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Ben Zina, E., M. W. Krir, H. Bel Hadj, R. Lansari, H. El Kefi, C. Ben Cheikh, and A. Omaya. "Self-esteem in Military Patients with Post-traumatic Stress Disorder." European Psychiatry 41, S1 (April 2017): S721. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1304.
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IntroductionMaintaining self-esteem is a fundamental human motivation. Trauma may lower self-esteem, which contributes to the development and maintenance of Post-Traumatic Stress Disorder (PTSD).ObjectivesAssessment of self-esteem in Tunisian military patients suffering from PTSD. Study of correlation between the severity of the PTSD symptoms and the rate of self-esteem.MethodsTransversal descriptive study of a sample of 22 patients treated for PTSD in the Tunisian Military Hospital during the period between August and October 2016.The PTSD Cheklist for DSM-5 (PCL-5), Hospital Anxiety and Depression scale (HAD), and the Rosenberg Self-Esteem Scale were administered for patients.ResultsAll the patients assessed were male. The mean age of the sample was 29.6 years. Fifty percent of the patients presented with a co-morbid major depression. Based on the score of the Rosenberg Self-Esteem Scale, patients had a self-esteem, which was very low in 45.45% of case, low in 45.45% of cases, average in 4.54% of cases and high in 4.54% of cases. The results also showed that lower levels of self-esteem are significantly correlated to the severity of the PTSD symptoms as measured by the PCL-5 score.ConclusionsThis study highlights the magnitude of self-esteem deficiency among patients suffering from PTSD. It remains unclear as to whether the relationship between trauma and depression is consistently mediated by a negative cognitive schema, such as low self-esteem, or whether trauma influences mood independently of low self-esteem. Further studies are required.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Shelef, Assaf, Dorit Brafman, Thom Rosing, Abraham Weizman, Rafael Stryjer, and Yoram Barak. "Equine Assisted Therapy for Patients with Post Traumatic Stress Disorder: A Case Series Study." Military Medicine 184, no. 9-10 (March 6, 2019): 394–99. http://dx.doi.org/10.1093/milmed/usz036.
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Abstract Introduction Equine assisted therapy (EAT) which includes therapeutic horseback riding (THR), grooming, horsemanship and ground level work with horses, has been studied as treatment for children with special needs and/or autistic spectrum disorder. Preliminary evidence indicates that EAT is also effective for improving self-efficacy and self-esteem in adults with psychiatric disorders. Empowerment, bonding and building trust with the horses, may promote functioning of patients struggling with post traumatic stress disorder (PTSD). The authors performed a prospective, pilot open case series study to assess the effect of EAT on patients with PTSD in terms of symptoms and functioning in work, family and social interaction. Methods Patients with PTSD received EAT once a week for 3 consecutive hours for 6 months. The Short Post Traumatic Stress Disorder Rating Interview (SPRINT) and the Sheehan Disability Scale (SDS) were assessed at baseline, the SDS after 1 and 6 months, and the SPRINT after 6 months. Results Thirteen of 23 participants completed the study. Ten participants withdrew from the study for various reasons including discomfort from horses. Total SPRINT scores showed a statistically significant improvement in PTSD symptoms (baseline vs. 6 months: 24.38 ± 6.4 vs. 21.54 ± 7.94 points; p < 0.05). SPRINT scores indicated improvement in the ability to work and perform daily tasks (p < 0.05). A statistically significant improvement in the total SDS score was revealed following 1 month (p < 0.03) and after 6 months (p < 0.02) of EAT. There was also a significant decline in the days of inefficiency (baseline vs. 6 months: 4.15 ± 2.73 vs, 1.88 ± 2.18 days per week, p < 0.02). Conclusion This preliminary pilot open case series study suggests that EAT may be a beneficial treatment for patients suffering from PTSD. The study demonstrated improved ability to work and perform daily tasks and reduction in the number of days of inefficiency. Further large-scale long-term studies are warranted to substantiate our observation.
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Zammit, Stan, Catrin Lewis, Sarah Dawson, Hannah Colley, Hannah McCann, Alice Piekarski, Helen Rockliff, and Jonathan Bisson. "Undetected post-traumatic stress disorder in secondary-care mental health services: systematic review." British Journal of Psychiatry 212, no. 1 (January 2018): 11–18. http://dx.doi.org/10.1192/bjp.2017.8.
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BackgroundComorbid post-traumatic stress disorder (PTSD) is associated with poorer outcomes of other disorders, but is treatable.AimsTo estimate the frequency of clinically undetected PTSD in secondary care.MethodA systematic review of studies that screened for PTSD and reported on PTSD documentation in clinical records. Frequency of undetected PTSD was estimated, and reasons for heterogeneity explored.ResultsThe median proportion of participants with undetected PTSD (29 studies) was 28.6% (interquartile range 18.2–38.6%). There was substantial heterogeneity, with studies conducted in the USA and those with the highest proportions of in-patients and patients with psychotic disorder reporting higher frequencies of undetected PTSD.ConclusionsUndetected PTSD is common in secondary care, even if the true value is at the lower limit of the estimates reported here. Trials examining the impact of routine screening for PTSD are required to determine whether such programmes should be standard procedure for all mental health services.Declaration of interestNone.
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Zivic, Bratislav, Danilo Jokovic, Marija Vranic, and Zvezdana Stojanovic. "Post-traumatic stress disorder psychotic subtype or comorbid psychotic disorder and evaluation of military service ability." Vojnosanitetski pregled 77, no. 3 (2020): 335–39. http://dx.doi.org/10.2298/vsp171128068z.
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Introduction. Recent studies have shown that diagnostic differences in the opinion whether some case is a psychotic subtype of posttraumatic stress disorder (PTSD) or a comorbid psychotic disorder still exist. In a case of mental disorders, a specific nature of military environment requires a detailed evaluation of abilities for military service (MS). Case report. A 34-year old male noncommissioned officer (NCO) showed symptomatology of PTSD (according to the Diagnostic and Statistical Manual of Mental Disorders ? DSM-IV) after experiencing a traumatic event in peacetime conditions. In addition to experiencing trauma as an adult, the patient was also exposed to early-age trauma, when his father committed suicide. After a pharmacotherapy and cognitive behavioral therapy treatment, he was remitted and returned to his duty. Triggered by new stress caused by unfavorable environmental factors (occupational environment), psychotic phenomenology appeared. After two years of psychiatric treatment, patient was evaluated unfit for MS. Conclusion. Early-age trauma and/or PTSD are predispositions for a comorbid psychotic disorder, while the diagnostic entity of psychotic subtype of PTSD requires further research. Evaluation of MS abilities in patients with psychotic disorder based on our clinical experience, will require a psychiatric treatment for at least two years, which is in accordance with a research conducted in the British Army.
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Yoshii, Takanobu. "The Role of the Thalamus in Post-Traumatic Stress Disorder." International Journal of Molecular Sciences 22, no. 4 (February 9, 2021): 1730. http://dx.doi.org/10.3390/ijms22041730.
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Post-traumatic stress disorder (PTSD) has a high lifetime prevalence and is one of the more serious challenges in mental health care. Fear-conditioned learning involving the amygdala has been thought to be one of the main causative factors; however, recent studies have reported abnormalities in the thalamus of PTSD patients, which may explain the mechanism of interventions such as eye movement desensitization and reprocessing (EMDR). Therefore, I conducted a miniature literature review on the potential contribution of the thalamus to the pathogenesis of PTSD and the validation of therapeutic approaches. As a result, we noticed the importance of the retinotectal pathway (superior colliculus−pulvinar−amygdala connection) and discussed therapeutic indicators.
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Cooper, John, Andrea J. Phelps, Chee H. Ng, and David Forbes. "Diagnosis and treatment of post-traumatic stress disorder during the COVID-19 pandemic." Australian Journal of General Practice 49, no. 12 (December 1, 2020): 785–89. http://dx.doi.org/10.31128/ajgp-07-20-5557.
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Background The COVID-19 pandemic has caused unprecedented stress globally, and the associated medical and health-related traumatic experiences pose significant risks for the development of post-traumatic stress disorder (PTSD), and the exacerbation of pre-existing PTSD, among patients, general practitioners (GPs) and healthcare staff. Objective The aim of this article is to provide guidance to GPs and healthcare staff working in Australia about the diagnosis and treatment of both newly developed and pre-existing PTSD in the COVID-19 context. Case studies are presented; the authors discuss whether pandemic-related PTSD is different to PTSD caused by different types of traumatic exposure, and the associated implications for treatment. Discussion The role of GPs in the management of PTSD during the COVID-19 pandemic remains central, involving early detection, assessment and referral. Moreover, health professionals are not immune to the mental health effects of the pandemic and are encouraged to maintain their wellbeing and to seek professional treatment if needed.
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Turgoose, David Paul, Stephanie Kerr, Paolo De Coppi, Simon Blackburn, Simon Wilkinson, Natasha Rooney, Richard Martin, Suzanne Gray, and Lee Duncan Hudson. "Prevalence of traumatic psychological stress reactions in children and parents following paediatric surgery: a systematic review and meta-analysis." BMJ Paediatrics Open 5, no. 1 (July 2021): e001147. http://dx.doi.org/10.1136/bmjpo-2021-001147.
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BackgroundChildren undergoing surgery and their parents are at risk of developing post-traumatic stress reactions. We systematically reviewed the literature to understand the prevalence of this issue, as well as potential risk factors.MethodsWe conducted a systematic review and meta-analysis, using PubMed, PsycInfo, Web of Science and Google Scholar, with searches conducted in February 2021. Papers were included if they measured post-traumatic stress in children and/or parents following paediatric surgery and were excluded if they did not use a validated measure of post-traumatic stress. Data were extracted from published reports.FindingsOur search yielded a total of 1672 papers, of which 16 met our inclusion criteria. In meta-analysis, pooled studies of children estimated an overall prevalence of 16% meeting criteria for post-traumatic stress disorder post surgery (N=187, 95% CI 5% to 31%, I2=80%). After pooling studies of parents, overall prevalence was estimated at 23% (N=1444, 95% CI 16% to 31%, I2=91%). Prevalence rates were higher than those reported in the general population. Risk factors reported within studies included length of stay, level of social support and parental mental health.InterpretationThere is consistent evidence of traumatic stress following surgery in childhood which warrants further investigation. Those delivering surgical care to children would benefit from a raised awareness of the potential for post-traumatic stress in their patients and their families, including offering screening and support.
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Delic, Vedad, Whitney A. Ratliff, and Bruce A. Citron. "Sleep Deprivation, a Link Between Post-Traumatic Stress Disorder and Alzheimer’s Disease." Journal of Alzheimer's Disease 79, no. 4 (February 16, 2021): 1443–49. http://dx.doi.org/10.3233/jad-201378.
