Presentation Of Posttraumatic Stress Disorder Research Articles

Feasibility, acceptability and clinical benefit of a trauma-focused stabilisation group for post-traumatic stress disorder patients with complex presentations on primary care waitlists.

Large numbers of people showing complex presentations of post-traumatic stress disorder (PTSD) in the NHS Talking Therapies services routinely require multi-faceted and extended one-to-one National Institute of Clinical Excellence (NICE) recommended treatment approaches. This can lead to longer waits for therapy and prolong patient suffering. We therefore evaluated whether a group stabilisation intervention delivered to patients on the waitlist for individual trauma-focused psychological treatment could help address this burden. The study aimed to ascertain a trauma-focused stabilisation group's acceptability, feasibility, and preliminary clinical benefit. Fifty-eight patients with PTSD waiting for trauma-focused individual treatment were included in the study. Two therapists delivered six 5-session groups. The stabilisation group was found to be feasible and acceptable. Overall, PTSD symptom reduction was medium to large, with a Cohen's d of .77 for intent-to-treat and 1.05 for per protocol analyses. Additionally, for depression and anxiety, there was minimal symptom deterioration. The study provided preliminary evidence for the acceptability, feasibility and clinical benefit of attending a psychoeducational group therapy whilst waiting for one-to-one trauma therapy.

How Important Is Reprocessing in Personalized Multicomponent Therapy? Analyzing Longitudinal Data of Inpatients With Severe PTSD.

Treatment guidelines for complex presentations of posttraumatic stress disorder (PTSD) are often cautious about the reprocessing of traumatic memories and recommend multicomponent treatments that are widely used in clinical practice. Yet, the role of reprocessing in these multicomponent treatments remains unknown. Using naturalistic data of 97 patients treated for PTSD, we used a linear mixed model to investigate the role of reprocessing for the outcome at discharge and at 6-month follow-up. Treatment effects were significant and large ( g = 0.91-1.05). The final model showed good fit and explained 51% of the variance. There was a significant main effect of time ( B = -8.1 [-11.5; -4.8], p < 0.001), as well as a reprocessing by time interaction ( B = -17.2 [-30.5; -3.8], p = 0.012), indicating better outcomes with higher levels of reprocessing. Hence, maximizing the amount of reprocessing used in multicomponent treatments for PTSD may significantly enhance outcomes.

Presentation of Trauma Disorder in Adults with Intellectual Disability

Abstract: BackgroundIn the 20 years since a review by McCarthy (2001) on the presentation of Post-traumatic stress disorder (PTSD) in people with intellectual disability (ID), the understanding of trauma disorder has increased.Method &amp; FindingsDiagnostic criteria for ID will be presented to set the context. A brief summary of the key literature over the past twenty years will be discussed focusing on the presentation of PTSD in people with ID including the use of ICD-11 criteria. Evaluated tools available to assess the impact of life events and trauma for use in people with ID will be outlined including treatment options. The presentation of trauma disorder will be illustrated through a case study.ConclusionPsychiatrists need to be aware that a history of trauma may be an underlying factor in the presentation of people with ID to psychiatric services.ReferenceMcCarthy J (2001). Post-traumatic Stress Disorder in People with Learning Disability. Advances in Psychiatric Treatment; 7, pp. 163-169.Disclosure of InterestNone Declared

Investigating the experience of individuals with comorbid posttraumatic stress disorder and substance misuse attending a Seeking Safety group

PurposeThere is no specific recommended treatment for the co-morbid presentation of post-traumatic stress disorder (PTSD) and substance use disorder in the United Kingdom (UK). Seeking Safety (SS), a group-based treatment that targets symptoms of both disorder, has emerging evidence in the USA but lacks evidence from UK-based samples. The purpose of this study was to explore UK service users’ experience of attending SS and evaluate its impact on mental health symptomology and substance misuse.Design/methodology/approachA mixed method approach was used to evaluate the acceptability of SS for a small sample (n = 7) of adult users of a substance misuse service in the UK. Thematic analysis was used to explore their experiences, derived from individual semi-structured interviews. The authors also calculated the number of participants who achieved reliable and/or clinically significant change in mental health symptomology and substance misuse from data routinely collected by the service.FindingsSeven overarching themes emerged: strengthening the foundations of the self, the evocation and management of emotions, safety and validation provided relationally, readiness and commitment, content and delivery, Seeking Safety is Not an Island and ending. Most participants with data available both before and after the group made reliable (three out of four) and clinically significant (two out of three) change for depression and anxiety symptomology; however, this was less evident for PTSD symptomology with two out of three making reliable change and one out of three making clinically significant change.Originality/valueTo the best of the authors’ knowledge, this was the first study exploring the experiences of UK attendees of a SS group as an approach to treating comorbid PTSD and substance misuse.

