Social Determinants of Mental Health for Posttraumatic Stress Disorder

Psychiatric Annals, Год журнала: 2024, Номер 54(7)

Опубликована: Июль 1, 2024

Recognizing and addressing the social determinants of mental health (SDoMH) for posttraumatic stress disorder (PTSD) is essential effective practice psychiatry. Experiencing traumatic events subsequent development PTSD profoundly affects individuals, families, society, making it one most common disorders with substantial psychiatric comorbidity. This article delves into bidirectional aspects SDoMH in reviews diagnostic criteria, prevalence rates, repercussions on both an individual level within society. assessment, interventions, treatment are reviewed, including Prolonged Exposure, Cognitive Processing Therapy, Eye Movement, Desensitization Reprocessing, trauma-focused grief therapy. Primary prevention PTSD, public considerations, positive psychiatry tenets reviewed. [ Psychiatr Ann . 2024;54(7):e209–e215.]

Язык: Английский

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One year clinical outcomes after transcranial direct current stimulation and virtual reality for posttraumatic stress disorder

Brain stimulation, Год журнала: 2024, Номер 17(4), С. 896 - 898

Опубликована: Июль 1, 2024

Posttraumatic stress disorder (PTSD) is a prevalent and disabling psychiatric [1Shalev A. Liberzon I. Marmar C. Post-traumatic disorder.N Engl J Med. 2017 Jun 22; 376 (Available from): 2459-2469https://doi.org/10.1056/NEJMra1612499Crossref PubMed Scopus (513) Google Scholar]. Unfortunately, current treatment options have modest efficacy challenges related to accessibility, burden, side effects [2Schnurr P.P. Hamblen J.L. Wolf J. Coller R. Collie Fuller M.A. et al.The management of posttraumatic acute disorder: synopsis the 2023 U.S. Department Veterans Affairs Defense Clinical Practice Guideline.Ann Intern 2024 Mar; 177 363-374https://doi.org/10.7326/M23-2757Crossref (3) Therefore, we others been developing non-invasive brain stimulation for PTSD, now with evidence that transcranial magnetic (TMS) can reduce PTSD symptoms in controlled trials naturalistic settings (e.g. Refs. [3Philip N.S. Barredo Aiken E. Larson V. Jones R.N. Shea M.T. al.Theta-burst disorder.Am Psychiatr. 2019 Nov 1; 176 939-948https://doi.org/10.1176/appi.ajp.2019.18101160Crossref (114) Scholar, 4Kozel F.A. Motes Didehbani N. DeLaRosa B. Bass Schraufnagel C.D. al.Repetitive TMS augment cognitive processing therapy combat veterans recent conflicts PTSD: randomized clinical trial.J Affect Disord. 2018 Mar 15; 229 506-514https://doi.org/10.1016/j.jad.2017.12.046Crossref (115) 5Madore M.R. Kozel Williams L.M. Green L.C. George M.S. Holtzheimer P.E. al.Prefrontal depression US military – cohort study health administration.J 2022 Jan 297 671-678https://doi.org/10.1016/j.jad.2021.10.025Crossref (22) Scholar], but see also [6Isserles M. Tendler Roth Y. Bystritsky Blumberger D.M. Ward H. al.Deep combined brief exposure prospective multisite trial.Biol 2021 90 721-728https://doi.org/10.1016/j.biopsych.2021.04.019Abstract Full Text PDF (43) Scholar]). Of note, likely indirectly modulates core neurocircuitry which consistently implicates relationship between ventromedial prefrontal cortex (VMPFC) amygdala [7Fenster R.J. Lebois L.A.M. Ressler K.J. Suh Brain circuit dysfunction post-traumatic from mouse man.Nat Rev Neurosci. Sep; 19 535-551https://doi.org/10.1038/s41583-018-0039-7Crossref (280) Scholar] among other regions. For reason, recently demonstrated VMPFC-targeted direct (tDCS) plus virtual reality (VR) could effectively [8van 't Wout-Frank Arulpragasam A.R. Faucher al.Virtual trial.JAMA May 81 437-446https://doi.org/10.1001/jamapsychiatry.2023.5661Crossref (5) This combination was designed leverage use tDCS as subthreshold perturbation, delivering weak electrical currents bias neurons depolarize therapeutic exposure-based VR context. In randomized, sham-controlled trial six sessions + over 2–3 weeks, active