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Kennedy CJ, Woodin E, Schmidt J, Biagioni JB, Garcia-Barrera MA. Ten Priorities for Research Addressing the Intersections of Brain Injury, Mental Health and Addictions: A Stakeholder-Driven Priority-Setting Study. Health Expect 2024; 27:e14136. [PMID: 38990165 PMCID: PMC11238575 DOI: 10.1111/hex.14136] [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: 01/30/2024] [Revised: 06/20/2024] [Accepted: 06/23/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVES The purpose of this study was to engage key stakeholders in a health research priority-setting process to identify, prioritize and produce a community-driven list of research questions addressing intersectional issues on mental health and addictions (MHA) in acquired brain injury (ABI). METHODS A multiphasic health research priority-setting process was co-designed and executed with community-based stakeholders, including researchers, health professionals, clinicians, service providers, representatives from brain injury associations, policy makers and people with lived experience of ABI and MHA, including patients and their family members. Stakeholders' ideas led to the generation of research questions, which were prioritized at a 1-day workshop. RESULTS Fifty-nine stakeholders participated in the priority-setting activity during the workshop, which resulted in a rank-ordered list of the top 10 questions for research addressing the intersections of ABI and MHA. Questions identified touched on several pressing issues (e.g., opioid crisis, homelessness), encompassed multiple subtypes of ABI (e.g., hypoxic-ischaemic, mild traumatic), and involved different domains (e.g., identification, intervention) of health research. CONCLUSIONS This community-driven health research priority-setting study identified and prioritized research questions addressing the intersections of ABI and MHA. Researchers and funding agencies should use this list to inform their agendas and address stakeholders' most urgent needs, fostering meaningful improvements to clinical services. PATIENT OR PUBLIC CONTRIBUTION An 11-person working group comprised of people with lived experience, service providers, researchers, healthcare professionals and other key stakeholders collaboratively developed and informed the scope, design, methodology and interpretation of this study. Over 50 community-based stakeholders contributed to the research priority-setting activity. One co-author is a person with lived experience.
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Affiliation(s)
- Cole J Kennedy
- Department of Psychology, University of Victoria, Victoria, Canada
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, Canada
- BC Consensus on Brain Injury, Mental Health, and Addiction, Victoria, British Columbia, Canada
| | - Erica Woodin
- Department of Psychology, University of Victoria, Victoria, Canada
- BC Consensus on Brain Injury, Mental Health, and Addiction, Victoria, British Columbia, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Julia Schmidt
- BC Consensus on Brain Injury, Mental Health, and Addiction, Victoria, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Janelle Breese Biagioni
- BC Consensus on Brain Injury, Mental Health, and Addiction, Victoria, British Columbia, Canada
- CGB Centre for Traumatic Life Losses, Victoria, Canada
| | - Mauricio A Garcia-Barrera
- Department of Psychology, University of Victoria, Victoria, Canada
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, Canada
- BC Consensus on Brain Injury, Mental Health, and Addiction, Victoria, British Columbia, Canada
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Kitaj M, Goff DC. Why Do Veterans Not Respond as Well as Civilians to Trauma-Focused Therapies for PTSD? Harv Rev Psychiatry 2024; 32:160-163. [PMID: 38990904 DOI: 10.1097/hrp.0000000000000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
ABSTRACT This column first reviews evidence that veterans have poorer response to trauma-focused therapies for PTSD compared to civilians. We then consider several explanations for this trend, starting with gender as a possible confounding variable. We also examine other hypotheses, including the effects of the military acculturation process, the unique influences of military traumas, such as combat and military sexual traumas, and the roles of traumatic brain injuries (TBIs) and moral injury. Future research, we conclude, must determine whether gender explains the differences in trauma-focused therapy response. If so, then the underlying reasons must be further explored. If not, then we must determine the unique characteristics of the veteran population that make it more resistant to treatment. Mining these elements will help us adapt our trauma-focused therapies to better help this population and close the response-rate gap.
