This document provides a summary of recent research on PTSD and related topics. It lists over 30 research articles and reports published in January 2016 covering a wide range of topics including PTSD treatment outcomes, the effects of combat deployment on mental health providers, the impact of stress and social support on military children, the diagnostic criteria of PTSD, masculinity and community reintegration in veterans with traumatic brain injury, and relationships between mental health issues like depression, substance abuse and suicide in military populations.
1) Preliminary results from the Norwegian TF-CBT study show that TF-CBT was more effective than TAU in reducing children's PTSD, depression, and anxiety symptoms.
2) Parental emotional reactions and post-trauma cognitions may mediate treatment outcomes. Parents in both groups reported less distress and depression over time, and changes in parental distress were related to child outcomes. Changes in children's post-trauma cognitions also predicted symptom reduction.
3) A stronger therapeutic alliance was associated with better outcomes for children receiving TF-CBT but not TAU, suggesting alliance may be an active ingredient in TF-CBT specifically.
LRI05 - Self Help for Distress in Cancer - Is It Time For An RCT [Oct 2005]Alex J Mitchell
This is an academic presentation from 2005 outlining the case for a randomized controlled trial of a self-help programme to help people deal with distress and depression following the diagnosis of cancer
Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment for complex trauma that involves multiple phases. It begins with establishing safety and stabilization, followed by trauma-focused elements and gradual exposure to trauma memories. The final phase involves rehabilitation. Research shows multi-phasic, multi-modal treatment is most effective for complex trauma involving multiple or chronic traumatic events, especially those involving childhood trauma. TF-CBT incorporates elements from other therapies while retaining a cognitive behavioral structure and focusing on meeting client needs.
This study examined the relationship between emotional intelligence (EI) and well-being in 73 surgical residents. The study found that EI scores positively correlated with psychological well-being and negatively correlated with burnout and depression. Regression analyses controlling for demographics found that EI strongly predicted well-being, emotional exhaustion, depersonalization, and depression among residents. The study concluded that EI is a strong predictor of resident well-being, and measuring EI could help identify residents most likely to thrive while interventions to increase EI may optimize resident wellness.
Motivational Enhancement Therapy in Addition to Physical
Therapy Improves Motivational Factors and Treatment
Outcomes in People With Low Back Pain: A Randomized
Controlled Trial
Brief interventions and motivational enhancement therapy for alcohol problemskavroom
Brief interventions involve short counseling sessions that provide feedback, advice, and support to motivate individuals to reduce risky drinking behaviors. MET is a client-centered counseling style based on motivational interviewing that aims to resolve ambivalence and increase intrinsic motivation for change. Both approaches are time-limited and focus on negotiating drinking reduction rather than requiring abstinence. Screening tools are used to identify hazardous drinkers who could benefit, with brief structured advice or extended brief counseling sessions depending on severity. Motivational strategies like FRAMES are employed to enhance engagement in the process of behavior change.
1) Preliminary results from the Norwegian TF-CBT study show that TF-CBT was more effective than TAU in reducing children's PTSD, depression, and anxiety symptoms.
2) Parental emotional reactions and post-trauma cognitions may mediate treatment outcomes. Parents in both groups reported less distress and depression over time, and changes in parental distress were related to child outcomes. Changes in children's post-trauma cognitions also predicted symptom reduction.
3) A stronger therapeutic alliance was associated with better outcomes for children receiving TF-CBT but not TAU, suggesting alliance may be an active ingredient in TF-CBT specifically.
LRI05 - Self Help for Distress in Cancer - Is It Time For An RCT [Oct 2005]Alex J Mitchell
This is an academic presentation from 2005 outlining the case for a randomized controlled trial of a self-help programme to help people deal with distress and depression following the diagnosis of cancer
Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment for complex trauma that involves multiple phases. It begins with establishing safety and stabilization, followed by trauma-focused elements and gradual exposure to trauma memories. The final phase involves rehabilitation. Research shows multi-phasic, multi-modal treatment is most effective for complex trauma involving multiple or chronic traumatic events, especially those involving childhood trauma. TF-CBT incorporates elements from other therapies while retaining a cognitive behavioral structure and focusing on meeting client needs.
This study examined the relationship between emotional intelligence (EI) and well-being in 73 surgical residents. The study found that EI scores positively correlated with psychological well-being and negatively correlated with burnout and depression. Regression analyses controlling for demographics found that EI strongly predicted well-being, emotional exhaustion, depersonalization, and depression among residents. The study concluded that EI is a strong predictor of resident well-being, and measuring EI could help identify residents most likely to thrive while interventions to increase EI may optimize resident wellness.
Motivational Enhancement Therapy in Addition to Physical
Therapy Improves Motivational Factors and Treatment
Outcomes in People With Low Back Pain: A Randomized
Controlled Trial
Brief interventions and motivational enhancement therapy for alcohol problemskavroom
Brief interventions involve short counseling sessions that provide feedback, advice, and support to motivate individuals to reduce risky drinking behaviors. MET is a client-centered counseling style based on motivational interviewing that aims to resolve ambivalence and increase intrinsic motivation for change. Both approaches are time-limited and focus on negotiating drinking reduction rather than requiring abstinence. Screening tools are used to identify hazardous drinkers who could benefit, with brief structured advice or extended brief counseling sessions depending on severity. Motivational strategies like FRAMES are employed to enhance engagement in the process of behavior change.
This document summarizes Peter Fonagy's presentation on psychotherapy for emerging borderline personality disorder. It discusses what is known about treating BPD in adolescence, including evidence for DBT, MBT, ERT, HYPE, and pharmacotherapy. It also summarizes results from RCTs comparing MBT to treatment as usual, finding that MBT was more effective in reducing self-harm, depression, BPD traits, and improving mentalization and attachment. The document considers whether BPD can be validly diagnosed in adolescence and reviews prevalence studies showing similar rates to adults.
The document provides an overview of adjustment disorders by summarizing several research studies and publications on the topic. Key points include that adjustment disorders involve the development of emotional or behavioral symptoms in response to an identifiable stressor or life event, and studies have examined the efficacy of various drug and herbal treatments for adjustment disorders with anxious or depressive symptoms.
A cancer diagnosis and cancer treatment can be traumatic. An experience with cancer can lead to serious psychological distress that should be addressed. In this webinar, Schuyler Cunningham, Clinical Social Worker, talks about what trauma is, how to identify it, and what steps to take next.
- Management of depression involves comprehensive assessment including detailed history, physical exam, mental status exam, and establishing a diagnosis based on diagnostic criteria.
- The assessment identifies the patient's symptoms, severity, comorbidities, risk factors, level of functioning, treatment history, and socio-cultural context.
- A treatment plan is formulated considering treatment setting, medications, psychotherapy, and safety monitoring based on the assessment.
Role of atypical antipsychotics in the treatement of generalized anxiety diso...Paul Coelho, MD
This review article examines the evidence for using atypical antipsychotics as adjunctive therapy or monotherapy to treat generalized anxiety disorder (GAD). The most evidence has been collected for quetiapine, which approximately 50% of participants tolerated, most commonly experiencing sedation and fatigue. Among those who continued treatment, significant reductions in anxiety were demonstrated when used as adjunctive therapy or monotherapy. While atypical antipsychotics show promise based on evidence from other disorders, their use for GAD remains off-label and careful consideration of risks and benefits is needed, especially regarding long-term use.
The Carlat Psychiatry Report (Interview with Scott Miller, April 2015)Scott Miller
The April 2015 issue of the Carlat Psychiatry Report, an unbiased report/review of "all things psychiatric." The issue contains a lengthy interview with Dr. Scott Miller on the subject of top performing clinicians.
Hani hamed dessoki, side effects of psychotherapyHani Hamed
This document discusses potential negative effects of psychotherapy. It begins by defining psychotherapy and noting its history. While psychotherapy is generally effective, it can sometimes cause harm, such as worsening of symptoms, new symptoms, or regression. Factors like techniques used, client variables, and therapist quality can all potentially contribute to negative outcomes. The document examines specific issues like suicide risk, dependence, and false memories. It emphasizes the importance of informed consent and managing risks of psychotherapy. Overall, the document provides an overview of possible harms of psychotherapy alongside its benefits.
This document summarizes changes to diagnoses of somatic disorders in the DSM-5 and provides guidance on assessing and treating patients with somatic symptoms. It discusses how the DSM-5 consolidated somatoform disorders into the new category of somatic symptom and related disorders. Specifically, it replaced somatization disorder, undifferentiated somatoform disorder, and pain disorder with the new diagnosis of somatic symptom disorder. It also analyzes challenges with applying the new DSM-5 criteria in clinical practice based on a case example of a patient named Andrew experiencing chronic pain.
Cognitive behaviour therapy aims to address addiction through four key areas: (1) Motivation and engagement, (2) Managing impulses and craving, (3) Mood management, and (4) Mindful recovery. CBT seeks to motivate change, teach skills to manage impulses to use substances, help manage negative emotions, and support mindful recovery approaches. Recent research also indicates cognitive control is impaired in addiction and CBT may need to directly target and rehabilitate neurocognitive functions to effectively treat addiction.
Edna b. foa barbara olasov rothbaum elizabeth a. hembree - prolonged exposu...ericaduran
This document provides an introduction to prolonged exposure therapy for treating PTSD. It describes the treatment's basis in emotional processing theory and exposure techniques. Prolonged exposure therapy uses psychoeducation, breathing retraining, in vivo exposure to trauma reminders, and imaginal exposure to the traumatic memory. The document reviews diagnostic criteria for PTSD and provides background on the prevalence and development of this evidence-based treatment program.
Overview of international challenges faced by psychiatrists through their practice
Collaborative work of:
1-Dr Yomna Gaber Senior Registrar Psychiatrist
2- Dr Hosam Kasseb Senior Registrar Psychiatrist
3-Dr Wasem Marey Consultant Psychiatrist
Efficacy Of Meditation In The Management Of Anxietydburr
This document summarizes a research study on the efficacy of meditation for treating anxiety disorders. The study reviewed 11 research studies on meditation and anxiety. It found that mindfulness meditation was effective for preventing acute anxiety attacks and maintaining long-term management of anxiety. Meditation improved quality of life by reducing symptoms, improving relationships, and decreasing reliance on healthcare services. Regular meditation practice facilitated anxiety reduction and improved psychological outcomes.
This document provides an intervention plan for a 12-year-old African American girl ("P") who was placed in foster care due to neglect and sexual abuse. The plan recommends Trauma-Focused CBT to address P's severe psychological impairments, delusions, and lack of social support. The intervention would focus first on developing trust and coping skills before directly addressing traumatic experiences. It outlines 12 weekly sessions covering psychoeducation, relaxation techniques, cognitive restructuring, and creating a trauma narrative. Considerations are discussed around modifying the plan for P's cultural background and slowly exposing her to trauma processing.
a. Understand the prevalence and nature of pain concerns in returning combat veterans.
b. Understand that pain issues are part of a complex group of co-occurring and inter-related issues.
c. Describe a collaborative, bio-psycho-social approach to address pain issues.
d. Understand the stepped-care, collaborative approach in VA.
e. Understand how to implement collaborative pain care on PACT teams - a nuts and bolts approach
This two-part class will begin by highlighting collaborative pain care in Primary Care using real-life scenarios that address the complex issues and needs of returning Veterans and then move on to address how to apply a nuts-and-bolts approach within a Patient Aligned Care Team in the VA.
Psychological Assessment For Implantable Therapies Dr Peter Murphyepicyclops
Psychological assessment is recommended for patients undergoing spinal cord stimulation (SCS) therapy based on evidence that it leads to better outcomes. A brief psychological evaluation can identify potential mental health issues like depression or anxiety that are common in chronic pain patients and associated with poorer prognoses. It also aims to ensure patients have realistic expectations of SCS and a plan for managing their pain should the treatment not achieve the desired level of relief. While certain personality traits alone may not predict outcomes, evaluations can help optimize patient selection and preparation for SCS.
Filmed in Germany and Austria, The Age of Fear: Psychiatry's Reign of Terror, draws from over 80 interviews of psychiatric experts, historians and survivors.
Organizational Contex and Patient Safety: Is there a Role for Mindfulness?Heather Gilmartin
Presentation to review and define the concept of organizational context, present research on context and the relationship to healthcare associated infections, review the practice of mindfulness, discuss a role of mindfulness in patient safety.
This study surveyed behavioral health clinicians with experience using stellate ganglion block (SGB) as an adjunct treatment for trauma-related disorders like PTSD. Of the 23 respondents, 95% would recommend SGB to colleagues. Respondents rated SGB as at least as useful as the highest rated standard PTSD interventions. SGB was seen as most helpful for reducing arousal/reactivity symptoms. The majority would refer patients for SGB at any stage of therapy, including before starting other treatments.
