Posttraumatic Stress Disorder Conditions Research Articles

Advancing Posttraumatic Stress Disorder Diagnosis and the Treatment of Trauma in Humanitarian Emergencies via Mobile Health: Protocol for a Proof-of-Concept Nonrandomized Controlled Trial.

BackgroundDecentralized health systems in low- and middle-income countries (LMICs) affected by humanitarian crises lack resources and a qualified workforce to attend to the overwhelming demand for mental health care in emergencies. Innovative approaches that are safe, cost-effective, and scalable are needed to address the burden of traumatic stress caused by emergencies. High mobile phone ownership rates combined with the precision of neural, cognitive, and biometric measures of trauma and their feasible integration with artificial intelligence makes digital app interventions a promising pathway to promote precision diagnosis and high-impact care.ObjectiveThis study aimed to advance methods for the objective diagnosis and treatment of trauma in emergencies across LMICs by examining neural, cognitive, and biometric markers and the efficacy of the eResilience app, a neuroscience-informed mobile health mental health app intervention, via changes in clinical symptomatology, cognitive performance, and brain activity.MethodsTrauma-exposed African refugees residing in Australia were selected for this study. A research software version of the eResilience app with advanced monitoring capabilities was designed for this trial. Participants completed the eResilience app at home during a 7-day period. Clinical, cognitive, and electrophysiological data were collected at baseline, along with posttest measurements to examine biomarkers of trauma and the efficacy of the proposed digital intervention for the treatment of trauma and its potential outcomes, including depression, anxiety, physical symptoms, self-harm, substance misuse, and cognitive impairment. In addition, biofeedback, well-being, and subjective stress data points were collected via the app during the treatment week, followed by clinical interviews at 1, 3, 6, and 12 months after the intervention.ResultsData collection was conducted between 2018 and 2020. A total of 100 participants exposed to war were screened; 75 (75%) were enrolled and assigned to a trauma-exposed control (38/75, 51%) or posttraumatic stress disorder condition (37/75, 49%); and 70 (70%) completed all baseline, treatment, and posttest assessments. A total of 89% (62/70) of those who completed the intervention opted to enroll in the 3-, 6-, and 12-month follow-ups. Data collection is complete. As of May 2022, the results of all proposed analyses are being prepared for publication. If proven efficacious, this proof-of-concept clinical trial will inform fully powered randomized clinical trials in LMICs to further develop artificial intelligence–powered, app-based diagnostic and prognostic features and determine the app’s cross-cultural efficacy for the treatment of trauma in emergency settings.ConclusionsThis protocol provides researchers with a comprehensive background of the study rationale, a detailed guideline for replication studies interested in examining the feasibility and efficacy of the eResilience app across varied demographics, and a robust framework for investigating low-cost objective diagnostic markers in mental health interventions. Methodological limitations and suggestions are also provided.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12616001205426; https://tinyurl.com/yckwc4d7International Registered Report Identifier (IRRID)RR1-10.2196/38223

Olfactory Virtual Reality: A New Frontier in the Treatment and Prevention of Posttraumatic Stress Disorder.

This perspective piece reviews the clinical condition of posttraumatic stress disorder (PTSD), which is currently increasing due to the COVID-19 pandemic, and recent research illustrating how olfaction is being incorporated into virtual reality (VR) platforms. I then discuss the latest work examining the potential of olfactory virtual reality (OVR) for the treatment of PTSD. From this foundation I suggest novel ways in which OVR may be implemented in PTSD therapy and harnessed for preventing the development of PTSD. Perceptual and chemical features of olfaction that should be considered in OVR applications are also discussed.

Addressing the Co-morbidity of HIV, Substance Abuse and Trauma: Exploring an Integrated Intervention

Given the high incidence of comorbid conditions of Post-Traumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) among women living with the human immunodeficiency virus (HIV), there is a critical need to develop integrated interventions to address the comorbidity of HIV/AIDS, PTSD and SUD. This paper discusses a study conducted with African American women living with HIV/AIDS and histories of substance abuse and trauma in a major metropolitan city in the U.S. The purpose was to have women respond to a presentation on the acceptability of an integrated intervention entitled Trauma Affect Regulation: Guide for Education and Therapy (TARGET). The women also generated ideas on how to adapt the intervention for African American women. Participants responded favorably to TARGET and indicated that a holistic focus on the stigma of HIV/AIDS, and disclosure of HIV/AIDS to children and sexual partners were important considerations to include in an integrated PTSD/SUD treatment intervention.

