RESUMO
BACKGROUND: Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2-3% and is a leading cause of global disability. Brain circuit abnormalities in individuals with OCD have been identified, but important knowledge gaps remain. The goal of the new global initiative described in this paper is to identify robust and reproducible brain signatures of measurable behaviors and clinical symptoms that are common in individuals with OCD. A global approach was chosen to accelerate discovery, to increase rigor and transparency, and to ensure generalizability of results. METHODS: We will study 250 medication-free adults with OCD, 100 unaffected adult siblings of individuals with OCD, and 250 healthy control subjects at five expert research sites across five countries (Brazil, India, Netherlands, South Africa, and the U.S.). All participants will receive clinical evaluation, neurocognitive assessment, and magnetic resonance imaging (MRI). The imaging will examine multiple brain circuits hypothesized to underlie OCD behaviors, focusing on morphometry (T1-weighted MRI), structural connectivity (Diffusion Tensor Imaging), and functional connectivity (resting-state fMRI). In addition to analyzing each imaging modality separately, we will also use multi-modal fusion with machine learning statistical methods in an attempt to derive imaging signatures that distinguish individuals with OCD from unaffected siblings and healthy controls (Aim #1). Then we will examine how these imaging signatures link to behavioral performance on neurocognitive tasks that probe these same circuits as well as to clinical profiles (Aim #2). Finally, we will explore how specific environmental features (childhood trauma, socioeconomic status, and religiosity) moderate these brain-behavior associations. DISCUSSION: Using harmonized methods for data collection and analysis, we will conduct the largest neurocognitive and multimodal-imaging study in medication-free subjects with OCD to date. By recruiting a large, ethno-culturally diverse sample, we will test whether there are robust biosignatures of core OCD features that transcend countries and cultures. If so, future studies can use these brain signatures to reveal trans-diagnostic disease dimensions, chart when these signatures arise during development, and identify treatments that target these circuit abnormalities directly. The long-term goal of this research is to change not only how we conceptualize OCD but also how we diagnose and treat it.
Assuntos
Mapeamento Encefálico , Encéfalo/diagnóstico por imagem , Imagem de Tensor de Difusão , Internacionalidade , Imageamento por Ressonância Magnética , Estudos Multicêntricos como Assunto/métodos , Transtorno Obsessivo-Compulsivo/diagnóstico por imagem , Adolescente , Adulto , Encéfalo/patologia , Encéfalo/fisiopatologia , Brasil , Estudos de Casos e Controles , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Países Baixos , Transtorno Obsessivo-Compulsivo/patologia , Transtorno Obsessivo-Compulsivo/fisiopatologia , Projetos de Pesquisa , Irmãos/psicologia , África do Sul , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: This study reports the extent to which states have adopted the national culturally and linguistically appropriate services (CLAS) standards. METHODS: Officials from public mental health agencies in the 50 states, Washington, D.C., and Puerto Rico were contacted between January and June 2016 to obtain information about adoption of CLAS standards in current policies. Each policy was coded through thematic analysis to determine its correspondence with any of the 14 national CLAS standards, which are grouped into three domains. RESULTS: Officials from 47 states and territories (90%) responded. Eight states (17%) reported adopting all national CLAS standards. Ten (23%) had adopted no CLAS policies, five (12%) had adopted policies under one domain, three (7%) under two domains, and 25 (58%) under all three domains. CONCLUSIONS: Most states do not have policies that meet all CLAS standards, raising questions about how CLAS standards should be adopted.
Assuntos
Assistência à Saúde Culturalmente Competente/normas , Órgãos Governamentais/normas , Serviços de Saúde Mental/normas , Saúde Mental/normas , Formulação de Políticas , Guias de Prática Clínica como Assunto/normas , Humanos , Porto Rico , Estados UnidosRESUMO
BACKGROUND: The development of youth psychopathology may be associated with direct and continuous contact with a different culture (acculturation) and to distress related to this process (cultural stress). We examine cultural experiences of Puerto Rican families in relation to youth psychiatric symptoms in two different contexts: one in which migrant Puerto Ricans reside on the mainland as an ethnic minority and another in which they reside in their place of origin. SAMPLE: Probability samples of 10- to 13-year-old youth of Puerto Rican background living in the South Bronx, New York City (SB) and in the San Juan Metropolitan area in Puerto Rico (PR) (N = 1,271) were followed over time. measures: Three assessments of internalizing psychiatric symptoms (elicited through the DISC-IV) and of antisocial behaviors (ASB) quantified through a six-point index were carried out. Independent variables included scales of adult and child acculturation and cultural stress, and other putative correlates. DATA ANALYSIS: Within each study site, multilevel linear regression models were examined. RESULTS: Parental acculturation was associated with ASB in youth at both sites, but youth acculturation itself was not related to psychiatric symptoms. At both contexts, cultural stress was a more consistent correlate of youth psychiatric symptoms than acculturation after controlling for nativity, maternal education, child gender, stressful life events and parental psychopathology. However, the strength of the youth cultural stress association decreased over time. CONCLUSION: The association between cultural factors and child psychiatric symptoms is not restricted to contexts where an ethnic group is a minority.
