Differential Psychological Treatment Effects in Patients With Late-Life Depression and a History of Childhood Maltreatment.

OBJECTIVE: This is the first interventional study to assess the impact of childhood maltreatment (CM) on psychological treatment outcomes in patients with late-life depression (LLD). METHODS: This is a secondary analysis of a multicenter, randomized controlled trial with 251 participants aged ≥60 years with moderate to severe depression. Participants were randomly assigned to cognitive behavioral therapy for late life depression (LLD-CBT) or to a supportive intervention (SUI). Treatment outcomes were measured by changes in the Geriatric Depression Scale (GDS). RESULTS: In the intention-to-treat sample (n = 229), both LLD-CBT (n = 115) and SUI (n = 114) significantly reduced depressive symptoms in patients with CM, with large effects at post-treatment (d = 0.95 [95% CI: 0.65 to 1.25] in LLD-CBT; d = 0.82 [95% CI: 0.52 to 1.12] in SUI). A significant treatment group*CM interaction (F(1,201.31) = 4.71; p = .031) indicated greater depressive symptom reduction in LLD-CBT compared to SUI at week 5 and post-treatment for patients without CM, but not at 6-month follow-up. Across both treatments, higher severity of the CM subtype 'physical neglect' was associated with a smaller depressive symptom reduction (F(1,207.16) = 5.37; p = .021). CONCLUSIONS: Specific and non-specific psychotherapy effectively reduced depressive symptoms in older individuals with depression and early trauma. For patients without early trauma, LLD-CBT may be preferable over SUI. Considering early trauma subtypes may contribute to develop personalized treatment approaches.

Comparison of early risk factors between healthy siblings and subjects with schizophrenia and bipolar disorder.

Introduction: The following work aims to compare the types and magnitude of risk events in patients with Schizophrenia and Bipolar Disorder and each of those groups with of a group of healthy siblings, exploring differences and similarities of the two psychotic disorders. Methods: Retrospective interviews were conducted with 20 families to investigate maternal and obstetric health, social support and the presence of early trauma for the affected family members and healthy siblings. Mothers were interviewed with the Prenatal Psychosocial Profile and each family participant was assessed with the Early Trauma Inventory, Screening Questionnaire of the Genomic Psychiatry Cohort and the Diagnostic Interview for Psychosis and Affective Disorders. Results: Obstetric and gestational history, pregnancy weight changes and early trauma were associated with offspring's mental illness, including statistically significant findings for complications of pregnancy, pregnancy weight changes, general trauma, physical punishment and emotional abuse. Conclusion: These findings highlight the different risk factor exposures that occur within a family, which may increase the risk for severe mental illness.

Algorithm-based modular psychotherapy vs. cognitive-behavioral therapy for patients with depression, psychiatric comorbidities and early trauma: a proof-of-concept randomized controlled trial.

