PTSD treatment of African American adults in primary care: the gap between current practice and evidence-based treatment guidelines.
J Natl Med Assoc. 2011 Jul;103(7):585-93
Authors: Graves RE, Freedy JR, Aigbogun NU, Lawson WB, Mellman TA, Alim TN
BACKGROUND: Posttraumatic stress disorder (PTSD) is a common, potentially disabling, underdiagnosed, and under-treated illness. Primary care physicians assume a critical role in the diagnosis, treatment, and referral of African Americans with PTSD since mental health access is limited for this population. This study is an examination of PTSD treatment of African Americans in the primary care setting. Actual treatment provision is contrasted with existing evidence-based PTSD treatment guidelines.
METHOD: Researchers screened 738 consenting, mostly African American, adults in 4 academically affiliated primary care offices for both trauma exposure and mental health symptoms, including PTSD.
RESULTS: Employing criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-IV), investigators diagnosed 91 of the participants with current PTSD using the Structured Clinical Interview for DSM and the clinician-administered of PTSD Scale for DSM-IV. Treatment statistics include: 69.2% (n=63) had never received treatment from a mental health provider: 18.6% (n=17) were currently seeing a mental health practitioner; nearly half (47.9%, n=24) of a subsample had never discussed traumatic event exposure or mental health symptoms with their primary care doctor; 32% (n=29) were prescribed psychotropic medication and only 18.6% (n=17) were participating in any form of psychotherapy. Concurrent psychiatric disorders were found in 46.2% (n = 42) of the participants with PTSD.
CONCLUSION: Most African American adult primary care patients with PTSD were either undiagnosed or undertreated in this inner-city setting. These results demonstrate a clear need to improve screening and treatment services. Both individual (provider and patient) and system-based changes will be required to meet the demonstrated clinical need.
PMID: 21999033 [PubMed - in process]care doctor, clinical interview, PTSD treatment of African American, diagnostic and statistical manual of mental disorders
Abnormal ECG Patterns in Chronic Post-War PTSD Patients: A Pilot Study.
Int J Behav Med. 2011 Sep 30;
Authors: Khazaie H, Saidi MR, Sepehry AA, Knight DC, Ahmadi M, Najafi F, Parvizi AA, Samadzadeh S, Tahmasian M
BACKGROUND: Posttraumatic stress disorder (PTSD) is a psychiatric syndrome associated with high levels of sympathetic activation of the autonomic nervous system. Individuals diagnosed with PTSD have a high propensity for electrocardiogram (ECG) abnormalities, atrioventricular conductive defects, and cerebrovascular incidents. PURPOSE: The aim of this study was to investigate ECG abnormalities in post-war PTSD patients. METHOD: This pilot study compared patients diagnosed with chronic post-war PTSD (n = 30) to patients diagnosed with major depressive disorder (MDD; n = 24) and healthy controls (n = 20). Following the completion of the Structured Clinical Interview for the DSM (SCID), participants were assessed with a standard 12-lead ECG. RESULTS: ECG abnormalities were observed in 66.7% of PTSD patients and 70.8% of MDD patients. In contrast, only 28.6% of the healthy control group showed ECG abnormalities. Multivariate logistic regression was used to adjust for participants’ sex, smoking rate, education level, disease duration, and marital status. The results indicated that PTSD and MDD patients were more likely to have ECG abnormalities than the normal population (odds ratio for PTSD = 12.7, 95% confidence interval 1.9-83.9; and odds ratio for MDD = 14.9, 95% confidence interval 1.3-170.5). CONCLUSION: PTSD and MDD patients showed elevated rates of ECG abnormalities compared to healthy controls. These findings have important implications for the medical treatment of PTSD and MDD given that both of these patient groups appear to be at increased risk of cardiovascular disorder.
PMID: 21960258 [PubMed - as supplied by publisher]odds ratio, posttraumatic stress disorder, electrocardiogram ecg, major depressive disorder, Abnormal ECG, ECG abnormalities
Insomnia characteristics and clinical correlates in Operation Enduring Freedom/Operation Iraqi Freedom veterans with post-traumatic stress disorder and mild traumatic brain injury: An exploratory study.
Sleep Med. 2011 Sep 16;
Authors: Wallace DM, Shafazand S, Ramos AR, Carvalho DZ, Gardener H, Lorenzo D, Wohlgemuth WK
BACKGROUND: There is limited data on chronic insomnia in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, in whom post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) often co-exist. Our aim was to compare sleep characteristics of three groups of OEF/OIF veterans: (1) healthy sleepers (HS), (2) those with insomnia associated with PTSD and mTBI (PTSD-mTBI), and (3) those with insomnia associated with PTSD alone. METHODS: Consecutive veterans with insomnia complaints (>6months) were recruited over 6months from the Miami VA Post Deployment clinic. Participants completed a sleep disorders clinical interview, medical history, and questionnaires about insomnia, sleepiness, pain, fatigue, depression, PTSD, and health-related quality of life. They underwent polysomnography (PSG) with 2weeks of actigraphy (ACT) and sleep diaries. RESULTS: There were no differences in demographics or most questionnaire responses between PTSD and PTSD-mTBI groups. Subjective daytime sleepiness was significantly greater in PTSD-mTBI subjects compared with HS and PTSD participants. Significant co-morbid sleep disorders were noted in insomnia patients. PSG and ACT wake after sleep onset was significantly shorter in PTSD-mTBI subjects as compared with PTSD participants. CONCLUSION: Insomnia patients with PTSD-mTBI were subjectively sleepier despite spending less time awake during the night than PTSD subjects, possibly as a consequence of head trauma.
PMID: 21925943 [PubMed - as supplied by publisher]clinical correlates, clinic participants, clinical correlates in Operation Enduring