Day 1 :
Keynote Forum
Victor G. Carrion
Professor and Vice-Chair, Stanford University
Keynote: Neuroscience-informed interventions for youth with history of traumatic stress
Time : 10:00-10:40
Biography:
Dr. Carrion is the John A. Turner, M.D. Endowed Professor and Vice-Chair in the Department of Psychiatry and Behavioral Sciences at Stanford University and Director of the Stanford Early Life Stress and Pediatric Anxiety Program. He is in the faculty at both Stanford University School of Medicine and Lucile Packard Children’s Hospital. His multidisciplinary research on the behavioral, academic, emotional, and biological late effects of experiencing trauma has led to the development and implementation of effective new interventions for treating children who experience traumatic stress. Using Posttraumatic Stress Disorder (PTSD) as an anchor, Dr. Carrion is investigating, through longitudinal studies, the effects of stress on developmental physiology and brain development and function.
Abstract:
Statement of the Problem: 35% of youth living in communities of high violence will develop significant posttraumatic stress disorder symptoms. Current treatment modalities that anchor in cognitive behavioral therapy (CBT) may leave 20-50% of youth without adequate symptom relieve. New treatment modalities that address executive function, memory and emotion regulation are needed, and access and dissemination should be taken into consideration. This presentation will introduce Stanford’s Cue-Centered Therapy (CCT) and a school-district wide prevention effort that involves yoga and mindfulness in students’ curriculum. CCT integrates elements from CBT with other empirically validated interventions for traumatized youth (psychodynamic therapy, insight, self-efficacy, education). The prevention study focuses on health and wellness through meditation and exercise. Methodology & Theoretical Orientation: Our research identifying key brain regions (e.g.; hippocampus, amygdala, prefrontal cortex) alterations in structure and function as related to traumatic stress informed the development of CCT. CCT demonstrated effectiveness in reducing anxiety, depression and posttraumatic stress symptoms in a randomized controlled trial. We are currently engaged in treatment outcome research to demonstrate CCT’s efficacy in improving brain function and cognitive and emotional outcomes. Findings: The presentation will focus on our imaging (sMRI and fMRI) and salivary cortisol studies that set the stage for the development of CCT. In addition, sleep was investigated in our prevention study. A curriculum of yoga and mindfulness improves sleep variables and these will be presented. Conclusion & Significance: New treatment modalities and dissemination plans need to be developed to address the highly heterogenous group of children that fall under the diagnostic umbrella of posttraumatic stress disorder (PTSD). Approaching both prevention and treatment that are informed by neuroscience research promises to make our interventions more focused and targeted.
Keynote Forum
Francheska Perepletchikova
Weill Cornell Medical College, USA
Keynote: Dialectical Behavior Therapy: A new frontier in treatment of pre-adolescent children with severe emotional and behavioural dysregulation
Time : 11:00-11:40
Biography:
Francheska Perepletchikova, Ph.D., DBT-Linehan Board of Certification Board Certified Clinician is an Assistant Professor of Psychology, Department of Psychiatry, Weill Cornell Medical College. Dr. Perepletchikova received her B.A. degree at St. John's University and graduated with gold medal for the highest academic average. Dr. Perepletchikova received graduate training in two disciplines, developmental and clinical psychology. She obtained M.A. in Developmental Psychology from Teachers College, Columbia University in 1996 and received Ph.D. in Clinical Psychology from Yale University Department of Psychology in 2007 with James B. Grossman Best Dissertation Prize. During her internship and post-doctoral training at Yale University School of Medicine, Dr. Perepletchikova gained expertise in Dialectical Behavior Therapy (DBT). She obtained intensive and advanced intensive trainings in DBT with Dr. Linehan. Further, Dr. Perepletchikova have been established as able to deliver DBT with adherence and calibrated as a reliable DBT adherence rater by Behavioral Research and Therapy Clinics at the University of Washington. In 2015, she became a BTech trainer. In 2016 Dr. Perepletchikova became a DBT-Linehan Board of Certification Board Certified Clinician.
