Ugam's+EE

Useful sources from meeting on January 17 http://www.sciencedaily.com/releases/2010/10/101027091528.htm http://psychcentral.com/news/2010/10/28/victims-of-child-abuse-may-have-ptsd/20278.html http://www.psychologytoday.com/blog/somatic-psychology/201104/the-lingering-trauma-child-abuse-0 http://www.aifs.gov.au/nch/pubs/sheets/rs20/rs20.html Ugam, make sure you add annotations to your running bibliography so you can identify what topics that source was most useful for :)

//*I still need to paraphrase, most of the notes are just copied/pasted directly from the websites.//

=Re-thinking the question (March 15)= =Topics= =(Decide what factors you want on the basis of your reading. Examples given below. Once you know, you can create topic pages, and move your notes there)= Background and Prevalence Symptoms (and DSM IV) Connection between psychological trauma, brain development and PTSD (localization as well as impact of environmental factors on the brain) Individual personality factors Loss of self-regulatory processes Quotes FACTORS: Genetic inheritance Neuroticism Amount of Support
 * To what extent does genetic inheritance explain the development of PTSD in child victims of abuse? (specific genes have been isolated) **

=Bibliography=

Resources
Behavioral Health Advisor. (2010, October). Post-Traumatic Stress Disorder (PTSD). //CRS-Behavioral Health Advisor//, //5//, 1-1. Retrieved January 17, 2012, from the Health Source-Consumer Edition database. NIMH Â· Post-Traumatic Stress Disorder (PTSD). (n.d.). //NIMH Â· Home//. Retrieved January 17, 2012, from http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml Scully Jr., J. H. (Director) (2005, July 25). Post Traumatic Stress Syndrome. //House Veterans' Affairs//. Lecture conducted from American Psychiatric Association, United States. Post-traumatic Stress Disorder (PDQ®) - National Cancer Institute. (n.d.).//Comprehensive Cancer Information - National Cancer Institute//. Retrieved January 17, 2012, from http://www.cancer.gov/cancertopics/pdq/supportivecare/post-traumatic-stress/Patient Post-traumatic Stress Disorder (PDQ®) - National Cancer Institute. (n.d.). //Comprehensive Cancer Information - National Cancer Institute//. Retrieved January 17, 2012, from http://www.cancer.gov/cancertopics/pdq/supportivecare/post-traumatic-stress/HealthProfessional Post-traumatic stress disorder - PubMed Health. (n.d.). //National Center for Biotechnology Information//. Retrieved January 17, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001923/

Studies
Cohen, M. H., Shi, Q., Fabri, M., Cai, X., Hoover, D. R., Binagwaho, A., et al. (2011). Improvement in Posttraumatic Stress Disorder in Postconflict Rwandan Women.. //Journal of Women's Health (15409996)//, //20//(9), 1325-1332. Su, C., Tsai, K., Chou, F. H., Ho, W., Liu, R., & Lin, W. (2010). A three-year follow-up study of the psychosocial predictors of delayed and unresolved post-traumatic stress disorder in Taiwan Chi-Chi earthquake survivors. //Psychiatry & Clinical Neurosciences//, //64//(3), 239-248.

=Ideas=
 * Post-Traumatic Stress Disorder and child abuse
 * The relationship between the two.
 * Causes
 * Treatment (?)
 * Type of Abuse
 * Emotional (eg. neglect)
 * Physical
 * Physiological impact
 * To what extent does PTSD have an effect on children and adolescents affected by PTSD, who has grown up in abusive environments?

=Notes=

=To what extent does genetic inheritance explain the development of PTSD in the victims of child abuse?= =*will not talk about sexual abuse.=

__ Background Info __

 * Post-traumatic stress disorder is a type of anxiety disorder. It can occur after you've seen or experienced a traumatic event that involved the threat of injury or death.
 * PTSD is an anxiety disorder that some people get after seeing or living through a dangerous event.

Who can get PTSD?

 * * Anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events.
 * Not everyone with PTSD has been through a dangerous event. Some people get PTSD after a friend or family member experiences danger or is harmed. The sudden, unexpected death of a loved one can also cause PTSD ||

How does it occur?

