scholarly journals Pharmacotherapy of 1,044 inpatients with posttraumatic stress disorder: current status and trends in German-speaking countries

2020 ◽  
Author(s):  
Matthias A. Reinhard ◽  
Johanna Seifert ◽  
Timo Greiner ◽  
Sermin Toto ◽  
Stefan Bleich ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Treatment Options ◽  
Psychiatric Inpatient ◽  
Primary Diagnosis ◽  
Current Status ◽  
German Speaking ◽  
Inpatient Settings ◽  
Prescription Rates

AbstractPosttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder with limited approved pharmacological treatment options and high symptom burden. Therefore, real-life prescription patterns may differ from guideline recommendations, especially in psychiatric inpatient settings. The European Drug Safety Program in Psychiatry (“Arzneimittelsicherheit in der Psychiatrie”, AMSP) collects inpatients’ prescription rates cross-sectionally twice a year in German-speaking psychiatric hospitals. For this study, the AMSP database was screened for psychiatric inpatients with a primary diagnosis of PTSD between 2001 and 2017. N = 1,044 patients with a primary diagnosis of PTSD were identified with 89.9% taking psychotropics. The average prescription rate was 2.4 (standard deviation: 1.5) psychotropics per patient with high rates of antidepressant drugs (72.0%), antipsychotics drugs (58.4%) and tranquilizing drugs (29.3%). The presence of psychiatric comorbidities was associated with higher rates of psychotropic drug use. The most often prescribed substances were quetiapine (24.1% of all patients), lorazepam (18.1%) and mirtazapine (15.0%). The use of drugs approved for PTSD was low (sertraline 11.1%; paroxetine 3.7%). Prescription rates of second-generation antipsychotic drugs increased, while the use of tranquilizing drugs declined over the years. High prescription rates and extensive use of sedative medication suggest a symptom-driven prescription (e.g., hyperarousal, insomnia) that can only be explained to a minor extent by existing comorbidities. The observed discrepancy with existing guidelines underlines the need for effective pharmacological and psychological treatment options in psychiatric inpatient settings.

scholarly journals Adjunct pharmacotherapy for psychotherapy

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S166-S167
Author(s):  
Jessica Lochtenberg ◽  
Ari Kirshenbaum ◽  
Matthew Johnson
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Therapeutic Alliance ◽  
Posttraumatic Stress ◽  
Substance Dependence ◽  
Stress Disorder ◽  
Psychiatric Symptoms ◽  
Treatment Options ◽  
Term Treatment ◽  
Compulsive Disorder ◽  
Long Term Treatment

AimsA variety of pharmacotherapies have been used to assist the psychotherapy process as “adjunctive therapies.” These drugs are used in an acute, targeted fashion, such that they are explicitly delivered in the context of psychotherapy for anxiety, mood and substance-dependence disorders (SUDs). Our narrative review highlights the potential of medically-assisted psychotherapy by outlining the current state of research on few of these medications and describing the basic science that supports their use.MethodFirstly, we researched an assortment of medications that have been used off-label to enhance psychotherapy, and selected a few that have received the most empirical attention in preclinical and clinical-trial settings. Our review of clinical trials focused on three of the most common psychiatric ailments. For all studies reviewed, we identify the strengths and weaknesses of the data supporting the use of the medications for the three aforementioned disorders.ResultD-cycloserine: accelerates the process of associative emotional learning, enhancing exposure therapy in the treatment of various anxiety disorders, including obsessive-compulsive disorder and posttraumatic stress disorder. Limited studies are available on efficacy in treating SUDs.Intranasal oxytocin: accelerates memory retrieval-extinction procedures used in posttraumatic stress disorder, and promotes prosocial cognition and behaviour, facilitating a therapeutic alliance. Sufficiently powered studies and safety studies are required before strong conclusions can be made.Propranolol: interrupts the reconsolidation of memories (leading to maladaptive learned responses) involved in posttraumatic stress disorder during memory-reactivation therapy sessions, but there is little evidence that this drug can be used for depression or SUDs.Psychedelics: may effect the brain's default mode network, engendering a transformative experience that is often followed by a reduction in psychiatric symptoms. 3,4-methylenedioxymethamphetamine may additionally modulate the amygdala response in a way that allows for reprocessing of traumatic memories, and improves the therapeutic alliance. Anxiety, mood, and SUDs appear to be positively influence by traditional and non-traditional (ketamine) psychedelics.ConclusionAlthough the efficacy of the medically-assisted psychotherapies reviewed is still under investigation, we propose that these novel treatment approaches may be preferred over traditional psychopharmacological treatments due to the presence of fewer chronic side effects, as well less toxicity and abuse potential. Furthermore, these adjunctive pharmacotherapies may help to reinforce the psychotherapeutic alliance and may ultimately yield better long-term treatment outcomes. If at least some of the adjunctive pharmacotherapies outlined in this review are found to be clinically efficacious and safe, patients will benefit from having more treatment options available to them in the future.

scholarly journals Epigenetic Aspects of Posttraumatic Stress Disorder

2011 ◽  
Vol 30 (2-3) ◽  
pp. 77-87 ◽  
Author(s):  
Ulrike Schmidt ◽  
Florian Holsboer ◽  
Theo Rein
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Treatment Options ◽  
Adverse Life Events ◽  
Genome Wide ◽  
Recent Developments ◽  
Covalent Modifications ◽  
Genetic And Environmental Factors ◽  
And Control

Development of psychiatric diseases such as posttraumatic stress disorder (PTSD) invokes, as with most complex diseases, both genetic and environmental factors. The era of genome-wide high throughput technologies has sparked the initiation of genotype screenings in large cohorts of diseased and control individuals, but had limited success in identification of disease causing genetic variants. It has become evident that these efforts at the genomic level need to be complemented with endeavours in elucidating the proteome, transcriptome and epigenetic profiles. Epigenetics is attractive in particular because there is accumulating evidence that the lasting impact of adverse life events is reflected in certain covalent modifications of the chromatin.In this review, we outline the characteristics of PTSD as a stress-related disease and survey recent developments revealing epigenetic aspects of stress-related disorders in general. There is also increasing direct evidence for gene programming and epigenetic components in PTSD. Finally, we discuss treatment options in the light of recent discoveries of epigenetic mechanisms of psychotropic drugs.

PTSD in Children 6 Years and Younger

2018 ◽  
Author(s):  
Alexandra C. De Young ◽  
Michael S. Scheeringa
Keyword(s):  
At Risk ◽  
Posttraumatic Stress Disorder ◽  
Early Childhood ◽  
Young Children ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Treatment Options ◽  
High Risk Population ◽  
Accurate Assessment ◽  
Dsm 5

This chapter is an overview of the new Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM-5) subtype “posttraumatic stress disorder for children 6 years and younger” and what is known about posttraumatic stress disorder during early childhood. It outlines issues that complicate the accurate assessment of trauma-related problems in young children and reviews the new DSM-5 category, instruments currently available, and evidence for different treatment options. Young children are a high-risk population for exposure to traumatic events and are likewise at risk of developing trauma- and stressor-related disorders following trauma exposure. Early childhood is associated with unique vulnerabilities that may put young children at risk of poor outcomes and rapid maturational growth that may enhance resilience. Early and accurate assessment and treatment of posttrauma reactions in very young children can be challenging, but, because of these factors, it is critical.

Quetiapine Therapy for Posttraumatic Stress Disorder

2002 ◽  
Vol 36 (12) ◽  
pp. 1875-1878 ◽  
Author(s):  
S Pirzada Sattar ◽  
Bernadette Ucci ◽  
Kathleen Grant ◽  
Subhash C Bhatia ◽  
Frederick Petty
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
English Language ◽  
Rating Scale ◽  
Stress Disorder ◽  
Traumatic Event ◽  
Treatment Options ◽  
Clinical Signs ◽  
Ptsd Symptoms ◽  
First Case

OBJECTIVE: To report a case of improvement in posttraumatic stress disorder (PTSD) after adjunctive therapy with quetiapine. CASE SUMMARY: A 49-year-old white man witnessed a traumatic event and experienced severe PTSD. He was started on paroxetine, with increases in dosage and no significant improvement. Quetiapine was added to his regimen, with increased doses resulting in improvement of PTSD symptoms, both clinically and as measured on the Hamilton-D rating scale for depression and the clinician-administered PTSD screen. DISCUSSION: This is the first case published in the English language literature describing improvement in PTSD symptoms after treatment with quetiapine. There are several treatment options for PTSD, but some severe cases may require treatment with antipsychotic medications. Because of the lower risks of serious adverse effects, the newer atypical antipsychotics are much safer than the older antipsychotics. Although use of risperidone and olanzapine in the successful treatment of PTSD has been reported in the literature, there are no reports of quetiapine use in this clinical condition. CONCLUSIONS: Quetiapine appeared to improve clinical signs and symptoms of PTSD in this patient. It may be a treatment option in other severe cases of PTSD.

scholarly journals Treatment utilisation and trauma characteristics of child and adolescent inpatients with posttraumatic stress disorder

Curationis ◽  
2002 ◽  
Vol 25 (4) ◽  
Author(s):  
A. Traut ◽  
D. Kaminer ◽  
D. Boshoff ◽  
S. Seedat ◽  
S. Hawkridge ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Children And Adolescents ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Psychiatric Inpatient ◽  
Child And Adolescent ◽  
Inpatient Unit ◽  
Treatment Utilisation ◽  
The Impact ◽  
Adolescent Inpatients

Objective. Few empirical studies have addressed the impact of trauma exposure and posttraumatic stress disorder (PTSD) on treatment utilisation and outcome in South African youth. This study was undertaken to document demographic, clinical, and treatment characteristics of child and adolescent inpatients with PTSD. Design. A retrospective chart study of all patients presenting to a child and adolescent inpatient unit was conducted between 1994-1996. For children and adolescents diagnosed with PTSD; demographic, diagnostic and treatment variables, including trauma type, family history, and delays in treatment seeking, were documented. Setting. Child and Adolescent Psychiatric Inpatient Unit, Tygerberg Hospital, Cape Town. Subjects. Children and adolescents (2 to 18 years) presenting to an inpatient unit (n=737). Results. 10.3% (n=76) met diagnostic criteria for PTSD. Gender differences were clearly evident: PTSD was six times more prevalent in girls (65 with PTSD were female and 11 were male); girls were most likely to have experienced rape or sexual abuse while boys were most likely to have witnessed a killing. Psychotherapy was the most common intervention for PTSD, followed by treatment with a tricyclic antidepressant. 97.4% of children and adolescents who were treated demonstrated significant improvement. Delays in seeking treatment and problems with the primary support group were highly prevalent. Conclusion. PTSD is a common disorder that is responsive to treatment with psychotherapy and/or tricyclic antidepressants in child and adolescent inpatients. These findings underscore the importance of early identification and treatment of childhood PTSD in mental health settings, in particular tertiary service institutions.

Symptom Correlates among Adolescents Showing Posttraumatic Stress Disorder versus Conduct Disorder

1991 ◽  
Vol 69 (3) ◽  
pp. 920-922 ◽  
Author(s):  
J. A. Atlas ◽  
W. J. Di Scipio ◽  
R. Schwartz ◽  
L. Sessoms
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Behavior Problems ◽  
Posttraumatic Stress ◽  
State Anxiety ◽  
Stress Disorder ◽  
Primary Diagnosis ◽  
Conduct Disordered ◽  
Symptoms Of Depression ◽  
Associated Symptoms ◽  
Anxiety Behavior

21 adolescents with a primary diagnosis of Posttraumatic Stress Disorder, 24 Conduct Disordered, and 23 control adolescents were compared on measures of depression, anxiety, behavior problems, and fears. Analyses showed that posttraumatic adolescents showed associated symptoms of depression and state-anxiety, Conduct Disordered adolescents showed depressive trends, and both groups were evaluated by their teachers as showing significant behavior problems.

scholarly journals The Status of EMDR Therapy in the Treatment of Posttraumatic Stress Disorder 30 Years After Its Introduction

2019 ◽  
Vol 13 (4) ◽  
pp. 261-269 ◽  
Author(s):  
Ad de Jongh ◽  
Benedikt L. Amann ◽  
Arne Hofmann ◽  
Derek Farrell ◽  
Christopher W. Lee
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Psychiatric Disorders ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Behavioral Therapy ◽  
Evidence Base ◽  
Primary Diagnosis ◽  
Treatment Intervention ◽  
First Choice ◽  
Emdr Therapy

Given that 2019 marks the 30th anniversary of eye movement desensitization and reprocessing (EMDR) therapy, the purpose of this article is to summarize the current empirical evidence in support of EMDR therapy as an effective treatment intervention for posttraumatic stress disorder (PTSD). Currently, there are more than 30 randomized controlled trials (RCT) demonstrating the effectiveness in patients with this debilitating mental health condition, thus providing a robust evidence base for EMDR therapy as a first-choice treatment for PTSD. Results from several meta-analyses further suggest that EMDR therapy is equally effective as its most important trauma-focused comparator, that is, trauma-focused cognitive behavioral therapy, albeit there are indications from some studies that EMDR therapy might be more efficient and cost-effective. There is emerging evidence showing that EMDR treatment of patients with psychiatric disorders, such as psychosis, in which PTSD is comorbid, is also safe, effective, and efficacious. In addition to future well-crafted RCTs in areas such as combat-related PTSD and psychiatric disorders with comorbid PTSD, RCTs with PTSD as the primary diagnosis remain pivotal in further demonstrating EMDR therapy as a robust treatment intervention.

scholarly journals Evidence Update for Clinicians: Treatment Options for People with Posttraumatic Stress Disorder (PTSD)

2019 ◽  
Author(s):  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Partner Violence ◽  
Stress Disorder ◽  
Motor Vehicle ◽  
Traumatic Event ◽  
Treatment Options ◽  
Motor Vehicle Crash ◽  
Pharmacological Treatments ◽  
Review Reports

A recent update of a systematic review, supported by PCORI through a research partnership with AHRQ, informs clinicians on psychological and pharmacological treatments for PTSD in adults. The review reports on 207 articles from 193 studies published before 2018, updating a 2013 review. Posttraumatic stress disorder (PTSD) affects about 6% of US adults. It is more common in groups including women, younger people, and those who did not complete high school or who have lower incomes. PTSD can affect military personnel serving in combat, but it may also develop after a person experiences or witnesses intimate partner violence, sexual violence, physical abuse or assault, a motor vehicle crash, natural disaster, violent crime, or other traumatic event.

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