Abstract:
Chronic irritability and difficulty with self-control may negatively affect child’s emotional, social and cognitive development and are predictive of personality disorders, dysphoric mood, substance and alcohol abuse, suicidality and non-suicidal self-injury in adolescence and adulthood. Dialectical Behavior Therapy for pre-adolescent children (DBT-C) aims to facilitate adaptive responding by teaching coping skills and encouraging caregivers to create a validating and change-ready environment.Method:Two RCTs were conducted to examine feasibility and initial efficacy of DBT-C.1) In the NIMH funded RCT of DBT-C for Disruptive Mood Dysregulation Disorder, 43 children (7-12 years) were randomly assigned to DBT-C or TAU. Children were provided with 32 individual sessions that included child counselling, parent sessions and skills training.2) In the Private Foundation funded RCT of DBT-C for children in residential care, 47 children (7-12 years) were randomly assigned to DBT-C or TAU. Children were provided with 34 individual sessions, 48 group skills trainings and 12 parent trainings.Results:1) Subjects in DBT-C attended 40.4% more sessions than subjects in TAU. No subjects dropped out of DBT-C, while 36.4% dropped from TAU. Further, 90.4% of children in DBT-C responded to treatment compared to 45.5% in TAU, on the Clinical Global Impression Scale. All changes were clinically significant and sustained at 3-months follow-up.2) In the residential care trial significant differences were observed on the main measure of outcome – Child Behavior Checklist (CBCL) staff report. Children in the DBT-C condition as compared to TAU had significantly greater reduction in symptoms on both Internalizing and Externalizing subscales. All changes were clinically significant. Results were maintained at 3- and 6-month follow-up.
- Sessions:
Anxiety & Depression Disorders | Psychology | Bipolar disorder | Psychiatry | Psychiatry and Psychological disorders | Mental health education and Training | Schizophrenia
Session Introduction
Rodrigo Chiavaro da Fonseca
Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil
Title: Frequency of brain tissue donation for research after suicide
Time : 11:40-12:10
Biography:
Rodrigo Chiavaro da Fonseca is a medical student, interested in research since the beginning of college. Today he is working in multiple projects, such as “Evaluation of Biochemical and Molecular Parameters of the Brain and their Clinical Correlations in Individuals Who Committed Suicide”, “Brazil’s Suicide Rate from 2000 to 2014 Stratified by Genre and Age” and “Hospital Waste: Is it possible to minimize the environmental impact of a big university hospital?”. He is also teaching as monitor in “Promotion and Protection of Elderlys and Adults’ Health” class since 2016, August. Rewarded with the Award of Best Oral Presentation at the 36th Scientific Week of HCPA in 2016.
Abstract:
Obtaining central nervous system tissue is essential for neurobiological research in mental health. There is a growing demand for the availability of human brain tissue, with greater interest in using these tissues for investigation of basic biological processes associated with mental illness. In the current scenario, however, brain tissue biobanks dedicated to psychiatric disorders are extremely scarce. Little is known about organ donation for research. The main reasons and facilitators found for donation to biobanks are: 1) the desire to help others; 2) open dialogue within the family about the organ donation process; and 3) a desire to contribute to medical progress.Our objective is to describe the frequency of brain tissue donation for research purposes by families of individuals that committed suicide.We included all requests for brain tissue donation to a brain biorepository made to the families of individuals aged 18-60 years who had committed suicide between March 2014 and February 2016. Cases presenting with brain damage due to acute trauma were excluded.Fifty-six cases of suicide were reported. Of these, 24 fulfilled the exclusion criteria, and 11 others were excluded because no next of kin was found to provide informed consent. Of the 21 remaining cases, brain tissue donation was authorized in nine (tissue fragments in seven and the entire organ in two). The sample was composed mainly of men, with a mean age of 39 years. Those responsible for providing informed consent were most often siblings, followed by the children of the tissue donor (Table 1).Donation of brain tissue from suicide cases for research purposes is feasible. The acceptance rate of 42.8% in our sample is in accordance with international data on such donations, and similar to rates reported for neurodegenerative diseases.
Murilo Martini
Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil
Title: Multiple Pathways to PTSD after suicide
Time : 12:10-12:40
Biography:
Murilo Martini is a medical student at UFRGS. Today he is working in multiple projects, such as “Evaluation of Biochemical and Molecular Parameters of the Brain and their Clinical Correlations in Individuals Who Committed Suicide”, “Brazil’s Suicide Rate from 2000 to 2014 Stratified by Genre and Age” and “Hospital Waste: Is it possible to minimize the environmental impact of a big university hospital?”. He also taught as monitor in “Fundamentals of Microbiology”, “Medical Histology” and “Medical Physiology” classes.
Abstract:
Background: The bereavement period is associated with elevated risk for the onset of trauma related psychiatric disorders, especially when following unexpected and violent death. The sudden loss of a loved one can also be linked with higher levels of grief.Methods: The course of illness and psychiatric features following a traumatic loss by suicide of a loved one are illustrated in a single case report.Results: The case presented demonstrates how the traumatic event of losing a loved one by suicide triggered a series of psychiatric symptoms such as insomnia, depression, panic disorder, along with work impairment and difficulty to live by oneself, all of which persisted for over a year. Conclusions: This case study indicates that after suicide a person can develop severe symptoms of posttraumatic stress disorder via many factors that operate in the situation, indicating the need of a proper mental health management following suicide.
