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Ehrencrona C, Li Y, Angenete E, Haglind E, Franzén S, Grimby-Ekman A, Bock D. Do beta-blockers reduce negative intrusive thoughts and anxiety in cancer survivors? - An emulated trial. BMC Cancer 2024; 24:447. [PMID: 38605350 PMCID: PMC11007941 DOI: 10.1186/s12885-024-12236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/09/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND High rates of negative intrusive thoughts have been reported among cancer patients. Prevalent users of beta-blocker therapy have reported lower levels of cancer related intrusive thoughts than non-user. The aim of this study is to investigate if initiation of beta-blocker therapy reduces the prevalence and severity of intrusive thoughts (co-primary endpoints) and the prevalence of anxiety, depressed mood, and low quality of life (secondary endpoints) in cancer survivors. METHODS Data on patient-reported outcomes from three cohort studies of Swedish patients diagnosed with colon, prostate or rectal cancer were combined with data on beta-blocker prescriptions retrieved from the Swedish Prescribed Drug Register. Two randomized controlled trials were emulated. Trial 1 had follow-up 1 year after diagnosis, trial 2 had follow-up 2 years after diagnosis, baseline in both trials was 12 months before follow-up. Those who initiated beta-blocker therapy between baseline and follow-up was assigned Active group, those who did not was assigned Control group. All endpoints were analysed using Bayesian ordered logistic regression. RESULTS Trial 1 consisted of Active group, n = 59, and Control group, n = 3936. Trial 2 consisted of Active group, n = 87, and Control group, n = 3132. The majority of participants were men, 83% in trial 1 and 94% in trial 2. The prevalence and severity of intrusive thoughts were lower in the Active group in trial 1, but no significant differences between groups were found in either trial. The prevalence of depressed mood, worse quality of life and periods of anxiety were higher in the Active group in both trials with significant differences for quality of life in trial 1 and anxiety in trial 2. CONCLUSIONS The emulated trials demonstrated no evidence of a protective effect of beta-blocker therapy against intrusive thoughts. The Active group had reduced quality of life and elevated anxiety compared to the Control group. TRIAL REGISTRATION The three cohort studies were registered at isrctn.com/clinicaltrials.gov (ISRCTN06393679, NCT02530593 and NCT01477229).
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Affiliation(s)
- Carolina Ehrencrona
- Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ying Li
- Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Angenete
- Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Haglind
- Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Franzén
- Medical & Payer Evidence Statistics, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Grimby-Ekman
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Bock
- Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Early Biometrics and Statistical Innovation, Data Science & AI, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
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Hinton M, Metcalf O, Varker T, Roebuck G, McGaw V, Watson L, Fredrickson J, Johnson L, Forbes D, Phelps A, Kartal D, Dell L, Bryant R, McFarlane AC, Hopwood M, O'Donnell M. A Qualitative Study of the Expectations, Experiences, and Perceptions That Underpin Decisions Regarding PTSD Treatment in Help-seeking Veterans. Mil Med 2023; 188:e2234-e2241. [PMID: 36433752 DOI: 10.1093/milmed/usac374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/06/2022] [Accepted: 11/14/2022] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION A range of evidence-based treatments are available for PTSD. However, many veterans with PTSD do not engage in these treatments. Concurrently, various novel PTSD treatments with little or no evidence based are increasingly popular among veterans. This qualitative study explored the expectations, experiences, and perceptions of help-seeking veterans with PTSD to improve understanding of how these veterans make treatment decisions. MATERIALS AND METHODS Fifteen treatment-seeking veterans with PTSD participated in the study. Participants took part in semi-structured interviews. Data were analyzed using interpretative phenomenological analysis. RESULTS A number of themes and subthemes emerged from the data, providing a detailed account of the factors that influenced participants' treatment decisions. Most participants were in an acute crisis when they made the initial decision to seek treatment for their PTSD. In choosing a specific treatment, they tended to follow recommendations made by other veterans or health professionals or orders or directions from their superiors, health providers, or employers. Few participants actively considered the scientific evidence supporting different treatments. Participants had a strong preference for treatment provided by or involving other veterans. They reported finding PTSD treatments helpful, although some were not convinced of the value of evidence-based treatments specifically. Many participants reported negative experiences with treatment providers. CONCLUSIONS These findings will inform strategies to improve engagement of veterans in evidence-based PTSD treatments and advance progress toward veteran-centered care.
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Affiliation(s)
- Mark Hinton
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Olivia Metcalf
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Tracey Varker
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Greg Roebuck
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Violette McGaw
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Loretta Watson
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Julia Fredrickson
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Lucinda Johnson
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - David Forbes
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Andrea Phelps
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Dzenana Kartal
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Lisa Dell
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Kensington, NSW 2052, Australia
| | - Alexander C McFarlane
- Adelaide Medical School, University of Adelaide, Adelaide Health and Medical Sciences building, Adelaide, SA 5000, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Parkville, VIC 3010, Australia
| | - Meaghan O'Donnell
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC 3053, Australia
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Becker CR, Milad MR. Contemporary Approaches Toward Neuromodulation of Fear Extinction and Its Underlying Neural Circuits. Curr Top Behav Neurosci 2023; 64:353-387. [PMID: 37658219 DOI: 10.1007/7854_2023_442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Neuroscience and neuroimaging research have now identified brain nodes that are involved in the acquisition, storage, and expression of conditioned fear and its extinction. These brain regions include the ventromedial prefrontal cortex (vmPFC), dorsal anterior cingulate cortex (dACC), amygdala, insular cortex, and hippocampus. Psychiatric neuroimaging research shows that functional dysregulation of these brain regions might contribute to the etiology and symptomatology of various psychopathologies, including anxiety disorders and post traumatic stress disorder (PTSD) (Barad et al. Biol Psychiatry 60:322-328, 2006; Greco and Liberzon Neuropsychopharmacology 41:320-334, 2015; Milad et al. Biol Psychiatry 62:1191-1194, 2007a, Biol Psychiatry 62:446-454, b; Maren and Quirk Nat Rev Neurosci 5:844-852, 2004; Milad and Quirk Annu Rev Psychol 63:129, 2012; Phelps et al. Neuron 43:897-905, 2004; Shin and Liberzon Neuropsychopharmacology 35:169-191, 2009). Combined, these findings indicate that targeting the activation of these nodes and modulating their functional interactions might offer an opportunity to further our understanding of how fear and threat responses are formed and regulated in the human brain, which could lead to enhancing the efficacy of current treatments or creating novel treatments for PTSD and other psychiatric disorders (Marin et al. Depress Anxiety 31:269-278, 2014; Milad et al. Behav Res Ther 62:17-23, 2014). Device-based neuromodulation techniques provide a promising means for directly changing or regulating activity in the fear extinction network by targeting functionally connected brain regions via stimulation patterns (Raij et al. Biol Psychiatry 84:129-137, 2018; Marković et al. Front Hum Neurosci 15:138, 2021). In the past ten years, notable advancements in the precision, safety, comfort, accessibility, and control of administration have been made to the established device-based neuromodulation techniques to improve their efficacy. In this chapter we discuss ten years of progress surrounding device-based neuromodulation techniques-Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Magnetic Seizure Therapy (MST), Transcranial Focused Ultrasound (TUS), Deep Brain Stimulation (DBS), Vagus Nerve Stimulation (VNS), and Transcranial Electrical Stimulation (tES)-as research and clinical tools for enhancing fear extinction and treating PTSD symptoms. Additionally, we consider the emerging research, current limitations, and possible future directions for these techniques.
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Affiliation(s)
- Claudia R Becker
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Mohammed R Milad
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
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Kim SH, Kim KA, Baek J, Choi J, Chu SH. e-Health for Traumatized Refugees: A Scoping Review. Telemed J E Health 2022; 29:635-645. [PMID: 36169628 DOI: 10.1089/tmj.2022.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: High prevalence of post-traumatic stress disorder (PTSD) is reported among refugees exposed to traumatic experiences, while escaping from their home country, entering a third country, and adjusting to a new society. Electronic health (e-health) treatments have been utilized to overcome challenges such as high costs, limited access to care, and a shortage of resources faced by traumatized refugees. Objective: The aim of this scoping review was to summarize the current science on e-health to screen and treat PTSD in traumatized refugees, examine its benefits and challenges, and suggest strategies for future research. Methods: We conducted a scoping review guided by Arksey and O'Malley's 6-stage scoping review framework. Results: Of the 2,782 articles identified, 8 studies were included for the final analysis. Due to the heterogeneity of studies, the synthesis of results was not feasible. However, the findings of individual studies were examined. The most commonly used technology modality was the smartphone (n = 5). One study revealed the possibility of telephonic screening of PTSD to be equally efficacious as in-person screening, and all interventions through smartphone and the internet reported high feasibility and acceptability. Conclusion: e-Health is suggested to be a novel and scalable platform to provide mental health care in settings with limited resources. Larger and highly robust studies in refugee populations with PTSD-targeted, theory-based approaches and diverse technological formats such as video conferencing and virtual reality are warranted.
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Affiliation(s)
- Soo Hyun Kim
- Department of Nursing, Yonsei University College of Nursing, Seoul, Korea
| | - Kyoung-A Kim
- Department of Nursing, Gachon University College of Nursing, Incheon, Korea
| | - Jiwon Baek
- Department of Nursing, Yonsei University College of Nursing, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
| | - JiYeon Choi
- Department of Nursing, Yonsei University College of Nursing, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
| | - Sang Hui Chu
- Department of Nursing, Yonsei University College of Nursing, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
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5
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Touch: An integrative review of a somatosensory approach to the treatment of adults with symptoms of post-traumatic stress disorder. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zemestani M, Mohammed AF, Ismail AA, Vujanovic AA. A Pilot Randomized Clinical Trial of a Novel, Culturally Adapted, Trauma-Focused Cognitive-Behavioral Intervention for War-Related PTSD in Iraqi Women. Behav Ther 2022; 53:656-672. [PMID: 35697429 DOI: 10.1016/j.beth.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 01/20/2022] [Accepted: 01/29/2022] [Indexed: 12/12/2022]
Abstract
Trauma-focused cognitive-behavioral therapy (TF-CBT), broadly, is one of the leading evidence-based treatments for youth with posttraumatic stress disorder (PTSD). Generally, few culturally adapted TF-CBT interventions have been examined among war trauma-affected populations in low- and middle-income countries. Using a randomized clinical trial design, a total of 48 war trauma-exposed women in Iraq, Mage (SD) = 32.91 (5.33), with PTSD were randomly assigned to either TF-CBT or wait-list control (WLC) conditions. The intervention group received 12 individual weekly sessions of a culturally adapted TF-CBT intervention. Significant reductions in PTSD symptom severity were reported by women in the TF-CBT condition from pre- to posttreatment. Women in the TF-CBT condition reported significantly greater reductions in PTSD symptoms compared to WLC at 1-month follow-up. Additionally, levels of depression, anxiety, stress, and use of maladaptive emotion regulation strategies were significantly lower in the TF-CBT condition at posttreatment and 1-month follow-up, compared to the WLC condition. Women in the TF-CBT condition also reported significant improvements in various domains of quality of life at posttreatment and 1-month follow-up. This clinical trial provides preliminary cross-cultural support for the feasibility and efficacy of TF-CBT for the treatment of PTSD symptoms among women in non-Western cultures. Future directions and study limitations are discussed.
