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1.
Monoamine Oxidase Inhibitors (MAOIs) in Psychiatric Practice: How to Use them Safely and Effectively.
Chamberlain, SR, Baldwin, DS
CNS drugs. 2021;(7):703-716
Abstract
Monoamine oxidase inhibitors (MAOIs) were among the first licensed pharmacological treatments for patients with depression but over time have fallen out of mainstream clinical use. This has led to a loss of clinician training opportunities and reduced availability of MAOIs for prescribing. This article provides a concise and practical overview of how to use MAOIs safely and effectively in psychiatric practice. We consider the history of MAOIs, why they are not used more frequently, their mechanisms of action, availability, indications and efficacy, general tolerability, withdrawal symptoms, and safety considerations (including hypertensive reactions and serotonin syndrome). Practical advice is given in terms of dietary restrictions, interactions with other medications (both prescribed and non-prescribed), and how prescribers can stop and switch MAOIs, both within the drug class and outside of it. We also provide advice on choice of MAOI and treatment sequencing. Lastly, we consider emerging directions and potential additional indications.
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2.
Gender differences in the experienced emotional intensity of experimentally induced memories of negative scenes.
Staugaard, SR, Berntsen, D
Psychological research. 2021;(4):1732-1747
Abstract
It is well documented that women have an increased risk of emotional disorders, such as anxiety and depression. Such disorders are typically characterized by intrusive memories and rumination of past events, but findings are mixed as to whether women have enhanced access to memories of emotional events. Some studies have found that women, compared with men, report more frequent and more intense memories of emotionally stressful events, whereas other studies have failed to replicate this effect. These conflicting findings may reflect the use of different memory sampling techniques (e.g., retrospective vs. experimental data) and limited control for factors associated with both gender and emotional memory. The purpose of the present study was to investigate gender differences in memory for emotionally negative events, using three different sampling methods, while at the same time controlling for parameters that might co-vary with gender. Consistent with some previous studies, we found that women and men did not differ in their frequencies of emotionally negative involuntary memories. However, women rated their memories as more intense and arousing than men did, and women also reported higher increases in state anxiety after retrieval. Female gender accounted for unique variance in the emotional intensity and subjective arousal associated with negative memories, when controlling for other theoretically derived variables. The findings provide evidence that female gender is associated with a stronger emotional response to memories of negative events, but not that women remember such events more frequently than men do.
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3.
Health effects of COVID-19 for vulnerable adolescents in a randomized controlled trial.
Miller, RL, Moran, M, Shomaker, LB, Seiter, N, Sanchez, N, Verros, M, Rayburn, S, Johnson, S, Lucas-Thompson, R
School psychology (Washington, D.C.). 2021;(5):293-302
Abstract
Emerging evidence suggests the coronavirus disease 2019 (COVID-19) pandemic is adversely affecting adolescents' mental health and health behaviors, particularly among those with preexisting mental health conditions and from lower socioeconomic backgrounds. However, direct tests of changes in health outcomes among vulnerable adolescents from before to during COVID-19 are limited. In addition, little is known about how to buffer adolescents, particularly those who are most vulnerable, against stress-related decrements in health. This randomized controlled trial begins to fill these gaps in the literature by exploring changes in mental health, health behaviors, executive function, emotion regulation, and mindfulness among vulnerable adolescents involved in a mentoring program during the COVID-19 pandemic. It also examined to what extent there were protective benefits of incorporating mindfulness training within a mentoring program for buffering adolescents from negative pandemic health effects. Thirty-five adolescents (Mage = 12.9, 37% female) and 32 parents (Mage = 44.75, 80% female) completed questionnaires at baseline (February 2020) and follow-up (July 2020). There were few significant reductions in health; instead, on average, youth reported improvements in sleep, emotion regulation, executive function, and mindfulness over time. Adolescents randomized to mentoring + mindfulness displayed significantly less posttraumatic stress disorder (PTSD) symptomatology and emotional impulsivity at follow-up, compared to the mentoring-as-usual condition. These pilot findings suggest that mentoring with a mindfulness training component may offer an effective strategy for protecting adolescents from deteriorations in health outcomes during COVID-19. Further, there may be unique benefits of mindfulness training for vulnerable youth as a way to adapt to stressful events. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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4.
Posttraumatic Stress Disorder and Childhood Traumatic Loss: A Secondary Analysis of Symptom Severity and Treatment Outcome.
