Made available in DSpace on 2015-07-22T20:49:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-11-24. Added 1 bitstream(s) on 2015-08-11T03:26:29Z : No. of bitstreams: 1 Publico-346.pdf: 373324 bytes, checksum: b15251f6022f133299360a274f5cbd73 (MD5) / Objetivo: Avaliar eficácia da Psicoterapia Interpessoal no formato de grupo (TIP-G) adaptada para o Transtorno de Estresse Pós-Traumático (TEPT) como um tratamento adjunto para pacientes refratários a medicação. Método: Foram incluídos na pesquisa 40 pacientes do Programa de Atendimento e Pesquisa em Violência (Prove) do departamento de psiquiatria da Universidade Federal de São Paulo (Unifesp). Eles receberam tratamento farmacológico convencional por pelo menos 12 semanas e não obtiveram uma resposta clínica significativa. Após a assinatura do termo de consentimento livre e esclarecido (TCLE), o diagnóstico de TEPT era confirmado através da aplicação da entrevista diagnóstica semi-estruturada (SCID-I) segundo os critérios do DSM-IV. Ao início e no final da intervenção (TIP-G TEPT) foi aplicada a Clinician Administered PTSD Scale (CAPS) para avaliar a gravidade dos sintomas, a Beck Depression Inventory (BDI) depressão, a Beck Anxiety Inventory (BAI) ansiedade, a Social Adjustment Scale (SAS) para avaliar o ajustamento social, a MOS 36-Item Short-Form Health Survey (SF-36) para avaliar a qualidade de vida, e os resultados comparados. Resultados: Dos 40 pacientes incluídos no estudo 33 completaram a intervenção e apresentaram melhora significativa em todas as mensurações, com "effect size" elevado. Os escores da CAPS [72,3 (4,4) vs 35,5(5,4) ES=1,169 p<0,0001], do BDI [26,2 (1,8) vs 13,3 (1,56) ES=1,291 p<0,0001], do BAI [31,97(2,01) vs 17,03(2,14) ES=1,201 p<0,0001, da SAS [2,6(0,12) vs 2,17(0,11) ES=0,633 p=0,0007, e da SF-36 [ 80,16(3,2) vs 104,4(4,18) ES=1,04 p<0,0001. Conclusão: A adaptação da TIP-G para o TEPT se mostrou eficaz como tratamento adjuntivo e com ótima tolerabilidade para os pacientes que não responderam ao tratamento medicamentoso, não só na diminuição dos sintomas do TEPT, mas também na diminuição dos sintomas de depressão e ansiedade. Assim como uma melhora significante no ajustamento social e qualidade de vida. Novos estudos randomizados e controlados devem ser feitos para a confirmação desses resultados. / Background: Posttraumatic stress disorder (PTSD) is a highly prevalent condition, yet available treatments demonstrate only modest efficacy. Exposure therapies, considered by many to be the “gold standard” therapy for PTSD, are poorly tolerated by many patients and show high attrition. We evaluated interpersonal therapy, in a group format, adapted to PTSD (IPT-G PTSD), as an adjunctive treatment for patients who failed to respond to conventional psychopharmacological treatment. Methods: Research participants included 40 patients who sought treatment through a program on violence in the department of psychiatry of Federal University of São Paulo (UNIFESP). They had received conventional psychopharmacological treatment for at least 12 weeks and failed to have an adequate clinical response. After signing an informed consent, previously approved by the UNIFESP Ethics Review Board, they received a semistructured diagnostic interview (SCID-I), administered by a trained mental health worker, to confirm the presence of a-PTSD diagnosis according DSM-IV criteria. Other instruments were administered, and patients completed out selfreport instruments at baseline, and endpoint to evaluate clinical outcomes.Results: Thirty-three patients completed the trial, but all had at least one second outcome evaluation. There were significant improvements on all measures, with large effect sizes. Conclusions: IPT-G PTSD was effective not only in decreasing symptoms of PTSD, but also in decreasing symptoms of anxiety and depression. It led to significant improvements in social adjustment and quality of life. It was well tolerated and there were few dropouts. Our results are very preliminary; they need further confirmation through randomized controlled clinical trials. / TEDE / BV UNIFESP: Teses e dissertações

