Navegando por Palavras-chave "Post-traumatic stress disorder"
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- ItemSomente MetadadadosAttentional and executive functions are differentially affected by post-traumatic stress disorder and trauma(Elsevier B.V., 2014-01-01) Flaks, Mariana K. [UNIFESP]; Malta, Stella M. [UNIFESP]; Almeida, Priscila P. [UNIFESP]; Bueno, Orlando F. A. [UNIFESP]; Pupo, Mariana C. [UNIFESP]; Andreoli, Sergio B. [UNIFESP]; Mello, Marcelo F.; Lacerda, Acioly L. T. [UNIFESP]; Mari, Jair J. [UNIFESP]; Bressan, Rodrigo A. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Among the neurocognitive impairments observed in patients with Post-traumatic Stress Disorder (PTSD), attentional and executive dysfunctions appear to correlate with negative effects on education, work, daily life activities, and social relations, as well as the re-experiencing, avoidance, and hyperarousal symptoms of PTSD. However, there is no consensus regarding which aspects of attentional and executive functions are impaired in PTSD patients.Methods: Attentional and executive functions were assessed using the digit span (WAIS-III) and spatial span (WMS-III) tests under forward and backward recall conditions, the Stroop Test, and the Wisconsin Card Sorting Test (WCST). Our sample was composed of victims of urban violence who developed PTSD (PTSD+) (n = 81), victims of urban violence who did not develop PTSD (PTSD) (n = 70), and healthy controls not exposed to trauma (HC) (n = 50).Results: the PTSD+ group had poorer performance on the spatial span forward subtest (p = 0.023; eta(2) = 0.038) and poorer execution time (p = 0.023; eta(2) = 0.042) and accuracy (p = 0.019; eta(2) = 0.044) on the Stroop Test compared to HC.Conclusions: These data suggest that there are few differences between the PTSD+ and HC groups, which are restricted to less complex measures of attentional and executive functional processes (short term capacity, selective attention, processing speed, and inhibitory control) and are related to visual stimuli. Therefore, cognitive impairments directly correlated with the manifestation of PTSD. (C) 2013 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosCan childhood trauma predict response to topiramate in borderline personality disorder?(Blackwell Publishing, 2006-04-01) Prado-Lima, Pedro Antonio Schmidt do; Kristensen, Christian Haag; Bacaltchuk, Josué [UNIFESP]; Pontificia Univ Catolica Rio Grande Sul; Univ Vale Rio Sinos; Universidade Federal de São Paulo (UNIFESP); Janssen Cilag Farmaceut; Universidade Federal de São Paulo (UNIFESP)We report on a woman with borderline personality disorder and a history of childhood trauma that showed significant clinical response with low dosage of topiramate. We propose that topiramate changed some of the main features of this disorder, such as catastrophic reaction to real or imaginary abandonment or rejection, improving adaptive functioning. We hypothesize that topiramate might facilitate memory extinction, therefore decreasing emotional and behavioural reactivity.
- ItemSomente MetadadadosThe impact of trauma and post-traumatic stress disorder on the treatment response of patients with obsessive-compulsive disorder(Dr Dietrich Steinkopff Verlag, 2010-03-01) Shavitt, Roseli Gedanke; Valerio, Carolina; Fossaluza, Victor; Silva, Elizabeth Meyer da; Cordeiro, Quirino; Diniz, Juliana Belo; Belotto-Silva, Cristina; Cordioli, Aristides Volpato; Mari, Jair [UNIFESP]; Miguel, Euripedes Constantino; Universidade de São Paulo (USP); Univ Fed Rio Grande do Sul; Universidade Federal de São Paulo (UNIFESP)Few case series studies have addressed the issue of treatment response in patients with obsessive-compulsive disorder (OCD) and comorbid post-traumatic stress disorder (PTSD), and there are no prospective studies addressing response to conventional treatment in OCD patients with a history of trauma (HT). the present study aimed to investigate, prospectively, the impact of HT or PTSD on two systematic, first-line treatments for OCD. Two hundred and nineteen non-treatment-resistant OCD outpatients were treated with either group cognitive-behavioral therapy (GCBT n = 147) or monotherapy with a selective serotonin reuptake inhibitor (SSRI n = 72). Presence of HT and PTSD were assessed at intake, as part of a broader clinical and demographical baseline characterization of the sample. Severity and types of OCD symptoms were assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the Dimensional YBOCS (DYBOCS), respectively. Depression and anxiety symptoms were measured with the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Both treatments had 12-week duration. Treatment response was considered as a categorical [35% or greater reduction in baseline YBOCS scores plus a Clinical Global Impression-Improvement rating of better (2) or much better (1)] and continuous variable (absolute number reduction in baseline YBOCS scores). Treatment response was compared between the OCD + HT group versus the OCD without HT group and between the OCD + PTSD group versus the OCD without PTSD group. Parametric and non-parametric tests were used when indicated. Data on HT and PTSD were available for 215 subjects. Thirty-eight subjects (17.67% of the whole sample) had a positive HT (OCD + HT group) and 22 subjects (57.89% of the