Short Posttraumatic Stress Disorder Research Articles

Understanding psychological outcomes following exposure to potentially morally injurious events in animal care: development of the Moral Distress-Posttraumatic Growth Scale for Veterinary Professionals

ABSTRACT Aims To generate a taxonomy of potentially morally injurious events (PMIE) encountered in veterinary care and develop an instrument to measure moral distress and posttraumatic growth following exposure to PMIE in the veterinary population. Methods Development and preliminary evaluation of the Moral Distress-Posttraumatic Growth Scale for Veterinary Professionals (MD-PTG-VP) employed data from veterinary professionals (veterinarians, veterinary nurses, veterinary technicians) from Australia and New Zealand across three phases: (1) item generation, (2) content validation, and (3) construct validation. In Phase 1 respondents (n = 46) were asked whether they had experienced any of six PMIE and to identify any PMIE not listed that they had experienced. In Phase 2 a different group of respondents (n = 11) assessed a list of 10 PMIE for relevance, clarity and appropriateness. In Phase 3 the final instrument was tested with a third group of respondents (n = 104) who also completed the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), a measure of posttraumatic stress, and the Stress-Related Growth Scale–Short Form (SRGS-SF) a measure of perceived posttraumatic growth. Spearman’s correlation coefficients were calculated between respondent scores on each of the MD-PTG-VP subscales, the SPRINT, and the SRGS-SF to assess construct validity. Results A 10-item taxonomy of PMIE encountered in veterinary care was generated in Phase 1. Items were deemed relevant, clear and appropriate by veterinary professionals in Phase 2. These were included in the developed instrument which measures frequency and impact of exposure to 10 PMIE, yielding three subscale scores (exposure frequency, moral distress, and posttraumatic growth). Assessment of construct validity by measuring correlation with SPRINT and SRGS-SF indicated satisfactory validity. Conclusions The MD-PTG-VP provides an informative tool that can be employed to examine professionals’ mental health and wellbeing following exposure to PMIE frequently encountered in animal care. Further evaluation is required to ascertain population norms and confirm score cut-offs that reflect clinical presentation. Clinical relevance Once fully validated this instrument may be useful to quantify the frequency and intensity of positive and negative aspects of PMIE exposure on veterinary professionals so that accurate population comparisons can be made and changes measured over time.

Prospective Bidirectional Relationship Between Sleep Duration and Posttraumatic Stress Disorder Symptoms After Suspected Acute Coronary Syndrome.

Sleep disturbance is a "hallmark" symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD symptoms when PTSD is induced by acute coronary syndrome (ACS). We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year after hospital evaluation for ACS. Participants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration ("During the past month, how many hours of actual sleep did you get at night?") and cardiac event or hospitalization-induced PTSD symptoms (PTSD Checklist) were assessed at 1, 6, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms. The sample included 1145 participants; 16% screened positive for probable PTSD (PTSD Checklist score ≥33). Mean sleep duration across time points was 6.1 hours. Higher PTSD symptoms predicted shorter sleep duration at the next time point (i.e., 1-6 and 6-12 months; B = -0.14 hours/10-point difference, SE = 0.03, p < .001). Shorter sleep duration was associated with higher PTSD symptoms at the next time point (B = -0.25 points/hour, SE = 0.12, p = .04). Short sleep duration and PTSD symptoms are mutually reinforcing across the first year after ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.

Evaluating effects of burn injury characteristics on quality of life in pediatric burn patients and caregivers

ObjectivesThe purpose of this study was to evaluate pediatric burn patients’ and caregivers’ quality of life (QoL), while identifying clinical characteristics correlated with psychological stress. MethodsPediatric burn patients at an ABA-verified institution from November 2019-January 2021 were included. Caregivers of patients 0–4 years completed the Infant’s Dermatology QoL Index (IDQOL). Patients> 4–16 years completed the Children’s Dermatology Life Quality Index (CDLQI). The Short Post-Traumatic Stress Disorder Rating Interview (SPRINT) measured caregivers’ stress. Generalized linear mixed models evaluated associations between assessment scores and burn characteristics. ResultsOverall, 27.3% (39/143) of IDQOL and 53.1.% (41/96) of CDLQI scores indicated that patients’ burns caused moderate to extremely large effects on QoL. In caregivers, 4.5% (7/159) scored> 14 on the SPRINT, warranting further PTSD evaluation. For the IDQOL, each additional 1% TBSA burn was associated with a 2.75-point increase (p = 0.05), and patients sustaining 2nd degree deep partial thickness burns scored an average of 3.3 points higher compared to 2nd degree superficial partial thickness burns (P < 0.01). CLDQI and SPRINT scores demonstrated a similar pattern. ConclusionsQoL is impacted in a substantial proportion of pediatric burn patients. Larger TBSA and increased burn depths cause significantly more psychological stress in children, and caregivers may require more extensive psychological evaluation.

