Effects of duloxetine in treatment-refractory men with posttraumatic stress disorder.

INTRODUCTION: Although there is evidence that selective serotonin reuptake inhibitors provide some benefit in the treatment of post-traumatic stress disorder (PTSD), most meta-analytical reviews have concluded that effect sizes are small and, moreover, that there may be relatively little benefit for some populations (e. g., combat veterans with co-morbid major depression, MDD). This study aimed to evaluate the effectiveness and tolerability of the dual reuptake inhibitor duloxetine in the treatment of PTSD and co-morbid MDD. METHODS: Twenty-one treatment refractory, male, combat-related patients with PTSD and co-morbid MDD were enrolled in a naturalistic study and twenty completed the trial. Duloxetine was given between 60 and 120 mg daily over 8 weeks. RESULTS: Duloxetine led to a significant improvement of PTSD-characteristic symptoms as well as co-morbid MDD. Duloxetine effectively reduced nightmares, which is important because decreasing nightmares has been associated with improved sleep in PTSD. DISCUSSION: The results of this naturalistic study suggest that duloxetine is an effective and well-tolerated treatment for patients with PTSD and co-morbid MDD. These initial results need to be extended to the study of women with PTSD.

Issues of measurement and mechanism in meta-analyses: comment on Westen and Morrison (2001).

The authors suggest that D. Westen and K. Morrison's (2001) meta-analysis of treatment is critically limited in the consideration of measurement and mechanisms of therapeutic change. The measures included in the analysis fail to represent a comprehensive coverage of the domains within which change is expected. Moreover, they do not measure the theoretically derived constructs currently conceived as being central to each disorder. Further, the particular meta-analytical approach taken prohibits evaluation of the treatment components responsible for change. The authors reviewed the most recent data on comorbidity as an issue of treatment efficacy and generalizability, proffer an interpretation for the difference in outcome results across the 3 diagnostic groups, and discuss internally valid methodologies for the bridging from research to clinical practice.

Cognitive theories of generalized anxiety disorder.

The hallmark feature of generalized anxiety disorder, worry, has been hypothesized to be a key factor in the production of threat-related information-processing biases in the domains of attention, memory, interpretation of ambiguity, and problem solving; however, worry and cognitive biases are not unique to generalized anxiety disorder. What may be unique to generalized anxiety disorder is the pervasive use of worry as a strategy to avoid intense negative effect and the broad domains in which these biases are exhibited, directly relating to the clinical observation that patients with generalized anxiety disorder worry about numerous life stressors. Also, the authors conclude that information-processing biases contribute to worry but that they are insufficient for the development of generalized anxiety disorder. Directions for future research and clinical implications are discussed.

Frontal lobe contributions to hypnotic susceptibility: a neuropsychological screening of executive functioning.

Current theory on the cognitive mechanisms of hypnotic experience suggests that hypnosis is mediated by a dissociation between contention-scheduling mechanisms and a supervisory attention system. This theory is based on neuropsychological research with frontal lobe dysfunction patients, who show performance deficits similar in executive functioning to hypnotized individuals. To test an extension of this theory, high hypnotically susceptible (n = 9) and low hypnotically susceptible (n = 7) participants were given four tests of executive functioning. In a baseline condition, high susceptible individuals performed significantly better on one of the four tests (the Wisconsin Card Sorting Test). The role of increased cognitive flexibility in hypnotic susceptibility is considered as a possible component of the dissociated control model of hypnosis.

Cardiovascular reactivity during hypnosis and hypnotic susceptibility: three studies of heart rate variability.

This paper was designed to examine the relationship between hypnotic susceptibility and cardiovascular measures, especially parasympathetic activity, in 3 separate studies. In these studies, neither heart rate nor heart rate variability differed between the high and low hypnotically susceptible individuals at the initial baseline. Furthermore, in the first study, experimental tasks designed to elicit differential sympathetic and parasympathetic cardiac responses demonstrated no interaction with hypnotic susceptibility. Overall, these 3 studies suggest that hypnotic susceptibility in itself is not associated with parasympathetic aspects of either basal cardiac states or cardiac responses. In addition, a hypnotic induction itself did not differentially influence parasympathetic activity for the high versus low susceptible individuals.

Transfer of stimulus control from motor to verbal stimuli.

A transfer of stimulus control procedure was used to teach three profoundly retarded adolescents a series of specific responses to specific verbal instructions. After imitative control of a behavior was established, a verbal instruction was presented immediately before the behavior was modelled. Each correct response was followed on the next trial by inserting a delay between the verbal instruction and the modelling of the behavior. The delays increased from trial to trial. Transfer of stimulus control was indicated when a subject responded correctly on five consecutive trials before the behavior was modelled. All three subjects responded correctly to each verbal instruction after that item was trained in a multiple-baseline order. Generalization did not occur to items that had not been trained. Probe data revealed that some variations of the verbal instructions controlled responses after training was completed.

Blood MR signal suppression by preexcitation with inverting pulses.

A cardiac-gated sequence has been developed for functional cardiac imaging. It uses a nonselective 180 degrees preinverting pulse before a spin-echo (SE) readout sequence with an echo time (TE) of 28 msec. In seven healthy volunteers this sequence provided superior wall-to-chamber contrast in end diastole and end systole when compared with the following sequences: SE, TE = 28 msec; SE, TE = 28 msec with dephasing gradients; and SE, TE = 28 msec with presaturation bands.