Chronic Posttraumatic Stress Disorder Research Articles

Co-occurring Chronic Pain and PTSD Among US Military Veterans: Prevalence, Correlates, and Functioning.

The prevalence of co-occurring chronic pain and posttraumatic stress disorder (PTSD) has yet to be established in a nationally representative sample of US veterans, and little is known about the individual contributing roles of these disorders to the psychiatric and functional burden of this comorbidity. To determine the prevalence of chronic pain, PTSD, and co-occurring chronic pain and PTSD, and psychiatric comorbidities and psychosocial functioning in these groups. Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of US veterans. Veterans (n=4069) were classified into four groups: control (i.e., no PTSD or chronic pain), chronic pain only, PTSD only, and co-occurring chronic pain and PTSD. A probable PTSD diagnosis was established using the PTSD Checklist for DSM-5, and a chronic pain diagnosis using a self-report item that queried health care professional diagnoses. Psychiatric and functional status were assessed using the Patient Health Questionnaire-4, Alcohol Use Disorders Identification Test, Screen of Drug Use, Suicide Behaviors Questionnaire-Revised, Short Form Health Survey-8, Brief Inventory of Psychosocial Functioning, and Medical Outcomes Study Cognitive Functioning Scale. A total of 3.8% of veterans reported both probable PTSD and a diagnosis of chronic pain. Relative to veterans with chronic pain alone, those with co-occurring chronic pain and probable PTSD were more likely to screen positive for psychiatric disorders (odds ratios [ORs]=2.59-9.88) and scored lower on measures of psychosocial functioning (Cohen's ds=0.38-1.43). Relative to veterans with probable PTSD only, those with co-occurring chronic pain and probable PTSD were more likely to have attempted suicide (OR=4.79; 95%CI, 1.81-12.69). Results underscore the importance of whole health care that considers a broad range of health and functional domains in the assessment and treatment of co-occurring chronic pain and PTSD in veterans.

The role of nitric oxide and hormone signaling in chronic stress, anxiety, depression and post-traumatic stress disorder

This paper provides a summary of the role of nitric oxide (NO) and hormones in the development of chronic stress, anxiety, depression, and post-traumatic stress disorder (PTSD). These mental health conditions are prevalent globally and involve complex molecular interactions. Although there is a significant amount of research and therapeutic options available, the underlying mechanisms of these disorders are still not fully understood. The primary pathophysiologic processes involved in chronic stress, anxiety, depression, and PTSD include dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, the intracellular influence of neuronal nitric oxide synthase (nNOS) on transcription factors, an inflammatory response with the formation of nitrergic oxidative species, and reduced serotonergic transmission in the dorsal raphe nucleus. Despite the extensive literature on this topic, there is a great need for further research to clarify the complexities inherent in these pathways, with the primary aim of improving psychiatric care.

Forensic Dimensions of Chronic Stress (PTSD) and its Impact on Brain Activity and Mental Health: A Systematic Review

Introduction: The effects of chronic stress on the brain and mental health are significant and are frequently linked to post-traumatic stress disorder (PTSD). The impact of persistent stress, especially PTSD, on the brain and mental health is examined in this study from a forensic perspective. To ensure fair evaluations, assessments, and decision-making procedures, the legal system needs to comprehend these ramifications. Aim:This study aims to investigate the neurobiological modifications, cognitive deficits, and psychological effects brought on by chronic stress and their applicability in a forensic setting. The study emphasizes the necessity for thorough evaluations in judicial procedures and seeks to shed light on the impact of prolonged stress on brain function and mental health. Methodology: Using pertinent keywords including chronic stress, brain structure, brain function, depression, anxiety, and PTSD, a thorough search of scientific databases was carried out, including PubMed, PsycINFO, and Google Scholar. Relevance to the subject, the study's caliber, and the publication date were all considered while choosing papers. Key facts and insights were determined by a comprehensive study of the literature. Results: Chronic stress affects emotional regulation, memory, and the stress response by causing neurobiological changes in the prefrontal cortex, hippocampus, amygdala, and HPA axis. Prolonged stress is accompanied by cognitive impairments, especially in PTSD, which include executive dysfunction and attention problems. Anxiety, sadness, and increased susceptibility to substance misuse are examples of psychological effects. Conclusion There are important forensic ramifications to persistent stress, particularly PTSD, on brain function and mental health. While psychological issues make it difficult to participate in court proceedings effectively, neurobiological changes and cognitive deficits might damage someone's credibility as a witness or victim. Fair evaluations require a bridge between neuroscience, mental health, and the legal system. Future studies should pinpoint distinct neuronal processes and consider efficient cures to lessen the effects on forensic outcomes.