What Is Solastalgia and How Is It Measured? SOS, a Validated Scale in Population Exposed to Drought and Forest Fires.

Solastalgia is a recent concept that refers to disruptive psychological responses in people exposed to environmental degradation. The aim of this study was to determine the number of dimensions solastalgia has using a sample of people exposed to the effects of climate change in the coastal dry land of Maule region, Chile. In order to achieve this, a Scale Of Solastalgia (SOS) was designed and then validated, by means of applying it to 223 inhabitants at the municipalities of Pencahue (n = 105) and Curepto (n = 118), who were also evaluated by the Short Post-traumatic Stress Disorder Rating Interview (SPRINT-E). Using robust validation methods (Parallel factor analysis and Omega), two dimensions were obtained for solastalgia: solace and algia. Both correlate with the SPRINT-E scale (r = 0.150, p < 0.01 and r = 0.359, p < 0.01, respectively) and have 58% sensitivity and 67% specificity to detect cases of post-traumatic stress disorder (PTSD). Like PTSD, solastalgia is related to psychopathologies expected after disasters and also presents a spatial pattern where the concentration of positive cases occurs in places of greater exposure to environmental change or degradation.

Aggression towards clinicians within Opiate Substitution Treatment (OST) services: A survey of service providers

BackgroundHigh levels of aggression towards staff in healthcare settings have been reported. It seems likely that workers in Opioid Substitution Therapy (OST) would be at increased risk of adverse events and their consequences. ObjectivesThis study aimed to establish if practitioners who provide OST are experiencing negative outcomes, specifically aggression, distress, and burnout, and to identify if workload and professional affiliation were associated with these risks. MethodsA survey was conducted of OST practitioners in a single geographical region of New Zealand (population approx. 344,000). The survey asked for demographics (including caseloads), Perception of Patient Aggression Scale New Zealand Revision (POPAS-NZ), Kessler 10 (K10), Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), and Abbreviated Maslach Burnout Inventory (aMBI) and two qualitative questions asking about the best and worst aspects of working in OST. ResultsAll recorded OST workers in the region (n = 181) were invited to participate, 95 practitioners responded to the survey (52.4%). This group included pharmacists, doctors, nurses, social workers and addiction workers. Results indicated aggression, distress, and burnout were being experienced by practitioners. Number of patients seen by a practitioner significantly increased risk of aggression (F(1,90) = 14.14, p < 0.001). Psychiatrists were the most at risk profession (p = 0.016). Burnout responses were high for around 20% of practitioners, with low numbers meeting criteria for distress and PTSD. Positive things about working in OST were relationships with patients, appreciating patient outcomes and positive team environments. Negative aspects were patient behaviours, maintaining empathy, and, administration tasks. ConclusionsAggression was a workplace hazard for OST clinicians. Low rates of distress and PTSD symptoms were reported and some evidence of practitioner burnout. Practitioners reported positive relationships, making a difference and teamwork may have been improving this area of mental health work.

Post-Traumatic Growth in Parents following Their Child's Death in a Pediatric Intensive Care Unit.

