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Petersen EA, Stauss T, Scowcroft J, Jaasma M, White J, Sills S, Amirdelfan K, Guirguis M, Xu J, Yu C, Nairizi A, Patterson D, Creamer M, Galan V, Bundschu R, Mehta N, Sayed D, Lad NP, DiBenedetto D, Sethi KA, Wu P, Argoff C, Nasr C, Taylor R, Caraway D, Mekhail N. 440 10 kHz Spinal Cord Stimulation (SCS) Provides Significant, Durable Pain Relief for Patients with Painful Diabetic Neuropathy (PDN): 24-Month Results. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Bolash R, Creamer M, Rauck R, Vahedifar P, Calodney A, Fox I, Ozaktay C, Vanquathem N. Multi-waveform Spinal Cord Stimulation with High Frequency Electromagnetic Coupled (HF-EMC) Powered Implanted Electrode Array and Receiver for the Treatment of Chronic Back and Leg Pain (SURF Study). Pain Physician 2022; 25:67-76. [PMID: 35051146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Novel externally powered spinal cord stimulation technology can be fully implanted when trialing the effectiveness of the therapy, since no percutaneous leads are needed, and the trial period lasted 30 days. Multiple tests of different stimulation modalities and parameters are possible, thus improving the chances that the therapy will lead to effective pain reduction. OBJECTIVES The objective of this study was to analyze the effectiveness of the Freedom Spinal Cord Stimulator System (Stimwave LLC, Pompano Beach, FL) for the treatment of failed back surgery syndrome due to postlaminectomy syndrome utilizing multiple waveforms. STUDY DESIGN This was a prospective, single cohort study. Patients were enrolled and implanted with up to 2 permanent, 8-contact electrode arrays with receiver, controlled regularly during 6 months of follow-up after a one month trial period. Pain and overall improvement were evaluated at 3 months and 6 months following an initial one-month implanted trial period. SETTINGS A variety of frequency stimulation waveforms (tonic as well as subthreshold) at frequencies of 10 Hz to 1500 Hz* and 50 to 800 µs pulse width, were provided. (*Note: While 1500 Hz was utilized in the study, Stimwave Technologies is currently only permitted to provide spinal cord stimulation therapy at frequencies below 1500 Hz, therefore pulse rates used in this study are not commercially available on Stimwave Technologies' products). METHODS Endpoints evaluated included the Visual Analog Scale (VAS) for pain intensity, Oswestry Disability Index (ODI) for functionality, Patient Global Impression of Change (PGIC) for overall health improvement, and quality of life as measured by the European Quality of Life 5 Dimension questionnaire (EQ-5D-5L). RESULTS Thirty-nine patients completed the study. At 6 months, the responder rate (? 50% reduction VAS for back pain) was 33/39 = 85%. Mean VAS for back pain decreased 62%. The mean ODI decreased 46% from 54 to 29.2, indicating a reduction from severe to moderate disability. The median satisfaction as measured with the PGIC was 6 out of 7. The mean EQ-5D-5L utility score increased from 0.54 to 0.75. At the 6-months endpoint, 44% (17/39) of patients preferred tonic stimulation with a back pain per protocol responder rate of 82%; 41% (16/39) preferred surge with a responder rate of 56%; and 15% (6/39) preferred high density, with a responder rate of 83%. Fifteen patients reported 28 adverse events. Migration of the electrode array (n = 10) was the adverse event most reported. Two serious adverse events related to infection were reported. LIMITATIONS This study had several limitations. Trial failures were excluded from the analysis, there was a small sample size, and there was a lack of blinding due to the suprathreshold nature of tonic stimulation. CONCLUSION The study demonstrates that spinal cord stimulation with multiple stimulation patterns demonstrates clinical and functional efficacy when using an externally powered stimulation system.
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Affiliation(s)
| | - Michael Creamer
- Central Florida Pain Centers, Compass Research LLC, Orlando, FL
| | | | - Payam Vahedifar
- Nuvo Spine and Sports Institute & Ortho Regenerative Center, Beverly Hills, CA
| | | | - Ira Fox
- Anesthesia Pain Care Consultants, Tamarac, FL
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Creamer M, Cloud G, Kossmehl P, Yochelson M, Francisco GE, Ward AB, Wissel J, Zampolini M, Abouihia A, Calabrese A, Saltuari L. Effect of Intrathecal Baclofen on Pain and Quality of Life in Poststroke Spasticity. Stroke 2019; 49:2129-2137. [PMID: 30354975 PMCID: PMC6116794 DOI: 10.1161/strokeaha.118.022255] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Intrathecal baclofen (ITB) is an effective treatment for managing patients with severe poststroke spasticity, who can experience continued pain and decline in their quality of life (QoL). SISTERS (Spasticity In Stroke-Randomized Study) was a randomized, controlled, open-label, multicenter, phase 4 study to evaluate ITB therapy versus conventional medical management (CMM) with oral antispastic medications for treatment of poststroke spasticity. Methods- Poststroke patients with spasticity in ≥2 extremities and an Ashworth Scale score of ≥3 in ≥2 affected lower extremity muscle groups were randomized (1:1) to ITB (N=31) or CMM (N=29). Both treatment arms received physiotherapy throughout. The primary outcome was the change in average Ashworth Scale score in the lower extremities of the affected side from baseline to month 6. Here, we report results for secondary outcomes: pain via the Numeric Pain Rating Scale, health-related QoL by the EuroQol-5 dimensional 3 level utility score and health status visual analog scale score, stroke-specific QoL, and patient satisfaction. Analyses were performed on an intention-to-treat basis. Results- We observed significant treatment effects in favor of ITB over CMM for changes from baseline to month 6 in Numeric Pain Rating Scale scores for actual pain (ITB versus CMM: mean, -1.17 [SD, 3.17] versus 0.00 [3.29]; median, -1.00 versus 0.00; P=0.0380) and least pain (mean, -1.61 [2.29] versus 0.24 [3.07]; median, -1.00 versus 0.00; P=0.0136), and EuroQol-5 dimensional 3 level utility scores (mean, +0.09 [0.26] versus +0.01 [0.16]; median, +0.07 versus 0.00; P=0.0197). Between-group differences were not statistically significant for EuroQol-5 dimensional 3 level visual analog scale, stroke-specific QoL summary, or Numeric Pain Rating Scale worst pain scores, although ITB patients showed greater numeric improvements from baseline during follow-up. More ITB patients than CMM patients (73% versus 48%) were satisfied with the spasticity reduction at month 6. Conclusions- These data support that ITB therapy is associated with improvements in pain and QoL in poststroke patients. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT01032239.
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Affiliation(s)
- Michael Creamer
- From the Central Florida Pain Relief Centers, Orlando (M.C.)
| | - Geoffrey Cloud
- St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (G.C.).,Department of Neurology, Alfred Health, Melbourne, VIC, Australia (G.C.)
| | - Peter Kossmehl
- Kliniken Beelitz GmbH Neurologische Rehabilitationsklinik, Beelitz-Heilstätten, Germany (P.K.)
| | - Michael Yochelson
- MedStar National Rehabilitation Hospital, Washington, DC (M.Y.).,Shepherd Center, Atlanta, GA (M.Y.)
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center and TIRR Memorial Hermann Hospital, Houston (G.E.F.)
| | - Anthony B Ward
- North Staffordshire Rehabilitation Centre, Haywood Hospital, Stoke-On-Trent, United Kingdom (A.B.W.)
| | - Jörg Wissel
- Neurological Rehabilitation and Physical Therapy, Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany (J.W.)
| | - Mauro Zampolini
- USL Umbria 2, Department of Rehabilitation, Ospedale di Foligno, Perugia, Italy (M.Z.)
| | - Abdallah Abouihia
- Neuromodulation Clinical, Medtronic International, Tolochenaz, Switzerland (A.A., A.C.)
| | - Alessandra Calabrese
- Neuromodulation Clinical, Medtronic International, Tolochenaz, Switzerland (A.A., A.C.)
| | - Leopold Saltuari
- Abteilung für Neurologie Landeskrankenhaus Hochzirl, Austria (L.S.).,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy (L.S.)
