Combat-related Posttraumatic Stress Disorder Research Articles

CONSIDERATION OF THE PECULIARITIES OF A PERSON WITH POST-TRAUMATIC STRESS DISORDER IN MEDIATOR`S PROFESSIONAL ACTIVITY

Aim: To study and take into account the behavioral characteristics of a person with post-traumatic stress disorder (PTSD) during the mediation procedure and to experimentally test the peculiarities of PTSD in young adults and to study the causal relationship between PTSD and personality resilience. Materials and Methods: The diagnosis was carried out using the methods of diagnosing resilience (S. Muddy in the adaptation of D. Leontiev) and the Mississippi Scale for Combat-Related PTSD. Statistical analysis was performed using the statistical software package STATISTICA 10. The analysis of the study results included the distribution of the results of the arithmetic mean and the identification of correlations using Pearson’s correlation coefficient. The obtained empirical data were processed qualitatively and quantitatively. Results: In the course of the study we found that mediation is the best alternative way to resolve legal disputes with a person with PTSD, as the mediator creates a safe space, an atmosphere of trust, helps to cope with emotions, and, through questioning and other techniques, forms a conscious attitude towards their own needs and interests. Such interaction is empathetic and non-traumatic for a person with PTSD who is a party to mediation. It has been established that the level of PTSD manifestation in young adults affects their level of resilience. Conclusions: mediator’s work with a person with PTSD requires more activity on the part of the mediator, empathic communication, and possession of skills in dealing with psychotrauma. All decisions made as a result of mediation will be aimed at satisfying the basic need for safety of such a person.

Quetiapine as an adjunct to enhance engagement in prolonged exposure therapy for PTSD in veterans: A randomized, pilot trial

Despite established efficacy, there is low engagement in prolonged exposure (PE) therapy for PTSD among combat veterans. In preparation for a full-scale randomized trial, we sought to evaluate the feasibility, safety, and preliminary efficacy of quetiapine to enhance patient engagement in PE therapy. Open-label, randomized pilot trial of quetiapine monotherapy vs. Treatment as Usual (TAU) medications in 20 military veterans with combat related PTSD who were seeking care from the San Antonio Polytrauma Rehabilitation Center at the South Texas Veterans Healthcare System (STVHCS). Participants were randomized to receive either Quetiapine ( n = 10) monotherapy or pharmacological TAU ( n = 10) in patients who were receiving PE as a standard of care therapy. We collected information on (1) the number of potentially eligible veterans approached, the number screened, and the number randomized, (2) adverse events reported, (3) number of participants continuing PE treatment at least until session #4 (i.e., after first exposure session) and the total number of sessions of PE completed by the participants, and (4) change in PTSD severity and sleep quality measured by the PTSD Checklist for DSM-5 (PCL-5) and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed for 18 intent-to-treat participants with mean (SD) age, 53.5 (13.4) years; and baseline PCL-5 score, 57.6 (7.6). More veterans in the quetiapine group ( n = 9; 100%) received at least the first exposure session of PE therapy compared to TAU (( n = 3; (37.5%), p = .006] and completed PE therapy ( n = 8; (88.9%) vs ( n = 3; (37.5%), p = .03). Both PCL-5 ( p = .03) and PSQI ( p = .02) scores decreased significantly more for participants in the quetiapine than the TAU group. Preliminary findings support the feasibility, safety, and possible efficacy of quetiapine as an adjunct to enhancing engagement in PE therapy. A full-scale randomized trial is required to determine the true efficacy of quetiapine to enhance engagement in PE treatment.

