The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline.

DESCRIPTION: The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) worked together to revise the 2017 VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. This article summarizes the 2023 clinical practice guideline (CPG) and its development process, focusing on assessments and treatments for which evidence was sufficient to support a recommendation for or against. METHODS: Subject experts from both departments developed 12 key questions and reviewed the published literature after a systematic search using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) method. The evidence was then evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Recommendations were made after consensus was reached; they were based on quality and strength of evidence and informed by other factors, including feasibility and patient perspectives. Once the draft was peer reviewed by an external group of experts and their inputs were incorporated, the final document was completed. RECOMMENDATIONS: The revised CPG includes 34 recommendations in the following 5 topic areas: assessment and diagnosis, prevention, treatment, treatment of nightmares, and treatment of posttraumatic stress disorder (PTSD) with co-occurring conditions. Six recommendations on PTSD treatment were rated as strong. The CPG recommends use of specific manualized psychotherapies over pharmacotherapy; prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy; paroxetine, sertraline, or venlafaxine; and secure video teleconferencing to deliver recommended psychotherapy when that therapy has been validated for use with video teleconferencing or when other options are unavailable. The CPG also recommends against use of benzodiazepines, cannabis, or cannabis-derived products. Providers are encouraged to use this guideline to support evidence-based, patient-centered care and shared decision making to optimize individuals' health outcomes and quality of life.

Modest effects of dietary supplements during the COVID-19 pandemic: insights from 445 850 users of the COVID-19 Symptom Study app.

OBJECTIVES: Dietary supplements may ameliorate SARS-CoV-2 infection, although scientific evidence to support such a role is lacking. We investigated whether users of the COVID-19 Symptom Study app who regularly took dietary supplements were less likely to test positive for SARS-CoV-2 infection. DESIGN: App-based community survey. SETTING: 445 850 subscribers of an app that was launched to enable self-reported information related to SARS-CoV-2 infection for use in the general population in the UK (n=372 720), the USA (n=45 757) and Sweden (n=27 373). MAIN EXPOSURE: Self-reported regular dietary supplement usage (constant use during previous 3 months) in the first waves of the pandemic up to 31 July 2020. MAIN OUTCOME MEASURES: SARS-CoV-2 infection confirmed by viral RNA reverse transcriptase PCR test or serology test before 31 July 2020. RESULTS: In 372 720 UK participants (175 652 supplement users and 197 068 non-users), those taking probiotics, omega-3 fatty acids, multivitamins or vitamin D had a lower risk of SARS-CoV-2 infection by 14% (95% CI (8% to 19%)), 12% (95% CI (8% to 16%)), 13% (95% CI (10% to 16%)) and 9% (95% CI (6% to 12%)), respectively, after adjusting for potential confounders. No effect was observed for those taking vitamin C, zinc or garlic supplements. On stratification by sex, age and body mass index (BMI), the protective associations in individuals taking probiotics, omega-3 fatty acids, multivitamins and vitamin D were observed in females across all ages and BMI groups, but were not seen in men. The same overall pattern of association was observed in both the US and Swedish cohorts. CONCLUSION: In women, we observed a modest but significant association between use of probiotics, omega-3 fatty acid, multivitamin or vitamin D supplements and lower risk of testing positive for SARS-CoV-2. We found no clear benefits for men nor any effect of vitamin C, garlic or zinc. Randomised controlled trials are required to confirm these observational findings before any therapeutic recommendations can be made.

Psychosomatic symptoms among hospital physicians during the Gaza War: a repeated cross-sectional study.

Research regarding psychosomatic symptoms among hospital physicians during armed conflict is scarce. The current study compared psychosomatic symptoms of exposed and unexposed hospital physicians in two studies. The studies were conducted during 2009 and included a survey of two random samples of hospital physicians, one conducted during the Gaza War and the other conducted six months later. Each sample included hospital physicians who were directly exposed to war related stress and others who were not (Study 1: N = 54; Study 2: N = 31). In Study 1, exposed hospital physicians did not differ from unexposed physicians in the level of psychosomatic symptoms during the war (Psychosomatic Problems Scale 6.48 vs 4.09). However, in Study 2, exposed physicians reported a higher level of psychosomatic symptoms (10.33 vs 3.21). Moreover, analysis of covariance revealed a significant interaction effect of Exposure X Study (F = 7.976; p = .006; ?p2 = .100). Exposure to war-related stress takes a toll on psychosomatic symptoms among hospital physicians. This late onset of psychosomatic symptoms is discussed in light of the cognitive-energetical model.

Differential influences of emotion, task, and novelty on brain regions underlying the processing of speech melody.

We investigated the functional characteristics of brain regions implicated in processing of speech melody by presenting words spoken in either neutral or angry prosody during a functional magnetic resonance imaging experiment using a factorial habituation design. Subjects judged either affective prosody or word class for these vocal stimuli, which could be heard for either the first, second, or third time. Voice-sensitive temporal cortices, as well as the amygdala, insula, and mediodorsal thalami, reacted stronger to angry than to neutral prosody. These stimulus-driven effects were not influenced by the task, suggesting that these brain structures are automatically engaged during processing of emotional information in the voice and operate relatively independent of cognitive demands. By contrast, the right middle temporal gyrus and the bilateral orbito-frontal cortices (OFC) responded stronger during emotion than word classification, but were also sensitive to anger expressed by the voices, suggesting that some perceptual aspects of prosody are also encoded within these regions subserving explicit processing of vocal emotion. The bilateral OFC showed a selective modulation by emotion and repetition, with particularly pronounced responses to angry prosody during the first presentation only, indicating a critical role of the OFC in detection of vocal information that is both novel and behaviorally relevant. These results converge with previous findings obtained for angry faces and suggest a general involvement of the OFC for recognition of anger irrespective of the sensory modality. Taken together, our study reveals that different aspects of voice stimuli and perceptual demands modulate distinct areas involved in the processing of emotional prosody.