Moral reasoning in women with posttraumatic stress disorder related to childhood abuse.

BACKGROUND: Preliminary evidence suggests that relative to healthy controls, patients with posttraumatic stress disorder (PTSD) show deficits on several inter-related social cognitive tasks, including theory of mind, and emotion comprehension. Systematic investigations examining other aspects of social cognition, including moral reasoning, have not been conducted in PTSD stemming from childhood trauma. OBJECTIVE: To conduct a comprehensive assessment of moral reasoning performance in individuals with PTSD stemming from childhood abuse. METHOD: Moral reasoning performance was assessed in 28 women with PTSD related to prolonged childhood trauma and 19 matched healthy controls. Performance was assessed using 12 modified moral dilemmas and was queried in three domains: utilitarian/deontological sacrificial dilemmas (personal and impersonal), social order vs. compassion, and altruism vs. self-interest. Participants were asked whether a proposed action was morally acceptable or unacceptable and whether or not they would perform this action under the circumstances described. RESULTS: Women with PTSD were less likely to carry out utilitarian actions in personal, sacrificial moral dilemmas, a choice driven primarily by consequential intrapersonal disapproval. Increased concern regarding intrapersonal disapproval was related to higher symptoms of guilt in the PTSD group. Patients with PTSD demonstrated less altruistic moral reasoning, primarily associated with decreased empathic role-taking for beneficiaries. CONCLUSIONS: Women with PTSD due to childhood trauma show alterations in moral reasoning marked by decreased utilitarian judgment and decreased altruism. Childhood trauma may continue to impact moral choices made into adulthood.

Dissociative symptoms are associated with reduced neuropsychological performance in patients with recurrent depression and a history of trauma exposure.

BACKGROUND: Although preliminary work suggests that dissociative symptoms may impact neuropsychological performance in trauma-exposed populations, the relation between dissociation and cognitive performance has not been explored in patients with depression. OBJECTIVE: The present study examined dissociative symptoms in relation to neuropsychological performance in participants with a primary diagnosis of recurrent major depressive disorder (MDD) and a history of trauma exposure. METHOD: Twenty-three participants with MDD and 20 healthy controls who did not differ in age, sex, education, or IQ were assessed. In addition to a standardized neuropsychological battery assessing frontotemporally mediated cognitive processes, participants completed clinical measures assessing dissociative symptoms, illness severity, and past history of trauma exposure. RESULTS: Among participants with MDD, greater severity of derealization was associated with reduced performance on measures of delayed visuospatial recall and recognition on a task of verbal memory recognition. In addition, more severe depersonalization was associated with slower processing speed and a response style lending itself toward better performance in a less active environment. CONCLUSIONS: These findings point toward dissociative symptoms as a transdiagnostic factor associated with neuropsychological dysfunction in patients with depression and a history of trauma. Limitations and recommendations for future research are discussed.

Effects of electroconvulsive therapy on cognitive functioning in patients with depression: protocol for a systematic review and meta-analysis.

INTRODUCTION: Depression is the leading cause of disability worldwide, affecting approximately 350 million people. Evidence indicates that only 60-70% of persons with major depressive disorder who tolerate antidepressants respond to first-line drug treatment; the remainder become treatment resistant. Electroconvulsive therapy (ECT) is considered an effective therapy in persons with treatment-resistant depression. The use of ECT is controversial due to concerns about temporary cognitive impairment in the acute post-treatment period. We will conduct a meta-analysis to examine the effects of ECT on cognition in persons with depression. METHODS: This systematic review and meta-analysis has been registered with PROSPERO (registration number: CRD42014009100). We developed our methods following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. We are searching MEDLINE, PsychINFO, EMBASE, CINAHL and Cochrane from the date of database inception to the end of October 2014. We are also searching the reference lists of published reviews and evidence reports for additional citations. Comparative studies (randomised controlled trials, cohort and case-control) published in English will be included in the meta-analysis. Three clinical neuropsychologists will group the cognitive tests in each included article into a set of mutually exclusive cognitive subdomains. The risk of bias of randomised controlled trials will be assessed using the Jadad scale. We will supplement the Jadad scale with additional questions based on the Cochrane risk of bias tool. The risk of bias of cohort and case-control studies will be assessed using the Newcastle-Ottawa Scale. We will employ the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the strength of evidence. STATISTICAL ANALYSIS: Separate meta-analyses will be conducted for each ECT treatment modality and cognitive subdomain using Comprehensive Meta-Analysis V.2.0.

Alterations in empathic responding among women with posttraumatic stress disorder associated with childhood trauma.