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An estimated 5 million Americans are living with Alzheimer's disease (AD), and there is also a significant impact on caregivers, with an additional 16 million Americans providing unpaid care for individuals with AD and other dementias. These numbers are projected to increase in the coming years. While AD is still without a cure, continued research efforts have led to better understanding of pathology and potential risk factors that could be exploited to slow disease progression. A bidirectional relationship between sleep deprivation and AD has been suggested and is well supported by both human and animal studies. Even brief episodes of inadequate sleep have been shown to cause an increase in amyloidβ and tau proteins, both well-established contributors toAD pathology. Sleep deprivation is also the most common consequence of post-traumatic stress disorder (PTSD). Patients with PTSD frequently present with sleep disturbances and also develop dementia at twice the rate of the general population accounting for a disproportionate representation of AD among U.S. Veterans. The goal of this review is to highlight the relationship triad between sleep deprivation, AD, and PTSD as well as their impact on molecular mechanisms driving AD pathology.
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Akechi, Tatsuo, Toru Okuyama, Yuriko Sugawara, Tomohito Nakano, Yasuo Shima, and Yosuke Uchitomi. "Major Depression, Adjustment Disorders, and Post-Traumatic Stress Disorder in Terminally Ill Cancer Patients: Associated and Predictive Factors." Journal of Clinical Oncology 22, no. 10 (May 15, 2004): 1957–65. http://dx.doi.org/10.1200/jco.2004.08.149.
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Purpose Few studies have been conducted to elucidate the psychological distress of terminally ill cancer patients. This study attempted to determine the prevalence of adjustment disorders (AD), major depression (MD), and post-traumatic stress disorder (PTSD) among terminally ill cancer patients, to identify factors that contribute to them, and to determine how they change longitudinally. Patients and Methods Consecutive terminally ill cancer patients were recruited. Patients were assessed for psychiatric disorders by structured clinical interview twice: once at the time of their registration with a palliative care unit (baseline), and again at the time of their palliative care unit admission (follow-up). Possible contributed biomedical and psychosocial factors were evaluated. Results The proportions of patients diagnosed with AD, MD, and PTSD at baseline (n = 209) were 16.3%, 6.7%, and 0% respectively, whereas at follow-up (n = 85), 10.6% were diagnosed with AD and 11.8% with MD. Lower performance status, concern about being a burden to others, and lower satisfaction with social support were significantly associated with AD/MD at baseline. There were changes in the diagnosis of AD and MD in 30.6% of the patients. Only the Hospital Anxiety and Depression Scale at the baseline was significantly predictive of AD/MD at follow-up. Conclusion The factors underlying psychological distress are multifactorial. Early intervention to treat subclinical anxiety and depression may prevent subsequent psychological distress.
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Khitab, Aaron, John Reid, Vern Bennett, G. Camelia Adams, and Lloyd Balbuena. "Late Onset and Persistence of Post-Traumatic Stress Disorder Symptoms in Survivors of Critical Care." Canadian Respiratory Journal 20, no. 6 (2013): 429–33. http://dx.doi.org/10.1155/2013/861517.
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BACKGROUND: Several recent studies have reported that post-traumatic stress disorder (PTSD) is a frequent occurrence in survivors of an intensive care unit (ICU) admission.OBJECTIVE: To assess the frequency of PTSD symptoms at three and nine months post-ICU admission and examine possible risk factors that predispose to the development of PTSD symptoms.METHOD: Using the following scales: Davidson Trauma Scale, Impact of Event Scale and the Post-traumatic Symptom Scale, 69 ICU survivors were assessed for PTSD symptoms at three months post-ICU admission. Of the original 69 patients, 37 completed the same questionnaires at the second follow-up at nine months post-ICU admission. Mean symptom levels for avoidance, intrusive thoughts and hyperarousal were calculated, and risk factors for the development of PTSD symptomatology were examined.RESULTS: Depending on which scale was used, 16% to 33% of ICU survivors met the criteria for PTSD at either three or nine months. Younger age and the use of a prescription psychoactive medication at time of ICU admission were both independently associated with a higher risk of developing PTSD symptoms. Interestingly, symptoms of hyperarousal worsened during the follow-up interval for female patients, while they remained constant for males.CONCLUSION: The frequency of PTSD symptoms was high in patients who survived an admission to the ICU. Depending on sex, symptoms may present and evolve differently. The adoption of screening tools and a multicentre ICU database in Canada is recommended to identify patients who are most at risk.
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Lampen-Imkamp, S., and W. Dillo. "Varenicline for the Treatment of Nightmares and Sleep Disturbance in Patients with Post-traumatic-stress-disorder (PTSD) - Two Case Reports." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71457-9.
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Aims:Varenicline is a drug used for smoking withdrawal symptoms. It reduces cravings by binding to alpha4-beta2-nicotine-acethylcholine-receptors of the central nervous system. Side effects are nausea, headache, sleeping disorders. Patients with PTSD complain of depressions, social isolation, insomnia, nightmares and flashbacks. These symptoms often cause a severe drug abuse. We present two patients complaining of sleeping disorders caused by nightmares. These symptoms were significantly reduced under treatment with Varenicline due to a nicotine abuse.Method:Patient A was a woman with a history of sexual abuse in childhood. Besides a drug abuse of benzodiazepines she presented a nicotine addiction. She was increasingly affected by nightmares and insomnia. Patient B was a woman, who grew up in a children's protectory, where she was involved in violence. A PTSD was accompanied by alcohol and benzodiazepine abuse. The PTSD caused episodes of depression with suicidal ideation, nightmares and insomnia.Results:Both patients were treated with Varenicline for smoking cessation. After few days of treatment, they reported improved sleeping behaviours and diminished nightmares.Conclusion:Currently only few studies confirm the effectiveness of alpha1-receptor-agonists (Prazosin) in PTSD-associated nightmares. Our case reports demonstrated the effectiveness of Vareniclin in the treatment of nightmares and sleeping disorders in two patients. The treatment with Vareniclin lead to modified dreaming behaviours with positive, less threatening dreams. Therefore a placebo-controlled study to assess the effectiveness of Vareniclin in the treatment of nightmares is necessary.
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Barton, Luisa, Clara Nisan, Carey Burleigh, and Suzanne Fredericks. "Case presentation of Safe and Effective Use of Medical Cannabis in the Elderly." Nurse Practitioner Open Journal 1, no. 1 (May 14, 2021): 9–16. http://dx.doi.org/10.28984/npoj.v1i1.343.
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Introduction: The therapeutic benefits of medical cannabis have been demonstrated for a number of chronic conditions impacting the elderly population, such as pain management, and as alternatives to antipsychotic and opioid interventions, as well as end of life treatments. However, this therapeutic intervention has not become part of routine care for seniors living in long-term care facilities because of reduced public acceptance and stigma. The aim of this paper was to present case studies outlining the effective use of medical cannabis to treat elderly patients with a variety of medical conditions and symptoms such as: post traumatic stress disorder, pain, anxiety, delusions, as well as palliative care. Cannabis was also used to taper antipsychotic medications, and for managing those in palliative care.
Case Presentation: Three cases highlighting the use of medical cannabis are described, from the perspective of a nurse practitioner-led interdisciplinary team approach.
Management and Outcome: Using a variety of combinations of medical cannabis (cannabidiol and delta-9-tetrahydrocannabinol) in oral formulations, the long-term care facility has achieved a dramatic reduction in the use of antipsychotic medications. Medical cannabis has shown alleviation of many symptoms such as: pain, dyspnea, agitation, fatigue, weakness, loss of appetite, nausea, vomiting, and twitching. Positive results were noted in several palliative care patients who received medical cannabis for pain and symptom management.
Conclusion: As an adjunct therapy for managing post traumatic stress disorder and other conditions, medical cannabis has been effective in reducing symptoms and for improving the patients’ overall quality of life. Continued evaluation into the long effectiveness of medical cannabis provided to individuals over the age of 65 years is suggested. This nurse practitioner-led therapeutic intervention highlights the potential health benefits of medical cannabis and has clinical implications for practice and education.
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Sideris, Tina. "From post-traumatic stress disorder to absolute dependence in an intensive care unit: reflections on a clinical account." Medical Humanities 45, no. 1 (June 20, 2018): 37–44. http://dx.doi.org/10.1136/medhum-2017-011435.
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This paper tells the story of one man’s experience of terrifying hallucinations and nightmares in an intensive care unit (ICU), drawing attention to the reality that intensive care treatment induces emotional suffering severe enough to be identified as post-traumatic stress disorder (PTSD). A body of international research, confirmed by South African studies, links life-saving critical care to symptoms which qualify for secondary psychiatric diagnosis including of post-traumatic stress. Risk factors include pre-ICU comorbid psychopathology. Early on in the clinical encounter with the patient in this paper it emerged that he bore the scars of another trauma. He had been a soldier. Recounting the terror he experienced when he was being weaned off mechanical ventilation evoked memories of his military history. Paradoxically, these shifted the focus away from the symptoms of PTSD, to make the helplessness and dependency of ICU patients more visible. This patient’s clinical account and patient experiences in other studies reveal the relational vulnerability of ICU patients. In as much as experiences of ICU treatment can be terrifying, the non-response of carers distresses patients. This interplay of wounding and care provides a starting point from which to explore how we account for the neglect of relational care that is a recurring theme in medical contexts, without blaming the carers. These questions find resonance in a South African novel to which the paper refers. A novel about war and trauma movingly portrays the internal conflict of the central character, a nurse and her quest not to care, as a defence against vulnerability. In these ways writing about the relational vulnerability of patients opened up questions about the social and institutional context of carer vulnerability.
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Yasar, A. B., F. D. Usta, A. E. Abamor, S. Erdogan Taycan, and B. Kaya. "EMDR therapy on trauma-based restrictive eating cases." European Psychiatry 41, S1 (April 2017): S560—S561. http://dx.doi.org/10.1016/j.eurpsy.2017.01.811.
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IntroductionEating Disorders (ED) affect an individual's physical and mental health with abnormal eating habits. Traumatic life events may underlie the development of ED as many studies document [1]. In the present study, we examined the effectiveness of EMDR therapy that was originally used to treat Post-Traumatic Stress Disorder (PTSD) [2], on restrictive eating symptoms associated with trauma. Cases B.Ö. (18) and B.S. (20) came to the clinic consecutively for resembling complaints about the sense of food sticking in their throat, breathing difficulties, raised heart beatings, unease to swallow, and choking fear. The patients revealed past traumatic events about being out of breath while swallowing their bites. Then, they have started to restrict their food intake and the types of food consumed, which led to emaciation with health problems, interrupted daily routines, and social isolation; meeting the diagnosis of avoidant/restrictive food intake disorder (ARFID) in DSM-5. Due to traumatic experiences, EMDR therapy was applied.DiscussionAfter five EMDR therapy sessions, patients turned back to healthy eating habits, normal BMI, and effective daily life. As expected, EMDR therapy made significant improvements in the treatment of ARFID.ConclusionEMDR can be useful to treat ED with traumatic background.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Vin-Raviv, Neomi, Rachel Dekel, Micha Barchana, Shai Linn, and Lital Keinan-Boker. "World War II-related post-traumatic stress disorder and breast cancer risk among Israeli women: a case-control study." International Psychogeriatrics 26, no. 3 (December 2, 2013): 499–508. http://dx.doi.org/10.1017/s1041610213002081.