Mental health conditions and co-morbidities among internally displaced populations (IDPs) in Ukraine

Reliable epidemiological data on the burden of mental health conditions and key risk factors is crucial in helping to design appropriate trauma-informed mental health and psychosocial support responses for the estimated 1.4 million IDPs in Ukraine. The aim of the proposed study is to collect evidence on mental health and psychosocial support needs among IDPs in order to help inform mental health policy in Ukraine.The specific objectives were to:– measure the prevalence of mental health conditions of post-traumatic stress disorder (PTSD), depression, anxiety, and their co-morbidity;– examine the characteristics associated with the mental disorders (e.g. gender, age, trauma exposure, socio-economic stressors);– draft evidence-based recommendations for mental health and psychosocial support to relevant governmental and professional bodies in Ukraine.The study used a cross-sectional survey conducted throughout Ukraine in 2016 with 2203 IDPs aged 18 years and over. Descriptive and multivariate regression analyses were used. PTSD prevalence was 32% (22% men; 36% women), depression–22% (16% men; 25% women), and anxiety prevalence was 17% (13% men; 20% women). There were also high levels of co-morbidity between PTSD, anxiety and depression. Key factors statistically significantly associated with mental disorders included female gender, older age, cumulative trauma exposure, more recent displacement and a bad household economic situation. The findings provided sufficient evidence to draft the trauma-informed mental health policy recommendations to key policy-makers in Ukraine.Disclosure of interestThe authors have not supplied their declaration of competing interest.

'Everything just seems much more right in nature': How veterans with post-traumatic stress disorder experience nature-based activities in a forest therapy garden.

Available evidence shows that an increasing number of soldiers are seeking help for post-traumatic stress disorder. The post-traumatic stress disorder condition has big emotional and psychological consequences for the individual, his/her family and the society. Little research has been done to explore the impact of nature-based therapy for veterans with post-traumatic stress disorder although there is a growing amount of evidence pointing towards positive outcome. This qualitative study aims to achieve a deeper understanding of this relationship from the veteran’s perspective. Eight Danish veterans participated in a 10-week nature-based therapy. Qualitative interviews were conducted and analysed using the interpretative phenomenological method. The results indicated that the veterans have achieved tools to use in stressful situations and experienced an improvement in their post-traumatic stress disorder symptoms.

Case Report of a 24-Year-Old Man With Resolution of Treatment-Resistant Major Depressive Disorder and Comorbid PTSD Using rTMS

Although there is a large amount of literature indicating the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant major depressive disorder (trMDD), the authors did not find any literature supporting rTMS for MDD with the comorbid condition of posttraumatic stress disorder (PTSD). Here, we report an original case of a patient whose trMDD and PTSD remitted using rTMS at the left dorsolateral prefrontal cortex.

Sleep Disorders and Associated Medical Comorbidities in Active Duty Military Personnel

Describe the prevalence of sleep disorders in military personnel referred for polysomnography and identify relationships between demographic characteristics, comorbid diagnoses, and specific sleep disorders. Retrospective cross-sectional study. Military medical treatment facility. Active duty military personnel with diagnostic polysomnogram in 2010. Primary sleep disorder rendered by review of polysomnogram and medical record by a board certified sleep medicine physician. Demographic characteristics and conditions of posttraumatic stress disorder (PTSD), mild traumatic brain injury (mTBI), anxiety, depression, and pain syndromes determined by medical record review. Primary sleep diagnoses (n = 725) included: mild obstructive sleep apnea (OSA), 207 (27.2%); insomnia, 188 (24.7%); moderate-to-severe OSA, 183 (24.0 %); and paradoxical insomnia,39 (5.1%); behaviorally induced insufficient sleep syndrome, 68 (8.9%) and snoring, 40 (5.3%) comprised our control group. Short sleep duration (< 5 h) was reported by 41.8%. Overall 85.2% had deployed, with 58.1% having one or more comorbid diagnoses. Characteristics associated with moderate-to-severe OSA were age (adjusted odds ratio [OR], 1.03 [95% confidence interval {CI}, 1.0-1.05], sex (male) (adjusted OR, 19.97 [95% CI, 2.66-150.05], anxiety (adjusted OR, 0.58 [95% CI, 0.34-0.99]), and body mass index, BMI (adjusted OR 1.19 [95% CI, 1.13-1.25]; for insomnia, characteristics included PTSD (adjusted OR, 2.12 [95% CI, 1.31-3.44]), pain syndromes (adjusted OR, 1.48 [95%CI, 1.01-2.12]), sex (female) (adjusted OR, 0.22 [95% CI, 0.12-0.41]) and lower BMI (adjusted OR, 0.91 [95% CI, 0.87, 0.95]). Service-related illnesses are prevalent in military personnel who undergo polysomnography with significant associations between PTSD, pain syndromes, and insomnia. Despite having sleep disorders, almost half reported short sleep duration. Multidisciplinary assessment and treatment of military personnel with sleep disorders and service-related illnesses are required. Mysliwiec V; McGraw L; Pierce R; Smith P; Trapp B; Roth BJ. Sleep disorders and associated medical comorbidities in active duty military personnel. SLEEP 2013;36(2):167-174.