Graph theory-based analysis reveals neural anatomical network alterations in chronic post-traumatic stress disorder

Abstract Multimodal imaging using network connectivity techniques shows promise for investigating neuropathology influencing Post-Traumatic Stress Disorder (PTSD) symptom maintenance and course. We recruited World Trade Center (WTC) responders who continued to suffer from chronic PTSD into a diffusion tensor neuroimaging protocol (n=100), along with nine unexposed controls without PTSD from other sources. Using a graph theory approach to probe network alterations in brain diffusion images, we calculated weighted characteristics path length as a surrogate marker for the effective neuroanatomical distance between anatomical nodes. The sample (N=109; 47 with chronic PTSD) was in their mid-fifties, and the majority were male. Responders were matched in terms of cognitive performance, occupation, and demographics. The anatomical connectivity graph was constructed for each participant using deterministic diffusion tractography. We identified a significant difference in weighted Characteristic Path Length (wCPL) between trauma-exposed WTC responders (Cohen’s d = 0.42, P<0.001) that was highest in people with PTSD, and not explained by WTC exposure severity or duration. We also found that wCPL was associated with PTSD symptom severity in responders with PTSD. In the largest study to date to examine the relationship between chronic PTSD and anatomy, we examined the anatomical topography of neural connections and found that wCPL differed between the PTSD+ and PTSD- diagnostic categories.

Peer Victimization, Posttraumatic Stress Symptoms, and Chronic Pain: A Longitudinal Examination

Chronic pain and posttraumatic stress disorder symptoms (PTSS) co-occur at high rates in youth and are linked to worse pain outcomes and quality of life. While peer victimization has been posited as a mechanism underlying the PTSS-pain relationship in youth, empirical evidence suggests that it may exacerbate both PTSS and pain. The present study aimed to longitudinally examine PTSS as a mediator in the relationship between peer victimization at baseline and pain-related outcomes at 3 months in youth with chronic pain. Participants included 182 youth aged 10 to 18 years recruited from a tertiary-level children’s hospital in Western Canada. At baseline, participants completed measures to assess pain (intensity and interference), peer victimization (relational and overt), and PTSS. The pain was reassessed at a 3-month follow-up. Primary hypotheses were tested utilizing a series of mediation analyses with PTSS as a proposed mediator in the associations between peer victimization and pain outcomes. Youth PTSS mediated the relationship between higher baseline relational victimization and higher 3-month pain interference while controlling for baseline pain interference. Three-month pain intensity was not correlated with peer victimization; thus, pain intensity was not included in the analyses. These findings reveal that PTSS may be an underlying factor in the co-occurrence of peer victimization and chronic pain in youth. Further research is needed to better understand the role of peer victimization in the maintenance of chronic pain to ensure appropriate, effective, and timely interventions that address the social and mental health issues impacting the lives of these youth as well as their pain. PerspectivePTSS may be an underlying factor in the co-occurrence between peer victimization and chronic pain in youth, highlighting the need to assess for both peer relationship problems and PTSS in youth with chronic pain.

Randomized controlled trial of two internet-based written therapies for world trade center workers and survivors with persistent PTSD symptoms

Posttraumatic stress disorder (PTSD) remains prevalent among individuals exposed to the 9/11 World Trade Center (WTC) terrorist attacks. The present study compared an Internet-based, therapist-assisted psychotherapy for PTSD to an active control intervention in WTC survivors and recovery workers with WTC-related PTSD symptoms (n = 105; 75% syndromal PTSD). Participants were randomized to integrative testimonial therapy (ITT), focused on WTC-related trauma, or modified present-centered therapy (I-MPCT), each comprising 11 assigned written narratives. The primary outcome was baseline-to-post-treatment change in PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5). Secondary measures included PTSD symptom clusters, depressive/anxiety symptoms, functioning, and quality of life. A significant main effect of time was observed for the primary outcome (average “large” effect size improvement, d = 1.49). Significant and “moderate-to-large” main effects of time were also observed for all PTSD symptom clusters, depressive symptoms, quality of life, and mental health-related functioning (d range=0.62–1.33). Treatment and treatment-by-time interactions were not significant. In planned secondary analyses incorporating 3-month follow-up measures, ITT was associated with significantly greater reductions than I-MPCT in PTSD avoidance and negative alterations in cognitions and mood, anxiety, and mental health-related functioning. Both therapies significantly lowered PTSD symptoms, suggesting they may benefit hard-to-reach individuals with chronic WTC-related PTSD symptoms.