OCD + HT group and 10.23% of the whole sample) met full DSM-IV criteria for PTSD. the OCD + HT and OCD without HT groups presented similar response to GCBT (60% of responders in the first group and 63% of responders in the second group, p = 1.00). Regarding SSRI treatment, the difference between the response of the OCD + HT (47.4%) and OCD without HT (22.2%) groups was marginally significant (p = 0.07). in addition, the OCD + PTSD group presented a greater treatment response than the OCD without PTSD group when treatment response was considered as a continuous variable (p = 0.01). the age when the first trauma occurred had no impact on treatment response. in terms of specific OCD symptom dimensions, as measured by the DYBOCS, OCD treatment fostered greater reductions for the OCD + PTSD group than for the OCD without PTSD group in the scores of contamination obsessions and cleaning compulsions, collecting and hoarding and miscellaneous obsessions and related compulsions (including illness concerns and mental rituals, among others). the OCD + PTSD group also presented a greater reduction in anxiety scores than the OCD without PTSD group (p = 0.003). the presence of HT or PTSD was not related to a poorer treatment response in this sample of non-treatment-resistant OCD patients. Unexpectedly, OCD patients with PTSD presented a greater magnitude of response when compared with OCD without PTSD patients in specific OCD symptom dimensions. Future studies are needed to clarify if trauma and PTSD have a more significant impact on the onset and clinical expression of OCD than on the conventional treatment for this condition, and whether OCD stemming from trauma would constitute a subtype of OCD with a distinct response to conventional treatment.
- ItemAcesso aberto (Open Access)A influência do estilo de apego na clínica e no tratamento de mulheres com Transtorno de Estresse Pós Traumático após violência sexual(Universidade Federal de São Paulo, 2024-05-03) Maciel, Mariana Rangel [UNIFESP]; Mello, Andrea de Abreu Feijó de [UNIFESP]; http://lattes.cnpq.br/5024373026936383; http://lattes.cnpq.br/4304514986088514Introdução: Estilos inseguros de apego estão estabelecidos como fator de risco para desenvolvimento de Transtorno de Estresse Pós-Traumático (TEPT) e como preditores de evolução e resposta ao tratamento do quadro. Estilo de apego no adulto pode mudar a depender das experiências ao longo da vida e com o próprio tratamento. Objetivos: Procuramos investigar as dimensões de apego em mulheres adultas com TEPT após violência sexual, tratadas por 14 semanas com psicoterapia interpessoal ou medicação sertralina. Investigamos se houve mudança nas dimensões de ansiedade e evitação do apego ao longo do tempo; avaliamos se estas mudanças nas dimensões de apego foram mediadoras da resposta ao tratamento; e verificamos se a resposta ao tratamento esteve associada com as dimensões de ansiedade e evitação de apego. Métodos: Um grupo de 74 mulheres foi acompanhado por 14 semanas. Foram aplicadas a Escala de TEPT Administrada pelo Clínico-5 (CAPS-5) e a Escala Revisada de Apego no Adulto (RAAS) no início do estudo, na semana 8 e na semana 14 de tratamento. Realizamos um modelo paralelo de mediação para explorar se havia papel mediador de mudança no apego na redução dos sintomas do TEPT causada pelos dois tratamentos realizados, ou seja, efeito indireto via dimensões de evitação e ansiedade. Modelo linear múltiplo foi desenvolvido para explicar os valores das dimensões de apego no início do estudo. Dois modelos lineares mistos foram estruturados para verificar como cada uma das duas dimensões de apego variou ao longo do tempo de seguimento (desfecho RAAS), e como os sintomas de TEPT variaram ao longo das 14 semanas de acompanhamento em função das dimensões de apego e de outras variáveis relevantes (desfecho CAPS-5). Resultados: O modelo de mediação não evidenciou efeito indireto das intervenções nos sintomas de TEPT via dimensões de apego. Observamos no início do estudo relação de maior ansiedade do apego com experiências adversas na infância e adolescência; nenhuma variável relacionou-se com a dimensão evitação. A dimensão ansiedade do apego não mudou ao longo do tratamento. Já a dimensão evitação do apego apresentou aumento ao longo das 14 semanas, maior para as pacientes com mais sintomas de TEPT, de origem étnica não-branca (negras, pardas e asiática), e mais jovens. Analisando o desfecho dos sintomas de TEPT ao longo do tempo, observamos interação significativa e negativa com o tempo – redução dos sintomas de TEPT em relação ao início do estudo. A redução dos sintomas de TEPT foi quase 5 pontos maior nas mulheres negras, pardas ou asiáticas. Houve associação entre os sintomas de TEPT e apego; quanto maior o escore de ansiedade, maior o nível de sintomas de TEPT. Essa relação teve interação estatisticamente significante com tempo: valores maiores da CAPS são encontrados à medida que o escore de ansiedade do apego fica mais alto. Conclusão: As dimensões de apego apresentaram comportamento diferente do esperado, com aumento do nível de evitação ao longo do tratamento, apesar da redução dos sintomas de TEPT; este aumento foi maior nas mulheres que se mantiveram mais sintomáticas do TEPT. Maior ansiedade do apego esteve associada com pior resposta ao tratamento do TEPT.