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Sirovica LV, Creamer M, Horback KM. Preference for and behavioural response to environmental enrichment in a small population of sexually mature, commercial boars. Anim Welf 2019. [DOI: 10.7120/109627286.28.3.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An increasing public concern over the welfare of livestock species is motivating more producers to consider changes to production practices. Providing environmental enrichment for intensively housed animals is one such potentially welfare-enhancing change. The goal of environmental
enrichment is to provide biologically relevant environmental stimuli that allows an animal to perform highly motivated, species-specific behaviours. To date, there is no research specific to the applicability of environmental enrichment for commercial boars (Sus scrofa domesticus),
nor on commercial boar welfare in general. In this study, eight individually housed, mature boars were observed to prefer interacting with hanging cotton rope enrichment over hanging rubber chew sticks when given the option. There was a significantly negative correlation between the amount
of time boars spent interacting with rope and the amount of time they spent performing stereotypic pen manipulation, suggesting that the rope was more effective at reducing stereotypic behaviour than the rubber. Such reductions in amount of time spent performing abnormal stereotypic behaviours
could indicate that some of the animals' behavioural needs are being met by the enrichment object. Thus, the results of this study could help provide producers with more objective, research-based suggestions concerning the efficacy of practical enrichment choices for individually housed boars.
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North RB, Calodney A, Bolash R, Slavin KV, Creamer M, Rauck R, Vahedifar P, Fox I, Özaktay C, Panchal S, Vanquathem N. Redefining Spinal Cord Stimulation "Trials": A Randomized Controlled Trial Using Single-Stage Wireless Permanent Implantable Devices. Neuromodulation 2019; 23:96-101. [PMID: 31157949 PMCID: PMC7004134 DOI: 10.1111/ner.12970] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/08/2019] [Accepted: 04/25/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND "Traditional" spinal cord stimulation (SCS) trials with percutaneous electrodes externalized to a pulse generator (PG) are typically limited in duration due to risk of infection. Newer miniaturized wireless SCS technology eliminates the percutaneous extension (as well as PGs implanted for chronic use), thus facilitating a single-stage implantation after which the device can remain indefinitely. OBJECTIVE To evaluate fully implanted wireless SCS devices during a 30-day screening trial in subjects with chronic low back pain and leg pain and a history of lumbosacral spine surgery. METHODS In a randomized controlled trial of single-stage wireless SCS using a wireless percutaneous system, 99 subjects received either 10 kHz high frequency stimulation (HFS) or lower frequency stimulation (LFS) below 1500 Hz (Bolash R, Creamer M, Rauck R, et al. Wireless high frequency spinal cord stimulation (10 kHz) compared to multi-waveform low frequency spinal cord stimulation in the management of chronic pain in failed back surgery syndrome subjects: preliminary results of a multicenter, prospective, randomized controlled study. Pain Med 2019, https://doi.org/10.1093/pm/pnz019). In this report, we assess the 30-day trial success rate (≥50% pain relief from baseline) and complications. RESULTS The overall trial success rate was 88% (87/99): 92% (46/50) for HFS and 84% (41/49) for LFS (NS). The trial success rate in the 64 subjects with predominant low back pain was 92% (59/64) vs. 80% (28/35) in those with leg pain ≥ low back pain (NS). During the screening trial, one infection occurred (1%) and one subject withdrew and was explanted (1%). Electrode migrations were seen on routine follow-up x-rays in 10 cases (10%). CONCLUSION Using wireless SCS devices that allow for an extended trial period and evaluation of various waveforms, we observed a high rate trial success rate with both HFS and LFS waveforms, with minimal incidence of infection. Long-term follow-up will address the cost-effectiveness and morbidity associated with this technology, which facilitates single-stage treatment.
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Affiliation(s)
- Richard B North
- Departments of Neurosurgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aaron Calodney
- Department of Anesthesiology, Louisiana State University Health Science Center, Shreveport, LA, USA
| | - Robert Bolash
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Michael Creamer
- Department of Geriatrics Physical Medicine & Rehabilitation, Florida State University, Tallahassee, FL, USA
| | - Richard Rauck
- Department of Anesthesiology, Wake Forest University, Winston-Salem, NC, USA
| | | | - Ira Fox
- Anesthesia Pain Care Consultants, Tamarac, FL, USA
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Bolash R, Creamer M, Rauck R, Vahedifar P, Calodney A, Fox I, Özaktay C, Panchal S, Vanquathem N, Yasin M. Wireless High-Frequency Spinal Cord Stimulation (10 kHz) Compared with Multiwaveform Low-Frequency Spinal Cord Stimulation in the Management of Chronic Pain in Failed Back Surgery Syndrome Subjects: Preliminary Results of a Multicenter, Prospective Randomized Controlled Study. Pain Medicine 2019; 20:1971-1979. [DOI: 10.1093/pm/pnz019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
This study aimed to evaluate the wireless Freedom Spinal Cord Stimulator (WSCS) System for the treatment of chronic back and/or leg pain associated with failed back surgery syndrome (FBSS) refractory to standard medical treatment utilizing 10-kHz stimulation (high-frequency [HF]) in comparison with 10–1,500-Hz stimulation (low-frequency [LF]) waveforms.
Methods
Ninety-nine subjects were randomized in a 1:1 ratio to receive either HF or LF stimulation waveforms utilizing the same Freedom WSCS System. All subjects were implanted with two 8-electrode arrays in the exact same anatomical positions within the dorsal epidural spinal column, with the top electrode positioned at the T8 and T9 vertebrae levels, respectively, and the wireless receiver placed under the skin in a subcutaneous pocket.
Results
Seventy-two (HF: N = 38; LF: N = 34) subjects had completed the six-month follow-up after an initial 30-day trial period at the time of this report. For both the HF and LF arms, mean visual analog scale (VAS) scores for back and leg pain decreased significantly: 77% and 76%, respectively, for the HF arm and 64% and 64%, respectively, for the LF arm. In addition, most subjects experienced significant improvements in VAS, Oswestry Disability Index, European Quality of Life 5 Dimension questionnaire, Patient Global Impression of Change, and sleep duration.
Conclusions
These preliminary results demonstrate that WSCS devices can reduce FBSS chronic pain substantially with both LF and HF stimulation waveforms over a seven-month period (30-day trial period and six-month post-trial evaluation).
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Affiliation(s)
| | - Michael Creamer
- Central Florida Pain Centers, Orlando, Florida
- Compass Research LLC, Orlando, Florida
| | - Richard Rauck
- Carolina’s Pain Institute, Winston-Salem, North Carolina
| | - Payam Vahedifar
- Nuvo Spine and Sports Institute & Ortho Regenerative Center, Beverly Hills, California
| | | | - Ira Fox
- Anesthesia Pain Care Consultants, Tamarac, Florida
| | | | | | | | - Mezaun Yasin
- Anesthesia Pain Care Consultants, Tamarac, Florida
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Yochelson M, Creamer M, Cloud G, Kossmehl P, Francisco G, Ward A, Wissel J, Zampolini M, Abouihia A, Calabrese A, Saltuari L. Intrathecal baclofen therapy versus conventional medical management in post-stroke spasticity: Assessment of patient-reported outcome: Quality of life, pain and satisfaction (SISTERS). Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Creamer M, Cloud G, Kossmehl P, Yochelson M, Francisco GE, Ward AB, Wissel J, Zampolini M, Abouihia A, Berthuy N, Calabrese A, Loven M, Saltuari L. Intrathecal baclofen therapy versus conventional medical management for severe poststroke spasticity: results from a multicentre, randomised, controlled, open-label trial (SISTERS). J Neurol Neurosurg Psychiatry 2018; 89:642-650. [PMID: 29326296 PMCID: PMC6031277 DOI: 10.1136/jnnp-2017-317021] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/13/2017] [Accepted: 12/05/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intrathecal baclofen (ITB) is a treatment option for patients with severe poststroke spasticity (PSS) who have not reached their therapy goal with other interventions. METHODS 'Spasticity In Stroke-Randomised Study' (SISTERS) was a randomised, controlled, open-label, multicentre phase IV study to evaluate the efficacy and safety of ITB therapy versus conventional medical management (CMM) with oral antispastic medications for treatment of PSS. Patients with chronic stroke with spasticity in ≥2 extremities and an Ashworth Scale (AS) score ≥3 in at least two affected muscle groups in the lower extremities (LE) were randomised (1:1) to ITB or CMM. Both treatment arms received physiotherapy throughout. The primary outcome was the change in the average AS score in the LE of the affected body side from baseline to month 6. Analyses were performed for all patients as randomised (primary analysis) and all randomised patients as treated (safety analysis). RESULTS Of 60 patients randomised to ITB (n=31) or CMM (n=29), 48 patients (24 per arm) completed the study. The primary analysis showed a significant effect of ITB therapy over CMM (mean AS score reduction, -0.99 (ITB) vs -0.43 (CMM); Hodges-Lehmann estimate, -0.667(95.1%CI -1.0000 to -0.1667); P=0.0140). More patients reported adverse events while receiving ITB (24/25 patients, 96%; 149 events) compared with CMM (22/35, 63%; 77 events), although events were generally consistent with the known safety profile of ITB therapy. CONCLUSIONS These data support the use of ITB therapy as an alternative to CMM for treatment of generalised PSS in adults. TRIAL REGISTRATION NUMBER NCT01032239; Results.