The document discusses challenges faced by US veterans, including physical disabilities and mental health issues like post-traumatic stress disorder (PTSD). It reviews research on effective PTSD therapies like mindfulness-based stress reduction, exposure therapy, and an integrated approach combining behavioral activation and exposure techniques. However, it notes high unemployment among veterans and few programs addressing both therapy and vocational needs. The proposed program integrates group therapy based on the Veterans Transition Program model with a vocational component to help veterans transition to civilian life by addressing PTSD symptoms and employment. It outlines program details, limitations, and potential funding sources.
This document summarizes Peter Fonagy's presentation on psychotherapy for emerging borderline personality disorder. It discusses what is known about treating BPD in adolescence, including evidence for DBT, MBT, ERT, HYPE, and pharmacotherapy. It also summarizes results from RCTs comparing MBT to treatment as usual, finding that MBT was more effective in reducing self-harm, depression, BPD traits, and improving mentalization and attachment. The document considers whether BPD can be validly diagnosed in adolescence and reviews prevalence studies showing similar rates to adults.
The document provides an overview of adjustment disorders by summarizing several research studies and publications on the topic. Key points include that adjustment disorders involve the development of emotional or behavioral symptoms in response to an identifiable stressor or life event, and studies have examined the efficacy of various drug and herbal treatments for adjustment disorders with anxious or depressive symptoms.
A cancer diagnosis and cancer treatment can be traumatic. An experience with cancer can lead to serious psychological distress that should be addressed. In this webinar, Schuyler Cunningham, Clinical Social Worker, talks about what trauma is, how to identify it, and what steps to take next.
- Management of depression involves comprehensive assessment including detailed history, physical exam, mental status exam, and establishing a diagnosis based on diagnostic criteria.
- The assessment identifies the patient's symptoms, severity, comorbidities, risk factors, level of functioning, treatment history, and socio-cultural context.
- A treatment plan is formulated considering treatment setting, medications, psychotherapy, and safety monitoring based on the assessment.
Role of atypical antipsychotics in the treatement of generalized anxiety diso...Paul Coelho, MD
This review article examines the evidence for using atypical antipsychotics as adjunctive therapy or monotherapy to treat generalized anxiety disorder (GAD). The most evidence has been collected for quetiapine, which approximately 50% of participants tolerated, most commonly experiencing sedation and fatigue. Among those who continued treatment, significant reductions in anxiety were demonstrated when used as adjunctive therapy or monotherapy. While atypical antipsychotics show promise based on evidence from other disorders, their use for GAD remains off-label and careful consideration of risks and benefits is needed, especially regarding long-term use.
The Carlat Psychiatry Report (Interview with Scott Miller, April 2015)Scott Miller
The April 2015 issue of the Carlat Psychiatry Report, an unbiased report/review of "all things psychiatric." The issue contains a lengthy interview with Dr. Scott Miller on the subject of top performing clinicians.
Hani hamed dessoki, side effects of psychotherapyHani Hamed
This document discusses potential negative effects of psychotherapy. It begins by defining psychotherapy and noting its history. While psychotherapy is generally effective, it can sometimes cause harm, such as worsening of symptoms, new symptoms, or regression. Factors like techniques used, client variables, and therapist quality can all potentially contribute to negative outcomes. The document examines specific issues like suicide risk, dependence, and false memories. It emphasizes the importance of informed consent and managing risks of psychotherapy. Overall, the document provides an overview of possible harms of psychotherapy alongside its benefits.
This document summarizes changes to diagnoses of somatic disorders in the DSM-5 and provides guidance on assessing and treating patients with somatic symptoms. It discusses how the DSM-5 consolidated somatoform disorders into the new category of somatic symptom and related disorders. Specifically, it replaced somatization disorder, undifferentiated somatoform disorder, and pain disorder with the new diagnosis of somatic symptom disorder. It also analyzes challenges with applying the new DSM-5 criteria in clinical practice based on a case example of a patient named Andrew experiencing chronic pain.
Cognitive behaviour therapy aims to address addiction through four key areas: (1) Motivation and engagement, (2) Managing impulses and craving, (3) Mood management, and (4) Mindful recovery. CBT seeks to motivate change, teach skills to manage impulses to use substances, help manage negative emotions, and support mindful recovery approaches. Recent research also indicates cognitive control is impaired in addiction and CBT may need to directly target and rehabilitate neurocognitive functions to effectively treat addiction.
Edna b. foa barbara olasov rothbaum elizabeth a. hembree - prolonged exposu...ericaduran
This document provides an introduction to prolonged exposure therapy for treating PTSD. It describes the treatment's basis in emotional processing theory and exposure techniques. Prolonged exposure therapy uses psychoeducation, breathing retraining, in vivo exposure to trauma reminders, and imaginal exposure to the traumatic memory. The document reviews diagnostic criteria for PTSD and provides background on the prevalence and development of this evidence-based treatment program.
Overview of international challenges faced by psychiatrists through their practice
Collaborative work of:
1-Dr Yomna Gaber Senior Registrar Psychiatrist
2- Dr Hosam Kasseb Senior Registrar Psychiatrist
3-Dr Wasem Marey Consultant Psychiatrist
Efficacy Of Meditation In The Management Of Anxietydburr
This document summarizes a research study on the efficacy of meditation for treating anxiety disorders. The study reviewed 11 research studies on meditation and anxiety. It found that mindfulness meditation was effective for preventing acute anxiety attacks and maintaining long-term management of anxiety. Meditation improved quality of life by reducing symptoms, improving relationships, and decreasing reliance on healthcare services. Regular meditation practice facilitated anxiety reduction and improved psychological outcomes.
This document provides an intervention plan for a 12-year-old African American girl ("P") who was placed in foster care due to neglect and sexual abuse. The plan recommends Trauma-Focused CBT to address P's severe psychological impairments, delusions, and lack of social support. The intervention would focus first on developing trust and coping skills before directly addressing traumatic experiences. It outlines 12 weekly sessions covering psychoeducation, relaxation techniques, cognitive restructuring, and creating a trauma narrative. Considerations are discussed around modifying the plan for P's cultural background and slowly exposing her to trauma processing.
a. Understand the prevalence and nature of pain concerns in returning combat veterans.
b. Understand that pain issues are part of a complex group of co-occurring and inter-related issues.
c. Describe a collaborative, bio-psycho-social approach to address pain issues.
d. Understand the stepped-care, collaborative approach in VA.
e. Understand how to implement collaborative pain care on PACT teams - a nuts and bolts approach
This two-part class will begin by highlighting collaborative pain care in Primary Care using real-life scenarios that address the complex issues and needs of returning Veterans and then move on to address how to apply a nuts-and-bolts approach within a Patient Aligned Care Team in the VA.
Psychological Assessment For Implantable Therapies Dr Peter Murphyepicyclops
Psychological assessment is recommended for patients undergoing spinal cord stimulation (SCS) therapy based on evidence that it leads to better outcomes. A brief psychological evaluation can identify potential mental health issues like depression or anxiety that are common in chronic pain patients and associated with poorer prognoses. It also aims to ensure patients have realistic expectations of SCS and a plan for managing their pain should the treatment not achieve the desired level of relief. While certain personality traits alone may not predict outcomes, evaluations can help optimize patient selection and preparation for SCS.
Filmed in Germany and Austria, The Age of Fear: Psychiatry's Reign of Terror, draws from over 80 interviews of psychiatric experts, historians and survivors.
Organizational Contex and Patient Safety: Is there a Role for Mindfulness?Heather Gilmartin
Presentation to review and define the concept of organizational context, present research on context and the relationship to healthcare associated infections, review the practice of mindfulness, discuss a role of mindfulness in patient safety.
This study surveyed behavioral health clinicians with experience using stellate ganglion block (SGB) as an adjunct treatment for trauma-related disorders like PTSD. Of the 23 respondents, 95% would recommend SGB to colleagues. Respondents rated SGB as at least as useful as the highest rated standard PTSD interventions. SGB was seen as most helpful for reducing arousal/reactivity symptoms. The majority would refer patients for SGB at any stage of therapy, including before starting other treatments.
The document discusses challenges faced by US veterans, including physical disabilities and mental health issues like post-traumatic stress disorder (PTSD). It reviews research on effective PTSD therapies like mindfulness-based stress reduction, exposure therapy, and an integrated approach combining behavioral activation and exposure techniques. However, it notes high unemployment among veterans and few programs addressing both therapy and vocational needs. The proposed program integrates group therapy based on the Veterans Transition Program model with a vocational component to help veterans transition to civilian life by addressing PTSD symptoms and employment. It outlines program details, limitations, and potential funding sources.
Running head PSYCHOLOGY1PSYCHOLOGY5Empirical res.docxSUBHI7
Running head: PSYCHOLOGY
1
PSYCHOLOGY
5
Empirical research on the prevalence of PTSD on servicemen and veterans from combat
Developments in combat zone medicine infer more aggrieved servicemen and veterans are surviving their injuries; though, numerous injuries are not as noticeable such as missing appendages and other bodily wounds, explicitly distressing cognitive damages and post-traumatic stress writhed by both soldiers and citizens in the way of relatives and friends. The frequency of these injuries can be, and still are, not clear-cut. Moreover, the categorizations of these injuries have transformed over the course of time, touching on the way in which the sum of the aggrieved is tallied over and above the interventions presented (Angkaw et.al, 2015). An editorial in The Economist on March 2013 centered on the upsurge in the figure of war veterans pursuing medical assistance as a result of post-traumatic stress symptoms. The rise was realized amongst the newly repatriated officers, albeit similarly among elderly veterans of prior wars, and had resulted to a surge in America`s disabled former soldiers count by nearly 45% from the year 2000. A lot of empirical research reinforces the assertion made in the Economist piece, and investigation correspondingly demonstrates the long-term overheads will be a reality for many nations involved in the cross-border wars (Beckham et.al, 2014). Internationally, a rise in number of war veterans looking for assistance for psychological signs that are every so often well-matched with PTSD disorder explicate that the number of troupers affected with PTSD in the year 2013 will grow to over 300,000 persons in the United States. A similar predisposition is noticed in other nation state, and a recent research from Europe (particularly United Kingdom) pronounces late onset indications among servicemen. Our test hypothesis will appraise the prevalence and frequency of PTSD in servicemen and veteran from the warzone. From the prevalence then apt interventions can be devised to help assist all those who served and are affected with disorder.
How is PTSD perceived in a health perspective?
PTSD is a mental disorder, which is described and defined in the ensuing two classifications; the International Classification of Diseases (ICD-10) established by the World Health Organization (WHO), together with the Diagnostic and Statistical Manual of Mental Disorders (DMMD) instigated by the American Psychiatric Association (DSM-5). The analytical measures in the two classifications are articulated somewhat differently, but overall they are seen as alike. The analytical criteria consist of the following: experiencing a traumatic situation or event, short or long lasting, in which the person is exposed to fears of loss of life, grim harm or sexual abuse. The exposure is a due to circumstances with unswervingly involves the distressing event or observes the traumatic happening personally (Angkaw et.al, 2015). The social-b ...
Please I need a response to this case study.1 pagezero plagi.docxcherry686017
Please I need a response to this case study.
1 page
zero plagiarism
three references
The Case:
The sleepy woman with anxiety
This week’s discussion presents a case study involving a 44-year old woman with a chief complaint of anxiety beginning at age 15 years old. She has a long history of mental illness and continued therapies. The purpose of this discussion is to analyze her case history to determine medication and treatment effectiveness.
Client Questions
Question 1. Are you having feelings of harming yourself or harming someone else?
Rationale: This is a possibly uncomfortable yet important set of questions to ask each client. Primary care providers may be in a unique position to prevent suicide due to their frequent interactions with suicidal patients. Reviews suggest that among patients who committed suicide, 80 percent had contact with primary care clinicians within one year of their death, whereas only 25 to 30 percent of decedents had contact with psychiatric clinicians within the year of their death (Stene-Lars & Reneflot, 2017).
Question 2. What was happening in your life as a teenager when the anxiety started and you began to self-medicate?
Rationale: Per our report, this patient began suffering signs and symptoms of anxiety at 15-years old. Asking these types of questions we may gain insight into an underlying cause or triggering event. Anxiety disorders are the most common psychiatric disorders with onset in childhood, with prevalence estimates ranging from 10 to 30 percent. Nearly 37 percent of behaviorally inhibited preschool-age children had social anxiety disorder at age 15, compared with 15 percent of non- behaviorally inhibited children
.
Children with anxiety disorders are more likely to have persistent anxiety disorders into adulthood. (Rapee, 2014).
Question 3. What was happening in your life a year ago when these symptoms returned and became debilitating? Let’s discuss what the triggering events may have been.
Rationale: Self-discovery of triggering events may help the client to come to terms with the determinants of her anxiety and depression. Studies have shown that specific types of stressors were found to differentially predict increases in specific facets of anxiety sensitivity; health-related stressors predicted increases in disease-related concerns and fear of mental incapacitation, whereas stressors related to family discord predicted increases in fear of feeling unsteady, fear of mental incapacitation, and fear of having publicly observable symptoms of anxiety (McLaughlin & Hatzenbuehler, 2009).
Support System
The support system as reported by our client is her husband. She states he is supportive and has little to no contact with the family of origin. She has a few friends and a few outside interests. As PMHNP, discussing relationships with the client is one avenue to gain insight into anxiety patterns and coping mechanisms as seen by outside support. With the client’s permissio.
