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1. Aurora, R. N., Zak, R. S., Auerbach, S. H., Casey, K. R., Chowdhuri, S., Karippot, A., Maganti, R. K., Ramar, K., Kristo, D. A., Bista, S. R., Lamm, C. I., & Morgenthaler, T. I. (2010, August). Best practice guide for the treatment of nightmare disorder in adults. Journal of Clinical Sleep Medicine, 6(4), 389-401.

Language: English

Format: Journal

Abstract:
Prazosin is recommended for treatment of Posttraumatic Stress Disorder (PTSD)-associated nightmares. Level A. Image Rehearsal Therapy (IRT) is recommended for treatment of nightmare disorder. Level A. Systematic Desensitization and Progressive Deep Muscle Relaxation training are suggested for treatment of idiopathic nightmares. Level B. Venlafaxine is not suggested for treatment of PTSD-associated nightmares. Level B. Clonidine may be considered for treatment of PTSD-associated nightmares. Level C. The following medications may be considered for treatment of PTSD-associated nightmares, but the data are low grade and sparse: trazodone, atypical antipsychotic medications, topiramate, low dose cortisol, fluvoxamine, triazolam and nitrazepam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants. Nefazodone is not recommended as first line therapy for nightmare disorder because of the increased risk of hepatotoxicity. Level C. The following behavioral therapies may be considered for treatment of PTSD-associated nightmares based on low-grade evidence: Exposure, Relaxation, and Rescripting Therapy (ERRT); Sleep Dynamic Therapy; Hypnosis; Eye-Movement Desensitization and Reprocessing (EMDR); and the Testimony Method. Level C. The following behavioral therapies may be considered for treatment of nightmare disorder based on low-grade evidence: Lucid Dreaming Therapy and Self-Exposure Therapy. Level C No recommendation is made regarding clonazepam and individual psychotherapy because of sparse data.

Keywords: Nightmares  Posttruamatic Stress Disorder  PSTD  

Accuracy Verified: Yes

2. 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

3. Cybulska, E. M. (1997). Globus hystericus — A somatic symptom of depression? The role of electroconvulsive therapy and antidepressants. Psychosomatic Medicine 59, 67-69.

Language: English

Format: Journal

Abstract:
Objective: An association of "globus hystericus" with depressive illness has already been established. Successful treatment with antidepressants has been previously reported but this is the first report of globus symptom responding to electroconvulsive therapy (ECT) followed by long-term remission on maintenance dose with tricyclic antidepressant. Method: A detailed retrospective study of an elderly patient's General Practice medical notes revealed 45-year history of recurrent globus symptom, interspersed with other somatic complaints. Patient's frequency of consultations with her family physician was noted before treatment and during the 5-year follow-up period. Using DSM-III diagnostic categories, the patient was diagnosed as suffering from major depressive disorder with globus symptom. The notes were insufficient to ascertain whether past episodes of globus occurred in a setting of depressive disorder. Results: A prompt response of globus symptom to ECT was observed with 5-year symptom-free follow-up period as long as the patient remained on a maintenance dose of antidepressant. A marked reduction in frequency of medical consultations for other somatic complaints was noted. Conclusions: The case illustrates a strong association of globus symptom with depressive disorder and other somatic concerns. Patients with recurrent globus symptom and family history of depressive illness should be screened for a possibility of depressive disorder. ECT and antidepressants may be successfully used in treatment of globus in a setting of depressive illness. Long-term maintenance with antidepressive medication may keep at least some of these patients symptom-free. It is suggested that globus hystericus could be more appropriately viewed as a somatic symptom of depression rather than a conversion disorder.

Keywords: Antidepressants  Depression  ECT  Electroconvulsive Therapy  Globus Hystericus  Somatization  

Accuracy Verified: Yes

4. Frustaci, A., Pozzi, G., Aurigemma, C., La Rosa, C., Lanza, G., Fernandez, I., & Ruggeri, G. (2006, Febbraio). Indicatori di cambiamento in pazienti con disturbi da eventi stressanti: Impiego della heart rate variability [Indicators of change in patients with disorders of stressful events: Use of heart rate variability]. Poster presentato al XI Congresso SOPSI (Società Italiana di Psicopatologia), Roma, Italia.

