Post-traumatic stress disorder moderates the relationship between trauma exposure and chronic pain.

Background: Trauma exposure and post-traumatic stress disorder (PTSD) are risk factors for chronic pain. Objective: This study investigated how exposure to intentional and non-intentional traumatic events and PTSD are related to pain severity and outcome of treatment in chronic pain patients. Methods: We assessed exposure to potentially traumatizing events, psychiatric diagnosis with structured clinical interview, and pain severity in 63 patients at a secondary multidisciplinary pain clinic at the beginning of treatment, and assessed level of pain at follow up. Exposure to potentially traumatizing events and PTSD were regressed on pain severity at the initial session and at follow up in a set of multiple regression analysis. Results: The participants reported exposure to an average of four potentially traumatizing events, and 32% had PTSD. Exposure to intentional traumatic events and PTSD were significantly associated with more severe pain, and PTSD significantly moderated the relationship between trauma exposure and pain (all p < .05). The treatment programme reduced pain moderately, an effect that was unrelated to trauma exposure and PTSD. Conclusions: Trauma exposure is related to chronic pain in the same pattern as to mental disorders, with intentional trauma being most strongly related to pain severity. PTSD moderated the relationship between trauma exposure and pain. While pain patients with PTSD initially report more pain, they responded equally to specialist pain treatment as persons without PTSD.

Planteamiento: La exposición al trauma y el trastorno de estrés postraumático (TEPT) son factores de riesgo para el dolor crónico. Este estudio investigó cómo el TEPT y la exposición a acontecimientos traumáticos intencionales y no intencionales se relacionan con la gravedad del dolor y el resultado del tratamiento en pacientes con dolor crónico. Métodos: Al inicio del tratamiento, evaluamos la exposición a acontecimientos potencialmente traumatizantes, el diagnóstico psiquiátrico con la entrevista clínica estructurada y la gravedad del dolor en 63 pacientes de una clínica para el dolor multidisciplinaria secundaria. En el seguimiento, se evaluó el nivel de dolor. La exposición a acontecimientos potencialmente traumatizantes y al TEPT había retrocedido en cuanto a la gravedad del dolor en la sesión inicial y en el seguimiento en un conjunto de análisis de regresión múltiple. Resultados: Los participantes informaron de la exposición a un promedio de cuatro eventos potencialmente traumatizantes, y el 32% tenían TEPT. La exposición a eventos traumáticos intencionales y el TEPT se asociaron significativamente con dolor más intenso y el TEPT moderó significativamente la relación entre la exposición al trauma y el dolor (todos los valores p <0,05). El programa de tratamiento redujo el dolor moderadamente, efecto que no estaba relacionado con la exposición al trauma y el TEPT. Conclusiones: La exposición al trauma está relacionada con el dolor crónico de modo similar que con los trastornos mentales, siendo el trauma intencional el que está más intensamente relacionado con la gravedad del dolor. El TEPT moderó la relación entre la exposición al trauma y el dolor. Mientras que los pacientes con dolor y con TEPT inicialmente refirieron más dolor, respondieron del mismo modo al tratamiento especializado del dolor como las personas sin TEPT.

Post-traumatic stress among rescue workers after terror attacks in Norway.

BACKGROUND: On 22 July 2011, Norway was struck by two terror attacks. Seventy-seven people were killed, and many injured. Rescue workers from five occupational groups and unaffiliated volunteers faced death and despair to assist victims. AIMS: To investigate the level of, and associations between, demographic variables, exposure and work-related variables and post-traumatic stress symptoms (PTSS). METHODS: A cross-sectional study of general and psychosocial health care personnel, police officers, firefighters, affiliated and unaffiliated volunteers were conducted ~10 months after the terror attacks. The respondents answered a self-reported questionnaire. Post-traumatic stress disorder (PTSD) Checklist - specific (PCL-S) assessed PTSS. RESULTS: There were 1790 participants; response rate was 61%. About 70% of the professional rescue workers had previous work experience with similar tasks or had participated in training or disaster drills. They assessed the rescue work as a success. Firefighters and unaffiliated volunteers reported more perceived threat compared with the other groups. Among the professional personnel, the prevalence of sub-threshold PTSD (PCL 35-49) was 2% and possible PTSD (PCL ≥ 50) 0.3%. The corresponding figures among the unaffiliated volunteers were 24% and 15%, respectively. In the multivariate analysis, female gender (ß = 1.7), witnessing injured/dead (ß = 2.0), perceived threat (ß = 1.1), perceived obstruction in rescue work (ß = 1.6), lower degree of previous training (ß = -0. 9) and being unaffiliated volunteers (ß = 8.3) were significantly associated with PTSS. CONCLUSIONS: In the aftermath of a terror attack, professional rescue workers appear to be largely protected from post-traumatic stress reactions, while unaffiliated volunteers seem to be at higher risk.