Neuropsychological assessment
Kevin Atkinson, Bella Baron, Shonda Green, Bonita Hill, Ruby Lee, Brian McCullough, & Jessica Williams
Psych/655
March 30, 2020
Professor Dina Francisco
Introduction
Bonita
The purpose of this presentation we will discuss the purpose and magnitude of this instrument for those that suffer with PTSD. Also, express strongly about the use and legal consideration for this instrument. Finally, we want to explain ethical use of this instrument. Should there be any concerns after this presentation our team will be glad to assist with any questions.
The purpose of this presentation to give the audience more detail information regarding clinician Administered on the PTSD Scale. The PTSD scale was established in 1989 for the U.S. Department of Veteran Affairs National Center for PTSD. The definition and analytic criteria of PTSD, that CAPS has been modified to the DSM-5 criteria,4 and has proved excellent psychometric properties when linked to its previous form. In other words, scholars have been improving a great deal of knowledge regarding individual who suffers from PTSD. Research found that post-traumatic stress disorder (PTSD) have been challenging in academic and clinical study. PTSD play a major part that relate to individual that suffer with this illness for example, death, traumatic event, witness a death, and sexual event. Ehlersand Clark’s cognitive model of PTSD 3,4 advanced the negative interpretations of the traumatic memory outcomes in heightened level of stress. In other words when a person rumination about certain tragedies their level of stress becoming more stressful.
2
Clinician-Administered PTSD scale
for dsm-5 (caps-5)
(kevin)
Clinician-Administered PTSD scale
for dsm-5 (caps-5)
(kevin)
Purpose of the caps-5 (bella)
Trauma
PTSD
CAPS-5
U.S. Department of Veteran Affairs
https://www.google.com/imgres?imgurl=https%3A%2F%2Fwww.va.gov%2Fimg%2Fdesign%2Flogo%2Fva-og-twitter-image.png&imgrefurl=https%3A%2F%2Fwww.va.gov%2F&tbnid=LAWc9vWdLRtpdM&vet=12ahUKEwj-iNrl8rvoAhWGVjABHSpuD3gQMygCegUIARD7AQ..i&docid=qqLiDhLo7LS38M&w=1200&h=1200&q=us%20department%20of%20veterans%20affairs&client=safari&ved=2ahUKEwj-iNrl8rvoAhWGVjABHSpuD3gQMygCegUIARD7AQ
Trauma, in psychology, refers to a a wide range of intensifying stressful situations where an individual is exposed to increased levels of danger and fear where the intensity of the fear exceeds a normal capacity to cope (Fairbank, Ebert, & Caddel, 2004). These stressful situations are so intense that they cause increased symptoms of distress, because these experiences are outside of the range of normal human experience (Fairbank, Ebert & Caddel, 2004). Some examples of these uncommon, yet catastrophic events include, but is not limited to, war, sexual assault/rape, natural disasters, and torture. Evidence based practice requires careful assessment. While an initial assessment assist with treatment options, periodic assessments throughout care ca ...
Neuropsychological assessment
Kevin Atkinson, Bella Baron, Shonda Green, Bonita Hill, Ruby Lee, Brian McCullough, & Jessica Williams
Psych/655
March 30, 2020
Professor Dina Francisco
Introduction
Bonita
The purpose of this presentation we will discuss the purpose and magnitude of this instrument for those that suffer with PTSD. Also, express strongly about the use and legal consideration for this instrument. Finally, we want to explain ethical use of this instrument. Should there be any concerns after this presentation our team will be glad to assist with any questions.
The purpose of this presentation to give the audience more detail information regarding clinician Administered on the PTSD Scale. The PTSD scale was established in 1989 for the U.S. Department of Veteran Affairs National Center for PTSD. The definition and analytic criteria of PTSD, that CAPS has been modified to the DSM-5 criteria,4 and has proved excellent psychometric properties when linked to its previous form. In other words, scholars have been improving a great deal of knowledge regarding individual who suffers from PTSD. Research found that post-traumatic stress disorder (PTSD) have been challenging in academic and clinical study. PTSD play a major part that relate to individual that suffer with this illness for example, death, traumatic event, witness a death, and sexual event. Ehlersand Clark’s cognitive model of PTSD 3,4 advanced the negative interpretations of the traumatic memory outcomes in heightened level of stress. In other words when a person rumination about certain tragedies their level of stress becoming more stressful.
2
Clinician-Administered PTSD scale
for dsm-5 (caps-5)
(kevin)
Clinician-Administered PTSD scale
for dsm-5 (caps-5)
(kevin)
Purpose of the caps-5 (bella)
Trauma
PTSD
CAPS-5
U.S. Department of Veteran Affairs
https://www.google.com/imgres?imgurl=https%3A%2F%2Fwww.va.gov%2Fimg%2Fdesign%2Flogo%2Fva-og-twitter-image.png&imgrefurl=https%3A%2F%2Fwww.va.gov%2F&tbnid=LAWc9vWdLRtpdM&vet=12ahUKEwj-iNrl8rvoAhWGVjABHSpuD3gQMygCegUIARD7AQ..i&docid=qqLiDhLo7LS38M&w=1200&h=1200&q=us%20department%20of%20veterans%20affairs&client=safari&ved=2ahUKEwj-iNrl8rvoAhWGVjABHSpuD3gQMygCegUIARD7AQ
Trauma, in psychology, refers to a a wide range of intensifying stressful situations where an individual is exposed to increased levels of danger and fear where the intensity of the fear exceeds a normal capacity to cope (Fairbank, Ebert, & Caddel, 2004). These stressful situations are so intense that they cause increased symptoms of distress, because these experiences are outside of the range of normal human experience (Fairbank, Ebert & Caddel, 2004). Some examples of these uncommon, yet catastrophic events include, but is not limited to, war, sexual assault/rape, natural disasters, and torture. Evidence based practice requires careful assessment. While an initial assessment assist with treatment options, periodic assessments throughout care ca.
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxjenkinsmandie
The document discusses research on PTSD causes, treatments, and support systems for veterans. It summarizes five research studies that evaluate PTSD among veterans. The studies examine predictors of symptom change during intensive outpatient treatment, the feasibility of computerized executive function training, nature-based therapy as an alternative treatment, screening and treatment of moral injury, and the relationship between PTSD, depression, and health behaviors. The document concludes that understanding PTSD symptoms and integrating both medical and conventional interventions can improve treatment effectiveness for veterans. Evaluating different treatment approaches is important to ensure consistency in care and program modifications.
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxrtodd599
Running head: VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 1
VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 3
Veterans PTSD Causes, Treatments, and Support systems
Yoan Collado
Carlos Albizu University
Veterans PTSD Causes, Treatments, and Support systems
Evaluations on Post Traumatic Stress Disorder (PTSD) among veterans is imperative for a positive health outcome. The evaluations and analysis of the results ensure that barriers to treatment are addressed and have access to the available support systems. Studies carried out have depicted the successes of the treatments and support programs in the health systems to veterans. Modifications on the systems have also been recommended to combat and control PTSD. Alternative approaches such as computerized systems, natural treatment methods, and home-based systems are also essential in providing a holistic approach in PTSD treatments. Treatment methods success ensures that veterans do not fall victim to depression, which can result in chronic diseases. This can be as a result of negative health behaviors and lifestyles. Understanding the consequences of PTSD among veterans will ensure that approaches utilized offer not only treatment methods but also offer support systems for general wellbeing.
The first source focuses on the treatment and success of three-week outpatient program by “evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD.” The study is evidence-based on statistics drawn from the program and modifications for optimal success rates. 191 veterans were the participants in the research comprising of a daily group and individual Cognitive Processing Therapy (Zalta et al., 2018). The data was analyzed from the sample cohorts in accordance with military and demographic characteristics. Measures in the study involved treatment engagement as well as comparison of pre-treatment and post-treatment changes (Zalta et al., 2018). The results showed progress in the evaluation of predictors and patterns in treatment changes. Procedures utilized involved group sessions with daily activities for the development of the treatment program. Self-report metrics were also applied in the procedures as control groups were challenging in the study. Modified and intensive outpatient (IOP) treatment to veterans showed high success levels in the program (Zalta et al., 2018).
The second source examines a new treatment in exploring the feasibility of computerized, placebo-controlled, and home-based executive function training (EFT) on psychological and neuropsychological functions. The source titled “Computer-based executive function training for combat veterans with PTSD” shows trials in assessing feasibility and predictors output. The study shows how the functions can be useful in brain activation combating PTSD in veterans. Symptoms experienced after treatment on PTSD cases are stimulated through neural and c.
717JRRDJRRD Volume 49, Number 5, 2012Pages 717–728Coup.docxsleeperharwell
717
JRRDJRRD Volume 49, Number 5, 2012Pages 717–728
Couple/family therapy for posttraumatic stress disorder: Review to
facilitate interpretation of VA/DOD Clinical Practice Guideline
Candice M. Monson, PhD;1–2* Alexandra Macdonald, PhD;3 Amy Brown-Bowers1
1Ryerson University, Toronto, Ontario, Canada; 2Department of Veterans Affairs (VA) National Center for PTSD,
Women’s Health Sciences Division, Boston, MA; 3VA National Center for PTSD, Behavioral Science Division, and
Boston University School of Medicine, Boston, MA
Abstract—A well-documented association exists among Vet-
erans’ posttraumatic stress disorder (PTSD) symptoms, family
relationship problems, and mental health problems in partners
and children of Veterans. This article reviews the recommenda-
tions regarding couple/family therapy offered in the newest
version of the Department of Veterans Affairs (VA)/Depart-
ment of Defense (DOD) VA/DOD Clinical Practice Guideline
for Management of Post-Traumatic Stress. We then provide a
heuristic for clinicians, researchers, and policy makers to con-
sider when incorporating couple/family interventions into Vet-
erans’ mental health services. The range of research that has
been conducted on couple/family therapy for Veterans with
PTSD is reviewed using this heuristic, and suggestions for
clinical practice are offered.
Key words: caregiver burden, clinical practice guidelines,
cognitive-behavioral therapy, couple/family therapy, emotion-
ally focused couple therapy, mental health, PTSD, rehabilita-
tion, strategic approach therapy, Veterans.
INTRODUCTION
To their credit and our benefit, Veterans and their fami-
lies have been the predominant contributors to our knowl-
edge about the role of posttraumatic stress disorder (PTSD)
symptoms in family functioning and vice versa. This
research documents a clear and convincing association
between PTSD symptoms and a range of family problems
(see Monson et al. [1] for review). In addition, Veterans’
PTSD symptoms have been associated with a myriad of
individual mental health problems in spouses and children
(see Renshaw et al. [2] for review). Yet, research on couple/
family therapies for Veterans with PTSD has lagged behind
individual psychotherapy treatment outcome efforts. This is
in spite of research showing that Veterans desire greater
family involvement in their treatment (e.g., Batten et al. [3])
and the presence of significant mental health problems in
Veterans’ loved ones who may individually profit from
family therapy. In addition, treatments for PTSD do not
necessarily improve couple and family functioning (e.g.,
Abbreviations: BCT = behavioral couple therapy, BFT =
behavioral family therapy, CBCT = cognitive-behavioral con-
joint therapy, CPG = Clinical Practice Guideline, CSO = con-
cerned significant other, DOD = Department of Defense, DTE =
directed therapeutic exposure, EFCT for Trauma = emotionally
focused couple therapy for trauma, LMC = lifestyl.
1PAGE 21. What is the question the authors are asking .docxfelicidaddinwoodie
1
PAGE
2
1. What is the question the authors are asking?
They asked about a reduction in judgmental biases regarding the cost and probability associated with adverse social events as they are presumed as being mechanisms for the treatment of Social Anxiety Disorder (SAD). Also, the authors poised on the changes in judgmental biases as mechanisms to explain cognitive-behavioral therapy for social anxiety disorder. On top of that, they stated that methodological limitations extant studies highlight the possibility that rather than causing symptom relief, a significant reduction in judgmental biases tends to be consequences of it or correlate. Considerably, they expected cost bias at mid-treatment to be a predictor of the treatment outcome.
2. Why do the authors believe this question is important?
According to the authors, this question was relevant as methodological limitations of present studies reflect on the possibility that instead of causing symptom belief, a significant reduction in judgmental biases can be consequences or correlated to it. Additionally, they ought to ascertain the judgment bias between treated and non-treated participants. Significantly, this was important as they had to determine the impact of pre and post changes in cost and probability of the treatment outcomes. But, probability bias at mid-treatment was a predictor of the treatment outcome contrary to the cost bias at mid-treatment that could not be identified as a significant predictor of the treatment outcome.
