Origin of psychiatric symptoms in posttraumatic stress disorder: Findings from monozygotic twins discordant for combat exposure

Hemicrania continua is a headache characterized by chronic unremitting unilateral pain associated with ipsilateral autonomic findings. This type of headache responds to high-flow oxygen and indomethacin. This case report describes a male veteran with posttraumatic stress disorder (PTSD) and major depressive disorder who suffers from comorbid hemicrania continua. The psychiatric symptoms were recalcitrant to psychopharmacological intervention. However, when the patient's hemicrania continua was treated appropriately, the patient's psychiatric symptoms also abated. This case demonstrates the need to address physical comorbidities that may exacerbate psychiatric disorders, such as PTSD.

Download Full-text

Adjunct pharmacotherapy for psychotherapy

BJPsych Open ◽

10.1192/bjo.2021.460 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S166-S167

Author(s):

Jessica Lochtenberg ◽

Ari Kirshenbaum ◽

Matthew Johnson

Keyword(s):

Posttraumatic Stress Disorder ◽

Therapeutic Alliance ◽

Posttraumatic Stress ◽

Substance Dependence ◽

Stress Disorder ◽

Psychiatric Symptoms ◽

Treatment Options ◽

Term Treatment ◽

Compulsive Disorder ◽

Long Term Treatment

AimsA variety of pharmacotherapies have been used to assist the psychotherapy process as “adjunctive therapies.” These drugs are used in an acute, targeted fashion, such that they are explicitly delivered in the context of psychotherapy for anxiety, mood and substance-dependence disorders (SUDs). Our narrative review highlights the potential of medically-assisted psychotherapy by outlining the current state of research on few of these medications and describing the basic science that supports their use.MethodFirstly, we researched an assortment of medications that have been used off-label to enhance psychotherapy, and selected a few that have received the most empirical attention in preclinical and clinical-trial settings. Our review of clinical trials focused on three of the most common psychiatric ailments. For all studies reviewed, we identify the strengths and weaknesses of the data supporting the use of the medications for the three aforementioned disorders.ResultD-cycloserine: accelerates the process of associative emotional learning, enhancing exposure therapy in the treatment of various anxiety disorders, including obsessive-compulsive disorder and posttraumatic stress disorder. Limited studies are available on efficacy in treating SUDs.Intranasal oxytocin: accelerates memory retrieval-extinction procedures used in posttraumatic stress disorder, and promotes prosocial cognition and behaviour, facilitating a therapeutic alliance. Sufficiently powered studies and safety studies are required before strong conclusions can be made.Propranolol: interrupts the reconsolidation of memories (leading to maladaptive learned responses) involved in posttraumatic stress disorder during memory-reactivation therapy sessions, but there is little evidence that this drug can be used for depression or SUDs.Psychedelics: may effect the brain's default mode network, engendering a transformative experience that is often followed by a reduction in psychiatric symptoms. 3,4-methylenedioxymethamphetamine may additionally modulate the amygdala response in a way that allows for reprocessing of traumatic memories, and improves the therapeutic alliance. Anxiety, mood, and SUDs appear to be positively influence by traditional and non-traditional (ketamine) psychedelics.ConclusionAlthough the efficacy of the medically-assisted psychotherapies reviewed is still under investigation, we propose that these novel treatment approaches may be preferred over traditional psychopharmacological treatments due to the presence of fewer chronic side effects, as well less toxicity and abuse potential. Furthermore, these adjunctive pharmacotherapies may help to reinforce the psychotherapeutic alliance and may ultimately yield better long-term treatment outcomes. If at least some of the adjunctive pharmacotherapies outlined in this review are found to be clinically efficacious and safe, patients will benefit from having more treatment options available to them in the future.

Download Full-text

Does deployment-related military sexual assault interact with combat exposure to predict posttraumatic stress disorder in female veterans?

