Francine Shapiro Library ~ EMDR Bibliography

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1. Becker, C. B., Darius, E., & Schaumberg, K. (2007, December). An analog study of patient preferences for exposure versus alternative treatments for posttraumatic stress disorder. Behaviour Research and Therapy, 45(12), 2861-2873. DOI:10.1016/j.brat.2007.05.006 .

Language: English

Format: Journal

Abstract:
Although several efficacious treatments for PTSD exist, these treatments are currently underutilized in clinical practice. To address this issue, research must better identify barriers to dissemination of these treatments. This study investigated patient preferences for PTSD treatment given a wide range of treatment options in an analog sample. 160 individuals, with varying degrees of trauma history, were asked to imagine themselves undergoing a trauma, developing PTSD, and seeking treatment. Participants evaluated 7 different treatment descriptions, which depicted treatment options that they might encounter in a clinical setting. Participants rated their most and least preferred treatments along with their personal reactions to and the perceived credibility of each treatment. Participants also completed a critical thinking skills questionnaire. Participants predominantly chose exposure or another variant of cognitive-behavioral therapy as their most preferred therapy, and those who chose exclusively empirically supported treatments evidenced higher critical thinking skills. The present study contributes to a growing literature indicating that patients may be more interested in these therapies than indicated by utilization rates. The problem of underutilization of empirically supported treatments for PTSD in clinical practice may be due to therapist factors. [Author Abstract]

Keywords: Adults Americans Cognitive Processes Cognitive Therapy College Students Evidence Based Treatment Exposure Empirically Supported Treatment Patient Preference Posttraumatic Stress Disorder Posttraumatic Stress Disorder Psychoanalytic Psychotherapy Psychotherapeutic Processes PTSD Selective Serotonin Reuptake Inhibitors Stressors Survivors TFT Thought Field Therapy

Accuracy Verified: Yes

2. Forbes, D., Creamer, M., Phelps, A., Bryant, R., McFarlane, A., Devilly, G. J., Lynda Matthews, L., Raphael, B., Doran, C., Merlin, T., & Skye N. (2007, August). Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder. Australian & New Zealand Journal of Psychiatry, 41(8), 637-648. doi:10.1080/00048670701449161.

Language: English

Format: Journal

Abstract:
Over the past 2-3 years, clinical practice guidelines (CPGs) for post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) have been developed in the USA and UK. There remained a need, however, for the development of Australian CPGs for the treatment of ASD and PTSD tailored to the national health-care context. Therefore, the Australian Centre for Posttraumatic Mental Health in collaboration with national trauma experts, has recently developed Australian CPGs for adults with ASD and PTSD, which have been endorsed by the National Health and Medical Research Council (NHMRC). In consultation with a multidisciplinary reference panel (MDP), research questions were determined and a systematic review of the evidence was then conducted to answer these questions (consistent with NHMRC procedures). On the basis of the evidence reviewed and in consultation with the MDP, a series of practice recommendations were developed. The practice recommendations that have been developed address a broad range of clinical questions. Key recommendations indicate the use of trauma-focused psychological therapy (cognitive behavioural therapy or eye movement desensitization and reprocessing in addition to in vivo exposure) as the most effective treatment for ASD and PTSD. Where medication is required for the treatment of PTSD in adults, selective serotonin re-uptake inhibitor antidepressants should be the first choice. Medication should not be used in preference to trauma-focused psychological therapy. In the immediate aftermath of trauma, practitioners should adopt a position of watchful waiting and provide psychological first aid. Structured interventions such as psychological debriefing, with a focus on recounting the traumatic event and ventilation of feelings, should not be offered on a routine basis. [InformaWorld]

Keywords: ASD Guidelines Posttraumatic Stress Disorder PTSD Trauma Treatment

Accuracy Verified: Yes

3. Australian Centre for Posttraumatic Mental Health (2007, February). Australian Guidelines for the treatment of Adults with Acute Stress disorder and posttraumatic stress disorder. Melbourne, Victoria: ACPMH.

Language: English

Format: Other

Abstract:
The Australian Centre for Posttraumatic Mental Health in collaboration with national trauma experts, has recently developed Australian CPGs for adults with ASD and PTSD, which have been endorsed by the National Health and Medical Research Council (NHMRC). In consultation with a multidisciplinary reference panel (MDP), research questions were determined and a systematic review of the evidence was then conducted to answer these questions (consistent with NHMRC procedures). On the basis of the evidence reviewed and in consultation with the MDP, a series of practice recommendations were developed. The practice recommendations that have been developed address a broad range of clinical questions. Key recommendations indicate the use of trauma-focused psychological therapy (cognitive behavioural therapy or eye movement desensitization and reprocessing in addition to in vivo exposure) as the most effective treatment for ASD and PTSD. Where medication is required for the treatment of PTSD in adults, selective serotonin re-uptake inhibitor antidepressants should be the first choice. Medication should not be used in preference to trauma-focused psychological therapy. In the immediate aftermath of trauma, practitioners should adopt a position of watchful waiting and provide psychological first aid. Structured interventions such as psychological debriefing, with a focus on recounting the traumatic event and ventilation of feelings, should not be offered on a routine basis. [InformaWorld]

Keywords: Treatment Guidelines

Accuracy Verified: Yes

4. Cook, J. M., Biyanova, T., & Coyne, J. C. (2009, October). Comparative case study of diffusion of eye movement desensitization and reprocessing in two clinical settings: Empirically supported treatment status is not enough. Professional Psychology: Research and Practice, 40(5), 518-524. doi:10.1037/a0015144.

Language: English

Format: Journal

Abstract:
An in-depth comparative case study was conducted of two attempts at diffusion of an empirically supported, but controversial, psychotherapy: eye movement desensitization and reprocessing (EMDR). One Department of Veterans Affairs (VA) treatment setting in which there was substantial uptake was compared with a second VA setting in which it was not adopted. Qualitative interviews were conducted with 10 mental health clinicians at the first site, and 19 at the second. Critical selling points for EMDR were a highly regarded champion, the observability of effects with patients, and personally experiencing its effects during a role training session. Compatibility with existing psychotherapist practices and values further allowed the therapy to become embedded in the organizational culture. At the second site, a sense that EMDR was not theoretically coherent or compelling overwhelmed other considerations, including its empirical status. Comparative studies contrasting settings in which innovative therapies are implemented versus those in which they were rejected may aid in refining theories of and strategies for dissemination.

Keywords: Diffusion Evidence-Supported Treatment Marketing Psychotherapy

Accuracy Verified: Yes

5. van Etten, M. L., & Taylor, S. (1998). Comparative efficacy of treatments for posttraumatic stress disorder: A meta-analysis. Clinical Psychology and Psychotherapy, 5(3), 126-144. doi:10.1002/(SICI)1099-0879(199809).

