Outcome of treatment for post-traumatic stress disorder in a primary care unit serving vietnam veterans

Veterans diagnosed with PTSD (PTSD in-treatment,N=39), newly admitted to a comprehensive 90-day inpatient treatment program, were tracked at 4-week intervals from admission to discharge. Two control groups were also tracked over 12-week periods — one of previously PTSD diagnosed and treated veterans (PTSD out-of-treatment,N=26), and a second that combined non-PTSD Vietnam era veterans (N=17) and non-veterans (N=16) (non-PTSD nontreatment). As measured by the Penn Inventory for PTSD, 48% of those who completed treatment showed some or substantial gains, 39% showed no gain, and 13% reported some increase in symptoms at the time of discharge. Several patterns were observed on other assessment measures. One year follow-up for those who completed treatment showed a return to pretreatment levels on the PTSD symptom measures employed in this study. These results are discussed in relation to other treatment program outcome studies as a baseline for further research.     

The concept of the second generation program in the treatment of post-traumatic stress disorder among vietnam veterans

The concepts of First and Second Generation treatment programs for Vietnam veterans with post-traumatic stress disorder are presented, based on a developmental theoretical model of adaptation. First Generation programs focus on accessing and then working through the effects of the war trauma and aim to diminish the intensity of core PTSD symptoms. Second Generation programs focus on reintegrating veterans into the social context of family and work, and aim to improve their ability to function in society. Both types of treatment may be required in order to help veterans resume their psychological and social development. The need to develop sophisticated models of comprehensive inpatient treatment in order to support scholarly discourse and outcome research is emphasized.     

Race and outcome of treatment for veterans suffering from PTSD

This study examines the relationship between racial group membership and psychometrically measured outcomes 4, 8 and 12 months after program entry in a program for veterans seeking treatment for war-related posttraumatic stress disorder (PTSD). Longitudinal assessment data were gathered and used to compare service use, clinicians' improvement ratings and psychometrically assessed clinical change among Black (n=122) and White (n=403) veterans treated at six geographically diverse sites. There were no significant differences between Blacks and Whites on any of the clinicians' improvement ratings, or on 13 of the 17 outcome measures. In this prospective study of veterans suffering from long-standing, severe PTSD, no consistent or sustained differences were observed between racial groups in improvement whether measured as psychometric change or by clinicians' ratings.     

Modes of long-term coping with trauma memories: Relative use and associations with personality among vietnam veterans with chronic PTSD

Little is known about how individuals who develop chronic posttraumatic stress disorder (PTSD) cope with recurring trauma memories, or how enduring personality characteristics influence such coping. Focusing on 110 hospitalized Vietnam combat veterans with chronic PTSD, this exploratory study assessed the relative frequency of using eight ways of coping with war memories, and associations between relative use of these strategies and eight dysfunctional personality styles. As a secondary issue, associations between coping strategies, combat exposure, and PTSD severity were also examined. Consistent with prior findings, these veterans predominantly used emotion-focused and avoidant strategies to cope with war memories. Differing personality styles and relative use or nonuse of particular coping strategies were also associated in psychologically coherent ways. These preliminary findings are discussed in relation to methodologic and future research issues.     

Post-traumatic stress and associated disorders among vietnam veterans: The significance of combat exposure and social support

The hypothesis is tested that individuals exposed to traumatic stress who currently have lower social support have higher rates of post-traumatic stress and associated disorders. To test this, the current prevalence of five psychiatric disorders, including post-traumatic stress, generalized anxiety, depression, alcohol abuse, and drug abuse, were studied among a random sample of veterans who served in Vietnam (N=2,490) and a random sample of era veterans who did not (N=1,972). Logistic regression was used to analyze each disorder, controlling for past combat exposure, current social status, childhood delinquency, military adjustment, and current social support. Combat exposure was the best predictor of post-traumatic stress and was also associated with anxiety and depression, but not alcohol or drug abuse. Substance abuse was associated with childhood delinquency, and the best predictor of drug abuse was illicit Army drug use. Lower social support was associated with all disorders, except drug abuse. Although the causal nexus is not clear in this case, this study suggests that future research and clinical interventions should not overlook the significance of social support among victims of traumatic stress.     