3. How do they try to answer this question?
They conducted a study to evaluate the significant changes in judgmental bias as aspects of cognitive-behavioral therapy for social anxiety disorders. To do this, they conducted a study using information from two treatment studies; an uncontrolled trial observing amygdala activity as a response to VRE (Virtual Reality Exposure Therapy) with the use of functional magnetic resonance imaging and a randomized control trial that compared Virtual Reality Exposure Therapy with Exposure Group Therapy for SAD. A total of 86 individuals who met the DSM-IV-TR criteria for the diagnosis of non-generalized (n=46) and generalized (n=40) SAD participated. After completing eight weeks of the treatment protocol, the participants who identified public speaking as their most fearsome social situation were included. The SCID (Structured clinical interview for the DSM-IV) was used to ascertain diagnostic and eligibility status on Axis 1 conditions within substance abuse, mood and anxiety disorder modules. The social anxiety measures were measured with the use of BFNE (Brief Fear of Negative Evaluation), a self-reporting questioner that examined the degree to which persons fear to be assessed by other across different social settings. Additionally, the OPQ (Outcome Probability Questionnaire) self-reporting questionnaire was used to evaluate individual’s estimate on the probability that adverse, threatening events will occur at t ...
13 hours ago
Charlene Ricketts
Week 5- Discussion
COLLAPSE
Top of Form
Discussion: Posttraumatic Stress Disorder (PTSD)
Posttraumatic Stress Disorder (PTSD) is known as a mental health condition or a psychiatric disorder that occurs in people who witnessed or experienced a traumatic event in which physical harm occurred or was threatened (Bisson, Cosgrove, Lewis, & Roberts, 2015). According to Lancaster et al. (2016), PTSD creates long-lasting consequences of traumatic ordeals that creates intense fear, feeling of guilt, helplessness, persistent sadness due to sudden death of loved one, natural disaster, major accident, war or combat, physical assault, rape, terrorist attacks. According to Pai et al. (2017), DSM-5 diagnostic criteria related to PSTD includes flashbacks of the trauma, nightmares, intense distress, panicking, lack of sleep or self-disturbance, self-destructive behavior, aggressive behavior, reduce interest, avoidance or avoiding distress memories, emotionally numb and increase the use of alcohol and drugs. In the case study of Thomson Family, William Thompson is a 38 years old African American who is the younger brother of henry. William is a military person and was involved in an Iraq war veteran who recently starts living with her brother in Pasadena, California (Laureate Education, 2012a). Both his brother and wife argue that William is suffering from PTSD but William does not accept this thing and show the symptoms of avoidance when someone tries to talk to him about that. William starts living with his brother when he was unable to pay his mortgage and now working on jeopardy due to his PTSD and alcoholic concerns. The behavior of William that aligns with the DSM-5 diagnostic criteria of PTSD includes avoidance, war veteran, alcoholic concerns, concentration issues on working due to which he was unable to pay the mortgage due to joblessness, working in jeopardy due to PTSD concerns and his brother also admits that William is suffering from PTSD.
Psychotropic Medications
Selective serotonin reuptake inhibitors (SSRIs) are the only FDA-approved drugs that are used in the treatment of PTSD (Ipser & Stein, 2012). In PTSD treatment sertraline antidepressants such as Zoloft, Pfizer and Paroxetine antidepressant HCl such as Paxil are recommended in the medication process. SSRIs work by helping to create a balance between certain chemicals such as neurotransmitter serotonin levels in the brain (Feduccia, et al., 2019). This chemical balance in the brain helps in regulating mood, improving sleep disturbance, improving appetite and decreasing other symptoms. According to Alexander (2012), the first-line treatment method for PTSD includes the use of Fluoxetine (Prozac) which helps in improving the energy level, restoring daily interest, decrease fear, unwanted thought, improve concentration and reduce panic attacks.
In the case of PTSD along with first-line treatment process different therapeutic approaches are also adopted for the .
This is a presentation that I give to medical professionals educating them on the role and potential use of social work in the hospital setting. I presented this on May 22, 2009 to the Trauma Education & Research Committee.
The practitioner conducted a psychiatric assessment of a male adolescent patient presenting with depression. The practitioner established rapport but could have improved the assessment by asking more gender-appropriate questions initially. A thorough assessment is important for children and adolescents and should involve standardized rating scales and input from parents/guardians due to challenges interviewing this population. Key areas for the practitioner to assess further include suicide risk, comorbidities, and developing a safety plan.
Research Paper Assignment – Waste Management Purpose .docxverad6
Research Paper Assignment – Waste Management
Purpose: This assignment supports the following objective for the course: define waste
management and the strategies for achieving it.
Key Dates: The topic for your research paper is one that you can begin work on immediately.
While the final paper is not due until the end of the term, it is recommended from a time
management standpoint that you start early.
Key due dates are:
Detailed outline, including key conclusions, due by the end of Week 6.
Final report, containing all the elements below, due by the end of Week 8.
[Note an appendix is optional; it is not required for the paper to be complete.]
Research Topic: Should container deposit laws (bottle bills) be expanded to include
noncarbonated drinks?
Format: The paper must be submitted as a Word document using the APA format and
headings. It should be 1500 to 2500 words in length, written in 12 point font and double
spaced. For full credit it must contain each of the following elements:
Title Page.
Body of Paper - Based on your research:
o Briefly describe the history of container deposit laws.
o Describe how container deposit laws work.
o Explain why proponents believe bottle laws should be updated to include bottled
water, sports drinks, teas, and other noncarbonated beverages.
o Explain the position of those that oppose changing the law.
Conclusions (minimum 2 paragraphs): Based on the above state and defend your
position on whether states should expand their container deposit laws to include
noncarbonated beverages.
Bibliography: Include at least three sources not in the weekly reading assignments that
you used in this paper. (Wikipedia is not an acceptable source.)
Appendices (optional): Include appropriate charts, graphs, or other documents for extra
credit. (Note: Appendices do not count as part of the overall length requirement).
Psychological Services
Treatment Choice Among Veterans With PTSD Symptoms
and Substance-Related Problems: Examining the Role of
Preparatory Treatments in Trauma-Focused Therapy
Laura D. Wiedeman, Susan M. Hannan, Kelly P. Maieritsch, Cendrine Robinson, and Gregory
Bartoszek
Online First Publication, November 26, 2018. http://dx.doi.org/10.1037/ser0000313
CITATION
Wiedeman, L. D., Hannan, S. M., Maieritsch, K. P., Robinson, C., & Bartoszek, G. (2018, November
26). Treatment Choice Among Veterans With PTSD Symptoms and Substance-Related Problems:
Examining the Role of Preparatory Treatments in Trauma-Focused Therapy. Psychological
Services. Advance online publication. http://dx.doi.org/10.1037/ser0000313
Treatment Choice Among Veterans With PTSD Symptoms and Substance-
Related Problems: Examining the Role of Preparatory Treatments in
Trauma-Focused Therapy
Laura D. Wiedeman
Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois, and
Veterans Affairs Northern California Health Care System,
Martinez, Califor.
This document discusses the treatment of a veteran with PTSD using exposure therapy delivered via telehealth. It provides background on PTSD and exposure therapy. The veteran was diagnosed with PTSD and alcohol dependence related to his combat experiences in Iraq. He underwent 11 weekly sessions of exposure therapy targeting traumatic memories and avoided situations. Exposure techniques included imaginal, in vivo, and interoceptive exposure. The veteran showed reductions in PTSD and alcohol use symptoms over the course of treatment.
This document discusses treatment options for post traumatic stress disorder (PTSD). It notes that PTSD can be caused by traumatic events like disasters, accidents, abuse or combat. Symptoms include anxiety, sleep issues, depression and relationship problems. The document outlines that treatment may include cognitive behavioral therapy, exposure therapy, counseling, medication and group therapy. It concludes that correctly diagnosing PTSD and tailoring treatment to the individual and trauma is important for successful recovery.
Screening for depression in medical settings 2015 updateJames Coyne
This document summarizes a presentation on screening for depression in medical settings. The presenter expresses skepticism about screening and notes controversies should be resolved by evidence. Screening is meant to detect untreated depressed patients but success requires identifying many such patients and engaging them in effective treatment. However, evidence shows recognition alone does not improve outcomes and benefits of screening depend on the quality of routine care available. Overall, the presenter argues the evidence does not clearly support widespread screening and identifies potential harms such as high false positive rates and risks of overdiagnosis.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
The document proposes changes to address SMS fraud by describing the use of a TCAP handshake for mobile terminated SMS transfers. Specifically, it:
1) Describes using a TCAP handshake prior to the MAP payload exchange to provide a limited level of message authenticity without using MAPsec.
2) Proposes measures for networks to take to counteract spoofing attempts, such as verifying the SMS-GMSC address matches the originating SCCP address.
3) Suggests a method for operators to gradually introduce the TCAP handshake by defining trusted and untrusted operator groups with different requirements.
The study found that 69.2% of 195 young Iraq and Afghanistan veterans visiting a VA PTSD clinic were at high risk for sleep apnea. The risk of sleep apnea increased with the severity of PTSD symptoms, with every clinically significant increase in PTSD symptoms associated with a 40% increase in risk of sleep apnea. Screening for sleep apnea is important for veterans with PTSD since untreated sleep apnea can lead to health issues and exacerbate PTSD symptoms. The relationship between sleep apnea and PTSD in veterans remains unclear but may involve disturbed sleep and hyperarousal from combat or chronic stress from PTSD.
WiMAX is an emerging wireless broadband technology that provides transmission of data over long distances. The WiMAX Forum aims to ensure interoperability between WiMAX products based on the 802.16 wireless network standards. While no WiMAX compliant products currently exist, they are expected in 2005 and will be based on the 802.16d standard. WiMAX allows for both fixed and mobile broadband connections using various spectrum bands and modulation techniques to provide transmission ranges from 1-50 km depending on conditions.
This document provides an overview of a lecture on wireless communication systems. The lecture covers Wireless Local Area Networks (WLAN) standards such as 802.11b, 802.11a, and 802.11g. It also discusses emerging wireless technologies including Bluetooth, Ultra-Wideband (UWB), WiMax, and the fusion of telephony and IP networks. The lecture focuses in more detail on WiMax and Bluetooth standards, characteristics, architectures, and applications.
This document describes a bit-serial message-passing low-density parity-check (LDPC) decoder. It discusses the history and use of channel coding and different coding techniques. It then explains the structure and min-sum decoding algorithm for LDPC codes. The document proposes a bit-serial message passing technique for the decoder architecture to reduce routing congestion compared to fully parallel architectures. It provides implementation details of an application-specific integrated circuit (ASIC) and field-programmable gate array (FPGA) version of the decoder.
This document provides an overview of a lecture on wireless communication systems. The lecture covers Wireless Local Area Networks (WLAN) standards such as 802.11b, 802.11a, and 802.11g. It also discusses emerging wireless technologies including Bluetooth, Ultra-Wideband (UWB), WiMax, and the fusion of telephony and IP networks. The lecture focuses in more detail on WiMax and Bluetooth standards, characteristics, architectures, and applications.
The document discusses the architecture of WiMAX networks, including:
- The generic mobile WiMAX architectural model includes an access network, core network, and application service providers with flexible relationships between network operators.
- There are three defined ASN profiles - Profile A with separate BS and ASN-GW, Profile B with combined BS and ASN-GW, and Profile C similar to Profile A but with RRM functions in the BS.
- Key network features discussed include AAA and roaming frameworks, QoS framework, and mobility framework based on mobile IP or proxy mobile IP.
- Interworking with 3G networks is also described, including common billing scenarios and using a WiMAX CSN I
WiMAX is a wireless technology that provides broadband internet access over long distances. It can offer speeds up to 1 Gbit/s for fixed access and 40 Mbit/s for mobile access. WiMAX was developed to provide wireless alternatives to cable and DSL through standards developed by the IEEE and promoted by the WiMAX Forum. It has applications for broadband internet, mobile backhaul, and triple-play services. Users connect to WiMAX networks using gateways, USB dongles, or some mobile phones.
This document provides an overview of ASN.1 (Abstract Syntax Notation One) and encoding rules. ASN.1 defines the syntax for messages exchanged between applications independently of machine representation. Encoding rules like BER (Basic Encoding Rules) and PER (Packed Encoding Rules) define how ASN.1 messages are encoded for transmission. ASN.1 sees widespread use for applications like audio/video streaming, electronic commerce, telephony, and network management. It provides benefits like language/platform independence and reduced development time.
This document provides a summary of the contents of a report on mobile prepay communications. The report is divided into four parts that cover: 1) technical introduction and issues, 2) marketing and business issues, 3) advanced concepts and applications, and 4) deployment and operational issues. It discusses topics like the technology behind prepay, target markets, commercial offerings, marketing strategies, payment options, and future trends in prepay. The author's goal is to provide knowledge on technical and business issues related to prepay strategy, planning, deployment and operations.
This document provides a tutorial on multi-core CPUs, computer clusters, and grid computing for economists. It begins by discussing trends in microprocessor development such as increasing transistor counts and clock speeds. Future improvements will come from multi-core CPUs rather than increased clock speed. It also discusses increases in network speeds that enable computer clusters and grids. The document then provides suggestions for optimizing code performance on a single CPU before parallelization. This includes minimizing branches, inlining subroutines, and using high-performance libraries. The rest of the document discusses programming multi-core CPUs, clusters, and grids.
