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Post-Traumatic Stress Disorders: HELP
Articles from USA
Based on 10,744 articles published since 2010
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These are the 10744 published articles about Stress Disorders, Post-Traumatic that originated from USA during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
301 Review Neurobiology of Trauma and Mindfulness for Children. 2018

Iacona, Jaclyn / Johnson, Stephanie. ·School of Nursing, Oakland University, Rochester, Michigan. ·J Trauma Nurs · Pubmed #29742631.

ABSTRACT: Adverse child experiences (ACEs) have a significant impact on developing children, both physically and psychologically, with ongoing consequences that may manifest throughout adulthood. These negative health consequences can be mitigated if a child is given a supportive environment in which to develop healthy coping mechanisms. Those who specialize in caring for children with ACEs must understand the neurobiology of trauma to conceptualize how trauma triggers the brain and body when encountering stressful events. Mindfulness is an evidence-based practice that can be used as a healthy coping mechanism to develop self-regulation and resiliency in children. The purpose of this article is to provide evidenced-based research on the neurobiology of trauma and mindfulness intervention as a recommended modality for use in children. Furthermore, the content in this article was utilized in developing a training module for a suburban, youth organization that provides residential housing, basic necessities, education, and therapy for children with ACEs. The training module is intended to assist staff members in understanding the neurobiology of trauma and mindfulness techniques in their interactions with the children, thereby improving child-staff relationships and encouraging the development of self-regulation and healthy coping mechanisms.

302 Review Trauma-Focused Psychodynamic Psychotherapy. 2018

Busch, Fredric N / Milrod, Barbara L. ·65 East 76th Street, Suite 1B, New York, NY 10021, USA; Weill Cornell Medical College, 525 East 68th Street, New York, NY 10021, USA; Columbia University Center for Psychoanalytic Training and Research, 1051 Riverside Drive, New York, NY 10032, USA. Electronic address: fnb80@aol.com. · 65 East 76th Street, Suite 1B, New York, NY 10021, USA; Weill Cornell Medical College, 525 East 68th Street, New York, NY 10021, USA; Columbia University Center for Psychoanalytic Training and Research, 1051 Riverside Drive, New York, NY 10032, USA; The New York Psychoanalytic Institute, 247 East 82nd Street, New York, NY 10028, USA. ·Psychiatr Clin North Am · Pubmed #29739526.

ABSTRACT: The authors describe a psychodynamic psychotherapeutic approach to posttraumatic stress disorder (PTSD), trauma-focused psychodynamic psychotherapy. This psychotherapy addresses disruptions in narrative coherence and affective dysregulation by exploring the psychological meanings of symptoms and their relation to traumatic events. The therapist works to identify intrapsychic conflicts, intense negative affects, and defense mechanisms related to the PTSD syndrome using a psychodynamic formulation that provides a framework for intervention. The transference provides a forum for patients to address feelings of mistrust, difficulties with authority, fears of abuse, angry and guilty feelings, and fantasies.

303 Review The Effects of Trauma, with or without PTSD, on the Transgenerational DNA Methylation Alterations in Human Offsprings. 2018

Youssef, Nagy A / Lockwood, Laura / Su, Shaoyong / Hao, Guang / Rutten, Bart P F. ·Department of Psychiatry & Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA. nyoussef@augusta.edu. · Academic Affairs, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA. nyoussef@augusta.edu. · Department of Psychiatry and Neuropsychology, University of Alabama at Birmingham, Birmingham, AL 35233, USA. llockwood@uabmc.edu. · Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA. SSU@augusta.edu. · Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA. GHAO@augusta.edu. · Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, School for Mental Health and Neuroscience, 6202 AZ Maastricht, The Netherlands. b.rutten@maastrichtuniversity.nl. ·Brain Sci · Pubmed #29738444.

ABSTRACT: Exposure to psychological trauma is a strong risk factor for several debilitating disorders including post-traumatic stress disorder (PTSD) and depression. Besides the impact on mental well-being and behavior in the exposed individuals, it has been suggested that psychological trauma can affect the biology of the individuals, and even have biological and behavioral consequences on the offspring of exposed individuals. While knowledge of possible epigenetic underpinnings of the association between exposure to trauma and risk of PTSD has been discussed in several reviews, it remains to be established whether trauma-induced epigenetic modifications can be passed from traumatized individuals to subsequent generations of offspring. The aim of this paper is to review the emerging literature on evidence of transgenerational inheritance due to trauma exposure on the epigenetic mechanism of DNA methylation in humans. Our review found an accumulating amount of evidence of an enduring effect of trauma exposure to be passed to offspring transgenerationally via the epigenetic inheritance mechanism of DNA methylation alterations and has the capacity to change the expression of genes and the metabolome. This manuscript summarizes and critically reviews the relevant original human studies in this area. Thus, it provides an overview of where we stand, and a clearer vision of where we should go in terms of future research directions.

304 Review Understanding Resilience and Preventing and Treating PTSD. 2018

Horn, Sarah R / Feder, Adriana. ·From the Department of Psychology, University of Oregon (Ms. Horn) · Department of Psychiatry, Icahn School of Medicine at Mount Sinai (Dr. Feder). ·Harv Rev Psychiatry · Pubmed #29734229.

