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Lappas AS, Glarou E, Polyzopoulou ZA, Goss G, Huhn M, Samara MT, Christodoulou NG. Pharmacotherapy for sleep disturbances in post-traumatic stress disorder (PTSD): A network meta-analysis. Sleep Med 2024; 119:467-479. [PMID: 38795401 DOI: 10.1016/j.sleep.2024.05.032] [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: 03/12/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND Sleep disturbances are an important symptom dimension of post-traumatic-stress-disorder (PTSD). There is no meta-analytic evidence examining the effects of all types of pharmacotherapy on sleep outcomes among patients with PTSD. METHODS Medline/Embase/PsychInfo/CENTRAL/clinicaltrials.gov/ICTRP, reference lists of published reviews and all included studies were searched for Randomised Controlled Trials (RCTs) examining any pharmacotherapy vs. placebo or any other drug among patients with PTSD. PRIMARY OUTCOMES total sleep time, nightmares, sleep quality. SECONDARY OUTCOMES sleep onset latency, number of nocturnal awakenings, time spent awake following sleep onset, dropouts due to sleep-related adverse-effects, insomnia/somnolence/vivid-dreams as adverse-effects. Pairwise and network meta-analyses were performed. RESULTS 99 RCTs with 10,481 participants were included. Prazosin may be the most effective treatment for insomnia (SMD = -0.88, 95%CI = [-1.22;-0.54], nightmares (SMD = -0.44, 95%CI = [-0.84;-0.04]) and poor sleep quality (SMD = -0.55, 95%CI = [-1.01;-0.10]). Evidence is scarce and indicates lack of efficacy for SSRIs, Mirtazapine, z-drugs and benzodiazepines, which are widely used in daily practice. Risperidone and Quetiapine carry a high risk of causing somnolence without having a clear therapeutic benefit. Hydroxyzine, Trazodone, Nabilone, Paroxetine and MDMA-assisted psychotherapy may be promising options, but more research is needed. CONCLUSIONS Underpowered individual comparisons and very-low to moderate confidence in effect estimates hinder the generalisability of the results. More RCTs, specifically reporting on sleep-related outcomes, are urgently needed.
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Affiliation(s)
- Andreas S Lappas
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa, Greece; Aneurin Bevan University Health Board, Wales, United Kingdom.
| | - Eleni Glarou
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom; Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Zoi A Polyzopoulou
- Department of Psychology, University of Western Macedonia, Florina, Greece
| | - Grace Goss
- Cwm Taf Morgannwg University Health Board, Wales, United Kingdom
| | - Maximillian Huhn
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, District Hospital Bayreuth/Psychiatric Health Care Facilities of Upper Franconia, Bayreuth, Germany
| | - Myrto T Samara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa, Greece; Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Nikos G Christodoulou
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa, Greece
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Boltivets S, Gonchar T, Gonchar O, Uralova L, Chelyadyn Y. Neurotic Disorders in Children and Adults Under Social Stress Neurosis in Kids and Adults: Social Stress. J Nerv Ment Dis 2024; 212:317-324. [PMID: 38536041 DOI: 10.1097/nmd.0000000000001774] [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: 05/31/2024]
Abstract
ABSTRACT The relevance of the research subject is to explore the neurotic disorders that arise in people affected by the Russian-Ukrainian war and who witness violence and war crimes. The purpose of the research is to reflect the specific features of the mental reaction of children and adults to military actions as an example of global social stress. Bibliographic, bibliosemantic, and statistical research methods were used in the research. Since the beginning of the full-scale invasion, the number of patients with prolonged depression and schizophrenia has increased, and neurotic disorders has become more severe and acute. Particular attention should be devoted to assistance to military personnel who have been in the combat zone for a long time and former military prisoners of war. Attention should be devoted to the psyche, emotionality, and behavior of people with labile and unformed nervous systems-children, adolescents, pregnant women, and people of retirement age.
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Affiliation(s)
- Sergii Boltivets
- Department of Youth Policy Development, State Institute of Family and Youth Policy of Ukraine
| | - Tymur Gonchar
- Departments of Psychiatry, Psychotherapy, and Medical Psychology
| | - Oleksiy Gonchar
- Radiology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Lyudmila Uralova
- Departments of Psychiatry, Psychotherapy, and Medical Psychology
| | - Yuliya Chelyadyn
- Departments of Psychiatry, Psychotherapy, and Medical Psychology
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Murad ST, Hansen AL, Sim LA, Murad MH. Heterogeneity in Treatment Effect in Posttraumatic Stress Syndrome Trials: A Meta-Regression Analysis. Mayo Clin Proc Innov Qual Outcomes 2024; 8:301-307. [PMID: 38832354 PMCID: PMC11144657 DOI: 10.1016/j.mayocpiqo.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Objective To evaluate the heterogeneity in treatment effect in posttraumatic stress disorder (PTSD) trials. Patients and Methods We downloaded data from a publicly available repository that captured PTSD trials published from January 1988 through February 2023. We applied restricted maximum-likelihood random-effect meta-analyses and meta-regression to explore potential moderators of treatment effect including methodologic study features (risk of bias domains and control group response rate), characteristics of the population, and intervention features following the theme, intensity, and platform framework. Results We included 199 PTSD trials that reported the outcomes of diagnosis resolution (122 trials, 8437 patients) and clinically meaningful improvement (133 trials, 9895 patients). Multiple treatments demonstrated effectiveness but with significant heterogeneity. Statistically significant moderators included risk of bias domains of randomization sequence and outcome measurement, control group response rate reflecting severity of PTSD in the enrolled population, and whether the psychotherapeutic approach was trauma focused (P values <0.05). There was no statistically significant effect for the frequency of treatments per week, format of the intervention (eg, individual vs group), duration of the intervention, or delivery method (in person vs not), (P values <0.05). Characteristics of the population such as sex, age, and military status did not appear to significantly affect the treatment effect (P values <0.05). Conclusion Trauma focused psychotherapies should be considered the first-line intervention to induce remission. Several patient characteristics or treatment context did not modify the treatment effect, which allows tailoring care based on patient values, preferences and logistics.
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Affiliation(s)
- Sammy T. Murad
- College of Liberal Arts, University of Minnesota, Minneapolis, MN
| | | | - Leslie A. Sim
- Department of Psychiatry and PsychologyMayo Clinic, Rochester, MN
| | - M. Hassan Murad
- Evidence-based Practice Center, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN
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Andrews SR, Harch PG. Systematic review and dosage analysis: hyperbaric oxygen therapy efficacy in the treatment of posttraumatic stress disorder. Front Neurol 2024; 15:1360311. [PMID: 38882688 PMCID: PMC11179433 DOI: 10.3389/fneur.2024.1360311] [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: 12/22/2023] [Accepted: 05/08/2024] [Indexed: 06/18/2024] Open
Abstract
Background Studies of hyperbaric oxygen therapy (HBOT) treatment of mild traumatic brain injury persistent postconcussion syndrome in military and civilian subjects have shown simultaneous improvement in posttraumatic stress disorder (PTSD) or PTSD symptoms, suggesting that HBOT may be an effective treatment for PTSD. This is a systematic review and dosage analysis of HBOT treatment of patients with PTSD symptoms. Methods PubMed, CINAHL, and the Cochrane Systematic Review Database were searched from September 18 to November 23, 2023, for all adult clinical studies published in English on HBOT and PTSD. Randomized trials and studies with symptomatic outcomes were selected for final analysis and analyzed according to the dose of oxygen and barometric pressure on symptom outcomes. Outcome assessment was for statistically significant change and Reliable Change or Clinically Significant Change according to the National Center for PTSD Guidelines. Methodologic quality and bias were determined with the PEDro Scale. Results Eight studies were included, all with < 75 subjects/study, total 393 subjects: seven randomized trials and one imaging case-controlled study. Six studies were on military subjects, one on civilian and military subjects, and one on civilians. Subjects were 3-450 months post trauma. Statistically significant symptomatic improvements, as well as Reliable Change or Clinically Significant changes, were achieved for patients treated with 40-60 HBOTS over a wide range of pressures from 1.3 to 2.0 ATA. There was a linear dose-response relationship for increased symptomatic improvement with increasing cumulative oxygen dose from 1002 to 11,400 atmosphere-minutes of oxygen. The greater symptomatic response was accompanied by a greater and severe reversible exacerbation of emotional symptoms at the highest oxygen doses in 30-39% of subjects. Other side effects were transient and minor. In three studies the symptomatic improvements were associated with functional and anatomic brain imaging changes. All 7 randomized trials were found to be of good-highest quality by PEDro scale scoring. Discussion In multiple randomized and randomized controlled clinical trials HBOT demonstrated statistically significant symptomatic improvements, Reliable Changes, or Clinically Significant Changes in patients with PTSD symptoms or PTSD over a wide range of pressure and oxygen doses. The highest doses were associated with a severe reversible exacerbation of emotional symptoms in 30-39% of subjects. Symptomatic improvements were supported by correlative functional and microstructural imaging changes in PTSD-affected brain regions. The imaging findings and hyperbaric oxygen therapy effects indicate that PTSD can no longer be considered strictly a psychiatric disease.
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Affiliation(s)
- Susan R Andrews
- Neuropsychological Services for Children and Adults, Metairie, LA, United States
| | - Paul G Harch
- Section of Emergency and Hyperbaric Medicine, Department of Medicine, LSU Health Sciences Center, New Orleans, LA, United States
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Bachem R, Maercker A, Levin Y, Köhler K, Willmund G, Bohus M, Koglin S, Roepke S, Schoofs N, Priebe K, Wülfing F, Schmahl C, Stadtmann MP, Rau H, Augsburger M. Assessing complex PTSD and PTSD: validation of the German version of the International Trauma Interview (ITI). Eur J Psychotraumatol 2024; 15:2344364. [PMID: 38687289 PMCID: PMC11062267 DOI: 10.1080/20008066.2024.2344364] [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: 05/16/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
Background: With the introduction of the ICD-11 into clinical practice, the reliable distinction between Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) becomes paramount. The semi-structured clinician-administered International Trauma Interview (ITI) aims to close this gap in clinical and research settings.Objective: This study investigated the psychometric properties of the German version of the ITI among trauma-exposed clinical samples from Switzerland and Germany.Method: Participants were 143 civilian and 100 military participants, aged M = 40.3 years, of whom 53.5% were male. Indicators of reliability and validity (latent structure, internal reliability, inter-rater agreement, convergent and discriminant validity) were evaluated. Confirmatory factor analysis (CFA) and partial correlation analysis were conducted separately for civilian and military participants.Results: Prevalence of PTSD was 30% (civilian) and 33% (military) and prevalence of CPTSD was 53% (civilians) and 21% (military). Satisfactory internal consistency and inter-rater agreement were found. In the military sample, a parsimonious first-order six-factor model was preferred over a second-order two-factor CFA model of ITI PTSD and Disturbances in Self-Organization (DSO). Model fit was excellent among military participants but no solution was supported among civilian participants. Overall, convergent validity was supported by positive correlations of ITI PTSD and DSO with DSM-5 PTSD. Discriminant validity for PTSD symptoms was confirmed among civilians but low in the military sample.Conclusions: The German ITI has shown potential as a clinician-administered diagnostic tool for assessing ICD-11 PTSD and CPTSD in primary care. However, further exploration of its latent structure and discriminant validity are indicated.
