DOCSLIB.ORG

In This Issue

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
In This Issue July 2020 NEWS Post-Traumatic Stress Disorder (PTSD) Assessment and Treatment In this Issue: Guidelines for Pediatric Primary Upcoming Clinical Care Conversations 5 Clinical Conversation: May 26, 2020 Presented by Sylvia Krinsky, MD, Tufts Medical Center For some children, childhood is far from a carefree time; they Leadership: experience trauma which can disrupt development and lead John Straus, MD to post-traumatic stress disorder (PTSD). At the May Clinical Founding Director Conversation, Sylvia Krinsky, MD, MCPAP site director at Tufts Barry Sarvet, MD Medical Center, discussed how to address PTSD in the primary Medical Director care setting. Beth McGinn Types of trauma Program Manager There are three major types of trauma: Elaine Gottlieb • Discrete Trauma – examples include a car accident, injury, Contributing Writer medical procedure, or a single episode of physical or sexual assault, when life is filled with otherwise helpful and supportive people • Complex Trauma – series of repeated traumas usually in close interpersonal contexts, such as childhood abuse or neglect, witnessing domestic or community violence, or racism and chronic social adversities • Adverse Childhood Event – a term from the Adverse Childhood Experiences (ACE) study, referring to potentially traumatic events that can have an impact on physical and psychological health Discrete trauma is most recognized in the DSM-5, while ACE is more familiar to the medical community, says Dr. Krinsky. 1000 Washington St., Suite 310 One study reported in the Journal of the American Medical Boston, MA 02118 Association (JAMA) found that more than 90 percent of pediatric Email: [email protected] patients seen in a primary care pediatric clinic had experienced a traumatic exposure, and 25 percent met full or partial criteria for www.mcpap.org PTSD. Continued on page 2 MCPAP is funded by the Massachusetts Department of Mental Health. 2 PTSD Assessment and Treatment Guidelines for Pediatric Primary Care Continued from page 1 When trauma occurs in early childhood, from • Two alterations in arousal and reactivity infancy to age three, it has a major impact on – irritable/angry outbursts, reckless/self- brain development. “At this stage, there is so destructive behavior, hypervigilance, high much cognitive maturation. The child is entirely startle reflex, concentration problems, sleep dependent on the caregiver, so trauma can difficulty disrupt secure, normal attachment. It also has a long-lasting impact on the biologic system, Differential diagnoses and abuse and neglect are linked to somatizing Differential diagnoses following a traumatic event conditions” says Dr. Krinsky. can include: Of course, children vary greatly in their response • Adjustment disorder to trauma; what may be traumatic for one child isn’t for another. • Acute Stress Disorder • PTSD • Anxiety • Depression “Patients should be assessed for PTSD immediately after a traumatic event or during an assessment of mental health complaints during a well-child visit,” says Dr. Krinsky. Acute stress disorder Acute stress disorder has similar symptoms as DSM-5 definition of PTSD PTSD but they last less than a month, whereas PTSD persists; when it lasts longer than three According to the DSM-5, which has more narrow months, it will require treatment. criteria, PTSD is an exposure to a traumatic event and can include: Adjustment disorder • One re-experiencing symptom – intrusive • Development of emotional/behavioral thoughts/memories, nightmares, flashbacks, symptoms due to an identifiable stressor(s) intense distress at reminders, physiological and occurring within three months of the re-experiencing onset of the stressor • One avoidance symptom – avoiding • Marked by distress that is in excess of what memories, thoughts, or specific places/ would be expected within the context, given experiences associated with trauma the nature of the stressor, and/or marked by significant impairment in social, occupational, • Two negative alterations in cognition or mood or other important areas of functioning – inability to remember parts of the trauma, negative beliefs about self/others/world, self- • Exclude if the disturbance meets criteria blame for the trauma, persistent negative for another condition or is an exacerbation emotional state, inability to experience of