BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive...BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.展开更多
BACKGROUND Studies have demonstrated that patients who have experienced acute coronary syndrome(ACS)have an increased risk of developing posttraumatic stress disorder(PTSD)and experiencing worse survival outcomes than...BACKGROUND Studies have demonstrated that patients who have experienced acute coronary syndrome(ACS)have an increased risk of developing posttraumatic stress disorder(PTSD)and experiencing worse survival outcomes than those who do not develop PTSD.Nevertheless,the prevalence rates of PTSD following ACS vary widely across studies,and it is noteworthy that in most cases,the diagnosis of PTSD was based on self-report symptom questionnaires,rather than being established by psychiatrists.Additionally,the individual characteristics of patients who develop PTSD after ACS can differ widely,making it difficult to identify any consistent patterns or predictors of the disorder.AIM To investigate the prevalence of PTSD among a large sample of patients undergoing cardiac rehabilitation(CR)after ACS,as well as their characteristics in comparison to a control group.METHODS The participants of this study are patients who have experienced ACS with or without undergoing percutaneous coronary intervention and are enrolled in a 3-wk CR program at the largest CR center in Croatia,the Special Hospital for Medical Rehabilitation Krapinske Toplice.Patient recruitment for the study took place over the course of one year,from January 1,2022,to December 31,2022,with a total of 504 participants.The expected average follow-up period for patients included in the study is about 18 mo,and currently ongoing.Using self-assessment questionnaire for PTSD criteria and clinical psychiatric interview,a group of patients with a PTSD diagnosis was identified.From the participants who do not have a PTSD diagnosis,patients who would match those with a PTSD diagnosis in terms of relevant clinical and medical stratification variables and during the same rehabilitation period were selected to enable comparability of the two groups.RESULTS A total of 507 patients who were enrolled in the CR program were approached to participate in the study.Three patients declined to participate in the study.The screening PTSD Checklist-Civilian Version questionnaire was completed by 504 patients.Out of the total sample of 504 patients,74.2%were men(n=374)and 25.8%were women(n=130).The mean age of all participants was 56.7 years(55.8 for men and 59.1 for women).Among the 504 participants who completed the screening questionnaire,80 met the cutoff criteria for the PTSD and qualified for further evaluation(15.9%).All 80 patients agreed to a psychiatric interview.Among them,51 patients(10.1%)were diagnosed with clinical PTSD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders criteria.Among the variables analyzed,there was a noticeable difference in the percentage of theoretical maximum achieved on exercise testing between the PTSD and non-PTSD groups.Non-PTSD group achieved a significantly higher percentage of their maximum compared to the PTSD group(P=0.035).CONCLUSION The preliminary results of the study indicate that a significant proportion of patients with PTSD induced by ACS are not receiving adequate treatment.Furthermore,the data suggest that these patients may exhibit reduced physical activity levels,which could be one of the possible underlying mechanisms in observed poor cardiovascular outcomes in this population.Identifying cardiac biomarkers is crucial for identifying patients at risk of developing PTSD and may derive benefits from personalized interventions based on the principles of precision medicine in multidisciplinary CR programs.展开更多
There are various types of traumatic stimuli,such as catastrophic events like wars,natural calamities like earthquakes,and personal trauma from physical and psychological neglect or abuse and sexual abuse.Traumatic ev...There are various types of traumatic stimuli,such as catastrophic events like wars,natural calamities like earthquakes,and personal trauma from physical and psychological neglect or abuse and sexual abuse.Traumatic events can be divided into type I and type II trauma,and their impacts on individuals depend not only on the severity and duration of the traumas but also on individuals’self-evaluation of the traumatic events.Individual stress reactions to trauma include posttraumatic stress disorder(PTSD),complex PTSD and trauma-related depression.Trauma-related depression is a reactive depression with unclear pathology,and depression occurring due to trauma in the childhood has gained increasing attention,because it has persisted for a long time and does not respond to conventional antidepressants but shows good or partial response to psychotherapy,which is similar to the pattern observed for PTSD.Because trauma-related depression is associated with high risk of suicide and is chronic with a propensity to relapse,it is necessary to explore its pathogenesis and therapeutic strategy.展开更多
Because posttraumatic stress disorder(PTSD) is a highly debilitating condition, prevention is an important research topic. This article reviews possible prevention approaches that involve the administration of drugs b...Because posttraumatic stress disorder(PTSD) is a highly debilitating condition, prevention is an important research topic. This article reviews possible prevention approaches that involve the administration of drugs before the traumatic event takes place. The considered approaches include drugs that address the sympathetic nervous system, drugs interfere with the hypothalamic-pituitary-adrenal(HPA) axis, narcotics and other psychoactive drugs, as well as modulators of protein synthesis. Furthermore, some thoughts on potential ethical implications of the use of drugs for the primary prevention of PTDS are presented. While there are many barriers to overcome in this field of study, this paper concludes with a call for additional research, as there are currently no approaches that are well-suited for regular daily use.展开更多
BACKGROUND The capacity of posttraumatic stress disorder(PTSD)to occur with delayed onset has been documented in several systematic reviews and meta-analyses.Neurobiological models of PTSD may provide insight into the...BACKGROUND The capacity of posttraumatic stress disorder(PTSD)to occur with delayed onset has been documented in several systematic reviews and meta-analyses.Neurobiological models of PTSD may provide insight into the mechanisms underlying the progressive increase in PTSD symptoms over time as well as into occasional occurrences of long-delayed PTSD with few prodromal symptoms.AIM To obtain an overview of key concepts explaining and types of evidence supporting neurobiological underpinnings of delayed PTSD.METHODS A scoping review of studies reporting neurobiological findings relevant to delayed PTSD was performed,which included 38 studies in the qualitative synthesis.RESULTS Neurobiological mechanisms underlying PTSD symptoms,onset,and course involve several interconnected systems.Neural mechanisms involve the neurocircuitry of fear,comprising several structures,such as the hippocampus,amygdala,and prefrontal cortex,that are amenable to time-dependent increases in activity through sensitization and kindling.Neural network models explain generalization of the fear response.Neuroendocrine mechanisms consist of autonomic nervous system and hypothalamic-pituitary-adrenocortical axis responses,both of which may be involved in sensitization to stress.Neuroinflammatory mechanisms are characterized by immune activation,which is sometimes due to the effects of traumatic brain injury.Finally,neurobehavioral/contextual mechanisms involve the effects of intervening stressors and mental and physical disorder comorbidities,and these may be particularly relevant in cases of long-delayed PTSD.CONCLUSION Thus,delayed PTSD may result from multiple underlying neurobiological mechanisms that may influence the likelihood of developing prodromal symptoms preceding the onset of full-blown PTSD.展开更多