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Affiliation(s)
- Rahel Bachem
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Yafit Levin
- School of Social Work, Ariel University, Ariel, Israel
| | - Kai Köhler
- Bundeswehr Center for Military Mental Health, Berlin, Germany
| | - Gerd Willmund
- Bundeswehr Center for Military Mental Health, Berlin, Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Stefanie Koglin
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Nikola Schoofs
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Kathlen Priebe
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Wülfing
- Department of Psychiatry and Neurosciences, Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Manuel P. Stadtmann
- Eastern Switzerland University of Applied Sciences, Competence Centre for Mental Health, St. Gallen, Switzerland
| | - Heinrich Rau
- Bundeswehr Center for Military Mental Health, Berlin, Germany
| | - Mareike Augsburger
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
- Klenico Health AG, University of Zurich startup, Zürich, Switzerland
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Karatzias T, Shevlin M, Cloitre M, Busuttil W, Graham K, Hendrikx L, Hyland P, Biscoe N, Murphy D. Enhanced Skills Training in Affective and Interpersonal Regulation versus Treatment as Usual for ICD-11 Complex PTSD: A Pilot Randomised Controlled Trial (The RESTORE Trial). PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:203-215. [PMID: 38688242 DOI: 10.1159/000538428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/16/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Complex PTSD (CPTSD) is a relatively new condition in ICD-11. This pilot randomised controlled trial aimed to compare a four-module intervention developed to target all symptoms of ICD-11 CPTSD, namely Enhanced Skills in Affective and Interpersonal Regulation (ESTAIR) with treatment as usual (TAU). The purpose of the study was to assess feasibility, safety, acceptability, and preliminary outcomes at the end of treatment and 3-month follow-up. METHODS A total of N = 56 eligible veterans with CPTSD were randomised to either ESTAIR (n = 28) or TAU (n = 28). Linear mixed models were conducted to assess CPTSD severity, the primary outcome, as measured by the International Trauma Questionnaire (ITQ). RESULTS Treatment dropout in ESTAIR and TAU was low and equivalent (18% vs. 11%; χ2 (1) = 1.19, p = 0.275), and study retention was high, supporting the feasibility of the study. No serious adverse effects and very few adverse effects occurred, none of which were deemed related to the study. ESTAIR provided significantly greater reduction in CPTSD severity across time for ITQ PTSD (p < 0.001) and DSO (p < 0.001) symptoms. CPTSD pre-to-post effect sizes for ESTAIR were large (PTSD d = 1.78; DSO d = 2.00). Remission of probable CPTSD diagnosis at post-treatment was substantially greater in ESTAIR compared to TAU with only 13.6% versus 84% (p < 0.001) retaining the diagnosis. CONCLUSION A trial of ESTAIR versus TAU for the treatment of ICD-11 CPTSD indicates the potential efficacy of ESTAIR as well as its feasibility, safety, and acceptability.
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Affiliation(s)
- Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- NHS Lothian Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Northern Ireland, UK
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, California, USA
| | | | | | | | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Dominic Murphy
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA
- King's Centre for Military Research, Kings College London, London, UK
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Wigard I, Meyerbröker K, Ehring T, Topper M, Arntz A, Emmelkamp P. Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial. Eur J Psychotraumatol 2024; 15:2332104. [PMID: 38629403 PMCID: PMC11025408 DOI: 10.1080/20008066.2024.2332104] [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: 05/02/2023] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
Abstract
Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..
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Affiliation(s)
- I. Wigard
- Parnassiagroep, Amsterdam, the Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - K. Meyerbröker
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
- Altrecht Academic Anxiety Centre, Utrecht, the Netherlands
| | - T. Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - M. Topper
- GGZ-Noord-Holland-Noord, Alkmaar, the Netherlands
| | - A. Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - P. Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Chu YC, Wang HH, Chou FH, Hsu YF, Liao KL. Outcomes of trauma-informed care on the psychological health of women experiencing intimate partner violence: A systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2024; 31:203-214. [PMID: 37697899 DOI: 10.1111/jpm.12976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Women are more likely to experience intimate partner violence (IPV) than men; 19.2%-69.0% of women have experienced IPV, and the percentage is increasing. Survivors of IPV suffer from physical, psychological, social and reproductive health problems and numerous adverse health consequences such as post-traumatic stress disorder, depression and anxiety. These are considered IPV comorbidities, especially among women. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study reviews and reinforces existing scientific knowledge regarding the application of trauma-informed care (TIC), including intervention content or type, frequency, duration of session and length. This study focused on the effects of TIC. Furthermore, it examines short-term (3 months) and medium-term (6 months) outcome effects, which are more significant for clinical practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Development of a standardized protocol to address specific needs for TIC in IPV care settings. Among multidisciplinary teams, nurses are the ideal professionals to support women experiencing IPV. They can understand their traumatic experiences better, improve their therapeutic relationships and engage patients in collaborative care. ABSTRACT INTRODUCTION: Post-traumatic stress disorder (PTSD), depression and anxiety are considered intimate partner violence (IPV) comorbidities, especially among women. Trauma-informed care (TIC) is the most common element of IPV care. AIM This study analysed the short-term (3 months) and medium-term (6 months) outcomes of TIC on PTSD, depression and anxiety in women experiencing IPV. METHOD The Preferred Items for Systematic Reviews and Meta-Analysis guidelines were followed, and databases were searched from their inception to September 2022. RESULTS Thirteen randomized controlled trials included 850 women randomly assigned to the TIC and usual care groups. Overall, TIC showed a superior psychological health-improving effect. Depression and anxiety significantly improved after treatment and at three and 6 months. No difference was observed in PTSD between the two groups at 3 and 6 months. DISCUSSION The growing evidence demonstrates that the lack of IPV intervention effects reported by reviews may be due to the attributes of PTSD, heterogeneity of TIC intervention design and components of TIC. Therefore, its clinical efficacy remains inconclusive. IMPLICATIONS FOR PRACTICE We analysed studies by stratifying intervention frequencies of once or twice a week. Regardless of the intervention frequency, length and design, PTSD decreased immediately after the TIC intervention. However, a significant difference in depression was observed after a TIC intervention of above 9 weeks.
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Affiliation(s)
- Yi-Chin Chu
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiu-Hung Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Fen Hsu
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuei-Lin Liao
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Poli A, Miccoli M. Validation of the Italian version of the Neuroception of Psychological Safety Scale (NPSS). Heliyon 2024; 10:e27625. [PMID: 38533067 PMCID: PMC10963227 DOI: 10.1016/j.heliyon.2024.e27625] [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: 03/19/2023] [Revised: 02/18/2024] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
Research on the neuroscience of fear in both humans and non-humans has suggested that a lack of acquisition of safety cues might be a biological hallmark of posttraumatic stress disorder (PTSD). Danger perception, and in particular, feeling as one's own life is in danger, is thought to represent a major predictor of PTSD. Persistent danger perception is concurrently associated with a persistence of lack of safety. However, despite several research efforts, no validated psychometric tools exist regarding psychological safety as a unique core construct in the domain of a soothing-contentment system. By including social, compassionate, and bodily components, the Neuroception of Psychological Safety Scale (NPSS), neurophysiologically rooted in the polyvagal theory, aims to specifically assess psychological safety. Originally developed in English, we employed a rather large non clinical sample to validate our Italian translation of the NPSS (n = 338) and the scale was found to retain a three-factor structure. In light of its positive moderate correlations with the Unconditional Self-Kindness Scale (ρ = 0.376) and the Self-Compassion Scale-Short-Form (ρ = 0.481), good convergent validity and robust psychometric properties were shown by the NPSS. The Subjective Traumatic Outlook Questionnaire (ρ = -0.283) and the three subscales of the Body Perception Questionnaire-22-Body Awareness (ρ = -0.103), Supradiaphragmatic Reactivity (ρ = -0.234), and Body Awareness/Subdiaphragmatic Reactivity (ρ = -0.146)-were found to have weak negative correlations with the NPSS, which further demonstrated its good discriminant validity. Eventually, the NPSS was found to show good test-retest reliability (intraclass correlation coefficient = 0.922; three-week time interval), and its usage is fostered in clinical and research contexts where the evaluation of psychological safety is of relevance.
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Affiliation(s)
- Andrea Poli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126, Pisa, Italy
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Al-Shargie F, Taresh SM, Al-Ezzi A. Mental Stress and Cognitive Deficits Management. Brain Sci 2024; 14:316. [PMID: 38671968 PMCID: PMC11047847 DOI: 10.3390/brainsci14040316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 04/28/2024] Open
Abstract
Mental stress is a prevalent aspect of contemporary life that affects individuals from diverse backgrounds [...].
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Affiliation(s)
- Fares Al-Shargie
- Electrical Engineering, American University of Sharjah, Sharjah P.O. Box 26666, United Arab Emirates
- Alfares for Research and Development Consultancy, Dubai 341041, United Arab Emirates
| | - Sahar Mohammed Taresh
- Faculty of Social Science, Arts and Humanities, Lincoln University College, Petaling Jaya 47301, Malaysia;
| | - Abdulhakim Al-Ezzi
- Neurosciences, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
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11
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O'Donald F, Gunter E, Castle A, Warner R, Moore F. An evaluation of survive and thrive: a 10-week group psychoeducational course for adult interpersonal trauma survivors in Scotland. Cogn Behav Ther 2024:1-18. [PMID: 38525889 DOI: 10.1080/16506073.2024.2333961] [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: 12/11/2023] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
Emerging evidence supports a phased approach to trauma treatment, including manualised group-based interventions, to facilitate symptom reduction resulting from complex trauma sequelae. This study investigates the efficacy of Survive and Thrive, a 10-week group psychoeducational course for adult survivors of interpersonal trauma. Between August 2019 and February 2022, participants were enrolled on the course. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and Difficulties in Emotion Regulation Scale-Short Form (DERS-SF) were administered pre-intervention and immediately post-intervention. In addition, thematic analysis was applied to qualitative feedback. Results revealed significant reductions in CORE-OM and DERS-SF scores post-intervention, with minimal variability in scores attributed to group delivery (either face-to-face or online). The thematic analysis demonstrated that normalising trauma symptoms and providing coping skills positively impacted participants' experiences. At the same time, the breadth and nature of the content were observed to be an occasional barrier to engagement. In summary, this study proposes that group-based psychoeducational interventions are generally effective for those with mild-to-moderate symptoms of complex trauma. However, further evidence is needed to offer more nuanced recommendations for identifying individuals who may benefit the most from these interventions.
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Affiliation(s)
- Frederick O'Donald
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
- School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Elise Gunter
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
| | - Ailie Castle
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
| | - Rachel Warner
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
| | - Fhionna Moore
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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12
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Wells M, Karl A, Handley R. Feasibility, acceptability and clinical benefit of a trauma-focused stabilisation group for post-traumatic stress disorder patients with complex presentations on primary care waitlists. Behav Cogn Psychother 2024; 52:119-134. [PMID: 37877221 DOI: 10.1017/s1352465823000486] [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] [Indexed: 10/26/2023]
Abstract
BACKGROUND Large numbers of people showing complex presentations of post-traumatic stress disorder (PTSD) in the NHS Talking Therapies services routinely require multi-faceted and extended one-to-one National Institute of Clinical Excellence (NICE) recommended treatment approaches. This can lead to longer waits for therapy and prolong patient suffering. We therefore evaluated whether a group stabilisation intervention delivered to patients on the waitlist for individual trauma-focused psychological treatment could help address this burden. AIMS The study aimed to ascertain a trauma-focused stabilisation group's acceptability, feasibility, and preliminary clinical benefit. METHOD AND RESULTS Fifty-eight patients with PTSD waiting for trauma-focused individual treatment were included in the study. Two therapists delivered six 5-session groups. The stabilisation group was found to be feasible and acceptable. Overall, PTSD symptom reduction was medium to large, with a Cohen's d of .77 for intent-to-treat and 1.05 for per protocol analyses. Additionally, for depression and anxiety, there was minimal symptom deterioration. CONCLUSIONS The study provided preliminary evidence for the acceptability, feasibility and clinical benefit of attending a psychoeducational group therapy whilst waiting for one-to-one trauma therapy.
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Affiliation(s)
- Michelle Wells
- Plymouth Options, Plymouth, UK
- College of Life and Environmental Sciences (CLES), Psychology, University of Exeter, Exeter, UK
| | - Anke Karl
- College of Life and Environmental Sciences (CLES), Psychology, University of Exeter, Exeter, UK
| | - Rachel Handley
- College of Life and Environmental Sciences (CLES), Psychology, University of Exeter, Exeter, UK
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13
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Samson JA, Newkirk TR, Teicher MH. Practitioner Review: Neurobiological consequences of childhood maltreatment - clinical and therapeutic implications for practitioners. J Child Psychol Psychiatry 2024; 65:369-380. [PMID: 37609790 DOI: 10.1111/jcpp.13883] [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] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Childhood maltreatment is one of the most important preventable risk factors for a wide variety of psychiatric disorders. Further, when psychiatric disorders emerge in maltreated individuals they typically do so at younger ages, with greater severity, more psychiatric comorbid conditions, and poorer response to established treatments, resulting in a more pernicious course with an increased risk for suicide. Practitioners treating children, adolescents, and young adults with psychiatric disorders will likely encounter the highest prevalence of clients with early-onset maltreatment-associated psychiatric disorders. These may be some of their most challenging cases. METHOD In this report, we explore key validated alterations in brain structure, function, and connectivity associated with exposure to childhood maltreatment as potential mechanisms behind their patients' clinical presentations. RESULTS We then summarize key behavioral presentations likely associated with neurobiological alterations and propose a toolkit of established trauma and skills-based strategies that may help diminish symptoms and foster recovery. We also discuss how some of these alterations may serve as latent vulnerability factors for the possible development of future psychopathology. CONCLUSIONS Research on the neurobiological consequences of childhood adversity provides a vastly enriched biopsychosocial understanding of the developmental origins of health and pathology that will hopefully lead to fundamental advances in clinical psychology and psychiatry.
