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Longitudinal study of PTSD and depression in a war-exposed sample – comorbidity increases distress and suicide risk

Abstract

Background

Major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) are the most common mental disorders following traumatic experiences. The aim of this study was to investigate the extent to which PTSD and depression co-occurred in Serbian general population at baseline and 1 year after the follow-up, as well as how this co-occurrence was associated with sociodemographic factors, personal distress, suicidality and quality of life.

Subjects and methods

The sample consisted of 159 subjects, who fulfilled the IES criteria for PTSD, and were taken from a larger sample of 640 participants, which was chosen by a random walk technique in five regions of the country affected by major trauma. The assessment was carried out by the following instruments: Mini International Neuropsychiatric Interview 5 (MINI 5), Life Stressor Checklist-Revised (BSC-R), Brief Symptom Inventory (BSI), Impact of Event Scale-Revised (IES-R) and Manchester Short Assessment of Quality of Life Scale (MANSA). The follow-up study was carried out 1 year after the baseline.

Results

In the initial phase, PTSD was found in 100 out of 159 participants (62.9%), while 81 (51%) fulfilled the diagnostic criteria for MDD. Comorbidity of PTSD and depression was identified in 65 (40.9%) subjects of the sample. After 1 year, PTSD was found in 56 (35.2%) and MDD in 73 (45.9%) participants. Comorbidity of PTSD and depression in the follow-up phase was identified in 41 (25.8%) subjects of the sample. The subjects with comorbidity had significantly higher level of post-traumatic stress symptoms, general psychological distress as well as suicide risk and lower level of quality of life than participants with either condition alone.

Conclusion

PTSD–depression comorbidity is a common post-traumatic condition. Complex psychopathology, severity of symptoms and their consequences, both at individual and community levels, require attention to be paid to early diagnostics and treatment of affected persons.

Open access
Perceptions of Pakistani community towards their mental health problems: a systematic review

Abstract

Objectives

The objective of this research is to explore how Pakistani community perceive their mental health problems by systematically reviewing the scientific literature published on major databases. The findings expectedly will be useful for general public, for clinicians and for the researchers.

Methods

The methodology of this systematic literature search involved identifying and critically appraising studies that attempted to explore how Pakistani community perceives and understands its mental health problems. We carried out literature search on some major databases including PubMed, Cochrane database of systematic reviews and Google Scholar. We followed selection criteria where researchers aimed to find perceptions and understandings of Pakistani participants regarding their mental health by adopting scientific methodologies. The extraction of data was carried out after reading the selected papers and organising the findings under specific categories, in the form of a table. Data analysis was based on the information gathered from these studies.

Results

The results suggest that Pakistani community exhibits negligible to little understanding regarding their psychological experiences and emotional processes as separate identifiable entities. Nonetheless, multiple parallel sociocultural concepts such as religion or faith driven practices and mythical or supernatural understandings are highlighted by this research. These are accepted and practiced in order to address mental health problems.

Conclusion

It appears that Pakistani community has limited understanding and scarce vocabulary to describe their inner psychological and emotional experiences. However, in order to address the mental health issues, the community exhibits a variety of responses and reactions that are driven from several unique social, cultural and religious factors. Whether these are general perceptions or causations or protective factors towards illness or possible treatment options, they all are approached and addressed with some unique understandings and perceptions that are specific to this community.

Open access
Implementing a psychosocial intervention DIALOG+ for patients with psychotic disorders in low and middle income countries in South Eastern Europe: protocol for a hybrid effectiveness-implementation cluster randomized clinical trial (IMPULSE)

Abstract

Objectives

Psychotic disorders have large treatment gap in low- and middle-income countries (LMICs) in South-Eastern Europe, where up to 45% of affected people do not receive care for their condition. This study will assess the implementation of a generic psychosocial intervention called DIALOG+ in mental health care services and its effectiveness at improving patients’ clinical and social outcomes.

Methods

This is a protocol for a multi-country, pragmatic, hybrid effectiveness–implementation, cluster-randomised, clinical trial. The trial aims to recruit 80 clinicians and 400 patients across 5 South-Eastern European LMICs: Bosnia and Herzegovina, Kosovo*, Montenegro, Republic of North Macedonia and Serbia. Clusters are clinicians working with patients with psychosis, and each clinician will deliver the intervention to five patients. After patient baseline assessments, clinicians will be randomly assigned to either the DIALOG+ intervention or treatment as usual, with an allocation ratio of 1:1. The intervention will be delivered six times over 12 months during routine clinical meetings. TThe primary outcome measure is the quality of life at 12 months [Manchester Short Assessment of Quality of Life (MANSA)]; the secondary outcomes include mental health symptoms [Brief Psychiatric Rating Scale (BPRS), Clinical Assessment Interview for Negative Symptoms (CAINS), Brief Symptom Inventory (BSI)], satisfaction with services [Client Satisfaction Questionnaire (CSQ-8)] and economic costs at 12 months [based on Client Service Receipt Inventory (CSRI), EQ-5D-5L and Recovering Quality of Life (ReQOL-10)]. The study will assess the intervention fidelity and the experience of clinicians and patients’ about implementing DIALOG+ in real-life mental health care settings. In the health economic assessment, the incremental cost-effectiveness ratio is calculated with effectiveness measured by quality-adjusted life year. Data will also be collected on sustainability and reach to inform guidelines for potentially scaling up and implementing the intervention widely. Conclusion: The study is expected to generate new scientific knowledge on the treatment of people with psychosis in health care systems with limited resources. The learning from LMICs could potentially help other countries to expand the access to care and alleviate the suffering of patients with psychosis and their families.