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Affiliation(s)
- Max Kitaj
- From Department of Psychiatry, NYU Grossman School of Medicine (Drs. Kitaj and Goff)
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3
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Cai LT, Brett BL, Palacios EM, Yuh EL, Bourla I, Wren-Jarvis J, Wang Y, Mac Donald C, Diaz-Arrastia R, Giacino JT, Okonkwo DO, Levin HS, Robertson CS, Temkin N, Markowitz AJ, Manley GT, Stein MB, McCrea MA, Zafonte RD, Nelson LD, Mukherjee P. Emotional Resilience Predicts Preserved White Matter Microstructure Following Mild Traumatic Brain Injury. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:164-175. [PMID: 36152948 PMCID: PMC10065831 DOI: 10.1016/j.bpsc.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/12/2022] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adult patients with mild traumatic brain injury (mTBI) exhibit distinct phenotypes of emotional and cognitive functioning identified by latent profile analysis of clinical neuropsychological assessments. When discerned early after injury, these latent clinical profiles have been found to improve prediction of long-term outcomes from mTBI. The present study hypothesized that white matter (WM) microstructure is better preserved in an emotionally resilient mTBI phenotype compared with a neuropsychiatrically distressed mTBI phenotype. METHODS The present study used diffusion magnetic resonance imaging to investigate and compare WM microstructure in major association, projection, and commissural tracts between the two phenotypes and over time. Diffusion magnetic resonance images from 172 patients with mTBI were analyzed to compute individual diffusion tensor imaging maps at 2 weeks and 6 months after injury. RESULTS By comparing the diffusion tensor imaging parameters between the two phenotypes at global, regional, and voxel levels, emotionally resilient patients were shown to have higher axial diffusivity compared with neuropsychiatrically distressed patients early after mTBI. Longitudinal analysis revealed greater compromise of WM microstructure in neuropsychiatrically distressed patients, with greater decrease of global axial diffusivity and more widespread decrease of regional axial diffusivity during the first 6 months after injury compared with emotionally resilient patients. CONCLUSIONS These results provide neuroimaging evidence of WM microstructural differences underpinning mTBI phenotypes identified from neuropsychological assessments and show differing longitudinal trajectories of these biological effects. These findings suggest that diffusion magnetic resonance imaging can provide short- and long-term imaging biomarkers of resilience.
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Affiliation(s)
- Lanya T Cai
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Benjamin L Brett
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Eva M Palacios
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Esther L Yuh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Ioanna Bourla
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Jamie Wren-Jarvis
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Yang Wang
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christine Mac Donald
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Ramon Diaz-Arrastia
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Harvey S Levin
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Amy J Markowitz
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Geoffrey T Manley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Michael A McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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4
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MacGregor AJ, Casachahua JD, Walton SR, Harbertson J, Jurick SM, Dougherty AL, McCabe CT, Watrous JR, Fraser JJ. Deployment-related concussion and long-term health-related quality of life among US military personnel. Qual Life Res 2023:10.1007/s11136-023-03367-4. [PMID: 36897531 DOI: 10.1007/s11136-023-03367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To examine the relationship between deployment-related concussion and long-term health-related quality of life (HRQoL) among injured US military personnel. METHODS The study sample included 810 service members with deployment-related injuries between 2008 and 2012 who responded to a web-based longitudinal health survey. Participants were categorized into three injury groups: concussion with loss of consciousness (LOC; n = 247), concussion without LOC (n = 317), or no concussion (n = 246). HRQoL was measured using the 36-Item Short Form Health Survey physical and mental component summary (PCS and MCS) scores. Current post-traumatic stress disorder (PTSD) and depression symptoms were examined. Multivariable linear regression models assessed the effects of concussion on PCS and MCS scores, while controlling for covariates. RESULTS A lower PCS score was observed in participants with concussion with LOC (B = - 2.65, p = 0.003) compared with those with no history of concussion. Symptoms of PTSD (PCS: B = - 4.84, p < 0.001; MCS: B = - 10.53, p < 0.001) and depression (PCS: B = - 2.85, p < 0.001; MCS: B = - 10.24, p < 0.001) were the strongest statistically significant predictors of lower HRQoL. CONCLUSION Concussion with LOC was significantly associated with lower HRQoL in the physical domain. These findings affirm that concussion management should integrate physical and psychological care to improve long-term HRQoL and warrant a more detailed examination of causal and mediating mechanisms. Future research should continue to incorporate patient-reported outcomes and long-term follow-up of military service members to further define the lifelong impact of deployment-related concussion.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