ABSTRACT: Resilience is defined as the dynamic ability to adapt successfully in the face of adversity, trauma, or significant threat. Some of the key early studies of resilience were observational studies in children. They were followed by research in adults, studies testing interventions to promote resilience in different populations, and a recent upsurge of studies on the underlying genomic and neurobiological mechanisms. Neural and molecular studies in preclinical models of resilience are also increasingly identifying active stress adaptations in resilient animals. Knowledge gained from animal and human studies of resilience can be harnessed to develop new preventive interventions to enhance resilience in at-risk populations. Further, treatment interventions focused on enhancing potentially modifiable protective factors that are consistently linked to psychological resilience can enrich currently available treatment interventions for individuals with posttraumatic stress disorder (PTSD). Translating our expanding knowledge of the neurobiology of resilience additionally promises to yield novel therapeutic strategies for treating this disabling condition. This review summarizes the vast field of resilience research spanning genomic, psychosocial, and neurobiological levels, and discusses how findings have led and can lead to new preventive and treatment interventions for PTSD.

305 Review Glucocorticoids and Hippocampal Structure and Function in PTSD. 2018

Szeszko, Philip R / Lehrner, Amy / Yehuda, Rachel. ·From the Department of Psychiatry, Icahn School of Medicine at Mount Sinai; James J. Peters VA Medical Center, Bronx, NY. ·Harv Rev Psychiatry · Pubmed #29734228.

ABSTRACT: This review examines the putative link between glucocorticoid and hippocampal abnormalities in posttraumatic stress disorder (PTSD). Increased glucocorticoid receptor (GR) sensitivity in PTSD may permit enhanced negative feedback inhibition of cortisol at the pituitary, hypothalamus, or other brain regions comprising the hypothalamic-pituitary-adrenal (HPA) axis and would be expected to affect other physiological systems that are regulated by glucocorticoids. Molecular and transcriptional studies of cortisol are consistent with the hypothesis that cortisol actions may be amplified in PTSD as a result of enhanced GR sensitivity in monocytes and some brain regions, although cortisol levels themselves are unchanged and oftentimes lower than normal. Concurrently, magnetic resonance imaging studies have demonstrated that individuals with PTSD have smaller hippocampal volume than individuals without PTSD. Initial hypotheses regarding the mechanism underlying hippocampal alterations in PTSD focused on elevated glucocorticoid levels in combination with extreme stress as the primary cause, but this explanation has not been well supported in human studies. Lack of data from neuroimaging studies preclude a firm link between PTSD onset and hippocampal volume changes. Rather, the available evidence is consistent with the possibility that smaller hippocampal volume (like reduced cortisol levels and enhanced GR sensitivity) may be a vulnerability factor for developing the disorder; limitations of hippocampal-based models of PTSD are described. We further review neuroimaging studies examining hippocampal structure and function following manipulation of glucocorticoid levels and also examining changes in the hippocampus in relationship to other brain regions. Evidence that the GR may be an important therapeutic target for the treatment of PTSD, especially for functions subserved by the hippocampus, is discussed. Implications of the current review for future research are described, with an emphasis on the need to integrate findings of glucocorticoid abnormalities with functional-imaging paradigms to formulate a comprehensive model of HPA-axis functioning in PTSD.

306 Review Fear Processing, Psychophysiology, and PTSD. 2018

Norrholm, Seth Davin / Jovanovic, Tanja. ·From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine (Drs. Norrholm and Jovanovic) · Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA (Dr. Norrholm). ·Harv Rev Psychiatry · Pubmed #29734227.

ABSTRACT: The processing and regulation of fear is one of the key components of posttraumatic stress disorder (PTSD). Fear can involve both acute and potential threats that can manifest in different behaviors and result from activity within different neural nodes and networks. Fear circuits have been studied extensively in animal models for several decades and in human neuroimaging research for almost 20 years. Therefore, the centrality of fear processing to PTSD lends the disorder to be more tractable to investigation at the level of brain and behavior, and provides several observable phenotypes that can be linked to PTSD symptoms. Moreover, psychophysiological metrics of fear conditioning offer tools that can be used to shift diagnostic paradigms in psychiatry toward neurobiology-consistent with a Research Domain Criteria approach to PTSD. In general, mammalian fear processing can be divided into fear learning (or acquisition), during which an association develops between previously neutral stimuli and aversive outcomes, and fear extinction, in which the latter associations are suppressed by a new form of learning. This review describes translational research in both fear acquisition and extinction, along with their relevance to PTSD and PTSD treatment, focusing specifically on the empirical value and potential clinical utility of psychophysiological methods.

307 Review Functional Neuroanatomy of Emotion and Its Regulation in PTSD. 2018

Fitzgerald, Jacklynn M / DiGangi, Julia A / Phan, K Luan. ·From the Departments of Psychiatry (all), Psychology (Drs. Fitzgerald and Phan), and Anatomy and Cell Biology (Dr. Phan), and Graduate Program in Neuroscience (Dr. Phan), University of Illinois at Chicago · Jesse Brown VA Medical Center, Chicago, IL (Drs. DiGangi and Phan). ·Harv Rev Psychiatry · Pubmed #29734226.