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Affiliation(s)
| | - Geoffrey Cloud
- St. George's University Hospitals NHS Foundation Trust, London, UK.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Peter Kossmehl
- Kliniken Beelitz GmbH Neurologische Rehabilitationsklinik, Beelitz-Heilstätten, Germany
| | - Michael Yochelson
- MedStar National Rehabilitation Hospital, Washington DC, USA.,Shepherd Center, Atlanta, Georgia, USA
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, Texas, USA.,TIRR Memorial Hermann Hospital, Houston, Texas, USA
| | - Anthony B Ward
- North Staffordshire Rehabilitation Centre, Haywood Hospital, Stoke on Trent, UK
| | - Jörg Wissel
- Department of Neurology, Neurological Rehabilitation and Physical Therapy, Vivantes Hospital Spandau, Berlin, Germany
| | - Mauro Zampolini
- Department of Rehabilitation, Ospedale di Foligno, USL Umbria 2, Perugia, Italy
| | - Abdallah Abouihia
- Neuromodulation Clinical, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Nathalie Berthuy
- Neuromodulation Clinical, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Alessandra Calabrese
- Neuromodulation Clinical, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | - Leopold Saltuari
- Abteilung für Neurologie, Landeskrankenhaus Hochzirl, Zirl, Austria.,Research Unit for Neurorehabilitation, South Tyrol, Bolzano, Italy
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Desai MJ, Kapural L, Petersohn JD, Vallejo R, Menzies R, Creamer M, Gofeld M. Twelve-Month Follow-up of a Randomized Clinical Trial Comparing Intradiscal Biacuplasty to Conventional Medical Management for Discogenic Lumbar Back Pain. Pain Med 2018; 18:751-763. [PMID: 27570246 DOI: 10.1093/pm/pnw184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective This report conveys 12-month outcomes of subjects treated with intradiscal biacuplasty (IDB) and conservative medical management (CMM) for chronic low back pain of discogenic origin, and results for subjects who elected to receive IDB + CMM 6 months after CMM-alone. Methods Sixty-three subjects were originally randomized to the IDB + CMM group (N = 29) or CMM-alone (N = 34). Six months following continuous CMM-alone treatment, participants in this study group were permitted to "cross-over" to IDB + CMM (N = 25), and followed for an additional 6 months. The original IDB + CMM study subjects were followed for a total of 12 months (N = 22). Results Pain reduction at 12 months was statistically significant and clinically meaningful in the original IDB + CMM group compared to baseline. Functional and disability outcomes were also improved statistically and clinically. Fifty-five percent of the IDB + CMM patients responded to treatment with a mean VAS reduction of 2.2 points at 12 months. Furthermore, 50% and 64% of subjects reported clinically significant improvements in SF36-PF and in ODI, respectively. There was a 1.7-point reduction (improvement) on a 7-point PGIC scale, and a 0.13-point increase (improvement) in the EQ-5D Health Index. Fifty-percent of cross-over subjects responded to IDB + CMM intervention. Mean outcome scores for cross-over subjects were similar to those of the originally-treated subjects, and functional and disability endpoints were improved statistically and clinically compared to respective baseline values. Conclusions The study demonstrated long-term clinical effectiveness of IDB + CMM for treating chronic lumbar discogenic pain. Furthermore, the cross-over study subjects experienced similar improvements in pain, function, disability, and satisfaction.
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Affiliation(s)
- Mehul J Desai
- George Washington University Medical Center, Washington, District of Columbia, USA.,International Spine, Pain, and Performance Center, Washington, District of Columbia, USA
| | - Leonardo Kapural
- Center for Clinical Research, Winston-Salem, North Carolina, USA
| | | | | | - Robert Menzies
- JPS Orthopedic and Sports Medicine, Arlington, Texas, USA
| | | | - Michael Gofeld
- Department of Anesthesia and Pain Medicine, University Health Network, Toronto, Canada
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Bryant RA, Creamer M, O'Donnell M, Forbes D, Felmingham KL, Silove D, Malhi G, van Hoof M, McFarlane AC, Nickerson A. Separation from parents during childhood trauma predicts adult attachment security and post-traumatic stress disorder. Psychol Med 2017; 47:2028-2035. [PMID: 28535839 DOI: 10.1017/s0033291717000472] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Prolonged separation from parental support is a risk factor for psychopathology. This study assessed the impact of brief separation from parents during childhood trauma on adult attachment tendencies and post-traumatic stress. METHOD Children (n = 806) exposed to a major Australian bushfire disaster in 1983 and matched controls (n = 725) were assessed in the aftermath of the fires (mean age 7-8 years) via parent reports of trauma exposure and separation from parents during the fires. Participants (n = 500) were subsequently assessed 28 years after initial assessment on the Experiences in Close Relationships scale to assess attachment security, and post-traumatic stress disorder (PTSD) was assessed using the PTSD checklist. RESULTS Being separated from parents was significantly related to having an avoidant attachment style as an adult (B = -3.69, s.e. = 1.48, β = -0.23, p = 0.013). Avoidant attachment was associated with re-experiencing (B = 0.03, s.e. = 0.01, β = 0.31, p = 0.045), avoidance (B = 0.03, s.e. = 0.01, β = 0.30, p = 0.001) and numbing (B = 0.03, s.e. = 0.01, β = 0.30, p < 0.001) symptoms. Anxious attachment was associated with re-experiencing (B = 0.03, s.e. = 0.01, β = 0.18, p = 0.001), numbing (B = 0.03, β = 0.30, s.e. = 0.01, p < 0.001) and arousal (B = 0.04, s.e. = 0.01, β = 0.43, p < 0.001) symptoms. CONCLUSIONS These findings demonstrate that brief separation from attachments during childhood trauma can have long-lasting effects on one's attachment security, and that this can be associated with adult post-traumatic psychopathology.
