Jose Paulo Fiks

Transgenerational transmission of trauma and resilience: a qualitative study with Brazilian offspring of Holocaust survivors

BackgroundOver the past five decades, clinicians and researchers have debated the impact of the Holocaust on the children of its survivors. The transgenerational transmission of trauma has been explored in more than 500 articles, which have failed to reach reliable conclusions that could be generalized. The psychiatric literature shows mixed findings regarding this subject: many clinical studies reported psychopathological findings related to transgenerational transmission of trauma and some empirical research has found no evidence of this phenomenon in offspring of Holocaust survivors.MethodThis qualitative study aims to detect how the second generation perceives transgenerational transmission of their parents’ experiences in the Holocaust. In-depth individual interviews were conducted with fifteen offspring of Holocaust survivors and sought to analyze experiences, meanings and subjective processes of the participants. A Grounded Theory approach was employed, and constant comparative method was used for analysis of textual data.ResultsThe development of conceptual categories led to the emergence of distinct patterns of communication from parents to their descendants. The qualitative methodology also allowed systematization of the different ways in which offspring can deal with parental trauma, which determine the development of specific mechanisms of traumatic experience or resilience in the second generation.ConclusionsThe conceptual categories constructed by the Grounded Theory approach were used to present a possible model of the transgenerational transmission of trauma, showing that not only traumatic experiences, but also resilience patterns can be transmitted to and developed by the second generation. As in all qualitative studies, these conclusions cannot be generalized, but the findings can be tested in other contexts.

Aripiprazole in the treatment of posttraumatic stress disorder: an open-label trial

OBJECTIVE Post traumatic stress disorder is frequent in the general population (7.8%-lifetime-USA). The selective serotonin reuptake inhibitors are the first choice of treatment but result in low remission rates. This study aims to evaluate the effect of aripiprazole monotherapy for the treatment of post traumatic stress disorder. METHOD Thirty-two patients diagnosed with post traumatic stress disorder were included in a 16-week open label trial of aripiprazole. They were evaluated at baseline, week 8, and 16 with the Clinician-Administered PTSD Scale, Beck Depression Inventory, Beck Anxiety Inventory, Medical Outcome Study Short Form 36, and Social Adjustment Scale. Statistical analysis were performed with an intention-to-treat approach and last observation carried forward. A general linear model for repeated measures comparing the factor with 3 continuous measures from baseline, 8 and 16 weeks was used. A between-subject factor was included RESULTS Nine patients discontinued the treatment. The mean aripiprazole dose was 9.6 (+/- 4.3) mg/day. The mean scores at baseline and endpoint for all measures were: Clinician-Administered PTSD Scale - 82.7 (+/- 23.1) and 51.4 (+/- 31.4) (F = 11.247, p = 0.001); Beck Anxiety Inventory - 31.7 (+/- 13.4) and 25.4 (+/- 18.2) (F = 8.931, p = 0.011); Social Adjustment Scale - 2.4 (+/- 0.45) and 2.27 (+/- 0.57) (F = 8.633, p = 0.012); Medical Outcome Study Short Form 36 - 76.6 (+/- 14.11) and 94.01 (+/- 25.06) (F = 10.127 p = 0.007); and Beck Depression Inventory - 26.06 (+/- 11.6) and 21.35 (+/- 12.6) (F = 1.580, p = 0.042). In all measurements, the differences were statistically significant. CONCLUSIONS Patients achieved a good response to treatment with aripiprazole, but placebo-controlled studies are needed for more accurate results.

Gravidade psicopatológica em mulheres vítimas de violência doméstica

OBJECTIVE: To assess the presence of psychopathological symptoms in women victims of domestic violence who seek help at police units offering womens protective services. METHODS: Women aged between 20 and 50 years who sought help at womens protective services complaining of domestic violence were assessed. During the interview, all participants were submitted to assessment using a Social Indicator Report and filled 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 their partners; 71% of the partners were drug abusers. In addition, 53% of the women reported exposure to domestic violence during childhood. From the total sample, 89% presented a high probability of having major depressive disorder, 94% anxiety disorder, 76% post-traumatic stress disorder, and 88% showed high scores of peritraumatic dissociative experiences. CONCLUSION: Victims of violence seeking help at womens protective services showed a high probability of having psychiatric morbidities cognitive dysfunction that prevent these women from interrupting exposure to this specific type of violence.