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7
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Pharmacological Management of Nightmares Associated with Posttraumatic Stress Disorder. CNS Drugs 2022; 36:721-737. [PMID: 35688992 DOI: 10.1007/s40263-022-00929-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
Posttraumatic stress disorder (PTSD) can be a chronic and disabling condition. Post-traumatic nightmares (PTNs) form a core component of PTSD and are highly prevalent in this patient population. Nightmares in PTSD have been associated with significant distress, functional impairment, poor health outcomes, and decreased quality of life. Nightmares in PTSD are also an independent risk factor for suicide. Nightmare cessation can lead to improved quality of life, fewer hospital admissions, lower healthcare costs, and reduced all-cause mortality. Effective treatment of nightmares is critical and often leads to improvement of other PTSD symptomatology. However, approved pharmacological agents for the treatment of PTSD have modest effects on sleep and nightmares, and may cause adverse effects. No pharmacological agent has been approved specifically for the treatment of PTNs, but multiple agents have been studied. This current narrative review aimed to critically appraise proven as well as novel pharmacological agents used in the treatment of PTNs. Evidence of varying quality exists for the use of prazosin, doxazosin, clonidine, tricyclic antidepressants, trazodone, mirtazapine, atypical antipsychotics (especially risperidone, olanzapine and quetiapine), gabapentin, topiramate, and cyproheptadine. Evidence does not support the use of venlafaxine, β-blockers, benzodiazepines, or sedative hypnotics. Novel agents such as ramelteon, cannabinoids, ketamine, psychedelic agents, and trihexyphenidyl have shown promising results. Large randomized controlled trials (RCTs) are needed to evaluate the use of these novel agents. Future research directions are identified to optimize the treatment of nightmares in patients with PTSD.
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8
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Zhu L, Li L, Li XZ, Wang L. Mind–Body Exercises for PTSD Symptoms, Depression, and Anxiety in Patients With PTSD: A Systematic Review and Meta-Analysis. Front Psychol 2022; 12:738211. [PMID: 35153889 PMCID: PMC8833099 DOI: 10.3389/fpsyg.2021.738211] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives This study aims to systematically analyze the effects of mind–body exercises on post-traumatic stress disorder (PTSD) symptoms, depression, and anxiety in patients with PTSD. Furthermore, it intends to provide scientific evidence-based exercise prescriptions. Methods Chinese (i.e., China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, and Wanfang) and English (i.e., Web of Science, PubMed, the Cochrane Library, and EMBASE) databases were used as data sources to search for studies on the effects of mind–body exercises on symptoms associated with patients with PTSD from January 1980 to November 2020. After a rigorous screening, 16 eligible randomized controlled trials (RCTs) were included in the meta-analysis. Results Mind–body exercises exerted a significant effect on PTSD symptoms [standard mean difference (SMD) = −0.41, 95% confidence interval (CI) −0.64 to −0.19, p < 0.001], depression (SMD = −0.35, 95% CI: −0.55 to −0.15, p < 0.001), and anxiety (SMD = −0.31, 95% CI: −0.74 to −0.12, p < 0.001) among patients with PTSD. Subgroup analysis demonstrated that 60–150 min per session for 8–16 weeks of mindfulness was more effective in improving symptoms in patients with PTSD under 45 years of age compared with other subgroups. For depression, 150–180 min of yoga exercises once per week was effective. For anxiety, the frequency, timing, duration, and type of mind–body exercises that are most effective in relieving anxiety in patients with PTSD cannot be determined at this time due to the limited number of eligible RCTs. Conclusions Mind–body exercises were found to be significantly effective in improving PTSD symptoms, depression, and anxiety in patients with PTSD. Therefore, they can be used as an adjunct to intervention for symptoms of patients with PTSD. However, this conclusion requires further confirmation through additional scientific and objective RCTs. Systematic Review Registration: Unique Identifier: INPLASY2020120072.
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Affiliation(s)
- Lin Zhu
- School of Wushu and Art, Nanjing Sport Institute, Nanjing, China
| | - Long Li
- School of Wushu and Art, Nanjing Sport Institute, Nanjing, China
- *Correspondence: Long Li
| | - Xiao-zhi Li
- Department of Physical Education, Southeast University, Nanjing, China
| | - Lin Wang
- Department of Physical Education, Wuhan University of Technology, Wuhan, China
- Lin Wang
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Nieforth LO, Craig EA. Patient-Centered Communication (PCC) in Equine Assisted Mental Health. HEALTH COMMUNICATION 2021; 36:1656-1665. [PMID: 32586134 DOI: 10.1080/10410236.2020.1785376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Experiencing trauma can lead to a variety of chronic and acute symptoms, including post- traumatic stress disorder (PTSD), anxiety, depression, substance abuse, and poor social skills. Given the variety of causes for trauma incorporating individualized treatment options is important for efficacy. Equine assisted mental health (EAMH) - a team approach incorporating equines, clients, and practitioners - has been successful in treating those who have experienced trauma, including veterans and individuals with PTSD, at-risk youth, victims of sexual violence, and children who have been neglected. Although researchers and practitioners understand some about how EAMH treatment results in positive outcomes for these individuals, little is known about the communicative processes that support them. The current study included 19 in-depth interviews with EAMH therapists and practitioners to explore the role of equine communication (i.e., congruence, ongoing positive regard, and empathy) as a communicative process that is integral to the facilitation of EAMH as individualized therapeutic treatment. Using tenets of patient-centered communication (PCC) and principles of client-centered therapy, implications for human-horse communication in therapeutic contexts and client-centered care are discussed.
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Roberts TJ, Ringler T, Krahn D, Ahearn E. The My Life, My Story Program: Sustained Impact of Veterans' Personal Narratives on Healthcare Providers 5 Years After Implementation. HEALTH COMMUNICATION 2021; 36:829-836. [PMID: 31999933 DOI: 10.1080/10410236.2020.1719316] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patient-centered care promotes positive patient, staff, and organizational outcomes. Communication is one critical element of patient-centered care. Establishing a patient-provider relationship in which a patient feels comfortable sharing their goals, preferences, and values is important to support patient-centered care and positive health outcomes. The My Life, My Story (MLMS) program was developed in 2013 to elicit and share Veterans' life stories with their healthcare providers. Life stories become part of the Veteran's chart so providers can access, read, and utilize as appropriate. To evaluate the program's sustained value and impact 5 years after implementation, healthcare staff were recruited to complete a short survey with closed and open-ended items. Descriptive statistics were used to analyze the quantitative survey responses and thematic analysis was used to analyze qualitative responses. Approximately 94% of staff indicated they had read MLMS notes and over 86% agreed or strongly agreed that reading the notes was a good use of their clinical time and helped them provide better treatment or care. Staff also described making more personalized decisions about the plan of treatment or care delivery after knowing the Veteran better from their story. Our findings suggest the MLMS program has been well sustained over time, and the use of patient stories in healthcare may be a valuable, practical, and sustainable tool to support the delivery of patient-centered care.
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Affiliation(s)
- Tonya J Roberts
- William S. Middleton Memorial Veterans Hospital
- School of Nursing, University of Wisconsin - Madison
| | - Thor Ringler
- William S. Middleton Memorial Veterans Hospital
- School of Medicine & Public Health, University of Wisconsin - Madison
| | - Dean Krahn
- William S. Middleton Memorial Veterans Hospital
- School of Medicine & Public Health, University of Wisconsin - Madison
| | - Eileen Ahearn
- William S. Middleton Memorial Veterans Hospital
- School of Medicine & Public Health, University of Wisconsin - Madison
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Zhu L, Li L, Li XZ, Wang L. Effects of mind-body exercise on PTSD symptoms, depression and anxiety in PTSD patients: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24447. [PMID: 33530251 PMCID: PMC7850731 DOI: 10.1097/md.0000000000024447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The present study aimed to systematically analyze the effects of mind-body exercise on PTSD symptom, depression and anxiety among patients with post-traumatic stress disorder (PTSD) and to provide a scientific evidence-based exercise prescription. Meanwhile, it will also help reduce the global mental health burden of COVID-19. METHODS Both Chinese and English databases (PubMed, Web of Science, the Cochrane Library, EMBASE, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang) were used as sources of data to search for randomized controlled trials (RCTs) published between January 1980 to September 2020 relating to the effects of mind-body exercise on PTSD symptom, depression and anxiety in PTSD patients. CONCLUSION This systematic review and meta-analysis will provide stronger evidence on the effectiveness and safety of mind-body exercise for PTSD symptoms in PTSD patients. SYSTEMATIC REVIEW REGISTRATION INPLASY2020120072.
