1
|
Harwood-Gross A, Brom D, Schramm-Yavin S, Fruchter E, Vermetten E. Trauma care in crisis: war trauma and mental health funding. Eur J Psychotraumatol 2024; 15:2375140. [PMID: 38984725 PMCID: PMC11238647 DOI: 10.1080/20008066.2024.2375140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/21/2024] [Indexed: 07/11/2024] Open
Abstract
Background: Israel is currently under a state of continued unrest and state of war. There has been an influx of financial aid to treat the mental health fallout both from within Israel and abroad. Despite increased research into resilience, treatment and wide-scale interventions, there is a concern that this is not significantly influencing mental health aid allocation.Objective: This letter to the editor aims to describe the current situation and address current difficulties in regard to the relevant literature from recent conflicts and national traumatic events.Method: A consortium of national and international trauma experts pooled together their knowledge to produce a working statement based on evidence from clinical and research findings.Results: As opposed to wider, short-term psychological interventions which have limited long-term proven efficacy, lessons from previous war zones, wide-scale exposure to trauma and current war-torn countries highlight the importance of targeting and assessment, addressing barriers to care, strengthening existing systems and promoting community resilience and care.Conclusions: In addition to acute care, funding should be allocated to long-term care, enhancing treatment accessibility and community follow-up and additionally support long-term research to assess effectiveness and contribute to international knowledge.
Collapse
Affiliation(s)
- Anna Harwood-Gross
- METIV Israel Psychotrauma Center, Herzog Medical Center, Jerusalem, Israel
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Danny Brom
- METIV Israel Psychotrauma Center, Herzog Medical Center, Jerusalem, Israel
| | | | - Eyal Fruchter
- Maale Hacarmel Mental Health Center, Tirat HaCarmel, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, the Technion, Haifa, Israel
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
2
|
Burback L, Forner C, Winkler OK, Al-Shamali HF, Ayoub Y, Paquet J, Verghese M. Survival, Attachment, and Healing: An Evolutionary Lens on Interventions for Trauma-Related Dissociation. Psychol Res Behav Manag 2024; 17:2403-2431. [PMID: 38912158 PMCID: PMC11193433 DOI: 10.2147/prbm.s402456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Dissociation is a necessary part of our threat response system, common to all animal species, normally temporarily activated under conditions of extreme or inescapable threat. Pathological dissociation, however, continues to occur after the initial threat has passed, in response to reminders or inaccessibility of safety and security. Present across the spectrum of psychiatric diagnoses, recurrent dissociative symptoms are linked to severe trauma exposure, insecure attachment, treatment non-response, and maladaptive coping behaviors such as substance use, suicidality, and self-harm. However, empirical studies testing treatments specific to dissociative processes remain scarce. This narrative review summarizes existing studies and provides theoretical, neurobiological, and evolutionary perspectives on dissociative processes and treatments for pathological dissociation. Methods A systematic search of five databases (MEDLINE, EMBASE, APA PsycINFO, CINAHL plus, Scopus) was conducted on April 13, 2023. Peer-reviewed clinical studies with adult participants, assessing intervention effects on dissociative symptoms, were included. Results were thematically analyzed and summarized. Results Sixty-nine studies were identified, mainly focused on posttraumatic stress disorder, trauma-exposed populations, and borderline personality disorder. Psychotherapy was studied in 72.5% of studies; other interventions included medications and neurostimulation. The majority reported positive outcomes, despite the heterogeneous spectrum of interventions. However, treatment of dissociative symptoms was the primary objective in only a minority. Conclusion Pathological dissociation is a complex phenomenon involving brain and body systems designed for perceiving and responding to severe threats, requiring an individualized approach. A literature is emerging regarding potentially evidence-based treatments to help those impacted by recurrent dissociative symptoms. When contextualized within a neurobiological and evolutionary perspective, these treatments can be understood as facilitating an internal and/or relational sense of safety, resulting in symptom reduction. Further studies are needed to explore effective treatments for dissociative symptoms.
