Certain therapies appear beneficial in reducing PTSD symptoms in some trauma survivors
October 4, 2011
Science Daily/JAMA and Archives Journals
Prolonged exposure therapy, cognitive therapy, and delayed prolonged exposure therapy, appear to reduce posttraumatic stress disorder symptoms in patients who have experienced a recent traumatic event, according to a report published Online First by Archives of General Psychiatry, one of the JAMA/Archives journals.
"Chronic PTSD is tenacious and disabling. Short-term interventions without prior assessment or diagnosis have failed to prevent PTSD," the authors write as background information in the study. "Preventing posttraumatic stress disorder (PTSD) is a pressing public health need."
Arieh Y. Shalev, M.D., and colleagues from Hadassah University Hospital, Jerusalem, Israel, conducted a study to compare early and delayed exposure-based, cognitive and pharmacological interventions for preventing PTSD. Study participants were selected from consecutively admitted survivors of traumatic events at Hadassah Hospital in Jerusalem, through a telephone-based interview a mean (average) 9.61 days after the traumatic event occurred. Patients identified as having symptoms of acute stress disorder during the telephone interview were referred for clinical assessment, and those who met PTSD symptom criteria during assessment were invited to receive treatment.
The authors randomly assigned consenting patients to one of four intervention groups: prolonged exposure (PE), cognitive therapy (CT), a double-blind comparison of treatment with a selective serotonin reuptake inhibitor (SSRI) vs. placebo, or a waiting list (WL) control group. The study design allowed participants to decline treatment options they did not desire, and to be randomly assigned to one of the remaining treatment groups. Participants in the WL group who met PTSD criteria at the five-month follow-up received PE at that time, to compare the effects of a delayed intervention on PTSD symptoms. Prolonged exposure included psychoeducation, training in breathing control, prolonged imaginal exposure to traumatic memories and in vivo exposure to avoided situations. Cognitive therapy included identifying and challenging negative automatic thoughts and modifying underlying cognitive schemas. Participants in each of these groups received 12 weekly 1.5-hour sessions administered by clinical psychologists with prior PTSD treatment experience. PTSD prevalence was determined using the Clinician-Administered PTSD Scale (CAPS).
Following randomization, 63 participants started PE, 40 started CT, 93 were placed on the waiting list and 46 were in the SSRI and placebo subgroups (23 in each group). At the five-month follow-up, the prevalence of PTSD in the PE and CT groups (21.4 percent and 18.2 percent, respectively) were significantly less than in the WL, SSRI and placebo groups (58.2 percent, 61.9 percent and 55.6 percent, respectively). The analysis showed significant group differences in CAPS and mean (average) PTSD Symptom Scale-Self Report scores at five months, showing fewer PTSD symptoms in the PE and CT groups compared with the WL, SSRI and placebo groups. At the five-month follow-up, 57 WL participants had PTSD and were eligible for delayed PE and 41 started treatment at that time.
At the nine-month follow-up, the prevalence of PTSD in the PE, CT and WL groups were 21.2 percent, 22.8 percent, and 22.9 percent, respectively while rates for the SSRI and placebo subgroups (42.1 percent and 47.1 percent, respectively) remained higher. Analysis also showed significant group differences in CAPS and mean PTSD Symptom Scale-Self Report scores at nine months, showing fewer PTSD symptoms in the PE, CT and WL groups compared with the SSRI and placebo groups. Participants with partial PTSD before treatment onset did similarly well with and without treatment.
"The results of our study show that there are significant and similar preventive effects of PE and CT," the authors conclude. "Our finding suggests that delaying the intervention does not increase the risk of chronic PTSD…Thus, a delayed intervention is an acceptable option when early clinical interventions cannot be provided (e.g., during wars, disasters, or continuous hostilities)."
http://www.sciencedaily.com/releases/2011/10/111003161931.htm
Use of antipsychotics for reducing military-related chronic PTSD symptoms does not appear effective
August 2, 2011
Science Daily/JAMA and Archives Journals
Patients with military-related, chronic posttraumatic stress disorder (PTSD) and symptoms that were not improved with use of an antidepressant medication did not experience a reduction in PTSD symptoms with use of the antipsychotic medication risperidone, according to a new study.
Posttraumatic stress disorder is among the most common and disabling psychiatric disorders among military personnel serving in combat. Antidepressants are the predominant pharmacotherapy for PTSD, and within the U.S. Department of Veterans Affairs (VA), 89 percent of veterans diagnosed with PTSD and treated with pharmacotherapy are prescribed serotonin reuptake inhibitors (SRIs), according to background information in the article.
"However, SRIs appear to be less effective in men than in women and less effective in chronic PTSD than in acute PTSD. Thus, it may not be surprising that an SRI study in veterans produced negative results. Second-generation antipsychotics (SGAs) are commonly used medications for SRI-resistant PTSD symptoms, despite limited evidence supporting this practice," the authors write.
