Editor-in-Chief: John A. Talbott, MD
ISSN: 0022-3018
Online ISSN: 1539-736X
Frequency: 12 issues / year
Ranking: Psychiatry 51/120
Impact Factor: 1.688
Article Summaries

REVIEW ARTICLE

Neurofeedback Treatment and PTSD: Effectiveness of Neurofeedback on PTSD and the Optimal Choice of Protocol
Karen Reiter, MD, Søren Bo Andersen, PhD, Jessica Carlsson, MD, PhD

To review the evidence on effectiveness and preferred protocol when using neurofeedback treatment on posttraumatic stress disorder (PTSD), a systematic search of PubMed, PsychInfo, Embase, and Cochrane databases was undertaken. Five studies were included in this review. Neurofeedback had a statistically significant effect in three studies. The optimistic results presented here qualify neurofeedback as probably efficacious for PTSD treatment.

ORIGINAL ARTICLES

Posttraumatic Stress Disorder-Related Hospitalizations in the U.S. (2002-2011): Rates, Co-occurring illnesses, suicidal ideation/self-harm, and hospital charges
Mark Haviland, PhD, Jim E. Banta, PhD, MPH, Janet L. Sonne, PhD, Peter Przekop, DO, PhD

The purpose of the present study was to evaluate PTSD–related hospitalizations in the United States (2002–2011). Over this period, there were an estimated 1,477,944 hospitalizations (915,591 women) with either a primary (reason for hospitalization) or secondary PTSD diagnosis. Population-based hospitalization rates rose from 2002 to 2011; women in the age range of 20 to 44 years had the highest rates and the steepest rise. Most of the hospitalizations for men and women younger than 45 years had been assigned a primary diagnosis of mental illness (including PTSD). Mood and substance use disorders were among the most common psychiatric diagnoses with PTSD. Suicidal ideation/suicide attempts declined with increasing age. The strongest predictor of this criterion was mood disorder, and its importance as a predictor increased as people aged. Total inflation-adjusted charges for all PTSD-related hospitalizations were $34.9 billion, with 36% being for hospitalizations where a mental illness (including PTSD) was the primary diagnosis.

The Burden of Repeated Mood Episodes in Bipolar I Disorder: Results from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC)
Thilo Deckersbach, PhD, Amy T. Peters, MA, Amy E. West, PhD, Lori Eisner, PhD, Jihyun Baek, MD

The aim of this study was to examine the association between previous mood episodes and clinical course/functioning in a community sample (National Epidemiological Survey on Alcohol and Related Conditions [NESARC]). Subjects (n = 909) met criteria for bipolar I disorder and provided data on number of previous episode recurrences. Number of previous mood episodes was used to predict outcomes at wave 1 and wave 2 of the NESARC. Recurrence was associated with poorer functioning, psychiatric and medical comorbidity, and increased odds of suicidality, disability, unemployment, and hospitalization at wave 1. Recurrences were associated with greater risk for new onset suicidality, psychiatric comorbidity, disability, unemployment, and poor functioning by wave 2. The course of bipolar disorder does worsen with progressive mood episodes but is attenuated in community, relative to clinical samples.

The Role of Generalized Explicit and Implicit Guilt and Shame in Interpersonal Traumatization and Posttraumatic Stress Disorder
Estelle Bockers, MSc, Stefan Röpke, MD, PhD, Lars Michael, PhD, Babette Renneberg, PhD, Christine Knaevelsrud, PhD

Interpersonally traumatized women either with PTSD (n = 28) or without PTSD (n = 32) and 32 nontraumatized women completed the Test of Self-Conscious Affect-3 and the Implicit Association Test to measure explicit and implicit guilt and shame. Explicit guilt and shame were significantly higher in women with PTSD than in traumatized women without PTSD. Traumatized women without PTSD showed significantly higher levels of explicit guilt and shame than nontraumatized women did. PTSD was associated with implicit guilt but not implicit shame. In addition to trauma-related guilt and shame, generalized explicit guilt and shame and implicit guilt seem to play a crucial role in PTSD.