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Affiliation(s)
- Jacqueline A Samson
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
| | - Thatcher R Newkirk
- Department of Psychiatry, Geisel School of Medicine, Dartmouth Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Martin H Teicher
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
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14
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Davis LL, Urganus A, Gagnon-Sanschagrin P, Maitland J, Bedard J, Bellefleur R, Cloutier M, Guérin A, Aggarwal J. Patient journey of civilian adults diagnosed with posttraumatic stress disorder-A chart review study. Curr Med Res Opin 2024; 40:505-516. [PMID: 38258436 DOI: 10.1080/03007995.2024.2308016] [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: 11/07/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To assess the journey of individuals from experiencing a traumatic event through onset of symptoms, diagnosis, and treatment of posttraumatic stress disorder (PTSD). METHODS Patient- and psychiatrist-level data was collected (02/2022-05/2022) from psychiatrists who treated ≥1 civilian adult diagnosed with PTSD. Eligible charts covered civilian adults diagnosed with PTSD (2016-2020), receiving ≥1 PTSD-related treatment (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs], atypical antipsychotics [AAs]), and having ≥1 medical visit in the last 12 months. Collected information included clinical and treatment characteristics surrounding the PTSD diagnosis. RESULTS A total of 273 psychiatrists contributed data on 687 patients with PTSD (average age 36.1; 60.4% female). On average, the traumatic event and symptom onset occurred 8.7 years and 6.5 years prior to PTSD diagnosis, respectively. In the 6 months before diagnosis, 88.9% of patients had received a PTSD-related treatment. At time of diagnosis, 87.8% of patients had intrusion symptoms and 78.9% had alterations in cognition/mood; 41.2% had depressive disorder and 38.7% had anxiety. Diagnosis prompted treatment changes for 79.3% of patients, receiving treatment within 1.9 months on average, often with a first-line SSRI as either monotherapy (52.8%) or combination (24.9%). At the end of the 24-month study period, 34.4% of patients achieved psychiatrist-recorded remission. A total of 23.0% of psychiatrists expressed dissatisfaction with approved PTSD treatments, with 88.3% at least somewhat likely to prescribe AAs despite lack of FDA approval. CONCLUSION PTSD presents heterogeneously, with an extensive journey from trauma to diagnosis with low remission rates and limited treatment options.
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Affiliation(s)
- Lori L Davis
- Research Service, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA
| | | | | | | | | | | | | | | | - Jyoti Aggarwal
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
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15
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Shahid S, Kelson J, Saliba A. Effectiveness and User Experience of Virtual Reality for Social Anxiety Disorder: Systematic Review. JMIR Ment Health 2024; 11:e48916. [PMID: 38329804 PMCID: PMC10884902 DOI: 10.2196/48916] [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: 05/21/2023] [Revised: 11/24/2023] [Accepted: 12/05/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is a debilitating psychiatric disorder that affects occupational and social functioning. Virtual reality (VR) therapies can provide effective treatment for people with SAD. However, with rapid innovations in immersive VR technology, more contemporary research is required to examine the effectiveness and concomitant user experience outcomes (ie, safety, usability, acceptability, and attrition) of emerging VR interventions for SAD. OBJECTIVE The aim of this systematic review was to examine the effectiveness and user experience of contemporary VR interventions among people with SAD. METHODS The Cochrane Library, Emcare, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science databases were searched between January 1, 2012, and April 26, 2022. Deduplicated search results were screened based on title and abstract information. Full-text examination was conducted on 71 articles. Studies of all designs and comparator groups were included if they appraised the effectiveness and user experience outcomes of any immersive VR intervention among people with SAD. A standardized coding sheet was used to extract data on key participant, intervention, comparator, outcome, and study design items. RESULTS The findings were tabulated and discussed using a narrative synthesis. A total of 18 studies met the inclusion criteria. CONCLUSIONS The findings showed that VR exposure therapy-based interventions can generally provide effective, safe, usable, and acceptable treatments for adults with SAD. The average attrition rate from VR treatment was low (11.36%) despite some reported user experience difficulties, including potential simulator sickness, exposure-based emotional distress, and problems with managing treatment delivered in a synchronous group setting. This review also revealed several research gaps, including a lack of VR treatment studies on children and adolescents with SAD as well as a paucity of standardized assessments of VR user experience interactions. More studies are required to address these issues. TRIAL REGISTRATION PROSPERO CRD42022353891; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=353891.
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Affiliation(s)
- Simon Shahid
- Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Bathurst, Australia
| | - Joshua Kelson
- Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Bathurst, Australia
| | - Anthony Saliba
- Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Bathurst, Australia
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Hoppen TH, Meiser-Stedman R, Kip A, Birkeland MS, Morina N. The efficacy of psychological interventions for adult post-traumatic stress disorder following exposure to single versus multiple traumatic events: a meta-analysis of randomised controlled trials. Lancet Psychiatry 2024; 11:112-122. [PMID: 38219762 DOI: 10.1016/s2215-0366(23)00373-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/17/2023] [Accepted: 10/31/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Previous meta-analyses of psychological interventions for adult post-traumatic stress disorder (PTSD) did not investigate whether efficacy is diminished in individuals with PTSD related to multiple (vs single) traumatic events. We aimed to assess whether treatment efficacy would be lower in randomised controlled trials involving multiple-event-related PTSD versus single-event-related PTSD. METHODS For this meta-analysis, we searched PsycINFO, MEDLINE, Web of Science, and PTSDpubs from database inception to April 18, 2023. Randomised controlled trials involving adult clinical samples (≥70% meeting full PTSD criteria) with adequate size (≥10 participants per arm) were included. We extracted data on trial characteristics, demographics, and outcome data. Random-effects meta-analyses were run to summarise standardised mean differences (Hedges' g). Trials involving 100% of participants with single-event-related PTSD versus at least 50% of participants with multiple-event-related PTSD (ie, associated with ≥two traumatic events) were categorised. Quality of evidence was assessed using the Cochrane criteria. The review protocol was registered in PROSPERO (CRD42023407754). FINDINGS Overall, 137 (85%) of 161 randomised controlled trials were included in the quantitative synthesis, comprising 10 684 participants with baseline data and 9477 with post-treatment data. Of those randomly assigned, 5772 (54%) of 10 692 participants identified as female, 4917 (46%) as male, and three (<1%) as transgender or other. 34 (25%) of 137 trials exclusively involved women, 15 (11%) trials exclusively involved men, and the remainder were mixed samples. Mean age across the trials was 40·2 years (SD 9·0) ranging from 18·0 years to 65·4 years. 23 (17%) of 137 trials involved participants from low-income and middle-income countries (23 [17%] of 137). Data on ethnicity were not extracted. At treatment endpoint, psychological interventions were highly effective for PTSD when compared with passive control conditions in both samples with single-event-related PTSD (Hedges' g 1·04 [95% CI 0·77-1·31]; n=11; I2=43%) and multiple-event-related PTSD (Hedges' g 1·13 [0·90-1·35]; n=55, I2=87%), with no efficacy difference between these categories (p=0·48). Heterogeneity between studies was substantial but outlier-corrected analysis yielded similar results. Moderate-sized effects were found compared with active control conditions with no significant difference between single-trauma and multiple-trauma trials. Results were robust in various sensitivity analyses (eg, 90% cutoff for multiple-trauma trials) and analyses of follow-up data. The quality of evidence was moderate to high. INTERPRETATION Contrary to our hypothesis, we found strong evidence that psychological interventions are highly effective treatments for PTSD in patients with a history of multiple traumatic events. Results are encouraging for clinical practice and could counteract common misconceptions regarding treatment and treatment barriers. FUNDING None.
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Affiliation(s)
- Thole H Hoppen
- Institute of Psychology, University of Münster, Münster, Germany.
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ahlke Kip
- Institute of Psychology, University of Münster, Münster, Germany
| | | | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
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17
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Kleva CS, Keeley JW, Evans SC, Maercker A, Cloitre M, Brewin CR, Roberts M, Reed GM. Examining accurate diagnosis of complex PTSD in ICD-11. J Affect Disord 2024; 346:110-114. [PMID: 37918575 DOI: 10.1016/j.jad.2023.10.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Complex posttraumatic stress disorder (complex PTSD), the most frequently suggested new category for inclusion by mental health professionals, has been included in the Eleventh Revision of the World Health Organization's International Classification of Diseases (ICD-11). Research has yet to explore whether clinicians' recognition of the distinct complex PTSD symptoms predicts giving the correct diagnosis. The present study sought to determine if international mental health professionals were able to accurately diagnose complex PTSD and identify the shared PTSD features and three essential diagnostic features, specific to complex PTSD. METHODS Participants were randomly assigned to view two vignettes and tasked with providing a diagnosis (or indicating that no diagnosis was warranted). Participants then answered a series of questions regarding the presence or absence of each of the essential diagnostic features specific to the diagnosis they provided. RESULTS Clinicians who recognized the presence or absence of complex PTSD specific features were more likely to arrive at the correct diagnostic conclusion. Complex PTSD specific features were significant predictors while the shared PTSD features were not, indicating that attending to each of the specific symptoms was necessary for diagnostic accuracy of complex PTSD. LIMITATIONS The use of written case vignettes including only adult patients and a non-representative sample of mental health professionals may limit the generalizability of the results. CONCLUSIONS Findings support mental health professionals' ability to accurately identify specific features of complex PTSD. Future work should assess whether mental health providers can effectively identify symptoms of complex PTSD in a clinical setting.
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Affiliation(s)
- Christopher S Kleva
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Spencer C Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Marylene Cloitre
- National Center for PTSD, Division of Dissemination and Training, VA Palo Alto Health Care System, CA, USA; Department of Psychiatry and Behavioral Sciences, Standford University, Stanford, CA, USA
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Michael Roberts
- Office of Graduate Studies and Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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18
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Burback L, Brémault-Phillips S, Nijdam MJ, McFarlane A, Vermetten E. Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. Curr Neuropharmacol 2024; 22:557-635. [PMID: 37132142 PMCID: PMC10845104 DOI: 10.2174/1570159x21666230428091433] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 05/04/2023] Open
Abstract
This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.
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Affiliation(s)
- Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | | | - Mirjam J. Nijdam
- ARQ National Psychotrauma Center, Diemen, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, New York University Grossman School of Medicine, New York, USA
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19
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Pinho M, Martins DO, Santos MF, Coutinho F. When Addressing Trauma Makes a Difference: A Case Report of Undiagnosed Complex Post-traumatic Stress Disorder. Cureus 2024; 16:e51640. [PMID: 38313901 PMCID: PMC10837782 DOI: 10.7759/cureus.51640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Complex post-traumatic stress disorder (C-PTSD) is an emergent diagnosis, which acknowledges the impact of prolonged interpersonal abuse on affect regulation, interpersonal functioning, and self-concept. We present the case of a 59-year-old woman who remained undiagnosed and untreated for this condition for three decades while under follow-up in mental health services for the diagnosis of personality disorder and bipolar disorder. The patient suffered repeated sexual abuse in her childhood, resulting in intrusive traumatic memories she emotionally and cognitively avoided, dissociative amnesia, a persistent inability to experience positive emotions, a persistent sense of guilt, re-experiencing phenomena, and hypervigilance toward others and their intentions to harm her. She persistently believed herself to be worthless, defective, inferior, and lacking value; had a history of affective dysregulation resulting in suspicion of bipolar disorder; and displayed a pattern of relationship avoidance. Addressing chronic trauma and assessing its impact offered deeper contextualization of the patient's symptoms and proved pivotal in redefining her diagnosis and providing access to trauma-focused psychotherapy, which is the mainstay of treatment for C-PTSD.