Background: Although bereaved parents suffer greatly, some may experience positive change referred to as post-traumatic growth. Objective: Explore the extent to which parents perceive post-traumatic growth after their child's death in a pediatric intensive care unit (PICU), and associated factors. Design: Longitudinal parent survey conducted 6 and 13 months after a child's death. Surveys included the Post-traumatic Growth Inventory-Short Form (PTGI-SF), a 10-item measure with range of 0-50 where higher scores indicate more post-traumatic growth. Surveys also included the Inventory of Complicated Grief (ICG), the Patient Health Questionnaire-8 (PHQ-8) for depression, the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), a single item on perceived overall health, and sociodemographics. Setting/Subjects: One hundred fifty-seven parents of 104 children who died in 1 of 8 PICUs affiliated with the U.S. Collaborative Pediatric Critical Care Research Network. Results: Of participating parents, 62.4% were female, 71.6% White, 82.7% married, and 89.2% had at least a high school education. Mean PTGI-SF scores were 27.5 ± 12.52 (range 5-50) at 6 months and 28.6 ± 11.52 (range 2-49) at 13 months (p = 0.181). On multivariate modeling, higher education (compared with those not completing high school) and higher 6-month ICG scores (reflecting more complicated grief symptoms) were associated with lower 13-month PTGI-SF scores (p = 0.005 and 0.033, respectively). Conclusion: Parents bereaved by their child's PICU death perceive a moderate degree of post-traumatic growth in the first 13 months after the death however variability is wide. Education level and complicated grief symptoms may influence parents' perception of post-traumatic growth.

The Association between Therapeutic Alliance and Parental Health Outcomes following a Child's Death in the Pediatric Intensive Care Unit.

Therapeutic alliance reflects the strength and quality of the physician-patient/family relationship. We investigated the association between therapeutic alliance and bereaved parents' mental health and perceived overall health following their child's death in a pediatric intensive care unit (PICU). Bereaved parents were surveyed 6 months after their child's death in a PICU affiliated with the Collaborative Pediatric Critical Care Research Network. Parents were evaluated for complicated grief, depression, and post-traumatic stress using the Inventory of Complicated Grief (ICG), the Patient Health Questionnaire (PHQ-8), and the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), respectively. Overall health was evaluated using a single item. Therapeutic alliance between parents and their deceased child's PICU physicians was assessed using the Human Connection scale (HCS). Two hundred and thirty-five parents of 158 deceased children completed surveys. Mean ICG score was 34.4 ± 14.9 with 142 (60.4%) parents screening positive for complicated grief. Mean PHQ-8 score was 9.1 ± 6.2 with 102 (43.4%) screening positive for at least moderate depression. Mean SPRINT score was 14.6 ± 8.2 with 122 (51.9%) screening positive for post-traumatic stress disorder. Overall health was perceived as fair for 47 (20.0%) parents and poor for 10 (4.3%). Using multivariable modeling, higher HCS score (greater therapeutic alliance) was significantly associated with lower (better) ICG score (-0.23, 95% CI -0.42, -0.04, p = 0.018). HCS score was not significantly associated with PHQ-8, SPRINT, or overall health scores. We conclude that bereaved parents experience a high level of adverse mental health symptoms including complicated grief, depression, and post-traumatic stress symptoms. Greater therapeutic alliance with PICU physicians may lessen symptoms of complicated grief during bereavement.

Complicated Grief, Depression and Post-Traumatic Stress Symptoms Among Bereaved Parents following their Child's Death in the Pediatric Intensive Care Unit: A Follow-Up Study.

Parents often suffer reduced mental health after their child's death; however, the trajectory and risk factors are not well described. Describe the change in complicated grief, depression, and post-traumatic stress symptoms among parents between 6 and 13 months after their child's death in a pediatric intensive care unit (PICU), and factors associated with 13-month symptoms. Parents whose children died in 1 of 8 PICUs affiliated with the Collaborative Pediatric Critical Care Research Network completed surveys 6 and 13 months after their child's death. Surveys included the Inventory of Complicated Grief (ICG), the Patient Health Questionnaire-8 (PHQ-8) for depression, and the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT). Parents provided sociodemographics. Charts were reviewed for child characteristics. One-hundred and fifty seven parents of 104 deceased children completed surveys at both time points. Mental health symptoms declined over time (mean (SD)): ICG (33.8 (15.4) vs. 30.5 (15.2), p < 0.001), PHQ-8 (9.0 (6.4) vs. 7.3 (5.8), p < 0.001), and SPRINT (14.1 (8.3) vs. 12.0 (8.2), p < 0.001). After controlling for 6-month scores, higher 13-month ICG was independently associated with sudden unexpected death; higher PHQ-8 with Black race, insecure attachment style, and sudden unexpected death; and higher SPRINT with having a high school level of education (compared to college degree or higher). Mental health symptoms improve among parents during the first 13 months after their child's death; however, symptoms persist for many. Black parents and those whose children die suddenly may be high risk for poor adjustment during bereavement.

Insomnia, fatigue and psychosocial well-being during COVID-19 pandemic: A cross-sectional survey of hospital nursing staff in the United States.

