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insomnia in C-Ptsd patients

Justin M Johnson, Bruce P Capehart
BACKGROUND: Post-September 11, 2001 combat veterans represent a growing cohort of patients with unique mental health needs, particularly around post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). The United States (US) remains engaged in conflicts around the globe, so this patient cohort will continue to grow in number. With around 40% of American combat veterans from Iraq and Afghanistan seeking mental health care outside of the Veterans Affairs, understanding the psychiatric needs of the post-September 11 combat veteran is an important goal for all psychiatrists...
November 30, 2018: Psychosomatics
Rebecca C Hendrickson, Murray A Raskind, Steven P Millard, Carl Sikkema, Garth E Terry, Kathleen F Pagulayan, Ge Li, Elaine R Peskind
Background: Increases in the quantity or impact of noradrenergic signaling have been implicated in the pathophysiology of posttraumatic stress disorder (PTSD). This increased signaling may result from increased norepinephrine (NE) release, from altered brain responses to NE, or from a combination of both factors. Here, we tested the hypothesis that Veterans reporting a history of trauma exposure would show an increased association between brain NE and mental health symptoms commonly observed after trauma, as compared to Veterans who did not report a history of trauma exposure, consistent with the possibility of increased brain reactivity to NE after traumatic stress...
February 2018: Neurobiology of Stress
Paul R King, Gregory P Beehler, Bonnie M Vest, Kerry Donnelly, Laura O Wray
PURPOSE/OBJECTIVE: Explore cognitive, affective, and experiential factors that inform veterans' traumatic brain injury (TBI)-related beliefs. Research Method/Design: Qualitative descriptive study of 22 veterans who received care for TBI at a VA Medical Center in the Northeastern United States using directed content analysis. Measures included a semistructured interview, demographic survey, the Alcohol Use Disorders Identification Test-Consumption Items (AUDIT-C), Patient Health Questionnaire-9 (PHQ-9), PTSD Checklist (PCL), Neurobehavioral Symptom Inventory (NSI), and Insomnia Severity Index (ISI)...
February 2018: Rehabilitation Psychology
Elizabeth C Parsons, Catherine L Hough, Michael V Vitiello, Brian Palen, Douglas Zatzick, Dimitry S Davydow
BACKGROUND: There is no insomnia screening tool validated in intensive care unit (ICU) survivors. OBJECTIVES: To examine the validity of a single item from the PTSD checklist-Civilian version (PCL-C) to detect insomnia by Insomnia Severity Index (ISI) METHODS: We performed a secondary analysis of data from a longitudinal investigation in 120 medical-surgical ICU survivors. At 1 year post-ICU, patients completed ISI, PCL-C, and Medical Short-Form 12 (SF-12) by telephone...
March 2018: Heart & Lung: the Journal of Critical Care
Robin E Cushing, Kathryn L Braun, Susan W Alden C-Iayt, Alan R Katz
Introduction: Among veterans of post-9/11 conflicts, estimates of post-traumatic stress disorder (PTSD) range from 9% shortly after returning from deployment to 31% a year after deployment. Clinical and pharmaceutically based treatments are underutilized. This could be due to concerns related to lost duty days, as well as PTSD patients' fears of stigma of having a mental health condition. Yoga has been shown to reduce PTSD symptoms in the civilian population, but few studies have tested the impact of yoga on veterans of post-9/11 conflicts...
May 1, 2018: Military Medicine
C Laurel Franklin, Jessica L Walton, Amanda M Raines, Jessica L Chambliss, Sheila A Corrigan, Lisa-Ann J Cuccurullo, Nancy J Petersen, Karin E Thompson
Introduction It is estimated that 70% of patients with posttraumatic stress disorder (PTSD) have chronic insomnia. A recent meta-analysis examined cognitive-behavioural therapy for insomnia (CBT-I) in veterans with and without PTSD, and suggested that most studies had questionable methodology, but generally supported its effectiveness in this population. Further, while CBT-I via telehealth (i.e. using telecommunication and information technology to deliver health services) has shown effectiveness for primary insomnia, it has not been applied to PTSD-related insomnia...