Clearance of fear memory from the hippocampus through neurogenesis by omega-3 fatty acids: A novel preventive strategy for posttraumatic stress disorder?

Not only has accidental injury been shown to account for a significant health burden on all populations, regardless of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric condition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentially important goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunity to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence and associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory and proposes a new, rationally hypothesized translational preventive intervention for PTSD through promoting hippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial of injured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediately after accidental injury can reduce subsequent PTSD symptoms.

History's Broken Wings: "Narrative Paralysis" as Resistance to History in Amos Gitai's Film &lt;i&gt;Kedma&lt;/i&gt;

Amos Gitai's deconstruction of the Zionist historical narrative in his film Kedma (IL/FR, 2004) generates a narrative paralysis-by displacing events, disconnecting them both their real referents and their normal temporal sequence. This paralysis is tantamount a post-traumatic rhetoric that marks the historical condition, one in which the movie was created as posttraumatic. This rhetoric can be read as subversive because it undermines the linear and teleological hegemonic narratives of both the film and the Zionist ideology that it recounts. The post-traumatic condition is, therefore, political. Thus, the film suggests alternative, if not redemptive, modes of employment that may work through the trauma and create a return reality. Kedma belongs, in terms of its structure, the road movie genre and, as such, is essentially based on movement. It follows the progress of Jewish Holocaust refugees their European countries of origin, via the ship that brings them shore, the Land of Israel, a military clash with the Arabs, and Jerusalem. In the course of this voyage, the refugees, as film characters, are expected participate in the cinematic plot that epitomizes the Zionist narrative: they must forget their erstwhile traumas, overcome the memories of the Diaspora, jettison the Jewish characteristics of their identity, fight the Arabs, and thus be transformed passive Jews warring Hebrews who fight for their lives and their fate. Yet unlike classical road movies that causally progress a point of departure a destination-Kedma's journey is deconstructed and directionless, infused with people who move to and from aimlessly, expressing a journey of obstructed movement characteristic of what Deleuze has called a sensor-motor crisis.1 Following Bhabha,2 who views the linear, teleological narrative movement as the ideological apparatus of hegemony, the obstruction of movement-and its outcome, paralysis-is perceivable as the subversion of and opposition the dominant narrative. Thus this paralysis, attributable the condition of post-traumatic stress disorder, as suggested by Freud,3 is, in this sense, the post-traumatic condition and should be read as one of historical-political resistance. A Journey in Paralysis Kedma's paralysis reflects a struggle between progressing toward the future and the inability make this progress due a post-traumatic condition that has not yet been worked through and cannot be worked through as long as the survivor-characters are compelled move forward and relinquish their past. Post-traumatic stress disorder is characterized by the repeated experiencing of symptoms long after a trauma has occurred.4 Thus, the original event is displaced and set within another experience that signifies it. This causes a state of behavioral block. The way deal with such a block, Freud claims, is reinsert the occurrence in the chain of causal events which it slipped away, i.e., integrate it into a narrative, since post-traumatic stress disorder is actually the deconstruction of a mental narrative that is based on cause and effect. Therefore, a post-traumatic condition is one of narrative failure or the deconstruction of a sequence of events. Such a deconstruction is a way of resisting the coherent linear hegemonic narrative. The first indication that Kedma is a film about movement (and thus one which can be seen as an expression of the failure of movement) is in its title. The Hebrew word kedma alludes movement through both geographical and ideological space: forward toward the future and toward the east, a direction that carries the memory of an ancient past. Kedma is also the name of the illegal immigrant ship in which the film's protagonists begin their travel.5 By starting with the ship sequence, Kedma reveals, ab initio, the paralysis aesthetics that characterize the film throughout. A ship is a space that moves but it is also immobile-its exterior moves but its interior and all its contents remain static. …

Attachment Theory and Post-Traumatic Stress Disorder

Attachment theory is applied to understanding and treatment of the anxiety condition of post-traumatic stress disorder in adults. Conceptualized as intensified attachment behavior which is elicited at separation or loss or threat of separation, PTSD responses represent an inherent, though exaggerated, attempt to ensure protection and security. The secure base of a therapeutic relationship reduces the intensity of responses and provides an opportunity to review experiences relevant to current distress in order to affirm emotional reactions and come to terms with distressing events. Implications for prevention are discussed.