The Posttraumatic Stress Disorder Checklist (PCL) is a widely used DSM‐correspondent self‐report measure of PTSD symptoms. The PCL was recently revised to reflect DSM‐5 changes to the PTSD criteria. ...In this article, the authors describe the development and initial psychometric evaluation of the PCL for DSM‐5 (PCL‐5). Psychometric properties of the PCL‐5 were examined in 2 studies involving trauma‐exposed college students. In Study 1 (N = 278), PCL‐5 scores exhibited strong internal consistency (α = .94), test‐retest reliability (r = .82), and convergent (rs = .74 to .85) and discriminant (rs = .31 to .60) validity. In addition, confirmatory factor analyses indicated adequate fit with the DSM‐5 4‐factor model, χ2(164) = 455.83, p < .001, standardized root mean square residual (SRMR) = .07, root mean squared error of approximation (RMSEA) = .08, comparative fit index (CFI) = .86, and Tucker‐Lewis index (TLI) = .84, and superior fit with recently proposed 6‐factor, χ2 (164) = 318.37, p < .001, SRMR = .05, RMSEA = .06, CFI = .92, and TLI = .90, and 7‐factor, χ2 (164) = 291.32, p < .001, SRMR = .05, RMSEA = .06, CFI = .93, and TLI = .91, models. In Study 2 (N = 558), PCL‐5 scores demonstrated similarly strong reliability and validity. Overall, results indicate that the PCL‐5 is a psychometrically sound measure of PTSD symptoms. Implications for use of the PCL‐5 in a variety of assessment contexts are discussed.
Resumen
Spanish s by the Asociacion Chilena de Estres Traumatico
Lista de verificación del Trastorno por Estrés Postraumatico para el
DSM‐5
La lista de verificación del Trastorno por Estrés Post‐Traumático (LVP o PCL por sus siglas en ingles: Posttraumatic Stress Disorder Checklist) es una medida DSM‐correspondiente de auto‐reporte de síntomas de TEPT ampliamente usada. La LVP fue recientemente revisada para reflejar los cambios DSM‐5 a los criterios de TEPT. Este artículo describe el desarrollo y evaluación psicométrica inicial de LVP para DSM‐5 (LVP‐5). Fueron examinadas propiedades psicométricas de LVP‐5 en dos estudios que involucraron estudiantes universitarios expuestos a trauma. En el estudio 1 (N = 278) las puntuaciones LVP‐ 5 exhibían fuerte consistencia interna (a = .94), y confiabilidad test‐re‐test (r = .82), y convergente (rs = .74 a .85) y validez discriminativa (rs = .31 a .60). Adicionalmente, análisis factoriales confirmatorios indicaron un ajuste adecuado con el modelo cuatro‐factores DSM‐5, Χ2 (164) = 455.83, p < .001; raíz cuadrada media estandarizada residual (RMER) = .07; error cuadrado medio de aproximación (ECMA) = .08; Índice de Ajuste Comparativo (IAC) = .86; y el Índice Tucker‐Lewis (ITL) = .84, y ajuste superior con el recientemente propuesto seis‐ (Χ2 (164) = 318.37, p < .001; RMER = .05; ECMA = .06; IAC = .92; y ITL = .90 y siete‐ (Χ2 (164) = 291.32, p < .001; RMER = .05; ECMA = 0.6; IAC = .93; y ITL = .91) modelos factoriales. En el Estudio 2 (N = 558) las puntuaciones LVP‐5 demostraron similarmente fuerte confiabilidad y validez. En general, los resultados indican que el LVP‐5 es una medida psicométrica sólida de TEPT. Son discutidas las implicaciones para el uso de LVP‐5 en una variedad de contextos de evaluación.