Miami in touch-amdocs-lte-2011-05-16-handoutArthur Sanchez
Vodafone Germany implemented an Amdocs OSS solution for their LTE deployments to accelerate processes for LTE planning and rollout. The Amdocs solution provided automated inventory, provisioning, and maintenance capabilities for LTE equipment. This improved planner efficiency and reduced TCO. Initial results showed accelerated ROI through an early milestone and improved collaboration between teams. Lessons learned included having an onsite Amdocs presence, securing management attention, and balancing design documentation with flexibility.
Frost & sullivan oss-bss global competitive strategiesArthur Sanchez
This document summarizes a report on next generation tools for network planning and engineering. It discusses how network planning has expanded beyond physical infrastructure to include capacity planning and logical service design. It also outlines business requirements for these tools like accelerating the design process, reducing errors, improving network survivability, and better supporting field personnel. Several vendor case studies are also reviewed that aim to meet these new requirements through integrated solutions.
Alpha lipoic acid (ALA) is a metabolic antioxidant that aids in energy production and reduces oxidative stress. It helps treat diabetes by improving insulin sensitivity and reducing neuropathy symptoms. ALA also enhances the effects of other antioxidants like vitamins C and E. It may help manage blood sugar levels and has potential benefits for skin health, detoxification, and types of glaucoma.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
160121 cdp research update
1. CDP Research Update -- January 21, 2016
What’s Here:
● PTSD Monthly Update: New Year, New Treatment
● Meta-Analysis of Counseling Outcomes for the Treatment of Posttraumatic Stress
Disorder.
● Mental Health Provider Experiences with Utilizing Evidence-Based Treatment for Post-
Traumatic Stress Disorder during a Combat Deployment.
● The Effects of Stress and Social Support on Externalizing Behaviors Among Children in
Military Families.
● Is Helplessness Still Helpful in Diagnosing Posttraumatic Stress Disorder?
● The effect of masculinity on community reintegration following TBI in military veterans.
● Employment status, employment functioning, and barriers to employment among VA
primary care patients.
● Open trial of exposure therapy for PTSD among patients with severe and persistent
mental illness.
● Military Generation and Its Relationship to Mortality in Women Veterans in the Women’s
Health Initiative.
● Retrospective Appraisals Mediate the Effects of Combat Experiences on PTS and
Depression Symptoms in U.S. Army Medics.
● Characteristics of Veterans Receiving Buprenorphine vs. Methadone for Opioid Use
Disorder Nationally in the Veterans Health Administration.
● Clinical Utility and Psychometric Properties of the Traumatic Brain Injury Quality of Life
Scale (TBI-QOL) in US Military Service Members.
● Effects of Blast Exposure on Subjective and Objective Sleep Measures in Combat
Veterans with and without PTSD.
● Long-Term Trajectories of PTSD in Vietnam-Era Veterans: The Course and
Consequences of PTSD in Twins.
2. ● Obstructive sleep apnea syndrome and post-traumatic stress disorder: Clinical outcomes
and impact of PAP therapy.
● Enhancing Recovery from Trauma: Facilitating a Mindfulness Skills Group on a
Department of Veterans Affairs Inpatient PTSD Unit.
● Development of the Military Compass of Shame Scale.
● Stolen trauma: why some veterans elaborate their psychological experience of military
service.
● Military Socialization: A Motivating Factor for Seeking Treatment in a Veterans’
Treatment Court.
● Ecological momentary assessment of PTSD symptoms and alcohol use in combat
veterans.
● Meta-Analysis of Counseling Outcomes for the Treatment of Posttraumatic Stress
Disorder.
● Comparison of Suicide Attempters and Decedents in the U.S. Army: A Latent Class
Analysis.
● 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.
● Anger Assessment in Clinical and Nonclinical Populations: Further Validation of the
State–Trait Anger Expression Inventory-2.
● Trends in Disability and Program Participation among U.S. Veterans.
● 5-Hz Transcranial Magnetic Stimulation for Comorbid Posttraumatic Stress Disorder and
Major Depression.
● Baccalaureate Nursing Faculty Competencies and Teaching Strategies to Enhance the
Care of the Veteran Population: Perspectives of Veteran Affairs Nursing Academy
(VANA) Faculty.
● Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient
Populations.
● Virtual reality in the psychological treatment for mental health problems: An systematic
review of recent evidence.
● Post-Traumatic Stress Constrains the Dynamic Repertoire of Neural Activity.
● Firearms matter: The moderating role of firearm storage in the association between
current suicidal ideation and likelihood of future suicide attempts among United States
military personnel.
3. ● Links of Interest
● Resource of the Week - Research Brief: Assessing the Department of Defense's
Approach to Reducing Mental Health Stigma
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http://content.govdelivery.com/accounts/USVHA/bulletins/1312769
PTSD Monthly Update: New Year, New Treatment
National Center for PTSD
January 2016
A new year brings thoughts of new beginnings. If you are struggling after a recent trauma or one
that happened a long time ago, 2016 might be a time to think about a new treatment for PTSD.
There are good treatments available for PTSD. For some people, treatment can get rid of PTSD
altogether. For others, it can make symptoms less intense. Treatment gives you the tools to
manage symptoms so they don't keep you from living your life.
Not sure it's PTSD? Take a brief screen and learn why you shouldn't wait to seek help.
Hesitating to get help? Learn about overcoming barriers to care.
Don't know what to say to your doctor? Here are some tips that can help you talk to your doctor
about trauma and PTSD.
If you know someone struggling with PTSD, we have resources for you.
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http://onlinelibrary.wiley.com/doi/10.1002/jcad.12058/full
Meta-Analysis of Counseling Outcomes for the Treatment of Posttraumatic Stress
Disorder.
Erford, B. T., Gunther, C., Duncan, K., Bardhoshi, G., Dummett, B., Kraft, J., Deferio, K., Falco,
M. and Ross, M.
Journal of Counseling & Development, 94: 13–30
doi: 10.1002/jcad.12058
4. This meta-analysis of 152 published posttraumatic stress disorder (PTSD) clinical trials from
1990 to 2012 concluded that counseling generally produced a small to large effect of treatment
across all comparison conditions at termination (d+ = 0.30 to 0.89). These gains were
maintained at longest follow-up (d+ = 0.58 to 0.86) for the wait-list, treatment-as-usual, and
single-group comparisons, but not for the follow-up placebo comparison (d+ = 0.15), probably
because of the low power (j = 3 placebo studies). Clinical trial findings were synthesized using a
random-effects model. No effects of publication bias or moderating variables were evident. No
difference was found between trauma-focused and non-trauma-focused approaches.
Implications for counseling practice and future PTSD outcome research are addressed.
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http://www.tandfonline.com/doi/abs/10.1080/21635781.2015.1133348
Mental Health Provider Experiences with Utilizing Evidence-Based Treatment for Post-
Traumatic Stress Disorder during a Combat Deployment.
Elizabeth A. Penix , Amy B. Adler , Paul Y. Kim , Joshua E. Wilk , Charles W. Hoge
Military Behavioral Health
Accepted author version posted online: 12 Jan 2016
DOI:10.1080/21635781.2015.1133348
The present study assesses mental health care staff experiences with evidence-based
treatments (EBTs) for post-traumatic stress disorder (PTSD) in a deployed environment. Mental
health care providers (n = 19) and technicians (n = 20) were surveyed in Afghanistan
concerning EBT delivery, attitudes, and perceived barriers to the implementation of EBTs.
Relaxation techniques and supportive psychotherapy were most frequently utilized; exposure
therapy techniques were least frequently utilized. Most participants had positive attitudes toward
EBTs; however, providers identified unique challenges to delivering EBTs. Modular EBTs may
be useful to consider to address provider concerns and improve the implementation of EBTs.
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http://www.tandfonline.com/doi/abs/10.1080/01639625.2015.1012403
The Effects of Stress and Social Support on Externalizing Behaviors Among Children in
Military Families.
Jennifer Sumner , Danielle Boisvert , Judith P. Andersen
Deviant Behavior
Published online: 29 Dec 2015
DOI: 10.1080/01639625.2015.1012403
5. Drawing on social support theory, this study examines the main and interactive effects of
parental perceived stress and social support on externalizing behaviors in military youth.
Findings reveal that not only do social support and stress affect the conduct of military children,
but social support also moderately buffers the effects of parental stress. Given the increasing
distance between military and American culture, more generally, this research is one
opportunity to make sense of contradictory expectations about the well-being of military youth.
In doing so, it provides implications for how a more supportive organization can benefit military
families.
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http://journals.lww.com/jonmd/Abstract/2016/01000/Is_Helplessness_Still_Helpful_in_Diagnosin
g.2.aspx
Is Helplessness Still Helpful in Diagnosing Posttraumatic Stress Disorder?
Pivovarova, Ekaterina; Tanaka, Gen; Tang, Michael
Journal of Nervous & Mental Disease:
January 2016 - Volume 204 - Issue 1 - p 3–8
doi: 10.1097/NMD.0000000000000416
Criteria A2, experience of helplessness, fear, or horror at the time of the traumatic event, was
removed from the posttraumatic stress disorder diagnosis in the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition. We argue that there is empirical support for retention
of A2, a criterion that has clinical value and may improve diagnostic accuracy. Specifically, we
demonstrate that A2 has high negative predictive power, aids in the prediction of symptom
severity, and can be indispensible to detecting the disorder in children. We examine how
augmenting A2 with other peritramautic emotions could improve clinical and diagnostic utility. In
our opinion, rather than being eliminated, A2 needs to be reconstructed and included as one
criterion of PTSD.
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http://psycnet.apa.org/psycinfo/2015-54189-001/
The effect of masculinity on community reintegration following TBI in military veterans.
Meyers, Noah M.; Chapman, Julie C.; Gunthert, Kathleen C.; Weissbrod, Carol S.
Military Psychology
Vol 28(1), Jan 2016, 14-24
http://dx.doi.org/10.1037/mil0000097
6. The present study examined the effect of level of traditional masculine gender role norms as
well as the moderating effect of cognitive flexibility on community reintegration outcomes in a
sample of 60 male military veterans who had sustained a traumatic brain injury during
deployment. Data were collected through self-report measures and cognitive tests. Results
suggested that greater endorsement of traditional masculine gender role beliefs, attitudes, and
behaviors was significantly inversely related to the community integration domains of
relationships and living skills and not significantly related to work and leisure. The effect of
masculinity on healthy living skills was moderated by cognitive flexibility; the protective effect of
low masculinity on living skills was only present if the veteran also had high cognitive flexibility
skills. Results are discussed in the context of gender role strain, potential limiting aspects of
stereotypy on recovery and reintegration, and the importance of cognitive flexibility in the
recovery/reintegration process. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
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http://www.sciencedirect.com/science/article/pii/S0165032715311113
Employment status, employment functioning, and barriers to employment among VA
primary care patients.
Kara Zivin, Matheos Yosef, Debra S. Levine, Kristen M. Abraham, Erin M. Miller, Jennifer
Henry, C. Beau Nelson, Paul N. Pfeiffer, Rebecca K. Sripada, Molly Harrod, Marcia Valenstein
Journal of Affective Disorders
Volume 193, 15 March 2016, Pages 194–202
doi:10.1016/j.jad.2015.12.054
Background
Prior research found lower employment rates among working-aged patients who use the VA
than among non-Veterans or Veterans who do not use the VA, with the lowest reported
employment rates among VA patients with mental disorders. This study assessed employment
status, employment functioning, and barriers to employment among VA patients treated in
primary care settings, and examined how depression and anxiety were associated with these
outcomes.
Methods
The sample included 287 VA patients treated in primary care in a large Midwestern VA Medical
Center. Bivariate and multivariable analyses were conducted examining associations between
socio-demographic and clinical predictors of six employment domains, including: employment
status, job search self-efficacy, work performance, concerns about job loss among employed
Veterans, and employment barriers and likelihood of job seeking among not employed
Veterans.
7. Results
54% of respondents were employed, 36% were not employed, and 10% were economically
inactive. In adjusted analyses, participants with depression or anxiety (43%) were less likely to
be employed, had lower job search self-efficacy, had lower levels of work performance, and
reported more employment barriers. Depression and anxiety were not associated with perceived
likelihood of job loss among employed or likelihood of job seeking among not employed.
Limitations
Single VA primary care clinic; cross-sectional study.
Discussion
Employment rates are low among working-aged VA primary care patients, particularly those
with mental health conditions. Offering primary care interventions to patients that address
mental health issues, job search self-efficacy, and work performance may be important in
improving health, work, and economic outcomes.
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http://www.sciencedirect.com/science/article/pii/S000579671530070X
Open trial of exposure therapy for PTSD among patients with severe and persistent
mental illness.
Anouk L. Grubaugh, Joshua D. Clapp, B. Christopher Frueh, Peter W. Tuerk, Rebecca G.
