Archives for April 2016

Female veterans’ preferences for counseling related to intimate partner violence: Informing patient-centered interventions.

April 27, 2016 05:11

Female veterans’ preferences for counseling related to intimate partner violence: Informing patient-centered interventions.

http:--linkinghub.elsevier.com-ihub-imag

Female veterans’ preferences for counseling related to intimate partner violence: Informing patient-centered interventions.

Gen Hosp Psychiatry. 2016 Mar 18;

Authors: Iverson KM, Stirman SW, Street AE, Gerber MR, Carpenter SL, Dichter ME, Bair-Merritt M, Vogt D

Abstract

OBJECTIVE: Female veterans are at high risk for intimate partner violence (IPV). A critical issue in the provision of health care to women who experience IPV is the delivery of effective brief counseling interventions that address women’s unique needs. We aimed to identify female veterans’ priorities and preferences for healthcare-based IPV counseling.

METHOD: A 2014 Web-based survey was administered to a national sample of US female veterans. Among 411 respondents (75% participation rate), 55% (n=226) reported IPV during their lifetime. These women identified priorities for the content focus of IPV-related counseling and preferences for the delivery of these services.

RESULTS: Women prioritized counseling that focuses on physical safety and emotional health, with learning about community resources being a relatively lower priority. Participants preferred counseling to focus specifically on enhancing coping skills and managing mental health symptoms. In addition, women want counseling to be individualized and preferred the option to meet with a counselor immediately following disclosure. Affordable services and attention to privacy concerns were of paramount importance in the context of IPV-related counseling.

CONCLUSION: These findings can inform patient-centered brief counseling interventions for women who experience IPV, which may ultimately reduce health disparities and violence among this population.

PMID: 27083252 [PubMed – as supplied by publisher]

Perceptions of Individual and Family Functioning Among Deployed Female National Guard Members.

April 27, 2016 05:05

Perceptions of Individual and Family Functioning Among Deployed Female National Guard Members.

Perceptions of Individual and Family Functioning Among Deployed Female National Guard Members.

J Fam Nurs. 2016 Apr 13;

Authors: Kelly PJ, Cheng AL, Berkel LA, Nilsson J

Abstract

Females currently make up 15% of U.S. military service members. Minimal attention has been paid to families of female National Guard members who have been deployed and their subsequent reintegration challenges. This cross-sectional Internet-based survey of female members of four National Guard units compared those who were and were not deployed. Instruments, guided by the variables of the Family Resilience Model, measured individual, family, and deployment-related factors. Bivariate analysis and ordinal logistic regression were done to assess differences between the groups. Of the 239 National Guard members surveyed, deployed women (n= 164) had significantly higher levels of posttraumatic stress disorder (PTSD;p< .001) and lower coping skills (p= .003) than non-deployed women (n= 75). Perceptions of overall family functioning were higher among deployed when compared with never deployed women. Results indicate community interventions that focus on strengthening coping skills of female Guard members would be useful for this population.

PMID: 27076466 [PubMed – as supplied by publisher]

Transcranial magnetic stimulation for posttraumatic stress disorder: an updated systematic review and meta-analysis.

April 27, 2016 05:03

Transcranial magnetic stimulation for posttraumatic stress disorder: an updated systematic review and meta-analysis.

Transcranial magnetic stimulation for posttraumatic stress disorder: an updated systematic review and meta-analysis.

Trends Psychiatry Psychother. 2016 Mar;38(1):50-5

Authors: Trevizol AP, Barros MD, Silva PO, Osuch E, Cordeiro Q, Shiozawa P

Abstract

Introduction Transcranial magnetic stimulation (TMS) is a promising non-pharmacological intervention for posttraumatic stress disorder (PTSD). However, randomized controlled trials (RCTs) and meta-analyses have reported mixed results. Objective To review articles that assess the efficacy of TMS in PTSD treatment. Methods A systematic review using MEDLINE and other databases to identify studies from the first RCT available up to September 2015. The primary outcome was based on PTSD scores (continuous variable). The main outcome was Hedges’ g. We used a random-effects model using the statistical packages for meta-analysis available in Stata 13 for Mac OSX. Heterogeneity was evaluated with I2 (> 35% for heterogeneity) and the χ2 test (p < 0.10 for heterogeneity). Publication bias was evaluated using a funnel plot. Meta-regression was performed using the random-effects model. Results Five RCTs (n = 118) were included. Active TMS was significantly superior to sham TMS for PTSD symptoms (Hedges’ g = 0.74; 95% confidence interval = 0.06-1.42). Heterogeneity was significant in our analysis (I2 = 71.4% and p = 0.01 for the χ2 test). The funnel plot shows that studies were evenly distributed, with just one study located marginally at the edge of the funnel and one study located out of the funnel. We found that exclusion of either study did not have a significant impact on the results. Meta-regression found no particular influence of any variable on the results. Conclusion Active TMS was superior to sham stimulation for amelioration of PTSD symptoms. Further RCTs with larger sample sizes are fundamental to clarify the precise impact of TMS in PTSD.

