Trauma, resilience and saliostasis: effects of treatment in post-traumatic stress disorder Cognitive therapy for post-traumatic stress disorder: development and evaluation. Attentional bias in post-traumatic stress disorder diminishes after symptom amelioration. Interference control training for PTSD: A randomized controlled trial of a novel computer-based intervention. Hurt people who hurt people: violence amongst individuals with comorbid substance use disorder and post traumatic stress disorder. Post-traumatic Stress Disorder Post Partum: The Impact of Birth on the Prevalence of Post-traumatic Stress Disorder (PTSD) in Multiparous Women. Exercise augmentation compared to usual care for Post Traumatic Stress Disorder: A Randomised Controlled Trial (The REAP study: Randomised Exercise Augmentation for PTSD) Posttraumatic stress disorder in an urban population of young adults: risk factors for chronicity. The efficacy of eye movement desensitization and reprocessing for post-traumatic stress disorder and depression among Syrian refugees: results of a randomized controlled trial. Post-traumatic stress disorder (PTSD) is not a contraindication to gastric bypass in veterans with morbid obesity Naltrexone and Disulfiram in Patients with Alcohol Dependence and Comorbid Post-Traumatic Stress Disorder Effects of psychotherapy on regional cerebral blood flow during trauma imagery in patients with post-traumatic stress disorder: a randomized clinical trial. Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Dialectical Behaviour Therapy for Post-traumatic Stress Disorder after Childhood Sexual Abuse in Patients with and without Borderline Personality Disorder: A Randomised Controlled Trial Attention and memory dysfunction in posttraumatic stress disorder. Post-Traumatic Stress Disorder in Patients 3 Years after Aneurysmal Subarachnoid Haemorrhage A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events. A Pilot Study of the Effects of Mindfulness-Based Stress Reduction on Post-traumatic Stress Disorder Symptoms and Brain Response to Traumatic Reminders of Combat in Operation Enduring Freedom/Operation Iraqi Freedom Combat Veterans with Post-traumatic Stress Disorder The effect of flexible cognitive-behavioural therapy and medical treatment, including antidepressants on post-traumatic stress disorder and depression in traumatised refugees: pragmatic randomised controlled clinical trial. Can Asylum-Seekers with Posttraumatic Stress Disorder Be Successfully Treated? A Randomized Controlled Pilot Study PTSD, depression, and their comorbidity in relation to suicidality: cross-sectional and prospective analyses of a national probability sample of women. The impact of post-traumatic stress disorder on treatment outcomes for heroin dependence.
There has been growing interest in the concept of resilience and the question as to whether psychotropic medications or psychosocial treatments might have resilience-enhancing effects . This pilot study investigates resilience in a sample of patients with post-traumatic stress disorder ( PTSD ) before and after treatment . Effects of treatment with tiagabine , fluoxetine , sertraline alone , and sertraline with cognitive behavioural therapy on resilience were assessed using the Connor-Davidson Resilience Scale ( CD-RISC ) . Changes in resilience after treatment were measured and response to treatment was predicted from demographic , resilience and baseline disability measures . Changes in resilience following treatment were statistically significant . Items that showed the greatest change related to confidence , control , coping , knowing where to turn for help and adaptability . Items showing the least change related to religious and existential aspects of resiliency , effort , acting on a hunch , decision-making and goals . In linear and logistic regression models , gender , baseline CD-RISC score , baseline Sheehan Disability Scale score and an individual item from the CD-RISC scale , ‘ Sense of Humor ’ , were significant predictors of response to treatment . Treatment of PTSD significantly improved resilience and reduced symptoms in this sample . Further controlled studies are indicated The paper describes the development of a cognitive therapy ( CT ) program for  post-traumatic stress disorder ( PTSD )  that is based on a recent cognitive model ( Behav . Res . Therapy 38 ( 2000 ) 319 ) . In a consecutive case series , 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD , depression and anxiety .  