Topiramate as Monotherapy or Adjunctive Treatment for Posttraumatic Stress Disorder: A Meta-Analysis.

Posttraumatic stress disorder (PTSD) is a chronic and debilitating condition for which clinicians sometimes turn to anticonvulsants as a treatment for symptoms. This study was a systematic review and meta-analysis of randomized controlled trials (RCT) that have assessed the efficacy of topiramate as monotherapy or adjunctive therapy, compared to placebo, for the treatment of PTSD in adults. Prescribers may be reluctant to turn to topiramate, given the commonly reported side effects of impaired cognition, sedation, fatigue, and headache. We searched PubMed, PsycInfo, and Cochrane Central databases for relevant trials. Five studies were identified as RCTs and thus met inclusion criteria; one additional nonpublished study was identified via phone contact with its authors. Of these six studies, one was excluded from the statistical meta-analysis due to its high dropout rate (16 of 40 participants). One of these studies was excluded from a stratified analysis of symptom types because this subscale data were unavailable.  For overall symptomatology, topiramate showed a medium, but not significant effect, standardized mean difference (SMD) = 0.55, p = .082. Topiramate showed a small and significant reduction of hyperarousal symptoms, SMD = 0.35, 95% CI [0.029, 0.689], p = .033. Topiramate did not significantly reduce reexperiencing symptoms, SMD = 0.29, 95% CI [-0.019, 0.597], p = .067, or avoidance symptoms, SMD = 0.20, 95% CI [-0.105, 0.509], p = .198. Results did not differ significantly between veteran and nonveteran subjects, or between topiramate as monotherapy and adjunctive therapy. Further studies on topiramate will clarify its role in PTSD treatment.

The effect of obesity on outcomes among injured patients.

INTRODUCTION: The potential consequences of obesity in trauma patients are significant, yet incompletely defined by previous studies. OBJECTIVES: To evaluate the effect of obesity on morbidity and mortality among injured patients. METHODS: Medical records of all trauma patients evaluated at an American College of Surgeons verified Level I trauma center over a 1-year period were retrospectively reviewed. Morbidity and mortality were assessed after patients were stratified according to body mass index (BMI=kilograms/meters) and injury severity score. RESULTS: The mortality of patients with a BMI > or =35 (obese patients) was 10.7% versus 4.1% for patients with a BMI<35 (lean patients, p = 0.003). Nearly 27% of obese patients versus 17.6% of lean patients experienced one or more complications while in the hospital (p = 0.02). CONCLUSIONS: Obese patients are significantly more likely than lean patients to experience complications and death after a traumatic event. This effect is enhanced with higher levels of injury.