PMID: 27074341 [PubMed – in process]

Prevalence of Central Nervous System Polypharmacy and Associations with Overdose and Suicide-Related Behaviors in Iraq and Afghanistan War Veterans in VA Care 2010-2011.

April 27, 2016 05:03

Prevalence of Central Nervous System Polypharmacy and Associations with Overdose and Suicide-Related Behaviors in Iraq and Afghanistan War Veterans in VA Care 2010-2011.

Prevalence of Central Nervous System Polypharmacy and Associations with Overdose and Suicide-Related Behaviors in Iraq and Afghanistan War Veterans in VA Care 2010-2011.

Drugs Real World Outcomes. 2016;3:45-52

Authors: Collett GA, Song K, Jaramillo CA, Potter JS, Finley EP, Pugh MJ

Abstract

BACKGROUND: The increase in the quantities of central nervous system (CNS)-acting medications prescribed has coincided with increases in overdose mortality, suicide-related behaviors, and unintentional deaths in military personnel deployed in support of the wars in Iraq and Afghanistan. Data on the extent and impact of prescribing multiple CNS drugs among Iraq and Afghanistan Veterans (IAVs) are sparse.

OBJECTIVES: We sought to identify the characteristics of IAVs with CNS polypharmacy and examine the association of CNS polypharmacy with drug overdose and suicide-related behaviors controlling for known risk factors.

METHODS: This cross-sectional cohort study examined national data of Iraq and Afghanistan Veterans (N = 311,400) who used the Veterans Health Administration (VHA) during the fiscal year 2011. CNS polypharmacy was defined as five or more CNS-acting medications; drug/alcohol overdose and suicide-related behaviors were identified using ICD-9-CM codes. Demographic and clinical characteristics associated with CNS polypharmacy were identified using a multivariable logistic regression model.

RESULTS: We found that 25,546 (8.4 %) of Iraq and Afghanistan Veterans had CNS polypharmacy. Those with only post-traumatic stress disorder (PTSD) (adjusted odds ratio (AOR) 6.50, 99 % confidence interval (CI) 5.96-7.10), only depression (AOR 6.42, 99 % CI 5.86-7.04), co-morbid PTSD and depression (AOR 12.98, 99 % CI 11.97-14.07), and co-morbid traumatic brain injury (TBI), PTSD, and depression (AOR 15.30, 99 % CI 14.00-16.73) had the highest odds of CNS polypharmacy. After controlling for these co-morbid conditions, CNS polypharmacy was significantly associated with drug/alcohol overdose and suicide-related behavior.

CONCLUSION: CNS polypharmacy was most strongly associated with PTSD, depression, and TBI, and independently associated with overdose and suicide-related behavior after controlling for known risk factors. These findings suggest that CNS polypharmacy may be used as an indicator of risk for adverse outcomes. Further research should evaluate whether CNS polypharmacy may be used as a trigger for evaluation of the current care provided to these individuals.

PMID: 27073756 [PubMed – as supplied by publisher]

Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress.

April 27, 2016 05:03

Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress.

Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress.

J Clin Sleep Med. 2016 Mar 21;

Authors: Mayer SB, Levy JR, Farrell-Carnahan L, Nichols MG, Raman S

Abstract

STUDY OBJECTIVES: This cross-sectional study aimed to characterize sleep patterns, the quality and duration of sleep, and estimate the prevalence of common sleep disorders and posttraumatic stress disorder (PTSD) in a hospital-based Veterans Affairs MOVE! (Managing Overweight Veterans Everywhere) clinic.

METHODS: Participants completed five instruments: the Pittsburgh Sleep Quality Index (PSQI), Smith’s Measure of Morningness/ Eveningness, Restless Legs Syndrome Rating Scale, the STOP Questionnaire, and the Posttraumatic Stress Disorder (PTSD) Checklist – Civilian Version (PCL-C).

RESULTS: Enrolled Veterans (n = 96) were mostly male (78%), African American (49%), mean age 58 (SD 10.6) years, and mean body mass index (BMI) 38.4 kg/m2 (SD 8.4). By PSQI, 89% rated sleep quality as “poor” (M = 11.1, SD = 5.1), consistent with severely impaired sleep. Most were at high risk for sleep disorders including restless leg syndrome (53%), obstructive sleep apnea (66%), and circadian sleep disorders (72%). Forty-seven percent endorsed clinically significant symptoms of PTSD. Hypotheses-generating regression models suggest sleep latency (minutes before falling asleep) was associated with BMI (p = 0.018). Bedtime, getting up time, hours of sleep, waking up in the middle of the night or early morning, having to get up to use the bathroom, inability to breathe comfortably, cough or snore loudly, feeling too cold or too hot, having bad dreams, pain, and frequency of having trouble sleeping, were not significantly associated with BMI.