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Affiliation(s)
- Mauro Pinho
- Acute Psychiatry Service Unit, Centro Hospitalar Universitário de Santo António - Hospital de Magalhães Lemos, Porto, PRT
| | - Daniela O Martins
- Acute Psychiatry Service Unit, Centro Hospitalar Universitário de Santo António - Hospital de Magalhães Lemos, Porto, PRT
| | - Mónica F Santos
- Acute Psychiatry Service Unit, Centro Hospitalar Universitário de Santo António - Hospital de Magalhães Lemos, Porto, PRT
| | - Francisco Coutinho
- Acute Psychiatry Service Unit, Centro Hospitalar Universitário de Santo António - Hospital de Magalhães Lemos, Porto, PRT
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20
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Yim SH, Lorenz H, Salkovskis P. The Effectiveness and Feasibility of Psychological Interventions for Populations Under Ongoing Threat: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:577-592. [PMID: 36861772 PMCID: PMC10666526 DOI: 10.1177/15248380231156198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Current views of psychological therapies for trauma typically assume the traumatic event to be in the past. Yet, individuals who live in contexts of ongoing organized violence or experience intimate partner violence (IPV) may continue to be (re)exposed to related traumatic events or have realistic fears of their recurrence. This systematic review considers the effectiveness, feasibility, and adaptations of psychological interventions for individuals living with ongoing threat. PsychINFO, MEDLINE, and EMBASE were searched for articles that examined psychological interventions in contexts of ongoing threat of either IPV or organized violence and used trauma-related outcome measures. The search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data on study population, ongoing threat setting and design, intervention components, evaluation methods, and outcomes were extracted, and study quality was assessed using the Mixed-Method Appraisal Tool. Eighteen papers featuring 15 trials were included (12 on organized violence and 3 on IPV). For organized violence, most studies showed moderate to large effects in reducing trauma-related symptoms when compared to waitlists. For IPV, findings were varied. Most studies made adaptations related to culture and ongoing threat and found that providing psychological interventions was feasible. The findings, albeit preliminary with mixed methodological quality, showed psychological treatments can be beneficial and should not be withheld in the context of ongoing organized violence and IPV. Clinical and research recommendations are discussed.
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Affiliation(s)
- See Heng Yim
- University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Hjördis Lorenz
- University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Paul Salkovskis
- University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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21
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Logie CH, Loutet MG, Okumu M, Coelho M, Lukone SO, Kisubi N, Latif M, McAlpine A, Kyambadde P. Exploring a syndemic of poverty, cumulative violence, and HIV vulnerability among refugee youth: multi-method insights from a humanitarian setting in Uganda. AIDS Care 2024; 36:36-43. [PMID: 37921837 DOI: 10.1080/09540121.2023.2277151] [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: 12/18/2022] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Synergistic associations between social inequities and HIV vulnerabilities - known as a syndemic - are understudied with youth in humanitarian settings. We explored refugee youths' HIV prevention needs in Bidi Bidi Refugee Settlement, Uganda. This multi-methods study involved 6 focus groups and 12 in-depth individual interviews (IDI) with refugee youth (n = 60) aged 16-24, and IDI with refugee elders (n = 8) and healthcare providers (n = 8). We then conducted cross-sectional surveys with refugee youth (16-24 years) (n = 115) to assess: poverty, recent sexual and gender-based violence (SGBV), and condom engagement motivation (CEM) (wanting to learn about condoms for HIV prevention). Multivariable logistic regression was used to estimate adjusted odds ratios for associations between poverty and SGBV with CEM. Qualitative narratives revealed poverty and trauma elevated substance use, and these converged to exacerbate SGBV. SGBV and transactional sex increased HIV vulnerabilities. Among survey participants, poverty and recent SGBV were associated with reduced odds of CEM. The interaction between poverty and recent SGBV was significant: the predicted probability of CEM among youth who experienced both poverty and SGBV was almost half than among youth who experienced poverty alone, SGBV alone, or neither. Findings signal the confluence of poverty, violence, and substance use elevate refugee youth HIV vulnerabilities.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Miranda G Loutet
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Moses Okumu
- School of Social Work, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | | | | | - Nelson Kisubi
- Uganda Refugee and Disaster Management Council, Yumbe, Uganda
| | - Maya Latif
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Alyssa McAlpine
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Peter Kyambadde
- National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda
- Most at Risk Population Initiative (MARPI), Kampala, Uganda
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22
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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.
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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
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23
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Dialectical behaviour therapy for posttraumatic stress disorder (DBT-PTSD): transportability to everyday clinical care in a residential mental health centre. Eur J Psychotraumatol 2023; 14:2157159. [PMID: 37052092 PMCID: PMC9848310 DOI: 10.1080/20008066.2022.2157159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Dialectical Behaviour Therapy for Posttraumatic Stress Disorder (DBT-PTSD) is a phase-based treatment for PTSD. The DBT-PTSD treatment programme's efficacy has not been tested during standard operation, outside of laboratory outcome studies.Objective: The present pilot study investigated the transportability of the DBT-PTSD treatment to a real word clinical setting in a residential mental health centre.Methods: The DBT-PTSD treatment was compared to a treatment as usual (TAU) condition in a non-randomized study. Overall, 156 patients from a residential mental health centre were included. Propensity score matching was used to match participants in the two treatment arms based on baseline characteristics. Primary and secondary outcomes (PTSD and other symptoms) were assessed at the time of admission and at the time of discharge.Results: The DBT-PTSD treatment outperformed the TAU condition in the improvement of all primary outcomes, as indicated by a significant time and group interaction. There were notable differences in the effect sizes between the unmatched and matched sample as well as between the available and the intent-to-treat (ITT) data analyses. The effect sizes in the ITT data analyses were much lower. Both treatment groups showed similar improvements in secondary outcomes.Conclusions: This study provides initial evidence for the transportability of the DBT-PTSD treatment to a naturalistic clinical care setting, but with considerably lower effect sizes than in previously published laboratory RCTs. The higher efficacy of DBT-PTSD compared to TAU may largely depend on patient's adherence to treatment.
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Sele P, Hoffart A, Cloitre M, Hembree E, Øktedalen T. Comparing phase-based treatment, prolonged exposure, and skills-training for Complex Posttraumatic Stress Disorder: A randomized controlled trial. J Anxiety Disord 2023; 100:102786. [PMID: 37871452 DOI: 10.1016/j.janxdis.2023.102786] [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: 02/01/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This study examines treatment effects in STAIR Narrative Therapy (SNT), a phase-based treatment where Skills Training in Affective and Interpersonal Regulation (STAIR) precedes Narrative Therapy (NT), compared to Prolonged Exposure (PE) and to STAIR. METHOD Ninety-two adult patients diagnosed with DSM-5 PTSD and ICD-11 CPTSD following childhood abuse were randomly assigned to enhanced versions of SNT (12 group STAIR sessions + 8 individual NT sessions), PE (8-16 individual sessions), or STAIR (12 group STAIR sessions) provided in residential care. Outcome was assessed by mixed models. RESULTS PE produced greater improvements in DSM-5 PTSD symptoms compared to SNT from pre-treatment to post-treatment, but not compared to STAIR. Reductions in ICD-11 CPTSD symptoms were not significantly different among conditions. From pre-treatment to 1 year follow-up, PE produced greater PTSD symptom improvements than SNT and STAIR, and PE and STAIR produced greater CPTSD symptom improvements than SNT. CONCLUSIONS The predicted stronger effect of SNT compared to PE and STAIR on DSM-5 PTSD and ICD-11 CPTSD symptoms was not supported by the findings. The benefits of immediate trauma-focused treatments (TFT) as compared to phase-based treatments, and the potential non-inferiority of skills-training as compared to TFT in CPTSD needs to be further investigated.
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Affiliation(s)
- Peter Sele
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund N-3370, Norway; Department of Psychology, University of Oslo, Norway.
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund N-3370, Norway; Department of Psychology, University of Oslo, Norway
| | - Marylène Cloitre
- National Center for PTSD, Division of Dissemination and Training, VA Palo Alto Health Care System, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Standford University, Stanford, CA 94305, USA
| | - Elizabeth Hembree
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tuva Øktedalen
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund N-3370, Norway
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Bertó C, Almansa-Tomás B, Ferrín M, Livianos L, Rojo L, Barberá M, García-Blanco A. Are Socially Relevant Scenes Abnormally Processed in Complex Trauma-Exposed Children? JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:1031-1040. [PMID: 38045849 PMCID: PMC10689592 DOI: 10.1007/s40653-023-00549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 12/05/2023]
Abstract
Abnormal attentional processes to socially relevant information may underlie behavioral dysfunctional symptoms in children exposed to a complex trauma. Attentional biases to social scenes close to real-world situations and their association with behavioral symptomatology were examined in complex trauma-exposed children. A visual dot-probe task involving neutral versus emotional (i.e., threatening, sad, or happy) scenes was applied to twenty-one maltreated children (mean age 10.43; 42.8% female; 61.1% White). These children were exposed to a complex trauma (i.e., severe, repeated, multiple, prolonged, and interpersonal) and were safeguarded in a juvenile welfare home after all parental responsibility was removed. Twenty-four comparable non-maltreated children (mean age 10.13; 29.2% female; 76% White), served as control group. All participants were at risk of social exclusion and every legal representative completed the Child Behavior Checklist (CBCL). Complex trauma-exposed children showed an attentional bias toward threatening scenes, while the control group showed an attentional bias toward sad scenes. There were no differences for happy scenes between groups. Attentional bias toward threatening scenes was associated with withdrawn symptoms in complex trauma-exposed children. Children exposed to a complex trauma show an abnormal attention to threatening social situations, which can trigger maladaptive behaviors such as withdrawn. The understanding of how complex trauma-exposed children process affective environmental information may provide new targets in the social skills interventions such as diminishing maladaptive behaviors and improving coping strategies to face threatening situations.
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Affiliation(s)
- Clara Bertó
- Department of Psychiatry and Psychology, Hospital Francesc de Borja, Gandía, Spain
| | | | - Maite Ferrín
- University of Southampton, Southampton, UK
- ReCognition Health, London, UK
| | - Lorenzo Livianos
- Department of Psychiatry and Clinical Psychology, University and Polytechnic Hospital La Fe, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Luis Rojo
- Department of Psychiatry and Clinical Psychology, University and Polytechnic Hospital La Fe, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - María Barberá
- Department of Psychiatry and Clinical Psychology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Ana García-Blanco
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain
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Arpalahti A, Haapanen A, Auro K, Abio A, Snäll J. Psychiatric disorders and interventions in patients sustaining facial fractures from interpersonal violence. Head Face Med 2023; 19:45. [PMID: 37872614 PMCID: PMC10591386 DOI: 10.1186/s13005-023-00393-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND This retrospective study clarified patients´ psychiatric morbidity in IPV-related facial fractures; in particular, their additional psychiatric care. We hypothesized that patients in need of additional support can be identified, allowing overall care processes to be improved. METHODS Patients' age, sex, anamnestic psychiatric disorders, history of substance abuse, and psychiatric interventions were recorded, as well as the perpetrator, location, time of day, assault mechanism, fracture type, treatment, and associated injuries. RESULTS In all, 807 adult patients were included in the study. Of these, 205 patients (25.4%) had anamnestic psychiatric disorders that were associated independently with female sex (OR 1.95, 95% CI 1.12, 3.41; p = 0.019) or history of substance abuse (OR 5.82, 95% CI 4.01, 8.46; p < 0.001). Patients with anamnestic psychiatric disorder were more likely to be subjected to severe violence, with an increased risk for combination fractures (OR 2.51, 95% CI 1.30, 4.83; p = 0.006). Of all patients, 61 (7.6%) received a psychiatric intervention within the first 12 months. The most common reasons for intervention were anxiety/fear and psychotic symptoms, surfacing within one month in 57% of patients. Anamnestic psychiatric disorders (OR 2.00, 95% CI 1.04, 3.82; p = 0.036), severe mental illnesses (OR 2.45, 95% CI 1.04, 5.77; p = 0.040), and use of an offensive weapon (OR 2.11, 95% CI 1.11, 4.02; p = 0.023) were the strongest independent predictors of psychiatric intervention. CONCLUSIONS Our results emphasize the need for more structured treatment protocols for patients sustaining IPV injury. Special attention is recommended for patients with anamnestic psychiatric disorders, severe mental illnesses, and those assaulted with an offensive weapon.