Language: English

Format: Journal

Abstract:
A meta-analysis was conducted on 61 treatment outcome trials for PTSD. Conditions included drug therapies (TCAs, carbamazepine, MAOIs, SSRIs, and BDZs), psychological therapies (behaviour therapy, Eye-Movement Desensitization and Reprocessing (EMDR), relaxation training, hypnotherapy, and dynamic therapy), and control conditions (pill placebo, wait-list controls, supportive psychotherapies, and non-saccade EMDR control). Psychological therapies had significantly lower drop-out rates than pharmacotherapies (14% versus 32%), with attrition being uniformly low across all psychological therapies. In terms of symptom reduction, psychological therapies were more effective than drug therapies, and both were more effective than controls. Among the drug therapies, the SSRIs and carbamazepine had the greatest effect sizes, although the latter was based upon a single trial. Among the psychological therapies, behaviour therapy and EMDR were most effective, and generally equally so. The most effective psychological therapies and drug therapies were generally equally effective. Differences across treatment conditions were generally evident across symptom domains, with little matching of symptom domain to treatment type. However, SSRIs had some advantage over psychological therapies in treating depression. Follow-up results were not available for most treatments, but available data indicates that treatment effects for behaviour therapy and EMDR are maintained at 15-week follow-up. [Author Abstract]

Keywords: Antimanic Drugs Benzodiazepine Derivatives Hypnotherapy Meta Analysis Monoamine Oxidase Inhibitors Posttraumatic Stress Disorder Psychoanalytic Psychotherapy PTSD Relaxation Therapy Selective Serotonin Reuptake Inhibitors Treatment Effectiveness Tricyclic Derivatives

Accuracy Verified: Yes

6. Softic, R, & Becirovic, E, (2009, Septembra). Desenzitizacija pokretima ociju i reprocesiranje (EMDR): Kada su rijeci nemocne [Desensitization of eye movements and reprocessing (EMDR): When words are disabled]. Prvi Psihoterapijski Simpozijum Bosne I Hercegovine Sarajevo, Bosnia and Herzegovina.

Language: Serbian

Format: Conference

Abstract:
Neki ljudi doţive traumatska stanja koja ne mogu u potpunosti opisati rijeĉima. Mnogi od njih nikada ni ne progovore o tome što su doţivjeli. Ali patnja se u njima nastavlja i organizam, a ĉesto i okolina plaćaju ogromnu cijenu. U takvim sluĉajevima psihoterapija koja koristi rijeĉi je nemoćna. Istraţivanja upućuju da jedna, relativno nova psihoterapijska metoda desenzitizacija pokretima oĉiju i reprocesiranje (EMDR), moţe pomoći i takvim osobama. Kada neko iskusi ozbiljnu psihološku traumu, ĉini se da dolazi do narušavanja ravnoteţe u nervnom sistemu. Ta ravnoteţa je, moguće, narušena i posredstvom razliĉitih medijatora poput adrenalina, serotonina, dopamina, kortizola itd. Zbog takve neravnoteţe onemogućeno je optimalno funkcioniranje sistema za procesiranje informacija, a informacije vezane uz traumatiĉan dogaĊaj poput slika, zvukova, afekata i fiziĉkih senzacija se zadrţavaju u disfunkcionalnom, uznemirujućem obliku. Danas izranja shvatanje da postoji неуролошки balans u razliĉitim fiziološkim sistemima što omogućuje da informacije budu procesirane na adaptivan naĉin. EMDR kod nekih traumatiziranih djeluje ĉak i kada osoba ne moţe govoriti o tome što je preţivjela. Ono što je bitno jeste da se fokusira na traumatski dogaĊaj i da suraĊuje sa terapeutom u procesu stimulisanja dualne paţnje što omogućava adaptivno procesiranje informacija. Adaptivno procesiranje znaĉi uspostavljanje adekvatnih asocijacija i pojavu da iskustvo biva konstruktivno ugraĊeno u pozitivne kognitivne i emocionalne sheme pojedinca. Odnosno, oslobaĊa od simptoma i omogućava da se nova iskustva doţive bez blokirajućeg uticaja traume.

Some people doţive traumatic conditions that can not fully describe in words. Many of them never to speak of it as doţivjeli. But the suffering in them continues and the body, and environment, and often pay a huge price. In such cases psychotherapy that uses words of the powerless. Research suggests that a relatively new psychotherapeutic methods desensitization and reprocessing eye movement (EMDR), and can help such people. When someone has experienced serious psychological trauma, it seems that there is a violation of equilibrium in the nervous system. This equilibrium is possible, and disrupted through a variety of mediators such as adrenaline, serotonin, dopamine, cortisol, etc.. Because of such imbalance prevented the optimal functioning of the system for information processing and information related to traumatic an event such as images, sounds, physical sensations and affects it retains in the dysfunctional, disturbing form. It emerges that there is understanding of neurological balance in different physiological systems, which allows information to be processed on adaptive manner. EMDR works by some traumatized even when the person can not talk about what is preţivjela. What is important is to focus on the traumatic events and to co-operate with the therapist in the process of stimulating the attention of the dual provides adaptive information processing. Adaptive processing means getting the right associations and the emergence of the experience of being a built-in positive constructive cognitive and emotional schemas of the individual. That is, oslobaĊa of symptoms and allows for new experiences doţive without blocking effects of trauma.

Keywords: Doţ ivjeli Preţ ivjela

Accuracy Verified: Yes

7. Pagani, M., Hogberg, G., Salmaso, D, Tarnell, B., Nardo, D., Sundin, Ö., Jonsson, C., Soares, J., Aberg-Wistedt, A., Jacobsson, H., Larsson, S.A., Hällström, T. (2007, October). Effects of EMDR psychotherapy on 99mTc-HMPAO distribution in occupation-related post-traumatic stress disorder. Nuclear Medicine Communications, 28(10), 757-765. doi:10.1097/MNM.0b013e3282742035.

Language: English

Format: Journal

Abstract:
Background: Post-traumatic stress disorder (PTSD) is a derangement of mood control with involuntary, emotionally fraught recollections that may follow deep psychological trauma in susceptible individuals. This condition is treated with pharmacological and/or cognitive therapies as well as psychotherapy with eye movement desensitization and reprocessing (EMDR). However, only a very limited number of studies have been published dealing with work-related PTSD, and investigations on the effect of treatment on cerebral blood flow represent an even smaller number. Aim: To investigate the short-term outcome of occupation-related PTSD after EMDR therapy by 99mTc-HMPAO SPECT. Method: Fifteen patients, either train drivers suffering from PTSD after having been unintentionally responsible for a person-under-train accident or employees assaulted in the course of duty, were recruited for the study. 99mTc-HMPAO SPECT was performed on these patients both before and after EMDR therapy while they listened to a script portraying the traumatic event. Tracer distribution analysis was then carried out at volume of interest (VOI) level using a three-dimensional standardized brain atlas, and at voxel level by SPM. The CBF data of the 15 patients were compared before and after treatment as well as with those of a group of 27 controls who had been exposed to the same psychological traumas without developing PTSD. Results: At VOI analysis significant CBF distribution differences were found between controls and patients before and after treatment (P=0.023 and P=0.0039, respectively). Eleven of the 15 patients responded to treatment, i.e., following EMDR they no longer fulfilled the DSM-IV criteria for PTSD. When comparing only the eleven responders with the controls, the significant group difference found before EMDR (P=0.019) disappeared after treatment. Responders and non-responders showed after therapy significant regional differences in frontal, parieto-occipital and visual cortex and in hippocampus. SPM analysis showed significant uptake differences between patients and controls in the orbitofrontal cortex (Brodmann 11) and the temporal pole (Brodmann 38) both before and after treatment. A significant tracer distribution difference present before treatment in the uncus (Brodmann 36) disappeared after treatment, while a significant difference appeared in the lateral temporal lobe (Brodmann 21). Conclusion: Significant 99mTc-HMPAO uptake regional differences were found, mainly in the peri-limbic cortex, between PTSD patients and controls exposed to trauma but not developing PTSD. Tracer uptake differences between responders and patients not responding to EMDR were found after treatment suggesting a trend towards normalization of tracer distribution after successful therapy. These findings in occupational related PTSD are consistent with previously described effects of psychotherapy on anxiety disorders. [PubMed]

Keywords: 99mTc-HMPAO Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

8. Pagani, M., Hogberg, G., Salmaso, D., Nardo, D., Jonsson, C., Danielsson, A.M., Engelin, L., Jacobsson, H., Larsson, S. A., Hallstrom, T., & Sundin, Ö. (2006, September). Effects of EMDR therapy on 99mTc-HMPAO distribution in Post-traumatic stress disorder. Presentation at the European Assocation of Nuclear Medicine Congress, Athens, Greece. European Journal of Nuclear Medical and Molecular Imaging, 33, S169.