Collapse
Affiliation(s)
- Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
- Neuroscience and Mental Health Institute (NMHI), University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Huda F Al-Shamali
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Yahya Ayoub
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Jacquelyn Paquet
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Myah Verghese
- Department of Neuroscience, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
3
|
Schnyder U. Treating Posttraumatic Stress Disorder: The Complexities of the Clinical Realm. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024:1-5. [PMID: 38768564 DOI: 10.1159/000538954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/16/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Ulrich Schnyder
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| |
Collapse
|
4
|
Yu Z, Burback L, Winkler O, Xu L, Dennett L, Vermetten E, Greenshaw A, Li XM, Milne M, Wang F, Cao B, Winship IR, Zhang Y, Chan AW. Alterations in brain network connectivity and subjective experience induced by psychedelics: a scoping review. Front Psychiatry 2024; 15:1386321. [PMID: 38807690 PMCID: PMC11131165 DOI: 10.3389/fpsyt.2024.1386321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/23/2024] [Indexed: 05/30/2024] Open
Abstract
Intense interest surrounds current research on psychedelics, particularly regarding their potential in treating mental health disorders. Various studies suggest a link between the subjective effects produced by psychedelics and their therapeutic efficacy. Neuroimaging evidence indicates an association of changes in brain functional connectivity with the subjective effects of psychedelics. We conducted a review focusing on psychedelics and brain functional connectivity. The review focused on four psychedelic drugs: ayahuasca, psilocybin and LSD, and the entactogen MDMA. We conducted searches in databases of MEDLINE, Embase, APA PsycInfo and Scopus from inception to Jun 2023 by keywords related to functional connectivity and psychedelics. Using the PRISMA framework, we selected 24 articles from an initial pool of 492 for analysis. This scoping review and analysis investigated the effects of psychedelics on subjective experiences and brain functional connectivity in healthy individuals. The studies quantified subjective effects through psychometric scales, revealing significant experiences of altered consciousness, mood elevation, and mystical experiences induced by psychedelics. Neuroimaging results indicated alterations in the functional connectivity of psychedelics, with consistent findings across substances of decreased connectivity within the default mode network and increased sensory and thalamocortical connectivity. Correlations between these neurophysiological changes and subjective experiences were noted, suggesting a brain network basis of the psychedelics' neuropsychological impact. While the result of the review provides a potential neural mechanism of the subjective effects of psychedelics, direct clinical evidence is needed to advance their clinical outcomes. Our research serves as a foundation for further exploration of the therapeutic potential of psychedelics.
Collapse
Affiliation(s)
- Zijia Yu
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Lujie Xu
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Centre, Leiden, Netherlands
| | - Andrew Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Xin-Min Li
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Michaela Milne
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Institute of Human Nutrition at the Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Fei Wang
- Nanjing Medical University Affiliated Brain Hospital, Nanjing, Jiangsu, China
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Ian R. Winship
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Yanbo Zhang
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Allen W. Chan
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
5
|
van Minnen A, Vos L, Bet PM, de Jongh A, Linsen F, van Marle HJF, Meijer OC, Otte WM, Russcher M, Vinkers CH. Three Prospective Case Studies Examining Mifepristone's Efficacy in Patients with Treatment-Resistant PTSD. Case Rep Psychiatry 2024; 2024:4768647. [PMID: 38706512 PMCID: PMC11068447 DOI: 10.1155/2024/4768647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/04/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Despite the availability of various treatment approaches for patients with posttraumatic stress disorder (PTSD), some patients do not respond to these therapies, and novel treatment approaches are needed. This study investigated the efficacy of mifepristone, a glucocorticoid receptor antagonist, in treatment-resistant PTSD patients. Three patients with PTSD who were resistant to standard psychological and pharmacological treatments were prescribed mifepristone (600-1,200 mg/day) for 1 week. A baseline-controlled single-case design was used, involving a 2-week baseline phase (no intervention), a 1-week intervention phase (mifepristone), and a 2-week postintervention phase. The primary outcome measure, self-reported PTSD symptom severity (PCL-5), was assessed daily, with participants providing their own control condition. Two of the three patients experienced a significant reduction in PTSD symptom severity after the intervention phase and no longer met the diagnostic criteria for PTSD. These positive results were maintained during long-term follow-up. These findings support the potential effectiveness of mifepristone in the treatment of patients with treatment-resistant PTSD. However, our findings must be interpreted with caution, and further studies with larger sample sizes and more rigorous designs are necessary to confirm the promising results.
Collapse
Affiliation(s)
- Agnes van Minnen
- Psychotrauma Expertise Centre (PSYTREC) Bilthoven, Bilthoven, Netherlands
- Behavioural Science Institute (BSI), Radboud University, Nijmegen, Netherlands
| | - Lizelotte Vos
- Psychotrauma Expertise Centre (PSYTREC) Bilthoven, Bilthoven, Netherlands
| | - Pierre M. Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ad de Jongh
- Psychotrauma Expertise Centre (PSYTREC) Bilthoven, Bilthoven, Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
- School of Health Sciences, Salford University, Salford, Manchester, UK
- Institute of Health and Society, University of Worcester, Worcester, UK
- School of Psychology, Queen's University, Belfast, UK
| | - Felix Linsen
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam, Neuroscience, Mood, Anxiety, Psychosis, Sleep and Stress Program, Amsterdam, Netherlands
| | - Hein J. F. van Marle
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam, Neuroscience, Mood, Anxiety, Psychosis, Sleep and Stress Program, Amsterdam, Netherlands
- ARQ National Psychotrauma Center, Diemen, Netherlands
- GGZ inGeest Mental Health Care, Amsterdam, Netherlands
| | - Onno C. Meijer
- Department of Medicine, Division Endocrinology, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Willem M. Otte
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marije Russcher
- Department of Hospital Pharmacy, Meander Medical Center, Amersfoort, Netherlands
| | - Christiaan H. Vinkers
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam, Neuroscience, Mood, Anxiety, Psychosis, Sleep and Stress Program, Amsterdam, Netherlands
- GGZ inGeest Mental Health Care, Amsterdam, Netherlands
| |
Collapse
|
6
|
Fetterhoff D, Costa M, Hellerstedt R, Johannessen R, Imbach L, Sarnthein J, Strange BA. Neuronal population representation of human emotional memory. Cell Rep 2024; 43:114071. [PMID: 38592973 PMCID: PMC11063625 DOI: 10.1016/j.celrep.2024.114071] [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] [Received: 06/13/2023] [Revised: 03/07/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
Understanding how emotional processing modulates learning and memory is crucial for the treatment of neuropsychiatric disorders characterized by emotional memory dysfunction. We investigate how human medial temporal lobe (MTL) neurons support emotional memory by recording spiking activity from the hippocampus, amygdala, and entorhinal cortex during encoding and recognition sessions of an emotional memory task in patients with pharmaco-resistant epilepsy. Our findings reveal distinct representations for both remembered compared to forgotten and emotional compared to neutral scenes in single units and MTL population spiking activity. Additionally, we demonstrate that a distributed network of human MTL neurons exhibiting mixed selectivity on a single-unit level collectively processes emotion and memory as a network, with a small percentage of neurons responding conjointly to emotion and memory. Analyzing spiking activity enables a detailed understanding of the neurophysiological mechanisms underlying emotional memory and could provide insights into how emotion alters memory during healthy and maladaptive learning.
