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Rosenstand NJ, Nielsen AS, Skøt L, Anhøj S, Nielsen DG, Højlund M, Mellentin AI. Pharmacological Treatment of Alcohol use Disorder in Patients with Psychotic Disorders: A Systematic Review. Curr Neuropharmacol 2024; 22:1129-1143. [PMID: 36582063 DOI: 10.2174/1570159x21666221229160300] [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: 07/08/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients with psychotic disorders (PD) often have comorbid alcohol use disorder (AUD), which is typically treated pharmacologically. Up till now, no systematic review has examined the effectiveness and safety of AUD treatment in PD patients. OBJECTIVES This study aimed to systematically review the literature on (1) the effects of pharmacological treatments for AUD on drinking outcomes, (2) the side effects of the drugs, and (3) the effects of polypharmacy in patients with comorbid AUD and PD. METHODS Bibliographic searches were conducted in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO. At least two reviewers extracted the data, assessed the risk of bias, and performed the qualitative synthesis of the collected evidence. RESULTS Twelve eligible studies were identified, half being randomized controlled trials (RCTs). Three studies examined disulfiram, nine naltrexone, two acamprosate, and one nalmefene by comparing the effects of treatment to placebo, baseline, or pharmacological agents. Disulfiram and naltrexone were shown to reduce alcohol intake. Regarding acamprosate, the findings were mixed. Nalmefene decreased alcohol intake. All pharmacological agents appeared safe to use as AUD monotherapy, but cardiac events were reported when combining naltrexone and disulfiram. Nine studies had a high risk of bias, and three had some other concerns. CONCLUSION The studies provide tentative support for the use of naltrexone and disulfiram in this population, although combinations of pharmacological AUD treatments and other polypharmacy remain unexplored. The studies had high adherence rates that are hardly replicable in real-world settings. Thus, the findings should be confirmed in larger high quality efficacy and effectiveness RCTs with longer follow-ups.
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Affiliation(s)
- Niels Jørgen Rosenstand
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Psychiatry, Odense University Hospital, Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), University of Southern Denmark, Odense, Denmark
| | - Lotte Skøt
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Simon Anhøj
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Psychiatry, Region of Southern Denmark, Svendborg, Denmark
| | - Dorthe Grüner Nielsen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Drug Treatment Center Odense, Odense C, Denmark
| | - Mikkel Højlund
- Drug Treatment Center Odense, Odense C, Denmark
- Department of Psychiatry Aabenraa, Mental Health Services in the Region of Southern Denmark, Aabenraa, Denmark
| | - Angelina Isabella Mellentin
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Department of Psychiatry, Odense University Hospital, Region of Southern Denmark, Odense, Denmark
- Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense, Denmark
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Williams MW, King-Casas B, Chiu PH, Sciarrino N, Estey M, Hunt C, McCurry K, Graham DP. Do early responders and treatment non-responders offer guidance to make CPT group a more effective treatment? J Clin Psychol 2022; 78:1376-1387. [PMID: 35170058 DOI: 10.1002/jclp.23307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/26/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Treatment dropout has been problematic with evidence-based treatments for posttraumatic stress disorder (PTSD), including cognitive processing therapy (CPT). This study sought to evaluate whether CPT group contributed to symptom improvement among treatment completers and non-completers. METHODS Sixty-one Iraq and Afghanistan combat Veterans self-selected CPT group or treatment as usual (TAU) forming a convenience sample. Defining treatment completion as attending at least nine sessions: 18 completed treatment, 20 dropped-out (DOs); 20 completed TAU, 3 lost to TAU follow-up. RESULTS Multiple Regression revealed significant pre-post-treatment improvement, the Clinician-Administered PTSD Scale (CAPS-IV, F(5, 40.1) = 2.53, p = 0.0436). Reviewing DOs' last available PTSD Checklist-Military Version scores before leaving treatment, six achieved clinically significant improvement of >10 points; seven a clinically reliable change of 5-10 points. CONCLUSION These findings highlight that CPT group may be effective at reducing trauma-related symptoms among treatment completers and dropouts and point to the utility of a clinical definition of good treatment end-state.