"In summary, risperidone, the second most widely prescribed second-generation antipsychotic within VA for PTSD and the best data-supported adjunctive pharmacotherapy for PTSD, did not reduce overall PTSD severity, produce global improvement, or increase quality of life in patients with chronic SRI-resistant military-related PTSD symptoms.
Overall, the data do not provide strong support for the current widespread prescription of risperidone to patients with chronic SRI-resistant military-related PTSD symptoms, and these findings should stimulate careful review of the benefits of these medications in patients with chronic PTSD," the authors conclude
http://www.sciencedaily.com/releases/2011/08/110802162319.htm
New research might help people suffering from post-traumatic stress disorder
August 2, 2011
Science Daily/University of Bristol
Researchers have discovered a mechanism in the brain that explains for the first time why people make particularly strong, long-lasting memories of stressful events in their lives.
The research found that stress hormones directly stimulate biochemical processes in neurons that play a role in learning and memory. The way these hormones stimulate these signalling and epigenetic processes in neurons is completely new and has never been shown before.
In the healthy brain these processes operate smoothly and help people to cope with and learn from stressful events in their lives. In vulnerable people or in strongly traumatized people (victims of rape or war), these processes may be disturbed and stressful events may result in the formation of highly traumatic memories such as those seen in patients suffering from post-traumatic stress disorder (PTSD). The discovery may lead to new ways to develop drugs to help these patients and to prevent PTSD in trauma victims.
It is well known that people make very strong memories of stressful, emotionally disturbing events in their lives. These so-called episodic memories are memories of the place (e.g. room, office) or surroundings where the event happened, how we felt at the time (mood), and the time of the day at which it happened. These kinds of memories can last a lifetime.
The consolidation of such memories is taking place in a specific limbic brain region called the hippocampus -- part of the brain involved in memory and learning. Hormones secreted during stress like the glucocorticoid hormone cortisol (in rodents, corticosterone) act on the hippocampus to enhance the consolidation of these memories. However, until now it has been unknown how these hormones act on the hippocampus to enhance the formation of emotional event-related memories.
http://www.sciencedaily.com/releases/2011/08/110801160229.htm
Eight-question survey can help predict post-traumatic stress disorder
July 18, 2011
Science Daily/University of Pennsylvania School of Nursing
A simple eight-question survey administered soon after injury can help predict which of the 30 million Americans seeking hospital treatment for injuries each year may develop depression or post-traumatic stress, researchers report.
"Depression and PTSD exert a significant, independent, and persistent effect on general health, work status, somatic symptoms, adjustment to illness, and function after injury," the authors wrote, also emphasizing that even minor injuries can lead to traumatic stress responses. The findings allow healthcare providers to identify patients at highest risk for developing these disorders and to target appropriate resources to this vulnerable group.
This screening tool -- reportedly one of the first of its kind for adults in the U.S. -- could have a great impact on the judicious allocation of costly mental health resources.
Using an eight-question survey, all injured patients can be rapidly assessed for risk in the hospital. Healthcare providers can then provide patients classed as high-risk for developing depression or PTSD with information about symptoms to look for and advise them to contact their primary care provider should symptoms surface. This intervention can facilitate early diagnosis of these disabling disorders.
The study reported nearly 100 percent accuracy in negative results. Only five percent of injured patients who tested negative for risk of depression on the screening survey developed depression and no patients who tested negative for PTSD risk developed PTSD. At the same time, not all patients who screen positive will develop these disorders. The researchers do not suggest that all patients who screen positive receive mental health services, but rather that this finding prompt systematic provision of information and additional follow-up.
http://www.sciencedaily.com/releases/2011/07/110718155614.htm
Sleep Problems Are Common in US Soldiers Returning from Wartime Deployment
June 9, 2010 —
Science Daily/ American Academy of Sleep Medicine
There is an extremely high prevalence of sleep disturbances in U.S. soldiers returning from wartime deployment, according to a research abstract presented June 8, 2010, in San Antonio, Texas, at SLEEP 2010, the 24th annual meeting of the Associated Professional Sleep Societies LLC.
Results indicate that 86 percent of participants had sleep disturbances upon return from deployment and 45 days later even though the majority of them had no signs of post-traumatic stress disorder or depression. Soldiers were more likely to have sleep disturbances if they had a personal history of sleep problems, symptoms of physical illness or mild traumatic brain injury.
"This is the first study to describe the prevalence of sleep disturbances at two different time points in soldiers returning from deployment without any apparent physical trauma from blasts or amputation," said principal investigator Major Betty Garner, PhD, a nurse scientist in the Nursing Research Office at Landstuhl Regional Medical Center in Landstuhl, Germany. "The most surprising finding from this small preliminary sample was the extremely high percentage of sleep disturbances in soldiers even 45 days after they returned from wartime deployment back to the United States -- the safe zone."