Aims and objectivesTo describe the levels of insomnia, fatigue and intershift recovery, and psychological well‐being (burnout, post‐traumatic stress and psychological distress), and to examine differences in these measures based on work‐related characteristics among nursing staff during COVID‐19 pandemic in the United States.BackgroundThe COVID‐19 pandemic has created a major physical and psychological burden on nursing staff in the United States and worldwide. A better understanding of these conditions will lead to tailored support and resources for nursing staff during and after the pandemic.DesignCross‐sectional study.MethodsHospital nurses and nursing assistants (N = 587) were recruited online between May–June 2020. The survey included measures on insomnia (Insomnia Severity Index) fatigue and intershift recovery (Occupational Fatigue and Exhaustion Recovery‐15), burnout (Maslach Burnout Inventory‐Human Services Survey), post‐traumatic stress (Short Post‐Traumatic Stress Disorder Rating Interview) and psychological distress (Patient Health Questionnaire‐4), and questions on work and demographics. The STROBE checklist was followed for reporting.ResultsThe sample had subthreshold insomnia, moderate‐to‐high chronic fatigue, high acute fatigue and low‐to‐moderate intershift recovery. The sample experienced increased emotional exhaustion and depersonalisation, increased personal accomplishment, moderate psychological distress and high post‐traumatic stress. Nurses who cared for COVID‐19 patients had significantly scored worse on almost all measures than their co‐workers. Certain factors such as working hours per week and the frequency of 30‐min breaks were significant.ConclusionNursing staff experienced poor sleep, fatigue and multiple psychological problems during the COVID‐19 pandemic. Moreover, staff who were involved in the care of COVID‐19 patients, worked more than 40 h per week and skipped 30‐min breaks showed generally worse self‐reported outcomes.Relevance to clinical practiceNursing administration is recommended to monitor for fatigue and distress on nursing units, re‐visit current scheduling practices, reinforce rest breaks and provide access to mental health and sleep wellness resources with additional support for their front‐line nursing groups.

Does cumulative exposure to traumatic stressors predict treatment outcome of community-implemented exposure-based therapy for PTSD?

ABSTRACT Background: Posttraumatic Stress Disorder (PTSD) is associated with high levels of functional impairments such as difficulties in academic or occupational performance and in social relationships. With an increasing number of traumatic event types experienced (trauma load), PTSD risk increases in a dose-dependent manner. Accordingly, high rates of PTSD can impair the reconstruction process in post-conflict societies. In order to meet these high needs for mental health services in societies with little access to professional care, task shifting approaches and community-based interventions have been suggested. Narrative Exposure Therapy (NET) has been developed as a short and pragmatic exposure-based PTSD treatment that can be easily trained to lay personnel. Yet, it remains unclear whether NET can be effectively provided by trained lay counsellors even at high levels of trauma load. Objective: To investigate whether trauma load influences the treatment effectiveness of NET provided by trained and supervised local lay counsellors. Method: Linear mixed models were calculated to investigate the influence of trauma load on treatment effectiveness in a sample of N = 323 rebel war survivors from Northern Uganda with PTSD. Results: We found a strong reduction of PTSD symptoms following NET, which was not influenced by trauma load. However, individuals with higher levels of trauma load reported higher PTSD symptoms before therapy as well as 4 and 10 months following treatment completion compared to individuals with lower trauma load. Conclusions: Treatment with NET by lay counsellors is effective independent of trauma load. However, individuals with higher trauma load have a higher probability to show residual symptoms, which might require additional time, sessions or treatment modules.

The Effects of the EMDR Group Traumatic Episode Protocol With Cancer Survivors

The purpose of this pre-experimental case study was to explore the efficacy and safety of the Eye Movement Desensitization and Reprocessing (EMDR) Group Traumatic Episode Protocol (G-TEP) in the psychological treatment of cancer survivors and its potential effects on posttraumatic stress, anxiety, and depressive symptoms. Participants (N = 35) were patients with various types of cancer, in different stages, initial or recurring, with diagnosis or oncology treatment received within the past year. Following an individual psychoeducational intake session, participants received two 90-minute EMDR G-TEP sessions, administered on consecutive days. They were randomly assigned to a treatment group or a delayed treatment group. Assessments were administered at pre, post, and follow-up using the Short PostTraumatic Stress Disorder Interview (SPRINT), State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI-II). Repeated measures comparisons of PTSD symptoms, anxiety, and depression revealed significant differences between pretest and posttest, with most results maintained at follow-up. Pre-follow-up effect sizes showed medium effects. These promising results suggest the value in providing a lengthier course of treatment. They support the need for research with large sample, randomized clinical trials to examine the viability of providing EMDR G-TEP in the psychological treatment of cancer survivors. No serious adverse effects were reported and we conclude that the EMDR G-TEP may be effective and safe in the psychological treatment of an oncology population.