ABSTRACT: Posttraumatic stress disorder (PTSD) is a devastating disorder, linked to profound mental, physical, occupational, and functional impairment. In addition, it is a highly complex disorder, characterized by symptom heterogeneity across multiple domains. Nevertheless, emotion dysregulation arising from the exaggerated response to threat or from the inability to regulate negative emotional states plays a defining role in the pathophysiology of PTSD. In order to improve our understanding of how emotion dysregulation manifests in this illness, functional neuroimaging research over the past 20 years provides great insight into underlying neuroanatomy of each component of emotion dysregulation in the context of PTSD. While prior reviews exist on the topic of neuroimaging findings in PTSD, the present review synthesizes that work through the lens of emotion and its regulation. Studies that employed tasks of emotional responding and symptom provocation, implicit regulation (e.g., emotional Stroop and interference), explicit regulation (e.g., cognitive reappraisal), and fear conditioning/extinction were reviewed. Findings demonstrate that emotion dysregulation in PTSD arises from complications within a large neurocircuitry involving the amygdala, insula, hippocampus, anterior cingulate cortex, and prefrontal cortex. Although an exaggerated response in the amygdala and insula to negative emotional triggers is pervasive, PTSD is also marked by deficient appraisal, resolution, and management of negative emotional states subserved by the anterior cingulate cortex and prefrontal cortex during regulation. These findings further support the importance of studying emotion-regulation deficits in tandem with exaggerated symptom provocation in order to better understand the constellation of symptoms present in those with PTSD.

308 Review Evidenced-Based Treatment of Posttraumatic Stress Disorder: An Updated Review of Validated Psychotherapeutic and Pharmacological Approaches. 2018

Charney, Meredith E / Hellberg, Samantha N / Bui, Eric / Simon, Naomi M. ·From Harvard Medical School · Massachusetts General Hospital (Drs. Charney, Bui, and Simon). ·Harv Rev Psychiatry · Pubmed #29734225.

ABSTRACT: LEARNING OBJECTIVES: After participating in this activity, learners should be better able to:• Evaluate psychotherapeutic and pharmacologic approaches to treating patients with posttraumatic stress disorder. ABSTRACT: A strong evidence base exists for psychological and pharmacological interventions for the treatment of posttraumatic stress disorder (PTSD). The published literature investigating the effectiveness of these treatments in reducing the symptoms and impairments associated with PTSD has expanded substantially in recent years. This review provides a concise overview of the empirical literature examining these treatment approaches. Evidence-based, trauma-focused therapies are recommended as first-line interventions, with the most support for cognitive- and exposure-based approaches. Prolonged exposure and cognitive processing therapy are the two most cited and rigorously investigated. Various other evidence-supported protocols are discussed. Pharmacotherapies can be used when evidence-based psychotherapies are not available or are ineffective, or on the basis of patient preference. Pharmacotherapy with the most support for PTSD includes selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Evidence supports the implementation of these interventions across genders, populations, and settings. Given that little research directly compares the effectiveness of different PTSD interventions and their mechanisms of action, it remains uncertain how to best select and tailor treatments to optimize individual outcomes. Future directions and novel, ongoing research are discussed.

309 Review Increasing Resilience to Traumatic Stress: Understanding the Protective Role of Well-Being. 2018

Tory Toole, J / Rice, Mark A / Cargill, Jordan / Craddock, Travis J A / Nierenberg, Barry / Klimas, Nancy G / Fletcher, Mary Ann / Morris, Mariana / Zysman, Joel / Broderick, Gordon. ·College of Psychology, Nova Southeastern University, Ft. Lauderdale, FL, USA. · Center for Clinical Systems Biology, Rochester General Hospital Research Institute, Rochester, NY, USA. · Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA. · Miami Veterans Affairs Medical Center, Miami, FL, USA. · Center for Computational Science, University of Miami, Miami, FL, USA. · Center for Clinical Systems Biology, Rochester General Hospital Research Institute, Rochester, NY, USA. gordonbroderick55@gmail.com. · Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, USA. gordonbroderick55@gmail.com. ·Methods Mol Biol · Pubmed #29705844.

ABSTRACT: The brain maintains homeostasis in part through a network of feedback and feed-forward mechanisms, where neurochemicals and immune markers act as mediators. Using a previously constructed model of biobehavioral feedback, we found that in addition to healthy equilibrium another stable regulatory program supported chronic depression and anxiety. Exploring mechanisms that might underlie the contributions of subjective well-being to improved therapeutic outcomes in depression, we iteratively screened 288 candidate feedback patterns linking well-being to molecular signaling networks for those that maintained the original homeostatic regimes. Simulating stressful trigger events on each candidate network while maintaining high levels of subjective well-being isolated a specific feedback network where well-being was promoted by dopamine and acetylcholine, and itself promoted norepinephrine while inhibiting cortisol expression. This biobehavioral feedback mechanism was especially effective in reproducing well-being's clinically documented ability to promote resilience and protect against onset of depression and anxiety.

