Frontiers in psychiatry
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Frontiers in psychiatry · Jan 2018
Psychosocial Predictors of Postpartum Posttraumatic Stress Disorder in Women With a Traumatic Childbirth Experience.
Objective: To analyze the predictive value of antepartum vulnerability factors, such as social support, coping, history of psychiatric disease, and fear of childbirth, and intrapartum events on the development of symptoms of postpartum posttraumatic stress disorder (PP-PTSD) in women with a traumatic childbirth experience. Materials and methods: Women with at least one self-reported traumatic childbirth experience in or after 2005 were invited to participate through various social media platforms in March 2016. They completed a 35-item questionnaire including validated screening instruments for PTSD (PTSD Symptom Checklist, PCL-5), social support (Oslo social support scale, OSS-3), and coping (Antonovsky's sense of coherence scale, SoC). ⋯ A predictive model which could differentiate between women fulfilling vs. not fulfilling the symptom criteria for PTSD had a sensitivity of 80.8% and specificity of 62.6% with an accuracy of 66.5%. Conclusions: Low social support, poor coping, experiencing "threatened death" and experiencing "actual or threatened injury to the baby" were the four significant factors in the predictive model for women with a traumatic childbirth experience to be at risk of developing PP-PTSD. Further research should investigate the effects of interventions aimed at the prevention of PP-PTSD by strengthening coping skills and increasing social support, especially in women at increased risk of unfavorable obstetrical outcomes.
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Frontiers in psychiatry · Jan 2018
Evaluation of the Association Between Genetic Variants in Circadian Rhythm Genes and Posttraumatic Stress Symptoms Identifies a Potential Functional Allele in the Transcription Factor TEF.
Previous studies suggest that genetic variants within genes affecting the circadian rhythm influence the development of posttraumatic stress symptoms (PTSS). In the present study, we used data from three emergency care-based cohorts to search genetic variants in circadian pathway genes previously associated with neuropsychiatric disorders for variants that influence PTSS severity. The three cohorts used included a discovery cohort of African American men and women enrolled following motor vehicle collision (n = 907) and two replication cohorts: one of multi-ethnic women enrolled following sexual assault (n = 274) and one of multi-ethnic men and women enrolled following major thermal burn injury (n = 68). ⋯ Further analysis of genetic variants in the genetic region surrounding TEFrs5758324 (±125,000 nucleotides) indicated that this allele showed the strongest association. Further, TEF RNA expression levels (determined via RNA-seq) were positively associated with PTSS severity in distressed individuals with at least one copy of the TEFrs5758324 minor allele. These results suggest that rs5758324 genetic variant in TEF, a regulator of clock-controlled genes and key mediator of the core circadian rhythm, influence PTSS severity in a stress-dependent manner.
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Frontiers in psychiatry · Jan 2018
Transcranial Magnetic Stimulation of Medial Prefrontal and Cingulate Cortices Reduces Cocaine Self-Administration: A Pilot Study.
Previous studies have shown that repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex may serve as a potential treatment for cocaine use disorder (CUD), which remains a public health problem that is refractory to treatment. The goal of this pilot study was to investigate the effect of rTMS on cocaine self-administration in the laboratory. In the self-administration sessions, CUD participants chose between cocaine and an alternative reinforcer (money) in order to directly measure cocaine-seeking behavior. The rTMS was delivered with the H7 coil, which provides stimulation to the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC). These brain regions were targeted based on previous imaging studies demonstrating alterations in their activation and connectivity in CUD. ⋯ Taken in the context of the existing literature, these results contribute to the data showing that high frequency rTMS to the prefrontal cortex may serve as a potential treatment for CUD.
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Frontiers in psychiatry · Jan 2018
Protecting Life While Preserving Liberty: Ethical Recommendations for Suicide Prevention With Artificial Intelligence.
In the United States, suicide increased by 24% in the past 20 years, and suicide risk identification at point-of-care remains a cornerstone of the effort to curb this epidemic (1). As risk identification is difficult because of symptom under-reporting, timing, or lack of screening, healthcare systems rely increasingly on risk scoring and now artificial intelligence (AI) to assess risk. AI remains the science of solving problems and accomplishing tasks, through automated or computational means, that normally require human intelligence. ⋯ Only in the last few years has it been applied rigorously in suicide risk prediction and prevention. Applying AI in this context raises significant ethical concern, particularly in balancing beneficence and respecting personal autonomy. To navigate the ethical issues raised by suicide risk prediction, we provide recommendations in three areas-communication, consent, and controls-for both providers and researchers (2).
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Japan recently ordered a string of death sentences for offenders with mental illness. Based on the verdicts, we describe cases where one or more psychiatrists conducted psychiatric evaluations for several months and testified in lay judge courts. We compared these cases with those in which the death penalty was avoided, or the mandating treatment order was applied. ⋯ The death penalty also eliminates the possibility of treatment or rehabilitation, despite the fact that psychiatrists should support the possibility of treatment or rehabilitation in all cases. Further, the Japanese Penal Code does not permit execution for those mentally ill deemed unable to receive sentence; however, it is unclear who will conduct these evaluations and how they will do so. We describe our beliefs of how psychiatrists should act in these situations.