Psychiatry and Clinical Psychopharmacology最新文献

Rates of veteran suicide, post-traumatic stress, and moral injury remain alarmingly high and continue to rise. While virtual reality and augmented reality technologies have shown promise in improving post- traumatic stress disorder (PTSD) severity, research on these innovative methods is still limited. Multi- modal memory desensitization and reconsolidation (3MDR), a cutting-edge therapy that combines Virtual Reality Exposure Therapy or Augmented Reality Exposure Therapy with a "walk and talk" therapy, has demonstrated significant potential in enhancing participant engagement and substantially reducing symptoms of PTSD and moral injury among combat veterans. This case study highlights the novel use of 3MDR with an augmented reality head-mounted display for treating combat-related PTSD and moral injury, offering a new perspective on addressing these critical issues.

Background: In recent years, dramatic political changes and the ensuing war in Ukraine have led to a significant increase in the number of stress-related disorders, in particular among military personnel. The study was designed to evaluate the prevalence and distribution of mental health disorders among the Ukrainian military referred to inpatient assessment and treatment at a large military psychiatric hospital located in Kyiv, Ukraine. Methods: The study was a retrospective analysis of 9109 inpatient admissions to the psychiatric clinic of national military medical clinical centre in Kyiv, Ukraine, between January 2014 and December 2018. Most of the patients were contracted military service officers, 2014-2018. Results: The population suffered from a wide range of mental illnesses. Neurotic, stress-related, and somatoform disorders were predominant among the officers, while psychotic disorders, personality disorders, and mental retardation were prevalent among the conscripts. In 2016-2018, the nosological structure of mental disorders remained stable with the highest prevalence of stress-related and somatoform disorders, except a decrease in substance use disorders and an increase in psychotic disorders. Among the outpatients discharged (n = 128) in 2017-2018, the majority had sleep disturbances and flashbacks (73%); anxiety and irritability (84%); and suffered from fatigue and low mood (80.9%). The level of satisfaction with the social benefits and support from the authorities of the veterans was extremely low (7.4%). Conclusion: The study revealed the impact of war trauma on the mental health of the service members, necessitating the development of specific preventive measures and digital mental health tools to support military personnel resource shortages and stigma.

Traditional trauma-focused psychotherapies (TFPs) were developed based on an anxiety disorder model of posttraumatic stress disorder (PTSD). However, PTSD is a more complex disorder with heterogeneous onset, presentation, trajectory, and treatment responsivity. As half of treated patients do not respond to first-line treatments, innovative therapies are emerging to improve outcomes. This narrative review of therapist-delivered psychotherapies for PTSD focuses on interventions not yet endorsed by clinical guidelines. A systematic search of MEDLINE and American Psychological Association PsycINFO was conducted for English-language human clinical studies, guidelines, and reviews related to PTSD psychotherapy through June 29, 2024. Data were thematically analyzed, focusing on how emerging interventions modify or diverge from current guideline-recommended treatments. The review identified 4 key themes for improving trauma therapy: (1) optimizing existing TFPs, (2) adapting psychotherapies used for other conditions, (3) reimagining exposure therapies, and (4) new therapeutic modalities. New exposure treatments include those capitalizing on memory reconsolidation science, combination with pharmacotherapies, neuromodulation, or virtual reality technologies, and mind-body and somatic psychotherapies. Moral injury, identity, and spirituality-focused therapies aim to resolve intense internal conflicts, guilt and shame, and issues of meaning and purpose. Finally, multi-modal treatments like 3MDR and psychedelic-assisted psychotherapies have multiple synergistic mechanisms. Ongoing research will be crucial to validating emerging approaches and optimizing their combined potential. A PTSD staging model may provide a structured framework for rigorous empirical evaluation and clinical implementation. Future research should prioritize randomized controlled trials with diverse patient populations and long-term follow-up to ensure their safety, efficacy, and scalability.

The well-being of postpartum mothers can be significantly affected by posttraumatic stress disorder (PTSD) and grief. Success with standard PTSD interventions for this population has been inconsistent. Multi-modal motion-assisted memory desensitization and reconsolidation therapy (3MDR) is an intervention that has been studied favorably with military and veteran populations with PTSD and related conditions. Minimal research is available, however, regarding its application in the civilian population. This case report investigates the use of 3MDR in facilitating trauma and grief processing and reducing PTSD symptoms in a 35-year-old postpartum mother with treatment-resistant PTSD and grief undergoing 3MDR. Qualitative data collected throughout the 3MDR intervention and at the 3-, 6-, and 10-month follow-ups were thematically analyzed. The participant reported feeling increased control over her life after 3MDR and reduced adverse reactions to normally distressing events. During the follow-up sessions, the overarching trauma process was one of peeling back layers of her experiences. The following 3 themes emerged: gaining control in chaos, shifting from an ideal to a real perspective, overcoming trauma and moving forward in life. This case report suggests that 3MDR's immersive, motion-assisted, patient-centered psychotherapeutic approach and strong therapeutic relationship facilitated unique trauma and grief processing, empowering meaningful progress where prior interventions had failed.

Background: Conventional forms of trauma-focused psychological interventions seem to be less effective in military veterans with post-traumatic stress disorder (PTSD). Equine Assisted Interventions (EAI) have become increasingly popular as an additional treatment, resulting in increasing research on the effects of EAI. However, no systematic review on the effects of EAI has focused on PTSD, anxiety and/or mood disorders and whether the effects are reflected in psychological and physiological measures. This systematic review investigated the treatment effects, study design, population, intervention, and psychological and physiological measurements in EAI research. Methods: The search strategy yielded 1028 original articles from 3 electronic databases: PubMed, Scopus, and CAB Abstracts. These articles were screened by 2 individual blinded researchers with Rayyan according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and rendered 31 eligible studies. Results: Although all quantitative studies reported 1 or more positive treatment effects on symptoms of PTSD, anxiety and/or mood disorders, well-designed studies were sparse. This review demonstrated a lack of methodological information and few randomized controlled studies, in addition to a large heterogeneity in population characteristics, interventions, terminology, and questionnaires. Conclusion: Future studies should address these methodological considerations in order to advance the understanding of EAI and optimize their efficacy in treating PTSD, anxiety and/or mood disorders.

Background: Posttraumatic stress disorder (PTSD) is a severe, often difficult-to-treat condition, highlighting the need for innovative therapies. Interventional treatments, including neuromodulation, rapid-acting pharmacotherapies such as intravenous ketamine (IV-KET) and esketamine (ESK), and emerging psychedelic-assisted psychotherapies, offer promising solutions. This systematic review evaluates the efficacy, safety, and future research priorities of these treatments for PTSD.

Methods: A search strategy was implemented across 3 electronic databases. Peer-reviewed articles written in English that focused on interventional psychiatry treatments for adult patients with PTSD were included.

Results: The systematic review encompassed 94 studies, including 39 on transcranial magnetic stimulation (TMS), 8 on IV-KET, 3 on intranasal esketamine (IN-ESK), 4 on intravenous ketamine (IV-KET) assisted therapy (KET-AT), 1 on esketamine (ESK) assisted therapy (ESK-AT), and 14 on 3,4-methylenedioxymethamphetamine assisted therapy (MDMA-AT). Randomized controlled trials demonstrated response rates of 12.5%-80% for TMS, 17%-67% for IV-KET, and 50%-87% for MDMA. Additional treatments reviewed included Electroconvulsive Therapy, transcranial direct current stimulation, and other pharmacological and neurostimulation treatments. Most treatments were well tolerated, with only mild, transient adverse effects.

Conclusions: This review highlights the heterogeneity in efficacy, safety, and tolerability across neuromodulation and pharmacologic treatments for PTSD. Variability in response rates reflects differences in patient populations, protocols, and comorbidities. While repetitive TMS, IV-KET, ESK, KET-AT, and MDMA-AT show symptom improvement, sustained efficacy varies, underscoring the need for maintenance strategies. Although direct evidence on stage-specific approaches is limited, these methods, guided by neuroscience-based nomenclature, may improve therapeutic precision, especially in complex cases.

Addressing the spectrum of mental health requires innovative methods. Network theory views psychopathological symptoms as complex dynamic systems, potentially allowing for the identification of better monitoring and intervention targets. This article advocates for the Dynamic Time Warping (DTW) algorithm to construct symptom networks, building on two recent studies on Post-Traumatic Stress Disorder (PTSD). The studies used a cohort of 55,632 Japan Ground Self-Defense Force personnel who completed the Impact of Event Scale-Revised annually from 2013 to 2018. The first study applied DTW to create symptom networks for individuals with significant PTSD symptoms (IES-R ≥ 25, n = 1,120). The second study analyzed dynamic symptom networks in four PTSD symptom trajectories (cumulative IES-R > 5, n = 10,211), generating temporal lead and -lag profiles to reflect symptom improvement and worsening. The first study identified four PTSD symptom clusters, yielding evidence for a new dissociation cluster. In the second study, lower network density in undirected DTW analyses was associated with chronic PTSD. Directed analyses showed that dissociation symptoms decreased first during recovery, while emotional reactivity persisted. Conversely, in worsening PTSD avoidance symptoms escalated first, while dissociation symptoms intensified last. These findings demonstrate the potential of DTW as a tool for constructing interpretable networks that capture the complex dynamics of psychological processes. This approach could enhance our understanding and treatment of a wide range of mental health conditions. Future research should further explore its applications to enable more personalized and effective mental health interventions.

Background: The prevalence of trauma-related disorders in Türkiye is higher than in high-income countries due to an increased likelihood of exposure to traumatic events. Türkiye's high prevalence of trauma-related disorders underscores the need for validated tools to screen for trauma-related symptoms. The Global Psychotrauma Screen (GPS) is a newly developed, brief instrument designed to screen for transdiagnostic trauma-related symptoms and risk factors. However, its validity in Turkish populations has yet to be established. This study aimed to evaluate the psychometric properties of the Turkish version of the GPS in a general population sample from Türkiye. Methods: The Turkish version of the GPS was administered digitally to 499 individuals (36.3% male, 63.7% female) aged 18 to 74 years (mean ± SD = 24.58 ± 9.26). Psychometric analyses included exploratory factor analysis, internal consistency, reliability, clinical validity, and convergent-divergent validity. Specific statistical tests such as Cronbach's alpha for internal consistency and confirmatory factor analysis for validity were conducted. Convergent-divergent validity was assessed using correlations with other established measures of trauma symptoms, such as the posttraumatic stress disorder (PTSD) Checklist (PCL). Linear regression examined associations between risk factors and trauma-related symptoms. Results: Exploratory factor analysis indicated a single-factor structure for trauma-related symptoms. The GPS showed strong internal consistency (α = 0.87) and reliability. Clinical validity was moderate with cut-off scores of 3 for probable PTSD and 2 for depression and anxiety. These cut-off scores resulted in high sensitivity but low specificity. Risk factors such as low social support, childhood trauma, a history of mental illness, and exposure to other stressful events were significantly associated with higher GPS symptoms. The convergent validity analysis indicated a significant correlation with the PTSD Checklist (PCL), showing convergence (r = 0.48, P < .01). Conclusion: The Turkish version of the GPS is a valid and reliable screening tool for trauma-related symptoms and provides a quick and efficient screening process. However, clinical interviews are recommended following GPS screening to confirm diagnoses. These findings support the Turkish GPS as a rapid and culturally adaptable screening tool for trauma-related symptoms, although confirmatory clinical interviews remain essential for diagnosis. These findings support the applicability of GPS across diverse cultural contexts. Further studies are needed to explore its psychometric properties in other regions and languages.

Since the last publication of the Psychopharmacology Algorithm Project at the Harvard South Shore Program Posttraumatic Stress Disorder (PTSD) algorithm in 2022, additional evidence has reinforced key treatment recommendations. Prazosin remains the first-line treatment for PTSD-related sleep impairment, including nightmares and disturbed awakenings, and it may be useful for individuals with comorbid alcohol use disorder and comorbid headaches. After treating PTSD insomnia, if significant daytime symptoms remain, a selective serotonin reuptake inhibitor ( SSRI, sertraline or paroxetine are suggested), and this may be augmented by an antipsychotic (consider aripiprazole first) if psychotic symptoms, if any, do not respond to the SSRI. If results are still unsatisfactory, a second SSRI or a selective norepinephrine reuptake inhibitor (SNRI) could be considered, though they offer no benefit for hyperarousal symptoms, and prazosin may also be tried for residual daytime symptoms. This update also evaluates emerging treatments, including transcranial magnetic stimulation, direct current stimulation, stellate ganglion block, and pimavanserin, though concluding that current evidence does not yet warrant their inclusion in the core algorithm. This update provides clinicians with an evidenceinformed approach to pharmacological PTSD management based on the latest available data.

Earthquakes can have a substantial impact on communities, leading to severe economic losses, structural damage, casualties, and displacement, as well as adverse psychological effects on survivors. Previous studies have highlighted a broad spectrum of adverse psychological effects following disasters, such as sleep disturbances, emotional distress, depression, suicidal thoughts, anxiety, posttraumatic stress disorder (PTSD). Posttraumatic stress disorder is particularly common among disaster survivors. It is characterized by the emergence of specific symptoms following direct exposure (experiencing a traumatic event firsthand or witnessing it happen to others) or indirect exposure (learning about a traumatic event involving loved ones or repeatedly being exposed to distressing details of the event). Disasters, crises, and traumas are difficult life experiences that require individuals to seek support. It is crucial to identify key factors such as individuals' location, emotional state, and their specific needs during these times to provide effective assistance. Addressing these aspects is essential in preventing trauma from worsening or becoming more entrenched. Post-earthquake psychosocial support should include comprehensive, long-term, and sustainable interventions to improve the mental health of both individuals and society. The aim of this article is to evaluate PTSD and related mental health issues following earthquakes.