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Affiliation(s)
- Lin Zhu
- School of Physical Education, Soochow University, Suzhou
| | - Long Li
- School of Physical Education, Soochow University, Suzhou
| | - Xiao-Zhi Li
- Department of Physical Education, Southeast University, Nanjing, Jiangsu
| | - Lin Wang
- Department of Physical Education, Wuhan University of Technology, Wuhan, China
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12
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Boelen PA. Dampening of positive affect is associated with posttraumatic stress following stressful life events. Eur J Psychotraumatol 2021; 12:1851077. [PMID: 33505637 PMCID: PMC7817208 DOI: 10.1080/20008198.2020.1851077] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Treatments for posttraumatic stress (PTS) are effective for many but not all people. There is a continued need to further our understanding of psychological mechanisms involved in the development and maintenance of PTS. Research has examined dysregulation of negative affect (NA) in PTS but relatively little attention has been paid to the role of dysregulation of positive affect (PA) in PTS. Objective: The current study sought to examine the incremental role of PA dysregulation - specifically self-focused and emotion-focused rumination (strategies to upregulate PA) and dampening (a strategy downregulating PA) in explaining variance in PTS, while taking into account neuroticism, plus more often-researched processes of NA regulation (i.e. brooding and reflection) and experiential acceptance and mindfulness - broader regulatory styles involved in PTS. Method: Data were available from 473 students who completed measures about stressful life events experienced, PTS, and measures of PA dysregulation and all other variables of interest. Results: Zero order correlations showed that dampening of PA but not self-focused and emotion-focused regulation of PA were associated with PTS total scores and PTS clusters of re-experiencing, avoidance, and hyperarousal. Multiple regression analyses revealed, among other things, that dampening of PA, neuroticism, brooding, and mindfulness (but not emotion-focused and self-focused rumination about PA, reflection, and experiential acceptance) explained unique proportions of variance in PTS when taking into account the shared variance between these variables. Conclusions: Future research may continue addressing difficulties in regulating PA alongside difficulties regulating NA to improve the understanding of mechanisms maintaining PTS and to examine the usefulness of interventions improving PA regulation in the treatment of PTS.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
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Nagrath J. Investigating the Efficacy of Equine Assisted Therapy for Military Veterans With Posttraumatic Stress Symptomology. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i2.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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14
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Flint DD, Ferrell EL, Engelman J. Clinical research on behavioral activation as treatment for post‐traumatic stress disorder: A brief review and meta‐analysis. BEHAVIORAL INTERVENTIONS 2020. [DOI: 10.1002/bin.1712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Daniel D. Flint
- Department of PsychologyBowling Green State University Bowling Green Ohio USA
| | - Emily L. Ferrell
- Department of PsychologyBowling Green State University Bowling Green Ohio USA
| | - Joel Engelman
- Department of PsychologyBowling Green State University Bowling Green Ohio USA
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Bahji A, Forsyth A, Groll D, Hawken ER. Efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for posttraumatic stress disorder: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2020; 96:109735. [PMID: 31437480 DOI: 10.1016/j.pnpbp.2019.109735] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/27/2019] [Accepted: 08/10/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a common psychiatric condition that can develop following a traumatic experience. PTSD is associated with significant disability, a large economic burden, and despite the range of therapies to treat PTSD, response to antidepressants is limited. A growing body of clinical research suggests the efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in individuals with treatment-refractory PTSD. AIM To assess the effectiveness and safety of MDMA-assisted psychotherapy for reducing symptoms of PTSD, a systematic review and meta-analysis was undertaken. METHODS Six online databases were searched from inception to December 2018. Reference lists of relevant articles were manually searched as well as electronic sources of ongoing trials and conference proceedings. Researchers active in the subject were also contacted. Eligible studies included randomized and quasi-randomized clinical trials using MDMA-assisted psychotherapy for PTSD in comparison with other medications, placebo or no medication (supportive care). We used standard methodological procedures expected by the Cochrane Collaboration. Two authors assessed studies for inclusion and extracted data. Using random-effects meta-analysis with Cochrane's Review Manager 5.3, we obtained standardized mean differences [SMD] and rate ratios [RR] for reduction in PTSD symptomatology. RESULTS A total of 5 trials met inclusion criteria, totaling 106 participants (average age: 35-40 years, 70% female). Studies were rated as moderate in quality. MDMA-assisted psychotherapy demonstrated a high rate of clinical response (RR = 3.47, 95% CI: 1.70, 7.06), remission (RR = 2.63, 95% CI: 1.37, 5.02), with a large effect size at reducing the symptoms of PTSD (SMD = 1.30, 95% CI: 0.66, 1.94). Available evidence indicates that MDMA was well-tolerated, with few serious adverse events reported across studies. CONCLUSIONS MDMA-assisted psychotherapy appears to be a potentially safe, effective, and durable treatment for individuals with chronic, treatment-refractory PTSD. However, future studies involving larger samples and longer durations of treatment and follow-up are warranted-and underway.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Ashleigh Forsyth
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Providence Care Hospital, Kingston, Ontario, Canada
| | - Dianne Groll
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Emily R Hawken
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Providence Care Hospital, Kingston, Ontario, Canada
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Deng W, Hu D, Xu S, Liu X, Zhao J, Chen Q, Liu J, Zhang Z, Jiang W, Ma L, Hong X, Cheng S, Liu B, Li X. The efficacy of virtual reality exposure therapy for PTSD symptoms: A systematic review and meta-analysis. J Affect Disord 2019; 257:698-709. [PMID: 31382122 DOI: 10.1016/j.jad.2019.07.086] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/27/2019] [Accepted: 07/29/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Virtual reality exposure therapy (VRET) for PTSD is an emerging treatment of remarkable promise, but its efficacy and safety are still unclear. Our aim was to investigate the efficacy of VRET for individuals with PTSD, and to identify the potential moderating variables associated with interventions. METHODS Literature search was conducted via PubMed, Embase, Web of Science, Cochrane Library, PsycInfo, Science Direct, and EBSCO. We identified 18 studies on PTSD including 13 randomized controlled trials (RCTs; 654 participants) and 5 single-group trials (60 participants). RESULTS The main effects analysis showed a moderate effect size (g = 0.327, 95% CI: 0.105-0.550, p<0.01) for VRET compared to control conditions on PTSD symptoms. Subgroup analysis revealed that the effects of VRET were larger when compared to inactive groups (g = 0.567) than active control groups (g = 0.017). This finding was in agreement with depressive symptoms. A dose-response relationship existed with more VRET sessions showing larger effects. There was a long-range effect of VRET on PTSD symptoms indicating a sustained decrease in PTSD symptoms at 3-month follow-up (g = 0.697) and 6-month follow-up (g = 0.848). The single-group trials analysis revealed that the VRET intervention had a significant effect on PTSD. LIMITATIONS Many of the combat-related PTSD subjects resulted in uncertainty regarding meta-analytical estimates and subsequent conclusions. CONCLUSIONS These findings demonstrated that VRET could produce significant PTSD symptoms reduction and supported its application in treating PTSD.
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Affiliation(s)
- Wenrui Deng
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, Anhui 230032, China
| | - Die Hu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, Anhui 230032, China
| | - Sheng Xu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, Anhui 230032, China
| | - Xiaoyu Liu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, Anhui 230032, China
| | - Jingwen Zhao
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, Anhui 230032, China
| | - Qian Chen
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, Anhui 230032, China
| | - Jiayuan Liu
- Department of Medical Anesthesia, the First Clinical Medical College of Anhui Medical University, Hefei, Anhui 230032, China
| | - Zheng Zhang
- Department of Medical Anesthesia, the First Clinical Medical College of Anhui Medical University, Hefei, Anhui 230032, China
| | - Wenxiu Jiang
- Department of Stomatology, Stomatology College of Anhui Medical University, Hefei, Anhui 230032, China
| | - Lijun Ma
- Department of Psychology, School of Education, Anqing Normal University, Anqing, Anhui 246133, China
| | - Xinyi Hong
- Department of Clinical Medical, the First Clinical Medical College, Anhui Medical University, Hefei, Anhui 230032, China
| | - Shengrong Cheng
- Department of Clinical Medical, the First Clinical Medical College, Anhui Medical University, Hefei, Anhui 230032, China
| | - Boya Liu
- Department of Clinical Medical, the First Clinical Medical College, Anhui Medical University, Hefei, Anhui 230032, China
| | - Xiaoming Li
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, Anhui 230032, China.
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Wafa MH, Viprey M, Magaud L, Haesebaert J, Leaune E, Poulet E, Bied C, Schott AM. Identification of biopSychoSocial factors predictive of post-traUmatic stress disorder in patients admitted to the Emergency department after a trauma (ISSUE): protocol for a multicenter prospective study. BMC Psychiatry 2019; 19:163. [PMID: 31146712 PMCID: PMC6543570 DOI: 10.1186/s12888-019-2154-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Traumatic exposure is a frequent issue in patients visiting emergency departments (EDs). Some patients will subsequently develop post-traumatic stress disorder (PTSD) while other will not. The problem is under-diagnosed in EDs and no standardized management is provided to prevent PTSD. Most studies focused on a particular group of trauma whereas we need a global approach to further develop interventions for detecting and treating patients at high risk. We aim to assess the prevalence of traumatic exposure and situation at high risk of further PTSD and identify pre and peri-traumatic biopsychosocial factors predisposing individuals to PTSD in the general context of EDs. METHODS This comprehensive multicenter study will have two steps. The first step will be a cross-sectional study on moderate and high risk of PTSD prevalence among EDs visitors with a recent history of trauma. All patients aged 18-70 years, presenting with a recent history of trauma (< 1 month) in one of the six EDs in the Auvergne-Rhône-Alpes region (≈1/10° of the French population) will be included over a 1-month period and approximately 1500 subjects are expected in this cross-sectional step. The risk of PTSD will be assessed using the Impact of Event Scale Revised (IES-R). Self-administered questionnaires will be used to measure acute stress (IES-R), and a number of potential bio-psycho-social risk factors. Demographic and physical health-related data will be collected from medical file. Second step will be a prospective cohort study within a sub-sample of 400 patients enrolled in step 1, randomly selected with stratification on sex, age, ED, and IES-R score. At 3 months, PTSD will be defined by a ≥ 33 score at PTSD Check List for DSM-5 (PCL-5) through a telephone interview. We will evaluate definite PTSD biopsychosocial predictive factors using a multivariate logistic regression model and describe evolution of PTSD at 3 months. DISCUSSION This is the first study to assess PTSD predictors prospectively with a biopsychosocial approach within a cohort representative of EDs visitors. The results will inform the development of dedicated interventions to decrease the risk of subsequent PTSD. TRIAL REGISTRATION ClinicalTrials.gov: NCT03615014 ; ISSUE protocol 2nd version was approved on 07/08/2018.