January 1, 2017: Journal of Telemedicine and Telecare
Mark A Greenbaum, Thomas C Neylan, Craig S Rosen
This study tested whether sleep medications prescribed to veterans diagnosed with posttraumatic stress disorder (PTSD) are being targeted to patients who report more severe insomnia or nightmares. Secondary analysis of survey and pharmacy data was conducted in samples of veterans from two periods: from 2006 to 2008 and from 2009 to 2013. Logistic regression tested associations between self-reported insomnia and nightmare severity, and being prescribed trazodone, prazosin, zolpidem, and benzodiazepines, controlling for PTSD severity and other covariates...
February 2017: Journal of Nervous and Mental Disease
Laura D Straus, Sean P A Drummond, Carla M Nappi, Melissa M Jenkins, Sonya B Norman
Sleep disturbances are prevalent in posttraumatic stress disorder (PTSD) and are associated with a number of adverse health consequences. Few studies have used comprehensive assessment methods to characterize sleep in Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OEF/OIF/OND) veterans with PTSD. OEF/OIF/OND veterans with PTSD and sleep disturbance (n = 45) were compared to patients with primary insomnia (n = 25) and healthy control subjects (n = 27). Participants were assessed using questionnaire-based measures as well as daily subjective and objective measures of sleep...
February 2015: Journal of Traumatic Stress
Brittney Brown, Erick C Jones, Kyra P Clark, Felicia Jefferson
Sleep disturbances are found in a majority of individuals diagnosed with posttraumatic stress disorder (PTSD). The purpose of this literature review is to provide information about PTSD, in addition to assessing sleep quality. Current research observes that the lifetime prevalence of PTSD diagnosis in women is increasing. Although there are several studies that have been conducted to assess PTSD and sleep, there is a gap in the research that pertains to women, PTSD, and sleep quality. The current study will compile information on the subject to aid in decreasing the gender disparity in PTSD research, which is important for treating the entire PTSD population...
2014: Neuro Endocrinology Letters
Rakesh Jetly, Alexandra Heber, George Fraser, Denis Boisvert
OBJECTIVE: Investigate the efficacy of nabilone capsules (NAB) in reducing the frequency and intensity of nightmares in subjects with PTSD. PATIENTS AND METHODS: Canadian male military personnel with PTSD, who despite standard treatment continued to experience trauma-related nightmares, received double-blind treatment with 0.5mg NAB or placebo (PBO), and then titrated to the effective dose (nightmare suppression) or reaching a maximum of 3.0mg. Subjects were followed for 7 weeks and then, following a 2-week washout period, were titrated with the other study treatment and followed for an additional 7 weeks...
January 2015: Psychoneuroendocrinology
Dieter J Meyerhoff, Anderson Mon, Thomas Metzler, Thomas C Neylan
STUDY OBJECTIVES: To test if posttraumatic stress disorder (PTSD) is associated with low brain gamma-aminobutyric acid (GABA) levels and if reduced GABA is mediated by poor sleep quality. DESIGN: Laboratory study using in vivo proton magnetic resonance spectroscopy (1H MRS) and behavioral testing. SETTING: VA Medical Center Research Service, Psychiatry and Radiology. PATIENTS OR PARTICIPANTS: Twenty-seven patients with PTSD (PTSD+) and 18 trauma-exposed controls without PTSD (PTSD-), recruited from United States Army reservists, Army National Guard, and mental health clinics...
