Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.972
Filtrar
2.
Depress Anxiety ; 37(1): 63-72, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31916660

RESUMO

BACKGROUND: Complicated grief (CG) is a bereavement-specific syndrome distinct from but commonly comorbid with posttraumatic stress disorder (PTSD). While bereavement is common among military personnel (Simon et al., 2018), there is little research on the impact of CG comorbidity on PTSD treatment outcomes. METHODS: To evaluate the impact of comorbid CG on PTSD treatment outcomes we analyzed data from a randomized trial comparing prolonged exposure, sertraline, and their combination in veterans with a primary diagnosis of combat-related PTSD (n = 194). Assessment of PTSD, trauma-related guilt, functional impairment, and suicidal ideation and behavior occurred at baseline and weeks 6, 12, and 24 during the 24-week trial. RESULTS: CG was associated with lower PTSD treatment response (odds ratio (OR) = 0.29, 95% confidence interval (CI) [0.12, 0.69], p = 0.005) and remission (OR = 0.28, 95% CI [0.11, 0.71], p = 0.007). Those with CG had greater severity of PTSD (p = 0.005) and trauma-related guilt (<0.001) at baseline and endpoint. In addition, those with CG were more likely to experience suicidal ideation during the study (CG: 35%, 14/40 vs. no CG 15%, 20/130; OR = 3.01, 95% CI [1.29, 7.02], p = 0.011). CONCLUSIONS: Comorbid CG is associated with elevated PTSD severity and independently associated with poorer endpoint treatment outcomes in veterans with combat-related PTSD, suggesting that screening and additional intervention for CG may be needed.


Assuntos
Luto , Pesar , Culpa , Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Suicídio/psicologia , Veteranos/psicologia , Adulto , Distúrbios de Guerra/diagnóstico , Distúrbios de Guerra/tratamento farmacológico , Distúrbios de Guerra/psicologia , Comorbidade , Feminino , Humanos , Masculino , Programas de Rastreamento , Sertralina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Ideação Suicida
3.
Anesth Analg ; 130(2): 402-408, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31335405

RESUMO

BACKGROUND: Ketamine is routinely used within the context of combat casualty care. Despite early concerns that ketamine administration may be associated with elevated risk of posttraumatic stress disorder (PTSD), more recent evidence suggests no relationship. Because PTSD occurs with regular frequency in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Service Members (SMs) and combat-related injuries are associated with higher likelihood of PTSD, it is important to investigate the relationship between ketamine exposure during inpatient medical and surgical care and PTSD symptoms in OIF/OEF SMs. METHODS: Medical record data from OIF/OEF SMs medically evacuated from combat (N = 1158) included demographic characteristics, injury severity, body areas injured, and PTSD Checklist (PCL) scores. The primary analysis assessed the association between ketamine versus nonketamine exposure on positive PTSD screen (logistic regression) and PCL scores (linear regression) after using 1:1 propensity score matching to adjust for available potential confounding variables. Because there were 2 primary outcomes, the binary positive PTSD screen (yes/no) and continuous PCL score, the significance level was set at P ≤ .025. In sensitivity analyses, propensity scores were used to match ketamine to nonketamine records in a 1:4 ratio, as well as to conduct inverse probability treatment weighting (IPTW). Regressions examining the relationship between ketamine exposure and outcomes were repeated for unconditional, 1:4 matching, and IPTW models. RESULTS: In the sample, 107 received ketamine and 1051 did not. In the logistic regression, the probability of a positive PTSD screen was not significantly different between ketamine versus nonketamine patients (odds ratio [OR] = 1.28; 95% confidence interval [CI], 0.48-3.47; P = .62). In the linear regression, PCL scores were not significantly different between ketamine versus nonketamine patients (mean difference = 1.98 [95% CI, -0.99 to 4.96]; P = .19). The results were consistent in the unconditional, 1:4 matching, and IPTW models. CONCLUSIONS: No differences in PTSD screening risk or symptom levels between ketamine exposed and nonexposed were found. Given the small sample size, wide CIs of the effects, and additional confounds inherent to retrospective studies, future studies are needed to examine the complex relationships between ketamine and psychological symptoms.


