Anger and predictors of drop-out from PTSD treatment of veterans and first responders.

BACKGROUND: Drop-out is an important barrier in treating post-traumatic stress disorder (PTSD) with consequences that negatively impact clients, clinicians and mental health services as a whole. Anger is a common experience in people with PTSD and is more prevalent in military veterans. To date, no research has examined if anger may predict drop-out in military veterans or first responders. AIMS: The present study aimed to determine the variables that predict drop-out among individuals receiving residential treatment for PTSD. METHOD: Ninety-five military veterans and first responders completed pre-treatment measures of PTSD symptom severity, depression, anxiety, anger, and demographic variables. Logistic regression analyses were used to determine if these variables predicted drop-out from treatment or patterns of attendance. RESULTS: Female gender was predictive of drop-out. However, when analysed by occupation female gender was predictive of drop-out among first responders and younger age was predictive of drop-out in military participants. Anger, depression, anxiety and PTSD symptom severity were not predictive of drop-out in any of the analyses. No variables were found to predict attendance patterns (consistent or inconsistent) or early versus late drop-out from the programme. CONCLUSION: These results suggest that although anger is a relevant issue for treating PTSD, other factors may be more pertinent to drop-out, particularly in this sample. In contrast with other findings, female gender was predictive of drop-out in this study. This may indicate that in this sample, there are unique characteristics and possible interacting variables that warrant exploration in future research.

Protocol for CLASSIC PBB: comparison of lower airway sampling strategies in children with protracted bacterial bronchitis.

BACKGROUND: Protracted bacterial bronchitis (PBB) is an endobronchial infection and a the most common cause of chronic wet cough in young children. It is treated with antibiotics, which can only be targeted if the causative organism is known. As most affected children do not expectorate sputum, lower airway samples can only be obtained by bronchoalveolar lavage (BAL) samples taken during flexible bronchoscopy (FB-BAL). This is invasive and is therefore reserved for children with severe or relapsing cases. Most children with PBB are treated empirically with broad spectrum antibiotics. CLASSIC PBB will compare the pathogen yield from two less invasive strategies with that from FB-BAL to see if they are comparable. METHODS: 131 children with PBB from four UK centres referred FB-BAL will be recruited. When attending for FB-BAL, they will have a cough swab and an induced sputum sample obtained. The primary outcome will be the discordance of the pathogen yield from the cough swab and the induced sputum when compared with FB-BAL. Secondary outcomes will be the sensitivity of each sampling strategy, the success rate of the induced sputum in producing a usable sample and the tolerability of each of the three sampling strategies. DISCUSSION: If either or both of the two less invasive airway sampling strategies are shown to be a useful alternative to FB-BAL, this will lead to more children with PBB having lower airway samples enabling targeted antibiotic prescribing. It would also reduce the need for FB, which is known to be burdensome for children and their families. TRIAL REGISTRATION NUMBER: ISRCTN79883982.

Pain offset reduces rumination in response to evoked anger and sadness.

Four studies examined whether pain offset reduces rumination in response to anger or sadness. Past research has demonstrated that, following the offset of pain, individuals show a distinct state of relief involving both reduction in negative affect and an increase in positive affect. This response may help to explain why people sometimes seek out pain and discomfort (e.g., vigorous exercise, self-harm) to regulate negative emotion and suggests that following pain people should recover better from negative emotional states. To test this, we examined ruminative responses to anger and sadness. These negative, approach-related emotions often produce rumination; a response that is generally considered maladaptive. In Study 1, pain was manipulated through a cold pressor task, and participants were induced to experience anger through autobiographical recall. In Study 2, pain was also manipulated pain via a cold pressor task, and anger and sadness were induced through social exclusion using the Cyberball paradigm. In Study 3, pain was manipulated by squeezing exercise handgrips, and sadness was induced with imagery from a sad video. Study 4 replicated the methods of Study 3 and added measures of relief and distraction to examine whether these moderated the effect. A minimeta-analysis showed that, across all studies, individuals engaged in less rumination in the pain conditions as measured by a thought-listing task and a self-reported rumination questionnaire. These results suggest that the regulation of anger and sadness are improved following pain offset. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Primary abdominal gestational choriocarcinoma.

BACKGROUND: Gestational choriocarcinoma associated with ectopic pregnancy is an extremely infrequent event. Primary abdominal gestational choriocarcinoma has not been previously described. CASE: A pregnant woman presented to the emergency room with 6 days of vaginal spotting. Her last menstrual period suggested a gestation at 6 4/7 weeks. Transvaginal sonogram showed a hemoperitoneum with no intrauterine pregnancy. The serum human chorionic gonadotropin level was noted to be 317,735 mIU/mL. A 20 x 20-mm friable, bleeding mass on the left anterior abdominal wall was laparoscopically resected. Gestational choriocarcinoma was identified on histopathologic review. International Federation of Gynecology and Obstetrics stage IV:4 was assigned, and the patient achieved clinical remission with combination chemotherapy. CONCLUSION: Primary abdominal gestational choriocarcinoma can present with findings similar to a ruptured ectopic pregnancy; it should be treated by surgical excision and chemotherapy.