Effect sizes of psychotherapies currently stagnate at a low-to-moderate level. Personalizing psychotherapy by algorithm-based modular procedures promises improved outcomes, greater flexibility, and a better fit between research and practice. However, evidence for the feasibility and efficacy of modular-based psychotherapy, using a personalized treatment algorithm, is lacking. This proof-of-concept randomized controlled trial was conducted in 70 adult outpatients with a primary DSM-5 diagnosis of major depressive disorder, a score higher than 18 on the 24-item Hamilton Rating Scale for Depression (HRSD-24), at least one comorbid psychiatric diagnosis according to the Structured Clinical Interview for DSM-5 (SCID-5), a history of at least "moderate to severe" childhood maltreatment on at least one domain of the Childhood Trauma Questionnaire (CTQ), and exceeding the cut-off value on at least one of three measures of early trauma-related transdiagnostic mechanisms: the Rejection Sensitivity Questionnaire (RSQ), the Interpersonal Reactivity Index (IRI), and the Difficulties in Emotion Regulation Scale-16 (DERS-16). Patients were randomized to 20 sessions of either standard cognitive-behavioral therapy alone (CBT) or CBT plus transdiagnostic modules according to a mechanism-based treatment algorithm (MoBa), over 16 weeks. We aimed to assess the feasibility of MoBa, and to compare MoBa vs. CBT with respect to participants' and therapists' overall satisfaction and ratings of therapeutic alliance (using the Working Alliance Inventory - Short Revised, WAI-SR), efficacy, impact on early trauma-related transdiagnostic mechanisms, and safety. The primary outcome for efficacy was the HRSD-24 score at post-treatment. Secondary outcomes included, among others, the rate of response (defined as a reduction of the HRSD-24 score by at least 50% from baseline and a score <16 at post-treatment), the rate of remission (defined as a HRSD-24 score ≤8 at post-treatment), and improvements in early trauma-related mechanisms of social threat response, hyperarousal, and social processes/empathy. We found no difficulties in the selection of the transdiagnostic modules in the individual patients, applying the above-mentioned cut-offs, and in the implementation of MoBa. Both participants and therapists reported higher overall satisfaction and had higher WAI-SR ratings with MoBa than CBT. Both approaches led to major reductions of depressive symptoms at post-treatment, with a non-significant superiority of MoBa over CBT. Patients randomized to MoBa were nearly three times as likely to experience remission at the end of therapy (29.4% vs. 11.4%; odds ratio, OR = 3.2, 95% CI: 0.9-11.6). Among mechanism-based outcomes, MoBa patients showed a significantly higher post-treatment effect on social processes/empathy (p<0.05) compared to CBT patients, who presented an exacerbation on this domain at post-treatment. Substantially less adverse events were reported for MoBa compared to CBT. These results suggest the feasibility and acceptability of an algorithm-based modular psychotherapy complementing CBT in depressed patients with psychiatric comorbidities and early trauma. While initial evidence of efficacy was observed, potential clinical advantages and interindividual heterogeneity in treatment outcomes will have to be investigated in fully powered confirmation trials.

The maltreated eco-phenotype of eating disorders: A new diagnostic specifier? A systematic review of the evidence and comprehensive description.

This systematic review aimed to summarize the evidence on the existence of a distinct phenotypic expression of Eating Disorders (EDs) associated with childhood maltreatment (CM), the so-called maltreated eco-phenotype of EDs. PRISMA standards were followed. Articles providing data about the characteristics of individuals with an ED reporting CM were included. Relevant results were extracted and summarized. A quality assessment was performed. A total of 1207 records were identified and screened, and 97 articles published between 1994 and 2023 were included. Findings revealed distinct biological and clinical features in patients with EDs reporting CM, including neuroanatomical changes, altered stress responses, ghrelin levels, inflammation markers, and gut microbiota composition. Clinically, CM correlated with severer eating behaviors, higher psychiatric comorbidity, impulsivity, emotional dysregulation, and risky behaviors. Additionally, CM was associated with poorer treatment outcomes, especially in general psychopathology and psychiatric comorbidities. This review highlighted the need to move towards an etiologically informed nosography, recognizing CM not merely as a risk factor, but also as an etiologic agent shaping different eco-phenotypic variants of EDs.

A psychometric analysis of the Early Trauma Inventory-Short Form in Colombia: CTT and Rasch model.

BACKGROUND: Potential childhood traumatic experiences increase risk for mental and physical health disorders and their precise assessment can help to promote health prevention and promotion strategies for countries with limited data and measurement strategies like Colombia. OBJECTIVE: The goal of the present study is to strengthen evidence for the validity of scores from an adapted version of the Early Trauma Inventory self report-short form (ETI-SF) using Item Response Theory and by assessing factorial invariance across gender and education level. PARTICIPANTS AND SETTING: The study assessed a total of 1909 Colombian participants (66.16 % women, 32.16 % men, 1.68 % other gender; age range 18-72 years old). METHODS: Participants answered the ETI-SF via a web-based sampling strategy. RESULTS: The total scores of the scale showed good reliability coefficients (α = 0.81 and ω = 0.60). A specific analysis for the subscales showed good reliability for the emotional, physical, and sexual trauma subscales (αs and ωs >0.64), while general trauma showed lower than accepted reliability values (α =0.56 and ω = 0.37). Most of the individual items of the scale showed good calibration. The factorial invariance analysis suggests the possibility of some gender and educational differences. CONCLUSIONS: The study confirms particularly high rates of potential childhood traumatic experiences in Colombia and complement data for specific trauma types. Overall, the ETI-SF is confirmed as useful for Colombia, which highlights this scale as a good tool to use for public health assessment. Future research can continue the integration of diverse methods for estimating the quality of the scale.