Virtual Reality and Transcranial Direct Current Stimulation for Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that is particularly difficult to treat in military veterans. Noninvasive brain stimulation has significant potential as a novel treatment to reduce PTSD symptoms. To test whether active transcranial direct current stimulation (tDCS) plus virtual reality (VR) is superior to sham tDCS plus VR for warzone-related PTSD. This double-blind randomized clinical trial was conducted among US military veterans enrolled from April 2018 to May 2023 at a secondary care Department of Veterans Affairs hospital and included 1- and 3-month follow-up visits. Participants included US military veterans with chronic PTSD and warzone-related exposure, recruited via referral and advertisement. Patients in psychiatric treatment had to be on a stable regimen for at least 6 weeks to be eligible for enrollment. Data were analyzed from May to September 2023. Participants were randomly assigned to receive 2-mA anodal tDCS or sham tDCS targeted to the ventromedial prefrontal cortex, during six 25-minute sessions of standardized warzone VR exposure, delivered over 2 to 3 weeks. The co-primary outcomes were self-reported PTSD symptoms, measured via the PTSD checklist for DSM-5 (PCL-5), alongside quality of life. Other outcomes included psychophysiological arousal, clinician-assessed PTSD, depression, and social/occupational function. A total of 54 participants (mean [SD] age, 45.7 [10.5] years; 51 [94%] males) were assessed, including 26 in the active tDCS group and 28 in the sham tDCS group. Participants in the active tDCS group reported a superior reduction in self-reported PTSD symptom severity at 1 month (t = -2.27, P = .02; Cohen d = -0.82). There were no significant differences in quality of life between active and sham tDCS groups. Active tDCS significantly accelerated psychophysiological habituation to VR events between sessions compared with sham tDCS (F5,7689.8 = 4.65; P < .001). Adverse effects were consistent with the known safety profile of the corresponding interventions. These findings suggest that combined tDCS plus VR may be a promising strategy for PTSD reduction and underscore the innovative potential of these combined technologies. ClinicalTrials.gov Identifier: NCT03372460.

Internet-based acceptance and commitment therapy for transdiagnostic treatment of comorbid posttraumatic stress disorder and chronic pain: A development pilot study.

Acceptance and commitment therapy (ACT) is a transdiagnostic, behavioral treatment focusing on common processes behind different diagnoses. Internet-based treatment programs can improve access to treatment and easily be integrated into the individual's life. This single-arm, pre-post-follow-up pilot study examined the acceptability, safety, and effectiveness of internet-based ACT (iACT) for participants with comorbid posttraumatic stress disorder (PTSD) and chronic pain treated at a tertiary pain clinic. All participants (N = 10) received the iACT program over a period of 10 weeks and were assessed pre- and postintervention and at a 3-month follow-up. This study provides preliminary evidence for the acceptability, safety, and effectiveness of iACT for comorbid PTSD and chronic pain. The program showed clinically significant improvement in relation to the primary outcomes PTSD symptom severity and pain interference for this patient group with complex, comorbid symptoms, with sustained effects at the 3-month follow-up. These results add to previous research where face-to-face ACT has been shown to be of benefit to individuals with either chronic pain or PTSD. The findings also suggest that iACT can be delivered to individuals with comorbid PTSD and chronic pain with an effectiveness that is comparable to other cognitive behavioral therapy-based treatments for somatic and psychiatric disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The mediating role of posttraumatic stress disorder symptoms in pain cognitions among Veterans with chronic pain

ABSTRACT Symptoms of posttraumatic stress disorder (PTSD) are highly prevalent among Veterans with chronic pain. Considerable research has examined the intersection of chronic pain and PTSD symptoms. However, it remains unclear whether changes in PTSD may potentially serve a mechanistic role in improving unhelpful pain cognitions for individuals with chronic pain. The present research contributes to the foundational knowledge by addressing this question. Baseline data from a randomized controlled trial targeting pain-related disability for Veterans (n = 103; mean age 43.66; SD = 10.17) with musculoskeletal pain and depression and/or PTSD symptoms were used. Cross-sectional mediation analyses showed that PTSD symptoms mediated the relationship between pain severity and pain catastrophizing, and between pain severity and pain acceptance. After controlling for depression, the mediation involving pain catastrophizing remained significant, while the mediation for pain acceptance did not. Although limitations exist, results point to several treatment recommendations, including ensuring that depressive affect, PTSD-specific symptoms, and attention to both body and mind are included in treatment. Results also provide preliminary evidence for examining these associations longitudinally to improve our understanding of this population and corresponding treatment recommendations.