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Affiliation(s)
| | - Marie Viprey
- 0000 0001 2172 4233grid.25697.3fHESPER EA 7425, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France ,0000 0001 2163 3825grid.413852.9Pôle de santé publique, Hospices Civils de Lyon, Lyon, France
| | - Laurent Magaud
- 0000 0001 2172 4233grid.25697.3fHESPER EA 7425, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France ,0000 0001 2163 3825grid.413852.9Pôle de santé publique, Hospices Civils de Lyon, Lyon, France
| | - Julie Haesebaert
- 0000 0001 2172 4233grid.25697.3fHESPER EA 7425, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France ,0000 0001 2163 3825grid.413852.9Pôle de santé publique, Hospices Civils de Lyon, Lyon, France
| | - Edouard Leaune
- PsyR2 Team, U 1028, INSERM and UMR 5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), CH Le Vinatier, Lyon-1 University, Bron, France ,SHU, CH Le Vinatier, Lyon 1 Université, Bron, France
| | - Emmanuel Poulet
- PsyR2 Team, U 1028, INSERM and UMR 5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), CH Le Vinatier, Lyon-1 University, Bron, France ,0000 0001 2198 4166grid.412180.eDepartment of Psychiatry Emergencies, CHU Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Clemence Bied
- 0000 0001 2198 4166grid.412180.eDepartment of Psychiatry Emergencies, CHU Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Anne-Marie Schott
- 0000 0001 2172 4233grid.25697.3fHESPER EA 7425, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France ,0000 0001 2163 3825grid.413852.9Pôle de santé publique, Hospices Civils de Lyon, Lyon, France
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Paintain E, Cassidy S. First-line therapy for post-traumatic stress disorder: A systematic review of cognitive behavioural therapy and psychodynamic approaches. COUNSELLING & PSYCHOTHERAPY RESEARCH 2018; 18:237-250. [PMID: 30147450 PMCID: PMC6099301 DOI: 10.1002/capr.12174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite evidence supporting cognitive behavioural therapy (CBT)-based interventions as the most effective approach for treating post-traumatic stress disorder (PTSD) in randomised control trials, alternative treatment interventions are often used in clinical practice. Psychodynamic (PDT)-based interventions are one example of such preferred approaches, this is despite comparatively limited available evidence supporting their effectiveness for treating PTSD. AIMS Existing research exploring effective therapeutic interventions for PTSD includes trauma-focused CBT involving exposure techniques. The present review sought to establish the treatment efficacy of CBT and PDT approaches and considers the potential impact of selecting PDT-based techniques over CBT-based techniques for the treatment of PTSD. RESULTS The evidence reviewed provided examples supporting PDT-based therapy as an effective treatment for PTSD, but confirmed CBT as more effective in the treatment of this particular disorder. Comparable dropout rates were reported for both treatment approaches, suggesting that relative dropout rate should not be a pivotal factor in the selection of a PDT approach over CBT for treatment of PTSD. CONCLUSION/IMPLICATIONS The need to routinely observe evidence-based recommendations for effective treatment of PTSD is highlighted and factors undermining practitioner engagement with CBT-based interventions for the treatment of PTSD are identified.
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Veteran Treatments: PTSD Interventions. Healthcare (Basel) 2018; 6:healthcare6030094. [PMID: 30082634 PMCID: PMC6164350 DOI: 10.3390/healthcare6030094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 11/17/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) has resulted in high social costs in terms of the lingering inability of veterans to adapt to societal norms. These costs accrue to individual veterans, their families, friends, and others. In addition, society suffers from the lost productivity of veterans. There is a need to pay greater attention to the extant literature regarding the effectiveness or ineffectiveness of various interventions. This study reviews the most relevant research regarding PTSD, veterans, interventions, treatment, counseling, job training and medication. Increasing awareness of the existing state of knowledge can lead to better targeting of resources and better health outcomes.
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Rumination and Its Relationship with Thought Suppression in Unipolar Depression and Comorbid PTSD. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9935-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pradhan B, Mitrev L, Moaddell R, Wainer IW. d-Serine is a potential biomarker for clinical response in treatment of post-traumatic stress disorder using (R,S)-ketamine infusion and TIMBER psychotherapy: A pilot study. BIOCHIMICA ET BIOPHYSICA ACTA. PROTEINS AND PROTEOMICS 2018; 1866:831-839. [PMID: 29563072 PMCID: PMC9067607 DOI: 10.1016/j.bbapap.2018.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/02/2018] [Accepted: 03/14/2018] [Indexed: 12/17/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a chronic and debilitating condition that is often refractory to standard frontline antidepressant therapy. A promising new approach to PTSD therapy is administration of a single sub-anesthetic dose of (R,S)-ketamine (Ket). The treatment produces rapid and significant therapeutic response, which lasts for only 4-7 days. In one of our studies, the mean duration of response was increased to 33 days when Ket administration was combined with a mindfulness-based cognitive therapy, Trauma Interventions using Mindfulness Based Extinction and Reconsolidation (TIMBER). We now report the results from a 20-patient study, which examined the duration of sustained response with combined TIMBER-Ket therapy, TIMBER-K arm, relative to the response observed in a placebo-controlled arm, TIMBER-P. A significant difference in the duration of response was observed between TIMBER-K and TIMBER-P arms: 34.44 ± 19.12 days and 16.50 ± 11.39 days, respectively (p = 0.022). Previous studies identified a negative correlation between antidepressant response to Ket and basal plasma concentrations of d-serine (DSR). In this study, the basal DSR levels positively correlated with the pre-treatment severity of PTSD symptoms (Pearson's r = 0.42, p = 0.07) and patients with basal DSR level ≥ 3.5 μM displayed not only higher PTSD severity but also shorter duration of response. The data indicate that basal DSR levels may serve as a biomarker of the severity of PTSD symptoms and as a predictor of clinical response. This article is part of a Special Issue entitled: d-Amino acids: biology in the mirror, edited by Dr. Loredano Pollegioni, Dr. Jean-Pierre Mothet and Dr. Molla Gianluca.
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Affiliation(s)
- Basant Pradhan
- Department of Psychiatry, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Ludmil Mitrev
- Department of Psychiatry, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Ruin Moaddell
- Bio-analytical Chemistry and Drug Discovery Section of the National Institute on Aging (NIA), National Institute of Health (NIH), Bethesda, MD, USA
| | - Irving W Wainer
- Department of Anesthesiology, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA.
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22
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Weiss TC, Dickstein BD, Hansel JE, Schumm JA, Chard KM. Aikido as an Augment to Residential Posttraumatic Stress Disorder Treatment. MILITARY PSYCHOLOGY 2018. [DOI: 10.1037/mil0000194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Jeremiah A. Schumm
- Cincinnati Veterans Administration Medical Center, and Wright State University
| | - Kathleen M. Chard
- Cincinnati Veterans Administration Medical Center, and University of Cincinnati
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23
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Boelen PA, Lenferink LIM. Experiential acceptance and trait-mindfulness as predictors of analogue post-traumatic stress. Psychol Psychother 2018; 91:1-14. [PMID: 28707425 DOI: 10.1111/papt.12138] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 06/06/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Experiential acceptance and trait-mindfulness are associated with post-traumatic stress disorder (PTSD) after traumatic events. This study was a preliminary attempt to examine (1) associations of experiential acceptance and trait-mindfulness with post-traumatic stress (PTS) associated with negative, but not necessarily traumatizing, life events ('analogue' PTS), (2) the role of these variables in the context of neuroticism as well as worry and rumination - two other regulatory strategies associated with PTS, and (3) the impact of pre-trauma tendencies towards experiential acceptance and mindfulness on analogue PTS. DESIGN Data were obtained from two distinct student samples. A first sample provided cross-sectional data. In a second sample, indices of acceptance, mindfulness, neuroticism, worry, and rumination were tapped at inclusion into the study, and analogue PTS and confrontation with stressful life events were subsequently assessed 1 year later. RESULTS In the cross-sectional sample, higher acceptance and mindfulness were associated with lower analogue PTS, even when controlling for neuroticism, worry, and rumination. In the prospective sample, pre-trauma mindfulness (but not experiential acceptance, neuroticism, worry, and rumination) assessed at baseline predicted levels of analogue PTS 1 year later. CONCLUSIONS Findings suggest that experiential acceptance and trait-mindfulness are incrementally related to PTS beyond neuroticism, worry, and rumination and that pre-trauma trait-mindfulness may be a resilience factor protecting against severe PTS. PRACTITIONER POINTS We examined associations of experiential acceptance and trait-mindfulness with post-traumatic stress (PTS) associated with negative life events ('analogue' PTS). Experiential acceptance and trait-mindfulness were associated with concurrent analogue PTS, over and above neuroticism, worry, and rumination. Pre-trauma trait-mindfulness (but not pre-trauma experiential acceptance) significantly predicted analogue PTS in prospective analyses. Enhancing mindfulness skills could be a useful tool to reduce the risk of PTS in trauma-exposed samples.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Lonneke I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, The Netherlands
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O'Haire ME, Rodriguez KE. Preliminary efficacy of service dogs as a complementary treatment for posttraumatic stress disorder in military members and veterans. J Consult Clin Psychol 2018; 86:179-188. [PMID: 29369663 PMCID: PMC5788288 DOI: 10.1037/ccp0000267] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Psychiatric service dogs are an emerging complementary treatment for military members and veterans with posttraumatic stress disorder (PTSD). Yet despite anecdotal accounts of their value, there is a lack of empirical research on their efficacy. The current proof-of-concept study assessed the effects of this practice. METHOD A nonrandomized efficacy trial was conducted with 141 post-9/11 military members and veterans with PTSD to compare usual care alone (n = 66) with usual care plus a trained service dog (n = 75). The primary outcome was longitudinal change on The PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993), including data points from a cross-sectional assessment and a longitudinal record review. Secondary outcomes included cross-sectional differences in depression, quality of life, and social and work functioning. RESULTS Mixed-model analyses revealed clinically significant reductions in PTSD symptoms from baseline following the receipt of a service dog, but not while receiving usual care alone. Though clinically meaningful, average reductions were not below the diagnostic cutoff on the PCL. Regression analyses revealed significant differences with medium to large effect sizes among those with service dogs compared with those on the waitlist, including lower depression, higher quality of life, and higher social functioning. There were no differences in employment status, but there was lower absenteeism because of health among those who were employed. CONCLUSION The addition of trained service dogs to usual care may confer clinically meaningful improvements in PTSD symptomology for military members and veterans with PTSD, though it does not appear to be associated with a loss of diagnosis. (PsycINFO Database Record
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Affiliation(s)
- Marguerite E O'Haire
- Center for the Human-Animal Bond, Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University
| | - Kerri E Rodriguez
- Center for the Human-Animal Bond, Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University
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Kim JE, Dager SR, Jeong HS, Ma J, Park S, Kim J, Choi Y, Lee SL, Kang I, Ha E, Cho HB, Lee S, Kim EJ, Yoon S, Lyoo IK. Firefighters, posttraumatic stress disorder, and barriers to treatment: Results from a nationwide total population survey. PLoS One 2018; 13:e0190630. [PMID: 29304155 PMCID: PMC5755833 DOI: 10.1371/journal.pone.0190630] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022] Open
Abstract
Repeated exposure to traumatic experiences may put professional firefighters at increased risk of developing posttraumatic stress disorder (PTSD). To date, however, the rate of PTSD symptoms, unmet need for mental health treatment, and barriers to treatment have only been investigated in subsamples rather than the total population of firefighters. We conducted a nationwide, total population-based survey of all currently employed South Korean firefighters (n = 39,562). The overall response rate was 93.8% (n = 37,093), with 68.0% (n = 26,887) complete responses for all variables. The rate of current probable PTSD was estimated as 5.4%. Among those with current probable PTSD (n = 1,995), only a small proportion (9.7%) had received mental health treatment during the past month. For those who had not received treatment, perceived barriers of accessibility to treatment (29.3%) and concerns about potential stigma (33.8%) were reasons for not receiving treatment. Although those with higher PTSD symptom severity and functional impairment were more likely to seek treatment, greater symptom severity and functional impairment were most strongly associated with increased concerns about potential stigma. This nationwide study points to the need for new approaches to promote access to mental health treatment in professional firefighters.