Trial registration: ISRCTN 11913964

Open access
The Archaic, Archaic Communication and Psychic Figurability

Abstract

In “Constructions in analysis” (1937), S. Freud compared the analyst’s work to that of the archaeologist searching among vestiges, with the big difference that the object of our work is alive, and working with it causes fear, pain and suffering. Last year, during a visit to Pompeii and Mount Vesuvius, impressed by the strangeness of the atmosphere, by people carbonised by lava, eternal statues in a shocking atemporality among the archaic objects and traces of the place, I picked up the thread of psychoanalytic reflections on such ruins, vestiges, the layers of “ash” also present in the human psyche and their relevance in the work of the analytic cure. How to communicate the unthinkable, the unsayable, the un-representable, the barely figurable? How to transform traces of your “ancestors’ ancestors’ ancestors”, even as passed down from Superego to Superego, or via inter-transgenerational transmissions? How to transform the formless into form?

From S. Freud to D. W. Winnicott, and W. Bion, from A. Green and J. McDougall, via D. Anzieu and R. Roussillon, the author is proposing to revisit the psychic vestiges as they are expressing during the analytic process.

Open access
Bitter Moon. Brief Psychoanalytical Reflexions on a Detail

Abstract

The majority of book-to-film adaptations operate more or less important adjustments on the initial text. In this respect, the present article attempts to investigate the psychoanalytical relevance of such a textual intervention in Roman Polanski’s 1992 film, “Bitter Moon”, based on Pascal Bruckner’s novel, “Lunes de fiel” (1981). The analysis takes the Freudian theories on sadomasochism and death instinct as a starting point.

Open access
Editorial
Open access
From Body to Word…, From Word to Eros
An Analyst’s Reading the Llosa’s “Storyteller”

Abstract

When describing the two instincts in his work “The Ego and the Id”, Freud says that the “Eros, by bringing about a more and more far-reaching combination of the particles into which living substance is dispersed, aims at complicating life and at the same time, of course, at preserving it”. This complication, which I consider to be rather an increased complexity, can be found in the patients’ discourse through the diversification of means of expression and attributed significations, when their “stories” open up to us and to new meanings… However, when stories are meant to free the body of the burden of a stigmata, which must be covered with histories and significants, how can we identify the flux of the Eros in the counter-sense of a Thanatos that, as Freud said, “tends to return the organic to the lifeless state”? I therefore propose that we try and explore this effort to tell the story of the body expression forms trough words, in Mario Vargas Llosa’s novel, The Storyteller…

Open access
Fusion I. One of the Basic Mechanisms of the Human Psyche

Abstract

Fusion is one of the fundamental mechanisms of mental functioning, an essential element in all object relations – with variations only in the degree of participation – along with the component connoted by separateness. There is a continuous dialectic relationship between levels of fusion and separateness in every human relationship.

Among the goals of the basic human search for an object we should also include the attempt to establish common mental areas with sufficiently similar objects through fusion. Mental contents can flow freely between the subject and the objects through these shared areas. Human beings seem characterized by an extremely sophisticated and continuously changing boundary system.

The simultaneous dialectic presence of three levels of mutual relation is stressed in object relations: the level of fusion, the level of incomplete separation and the level of complete separation. The three levels are compared to the three positions (one more primitive: Fusion as well as the Kleinian PS and D).

Open access
Midlife - Maturity and Creativity

Abstract

Midlife is an age of crisis according to many authors, as it sets the subject up against the inevitability of the ageing process, loss, and the limitedness of life. Most authors view midlife as an age of crisis where everything can be staked back into the game. But some other authors have highlighted how midlife is characterised by a new burst of creativity, by new object investments and by a redressing of the balance between narcissism (which decreases) and object investments for which a larger share of the libido becomes available. The Author thinks that it seems worthwhile to make a distinction between midlife, as indicative of a phase of life, and maturity, construed as a psychic position which is relatively independent of age.

Therefore, she explores the creativity area of the trans-generational transmission, quoting some psychoanalysts and poets, and introducing a clinical example of the mourning process for losses inherent in the passing of time and the development of tolerance capacities to deal with a change in the balance between the libido and narcissism.

Then the Author affords a specific difficulty in transmitting a trans-generational mandate, when the treatment concerns cases of severe trauma, like victims of collective trauma and mass murders. What can be transmitted in these cases if the psychological concatenation between the generations is interrupted and breaks down? How can it be linked up again? The story and re-elaboration by Henri Parens is brought as an example to be studied and commented.

Open access
Mother’s Primacy in Anthropology and Psychoanalysis

Abstract

The theory of matriarchy still enjoys wide popularity, even among psychoanalysts. Following Freud’ ideas, they invoke the passage from matriarchy to patriarchy as a historical analogue to the individual psychosexual development.

After a review of anthropological discussions, some hypotheses vis-a-vis this persistence are proposed: matriarchy is a secular cosmogonic myth, developed within the evolutionary paradigm; a fantasy of origin of mankind within the mother’s primacy constellation, both defensive formations against underlying anxieties constitutive of societal institution.

Having recourse to Peirce’s and Green’s concept of thirdness, a critical approach of linearity is undertaken. Finally, a structural correlation between gynaecocracy and matriarchal theory is proposed.

Open access