Information-processing studies have shown an attentional bias (AB) towards threat cues in individuals with anxiety disorders. Research has consistently shown that AB to threat may play a causal role in the development and maintenance of anxiety disorders. Recent empirical evidence has demonstrated support for Attention Retraining (AR) to modify AB to threat, resulting in reductions of anxiety. Currently, AR approaches have not been systematically tested in individuals with Post-traumatic Stress Disorder (PTSD). The purpose of this study was to assess the feasibility of a computer-based attention retraining (CBAR) treatment for clinical levels of PTSD using a modified dot-probe paradigm. A single-case time-series design was employed with a treatment and post-treatment period, following baseline. Results indicated significant reductions in trauma-related symptoms, attention to threat cues, state anxiety and depression, along with a significant increase in coping self-efficacy. AB change for the group was not significant. A significant relationship between AB change and PTSD symptoms was found. The results were discussed from the standpoint of the viability of AR for trauma. / Master of Science

Over 15 million contact sports players and military veterans are at risk for the development of chronic traumatic encephalopathy (CTE), a neurodegenerative disease associated with exposure to repetitive head impacts (RHI) that sometimes presents with parkinsonian motor symptoms, although very little is understood about how these individuals develop parkinsonism. CTE is characterized by accumulation of hyperphosphorylated tau protein (p-tau), and diagnosis requires the presence of neuronal tau in the form of neurofibrillary tangles at the depth of cortical sulci. We performed quantitative immunoassays for markers of neurovascular inflammation within the postmortem dorsolateral frontal cortex of participants with and without a history of RHI and CTE (n = 156), and tested for associations with RHI, microgliosis, and tau pathology measures. Levels of vascular injury-associated markers were increased in CTE compared to RHI-exposed and -naïve controls. Markers increased with RHI exposure duration and were associated with increased microglial density and tau pathology. Histologically, there was significantly increased ICAM1 staining of the microvasculature, extracellular space, and astrocytes at the sulcal depths in high stage CTE compared to both low stage CTE and controls. Multifocal perivascular immunoreactivity for serum albumin was present in all RHI-exposed individuals. These findings demonstrate that vascular injury markers are associated with RHI exposure, duration, and microgliosis, are elevated in CTE, and increase with disease severity. We next performed a cross-sectional analysis of all brain donors with CTE and without comorbid neurodegenerative disease (n=495) in the UNITE Brain Bank. Participants with parkinsonism (CTE-p, n=119) had a higher mean age at death (71.5 years (y)) than participants without parkinsonism (CTE-np, n=362, 54.1 y) and exhibited a higher rate of dementia than CTE-np participants. CTE-p participants had a more severe CTE stage and nigral pathology (NFTs, neuronal loss, and more frequent Lewy bodies), though the majority of cases were negative for nigral Lewy bodies. In American football players, simultaneous regression analysis demonstrated that nigral NFTs and neuronal loss mediate a connection between years of play and parkinsonism in CTE. In this cross-sectional study of contact sports athletes with CTE, years of contact sports participation was associated with SN proteinopathy and neuronal loss, and these pathologies were associated with parkinsonism. Finally, in a postmortem cohort (n=392) of brain donors with CTE without comorbid neurodegenerative disease, we used linear regression modelling to analyze the associations between isodendritic core nuclei pathology (semiquantitative neurofibrillary tangles (NFTs), neurites, and neuronal loss scores) and CTE disease severity, RHI exposure duration (years of contact sport play), and informant-reported cognitive and daily function as assessed by the Cognitive Difficulties Scale (CDS) and Functional Activities Questionnaire (FAQ), respectively. Overall, isodendritic core (IC) NFT scores increase with disease stage, Initially in the locus coeruleus and finally in the median raphe nuclei. Neuronal loss occurred at later disease stages than NFT accumulation. RHI exposure was associated with p-tau pathology for all IC regions. NFTs and neuronal loss in the substantial nigra were associated with increased CDS scores (i.e., worse cognitive function), and neuronal loss in the substantia nigra and locus coeruleus were associated with increased FAQ scores (i.e., worse daily function). We are able to show CTE is similar in distribution of p-tau pathology to progressive supranuclear palsy (PSP), a disease that is thought to primarily affect subcortical regions, especially by end stage disease. These results demonstrate the vulnerability of the isodendritic core nuclei to p-tau pathology and neuronal loss in CTE, and suggest that their involvement contributes to cognitive and functional symptoms during life. This work highlights the possible linkage between neuroinflammation leading to nigral p-tau accumulation and neuron loss which likely underlies the development and progression of parkinsonian motor symptoms in CTE.