BACKGROUND The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder(PTSD). An association has been found between PTSD and substance abuse. PTSD is a s...BACKGROUND The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder(PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder(OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.AIM To perform a systematic review on the association between PTSD, chronic noncancer pain(CNCP), and opioid intake(i.e., prescription, misuse, and abuse).METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention,Comparator, and Outcomes(PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases:Pub Med, MEDLINE, Psyc INFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling,confounding variables, and the statistical analysis.RESULTS A total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men(81.6%). The most common chronic pain condition was musculoskeletal pain:back pain(47.14% across studies;range: 16%-60.6%), arthritis and joint pain(31.1%;range: 18%-67.5%), and neck pain(28.7%;range: 3.6%-63%). In total,42.4% of the participants across studies had a diagnosis of PTSD(range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.CONCLUSION Opioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.展开更多
BACKGROUND Studies have indicated that childhood exposure to domestic violence is a common factor in posttraumatic growth(PTG)and posttraumatic stress disorder(PTSD),but it is unclear whether PTG and PTSD share a comm...BACKGROUND Studies have indicated that childhood exposure to domestic violence is a common factor in posttraumatic growth(PTG)and posttraumatic stress disorder(PTSD),but it is unclear whether PTG and PTSD share a common/different underlying mechanism.AIM To explore the common/different underlying mechanism of PTG and PTSD.METHODS Between February 12 and 17,2020,a nationwide cross-sectional online survey was conducted in China among 2038 university students,and a self-administered questionnaire was used for the data collection.The data included demographic characteristics,such as age,gender,and subjective social economic status,and childhood exposure to domestic violence scale that was selected from the Chinese version of revised Adverse Childhood Experiences Question,Self-compassion Scale,Connor–Davidson Resilience Scale,Posttraumatic Growth Inventory,and the Abbreviated PTSD Checklist-Civilian version.A structural equation model was used to test the hypotheses.RESULTS Exposure to domestic violence was significantly associated with PTG and PTSD via a 1-step indirect path of self-compassion(PTG:β=-0.023,95%CI:-0.44 to-0.007;PTSD:β=0.008,95%CI:0.002,0.014)and via a 2-step indirect path from self-compassion to resilience(PTG:β=-0.008,95%CI:-0.018 to-0.002;PTSD:β=0.013,95%CI:0.004-0.024).However,resilience did not mediate the relationship between exposure to domestic violence and PTG and PTSD.CONCLUSION PTG and PTSD are common results of childhood exposure to domestic violence,which may be influenced by self-compassion and resilience.展开更多
BACKGROUND The case report supports the recent findings regarding the correlation of posttraumatic stress disorder(PTSD)and schizophrenia.The report accomplished the following objectives:(1)To present a case of an adu...BACKGROUND The case report supports the recent findings regarding the correlation of posttraumatic stress disorder(PTSD)and schizophrenia.The report accomplished the following objectives:(1)To present a case of an adult female manifesting with somatic type of delusion(foul body odor)and history of PTSD;(2)To discuss the biopsychosocial factors,psychodynamics and management of the patient;and(3)To differentiate delusional disorder from schizophrenia according to recent studies.Schizophrenia and delusional disorder have certain defining features that separate the two.However,at times it may be difficult to actually classify one from the other.A psychiatrist must be able to carefully examine and assess the history of the patient,helping them share early life experiences of past traumatic events.The early past traumatic experiences and life events greatly influence the predisposition of a patient to develop schizophrenia.However,people with schizophrenia were known to underreport their trauma experience.CASE SUMMARY This is a case of a young adult female diagnosed with delusional disorder with a history of PTSD and associated depression.The patient manifested with somatic type of delusion with a fixed false belief that a foul body odor was coming from her underarms.CONCLUSION Developing a therapeutic alliance is vital in achieving therapy goals through empathy,support and warmth between the patient and physician.History of PTSD predisposes patients with schizophrenia to develop depressive disorders as a comorbidity.展开更多
Introduction: On the 5<sup>th</sup> of June 2022, an incident of a mass attack following multiple gunshots and explosions occurred in a community in Ondo State Nigeria. This study aims to assess the mental...Introduction: On the 5<sup>th</sup> of June 2022, an incident of a mass attack following multiple gunshots and explosions occurred in a community in Ondo State Nigeria. This study aims to assess the mental health status of victims of the mass attack to guide further interventions among them. Methods: A cross-sectional study was conducted among victims of a mass attack in Owo community, Ondo State. A total of 209 affected victims were interviewed on socio-demographic characteristics, symptoms of anxiety (AD) and post-traumatic stress disorder (PTSD), threat experienced, and mental health support received. A 7-item Generalized Anxiety Disorder (GAD-7) and 9-item Post Traumatic Stress Disorder (PTSD) scale were used to assess the mental health status of the victims. A point was assigned to respondents who reported the symptoms of GAD, with a maximum score of 7 attained. For GAD, scores were categorized as follows: 1 - 2 as mild, 2 - 3 as minimal, 4 - 5 as moderate and 6 - 7 as severe. The PTSD symptoms were rated using a 5-point Likert scale response, and assigned the following points;4 = extremely, 3 = quite a bit, 2 = moderate, 1 = a little bit and 0 = not at all. From a maximum score of 36, participants with scores 18 and above were categorized as those with provisional PTSD. The independent samples t-test and correlational analysis were used to determine the association between PTSD score and other independent variables, with an alpha level of significance set at 0.05. Results: Generally, 38 (18.2%) of the respondents had severe AD. About half (89;42.6%) were categorized as those with provisional PTSD. The mean level of both AD (3.40 ± 2.26) and PTSD (16.51 ± 7.63) score is higher among those who were married compared to those not married (anxiety disorder;2.52 ± 2.20, P = 0.005 and PTSD;13.20 ± 8.86, P = 0.004). Respondents who have been counseled by a healthcare worker had a higher mean level (15.89 ± 7.58) of provisional PTSD compared to those not counseled by a healthcare worker (13.56 ± 9.22, P = 0.046). The level of PTSD score increased with a higher age group (r = 0.21, P = 0.003). Conclusions: The results show that the mass attack had psychological consequences among a high proportion of the victims, particularly, those married and in the older age groups. This suggests the need for continuous supportive counseling targeting these affected groups, and considering other factors moderating the effectiveness of counseling among them in future interventions.展开更多