抽象
Traditional and Simplified Chinese s by AsianSTSS
標題 : DSM‐5的創傷後壓力症檢查表(PCL‐5)發展和初步心理測量評估
撮要: 與《精神疾病診斷與統計手冊》對應的創傷後壓力症檢查表(PCL)是普遍為人使用的PTSD症狀自評測量工具༌其最近因配合DSM‐5對PTSD診斷準則的修改而更新。本論文描述PCL(PCL‐5)為配合DSM‐5作出的發展和PCL‐5的初步心理測量評估༌利用兩項有關受創大學生的研究檢視PCL‐5的心理測量特性。研究一(N = 278)的PCL‐5分數反映強的內部一致性(α = .94)、重測信度(r = .82)、匯聚(rs = .74 至 .85)及判別效度(rs = .31 至 .60)。驗證性因數分析亦顯示PCL‐5跟DSM‐5的四因素模型有足夠適配度༌χ2 (164) = 455.83, p < .001༌
標準化殘差均方根 (SRMR) = .07༌漸進誤差均方根(RMSEA) = .08༌比較適配指數 (CFI) = .86༌Tucker Lewis指數(TLI) = .84༛並與最近提出的六因素模型(χ2 (164) = 318.37, p < .001; SRMR = .05; RMSEA = .06; CFI = .92; and TLI = .90)及七因素模型(χ2 (164) = 291.32, p < .001; SRMR = .05; RMSEA = .06; CFI = .93; and TLI = .91)有優越適配度。研究二(N = 558)的PCL‐5分數反映相近強度的信度和效度。整體結果反映PCL‐5是測量PTSD的好方法。論文亦討論到在各種評估情境下使用PCL‐5的意味。
标题 : DSM‐5的创伤后压力症检查表(PCL‐5)发展和初步心理测量评估
撮要: 与《精神疾病诊断与统计手册》对应的创伤后压力症检查表(PCL)是普遍为人使用的PTSD症状自评测量工具༌其最近因配合DSM‐5对PTSD诊断准则的修改而更新。本论文描述PCL(PCL‐5)为配合DSM‐5作出的发展和PCL‐5的初步心理测量评估༌利用两项有关受创大学生的研究检视PCL‐5的心理测量特性。研究一(N = 278)的PCL‐5分数反映强的内部一致性(α = .94)、重测信度(r = .82)、汇聚(rs = .74 至 .85)及判别效度(rs = .31 至 .60)。验证性因子分析亦显示PCL‐5跟DSM‐5的四因素模型有足够适配度༌χ2 (164) = 455.83, p < .001༌
标准化残差均方根 (SRMR) = .07༌渐进误差均方根(RMSEA) = .08༌比较适配指数 (CFI) = .86༌Tucker Lewis指数(TLI) = .84༛并与最近提出的六因素模型(χ2 (164) = 318.37, p < .001; SRMR = .05; RMSEA = .06; CFI = .92; and TLI = .90)及七因素模型(χ2 (164) = 291.32, p < .001; SRMR = .05; RMSEA = .06; CFI = .93; and TLI = .91)有优越适配度。研究二(N = 558)的PCL‐5分数反映相近强度的信度和效度。整体结果反映PCL‐5是测量PTSD的好方法。论文亦讨论到在各种评估情境下使用PCL‐5的意味。
Synaptic loss and deficits in functional connectivity are hypothesized to contribute to symptoms associated with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The ...synaptic vesicle glycoprotein 2A (SV2A) can be used to index the number of nerve terminals, an indirect estimate of synaptic density. Here, we used positron emission tomography (PET) with the SV2A radioligand
CUCB-J to examine synaptic density in n = 26 unmedicated individuals with MDD, PTSD, or comorbid MDD/PTSD. The severity of depressive symptoms was inversely correlated with SV2A density, and individuals with high levels of depression showing lower SV2A density compared to healthy controls (n = 21). SV2A density was also associated with aberrant network function, as measured by magnetic resonance imaging (MRI) functional connectivity. This is the first in vivo evidence linking lower synaptic density to network alterations and symptoms of depression. Our findings provide further incentive to evaluate interventions that restore synaptic connections to treat depression.
