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Beyond PTSD: Client presentations of developmental trauma disorder from a national survey of clinicians

DePierro, Jonathan; D'Andrea, Wendy; Spinazzola, Joseph; Stafford, Erin; van Der Kolk, Bessel; Saxe, Glenn; Stolbach, Bradley; McKernan, Scott; Ford, Julian D
OBJECTIVE:PTSD and proposed developmental trauma disorder (DTD) diagnoses relate to functional impairment and trauma exposure using clinician-report surveys. METHOD/METHODS:= 210; age range = 2-21). We fit symptom data to the draft criteria for (1) DTD, a proposed trauma diagnosis for children and (2) existing criteria for adult and child/preschool PTSD. RESULTS:Results indicated that comorbidity between DTD and PTSD was high (52.4% and 59.9% for adult and child/preschool criteria, respectively). Comorbid DTD/PTSD and DTD-alone groups had more functional domains impacted and greater exposure to some types of trauma relative to the other groups. CONCLUSIONS:These findings speak to the relationship between trauma complexity and wide-ranging symptom presentations, provide support for research and clinical emphasis on a developmentally informed diagnosis, and may support existing treatment approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
PMID: 31855007
ISSN: 1942-969x
CID: 4271592

Mental health progress requires causal diagnostic nosology and scalable causal discovery

Saxe, Glenn N; Bickman, Leonard; Ma, Sisi; Aliferis, Constantin
Nine hundred and seventy million individuals across the globe are estimated to carry the burden of a mental disorder. Limited progress has been achieved in alleviating this burden over decades of effort, compared to progress achieved for many other medical disorders. Progress on outcome improvement for all medical disorders, including mental disorders, requires research capable of discovering causality at sufficient scale and speed, and a diagnostic nosology capable of encoding the causal knowledge that is discovered. Accordingly, the field's guiding paradigm limits progress by maintaining: (a) a diagnostic nosology (DSM-5) with a profound lack of causality; (b) a misalignment between mental health etiologic research and nosology; (c) an over-reliance on clinical trials beyond their capabilities; and (d) a limited adoption of newer methods capable of discovering the complex etiology of mental disorders. We detail feasible directions forward, to achieve greater levels of progress on improving outcomes for mental disorders, by: (a) the discovery of knowledge on the complex etiology of mental disorders with application of Causal Data Science methods; and (b) the encoding of the etiological knowledge that is discovered within a causal diagnostic system for mental disorders.
PMID: 36458123
ISSN: 1664-0640
CID: 5383722

Neighborhood characteristics and psychiatric disorders in the aftermath of mass trauma: A representative study of New York City public school 4th-12th graders after 9/11

Musa, George J; Geronazzo-Alman, Lupo; Fan, Bin; Cheslack-Postava, Keely; Bavley, Rachel; Wicks, Judith; Bresnahan, Michaeline; Amsel, Lawrence; Fiano, Emily; Saxe, Glenn; Kummerfeld, Erich; Ma, Sisi; Hoven, Christina W
Studies of the relationship between neighborhood characteristics and childhood/adolescent psychopathology in large samples examined one outcome only, and/or general (e.g., 'psychological distress') or aggregate (e.g., 'any anxiety disorder') measures of psychopathology. Thus, in the only representative sample of New York City public school 4th-12th graders (N = 8202) surveyed after the attacks of 9/11/2001, this study examined whether (1) indices of neighborhood Socioeconomic Status, Quality, and Safety and (2) neighborhood disadvantage (defined as multidimensional combinations of SES, Quality and Safety indicators) are associated with eight psychiatric disorders: posttraumatic stress disorder, separation anxiety disorder (SAD), agoraphobia, generalized anxiety disorder (GAD), panic disorder, major depression, conduct disorder, and alcohol use disorder (AUD). (1) The odds ratios (OR) of psychiatric disorders were between 0.55 (AUD) and 1.55 (agoraphobia), in low and intermediate-low SES neighborhoods, respectively, between 0.50 (AUD) and 2.54 (agoraphobia) in low Quality neighborhoods, and between 0.52 (agoraphobia) and 0.65 (SAD) in low Safety neighborhoods. (2) In neighborhoods characterized by high disadvantage, the OR were between 0.42 (AUD) and 1.36 (SAD). This study suggests that neighborhood factors are important social determinants of childhood/adolescent psychopathology, even in the aftermath of mass trauma. At the community level, interventions on modifiable neighborhood characteristics and targeted resources allocation to high-risk contexts could have a cost-effective broad impact on children's mental health. At the individual-level, increased knowledge of the living environment during psychiatric assessment and treatment could improve mental health outcomes; for example, specific questions about neighborhood factors could be incorporated in DSM-5's Cultural Formulation Interview.
PMID: 33992981
ISSN: 1879-1379
CID: 4886662

A developmental perspective on childhood traumatic stress

Chapter by: Brown, Adam D; Becker-Weidman, Emily; Saxe, Glenn N
in: Handbook of PTSD: Science and practice by Friedman, Matthew J [Ed]; Schnurr, Paula P [Ed]; Keane, Terence M [Ed]
New York, NY, US: The Guilford Press, 2021
pp. 246-262
ISBN: 9781462547074
CID: 5158892

