Feasibility and Acceptability of Group-Facilitated Prolonged Exposure Therapy for PTSD in VA Residential Rehabilitation Treatment Programs.

Prolonged Exposure therapy (PE) is a first-line treatment for posttraumatic stress disorder (PTSD); however, few VA patients receive this treatment. One of the barriers to PE receipt is that it is only available in an individual (one-on-one) format, whereas many VA mental health clinics provide the majority of their psychotherapy services in group format. In particular, PTSD residential rehabilitation treatment programs (RRTPs) offer most programming in group format. Consequently, strategies are needed to improve the scalability of PE by adapting it to fit the delivery setting. The current study was designed to pilot test a group-facilitated format of PE in RRTPs. Thirty-nine Veterans who were engaged in care in the PTSD RRTP at a Midwestern VA were recruited to participate in a Group-facilitated PE protocol. Participants engaged in twelve 90-minute sessions of Group PE over the course of 6 weeks, plus six 60-minute individual sessions for imaginal exposure. Group treatment followed the PE model and consisted of psychoeducation, treatment rationale, and in vivo exposure to reduce trauma-related avoidance and thereby improve PTSD symptoms. PTSD symptoms were measured via the PTSD Checklist for DSM-5 (PCL-5) and depression symptoms were measured via the Patient Health Questionnaire (PHQ-9) at baseline, endpoint (6 weeks), and at 2-month follow-up. Thirty-nine individuals initiated Group-facilitated PE and 34 completed treatment. The average number of group sessions attended was 11 out of 12. Acceptability ratings were high. Mean change (improvement) in the intent-to-treat sample at 2-month follow-up was 20.0 points on the PCL-5 (CI 18.1, 21.9; Cohen's d = 1.1) and 4.8 points on the PHQ-9 (CI 4.1, 5.5, d = .8). These results suggest that adapted evidence-based interventions for PTSD can improve treatment access and efficiency for the RRTP setting. A group-based approach has the potential to improve the scalability of PTSD treatment by reducing required resources. A fully powered trial is now needed to test the effectiveness of Group-facilitated PE in the RRTP setting.

The Association Between Service Connection and Treatment Outcome in Veterans Undergoing Residential PTSD Treatment.

The Department of Veterans Affairs has invested significant time and resources into the treatment of posttraumatic stress disorder (PTSD). Despite concerted efforts, a significant portion of patients do not respond optimally to trauma-focused treatment. One of the factors that has been hypothesized to be associated with treatment response is participation in the Veterans Benefits Administration service-connected disability process. This factor may be particularly relevant in the residential treatment setting, where most participants are engaged in the compensation seeking process. We conducted a retrospective chart review of 105 veterans who completed Cognitive Processing Therapy (CPT) in a residential rehabilitation program. ANCOVAs that adjusted for baseline PTSD severity compared symptom change between those who were and were non-compensation seeking at the time of treatment. Compensation seeking status was associated with significantly less symptom improvement over the course of CPT after adjusting for baseline PTSD severity (F(1, 102) = 4.29, p < .001, η2 = .03). Sensitivity analyses did not detect a similar effect during a prior coping skills phase of treatment. During CPT, clinically significant change was met by 66.7% of non-compensation seeking veterans (M = -15, SD = 14.56) and by 40.1% of the compensation seeking group (M = -7.1, SD = 12.24). Compensation-seeking may be associated with reduced response to trauma-focused treatment in certain settings. Future research is needed to better understand the mechanisms underlying this effect.

Complicaciones de la histerectomía total laparoscópica en pacientes de un hospital de alta especialidad.