| | - John D Casachahua
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Samuel R Walton
- Virginia Commonwealth University School of Medicine, Department of Physical Medicine and Rehabilitation, Richmond, VA, USA
| | - Judith Harbertson
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - Sarah M Jurick
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - Cameron T McCabe
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - Jessica R Watrous
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - John J Fraser
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA
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5
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Silverberg ND, Mikolić A. Management of Psychological Complications Following Mild Traumatic Brain Injury. Curr Neurol Neurosci Rep 2023; 23:49-58. [PMID: 36763333 DOI: 10.1007/s11910-023-01251-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW It has been clear for decades that psychological factors often contribute to mild traumatic brain injury (mTBI) outcome, but an emerging literature has begun to clarify which specific factors are important, when, for whom, and how they impact recovery. This review aims to summarize the contemporary evidence on psychological determinants of recovery from mTBI and its implications for clinical management. RECENT FINDINGS Comorbid mental health disorders and specific illness beliefs and coping behaviors (e.g., fear avoidance) are associated with worse recovery from mTBI. Proactive assessment and intervention for psychological complications can improve clinical outcomes. Evidence-based treatments for primary mental health disorders are likely also effective for treating mental health disorders after mTBI, and can reduce overall post-concussion symptoms. Broad-spectrum cognitive-behavioral therapy may modestly improve post-concussion symptoms, but tailoring delivery to individual psychological risk factors and/or symptoms may improve its efficacy. Addressing psychological factors in treatments delivered primarily by non-psychologists is a promising and cost-effective approach for enhancing clinical management of mTBI. Recent literature emphasizes a bio-psycho-socio-ecological framework for understanding mTBI recovery and a precision rehabilitation approach to maximize recovery. Integrating psychological principles into rehabilitation and tailoring interventions to specific risk factors may improve clinical management of mTBI.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, V5Z 1M9, Canada.
| | - Ana Mikolić
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, V5Z 1M9, Canada
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Mureșanu IA, Grad DA, Mureșanu DF, Dobran SA, Hapca E, Strilciuc Ș, Benedek I, Capriș D, Popescu BO, Perju-Dumbravă L, Cherecheș RM. Evaluation of post-traumatic stress disorder (PTSD) and related comorbidities in clinical studies. J Med Life 2022; 15:436-442. [PMID: 35646173 PMCID: PMC9126456 DOI: 10.25122/jml-2022-0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/25/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with traumatic brain injury (TBI) of varying severities are experiencing adverse outcomes during and after rehabilitation. Besides depression and anxiety, post-traumatic stress disorder (PTSD) is highly encountered in civilian and military populations. As more prospective and retrospective studies - focused on evaluating new or old psychological therapies in inpatient, outpatient, or controlled environments, targeting patients with PTSD with or without a history of TBI - are carried out, researchers are employing various scales to measure PTSD as well as other psychiatric diagnoses or cognitive impairments that might appear following TBI. We aimed to explore the literature published between January 2010 and October 2021 by querying three databases. Our preliminary results showed that several scales - such as the Clinician-Administered PTSD Scale (CAPS), the Posttraumatic Stress Disorder Checklist Military Version (PCL-M) as well as Specific Version (PCL-S), and Civilian Version (PCL-C) - have been frequently used for PTSD diagnosis and symptom severity. However, heterogeneity in the scales used when assessing and evaluating additional psychiatric comorbidities and cognitive impairments are due to the study aim and therapeutic approaches. Therefore, conducting an intervention focusing on post-TBI PTSD patients requires increased attention to patients' medical history in capturing multiple cognitive impairments and affected neuropsychological processes when designing the study and including validated instruments for measuring primary and secondary neuropsychological outcomes.
