Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 40
Filtrar
1.
Depress Anxiety ; 38(9): 882-885, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34469042

RESUMO

INTRODUCTION: The ongoing coronavirus disease 2019 (COVID-19) pandemic is a globally significant crisis with a rapid spread worldwide, high rates of illness and mortality, a high degree of uncertainty, and a disruption of daily life across the sociodemographic spectrum. The clinically relevant psychological consequences of this catastrophe will be long-lasting and far-reaching. There is an emerging body of empirical literature related to the mental health aspects of this pandemic and this body will likely expand exponentially. The COVID-19 pandemic is an example of a historic catastrophe from which we can learn much and from which the field will need to archive, interpret, and synthesize a multitude of clinical and research observations. METHODS: In this commentary, we discuss situations and contexts in which a diagnosis of posttraumatic stress disorder (PTSD) may or may not apply within the context of diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) criteria. RESULTS: Our consensus is that a COVID-related event cannot be considered traumatic unless key aspects of DSM-5's PTSD Criterion A have been established for a specific type of COVID-19 event (e.g., acute, life-threatening, and catastrophic). CONCLUSION: The application of a more liberal interpretation of Criterion A will dilute the PTSD diagnosis, increase heterogeneity, confound case-control research, and create an overall sample pool with varying degrees of risk and vulnerability factors.


Assuntos
COVID-19 , Transtornos de Estresse Pós-Traumáticos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Pandemias , SARS-CoV-2 , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia
2.
Trials ; 22(1): 594, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488824

RESUMO

BACKGROUND: Post-traumatic stress disorder (PTSD) is a significant public health problem, affecting approximately 7% of the general population and 13-18% of the combat Veteran population. The first study using acupuncture for PTSD in a civilian population showed large pre- to post-treatment effects for an empirically developed verum protocol, which was equivalent to group cognitive behavior therapy and superior to a wait-list control. The primary objective of this study is to determine both clinical and biological effects of verum acupuncture for combat-related PTSD in treatment-seeking US Veterans. METHODS: This is a two-arm, parallel-group, prospective randomized placebo-controlled clinical trial. The experimental condition is verum acupuncture and the placebo control is sham (minimal) acupuncture in 1-h sessions, twice a week for 12 weeks. Ninety subjects will provide adequate power and will be allocated to group by an adaptive randomization procedure. The primary outcome is change in PTSD symptom severity from pre- to post-treatment. The secondary biological outcome is change from pre- to post-treatment in psychophysiological response, startle by electromyographic (EMG) eyeblink. Assessments will be conducted at pre-, mid-, post-, and 1-month post-treatment, blind to group allocation. Intent-to-treat analyses will be conducted. DISCUSSION: The study results will be definitive because both clinical and biological outcomes will be assessed and correlated. Issues such as the number needed for recruitment and improvement, use of sham acupuncture, choice of biological measure, and future research need will be discussed. TRIAL REGISTRATION: ClinicalTrials.gov NCT02869646 . Registered on 17 August 2016.


Assuntos
Terapia por Acupuntura , Transtornos de Estresse Pós-Traumáticos , Veteranos , Terapia por Acupuntura/efeitos adversos , Humanos , Estudos Prospectivos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/terapia , Resultado do Tratamento
3.
Behav Brain Res ; 404: 113172, 2021 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-33577879

RESUMO

Obstructive sleep apnea (OSA) is a respiratory condition characterized by interrupted sleep due to repeated, temporary collapse of the soft tissue of the upper airway that can lead to a cascade of physiological and psychological adverse health outcomes. The most common therapeutic interventions for OSA patients include the application of continuous positive airway pressure (CPAP) which acts to keep the airway open and, as such, provides less interrupted and more restorative sleep. Improved sleep has been linked to more efficacious treatments for psychiatric conditions most notably those that include cognitive-behavioral elements, new learning, and memory consolidation. In the current study, we investigated the acquisition, inhibition, and extinction of conditioned fear in OSA patients, before and after CPAP therapy, using an established fear-potentiated startle paradigm. Patients with OSA displayed an intact ability to acquire, inhibit, and extinguish fear prior to CPAP treatment and this ability was significantly enhanced following CPAP usage. In addition, those patients with more severe OSA, as measured by apnea-hypopnea index (AHI), were more likely to show improved fear inhibition and extinction. Lastly, we observed impairments in discrimination between reinforced and nonreinforced conditioned stimuli, in the inhibition of fear, and in fear extinction in a subset of patients with OSA and co-morbid posttraumatic stress disorder (PTSD). These data suggest that evolving treatment algorithms for PTSD should address disrupted sleep problems prior to initiation of inhibition/extinction-based exposure therapies.