Mental health symptoms secondary to trauma exposure and substance use disorders(SUDs)co-occur frequently in both clinical and community samples.The possibility of a shared aetiology remains an important question in tr...Mental health symptoms secondary to trauma exposure and substance use disorders(SUDs)co-occur frequently in both clinical and community samples.The possibility of a shared aetiology remains an important question in translational neuroscience.Advancements in genetics,basic science,and neuroimaging have led to an improved understanding of the neural basis of these disorders,their frequent comorbidity and high rates of relapse remain a clinical challenge.This project aimed to conduct a review of the field’s current understanding regarding the neural circuitry underlying posttraumatic stress disorder and SUD.A comprehensive review was conducted of available published literature regarding the shared neurobiology of these disorders,and is summarized in detail,including evidence from both animal and clinical studies.Upon summarizing the relevant literature,this review puts forth a hypothesis related to their shared neurobiology within the context of fear processing and reward cues.It provides an overview of brain reward circuitry and its relation to the neurobiology,symptomology,and phenomenology of trauma and substance use.This review provides clinical insights and implications of the proposed theory,including the potential development of novel pharmacological and therapeutic treatments to address this shared neurobiology.Limitations and extensions of this theory are discussed to provide future directions and insights for this shared phenomena.展开更多
Background:Posttraumatic stress disorder(PTSD)has been associated with volumetric and white matter microstructural changes among general and veteran populations.However,regions implicated have greatly varied and often...Background:Posttraumatic stress disorder(PTSD)has been associated with volumetric and white matter microstructural changes among general and veteran populations.However,regions implicated have greatly varied and often conflict between studies,potentially due to confounding comorbidities within samples.This study compared grey matter volume and white matter microstructure among Australian combat veterans with and without a lifetime diagnosis of PTSD,in a homogenous sample assessed for known confounding comorbidities.Methods:Sixty-eight male trauma-exposed veterans(16 PTSD-diagnosed;mean age 69 years)completed a battery of psychometric assessments and underwent magnetic resonance and diffusion tensor imaging.Analyses included tractbased spatial statistics,voxel-wise analyses,diffusion connectome-based group-wise analysis,and volumetric analysis.Results:Significantly smaller grey matter volumes were observed in the left prefrontal cortex(P=0.026),bilateral middle frontal gyrus(P=0.021),and left anterior insula(P=0.048)in the PTSD group compared to controls.Significant negative correlations were found between PTSD symptom severity and fractional anisotropy values in the left corticospinal tract(R^(2)=0.34,P=0.024)and left inferior cerebellar peduncle(R^(2)=0.62,P=0.016).No connectome-based differences in white matter properties were observed.Conclusions:Findings from this study reinforce reports of white matter alterations,as indicated by reduced fractional anisotropy values,in relation to PTSD symptom severity,as well as patterns of reduced volume in the prefrontal cortex.These results contribute to the developing profile of neuroanatomical differences uniquely attributable to veterans who suffer from chronic PTSD.展开更多
In accordance with the guidelines established by prominent European and global cardiology associations,comprehensive cardiac rehabilitation(CR)stands as an officially endorsed and highly recommended therapeutic approa...In accordance with the guidelines established by prominent European and global cardiology associations,comprehensive cardiac rehabilitation(CR)stands as an officially endorsed and highly recommended therapeutic approach(class I recommendations;level of evidence A)for a diverse spectrum of cardiac patients.Nevertheless,it is a cause for concern to observe that fewer than 50%of eligible patients are being effectively referred for CR,whether in an outpatient or in-patient setting.Concurrently,studies reveal that a substantial proportion of individuals with atherosclerotic cardiovascular disease maintain unhealthy lifestyles and exhibit suboptimal management of modifiable cardiovascular risk factors,including hypertension,lipid levels,and diabetes.Beyond the conven-tional patient profile encompassing those recovering from acute coronary syndrome with or without percutaneous coronary intervention,as well as patients who have undergone coronary or valvular surgery,contemporary CR now emphasizes specialized subgroups of patients.These include frail elderly patients,the female population with its unique considerations,individuals burdened by multiple cardiovascular comorbidities,those who have developed psychological consequences due to a cardiac illness and particularly those grappling with chronic heart failure.This editorial seeks to offer a state-of-the-art assessment of the significance and role of comprehensive CR within modern cardiology.展开更多
AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with I...AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, Pub Med and Psyc INFO, we searched full manuscripts in English and published until September 1, 2014. RESULTS We found sixteen studies exploring psychological issues in patients with IE(six studies) and in TAD(ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE(four papers) and in TAD(eight papers). Depression and anxiety were analyzed in TAD only(five papers). Post-traumatic stress disorder was assessed in IE(one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ. CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.展开更多
Like soldiers,frontline medical staff provide a first line of defense and have played a critical role in responses to the outbreak of coronavirus disease-2019 in December 2019.It is important to acknowledge the consid...Like soldiers,frontline medical staff provide a first line of defense and have played a critical role in responses to the outbreak of coronavirus disease-2019 in December 2019.It is important to acknowledge the considerable pressure placed on frontline medical staff in the face of a new type of coronavirus that is highly infectious and for which no specific treatment is available.Here,we review the various kinds of psychological problems afflicting frontline medical staff who are combatting the severe acute respiratory syndrome epidemic.These include anxiety,insomnia,depression,interpersonal difficulties,and post-traumatic stress disorder syndrome.We further present a summary of countermeasures for alleviating these problems based on our findings.These countermeasures include ensuring the provision of adequate protective gear for frontline medical staff,developing timely and clear guidelines,strengthening social support,and providing clear criteria and additional training,focusing on the choice of frontline medical staff.An understanding of the psychological impacts of an epidemic situation and of relevant countermeasures will contribute to reducing the psychological pressures on frontline medical staff.Consequently,they will be able to cope better with outbreaks of infectious diseases in the future,to reduce the psychological pressure of the front-line medical staff,and to improve the treatment level.展开更多