Assuntos
Anestésicos Dissociativos/administração & dosagem , Distúrbios de Guerra/psicologia , Hospitalização/tendências , Ketamina/administração & dosagem , Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Anestésicos Dissociativos/efeitos adversos , Estudos de Coortes , Distúrbios de Guerra/diagnóstico , Feminino , Hospitais de Veteranos/tendências , Humanos , Ketamina/efeitos adversos , Masculino , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/induzido quimicamente , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Resultado do Tratamento , Adulto Jovem
4.
Neuropsychology ; 34(1): 116-126, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31545626

RESUMO

OBJECTIVES: Many combat veterans exhibit cognitive limitations of uncertain origin. In this study, we examined factors that predict cognitive functioning by considering effects of blast-related concussion (BRC), non-blast-related concussion (NBRC), and posttraumatic stress disorder (PTSD) symptoms. Analyses specifically tested whether (a) BRC and NBRC were distinct in their prediction of cognitive performance; (b) a dose-response relationship existed between recurrent concussion (BRC and NBRC) and cognitive impairment; and (c) PTSD symptoms mediated the relationship between BRC and cognitive performance. METHOD: Two hundred eighty veterans with combat zone deployment histories completed semistructured clinical interviews to define BRC and NBRC histories, current and past mental health disorders, and dimensional ratings of PTSD symptomatology. Participants were also administered a number of neuropsychological measures to appraise cognitive functioning. RESULTS: A structural equation model (SEM) suggested that BRC and NBRC were not distinct in their prediction of cognitive performance, and there was no evidence that recurrent concussion (blast or nonblast) was directly associated with cognitive performance. BRC was significantly associated with PTSD symptoms (r = .24), PTSD symptoms were significantly associated with cognitive performance in the SEM (r = -.27), and PTSD symptoms significantly mediated the link between BRC and cognitive performance (p = .03). CONCLUSIONS: These results suggest that concussion history fails to directly contribute to cognitive performance, regardless of mechanism (blast or nonblast) and recurrence. BRC is nonetheless unique in its contribution to PTSD and PTSD-related cognitive deficits. Results support interventions specific to PTSD management in the interest of promoting neuropsychological functioning among war veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Traumatismos por Explosões/psicologia , Concussão Encefálica/psicologia , Distúrbios de Guerra/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Campanha Afegã de 2001- , Cognição , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Feminino , Humanos , Guerra do Iraque 2003-2011 , Masculino , Testes Neuropsicológicos , Desempenho Psicomotor , Recidiva
5.
Adv Gerontol ; 32(4): 492-501, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31800175

RESUMO

The study involving 317 former combatants aged 24 to 69 years was conducted. The aim of the study was to determine the regularities of the age dynamics of stress-induced pathology of combatants to develop the concept of their accelerated aging as a final component of the consequences of combat stress. It turned out that in relation to the period of influence of factors of combat stress and age, first manifests the pathology of the musculoskeletal system, gastrointestinal tract and arterial hypertension, then-cardiovascular disease associated with atherosclerosis. The formation of post-traumatic stress disorder occurred in 289 (91,2%) cases, and the chronic pain syndromes of different localization and different origin - in 192 (60,6%) at different times of the post-war period. But it is post-traumatic stress disorder in combination with chronic pain were decisive in the overall severity of the state of combatants, changes in indicators of free radical oxidation and an increase in biological age. It is proposed to consider accelerated aging, which is formed on the basis of the consequences of severe stress effects, as an independent disease.