Covid-19 and Psychological Impact: A Case of Post-Traumatic Stress Disorder in a Female Survivor of Covid-19 in Senegal

The psychological impact of Covid-19 on those affected is well documented. Since the beginning of the pandemic, mental health specialists have drawn attention to the possibility of a wave of mental disorders, some of which are post-traumatic stress disorders. We report the case of a 36-year-old female patient, who was directly confronted with Covid-19 with a 10-day stay in an epidemic treatment center. She presented to the psychiatry seven months later with frequent forgetfulness, incessant crying, and intrusive thoughts about her stay at the epidemic treatment center and absenteeism from work, and was found to have post-traumatic stress disorder with depressive symptoms. This case study aims to evaluate the clinical presentation of post-traumatic stress disorder in a survivor of Covid-19. This case report shows that it is not uncommon in the current health crisis to have patients consulting psychiatry for post-traumatic stress disorder, especially those who are directly confronted with the disease. We hope that the follow-up of recovered Covid-19 patients will be the subject of further scientific research in order to detect those who are at risk of developing post-traumatic stress disorder.

Personality-Based PTSD Subtypes in Young Adults.

The symptom presentation of Posttraumatic Stress Disorder (PTSD) varies widely between individuals, which can complicate both diagnosis and treatment. Personality may help to explain this variability, and personality-based subtypes of PTSD (Externalizing, Internalizing, Simple; Miller et al., 2003) have been identified for this purpose. Yet, empirical tests of these subtypes have been limited, focusing largely on older samples with combat trauma or other homogenous trauma types. Our study examined PTSD subtypes in two samples of young adults with heterogeneous trauma exposure using cluster analyses. We tested for subtype-based heterogeneity in traumatic response (i.e., PTSD symptomatology). Results revealed that, across the two samples, Externalizing (low conscientiousness, moderate neuroticism), Internalizing (low extraversion, moderate neuroticism), and Simple (low neuroticism) personality-based subtypes emerged, consistent with the existing literature. Subtype-based differences in PTSD symptom severity also were observed, with the Simple subtype generally exhibiting less severe PTSD symptomatology than Internalizing and Externalizing subtypes. However, the subtypes did not differ in terms in number or type (interpersonal versus non-interpersonal) of traumatic experiences. Findings support PTSD subtypes and their relevance for post-traumatic response, particularly PTSD severity, in young adults with a variety of trauma types.

Evaluation of a Trauma-Focused CBT Training Programme for IAPT services.

Therapists in Improving Access to Psychological Therapies (IAPT) services are often expected to treat complex presentations of post-traumatic stress disorder (PTSD), such as individuals with multiple, prolonged or early life trauma histories and significant co-morbidity, for which they have received minimal training. Although high recovery rates for PTSD have been demonstrated in randomized controlled trials, these are not always replicated in routine practice, suggesting that training interventions are required to fill the research-practice gap. This study investigated the outcomes of a therapist training programme on treating PTSD with trauma-focused cognitive behavioural therapy (TF-CBT). Twenty therapists from ten IAPT services participated in the training, which consisted of workshops, webinars and consultation sessions over a 6-month period. Feedback indicated that participants found the training highly acceptable. PTSD knowledge and self- and supervisor-rated competence on TF-CBT measures improved following the training and improvements were maintained a year later. Client outcomes on a PTSD measure improved following the training. Participants reported attempts to disseminate learning from the course back to their teams. The findings indicate that the training programme was successful in improving TF-CBT knowledge, skills and outcomes for IAPT therapists. Tentative support for training 'trauma experts' within IAPT services was found, although institutional constraints and staff turnover may limit the sustainability of the model.

The changing face of posttraumatic stress disorder in modern warfare.