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ABSTRACTBackground:Several studies have suggested that post-traumatic stress disorder (PTSD) is related to adverse health outcomes. There are limited data on PTSD and cancer, which has a long latency period. We investigated the association between World War II (WWII)-related PTSD and subsequent breast cancer (BC) risk among Jewish WWII survivors and examined whether this association was modified by exposure to hunger during WWII.Methods:We compared 65 BC patients diagnosed in 2005 through 2010 to 200 population-based controls who were members of various organizations for Jewish WWII survivors in Israel. All participants were born in Europe, lived at least six months under Nazi rule during WWII, and immigrated to Israel after the war. We estimated PTSD using the PTSD Inventory and applied logistic regression models to estimate the association between WWII-related PTSD and BC, adjusting for potential confounders.Results:We observed a linear association between WWII-related PTSD and BC risk. This association remained significant following adjustment for potential confounders, including obesity, alcohol consumption, smoking, age during WWII, hunger exposure during WWII, and total number of traumatic life events (OR = 2.89, 95% CI = 1.14–7.31). However, the level of hunger exposure during WWII modified this effect significantly.Conclusions:These findings suggest an independent association between WWII-related PTSD and subsequent BC risk in Jewish WWII survivors that is modified by hunger, a novel finding. Future research is needed to further explore these findings.
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Romero, E. K., I. M. Kronish, and A. Shechter. "1154 Self-reported Sleep Duration And Quality Are Associated With Post-traumatic Stress Disorder Following Stroke." Sleep 43, Supplement_1 (April 2020): A440. http://dx.doi.org/10.1093/sleep/zsaa056.1148.
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Abstract Introduction Up to one in eight patients may experience post-traumatic stress disorder (PTSD) within the year following a stroke or transient ischemic attack (TIA). Sleep disturbance is a chief complaint in PTSD and is common following stroke. We therefore examined whether sleep was associated with post-stroke PTSD. Methods The Reactions to Acute Care and Hospitalization (REACH)-Stroke study is an observational cohort study examining factors related to long-term health outcomes following stroke/TIA. Typical sleep duration (self-report) and quality (1: very good to 4: very bad) over the month following hospital discharge was assessed at 1-month follow-up. At 1 month, patients also completed the PTSD checklist for DSM-5 (PCL-5 cued to the stroke/TIA event). Binary logistic regression was conducted, producing odds ratios (OR) on the association between sleep within the month following discharge and PTSD symptoms at 1 month post-stroke, controlling for age, sex, and race/ethnicity. Results Analyses included 459 patients (age: 61.1 ± 15.6 y, 53.2% female). Short sleep (<7 h/night) and poor sleep quality (fairly/very bad) was reported in 49.2% and 25.5% of patients, respectively. Elevated PTSD symptoms (PCL-5 score ≥30) at 1 month were reported in 10.9% of patients. Sleep was significantly shorter and worse quality in those with PTSD vs. without (p-values<0.001). Short sleep duration vs. not short duration throughout the month following discharge was significantly associated with elevated PTSD symptoms at 1-month (OR=3.34, 95% CI: 1.51-7.38, p=0.003). Poor sleep quality (fairly or very bad rating) vs. good sleep (fairly or very good rating) was also significantly associated with elevated PTSD symptoms at 1-month (OR=2.23, 95% CI: 1.13-4.41, p=0.021). Conclusion Patients with short duration and poor quality sleep in the month following stroke are at an increased risk of having elevated PTSD symptoms. Understanding factors related to the development of post-stroke PTSD is important since PTSD in stroke survivors can reduce quality of life, contribute to non-adherence to prescribed medications, and increase risk of recurrent stroke and/or cardiovascular events. Future studies should be conducted to determine whether sleep is a modifiable determinant of PTSD symptoms after stroke. Support R01HL141494, R01HL132347
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Ng, Ada, Madhu Reddy, Alyson K. Zalta, and Stephen M. Schueller. "Veterans’ Perspectives on Fitbit Use in Treatment for Post-Traumatic Stress Disorder: An Interview Study." JMIR Mental Health 5, no. 2 (June 15, 2018): e10415. http://dx.doi.org/10.2196/10415.
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Background The increase in availability of patient data through consumer health wearable devices and mobile phone sensors provides opportunities for mental health treatment beyond traditional self-report measurements. Previous studies have suggested that wearables can be effectively used to benefit the physical health of people with mental health issues, but little research has explored the integration of wearable devices into mental health care. As such, early research is still necessary to address factors that might impact integration including patients' motivations to use wearables and their subsequent data. Objective The aim of this study was to gain an understanding of patients’ motivations to use or not to use wearables devices during an intensive treatment program for post-traumatic stress disorder (PTSD). During this treatment, they received a complementary Fitbit. We investigated the following research questions: How did the veterans in the intensive treatment program use their Fitbit? What are contributing motivators for the use and nonuse of the Fitbit? Methods We conducted semistructured interviews with 13 veterans who completed an intensive treatment program for PTSD. We transcribed and analyzed interviews using thematic analysis. Results We identified three major motivations for veterans to use the Fitbit during their time in the program: increase self-awareness, support social interactions, and give back to other veterans. We also identified three major reasons certain features of the Fitbit were not used: lack of clarity around the purpose of the Fitbit, lack of meaning in the Fitbit data, and challenges in the veteran-provider relationship. Conclusions To integrate wearable data into mental health treatment programs, it is important to understand the patient’s perspectives and motivations in using wearables. We also discuss how the military culture and PTSD may have contributed to our participants' behaviors and attitudes toward Fitbit usage. We conclude with possible approaches for integrating patient-generated data into mental health treatment settings that may address the challenges we identified.
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Sumpton, BScN, Bryn, and Amanda Baskwill, PhD, MSc, BEd, RMT. "A Series of Case Reports Regarding the Use of Massage Therapy to Improve Sleep Quality in Individuals with Post-Traumatic Stress Disorder (PTSD)." International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice 12, no. 4 (September 17, 2019): 3–9. http://dx.doi.org/10.3822/ijtmb.v12i4.381.
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Background: Post-traumatic stress disorder (PTSD) is a common mental health diagnosis in Canada with prevalence estimated at about 2.4% in the general population. Previous studies have suggested massage therapy may be able to reduce the symptoms of PTSD. One of the symptoms commonly experienced is difficulty falling or staying asleep. No previously published massage therapy research has specifically assessed sleep symptoms of PTSD.
Objectives: The research question was, “For individuals who have PTSD as a result of experiencing traumatic events, does MT have an effect on sleep quality?”Methods: A prospective series of case reports describing 10-week MT treatment plans provided by Registered Massage Therapists at Sutherland-Chan Clinic’s Belleville location. Three individuals with PTSD were recruited using promotional posters in the community. Treatment focused on improving sleep quality and followed a pragmatic treatment protocol using light to moderate pressure. Out-comes were measured using a sleep diary, Pittsburgh Sleep Quality Index, and the Leeds Sleep Evaluation Questionnaire.
Results: Data collected at baseline and throughout the series showed inconsistent improvement and worsening of symptoms amongst participants. Treatment was well tolerated and attended. No harmful incidents were noted.
Conclusion: For these participants, MT did not predictably impact sleep quality. It is possible, as the underlying cause of poor sleep quality was unlikely resolved, the participants did not have a significant change in their sleep quality. This differs from findings of previous studies in which MT improved sleep for patients with poor sleep quality due to exposure to traumatic events. There is need for further understanding of how MT affects sleep.
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Koenig, Harold G., Faten Al-Zaben, and Tyler J. VanderWeele. "Religion and psychiatry: recent developments in research." BJPsych Advances 26, no. 5 (April 8, 2020): 262–72. http://dx.doi.org/10.1192/bja.2019.81.
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SUMMARYThe evidence base on the relationship between religion and mental health is growing rapidly, and we summarise the latest research on the topic. This includes studies on religious involvement and depression, bipolar disorder, suicide, post-traumatic stress disorder (PTSD), substance use disorders, personality disorder, chronic psychotic disorder, marital/family stability, social support and psychological well-being. We also review a relatively new topic in psychiatry, moral injury, which often accompanies PTSD and may interfere with its treatment. We describe a theoretical model that explains how religion might affect mental health and briefly discuss its applications in clinical practice, including a discussion of religiously integrated therapies for depression, anxiety and other emotional problems. Overall, studies indicate that religious involvement often serves as a powerful resource for patients, one that can be integrated into psychiatric care. At times, however, religion may impede or complicate treatment. This article will help clinicians determine, on the basis of the latest research, whether religion is an asset or a liability for a particular patient.
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Sonne, Charlotte, Jessica Carlsson, Per Bech, and Erik Lykke Mortensen. "Pharmacological treatment of refugees with trauma-related disorders: What do we know today?" Transcultural Psychiatry 54, no. 2 (December 12, 2016): 260–80. http://dx.doi.org/10.1177/1363461516682180.
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There is a dearth of evidence on the effectiveness of pharmacological treatment for refugees with trauma-related disorders. The present paper provides an overview of available literature on the subject and discusses the transferability of results from studies on other groups of patients with post traumatic stress disorder (PTSD). We conducted a systematic review of published treatment outcome studies on PTSD and depression among refugees. Fifteen studies were identified and reviewed. Most studies focused on the use of antidepressants. Included studies differed widely in method and quality. The majority were observational studies and case studies. Small sample sizes limited the statistical power. Few studies reported effect sizes, confidence intervals, and statistical significance of findings. No specific pharmacological treatment for PTSD among refugees can be recommended on the basis of the available literature. There is a need for well-designed clinical trials, especially with newer antidepressants and antipsychotics. Until such studies are available, clinical practice and design of trials can be guided by results from studies of other groups of PTSD patients, although differences in pharmacogenetics, compliance, and trauma reactions may affect the direct transferability of results from studies on nonrefugee populations.
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Baker, Amy, and Jonathan Bisson. "Pharmacological treatment of post-traumatic stress disorder- an audit of Cardiff Health access practice using a pharmacological prescribing algorithm." BJPsych Open 7, S1 (June 2021): S310. http://dx.doi.org/10.1192/bjo.2021.820.
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BackgroundPost-Traumatic Stress Disorder (PTSD) is a mental health disorder characterised by symptoms of re-experiencing, avoidance and hyperarousal that may develop after exposure to a traumatising event. The prevalence of PTSD within the refugee population is ten times higher than in the general population. This audit was carried out in Cardiff Health Access Practice (CHAP) which is the main provider of primary health care for refugees and asylum seekers who are sent to Cardiff. The main objective of this audit was to evaluate current PTSD prescribing practice for patients presenting to Cardiff Health Access Practice (CHAP) against a pharmacological prescribing algorithm which has been developed for the Cardiff and Vale Traumatic Stress Service based on NICE and International Society for Traumatic Stress Studies guidelinesMethodA retrospective audit of patients with PTSD seen in the last 12 months at CHAP. Data were collected from patient notes and information on age, sex, trauma, comorbidities and medication dose was collated and analysed using SPSS statistics.Result130 patients with PTSD were identified and their medications assessed for the audit. The mean age of these patients was 33 years and there was a 1.5:1 male to female ratio. Of the 130 patients only 10 were initiated on a first line medication, 117 were started on a fourth line medication. No patients were prescribed either the second- or third-line medications.ConclusionThe low rates of compliance with the All Wales Pharmacological PTSD pharmacological prescribing algorithm are disappointing although not unexpected as it has yet to be fully introduced to the service. Following discussion of the results and teaching about the algorithm with clinicians in Cardiff Health Access Practice rates of evidence-based prescribing should improve. This audit focuses on a patient group (refugee and asylum seekers) which has been identified as a priority group by the Welsh Government. Through further implementation of this algorithm there should be improved evidence-based prescribing and continuity of care for refugees
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Tomaz, Teresa, and Ivone Castro-Vale. "Trauma-Informed Care in Primary Health Settings—Which Is Even More Needed in Times of COVID-19." Healthcare 8, no. 3 (September 14, 2020): 340. http://dx.doi.org/10.3390/healthcare8030340.