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Affiliation(s)
- Jieun E. Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Stephen R. Dager
- Department of Radiology, University of Washington, Seattle, Washington, United States of America
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Hyeonseok S. Jeong
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jiyoung Ma
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Shinwon Park
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Jungyoon Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Yera Choi
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Suji L. Lee
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Ilhyang Kang
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Eunji Ha
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Han Byul Cho
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, United States of America
| | - Sunho Lee
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Eui-Jung Kim
- Department of Psychiatry, Ewha Womans University, Seoul, South Korea
| | - Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
- * E-mail:
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ICU-related PTSD – A review of PTSD and the potential effects of collaborative songwriting therapy. J Crit Care 2017; 42:78-84. [DOI: 10.1016/j.jcrc.2017.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/06/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
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Ghasemi M, Abrari K, Goudarzi I, Rashidy-Pour A. Effect of WIN55-212-2 and Consequences of Extinction Training on Conditioned Fear Memory in PTSD Male Rats. Basic Clin Neurosci 2017; 8:493-502. [PMID: 29942432 PMCID: PMC6010652 DOI: 10.29252/nirp.bcn.8.6.493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction This study investigates the effects of cannabinoid agonist WIN55-212-2 on acquisition and consolidation phases of the fear memory extinction and also on anxiety and motor activity. Methods In this study, we used SPS & S model to induce post-traumatic stress disorder. One week after SPS, to establish a conditioned fear memory, rats received an electric foot shock within shock chamber. After 24 h, for extinction training, the rats were placed back to the chamber for 9 min, without receiving any shock. In 3 consecutive days and on days 17, 24 and 37, extinction tests were carried out and the freezing behavior was evaluated. Thirty minutes before the first three extinction tests, animals received IP injections of WIN or vehicle. Anxiety-like behavior examined with elevated plus-maze and motor activity with open field, 32 days after conditioning. Results Exaggerated and continued conditioned fear memory observed in SPS & S group compared with shock group. IP injection of a 0.25 mg/kg dose of WIN before extinction training led to reducing fear responses in animals. Conclusion IP injection of WIN increased acquisition or consolidation of fear memory extinction. SPS & S caused anxiety and this effect improved by the agonist (0.25 mg/kg).
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Affiliation(s)
- Malihe Ghasemi
- Department of Physiology, School of Biology, Damghan University, Damghan, Iran
| | - Kataneh Abrari
- Department of Physiology, School of Biology, Damghan University, Damghan, Iran
| | - Iran Goudarzi
- Department of Physiology, School of Biology, Damghan University, Damghan, Iran
| | - Ali Rashidy-Pour
- Physiology Research Center, Semnan University of Medical Sciences, Semnan, Iran
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High ambient temperature facilitates the acquisition of 3,4-methylenedioxymethamphetamine (MDMA) self-administration. Pharmacol Biochem Behav 2017; 163:38-49. [PMID: 29054819 DOI: 10.1016/j.pbb.2017.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/19/2017] [Accepted: 10/16/2017] [Indexed: 11/23/2022]
Abstract
RATIONALE MDMA alters body temperature in rats with a direction that depends on the ambient temperature (TA). The thermoregulatory effects of MDMA and TA may affect intravenous self-administration (IVSA) of MDMA but limited prior reports conflict. OBJECTIVE To determine how body temperature responses under high and low TA influence MDMA IVSA. METHODS Male Sprague-Dawley rats were trained to IVSA MDMA (1.0mg/kg/infusion; 2-h sessions; FR5 schedule of reinforcement) under TA 20°C or 30°C. Radiotelemetry transmitters recorded body temperature and activity during IVSA. RESULTS MDMA intake increased under both TA during acquisition, but to a greater extent in the 30°C group. The magnitude of hypothermia was initially equivalent between groups but diminished over training in the 30°C group. Within-session activity was initially lower in the 30°C group, but by the end of acquisition and maintenance, activity was similar for both groups. When TA conditions were swapped, the hot-trained group increased MDMA IVSA under 20°C TA and a modest decrease in drug intake was observed in the cold-trained group under 30°C TA. Subsequent non-contingent MDMA (1.0-5.0mg/kg, i.v.) found that rats with higher MDMA IVSA rates showed blunted hypothermia compared with rats with lower IVSA levels; however, within-session activity did not differ by group. High TA increased intracranial self-stimulation thresholds in a different group of rats and MDMA reduced thresholds below baseline at low, but not high, TA. CONCLUSIONS High TA appears to enhance acquisition of MDMA IVSA through an aversive effect and not via thermoregulatory motivation.
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Haubrich J, Machado A, Boos FZ, Crestani AP, Sierra RO, Alvares LDO, Quillfeldt JA. Enhancement of extinction memory by pharmacological and behavioral interventions targeted to its reactivation. Sci Rep 2017; 7:10960. [PMID: 28887561 PMCID: PMC5591313 DOI: 10.1038/s41598-017-11261-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/22/2017] [Indexed: 12/22/2022] Open
Abstract
Extinction is a process that involves new learning that inhibits the expression of previously acquired memories. Although temporarily effective, extinction does not erase an original fear association. Since the extinction trace tends to fade over time, the original memory can resurge. On the other hand, strengthening effects have been described in several reconsolidation studies using different behavioral and pharmacological manipulations. In order to know whether an extinction memory can be strengthened by reactivation-based interventions in the contextual fear conditioning task, we began by replicating the classic phenomenon of spontaneous recovery to show that brief reexposure sessions can prevent the decay of the extinction trace over time in a long-lasting way. This fear attenuation was shown to depend both on L-type calcium channels and protein synthesis, which suggests a reconsolidation process behind the reactivation-induced strengthening effect. The extinction trace was also susceptible to enhancement by a post-reactivation infusion of a memory-enhancing drug (NaB), which was also able to prevent rapid fear reacquisition (savings). These findings point to new reactivation-based approaches able to strengthen an extinction memory to promote its persistence. The constructive interactions between extinction and reconsolidation may represent a promising novel approach in the realm of fear-related disorder treatments.
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Affiliation(s)
- Josué Haubrich
- Psychobiology and Neurocomputation lab and Neurobiology of Memory lab. Neurosciences Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Adriano Machado
- Psychobiology and Neurocomputation lab and Neurobiology of Memory lab. Neurosciences Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávia Zacouteguy Boos
- Psychobiology and Neurocomputation lab and Neurobiology of Memory lab. Neurosciences Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana P Crestani
- Psychobiology and Neurocomputation lab and Neurobiology of Memory lab. Neurosciences Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodrigo O Sierra
- Psychobiology and Neurocomputation lab and Neurobiology of Memory lab. Neurosciences Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas de Oliveira Alvares
- Psychobiology and Neurocomputation lab and Neurobiology of Memory lab. Neurosciences Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jorge A Quillfeldt
- Psychobiology and Neurocomputation lab and Neurobiology of Memory lab. Neurosciences Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Saur L, Neves LT, Greggio S, Venturin GT, Jeckel CMM, Costa Da Costa J, Bertoldi K, Schallenberger B, Siqueira IR, Mestriner RG, Xavier LL. Ketamine promotes increased freezing behavior in rats with experimental PTSD without changing brain glucose metabolism or BDNF. Neurosci Lett 2017; 658:6-11. [PMID: 28823895 DOI: 10.1016/j.neulet.2017.08.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 12/16/2022]
Abstract
Acute treatment with ketamine, an NMDA receptor antagonist, has been reported to be efficacious in treating depression. The goal of our study was to evaluate ketamine treatment in an animal model of another important psychiatric disease, post-traumatic stress disorder (PTSD). Fifty-eight male rats were initially divided into four groups: Control+Saline (CTRL+SAL), Control+Ketamine (CTRL+KET), PTSD+Saline (PTSD+SAL) and PTSD+Ketamine (PTSD+KET). To mimic PTSD we employed the inescapable footshock protocol. The PTSD animals were classified according to freezing behavior duration into "extreme behavioral response" (EBR) or "minimal behavioral response" (MBR). Afterwards, the glucose metabolism and BDNF were evaluated in the hippocampus, frontal cortex, and amygdala. Our results show that animals classified as EBR exhibited increased freezing behavior and that ketamine treatment further increased freezing duration. Glucose metabolism and BDNF levels showed no significant differences. These results suggest ketamine might aggravate PTSD symptoms and that this effect is unrelated to alterations in glucose metabolism or BDNF protein levels.