The multi-level outcome study of psychoanalysis for chronically depressed patients with early trauma (MODE): rationale and design of an international multicenter randomized controlled trial.

BACKGROUND: Whether and how psychotherapies change brain structure and function is unknown. Its study is of great importance for contemporary psychotherapy, as it may lead to discovery of neurobiological mechanisms that predict and mediate lasting changes in psychotherapy, particularly in severely mentally ill patients, such as those with chronic depression. Previous studies have shown that psychoanalytic psychotherapies produce robust and enduring improvements in not only symptom severity but also personality organization in patients who have chronic depression and early life trauma, especially if therapy is delivered at a high weekly frequency. METHODS/DESIGN: Patients with chronic major depression and a history of early life trauma will be recruited, assessed, and treated across 3 international sites: Germany, Switzerland, and the United States. They will be randomized to one of two treatment arms: either (1) once weekly psychoanalytic psychotherapies, or (2) 3-4 times weekly psychoanalytic psychotherapies. They will have full clinical characterization as well as undergo MRI scanning at study baseline prior to randomization and again one year later. A group of matched healthy controls will undergo similar assessments and MRI scanning at the same time points to help discern whether study treatments induce brain changes toward or away from normal values. Primary study outcomes will include anatomical MRI, functional MRI, and Diffusion Tensor Imaging measures. Study hypotheses will be tested using the treatment-by-time interaction assessed in multiple general linear models with repeated measures analyses in an intent-to-treat analysis. DISCUSSION: MODE may allow the identification of brain-based biomarkers that may be more sensitive than traditional behavioral and clinical measures in discriminating, predicting, and mediating treatment response. These findings could help to personalize care for patients who have chronic depression patients and early life trauma, and they will provide new therapeutic targets for both psychological and biological treatments for major depressive illness.

[Innovative Integrative Approach in the Trauma Treatment in the First Years of Life: Integrative Attachment-Based TraumaTherapy for Infants and Toddlers]. / Innovativer integrativer Ansatz in der Trauma-Behandlung in den ersten Lebensjahren: Integrative Bindungsorientierte Traumatherapie bei Säuglingen und Kleinkindern.

Untreated trauma in the first years of life has profound consequences for the further psychological, neurobiological and physical development of those affected.The earlier psychotherapeutic treatment takes place, the sooner the consequences can bemitigated or even prevented. Integrative Attachment-Based TraumaTherapy for Infants and Toddlers (I.B.T.®) describes an innovative approach that incorporates treatment aspects of proven trauma integrativemethods such as EMDR and trauma narrative, as well as elements of systemic, attachment-oriented and stressorbased psychotherapy. Treatment includes work with attachment figures, improving the quality of attachment between caregivers and child, as well as direct trauma integrative work on the infant and toddler themselves. Experience to date shows a rapid, complete remission of symptoms, as well as an improvement in the quality of attachment between caregivers and child.

Need for intensive care admission based on point-of-care measurement of serum lactate levels in early trauma care.

Trauma is the leading cause of preventable death in the world. The time delay in presentation and the lack of knowledge about the availability of early markers of severity assessment decrease the success of survivability. The serum lactate analyses help the intensivist in effective triaging and thereby sorting out the indeed need of trauma victims for early intensive care management. Moreover, it guides orthopaedic surgeons, on when they should impart definitive surgery on polytrauma patients. Serum lactate analysis is an excellent 'resuscitation predictor' and its value have well utilized for framing a resuscitation protocol in advanced trauma care. The objective of this review is to enlighten the usage of serum lactate analysis at the point of early trauma care. Nevertheless, it describes the application of a continuous lactate monitoring system using sensor-based technologies in sports as well as trauma medicine.