improved self-reported at one-month (d = −0.82, p 0.02) accelerated psychophysiological habituation events (p < 0.001). Follow up visits 3-months indicated continued improvements time group, included superior improvement social occupational function 1.2, 0.006) clinically meaningful (but not statistically significant due attrition) effect sizes reduction −0.88, 0.07). These findings increased benefit yet whether these are durable remains unknown. Here examined 1-year outcomes, hypothesizing would yield outcomes. The VA Providence IRB approved all procedures; full information parent be found (8; NCT03372460). electronic medical records were reviewed evaluate outcomes 1-month primary outcome timepoint. Assignment followed randomization (n 26 group n 28 sham) balanced groups (see Supplemental Information (8)). this relapse, operationally defined any suicide attempt, inpatient treatment, residential program admission, rescue TMS, or emergency/urgent care visit suicidal ideation. definition identical our prior examination long-term following intermittent theta burst (iTBS) [9Petrosino N.J. van't Swearingen H.R. Zandvakili al.One-year disorder.Neuropsychopharmacology. 2020 May; 45 940-946https://doi.org/10.1038/s41386-019-0584-4Crossref (28) Kaplan-Meyer survival curves odds ratios calculated relapse within one year compare sham. Medication evaluated determine if regimen had increased, decreased, remained unchanged, via chi square tests. Non-psychiatric medications included, although clear dual (e.g., prazosin) included. Due varied changes, statistical evaluation individual classes performed. Lastly, psychophysiology arousal (i.e., successful habituation) predicted survival, Spearman correlation. Analyses performed SPSS (v20, IBM, Armonk, NY). one-year period, there no deaths (or causes). Overall, 17 (31 %) patients relapsed year. majority 13, 76.5 sham four (23.5 group. Survival superiority VR: 315 ± 22 days versus 231 (log rank chi-square 5.59, df 1, 0.019; Fig. 1). Odds participants more (OR 3.02; 95 % CI 1.1–8.1). average (SD 11.1) 76.9 58.4) did significantly differ (t −1.86, .08). Post hoc exploration indicate component drove observed results. changes favored (chi-square 8.62, 2, 0.013). 26), 18 (69.2 exhibited 10 (26.9 reductions, (3.8 an increase. 28), 14 (50 (14.2 reduced medications, (35.7 pharmacology (Supplemental Table low rate 4), only sufficient power examine correlated positively longer (Spearman's rho 0.58, 0.04, 13). VR. Outcomes across multiple domains, lower their often reduced. appeared first two months, consistent timeframe consolidation-based neuroplasticity. Early predictive longer-term least differs dorsolateral script-driven [10Eyraud Poupin P. Legrand Caille Sauvaget Bulteau S. Gohier Harika-Germaneau G. Drapier D. Jaafari Bodic O. Brizard Gissot Belzung Courtine J.B. El-Hage W. Combining trauma script alleviate two-arm multicenter trial.Brain Stimul. May-Jun; (Epub 3. PMID: 38704084): 591-593https://doi.org/10.1016/j.brs.2024.04.018Abstract (2) find separation sham; differences studies administered simultaneously targeting VMPFC. Parenthetically, rates than those comparable follow iTBS comparisons should focus future inquiry. Limitations work inherent chart reviews. Symptoms systematically measured; some rating scales part routine measurement-based care, evenly distributed. Our based upon indicators severe illness subtle may missed. It possible factors, such substance use, factored into course. Several factors generalizability; sample skewed male white, required warzone exposure, many kinds (including extensive pre-military trauma) highly represented supplement [17]). closing, provide important, real-world benefits PTSD. Effort on paper supported by grant I01 RX002450 RR&D Center Neurorestoration Neurotechnology. funders role conduct study, preparation, decision submit publication. views expressed article authors do necessarily reflect position policy funders. report relevant biomedical interest.