4.
Psychiatr Serv ; 72(3): 247-253, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33167819

RESUMO

OBJECTIVE: Coordinated specialty care (CSC) has become the standard of care for first-episode psychosis (FEP). The gap between CSC best practices and the actual care delivered is unknown. This longitudinal study aimed to measure that gap by using a large Medicaid claims database and 10 quality indicators (QIs) reflecting aspects of CSC and to study the relationship between these QIs and future health care utilization. METHODS: Individuals with FEP were identified in a Missouri Medicaid claims database. Participants were required to have been eligible for Medicaid benefits for at least 10 months in the year prior to and the year after their first episode of psychosis and to have had no evidence of a prior psychosis diagnosis. Descriptive statistics were generated for each of the QIs, and a stratified Cox regression was used to identify predictors of subsequent health care utilization. RESULTS: Data were obtained for 6,246 participants, and follow-up lasted a mean of 4.24 years. Significant practice gaps were found in the use and monitoring of antipsychotic medications. Of those prescribed antipsychotic medication, 5% received prescriptions above recommended daily doses, 16% received two or more antipsychotics, and 20% were treated with olanzapine or clozapine. Among the QIs, lack of monitoring for smoking (hazard ratio [HR]=2.71, 95% confidence interval [CI]=2.47-2.97) and lack of integrated care delivery in treatment (HR=2.00, 95% CI=1.92-2.08) were most associated with psychiatric hospitalization. CONCLUSIONS: In most cases, treatment was far from meeting CSC recommendations, suggesting that implementation of CSC requires substantial modifications to delivery of care for individuals with FEP.

5.
CNS Spectr ; : 1-7, 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32362287

RESUMO

BACKGROUND.: Prazosin has been an accepted treatment for patients with post-traumatic stress disorder (PTSD) who experience sleep disturbances, including nightmares. Results of a recent large randomized control trial did not find benefit of prazosin vs placebo in improving such outcomes. A meta-analysis that includes this most recent trial was conducted to examine the pooled effect of prazosin vs placebo on sleep disturbances and overall PTSD symptoms in patients with PTSD. METHODS.: A systematic review of the published literature on trials comparing prazosin vs placebo for improvement of overall PTSD scores, nightmares, and sleep quality was conducted. Hedges' g standardized mean differences (SMD) between prazosin and placebo were calculated for each outcome across studies. RESULTS.: Six randomized placebo-controlled studies representing 429 patients were included in the analysis, including two studies with a crossover design. Results showed prazosin significantly improved overall PTSD scores (SMD = -0.31; 95% confidence intervals [CI]: -0.62, -0.01), nightmares (SMD = -0.75; 95% CI: -1.24, -0.27), and sleep quality (SMD = -0.57; 95% CI: -1.02, -0.13). In the largest trial, prazosin showed a reduction in clinical outcome measures similar to past studies, but a relatively large placebo effect size, particularly for nightmares, contributed to no treatment differences. CONCLUSIONS.: Despite the results of a recent, large randomized study, pooled effect estimates show that prazosin has a statistically significant benefit on PTSD symptoms and sleep disturbances. Limitations that should be considered include heterogeneity of study design and study populations as well as the small number of studies conducted and included in this meta-analysis.

6.
PLoS One ; 14(11): e0216266, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31697679

RESUMO

Substance Use Disorder (SUD) is a major public health concern affecting an estimated 22.5 million individuals in the United States. The primary aim of this study was to characterize psychological pain in a cohort of patients participating in outpatient treatment for SUD. A secondary aim was to determine the relationships between pre-treatment assessments of psychological pain, depression, anxiety and hopelessness with treatment retention time and completion rates. Data was analyzed from 289 patients enrolled in an outpatient community drug treatment clinic in Southern California, U.S. A previously determined threshold score on the Mee-Bunney Psychological Pain Assessment Scale (MBP) was utilized to group patients into high and low-moderate scoring subgroups. The higher pain group scored higher on measures of anxiety, hopelessness and depression compared to those in the low-moderate pain group. Additionally, patients scoring in the higher psychological pain group exhibited reduced retention times in treatment and more than two-fold increased odds of dropout relative to patients with lower pre-treatment levels of psychological pain. Among all assessments, the correlation between psychological pain and treatment retention time was strongest. To our knowledge, this is the first study to demonstrate that psychological pain is an important construct which correlates with relevant clinical outcomes in SUD. Furthermore, pre-treatment screening for psychological pain may help target higher-risk patients for clinical interventions aimed at improving treatment retention and completion rates.


