vivo victims voice University of Konstanz TORTURED BRAINS

Transcription

1 vivo victims voice University of Konstanz TORTURED BRAINS

2 Torture experiences in a sample of survivors of organized violence seeking asylum in Germany being stripped naked rape /penetration with object twisting/ mutilation of genitals being beaten on genitals being hung being burned being submersed under water strangling mock execution death threats being forced to witness torture electric shock being blindfolded Falanga/Falaka being beaten on the body being beaten on the head % subjects

3 Torture experiences of refugees in a Ugandan refugee camp 0% 10% 20% 30% 40% 50% 60% 70% 80% witnessed beatings or torture witnessed injury by weapon witnessed abduction confiscation of property by officials witnessed robbery / extorsion witnessed murder witnessed accident witnessed rape of a woman witnessed act of suicide witnessed combat situation dangerous evacuation beatings or torture witnessed forced circumcision robbery / extorsion harassment of armed personel accidents Series1 combat situation imprisonment abduction forced isolation experienced injury by weapon forced marriage child marriage beatings from spouse rape forced circumcision sex for food or security forced prostitution / sex. slavery

4 POST-TRAUMATIC TRAUMATIC STRESS DISORDER (PTSD) reexperiencing avoidance hyperarousal

5 vivo outpatient clinic for refugees University of Konstanz, Germany

6 Prevalence of Post-traumatic traumatic Stress Disorder (PTSD) Refugees Torture survivors 37% 93% PTSD vivo outpatient clinic for refugees, Germany no PTSD

7 Ongoing epidemiological survey on traumatic life experiences and mental health of refugees & asylum seekers in Northern Italy COUNTRY OF ORIGIN Sierra Leone; 3% Costa d'avorio; 6% Bosnia; 9% Guinea; 3% Liberia; 3% Irak; 3% Turkey; 3% ngo - Dem. Rep.; 6% Kossovo; 3% Togo; 12% Etiopia; 3% Camerun; 38% Sudan (Darfur); 9% PTSD was more frequently diagnosed in torture survivors compared to other refugees/ asylum seekers.

8 Predictors of PTSD Symptom Severity in torture survivors BETA St. Err. p Constant 0,7 age 0,07 0,16 0,66 Sex (female) 0,43 0,16 < 0,05 Years of education 0,01 0,16 0,93 Number of arrests -0,21 0,17 0,25 Months since event 0,31 1,16 0,06 Tot. number of war- and torture related event types ever experienced 0,59 0,17 < 0,005 Linear Regression on PTSD symptom score (R² corr.=.33; p <.01) Strongest predictors of PTSD symptom severity were female sex and number of war and torture event types

9 Dose Effect of traumatic stress Tamil school children, North-East Sri Lanka Sudanese refugees, Imvepi refugee camp, Uganda (Catani et al., 2005, ESTSS) (Neuner et al. 2004, BMC Psychiatry)

10 ABNORMAL SLOW WAVE ACTIVITY (ASWA) IN TORTURE VICTIMS WITH PTSD Abnormal slow-wave rhythms (delta range Hz) in the brain have been found to be related to brain pathology or dysfunctional neural tissue. Also, ASWA was found in conditions of psychopathology, such as depression and schizophrenia. ASWA can be produced by both structural and functional neural networks that are deprived of their inputs. Neural generators of slow-wave rhythms can be identified through magnetic source imaging by using dipole density measurements from MEG. (Rockstroh, B. et al.. submitted)

11 Prefrontal & temporal ASWA focus in torture victims with PTSD

12 SPEECHLESS TERROR - Indicators of decoupling of frontal affective processors from left cortical language areas in torture victims Psychological dissociation in torture victims and its manifestation within neural networks in the brain Dissociative experiences associated with ASWA generated in the left ventrolateral frontal cortex. (Ray, Odenwald et al., 2006) Torture victims showed elevated production of focally generated slow waves, particularly in left temporal brain regions (peak in the insular cortex). (Kolassa, Wienbruch, Neuner et al., submitted)

13 AFFECTIVE STIMULUS PROCESSING IN TORTURE SURVIVORS WITH PTSD Pleasant picture (2 s) ISI & fixation (4-10 s) Neutral picture (2 s) t Unpleasant picture (2 s) Pictures taken from the International Affective Picture System (IAPS)

14 Subjective affective ratings and heart rate responses to emotional visual stimuli sustained heart rate acceleration for high arousing unpleasant pictures in PTSD patients unpleasant pictures rated significantly more arousing by PTSD patients

15 Significantly enhanced late P3 component for arousing pictures in PTSD patients. Controls PTSD patients MEG data: Grand Mean Activity (rms)for each affective category Schizophrenia patients Saleptsi et al, in prep.

16 MEG in the EPN-M time interval FAST PICTURE PROCESSING IN TORTURE SURVIVORS WITH PTSD fmri Areas of significant group effect in the ms time interval ms PTSD; Aversive PTSD; Neutral Controls; Aversive Controls; Neutral Junghöfer et al., 2001 Neuner, Junghöfer et al., in prep.