Post traumatic stress disorder

The world currently faces terrible issues of corruption, conflicts, political instabilities, violence and injustices causing traumatic experiences for humans and nature. Likewise, Hos 4:1-3 offers a link between the corruption of the Israelite society and the wounds of the Earth community. These three verses are generally read as a ‫יב‬ ִ ‫ר‬ genre, in which Yahweh brings a lawsuit against the people of Israel. However, scholars mostly focus on the crimes and fate of humans, and ignore or silence the expression of trauma of the Earth as mourning and its non-human members as languishing. Using the framework of trauma studies, the insights of " Cosmic Covenant " from the book of Murray (1992) and the Earth Bible principles of interconnectedness and voice, this article aims to explore a unique aspect of Hosea's rhetoric of trauma establishing the relationship between people's misdeeds and the wounds of the natural world.

Terrorism is considered the ultimate ''weapon of the weak''. Groups that could not possibly succeed using conventional tactics on the battlefield employ unconventional means to strike terror behind the battle lines. Increasingly, however, the ''weakest'' members of society, notably women and children, have been drawn into the fray as operatives. Once an occasional occurrence, the use of women is growing at an alarming rate. Using female recruits provides the terrorist organizations with a comparative advantage, particularly the element of surprise. At the same time, this strategy damages the psychological well being and morale of the soldiers opposing them. Soldiers have been trained to protect the civilian population. US Army doctrine specifies that, ''preserving noncombatant lives and dignity is central to mission accomplishment in counterinsurgency'' (Lt. Col. Perez in The embedded morality in FM 3-24 Counterinsurgency, Military Review, 32) The requirement to shoot people that soldiers are ordinarily trained to protect can have deep psychological impact disproportionate to killing adult men. This often results in higher levels of post-traumatic stress disorder (PTSD) and battle fatigue. The upsurge in female suicide bombers has occurred across a variety of nationalistic and secular groups but has also spread to the conservative religious terror networks. This article assesses the growing phenomenon of female terrorists and looks at the different roles that women play in terrorist organizations. It also analyzes the different Portions of this article are taken from an earlier draft of Bombshell: the Many Faces of Women Terrorists. Toronto: Penguin (Viking) mechanisms for women's mobilization and briefly discusses whether women are coerced or are willing participants in terrorist violence.

Post Traumatic Stress Disorder is a very debilitating and painstaking problem that plagues our nation’s Veteran population. Currently anywhere from 11-30% of Veterans who served in the three most recent U.S. wars experienced or currently suffers from PTSD (U.S. Department of Veterans Affairs, 2015). The effects of PTSD on the Veteran population are discussed, as well as the various treatment modalities available.  Further research is dedicated to understanding more about which treatment modalities have been shown to be the most effective, including both Empirically Supported Treatments and Complimentary and Alternative Treatment approaches.

This chapter draws from George Monbiot’s (2017) thoughts on the political power of storytelling. He emphasizes that stories function as schema through which people organize information and develop a sense of order and purpose. It is a mistake, he warns, to try to rely on data to challenging a misleading story since ‘[t]he only thing that can displace a story is a story’ (Monbiot, 2017, p 3). In short, information is not sufficient to challenge disinformation: we must also supply a meaningful framework in which that information makes sense. In this chapter, I suggest that the success of ‘false memory’ was due, largely, to its compelling narrative features. False memory advocates were skilled at retelling the story of child abuse as a drama with heroes (people falsely accused of abuse and their allies) and villains (therapists, social workers, feminists) locked in a battle of good (science, reason, rationality) against the forces of darkness (dogma, fantasy, hysteria). Attempts by experts in trauma and dissociation to counter this story with data have, at times, struggled for purchase, since they have not challenged the affective foundations of the ‘false memory’ narrative.

In this chapter, I argue that we have the opportunity to tell a new, and more hopeful, story about abuse and trauma. While the ‘false memory’ story persists, it has been destabilized by revelations of widespread clergy and institutional abuse, and its valorization of staunch individualism and devaluing of health and welfare services has lost much of its sheen. At the same time, the conceptual apparatus of trauma has taken on increasing social and political as well as psychological significance as a descriptor for the violation of human relationality and the restorative power of care and support. Increased public interest and understanding of trauma provides much of the material for counter-narratives that oppose the alienating individualism and cynicism promoted by ‘false memory’ advocates. As public and professional interest in trauma grows, ‘storifying’ trauma in principled and solutions-focused ways offers a genuine alternative to the outmoded narratives of the past.