Язык: Английский

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Current Status and Future Directions of Artificial Intelligence in Post-Traumatic Stress Disorder: A Literature Measurement Analysis

Behavioral Sciences, Год журнала: 2024, Номер 15(1), С. 27 - 27

Опубликована: Дек. 30, 2024

This study aims to explore the current state of research and applicability artificial intelligence (AI) at various stages post-traumatic stress disorder (PTSD), including prevention, diagnosis, treatment, patient self-management, drug development. We conducted a bibliometric analysis using software tools such as Bibliometrix (version 4.1), VOSviewer 1.6.19), CiteSpace 6.3.R1) on relevant literature from Web Science Core Collection (WoSCC). The reveals significant increase in publications since 2017. Kerry J. Ressler has emerged most influential author field date. United States leads number publications, producing seven times more papers than Canada, second-ranked country, demonstrating substantial influence. Harvard University Veterans Health Administration are also key institutions this field. Journal Affective Disorders highest impact area. In recent years, keywords related functional connectivity, risk factors, algorithm development have gained prominence. holds immense potential, with AI poised revolutionize PTSD management through early symptom detection, personalized treatment plans, continuous monitoring. However, there numerous challenges, fully realizing AI's potential will require overcoming hurdles design, data integration, societal ethics. To promote extensive in-depth future research, it is crucial prioritize standardized protocols for implementation, foster interdisciplinary collaboration-especially between neuroscience-and address public concerns about role healthcare enhance its acceptance effectiveness.

Язык: Английский

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VA/Department of Defense Clinical Practice Guideline for PTSD and ASD

JAMA Psychiatry, Год журнала: 2024, Номер 81(8), С. 743 - 743

Опубликована: Май 29, 2024

This Viewpoint discusses the Department of Veterans Affairs and Defense clinical practice guideline for posttraumatic stress disorder acute were developed.

Язык: Английский

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The effectiveness and value of midomafetamine-assisted psychotherapy for posttraumatic stress disorder

Journal of Managed Care & Specialty Pharmacy, Год журнала: 2024, Номер 30(10), С. 1191 - 1195

Опубликована: Сен. 25, 2024

Язык: Английский

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Posttraumatic Stress Disorder and Substance Use Disorder Screening, Assessment, and Treatment

Current Psychiatry Reports, Год журнала: 2024, Номер unknown

Опубликована: Окт. 16, 2024

Язык: Английский

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Emerging pharmacological agents for post-traumatic stress disorder show promise, but more evidence is needed

Drugs & Therapy Perspectives, Год журнала: 2024, Номер unknown

Опубликована: Ноя. 13, 2024

Язык: Английский

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“I wish people could come together like we have,” patient and provider perspectives on VA residential PTSD treatment.

Psychological Services, Год журнала: 2022, Номер 20(4), С. 809 - 819

Опубликована: Сен. 22, 2022

Although most posttraumatic stress disorder (PTSD) care in the Veterans health administration (VHA) is provided on an outpatient basis, VHA has 40 residential rehabilitation treatment programs (RRTPs) designed to treat who require more intensive and closely monitored care. Unfortunately, clinical outcomes of these are modest, previous attempts identify key drivers have uncovered few modifiable factors. The present study, informed by model resources, life events changes psychological state, was factors associated with response among RRTP patients providers. Semistructured interviews were conducted 24 12 providers at three regional RRTPs, using interview guides based theoretical model. Data analyzed rapid analysis. Results showed that agreed several critical success. These included provision evidence-based psychotherapy (EBP), support understanding from fellow patients, skill Patients also noted importance flexibility, openness, willingness change. experienced less symptom improvement over course likely report poor therapeutic alliance. findings underscore continued emphasis EBP delivery but suggest RRTPs might find additional ways capitalize milieu encourage engagement a focus (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Язык: Английский

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