another condition or results from positive emotions, diminished interest and bereavement participation in activities • Does not persist longer than six months Continued on page 3 MCPAP News July 2020 3 PTSD Assessment and Treatment Guidelines for Pediatric Primary Care Continued from page 2 Consider whether the patient’s coping is normal. difficulty relating to others. “Adjustment disorder is not a mental illness, just difficulty adjusting for six months or less,” says ADHD – consider the time course of symptoms. Dr. Krinsky. Did the inattention start after a traumatic event? PTSD can disrupt concentration and Depression cause hyperarousal, hypervigilance and an exaggerated startle reflex. • Sad, irritable mood with difficulty or inability to enjoy things that used to give pleasure Bipolar disorder – very rare before puberty; usually there’s a family history. Bipolar disorder • Hopeless and guilty ruminations can cause irritability, anger, and mood instability. • Decreases in energy, interest, and Consider if PTSD is a differential diagnosis in concentration these cases. • Changes in sleep (early morning awakenings) Screening for trauma and appetite (typically lower) Patients should be screened for trauma at well- Anxiety disorders child visits and at mental health evaluations. Start with general questions about stress and • Intrusive level of worry • Frequently accompanied by somatic symptoms (stomachaches and headaches), especially in younger kids • Misperception of situations as overly threatening or dangerous • An urge to avoid that results in functional impairment Distinguishing trauma from other mental health conditions Trauma is a risk factor for mental health then more specific questions about trauma, disorders and can complicate treatment: patients using clinical interviewing and rating scales. may meet criteria for more than one condition. “Focus on what happened and how to stabilize Also, pre-existing major depression and anxiety the situation. The priority is safety and affirming disorders are risk factors for PTSD after a the therapeutic relationship,” says Dr. Krinsky. traumatic event. According to Dr. Krinsky, it’s Assessing impact on patient and family important to consider how the patient was doing before the traumatic event and any subsequent Trauma affects the entire family. During the changes. Diagnostic clarity is greatest in the assessment, find out how the child and family context of a known single discrete trauma. are functioning, including parental anxiety and ability to provide support. “Parents need to be Misdiagnosis able to soothe the child,” says Dr. Krinsky. PTSD can be misdiagnosed as: Assess the child’s symptoms, including Autism – consider early developmental history. separation difficulties, sleep problems, frequent Pediatric patients with PTSD can be withdrawn tearfulness, tantrums, changes in play, and shut down, but they have better social skills withdrawal, hopelessness and suicidal ideation. than children with autism, who always have Continued on page 4 MCPAP News July 2020 4 PTSD Assessment and Treatment Guidelines for Pediatric Primary Care Continued from page 3 In adolescents, look for self-injurious behavior Treatment options and substance abuse. Evidence-based treatments for trauma include: CATS assessment • Trauma-focused cognitive behavioral therapy Dr. Krinsky recommends using CATS (Child (CBT) – ages 3-21, focuses on building skills and Adolescent Trauma Screen) for ages 7-17 for emotional and behavioral regulation, and the PTSD Checklist for DSM-5 (PCL-5) for strengthening relationships, and processing patients over age 18. traumatic events CATS includes three types of questions: • Child Parent Psychotherapy (CPP) – ages 0-5, focuses on strengthening the parent- • A checklist of traumatic events, such as a child attachment serious accident, sudden death, and physical abuse • Parent-Child Interaction Therapy (PCIT)– ages 2-7, therapists coach parents on • Symptoms experienced, such as upsetting changing parent-child interactional patterns thoughts and bad dreams, and frequency • Attachment Regulation and Competency • Areas of life affected by symptoms, such as (ARC) – ages 2-21, provides a framework school or work and family relationships for working with children and adolescents • Score 21 or higher – probable PTSD who have experienced multiple or prolonged traumas Scoring CATS To find a provider of trauma-focused