Assuntos
Envelhecimento , Doença Crônica , Distúrbios de Guerra , Veteranos , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Dor Crônica/etiologia , Distúrbios de Guerra/complicações , Gastroenteropatias/etiologia , Humanos , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/etiologia , Veteranos/estatística & dados numéricos
6.
Aerosp Med Hum Perform ; 90(11): 953-958, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31666157

RESUMO

BACKGROUND: Actual studies in military training support the use of new methodological approaches such as high intensity interval training and inverse periodization training rather than conventional approaches. However, the application and analysis of success of these new methodologies are as yet unknown.METHODS: The military adapted the civil reverse periodization training system, composed of 6 wk and five sessions per week. For the first 3 wk soldiers performed two sessions with the objective of increasing the maximal strength of the upper and lower body muscles, and three sessions of short high-intensity interval training (HIIT). In the following 3 wk they combined two endurance HIIT and two resistance HIIT sessions with military equipment while conducting a military task.RESULTS: After the training a significant body mass index decrease was found, along with an increase in lower limb muscular strength, aerobic and anaerobic performance, resilience, stress tolerance, and psychological flexibility. Regarding the ratio of acceptance there was an increased ratio compared to previous years of 7%. In addition, married soldiers with children presented greater resilience, stress tolerance, psychological flexibility, and a higher ratio of success.DISCUSSION: Accepted soldiers presented greater psychological status and stress tolerance, highlighting the importance of the work of the unit psychologists to reinforce and monitor the psychometric profile of the soldiers as well as their intrinsic characteristics of personality and emotionality. The greater baseline physical condition and higher performance in all physical tests proves how reverse periodization training models are a great stimuli and training approach in soldiers.Tornero-Aguilera JF, Gregório Pelarigo J, Clemente-Suarez VJ. Psychophysiological intervention to improve preparedness in military Special Operations forces. Aerosp Med Hum Perform. 2019; 90(11):953-958.


Assuntos
Treinamento Intervalado de Alta Intensidade/organização & administração , Militares/psicologia , Força Muscular/fisiologia , Resistência Física/fisiologia , Treinamento de Resistência/organização & administração , Adulto , Índice de Massa Corporal , Distúrbios de Guerra/prevenção & controle , Distúrbios de Guerra/psicologia , Voluntários Saudáveis , Treinamento Intervalado de Alta Intensidade/métodos , Treinamento Intervalado de Alta Intensidade/psicologia , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Psicologia/organização & administração , Psicometria , Resiliência Psicológica , Treinamento de Resistência/métodos , Espanha , Estresse Psicológico/diagnóstico , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologia , Adulto Jovem
8.
Soc Cogn Affect Neurosci ; 14(9): 933-945, 2019 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-31588508

RESUMO

Resting-state functional connectivity (rsFC) is an emerging means of understanding the neurobiology of combat-related post-traumatic stress disorder (PTSD). However, most rsFC studies to date have limited focus to cognitively related intrinsic connectivity networks (ICNs), have not applied data-driven methodologies or have disregarded the effect of combat exposure. In this study, we predicted that group independent component analysis (GICA) would reveal group-wise differences in rsFC across 50 active duty service members with PTSD, 28 combat-exposed controls (CEC), and 25 civilian controls without trauma exposure (CC). Intranetwork connectivity differences were identified across 11 ICNs, yet combat-exposed groups were indistinguishable in PTSD vs CEC contrasts. Both PTSD and CEC demonstrated anatomically diffuse differences in the Auditory Vigilance and Sensorimotor networks compared to CC. However, intranetwork connectivity in a subset of three regions was associated with PTSD symptom severity among executive (left insula; ventral anterior cingulate) and right Fronto-Parietal (perigenual cingulate) networks. Furthermore, we found that increased temporal synchronization among visuospatial and sensorimotor networks was associated with worse avoidance symptoms in PTSD. Longitudinal neuroimaging studies in combat-exposed cohorts can further parse PTSD-related, combat stress-related or adaptive rsFC changes ensuing from combat.


