Post-traumatic stress disorder following a suicide attempt

How commonly does a suicide attempt lead to post-traumatic stress disorder? The terrifying nature of events before and after many suicide attempts and the increasing rates of suicide attempts in the general population suggest that PTSD as a result of a suicide attempt should not be a rare occurrence. However, a thorough review of the literature revealed no reports. We provide one case report and discuss the theoretical, clinical, and research questions linking traumatic suicide attempts to subsequent PTSD.     

“Seeking Safety”: Outcome of a New Cognitive-Behavioral Psychotherapy for Women with Posttraumatic Stress Disorder and Substance Dependence

Women with current posttraumatic stress disorder (PTSD) comprise 30–59% of substance abuse treatment samples and experience a more severe course than women with either disorder alone. As yet, no effective treatment for this population has been identified. This paper reports outcome results on 17 women who completed a new manual-based 24-session cognitive behavioral group therapy protocol treatment, based on assessments at pretreatment, during treatment, posttreatment, and at 3-month follow-up. Results showed significant improvements in substance use, trauma-related symptoms, suicide risk, suicidal thoughts, social adjustment, family functioning, problem solving, depression, cognitions about substance use, and didactic knowledge related to the treatment. Patients' treatment attendance, alliance, and satisfaction were also very strong. Treatment completers were more impaired than dropouts, yet more engaged in the treatment. Overall, our data suggest that women with PTSD and substance abuse can be helped when provided with a treatment designed for them. All results are clearly tentative, however, due to the lack of a control group, multiple comparisons, and absence of assessment of dropouts.     

The association between executive functioning and parental stress and psychological distress is mediated by parental reflective functioning in mothers with substance use disorder

Mothers with a substance use disorder (SUD) have been found to exhibit heightened experience of stress and deficits in executive functioning (EF) and in parental reflective functioning (PRF). Although experiences of stress, EF and PRF are important for caregiving capacities; no studies have explored associations between the phenomena in mothers with SUD. This study aimed to examine the association between EF (working memory, inhibition, and cognitive flexibility) and different forms of stress (parental stress, general life stress, and psychological distress) in 43 mothers with SUD with infants. We further aimed to investigate whether PRF had a mediating function between EF and the experience of stress. The mothers completed self‐report questionnaires regarding experiences of different types of stress, and we also used neuropsychological tests to assess EF and a semistructured interview to assess PRF. Results identified problems in EF were associated with higher parental stress and psychological distress but not with general life stress. Cognitive flexibility contributed uniquely to variance in parental stress, whereas working memory was a unique contributor to variance in psychological distress. PRF had a mediating function between EF and parental stress and between EF and psychological distress. Findings highlight the importance of considering individual differences in PRF when targeting EF in interventions trying to reduce the experience of parental stress and psychological distress in mothers with SUD.     

The older anaesthetist

It is not possible to generalise about the way in which increasing years affect the performance of an individual anaesthetist. Physical and mental deterioration occurs as we age; most anaesthetists will be able to reach the normal retirement age of 65 years without that deterioration affecting their clinical practice. In some, however, decreasing competence and an unwillingness to embrace a continuing education regime may offer a direct threat to patient safety. Stress and 'burnout' are common in anesthetists; clinical depression can often be one of the factors involved. Continuing involvement in the on-call rota is a potent stressor. Airline pilots are required to retire at 60 years; the feasibility and desirability of applying this process to anaesthetists are discussed. Employers have a duty to provide employees with adequate and achievable demands in relation to their agreed hours of work and to have in place policies and procedures to offer adequate support.     

Opioid use disorder in adult burn patients: Implications for future mental health,behavioral and substance use patterns

BackgroundBurn patients continue to have a high opioid requirement, despite current national trends to decrease opioid prescribing. While effective, long-term opioid use results in opioid dependence and possibly other mental health comorbidities. This retrospective cohort study seeks to evaluate implications of diagnosed opioid use disorder in the development of subsequent psychiatric, behavioral and substance abuse patterns.MethodsThe TriNetX database was queried for patients 18 years and older with a diagnosis of thermal or chemical burn who developed opioid use disorder after their burn injury. Two matched cohorts were studied, opioid use disorder versus non-opioid use disorder, to evaluate risk of developing subsequent mental health and behavioral conditions, use of psychiatric health services, and future substance abuse.ResultsA total of 2020 patients were identified in each cohort, matched for demographics, external trauma, and burn size. Patients in the opioid use disorder group had a significantly higher incidence of mental health diagnoses (79.7 % versus 57.7 %, OR 1.973, CI 1.741–2.236, p < 0.0001), including major depressive disorder, generalized anxiety disorder, and post-traumatic stress disorder. This group was also more likely to utilize psychiatric services (16.0 % versus 10.3 %, OR 1.926, CI 1.595–2.326, p < 0.0001) and psychotherapy (12.6 % versus 7.2 %, OR 2.046, CI 1.650–2.536, p<0.0001). Furthermore, the opioid use disorder group had higher rates of polysubstance abuse (29.9 % versus 12.3 %, OR 3.048, CI 2.588–3.589, p<0.0001), suicidal / homicidal ideations (8.2 % versus 3.2 %, OR 3.057, CI 2.274–4.109, p<0.0001), and suicide attempts (2.0 % versus 0.7 %, OR 2.971, CI 1.611–5.478, p = 0.003).ConclusionsBurn patients who develop opioid use disorder have significantly higher rates of future psychiatric diagnoses, behavioral disturbances, and polysubstance abuse. A multidisciplinary team approach, including early involvement of pain and mental health services, could potentially reduce the development of opioid use disorder and its consequences.     

Posttraumatic Stress Disorder and Substance Abuse: Use of Research in a Clinical Setting

The goal of the present investigation was to evaluate whether the process of assessing posttraumatic stress disorder (PTSD) in substance abuse/dependence inpatients (N = 95) as part of a research protocol influenced the diagnostic assessment conducted by clinical staff. The prevalence of current crime-related PTSD (CR-PTSD) observed with a research interview was 40% (n = 38), whereas the rate of current CR-PTSD documented in (the same) patients' discharge summaries was 15% (n = 14). An even lower CR-PTSD prevalence rate of 8% (n = 5) was obtained from a new sample of patient discharge summaries (N = 59) collected after the cessation of the research project. On chart intake reports, clinical staff documented a history of sexual and/or physical assault in approximately one-half of these patients, but PTSD was not evaluated. PTSD appears to be under-diagnosed by clinical staff in patients with substance use disorders.     

Screening for PTSD in a Substance Abuse Sample: Psychometric Properties of a Modified Version of the PTSD Symptom Scale Self-Report

The high rate of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients has been documented in research protocols, but there is evidence that it is markedly under-diagnosed in clinical settings. To address the need for a brief self-report measure to identify SUD patients who may benefit from further assessment and/or treatment for PTSD, the psychometric properties of a modified version of the PTSD Symptom Scale Self-Report (PSSSR) were examined in a treatment-seeking SUD sample (N = 118). The modified version of the PSS-SR, which measures both frequency and severity of PTSD symptoms, demonstrated good internal consistency reliability and was correlated with other self-report measures of trauma-related symptomatology. Comparisons between a structured PTSD diagnostic interview and the modified PSS-SR indicated that 89% of the PTSD positive patients were correctly classified by the modified PSS-SR. The clinical relevance of these findings was discussed.     

Time‐clustered Deaths and Substance Use Disorder among Young Adults

This study assesses whether experiencing multiple deaths of loved ones clustered in time increases risk for substance use problems. Using survey data from a community sample of young adults in Miami, Florida (N = 1747), time‐clustered deaths were categorized based on the age of the respondent at the time of each death, with less time between deaths representing greater time‐clustering. Results indicate that young adults experiencing multiple deaths that are highly time clustered are at increased risk for substance use disorder and alcohol use. This study provides an alternative way of thinking about how young people may be affected by major life events. It suggests that the increased risk for substance use disorder associated with multiple deaths may be more likely to materialize when the deaths are highly clustered in time. Copyright © 2014 John Wiley & Sons, Ltd.     

Genetic and environmental influences on the relationship among combat exposure, posttraumatic stress disorder symptoms, and alcohol use

The role of genetic and environmental influences on the relationship between combat exposure, posttraumatic stress disorder (PTSD) symptoms, and alcohol use were examined in 4072 male–male twin pairs who served in the United States military during the Vietnam era (1965–1975). Results indicate that the relationship between combat and alcohol use and between PTSD symptom factors and alcohol use were both substantially influenced by genetic factors. Findings are most consistent with a shared vulnerability model for the etiology of the association between PTSD symptoms and alcohol use. Specific unique environmental factors were more important than genetic factors for PTSD symptoms, and both factors were equally important for alcohol use. Further support is also found for the role of the unique environment in PTSD symptoms.     

Substance abuse and dependence in anaesthetists

The incidence of substance abuse amongst anaesthetists in the United Kingdom is unknown. In the interests of patient safety, it is essential that the dependent doctor is identified and entered into a treatment regime. No national strategy is in place to treat and, where possible, return the anaesthetist in recovery to work. It is important therefore, that individual employers have a standing operating procedure to deal with the addicted doctor. It is essential that the initial approach is made by a competent panel, each of whom has experience of dealing with dependent doctors. This is an extremely stressful time for the doctor involved; it is therefore essential that active support is given. It is not always necessary to suspend the doctor from work whilst treatment is undertaken. In the dependent doctor sudden withdrawal of the substance of addiction can be life-threatening. It is therefore essential that the supervising physician has specialist knowledge of the treatment of addiction. Residential care probably provides the greatest hope of success. In the United States, Canada, Australia and New Zealand 'impaired physician' programmes are in place which allow some doctors to return to work, initially under strict supervision. Registration with a self-help organisation is essential; a list of such groups in the United Kingdom is appended.     

Approach Behaviour,Stress and Substance Use in Young Adults

We investigated the interaction between approach behaviours (measured through performance on a resource‐gathering task) and self‐reported global life stress to predict substance use. Our hypothesis that high levels of approach behaviour in combination with high life stress would predict elevated substance use was guided by the reinforcement sensitivity theory (Gray & McNaughton, 2000 ). Ninety‐three young adult students (61 women and 32 men) completed a computerized resource‐gathering task and questionnaires assessing global life stress and substance use. Consistent with the hypothesis, approach behaviour was positively related to substance use for individuals with high life stress. The findings suggest that person by environment interactions are useful in understanding substance use and we discuss how approach‐motivated individuals may arrive at different substance use outcomes as a function of stressful contexts. Copyright © 2016 John Wiley & Sons, Ltd.     

The use of anticonvulsants in posttraumatic stress disorder: Case study and overview

A case of posttraumatic stress disorder is described in which a favorable response to the anticonvulsants carbemazepine and sodium valproate occurred. The literature on the use of anticonvulsants in this disorder is reviewed.     

Post-traumatic stress disorder in Vietnam combat veterans: Effects of traumatic violence exposure and military adjustment

Thirty high-combat Vietnam veterans with a diagnosis of Post-traumatic Stress Disorder (PTSD) were compared with a second group of 30 high-combat Vietnam veterans without evidence of PTSD on measures of military adjustment and exposure to traumatic violence during combat. Military adjustment was assessed for precombat and combat service periods and included measures of alcohol and drug use, disciplinary actions, and social support. The PTSD-positive group reported significantly greater exposure to traumatic violence and more distress at having observed and participated in such acts than did the PTSD-negative group. Multiple regression analysis revealed the five traumatic violence frequency and distress scales to be significant predictors of severity of PTSD symptoms. Group differences were not attributable to premilitary demographic or social adjustment variables. Analyses of covariance demonstrated that both groups increased their drug and alcohol use and reported fewer social supports from precombat to combat periods. Results support the residual stress model of PTSD etiology, implicating trauma as the major contributing factor in the disorder.