PTSD diagnoses and treatments: closing the gap between ICD-11 and DSM-5

2020 ◽  
Vol 26 (3) ◽  
pp. 153-155
Author(s):  
Amy Lehrner ◽  
Rachel Yehuda
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Treatment Guidelines ◽  
Clinical Care ◽  
Post Traumatic Stress ◽  
Affect Dysregulation ◽  
Dsm 5 ◽  
Interpersonal Difficulties ◽  
Post Traumatic ◽  
Closing The Gap

SUMMARYThe diagnostic status of ‘complex’ post-traumatic stress disorder (PTSD) remains controversial. The revisions to PTSD diagnostic criteria in ICD-11 and DSM-5 take opposing positions on how best to conceptualise post-traumatic presentations that include affect dysregulation, interpersonal difficulties and negative self-concept. ICD-11 carved out a separate category of complex PTSD (CPTSD) that is distinct from PTSD, whereas DSM-5 expanded PTSD to encompass such symptoms. Each approach carries problematic implications for clinical care. ICD-11 creates a dichotomy but the criteria themselves suggest a difference in severity rather than category. Furthermore, separating CPTSD perpetuates expectations that a ‘simple’ PTSD can be easily treated with brief trauma-focused therapy. DSM-5 complicates the PTSD diagnosis, but does not revise treatment recommendations. Both ICD and DSM need to recognise that most patients with PTSD do not reflect the clinical trial samples and do not fully recover with brief manualised therapies. Treatment guidelines should be developed that address the multiple needs and challenges of all patients with PTSD.

Evaluating the effectiveness of post-traumatic stress disorder (PTSD) treatment using acupuncture combined with cognitive behavioral therapy in Thua Thien Hue province

2019 ◽  
pp. 74-80
Author(s):  
Thi Tan Nguyen ◽  
Van Minh Doan ◽  
Nhat Minh Tran ◽  
Van Hung Nguyen
Keyword(s):  
Side Effects ◽  
Cognitive Behavioral Therapy ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Behavioral Therapy ◽  
Post Traumatic Stress ◽  
Dsm 5 ◽  
Effectiveness Rate ◽  
Post Traumatic

Post-traumatic Stress Disorder (PTSD) is a mental disorder that develops in people who have experienced or witnessed a serious traumatic event, such as natural catastrophes, sexual assaults, war… Some studies showed that acupuncture was effective for PTSD. However, there is no published research on the treatment of PTSD using acupuncture and cognitive behavioral therapy (CBT) in Vietnam. The aim of this study was to evaluate the effectiveness of treating PTSD using acupuncture combined with CBT in Thua Thien Hue province. Method and subject: This study was an interventional study conducted in two districts of Thua Thien Hue province. Thirty patients were diagnosed with PTSD using Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Participants were assessed on PTSD symptoms using PTSD Checklist for DSM-5 (PCL–5); depression, anxiety and stress status using DASS-21; and other health states before and after treatment. Result: The effectiveness rate of treatment was 83.3% by PCL–5 and 86.7% by DASS-21. The improvement of symptoms after 5 weeks of treatment was statistically significant (p <0.05). Side effects were itch (5.0%), pain (4.3%); bleeding (1.3%); and others (0%). Conclusion: Treatment of PTSD using acupuncture and CBT has a high effectiveness rate on PCL - 5 scale and DASS21 scale. Improvement was similar when evaluated by the two scales. Acupuncture was safe and did not cause any significant side effects. Key words: Post-traumatic Stress Disorder, PTSD, acupuncture, cognitive behavior therapy, CBT, Thua Thien Hue

scholarly journals Daily variation in sleep characteristics in individuals with and without post traumatic stress disorder

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Quinn M. Biggs ◽  
Robert J. Ursano ◽  
Jing Wang ◽  
Gary H. Wynn ◽  
Rohul Amin ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Sleep Duration ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Daily Variation ◽  
Clinical Care ◽  
Post Traumatic Stress ◽  
Falling Asleep ◽  
Post Traumatic

Abstract Background Sleep disturbances are common in individuals with post traumatic stress disorder (PTSD). However, little is known about how daily variation in sleep characteristics is related to PTSD. This study examined the night-to-night and weekday versus weekend variation in sleep duration, sleep quality, trouble falling asleep, and difficulty staying asleep in individuals with and without PTSD. Methods Participants (N = 157; 80 with PTSD, 77 without PTSD) completed daily self-reports of their nighttime sleep characteristics for 15 consecutive days. Linear mixed models were used to examine the associations between the 7 days of the week and weekday versus weekend variation in sleep characteristics and PTSD. Results Individuals with PTSD reported shorter sleep duration, lower sleep quality, more trouble falling asleep, and more difficulty staying asleep than individuals without PTSD. The pattern of change across the week and between weekdays and weekends was different between those with and without PTSD for sleep quality and trouble falling asleep. Among those with PTSD, sleep duration, sleep quality, and trouble falling asleep differed across the 7 days of the week and showed differences between weekdays and weekends. For those without PTSD, only sleep duration differed across the 7 days of the week and showed differences between weekdays and weekends. Neither group showed 7 days of the week nor weekday versus weekend differences in difficulty staying asleep. Conclusions On average those with PTSD had shorter sleep duration, poorer sleep quality, and greater trouble falling and staying asleep. In particular, the day of week variation in sleep quality and trouble falling asleep specifically distinguishes those with PTSD from those without PTSD. Our findings suggest that clinical care might be improved by assessments of sleep patterns and disturbances across at least a week, including weekdays and weekends. Future studies should explore the mechanisms related to the patterns of sleep disturbance among those with PTSD.

Post-traumatic stress disorder among patients with chronic pain and chronic fatigue

2004 ◽  
Vol 34 (2) ◽  
pp. 363-368 ◽  
Author(s):  
P. ROY-BYRNE ◽  
W. R. SMITH ◽  
J. GOLDBERG ◽  
N. AFARI ◽  
D. BUCHWALD
Keyword(s):  
Chronic Pain ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Clinical Care ◽  
Chronic Fatigue ◽  
Psychiatric Evaluation ◽  
Post Traumatic Stress ◽  
Tender Points ◽  
Post Traumatic

Background. Fibromyalgia (FM), a chronic pain condition of unknown aetiology often develops following a traumatic event. FM has been associated with post-traumatic stress disorder (PTSD) and major depression disorder (MDD).Method. Patients seen in a referral clinic (N=571) were evaluated for FM and chronic fatigue syndrome (CFS) criteria. Patients completed questionnaires, and underwent a physical examination and a structured psychiatric evaluation. Critical components of the diagnostic criteria of FM (tender points and diffuse pain) and CFS (persistent debilitating fatigue and four of eight associated symptoms) were examined for their relationship with PTSD.Results. The prevalence of lifetime PTSD was 20% and lifetime MDD was 42%. Patients who had both tender points and diffuse pain had a higher prevalence of PTSD (OR=3·4, 95% CI 2·0–5·8) compared with those who had neither of these FM criteria. Stratification by MDD and adjustment for sociodemographic factors and chronic fatigue revealed that the association of PTSD with FM criteria was confined to those with MDD. Patients with MDD who met both components of the FM criteria had a three-fold increase in the prevalence of PTSD (95% CI 1·5–7·1); conversely, FM patients without MDD showed no increase in PTSD (OR=1·3, 95% CI 0·5–3·2). The components of the CFS criteria were not significantly associated with PTSD.Conclusion. Optimal clinical care for patients with FM should include an assessment of trauma in general, and PTSD in particular. This study highlights the importance of considering co-morbid MDD as an effect modifier in analyses that explore PTSD in patients with FM.

scholarly journals Post Traumatic Stress Disorder and Depression in Survivors of Thrombotic Thrombocytopenic Purpura

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1364-1364
Author(s):  
Shruti Chaturvedi ◽  
Olalekan O Oluwole ◽  
Sydney Kodatsky ◽  
Spero Cataland ◽  
Keith R. McCrae
Keyword(s):  
Primary Care ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Traumatic Stress ◽  
Thrombocytopenic Purpura ◽  
Positive Screen ◽  
Primary Care Population ◽  
Dsm 5 ◽  
Post Traumatic

Abstract Background and objective: Recent data suggests that patients with thrombotic thrombocytopenic purpura (TTP) have higher rates of chronic morbidities including neurocognitive complications and depression. There is limited information regarding the psychological consequences of this disorder. TTP is conceivably an emotional trauma with a risk of post-traumatic stress disorder (PTSD). We conducted this cross sectional study to estimate the prevalence of symptoms of PTSD and depression in survivors of TTP. Methods: We developed an online survey tool based on two validated questionnaires: the PTSD checklist for DSM-5 (PCL-5) and Beck Depression Inventory-II (BDI-II). We also collected information regarding patient demographics clinical features and experiences. Surveys were distributed through email in collaboration with AnsweringTTP, a patient support organization. Survey responses were managed in RedCap. Associations of clinical and demographic variables with a positive screen for PTSD were first evaluated by the chi-square test and t-test, and then in a multivariable regression model. Prevalence of PTSD and depression were compared with a general primary care population. A p-value of 0.05 was considered significant for all analyses. Results: Three hundred and sixteen patients responded to the survey (response rate 27.5%). Of these, 290 completed consent to participate in the study, and 236 completed either the PCL-5 (n=231) or BDI-II (209) and were included in the analysis. Median age was 44 years and 206 (87.3%) were female. A pre-existing diagnosis of depression, anxiety disorder and PTSD was present in 97 (41.1%), 81 (34.3%) and 37 (15.7%) respondents, respectively. Median time from initial diagnosis of TTP was 80 months (interquartile range 37 to 132 months). BDI-II scores >13 indicating at least mild depressive symptoms were present in 169 (80.8%) patients. Thirty-three (15.8%), 59 (28.2%) and 77 (36.8%) had mild, moderate and severe depressive symptoms, respectively. Eighty-one (35.1%) individuals had a positive screen for PTSD (PCL-5 score >= 38), and 75 (32.4%) met criteria for a provisional diagnosis of PTSD based on the DSM-5 criteria of presence of cluster B, C, D and E symptoms. Compared to an age and sex adjusted primary care population, TTP survivors had a higher prevalence of PTSD (32.4% versus 3.5%) and depression (80.9% versus 10.5%). On multivariable analysis, a previous diagnosis of depression [odds ratio (OR) 3.65 (95% CI 1.26 - 10.57); p=0.017] and being unemployed due to TTP [OR 5.86 (95% CI 1.26 - 27.09); p = 0.024] were identified as significant predictors of depression. A positive screen for PTSD was associated with younger age (p = 0.017), a pre-existing diagnosis of anxiety disorder [OR 3.57 (95% CI 1.76 - 7.25), p < 0.001], and being unemployed for reasons attributable to TTP [OR 6.42 (95% CI 2.75-415.00), p < 0.001). Conclusion: We found a high prevalence of PTSD (32.4%) and depression (80.8%) in survivors of TTP. While responder bias may lead to overestimation of prevalence in this study, these results are concerning and indicate a need for further investigation. Disclosures No relevant conflicts of interest to declare.

scholarly journals Serious life events and post-traumatic stress disorder in the Norwegian population

BJPsych Open ◽  
2019 ◽  
Vol 5 (5) ◽  
Author(s):  
Trond Heir ◽  
Tore Bonsaksen ◽  
Tine Grimholt ◽  
Øivind Ekeberg ◽  
Laila Skogstad ◽  
...  
Keyword(s):  
Life Events ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Traumatic Stress ◽  
Dsm 5 ◽  
Life Threatening Illness ◽  
Norwegian Population ◽  
Life Threatening ◽  
Post Traumatic

Background It has been suggested that countries with more resources and better healthcare have populations with a higher risk of post-traumatic stress disorder (PTSD). Norway is a high-income country with good public healthcare. Aims To examine lifetime trauma exposure and the point prevalence of PTSD in the general Norwegian population. Method A survey was administered to a national probability sample of 5500 adults (aged ≥18 years). Of 4961 eligible individuals, 1792 responded (36%). Responders and non-responders did not differ significantly in age, gender or urban versus rural residence. Trauma exposure was measured using the Life Events Checklist for the DSM-5. PTSD was measured with the PTSD Checklist for the DSM-5. We used the DSM-5 diagnostic guidelines to categorise participants as fulfilling the PTSD symptom criteria or not. Results At least one serious lifetime event was reported by 85% of men and 86% of women. The most common event categories were transportation accident and life-threatening illness or injury. The point prevalence of PTSD was 3.8% for men and 8.5% for women. The most common events causing PTSD were sexual and physical assaults, life-threatening illness or injury, and sudden violent deaths. Risk of PTSD increased proportionally with the number of event categories experienced. Conclusions High estimates of serious life events and correspondingly high rates of PTSD in the Norwegian population support the paradox that countries with more resources and better healthcare have higher risk of PTSD. Possible explanations are high expectations for a risk-free life and high attention to potential harmful mental health effects of serious life events. Declaration of interest None.

scholarly journals Post-Traumatic Stress Disorder in People with Visual Impairment Compared with the General Population

2022 ◽  
Vol 19 (2) ◽  
pp. 619
Author(s):  
Tore Bonsaksen ◽  
Audun Brunes ◽  
Trond Heir
Keyword(s):  
General Population ◽  
Visual Impairment ◽  
Life Events ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Vision Loss ◽  
Stress Disorder ◽  
Post Traumatic Stress ◽  
Dsm 5 ◽  
Post Traumatic

Background: People with a visual impairment appear to have an increased risk of experiencing potentially traumatizing life events and possibly also subsequently developing post-traumatic stress disorder (PTSD). This study investigated the point prevalence of PTSD in people with a visual impairment compared with the general population of Norway and examined factors associated with PTSD among people with a visual impairment. Methods: A telephone-based survey was administered to a probability sample of 1216 adults with a visual impairment. Of these, 736 (61% response rate) participated. A probability sample from the general population served as a reference (n = 1792, 36% response rate). PTSD was measured with the PTSD Checklist for the DSM-5 (PCL-5), based on the currently most bothersome event reported from the Life Events Checklist for DSM-5 (LEC-5). We used the DSM-5 diagnostic guidelines to categorize participants as fulfilling the PTSD symptom criteria or not. Results: The prevalence of PTSD was higher among people with a visual impairment than in the general population, both for men (9.0% vs. 3.8%) and women (13.9% vs. 8.5%). The prevalence rates of PTSD from the illness or injury that had caused the vision loss (men 3.9%, women 2.2%) accounted for a considerable part of the difference between the populations. For women, PTSD related to sexual assaults also contributed significantly to a higher PTSD prevalence in the visually impaired versus the general population (5.2% vs. 2.2%), while for men there were no other event categories which resulted in significant differences. Among people with a visual impairment, the higher risk of PTSD was associated with lower age, female gender, having acquired the vision loss, and having other impairments in addition to the vision loss. Conclusion: The higher prevalence of PTSD in people with a visual impairment suggests that vulnerability to mental health problems is associated with serious life events. The higher incidence than in the general population is partly due to the illness or injury that had led to the vision loss and partly due to people with vision loss appearing to be more vulnerable through exposure to other types of potentially traumatizing events, such as sexual abuse.

Trauma Exposure, DSM-5 Post-Traumatic Stress Disorder, and Sexual Risk Outcomes

2019 ◽  
Vol 56 (2) ◽  
pp. 215-223 ◽  
Author(s):  
Natalie P. Mota ◽  
Sarah Turner ◽  
Tamara Taillieu ◽  
Isabel Garcés ◽  
Kirby Magid ◽  
...  
Keyword(s):  
Sexual Risk ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Trauma Exposure ◽  
Post Traumatic Stress ◽  
Dsm 5 ◽  
Post Traumatic

scholarly journals Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis

2019 ◽  
Vol 49 (11) ◽  
pp. 1761-1775 ◽  
Author(s):  
Thanos Karatzias ◽  
Philip Murphy ◽  
Marylene Cloitre ◽  
Jonathan Bisson ◽  
Neil Roberts ◽  
...  
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Meta Analysis ◽  
Psychological Interventions ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Affect Dysregulation ◽  
Post Traumatic ◽  
Disturbed Relationships

AbstractBackgroundThe 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.MethodsWe conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.ResultsFifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = −0.90 (CBT; k = 27, 95% CI −1.11 to −0.68; moderate quality) to g = −1.26 (EMDR; k = 4, 95% CI −2.01 to −0.51; low quality). CBT and EA each had moderate–large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate–large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.ConclusionsThe development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.

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