Caring for Traumatized Elders: Lessons Learned From Trauma-Informed Care.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Prim Care Companion CNS Disord 2024;26(2):23f03643. Author affiliations are listed at the end of this article.

Structural transphobia is associated with psychological distress and suicidality in a large national sample of transgender adults.

PURPOSE: Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults' psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity. METHODS: We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18-100) residing in 45 US states and the District of Columbia (DC). RESULTS: Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts. CONCLUSION: Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia's multifaceted nature and negative mental health consequences.

Sexual Violence-Related Stigma, Mental Health, and Treatment-Seeking: A Multimodal Assessment in a Population-Based Study of Young Adults.

Sexual violence (SV) is a stigmatized form of trauma, yet the stigma experiences of those reporting SV are often assumed rather than explicitly measured. We adapted a measure that quantified three key features of SV stigma across three levels: negative self-image (individual), disclosure concerns (interpersonal), and concerns about public attitudes (structural). We administered this measure to a population-based sample of Swedish young adults (N = 453) who reported a history of either sexual assault (SA) or intimate partner sexual violence (IPSV). Among both groups, 89% endorsed at least one item on the stigma scale. Experiences of SV-related stigma were associated with significantly higher symptoms of generalized anxiety, depression, and posttraumatic stress disorder, with greater perceived need for mental health treatment, and with more shame (measured implicitly via a reaction-time task). Experiences of stigma were negatively associated with symptoms of alcohol misuse. Results suggest that exposure to SV stigma may be a critical, but often overlooked, correlate of post-assault recovery.

Self-triggering: Does function determine pathogenesis?

OBJECTIVE: Research suggests six motives for exposing oneself to painful reminders of a trauma outside of a therapeutic context (self-triggering). These include provoking arousal, escaping emotional numbness, self-punishment, controlling symptoms of posttraumatic stress disorder (PTSD), making meaning of one's trauma, and generating an experience that matches one's emotions. The goal of the current study is to examine if these motives subserve broader functions of self-triggering behavior that differentially relate to PTSD symptoms. METHOD: We conducted an exploratory factor analysis on the self-reported reasons for self-triggering collected from 360 adults who endorsed lifetime self-triggering. We then theorized higher-order factors and tested both their fit to the data with a confirmatory factor analysis and whether they moderated the relationship between self-triggering and PTSD symptoms. RESULTS: We found that five factors best described the reasons for self-triggering. We theorized one higher-order factor (function) of "emotional modification" that encompasses sensation-seeking, antinumbing, self-punishment, and affect-matching. The "meaning-making" function consists of efforts to make meaning of one's trauma. This structure fit the data well in a confirmatory factor analysis. Self-triggering frequency no longer predicted symptom severity when meaning-making was highly endorsed as a function of self-triggering. Emotional modification did not affect this relationship. CONCLUSIONS: Generalizability may be limited by the sample's high symptom levels, limited demographic diversity, and high proportion of interpersonal trauma. These findings suggest that the degree to which individuals self-trigger to make meaning of trauma may affect how pathogenic the behavior is, underscoring the clinical importance of identifying the function of patients' self-triggering. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Translational studies of estradiol and progesterone in fear and PTSD.

Translational models of fear have greatly informed our understanding of PTSD and its underlying fear circuitry. One of the most replicated findings in the field is the two-fold higher PTSD incidence in females compared to males. While sociocultural factors play a role, the most robust biological influencers to date are gonadal hormones, such as estradiol and progesterone, which fluctuate across the menstrual cycle. Among studies that account for these hormones, most do so in isolation or collect both and only report one. Variation in study findings suggests that the ratio between these two hormones (the P/E ratio) may be an important and missing variable to further understand gonadal hormone influences on fear. Here we review cross-species examinations of fear and PTSD, within the contexts of estradiol and progesterone as well as P/E ratios that were calculated based on extant literature. We then provide recommendations for best practices in assay methods and reporting to improve research on the P/E ratio in fear and PTSD. Ultimately, greater understanding of this important variable will advance efforts to characterize gonadal hormone influences on fear learning processes in humans and animals.

Los modelos traslacionales del miedo han enriquecido nuestro conocimiento sobre el TEPT y el circuito del miedo subyacente. Uno de los hallazgos más replicados en el campo es la incidencia dos veces mayor de TEPT en mujeres en comparación a los hombres. Aunque los factores socioculturales juegan un rol, las influencias biológicas más robustas a la fecha son las hormonas gonadales, tales como el estradiol y la progesterona, que fluctúan durante el ciclo menstrual. Entre los estudios que dan cuenta de estas hormonas, la mayoría las estudian de forma aislada u obtienen ambas y solo reportan una. La variación en los hallazgos de los estudios sugiere que la razón entre estas dos hormonas (la razón P/E) puede ser una variable poco estudiada e importante para mejorar la comprensión de la influencia de las hormonas gonadales en el miedo. En este trabajo hacemos una revisión de hallazgos trans-especie sobre el miedo y el TEPT, dentro del contexto del estradiol y la progresterona así como de la razón P/E que fue calculada basándose en la literatura existente Posteriormente proveemos recomendaciones para mejorar las prácticas en los métodos de ensayo y reportes para mejorar la investigación sobre la razón P/E en miedo y TEPT. En última instancia, mayor comprensión de esta importante variable hará que progresen los esfuerzos para caracterizar la influencia de las hormonas gonadales en procesos de aprendizaje del miedo en humanos y animales.

Lamotrigine Therapy and Biomarkers of Cerebral Energy Metabolism in Older Age Bipolar Depression.

OBJECTIVE: This study compared brain energy metabolism, as measured by cerebral concentrations of glutamate (Glu), glutamine (Gln), and N-acetyl aspartate (NAA), in older age bipolar depression (OABD) to that of psychiatrically healthy comparison subjects using proton (1H) magnetic resonance spectroscopy imaging at 4-Tesla. Metabolite levels were assessed in OABD subjects before and after 8 weeks of lamotrigine therapy with the goal of determining relationships between cerebral energy metabolism, depression symptom severity, and changes in depression symptom response. METHODS: Individuals (n = 21, mean age: 62.0 ± 5.9 years) with bipolar disorder, current episode depressed, and a healthy comparison group (n = 14, mean age: 67.5 ± 8.8 years) were selected. Participants with bipolar disorder, current episode depressed, were treated in open label fashion with lamotrigine monotherapy for 8 weeks. All subjects were scanned with 1H magnetic resonance spectroscopy at 4T at baseline and again after 8 weeks to assess levels of cerebral metabolites in the anterior cingulate cortex and parieto-occipital cortex. Metabolite levels were examined as ratios relative to creatine (Cr). Response to 8 weeks of lamotrigine treatment in the bipolar disorder, current episode depressed group, was assessed as a continuous measure on the Montgomery-Asberg Depression Rating Scale. RESULTS: NAA/Cr ratio in OABD was significantly lower by 14% (95% confidence interval: [1%, 26%]) than in comparison subjects at baseline. However, there were no associations between NAA/Cr, Glu/Cr, or Gln/Cr and either depression severity or lamotrigine treatment. CONCLUSION: Group differences in NAA suggest evidence for a deficit in cerebral energy metabolism in OABD.