Francheska Perepletchikova
Weill Cornell Medicine, USA
Title: Dialectical behaviour therapy for pre-adolescent children: Current evidence and future direction
Time : 13:40-15:10
Biography:
Francheska Perepletchikova, Ph.D., DBT-Linehan Board of Certification Board CertifiedClinician is an Assistant Professor of Psychology, Department of Psychiatry, Weill CornellMedical College. Dr. Perepletchikova received her B.A. degree at St. John's University and graduated with gold medal for the highest academic average. Dr. Perepletchikova received graduate training in two disciplines, developmental and clinical psychology. She obtained M.A. in Developmental Psychology from Teachers College, Columbia University in 1996 and received Ph.D. in Clinical Psychology from Yale University Department of Psychology in 2007 with James B. Grossman Best Dissertation Prize. During her internship and post-doctoral training at Yale University School of Medicine, Dr. Perepletchikova gained expertise in Dialectical Behavior Therapy (DBT). She obtained intensive and advanced intensive trainings in DBT with Dr. Linehan. Further, Dr. Perepletchikova have been established as able to deliver DBT withadherence and calibrated as a reliable DBT adherence rater by Behavioral Research andTherapy Clinics at the University of Washington. In 2015, she became a BTech trainer. In2016 Dr. Perepletchikova became a DBT-Linehan Board of Certification Board CertifiedClinician.
Abstract:
Background:Chronic irritability and difficulty with self-control may negatively affect child’s emotional, social and cognitive development and are predictive of personality disorders, dysphoric mood, substance and alcohol abuse, suicidality and non-suicidal self-injury in adolescence and adulthood. Dialectical Behavior Therapy for pre-adolescent children (DBT-C) aims to facilitate adaptive responding by teaching coping skills and encouraging caregivers to create a validating and change-ready environment.Method:Two RCTs were conducted to examine feasibility and initial efficacy of DBT-C.1) In the NIMH funded RCT of DBT-C for Disruptive Mood Dysregulation Disorder, 43 children (7-12 years) were randomly assigned to DBT-C or TAU. Children were provided with 32 individual sessions that included child counselling, parent sessions and skills training.2) In the Private Foundation funded RCT of DBT-C for children in residential care, 47 children (7-12 years) were randomly assigned to DBT-C or TAU. Children were provided with 34 individual sessions, 48 group skills trainings and 12 parent trainings.Results:1) Subjects in DBT-C attended 40.4% more sessions than subjects in TAU. No subjects dropped out of DBT-C, while 36.4% dropped from TAU. Further, 90.4% of children in DBT-C responded to treatment compared to 45.5% in TAU, on the Clinical Global Impression Scale. All changes were clinically significant and sustained at 3-months follow-up.2) In the residential care trial significant differences were observed on the main measure of outcome – Child Behavior Checklist (CBCL) staff report. Children in the DBT-C condition as compared to TAU had significantly greater reduction in symptoms on both Internalizing and Externalizing subscales. All changes were clinically significant. Results were maintained at 3- and 6-month follow-up.Conclusions:Results of both trials supported the feasibility and initial efficacy of DBT adapted for pre-adolescent children with severe emotional and behavioural dysregulation in multiple settings.
Murilo Martini
Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil
Title: Brazil’s Suicide Rate from 2000 to 2014 Stratified by Gender and Age
Time : 15:10-15:40
Biography:
Murilo Martini is a medical student at UFRGS. Today he is working in multiple projects, such as “Evaluation of Biochemical and Molecular Parameters of the Brain and their Clinical Correlations in Individuals Who Committed Suicide”, “Brazil’s Suicide Rate from 2000 to 2014 Stratified by Genre and Age” and “Hospital Waste: Is it possible to minimize the environmental impact of a big university hospital?”. He also taught as monitor in “Fundamentals of Microbiology”, “Medical Histology” and “Medical Physiology” classes
Abstract:
According to WHO, about 800.000 people commit suicide every year. The elderlies have the highest rates of suicide in many countries. Also, men have a higher suicide rate than women. It is not known yet how the proportion of men and women behaves according to age group. In face of that, our objective is to verify Brazil’s suicide rates, stratify by sex and age group, and analyze their variation throughout time, utilizing data from DATASUS, from 2000 to 2014.In 2014, 10.653 suicides were notified in Brazil. Suicide rate is 3,86 higher among men (8,41) when compared to women (2,18). An attenuation of this ratio is observed in ages between 45 and 59 years old, due to an elevation of women’s suicide rate, whose highest rates are in this age group. In the elders, we observe the highest tendency to dissociation: In women, the suicide rate remains stable – tending to decline in the age group of 80+. On the other hand, men present progressive elevation after 65 years old, reaching a peak of 18,22 in 80+ age group.Time evaluation from 2000 through 2014 shows important raise of 34,18% in suicide rate among men, and 37,44% among women. This rise occurred progressively but not homogeneously: In men, 20-34 and 35-49 age groups showed the highest rate rises – 28,50% and 15,15%, respectively. However, in women, the highest raises were seen in 35-49 and 50-64 age groups – 32,06% and 31,53%, respectively.Our analysis suggest the rise of suicide rates differ according to gender. In men, the rise is higher in those below 50 years old, although suicide rates are still higher in the elders. In women, the highest rise is seen in the transition between adult life and elderliness, an age group historically under higher risk.
