Prolonged Exposure (PE) for Treatment of Childhood Sexual Abuse-Related PTSD: Do We Need to Augment It?

Kramer's thoughtful and extremely thorough case study of treating Caroline, a survivor of childhood sexual abuse (CSA), raises several important issues. A major assumption underlying Kramer's approach with Caroline's PTSD symptoms is that the Prolonged Exposure (PE) manualized treatment of Foa and her colleagues is a necessary but not sufficient method to address the clinical needs of such a client. Thus Kramer begins his treatment of this client with other clinical components, such as an assessment of Caroline's interpersonal patterns utilizing Caspar'sPlan Analysis method; custom tailoring of his therapeutic relationship with Caroline; imaginative relaxation; cognitive crisis intervention; and interventions to enhance the client's social competence. He then initiates a brief course of in vivo and imaginal exposure, following the procedures in the PE manual. In this commentary, we critically evaluate this major assumption of Kramer's and review data which argue that PE can be sufficient for treating clients like Caroline. Specifically, our commentary considers the following questions: (a) What are the effects of exposure alone versus exposure combined with other treatments for PTSD? (b) Does CSA-related PTSD require additional treatment components other than PE? (c) Is PE intolerable without additional interventions? (d) Why is length of treatment important? and (e) What are some of the issues raised by the manner in which Kramer implemented the PE treatment

Serum Testosterone Levels After Cardiac Transplantation

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Work Related Post Traumatic Stress Disorder in Medicine Residents.

OBJECTIVE: This study sought to screen for the burden of work-related posttraumatic stress disorder (PTSD) symptoms in internal medicine residents. METHODS: A cross-sectional survey of internal medicine residents from three academic institutions was conducted using the PCL-5 screening tool. RESULTS: Off all residents surveyed, 5.2% screened positive for PTSD symptoms (N = 194). 86.1% of all trainees identified stressors during training. Positive PTSD screens were significantly higher in PGY3 residents (X CONCLUSIONS: Self-reported stressors are highly prevalent in internal medicine trainees. Verbal/physical assault by patients and families appear to be the triggering event for most positive screens. These observations will help with future study designs to quantify the burden of work related PTSD in internal medicine trainee physicians so that appropriate supportive measures can be provided

Is Exposure Necessary? A Randomized Clinical Trial of Interpersonal Psychotherapy for PTSD.

BACKGROUND: Exposure to trauma reminders has been considered imperative in psychotherapy for posttraumatic stress disorder (PTSD). No treatment benefits all patients, however. We tested Interpersonal Psychotherapy, which has demonstrated antidepressant efficacy and showed promise in pilot PTSD research, as a non-exposure-based, non-cognitive behavioral PTSD treatment. METHODS: A randomized, fourteen-week trial compared Interpersonal Psychotherapy; Prolonged Exposure, an exposure-based exemplar; and Relaxation Therapy, an active control psychotherapy. Subjects were 110 unmedicated patients having DSM-IV chronic PTSD and Clinician-Administered PTSD Scale (CAPS) score >50. Randomization stratified for comorbid major depression. We hypothesized Interpersonal Psychotherapy would be no more than minimally inferior (CAPS difference <12.5 points) to Prolonged Exposure. RESULTS: All therapies had large within-group pre/post effect sizes (d=1.32–1.88). Response rates (>30% CAPS improvement) were: Interpersonal Psychotherapy 63%, Prolonged Exposure 47%, Relaxation Therapy 38% (n.s.). Interpersonal psychotherapy and Prolonged Exposure CAPS outcome differed by 5.5 points (n.s.); the null hypothesis of more than minimal Interpersonal Psychotherapy inferiority was rejected (p=0.035). Patients with comorbid major depression dropped out from Prolonged Exposure nine times more than non-depressed Prolonged Exposure patients. Interpersonal Psychotherapy and Prolonged Exposure improved quality of life and social functioning more than Relaxation Therapy. CONCLUSIONS: This first controlled study of individual Interpersonal Psychotherapy for PTSD demonstrated non-inferiority to the “gold standard” PTSD treatment. Interpersonal Psychotherapy had (non-significantly) lower attrition and higher response rates than Prolonged Exposure. Contradicting a widespread clinical belief, PTSD treatment may not require cognitive behavioral exposure to trauma reminders. Moreover, as differential therapeutics, patients with comorbid major depression may fare better in Interpersonal Psychotherapy than Prolonged Exposure

A Comparative Study of the Metabolic and Skeletal Response of C57BL/6J and C57BL/6N Mice in a Diet-Induced Model of Type 2 Diabetes

Type 2 diabetes mellitus (T2DM) represents a complex clinical scenario of altered energy metabolism and increased fracture incidence. The C57BL/6 mouse model of diet-induced obesity has been used to study the mechanisms by which altered glucose homeostasis affects bone mass and quality, but genetic variations in substrains of C57BL/6 may have confounded data interpretation. This study investigated the long-term metabolic and skeletal consequences of two commonly used C57BL/6 substrains to a high fat (HF) diet. Male C57BL/6J, C57BL/6N, and the negative control strain, C3H/HeJ, mice were fed a control or HF diet for 24 wks. C57BL/6N mice on a HF diet demonstrated an increase in plasma insulin and blood glucose as early as 4 wk, whereas these responses were delayed in the C57BL/6J mice. The C57BL/6N mice exhibited more severe hepatic steatosis and inflammation. Only the C57BL/6N mice lost significant trabecular bone in response to the high fat diet. The C3H/HeJ mice were protected from bone loss. The data show that C57BL/6J and C57BL/6N mice differ in their metabolic and skeletal response when fed a HF diet. These substrain differences should be considered when designing experiments and are likely to have implications on data interpretation and reproducibility