Post-traumatic stress, while not unique to war, results from normal human reactions to combat. Historically, civilizations provided communal rituals to support and treat returning warriors. We do not. When combat stress reactions adversely affect normal functioning, we label them Post Traumatic Stress Disorder, implying something wrong with the sufferer, when in reality what is wrong is war itself. Not all veterans develop diagnosable PTSD or seek treatment, but all deal with post-traumatic stress. Complex, with moral, societal, and spiritual dimensions, combat stress manifests physically and emotionally. Veteran support should address both. Battlefields are places to contemplate the nature of war and martial sacrifice, and to experience emotional empathy with those who fought there. The ground itself is the link to this empathy. Battlefield landscapes can be designed to help veterans process their responses to combat, recognize them as normal human reactions inherent to the warrior experience, and participate in meaningful communalization experiences to aid in social reintegration. These concepts were applied at Fredericksburg, Virginia, resulting in a 26-mile battlefield trail linking experientially important sites and ending at an outdoor amphitheater. The trail offers the stress-relieving benefits of exercise. It also allows veterans to examine their own experiences in the context of others' and prepares them for communal experiences at the culminating public space. Pilgrimage on hallowed battlefield ground helps veterans tell themselves their own story. Telling that story to others allows the community to share the burden of peace and helps veterans complete their warrior's journey home. / Master of Landscape Architecture

Sexual victimization is an act of interpersonal violence that affects the lives of many college women. Such incidents are often characterized by women as traumatic experiences which also result forms of psychological distress, with the most common being posttraumatic stress disorder (PTSD). The relationship between sexual victimization and PTSD is strengthened by revictimization. Although perceived social support has been shown to play a protective role in the sexual victimizationâ ³psychological distress relationship, there is also evidence that the moderating effect of perceived social support diminishes with chronic distress. Therefore, the current study assumed that there would be a changing role of perceived social support, from a moderator to a mediator, in the relationship between sexual victimization and PTSD. Three hundred college females (mean age 19) completed questionnaires related to sexual victimization experiences, perceived social support, and PTSD symptoms in addition to other personality and socio-demographic factors. The hypotheses were not supported. However, as with previous findings, the results showed that sexual victimization significantly predicted PTSD symptom severity. / Master of Science

Yes / Klüver-Bucy syndrome (KBS) is a rare clinical presentation following traumatic brain injury (TBI). Symptoms include visual agnosia, placidity, hyperorality, sexual hyperactivity, changes in dietary behavior, and hypermetamorphosis. The purpose of this article was to identify and synthesize the available evidence from case reports and case series on the treatment profile of KBS among adolescents and adults after TBI. Four bibliographic databases (MEDLINE OVID, EMBASE, PsycINFO, and SCOPUS) were searched for relevant literature. No date or language restrictions were applied. All case reports containing original data on KBS following TBI among adolescents and adults were included. Articles were evaluated, and data were extracted according to predefined criteria. The literature search identified 24 case reports of KBS post-TBI published between 1968 and 2017. Most case subjects were male (70.1%), and the mean age at injury was 25.1 years (range, 13–67 years). Injury to one or both temporal lobes occurred in most cases. Inappropriate sexual hyperactivity was the most common KBS symptom, followed by a change in dietary behavior and hyperorality. Visual agnosia was the least reported. In 50% of cases, the patient fully recovered from KBS. One-half of all participants described pharmacological management; the most common medication prescribed was carbamazepine. Overall, there was a lack of data available on pharmacotherapy initiation and duration. The complex presentation of KBS presents challenges in terms of treatment options. Although overall individuals who were prescribed carbamazepine had positive outcomes, given the reliance on case reports, it is difficult to make a definitive recommendation to guide clinical practice. / Institute for Safety, Compensation and Recovery Research, Monash University, Bionomics,Eli Lilly, Lundbeck, Novartis, Servier