Collapse
Affiliation(s)
- Dustin Fetterhoff
- Laboratory for Clinical Neuroscience, Center for Biomedical Technology, Universidad Politécnica de Madrid, IdISSC, Madrid, Spain.
| | - Manuela Costa
- Laboratory for Clinical Neuroscience, Center for Biomedical Technology, Universidad Politécnica de Madrid, IdISSC, Madrid, Spain
| | - Robin Hellerstedt
- Laboratory for Clinical Neuroscience, Center for Biomedical Technology, Universidad Politécnica de Madrid, IdISSC, Madrid, Spain
| | - Rebecca Johannessen
- Swiss Epilepsy Center, Klinik Lengg, Zurich, Switzerland; Department of Psychology, University of Zurich, Switzerland
| | - Lukas Imbach
- Swiss Epilepsy Center, Klinik Lengg, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Johannes Sarnthein
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland; Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bryan A Strange
- Laboratory for Clinical Neuroscience, Center for Biomedical Technology, Universidad Politécnica de Madrid, IdISSC, Madrid, Spain; Reina Sofia Centre for Alzheimer's Research, Madrid, Spain
| |
Collapse
|
7
|
Rojnic Kuzman M, Padberg F, Amann BL, Schouler-Ocak M, Bajic Z, Melartin T, James A, Beezhold J, Artigue Gómez J, Arango C, Jendricko T, Ismayilov J, Flannery W, Chumakov E, Başar K, Vahip S, Dudek D, Samochowiec J, Mihajlovic G, Rota F, Stoppe G, Dom G, Catthoor K, Chkonia E, Heitor Dos Santos MJ, Telles D, Falkai P, Courtet P, Patarák M, Izakova L, Skugarevski O, Barjaktarov S, Babic D, Racetovic G, Fiorillo A, Carpiniello B, Taube M, Melamed Y, Chihai J, Cozman DCM, Mohr P, Szekeres G, Delic M, Mazaliauskienė R, Tomcuk A, Maruta N, Gorwood P. Clinician treatment choices for post-traumatic stress disorder: ambassadors survey of psychiatrists in 39 European countries. Eur Psychiatry 2024; 67:e24. [PMID: 38450651 PMCID: PMC10988156 DOI: 10.1192/j.eurpsy.2024.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians' treatment choices for post-traumatic stress disorder (PTSD). METHODS The case-based analysis included 611 participants, who correctly classified the vignette as a case of PTSD, from Central/ Eastern Europe (CEE) (n = 279), Southern Europe (SE) (n = 92), Northern Europe (NE) (n = 92), and Western Europe (WE) (N = 148). RESULTS About 82% woulduse antidepressants (sertraline being the most preferred one). Benzodiazepines and antipsychotics were significantly more frequently recommended by participants from CEE (33 and 4%, respectively), compared to participants from NE (11 and 0%) and SE (9% and 3%). About 52% of clinicians recommended trauma-focused cognitive behavior therapy and 35% psychoeducation, irrespective of their origin. In the latent class analysis, we identified four distinct "profiles" of clinicians. In Class 1 (N = 367), psychiatrists would less often recommend any antidepressants. In Class 2 (N = 51), clinicians would recommend trazodone and prolonged exposure therapy. In Class 3 (N = 65), they propose mirtazapine and eye movement desensitization reprocessing therapy. In Class 4 (N = 128), clinicians propose different types of medications and cognitive processing therapy. About 50.1% of participants in each region stated they do not adhere to recognized treatment guidelines. CONCLUSIONS Clinicians' decisions for PTSD are broadly similar among European psychiatrists, but regional differences suggest the need for more dialogue and education to harmonize practice across Europe and promote the use of guidelines.
