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Preston G, Kirdar F, Kozicz T. The role of suboptimal mitochondrial function in vulnerability to post-traumatic stress disorder. J Inherit Metab Dis 2018; 41:585-596. [PMID: 29594645 DOI: 10.1007/s10545-018-0168-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/28/2018] [Accepted: 03/02/2018] [Indexed: 12/13/2022]
Abstract
Post-traumatic stress disorder remains the most significant psychiatric condition associated with exposure to a traumatic event, though rates of traumatic event exposure far outstrip incidence of PTSD. Mitochondrial dysfunction and suboptimal mitochondrial function have been increasingly implicated in several psychopathologies, and recent genetic studies have similarly suggested a pathogenic role of mitochondria in PTSD. Mitochondria play a central role in several physiologic processes underlying PTSD symptomatology, including abnormal fear learning, brain network activation, synaptic plasticity, steroidogenesis, and inflammation. Here we outline several potential mechanisms by which inherited (genetic) or acquired (environmental) mitochondrial dysfunction or suboptimal mitochondrial function, may contribute to PTSD symptomatology and increase susceptibility to PTSD. The proposed pathogenic role of mitochondria in the pathophysiology of PTSD has important implications for prevention and therapy, as antidepressants commonly prescribed for patients with PTSD have been shown to inhibit mitochondrial function, while alternative therapies shown to improve mitochondrial function may prove more efficacious.
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Affiliation(s)
- Graeme Preston
- Hayward Genetics Center, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA.
| | - Faisal Kirdar
- Hayward Genetics Center, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA
| | - Tamas Kozicz
- Hayward Genetics Center, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
- Department of Anatomy, Radboud University Medical Center, Nijmegen, Netherlands
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Cox DW, Motl TC, Myfanwy Bakker A, Lunt RA. Cognitive fusion and post-trauma functioning in veterans: Examining the mediating roles of emotion dysregulation. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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History of Solitary Confinement Is Associated with Post-Traumatic Stress Disorder Symptoms among Individuals Recently Released from Prison. J Urban Health 2018; 95:141-148. [PMID: 28281161 PMCID: PMC5906377 DOI: 10.1007/s11524-017-0138-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study assessed the relationship between solitary confinement and post-traumatic stress disorder (PTSD) symptoms in a cohort of recently released former prisoners. The cross-sectional design utilized baseline data from the Transitions Clinic Network, a multi-site prospective longitudinal cohort study of post-incarceration medical care. Our main independent variable was self-reported solitary confinement during the participants' most recent incarceration; the dependent variable was the presence of PTSD symptoms determined by primary care (PC)-PTSD screening when participants initiated primary care in the community. We used multivariable logistic regression to adjust for potential confounders, such as prior mental health conditions, age, and gender. Among 119 participants, 43% had a history of solitary confinement and 28% screened positive for PTSD symptoms. Those who reported a history of solitary confinement were more likely to report PTSD symptoms than those without solitary confinement (43 vs. 16%, p < 0.01). In multivariable logistic regression, a history of solitary confinement (OR = 3.93, 95% CI 1.57-9.83) and chronic mental health conditions (OR = 4.04, 95% CI 1.52-10.68) were significantly associated with a positive PTSD screen after adjustment for the potential confounders. Experiencing solitary confinement was significantly associated with PTSD symptoms among individuals accessing primary care following release from prison. Larger studies should confirm these findings.
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Keyhani S, Vali M, Cohen B, Woodbridge A, Arenson M, Eilkhani E, Aivadyan C, Hasin D. A search algorithm for identifying likely users and non-users of marijuana from the free text of the electronic medical record. PLoS One 2018; 13:e0193706. [PMID: 29509775 PMCID: PMC5839555 DOI: 10.1371/journal.pone.0193706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/19/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The harmful effects of marijuana on health and in particular cardiovascular health are understudied. To develop such knowledge, an efficient method of developing an informative cohort of marijuana users and non-users is needed. METHODS We identified patients with a diagnosis of coronary artery disease using ICD-9 codes who were seen in the San Francisco VA in 2015. We imported these patients' medical record notes into an informatics platform that facilitated text searches. We categorized patients into those with evidence of marijuana use in the past 12 months and patients with no such evidence, using the following text strings: "marijuana", "mjx", and "cannabis". We randomly selected 51 users and 51 non-users based on this preliminary classification, and sent a recruitment letter to 97 of these patients who had contact information available. Patients were interviewed on marijuana use and domains related to cardiovascular health. Data on marijuana use collected from the medical record was compared to data collected as part of the interview. RESULTS The interview completion rate was 71%. Among the 35 patients identified by text strings as having used marijuana in the previous year, 15 had used marijuana in the past 30 days (positive predictive value = 42.9%). The probability of use in the past month increased from 8.8% to 42.9% in people who have these keywords in their medical record compared to those who did not have these terms in their medical record. CONCLUSION Methods that combine text search strategies for participant recruitment with health interviews provide an efficient approach to developing prospective cohorts that can be used to study the health effects of marijuana.