Assuntos
Dor/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Assistência Ambulatorial/psicologia , Ansiedade/psicologia , Ansiedade/terapia , Depressão/psicologia , Depressão/terapia , Feminino , Humanos , Masculino , Dor/diagnóstico , Medição da Dor/métodos , Medição da Dor/psicologia , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos
7.
Contemp Clin Trials ; 87: 105857, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31669451

RESUMO

BACKGROUND: PTSD, which has been identified in up to 23% of post-9-11 veterans, often results in a chronic, pernicious course. Thus, effective treatments are imperative. The Institute of Medicine (IOM) concluded that the only intervention for PTSD with sufficient evidence to conclude efficacy is exposure therapy. This Phase III trial compares the efficacy of exposure therapy for combat-related PTSD delivered in two different formats- via virtual reality exposure therapy (VRE) or prolonged exposure therapy (PE)- combined with D-Cycloserine (DCS), a cognitive enhancer shown to facilitate the extinction of fear. METHODS/DESIGN: Military personnel of any duty status and civilians deployed to Iraq and Afghanistan were eligible. Participants were randomly assigned to 9 sessions of exposure therapy (VRE or PE) and medication (50 mg DCS or placebo). Participants were treated at three geographically diverse sites. Participants were re-assessed at 3-months post-treatment. The co-primary hypotheses are that (1) DCS will augment response to exposure therapy (both VRE and PE) on PTSD symptoms; (2) VRE will be associated with greater improvement than PE. Genetic and psychophysiological markers will be evaluated as potential moderators and mediators of treatment outcomes as well as secondary outcomes. DISCUSSION: This study is the first to compare the relative efficacy of DCS-augmented VRE versus PE on PTSD symptoms. The design has several advantages: participants received an active, effective treatment and predictors of response to treatment included genetic and psychobiological measures. The results may directly influence the future delivery of services, and contribute to the development of a standardized treatment protocol. TRIAL REGISTRATION: NCT01352637.


Assuntos
Ciclosserina/uso terapêutico , Terapia Implosiva/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Terapia de Exposição à Realidade Virtual/métodos , Terapia Combinada , Ciclosserina/administração & dosagem , Humanos , Transtornos de Estresse Pós-Traumáticos/genética
8.
Psychiatr Rehabil J ; 42(3): 210-219, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30920257

RESUMO

OBJECTIVE: Examine preferences for family involvement in psychiatric care in a large, representative sample of veterans in treatment for schizophrenia. METHOD: Veterans with schizophrenia or schizoaffective disorder (N = 801) completed an assessment that included questions about demographic and clinical characteristics, status of family support, and preference for family involvement in their psychiatric care. Open-ended items were independently coded by two raters and categorized; Cohen's kappa was calculated for each category. RESULTS: Among the 801 participants, 496 (61.9%) indicated that they had a family member who provided them with regular support; 304 (37.9%) had no family member who provided support; and 1 did not respond. Among the 304 without support, 272 (89.4%) had a living family member. Of the 496 participants who had a supportive family member, 135 (27.2%) wanted their family member involved in their care. Of the 272 participants who did not have a supportive family member, but had living family, 57 (21.0%) wanted their family involved. Barriers to involvement included concerns about privacy and burden. Preferred method of involvement included contact with the patient's psychiatrist and education about the illness. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Preferences indicated by this large representative sample of individuals in care for schizophrenia indicate that a majority have supportive family and a substantial minority want family involved in their psychiatric care. Clinicians can address concerns about privacy and burden and deliver preferred services by phone or mail, overcoming anticipated barriers. Desire for family support groups was limited but present. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Família , Preferência do Paciente/estatística & dados numéricos , Transtornos Psicóticos/terapia , Esquizofrenia/terapia , Apoio Social , Veteranos/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
9.
J Behav Health Serv Res ; 46(1): 129-139, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30465314