EMDR-Based Divorce Recovery Group: A Case Study

This case study investigated the effects of an eye movement desensitization and reprocessing (EMDR)-based divorce recovery group, consisting of four modalities: (a) modified EMDR Integrative Group Treatment Protocol adapted for adolescents and adults living with ongoing traumatic stress (EMDR-IGTP-OTS) to deal with the trauma from the divorce, (b) modified Affect Circuit Reset protocol to reduce intensity of negative affects, (c) psychoeducation on affects and divorce-related issues, and (d) small group discussion. The divorce recovery program is an attempt to provide an affordable, trauma-focused intervention for divorce recovery for low-income populations. This report summarizes the outcomes in a divorce recovery group of six women, all Chinese immigrants. Aside from one person in the midst of divorce, the group consisted of individuals divorced for 7 years or more, for whom the distress had lasted more than the 2 to 3 years typical of divorce recovery. Short Post-Traumatic Stress Disorder (PTSD) Rating Interview (SPRINT) scores collected at the beginning of week 2, at the end of week 7, and at the beginning of week 8 showed PTSD symptoms dropping from severe to mild. The mean SPRINT scores at 6 weeks and 13 weeks after treatment continued to decrease, approaching the no/minimal symptom range. The SPRINT scores showed a 65.6% reduction between week 2 (18.0 [SD = 8.4]) and 13 weeks after treatment (6.2 [SD= 5.5]), with a large effect size of d = 1.40, and a significant decrease of t(4)=4.0, p = .016.

Cognitive appraisal of exposure to specific types of trauma - a study of gender differences

BackgroundThe role of gender in posttraumatic cognitions has increasingly been approached. The current study comparatively evaluates posttraumatic cognitions in men and women exposed to specific nonsexual trauma (motor vehicle accidents, work – related accidents, burns).MethodsPosttraumatic cognitions and posttraumatic stress symptoms were comparatively assessed in 53 men and 37 women treated in 3 Romanian primary care units after specific accidental trauma. Posttraumatic Cognitions Inventory (PTCI) was used to assess posttraumatic cognitions, and the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT) was used to assess posttraumatic stress symptoms.ResultsMen with significant posttraumatic stress symptoms endorsed more negative cognitions than women. Men with posttraumatic disability more consistently endorsed some negative cognitions regarding instrumentality, strength and control than their female counterparts. Women and men without posttraumatic disability reported similarly low levels of negative posttraumatic cognitions. Time elapsed since trauma increased most negative cognitions in men.ConclusionsThe intensity of PTSD symptoms and presence of posttraumatic disability influence negative cognitions after exposure to accidental trauma. Women experiencing clinically significant PTSD symptoms endorse more cognitions regarding instrumentality, strength and control than male counterparts. Women with permanent disability after trauma report less cognitions involving emotionality, dependence and low self – efficacy than male counterparts. In the absence of permanent posttraumatic disability, men and women endorse similar levels of negative cognitions after accidental trauma. With time elapsed since trauma, men perceive decreasing self – efficacy, problem – solving and emotional control, while women perceive decreasing interpersonal cooperation. Despite limitations (cross-sectional design, lack of normative data for PTCI to ascertain culturally – specific gendered cognitions), this study supports the gender – sensitive approach of accidental trauma, especially when its consequences are pervasive, disabling and increasingly burdensome.

