Browsing by Subject "PTSD"
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Item Open Access A PRACTICAL STUDY REGARDING THE THERAPEUTIC ROLE OF NATURE IN THE REHABILITION OF COMBAT-INJURED SERVICEMEMBERS(2009-04-22T17:39:30Z) Bernitt, ThomasThe healing powers of nature have been documented in the past two decades, primarily in the collaboration of health care professionals and architectural/design firms who build hospitals. The relationship between accelerated healing and the patient’s surroundings when nature is consciously made a part of the overall environment of the treatment facility has been impressive. Nowhere is this need more pressing than in the treatment of traumatic combat casualties of returning service members from Afghanistan and Iraq. The irony of the modern age is that the exponential improvement in medical assistance on the battlefield has resulted in a much larger than anticipated population of service members who have survived with amputated limbs and Traumatic Brain Injuries or Post Traumatic Stress Disorders. Thus the military hospitals have been overwhelmed with the need to provide care for these “Wounded Warriors.” Additionally, the revelations at Walter Reed in 2007 underscore the inadequacy of the system to provide a modicum of care to many of these brave young men and women. This Masters Project then attempts to bring the two ideas together to synergistically meld the two concepts of nature as a curative, “eco-therapy,” with the pressing needs of the military hospitals in the treatment of their seriously wounded. Working in collaboration with Naval Medical Center, San Diego, CA and the San Diego National Wildlife Complex of the U.S. Fish and Wildlife Service, a pilot program was initiated in 2008 to determine if using eco-therapy would prove beneficial.Item Open Access Accounting for Posttraumatic Stress Disorder Symptom Severity With Pre- and Posttrauma Measures: A Longitudinal Study of Older Adults.(Clin Psychol Sci, 2016-03) Ogle, CM; Rubin, DC; Siegler, ICUsing data from a longitudinal study of community-dwelling older adults, we analyzed the most extensive set of known correlates of PTSD symptoms obtained from a single sample to examine the measures' independent and combined utility in accounting for PTSD symptom severity. Fifteen measures identified as PTSD risk factors in published meta-analyses and 12 theoretically and empirically supported individual difference and health-related measures were included. Individual difference measures assessed after the trauma, including insecure attachment and factors related to the current trauma memory, such as self-rated severity, event centrality, frequency of involuntary recall, and physical reactions to the memory, accounted for symptom severity better than measures of pre-trauma factors. In an analysis restricted to prospective measures assessed before the trauma, the total variance explained decreased from 56% to 16%. Results support a model of PTSD in which characteristics of the current trauma memory promote the development and maintenance of PTSD symptoms.Item Open Access Adapting culturally appropriate mental health screening tools for use among conflict-affected and other vulnerable adolescents in Nigeria(Global Mental Health, 2019) Kaiser, BN; Ticao, C; Anoje, C; Minto, J; Boglosa, J; Kohrt, BABackgroundThe Boko Haram insurgency has brought turmoil and instability to Nigeria, generating a large number of internally displaced people and adding to the country's 17.5 million orphans and vulnerable children. Recently, steps have been taken to improve the mental healthcare infrastructure in Nigeria, including revamping national policies and initiating training of primary care providers in mental healthcare. In order for these efforts to succeed, they require means for community-based detection and linkage to care. A major gap preventing such efforts is the shortage of culturally appropriate, valid screening tools for identifying emotional and behavioral disorders among adolescents. In particular, studies have not conducted simultaneous validation of screening tools in multiple languages, to support screening and detection efforts in linguistically diverse populations. We aim to culturally adapt screening tools for emotional and behavioral disorders for use among adolescents in Nigeria, in order to facilitate future validation studies.MethodsWe used a rigorous mixed-method process to culturally adapt the Depression Self Rating Scale, Child PTSD Symptom Scale, and Disruptive Behavior Disorders Rating Scale. We employed expert translations, focus group discussions (N = 24), and piloting with cognitive interviewing (N = 24) to achieve semantic, content, technical, and criterion equivalence of screening tool items.ResultsWe identified and adapted items that were conceptually difficult for adolescents to understand, conceptually non-equivalent across languages, considered unacceptable to discuss, or stigmatizing. Findings regarding problematic items largely align with existing literature regarding cross-cultural adaptation.ConclusionsCulturally adapting screening tools represents a vital first step toward improving community case detection.Item Open Access Efficacy and safety of ketamine in the management of anxiety and anxiety spectrum disorders: a review of the literature.