A subsequent r and omized controlled trial compared CT ( N = 14 ) and a 3-month waitlist condition ( WL , N = 14 ) . CT led to large reductions in PTSD symptoms , disability , depression and anxiety , whereas the waitlist group did not improve . In both studies , treatment gains were well maintained at 6-month follow-up . CT was highly acceptable , with an overall dropout rate of only 3 % . The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70 - 2.82 ( self-report ) , and 2.07 ( assessor-rated ) . The controlled effect sizes for CT versus WL post-treatment scores were 2.25 ( self-report ) and 2.18 ( assessor-rated ) . As predicted by the cognitive model , good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions . Patient characteristics such as comorbidity , type of trauma , history of previous trauma , or time since the traumatic event did not predict treatment response , however , low educational attainment and low socioeconomic status were related to better outcome BACKGROUND Avoidance and hypervigilance to reminders of a traumatic event are among the main characteristics of post-traumatic stress disorder ( PTSD ) . Attentional bias toward aversive cues in PTSD has been hypothesized as being part of the dysfunction causing etiology and maintenance of PTSD . The aim of the present study was to investigate the cognitive strategy underlying attentional bias in PTSD and whether normal cognitive processing is restored after a treatment suppressing core PTSD symptoms . METHODS Nineteen healthy controls were matched for age , sex and education to 19 PTSD patients . We used the  emotional stroop and detection of target tasks , before and after an average of 4.1 sessions of eye movement desensitization and reprocessing ( EMDR ) therapy . RESULTS We found that on both tasks , patients were slower than controls in responding in the presence of emotionally negative words compared to neutral ones . After symptoms removal , patients no longer had attentional bias , and responded similarly to controls . CONCLUSION These results support the existence of an attentional bias in PTSD patients due to a disengagement difficulty . There was also preliminary evidence that the disengagement was linked to PTSD symptomatology . It should be further explored whether attentional bias and PTSD involve common brain mechanisms Post-traumatic stress disorder ( PTSD ) is a chronic and debilitating condition characterized by persistent intrusive memories . Although effective treatments exist for PTSD , there is a need for development of alternative treatments . Diminished ability to control proactive interference may contribute to re-experiencing symptoms and may be a novel intervention target . The present study tested an intervention design ed to modify proactive interference control clinical trials.gov identifier : ( NCT02139137 ) . Forty-two women with PTSD were r and omly assigned to a computerized cognitive training or a control condition . The impact of these programs on cognitive performance and symptoms was assessed . PTSD re-experiencing symptoms and interference control performance improved significantly more for individuals in the training group relative to those in the control group . Other PTSD and general distress symptoms improved equally over time in both groups . Cognitive training of this type may hold promise as a novel intervention for reducing PTSD symptoms , although the mechanism of action and implication s for models of PTSD requires future study AIMS The association between substance use disorder ( SUD ) and the perpetration of violence has been well documented . There is some evidence to suggest that the co-occurrence of post traumatic stress disorder ( PTSD ) may increase the risk for violence . This study aims to determine the prevalence of violence perpetration and examine factors related to violence amongst individuals with comorbid SUD and PTSD . DESIGN AND PARTICIPANTS Data was collected via interview from 102 participants recruited to a r and omised controlled trial of an integrated treatment for comorbid SUD and PTSD .  MEASUREMENTS The interview addressed demographics , perpetration of violent crime , mental health including aggression , substance use , PTSD , depression , anxiety and borderline personality disorder . FINDINGS Over half of participants reported committing violence in their lifetime and 16 % had committed violence in the past month . Bivariate associations were found between violence perpetration and trait aggression , higher levels of alcohol and cannabis use , lower levels of other opiate use , and experiencing more severe PTSD symptoms , particularly in relation to hyperarousal . When entered into a backward stepwise logistic regression however , only higher levels of physical aggression and more severe PTSD hyperarousal symptoms remained as independent predictors of violence perpetration . CONCLUSIONS These findings highlight the importance of assessing for PTSD amongst those with SUD particularly in forensic setting s. They also indicate that it is the hyperarousal symptoms of PTSD specifically that need to be targeted by interventions aim ed at reducing violence amongst individuals with SUD and PTSD Traumatic birth experiences may lead to serious psychological impairment . Recent studies show that a considerable number of women can develop post-traumatic stress disorder ( PTSD ) , in some cases in a