Comparison of Post-traumatic Stress, Burnout, and Psychological Disorders in Nurses With and Without COVID-19

Background & Aims Coronavirus disease 2019 (COVID-19) caused many psychological and social problems in people around the world, especially nurses. The present study aims to investigate and compare post-traumatic stress disorder (PTSD), burnout, and psychological disorders in nurses with and without COVID-19. Materials & Methods This is a causal-comparative study. The study population includes all male and female nurses of non-government hospitals in Tehran from July to September 2021. Of these, 220 nurses (110 without COVID-19 infection and 110 with COVID-19) voluntarily participated in the study. The questionnaires were the Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder, the Maslach Burnout Inventory, and the Depression, Anxiety, Stress Scale. Finally, data analysis was performed using multivariate and univariate analysis of variance in SPSS software, version 16. Results There was a significant difference between the two groups in terms of PTSD, burnout, and psychological disorders (P<0.05). Nurses with COVID-19 had higher scores in PTSD (F=96.38, P<0.001), emotional exhaustion (P<0.001, F=12.45), depersonalization (F=15.49, P<0.001), depression (F=92.97, P<0.001), anxiety (F=37.94, P<0.001) and stress (F=47.6, P<0.001). The nurses with no COVID-19 had higher score in personal accomplishment. Conclusion Nurses who were infected with COVID-19 had lower psychological health compared to non-infected nurses. For this purpose, it is necessary to take measures to identify and provide psychological treatments to improve the mental health of vulnerable nurses.

Predictors of Chronic Combat-Related Post-Traumatic Stress Disorder Group Psychotherapy Favorable Outcomes; A Prospective Cohort Study in Croatia.

Combat-related chronic post-traumatic stress disorder (PTSD) is a therapeutically resistant disorder of the fluctuating course. The success of a group psychotherapy is partial. The aim of this paper is to determine baseline characteristics of veterans for whom a group psychotherapy will be the effective psychotherapeutic treatment. We performed this prospective cohort study in two geographically distant institutions: Regional Psychotrauma Center at the Psychiatric Clinic Split, and the Daily Hospital of the Psychiatric Hospital "Sveti Ivan" Zagreb, Croatia. We selected a consecutive sample of 86 veterans with combat-related chronic PTSD admitted to the group psychotherapy during 2009-2012. The primary outcome was ≥5% improvement in PTSD symptoms severity measured by Mississippi Scale for Combat-Related PTSD and adjusted for the baseline Mississippi scale score. Predictors were participants' 17 baseline sociodemographic and clinical characteristics and psychological features like personality traits, stress-coping mechanisms, and depression. We identified two patients' segments with significantly higher likelihood for the favorable treatment outcome. The first one were patients with the low score (≤8) on the phobia scale and high score (≥7) on the hysterical personality scale. In this segment 100% of patients experienced a favorable treatment outcome. The second one were the patiens with a higher score (>8) on the phobia scale, the low score (≤12) on the free-floating anxiety scale and the high score ≥8) on the obsession scale. In this segment, 64% experienced the favorable treatment outcome. The favorable outcome of the group psychotherapy of PTSD symptoms severity in patients with combat-related chronic PTSD can be predicted before the start of the treatment. The favorable outcome should be expected in patients with the low phobia and pronounced hysteria personality traits, or in patients with higher phobia, but with low free-floating anxiety and low obsession.

Prospective longitudinal assessment of sensorimotor gating as a risk/resiliency factor for posttraumatic stress disorder.

Little is understood about cognitive mechanisms that confer risk and resiliency for posttraumatic stress disorder (PTSD). Prepulse Inhibition (PPI) is a measure of pre-attentional response inhibition that is a stable cognitive trait disrupted in many neuropsychiatric disorders characterized by poor behavioral or cognitive inhibition, including PTSD. Differentiating between PTSD-related phenotypes that are pre-existing factors vs. those that emerge specifically after trauma is critical to understanding PTSD etiology and can only be addressed by prospective studies. This study tested the hypothesis that sensorimotor gating performance is associated with risk/resiliency for combat-related PTSD. As part of a prospective, longitudinal study,1226active duty Marines and Navy Corpsman completed a PPI test as well as a clinical interview to assess PTSD symptoms both before, and 3 and 6 months after acombat deployment. Participants that developed PTSD 6 months following deployment (N=46) showed lower PPI across pre and post-deployment time pointscompared to participants who did not develop PTSD(N=1182) . Examination of the distribution of PTSD across PPI performance revealed a lower than expected number of cases in the highest performing quartile compared to the rest of the distribution (p < 0.04). When controlling for other factors that predict PTSD in this population, those in the top 25% of PPI performance showed a >50% reduction in chance to develop PTSD (OR = 0.32). Baseline startle reactivity and startle habituation were not significantly different between PTSD risk and control groups. These findings suggest that robust sensorimotor gating may represent a resiliency factor for development of PTSD following trauma.