OBJETIVO: Describir las complicaciones transoperatorias y posoperatorias en pacientes operadas de histerectomía total laparoscópica. MÉTODO: Serie de casos del servicio de ginecología de la Unidad Médica de Alta Especialidad Hospital de Gineco-Obstetricia No. 3 del Centro Médico Nacional La Raza, del Instituto Mexicano del Seguro Social, de las pacientes sometidas a histerectomía total laparoscópica de diciembre de 2015 a diciembre de 2018. Se documentaron el peso uterino, el índice de masa corporal, la edad, la comorbilidad, el uso de dióxido de carbono y las complicaciones. Se usaron frecuencias, proporciones, medidas de tendencia central y dispersión. RESULTADOS: Se reportan 79 pacientes de 44.2 ± 7.5 años, tiempo de cirugía de 104.3 ± 32.7 minutos y promedio de sangrado 102.8 ± 62.3 ml. Presentaron complicaciones transoperatorias seis (7.6%): dos (2.5%) lesión vesical, una (1.3%) lesión intestinal, una (1.3%) hemorragia de muñón y dos (2.5%) más conversión a laparotomía exploradora (una por tamaño uterino > 14 cm y otra por hallazgo de tumor ovárico de aspecto maligno). Siete pacientes (8.8%) tuvieron complicaciones posoperatorias: cuatro (5.1%) fueron reintervenidas (tres por hemorragia y una por dehiscencia de cúpula vaginal) y tres (3.7%) tuvieron colección vaginal. CONCLUSIONES: La tasa de complicaciones perioperatorias en esta serie coincide con la reportada en otros estudios. El tiempo quirúrgico y el sangrado fueron ligeramente menores, pese al poco tiempo de madurez del programa. OBJECTIVE: Describe the intraoperative and postoperative complications in patients undergoing total laparoscopic hysterectomy (TLH). METHOD: Cases series carried out in the gynecology service of Hospital de Gineco-Obstetricia No. 3, Centro Medico Nacional La Raza, Instituto Mexicano del Seguro Social, of all patients undergoing total laparoscopic hysterectomy from December 2015 to December 2018. Uterine weight, body mass index, age, comorbidities, CO2 use, and complications were documented. Frequencies, proportions, central tendency and dispersion measures were used. RESULTS: 79 patients are reported. Mean age was 44.2 ± 7.5 years. Surgery time was 104.3 ± 32.7 minutes, and bleeding 102.8 ± 62.3 mL. Six (7.6%) had intraoperative complications: two (2.5%) bladder injury, one (1.3%) bowel injury, one (1.3%) stump hemorrhage, and two (2.6%) where converted to exploratory laparotomy: one for uterine size > 14 cm, and one because malignant ovarian tumor was suspected. Seven patients (8.8%) had postoperative complications: four (5.1%) were re operated: 3 due to hemorrhage and 1 due to vaginal dome dehiscence; three (3.7%) had vaginal collection. CONCLUSIONS: The rate of perioperative complications reported in this series coincides with that reported in other studies. Surgery time and bleeding were slightly minors regardless of program's youth.

Residential PTSD treatment outcomes during cognitive processing therapy for veterans with and without recent histories of cannabis use.

Prior evidence has suggested that cannabis use is associated with greater posttraumatic stress disorder (PTSD) symptom severity and worse outcomes following trauma-focused treatment. However, lack of high-quality randomized studies necessitates the use of clinical data to clarify the relationship between cannabis use and PTSD treatment to help inform clinical practice. A total of 114 veterans completed cognitive processing therapy in a residential PTSD treatment program. Differences in treatment response between cannabis users and nonusers were evaluated for measures of PTSD, depression, and posttraumatic growth using analysis of covariance to control for pretreatment scores and other drug use. At baseline, cannabis users reported higher levels of PTSD symptom severity relative to nonusers but reported similar levels of depression and posttraumatic growth. Significant differences between groups in the amount of change were not observed on any of the measures from before to after treatment; however, the total sample reported significant improvements in all measures of interest. These results suggest that PTSD treatment outcomes for cannabis users may be similar to nonusers when use is stopped during treatment. Additional data are needed regarding whether outcomes remain similar at follow-up, whether cannabis users maintain abstinence after treatment, and the impact of resumed cannabis use on PTSD symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Fluorescence Methods Applied to the Description of Urea-Dependent YME1L Protease Unfolding.