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Affiliation(s)
- M Wright Williams
- PTSD Clinical Team, Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Brooks King-Casas
- Research Service Line, Salem Veterans Affairs Medical Center, Salem, Virginia, USA.,Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia, USA
| | - Pearl H Chiu
- Research Service Line, Salem Veterans Affairs Medical Center, Salem, Virginia, USA.,Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia, USA
| | - Nicole Sciarrino
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | | | - Christopher Hunt
- PTSD Clinical Team, Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Department of Psychology, Clinical Division, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Katherine McCurry
- Research Service Line, Salem Veterans Affairs Medical Center, Salem, Virginia, USA.,Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia, USA
| | - David P Graham
- PTSD Clinical Team, Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.,Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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Brager A, Hosamane N, Ritland B, Capaldi V, Simonelli G. Geographically based risk assessment of sleep disorders and disease states impacting medical readiness across active duty army installations from military medical databases in fiscal year 2017. Sleep Health 2020; 7:31-36. [PMID: 33020028 DOI: 10.1016/j.sleh.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/15/2020] [Accepted: 07/19/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The impact of sleep disorders on active duty Soldiers' medical readiness is clinically significant. Sleep disorders often present high comorbidity with disease states impacting readiness ranging from obesity and drug dependence. Patient data generated from military health databases can be accessed to examine such relationships. The current study performed a risk assessment of sleep disorders, obesity, tobacco use, and substance abuse based on geographical distribution of active duty Army installations through a comprehensive analysis of the Office of the Army Surgeon General Health of the Force report, specifically for Fiscal Year 2017, which summarizes data collected during 2016. METHODS Health incidences (percent active duty per installation) were queried from the Health of the Force Fiscal Year 2017 (n = 471,000; 85.5% male, >70% between 18 and 34). Nonparametric ranked tests identified active duty Army installations at low risk (green; <25% percentile relative to mean rank), moderate risk (amber; 25%-50% percentile relative to mean rank), and high risk (red; >75% percentile relative to mean rank). Pearson's correlations determined extent of generalized comorbidity of sleep disorders with obesity, tobacco use, and substance abuse across all installations. RESULTS Large combat arms and training installations of the Southern U.S. were at highest risk for sleep disorder. Mean rank comparisons for sleep disorders versus obesity (P = .306), tobacco use (P = .378), and substance abuse (P = .591) did not differ for each installation. There was a high degree of generalized comorbidity of diagnosed sleep disorder with obesity (P < .001; r2 = 0.963), tobacco use (P < .001; r2 = 0.928), and substance abuse (P < .001; r2 = 0.968). CONCLUSIONS These risk assessments mirror geographical risk data from civilian populations which is surprising because there is a large degree of inter-individual variability in geographical origin, race/ethnicity, and socioeconomic statuses within a single Army installation. Nevertheless, these data demonstrate strong geographical influences on medical readiness in active duty Soldiers comparable to civilian sectors.
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Affiliation(s)
- Allison Brager
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
| | - Nishitha Hosamane
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Bradley Ritland
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Vincent Capaldi
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Guido Simonelli
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA; Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, Canada; Department of Psychology, Université de Montréal, Montreal, Canada
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Sciarrino NA, Moschetto JM, Choquette EM, Davis BC, Bannister JA. Understanding the impact of attachment insecurity on PTSD symptoms among male Veterans and military personnel. MILITARY PSYCHOLOGY 2020; 32:379-389. [PMID: 38536335 PMCID: PMC10013455 DOI: 10.1080/08995605.2020.1774322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/22/2020] [Indexed: 10/23/2022]
Abstract
Attachment insecurity (i.e., attachment anxiety and attachment avoidance) has been found to contribute to PTSD symptom severity in Veterans. However, little is known of the unique contribution of attachment insecurity on individual PTSD symptom clusters. In a community sample of 106 combat-deployed Veterans, active duty service members, and reservists, this study examined: (1) the relationships between childhood family experience, combat experience, attachment insecurity, and PTSD symptom clusters, and (2) the influence of attachment insecurity on PTSD symptom clusters. Results revealed significant correlations between attachment anxiety and all PTSD symptom clusters (rs = .22 -.43) and attachment avoidance and PTSD symptom clusters, except the avoidance cluster (rs = .21 -.36). Four multiple regression analyses were employed to address the second study aim. Childhood family experiences predicted negative alterations in cognitions and mood (β = -.30) and alterations in arousal and reactivity (β = -.20). Further, combat experience significantly predicted each symptom cluster of PTSD (βs = .03 -.44). In the second step, attachment anxiety and attachment avoidance were added to each model. Attachment anxiety and attachment avoidance predicted negative alterations in cognitions and mood (βs = .22 and .35) and alterations in arousal and reactivity (βs = .27 and .17). Inconsistent with previous research, attachment insecurity did not predict symptoms of avoidance. These results highlight the impact of attachment among a diverse sample of trauma exposed individuals and may provide insights for clinical implications and therapeutic approaches when working with Veterans and military personnel high in attachment insecurity.
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Affiliation(s)
- Nicole A. Sciarrino
- James A. Haley Veterans’ Hospital, Tampa, Florida
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | | | | | - Brittany C. Davis
- James A. Haley Veterans’ Hospital, Tampa, Florida
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida
| | - Jenny A. Bannister
- James A. Haley Veterans’ Hospital, Tampa, Florida
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida
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Taylor S, Miller BL, Tallapragada M, Vogel M. Veterans’ Transition Out of the Military and Knowledge of Mental Health Disorders. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i1.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Teachman J, Tedrow L. Delinquent behavior, the transition to adulthood, and the likelihood of military enlistment. SOCIAL SCIENCE RESEARCH 2014; 45:46-55. [PMID: 24576626 PMCID: PMC3938863 DOI: 10.1016/j.ssresearch.2013.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 12/24/2013] [Accepted: 12/29/2013] [Indexed: 06/03/2023]
Abstract
Using data taken from the 1997 National Longitudinal Survey of Youth we examine the relationship between delinquency and enlistment in the military. We argue that delinquent behavior is positively related to enlistment because military service is an attractive alternative for delinquents to mark their transition to adulthood and their desistance from delinquent behavior. We also argue, however, that this relationship is not linear, with higher levels of delinquent behavior actually acting to reduce the likelihood of enlistment. We further suggest that the relationship between delinquency and enlistment is similar for men and women. We test and find support for our hypotheses using data taken from the 1997 National Longitudinal Survey of Youth.
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Affiliation(s)
- Jay Teachman
- Department of Sociology, Western Washington University, Bellingham, WA, United States.
| | - Lucky Tedrow
- Department of Sociology, Western Washington University, Bellingham, WA, United States
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