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Affiliation(s)
- Lisiani Saur
- Laboratório de Biologia Celular e Tecidual, FaBio, PUCRS, Porto Alegre, RS, Brazil.
| | - Laura Tartari Neves
- Laboratório de Biologia Celular e Tecidual, FaBio, PUCRS, Porto Alegre, RS, Brazil
| | - Samuel Greggio
- Instituto do Cérebro do Rio Grande do Sul- PUCRS, Porto Alegre, RS, Brazil
| | | | | | | | - Karine Bertoldi
- Departamento de Farmacologia, ICBS, UFRGS, Porto Alegre, RS, Brazil
| | | | | | | | - Léder Leal Xavier
- Laboratório de Biologia Celular e Tecidual, FaBio, PUCRS, Porto Alegre, RS, Brazil
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Madsen C, Vaughan M, Koehlmoos TP. Use of Integrative Medicine in the United States Military Health System. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2017; 2017:9529257. [PMID: 28690665 PMCID: PMC5485330 DOI: 10.1155/2017/9529257] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/05/2017] [Accepted: 05/10/2017] [Indexed: 12/20/2022]
Abstract
Integrative medicine (IM) is a model of care which uses both conventional and nonconventional therapies in a "whole person" approach to achieve optimum mental, physical, emotional, spiritual, and environmental health, and is increasingly popular among patients and providers seeking to relieve chronic or multifactorial conditions. The US Department of Defense (DoD) shows particular interest in and usage of IM for managing chronic conditions including the signature "polytrauma triad" of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD) among its beneficiaries in the Military Health System (MHS). These modalities range from conventional nondrug, nonsurgical options such as cognitive-behavioral therapy to nonconventional options such as acupuncture, chiropractic, and mind-body techniques. These are of particular interest for their potential to relieve symptoms without relying on opiates, which impair performance and show high potential for abuse while often failing to provide full relief. This review describes the use of IM in the MHS, including definitions of the model, common therapies and potential for use, and controversy surrounding the practice. More research is needed to build a comprehensive usage analysis, which in turn will inform sound clinical and financial practice for the MHS and its beneficiaries.
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Affiliation(s)
- Cathaleen Madsen
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Megan Vaughan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Defense and Veterans Center for Integrative Pain Management, Rockville, MD, USA
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Shnaider P, Sijercic I, Wanklyn SG, Suvak MK, Monson CM. The Role of Social Support in Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder. Behav Ther 2017; 48:285-294. [PMID: 28390493 DOI: 10.1016/j.beth.2016.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 05/04/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
The current study examined the effect of total, as well as different sources (i.e., family, friends, significant other) of, pretreatment/baseline social support on posttraumatic stress disorder (PTSD) severity and treatment response to cognitive-behavioral conjoint therapy (CBCT) for PTSD. Thirty-six patients were randomized to receive treatment immediately or to a waitlist condition. Those in the treatment condition were offered CBCT for PTSD, a couple-based therapy aimed at reducing PTSD symptoms and improving relationship functioning. PTSD symptoms were assessed at pre-/baseline, mid-/4 weeks of waiting, and posttreatment/12 weeks of waiting using the Clinician-Administered PTSD Scale, and patients self-reported on their levels of pretreatment/baseline social support using the Multidimensional Scale of Perceived Social Support. Total support, as well as social support from family and friends, was not associated with initial PTSD severity or treatment response. However, there was a significant positive association between social support from a significant other and initial PTSD severity (g = .92). Additionally, significant other social support moderated treatment outcomes, such that higher initial significant other support was associated with larger decreases in PTSD severity for those in the treatment condition (g = -1.14) but not the waitlist condition (g = -.04). Social support from a significant other may influence PTSD treatment outcomes within couple therapy for PTSD. The inclusion of intimate partners and other family members may be a fruitful avenue for improving PTSD treatment outcomes; however, future studies are needed to examine whether support can be increased with treatment and whether those improvements lead to greater PTSD symptom response.
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Glintborg C, Hansen TGB. How Are Service Dogs for Adults with Post Traumatic Stress Disorder Integrated with Rehabilitation in Denmark? A Case Study. Animals (Basel) 2017; 7:ani7050033. [PMID: 28441333 PMCID: PMC5447915 DOI: 10.3390/ani7050033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The use of service dogs for adults with mental illnesses has become generally accepted. With reference to a single case study of a client with Post Traumatic Stress (PTSD), this study illustrates some of the potential advantages, but also note an important concern that appears to have gone unnoticed. The provision of service animals/therapy animals for adults with mental illnesses must be sufficiently informed by relevant knowledge and integrated with concurrent rehabilitation efforts. When it is not, it may contradict existing evidence-based treatments or unintentionally worsen conditions such as anxiety. This study argues that integration is possible and greater coordination efforts should be made. Abstract A severe mental illness like Post Traumatic Stress Disorder (PTSD) is known to have psychosocial consequences that can lead to a decreased quality of life. Research in Animal-Assisted Therapy (AAT) has revealed that the presence of a dog can have a positive effect on health, e.g., increase quality of life and lessen depression and anxiety. However, canine companionship is not a catch-all solution. Previous research has revealed methodological limitations that prohibit any clear conclusions, as well as a sparsity of critical reflection in anecdotal reports and case studies, which means that more research is needed to contextualize the findings. There has been an increasing interest in animal-assisted intervention in Denmark in recent years. Previously, authorities could only grant service dogs to adults with physical disabilities, but now this has been extended to adults with mental illnesses. Therefore, it has become important to explore how these service dogs are incorporated into rehabilitation practices in mental health, and how rehabilitation professionals react to the use of service dogs. This paper is a case study of a person who suffers from PTSD. This study examines how the person describes the significance of having a dog during her rehabilitation process, and how this is integrated with existing rehabilitation. The case study has been developed based on a semi-structured interview. A Thematic Content analysis was used to reveal dominant patterns and categories. This study revealed a lack of communication and collaboration between public administration (social service), service dog providers, health rehabilitation services, and providers of psychological treatment. It also revealed limited access for the dog to public services, limited success in incorporating the dog into goal-directed treatment and rehabilitation procedures, a strongly felt emotional support from the dog, and a perceived stigma by having the dog wearing a vest with he words “mentally ill” printed on it.
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Affiliation(s)
- Chalotte Glintborg
- Department of Communication and Psychology, Center for Developmental & Applied Psychological Science (CeDAPS), Aalborg University, Kroghstræde 3, Aalborg 9220, Denmark.
| | - Tia G B Hansen
- Department of Communication and Psychology, Center for Developmental & Applied Psychological Science (CeDAPS), Aalborg University, Kroghstræde 3, Aalborg 9220, Denmark.
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Loranger C, Bouchard S. Validating a Virtual Environment for Sexual Assault Victims. J Trauma Stress 2017; 30:157-165. [PMID: 28422323 DOI: 10.1002/jts.22170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 11/16/2016] [Accepted: 01/02/2017] [Indexed: 11/12/2022]
Abstract
Virtual reality has shown promising results in the treatment of posttraumatic stress disorder (PTSD) for some traumatic experiences, but sexual assault has been understudied. One important question to address is the relevance and safety of a virtual environment (VE) allowing patients to be progressively exposed to a sexual assault scenario. The aim of this study was to validate such a VE. Thirty women (victims and nonvictims of sexual assault) were randomly assigned in a counter-balanced order to 2 immersions in a virtual bar: a control scenario where the encounter with the aggressor does not lead to sexual assault and an experimental scenario where the participant is assaulted. Immersions were conducted in a fully immersive 6-wall system. Questionnaires were administered and psychophysiological measures were recorded. No adverse events were reported during or after the immersions. Repeated-measures analyses of covariance revealed a significant time effect and significantly more anxiety (Cohen's f = 0.41, large effect size) and negative affect (Cohen's f = 0.35, medium effect size) in the experimental scenario than in the control condition. Given the safety of the scenario and its potential to induce emotions, it can be further tested to document its usefulness with sexual assault victims who suffer from PTSD.
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Affiliation(s)
- Claudie Loranger
- Centre Intégré de Santé, et de Services Sociaux de l'Outaouais, Gatineau, Canada.,Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Canada
| | - Stéphane Bouchard
- Centre Intégré de Santé, et de Services Sociaux de l'Outaouais, Gatineau, Canada.,Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Canada
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Simon PYR, Rousseau PF. Treatment of Post-Traumatic Stress Disorders with the Alpha-1 Adrenergic Antagonist Prazosin. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:186-198. [PMID: 27432823 PMCID: PMC5317016 DOI: 10.1177/0706743716659275] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The present review aims to assess the clinical efficacy and safety of the α-1-adrenergic antagonist prazosin as primary pharmacologic treatment for post-traumatic stress disorder (PTSD). METHOD A systematic review was performed using keywords (i.e., prazosin, α-1-adrenergic antagonist, α-1-blocker, post-traumatic stress disorder) in the databases PubMed/Medline (1966-May 2016), Embase (1966-May 2016), ScienceDirect (1823-May 2016), OvidSP (1946-May 2016) and Nature (1845-May 2016). To be considered for inclusion, studies had to test the efficacy of prazosin either alone or added to ongoing treatment in adults with PTSD, use validated tools to assess and monitor the disorders, allow comparisons on the basis of univariate analyses (i.e., p-values of t-tests and effect sizes) and list the identified adverse reactions. RESULTS 12 studies were included: 5 randomized controlled trials, 4 open-label prospective trials and 3 retrospective file reviews. The evaluation concerned 276 patients exposed to civilian trauma (19%) or war trauma (81%). Prazosin significantly decreases trauma nightmares, avoidance, hypervigilance and improves patient status in all studies. No significant difference of blood pressure was observed at the end of trials. CONCLUSIONS Beyond the methodological and clinical biases of these studies, the present review not only confirms the effectiveness and good tolerability of prazosin, but also suggests its possible use as primary pharmacologic treatment for PTSD. Uncertainties remain, however, regarding the prescription modalities and dosages.