 * Not everyone who is exposed to a stressful event gets PTSD. It is not fully clear why one person involved in something like a robbery, rape, or severe car accident develops PTSD while another does not. Some factors that may lead to PTSD include:
 * a family or personal history of mental illness
 * the severity of the stressful event
 * lack of family and social support available after the event
 * Studies show that 1 to 14% of people will have PTSD for some period in their lives, at least in a very mild form.
 * PTSD can occur at any age. Symptoms can start right after the stressful event, but sometimes symptoms begin 3 months or more after the event. Having PTSD symptoms lasting up to a month after a stressful event is a normal human reaction and is not considered PTSD. It is called acute stress disorder. If symptoms last more than a month it is called PTSD.

Symptoms:

 * Re experiencing symptoms
 * Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
 * Bad dreams
 * Frightening thoughts.
 * May cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.
 * Avoidance symptoms
 * Staying away from places, events, or objects that are reminders of the experience
 * Feeling emotionally numb
 * Feeling strong guilt, depression, or worry
 * Losing interest in activities that were enjoyable in the past
 * Having trouble remembering the dangerous event.
 * Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine.
 * Hyperarousal symptoms
 * Being easily startled
 * Feeling tense or “on edge”
 * Having difficulty sleeping, and/or having angry outbursts.
 * usually constant, instead of being triggered by things that remind one of the traumatic event. can make the person feel stressed and angry. symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

Treatment

 * Medicine
 * Medicines are sometimes needed when the symptoms are very severe. Medicines may help reduce symptoms of anxiety and panic, having nightmares, and having flashbacks. If you have symptoms of depression, antidepressant medicine may be prescribed.
 * No nonprescription medicines are available to treat PTSD.
 * Therapy
 * Seeing a psychiatrist or other psychotherapist can help when you are having symptoms of PTSD. Therapy may last just a short time or may need to last for months or years. Two types of psychotherapy sometimes used to treat PTSD are cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR).
 * CBT is a way to help you identify and change thoughts that lead to PTSD symptoms. Replacing negative thoughts with more positive ones can help you to control your symptoms.
 * EMDR is a fairly new psychotherapy technique that uses eye movement to activate the brain while you remember the stressful event and your feelings about the experience. The therapy is designed to release "trapped" emotional experiences from the stressful event. Dealing with these experiences may help you to have more peaceful, calm feelings.
 * Claims have been made that certain herbal and dietary products help control PTSD symptoms. No herb or dietary supplement has been proven to consistently or completely relieve PTSD. Supplements are not tested or standardized and may vary in strength and effects. They may have side effects and are not always safe.
 * Learning ways to relax may help. Yoga and meditation may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and psychotherapy.

How long does it last?
 * 3 months for most people, can be upto a year.

Using positron emission tomography (PET) and single photon emission computed tomography (SPECT) studies, researchers have found that the hippocampus a part of the brain critical to memory and emotion appears to be different in cases of PTSD

One of the common misconceptions about PTSD is that it is highly subjective and not readily apparent to the trained professional, In fact, PTSD is marked by clear biological changes as well as emotional symptoms. PTSD is an illness that is related to structural and chemical changed in the brain. Using positron emission tomography (PET) and single photon emission computed tomography (SPECT) studies, researchers have found that the hippocampus a part of the brain critical to memory and emotion appears to be different in cases of PTSD. Scientists are investigating whether this is related to short-term memory problems. Changes in the hippocampus are thought to be responsible for intrusive memories and flashbacks that occur in people with this **disorder**.

Other studies demonstrate that people with PTSD tend to have abnormal levels of key hormones involved in response to **stress**. Some studies have shown that cortisol levels are lower than normal and epinephrine and norepinephrine are higher than normal. Current research at the National Institutes of Mental Health to understand the neurotransmitter systems involved in memories of emotionally charged events may lead to discovery of medications or psychosocial interventions that, if given early, could block the development of PTSD symptoms.

DSM-IV
A. The person was exposed to one or more of the following event(s): death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation, in one or more of the following ways: **

B. Intrusion symptoms that are associated with the traumatic event(s) (that began after the traumatic event(s)), as evidenced by 1 or more of the following:
 * Experiencing the event(s) him/herself
 * Witnessing, in person, the event(s) as they occurred to others
 * Learning that the event(s) occurred to a close relative or close friend; in such cases, the actual or threatened death must have been violent or accidental
 * Experiencing repeated or extreme exposure to aversive details of the event(s) (e.g., first responders collecting body parts; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

C. Persistent avoidance of stimuli associated with the traumatic event(s) (that began after the traumatic event(s)), as evidenced by efforts to avoid 1 or more of the following:
 * Spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
 * Recurrent distressing dreams in which the content and/or affect of the dream is related to the event(s). Note: In children, there may be frightening dreams without recognizable content. ***
 * Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
 * Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
 * Marked physiological reactions to reminders of the traumatic event(s)

D. Negative alterations in cognitions and mood that are associated with the traumatic event(s) (that began or worsened after the traumatic event(s)), as evidenced by 3 or more of the following: Note: In children, as evidenced by 2 or more of the following:
 * Avoids internal reminders (thoughts, feelings, or physical sensations) that arouse recollections of the traumatic event(s)
 * Avoids external reminders (people, places, conversations, activities, objects, situations) that arouse recollections of the traumatic event(s).