subsyndromal form . Until now , the possibility that postpartum psychological symptoms might be a continuum of a pre-existing disorder in pregnancy has rarely been considered . This study therefore aim ed to evaluate the proportion of women who develop  post-traumatic stress disorder  as a result of childbirth . Material s and Methods : 56 multiparous women were recruited for the study . The diagnosis of PTSD was made according to the criteria for psychological disorders in the DSM-IV ( Diagnostics and Statistical Manual of Mental Disorders ) . The data were collected in structured interviews in the 30th to 38th week of gestation and in the 6th week post partum . Results : Of the 56 women participating , 52 ( 93 % ) completed the survey . Uncontrolled results showed that 21.15 % of the multiparous women met the full diagnostic PTSD criteria in the 6th week post partum . After the exclusion of all cases already characterised by all criteria or a subsyndromal form of PTSD caused by previous traumatisation , the PTSD rate was below 8 % at 6 weeks postpartum (= incidence rate of PTSD post partum ) . Conclusions : The present study is the first prospect i ve longitudinal study to demonstrate the occurrence of full criteria PTSD in multiparous women as a result of childbirth after having excluded pre-existing PTSD . The results of our study show a high prevalence rate of PTSD during pregnancy . A number of women report all aspects of post-traumatic stress disorder as a result of childbirth Background The physical wellbeing of people with mental health conditions can often be overlooked in order to treat the primary mental health condition as a priority . Exercise however , can potentially improve both the primary psychiatric condition as well as physical measures that indicate risk of other conditions such as diabetes mellitus and cardiovascular disease . Evidence supports the role of exercise as an important component of treatment for depression and anxiety , yet no r and omised controlled trials ( RCT 's ) have been conducted to evaluate the use of exercise in the treatment of people with post traumatic stress disorder (PTSD).This RCT will investigate the effects of structured , progressive exercise on PTSD symptoms , functional ability , body composition , physical activity levels , sleep patterns and medication usage . Methods and design Eighty participants with a Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV ) diagnosis of PTSD will be recruited . Participants will have no contraindications to exercise and will be cognitively able to provide consent to participate in the study .The primary outcome measures will be PTSD symptoms , measured through the PTSD Checklist Civilian ( PCL-C ) scale . Secondary outcome measures will assess depression and anxiety , mobility and strength , body composition , physical activity levels , sleep patterns and medication usage . All outcomes will be assessed by a health or exercise professional masked to group allocation at baseline and 12 weeks after r and omisation . The intervention will be a 12 week individualised program , primarily involving resistance exercises with the use of exercise b and s. A walking component will also be incorporated . Participants will complete one supervised session per week , and will be asked to perform at least two other non-supervised exercise sessions per week . Both intervention and control groups will receive all usual non-exercise interventions including psychotherapy , pharmaceutical interventions and group therapy . Discussion This study will determine the effect of an individualised and progressive exercise intervention on PTSD symptoms , depression and anxiety , mobility and strength , body composition , physical activity levels , sleep patterns and medication usage among people with a DSM-IV diagnosis of PTSD.Trial Registration OBJECTIVE Despite progress in epidemiologic research on posttraumatic stress disorder ( PTSD ) , little is known about factors that distinguish chronic from nonchronic PTSD . In a previous report , the authors identified a set of personal predispositions associated with PTSD following traumatic events in a general population sample of young adults . The purpose of this analysis was to identify characteristics of chronic PTSD and examine whether any of the suspected risk factors for PTSD was associated specifically with chronic PTSD . METHOD A r and om sample of 1,007 21- to 30-year-old members of a large health maintenance organization in the Detroit area was interviewed , using the National Institute of Mental Health Diagnostic Interview Schedule ( DIS ) , revised for DSM-III-R. The analysis was performed on data from 394 respondents who reported traumatic events , of whom 93 met criteria for PTSD . Chronic PTSD was defined as duration of symptoms for 1 year or more . RESULTS Persons with chronic PTSD ( N = 53 ) had , on the average , a significantly higher total number of PTSD