CONCLUSIONS: Our cross-sectional study suggests that sleep difficulties are common among Veterans referred to a weight loss program at a Veterans Affairs Hospital. Controlled studies are needed to investigate whether the results are generalizable and whether obesity among veterans is a risk factor for sleep disorders and PTSD.

PMID: 27070244 [PubMed – as supplied by publisher]

Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA.

April 27, 2016 05:03

Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA.

Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA.

Lancet Psychiatry. 2016 Apr 5;

Authors: Mithoefer MC, Grob CS, Brewerton TD

Abstract

4-phosphorloxy-N,N-dimethyltryptamine (psilocybin) and methylenedioxymethamfetamine (MDMA), best known for their illegal use as psychedelic drugs, are showing promise as therapeutics in a resurgence of clinical research during the past 10 years. Psilocybin is being tested for alcoholism, smoking cessation, and in patients with advanced cancer with anxiety. MDMA is showing encouraging results as a treatment for refractory post-traumatic stress disorder, social anxiety in autistic adults, and anxiety associated with a life-threatening illness. Both drugs are studied as adjuncts or catalysts to psychotherapy, rather than as stand-alone drug treatments. This model of drug-assisted psychotherapy is a possible alternative to existing pharmacological and psychological treatments in psychiatry. Further research is needed to fully assess the potential of these compounds in the management of these common disorders that are difficult to treat with existing methods.

PMID: 27067625 [PubMed – as supplied by publisher]

Association of Spirituality With Mental Health Conditions in Ohio National Guard Soldiers.

April 27, 2016 05:03

Association of Spirituality With Mental Health Conditions in Ohio National Guard Soldiers.

http:--pt.wkhealth.com-pt-pt-core-templa

Association of Spirituality With Mental Health Conditions in Ohio National Guard Soldiers.

J Nerv Ment Dis. 2016 Apr 8;

Authors: Ganocy SJ, Goto T, Chan PK, Cohen GH, Sampson L, Galea S, Liberzon I, Fine T, Shirley E, Sizemore J, Calabrese JR, Tamburrino MB

Abstract

Research exploring spirituality in military populations is a relatively new field with limited published reports. This study used the Spiritual Well-Being Scale to examine the association of spiritual well-being with suicidal ideation/behavior, posttraumatic stress disorder (PTSD), and depression and alcohol use disorders in a randomized sample of Ohio Army National Guard soldiers. The participants were 418 soldiers, mostly white and male, with nearly three-quarters indicating that they had been deployed at least once during their careers. Higher spirituality, especially in the existential well-being subscale, was associated with significantly less lifetime PTSD, depression, and alcohol use disorders and with less suicidal ideation over the past year. Future research in this area may benefit from a longitudinal design that can assess spirituality and mental health behaviors in addition to diagnoses at different time points, to begin to explore spirituality in a larger context.

PMID: 27065107 [PubMed – as supplied by publisher]

Prominence of Hyperarousal Symptoms Explains Variability of Sleep Disruption in Posttraumatic Stress Disorder.

April 27, 2016 05:03

Prominence of Hyperarousal Symptoms Explains Variability of Sleep Disruption in Posttraumatic Stress Disorder.

Prominence of Hyperarousal Symptoms Explains Variability of Sleep Disruption in Posttraumatic Stress Disorder.

Psychol Trauma. 2016 Apr 11;

Authors: van Wyk M, Thomas KG, Solms M, Lipinska G

Abstract

OBJECTIVE: Disrupted sleep is a central feature of posttraumatic stress disorder (PTSD). The precise nature of that disruption is not agreed upon, however, and there is no explanation for why sleep disruptions are detected in some PTSD-diagnosed individuals but not in others. We tested the novel proposition that PTSD-diagnosed individuals with prominent hyperarousal symptoms will have more disrupted sleep than those without such symptoms.

METHOD: We assigned each of 57 female volunteers to 1 of 4 groups: PTSD + Hyperarousal (PTSD + HYP; n = 14), PTSD – Hyperarousal (n = 13), depression (n = 14), or healthy control (n = 16). Each experienced 1 night of polysomnographic recording in a sleep laboratory.

RESULTS: General linear modeling confirmed that group status (i.e., being in the PTSD + HYP group rather than the other groups) predicted disrupted sleep quality most strongly. PTSD patients with prominent hyperarousal symptoms, relative to those without such symptoms, experienced reduced sleep efficiency, spent more time awake after sleep onset, and self-reported poorer sleep quality.

CONCLUSION: These preliminary findings, although requiring replication in larger samples, suggest an important association between hyperarousal symptoms and sleep quality in PTSD, and may help explain why some PTSD-diagnosed individuals experience markedly disrupted sleep whereas others do not. (PsycINFO Database Record

PMID: 27065065 [PubMed – as supplied by publisher]