Depth Psychology Conceptualization of Trauma-Focused Treatment for Patients with Combat-Related PTSD: Joining the Therapeutic Quest and Alchemy

Evidence-based psychological treatments of combat posttraumatic stress disorder (PTSD) focus on well-organized protocols whose aim is symptom resolution. However, these protocols do not address either the patient’s subjective experience or to the therapist’s role during such treatments. According to the depth psychology perspective presented herein, combat PTSD patients are heroes whose quest was to serve their country, but their encounter with the dragon left them with psychic and spiritual deadness. During the treatment of such patients, the therapist the therapist embodies, or personifies, the ancient Greek god, Hermes, who helps the patient to acquire the necessary skills for the therapeutic quest. In this quest, the therapist symbolizes aliveness and is the generator of an alchemical change.

Inpatient residential treatment program for combat-related posttraumatic stress disorder (PTSD): Results from the 2020 Artsakh (Nagorno-Karabakh) War

ABSTRACT Inpatient residential treatment programs to evaluate active military service members for potential return to service or discharge are considered an integral component of rehabilitation for trauma related conditions. This retrospective study was conducted on combat-exposed military service members who were admitted to an inpatient residential treatment program for evaluation of fitness to serve and treatment of trauma related conditions. The PTSD Checklist for DSM-5 (PCL-5) was used to screen for PTSD, determine symptom severity, and monitor symptom change. At the time of admission, 54.3% of the service members met the provisional PTSD diagnosis, whereas at the time of discharge, 16.28% of the service members met the provisional diagnostic criteria. The most common symptoms rated moderately or higher were sleep troubles, followed by super alert, disturbing memories, feeling upset, disturbing dreams, physical reactions, avoiding memories, and negative feelings. Paired t-test results comparing the PCL-5 five Subscales and Total Score at the time of admission and discharge showed significant reductions. The five symptoms that improved the least were sleep troubles, feeling upset, avoiding memories, difficulty concentrating, and trouble remembering. The successful creation and implementation of an Armenian version of the PCL-5 was realized and, when put to the test, aided in screening, diagnosing, and monitoring PTSD symptoms among Armenian Army Service members. The results suggest that PTSD symptoms in an inpatient residential treatment program decreased over time. The symptoms that bothered the service members at most during the time of admission, however, improved the least at the time of discharge.

Limitations of benefit finding as a coping mechanism for combat-related PTSD symptoms

ABSTRACT Benefit finding has been identified as a buffer of the combat exposure-PTSD symptom link in soldiers. However, benefit finding may have a limited buffering capacity on the combat-PTSD symptom link over the course of a soldier’s post-deployment recovery period. In the present study, soldiers returning from Operation Iraqi Freedom (OIF) were surveyed at two different time periods post-deployment: Time 1 was 4 months post-deployment (n = 1,510), and Time 2 was at 9 months post-deployment (n = 783). The surveys assessed benefit finding, PTSD symptoms, and combat exposure. Benefit finding was a successful buffer of the cross-sectional relationship between combat exposure and PTSD reexperiencing symptoms at Time 1, but not at Time 2. In addition, the benefit finding by combat interaction at time 1 revealed that greater benefit finding was associated with higher symptoms under high combat exposure at Time 2 after controlling for PTSD arousal symptoms at Time 1. The results of the present study indicate that benefit finding may have a buffering capacity in the immediate months following a combat deployment, but also indicates that more time than is allotted during the post-deployment adjustment period is needed to enable recovery from PTSD. Theoretical implications are discussed.