Collapse
Affiliation(s)
- Martina Rojnic Kuzman
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Benedikt L. Amann
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
- Mental Health Institute Hospital del Mar and Hospital del Mar Research Institute, Barcelona, CIBERSAM, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital Berlin, Berlin, Germany
| | - Zarko Bajic
- Research Unit “Dr. Mirko Grmek”, Psychiatric Clinic “Sveti Ivan”, Zagreb, Croatia
| | - Tarja Melartin
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Julian Beezhold
- Great Yarmouth Acute Service, Northgate Hospital/Norfolk & Suffolk NHS Foundation Trust, Great Yarmouth, UK
| | | | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | | | | | - William Flannery
- Department of Adult Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Egor Chumakov
- Department of Psychiatry and Addiction, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Koray Başar
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Simavi Vahip
- Affective Disorders Unit, Department of Psychiatry, Ege University Medicine Faculty, Izmir, Turkey
| | - Dominika Dudek
- Psychiatry and Department of Adult Psychiatry, Collegium Medicum Jagiellonian University, Cracow, Poland
| | | | - Goran Mihajlovic
- Clinic for Psychiatry, University of Kragujevac, Kragujevac, Serbia
| | - Fulvia Rota
- Swiss Society for Psychiatry and Psychotherapy, Switzerland
| | | | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Antwerp, Belgium
| | - Kirsten Catthoor
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Antwerp, Belgium
| | - Eka Chkonia
- Department of Psychiatry, Tbilisi State Medical University, Tbilisi, Georgia
| | - Maria João Heitor Dos Santos
- Psychiatry and Mental Health Department, Hospital Beatriz Ângelo, Loures, Portugal
- Centro de Investigação Interdisciplinar em Saúde (CIIS), Universidade Católica Portuguesa, Lisbon, Portugal
- Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Diogo Telles
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post Acute Care, Hôspital Lapeyronie, CHU Montpellier,Montpellier, France
| | - Michal Patarák
- Department of Psychiatry, Slovak Medical University, Bratislava, Slovakia
- Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Lubomira Izakova
- Department of Psychiatry, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Oleg Skugarevski
- Department of Psychiatry and Medical Psychology, Belarusian State Medical University, Minsk, Belarus
| | - Stojan Barjaktarov
- University Clinic of Psychiatry, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Dragan Babic
- Psychiatry Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Goran Racetovic
- Community Mental Health Center, Health Center Prijedor, Prijedor, Bosnia and Herzegovina
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Bernardo Carpiniello
- University of Cagliari and Psychiatry Unit, Section of Psychiatry, Department of Medical Sciences and Public Health, University Hospital, Cagliari, Italy
| | - Maris Taube
- Department of Psychiatry and Narcology, Riga Stradiņš University, Riga Centre of Psychiatry and Narcology, Riga, Latvia
| | | | - Jana Chihai
- Department of Mental Health, Medical Psychology and Psychotherapy, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Kishinev, Moldova
| | | | - Pavel Mohr
- Clinical Department, National Institute of Mental Health, Klecany, Czechia
- Third School of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Ramunė Mazaliauskienė
- Psychiatric Clinic, Lithuanian Health Sciences University Kaunas Hospital, Kaunas, Lithuania
| | | | - Nataliya Maruta
- Institute of Neurology, Psychiatry and Narcology, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Philip Gorwood
- Université Paris Cité, INSERM UMR1266, Paris, France
- CMME, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| |
Collapse
|
8
|
Boelen PA, Eisma MC, de Keijser J, Lenferink LIM. Treatment Gap in Mental Health Care for Victims of Road Traffic Accidents. Clin Psychol Psychother 2024; 31:e2970. [PMID: 38600844 DOI: 10.1002/cpp.2970] [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: 12/21/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024]
Abstract
Road traffic accidents (RTAs) are among the most frequent negative life-events. About one in five RTA survivors is susceptible to posttraumatic stress disorder (PTSD). Knowledge about needs for, and usage of, mental health services (MHSs) may improve options for care for RTA victims. The current study aimed to assess rates of victims using different MHSs, including psychotherapy, pharmacotherapy and support groups, and to explore correlates of needs for and use of these MHSs. Further, we aimed to estimate the treatment gap in post-RTA care, defined as including people with probable PTSD who did not use MHSs and people wanting but not getting help from MHSs. Dutch victims of nonlethal RTAs (N = 259) completed self-report measures on needs for and use of MHSs and PTSD. Results showed that 26% of participants had utilized care from psychotherapy, pharmacotherapy or support groups. Among people with probable PTSD, this was 56%. Increased posttraumatic stress was the strongest correlate of MHS use. Forty-eight participants (17.8%) had an unmet care need and represented the treatment gap. Commonly reported reasons and barriers preventing MHS use were perceptions that problems were limited or would disappear without care and financial worries. Regarding possible future care, participants reported a preference for face-to-face (over online) help from a psychologist (over other professionals). The treatment gap for Dutch RTA victims may be limited. However, a significant number of RTA victims need care but do not obtain this care. Care options may be improved by reducing practical barriers to MHSs and increasing mental health literacy and acceptability of different forms of care (besides face-to-face care).
