Simone Hauck

Serum brain-derived neurotrophic factor in patients with trauma psychopathology

OBJECTIVE Brain-derived neurotrophic factor (BDNF) has an important role in learning, motivation and regulation of mood. The aim of this study was to investigate levels of serum BDNF in patients with trauma psychopathology (acute and post-traumatic stress disorder) when compared to age and gender matched controls. METHOD A consecutive sample of 34 patients was evaluated regarding socio-demographic and clinical variables by means of a standard protocol, Davidson Trauma Scale, Beck Depression Inventory, Clinical Global Impression and the Global Assessment of Functioning. BDNF serum levels were measured right after the intake interview. RESULTS Patients had higher BDNF levels than controls. Those levels, however, were higher right after the traumatic event, decreasing over time. When two groups of patients (recent and remote trauma) were investigated in separate, the recent trauma group (less than 1year since the traumatic event) had higher BDNF than controls, but this effect was not detected in the remote trauma group. The recent and remote trauma groups had different BDNF levels. Those findings persisted, even controlling for symptom severity, use of psychotropic medication, and history of psychiatric disease. CONCLUSIONS As far as we know this is the first report of elevated serum BDNF levels in patients with recent trauma. Based in animal models that implicate BDNF in memory formation and consolidation, higher BDNF in recent PTSD could be related to memory and learning disruption central in PTSD psychopathology.

Adaptação transcultural para o português brasileiro do Parental Bonding Instrument (PBI)

OBJETIVE: This article aims to present a cross-cultural adaptation of the Parental Bonding Instrument to Brazilian Portuguese. It is a self-administered questionnaire developed in 1979, which has been used since then to measure the subjective experience of being parented to the age of 16 years. METHOD: The following steps were performed: conceptual equivalence, item equivalence, semantic equivalence, operational equivalence, functional equivalence, and approval of the final version by the author of the original instrument. RESULTS: The study has reached the objectives of equivalence, and the final Brazilian Portuguese version has been approved by the original author. CONCLUSION: The study provides a Brazilian Portuguese version of an instrument that has been proven extremely useful in risk and resilience researches over the past decades, assessing the perception of parental characteristics traditionally related to personality development.

Confirmatory Factor Analysis of the Parental Bonding Instrument in a Brazilian Female Population

Objective: The Parental Bonding Instrument (PBI) is a widely used measure of parenting. Recent studies have proposed different factor structures. There is a disagreement in the literature about whether the PBI is best used as a two-factor or a three-factor measure. Method: Two hundred and fifty-seven female adults were recruited from a clinical population (139 psychiatric patients and 118 controls) and were requested to complete the PBI. Maximum likelihood confirmatory factor analyses were performed to compare the five different factor structures in terms of model fit. Results: The poorest fit to the data was obtained by the Parker et al. model. The Kendler model was the only model that had an adjusted goodness-of-fit index >0.8 regarding both paternal and maternal PBI. When considering invariance of factor structure across age subgroups, the Kendler model was also the only acceptable model. Conclusion: Three-factor structures are preferable to two-factor structures. The Kendler model was the only one to provide an acceptable fit, but it must be considered that it was a female sample, and when considering gender subgroups other studies have found the same results. Despite the gender limitation, the present study contributes to a better understanding and use of the PBI in Brazilian samples.

Fatores associados a abandono precoce do tratamento em psicoterapia de orientação analítica

Abstract Introduction: The efficacy of psychoanalytic psychotherapy is well established in controlled clinical trials; however, someindividual characteristics that predict better outcomes are yet poorly studied. This study aimed at evaluating the association ofdemographics data, psychiatric diagnosis, clinical impairment, quality of life, aspects of psychotherapy suitability, defensivestyle and dropout before 3 months. Method: A consecutive sample of 56 subjects was evaluated after psychotherapy indication through a standardized protocol,World Health Organization Quality of Life Bref (WHOQOL-Bref), Self Report Questionnaire, Defensive Style Questionnaire,Scale of Defensive Functioning of Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV-TR) andGlobal Assessment of Functioning, and followed for 3 months. Results: Dropout rate was 12.5%. There was no difference between groups in respect to Global Assessment of Functioning, SelfReport Questionnaire and Defensive Style Questionnaire scores. Dropout patients reported to be satisfied with their health,despite psychopathological severity, even when other variables were controlled (p < 0.0001). The group that remained inpsychotherapy was better adjusted before treatment and had average or superior estimated intelligence (p < 0.05). More dropoutpatients presented lower levels of defensive style, by means of the Scale of Defensive Functioning of DSM-IV-TR.

Serum levels of brain-derived neurotrophic factor in acute and posttraumatic stress disorder: a case report study

OBJECTIVE The aim of this study was to evaluate brain-derived neurotrophic factor levels in two patients, one with posttraumatic stress disorder and one with acute stress disorder, before and after treatment, and to compare those levels to those of healthy controls. METHOD Brain-derived neurotrophic factor level, Davidson Trauma Scale, Beck Depression Inventory, Global Assessment of Functioning, and Clinical Global Impression were assessed before and after 6 weeks of treatment. RESULTS Brain-derived neurotrophic factor levels were higher in patients than in matched controls before treatment. After 6 weeks, there was a reduction in symptoms and an improvement in functioning in both cases. At the same time, brain-derived neurotrophic factor levels decreased after treatment, even in case 2, treated with psychotherapy only. CONCLUSIONS These results suggest that serum levels of brain-derived neurotrophic factor, as opposed to what has been described in mood disorders, are increased in posttraumatic stress disorder as well as in acute stress disorder.