(CNS spectrums, 2020-06) Banov, Michael D; Young, Jonathan R; Dunn, Tyler; Szabo, Steven TAnxiety disorders are among the most prevalent psychiatric conditions. Despite many proven pharmacological and non-pharmacological treatments available, high rates of partial response and low rates of long-term remission remain. Ketamine has been receiving increasing attention as an interventional treatment modality in psychiatry, especially among refractory conditions, including major depressive disorder. There is limited yet growing evidence to support the use of ketamine in anxiety disorders. In this review of the literature, we present case reports, case series, and controlled trials demonstrating proof-of-concept for its potential role in the treatment of anxiety and anxiety spectrum disorders. Its unique mechanism of action, rapid onset, and high rate of response have driven its use in clinical practice. Ketamine is generally well tolerated by patients and has a limited side effect profile; however, the effects of long-term use are unknown. While there is a growing body of research and increasing clinical experience to suggest ketamine may have clinical applications in the treatment of refractory anxiety disorders, further research to determine long-term safety and tolerability is indicated.Item Open Access Neural systems for cognitive and emotional processing in posttraumatic stress disorder.(Front Psychol, 2012) Brown, Vanessa M; Morey, Rajendra AIndividuals with posttraumatic stress disorder (PTSD) show altered cognition when trauma-related material is present. PTSD may lead to enhanced processing of trauma-related material, or it may cause impaired processing of trauma-unrelated information. However, other forms of emotional information may also alter cognition in PTSD. In this review, we discuss the behavioral and neural effects of emotion processing on cognition in PTSD, with a focus on neuroimaging results. We propose a model of emotion-cognition interaction based on evidence of two network models of altered brain activation in PTSD. The first is a trauma-disrupted network made up of ventrolateral PFC, dorsal anterior cingulate cortex (ACC), hippocampus, insula, and dorsomedial PFC that are differentially modulated by trauma content relative to emotional trauma-unrelated information. The trauma-disrupted network forms a subnetwork of regions within a larger, widely recognized network organized into ventral and dorsal streams for processing emotional and cognitive information that converge in the medial PFC and cingulate cortex. Models of fear learning, while not a cognitive process in the conventional sense, provide important insights into the maintenance of the core symptom clusters of PTSD such as re-experiencing and hypervigilance. Fear processing takes place within the limbic corticostriatal loop composed of threat-alerting and threat-assessing components. Understanding the disruptions in these two networks, and their effect on individuals with PTSD, will lead to an improved knowledge of the etiopathogenesis of PTSD and potential targets for both psychotherapeutic and pharmacotherapeutic interventions.Item Open Access Physical Activity Counseling Promotes Physical and Psychological Resilience in Older Veterans with Posttraumatic Stress Disorder.(Mental health and physical activity, 2016-10) Hall, Katherine S; Gregg, Jeffrey; Bosworth, Hayden B; Beckham, Jean C; Hoerster, Katherine D; Sloane, Richard; Morey, Miriam CIndividuals with posttraumatic stress disorder (PTSD) have elevated rates of morbidity, and a sedentary lifestyle can cause and aggravate the physical health needs of adults with PTSD. The primary aim of this paper was to explore the impact of physical activity (PA) counseling (vs. usual care) on physical and psychological outcomes among individuals with PTSD. A secondary aim was to compare these arm effects between those with and without PTSD.Methods
Older (>60 years) overweight veterans with impaired glucose tolerance were randomly assigned to an intervention or a usual care control arm. Of the 302 participants who underwent randomization, 67 (22%) had PTSD. Participants in the intervention arm received one in-person activity counseling session followed by regular PA telephone counseling over 12 months. Physical and psychological outcomes were assessed at baseline, 3, and 12 months.Results
Primary Aim (intervention vs. usual care among those with PTSD): PA increased on average from 80 minutes/week to 161 minutes/week among participants in the intervention arm (p=0.01). Large, clinically meaningful improvements in six-minute walk test and psychological health were observed over the course of the intervention (p<0.01). Secondary Aim (PTSD/No PTSD, intervention/usual care): participants with PTSD responded equally well to the intervention compared to participants without PTSD, though we observed significantly greater improvements in vitality and six-minute walk compared to participants without PTSD (p<0.05).Conclusions