Unterhitzenberger, J, Sachser, C, Rosner, R
Journal of traumatic stress. 2020;(3):208-217
Abstract
Loss is a commonly experienced traumatic event among children. Although the experience of loss can potentially lead to posttraumatic stress symptoms (PTSS), little is known about PTSS levels after traumatic loss versus other traumatic events. We investigated data from a randomized controlled trial (RCT) on trauma-focused cognitive behavioral therapy (TF-CBT) versus a waitlist condition for children with PTSS. In a secondary analysis, we compared participants who reported traumatic loss as their index event (n = 23) to those who reported the two most frequently reported index events in the RCT: sexual abuse (SA; n = 59) and physical violence (PV; n = 55). The index event was rated according to the participants' most distressing traumatic event reported on the Clinician-Administered PTSD Scale for Children and Adolescents. Participants who experienced traumatic loss reported fewer PTSS and better general functioning than those who reported SA. A subgroup RCT (n = 19) revealed TF-CBT to be highly effective in reducing PTSS in cases of traumatic loss, d = 1.69. The effect sizes for PTSS indicated that all three trauma groups benefited from TF-CBT. In the waitlist group, PTSS symptoms improved for SA and PV, ds = 0.76 and 0.98, respectively, but not for traumatic loss, d = 0.23. These findings suggest that TF-CBT is a feasible and promising treatment for children who experience PTSS after traumatic loss. The results are limited by the post hoc quality of the analyses and lack of a measure of grief in the RCT.
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5.
Metabolic syndrome risk in relation to posttraumatic stress disorder among trauma-exposed civilians in Gansu Province, China.
LIhua, M, Tao, Z, Hongbin, M, Hui, W, Caihong, J, Xiaolian, J
Medicine. 2020;(1):e18614
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Abstract
This study included 1456 men and 1411 women who were trauma-exposed and underwent routine health examinations in a community epidemiological investigation. The participants completed the posttraumatic stress disorder (PTSD) Check List-Civilian Version (PCL-C) for PTSD and medical examinations to detect metabolic syndrome. Adjustments for age, marriage, exercise, education, cigarette smoking, cancer, stroke, angina, and thyroid disease were performed. The relationship between PTSD and metabolic syndrome and each of its components was analyzed by multiple logistic regression.In women, PTSD was associated with metabolic syndrome (OR = 1.53, 95% CI = 1.01-1.95, P = .047) and the high-density lipoprotein cholesterol component (OR = 1.98, 95% CI = 1.04-2.12, P = .002). In men, PTSD was related to the hypertension component of metabolic syndrome (OR = 0.54, 95% CI = 0.31-0.92, P = .023). There was also a relationship between PTSD severity and metabolism (OR = 1.141, 95% CI = 1.002-1.280, P = 0.037) in women, and PTSD was inversely associated with the hypertension component (OR = 0.54, 95% CI = 0.31-0.92, P = .023) in men.PTSD was related to metabolic syndrome only in women. We plan to further research the mechanism of sex differences and dyslipidemia.
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6.
Cannabinoids as an Emerging Therapy for Posttraumatic Stress Disorder and Substance Use Disorders.
Cohen, J, Wei, Z, Phang, J, Laprairie, RB, Zhang, Y
Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2020;(1):28-34
Abstract
Posttraumatic Stress Disorder (PTSD) is a leading psychiatric disorder that mainly affects military and veteran populations but can occur in anyone affected by trauma. PTSD treatment remains difficult for physicians because most patients with PTSD do not respond to current pharmacological treatment. Psychotherapy is effective, but time consuming and expensive. Substance use disorder is often concurrent with PTSD, which leads to a significant challenge for PTSD treatment. Cannabis has recently received widespread attention for the potential to help many patient populations. Cannabis has been reported as a coping tool for patients with PTSD and preliminary legalization data indicate Cannabis use may reduce the use of more harmful drugs, such as opioids. Rigorous clinical studies of Cannabis could establish whether Cannabis-based medicines can be integrated into treatment regimens for both PTSD and substance use disorder patients.
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The Two Faces of Janus: Why Thyrotropin as a Cardiovascular Risk Factor May Be an Ambiguous Target.
Dietrich, JW, Hoermann, R, Midgley, JEM, Bergen, F, Müller, P
Frontiers in endocrinology. 2020;:542710
Abstract
Elevated concentrations of free thyroid hormones are established cardiovascular risk factors, but the association of thyrotropin (TSH) levels to hard endpoints is less clear. This may, at least in part, ensue from the fact that TSH secretion depends not only on the supply with thyroid hormones but on multiple confounders including genetic traits, medication and allostatic load. Especially psychosocial stress is a still underappreciated factor that is able to adjust the set point of thyroid function. In order to improve our understanding of thyroid allostasis, we undertook a systematic meta-analysis of published studies on thyroid function in post-traumatic stress disorder (PTSD). Studies were identified via MEDLINE/PubMed search and available references, and eligible were reports that included TSH or free thyroid hormone measurements in subjects with and without PTSD. Additionally, we re-analyzed data from the NHANES 2007/2008 cohort for a potential correlation of allostatic load and thyroid homeostasis. The available evidence from 13 included studies and 3386 euthyroid subjects supports a strong association of both PTSD and allostatic load to markers of thyroid function. Therefore, psychosocial stress may contribute to cardiovascular risk via an increased set point of thyroid homeostasis, so that TSH concentrations may be increased for reasons other than subclinical hypothyroidism. This provides a strong perspective for a previously understudied psychoendocrine axis, and future studies should address this connection by incorporating indices of allostatic load, peripheral thyroid hormones and calculated parameters of thyroid homeostasis.
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8.
Psychological Adjustment of Aging Vietnam Veterans: The Role of Social Network Ties in Reengaging with Wartime Memories.
Marini, CM, Fiori, KL, Wilmoth, JM, Pless Kaiser, A, Martire, LM
Gerontology. 2020;(2):138-148
Abstract
It is projected that by 2020 there will be 8.7 million veterans over the age of 65 years, more than half (64%) of whom served during the Vietnam War. The effects of military service on mental health and well-being may be more pronounced later in life among those who served in Vietnam than prior cohorts of veterans. Many veterans confront and rework their wartime memories later in life in an attempt to find meaning and coherence, engaging in a process referred to as Later-Adulthood Trauma Reengagement (LATR). LATR often occurs in the context of other stressors that are a normative part of aging, such as role transitions (e.g., retirement), declines in physical health, and the death of close others (e.g., spouses), perhaps because these events trigger reminiscence. Importantly, LATR may result in either positive (e.g., acceptance) or negative (e.g., distress) psychological outcomes. It has been suggested that the presence of social/environmental resources, including socioemotional support, may aid veterans in successfully navigating LATR. We, therefore, review relevant areas of research to delineate the role that various layers of social context may play in -helping - or hindering - aging Vietnam veterans as they navigate LATR in the context of normative late-life stressors. We conclude by offering fruitful directions for future research and applied implications for intervention efforts.
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9.
Combining Xenon Inhalation With Trauma Memory Reactivation to Reduce Symptoms of Posttraumatic Stress Disorder: Case Report, Justification of Approach, and Review of the Literature.
Dobrovolsky, A, Bogin, V, Meloni, EG
The primary care companion for CNS disorders. 2019;(5)
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating disease with limited available treatment options and for which novel effective interventions constitute a significant unmet need. This case report describes successful treatment of a patient with panic disorder and PTSD stemming from the 2010 Moscow subway terrorist attacks through the combination of script-driven trauma memory reactivation and inhalation of a xenon-based gas mixture. Xenon is a competitive inhibitor of N-methyl-d-aspartate receptors known to play a role in memory reconsolidation, a learning and memory process wherein memories temporarily enter a labile state after reactivation and may be modified. Literature describing current pharmacologic and exposure-based treatments is reviewed and provides the basis for use of this novel treatment strategy to target and modify emotional memories.
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10.
Childhood adversity and women's cardiometabolic health in adulthood: associations with health behaviors, psychological distress, mood symptoms, and personality.
van Dammen, L, Bush, NR, de Rooij, SR, Mol, BWJ, Groen, H, Hoek, A, Roseboom, TJ
BMC women's health. 2019;(1):102
Abstract
BACKGROUND We tested whether childhood adversity is associated with poor cardiometabolic health in adulthood among a sample of overweight or obese Dutch women of reproductive age. Health behaviors, psychological distress, mood symptoms, or personality traits were included as potential mediators. METHODS Data came from a follow-up visit (N = 115), carried out in 2016/2017, of a randomized controlled lifestyle intervention trial in 577 obese infertile women. The associations between total adversity exposure score and cardiometabolic health were tested with regression models. Sleep, smoking and eating behavior, symptoms of depression, anxiety and stress, and personality traits were potential mediators. RESULTS Childhood adversity scores were not associated with cardiometabolic outcomes but were associated with poorer sleep quality score (M = 7.2 (SD = 3.5) for those with ≥2 types of events versus 4.8 (2.9) for those with no events; p = 0.022), higher external eating score (26.4 (8.7) versus 21.8 (10.3); p = 0.038), higher perceived stress score (17.1 (6.8) versus 12.3 (4.5); p = 0.016), post-traumatic stress score (1.9 (1.5) versus 0.6 (1.1); p < 0.001), and lower agreeableness score (28.2 (4.2) versus 30.3 (3.1); p = 0.035). CONCLUSION Childhood adversity was associated with poorer health behaviors including sleep and eating behavior, and more stress-related symptoms, but not with women's cardiometabolic health.