Methylome-wide Association Study of Patients with Recent-onset Psychosis.

Objective: Dysregulation of gene expression through epigenetic mechanisms may have a vital role in the pathogenesis of schizophrenia (SZ). In this study, we investigated the association of altered methylation patterns with SZ symptoms and early trauma in patients and healthy controls. Methods: The present study was conducted to identify methylation changes in CpG sites in peripheral blood associated with recent-onset (RO) psychosis using methylome-wide analysis. Lifestyle factors, such as smoking, alcohol, exercise, and diet, were controlled. Results: We identified 2,912 differentially methylated CpG sites in patients with RO psychosis compared to controls. Most of the genes associated with the top 20 differentially methylated sites had not been reported in previous methylation studies and were involved in apoptosis, autophagy, axonal growth, neuroinflammation, protein folding, etc. The top 15 significantly enriched Kyoto Encyclopedia of Genes and Genomes pathways included the oxytocin signaling pathway, long-term depression pathway, axon guidance, endometrial cancer, long-term potentiation, mitogen-activated protein kinase signaling pathway, and glutamatergic pathway, among others. In the patient group, significant associations of novel methylated genes with early trauma and psychopathology were observed. Conclusion: Our results suggest an association of differential DNA methylation with the pathophysiology of psychosis and early trauma. Blood DNA methylation signatures show promise as biomarkers of future psychosis.

Contribution of brain network connectivity in predicting effects of polygenic risk and childhood trauma on state-trait anxiety.

BACKGROUND: Anxiety is usually attributed to adverse environmental factors, but it is known as a polygenic inheritance disease. Gene-environment interactions on the occurrence and severity of anxiety are still unclear. The role of brain network connectivity in the gene-environment effects on anxiety has not been explored and may be key to understanding neuropathogenesis and guiding treatment. METHODS: This study recruited 177 young adults from the community that completed functional magnetic resonance imaging, Childhood Trauma Questionnaire (CTQ), state-trait anxiety scores, and whole exome sequencing. We calculated polygenic risk score (PRS) for anxiety and the sum score of CTQ, which are genetic and environmental factors that may affect anxiety, respectively. Abnormal brain network connectivity determined by the gene-environment effects and its associations with anxiety scores were then explored. RESULTS: Except for the main effect of PRS or CTQ on intra-network connectivity, significant interactions were found in intra-network connectivity of visual network, default mode network, self-reference network, and sensorimotor network. Moreover, altered network connectivity was related to anxious tendency. In particular, the effect of CTQ on trait anxiety was mediated by the disrupted sensorimotor network, accompanied by a significant direct effect. However, the PRS influence on anxiety was mainly mediated through sensorimotor network paths, which exceeded the direct influence and was moderated by childhood trauma levels. CONCLUSIONS: These network-specific functional changes related to individual gene-environment risks advance our understanding of psychiatric pathogenesis of anxiety and provide new insights for clinical intervention.

Low initial in-hospital end-tidal carbon dioxide predicts poor patient outcomes and is a useful trauma bay adjunct.

INTRODUCTION: Appropriate triage of the trauma patient is critical. Low end-tidal carbon dioxide (ETCO2) is associated with mortality and hemorrhagic shock in trauma, but the relationship between low ETCO2 and important clinical variables is not known. This study investigates the association of initial in-hospital ETCO2 and patient outcomes, as well as the utility of ETCO2 as a predictive aid for blood transfusion. METHODS: Adult patients who presented to a Level One trauma center from 2019 to 2020 were eligible. Trauma bay ETCO2 measured by side-stream capnography was prospectively obtained for all trauma activations at time of initial evaluation. Using the Liu method of cut point estimation, patients were stratified as having low (≤29.5 mmHg) or normal ETCO2 (>29.5 mmHg). Multivariable regression was used to estimate the association of low ETCO2 with patient outcomes. RESULTS: A total of 955 patients underwent initial in-hospital ETCO2 measurement. Median time from arrival to ETCO2 measurement was 4 min. Among admitted patients (N = 493), 48.9% had low ETCO2. Compared to patients with normal ETCO2, those with low ETCO2 were older (median age 53 vs 46, p = 0.01) and more likely to have the highest trauma activation (27.4% vs 19.8%, p = 0.048). There was no difference in head injury. After adjustment, patients with low ETCO2 had greater odds of blood transfusion (OR 4.65, 95%CI 2.0-10.7), mortality (OR 5.10, 95%CI 1.1-24.9), inferior disposition (OR 1.64, 95%CI 1.1-2.6), and complications (OR 3.35, 95%CI 1.5-7.4). ETCO2 was more predictive of early blood transfusion than Shock Index (area under ROC = 67.6% vs 58.2%). CONCLUSIONS: Low trauma bay ETCO2 remains significantly associated with inferior clinical outcomes after adjustment. In comparison to other triage tools, low ETCO2 values may be more predictive of the need for blood transfusion. Further studies are needed to evaluate the role of ETCO2 as a decision making tool for early trauma management.

