RESUMO
Smoking prevalence among patients with posttraumatic stress disorder (PTSD) is over 40%. Baseline data from the VA Cooperative Studies Program trial of integrated versus usual care for smoking cessation in veterans with PTSD (N = 863) were used in multivariate analyses of PTSD and depression severity, and 4 measures of smoking intensity: cigarettes per day (CPD), Fagerström Test for Nicotine Dependence (FTND), time to first cigarette, and expired carbon monoxide. Multivariate regression analysis showed the following significant associations: CPD with race (B = -7.16), age (B = 0.11), and emotional numbing (B =0 .16); FTND with race (B = -0.94), education (B = -0.34), emotional numbing (B = 0.04), significant distress (B = -0.12), and PHQ-9 (B = 0.04); time to first cigarette with education (B = 0.41), emotional numbing (B = -0.03), significant distress (B = 0.09), and PHQ-9 (B = -0.03); and expired carbon monoxide with race (B = -9.40). Findings suggest that among veterans with PTSD, White race and emotional numbing were most consistently related to increased smoking intensity and had more explanatory power than total PTSD symptom score. Results suggest specific PTSD symptom clusters are important to understanding smoking behavior in patients with PTSD.
Assuntos
Fumar/epidemiologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Autorrelato , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/psicologia , Estados Unidos/epidemiologia , Veteranos/psicologia , Adulto JovemRESUMO
The objective of the present study was to compare three specialized treatment programs for post-traumatic stress disorder (PTSD) in different Veterans Affairs medical centers, in terms of the format of therapeutic services and the medications prescribed for PTSD. Chart review methods were used to examine medical records for 50 patients from each facility over a 6-month period. Results indicated that the medications prescribed were fairly consistent across sites, although they were not always consistent with treatment recommendations. Therapy formats for two of the facilities were quite different, with one offering more case management services and the other offering more intensive individual and group therapy services. Additional research is needed to broaden our knowledge of how PTSD is being treated currently and to study the effectiveness of the treatment strategies being used.
Assuntos
Hospitais de Veteranos , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Veteranos/psicologia , Administração de Caso , Revisão de Uso de Medicamentos , Hospitais de Veteranos/normas , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Avaliação de Processos em Cuidados de Saúde , Psicoterapia de Grupo , Transtornos de Estresse Pós-Traumáticos/terapia , Estados UnidosRESUMO
Although clinicians have patients interpret proverbs in mental status exams for psychosis, there are few empirical studies investigating the significance of proverb interpretation. In schizophrenia patients, we found abstraction positively correlated with overall intelligence but no symptom measures, concreteness negatively correlated with overall intelligence, executive functioning, attention, and memory, and bizarre-idiosyncratic responses associated with positive formal thought disorder but no cognitive functions.
Assuntos
Aforismos e Provérbios como Assunto , Transtornos Cognitivos/etiologia , Esquizofrenia/complicações , Adulto , Escalas de Graduação Psiquiátrica Breve , Transtornos Cognitivos/diagnóstico , Feminino , Humanos , Masculino , Esquizofrenia/diagnóstico , Índice de Gravidade de Doença , Fatores Socioeconômicos , PensamentoRESUMO
OBJECTIVE: To evaluate the effectiveness of cognitive-behavioral therapy for insomnia (CBT-I)-informed sleep skills education on sleep quality and initial sleep latency in patients attending a psychiatry partial hospitalization program. METHOD: This retrospective chart review was conducted in a psychiatry partial hospitalization program of a teaching Veterans Affairs medical center located in Minneapolis, Minnesota. Patients typically attend the program for 1 month. Data were collected from a continuous improvement project from November 2007 to March 2009. The Pittsburgh Sleep Quality Index (PSQI) was administered to the patients at the time of entry into the program and at their discharge. Patients who completed both PSQI assessments were included in the study. RESULTS: A total of 183 patients completed both PSQI assessments. Of those, 106 patients attended CBT-I-informed sleep skills education and 77 did not (all patients completed the psychiatry partial hospitalization program). For all patients, the mean ± SD baseline PSQI score was 12.5 ± 4.8. PSQI scores improved by a mean of 3.14 points (95% CI, 2.5-3.8; P < .001) in all patients who completed the psychiatry partial hospitalization program. For all patients, there were significant reductions in sleep latency (17.6 minutes) (t 183 = 6.58, P < .001) and significant increases in overall sleep time, from 6.1 to 6.7 hours (t 183 = 4.72, P < .001). There was no statistically significant difference in PSQI scores of patients who attended CBT-I-informed sleep skills education and those who did not during their stay in the partial hospitalization program. CONCLUSIONS: The quality of sleep and initial sleep latency improved in patients who completed the psychiatry partial hospitalization program regardless of whether they attended CBT-I-informed sleep skills education or not. In this study, a structured psychiatry partial hospitalization program improved perceived sleep quality and initial sleep latency. Additional randomized controlled trials with a higher intensity of CBT-I-informed sleep skills education are needed.
Assuntos
Transtornos Cognitivos/diagnóstico , Testes Neuropsicológicos , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Adulto , Atenção , Doença Crônica , Transtornos Cognitivos/psicologia , Feminino , Humanos , Inteligência , Masculino , Memória de Curto Prazo , Reconhecimento Visual de Modelos , Resolução de Problemas , Escalas de Graduação Psiquiátrica , Desempenho Psicomotor , Ajustamento Social , Aprendizagem VerbalRESUMO
BACKGROUND: Patients with chronic psychiatric diagnoses have a prevalence of chronic hepatitis C (HCV) approximately 11 times higher than the general American population. Posttraumatic stress disorder (PTSD) is particularly common among HCV patients. OBJECTIVE: The authors describe the effect of treatment with pegylated-interferon-alpha(2b) (IFN) and ribavirin for patients with HCV on their posttraumatic stress disorder (PTSD) symptoms. METHOD: Sixteen patients with HCV and combat-related PTSD were followed for 24 weeks and assessed with self-report measures of PTSD, hostility, and depression. RESULTS: Depression and Resentment scores significantly increased in five patients treated with IFN and ribavirin, but no significant differences were found in PTSD scores when compared with 11 control patients. CONCLUSION: The results suggest that patients with PTSD and HCV can be safely treated with anti-viral therapies when they are given appropriate psychiatric care.
Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/psicologia , Interferon-alfa/uso terapêutico , Ribavirina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/etiologia , Antidepressivos/uso terapêutico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Seguimentos , Hepatite C Crônica/epidemiologia , Hostilidade , Humanos , Interferon alfa-2 , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis , Vigilância da População/métodos , Prevalência , Proteínas Recombinantes , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Inquéritos e Questionários , Veteranos/psicologia , Veteranos/estatística & dados numéricosRESUMO
Guilt about surviving a traumatic event is thought to be an associated feature of posttraumatic stress disorder (PTSD). Shame is an emotion closely related to guilt but is a distinct affective state. Little is known regarding the role of shame in PTSD and there are no studies of PTSD where shame and guilt are examined simultaneously. We used a measure of shame- and guilt-proneness in 107 community residing former prisoner of war veterans all of whom had been exposed to trauma. The measure of shame-proneness was positively correlated with PTSD symptom severity whereas guilt-proneness was not. This study provides the first empirical data regarding a possible role for shame in PTSD and may have important therapeutic and theoretical implications.