Rates of childhood trauma exposure are extremely high,with approximately 70%of children and adolescents experiencing at least one traumatic event.Among the most common non-specific consequences of stress and trauma ar...Rates of childhood trauma exposure are extremely high,with approximately 70%of children and adolescents experiencing at least one traumatic event.Among the most common non-specific consequences of stress and trauma are disruptions of sleep.Sleep problems,such as shorter sleep duration,difficulty falling asleep,frequent awakenings,nightmares,sleepless nights,and early-morning wakefulness appear to have a higher prevalence among children and adolescents following traumatic events.This review will illustrate the role of sleep problems in traumatized children and adolescents,and emphasize the need to consider a wide range of etiological mechanisms for these symptoms.However,the relationship of trauma exposure to sleep problems among children and adolescents needs further investigation in future research.Moreover,in view of the adverse consequences of long-term disrupted sleep on mental health outcomes following trauma,the need to effectively address sleep disturbances in traumatized children and adolescents is crucial.展开更多
Background:Evidence-based treatments for service-related health conditions such as posttraumatic stress disorder(PTSD),depression,and traumatic brain injury(TBI)are not effective for all veterans.Equine-assisted inter...Background:Evidence-based treatments for service-related health conditions such as posttraumatic stress disorder(PTSD),depression,and traumatic brain injury(TBI)are not effective for all veterans.Equine-assisted interventions are emerging as an additional treatment modality,but little is known regarding the safe and effective delivery of these interventions.This study aimed to describe the following features of the body of literature concerning equineassisted interventions among veterans:1)veterans who have participated in equine-assisted interventions;2)specific characteristics of equine-assisted interventions in veterans;and 3)the specific characteristics of research on equineassisted interventions in veterans.Methods:We conducted a systematic mapping review of peer-reviewed literature reporting on equine-assisted interventions among veterans between 1980 and 2017.Searches of nine databases yielded 3336 unique records,six of which met the inclusion criteria and were reviewed.Data relevant to the study aims were extracted and analyzed.Results:Equine-assisted interventions among veterans disproportionately targeted psychosocial outcomes and yielded promising results.The detailed methods of EAI varied in the reported studies,ranging from communicating with the horse to mounted exercises.There was also great diversity in outcome measurement.The state of theoretical development regarding the mechanisms by which equine-assisted interventions benefit the veteran population is currently underdeveloped.Studies provided insufficient detail with respect to the description of the intervention,reasons for attrition,and the dose-response relationship.Conclusions:Scientific development of equine-assisted interventions targeting psychosocial outcomes among veterans is warranted to establish their efficacy.Targeted outcomes should be expanded,including outcomes more closely aligned with the nature of polytraumatic injuries.Future research must also emphasize the theoretical development of equine-assisted interventions for veterans and thoroughly describe the participants,components of the intervention,factors contributing to attrition,and optimal dose-response relationships.展开更多
Background: Selective serotonergic reuptake inhibitors(SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder(PTSD), but must be given over extended period of time before the on...Background: Selective serotonergic reuptake inhibitors(SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder(PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury(m TBI) is problematic since SSRIs could exacerbate post-concussion syndrome(PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy.Methods: We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of m TBI.Discussion: We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full-scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans.Trial registration: NCT04280965.展开更多
The therapeutic termination of pregnancy(TToP)is an induced abortion following a diagnosis of medical necessity.TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability.This...The therapeutic termination of pregnancy(TToP)is an induced abortion following a diagnosis of medical necessity.TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability.This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother.Sociocultural and economic determinants could influence the desire for children and family planning in couples,as well as the use of effective contraception and the choice to perform an induced abortion.Also,pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP.Furthermore,the TToP is a reproductive event with an important traumatic burden,but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples.The aim of this review is to evaluate what demographic,reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women.Also,we will examine both positive and negative consequences of this procedure on women’s mental health,underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.展开更多
Posttraumatic stress disorder(PTSD)has an important and complex relationship with traumatic brain injury(TBI).The prevalence of comorbid PTSD and TBI is increasing in both military and civilian populations.Moreover,TB...Posttraumatic stress disorder(PTSD)has an important and complex relationship with traumatic brain injury(TBI).The prevalence of comorbid PTSD and TBI is increasing in both military and civilian populations.Moreover,TBI has emerged as an important risk factor for the development and manifestation of PTSD.Meanwhile,PTSD is also a significant mediator of the negative sequelae of TBI.PTSD and TBI,especially mild TBI(mTBI),have overlapping neural substrates and neuroanatomical functional features.Given that comorbid PTSD and TBI remain a challenge for forensic psychiatry evaluation,we review the relationship between the two disorders and discuss special considerations during evaluation of the condition.展开更多
Background: Traumatic brain injury (TBI) remains a cause of lifelong disability, death, and suicide worldwide. TBI-induced near-death experience (NDE) could increase suicide risks. Objective: We investigated TBI coupl...Background: Traumatic brain injury (TBI) remains a cause of lifelong disability, death, and suicide worldwide. TBI-induced near-death experience (NDE) could increase suicide risks. Objective: We investigated TBI coupled with NDE and posttraumatic stress disorder (PTSD) as a possible indicator of suicide. Methods: A 17-year-old male who sustained an acute severe TBI in a traffic collision, was comatose 14 days, had an NDE awakening from the coma, and, years after rehabilitation, suffered PTSD, clinical depression, and survived a suicide attempt. This personal experience of a TBI-induced NDE and lingering PTSD was acquired directly from the patient by interview. We discuss his case while considering relevant literature. Results: Longitudinal data from 1961 to 2021 generated from the PubMed interface revealed 4056 TBI patients committed suicide. NDE was only reported in one of those cases and, although not a suicide, in the personal experience. Neuropsychological assessment at long-term follow-ups revealed few TBI patients exhibited normal mental/physical functions compared to the general population. Unfavorable GOS scores were risk predictors for neuropsychological/physical impairments later in life, with outcomes of depression, PTSD, poor QOL, and/or suicide. Conclusions: For TBI-NDE survivors, including those with PTSD, long-term periodic neuropsychological follow-ups and psychosocial support may help decrease suicide risks.展开更多
基金Science and Technology Development Plan Project of Suzhou(SKJYD2021035)Science and Technology Development Plan Project of Suzhou(SKJYD2022078)The Key Project Research Fund of the Second Affiliated Hospital of Wannan Medical College(YK2023Z04)。
文摘BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.