At the train station: the self, suspended in collective trauma. Symbolic analysis with victims of childhood trauma caused by state terrorism.

This paper explores the consequences of a collective trauma on the individual psyche. The author aims to show the difficulties emerging in the process of working through an early trauma when the personal wound is merged with a family and cultural trauma. Referencing clinical dream material, the author also highlights the importance of including the objective and the subjective levels of analysis, because if the clinical work is solely focused upon the intrapsychic subjective dimension, this may tend to perpetuate the traumatic cycle based on the original denial. This process requires from the analyst sensitivity and receptivity to accept the reality of the collective trauma with all its overwhelming affects, without losing the capacity for imagination; thus, the horror of the non-representable may gradually find - within the analytic dyad - a symbolic way to be retrieved, metabolized, and elaborated.

Cet article explore les conséquences d'un traumatisme collectif sur la psyché individuelle. L'auteur vise à exposer les difficultés qui émergent dans le processus de perlaboration d'un traumatisme précoce quand la blessure personnelle est fusionnée avec le traumatisme familial et culturel. Faisant référence à du matériel clinique d'analyse de rêves, l'auteur souligne aussi l'importance d'inclure les niveaux d'analyse objectif et subjectif. Car si le travail clinique se concentre uniquement sur la dimension intrapsychique subjective, ceci peut avoir tendance à perpétuer le cycle traumatisant fondé sur le déni originel. Ce processus requiert de l'analyste de la sensibilité et de la réceptivité pour accepter la réalité du traumatisme collectif avec tous ses affects accablants, sans pour autant perdre la capacité d'imagination: ainsi l'horreur du non-représentable peut trouver peu à peu - dans la dyade analytique - une manière symbolique d'être récupérée, métabolisée, et élaborée.

El presente trabajo explora las consecuencias de un trauma colectivo en la psique individual. La autora busca mostrar las dificultades que emergen en el trabajo clínico con trauma temprano cuando la herida personal se encuentra fusionada a un trauma familiar y cultural. A partir de material clínico de sueños, se destaca la importancia de incluir el nivel objetico y subjetivo del análisis, debido a que, si el trabajo clínico se focaliza solamente en la dimensión subjetiva intrapsíquica, esto podría perpetuar el ciclo traumático basado en la negación original. Este proceso requiere por parte de la analista sensibilidad y receptividad para aceptar la realidad del trauma colectivo con todas sus emociones devastadoras, sin perder la capacidad para imaginar. De este modo, el horror de lo sin representación puede gradualmente encontrar - al interior de la díada analítica - una vía simbólica para ser recuperado, metabolizado y elaborado.

Este artigo explora as consequências de um trauma coletivo na psique individual. O autor tem como objetivo mostrar as dificuldades emergentes no processo de trabalho através de um trauma precoce quando a ferida pessoal é fundida com um trauma familiar e cultural. Referenciando material de sonho clínico, o autor também destaca a importância de incluir os níveis objetivos e subjetivos da análise, porque se o trabalho clínico está focado apenas na dimensão subjetiva intrapsíquica, isso pode tender a perpetuar o ciclo traumático com base na negação original. Esse processo requer sensibilidade e receptividade do analista para aceitar a realidade do trauma coletivo com todos os seus efeitos esmagadores, sem perder a capacidade de imaginação; assim, o horror do não representável pode gradualmente encontrar - dentro da díade analítica - uma maneira simbólica de ser recuperado, metabolizado e elaborado.

