Background: Early trauma predicts poor psychological and physical health. Glutamatergic synaptic processes offer one avenue for understanding this relationship, given glutamate\'s abundance and involvement in reward and stress sensitivity, emotion, and learning. Trauma-induced glutamatergic excitotoxicity may alter neuroplasticity and approach/avoidance tendencies, increasing risk for psychiatric disorders. Studies examine upstream or downstream effects instead of glutamatergic synaptic processes in vivo, limiting understanding of how trauma affects the brain.Objective: In a pilot study using a previously published data set, we examine associations between early trauma and a proposed measure of synaptic strength in vivo in one of the largest human samples to undergo Carbon-13 (13C MRS) magnetic resonance spectroscopy. Participants were 18 healthy controls and 16 patients with PTSD (male and female).Method: Energy per cycle (EPC), which represents the ratio of neuronal oxidative energy production to glutamate neurotransmitter cycling, was generated as a putative measure of glutamatergic synaptic strength.Results: Results revealed that early trauma was positively correlated with EPC in individuals with PTSD, but not in healthy controls. Increased synaptic strength was associated with reduced behavioural inhibition, and EPC showed stronger associations between reward responsivity and early trauma for those with higher EPC.Conclusion: In the largest known human sample to undergo 13C MRS, we show that early trauma is positively correlated with EPC, a direct measure of synaptic strength. Our study findings have implications for pharmacological treatments thought to impact synaptic plasticity, such as ketamine and psilocybin.
Abnormalities in the strength of synaptic connections have been implicated in trauma and trauma-related disorders but not directly examined.We used magnetic resonance spectroscopy to investigate the association between early trauma and an in vivo measure of synaptic strength.For people with posttraumatic stress disorder, as early trauma severity increased, synaptic strength increased, highlighting the potential for treatments thought to change synaptic connections in trauma-related disorders.

Background: Prolonged exposure (PE) is an effective treatment for post-traumatic stress disorder (PTSD).Objective: This study aimed to analyse the cost-effectiveness of three exposure-based treatments in patients with childhood abuse-related PTSD.Method: A net-benefit analysis was conducted alongside a pragmatic randomized controlled trial with participants (N = 149) randomized to three conditions: PE (n = 48), intensified PE (i-PE, n = 51), and phase-based PE [Skills Training in Affective and Interpersonal Regulation (STAIR) + PE, n = 50]. Assessments took place at baseline (T0), post-treatment (T3), 6 month follow-up (T4), and 12 month follow-up (T5). Costs stemming from healthcare utilization and productivity losses were estimated using the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness. Quality-adjusted life-years (QALYs) were based on the 5-level EuroQoL 5 Dimensions (EQ-5D-5L) using the Dutch tariff. Missing values of costs and utilities were multiply imputed. To compare i-PE to PE and STAIR + PE to PE, pair-wise unequal-variance t-tests were conducted. Net-benefit analysis was used to relate costs to QALYs and to draw acceptability curves.Results: Intervention costs did not differ across the three treatment conditions. Total medical costs, productivity losses, total societal costs, and EQ-5D-5L-based QALYs did not differ between treatment conditions either (all p > .10). At the relevant €50,000/QALY threshold, the probability of one treatment being more cost-effective than another was 32%, 28%, and 40% for PE, i-PE, and STAIR-PE, respectively.Conclusion: Three equally effective treatments were compared and no differences in cost-effectiveness between treatments were found. Therefore, we advocate the implementation and adoption of any of the treatments and endorse shared decision making.
This is the first study to compare cost-effectiveness of three exposure-based treatments in patients with CA-PTSD alongside a randomized controlled clinical trial (N = 149).The three exposure-based treatments did not differ in terms of outcomes and costs.Findings underline that any of these treatments can be implemented, and we endorse shared decision making to meet patient treatment preference.

Background: Childhood maltreatment (CM) is a common psychological stressor associated with multiple mental disorders. While CM is associated with vulnerability to depression and anxiety, little is known about the specific mechanism underlying this relationship.Objective: This study aimed to investigate the white matter (WM) of healthy adults with CM and their relationships with depression and anxiety to provide biological evidence for the development of mental disorders in subjects with childhood trauma.Methods: The CM group included 40 healthy adults with CM. The non-CM group included 40 healthy adults without CM. Diffusion tensor imaging (DTI) data were collected, and tract-based spatial statistics (TBSS) were applied to the whole brain to assess WM differences between the two groups; post-hoc fibre tractography was used to characterise the developmental differences; and mediation analysis was used to assess the relationships among the Child Trauma Questionnaire (CTQ) results, DTI indices, and depression and anxiety scores.Results: Relative to the non-CM group, the CM group revealed significantly lower fractional anisotropy (FA) in the right posterior corona radiata (PCR-R), right anterior corona radiata (ACR-R), left super corona radiata (SCR-L), anterior thalamic radiation (ATR), and right posterior limb of the internal capsule (PLIC-R). Additionally, shorter fibre bundles passed through the PCR-R, ACR-R, and ATR in the CM group compared with the non-CM group. Besides, the length of the ACR-R mediated the relationship between CM and trait anxiety.Conclusions: The alteration of white matter microstructure associated with childhood trauma in healthy adults may reflect biomarkers of childhood trauma. Besides, an alteration of WM microstructure in healthy adults with CM mediates the association between CM and trait anxiety, which may represent the vulnerability to developing mental disorders after childhood trauma experiences.
In this paper, we found specific alterations associated with CM in healthy adults, which may mediate the relationship between childhood trauma and trait anxiety in later life.