Assuntos
Encéfalo/fisiopatologia , Distúrbios de Guerra/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Encéfalo/diagnóstico por imagem , Feminino , Neuroimagem Funcional , Giro do Cíngulo/fisiopatologia , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Neuroimagem
9.
Med Hypotheses ; 132: 109373, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31450077

RESUMO

Immune system dysregulation in 1991 Gulf War Veterans was caused in part by the nerve gas prophylactic drug pyridostigmine bromide (PB) by direct agonist activation of muscarinic receptors on anergic B and T lymphocytes, leading to multiple types of autoimmune illnesses, and this effect may have been potentiated by combat stress.


Assuntos
Doenças Autoimunes/induzido quimicamente , Distúrbios de Guerra/complicações , Agentes Neurotóxicos/efeitos adversos , Síndrome do Golfo Pérsico/etiologia , Brometo de Piridostigmina/efeitos adversos , Linfócitos B/efeitos dos fármacos , Linfócitos B/imunologia , Distúrbios de Guerra/psicologia , Guerra do Golfo , Humanos , Agonistas Muscarínicos/efeitos adversos , Síndrome do Golfo Pérsico/psicologia , Receptores Muscarínicos , Estresse Psicológico , Linfócitos T/efeitos dos fármacos , Linfócitos T/imunologia
10.
Clin Neurophysiol ; 130(10): 1869-1881, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31408789

RESUMO

OBJECTIVE: To investigate the relationship between the severity of PTSD symptoms, modulation of alpha band oscillations, and behavioral performance in a working memory task. METHODS: Magnetoencephalography data were recorded in 35 participants with combat exposure and various degrees of PTSD symptom severity while they performed a modified Sternberg working memory task: briefly presented sets of two or six letters had to be held in memory and participants indicated whether subsequent probe letters were present or absent from these sets. RESULTS: PTSD scores were positively correlated with the false positive rate in the high memory load condition. Higher rates of false recognition were associated with negative probes that were seen in recent previous trials (negative probe recency effect) or were physically similar with the list letters. The relative alpha band power in the left middle frontal gyrus was negatively correlated with both PTSD scores and false positive rates. CONCLUSIONS: Reduced task specific modulation of alpha band oscillations in left middle frontal cortex may reflect alterations in the functions of pattern separation and suppression of memory traces for irrelevant or no longer relevant information in PTSD. SIGNIFICANCE: The lower amplitude of prefrontal alpha band oscillations may represent an important physiological basis for core PTSD symptoms and can provide a target for interventions to augment response to treatment.


Assuntos
Ritmo alfa/fisiologia , Distúrbios de Guerra/fisiopatologia , Magnetoencefalografia/métodos , Memória de Curto Prazo/fisiologia , Militares , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Distúrbios de Guerra/diagnóstico por imagem , Distúrbios de Guerra/psicologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Militares/psicologia , Tempo de Reação/fisiologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico por imagem , Transtornos de Estresse Pós-Traumáticos/psicologia
11.
Pathologica ; 111(2): 79-85, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31388201

RESUMO

In the conviction that a look at the past can contribute to a better understanding of the present in the field of science too, we discuss here two aspects of the relationship between early 20th century anatomic pathology and psychiatry that have received very little attention, in Italy at least. There was much debate between these two disciplines throughout the 19th century, which began to lose momentum in the early years of the 20th, with the arrival on the scene of schizophrenia (a disease histologically sine materia) in all its epidemiological relevance.The First World War also contributed to the separation between psychiatry and pathology, which unfolded in the fruitless attempts to identify a histopathological justification for the psychological trauma known as shell shock. This condition was defined at the time as a "strange disorder" with very spectacular symptoms (memory loss, trembling, hallucinations, blindness with no apparent organic cause, dysesthesias, myoclonus, bizarre postures, hemiplegia, and more), that may have found neuropathological grounds only some hundred years later.Among the doctors with a passed involvement in the conflict, Ugo Cerletti, the inventor of electroshock treatment, focused on the problem of schizophrenia without abandoning his efforts to identify its organic factors: if inducing a controlled electric shock, just like an experimentally-induced epileptic seizure, seems to allay the psychotic symptoms and heal the patient, then what happens inside the brain? In seeking histological proof of the clinical effects of electroconvulsive therapy ("the destruction of the pathological synapses"), and attempting to isolate molecules (that he called acroagonins) he believed to be synthesized by neurons exposed to strong electric stimulation, Cerletti extended a hand towards anatomic pathology, and took the first steps towards a neurochemical perspective. However his dedication to finding a microscopic explanation for schizophrenia - in the name of a "somatist" approach that, some years earlier, the psychiatrist Enrico Morselli had labelled "histomania" - was unable to prevent psychiatry from moving further and further away from anatomic pathology.