Early trauma and schizophrenia onset: preliminary results of an outpatient cohort in Brazil.

OBJECTIVES: To assess the prevalence of early trauma in individuals with onset of schizophrenia (SZ) at early (≤ 18 years) and adult (> 18 years) ages (EOP and AOP, respectively) and explore relationships between the onset of disease and clinical variables including traumatic events and psychotic and mood symptoms. METHODS: Subjects with SZ (n = 71) and EOP and AOP were compared for history of psychological trauma, sexual abuse, and physical punishment using the Early Trauma Inventory Self Report - Short Form (ETISR-SF). They were also compared for history of comorbidities and affective disorders using the Diagnostic Interview for Psychosis and Affective Disorders, the Positive and Negative Syndrome Scale, the Liebowitz Social Anxiety Scale, and the Calgary Depression Scale for Schizophrenia. Coefficients were calculated for correlations between scale results and disease duration. RESULTS: Early trauma was significantly associated with an early onset psychotic episode (r = -0.315, p < 0.01). General trauma and depressive symptoms in adulthood were also associated (r = 0.442, p < 0.01), as were social anxiety symptoms and early trauma (r = 0.319, p < 0.01). Total ETISR-SF scores and the physical abuse item were significantly higher in EOP than in AOP. In the hierarchical regression, PANSS scores were best predicted by a model including the duration of disease and age of first psychotic episode (R = 0.303). CONCLUSIONS: Our results support the hypothesis that early trauma, including physical abuse, may play a relevant role in schizophrenia symptoms, such as an earlier psychotic occurrence, as well as features of other psychiatric disorders, such as greater severity of social anxiety and depression.

Early trauma and schizophrenia onset: preliminary results of an outpatient cohort in Brazil

Abstract Objectives To assess the prevalence of early trauma in individuals with onset of schizophrenia (SZ) at early (≤ 18 years) and adult (> 18 years) ages (EOP and AOP, respectively) and explore relationships between the onset of disease and clinical variables including traumatic events and psychotic and mood symptoms. Methods Subjects with SZ (n = 71) and EOP and AOP were compared for history of psychological trauma, sexual abuse, and physical punishment using the Early Trauma Inventory Self Report - Short Form (ETISR-SF). They were also compared for history of comorbidities and affective disorders using the Diagnostic Interview for Psychosis and Affective Disorders, the Positive and Negative Syndrome Scale, the Liebowitz Social Anxiety Scale, and the Calgary Depression Scale for Schizophrenia. Coefficients were calculated for correlations between scale results and disease duration. Results Early trauma was significantly associated with an early onset psychotic episode (r = -0.315, p < 0.01). General trauma and depressive symptoms in adulthood were also associated (r = 0.442, p < 0.01), as were social anxiety symptoms and early trauma (r = 0.319, p < 0.01). Total ETISR-SF scores and the physical abuse item were significantly higher in EOP than in AOP. In the hierarchical regression, PANSS scores were best predicted by a model including the duration of disease and age of first psychotic episode (R = 0.303). Conclusions Our results support the hypothesis that early trauma, including physical abuse, may play a relevant role in schizophrenia symptoms, such as an earlier psychotic occurrence, as well as features of other psychiatric disorders, such as greater severity of social anxiety and depression.

Psychopathology and Dissociation among Boarding School Students in Eastern Turkey.

