Treating PTSD in Patients With Psychosis: A Within-Group Controlled Feasibility Study Examining the Efficacy and Safety of Evidence-Based PE and EMDR Protocols

The present study uses a within-group controlled design to examine the efficacy and safety of two psychological approaches to posttraumatic stress disorder (PTSD) in 10 patients with a concurrent psychotic disorder. Patients were randomly assigned either to prolonged exposure (PE; N = 5) or eye movement desensitization and reprocessing (EMDR; N = 5). Before, during, and after treatment, a total of 20 weekly assessments of PTSD symptoms, hallucinations, and delusions were carried out. Twelve weekly assessments of adverse events took place during the treatment phase. PTSD diagnosis, level of social functioning, psychosis-prone thinking, and general psychopathology were assessed pretreatment, posttreatment, and at three-month follow-up. Throughout the treatment, adverse events were monitored at each session. An intention-to-treat analysis of the 10 patients starting treatment showed that the PTSD treatment protocols of PE and EMDR significantly reduced PTSD symptom severity; PE and EMDR were equally effective and safe. Eight of the 10 patients completed the full intervention period. Seven of the 10 patients (70%) no longer met the diagnostic criteria for PTSD at follow-up. No serious adverse events occurred, nor did patients show any worsening of hallucinations, delusions, psychosis proneness, general psychopathology, or social functioning. The results of this feasibility trial suggest that PTSD patients with comorbid psychotic disorders benefit from trauma-focused treatment approaches such as PE and EMDR.     

A Behavioral Health Screening Measure for Use with Young Adults in Primary Care Settings

Many healthcare professionals argue that mental health assessment should be routinely incorporated into young adults' medical health care. This project is an evaluation of the Behavioral Health Screening Measure (BHSM) that could be integrated into a primary healthcare setting to aid in the identification of mental illness in young adults. First, Receiver Operating Characteristics analysis was used to calculate a cutoff score that distinguishes a sample of 134 young adult outpatients and 233 young adult nonpatients. Second, a sample of 120 young adults that completed BHSM was divided into two groups by using the cutoff score. Analyses suggested that the two groups had significantly different scores on various measures of depression, anxiety, and general well-being. Results suggest that BHSM would be a valid screening instrument for detecting emotional problems in young adults.     

Latent Profiles of Comorbid Depression as Predictors of PTSD Treatment Outcome

Posttraumatic stress disorder (PTSD) frequently co-occurs with major depressive disorder, and empirically supported PTSD treatments consistently improve depression. However, both diagnoses are heterogeneous and specific patterns of symptom overlap may be related to worse treatment outcome. Two hundred individuals with chronic PTSD participated in a doubly randomized preference trial comparing prolonged exposure and sertraline. Latent Profile Analysis was used to identify classes based on PTSD and depression symptoms prior to starting treatment. A three-class model best fit the data, with a high depression and PTSD severity class (distressed), a moderate depression and low PTSD avoidance class (depressive), and a low depression and high PTSD avoidance class (avoidant). The avoidant class showed the lowest rates of major depressive disorder diagnosis and transdiagnostic vulnerabilities to depression. Patients in the distressed class experienced more robust PTSD treatment response, with no differences between prolonged exposure and sertraline. These findings highlight the role of avoidance in nondepressed PTSD presentations while also demonstrating that co-occurring depression is not contraindicated in evidence-based PTSD treatment.     

Using Prolonged Exposure and Cognitive Processing Therapy to Treat Veterans With Moral Injury-Based PTSD: Two Case Examples

Moral injury refers to acts of commission or omission that violate individuals’ moral or ethical standards. Morally injurious events are often synonymous with psychological trauma, especially in combat situations—thus, morally injurious events are often implicated in the development of posttraumatic stress disorder (PTSD) for military service members and veterans. Although prolonged exposure (PE) and cognitive processing therapy (CPT) have been well established as effective treatments for veterans who are struggling with PTSD, it has been suggested that these two evidence-based therapies may not be sufficient for treating veterans whose PTSD resulted from morally injurious events. The purpose of this paper is to detail how the underlying theories of PE and CPT can account for moral injury-based PTSD and to describe two case examples of veterans with PTSD stemming from morally injurious events who were successfully treated with PE and CPT. The paper concludes with a summary of challenges that clinicians may face when treating veterans with PTSD resulting from moral injury using either PE or CPT.     

不同语境下的初级卫生保健

初级卫生保健一词在国内文献中涵义不同,研究发现《阿拉木图宣言》中的初级卫生保健更多的具有卫生体系变革的涵义,强调公平性、多部门合作、社区参与、适宜技术和适宜人力的原则;选择性初级卫生保健则以推广具有成本效益的卫生干预措施为重点;国内政策语境下的初级卫生保健则更多的是具体的卫生服务内容。     

Cortisol Response Following Exposure Treatment for PTSD in Rape Victims

This study examined changes in salivary cortisol levels pre- to posttreatment in adult female rape victims diagnosed with posttraumatic stress disorder (PTSD) randomly assigned to be treated with either prolonged exposure therapy or eye movement desensitization and reprocessing. Salivary cortisol was collected at baseline, Session 3, and Session 9. A significant decrease in salivary cortisol levels was observed in individuals classified as treatment responders in both treatment conditions. Findings suggest that successful exposure-based treatments for PTSD that result in trauma-related and depressive symptom reduction may impact the action of the hypothalamic–pituitary–adrenal axis as measured by changes in level of salivary cortisol from pre- to posttreatment.     

The BAI–PC as a Screen for Anxiety, Depression, and PTSD in Primary Care

Despite the prevalence of psychiatric disorders in medical settings, mental health problems often go undetected and patients do not receive appropriate treatment. The main goal of this study is to provide additional information about the Beck Anxiety Inventory – Primary Care (BAI–PC), a brief instrument that screens for patients with anxiety. This study provides information on the performance of the BAI–PC as a screening instrument for depression and PTSD in addition to its original purpose as a screening instrument for anxiety. This efficient tool can identify patients who can benefit from effective psychological treatments and facilitate referrals to psychologists working in medical settings.