RESUMO

"Enhancing QUality of Care In Psychosis" (EQUIP) was an eight-site clustered controlled trial of the implementation and effectiveness of patient-reported outcomes to support evidence-based practice and improve care for schizophrenia. Implementation sites chose to improve care for weight. Implementation included monitoring patient-reported outcomes using kiosks, patient and staff education, quality improvement teams, and phone care management. Qualitative and quantitative methods compared implementation and effectiveness between sites for 13 months. Eighty percent of 801 randomly selected patients were overweight. Two hundred one clinicians varied in competency. Baseline use of behavioral weight services was low. At implementation sites, patients became 2.3 times more likely to use weight services compared with control sites (95% CI, 1.5-3.6; χ2 = 14.4; p < 0.01). There was no effect on the weight gain liability of medications prescribed. Controlling for baseline, patients' final weight at control sites was 5.9 ± 2.7 kg heavier than at implementation sites (F = 4.8, p = 0.03). Patient-reported outcomes can inform implementation of evidence-based practice and improvement in outcomes.


Assuntos
Atitude do Pessoal de Saúde , Comportamentos Relacionados com a Saúde , Pessoal de Saúde/psicologia , Serviços de Saúde Mental , Sobrepeso/prevenção & controle , Psicologia do Esquizofrênico , Adulto , Análise de Variância , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Peso Corporal , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/complicações , Sobrepeso/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Escalas de Graduação Psiquiátrica , Esquizofrenia/tratamento farmacológico , Estados Unidos , Ganho de Peso
10.
N Engl J Med ; 378(6): 507-517, 2018 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-29414272

RESUMO

BACKGROUND: In randomized trials, prazosin, an α1-adrenoreceptor antagonist, has been effective in alleviating nightmares associated with post-traumatic stress disorder (PTSD) in military veterans. METHODS: We recruited veterans from 13 Department of Veterans Affairs medical centers who had chronic PTSD and reported frequent nightmares. Participants were randomly assigned to receive prazosin or placebo for 26 weeks; the drug or placebo was administered in escalating divided doses over the course of 5 weeks to a daily maximum of 20 mg in men and 12 mg in women. After week 10, participants continued to receive prazosin or placebo in a double-blind fashion for an additional 16 weeks. The three primary outcome measures were the change in score from baseline to 10 weeks on the Clinician-Administered PTSD Scale (CAPS) item B2 ("recurrent distressing dreams"; scores range from 0 to 8, with higher scores indicating more frequent and more distressing dreams); the change in score from baseline to 10 weeks on the Pittsburgh Sleep Quality Index (PSQI; scores range from 0 to 21, with higher scores indicating worse sleep quality); and the Clinical Global Impression of Change (CGIC) score at 10 weeks (scores range from 1 to 7, with lower scores indicating greater improvement and a score of 4 indicating no change). RESULTS: A total of 304 participants underwent randomization; 152 were assigned to prazosin, and 152 to placebo. At 10 weeks, there were no significant differences between the prazosin group and the placebo group in the mean change from baseline in the CAPS item B2 score (between-group difference, 0.2; 95% confidence interval [CI], -0.3 to 0.8; P=0.38), in the mean change in PSQI score (between-group difference, 0.1; 95% CI, -0.9 to 1.1; P=0.80), or in the CGIC score (between-group difference, 0; 95% CI, -0.3 to 0.3; P=0.96). There were no significant differences in these measures at 26 weeks (a secondary outcome) or in other secondary outcomes. At 10 weeks, the mean difference between the prazosin group and the placebo group in the change from baseline in supine systolic blood pressure was a decrease of 6.7 mm Hg. The adverse event of new or worsening suicidal ideation occurred in 8% of the participants assigned to prazosin versus 15% of those assigned to placebo. CONCLUSIONS: In this trial involving military veterans who had chronic PTSD, prazosin did not alleviate distressing dreams or improve sleep quality. (Funded by the Department of Veterans Affairs Cooperative Studies Program; PACT ClinicalTrials.gov number, NCT00532493 .).