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Affiliation(s)
- Salomeh Keyhani
- San Francisco VA Medical Center, San Francisco, CA, United States of America
- University of California San Francisco, Department of Medicine, San Francisco, CA, United States of America
- * E-mail:
| | - Marzieh Vali
- San Francisco VA Medical Center, San Francisco, CA, United States of America
| | - Beth Cohen
- San Francisco VA Medical Center, San Francisco, CA, United States of America
- University of California San Francisco, Department of Medicine, San Francisco, CA, United States of America
| | - Alexandra Woodbridge
- Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Melanie Arenson
- University of Maryland, Department of Psychology, College Park, Maryland, United States of America
| | - Elnaz Eilkhani
- University of California San Francisco, Department of Medicine, San Francisco, CA, United States of America
| | - Christina Aivadyan
- New York State Psychiatric Institute, New York, NY, United States of America
| | - Deborah Hasin
- New York State Psychiatric Institute, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Gilam G, Maron-Katz A, Kliper E, Lin T, Fruchter E, Shamir R, Hendler T. Tracing the Neural Carryover Effects of Interpersonal Anger on Resting-State fMRI in Men and Their Relation to Traumatic Stress Symptoms in a Subsample of Soldiers. Front Behav Neurosci 2017; 11:252. [PMID: 29326568 PMCID: PMC5742339 DOI: 10.3389/fnbeh.2017.00252] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/11/2017] [Indexed: 12/21/2022] Open
Abstract
Uncontrolled anger may lead to aggression and is common in various clinical conditions, including post traumatic stress disorder. Emotion regulation strategies may vary with some more adaptive and efficient than others in reducing angry feelings. However, such feelings tend to linger after anger provocation, extending the challenge of coping with anger beyond provocation. Task-independent resting-state (rs) fMRI may be a particularly useful paradigm to reveal neural processes of spontaneous recovery from a preceding negative emotional experience. We aimed to trace the carryover effects of anger on endogenous neural dynamics by applying a data-driven examination of changes in functional connectivity (FC) during rs-fMRI between before and after an interpersonal anger induction (N = 44 men). Anger was induced based on unfair monetary offers in a previously validated decision-making task. We calculated a common measure of global FC (gFC) which captures the level of FC between each region and all other regions in the brain, and examined which brain regions manifested changes in this measure following anger. We next examined the changes in all functional connections of each individuated brain region with all other brain regions to reveal which connections underlie the differences found in the gFC analysis of the previous step. We subsequently examined the relation of the identified neural modulations in the aftermath of anger with state- and trait- like measures associated with anger, including brain structure, and in a subsample of designated infantry soldiers (N = 21), with levels of traumatic stress symptoms (TSS) measured 1 year later following combat-training. The analysis pipeline revealed an increase in right amygdala gFC in the aftermath of anger and specifically with the right inferior frontal gyrus (IFG).We found that the increase in FC between the right amygdala and right IFG following anger was positively associated with smaller right IFG volume, higher trait-anger level and among soldiers with more TSS. Moreover, higher levels of right amygdala gFC at baseline predicted less reported anger during the subsequent anger provocation. The results suggest that increased amygdala-IFG connectivity following anger is associated with maladaptive recovery, and relates to long-term development of stress symptomatology in a subsample of soldiers.