文摘BACKGROUND Studies have demonstrated that patients who have experienced acute coronary syndrome(ACS)have an increased risk of developing posttraumatic stress disorder(PTSD)and experiencing worse survival outcomes than those who do not develop PTSD.Nevertheless,the prevalence rates of PTSD following ACS vary widely across studies,and it is noteworthy that in most cases,the diagnosis of PTSD was based on self-report symptom questionnaires,rather than being established by psychiatrists.Additionally,the individual characteristics of patients who develop PTSD after ACS can differ widely,making it difficult to identify any consistent patterns or predictors of the disorder.AIM To investigate the prevalence of PTSD among a large sample of patients undergoing cardiac rehabilitation(CR)after ACS,as well as their characteristics in comparison to a control group.METHODS The participants of this study are patients who have experienced ACS with or without undergoing percutaneous coronary intervention and are enrolled in a 3-wk CR program at the largest CR center in Croatia,the Special Hospital for Medical Rehabilitation Krapinske Toplice.Patient recruitment for the study took place over the course of one year,from January 1,2022,to December 31,2022,with a total of 504 participants.The expected average follow-up period for patients included in the study is about 18 mo,and currently ongoing.Using self-assessment questionnaire for PTSD criteria and clinical psychiatric interview,a group of patients with a PTSD diagnosis was identified.From the participants who do not have a PTSD diagnosis,patients who would match those with a PTSD diagnosis in terms of relevant clinical and medical stratification variables and during the same rehabilitation period were selected to enable comparability of the two groups.RESULTS A total of 507 patients who were enrolled in the CR program were approached to participate in the study.Three patients declined to participate in the study.The screening PTSD Checklist-Civilian Version questionnaire was completed by 504 patients.Out of the total sample of 504 patients,74.2%were men(n=374)and 25.8%were women(n=130).The mean age of all participants was 56.7 years(55.8 for men and 59.1 for women).Among the 504 participants who completed the screening questionnaire,80 met the cutoff criteria for the PTSD and qualified for further evaluation(15.9%).All 80 patients agreed to a psychiatric interview.Among them,51 patients(10.1%)were diagnosed with clinical PTSD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders criteria.Among the variables analyzed,there was a noticeable difference in the percentage of theoretical maximum achieved on exercise testing between the PTSD and non-PTSD groups.Non-PTSD group achieved a significantly higher percentage of their maximum compared to the PTSD group(P=0.035).CONCLUSION The preliminary results of the study indicate that a significant proportion of patients with PTSD induced by ACS are not receiving adequate treatment.Furthermore,the data suggest that these patients may exhibit reduced physical activity levels,which could be one of the possible underlying mechanisms in observed poor cardiovascular outcomes in this population.Identifying cardiac biomarkers is crucial for identifying patients at risk of developing PTSD and may derive benefits from personalized interventions based on the principles of precision medicine in multidisciplinary CR programs.
基金Supported by the Science and Technology Project of Zhejiang Provincial,No.GF22H093655Nonprofit Applied Research Project of Huzhou Science and Technology Bureau,2021GYB16.
文摘There are various types of traumatic stimuli,such as catastrophic events like wars,natural calamities like earthquakes,and personal trauma from physical and psychological neglect or abuse and sexual abuse.Traumatic events can be divided into type I and type II trauma,and their impacts on individuals depend not only on the severity and duration of the traumas but also on individuals’self-evaluation of the traumatic events.Individual stress reactions to trauma include posttraumatic stress disorder(PTSD),complex PTSD and trauma-related depression.Trauma-related depression is a reactive depression with unclear pathology,and depression occurring due to trauma in the childhood has gained increasing attention,because it has persisted for a long time and does not respond to conventional antidepressants but shows good or partial response to psychotherapy,which is similar to the pattern observed for PTSD.Because trauma-related depression is associated with high risk of suicide and is chronic with a propensity to relapse,it is necessary to explore its pathogenesis and therapeutic strategy.
文摘Because posttraumatic stress disorder(PTSD) is a highly debilitating condition, prevention is an important research topic. This article reviews possible prevention approaches that involve the administration of drugs before the traumatic event takes place. The considered approaches include drugs that address the sympathetic nervous system, drugs interfere with the hypothalamic-pituitary-adrenal(HPA) axis, narcotics and other psychoactive drugs, as well as modulators of protein synthesis. Furthermore, some thoughts on potential ethical implications of the use of drugs for the primary prevention of PTDS are presented. While there are many barriers to overcome in this field of study, this paper concludes with a call for additional research, as there are currently no approaches that are well-suited for regular daily use.