Language: English

Format: Conference

Abstract:
Background Post-traumatic stress disorder (PTSD) is a derangement of mood control with emotional trauma recollections that may follow psychological trauma. It is treated with pharmacological and cognitive therapies as well as with eye movement desensitization and reprocessing (EMDR). However, a limited number of studies have been published dealing with job related PTSD, and an even smaller number have assessed the effects of treatment on CBF. The aim of this study was to investigate the short term outcome of occupation based PTSD after EMDR therapy by 99mTc-HMPAO SPECT. Methods Fifteen patients suffering PTSD after having experienced a person under train accident or having been assaulted at work were included into the study. 99mTc-HMPAO SPECT was performed before and after EMDR therapy while listening to a script portraying the traumatic event. Tracer distribution analysis was performed at VOI level using a 3D standardised brain atlas and at cluster of voxel level by SPM and was subjected to an analysis of treatment as well as contrasted to a group of 27 subjects exposed to the same psychological trauma and not developing PTSD. Results Eleven of 15 patients responded to treatment, i.e. they did no longer fulfil the DSM-IV criteria for PTSD after EMDR. Overall VOI analysis showed significant differences between, both before and after treatment conditions and controls (p<0.05) but no effect of period, i.e. treatment. However, when contrasting responders to controls the significant group difference present after treatment disappeared, indicating a normalization effect due to successful EMDR treatment. SPM analysis showed significant uptake differences in orbitofrontal cortex (Brodmann 11) and temporal pole (Brodmann 38) before as well as after treatment as compared to controls. A significant tracer uptake group difference present before treatment in uncus (Brodmann 36) disappeared after treatment while a significant difference appeared in lateral temporal lobe (Brodmann 21). No tracer uptake differences were found by SPM as an effect of treatment, nor between the 11 responders and controls. Conclusion Significant 99mTc-HMPAO uptake differences, mainly in peri-limbic cortex, between PTSD patients investigated before and after EMDR and subject exposed to trauma not developing PTSD were found. Differences between the tracer distribution in patients before and after therapy were not significant neither at SPM nor at VOI analyses but the latter showed at group level an effect of symptom remission on tracer distribution. The findings underscore the validity of psychotherapy in anxiety disorders and confirm the efficacy of SPECT in psychiatry. [EANM]

Keywords: 99mTc-HMPAO Distribution Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

9. Pagani, M., Hogberg, G., Salmaso, D., Nardo, D., Jonsson, C., Danielsson, A. M., Engelin, L., Jacobsson, H., Larsson, S. A., Hallstrom, T., & Sundin, Ö. (2006, September-October). Effects of EMDR therapy on 99mTc-HMPAO distribution in Post-traumatic Stress Disorder. Presentation at the European Assocation of Nuclear Medicine Congress, Athens, Greece.

Language: English

Format: Conference

Keywords: 99mTc-HMPAO Distribution Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

10. van Rood,Y., & de Roos, C. (2010, June). EMDR in the treatment of body dysmorphic disorder. Presentation at the annual meeting of the EMDR Europe Association, Hamburg, Germany.

Language: English

Format: Conference

Abstract:
Body dysmorphic disorder (BDD) is defined in the Diagnostic and Statistical Manual IV-TR (DSM-IV-TR) as a disorder characterised by a preoccupation with an imagined defect in one's appearance (American Psychiatric Association (APA), 1994). BDD can be treated effectively with selective serotonin reuptake inhibitors (SSRls) or cognitive behaviour therapy (CBT) (Williams et al.. 2006). CBT interventions which are most often described in the literature are exposure and response prevention (ERP) and cognitive techniques. These interventions successfully weaken the catastrophic expectations of the patients. However, they do not affect the negative valence of patients' appearance. This negative meaning is not inborn but acquired during life through association with distressful or even traumatic events. Patients with BDD often report stressful events as the starting point of their complaints (Buhlmann et al., 2007) as well as PTSS like symptoms. i.e. intrusions (Osman et al.. 2004). Processing of these unprocessed memories might free the way to the development of a more positive meaning of their appearance. Indeed, case series have been described in which EMDR has been successfully applied in the treatment of BDD (Brown et al , 1997). In the first part of this workshop background information will be presented which might help identifying BDD patients who might profit from EMDR and planning subsequent EMDR treatment. In the second part of the workshop we share our experiences treating BDD patients with EMDR. Clinical issues will be analysed using videotaped cases of patients for illustration. The goal of this workshop is to increase knowledge and understanding of the use of EMDR in the treatment for BDD. American Psychiatric Association (APA) (1994). Diagnostic and statistical manual of mental disorders. (4th ed.) Washington DC. American Psychiatric Association. Brown, K. W., McGoldrick, T., & Buchanan, R. (1997). Body dysmorphic disorder: Seven cases treated with eye movement desensitization and reprocessing. Behavioural and Cognitive Psychotherapy. 25(2), 203-207 Buhlmann, U., Cook, L. M., Fama, 1. M., & Wilhelm, 5. (2007). Perceived teasing experiences in body dysmorphic disorder. Body Image. 4, 381-385. Osman. S., Cooper, M., Hackmann, A,, & Veale, D. (2004). Spontaneously occurring images and early memories in people with body dysmorphic disorder Memory, 12, 428-436. Williams, J., Hadjistavropoulos, T., & Sharpe, D. (2006). A meta- analysis of psychological and pharmacological treatments for Body Dysmorphic Disorder. Behaviour Research and Therapy. 44, 99-111.

Keywords: Body Dysmorphic Disorder

Accuracy Verified: Yes

11. Corrigan, F. M., & Jennett, J. (2004, August). Ephedra alkaloids and brief relapse in EMDR-treated obsessive compulsive disorder. Acta Psychiatrica Scandinavica, 110(2), 158. doi:10.1111/j.1600-0047.2004.00368.x.

Language: English

Format: Journal

Abstract:
Letter to the editor commenting on an article by E. Ernst (see record 2003-05653-002). We report the case of a patient who was effectively treated for severe obsessive compulsive disorder but relapsed briefly following ingestion of herbal products containing ephedra alkaloids that she bought to facilitate weight loss. The patient was a 29-year-old woman with a 10-year history of obsessive compulsive disorder who was referred for Eye Movement Desensitisation and Reprocessing (EMDR) when her condition had not responded to cognitive behavior therapy nor to various medications including Fluoxetine, Paroxetine, Clomipramine and Amitriptyline. Her score on the Dissociative Experiences Scale was low and there was nothing in the clinical history to suggest major dissociative disorder, so after preparation with mindfulness, relaxation and safe place imagery she proceeded to treatment with EMDR. Nine months later she reported a relapse into increased anxiety with a partial return to compulsive thoughts and behaviours after she had obtained a herbal health product sold to promote weight loss. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Keywords: Comment Desensitization Ephedra Letter Luvoxamine Obsessive Compulsive Disorder OCD Plant Preparations Relapse Reply Review Serotonin Uptake Inhibitors

Accuracy Verified: Yes

12. Ohtani, T., & Matsuo, K. (2006). Functional abnormality of the prefrontal cortex in posttraumatic stress disorder: Psychophysiology and treatment studies assessed by near-infrared spectroscopy. In N. Kato; M. Kawata, & Pitman, R. K (Eds.), PTSD: Brain mechanisms and clinical implications (pp. 235-245). Tokyo: Springer-Verlag.