The curator of MOCA Taipei's exhibition, Rosa's Wound, used Paul Celan's poem to name the exhibition, which showcased artworks by artists from various Asian countries to discuss the relationship between art and trauma. The background of these artworks involved a wide range of issues, including the history of martial law, political prisoners, colonization, suppression, racial violence, and war. Without any knowledge of the background and context of these ideas, the general audience would have difficulties understanding the purpose of such an exhibition as well as the curatorial efforts made in the process. In this article, I have sorted out the development and trends of trauma studies in recent years, and proposed that the concept of the "post-trauma era" could help us contextualize this exhibition and gain a better understanding. Modern History and the History of Trauma Etymologically speaking, the English word "trauma" comes from Greek, originally meaning "wound," especially one that penetrates the body. The word was first used in psychology in the nineteenth century to refer to shocking experiences in modern life (such as the shock suffered by WWI soldiers in the battlefield), in which the mind's protective mechanism that was supposed to function like a shield was "penetrated" due to excessive external stimulation. 1 From the psychoanalytical perspective, trauma falls into the domain of the "Thing," which cannot be objectified. "The 'Thing' is traumatic and brings pain. We do not know where it causes pain, or even that it causes pain. It strives to be known by the mind, but fails, and can only be temporarily liberated in symptomatic repetitions." 2 The British art historian, Griselda Pollock, has dedicated her recent years to the study of the relationship between trauma and art by adopting psychoanalytical points of view (especially Israeli psychoanalyst Bracha L. Ettinger's revisions of Lacan's theory). Pollock concluded her study in 2013 and stated five characteristics of trauma: 1. Trauma seems to exist in a non-temporal, non-spatial realm: it exists permanently and is non-temporal. Like a stranger that lives in the mind, it colonizes the host. The 1 Griselda Pollock, Afetr-affects/After-images: Trauma and aesthetic transformation in the virtual feminist museum, Manchester: Manchester, UP, 2013, p. 2. 2 Bracha Lichtenberg Ettinger, " Traumatic Wit(h)ness – and Martrixial Co/in-habit(u)ating " , parallax, vol. 5 no. 1, 1999, p. 89.

Many researchers accept that trauma-focused treatments are superior to non-trauma focused treatments for Post-Traumatic Stress Disorder (PTSD). However, Benish, Imel, and Wampold (2008) recently published a meta-analysis of clinical trials directly comparing 'bona fide' PTSD treatments that failed to reject the null hypothesis that PTSD treatments are similarly effective. They concluded that the results of previous metaanalysis may have been influenced by several confounds, including the use of control treatments, to make conclusions about the relative efficacy of specific PTSD treatments. claim that the selection procedures of the Benish et al. meta-analysis were biased and cite results from individual studies and previous meta-analyses that suggest trauma-focused psychological treatments are superior to nontrauma focused treatments. We first offer a review and justification of the coding criteria and procedure used in Benish et al. In addition, we discuss the appropriateness of utilizing treatments designed to control for non-specifics or common factors such as 'supportive therapy' for determining the relative efficacy of specific PTSD treatments. Finally, we note several additional confounds, such as therapist effects, allegiance, and alteration of legitimate protocols, in PTSD research and describe conceptual problems involved in the classification scheme used to determine the "trauma focus" of interventions, which lead to inappropriate conclusions about what works in the treatment of PTSD.

This article presents a quasi-experimental study of a mindfulness-based intervention for traumatically bereaved individuals using a single group with pre-test and post-test design. The intervention consists of the ATTEND model, which is comprised of the following elements practiced by the clinician: attunement, trust, therapeutic touch, egalitarianism, nuance, and death education. The study is based on the charts of 42 clients seeking grief counseling at a mental health agency viewed retrospectively. Participants' intake scores on the Impact of Event Scale-Revised (IES-R), which measures trauma symptoms, and 25-item Hopkins Symptom Checklist (HSCL-25), which measures depressive and anxious symptoms, were compared to their scores after an average of 14.64 hours of counseling. Paired samples t tests showed a statistically significant decline in trauma symptoms on the IES-R, and in anxious and depressive symptoms on the HSCL-25. These results provide preliminary support for the use of this mindfulness-based approach for difficulties associated with traumatic bereavement, though more extensive research is needed to determine the effectiveness of this approach.