Assuntos
Eletroconvulsoterapia/tendências , Psiquiatria/tendências , Choque Traumático/psicologia , Choque Traumático/terapia , Distúrbios de Guerra/patologia , Distúrbios de Guerra/psicologia , Distúrbios de Guerra/terapia , Eletroconvulsoterapia/métodos , Eletrochoque , Humanos , Itália , Psiquiatria/métodos , Choque Traumático/patologia , I Guerra Mundial
12.
Sports Med Arthrosc Rev ; 27(3): 124-128, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31361723

RESUMO

Resilience, the capacity to recover from a setback or adversity, is a concept that has received considerable recent attention. An individual's resilience predicts their life trajectory following stressful events and this has increasingly been shown in a wide variety of applications. Our understanding of the degree to which we can modify our resilience, and the optimal means to do so, remains in its infancy. The US military has embraced extensive efforts to quantify and build resilience in service members in an effort to preserve the fighting force. We specifically look at the understanding of resilience as it relates to the athletes in terms of competition and return from injury. This article explores the concept of resilience, the efforts to build resilience, lessons learned from the military and applications of the resilience concept to surgical and trauma patients.


Assuntos
Atletas/psicologia , Distúrbios de Guerra/psicologia , Militares/psicologia , Resiliência Psicológica , Humanos , Recuperação de Função Fisiológica , Volta ao Esporte , Retorno ao Trabalho , Estados Unidos
13.
Psychiatry Res ; 278: 309-314, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31255954

RESUMO

Research has described the association between lifetime trauma exposure and psychiatric symptoms among various cohorts, but little is known about the effect of lifetime trauma histories on the symptom expression of active-duty military personnel diagnosed with combat-related posttraumatic stress disorder (PTSD). Active-duty soldiers (N = 162) were diagnosed with PTSD from deployments to Iraq or Afghanistan using the Clinician Administered PTSD Scale. Soldiers then completed self-report measures of depression, anxiety, and PTSD. Lifetime exposure to categories of trauma types and the intensity of exposure was reported on the Life Events Checklist. The number of categories of trauma that happened to them significantly predicted the severity of depression, anxiety, and PTSD symptoms, as well as a positive screen for likely depression diagnosis based on self-reported symptoms. Direct exposure to trauma explained most of the association, as witnessing trauma and hearing about trauma did not explain symptoms beyond events that happened to participants. Interpersonal traumatic events were not associated with psychiatric functioning after controlling for non-interpersonal traumatic events. Assessment of trauma history among post-9/11 service members and veterans should include the frequency and variety of lifetime trauma exposure, given the association with psychiatric functioning.


