ABSTRACT
Trauma-related nightmares (TRN), one of the most reported symptoms of posttraumatic stress disorder (PTSD), may not always respond to current pharmacologic and therapeutic treatments. Validity of electroconvulsive therapy (ECT), which is used worldwide in clinical treatment for a broad range of neuropsychiatric conditions, is investigated as a potential therapeutic option for TRN in this report. A case of a 39-year-old male with a history of severe combat-related PTSD, major depressive disorder, history of traumatic brain injury, suicidal ideations, and persistent TRN is discussed here. Successful treatment outcome of this case with six sessions of right unilateral ECT is presented. On initial presentation, the patient had a Patient Health Questionnaire-9 (PHQ-9) score of 27 and a Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) score of 77. After six sessions of ECT, the patient had a PHQ-9 score of 3 and a PCL-5 score of 45. Furthermore, the rationale and potential mechanisms of action underlying the ECT treatment for treatment-resistant PTSD and TRN are also reviewed in this report.
ABSTRACT
OBJECTIVE: Completion of an advance directive (AD) document is one component of advanced care planning. We evaluated a brief intervention to enhance AD completion and assess whether the intervention effect varied according to health literacy. METHODS: A randomized controlled study was conducted in 2 internal medicine clinics. Participants were over 50, without documented AD, no diagnosis of dementia, and spoke English. Participants were screened for health literacy utilizing REALM-SF. Participants were randomized in a 1:1 ratio to the intervention, a 15-minute scripted introduction (grade 7 reading level) to our institution's AD forms (grade 11 reading level) or to the control, in which subjects were handed blank AD forms without explanation. Both groups received reminder calls at 1, 3, and 5 months. The primary outcome was AD completion at 6 months. RESULTS: Five hundred twenty-nine subjects were enrolled; half were of limited and half were of adequate health literacy. The AD completion rate was 21.7% and was similar in the intervention vs. the control group (22.4% vs 22.2%, P = .94).More participants with adequate health literacy completed an AD than those with limited health literacy (28.4% vs 16.2%, P = .0008), although the effect of the intervention was no different within adequate or limited literacy groups. CONCLUSION: A brief intervention had no impact on AD completion for subjects of adequate or limited health literacy. PRACTICE IMPLICATIONS: Our intervention was designed for easy implementation and to be accessible to patients of adequate or limited health literacy. This intervention was not more likely than the control (handing patients an AD form) to improve AD completion for patients of either limited or adequate health literacy. Future efforts and research to improve AD completion rates should focus on interventions that include: multiple inperson contacts with patients, contact with a trusted physician, documents at 5th grade reading level, and graphic/video decision aids. TRIAL REGISTRATION NUMBER: NCT02702284, Protocol ID IRB201500776.
Subject(s)
Advance Care Planning , Health Literacy , Physicians , Advance Directives , Crisis Intervention , HumansABSTRACT
Maintaining water homeostasis is fundamental for cellular function. Many diseases and drugs affect water balance and plasma osmolality. Water homeostasis studies in small animals require the use of invasive or terminal methods that make intracellular fluid volume and extracellular fluid volume (ECF) monitoring over time stressful and time consuming. We examined the feasibility of monitoring mouse ECF by a noninvasive method using time-domain nuclear magnetic resonance (TD-NMR). This technique allows differentiation of protons in a liquid environment (free fluid) from protons in soft tissues containing a majority of either small molecules (lean) or large molecules (fat). Moreover, this apparatus enables rapid, noninvasive, and repeated measurements on the same animal. We assessed the feasibility of coupling TD-NMR analysis to a longitudinal metabolic cage study by monitoring mice daily. We determined the effect of 24-h water deprivation on mouse body parameters and detected a sequential and overlapping decrease in free fluid and lean mass during water deprivation. Finally, we studied the effect of mineralocorticoids that are known to induce a transient increase in ECF but for which no direct measurements have been performed in mice. We showed, for the first time, that mineralocorticoids induced a transient ~15% increase in free fluid in conscious mice. TD-NMR is, therefore, the first method to allow direct measurement of discrete changes in ECF in conscious small animals. This method allows analysis of kinetic changes to stimuli before investigating with terminal methods and will allow further understanding of fluid disorders.