E. Alterations in arousal and reactivity that are associated with the traumatic event(s) (that began or worsened after the traumatic event(s)), as evidenced by 3 or more of the following: Note: In children, as evidenced by 2 or more of the following:
 * Inability to remember an important aspect of the traumatic event(s) (typically dissociative amnesia; not due to head injury, alcohol, or drugs).
 * Persistent and exaggerated negative expectations about one’s self, others, or the world (e.g., “I am bad,” “no one can be trusted,” “I’ve lost my soul forever,” “my whole nervous system is permanently ruined,” "the world is completely dangerous").
 * Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
 * Pervasive negative emotional state -- for example: fear, horror, anger, guilt, or shame
 * Markedly diminished interest or participation in significant activities.
 * Feeling of detachment or estrangement from others.
 * Persistent inability to experience positive emotions (e.g., unable to have loving feelings, psychic numbing)

F. Duration of the disturbance (symptoms in Criteria B, C, D and E) is more than one month.
 * Irritable or aggressive behavior
 * Reckless or self-destructive behavior
 * Hypervigilance
 * Exaggerated startle response
 * Problems with concentration
 * Sleep disturbance -- for example, difficulty falling or staying asleep, or restless sleep.

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H. The disturbance is not due to the direct physiological effects of a substance (e.g., medication or alcohol) or a general medical condition (e.g., traumatic brain injury, coma).

Specify if:

With Delayed Onset: if diagnostic threshold is not exceeded until 6 months or more after the event(s) (although onset of some symptoms may occur sooner than this).


 * Developmental manifestions of PTSD are still being developed. The term 'developmental manifestation' in DSM-V refers to age-specific expressions of one or another criteria that is used to make a diagnosis across age groups.


 * For children, inclusion of loss of a parent or other attachment figure is being considered.


 * An alternative is to retain the DSM-IV criterion


 * The optimal number of required symptoms for both adults and children will be further examined with empirical data

APA DSM-5. (n.d.). //APA DSM-5//. Retrieved February 5, 2012, from http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=165

Causes
Not every child or adolescent who experiences trauma such as child abuse or neglect develops PTSD. The development of PTSD is unpredictable following a traumatic event, and, as more research on the condition emerges, it appears that PTSD can be viewed as a phenomenon resulting from a gene-environment interaction. The onset of PTSD may be initiated through either direct or witnessed exposure to a single or chronic trauma. See Frequency for more details related to specific types of traumatic events, such as sexual assault. Some differentiate trauma exposures into two types, as follows: Type I: Single, acute, unpredictable stressor. One person may have repeated exposures to this kind of stressor. Type II: Chronic, enduring stressors, such as ongoing physical or sexual abuse, characterize type II. The frequency and total number of traumatic events experienced (ie, chronicity) appears to influence the presence and severity of psychological sequelae. This is also often complicated by further traumatic experiences; for example, children who experience abuse and neglect may later be taken into state custody and moved among foster homes and child protective services (CPS) placements. As another example of additive traumatic exposures, children who experience a traumatic accidental injury may subsequently undergo painful surgery and invasive procedures in the hospital, which may only compound the initial traumatic experience.

[|http://emedicine.medscape.com/article/916007-clinical#a0218]

Diagnosis
Several psychometric measures, such as semi-structured interviews or self-report measures, are used to evaluate PTSD in children. Semi-structured measures include the Child and Adolescent Psychiatric Assessment: Life Events Section and PTSD Module (CAPA-PTSD) and the Children’s PTSD Inventory (CPTSDI). Self-report measures include the abbreviated UCLA PTSD Reaction Index, the Trauma Symptom Checklist for Children (TSCC), the Impact of Events Scale, and the Screen for Child Anxiety Related Disorders (SCARED).

Researchers have cautioned that children with PTSD symptoms who do not cross the traditional threshold for PTSD diagnosis may still suffer significant functional impairment.

