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CNS Spectrums Feb 2006Posttraumatic stress symptoms have been shown to occur in pediatric and adult solid-organ transplant recipients. The presence of these symptoms is associated with... (Review)
Review
Posttraumatic stress symptoms have been shown to occur in pediatric and adult solid-organ transplant recipients. The presence of these symptoms is associated with non-adherence to medications, increased distress, and poor outcome. Because posttraumatic stress disorder is treatable and because a transplant operation usually is an "anticipated trauma," it is possible to address posttraumatic stress disorder symptoms in transplant recipients and attempt to prevent their development. Under my direction, the pediatric liver transplant program at Mount Sinai Medical Center in New York City created research and clinical programs to address posttraumatic stress symptoms and their consequences. Specifically, the focus on non-adherence to immunosuppressive medications in transplant recipients who are distressed and their parents. This article begins with a review of the data that led to the decision to start these programs. I then present the basic elements that are in place, in this particular program, to address patients' needs. I end this review with preliminary outcome data that illustrate the potential impact of such an integrated approach to patient care on medical outcomes.
Topics: Child; Humans; Mental Health Services; Organ Transplantation; Program Development; Psychology; Stress Disorders, Post-Traumatic
PubMed: 16520689
DOI: 10.1017/s1092852900010658 -
Intensive Care Medicine Jun 2014Quality of life is frequently impaired among survivors of critical illness, and psychiatric morbidity is an important element contributing to poor quality of life in... (Review)
Review
Quality of life is frequently impaired among survivors of critical illness, and psychiatric morbidity is an important element contributing to poor quality of life in these patients. Among potential manifestations of psychiatric morbidity following critical illness, symptoms of posttraumatic stress are prevalent and intricately linked to the significant stressors present in the intensive care unit (ICU). As our understanding of the epidemiology of post-ICU posttraumatic stress disorder improves, so must our ability to identify those at highest risk for symptoms in the period of time following critical illness and our ability to implement strategies to prevent symptom development. In addition, a focus on strategies to address clinically apparent psychiatric morbidity will be essential. Much remains to be understood about the identification, prevention, and management of this significant public health problem. This article addresses the importance of uniformity in future epidemiologic studies, proposes framing of risk factors into those likely to be modifiable versus non-modifiable, and provides an assessment of modifiable risk factors in the context of a novel conceptual model that offers insight into potential strategies to attenuate symptoms of posttraumatic stress among survivors of critical illness.
Topics: Critical Illness; Humans; Intensive Care Units; Models, Theoretical; Prevalence; Quality of Life; Risk Factors; Stress Disorders, Post-Traumatic; Survivors
PubMed: 24807082
DOI: 10.1007/s00134-014-3306-8 -
International Journal of Geriatric... Mar 2012Posttraumatic stress disorder (PTSD) is a common and disabling condition following a traumatic event. Despite its high prevalence rates, relatively little is known about... (Review)
Review
OBJECTIVE
Posttraumatic stress disorder (PTSD) is a common and disabling condition following a traumatic event. Despite its high prevalence rates, relatively little is known about the manifestation and course of the disorder in older adults. Moreover, there has been little evaluation of the efficacy of psychotherapeutic treatment approaches for older patients.
DESIGN
This overview aims to summarize available data on the prevalence and symptoms of late-life PTSD and to review the current treatment approaches for older adults.
RESULTS
The course and severity of PTSD symptoms in older adults depend on the time the trauma occurred (early versus late life). In the case of acute traumatization, lower prevalence rates and symptom severities are generally observed in older than in younger populations. In the case of early-life traumatization, a decline in PTSD symptom severity can be observed over the life course. Research on treatment approaches has produced promising results, indicating that disorder-specific interventions (i.e., trauma confrontation and cognitive restructuring) can be effectively combined with an age-specific narrative life-review approach.
CONCLUSION
Given the limited empirical evidence, caution is warranted in generalizing the reported findings. Nevertheless, it is possible to draw a number of conclusions concerning the characteristics and treatment of PTSD in older adults. Further research is needed to better understand the various presentations of PTSD in late life and to validate and improve the effectiveness of available treatment approaches.
Topics: Age Factors; Aged; Aged, 80 and over; Cognitive Behavioral Therapy; Humans; Narration; Psychotherapy; Stress Disorders, Post-Traumatic
PubMed: 21538540
DOI: 10.1002/gps.2725 -
The Journal of Burn Care &... 1999This article reviews the literature about the extent of posttraumatic stress disorder (PTSD) in patients with burns. PTSD is a relatively new diagnostic label, although... (Review)
Review
This article reviews the literature about the extent of posttraumatic stress disorder (PTSD) in patients with burns. PTSD is a relatively new diagnostic label, although the emotional effects of severe trauma have long been recognized. A burn injury-one of the most traumatic of all injuries--can be accompanied by serious psychological sequelae, including PTSD. Psychiatric symptoms may not be immediately apparent in patients with burns because the patients often develop PTSD many months after the injury. The reported prevalence rate of PTSD in patients with burns varies from 8% to 45%. The factors increasing these patients' risks include preburn affective disorder, delirium or severe pain during acute treatment, and less perceived social support. Psychosocial issues must be considered in the recovery or rehabilitation phase. Pharmacotherapy, psychodynamic psychotherapy, cognitive-behavioral therapy, and eye-movement desensitization and reprocessing may be helpful to the PTSD patient. Early detection and treatment of PTSD cannot only diminish the effects of this disabling disorder but can also help the rehabilitation of patients with this condition.