Religious Coping as Moderator of Psychological Responses to Stressful Events: A Longitudinal Study

The aim of this study was to evaluate the association of positive and negative religious coping with posttraumatic symptoms (PTS) and growth (PTG). Their moderating role was also examined among predictors such as social support and the subjective severity of event with PTS and PTG. Two hundred and eleven Chilean adults (58.3% women) of 18 years and older who had been exposed to highly stressful were surveyed. The Brief-RCOPE, the Brief-COPE subscale of social support, the Subjective Severity of Event Scale, and a socio-demographic questionnaire were used as measurements at time one. The Posttraumatic Growth Inventory-short form (PTGI-SF) and Short Posttraumatic Stress Disorder Rating Interview (SPRINT-E) was used to collect baseline scores and six months after. The results show that negative religious coping predicts the increase in PTS, positive religious coping predicts the increase in PTG and plays a moderation role: at low levels of positive religious coping it was found a strong association between coping by seeking social support and PTG, while at high level the association is weak. These results are discussed in the framework of the functionality of positive and negative religious coping and its role in adjusting to potentially traumatic events.

Crisis Counselors' Perceptions and Assessment of Suicidal Behavior Among Hurricane Survivors Receiving Crisis Counseling Services.

The aims of this study were to assess the awareness of risk for suicidal behaviors and perspectives of Project Recovery counselors who provided crisis counseling services to hurricane survivors. The Short Posttraumatic Stress Disorder Rating Interview-Extended, a quantitative disaster mental health measure, was used to assess distress and dysfunction to the recent hurricanes. Project Recovery counselor data were collected through a 22-item qualitative interview. Seven out of 207 clients (3.4%) endorsed the quantitative item measuring suicidal ideation. Clients who reported suicidal ideation had significantly higher scores on items indicating a loss of enjoyment, feelings of depression, feeling less able to handle stress, and other mental health items. Counselor responses fell into 5 major themes: Assessment and Action, Client Characteristics, Services, Counselor Training and Preparedness, and Future Directions. Suicidal behavior is a serious mental health emergency, yet it remains a challenging issue as suicidal behaviors are complex and disaster survivors with suicidal ideation may experience intense psychological reactions to the event. In order to provide competent care to survivors experiencing suicidal thoughts or behaviors, the need for counselors to receive adequate training in suicide assessment and management is essential.

Pilot Research Study on the Provision of the Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol With Female Cancer Patients

The purpose of this research is to evaluate the effectiveness of the eye movement desensitization and reprocessing (EMDR) Integrative Group Treatment Protocol (EMDR-IGTP) in reducing posttraumatic stress disorder (PTSD) symptoms related to the diagnosis and treatment of different types of cancer in adult women. EMDR-IGTP intensive therapy was administered for 3 consecutive days, twice daily, to 24 adult women diagnosed with different types of cancer (cervical, breast, colon, bladder, and skin) who had PTSD symptoms related to their diagnosis and treatment. The data was analyzed using factorial ANOVA with the effects of the EMDR-IGTP evaluated with the Short PTSD Rating Interview as dependent variable and group (two groups of patients: active phase and follow-up phase of cancer treatment) and time (four time points) as independent variables. Post hoc analyses were carried out. Results showed significant main effects for time and group. No significant interaction was found. Results also showed an overall subjective improvement in the participants. This pilot study suggests that intensive administration of the EMDR-IGTP can be a valuable support for cancer patients with PTSD symptoms related to their diagnosis and treatment. Further research with randomized controlled studies is needed to demonstrate the effectiveness of EMDR-IGTP in this population.

The sleep effects of tiagabine on the first night of treatment predict post-traumatic stress disorder response at three weeks

We sought to test the hypothesis that improvements in sleep might mediate treatment-related improvements in daytime symptoms of post-traumatic stress disorder (PTSD). We evaluated whether changes in sleep occurring on the first night of tiagabine (a gamma-amino butyric acid (GABA) reuptake inhibitor) administration predicted subsequent PTSD response. This was an open-label three-week polysomnographic (PSG) study of nightly treatment with tiagabine dosing from 2-12 mg including 20 adults with PTSD with ≥30 min of self-reported and PSG wake time after sleep onset (WASO). A treatment night 1 decrease in self-reported and PSG WASO and an increase in slow-wave sleep (SWS) accounted for 94% of the variance in week 3 Short PTSD Rating Interview (SPRINT) score, the primary outcome measure (p<0.001). Increased night 1 SWS also accounted for 91% of the variance in Work/School Impairment and 45% of the variance in Social Life Impairment as measured with the Sheehan Disability Scale (p<0.001). These relationships were much stronger correlates of three-week outcome than three-week sleep effects. The initial sleep response to tiagabine may mediate or be an indicator of the subsequent PTSD response. The findings highlight the importance of sleep maintenance and SWS in the treatment of PTSD and also suggest a potential relationship between SWS and daytime function.