Violent crime and trauma are very common within the society and students at the technikon are as exposed to these traumatic situations that characterize the broader national context as anybody. The purpose of this study was to explore therapeutic intervention techniques that can be used by the educational psychologist in assisting students suffering from post-traumatic stress. The phenomena of post-traumatic stress and post-traumatic stress disorder were studied with reference to the DSM IV classification and description. Traumatic events and stressors among students were outlined. A case study was conducted with a subject selected at the technikon who was suffering from post-traumatic stress due to earlier physical abuse and violence she experienced at home. The Trauma-100-Questionnaire was used to investigate the extent of the trauma and the results showed that the subject was involved with negative self-talk and employed ego defence mechanisms. An analysis of the subject's problem was done through the relations theory and various techniques from the literature study were implemented in therapy with the subject. / Educational Studies / M.Ed. (Guidance and Counselling)

Thesis (MA)--Stellenbosch University, 2001 / ENGLISH ABSTRACT: Post-traumatic stress disorder (PTSD) is the most recognised mental disorder stemming from severe psychological trauma. One of the differential diagnoses of post-traumatic stress disorder, amongst others, is obsessive-compulsive disorder (OGD). These two disorders overlap at some point in terms of symptomatology. More specifically, both are characterized by recurrent intrusive thoughts. It has been hypothesized that trauma may also be a significant source of OGD development. OGD and PTSD are disorders that present in adulthood, as well as in childhood and adolescence. It is shown that PTSD and OGD can present comorbidly in adulthood and it is theorized that it may also be the case in childhood and adolescence. Evidence of OGD developing in the context of trauma and theories of how this might have happened are presented. It is shown how complicated it is to distinguish between OGD developing in the wake of trauma and PTSD and the importance of such a distinction. / AFRIKAANSE OPSOMMING: Post-traumatiese Stresversteurig (PTSD) is een van die mees erkende sielkundigeversteurings wat ontwikkel na die blootstelling aan sielkundige trauma. Obsessiewe-kompulsieweversteuring (OGD) is, onder andere, een van die differensiële diagnoses van PTSD. Die twee versteurings oorvleuel ten opsigte van simptomalogie. Meer spesifiek word beide gekenmerk deur herhalende indringende gedagtes. Daar word tans gehipotiseer dat trauma nie net 'n rol in die ontwikkeling van PTSD speel nie maar ook 'n oorsaaklike rol het in die ontwikkeling van OGD. OGD en PTSD is versteurings wat kan voorkom tydens volwassenheid, asook tydens die kinderjare en adolessensie. Daar word bewys gedoen van PTSD en OGD wat saam voorkom gedurende volwassenheid en daar word geteoretiseer dat dit ook die geval mag wees tydens die kinderjare en adolessensie. Bewys word gelewer van OGD wat ontwikkel na blootstelling aan trauma en teorië ten opsigte van die ontwikkeling word aangebied. Die onderskeid tussen OGD wat na trauma blootstelling ontwikkel en PTSD is ingewikkeld, dog is die onderskeid baie belangrik in vele opsigte.

Individuals who have experienced a traumatic event and develop Post-Traumatic Stress Disorder (PTSD) frequently show deficits in both primarily “cool” and “hot” cognitive executive functions (e.g., traditional & emotional Stroop tasks, respectively) that can be impacted by high affective salience. Given the dimensional nature of psychopathology, questions remain about individuals within the general population who have experienced trauma but do not meet full criteria for PTSD and yet may manifest problems in these areas, especially areas of hot and cool executive functioning (EF). Thus, the current project was designed to assess hot and cool EF in a relatively large sample of individuals from the general population who have experienced trauma and currently demonstrate sub-clinical levels of post-traumatic symptoms. The Stroop task, Emotional Stroop task, and a novel modified Implicit Association Test were utilized to assess EF across a spectrum of individuals with varying traumatic histories and level of post-traumatic symptoms. Results suggest that a greater frequency of trauma experiences was moderately associated with worse performance on both hot and cool executive functioning measures. Specifically, females within the sample evidenced a close relationship between traumatic experiences, post-trauma symptoms, and executive functioning. Clinical and theoretical implications are discussed.

The role of exposure to a human-made disaster and the subsequent development of post-traumatic stress reactions were examined. Subjects included 49 males and 30 females who were variously exposed to the Luby's shooting incident in Killeen, Texas in October of 1991. Post-traumatic stress symptomatology was measured by the SCL-90R. Exposure was operationalized by using a scenario-rating scheme with independent raters estimating each subject's level of exposure. A regression and commonality analysis revealed that exposure is an important predictor in post-traumatic symptomatology. Premorbid functioning and gender were also found to play important roles, with females expressing higher levels of symptomatology.