Topics: Adult; Burns; Child, Preschool; Female; Humans; Male; Prevalence; Risk Factors; Stress Disorders, Post-Traumatic
PubMed: 10501332
DOI: 10.1097/00004630-199909000-00017 -
The American Journal of Medicine May 2006Posttraumatic stress disorder (PSTD), classified as an anxiety disorder, has become increasingly important because of wars overseas, natural disasters, and domestic... (Review)
Review
Posttraumatic stress disorder (PSTD), classified as an anxiety disorder, has become increasingly important because of wars overseas, natural disasters, and domestic violence. After trauma exposes the victim to actual or threatened death or serious injury, 3 dimensions of PTSD unfold: (1) reexperiencing the event with distressing recollections, dreams, flashbacks, and/or psychologic and physical distress; (2) persistent avoidance of stimuli that might invite memories or experiences of the trauma; and (3) increased arousal. Traumatic events sufficient to produce PTSD in susceptible subjects may reach a lifetime prevalence of 50% to 90%. The actual lifetime prevalence of PTSD among US citizens is approximately 8%, with the clinical course driven by pathophysiologic changes in the amygdala and hippocampus. Comorbid depression and other anxiety disorders are common. General principles of treatment include the immediate management of PTSD symptoms and signs; management of any trauma-related comorbid conditions; nonpharmacologic interventions including cognitive behavioral treatment; and psychopharmacologic agents including antidepressants (selective serotonin reuptake inhibitors most commonly), antianxiety medications, mood stabilizing drugs, and antipsychotics. This review of PTSD will provide the reader with a clearer understanding of this condition, an increased capacity to recognize and treat this syndrome, and a greater appreciation for the role of the internist in PTSD.
Topics: Cognitive Behavioral Therapy; Comorbidity; Diagnosis, Differential; Humans; Internal Medicine; Physician's Role; Prevalence; Prognosis; Stress Disorders, Post-Traumatic
PubMed: 16651048
DOI: 10.1016/j.amjmed.2005.09.027 -
Psychiatry Research Nov 2021Posttraumatic stress disorder (PTSD) is a common psychiatric disorder for military Veterans, characterized by hyperarousal, intrusive thoughts, flashbacks,... (Review)
Review
Posttraumatic stress disorder (PTSD) is a common psychiatric disorder for military Veterans, characterized by hyperarousal, intrusive thoughts, flashbacks, hypervigilance, and distress after experiencing traumatic events. Some of the known physiological effects of PTSD include hypothalamic-pituitary-adrenal (HPA)-axis imbalance, a cortical function resulting in neuronal deficit and changes in behavior. Moreover, excessive discharge of inflammatory molecules and a dysregulated immune system are implicated in the pathophysiology of PTSD. Due to complex nature of this disorder, the biological underpinnings of PTSD remain inexplicable. Investigating novel biomarkers to understanding the pathogenesis of PTSD may reflect the underlying molecular network for therapeutic use and treatment. Circulatory microRNAs (miRNAs) and exosomes are evolving biomarkers that have shown a key role in psychiatric and neurological disorders including PTSD. Given the unique nature of combat trauma, as well as evidence that a large portion of Veterans do not benefit from frontline treatments, focus on veterans specifically is warranted. In the present review, we delineate the identification and role of several miRNAs in PTSD among veterans. An association of miRNA with HPA-axis regulation through FKBP5, a key modulator in PTSD is discussed as an emerging molecule in psychiatric diseases. We conclude that miRNAs may be used as circulatory biomarker detection in Veterans with PTSD.
Topics: Biomarkers; Humans; MicroRNAs; Pituitary-Adrenal System; Stress Disorders, Post-Traumatic; Veterans
PubMed: 34739954
DOI: 10.1016/j.psychres.2021.114252 -
Acta Psychiatrica Scandinavica Jan 2023Several medical and psychiatric disorders have stage-based treatment decision-making methods. However, international treatment guidelines for posttraumatic stress...
OBJECTIVES
Several medical and psychiatric disorders have stage-based treatment decision-making methods. However, international treatment guidelines for posttraumatic stress disorder (PTSD) fail to give specific treatment recommendations based on chronicity or stage of the disorder. There is convincing evidence of a finite range of PTSD symptom trajectories, implying that different phenotypes of the disorder can be distinguished, which are highly relevant for a staging typology of PTSD.
METHODS
State-of-the-art review building on prior work on staging models in other disorders as a mapping tool to identify and synthesize toward PTSD.