A subset of boarding schools for adolescents was established in 1993 in the rural sections of Eastern Turkey to provide equity in terms of availability of education. Even though these schools were beneficial in many respects, implementation of this institutional model gave rise to many challenges such as weaker relationships with parents and defiance of authority figures. Failure to develop a mature response to these challenges could lead to the development of psychopathologies such as depression, psychosis, and dissociation. The main objective of this study is to assess the incidence of psychopathology and dissociative experiences of the residential female students in the regional boarding schools compared to a control group. 187 female participants, 128 attending boarding school, and 59 attending day school, as the control group, were included in the study. Brief Symptom Inventory (BSI) and Adolescent Dissociative Experiences Scale (ADES) were used as measurement scales. T-test, Mann Whitney-U, Spearman correlation chi-square tests were used to evaluate the association between the variables. There was a significant difference in Interpersonal sensitivity and Psychoticism subscales of BSI. ADES score was found to be significantly higher in the Boarding school group. Boarding school students are at a higher risk of developing psychopathology as a common trauma on a group of people can result in shared dissociation, a collective defense mechanism to cope with the injury, which resembles shared delusional disorder within DSM-V (The Diagnostic and Statistical Manual of Mental Disorders). Screening measures should be implemented in boarding schools to evaluate adolescents for psychopathology and preventive measures should be taken to intervene in the early stages.

Functional Impairment in Patients with Panic Disorder.

OBJECTIVE: Anxiety and depression and sociodemographic factors such as age, gender, education level, income, and marital status among people with panic disorder (PD) are associated with functional impairment in the areas of work, social, and family. Although both PD-specific scales such as the Panic Disorder Severity Scale (PDSS) and Anxiety Sensitivity Inventory-Revised (ASI-R) and early trauma have been investigated, their relationship with functional impairment in PD patients has not been clarified. METHODS: This study included 267 PD patients. The PDSS, Beck Depression Inventory (BDI), ASI-R, and Early Trauma Inventory were used. Pearson's correlation and multiple linear regression analyses were performed. The Sheehan Disability Scale (SDS) was administered to assess the functional impairment level in PD patients. RESULTS: Our findings showed that high levels of PDSS, BDI, and ASI-R were significantly correlated with the functional impairment among PD patients. Multiple regression analyses showed that PDSS, BDI, and ASI-R can predict the functional impairment levels, and PDSS and ASI-R were significantly associated with lost and underproductive days in PD patients. CONCLUSION: Panic-specific symptoms, depression, and AS are associated with functional impairment level in PD patients. Elevated symptom severity can play a role by affecting productivity and daily responsibilities in PD patients.

Toward a Complex Network of Risks for Psychosis: Combining Trauma, Cognitive Biases, Depression, and Psychotic-like Experiences on a Large Sample of Young Adults.

Although the linkage between traumatic life events and psychotic-like experiences (PLEs) is well established, the knowledge of potential mechanisms of this relationship is scarce. The aim of the present study was to better understand the structure of connections between traumatic life events and PLEs by considering at the same time the role of cognitive biases and depressive symptoms in the population of young adults (18-35 years of age, M = 26.52, SD = 4.74, n = 6772). Our study was conducted within a framework of network analysis. PLEs were measured with the Prodromal Questionnaire (PQ-16), cognitive biases were measured with nine items from the Davos Assessment of Cognitive Biases Scale-18 (DACOBS-18), depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression Scale (CESD-R) and exposure to traumatic life events was measured with a combination of Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and Traumatic Experience Checklist (TEC). The results present a network of all nodes being interconnected within and between domains, with no isolated factors. Exposures to sexual trauma were the most central node in the network. Pathways were identified from trauma to PLEs via cognitive biases and depressive symptoms. However, the shortest pathway between the most central traumatic life event and PLEs was through other traumatic life events, without cognitive biases or depressive symptoms along the way. Our findings suggest the importance of environmental adversities as well as dysfunctional information processing and depression in the network of psychosis risks.

The interaction effect of early trauma exposure and a diagnosis of panic disorder on cortical thickness.