OBJECTIVE: Although studies increasingly point toward problems with social cognition among individuals with posttraumatic stress disorder (PTSD), few studies have assessed empathic responding. The aim of the current study was to investigate empathic responding in women with PTSD related to childhood trauma, and the contribution of parental bonding to empathic abilities in this sample. METHODS: Participants with PTSD (n = 29) and sex- and age-matched healthy controls (n = 20) completed two self-report empathy measures, the Interpersonal Reactivity Index (IRI) and the Toronto Empathy Questionnaire (TEQ), and a self-report measure of attachment, the Parental Bonding Instrument (PBI). RESULTS: Women with PTSD, relative to controls, reported significantly lower levels of empathic concern (r = 0.29) and perspective taking (r = 0.30), yet significantly higher levels of personal distress (r = 0.45) on the IRI. Women with PTSD also reported elevated scores on the TEQ (η (2) = 0.13). Levels of paternal care on the PBI, rather than childhood trauma severity or PTSD symptom severity best predicted perspective taking scores on the IRI in the PTSD sample (R (2) = 0.20). CONCLUSION: Women with PTSD associated with childhood trauma reported alterations among different domains of empathic functioning that may be related to low levels of paternal care.

Inter-rater and test-retest reliability of quality assessments by novice student raters using the Jadad and Newcastle-Ottawa Scales.

INTRODUCTION: Quality assessment of included studies is an important component of systematic reviews. OBJECTIVE: The authors investigated inter-rater and test-retest reliability for quality assessments conducted by inexperienced student raters. DESIGN: Student raters received a training session on quality assessment using the Jadad Scale for randomised controlled trials and the Newcastle-Ottawa Scale (NOS) for observational studies. Raters were randomly assigned into five pairs and they each independently rated the quality of 13-20 articles. These articles were drawn from a pool of 78 papers examining cognitive impairment following electroconvulsive therapy to treat major depressive disorder. The articles were randomly distributed to the raters. Two months later, each rater re-assessed the quality of half of their assigned articles. SETTING: McMaster Integrative Neuroscience Discovery and Study Program. PARTICIPANTS: 10 students taking McMaster Integrative Neuroscience Discovery and Study Program courses. MAIN OUTCOME MEASURES: The authors measured inter-rater reliability using κ and the intraclass correlation coefficient type 2,1 or ICC(2,1). The authors measured test-retest reliability using ICC(2,1). RESULTS: Inter-rater reliability varied by scale question. For the six-item Jadad Scale, question-specific κs ranged from 0.13 (95% CI -0.11 to 0.37) to 0.56 (95% CI 0.29 to 0.83). The ranges were -0.14 (95% CI -0.28 to 0.00) to 0.39 (95% CI -0.02 to 0.81) for the NOS cohort and -0.20 (95% CI -0.49 to 0.09) to 1.00 (95% CI 1.00 to 1.00) for the NOS case-control. For overall scores on the six-item Jadad Scale, ICC(2,1)s for inter-rater and test-retest reliability (accounting for systematic differences between raters) were 0.32 (95% CI 0.08 to 0.52) and 0.55 (95% CI 0.41 to 0.67), respectively. Corresponding ICC(2,1)s for the NOS cohort were -0.19 (95% CI -0.67 to 0.35) and 0.62 (95% CI 0.25 to 0.83), and for the NOS case-control, the ICC(2,1)s were 0.46 (95% CI -0.13 to 0.92) and 0.83 (95% CI 0.48 to 0.95). CONCLUSIONS: Inter-rater reliability was generally poor to fair and test-retest reliability was fair to excellent. A pilot rating phase following rater training may be one way to improve agreement.

Disaster-related prenatal maternal stress influences birth outcomes: project Ice Storm.

BACKGROUND: Previous research suggests that prenatal maternal stress (PNMS) impacts birth outcomes, but many human studies cannot distinguish between the effects of different types of stressors or examine effects of exposure timing on outcomes. OBJECTIVES: Our goal was to determine how timing and severity of exposure during pregnancy to objective and subjective stress due to a natural disaster influenced gestation length and fetal growth patterns. METHODS: We assessed objective and subjective PNMS levels among 172 women exposed to an ice storm during or shortly before pregnancy. We analyzed associations between PNMS levels and outcomes (gestation length, birth weight, birth length, head circumference, and growth ratios), controlling for other variables such as age, obstetric complications, socioeconomic status, and trait anxiety. RESULTS: Gestation lengths and predicted birth weights were shorter among participants exposed to the ice storm during early to mid pregnancy, compared to 3rd trimester and pre-pregnancy exposure. Birth lengths were shorter in the sample compared to population references, and predicted values were shorter among participants with a "discrepancy" between their objective and subjective PNMS levels. High objective PNMS levels predicted smaller head circumferences in early pregnancy, but we also observed patterns in predicted values of head circumference to birth length ratios suggesting the sparing of brain development relative to birth length among boys in early pregnancy. These sparing effects decreased in later pregnancy. CONCLUSIONS: Exposure to stressful events during pregnancy influences birth outcomes independently of other factors. Exposure timing, newborn sex, and the type of stressor influence the effects observed.