Childhood trauma mediates the association between ethnic minority status and more severe hallucinations in psychotic disorder.

BACKGROUND: Ethnic minority status and childhood trauma are established risk factors for psychotic disorders. Both are found to be associated with increased level of positive symptoms, in particular auditory hallucinations. Our main aim was to investigate the experience and effect of childhood trauma in patients with psychosis from ethnic minorities, hypothesizing that they would report more childhood trauma than the majority and that this would be associated with more current and lifetime hallucinations. METHOD: In this cross-sectional study we included 454 patients with a SCID-I DSM-IV diagnosis of non-affective or affective psychotic disorder. Current hallucinations were measured with the Positive and Negative Syndrome Scale (P3; Hallucinatory Behaviour). Lifetime hallucinations were assessed with the SCID-I items: auditory hallucinations, voices commenting and two or more voices conversing. Childhood trauma was assessed with the Childhood Trauma Questionnaire, self-report version. RESULTS: Patients from ethnic minority groups (n = 69) reported significantly more childhood trauma, specifically physical abuse/neglect, and sexual abuse. They had significantly more current hallucinatory behaviour and lifetime symptoms of hearing two or more voices conversing. Regression analyses revealed that the presence of childhood trauma mediated the association between ethnic minorities and hallucinations. CONCLUSIONS: More childhood trauma in ethnic minorities with psychosis may partially explain findings of more positive symptoms, especially hallucinations, in this group. The association between childhood trauma and these first-rank symptoms may in part explain this group's higher risk of being diagnosed with a schizophrenia-spectrum diagnosis. The findings show the importance of childhood trauma in symptom development in psychosis.

Biocompatible molecularly imprinted polymers for the voltage regulated uptake and release of L-glutamate in neutral pH solutions.

A biocompatible device for the voltage dependent uptake and release of the neural transmitter L-glutamate in neutral pH solutions is demonstrated. The device consists of a gold electrode coated with molecularly imprinted, overoxidised polypyrrole (oPPy). It is shown here that oPPy can behave as an anion exchanger in neutral pH. The voltage dependent uptake and release of glutamate from the oPPy as well as the enantioselectivity of the polymer layer for L-glutamate over D-glutamate are investigated in neutral pH solutions using electrochemical quartz crystal microbalance techniques. The biocompatibility of the oPPy layer is demonstrated using retinae from young rats. The retinae were isolated and the dissociated cells were kept in culture for up to 1-week. The cells were exposed to the oPPy layers for 3 days, and there is no significant difference in the survival rate between the cells cultured on the oPPy layers and the control samples. Additionally the cell-polymer interface from cells grown directly on the oPPy layers is investigated using electron microscopy.

Impact of the incorporation of Au nanoparticles into polymer/fullerene solar cells.

The addition of small amounts of dodecylamine-capped Au nanoparticles into the active layer of organic bulk heterojunction solar cells consisting of poly(3-octylthiophene) (P3OT) and C(60) was recently suggested to have a positive impact on device performance due to improved electron transport. This issue was systematically further investigated in the present work. Different strategies to incorporate colloidally prepared Au nanoparticles with a narrow size distribution into organic solar cells with the more common donor/acceptor system consisting of poly(3-hexylthiophene) (P3HT) and [6,6]-phenyl C(61)-butyric acid methyl ester (PCBM) were pursued. Au nanoparticles were prepared with either P3HT or dodecylamine as ligands. Additionally, efforts were undertaken to incorporate nearly ligand-free Au nanoparticles into the system. Therefore, a procedure was successfully developed to remove the dodecylamine ligand shell by a postpreparative ligand exchange with pyridine, a much smaller molecule that can later partly be removed from solid films by annealing. However, for all types of nanoparticles studied here, the performance of the P3HT/PCBM solar cells was found to decrease with the Au particles as an additive to the active layer, meaning that adding Au nanoparticles is not a suitable strategy in the case of the P3HT/PCBM system. Possible reasons are discussed on the basis of detailed investigations of the structure, photophysics and charge transport in the system.

Association between patients' gender, age and immigrant background and use of restraint--a 2-year retrospective study at a department of emergency psychiatry.

The study aimed to determine rates and types of patient restraint, and their relationship to age, gender and immigrant background. The study retrospectively examined routinely collected data and data from restraint protocols in a department of acute psychiatry over a 2-year period. Each patient is only counted once in this period, controlling for readmission. Of 960 admitted patients, 14% were exposed to the use of restraints. The rate was significantly higher among patients with immigrant background, especially in the younger age groups. Most commonly used were mechanical restraint alone for native-born patients and a combination of mechanical and pharmacological restraints for patients with immigrant background. The use of restraints decreased when patients reached 60 years. Both patients' age and immigrant background seem to have an impact on the use of restraint.