care, visit A score of 6-7: avoidance symptoms the state Child Trauma Training Center or call (855-Link-Kid). A score of 8-14: negative alteration in cognition; scoring less than 15 indicates no clinically Medication related problem, normal response Consider medication when the: A score of 15-20: hyperarousal, such as anger and inattention; may have moderate, trauma- • Patient has comorbid depression and/or related stress anxiety requiring medication treatment (see appropriate MCPAP algorithm) Responding to disclosures • Symptoms are causing significant distress or In discussing a sensitive area like trauma with functional impairment despite an adequate the patient and family, a calm demeanor and trial of an evidence-based psychotherapy for empathy are important. Just talking about PTSD
Load more

Recommended publications
  • About Emotions There Are 8 Primary Emotions. You Are Born with These
    About Emotions There are 8 primary emotions. You are born with these emotions wired into your brain. That wiring causes your body to react in certain ways and for you to have certain urges when the emotion arises. Here is a list of primary emotions: Eight Primary Emotions Anger: fury, outrage, wrath, irritability, hostility, resentment and violence. Sadness: grief, sorrow, gloom, melancholy, despair, loneliness, and depression. Fear: anxiety, apprehension, nervousness, dread, fright, and panic. Joy: enjoyment, happiness, relief, bliss, delight, pride, thrill, and ecstasy. Interest: acceptance, friendliness, trust, kindness, affection, love, and devotion. Surprise: shock, astonishment, amazement, astound, and wonder. Disgust: contempt, disdain, scorn, aversion, distaste, and revulsion. Shame: guilt, embarrassment, chagrin, remorse, regret, and contrition. All other emotions are made up by combining these basic 8 emotions. Sometimes we have secondary emotions, an emotional reaction to an emotion. We learn these. Some examples of these are: o Feeling shame when you get angry. o Feeling angry when you have a shame response (e.g., hurt feelings). o Feeling fear when you get angry (maybe you’ve been punished for anger). There are many more. These are NOT wired into our bodies and brains, but are learned from our families, our culture, and others. When you have a secondary emotion, the key is to figure out what the primary emotion, the feeling at the root of your reaction is, so that you can take an action that is most helpful. .
    [Show full text]
  • Acute Stress Disorder
    Trauma and Stress-Related Disorders: Developments for ICD-11 Andreas Maercker, MD PhD Professor of Psychopathology, University of Zurich and materials prepared and provided by Geoffrey Reed, PhD, WHO Department of Mental Health and Substance Abuse Connuing Medical Educaon Commercial Disclosure Requirement • I, Andreas Maercker, have the following commercial relaonships to disclose: – Aardorf Private Psychiatric Hospital, Switzerland, advisory board – Springer, book royales Members of the Working Group • Christopher Brewin (UK) Organizational representatives • Richard Bryant (AU) • Mark van Ommeren (WHO) • Marylene Cloitre (US) • Augusto E. Llosa (Médecins Sans Frontières) • Asma Humayun (PA) • Renato Olivero Souza (ICRC) • Lynne Myfanwy Jones (UK/KE) • Inka Weissbecker (Intern. Medical Corps) • Ashraf Kagee (ZA) • Andreas Maercker (chair) (CH) • Cecile Rousseau (CA) WHO scientists and consultant • Dayanandan Somasundaram (LK) • Geoffrey Reed • Yuriko Suzuki (JP) • Mark van Ommeren • Simon Wessely (UK) • Michael B. First WHO Constuencies 1. Member Countries – Required to report health stascs to WHO according to ICD – ICD categories used as basis for eligibility and payment of health care, social, and disability benefits and services 2. Health Workers – Mulple mental health professions – ICD must be useful for front-line providers of care in idenfying and treang mental disorders 3. Service Users – ‘Nothing about us without us!’ – Must provide opportunies for substanve, early, and connuing input ICD Revision Orienting Principles 1. Highest goal is to help WHO member countries reduce disease burden of mental and behavioural disorders: relevance of ICD to public health 2. Focus on clinical utility: facilitate identification and treatment by global front-line health workers 3. Must be undertaken in collaboration with stakeholders: countries, health professionals, service users/consumers and families 4.