Summary Background For children with sickle cell anaemia and high transcranial doppler (TCD) flow velocities, regular blood transfusions can effectively prevent primary stroke, but must be continued ...indefinitely. The efficacy of hydroxycarbamide (hydroxyurea) in this setting is unknown; we performed the TWiTCH trial to compare hydroxyurea with standard transfusions. Methods TWiTCH was a multicentre, phase 3, randomised, open-label, non-inferiority trial done at 26 paediatric hospitals and health centres in the USA and Canada. We enrolled children with sickle cell anaemia who were aged 4–16 years and had abnormal TCD flow velocities (≥200 cm/s) but no severe vasculopathy. After screening, eligible participants were randomly assigned 1:1 to continue standard transfusions (standard group) or hydroxycarbamide (alternative group). Randomisation was done at a central site, stratified by site with a block size of four, and an adaptive randomisation scheme was used to balance the covariates of baseline age and TCD velocity. The study was open-label, but TCD examinations were read centrally by observers masked to treatment assignment and previous TCD results. Participants assigned to standard treatment continued to receive monthly transfusions to maintain 30% sickle haemoglobin or lower, while those assigned to the alternative treatment started oral hydroxycarbamide at 20 mg/kg per day, which was escalated to each participant's maximum tolerated dose. The treatment period lasted 24 months from randomisation. The primary study endpoint was the 24 month TCD velocity calculated from a general linear mixed model, with the non-inferiority margin set at 15 cm/s. The primary analysis was done in the intention-to-treat population and safety was assessed in all patients who received at least one dose of assigned treatment. This study is registered with ClinicalTrials.gov , number NCT01425307. Findings Between Sept 20, 2011, and April 17, 2013, 159 patients consented and enrolled in TWiTCH. 121 participants passed screening and were then randomly assigned to treatment (61 to transfusions and 60 to hydroxycarbamide). At the first scheduled interim analysis, non-inferiority was shown and the sponsor terminated the study. Final model-based TCD velocities were 143 cm/s (95% CI 140–146) in children who received standard transfusions and 138 cm/s (135–142) in those who received hydroxycarbamide, with a difference of 4·54 (0·10–8·98). Non-inferiority (p=8·82 × 10−16 ) and post-hoc superiority (p=0·023) were met. Of 29 new neurological events adjudicated centrally by masked reviewers, no strokes were identified, but three transient ischaemic attacks occurred in each group. Magnetic resonance brain imaging and angiography (MRI and MRA) at exit showed no new cerebral infarcts in either treatment group, but worsened vasculopathy in one participant who received standard transfusions. 23 severe adverse events in nine (15%) patients were reported for hydroxycarbamide and ten serious adverse events in six (10%) patients were reported for standard transfusions. The most common serious adverse event in both groups was vaso-occlusive pain (11 events in five 8% patients with hydroxycarbamide and three events in one 2% patient for transfusions). Interpretation For high-risk children with sickle cell anaemia and abnormal TCD velocities who have received at least 1 year of transfusions, and have no MRA-defined severe vasculopathy, hydroxycarbamide treatment can substitute for chronic transfusions to maintain TCD velocities and help to prevent primary stroke. Funding National Heart, Lung, and Blood Institute, National Institutes of Health.
Despite well-known peripheral immune activation in posttraumatic stress disorder (PTSD), there are no studies of brain immunologic regulation in individuals with PTSD.
CPBR28 Positron Emission ...Tomography brain imaging of the 18-kDa translocator protein (TSPO), a microglial biomarker, was conducted in 23 individuals with PTSD and 26 healthy individuals-with or without trauma exposure. Prefrontal-limbic TSPO availability in the PTSD group was negatively associated with PTSD symptom severity and was significantly lower than in controls. Higher C-reactive protein levels were also associated with lower prefrontal-limbic TSPO availability and PTSD severity. An independent postmortem study found no differential gene expression in 22 PTSD vs. 22 controls, but showed lower relative expression of TSPO and microglia-associated genes TNFRSF14 and TSPOAP1 in a female PTSD subgroup. These findings suggest that peripheral immune activation in PTSD is associated with deficient brain microglial activation, challenging prevailing hypotheses positing neuroimmune activation as central to stress-related pathophysiology.
Altered metabotropic glutamate receptor 5 markers in PTSD Holmes, Sophie E.; Girgenti, Matthew J.; Davis, Margaret T. ...