Language: English

Format: Book Section

Abstract:
A growing number of functional neuroimaging studies on PTSD have described the abnormal response of amygdala and prefrontal cortex to traumatic stimuli. Abnormal activation of some parts of the prefrontal cortex might possibly be involved in the pathophysiology of PTSD. [Adapted from Text, pp. 235-236]TOPICS TREATED: Near-infrared spectroscopy (NIRS); NIRS studies in PTSD; Neuroimaging studies of treatment in PTSD (Selective-serotonin reuptake inhibitor [SSRI] and Eye movement desensitization and reprocessing [EMDR].([Adapted from Text, pp. 235-236] [Pilots]

Keywords: Brain Imaging Neuroanatomy Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

13. Burne, J. (2004). Healing without Freud or prozac. London, England: The Independent.

Language: English

Format: Newspaper

Abstract:
Where do you get the blues? Most people would say in the head. That's where we look for mental problems. Depression, anxiety, distress are all the result of brain chemistry going wrong - not enough serotonin, for example. And that's why we treat them with talking therapies and "serotonin reuptake inhibitors" such as Prozac.

Keywords: General London Overview

Accuracy Verified: Yes

14. Occhi, S., Albiol, L. M., & Cicognani, E. (2007). Il disturbo post-traumatico da stress: Una rassegna [Post-traumatic stress disorder: A review]. Psicoterapia Cognitiva e Comportamentale, 13(3), 323-344.

Language: Italian

Format: Journal

Abstract:
Questo articolo presenta una rassegna aggiornata teorico del Post-Traumatico da Stress Disorder (PTSD) concetto, un disturbo mentale che può comparire dopo essere stato esposto direttamente o indirettamente, ad un evento traumatico. L'articolo inizia con una descrizione della sintomatologia, suddivisi in: rivivere l'evento traumatico, evitamento, ottundimento reattività generale e ipervigilanza. Questo è seguito da una presentazione dei più recenti studi che indicano la presenza di disordine da stress post-traumatico nella popolazione, sia nella popolazione generale e nei soggetti direttamente coinvolti in un evento traumatico. Post-traumatico da stress sintomi del disturbo sono identificati mediante questionari specifici descritti nella sezione riferimento a strumenti di indagine. Lo studio delle basi biologiche per il PTSD è diventata particolarmente significativo negli ultimi anni, e abbiamo analizzato questo contesto in modo più approfondito per questo motivo, con particolare riferimento al ruolo dell'asse ipotalamo-ipofisi-surrene. Un impulso importante dello studio del PTSD è dovuto alla crescente importanza dato alla prevenzione, intesa come riduzione dell'impatto dei disturbi psichiatrici che concentrandosi su Eye Movement Desensibilizzazione e ritrattamento (EMDR), il trattamento psicologico, con il supporto di tecniche che riguarda la terapia cognitivo comportamentale e il trattamento farmacologico che prevede l'uso di inibitori della ricaptazione della serotonina selettiva, quali siano le forme più studiate. (PsycINFO record del database (c) 2008 APA, tutti i diritti riservati)

This article presents an updated theoretical review of the Post-Traumatic Stress Disorder (PTSD) concept, a mental disorder that can appear after being exposed directly or indirectly to a traumatic event. The article begins with a description of the symptomatology, divided in: re-living the traumatic event, avoidance, dulling general reactivity and hyperarousal. This is followed by a presentation of the most recent studies which indicate the presence of post-traumatic stress disorder in the population, both in the general population and in subjects directly involved in a traumatic event. Post-traumatic stress disorder symptoms are identified by using specific questionnaires described in the section referring to investigation instruments. The study of the biological bases for PTSD has become particularly significant in recent years, and we analysed this context in greater detail for this reason, with particular reference to the role of the hypothalamo-pituitary-adrenocortical axis. An important boost of the study of PTSD is due to the increasing importance placed on prevention, understood as a reduction of the impact of psychiatric disorders which focusing on Eye Movement Desensitisation and Reprocessing (EMDR), on psychological treatment, with the support of techniques that concerns cognitive behavioral therapy and pharmacological treatment that involves the use of serotonin selective reuptake inhibitors, which are the forms studied most. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Keywords: Posttraumatic Stress Disorder PTSD Review

Accuracy Verified: No

15. Bryant, R. A., & Friedman, M. J. (2001, March). Medication and non-medication treatments of post-traumatic stress disorder. doi:10.1097/00001504-200103000-00004. Current Opinion in Psychiatry, 14(2), 119-123.

Language: English

Format: Journal

Abstract:
Recent developments in the psychological and pharmacological management of post-traumatic stress disorder are reviewed. This review of controlled outcome studies indicates that: (i) cognitive behavior therapy is the psychological treatment of choice; (ii) different components of cognitive behavior therapy can be effective; (iii) eye movement desensitization and reprocessing is not as effective as cognitive behavior therapy; (iv) selective serotonin re-uptake inhibitors are the pharmacological treatment of choice; and (v) there is increasing support for nefazadone but not for cyproheptadine in reducing the symptoms of post-traumatic stress disorder. The need for increased treatment effectiveness and the integration of recent findings into clinical practice is discussed. [Author Abstract]

Keywords: Atypical Antidepressants Cognitive Therapy Drug Therapy Literature Review Posttraumatic Stress Disorder PTSD Selective Serotonin Reuptake Inhibitors Treatment Treatment Effectiveness

Accuracy Verified: Yes

16. Pagani, M., Flumeri, F., Salmaso, D., Nardo, D., Sanchez-Crespo, A., Danielsson, A. M., Brolin, F., Jacobsson, H., Larsson, S. A., & Hogberg, G. (2008, October). Neurobiological changes in post traumatic stress disorder following treatment with eye movement desensitisation reprocessing. Presentation at the European Association of Nuclear Medicine Congress, Munich, Germany, European Journal of Nuclear Medical and Molecular Imaging, 35(Supp 2).

Language: English

Format: Conference

Abstract:
Background: Only few studies have reported functional or structural modifications in Post Traumatic Stress Disorder (PTSD) patients following pharmacological treatment or psychotherapy. Eye movement desensitization and reprocessing (EMDR) is a novel eclectic psychotherapy utilising, among other techniques, relaxation and safe place exercises, cognitive restructuring, future projections, and imaginal exposure of the trauma combined with sensory stimulation. The aim of the study was to analyse the differences in regional cerebral blood flow (rCBF) distribution and in brain volumetry before and after EMDR therapy. Subjects and Methods: Fifteen subjects with chronic PTSD following occupational health hazards were treated with five sessions of EMDR. They were assessed with psychometric scales and diagnostic interviews before and directly after treatment. SPECT, during administration of an individualised trauma script, was performed using 99mTc-HMPAO. After EMDR, the subjects were subdivided into responders (R, n=10) and non-responders (NS, n=5), based on the absence or presence, respectively, of full PTSD diagnosis. SPECT and volumetric data (MRI) analyses were carried out by Statistical Parametric Mapping (SPM2). SPECT and MRI data were covaried by age and by time elapsed from trauma to SPECT. SPECT data were further covaried by the amount of grey matter normalised by the total intracranial volume. Results: Immediate significant post-treatment changes towards normality in all scales measuring psychological status were found in responders. As compared to NR, R showed a significantly decreased tracer uptake in parieto-occipital (Brodmann Area, BA, 37, fusiform gyrus) and in primary visual cortex (BA17) and in the hippocampus (p<0.001). The opposite comparison highlighted an increased tracer uptake in left frontal cortex (BA 44; p<0.05). Structural grey matter modifications were found in visual, posterior cingulate and parieto-temporal cortex, paralleling the functional changes. Conclusion: The positive EMDR outcome corresponded to increased 99mTc-HMPAO uptake in the left dorsolateral frontal cortex, processing attention and self confidence and exerting an inhibitory effect on the amygdala whose firing is supposed to be responsible for PTSD. After successful treatment significant decreases were found in primary visual cortex, processing images of traumatic memories and flashbacks; in fusiform gyrus, processing the memories of faces, bodies and words and in the hippocampi, involved in episodic and autobiographical memories. Volumetric changes paralleled the ones in tracer uptake in all regions Taken as a whole these findings suggest that the positive clinical outcome following EMDR therapy causes functional and structural neurobiological changes towards normality.