Given the epidemic of comorbid psychological illness and lifestyle-related disease among persons with PTSD, our findings support development and implementation of targeted PA interventions in this high-risk population.Item Open Access Prevalence of Violence Exposure and Post Traumatic Stress Disorder (PTSD) Among Adolescents in Udugama, Sri Lanka(2021) Lowitzer, Grace ElizabethBackground: Violence exposure in children can lead to psychological problems and poor health outcomes that can be associated with post-traumatic stress disorders (PTSD). This study aimed to estimate the prevalence of full or partial PTSD associated with exposure to community and domestic violence in school-aged children in Sri Lanka. The study aimed to (1a) estimate the prevalence of community violence and domestic violence among school-aged adolescents in Sri Lanka, (1b) estimate the prevalence of community violence and domestic violence overall and by sex among school-aged adolescents in Udugama, Sri Lanka, (2) estimate the prevalence of partial PTSD and full PTSD among those who experience community and/or domestic violence, (3) and does it vary by age, sex, socioeconomic status, and length of exposure to do violence with exposure to domestic and community violence.Methods: This study was a secondary data analysis that utilized a cross-sectional design, using two questionnaires: (1) Child Exposure to Domestic Violence (CEDV) Scale to measure violence exposure, and (2) The UCLA PTSD Reaction Index for DSM IV, a self-report questionnaire to screen for exposure to traumatic events and assess PTSD symptoms in school-age children and adolescents. 346 school children were selected for the study. Children in grades 10 and 11 were selected with a mean age of 14.9 years (SD = 0.02), with a range of 14 to 16 years old were randomly selected from two secondary schools in Udugama MOH area. The two largest schools were non-randomly selected. Within the two schools, four classes were selected randomly. All children present on the day of data collection were selected for the study. As more than 90% of the children are schooling in Sri Lanka, we believe a school-based screening will obtain a representative sample of adolescents in the community. Logistic regression models were used to explore the relationship between sex, age, socioeconomic status, and length of exposure with domestic and community violence. Log-risk regression models were used to explore the prevalence of community and domestic violence and the relationship between violence exposure and full or partial PTSD symptoms. Univariable logistic models were used to estimate associations between individual characteristics (such as age, sex, socioeconomic status, and length of exposure to violence) and partial or full PTSD. Results: Among the 346 participants, 304 (88%) adolescents reported experiencing some type of violence, whether it was community violence or domestic violence on the CEDV questionnaire. Only those who reported experiencing violence were then asked to take the UCLA PTSD Index. Of these, a total of 203 (68%) met criteria A on the UCLA PTSD index and therefore had experienced at least one traumatic event. Of these a total of 52(26%) did not have PTSD, 53 (26%) had partial PTSD, and 98 (48%) had full PTSD. The results showed that age and sex were not associated with PTSD severity. Sex was not associated with the outcome of partial PTSD (p > 0.682; CI: -0.136, 0.089) and full PTSD (p > 0.682; CI: -0.089, 0.136). Age was not statistically significantly associated with the outcome of partial PTSD (p > 0.924; CI: -0.147, 0.162) and full PTSD (p >0.924; CI: -0.162, 0.147). However, the age range was limited to 14 to 16 years, and further research needs to be done for more definitive conclusions. Duration of violence was the only individual characteristic that was statistically significant in the analysis for two responses 1) two to three years back (OR 5.07 (CI:1.11; 23.21) p = 0.037) and 2) as long as I can remember (OR 11.03 (CI: 1.22; 99.51) p = 0.032). Conclusions: The most significant finding of this study is that of those who experience domestic or community violence, 61.9% will develop PTSD. Additionally, domestic violence 189 (90.8%) was reported more often by adolescents than community violence 20 (9.57%). This study was limited due to the small study size and the narrow range of age, which limits its generalizability to the wider population of Sri Lanka or adolescents in general. Therefore, conclusions about the significance of individual characteristics such as age, sex, socioeconomic status, and duration of violence exposure resulting in partial or full PTSD could not be determined. More studies are necessary to test the hypothesis of whether individual characteristics of adolescents in Sri Lanka is associated with partial or full PTSD.