Factor Structure of the PCL-5: Relationships among symptom clusters, anger, and impulsivity
Cherie Armour, PhD, Ateka Contractior, Tracie Shea, PhD, Jon D. Elhai, PhD, Robert H. Pietrzak, PhD, MPH

We evaluated six competing models of DSM-5 PTSD symptoms, including Anhedonia, Externalizing Behaviors, and Hybrid models, using confirmatory factor analyses in a sample of 412 trauma-exposed college students. We then examined whether PTSD symptom clusters were differentially related to measures of anger and impulsivity using Wald chi-square tests. All symptom clusters were associated with anger; the strongest association was between externalizing behaviors and anger (r = 0.54). All symptom clusters, except reexperiencing and avoidance, were associated with impulsivity, with the strongest association between externalizing behaviors and impulsivity (r = 0.49). A seven-factor Hybrid model provides superior fit to DSM-5 PTSD symptom data, with the externalizing behaviors factor being most strongly related to anger and impulsivity.

Understanding Perceptions of Anxiety Disorders and Their Treatment
Casey Schofield, PhD, Crystal Dea Moore, PhD, Anna Hall, BA, Meredith E. Coles, PhD

In a sample of 626 adults recruited via Amazon's Mechanical Turk, this study evaluated 1) perceptions of symptoms of anxiety disorders and depression, 2) perceived usefulness of coping approaches, and 3) awareness of available resources. Results indicated that participants generally recognized that symptoms warranted professional help, and recognition was associated with self-efficacy for seeking mental health care, but not with participants' own symptoms. Furthermore, participants perceived psychotherapy to be the most useful coping approach. In all, results suggest that there are areas for growth regarding mental health literacy for anxiety disorders.

Interrelationships Among Three Avoidant Coping Styles and their Relationship to Trauma, Peritraumatic Distress, and PTSD
Melanie D. Hetzel-Riggin, PhD, Christina L. Meads, MS

The present study sought to confirm if these three avoidant coping mechanisms are different constructs and how they relate to each other and the experience of trauma, peritraumatic distress, and PTSD. A total of 227 participants with a trauma history completed measures on trauma experience, peritraumatic distress, peritraumatic dissociation, secondary alexithymia, experiential avoidance, and PTSD. Structural equation modeling confirmed that peritraumatic dissociation, secondary alexithymia, and experiential avoidance influence different phases of the development of traumatic stress problems.

Severity of Needs Among Individuals with Severe Mental Disorders: Changes at five-year follow-up
Marie-Josée Fleury, PhD, Guy Grenier, Jean-Marie Bamvita

This study aims to assess (1) changes in severity of needs among 204 individuals with severe mental disorders (SMD) at 5-year follow-up and (2) predictors of the overall change in severity of needs. Severity of needs in 26 areas was compared at three different times. Over the 5-year period, the severity of needs decreased significantly in five areas and increased significantly in only one. Predictors of overall change in severity of needs were related mostly to clinical and healthcare services variables. To better respond to needs, healthcare services should focus on more disadvantaged individuals with SMD and dual diagnosis, especially those who require basic education and help in securing food.

Decreased Self-Concept Clarity in People with Schizophrenia
David Colin Cicero, PhD, Elizabeth A. Martin, PhD, Theresa M. Becker, PhD, John G. Kerns, PhD

Participants with schizophrenia (N = 54) and healthy controls (N = 32) completed the Me Not-Me Decision Task (MNMDT), in which they decided whether 60 adjectives (30 pairs of antonyms) did or did not describe themselves. Self-concept clarify (SCC) is conceptualized as the number of consistent responses. Participants also completed the Self-Concept Clarity Scale (SCCS). Compared to healthy controls, participants with schizophrenia scored lower on the MNMDT and SCCS, and scores were negatively correlated with positive and negative symptoms. In a simultaneous regression, SCCS scores were uniquely associated with positive symptoms, whereas MNMDT scores were uniquely associated with negative symptoms. This suggests that people with schizophrenia have decreased self-concept clarity that is related to positive and negative symptoms.