Keywords: Brain Volumetry Neurobiological Changes Posttraumtic Stress Disorder PTSD rCBF Regional Cerebral Blood Flow

Accuracy Verified: Yes

17. Bossini, L., Poliziotto, N., Tavanti, M., Calossi, S., Lombardelli, A., Vatti, G., & Castrogiovanni, P. (2006, Febbraio). Neuroimaging e PTSD: Dati morfovolumetrici e loro variazioni dopo trattamento [Neuroimaging and PTSD: Facts morfovolumetrici and their changes after treatment]. Presentazione al Congresso XI SOPSI (Società Italiana di Psicopatologia), Roma, Italia.

Language: Italian

Format: Conference

Abstract:
Introduzione: molti studi concordano sulla riduzione del volume ippocampale nei pazienti affetti da PTSD 1 e che tale alterazione anatomica è correlata con deficit cognitivi e con la gravità dei sintomi. Comunque ad oggi non è stato ancora chiarito se l’atrofia ippocampale rappresenta l’esito di un effetto neurotossico del trauma o, piuttosto, una condizione preesistente che predispone allo sviluppo di alcune patologie psichiatriche. Già da tempo studi su animali dimostrano come lo stress causi atrofia ippocampale e inibizione della neurogenesi, con meccanismi verosimilmente legati ai glucocorticoidi, all’increzione del fattore corticotropo, all’aumento degli aminoacidi eccitatori, all’inibizione fattore neurotrofico cerebrale con perdita della plasticità neuronale. Nell’uomo, tuttavia, i risultati non sono così lineari. Da un lato alcuni studi hanno individuato come fattore principale l’aumento dei glucocorticoidi 2, dall’altro tale teoria è stata fortemente criticata 3. Secondo Yehuda il meccanismo di atrofia ippocampale è dovuto ad un’alterazione dell’asse Ipotalamo-Ipofisi-Surrene (HPA), ma in termini di una bassa increzione di glucocorticoidi che determina un aumento del feedback negativo dell’asse stesso ed un’ipersensibilità recettoriale. Indipendentemente dal meccanismo d’azione, la perdita di neuroni a livello ippocampale nei soggetti che hanno subito eventi traumatici sembra sufficientemente dimostrata e, fino a poco tempo fa, era considerata irreversibile. In realtà l’ippocampo sembra presentare una inusuale e spontanea capacità rigenerativa. Questo dato è stato individuato in molte specie animali e, in un unico studio, anche nell’uomo 4. Inoltre recenti evidenze pre-cliniche e cliniche hanno indicato che gli SSRI (Selective Serotonin Reuptake Inhibitors) promuovono la neurogenesi e riducono l’atrofia ippocampale indotta dallo stress nell’animale 5 e nell’uomo sono in grado di ridurre i sintomi del PTSD, incrementare le dimensioni dell’ippocampo e ridurre i deficit mnesici tipici della patologia 6 7. Un altro fattore che sembra essere in grado di stimolare la neurogenesi negli animali sembra essere “l’ambiente arricchito” verosimilmente tramite i meccanismi molecolari dell’apprendimento che sembrano in grado di attivare la trascrizione dell’mRNA per il Brain Derived Neurotrophic Factor. Questo dato della letteratura supporta il razionale dell’efficacia della psicoterapia anche se l’unico studio che valuta le modificazioni morfostrutturali dopo psicoterapia non ha riportato risultati positivi 8. Gli scopi di questo studio sono: – valutare la presenza di atrofia ippocampale nei pazienti affetti da PTSD (T0-drug-free); – valutare l’effetto della terapia: farmacologica con SSRI e psicoterapica con EMDR (Eye Movement Desensitization and Reprocessing) sia sul piano clinico e neuropsicologico, che sul volume ippocampale, sia sulla memoria (T1). Metodologia: abbiamo analizzato un campione di 20 pazienti, di età compresa tra i 15 ed i 65 anni, reclutati nell’ambulatorio psichiatrico del Policlinico universitario di Siena affetti da PTSD e un gruppo di controllo di soggetti sani appaiati per sesso, età, peso e altezza. I soggetti di entrambi i gruppi sono stati sottoposti ad uno studio morfovolumetrico computerizzato dell’Ippocampo tramite RM (Risonanza Magnetica). Inoltre, i diciassette pazienti con PTSD sono stati valutati tramite la somministrazione di test neuropsicologici e scale psicometriche per approfondire il quadro psicopatologico e valutare l’eventuale presenza di deficit cognitivi. Nei soggetti affetti da PTSD dopo un periodo di sei mesi di terapia psicofarmacologica sono stati ripetuti i test neuropsicologici, le scale psicometriche e l’analisi morfovolumetrica dell’ippocampo tramite RM. Tre pazienti, dopo le valutazioni al T0, hanno effettuato un protocollo terapeutico con solo EMDR e sono stati rivalutati dopo 8 sedute (due mesi). Risultati: i risultati della prima parte sperimentale (T0-drug-free) evidenziano che le dimensioni dell’ippocampo di sinistra nei soggetti affetti da PTSD sono significativamente minori rispetto ai controlli sani. Dai risultati osservati al follow-up (T1-post-terapia) è possibile evincere che la terapia nei soggetti considerati è associata ad un miglioramento della sintomatologia e ad un aumento dei volumi ippocampali, pari al 9,87% per l’ippocampo di destra e dell’8,37% per l’ippocampo di sinistra. Questi dati sono concordi con i dati presenti in letteratura, anche se la percentuale di recupero su base neuroplastica nel nostro studio risulta sensibilmente superiore rispetto ai due studi presenti in letteratura incremento pari al 4,6% 6; pari al 5% 7. I tre pazienti che hanno effettuato terapia con EMDR hanno anch’essi mostrato al T1 un miglioramento sintomatologico (CAPS non più positiva per i criteri diagnostici) ed un aumento medio dei volumi ippocampali pari a 338,25 mm3 per l’ippocampo DX e 357,93 mm3 per l’ippocampo SN. Conclusioni: la terapia nei soggetti considerati si è associata ad un aumento dei volumi ippocampali (9,87%-8,37%). L’aumento dei volumi ippocampali appare rilevante, consistente con i dati in letteratura, sebbene quantitativamente superiore, sottolineando l’efficacia degli SSRI verosimilmente tramite il meccanismo di attivazione della neurogenesi; è ipotizzabile che l’aumento di volume non sia da imputare ad un aumento delle cellule gliali ma ad un aumento di neuroni ippocampali visto il contemporaneo miglioramento clinico. Particolarmente interessante ci sembra il dato relativo all’efficacia clinica e sulla plasticità neurale della EMDR. Questa osservazione su solo tre casi, necessita chiaramente di essere confermata su un campione più ampio ma rappresenta la prima evidenza in letteratura di un’azione della psicoterapia diretta alla struttura cerebrale.

