ABSTRACT
Background: Both post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) have been included in the 11th edition of the International Classification of Diseases (ICD-11). Although the validity of CPTSD has been controversial, a growing number of studies support the distinction between PTSD and CPTSD. However, the majority of this research has originated in high-income countries (HICs), whereas the prevalence of trauma experience associated with PTSD/CPTSD diagnosis is significantly higher in low- and middle-income countries (LMICs). Objective: This study assessed whether a sample from an LMIC setting produced distinct classes that reflect ICD-11 criteria for PTSD and CPTSD. Furthermore, this study investigated whether childhood trauma distinguished between PTSD and CPTSD. Method: International Trauma Questionnaire responses from a sample of South African university undergraduates were used as indicator variables in a latent class analysis (LCA). Chi-squared tests of independence and Kruskal-Wallis H tests were used to assess between-class differences. Results: The LCA identified four distinct classes: a PTSD class with elevated symptoms of PTSD, but low endorsement of disturbances in self-organization (DSO; symptoms that are specific to CPTSD); a CPTSD class with elevated symptoms of PTSD and DSO; a DSO class with low symptoms of PTSD, but elevated symptoms of DSO; and a Low class with low endorsements on all symptoms. Regarding childhood trauma, participants in the CPTSD class had more severe childhood abuse and neglect, specifically emotional abuse and neglect, than participants in the PTSD class. Conclusions: Findings were consistent with the distinction between PTSD and CPTSD symptom profiles in the ICD-11. Our findings support a similar qualitative distinction between PTSD and CPTSD in our LMIC context, as previously reported in HICs. This distinction is especially relevant in LMICs because of the significant number of individuals vulnerable to these disorders.
Antecedentes: Tanto el trastorno de estrés postraumático (TEPT) como el trastorno de estrés postraumático complejo (TEPT-C) se han incluido en la 11ª edición de la Clasificación Internacional de Enfermedades (CIE-11). Aunque la validez del TEPT-C ha sido controvertida, un número creciente de estudios apoyan la distinción entre TEPT y TEPT-C. Sin embargo, la mayor parte de esta investigación se ha originado en países de ingresos altos (HIC en su sigla en inglés), mientras que la prevalencia de experiencias traumáticas asociadas con el diagnóstico de TEPT/TEPT-C es significativamente mayor en países de ingresos bajos y medios (LMIC en su sigla en inglés).Objetivo: Este estudio evaluó si una muestra de un entorno de LMIC produjo clases distintas que reflejan los criterios de la CIE-11 para TEPT y TEPT-C. Además, este estudio investigó si el trauma infantil distinguía entre TEPT y TEPT-C.Método: Las respuestas del Cuestionario Internacional de Trauma (ITQ en su sigla en inglés) de una muestra de estudiantes universitarios de Sudáfrica se utilizaron como variables indicadoras en un análisis de clase latente (LCA en su sigla en inglés). Se utilizaron pruebas de independencia de chi-cuadrado y pruebas H de Kruskal-Wallis para evaluar las diferencias entre clases.Resultados: El LCA identificó cuatro clases distintas: una clase de trastorno de estrés postraumático con síntomas elevados de trastorno de estrés postraumático, pero baja validación de las alteraciones en la autoorganización (DSO en su sigla en inglés; síntomas que son específicos de TEPT-C); una clase de TEPT-C con síntomas elevados de TEPT y DSO; una clase de DSO con síntomas bajos de TEPT, pero síntomas elevados de DSO; y una clase baja con baja validación de todos los síntomas. Con respecto al trauma infantil, los participantes en la clase de TEPT-C tuvieron abuso y negligencia infantil más severos, específicamente abuso y negligencia emocional, que los participantes en la clase de TEPT.Conclusiones: Los hallazgos fueron consistentes con la distinción entre los perfiles de síntomas de TEPT y TEPT-C según la CIE-11. Nuestros hallazgos apoyan una distinción cualitativa similar entre TEPT y TEPT-C en nuestro contexto de LMIC a lo reportado anteriormente en los HIC. Esta distinción es especialmente relevante en los países de ingresos bajos y medios debido al número significativo de personas vulnerables a estos trastornos.
ABSTRACT
BACKGROUND: British National guidelines (NICE) recommend bariatric surgery for patients with a body mass index (BMI) > 40 kg/m2, or BMI > 35 kg/m2 with any comorbidities of the metabolic syndrome. Intra-gastric balloons (IGB) can be used in super obese patients as a first step, before definitive surgery. AIMS: Quantify weight loss 6 months after IGB placement, measure progression to definitive surgery and identify complications. METHODS: Data collected retrospectively on 50 patients. Forty-six proposed for definitive bariatric surgery, four patients excluded. Analysis performed using SPSS v23.0. RESULTS: Median weight decreased from 165.5 to 155 kg (range 78 to 212, p < 0.01), BMI from 57.4 to 52.15 (range 32.9 to 70.5, p < 0.01), percentage excess weight loss (%EWL) was 12.9% (range - 3.3 to 64.66%, p < 0.01) and BMI reduction was 4.25 kg/m2 (range - 1.3 to 13.9, p < 0.01). Twenty-nine out of 46 patients (63%) progressed to definitive bariatric surgery. Ten out of 46 patients (21.7%) had complications requiring readmission. Seven of these patients required early balloon removal and six failed to progress to definitive surgery. Six patients had a second balloon placement, their actual weight loss was less successful, with some regaining weight. DISCUSSION: IGB is useful to aid weight loss prior to definitive bariatric surgery. Results from first balloon placement are encouraging and comparable with other studies "as reported by Genco et al. (Int J of Obes 30:129-133, 2006)." Readmission due to nausea, vomiting, dehydration and poor compliance may be associated with poor weight loss and failure to progress to definitive surgery. Second balloon placements were less successful. CONCLUSION: IGB as bridging therapy is a safe and useful adjunct. Sequential IGBs do not seem to provide additional benefit.