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Affiliation(s)
- R A Bryant
- School of Psychology,University of New South Wales,Sydney,NSW 2052,Australia
| | - M Creamer
- Phoenix Institute,University of Melbourne,161 Barry Street,Carlton,VIC 3053,Australia
| | - M O'Donnell
- Phoenix Institute,University of Melbourne,161 Barry Street,Carlton,VIC 3053,Australia
| | - D Forbes
- Phoenix Institute,University of Melbourne,161 Barry Street,Carlton,VIC 3053,Australia
| | - K L Felmingham
- Department of Psychology,University of Tasmania,Hobart,TAS 7000,Australia
| | - D Silove
- School of Psychology,University of New South Wales,Sydney,NSW 2052,Australia
| | - G Malhi
- Department of Psychiatry,University of Sydney,St Leonards,NSW 2065,Australia
| | - M van Hoof
- Department of Psychiatry,University of Adelaide,Adelaide,SA 5000,Australia
| | - A C McFarlane
- Department of Psychiatry,University of Adelaide,Adelaide,SA 5000,Australia
| | - A Nickerson
- School of Psychology,University of New South Wales,Sydney,NSW 2052,Australia
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Harrell M, Weaver S, Loukas A, Creamer M, Marti C, Jackson C, Heath J, Nayak P, Perry C, Pechacek T, Eriksen M. Flavored e-cigarette use: Characterizing youth, young adult, and adult users. Prev Med Rep 2017; 5:33-40. [PMID: 27896041 PMCID: PMC5121224 DOI: 10.1016/j.pmedr.2016.11.001] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/26/2016] [Accepted: 11/06/2016] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study is to investigate how the use of flavored e-cigarettes varies between youth (12-17 years old), young adults (18-29 years old), and older adults (30 + years old). Cross-sectional surveys of school-going youth (n = 3907) and young adult college students (n = 5482) in Texas, and young adults and older adults (n = 6051) nationwide were administered in 2014-2015. Proportions and 95% confidence intervals were used to describe the percentage of e-cigarette use at initiation and in the past 30 days that was flavored, among current e-cigarette users. Chi-square tests were applied to examine differences by combustible tobacco product use and demographic factors. Most e-cigarette users said their first and "usual" e-cigarettes were flavored. At initiation, the majority of Texas school-going youth (98%), Texas young adult college students (95%), and young adults (71.2%) nationwide said their first e-cigarettes were flavored to taste like something other than tobacco, compared to 44.1% of older adults nationwide. Fruit and candy flavors predominated for all groups; and, for youth, flavors were an especially salient reason to use e-cigarettes. Among adults, the use of tobacco flavor at initiation was common among dual users (e-cigarettes + combustible tobacco), while other flavors were more common among former cigarette smokers (P = 0.03). Restricting the range of e-cigarette flavors (e.g., eliminating sweet flavors, like fruit and candy) may benefit youth and young adult prevention efforts. However, it is unclear what impact this change would have on adult smoking cessation.
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Affiliation(s)
- M.B. Harrell
- UTHealth School of Public Health in Austin, Michael & Susan Dell Center for Healthy Living, , 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - S.R. Weaver
- Georgia State University Tobacco Center of Regulatory Science & Division of Epidemiology & Biostatistics, School of Public Health, Georgia State University, 33 Gilmer Street SE, Atlanta, GA 30303, USA
| | - A. Loukas
- Department of Kinesiology & Health Education, University of Texas at Austin, 2109 San Jacinto Blvd., Stop D3700, Austin, TX 78712-1415, USA
| | - M. Creamer
- UTHealth School of Public Health in Austin, Michael & Susan Dell Center for Healthy Living, , 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - C.N. Marti
- Department of Kinesiology & Health Education, University of Texas at Austin, 2109 San Jacinto Blvd., Stop D3700, Austin, TX 78712-1415, USA
| | - C.D. Jackson
- UTHealth School of Public Health in Austin, Michael & Susan Dell Center for Healthy Living, , 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - J.W. Heath
- Georgia State University Tobacco Center of Regulatory Science, Urban Life Building, 140 Decatur Street, NE, Atlanta, GA 30303, USA
| | - P. Nayak
- Georgia State University Tobacco Center of Regulatory Science, Urban Life Building, 140 Decatur Street, NE, Atlanta, GA 30303, USA
| | - C.L. Perry
- UTHealth School of Public Health in Austin, Michael & Susan Dell Center for Healthy Living, , 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - T.F. Pechacek
- Georgia State University Tobacco Center of Regulatory Science & Division of Health Management & Policy, Urban Life Building, 140 Decatur Street, NE, Atlanta, GA 30303, USA
| | - M.P. Eriksen
- Georgia State University Tobacco Center of Regulatory Science & Division of Health Management & Policy, Urban Life Building, 140 Decatur Street, NE, Atlanta, GA 30303, USA
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Nickerson A, Creamer M, Forbes D, McFarlane AC, O'Donnell ML, Silove D, Steel Z, Felmingham K, Hadzi-Pavlovic D, Bryant RA. The longitudinal relationship between post-traumatic stress disorder and perceived social support in survivors of traumatic injury. Psychol Med 2017; 47:115-126. [PMID: 27670088 DOI: 10.1017/s0033291716002361] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although perceived social support is thought to be a strong predictor of psychological outcomes following trauma exposure, the temporal relationship between perceived positive and negative social support and post-traumatic stress disorder (PTSD) symptoms has not been empirically established. This study investigated the temporal sequencing of perceived positive social support, perceived negative social support, and PTSD symptoms in the 6 years following trauma exposure among survivors of traumatic injury. METHOD Participants were 1132 trauma survivors initially assessed upon admission to one of four Level 1 trauma hospitals in Australia after experiencing a traumatic injury. Participants were followed up at 3 months, 12 months, 24 months, and 6 years after the traumatic event. RESULTS Latent difference score analyses revealed that greater severity of PTSD symptoms predicted subsequent increases in perceived negative social support at each time-point. Greater severity of PTSD symptoms predicted subsequent decreases in perceived positive social support between 3 and 12 months. High levels of perceived positive or negative social support did not predict subsequent changes in PTSD symptoms at any time-point. CONCLUSIONS Results highlight the impact of PTSD symptoms on subsequent perceived social support, regardless of the type of support provided. The finding that perceived social support does not influence subsequent PTSD symptoms is novel, and indicates that the relationship between PTSD and perceived social support may be unidirectional.
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Affiliation(s)
- A Nickerson
- School of Psychology,University of New South Wales,Sydney,NSW,Australia
| | - M Creamer
- Department of Psychiatry,University of Melbourne,Melbourne,VIC,Australia
| | - D Forbes
- Department of Psychiatry,University of Melbourne,Melbourne,VIC,Australia
| | - A C McFarlane
- Center for Traumatic Stress Studies,University of Adelaide,Adelaide,SA,Australia
| | - M L O'Donnell
- Department of Psychiatry,University of Melbourne,Melbourne,VIC,Australia
| | - D Silove
- School of Psychiatry and Ingham Institute,University of New South Wales,Sydney,NSW,Australia
| | - Z Steel
- School of Psychiatry and Ingham Institute,University of New South Wales,Sydney,NSW,Australia
| | - K Felmingham
- School of Psychological Science,University of Melbourne,Melbourne,VIC,Australia
| | - D Hadzi-Pavlovic
- School of Psychiatry and Ingham Institute,University of New South Wales,Sydney,NSW,Australia
| | - R A Bryant
- School of Psychology,University of New South Wales,Sydney,NSW,Australia
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13
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Rosenberg J, Fabi A, Candido K, Knezevic N, Creamer M, Carayannopoulos A, Ghodsi A, Nelson C, Bennett M. Spinal Cord Stimulation Provides Pain Relief with Improved Psychosocial Function: Results from EMP3OWER. Pain Med 2016; 17:2311-2325. [PMID: 28025365 DOI: 10.1093/pm/pnw152] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The EMP3OWER™ study evaluated spinal cord stimulation (SCS) safety and efficacy and the associated changes in psychosocial and functional outcomes. METHODS Upon informed consent and IRB approval, 620 eligible subjects were enrolled prior to SCS trial evaluation and were assessed at baseline, 3, 6 and 12 months post-implant. Patient-reported pain relief (PRP), numerical rating scale (NRS), satisfaction, quality of life (QOL), and pain disability index (PDI) were assessed at all follow-up visits while the pain catastrophizing scale (PCS), short form-36 (SF-36), short form-McGill pain questionnaire version 2 (SF-MPQ-2), and the state-trait anxiety inventory (STAI) were assessed at the 6- and 12-month follow-up visits. Device and/or procedure-related adverse events were also recorded and reported. Subjects reporting a PRP ≥ 50% were considered responders. Repeated measures analysis of variance (RMANOVA) examined the changes across time for all continuous measures. RESULTS A total of 401 (71%) subjects received a permanent implant. Mean (±SD) patient-reported pain relief was 59.3% (±26.2), 59.2% (±28.9), and 58.2% (±32.0) at 3, 6, and 12 months, respectively. A majority of enrolled subjects were responders at 3 (75.5%), 6 (74.7%), and 12 months (69.7%). RMANOVA revealed a statistically significant change for NRS, PCS, PDI, SF-36, SF-MPQ-2, and STAI scores. At 3 months, the majority of subjects (85.7%) were either very satisfied or satisfied with their device, with similar results at 6 and 12 months. At 3 months, the majority of subjects (73.3%) reported greatly improved or improved QOL with similar results at 6 and 12 months. CONCLUSIONS Spinal cord stimulation provided pain relief and significant improvement of patient psychological and functional outcome measures.
