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1.
Medicine (Baltimore) ; 99(1): e18614, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895815

RESUMO

This study included 1456 men and 1411 women who were trauma-exposed and underwent routine health examinations in a community epidemiological investigation. The participants completed the posttraumatic stress disorder (PTSD) Check List-Civilian Version (PCL-C) for PTSD and medical examinations to detect metabolic syndrome. Adjustments for age, marriage, exercise, education, cigarette smoking, cancer, stroke, angina, and thyroid disease were performed. The relationship between PTSD and metabolic syndrome and each of its components was analyzed by multiple logistic regression.In women, PTSD was associated with metabolic syndrome (OR = 1.53, 95% CI = 1.01-1.95, P = .047) and the high-density lipoprotein cholesterol component (OR = 1.98, 95% CI = 1.04-2.12, P = .002). In men, PTSD was related to the hypertension component of metabolic syndrome (OR = 0.54, 95% CI = 0.31-0.92, P = .023). There was also a relationship between PTSD severity and metabolism (OR = 1.141, 95% CI = 1.002-1.280, P = 0.037) in women, and PTSD was inversely associated with the hypertension component (OR = 0.54, 95% CI = 0.31-0.92, P = .023) in men.PTSD was related to metabolic syndrome only in women. We plan to further research the mechanism of sex differences and dyslipidemia.


Assuntos
Síndrome Metabólica/etiologia , Transtornos de Estresse Pós-Traumáticos/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Fatores Sexuais , Adulto Jovem
2.
Fortschr Neurol Psychiatr ; 87(11): 638-641, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31756746

RESUMO

This text examines post-traumatic stress disorders and trauma sequel disorders in adolescence, focusing in particular on the problem of transition. On the one hand, on the diagnostic level traumatizations are often not PTSD-specific, but rather self-help and self-medication measures as well as alcohol and drug addiction and dissociality, which are often not sufficiently questioned in the adult psychiatric system. On the other hand, it is about the further development and implementation of trauma pedagogical approaches, especially for young people who grow up in critical high-risk constellations or who are already in institutions of youth welfare or integration assistance. Here, not only a blatant lack of initial, further and continuing training for the occupational groups involved is noted, but also a lack of empirical therapy studies.


Assuntos
Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Humanos , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia
4.
Neuropsychiatr ; 33(4): 207-211, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31696411

RESUMO

BACKGROUND: Learning, competence development and scientific thinking in medicine need several strategies to facilitate new diagnostic and therapeutic ways. The optimal collaboration between creative thinking and biomedical informatics provides innovation for the individual patient and for a medical school or society. Utilizing the flexibilities of an e­learning platform, a case based blended learning (CBBL) framework consisting of A) case based textbook material, B) online e­CBL with question driven learning scenarios and C) simulated patient (SP) contact seminars was developed and implemented in multiple medical fields. Real-life clinical cases were anonymized and transferred into an interactive and an interdisciplinary eLearning platform. METHODS: As an example of the offered clinical teaching-case collection, an example of a psychiatric case for the disease "posttraumatic stress disorder (PTSD)" is presented: a 30-year-old man with a history of insomnia with difficulties in falling asleep and sleeping through, nightmares, nervousness and psychomotor restlessness. The students are challenged to identify possible differential diagnoses and further get to know the patient's personal history (loss of relatives due to war, torture and flight from home country). Further, the students are guided through the principles of fear conditioning including translational aspects like neurotransmitter signaling of PTSD pathomechanism (translational and research aspects like dopamine transporter gene polymorphism, long term potentiation and synaptic signaling). RESULTS/CONCLUSION: The case presentation comprises different learning aspects: First, declarative knowledge has to be acquired and collected in basic medical sciences, knowledge that is in fact available and can be accessed on the conscious and preconscious level in long-term memory. Second, associative learning leads to the formation of neuronal connections and is an important way of learning and discovering, founded in neural associations. Third, polythematic-crosslinking thinking is needed as ability to link information in a meaningful way. These steps are a typical intellectual ability of gifted learners and researchers that combine previously seemingly unrelated areas to each other and drive innovation.


Assuntos
Competência Clínica , Instrução por Computador , Aprendizagem , Estudantes de Medicina/psicologia , Adulto , Diagnóstico Diferencial , Educação Médica , Humanos , Masculino , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/psicologia , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia
6.
Adv Gerontol ; 32(3): 397-404, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31512427

RESUMO

The cancer incidence increase in elderly patients determines the actuality of this study, because oncological illnesses are often accompanied by mental disturbances. This article considers clinical psychological risk factors of the posttraumatic stress disorder (PTSD) onset in prostate and rectal cancer elderly patients after surgical treatment. The study results showed that lack of social support, deficit of the successful stress coping experience in the past, maladaptive internal disease model, and destructive personality profile proved to be statistically significant risk factors and consequently psychotherapeutic interventions targets in PTSD treatment and prevention. Consideration of the elderly oncology patient clinical, psychological and social characteristics allows to elaborate effective personalized strategies of the complex medical-psychological care in geriatric medicine.


Assuntos
Neoplasias , Transtornos de Estresse Pós-Traumáticos , Adaptação Psicológica , Idoso , Comorbidade , Humanos , Masculino , Neoplasias/complicações , Neoplasias/reabilitação , Neoplasias/cirurgia , Apoio Social , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/reabilitação
7.
Presse Med ; 48(10): 1051-1058, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31473024

RESUMO

Subjects suffering from post-traumatic stress disorder present sleeping disorders like a chronic insomnia, traumatic nightmares, but also less expected, sleep breathing disorders. Sleep problems are a factor of development and maintenance of PTSD, but also a factor of resistance to treatment. After a therapy focused on PTSD, they represent frequent residual symptoms. It is necessary to couple, with the usual management of PTSD, targeted approaches for sleep problems. These targeted approaches allow an improvement of the nocturnal properties but also diurnal specific symptoms of PTSD. Stakes around primary, secondary and tertiary prevention of PTSD emerge around these sleep disorders.


Assuntos
Síndrome das Pernas Inquietas/etiologia , Síndromes da Apneia do Sono/etiologia , Transtornos do Sono-Vigília/etiologia , Transtornos de Estresse Pós-Traumáticos/complicações , Sonhos , Humanos , Síndrome das Pernas Inquietas/terapia , Prevenção Secundária , Síndromes da Apneia do Sono/terapia , Transtornos do Sono-Vigília/terapia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Transtornos de Estresse Pós-Traumáticos/terapia , Prevenção Terciária
8.
Int. j. clin. health psychol. (Internet) ; 19(3): 228-236, sept. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184969

RESUMO

Background/Objective: The current study aimed to examine the relationship between Posttraumatic Stress Disorder (PTSD) symptoms and executive dysfunction in children and adolescents after psychological trauma. Method: Participants were 13,438 of children and adolescents aged 6 to 18 years exposed to the 2008 Wenchuan earthquake. PTSD and dysexecutive symptoms were assessed using the UCLA PTSD Reaction Index for Children and the Self-Report Dysexecutive Questionnaire. Latent Profile Analysis (LPA) was conducted using Mplus version 7.4. Subgroup differences in trauma exposure and quality of life were calculated using ANCOVA. Results: A 4-class parallel model was found to best describe latent PTSD symptom profiles and executive dysfunction. Individuals in higher symptom groups showed more trauma exposure and lower quality of life. Conclusions: This LPA study shed light on the relationship between PTSD and executive dysfunction symptoms in children and adolescents. The correlation between PTSD and executive dysfunction was maintained after individual differences were taken into consideration. Our findings provide a new view on how PTSD relates to executive dysfunction and several suggestions for treating child and adolescent PTSD patients


Antecedentes/Objetivo: Se plantea examinar la relación entre síntomas del Trastorno de Estrés Postraumático (TEPT) y disfunción ejecutiva en niños y adolescentes después de un trauma psicológico. Método: Los participantes fueron 13,438 niños y adolescentes de 6 a 18 años de edad expuestos al terremoto de Wenchuan de 2008, a los que se le evaluaron síntomas de TEPT utilizando el UCLA PTSD Reaction Index for Children y síntomas de disfunción ejecutiva mediante el Self-Report Dysexecutive Questionnaire. Se realizó un Análisis de Perfil Latente (APL) mediante Mplus versión 7.4. Las diferencias de subgrupos en la exposición al trauma y la calidad de vida se calcularon utilizando ANCOVA. Resultados: Un modelo paralelo de 4-clases describe mejor los perfiles de síntomas de TEPT latentes y disfunción ejecutiva. Los grupos con síntomas más intensos mostraron mayor exposición al trauma y menor calidad de vida. Conclusiones: Se aclara la relación TEPT-síntomas de disfunción ejecutiva en niños y adolescentes. La correlación entre el trastorno de estrés postraumático y la disfunción ejecutiva se mantuvo después de considerar la heterogeneidad de la población. Se ofrece una nueva visión de cómo el TEPT se relaciona con la disfunción ejecutiva y varias sugerencias para tratar a pacientes jóvenes con TEPT


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Qualidade de Vida , Inquéritos e Questionários
9.
Undersea Hyperb Med ; 46(3): 313-327, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31394601

RESUMO

To date, several Department of Defense (DoD) and civilian studies have evaluated hyperbaric oxygen for mild forms of traumatic brain injury. Prior to the DoD-sponsored "Brain Injury and Mechanisms of Action of Hyperbaric Oxygen for Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury (mTBI) (BIMA)" trial, none included post-intervention follow-up beyond three to six months. Post-hoc attempts at long-term follow-up were complicated by low participation and potential self-selection bias. BIMA planned for follow-up through 12 months but was amended to add post-concussive and post-traumatic stress disorder, quality of life, pain, depression, anxiety, and alcohol use assessments at 24 and 36 months. A total of 42 of 71 BIMA participants consented to extendedfollow-up, and 40 and 14 completed a 24- or 36-month visit, respectively, representing an overall response rate of 59% and 20%. Participants who completed extended follow-up were similar to the study group that did not in terms of demographics, perceived intervention allocation, and initial response to intervention. There were no significant differences at 24 or 36 months between intervention groups, and group mean scores were near pre-intervention values. This return to baseline could be due to waning treatment effect, selection bias, or participant or perception effects. Though BIMA implemented several participant retention strategies, more frequent participant contact and increased compensation might improve long-term retention in future studies. clinicaltrials.gov Identifier NCT01611194.


Assuntos
Oxigenação Hiperbárica , Síndrome Pós-Concussão/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Concussão Encefálica/complicações , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Militares , Seleção de Pacientes , Síndrome Pós-Concussão/complicações , Síndrome Pós-Concussão/tratamento farmacológico , Qualidade de Vida , Autorrelato , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Avaliação de Sintomas , Fatores de Tempo , Resultado do Tratamento
10.
Undersea Hyperb Med ; 46(3): 353-383, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31394604

RESUMO

Background: Some clinical trials report improvement in persistent post-concussive symptoms (PCS) with hyperbaric oxygen (HBO2) following mild traumatic brain injury (mTBI), but questions remain regarding the utility of HBO2 for PCS, the effects of HBO2 on post-traumatic stress disorder (PTSD), and the influences of sham control exposures. Methods: A systematic review and pooled analysis was conducted to summarize available evidence for HBO2 in mTBI-associated PCS ± PTSD. Data aggregated from four Department of Defense (DoD) studies with participant-level data (n=254) were grouped into pooled HBO2 and sham intervention groups. Changes from baseline to post-intervention on PCS, PTSD, and neuropsychological measures were assessed using linear mixed models to evaluate main intervention and intervention-by-baseline PTSD effects. Potential dose-response relationships to oxygen partial pressures were investigated. Intervention effects from three other published studies with summary-level participant data (n=135) were also summarized.. Results: Pooled DoD data analyses indicated trends toward improvement favoring HBO2 for PCS (Rivermead Total Score: -2.3, 95% CI [-5.6, 1.0], p=0.18); PTSD (PTSD Checklist Total Score: -2.7, 95% CI [-5.8, 0.4], p=0.09); and significant improvement in verbal memory (CVLT-II Trial 1-5 Free Recall: 3.8; 95% CI [1.0, 6.7], p=0.01). A dose-response trend to increasing oxygen partial pressure was also found, with a greater HBO2 effect in mTBI-associated PTSD suggested. The direction of results was consistent with other published studies. Conclusion: A definitive clinical trial, with an appropriate control group, should be considered to identify the optimal HBO2 dosing regimen for individuals with mTBI-associated PTSD ± PCS.


Assuntos
Oxigenação Hiperbárica , Síndrome Pós-Concussão/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Concussão Encefálica/complicações , Lista de Checagem , Feminino , Humanos , Modelos Lineares , Masculino , Memória , Rememoração Mental , Pessoa de Meia-Idade , Militares , Testes Neuropsicológicos , Oxigênio , Pressão Parcial , Síndrome Pós-Concussão/complicações , Qualidade de Vida , Sensibilidade e Especificidade , Transtornos de Estresse Pós-Traumáticos/complicações , Resultado do Tratamento , Estados Unidos , United States Department of Defense , Adulto Jovem
11.
Behav Ther ; 50(5): 910-923, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31422847

RESUMO

While evidence-based interventions can help the substantial number of veterans diagnosed with comorbid PTSD and depression, an emerging literature has identified sleep disturbances as predictors of treatment nonresponse. More specifically, predicting effects of residual insomnia and nightmares on postintervention PTSD and depressive symptoms among veterans with comorbid PTSD and depression has remained unclear. The present study used data from a clinical trial of Behavioral Activation and Therapeutic Exposure (BA-TE), a combined approach to address comorbid PTSD and depression, administered to veterans (N = 232) to evaluate whether residual insomnia and nightmare symptoms remained after treatment completion and, if so, whether these residual insomnia and nightmare symptoms were associated with higher levels of comorbid PTSD and depression at the end of treatment. Participants (ages 21 to 77 years old; 47.0% Black; 61.6% married) completed demographic questions, symptom assessments, and engagement-related surveys. Hierarchical multiple linear regression models demonstrated that residual insomnia was a significant predictor of PTSD and depression symptom reduction above and beyond the influence of demographic and engagement factors (e.g., therapy satisfaction). Consistent with previous research, greater residual insomnia symptoms were predictive of smaller treatment gains. Findings illustrate the potential significance of insomnia during the course of transdiagnostic treatment (e.g., PTSD and depression), leading to several important clinical assessment and treatment implications.


Assuntos
Depressão/complicações , Distúrbios do Início e da Manutenção do Sono/complicações , Transtornos do Sono-Vigília/complicações , Transtornos de Estresse Pós-Traumáticos/complicações , Veteranos/psicologia , Adulto , Idoso , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Distúrbios do Início e da Manutenção do Sono/psicologia , Transtornos do Sono-Vigília/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/estatística & dados numéricos , Adulto Jovem
12.
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
13.
Work ; 63(2): 283-289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31156209

RESUMO

BACKGROUND: PTSD is associated with high levels of vocational difficulty, and research on relationships between PTSD and vocational adjustment may be relevant to vocational rehabilitation services to achieve optimal outcomes. Veteran perception of ability to cope with stressors in the workplace setting may play a role in rehabilitation outcome. OBJECTIVE: This article outlines preliminary steps in the development of the Vocational Efficacy in Trauma Survivors Scale (VETSS), to measure perceived efficacy in managing PTSD symptoms in the workplace. This has potential to expand future options for research in vocational rehabilitation for veterans with PTSD. METHODS: Veterans in outpatient treatment for PTSD at a large, mid-western Veterans Affairs Health Care System facility responded to items on the proposed instrument and items on other measures of vocational and psychological functioning to assess the potential validity of items for an instrument to measure vocational self-efficacy among veterans managing PTSD. RESULTS: In a sample of 63 working veterans who receive outpatient care for PTSD, exploratory factor analysis identified two viable subscales, one tapping Workplace Coping, and another tapping Self-Disclosure. CONCLUSIONS: Preliminary findings indicate that the measure demonstrated acceptable indications of reliability and validity, suggesting promise for future use in vocational rehabilitation research.


Assuntos
Adaptação Psicológica , Percepção , Transtornos de Estresse Pós-Traumáticos/complicações , Adulto , Feminino , Humanos , Masculino , Minnesota , Psicometria/instrumentação , Psicometria/métodos , Psicometria/estatística & dados numéricos , Reabilitação Vocacional/métodos , Reabilitação Vocacional/psicologia , Reabilitação Vocacional/estatística & dados numéricos , Autoeficácia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estados Unidos , United States Department of Veterans Affairs/organização & administração , United States Department of Veterans Affairs/estatística & dados numéricos , Local de Trabalho/psicologia , Local de Trabalho/normas
14.
Biomed Pharmacother ; 117: 108834, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31177066

RESUMO

Recent research strongly supports the hypothesis that posttraumatic stress disorder (PTSD) can be accompanied by obesity and related metabolic disturbances. The mechanisms of these associations are however still not well defined, although disturbed functions in the sympathetic-adrenergic nervous system together with the disturbed release of hormones via the endocrine HPA (hypothalamic-pituitary-adrenal) axis apparently play a role. Leptin resistance and ghrelin excesses might contribute to a disturbed hypothalamic function, and also disturb other cerebral functions, leading to dysfunctional reward signaling and uncontrolled appetite combined with a tendency to alcohol abuse. Secondarily, cortisol stimulation will contribute to the development of central obesity which is known to facilitate the development of metabolic syndrome, including slightly increased levels of inflammatory biomarkers such as C-reactive protein and fibrinogen. While previous therapeutic strategies have focused on early psychotherapeutic interventions in PTSD, the present review emphasizes the importance of better therapeutic approaches regarding the somatic correlates of the syndrome. Strict regulation of dietary meals and food composition with minimal intake of sweets and saturated fat, as well as alcohol avoidance, can provide a basic therapeutic framework. A cognitive psychotherapeutic approach with graduated desensitization toward trigging factors, combined with pharmacotherapy, is discussed in the present review.


Assuntos
Obesidade/etiologia , Transtornos de Estresse Pós-Traumáticos/complicações , Ansiedade/complicações , Citocinas/metabolismo , Humanos , Leptina/metabolismo
15.
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
16.
Schmerz ; 33(4): 329-332, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31037342

RESUMO

A patient with long-term fibromyalgia syndrome and concomitant post-traumatic stress disorder is reported. The relocation to a so-called external safe site resulted within a very short time in a sustained remission of the fibromyalgia syndrome, due to psychotherapeutic interventions. This shows that-according to the clinical guidelines-a psychiatric examination and, if necessary, targeted therapy of the psychiatric comorbidity is indispensable in patients with fibromyalgia syndrome.


Assuntos
Fibromialgia , Dor , Transtornos de Estresse Pós-Traumáticos , Comorbidade , Fibromialgia/complicações , Humanos , Dor/diagnóstico , Manejo da Dor/psicologia , Processos Psicoterapêuticos , Transtornos de Estresse Pós-Traumáticos/complicações
17.
Spine (Phila Pa 1976) ; 44(17): 1220-1227, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30985567

RESUMO

STUDY DESIGN: A longitudinal cotwin control study of the Vietnam Era Twin Registry. OBJECTIVE: The aim of this study was to examine the association of post-traumatic stress disorder (PTSD) symptoms with incident chronic back pain (CBP), while controlling for genetic factors and early family environment. SUMMARY OF BACKGROUND DATA: It is unknown whether PTSD symptoms are associated with an increased incidence of CBP. METHODS: In 2010 to 2012, a baseline survey was undertaken as part of a large-scale study of PTSD. Study participants completed the PTSD Symptom Checklist (PCL) and a self-report measure of CBP. In 2015 to 2017, a follow-up survey was sent to all 171 monozygotic (MZ) twin pairs (342 individuals) where both cotwins had no history of CBP at baseline, but only one cotwin in the pair met criteria for having current PTSD symptoms (one twin with PCL <30 and the cotwin with PCL ≥30). No other inclusion/exclusion criteria were applied. CBP at 5-year follow-up was defined as back pain of duration ≥3 months in the low back or mid/upper back. Covariates included age, race, education, income, Veterans Affairs health care use, disability compensation, smoking, body mass index, and depression. Statistical analysis estimated the cumulative incidence of CBP according to baseline PTSD symptoms. Risk ratios (RRs) and 95% confidence intervals (95% CIs) were estimated in matched-pair cotwin control analyses adjusting for familial factors. RESULTS: Among 227 males completing 5-year follow-up, including 91 MZ twin pairs, the mean age was 62 years. Five-year incidence of CBP in those without and with baseline PTSD symptoms was 40% and 60%, respectively. Baseline PTSD symptoms were significantly associated with incident CBP in crude and multivariable-adjusted within-pair analyses (RR 1.6, 95% CI 1.2-2.1; P = 0.002). CONCLUSION: PTSD symptoms were associated with an increased incidence of CBP, without confounding by genetic factors or early family environment. PTSD symptoms may be a modifiable risk factor for prevention of CBP. LEVEL OF EVIDENCE: 3.


Assuntos
Dor nas Costas , Dor Crônica , Transtornos de Estresse Pós-Traumáticos , Gêmeos Monozigóticos/estatística & dados numéricos , Veteranos/estatística & dados numéricos , Dor nas Costas/complicações , Dor nas Costas/epidemiologia , Dor Crônica/complicações , Dor Crônica/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/epidemiologia
18.
Presse Med ; 48(5): 488-502, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31005500

RESUMO

INTRODUCTION: Exposure to a traumatic event may not only lead to a large variety of mental disorders, such as post-traumatic stress disorder (PTSD) but also respiratory symptoms and/or respiratory diseases, as asthma. OBJECTIVES: Systematic literature review of data on the impact of post-traumatic stress disorder on asthma. DOCUMENTARY SOURCES: Medline, on the period 1980-2018 with the following keywords: "PTSD" or "post-traumatic stress disorder" or "post-traumatic stress disorder" and "asthma", limits "title/abstract"; the selected languages were English or French. Among 141 articles, 23 abstracts have given use to a dual reading to select 14 studies. RESULTS: While PTSD may develop 4 weeks after being exposed to a traumatic event during which the physical integrity of the person has been threatened, it might also develop several months or years later. PTSD has been reported to be a risk factor for asthma and also a factor that might enhance a preexisting asthma. It is also important to note that this relation has been highlighted among several populations, traumatic events and regardless the gender and/or cultural factors. Despite its impact on the development of asthma, in asthmatic patients, PTSD may be responsible for poor asthma control, increased rates of healthcare use (visit in the emergency department and/or hospitalization for asthma) and poor asthma-related quality of life. The study of the association between PTSD and asthma have to take into account some potentially confounding factors, such as smoking status and dust exposure (e.g.: asthma following the terrorist attacks of the World Trade Center). Less is known regarding the potential mechanisms involved in the association between PTSD and asthma. Several factors including the nervous system, the hypothalamo-pituitary-adrenal axis, the inflammatory response and the immune system may explain the association. CONCLUSION: PTSD is a risk factor for the development of asthma and for the worsening of preexisting asthma. In asthmatic patients, it is of primary importance to systematically screen potential PTSD that might be developed after a traumatic event or a preexisting traumatic condition. Moreover, after exposure to a traumatic event, a special attention needs to be paid to somatic reactions such as asthma. The majority of studies having been conducted on American samples, replicating studies among European samples appears of prime importance in order to add a body of knowledge on the association between somatic and psychiatric conditions.


Assuntos
Asma/etiologia , Transtornos de Estresse Pós-Traumáticos/complicações , Progressão da Doença , Humanos
19.
Depress Anxiety ; 36(7): 607-616, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31006959

RESUMO

BACKGROUND: The diagnosis of posttraumatic stress disorder (PTSD) is usually based on clinical interviews or self-report measures. Both approaches are subject to under- and over-reporting of symptoms. An objective test is lacking. We have developed a classifier of PTSD based on objective speech-marker features that discriminate PTSD cases from controls. METHODS: Speech samples were obtained from warzone-exposed veterans, 52 cases with PTSD and 77 controls, assessed with the Clinician-Administered PTSD Scale. Individuals with major depressive disorder (MDD) were excluded. Audio recordings of clinical interviews were used to obtain 40,526 speech features which were input to a random forest (RF) algorithm. RESULTS: The selected RF used 18 speech features and the receiver operating characteristic curve had an area under the curve (AUC) of 0.954. At a probability of PTSD cut point of 0.423, Youden's index was 0.787, and overall correct classification rate was 89.1%. The probability of PTSD was higher for markers that indicated slower, more monotonous speech, less change in tonality, and less activation. Depression symptoms, alcohol use disorder, and TBI did not meet statistical tests to be considered confounders. CONCLUSIONS: This study demonstrates that a speech-based algorithm can objectively differentiate PTSD cases from controls. The RF classifier had a high AUC. Further validation in an independent sample and appraisal of the classifier to identify those with MDD only compared with those with PTSD comorbid with MDD is required.


Assuntos
Algoritmos , Fala/fisiologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Área Sob a Curva , Feminino , Humanos , Masculino , Curva ROC , Transtornos de Estresse Pós-Traumáticos/complicações , Veteranos
20.
Neurol Res ; 41(7): 609-623, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31007155

RESUMO

Introduction: Risk factors for young adults with mTBI are not well understood. Improved understanding of age and sex as risk factors for impaired six-month outcomes in young adults is needed. Methods: Young adult mTBI subjects aged 18-39 years (18-29y; 30-39y) with six-month outcomes were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Multivariable regressions were performed for outcomes with age, sex, and the interaction factor age-group*sex as variables of interest, controlling for demographic and injury variables. Mean-differences (B) and 95% CIs are reported. Results: One hundred mTBI subjects (18-29y, 70%; 30-39y, 30%; male, 71%; female, 29%) met inclusion criteria. On multivariable analysis, age-group*sex was associated with six-month post-traumatic stress disorder (PTSD; PTSD Checklist-Civilian version); compared with female 30-39y, female 18-29y (B= -19.55 [-26.54, -4.45]), male 18-29y (B= -19.70 [-30.07, -9.33]), and male 30-39y (B= -15.49 [-26.54, -4.45]) were associated with decreased PTSD symptomatology. Female sex was associated with decreased six-month functional outcome (Glasgow Outcome Scale-Extended (GOSE): B= -0.6 [1.0, -0.1]). Comparatively, 30-39y scored higher on six-month nonverbal processing speed (Wechsler Adult Intelligence Scale-Processing Speed Index (WAIS-PSI); B= 11.88, 95% CI [1.66, 22.09]). Conclusions: Following mTBI, young adults aged 18-29y and 30-39y may have different risks for impairment. Sex may interact with age for PTSD symptomatology, with females 30-39y at highest risk. These results may be attributable to cortical maturation, biological response, social modifiers, and/or differential self-report. Confirmation in larger samples is needed; however, prevention and rehabilitation/counseling strategies after mTBI should likely be tailored for age and sex.


Assuntos
Concussão Encefálica/psicologia , Caracteres Sexuais , Adolescente , Adulto , Fatores Etários , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Projetos Piloto , Estudos Prospectivos , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Escalas de Wechsler , Adulto Jovem
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