Treatment decision-making for posttraumatic stress disorder: The impact of patient and therapist characteristics.

Objective: The purpose of this study was to assess how patient and provider factors influence the use of evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD).

Method: This study used a 2 × 2 survey design to assess providers' willingness to select EBPs for patients presented in clinical case vignettes. PTSD providers (N = 185) were randomized and asked to respond to 1 of 4 case vignettes in which the patients' age and alcohol use comorbidity were manipulated.

Ketamine Treatment and Global Brain Connectivity in Major Depression.

Capitalizing on recent advances in resting-state functional connectivity magnetic resonance imaging (rs-fcMRI) and the distinctive paradigm of rapid mood normalization following ketamine treatment, the current study investigated intrinsic brain networks in major depressive disorder (MDD) during a depressive episode and following treatment with ketamine. Medication-free patients with MDD and healthy control subjects (HC) completed baseline rs-fcMRI. MDD patients received a single infusion of ketamine and underwent repeated rs-fcMRI at 24 h posttreatment.

Effect of Patient-Therapist Gender Match on Psychotherapy Retention Among United States Veterans with Posttraumatic Stress Disorder.

Extant literature suggests that patient-therapist gender matching may be associated with psychotherapy retention. We examined this relationship in a national cohort of Veterans (n = 506,471) initiating psychotherapy for posttraumatic stress disorder (PTSD) using multivariate logistic regression models. Overall, women were retained in psychotherapy at higher rates than men.

Punishment Learning in U.S. Veterans With Posttraumatic Stress Disorder.

Learning processes have been implicated in the development and course of posttraumatic stress disorder (PTSD); however, little is currently known about punishment-based learning in PTSD. The current study investigated impairments in punishment-based learning in U.S.

System-Wide Implementation of Routine Outcome Monitoring and Measurement Feedback System in a National Network of Operational Stress Injury Clinics.

This manuscript reviews the development and implementation process of the Client Reported Outcome Monitoring Information System in the VA Canada Operational Stress Injury National Network, and reports on outcomes of an evaluation to assess usage, barriers, and facilitators to implementation. The majority of clinicians reported regular use of routine outcomes monitoring, although objective data suggested somewhat lower actual use. In general, clinicians endorsed all barriers and most facilitators as influencing their use of routine outcomes monitoring in a minor way.

Genome-wide significant loci for addiction and anxiety.

Background: Psychiatric comorbidity is common among individuals with addictive disorders, with patients frequently suffering from anxiety disorders. While the genetic architecture of comorbid addictive and anxiety disorders remains unclear, elucidating the genes involved could provide important insights into the underlying etiology.

Methods: Here we examine a sample of 1284 Mexican-Americans from randomly selected extended pedigrees.

Reduced global functional connectivity of the medial prefrontal cortex in major depressive disorder.

Background: Major depressive disorder is a disabling neuropsychiatric condition that is associated with disrupted functional connectivity across brain networks. The precise nature of altered connectivity, however, remains incompletely understood. The current study was designed to examine the coherence of large-scale connectivity in depression using a recently developed technique termed global brain connectivity.

Investigating the Aftermath of Terror: Fundamental Outcomes, Methodological Choices, and Future Directions.

Acts of terrorism are becoming increasingly common throughout the world. These events represent a significant public health concern given the associated health consequences. Although it is clear that terrorist attacks have mental and physical health sequelae, the exact nature and prevalence of these consequences are unclear.

The impact of proposed changes to ICD-11 on estimates of PTSD prevalence and comorbidity.

The World Health Organization's posttraumatic stress disorder (PTSD) work group has published a proposal for the forthcoming edition of the International Classification of Diseases (ICD-11) that would yield a very different diagnosis relative to DSM-5. This study examined the impact of the proposed ICD-11 changes on PTSD prevalence relative to the ICD-10 and DSM-5 definitions and also evaluated the extent to which these changes would accomplish the stated aim of reducing the comorbidity associated with PTSD. Diagnostic prevalence estimates were compared using a U.

Brief treatment for PTSD: A non-inferiority trial.

Prior studies have identified several psychosocial treatment approaches as effective for posttraumatic stress disorder (PTSD). Unfortunately, a substantial minority of individuals who receive these treatments drop out prematurely. Moreover, a considerable number of individuals in need of PTSD treatment do not present for treatment due to time constraints and other barriers to care.

Consistency of Reporting for Stressful Life Events Among Nondeployed Soldiers.

Objectives: Measurement of stress exposure is central to understanding military mental health outcomes. Although temporal stability of combat event reporting has been examined, less is known about the stability of reporting for noncombat events in military samples. Objectives are to examine consistency in reporting stressful life events in nondeployed U.

Sleep disturbance in chronic military-related PTSD: clinical impact and response to adjunctive risperidone in the Veterans Affairs cooperative study #504.

Objective: Sleep disturbances are common among veterans with chronic military-related posttraumatic stress disorder (PTSD). This article reports the results of a multicenter clinical trial that explored the clinical correlates of reported sleep impairment in these veterans and tested the impact of the second-generation antipsychotic risperidone upon these symptoms.

Method: This article reports secondary analyses of a 24-week multicenter randomized placebo-controlled trial of adjunctive risperidone in patients with chronic military-related PTSD symptoms (n = 267, 97% male) who were symptomatic despite treatment with antidepressants and other medications.