Assuntos
Transtorno da Personalidade Antissocial/diagnóstico , Transtorno da Personalidade Antissocial/etnologia , Cultura , Aculturação , Adolescente , Transtorno da Personalidade Antissocial/psicologia , Criança , Pré-Escolar , Manual Diagnóstico e Estatístico de Transtornos Mentais , Etnicidade/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Porto Rico/etnologia , Estresse Psicológico/etnologia , Estresse Psicológico/psicologiaRESUMO
Many studies have found that individuals with schizophrenia have been born in winter months in disproportionately high numbers. Temperature and weather effects, such as hot summers or cold winters, have been among the suggested explanations for this seasonality effect. We studied the relationship between schizophrenia and season of birth in Puerto Rico, a tropical island with mild seasonal variation of temperature and virtually no cold periods. Our sample consisted of 132 subjects (57 with schizophrenia, 75 without) from 24 multiplex families. Schizophrenic family members were significantly more likely to be born during the winter months (21/57; 36.8%) than their unaffected relatives (16/75; 21.3%). These results suggest that extreme temperatures are not a sufficient explanation for the seasonality effect and that other factors associated with seasonality may have an effect on the later development of schizophrenia. The fact that a seasonality effect was found in a group likely to have an increased genetic loading for schizophrenia suggests that seasonality may be associated with a second, environmental "hit" in a "two-hit hypothesis" of schizophrenia.
Assuntos
Parto , Esquizofrenia/epidemiologia , Estações do Ano , Clima Tropical , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Esquizofrenia/genéticaRESUMO
This paper is about naming illnesses--about who determines what categories are used and the implications of these determinations. The central concerns of medical/psychiatric anthropology have been to understand popular categories of and systems for classification of illness, to examine the relationship of illness categories to cultural understandings of the body, and to interpret the role of categories of illness in mediating between the personal and social spheres. At the same time, the paper also discusses the interplay of popular categories and psychiatric diagnoses. This paper examines the multiple experiences of nervios among Puerto Ricans in Puerto Rico and New York City. Our contention is that nervios is more than a diffuse idiom of distress, and that there are different categories and experiences of nervios which provide insights into how distress is experienced and expressed by Puerto Ricans and point to different social sources of suffering. The data in this paper come from the responses to a series of open-ended questions which tapped into people's general conceptions of nervios and ataques de nervios. These questions were incorporated into follow-up interviews to an epidemiological study of the mental health of adults in Puerto Rico. The results suggest ways to incorporate these different categories of nervios into future research and clinical work with different Latino groups in the United States and in their home countries.
Assuntos
Ansiedade/etnologia , Atitude Frente a Saúde/etnologia , Diversidade Cultural , Hispânico ou Latino/psicologia , Medicina Tradicional , Estresse Psicológico/etnologia , Terminologia como Assunto , Adolescente , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Escalas de Graduação Psiquiátrica , Porto Rico/etnologia , Estresse Psicológico/diagnóstico , Estresse Psicológico/etiologiaRESUMO
The terrorist attacks on the World Trade Center (WTC) on September 11, 2001 strained the emotional resources of many New York City residents. The expectation of another terrorist attack, including the fear of bio-terrorism, complicates the recovery process of individuals who were directly affected by the disaster. These individuals are experiencing an amalgan of psychological problems, including Posttraumatic Stress Disorder (PTSD), depression, anxiety, traumatic grief, and self-destructive behaviors. In addition, for some victims, the collapse of the WTC was experienced within a religious context of an apocalyptic nature (e.g., "doomsday" or "the end of the world"). To date, this has been the deadliest act of terrorism in the United States. In this paper we discuss the following: (1) the immediate mental health effects of the terrorist attacks, (2) the prevalence of PTSD before and after September 11, 2001, (3) vulnerability factors implicated in the development of PTSD, (4) the immediate responses to the disaster by government, private, and academic institutions, and (5) a brief description of evidence-based treatments for PTSD. The paper concludes with an account of the horrific and terrifying experience of a WTC survivor.