基金Supported by the Danish Working Environment Research Fund from Arbejdsmilj?forskningsfonden(to Bonde JP)。
文摘BACKGROUND The capacity of posttraumatic stress disorder(PTSD)to occur with delayed onset has been documented in several systematic reviews and meta-analyses.Neurobiological models of PTSD may provide insight into the mechanisms underlying the progressive increase in PTSD symptoms over time as well as into occasional occurrences of long-delayed PTSD with few prodromal symptoms.AIM To obtain an overview of key concepts explaining and types of evidence supporting neurobiological underpinnings of delayed PTSD.METHODS A scoping review of studies reporting neurobiological findings relevant to delayed PTSD was performed,which included 38 studies in the qualitative synthesis.RESULTS Neurobiological mechanisms underlying PTSD symptoms,onset,and course involve several interconnected systems.Neural mechanisms involve the neurocircuitry of fear,comprising several structures,such as the hippocampus,amygdala,and prefrontal cortex,that are amenable to time-dependent increases in activity through sensitization and kindling.Neural network models explain generalization of the fear response.Neuroendocrine mechanisms consist of autonomic nervous system and hypothalamic-pituitary-adrenocortical axis responses,both of which may be involved in sensitization to stress.Neuroinflammatory mechanisms are characterized by immune activation,which is sometimes due to the effects of traumatic brain injury.Finally,neurobehavioral/contextual mechanisms involve the effects of intervening stressors and mental and physical disorder comorbidities,and these may be particularly relevant in cases of long-delayed PTSD.CONCLUSION Thus,delayed PTSD may result from multiple underlying neurobiological mechanisms that may influence the likelihood of developing prodromal symptoms preceding the onset of full-blown PTSD.
文摘BACKGROUND The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder(PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder(OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.AIM To perform a systematic review on the association between PTSD, chronic noncancer pain(CNCP), and opioid intake(i.e., prescription, misuse, and abuse).METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention,Comparator, and Outcomes(PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases:Pub Med, MEDLINE, Psyc INFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling,confounding variables, and the statistical analysis.RESULTS A total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men(81.6%). The most common chronic pain condition was musculoskeletal pain:back pain(47.14% across studies;range: 16%-60.6%), arthritis and joint pain(31.1%;range: 18%-67.5%), and neck pain(28.7%;range: 3.6%-63%). In total,42.4% of the participants across studies had a diagnosis of PTSD(range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.CONCLUSION Opioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.
文摘BACKGROUND Studies have indicated that childhood exposure to domestic violence is a common factor in posttraumatic growth(PTG)and posttraumatic stress disorder(PTSD),but it is unclear whether PTG and PTSD share a common/different underlying mechanism.AIM To explore the common/different underlying mechanism of PTG and PTSD.METHODS Between February 12 and 17,2020,a nationwide cross-sectional online survey was conducted in China among 2038 university students,and a self-administered questionnaire was used for the data collection.The data included demographic characteristics,such as age,gender,and subjective social economic status,and childhood exposure to domestic violence scale that was selected from the Chinese version of revised Adverse Childhood Experiences Question,Self-compassion Scale,Connor–Davidson Resilience Scale,Posttraumatic Growth Inventory,and the Abbreviated PTSD Checklist-Civilian version.A structural equation model was used to test the hypotheses.RESULTS Exposure to domestic violence was significantly associated with PTG and PTSD via a 1-step indirect path of self-compassion(PTG:β=-0.023,95%CI:-0.44 to-0.007;PTSD:β=0.008,95%CI:0.002,0.014)and via a 2-step indirect path from self-compassion to resilience(PTG:β=-0.008,95%CI:-0.018 to-0.002;PTSD:β=0.013,95%CI:0.004-0.024).However,resilience did not mediate the relationship between exposure to domestic violence and PTG and PTSD.CONCLUSION PTG and PTSD are common results of childhood exposure to domestic violence,which may be influenced by self-compassion and resilience.
文摘BACKGROUND The case report supports the recent findings regarding the correlation of posttraumatic stress disorder(PTSD)and schizophrenia.The report accomplished the following objectives:(1)To present a case of an adult female manifesting with somatic type of delusion(foul body odor)and history of PTSD;(2)To discuss the biopsychosocial factors,psychodynamics and management of the patient;and(3)To differentiate delusional disorder from schizophrenia according to recent studies.Schizophrenia and delusional disorder have certain defining features that separate the two.However,at times it may be difficult to actually classify one from the other.A psychiatrist must be able to carefully examine and assess the history of the patient,helping them share early life experiences of past traumatic events.The early past traumatic experiences and life events greatly influence the predisposition of a patient to develop schizophrenia.However,people with schizophrenia were known to underreport their trauma experience.CASE SUMMARY This is a case of a young adult female diagnosed with delusional disorder with a history of PTSD and associated depression.The patient manifested with somatic type of delusion with a fixed false belief that a foul body odor was coming from her underarms.CONCLUSION Developing a therapeutic alliance is vital in achieving therapy goals through empathy,support and warmth between the patient and physician.History of PTSD predisposes patients with schizophrenia to develop depressive disorders as a comorbidity.
文摘Introduction: On the 5<sup>th</sup> of June 2022, an incident of a mass attack following multiple gunshots and explosions occurred in a community in Ondo State Nigeria. This study aims to assess the mental health status of victims of the mass attack to guide further interventions among them. Methods: A cross-sectional study was conducted among victims of a mass attack in Owo community, Ondo State. A total of 209 affected victims were interviewed on socio-demographic characteristics, symptoms of anxiety (AD) and post-traumatic stress disorder (PTSD), threat experienced, and mental health support received. A 7-item Generalized Anxiety Disorder (GAD-7) and 9-item Post Traumatic Stress Disorder (PTSD) scale were used to assess the mental health status of the victims. A point was assigned to respondents who reported the symptoms of GAD, with a maximum score of 7 attained. For GAD, scores were categorized as follows: 1 - 2 as mild, 2 - 3 as minimal, 4 - 5 as moderate and 6 - 7 as severe. The PTSD symptoms were rated using a 5-point Likert scale response, and assigned the following points;4 = extremely, 3 = quite a bit, 2 = moderate, 1 = a little bit and 0 = not at all. From a maximum score of 36, participants with scores 18 and above were categorized as those with provisional PTSD. The independent samples t-test and correlational analysis were used to determine the association between PTSD score and other independent variables, with an alpha level of significance set at 0.05. Results: Generally, 38 (18.2%) of the respondents had severe AD. About half (89;42.6%) were categorized as those with provisional PTSD. The mean level of both AD (3.40 ± 2.26) and PTSD (16.51 ± 7.63) score is higher among those who were married compared to those not married (anxiety disorder;2.52 ± 2.20, P = 0.005 and PTSD;13.20 ± 8.86, P = 0.004). Respondents who have been counseled by a healthcare worker had a higher mean level (15.89 ± 7.58) of provisional PTSD compared to those not counseled by a healthcare worker (13.56 ± 9.22, P = 0.046). The level of PTSD score increased with a higher age group (r = 0.21, P = 0.003). Conclusions: The results show that the mass attack had psychological consequences among a high proportion of the victims, particularly, those married and in the older age groups. This suggests the need for continuous supportive counseling targeting these affected groups, and considering other factors moderating the effectiveness of counseling among them in future interventions.