This study examined aspects of modern warfare and determined whether they have changed the clinical presentation of posttraumatic stress disorder (PTSD). The relationship between PTSD, mild traumatic brain injury, unmanned aerial vehicle operations and women in combat examined. It was concluded that there are significant changes in how contemporary combat veterans may present with PTSD.

Differential treatment response trajectories in individuals with subclinical and clinical PTSD

Subclinical presentations of posttraumatic stress disorder (PTSD), wherein patients are one or two symptom criteria short of the full disorder, are prevalent and associated with levels of distress and impaired functioning approximating that of full PTSD. Nonetheless, research examining treatment efficacy for this group is in the nascent stage. The purpose of the present study was to examine whether the subclinical PTSD group would: (1) show a greater reduction in PTSD symptoms at pre and post treatment in response to an exposure based treatment and (2) show a greater rate of change over the course of treatment, when compared to the full criteria PTSD group. We also examined whether differences would emerge when examining PTSD symptom clusters. Consistent with predictions, the subclinical PTSD group demonstrated a greater reduction in PTSD symptoms at post-treatment (29%) than those with a PTSD diagnosis (14%). Further, the groups had different treatment trajectories, with the subclinical PTSD group showing a marginally greater rate of change during the course of treatment. Findings also varied by symptom cluster with the subclinical group showing a greater rate of change in the intrusions, hypervigilance, and avoidance symptom clusters. There was not a significant between group difference in the numbing symptom cluster. This study provides preliminary evidence that treating PTSD symptoms at the subclinical level may result in a larger, and more rapid symptom reduction, and thus has implications supporting treatment earlier in the developmental trajectory of the disorder.

Cortical Excitability and Agressive Behavior in Post-Traumatic Stress Disorder.

Hyperarousal and alertness play an important role in the clinical presentation of Post-traumatic stress disorder (PTSD). Strenuous effort has been made to shed light on the mechanisms that cause these symptoms of patients. Based on the claim that there is a relationship between some subtypes of hyperarousal symptoms and aggression in patients with PTSD, we aimed to examine the relationship between electrophysiological measurements that was measured through transcranial magnetic stimulation (TMS) and aggression scale scores of PTSD patients in this study. The study included 37 patients with a diagnosis of PTSD according to DSM-IV criteria and 25 healthy volunteers. Electrophysiological measurements of participants were made with TMS. The Buss Perry Aggression Questionnaires was administered to patients and control group. In the patient group, a positive correlation was found between scores of aggression and arousal symptoms. Motor excitability threshold, one of TMS measurements, which is a sign of cortical excitability, was significantly lower in the patient group than the control group. There was a negative correlation between aggression scale scores and the parameters of motor excitability threshold and cortical silent period which both shows cortical excitability of the patients. We concluded that there was an increase in cortical excitability in PTSD patients and we suggest that this increase might be associated with hyperarousal symptoms and aggressive behavior.

Survivors of Homicide: Mental Health Outcomes, Social Support, and Service Use Among a Community-Based Sample.

This study aims to explore rates of bereavement-related mental health outcomes and diagnostic comorbidity along with the associations between mental health outcomes, perceived social support, knowledge of services, and service use among a diverse sample of 47 survivors 2 years post loss. Findings are consistent with prior studies in that homicide is associated with an overlapping of significant symptom presentation of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and complicated grief (CG). Lack of grief-specific social support was demonstrated to be associated with PTSD and MDD but not with CG. Although a significant number of survivors reported poor mental health outcomes, a limited number were using services.

Eye Movement Desensitization and Reprocessing (EMDR) as Treatment for Combat-Related PTSD: A Meta-Analysis

Although the symptom presentation of post-traumatic stress disorder (PTSD) in the general and military population is very similar, combat-related PTSD is typically thought to be more severe due to repeated and prolonged exposure to traumatic events. One of the treatments of choice, eye-movement desensitization and reprocessing (EMDR) has, however, not been validated for the military population. A meta-analysis was carried out on literature ranging back to 1987. The analysis thus far resulted in a failure to support the effectiveness of EMDR in treating PTSD in the military population. Several possible explanations are given, of which the limited number of well-designed randomized controlled trials (RCTs) seems to be the most important one. Until more research is done, EMDR as treatment of choice for combat-related PTSD should be used only if other treatment protocols have proven unsuccessful.

