ResumoObjetivo: Avaliar a presença de sintomas psicopatológicos em mulheres vítimas de violência doméstica (VD) que procuraram uma delegacia de defesa da mulher. Métodos: Foram avaliadas mulheres com idade entre 20 e 50 anos que deram entrada em uma delegacia da mulher com queixa de VD. Durante a entrevista, todas foram submetidas ao Relatório de Indicadores Sociais e preencheram os seguintes instrumentos de autoaplicação: Inventário de Depressão de Beck, Inventário de Ansiedade de Beck, Post-Traumatic Stress Disorder Checklist -Civilian Version e o Questionário de Experiências Dissociativas Peritraumáticas (todos em língua portuguesa). Foram usadas notas de corte a partir dos estudos de validação desses instrumentos para categorizar indivíduos com alta probabilidade de apresentar transtorno depressivo maior, transtorno de ansiedade, transtorno de estresse pós-traumático, ou alta/baixa dissociação peritraumática. Resultados: Foram avaliadas 17 mulheres com idade média de 34,7±7,7 anos. O tempo médio de duração da violência foi de 9,1±8,7 anos. Do total de mulheres, 53% eram vítimas de agressão excessiva e 84% eram ameaçadas de morte pelo companheiro; em 71% dos casos, os companheiros eram usuários de drogas. Além disso, 53% das mulheres afi rmaram ter sofrido VD na infância. Do total da amostra, 89% tiveram grande probabilidade de apresentar transtorno depressivo maior, 94% transtorno de ansiedade, 76% transtorno de estresse pós-traumático e 88% apresentaram elevados níveis de experiências dissociativas peritraumáticas. Conclusão: As vítimas de VD que dão entrada em delegacias de defesa da mulher têm alta probabilidade de apresentar morbidade psiquiátrica, assim como alterações cognitivas que as impossibilitam de sair do ciclo da violência. Descritores: Mulheres maltratadas, transtornos dissociativos, transtornos de estresse pós-traumáticos, violência doméstica. AbstractObjective: To assess the presence of psychopathological symptoms in women victims of domestic violence who seek help at police units offering women's protective services. Methods: Women aged between 20 and 50 years who sought help at women's protective services complaining of domestic violence were assessed. During the interview, all participants were submitted to assessment using a Social Indicator Report and fi lled in the following self-report instruments: Beck Depression Inventory, Beck Anxiety Inventory, Post-Traumatic Stress Disorder Checklist -Civilian Version, and the Peritraumatic Dissociative Experiences Questionnaire (all in Brazilian Portuguese). Cut-off points were established based on instrument validation studies and were used to identify subjects with a high probability of having major depressive disorder, anxiety disorder, post-traumatic stress disorder, or high/low peritraumatic dissociation. Results: Seventeen women with a mean age of 34.7±7.7 years were assessed. Average duration of exposure to domestic violence was 9.1±8.7 years. Of the total sample, 53% were exposed to excessive violence and 84% received death threats from t...
Background Posttraumatic stress disorder (PTSD) is a prevalent, chronic, and severe disorder related to traumatic events. Women are disproportionately affected by PTSD than men and are more at risk in the occurrence of sexual assault victimization. Estimates suggest that 50% of women develop PTSD following sexual assault and successful clinical management can be challenging. Growing evidence has implicated neural, immune, and endocrine alterations underpinning PTSD, but only few studies have assessed the evolution of acute PTSD in women. Objective This study aims to measure whether the onset of PTSD is associated with accelerated aging in women following sexual assault. We hypothesize that the increase of allostatic load caused by PTSD leads to neuroprogression. We will implement a randomized clinical trial to compare responses to treatment with either interpersonal psychotherapy adapted for PTSD (IPT-PTSD) or the selective serotonin reuptake inhibitor sertraline. Methods We will include women between 18 and 45 years of age, who experienced sexual assault from 1 to 6 months before the initial evaluation, and present with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnosis of PTSD. Baseline evaluation will comprise clinical and psychometric assessments, structural and functional magnetic resonance imaging, neuropsychological testing, polysomnography, evaluation of immune and endocrine parameters, and genetic analyses. Age-matched female healthy controls will be included and subjected to the same evaluation. Patients will be randomized for treatment in 1 of the 2 arms of the study for 14 weeks; follow-up will continue until 1 year after inclusion via treatment as usual. The researchers will collect clinical and laboratory data during periodic clinical assessments up to 1-year follow-up. Results Data collection started in early 2016 and will be completed by the end of the first semester of 2020. Analyses will be performed soon afterward, followed by the elaboration of several articles. Articles will be submitted in early 2021. This research project has obtained a grant from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2014/12559-5). Conclusions We expect to provide insight into the consequences of recent sexual assault exposure in women by investigating the degree of neuroprogression developing from an early stage of PTSD. We also expect to provide important evidence on the efficacy of a non-exposure psychotherapy (IPT-PTSD) to mitigate PTSD symptoms in recently sexually assaulted women. Further, we aim to obtain evidence on how treatment outcomes are associated with neuroprogression measures. Trial Registration Brazilian Clinical Trials Registry RBR-3z474z; http://www.ensaiosclinicos.gov.br/rg/RBR-3z474z/ International Registered Report Identifier (IRRID) DERR1-10.2196/19162
Scientific evidence showed significant correlations between symptoms of posttraumatic stress disorder (PTSD) and deficits in cognitive processing. Understanding how these deficits correlate with symptoms of PTSD in prospective studies can provide arguments to improve explanatory models of pathological mechanisms of this disorder. Our objective was to prospectively evaluate adult victims of urban violence suffering from PTSD, considering its impact on attention, executive functions, and the factors associated with these changes. We reapplied a battery of neuropsychological tests on a cohort of 43 patients with PTSD due to urban violence. We also reapplied the Clinician Administered PTSD Scale (CAPS) and the Beck Depression Inventory (BDI-I) scales. We administered a battery of neuropsychological tests: Wechsler Adult Intelligence Scale (WAIS-III) Digit Span, Wechsler's Memory Scale-Revised (WMS-III), Spatial Span, Stroop, and Wisconsin Card Sort Test (WCST). Patients showed a clinical improvement evidenced by a statistically significant decrease in CAPS and BDI scores at follow-up. Regarding neuropsychological testing, significant differences were found at follow ups such as a reduced number of perseverative errors in WCST (p ϭ .004) and an increase in the span of the backward digit subtest (p ϭ .007). These changes are directly associated with education level (p ϭ .030), and PTSD symptoms (p ϭ .005). Patients on average showed an improvement in PTSD and depression symptoms at reevaluation. The data showed an improvement in cognitive performance of executive functions such as working memory and cognitive flexibility over the years. These enhancements are significant for patients with more years of study, and for those that have recovered clinically, showing fewer symptoms of depression PTSD.