Knapp, Leonard E. Egede
Behaviour Research and Therapy
Volume 78, March 2016, Pages 1–12
doi:10.1016/j.brat.2015.12.006
Objective
There are few empirical data regarding effective treatment of trauma-related symptoms among
individuals with severe mental illness (SMI; e.g., bipolar disorder, schizophrenia). This under-
examined clinical issue is significant because rates of trauma and PTSD are higher among
individuals with SMI relative to the general population, and there are sufficient data to suggest
that PTSD symptoms exacerbate the overall course and prognosis of SMI.
Method
34 veterans with SMI received prolonged exposure (PE) for PTSD using an open trial study
design.
Results
Data suggest that PE is feasible to implement, well-tolerated, and results in clinically significant
decreases in PTSD severity in patients with SMI. Mean CAPS scores improved 27.2 points from
8. baseline to immediate post [95% CI for mean change: −44.3, - 10.1; p = 0.002, paired t-test, and
treatment gains were maintained at 6 months [mean change from baseline to 6-months, −16.1;
95% CI: −31.0, –1.2; p = 0.034, paired t-test].
Conclusions
The current data support the use of exposure-based interventions for PTSD among individuals
with SMI and highlight the need for rigorous randomized efficacy trials investigating frontline
PTSD interventions in this patient population.
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http://gerontologist.oxfordjournals.org/content/56/Suppl_1/S126.short
Military Generation and Its Relationship to Mortality in Women Veterans in the Women’s
Health Initiative.
Donna L. Washington, Chloe E. Bird, Michael J. LaMonte, Karen M. Goldstein, Eileen Rillamas-
Sun, Marcia L. Stefanick, Nancy F. Woods, Lori A. Bastian, Margery Gass, and Julie C. Weitlauf
Military Generation and Its Relationship to Mortality in Women Veterans in the Women’s Health
Initiative.
The Gerontologist (2016) 56 (Suppl 1): S126-S137
doi:10.1093/geront/gnv669
Purpose of the Study:
Women’s military roles, exposures, and associated health outcomes have changed over time.
However, mortality risk—within military generations or compared with non-Veteran women—has
not been assessed. Using data from the Women’s Health Initiative (WHI), we examined all-
cause and cause-specific mortality by Veteran status and military generation among older
women.
Design and Methods:
WHI participants (3,719 Veterans; 141,802 non-Veterans), followed for a mean of 15.2 years,
were categorized into pre-Vietnam or Vietnam/after generations based on their birth cohort. We
used cox proportional hazards models to examine the association between Veteran status and
mortality by generation.
Results:
After adjusting for sociodemographic characteristics and WHI study arm, all-cause mortality
hazard rate ratios (HRs) for Veterans relative to non-Veterans were 1.16 (95% CI: 1.09–1.23)
for pre-Vietnam and 1.16 (95% CI: 0.99–1.36) for Vietnam/after generations. With additional
adjustment for health behaviors and risk factors, this excess mortality rate persisted for pre-
Vietnam but attenuated for Vietnam/after generations. After further adjustment for medical
9. morbidities, across both generations, Veterans and non-Veterans had similar all-cause mortality
rates. Relative to non-Veterans, adjusting for sociodemographics and WHI study arm, pre-
Vietnam generation Veterans had higher cancer, cardiovascular, and trauma-related morality
rates; Vietnam/after generation Veterans had the highest trauma-related mortality rates (HR =
2.93, 1.64–5.23).
Implications:
Veterans’ higher all-cause mortality rates were limited to the pre-Vietnam generation, consistent
with diminution of the healthy soldier effect over the life course. Mechanisms underlying
Vietnam/after generation Veteran trauma-related mortality should be elucidated. Efforts to
modify salient health risk behaviors specific to each military generation are needed.
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http://onlinelibrary.wiley.com/doi/10.1002/jts.22067/abstract
Retrospective Appraisals Mediate the Effects of Combat Experiences on PTS and
Depression Symptoms in U.S. Army Medics.
Barbara L. Pitts andMartin A. Safer
Journal of Traumatic Stress
Article first published online: 13 JAN 2016
DOI: 10.1002/jts.22067
A life-threatening traumatic experience can cause physical and psychological distress, but it can
also be remembered with pride from having demonstrated one's courage and abilities under
severe circumstances. Characteristics of the event, early response, as well as later personal
reflection, together determine the individual's response to a traumatic event. We investigated
how traumatic combat experiences and retrospective appraisals of those experiences affected
reports of symptoms of posttraumatic stress and depression in 324 U.S. Army medics. Higher
levels of combat experiences were associated with both appraisals of threat to life (r = .40) and
appraisals of personal benefit of the deployment (r = .15). Threat appraisals were associated
with increases (r = .33 and .29), whereas benefit appraisals were associated with decreases (r =
−.28 and −.30, respectfully), in symptoms of posttraumatic stress and depression. These
opposing mediation pathways led to weak or nonsignificant total effects, which concealed the
effects of combat intensity on posttraumatic stress (R2 = .28) and depression (R2 = .24).
Acknowledging the beneficial effects that a combat experience had on one's life was associated
with less intense behavioral health symptoms and offset the detrimental effects of traumatic
combat experiences.
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10. http://www.sciencedirect.com/science/article/pii/S0376871616000065
Characteristics of Veterans Receiving Buprenorphine vs. Methadone for Opioid Use
Disorder Nationally in the Veterans Health Administration.
Ajay Manhapra, Lantie Quinones, Robert Rosenheck
Drug and Alcohol Dependence
Available online 13 January 2016
doi:10.1016/j.drugalcdep.2015.12.035
BACKGROUND
The advent of buprenorphine as an alternative to methadone has dramatically shifted the
landscape of opioid agonist therapy (OAT) for opioid use disorder (OUD). However, there is
limited US national level data describing thedifferences between patients who are prescribed
these two OAT options.
METHODS
From veterans with OUD diagnosis who used Veterans Health Administration services in 2012,
we identified 3 mutually exclusive groups: those who received (1) buprenorphine only (n =
5,670); (2) methadone only (n = 6,252); or (3) both buprenorphine and methadone in the same
year (n = 2513). We calculated the bi-varate effect size differences (risk ratios and Cohen's d)
forcharacteristics that differentiated these groups. Logistic regression analysis was then used to
identify factors independently differentiating the groups.
RESULTS
Ten year increment in age (OR 0.67; 95% CI 0.64–0.70), urban residence (OR 0.26; 95% CI
0.25–0.33), and black race (OR 0.39; 95% CI 0.35–0.43) were strongly and negatively
associated with odds of receiving buprenorphine compared to methadone, while medical and
psychiatric comorbidities or receipt of other psychiatric medications did not demonstrate
substantial differences between groups.
CONCLUSIONS
Differences between veterans receiving buprenorphine or methadone based OAT seems to be
largely shaped by demographic characteristics rather than medical or psychiatric or service use
characteristics. A clearer understanding of the reasons for racial differences could be helpful in
assuring that black OUD patients are not denied the opportunity to receive buprenorphine if that
is their preference.
-----
11. http://www.ncbi.nlm.nih.gov/pubmed/26716697
J Head Trauma Rehabil. 2016 Jan-Feb;31(1):62-78. doi: 10.1097/HTR.0000000000000149.
Clinical Utility and Psychometric Properties of the Traumatic Brain Injury Quality of Life
Scale (TBI-QOL) in US Military Service Members.
Lange RT, Brickell TA, Bailie JM, Tulsky DS, French LM.OBJECTIVE:
To examine the clinical utility and psychometric properties of the Traumatic Brain Injury Quality
of Life (TBI-QOL) scale in a US military population.
PARTICIPANTS:
One hundred fifty-two US military service members (age: M = 34.3, SD = 9.4; 89.5% men)
prospectively enrolled from the Walter Reed National Military Medical Center and other
nationwide community outreach initiatives. Participants included 99 service members who had
sustained a mild traumatic brain injury (TBI) and 53 injured or noninjured controls without TBI (n
= 29 and n = 24, respectively).
PROCEDURE:
Participants completed the TBI-QOL scale and 5 other behavioral measures, on average, 33.8
months postinjury (SD = 37.9).
MAIN OUTCOME MEASURES:
Fourteen TBI-QOL subscales; Neurobehavioral Symptom Inventory; Posttraumatic Stress
Disorder Checklist-Civilian version; Alcohol Use Disorders Identification Test; Combat Exposure
Scale.
RESULTS:
The internal consistency reliability of the TBI-QOL scales ranged from α = .91 to α = .98. The
convergent and discriminant validity of the 14 TBI-QOL subscales was high. The mild TBI group
had significantly worse scores on 10 of the 14 TBI-QOL subscales than the control group
(range, P < .001 to P = .043). Effect sizes ranged from medium to very large (d = 0.35 to d =
1.13). The largest differences were found on the Cognition-General Concerns (d = 1.13),
Executive Function (d = 0.94), Grief-Loss (d = 0.88), Pain Interference (d = 0.83), and
Headache Pain (d = 0.83) subscales.
CONCLUSION:
These results support the use of the TBI-QOL scale as a measure of health-related quality of life
in a mild TBI military sample. Additional research is recommended to further evaluate the
clinical utility of the TBI-QOL scale in both military and civilian settings.
-----
12. http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=30416
Effects of Blast Exposure on Subjective and Objective Sleep Measures in Combat
Veterans with and without PTSD.
Stocker RP, Paul BT, Mammen O, Khan H, Cieply MA, Germain A.
Journal of Clinical Sleep Medicine
2016;12(1):49–56
http://dx.doi.org/10.5664/jcsm.5392
Study Objectives
This study examined the extent to which self-reported exposure to blast during deployment to
Iraq and Afghanistan affects subjective and objective sleep measures in service members and
veterans with and without posttraumatic stress disorder (PTSD).
Methods
Seventy-one medication-free service members and veterans (mean age = 29.47 ± 5.76 years
old; 85% men) completed self-report sleep measures and overnight polysomnographic studies.
Four multivariate analyses of variance (MANOVAs) were conducted to examine the impact of
blast exposure and PTSD on subjective sleep measures, measures of sleep continuity, non-
rapid eye movement (NREM) sleep parameters, and rapid eye movement (REM) sleep
parameters.
Results
There was no significant Blast × PTSD interaction on subjective sleep measures. Rather, PTSD
had a main effect on insomnia severity, sleep quality, and disruptive nocturnal behaviors. There
was no significant Blast × PTSD interaction, nor were there main effects of PTSD or Blast on
measures of sleep continuity and NREM sleep. A significant PTSD × Blast interaction effect was
found for REM fragmentation.
Conclusions
The results suggest that, although persistent concussive symptoms following blast exposure are
associated with sleep disturbances, self-reported blast exposure without concurrent symptoms
does not appear to contribute to poor sleep quality, insomnia, and disruptive nocturnal
disturbances beyond the effects of PTSD. Reduced REM sleep fragmentation may be a
sensitive index of the synergetic effects of both psychological and physical insults.
-----
http://onlinelibrary.wiley.com/doi/10.1002/jts.22075/abstract
Long-Term Trajectories of PTSD in Vietnam-Era Veterans: The Course and
Consequences of PTSD in Twins.
13. Magruder, K. M., Goldberg, J., Forsberg, C. W., Friedman, M. J., Litz, B. T., Vaccarino, V.,
Heagerty, P. J., Gleason, T. C., Huang, G. D. and Smith, N. L.
Journal of Traumatic Stress
Article first published online: 13 JAN 2016
DOI: 10.1002/jts.22075
We estimated the temporal course of posttraumatic stress disorder (PTSD) in Vietnam-era
veterans using a national sample of male twins with a 20-year follow-up. The complete sample
included those twins with a PTSD diagnostic assessment in 1992 and who completed a DSM-IV
PTSD diagnostic assessment and a self-report PTSD checklist in 2012 (n = 4,138). Using PTSD
diagnostic data, we classified veterans into 5 mutually exclusive groups, including those who
never had PTSD, and 4 PTSD trajectory groups: (a) early recovery, (b) late recovery, (c) late
onset, and (d) chronic. The majority of veterans remained unaffected by PTSD throughout their
lives (79.05% of those with theater service, 90.85% of those with nontheater service); however,
an important minority (10.50% of theater veterans, 4.45% of nontheater veterans) in 2012 had
current PTSD that was either late onset (6.55% theater, 3.29% nontheater) or chronic (3.95%
theater, 1.16% nontheater). The distribution of trajectories was significantly different by theater
service (p < .001). PTSD remains a prominent issue for many Vietnam-era veterans, especially
for those who served in Vietnam.
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http://www.sciencedirect.com/science/article/pii/S0012369215001294
Obstructive sleep apnea syndrome and post-traumatic stress disorder: Clinical
outcomes and impact of PAP therapy.
Christopher J. Lettieri, Scott G. Williams, Jacob F. Collen
Chest
Available online 1 January 2016
doi:10.1378/chest.15-0693
Purpose
We sought to determine the impact of OSAS on symptoms and quality of life (QoL) among
patients with PTSD. In addition, we assessed adherence and response to positive airway
pressure (PAP) therapy in this population.