Collapse
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
| | - Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Jos de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Lonneke I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
- Psychology, Health & Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| |
Collapse
|
9
|
Smith JR, Drouillard KJ, Foster AM. Exploring Care and Recovery for Individuals With Post-traumatic Stress Disorder: A Scoping Review. Cureus 2024; 16:e53741. [PMID: 38465133 PMCID: PMC10920405 DOI: 10.7759/cureus.53741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/12/2024] Open
Abstract
Most people experience trauma at some point in their lives. The sources of trauma can include accidents, natural disasters, physical or sexual assault, combat, torture, or the death of a loved one. Experiencing or witnessing any of these, or other terrifying events, may make one susceptible to developing post-traumatic stress disorder (PTSD), a trauma- and stressor-related mental health condition. The common symptoms and consequences of PTSD include intrusive and distressing thoughts, memories, or flashbacks related to the traumatic event; avoidance of situations, people, or activities that remind one of the traumatic event; irritability, sleep difficulties, or hypervigilance; feelings of guilt, shame, or fear; substance use; strains on relationships; and suicidal thoughts and behaviors. These consequences can have devastating effects on the individual and their family members, friends, co-workers, peers, and communities. Effectively treating PTSD, therefore, is critical not only for the individual but also for the well-being of families, communities, and society at large. However, while treatments for PTSD exist, effectively treating patients with PTSD remains elusive. Further, despite the recognition that people's experiences are essential in understanding PTSD and provide valuable insights into what interventions are effective and how they impact recovery, patient perspectives and experiences of care and recovery have not been well-explored. We conducted a scoping review to address the following question: what is known about the experiences and perspectives of care and recovery for individuals with PTSD? We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, American Psychological Association's (APA) PsycInfo, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PTSDPubs, and Google Scholar for peer-reviewed and grey literature that used qualitative methods to report on the recovery or care experiences of adults with lived experiences of PTSD. We extracted information about study objectives, study characteristics, and key findings; reported summary statistics; and performed content and thematic analyses. We identified 14 relevant studies that provide insight into the participants' lived experiences and perspectives of PTSD care and recovery. Though limited, the body of literature sheds light on critical themes and processes in the journey of care of PTSD, which we organized into four overarching categories: pre-treatment understanding and experiences of PTSD, the experience of care or treatment, the importance of relationships and social support, and expanding the understandings of recovery. Living with and healing from PTSD are a unique and individualized human experience of developing and redeveloping relationships with oneself, with others, and with society. The recommendations for practice include educating and establishing well-informed support networks for individuals with PTSD, training healthcare practitioners in all aspects of formal and informal PTSD treatment and care needs, ensuring a continuum of care, and understanding the human experience of PTSD.
Collapse
Affiliation(s)
| | | | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, CAN
| |
Collapse
|
10
|
Modlin NL, Creed M, Sarang M, Maggio C, Rucker JJ, Williamson V. Trauma-Informed Care in Psychedelic Therapy Research: A Qualitative Literature Review of Evidence-Based Psychotherapy Interventions in PTSD and Psychedelic Therapy Across Conditions. Neuropsychiatr Dis Treat 2024; 20:109-135. [PMID: 38268571 PMCID: PMC10807282 DOI: 10.2147/ndt.s432537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/10/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) is associated with significant patient burden. While pharmacotherapies and evidence-based psychotherapy interventions (EBPI) are effective, studies consistently highlight inadequate outcomes and high treatment dropout. Psychedelic therapy (PT) has shown preliminary promise across difficult-to-treat conditions, including MDMA-assisted therapy for PTSD, however trials of classical psychedelics in PTSD are lacking. Understanding patients' experiences of EBPI could help promote safety in PT. Aim To systematically review qualitative research on patients' subjective experience of EBPI for PTSD, and of PT, and examine areas of overlap and divergence between them. Methods Systematic literature searches for studies published between 2010 and 2023 were conducted on OVID, PubMed, Web of Science, and PsycInfo. Included were original studies in English that presented qualitative data of patient experiences of EBPI in PTSD, or PT for any indication. Extracted data from included studies were analysed using thematic synthesis. Syntheses were completed separately for EBPI and PT, before similarities and differences between the therapies were identified. Results 40 research articles were included for review: 26 studies on EBPI for PTSD, and 14 studies on PT. EBPI studied were CBT, EMDR, CPT and PE. Psychedelic compounds studied were psilocybin, ibogaine, LSD, MDMA and ketamine, for treatment of substance use disorders, anxiety relating to physical illness, depression, and PTSD. Core themes from patient experiences of EBPI: 1) patient burden in PTSD treatment; 2) readiness; 3) key mechanisms of change; 4) psychological safety and trust. Themes identified in the review of PT: 1) indirect trauma processing; 2) reorganisation of self-narratives via processes of relatedness and identification; 3) key treatment characteristics. Conclusion This study suggests overlap between patients' experience of EBPI and PT in terms of key mechanisms of change, the importance of psychological safety and readiness to engage in treatment. Trauma-informed care paradigms and practices may improve safety and acceptability of PT research.