Social functioning of patients with schizophrenia in high-income welfare societies.

OBJECTIVE: The study assessed the level of reintegration into the community of patients with schizophrenia in Oslo, Norway, a country with a well-developed social welfare system and low unemployment rates. METHODS: Eighty-one patients with a DSM-III-R diagnosis of schizophrenia treated in 1980 and in 1983 in a short-term ward of a psychiatric hospital were followed up after seven years. Seventy-four of 76 patients alive at follow-up agreed to participate. Social functioning was measured by the Strauss-Carpenter Level of Functioning Scale and the Social Adjustment Scale. RESULTS: At follow-up 78 percent of patients lived independently, 47 percent were socially isolated, and 94 percent were unemployed. Thirty-four percent had lost employment in the follow-up period. A poor outcome in terms of social functioning and community reintegration was associated with loss of employment. A good outcome was predicted by short periods of inpatient hospitalization, high levels of education, being married, male gender, and not having a late onset of psychosis. CONCLUSIONS: The level of homelessness among these patients with schizophrenia was encouragingly low, which may have been expected in a high-income welfare society. However, insufficient efforts were aimed at social and instrumental rehabilitation, and the level of unemployment was alarmingly high.

Establishing social contact in exile: a prospective community cohort study of Vietnamese refugees in Norway.

The social networks of Vietnamese refugees and predictors of their intra- and inter-ethnic social contact after 3 years in Norway were studied. An unselected community cohort of Vietnamese boat refugees was personally interviewed, first on arrival in Norway (n = 145) and again after 3 years (n = 130). By the time of the second interview, the refugees had to a large degree reconstructed social networks and 54% had good contact with other Vietnamese. Only 17% had equally good contact with Norwegians. Female gender, further education after resettlement and having a close confidant on arrival were related to good inter-ethnic social contact. The latter was the only predictor of good intra-ethnic social contact. Competency in the Norwegian language, surprisingly, did not predict good social contact with Norwegians. The refugees were largely successful in re-establishing a social platform in relation to their own ethnic group in their new environment. It was much more difficult to establish good social contact with Norwegians. Educational institutions appear to be important social arenas in this respect. The personal capacity for close attachments during a period of psychosocial transition is also important.

Mental disorder among refugees and the impact of persecution and exile: some findings from an out-patient population.

BACKGROUND: Refugees have long been considered at risk for mental disorder. We sought to characterise this risk in an out-patient refugee sample by analysing the relationship between psychiatric symptoms and dysfunction, and between symptoms and the socio-demographic background and stressors specific to this refugee sample. METHOD: A consecutive sample of 231 refugee patients referred to the psychiatric out-patient unit at the Psychosocial Centre for Refugees, University of Oslo, was examined with a semi-structured interview guide, Brief Psychiatric Rating Scale (BPRS), Hopkins Symptom Check-List (HSCL-25) and a check-list for post-traumatic symptoms (PTSS-10). Global Assessment of Function (GAF) scores were obtained; and the data were analysed using nine predictor variables. RESULTS: It was found that 46.6% of the patients had a post-traumatic stress disorder according to the criteria for DSM-III-R as the main diagnosis, while the mean GAF score for the patients was 57.3. Analysis of the GAF and BPRS data did not reveal any predictor of psychotic behaviour. However, torture emerged as an important predictor of emotional withdrawal/retardation. Also, age, gender and no employment or education predicted for anxiety/depression, while refugee status and no employment or school predicted for hostility/aggression. CONCLUSIONS: The results confirm earlier findings that refugees constitute a population at risk for mental disorder. Past traumatic stressors and current existence in exile constitute independent risk factors. However, stressors other than those discussed here appear to be important also, particularly with regard to psychotic symptoms.

The importance of ward atmosphere in inpatient treatment of schizophrenia on short-term units.

OBJECTIVE: The reorganization in 1981 of a general hospital psychiatric ward in Oslo, Norway, to achieve a more suitable treatment milieu for patients with schizophrenia resulted in a change in patients' perceptions of the ward atmosphere. Reduced group participation and increased individualized support from staff led patients to perceive of the ward as having a low level of anger and aggression and a high level of order and organization. This study examined whether the reorganization was associated with improved treatment outcome. METHODS: Psychiatrists retrospectively examined the charts of all patients with a DSM-III-R diagnosis of schizophrenia or schizophreniform disorder who were admitted to the ward the year before and the second year after the reorganization. Multiple regression analyses were used to examine treatment outcomes for both groups. Outcome was measured indirectly by length of stay, level of functioning at discharge, and whether the patient was rehospitalized during the following seven years. RESULTS: Patients treated after the reorganization had significantly shorter stays with no reductions in either level of functioning at discharge or length of community tenure after discharge. Differences in demographic characteristics, illness history, or psychopharmacological treatment could not account for differences in outcome. CONCLUSIONS: The results supported the hypothesis that the organization and milieu of brief-stay wards influence the short-term outcome of inpatient treatment of patients with schizophrenia.