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Affiliation(s)
- Annamari Arpalahti
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, 00029, HUS, Finland.
| | - Aleksi Haapanen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, 00029, HUS, Finland
| | - Kirsi Auro
- Department of Psychiatry and Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Population Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Anne Abio
- Injury Epidemiology and Prevention Research Group, Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, 00029, HUS, Finland
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Moldovan F, Moldovan L. Fair Healthcare Practices in Orthopedics Assessed with a New Framework. Healthcare (Basel) 2023; 11:2753. [PMID: 37893827 PMCID: PMC10606008 DOI: 10.3390/healthcare11202753] [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: 09/15/2023] [Revised: 10/08/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Background and Objectives: Healthcare systems are supported by the European ideology to develop their egalitarian concerns and to encourage the correct and fair behavior of medical staff. By integrating fair healthcare practices into sustainability, this requirement is addressed. In this research, our objective is to develop and validate, in the current activity of healthcare facilities, a new instrument for evaluating fair healthcare practices as a component of social responsibility integrated into sustainability. Materials and Methods: The research methods consist of deciding the domains of a new framework that integrates fair healthcare practices; the collection of the most recent fair healthcare practices reported by healthcare facilities around the world; elaboration of the contents and evaluation grids of the indicators; the integration of indicators related to fair healthcare practices in the matrix of the new framework for sustainable development; validation of the theoretical model at an orthopedic hospital. Results: The theoretical model of the new framework is composed of five domains: organizational management, provision of sustainable medical care services, economic, environmental, and social. The last domain is developed on the structure of the seven subdomains of the social responsibility standard ISO 26000. The seven indicators that describe fair healthcare practices are attitudes of the profession towards accreditation, effective intervention application, promoting a culture of patient safety, characteristics that affect the effectiveness of transfers, effective healthcare practices, feedback to medical staff, safety checklists. The new reference framework was implemented and validated in practice at an emergency hospital with an orthopedic profile. Conclusions: The practical implementation highlighted the usefulness of the new reference framework, its compatibility, and the possibility of integration with the reference frameworks for the evaluation of European hospitals, with the national legislation for the accreditation of hospitals and outpatient units, as well as with the ISO 9001 standard regarding the implementation of quality management systems. Its added value consists in promoting sustainable development by orienting staff, patients, and interested parties towards sustainability.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics—Traumatology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Faculty of Engineering and Information Technology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania;
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Askovic M, Soh N, Elhindi J, Harris AW. Neurofeedback for post-traumatic stress disorder: systematic review and meta-analysis of clinical and neurophysiological outcomes. Eur J Psychotraumatol 2023; 14:2257435. [PMID: 37732560 PMCID: PMC10515677 DOI: 10.1080/20008066.2023.2257435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a debilitating condition affecting millions of people worldwide. Existing treatments often fail to address the complexity of its symptoms and functional impairments resulting from severe and prolonged trauma. Electroencephalographic Neurofeedback (NFB) has emerged as a promising treatment that aims to reduce the symptoms of PTSD by modulating brain activity.Objective: We conducted a systematic review and meta-analysis of ten clinical trials to answer the question: how effective is NFB in addressing PTSD and other associated symptoms across different trauma populations, and are these improvements related to neurophysiological changes?Method: The review followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guidelines. We considered all published and unpublished randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) involving adults with PTSD as a primary diagnosis without exclusion by type of trauma, co-morbid diagnosis, locality, or sex. Ten controlled studies were included; seven RCTs and three NRSIs with a total number of participants n = 293 (128 male). Only RCTs were included in the meta-analysis (215 participants; 88 male).Results: All included studies showed an advantage of NFB over control conditions in reducing symptoms of PTSD, with indications of improvement in symptoms of anxiety and depression and related neurophysiological changes. Meta-analysis of the pooled data shows a significant reduction in PTSD symptoms post-treatment SMD of -1.76 (95% CI -2.69, -0.83), and the mean remission rate was higher in the NFB group (79.3%) compared to the control group (24.4%). However, the studies reviewed were mostly small, with heterogeneous populations and varied quality.Conclusions: The effect of NFB on the symptoms of PTSD was moderate and mechanistic evidence suggested that NFB leads to therapeutic changes in brain functioning. Future research should focus on more rigorous methodological designs, expanded sample size and longer follow-up.
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Affiliation(s)
- Mirjana Askovic
- New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, NSW, Australia
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Nerissa Soh
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - James Elhindi
- Research and Education Network, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anthony W.F. Harris
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
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29
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Freeman SC, Saeedi E, Ordóñez-Mena JM, Nevill CR, Hartmann-Boyce J, Caldwell DM, Welton NJ, Cooper NJ, Sutton AJ. Data visualisation approaches for component network meta-analysis: visualising the data structure. BMC Med Res Methodol 2023; 23:208. [PMID: 37715126 PMCID: PMC10502971 DOI: 10.1186/s12874-023-02026-z] [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: 06/08/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Health and social care interventions are often complex and can be decomposed into multiple components. Multicomponent interventions are often evaluated in randomised controlled trials. Across trials, interventions often have components in common which are given alongside other components which differ across trials. Multicomponent interventions can be synthesised using component NMA (CNMA). CNMA is limited by the structure of the available evidence, but it is not always straightforward to visualise such complex evidence networks. The aim of this paper is to develop tools to visualise the structure of complex evidence networks to support CNMA. METHODS We performed a citation review of two key CNMA methods papers to identify existing published CNMA analyses and reviewed how they graphically represent intervention complexity and comparisons across trials. Building on identified shortcomings of existing visualisation approaches, we propose three approaches to standardise visualising the data structure and/or availability of data: CNMA-UpSet plot, CNMA heat map, CNMA-circle plot. We use a motivating example to illustrate these plots. RESULTS We identified 34 articles reporting CNMAs. A network diagram was the most common plot type used to visualise the data structure for CNMA (26/34 papers), but was unable to express the complex data structures and large number of components and potential combinations of components associated with CNMA. Therefore, we focused visualisation development around representing the data structure of a CNMA more completely. The CNMA-UpSet plot presents arm-level data and is suitable for networks with large numbers of components or combinations of components. Heat maps can be utilised to inform decisions about which pairwise interactions to consider for inclusion in a CNMA model. The CNMA-circle plot visualises the combinations of components which differ between trial arms and offers flexibility in presenting additional information such as the number of patients experiencing the outcome of interest in each arm. CONCLUSIONS As CNMA becomes more widely used for the evaluation of multicomponent interventions, the novel CNMA-specific visualisations presented in this paper, which improve on the limitations of existing visualisations, will be important to aid understanding of the complex data structure and facilitate interpretation of the CNMA results.
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Affiliation(s)
- Suzanne C Freeman
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK.
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK.
| | - Elnaz Saeedi
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clareece R Nevill
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola J Cooper
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
| | - Alex J Sutton
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
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30
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Karatzias T, Mc Glanaghy E, Cloitre M. Enhanced Skills Training in Affective and Interpersonal Regulation (ESTAIR): A New Modular Treatment for ICD-11 Complex Posttraumatic Stress Disorder (CPTSD). Brain Sci 2023; 13:1300. [PMID: 37759901 PMCID: PMC10527561 DOI: 10.3390/brainsci13091300] [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: 08/22/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) is a relatively new condition; therefore, there is limited available evidence for its treatment. Prior to the recognition of CPTSD as a separate trauma condition, people who met criteria were often diagnosed with multiple co-morbid conditions such as PTSD, anxiety, depression, and emotional dysregulation difficulties. In the absence of a coherent evidence base, treatment tended to involve multiple treatments for these multiple conditions or lengthy phase-based interventions, often delivered in an integrative fashion, which was not standardized. In this paper, we present Enhanced Skills Training in Affective and Interpersonal Regulation (ESTAIR), a new flexible multi-modular approach for the treatment of CPTSD and its transdiagnostic symptoms. ESTAIR is consistent with trauma-informed and patient-centered care, which highlights the importance of patient choice in identification and sequencing in targeting CPTSD symptoms. Directions for future research are discussed.
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Affiliation(s)
- Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK
- NHS Lothian Rivers Centre, EH11 1BG, Stanford University, 450 Jane Stanford Way, Stanford, CA 94305, USA
| | - Edel Mc Glanaghy
- NHS Forth Valley, Mayfield Building, Falkirk Community Hospital, Scotland FK1 5QE, UK;
| | - Marylene Cloitre
- National Centre for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA;
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA 94305, USA
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31
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Mansour M, Joseph GR, Joy GK, Khanal S, Dasireddy RR, Menon A, Barrie Mason I, Kataria J, Patel T, Modi S. Post-traumatic Stress Disorder: A Narrative Review of Pharmacological and Psychotherapeutic Interventions. Cureus 2023; 15:e44905. [PMID: 37814755 PMCID: PMC10560516 DOI: 10.7759/cureus.44905] [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: 08/06/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a complex mental health condition affecting individuals exposed to traumatic events. This paper is a narrative review of the existing literature on pharmacological and psychotherapeutic interventions for PTSD. Treatment includes selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and alpha-1 adrenergic receptor antagonists. By exploring the outcomes of these interventions, the review seeks to provide valuable insights into their potential as PTSD treatment options. The paper also highlights the importance of tailoring treatment plans to individual needs and discusses emerging treatments, such as mindfulness-based therapies, virtual reality therapy, and neurostimulation techniques. By integrating findings from various studies, it aims to offer valuable information to optimize treatment strategies and enhance outcomes for individuals suffering from PTSD. The goal is to support informed decision-making, ultimately leading to more effective and tailored approaches to address the challenges posed by this debilitating condition.
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Affiliation(s)
- Mohammad Mansour
- General Medicine, University of Debrecen, Debrecen, HUN
- General Medicine, Jordan University Hospital, Amman, JOR
| | | | - Golda K Joy
- General Practice, St. John's Medical College, Bengaluru, IND
| | | | | | - Aardra Menon
- General Practice, PK Das Institute of Medical Sciences, Kerala, IND
| | - Iyesatu Barrie Mason
- General Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Janvi Kataria
- School of Medicine, D.Y. Patil University, Mumbai, IND
| | - Tirath Patel
- School of Medicine, American University of Antigua, St. John's, ATG
| | - Shivani Modi
- Internal Medicine, Einstein Healthcare Network, Philadelphia, USA
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32
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Mak J, Bentley A, Paphtis S, Huq M, Zimmerman C, Osrin D, Devakumar D, Abas M, Kiss L. Psychosocial interventions to improve the mental health of survivors of human trafficking: a realist review. Lancet Psychiatry 2023; 10:557-574. [PMID: 37353265 DOI: 10.1016/s2215-0366(23)00105-0] [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] [Received: 10/07/2022] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 06/25/2023]
Abstract
More than 50 million people globally are subjected to modern slavery and human trafficking. Adverse mental health consequences of extreme exploitation are prevalent and often severe. We conducted a systematic and realist review on evaluations of psychosocial interventions for survivors of human trafficking. The review aimed to identify the influence of these interventions on the mental health and wellbeing of trafficked people and examine how they worked for which survivors in which contexts. We searched eight databases (MEDLINE, MEDLINE In-Process, Embase, PsycINFO, Global Health, CINAHL Plus, Web of Science, and Cochrane) for published evaluations of psychosocial interventions for survivors of human-trafficking. We followed a realist approach to analyse the data and report on the limitations of the studies identified. We identified four mechanisms of change as being triggered by the various intervention activities: (1) awareness and understanding; (2) trust, safety, and security; (3) agency, autonomy, empowerment, and social connections; and (4) self-reflection, self-expression, and self-care. Improving mental health after traumatic events is an ongoing, nonlinear process. Intervention effectiveness and transferability would benefit from more transparent programme theories and well articulated assumptions that identify the pathways to change.
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Affiliation(s)
- Joelle Mak
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Abigail Bentley
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sharli Paphtis
- Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Mita Huq
- Institute for Global Health, University College London, London, UK
| | - Cathy Zimmerman
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - David Osrin
- Institute for Global Health, University College London, London, UK
| | | | - Melanie Abas
- Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Ligia Kiss
- Institute for Global Health, University College London, London, UK.
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33
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Pouchieu C, Pourtau L, Brossaud J, Gaudout D, Corcuff JB, Capuron L, Castanon N, Philip P. Acute Effect of a Saffron Extract (Safr'Inside TM) and Its Main Volatile Compound on the Stress Response in Healthy Young Men: A Randomized, Double Blind, Placebo-Controlled, Crossover Study. Nutrients 2023; 15:2921. [PMID: 37447245 DOI: 10.3390/nu15132921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
According to animal studies, saffron and its main volatile compound safranal may reduce biological and behavioral signs of acute stress. However, little is known about its impact in humans. This study investigated the acute effect of a saffron extract and safranal on the biological and psychological stress responses in healthy men experiencing a laboratory stress procedure. In this double-blind, placebo-controlled, randomized, cross-over study, 19 volunteers aged 18-25 received a single dose of 30 mg saffron extract (Safr'InsideTM), 0.06 mg synthetic safranal, or a placebo on three visits separated by a 28-day washout. Thirteen minutes after administration, participants were exposed to the Maastricht acute stress test (MAST). Salivary cortisol and cortisone were collected from 15 min before the MAST (and pre-dose), 3 min before the MAST, and then 15, 30, 45, 60, and 75 min after the MAST, and stress and anxiety were measured using visual analogic scales. Compared to the placebo, stress and anxiety were significantly toned down after Safranal and Safr'InsideTM administration and coupled with a delay in the times to peak salivary cortisol and cortisone concentrations (p < 0.05). Safr'InsideTM and its volatile compound seem to improve psychological stress response in healthy men after exposure to a lab-based stressor and may modulate the biological stress response.