Collapse
Affiliation(s)
- Nadav Liam Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Michael Creed
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Maria Sarang
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Carolina Maggio
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - James J Rucker
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Victoria Williamson
- King’s Centre for Military Health Research, King’s College London, London, SE5 9RJ, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, OX2 6 GG, UK
| |
Collapse
|
11
|
Rothärmel M, Mekaoui L, Kazour F, Herrero M, Beetz-Lobono EM, Lengvenyte A, Holtzmann J, Raynaud P, Cuenca M, Bulteau S, de Maricourt P, Husson T, Olié E, Gohier B, Sauvaget A, Gaillard R, Richieri R, Szekely D, Samalin L, Guillin O, Moulier V, El-Hage W, Laurin A, Berkovitch L. Esketamine-induced post-traumatic stress disorder flashbacks during treatment-resistant depression indication: is it just a side effect? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.09.24300998. [PMID: 38293161 PMCID: PMC10827260 DOI: 10.1101/2024.01.09.24300998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background Posttraumatic stress disorder (PTSD) is a severe and frequent affection that is highly comorbid to major depressive disorder. Comorbid PTSD and depression are usually treatment-resistant, with a high risk of functional impairment and suicide. Esketamine nasal spray is a recent validated treatment for treatment-resistant depression (TRD), but its efficacy on comorbid TRD-PTSD remains insufficiently documented. In particular, flashbacks can occur during esketamine administration and their influence on clinical outcomes is unknown. Objectives Our main objective was to describe esketamine-induced traumatic flashbacks and their impact on clinical trajectories within a sample of patients with comorbid TRD-PTSD. Methods We retrospectively collected clinical data of patients receiving esketamine nasal spray for TRD with comorbid PTSD who experienced at least one flashback of their trauma during esketamine sessions across 11 psychiatric departments. Results Between February 2020 and March 2023, 22 adult patients with TRD met inclusion criteria. In sixteen patients (72.7%) flashbacks disappeared as the sessions progressed. In six patients (27.3%), esketamine treatment was stopped because of persistent flashbacks. When esketamine was continued, clinical response was observed both for depression and PTSD (depression response rate: 45.5% and remission rate: 22.7%; PTSD response rate: 45.5% and remission: 18.2%). Limitations The retrospective design of the study and the absence of a comparator group are the main limitations of our study. Conclusions Our results suggest that the occurrence of esketamine-induced traumatic flashbacks does not hinder clinical response. On the contrary, when managed appropriately and combined with targeted psychotherapy, it could even contribute to positive outcomes.
Collapse
Affiliation(s)
- Maud Rothärmel
- University Department of Psychiatry, Therapeutic Centre of Excellence, Institute of Psychiatry – Rouvray Hospital Centre, Sotteville-lès-Rouen, France
| | - Lila Mekaoui
- Mental and Brain Illness Clinic, Sainte-Anne Hospital, GHU Paris – Psychiatry and Neurosciences, Paris, France
| | - François Kazour
- Department of Psychiatry and Addictology, CHU Angers, Angers, France
| | - Morgane Herrero
- Department of Psychiatry, CHU Saint Etienne, Saint Etienne, France
| | | | - Aiste Lengvenyte
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Jérôme Holtzmann
- Service de Psychiatrie de l’Adulte, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, hôpital Nord, Grenoble, France
| | | | - Macarena Cuenca
- University Department of Psychiatry, Pôle Hospitalo-Universitaire Psychiatrie Paris 15, Groupe Hospitalier Universitaire Paris, Paris, France
| | - Samuel Bulteau
- Nantes Université, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France
| | - Pierre de Maricourt
- University Department of Psychiatry, Pôle Hospitalo-Universitaire Psychiatrie Paris 15, Groupe Hospitalier Universitaire Paris, Paris, France
| | - Thomas Husson
- University Department of Psychiatry, Therapeutic Centre of Excellence, Institute of Psychiatry – Rouvray Hospital Centre, Sotteville-lès-Rouen, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Bénédicte Gohier
- Department of Psychiatry and Addictology, CHU Angers, Angers, France
| | - Anne Sauvaget
- Nantes Université, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France
| | - Raphaël Gaillard
- University Department of Psychiatry, Pôle Hospitalo-Universitaire Psychiatrie Paris 15, Groupe Hospitalier Universitaire Paris, Paris, France
| | - Raphaëlle Richieri
- Service Universitaire de santé mentale et physique, Centre Expert Dépression Résistante, CHU Sainte-Marguerite, APHM, Université Aix-Marseille, Marseille, France; Aix Marseille Univ, CNRS, Centrale Marseille, Institut Fresnel, Marseille, France
| | - David Szekely
- Centre Hospitalier Princesse Grace, Service de psychiatrie, Principauté de Monaco
| | - Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Olivier Guillin
- University Department of Psychiatry, Therapeutic Centre of Excellence, Institute of Psychiatry – Rouvray Hospital Centre, Sotteville-lès-Rouen, France
- CHU Rouen, Normandy University, Rouen, France
| | - Virginie Moulier
- University Department of Psychiatry, Therapeutic Centre of Excellence, Institute of Psychiatry – Rouvray Hospital Centre, Sotteville-lès-Rouen, France
- Unité de Recherche Clinique (URC), EPS Ville Evrard, Neuilly-sur-Marne, France
| | - Wissam El-Hage
- Centre Régional de Psychotraumatologie, Centre Hospitalier Régional
- Universitaire (CHRU) de Tours, Tours, France, 3 INSERM U1253 Imagerie et Cerveau (iBrain), Tours, France
| | - Andrew Laurin
- Nantes Université, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France
| | - Lucie Berkovitch
- University Department of Psychiatry, Pôle Hospitalo-Universitaire Psychiatrie Paris 15, Groupe Hospitalier Universitaire Paris, Paris, France
- Paris Cité University, Paris, France
- Department of Psychiatry, Yale University School of Medicine, 40 Temple Street, New Haven, CT, 06511, United States
- Saclay CEA Centre, Neurospin, Gif-Sur-Yvette Cedex, France
| |
Collapse
|
12
|
Agorastos A. Thematic Selection: Stress and Stress-related Disorders Posttraumatic Stress Disorder (Part 2). Curr Neuropharmacol 2024; 22:522-523. [PMID: 38284340 PMCID: PMC10845103 DOI: 10.2174/1570159x2204231106143917] [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: 01/30/2024] Open
Affiliation(s)
- Agorastos Agorastos
- Assistant Professor of Psychiatry, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
13
|
Israel BS, Belcher AM, Ford JD. A Harm Reduction Framework for Integrated Treatment of Co-Occurring Opioid Use Disorder and Trauma-Related Disorders. J Dual Diagn 2024; 20:52-85. [PMID: 38165922 DOI: 10.1080/15504263.2023.2295416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.
