The aim of this article is to bring together the concepts of borderline pathology and complex trauma. We wish to show that the symptomatology characteristic of borderline pathology approaches, is indeed similar to, th...The aim of this article is to bring together the concepts of borderline pathology and complex trauma. We wish to show that the symptomatology characteristic of borderline pathology approaches, is indeed similar to, that of Non-Specific Extreme Stress (NSES) states. Thus the hypothesis is that states of NSES and borderline pathology constitute psychopathological entities which overlap but reflect different paradigms. The former is linked to the field of psychotraumatology while the latter is more rooted in psychoanalytic theory. In this way traumatic etiology opens the way for the clinician to explore new psychotherapeutic strategies.展开更多
Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th) version, due to be published, two decades after i...Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th) version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder(BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses(PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities' biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.展开更多
Recently, nonlinear analysis of R-to-R interval (RRI) in heart rate has brought research attention in medicine to improve predictive accuracy of medication in severely injured patients. It seems conventional vital sig...Recently, nonlinear analysis of R-to-R interval (RRI) in heart rate has brought research attention in medicine to improve predictive accuracy of medication in severely injured patients. It seems conventional vital signs information such as heart rate and blood pressure to identify critically injured patients eventually replaced by heartrate complexity (HRC) analysis to the electrocardiogram (ECG) of patients in trauma centers. In this respect, different nonlinear analysis tools such as;power spectra, entropy, fractal dimension, auto-correlation function and auto-correlation have been adapted for this complexity analysis of ECG signal. Reidbord and Redington [1] were one of the early reports on applications of nonlinear analysis of the heart physiology. Moody and his colleagues could confidently predicted survival in heart failure cases by use of fully automated methods for deriving nonlinear and conventional indices of heart rate dynamics [2]. Further studies were reported in cases of arrhythmia or general anesthesia by Pomfrett [3], Fortrat [4], Lass [5] and references therein. Recently, noteworthy works of Batchinsky and coworkers have shown that prehospital loss of RRI complexity is associated with mortality in trauma patients [6-8]. They have also shown that prediction of trauma survival by analysis of heart rate complexity is even possible by reducing data set size from 800-beat to 200 or lower beat data sets. In this article, we will use different data nonlinear analysis tools such as;power spectrum, entropy, Lyapunov exponent, capacity dimension and correlation function to analyze HRC as a sensitive indictor of physiologic deterioration. In these analyses, we will use real data of 270-beat sections of ECG from 45 emergency patients brought to Shiraz Rejaee Hospetal trauma center prior to any medication. As we can see, using some manipulation on raw data will provide more informative vital signs in our nonlinear analyses.展开更多
In order to provide culturally competent care to children and adolescents that have been subject to forced migration,clinicians must first understand the unique trauma these individuals experienced.Victims of forced m...In order to provide culturally competent care to children and adolescents that have been subject to forced migration,clinicians must first understand the unique trauma these individuals experienced.Victims of forced migration frequently experience trauma pre-displacement,typically resulting from the same factors that led to the forced migration.They then often experience trauma during the migration itself and post-migration as they settle in a new environment,sometimes without their families if they are unaccompanied minors.An increased risk of developing complex PTSD(C-PTSD)correlates with the number of adverse childhood experiences(ACEs)such as those experienced by children and adolescents that experience forced migration.Understanding the nuances of these traumas and their specific manifestations for the individual child or adolescent is critical for effective behavioral health support.Trauma signature(TSIG)analysis offers clinicians a method to understand the relationship between traumatic events and the physical and psychological consequences to best support these victims.展开更多
文摘The aim of this article is to bring together the concepts of borderline pathology and complex trauma. We wish to show that the symptomatology characteristic of borderline pathology approaches, is indeed similar to, that of Non-Specific Extreme Stress (NSES) states. Thus the hypothesis is that states of NSES and borderline pathology constitute psychopathological entities which overlap but reflect different paradigms. The former is linked to the field of psychotraumatology while the latter is more rooted in psychoanalytic theory. In this way traumatic etiology opens the way for the clinician to explore new psychotherapeutic strategies.
文摘Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th) version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder(BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses(PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities' biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.
文摘Recently, nonlinear analysis of R-to-R interval (RRI) in heart rate has brought research attention in medicine to improve predictive accuracy of medication in severely injured patients. It seems conventional vital signs information such as heart rate and blood pressure to identify critically injured patients eventually replaced by heartrate complexity (HRC) analysis to the electrocardiogram (ECG) of patients in trauma centers. In this respect, different nonlinear analysis tools such as;power spectra, entropy, fractal dimension, auto-correlation function and auto-correlation have been adapted for this complexity analysis of ECG signal. Reidbord and Redington [1] were one of the early reports on applications of nonlinear analysis of the heart physiology. Moody and his colleagues could confidently predicted survival in heart failure cases by use of fully automated methods for deriving nonlinear and conventional indices of heart rate dynamics [2]. Further studies were reported in cases of arrhythmia or general anesthesia by Pomfrett [3], Fortrat [4], Lass [5] and references therein. Recently, noteworthy works of Batchinsky and coworkers have shown that prehospital loss of RRI complexity is associated with mortality in trauma patients [6-8]. They have also shown that prediction of trauma survival by analysis of heart rate complexity is even possible by reducing data set size from 800-beat to 200 or lower beat data sets. In this article, we will use different data nonlinear analysis tools such as;power spectrum, entropy, Lyapunov exponent, capacity dimension and correlation function to analyze HRC as a sensitive indictor of physiologic deterioration. In these analyses, we will use real data of 270-beat sections of ECG from 45 emergency patients brought to Shiraz Rejaee Hospetal trauma center prior to any medication. As we can see, using some manipulation on raw data will provide more informative vital signs in our nonlinear analyses.
文摘In order to provide culturally competent care to children and adolescents that have been subject to forced migration,clinicians must first understand the unique trauma these individuals experienced.Victims of forced migration frequently experience trauma pre-displacement,typically resulting from the same factors that led to the forced migration.They then often experience trauma during the migration itself and post-migration as they settle in a new environment,sometimes without their families if they are unaccompanied minors.An increased risk of developing complex PTSD(C-PTSD)correlates with the number of adverse childhood experiences(ACEs)such as those experienced by children and adolescents that experience forced migration.Understanding the nuances of these traumas and their specific manifestations for the individual child or adolescent is critical for effective behavioral health support.Trauma signature(TSIG)analysis offers clinicians a method to understand the relationship between traumatic events and the physical and psychological consequences to best support these victims.