Male-perpetrated violence among Vietnam veteran couples: relationships with veteran's early life characteristics,trauma history,and PTSD symptomatology

Using structural equation modeling, we examined the impact of early-life stressors, war-zone stressors, and PTSD symptom severity on partner's reports of recent male-perpetrated intimate partner violence (IPV) among 376 Vietnam veteran couples. Results indicated that several variables demonstrated direct relationships with IPV, including relationship quality with mother, war-zone stressor variables, and PTSD symptom severity. Importantly, retrospective reports of a stressful early family life, childhood antisocial behavior, and war-zone stressors were indirectly associated with IPV via PTSD. One of our 2 war-zone stressor variables, perceived threat, had both direct and indirect (through PTSD) relationships with IPV. Experiencing PTSD symptoms as a result of previous trauma appears to increase an individual's risk for perpetrating IPV. Implications for research and treatment are discussed.     

Fear activation and habituation patterns as early process predictors of response to prolonged exposure treatment in PTSD

Improved (n = 21) and nonimproved (n = 13) PTSD patients (a mixed trauma population) were compared for fear activation and habituation patterns during and between the 1st and 2nd prolonged exposure sessions. Drop-outs (n = 11) were also evaluated. Nonimproved patients had significantly higher ratings of anxiety at the start of the first exposure session. Improved patients showed more within-session habituation during the self-exposures at home and more between-session habituation. Even after controlling for initial PTSD and depression symptom severity, habituation between the first and second exposure sessions was significantly related to treatment outcome. Patients who dropped out of the treatment were found not to differ from completers on fear activation and within-session habituation during the first exposure session.     

Imagery vividness and perceived anxious arousal in prolonged exposure treatment for PTSD

The present paper examines imagery vividness and anxiety during Prolonged Exposure (PE) for chronic PTSD among 69 female survivors of sexual or nonsexual assault. All participants received between 9 and 12 individual sessions of either PE alone or in combination with cognitive restructuring. As hypothesized, vividness and anxiety ratings from early imaginal exposure sessions were moderately to highly correlated, but these correlations decreased in later sessions. Both subjective distress and vividness decreased significantly with exposure. Greater reductions in subjective distress between the first and last exposure session were related to better outcome. However, contrary to hypothesis, vividness was not related to outcome. Theoretical implications of the results are discussed.     

PTSD: Theoretical and practical considerations as reflected through Koach—An innovative treatment project

This article summarizes the achievements of the Koach project and attempts to draw conclusions regarding the treatment of chronic PTSD. It also attempts to reconcile the apparent contradictions between the participants' and therapists' positive impressions of the project and the less encouraging findings of the systematic assessment of its effectiveness.     

Post-traumatic stress disorder: Evaluation of a behavioral treatment program

The relative values of imaginal and real-life exposure exercises were tested in this study by randomizing 14 patients who met DSM-III-R criteria for PTSD at least 6 months after the initiating trauma to one of two groups. Group 1 (n=7) had four, weekly, hour-long sessions of imaginal exposure followed by four, weekly, hour-long sessions of live exposure. Group 2 (n=7) had the reverse order of four live exposure sessions followed by four imaginal exposure sessions. Both groups improved significantly on both PTSD-specific measures and measures of general health post-treatment, and significantly further on 7 out of 12 measures at follow up 12 months post-treatment. Clinical improvement was in the order of 65–80% reduction in target symptoms. On one measure only (problem 2 — phobic avoidance), live exposure yielded more improvement than imaginal exposure whether given first or second. The importance of both live and imaginal exposure to all relevant cues, behavioral and cognitive, is discussed, together with the value of self-exposure homework for patients with PTSD.     

Contribution of intraoperative radiotherapy (IORT) for therapeutic de‐escalation in early breast cancer: Report of a single institution's experience

The spread of systematic screening and the emergence of oncoplastic techniques allow more breast conservative treatment associating lumpectomy and external beam radiation therapy. In order to furthermore facilitate the patient's treatment, intraoperative radiation therapy (IORT) has been developed. The oncological safety of this technique has been studied, and is considered acceptable. Many questions remain unsolved in regard of the toxicity of this procedure as well as the patient's selection criteria. In this study, we present the first results and complications rate of patients treated by IORT in a single French institution. Between 2012 and 2015, all patients with breast cancer treated in a one‐step procedure associating lumpectomy and IORT were retrospectively included in a monocentric cohort. Acute and long‐term toxicities were evaluated using CTCAE v4.0 classification. 280 breast cancers were treated using IORT procedure. Additional external beam radiation therapy was requested for 45.7% patients. The acute complications rate was 14.6%, with 5 surgical revisions needed (1.78%). With a median follow up of 911 days, the long‐term grade‐3 toxicity rate was 1.1%. The only risk factor for local fibrosis was external beam radiation therapy (EBRT) (OR = 1.99; IC95 [1.05–3.81], P = 0.036). Three patients (1.07%) were diagnosed with local recurrence. The results from this cohort confirm the low complication and recurrence rate of IORT procedure. A good selection of patients is necessary in order to lower the EBRT rate and allow therapeutic de‐escalation. The classification of tumors into IHC subsets seems a good selection gate. Intraoperative radiation therapy appears to have a low toxicity rate with an acceptable local recurrence risk, and should therefore be considered as an option in the treatment of early breast cancer.     

High pre‐exposure prophylaxis uptake and early adherence among men who have sex with men and transgender women at risk for HIV Infection: the PrEP Brasil demonstration project

Introduction : The efficacy of pre‐exposure prophylaxis (PrEP) in preventing sexual acquisition of human immunodeficiency virus (HIV) is well established. Little is known about the feasibility of PrEP implementation in middle‐income settings with concentrated epidemics among men who have sex with men (MSM) and transgender women (TGW). Methods : PrEP Brasil is a prospective, multicentre, open‐label demonstration project assessing PrEP delivery in the context of the Brazilian Public Health System. HIV‐uninfected MSM and TGW in 3 referral centres in Rio de Janeiro and São Paulo were evaluated for eligibility and offered 48 weeks of daily emtricitabine/tenofovir for PrEP. Concentrations of tenofovir diphosphate in dried blood spot samples (DBS) at week 4 after enrolment (early adherence) were measured. Predictors of drug levels were assessed using ordinal logistic regression models considering the DBS drug level as a 3 level variable (<350 fmol/punch, ≥350–699 fmol/punch and ≥700 fmol/punch). Results : 1,270 individuals were assessed for participation; n = 738 were potentially eligible and n = 450 were offered PrEP (PrEP uptake was 60.9%). Eligible but not enrolled individuals were younger, had lower HIV risk perception and had lower PrEP awareness. At week 4, 424 participants (of the 450 enrolled) had DBS TFV‐DP concentrations, 94.1% in the protective range (≥350 fmol/punch, consistent with ≥2 pills per week), and 78% were in the highly protective range (≥700 fmol/punch, ≥4 pills per week). Participants with ≥12 years of schooling had 1.9 times the odds (95%CI 1.10–3.29) of a higher versus lower drug level than participants with <12 years of schooling. Condomless receptive anal intercourse in the prior 3 months was also associated with higher drug levels (adjusted OR = 1.78; 95% CI 1.08–2.94). Conclusions : The high uptake and early adherence indicate that PrEP for high‐risk MSM and TGW can be successfully delivered in the context of the Brazilian Public Health System. Interventions to address disparities on PrEP awareness and HIV risk perception among the younger and less educated are urgently needed in order to maximize the impact of this prevention strategy on the reduction of HIV infection among MSM and TGW in Brazil.