Proceedings of the National Academy of Sciences - PNAS,
08/2017, Letnik:
114, Številka:
31
Journal Article
Recenzirano
Odprti dostop
Posttraumatic stress disorder (PTSD) is a prevalent and highly disabling disorder, but there is currently no targeted pharmacological treatment for it. Dysfunction of the glutamate system has been ...implicated in trauma and stress psychopathology, resulting in a growing interest in modulation of the glutamate system for the treatment of PTSD. Specifically, the metabotropic glutamate receptor 5 (mGluR5) represents a promising treatment target. We used 18FFPEB, a radioligand that binds to the mGluR5, and positron emission tomography (PET) to quantify in vivo mGluR5 availability in human PTSD vs. healthy control (HCs) subjects. In an independent sample of human postmortem tissue, we investigated expression of proteins that have a functional relationship with mGluR5 and glucocorticoids in PTSD. We observed significantly higher cortical mGluR5 availability in PTSD in vivo and positive correlations between mGluR5 availability and avoidance symptoms. In the postmortem sample, we observed up-regulation of SHANK1, a protein that anchors mGluR5 to the cell surface, as well as decreased expression of FKBP5, implicating aberrant glucocorticoid functioning in PTSD. Results of this study provide insight into molecular mechanisms underlying PTSD and suggest that mGluR5 may be a promising target for mechanism-based treatments aimed at mitigating this disorder.
Intravenous (IV) subanesthetic doses of ketamine have been shown to reduce psychiatric distress in both major depressive (MDD) and posttraumatic stress disorder (PTSD). However, the effect of ...ketamine on cognitive function in these disorders is not well understood. To address this gap, we examined the effect of a single dose of IV ketamine on cognition in individuals with MDD and/or PTSD relative to healthy controls (HC). Psychiatric (n = 29; 15 PTSD, 14 MDD) and sex- age- and IQ matched HC (n = 29) groups were recruited from the community. A single subanesthetic dose of IV ketamine was administered. Mood and cognitive measures were collected prior to, 2 h and 1 day post-ketamine administration. MDD/PTSD individuals evidenced a large-magnitude improvement in severity of depressive symptoms at both 2-hours and 1 day post-ketamine administration (p's < .001, Cohen d's = 0.80-1.02). Controlling for baseline performance and years of education, IV ketamine induced declines in attention (ATTN), executive function (EF), and verbal memory (VM) 2 h post-administration, all of which had resolved by 1 day post-ketamine across groups. The magnitude of cognitive decline was significantly larger in MDD/PTSD relative to HC on attention only (p = .012, d = 0.56). Ketamine did not affect working memory (WM) performance. Cognitive function (baseline, change from baseline to post-ketamine) was not associated with antidepressant response to ketamine. Results suggest that while ketamine may have an acute deleterious effect on some cognitive domains in both MDD/PTSD and HC individuals, most notably attention, this reduction is transient and there is no evidence of ketamine-related cognitive dysfunction at 1 day post-administration.
Mothers with a history of childhood maltreatment (CM) are particularly vulnerable to postpartum mental health changes. Variability in mental health trajectories is present over the first 18-months ...postpartum. Little is known about the potentially unique impacts of post-traumatic change or resilience on later postpartum mental health.
Participants (N = 97) completed questionnaires over the first 18-months postpartum measuring demographic risk, mental health symptoms, traumatic experiences, and resilience. Mothers also completed an interview measure coded for post-traumatic changes at 6-months postpartum. Multinomial logistic regression models examined post-traumatic change and resilience factors as predictors of mothers' longitudinal latent mental health trajectory.
Three classes of latent postpartum mental health emerged: low-symptom, vulnerable, and chronic high-risk. Mothers reporting stronger positive post-traumatic changes were more likely to be in the low-symptom class than the chronic high-risk class (B = −1.082, p = .01). Mothers reporting stronger negative post-traumatic changes were more likely to be in the vulnerable class (B = 0.778, p = .006) or chronic high-risk class (B = 0.906, p = .046) than the low-symptom class. Resilience was not predictive of mental health class.
Findings are correlational, and causal effects between post-traumatic growth and mental health symptoms cannot be assumed. Mothers who consented to the interview may not be fully representative of all women who have experienced CM, limiting generalizability of findings.
Positive post-traumatic change is associated with reduced psychopathology. These findings may assist in identification of mothers at greater risk of adverse postpartum outcomes and futher inform interventions focused on enhancing positive changes in post-traumatic cognitions.