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Affiliation(s)
- Jason Rosenberg
- *SC Pain and Spine Specialists LLC, Murrells Inlet, South Carolina
| | - Alain Fabi
- Bronson Neuroscience Center, Kalamazoo, Mississippi
| | | | - Nick Knezevic
- Advocate Illinois Masonic Medical Center, Chicago, Illinois
| | | | | | - Abdi Ghodsi
- PARS Neurosurgical Associates, Parkersburg, West Virginia
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14
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Desai MJ, Kapural L, Petersohn J, Vallejo R, Mekhail N, Menzies R, Creamer M, Gofeld M. Poster 173 A Prospective, Randomized, Multi-Center, Open-Label Clinical Trial Comparing Intradiscal Biacuplasty to Conservative Therapy for Discogenic Lumbar Back Pain. PM R 2015. [DOI: 10.1016/j.pmrj.2015.06.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Lloyd D, Nixon RDV, Varker T, Elliott P, Perry D, Bryant RA, Creamer M, Forbes D. Comorbidity in the prediction of Cognitive Processing Therapy treatment outcomes for combat-related posttraumatic stress disorder. J Anxiety Disord 2014; 28:237-40. [PMID: 24507630 DOI: 10.1016/j.janxdis.2013.12.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 12/05/2013] [Accepted: 12/14/2013] [Indexed: 10/25/2022]
Abstract
This paper examines clinical predictors of posttraumatic stress disorder (PTSD) treatment outcomes following Cognitive Processing Therapy (CPT) in Australian military veterans. Fifty nine treatment seeking veterans were enrolled in a randomized controlled trial comparing 12 sessions of CPT (n = 30) with usual treatment (n = 29) at three community-based veterans counseling centers. PTSD and key co-morbidities (depression, anxiety, anger and alcohol use) were measured. Growth curve modeling was used to examine factors which influenced PTSD severity post-treatment. For the CPT condition, baseline anger was the only co-morbidity predictive of change in PTSD severity over time. Participants with higher anger scores showed less of a decrease in PTSD severity over time. Higher anxiety in participants in treatment as usual was significantly associated with better treatment gains. This research suggests that veterans experiencing high levels of anger might benefit from targeted anger reduction strategies to increase the effectiveness of CPT treatment for PTSD.
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Affiliation(s)
- D Lloyd
- Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Vic, Australia.
| | - R D V Nixon
- Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Vic, Australia; School of Psychology, Flinders University, SA, Australia
| | - T Varker
- Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Vic, Australia
| | - P Elliott
- Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Vic, Australia
| | - D Perry
- Veterans and Veterans' Families Counselling Service, Australia
| | - R A Bryant
- School of Psychology, University of New South Wales, NSW, Australia
| | - M Creamer
- Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Vic, Australia
| | - D Forbes
- Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Vic, Australia
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16
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Rosen SM, Bromberg TA, Padda G, Barsa J, Dunbar E, Dwarakanath G, Navalgund Y, Jaffe T, Yearwood TL, Creamer M, Deer T. Intrathecal Administration of Infumorph®vs Compounded Morphine for Treatment of Intractable Pain Using the Prometra®Programmable Pump. Pain Med 2013; 14:865-73. [DOI: 10.1111/pme.12077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Steven M. Rosen
- Fox Chase Pain Management Associates; Jenkintown; Pennsylvania
| | | | - Gurpreet Padda
- Center for Interventional Pain Management; St. Louis; Missouri
| | | | | | | | | | - Todd Jaffe
- Brevard Pain Management; Titusville; Florida
| | | | | | - Timothy Deer
- Center for Pain Relief; Charleston; West Virginia; USA
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17
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Abstract
BACKGROUND Few studies have focused on post-traumatic stress disorder (PTSD) remission in the population, none have modelled remission beyond age 54 years and none have explored in detail the correlates of remission from PTSD. This study examined trauma experience, symptom severity, co-morbidity, service use and time to PTSD remission in a large population sample. METHOD Data came from respondents (n=8841) of the 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB). A modified version of the World Health Organization's World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to determine the presence and age of onset of DSM-IV PTSD and other mental and substance use disorders, type, age, and number of lifetime traumas, severity of re-experiencing, avoidance and hypervigilance symptoms and presence and timing of service use. RESULTS Projected lifetime remission rate was 92% and median time to remission was 14 years. Those who experienced childhood trauma, interpersonal violence, severe symptoms or a secondary anxiety or affective disorder were less likely to remit from PTSD and reported longer median times to remission compared to those with other trauma experiences, less severe symptoms or no co-morbidity. CONCLUSIONS Although most people in the population with PTSD eventually remit, a significant minority report symptoms decades after onset. Those who experience childhood trauma or interpersonal violence should be a high priority for intervention.
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Affiliation(s)
- C Chapman
- The National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.
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18
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Abstract
BACKGROUND Fear circuitry disorders purportedly include post-traumatic stress disorder (PTSD), panic disorder, agoraphobia, social phobia and specific phobia. It is proposed that these disorders represent a cluster of anxiety disorders triggered by stressful events and lead to fear conditioning. Elevated heart rate (HR) at the time of an aversive event may reflect strength of the unconditioned response, which may contribute to fear circuitry disorders. METHOD This prospective cohort study assessed HR within 48 h of hospital admission in 602 traumatically injured patients, who were assessed during hospital admission and within 1 month of trauma exposure for lifetime psychiatric diagnosis. At 3 months after the initial assessment, 526 patients (87%) were reassessed for PTSD, major depressive disorder, panic disorder, agoraphobia, social phobia, obsessive compulsive disorder and generalized anxiety disorder. RESULTS At the 3-month assessment there were 77 (15%) new cases of fear circuitry disorder and 87 new cases of non-fear circuitry disorder (17%). After controlling for gender, age, type of injury and injury severity, patients with elevated HR (defined as ≥96 beats per min) at the time of injury were more likely to develop PTSD [odds ratio (OR) 5.78, 95% confidence interval (CI) 2.32-14.43], panic disorder (OR 3.46, 95% CI 1.16-10.34), agoraphobia (OR 3.90, 95% CI 1.76-8.61) and social phobia (OR 3.98, 95% CI 1.42-11.14). Elevated HR also predicted new fear circuitry disorders that were not co-morbid with a non-fear circuitry disorder (OR 7.28, 95% CI 2.14-24.79). CONCLUSIONS These data provide tentative evidence of a common mechanism underpinning the onset of fear circuitry disorders.
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Affiliation(s)
- R A Bryant
- University of New South Wales, Sydney, NSW, Australia.
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19
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Liedl A, O'Donnell M, Creamer M, Silove D, McFarlane A, Knaevelsrud C, Bryant RA. Support for the mutual maintenance of pain and post-traumatic stress disorder symptoms. Psychol Med 2010; 40:1215-1223. [PMID: 19811699 DOI: 10.1017/s0033291709991310] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pain and post-traumatic stress disorder (PTSD) are frequently co-morbid in the aftermath of a traumatic event. Although several models attempt to explain the relationship between these two disorders, the mechanisms underlying the relationship remain unclear. The aim of this study was to investigate the relationship between each PTSD symptom cluster and pain over the course of post-traumatic adjustment. METHOD In a longitudinal study, injury patients (n=824) were assessed within 1 week post-injury, and then at 3 and 12 months. Pain was measured using a 100-mm Visual Analogue Scale (VAS). PTSD symptoms were assessed using the Clinician-Administered PTSD Scale (CAPS). Structural equation modelling (SEM) was used to identify causal relationships between pain and PTSD. RESULTS In a saturated model we found that the relationship between acute pain and 12-month pain was mediated by arousal symptoms at 3 months. We also found that the relationship between baseline arousal and re-experiencing symptoms, and later 12-month arousal and re-experiencing symptoms, was mediated by 3-month pain levels. The final model showed a good fit [chi2=16.97, df=12, p>0.05, Comparative Fit Index (CFI)=0.999, root mean square error of approximation (RMSEA)=0.022]. CONCLUSIONS These findings provide evidence of mutual maintenance between pain and PTSD.
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Affiliation(s)
- A Liedl
- Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Germany.