This survey reports on the prevalence of trauma and factors impacting wellbeing among a response sample of 2204 frontline police in Ireland. It shows the potential prevalence of diagnosable PTSD of 16% among participants and discusses the impact of sub-threshold PTSD symptoms among police. The report also proviides and impact analysis (Juniper 2010) of factors affecting wellbeing among respondents.

Sexual assault survivors with post-traumatic stress disorder (PTSD) were assessed for frequency of nightmares, measured retrospectively on the Nightmare Frequency Questionnaire (NFQ) and prospectively on nightmare dream logs (NLOG). Retrospective frequency was extremely high, averaging occurrences every other night and an estimated number of nightmares greater than ®ve per week. Test±retest reliability data on the NFQ yielded weighted kappa coef®cients of .85 (95% CI, .74±.95) for nights and .90 (95% CI, .83±.97) for nightmares. Correlations between retrospective and prospective nightmare frequencies ranged between .53 (P :001) for nights and .63 (P :001) for nightmares. Correlations between frequency and distress measures (anxiety, depression, post-traumatic stress) yielded coef®cients ranging from (r :28±.53). Compared with intrusive, cumbersome and time-consuming prospective measurements, the NFQ appears reliable, convenient, and equally useful in assessing nightmare frequency in a group of sexual assault survivors. Nightmare frequency, prevalence, distress and impairment are discussed. #

Virtual Reality Graded Exposure Therapy (VRGET) is an effective treatment for combat-related PTSD. We summarize the outcomes of a VRGET pilot study with 12 participants who completed one to multiple combat tours in support of the War on Terrorism and who were subsequently diagnosed with combat-related PTSD. Details of the collaborative program amongst the Virtual Reality Medical Center (VRMC), Office of Naval Research, the Naval Medical Center San Diego (NMCSD) and the Navy Hospital Camp Pendleton are discussed as is the VRGET outcomes of significant reductions in PTSD symptoms severity. We also described the estimated cost-effectiveness of VRGET for the treatment of combat-related PTSD, as contrasted to Treatment as Usual (TAU) for combat-related PTSD.

Background  Trafficking in women is a widespread human rights violation commonly associated with poor mental health. Yet, to date, no studies have used psychiatric diagnostic assessment to identify common forms of mental distress among survivors returning to their home country. Methods  A longitudinal study was conducted of women aged 18 and over who returned to Moldova between December 2007 and December 2008

Post Traumatic Stress Disorder (PTSD) is reported to be caused by traumatic events that are outside the range of usual human experiences including (but not limited to) military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Initial data suggests that 1 out of 6 returning Iraq War military personnel are exhibiting symptoms of depression, anxiety and PTSD. Virtual Reality (VR) exposure therapy has been used in previous treatments of PTSD patients with reports of positive outcomes. The aim of the current paper is to specify the rationale, design and development of an Iraq War PTSD VR application that is being created from the virtual assets that were initially developed for theX-Box game entitled Full Spectrum Warrior which was inspired by a combat tactical training simulation, Full Spectrum Command.

Done properly by experienced therapists, re-exposure to memories of traumatic events via imaginal exposure therapy can lead to a reduction of Post-traumatic Stress Disorder (PTSD) symptoms. Exposure helps the patient process and habituate to memories and strong emotions associated with the traumatic event: memories and emotions they have been carefully avoiding. But many patients are unwilling or unable to self-generate and re-experience painful emotional images. The present case study describes the treatment of a survivor of the World Trade Center (WTC) attack of 9-11-01 who had developed acute PTSD. After she failed to improve with traditional imaginal exposure therapy, we sought to increase emotional engagement and treatment success using virtual reality (VR) exposure therapy. Over the course of six 1-h VR exposure therapy sessions, we gradually and systematically exposed the PTSD patient to virtual planes flying over the World Trade Center, jets crashing into the World Trade Center with animated explosions and sound effects, virtual people jumping to their deaths from the burning buildings, towers collapsing, and dust clouds. VR graded exposure therapy was successful for reducing acute PTSD symptoms. Depression and PTSD symptoms as measured by the Beck Depression Inventory and the Clinician Administered PTSD Scale indicated a large (83%) reduction in depression, and large (90%) reduction in PTSD symptoms after completing VR exposure therapy. Although case reports are scientifically inconclusive by nature, these strong preliminary results suggest that VR exposure therapy is a promising new medium for treating acute PTSD. This study may be examined in more detail at www.vrpain.com.