Resumo O Transtorno de Estresse Pós-Traumático (TEPT) é frequentemente associado a déficits cognitivos, porém ainda existem divergências com relação as funções cognitivas afetadas. O objetivo do presente estudo foi avaliar o impacto do TEPT na memória operacional, na memória visual de curto prazo, na memória episódica de longo prazo, na memória semântica de longo prazo e na memória prospectiva. A amostra foi composta por 20 mulheres com idades entre 20 e 60 anos, sendo 10 mulheres provenientes do Programa de Atendimento e Pesquisa em Violência da Universidade Federal de São Paulo (PROVE) com diagnóstico de TEPT (GTEPT) e 10 mulheres controle com a mesma idade e escolaridade (GC). O instrumento utilizado foi o Instrumento de Avaliação Neuropsicológica Breve (NEUPSILIN). Os dados foram analisados por teste t de Student para amostras dependentes e o nível de significância adotado foi de 5%. Os resultados obtidos a partir da análise do NEUPSILIN apontam para prejuízos na memória operacional (p = 0,04) e na memória prospectiva (p = 0,02) associados ao TEPT. Porém não foram observadas diferenças entre os grupos no que diz respeito aos outros tipos de memória investigados (p > 0,05). Os achados deste estudo, com relação aos prejuízos na memória operacional e na memória prospectiva associados ao TEPT estão de acordo com a literatura. Ambas funções são de extrema importância para o desempenho de atividades cotidianas, portanto, a intervenção e reabilitação destas funções no sujeito com TEPT podem auxiliar significativamente na melhora da qualidade de vida.
Background: Peritraumatic dissociation has become increasingly important for both the diagnosis and the prognosis of Post-traumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD). Changes in inflammatory mediators, immune-related genes and alterations of the hypothalamic-pituitary adrenal axis are suggestive findings that support the role of stress and neurodegeneration that might result in negative cognitive outcomes, such as dementia and other comorbidities. This study aims to describe an ASD case with persistent peritraumatic dissociation, its evolution to PTSD and the concomitant early onset demential syndrome. Methods and Findings: The patient, a woman, victim of urban violence, experienced peritraumatic dissociation; she was diagnosed with ASD and later developed PTSD and concomitant EOD, the latter being an unexpected and devastating outcome. Dissociative symptoms and cognitive impairment persisted throughout the patient's clinical status evolution. Moreover, the patient underwent a full psychiatric interview and was assessed through a battery of neuropsychological tests, neuroimage studies and a complementary examination. Over two years, no proposed treatment was satisfactory for improving her symptoms of PSTD and the neuropsychological evaluation confirmed EOD. Conclusion: This case illustrates that peritraumatic and persistent dissociation can be a possible psychopathological marker of neurodegeneration and an important factor for causing irreversible functional impairment.
UNSTRUCTURED Posttraumatic stress disorder (PTSD) is a prevalent, chronic, and severe disorder related to traumatic events. Growing evidence has implicated neural, immune, and endocrine alterations underpinning PTSD, but few studies have assessed the evolution of acute PTSD in women. The present study aims to measure whether the onset of PTSD is associated with accelerated aging in women following sexual assault. We hypothesize that the increase of allostatic load caused by PTSD leads to neuroprogression. A randomized controlled trial will also be performed to compare responses to treatment with either interpersonal psychotherapy adapted for PTSD or with the selective serotonin reuptake inhibitor, sertraline. We will include women between 18 and 45 years of age, who experienced sexual assault from 1 to 6 months before the initial evaluation and presented with a diagnosis of PTSD according to the DSM-5. Baseline evaluation will comprise clinical and psychometric assessments, magnetic resonance imaging, neuropsychological testing, polysomnography, immune and endocrinal parameters, and genetic analyses. Age-matched female healthy controls will be included and subjected to the same evaluation. Patients will be randomized for treatment in one of the two arms of the study for 14 weeks; follow-up will continue until 1 year after inclusion via treatment as usual. The researchers will collect clinical and laboratory data during periodic clinical assessments up to 1-year follow-up. We expect to provide insight into the consequences of recent sexual assault exposure in women by investigating the degree of neuroprogression developing from an early stage of PTSD. Since PTSD is often challenging to successful treatment, our research may provide important evidence on the efficacy of a non-exposure psychotherapy technique to mitigate symptoms. We aim to obtain evidence on how biological measures are associated with PTSD and treatment response. Trial Registration: RBR-3z474z. Registered 24th of March 2015.
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