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Sonhos/efeitos dos fármacos , Prazosina/administração & dosagem , Transtornos do Sono-Vigília/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Veteranos , Antagonistas de Receptores Adrenérgicos alfa 1/efeitos adversos , Adulto , Terapia Combinada , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Hospitais de Veteranos , Humanos , Masculino , Pessoa de Meia-Idade , Prazosina/efeitos adversos , Escalas de Graduação Psiquiátrica , Psicoterapia , Sono/efeitos dos fármacos , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Ideação Suicida , Falha de Tratamento , Estados Unidos
12.
Artigo em Inglês | MEDLINE | ID: mdl-28858440

RESUMO

Objective: To determine the efficacy, safety, and tolerability of vilazodone in the treatment of posttraumatic stress disorder (PTSD) with comorbid mild-to-moderate depression. Methods: A 12-week randomized, double-blind, placebo-controlled trial was conducted in adult outpatients who met DSM-IV criteria for PTSD with comorbid depression between February 2013 and September 2015. Participants were randomly assigned to receive vilazodone 40 mg/d or placebo, and outcome measures were obtained at scheduled visits. Primary outcome measures included change in PTSD symptoms from baseline to end of study as indexed by the Clinician-Administered PTSD Scale (CAPS) and PTSD Symptom Scale-Self-Report (PSS-SR). Secondary outcome measures of anxiety, depression, and impairment were obtained, as well as biomarker assessment at baseline and end of study. Results: A total of 59 patients were randomly assigned to receive vilazodone (n = 29) or placebo (n = 30). Of those who were randomized, there were 25 completers in the vilazodone group and 22 completers in the placebo group. No significant differences were observed between the groups on any of the primary or secondary outcome measures. Vilazodone was generally well tolerated with few differences in the rate of adverse events between groups. Conclusions: Treatment with vilazodone 40 mg/d did not improve symptoms of PTSD and comorbid depression. Further investigation of the biological mechanisms underlying PTSD may lead to identification of improved therapeutic targets. Trial Registration: ClinicalTrials.gov identifier: NCT01715519.


Assuntos
Transtorno Depressivo/complicações , Transtorno Depressivo/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Cloridrato de Vilazodona/uso terapêutico , Adulto , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Comorbidade , Método Duplo-Cego , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Autorrelato , Inibidores de Captação de Serotonina/efeitos adversos , Resultado do Tratamento , Cloridrato de Vilazodona/efeitos adversos
13.
PLoS One ; 12(5): e0177974, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28558020

RESUMO

Psychological pain is a relatively understudied and potentially important construct in the evaluation of suicidal risk. Psychological pain also referred to as 'mental pain' or 'psychache' can be defined as an adverse emotional reaction to a severe trauma (e.g., the loss of a child) or may be associated with an illness such as depression. When psychological pain levels reach intolerable levels, some individuals may view suicide as the only and final means of escape. To better understand psychological pain, we previously developed and validated a brief self-rating 10-item scale, Mee-Bunney Psychological Pain Assessment Scale [MBP] in depressed patients and non-psychiatric controls. Our results showed a significant increase in psychological pain in the depressed patients compared to controls. We also observed a significant linear correlation between psychological pain and suicidality in the depressed patient cohort. The current investigation extends our study of psychological pain to a diagnostically heterogeneous population of 57 US Veterans enrolled in a suicide prevention program. In addition to the MBP, we administered the Columbia Suicide Severity Rating Scale (C-SSRS), Beck Depression Inventory (BDI-II), Beck Hopelessness Scale (BHS), and the Barratt Impulsiveness Scale (BIS-11). Suicidal patients scoring above a predetermined threshold for high psychological pain also had significantly elevated scores on all the other assessments. Among all of the evaluations, psychological pain accounted for the most shared variance for suicidality (C-SSRS). Stepwise regression analyses showed that impulsiveness (BIS) and psychological pain (MBP) contributed more to suicidality than any of the other combined assessments. We followed patients for 15 months and identified a subgroup (24/57) with serious suicide events. Within this subgroup, 29% (7/24) had a serious suicidal event (determined by the lethality subscale of the C-SSRS), including one completed suicide. Our results build upon our earlier findings and recent literature supporting psychological pain as a potentially important construct. Systematically evaluating psychological pain along with additional measures of suicidality could improve risk assessment and more effectively guide clinical resource allocation toward prevention.