Childhood maltreatment and difficulties in emotion regulation are common in patients with Borderline Personality Disorder (BPD) and Depressive Disorders (DD).
This study examines differences between patients with BPD and patients with DD, regarding childhood maltreatment and difficulties in emotion regulation as well as the mediating effect of different aspects of emotion regulation deficits on the association between childhood maltreatment and BPD-symptoms.
A total of 305 participants, 177 with BPD and 128 with DD completed an assessment including the Childhood Trauma Questionnaire (CTQ), the Emotion Regulation Scale (DERS), the Brief Symptom Inventory (BSI), and the Structured Clinical Interview for DSM-IV (SCID). Data was analyzed using multiple analyses of variances and mediation analyses.
Patients with BPD reported more childhood maltreatment and more difficulties in emotion regulation than patients with DD. When general symptom severity, age, and gender were included in the analysis as covariates only group differences regarding \'impulse control difficulties\' (F(1,299) = 38.97, p < .001, ηp2 = .115), \'limited access to emotion regulation strategies\' (F(1,299) = 4.66, p = .032, ηp2 = .015), and \'lack of emotional clarity\' (F(1,299) = 9.38, p = .002, ηp2 = .030) remained statistically significant. A mediation analysis, including above-mentioned covariates, indicated an association between emotional abuse and BPD-symptoms, which was mediated by difficulties in emotion regulation (indirect effect B = .012, 95% CI [.001; .031], R2 = .429). Subscale analyses revealed \'impulse control difficulties\' as the aspect of difficulties in emotion regulation that has the greatest impact on this association (B = .021, 95% CI [.003; .045]).
Patients with BPD display more childhood maltreatment and difficulties in emotion regulation than patients with DD. Difficulties in emotion regulation, especially difficulties in impulse control, seem to play an important role in the association between childhood emotional abuse and BPD-symptoms.
Antecedentes: El maltrato infantil y las dificultades en la regulación emocional son frecuentesw en pacientes con trastorno límite de personalidad (TLP) y pacientes con trastornos depresivos (TD).Objetivo: Este estudio examina las diferencias entre pacientes con TLP y pacientes con TD, en cuanto al maltrato infantil y las dificultades en la regulación de las emociones, así como el efecto mediador de diferentes aspectos de los déficits en la regulación de las emociones sobre la asociación entre el maltrato infantil y los síntomas del TLP.Método: Un total de 305 participantes, 177 pacientes con TLP y 128 pacientes con TD completaron una evaluación que incluyó el Cuestionario de Trauma Infantil (CTQ), la Escala de Regulación de las Emociones (DERS), el Inventario Breve de Síntomas (BSI) y la Entrevista Clínica Estructurada para DSM-IV (SCID). Los datos se analizaron mediante múltiples análisis de variaciones y análisis de mediación.Resultados: Los pacientes con TLP informaron más maltrato infantil y más dificultades en la regulación de las emociones que los pacientes con TD. Cuando la gravedad de los síntomas generales, la edad y el sexo se incluyeron en el análisis como covariables, solo las diferencias de grupo con respecto a las ‘dificultades de control de impulsos’ (F (1.299) = 38,97, p <.001, ηp2 = .115), ‘acceso limitado a estrategias de regulación de las emociones ‘(F (1,299) = 4.66, p = .032, ηp2 = .015) y’ falta de claridad emocional ‘(F (1,299) = 9.38, p = .002, ηp2 = .030) permanecieron estadísticamente significativas. Un análisis de mediación, incluidas las covariables antes mencionadas, indicó una asociación entre el abuso emocional y los síntomas del TLP, que fue mediada por dificultades en la regulación de las emociones (efecto indirecto B = .012, IC del 95% [.001; .031], R2 =. 429). Los análisis de subescalas revelaron “dificultades de control de impulsos” como el aspecto de las dificultades en la regulación de las emociones que tiene el mayor impacto en esta asociación (B = .021, IC del 95% [.003; .045]).Conclusiones: Los pacientes con TLP presentan más maltrato infantil y dificultades en la regulación de las emociones que los pacientes con TD. Las dificultades en la regulación de las emociones, especialmente las dificultades en el control de los impulsos, parecen jugar un papel importante en la asociación entre el abuso emocional infantil y los síntomas del TLP.
背景: 边缘性人格障碍 (BPD) 患者和抑郁障碍 (DD) 患者经常报告有童年期虐待和情绪调节困难。目的: 本研究探讨了BPD患者与DD患者在童年期虐待和情绪调节困难, 以及情绪调节缺陷不同方面对童年期虐待和BPD症状之间关联的中介作用的差异。方法: 共有305名参与者, 177名BPD患者和128名DD患者完成了一项评估, 包括儿童创伤问卷 (CTQ), 情绪调节量表 (DERS), 简要症状量表 (BSI) 和DSM-IV结构化临床访谈 (SCID)。数据分析使用方差多重分析和中介分析。结果: 与DD患者相比, BPD患者报告了更多的童年期虐待和情绪调节困难。当将一般症状的严重程度, 年龄和性别以协变量纳入分析时, 只有 “冲动控制困难” (F(1,299)= 38.97, p <.001, ηp2= .115), “有限的情绪调节策略” (F(1,299)= 4.66, p = .032, ηp2= .015) 和’缺乏情感清晰度’ (F(1,299)= 9.38, p = .002, ηp2= .030) 的组间差异仍在统计上显著。纳入上述协变量的一项中介分析表明, 情绪滥用与BPD症状之间存在关联, 由情绪调节困难所中介 (间接效应B = .012, 95%CI [.001; .031], R2 = .429)。分量表分析显示, “冲动控制困难”是情绪调节困难中对这种关联影响最大的一个方面 (B = .021, 95% CI [.003; .045])。结论: BPD患者比DD患者表现出更多的童年期虐待和情绪调节困难。情绪调节困难, 尤其是冲动控制方面的困难, 似乎在童年期情绪虐待与BPD症状之间的关联中起着重要作用。.