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O presente trabalho investiga os diferentes processos sociais relacionados ao surgimento do transtorno de estresse pós-traumático (TEPT) no contexto brasileiro. Categoria diagnóstica norte-americana instituída na década de 1980 pela terceira edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (Diagnostic and Statistical Manual of Mental Disorders DSM-III) uma publicação da Associação Americana de Psiquiatria (American Psychiatric Association APA) o TEPT tornou-se, desde a sua aparição, uma das categorias nosológicas mais difundidas, estudadas e diagnosticadas da psiquiatria contemporânea. A partir do cotidiano de um laboratório de pesquisa e tratamento do TEPT, de análises conversacionais dos atendimentos médicos, de um estudo das diferentes escalas psiquiátricas utilizadas no acompanhamento dos pacientes e de pesquisas sobre a mídia relacionada às experiências traumáticas buscou-se entender os entrelaçamentos entre os processos de difusão e a construção da legitimidade da categoria diagnóstica do TEPT. A abordagem aqui proposta pretende ir além do aparente dilema entre uma concepção medicalizada que assumem a existência o TEPT como um fenômeno natural e as abordagens sócio-antropológicas que veem o TEPT como uma experiência culturalmente construída. Por fim, pretendo mostrar, pela investigação dos alicerces políticos e culturais dos denominados transtornos mentais, que o estatuto social dos diagnósticos e dos tratamentos da moderna psiquiatria só pode ser compreendido tendo como referência as dinâmicas de longo prazo nas sociedades contemporâneas. / This dissertation examines the social processes related to the reception of the Post Traumatic Stress Disorder (PTSD) in Brazil. Originating in the United States during the 1980, this diagnostic category first appeared in the Diagnostic and Statistical Manual of Mental Disorders DSM-III, a publication of the American Psychiatric Association APA. It soon became one of the most studied and diagnosed syndrome of contemporary psychiatry. In order to map out the interrelated processes of diffusion and construction of PTSD I resorted to the analysis of a gamut sources: the daily operation of a research and treatment psychiatric institution, the verbal exchanges between psychiatrists and patients during medical appointments, psychiatric manuals and diagnostic tables and questionnaires, and mass media articles on PTSD. The approach adopted here intends to go beyond the apparent dilemma between a medicalized conception of PTSD as a natural phenomenon and an anthropological approach that sees PTSD as a culturally construed social experience. Finally, I also intend to show that the political and cultural underpinnings of the so called mental disorders cannot be correctly understood without taking into consideration the longue dureé dynamics of contemporary societies.

abstract: The present study utilized longitudinal data from a high-risk community sample (n= 377; 166 trauma-exposed; 54% males; 52% children of alcoholics; 73% non-Hispanic/Latino Caucasian; 22% Hispanic/Latino; 5% other ethnicity) to test a series of hypotheses that may help explain the risk pathways that link traumatic stress, posttraumatic stress disorder (PTSD) symptomatology, and problematic alcohol and drug use. Specifically, this study examined whether pre-trauma substance use problems increase risk for trauma exposure (the high-risk hypothesis) or PTSD symptoms (the susceptibility hypothesis), whether PTSD symptoms increase risk for later alcohol/drug problems (the self-medication hypothesis), and whether the association between PTSD symptoms and alcohol/drug problems is due to shared risk factors (the shared vulnerability hypothesis). This study also examined the roles of gender and ethnicity in these pathways. A series of logistic and negative binomial regressions were performed in a path analysis framework. A composite pre-trauma family adversity variable was formed from measures of family conflict, family life stress, parental alcoholism, and other parent psychopathology. Results provided the strongest support for the self-medication hypothesis, such that PTSD symptoms predicted higher levels of later alcohol and drug problems among non-Hispanic/Latino Caucasian participants, over and above the influences of pre-trauma family adversity, pre-trauma substance use problems, trauma exposure, and demographic variables. Results partially supported the high-risk hypothesis, such that adolescent substance use problems had a marginally significant unique effect on risk for assaultive violence exposure but not on overall risk for trauma exposure. There was no support for the susceptibility hypothesis, as pre-trauma adolescent substance use problems did not significantly influence risk for PTSD diagnosis/symptoms over and above the influence of pre-trauma family adversity. Finally, there was little support for the shared vulnerability hypothesis. Neither trauma exposure nor preexisting family adversity accounted for the link between PTSD symptoms and later substance use problems. These results add to a growing body of literature in support of the self-medication hypothesis. Findings extend previous research by showing that PTSD symptoms may influence the development of alcohol and drug problems over and above the influence of trauma exposure itself, preexisting family risk factors, and baseline levels of substance use. / Dissertation/Thesis / Ph.D. Psychology 2014