Collapse
Affiliation(s)
- Benjamin S Israel
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
| |
Collapse
|
14
|
Zaretsky TG, Jagodnik KM, Barsic R, Antonio JH, Bonanno PA, MacLeod C, Pierce C, Carney H, Morrison MT, Saylor C, Danias G, Lepow L, Yehuda R. The Psychedelic Future of Post-Traumatic Stress Disorder Treatment. Curr Neuropharmacol 2024; 22:636-735. [PMID: 38284341 PMCID: PMC10845102 DOI: 10.2174/1570159x22666231027111147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 01/30/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) is a mental health condition that can occur following exposure to a traumatic experience. An estimated 12 million U.S. adults are presently affected by this disorder. Current treatments include psychological therapies (e.g., exposure-based interventions) and pharmacological treatments (e.g., selective serotonin reuptake inhibitors (SSRIs)). However, a significant proportion of patients receiving standard-of-care therapies for PTSD remain symptomatic, and new approaches for this and other trauma-related mental health conditions are greatly needed. Psychedelic compounds that alter cognition, perception, and mood are currently being examined for their efficacy in treating PTSD despite their current status as Drug Enforcement Administration (DEA)- scheduled substances. Initial clinical trials have demonstrated the potential value of psychedelicassisted therapy to treat PTSD and other psychiatric disorders. In this comprehensive review, we summarize the state of the science of PTSD clinical care, including current treatments and their shortcomings. We review clinical studies of psychedelic interventions to treat PTSD, trauma-related disorders, and common comorbidities. The classic psychedelics psilocybin, lysergic acid diethylamide (LSD), and N,N-dimethyltryptamine (DMT) and DMT-containing ayahuasca, as well as the entactogen 3,4-methylenedioxymethamphetamine (MDMA) and the dissociative anesthetic ketamine, are reviewed. For each drug, we present the history of use, psychological and somatic effects, pharmacology, and safety profile. The rationale and proposed mechanisms for use in treating PTSD and traumarelated disorders are discussed. This review concludes with an in-depth consideration of future directions for the psychiatric applications of psychedelics to maximize therapeutic benefit and minimize risk in individuals and communities impacted by trauma-related conditions.
Collapse
Affiliation(s)
- Tamar Glatman Zaretsky
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathleen M. Jagodnik
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Barsic
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josimar Hernandez Antonio
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip A. Bonanno
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carolyn MacLeod
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charlotte Pierce
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hunter Carney
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Morgan T. Morrison
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles Saylor
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Danias
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren Lepow
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
15
|
Aarts I, Vriend C, van den Heuvel OA, Thomaes K. Brain activation during an emotional task in participants with PTSD and borderline and/or cluster C personality disorders. Neuroimage Clin 2023; 41:103554. [PMID: 38128160 PMCID: PMC10777111 DOI: 10.1016/j.nicl.2023.103554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Although comorbidity of post-traumatic stress disorder (PTSD) with borderline personality disorder (BPD) and/or cluster C personality disorders (CPD) is common, neural correlates of this comorbidity are unknown. METHODS We acquired functional MRI scans during an emotional face task in participants with PTSD + CPD (n = 34), PTSD + BPD (n = 24), PTSD + BPD + CPD (n = 18) and controls (n = 30). We used ANCOVAs and Bayesian analyses on specific ROIs in a fearful vs. scrambled faces contrast. We also investigated associations with clinical measures. RESULTS There were no robust differences in brain activation between the groups with ANCOVAs. Transdiagnostically, we found a negative association between severity of dissociation and right insula and right dmPFC activation, and emotion regulation problems with right dmPFC activation. Bayesian analyses showed credible evidence for higher activation in all ROIs in the PTSD + BPD + CPD group compared to PTSD + BPD and PTSD + CPD. DISCUSSION Our Bayesian and correlation analyses support new dimensional conceptualizations of personality disorders.