    [Show full text]
  • Understanding Children's Mental Health Disorders and the Impact On
    Understanding Children’s Mental Health Disorders and the Impact on Learning and Functioning 1 2 Introduction to Children’s Mental Health An Overview of Depression 3 Depression is Common Estimates of Incidence 1 % Preschoolers 2 % School age 5 % Adolescents 20 % Lifetime prevalence during adolescence (parallels adult life time prevalence) Birmaher et al., 2002 4 Risk and Reoccurrence Childhood Adolescent Later Onset Depression Adolescent Depression Depression Adult Depression 5 Depression is… a mood disorder a sleep and energy disorder a thinking disorder 6 Depression: Signs and Symptoms Mood Changes Behaviors MEANING Interpersonal Relationships Physical Changes Cognitive Changes School Performance 7 Mood Symptoms Sad Sadness Irritable “mood swings” Anhedonia loss of interest social withdrawal or Anhedonia Irritability isolation boredom 8 Physical Symptoms Sleep Difficulty either with too much or too little sleep Fatigue Appetite Change loss of appetite increased carbohydrate craving 9 Cognitive Symptoms Difficulty concentrating Increased distractibility and “spaciness” Decreased attention and focus 10 Cognitive Symptoms Worried, ruminating thoughts Worthlessness, low self-esteem, guilt Distortions, misperceptions, misinterpretations 11 Symptoms in Infants and Toddlers Mood – Excessive whining – Too little or too much crying – Withdrawn from cuddling, being held – Lack of interest in surroundings 12 Symptoms in Infants and Toddlers Physical – Sleep disturbance – Sad or flat facial expression – Little motor activity – Failure to grow and
    [Show full text]
  • Behavioral Interventions for Anxiety and Irritability in Children and Adolescents with Autism Spectrum Disorder
    Behavioral Interventions for Anxiety and Irritability in Children and Adolescents with Autism Spectrum Disorder Denis G. Sukhodolsky, Ph.D. Yale Child Study Center Disclosures • Research support: – NIMH R01 MH101514 – NIMH K01 MH079130 – NICHD R01 HD083881 • Book royalty: – The Guilford Press Autism Spectrum Disorder (ASD) • Core symptoms – Impairment in social interaction and communication – Restricted interests and repetitive behavior • Associated features – Cognitive impairment – Deficits in adaptive functioning – Anxiety – Disruptive behavior problems Anxiety in ASD • Excessive fearfulness • Changes in routines and social situations • Can be related to core ASD symptoms • Co-occurring anxiety disorders may be present • Social anxiety may be difficult to diagnose • Contributes to impairment in functioning Cognitive-Behavior Therapy for Anxiety CBT is a well-established intervention for anxiety in children without autism. Key components: education, emotion regulation, and exposure and response prevention. Short-term duration, 8 to 16 weekly sessions. Treatment is conducted with the child and includes parent involvement. Is CBT helpful for anxiety in ASD? Main Findings: • 8 randomized controlled studies of CBT for anxiety were located. • CBT was superior to waitlist on parent and clinician-rated anxiety. • Effect sizes were 1.19 for parent ratings, 1.21 for clinician ratings and 0.68 for child self-report. Sukhodolsky, Bloch, Panza, Reichow Pediatrics, 2013 Neural Mechanisms of CBT for anxiety in ASD Subjects: • 10 children with ASD and
    [Show full text]
  • Dysphoria As a Complex Emotional State and Its Role in Psychopathology
    Dysphoria as a complex emotional state and its role in psychopathology Vladan Starcevic A/Professor, University of Sydney Faculty of Medicine and Health Sydney, Australia Objectives • Review conceptualisations of dysphoria • Present dysphoria as a transdiagnostic complex emotional state and assessment of dysphoria based on this conceptualisation What is dysphoria? • The term is derived from Greek (δύσφορος) and denotes distress that is hard to bear Dysphoria: associated with externalisation? • “Mixed affect” leading to an “affect of suspicion”1,2 1 Sandberg: Allgemeine Zeitschrift für Psychiatrie und Psychisch-Gerichtl Medizin 1896; 52:619-654 2 Specht G: Über den pathologischen Affekt in der chronischen Paranoia. Festschrift der Erlanger Universität, 1901 • A syndrome that always includes irritability and at least two of the following: internal tension, suspiciousness, hostility and aggressive or destructive behaviour3 3 Dayer et al: Bipolar Disord 2000; 2: 316-324 Dysphoria: associated with internalisation? • Six “dysphoric symptoms”: depressed mood, anhedonia, guilt, suicide, fatigue and anxiety1 1 Cassidy et al: Psychol Med 2000; 30:403-411 Dysphoria: a nonspecific state? • Dysphoria is a “nonspecific syndrome” and has “no particular place in a categorical diagnostic system”1; it is neglected and treated like an “orphan”1 1 Musalek et al: Psychopathol 2000; 33:209-214 • Dysphoria “can refer to many ways of feeling bad”2 2 Swann: Bipolar Disord 2000; 2:325-327 Textbook definitions: dysphoria nonspecific, mainly internalising? • “Feeling