Language: Italian

Format: Conference

Abstract:
Introduzione: i pazienti traumatizzati presentano alterazioni sintomatiche quali intrusività, evitamento ed aumentato arousal, che ostacolerebbe la possibilità di elaborazione/integrazione delle tracce mnesiche, oltre ad esprimersi a livello periferico. Tecniche specifiche di trattamento sembrano promuovere l’elaborazione/integrazione delle memorie traumatiche, tra cui la Eye Movement Desensitization and Reprocessing (EMDR). Nella ricerca valutativa è quindi necessario affiancare alle scale psicologiche un appropriato indicatore biologico di attivazione neurovegetativa. La variabilità della frequenza cardiaca (Heart Rate Variability – HRV) esprime l’integrità funzionale del sistema neurovegetativo in risposta allo stress e può essere misurata nei domini di tempo o di frequenza. Lo studio della HRV è stato applicato in psichiatria ai disturbi d’ansia (panico, DOC, PTSD) e dell’umore (depressione unipolare) in ricerche trasversali (confronto con controlli sani) e longitudinali di trattamento farmacologico (triciclici, SSRIs) ma in pochi casi a trattamenti psicoterapici. Gli AA. valutano l’impiego della HRV come indicatore biologico nel trattamento psicoterapeutico di pazienti con Disturbo dell’adattamento erdurante da oltre un mese dopo l’esposizione ad eventi vitali stressanti (EVS). Metodi: sono stati reclutati 6 soggetti (M/F = 1/5, età 40,5 ± 11,0) esposti ad EVS ed avviati a ciclo di trattamento psicoterapico breve (4-6 sedute a cadenza settimanale) di tipo specifico (EMDR) o generico (colloqui supportivi). Costituivano criteri di esclusione: età < 18 o > 65 anni; comorbilità psichiatrica, neurologica e cardiologica; uso di farmaci interferenti. Le valutazioni psicopatologiche sono state eseguite al reclutamento (TBASE: colloquio anamnestico, MINI, Brief COPE), a inizio e fine ciclo di trattamento (TINI, TFINE: IES, SCL-90-R), a uno e tre mesi di follow-up (T30, T90: IES, SCL-90-R, Brief COPE). Le registrazioni Holter sono state effettuate ad ogni intervallo valutativo coprendo: 60 min. attività libera, 10 min. tilt-test, 3-5 min. ascolto dell’evento traumatico, 30-45 min. seduta psicoterapica. Sono stati impiegati test statistici non parametrici per l’analisi delle correlazioni (Spearman) e delle differenze (Wilcoxon). Risultati preliminari: vengono valutate le correlazioni a TINI e le variazioni T90 vs. TINI. Sono significative le seguenti correlazioni: ansia fobica SCL e SDNN (dev. standard intervalli R-R) [r = + 0,9; p = ,037]; collera-ostilità SCL e SDNN [r = -0,95; p =.014]; depressione SCL e r-MSSD (radice media somma quadrati diff. R-R) [r = + 0,9; p = ,037]; sint. intrusivi IES e LF (basse frequenze) [r = -0,9; p = ,037]. Sono risultate statisticamente significative le seguenti variazioni: IES totale [Z = -1,99; p = ,046], sintomi intrusivi IES [Z = -2,21; p = ,027], sintomi di evitamento IES [Z = -1,99; p = ,046], ideazione paranoide SCL [Z = -2,21; p = ,027]; R-R, LF e LF/HF (rapporto basse/alte frequenze) durante ascolto evento [Z = -2,02; p = ,043]. Discussione: a livello basale gli indicatori HRV di distress vegetativo correlano positivamente con collera-ostilità e sintomi intrusivi, negativamente con ansia e depressione. Anche dopo tre mesi dalla fine del trattamento gli interventi psicoterapeutici tendono a ridurre i punteggi sintomatici, e migliorano il bilancio simpato-vagale durante il riascolto dell’evento traumatico.