Le traumatisme psychique définit le choc émotionnel d'un individu à la suite à d'un évènement traumatique. Dans certains cas, la symptomatologie psychotraumatique s'installe et perdure entrainant l'apparition d'un Trouble de Stress Post Traumatique. La littérature décrit amplement les désordres mnésiques qui accompagnent la maladie et notamment l'altération de la mémoire autobiographique. Ce système de mémoire complexe renferme l'histoire de notre passé sur laquelle s'appuie notre individualité présente et nos aspirations futures. Cependant, l'origine du dysfonctionnement de la mémoire autobiographique reste confuse, cette altération pourrait être un facteur prémorbide, la conséquence de l'exposition traumatique ou celle de la maladie. Les recherches restent incertaines sur les relations existantes entre le dysfonctionnement de la mémoire autobiographique et le traumatisme psychique. Tout au long de ce travail, nous caractériserons le fonctionnement de la mémoire autobiographique dans le contexte d'un traumatisme psychique. Les deux premières études permettront d'analyser la mémoire autobiographique suite à une exposition traumatique unique et suite à des expositions répétées. La dernière étude nous éclairera sur le fonctionnement de la mémoire autobiographique chez des sujets en rémission partielle d'un trouble de stress post traumatique. / Psychological trauma defines the emotional shock experienced by an individual following a traumatic event. In some cases, the psychotraumatic symptomatology develops and persists, leading to the onset of posttraumatic stress disorder. The literature has widely described the memory impairment associated with the disease, especially dysfunction of autobiographical memory. This complex memory system contains the story of our past, on which our present identity and future aspirations are based. However, it remains unclear whether this deficit is due to premorbid autobiographical memory dysfunction, to the trauma exposure itself, or to the subsequent development of posttraumatic stress disorder symptomatology. Research has not yet clarified the relationship between autobiographical memory dysfunction and psychological trauma. Throughout this work, we will define autobiographical memory function in the context of psychological trauma. The first two studies will analyze autobiographical memory function following a single traumatic exposure and following repeated exposures. The final study will shed light on how autobiographical memory functions among participants with posttraumatic stress disorder in partial remission.

Magister Psychologiae - MPsych / Exposure to severe trauma and resulting PTSD affects individuals of all ages, cultures and geographical areas. Epidemiological surveys reveal that approximately one third of the general population is exposed to a traumatic event at some point in their lives. From the people exposed to a traumatic event about 10% will develop PTSD. Compelling evidence further suggests that the PTSD prevalence in South Africa is even higher,especially among the youth, and has thus been identified as a significant public health concern. In order to adequately address the diverse effects of PTSD,reliable and valid instruments diagnosing PTSD are required. It is a further imperative that these instruments are adapted to the specific context in which they will be utilized. This study thus focused on assessing the psychometric properties (factorial validity and internal consistency) of the Child PTSD Checklist in a sample of treatment-seeking children adolescents in the Western Cape. For the purpose of this study secondary data from a larger, longitudinal study investigating PTSD in children and adolescents was utilized.The preliminary study employed a quantitative research design in order to obtain data from the participants. The sample comprised of 200 children and adolescents between the ages of 8 and 18 years that were selected from the Youth Stress Clinic. In terms of the psychometric properties the scale demonstrated excellent internal consistency(Cronbach’s alpha = 0.93). Exploratory factor analysis revealed a three factor structure(anxiety and avoidance, anger and dissociation, depressive symptoms) which accounted for 41,96 % of the total variance. In conclusion, the Child PTSD Checklist appears to be a promising tool for assessing PTSD in trauma-exposed youth in clinic settings, however further studies are needed to address its broader utility.

