Reducing posttraumatic stress in parents of patients with a rare inherited metabolic disorder using eye movement desensitization and reprocessing therapy: a case study

Parents of children with severe inborn errors of metabolism frequently face stressful events related to the disease of their child and are consequently at high risk for developing parental posttraumatic stress disorder (PTSD). Assessment and subsequent treatment of PTSD in these parents is however not common in clinical practice. PTSD can be effectively treated by Eye Movement Desensitization and Reprocessing (EMDR), however no studies have been conducted yet regarding the effect of EMDR for parental PTSD. EMDR is generally offered in multiple weekly sessions which may preclude participation of parents as they are generally overburdened by the ongoing and often intensive care for their child. Therefore, we offered time-limited EMDR with a maximum of four sessions over two subsequent days to two parents of mucopolysaccharidosis type III (MPS III) patients to explore its potential effects. Both qualitative and quantitative outcomes were used to evaluate treatment effects. Both parents felt more resilient and competent to face future difficulties related to the disease of their child, and no adverse effects were reported. Quantitative outcomes showed a clinically significant decrease in post traumatic stress symptoms and comorbid psychological distress from pre- to post treatment, and these beneficial effects were maintained at follow-up. In conclusion, time-limited EMDR may be a highly relevant treatment for traumatized parents of children with MPS III, and probably also for parents of children with other rare progressive disorders. Further research is needed to validate the efficacy of EMDR in this specific population.

Insomnia and post-traumatic stress disorder: A meta-analysis on prevalence and interrelated association

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder with several comorbidities (e.g., sleep disturbances). However, no convergent quantitative finding exists despite the well-documented link between PTSD and insomnia. Hence, a meta-analysis was conducted to examine the aggregate association and the magnitude of insomnia in PTSD. Here, we searched electronic medical search engines to identify studies reporting either the correlation or the prevalence of insomnia in PTSD. Forty studies met inclusion criteria and two aggregate effect size (ES) estimates were generated upon the correlations (K=18, comprising 5469 subjects) and the frequencies (K=16, comprising 5570392 subjects). A medium-size significant correlation was found [ES: 0.57 (CI: 0.49-0.63); n=5469], with a significant male sex effect [Slope: 0.0033; SE: 0.0017; P-value: 0.0446]. The prevalence of insomnia in PTSD was 48% [CI: 34-63; n ratio=1363384/5570392], and was moderated by insomnia and PTSD assessment scales, and diagnosis approach. This convergent perspective provides a better understanding of the association between insomnia and PTSD and warrants screening and better patient management.

Toward Reduced Burden in Evidence-Based Assessment of PTSD: A Machine Learning Study

Structured diagnostic interviews involve significant respondent burden and clinician administration time. This study examined whether we can maintain diagnostic accuracy using fewer posttraumatic stress disorder (PTSD) assessment questions. Our study included 1,265 U.S. veterans of the Afghanistan and Iraq conflicts who were assessed for PTSD using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (SCID-5). We used random forests to assess the importance of each diagnostic item in predicting a SCID-5 PTSD diagnosis. We used variable importance to rank each item and removed the lowest ranking items while maintaining ≥90% accuracy (i.e., efficiency), sensitivity, and other metrics. We eliminated six diagnostic items among the overall sample, four items among male veterans, and six items among female veterans. Our findings demonstrate that we may shorten the SCID-5 PTSD module while maintaining excellent diagnostic performance. These findings have implications for potentially reducing patient and provider burden of PTSD diagnostic assessment.

Assessing PTSD Symptoms

Posttraumatic stress disorder (PTSD) is a serious and prevalent mental health disorder that poses significant challenges for accurate assessment and diagnosis. This chapter describes some of the most widely used PTSD assessment tools for adult trauma survivors, including structured interviews, self-report measures, and biologically based methods, with an eye toward updates reflecting the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD criteria. It also discusses several key issues in PTSD assessment, including identifying an index traumatic event for symptom inquiry, linking symptoms to the index event, assessing for the new dissociative subtype, and detecting exaggerated symptom reporting. The chapter concludes with a brief discussion of future directions for research on PTSD assessment.