Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study

Objective

There has been uncertainty about whether refugees and asylum seekers with PTSD can be treated effectively in standard psychiatric settings in industrialized countries. In this study, Narrative Exposure Therapy (NET) was compared to Treatment As Usual (TAU) in 11 general psychiatric health care units in Norway. The focus was on changes in symptom severity and in the diagnostic status for PTSD and depression.

Method

Refugees and asylum seekers fulfilling the DSM-IV criteria for PTSD (N = 81) were randomized with an a-priori probability of 2:1 to either NET (N = 51) or TAU (N = 30). The patients were assessed with Clinician Administered PTSD Scale, Hamilton rating scale for depression and the MINI Neuropsychiatric Interview before treatment, and again at one and six months after the completion.

Results

Both NET and TAU gave clinically relevant symptom reduction both in PTSD and in depression. NET gave significantly more symptom reduction compared to TAU as well as significantly more reduction in participants with PTSD diagnoses. No difference in treatment efficacy was found between refugees and asylum seekers.

Conclusions

The study indicated that refugees and asylum seekers can be treated successfully for PTSD and depression in the general psychiatric health care system; NET appeared to be a promising treatment for both groups.

ClinicalTrials.gov registry number

NCT00218959.     

Agonistic behavior and growth in newly emerged brown trout (Salmo trutta L) of sea‐ranched and wild origin

Selection experiments and game theory models have revealed that the changes in agonistic behavior following selection for rapid growth rate of fish depend on the access of food. If food is spatially restricted and in excess of demand, the intensity of agonistic behaviors will decrease. This prediction was tested in an experiment on wild and sea‐ranched brown trout (Salmo trutta L.) fry originating from a common stock. Agonistic behavior, activity, and specific growth rate were studied in tanks (56 × 56 cm) at high (159.4 fry/m²) and low (9.6 fry/m²) stocking densities given either a large or small food ration (3.0% and 1.5%, respectively, food per total body weight and day). Observations were done during 4 days in each trial. Generally, fry of sea‐ranched origin had a higher growth rate. No differences in activity were found. Intensity of agonistic behavior was higher among wild groups. There was a tendency for interaction between density and strain, e.g., wild fish were relatively more aggressive at higher densities. Food ration had no effect on level of agonistic behavior. These results indicate that the selection for rapid growth in hatcheries may indirectly select for reduced aggressiveness. Genetic integrity and diversity of wild populations may be threatened when interbreeding occurs between wild and hatchery fish. Aggr. Behav. 28:145–153, 2002. © 2002 Wiley‐Liss, Inc.     

MMPI profiles of women in codependency treatment.

The Minnesota Multiphasic Personality Inventory (MMPI) profiles of 73 women presenting themselves for treatment of codependency in a 10-day residential setting were examined. Results suggest a significant amount of psychopathology to be present in this population. More than 50% of these individuals produced clinically significant elevations of five or more scales, and 38% produced elevations on six or more scales.     

Effects of facial expression on working memory

In long‐term memory (LTM) emotional content may both enhance and impair memory, however, disagreement remains whether emotional content exerts different effects on the ability to maintain and manipulate information over short intervals. Using a working‐memory (WM) recognition task requiring the monitoring of faces displaying facial expressions of emotion, participants judged each face as identical (target) or not (non‐target) to that presented 2 trials back (2‐back). Negative expression was better and faster recognised, illustrated by higher target discriminability and target detection. Positive and negative expressions also induced a more liberal detection bias compared with neutral. Taking the preceding item into account, additional accuracy impairment (negative preceding negative target) and enhancement effects (negative or positive preceding neutral target) appeared. This illustrates a differential modulation of WM based on the affective tone of the target (mirroring LTM enhancement‐ and recognition bias effects), and of the preceding item (enhanced and impaired target detection).     

Panentheism and its neighbors

International Journal for Philosophy of Religion - In this paper I suggest that we should identify panentheism on a scale, with deism at one extreme and pantheism at the other. The surprising...     