    [Show full text]
  • The Neuroscience of Animal Welfare: Theory 80-20
    Review Article The neuroscience of animal welfare: theory 80-20 La neurociencia del bienestar animal: teoría 80-20 Genaro A. Coria-Avila, DVM, PhD1*, Deissy Herrera-Covarrubias, BSc, MSc2 1Centro de Investigaciones Cerebrales, Universidad Veracruzana, Xalapa, Ver., México 2Doctorado en Neuroetología, Universidad Veracruzana, Xalapa, Ver., México. Recibido: 28 de agosto de 2012 Aceptado: 16 de octubre de 2012 Puedes encontrar este artículo en: http://www.uv.mx/eneurobiologia/vols/2012/6/6.html Abstract Animal welfare is commonly regarded as the physical and psychological well-being of animals, fulfilled if animals are free: 1) from hunger, thirst and malnutrition, 2) from discomfort, 3) from pain, 4) to express normal behavior, and 5) from fear and distress. This paper is meant to provoke the reader to re-think the concept of welfare. Evidence indicates that animal welfare is not a constant state, but rather it must be fulfilled several times a day. A theory is proposed arguing that well-being occurs when the proportion of desiring and obtaining something occurs in a 80-20% proportion, respectively. The neurobiological bases of motivated behaviors are discussed to support a new view on animal welfare. Key words: Dopamine, Opioids, Environmental enrichment, Well-being, Desire, Reward. Resumen Comúnmente se considera al bienestar animal cuando los animales están bien física y psicológicamente. Esto se logra cuando están libres: 1) de hambre, sed y malnutrición, 2) de incomodidad, 3) de dolor, 4) para expresar conducta normal, 5) de miedo y estrés. Este artículo tiene la intención de provocar al lector para reconsiderar el concepto de bienestar animal.
    [Show full text]
  • The Relationship Between Dispositional Empathy, Psychological Distress, and Posttraumatic Stress Responses Among Japanese Unifor
    Nagamine et al. BMC Psychiatry (2018) 18:328 https://doi.org/10.1186/s12888-018-1915-4 RESEARCH ARTICLE Open Access The relationship between dispositional empathy, psychological distress, and posttraumatic stress responses among Japanese uniformed disaster workers: a cross-sectional study Masanori Nagamine1* , Jun Shigemura2, Toshimichi Fujiwara3, Fumiko Waki3, Masaaki Tanichi2, Taku Saito2, Hiroyuki Toda2, Aihide Yoshino2 and Kunio Shimizu1 Abstract Background: Disaster workers suffer from psychological distress not only through the direct experience of traumatic situations but also through the indirect process of aiding disaster victims. This distress, called secondary traumatic stress, is linked to dispositional empathy, which is the tendency for individuals to imagine and experience the feelings and experiences of others. However, the association between secondary traumatic stress and dispositional empathy remains understudied. Methods: To examine the relationship between dispositional empathy and mental health among disaster workers, we collected data from 227 Japan Ground Self-Defense Force personnel who engaged in international disaster relief activities in the Philippines following Typhoon Yolanda in 2013. The Impact of Event Scale-Revised and the Kessler Psychological Distress Scale were used to evaluate posttraumatic stress responses (PTSR) and general psychological distress (GPD), respectively. Dispositional empathy was evaluated through the Interpersonal Reactivity Index, which consists of four subscales: Perspective Taking, Fantasy, Empathic Concern, and Personal Distress. Hierarchial linear regression analyses were performed to identify the variables related to PTSR and GPD. Results: High PTSR was significantly associated with high Fantasy (identification tendency, β =0.21,p < .01), high Personal Distress (the self-oriented emotional disposition of empathy, β =0.18,p <.05),andnoexperienceofdisaster relief activities (β =0.15,p < .05).
