Self-reported bruxism in patients with post-traumatic stress disorder.

OBJECTIVE: The present study aimed to investigate the association between self-reported awake/sleep bruxism, and orofacial pain with post-traumatic stress disorder (PTSD). METHODS: A case-control study with a convenience sample was designed. Participants were recruited from a university-based Trauma Ambulatory. The diagnosis of PTSD was established through a clinical interview and the Structured Clinical Interview (SCID-I/P). Thirty-eight PTSD patients and 38 controls completed the Research Diagnostic Criteria for Temporomandibular Disorders Axis-II to categorize awake/sleep bruxism and orofacial pain. Following this, we performed a short clinical examination of the temporomandibular joint and extraoral muscles. RESULTS: Adjusted logistic regression analysis showed that awake bruxism was associated with PTSD (OR = 3.38, 95% CI = 1.01-11.27, p = 0.047). Sleep bruxism was not associated with any covariate included in the model. In a Poisson regression model, PTSD (IRR = 3.01, 95% CI = 1.38-6.55, p = 0.005) and the muscle pain/discomfort (IRR = 5.12, 95% CI = 2.80-9.36, p < 0.001) were significant predictors for current orofacial pain. CONCLUSIONS: PTSD was associated with self-reported awake bruxism and low-intensity orofacial pain. These conditions were frequent outcomes in patients previously exposed to traumatic events. CLINICAL RELEVANCE: We suggest including a two-question screening for bruxism in psychiatry/psychology interviews to improve under-identification and to prevent harmful consequences at the orofacial level.

Traumatic memory retrieval followed by electroconvulsive therapy as a treatment for posttraumatic stress disorder: A pilot study.

Delivering electroconvulsive therapy (ECT) during the reconsolidation of traumatic memories may enhance the treatment efficacy in posttraumatic stress disorder (PTSD). To test this, 14 patients with severe and refractory PTSD were randomly allocated to receive ECT sessions either after retrieving the traumatic (n=8) or a neutral (n=6) memory. We found that delivering ECT after retrieving the traumatic memory enhanced the improvement of PTSD symptoms and the reduction of subjective reactivity to the traumatic memory. Reduction in anxiety and mood symptoms and physiological reactivity to the traumatic memory were observed in the sample as a whole regardless of memory retrieval.

A randomized clinical trial to assess the efficacy of trial-based cognitive therapy compared to prolonged exposure for post-traumatic stress disorder: preliminary findings.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a prevalent mental health condition that is often associated with psychiatric comorbidities and changes in quality of life. Prolonged exposure therapy (PE) is considered the gold standard psychological treatment for PTSD, but treatment resistance and relapse rates are high. Trial-based cognitive therapy (TBCT) is an effective treatment for depression and social anxiety disorder, and its structure seems particularly promising for PTSD. Therefore, we evaluated the efficacy of TBCT compared to PE in patients with PTSD. METHODS: Ninety-five patients (77.6% females) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for PTSD were randomly assigned to receive either TBCT (n = 44) or PE (n = 51). Patients were evaluated before and after treatment, and at follow-up 3 months after treatment. The primary outcome was improvement in PTSD symptoms as assessed by the Davidson Trauma Scale (DTS). Secondary outcomes were depression, anxiety, and dysfunctional attitudes assessed by the Beck Depression/Anxiety Inventories and Dysfunctional Attitudes Scale, as well as the dropout rate. RESULTS: A significant reduction in DTS scores was observed in both arms, but no significant difference between treatments. Regarding the secondary outcomes, we found significant differences in depressive symptoms in favor of TBCT, and the dropout rate was lower in the TBCT group than the PE group. CONCLUSION: Our preliminary results suggest that TBCT may be an effective alternative for treating PTSD. Further research is needed to better understand its role and the mechanisms of change in the treatment of this disorder.

Targeting the reconsolidation of traumatic memories with a brief 2-session imaginal exposure intervention in post-traumatic stress disorder.

BACKGROUND: Evidence suggests that extinction during memory reconsolidation diminishes the return of defensive responses. In order to translate these effects to the clinical setting, we tested whether retrieving a traumatic memory and delivering a brief two-sessions imaginal exposure intervention during its reconsolidation would produce stronger decreases in reactivity to these memories than standard imaginal exposure method. METHODS: Participants with Post-Traumatic Stress Disorder (PTSD) had either their traumatic (n = 21) or a neutral (n = 21) memory retrieved 1 h before an imaginal exposure session for two consecutive days. One day before and one day after, participants were exposed to script-driven imagery of their traumatic event, during which skin conductance responses were measured and, immediately after, subjective responses were assessed by means of Visual Analogue Scales. RESULTS: Traumatic retrieval improved the physiological, but not the subjective effects of imaginal exposure intervention on over-reactivity to traumatic memories. CONCLUSIONS: Our results suggest that delivering extinction-based treatments over the reconsolidation of traumatic memories may enhance its effects. These results suggest that this is a promising path toward the development of new therapeutic techniques.