RESULTS
We propose a four-stage model of PTSD ranging from stage 0: trauma-exposed asymptomatic but at risk to stage 4: severe unremitting illness of increasing chronicity. We favor a symptom description in various chronological characteristics based on neurobiological markers, information processing systems, stress reactivity, and consciousness dimensions. We also advocate for a separate phenomenology of treatment resistance since this can yield treatment recommendations.
CONCLUSION
A staging perspective in the field of PTSD is highly needed. This can facilitate the selection of interventions that are proportionate to patients' current needs and risk of illness progression and can also contribute to an efficient framework to organize biomarker data and guide service delivery. Therefore, we propose that a neurobiologically driven trajectory-based typology of PTSD can help deduct several treatment recommendations leading to a more personalized and refined grid to strategize, plan and evaluate treatment interventions.
Topics: Humans; Stress Disorders, Post-Traumatic
PubMed: 36367112
DOI: 10.1111/acps.13520 -
Drug and Alcohol Dependence Aug 2022Posttraumatic stress disorder (PTSD) symptoms have been shown to increase the likelihood of substance use in the general population. First responders (e.g., EMTs,...
BACKGROUND
Posttraumatic stress disorder (PTSD) symptoms have been shown to increase the likelihood of substance use in the general population. First responders (e.g., EMTs, paramedics, and firefighters) are routinely exposed to potentially traumatic events (PTEs) as part of their regular duties, increasing their risk for a range of adverse mental health outcomes including PTSD symptoms. However, no study to our knowledge has explored the relationship between PTEs, PTSD symptoms, and substance use in this population. In the current study, we examined whether PTSD symptoms were associated with alcohol and drug use in first responders above and beyond demographic variables, job-related characteristics, social support, and cumulative work-related PTE exposure, and whether work-related PTE exposure had an indirect effect on substance use via PTSD symptoms.
METHODS
Participants (N = 885; mean age = 37.13; 59.0% male; 91.5% White) were recruited from all 50 U.S. states, the Virgin Islands, and Puerto Rico to complete an online survey.
RESULTS
In hierarchical regression analyses, PTSD symptoms were significantly associated with alcohol and drug use above and beyond all the other variables. Work-related PTE exposure was not a significant predictor of either outcome once PTSD symptoms were included, suggesting that PTEs confer risk for substance use via their association with PTSD symptoms. This finding was confirmed by an analysis showing that PTE exposure had a significant indirect effect on both alcohol and drug use via PTSD symptoms.
CONCLUSION
Results support the need for periodic assessment of both PTSD symptoms and substance use in first responders.
Topics: Adult; Emergency Responders; Female; Humans; Male; Puerto Rico; Stress Disorders, Post-Traumatic; Substance-Related Disorders; Surveys and Questionnaires
PubMed: 35623285
DOI: 10.1016/j.drugalcdep.2022.109439 -
Journal of Traumatic Stress Jun 2023This article introduces the special section in the Journal of Traumatic Stress focused on social relationships and their connection to treatment among individuals with...
This article introduces the special section in the Journal of Traumatic Stress focused on social relationships and their connection to treatment among individuals with posttraumatic stress disorder (PTSD). Interpersonal relationships have the potential to influence treatment-seeking, retention, and outcomes. For individuals with PTSD, social relationships have long been understood to be intimately and bidirectionally tied to symptom levels. In light of somewhat modest rates of treatment response to current first-line interventions for PTSD, there is growing interest in engaging these relationships, as well as relationship-relevant beliefs and behaviors, to enhance PTSD treatment. This introductory article frames the rationale for examining these social factors to better understand and improve treatments and provides an overview of the collection of articles contained herein.
Topics: Humans; Interpersonal Relations; Stress Disorders, Post-Traumatic
PubMed: 36853594
DOI: 10.1002/jts.22922 -
Turkish Journal of Medical Sciences Oct 2021To investigate the predictive effect of different symptoms of early acute stress disorder (ASD) on posttraumatic stress disorder (PTSD) in traffic accident survivors.
BACKGROUND
To investigate the predictive effect of different symptoms of early acute stress disorder (ASD) on posttraumatic stress disorder (PTSD) in traffic accident survivors.
METHODS
A total of 206 traffic accident survivors were assessed with the acute stress disorder scale (ASDS) within 2-23 days after accidents, as well as with 17-item PTSD checklist-specific stressor version (PCL-S) during 4-12 months after accidents. All into the first group of subjects by senior surgeon assessment, based on the clinical, radiological and laboratory examination, excluded traumatic brain injuries, and mild brain injury. And then, assessment by clinical psychological practitioner.
RESULTS
The severity of ASD can significantly predict the severity of PTSD symptoms. ASD reexperience symptoms and avoidance symptoms can significantly predict PTSD reexperience symptoms and avoidance symptoms. ASD hyperarousal symptoms can significantly predict PTSD hyperarousal symptoms.
DISCUSSION
ASD and PTSD are common psychological disorders among traffic accident survivors. ASD can predict the symptoms and severity of PTSD.
Topics: Humans; Stress Disorders, Traumatic, Acute; Stress Disorders, Post-Traumatic; Accidents, Traffic; Survivors; Brain Injuries
PubMed: 34165271
DOI: 10.3906/sag-2008-282