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Affiliation(s)
- Philippe Yves Rémy Simon
- Recherche clinique, Hôpital d’Instruction des Armées Sainte-Anne, Toulon, France
- Philippe Yves Rémy Simon, PhD, HIA Sainte-Anne, Recherche clinique, BP 20545, 83041 Toulon cedex 9, France. Courriel:
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Pradhan B, Wainer I, Moaddel R, Torjman M, Goldberg M, Sabia M, Parikh T, Pumariega A. Trauma Interventions using Mindfulness Based Extinction and Reconsolidation (TIMBER) psychotherapy prolong the therapeutic effects of single ketamine infusion on post-traumatic stress disorder and comorbid depression: a pilot randomized, placebo-controlled, crossover clinical trial. ACTA ACUST UNITED AC 2017. [DOI: 10.4103/2542-3932.211589] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shimshoni JA, Winkler I, Golan E, Nutt D. Neurochemical binding profiles of novel indole and benzofuran MDMA analogues. Naunyn Schmiedebergs Arch Pharmacol 2016; 390:15-24. [PMID: 27650729 DOI: 10.1007/s00210-016-1297-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 09/02/2016] [Indexed: 12/11/2022]
Abstract
3,4-Methylenedioxy-N-methylamphetamine (MDMA) has been shown to be effective in the treatment of post-traumatic stress disorder (PTSD) in numerous clinical trials. In the present study, we have characterized the neurochemical binding profiles of three MDMA-benzofuran analogues (1-(benzofuran-5-yl)-propan-2-amine, 5-APB; 1-(benzofuran-6-yl)-N-methylpropan-2-amine, 6-MAPB; 1-(benzofuran-5-yl)-N-methylpropan-2-amine, 5-MAPB) and one MDMA-indole analogue (1-(1H-indol-5-yl)-2-methylamino-propan-1-ol, 5-IT). These compounds were screened as potential second-generation anti-PTSD drugs, against a battery of human and non-human receptors, transporters, and enzymes, and their potencies as 5-HT2 receptor agonist and monoamine uptake inhibitors determined. All MDMA analogues displayed high binding affinities for 5-HT2a,b,c and NEα2 receptors, as well as significant 5-HT, DA, and NE uptake inhibition. 5-APB revealed significant agonist activity at the 5-HT2a,b,c receptors, while 6-MAPB, 5-MAPB, and 5-IT exhibited significant agonist activity at the 5-HT2c receptor. There was a lack of correlation between the results of functional uptake and the monoamine transporter binding assay. MDMA analogues emerged as potent and selective monoamine oxidase A inhibitors. Based on 6-MAPB favorable pharmacological profile, it was further subjected to IC50 determination for monoamine transporters. Overall, all MDMA analogues displayed higher monoamine receptor/transporter binding affinities and agonist activity at the 5-HT2a,c receptors as compared to MDMA.
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Affiliation(s)
- Jakob A Shimshoni
- Department of Toxicology, Kimron Veterinary Institute, Bet Dagan, Israel.
| | | | | | - David Nutt
- Neuropsychopharmacology Unit, Imperial College London, London, UK
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Teo WP, Muthalib M, Yamin S, Hendy AM, Bramstedt K, Kotsopoulos E, Perrey S, Ayaz H. Does a Combination of Virtual Reality, Neuromodulation and Neuroimaging Provide a Comprehensive Platform for Neurorehabilitation? - A Narrative Review of the Literature. Front Hum Neurosci 2016; 10:284. [PMID: 27445739 PMCID: PMC4919322 DOI: 10.3389/fnhum.2016.00284] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/25/2016] [Indexed: 01/29/2023] Open
Abstract
In the last decade, virtual reality (VR) training has been used extensively in video games and military training to provide a sense of realism and environmental interaction to its users. More recently, VR training has been explored as a possible adjunct therapy for people with motor and mental health dysfunctions. The concept underlying VR therapy as a treatment for motor and cognitive dysfunction is to improve neuroplasticity of the brain by engaging users in multisensory training. In this review, we discuss the theoretical framework underlying the use of VR as a therapeutic intervention for neurorehabilitation and provide evidence for its use in treating motor and mental disorders such as cerebral palsy, Parkinson’s disease, stroke, schizophrenia, anxiety disorders, and other related clinical areas. While this review provides some insights into the efficacy of VR in clinical rehabilitation and its complimentary use with neuroimaging (e.g., fNIRS and EEG) and neuromodulation (e.g., tDCS and rTMS), more research is needed to understand how different clinical conditions are affected by VR therapies (e.g., stimulus presentation, interactivity, control and types of VR). Future studies should consider large, longitudinal randomized controlled trials to determine the true potential of VR therapies in various clinical populations.
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Affiliation(s)
- Wei-Peng Teo
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood VIC, Australia
| | - Makii Muthalib
- EuroMov, University of MontpellierMontpellier, France; Cognitive Neuroscience Unit, Deakin University, BurwoodVIC, Australia
| | - Sami Yamin
- Liminal Pty Ltd., MelbourneVIC, Australia; Adult Mental Health, Monash Health, DandenongVIC, Australia
| | - Ashlee M Hendy
- School of Exercise and Nutrition Sciences, Deakin University, Burwood VIC, Australia
| | | | - Eleftheria Kotsopoulos
- Liminal Pty Ltd., MelbourneVIC, Australia; Aged Persons Mental Health Service, Monash Health, CheltenhamVIC, Australia
| | | | - Hasan Ayaz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, PhiladelphiaPA, USA; Department of Family and Community Health, University of Pennsylvania, PhiladelphiaPA, USA; The Division of General Pediatrics, Children's Hospital of Philadelphia, PhiladelphiaPA, USA
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Mental Health Effects of Premigration Trauma and Postmigration Discrimination on Refugee Youth in Canada. J Nerv Ment Dis 2016; 204:464-70. [PMID: 27101023 DOI: 10.1097/nmd.0000000000000516] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This report examines the role of pre- and post-migration trauma in explaining differences in refugee and immigrant mental health. Data were derived from mother-youth refugee and immigrant dyads from six countries of origin who were living in Canada at the time of the study. Youth reports of emotional problems (EP) and aggressive behavior (AB) were the mental health outcomes. EP and AB were regressed on predictor blocks: a) status (refugee versus immigrant), visible minority, and gender; b) premigration trauma and postmigration discrimination; c) parent and youth human and social capital; d) poverty, neighborhood, and schools. Refugees suffered higher levels of EP and AB, premigration traumas, and discrimination. Postmigration perception of discrimination predicted both EP and AB and explained immigrant versus refugee differences in EP. Antirefugee discrimination net of discrimination based on immigrant or visible minority status has deleterious mental health consequences.
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Lee JP, Kirkpatrick S, Rojas-Cheatham A, Sin T, Moore RS, Tan S, Godoy S, Ercia A. Improving the Health of Cambodian Americans: Grassroots Approaches and Root Causes. Prog Community Health Partnersh 2016; 10:113-21. [PMID: 27018360 DOI: 10.1353/cpr.2016.0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cambodian Americans experience great disparities in health compared to other Americans, yet may be underserved by conventional healthcare systems. Community-based participatory research (CBPR) is a means to engage underserved communities in health research and programming. We describe results of our efforts to engage the Cambodian grassroots members as well as formal leaders in Oakland, California. OBJECTIVES In addition to a community advisory group, we convened a Community Work Group (CWG), composed of 10 grassroots community women of varying ages and backgrounds. The project aimed to leverage the lived experiences of these women and their understandings of health and wellness in identifying specific health issues and developing culturally resonant strategies. METHODS The CWG met weekly with staff facilitators using methods for collective analysis including theater, body mapping, and other expressive arts. RESULTS The approach proved logistically challenging, but resulted in novel analyses and strategies. The group identified trauma, along with poor access to education, unemployment and underemployment, social isolation, and generation gap, together with community violence, as root causes of key behavioral health issues, namely, alcohol abuse, gambling, prescription drug misuse, and domestic violence. Strategies proposed and implemented by the group and project staff were a community garden, Cambodian New Year's celebrations, and a museum exhibit on the Cambodian refugee experiences. CONCLUSIONS Grassroots community engagement can support projects in identifying social determinants of health and developing the capacities of community members to conduct research and actions to improve health.
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Pradhan B, Kluewer D'Amico J, Makani R, Parikh T. Nonconventional interventions for chronic post-traumatic stress disorder: Ketamine, repetitive trans-cranial magnetic stimulation (rTMS), and alternative approaches. J Trauma Dissociation 2016; 17:35-54. [PMID: 26162001 DOI: 10.1080/15299732.2015.1046101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
It is alarming that only 59% of those who have post-traumatic stress disorder (PTSD) respond to selective serotonin reuptake inhibitors. Many existing treatments, both pharmacological and nonpharmacological, do not directly target trauma memories that lay at the core of the PTSD pathogenesis. Notable exceptions are medications like ketamine and propranolol and trauma-focused psychotherapies like eye-movement desensitization and reprocessing therapy (developed by Shapiro) and Trauma Interventions using Mindfulness Based Extinction and Reconsolidation (TIMBER) for trauma memories (developed by Pradhan). Although the antidepressant effects of ketamine are no longer news, ketamine's effects on treatment refractory PTSD (TR-PTSD) is a recent concept. As TR-PTSD has a marked public health burden and significant limitations in terms of treatment interventions, a thorough assessment of current strategies is required. Research to bring clarity to the underlying pathophysiology and neurobiology of TR-PTSD delineating the chemical, structural, and circuitry abnormalities will take time. In the interim, in the absence of a 1-size-fits-all therapeutic approach, pragmatically parallel lines of research can be pursued using the pharmacological and nonpharmacological treatments that have a strong theoretical rationale for efficacy. This article aims to review the current literature on interventions for PTSD, most notably ketamine, trans-cranial magnetic stimulation treatment, yoga and mindfulness interventions, and TIMBER. We present an outline for their future use, alone as well as in combination, with a hope of providing additional insights as well as advocating for developing more effective therapeutic intervention for this treatment-resistant and debilitating condition.
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Affiliation(s)
- Basant Pradhan
- a Department of Psychiatry , Cooper University Hospital and Cooper Medical School of Rowan University , Camden , New Jersey , USA
| | | | - Ramkrishna Makani
- a Department of Psychiatry , Cooper University Hospital and Cooper Medical School of Rowan University , Camden , New Jersey , USA
| | - Tapan Parikh
- a Department of Psychiatry , Cooper University Hospital and Cooper Medical School of Rowan University , Camden , New Jersey , USA
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Abstract
A systematic review and meta-analysis of the efficacy of hypnotherapy in the treatment of PTSD used literature searches to obtain 47 articles. However, only 6 were experiments testing the efficacy of hypnosis-based treatments. A fixed-effects meta-analysis was applied to postintervention assessment results and 4-week follow-ups. A large effect in favor of hypnosis-based (especially manualized abreactive hypnosis) treatment was found for the studies that reported the posttest results (d = 1.17). The temporal stability of the effect remains strong, as reflected by the 4-week follow-up assessments (d = 1.58) and also by long-term evaluations (e.g., 12 months). Hypnosis appears to be effective in alleviating PTSD symptoms.