ATP-dependent proteases are ubiquitous across all kingdoms of life and are critical to the maintenance of intracellular protein quality control. The enzymatic function of these enzymes requires structural stability under conditions that may drive instability and/or loss of function in potential protein substrates. Thus, these molecular machines must demonstrate greater stability than their substrates in order to ensure continued function in essential quality control networks. We report here a role for ATP in the stabilization of the inner membrane YME1L protease. Qualitative fluorescence data derived from protein unfolding experiments with urea reveal non-standard protein unfolding behavior that is dependent on [ATP]. Using multiple fluorophore systems, stopped-flow fluorescence experiments demonstrate a depletion of the native YME1L ensemble by urea-dependent unfolding and formation of a non-native conformation. Additional stopped-flow fluorescence experiments based on nucleotide binding and unfoldase activities predict that unfolding yields significant loss of active YME1L hexamers from the starting ensemble. Taken together, these data clearly define the stress limits of an important mitochondrial protease.

Predictors of change in cognitive processing therapy for veterans in a residential PTSD treatment program.

OBJECTIVE: Cognitive processing therapy is an evidence-based treatment for posttraumatic stress disorder (PTSD); however, questions remain regarding variability in treatment response. METHOD: A total of 123 veterans participated in group-based cognitive processing therapy (CPT) in residential PTSD treatment. Change over time in PTSD symptoms was modeled as a function of selected demographic and clinical variables. RESULTS: PTSD checklist (PCL) scores decreased by an average of 1 point per session (standard deviation [SD] = 0.1). Initial PCL scores were predicted by the Beck Depression Inventory-II (γ01 = 0.25; standard error [SE] = 0.08), Insomnia Severity Index (γ02 = 0.53; SE = 0.15), and Infrequency (F) scale of the Minnesota Multiphasic Personality Inventory-2 (γ03 = 0.09; SE = 0.04). Rate of change was predicted by the Somatic Complaints (RC1) scale (γ11 = -0.03; SE = 0.01) and the Antisocial Behavior (RC4) scale (γ12 = 0.02; SE = 0.01). CONCLUSIONS: These results provide insight into characteristics that may influence degree of benefit received from group-based CPT.

Evidence-based Treatments for Military-related Posttraumatic Stress Disorder in a Veterans Affairs Setting.

Posttraumatic stress disorder (PTSD) can have a significant negative impact on the physical, emotional, and mental health of individuals. This article discusses the prevalence, risk factors, and diagnostic criteria for PTSD. Given the high incidence of PTSD in the Veteran population, much attention has been given to assessment and treatment issues. Treatment options for PTSD, including the 2 most effective treatments, prolonged exposure and cognitive processing therapy, are discussed. Special issues concerning the treatment of Veterans are also reviewed.

Implementing an Assessment Clinic in a Residential PTSD Program.

Creating useful treatment plans can help improve services to consumers of mental health services. As more evidence-based practices are implemented, deciding what treatment, at what time, for whom becomes an important factor in facilitating positive outcomes. Readiness for trauma-focused treatments for Posttraumatic Stress Disorder (PTSD) such as Cognitive Processing Therapy or Prolonged Exposure Therapy may influence whether an individual can successfully complete either protocol. In addition, components of adjunctive therapies such as Acceptance and Commitment Therapy or Dialectical Behavior Therapy may be useful in moving a particular patient toward readiness and successful completion of treatment. Psychological assessment adds valuable data to inform these types of treatment decisions. This paper describes the implementation of a psychological assessment clinic in a residential PTSD treatment setting. Barriers to implementation, use of the data, and Veterans' reactions to the feedback provided to them are included.

Effects of augmenting response options on MMPI-2 RC scale psychometrics.

A number of empirical investigations indicate that tests with a greater number of response options tend to yield better psychometric performance. We hypothesized that a version of the MMPI-2 with a polytomous response format would outperform the standard dichotomous format in terms of observed score reliability and validity. Two versions of the MMPI-2 RC scales were administered consecutively in counterbalanced order to 199 undergraduate students attending a large Midwestern university: the standard true-false version, and an experimental version containing 4 response options (very true, mainly true, slightly true, and false, not at all true). After participants completed both versions, 2 scales from the multidimensional personality questionnaire (MPQ) were administered to assess differences in convergent validity. Results showed enhancements in reliability for all RC scale scores and increases in the convergent validity of scores. Directions for further investigation and potential implications for future test development are discussed.