Iván Arango

Background: The Russian invasion of Ukraine has resulted in forced displacement, with over six million Ukrainian refugees across Europe, of whom 81,770 are residing in Norway. This displacement and, in many cases, preceding war experiences, has led to increased vulnerability to trauma and mental health challenges. There is to date little knowledge about the extent to which structured mental health interventions can mitigate symptoms in Ukrainian refugees. Narrative Exposure Therapy (NET), a short-term trauma-focused intervention, has demonstrated efficacy in reducing post-traumatic stress disorder (PTSD), depression and dissociation symptoms among individuals exposed to organized violence and war.Aim: The protocol aims to assess the clinical effects of NET on PTSD, dissociation, and depression symptoms among Ukrainian refugees in Norway and to facilitate training and supervised praxis for Ukrainian health professionals in using NET.Methods: This study employs a pretest-posttest randomized controlled experimental design (RCT). Ukrainian health workers in Norway will receive a total of 450 hours of NET training through an online course. As a part of the training, they will, under supervision, administrate NET to Ukrainian refugees. Participants will be screened and assessed at three time points: baseline, immediately after treatment, and at a 6-month follow-up. Validated instruments in Ukrainian and Russian will be used to assess trauma experiences, symptoms, and comorbidities. Exclusion criteria: active psychotic spectrum disorders, neurodevelopmental disorders and concurrent trauma therapy. The study also contains an embedded qualitative sub study that will involve phronetic iterative thematic analysis of anonymized therapy narratives collected during NET sessions, aiming to understand how participants construct meaning from traumatic events, how narrative coherence evolves throughout therapy, and how identity reconstruction occurs post-trauma.Trial registration: ClinicalTrials.gov identifier: NCT07062042..

Background: Borderline Personality Disorder (BPD) may include rigid thoughts, interpersonal difficulties, unstable identity, and the presentation of intense and volatile emotions; the leading indicator for this condition is symptom severity (SS). Within this spectrum, there could be subjective cognitive complaints (SCC) that may worsen the severity of the clinical condition. The present study aimed to compare SCC scores between BPD participants and a group of control subjects (CS) and to determine the association between BPD symptom severity and SCC in participants with BPD. Methods: 102 participants with BPD and 73 CS participants from Ramon de la Fuente Muñiz National Institute of Psychiaty were included. In order to measure symptom severity, participants responded to the Borderline Evaluation of Severity Over Time (BEST) scale, and for SCC through the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) scale. Results: COBRA total scores were higher in participants with BPD (26.9 ± 9.3) compared to CS (12.9 ± 6.8; t = –10.8, p < 0.001). Positive correlations resulted between the COBRA total score and the BEST dimensions of thoughts and feelings (r = 0.38, p < 0.001), Negative behaviors (r = 0.30, p < 0.002), and the Total BEST score (r = 0.38, p < 0.001). Conclusion: Participants of this study experience high levels of SS, which includes the constant presence of harmful and intrusive thoughts and feelings, as well as dysfunctional behaviors. This clinical context correlates positively with a high report of SCC, thus highlighting the importance of evaluating SCC as a relevant factor of patients' clinical experience and considering it within their personal needs to improve the course and prognosis throughout their treatment.

Background: Borderline personality disorder (BPD) has a high prevalence, presenting with self-injurious behaviors, suicide attempts and other psychiatric comorbidities. This condition is accompanied by high levels of stigma and self-stigma, driving to deleterious effects on prognosis. The present study aimed to compare demographic and clinical characteristics of women diagnosed with BPD with low and high internalized stigma and to address internalized stigma dimensions severity (disclosure, positive aspects, and discrimination) between the source of perceived stigma. Methods: A total of 106 women with a diagnosis of BPD were evaluated for sociodemographic data, sources of stigma, the severity of the symptomatology and internalized stigma, evaluated with the Borderline Evaluation of Severity Over Time (BEST) and the Spanish version of King's Internalized Stigma Scale (ISS), respectively. Results: Participants with high internalized stigma reported greater symptom severity. Regarding the reported sources of stigma, in almost all sources of stigma, discrimination was perceived as greater (p < 0.05) (friends, co-workers, doctors, psychiatrists and nurses) as well as the perceived global internalized stigma (p < 0.05) for friends, co-workers and nursing staff. Conclusion: It is necessary to address stigmatizing behaviors by health personnel and the support network close to the patient in addition to improving awareness about associated internalized stigma which is related to worse outcomes.