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Included in the general practitioner’s (GP) core competencies is the ability to adopt a person-centered approach, and the use of the biopsychosocial model in their clinical work. Traumatic events (TEs) are frequently experienced within the population and are known to dysregulate the stress response system and to be associated with psychiatric and physical disorders. GPs may feel reluctant to confront TEs for a variety of reasons, such as a lack of sufficient training in trauma-informed care or a fear of causing harm when discussing a patient’s more complicated issues, among others. This perspective paper aims to review the existing studies that support the practice of trauma-informed healthcare and to summarise best practices. Studies have shown that patients appreciate the questions that clinicians ask them about trauma-related issues and that they understand that this can be important for their healthcare. Furthermore, asking about trauma-related issues in a patient-centered and empathic way can result in better doctor–patient relationships, which improves the levels of satisfaction of both the patient and the doctor with the consultation, as well as improved health-related outcomes. As past traumatic experiences increase the risk of developing post-traumatic stress disorder on exposure to a new TE, the onset of the COVID-19 pandemic has led to trauma-informed care becoming even more important if the strategy is to continue to invest in preventive medicine.
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Pitman, Roger K., and Douglas L. Delahanty. "Conceptually Driven Pharmacologic Approaches to Acute Trauma." CNS Spectrums 10, no. 2 (February 2005): 99–106. http://dx.doi.org/10.1017/s109285290001943x.
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ABSTRACTSecondary prevention of posttraumatic stress disorder (PTSD) entails intervening in the aftermath of a traumatic event to forestall the development of PTSD. There has been little psychopharmacologic research in this area. This is surprising, given that PTSD is the mental disorder with the most clearly identified cause and onset. In a translational model of PTSD's pathogenesis presented herein: A traumatic event (unconditioned stimulus) overstimulates endogenous stress hormones (unconditioned response); these mediate an overconsolidation of the event's memory trace; recall of the event in response to reminders (conditioned stimulus); releases further stress hormones (conditioned response); these cause further overconsolidation; and the overconsolidated memory generates PTSD symptoms. Noradrenergic hyperactivity in the basolateral amygdala is hypothesized to mediate this cycle. Preventing pre-synaptic norepinephrine release with α2-adrenergic agonists or opioids, or blocking post-synaptic norepinephrine sreceptors with β-adrenergic antagonists such as propranolol, reduces hormonally enhanced memories and fear conditioning. Two controlled studies of trauma victims presenting to emergency rooms suggest that posttrauma propranolol reduces subsequent PTSD, as does one naturalistic clinical study of morphine treatment of burned children. Cortisol both enhances memory consolidation and reduces memory retrieval, leading to mixed predictions. Two controlled studies of intensive care unit patients found that cortisol reduced PTSD. One study did not find benzodiazepines effective in preventing PTSD. Selective serotonin reuptake inhibitors, antiepileptics, and α2-adrenergic agonists have yet to be tried.
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HARVEY, ALLISON G., CHRIS R. BREWIN, CHARLIE JONES, and MICHAEL D. KOPELMAN. "Coexistence of posttraumatic stress disorder and traumatic brain injury: Towards a resolution of the paradox." Journal of the International Neuropsychological Society 9, no. 4 (May 2003): 663–76. http://dx.doi.org/10.1017/s1355617703940069.
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The coexistence of posttraumatic stress disorder (PTSD) and traumatic head or brain injury (TBI) in the same individual has been proposed to be paradoxical. It has been argued that individuals who sustain a TBI and have no conscious memory of their trauma will not experience fear, helplessness and horror during the trauma, nor will they develop reexperiencing symptoms or establish the negative associations that underlie avoidance symptoms. However, single case reports and incidence studies suggest that PTSD can be diagnosed following TBI. We highlight critical issues in assessment, definitions, and research methods, and propose two possible resolutions of the paradox. One resolution focuses on ambiguity in the criteria for diagnosing PTSD. The other involves accepting that TBI patients do experience similar symptoms to other PTSD patients, but that there are crucial differences in symptom content. (JINS, 2003, 9, 663–676.)
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Klein, Ehud, Yael Caspi, and Sharon Gil. "The Relation between Memory of the Traumatic Event and PTSD: Evidence from Studies of Traumatic Brain Injury." Canadian Journal of Psychiatry 48, no. 1 (February 2003): 28–33. http://dx.doi.org/10.1177/070674370304800106.
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Objective: This paper focuses on the relation between memory and posttraumatic stress disorder (PTSD). More specifically, it addresses the debate regarding the role of memory of the traumatic event in the development of PTSD. Traumatic brain injury (TBI) is used as a naturally occuring model for traumatic exposure that is often associated with memory impairment. Method: We present a critical review of the literature on studies assessing the relation between TBI and PTSD, with a focus on memory of the traumatic event as a critical factor. We also discuss results from recent studies conducted by our group. Results: The literature review offers an inconclusive picture wherein a significant proportion of the studies indicate that PTSD and TBI are mutually exclusive, especially in individuals who exhibit lack of memory for the traumatic event. This finding supports the possibility that lack of memory may protect against the development of PTSD. However, some studies show that PTSD does occur in patients with head injury, suggesting that PTSD may develop in TBI survivors—even in those who cannot remember the traumatic event. Generally speaking, though, the overall balance of the findings (including our own findings) seems to support the possibility that, in subjects with TBI, impaired memory of the traumatic event is associated with reduced prevalence of PTSD. Conclusions: The suggestion that amnesia regarding the traumatic event may protect against the development of PTSD has both theoretical and practical importance. This review focused on the case of trauamtic brain injury as a model for impaired memory for the traumatic event. However, it still remains to be proven that the conclusions based on these findings are generalizable beyond the case of TBI. While some patients with posttraumatic amnesia do develop PTSD despite lack of memory for the traumatic event, the majority of those who lack memory for the event seem to be protected from developing the disorder. Nevertheless, based on this assumption, we suggest that pharmacologic disruption of newly acquired—or even old—traumatic memories, which has been shown to be possible in animals, might therapeutically benefit trauma survivors.
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Bakken, Trine Lise, Arvid Nikolai Kildahl, Vibeke Gjersøe, Espen Matre, Tone Kristiansen, Arvid Ro, Anne Louise Tveter, and Siv Helene Høidal. "Identification of PTSD in adults with intellectual disabilities in five patients in a specialised psychiatric inpatient unit." Advances in Mental Health and Intellectual Disabilities 8, no. 2 (March 3, 2014): 91–102. http://dx.doi.org/10.1108/amhid-01-2013-0002.
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Purpose – The purpose of this paper is to describe and discuss assessment of post-traumatic stress disorder (PTSD) in adults with intellectual disabilities. Existing research in this area encompasses case studies, and includes, for the most part, persons with mild intellectual disabilities. Design/methodology/approach – The aim of this study is to investigate symptom presentation and subsequent identification of PTSD in persons with more severe intellectual disabilities; i.e. persons with moderate or severe intellectual disabilities. Five patients in a specialised psychiatric inpatient unit for patients with intellectual disabilities were included. Information about the patients was collected through case files and interviews with key informants: family, milieu therapists, and caregivers in community settings, and observations through inpatient admission. The authors of this paper followed a training programme for trauma therapists in addition to the inpatient treatment of the five patients. The five patients all met criteria for PTSD according to the Diagnostic Manual – Intellectual Disability. Findings – Previously, it was not suspected that the five patients suffered from PTSD, although they had experienced terrifying incidents. All patients displayed severe changes in behaviour, which may have overshadowed symptoms of PTSD. PTSD in persons with more severe intellectual disabilities may be interpreted as challenging behaviour, or other psychiatric disorders such as psychosis. Research limitations/implications – The limitation of the study is the small number of participants. Practical implications – Practical implication is linked to clinical practice related to identification of PTSD in persons with intellectual disabilities. Originality/value – The paper may encourage more research into how PTSD can be identified in persons with moderate and severe intellectual disabilities. The case reports may help clinicians to look for traumatic experiences in persons with intellectual disabilities who have experienced terrifying incidents.
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Welch, A., S. Sachdeva, C. Chung, and A. Alao. "Medicating Malingerers: A Case Study of Feigned Sickle Cell Disease." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71228-3.
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Speculation exists that bone pain crises among sickle cell disease (SCD) patients are not adequately treated. We counter this assertion with the case of a 17 year-old African American woman receiving narcotics while malingering SCD.There are various complications of SCD with the most common resulting from ischemia of the bone marrow. While depression, anxiety, and post-traumatic stress disorder have been described, psychiatric complications are not well documented in SCD.A 17 year old African American female entered the emergency room (ER) with right tibia and fibula fractures. She admitted to having SCD with bone pain crises previously treated with Ketorolac and Meperidine.On this occasion, radiological studies did not confirm sickle cell changes. A subsequent immunoglobulin electrophoresis came back hemoglobin AA. After the patient received notification she did not have SCD, she attempted to leave against medical advice. Her fractures were treated and she was discharged.DSM IV defines malingering as “the intentional production of false or grossly exaggerated physical or psychological symptoms”. One previous report of malingering sickle cell crises exists.1 This case demonstrates that the motivation to gain narcotic analgesics is a determining factor for malingering vis-à-vis factitious disorder, in which the primary goal is to assume the sick role.1Clinicians may assume the validity of a self-reported SCD history. In this case, ER physicians prescribed narcotics without objective evidence of SCD pathology. We suggest verification of SCD diagnosis in order to prevent unnecessary prescription of narcotics.
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Landera Rodríguez, R., M. Gómez Revuelta, M. Juncal Ruíz, O. Porta Olivares, R. Martín Gutiérrez, L. Sánchez Blanco, D. Abejas Díez, G. Pardo de Santayana Jenaro, M. Fernández Rodríguez, and L. A. Giraldo Vegas. "A mixed approach: Posttraumatic obsessive compulsive disorder." European Psychiatry 41, S1 (April 2017): S411. http://dx.doi.org/10.1016/j.eurpsy.2017.01.350.