310 Review Factors influencing the adoption of telemedicine for treatment of military veterans with post-traumatic stress disorder. 2018

Kruse, Clemens Scott / Atkins, James M / Baker, Tiffany D / Gonzales, Estefania N / Paul, Jennifer L / Brooks, Matthew. ·School of Health Administration, Texas State University, 78666 San Marcos, USA. scottkruse@txstate.edu. ·J Rehabil Med · Pubmed #29700551.

ABSTRACT: BACKGROUND: Military veterans returning from a combat zone often face mental health challenges as a result of traumatic experiences. The veteran in the United States has been underdiagnosed and underserved. Since its advancement in the 1990s, telemedicine has become a more prevalent means of delivering services for post-traumatic stress disorder among veterans in the United States, but its adoption is not ubiquitous. OBJECTIVE: To clarify the association of telemedicine and the treatment of veterans with post-traumatic stress disorder through identification of facilitators and barriers to the adoption of the modality. METHODS: Reviewers analysed articles from CINAHL and PubMed databases, using relative key words, selecting the 28 most germane to the study objective. RESULTS: The most common adoption facilitators were: improving access to rural populations of veterans (22%), effective treatment outcomes (16%), and decreased costs related to care (13%). The most prevalent barriers were: veterans lacking access to necessary modalities (25%), availability of physicians competent in post-traumatic stress disorder treatment (20%), and complications with technology (20%). Five themes surfaced for facilitators: accessibility, effectiveness, cost reduction, positive patient perception, and supportive community; and 5 themes for barriers: access to technology, technical complications, physician availability, negative patient perception, and uninformed patients. CONCLUSION: This literature review identifies cost and outcomes-effectiveness. The association of telemedicine with the treatment of veterans with post-traumatic stress disorder is feasible, beneficial and effective.

311 Review Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occuring smoking: A systematic review and meta-analysis. 2018

van den Berk-Clark, Carissa / Secrest, Scott / Walls, Jesse / Hallberg, Ellen / Lustman, Patrick J / Schneider, F David / Scherrer, Jeffrey F. ·Department of Family and Community Medicine, Saint Louis University School of Medicine. · Department of Psychiatry, Washington University in St. Louis. ·Health Psychol · Pubmed #29698016.

ABSTRACT: OBJECTIVES: Research has shown that posttraumatic stress disorder (PTSD) increases the risk of development of cardiometabolic disease (CMD) including cardiovascular disease and diabetes. Whether PTSD is also associated with behavioral risk factors (e.g., diet, exercise, smoking and obesity) for CMD, is less clear. METHODS: PubMed, Web of Science, and Scopus databases were searched to obtain papers published between 1980-2016. Studies were reviewed for quality using the Quality of Cohort screen. Significance values, odds ratios (OR), 95% confidence intervals (CI), and tests of homogeneity of variance were calculated. PRINCIPAL FINDINGS: A total of 1,349 studies were identified from our search and 29 studies met all eligibility criteria. Individuals with PTSD were 5% less likely to have healthy diets (pooled adjusted OR = 0.95; 95% CI: 0.92, 0.98), 9% less likely to engage in physical activity (pooled adjusted OR = 0.91; 95% CI: 0.88, 0.93), 31% more likely to be obese (pooled adjusted OR = 1.31; 95% CI:1.25, 1.38), and about 22% more likely to be current smokers (pooled adjusted OR = 1.22; 95% CI: 1.19, 1.26), than individuals without PTSD. CONCLUSIONS: Evidence shows PTSD is associated with reduced healthy eating and physical activity, and increased obesity and smoking. The well-established association between PTSD and metabolic and cardiovascular disease may be partly due to poor diet, sedentary lifestyle, high prevalence of obesity, and co-occurring smoking in this population. The well-established association of PTSD with CMD is likely due in part to poor health behaviors in this patient population. (PsycINFO Database Record

312 Review Neurological disease in the aftermath of terrorism: a review. 2018

De Cauwer, Harald / Somville, Francis J M P. ·Department of Neurology, AZ St Dimpna Regional Hospital, JB Stessenstraat 2, 2440, Geel, Belgium. harald.decauwer@ziekenhuisgeel.be. · Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium. harald.decauwer@ziekenhuisgeel.be. · Department of Emergency Medicine, Dimpna Regional Hospital, Geel, Belgium. · Department of Health Psychology, University of Leiden, Leiden, The Netherlands. · Clerkships Office, Faculty of Medicine, University of Leuven, Leuven, Belgium. ·Acta Neurol Belg · Pubmed #29694644.

ABSTRACT: The purpose of our review is to discuss current knowledge on long-term sequelae and neurological disorders in the aftermath of a terrorist attack. The specific aspects of both psychological and physical effects are mentioned in more detail in this review. Also, the outcomes such as stress-related disorders, cardiovascular disease, and neurodegenerative disease are explained. Moreover, PTSD and posttraumatic structural brain changes are a topic for further investigations of the patients suffering from these attacks. Not only the direct victims are prone to the after effects of the terroristic attacks, but the rescue workers, physicians, witnesses and worldwide citizens may also be affected by PTSD and other neurological diseases as well. The determination of a whole series of risk factors for developing neurological disorders can be a means to set up early detection, preventative measures, to refine treatment and thus to gain better outcome in the future.