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20
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Dileo JF, Brewer WJ, Hopwood M, Anderson V, Creamer M. Olfactory identification dysfunction, aggression and impulsivity in war veterans with post-traumatic stress disorder. Psychol Med 2008; 38:523-531. [PMID: 17903334 DOI: 10.1017/s0033291707001456] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Due to neuropsychological conceptualizations of orbitoprefrontal cortex (OFC) dysfunction underpinning impulsive aggression and the incidence of such behaviour in post-traumatic stress disorder (PTSD), this study aimed to explore olfactory identification (OI) ability in war veterans with PTSD as a probe of putative OFC dysfunction; and to explore the utility of OI ability in predicting aggressive and impulsive behavior in this clinical population. METHOD Participants comprised 31 out-patient male war veterans with PTSD (mean=58.23 years, s.d.=2.56) recruited from a Melbourne Veterans Psychiatry Unit, and 31 healthy age- and gender-matched controls (mean=56.84 years, s.d.=7.24). All participants were assessed on clinical measures of PTSD, depression, anxiety, and alcohol misuse; olfactory identification; neurocognitive measures of dorsolateral prefrontal, lateral prefrontal and mesial temporal functioning; and self-report measures of aggression and impulsivity. RESULTS War veterans with PTSD exhibited significant OI deficits (OIDs) compared to controls, despite uncompromised performance on cognitive measures. OIDs remained after covaring for IQ, anxiety, depression and alcohol misuse, and were significant predictors of aggression and impulsivity. CONCLUSIONS This research contributes to emerging evidence of orbitoprefrontal dysfunction in the pathophysiology underlying PTSD. This is the first study to report OIDs as a predictor of aggression and impulsivity in this clinical population. It prompts further exploration of the potential diagnostic utility of OIDs in the assessment of PTSD. Such measures may help delineate the clinical complexity of PTSD, and support more targeted interventions for individuals with a greater susceptibility to aggressive and impulsive behaviors.
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Affiliation(s)
- J F Dileo
- Department of Psychology, University of Melbourne, Australia
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21
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Eguare E, Tierney S, Maher R, Creamer M, Grace P, Cronin CJ, Burke P. Demands for vascular access in a renal dialysis unit: Implications for a regional vascular unit. Ir J Med Sci 2006; 175:24-8. [PMID: 16615224 DOI: 10.1007/bf03168995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The development of regional dialysis units and the expanding indications for dialysis has led to increased demand for vascular access surgery. Consequently, the provision and maintenance of access, and the management of related complications has created a considerable burden on vascular surgical units in hospitals providing renal replacement therapy (RRT). AIMS The objectives of our study were to review our experience with a variety of vascular access modalities for haemodialysis and to quantify the associated surgical workload. METHODS We reviewed our experience in a consecutive group of dialysis patients who had access surgery for RRT in a regional hospital setting. RESULTS Between January 1995 and January 2000, 69 patients entered the long-term dialysis programme in the Mid-Western region (population = 320,000). Of the 158 procedures performed, 138 (87%) were for access creation, and 20 (13%) related to access revision procedures. Twenty patients (29%) developed a total of 30 access related complications. Vascular access procedures accounted for 10% of the vascular surgical workload (1598 procedures) in the five-year period. CONCLUSION Vascular access is an important part of the haemodialysis services and surgical expertise should be available at local level to cope with likely demand.
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Affiliation(s)
- E Eguare
- Dept of Surgery and The Haemodialysis Unit, Regional General Hospital, Dooradoyle, Limerick
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22
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McKenzie DP, Ikin JF, McFarlane AC, Creamer M, Forbes AB, Kelsall HL, Glass DC, Ittak P, Sim MR. Psychological health of Australian veterans of the 1991 Gulf War: an assessment using the SF-12, GHQ-12 and PCL-S. Psychol Med 2004; 34:1419-1430. [PMID: 15724873 DOI: 10.1017/s0033291704002818] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Elevated rates of psychological morbidity and symptomatology have been widely reported in 1991 Gulf War veterans. The present study used brief self-report instruments to compare the psychological health of Australian Gulf War veterans with that of a randomly sampled military comparison group. METHOD The 12-item Short Form Health Survey (SF-12), 12-item General Health Questionnaire (GHQ-12), Posttraumatic Stress Disorder Checklist--Specific (PCL-S) and Military Service Experience (MSE) questionnaire were administered to 1424 male Australian Gulf War veterans and 1548 male Australian Defence Force members who were operational at the time of the Gulf War conflict, but were not deployed there. RESULTS The Gulf War veterans exhibited poorer psychological health, as measured by the above three instruments, than the comparison group members. For Gulf War veterans, the number of stressful experiences, as measured by the MSE questionnaire, was correlated with scores on the three instruments. SF-12 mental health component summary scores and PCL-S caseness, but not GHQ-12 caseness, differed significantly between Gulf War veterans and comparison group members who had been on at least one active deployment. CONCLUSIONS More than a decade after the 1991 Gulf War, Australian Gulf War veterans are exhibiting higher levels of current (past month) psychological ill-health, as measured using the GHQ-12 and PCL-S, as well as lower mental health status, as measured by the SF-12, than the comparison group. Although not a replacement for formal psychiatric diagnosis, instruments such as those above may aid in the assessment of veterans' psychological health.
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Affiliation(s)
- D P McKenzie
- Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Victoria, Australia.
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23
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Biddle D, Elliott P, Creamer M, Forbes D, Devilly GJ. Self-reported problems: a comparison between PTSD-diagnosed veterans, their spouses, and clinicians. Behav Res Ther 2002; 40:853-65. [PMID: 12074378 DOI: 10.1016/s0005-7967(01)00084-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study investigated self-reported problems in a sample of help-seeking Vietnam veterans, comparing the veteran's own view with clinician and spouse perspectives, with the aim of examining convergence in reports across different informants. Veterans with PTSD (N = 459) were asked to list and rate their five most serious problems. Spouses and treating clinicians completed the same questionnaire in relation to the veteran. Rates of endorsement for each problem area, and levels of agreement between raters, were calculated. Veterans, spouses, and clinicians were all likely to rate anger as a high priority, with veterans also likely to nominate anxiety and depression. Spouses were likely to nominate more observable behavioural problems such as interpersonal difficulties and avoidance, while clinicians were likely to nominate indications of psychopathology, such as anxiety, depression, and intrusive thoughts. Agreement across raters was generally high, although interpretation of agreement levels was complex.
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Affiliation(s)
- D Biddle
- Australian Centre for Posttraumatic Mental Health, West Heidelberg, Melbourne, Vic.
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Abstract
BACKGROUND We report on the epidemiology of post-traumatic stress disorder (PTSD) in the Australian community, including information on lifetime exposure to trauma, 12-month prevalence of PTSD, sociodemographic correlates and co-morbidity. METHODS Data were obtained from a stratified sample of 10,641 participants as part of the Australian National Survey of Mental Health and Well-being. A modified version of the Composite International Diagnostic Interview was used to determine the presence of PTSD, as well as other DSM-IV anxiety, affective and substance use disorders. RESULTS The estimated 12-month prevalence of PTSD was 1-33%, which is considerably lower than that found in comparable North American studies. Although females were at greater risk than males within the subsample of those who had experienced trauma, the large gender differences noted in some recent epidemiological research were not replicated. Prevalence was elevated among the never married and previously married respondents, and was lower among those aged over 55. For both men and women, rape and sexual molestation were the traumatic events most likely to be associated with PTSD. A high level of Axis 1 co-morbidity was found among those persons with PTSD. CONCLUSIONS PTSD is a highly prevalent disorder in the Australian community and is routinely associated with high rates of anxiety, depression and substance disorders. Future research is needed to investigate rates among other populations outside the North American continent.
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Affiliation(s)
- M Creamer
- National Centre for PTSD, Mental Health Research Institute, University of Melbourne, VIC, Australia
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25
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Abstract
This prospective, longitudinal study investigated risk factors in the development of psychological ill health and posttraumatic stress symptoms in a sample of 223 junior police officers. Participants were assessed using a self-report methodology during training and again 12 months later on a range of personality, trauma exposure, and symptom measures. Risk factors for general psychological ill health at phase 2 of the research were found to comprise mostly stable, preexisting characteristics such as personality style, gender, and trait dissociation. Conversely, specific traumatic stress symptoms were more heavily influenced by experiences in the intervening 12 months, such as severity of incident exposure and peritraumatic dissociation. The implications for differential intervention are discussed.
