Exercise and PTSD Symptoms in Emergency Service and Frontline Medical Workers: A Systematic Review

BackgroundPharmacological treatment is widely used for post-traumatic stress disorder (PTSD) despite questions over its efficacy.AimsTo determine the efficacy of all types of pharmacotherapy, as monotherapy, in reducing symptoms of PTSD, and to assess acceptability.MethodA systematic review and meta-analysis of randomised controlled trials was undertaken; 51 studies were included.ResultsSelective serotonin reuptake inhibitors were found to be statistically superior to placebo in reduction of PTSD symptoms but the effect size was small (standardised mean difference −0.23, 95% CI −0.33 to −0.12). For individual pharmacological agents compared with placebo in two or more trials, we found small statistically significant evidence of efficacy for fluoxetine, paroxetine and venlafaxine.ConclusionsSome drugs have a small positive impact on PTSD symptoms and are acceptable. Fluoxetine, paroxetine and venlafaxine may be considered as potential treatments for the disorder. For most drugs there is inadequate evidence regarding efficacy for PTSD, pointing to the need for more research in this area.

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Early interventions for the prevention of post-traumatic stress symptoms in survivors of critical illness: protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2017-018270 ◽

2017 ◽

Vol 7 (9) ◽

pp. e018270 ◽

Cited By ~ 2

Author(s):

Lindsey J Glaspey ◽

Michael B Roberts ◽

Anthony Mazzarelli ◽

Stephen Trzeciak ◽

Brian W Roberts

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Critical Illness ◽

Outcome Measures ◽

Traumatic Stress ◽

Early Interventions ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Registration Number ◽

Post Traumatic

IntroductionPost-traumatic stress disorder (PTSD) is being increasingly reported among survivors of critical illness and injury. Previous work has demonstrated that PTSD reduces patient quality of life and ability to return to work, as well as increases healthcare costs. As such, identifying interventions aimed at preventing the development of critical illness-related PTSD could have an important public health impact. The objective of this systematic review is to collate the world’s literature on early interventions aimed at preventing PTSD among survivors of critical illness.Methods and analysisWe will perform a qualitative systematic review of human clinical trials of interventions aimed at preventing or reducing critical illness-related PTSD symptoms. We will methodically search CENTRAL, MEDLINE, Embase and CINAHL. We will also search websites containing details on clinical trials registration (National Library of Medicine’s ClinicalTrials.gov and the WHO’s International Clinical Trials Registry Platform), as well as screen reference lists of the articles we select for inclusion to identify additional studies for potential inclusion. Two authors will independently review all search results. After identification and inclusion of articles, we will use a standardised form for data extraction. We will use tables to describe the study type, populations, interventions tested and timing of interventions, outcome measures and effects of interventions on outcome measures compared with control groups. This review will be completed between 1 August 2017 and 31 August 2017.Ethics and disseminationThe proposed systematic review will not collect individual patient level data and does not require ethical approval. Results of this study will contribute to the understanding of critical illness-related PTSD and help prompt future research aimed at further developing interventions to prevent PTSD symptoms in survivors of critical illness.PROSPERO registration numberThis systematic review is registered in the PROSPERO international prospective register of systematic reviews (registration number CRD42017069672).

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Electroencephalography-based neurofeedback as treatment for post-traumatic stress disorder: A systematic review and meta-analysis

European Psychiatry ◽

10.1192/j.eurpsy.2019.7 ◽

2020 ◽

Vol 63 (1) ◽

Cited By ~ 5

Author(s):

Steinn Steingrimsson ◽

Gorana Bilonic ◽

Ann-Catrin Ekelund ◽

Tomas Larson ◽

Ida Stadig ◽

...

Keyword(s):

Systematic Review ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Meta Analysis ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Suicidal Thoughts ◽

Assessment Development ◽

Post Traumatic

Abstract Background. Post-traumatic stress disorder (PTSD) is debilitating for patients and society. There are a number of treatment methods albeit not all patients respond to these and an interesting method using electroencephalography-based neurofeedback (EEG-NF) has become more prominent in recent years. This systematic review aimed to assess whether EEG-NF, compared with sham NF, other treatment, or no treatment, is effective for PTSD. Primary outcomes were self-harm, PTSD symptoms, level of functioning and health-related quality of life. Methods. Systematic literature searches for randomized controlled trials (RCTs) were conducted in six databases. Random effects meta-analysis was performed. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. Results. Four RCTs were included (123 participants). Suicidal thoughts were significantly reduced after EEG-NF compared with a waiting list in a small study. PTSD symptoms were assessed in all studies with different instruments. Results were consistently in favor of EEG-NF with large effect sizes (standardized mean difference −2.30 (95% confidence interval: −4.37 to −0.24). One study reported significantly improved level of executive functioning and one study a reduction in use of psychotropic medication. Complications were scarcely reported. Certainty of evidence was assessed as very low for the four assessed outcomes. Conclusions. Based on four RCTs, with several study limitations and imprecision, it is uncertain whether EEG-NF reduces suicidal thoughts, PTSD symptoms, medication use, or improves function. Although all studies showed promising results, further studies are needed to increase the certainty of evidence.

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Glucocorticoid-based therapeutic options for PTSD

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.521 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S215-S215

Author(s):

S. Ouanes

Keyword(s):

Systematic Review ◽

Glucocorticoid Receptor ◽

Glucocorticoid Receptors ◽

Traumatic Event ◽

Therapeutic Options ◽

Curative Treatment ◽

Ptsd Symptoms ◽

Preventive Interventions ◽

Competing Interest ◽

Receptor Modulators

IntroductionPTSD has been associated with HPA axis alterations, mainly consisting of reduced cortisol levels, elevated CRH and enhanced glucocorticoid receptor responsiveness. These findings led to the emergence of glucocorticoid-based therapeutic options for PTSD.ObjectiveTo outline the different glucocorticoid-based interventions for PTSD either for prophylactic or for curative treatment.MethodsA systematic review was performed. The Medline database was searched using the following keywords: ‘PTSD’, ‘treatment’, ‘Glucocorticoids’, ‘hydrocortisone’.ResultsGlucocorticoid-based therapeutic for PTSD comprise preventive and curative interventions. Preventive interventions mainly consist of administering one single bolus of hydrocortisone shortly following the exposure to a traumatic event. Evidence comes from six published trials, all positive. Curative interventions include: prescribing hydrocortisone over short periods of time to treat PTSD symptoms, using Glucocorticoids to augment psychotherapy (in particular exposure therapy) for PTSD and using Mifepristone, a glucocorticoid receptor antagonist. Moreover, novel glucocorticoid receptor modulators are currently being developed and tested on animal models as a potential curative treatment for PTSD.ConclusionsUse of hydrocortisone in preventing PTSD might be tempting, as is the use of hydrocortisone or Glucocorticoid receptors antagonists/modulators in treating PTSD. Yet, it should be emphasized that these interventions are not mainstream yet. They rather reflect a revolutionary new direction.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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Transcranial magnetic stimulation for posttraumatic stress disorder: an updated systematic review and meta-analysis

Trends in Psychiatry and Psychotherapy ◽

10.1590/2237-6089-2015-0072 ◽

2016 ◽

Vol 38 (1) ◽

pp. 50-55 ◽

Cited By ~ 26

Author(s):

Alisson Paulino Trevizol ◽

Mirna Duarte Barros ◽

Paula Oliveira Silva ◽

Elizabeth Osuch ◽

Quirino Cordeiro ◽

...

Keyword(s):

Systematic Review ◽

Posttraumatic Stress Disorder ◽

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Stress Disorder ◽

Meta Analysis ◽

Random Effects Model ◽

Ptsd Symptoms ◽

Funnel Plot ◽

Meta Regression

Introduction Transcranial magnetic stimulation (TMS) is a promising non-pharmacological intervention for posttraumatic stress disorder (PTSD). However, randomized controlled trials (RCTs) and meta-analyses have reported mixed results. Objective To review articles that assess the efficacy of TMS in PTSD treatment. Methods A systematic review using MEDLINE and other databases to identify studies from the first RCT available up to September 2015. The primary outcome was based on PTSD scores (continuous variable). The main outcome was Hedges' g. We used a random-effects model using the statistical packages for meta-analysis available in Stata 13 for Mac OSX. Heterogeneity was evaluated with I2 (> 35% for heterogeneity) and the χ2 test (p < 0.10 for heterogeneity). Publication bias was evaluated using a funnel plot. Meta-regression was performed using the random-effects model. Results Five RCTs (n = 118) were included. Active TMS was significantly superior to sham TMS for PTSD symptoms (Hedges' g = 0.74; 95% confidence interval = 0.06-1.42). Heterogeneity was significant in our analysis (I2 = 71.4% and p = 0.01 for the χ2 test). The funnel plot shows that studies were evenly distributed, with just one study located marginally at the edge of the funnel and one study located out of the funnel. We found that exclusion of either study did not have a significant impact on the results. Meta-regression found no particular influence of any variable on the results. Conclusion Active TMS was superior to sham stimulation for amelioration of PTSD symptoms. Further RCTs with larger sample sizes are fundamental to clarify the precise impact of TMS in PTSD.

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Post-Traumatic Stress Reactions in Caregivers of Children and Adolescents/Young Adults with Severe Diseases: A Systematic Review of Risk and Protective Factors

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010189 ◽

2020 ◽

Vol 18 (1) ◽

pp. 189

Author(s):

Claudia Carmassi ◽

Valerio Dell’Oste ◽

Claudia Foghi ◽

Carlo Antonio Bertelloni ◽

Eugenia Conti ◽

...

Keyword(s):

Systematic Review ◽

Young Adults ◽

Protective Factors ◽

Children And Adolescents ◽

Potential Risk ◽

Traumatic Stress ◽

Risk And Protective Factors ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Post Traumatic

Severe illnesses in children and adolescents/young adults (AYAs) may represent a complex burden for patients and their caregivers, including a wide range of mental disorders, particularly post-traumatic stress disorder (PTSD). Few events are as potentially traumatizing as having a son or a daughter diagnosed with a severe, life-threatening, or disabling disease. The presence of PTSD symptoms in caregivers may compromise their efficacy as caregivers and negatively affect the child’s well-being. This systematic review aims at outlining potential risk and protective factors for the development of PTSD symptoms in caregivers of children and AYAs affected by severe acute or chronic illnesses. Thirty-one studies on caregivers of children and AYAs affected by severe, acute, or chronic diseases were included. Socio-demographic and socio-economic characteristics, illness-related distress, psychiatric symptoms, support, and coping styles were found as potential risk/protective factors across studies. It is crucial to consider risk factors affecting caregivers of severely ill young patients, in order to plan focused interventions aimed at preventing an adverse clinical outcome in caregivers and at enhancing caregivers’ coping skills, in order to ultimately improve their quality of life.

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A Systematic Review and Meta-Analysis of e-Mental Health Interventions to Treat Symptoms of Posttraumatic Stress

JMIR Mental Health ◽

10.2196/mental.5558 ◽

2017 ◽

Vol 4 (2) ◽

pp. e14 ◽

Cited By ~ 20

Author(s):

Sara Simblett ◽

Jennifer Birch ◽

Faith Matcham ◽

Lidia Yaguez ◽

Robin Morris

Keyword(s):

Mental Health ◽

Systematic Review ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Meta Analysis ◽

Intervention Group ◽

Health Interventions ◽

Ptsd Symptoms ◽

Active Intervention Group ◽

Mental Health Interventions

Background Posttraumatic stress disorder (PTSD) is a stress disorder characterized by unwanted intrusive re-experiencing of an acutely distressing, often life-threatening, event, combined with symptoms of hyperarousal, avoidance, as well as negative thoughts and feelings. Evidence-based psychological interventions have been developed to treat these symptoms and reduce distress, the majority of which were designed to be delivered face-to-face with trained therapists. However, new developments in the use of technology to supplement and extend health care have led to the creation of e-Mental Health interventions. Objective Our aim was to assess the scope and efficacy of e-Mental Health interventions to treat symptoms of PTSD. Methods The following databases were systematically searched to identify randomized controlled trials of e-Mental Health interventions to treat symptoms of PTSD as measured by standardized and validated scales: the Cochrane Library, MEDLINE, EMBASE, and PsycINFO (in March 2015 and repeated in November 2016). Results A total of 39 studies were found during the systematic review, and 33 (N=3832) were eligible for meta-analysis. The results of the primary meta-analysis revealed a significant improvement in PTSD symptoms, in favor of the active intervention group (standardized mean difference=-0.35, 95% confidence interval -0.45 to -0.25, P<.001, I2=81%). Several sensitivity and subgroup analyses were performed suggesting that improvements in PTSD symptoms remained in favor of the active intervention group independent of the comparison condition, the type of cognitive behavioral therapy-based intervention, and the level of guidance provided. Conclusions This review demonstrates an emerging evidence base supporting e-Mental Health to treat symptoms of PTSD.

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The helicopter emergency service in the transport of trauma patients: a systematic review of the evidence

Injury Extra ◽

10.1016/j.injury.2010.07.448 ◽

2010 ◽

Vol 41 (12) ◽

pp. 146-147

Author(s):

Daniel P. Butler ◽

Keith Willett

Keyword(s):

Systematic Review ◽

Emergency Service ◽

Trauma Patients

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Effectiveness of Psychological Interventions to Improve the Mental Well-Being of Parents Who Have Experienced Traumatic Childbirth: A Systematic Review and Meta-Analysis

Trauma Violence & Abuse ◽

10.1177/15248380211060808 ◽

2021 ◽

pp. 152483802110608

Author(s):

Shefaly Shorey ◽

Soo Downe ◽

Joelle Yan Xin Chua ◽

Sofia O. Byrne ◽

Maaike Fobelets ◽

...

Keyword(s):

Systematic Review ◽

Well Being ◽

Psychological Interventions ◽

Ptsd Symptoms ◽

Fear Of Childbirth ◽

Childbirth Experience ◽

Geographical Regions ◽

Traumatic Childbirth ◽

Anxiety Depression ◽

Mental Well Being

Considering the adverse impact that traumatic childbirth experiences can have on parental mental well-being, studies that have investigated the potential of providing postnatal psychological support for this group of parents require evaluation. This systematic review aimed to examine the effectiveness of psychological interventions at improving the mental well-being of parents who have experienced traumatic childbirth in terms of anxiety, depression, fear of childbirth, and post-traumatic stress disorder (PTSD) symptoms. Seven electronic databases were searched from their respective inception dates up to January 2021. Only quantitative studies that reported the effects of psychological interventions on anxiety, depression, fear of childbirth, and/or PTSD symptoms in selective (at risk of traumatic childbirth experience) or indicated (self-defined childbirth experience as traumatic for any reason) populations of parents (mothers and/or fathers) were included. Eight studies were included and meta-analyses were conducted using a random-effect model. All studies were conducted on mothers only, and one study had minimal father involvement. Results showed that psychological interventions were more effective in reducing fear of childbirth and improving PTSD symptoms compared to anxiety and depression. Greater improvement in depression was reported at 3–8 weeks’ follow-up than at immediate post-intervention. Subgroup analyses showed that technology-based interventions were feasible, and indicated interventions were more effective than selective interventions. Conducting future interventions in more geographical regions, engaging and including fathers more actively, incorporating both personalized professional therapy and informal peer support, striving for flexibility and convenience, as well as addressing topics on self-doubt and coping skills can improve current interventions.

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What Will Be the Impact of the COVID-19 Quarantine on Psychological Distress? Considerations Based on a Systematic Review of Pandemic Outbreaks

Healthcare ◽

10.3390/healthcare9010101 ◽

2021 ◽

Vol 9 (1) ◽

pp. 101

Author(s):

Marco Cavicchioli ◽

Roberta Ferrucci ◽

Matteo Guidetti ◽

Maria Paola Canevini ◽

Gabriella Pravettoni ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Psychological Distress ◽

Evidence Based ◽

The Novel ◽

Ptsd Symptoms ◽

Clinically Significant ◽

Novel Coronavirus ◽

Restrictive Measures ◽

The Impact

Background: The novel coronavirus (SARS-CoV-2) and related syndrome (COVID-19) has led to worldwide measures with severe consequences for millions of people. In the light of the psychopathological consequences of restrictive measures detected during previous outbreaks, a systematic review was carried out to provide an evidence-based assessment of possible effects of the current COVID-19 quarantine on mental health. Methods: This review included studies that assessed mental health indexes (e.g., overall psychological distress, depressive and PTSD symptoms) during and after quarantine periods adopted to management different outbreaks (e.g., COVID-19, SARS, MERS). Results: Twenty-one independent studies were included for a total of 82,312 subjects. At least 20% of people exposed to restrictive measures for the management of pandemic infections reported clinically significant levels of psychological distress, especially PTSD (21%) and depressive (22.69%) symptoms. Overall, original studies highlighted relevant methodological limitations. Conclusions: Nowadays, almost one out of every five people is at risk of development of clinically significant psychological distress. Further research on mental health after the current COVID-19 quarantine measures is warranted.

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