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Affiliation(s)
| | - Andrei Rusu
- b Alexandru Ioan-Cuza University of Iași and West University of Timișoara , Romania
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Shorter D, Hsieh J, Kosten TR. Pharmacologic management of comorbid post-traumatic stress disorder and addictions. Am J Addict 2015; 24:705-12. [PMID: 26587796 DOI: 10.1111/ajad.12306] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Post-traumatic Stress Disorder (PTSD) and substance use disorders (SUD) frequently co-occur, and their combination can increase poor health outcomes as well as mortality. METHODS Using PUBMED and the list of references from key publications, this review article covered the epidemiology, neurobiology and pharmacotherapy of PTSD with comorbid alcohol, opiate, and cannabis use disorders. These SUD represent two with and one without FDA approved pharmacotherapies. RESULTS SUD is two to three times more likely among individuals with lifetime PTSD, and suicide, which is made more likely by both of these disorders, appears to be additively increased by having this comorbidity of SUD and PTSD. The shared neurobiological features of these two illnesses include amygdalar hyperactivity with hippocampal, medial prefrontal and anterior cingulate cortex dysfunction. Medications for comorbid PTSD and SUD include the PTSD treatment sertraline, often used in combination with anticonvulsants, antipsychotics, and adrenergic blockers. When PTSD is comorbid with alcohol use disorder (AUD), naltrexone, acamprosate or disulfiram may be combined with PTSD treatments. Disulfiram alone may treat both PTSD and AUD. For PTSD combined with opiate use disorder methadone or buprenorphine are most commonly used with sertraline. Marijuana use has been considered by some to be a treatment for PTSD, but no FDA treatment for this addiction is approved. Pregabalin and D-cycloserine are two innovations in pharmacotherapy for PTSD and SUD. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Comorbid PTSD and SUD amplifies their lethality and treatment complexity. Although they share important neurobiology, these patients uncommonly respond to a single pharmacotherapy such as sertraline or disulfiram and more typically require medication combinations and consideration of the specific type of SUD.
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Affiliation(s)
- Daryl Shorter
- Michael E. DeBakey V.A. Medical Center, Mental Health Care Line, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - John Hsieh
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Thomas R Kosten
- Michael E. DeBakey V.A. Medical Center, Mental Health Care Line, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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Dennis TS, Perrotti LI. Erasing Drug Memories Through the Disruption of Memory Reconsolidation: A Review of Glutamatergic Mechanisms. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/jabr.12031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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46
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O'Haire ME, Guérin NA, Kirkham AC. Animal-Assisted Intervention for trauma: a systematic literature review. Front Psychol 2015; 6:1121. [PMID: 26300817 PMCID: PMC4528099 DOI: 10.3389/fpsyg.2015.01121] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/20/2015] [Indexed: 12/02/2022] Open
Abstract
Animals have a long history of inclusion in psychiatric treatment. There has been a recent growth in the empirical study of this practice, known as Animal-Assisted Intervention (AAI). We conducted a systematic review of the empirical literature on AAI for trauma, including posttraumatic stress disorder (PTSD). Ten studies qualified for inclusion, including six peer-reviewed journal articles and four unpublished theses. Participants were predominantly survivors of child abuse, in addition to military veterans. The presentation of AAI was highly variable across the studies. The most common animal species were dogs and horses. The most prevalent outcomes were reduced depression, PTSD symptoms, and anxiety. There was a low level of methodological rigor in most studies, indicating the preliminary nature of this area of investigation. We conclude that AAI may provide promise as a complementary treatment option for trauma, but that further research is essential to establish feasibility, efficacy, and manualizable protocols.
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Affiliation(s)
- Marguerite E O'Haire
- Center for the Human-Animal Bond, Center for Animal Welfare Science, Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University West Lafayette, IN, USA
| | - Noémie A Guérin
- Center for the Human-Animal Bond, Center for Animal Welfare Science, Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University West Lafayette, IN, USA
| | - Alison C Kirkham
- Center for the Human-Animal Bond, Center for Animal Welfare Science, Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University West Lafayette, IN, USA
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47
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Finnegan A, Kip K, Hernandez D, McGhee S, Rosenzweig L, Hynes C, Thomas M. Accelerated resolution therapy: an innovative mental health intervention to treat post-traumatic stress disorder. J ROY ARMY MED CORPS 2015; 162:90-7. [DOI: 10.1136/jramc-2015-000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 06/02/2015] [Indexed: 11/03/2022]
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Wooten NR. Military Social Work: Opportunities and Challenges for Social Work Education. JOURNAL OF SOCIAL WORK EDUCATION 2015; 51:S6-S25. [PMID: 26089628 PMCID: PMC4469218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Military social work is a specialized field of practice spanning the micro-macro continuum and requiring advanced social work knowledge and skills. The complex behavioral health problems and service needs of Iraq and Afghanistan veterans highlight the need for highly trained social work professionals who can provide militarily-relevant and culturally-responsive evidence-informed services. Responding to the military behavioral health workforce and service needs of recently returned veterans presents both opportunities and challenges for military social work education. This article discusses the rationale for a military social work specialization, the need for military social work education, and opportunities and challenges for social work education. An integrated model of intellectual capital is proposed to guide strategic planning for future military social work education.
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Affiliation(s)
- Nikki R Wooten
- University of South Carolina/District of Columbia Army National Guard
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49
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Eagle AL, Singh R, Kohler RJ, Friedman AL, Liebowitz CP, Galloway MP, Enman NM, Jutkiewicz EM, Perrine SA. Single prolonged stress effects on sensitization to cocaine and cocaine self-administration in rats. Behav Brain Res 2015; 284:218-24. [PMID: 25712697 PMCID: PMC5370568 DOI: 10.1016/j.bbr.2015.02.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/10/2015] [Accepted: 02/13/2015] [Indexed: 12/24/2022]
Abstract
Posttraumatic stress disorder (PTSD) is often comorbid with substance use disorders (SUD). Single prolonged stress (SPS) is a well-validated rat model of PTSD that provides a framework to investigate drug-induced behaviors as a preclinical model of the comorbidity. We hypothesized that cocaine sensitization and self-administration would be increased following exposure to SPS. Male Sprague-Dawley rats were exposed to SPS or control treatment. After SPS, cocaine (0, 10 or 20 mg/kg, i.p.) was administered for 5 consecutive days and locomotor activity was measured. Another cohort was assessed for cocaine self-administration (0.1 or 0.32 mg/kg/i.v.) after SPS. Rats were tested for acquisition, extinction and cue-induced reinstatement behaviors. Control animals showed a dose-dependent increase in cocaine-induced locomotor activity after acute cocaine whereas SPS rats did not. Using a sub-threshold sensitization paradigm, control rats did not exhibit enhanced locomotor activity at Day 5 and therefore did not develop behavioral sensitization, as expected. However, compared to control rats on Day 5 the locomotor response to 20mg/kg repeated cocaine was greatly enhanced in SPS-treated rats, which exhibited enhanced cocaine locomotor sensitization. The effect of SPS on locomotor activity was unique in that SPS did not modify cocaine self-administration behaviors under a simple schedule of reinforcement. These data show that SPS differentially affects cocaine-mediated behaviors causing no effect to cocaine self-administration, under a simple schedule of reinforcement, but significantly augmenting cocaine locomotor sensitization. These results suggest that SPS shares common neurocircuitry with stimulant-induced plasticity, but dissociable from that underlying psychostimulant-induced reinforcement.
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MESH Headings
- Akathisia, Drug-Induced/physiopathology
- Animals
- Catheters, Indwelling
- Cocaine/administration & dosage
- Cocaine-Related Disorders/physiopathology
- Cohort Studies
- Conditioning, Operant/drug effects
- Conditioning, Operant/physiology
- Disease Models, Animal
- Dopamine Uptake Inhibitors/administration & dosage
- Dose-Response Relationship, Drug
- Extinction, Psychological/drug effects
- Extinction, Psychological/physiology
- Male
- Rats, Sprague-Dawley
- Self Administration
- Stress, Psychological/physiopathology
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Affiliation(s)
- Andrew L Eagle
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, MI, USA
| | - Robby Singh
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, MI, USA
| | - Robert J Kohler
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, MI, USA
| | - Amy L Friedman
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Chelsea P Liebowitz
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthew P Galloway
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, MI, USA; Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nicole M Enman
- Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Emily M Jutkiewicz
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Shane A Perrine
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, MI, USA.
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50
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Simpson TL, Malte CA, Dietel B, Tell D, Pocock I, Lyons R, Varon D, Raskind M, Saxon AJ. A pilot trial of prazosin, an alpha-1 adrenergic antagonist, for comorbid alcohol dependence and posttraumatic stress disorder. Alcohol Clin Exp Res 2015; 39:808-17. [PMID: 25827659 DOI: 10.1111/acer.12703] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/16/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) commonly co-occur and are associated with greater symptom severity and costs than either disorder alone. No pharmacologic interventions have been found to decrease both alcohol use and PTSD symptom severity relative to matched placebo. Prazosin, an alpha-1 adrenoreceptor antagonist, has demonstrated the efficacy of reducing PTSD and AD symptoms among individuals with one or the other disorder and may be useful in addressing comorbid PTSD/AD. METHODS Prazosin and matched placebo were compared in the context of an outpatient 6-week double-blind randomized controlled pilot trial involving 30 individuals with comorbid PTSD/AD. Medication was titrated to 4 mg q am, 4 mg q pm and 8 mg qhs by the end of week 2. Participants in both conditions received 5 medical management sessions. Information regarding alcohol use, craving, and PTSD was gathered daily using a telephone interactive voice response system. RESULTS Participants randomized to prazosin had a greater reduction in percent days drinking per week and percent days heavy drinking per week between baseline and week 6 than did placebo participants. No significant differences were detected within or between groups in change from weeks 1 to 6 in total PTSD symptoms. Participants in the prazosin condition reported drowsiness on significantly more days than those in the placebo condition. CONCLUSIONS Consistent with the extant research evaluating medications for comorbid PTSD/AD, the current evaluation of prazosin also found decreased alcohol consumption but no medication effect on PTSD symptomatology.
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Affiliation(s)
- Tracy L Simpson
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington; Mental Illness Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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