Impact of post-traumatic stress disorder on oral health.

BACKGROUND: The stress experienced as an intense and traumatic event can increase the odds of orofacial pain, affect the biomechanics of masticatory system and compromise the periodontal health. This study was conducted to investigate the impact of post-traumatic stress disorder (PTSD) on oral health. METHODS: A case-control study with a convenience sample was designed. Probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing, and plaque were recorded at 6 sites per tooth. A visual analog scale (VAS) was used to evaluate the pain after probing. The Research Diagnostic Criteria for Temporomandibular Disorders Axis II (RDC/TMD Axis II) and Structured Clinical Interview (DSM-IV) were also applied. The final sample comprised 38 PTSD patients and 38 controls. RESULTS: Patients with PTSD had a higher degree of chronic pain, more depression and nonspecific physical symptoms (including and excluding pain) compared with the control group (Fisher exact test p < 0.001, and Chi-squared test, p < 0.001, < 0.001, < 0.001, respectively). Patients with PTSD also had more pain after periodontal probing compared with controls (Mann-Whitney, p = 0.037). The prevalence of sites with CAL or PPD ≥ 4, ≥ 5, ≥ 6 were not different between the groups. Age was associated with moderate periodontitis (multivariable logistic regression model, OR = 3.33, 95% CI = 1.03-10.75, p = 0.04). LIMITATION: The severity of PTSD precluded an ample sample size. CONCLUSIONS: Patients with PTSD presented a worse RDC/TMD Axis II profile, more pain after periodontal probing, and no difference related to periodontal clinical parameters. More studies are needed to confirm these findings.

A nova classificação americana para os transtornos mentais: o DMS-5 / The new American classification for mental disorders: DMS-5 / La nueva clasificación de América para los trastornos mentales: DMS-5

Algumas das principais mudanças introduzidas na nova classificação diagnóstica norte-americana são apresentadas de modo sintético à comunidade psicanalítica. Fruto de estudos de campo que investigaram a validade dos diagnósticos anteriores, possui vantagens, mas mostra as falhas que temos ainda no conhecimento dos transtornos mentais. Algumas das principais críticas também são apresentadas.(AU)

Some of the main changes introduced in the new North American diagnostic classification are presented in a synthetic way to the psychoanalytic community. Result of field studies that investigated the validity of previous diagnoses has advantages, but gaps in the present knowledge of mental disorders are still there. Some of the main criticisms are also presented.(AU)

Algunos de los principales cambios introducidos en la nueva clasificación diagnóstica de América del Norte se presentan de manera sintética a la comunidad psicoanalítica. El resultado de los estudios de campo que investigaron la validez de los diagnósticos anteriores tiene ventajas, pero demuestra que todavía tenemos lagunas en el conocimiento de los trastornos mentales. Se presentan también algunas de las principales críticas.(AU)

A nova classificação americana para os transtornos mentais: o DMS-5 / The new American classification for mental disorders: DMS-5 / La nueva clasificación de América para los trastornos mentales: DMS-5

Algumas das principais mudanças introduzidas na nova classificação diagnóstica norte-americana são apresentadas de modo sintético à comunidade psicanalítica. Fruto de estudos de campo que investigaram a validade dos diagnósticos anteriores, possui vantagens, mas mostra as falhas que temos ainda no conhecimento dos transtornos mentais. Algumas das principais críticas também são apresentadas...

Some of the main changes introduced in the new North American diagnostic classification are presented in a synthetic way to the psychoanalytic community. Result of field studies that investigated the validity of previous diagnoses has advantages, but gaps in the present knowledge of mental disorders are still there. Some of the main criticisms are also presented...

Algunos de los principales cambios introducidos en la nueva clasificación diagnóstica de América del Norte se presentan de manera sintética a la comunidad psicoanalítica. El resultado de los estudios de campo que investigaron la validez de los diagnósticos anteriores tiene ventajas, pero demuestra que todavía tenemos lagunas en el conocimiento de los trastornos mentales. Se presentan también algunas de las principales críticas...