Case Report: Prism for PTSD in severe traumatic brain injury with psychiatric comorbidities: two cases

BackgroundTraumatic brain injury (TBI) with post-traumatic stress disorder (PTSD) is treatment-resistant, with conventional psychotherapy showing limited efficacy due to neurocognitive impairments.Case SummaryWe report two patients with severe TBI and psychiatric comorbidities treated with Prism neurofeedback.Case 144-year-old female, 35 years post-childhood TBI, with agoraphobia and hyperacusis, achieved 42% PTSD reduction and substantial functional gains (social reintegration, independent driving) sustained through 4-month follow-up.Case 240-year-old male, 3.5 years post-adult TBI with bipolar II disorder and severe PTSD (PCL-5 = 62), achieved 90% PTSD reduction with complete remission sustained at 1-month follow-up, enabling return to work and family system transformation. Both patients developed personalized regulatory strategies and maintained gains without relapse.ConclusionsPrism neurofeedback demonstrates clinically meaningful outcomes in severe TBI-PTSD where traditional psychotherapy shows limited efficacy. The intervention’s circumvention of cognitive processing demands may explain the favorable outcomes. Controlled trials are warranted.

STAT+: OxyContin maker Purdue Pharma set to dissolve after judge approves its criminal sentence

NEWARK, N.J. — OxyContin maker Purdue Pharma is set to be dissolved and replaced by a company focused on the public good by the week’s end, as a massive legal settlement resolving thousands of lawsuits takes effect.

A federal judge on Tuesday delivered a criminal sentence to the company to resolve a Department of Justice probe — a last necessary step to clear the way for the settlement.

U.S. District Judge Madeline Cox Arleo made her decision after listening to hours of impact statements from people who lost loved ones or struggled with addiction themselves and requested she reject the negotiated sentence. While she didn’t go that far, she said she sympathized with people who bore the brunt of an epidemic linked to more than 900,000 deaths in the U.S. since 1999.

Continue to STAT+ to read the full story…

Implications of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) for Mood Disorders and Suicide Risk

A strategic imperative in mood disorders is to identify innovative mechanisms that translate into improved therapeutics when compared to the extant options. More specifically, there is a need for treatments with greater efficacy, shorter time-to-peak efficacy, greater durability of effect as well as improved tolerability profiles. Moreover, priority has also shifted towards identifying mood disorder therapeutics capable of targeting domains of psychopathology that are most pervasive, debilitating and inadequately treated by conventional pharmacology (e.g., anhedonia, cognitive impairment).

Current Landscape of Mental Health Conversational Agents From a Trauma-Informed Care Lens: Scoping Review

Background: Conversational agents (CAs) are increasingly used in mental health care to enhance access and engagement. However, their safe, ethical, and user-sensitive design remains a challenge. Despite growing attention to trauma-informed approaches in human-computer interaction, there is limited work on how the trauma-informed care (TIC) framework could be applied in the design of mental health CAs and no comprehensive synthesis to date. Objective: Guided by the Substance Abuse and Mental Health Services Administration’s TIC framework, this scoping review explored how TIC principles (safety; trustworthiness and transparency; collaboration and mutuality; empowerment, voice, and choice; peer support; and cultural, historical, and gender issues) are currently represented in the design and evaluation of mental health conversational agents (MHCAs) and identified gaps and opportunities to promote more trauma-informed design practices. Methods: Online databases, as well as a secondary survey of citation lists from an initial search, were used to identify English-language journal articles and conference proceedings from 2000 to 2024 that empirically evaluated an independent, web- or app-based, unassisted CA used for mental health and included concepts from TIC. Results: Our analysis included 38 publications (n=28, 73.7%, published in 2020 or later) covering 28 distinct MHCAs. Most studies used experimental methods (n=23, 60.6%) or user studies (n=11, 28.9%), with samples skewed toward female (men: mean 34.92%, SD 18.64%), young in age (mean 32.52, SD 14.6 y), and predominantly nonclinical (n=29, 76.3%). MHCAs were largely rule-based prototypes. No studies explicitly referenced the TIC framework as a guiding lens for MHCA design or evaluation. A total of 26 studies referenced terminology from TIC core principles but rarely defined them, while all 38 included language that could be linked to one or more principles. Overall, TIC-related concepts appeared most often within intervention design descriptions, qualitative assessments, or as items embedded in questionnaires evaluating broader constructs. Trustworthiness and transparency, safety, empowerment, voice and choice, and collaboration and mutuality were comparatively well addressed, while peer support and cultural, historical, and gender issues were largely absent. Design recommendations, where present, were relatively broad and emphasized secure, customizable, reliable, human-like, and context-sensitive MHCAs that offered multimodal interaction, goal setting and tracking, and transparency. Conclusions: Studies did not self-identify as using Substance Abuse and Mental Health Services Administration’s framework for TIC, making it more difficult to identify its elements. The fragmented terms, disciplines, and metrics used make it difficult to draw more systematic conclusions about the current research landscape related to TIC, but our analysis indicates TIC to be a descriptive and potentially unifying framework and provides a starting point for the explicit trauma-informed MHCA research and design.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/c41181a042ee9ad5f9b3c8394fcddce6" />