Introduction: There is a frequent incidence of post-traumatic stress disorder (PTSD) in people with substance use disorder (SUD) and there is also a frequent occurrence of substance use in people with PTSD. Many foreign authors highlight the complications that occur in individuals with this dual diagnosis: higher risk of drop-out from treatment, a higher number of suicide attempts, more serious consequences of substance use, more frequent relapses of both of two diagnoses, etc. The negative impact of this comorbidity on treatment outcomes, highlights the need to focus on improving procedures in the diagnosis of PTSD in people treating from SUD and a need of integrated treatment of both disorders. Many studies also suggest that improving the condition of PTSD increases the likelihood of improvement in substance use. In the Czech Republic, there is a lack of sources that focus on the relationship of these comorbidities and their treatment. Examples of a good practice are also missing. Aims: The aim of this thesis is to introduce the issue of dual diagnosis - PTSD and SUD. The intention of the theoretical part is to present the relationship of these two disorders, with a focus on possible etiology and treatment options. The aim of the practical part is to introduce specific models of integrated...

Cette thèse propose que l'état de stress post-traumatique (ESPT) et l'addiction impliquent un dysfonctionnement de la réactivation mnésique qui serait responsable des reviviscences intenses qui les caractérisent. Ce dysfonctionnement pourrait reposer sur un découplage des systèmes monoaminergiques, déjà mis en évidence après des expositions répétées aux drogues, qui se traduit par une sensibilisation comportementale et neurochimique, dépendantes du système noradrénergique. Nos données montrent que 1) le modèle animal de l'ESPT adopté (le SPS), reproduit des symptômes de l'ESPT dont une réactivité aux indices de rappel , 2) le SPS induit une sensibilisation locomotrice, dépendante du système noradrénergique et modulée par la recherche de nouveauté, 3) des injections répétées d'amphétamine reproduisent des symptômes de l'ESPT et induisent une sensibilisation modulée par la réaction à la nouveauté , 4) une sensibilisation locomotrice peut se manifester par l'exposition à des indices associés à la prise de drogue et, 5) un traitement combinant un état positif à une réactivation de la mémoire traumatique réduit les symptômes de l'ESPT, suggérant qu'un remodelage émotionnel pourrait constituer une nouvelle approche thérapeutique. Ce premier corpus de résultats supporte notre hypothèse de bases physiologiques communes entre ESPT et addiction. / The present thesis proposes that posttraumatic stress disorder (PTSD) and addiction both involve dysfunctions of memory reactivation, which might be responsible for the frequent and intense revivals that characterized them. This dysfunction could be based upon the uncoupling of monoaminergic systems, already demonstrated after repeated drugs exposures, resulting in noradrenergic dependent behavioral and neurochemical sensitizations. Our data show that 1) the selected PTSD animal model (SPS) reproduces PTSD symptoms, including a reactivity to reminder cues, 2) SPS induced a noradrenergic dependent locomotor sensitization, modulated by the novelty seeking 3) repeated injections of drugs mimic several PTSD symptoms and induce a behavioral sensitization modulated by novelty seeking, 4) locomotor sensitization can also be induced by exposure to drug associated cues and 5) a treatment combining both a positive state and a traumatic memory reactivation reduces PTSD symptoms, suggesting an emotional remodeling, which could be considered as a new therapeutic approach. This first corpus of results supports our hypothesis of common physiological basis between PTSD and addiction.

The objective of this study was to examine the relations between Posttraumatic Stress Disorder symptomatology and intelligence. Thirty American combat veterans of the Vietnam War, diagnosed with chronic PTSD, were given a psychodiagnostic structured interview. Participants were assessed for Intelligence Quotient as well as the veracity of their self report. The study found that there were significant differences in how participants experienced their PTSD symptoms that were correlated with intelligence. The higher IQ participants reported more frequent and intense guilt related symptoms as well as more intense intrusive recollections. The lower IQ participants experienced more frequent startle responses, more intense problems related to falling or remaining asleep and more frequent affective symptoms related to emotional numbing. Psychologists could use these differences in how PTSD is experienced in treatment planning. It may be useful for therapy to address sleep disturbances and affective numbing in lower IQ individuals. Therapy for higher IQ individuals may be more useful if it addresses feelings of guilt and intrusive recollections.

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