313 Review Leveraging genetics to enhance the efficacy of PTSD pharmacotherapies. 2018

Miller, Mark W. ·VA Boston Healthcare System, National Center for PTSD, Boston, MA USA; Boston University School of Medicine, Department of Psychiatry, Boston, MA USA. Electronic address: mark.miller5@va.gov. ·Neurosci Lett · Pubmed #29689343.

ABSTRACT: Progress in PTSD pharmacotherapy has lagged far behind that of other major mental illnesses. Unfortunately, due to the enormous costs and lengthy process involved in bringing drugs to market, delivering new treatments to patients with PTSD in the near future will remain a challenge. However, by capitalizing on recent advances in the pharmacogenetics of antidepressants, precision psychiatry approaches can be leveraged to optimize the delivery of currently-available medications in a fraction of the time and cost required to develop novel therapeutics. This paper provides a review of the pharmacogenetics of the four serotonin reuptake inhibitors (SRIs) that are currently endorsed for the treatment of PTSD (paroxetine, sertraline, fluoxetine and venlafaxine). It focuses on genes involved in SRI pharmacokinetics (including the liver enzyme genes CYP2D6 and CYP2C19 and blood-brain barrier-relevant gene ABCB1) as well as those implicated in both SRI pharmacodynamics and the pathophysiology of PTSD and related conditions (e.g., BDNF, FKBP5, HTR1A, HTR2A, TPH2). The review concludes with an overview of emerging commercial platforms for pharmacogenetic-guided prescription and a discussion of challenges and directions for future pharmacogenetic research on PTSD.

314 Review Sleep Disorders in Patients With Posttraumatic Stress Disorder. 2018

El-Solh, Ali A / Riaz, Usman / Roberts, Jasmine. ·VA Western New York Healthcare System, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; Department of Epidemiology and Environmental Health, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY. Electronic address: solh@buffalo.edu. · VA Western New York Healthcare System, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY. ·Chest · Pubmed #29684315.

ABSTRACT: A growing body of evidence supports a bidirectional relationship between posttraumatic stress disorder (PTSD) and sleep disturbances. Fragmented sleep induced by sleep-related breathing disorders, insomnia, and nightmares impacts recovery and treatment outcomes and worsens PTSD symptoms. Despite recent attention, management of these disorders has been unrewarding in the setting of PTSD. This review summarizes the evidence for empirically supported treatments of these sleep ailments, including psychotherapeutic and pharmacologic interventions, as it relates to PTSD. Recent advances in positive airway pressure technology have made treatment of OSA more acceptable; however, adherence to CPAP therapy presents a substantial challenge. Concomitant insomnia, which engenders psychiatric and medical conditions, including depression, suicide, and alcohol and substance abuse, can be managed with cognitive behavioral therapy. Hypnotic agents are considered an alternative therapy, but concerns about adverse events and lack of high-level evidence supporting their efficacy in PTSD treatment have limited their use to resistant cases or as adjuncts to behavioral therapy when the response is less than desirable. Intrusion of nightmares can complicate PTSD treatment and exert serious strain on social, occupational, and marital relations. Imagery rehearsal therapy has shown significant reduction in nightmare intensity and frequency. The success of noradrenergic blocking agents has not been consistent among studies, with one-half reporting treatment failure. An integrated stepped care approach that includes components of both behavioral and pharmacologic interventions customized to patients' sleep-maladaptive behaviors may offer a solution to delivering accessible, effective, and efficient services for individuals with PTSD.

315 Review Sex differences in behavioral and psychological expression of grief during adolescence: A meta-analysis. 2018

Shulla, Rachel M / Toomey, Russell B. ·Family Studies and Human Development, The University of Arizona, Tucson, AZ, USA. · Family Studies and Human Development, The University of Arizona, Tucson, AZ, USA. Electronic address: rmshulla@email.arizona.edu. ·J Adolesc · Pubmed #29674176.

ABSTRACT: This meta-analysis synthesizes the results of 14 independent studies conducted in the U.S. (N = 6979 participants) that examined sex differences in internalized, externalized, and PTSD symptoms associated with grief during adolescence. The mean age of participants was 12.22 years (SD = 2.31) with 50% male and 50% female sex assigned at birth. While no mean-level differences were found between adolescent females and males in externalizing behaviors associated with grief (d = 0.03), on average, females reported higher levels of internalized grief responses (d = 0.18) and higher levels of PTSD symptoms (d = 0.36) than their male counterparts. Findings suggest the need for additional, more nuanced research to investigate possible sex differences in externalized behaviors relating to grief. In addition, research should examine whether tailored therapeutic and intervention measures and resources are needed for adolescents experiencing internalized grief and PTSD symptoms given sex differences in these reactions.

316 Review Euthanasia of Cattle: Practical Considerations and Application. 2018

Shearer, Jan Keith. ·Professor and Extension Veterinarian, College of Veterinary Medicine, Iowa State University, Ames, IA 50011-1250, USA. JKS@iastate.edu. ·Animals (Basel) · Pubmed #29673140.