symptoms and higher rates of overreactivity to stimuli that symbolized the stressor and interpersonal numbing than persons with nonchronic PTSD . The rates of one or more additional anxiety or affective disorders and a variety of medical conditions were higher in persons with chronic than nonchronic PTSD . Family history of antisocial behavior and female sex were associated specifically with chronic PTSD . CONCLUSIONS The findings suggest that chronic PTSD may be associated with specific risk factors and clinical features . Longitudinal data on the course of PTSD are needed to determine whether the distinct features and the medical and psychiatric histories of persons with chronic PTSD are complications attendant on a chronic course or coexisting disturbances that inhibit recovery BACKGROUND Previous research indicates a high prevalence of post-traumatic stress disorder ( PTSD ) and depression among refugees .  Eye movement desensitization and reprocessing ( EMDR ) is an effective treatment for PTSD for victims of natural disasters , car accidents or other traumatic events . The current study examined the effect of EMDR on symptoms of PTSD and depression by comparing the treatment with a wait-list control condition in Syrian refugees . METHOD Adult refugees located in Kilis Refugee Camp at the Turkish-Syrian border with a PTSD diagnosis were r and omly allocated to either EMDR  ( n = 37 ) or wait-list control  ( n = 33 ) conditions . All participants were assessed with the Mini-International Neuropsychiatric Interview Plus at pre-intervention , at 1 week after finishing the intervention and at 5 weeks after finishing the intervention . The main outcome measures were the Harvard Trauma Question naire ( HTQ ) and the Impact of Event Scale-Revised . The Beck Depression Inventory and the Hopkins Symptoms Checklist-25 were included as secondary outcome measures . The Trial Registration no. is NCT01847742 . RESULTS Mixed-model analyses adjusted for the baseline scores indicated a significant effect of group at post-treatment indicating that the EMDR therapy group showed a significantly larger reduction of PTSD symptoms as assessed with the HTQ . Similar findings were found on the other outcome measures . There was no effect of time or group × time interaction on any measure , showing that the difference between the groups at the post-treatment was maintained to the 5-week follow-up . CONCLUSIONS EMDR may be effective in reducing PTSD and depression symptoms among Syrian refugees with PTSD located in a refugee camp Background The veteran population is routinely screened for post-traumatic stress disorder ( PTSD ) . The prevalence of obesity in this population continues to increase . We examined whether weight loss outcomes in veterans with PTSD is comparable to results in veterans who do not suffer from PTSD , after gastric bypass .  We also examined the effect of bariatric surgery on PTSD symptoms . Methods This retrospective review of prospect i ve data compares veterans with and without PTSD who underwent laparoscopic gastric bypass .  Differences between the means of age , initial BMI , and percent excess weight loss were compared between the groups using a Student ’s t test . Pearson ’s χ2 was used to evaluate the relationship between a diagnosis of PTSD , major depressive disorder ( MDD ) , and other Axis I psychiatric disorders . A similar analysis was done to assess for a relationship between PTSD and obesity-related comorbidities , including diabetes mellitus ( DM ) , hypertension ( HTN ) , hyperlipidemia , and GERD . Results We identified 24 patients who had gastric bypass and a diagnosis of PTSD before surgery and compared them to those without PTSD . Both groups had a similar mean age and initial BMI . There was no significant difference between the percent excess weight lost after 1 year follow-up between the PTSD group ( 66 % ) and the non-PTSD group ( 72 % ) ( p = 0.102 ) . In assessing comorbid conditions , we found a significant association between the diagnosis of PTSD and MDD ( p = 0.002 ) , PTSD and other Axis I disorders ( p = 0.004 ) , and PTSD and GERD ( p = 0.002 ) . However , we saw no significant association between PTSD and DM ( p = 0.977 ) , HTN ( p = 0.332 ) , and obstructive sleep apnea ( OSA ) ( p = 0.676 ) . The severity of PTSD symptoms fluctuated in the postoperative period . Conclusions Veterans with PTSD have comparable weight loss to those without PTSD after gastric bypass . In addition , surgery does not seem to have an adverse effect on PTSD symptoms , although PTSD symptomatology tends to fluctuate over time . Further study in this patient population is warranted BACKGROUND Although disulfiram and naltrexone have been approved by the Food and Drug Administration for the treatment of alcoholism , the effect of these medications on alcohol use outcomes and on psychiatric symptoms is still unknown in patients with co-occurring disorders post-traumatic stress