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IntroductionSeveral studies along the last two decades provide information indicating the relationship between posttraumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). The particular features described in patients who developed OCD symptoms closely after the onset of PTSD, may suggest the existence of a specific subtype of OCD more likely to be suffered after a traumatic event. The few studies focused on evaluating treatment efficacy for the association between OCD and PTSD seem to predict poor response to pharmacologic or behavioral cognitive (BCT) monotherapy.ObjectivesDespite the evidence, most widely used guidelines propose the employment of either a psychotherapeutic or psychopharmacologic approach. We propose to combine intensive BCT and serotonin profile antidepressants in order to optimize PTSD-OCD subtype.Material and methodsWe present two detailed case reports offering the results of combining intensive BCT and serotonin profile antidepressants as soon as the comorbid diagnosis for both disorders was established. These two patients were recruited from outpatient care centers.ResultsOur limited experience supplied promising outcome results. Significant improvement regarding to functional impairment appeared from early stages of the treatment in both patients.DiscussionDespite logistic difficulties, an intensive and coordinated psychopharmacologic and psychotherapeutic approach might constitute another treatment choice which may be taken into account in those cases monotherapy fails to reduce PTSD-OCD subtype patients’ impairment.ConclusionsA mixed treatment approach might be taken into account as a first line treatment in PTSD-OCD disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Oliveira, Rosana, Troy A. Moore, Cynthia A. Mascareñas, and Carrie Rogers. "Post-traumatic stress disorder in veterans of Operation Enduring Freedom/Operation Iraqi Freedom: Retrospective review of treatment received compared to evidence-based practice guidelines." Mental Health Clinician 4, no. 6 (November 1, 2014): 301–8. http://dx.doi.org/10.9740/mhc.n224783.
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Background: Post-Traumatic Stress Disorder (PTSD) is a syndrome that can emerge after exposure to a traumatic event. In the veteran population, the strongest predictor of developing PTSD is frequency and intensity of direct combat exposure. The 2010 Veterans Affairs (VA)/Department of Defense (DoD) guidelines for the treatment of PTSD published in 2010 recommend psychotherapy techniques and/or pharmacotherapy (selective serotonin reuptake inhibitor or venlafaxine) as initial management.Objective: This study aimed to determine whether Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans received treatment for PTSD in concordance with VA/DoD guidelines.Methods: A retrospective chart review was conducted for 400 patients at the South Texas Veterans Health Care System (STVHCS) with OEF/OIF service who had a PTSD-related encounter between September 1, 2011 and August 31, 2012. The primary outcome was the percentage of OEF/OIF veterans with PTSD who received treatment in concordance with VA/DoD guidelines. Secondary outcomes included length of time veterans waited to see mental health (MH) providers, and comparison of outcomes between patients who received evidence-based treatment to those that did not.Results: Two-hundred and seventy-nine patients met the inclusion criteria and the majority of patients (n = 183, 65.5%) received treatment consistent with the VA/DoD Guidelines. The overall median wait time to see a MH provider was 10 +/−26.64 days, and did not differ significantly between groups. Patients whose treatment did not follow guideline recommendations had statistically more psychiatric emergency department (ED) visits (10 vs. 17, p=0.0026).Conclusions: The majority of patients at the STVHCS received treatment for PTSD in concordance with the VA/DoD guidelines, and 67.7% of patients saw MH providers within 14 days. Patients who did not receive guideline-supported treatment had more frequent ED visits, but the reason for this is unknown and may be due to a number of factors not accounted for in this review. The number of ED visits may be reduced by fully utilizing the processes in place that work to improve veteran access to MH care and the provision of guideline-based treatment. Prospective studies are needed to clearly elucidate the factors that may impact whether or not patients receive recommended treatment.
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Simões, Gisela, and Rita Silva. "The emerging role of acceptance and commitment therapy as a way to treat trauma and stressor related disorders." BJPsych Open 7, S1 (June 2021): S290. http://dx.doi.org/10.1192/bjo.2021.770.
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AimsThe aim of this work is to gather and evaluate scientific evidence about the clinical effects of Acceptance and Commitment Therapy (ACT) in the treatment of patients with trauma-related Post-Traumatic Stress Disorder (PTSD).MethodA literature search was conducted on PubMed platform, starting from the following MeSH terms: “Acceptance and Commitment Therapy”, “Trauma and Stressor Related Disorders”, “Psychological Trauma”. Studies obtained were analysed, corresponding to investigations based on an adult population with trauma and stressor related disorders.ResultThe search provided 13 results, of which 12 met the defined criteria. Different types of studies with variable samples were considered, including randomised clinical trials, longitudinal observational studies, narrative reviews and an analysis of case reports.Globally, ACT has been showing a crescent role in the treatment of individuals with trauma histories by enhancing positive outcomes and by being associated with greater psychological flexibility. It is increasingly considered to be well-suited to the treatment of trauma by targeting avoidance, coping strategies with emotional disengagement and persistent dissociation, aspects associated with greater PTSD symptom severity and related psychopathology.Furthermore, research suggests that acceptance-based treatments are helpful in promoting emotional, behavioural, and neural changes in psychological disorders characterised by disgust, shame and guilt that commonly co-occur with PTSD.Among the various exposure factors, we found a growing production of recent literature in which ACT has been applied in the context of oncology life-threatening settings, demonstrating significant improvements in symptoms and quality of life, as well as reductions in emotional disturbances, physical pain and traumatic responses.However, little is known about implementation and results of ACT in situations of trauma and psychiatric comorbidities. Data suggest that, when applied to individuals with psychosis and history of trauma, there is an improvement in overall severity and anxiety symptoms, emotion regulation strategies and a greater sense of engagement in care; nevertheless, reduction of specific trauma symptoms remains controversial. More mention is made about the growth of literature evaluating the application of ACT as a conjunctial therapeutic method for trauma and simultaneous addictive disorders.ConclusionOverall, despite limited published research currently available, some evidence starts to support ACT's promising role as an effective psychotherapeutic approach to trauma and stressor related disorders. Its application in situations where organic diseases represent stress factors has been growing. Future research should focus on clarifying the role of ACT in psychiatric comorbidity scenarios, allowing this psychotherapy to help individuals find a meaningful and valuable life beyond trauma.
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Ramaswamy, S., A. Hickert, K. Miller, V. Kolli, D. Driscoll, and Y. KC. "ID: 42: FACTORS ASSOCIATED WITH TREATMENT SEEKING IN VETERANS WITH LATE-ONSET PTSD." Journal of Investigative Medicine 64, no. 4 (March 22, 2016): 946.1–946. http://dx.doi.org/10.1136/jim-2016-000120.68.
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Background and SignificancePost-traumatic stress disorder (PTSD) is a chronic anxiety disorder with a lifetime prevalence of 6.8% in the general population and up to 30% among Vietnam War veterans. While presentation of PTSD is typically acute, delayed onset of PTSD (i.e., 6 months post trauma) is considered to be relatively rare. There is anecdotal evidence supporting reactivation of trauma memories and symptoms of PTSD among aging veterans who previously had no symptoms or treatment for PTSD. Clinically this type of presentation appears to be different from those presenting with symptoms earlier in life. It is unclear what might precipitate or reactivate these symptoms many years following trauma exposure. The Veterans Health Administration has a growing population of aging veterans exposed to combat during their military service. Current treatment guidelines provide limited guidance towards the management of late-onset PTSD. The prevalence of PTSD among OEF/OIF veterans is very high and as this cohort ages, we need to be better equipped to manage clinical changes seen across the lifespan. Understanding the clinical phenomenology, risk factors and potential biomarkers of this condition could pave the way for better screening methods and treatment interventions for clinicians.ObjectiveTo identify the characteristics and risk factors among late-life post-traumatic stress disorder (PTSD) treatment seekers.MethodsThe study is a retrospective chart review of patients diagnosed with PTSD after the age of 55 and a comparison group of veterans diagnosed with PTSD prior to the age of 55 in the VA Nebraska–Western Iowa Health Care System.ResultsPrimary variables for analysis included demographic factors, military history, age at treatment seeking, PTSD Checklist (PCL) scores, PTSD treatment, recent stressors/reasons for seeking treatment (e.g., recent life changes, another trauma or reminder), and comorbid medical conditions.ConclusionsA number of explanations have been proposed for the development of late-onset PTSD, including chronic inflammation and cumulative stress. We are conducting a separate study to determine whether plasma concentration of the inflammatory marker C-reactive protein (CRP) might help in predicting late-onset PTSD. Further studies are needed to evaluate the contributions of other factors (e.g., physical or cognitive decline, sleep disturbances, other traumas) to late-onset PTSD.
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Avery, Debra K., and Julie Brann D. Min. "130 Temporal Lobe Epilepsy: Is It in Your Differential Diagnosis? Two Case Reports." CNS Spectrums 25, no. 2 (April 2020): 282. http://dx.doi.org/10.1017/s1092852920000462.
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Abstract:Temporal Lobe Epilepsy:Is it in your differential diagnosis? Two Case ReportsObjective:Temporal Lobe Epilepsy (TLE), also referred as Complex Partial Seizures, is a medical diagnosis that must be considered in the pediatric, adolescent, and adult population presenting for psychiatric care. Mood disorders are common in people with epilepsy, with a prevalence rate of 20 to 50%. Scant literature exists that seeks specifically to enhance our knowledge of the similarities and subtle differences between TLE, Bipolar Disorder (BD) and Post Traumatic Stress Disorder (PTSD). Our objective is to describe an adolescent and adult case; one initially diagnosed as BD, the other PTSD, when in fact, it was TLE. We aim to illustrate that misdiagnosis and failure to diagnose are common. The provider must engage in a thorough review of systems and consider TLE in the differential diagnosis. A delay in the appropriate diagnosis and treatment can lead to a substantial amount of adverse effects and worsening of symptoms and negatively impact one’s quality of life.Method:Two case studies; an adolescent and one adult, diagnosed with BD and the other PTSD. Both endorsed a history of symptoms indicative of TLE. Key assessment findings and screening diagnostics alerted us to the differential diagnosis of TLE. The overlap of the symptom presentation is described.Results:TLE and many psychiatric conditions often present with overlapping symptoms. Patients have the potential to present with absence seizures, unprovoked irritability, oppositionality, aggression, anger, paroxysmal anxiety, somatic symptoms such as headaches, nausea, burning in the abdomen, stereotyped movements or behaviors, hypergraphia bizarre or incongruous affect, symptoms of fear, disturbed sleep, tearfulness, memory problems, déjà vu, fugue states, changes in cognition, inability to concentrate, fatigue, auditory and visual hallucination and bad temper.Our differential diagnosis of TLE was confirmed with electroencephalogram (EEG). By prescribing the appropriate medications to these two individuals, they were able to experience improved moods, become more productive in society, working, attending church, family outings, etc. They were weaned off their antipsychotic medications, of which an abundance of troubling side effects is now a non-issue.Conclusions:A delay in the proper diagnosis of TLE can have a significant negative impact on the adolescent and adult population. A need exists to educate mental health professionals on the overlap of symptoms of TLE and psychiatric disorders. The significant issue at hand is that they may not be receiving adequate or appropriate medications. Considering TLE in the differential diagnosis of presenting mood instability ensures our patients they are getting the basics of psychiatric care; which always emphasizes ruling out medical conditions first.