Assuntos
Distúrbios de Guerra/psicologia , Militares/psicologia , Doenças Profissionais/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Campanha Afegã de 2001- , Ansiedade/psicologia , Depressão/psicologia , Feminino , Humanos , Guerra do Iraque 2003-2011 , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autorrelato , Estados Unidos
14.
Neuropsychology ; 33(7): 913-921, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31192654

RESUMO

OBJECTIVE: Cognitive complaints, such as attentional or memory concerns, are commonly reported by veterans diagnosed with posttraumatic stress disorder (PTSD) or a history of mild traumatic brain injury (mTBI). The degree to which those complaints actually map onto measurable cognitive deficits is unclear and is likely complicated by the severity of trauma-related sequelae. In the present study we sought to characterize the degree to which PTSD symptoms and mTBI accounted for the relationship of subjective cognitive complaints to objective cognitive performance, with the goal of facilitating the accurate assessment of trauma-exposed veterans complaining of cognitive decline. METHOD: A sample of 203 U.S. military veterans previously deployed to Iraq and/or Afghanistan were assessed for PTSD severity, history of blast and impact mTBI, objective cognitive function, and subjective cognitive complaints. Separate mediation analyses were conducted to explore the degree that PTSD severity, blast mTBI severity, and impact mTBI severity influenced the association between subjective cognitive complaints and objective cognitive performance. Models reflecting significant mediation were followed by post hoc moderated mediation analyses. RESULTS: Subjective cognitive complaints and objective cognitive performance were significantly associated (ß = -6.49, SE = 2.85, p = .03), but this relationship was mediated by PTSD severity (ß= -2.95, SE = 2.86, p = .30). PTSD mediation was not moderated by either blast or impact mTBI. CONCLUSION: The present results delineate the prominent impact of PTSD symptoms, relative to blast and impact mTBI, on cognition following combat. These findings highlight the importance of assessing for trauma-related psychopathology in those seeking neuropsychological assessment or rehabilitative care for cognitive complaints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Concussão Encefálica/psicologia , Transtornos Cognitivos/psicologia , Distúrbios de Guerra/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Campanha Afegã de 2001- , Traumatismos por Explosões/psicologia , Concussão Encefálica/complicações , Feminino , Humanos , Guerra do Iraque 2003-2011 , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Transtornos de Estresse Pós-Traumáticos/complicações , Estados Unidos , Adulto Jovem
15.
Curr Psychiatry Rep ; 21(7): 58, 2019 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-31172321

RESUMO

PURPOSE OF REVIEW: Combat-related posttraumatic stress disorder is increasingly recognized as having a variable course in returning veterans. Relatively few studies have identified predictors of illness duration or severity in this population. This review sought to synthesize the existing literature. RECENT FINDINGS: The existing literature remains limited and heterogeneous. However, several studies identified hyperarousal and pre-deployment dissociation as predictive of disease severity, and re-experiencing as predictive of suicidality in veterans with combat-related PTSD. No other pre-, peri-, or posttraumatic psychosocial predictors of individual symptoms or overall disease severity have been identified in replicated studies. Important clinical factors to explore in the assessment of PTSD in combat veterans may now include hyperarousal and a history of dissociation as these may predict disease severity, and re-experiencing as this has been identified as a significant predictor of suicidality. Further study into this topic may reveal biological or more sensitive psychosocial markers predicting illness severity and prognosis.


Assuntos
Distúrbios de Guerra/psicologia , Transtornos Dissociativos/psicologia , Crescimento Psicológico Pós-Traumático , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Distúrbios de Guerra/diagnóstico , Transtornos Dissociativos/diagnóstico , Humanos , Prognóstico , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Guerra
16.
Psychiatry Res ; 278: 65-69, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31153009

RESUMO

The World Health Organization recently released the 11th revision of the International Classification of Diseases with the inclusion of Complex Posttraumatic Stress Disorder (CPTSD). Despite the emerging research examining the symptom structure of CPTSD, to date, none so far have reached consensus on what best represents CPTSD, particularly in soldiers who are exposed regularly in combat situations. This study examined seven latent CPTSD models in a sample of Filipino combat-exposed soldiers (n = 450). Results of confirmatory factor analyses indicated that the correlated 6 factor first-order model (model 2), comprising of re-experiencing, avoidance, persistent sense of current threat, affective dysregulation, negative self-concept, and disturbances in relationships, has the best fit. These findings have implications for understanding CPTSD as a diagnostic entity and provide information on the assessment and crafting of complex trauma interventions, particularly among Filipino combat-exposed soldiers.