Methods
Case-controlled observational cohort at the Sleep Disorders Center of an academic military
medical center. 200 consecutive patients with PTSD underwent sleep evaluations. PTSD
patients with and without OSAS were compared to 50 consecutive age-matched OSAS patients
14. without PTSD and 50 age-matched normal controls. Polysomnographic data, sleep-related
symptoms and QoL measures, and objective PAP usage were obtained.
Results
Among patients with PTSD over half (56.6%) were diagnosed with OSAS. Patients with
PTSD+OSAS had lower QoL and more somnolence compared with the other groups. Patients
with PTSD demonstrated significantly lower adherence and response to PAP therapy.
Resolution of sleepiness occurred in 82% of patients with OSAS alone, compared with 62.5% of
PAP adherent and 21.4% of non-adherent PTSD+OSAS patients (p<0.001). Similarly, post-
treatment FOSQ≥17.9 was achieved in 72% of OSAS patients, compared to only 56.3% of
PTSD+OSA patients who were PAP adherent and 26.2% who were non-adherent (p<0.03).
Conclusion
In patients with PTSD, comorbid OSAS is associated with worsened symptoms, QoL, and
adherence and response to PAP. Given the negative impact on outcomes, OSAS should be
carefully considered in patients with PTSD. Close follow-up is needed to optimize PAP
adherence and efficacy in this at-risk population.
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http://www.tandfonline.com/doi/abs/10.1080/01609513.2014.999203
Enhancing Recovery from Trauma: Facilitating a Mindfulness Skills Group on a
Department of Veterans Affairs Inpatient PTSD Unit.
Sam Schwartz Landrum
Social Work with Groups
Vol. 39, Iss. 1, 2016
DOI:10.1080/01609513.2014.999203
Mindfulness and acceptance based treatments are being increasingly implemented for a variety
of emotional and psychological related problems, including the impact of military and combat
related trauma exposure. This article describes a mindfulness skills group as it was
implemented on a sub-acute inpatient PTSD Unit at a Department of Veterans Affairs medical
center, to demonstrate and explore the role of the mindfulness skills development in a group
setting, for Post-Traumatic Stress Disorder and other trauma related problems.
-----
http://www.tandfonline.com/doi/abs/10.1080/21635781.2015.1133346
Development of the Military Compass of Shame Scale.
15. Justin S. Campbell
Military Behavioral Health
Accepted author version posted online: 11 Jan 2016
DOI:10.1080/21635781.2015.1133346
The Military Compass of Shame Scale (M-CoSS) was designed to evaluate a service member's
response to four maladaptive shame regulation strategies. The M-CoSS is comprised of two
externalizing sub-scales (attack-other, AO; avoidance, AV) and two internalizing sub-scales
(withdrawal, WD; attack-self, AS). The final version of the scale was administered to a sample of
U.S. Navy Sailors preparing to deploy to Iraq and Afghanistan (n = 379). The final sample
consisted of active duty patients clinically diagnosed with posttraumatic stress disorder (PTSD)
and undergoing residential treatment (n = 27). Internal consistency reliability was acceptable to
good within both the large pre-deployment sample (α = .70 to .89) and the PTSD sample (α =
.79 to .89). Exploratory factor analysis provided evidence of construct validity in the pre-
deployment sample. Lastly, compared to the pre-deployment sample, the PTSD sample was
significantly more likely to utilize three of the four maladaptive shame regulation strategies, with
the exception of the AV scale. The M-CoSS is recommended for research purposes in the study
of shame regulation in service members diagnosed with PTSD and experiencing moral injury.
-----
http://www.tandfonline.com/doi/abs/10.1080/14751798.2015.1130318
Stolen trauma: why some veterans elaborate their psychological experience of military
service.
Edgar Jones , Hugh Milroy
Defense & Security Analysis
Published online: 13 Jan 2016
DOI:10.1080/14751798.2015.1130318
The embellishment of a warrior biography has a long history but examples of veteran
elaboration of traumatic experience have become increasingly apparent. Although legislative
change in the UK has removed the penalties for fabrication and a progressive decline in the
military footprint may have increased the likelihood of such false trauma narratives, a paradigm
shift in explanations for mental illness underpins this phenomenon. The recognition of post-
traumatic stress disorder (PTSD) in 1980, followed by studies to identify risk factors, led to a
greater appreciation of psychological vulnerability. As a result, the use of shame to discourage
acts formerly labelled as “cowardly” or “lacking in morale fibre” is no longer considered
appropriate. Recent conflicts in Iraq and Afghanistan generated popular sympathy for service
personnel, whilst media focus on PTSD has led the UK public to believe that most veterans
have been traumatised by their tours of duty.
16. -----
http://link.springer.com/article/10.1007/s12103-015-9332-4
Military Socialization: A Motivating Factor for Seeking Treatment in a Veterans’
Treatment Court.
Eileen M. Ahlin , Anne S. Douds
American Journal of Criminal Justice
First online: 29 December 2015
10.1007/s12103-015-9332-4
The veterans’ treatment court movement is just beyond the nascent period, and given the rapid
proliferation of these courts in recent years it is imperative that the scientific community
understand their operational procedures and assess whether they are meeting a unique need
beyond those addressed by other problem-solving courts. This paper provides an in-depth
examination of veteran culture and how it helps to distinguish veterans’ treatment courts from
other courts that focus on similar populations (e.g., drug, DWI, and mental health courts). Using
in-depth semi-structured interviews and focus group data collected from veteran participants,
veteran mentors, and court team members in Pennsylvania, we employ content analysis to
explore the veteran culture as a motivator for participants to enroll in a veterans’ treatment court
and engage with others throughout participation in treatment. The results of this exploratory
study suggest that a shared culture serves to motivate justice-involved veterans to seek out the
veterans’ treatment court over other treatment options and remain engaged in this problem-
solving court, while inspiring a sense of obligation to do well in treatment for them and their
fellow veterans. The shared experiences of military service and across-the-board support for
fellow service members suggest that the veterans’ treatment court creates a unique
environment for pursuing treatment.
-----
http://psycnet.apa.org/journals/adb/29/4/894/
Ecological momentary assessment of PTSD symptoms and alcohol use in combat
veterans.
Possemato, Kyle; Maisto, Stephen A.; Wade, Michael; Barrie, Kimberly; McKenzie, Shannon;
Lantinga, Larry J.; Ouimette, Paige
Psychology of Addictive Behaviors, Vol 29(4), Dec 2015, 894-905.
http://dx.doi.org/10.1037/adb0000129
17. Despite high rates of comorbid hazardous alcohol use and posttraumatic stress disorder
(PTSD), the nature of the functional relationship between these problems is not fully
understood. Insufficient evidence exists to fully support models commonly used to explain the
relationship between hazardous alcohol use and PTSD including the self-medication hypothesis
and the mutual maintenance model. Ecological momentary assessment (EMA) can monitor
within-day fluctuations of symptoms and drinking to provide novel information regarding
potential functional relationships and symptom interactions. This study aimed to model the daily
course of alcohol use and PTSD symptoms and to test theory-based moderators, including
avoidance coping and self-efficacy to resist drinking. A total of 143 recent combat veterans with
PTSD symptoms and hazardous drinking completed brief assessments of alcohol use, PTSD
symptoms, mood, coping, and self-efficacy 4 times daily for 28 days. Our results support the
finding that increases in PTSD are associated with more drinking within the same 3-hr time
block, but not more drinking within the following time block. Support for moderators was found:
Avoidance coping strengthened the relationship between PTSD and later drinking, while self-
efficacy to resist drinking weakened the relationship between PTSD and later drinking. An
exploratory analysis revealed support for self-medication occurring in certain times of the day:
Increased PTSD severity in the evening predicted more drinking overnight. Overall, our results
provide mixed support for the self-medication hypothesis. Also, interventions that seek to reduce
avoidance coping and increase patient self-efficacy may help veterans with PTSD decrease
drinking. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
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http://onlinelibrary.wiley.com/doi/10.1002/jcad.12058/full
Meta-Analysis of Counseling Outcomes for the Treatment of Posttraumatic Stress
Disorder.
Erford, B. T., Gunther, C., Duncan, K., Bardhoshi, G., Dummett, B., Kraft, J., Deferio, K., Falco,
M. and Ross, M.
Journal of Counseling & Development, 94: 13–30
doi: 10.1002/jcad.12058
This meta-analysis of 152 published posttraumatic stress disorder (PTSD) clinical trials from
1990 to 2012 concluded that counseling generally produced a small to large effect of treatment
across all comparison conditions at termination (d+ = 0.30 to 0.89). These gains were
maintained at longest follow-up (d+ = 0.58 to 0.86) for the wait-list, treatment-as-usual, and
single-group comparisons, but not for the follow-up placebo comparison (d+ = 0.15), probably
because of the low power (j = 3 placebo studies). Clinical trial findings were synthesized using a
random-effects model. No effects of publication bias or moderating variables were evident. No
difference was found between trauma-focused and non-trauma-focused approaches.
Implications for counseling practice and future PTSD outcome research are addressed.
18. -----
http://onlinelibrary.wiley.com/doi/10.1111/sltb.12227/abstract
Comparison of Suicide Attempters and Decedents in the U.S. Army: A Latent Class
Analysis.
Skopp, N. A., Smolenski, D. J., Sheppard, S. C., Bush, Nigel. E. and Luxton, D. D.
Suicide and Life-Threatening Behavior
Article first published online: 8 JAN 2016
DOI: 10.1111/sltb.12227
A clearer understanding of risk factors for suicidal behavior among soldiers is of principal
importance to military suicide prevention. It is unclear whether soldiers who attempt suicide and
those who die by suicide have different patterns of risk factors. As such, preventive efforts
aimed toward reducing suicide attempts and suicides, respectively, may require different
strategies. We conducted a latent class analysis (LCA) to examine classes of risk factors among
suicide attempters (n = 1,433) and decedents (n = 424). Both groups were represented by three
classes: (1) External/Antisocial Risk Factors, (2) Mental Health Risk Factors, and (3) No
Pattern. These findings support the conceptualization that military suicide attempters and
decedents represent a single population.
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http://link.springer.com/article/10.1007/s40801-015-0055-0
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.
Garen A. Collett, Kangwon Song, Carlos A. Jaramillo, Jennifer S. Potter, Erin P. Finley, Mary Jo
Pugh
Drugs - Real World Outcomes
First online: 08 January 2016
DOI 10.1007/s40801-015-0055-0
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.
19. 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.
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http://onlinelibrary.wiley.com/doi/10.1002/jclp.22253/abstract
Anger Assessment in Clinical and Nonclinical Populations: Further Validation of the
State–Trait Anger Expression Inventory-2.
Lievaart, M., Franken, I. H.A. and Hovens, J. E.
Journal of Clinical Psychology
Article first published online: 14 JAN 2016
DOI: 10.1002/jclp.22253
20. Objective
The most commonly used instrument for measuring anger is the State-Trait Anger Expression
Inventory-2 (STAXI-2; Spielberger, 1999). This study further examines the validity of the STAXI-
2 and compares anger scores between several clinical and nonclinical samples.
Method
Reliability, concurrent, and construct validity were investigated in Dutch undergraduate students
(N = 764), a general population sample (N = 1211), and psychiatric outpatients (N = 226).
Results
The results support the reliability and validity of the STAXI-2. Concurrent validity was strong,
with meaningful correlations between the STAXI-2 scales and anger-related constructs in both
clinical and nonclinical samples. Importantly, patients showed higher experience and expression
of anger than the general population sample. Additionally, forensic outpatients with addiction
problems reported higher Anger Expression-Out than general psychiatric outpatients.
Conclusion
Our conclusion is that the STAXI-2 is a suitable instrument to measure both the experience and
the expression of anger in both general and clinical populations.
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http://www.sciencedirect.com/science/article/pii/S1936657416000029
Trends in Disability and Program Participation among U.S. Veterans.
Yonatan Ben-Shalom, Jennifer R. Tennant, David C. Stapleton
Disability and Health Journal
Available online 6 January 2016
doi:10.1016/j.dhjo.2015.12.008
Background
Disability is increasingly part of the lives of veterans and more research is needed to understand
its impact on veterans’ participation in disability benefit programs.
Objective/Hypothesis
We examine how recent trends in receipt of service-connected disability compensation from the
Department of Veterans Affairs (VA) compare to trends in self-reported disability and
participation in Social Security Disability Insurance (DI) and Supplemental Security Income
(SSI) among veterans.
Methods
We use 2002–2013 data from the Current Population Survey to describe trends in receipt of VA
21. disability compensation and to compare between trends in self-reported disability and DI/SSI
participation for veterans versus nonveterans.
Results
The percentage of veterans reporting they receive VA disability compensation increased
substantially from 2002 to 2013 and was especially notable among younger (ages 18–39) and
older (ages 50–64) veterans. From 2009 to 2013, self-reported disability increased among the
younger and older veterans but not among middle-age veterans and nonveterans, and self-
reported cognitive disability increased substantially among young veterans. DI/SSI participation
among older veterans increased more than for nonveterans over the period examined.
