Earthquake brain: Impairment of spatial memory following long-term earthquake-related stress.

OBJECTIVES: The primary aim of this study was to investigate neuropsychological function in patients with earthquake-related posttraumatic stress disorder, compared with earthquake-exposed but resilient controls. We hypothesised that individuals with posttraumatic stress disorder would have poorer neuropsychological performance on tests of verbal and visuospatial learning and memory compared with the earthquake-exposed control group. The availability of groups of healthy patients from previous studies who had been tested on similar neuropsychological tasks prior to the earthquakes allowed a further non-exposed comparison. METHOD: In all, 28 individuals with posttraumatic stress disorder and 89 earthquake-exposed controls completed tests of verbal and visuospatial learning and memory and psychomotor speed. Further comparisons were made with non-exposed controls who had been tested before the earthquakes. RESULTS: No significant difference in performance on tests of verbal or visuospatial memory was found between the earthquake-exposed groups (with and without posttraumatic stress disorder), but the posttraumatic stress disorder group was significantly slowed on tests of psychomotor speed. Supplementary comparison with historical, non-exposed control groups showed that both earthquake-exposed groups had poorer performance on a test of visuospatial learning. CONCLUSION: The key finding from this study is that there were no differences in verbal or visuospatial learning and memory in individuals with posttraumatic stress disorder compared with similarly earthquake-exposed controls. Compared with non-exposed controls, both earthquake-exposed groups had poorer performance on a test of visuospatial (but not verbal) learning and memory. This offers preliminary evidence suggesting that it is earthquake (trauma) exposure itself, rather than the presence of posttraumatic stress disorder that affects aspects of neuropsychological functioning. If replicated, this may have important implications for how information is communicated in a post-disaster context.

Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study.

AIMS/HYPOTHESIS: Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes ('high-risk foot'), and to compare different subcategories of high-risk foot. METHODS: Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups. RESULTS: The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively. CONCLUSIONS/INTERPRETATION: In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.

Suitability and acceptability of computerised cognitive behaviour therapy for anxiety disorders in secondary care.

OBJECTIVE: To evaluate the suitability and acceptability of computerised cognitive behaviour therapy (CCBT). METHOD: Participants were patients who had been referred to a secondary care service in the usual manner, and then offered participation in a randomised controlled trial comparing the efficacy of CCBT with a control condition (waitlist) for patients with a current primary diagnosis of generalised anxiety disorder, panic disorder or social phobia. Data were collected regarding the recruitment and retention of patients, and patient ratings (anchored Likert scales) of treatment credibility, treatment satisfaction, treatment acceptability and telephone support. RESULTS: A total of 1141 referrals were received by the secondary care service. Of the 1141, 748 (66%) were not suitable for the study, 178 (16%) declined to participate and 127 (11%) were not contactable. Therefore, of the 1141 patients referred to the secondary care service, only 88 patients (8%) were eligible and consenting for the study. The single most common reason for patients not being suitable for the study was that the referral was urgent. In a clinical setting where CCBT could be used alongside clinical management, many of these patients may have been suitable for CCBT. Of the patients randomised to treatment (n = 40), 65% completed treatment. Drop-out rates were not significantly different across diagnostic groups. The single most commonly cited reason for not completing treatment was 'too busy'. Patient ratings of treatment were typically favourable (credibility, satisfaction, acceptability and telephone support). CONCLUSIONS: CCBT was typically rated favourably by patients referred to a secondary care service and randomised to treatment. However, only a small minority of patients was eligible and consenting for the trial. Therefore, while CCBT may be an acceptable treatment, its suitability for secondary care settings remains unclear.

Effectiveness of computerised cognitive behaviour therapy for anxiety disorders in secondary care.

OBJECTIVE: This study aimed to compare the effectiveness of computerised cognitive behaviour therapy (CCBT) with a wait list control (WLC) for the treatment of patients with an anxiety disorder (social phobia, panic disorder, generalised anxiety disorder) referred to a specialist, publically funded, outpatient anxiety service. METHOD: Patients with social phobia (n = 37), panic disorder (n = 32) or generalised anxiety disorder (n = 14) were randomised to treatment with either CCBT (n = 40) or WLC (n = 43). Self-report rating scale assessments were conducted at baseline, 12 and 24 weeks. RESULTS: Compared with WLC, the CCBT group improved significantly on approximately half of the self-report primary (the Work and Social Adjustment Scale) and approximately half of the secondary measures at both 12 and 24 weeks (the Liebowitz Social Anxiety Scale, the Penn State Worry Questionnaire, the Generalised Anxiety inventory and the Fear Questionnaire). Effect sizes in this study were moderate. CONCLUSION: This is one of the few studies to investigate CCBT for anxiety disorders in patients in a secondary care service. The results show that CCBT in this secondary care setting has the potential to be beneficial and confirms and extends the findings from previous studies of self-referral or primary care settings.

Earthquake Brain: Altered Recognition and Misclassification of Facial Expressions Are Related to Trauma Exposure but Not Posttraumatic Stress Disorder.

OBJECTIVES: The study investigated facial expression recognition (FER) in posttraumatic stress disorder (PTSD) caused by exposure to earthquakes, and in particular whether people with this condition showed a bias toward interpreting facial expressions as threat-related emotions (i.e., as anger, fear, or disgust). The study included a trauma-exposed control group who had been similarly exposed to the earthquakes but had not developed PTSD. We hypothesized that individuals with PTSD would have increased sensitivity to threat-related facial emotions compared with the trauma-exposed control group. This would be shown by increased accuracy in recognition of threat-related emotions and the misinterpretation of neutral expressions to these emotions (i.e., misidentifying them as anger, fear, or disgust). The availability of a group of healthy controls from a previous study who had been tested on a similar task before the earthquakes allowed a further non-exposed comparison. METHOD: Twenty-eight individuals with PTSD (71% female, mean age 42.8 years) and 89 earthquake-exposed controls (66% female, mean age 50.1 years) completed an FER task, which featured six basic emotions. Further comparisons were made with 50 non-exposed controls (64% female, mean age 38.5 years) who had been tested before the earthquakes. RESULTS: There was no difference in sensitivity to threat-related facial expressions (as measured by accuracy in recognition of threat-related facial expressions and the misinterpretation of neutral expressions as threatening) in individuals with PTSD compared with similarly earthquake-exposed controls. Supplementary comparison with an historical, non-exposed control group showed that both earthquake-exposed groups had increased accuracy for the identification of all facial emotions and showed a bias in the misclassification of neutral facial expressions to the threat-related emotions of anger and disgust. CONCLUSION: These findings suggest that it is exposure to earthquakes and repeated aftershocks, rather than the presence of PTSD that affects FER accuracy and misinterpretation. The importance of these biases in both PTSD and trauma-exposed controls needs further exploration and is an area for future research.