Stellate ganglion block in the treatment of SAPHO syndrome: a case report.

Synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare and refractory autoinflammatory disease, and there is no consensus on its treatment. Stellate ganglion block (SGB) blocks sympathetic nerves, ameliorates immune dysfunction, and alleviates stress response, which has been used to treat various chronic pain syndromes, arrhythmias, and post-traumatic stress disorder (PTSD). Also, the SGB has been reported to be successfully used to treat certain skin diseases, autoinflammatory diseases, and menopausal symptoms. In this study, over 3 years of follow-up, we found that SGB successfully intervened the symptoms of SAPHO syndrome, including sternoclavicular joint arthritis and palmoplantar pustulosis.

The role of interoception in reducing trauma-associated distress: a feasibility study

ABSTRACT Background: Altered interoception plays an important role in chronic stress and posttraumatic stress disorder. The aim of this study was to evaluate the feasibility of a Trauma Sensitive Yoga (TSY) intervention for improving emotional distress and psychological discomfort in women living under circumstances of social and gender vulnerability. We assessed the effect of the treatment on the interoceptive mechanisms, and whether the psychological improvements were mediated by the changes in these mechanisms. Methods: The study involved a sample of 62 women who attended public community centres dedicated to supporting women victims of gender-based violence or who were socially and economically disadvantaged because of their gender. Participants underwent a six-week TSY programme. We evaluated dropout rate, adherence, and intervention satisfaction. We measured emotional distress, psychological discomfort, interoceptive mechanisms, and two nonequivalent dependent variables to enhance internal validity. We compared pre–post differences using paired samples t-test and a structural equation model (SEM) analysis was performed to compare the changes in the outcomes with the changes in the nonequivalent dependent variables. Mediation models were adjusted to evaluate the role of changes in interoception on outcome changes. Results: Fourteen (23%) women dropped out, mainly after the first intervention session. Intervention adherence (mean attendance 5.3 over 6 sessions) and acceptability were high (mean satisfaction 3.4 over 4). We observed post-intervention improvements in anxiety, depression, psychological discomfort, body responsiveness, and interoceptive awareness. The changes in the outcomes were larger than the changes in the nonequivalent dependent variables. Additionally, we found that the changes in body responsiveness partially mediated the change in anxiety and psychological discomfort but not in depression. Conclusions: TSY could be an interesting therapeutic approach for women experiencing chronic posttraumatic stress symptomatology. Our findings underscore the role of interoceptive mechanisms in traumatic stress and emphasize the importance of addressing these aspects.

Amygdala-derived-EEG-fMRI-pattern neurofeedback for the treatment of chronic post-traumatic stress disorder. A prospective, multicenter, multinational study evaluating clinical efficacy

We conducted a prospective, single arm, multisite, multinational, open label trial assessing the safety and efficacy of a novel amygdala derived neurofeedback treatment, designated Amygdala-Derived-EFP, for chronic PTSD. Participants, including veterans and civilians, underwent screening, training, 15 neurofeedback sessions over 8 weeks and; baseline, termination (8 weeks) and 3 month post treatment assessments with validated measures. The primary endpoint was more than 50 % of the participants demonstrating a Minimally Clinically Important Difference (MCID) defined as a 6-point reduction, on the Clinician Administered PTSD Scale (CAPS-5) total score at 3 months. Secondary measures included the PCL-5, ERQ, PHQ-9, and CGI. Statistical analyses were performed using SAS®V9.4. The primary endpoint was met, with a CAPS-5 MCID response rate of 66.7 %. The average reduction in CAPS-5 total scores at 3 month follow up was 13.5 points, more than twice the MCID. Changes from baseline in CAPS-5, PCL-5, PHQ-9 scores at 8 weeks and the 3 month follow-up demonstrated statistically significant improvements in response and; demonstrated effect sizes ranging from 0.46 to 1.07. Adverse events were mild and resolved after treatment. This study builds on prior research demonstrating similar outcomes using amygdala-derived neurofeedback. Positive attributes of this therapy include monitoring by non-physician personnel, affordability, accessibility, and tolerability.