The Many Presentations of Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) has been a controversial diagnosis, with concerns including the sheer number of possible minimal diagnostic combinations (1,750), increasing to &gt;10,000 theoretical possibilities in Diagnostic and Statistical Manual of Mental Disorders (5th ed.) proposals. This study examined whether the theoretical combinations postulated actually occur in a large sample of military personnel. The design of the study was a retrospective examination of PTSD checklists from 3,810 participants who, based on scores, endorsed symptoms consistent with probable PTSD. Combinations of PTSD Checklist–Civilian Version (PCL-C) symptom clusters were identified using data from active-duty military personnel who completed the 2005 and the 2008 Department of Defense (DoD) Health Related Behaviors Among Active Duty Military Personnel Survey. The study examined (a) occurrence of combinations, (b) unique minimum combinations, (c) most frequent combinations, and (d) replication of symptom combinations and clusters. The PCL-C scores showed 1,837 unique scoring combinations, 83.5% (1,533/1,837) of the observed unique scoring combinations occurred just once. The most frequently occurring combination (17/17 endorsed) accounted for 955 participants (25.1%), the second most frequent (16/17 endorsed) accounted for 75 participants (2.0%). PTSD most often presented as a unique constellation of symptom clusters, either capturing symptoms while allowing for considerable variability in its presentation, reflecting different severities of the disorder, or raising concerns about the classification itself, and any future classification that Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-V) might develop.

P.4.a.009 Clinical presentation of posttraumatic stress disorder with and without traumatic brain injuries

IRT has been demonstrated as an effective treatment for severe, refractory OCD.Consecutive IRT subjects were ascertained over a 12 month period (female N = 26, male N = 35). Psychometric measures were completed at admission and discharge from the McLean/MGH OCD Institute IRT, including the Yale-Brown Obsessive–Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI) and the Work and Social Adjustment Scale (WSA)(N = 61). These measures were repeated at one (N = 57), three (N = 42) and six months (N = 36) following discharge. This study was IRB approved.OCD mean severity did not significantly worsen from discharge to the one (17.4, SD 6.5), three (16.5, SD 7.4) or six month (16.2, SD 7.3) follow-up (p > 0.25). Furthermore, the significant improvement from admission was maintained at each of the one (17.4, SD 6.5), three (16.5, SD 7.4) and six month (16.2, SD SD 7.3) follow-up time points (p < 0.001). Relapsers were significantly more likely to be living alone following discharge (p = 0.01), and were less likely to have comorbid illnesses (p = 0.02). There were no significant differences found between study dropouts and completers with regards to YBOCS scores (P > 0.47).In the first OCD IRT long-term follow-up study to date, findings have indicated that mean treatment gains were maintained at one, three, and six months post-discharge. This finding is important as it suggests that improvements of OCD severity were subsequently retained in home and work environments. Improvement of depression severity from admission was also maintained.

Heterogeneity in clinical presentations of posttraumatic stress disorder among medical patients: Testing factor structure variation using factor mixture modeling

The present study used factor mixture modeling to explore empirically defined subgroups of psychological trauma victims based on confirmatory factor analysis (CFA) and latent class analysis of posttraumatic stress disorder (PTSD) symptoms. We sampled 310 medical patients with a history of trauma exposure. Confirmatory factor analysis revealed that the 4-factor emotional numbing PTSD model yielded the best model fit. Using latent factor means derived from this model and the 4-factor dysphoria PTSD model (indexing severity on PTSD factors), 3 latent classes of participants were identified using factor mixture modeling. The 3-class model fit the data very well and was validated against external measures of anxiety and rumination.

The effects of peripheral message cues on clinicians' judgments about clients' psychological status

This research examined the influence of peripheral message cues on clinicians' judgment about the psychological status of clients. The elaboration likelihood model (ELM) of social persuasion suggests that peripheral message cues are likely to exert a greater influence on clinicians' judgments when a client's presentation meets some, but not all, diagnostic criteria for a disorder (i.e., when the presentation is ambiguous). Within this theoretical framework, we examined the effects of a peripheral message cue (level of irrelevant detail in the client's presentation) and presentation ambiguity on clinicians' judgments of need for treatment, illness severity, and distress. Consistent with predictions based on the ELM, for both obsessive-compulsive disorder and post-traumatic stress disorder presentations, high levels of irrelevant detail exerted a greater influence on clinicians' judgments of clients' need for treatment when presentation ambiguity was high than when it was low.