Reduced plasma BDNF concentration and cognitive decline in veterans with PTSD

Post-traumatic stress disorder (PTSD) is a trauma and stress related disorder frequently associated with cognitive decline. War veterans with PTSD have a higher risk of developing dementia than healthy subjects. Brain derived neurotrophic factor (BDNF) is an important protein that modulates plasticity, memory consolidation and cognitive processes. Lower circulating BDNF levels were related to memory impairment and cognitive deterioration. The aim of this study was to evaluate cognitive deterioration and plasma BDNF concentration in 120 veterans with combat related PTSD, 120 healthy controls, 47 subjects with mild cognitive impairment (MCI) and 76 patients with Alzheimer's disease (AD), and to assess if plasma BDNF concentration might be used as biomarker of cognitive deterioration. Veterans with PTSD had significantly decreased plasma BDNF concentration and worse cognitive performances (assessed using the Mini Mental State Examination, Clock Drawing test and Montreal Cognitive Assessment scores/categories) than healthy subjects, and similarly reduced plasma BDNF and cognitive decline as MCI subjects. Reduced plasma BDNF was found in cognitively impaired subjects. These results suggest that veterans with PTSD should be closely monitored in order to early detect and predict cognitive worsening and promote interventions that might help restore blood BDNF levels and cognitive functions.

Enhancing exposure therapy for posttraumatic stress disorder (PTSD): a randomized clinical trial of virtual reality and imaginal exposure with a cognitive enhancer

Posttraumatic stress disorder (PTSD) is a significant public health issue. Yet, there are limited treatment options and no data to suggest which treatment will work for whom. We tested the efficacy of virtual reality exposure (VRE) or prolonged imaginal exposure (PE), augmented with D-cycloserine (DCS) for combat-related PTSD. As an exploratory aim, we examined whether brain-derived neurotrophic factor (BDNF) and fatty acid amide hydrolase (FAAH) moderated treatment response. Military personnel with PTSD (n = 192) were recruited into a multisite double-blind randomized controlled trial to receive nine weeks of VRE or PE, with DCS or placebo. Primary outcome was the improvement in symptom severity. Randomization was stratified by comorbid depression (MDD) and site. Participants in both VRE and PE showed similar meaningful clinical improvement with no difference between the treatment groups. A significant interaction (p = 0.45) suggested VRE was more effective for depressed participants (CAPS difference M = 3.51 [95% CI 1.17–5.86], p = 0.004, ES = 0.14) while PE was more effective for nondepressed participants (M = −8.87 [95% CI −11.33 to −6.40], p < 0.001, ES = −0.44). The main effect of DCS vs. placebo was not significant. Augmentation by MDD interaction (p = 0.073) suggested that depressed participants improved more on placebo (M = −8.43 [95% CI −10.98 to −5.88], p < 0.001, ES = −0.42); DCS and placebo were equally effective for nondepressed participants. There was an apparent moderating effect of BDNF Val66Met polymorphism on DCS augmentation (ES = 0.67). Met66 allele carriers improved more on DCS (ES = −0.25). FAAH 385 A carriers improved more than non-carriers (ES = 0.33), particularly those with MDD (ES = 0.62). This study provides a step toward precision therapeutics for PTSD by demonstrating that comorbid MDD and genetic markers may help guide treatment selection.ClinicalTrials.gov Identifier: NCT01352637.

Лечение посттравматического стрессового расстройства у ветеранов боевых действий: руководство по использованию поведенческой терапии при тревоге и посттравматическом стрессовом расстройстве (BTAP)

&lt;p&gt;PTSD is a chronic and disabling condition associated with psychiatric and medical comorbidity and diminished quality of life. Military Veterans are at increased risk for developing PTSD, and combat-related PTSD may be more difficult to treat than civilian PTSD. Both Prolonged Exposure and Cognitive Processing Therapy are empirically supported treatments for PTSD in military populations with a strong empirical foundation. However, they require considerable resources to implement and can be difficult for providers and patients to learn. To address these limitations, we created Behavioral Therapy for Anxiety and PTSD (BTAP), which is a simple, behavior-based therapy rooted in learning theory. Building on empirically established therapies such as Prolonged Exposure, BTAP has a singular focus on identifying, reducing, and countering safety behaviors that maintain PTSD. Because it only focuses on safety behaviors, it is simple to learn and implement; therapist trainings are one day, and follow-up consultation provided as needed. In this special issue article, we describe the BTAP protocol as well as provide real world case examples from Veterans to illustrate key components of the treatment. We also present data from five Veteran patients that demonstrate feasibility, acceptance, and preliminary evidence of effectiveness. Patients reported significant reductions in PTSD symptoms, depressive symptoms, intrusions, and safety behaviors. This work suggests that BTAP for treating PTSD merits further investigation.&lt;/p&gt;

Reconsolidation and Consolidation Therapies for the Treatment and Prevention of Post-Traumatic Stress Disorder

&#x0D; The evidence about the clinical effectiveness of reconsolidation and consolidation therapies for the treatment and prevention of post-traumatic stress disorder (PTSD) is uncertain because these therapies include a wide range of interventions and the study results varied widely.&#x0D; The results from 1 systematic review suggest there were significantly greater improvements in PTSD severity in patients treated with reconsolidation therapy versus control. However, 3 other systematic reviews reported conflicting findings with some reconsolidation therapies indicating significant improvements in PTSD symptoms or severity versus control, whereas other reconsolidation therapies had no significantly different outcomes than the control groups.&#x0D; There was limited evidence suggesting that multi-modular motion-assisted memory desensitization and reprocessing therapy reduced PTSD symptoms in veterans with treatment-resistant and combat-related PTSD; however, the significance of these results was not reported.&#x0D; There was limited evidence suggesting a significant difference in PTSD incidence in favour of adults exposed to trauma treated with hydrocortisone versus control. There were no significant differences in PTSD incidence between adults exposed to trauma treated with any 1 of propranolol, omega-3 fatty acids, gabapentin, or paroxetine versus placebo.&#x0D;

Therapist and operator experiences utilizing multi-modal motion-assisted Memory Desensitization and Reconsolidation (3MDR) for treatment of combat related posttraumatic stress disorder amongst military and veteran populations

ABSTRACT Background As provisions of mental healthcare services to military and veteran populations increases the risk to service providers developing secondary traumatic stress (STS), efforts are needed to examine the impact of delivering novel interventions which may include 3MDR. As a virtual-reality supported intervention, 3MDR exposes the patient, therapist and operator to graphic and sensory stimuli (i.e. narratives, imagery, smells, and music) in the course of the intervention. 3MDR is actively being researched at multiple sites internationally within military and veteran populations. It is, therefore, crucial to ensure the safety and wellbeing of 3MDR therapists and operators who are exposed to potentially distressing sensory stimuli. Objective The purpose of this study is to qualitatively examine the impact and experiences of STS amongst therapists and operators in delivering 3MDR. For this study, impact will be defined as therapists or operators experiencing perceived STS as a result of delivering 3MDR. Methods This exploratory qualitative study recruited 3MDR therapists and operators (N = 18) from Canada, the Netherlands, the United Kingdom, and the United States who had previously delivered 3MDR therapy. Telephone or video-conferencing interviews were used to gather data that was subsequently transcribed and thematically analyzed. Results Four themes emerged among the therapists (n = 13) and operators (n = 5): (1) personal cost and benefits of 3MDR, (2) professional paradox of a 3MDR therapist, (3) perceived effect of 3MDR on patients, and (4) recommendations for future 3MDR use. Conclusions STS was not noted to be a significant challenge for 3MDR therapists and operators. Future research may investigate optimal means of providing training and ongoing support for 3MDR therapists and operators. HIGHLIGHTS Secondary Traumatic Stress was not noted to be a significant challenge for 3MDR therapists and operators Future research may investigate optimal means of providing training and ongoing support for 3MDR therapists and operators

Translation, cultural adaptation, and psychometric properties of the Spanish version of the Combat Exposure Scale (CES-S) with U.S. military Spanish speaking Latino veterans living in the Caribbean: A cross-sectional preliminary data study.

The Combat Exposure Scale (CES) is one of the most used self-report instruments to assess various combat situations experienced by military personnel. This article presents a comprehensive translation and cultural adaptation of the CES to Spanish and its psychometric properties. Fifty-five (n = 55) U.S. military Spanish-speaking Latino veterans diagnosed with combat-related PTSD were recruited from 2018 to 2020 to participate in this cross-sectional preliminary data study at the VA Caribbean Health Care System. The translation and cultural adaptation followed the recommendations by Chavez & Canino (2005). Statistical analysis included principal component factor analysis, internal consistency analysis, and content validity analysis. It included two different expert bilingual committees composed of veterans with combat experience and university professors at a doctoral level. The CES-S consists of seven items. The principal component factor analysis resulted in one factor and the content validity of =1. CES-S has an internal consistency of α=.84. The CES-S is suitable for its use with Spanish-speaking Latino veteran samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Technology Acceptance and Usability of a Virtual Reality Intervention for Military Members and Veterans With Posttraumatic Stress Disorder: Mixed Methods Unified Theory of Acceptance and Use of Technology Study.

BackgroundMilitary members and veterans exhibit higher rates of injuries and illnesses such as posttraumatic stress disorder (PTSD) because of their increased exposure to combat and other traumatic scenarios. Novel treatments for PTSD are beginning to emerge and increasingly leverage advances in gaming and other technologies, such as virtual reality. Without assessing the degree of technology acceptance and perception of usability to the end users, including the military members, veterans, and their attending therapists and staff, it is difficult to determine whether a technology-based treatment will be used successfully in wider clinical practice. The Unified Theory of Acceptance and Use of Technology model is commonly used to address the technology acceptance and usability of applications in 5 domains.ObjectiveUsing the Unified Theory of Acceptance and Use of Technology model, the purpose of this study was to determine the technology acceptance and usability of multimodal motion-assisted memory desensitization and reconsolidation (3MDR) on a virtual reality system in the primary user group (military members and veterans with treatment-resistant PTSD, 3MDR therapists, and virtual reality environment operators).MethodsThis mixed methods embedded pilot study included military members (n=3) and veterans (n=8) with a diagnosis of combat-related PTSD, as well as their therapists (n=13) and operators (n=5) who completed pre-post questionnaires before and on completion of 6 weekly sessions of 3MDR. A partial least squares structural equation model was used to analyze the questionnaire results. Qualitative data from the interviews were assessed using thematic analysis.ResultsEffort expectancy, which was the most notable predictor of behavioral intention, increased after a course of 3MDR with the virtual reality system, whereas all other constructs demonstrated no significant change. Participants’ expectations of the technology were met, as demonstrated by the nonsignificant differences in the pre-post scores. The key qualitative themes included feasibility and function, technical support, and tailored immersion.Conclusions3MDR via a virtual reality environment appears to be a feasible, usable, and accepted technology for delivering 3MDR to military members and veterans who experience PTSD and 3MDR therapists and operators who facilitate their treatment.

Associations between distress tolerance and posttraumatic stress symptoms among combat veterans and their parents: The mediating role of parents’ accommodation

Objective: Combat-related posttraumatic stress disorder (PTSD) might negatively impact the mental health of veterans’ family members. Nevertheless, nearly no research has examined secondary PTSD symptoms (PTSS) in veterans’ parents, and still to be explored are the mechanisms by which distress tolerance (DT) contributes to veterans’ PTSS and parents’ secondary PTSS (SPTSS). In the present study, we aimed to use a dyadic approach to explore the association between veterans’ and parents’ DT and their PTSS/SPTSS, as well as to examine the mediating role of parents’ accommodation of veterans’ behaviors in these associations. Method: A volunteer sample of 102 dyads of Israeli combat veterans and their parents responded to online validated self-report questionnaires in a cross-sectional study. Analysis included actor–partner interdependence modeling (APIM) and mediation analyses. Results: Veterans’ PTSS was positively correlated with parents’ SPTSS. Moreover, veterans’ DT and parents’ DT negatively predicted their own PTSS and SPTSS, respectively. Furthermore, veterans’ DT negatively predicted their parents’ SPTSS. Importantly, parents’ accommodation mediated the links between veterans’ DT and both veterans’ PTSS and parents’ SPTSS, as well as between parents’ DT and veterans’ PTSS with parents’ SPTSS. Conclusion: Parents of combat veterans might be indirectly traumatized by their offspring’s military experiences and suffer from secondary PTSS. Among both veterans and parents, low DT is associated with higher levels of parents’ accommodation, which in turn is related to more posttraumatic symptoms.