Preliminary evidence for the importance of therapeutic alliance in MDMA-assisted psychotherapy for posttraumatic stress disorder

ABSTRACT Background: MDMA-assisted psychotherapy (MDMA-AP) is a combined psychotherapeutic and pharmacologic intervention that shows promise in the treatment of posttraumatic stress disorder (PTSD). Although therapeutic alliance has been established as a key predictor across psychotherapies and is emphasised within MDMA-AP treatment manuals, research has not yet examined the relationship between therapeutic alliance and MDMA-AP treatment outcomes. Objective: Examine whether therapeutic alliance predicts changes in PTSD symptoms following MDMA-AP. Method: Twenty-three individuals with chronic PTSD participated in a MDMA-AP clinical trial that included a randomised (MDMA vs. placebo) and open-label phase. The present analyses focused on participants who were administered MDMA over the course of the randomised and open-label phases (n = 22). Therapeutic alliance was assessed using the Working Alliance Inventory at sessions baseline (pre-session 3) and sessions 4 and 9. PTSD symptoms were assessed using the Clinician Administered PTSD Scale and the Impact of Events Scale-Revised. Results: Controlling for baseline clinician-assessed PTSD severity, therapeutic alliance at sessions 4 and 9 (but not baseline) significantly predicted post-MDMA-AP clinician-assessed PTSD severity. Controlling for baseline self-reported PTSD severity, therapeutic alliance at baseline (although this did not survive correction for multiple comparisons) and sessions 4 and 9 predicted post-MDMA-AP self-reported PTSD severity. Conclusions: The present results provide the first preliminary evidence for the relationship between the therapeutic alliance and treatment outcomes within MDMA-AP for PTSD. These findings highlight the important role of psychotherapy, and common psychotherapeutic factors, within MDMA-AP. Replication in studies with larger and more diverse clinical samples remain necessary. Trial registration: ClinicalTrials.gov identifier: NCT00090064.

Gender differences in PTSD severity and pain outcomes: Baseline results from the LAMP trial.

Post-traumatic stress disorder (PTSD) and chronic pain are highly prevalent comorbid conditions. Veterans dually burdened by PTSD and chronic pain experience more severe outcomes compared to either disorder alone. Few studies have enrolled enough women Veterans to test gender differences in pain outcomes [catastrophizing, intensity, interference] by the severity of PTSD symptoms. Examine gender differences in the association between PTSD symptoms and pain outcomes among Veterans enrolled in a chronic pain clinical trial. Participants were 421 men and 386 women Veterans with chronic pain who provided complete data on PTSD symptoms and pain outcomes. We used hierarchical linear regression models to examine gender differences in pain outcomes by PTSD symptoms. Adjusted multivariable models indicated that PTSD symptoms were associated with higher levels of pain catastrophizing (0.57, 95% CI [0.51, 0.63]), pain intensity (0.30, 95% CI [0.24, 0.37]), and pain interference (0.46, 95% CI [0.39, 0.52]). No evidence suggesting gender differences in this association were found in either the crude or adjusted models (all interaction p-values<0.05). These findings may reflect the underlying mutual maintenance of these conditions whereby the sensation of pain could trigger PTSD symptoms, particularly if the trauma and pain are associated with the same event. Clinical implications and opportunities testing relevant treatments that may benefit both chronic pain and PTSD are discussed.

The potential role of chronic pain and the polytrauma clinical triad in predicting prodromal PD: A cross-sectional study of U.S. Veterans