Collapse
Affiliation(s)
- Inga Aarts
- Sinai Centrum, Arkin, Amstelveen, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neurosciences, Boelelaan 1117, Amsterdam, the Netherlands.
| | - Chris Vriend
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neurosciences, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, the Netherlands
| | - Odile A van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neurosciences, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, the Netherlands
| | - Kathleen Thomaes
- Sinai Centrum, Arkin, Amstelveen, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neurosciences, Boelelaan 1117, Amsterdam, the Netherlands
| |
Collapse
|
16
|
van Woudenberg C, Voorendonk EM, Tunissen B, van Beek VHF, Rozendael L, Van Minnen A, De Jongh A. The impact of intensive trauma-focused treatment on sexual functioning in individuals with PTSD. Front Psychol 2023; 14:1191916. [PMID: 37614489 PMCID: PMC10442952 DOI: 10.3389/fpsyg.2023.1191916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Background Individuals with posttraumatic stress disorder (PTSD) often experience sexual disturbances. Objective To determine whether intensive trauma-focused treatment is associated with an improvement in sexual functioning (i.e., sexual satisfaction and sexual desire) in individuals with PTSD. Method In total, 227 patients with PTSD (68.7% women, mean age = 40.97) participated in an intensive eight-day trauma-focused treatment program consisting of prolonged exposure, eye movement and desensitization and reprocessing (EMDR) therapy, physical activity, and psychoeducation. Patients were assessed (i.e., Clinician Administered PTSD Scale and Sexual Functioning Questionnaire) pre- and post-treatment and at 6-months follow-up. Results Sexual satisfaction and sexual desire increased significantly associated with trauma-focused treatment from pre-treatment to 6-months follow-up, albeit the effect sizes were small (Cohen's d = 0.39 and 0.17, respectively). Although men reported greater overall sexual desire than women, sexual functioning improved after treatment in both men and women. Furthermore, those with remission of PTSD reported greater sexual functioning post-treatment and at 6-months follow-up, than those without remission. However, changes in PTSD symptoms associated with treatment were not predictive of the level of sexual satisfaction or sexual desire 6 months after treatment. Conclusion The results of this uncontrolled study suggest that intensive treatment for PTSD can have beneficial effects on sexual satisfaction and desire in both men and women; however, this may not necessarily be due to a decrease in PTSD symptoms.
Collapse
Affiliation(s)
| | - Eline M. Voorendonk
- Research Department, PSYTREC, Bilthoven, Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
| | - Bo Tunissen
- Research Department, PSYTREC, Weert, Netherlands
| | | | | | - Agnes Van Minnen
- Research Department, PSYTREC, Bilthoven, Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
| | - Ad De Jongh
- Research Department, PSYTREC, Bilthoven, Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
- School of Psychology, Queen’s University, Belfast, United Kingdom
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
| |
Collapse
|
17
|
Lynch JH, Mulvaney SW, Bryan CJ, Hernandez D. Stellate Ganglion Block Reduces Anxiety Symptoms by Half: A Case Series of 285 Patients. J Pers Med 2023; 13:958. [PMID: 37373947 DOI: 10.3390/jpm13060958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
The stellate ganglion block (SGB) procedure has been used successfully for over twelve years to treat thousands of patients suffering from posttraumatic stress disorder (PTSD). Level 1b evidence supports this use of SGB, but no studies to date have reported specifically on anxiety symptom improvements following SGB. We collected Generalized Anxiety Disorder questionnaire (GAD-7) scores pre-procedure and at 1-week and 1-month post-procedure from 285 patients. The mean baseline GAD-7 score of 15.9 (indicating severe anxiety) declined significantly following SGB treatment. Changes in GAD-7 scores ≥ 4 were considered clinically meaningful. From baseline to 1 week, the GAD-7 scores dropped by 9.0 points (95% CI = 8.3-9.7, p < 0.001, d = 1.8), with 211 (79.6%) patients demonstrating clinically meaningful improvement. Furthermore, from baseline to 1 month, the GAD-7 scores dropped by 8.3 points (95% CI = 7.6-9.0, p < 0.001, d = 1.7), with 200 (75.5%) patients demonstrating clinically meaningful improvement. The stellate ganglion block treatment resulted in a decrease of GAD-7 scores of over twice the minimal clinically important difference in treating anxiety for at least 1 month following SGB. Given the results from this retrospective observational study, larger prospective studies should be conducted to determine the effects of SGB treatment as a novel therapeutic treatment for generalized anxiety disorder and other anxiety disorders.
Collapse
Affiliation(s)
- James H Lynch
- The Stellate Institute, 116 Defense Highway, Suite 203, Annapolis, MD 21401, USA
| | - Sean W Mulvaney
- The Stellate Institute, 116 Defense Highway, Suite 203, Annapolis, MD 21401, USA
| | - Craig J Bryan
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - David Hernandez
- The Retreat at Sheppard Pratt, 6501 N Charles Street, Baltimore, MD 21204, USA
| |
Collapse
|