Assessment of Psychiatric Symptoms at a Level I Trauma Center Surgery Follow-up Clinic: A Preliminary Report

At Level I trauma centers, psychiatric consultation is readily available to inpatient surgical services. This study sought to characterize the psychiatric symptoms present in the surgical follow-up clinic. Patients aged 18 years and older were assessed over one month for symptoms of posttraumatic stress disorder (PTSD) with the Short PTSD Rating Interview (SPRINT), depression with the Patient Health Questionnaire (PHQ-9), alcohol abuse with the Alcohol Use Disorder Identification Test (AUDIT), and the presence of violence using the MacArthur Community Violence Instrument (MCVIa [victimization] MCVIb [perpetration]). Twenty-five individuals participated. Using the SPRINT, 13 (52.0%) met the cutoff for PTSD. For PHQ-9 depression, 11 (44%) were in the moderate to severe range. For AUDIT, five (20.0%) likely had an alcohol problem. Using the MCVI, 15 (60.0%) reported victimization and 12 (48.0%) reported perpetration. Elevated levels of psychiatric symptoms were found in the trauma surgery follow-up clinic. Psychiatric care embedded in this setting may be warranted.

Validation of two screening instruments for PTSD in Dutch substance use disorder inpatients

Posttraumatic stress disorder (PTSD) is highly prevalent in substance use disorder (SUD) populations. Because resources for extensive and thorough diagnostic assessment are often limited, reliable screening instruments for PTSD are needed. The aim of the current study was to test two short PTSD measures for diagnostic efficiency in predicting PTSD compared to the Clinician-Administered PTSD Scale (CAPS). The sample consisted of 197 SUD patients receiving residential substance use treatment who completed questionnaires regarding substance use and trauma-related symptoms, all abstinent from substance for 4weeks. The PTSD section of the Mini International Neuropsychiatric Interview plus (MINIplus) and the Self-Report Inventory for PTSD (SRIP) are compared to the CAPS. Results showed low sensitivity (.58) and high specificity (.91) for the PTSD section of the MINIplus. The SRIP showed high sensitivity (.80) and moderately high specificity (.73) at a cut-off score of 48. The prevalence of PTSD as measured with the CAPS was 25.4% current and 46.2% lifetime. Results indicate that the MINIplus, a short clinical interview, has insufficient quality as a screener for PTSD. The SRIP, however, is a reliable instrument in detecting PTSD in a SUD inpatient population in The Netherlands. Screening for PTSD is time efficient and increases detection of PTSD in SUD treatment settings.

An open-label pilot study of aripiprazole for male and female Veterans with chronic post-traumatic stress disorder who respond suboptimally to antidepressants

Emerging data suggest that second-generation antipsychotics such as aripiprazole may be effective in the treatment of post-traumatic stress disorder (PTSD). However, few clinical trials have used aripiprazole in PTSD, and data are limited on its use in Veterans with PTSD. The objective of this pilot trial was to investigate the safety and efficacy of aripiprazole in Veterans with PTSD. Ten individuals (five men and five women) meeting the Diagnostic and statistical manual of mental disorders, 4th ed., PTSD criteria participated in this 12-week, open-label, flexibly dosed monotherapy trial. The dose range of aripiprazole was 5-30 mg/day, titrated to tolerability and clinical response. The primary outcome measure was the Clinician-Administered PTSD Scale. Additional outcomes included the Short PTSD Rating Interview, the Treatment Outcome PTSD Scale (Top-8), the Davidson Trauma Scale, the Positive and Negative Syndrome Scale, the Beck Depression Inventory-Fast Screen, and Clinical Global Impressions-Improvement. Eight participants completed the study, and aripiprazole was generally well tolerated and associated with a significant improvement in PTSD symptoms, as measured by the Clinician-Administered PTSD Scale (primary outcome measure) and by the Short PTSD Rating Interview, the Treatment Outcome PTSD Scale, and the Davidson Trauma Scale. An improvement was also observed on all three Positive and Negative Syndrome Scale subscales and the Beck Depression Inventory-Fast Screen, and the average Clinical Global Impressions-Improvement ratings indicated that patients were 'much improved'. These promising initial results merit further investigation in a larger, randomized-controlled trial.