    [Show full text]
  • Acute Stress Responses in Chinese Soldiers Performing Various Military Tasks Peng Huang1, Tengxiao Zhang2, Danmin Miao1* and Xia Zhu1*
    Huang et al. International Journal of Mental Health Systems 2014, 8:45 http://www.ijmhs.com/content/8/1/45 RESEARCH Open Access Acute stress responses in Chinese soldiers performing various military tasks Peng Huang1, Tengxiao Zhang2, Danmin Miao1* and Xia Zhu1* Abstract Background: To examine Chinese soldiers’ acute stress responses, we did this study. Methods: The soldiers completed the Acute Stress Response Scale (ASRS) when engaged in major tasks, such as earthquake rescue in Wenchuan, Sichuan, and maintaining social stability in Urumchi, Xinjiang. The ASRS has good reliability and validity. The study enrolled 1,832 male soldiers. Results: The results showed significant differences among five dimensions and the overall response index when comparing four diverse military tasks. Further analysis found that reduced work efficiency and 24 symptom clusters were significantly positively correlated. Conclusions: The acute stress response of soldiers performing various tasks was influenced by many factors, including the task characteristics and external factors. In addition, the acute stress response affected their work efficiency. Keywords: Chinese soldiers, Major tasks, Acute stress Introduction the Information Office of the State Council, the Peo- In recent years, natural disasters and terrorist attacks have ple’s Republic of China (please refer to http://eng.mod. increased worldwide, and China has not been spared [1,2]. gov.cn/Database/WhitePapers/). In this white paper, For example, there was a magnitude 7.0 earthquake in Ya’an the government identified the new situations, challenges, in western Sichuan province on April 20, 2013, and a mag- and missions facing the armed forces. In addition, the size nitude 8.0 earthquake in Sichuan on May 12, 2008.
    [Show full text]
  • Medical Treatment Guidelines (MTG)
    Post-Traumatic Stress Disorder and Acute Stress Disorder Effective: November 1, 2021 Adapted by NYS Workers’ Compensation Board (“WCB”) from MDGuidelines® with permission of Reed Group, Ltd. (“ReedGroup”), which is not responsible for WCB’s modifications. MDGuidelines® are Copyright 2019 Reed Group, Ltd. All Rights Reserved. No part of this publication may be reproduced, displayed, disseminated, modified, or incorporated in any form without prior written permission from ReedGroup and WCB. Notwithstanding the foregoing, this publication may be viewed and printed solely for internal use as a reference, including to assist in compliance with WCL Sec. 13-0 and 12 NYCRR Part 44[0], provided that (i) users shall not sell or distribute, display, or otherwise provide such copies to others or otherwise commercially exploit the material. Commercial licenses, which provide access to the online text-searchable version of MDGuidelines®, are available from ReedGroup at www.mdguidelines.com. Contributors The NYS Workers’ Compensation Board would like to thank the members of the New York Workers’ Compensation Board Medical Advisory Committee (MAC). The MAC served as the Board’s advisory body to adapt the American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines to a New York version of the Medical Treatment Guidelines (MTG). In this capacity, the MAC provided valuable input and made recommendations to help guide the final version of these Guidelines. With full consensus reached on many topics, and a careful review of any dissenting opinions on others, the Board established the final product. New York State Workers’ Compensation Board Medical Advisory Committee Christopher A. Burke, MD , FAPM Attending Physician, Long Island Jewish Medical Center, Northwell Health Assistant Clinical Professor, Hofstra Medical School Joseph Canovas, Esq.
    [Show full text]
  • Association of Irritability and Anxiety with the Neural Mechanisms of Implicit Face Emotion Processing in Youths with Psychopathology
    Supplementary Online Content Stoddard J, Tseng W-L, Kim P, et al. Association of irritability and anxiety with the neural mechanisms of implicit face emotion processing in youths with psychopathology. JAMA Psychiatry. Published online November 30, 2016. doi:10.1001/jamapsychiatry.2016.3282 eAppendix. Prior Research. eMethods 1. Participant Assessment. eMethods 2. Image Acquisition and Processing. eMethods 3. Estimating Neural Activation and Amygdala Functional Connectivity. eResults 1. ANX vs HV Only: A Comparison to a Prior Study. eResults 2. DMDD vs HV Only: A Comparison to a Prior Study. eResults 3. Analysis by Primary Diagnosis Instead of Anxiety and Irritability Dimensions. eResults 4. Cross Validation. eTable 1. Dimensional Measures by Primary Diagnosis. eTable 2. Excluded Participants. eTable 3. Details of Post Hoc Analyses of Medication Effects. eFigure 1. Positive Control of Activation. eFigure 2. Accuracy is Related to Irritability When Viewing the Higher Intensities of Anger. eFigure 3 Significant Connectivity Effects Not Depicted in Main Text. eFigure 4. Activation Maps of the Effect of ARI by Emotion on Activation. eReferences This supplementary material has been provided by the authors to give readers additional information about their work. © 2016 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/01/2021 eAppendix: Prior Research Prior investigations involving youths with severe, chronic irritability (operationalized either as severe mood dysregulation (SMD)1-4 or DMDD5) suggest the neural basis of irritability-associated face-emotion processing impairments.2 Of note, these prior studies involved two categories of irritability-related disorders, bipolar disorder and SMD/DMDD, and were designed to investigate their shared or distinct pathophysiology.6 They generally found that chronic irritability is associated with aberrant neural responses to different face emotions in visual (e.g.