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Gasteratos, Konstantinos, Pantelis Voitsidis, Nikolaos Vlahopoulos, and Abra H. Shen. "577 The Intersection Between Burns and Psychiatric Disorders." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S130—S131. http://dx.doi.org/10.1093/jbcr/iraa024.204.
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Abstract Introduction Burns constitute a major health problem accounting together with fires for more than 300.000 deaths per year worldwide and for a great rate of disability-adjusted life years (DALYs). Identifying the relationship between mental disorders and burns is crucial since the former seems to constitute an important risk factor for the latter. At the same time, clinical experience and scientific evidence suggest that survivors of burns often develop psychiatric sequelae, causing poorer outcomes and lower quality of life. Methods We conducted a systematic review in order to study the relationship between burns and psychopathology as well as the quality of life. We used the search engine “PubMed” with the term “((psychiatric[Title/Abstract]) OR psychological[Title/Abstract]) AND burns[Title/Abstract]” without limits regarding the time of publication, resulting in 761 studies. Using the Covidence online platform that enables screening of the articles by two reviewers, we screened the articles, first by title and abstract and then by full text. Non-English papers or papers with no full texts will be excluded from the study. We aim to register the review in the official international prospective register of the National Institute for Health Research (PROSPERO). Results Preliminary results suggest that a history of mental disorder is common among burn patients, whether self-inflicted or not. Research tends to focus on self-inflicted burns which are expected to show such an association. Indeed, psychotic disorders, drug dependence and depression constitute significant risk factors for self-immolation. At the same time, the presence of a mental disorder may be associated with a worse prognosis (burn complications, patient morbidity, and mortality, multiple hospitalizations, increased cost for treatment). Burn survivors are also at risk for developing psychiatric complications, such as Post Traumatic Stress Disorder (PTSD), depression and anxiety disorders, as well as experiencing a lower quality of life. It appears that the disfigurement, loss of function and change in body image perception caused by the burns lead to the emergence or recurrence of a psychiatric condition. Last but not least, the relationship between delirium in the Burns Intensive Care Unit patients is well established. Conclusions There seems to exist a significant ambidirectional connection between burns and mental disorders. Higher rates of mental disorders among burn patients in the pre- and post-burn period complicate the situation and lead to poorer results if left untreated. Applicability of Research to Practice Identifying risk factors for burns associated with the medical history, early recognition and appropriate treatment of mental disorders after the burn incident, improving rehabilitation and psychosocial re-integration of this patient population.
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Unoki, Takeshi, Hideaki Sakuramoto, Sakura Uemura, Takahiro Tsujimoto, Takako Yamaguchi, Yuko Shiba, Mayumi Hino, et al. "Prevalence of and risk factors for post-intensive care syndrome: Multicenter study of patients living at home after treatment in 12 Japanese intensive care units, SMAP-HoPe study." PLOS ONE 16, no. 5 (May 27, 2021): e0252167. http://dx.doi.org/10.1371/journal.pone.0252167.
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Few studies have examined the epidemiology of post-intensive care syndrome in Japan. This study investigated the mental health and quality of life of patients living at home in Japan after intensive care unit (ICU) discharge. Additionally, we examined whether unplanned admission to the ICU was associated with more severe post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms. An ambidirectional cohort study was conducted at 12 ICUs in Japan. Patients who stayed in the ICU for > 3 nights and were living at home for 1 year afterward were included. One year after ICU discharge, we retrospectively screened patients and performed a mail survey on a monthly basis, including the Impact of Event Scale—Revised (IER-S), the Hospital Anxiety Depression Scale (HADS), and the EuroQOL—5 Dimension (EQ-5D-L) questionnaires. Patients’ characteristics, delirium and coma status, drugs used, and ICU and hospital length of stay were assessed from medical records. Descriptive statistics and multilevel linear regression modeling were used to examine our hypothesis. Among 7,030 discharged patients, 854 patients were surveyed by mail. Of these, 778 patients responded (response rate = 91.1%). The data from 754 patients were analyzed. The median IES-R score was 3 (interquartile range [IQR] = 1‒9), and the prevalence of suspected PTSD was 6.0%. The median HADS anxiety score was 4.00 (IQR = 1.17‒6.00), and the prevalence of anxiety was 16.6%. The median HADS depression score was 5 (IQR = 2‒8), and the prevalence of depression was 28.1%. EQ-5D-L scores were lower in our participants than in the sex- and age-matched Japanese population. Unplanned admission was an independent risk factor for more severe PTSD, anxiety, and depressive symptoms. Approximately one-third of patients in the general ICU population experienced mental health issues one year after ICU discharge. Unplanned admission was an independent predictor for more severe PTSD symptoms.
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Rafi, Damir, Javier Ferreiro-Pisos, John Millwood Hargrave, and Cristina Losada Pérez. "An audit into the monitoring of off-label antipsychotics in primary care." BJPsych Open 7, S1 (June 2021): S213. http://dx.doi.org/10.1192/bjo.2021.569.
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AimsTo ascertain whether patients prescribed second generation antipsychotics for off-label indications are being monitored and screened adequately for physical health side-effects.BackgroundThe prevalence of off-label antipsychotic use has increased significantly over recent decades. Common off-licence uses include dementia, post-traumatic stress disorder, adjunctive treatment for unipolar depression and personality disorders. Recent studies have demonstrated that up to 65% of antipsychotic prescriptions are now off-label. Since the metabolic side-effects of second-generation antipsychotics are well-established, guidelines have emphasised the need for active, routine physical health screening of all individuals taking these drugs. However, there have been few studies or reviews which have specifically investigated screening rates of individuals receiving antipsychotic medications for off-licence indications.MethodAn audit of patients taking second-generation antipsychotics for off-label indications, under the caseload of Neighbourhoods 1, 3 and 4 of Lewisham Assessment & Liaison team, was conducted. After isolating individual patients fulfilling inclusion criteria, patient investigation documents were requested from relevant GP practices. 40 patients were isolated in total, and data were successfully collected in 60% (n = 24). Data were collected via a proforma. This consisted of patient information, indications for antipsychotic use, and each variable to be monitored. The audit standard used was the recommendations of the 12th Maudsley guidelines. Data were then entered into SPSS and analysed.ResultThe most common reasons for off-label antipsychotic prescribing were Emotionally Unstable Personality disorder (42%, n = 10) and depression (29%, n = 7). Findings demonstrated that 54% (n = 13) of patients audited had ‘basic’ blood screening (FBC, U&E, LFTs), however glucose (38%, n = 9), Prolactin (13%, n = 3), and Creatine Kinase (0%, n = 0), and monitoring was less frequent. 0% (n = 0) were completely monitored as per audit standard.ConclusionPrimary care monitoring of off-label antipsychotics is unsatisfactory, with no patients having a complete set of investigations. Reasons for this are unclear at this stage, however based on initial discussion with GP surgeries, may be due to lack of education regarding screening investigations, patients lost between primary and secondary care services, and a lack of clarity regarding responsibility and designated roles. This audit will be expanded to also include patients from Neighbourhood 2 of the Lewisham Assessment & Liaison team. A more detailed investigation will be conducted into the barriers to physical health screening, such that a targeted intervention can be implanted.
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Church, Dawson, Peta Stapleton, Phil Mollon, David Feinstein, Elizabeth Boath, David Mackay, and Rebecca Sims. "Guidelines for the Treatment of PTSD Using Clinical EFT (Emotional Freedom Techniques)." Healthcare 6, no. 4 (December 12, 2018): 146. http://dx.doi.org/10.3390/healthcare6040146.
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Clinical EFT (Emotional Freedom Techniques) is an evidence-based method that combines acupressure with elements drawn from cognitive and exposure therapies. The approach has been validated in more than 100 clinical trials. Its efficacy for post-traumatic stress disorder (PTSD) has been investigated in a variety of demographic groups including war veterans, victims of sexual violence, the spouses of PTSD sufferers, motor accident survivors, prisoners, hospital patients, adolescents, and survivors of natural and human-caused disasters. Meta-analyses of EFT for anxiety, depression, and PTSD indicate treatment effects that exceed those of both psychopharmacology and conventional psychotherapy. Studies of EFT in the treatment of PTSD show that (a) time frames for successful treatment generally range from four to 10 sessions; (b) group therapy sessions are effective; (c) comorbid conditions such as anxiety and depression improve simultaneously; (d) the risk of adverse events is low; (e) treatment produces physiological as well as psychological improvements; (f) patient gains persist over time; (g) the approach is cost-effective; (h) biomarkers such as stress hormones and genes are regulated; and (i) the method can be adapted to online and telemedicine applications. This paper recommends guidelines for the use of EFT in treating PTSD derived from the literature and a detailed practitioner survey. It has been reviewed by the major institutions providing training or supporting research in the method. The guidelines recommend a stepped-care model, with five treatment sessions for subclinical PTSD, 10 sessions for PTSD, and escalation to intensive psychotherapy or psychopharmacology or both for nonresponsive patients and those with developmental trauma. Group therapy, social support, apps, and online and telemedicine methods also contribute to a successful treatment plan.
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Hossack, Michael R., Matthew W. Reid, James K. Aden, Thomas Gibbons, Jody C. Noe, and Adam M. Willis. "Adverse Childhood Experience, Genes, and PTSD Risk in Soldiers: A Methylation Study." Military Medicine 185, no. 3-4 (December 9, 2019): 377–84. http://dx.doi.org/10.1093/milmed/usz292.
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Abstract Introduction Epigenetics can serve as a marker of susceptibility to many known psychiatric diseases. DNA methylation patterns of multiple genes have been studied in both civilian populations and military personnel with post-traumatic stress disorder (PTSD). Many of these genes serve various functions that span the hypothalamic-pituitary-adrenal axis, immune system, and central nervous system (CNS) growth factors and neurotransmission. It is thought that the methylation levels of such genes may be able to identify individuals who are at higher risk of developing PTSD. Our study seeks to establish whether previously reported PTSD genes possess a particular methylation pattern that is predictive of PTSD in active duty military members with combat exposure. Materials and Methods This is an institutional review board (IRB)-approved, cross-sectional, case control, gene-environment interaction study. About 170 active military members with and without PTSD were recruited. Patients with a history of structural brain damage, traumatic brain injury (TBI) resulting in loss of consciousness, predeployment diagnosis of PTSD or anxiety disorder, and predeployment prescription of an antidepressant or psychoactive medication were excluded. Validated measures of childhood trauma and adversity (adverse childhood experience [ACE] score), PTSD symptoms (PTSD check-list military version [PCL-M]), and combat exposure scales (CES) were measured via validated questionnaires for all subjects. After extracting DNA from peripheral blood provided by the 170 subjects, we determined methylation percentages, via pyrosequencing assays, for nine target areas within the following seven genes: BDNF, NR3C1, MAN2C1, TLR8, SLC6A4, IL-18, and SKA2. These genes are commonly reported in the literature as being highly correlated with PTSD and early-life traumatic experiences. Methylation levels were measured as a percentage at specific sites within the previously mentioned genes. Data were examined with SPSS v 22.0 Statistics and JMP v13.1 software using a general linear model for methylation × trauma (CES scores) split by diagnosis of PTSD or not, methylation versus childhood trauma (ACE scores), and methylation versus PTSD severity (PCL-M score). Two-way ANOVA was performed to control for antidepressant use. A two-tailed Student t-test was performed for PTSD analyses and was correlated with PTSD diagnosis, demographic information as well as ACE score, PCL-M score, and CES scores. Results Differentially methylated sites that were highly associated with PTSD diagnosis were found in three of seven candidate genes: BDNF, NR3C1, and MAN2C1. When compared to controls, patients with PTSD diagnosis had significantly lower levels of methylation, even after controlling for antidepressant use. PCL-M, ACE, and CES scores were significantly associated with PTSD diagnosis. Conclusion Our study suggests that methylation of key genes involved in synaptic plasticity and the hypothalamic-pituitary-adrenal axis is associated with lower levels of methylation in military PTSD subjects exposed to combat when compared to their non-PTSD counterparts. Strengths of this study include controlling for antidepressant use and excluding TBI patients. Similar studies in an active duty population of this size are scarce. What is not clear is whether methylation changes are driving PTSD symptomology or whether they are merely a marker of disease. Future areas of research include prospective studies that measure methylation pre- and postcombat exposure in the same individual.