disorder ( PTSD ) . METHODS Patients ( n = 254 ) with a major Axis I psychiatric disorder and comorbid alcohol dependence were treated for 12 weeks in a medication study at three Veterans Administration outpatient clinics . R and omization included ( 1 ) open r and omization to disulfiram or no disulfiram ; and ( 2 ) double-blind r and omization to naltrexone or placebo . This result ed in four groups : ( 1 ) naltrexone alone ; ( 2 ) placebo alone ; ( 3 ) disulfiram and naltrexone ; or ( 4 ) disulfiram and placebo . Outcomes were measures of alcohol use , PTSD symptoms , alcohol craving , GGT levels and adverse events . RESULTS 93 individuals ( 36.6 % ) met DSM-IV criteria for PTSD . Subjects with PTSD had better alcohol outcomes with active medication ( naltrexone , disulfiram or the combination ) than they did on placebo ;  overall psychiatric symptoms of PTSD improved . Individuals with PTSD were more likely to report some side effects when treated with the combination . CONCLUSIONS The results of this study suggest that disulfiram and naltrexone are effective and safe for individuals with PTSD and comorbid alcohol dependence BACKGROUND Functional brain-imaging studies in post-traumatic stress disorder ( PTSD ) have suggested functional alterations in temporal and prefrontal cortical regions . Effects of psychotherapy on these brain regions have not yet been examined . METHOD Twenty civilian PTSD out- patients and 15 traumatized control subjects were assessed at baseline using psychometric ratings . Cerebral blood flow was measured using trauma script-driven imagery during 99mtechnetium hexamethyl-propylene-amine-oxime single-photon emission computed tomography scanning .  All 20 out- patients were r and omly assigned to treatment or wait-list conditions . Treatment was brief eclectic psychotherapy ( BEP ) in 16 weekly individual sessions . RESULTS At baseline , greater activation was found in the right insula and right superior/middle frontal gyrus in the PTSD group than in the control group . PTSD patients treated with BEP significantly improved on all PTSD symptom clusters compared to those on the waiting list . After effective psychotherapy , lower activation was measured in the right middle frontal gyrus , compared to the PTSD patients on the waiting list . Treatment effects on PTSD symptoms correlated positively with activation in the left superior temporal gyrus , and superior/middle frontal gyrus . CONCLUSIONS BEP induced clinical recovery in PTSD patients , and appeared to modulate the functioning of specific PTSD-related sites in the prefrontal cortical regions Prevalence of crime and noncrime civilian traumatic events , lifetime posttraumatic stress disorder ( PTSD ) , and PTSD in the past 6 months were assessed in a sample of U.S. adult women ( N = 4,008 ) .  R and om digit-dial telephone methods were used to identify study participants . Structured telephone interviews for assessment of specific crime or other traumatic event history and PTSD were conducted by trained female interviewers . Lifetime exposure to any type of traumatic event was 69 % , whereas exposure to crimes that included sexual or aggravated assault or homicide of a close relative or friend occurred among 36 % . Overall sample prevalence of PTSD was 12.3 % lifetime and 4.6 % within the past 6 months . The rate of PTSD was significantly higher among crime versus noncrime victims ( 25.8 % vs. 9.4 % ) . History of incidents that included direct threat to life or receipt of injury was a risk factor for PTSD . Findings are compared with data from other epidemiological studies . Results are discussed as they relate to PTSD etiology BACKGROUND The study estimates the relative importance of specific types of traumas experienced in the community in terms of their prevalence and risk of leading to posttraumatic stress disorder ( PTSD ) . METHODS A representative sample of 2181 persons in the Detroit area aged 18 to 45 years were interviewed by telephone to assess the lifetime history of traumatic events and PTSD , according to DSM-IV . Posttraumatic stress disorder was assessed with respect to a r and omly selected trauma from the list of traumas reported by each respondent , using a modified version of the Diagnostic Interview Schedule , Version IV , and the World Health Organization Composite International Diagnostic Interview . RESULTS The conditional risk of PTSD following exposure to trauma was 9.2 % . The highest risk of PTSD was associated with assaultive violence ( 20.9 % ) . The trauma most often reported as the precipitating event among persons with PTSD ( 31 % of all PTSD cases ) was sudden unexpected death of a loved one , an event experienced by 60 % of the sample , and with a moderate risk of PTSD ( 14.3 % ) . Women were at higher risk of PTSD than men , controlling for type of trauma . CONCLUSIONS The risk of PTSD associated with a representative sample of traumas is less than previously estimated . Previous studies have overestimated the conditional risk of PTSD by focusing on the worst events the respondents had ever experienced . Although recent research has focused on combat , rape , and other assaultive violence as causes of PTSD , sudden unexpected death of a loved one is a far more important cause of PTSD in the community , accounting for nearly one third of PTSD cases Background : Post-traumatic stress disorder ( PTSD ) with co-occurring severe psychopathology such as borderline personality disorder ( BPD ) is a frequent sequel of childhood sexual abuse ( CSA ) . CSA-related PTSD has been effectively treated through cognitive-behavioural treatments , but it remains unclear whether success can be achieved in patients with co-occurring BPD . The aim of the present study was to determine the efficacy of a newly developed modular treatment programme ( DBT-PTSD ) that combines principles of dialectical behaviour therapy ( DBT ) and trauma-focused interventions . Methods : Female patients ( n = 74 ) with CSA-related PTSD were r and omised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list . About half of the participants met the criteria for co-occurring BPD . Individuals with ongoing self-harm were not excluded . The primary outcomes were reduction of PTSD symptoms as assessed by the Clinician-Administered PTSD Scale ( CAPS ) and by the Posttraumatic Stress Diagnostic Scale ( PDS ) . Hierarchical linear models were used to compare improvements across treatment groups . Assessment s were carried out by blinded raters at admission , at end of treatment , and at 6 and 12 weeks post-treatment . Results : Under DBT-PTSD the mean change was significantly greater than in the control group on both the CAPS ( 33.16 vs. 2.08 ) and the PDS ( 0.70 vs. 0.14 ) . Between-group effect sizes were large and highly significant . Neither a diagnosis of BPD nor the severity or the number of BPD symptoms was significantly related to treatment outcome . Safety analyses indicated no increase in dysfunctional behaviours during the trial . Conclusion : DBT-PTSD is an efficacious treatment of CSA-related PTSD , even in the presence of severe co-occurring psychopathology such as BPD Attention and memory performances were studied in Persian Gulf War veterans with and without posttraumatic stress disorder ( PTSD ) diagnoses . Veterans diagnosed with PTSD showed relative performance deficiencies on  tasks of sustained attention , mental manipulation , initial acquisition of information , and retroactive interference .  Their performances were also characterized by errors of commission and intrusion . The tendency toward response disinhibition and intrusion on cognitive tasks was correlated positively with reexperiencing symptoms and negatively with avoidance-numbing symptoms . These cognitive deficit patterns are consistent with models of PTSD that emphasize the role of hyperarousal and implicate dysfunction of frontal-subcortical systems . Results suggest that intrusion of traumatic memories in PTSD may not be limited to trauma-related cognitions but instead reflects a more general pattern of disinhibition Background : Subarachnoid haemorrhage ( SAH ) from a ruptured intracranial aneurysm accounts for approximately 5 % of all strokes . Post-traumatic stress disorder ( PTSD ) is common in the early phase after recovery from aneurysmal SAH . The aim of our study was to examine the prevalence of PTSD 3 years after SAH , its predictors , and relationship with health-related quality of life ( HRQoL ) in patients living independently in the community . Methods : From a prospect ively collected cohort of 143 patients with aneurysmal SAH who visited our outpatient clinic 3 months after SAH , 94 patients ( 65.7 % ) completed a mailed question naire  3 years after  SAH . We assessed PTSD with the Impact of Event Scale and HRQoL with the Stroke-Specific Quality of Life Scale ( SS-QoL ) . The χ2 and t tests were used to investigate if patients who returned the question naires were different from those who did not reply . Non-parametric tests ( χ2 and Mann-Whitney tests ) were used to test for differences between patients with and without PTSD . Relative risks and 95 % confidence intervals were calculated . Results : No relevant differences in demographic ( age , sex , education ) or SAH characteristics ( clinical condition on admission , complication , location of aneurysm , Glasgow Outcome Scale score at 3 months ) were seen between participants and drop-outs . In 24 patients ( 26 % ) , Impact of Event Scale scores indicated PTSD . Passive coping style ( relative risk , 5.7 ; 95 % confidence interval , 2.1 - 15.3 ) , but none of the demographic or SAH-related factors , predicted PTSD . The mean SS-QoL total score was 4.2 ( SD 1.1 ) , indicative of a relatively satisfactory HRQoL. PTSD was associated with lower HRQoL ( p < 0.001 ) , a mean SS-QoL score of 4.4 ( SD 1.0 ) without PTSD , and a mean SS-QoL score