Traumatology An International Journal ◽

10.1037/trm0000165 ◽

2019 ◽

Vol 25 (1) ◽

pp. 66-71

Author(s):

Georgina M. Gross ◽

Katherine C. Cunningham ◽

Daniel A. Moore ◽

Jennifer C. Naylor ◽

Mira Brancu ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Sexual Assault ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Combat Exposure ◽

Female Veterans ◽

Military Sexual Assault

Download Full-text

Psychological Risk Factors for Posttraumatic Stress Disorder in Workers After Toxic Chemical Spill in Gumi, South Korea

Workplace Health & Safety ◽

10.1177/2165079917750168 ◽

2018 ◽

Vol 66 (8) ◽

pp. 393-402 ◽

Cited By ~ 3

Author(s):

Ji Young Song ◽

Kyoung-Sook Jeong ◽

Kyeong-sook Choi ◽

Min-gi Kim ◽

Yeon-Soon Ahn

Keyword(s):

Risk Factors ◽

Posttraumatic Stress Disorder ◽

South Korea ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Psychiatric Symptoms ◽

Industrial Complex ◽

Event Scale ◽

Psychological Risk Factors ◽

Psychological Risk

The extent and severity of the psychological effects following chemical release disasters have not been widely reported. The aim of this study was to examine the prevalence of hydrogen fluoride (HF)–related posttraumatic stress disorder (PTSD) and to identify associated psychological risk factors. On September 2012, an estimated 8 to 12 tons of HF gas, which dissolves in air moisture to form droplets of corrosive hydrofluoric acid, escaped from an industrial complex in Gumi, South Korea. Ten months later, structured questionnaires that included items from the Impacts of Event Scale (revised Korean version) as well as questions about demographic and psychological risk factors related to PTSD were distributed to workers in the affected area. The prevalence rate of PTSD was 5.7%. The odds of PTSD in non-alcohol-dependent workers (odds ratio [OR] = 3.10, 95% confidence interval [CI] = [1.27, 7.60]) was significantly higher than in alcohol-independent workers. The OR for PTSD in workers with anxiety (OR = 7.63, 95% CI = [2.10, 27.71) was significantly higher than the OR workers without anxiety. The odds of PTSD in workers with high perceived stress scale (PSS) scores (OR = 8.72, 95 % CI = [2.29, 33.16]) was significantly higher than for workers with low PSS. Alcohol dependence, psychiatric symptoms at the time of the event, anxiety, and high PSS were associated with HF-related PTSD. Long-term employee assistance programs are needed to assist occupational health nurses and clinicians to reduce PTSD after industrial disasters.

Download Full-text

Typologies of Combat Exposure and Their Effects on Posttraumatic Stress Disorder and Depression Symptoms

Journal of Traumatic Stress ◽

10.1002/jts.22459 ◽

2019 ◽

Vol 32 (6) ◽

pp. 946-956

Author(s):

Marija Spanovic Kelber ◽

Derek J. Smolenski ◽

Don E. Workman ◽

Maria A. Morgan ◽

Abigail L. Garvey Wilson ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Combat Exposure ◽

Depression Symptoms

Download Full-text

Influence of Spirituality on Depression, Posttraumatic Stress Disorder, and Suicidality in Active Duty Military Personnel

Depression Research and Treatment ◽

10.1155/2012/425463 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 21

Author(s):

Laurel L. Hourani ◽

Jason Williams ◽

Valerie Forman-Hoffman ◽

Marian E. Lane ◽

Belinda Weimer ◽

...

Keyword(s):

Mental Health ◽

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Military Personnel ◽

Stress Disorder ◽

Active Duty ◽

Combat Exposure ◽

Self Report ◽

Depression Symptoms ◽

Active Duty Military

Understanding the role of spirituality as a potential coping mechanism for military personnel is important given growing concern about the mental health issues of personnel returning from war. This study seeks to determine the extent to which spirituality is associated with selected mental health problems among active duty military personnel and whether it moderates the relationship between combat exposure/deployment and (a) depression, (b) posttraumatic stress disorder (PTSD), and (c) suicidality in active duty military personnel. Data were drawn from the 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. Over 24,000 randomly selected active duty personnel worldwide completed an anonymous self-report questionnaire. High spirituality had a significant protective effect only for depression symptoms. Medium, as opposed to high or low, levels of spirituality buffered each of the mental health outcomes to some degree. Medium and low spirituality levels predicted depression symptoms but only among those with moderate combat exposure. Medium spirituality levels also predicted PTSD symptoms among those with moderate levels of combat exposure and predicted self-reported suicidal ideation/attempt among those never deployed. These results point to the complex relationship between spirituality and mental health, particularly among military personnel and the need for further research.

Download Full-text