Results indicate that 86 percent of participants had sleep disturbances upon return from deployment and 45 days later even though the majority of them had no signs of post-traumatic stress disorder or depression. Soldiers were more likely to have sleep disturbances if they had a personal history of sleep problems, symptoms of physical illness or mild traumatic brain injury.
http://www.sciencedaily.com/releases/2010/06/100608091842.htm
Bright Light Therapy Improves Sleep Disturbances in Soldiers with Combat PTSD
June 15, 2010 —
Science Daily/American Academy of Sleep Medicine
Bright light therapy has significant effects on sleep disturbances associated with combat-related post-traumatic stress disorder, according to a research abstract presented June 7, 2010, in San Antonio, Texas, at SLEEP 2010, the 24th annual meeting of the Associated Professional Sleep Societies LLC.
Results indicate that bright light therapy produced a significantly greater improvement than placebo in sleep disturbances specific to PTSD. Bright light therapy also produced a moderate improvement in PTSD symptoms and depression.
"Results of this ongoing study show significant effects of bright light on disruptive nocturnal behaviors associated with combat PTSD, as well as positive effects of bright light therapy on PTSD symptom severity," said study coordinator Shannon Cornelius, PhD, graduate research assistant for Dr. Shawn D. Youngstedt in the department of exercise science at the University of South Carolina in Columbia, S.C. "Because bright light therapy is a relatively simple, self-administered, inexpensive treatment with few side effects, these results are an important step to further establish the efficacy of bright light therapy as an alternative or adjunct treatment for combat-related PTSD."
The study involved 16 soldiers who returned to the U.S. with combat-related PTSD after serving in Operation Enduring Freedom or Operation Iraqi Freedom. Following a one-week baseline, participants were randomized to one of two four-week treatments. Eight soldiers received 10,000 lux of bright light therapy for 30 minutes each day. The other eight participants were assigned to the placebo group and received sham treatment with an inactivated negative ion generator. The Clinician-Administered PTSD Scale (CAPS-2) was completed at baseline and immediately following completion of the study. At weekly intervals, depression was assessed with the Beck Depression Inventory (BDI-II), and sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) with addendum for PTSD (PSQI-PTSD).
Cornelius noted that sleep disturbance is a commonly reported problem that can play both a precipitating and perpetuating role in PTSD, making it an important target for therapy.
"Disturbed sleep is known to interact with depression and anxiety in a vicious cycle," said Cornelius. "By reducing the severity and occurrence of sleep disturbances, it may be possible to reduce the severity of symptoms such as anxiety and depression in combat-related PTSD."
The study was supported by a U.S. Department of Veterans Affairs Merit Award.
The American Academy of Sleep Medicine reports that 70 to 90 percent of people with PTSD describe subjective sleep disturbance. Recurrent nightmares of the traumatic event represent one of the most problematic and enduring symptoms of PTSD. These nightmares may take the form of a realistic reliving of the traumatic event or depict only some of its elements.
Bright light therapy exposes your eyes to intense but safe amounts of light for a specific and regular length of time. Typically it involves exposure to up to 10,000 lux of light for scheduled periods of 20 minutes or more using a small light box.
In a 2007 study published in the journal BMC Psychiatry, Youngstedt reported that bright light exposure may have an anxiolytic effect. Three hours of exposure to 3,000 lux of bright light for three consecutive days reduced anxiety in a group of low-anxiety adults.
http://www.sciencedaily.com/releases/2010/06/100607065552.htm
Building fit minds under stress
February 17, 2010
Science Daily/University of Pennsylvania
A new study in which training was provided to a high-stress U.S. military group preparing for deployment to Iraq has demonstrated a positive link between mindfulness training, or MT, and improvements in mood and working memory.
The study found that the more time participants spent engaging in daily mindfulness exercises the better their mood and working memory, the cognitive term for complex thought, problem solving and cognitive control of emotions. The study also suggests that sufficient MT practice may protect against functional impairments associated with high-stress challenges that require a tremendous amount of cognitive control, self-awareness, situational awareness and emotional regulation.
To study the protective effects of mindfulness training on psychological health in individuals about to experience extreme stress, cognitive neuroscientist Amishi Jha of the Department of Psychology and Center for Cognitive Neuroscience at Penn and Elizabeth A. Stanley of Georgetown University provided mindfulness training for the first time to U.S. Marines before deployment. Jha and her research team investigated working memory capacity and affective experience in individuals participating in a training program developed and delivered by Stanley, a former U.S. Army officer and security-studies professor with extensive experience in mindfulness techniques.
The program, called Mindfulness-based Mind Fitness Training (MMFT™), aims to cultivate greater psychological resilience or "mental armor" by bolstering mindfulness.