<![CDATA[A multicenter study tests SAINT TMS for postpartum depression.]]>

Dissociation: Signs and Causes in Children

When people use the word dissociation, it can sound alarming. You may have seen it on social media, heard your child mention it, or noticed your child seeming “checked out” and wondered if that’s what’s happening. Dissociation can be confusing because it exists on a spectrum — from everyday experiences like daydreaming to more serious symptoms that may signal that a child is overwhelmed or struggling. The good news is that dissociation is often a temporary coping mechanism, and when it does become a problem, there are effective ways to help.

What is dissociation?

In simple terms, dissociation is a kind of mental disconnection. “When I think of dissociation, I think of there being some sort of disconnect between an individual and their sense of self, or a period of time that you later can’t recall, or feeling like you’re disconnected from your body,” says Lauren Allerhand, PsyD, a clinical psychologist at the Child Mind Institute and co-director of its DBT program.

Some kids describe dissociation as feeling spaced out, numb, or disconnected from their body or surroundings. Others say they feel like they’re watching themselves from outside their body, or that the world around them doesn’t feel real. “There’s some period of time where your normal sense of flow is disrupted,” Dr. Allerhand explains.

Is dissociation normal?

In its mildest form, dissociation is a commonplace occurrence. Kids might daydream in class, zone out during something boring like a long car trip, or feel detached when they are overwhelmed in some way. These experiences are usually not a cause for concern. “Our brains do a really good job of protecting ourselves,” Dr. Allerhand says. “Sometimes our brains develop strategies to protect us that are healthy, and other times they develop strategies that might work in short bursts but become less helpful if they happen too much.”

When dissociation happens often, or interferes with daily life, it may signal that a child is struggling with something more serious than ordinary, intermittent stress. “If it’s happening all the time, it’s less effective as a coping mechanism” because of the toll it can take when there is memory loss, confusion, and feeling disconnected to the self, she explains.

What does dissociation feel like?

Children and teens may describe dissociation differently. Some say they feel:

  • Like they’re in a dream
  • Emotionally numb
  • Detached from their body
  • Like they’re watching themselves in a movie
  • Like things around them aren’t real

“Kids might say they feel like a robot. Everything feels fake around them,” Dr. Allerhand says. “Younger children may not have the words to describe what they’re experiencing. Instead, parents might notice their child seems unusually quiet, unresponsive, or ‘not themselves.’”

Why do kids dissociate?

Dissociation is often linked to stress or overwhelming emotions — kids may dissociate when they feel unable to cope with what’s happening around them. “This could be a response to any sort of highly intense emotion or experience,” Dr. Allerhand says, such as:

  • Trauma
  • Anxiety or panic
  • Intense emotions
  • Depression
  • Major life changes
  • Overwhelming stress

“It’s another way of coping with stress or trauma,” says Tanvi Bahuguna, PsyD, a clinical psychologist at the Child Mind Institute who specializes in trauma and mood disorders. “There’s this psychological process that helps them disconnect from overwhelming pain.” Some kids dissociate during panic attacks or periods of intense anxiety. Children who have experienced significant adversity may be more likely to dissociate. These experiences can include:

  • Abuse
  • Neglect
  • Family instability (housing instability, domestic violence, addiction)
  • Loss of a family member, especially through violence or suicide

Still, experts are quick to note that dissociation doesn’t automatically mean a child has experienced trauma or has a serious disorder. “There are lots of exits on this highway before we’re at a dissociative disorder,” Dr. Allerhand says, adding that a full-blown dissociative disorder is very rare in children.

Mild vs. serious dissociation

It can be hard to recognize when a child is experiencing more serious dissociation because it doesn’t always look different from daydreaming or inattention. One key difference is distress. “Spacing out or not paying attention is not often experienced as distressing,” Dr. Allerhand says. Moderate or serious dissociation “is often somewhat distressing.” Kids who are daydreaming are still connected to themselves and their surroundings; kids who are experiencing more serious dissociation may feel cut off from their body, emotions, or reality altogether.