Introduction: trauma patients have symptomatic changes such as intrusiveness, avoidance and increased arousal, which hampers the development / integration of memory traces, as well as speak at the peripheral level. Specific techniques of treatment seem to promote the formulation and integration of traumatic memories, including eye movement desensitization and reprocessing (EMDR). In evaluation research is therefore necessary to combine psychological scales appropriate indicator organic autonomic activation. The heart rate variability (Heart Rate Variability - HRV) expresses functional integrity of the autonomic nervous system in response stress and can be measured in time or frequency domains. The study of HRV has been applied in psychiatric disorders anxiety (panic, DOC, PTSD) and mood (unipolar depression) in cross-disciplinary (compared with healthy controls) and longitudinal drug treatment (tricyclic SSRIs), but in a few cases in psychotherapeutic treatment. The AA. evaluate the use of HRV as a biological indicator in the psychotherapeutic treatment of patients with adjustment disorder erdurante more than a month after exposure to stressful life events (EVS). Methods: 6 subjects were recruited (M / F = 1 / 5, age 40.5 ± 11.0) exposed to EVS and initiated treatment cycle psychotherapeutic short (4-6 sessions weekly) type specific (EMDR) or generic (hearing supported). Exclusion criteria were: age <18 or> 65 years, psychiatric comorbidity, neurological and cardiological, use of drugs interfering. Psychopathological assessments were performed at recruitment (TBASE: anamnestic interview, MINI, Brief COPE) at the beginning and end of treatment cycle (TINI, TFINE: IES, SCL-90-R) in a three-month follow-up (T30, T90: IES, SCL-90-R, Brief COPE). Holter recordings were made at each interval evaluation covering: 60 min. free activity, 10 min. tilt-test, 3-5 min. listening to the traumatic event, 30-45 minutes. psychotherapy session. Were used nonparametric statistical tests for analysis correlations (Spearman) and differences (Wilcoxon). Preliminary results: the correlations are evaluated and changes TINI vs. T90. TINI. Significant correlations are the following: SCL phobic anxiety and SDNN (standard dev. RR intervals) [r = + 0.9, p =, 037]; anger-hostility SCL SDNN [r = -0.95, p =. 014]; SCL depression r-mssd (root mean square sum diff. RR) [r = + 0.9, p =, 037]; sint. IES intrusive and LF (low frequency) [r = -0.9, P =, 037]. Were statistically significant, the following changes: IES total [Z = -1.99, p =, 046], IES intrusive symptoms [Z = -2.21, p =, 027], symptoms of avoidance IES [Z = -1.99, p =, 046] , SCL paranoid [Z = -2.21, p =, 027], RR, LF and LF / HF ratio (low / high frequencies) while listening event [Z = -2.02, p =, 043]. Discussion: At baseline HRV indicators of distress correlated positively with growing anger-hostility, and intrusive symptoms, negatively with anxiety and depression. Even after three months of the end of psychotherapeutic treatment interventions aimed at reducing symptom scores and enhance sympathetic vagal balance during the playback of the traumatic event.

Keywords: Heart Rate Variability  Poster  Stress Disorders  

Accuracy Verified: Yes

5. 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

6. 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

7. 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

8. Russell, M. (2012, March 23). War atrocities in Afghanistan: Who is blameworthy?. Huffington Post. Retrieved from http://www.huffingtonpost.com/mark-c-russell-phd-abpp/robert-bales-mental-health-_b_1371478.html on 3/26/2012.

Language: English

Format: Other

Abstract:
When Politics Trumps Science in Military Mental Health Care In January 2011, the Government Accountability Office (GAO) investigated the DVA's indefensible decision to limit veterans' access to two of its homegrown PTSD treatments --Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) -- while excluding external competitors, like EMDR, developed outside the DVA. For instance, despite billions of dollars spent by the DVA/DoD to research PTSD treatments (e.g., massage, art therapy, marijuana derivatives, etc.), no EMDR research has been conducted since the wars began -- a blatant disregard of military medicine's mission to ensure that all war veterans have unrestricted access to the highest quality mental health treatment possible. Scientific and personal bias should never enter into the equation. The status quo is even more inexplicable when in February, 2012, the DVA informs the Congressional Budget Office that only 40 percent of VA PTSD patients successfully complete PTSD treatment -- a 60 percent wash-out rate! In stark contrast, randomized controlled trials of EMDR in 1998 with Vietnam combat veterans demonstrated that 77 percent of veterans no longer had PTSD diagnosis after 12 sessions -- with no drop-out [2]. Promising results; however, 1998 marked the last EMDR research trial the DVA has funded. [Excerpt]

Keywords: Afghanistan  Blog  Military  Posttraumatic Stress Disorder  PTSD  Veterans  War  

Accuracy Verified: Yes

9. Figgess, S. (2009). Working with trauma. A journey towards integration: Gestalt and EMDR. British Gestalt Journal, 18(1), 34-41.

Language: English

Format: Journal

Abstract:
This article explores points of convergence and divergence between EMDR and Gestalt in the context of one Gestalt therapist's experience in integrating EMDR and its derivatives into her practice. A longer case example illustrates the power of an EMDR-derived approach to facilitate a client's personal integration of traumatic material.

Keywords: Body Sensation  Gestalt  Inter-Psychic  Intersubjective  Neural Integration  Self-Integration  Unfinished Business  

Accuracy Verified: Yes