BRIEF REPORTS
Hypersensitivity to Contingent Behavior in Paranoia: A new virtual reality paradigm
Miriam Fornells-Ambrojo, PhD, DClinPsy, PGDip, Maaike Elenbaas, DClinPsy, Chris Barker, PhD, David Swapp, PhD, Xavier Navarro, MSc, Aitor Rovira, MSc, Josep Maria Sanahuja, MSc, Mel Slater, DSc

Sixty-one healthy participants were randomly allocated to have a social interaction with a pleasant virtual human (avatar) programmed to be highly responsive or not (high/low contingency). Perceived trustworthiness and trusting behavior were assessed alongside control variables attachment and anxiety. Higher paranoia and dismissive attachment were associated with larger interpersonal distances. Unexpectedly, extremely paranoid individuals experienced the highly contingent avatar as more trustworthy than their low contingency counterpart. Higher dismissive attachment was also associated with more subjective trust in both conditions. Extreme paranoia is associated with hypersensitivity to noncontingent behavior.

Somatic Symptoms Mediate the Relationship Between Trauma During the Arab Spring and Quality of Life Among Tunisians
Soraya Hiar, MD, Charmaine Thomas, PhD, Devon Hinton, MD, PhD, Juliette Salles, MD, Nelly Goutaudier, PhD, Bertrand Olliac, MD, PhD, Eric Bui, MD

Participants (n = 60) completed an online survey 1 year after the events, assessing peritraumatic distress, peritraumatic dissociation, PTSD symptoms, somatic complaints, and physical and mental quality of life. Results showed that peritraumatic dissociation was independently associated with increased PTSD symptoms and somatic complaints 12 months after the events. Multiple mediator mediation analyses revealed that somatic complaints (not PTSD symptoms) were the only independent mediators of the relationships between peritraumatic dissociation and both physical and mental quality of life. Assessing peritraumatic dissociation soon after trauma exposure among the North African population might help identify individuals at risk for PTSD. Furthermore, the impact of trauma on quality of life may be better explained by somatic complaints than PTSD symptoms among North Africans.

Caregiver Positive and Negative Appraisals: Effects of the National Alliance on Mental Illness Family-to-Family Intervention
Michael J. Toohey, PhD, Anjana Muralidharan, PhD, Deborah Medoff, PhD, Alicia Lucksted, PhD, Lisa Dixon, MD, MPH

The 3-month-long Family-to-Family intervention (FTF) has been shown to increase empowerment, knowledge, and coping and to reduce distress among caregivers of people with serious mental illness. Family members of individuals with mental illness who sought enrollment in FTF (n = 318) were randomly assigned to FTF or a waitlist condition. Positive and negative appraisals were measured using the Experiences of Caregiving Inventory at baseline and 3 months later; 259 participants completed both assessments. Regression analyses found significant increases in positive appraisal, but no significant decreases in negative appraisals for those in the FTF condition.

BOOK REVIEWS

Fatal Pauses: Getting Unstuck Through the Power of No and the Power of Go. Stuart C. Yudofsky, MD (2015) Washington, DC, and London, England: American Psychiatric Publishing. 575 pp.
Reviewed by Pedro Ruiz, MD.

Transference-Focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide. Frank E. Yeomans, MD, PhD, John F. Clarkin, PhD, and Otto F. Kernberg, MD (2015) Arlington, VA: American Psychiatric Publishing. 427 pp.
Reviewed by Radu V. Saveanu, MD.

DSM-5 Self Exam Questions: Test Questions For The Diagnostic Criteria. Philip R. Muskin, MD (2014) Arlington, VA: American Psychiatric Publishing. 479 pp.
Reviewed by Stephen Scheiber, MD.

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Dr. Talbott and Lippincott Williams & Wilkins
wish to thank the
University of Maryland School of Medicine
Department of Psychiatry
for their support of
The Journal of Nervous and Mental Disease 

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