Résumé : Les réanimateurs ont recours à des interventions à la fois médicales et chirurgicales en contexte de choc traumatique. Le rôle des vasopresseurs dans cette prise en charge est controversé. Alors que les lignes directrices américaines considèrent que les vasopresseurs sont contre-indiqués, certains experts européens en encouragent l’utilisation pour diminuer le recours aux liquides intraveineux. Avant d’élaborer un essai clinique, il importe de comprendre la pratique actuelle à laquelle se comparera une intervention expérimentale, ainsi que de connaître le niveau d’incertitude dans la littérature entourant la question de recherche. Le Chapitre 2 de ce travail présente une étude observationnelle effectuée dans un centre régional de traumatologie québécois. Cette étude documente les pratiques de réanimation adoptées par les équipes de traumatologie en 2013, particulièrement le recours aux liquides intraveineux et aux vasopresseurs. Les résultats démontrent que les vasopresseurs ont été utilisés chez plus de 40% des patients, particulièrement les victimes de traumatismes crâniens (RC 10.2, IC 95% 2.7-38.5). De plus, les vasopresseurs ont été administrés dans les phases précoces de la réanimation, soit avant l’administration d’un volume important de liquides. Le Chapitre 3 présente une revue systématique portant sur l’utilisation précoce de vasopresseurs en traumatologie. Les bases de données MEDLINE, EMBASE, CENTRAL et ClinicalTrials.gov ont été interrogées, ainsi que les abrégés présentés dans les conférences majeures en traumatologie depuis 2005. La sélection des études et l’extraction des données ont été effectuées en duplicata. Aucune donnée interprétable n’a pu être extraite des études observationnelles et le seul essai clinique identifié n’avait pas une puissance suffisante (RR de mortalité avec vasopresseurs 1.24, IC 95 % 0.64-2.43). Cette synthèse met en lumière l’incertitude scientifique sur le rôle des vasopresseurs en traumatologie. Les vasopresseurs ont des bénéfices potentiels importants, puisqu’ils permettent entre autres de supporter étroitement l’hémodynamie des patients. En revanche, ils présentent aussi un fort potentiel de dangerosité. Ils sont utilisés fréquemment, malgré l’absence de données sur leurs risques et bénéfices. Ces trouvailles établissent clairement la pertinence clinique et le bien-fondé éthique d’un essai clinique sur le rôle des vasopresseurs dans la prise en charge précoce des victimes de traumatismes. / Abstract : Trauma teams often make use of both medical and surgical interventions in the early management of traumatic shock. Vasopressors have an important clinical potential, namely because they allow fluid restriction and narrow hemodynamic support. However, they also have the potential for significant harm. The role of vasopressors in this early phase of care is controversial. Although North American guidelines consider that vasopressors are contraindicated in this clinical setting, some European experts encourage their use in the hopes of reducing intravenous fluid administration and its inherent risks. Before designing an adequate clinical trial on vasopressor use, a number of vital questions must be answered. First, current accepted practice must be described in order to determine how it will compare with an eventual experimental intervention. Second, relevant knowledge gaps in the scientific literature must be identified in order to establish equipoise and refine the research question. Chapter 2 of this document presents an observational study conducted in a regional trauma centre in the province of Québec. This retrospective study documents current practice patterns adopted by trauma teams over the course of 2013, with particular emphasis on vasopressor and intravenous fluid use. Over this timeframe, more than 40 % of patients received vasopressors, most often in the presence of traumatic brain injury (OR 10.2, 95% CI 2.7-38.5). Moreover, these vasopressors were often administered in the very early phases of trauma care, before any significant intravenous fluid loading. Chapter 3 consists of a systematic review on the early use of vasopressors in the management of traumatic shock. MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov were searched, as well as conference proceedings from major trauma meetings since 2005. Independent reviewers completed study selection and data extraction in duplicate. Observational studies yielded no interpretable data, and the only clinical trial addressing the research question had insufficient power to inform clinical practice (RR of death with vasopressor use 1.24, 95% CI 0.64-2.43). This knowledge synthesis highlights the uncertainty surrounding the role of vasopressors in trauma. Trauma teams routinely make use of vasopressors despite the absence of data on their risks and benefits. These findings clearly establish both the clinical impetus and ethical justification for a clinical trial focusing on the early use of vasopressors in the management of traumatic shock.