Organised violence and the stress of exile. Predictors of mental health in a community cohort of Vietnamese refugees three years after resettlement.

BACKGROUND: The prevalence and course of mental disorders among Vietnamese refugees were studied, using a model including variables from different research traditions. METHOD: A consecutive community cohort of 145 Vietnamese boat refugees aged 15 and above were personally interviewed on their arrival in Norway and three years later. RESULTS: Three years later, there was, unexpectedly, no decline in self-rated psychological distress (SCL-90-R), almost one in four suffered from psychiatric disorder and the prevalence of depression was 17.7% (Present State Examination). Female gender, extreme traumatic stress in Vietnam, negative life events in Norway, lack of a close confidant and chronic family separation were identified as predictors of psychopathology. CONCLUSIONS: The effects of war and persecution were long-lasting, and compounded by adversity factors in exile. A uniform course of improvement in mental health after resettlement cannot be expected in all contexts. The affected refugees need systematic rehabilitation.

Chronic posttraumatic stress disorder in Vietnamese refugees. A prospective community study of prevalence, course, psychopathology, and stressors.

A community cohort of 145 Vietnamese boat refugees in Norway was prospectively studied for presence of chronic posttraumatic stress disorder (PTSD) after resettlement. Ten percent had PTSD on arrival and/or after 3 years. This group had been exposed to significantly more traumatic stress before their escape (e.g., reeducation camps, combat, and other war incidents) and had more psychopathology (SCL-90-R Global Assessment Scale) after resettlement. A logistic regression analysis indicated that different types of traumatic stress had an independent relationship with chronic PTSD. Nine SCL-90-R items discriminated between the PTSD group and the rest both on arrival and follow-up. These were not anxiety items, but related to interpersonal sensitivity, somatization, and aggression. The inclusion of additional diagnostic features in the criteria for chronic PTSD is indicated.

Vietnamese boat refugees: the influence of war and flight traumatization on mental health on arrival in the country of resettlement. A community cohort study of Vietnamese refugees in Norway.

A consecutive cohort of 145 adult Vietnamese refugees were personally interviewed and completed the Symptom Checklist 90 R self-rating scale on arrival in Norway. Sixty-two percent had witnessed bombing, fires and shooting, 48% had witnessed other people being wounded or killed and 36% had been involved in life-threatening situations or had been wounded in the war. Nearly all war trauma variables but none of the escape or refugee camp variables were significantly related to mental health 7 years after the end of the war. War trauma was significantly associated with mental health, also when age, gender and previous mental problems were controlled for. These results and our clinical experience indicate that clinicians treating refugees should address such traumatic experiences specifically.

The Ullevål acute ward follow-up study: a personal 7-year follow-up of patients with functional psychosis admitted to the acute ward of a catchment area.

Eighty-eight patients were admitted to the acute ward of a catchment area suffering from the following functional psychoses: schizophrenia (S; n = 41), affective disorder (AD; n = 22), other disorders (OD; n = 25). Follow-up data were obtained for 97%. Ten patients were dead at follow-up, 8 due to suicide. Sixty-five were personally interviewed. While nearly all the patients had only brief periods of rehospitalization, most had used neuroleptics during the follow-up period. Compared to other samples, functioning at follow-up was fairly good for the AD and OD patients, but rather poor for the S patients.

[Psychosocial problems among refugees in Norway]. / Psykososiale problemer blant flyktninger i Norge.

172 patients were examined and treated by the Psychosocial Team for Refugees in Norway from 1 January 1986 to 15 November 1988. The patients came from 21 countries, the majority from Iran, Chile and Vietnam. Various reactive conditions dominated the clinical picture, and 53 patients had posttraumatic stress disorder, which was the most frequently occurring single diagnosis. The patient group had been exposed to a number of overwhelming experiences and at least half had been tortured. The therapists identified separation and loss, traumatic experiences and social isolation in exile as the factors of greatest importance for the development of the patients' conditions. 46% of the patients were found to have improved at the end of the treatment.

[Clinical experiences with refugees in need of treatment. Reflections on psychosocial problems of people living in exile]. / Klinisk erfaring med behandlingstrengende flyktninger. Refleksjoner omkring psykososiale problemer hos mennesker som lever i eksil.

In the light of experiences from the Psychosocial Team for Refugees in Norway, the authors describe factors of importance for understanding the personal meaning of the exile. We point to the implication of different traumatic events associated with flight and exile, and to the psychosocial consequence of such traumatization. We consider this to be important basic knowledge for doctors and other health workers engaged in preventive and curative work with refugees.