Item Open Access Psychological and clinical correlates of the Centrality of Event Scale: A systematic review.(Clinical psychology review, 2018-11) Gehrt, Tine B; Berntsen, Dorthe; Hoyle, Rick H; Rubin, David CThe Centrality of Event Scale (CES) was introduced to examine the extent to which a traumatic or stressful event is perceived as central to an individual's identity and life story, and how this relates to Posttraumatic Stress Disorder (PTSD) symptoms. In addition, the CES has been examined in relation to a range of other conditions and dispositions. We present a systematic review of the correlates of the CES. Results from 92 publications resulted in 25 measurement categories in the six theoretical domains of trauma, negative affect and distress, autobiographical memory, personality, positive affect, and gender. The mean weighted correlations of the 25 measurement categories ranged from -.17 to .55, with standard errors from .01 to .02, allowing us to distinguish empirically among effects. Consistent with the theoretical motivation for the CES and predictions predating the review, the CES correlated positively with a range of measures, correlating most highly with measures related to trauma, PTSD, grief, and autobiographical memory. The findings show that the CES probes aspects of autobiographical memory of broad relevance to clinical disorders, and with specific implications for theories of PTSD.Item Open Access Shared genetic etiology underlying late-onset Alzheimer's disease and posttraumatic stress syndrome.(Alzheimers Dement, 2020-06-26) Lutz, Michael W; Luo, Sheng; Williamson, Douglas E; Chiba-Falek, OrnitINTRODUCTION: Late-onset Alzheimer's disease (LOAD) manifests comorbid neuropsychiatric symptoms and posttraumatic stress disorder (PTSD) is associated with an increased risk for dementia in late life, suggesting the two disorders may share genetic etiologies. METHODS: We performed genetic pleiotropy analysis using LOAD and PTSD genome-wide association study (GWAS) datasets from white and African-American populations, followed by functional-genomic analyses. RESULTS: We found an enrichment for LOAD across increasingly stringent levels of significance with the PTSD GWAS association (LOAD|PTSD) in the discovery and replication cohorts and a modest enrichment for the reverse conditional association (PTSD|LOAD). LOAD|PTSD association analysis identified and replicated the MS4A genes region. These genes showed similar expression pattern in brain regions affected in LOAD, and across-brain-tissue analysis identified a significant association for MS4A6A. The African-American samples showed moderate enrichment; however, no false discovery rate-significant associations. DISCUSSION: We demonstrated common genetic signatures for LOAD and PTSD and suggested immune response as a common pathway for these diseases.Item Open Access The Influence of Elective Surgery on Health in Veterans with Chronic Posttraumatic Stress Disorder(2012) Wofford, Kenneth ArthurPosttraumatic stress disorder (PTSD) is common, chronic, and associated with greater risk of postoperative mortality in veterans. Therefore, the purpose of this dissertation was to determine if elective outpatient surgery had a persistent and deleterious effect on the physical or mental health of veterans, and also to explore factors that contributed to postoperative health change in this population. A longitudinal, mixed method, quasi-experimental, nonequivalent control group study was conducted. Physical and mental health, depressive symptom severity, posttraumatic symptom severity, and pain severity were measured in 29 veterans with PTSD before undergoing outpatient elective surgery, one week after surgery, one month after surgery, and three months after surgery. For comparison, parallel data were collected from a control group of 31 veterans with PTSD at enrollment, one week after enrollment, one month after enrollment, and three months after enrollment. Subjects who displayed clinically significant or distressing changes in health status after surgery were interviewed to identify factors associated with postoperative health change. Subjects in the surgical group reported significant declines in subjective physical and mental health at one week, but not one or three months after outpatient elective surgery. Depressive symptoms severity and posttraumatic symptom severity were unchanged after surgery by surgery. Subjects reported that this physical and mental distress was driven by acute postoperative pain, but that underlying chronic pain remained influential throughout their postoperative course.