The program emphasized integrating mindfulness exercises, like focused attention on the breath and mindful movement, into pre-deployment training. These mindfulness skills were to regulate symptoms in the body and mind following an experience of extreme stress. The importance of regularly engaging in mindfulness exercises was also emphasized.
"Our findings suggest that, just as daily physical exercise leads to physical fitness, engaging in mindfulness exercises on a regular basis may improve mind-fitness," Jha said. "Working memory is an important feature of mind-fitness. Not only does it safeguard against distraction and emotional reactivity, but it also provides a mental workspace to ensure quick-and-considered decisions and action plans. Building mind-fitness with mindfulness training may help anyone who must maintain peak performance in the face of extremely stressful circumstances, from first responders, relief workers and trauma surgeons, to professional and Olympic athletes."
The study findings are in line with prior research on Mindfulness Based Stress Reduction, or MBSR, programs and suggest that MMFT may provide "psychological prophylaxis," or protection from cognitive and emotional disturbances, even among high-stress cohorts such as members of the military preparing for deployment. Given the high rate of post-traumatic stress disorder and other mental-health disturbances suffered by those returning from war, providing such training prior to deployment may buffer against potential lifelong psychological illness by bolstering working memory capacity.
http://www.sciencedaily.com/releases/2010/02/100216101153.htm
Night Beat, Overtime and a Disrupted Sleep Pattern Can Harm Officers' Health
Nov. 17, 2009 —
Science Daily/University at Buffalo
A police officer who works the night shift, typically from 8 p.m. to 4 a.m., already is at a disadvantage when it comes to getting a good "night's" sleep.
A new study published in the current issue of Archives of Environmental & Occupational Health (vol. 64, No. 3) shows that this combination of night work, overtime and shortened sleep can contribute to the development among police officers of the metabolic syndrome, a combination of unhealthful factors that increase the risk of cardiovascular disease (CVD), primarily heart disease and stroke.
Results showed that overall, 30 percent of officers working the night shift had metabolic syndrome, compared to 21 percent in the National Health and Nutritional Examination Survey (NHANES III), which is based on data collected from the overall general population.
The percentages of several factors related to risk of metabolic syndrome were higher in night-shift officers than in the general population, as well as in day and evening-shift officers in the study:
55 percent had elevated waist circumference, compared to 50 percent and 30 percent for women and men
50 percent had low HDL cholesterol levels, compared to 38 percent and 35 percent in women and men, respectively.
Hypertension and glucose intolerance, an indication of diabetes, were more prevalent in night-shift officers.
In addition, officers who worked midnight shifts and had less than six hours sleep had a significantly higher average of metabolic-syndrome components than those who worked day shifts.
"Information from this study could help guide further investigation into health of first responders," Violanti said, "not only of police officers, but firefighters, emergency medical technicians, nurses, physicians, air traffic controllers and the military.
http://www.sciencedaily.com/releases/2009/11/091117161120.htm
Insomnia Among Returning War Vets As Severe As Patients With Chronic Insomnia
June 10, 2008 —
Science Daily/American Academy of Sleep Medicine
Insomnia together with post-deployment adjustment disorders among returning war veterans is as severe as patients suffering from chronic insomnia, according to a research abstract that will be presented on June 10 at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).
According to the results, returning OIF veterans endorsed significantly more severe disruptive nocturnal behaviors, such as nightmares and body movements, than both patients with insomnia and good sleepers. Insomnia complaints in returning veterans were as severe as complaints endorsed by insomnia patients. Sleep quality was significantly worse in veterans than in good sleepers.
"These findings highlight the urgent need for sleep-focused assessments and treatments in this new group of combat-exposed military veterans," said Anne Germain, Ph.D., the principal investigator of the study.
http://www.sciencedaily.com/releases/2008/06/080610071943.htm
Sleep Disorders Highly Prevalent Among Police Officers
June 13, 2007
Science Daily/American Academy of Sleep Medicine
A sampling of police officers shows a high incidence of sleep disorders among the members of this profession. Sleep disorders are common, costly and treatable, but often remain undiagnosed and untreated. Unrecognized sleep disorders adversely affect personal health and may lead to chronic sleep loss, which, in turn, increases the risk of accidents and injuries.
The percentage of those who screened positive for any sleep disorder was 38.4 percent, including 35.1 percent for OSA, 6.8 percent for insomnia, 0.7 percent for RLS, two percent for shift work sleep disorder and 0.5 percent for narcolepsy. These individuals were referred to a sleep clinic for a formal evaluation.
"Based on these data, sleep disorders appear to be highly prevalent in the present sample of police officers," said Rajaratnam. "Sleep disorder screening and treatment programs may potentially improve police officer health, safety and productivity."
http://www.sciencedaily.com/releases/2007/06/070612075008.htm