ABSTRACT: Acceptable methods for the euthanasia of cattle include overdose of an anesthetic, gunshot and captive bolt. The use of anesthetics for euthanasia is costly and complicates carcass disposal. These issues can be avoided by use of a physical method such as gunshot or captive bolt; however, each requires that certain conditions be met to assure an immediate loss of consciousness and death. For example, the caliber of firearm and type of bullet are important considerations when gunshot is used. When captive bolt is used, a penetrating captive bolt loaded with the appropriate powder charge and accompanied by a follow up (adjunctive) step to assure death are required. The success of physical methods also requires careful selection of the anatomic site for entry of a “free bullet” or “bolt” in the case of penetrating captive bolt. Disease eradication plans for animal health emergencies necessitate methods of euthanasia that will facilitate rapid and efficient depopulation of animals while preserving their welfare to the greatest extent possible. A portable pneumatic captive bolt device has been developed and validated as effective for use in mass depopulation scenarios. Finally, while most tend to focus on the technical aspects of euthanasia, it is extremely important that no one forget the human cost for those who may be required to perform the task of euthanasia on a regular basis. Symptoms including depression, grief, sleeplessness and destructive behaviors including alcoholism and drug abuse are not uncommon for those who participate in the euthanasia of animals.

317 Review Coroners and PTSD: Treatment Implications. 2018

Flannery, Raymond B / Greenhalgh, Thomas. ·Harvard Medical School, Boston, MA, USA. raymond_flannery@hms.harvard.edu. · Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA, 02139, USA. raymond_flannery@hms.harvard.edu. · National Public Safety Solutions, Inc., National Public Safety Solutions, Inc. , Burlington, MA, USA. ·Psychiatr Q · Pubmed #29651735.

ABSTRACT: Experimental studies have documented the development of posttraumatic stress disorder (PTSD) in first responders. These studies have routinely included police, firefighters, and paramedics. However, there is another group of first responders that are at risk for PTSD but that has received less research attention. This group is comprised of coroners. This paper reviewed the published data concerning coroners and PTSD and outlined various treatments for addressing coronial PTSD. The findings, the differing treatments, and a detailed methodological inquiry are presented. The need for a conceptual framework for the various other professional groups responding to critical incidents and a crisis intervention approach to address the psychological needs of both family survivors and coronial personnel are noted.

318 Review Posttraumatic stress disorder and nonadherence to medications prescribed for chronic medical conditions: A meta-analysis. 2018

Taggart Wasson, Lauren / Shaffer, Jonathan A / Edmondson, Donald / Bring, Rachel / Brondolo, Elena / Falzon, Louise / Konrad, Beatrice / Kronish, Ian M. ·Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States. Electronic address: lsw2107@cumc.columbia.edu. · Department of Psychology, College of Liberal Arts and Sciences University of Colorado at Denver, United States. · Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States. ·J Psychiatr Res · Pubmed #29631190.

ABSTRACT: BACKGROUND: Patients with posttraumatic stress disorder (PTSD) are at increased risk for adverse consequences from comorbid medical conditions. Nonadherence to medications prescribed to treat those comorbid conditions may help explain this increased risk. We sought to determine the association between PTSD and medication nonadherence and whether it varied according to the type of event inducing the PTSD. METHODS: Prospective observational cohort or cross-sectional studies relating PTSD and nonadherence among adults prescribed medications for a chronic medical illness were identified by searching MEDLINE, EMBASE, PsycINFO, the Cochrane Library, CINAHL, SCOPUS, and the PILOTS Database and by hand-searching bibliographies from selected articles. Individual estimates of odds ratios were pooled using random effects meta-analysis with inverse variance weighting. Articles were pooled separately according to whether PTSD was induced by a medical versus non-medical event. OUTCOMES: Sixteen articles comprising 4483 patients met eligibility criteria. The pooled effect size of the risk of PTSD to medication nonadherence was OR 1.22 (95% CI, 1.06-1.41). Among the 6 studies of medical event-induced PTSD, the OR was 2.08 (95% CI, 1.03-4.18); p = 0.04. Among the 8 studies in which PTSD was not induced by a medical event, the OR was 1.10 (95% CI, 0.99-1.24); p = 0.09. INTERPRETATION: Patients with PTSD were more likely to be nonadherent to medications prescribed for chronic medical conditions - an association that may exist specifically when PTSD was induced by a medical event. Medications may serve as aversive reminders among survivors of acute medical events, magnifying avoidance behaviors characteristic of PTSD. FUNDING: NHLBI.

319 Review Metabolism, Metabolomics, and Inflammation in Posttraumatic Stress Disorder. 2018

Mellon, Synthia H / Gautam, Aarti / Hammamieh, Rasha / Jett, Marti / Wolkowitz, Owen M. ·Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, California. · Integrative Systems Biology, United States Army Medical Research and Material Command, United States Army Center for Environmental Health Research, Fort Detrick, Frederick, Maryland. · Integrative Systems Biology, United States Army Medical Research and Material Command, United States Army Center for Environmental Health Research, Fort Detrick, Frederick, Maryland. Electronic address: marti.jett-tilton.civ@mail.mil. · Department of Psychiatry, University of California-San Francisco, San Francisco, California. ·Biol Psychiatry · Pubmed #29628193.