Response production during extinction training is not sufficient for extinction of evaluative conditioning

Two high-powered experiments examined the role of evaluative response production in the extinction of evaluative conditioning (EC) by positioning EC in the procedural and conceptual framework of classical conditioning (CC). According to Rescorla's response inhibition hypothesis, more frequent responding during extinction training results in larger extinction during testing. Experiment 1 used three extinction conditions following response acquisition in an EC procedure: evaluative responses were measured only after extinction; after acquisition and after extinction; or were continuously measured after acquisition, during extinction and after extinction. Based on Rescorla's response inhibition hypothesis, we predicted that extinction of EC would be the highest in the third condition. Experiment 2 was aimed at further facilitating extinction of EC by encouraging participants to experience that their evaluation may change over the course of the experiment. To this end, half of the participants completed pre- and post-acquisition ratings prior to practicing continuous response expression in the extinction phase. Contrary to our predictions, no extinction of EC was observed in either of these experiments. We conclude that Rescorla's inhibition response hypothesis may not apply to EC and discuss the theoretical implications of this finding.     

Fried and Freud on the Acropolis; on duality in the base of psychoanalytic thinking

Freud was conflicted in relation to his religious background. On the one hand, he was very clear on his adherence to a scientific Weltanschauung. On the other, he was fascinated by the Moses figure and one may see a Judaist structure in his way of thinking. The aim of this paper is to reflect on this conflict and the question of faith in psychoanalysis. After looking at object and method in religion and psychoanalysis, the authors go into the concept of ‘psychic reality’ and its change in the history of psychoanalysis. Through an analysis of Freud’s A Disturbance of Memory on the Acropolis and the function of literature, it is claimed that faith may be seen as a condition for the sense of experiential reality.     

Is Symptomatic Long QT Syndrome Associated with Depression in Women and Men?

We examined whether long QT syndrome (LQTS) mutation carrier status or symptomatic LQTS are associated with depression, and whether there are sex differences in these potential relationships. The sample comprised 782 participants (252 men). Of the 369 genetically defined LQTS mutation carriers, 169 were symptomatic and 200 were asymptomatic. The control group consisted of 413 unaffected relatives. Depression was assessed using the Beck Depression Inventory-II (BDI-II). No association was found for LQTS mutation carrier status with depression. The multinomial logistic regression showed that LQTS mutation carrier men with arrhythmic events scored higher on depression compared with the control group, even when adjusting for age, β-blockers, antidepressants, and social support (OR = 1.09, 95 % CI [1.02, 1.15], p = .007). The binary logistic regression comparing symptomatic and asymptomatic LQTS mutation carriers showed that symptomatic LQTS was associated with depression in men (OR = 1.10, 95 % CI [1.03, 1.19], p = .009). The results were unchanged when additionally adjusted for education. These findings suggest that symptomatic LQTS is associated with depression in men but not in women. Overall, however, depression is more frequent in women than men. Thus, regular screening for depression in LQTS mutation carriers and their unaffected family members can be important.     

Consistency in physiological stress responses and electromyographic activity during induced stress exposure in women and men

Physiological responses serve the role as objective indicators of stress as well as a link between psychosocial stress and various health outcomes. The aim of the present exposure session was to compare different physiological stress responses (systolic and diastolic blood pressure, heart rate, urinary epinephrine and norepinephrine, salivary cortisol) as well as trapezius muscle activity, measured by surface electromyography, during mental and physical stress in 11 women and ten men. The results show significantly increased activity in all measures but cortisol and significant associations between sympathetic arousal and EMG activity. The association between sympathetic arousal and muscle activity is of importance for understanding the high prevalence of musculoskeletal disorders in mentally stressful but physically light work tasks. Men had higher blood pressure and a more pronounced increase in epinephrine output than women, whereas women had higher heart rate. It was concluded that sympathetic activity is more sensitive to moderately intense stress exposure than pituitary adrenocortical (cortisol) activity and that men respond to performance stress with more epinephrine output than women. Although the correlations between the different indicators of sympathetic arousal were high, together they could still only explain 30–70% of the inter-individual variance. Thus, several parameters are needed in order to obtain a reliable measure of sympathetic activity.