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Affiliation(s)
- Gadi Gilam
- The Tel Aviv Center for Brain Function, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Adi Maron-Katz
- The Tel Aviv Center for Brain Function, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Blavatnik School of Computer Science, Tel-Aviv University, Tel Aviv, Israel
| | - Efrat Kliper
- The Tel Aviv Center for Brain Function, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Lin
- The Tel Aviv Center for Brain Function, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Eyal Fruchter
- Division of Mental Health, Israeli Defense Force Medical Corp, Haifa, Israel
| | - Ron Shamir
- Blavatnik School of Computer Science, Tel-Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | - Talma Hendler
- The Tel Aviv Center for Brain Function, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
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Bienvenu OJ. Critical Illness-related Post-traumatic Stress. An Important Message. Am J Respir Crit Care Med 2017; 193:1326-7. [PMID: 27304237 DOI: 10.1164/rccm.201601-0095ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- O Joseph Bienvenu
- 1 Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine Baltimore, Maryland
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Dexamethasone impairs encoding and expression of aversive conditioning promoted by pentylenetetrazole. Behav Pharmacol 2017; 31:435-447. [PMID: 28863004 DOI: 10.1097/fbp.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Behavioral and neuroendocrine responses following threatening situations promote the release of corticosterone, which is known to modulate trauma-related learning and memory process. However, it remains unknown whether the aversive learning generated by interoceptive fear conditioning is affected by glucocorticoid modulation. Therefore, the present study aimed to investigate the role of dexamethasone suppression in encoding and expression of pentylenetetrazole-induced olfactory fear conditioning (OFC) and in contextual second-order conditioning promoted by the conditioned odor. Adult male Long-Evans rats were treated with dexamethasone 60 min before the encoding or the expression in both OFC and contextual second-order conditioning. Dexamethasone treatment impaired encoding and expression of the OFC, but failed to impair encoding and expression of the contextual second-order conditioning. Altogether, our results show that although OFC and thereafter contextual second-order conditioning may allow the study of traumatic memories, each order of conditioning seems to present specific features related to their pharmacological modulation. These findings highlight the importance of addressing the role of neuromodulatory systems in first-order and second-order conditioning to gain a better understanding of these phenomena and support future therapies related to traumatic memories.
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Affiliation(s)
- Arieh Shalev
- From the Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and TBI, Department of Psychiatry, New York University School of Medicine, New York (A.S., C.M.); and the Department of Psychiatry, University of Michigan, and the Mental Health Service, Veterans Affairs Ann Arbor Health Systems - both in Ann Arbor (I.L.)
| | - Israel Liberzon
- From the Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and TBI, Department of Psychiatry, New York University School of Medicine, New York (A.S., C.M.); and the Department of Psychiatry, University of Michigan, and the Mental Health Service, Veterans Affairs Ann Arbor Health Systems - both in Ann Arbor (I.L.)
| | - Charles Marmar
- From the Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and TBI, Department of Psychiatry, New York University School of Medicine, New York (A.S., C.M.); and the Department of Psychiatry, University of Michigan, and the Mental Health Service, Veterans Affairs Ann Arbor Health Systems - both in Ann Arbor (I.L.)
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Abstract
One of the most potent protective factors against psychiatric symptoms after military trauma is perceived social support. Although group psychotherapy has been linked with increasing social support, no research has evaluated which therapeutic mechanisms are associated with this increase beyond symptom reduction. We investigated which interpersonal therapeutic factors were related to changes in social support, beyond posttraumatic stress disorder (PTSD) symptom reduction. Participants were 117 veterans in a multimodal outpatient group psychotherapy treatment designed to reduce PTSD symptoms and interpersonal difficulties. Generally, therapeutic factors were related to improvements in social support from baseline to posttreatment beyond the effects of PTSD symptom reduction. Specifically, social learning was associated with changes in appraisal support, secure emotional expression was associated with changes in tangible support, and neither was associated with changes in belonging support. Depending on the goals of treatment, understanding these variations are important so clinicians and researchers can appropriately design and target their interventions to facilitate desired changes.
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Prins A, Bovin MJ, Smolenski DJ, Marx BP, Kimerling R, Jenkins-Guarnieri MA, Kaloupek DG, Schnurr PP, Kaiser AP, Leyva YE, Tiet QQ. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample. J Gen Intern Med 2016; 31:1206-11. [PMID: 27170304 PMCID: PMC5023594 DOI: 10.1007/s11606-016-3703-5] [Citation(s) in RCA: 604] [Impact Index Per Article: 75.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/18/2016] [Accepted: 03/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Posttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common. OBJECTIVE The objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure. DESIGN We compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5. PARTICIPANTS A convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White. MEASURES The PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences. KEY RESULTS The PC-PTSD-5 demonstrated excellent diagnostic accuracy (AUC = 0.941; 95 % C.I.: 0.912- 0.969). Whereas a cut score of 3 maximized sensitivity (κ[1]) = 0.93; SE = .041; 95 % C.I.: 0.849-1.00), a cut score of 4 maximized efficiency (κ[0.5] = 0.63; SE = 0.052; 95 % C.I.: 0.527-0.731), and a cut score of 5 maximized specificity (κ[0] = 0.70; SE = 0.077; 95 % C.I.: 0.550-0.853). Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report. CONCLUSIONS The PC-PTSD-5 demonstrated strong preliminary results for diagnostic accuracy, and was broadly acceptable to patients.