Some research suggests that more functional impairment is observed in children who report intense (although not necessarily frequent) avoidance symptoms and distress in response to triggers. [|http://emedicine.medscape.com/article/916007-workup#a0721]

=Studies=

[|http://web.ebscohost.com/ehost/detail?vid=4&hid=113&sid=a0086d3a-78d8-4f0e-8c66-24f487661e9f%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=pbh&AN=55595142] Objective: Exposure to traumatic experiences, especially those occurring in childhood, has been linked to substance use disorders (SUDs), including abuse and dependence. SUDs are also highly comorbid with Posttraumatic Stress Disorder (PTSD) and other mood-related psychopathology. Most studies examining the relationship between PTSD and SUDs have examined veteran populations or patients in substance treatment programs. The present study further examines this relationship between childhood trauma, substance use, and PTSD in a sample of urban primary care patients. Method: There were 587 participants included in this study, all recruited from medical and OB/GYN clinic waiting rooms at Grady Memorial Hospital in Atlanta, GA. Data were collected through both screening interviews as well as follow-up interviews. Results: In this highly traumatized population, high rates of lifetime dependence on various substances were found (39% alcohol, 34.1% cocaine, 6.2% heroin/opiates, and 44.8% marijuana). The level of substance use, particularly cocaine, strongly correlated with levels of childhood physical, sexual, and emotional abuse as well as current PTSD symptoms. In particular, there was a significant additive effect of number of types of childhood trauma experienced with history of cocaine dependence in predicting current PTSD symptoms, and this effect was independent of exposure to adult trauma. Conclusions: These data show strong links between childhood traumatization and SUDs, and their joint associations with PTSD outcome. They suggest that enhanced awareness of PTSD and substance abuse comorbidity in high-risk, impoverished populations is critical to understanding the mechanisms of substance addiction as well as in improving prevention and treatment
 * STUDY 1 (does this one really help you with explaining cause? You're not investigating substance abuse) **

STUDY 2 [|http://web.ebscohost.com/ehost/detail?vid=5&hid=113&sid=a0086d3a-78d8-4f0e-8c66-24f487661e9f%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=pbh&AN=23579807] The association between childhood **abuse**, current life stressors, and the occurrence of adult medical problems was investigated in the National Comorbidity Survey. It was found that after controlling for a number of covariates, current life stressors moderated the relationship between **abuse** history and medical problems such that health problems were greater for individuals who had been abused in the presence of current stressors. The findings suggest that a history of childhood **abuse**, even without the presence of posttraumatic stress disorder (**PTSD**), can influence the occurrence of poor health if current life stressors are present. Future directions and implications are discussed.
 * The association between childhood abuse, PTSD, and the occurrence of adult health problems: Moderation via current life stress (same comment as above). **

COGNITIVE - STUDY 3 The role of the dopamine transporter (DAT) in the development of PTSD in preschool children. **(identify the topic this belongs to)** [|http://web.ebscohost.com/ehost/detail?sid=8ddfbdfd-47df-49e2-8303-6e07d2f2664f%40sessionmgr11&vid=1&hid=9&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=pbh&AN=47134925] Population-based association studies have supported the heritability of posttraumatic stress disorder (PTSD). This study explored the influence of genetic variation in the dopamine transporter (DAT) 3′ untranslated region variable number tandem repeat on the development of PTSD in preschool children exposed to Hurricane Katrina, diagnosed using a developmentally appropriate semistructured interview. A diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV; American Psychiatric Association, 1994), total symptoms, and specifically Criterion D symptoms were significantly more likely to be found in children with the 9 allele. This study replicates a previous finding in adults with PTSD. The specificity of this finding to the increased arousal symptoms of Criterion D suggests that dopamine and the DAT allele may contribute to one heritable path in a multifinality model of the development of PTSD.