Fear reacquisition and symptoms of combat-related PTSD: Specificity and preliminary examination of the influence of the 5-HT3A receptor gene

Several studies have examined the acquisition and extinction of fear in PTSD in the context of Pavlovian conditioning. However, research examining reconditioning of fear following extinction, a form of post-extinction re-emergence of conditioned behavior is limited. Although the 5-HT3A receptor gene polymorphism has been linked to trauma responses, its influence on the re-emergence of conditioned fear among those exposed to trauma remain unclear. In the present study, combat-exposed veterans (N = 114) completed a differential fear conditioning task in which one colored rectangle (CS+) predicted a loud scream (US), whereas a different colored rectangle (CS-) predicted no US. Acquisition, extinction, and post-extinction reconditioning effects indexed by conditioned anxiety, US expectancy, and skin conductance response were examined. Associations with allelic variation in the serotonin 5-HT3 gene, HTR3A (rs1062613) were also examined. Participants rated the CS+ as significantly more anxiety inducing and associated with greater US expectancy than the CS- during acquisition. The CS+ also elicited a stronger skin conductance response than the CS- during acquisition. A significant decrease in anxiety and US expectancy in response to the CS+ was observed after extinction and a re-emergence of conditioned responses to the CS+ was observed during reacquisition. Although a diagnosis of PTSD was characterized by greater anxiety to the CS + but not the CS- during acquisition and extinction, those with and without a PTSD diagnosis did not differ in the reacquisition of fear following extinction. Subsequent preliminary analysis did show that increased posttraumatic symptoms and cognitions were associated with increased US expectancy at reacquisition for the CS+ and CS- among CC carriers but not among T carriers of HTR3A (rs1062613). These findings suggest that posttraumatic symptoms among trauma exposed veterans with the CC polymorphism of the HTR3A gene may be associated with stronger reconditioning of fear following extinction.

Effectiveness, Acceptability and Safety of Pharmaceutical Management for Combat-Related PTSD in Adults Based on Systematic Review of Twenty-Two Randomized Controlled Trials.

Objective: This study assessed the efficacy, acceptability, and safety of pharmaceutical management for combat-related post-traumatic stress disorder (PTSD) to provide a clinical decision-making basis for clinicians. Method: A comprehensive search was conducted using Ovid MEDLINE, Ovid EMBASE, Cochrane Library, Scopus, ScienceDirect, and Web of Science for randomized controlled trails (RCTs), which reported pharmaceutical management and placobo for adults with combat-related PTSD, that were published until April 21, 2021. The effectiveness, acceptability, and adverse events (AEs), were designed as interested outcomes. The change in total symptoms of combat-related PTSD according to the clinician rating scale was defined as primary outcome, and the others were defined as secondary outcomes. Results: Twenty-two RCTs with 1,221 patients were involved. Compared with placebo, overall active comparators had statistical differences for all outcomes, including the change in total symptoms of combat-related PTSD [SMD = −0.36, 95%CI (−0.62,−0.09)], depression [SMD = −0.28, 95%CI (−0.45,−0.10)], anxiety [SMD = −0.44, 95%CI (−0.64,−0.23)], re-experience [SMD = −0.33, 95%CI (−0.52,−0.13)], avoidance [SMD = −0.24, 95%CI (−0.43,−0.05)], and hyper-arousal [SMD = −0.26, 95%CI (−0.48,−0.03)]. Compared with the placebo, in terms of acceptability, overall active comparators did not significantly decrease all-cause discontinuance rates [RR = 0.97, 95%CI (0.78,1.20)], and the significance decreased due to AEs [RR = 2.42, 95%CI (1.41,4.13)]. Nevertheless, overall there was no statistically significant difference for overall AEs, including somnolence, sedation, dizziness, paresthesia, anxiety, blurred vision, generalized anxiety disorder, and sleep disturbance. All funnel plots were symmetrical and no publication bias was found. Conclusion: Active drugs, especially amitriptyline, imipramine, and quetiapine, had a positive effect on the improvement of combat-related PTSD symptoms. Despite there being no significant increase in the AEs of the active drugs, the fact that the discontinuation rates of these drugs, including risperidone, imipramine, and topiramate, were increased deserves attention. Furthermore, as active drugs were effective across ethnic groups and battlefields, active drug regimens were revealed to be more appropriate for treating people with symptoms of extreme severe PTSD (≥80) or PTSD that is at least 8 weeks old. In addition, current evidence was from adults under 60 years of age and male combat-related PTSD. Whether this evidence can be extended to other populations of combat-related PTSD needs to be confirmed by subsequent high-quality, large-sample studies.