Conclusions
Effective policies are needed to incentivize work among young veterans and to help them obtain
both the skills they need to succeed in the labor force and the supports (such as psychiatric
health services) they need to do so. Older veterans are facing increasing challenges in the labor
market, and further research is needed to determine whether these challenges are primarily
related to health, a growing skills gap, or poorly-aligned incentives.
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http://onlinelibrary.wiley.com/doi/10.1002/jts.22065/abstract
5-Hz Transcranial Magnetic Stimulation for Comorbid Posttraumatic Stress Disorder and
Major Depression.
Philip, N. S., Ridout, S. J., Albright, S. E., Sanchez, G. and Carpenter, L. L.
Journal of Traumatic Stress
Article first published online: 7 JAN 2016
DOI: 10.1002/jts.22065
Current treatment options for posttraumatic stress disorder (PTSD) offer modest benefits,
underscoring the need for new treatments. Repetitive transcranial magnetic stimulation (rTMS)
depolarizes neurons in a targeted brain region with magnetic fields typically pulsed at low (1 Hz)
or high (10 Hz) frequency to relieve major depressive disorder (MDD). Prior work suggests an
intermediate pulse frequency, 5 Hz, is also efficacious for treating comorbid depressive and
anxiety symptoms. In this chart review study, we systematically examined the clinical and safety
outcomes in 10 patients with comorbid MDD and PTSD syndromes who received 5-Hz rTMS
therapy at the Providence VA Medical Center Neuromodulation Clinic. Self-report scales
measured illness severity prior to treatment, after every 5 treatments, and upon completion of
treatment. Results showed significant reduction in symptoms of PTSD (p = .003, effect size =
1.12, 8/10 with reliable change) and MDD (p = .005, effect size = 1.09, 6/10 with reliable
change). Stimulation was well tolerated and there were no serious adverse events. These data
22. indicate 5-Hz rTMS may be a useful option to treat these comorbid disorders. Larger, controlled
trials are needed to confirm the benefits of 5-Hz protocols observed in this pilot study.
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http://www.sciencedirect.com/science/article/pii/S875572231600020X
Baccalaureate Nursing Faculty Competencies and Teaching Strategies to Enhance the
Care of the Veteran Population: Perspectives of Veteran Affairs Nursing Academy
(VANA) Faculty.
Judy Carlson, EdD, APRN, FNP
Journal of Professional Nursing
Available online 12 January 2016
doi:10.1016/j.profnurs.2016.01.006
It is critical that faculty competencies, teaching strategies and the essential knowledge relating
to the care of our Veterans be delineated and taught to health care professionals in order for our
Veterans to receive optimal care. The purpose of this qualitative study was to ascertain from
nursing faculty members who have worked extensively with Veterans, the necessary faculty
competencies, essential knowledge and teaching strategies needed to prepare baccalaureate
level nurses to provide individualized, quality, and holistic care to Veterans. Six Veteran Affairs
Nursing Academy faculty members participated in two 2-hour focus group sessions.
There were a total of 12 multi-dimensional major concepts identified; 5 faculty competencies, 4
essential knowledge areas and 3 teaching strategies specifically related to Veteran Care.
The information generated can be used for: faculty, staff and or nurse development. Having a
comprehensive understanding of Veteran health care needs enable effective patient centered
care delivery to Veterans, which is the the gold standard in health care our Veterans deserve.
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http://www.annfammed.org/content/14/1/54.short
Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient
Populations.
Jeffrey F. Scherrer, Joanne Salas, Laurel A. Copeland, Eileen M. Stock, Brian K. Ahmedani,
Mark D. Sullivan, Thomas Burroughs, F. David Schneider, Kathleen K. Bucholz, and Patrick J.
Lustman
23. Annals of Family Medicine
January/February 2016 14:54-62
doi:10.1370/afm.1885
PURPOSE
Recent results suggests the risk of a new onset of depression increases with longer duration of
opioid analgesic use. It is unclear whether new-onset depression related to opioid analgesic use
is a function of the dose prescribed or the duration of use or both.
METHODS
Using a retrospective cohort design, we collected patient data from 2000 to 2012 from the
Veterans Health Administration (VHA), and from 2003 to 2012 from both Baylor Scott & White
Health (BSWH) and the Henry Ford Health System (HFHS). Patients (70,997 VHA patients,
13,777 BSWH patients, and 22,981 HFHS patients) were new opioid users, aged 18 to 80
years, without a diagnosis of depression at baseline. Opioid analgesic use duration was defined
as 1 to 30, 31 to 90, and more than 90 days, and morphine equivalent dose (MED) was defined
as 1 to 50 mg/d, 51 to 100 mg/d, and greater than 100 mg/d of analgesic. Pain and other
potential confounders were controlled for by inverse probability of treatment–weighted
propensity scores.
RESULTS
New-onset depression after opioid analgesic use occurred in 12% of the VHA sample, 9% of the
BSWH sample, and 11% of the HFHS sample. Compared with 1- to 30-day users, new-onset
depression increased in those with longer opioid analgesic use. Risk of new-onset depression
with 31 to 90 days of opioid analgesic use ranged from hazard ratio [HR] = 1.18 (95% CI, 1.10–
1.25) in VHA to HR = 1.33 (95% CI, 1.16–1.52) in HFHS; in opioid analgesic use of more than
90 days, it ranged from HR = 1.35 (95% CI, 1.26–1.44) in VHA to HR = 2.05 (95% CI, 1.75–
2.40) in HFHS. Dose was not significantly associated with a new onset of depression.
CONCLUSIONS
Opioid-related new onset of depression is associated with longer duration of use but not dose.
Patients and practitioners should be aware that opioid analgesic use of longer than 30 days
imposes risk of new-onset depression. Opioid analgesic use, not just pain, should be
considered a potential source when patients report depressed mood.
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http://www.sciencedirect.com/science/article/pii/S0165178116300257
Virtual reality in the psychological treatment for mental health problems: An systematic
review of recent evidence.
Lucia R. Valmaggia, Leila Latif, Matthew J. Kempton, Maria Rus-Calafell
24. Psychiatry Research
Available online 12 January 2016
doi:10.1016/j.psychres.2016.01.015
The aim of this paper is to provide a review of controlled studies of the use of Virtual Reality in
psychological treatment (VRT). Medline, PsychInfo, Embase and Web of Science were
searched. Only studies comparing immersive virtual reality to a control condition were included.
The search resulted in 1180 articles published between 2012 and 2015, of these, 24 were
controlled studies. The reviewed studies confirm the effectiveness of VRT compared to
treatment as usual, and show similar effectiveness when VRT is compared to conventional
treatments. Current developments and future research are discussed.
-----
http://www.jneurosci.org/content/36/2/419.abstract
Post-Traumatic Stress Constrains the Dynamic Repertoire of Neural Activity.
Bratislav Mišić, Benjamin T. Dunkley, Paul A. Sedge, Leodante Da Costa, Zainab Fatima, Marc
G. Berman, Sam M. Doesburg, Anthony R. McIntosh, Richard Grodecki, Rakesh Jetly, Elizabeth
W. Pang, and Margot J. Taylor
The Journal of Neuroscience
13 January 2016, 36(2):419-431
doi:10.1523/JNEUROSCI.1506-15.2016
Post-traumatic stress disorder (PTSD) is an anxiety disorder arising from exposure to a
traumatic event. Although primarily defined in terms of behavioral symptoms, the global
neurophysiological effects of traumatic stress are increasingly recognized as a critical facet of
the human PTSD phenotype. Here we use magnetoencephalographic recordings to investigate
two aspects of information processing: inter-regional communication (measured by functional
connectivity) and the dynamic range of neural activity (measured in terms of local signal
variability). We find that both measures differentiate soldiers diagnosed with PTSD from soldiers
without PTSD, from healthy civilians, and from civilians with mild traumatic brain injury, which is
commonly comorbid with PTSD. Specifically, soldiers with PTSD display inter-regional
hypersynchrony at high frequencies (80–150 Hz), as well as a concomitant decrease in signal
variability. The two patterns are spatially correlated and most pronounced in a left temporal
subnetwork, including the hippocampus and amygdala. We hypothesize that the observed
hypersynchrony may effectively constrain the expression of local dynamics, resulting in less
variable activity and a reduced dynamic repertoire. Thus, the re-experiencing phenomena and
affective sequelae in combat-related PTSD may result from functional networks becoming
“stuck” in configurations reflecting memories, emotions, and thoughts originating from the
traumatizing experience.
25. SIGNIFICANCE STATEMENT
The present study investigates the effects of post-traumatic stress disorder (PTSD) in combat-
exposed soldiers. We find that soldiers with PTSD exhibit hypersynchrony in a circuit of
temporal lobe areas associated with learning and memory function. This rigid functional
architecture is associated with a decrease in signal variability in the same areas, suggesting that
the observed hypersynchrony may constrain the expression of local dynamics, resulting in a
reduced dynamic range. Our findings suggest that the re-experiencing of traumatic events in
PTSD may result from functional networks becoming locked in configurations that reflect
memories, emotions, and thoughts associated with the traumatic experience.
-----
http://psycnet.apa.org/journals/mil/28/1/25/
Firearms matter: The moderating role of firearm storage in the association between
current suicidal ideation and likelihood of future suicide attempts among United States
military personnel.
Khazem, Lauren R.; Houtsma, Claire; Gratz, Kim L.; Tull, Matthew T.; Green, Bradley A.;
Anestis, Michael D.
Military Psychology
Vol 28(1), Jan 2016, 25-33
http://dx.doi.org/10.1037/mil0000099
The relationship between firearm ownership and suicide is well documented. This study
hypothesized that how soldiers store their firearms would moderate the relationship between
suicidal ideation and the self-reported likelihood of engaging in a future suicide attempt, and that
this relationship would be explained by fearlessness about death. There were 432 military
personnel (91.3% men, 74.2% White, Mage = 27.60) who endorsed current ownership of a
private firearm and who were recruited from a military base in the southeastern United States
(94.5% National Guard). Firearm storage moderated the relationship between suicidal ideation
and the self-reported likelihood of engaging in a future suicide attempt, but this relationship was
not explained by fearlessness about death. Individuals who reported keeping their firearms
loaded and stored in an unsecure location exhibited higher mean levels of fearlessness about
death. Findings highlight the need for research examining contributors to suicide risk in the
context of firearm storage, and provide support for suicide prevention efforts involving restricting
means. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-----
26. Links of Interest
Cost-effectiveness study supports preoperative cognitive-behavioral therapy for lumbar spinal
fusion
http://www.healio.com/spine-surgery/lumbar/news/online/%7B3d77125d-cd29-43f9-8997-
0f6268fa1f5f%7D/cost-effectiveness-study-supports-preoperative-cognitive-behavioral-therapy-
for-lumbar-spinal-fusion
More Sexual Assault Reports Show Growing Trust in System
www.defense.gov/News-Article-View/Article/641951/more-sexual-assault-reports-show-growing-
trust-in-system
Transcendental Meditation may reduce PTSD symptoms, medication use in active-duty
personnel
http://medicalxpress.com/news/2016-01-transcendental-meditation-ptsd-symptoms-
medication.html
Best Practices for Faculty Teaching Student Veterans
http://www.lydiawilkes.com/best-practices-for-teaching-student-veterans.html
Veterans Are Fighting the War on Sleep
http://motherboard.vice.com/read/veterans-are-fighting-the-war-on-sleep
A Deadly Deployment, a Navy SEAL’s Despair
http://mobile.nytimes.com/2016/01/20/world/asia/navy-seal-team-4-suicide.html
Department of Defense Releases Third Quarter Calendar Year 2015 Suicide Information
http://www.defense.gov/News/News-Releases/News-Release-View/Article/639842/department-
of-defense-releases-third-quarter-calendar-year-2015-suicide-informa
Repeated Blasts Linked to Brain Changes in Combat Vets
https://www.nlm.nih.gov/medlineplus/news/fullstory_156682.html
Medical experts look beyond drugs for sleep solutions
http://www.army.mil/article/160260/Medical_experts_look_beyond_drugs_for_sleep_solutions/
-----
Resource of the Week - Research Brief: Assessing the Department of Defense's
Approach to Reducing Mental Health Stigma
This RAND Corporation research brief finds that “Overall, current stigma-reduction efforts within
DoD are aligned with best practices and may be contributing to a decline in self-reported
stigma.” It puts forth a number of recommendations to further increase the effectiveness of
27. DoD’s efforts, including:
● Explore interventions that directly increase treatment-seeking beyond just stigma
reduction.
● Put evidence-based approaches in place that empower service members who have
mental health concerns to support their peers.
● Embed stigma-reduction interventions in clinical treatment.
● Implement and evaluate stigma-reduction programs targeting service members who
have not yet developed symptoms of mental illness.
● Examine the dynamic nature of stigma and how it interacts with internal and external
conditions over time.
● Improve measures of prevalence to improve tracking of stigma and other barriers to
care.
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Shirl Kennedy
Research Editor
Center for Deployment Psychology
www.deploymentpsych.org
skennedy@deploymentpsych.org
301-816-4749