    [Show full text]
  • Understanding Grief
    Understanding grief A guide for those grieving the death of a loved one kp.org/wa © 2018 Kaiser Foundation Health Plan of Washington GP0002339-50-17 Contents Understanding the journey of grief | 2 5 common myths about grief | 3 What to expect from grief | 5 Anticipatory grief | 7 Grief attacks or memory embraces | 9 The work of grieving | 10 Self-care while you grieve | 11 Common questions about grief support groups | 13 Ways to be good to yourself | 16 When does grief become depression? | 18 Where to get help | 20 1 Understanding the 5 common myths journey of grief about grief Grief is a healing journey we travel Myth #1: Grief and mourning are the through the death of a loved one and same experience. back to wholeness. Understanding this Grief describes the thoughts and process and the intense emotions that feelings we experience when someone can accompany it may help you move we love dies. Mourning describes our toward a healthy recovery. While the outward expression of grief, like crying, journey through grief may be slow and talking about the person, or celebrating difficult, it can also be a strengthening anniversary dates. Different cultures have and growth-filled experience. different customs for mourning. We can’t control everything that happens to us or our loved ones during this lifetime. Myth #2: There is a predictable, orderly But we do have control over how we way that everyone experiences grief. respond to those experiences. We can Certain experiences are common among choose to live in sorrow and anger, or we people who are grieving.
    [Show full text]
  • Exploring Longitudinal Mechanisms of Irritability in Children: Implications for Cognitive-Behavioral Intervention
    BETH-00899; No of Pages 15; 4C: Available online at www.sciencedirect.com ScienceDirect Behavior Therapy xx (xxxx) xxx www.elsevier.com/locate/bt Exploring Longitudinal Mechanisms of Irritability in Children: Implications for Cognitive-Behavioral Intervention Spencer C. Evans Harvard University Jennifer B. Blossom Seattle Children’s Hospital and University of Washington School of Medicine Paula J. Fite University of Kansas depressive symptoms, anxiety, reactive aggression, opposi- Severe irritability is a common and clinically important tionality, intolerance of uncertainty, and poor emotion problem longitudinally associated with internalizing and coping. From T1 irritability to T2/T3 outcomes, mediation externalizing problems in children. To better understand was found for poor sadness coping leading to reactive these mechanisms and to inform treatment research, we tested aggression and oppositionality; poor anger coping to anxiety, cognitive-behavioral processes as candidate mediators in the depressive symptoms, and oppositionality; and intolerance of paths from irritability to later problems. Methods: A school uncertainty to anxiety. Results offer further evidence for sample (N = 238, 48% female, ages 8–10) was assessed at internalizing and externalizing outcomes of youth irritability ~6-month intervals in fall (T1) and spring (T2) of third to and new evidence suggesting underlying mechanisms. Irrita- fourth grade, and again the following fall (T3). Measures bility may confer risk for externalizing problems via poor assessed irritability (T1/predictor); anger and sadness sadness/anger coping, and for internalizing problems via poor coping, intolerance of uncertainty, and rumination; (T1– anger coping and intolerance of uncertainty. Theoretical T2/mediators); and anxiety, depressive symptoms, reac- models and psychosocial treatment should consider address- tive aggression, and oppositionality (T1–T3/outcomes).
    [Show full text]