An open-label trial of evidence-based cognitive behavior therapy for nightmares and insomnia in crime victims with PTSD.

OBJECTIVE: Insomnia and nightmares are perceived as secondary phenomena in posttraumatic stress disorder (PTSD). Scant treatment research has targeted these two sleep disturbances. This study reports on an open-label trial of cognitive behavior therapy for insomnia and disturbing dreams in crime victims with PTSD. The relationship among nightmares, sleep disturbances, and PTSD symptoms is discussed. METHOD: Sixty-two participants completed a 10-hour group treatment consisting of imagery rehearsal for nightmares and sleep hygiene, stimulus control, and sleep restriction for insomnia. Nightmare frequency, sleep quality, sleep impairment, and ratings for PTSD, anxiety, and depression symptoms were assessed at baseline and at the 3-month follow-up. RESULTS: All measures demonstrated improvement that was roughly equivalent to changes in clinical severity from severe to moderate for sleep quality, sleep impairment, and nightmare frequency, from borderline severe to borderline moderate for PTSD symptoms, and from extremely severe to borderline severe for anxiety and depression symptoms. CONCLUSIONS: In this uncontrolled study, successful treatment for insomnia and nightmares in crime victims was associated with improvement in symptoms of PTSD, anxiety, and depression. Participants with clinical improvements in PTSD symptoms demonstrated significantly greater improvement in sleep quality and nightmare frequency than those whose PTSD symptoms did not improve.

[Osteosynthesis of the lower cervical spine using an anterior paediculo-isthmic screwed plate]. / Ostéosynthèse du rachis cervical inférieur par vissage antérieur pédiculo-isthmique.

The authors report a new arthrodesis of the inferior cervical spine using a plate screwed into the pedicles by an anterior route. The procedure allows a complete and immediate stabilization of the cervical spine. Cervical orthosis is unnecessary in postoperative course.

[Approach to the anterior and lateral segments of the dorsolumbar spine by conservative transverso-arthro-pediculotomy]. / Abord des segments antérieurs et latéraux du rachis dorso-lombaire par transverso-arthro-pédiculotomie conservatrice.

The authors report a new technique of uni or bilateral transversoarthropediculotomy. It allows, according to the need, a conservative removal of a part or the whole posterior arch. This technique seems most suitable to avoid removal of posterior columns when a posterolateral approach is decided.