COGNITIVE - STUDY 4 Applying EMDR on children with PTSD. [|http://web.ebscohost.com/ehost/detail?vid=8&hid=113&sid=a0086d3a-78d8-4f0e-8c66-24f487661e9f%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=pbh&AN=31757854] To find out child-adjusted protocol for eye movement desensitization and reprocessing (EMDR). Child-adjusted modification were made in the original adult-based protocol, and within-session measurements, when EMDR was used in a randomized controlled trial (RCT) on thirty-three 6–16-year-old children with post-traumatic stress disorder (PTSD). EMDR was applicable after certain modifications adjusted to the age and developmental level of the child. The average treatment effect size was largest on re-experiencing, and smallest on hyperarousal scale. The age of the child yielded no significant effects on the dependent variables in the study. A child-adjusted protocol for EMDR is suggested after being applied in a RCT for PTSD among traumatized and psychosocially exposed children.
 * (does this help you with explaining cause? You're not investigating treatment) **

COGNITIVE - STUDY 5 Neurostructural imaging findings in children with post-traumatic stress disorder: Brief review. ** (what topic does this belong to?) ** [|http://web.ebscohost.com/ehost/detail?vid=9&hid=14&sid=a0086d3a-78d8-4f0e-8c66-24f487661e9f%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=pbh&AN=36141941] Child maltreatment has been associated with different psychiatric disorders. Studies on both animals and humans have suggested that some brain areas would be directly affected by severe psychological trauma. The pathophsysiology of post-traumatic stress disorder (PTSD) appears to be related to a complex interaction involving genetic and environmental factors. Advanced neuroimaging techniques have been used to investigate neurofunctional and neurostructural abnormalities in children, adolescents, and adults with PTSD. This review examined structural brain imaging studies that were performed in abused and traumatized children, and discusses the possible biological mechanisms involved in the pathophysiology of PTSD, the implications and future directions for magnetic resonance imaging (MRI) studies. Published reports in refereed journals were reviewed by searching Medline and examining references of the articles related to structural neuroimaging of PTSD. Structural MRI studies have been performed in adults and children to evaluate the volumetric brain alterations in the PTSD population. In contrast with studies involving adults, in which hippocampus volumetric reduction was the most consistent finding, studies involving children and adolescents with PTSD have demonstrated smaller medial and posterior portions of the corpus callosum.

//STUDY 6// //A Review of PTSD in Children.//
 * (what topic does this belong to?) **

[|//http://web.ebscohost.com/ehost/detail?vid=8&hid=125&sid=a0086d3a-78d8-4f0e-8c66-24f487661e9f%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d//] //The article reviews Posttraumatic stress disorder (PTSD) and explains the causes of PTSD in children and adolescents. The influence of parental reactions on children's trauma reactions and the wide range of stress reactions, which differ with age and gender, are also explained. The need for more research in intervention methods, despite the existing cognitive behavioural therapy (CBT) and trauma-focused CBT, is analyzed.//

COGNITIVE/SOCIOCULTURAL - STUDY 7 Psychological resilience and neurocognitive performance in a traumatized community sample. [|http://web.ebscohost.com/ehost/detail?vid=8&hid=125&sid=a0086d3a-78d8-4f0e-8c66-24f487661e9f%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=pbh&AN=52746218] Whether psychological resilience correlates with neurocognitive performance is largely unknown. Therefore, we assessed association between neurocognitive performance and resilience in individuals with a history of childhood abuse or trauma exposure. Methods: In this cross-sectional study of 226 highly traumatized civilians, we assessed neurocognitive performance, history of childhood abuse and other trauma exposure, and current depressive and PTSD symptoms. Resilience was defined as having ≥1 trauma and no current depressive or PTSD symptoms; non-resilience as having ≥1 trauma and current moderate/severe depressive or PTSD symptoms. Results: The non-resilient group had a higher percentage of unemployment (P=.006) and previous suicide attempts (P<.0001) than the resilient group. Both groups had comparable education and performance on verbal reasoning, nonverbal reasoning, and verbal memory. However, the resilient group performed better on nonverbal memory (P=.016) with an effect size of .35. Additionally, more severe childhood abuse or other trauma exposure was significantly associated with non-resilience. Better nonverbal memory was significantly associated with resilience even after adjusting for severity of childhood abuse, other trauma exposure, sex, and race using multiple logistic regression (adjusted OR=1.2; P=.017). Conclusions: We examined resilience as absence of psychopathology despite trauma exposure in a highly traumatized, low socioeconomic, urban population. Resilience was significantly associated with better nonverbal memory, a measure of ability to code, store, and visually recognize concrete and abstract pictorial stimuli. Nonverbal memory may be a proxy for emotional learning, which is often dysregulated in stress-related psychopathology, and may contribute to our understanding of resilience.
 * (what topic does this belong to?) **

STUDY 8 -

Structure of Essay
Factor 1: Genes

but genetic inheritance isn't the only factor, others affect it too.

Factor 2: Neuroticism [|1]

Factor 3: Environmental Factors- Trauma Exposure

Factor 4: