Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.799
Filtrar
1.
Med Klin Intensivmed Notfmed ; 116(3): 210-215, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33687486

RESUMO

After a stay on an intensive care unit (ICU), patients and relatives may be affected by psychological consequences such as anxiety, depression or posttraumatic stress disorder. ICU diaries written for patients during the stay by clinicians and relatives can alleviate the consequences. Diaries can contribute to the humanization of intensive care through the person-centered approach. A case report illustrates the perspective and benefits from a patient's perspective.


Assuntos
Estado Terminal , Transtornos de Estresse Pós-Traumáticos , Cuidados Críticos , Família , Humanos , Unidades de Terapia Intensiva , Transtornos de Estresse Pós-Traumáticos/terapia
2.
Psychiatr Danub ; 33(Suppl 1): 13-17, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33638951

RESUMO

INTRODUCTION: Trauma Aid UK (previously HAP UK & Ireland) conducted three EMDR trainings in Turkey: the first was in Istanbul on 28th November 2013. Since then, 3 groups of mental health trainees attending part 1 of 3 parts EMDR training. In total, 86 clinicians were trained. Also, in June 2016, the first part of a three-part EMDR training in Nepal was completed following the Nepal Earthquake in 2015. The purpose of this study is to assess, analyse and understand the needs of Syrian refugees, who have being experiencing man made trauma since 2011, with Nepalese people who were exposed to the earthquake on 25/4/2015, in their needs for trauma services, training and provision as assessed by mental health professionals working with both groups of people. SUBJECTS AND METHODS: A survey was conducted at the beginning of each of the above-mentioned training courses. Participants were asked to consent to participate in the study and, if they did, they were given the 'The Need for Trauma-based Services' quantitative and qualitative questionnaire, or its Arabic translation. 63 Syrian participants of the Istanbul and Gaziantep EMDR training were compared with 37 Nepalese participants who also completed the survey. RESULTS: The results analysis of these surveys showed significantly higher PTSD prevalence in the man-made trauma of the Syrian conflict compared with the prevalence following the natural Earthquake in Nepal. 52% of the Syrian mental health professionals surveyed suggested that PTSD is the major mental health problem in their country, compared to only 6% of the Nepalese mental health professionals. Both the Syrian (33%) and Nepalese (27%) health professionals surveyed felt that they were only able to meet around a third of their clients' needs. They felt that training in EMDR in their mother-tongue would help increase their meeting of these needs. Other suggestions of service provisions and innovations were made in order to meet more of the needs of their trauma survivors. CONCLUSIONS: This study highlighted a high need for trauma mental health services of the Syrian refugees as reported by mental health professionals working in the neighbouring countries. The important difference of these needs from those of the Nepalese people confirms that man-made trauma can cause much greater mental health disturbance and a higher level of needs. Recommendations for training and service development for Syrian refugees were made.


Assuntos
Terremotos , Desastres Naturais , Trauma Psicológico/terapia , Refugiados/psicologia , Inquéritos e Questionários , Humanos , Nepal , Trauma Psicológico/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Síria , Turquia
3.
Medicine (Baltimore) ; 100(4): e24447, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530251

RESUMO

BACKGROUND: The present study aimed to systematically analyze the effects of mind-body exercise on PTSD symptom, depression and anxiety among patients with post-traumatic stress disorder (PTSD) and to provide a scientific evidence-based exercise prescription. Meanwhile, it will also help reduce the global mental health burden of COVID-19. METHODS: Both Chinese and English databases (PubMed, Web of Science, the Cochrane Library, EMBASE, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang) were used as sources of data to search for randomized controlled trials (RCTs) published between January 1980 to September 2020 relating to the effects of mind-body exercise on PTSD symptom, depression and anxiety in PTSD patients. CONCLUSION: This systematic review and meta-analysis will provide stronger evidence on the effectiveness and safety of mind-body exercise for PTSD symptoms in PTSD patients. SYSTEMATIC REVIEW REGISTRATION: INPLASY2020120072.


Assuntos
Transtornos de Ansiedade/terapia , Depressão/terapia , Terapias Mente-Corpo , Projetos de Pesquisa , Transtornos de Estresse Pós-Traumáticos/terapia , Humanos , Metanálise como Assunto , Pandemias , Revisões Sistemáticas como Assunto
5.
J Vis Exp ; (167)2021 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-33522512

RESUMO

Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that changes the likelihood of neuronal firing through modulation of neural resting membranes. Compared to other techniques, tDCS is relatively safe, cost-effective, and can be administered while individuals are engaged in controlled, specific cognitive processes. This latter point is important as tDCS may predominantly affect intrinsically active neural regions. In an effort to test tDCS as a potential treatment for psychiatric illness, the protocol described here outlines a novel procedure that allows the simultaneous application of tDCS during exposure to trauma-related cues using virtual reality (tDCS+VR) for veterans with posttraumatic stress disorder (NCT03372460). In this double-blind protocol, participants are assigned to either receive 2 mA tDCS, or sham stimulation, for 25 minutes while passively watching three 8-minute standardized virtual reality drives through Iraq or Afghanistan, with virtual reality events increasing in intensity during each drive. Participants undergo six sessions of tDCS+VR over the course of 2-3 weeks, and psychophysiology (skin conductance reactivity) is measured throughout each session. This allows testing for within and between session changes in hyperarousal to virtual reality events and adjunctive effects of tDCS. Stimulation is delivered through a built-in rechargeable battery-driven tDCS device using a 1 (anode) x 1 (cathode) unilateral electrode set-up. Each electrode is placed in a 3 x 3 cm (current density 2.22 A/m2) reusable sponge pocket saturated with 0.9% normal saline. Sponges with electrodes are attached to the participant's skull using a rubber headband with the electrodes placed such that they target regions within the ventromedial prefrontal cortex. The virtual reality headset is placed over the tDCS montage in such a way as to avoid electrode interference.


Assuntos
Estimulação Transcraniana por Corrente Contínua , Realidade Virtual , Adolescente , Adulto , Idoso , Método Duplo-Cego , Eletrodos , Feminino , Resposta Galvânica da Pele , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Pré-Frontal/fisiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Estimulação Transcraniana por Corrente Contínua/psicologia
6.
Adv Mind Body Med ; 35(1): 16-24, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33513582

RESUMO

Background: Decades of research have documented post-traumatic stress disorder (PTSD) symptoms in war veterans. Current treatment options for PTSD are unappealing as they either require re-exposure to the traumatic event or medications that are greatly impacted by comorbidities. Meditation-based interventions are a promising alternative. However, there is a dearth of research examining their impact. Primary objective: The purpose of this study was to examine meditation-based interventions tested for efficacy in treating PTSD among veterans and provide collective evidence. Methods: Authors searched the MEDLINE and CINAHL databases for relevant studies using the following inclusion criteria: (1) published in peer-reviewed journals; (2) conducted between January 2014 and July 2020; (3) described the evaluation of interventions; and (4) incorporated quantitative or mixed methods. Setting: United States. Participants: U.S. Veterans. Results: A total of 15 studies (ten articles) met the inclusion criteria. Four tested Transcendental Meditation (n = 4), three tested Mantra Meditation (n = 3), two tested Mindful Meditation (n = 2), one tested Breathing-based Meditation (n = 1), one tested Mindfulness-based Exposure Therapy (n = 1), one tested Cognitively-based Compassion Training Meditation (n = 1), one tested Mantra Meditation and Mindfulness-based Treatment (n = 1), one tested Mindfulness-based PTSD Treatment (n = 1), and one tested Primary Care Brief Mindfulness Program (n = 1). The most common duration was 8 weeks (n = 8) and the most common evaluation design was the randomized controlled trial (n = 10). The most common outcome measure was the Clinician Administered PTSD Scale (CAPS) (n = 12). Conclusion: All interventions reported improvements in PTSD symptoms. Based on this review, meditation-based therapy is a promising approach for managing PTSD, particularly among veterans resistant to trauma-focused therapies. Randomized control trials with large sample sizes that apply CAPS as their primary outcome measure, and take into account effect size, attrition rates, and blinding are recommended for further research.


Assuntos
Terapia Implosiva/métodos , Meditação , Atenção Plena/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Resultado do Tratamento , Estados Unidos
7.
Nervenarzt ; 92(1): 81-89, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33410960

RESUMO

In the context of intensive care medicine, patients, their relatives, and more infrequently members of the ICU team can be affected by potential trauma. Acute stress disorder often results. Psychological symptoms of critically ill patients should therefore be regularly screened in a standardized manner in order to be able to identify and treat patients with a high symptom burden. Some traumatic stressors in intensive care medicine can be reduced using trauma-sensitive communication. Psychological and psychotherapeutic interventions can complement this basic care. High quality communication with relatives contributes to a risk reduction with regard to their subsequent psychological stress. On the part of the ICU team, stress should be differentiated from potentially traumatizing events and both problem areas should be dealt with preventively. After experiencing a traumatic event during work, a procedure analogous to physical work accidents is recommended.


Assuntos
Medicina , Transtornos de Estresse Pós-Traumáticos , Cuidados Críticos , Estado Terminal , Família , Humanos , Unidades de Terapia Intensiva , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/terapia , Estresse Psicológico
8.
Trials ; 22(1): 98, 2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509268

RESUMO

BACKGROUND: Sweden is home to a large and growing population of refugee youths who may be at risk of mental health problems such as post-traumatic stress disorder (PTSD). Thus, there is a need for interventions that address mental health problems in these populations. Schools have been identified as an ideal setting for delivering such interventions as they offer a non-stigmatizing space and are often central to young refugees' social networks. The RefugeesWellSchool trial in Sweden will investigate an intervention comprising two programmes: Teaching Recovery Techniques (TRT) and In-service Teacher Training (INSETT), delivered in a school setting, among refugee youth. TRT is a group-based programme for children and adolescents, informed by Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). INSETT is a multi-module course for teachers providing information on trauma and the refugee experience to build teachers' cultural competence and capacity for supporting refugee youths in schools. METHODS: This trial employs a cluster randomized-control design with two arms: (1) the intervention arm in which the TRT and INSETT programmes are offered (n = 350), (2) the wait-list control arm (n = 350) in which services are provided as usual until the TRT and INSETT programmes are offered approximately six months later. Data will be collected prior to the intervention, immediately following the intervention, and at three months post-intervention. Outcomes for the trial arms will be compared using linear mixed models or ANCOVA repeated measures as well as the Reliable Change Index (RCI). DISCUSSION: This study will provide knowledge about the effectiveness of an intervention comprising two programmes: a group-based programme for youth reporting symptoms of PTSD and a training course for teachers, in order to build their competence and ability to support refugee youths in schools. TRIAL REGISTRATION: ISRCTN, ISRCTN48178969 , Retrospectively registered 20/12/2019.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Promoção da Saúde/organização & administração , Refugiados/psicologia , Serviços de Saúde Escolar/organização & administração , Transtornos de Estresse Pós-Traumáticos/terapia , Adolescente , Terapia Cognitivo-Comportamental/organização & administração , Estudos de Equivalência como Asunto , Feminino , Implementação de Plano de Saúde , Promoção da Saúde/métodos , Humanos , Masculino , Saúde Mental , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Suécia , Capacitação de Professores/métodos , Capacitação de Professores/organização & administração , Resultado do Tratamento
9.
Unfallchirurg ; 124(1): 21-25, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33394060

RESUMO

Confrontation with aversive trauma symptoms is a key element in the treatment of stress-associated disorders, especially posttraumatic stress disorder. It is aimed at working through and reattributing aversive memories and situations. Various techniques enable confrontation in sensu (i.e. imagined) and in vivo (in reality). Confrontation techniques are highly effective; however, since there is a risk of temporarily enhanced, possibly previously suppressed traumatic memories, confrontation must be carefully prepared and revised.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Humanos , Memória , Transtornos de Estresse Pós-Traumáticos/terapia
10.
Unfallchirurg ; 124(1): 7-14, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33330948

RESUMO

The somatic sequelae of accidents and violent events can vary from uninjured to fatal but the psychological impact can vary from integrity, to transient reactions up to severe and chronic trauma-related mental health disorders. In a dynamic interaction they determine the individual processing and coping in the aftermath, the mid-term and long-term outcome of medical treatment and of psychosocial rehabilitation.Appropriate consideration of the psychological sequelae of trauma requires attention and sensitization, knowledge about widespread complaints and symptoms after potential traumatic events and their typical courses over time. A careful perception of early warning signals and basic skills of clinical management are required. When more specific psychodiagnostic and psychotherapeutic interventions seem necessary, mental health specialists have to be consulted within a staged care model.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Acidentes , Adaptação Psicológica , Doença Crônica , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/terapia
11.
Artigo em Inglês | MEDLINE | ID: mdl-33374648

RESUMO

Over the last few years there have been attempts to scale-up Teaching Recovery Techniques (TRT), a community-based group intervention for refugee youth reporting symptoms of post-traumatic stress, across Sweden using the distribution network pathway model. This implementation model allows for quick spread, but only for a low level of control at local sites. This study explores factors and agents that have facilitated the implementation and maintenance of the community-based intervention in successful sites. Seven semi-structured interviews were conducted with personnel from "successful" community sites, defined as having conducted at least two groups and maintaining full delivery. Data were analyzed using content analysis to identify a theme and categories. The main theme "Active networking and collaboration" was key to successful maintenance of community-based delivery. Categories included "Going to where the potential recipients are", relating to the importance of networks, and "Resource availability and management for maintenance", relating to the challenges due to the lack of a lead organization supplying necessary funds and support for maintenance. Additionally, "Careful integration of the interpreter" underlined that interpreters were essential co-facilitators of the intervention. Although the interviewed professionals represented successful sites, they remained dependent on informal networks and collaboration for successful maintenance of community-based delivery.


Assuntos
Refugiados , Transtornos de Estresse Pós-Traumáticos , Adolescente , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Suécia
12.
BMJ Open ; 10(12): e040123, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334832

RESUMO

INTRODUCTION: Success rates of psychotherapy in post-traumatic stress disorder related to childhood maltreatment (PTSD-CM) are limited. METHODS AND ANALYSIS: Observer-blind multicentre randomised clinical trial (A-1) of 4-year duration comparing enhanced methods of STAIR Narrative Therapy (SNT) and of trauma-focused psychodynamic therapy (TF-PDT) each of up to 24 sessions with each other and a minimal attention waiting list in PTSD-CM. Primary outcome is severity of PTSD (Clinician-Administered PTSD Scale for DSM-5 total) assessed by masked raters. For SNT and TF-PDT, both superiority and non-inferiority will be tested. Intention-to-treat analysis (primary) and per-protocol analysis (secondary). Assessments at baseline, after 10 sessions, post-therapy/waiting period and at 6 and 12 months of follow-up. Adult patients of all sexes between 18 and 65 years with PTSD-CM will be included. Continuing stable medication is permitted. To be excluded: psychotic disorders, risk of suicide, ongoing abuse, acute substance related disorder, borderline personality disorder, dissociative identity disorder, organic mental disorder, severe medical conditions and concurrent psychotherapy. To be assessed for eligibility: n=600 patients, to be e randomly allocated to the study conditions: n=328. Data management, randomisation and monitoring will be performed by an independent European Clinical Research Infrastructure Network (ECRIN)-certified data coordinating centre for clinical trials (KKS Marburg). Report of AEs to a data monitoring and safety board. Complementing study A-1, four inter-related add-on projects, including subsamples of the treatment study A-1, will examine (1) treatment integrity (adherence and competence) and moderators and mediators of outcome (B-1); (2) biological parameters (B-2, eg, DNA damage, reactive oxygen species and telomere shortening); (3) structural and functional neural changes by neuroimaging (B-3) and (4) cost-effectiveness of the treatments (B-4, costs and utilities). ETHICS AND DISSEMINATION: Approval by the institutional review board of the University of Giessen (AZ 168/19). Following the Consolidated Standards of Reporting Trials statement for non-pharmacological trials, results will be reported in peer-reviewed scientific journals and disseminated to patient organisations and media. TRIAL REGISTRATION NUMBER: DRKS 00021142.


Assuntos
Maus-Tratos Infantis , Terapia Narrativa , Transtornos Psicóticos , Transtornos de Estresse Pós-Traumáticos , Adulto , Criança , Humanos , Psicoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos de Estresse Pós-Traumáticos/terapia , Resultado do Tratamento
13.
PLoS One ; 15(12): e0244730, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382807

RESUMO

Refugee patients with severe traumatic experiences may need mental health treatment, but treatment results vary, and there is scarcity of studies demonstrating refugees' long-term health and well-being after treatment. In a 10-year naturalistic and longitudinal study, 54 multi-origin traumatized adult refugee patients, with a background of war and persecution, and with a mean stay in Norway of 10.5 years, were recruited as they entered psychological treatment in mental health specialist services. The participants were interviewed face-to-face with multiple methods at admittance, and at varying points in time during and after psychotherapy. The aim was to study the participants' trajectories of symptoms of post-traumatic stress, anxiety and depression, four aspects of quality of life, and two aspects of exile life functioning. Linear mixed effects analyses included all symptoms and quality of life measures obtained at different times and intervals for the participants. Changes in exile life functioning was investigated by exact McNemar tests. Participants responded to the quantitative assessments up to eight times. Length of therapy varied, with a mean of 61.3 sessions (SD = 74.5). The participants improved significantly in symptoms, quality of life, and exile life functioning. Improvement in symptoms of posttraumatic stress, anxiety, and depression yielded small effect sizes (r = .05 to .13), while improvement in quality of psychological and physical health yielded medium effect sizes (r = .38 and .32). Thus, long-time improvement after psychological therapy in these severely traumatized and mostly chronified refugee patients, was more notable in quality of life and exile life functioning than in symptom reduction. The results imply that major symptom reduction may not be attainable, and may not be the most important indication of long-term improvement among refugees with long-standing trauma-related suffering. Other indications of beneficial effects should be applied as well.


Assuntos
Saúde Mental , Qualidade de Vida/psicologia , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Ansiedade/psicologia , Ansiedade/terapia , Depressão/psicologia , Depressão/terapia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Noruega , Psicoterapia , Transtornos de Estresse Pós-Traumáticos/psicologia , Resultado do Tratamento
14.
J Trauma Stress ; 33(5): 634-642, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33007149

RESUMO

In response to COVID-19, continued workforce training is essential to ensure that evidence-based treatments are available on the frontline to meet communities' ongoing and emerging mental health needs. However, training during a pandemic imposes many new challenges. This paper describes a multisite training and implementation pilot program, facets of which allowed for continued training despite the onset of the COVID-19 pandemic and subsequent social distancing guidelines. This virtual facilitated learning collaborative in Written Exposure Therapy, an evidence-based treatment for posttraumatic stress disorder, included virtual workshop training, phone-based clinical consultation, implementation-focused video calls for program leadership, and program evaluation. Data are presented about program enrollees and patient impact following the onset of COVID-19-related social distancing restrictions. Challenges, successes, and practical guidance are discussed to inform the field regarding training strategies likely to be durable in an uncertain, dynamic healthcare landscape.


Assuntos
Infecções por Coronavirus/psicologia , Educação a Distância/organização & administração , Terapia Implosiva/educação , Pneumonia Viral/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Betacoronavirus , Medicina Baseada em Evidências/métodos , Humanos , Pandemias , Desenvolvimento de Programas/métodos , Transtornos de Estresse Pós-Traumáticos/psicologia , Redação
15.
BMC Psychol ; 8(1): 105, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023667

RESUMO

BACKGROUND: Trauma has a major impact on the mental health and wellbeing of people globally. Friends, family and members of the public are often well positioned to provide initial assistance if someone is experiencing extreme distress following a potentially traumatic event. Expert consensus guidelines for high income, Western countries on how to do this were published in 2008. The aim of the current study was to re-develop these guidelines to ensure they are current and reflect best practice. METHODS: The Delphi consensus method was used to determine which helping statements should be included in the guidelines. Helping statements were derived from a systematic search of literature that considered how a member of the public could help someone experiencing extreme distress following a potentially traumatic event. Two expert panels, comprising 28 mental health professionals with expertise in managing trauma and 26 consumer advocates, rated each statement. Statements were accepted for inclusion in the guidelines if they were endorsed by at least 80% of each panel. RESULTS: Out of 183 statements, 103 were endorsed as appropriate helping actions in providing assistance to someone experiencing extreme distress following a potentially traumatic event. These statements were used to form the re-developed guidelines. CONCLUSION: This study has resulted in a more comprehensive set of guidelines than the original version, with the endorsement of 103 helping actions, compared to 65 previously. The updated guidelines better represent the complexities of experiencing trauma and the considered approach required when providing first aid after a potentially traumatic event. The additional guidance on providing initial assistance, talking about the trauma, offering short-term assistance and seeking appropriate professional help reflects current knowledge. A notable addition is the inclusion of content on how a first aider can assist after a disclosure of abuse. The guidelines are available to the public and will inform future updates of Mental Health First Aid training courses.


Assuntos
Primeiros Socorros , Guias como Assunto , Saúde Mental , Transtornos de Estresse Pós-Traumáticos/terapia , Consenso , Técnica Delfos , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários
16.
PLoS One ; 15(10): e0239997, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052965

RESUMO

BACKGROUND: Chronic posttraumatic stress disorder (PTSD) is a disabling condition that generates considerable morbidity, mortality, and both medical and indirect social costs. Treatment options are limited. A novel therapy using 3,4-methylenedioxymethamphetamine (MDMA) has shown efficacy in six phase 2 trials. Its cost-effectiveness is unknown. METHODS AND FINDINGS: To assess the cost-effectiveness of MDMA-assisted psychotherapy (MAP) from the health care payer's perspective, we constructed a decision-analytic Markov model to portray the costs and health benefits of treating patients with chronic, severe, or extreme, treatment-resistant PTSD with MAP. In six double-blind phase 2 trials, MAP consisted of a mean of 2.5 90-minute trauma-focused psychotherapy sessions before two 8-hour sessions with MDMA (mean dose of 125 mg), followed by a mean of 3.5 integration sessions for each active session. The control group received an inactive placebo or 25-40 mg. of MDMA, and otherwise followed the same regimen. Our model calculates net medical costs, mortality, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Efficacy was based on the pooled results of six randomized controlled phase 2 trials with 105 subjects; and a four-year follow-up of 19 subjects. Other inputs were based on published literature and on assumptions when data were unavailable. We modeled results over a 30-year analytic horizon and conducted extensive sensitivity analyses. Our model calculates expected medical costs, mortality, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Future costs and QALYs were discounted at 3% per year. For 1,000 individuals, MAP generates discounted net savings of $103.2 million over 30 years while accruing 5,553 discounted QALYs, compared to continued standard of care. MAP breaks even on cost at 3.1 years while delivering 918 QALYs. Making the conservative assumption that benefits cease after one year, MAP would accrue net costs of $7.6 million while generating 288 QALYS, or $26,427 per QALY gained. CONCLUSION: MAP provided to patients with severe or extreme, chronic PTSD appears to be cost-saving while delivering substantial clinical benefit. Third-party payers are likely to save money within three years by covering this form of therapy.


Assuntos
Análise Custo-Benefício , Alucinógenos/uso terapêutico , N-Metil-3,4-Metilenodioxianfetamina/uso terapêutico , Psicoterapia/economia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Doença Crônica , Ensaios Clínicos Fase II como Assunto , Método Duplo-Cego , Feminino , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Psicoterapia/métodos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/mortalidade , Transtornos de Estresse Pós-Traumáticos/patologia , Taxa de Sobrevida
17.
Psychiatr Danub ; 32(Suppl 3): 320-336, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33030447

RESUMO

The war in Bosnia and Herzegovina (1992-1995) was an extremely hard traumatic event with different losses, separations of people, injuries, hard physical and psychical suffering of everyone. Children were especially in difficult conditions. One of the most remarkable things about children, as anyone who works with them soon finds out, is their resilience. While children are vulnerable to psychic damage and, if the damage is deep enough, to delays in emotional and even physical growth, they also have an astonishing capacity to bounce back. This is one of the most rewarding things about treating traumatized children. For many children, it takes very little, perhaps only some words of understanding, to help them tap into their own ability to heal. Taking care of child war psycho-trauma was a difficult task for me, as the war-time head of Department of psychiatry, without enough knowledge in child psycho-trauma and as person with a high responsibility, to organize together with other psychological caretakers of children, especially refugee children. This presentation will be some kind of my remembrance of period of 20-25 years ago when we, I think did good work of what we could and what we knew.


Assuntos
Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Guerra/psicologia , Adolescente , Adulto , Idoso , Bósnia e Herzegóvina , Criança , Família/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Refugiados/psicologia , Resiliência Psicológica , Transtornos de Estresse Pós-Traumáticos/reabilitação , Adulto Jovem
18.
Psychiatr Danub ; 32(Suppl 3): 367-370, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33030455

RESUMO

Although family should be the basis for the development and formation of a child's personality, violence is mostly done in the family, and remains undiscovered for a long time. The real number of abused children is much more than that displayed in the registered cases. The secrecy of the problem is an important feature of this phenomenon. Families in which abuse takes place are mostly isolated. Social isolation does not come about by chance; secrecy is usually encouraged by an abuser to control over famoly members. In most cases, social reaction to violence is late, inadequate and focused on the consequences, but not on the causes. "Abuse implies an act of execution that directly inflicts damage, while neglect implies an act of non-fulfillment of something that is necessary for the well-being of a child". The most common forms of domestic violence are physical, emotional abuse in the presence of violence against the mother, and in a lesser extent sexual abuse. In addition, there is physical, emotional, educational and medical neglect. The presence of violence against the mother and the feeling of impotence leave the same consequences as the endured violence. It is considered that children living in violent families are likely to live under cumulative stress. Traumatic responses include a wide range of conditions from acute stress reactions through post-traumatic stress disorder to complex long-lasting, repeated trauma syndrome. All children will not react to this kind of experience in the same way, with the protective and risk factors in developmental psychopathology having a significant role to play. Because of their developmental vulnerability and dependency, children are at greater risk of violence than adults. Researches point to the need for a multidisciplinary approach to treatment and prevention of child abuse, with greater interaction between health institutions, relevant centers for social work, police, court, government and non-governmental sector, and the existence of adequate family and criminal laws.


Assuntos
Maus-Tratos Infantis/psicologia , Violência Doméstica/psicologia , Trauma Psicológico/psicologia , Adulto , Criança , Maus-Tratos Infantis/legislação & jurisprudência , Maus-Tratos Infantis/prevenção & controle , Maus-Tratos Infantis/terapia , Violência Doméstica/legislação & jurisprudência , Violência Doméstica/prevenção & controle , Feminino , Humanos , Masculino , Mães/psicologia , Trauma Psicológico/prevenção & controle , Trauma Psicológico/terapia , Fatores de Risco , Instituições Acadêmicas , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia
20.
JMIR Mhealth Uhealth ; 8(9): e22079, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32955456

RESUMO

BACKGROUND: A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. OBJECTIVE: This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. METHODS: Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military & Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. RESULTS: A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. CONCLUSIONS: Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted.


Assuntos
Socorristas/psicologia , Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Telemedicina , Veteranos/psicologia , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...