Assuntos
Distúrbios de Guerra/diagnóstico , Distúrbios de Guerra/psicologia , Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Distúrbios de Guerra/epidemiologia , Análise Fatorial , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Filipinas/epidemiologia , Autoimagem , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Organização Mundial da Saúde
17.
Psychol Trauma ; 11(8): 877-885, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31070441

RESUMO

OBJECTIVE: Using Stein et al.'s (2012) categorization scheme for typing Criterion A events (i.e., Life Threat to Self, Life Threat to Other, Aftermath of Violence, Traumatic Loss, Moral Injury by Self, and Moral Injury by Other) and extending Litz et al.'s (2018) prior work, we investigated the prevalence of trauma types, prevalence of posttraumatic stress disorder within each trauma type, and associations between trauma types and behavioral and mental health outcomes for an epidemiological sample of service members. METHOD: Criterion A events coded by independent raters (kappas = .85-1.00) were used to determine prevalence rates and to conduct two path models examining all trauma types in relation to mental health outcomes. RESULTS: Consistent with prior research, we found events containing Life Threat to Self (51.1%) and Life Threat to Other (30.8%) to be most prevalent, and a majority of events (62.9%) were coded with one trauma type. Although least prevalent, Aftermath of Violence (12.0%) and Moral Injury by Self (4.8%) were most frequently and strongly associated with worse mental health outcomes. Path models predicted a very small amount of variance in continuous outcomes, thus limiting the interpretation of findings. CONCLUSION: More epidemiological research is needed to understand the role of trauma type in relation to mental health among nontreatment-seeking service members. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Distúrbios de Guerra/epidemiologia , Militares/estatística & dados numéricos , Trauma Psicológico/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Feminino , Humanos , Masculino , Trauma Psicológico/classificação , Estados Unidos/epidemiologia , Adulto Jovem
18.
Neuropsychology ; 33(5): 711-724, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31144830

RESUMO

OBJECTIVE: It is increasingly recognized that trauma victims, particularly Veterans, have co-occurring psychological and physical conditions that impact cognition, especially the domains of sustained attention and executive functioning. Although previous work has generally attempted to isolate the unique cognitive effects of common combat-related comorbidities, less work has been done to examine how these conditions co-occur, and whether unique cognitive signatures accompany certain clinical combinations. METHOD: To address this gap, we examined how several deployment-related conditions were associated with performance on a well-validated measure of sustained attention (i.e., gradual onset continuous performance task [gradCPT]) and a battery of standard neuropsychological measures in 123 Veterans from the Translational Research Center for TBI and Stress Disorders. Initially, a Principal component analysis was conducted to investigate how comorbid conditions grouped together. RESULTS: Several sustained attention measures from the gradCPT were differentially associated with four unique combinations of trauma-related pathology. Specifically, a somatic component representing the combination of current pain, sleep disturbance, and mild traumatic brain injury was associated with a higher rate of failures of attentional engagement. On the other hand, a comorbid posttraumatic stress disorder (PTSD) and mood disorder component (moodPTSD), as well as a substance use disorder component, were associated with higher rates of inhibitory control failures. Increased attentional instability was associated with moodPTSD as well as an anxiety disorder component. In contrast, the cognitive effects of deployment-related trauma were not observed on standard neuropsychological measures. CONCLUSION: These findings suggest that unique combinations of trauma-related pathology have dissociable effects on sustained attentional control. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/fisiopatologia , Atenção/fisiologia , Concussão Encefálica/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Distúrbios de Guerra/fisiopatologia , Função Executiva/fisiologia , Transtornos do Humor/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Veteranos , Adulto , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/epidemiologia , Concussão Encefálica/complicações , Concussão Encefálica/epidemiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Distúrbios de Guerra/complicações , Distúrbios de Guerra/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/complicações , Transtornos do Humor/epidemiologia , Testes Neuropsicológicos , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricos
19.
Sleep ; 42(8)2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31106808