- ItemSomente MetadadadosSexual trauma is more strongly associated with tonic immobility than other types of trauma - A population based study(Elsevier Science Bv, 2017) Kalaf, Juliana; Freire Coutinho, Evandro Silva; Pereira Vilete, Liliane Maria; Luz, Mariana Pires; Berger, William; Mendlowicz, Mauro; Volchan, Eliane; Andreoli, Sergio Baxter [UNIFESP]; Quintana, Maria Ines [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Figueira, IvanBackground: Tonic immobility is an involuntary motor and vocal inhibition reaction, considered the last-ditch response of the defensive cascade model. It is elicited in context of inescapable threat and perception of entrapment. Our aim was to investigate the association between different traumatic events and peritraumatic tonic immobility (PTI) in a representative sample of the general population. Methods: This is a cross-sectional study of general population from Rio de Janeiro and S (a) over tildeo Paulo with 3231 victims of traumatic events aged 15-75 years who completed the Tonic Immobility Scale (TIS). We calculated the frequency of the different traumatic events and estimated the mean scores with 95% confidence intervals for each traumatic event, controlling for the potential confounders using multiple linear regression models. Finally, we calculated the proportion of individual scoring zero in TIS for the 16 traumatic events. Results: PTI scores in child sexual abuse and adult sexual violence were almost twice as high as in other types of traumatic events, even when controlled for gender and educational level. Torture and war also showed high PTI scores, but these were based on very small number of cases and need to be interpreted with caution. Furthermore, victims of sexual trauma had the lowest proportion of individuals with total absence of PTI symptoms. Limitations: This is a cross-sectional study and causal inferences must be drawn with caution. Conclusions: Peritraumatic tonic immobility is more strongly associated with sexual trauma, particularly in childhood, than to other types of trauma in the general population.
- ItemSomente MetadadadosTowards a post-traumatic subtype of obsessive-compulsive disorder(Elsevier B.V., 2012-03-01) Fontenelle, Leonardo F.; Cocchi, Luca; Harrison, Ben J.; Shavitt, Roseli G.; Rosario, Maria Conceicao do; Ferrao, Ygor A.; Mathis, Maria Alice de [UNIFESP]; Cordioli, Aristides V.; Yuecel, Murat; Pantelis, Christos; Mari, Jair de Jesus [UNIFESP]; Miguel, Euripedes C.; Torres, Albina R.; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal Fluminense (UFF); Univ Melbourne; Melbourne Hlth; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Hlth Sci Fed Univ Porto Alegre; Univ Fed Rio Grande do SulWe evaluated whether traumatic events are associated with a distinctive pattern of socio-demographic and clinical features of obsessive-compulsive disorder (OCD). We compared socio-demographic and clinical features of 106 patients developing OCD after post-traumatic stress disorder (PTSD; termed post-traumatic OCD), 41 patients developing OCD before PTSD (pre-traumatic OCD), and 810 OCD patients without any history of PTSD (non-traumatic OCD) using multinomial logistic regression analysis. A later age at onset of OCD, self-mutilation disorder, history of suicide plans, panic disorder with agoraphobia, and compulsive buying disorder were independently related to post-traumatic OCD. in contrast, earlier age at OCD onset, alcohol-related disorders, contamination-washing symptoms, and self-mutilation disorder were all independently associated with pre-traumatic OCD. in addition, patients with post-traumatic OCD without a previous history of obsessive-compulsive symptoms (OCS) showed lower educational levels, greater rates of contamination-washing symptoms, and more severe miscellaneous symptoms as compared to post-traumatic OCD patients with a history of OCS. (C) 2011 Elsevier B.V. All rights reserved.