Assuntos
Medição da Dor , Dor/psicologia , Ideação Suicida , Veteranos/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Estados Unidos , United States Department of Veterans Affairs
14.
J Trauma Stress ; 30(2): 186-189, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28273371

RESUMO

There is growing evidence that sleep disturbances may impede the utility of existing therapeutic interventions for people with posttraumatic stress disorder (PTSD). This retrospective medical record review examined the hypothesis that sleep disturbance affects the outcome of prolonged exposure (PE) therapy for PTSD. We identified 18 combat veterans with PTSD who had completed PE therapy. There were 6 subjects who had sleep-disordered breathing, 5 of whom were documented by sleep polysomnography. All subjects in the sleep-disordered group took part in a minimum of 10 sessions; the mean number of sessions was comparable between the sleep-disordered group and the group without a sleep disorder. Posttreatment PTSD Checklist scores were significantly reduced in those without a sleep disorder (-28.25; 58.0% reduction, F(1, 11) = 59.04, p < .001), but were not reduced in those with sleep-disordered breathing (-7.17; 13.5% reduction, dIGPP = 2.25 [independent groups pretest-posttest design]). These observations supported the hypothesis that the efficacy of PE therapy is affected by sleep quality. If these findings are replicated, treatment algorithms may need to incorporate the presence or absence of sleep disorders as a factor in treatment choice.


Assuntos
Terapia Implosiva , Síndromes da Apneia do Sono/complicações , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/complicações , Resultado do Tratamento
15.
Psychiatr Serv ; 65(9): 1154-9, 2014 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-24828568

RESUMO

OBJECTIVE: This study explored the psychometric properties of the 30-item Mental Health Recovery Measure (MHRM) and a brief, ten-item version of the scale (MHRM-10) in a large, multisite sample of individuals with schizophrenia. METHODS: The sample consisted of 795 veterans with schizophrenia or schizoaffective disorder diagnoses who were receiving mental health services in one of eight Veterans Health Administration medical centers across four regions of the United States. Exploratory factor analysis was used to examine the factor structure of the MHRM and to select the most appropriate ten items for the brief measure. Correlations of the MHRM and the MHRM-10 with measures of quality of life, satisfaction with mental health services, symptom severity, and functioning were computed to further establish construct validity. Cronbach's alpha was used to assess the internal reliability of the MHRM and MHRM-10. RESULTS: Factor analysis resulted in an interpretable single-factor solution. The MHRM-10 was established by selecting the ten items with the highest factor loading scores. MHRM and MHRM-10 total scores correlated strongly and positively with quality-of-life measures (overall, leisure, general health, and daily activities) and negatively with depressive mood. Negligible correlations existed between the MHRM instruments and measures of functioning and satisfaction with services. Both instruments demonstrated excellent internal consistency. CONCLUSIONS: This study provides initial support for use of the MHRM-10 as a brief, valid, and reliable assessment of perceived recovery among individuals with schizophrenia and one that may be easily used in routine care.


Assuntos
Escalas de Graduação Psiquiátrica/normas , Psicometria/instrumentação , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Adulto , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/terapia , Esquizofrenia/terapia , Estados Unidos , United States Department of Veterans Affairs
16.
J Behav Health Serv Res ; 41(3): 370-80, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22430566

RESUMO

The objective of this study was to examine the effectiveness of a weight loss program for individuals with schizophrenia in usual care. The study included 146 adults with schizophrenia from two mental health clinics of the Department of Veterans Affairs. The 109 individuals who were overweight or obese were offered a 16-week, psychosocial, weight management program. Weight and Body Mass Index (BMI) were assessed at baseline, 1 year later, and at each treatment session. Only 51% of those who were overweight or obese chose to enroll in the weight management program. Participants attended an average of 6.7 treatment sessions, lost an average of 2.4 pounds, and had an average BMI decrease of 0.3. There was no significant change in weight or BMI compared to the control group. Intervention strategies that both improve utilization and yield greater weight loss need to be developed.


Assuntos
Obesidade/terapia , Sobrepeso/terapia , Avaliação de Programas e Projetos de Saúde/métodos , Veteranos/psicologia , Programas de Redução de Peso/métodos , Adulto , Índice de Massa Corporal , Comorbidade , Feminino , Promoção da Saúde , Hospitais de Veteranos , Humanos , Los Angeles , Masculino , Pessoa de Meia-Idade , Esquizofrenia/epidemiologia , Resultado do Tratamento , Estados Unidos , Veteranos/estatística & dados numéricos , Perda de Peso
17.
Health Serv Res ; 48(6 Pt 2): 2224-44, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24138608