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Pappal, Ryan D., Brian W. Roberts, Winston Winkler, Lauren H. Yaegar, Robert J. Stephens, and Brian M. Fuller. "Awareness and bispectral index (BIS) monitoring in mechanically ventilated patients in the emergency department and intensive care unit: a systematic review protocol." BMJ Open 10, no. 3 (March 2020): e034673. http://dx.doi.org/10.1136/bmjopen-2019-034673.
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IntroductionAccidental awareness with recall is one of the most feared complications for patients undergoing general anaesthesia and can lead to post-traumatic stress disorder in up to 70% of patients experiencing it. To reduce the incidence of awareness with recall, the bispectral index monitor is recommended for patients receiving total intravenous anaesthetics, especially those receiving neuromuscular blockers. While extensive investigation into awareness and bispectral index monitoring has occurred for operating room patients, this has not extended to other clinical arenas where sedated and mechanically ventilated patients are cared for, namely the intensive care unit and emergency department. The purpose of this systematic review is to assess the world’s literature to determine the incidence of awareness with paralysis in mechanically ventilated patients and the impact of bispectral index monitoring for reducing this complication.Methods and analysisRandomised trials and non-randomised studies are eligible for inclusion. With aid from a medical librarian, an electronic search will include Ovid Medline, Embase.com, Scopus, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. To find data published in abstract form, literature from professional society conferences (2010–2019) will be manually searched. Two authors will independently review search results and consensus will be reached with assistance from a third author, as needed. Heterogeneity and publication bias will be assessed and reported. If possible and appropriate, a meta-analysis of the data will be conducted for quantitative data analysis.Ethics and disseminationThe proposed systematic review does not require ethical approval, as it is conducted at the study level and does not involve individual patient-level data. Results will be disseminated by data sharing via academically established means, presentation at local and national scientific meetings and publication as a peer-reviewed manuscript.PROSPERO registration numberThe protocol has been submitted to International Prospective Register of Systematic Reviews and is awaiting registration.
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Conrad, E. Katherine, and R. DB Morrison. "MP31: Debriefing critical incidents in health care: a review of the evidence." CJEM 20, S1 (May 2018): S51—S52. http://dx.doi.org/10.1017/cem.2018.185.
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Introduction: Emergency health care providers (HCPs) regularly perform difficult medical resuscitations that require complex decision making and action. Critical incident debriefing has been proposed as a mechanism to mitigate the psychological effect of these stressful events and improve both provider and patient outcomes. The purpose of this updated systematic review is to determine if HCPs performing debriefing after critical incidents, compared to no debriefing, improves the outcomes of the HCPs or patients. Methods: We performed a librarian assisted systematic review of OVID Medline, CINAHL, OVID Embase and Google Scholar (January 2006 to February 2017) No restrictions for language were imposed. Two investigators evaluated articles independently for inclusion criteria, quality and data collection. Agreement was measured using the Kappa statistic and quality of the articles were assessed using the Downs and Black evaluation tool. Results: Among the 658 publications identified 16 met inclusion criteria. Participants included physicians, nurses, allied health and learners involved in both adult and pediatric resuscitations. Findings suggest that HCPs view debriefing positively (n=7). One moderate quality study showed that debriefing can enhance medical student and resident knowledge. Several studies (n=8) demonstrated at least some improvement in CPR and intubation related technical skills. Debriefing is also associated with improved short term patient survival but not survival to discharge (n=5). Two studies reported benefits to HCPs mental health as evidenced by improved ability to manage grief and decreased reported symptoms of Post-Traumatic Stress Disorder (PTSD). Conclusion: We found HCPs value debriefing after critical incidents and that debriefing is associated with improved HCP knowledge, skill and well-being. Despite these positive findings, there continues to be limited evidence that debriefing significantly impacts long term patient outcomes. Larger scale higher quality studies are required to further delineate the effect of structured debriefing on patient and provider outcomes.
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Hull, Alastair M. "Neuroimaging findings in post-traumatic stress disorder." British Journal of Psychiatry 181, no. 2 (August 2002): 102–10. http://dx.doi.org/10.1192/bjp.181.2.102.
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BackgroundFindings from neuroimaging studies complement our understanding of the wide-ranging neurobiological changes in trauma survivors who develop post-traumatic stress disorder (PTSD).AimsTo determine whether neuroimaging studies had identified structural and functional changes specific to PTSD.MethodA review of all functional and structural neuroimaging studies of subjects with PTSD was carried out. Studies were identified using general medical and specific traumatic stress databases and paper searches of current contents and other secondary sources.ResultsThe most replicated structural finding is hippocampal volume reduction, which may limitthe proper evaluation and categorisation of experience. Replicated localised functional changes include increased activation ofthe amygdala after symptom provocation (which may reflect its role in emotional memory) and decreased activity of Broca's area at the same time (which may explain the difficulty patients have in labelling their experiences).ConclusionsEvidence from neuroimaging studies has suggested areas ofthe brain that may be damaged by psychological trauma. The clinical implications ofthese neuroimaging findings need to be investigated further because they challenge traditional therapeutic approaches.
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Mouncey, Paul R., Dorothy Wade, Alvin Richards-Belle, Zia Sadique, Jerome Wulff, Richard Grieve, Lydia M. Emerson, et al. "A nurse-led, preventive, psychological intervention to reduce PTSD symptom severity in critically ill patients: the POPPI feasibility study and cluster RCT." Health Services and Delivery Research 7, no. 30 (August 2019): 1–174. http://dx.doi.org/10.3310/hsdr07300.
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Background High numbers of patients experience severe acute stress in critical care units. Acute stress has been linked to post-critical care psychological morbidity, including post-traumatic stress disorder (PTSD). Previously, a preventive, complex psychological intervention [Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients (POPPI)] was developed by this research team, to be led by nurses, to reduce the development of PTSD symptom severity at 6 months. Objectives The objectives were to (1) standardise and refine the POPPI intervention, and, if feasible, (2) evaluate it in a cluster randomised clinical trial (RCT). Design Two designs were used – (1) two feasibility studies to test the delivery and acceptability (to patients and staff) of the intervention, education package and support tools, and to test the trial procedures (i.e. recruitment and retention), and (2) a multicentre, parallel-group, cluster RCT with a baseline period and staggered roll-out of the intervention. Setting This study was set in NHS adult, general critical care units. Participants The participants were adult patients who were > 48 hours in a critical care unit, receiving level 3 care and able to consent. Interventions The intervention comprised three elements – (1) creating a therapeutic environment in critical care, (2) three stress support sessions for patients identified as acutely stressed and (3) a relaxation and recovery programme for patients identified as acutely stressed. Main outcome measures Primary outcome – patient-reported symptom severity using the PTSD Symptom Scale – Self Report (PSS-SR) questionnaire (to measure clinical effectiveness) and incremental costs, quality-adjusted life-years (QALYs) and net monetary benefit at 6 months (to measure cost-effectiveness). Secondary outcomes – days alive and free from sedation to day 30; duration of critical care unit stay; PSS-SR score of > 18 points; depression, anxiety and health-related quality of life at 6 months; and lifetime cost-effectiveness. Results (1) A total of 127 participants were recruited to the intervention feasibility study from two sites and 86 were recruited to the RCT procedures feasibility study from another two sites. The education package, support tools and intervention were refined. (2) A total of 24 sites were randomised to the intervention or control arms. A total of 1458 participants were recruited. Twelve sites delivered the intervention during the intervention period: > 80% of patients received two or more stress support sessions and all 12 sites achieved the target of > 80% of clinical staff completing the POPPI online training. There was, however, variation in delivery across sites. There was little difference between baseline and intervention periods in the development of PTSD symptom severity (measured by mean PSS-SR score) at 6 months for surviving patients in either the intervention or the control group: treatment effect estimate −0.03, 95% confidence interval (CI) −2.58 to 2.52; p = 0.98. On average, the intervention decreased costs and slightly improved QALYs, leading to a positive incremental net benefit at 6 months (£835, 95% CI −£4322 to £5992), but with considerable statistical uncertainty surrounding these results. There were no significant differences between the groups in any of the secondary outcomes or in the prespecified subgroup analyses. Limitations There was a risk of bias because different consent processes were used and as a result of the lack of blinding, which was mitigated as far as possible within the study design. The intervention started later than anticipated. Patients were not routinely monitored for delirium. Conclusions Among level 3 patients who stayed > 48 hours in critical care, the delivery of a preventive, complex psychological intervention, led by nurses, did not reduce the development of PTSD symptom severity at 6 months, when compared with usual care. Future work Prior to development and evaluation of subsequent psychological interventions, there is much to learn from post hoc analyses of the cluster RCT rich quantitative and qualitative data. Trial registration This trial is registered as ISRCTN61088114 and ISRCTN53448131. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 23, No. 30. See the NIHR Journals Library website for further project information.
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Ayers, Susan, Kirstie McKenzie-McHarg, and Andrew Eagle. "Cognitive behaviour therapy for postnatal post-traumatic stress disorder: case studies." Journal of Psychosomatic Obstetrics & Gynecology 28, no. 3 (January 2007): 177–84. http://dx.doi.org/10.1080/01674820601142957.
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Melcer, Ted, Jay Walker, Jocelyn Sazon, Robby Domasing, Katheryne Perez, Vibha Bhatnagar, and Michael Galarneau. "Outpatient Pharmacy Prescriptions During the First Year Following Serious Combat Injury: A Retrospective Analysis." Military Medicine 185, no. 7-8 (March 16, 2020): e1091-e1100. http://dx.doi.org/10.1093/milmed/usaa038.