Institutionally based health care workers' exposure to traumatogenic events: Systematic review of PTSD presentation

This review sought to identify published evidence for the presentation of posttraumatic stress disorder (PTSD) symptoms in institutionally based health care workers. The databases Medline, Psycinfo, PILOTS, CINAHL (R), EMBASE, and ISI Web of Science were searched in a systematic manner eliciting 9 quantitative studies. Presentation of PTSD among such workers appears comparable to data reported for emergency services staff. The authors discuss some of the theoretical debates underpinning the research as well as methodological weaknesses that temper the strength of conclusions drawn.

‘Peek-a-boo. How can you be there?’ Analytic work with a severely traumatised two-and-a-half-year-old girl

This paper traces the analytic work with a severely traumatised two-and-a-half-year-old girl Phoebe, whose early life was marked by chronic abuse and a violent murder she witnessed a few months prior to the beginning of treatment. Bringing the trauma in the room in a dissociative form, in line with post-traumatic stress disorder presentation, was Phoebe's unconscious means of communicating her pre-verbal encounters by projecting onto me the rage, shock and helplessness of her predicament. Thus, countertransference responses were a helpful window into her internal world, which was governed by cataclysmic losses and primitive states of fear. The importance of containment of the complex feelings aroused in the work and protecting against potential re-enactment of the abusive elements the patient, the family and often the professional network brought in the therapy is highlighted. The author hopes that this paper will encourage the offering of psychoanalytic psychotherapy to traumatised children particularly the under fives.

An Unusual Clinical Presentation of Posttraumatic Stress Disorder in a Sudanese Refugee

Some anxiety disorders may present with signs and symptoms that may linger many years after the stress-inducer events and threat has passed. A case of posttraumatic stress disorder is presented in this report of a Sudanese refugee presenting with chronic abdominal and lower back pain. PTSD in refugees may present with typical or atypical manifestations such as chronic pain syndromes. Therefore, the identification by medical providers of the spectrum of signs and symptoms compatible with PTSD is critical. We suggest that the diagnosis of PTSD requires a culture-based approach in the clinical history-taking incorporating geopolitical context and an in-depth assessment of the degree of exposure to serial traumatic events.

Le trouble de l’adaptation en oncologie : un cadre conceptuel à préciser

The use of stringent sets of diagnostic criteria often represents a daily clinical challenge for mental health professionals caring for cancer patients. Many nosological classification systems were not specifically developed to meet the peculiarities associated with the emotional experience of cancer. In particular, the diagnosis of adjustment disorder according to the Diagnostic and Statistical Manual of mental disorders appears inappropriate in this context. It is questionable, indeed, how to assess the "excessive" nature of psychological distress ari-sing in response to such a burdening event as a cancer diagnosis. Furthermore, the conceptual validity of the adjustment disorder construct may be of poor clinical relevance in patients suffering from a life-threatening medical condition and its widespread consequences. In this paper, we intend to offer an operational definition of adjustment and we argue that a vast majority of cancer patients currently receiving a diagnosis of adjustment disorder actually suffer from either subthreshold depression or from full or partial presentation of post-traumatic stress disorder. We first briefly review some available models of psychological adaptation. We also argue that trying to explain the experience of cancer alongside a continuum of psychological distress does not help us to better understand underlying adjustment processes and to treat emotional disturbances more effectively. The literature is currently scanty about the critical role of a psychological trauma, namely the diagnosis of cancer, in generating emotional, cognitive and behavioral responses. The very fact that an average of 10% of cancer patients have been shown to meet criteria for PTSD might suggest that the existence of a specific trauma stress adaptation process in this particular patient population. The confirmation of these hypotheses by clinical observation, experimental psychology paradigms or functional brain imagery studies could have substantial implications for the treatment of psychological distress in patients with cancer. Issues such as the relevance of pharmacological treatment of subthreshold depression--which has received little attention in the general literature--or the role of psychodynamic approaches in the management of cancer-related traumatic dimensions, should be addressed systematically.