RESUMEN
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder developing after a traumatic event like participation in combat activities. Objective diagnosis of combat PTSD and effective rehabilitation of war veterans is a current multifaceted problem with particularly high social costs. This review aims to evaluate the potential of virtual reality technique used as exposure therapy tool (VRET) to rehabilitate combat veterans and service members with PTSD. The review was written following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The final analysis includes 75 articles published in 2017-2022. VRET therapeutic effect mechanisms were examined along with protocols and scenarios of VRET combined with other interventions influencing PTSD treatment like pharmacotherapy, motion-assisted multi-modular memory desensitization and reconsolidation (3MDR), transcranial magnetic stimulation. The necessity is substantiated of psychophysiological measurements for objectification of PTSD clinical criteria and its dynamics during treatment. It was shown that inclusion of VRET to the package of PTSD rehabilitation interventions positively affects the results due to the enhanced effect of presence and greater experience personalization. Thus, VRET may be an effective, controlled, and cost-effective alternative for PTSD treatment in combatants, including those not responding to conventional therapy.
Asunto(s)
Terapia Implosiva , Medicina , Trastornos por Estrés Postraumático , Veteranos , Realidad Virtual , Humanos , Trastornos por Estrés Postraumático/terapiaRESUMEN
Forty patients were included in the study: 20 patients of main group received cereton in dosage 1000 mg intramuscular during 15 days and 20 patients of control group received placebo. Patient's state was assessed with MMSE, Hodkinson test, "learning of 10 words", Spielberg's trait-state anxiety inventory (a modification of Khanin), Beck depression scale. Brain blood supply was analyzed with rheoencephalography, balance in the vertical position--with stabilometry. The rehabilitation of disturbed cognitive functions measured with MMSE and "learning of 10 words" test was significantly better in the main group of patients (p < 0.05). Reoencephalographic data showed the significant increase of blood supply, mainly in the left brain hemisphere, compared with baseline values (p = 0.05) as well as with the control group (p = 0.03). There was a trend towards the higher rate of blood supply that reflected the decrease of baseline tonus of resistance arteries in both hemispheres, predominantly in the left side, with the positive dynamics as compared to the same values in the controls (p < 0.041). The results of stabilometric study revealed a trend toward the decrease of initially increased deviations of center of pressure on both axes, mostly in the frontal plane, in the main group (p < 0.001). Almost all patients reported a good tolerability of the drug. In conclusion, the course treatment with cereton in the late rehabilitation and residual periods of hemorrhagic stroke leads to the significant improvement of cognitive functions and brain blood supply, in particular brain hemispheric regions, due to the decrease of baseline tonus of resistance arteries and promotes the improvement of balance function.