A randomized, double-blind, placebo-controlled trial to assess the efficacy of topiramate in the treatment of post-traumatic stress disorder

BackgroundTopiramate might be effective in the treatment of posttraumatic stress disorder (PTSD) because of its antikindling effect and its action in both inhibitory and excitatory neurotransmitters. Open-label studies and few controlled trials have suggested that this anticonvulsant may have therapeutic potential in PTSD. This 12-week randomized, double-blind, placebo-controlled clinical trial will compare the efficacy of topiramate with placebo and study the tolerability of topiramate in the treatment of PTSD.Methods and designSeventy-two adult outpatients with DSM-IV-diagnosed PTSD will be recruited from the violence program of Federal University of São Paulo Hospital (UNIFESP). After informed consent, screening, and a one week period of wash out, subjects will be randomized to either placebo or topiramate for 12 weeks. The primary efficacy endpoint will be the change in the Clinician-administered PTSD scale (CAPS) total score from baseline to the final visit at 12 weeks.DiscussionThe development of treatments for PTSD is challenging due to the complexity of the symptoms and psychiatric comorbidities. The selective serotonin reuptake inhibitors (SSRIs) are the mainstream treatment for PTSD, but many patients do not have a satisfactory response to antidepressants. Although there are limited clinical studies available to assess the efficacy of topiramate for PTSD, the findings of prior trials suggest this anticonvulsant may be promising in the management of these patients.Trial RegistrationNCT 00725920

The Concept of Peritraumatic Dissociation A Qualitative Approach

Peritraumatic dissociation has been considered an important feature for the development of post-traumatic stress disorders, but this concept remains widely unclear. To explore the peritraumatic experience, we interviewed eight victims of urban violence shortly after their traumatic events. The data collected were compared and analyzed according to the systematic set of procedures of Grounded Theory (GT). The alterations reported by participants were coded and categorized according to their perceptions of their inner and outer world, and the impressions of others involved, including the examiner’s observations. The theoretical perspective for interpreting this study has parallels with Jaspers’ psychopathology. Peritraumatic dissociation was conceived as a failure of synthesis among emerging stimuli from the internal and the external world, including the time–space flow structure, even when cognitive–perceptual tools remain intact. This synthesis qualifies the totality of the perceptual experience as coherent and meaningful to conscience, enabling possibilities for being/existing.

Evolucionismo e genética do transtorno de estresse pós-traumático

Os autores discutem, a partir do conceito evolutivo, como a resposta de estresse, nas suas possibilidades de fuga e luta e de imobilidade tonica, pode levar a uma nova compreensao etiologica do transtorno de estresse pos-traumatico. Atraves da analise dos agrupamentos de sintomas desse diagnostico - revivencia, evitacao e hiperexcitacao -, procuram correlacionar os achados neurobiologicos e evolutivos. As descobertas atuais sobre a genetica do transtorno de estresse pos-traumatico sao resumidas e colocadas nessa perspectiva evolutiva, dentro de conceitos que possibilitam o entendimento da interacao gene/ambiente, como a epigenetica. Propoem que a pesquisa dos fatores de risco do transtorno de estresse pos-traumatico deva ser investigada do ponto de vista fatorial, onde a somatoria destes aumenta o risco de desenvolvimento do quadro, nao sendo possivel a procura da causa do transtorno de forma unica. A pesquisa de genes candidatos no transtorno de estresse pos-traumatico deve levar em consideracao todos os sistemas associados aos processos de respostas ao estresse, sistemas dos eixos hipotalamo-hipofisario-adrenal e simpatico, mecanismos de aprendizado, formacao de memorias declarativas, de extincao e esquecimento, da neurogenese e da apoptose, que envolvem varios sistemas de neurotransmissores, neuropeptideos e neuro-hormonios.