A new 13-item version of the Impact of Event Scale was adminstered to 2976 9-14 year old children from Bosnia as part of a large epidemiological screening survey. The IES-13 consists of four intrusion items, four avoidance items, and five new arousal items. Factor analyses showed the scale to have an identical underlying factor structure as when it was used with British children who experienced a single-incident trauma. In addition, there was also a third factor of hyperarousal, closely related to intrusion. These results are discussed in the context of the cross-cultural validity of post traumatic stress reactions in children. #

Culture is an essential variable of diagnosis and treatment. A cultural perspective draws attention to the social context within which symptoms arise, are given meaning, and are managed. Ethno-cultural work on illness narratives suggests that most people can provide culturally-based explanations for their symptoms. While these explanations are inconsistent with biomedical theory, they relieve patient distress by allowing the patient to create meaning for symptoms. Exploring the characteristics, context, and antecedents of the symptoms enables the patient to convey them to the clinician who may have a divergent explanation of sickness. This case study uses the Outline for Cultural Formulation of the DSM-IV created for clinicians to elicit a narrative account of the illness experience from the patient. Our study examines how the patient, a Laotian used social indignation ("Kwam khem keuang") as an explanatory model for his ailment. He was diagnosed with posttraumatic stress disorder after having undergone a traumatic amputation. In the process of explaining his illness through a cultural idiom, the patient was able to reveal both personal and collective meaning of repressed anger and frustration, expressing them in a context that was acceptable to him. This cultural idiom allowed the patient to reflect upon the structure of the health care system and the specific

Today the hypothesis that experience might alter the cells and behavior of an individual’s children and grandchildren has become widely accepted. In animals, exposure to stress, cold, or high-fat diets has been shown to trigger metabolic changes in later generations. And small studies in humans exposed to traumatic conditions—among them the children of Holocaust survivors—suggest subtle biological and health changes in their children.
The implications are profound. If our experiences can have consequences that reverberate to our children or our children’s children, that’s a powerful argument against everything from smoking to immigration policies that split families.
But proving that emotional trauma, as distinct from physical stress, can be passed on to subsequent generations in people is a challenge.

On the basis of literature that suggests that child sexual abuse (CSA) survivors with post traumatic stress disorder (PTSD) have higher baseline sympathetic nervous system (SNS) activity than healthy controls and research that suggests that the SNS plays a critical role in female physiological sexual arousal, we examined the impact of SNS activation through intense exercise on sexual arousal in women with CSA and PTSD. We measured physiological and subjective sexual arousal in women with CSA (n = 8), women with CSA and PTSD (n = 10), and healthy controls (n = 10) during exposure to nonerotic and erotic videos. After exercise, women with CSA and women with CSA and PTSD showed no significant differences in the physiological sexual response compared with no exercise, which was different from the increased physiological sexual response after exercise observed in control women.

Managed care organization use risk adjustment systems to allocate resources and evaluate provider performance. Managers of healthcare organizations need statistical methods to determine whether a particular risk adjustment system can be applied successfully to their organization's unique population and setting, and, if not, whether simple modifications can be effective. We demonstrate methods that can be used to evaluate risk adjustment

We evaluated the screening validity of a self-report measure for post traumatic stress disorder (PTSD), the PTSD Checklist (PCL), in female Veterans Affairs (VA) patients. All women seen for care at the VA Puget Sound Health Care system from October 1996–January 1999 (n=2,545) were invited to participate in a research interview. Participants (n=282) completed the 17-item PCL, followed by a

This paper presents interview survey data by social scientists using established health measures on the health effects of flooding for residents in 30 locations in England and Wales. Firstly, it examines the extent to which flooded residents reported suffering physical and psychological health effects during and after the event. Secondly, it explores the issue of whether these effects were long-lasting by comparisons with the general population and with those at risk but not flooded. In the study, about two thirds of the flood victims were found to have scores on the General Health Questionnaire-12 scale indicative of mental health problems (scores of 4+) at their worst time after flooding. The evidence of the study also suggests that some flood victims suffered long term mental health effects as a result of their experience of flooding. The study examines the influence of a wide range of factors: characteristics of the flood event, types of property, and socio-demographic and the i...