ABSTRACT: Posttraumatic stress disorder (PTSD) is defined by classic psychological manifestations, although among the characteristics are significantly increased rates of serious somatic comorbidities, such as cardiovascular disease, immune dysfunction, and metabolic syndrome. In this review, we assess the evidence for disturbances that may contribute to somatic pathology in inflammation, metabolic syndrome, and circulating metabolites (implicating mitochondrial dysfunction) in individuals with PTSD and in animal models simulating features of PTSD. The clinical and preclinical data highlight probable interrelated features of PTSD pathophysiology, including a proinflammatory milieu, metabolomic changes (implicating mitochondrial and other processes), and metabolic dysregulation. These data suggest that PTSD may be a systemic illness, or that it at least has systemic manifestations, and the behavioral manifestations are those most easily discerned. Whether somatic pathology precedes the development of PTSD (and thus may be a risk factor) or follows the development of PTSD (as a result of either shared pathophysiologies or lifestyle adaptations), comorbid PTSD and somatic illness is a potent combination placing affected individuals at increased physical as well as mental health risk. We conclude with directions for future research and novel treatment approaches based on these abnormalities.

320 Review The Function of Play for Coping and Therapy with Children Exposed to Disasters and Political Violence. 2018

Cohen, Esther / Gadassi, Reuma. ·School of Psychology, Interdisciplinary Center, Herzliya, Israel. Esther.cohen@mail.huji.ac.il. · School of Education, Hebrew University of Jerusalem, Mount Scopus, Jerusalem, Israel. Esther.cohen@mail.huji.ac.il. · Psychology Department, Yale University, New Haven, CT, USA. ·Curr Psychiatry Rep · Pubmed #29623498.

ABSTRACT: PURPOSE OF REVIEW: The objectives were to identify specific characteristics and patterns of children's play following events of political violence or disasters, examine their associations with risk and resilience, and explore their implications for preventive and therapeutic intervention. RECENT FINDINGS: Patterns of individual, dyadic, and social play are associated with measures of children's adaptation following collective traumatic events. Modifying the traditional child-centered play therapy, by integrating CBT principles or including parents, may increase efficacy. Preventive interventions in the aftermath of collective traumatic events must address children's need to play in safe spaces, with the support of significant adults. Recognizing that posttraumatic play is a multifaceted phenomenon implies the need for more individualized play therapy models, varying in level of therapist's activity and techniques employed. Research is needed to clarify the validity of play measures for assessing adaptation and to study the effectiveness of integrative play-based models.

321 Review Recent Genetics and Epigenetics Approaches to PTSD. 2018

Daskalakis, Nikolaos P / Rijal, Chuda M / King, Christopher / Huckins, Laura M / Ressler, Kerry J. ·Division of Depression & Anxiety Disorders, McLean Hospital, Department of Psychiatry, Harvard Medical School, Oaks Building 328, Mailstop 212, 115 Mill Street, Belmont, MA, 02478-1064, USA. · Department of Psychiatry, Genetics and Genomic Sciences, Icahn School of Medicine, New York, NY, USA. · Division of Depression & Anxiety Disorders, McLean Hospital, Department of Psychiatry, Harvard Medical School, Oaks Building 328, Mailstop 212, 115 Mill Street, Belmont, MA, 02478-1064, USA. kressler@mclean.harvard.edu. ·Curr Psychiatry Rep · Pubmed #29623448.

ABSTRACT: PURPOSE OF REVIEW: Following a life-threatening traumatic exposure, about 10% of those exposed are at considerable risk for developing posttraumatic stress disorder (PTSD), a severe and disabling syndrome characterized by uncontrollable intrusive memories, nightmares, avoidance behaviors, and hyperarousal in addition to impaired cognition and negative emotion symptoms. This review will explore recent genetic and epigenetic approaches to PTSD that explain some of the differential risk following trauma exposure. RECENT FINDINGS: A substantial portion of the variance explaining differential risk responses to trauma exposure may be explained by differential inherited and acquired genetic and epigenetic risk. This biological risk is complemented by alterations in the functional regulation of genes via environmentally induced epigenetic changes, including prior childhood and adult trauma exposure. This review will cover recent findings from large-scale genome-wide association studies as well as newer epigenome-wide studies. We will also discuss future "phenome-wide" studies utilizing electronic medical records as well as targeted genetic studies focusing on mechanistic ways in which specific genetic or epigenetic alterations regulate the biological risk for PTSD.

322 Review Stress Response Modulation Underlying the Psychobiology of Resilience. 2018

Averill, Lynnette A / Averill, Christopher L / Kelmendi, Benjamin / Abdallah, Chadi G / Southwick, Steven M. ·Department of Veterans Affairs National Center for PTSD - Clinical Neurosciences Division, Department of Psychiatry, Yale School of Medicine, 950 Campbell Avenue, 151E, West Haven, CT, 06516, USA. lynnette.averill@yale.edu. · Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA. lynnette.averill@yale.edu. · Department of Veterans Affairs National Center for PTSD - Clinical Neurosciences Division, Department of Psychiatry, Yale School of Medicine, 950 Campbell Avenue, 151E, West Haven, CT, 06516, USA. · Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA. ·Curr Psychiatry Rep · Pubmed #29594808.