•Comorbid postpartum MDD and PTSD trajectories showed low-symptom, vulnerable, and chronic high-risk groups.•Both positive and negative post-traumatic change independently impacted postpartum depression and PTSD trajectories in mothers with childhood trauma history.•Resilience factors did not significantly impact differences in postpartum mental health trajectories.
Purpose: The purpose of this study was to evaluate the ability to discriminate yes/no questions from statements in three groups of children: bilateral cochlear implant (CI) users, nontraditional CI ...users with aidable hearing preoperatively in the ear to be implanted, and controls with normal hearing. Half of the nontraditional CI users had sufficient postoperative acoustic hearing in the implanted ear to use electric–acoustic stimulation, and half used a CI alone. Method: Participants heard recorded sentences that were produced either as yes/no questions or as statements by three male and three female talkers. Three raters scored each participant response as either a question or a statement. Bilateral CI users ( n = 40, 4–12 years old) and normal-hearing controls ( n = 10, 4–12 years old) were tested binaurally in the free field. Nontraditional CI recipients ( n = 22, 6–17 years old) were tested with direct audio input to the study ear. Results: For the bilateral CI users, performance was predicted by age but not by 125-Hz acoustic thresholds; just under half ( n = 17) of the participants in this group had measurable 125-Hz thresholds in their better ear. For nontraditional CI recipients, better performance was predicted by lower 125-Hz acoustic thresholds in the test ear, and there was no association with participant age. Performance approached that of the normal-hearing controls for some participants in each group. Conclusions: Results suggest that a 125-Hz acoustic hearing supports discrimination of yes/no questions and statements in pediatric CI users. Bilateral CI users with little or no acoustic hearing at 125 Hz develop the ability to perform this task, but that ability emerges later than for children with better acoustic hearing. These results underscore the importance of preserving acoustic hearing for pediatric CI users when possible.
Borderline personality disorder (BPD) is a serious and understudied mental health condition associated with profound personal and public health consequences. Methodological differences in ...characterizing BPD may limit understanding the scope of the disorder's prevalence and effect. For example, using different diagnostic rules for BPD can affect apparent prevalence, comorbidity, and clinical presentation. This study examined how differences in diagnostic rules used to assign BPD diagnosis impacted its prevalence and associations with clinically relevant variables (e.g., demographics, comorbidity, treatment-seeking). Participants were a nationally representative sample of 36,309 noninstitutionalized U.S. adults. All variables were assessed via clinical interview (Alcohol Use Disorder and Associated Disabilities Interview Schedule-5). Six diagnostic rules determined BPD status. We used frequencies to examine prevalence rates of and associations between BPD and other clinical variables, and logistic regressions to examine the associations between each BPD variable and the other outcomes. The prevalence of BPD ranged widely-from 0.5% to 11.4%-per the diagnostic rule used. Associations between BPD diagnosis and various outcomes and clinical variables generally remained stable across all diagnostic rules, though effects became more extreme as diagnostic rules became more restrictive. Additionally, meaningful differences emerged as a function of the number of items used (30 vs. 18 items) even with no other changes to diagnostic rules. The field examining BPD and associated problem behaviors should critically consider how to most effectively characterize BPD to understand these problems more accurately and optimize the generalizability of findings.
Recent evidence implicates dysregulation of metabotropic glutamatergic receptor 5 (mGluR5) in pathophysiology of PTSD and suicidality. Using positron emission tomography and 18FFPEB, we quantified ...mGluR5 availability in vivo in individuals with PTSD (n = 29) and MDD (n = 29) as a function of suicidal ideation (SI) to compare with that of healthy comparison controls (HC; n = 29). Volume of distribution was computed using a venous input function in the five key frontal and limbic brain regions. We observed significantly higher mGluR5 availability in PTSD compared with HC individuals in all regions of interest (P’s = 0.001–0.01) and compared with MDD individuals in three regions (P’s = 0.007). mGluR5 availability was not significantly different between MDD and HC individuals (P = 0.17). Importantly, we observed an up-regulation in mGluR5 availability in the PTSD-SI group (P’s = 0.001–0.007) compared with PTSD individuals without SI. Findings point to the potential role for mGluR5 as a target for intervention and, potentially, suicide risk management in PTSD.
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