Le monde à notre porte :
l’apport de la culture et de la diversité dans la pratique psychiatrique

Vincenzo Di Nicola, MPhil, MD, PhD, FRCPC, DFAPA

Présentation à l'Institut de Santé Mentale de Montréal
Université de Montréal
8 février 2019

Survol de la présentation

Cette présentation présente une manière de travailler avec des enfants et des familles traumatisées à travers des cultures.

En ce qui concerne les traumatismes chez les enfants, nous devons répondre à trois questions fondamentales:

Pourquoi le développement est important
Pourquoi la famille est important
Pour la culture compte

Développement – famille – culture

Ces trois aspects constituent des contextes essentiels pour comprendre les « traumatismes séquentiels » des jeunes (Hans Keilson, 1992)

Illustrés par deux vignettes cliniques :
« Un train de traumatismes »
« La clinique de mémoire »

1. Fournir un cadre pour l'interaction de trois volets cruciaux pour la psychiatrie :

Culturel (anthropologie, psychologie interculturelle, psychiatrie transculturelle);
Social (déterminants sociaux de la santé); et
Relationnel (théorie de l'attachement, théorie des systèmes et thérapie familiale).

2. Démontrer la pertinence de l'interaction de ces domaines avec des exemples de leurs synthèses :

Thérapie familiale culturelle (psychiatrie transculturelle avec thérapie familiale);
Psychiatrie transculturelle pour enfants (psychiatrie transculturelle avec pédopsychiatrie);
Santé mentale globale axée sur l’enfant et la famille (santé mentale globale avec pédopsychiatrie et thérapie familiale).

3. Donner des exemples cliniques de syndromes liés à la culture et de changement de culture, tels que :

le Mutisme sélectif, et

les Troubles liés au traumatisme et au stress

A number of studies have demonstrated enhanced slow wave activity associated with pathological brain function e.g. in stroke patients, schizophrenia, depression, Morbus Alzheimer, and post-traumatic stress disorder. However, the association between slow wave activity and healthy aging has remained largely unexplored. This study examined whether the frequency at which focal generators of delta waves appear in the healthy cerebral cortex changes with age and whether this measure relates to cognitive performance. We investigated 53 healthy individuals aged 18 to 89 years and assessed MEG during a resting condition. Generators of focal magnetic slow waves were localized. Results showed a significant influence of age: dipole density decreases with increasing age. The relationship between cognitive performance and delta dipole density was not significant. The results suggest that in healthy aging slow waves decrease with aging and emphasize the importance of age-matched control groups for further studies. Increased appearance of slow waves as a marker for pathological stages can only be detected in relation to a control group of the same age.

Background Patients receiving intensive chemotherapy can experience increased distressed related to both the cancer diagnosis and treatment isolation. If not addressed, distress can lead to anxiety, depression, and post-traumatic stress disorder. The purpose of this study was to determine the feasibility and possible benefits of a music imagery intervention for patients hospitalized in a protective environment for the treatment of acute leukemia or highgrade non-Hodgkin's lymphoma. Materials and methods Adults receiving intensive myelosuppressive chemotherapy in a protective environment were randomized to standard care or standard care plus music imagery. The music imagery sessions occurred twice weekly for up to eight sessions. Patients were encouraged to use the music imagery daily. Results The principal criteria of feasibility were rate of consent, rate of completion of scheduled sessions, and rate of questionnaire completion. Forty-nine out of 78 patients consented, a 63% consent rate. Seventy-two percent of all scheduled music imagery sessions were completed. The rate of questionnaire completion was 60% with missing data because of illness severity and early discharge. The principal outcomes of benefit (e.g., efficacy) were positive and negative affects, fatigue, and anxiety. Both groups improved over time on all outcomes (all p < 0.001). However, a subgroup of individuals with low baseline negative affect who received the intervention reported significantly less anxiety at discharge than individuals with low baseline negative affect who did not receive the intervention. Conclusions Music imagery is feasible for adults with acute leukemia in protected environments. Patients with lower initial distress may benefit from a music imagery program in terms of reduced anxiety at discharge.

Low cortisol levels have been observed in patients with different stress-related disorders such as chronic fatigue syndrome, fibromyalgia, and post-traumatic stress disorder. Data suggest that these disorders are characterized by a symptom triad of enhanced stress sensitivity, pain, and fatigue. This overview will present data on the development, mechanisms and consequences of hypocortisolism on different bodily systems. We propose that the phenomenon of hypocortisolism may occur after a prolonged period of hyperactivity of the hypothalamic-pituitary-adrenal axis due to chronic stress as illustrated in an animal model. Further evidence suggests that despite symptoms such as pain, fatigue and high stress sensitivity, hypocortisolism may also have beneficial effects on the organism. This assumption will be underlined by some studies suggesting protective effects of hypocortisolism for the individual.

Logosynthesis is an Energy Psychology technique and approach that was developed by Willem Lammers. Although Logosynthesis draws from various schools of psychology - especially Psychodynamic Psychotherapy and Transactional Analysis, as well as from the field of Energy Psychology it is essentially a trans-psychological technique or approach, as it is one of the few psychological approaches that explicitly integrate mind, body and spirit. Logosynthesis embodies elements of hypnotherapy, somatosensory focusing, cognitive therapy, depth psychology, energy therapy and ritual. It is meditative in the sense of facilitating an internally focused, intentional state, attending to one’s internal reality as determining experience ‐ which permits a dissolving of the energetic structure of the problem. This results in more than a change in perception about the problem, and of oneself in relation to the problem; it is a change in one’s experience of oneself. Like all Energy Psychology techniques, L...

Children who experience sexual abuse often meet the criteria of Post-Traumatic Stress Disorder and other psychiatric disorders. This article examines Post-Traumatic Stress Disorder and their educational status among children who have been sexually abused and its effects on the children’s educational status. The study was carried
out between June 2015 and July 2016. The study adopted a longitudinal study design. The study was conducted at Kenyatta National Teaching and Referral Hospital and Nairobi Women’s Hospitals in Kenya. The children who had experienced sexual abuse and their parents/legal guardians were followed up for a period of one year after every
four months interval. One hundred and ninety one children who had experienced sexual abuse and their parents/ legal guardians were invited to participate in the study. Findings indicate that the children continued to experience PTSD one year after the sexual abuse incidence. PTSD was associated with the length of time taken to receive
medical attention (p<0.005). Children with partial PTSD who had experienced sexual abuse were 2 times more likely to perform above average than children with full PTSD, OR=2.1 [95% CI of OR 1.2-3.8], p=0.01. Children who experience sexual abuse have negative mental health outcomes. These outcomes have detrimental effects to the
normal development of children and educational status. There is need to screen for PTSD and offer psychosocial support and follow up to children who have been sexual abuse.

The relative values of imaginal and real-life exposure exercises were tested in this study by randomizing 14 patients who met DSM-III-R criteria for PTSD at least 6 months after the initiating trauma to one of two groups. Group 1 (n=7) had four, weekly, hour-long sessions of imaginal exposure followed by four, weekly, hour-long sessions of live exposure. Group 2 (n=7) had the reverse order of four live exposure sessions followed by four imaginal exposure sessions. Both groups improved significantly on both PTSD-specific measures and measures of general health post-treatment, and significantly further on 7 out of 12 measures at follow up 12 months post-treatment. Clinical improvement was in the order of 65–80% reduction in target symptoms. On one measure only (problem 2 — phobic avoidance), live exposure yielded more improvement than imaginal exposure whether given first or second. The importance of both live and imaginal exposure to all relevant cues, behavioral and cognitive, is discussed, together with the value of self-exposure homework for patients with PTSD.

Mr. B., a 57- year- old three lingual executive in an American Company was victim of a road accident. He was brought to hospital where no obvious lesions were found.
Following this accident, he suffered from constant nightmares with flashbacks of the accident, insomnia, loss of concentration, loss of memory and attention, emotional instability, great fatigue and anxiety.
As to the speech problems, he suffered from word finding problems and stuttering.

All the specialist reports (psychiatrist, first RMI etc.) concluded that he suffered from Post Traumatic Stress Disorder.

When he came to see me for a neurolinguistic analysis of his stuttering, I was puzzled by different aspects of his speech that did not fit in with “psychogenic stuttering following a choc”.
The analysis of his speech and the speech problems opened the way to more investigations.

This case study is emblematic for/of the assumption that very careful neurolinguistic analysis can detect neurological dysfunction linked to fine, discrete and diffuse lesions that might not be immediately detected by fRMI.

Objective: The purpose of this study was to prospectively evaluate the onset, overlap, and course of posttraumatic stress disorder (PTSD) and major depression following traumatic events. Method: The occurrence of PTSD and major depression and the intensity of related symptoms were assessed in 211 trauma survivors recruited from a general hospital's emergency room. Psychometrics and structured clinical interview (the Structured Clinical Interview for DSM-III-R and the Clinician-Administered PTSD Scale) were administered 1 week, 1 month, and 4 months after the traumatic event. Heart rate was assessed upon arrival at the emergency room for subjects with minor physical injury. Twenty-three subjects with PTSD and 35 matched comparison subjects were followed for 1 year. Results: Major depression and PTSD occurred early on after trauma; patients with these diagnoses had similar recovery rates: 63 survivors (29.9%) met criteria for PTSD at 1 month, and 37 (17.5%) had PTSD at 4 months. Forty subjects (19.0%) met criteria for major depression at 1 month, and 30 (14.2%) had major depression at 4 months. Comorbid depression occurred in 44.5% of PTSD patients at 1 month and in 43.2% at 4 months. Comorbidity was associated with greater symptom severity and lower levels of functioning. Survivors with PTSD had higher heart rate levels at the emergency room and reported more intrusive symptoms, exaggerated startle, and peritraumatic dissociation than those with major depression. Prior depression was associated with a higher prevalence of major depression and with more reported symptoms. Conclusions: Major depression and PTSD are independent sequelae of traumatic events, have similar prognoses, and interact to increase distress and dysfunction. Both should be targeted by early treatment interventions and by neurobiological research.

This brief paper provides a review of some of the literature regarding the constructs and nature of memory as formed through the hippocampus. It examines the processes of explicit memory, key neurotransmitters as well as structural differences with internal functioning in the hippocampus.

This paper presents preliminary findings from an ongoing study of survivors of residential fires. The purpose of this study was to examine psychological distress and extent of loss in order to provide a psychological profile of survivors over time. The sample (N = 69) was drawn consecutively from the database of residential fires available through the Philadelphia Fire Department. Levels of psychological distress were measured as well as reports of symptoms consistent with the diagnostic criteria for Post-traumatic Stress Disorder. The major findings indicate that residential fires caused significant and sustained distress. An agenda for further research and for services to survivors of these fires is presented.

Virtual Reality Graded Exposure Therapy (VRGET) is an effective treatment for combat-related PTSD. We summarize the outcomes of a VRGET pilot study with 12 participants who completed one to multiple combat tours in support of the War on Terrorism and who were subsequently diagnosed with combat-related PTSD. Details of the collaborative program amongst the Virtual Reality Medical Center (VRMC), Office of Naval Research, the Naval Medical Center San Diego (NMCSD) and the Navy Hospital Camp Pendleton are discussed as is the VRGET outcomes of significant reductions in PTSD symptoms severity. We also described the estimated cost-effectiveness of VRGET for the treatment of combat-related PTSD, as contrasted to Treatment as Usual (TAU) for combatrelated PTSD.

Anxiety disorders, including phobias and post-traumatic stress disorder, are common and disabling disorders that often involve avoidance behavior. Cognitive-behavioral treatments, specifically imaginal and in vivo forms of exposure therapy, have been accepted and successful forms of treatment for these disorders. Virtual reality exposure therapy, an alternative to more traditional exposure-based therapies, involves immersion in a computer-generated virtual environment that minimizes

In addition to repeated reexperiencing of the event, the delayed effects of severe psychological trauma, i.e., post traumatic stress disorder (PTSD), present a paradoxical mix of symptoms. There is enhancement of the self-preservative catecholamine states; anger and fear with a contrasting sense of meaninglessness and a blunting of the emotional responses of the attachment behavior so critical for species preservation. Hormonally, there is a striking separation of the catecholamine response, which stays elevated and that of the hypothalamo-pituitary-adrenal (HPA) axis, which may remain at normal levels. Pathophysiologically, the reexperiencing of the trauma and the arousal may be associated with dysfunction of the locus coeruleus, amygdala and hippocampal systems. This article explores the consequences of an additional dysfunction: a dissociation of the hemispheres that appears to be responsible for the alexithymic avoidance and failure of the cortisol response that so often follow severe psychological trauma. There is neurophysiological evidence that the left and right hemispheres subserve different emotional sets that correspond to “control” and “appraisal,” i.e., very approximately to the self and species preservative behavioral complexes, respectively. Several studies point to physiological dissociation of hemispheric functions during alexithymia. This raises the question: What has been lost if in this condition the right side no longer fully contributes to integrated cerebral function? Right hemispheric damaged children lose critical social skills and in adults the related sense of familiarity critical for bonding is lost. Such losses of social sensibilities may account for the lack of empathy and difficulties with bonding found in sociopathy and borderline personality: conditions now believed to result from repeated psychological trauma during development. On the other hand, systems that promote right hemispheric contributions provide solacing access to a “Higher Power.” They also appear to protect against socially disordered behavior, substance abuse, the failure of the HPA axis and some aspects of the pathophysiology of chronic disease.

Anxiety disorders, including phobias and posttraumatic stress disorder, are common and disabling disorders that often involve avoidance behavior. Cognitive-behavioral treatments, specifically imaginal and in vivo forms of exposure therapy, have been accepted and successful forms of treatment for these disorders. Virtual reality exposure therapy, an alternative to more traditional exposure-based therapies, involves immersion in a computer-generated virtual environment that minimizes avoidance and facilitates emotional processing. In this article, we review evidence on the application of virtual reality exposure therapy to the treatment of specific phobias and post-traumatic stress disorder and discuss its advantages and cautions.

Retrospective clinical reports suggesting that traumatic stress populations display an increased propensity for glucose metabolism disorders were examined in a controlled prospective animal model. Stress-induced behavioural and hypothalamic-pituitary-adrenal (HPA) axis response patterns were correlated to central and peripheral parameters of glucose metabolism and signalling, and to body measurements in Sprague–Dawley rats exposed to predator scent stress. Forty days post-exposure, fasting blood glucose and insulin levels, oral glucose tolerance test, body weight and white adipose tissue mass, systemic corticosterone levels and brain expression of insulin receptor (IR) and insulin-sensitive glucose transporter 4 (GLUT4) protein levels were evaluated. In a second experiment inbred strains with hyper- (Fischer) and hypo- (Lewis) reactive HPA axes were employed to assess the association of metabolic data with behavioural phenomenology versus HPA axis response profile. For data analysis, animals were classified according to their individual behavioural response patterns (assessed at day 7) into extreme, partial and minimal response groups. The exposed Sprague–Dawley rats fulfilling criteria for extreme behavioural response (EBR) (20.55%) also exhibited significant increases in body weight, abdominal circumference and abdominal white adipose tissue mass; a hyperglycaemic oral glucose tolerance test; and fasting hyperglycaemia, hyperinsulinaemia and hypercorticosteronemia, whereas minimal responders (MBR) and control animals displayed no such disturbances. Hippocampal and hypothalamic expression of IR and GLUT4 protein were significantly lower in EBR than in MBR and control rats. The inbred strains showed no metabolic differences at baseline. Exposed Fischer rats displayed hyperglycaemia and hyperinsulinaemia, whereas Lewis rats did not. A significant protracted disorder of glucose metabolism was induced by exposure to a stress paradigm. This metabolic response was associated with the characteristic pattern of HPA axis (corticosterone) response, which underlies the behavioural response to stress.

The article analyses Italian second reception system for asylum seekers and refugees (so-called SPRAR system), through the lens of psychosocial well-being. The author examines in depth the connections between migration, trauma and suffering, and proposes a
multidimensional definition of ‘psychosocial well-being’, by drawing on the conceptualization given by ‘Psychosocial Working Group’

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The stigma, misconceptions, and "tough it out" atttitude torwards trauma-related disorders has inspired the development of this document/digital zine, and why the first issue of Modern Minds has been dedicated to concepts relating to PTSD. I hope through the dissemination of this free magazine to broaden the definition of & destigmatize trauma-related 'disorders', encourage others to think critically & promote self-care wherby being kind to ourselves helps us to be kind to all.