Mental Health Disorders Related to COVID-19-Related Deaths

Simon, Naomi M; Saxe, Glenn N; Marmar, Charles R
PMID: 33044510
ISSN: 1538-3598
CID: 4632452

Computational causal discovery for post-traumatic stress in police officers

Saxe, Glenn N; Ma, Sisi; Morales, Leah J; Galatzer-Levy, Isaac R; Aliferis, Constantin; Marmar, Charles R
This article reports on a study aimed to elucidate the complex etiology of post-traumatic stress (PTS) in a longitudinal cohort of police officers, by applying rigorous computational causal discovery (CCD) methods with observational data. An existing observational data set was used, which comprised a sample of 207 police officers who were recruited upon entry to police academy training. Participants were evaluated on a comprehensive set of clinical, self-report, genetic, neuroendocrine and physiological measures at baseline during academy training and then were re-evaluated at 12 months after training was completed. A data-processing pipeline-the Protocol for Computational Causal Discovery in Psychiatry (PCCDP)-was applied to this data set to determine a causal model for PTS severity. A causal model of 146 variables and 345 bivariate relations was discovered. This model revealed 5 direct causes and 83 causal pathways (of four steps or less) to PTS at 12 months of police service. Direct causes included single-nucleotide polymorphisms (SNPs) for the Histidine Decarboxylase (HDC) and Mineralocorticoid Receptor (MR) genes, acoustic startle in the context of low perceived threat during training, peritraumatic distress to incident exposure during first year of service, and general symptom severity during training at 1 year of service. The application of CCD methods can determine variables and pathways related to the complex etiology of PTS in a cohort of police officers. This knowledge may inform new approaches to treatment and prevention of critical incident related PTS.
PMID: 32778671
ISSN: 2158-3188
CID: 4556122

Editorial: In the Causal Labyrinth: Finding the Path From Early Trauma to Neurodevelopment [Editorial]

Saxe, Glenn N
Exposure to traumatic events early in life has been associated with significant adverse neurodevelopmental consequences.1,2 Ideally, protecting children from trauma would prevent these consequences. Unfortunately, once a child is exposed to early trauma, the only means of prevention requires implementing effective interventions toward the mechanisms known to have caused the consequences. Therefore, it is imperative to carefully define the true mechanistic pathways from which the neurodevelopmental consequences of early trauma result. The process of determining the correct pathway(s) is not a trivial matter, as is made clear from a valiant effort reported in this issue of the Journal titled, "Early Sexual Trauma Exposure and Neural Response Inhibition in Adolescence and Young Adults: Trajectories of Frontal Theta Oscillations During a Go/No-Go Task."3 This editorial reviews the effort to infer causal mechanism in this article, and introduces a literature that can improve the field's capacity to infer causes from observational data.
PMID: 30738542
ISSN: 1527-5418
CID: 3655932

Brain entropy and human intelligence: A resting-state fMRI study

Saxe, Glenn N; Calderone, Daniel; Morales, Leah J
Human intelligence comprises comprehension of and reasoning about an infinitely variable external environment. A brain capable of large variability in neural configurations, or states, will more easily understand and predict variable external events. Entropy measures the variety of configurations possible within a system, and recently the concept of brain entropy has been defined as the number of neural states a given brain can access. This study investigates the relationship between human intelligence and brain entropy, to determine whether neural variability as reflected in neuroimaging signals carries information about intellectual ability. We hypothesize that intelligence will be positively associated with entropy in a sample of 892 healthy adults, using resting-state fMRI. Intelligence is measured with the Shipley Vocabulary and WASI Matrix Reasoning tests. Brain entropy was positively associated with intelligence. This relation was most strongly observed in the prefrontal cortex, inferior temporal lobes, and cerebellum. This relationship between high brain entropy and high intelligence indicates an essential role for entropy in brain functioning. It demonstrates that access to variable neural states predicts complex behavioral performance, and specifically shows that entropy derived from neuroimaging signals at rest carries information about intellectual capacity. Future work in this area may elucidate the links between brain entropy in both resting and active states and various forms of intelligence. This insight has the potential to provide predictive information about adaptive behavior and to delineate the subdivisions and nature of intelligence based on entropic patterns.
PMID: 29432427
ISSN: 1932-6203
CID: 2957842

System change designed to increase safety and stabilization for traumatized children and families: Trauma systems therapy

Chapter by: Brown, Adam D; Hansen, Susan; Saxe, Glenn N
in: Trauma responsive child welfare systems by Strand, Virginia C [Ed]; Sprang, Ginny [Ed]
Cham, Switzerland: Springer International Publishing; Switzerland, 2018
pp. 87-104
ISBN: 978-3-319-64601-5
CID: 3213912

Psychosocial interventions for child traumatic stress

Chapter by: Saxe, Glenn N; Gartner, Hannah; Brown, Adam D
in: (2018) by Stoddard, Frederick J Jr
xvi, 390 pp, 2018
pp. Trauma- and stressor
ISBN: 978-0-19-045713-6
CID: 3760132