RESUMO

OBJECTIVE: Study a quality improvement approach for implementing evidence-based employment services at specialty mental health clinics. DATA SOURCES/STUDY SETTING: Semistructured interviews with clinicians and administrators before, during, and after implementation. Qualitative field notes, structured baseline and follow-up interviews with patients, semistructured interviews with patients after implementation, and administrative data. STUDY DESIGN: Site-level controlled trial at four implementation and four control sites. Hybrid implementation-effectiveness study with mixed methods intervention evaluation design. DATA COLLECTION/EXTRACTION METHODS: Site visits, in-person and telephone interviews, patient surveys, patient self-assessment. A total of 801 patients completed baseline surveys and 53 clinicians and other clinical key stakeholders completed longitudinal qualitative interviews. PRINCIPAL FINDINGS: At baseline, sites varied in the availability, utilization, and quality of supported employment. Each site needed quality improvement for this service, though for differing reasons, with some needing development of the service itself and others needing increased service capacity. Improvements in knowledge, attitudes, beliefs, and referral behaviors were evident in mid- and postimplementation interviews, though some barriers persisted. Half of patients expressed an interest in working at baseline. Patients at implementation sites were 2.3 times more likely to receive employment services during the study year. Those who had a service visit were more likely to be employed at follow-up than those who did not. CONCLUSIONS: Studies of implementation and effectiveness require mixed methods to both enhance implementation in real time and provide context for interpretation of complex results. In this study, a quality improvement approach resulted in superior patient-level outcomes and improved clinician knowledge, attitudes, and behaviors, in the context of substantial variation among sites.


Assuntos
Emprego/organização & administração , Serviços de Saúde Mental/organização & administração , Melhoria de Qualidade/organização & administração , Esquizofrenia/terapia , Serviço Social em Psiquiatria/organização & administração , Adulto , Prática Clínica Baseada em Evidências , Feminino , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Capacitação em Serviço , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , Autoavaliação (Psicologia) , Marketing Social , Estados Unidos , United States Department of Veterans Affairs/organização & administração
18.
Anesthesiology ; 117(5): 981-95, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22929730

RESUMO

BACKGROUND: Work suggests the amnesia from dexmedetomidine (an α2-adrenergic agonist) is caused by a failure of information to be encoded into long-term memory and that dexmedetomidine might differentially affect memory for emotionally arousing material. We investigated these issues in humans using event-related neuroimaging to reveal alterations in brain activity and subsequent memory effects associated with drug exposure. METHODS: Forty-eight healthy volunteers received a computer-controlled infusion of either placebo or low-dose dexmedetomidine (target = 0.15 ng/ml plasma) during neuroimaging while they viewed and rated 80 emotionally arousing (e.g., graphic war wound) and 80 nonarousing neutral (e.g., cup) pictures for emotional arousal content. Long-term picture memory was tested 4 days later without neuroimaging. Imaging data were analyzed for drug effects, emotional processing differences, and memory-related changes with statistical parametric mapping-8. RESULTS: Dexmedetomidine impaired overall (mean ± SEM) picture memory (placebo: 0.58 ± 0.03 vs. dexmedetomidine: 0.45 ± 0.03, P = 0.001), but did not differentially modulate memory as a function of item arousal. Arousing pictures were better remembered for both groups. Dexmedetomidine had regionally heterogeneous effects on brain activity, primarily decreasing it in the cortex and increasing it in thalamic and posterior hippocampal regions. Nevertheless, a single subsequent memory effect for item memory common to both groups was identified only in the left hippocampus/amygdala. Much of this effect was found to be larger for the placebo than dexmedetomidine group. CONCLUSION: Dexmedetomidine impaired long-term picture memory, but did not disproportionately block memory for emotionally arousing items. The memory impairment on dexmedetomidine corresponds with a weakened hippocampal subsequent memory effect.


Assuntos
Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Imageamento por Ressonância Magnética/métodos , Transtornos da Memória/induzido quimicamente , Transtornos da Memória/diagnóstico , Memória de Longo Prazo/efeitos dos fármacos , Emoções/efeitos dos fármacos , Emoções/fisiologia , Potenciais Evocados/efeitos dos fármacos , Potenciais Evocados/fisiologia , Feminino , Humanos , Infusões Intravenosas , Masculino , Memória de Longo Prazo/fisiologia , Estimulação Luminosa/métodos , Desempenho Psicomotor/efeitos dos fármacos , Desempenho Psicomotor/fisiologia , Adulto Jovem
19.
J Clin Psychopharmacol ; 32(1): 110-3, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22198458