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Affiliation(s)
| | - Line Pourtau
- Activ'Inside, F-33750 Beychac et Caillau, France
| | - Julie Brossaud
- Hormone Laboratory, Nuclear Medicine, CHU Bordeaux, UMR INRA 1286, University Bordeaux, F-33000 Bordeaux, France
| | | | - Jean-Benoit Corcuff
- Hormone Laboratory, Nuclear Medicine, CHU Bordeaux, UMR INRA 1286, University Bordeaux, F-33000 Bordeaux, France
| | - Lucile Capuron
- INRAE, Nutrition and Integrative Neurobiology (NutriNeuro), Bordeaux University, UMR 1286, F-33000 Bordeaux, France
| | - Nathalie Castanon
- INRAE, Nutrition and Integrative Neurobiology (NutriNeuro), Bordeaux University, UMR 1286, F-33000 Bordeaux, France
| | - Pierre Philip
- Pôle Neurosciences Cliniques, Centre Hospitalier Universitaire de Bordeaux, F-33076 Bordeaux, France
- Sommeil, Addiction et NeuroPSYchiatrie, Bordeaux University, CNRS, SANPSY, UMR 6033, F-33000 Bordeaux, France
- Centre d'Investigation Clinique Bordeaux, INSERM CIC 1401, Centre Hospitalier Universitaire de Bordeaux, F-33000 Bordeaux, France
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34
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Wang SK, Feng M, Fang Y, Lv L, Sun GL, Yang SL, Guo P, Cheng SF, Qian MC, Chen HX. Psychological trauma, posttraumatic stress disorder and trauma-related depression: A mini-review. World J Psychiatry 2023; 13:331-339. [PMID: 37383283 PMCID: PMC10294137 DOI: 10.5498/wjp.v13.i6.331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/15/2023] [Accepted: 05/08/2023] [Indexed: 06/19/2023] Open
Abstract
There are various types of traumatic stimuli, such as catastrophic events like wars, natural calamities like earthquakes, and personal trauma from physical and psychological neglect or abuse and sexual abuse. Traumatic events can be divided into type I and type II trauma, and their impacts on individuals depend not only on the severity and duration of the traumas but also on individuals’ self-evaluation of the traumatic events. Individual stress reactions to trauma include posttraumatic stress disorder (PTSD), complex PTSD and trauma-related depression. Trauma-related depression is a reactive depression with unclear pathology, and depression occurring due to trauma in the childhood has gained increasing attention, because it has persisted for a long time and does not respond to conventional antidepressants but shows good or partial response to psychotherapy, which is similar to the pattern observed for PTSD. Because trauma-related depression is associated with high risk of suicide and is chronic with a propensity to relapse, it is necessary to explore its pathogenesis and therapeutic strategy.
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Affiliation(s)
- Shi-Kai Wang
- Department of Psychiatry, The Third People’s Hospital Affiliated to Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Min Feng
- Department of Psychiatry, The Third People’s Hospital Affiliated to Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Yu Fang
- Department of Psychiatry, The Third People’s Hospital Affiliated to Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Liang Lv
- Department of Psychiatry, The Third People’s Hospital Affiliated to Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Gui-Lan Sun
- Department of Psychiatry, The Third People’s Hospital Affiliated to Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Sheng-Liang Yang
- Department of Psychiatry, The Third People’s Hospital Affiliated to Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Ping Guo
- Department of Psychiatry, The Third People’s Hospital Affiliated to Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Shan-Fei Cheng
- Department of Psychiatry, The Third People’s Hospital Affiliated to Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Min-Cai Qian
- Department of Neurosis and Psychosomatic Diseases, The Third People’s Hospital Affiliated to Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Huan-Xin Chen
- Department of Key Laboratory, The Third People’s Hospital Affiliated to Huzhou University, Huzhou 313000, Zhejiang Province, China
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Hoppen TH, Meiser-Stedman R, Jensen TK, Birkeland MS, Morina N. Efficacy of psychological interventions for post-traumatic stress disorder in children and adolescents exposed to single versus multiple traumas: meta-analysis of randomised controlled trials. Br J Psychiatry 2023; 222:196-203. [PMID: 36855922 PMCID: PMC10895514 DOI: 10.1192/bjp.2023.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Previous meta-analyses of psychotherapies for children and adolescents with post-traumatic stress disorder (PTSD) did not investigate whether treatment efficacy is diminished when patients report multiple (versus single) traumas. AIMS To examine whether efficacy of psychological interventions for paediatric PTSD is diminished when patients report multiple (versus single) traumas. METHOD We systematically searched PsycInfo, MEDLINE, Web of Science and PTSDpubs on 21 April 2022 and included randomised controlled trials (RCTs) meeting the following criteria: (a) random allocation; (b) all participants presented with partial or full PTSD; (c) PTSD is the primary treatment focus; (d) sample mean age <19 years; (e) sample size n ≥ 20. Trauma frequency was analysed as a dichotomous (single versus ≥2 traumas) and continuous (mean number of exposures) potential moderator of efficacy. RESULTS Of the 57 eligible RCTs (n = 4295), 51 RCTs were included in quantitative analyses. Relative to passive control conditions, interventions were found effective for single-trauma-related PTSD (Hedges' g = 1.09; 95% CI 0.70-1.48; k = 8 trials) and multiple-trauma-related PTSD (g = 1.11; 95% CI 0.74-1.47; k = 12). Psychotherapies were also more effective than active control conditions in reducing multiple-trauma-related PTSD. Comparison with active control conditions regarding single-event PTSD was not possible owing to scarcity (k = 1) of available trials. Efficacy did not differ with trauma exposure frequency irrespective of its operationalisation and subgroup analyses (e.g. trauma-focused cognitive-behavioural therapy only). CONCLUSIONS The current evidence base suggests that psychological interventions for paediatric PTSD can effectively treat PTSD in populations reporting single and multiple traumas. Future trials for PTSD following single-event trauma need to involve active control conditions.
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Affiliation(s)
- Thole H. Hoppen
- Institute of Psychology, University of Münster, Münster, Germany
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tine K. Jensen
- Department of Psychology, University of Oslo, Oslo, Norway; and Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
| | | | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
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Malik N, Facer-Irwin E, Dickson H, Bird A, MacManus D. The Effectiveness of Trauma-Focused Interventions in Prison Settings: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:844-857. [PMID: 34711095 DOI: 10.1177/15248380211043890] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is overrepresented in prison relative to community populations and can be difficult to manage in an environment which can inherently exacerbate trauma-related symptomology. Little is known about the effectiveness of trauma-focused interventions in prison and less is known about factors that moderate the effectiveness of these interventions. AIM/METHODS We examined the effectiveness of trauma-focused interventions in prison relative to prison controls using meta-analytic techniques. We further used meta-regression analysis to examine treatment, methodological and participant-level moderators to determine factors that increased the effectiveness of these interventions. RESULTS From 16 studies eligible for the meta-analysis, we found a small but significant effect size for trauma-focused interventions. Phase 2 trauma processing interventions and interventions delivered individually led to greater reductions in PTSD symptoms. Studies utilizing an active treatment control resulted in smaller effect sizes than those using waitlist or no contact controls. Treatment length, study quality, outcome type, and gender were not significant moderators of treatment effectiveness. CONCLUSION Findings from this review are encouraging but should be interpreted with caution. Results suggest that trauma processing therapies, and individual modality trauma-focused interventions can be effective and delivered successfully in prison. However, inadequate comparison groups do not allow a firm conclusion to be drawn. There is a need for high quality Randomized Controlled Trial's that additionally measure Complex PTSD, utilize a modular treatment approach, and include treatments recommended in the National Institute for health and Care Excellence (NICE) guidelines such as Trauma-focused CBT and Eye Movement Desensitization Reprocessing (EMDR).
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Affiliation(s)
- Nabeela Malik
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Older Adults Psychiatry, North East London Foundation NHS Trust, London, England, United Kingdom
| | - Emma Facer-Irwin
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Clinical Psychology, School of Health and Social Care, University of Essex, Colchester, United Kingdom
- Joint first author
| | - Hannah Dickson
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Annie Bird
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Deirdre MacManus
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Consultant Forensic Psychiatrist; HMP Wandsworth, South London and Maudsley NHS Trust, London, England, United Kingdom
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Al Jowf GI, Ahmed ZT, Reijnders RA, de Nijs L, Eijssen LMT. To Predict, Prevent, and Manage Post-Traumatic Stress Disorder (PTSD): A Review of Pathophysiology, Treatment, and Biomarkers. Int J Mol Sci 2023; 24:ijms24065238. [PMID: 36982313 PMCID: PMC10049301 DOI: 10.3390/ijms24065238] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) can become a chronic and severely disabling condition resulting in a reduced quality of life and increased economic burden. The disorder is directly related to exposure to a traumatic event, e.g., a real or threatened injury, death, or sexual assault. Extensive research has been done on the neurobiological alterations underlying the disorder and its related phenotypes, revealing brain circuit disruption, neurotransmitter dysregulation, and hypothalamic–pituitary–adrenal (HPA) axis dysfunction. Psychotherapy remains the first-line treatment option for PTSD given its good efficacy, although pharmacotherapy can also be used as a stand-alone or in combination with psychotherapy. In order to reduce the prevalence and burden of the disorder, multilevel models of prevention have been developed to detect the disorder as early as possible and to reduce morbidity in those with established diseases. Despite the clinical grounds of diagnosis, attention is increasing to the discovery of reliable biomarkers that can predict susceptibility, aid diagnosis, or monitor treatment. Several potential biomarkers have been linked with pathophysiological changes related to PTSD, encouraging further research to identify actionable targets. This review highlights the current literature regarding the pathophysiology, disease development models, treatment modalities, and preventive models from a public health perspective, and discusses the current state of biomarker research.
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Affiliation(s)
- Ghazi I. Al Jowf
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- Department of Public Health, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
- Correspondence: (G.I.A.J.); (L.M.T.E.)
| | - Ziyad T. Ahmed
- College of Medicine, Sulaiman Al Rajhi University, Al-Bukairyah 52726, Saudi Arabia
| | - Rick A. Reijnders
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Laurence de Nijs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Lars M. T. Eijssen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Bioinformatics—BiGCaT, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
- Correspondence: (G.I.A.J.); (L.M.T.E.)
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Buchcik J, Kovach V, Adedeji A. Mental health outcomes and quality of life of Ukrainian refugees in Germany. Health Qual Life Outcomes 2023; 21:23. [PMID: 36894946 PMCID: PMC9996949 DOI: 10.1186/s12955-023-02101-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/18/2023] [Indexed: 03/11/2023] Open
Abstract
The war in Ukraine has generated an increase in the number of refugees. As one of the top recipients of refugees, Germany has introduced policies to ease the integration of Ukrainians. The current study explores mental health outcomes and their association with quality of life among a sample of Ukrainian refugees in Germany. Cross-sectional data were collected from a sample of Ukrainian refugees in Germany (n = 304) using standardised instruments. A t-test was used to check for possible significant differences based on gender. Multiple regression analysis was used to analyse potential associations between general health (GHQ-12) and depressive symptoms and anxiety (PHQ-4), and quality of life (EUROHIS-QOL 8 item). Female participants reported significantly higher psychological distress, depressive symptoms and anxiety. The significant model (p < .001) for the males accounts for 33.6% of the variance in quality of life. General psychological distress (β = - .240) and depressive symptoms and anxiety (β = - .411) are associated with decreased quality of life. For the female sample (p < .001), the model explains 35.7% of the variance in quality of life. General psychological distress (β = - .402) and depressive symptoms and anxiety (β = - .261) are associated with decreased quality of life. The current study provides the first knowledge on the prevalence of mental health problems and their associations with quality of life among Ukrainian refugees. The findings further identify the vulnerability of women refugees to poorer mental health outcomes. The results also confirm that traumatic experiences in the context of war explain a considerable bulk of mental health problems.