Parental bonding and emotional response to trauma: A study of rape victims

Abstract The aim of this study was to examine the impact of parental bonding as a resilience or a risk factor for psychopathology after rape. Women rape victims were assessed regarding the perception of parental bonding in childhood, acute posttraumatic stress disorder symptoms, acute stress disorder (ASD), and clinical severity. The perception of having less affective parents was correlated with severity, and ASD was more frequent in participants with less affectionate and more controlling fathers. Perceived support was associated with clinical impairment. These findings could help in identifying those who need early interventions and highlight the importance of social and emotional support in facing traumatic situations, reinforcing aspects of the parent–child relationship that generate adults more apt to face adverse situations.

Resilience to traumatic events related to urban violence and increased IL10 serum levels

The exposition to traumatic events related to urban violence is epidemic in Brazil, with rate of 80% in the general population, and is becoming a major cause of post-traumatic stress disorder (PTSD). The objective of the study was to compare serum levels of pro-inflammatory interleukin-6 (IL-6) and anti-inflammatory interleukin-10 (IL-10) in PTSD and resilient individuals. We hypothesized that resilient individuals present an attenuated pro-inflammatory and enhanced anti-inflammatory state. We conducted a case-control study comparing 30 resilient individuals and 30 PTSD patients exposed to traumatic events related to urban violence. The groups were evaluated using Self-Report Questionnaire (SRQ-20), Mini-International Neuropsychiatric Interview (MINI) and the Davidson Trauma Scale. For all individuals, blood samples were collected to determine IL-6, IL-10 and cortisol serum levels. All samples were frozen at -80°C until the assay and were analyzed with the same immunoassay kit and in duplicates. The resilient group presented higher IL-10 levels than PTSD patients [mean (CI95%); 1.03 (0.52-2.08) pg/mL vs. 0.29 (0.20-0.43) pg/mL; P=0.002]. There were no differences in terms of IL-6 or cortisol levels. The results provided evidence for increased levels of IL-10 in resilient individuals when compared to PTSD patients, probably conferring them a better anti-inflammatory response after exposition.

Defense style changes with the addition of psychodynamic group therapy to clonazepam in social anxiety disorder.

Psychodynamic Group Therapy (PGT) and clonazepam are strategies to reduce symptoms of generalized social anxiety disorder (GSAD). The addition of PGT might lead to changes in defense styles. The objective of this study is to examine changes in defense styles when comparing clonazepam to psychodynamic group therapy plus clonazepam in GSAD during 12 weeks. Fifty-seven patients that met DSM-IV criteria for GSAD participated. social anxiety disorder symptoms were evaluated with the Liebowitz Social Anxiety Scale, and defense styles with the Defense Style Questionnaire. All defense styles changed overtime for both groups, especially mature defense style, which increased independently of the treatment allocation group. Regression analyses found that overtime there was a reduction in neurotic defenses in the combined group, whereas there was an increase in the clonazepam group. Neurotic defense style can change toward greater adaptiveness with the addition of PGT to clonazepam in GSAD, even in 12 weeks.

A relação entre os mecanismos de defesa e a qualidade da aliança terapêutica em psicoterapia de orientação analítica

BACKGROUND: The quality of a therapeutic alliance is essential in psychoanalytic psychotherapy and influences the therapeutic process. This study evaluated the relationship between the level of defense mechanisms and the quality of therapeutic alliance established during psychotherapy. METHOD: Patients in psychotherapy and their respective therapists completed the Helping Alliance Questionnaire (patient version and therapist version, respectively). The level of defenses was inferred by the Defensive Functioning Scale proposed in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. RESULTS: There was no association between the quality of therapeutic alliance and the patients level of defense mechanisms in this sample. On the other hand, there was a difference when the therapist version was compared to the patient version: patients established a stronger therapeutic alliance in relation to their therapists. CONCLUSIONS: The lack of influence of defense level in the quality of therapeutic alliance suggests that the therapists training and personal characteristics may lead to the ability of connecting with the patient, despite impairment in their psychic functioning.

Childhood Trauma and Resilience: Vulnerabilities to Develop Crack/CocaineDependence

Background: Crack cocaine dependence is a health problem of epidemic proportions and there is lack of evidence concerning vulnerability factors that could lead to crack cocaine use. The aim of this study is to investigate characteristics of resilience in a group of crack cocaine users and its association with childhood trauma and PTSD. Method: This is a case-control study in which we evaluated 218 crack cocaine inpatients users and 215 healthy controls, recruited from the capital city of the southern State of Brazil. Childhood Trauma was evaluated with the Childhood Trauma Questionnaire; resilience was evaluated with the Resilience Scale; and post-traumatic stress disorder (PTSD) was evaluated with the Mini-International Neuropsychiatric Interview. Results: Childhood trauma was significantly higher among crack cocaine users in all trauma domains (p<0.001), except for sexual abuse. Most resilience scores was lower among crack cocaine users (p<0.01). Having higher scores of childhood trauma and lower scores of resilience increase the odds to become a crack cocaine user (p<0.001), despite the diagnosis of PTSD. Discussion: Childhood trauma appears to be a risk factor to become a crack cocaine user while resilience features may be a protection factor. To understand factors of vulnerabilities in this population is important for the development of more efficacious treatment and preventive strategies.