How Important Is Reprocessing in Personalized Multicomponent Therapy? Analyzing Longitudinal Data of Inpatients With Severe PTSD.

ABSTRACT: Treatment guidelines for complex presentations of posttraumatic stress disorder (PTSD) are often cautious about the reprocessing of traumatic memories and recommend multicomponent treatments that are widely used in clinical practice. Yet, the role of reprocessing in these multicomponent treatments remains unknown. Using naturalistic data of 97 patients treated for PTSD, we used a linear mixed model to investigate the role of reprocessing for the outcome at discharge and at 6-month follow-up. Treatment effects were significant and large ( g = 0.91-1.05). The final model showed good fit and explained 51% of the variance. There was a significant main effect of time ( B = -8.1 [-11.5; -4.8], p < 0.001), as well as a reprocessing by time interaction ( B = -17.2 [-30.5; -3.8], p = 0.012), indicating better outcomes with higher levels of reprocessing. Hence, maximizing the amount of reprocessing used in multicomponent treatments for PTSD may significantly enhance outcomes.

Altered endocannabinoid-dynamics in craniopharyngioma patients and their association with HPA-axis disturbances.

OBJECTIVE: Patients with craniopharyngioma (CP) frequently suffer from morbid obesity. Endocannabinoids (ECs) are involved in weight gain and rewarding behavior but have not been investigated in this context. DESIGN: Cross-sectional single-center study. METHODS: Eighteen patients with CP and 16 age- and sex-matched controls were included. Differences in endocannabinoids (2-arachidonoylglycerol (2-AG) and N-arachidonoylethanolamine (AEA)) and endocannabinoid-like molecules (oleoyl ethanolamide (OEA), palmitoylethanolamide (PEA), and arachidonic acid (AA) were measured at baseline and following endurance exercise. We further explored ECs-dynamics in relation to markers of HPA-axis activity (ACTH, cortisol, copeptin) and hypothalamic damage. RESULTS: Under resting conditions, independent of differences in BMI, 2-AG levels were more than twice as high in CP patients compared to controls. In contrast, 2-AG and OEA level increased in response to exercise in controls but not in CP patients, while AEA levels decreased in controls. As expected, exercise increased ACTH and copeptin levels in controls only. In a mixed model analysis across time and group, HPA measures did not provide additional information for explaining differences in 2-AG levels. However, AEA levels were negatively influenced by ACTH and copeptin levels, while OEA levels were negatively predicted by copeptin levels only. There were no significant differences in endocannabinoids depending on hypothalamic involvement. CONCLUSION: Patients with CP show signs of a dysregulated endocannabinoid system under resting conditions as well as following exercise in comparison to healthy controls. Increased 2-AG levels under resting conditions and the missing response to physical activity could contribute to the metabolic phenotype of CP patients.