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Affiliation(s)
- G A Hodgins
- Department of Psychology, The University of Melbourne, Victoria, Australia
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26
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Abstract
Little research to date has examined the ability of self-report measures to assess changes in symptom severity and diagnostic status as a function of treatment. This study investigated the validity of the posttraumatic stress disorder (PTSD) checklist (PCL) as a measure of symptomatic change following programmatic treatment. A sample of 97 Vietnam veterans with combat-related PTSD was assessed using the clinician-administered PTSD scale (CAPS) and the PCL prior to, and 9 months following, participation in a PTSD treatment program. Using the CAPS as the "gold standard" measure of PTSD symptomatology, the PCL demonstrated high diagnostic accuracy pre- and posttreatment. However, significant variations in accuracy were evident in the ability of the PCL to determine the presence and severity of individual symptoms at each time point. In addition, as symptoms improved from pre- to posttreatment, and approached the threshold criteria, the PCL demonstrated reductions in diagnostic accuracy. As a measure of overall symptomatic change, the PCL underrated improvement in comparison to the CAPS. The results supported the use of an overall cut-off score of 50 on the PCL for a diagnosis, and an item score of 3 for symptom criterion, in this population.
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Affiliation(s)
- D Forbes
- National Centre for War-Related PTSD, Melbourne, Australia.
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27
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Creamer M, Morris P, Biddle D, Elliott P. Treatment outcome in Australian veterans with combat-related posttraumatic stress disorder: a cause for cautious optimism? J Trauma Stress 1999; 12:545-58. [PMID: 10646175 DOI: 10.1023/a:1024702931164] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study investigated treatment outcome in combat-related posttraumatic stress disorder (PTSD). Participants were 419 Australian Vietnam veterans who completed a 12-week hospital-based program. A comprehensive protocol assessed PTSD, comorbidity, and social functioning at admission and at 3 and 9 months posttreatment. Overall, the group showed significant improvements in core PTSD symptoms, anxiety, depression, alcohol abuse, social dysfunction, and anger. Changes occurred mostly between admission and 3 months posttreatment, with gains maintained at 9 months. Ratings by patients and their partners indicated perceived improvement and strong satisfaction with treatment. Nevertheless, treatment gains were variable and, for most veterans, considerable pathology remained following the programs. The current study provides grounds for cautious optimism in the treatment of combat-related PTSD.
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Affiliation(s)
- M Creamer
- National Centre for PTSD, Victoria, Australia.
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28
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Abstract
Considerable attention has been devoted to the MMPI in the assessment of combat-related PTSD. To date, published data have focused almost exclusively on American Vietnam veterans. This study investigated MMPI-2 profiles of 100 Australian Vietnam veterans admitted to an intensive PTSD treatment program. Comparisons with United States (U.S.) data suggested strong similarities between the American and Australian populations in terms of F-scale elevations and typical 3-point code types (8-7-2). However, the American samples showed relatively higher elevations of Scales 4 and 6, suggesting social alienation and a tendency to externalize, while a subgroup of Australian veterans showed a greater propensity for somatization (Scale 1). The results provide overall support for the generalizability of American MMPI data to an alternative cultural group of combat veterans.
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Affiliation(s)
- D Forbes
- PTSD Program, Austin and Repatriation Medical Centre, Melbourne, Australia
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Relihan N, McGreal G, Murray M, McDermott EW, O’Higgins NJ, Duffy MJ, McNamara DA, Harmey J, Wang JH, Donovan D, Walsh TN, Bouchier-Hayes DJ, Kay E, Kelly JD, Weir HP, Keane PF, Johnston SR, Williamson KE, Hamilton PW, McManus D, Morrin M, Delaney PV, Winter DC, Harvey BJ, Geibel JP, O’Sullivan GC, Delaney CP, Coffey R, Gorey TF, Fitzpatrick JM, Fanning NF, Kirwan W, Cotter T, Bouchier-Hayes D, Redmond HP, McNamara DA, Pidgeon G, Harmey J, Walsh TN, Bouchier-Hayes DJ, Redmond HP, Fennessy F, Wang JH, Kelly C, Bouchier-Hayes D, Delaney CP, Flavin R, Coffey R, Gorey TF, Fitzpatrick JM, Rasheed AM, Wang JH, Kelly C, Bouchier-Hayes DJ, Leahy A, Lang EE, Caldwell MTP, Tanner WA, Kiely PD, O’Reilly M, Tierney S, Barry M, Delaney PV, Drumm J, Grace PA, Gallagher CM, Grant DC, Connell P, Barry MK, Traynor O, Hyland JMP, O’Sullivan MJ, Evoy D, Redmond HP, Kirwan WO, Cannon B, Kenny-Walshe L, Whelton MJ, O’Grady H, O’Neill S, Grant DC, Barry MK, Traynor O, Hyland JM, Teh SH, O’Ceallaigh S, O’Donohoe MK, Tanner WA, Keane FB, O’Toole GC, Grant DC, Barry MK, Hyland JMP, Calleary J, Basso L, Amjad SB, Khan Z, McMullin L, Joyce WP, Balfe PJ, Caldwell MT, Keane FB, Tanner WA, Teahan S, Al-Brekeit K, Tierney S, Rasheed A, Bouchier-Hayes D, Leahy A, O’Neill S, Delaney CP, Gorey TF, Fitzpatrick JM, Cullen A, O’Keane C, Fennessy F, Kelly C, Bouchier-Hayes D, Fennessy F, Wang JH, Kelly C, Bouchier-Hayes DJ, Winter DC, MacFarlane J, Harvey BJ, O’Sullivan GC, Walsh M, McGloughlin T, Grace P, Colgan D, Madhavan P, Sultan S, Colgan MP, Moore D, Shanik G, McEniff N, Molloy M, Eguare E, Fiuza C, Grace P, Burke P, Maher R, Creamer M, Cronin CJ, Sigurdsso HH, Kim W, Linklater G, Cross KS, Simpson WG, Shaw JAM, Pearson DWM, Fitzgerald P, Quinn P, Tierney S, Bouchier-Hayes D, Brady CM, Shah SMA, Ehtisham M, Khan MS, Flood HD, Loubani M, Sweeney K, Lenehan B, Lynch V, Joy A, McGreal G, Reidy D, Mahalingam K, Cashman W, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, O’Halloran D, McGreal G, McDermott EW, O’Higgins NJ, Neary P, Hamilton D, Haider N, Aherne N, Watson RGK, Walsh D, Murphy M, Joyce M, Johnston S, Clinton O, Given HF, Brannigan A, O’Donohoe M, Donohoe J, Corrigan T, Bresnihan M, O’Donohoe MK, Feeley TM, Sultan S, Madhavan P, Colgan MP, Moore D, Shanik G, McMonagle MP, Quinlan D, Kelly D, Hegarty PK, Tan B, Cronin C, Brady MP, Zeeshan M, McAvinchey DJ, Aherne N, Mooney C, Coyle D, Haider N, Hamilton D, Neary P, Watson RGK, Khayyat G, Masterson E, Thambi-Pillai T, Farah K, Delaney CP, Codd MB, Fitzpatrick JM, Gorey TF, Barry MK, Tsiotos GG, Johnson CD, Sarr MG, Kell MR, Lynch M, Ryan D, O’Donovan A, Winter DC, Redmond HP, Delaney CP, Cassidy M, Doyle M, Fulton G, O’Connell PR, Kingston R, Dillon M, Barry M, Tierney S, Grace PA, McGreal G, Lenehan B, Murray M, McDermott E, O’Higgins N, Kell MR, O’Sullivan RG, Tan B, O’Donnell JA. Sylvester o’halloran surgical scientific meeting. Ir J Med Sci 1998. [DOI: 10.1007/bf02937403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Creamer M, Jackson A, Ball R. A profile of help-seeking Australian veterans. J Trauma Stress 1996; 9:569-75. [PMID: 8827656 DOI: 10.1007/bf02103665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
While considerable information is available regarding American Vietnam veterans, surprisingly little has appeared concerning veterans of other nationalities who served in the Vietnam war. This paper provides a preliminary profile of help-seeking Australian veterans in order to afford a comparison with the available American data. Collected in the context of a review of the Vietnam Veterans Counselling Service (VVCS), demographic data suggest that the client population is similar in many ways to that of the American posttraumatic stress disorder (PTSD) Clinical Teams. Problems commonly reported by clients of VVCS included posttraumatic stress, relationship difficulties, anxiety, depression, and problems with pensions and benefits. A postal survey of a sub-sample of current clients revealed a mean score on the Combat Exposure Scale of 19.27 and a mean score on the Mississippi Scale for PTSD of 118.43. Again, these findings are broadly comparable with those of American help-seeking veterans.