RESUMO

Membrane transporters such as P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) are efflux pumps that remove drugs from the brain back to the peripheral blood compartment, serving as a functional component of the blood-brain barrier (BBB). We report here that coadministration of the P-gp and BCRP inhibitor ketoconazole with risperidone may preferentially increase D2 receptor occupancy in the striatum compared to pituitary. Four male patients with schizophrenia or schizoaffective disorder who had received at least 4 prior injections of the long-acting risperidone at a stable dose of 25 to 50 mg participated in this positron emission tomography study. Multiple-dose ketoconazole coadministration reduced the P-gp activity as shown by fexofenadine oral challenge. Importantly, we found a strong statistical trend in this sample of 4 subjects who consistently showed a decrease in striatal fluorine 18 (F)-fallypride binding (an indication of increased D2 receptor occupancy) after ketoconazole coadministration (P = 0.057), whereas the pituitary (a region that lies outside the BBB) F-fallypride binding did not change (P = 0.99). These observations warrant further research with selective drug transporter inhibitors. We suggest that in neuroimaging studies, the pituitary drug occupancy can serve as a useful new "positive control" to evaluate whether drug occupancy is preferentially increased in brain regions that fall inside the BBB after cotreatment with P-gp and BCRP inhibitors. This is a noteworthy study design consideration regarding the future clinical testing of novel adjunct interventions aimed at modulating membrane transporter function at the BBB, with the goal of augmenting drug access into the brain compartment, particularly in treatment-resistant psychiatric illness.


Assuntos
Antipsicóticos/farmacocinética , Antipsicóticos/uso terapêutico , Corpo Estriado/efeitos dos fármacos , Corpo Estriado/diagnóstico por imagem , Cetoconazol/uso terapêutico , Hipófise/efeitos dos fármacos , Hipófise/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Transtornos Psicóticos/diagnóstico por imagem , Transtornos Psicóticos/tratamento farmacológico , Receptores de Dopamina D2/efeitos dos fármacos , Risperidona/farmacocinética , Risperidona/uso terapêutico , Esquizofrenia/diagnóstico por imagem , Esquizofrenia/tratamento farmacológico , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/antagonistas & inibidores , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/metabolismo , Membro 2 da Subfamília G de Transportadores de Cassetes de Ligação de ATP , Transportadores de Cassetes de Ligação de ATP/antagonistas & inibidores , Transportadores de Cassetes de Ligação de ATP/metabolismo , Administração Oral , Adulto , Antialérgicos/farmacocinética , Antipsicóticos/efeitos adversos , Ligação Competitiva/efeitos dos fármacos , Barreira Hematoencefálica/efeitos dos fármacos , Quimioterapia Combinada , Humanos , Injeções Intramusculares , Masculino , Proteínas de Neoplasias/antagonistas & inibidores , Proteínas de Neoplasias/metabolismo , Risperidona/efeitos adversos , Terfenadina/análogos & derivados , Terfenadina/farmacocinética
20.
J Psychiatr Res ; 45(11): 1504-10, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21831397

RESUMO

Severe psychological or mental pain is defined as an experience of unbearable torment which can be associated with a psychiatric illness (e.g., major depressive disorder) or a tragic loss such as the death of a child. A brief self-rating scale (Mee-Bunney Psychological Pain Assessment Scale [MBPPAS]) was developed to assess the intensity of psychological pain. The scale was used to measure psychological pain in 73 major depressive episode (MDE) patients and 96 non-psychiatric controls. In addition to the MBPPAS, all subjects completed four additional instruments: Suicidal Behavior Questionnaire (SBQ), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and the Brief Pain Inventory (BPI). Known-groups, content and convergent validity, and internal reliability of the scale were established. MDE and control subjects were ranked according to MBPPAS scores. A threshold was set at 32 representing 0.5 SD above the mean for MDEs. MDE subjects above the threshold of 32 had significantly higher SBQ scores than those below. A significant linear correlation between psychological pain and SBQ suicidality scores was observed. This is the first study to contrast psychological pain in controls and patients with MDE. Our results suggest that psychological pain is a useful and unique construct in patients with MDE that can be reliably assessed and may aid in the evaluation of suicidal risk.


Assuntos
Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo Maior/psicologia , Dor/psicologia , Suicídio/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Escalas de Graduação Psiquiátrica , Fatores de Risco , Inquéritos e Questionários/normas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...