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Affiliation(s)
- Johanna Buchcik
- Department of Health Sciences, Faculty of Life Sciences, University of Applied Sciences, Hamburg, Germany.
| | - Viktoriia Kovach
- Department of Health Sciences, Faculty of Life Sciences, University of Applied Sciences, Hamburg, Germany
| | - Adekunle Adedeji
- Department of Health Sciences, Faculty of Life Sciences, University of Applied Sciences, Hamburg, Germany.,Bremen International Graduate School of Social Sciences (BIGSSS), Constructor University, Bremen, Germany
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Jones CW, An X, Ji Y, Liu M, Zeng D, House SL, Beaudoin FL, Stevens JS, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Punches BE, Lyons MS, Kurz MC, Swor RA, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Harris E, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Koenen KC, Ressler KJ, Kessler RC, McLean SA. Derivation and Validation of a Brief Emergency Department-Based Prediction Tool for Posttraumatic Stress After Motor Vehicle Collision. Ann Emerg Med 2023; 81:249-261. [PMID: 36328855 PMCID: PMC11181458 DOI: 10.1016/j.annemergmed.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
STUDY OBJECTIVE To derive and initially validate a brief bedside clinical decision support tool that identifies emergency department (ED) patients at high risk of substantial, persistent posttraumatic stress symptoms after a motor vehicle collision. METHODS Derivation (n=1,282, 19 ED sites) and validation (n=282, 11 separate ED sites) data were obtained from adults prospectively enrolled in the Advancing Understanding of RecOvery afteR traumA study who were discharged from the ED after motor vehicle collision-related trauma. The primary outcome was substantial posttraumatic stress symptoms at 3 months (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders-5 ≥38). Logistic regression derivation models were evaluated for discriminative ability using the area under the curve and the accuracy of predicted risk probabilities (Brier score). Candidate posttraumatic stress predictors assessed in these models (n=265) spanned a range of sociodemographic, baseline health, peritraumatic, and mechanistic domains. The final model selection was based on performance and ease of administration. RESULTS Significant 3-month posttraumatic stress symptoms were common in the derivation (27%) and validation (26%) cohort. The area under the curve and Brier score of the final 8-question tool were 0.82 and 0.14 in the derivation cohort and 0.76 and 0.17 in the validation cohort. CONCLUSION This simple 8-question tool demonstrates promise to risk-stratify individuals with substantial posttraumatic stress symptoms who are discharged to home after a motor vehicle collision. Both external validation of this instrument, and work to further develop more accurate tools, are needed. Such tools might benefit public health by enabling the conduct of preventive intervention trials and assisting the growing number of EDs that provide services to trauma survivors aimed at promoting psychological recovery.
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Affiliation(s)
- Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ
| | - Xinming An
- Department of Anesthesiology, Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yinyao Ji
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Mochuan Liu
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO
| | - Francesca L Beaudoin
- Department of Emergency Medicine and Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Thomas C Neylan
- Department of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine and Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI
| | - Sarah D Linnstaedt
- Department of Anesthesiology, Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA; The Many Brains Project, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience and Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, McLean Hospital, Belmont, MA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Phyllis L Hendry
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL; Department of Emergency Medicine, University of Cincinnati College of Medicine, and College of Nursing, University of Cincinnati, Cincinnati, OH
| | - Brittany E Punches
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL
| | - Michael S Lyons
- College of Nursing, University of Cincinnati, Cincinnati, OH
| | - Michael C Kurz
- Department of Emergency Medicine, Division of Acute Care Surgery, Department of Surgery, University of Alabama School of Medicine, and Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA; Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA
| | - Mark J Seamon
- Division of Traumatology, Department of Surgery, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, and the Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA
| | | | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St John Hospital, Detroit, MI
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX
| | - Leon D Sanchez
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St Louis, St Louis, MO
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston, MA; Clinical Neurosciences Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT
| | | | - Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, MO
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA
| | - John F Sheridan
- Department of Biosciences, and the Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, and Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA
| | - Steven E Harte
- Department of Anesthesiology, and Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI
| | - James M Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, and Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia, and Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, MO
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Samuel A McLean
- Departments of Emergency Medicine and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Kip A, Iseke LN, Papola D, Gastaldon C, Barbui C, Morina N. Efficacy of psychological interventions for PTSD in distinct populations - An evidence map of meta-analyses using the umbrella review methodology. Clin Psychol Rev 2023; 100:102239. [PMID: 36529109 DOI: 10.1016/j.cpr.2022.102239] [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: 06/01/2021] [Revised: 11/26/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
We aimed at mapping the meta-analytic evidence base on the efficacy of psychological treatments for posttraumatic stress disorder (PTSD) in specific populations. We conducted a systematic search until January 2022 in MEDLINE, PsycINFO, PTSDpubs, Web of Science, and the Cochrane Database of Systematic Reviews for meta-analyses of randomized controlled trials. We contrasted all eligible meta-analyses irrespective of overlapping datasets to present a comprehensive overview of the state of research. Reporting quality was assessed using the AMSTAR 2 tool and certainty of evidence was assessed using established umbrella review criteria. Nine meta-analyses with distinct adult populations (51 unique trials) and four with children and adolescents (24 unique trials) were included. Reporting quality of meta-analyses was heterogeneous with risk of bias assessment being rated lowest. The certainty of evidence on the efficacy of psychological interventions for adult populations was thoroughly weak because of small samples and large heterogeneity. In war- and conflict-affected youth, the certainty of evidence was suggestive. Our review highlights the need to improve quality of meta-analyses on treatment efficacy for PTSD. More importantly, however, the findings demonstrate the need for new large-scale trials on the efficacy of treatments for PTSD in distinct populations in order to increase certainty of evidence and to identify potential differences in treatment responses.
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Affiliation(s)
- Ahlke Kip
- Institute of Psychology, University of Münster, Münster, Germany
| | - Linnéa N Iseke
- Institute of Psychology, University of Münster, Münster, Germany
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany.
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Zaccari B, Lovejoy TI, O’Neil ME. Skills Training in Affective and Interpersonal Regulation Narrative Therapy Delivered via Synchronous Telehealth: A Case Study of a Rural Woman Veteran With Complex Posttraumatic Stress Disorder. Clin Case Stud 2023. [DOI: 10.1177/15346501231158400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The International Classification of Diseases– 11 th Revision (ICD-11) includes the diagnosis of complex posttraumatic stress disorder (CPTSD). Clinical practice guidelines support the use of phased care for individuals with CPTSD. This case study illustrates the use of synchronous telehealth to deliver phased treatment to a rural woman veteran with CPTSD. Mrs. A experienced sexual, physical, and emotional abuse throughout her life, perpetrated by family members, intimate partners, and military authority figures. She sought treatment for posttraumatic nightmares and body image issues; she also had pain related to fibromyalgia and chronic migraine headaches. Mrs. A participated in 19 sessions of Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative therapy via synchronous telehealth. Trauma and eating disorder symptoms were assessed before and after treatment and the patient demonstrated clinically significant improvement on measures of these disorders. Patient-provider working alliance and quality of life were assessed post-treatment. Synchronous telehealth use drastically increased with the onset of COVID-19; however, little information on treating CPTSD via synchronous video teleconferencing is available. This case study illustrates an evidence-based, phased therapy for CPTSD while highlighting the feasibility and value of in-home delivery of psychotherapy for CPTSD via synchronous telehealth.
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Affiliation(s)
- Belle Zaccari
- Veterans Affairs Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Travis I. Lovejoy
- Veterans Affairs Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Maya E. O’Neil
- Veterans Affairs Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
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Sauer KS, Wendler-Bödicker C, Boos A, Niemeyer H, Palmer S, Rojas R, Hoyer J, Hitzler M. Treatment of Comorbid Disorders, Syndromes, and Symptoms of Posttraumatic Stress Disorder Related to Childhood Maltreatment with STAIR-NT. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2023. [DOI: 10.1026/1616-3443/a000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Abstract. Background: Early interpersonal traumatic events, such as childhood maltreatment, increase the risk of developing complex posttraumatic stress symptoms. The biphasic treatment program STAIR-NT (Skills Training for Affective and Interpersonal Regulation with Narrative Therapy), developed specifically for this patient group, combines interventions to improve emotion regulation and interpersonal skills with narrative therapy. Objective: Many affected patients with PTSD after childhood maltreatment also suffer from various comorbid mental disorders and symptoms that can affect and impede the course and outcome of treatment with STAIR-NT. Method: Based on experience from a current treatment study, we provide recommendations for integrating treatment of comorbid mental symptoms into STAIR-NT. Results / Conclusion: Training affective and interpersonal regulation skills in the first treatment phase offers various interventions to efficiently adapt transdiagnostic mechanisms such as emotion dysregulation. In cases of severe comorbid mental disorders or symptoms, adding disorder-specific interventions to STAIR-NT may be indicated.
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Affiliation(s)
- Karoline Sophie Sauer
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Germany
| | | | - Anne Boos
- Psychotherapy Practice in Großhartau, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Sebastian Palmer
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Gießen, Germany
| | - Roberto Rojas
- University Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Melissa Hitzler
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Germany
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Bryant RA, Dawson KS, Azevedo S, Yadav S, Cahill C, Kenny L, Maccallum F, Tran J, Rawson N, Tockar J, Garber B, Keyan D. Augmenting trauma-focused psychotherapy for post-traumatic stress disorder with brief aerobic exercise in Australia: a randomised clinical trial. Lancet Psychiatry 2023; 10:21-29. [PMID: 36436532 DOI: 10.1016/s2215-0366(22)00368-6] [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] [Received: 08/13/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although exposure therapy is central in most front-line psychotherapies of post-traumatic stress disorder (PTSD), many patients do not respond to this treatment. We aimed to investigate the effects of brief aerobic exercise on the efficacy of exposure therapy in reducing the severity of PTSD. METHODS We did a single-blind, parallel, randomised controlled trial in Sydney, NSW, Australia. We included adults (aged ≥18 years) with clinician-diagnosed PTSD. We excluded participants aged 70 years or older, with imminent suicidal risk (reporting suicidal plan), presence of psychosis or substance dependence, history of moderate-to-severe traumatic brain injury, or presence of a physical disorder or impairment that might be exacerbated by aerobic exercise (eg, back pain). We randomly assigned participants (1:1) to nine 90-min weekly sessions of exposure therapy for PTSD with 10 min aerobic exercise or to the control group of exposure therapy with 10 min passive stretching. The primary outcome was PTSD severity measured by the clinician-administered PTSD scale 2 (CAPS-2), independently assessed at baseline, 1 week after treatment, and 6 months after treatment (primary outcome timepoint). FINDINGS Between Dec 12, 2012, and July 25, 2018, we enrolled 130 participants with PTSD, with 65 (50%) participants randomly assigned to exposure therapy with exercise and 65 (50%) to exposure therapy with passive stretching, including 79 (61%) women and 51 (39%) men, with a mean age of 39·1 years (SD 14·4; range 18-69). 99 (76%) participants were White, 14 (11%) were Asian, and 17 (13%) were listed as other. At the 6-month follow-up assessment, participants in the exposure therapy with exercise group showed greater reductions in CAPS-2 scores relative to those in the exposure therapy with stretching group (mean difference 12·1 [95% CI 2·4-21·8]; p=0·023), which resulted in a moderate effect size of 0·6 (0·1-1·1). No adverse events associated with the intervention were reported. The trial was prospectively registered on the Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864. INTERPRETATION Brief aerobic exercise has the potential to augment long-term gains of exposure therapy for PTSD, which accords with evidence from studies in animals and humans on the role of exercise in modulating the extinction learning processes. This strategy might offer a simple and affordable means to augment treatment gains for exposure therapy in people with PTSD. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia; Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, NSW, Australia.
| | - Katie S Dawson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Suzanna Azevedo
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Srishti Yadav
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Catherine Cahill
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Kenny
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Maccallum
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Natasha Rawson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Julia Tockar
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Benjamin Garber
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Dharani Keyan
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Brown JVE, Ajjan R, Siddiqi N, Coventry PA. Acceptability and feasibility of continuous glucose monitoring in people with diabetes: protocol for a mixed-methods systematic review of quantitative and qualitative evidence. Syst Rev 2022; 11:263. [PMID: 36494845 PMCID: PMC9733378 DOI: 10.1186/s13643-022-02126-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Good glycaemic control is a crucial part of diabetes management. Traditional assessment methods, including HbA1c checks and self-monitoring of blood glucose, can be unreliable and inaccurate. Continuous glucose monitoring (CGM) offers a non-invasive and more detailed alternative. Availability of this technology is increasing worldwide. However, there is no current comprehensive evidence on the acceptability and feasibility of these devices. This is a protocol for a mixed-methods systematic review of qualitative and quantitative evidence about acceptability and feasibility of CGM in people with diabetes. METHODS We will search MEDLINE, Embase, CINAHL, and CENTRAL for qualitative and quantitative evidence about the feasibility and acceptability of CGM in all populations with diabetes (any type) using search terms for "continuous glucose monitoring" and "diabetes". We will not apply any study-type filters. Searches will be restricted to studies conducted in humans and those published from 2011 onwards. We will not restrict the search by language. Study selection and data extraction will be carried out by two reviewers independently using Rayyan and Eppi-Reviewer, respectively, with disagreements resolved by discussion. Data extraction will include key information about each study, as well as qualitative evidence in the form of participant quotes from primary studies and themes and subthemes based on the authors' analysis. Quantitative data relating to acceptability and feasibility including data loss, adherence, and quantitative ratings of acceptability will be extracted as means and standard deviations or n/N as appropriate. Qualitative evidence will be analysed using framework analysis informed by the Theoretical Framework of Acceptability. Where possible, quantitative evidence will be combined using random-effects meta-analysis; otherwise, a narrative synthesis will be performed. The most appropriate method for integrating qualitative and quantitative findings will be selected based on the data available. DISCUSSION Ongoing assessment of the acceptability of interventions has been identified as crucially important to scale-up and implementation. This review will provide new knowledge with the potential to inform a programme theory of CGM as well as future roll-out to potentially vulnerable populations, including those with severe mental illness. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021255141.