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Affiliation(s)
- M Creamer
- Department of Psychology, University of Melbourne, Parkville, Victoria, Australia
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Wood S, Creamer M. Nutrition. Malnutrition in hospitals. Nurs Times 1996; 92:67-70. [PMID: 8717704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
This study investigated the properties of the Beck Anxiety Inventory (BAI) in a sample of 326 undergraduate students. Scores on the BAI were compared with data from the State-Trait Anxiety Inventory and the Beck Depression Inventory. The BAI demonstrated good psychometric properties, with a high level of internal consistency. Relatively low test-retest correlations, in comparison with the STAI-Trait, suggested that the scale was functioning as a state measure. Factor analysis revealed a unifactorial solution on the first administration (a time of low stress), but a two factor solution similar to that proposed initially by Beck, Epstein, Brown and Steer (Journal of Consulting and Clinical Psychology, 56, 893-897, 1988) at the second administration (hypothesised to be a time of increased stress). Thus, the two factor structure of the BAI (characterised by physical and cognitive symptoms) may not be distinguishable in the normal population in the absence of an external stressor. An apparent strength of the BAI was its superior ability in differentiating anxiety from depression when compared with the STAI. A combined factor analysis of the BAI and STAI-State revealed two distinct factors, suggesting that the scales may actually be measuring separate, although not necessarily independent, constructs. It is suggested that the high discriminant validity demonstrated by the BAI may have been achieved at the expense of some construct validity.
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Affiliation(s)
- M Creamer
- Department of Psychology, University of Melbourne, Parkville, Victoria, Australia
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Forbes D, Creamer M, Rycroft P. Eye movement desensitization and reprocessing in posttraumatic stress disorder: a pilot study using assessment measures. J Behav Ther Exp Psychiatry 1994; 25:113-20. [PMID: 7983220 DOI: 10.1016/0005-7916(94)90003-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Spectacular claims have been made regarding the efficacy of eye movement desensitization and reprocessing (EMDR) in the treatment of posttraumatic stress disorder (PTSD), but almost entirely on the basis of patients' reports and without objective criteria. This study reports on the treatment of eight patients with a diagnosis of PTSD who received EMDR treatment over four sessions. Assessment measures included two structured interviews, three self-report inventories, and the electromyogram (EMG). Assessments were conducted pre and posttreatment, and at 3-month follow-up. Despite some residual pathology at posttreatment and follow-up, significant improvements were obtained on all measures and across all PTSD symptom clusters. Compared with other treatments of PTSD, change was achieved in far fewer sessions.
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Affiliation(s)
- D Forbes
- University of Melbourne, Victoria, Australia
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Abstract
We integrated existing cognitive processing models of posttrauma reactions into a longitudinal model. Data were obtained after a multiple shooting in a city office block. The subject group comprised 158 office workers who were in the building at the time of the shootings. The methodology of this research was a repeated measures survey, with data collection at 4, 8, and 14 months posttrauma. Measures included the Impact of Events Scale (IES) and the Symptom Checklist-90-Revised. A path analysis was performed with the IES as an indication of cognitive processing. Intrusion and avoidance were shown to mediate between exposure to trauma and symptom development. Intrusion was also found to be negatively related to subsequent symptom levels. The findings provide provisional support for a cognitive processing model.
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Affiliation(s)
- M Creamer
- Department of Psychology, University of Melbourne, Parkville, Victoria, Australia
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Abstract
We integrated existing cognitive processing models of posttrauma reactions into a longitudinal model. Data were obtained after a multiple shooting in a city office block. The subject group comprised 158 office workers who were in the building at the time of the shootings. The methodology of this research was a repeated measures survey, with data collection at 4, 8, and 14 months posttrauma. Measures included the Impact of Events Scale (IES) and the Symptom Checklist-90-Revised. A path analysis was performed with the IES as an indication of cognitive processing. Intrusion and avoidance were shown to mediate between exposure to trauma and symptom development. Intrusion was also found to be negatively related to subsequent symptom levels. The findings provide provisional support for a cognitive processing model.
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Affiliation(s)
- M Creamer
- Department of Psychology, University of Melbourne, Parkville, Victoria, Australia
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Abstract
The current study investigated a model of post-trauma reactions proposed initially by McFarlane (1988 a). Two separate data sets, one obtained following a multiple shooting and the other reported by McFarlane following a natural disaster, were examined. The findings of both studies provide support for a cognitive processing conceptualization of the development of post-trauma reactions.
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Affiliation(s)
- M Creamer
- Department of Psychology, University of Melbourne, Parkville, Victoria, Australia
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Abstract
The development of post-traumatic stress disorder (PTSD) in a group of 42 individuals exposed to a multiple homicide was examined. A comparison of DSM-III and DSM-III-R indicated that 74% qualified for a diagnosis of PTSD using DSM-III, but only 33% met the criteria outlined in DSM-III-R. The most commonly reported symptoms were found to be intrusive recollections of the event and exaggerated startle response. In general, those symptoms that are new additions in the revised version were the least frequently reported, whilst guilt, which has been excluded from DSM-III-R, was experienced by 38% of the sample. It is suggested that the new criteria may not cluster with the core syndrome of PTSD.
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Affiliation(s)
- M Creamer
- Department of Psychology, University of Melbourne, Parkville, Vic
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Abstract
The discrepancy between the way individuals perceive themselves and the way they are perceived by their partners has been proposed as an indicator of dyadic adjustment. The present study employed the CPI to investigate the relation of interpersonal perception within dyads and real similarity of spouses to marital satisfaction. The subjects were 20 married couples. Support was provided for the use of the real similarity-assumed similarity-accuracy paradigm in studies of interpersonal perception. No sex differences were found in the ability of individuals to predict their spouse's responses on the CPI. Accuracy of prediction was correlated significantly with scores on the Hogan Empathy scale for males, but not for females. Conversely, accuracy was related significantly to dyadic adjustment in the case of females, but not males. Real similarity also was correlated positively with dyadic adjustment. Avenues for further research are suggested.
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Affiliation(s)
- M Creamer
- Ellery Clinic, Health Department of Victoria, Carlton, Australia
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Fellows BJ, Creamer M. An investigation of the role of 'hypnosis', hypnotic susceptibility and hypnotic induction in the production of age regression. Br J Soc Clin Psychol 1978; 17:165-71. [PMID: 647173 DOI: 10.1111/j.2044-8260.1978.tb00260.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In response to criticisms of the methodology of Barber's(1969)experiments, a 2x2 factorial design, varying hypnotic susceptibility and hypnotic treatment, was used to study the role of 'hypnosis' in the production of age regression by suggestion. Twenty subjects of high hypnotic susceptibility and 20 subjects of low hypnotic susceptibility were randomly allocated to one of two treatment conditions:hypnotic induction procedure or motivational instructions. Both treatments were followed by suggestions to regress to the age of seven years. Two measures of age regression were taken:the Draw-A-Man-Test and a subjective rating of the reality of the experience. The results showed significant effects of both variables, with high suceptibility and induction treatment producing better regression on both measures than low susceptibility and motivation treatment. Hypnotic susceptibility was the stronger of the two variables. The ranking of the four conditions corresponded with predictions of hypnotic depth from the state theory of hypnosis, but the findings were not inconsistent with the non-state theory. The drawings of all regressed groups were more mature than the norms for the age of seven and the drawings of a group of seven year old children.
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Creamer M. THE REVERIES OF A GENERAL PRACTITIONER. Cal State J Med 1921; 19:143-145. [PMID: 18738430 PMCID: PMC1516877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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