CRITICAL ANALYSIS OF THE CURRENT TREATMENT GUIDELINES FOR COMPLEX PTSD IN ADULTS.

According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a "stabilization phase." This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused treatment. The purpose of this paper is to critically evaluate the research underlying these treatment guidelines for cPTSD, and to specifically address the question as to whether a phase-based approach is needed.

Patterns of anterior versus posterior white matter fractional anistotropy concordance in adult nonhuman primates: Effects of early life stress.

Introduction: Functional neuroimaging studies report global prefrontal dysconnectivity in mood disorders, supporting the notion of widespread disruptions in brain networks. Microscopic alterations in white matter (WM) tracts - which possess neuroplastic properties and play a central role in brain connectivity - are interrogated herein in the context of brain dysconnectivity. Early life stress (ELS), an antecedent to human mood disorders, induces WM alterations in volumetrics and integrity.

Glutamate and norepinephrine interaction: Relevance to higher cognitive operations and psychopathology.

Mather and colleagues present an impressive interdisciplinary model of arousal-induced norepinephrine release and its role in selectively enhancing/inhibiting perception, attention, and memory consolidation. This model will require empirical investigation to test its validity and generalizability beyond classic norepinephrine circuits because it simplifies extremely complex and heterogeneous actions including norepinephrine mechanisms related to higher cognitive circuits and psychopathology.

Cognitive-behavioral group treatment for veterans diagnosed with PTSD: Design of a hybrid efficacy-effectiveness clinical trial.

Despite significant advances in individual treatment approaches for PTSD, knowledge of group approaches has lagged behind. Much of the reason knowledge about group treatment for PTSD has been limited is due to the complexity of conducting randomized controlled trials in the group treatment context. This limited empirical knowledge is unfortunate given the frequency with which group treatment for PTSD is used in clinical settings, including the Department of Veteran Affairs.

Decreased SGK1 Expression and Function Contributes to Behavioral Deficits Induced by Traumatic Stress.

Exposure to extreme stress can trigger the development of major depressive disorder (MDD) as well as post-traumatic stress disorder (PTSD). The molecular mechanisms underlying the structural and functional alterations within corticolimbic brain regions, including the prefrontal cortex (PFC) and amygdala of individuals subjected to traumatic stress, remain unknown. In this study, we show that serum and glucocorticoid regulated kinase 1 (SGK1) expression is down-regulated in the postmortem PFC of PTSD subjects.

Perceptual distortions and delusional thinking following ketamine administration are related to increased pharmacological MRI signal changes in the parietal lobe.

Ketamine produces effects in healthy humans that resemble the positive, negative and cognitive symptoms of schizophrenia. We investigated the effect of ketamine administration on brain activity as indexed by blood-oxygen-level-dependent (BOLD) signal change response, and its relationship to ketamine-induced subjective changes, including perceptual distortion. Thirteen healthy participants volunteered for the study.

Differential effects of prolonged exposure on posttraumatic stress disorder symptoms in female veterans.

Objective: We compared the effect of Prolonged Exposure (PE) on posttraumatic stress disorder (PTSD) symptom clusters and individual symptoms relative to a nonspecific comparison therapy (present-centered therapy; PCT) to identify the unique benefits of PE. We used data from a 12-site randomized clinical trial that found PE to be more effective than PCT for reducing PTSD symptom severity.

Method: Participants were 284 female veterans and active duty soldiers with PTSD (M age = 44.

Establishing a methodology to examine the effects of war-zone PTSD on the family: the family foundations study.

Military deployment may adversely affect not only returning veterans, but their families, as well. As a result, researchers have increasingly focused on identifying risk and protective factors for successful family adaptation to war-zone deployment, re-integration of the returning veteran, and the longer-term psychosocial consequences of deployment experienced by some veterans and families. Post-traumatic stress disorder (PTSD) among returning veterans may pose particular challenges to military and military veteran families; however, questions remain regarding the impact of the course of veteran PTSD and other potential moderating factors on family adaptation to military deployment.

System-Level Influences on the Sustainability of a Cognitive Therapy Program in a Community Behavioral Health Network.

Objective: The purpose of this study was to examine influences on the sustainability of a program to implement an evidence-based psychotherapy in a mental health system.

Methods: Interviews with program administrators, training consultants, agency administrators, and supervisors (N=24), along with summaries of program evaluation data and program documentation, were analyzed with a directed content-analytic approach.

Results: Findings suggested a number of interconnected and interacting influences on sustainability, including alignment with emerging sociopolitical influences and system and organizational priorities; program-level adaptation and evolution; intervention flexibility; strong communication, collaboration, planning, and support; and perceived benefit.

African American and European American veterans' perspectives on receiving mental health treatment.

Little is known about client attitudes, especially veterans', toward the types of structured interventions that are increasingly being offered in public sector and U.S. Department of Veterans Affairs mental health clinics, nor is the possible impact these attitudes may have on treatment engagement well understood.

Postdoctoral training in posttraumatic stress disorder research.

Postdoctoral training is increasingly common in the field of psychology. Although many individuals pursue postdoctoral training in psychology, guidelines for research training programs at this level do not exist. The rapid advances in the field, particularly with respect to genetics, neuroimaging, and data analytic approaches, require clinical scientists to possess knowledge and expertise across a broad array of areas.