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Affiliation(s)
- Annabel Prins
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.
- Department of Psychology, San Jose State University, One Washington Square, San Jose, CA, 95192, USA.
| | - Michelle J Bovin
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Derek J Smolenski
- National Center for Telehealth and Technology, Joint Base Lewis-McChord, WA, 98433, USA
| | - Brian P Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Rachel Kimerling
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | | | - Danny G Kaloupek
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Paula P Schnurr
- National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Yani E Leyva
- Research Division, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Quyen Q Tiet
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- California School of Professional Psychology, Alliant International University, San Francisco, CA, USA
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Iron-induced neuronal damage in a rat model of post-traumatic stress disorder. Neuroscience 2016; 330:90-9. [DOI: 10.1016/j.neuroscience.2016.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 01/19/2023]
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Confronting Mortality: Narratives of Military Veterans Enrolled in Home Hospice Care. J Hosp Palliat Nurs 2016; 18:219-226. [PMID: 27398071 DOI: 10.1097/njh.0000000000000250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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63
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Angstman KB, Marcelin A, Gonzalez CA, Kaufman TK, Maxson JA, Williams MD. The Impact of Posttraumatic Stress Disorder on the 6-Month Outcomes in Collaborative Care Management for Depression. J Prim Care Community Health 2016; 7:159-64. [PMID: 26994060 DOI: 10.1177/2150131916638329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) has symptoms that exist along a spectrum that includes depression and the 2 disorders may coexist. Collaborative care management (CCM) has been successfully used in outpatient mental health management (especially depression and anxiety) with favorable outcomes. Despite this, there exist limited data on clinical impact of a diagnosis of PTSD on depression outcomes in CCM. The present study used a retrospective cohort design to examine the association of PTSD with depression outcomes among 2121 adult patients involved in CCM in a primary care setting. Using standardized self-report measures, baseline depression scores and 6-month outcome scores were evaluated. Seventy-six patients had a diagnosis of PTSD documented in their electronic medical record. Patients with PTSD reported more severe depressive symptoms at baseline (Patient Health Questionnaire-9 score of 17.9 vs 15.4, P < .001) than those without PTSD. Controlling for sociodemographic and clinical characteristics, a clinical diagnosis of PTSD was associated with lower odds (AOR = 0.457, CI = 0.274-0.760, P = .003) of remission at 6 months and was also associated with higher odds (AOR = 3.112, CI = 1.921-5.041, P < .001) of persistent depressive symptoms at 6 months after CCM. When coexisting with depression, a diagnosis of PTSD was associated with worse depression outcomes, when managed with CCM in primary care. Opportunities still exist for more aggressive management of depression in these patients to help improve remission as well as reduce persistent depressive symptoms.
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Abstract
Primary care providers are increasingly involved in the management of patients with mental disorders, particularly as integrated models of care emerge. The recent publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) represents a shift in the classification of several mental disorders commonly encountered by primary care providers. With the advent of ICD-10 and the movement toward diagnostic specificity, it is crucial that primary care providers understand the rationale behind these changes. This paper provides an overview of the changes in the classification of mental disorders in DSM-5, a description of how these changes relate to frequently used screening tools in the primary care setting, and a critique of how these changes will affect mental health practice from a primary care perspective.
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Affiliation(s)
- Ian M Kronish
- Division of General Medicine, Columbia University Medical Center, 622 W. 168th Street, PH9-311, New York, NY, 10032, USA.
| | - Ravi N Shah
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Box 104, New York, NY, 10032, USA.
| | - Nathalie Moise
- Division of General Medicine, Columbia University Medical Center, 622 W. 168th Street, PH9-311, New York, NY, 10032, USA.
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Prevalence, Detection and Correlates of PTSD in the Primary Care Setting: A Systematic Review. J Clin Psychol Med Settings 2016; 23:160-80. [DOI: 10.1007/s10880-016-9449-8] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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