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Affiliation(s)
- Ioana Anamaria Mureșanu
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,Corresponding Author: Ioana Anamaria Mureșanu, RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Cluj, Romania. Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. E-mail:
| | - Diana Alecsandra Grad
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Dafin Fior Mureșanu
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Elian Hapca
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ștefan Strilciuc
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Irina Benedek
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - David Capriș
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Bogdan Ovidiu Popescu
- Department of Neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Răzvan Mircea Cherecheș
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
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Stein DJ, Craske MG, Rothbaum BO, Chamberlain SR, Fineberg NA, Choi KW, de Jonge P, Baldwin DS, Maj M. The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management. World Psychiatry 2021; 20:336-356. [PMID: 34505377 PMCID: PMC8429350 DOI: 10.1002/wps.20919] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The clinical construct of "anxiety neurosis" was broad and poorly defined, so that the delineation of specific anxiety disorders in the DSM-III was an important advance. However, anxiety and related disorders are not only frequently comorbid, but each is also quite heterogeneous; thus diagnostic manuals provide only a first step towards formulating a management plan, and the development of additional decision support tools for the treatment of anxiety conditions is needed. This paper aims to describe systematically important domains that are relevant to the personalization of management of anxiety and related disorders in adults. For each domain, we summarize the available research evidence and review the relevant assessment instruments, paying special attention to their suitability for use in routine clinical practice. We emphasize areas where the available evidence allows the clinician to personalize the management of anxiety conditions, and we point out key unmet needs. Overall, the evidence suggests that we are becoming able to move from simply recommending that anxiety and related disorders be treated with selective serotonin reuptake inhibitors, cognitive-behavioral therapy, or their combination, to a more complex approach which emphasizes that the clinician has a broadening array of management modalities available, and that the treatment of anxiety and related disorders can already be personalized in a number of important respects.
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Affiliation(s)
- Dan J Stein
- South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA
| | | | - Samuel R Chamberlain
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, and Southern Health NHS Foundation Trust, Southampton, UK
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, and Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
- University of Cambridge Clinical Medical School, Cambridge, UK
| | - Karmel W Choi
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, and Southern Health NHS Foundation Trust, Southampton, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Baig MR, Beck RD, Wilson JL, Lemmer JA, Meraj A, Meyer EC, Mintz J, Peterson AL, Roache JD. Quetiapine augmentation of prolonged exposure therapy in veterans with PTSD and a history of mild traumatic brain injury: design and methodology of a pilot study. Mil Med Res 2020; 7:46. [PMID: 33032657 PMCID: PMC7545554 DOI: 10.1186/s40779-020-00278-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 09/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Selective serotonergic reuptake inhibitors (SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder (PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury (mTBI) is problematic since SSRIs could exacerbate post-concussion syndrome (PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy. METHODS We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of mTBI. DISCUSSION We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full- scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans. TRIAL REGISTRATION NCT04280965 .
