Focusing On Employment Early Improves Success In Veterans with PTSD

MedicalResearch.com Interview with:

Dr. Lori Davis, MD Research and Development Service, Tuscaloosa Veterans Affairs (VA) Medical Center, Department of Psychiatry, School of Medicine, University of Alabama, Tuscaloosa Tuscaloosa, Alabama

Dr. Davis

Dr. Lori Davis, MD
Research and Development Service, Tuscaloosa Veterans Affairs (VA) Medical Center,
Department of Psychiatry, School of Medicine, University of Alabama, Tuscaloosa
Tuscaloosa, Alabama

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Symptoms of posttraumatic stress disorder (PTSD) interfere with a person’s ability to function at work, making it harder to stay employed and establish oneself in a career.  Veterans with PTSD are uniquely challenged given their motivation to serve others, be leaders and not be generally receptive to reaching out for help.

Conventional wisdom about PTSD and employment has traditionally been to first commit to treatment, learn coping skills, manage one’s symptoms and then reintegrate into mainstream employment. However, this view is being transformed by our research that suggests a more assertive recovery-oriented approach to the treatment of PTSD that involves returning to meaningful competitive employment as soon as possible.

This study compared Evidence-based Supported Employment (also known as Individual Placement and Support or IPS) integrated within PTSD treatment teams to the treatment as usual Transitional Work model offered within the VA. This multisite trial demonstrated significantly greater effectiveness of the IPS-supported employment over stepwise, transitional work vocational rehabilitation for Veterans living with chronic PTSD.

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Modeling Intelligence As Ability To Access Multiple Brain States

MedicalResearch.com Interview with:

Glenn N. Saxe, MD Professor of Child & Adolescent Psychiatry  Hassenfeld Children’s Hospital at NYU Langone Department of Child and Adolescent Psychiatry Child Study Center, One Park Avenue New York, NY 10016

Dr. Saxe

Glenn N. Saxe, MD
Professor of Child & Adolescent Psychiatry
Hassenfeld Children’s Hospital at NYU Langone
Department of Child and Adolescent Psychiatry
Child Study Center, One Park Avenue
New York, NY 10016 

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by brain entropy and how it relates to intelligence?

Response: Think of human intelligence as the capacity for a human being to understand their complex and ever-changing world. The world of a person is really complex and constantly in flux so the human brain must be ready to understand whatever may come – when there is no way beforehand to predict what might come. How does the brain understand its world? It creates specific models of the information it receives through specific patterns of neuronal connection. These are called brain states. The way the brain understands its world is largely through using such models, or brain states, to accurately predict what comes next. So you can see that for an intelligent brain to properly understand and predict events in the world, it will need to have access to a very, very large number of brain states. And this is how entropy is defined.

Entropy is a very old and very powerful concept in the history of science. Not only is it fundamental for thermodynamics – what we learned in high school physics – but it is also fundamental for the nature of information and it’s processing. Entropy is defined as the number of states – or distinct configurations – any system has access to at any point in time. High entropy means access to a very large number of states. Low entropy means access to a very small number of states. A solid is a phenomenon with very low entropy. A gas is a phenomenon with very high entropy. Life, and the brain, are somewhere in between.

Although it is impossible to precisely measure the number of states a brain has access to at any one moment, there is a highly related concept that can be measured. A system with access to a very high number of possible states (like a gas) has components with behavior that is highly unpredictable. A system with access to very few possible states (like a solid) has components whose behavior is highly predictable. We measured brain entropy through the predictability of the brains components at the smallest scale we had access to: what are called voxels in an fMRI scan. These are 3mm cubes of neurons in a functional MRI scan, and there are many thousands of these voxels in our measurement and each of these voxels contains information on the activity of hundreds of thousands of neurons. We measured the predictability of each of these voxels and then found clusters of voxels where their predictability – or entropy – was related to intelligence.

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Short-Term Prolonged Exposure Therapy Found Effective in PTSD Trial

MedicalResearch.com Interview with:
“Man’s best friend helps NC Guardsman with PTSD [Image 1 of 8]” by DVIDSHUB is licensed under CC BY 2.0, PhD

Professor of Psychiatry
Director, Center for the Treatment and Study of Anxiety
University of Pennsylvania
Philadelphia, Pa 19104

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As much as 10 to 20 percent of military members deployed to Iraq and Afghanistan following the September 11th attacks suffer from PTSD, which is often chronic and incapacitating. A constant increase in the number of individuals suffering from PTSD as a result of massive natural disasters, terror attacks, and the wars in Iraq and Afghanistan, has prompted an urgent need for effective and efficient evidence-based treatments for PTSD.

Prolong exposure (PE) is a form of cognitive-behavioral therapy that involves exposure to trauma memories and daily life trauma reminders. Previous studies have proven PE is quite effective for treating civilians and veterans with PTSD. In this five-year study, the researchers sought to determine whether PE could have similar success with active-duty military personnel. The researchers examined the benefit of various methods for delivering PE including Massed-PE, (10 therapy sessions administered over two weeks) and Spaced-PE (10 sessions administered over 8 weeks), as well as Present Centered Therapy (PCT), a non-trauma-focused therapy that involves identifying and discussing daily stressors in 10 sessions over eight weeks, and Minimal Contact Control (MCC), which included supportive phone calls from therapists once weekly for four weeks.

Patients who received Massed-PE therapy, delivered over two weeks, saw a greater reduction in PTSD symptoms than those who received MCC. Importantly, Massed-PE therapy was found to be equally effective to Spaced-PE in reducing PTSD symptom severity. The researchers also found that PCT might be an effective treatment option for PTSD in active military personnel although it was less effective than PE in veteran and civilian PTSD sufferers.  Continue reading

Virtual Human Interviewers May Help Armed Services Members Open Up About PTSD

MedicalResearch.com Interview with:

Dr. Gale Lucas, PhD Director of Research USC Institute for Creative Technologies Playa Vista, CA 

Dr. Lucas

Dr. Gale Lucas, PhD
Director of Research
USC Institute for Creative Technologies
Playa Vista, CA

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: A common barrier to healthcare for psychiatric conditions is the stigma associated with these disorders. Perceived stigma prevents many from reporting their symptoms. Stigma is a particularly pervasive problem among military service members, preventing them from reporting symptoms of combat-related conditions like posttraumatic stress disorder (PTSD).

This put them at risk for having their symptoms go untreated, with possible disastrous outcomes including suicide attempts. We envisioned a technology system – a virtual human interviewer – whereby military service members can get feedback about their risk for PTSD in a safe place without stigma. Indeed, our prior research has shown that, because its “just a computer” (therefore safe and anonymous), this virtual human interviewer helps people to feel safe discussing sensitive issues like mental health symptoms. In this follow-up research project (published in Frontiers), we sought to demonstrate the value of this kind of virtual human interviewer specifically for encouraging reporting of PTSD symptoms among service members.

Specifically, we were interested in comparing the willingness of service members to report symptoms of PTSD to our virtual human interviewer, compared to the gold standard of the Post Deployment Health Assessment (PDHA). We wanted to isolate the effect of anonymity, separating it from “relational factors” that the virtual human interviewer uses to encourage service members to open up. Indeed, before asking these same questions as on the PDHA to capture PTSD symptoms, the system engages in social dialogue, which build rapport with users. The system asks “get to know you questions,” and throughout the interview, engage in active listening with responses such as nods, smiles, saying “uh huh,” and other encouraging phrases like “that’s great.”

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Stepped Care Case-Finding Intervention Can Provide Cost Effective Care For PTSD After a Disaster

MedicalResearch.com Interview with:

Dr-Gregory-H-Cohen.jpg 

Dr. Cohen

Gregory H. Cohen, MPhil, MSW
Statistical Analyst
Department of Epidemiology
School of Public Health
Boston University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We simulated a stepped care case-finding approach to the treatment of posttraumatic stress in New York City, in the aftermath of Hurricane Sandy.

Stepped care includes an initial triage screening step which identifies whether a presenting individual is in need of Cognitive Behavioral Therapy, or can be adequately treated at a lower level of care.

Our simulation suggests that a stepped care approach to treating symptoms of posttraumatic stress in the aftermath of a hurricane is superior to care as usual in terms of reach and treatment-effectiveness, while being cost-effective. Continue reading

Weakening Neural Connections Can Eliminate Fearful Memories

MedicalResearch.com Interview with:

Jun-Hyeong Cho MD PhD Department of Molecular, Cell and Systems Biology University of California, Riverside Riverside, CA 92521

Dr. Jun-Hyeong Cho

Jun-Hyeong Cho MD PhD
Department of Molecular, Cell and Systems Biology
University of California, Riverside
Riverside, CA 92521

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: To survive in a dynamic environment, animals develop fear responses to dangerous situations. For these adaptive fear responses to be developed, the brain must discriminate between different sensory cues and associate only relevant stimuli with aversive events.

In our current study, we investigated the neural mechanism how the brain does this, using a mouse model of fear learning and memory. Our study demonstrates that the formation of fear memory associated with an auditory cue requires selective synaptic strengthening in neural pathways that convey the auditory signals to the amygdala, an essential brain area for fear learning and memory.

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Functional Brain Markers Can Suggest Susceptibility to PTSD

MedicalResearch.com Interview with:

Jennifer Stevens, PhD Director, Neuroscience of Memory, Emotion, and Stress Laboratory Instructor, Dept of Psychiatry & Behavioral Sciences Emory University School of Medicine

Dr. Stevens

Jennifer Stevens, PhD
Director, Neuroscience of Memory, Emotion, and Stress Laboratory
Instructor, Dept of Psychiatry & Behavioral Sciences
Emory University School of Medicine

MedicalResearch.com: What is the background for this study? 

Response: Post-traumatic stress disorder (PTSD) was once thought to be a disorder of combat veterans, however, we now know that more than 60% of Americans experience a traumatic event during their lifetimes, and that this can have negative consequences for mental and physical health. Many people recover from the psychological effects of trauma without any intervention, but a significant proportion have long-lasting debilitating symptoms.

Supported by the NIH, the cutting edge of PTSD research includes new strategies for preventing the disease, rather than treating PTSD after patients have been living with symptoms for months to years. In order to prevent the disease, it is critical that we are able to quickly identify people who will be at risk for the disease following a trauma, so that preventive strategies can be deployed bedside in the emergency room or in the battlefield. In the current study, we used functional MRI to predict which individuals would recover from trauma, and which individuals would have long-lasting symptoms of PTSD.

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Genetic Factors Raise Risk of PTSD After Trauma, Especially in Women

MedicalResearch.com Interview with:

Laramie E Duncan, PhD</strong> Stanford University

Dr. Duncan

Laramie E Duncan, PhD
Stanford University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Posttraumatic stress disorder (PTSD) is a mental health condition that some people experience after a traumatic event, like a terrorist attack, military conflict, or violence in the home. When people have PTSD, they may experience flashbacks to the traumatic event, nightmares, and other recollections of the event that can interfere with their day-to-day lives.

Before this study, not everyone was convinced that genetic factors make some people more prone to developing PTSD than others. Using a study of over 20,000 people and analyzing over two hundred billion (200,000,000,000) pieces of genetic information, we demonstrated that developing PTSD is partly genetic. We also found that genetic factors seem to play a stronger role for women than men, though for everyone, experiencing trauma is still the most important factor.

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Doxycycline May Mute Painful Memories Associated With PTSD

MedicalResearch.com Interview with:
Dominik R Bach, PhD, MD

University of Zurich

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Posttraumatic stress disorder (PTSD) can occur after a psychological trauma such as physical violence, abuse, or natural disaster. It is characterised by increased arousal, flashbacks, and nightmares that reflect memories of the trauma. Current therapies include talking therapy, but it is costly and does not work in everybody. This is why we were looking for ways of reducing aversive memories with a drug. In the current study, we found that the antibiotic doxycycline impairs the formation of negative memories in healthy volunteers.

To form memories, the brain needs to strengthen connections between neurons. It has recently emerged that for strengthening such connections particular proteins are required that sit between nerve cells, so-called MMPs. They are involved in many disorders outside the brain, such as certain cancers and heart disease. This is how we already know that doxycycline suppresses the activity of MMPs. Since doxycycline is relatively safe and readily accessible, our research was relatively straightforward.

76 healthy volunteers – half women, half men – came to the laboratory and received either placebo (a sugar pill) or 200 mg doxycycline. They then took part in a computer test in which one screen color was often followed by a mildly painful electric shock and another color was not.

A week later, volunteers came back to the lab. They were shown the colors again , this time followed by a loud sound but never by shocks. The loud sounds made people blink their eyes – a reflexive response to sudden threat. This eye blink response was measured. Volunteers who had initially been under placebo had stronger eye blink after the color that predicted electric shock than after the other color. This “fear response” is a sensitive measure for memory of negative associations. Strikingly, the fear response was 60% lower in participants who had initially taken doxycycline.

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Female Career Vietnam War Veterans Report Leading Happy, Productive Lives

MedicalResearch.com Interview with:

Jeanne Mager Stellman, PhD Professor Emerita & Special Lecturer Department of Health Policy & Management Mailman School of Public Health Columbia University York NY 10032

Dr. Jeanne Stellman

Jeanne Mager Stellman, PhD
Professor Emerita & Special Lecturer
Department of Health Policy & Management Mailman
School of Public Health Columbia University
York NY 10032

MedicalResearch.com: What is the background for this study?

Response: We examined the experiences of 1285 American women, military and civilian, who served in Vietnam during the war and responded to a mail survey conducted approximately 25 years later in which they were asked to report and reflect upon their experiences and social and health histories.

The data were collected as part of a much larger study that centered about methodological approaches to studying health effects of the military herbicides used in Vietnam. To our knowledge, this is the first study

(a) to describe the experiences of civilian women deployed to a war zone and to compare them to those of military women;

(b) to differentiate the experiences and outcomes among military women by the length of their military career service;

(c) to contextualize the general health and happiness, marital characteristics, and childbearing patterns of women deployed to Vietnam and those of their peers by comparing them to a contemporaneous nationally representative age-matched cohort, the General Social Survey (GSS).

Overall, this paper provides insight into the experiences of the understudied women who served in Vietnam, and sheds light on subgroup differences within the sample.

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