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Abstract Introduction Limited research has analyzed the full range of outpatient medication prescription activity following serious combat injury. The objectives of this study were to describe (1) outpatient medication prescriptions and refills during the first 12 months after serious combat injury, (2) longitudinal changes in medication prescriptions during the first-year postinjury, and (3) patient characteristics associated with outpatient prescriptions. Materials and methods This was a retrospective analysis of existing health and pharmacy data for a random sample of U.S. service members who sustained serious combat injuries in the Iraq and Afghanistan conflicts, 2010–2013 (n = 381). Serious injury was defined by an Injury Severity Score (ISS) of 9 or greater. These patients typically participate in military rehabilitation programs (eg, amputation care) where prescription medications are essential. Data sources were the Expeditionary Medical Encounter Database for injury-specific data, the Pharmacy Data Transaction Service for outpatient medication prescriptions and refills, and the Military Health System Data Repository for diagnostic codes of pain and psychological disorders. Military trauma nurses reviewed casualty records to identify types of injuries. Using the American Hospital Formulary Service Pharmacologic-Therapeutic Classification system, clinicians identified 13 categories of prescription medications (eg, opioid, psychotherapeutic, immunologic) for analysis. Multivariable negative binomial and logistic regression analyses evaluated significant associations between independent variables (eg, blast injury, traumatic brain injury [TBI], ISS, limb amputation, diagnoses of chronic pain, or psychological disorders) and prescription measures (ie, number or category of medication prescriptions). We also describe longitudinal changes in prescription activity postinjury across consecutive quarterly intervals (91 days) during the first-year postinjury. Results During the first-year postinjury, patients averaged 61 outpatient prescriptions, including all initial prescriptions and refills. They averaged eight different categories of medications, primarily opioid, immunologic, gastrointestinal/genitourinary, central nervous system (CNS), nonopioid analgesic, and psychotherapeutic medications (representing 82% of prescriptions) during the first year. Prescription activity generally declined across quarters. There was still substantial prescription activity during the fourth quarter, as 79% of patients had at least one prescription. From 39 to 49% of patients had fourth-quarter prescriptions for opioid, CNS, or psychotherapeutic medications. Longitudinally, we found that 24–34% of patients had an opioid, CNS, or psychotherapeutic prescription during each of the final three quarters. In multivariable analysis, ISS, limb amputation (particularly bilateral amputation), and diagnoses of chronic pain and post-traumatic stress disorder (PTSD) were associated with significantly higher counts of individual and multiple medication prescriptions. TBI was associated with significantly lower numbers of prescriptions for certain medications. Conclusions This is one of the first studies to provide a systematic analysis of outpatient medication prescriptions following serious combat injury. The results indicate substantial prescription activity from multiple medication categories throughout the first-year postinjury. Diagnoses of chronic pain, PTSD, and limb amputation and ISS were associated with significantly higher counts of prescriptions overall and more prescription medication categories. This study provides initial evidence to better understand medication prescription activity following serious combat injury. The results inform future research on medication prescription practices and planning for rehabilitation.
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Adshead, Gwen. "Psychological therapies for post-traumatic stress disorder." British Journal of Psychiatry 177, no. 2 (August 2000): 144–48. http://dx.doi.org/10.1192/bjp.177.2.144.
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BackgroundAfter exposure to traumatic stressors, a subgroup of survivors (20–30%) will develop post-traumatic stress disorder (PTSD).AimsSince the incidence and prevalence rates for PTSD in the community are significant, it is important that general practitioners and psychiatrists be familiar with possible therapeutic options. In this review we shall look at the published evidence about the effectiveness of psychological treatments for PTSD.MethodThe psychopathological mechanisms involved in PTSD are discussed. Studies of the effectiveness of different psychological therapies are reviewed.ResultsThe review suggests that persistent fear or shame reactions are key aspects of PTSD. Evidence from systematic reviews suggests that psychotherapeutic treatments are effective in the therapy of reactions based on fear, and may increase the effectiveness of pharmacological therapy. There is less systematic evidence for the efficacy of interventions for symptoms based on shame.ConclusionsAlthough a proportion of patients with complex or chronic PTSD may require specialist interventions, most patients can be treated effectively by a general psychiatric service which can offer both pharmacological and psychological interventions.
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Pyne, Jeffrey M., and Richard Gevirtz. "Psychophysiologic Assessment and Combat Post Traumatic Stress Disorder." Biofeedback 37, no. 1 (March 1, 2009): 18–23. http://dx.doi.org/10.5298/1081-5937-37.1.18.
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Abstract Post traumatic stress disorder (PTSD) is a common mental health outcome associated with combat operations. Since October 2001, more than 1.6 million U.S. troops have deployed as part of Operation Enduring Freedom or Operation Iraqi Freedom. Current estimates for postdeployment post-traumatic stress disorder in Operation Enduring Freedom and Operation Iraqi Freedom veterans range from 5%–30%. This paper will briefly review a series of new and ongoing projects that utilize psychophysiologic assessment for patients with Operation Enduring Freedom or Operation Iraqi Freedom combat-related PTSD. Two treatment studies are supported by the Office of Naval Research, one assessment study is supported by the Veterans Health Administration, and a second assessment study is supported by the Department of Defense. Psychophysiologic reactivity is not new to combat-related PTSD, but there are new technologies that may enhance our ability to assess and understand this aspect of the condition. Papers describing the outcomes of these studies will be forthcoming.
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Makput, D. M., N. Dami, C. G. Piwuna, T. N. Haa, and C. Maton. "Prevalence of Undiagnosed Post Traumatic Stress Disorder among In-Patients in a Substance Use Disorder Treatment Centre in Nigeria." Journal of BioMedical Research and Clinical Practice 1, no. 2 (June 30, 2018): 136–41. http://dx.doi.org/10.46912/jbrcp.53.
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Post traumatic stress disorder is a clinical disorder characterized by emotional and physical symptoms that may occur after exposure to a severely traumatic event. It occurs commonly as a co-morbid diagnosis with substance related disorders, as well as other psychiatric disorders. We postulated that post traumatic stress disorder may be under- diagnosed in therapeutic wards where substance use disorders are treated. This study thus sought to determine the prevalence of undiagnosed post traumatic stress disorder in a substance use disorder in-patient population. The posttraumatic stress disorder check list, Civilian version was administered to patients on admission at the Center for addiction treatment and research, Vom, Plateau state, Nigeria in June 2017. Socio-demographic data and information regarding substance use were also obtained from the patients. A total of 38 in-patients were analyzed and 8 (21%) met the Diagnostic and statistical manual of mental disorders (fourth edition) criteria for current post traumatic stress disorder. None of the patients had a diagnosis of post traumatic stress disorder in their case notes prior to the post traumatic stress disorder check list administration in this study. Post traumatic stress disorder which is frequently co-morbid with substance abuse remains undiagnosed in many patients admitted to our therapeutic center.
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Lambert, Michael T. "Pheochromocytoma Presenting as Exacerbation of Post Traumatic Stress Disorder Symptomology." International Journal of Psychiatry in Medicine 22, no. 3 (September 1992): 265–68. http://dx.doi.org/10.2190/87yy-10ml-0ajv-jxew.
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Objective: The following case report and discussion is intended to increase awareness of the difficulties in diagnosing pheochromocytoma when a primary psychiatric diagnosis is first suspected. Method: The case of a middle-aged combat veteran who was admitted with agitation and flashbacks is presented. Episodes of hypertension were initially believed to be related to agitation or alcohol withdrawal. When the hypertensive episodes persisted, further evaluation revealed a pheochromocytoma. In three years' follow-up since removal of the tumor, the patient has shown considerable improvement in the symptoms of Post Traumatic Stress Disorder (PTSD). Conclusions: Pheochromocytoma should be considered in patients with psychiatric disorders if a pattern of hypertensive episodes persists or worsens. The case highlights the importance of medical evaluation in patients presenting with psychiatric complaints.
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Tomas, Megan. "Treatment of sleep disturbances in post-traumatic stress disorder." Mental Health Clinician 4, no. 2 (March 1, 2014): 91–97. http://dx.doi.org/10.9740/mhc.n190104.
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Sleep disturbances are very common in patients suffering from post-traumatic stress disorder (PTSD) and can have various negative sequelae, including worsening of perceived levels of stress, depression, and suicidal ideation. Although PTSD treatment can lead to improved sleep in some patients, there are a number of patients whose sleep disturbances do not remit even after treatment and can persist long after the original trauma. There are various non-pharmacological and pharmacological treatment modalities that have been studied. Non-pharmacological therapies include image rehearsal therapy (IRT), cognitive behavioral therapy for insomnia (CBTI), prolonged exposure (PE), and eye-movement desensitization and reprocessing (EMDR). Pharmacological studies include alpha-1-adrenergic receptor antagonists, alpha-adrenergic agonists, selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) monoamine oxidase inhibitors (MAOIs), other antidepressants, atypical antipsychotics, benzodiazepines, sedative hypnotics, and antiepileptics. The therapies with the most evidence to support their use are Image Rehearsal Therapy (IRT) and the alpha-1-adrenergic receptor antagonist, prazosin.
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SIMPSON, STEVE, MIKE MORLEY, and BOB BALDWIN. "CRIME-RELATED POST-TRAUMATIC STRESS DISORDER IN ELDERLY PSYCHIATRIC PATIENTS: A CASE SERIES." International Journal of Geriatric Psychiatry 11, no. 10 (October 1996): 879–82. http://dx.doi.org/10.1002/(sici)1099-1166(199610)11:10<879::aid-gps397>3.0.co;2-g.
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Bijanki, Kelly R., Sanne J. H. van Rooij, Timothy D. Ely, Jennifer S. Stevens, Cory S. Inman, Rebecca E. Fasano, Sierra E. Carter, et al. "Case Series: Unilateral Amygdala Ablation Ameliorates Post-Traumatic Stress Disorder Symptoms and Biomarkers." Neurosurgery 87, no. 4 (April 7, 2020): 796–802. http://dx.doi.org/10.1093/neuros/nyaa051.
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Abstract BACKGROUND Post-traumatic stress disorder is a severe psychobiological disorder associated with hyperactivity of the amygdala, particularly on the right side. Highly selective laser ablation of the amygdalohippocampal complex is an effective neurosurgical treatment for medically refractory medial temporal lobe epilepsy that minimizes neurocognitive deficits relative to traditional open surgery. OBJECTIVE To examine the impact of amygdalohippocampotomy upon symptoms and biomarkers of post-traumatic stress disorder. METHODS Two patients with well-documented chronic post-traumatic stress disorder who subsequently developed late-onset epilepsy underwent unilateral laser amygdalohippocampotomy. Prospective clinical and neuropsychological measurements were collected in patient 1. Additional prospective measurements of symptoms and biomarkers were collected pre- and post-surgery in patient 2. RESULTS After laser ablation targeting the nondominant (right) amygdala, both patients experienced not only reduced seizures, but also profoundly abated post-traumatic stress symptoms. Prospective evaluation of biomarkers in patient 2 showed robust improvements in hyperarousal symptoms, fear potentiation of the startle reflex, brain functional magnetic resonance imaging responses to fear-inducing stimuli, and emotional declarative memory. CONCLUSION These observations support the emerging hypothesis that the right amygdala particularly perpetuates the signs and symptoms of post-traumatic stress disorder and suggests that focal unilateral amydalohippocampotomy can provide therapeutic benefit.