Item Open Access The Therapeutic Effects of Completing Autobiographical Memory Questionnaires for Positive and Negative Events: An Experimental Approach(COGNITIVE THERAPY AND RESEARCH, 2011-12) Boals, A; Hathaway, LM; Rubin, DCItem Open Access "Thinking too much": A systematic review of a common idiom of distress.(Soc Sci Med, 2015-12) Kaiser, Bonnie N; Haroz, Emily E; Kohrt, Brandon A; Bolton, Paul A; Bass, Judith K; Hinton, Devon EIdioms of distress communicate suffering via reference to shared ethnopsychologies, and better understanding of idioms of distress can contribute to effective clinical and public health communication. This systematic review is a qualitative synthesis of "thinking too much" idioms globally, to determine their applicability and variability across cultures. We searched eight databases and retained publications if they included empirical quantitative, qualitative, or mixed-methods research regarding a "thinking too much" idiom and were in English. In total, 138 publications from 1979 to 2014 met inclusion criteria. We examined the descriptive epidemiology, phenomenology, etiology, and course of "thinking too much" idioms and compared them to psychiatric constructs. "Thinking too much" idioms typically reference ruminative, intrusive, and anxious thoughts and result in a range of perceived complications, physical and mental illnesses, or even death. These idioms appear to have variable overlap with common psychiatric constructs, including depression, anxiety, and PTSD. However, "thinking too much" idioms reflect aspects of experience, distress, and social positioning not captured by psychiatric diagnoses and often show wide within-cultural variation, in addition to between-cultural differences. Taken together, these findings suggest that "thinking too much" should not be interpreted as a gloss for psychiatric disorder nor assumed to be a unitary symptom or syndrome within a culture. We suggest five key ways in which engagement with "thinking too much" idioms can improve global mental health research and interventions: it (1) incorporates a key idiom of distress into measurement and screening to improve validity of efforts at identifying those in need of services and tracking treatment outcomes; (2) facilitates exploration of ethnopsychology in order to bolster cultural appropriateness of interventions; (3) strengthens public health communication to encourage engagement in treatment; (4) reduces stigma by enhancing understanding, promoting treatment-seeking, and avoiding unintentionally contributing to stigmatization; and (5) identifies a key locally salient treatment target.Item Open Access Voxelwise Mapping of Neuronal Structural Connectivity in Adolescents(2012) Smith, Alex KennethLongitudinal studies have demonstrated that the white matter in adolescents is still developing well into young adulthood. However, these studies of the corpus callosum were anatomical and DTI studies involving manual region of interest measures, which have not proven to be as in depth of an analysis as the one proposed in this study. In addition, there have been relatively few studies that have looked at the effects of childhood maltreatment on brain structure.
The methodology presented here develops a technique that will perform an extensive analysis between a well characterized group of healthy adolescents with no trauma history and a group of maltreated adolescents with PTSD symptoms. It employs a voxelwise analysis to determine significant groups of voxels using cluster enhancement and permutation correction algorithms. It then uses these significant clusters to perform an in-depth ROI analysis to determine the correlations present in these clusters with several physical and neuropsychological measures. This technique has produced evidence that validates earlier studies showing that better executive function and task ability indicate stronger structural organization within the white matter of the brain. In addition, it has provided substantial evidence that maltreated children complete myelination within the corpus callosum of the brain earlier than healthy children, indicating that chronic stress during childhood may be associated with stress-induced premature ageing.