IntroductionThe research criteria for prodromal Parkinson disease (pPD) depends on prospectively validated clinical inputs with large effect sizes and/or high prevalence. Neither traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), nor chronic pain are currently included in the calculator, despite recent evidence of association with pPD. These conditions are widely prevalent, co-occurring, and already known to confer risk of REM behavior disorder (RBD) and PD. Few studies have examined PD risk in the context of TBI and PTSD; none have examined chronic pain. This study aimed to measure the risk of pPD caused by TBI, PTSD, and chronic pain. Methods216 US Veterans were enrolled who had self-reported recurrent or persistent pain for at least three months. Of these, 44 met criteria for PTSD, 39 for TBI, and 41 for all three conditions. Several pain, sleep, affective, and trauma questionnaires were administered. Participants’ history of RBD was determined via self-report, with a subset undergoing confirmatory video polysomnography. ResultsA greater proportion of Veterans with chronic pain met criteria for RBD (36 % vs. 10 %) and pPD (18.0 % vs. 8.3 %) compared to controls. Proportions were increased in RBD (70 %) and pPD (27 %) when chronic pain co-occurred with TBI and PTSD. Partial effects were seen with just TBI or PTSD alone. When analyzed as continuous variables, polytrauma symptom severity correlated with pPD probability (r = 0.28, P = 0.03). ConclusionThese data demonstrate the potential utility of chronic pain, TBI, and PTSD in the prediction of pPD, and the importance of trauma-related factors in the pathogenesis of PD.

THE EFFECTIVENESS OF INTERPERSONAL PSYCHOTHERAPY FOR POSTTRAUMATIC STRESS DISORDER (PTSD)

Background:Interventions are required that give a lecture depression and post-traumatic stress disorder (PTSD) indications and social wellbeing.The Psychotherapies aimed at Chronic PTSD randomizedexperimentalestablish that three fourteen -week psychotherapies severelyfurthered patients with chronic posttraumatic stress disorder (PTSD). Earlierinvestigation has describedconstant follow-up assistances for prolonged exposure (PE) and relaxation therapy (RT), but few comparable data exist for interpersonal psychotherapy (IPT). Mode:Theassociated Interpersonal Psychotherapy-Trauma (IPT-T), an IPT adaptation for this residents and background, to Clinic Psychotherapy (CP). CP clinicians were free to implement the psychotherapy of choice. Women with a major depressive episode (MDE) and history of sexual abuse before eighteen were randomly assigned to IPT-T or CP. Outcomes were MDE remission, improved depression (Beck Depression Inventory, Hamilton Depression Rating Scale) and PTSD symptoms (Modified PTSD Symptom Scale), and developed social health (e.g., UCLA Loneliness Scale). Weighted generalized estimating equations were used to examine outcomes at eight (primary) and twenty (secondary) months post-randomization.Acute responders, defined a priori as _30% improved from baseline, were reconsidered after three-month no-treatment follow-up by independent evaluators using the Clinician-Administered PTSD Scale (CAPS). Conclusion:Evidence-based psychotherapies like IPT-T are desired in CMHCs, where several of the maximumexposed patients obtain treatment. By means ofas good asconclusions for depression, IPT-Ts superior developments in social wellbeing and PTSD symptoms are source for hopefulness. IPT-T should be appraised in dissemination trials.These are the first methodicalstatistics on follow-up responder position and perseverance of acute treatment assistances in patientsacceptanceseparate IPT for prolonged PTSD. Patients usually maintained gains across treatments, mutablemaximum in RT. Study boundariesembraceminor sample size and momentary follow-up interval. PTSD examination should service response and decreasestandards.

5-MeO-DMT for post-traumatic stress disorder: a real-world longitudinal case study

Psychedelic therapy is, arguably, the next frontier in psychiatry. It offers a radical alternative to longstanding, mainstays of treatment, while exciting a paradigm shift in translational science and drug discovery. There is particular interest in 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT)—a serotonergic psychedelic—as a novel, fast-acting therapeutic. Yet, few studies have directly examined 5-MeO-DMT for trauma- or stress-related psychopathology, including post-traumatic stress disorder (PTSD). Herein, we present the first longitudinal case study on 5-MeO-DMT for chronic refractory PTSD, in a 23-year-old female. A single dose of vaporized bufotoxin of the Sonoran Desert Toad (Incilius alvarius), containing an estimated 10−15 mg of 5-MeO-DMT, led to clinically significant improvements in PTSD, with next-day effects. This was accompanied by marked reductions in hopelessness and related suicide risk. Improvements, across all constructs, were sustained at 1-, 3-, 6-, and 12-months follow-up, as monitored by a supporting clinician. The subject further endorsed a complete mystical experience, hypothesized to underly 5-MeO-DMT’s therapeutic activity. No drug-related, serious adverse events occurred. Together, results showed that 5-MeO-DMT was generally tolerable, safe to administer, and effective for PTSD; however, this was not without risk. The subject reported acute nausea, overwhelming subjective effects, and late onset of night terrors. Further research is warranted to replicate and extend these findings, which are inherently limited, non-generalizable, and rely on methods not clinically accepted.