文摘Mental health symptoms secondary to trauma exposure and substance use disorders(SUDs)co-occur frequently in both clinical and community samples.The possibility of a shared aetiology remains an important question in translational neuroscience.Advancements in genetics,basic science,and neuroimaging have led to an improved understanding of the neural basis of these disorders,their frequent comorbidity and high rates of relapse remain a clinical challenge.This project aimed to conduct a review of the field’s current understanding regarding the neural circuitry underlying posttraumatic stress disorder and SUD.A comprehensive review was conducted of available published literature regarding the shared neurobiology of these disorders,and is summarized in detail,including evidence from both animal and clinical studies.Upon summarizing the relevant literature,this review puts forth a hypothesis related to their shared neurobiology within the context of fear processing and reward cues.It provides an overview of brain reward circuitry and its relation to the neurobiology,symptomology,and phenomenology of trauma and substance use.This review provides clinical insights and implications of the proposed theory,including the potential development of novel pharmacological and therapeutic treatments to address this shared neurobiology.Limitations and extensions of this theory are discussed to provide future directions and insights for this shared phenomena.
基金RSL Queensland funded this study as part of the PTSD Initiative at the Gallipoli Medical Research Foundation.The Australian Government Department of Veterans’Affairs provided transport for eligible participants。
文摘Background:Posttraumatic stress disorder(PTSD)has been associated with volumetric and white matter microstructural changes among general and veteran populations.However,regions implicated have greatly varied and often conflict between studies,potentially due to confounding comorbidities within samples.This study compared grey matter volume and white matter microstructure among Australian combat veterans with and without a lifetime diagnosis of PTSD,in a homogenous sample assessed for known confounding comorbidities.Methods:Sixty-eight male trauma-exposed veterans(16 PTSD-diagnosed;mean age 69 years)completed a battery of psychometric assessments and underwent magnetic resonance and diffusion tensor imaging.Analyses included tractbased spatial statistics,voxel-wise analyses,diffusion connectome-based group-wise analysis,and volumetric analysis.Results:Significantly smaller grey matter volumes were observed in the left prefrontal cortex(P=0.026),bilateral middle frontal gyrus(P=0.021),and left anterior insula(P=0.048)in the PTSD group compared to controls.Significant negative correlations were found between PTSD symptom severity and fractional anisotropy values in the left corticospinal tract(R^(2)=0.34,P=0.024)and left inferior cerebellar peduncle(R^(2)=0.62,P=0.016).No connectome-based differences in white matter properties were observed.Conclusions:Findings from this study reinforce reports of white matter alterations,as indicated by reduced fractional anisotropy values,in relation to PTSD symptom severity,as well as patterns of reduced volume in the prefrontal cortex.These results contribute to the developing profile of neuroanatomical differences uniquely attributable to veterans who suffer from chronic PTSD.
文摘In accordance with the guidelines established by prominent European and global cardiology associations,comprehensive cardiac rehabilitation(CR)stands as an officially endorsed and highly recommended therapeutic approach(class I recommendations;level of evidence A)for a diverse spectrum of cardiac patients.Nevertheless,it is a cause for concern to observe that fewer than 50%of eligible patients are being effectively referred for CR,whether in an outpatient or in-patient setting.Concurrently,studies reveal that a substantial proportion of individuals with atherosclerotic cardiovascular disease maintain unhealthy lifestyles and exhibit suboptimal management of modifiable cardiovascular risk factors,including hypertension,lipid levels,and diabetes.Beyond the conven-tional patient profile encompassing those recovering from acute coronary syndrome with or without percutaneous coronary intervention,as well as patients who have undergone coronary or valvular surgery,contemporary CR now emphasizes specialized subgroups of patients.These include frail elderly patients,the female population with its unique considerations,individuals burdened by multiple cardiovascular comorbidities,those who have developed psychological consequences due to a cardiac illness and particularly those grappling with chronic heart failure.This editorial seeks to offer a state-of-the-art assessment of the significance and role of comprehensive CR within modern cardiology.
文摘AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, Pub Med and Psyc INFO, we searched full manuscripts in English and published until September 1, 2014. RESULTS We found sixteen studies exploring psychological issues in patients with IE(six studies) and in TAD(ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE(four papers) and in TAD(eight papers). Depression and anxiety were analyzed in TAD only(five papers). Post-traumatic stress disorder was assessed in IE(one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ. CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.
基金Supported by the Jiangsu Maternal and Child Health Research Project,No.F201766the Lianyungang Medical Scientific Project,No.201722.
文摘Like soldiers,frontline medical staff provide a first line of defense and have played a critical role in responses to the outbreak of coronavirus disease-2019 in December 2019.It is important to acknowledge the considerable pressure placed on frontline medical staff in the face of a new type of coronavirus that is highly infectious and for which no specific treatment is available.Here,we review the various kinds of psychological problems afflicting frontline medical staff who are combatting the severe acute respiratory syndrome epidemic.These include anxiety,insomnia,depression,interpersonal difficulties,and post-traumatic stress disorder syndrome.We further present a summary of countermeasures for alleviating these problems based on our findings.These countermeasures include ensuring the provision of adequate protective gear for frontline medical staff,developing timely and clear guidelines,strengthening social support,and providing clear criteria and additional training,focusing on the choice of frontline medical staff.An understanding of the psychological impacts of an epidemic situation and of relevant countermeasures will contribute to reducing the psychological pressures on frontline medical staff.Consequently,they will be able to cope better with outbreaks of infectious diseases in the future,to reduce the psychological pressure of the front-line medical staff,and to improve the treatment level.