of 3.5 ( SD 1.1 ) with PTSD . Conclusions : Even 3 years after SAH , 1 out of 4 patients had PTSD , which was associated with reduced HRQoL. Passive coping style was the most important predictor . There is a need to organize SAH care with more attention to and treatment of PTSD . Strategies shown to reduce PTSD in other conditions should be tested for effectiveness in SAH patients BACKGROUND Childbirth has been linked to postpartum impairment . However , controversy exists regarding the onset and prevalence of post-traumatic stress disorder ( PTSD ) after childbirth , with seminal studies being limited by method ological issues . This longitudinal prospect i ve study examined the prevalence of PTSD following childbirth in a large sample while controlling for pre-existing PTSD and affective symptomatology . METHOD Pregnant women in their third trimester were recruited over a 12-month period and interviewed to identify PTSD and anxiety and depressive symptoms during the last trimester of pregnancy , 4 - 6 weeks postpartum , 12 weeks postpartum and 24 weeks postpartum . RESULTS Of the 1067 women approached , 933 were recruited into the study . In total , 866 ( 93 % ) were retained to 4 - 6 weeks , 826 ( 89 % ) were retained to 12 weeks and 776 ( 83 % ) were retained to 24 weeks . Results indicated that , uncontrolled , 3.6 % of women met PTSD criteria at 4 - 6 weeks postpartum , 6.3 % at 12 weeks postpartum and 5.8 % at 24 weeks postpartum . When controlling for PTSD and partial PTSD due to previous traumatic events as well as clinical ly significant anxiety and depression during pregnancy , PTSD rates were less at 1.2 % at 4 - 6 weeks , 3.1 % at 12 weeks and 3.1 % at 24 weeks postpartum . CONCLUSIONS This is the first study to demonstrate the occurrence of full criteria PTSD result ing from childbirth after controlling for pre-existing PTSD and partial PTSD and clinical ly significant depression and anxiety in pregnancy . The findings indicate that PTSD can result from a traumatic birth experience , though this is not the normative response Objective Brain imaging studies in patients with post-traumatic stress disorder ( PTSD ) have implicated a circuitry of brain regions including the medial prefrontal cortex , amygdala , hippocampus , parietal cortex , and insula . Pharmacological treatment studies have shown a reversal of medial prefrontal deficits in response to traumatic reminders . Mindfulness-based stress reduction ( MBSR ) is a promising non-pharmacologic approach to the treatment of anxiety and pain disorders . The purpose of this study was to assess the effects of MBSR on PTSD symptoms and brain response to traumatic reminders measured with positron-emission tomography ( PET ) in Operation Enduring Freedom/Operation Iraqi Freedom ( OEF/OIF ) combat veterans with PTSD . We hypothesized that MBSR would show increased prefrontal response to stress and improved PTSD symptoms in veterans with PTSD . Method Twenty-six OEF/OIF combat veterans with PTSD who had recently returned from a combat zone were block r and omized to receive eight sessions of MBSR or present-centered group therapy ( PCGT ) . PTSD patients underwent assessment of PTSD symptoms with the Clinician-Administered PTSD Scale ( CAPS ) , mindfulness with the Five Factor Mindfulness Question naire ( FFMQ ) and brain imaging using PET in conjunction with exposure to neutral and Iraq combat-related slides and sound before and after treatment . Nine patients in the MBSR group and 8 in the PCGT group completed all study procedures . Results Post-traumatic stress disorder patients treated with MBSR ( but not PCGT ) had an improvement in PTSD symptoms measured with the CAPS that persisted for 6 months after treatment . MBSR also result ed in an increase in mindfulness measured with the FFMQ . MBSR-treated patients had increased anterior cingulate and inferior parietal lobule and decreased insula and precuneus function in response to traumatic reminders compared to the PCGT group . Conclusion This study shows that MBSR is a safe and effective treatment for PTSD . Furthermore , MBSR treatment is associated with changes in brain regions that have been implicated in PTSD and are involved in extinction of fear responses to traumatic memories as well as regulation of the stress response BACKGROUND Little evidence exists on the treatment of traumatised refugees . AIMS To estimate treatment effects of flexible cognitive-behavioural therapy ( CBT ) and antidepressants ( sertraline and mianserin ) in traumatised refugees . METHOD R and omised controlled clinical trial with 2 × 2 factorial design ( registered with Clinical trials.gov , NCT00917397 , EUDRACT no. 2008 - 006714 - 15 ) . Participants were refugees with war-related traumatic experiences , post-traumatic stress disorder ( PTSD ) and without psychotic disorder . Treatment was weekly sessions with a physician and /or psychologist over 6 months . RESULTS A total of 217 of 280 patients completed treatment ( 78 % ) . There was no effect on PTSD symptoms , no effect of psychotherapy and no interaction between psychotherapy and medicine . A small but significant effect of treatment with antidepressants was found on depression . CONCLUSIONS In a pragmatic clinical setting , there was no effect of flexible CBT and antidepressants on PTSD , and there was a small-to-moderate effect of antidepressants and psychoeducation on depression in traumatised refugees Rates of posttraumatic stress disorder ( PTSD ) are exceptionally high among asylum-seekers . Reportedly , stressors caused by the asylum procedure and psychological consequences of torture contribute to the maintenance of symptoms and interfere with treatment . In a pilot r and omized controlled trial , the authors examined the efficacy of trauma-focused treatment in 32 asylum-seekers with PTSD result ing from state-sponsored violence and other traumatic events .  Narrative exposure therapy ( NET ) was compared with treatment as usual ( TAU ) , with a focus on stabilization and psychoactive medication . Six months after treatment , a significant reduction of posttraumatic stress symptoms was found in the NET participants but not in the TAU group . Although treatment gains were moderate , these results indicate that NET is a promising approach for the treatment of PTSD in asylum-seekers living in unstable conditions BACKGROUND A growing body of literature implicates major depressive disorder ( MDD ) and posttraumatic stress disorder ( PTSD ) as risk factors for suicidal ideation ( SI ) and suicide attempts ( SA ) , though research has not adequately examined their differential contributions to increasing suicide risk prospect ively or cross-sectionally . METHODS The contribution of these disorders and their comorbidity to SI and SA was examined using a national household probability sample of women ( N=3,085 ) and covarying for trauma history , substance abuse , and demographic variables .  RESULTS Cross-sectional analyses indicated that lifetime comorbidity of MDD and PTSD were associated with much higher prevalence of SI than either diagnosis alone ; prevalence of SI was elevated and comparable for PTSD and MDD only . Comorbid diagnosis and PTSD only groups displayed greater prevalence of SA than those with MDD only . Lastly , a 2-year prospect i ve analysis indicated that PTSD only at baseline was predictive of greater subsequent SI risk than MDD only , though comorbid diagnosis did not differ from either PTSD only or MDD only . CONCLUSIONS PTSD appears to be a particularly strong predictor of SI and SA . Overall , only 16 % of women with lifetime SA did not have a history of MDD or PTSD , highlighting the importance of assessing these variables when assessing suicide risk AIMS To examine the impact of post-traumatic stress disorder ( PTSD ) on 2-year treatment outcomes for heroin dependence . DESIGN Prospect i ve longitudinal study . PARTICIPANTS Data were obtained from a predominantly treatment seeking sample of 615 dependent heroin users who were followed-up at 3 , 12 and 24 months ( follow-up rates : 89 % , 81 % and 76 % , respectively ) . MEASUREMENTS Outcomes examined include treatment retention and exposure , substance use , general physical and mental health and employment . FINDINGS Despite improvements in substance use , PTSD was associated with continued physical ( beta - 1.69 , SE 0.61 , P < 0.01 ) and mental disability ( beta - 2.07 , SE 0.66 , P < 0.01 ) , and reduced occupational functioning ( OR 0.67 , 95 % CI : 0.48 - 0.93 ) throughout the 2-year follow-up . CONCLUSIONS Although conventional treatment services are successful in producing improvements in substance use and associated disability , the disability associated with PTSD remains . An intervention targeting both heroin dependence and PTSD may help to improve the outcomes of those with PTSD
Of the medication classes , evidence of treatment efficacy was most convincing for the SSRIs .
In addition , medication was superior to placebo in reducing  comorbid depression and disability .
Medication was also less well tolerated than placebo .
A narrative review of the 3 maintenance trials suggested that long-term medication may be required in treating PTSD .
CONCLUSION Medication treatments can be effective in treating PTSD , acting to reduce its core symptoms , as well as associated depression and disability , and should be considered as part of the treatment of this disorder .
The findings of this review support the status of SSRIs as first-line agents in the pharmacotherapy of PTSD , as well as their value in longterm treatment .
BACKGROUND Post-traumatic stress disorder ( PTSD ) is a prevalent and disabling condition .
Evidence that PTSD is characterized by specific psychobiological dysfunctions has contributed to a growing interest in use of medication in its treatment .
OBJECTIVES To assess the effects of medication in the treatment of PTSD .