Introduction: Many studies agree on the reduction of hippocampal volume in patients with PTSD and that an anatomical alteration is correlated with cognitive deficits and the severity of symptoms. However to date has not yet been clarified whether hippocampal atrophy is the result of a neurotoxic effect of trauma or, rather, an underlying condition that predisposes to the development of some psychiatric disorders. For some time animal studies show that stress causes hippocampal atrophy and inhibition of neurogenesis, by mechanisms probably related to glucocorticoids, all'increzione corticotropo factor, increased excitatory amino acid, inhibition of brain neurotrophic factor with loss of neuronal plasticity. In humans, however, the results are not so linear. On the one hand, some studies have identified as the main factor increasing glucocorticoid two other such theory was strongly criticized 3. According to Yehuda mechanism of hippocampal atrophy is due to an alteration of hypothalamic-pituitary-adrenal (HPA), but in terms of a low secretion of glucocorticoids leading to an increase of negative feedback axis and the same receptor hypersensitivity . Regardless of the mechanism of action, loss of neurons in hippocampus in people who have suffered traumatic events seems sufficiently established and, until recently, was considered irreversible. In fact, the hippocampus appears to be an unusual and spontaneous regenerative capacity. This figure has been identified in many animal species and in one study in humans 4. Moreover, recent evidence pre-clinical and clinical studies have shown that SSRIs (Selective Serotonin Reuptake Inhibitors) promote neurogenesis and reduce stress-induced hippocampal atrophy in animals 5 and humans are able to reduce symptoms of PTSD, increase the size of the hippocampus and reduce the deficit mnesic typical of the disease 6 7. Another factor that seems to be able to stimulate neurogenesis in animals seems to be "enriched environment" probably through molecular mechanisms of learning that seem able to activate the transcription of mRNA for Brain Derived Neurotrophic Factor. This finding supports the rationale of the literature of the effectiveness of psychotherapy, even if the only study that evaluates changes morphostructural after psychotherapy has shown positive results 8. The aims of this study are: - To evaluate the presence of hippocampal atrophy in patients with PTSD (T0-drug-free) - to assess the effect of therapy: pharmacological SSRI and psychotherapy with EMDR (eye movement desensitization and reprocessing) is a clinical and neuropsychological, and on hippocampal volume, and memory (T1). Methods: We analyzed a sample of 20 patients, aged between 15 and 65, recruited nell'ambulatorio Psychiatric University Hospital of Siena with PTSD and a control group of healthy subjects matched by sex, age, weight and height. Subjects in both groups were subjected to a computerized study morfovolumetrico dell'Ippocampo using MRI (Magnetic Resonance). In addition, seventeen patients with PTSD were assessed through administration of psychometric scales and neuropsychological tests to study the psychopathological picture and evaluate the possible presence of cognitive deficits. In subjects with PTSD after a period of six months of pharmacological therapy were repeated neuropsychological tests, scales psychometric analysis morfovolumetrica hippocampus by MRI. Three patients at T0 after assessments, carried out a treatment protocol with only EMDR and were reassessed after eight sessions (two months). Results: The results of the first experiment (T0-drug-free) show that the size of the left hippocampus in patients with PTSD are significantly lower compared to healthy controls. The results observed during the follow-up (T1-post-therapy) can be inferred that therapy in patients considered to be associated with improvement in symptoms and an increase in hippocampal volume, equal to 9.87% for the right hippocampus and 8, 37% for the left hippocampus. These data are consistent with the data in the literature, although the recovery rate based on neuroplastic in our study is significantly higher than in the two studies in the literature increase of 4.6% 6; 5% 7. The three patients who have treatment with EMDR have also shown an improvement in symptoms at T1 (CAPS no longer positive for the diagnostic criteria) and an average increase in hippocampal volume amounted to 338.25 mm3 for the hippocampus and DX 357, 93 mm3 for the hippocampus SN. Conclusions: Therapy in patients considered was associated with an increase in hippocampal volume (9.87% -8.37%). The increase in hippocampal volume appear to be relevant, consistent with the literature data, although quantitatively greater, stressing the effectiveness of SSRIs probably through the mechanism of activation of neurogenesis, it is conceivable that the increase in volume is attributable to an increase glial cells but an increase of hippocampal neurons seen the simultaneous clinical improvement. Seems particularly interesting given the relative clinical effectiveness of EMDR and neural plasticity. This observation on only three cases, clearly needs to be confirmed on a larger sample but represents the first evidence in the literature of action of psychotherapy directed at brain structure.

Keywords: Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

18. Creamer, M., & O'Donnell, M. (2002). Post-traumatic stress disorder. Current Opinion in Psychiatry, 15(2), 163-168.

Language: English

Format: Journal

Abstract:
This paper provides an overview of recent developments in the literature on post-traumatic stress disorder. Epidemiological studies indicate that approximately 15-25% of individuals experiencing a significant trauma will go on to develop post-traumatic stress disorder, although approximately half will recover without formal intervention. Potential vulnerability factors for post-traumatic stress disorder have been identified, but the mechanisms and complexities require further exploration, with recent research suggesting that prevalence rates and risk factors may differ across populations. Studies of psychological treatment have demonstrated prolonged exposure and cognitive therapies to be equally beneficial, whereas eye movement desensitization and reprocessing may be useful but perhaps less effective in the long term. Pharmacological treatment studies indicate that selective serotonin reuptake inhibitors may be the first choice of drug treatments for post-traumatic stress disorder. Non-selective primary prevention strategies remain contentious, although secondary prevention, in the form of cognitive behavioural interventions for acutely symptomatic survivors, appears to reduce the subsequent development of post-traumatic stress disorder.

Keywords: Cognitive Therapies Drug Therapy Exposure Therapies Posttraumatic Stress Disorder Prevention Primary Prevention PTSD Risk Factors Secondary Prevention Susceptibility (Disorders) Treatment Vulnerability Factors

Accuracy Verified: Yes

19. Cahill, P. C., Pontoski, K., & D’Olio, C. M. (2005, September). Posttraumatic stress disorder and acute stress disorder II: Considerations for treatment and prevention. Psychiatry, 2(9), 34-46.

Language: English

Format: Journal

Abstract:
Posttraumatic stress disorder is a common and often chronic and disabling anxiety disorder that can develop after exposure to highly stressful events characterized by actual or threatened harm to the self or others. This is the second of two invited articles summarizing the nature and treatment of PTSD and the associated condition of acute stress disorder (ASD). The present article reviews evidence for the efficacy of psychological and pharmacological treatments for PTSD and ASD. In summary, cognitive behavior therapy (CBT) has been found efficacious in the treatment of chronic PTSD as well as the treatment of ASD/prevention of PTSD. The selective serotonin reuptake inhibitors, sertraline, paroxetine, and fluoxetine, have been found efficacious in the treatment of chronic PTSD, with sertraline and paroxetine receiving the FDA indication for this condition. There is less evidence for efficacious medications in the treatment of ASD/prevention of PTSD. At present, hydrocortisone and propranolol show the greatest promise. Limitations of these treatments, including dropout and a significant number of patients showing no or only partial response, are discussed as well as issues related to selecting among efficacious treatments.

Keywords: ASD Acute Stress Disorder Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

20. Davidson, J. R. T., Stein, D. J., Shalev, A.Y., & Yehuda, R. (2004, Spring). Posttraumatic stress disorder: Acquisition, recognition, course, and treatment. Journal of Neuropsychiatry and Clinical Neuroscience, 16(2), 135-147. doi:10.1176/appi.neuropsych.16.2.135.