Los ataques terroristas a las Torres Gemelas el 11 de septiembre de 2001 abrumaron los mecanismos psicológicos que utilizan diariamente los neoyorquinos para enfrentar el estrés. La expectativa de otro ataque terrorista, incluyendo el temor al bioterrorismo, complica el proceso de recuperación de muchos individuos afectados directamente por el desastre. Estas personas experimentan una combinación de problemas psicológicos, incluyendo el Trastorno por Estrés Postraumático (TEPT), la depresión, la ansiedad, el duelo traumático, y las conductas auto-destructivas. Además, algunas víctimas vivieron el desplome de las Torres Gemelas dentro de un marco religioso de naturaleza apocalíptica (por ejemplo, "el dia del juicio final" o "el fin del mundo"). Hasta la fecha, éste ha sido el acto terrorista más mortífero en la historia de Estados Unidos. En este artículo discutimos los siguientes temas: (1) el efecto psicólogico inmediato de los ataques terroristas, (2) la prevalencia del TEPT antes de y después del 11 de septiembre de 2001, (3) los factores que aumentan la vulnerabilidad para presentar el TEPT, (4) las respuestas inmediatas al desastre de parte de las instituciones gubernamentales, privadas y académicas, y (5) una descripción breve de los tratamientos para el TEPT avalados por la evidencia científica. El artículo concluye con un relato de la horrible y aterradora experiencia de un sobreviviente de los ataques.
RESUMO
This article examines a clinical sample of 66 Dominican and Puerto Rican subjects who reported ataques de nervios and also psychiatric disorder, and disentangles the phenomenological experiences of ataque de nervios, panic attacks, and panic disorder. In-depth cultural interviews assessed the symptomatic phenomenology of ataque episodes from the local perspective as well as in terms of key panic features, such as recurrence, rapid peaking of symptoms, and lack of provocation. Independent diagnostic assessments of panic attacks and disorder were also used to establish the phenomenological overlap between ataque and panic. Our findings indicate that 36 percent of ataques de nervios fulfill criteria for panic attacks and between 17 percent and 33 percent for panic disorder, depending on the overlap method used. The main features distinguishing ataques that fulfill panic criteria from ataques that do not include whether the episodes were provoked by an upsetting event in the person's life and the rapidity of crescendo of the actual attack. A key finding is that ataques often share individual phenomenological features with panic episodes, but that these features usually do not "run together" during the ataque experience. This confirms previous findings that ataque is a more inclusive construct than panic disorder. The importance of these findings for the clinical diagnosis and treatment of persons with ataques is discussed.
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Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/etnologia , Cultura , Hispânico ou Latino/psicologia , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/etnologia , Adolescente , Adulto , Idoso , Comorbidade , Diagnóstico Diferencial , República Dominicana/etnologia , Feminino , Hospitais Psiquiátricos , Humanos , Entrevista Psicológica , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , New York , Psiquiatria , Porto Rico/etnologia , Sociologia MédicaRESUMO
OBJECTIVE: This study examined the relationships of dissociation and childhood trauma with ataque de nervios. METHOD: Forty Puerto Rican psychiatric outpatients were evaluated for frequency of ataque de nervios, dissociative symptoms, exposure to trauma, and mood and anxiety psychopathology. Blind conditions were maintained across assessments. Data for 29 female patients were analyzed. RESULTS: Among these 29 patients, clinician-rated dissociative symptoms increased with frequency of ataque de nervios. Dissociative Experiences Scale scores and diagnoses of panic disorder and dissociative disorders were also associated with ataque frequency, before corrections were made for multiple comparisons. The rate of childhood trauma was uniformly high among the patients and showed no relationship to dissociative symptoms and disorder or number of ataques. CONCLUSIONS: Frequent ataques de nervios may, in part, be a marker for psychiatric disorders characterized by dissociative symptoms. Childhood trauma per se did not account for ataque status in this group of female outpatients.