O transtorno de estresse pós-traumático (TEPT) configura-se como um importante desafio para a saúde mental global, especialmente em contextos marcados por violência cumulativa, migração forçada e desigualdades estruturais. A Terapia de Exposição Narrativa (NET, acrônimo em inglês) é uma intervenção breve e focada no trauma, que promove a reconstrução da memória autobiográfica por meio da narrativa cronológica dos eventos de vida. Ao possibilitar a integração de experiências traumáticas fragmentadas em uma narrativa coerente, a NET facilita o processamento emocional e restaura a continuidade das histórias de vida interrompidas. Esta série de casos regionais examina a integração da NET nos sistemas de saúde mental do Brasil, República Democrática do Congo, Alemanha, Suíça, Japão, México, Reino Unido e Escandinávia. Com base em experiências diversas de implementação, o estudo identifica tanto condições favoráveis quanto desafios persistentes. Os resultados mostram que a NET é uma intervenção viável e adaptável a diferentes contextos socioculturais e níveis de recursos, especialmente quando apoiada por supervisão contínua, estratégias de deslocamento de tarefas e colaboração intersetorial. A incorporação da NET nas estruturas de serviços existentes ampliou o acesso a cuidados com enfoque no trauma baseados em evidências para populações frequentemente excluídas do tratamento especializado. Esses achados ressaltam o papel crítico de políticas públicas informadas pelo trauma na resposta às consequências da violência para a saúde mental em escala global.

Post-traumatic stress disorder represents a substantial global mental health burden, particularly in the face of cumulative violence, forced migration, and structural inequities. Narrative Exposure Therapy (NET) configures a brief trauma-focused intervention that supports the reconstruction of autobiographical memory by the chronological narration of life events. By integrating fragmented traumatic experiences into a coherent narrative, NET facilitates emotional processing and restores continuity to disrupted life stories. This regional case series examines the integration of NET into the mental health systems in Brazil, the Democratic Republic of Congo, Germany, Switzerland, Japan, Mexico, the United Kingdom, and Scandinavia. Drawing on diverse implementation experiences, the study identifies both enabling conditions and persistent challenges. Results highlight that NET is feasible and adaptable across different sociocultural and resource settings, especially when supported by sustained supervision, task-shifting strategies, and intersectoral collaboration. Embedding NET into existing service structures expanded access to evidence-based trauma care for populations often excluded from specialized treatment. These findings underscore the critical role of trauma-informed public policies in responding to the mental health consequences of violence on a global scale.

El deterioro cognitivo leve (DCL) es una entidad patológica precursora de la demencia. Las enfermedades cerebrales y cardiovasculares favorecen la aparición del DCL. Este es un estudio piloto sobre el DCL y la modulación autonómica cardiovascular y se planteó una metodología para evaluar a adultos mayores con DCL por medio del análisis de la variabilidad de la frecuencia cardiaca (VFC). En el estudio participaron 4 adultos mayores (66.8 ± 3 años) con DCL y 4 adultos mayores (70.5 ± 6 años) sin DCL. La VFC se evaluó durante una condición de reposo con ojos cerrados de 5 minutos de duración. Se encontró una correlación significativa negativa entre la edad y la potencia absoluta de la frecuencia alta relacionada con laArritmia Sinusal Respiratoria, aunque no se hallaron diferencias significativas en la VFC entre ambos grupos. La VFC en reposo no contribuyó en identificar la presencia del DCL. Para llevar a cabo la evaluación de la VFC, se recomienda llevar a cabo un estudio con una muestra más grande e incluir tareas de alta demanda.