Shafkat Jahan
Queensland University of Technology, Australia
Title: Assessing evidence for seasonality of acute episode of schizophrenia in Queensland, Australia
Time : 16:10-16:40
Biography:
Shafkat is currently doing Ph.D. in Public Health School of Queensland University of Technology. She has also completed her research masters in 2015 from QUT. Her main research focus is environmental aspects of mental health disorders. She is currently exploring the different climatic parameters with other environmental covariates responsible of acute onset of schizophrenia.
Abstract:
Whilst there is growing evidence of seasonality or the role of climatic variables on acute hospital admissions for some noticeable mental health disorders, however it is less documented for schizophrenia. The objective of this study was to assess the evidence for a seasonal pattern of acute episodes of schizophrenia in Queensland, Australia which contains a range of different climate patterns.Daily basis hospital admissions data for the primary diagnosis of schizophrenia were collected from Queensland Health for the period from January 1996 to December 2015. A Poisson regression model was used incorporating a flexible cosinor function to assess monthly excess as well as a seasonal pattern in hospital admissions of schizophrenia after adjusting for trends. The evidence for seasonality was also explored in different subgroups, including socio-demographic characteristics, admission status and psychiatric comorbidities.Overall, we found a significant seasonal pattern in the monthly hospital admission rate for schizophrenia. A significant winter pattern was detected with a peak in July (10% increase in monthly mean rate ratio for the period of June-August) in temperate Southeast Queensland. However, other areas of Queensland with distinct climatic feature show different seasonal patterns (e.g. a spring pattern was detected in tropical North Queensland with a peak in October). Hospital admissions were consistently higher among males of 20-39 years, Australian origin and unemployed particularly in winter. It was interesting to highlight schizophrenia in winter among patients without psychiatric comorbidity (57.98%).The study demonstrates evidence towards the seasonality of hospital admissions for schizophrenia in Queensland. Thus, the study can be used towards designing the early interventions and treatment strategies.
Rodrigo Chiavaro da Fonseca
Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil
Title: Clinical Outcomes in Bipolar Disorder and Childhood Trauma: A Community Sample of Young Adults
Time : 16:40-17:10
Biography:
Rodrigo Chiavaro da Fonseca is a medical student, interested in research since the beginning of college. Today he is working in multiple projects, such as “Evaluation of Biochemical and Molecular Parameters of the Brain and their Clinical Correlations in Individuals Who Committed Suicide”, “Brazil’s Suicide Rate from 2000 to 2014 Stratified by Genre and Age” and “Hospital Waste: Is it possible to minimize the environmental impact of a big university hospital?”. He is also teaching as monitor in “Promotion and Protection of Elderlies and Adults’ Health” class since 2016, August. Rewarded with the Award of Best Oral Presentation at the 36th Scientific Week of HCPA in 2016.
Abstract:
Background: Childhood trauma is a complex experience, much reported by subjects with bipolar disorder. There are still few studies that assess its consequences in a community sample of bipolar in early stage.Objective: The aim of the present study is to assess the association between childhood trauma and clinical outcomes in a community sample of young adults with bipolar disorder.Methods: This is a cross-sectional study with a community sample of subjects with bipolar disorder, from 23 to 30 years old, with and without childhood trauma. The trauma experiences during childhood were assessed by Childhood Trauma Questionnaire (CTQ). The functioning was assessed by Functioning Assessment Short Test (FAST).Results: Ninety subjects with bipolar disorder were included in the study (30 with childhood trauma and 60 without childhood trauma). Young adults with bipolar disorder and childhood trauma showed higher prevalence of current suicide risk, higher severity of depressive symptoms, and higher functioning impairment as compared to subjects with bipolar disorder without childhood trauma, as seen in Table 2.Conclusion: The frequency childhood trauma experiences appear to be an environmental risk factor for worse clinical outcomes and higher functional impairment.