BACKGROUND: Early trauma (ET) is a risk factor for adult psychiatric disorders. ET exposure is known to cause structural brain alterations, particularly in the fronto-temporo-limbic circuitry. ET-related effects on brain development may differ based on individual characteristics and cause different psychiatric outcomes. We investigated the interaction effect of ET exposure and panic disorder (PD) on cortical thickness. METHODS: Sixty-six participants with PD and 66 healthy controls were enrolled. High-resolution T1-weighted images were acquired, and a whole-brain vertex-based analysis was performed to estimate cortical thickness. The Early Trauma Inventory Self Report-Short Form, Anxiety Sensitivity Inventory-Revised, Panic Disorder Severity Scale, Beck Depression Inventory-II, and Beck Anxiety Inventory were administered. RESULTS: There was a significant interaction between ET exposure and PD on the mean cortical thickness in the bilateral insula and right pars triangularis. An exploratory correlational analysis revealed a positive correlation between the mean cortical thickness in the left insula and severity of anxiety sensitivity to cardiovascular symptoms in participants with PD. LIMITATIONS: Our findings may be affected by recall bias because this study is limited by its retrospective cross-sectional design. CONCLUSIONS: Our findings suggest that ET exposure may affect brain structures differently based on a diagnosis of PD. Furthermore, individual variations in brain alterations after ET may confer trait vulnerability that triggers the development of PD. Future longitudinal studies are warranted to elucidate the neurobiological mechanisms underlying ET and psychiatric outcomes.

Associations of longitudinal D-Dimer and Factor II on early trauma survival risk.

BACKGROUND: Trauma-induced coagulopathy (TIC) is a disorder that occurs in one-third of severely injured trauma patients, manifesting as increased bleeding and a 4X risk of mortality. Understanding the mechanisms driving TIC, clinical risk factors are essential to mitigating this coagulopathic bleeding and is therefore essential for saving lives. In this retrospective, single hospital study of 891 trauma patients, we investigate and quantify how two prominently described phenotypes of TIC, consumptive coagulopathy and hyperfibrinolysis, affect survival odds in the first 25 h, when deaths from TIC are most prevalent. METHODS: We employ a joint survival model to estimate the longitudinal trajectories of the protein Factor II (% activity) and the log of the protein fragment D-Dimer ([Formula: see text]g/ml), representative biomarkers of consumptive coagulopathy and hyperfibrinolysis respectively, and tie them together with patient outcomes. Joint models have recently gained popularity in medical studies due to the necessity to simultaneously track continuously measured biomarkers as a disease evolves, as well as to associate them with patient outcomes. In this work, we estimate and analyze our joint model using Bayesian methods to obtain uncertainties and distributions over associations and trajectories. RESULTS: We find that a unit increase in log D-Dimer increases the risk of mortality by 2.22 [1.57, 3.28] fold while a unit increase in Factor II only marginally decreases the risk of mortality by 0.94 [0.91,0.96] fold. This suggests that, while managing consumptive coagulopathy and hyperfibrinolysis both seem to affect survival odds, the effect of hyperfibrinolysis is much greater and more sensitive. Furthermore, we find that the longitudinal trajectories, controlling for many fixed covariates, trend differently for different patients. Thus, a more personalized approach is necessary when considering treatment and risk prediction under these phenotypes. CONCLUSION: This study reinforces the finding that hyperfibrinolysis is linked with poor patient outcomes regardless of factor consumption levels. Furthermore, it quantifies the degree to which measured D-Dimer levels correlate with increased risk. The single hospital, retrospective nature can be understood to specify the results to this particular hospital's patients and protocol in treating trauma patients. Expanding to a multi-hospital setting would result in better estimates about the underlying nature of consumptive coagulopathy and hyperfibrinolysis with survival, regardless of protocol. Individual trajectories obtained with these estimates can be used to provide personalized dynamic risk prediction when making decisions regarding management of blood factors.

What Language Are We Speaking? Bion and Early Emotional Life.

Bion (1970) saw his concept of 'O' as the central psychoanalytic perspective. It is a waking dream state, seen also as an essentially "religious" or spiritual perspective. While religious ideas may seem far afield in a discussion of fundamental elements of psychoanalysis, the word "spiritual" here refers simply to metaphysical matters of the spirit, mind, or personality, three terms used interchangeably by Bion. This essential experience of 'O' is seen as a selfless state, which the author clearly distinguishes from pathological states of selflessness, mindlessness, or nothingness often seen in patients who suffered early emotional trauma. Philosophical ideas about being and non-being help to clarify the difference. The challenges in finding an effective language to communicate verbally with pre-verbal states are explored through detailed clinical examples of working with often intractable states of resistance to being.