文摘Rates of childhood trauma exposure are extremely high,with approximately 70%of children and adolescents experiencing at least one traumatic event.Among the most common non-specific consequences of stress and trauma are disruptions of sleep.Sleep problems,such as shorter sleep duration,difficulty falling asleep,frequent awakenings,nightmares,sleepless nights,and early-morning wakefulness appear to have a higher prevalence among children and adolescents following traumatic events.This review will illustrate the role of sleep problems in traumatized children and adolescents,and emphasize the need to consider a wide range of etiological mechanisms for these symptoms.However,the relationship of trauma exposure to sleep problems among children and adolescents needs further investigation in future research.Moreover,in view of the adverse consequences of long-term disrupted sleep on mental health outcomes following trauma,the need to effectively address sleep disturbances in traumatized children and adolescents is crucial.
基金funded by the Carl and Caroline Swanson FoundationSupport was also provided through philanthropic support of the New Start for Student Veterans program by a private donor。
文摘Background:Evidence-based treatments for service-related health conditions such as posttraumatic stress disorder(PTSD),depression,and traumatic brain injury(TBI)are not effective for all veterans.Equine-assisted interventions are emerging as an additional treatment modality,but little is known regarding the safe and effective delivery of these interventions.This study aimed to describe the following features of the body of literature concerning equineassisted interventions among veterans:1)veterans who have participated in equine-assisted interventions;2)specific characteristics of equine-assisted interventions in veterans;and 3)the specific characteristics of research on equineassisted interventions in veterans.Methods:We conducted a systematic mapping review of peer-reviewed literature reporting on equine-assisted interventions among veterans between 1980 and 2017.Searches of nine databases yielded 3336 unique records,six of which met the inclusion criteria and were reviewed.Data relevant to the study aims were extracted and analyzed.Results:Equine-assisted interventions among veterans disproportionately targeted psychosocial outcomes and yielded promising results.The detailed methods of EAI varied in the reported studies,ranging from communicating with the horse to mounted exercises.There was also great diversity in outcome measurement.The state of theoretical development regarding the mechanisms by which equine-assisted interventions benefit the veteran population is currently underdeveloped.Studies provided insufficient detail with respect to the description of the intervention,reasons for attrition,and the dose-response relationship.Conclusions:Scientific development of equine-assisted interventions targeting psychosocial outcomes among veterans is warranted to establish their efficacy.Targeted outcomes should be expanded,including outcomes more closely aligned with the nature of polytraumatic injuries.Future research must also emphasize the theoretical development of equine-assisted interventions for veterans and thoroughly describe the participants,components of the intervention,factors contributing to attrition,and optimal dose-response relationships.
基金supported by the South Central Mental Illness Research,Education,and Clinical Center (SC MIRECC),which is a MIRECC for Veterans Integrated Service Network (VISN) 16&17。
文摘Background: Selective serotonergic reuptake inhibitors(SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder(PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury(m TBI) is problematic since SSRIs could exacerbate post-concussion syndrome(PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy.Methods: We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of m TBI.Discussion: We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full-scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans.Trial registration: NCT04280965.
文摘The therapeutic termination of pregnancy(TToP)is an induced abortion following a diagnosis of medical necessity.TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability.This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother.Sociocultural and economic determinants could influence the desire for children and family planning in couples,as well as the use of effective contraception and the choice to perform an induced abortion.Also,pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP.Furthermore,the TToP is a reproductive event with an important traumatic burden,but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples.The aim of this review is to evaluate what demographic,reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women.Also,we will examine both positive and negative consequences of this procedure on women’s mental health,underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.
基金This work was supported by the National Key Technology R&D Program of China(2012BAK16B03)Science and Technology Projects of Guangdong Province,China(2013B022000054).
文摘Posttraumatic stress disorder(PTSD)has an important and complex relationship with traumatic brain injury(TBI).The prevalence of comorbid PTSD and TBI is increasing in both military and civilian populations.Moreover,TBI has emerged as an important risk factor for the development and manifestation of PTSD.Meanwhile,PTSD is also a significant mediator of the negative sequelae of TBI.PTSD and TBI,especially mild TBI(mTBI),have overlapping neural substrates and neuroanatomical functional features.Given that comorbid PTSD and TBI remain a challenge for forensic psychiatry evaluation,we review the relationship between the two disorders and discuss special considerations during evaluation of the condition.
文摘Background: Traumatic brain injury (TBI) remains a cause of lifelong disability, death, and suicide worldwide. TBI-induced near-death experience (NDE) could increase suicide risks. Objective: We investigated TBI coupled with NDE and posttraumatic stress disorder (PTSD) as a possible indicator of suicide. Methods: A 17-year-old male who sustained an acute severe TBI in a traffic collision, was comatose 14 days, had an NDE awakening from the coma, and, years after rehabilitation, suffered PTSD, clinical depression, and survived a suicide attempt. This personal experience of a TBI-induced NDE and lingering PTSD was acquired directly from the patient by interview. We discuss his case while considering relevant literature. Results: Longitudinal data from 1961 to 2021 generated from the PubMed interface revealed 4056 TBI patients committed suicide. NDE was only reported in one of those cases and, although not a suicide, in the personal experience. Neuropsychological assessment at long-term follow-ups revealed few TBI patients exhibited normal mental/physical functions compared to the general population. Unfavorable GOS scores were risk predictors for neuropsychological/physical impairments later in life, with outcomes of depression, PTSD, poor QOL, and/or suicide. Conclusions: For TBI-NDE survivors, including those with PTSD, long-term periodic neuropsychological follow-ups and psychosocial support may help decrease suicide risks.