Language: English

Format: Journal

Abstract:
Following exposure to trauma, a large number of survivors will develop acute symptoms of posttraumatic stress disorder (PTSD), which mostly dissipate within a short time. In a minority, however, these symptoms will evolve into chronic and persistent PTSD. A number of factors increase the likelihood of this occurring, including characteristic autonomic and hypothalamic-pituitary-adrenal axis responses. PTSD often presents with comorbid depression, or in the form of somatization, both of which significantly reduce the possibilities of a correct diagnosis and appropriate treatment. Mainstay treatments include exposure-based psychosocial therapy and selective serotonin reuptake inhibitors, such as paroxetine and sertraline, both of which have been found to be effective in PTSD. This paper looks at the course of PTSD, its disabling effect, its recognition and treatment, and considers possible new research directions.

Keywords: Comorbidity Posttraumatic Stress Disorder PTSD Recognition and Treatment SSRIs

Accuracy Verified: Yes

21. van Loey, N. E. E., & van Son, M. J. M. (2003). Psychopathology and psychological problems in patients with burn scars: Epidemiology and management. American Journal of Clinical Dermatology, 4(4), 245-272.

Language: English

Format: Journal

Abstract:
Burn injury is often a devastating event with long-term physical and psychosocial effects. Burn scars after deep dermal injury are cosmetically disfiguring and force the scarred person to deal with an alteration in body appearance. In addition, the traumatic nature of the burn accident and the painful treatment may induce psychopathological responses. Depression and PTSD, which are prevalent in 13-23% and 13-45% of cases, respectively, have been the most common areas of research in burn patients. Risk factors related to depression are pre-burn depression and female gender in combination with facial disfigurement. Risk factors related to PTSD are pre-burn depression, type and severity of baseline symptoms, anxiety related to pain, and visibility of burn injury. Neuropsychological problems are also described, mostly associated with electrical injuries. Social problems include difficulties in sexual life and social interactions. Quality of life initially seems to be lower in burn patients compared with the general population. Problems in the mental area are more troublesome than physical problems. Over a period of many years, quality of life was reported to be rather good. Mediating variables such as low social support, emotion and avoidant coping styles, and personality traits such as neuroticism and low extraversion, negatively affect adjustment after burn injury. Few studies of psychological treatments in burn patients are available. From general trauma literature, it is concluded that cognitive (behavioral) and pharmacological (selective serotonin reuptake inhibitors) interventions have a positive effect on depression. With respect to PTSD, exposure therapy and eye movement reprocessing and desensitization [EMDR] are successful. Psychological debriefing aiming to prevent chronic post-trauma reactions has not, thus far, shown a positive effect in burn patients. Treatment of problems in the social area includes cognitive-behavioral therapy, social skills training, and community interventions. Sexual health promotion and counseling may decrease problems in sexual life. In conclusion, psychopathology and psychological problems are identified in a significant minority of burn patients. Symptoms of mood and anxiety disorders (of which PTSD is one) should be the subject of screening in the post-burn phase and treated if indicated. A profile of the patient at risk, based on pre-injury factors such as pre-morbid psychiatric disorder and personality characteristics, peri-traumatic factors and post-burn factors, is presented. Finally, objective characteristics of disfigurement appear to play a minor role, although other factors, such as proneness to shame, body image problems, and lack of self-esteem, may be of significance. [Author Abstract]

Keywords: Burns Comorbidity Epidemiology Literature Review Posttraumatic Stress Disorder Predisposition PTSD Survivors Treatment

Accuracy Verified: Yes

22. van der Kolk, B. A., Spinazzola, J., Blaustein, M. E., Hopper, J. W., Hopper, E. K., Korn, D. L., & Simpson, W. B. (2007, January). A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: Treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68(1), 37-46.

Language: English

Format: Journal

Abstract:
Objective: The relative short-term efficacy and long-term benefits of pharmacologic versus psychotherapeutic interventions have not been studied for PTSD. This study compared the efficacy of a selective serotonin reuptake inhibitor (SSRI), fluoxetine, with a psychotherapeutic treatment, eye movement desensitization and reprocessing (EMDR), and pill placebo and measured maintenance of treatment gains at 6-month follow-up. Method: 88 PTSD subjects diagnosed according to DSM-IV criteria were randomly assigned to EMDR, fluoxetine, or pill placebo. They received 8 weeks of treatment and were assessed by blind raters posttreatment and at 6-month follow-up. The primary outcome measure was the Clinician-Administered PTSD Scale, DSM-IV version, and the secondary outcome measure was the Beck Depression Inventory-II. The study ran from July 2000 through July 2003. Results: The psychotherapy intervention was more successful than pharmacotherapy in achieving sustained reductions in PTSD and depression symptoms, but this benefit accrued primarily for adult-onset trauma survivors. At 6-month follow-up, 75.0% of adult-onset versus 33.3% of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group. For most childhood-onset trauma patients, neither treatment produced complete symptom remission. Conclusions: This study supports the efficacy of brief EMDR treatment to produce substantial and sustained reduction of PTSD and depression in most victims of adult-onset trauma. It suggests a role for SSRIs as a reliable first-line intervention to achieve moderate symptom relief for adult victims of childhood-onset trauma. Future research should assess the impact of lengthier intervention, combination treatments, and treatment sequencing on the resolution of PTSD in adults with childhood-onset trauma. [Author Abstract]

Keywords: Adults Depressive Disorders Empirical Study Posttraumatic Stress Disorder PTSD Quantitative Study Random Clinical Trial RCT Selective Serotonin Reuptake Inhibitors Stressors Survivors Treatment Effectiveness

Accuracy Verified: Yes

23. Kapfhammer, H.-P. (2008, December). Therapeutische möglichkeiten nach traumatischen erlebnissen [Therapeutic possibilities after traumatic experiences]. Psychiatria Danubina, 20(4), 532-545.

Language: German

Format: Journal

Abstract:
Acute Belastungsstörung (ASD) und Posttraumatische Belastungsstörung (PTSD) sind häufige, aber nicht zwingend psychologische Folgeerscheinungen nach einem Trauma. Eine wichtige Untergruppe der Patienten vor einer chronischen Verlauf der Erkrankung mit einem erhöhten psychiatrischen Komorbidität und erhebliche Beeinträchtigungen in psychosozialen Anpassung assoziiert. Der typische psychopathologische Symptome von ASD und PTSD werden am besten in einem multifaktoriellen Modell der Integration sowohl neurobiologische und psychosoziale Einflüsse beschrieben. Die komplexen Ätiopathogenese von akuten und posttraumatischen Belastungsstörung begünstigt multimodalen Ansätzen in der Behandlung. Differential psychotherapeutische und pharmakologische Strategien zur Verfügung stehen. In einer kritischen Studie über empirische Studien, können psychologische Debriefing nicht als einen positiven Ansatz betrachtet werden, als allgemeine vorbeugende Maßnahme in der unmittelbaren posttraumatischen Phase empfohlen werden. Positive Auswirkungen der kognitiv-verhaltenstherapeutischen Interventionen kann für ASD eingerichtet werden. Psychodynamische Psychotherapie, kognitive Verhaltenstherapie und EMDR zeigen viel versprechende Ergebnisse bei der Behandlung von PTSD. Wesentliche klinische Einschränkungen der Patienten innerhalb von speziellen Probenahmen Forschungseinrichtungen, jedoch nicht gestatten, eine bedingungslose Verallgemeinerung dieser Daten zu psychiatrischen Routineversorgung. In einer empirischen Analyse der SSRIs sind die meisten und am besten untersuchten Medikamente für ASD und PTSD. Im Vergleich zu trizyklischen Antidepressiva SSRIs zeigen ein breiteres Spektrum an therapeutischen Wirkungen und sind besser verträglich. Die Substanzklassen der SNRI, DAS, SARI und NaSSA sind als Medikamente der zweiten Wahl angesehen werden. Sie versprechen eine therapeutische Wirksamkeit der SSRI gleichwertig, wobei bisher nur in offenen Studien untersucht. MAO-Hemmer können eine positive therapeutische Potenzial verfügen, müssen ihr Profil der Nebenwirkungen geachtet, jedoch werden. Mood-Stabilisatoren und atypische Neuroleptika können in Anspruch genommen werden und vor allem im Add-On-Strategien. Benzodiazepine sollten nur mit Vorsicht erhöht für eine kurze Zeit in den Staaten der akuten Krise eingesetzt werden. In frühen Interventionen, die blockierende Substanzen norepinephric Hyperaktivität scheinen vielversprechende Alternativen. Stress Dosen von Hydrocortison kann als experimentelle pharmakologische Strategie betrachtet so weit sein. [PubMed]

Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are frequent, but not obligatory psychological sequelae following trauma. A major subgroup of patients face a chronic course of illness associated with an increased psychiatric comorbidity and significant impairments in psychosocial adaptation. The typical psychopathological symptoms of ASD and PTSD are best described within a multifactorial model integrating both neurobiological and psychosocial influences. The complex etiopathogenesis of acute and posttraumatic stress disorder favours multimodal approaches in the treatment. Differential psychotherapeutic and pharmacological strategies are available. In a critical survey on empirical studies, psychological debriefing cannot be considered as a positive approach to be recommended as general preventive measure during the immediate posttraumatic phase. Positive effects of cognitive-behavioral interventions can be established for ASD. Psychodynamic psychotherapy, cognitive-behavioral therapy and EMDR show promising results in the treatment of PTSD. Major clinical restrictions of patient sampling within special research facilities, however, do not allow an unconditional generalization of these data to psychiatric routine care. In an empirical analysis the SSRIs are the most and best studied medications for ASD and PTSD. In comparison to tricyclic antidepressants SSRIs demonstrate a broader spectrum of therapeutic effects and are better tolerated. The substance classes of SSNRI, DAS, SARI and NaSSA are to be considered as drugs of second choice. They promise a therapeutic efficacy equivalent to the SSRIs, being investigated so far only in open studies. MAO-inhibitors may dispose of a positive therapeutic potential, their profile of side effects must be respected, however. Mood stabilizers and atypical neuroleptics may be used first and foremost in add-on strategies. Benzodiazepines should be used only with increased caution for a short time in states of acute crisis. In early interventions, substances blocking the norepinephric hyperactivity seem to be promising alternatives. Stress doses of hydrocortisone may be considered as an experimental pharmacological strategy so far.[PUBMED]

Keywords: Acute Stress Disorder ASD Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

24. Forbes, D., Creamer, M. C., Phelps, A. J., Couineau, A. L., Cooper, J. A., Bryant, R. A., McFarlane, A. C., Devilly, G. J., Matthews, L. R., & Raphael, B. (2007, July). Treating adults with acute stress disorder and post-traumatic stress disorder in general practice: A clinical update. Medical Journal of Australia, 187(2), 120-123.

Language: English

Format: Journal

Abstract:
General practitioners have an important role to play in helping patients after exposure to severe psychological trauma. In the immediate aftermath of trauma, GPs should offer "psychological first aid", which includes monitoring of the patient's mental state, providing general emotional support and information, and encouraging the active use of social support networks, and self-care strategies. Drug treatments should be avoided as a preventive intervention after traumatic exposure; they may be used cautiously in cases of extreme distress that persists. Adults with acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) should be provided with trauma-focused cognitive behaviour therapy (CBT). Eye movement desensitisation and reprocessing (EMDR) in addition to in-vivo exposure (confronting avoided situations, people or places in a graded and systematic manner) may also be provided for PTSD. Drug treatments should not normally replace trauma-focused psychological therapy as a first-line treatment for adults with PTSD. If medication is considered for treating PTSD in adults, selective serotonin reuptake inhibitor antidepressants are the first choice. Other new generation antidepressants and older tricyclic antidepressants should be considered as second-line pharmacological options. Monoamine oxidase inhibitors may be considered by mental health specialists for use in people with treatment-resistant symptoms.

Keywords: Acute Stress Disorder Anti-Depressants ASD MAO Inhibitors Posttraumatic Stress Disorder PSTD SSRIs

Accuracy Verified: Yes

25. Fisher, N. (2010, April). Treatment options for combat veterans with PTSD. Poster presented at the 2nd Bi-Annual International European Society for Trauma and Dissociation Conference, Belfast, Northern Ireland.

Language: English

Format: Conference

Abstract:
In this review I explored the most effective treatment options available for military veterans with Post Traumatic Stress Disorder. Specifically, psychotherapy and pharmacotherapy was examined. Psychotherapy encompassed cognitive behavioral therapy, emotional desensitization and reprocessing and exposure therapy. Pharmacotherapy included selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, novel antidepressants and benzodiazepines. Meta analyses, literature reviews and research experiments formed the basis for the comparisons between treatments. The main findings include that the psychotherapies cognitive behavioral therapy and eye movement desensitization and reprocessing, and the pharmacotherapy selective serotonin reuptake inhibitors are the most superior treatments for veterans with PTSD. Learning Outcomes
Delegates will learn about the variables which make treating combat veterans with PTSD different than other groups with PTSD. In terms of treatment, psychotherapeutic and psychopharmacologic options will be examined. Delegates will leave the presentation aware of what current research states on treatment efficacy of CBT, EMDR, Exposure Therapy, Antidepressants and Anxiolytics.

Keywords: Poster Posttraumatic Stress Disorder PSTD Veterans

Accuracy Verified: Yes

26. Cohena, J. A., Mannarino, A. P., & Rogal, S. (2001, January). Treatment practices for childhood posttraumatic stress disorder. Child Abuse and Neglect, 25(1), 123-135. doi:10.1016/S0145-2134(00)00226-X.

Language: English

Format: Journal

Abstract:
Objective: This study surveyed practices in treating childhood PTSD among child psychiatrists and non-M.D. therapists with self-identified interest in treating traumatized children. Method: An anonymous survey was mailed to 207 child psychiatrists ("medical") [members of the American Academy of Child and Adolescent Psychiatry] and 460 nonphysician ("non-medical") therapists [members of the International Society for Traumatic Stress Studies] inquiring about current interventions used to treat children with PTSD. Results: 247 responses were received: of 77 medical and 82 nonmedical respondents who currently treat children with PTSD, a wide variety of modalities are used. Most preferred modalities among medical responders were pharmacotherapy, psychodynamic, and cognitive-behavioral therapy. Most preferred modalities among nonmedical respondents were cognitive-behavioral, family, and nondirective play therapy. 95% of medical respondents used pharmacotherapy for this disorder; most preferred medications to treat childhood PTSD were selective serotonin reuptake inhibitors and alpha-adrenergic agonists. Several significant differences between medical and nonmedical practices were identified. Conclusions: There is little clinical consensus regarding the effectiveness of the many modalities used to treat traumatized children who have PTSD symptoms; empirical research is particularly needed to evaluate the efficacy of pharmacotherapy and EMDR. [Author Abstract]

Keywords: Adolescents Arousal Avoidance Children Drug Therapy Mental Health Personnel Reexperiencing Posttraumatic Stress Disorder PTSD Treatment Effectiveness

Accuracy Verified: Yes