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Affiliation(s)
| | - Ramzi Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, YO10 5DD, UK.,Hull York Medical School, York, UK.,Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, YO10 5DD, UK.,York Environmental Sustainability Institute, University of York, York, UK.,Leverhulme Centre for Anthropocene Biodiversity, University of York, York, UK
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45
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Keyser L, Maroyi R, Mukwege D. Violence Against Women – A Global Perspective. Obstet Gynecol Clin North Am 2022; 49:809-821. [DOI: 10.1016/j.ogc.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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46
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Melegkovits E, Blumberg J, Dixon E, Ehntholt K, Gillard J, Kayal H, Kember T, Ottisova L, Walsh E, Wood M, Gafoor R, Brewin C, Billings J, Robertson M, Bloomfield M. The effectiveness of trauma-focused psychotherapy for complex post-traumatic stress disorder: A retrospective study. Eur Psychiatry 2022; 66:e4. [PMID: 36423898 PMCID: PMC9879871 DOI: 10.1192/j.eurpsy.2022.2346] [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] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We retrospectively evaluated the effectiveness of trauma-focused psychotherapy (TF-P) versus stabilization and waiting in a civilian cohort of patients with an 11th version of the international classification of disease (ICD-11) diagnosis of complex post-traumatic stress disorder (CPTSD). METHODS We identified patients with CPTSD treated at a specialist trauma service over a 3-year period by triangulating evidence from self-report questionnaires, file review, and expert-clinician opinion. Patients completed a phase-based treatment: stabilization consisting of symptom management and establishing safety, followed by waiting for treatment (phase 1); individual TF-P in the form of trauma-focused cognitive behavioral therapy (TF-CBT), or eye movement desensitization and reprocessing (EMDR) or TF-CBT plus EMDR (phase 2). Our primary outcome was PTSD symptoms during phase 2 versus phase 1. Secondary outcomes included depressive symptoms, functional impairment, and a proxy CPTSD measure. Exploratory analysis compared outcomes between treatments. Adverse outcomes were recorded. RESULTS Fifty-nine patients were included. Compared to receiving only phase 1, patients completing TF-P showed statistically significant reductions in PTSD [t(58) = -3.99, p < 0.001], depressive symptoms [t(58) = -4.41, p < 0.001], functional impairment [t(58) = -2.26, p = 0.028], and proxy scores for CPTSD [t(58) = 4.69, p < 0.001]. There were no significant differences in outcomes between different treatments offered during phase 2. Baseline depressive symptoms were associated with higher PTSD symptoms and functional impairment. CONCLUSIONS This study suggests that TF-P effectively improves symptoms of CPTSD. However, prospective research with validated measurements is necessary to evaluate current and new treatments and identify personal markers of treatment effectiveness for CPTSD.
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Affiliation(s)
- Eirini Melegkovits
- Traumatic Stress Clinic, Division of Psychiatry, University College London, London, United Kingdom.,Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Jocelyn Blumberg
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Emily Dixon
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Kimberley Ehntholt
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Julia Gillard
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Hamodi Kayal
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Tim Kember
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Livia Ottisova
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Eileen Walsh
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Maximillian Wood
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Rafael Gafoor
- Research Department of Primary Care and Population Health, UCL, Royal Free Hospital, London, United Kingdom
| | - Chris Brewin
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Jo Billings
- Traumatic Stress Clinic, Division of Psychiatry, University College London, London, United Kingdom
| | - Mary Robertson
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Michael Bloomfield
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom.,Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, University College London, London, United Kingdom.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Snaychuk LA, Ferrão YA, Fontenelle LF, Miguel EC, de Mathis MA, Scanavino MDT, Kim HS. Co-Occurring Obsessive-Compulsive Disorder and Compulsive Sexual Behavior: Clinical Features and Psychiatric Comorbidities. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:4111-4123. [PMID: 36066680 DOI: 10.1007/s10508-022-02412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Obsessive-compulsive disorder (OCD) commonly co-occurs with other psychiatric conditions. Though research is limited, there is preliminary evidence that OCD also co-occurs with compulsive sexual behavior (CSB). Yet, few studies have investigated the demographic, clinical, and psychiatric comorbidities associated with co-occurring OCD and CSB. To address this gap, the current study aimed to evaluate rates of co-occurring OCD and CSB, identify demographic and clinical factors associated with comorbid OCD and CSB, and assess associated psychiatric comorbidity. Participants (N = 950) were patients of a large multisite treatment for OCD. Standardized self-report measures were used to assess demographic and clinical characteristics such as anxiety, depression, and severity and dimensions of OCD. Semi-structured interviews including the SCID were used to assess psychiatric comorbidities. A total of 36 (3.8%) of participants met the criteria for CSB. Binary logistic regression analysis revealed that males were significantly more likely to present with CSB than females and CSB was associated with greater psychiatric comorbidity, particularly impulse control disorders. These findings suggest that individuals with co-occurring OCD and CSB may have more complex treatment needs, and more tailored interventions may be necessary.
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Affiliation(s)
- Lindsey A Snaychuk
- Department of Psychology, Toronto Metropolitan University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada
| | - Ygor A Ferrão
- Clinical Neurosciences Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Leonardo F Fontenelle
- Departamento de Psiquiatria e Medicina Legal, Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ) e Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | | | - Maria A de Mathis
- Institute of Psychiatry, Universidade de São Paulo, São Paulo, Brazil
| | | | - Hyoun S Kim
- Department of Psychology, Toronto Metropolitan University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, ON, Canada.
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Ryk J, Simpson R, Hosseiny F, Notarianni M, Provencher MD, Rudnick A, Upshur R, Sud A. Virtually-delivered Sudarshan Kriya Yoga (SKY) for Canadian veterans with PTSD: A study protocol for a nation-wide effectiveness and implementation evaluation. PLoS One 2022; 17:e0275774. [PMID: 36288364 PMCID: PMC9605019 DOI: 10.1371/journal.pone.0275774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) remains a significant treatment challenge among Canadian veterans. Currently accessible pharmacological and non-pharmacological interventions for PTSD often do not lead to resolution of PTSD as a categorical diagnosis and have significant non-response rates. Sudarshan Kriya Yoga (SKY), a complementary and integrative health (CIH) intervention, can improve symptoms of PTSD. In response to the COVID-19 pandemic, this intervention has pivoted to virtual delivery and may be reaching new sets of participants who face multiple barriers to care. OBJECTIVE To evaluate the implementation and effectiveness of virtually delivered Sudarshan Kriya Yoga (SKY) on decreasing PTSD symptom severity, symptoms of depression, anxiety, and pain, and improving quality of life in Canadian veterans affected by PTSD. METHODS AND ANALYSIS Using a mixed-methods approach guided by the RE-AIM framework, we will conduct a hybrid type II effectiveness and implementation study of virtually delivered Sudarshan Kriya Yoga (SKY) for Canadian veterans. Effectiveness will be evaluated by comparing virtually delivered SKY to a waitlist control in a single-blinded (investigator and data analyst) randomized controlled trial (RCT). Change in PTSD symptoms (PCL-5) is the primary outcome and quality of life (SF-36), symptoms of depression (PHQ-9), anxiety (GAD-7), and pain (BPI) are secondary outcomes. The SKY intervention will be conducted over a 6-week period with assessments at baseline, 6-weeks, 12-weeks, and 30 weeks. The reach, effectiveness, adoption, implementation, and maintenance of the intervention will be evaluated through one-on-one semi-structured interviews with RCT participants, SKY instructors, health professionals, and administrators that work with veterans. DISCUSSION This is the first investigation of the virtual delivery of SKY for PTSD in veterans and aims to determine if the intervention is effective and implementable at scale.
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Affiliation(s)
- Justin Ryk
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Robert Simpson
- Toronto Rehabilitation Institute, University Hospital Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fardous Hosseiny
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada
| | - MaryAnn Notarianni
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada
| | - Martin D. Provencher
- École de Psychologie, Université Laval, Québec City, Québec, Canada
- Centre d’évaluations et d’interventions en santé mentale (CÉISM), Université Laval, Québec City, Québec, Canada
- VITAM and CERVO Research Centres, Québec City, Québec, Canada
| | - Abraham Rudnick
- Departments of Psychiatry and Bioethics and School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Operational Stress Injury Clinic, Nova Scotia Health, Dartmouth, Nova Scotia, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Abhimanyu Sud
- Department of Family and Community Medicine, Temerty Medicine, University of Toronto, Toronto, Ontario, Canada
- Humber River Hospital, Toronto, Ontario, Canada
- * E-mail:
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49
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Banz L, Stefanovic M, von Boeselager M, Schäfer I, Lotzin A, Kleim B, Ehring T. Effects of current treatments for trauma survivors with posttraumatic stress disorder on reducing a negative self-concept: a systematic review and meta-analysis. Eur J Psychotraumatol 2022; 13:2122528. [PMID: 36325255 PMCID: PMC9621279 DOI: 10.1080/20008066.2022.2122528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background: A negative self-concept is characterised by dysfunctional cognitions about the self and has been suggested to be a key factor involved in the development and maintenance of posttraumatic stress disorder (PTSD). In addition, the current definitions of PTSD according to DSM-5 and the new ICD-11 diagnosis of Complex PTSD (CPTSD) include aspects of negative self-concept in their diagnostic criteria. Objective: The aim of this meta-analysis was to synthesise the currently available evidence on the effects of psychological interventions for PTSD on negative self-concept. Methods: PubMed, PsychINFO, PSYNDEX, PTSDpubs and Cochrane Library were searched for randomised controlled trials (RCTs) of psychological treatments for PTSD symptoms in adults, published up to February 2021. A systematic review and meta-analysis were conducted, with risk of bias assessed by the Cochrane Risk of Bias Assessment Tool. Results: A total of 25 RCTs (N = 2585) were included in the meta-analysis. Results showed that psychological interventions significantly improve a negative self-concept with a moderate to large controlled effect size (k = 30, g = 0.67, 95% CI [0.31, 1.02], p < .001) at post-treatment. Heterogeneity between studies was large but could not be accounted for by moderators included in the current analysis, i.e. different types of interventions (e.g. with vs. without a cognitive restructuring component, trauma-focused vs. not). Conclusions: Current treatments for PTSD are effective in reducing a negative self-concept. However, more research is needed to identify moderators of this effect and identify interventions that are most effective for reducing negative self-concept.
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Affiliation(s)
| | | | | | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Kleim
- Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
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50
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Stekl EK, Collen JF. No time to waste! Acute sleep interventions after trauma. J Clin Sleep Med 2022; 18:2091-2092. [PMID: 36047783 PMCID: PMC9435324 DOI: 10.5664/jcsm.10204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Emily K. Stekl
- Sleep Research Center, Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jacob F. Collen
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
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