ABSTRACT: PURPOSE OF REVIEW: This review focuses on the relationship between resilience and the ability to effectively modulate the stress response. Neurobiological and behavioral responses to stress are highly variable. Exposure to a similar stressor can lead to heterogeneous outcomes-manifesting psychopathology in one individual, but having minimal effect, or even enhancing resilience, in another. We highlight aspects of stress response modulation related to early life development and epigenetics, selected neurobiological and neurochemical systems, and a number of emotional, cognitive, psychosocial, and behavioral factors important in resilience. We also briefly discuss interventions with potential to build and promote resilience. RECENT FINDINGS: Throughout this review, we include evidence from recent preclinical and clinical studies relevant to the psychobiology of resilient stress response modulation. Effective modulation of the stress response is an essential component of resilience and is dependent on a complex interplay of neurobiological and behavioral factors.

323 Review The role of suboptimal mitochondrial function in vulnerability to post-traumatic stress disorder. 2018

Preston, Graeme / Kirdar, Faisal / Kozicz, Tamas. ·Hayward Genetics Center, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA. gpreston@tulane.edu. · Hayward Genetics Center, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA. · Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA. · Department of Anatomy, Radboud University Medical Center, Nijmegen, Netherlands. ·J Inherit Metab Dis · Pubmed #29594645.

ABSTRACT: Post-traumatic stress disorder remains the most significant psychiatric condition associated with exposure to a traumatic event, though rates of traumatic event exposure far outstrip incidence of PTSD. Mitochondrial dysfunction and suboptimal mitochondrial function have been increasingly implicated in several psychopathologies, and recent genetic studies have similarly suggested a pathogenic role of mitochondria in PTSD. Mitochondria play a central role in several physiologic processes underlying PTSD symptomatology, including abnormal fear learning, brain network activation, synaptic plasticity, steroidogenesis, and inflammation. Here we outline several potential mechanisms by which inherited (genetic) or acquired (environmental) mitochondrial dysfunction or suboptimal mitochondrial function, may contribute to PTSD symptomatology and increase susceptibility to PTSD. The proposed pathogenic role of mitochondria in the pathophysiology of PTSD has important implications for prevention and therapy, as antidepressants commonly prescribed for patients with PTSD have been shown to inhibit mitochondrial function, while alternative therapies shown to improve mitochondrial function may prove more efficacious.

324 Review Using a social construction of gender lens to understand gender differences in posttraumatic stress disorder. 2018

Street, Amy E / Dardis, Christina M. ·National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States. Electronic address: amy.street@va.gov. · Department of Psychology, Towson University, Towson, MD, United States. ·Clin Psychol Rev · Pubmed #29580673.

ABSTRACT: A wealth of research has established clear gender differences in exposure to potentially traumatic events and in subsequent posttraumatic stress disorder (PTSD). One perspective that is missing from most conversations about gender differences in PTSD is a systematic discussion of gender role socialization, and relatedly, the social construction of gender within our society. The purpose of the present review is to provide exposure to these theories as they relate to gender differences in PTSD, including differences in trauma exposure, risk for the development and maintenance of PTSD symptoms, and PTSD treatment outcome. In this review we focus on characteristics and behaviors that arise from a way of being in the world that is largely influenced by assigned gender. These include gender differences in patterns of trauma exposure, chronic environmental strain, behavioral responses to distress, cognitive factors, and the experience and expression of emotion. We posit that these different sets of factors reciprocally influence each other and combine synergistically to influence observed gender differences. The research reviewed here indicates that societal definitions of masculinity and femininity have psychological consequences in that they produce gender differences in major risk factors relevant to PTSD.

325 Review Remission in CBT for adult anxiety disorders: A meta-analysis. 2018

Springer, Kristen S / Levy, Hannah C / Tolin, David F. ·Anxiety Disorders Center, Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106, United States. · Anxiety Disorders Center, Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106, United States; Department of Psychiatry, Yale University School of Medicine, 300 George St. New Haven, CT 06511, United States. Electronic address: David.Tolin@hhchealth.org. ·Clin Psychol Rev · Pubmed #29576326.

ABSTRACT: Currently there is no universally accepted definition of remission in anxiety disorders. This may be causing significantly different estimates of treatment efficacy across anxiety disorders. The aim of this paper was to determine not only the overall remission rate in cognitive-behavioral therapy (CBT) for anxiety disorders, but also to examine whether the different definitions of remission lead to significantly different remission rates. From the initial 228 abstracts reviewed by the authors, 100 articles were retained. The overall mean remission rate was 51.0%. Remission rates were highest when remission was defined as good end state functioning or no longer meeting criteria for the primary diagnosis. Studies of posttraumatic stress disorder had the highest remission rates, while those of obsessive-compulsive disorder and social anxiety disorder had the lowest remission rates. Rates of remission differed by certain demographic (e.g., older age) and clinical (e.g., medication use) characteristics. Although CBT is an empirically supported treatment for anxiety disorders, it is clear that there is room for improvement, as many patients do not achieve remission status.

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