RESUMO

Since 2001, the United States has been engaged in the longest and most expensive overseas conflict in its history. Sleep disorders, especially insomnia and obstructive sleep apnea (OSA), are common in service members and appear related to deployment and combat exposure, but this has not been systematically examined. Therefore, the incidence of clinically diagnosed insomnia and OSA from 1997 to 2011 in the entire population of US Army soldiers was determined and associations of these disorders with deployment and combat exposure examined. This observational retrospective cohort study linked medical, demographic, deployment, and combat casualty data from all active duty US Army soldiers serving from 1997 to 2011 (n = 1 357 150). The mediating effects of multiple known comorbid conditions were considered. From 2003 to 2011, there were extraordinary increases in incidence of insomnia (652%) and OSA (600%). Factors increasing insomnia risk were deployment (risk ratio [RR] [deployed/not deployed] = 2.06; 95% confidence interval [CI], 2.04-2.08) and combat exposure (RR [exposed/not exposed] = 1.20; 95% CI, 1.19-1.22). Risk of OSA was increased by deployment (RR [deployed/not deployed] = 2.14; 95% CI, 2.11-2.17), but not combat exposure (RR [exposed/not exposed] = 1.00; 95% CI, 0.98-1.02). These relationships remained after accounting for other factors in multivariable analyses. A number of comorbid medical conditions such as posttraumatic stress disorder and traumatic brain injury mediated a portion of the association between the sleep disorders and deployment. It is essential to determine underlying mechanisms responsible for these very large increases in insomnia and OSA and introduce effective preventive measures.


Assuntos
Distúrbios de Guerra/epidemiologia , Militares/estatística & dados numéricos , Apneia Obstrutiva do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos
20.
Psychiatr Q ; 90(2): 431-445, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31054021

RESUMO

To evaluate the outcomes of the antiarousal medications valproate, risperidone, and quetiapine on completion of treatment of cognitive processing therapy (CPT) for PTSD. A case series of fifty treatment-seeking adult (≥18 years) veterans with mild traumatic brain injury and combat-related PTSD who had unsuccessful trials of 2 or more first-line agents and previously declined treatment with trauma-focused therapy, seen at the psychiatric outpatient services of the local Polytrauma Rehabilitation Center from January 1, 2014, through December 31, 2017. Patients were prescribed valproate (n = 8), risperidone (n = 17), or quetiapine (n = 25) and were referred for individual weekly treatment with CPT. Outcome measurements of interest were measures of engagement and completion rate of CPT, PTSD Checklist total score (range, 0-80; higher scores indicate greater PTSD severity) and arousal subscale score (range, 0-24; higher scores indicate greater arousal severity), and clinical observations of sleep variables. Of the 50 patients included in the study, 48 (96%) were men; mean (SD) age was 36 (8) years. Eighteen (86%) patients initially receiving quetiapine and none taking valproate or risperidone became adequately engaged in and completed CPT. Among patients who completed CPT, the mean decrease in the PTSD Checklist score was 25 [95% CI, 30 to 20] and 9 (50%) patients no longer met criteria for PTSD. These preliminary findings support quetiapine as an adjunctive medication to facilitate CPT. A pragmatic trial is needed to evaluate the efficacy, safety, and feasibility of quetiapine to improve engagement in and completion rate of CPT.


Assuntos
Antipsicóticos/farmacologia , Concussão Encefálica/terapia , Terapia Cognitivo-Comportamental , Distúrbios de Guerra/terapia , Avaliação de Resultados em Cuidados de Saúde , Fumarato de Quetiapina/farmacologia , Transtornos de Estresse Pós-Traumáticos/terapia , Cooperação e Adesão ao Tratamento , Veteranos , Adulto , Concussão Encefálica/tratamento farmacológico , Distúrbios de Guerra/tratamento farmacológico , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA