Examining well-being in posttraumatic stress disorder treatment:An explorative study

Although the importance of well‐being in mental health is widely acknowledged, well‐being as a predictor of and outcome in the treatment for posttraumatic stress disorder (PTSD) has received little attention. This naturalistic study aimed to investigate well‐being in the context of care‐as‐usual treatment for PTSD. Patients with PTSD attending a community mental health center (N = 318) completed measures of well‐being and PTSD symptoms before and after symptom‐focused treatment. Following treatment, well‐being increased among patients with PTSD, with emotional, d = −0.25, and psychological well‐being, d = ‐0.24, showing the largest improvements relative to social well‐being, d = −0.15. Although levels of well‐being improved overall within the sample, participant scores on measures of well‐being remained low compared with the general population. Well‐being predicted treatment efficiency such that participants with more severe PTSD symptoms benefitted more from care‐as‐usual treatment when they reported relatively high levels of well‐being at the start of treatment. The findings suggest a benefit to including well‐being as a pretreatment and outcome variable when evaluating PTSD treatments

Welbevindentherapie:Achtergrond, doelstelling en protocol

Geestelijke gezondheid is meer is dan de afwezigheid van psychische klachten. Geestelijke gezondheid omvat ook emotioneel, psychologisch en sociaal welbevinden. Psychopathologie en welbevinden zijn twee gerelateerde maar verschillende dimensies van geestelijke gezondheid. Dit wordt het tweecontinuamodel genoemd. Bij cliënten met psychische stoornissen is sprake van herstel bij afwezigheid van matige of ernstige psychische klachten en aanwezigheid van voldoende welbevinden. Welbevindentherapie richt zich op het versterken van welbevinden. In dit artikel worden de achtergronden en de doelstellingen van welbevindentherapie beschreven alsook een protocol van acht sessies. Het versterken van positieve emoties, het doen toenemen van positieve ervaringen en het vergroten van zelfcompassie staan centraal in de eerste sessies. Een pilotonderzoek waarin welbevindentherapie werd aangeboden aan cliënten met een stemmingsstoornis laat positieve effecten zien. Welbevindentherapie kan ook goed na afloop van een klachtgerichte behandeling worden aangeboden

Inherited variants in CHD3 show variable expressivity in Snijders Blok-Campeau syndrome

Purpose: Common diagnostic next-generation sequencing strategies are not optimized to identify inherited variants in genes associated with dominant neurodevelopmental disorders as causal when the transmitting parent is clinically unaffected, leaving a significant number of cases with neurodevelopmental disorders undiagnosed. Methods: We characterized 21 families with inherited heterozygous missense or protein-truncating variants in CHD3, a gene in which de novo variants cause Snijders Blok-Campeau syndrome. Results: Computational facial and Human Phenotype Ontology–based comparisons showed that the phenotype of probands with inherited CHD3 variants overlaps with the phenotype previously associated with de novo CHD3 variants, whereas heterozygote parents are mildly or not affected, suggesting variable expressivity. In addition, similarly reduced expression levels of CHD3 protein in cells of an affected proband and of healthy family members with a CHD3 protein-truncating variant suggested that compensation of expression from the wild-type allele is unlikely to be an underlying mechanism. Notably, most inherited CHD3 variants were maternally transmitted. Conclusion: Our results point to a significant role of inherited variation in Snijders Blok-Campeau syndrome, a finding that is critical for correct variant interpretation and genetic counseling and warrants further investigation toward understanding the broader contributions of such variation to the landscape of human disease

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Integration of Well-Being Therapy and Positive Psychotherapy: A Response to Fava and Guidi's (2021) Commentary on Radstaak et al. (2020)

The results of our study on the effects of well-being therapy (WBT) compared with a treatment-as-usual (TAU) control condition among individuals with residual symptoms of posttraumatic stress disorder (PTSD) were recently published in the Journal of Traumatic Stress (Radstaak et al., 2020). In a subsequent commentary, Fava and Guidi (2020) raised several conceptual and methodological issues that they asserted potentially limited the interpretation of the results. In this response, we aim to clarify these issues, thus contributing to the optimal interpretation of the findings

Well-Being Therapy as Rehabilitation Therapy for Posttraumatic Stress Disorder Symptoms: A Randomized Controlled Trial

Many individuals with posttraumatic stress disorder (PTSD) continue to have substantial residual symptoms after completing psychological treatment. Well-being therapy (WBT) has been developed to treat the residual phase of mental disorders, prevent relapse, and promote a full recovery. The present study aimed to compare treatment as usual (TAU) with the long-term effects of WBT as a rehabilitation therapy in adults who successfully completed psychological treatment for PTSD. Participants who did not meet PTSD diagnostic criteria after completing treatment were randomized to WBT (n = 29) or TAU (n = 35) groups. Assessments of well-being, residual PTSD symptoms, and posttraumatic growth were conducted at baseline (T0) and again after 3 months (T1), 6 months (T2), and 1 year (T3). The results of the multilevel analysis revealed that WBT was not more effective than TAU in increasing levels of well-being, γ = 0.02 (SE = 0.11) or posttraumatic growth, γ = 0.10 (SE = 0.13) nor in decreasing PTSD symptoms, γ = −0.04 (SE = 0.05). However, for participants with low levels of well-being at baseline (Mental Health Continuum-Short Form score < 2.6), WBT was more effective than TAU in increasing ratings of well-being, γ = −0.41 (SE = 0.19) and posttraumatic growth, γ = −0.55 (SE = 0.24); this effect was most evident at T3 for posttraumatic growth, d = 1.23. Future research should assess clinically relevant individual characteristics that to optimize the effectiveness and utility of WBT