Using grounding techniques for dissociation

If you think your child may be dissociating, the most important thing you can do is not panic or try to get your child to “snap out of it.”  “The number one thing a parent can do is stay as calm as possible,” Dr. Bahuguna says. Speak gently, use short sentences, and reassure your child that they’re safe. Saying your child’s name and reminding them you’re there can help them reconnect.

Grounding techniques can also bring kids back into the present moment. One common method is called the 5-4-3-2-1 technique: Ask the child to name five things they can see, four things they can feel, three things they can hear, two things they can smell, one thing they can taste or imagine tasting. Other grounding strategies include:

  • Deep breathing
  • Squeezing a stress ball
  • Holding something cold
  • Gently moving the body

If you find your child often dissociates, Dr. Allerhand recommends helping them make a plan for it. During a calm moment, talk with your child about what they find helpful. “I noticed that this is happening. How can I help you when this is happening?” she suggests asking. Having a plan in advance makes it easier to respond in the moment — and in the meantime, stay nearby and make sure your child is safe until the episode passes.

When should parents seek help for a child who dissociates?

If dissociation is frequent, distressing, or associated with changes in your child’s functioning, seeking professional support is appropriate. “If something dissociative happens, and there’s a really big change in your child’s functioning, then I would be concerned,” Dr. Allerhand says.

Signs it may be time to reach out include:

  • Memory gaps after the episode
  • Noticeable personality changes
  • Difficulty at school
  • Withdrawal from friends or activities
  • Significant distress or confusion

A good place to start would be talking to your pediatrician, who may refer you to a mental health professional. “If your child is displaying behaviors that seem out of the ordinary, you should trust your instincts,” Dr. Allerhand says.

How to identify dissociation

To determine whether a child is dissociating, a mental health professional gathers information from multiple sources, including parents, the child, and sometimes teachers, asking about the child’s behaviors, history, and any recent stressors or changes in behavior.

“The first thing would be a structured diagnostic interview with a qualified clinician,” Dr. Allerhand explains. “Parents bring the history and describe the behavior, and then the clinician meets with the child.” Clinicians also consider whether dissociation might be a symptom of another condition, such as post-traumatic stress disorder, borderline personality disorder, anxiety (especially panic disorder), and depression.

“It’s really gathering history, meeting the child, observing the child, and figuring out what this cluster of behaviors leads to,” she says. It’s more frequent to find that dissociation is a result of another disorder than an actual dissociative disorder.

How is dissociation treated?

Treatment depends on what’s driving the dissociation. If trauma is involved, therapy may focus on helping the child process difficult experiences and build coping skills. Evidence-based approaches include trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR).

If anxiety or emotional overwhelm is the primary cause, treatment may focus on emotion regulation, grounding techniques, and identifying triggers and early warning signs. Therapy, such as dialectical behavior therapy (DBT), typically involves both children and parents, helping families recognize patterns and respond in supportive ways.

For more severe or persistent dissociation, treatment may happen in phases — beginning with safety and stabilization, then skill-building, and eventually, when appropriate, processing difficult experiences. “The goal is helping the child learn to cope with their experience and stay in their body,” Dr. Allerhand says.

What are dissociative disorders?

In children and teens, dissociation is usually a symptom of another condition. But in cases of very serious early trauma, abuse, or neglect, it can progress into a full-blown disorder. There are a number of dissociative disorders, including:

  • Dissociative identity disorder (what was once called multiple personality disorder) involves two or more distinct personality states and gaps in memory and is typically linked to significant early trauma. Parents who search online may find alarming information, but Dr. Allerhand says this condition is very rare in kids.
  • Dissociative amnesia involves gaps in memory that can’t be explained by ordinary forgetfulness — such as not remembering important personal information or periods of time — and is often associated with stressful or traumatic experiences.
  • Depersonalization/derealization disorder involves feeling detached from oneself, as though watching yourself from outside your body, or feeling that the world around you isn’t real.

These disorders sometimes attract media attention, but they are extremely rare in children. What’s important for parents to know is that if you see dissociative behavior in a child, it’s most likely a normal coping mechanism for a child experiencing some stress or intense emotion. If it persists, is causing distress, or is interfering with a child’s life, it’s time to consult a pediatrician or mental health professional. Identifying what might be causing the behavior is the first step to getting appropriate treatment.

Frequently Asked Questions

What is dissociation?