In-office, in-home, and telehealth cognitive processing therapy for posttraumatic stress disorder in veterans: a randomized clinical trial

BackgroundTrauma-focused psychotherapies for combat-related posttraumatic stress disorder (PTSD) in military veterans are efficacious, but there are many barriers to receiving treatment. The objective of this study was to determine if cognitive processing therapy (CPT) for PTSD among active duty military personnel and veterans would result in increased acceptability, fewer dropouts, and better outcomes when delivered In-Home or by Telehealth as compared to In-Office treatment.MethodsThe trial used an equipoise-stratified randomization design in which participants (N = 120) could decline none or any 1 arm of the study and were then randomized equally to 1 of the remaining arms. Therapists delivered CPT in 12 sessions lasting 60-min each. Self-reported PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5) served as the primary outcome.ResultsOver half of the participants (57%) declined 1 treatment arm. Telehealth was the most acceptable and least often refused delivery format (17%), followed by In-Office (29%), and In-Home (54%); these differences were significant (p = 0.0008). Significant reductions in PTSD symptoms occurred with all treatment formats (p < .0001). Improvement on the PCL-5 was about twice as large in the In-Home (d = 2.1) and Telehealth (d = 2.0) formats than In-Office (d = 1.3); those differences were statistically large and significant (d = 0.8, 0.7 and p = 0.009, 0.014, respectively). There were no significant differences between In-Home and Telehealth outcomes (p = 0.77, d = −.08). Dropout from treatment was numerically lowest when therapy was delivered In-Home (25%) compared to Telehealth (34%) and In-Office (43%), but these differences were not statistically significant.ConclusionsCPT delivered by telehealth is an efficient and effective treatment modality for PTSD, especially considering in-person restrictions resulting from COVID-19.Trial registrationClinicalTrials.gov ID NCT02290847 (Registered 13/08/2014; First Posted Date 14/11/2014).

Predictors of treatment failure among patients with gunshot wounds and post-traumatic stress disorder

BackgroundThe 82.1% treatment failure of post-traumatic stress disorder (PTSD), associated with gunshot wounds, is related to high incidence of chronic pain syndrome as well as resistance to the PTSD treatment. Defining treatment failure predictors among the PTSD patients with gunshot extremity wounds and the following therapy would improve treatment outcomes.MethodsA total of 218 patients completed the study. The Mississippi Scale for Combat-Related PTSD (M-PTSD) was used for assessment of the treatment outcome rate. The risk relation between treatment failure and factors was assessed by a univariate or multivariate logistic regression method, with the model accuracy measured by the AUC – Area under the ROC curve. The odds ratio (OR) was considered for the qualitative factor assessment.ResultsThe predictors of the PTSD treatment failure among the patients with gunshot wounds to the extremities are: 1) anesthesia type: the risk of failure is higher with the general anesthesia compared to the regional (p = 0.002), OR = 0.30 (95% CI 0.13-0.69) and the regional one with sedation (p = 0.004), OR = 0.30 (95% CI 0,14-0.65); 2) severe postoperative pain: the risk of treatment failure rises with increased pain intensity assessed by the visual analogue scale (p = 0.02), OR = 3.2 (95% CI 1.2-8.3).ConclusionsThe analysis showed that administration of general anesthesia compared to the regional one (regardless of the sedation) and high postoperative pain intensity are associated with higher risk of the PTSD treatment failure among patients with gunshot wounds to the extremities. The preference of regional anesthesia and postoperative pain control may potentially improve the treatment outcomes.Trial registrationClinicalTrials.gov: Retrospectively registered on December 30, 2020, NCT04689022.