the efficacy of cognitive behavioral therapy in post-traumatic stress disorder with dissociative symptoms: a case report

INTRODUÇÃO: O transtorno de estresse pós-traumático (TEPT) tem sido associado à desregulação de diversos parâmetros psicofisiológicos e pode apresentar comorbidade com diversas psicopatologias, inclusive a dissociação, podendo dificultar o tratamento. O objetivo do presente trabalho foi investigar os efeitos da terapia cognitivo-comportamental em um paciente com TEPT e sintomas dissociativos com base em medidas psicofisiológicas e psicométricas em diferentes momentos do tratamento. DESCRIÇÃO DO CASO: O paciente é um homem de 38 anos, com diagnósticos de TEPT e transtorno depressivo maior recorrente com sintomas dissociativos e resistência ao tratamento farmacológico. O tratamento psicoterápico teve duração de 4 meses, sendo composto por uma sessão semanal de terapia e três sessões semanais de coterapia. Os parâmetros fisiológicos (frequência cardíaca, tônus vagal, balanço simpático e cortisol) e psicométricos (afeto negativo e positivo, resiliência e sintomas de estresse pós-traumático, depressão, ansiedade e dissociação) foram medidos antes, durante (uma vez ao mês) e após o tratamento. COMENTÁRIOS: Os resultados mostraram diminuição do balanço simpático e aumento do tônus vagal, da frequência cardíaca e dos níveis de cortisol ao longo do tratamento. O tratamento também promoveu redução no afeto negativo e nos sintomas de estresse pós-traumático, depressão, ansiedade e dissociação, além de um aumento nos escores de resiliência, apoio social e afeto positivo. Esses resultados sugerem que a terapia cognitivo-comportamental é um tratamento eficaz para o TEPT com sintomas dissociativos. Além disso, parece promover a normalização das alterações fisiológicas do sistema nervoso autônomo e neuroendócrino relacionadas ao TEPT.

INTRODUCTION: Post-traumatic stress disorder (PTSD) has been associated with dysregulation of many psychophysiological parameters and may present comorbidity with different psychopathologies, including dissociation, potentially affecting treatment outcome. The aim of this study was to evaluate the effects of cognitive behavioral therapy in a patient with PTSD and dissociative symptoms based on psychophysiological and psychometric measures at different time points throughout the course of treatment. CASE DESCRIPTION: Our patient is a 38-year old man diagnosed with PTSD, major depression, and dissociative symptoms, resistant to pharmacotherapy. Psychological treatment lasted for 4 months and consisted of one weekly therapy session and three weekly coaching sessions. Physiological (heart rate, vagal tone, sympathovagal balance, and cortisol) and psychometric measures (negative and positive affect, resilience, and post-traumatic stress, depression, anxiety, and dissociative symptoms) were obtained before, during (once a month) and after treatment. COMMENTS: Results showed a decrease in sympathovagal balance and an increase in heart rate, vagal tone and cortisol levels during the course of treatment. Treatment also lead to a decrease in negative affect and in post-traumatic stress, depression, anxiety, and dissociation symptoms, as well as to an increase in resilience, social support and positive affect scores. These results suggest that cognitive behavioral therapy is an effective treatment for PTSD patients with dissociative symptoms. Moreover, the treatment seems to be able to normalize PTSD-related physiological parameters in the neuroendocrine and autonomic nervous systems.