Dissociation is a mental disconnection from your thoughts, feelings, body, or surroundings. Kids may feel spaced out, numb, or like they’re watching themselves from the outside, as if the world doesn’t feel real.

What are common symptoms of dissociation?

Common signs include feeling detached from the body, emotionally numb, or like you’re in a dream. Some kids seem unusually quiet or “not themselves,” while others have trouble recalling what happened during that time.

What causes dissociation?

Dissociation is often a response to stress, anxiety, or overwhelming emotions. It can also be linked to trauma, major life changes (such as the sudden loss of a family member), or intense feelings the child doesn’t yet know how to manage.

How can you stop dissociating?

Grounding techniques can help bring you back to the present moment, like naming what you see, hear, and feel, or focusing on breathing. Having a plan for what you will do the next time can make it easier to manage when it happens.

The post Dissociation: Signs and Causes in Children appeared first on Child Mind Institute.

Acceptance of mental illness and attitude towards pharmacotherapy among patients hospitalized in forensic psychiatry departments

Aim of the studyThe aim of the study was to assess the level of acceptance of the disease and attitudes towards pharmacological treatment in patients hospitalized in forensic psychiatry departments and to analyze the relationship between these variables and the length of hospitalization.Materials and methodsThe study included 121 patients hospitalized in forensic psychiatry wards. The Acceptance of Illness Scale (AIS) and the Drug Attitude Inventory (DAI) were used. Statistical analysis was performed using nonparametric tests, with a significance level of p < 0.05.ResultsThe mean AIS score was 28 points, indicating moderate to good disease acceptance. A positive attitude toward pharmacological treatment was demonstrated by 74% of respondents. There was no significant correlation between disease acceptance and attitudes toward treatment (p = 0.70), nor was there any effect of hospitalization length on attitudes toward pharmacotherapy (p = 0.317).ConclusionsPatients of forensic psychiatry wards demonstrate a medium or high level of acceptance of the disease and a mostly positive attitude towards pharmacotherapy; the lack of significant correlations between these variables and the independence from the length of hospitalization indicate the need for individualized therapy.

Harsh discipline mediates the association between parenting stress and internalizing problems in children and adolescents: survey-based and online intervention evidence

BackgroundParenting stress evokes harsh discipline and induces internalizing problems in children and adolescents. To test this hypothesis, this study examined the potential mediating role of harsh discipline in the association between parenting stress and internalizing problems in children and adolescents while considering the moderating effect of emotion regulation.MethodsTwo studies were conducted: Study 1 was a cross-sectional survey using questionnaires (N = 971), and Study 2 implemented a three-week online parental intervention training program combining courses and psychological diary recording (N = 123).ResultsBoth studies consistently demonstrated that harsh discipline mediated the link between parenting stress and internalizing problems in children and adolescents. Furthermore, acceptance and cognitive reappraisal reduced the effect of parenting stress on harsh discipline, whereas distraction and rumination enhanced it. Expressive suppression had no significant moderating effect. The intervention enhanced parents’ emotion regulation (increased acceptance), reduced parenting stress and alleviated internalizing problems in children and adolescents, with preliminary evidence of reduced harsh discipline.ConclusionThese findings clarify the psychological mechanisms through which parenting stress influences child adaptiveness and underscore the value of interventions focused on emotion regulation in mitigating parenting stress, harsh discipline and enhancing child mental health.

A Scalable Trans Diagnostic Intervention Targeting Adolescent Agency Supported by Conversational AI (AGENCIA)

Conditions: Irritability; Neurodevelopmental Disorders; Impulsivity; Emotional Dysregulation; Distress, Emotional; Distress, Psychological

Interventions: Behavioral: AGENCIA Digital Self-Guided; Behavioral: AGENCIA In-person With Digital Assistant

Sponsors: Fundación Pública Andaluza para la gestión de la Investigación en Sevilla; Hospital Universitario Virgen del Rocio; Instituto de Salud Carlos III

Not yet recruiting

Many Trauma-affected Youth Face Long Waits for Therapy, Worsening Stress, and Avoidance. CISS, a 90-minute Session Based on Stanford’s Cue-Centered Therapy, Offers Coping Tools and Psychoeducation During This Gap. This Pilot Tests CISS’s Feasibility, Acceptability, and Impact on 30-40 Adolescents.

Conditions: Wellbeing; Mental Health; Psychological; Stress; Trauma Exposure

Interventions: Other: Cue-Centered Therapy (CCT)-Informed Single Session Intervention (CISS)

Sponsors: Stanford University; University of Auckland, New Zealand; Health New Zealand

Not yet recruiting