Acute stress-induced disorders in general practice

Stress defines a cluster of psychophysiological responses aimed at enabling resources to solve difficult situations, as well as restoring and maintaining homeostasis in the body. Stress is a combination of physiological, neuroendocrine, behavioural and emotional responses to new or threatening stimuli and serves as a protective adaptation of the body under physiological conditions. In accordance with the effect on the body, beneficial and negative stress is distinguished. Stress can be divided into “chronic” and “acute”. The intensity of the physiological response to a stressor is highly individual and situationally dependent. Many variables, including personal attributes, coping strategies, social support, and past experiences may modify the physiological stress response in any given situation and can account for the different response of people exposed to the same stressor. Intense and persistent stress can lead to psychological and pathological body injury. Stress has a significant impact on different brain regions, including the hippocampus, hypothalamus, amygdala etc. Depression, anxiety, cognitive deficits, and even stress-induced mental diseases are closely related to functional and structural damage of the related brain regions. Repetitive daily acute stress can be associated with different diseases, first of all cardiovascular diseases, which affect quality of life and can cut short life expectancy. Timely treatment is required to prevent progression of early stress reactions to chronic post-traumatic stress disorder, especially in individuals at high risk. Advanced stress and anxiety management interventions include non-pharmacological and pharmacological treatments.

Psychological rehabilitation of combatants in Ukraine from 2014 to 2021: statistics and current status

Military action in eastern Ukraine [Anti-terrorist Operation (ATO)] has a significant impact on the psyche of combat participants and causes changes in the life activities and behaviour of the individuals concerned. The traumatic experience gained during hostilities has a negative impact on the health of military personnel. According to psychiatrists’ forecasts, in the best-case scenario, 20% of combatants in Ukraine will be diagnosed with chronic post-traumatic stress disorder, which has already been given the name “ATO syndrome”. Given this, there is now an urgent need for rehabilitation activities, and the new conditions of hybrid warfare require social service professionals to respond quickly to combatants’ requests to organise and deliver comprehensive rehabilitation. Therefore, the aim of this study is to analyse the provision and conduct of psychological rehabilitation of combatants in Ukraine from 2014 to 2021.Philosophical and general scientific methods were employed to achieve the aim. Among the general scientific methods, the theoretical (analysis, generalisation, classification, and synthesis) and empirical (description and comparison) levels should be highlighted. Also, a bibliosemantic method was used to summarise the analysis of the subject literature and our own experimental data. In addition, various programs were employed to rehabilitate the military. For example, the “Cyber Defenders” project, which was launched in 2021. This involved 30 veterans who will receive a certificate in cybersecurity upon graduation. The E-Veteran system, which allows veterans to seek psychological support, was also analyzed.As the main results, it is worth mentioning that psychological rehabilitation is a pool of psychophysiological, psychotherapeutic, organisational, and medical measures aimed at the resumption of lost mental functions and psychocorrection of the social status of military personnel who have suffered mental combat trauma. The study analysed the mental state and profile of servicemen and servicewomen, the psychological and psychiatric problems that affected them, and government programmes and projects to support and assist ATO/JFO(Joint Forces Operation) veterans. Regarding the process of psychological rehabilitation for military personnel in Ukraine itself, positive trends can be observed since 2014, such as the opening of the Ministry of Veterans’ Affairs, but in the light of current threats and challenges, these undertakings are still insufficient.The system of psychological assistance and rehabilitation of ATO participants should be considered a component of the national security of the state. The article is of practical value in a range of areas, including in political, social work, pedagogical, and educational fields, as well as having application in criminal justice and the law.

Time to Reconsider Analgesia in Mass Casualty Incidents

The provision of analgesia in mass casualty incidents has traditionally been viewed as low-priority and reserved for later stages of care. Poor pain management is commonplace in trauma victims, and inadequate acute pain management can hinder evacuation efforts and may lead to the development of chronic pain and posttraumatic stress disorder. New, safe, and simple methods for administering quality analgesia have proven to be safe and effective in the prehospital setting and, as such, could easily be implemented into mass casualty incident protocols and allow for analgesia at earlier stages in such incidents, thereby improving patient care.