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Affiliation(s)
- Muhammad R Baig
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA. .,Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, TX, USA. .,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Robert D Beck
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, TX, USA
| | - Jennifer L Wilson
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, TX, USA
| | - Jennifer A Lemmer
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, TX, USA
| | - Adeel Meraj
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
| | - Eric C Meyer
- Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.,Central Texas Veterans Healthcare System, Waco, TX, USA.,Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alan L Peterson
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, USA
| | - John D Roache
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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9
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Fonzo GA, Federchenco V, Lara A. Predicting and Managing Treatment Non-Response in Posttraumatic Stress Disorder. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2020; 7:70-87. [PMID: 33344106 PMCID: PMC7748158 DOI: 10.1007/s40501-020-00203-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This review aims to synthesize existing research regarding the definition of treatment resistance in posttraumatic stress disorder (PTSD), predictors of treatment non-response to first-line interventions, and emerging second-line PTSD treatment options into an accessible resource for the practicing clinician. RECENT FINDINGS The concept of treatment resistance in PTSD is currently poorly defined and operationalized. There are no well-established predictors of treatment non-response utilized in routine clinical care, but existing research identifies several potential candidate markers, including male gender, low social support, chronic and early life trauma exposure, comorbid psychiatric disorders, severe PTSD symptoms, and poor physical health. The most promising available treatment options for PTSD patients non-responsive to first-line psychotherapies and antidepressants include transcranial magnetic stimulation and ketamine infusion. Methylenedioxymethamphetamine-assisted psychotherapy also appears promising but is only available in a research context. These options require careful consideration of risks and benefits for a particular patient. SUMMARY More research is required to develop a robust, clinically-useful definition of treatment resistance in PTSD; identify reliable, readily assessable, and generalizable predictors of PTSD treatment non-response; and implement measurement and prediction in clinical settings to identify individuals unlikely to respond to first-line treatments and direct them to appropriate second-line treatments.
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Affiliation(s)
- Gregory A. Fonzo
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin
| | - Vecheslav Federchenco
- General Psychiatry Residency, Dell Medical School, The University of Texas at Austin
- Equal contributions to authorship
| | - Alba Lara
- General Psychiatry Residency, Dell Medical School, The University of Texas at Austin
- Equal contributions to authorship
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10
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Fesharaki-Zadeh A, Miyauchi JT, St. Laurent-Arriot K, Tsirka SE, Bergold PJ. Increased Behavioral Deficits and Inflammation in a Mouse Model of Co-Morbid Traumatic Brain Injury and Post-Traumatic Stress Disorder. ASN Neuro 2020; 12:1759091420979567. [PMID: 33342261 PMCID: PMC7755938 DOI: 10.1177/1759091420979567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/03/2020] [Accepted: 11/08/2020] [Indexed: 01/21/2023] Open
Abstract
Comorbid post-traumatic stress disorder with traumatic brain injury (TBI) produce more severe affective and cognitive deficits than PTSD or TBI alone. Both PTSD and TBI produce long-lasting neuroinflammation, which may be a key underlying mechanism of the deficits observed in co-morbid TBI/PTSD. We developed a model of co-morbid TBI/PTSD by combining the closed head (CHI) model of TBI with the chronic variable stress (CVS) model of PTSD and examined multiple behavioral and neuroinflammatory outcomes. Male C57/Bl6 mice received sham treatment, CHI, CVS, CHI then CVS (CHI → CVS) or CVS then CHI (CVS → CHI). The CVS → CHI group had deficits in Barnes maze or active place avoidance not seen in the other groups. The CVS → CHI, CVS and CHI → CVS groups displayed increased basal anxiety level, based on performance on elevated plus maze. The CVS → CHI had impaired performance on Barnes Maze, and Active Place Avoidance. These performance deficits were strongly correlated with increased hippocampal Iba-1 level an indication of activated MP/MG. These data suggest that greater cognitive deficits in the CVS → CHI group were due to increased inflammation. The increased deficits and neuroinflammation in the CVS → CHI group suggest that the order by which a subject experiences TBI and PTSD is a major determinant of the outcome of brain injury in co-morbid TBI/PTSD.
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Affiliation(s)
- Arman Fesharaki-Zadeh
- Department of Psychiatry, State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Jeremy T. Miyauchi
- Department of Physiology, State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Karrah St. Laurent-Arriot
- Department of Pharmacology, State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Stella E. Tsirka
- Department of Physiology, State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Peter J. Bergold
- Department of Pharmacology, State University of New York, Downstate Medical Center, Brooklyn, New York
- Department of Neurology, State University of New York, Downstate Medical Center, Brooklyn, New York
- Department of Pharmacological Sciences, Stony Brook Medicine, Stony Brook University, Stony Brook, New York
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