May 1, 2014: Sleep
Lisa S Talbot, Shira Maguen, Thomas J Metzler, Martha Schmitz, Shannon E McCaslin, Anne Richards, Michael L Perlis, Donn A Posner, Brandon Weiss, Leslie Ruoff, Jonathan Varbel, Thomas C Neylan
STUDY OBJECTIVES: Examine whether cognitive behavioral therapy for insomnia (CBT-I) improves sleep in posttraumatic stress disorder (PTSD) as well as nightmares, nonsleep PTSD symptoms, depression symptoms, and psychosocial functioning. DESIGN: RANDOMIZED CONTROLLED TRIAL WITH TWO ARMS: CBT-I and monitor-only waitlist control. SETTING: Department of Veterans Affairs (VA) Medical Center. PARTICIPANTS: Forty-five adults (31 females: [mean age 37 y (22-59 y)] with PTSD meeting research diagnostic criteria for insomnia, randomly assigned to CBT-I (n = 29; 22 females) or monitor-only waitlist control (n = 16; nine females)...
February 1, 2014: Sleep
Taylor R Plumb, John T Peachey, Diane C Zelman
Sleep routines that develop as an adaptation or reaction to deployment can persist upon return stateside. Sleep problems intensify and are intensified by psychiatric distress. This research presents the findings of a comprehensive survey of sleep impairment in relation to demographic data, military history, combat exposure, and mental illness symptoms among a general sample of 375 servicemembers and veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) at a wide range of times postdeployment. Sleep impairment was assessed with the Pittsburgh Sleep Quality Index (PSQI) and the Addendum for PTSD...
May 2014: Psychological Services
Philip Gehrman, Amber D Seelig, Isabel G Jacobson, Edward J Boyko, Tomoko I Hooper, Gary D Gackstetter, Christi S Ulmer, Tyler C Smith
STUDY OBJECTIVES: To evaluate predeployment sleep duration and insomnia symptoms in relation to the development of mental health symptoms. DESIGN: Longitudinal cohort study. SETTING: The Millennium Cohort Study survey is administered via a secure website or US mail. PARTICIPANTS: Data were from 15,204 participants who completed their first deployment between the submissions of 2 consecutive Millennium Cohort questionnaires (2001-2008)...
July 1, 2013: Sleep
Frank B Schoenfeld, Jason C Deviva, Rachel Manber
Sleep disturbances are among the most commonly reported posttraumatic stress disorder (PTSD) symptoms. It is essential to conduct a careful assessment of the presenting sleep disturbance to select the optimal available treatment. Cognitive-behavioral therapies (CBTs) are at least as effective as pharmacologic treatment in the short-term and more enduring in their beneficial effects. Cognitive-behavioral treatment for insomnia and imagery rehearsal therapy have been developed to specifically treat insomnia and nightmares and offer promise for more effective relief of these very distressing symptoms...
2012: Journal of Rehabilitation Research and Development
Alicia R Maher, George Theodore
BACKGROUND: Conventional and atypical antipsychotic medications are approved by the FDA for treatment of schizophrenia and bipolar disorder. Over many decades, the widespread use of conventional antipsychotics produced various side effects requiring additional medications, such as the atypical antipsychotics. Beginning in 2006, 9 atypical antipsychotic drugs have been approved by the FDA for indications that were previously off-label uses: aripiprazole (as augmentation for major depressive disorder [MDD] and for autism spectrum disorders), asenapine, clozapine, iloperidone, olanzapine (in combination with fluoxetine for MDD and bipolar depression), paliperidone, quetiapine (quetiapine and quetiapine XR [extended release] as monotherapy in bipolar depression and quetiapine XR as augmentation for MDD), risperidone (for autism spectrum disorders), and ziprasidone...
June 2012: Journal of Managed Care Pharmacy: JMCP
Elizabeth C Parsons, Erin K Kross, Ellen S Caldwell, Vishesh K Kapur, Susan M McCurry, Michael V Vitiello, Catherine L Hough
INTRODUCTION: Sleep disturbance is common during critical illness, yet little is known about its prevalence or role in post-discharge quality of life among high-risk acute lung injury (ALI) patients. METHODS: In a prospective cohort of 61 mechanically ventilated ALI patients, we examined the association between insomnia symptoms and quality of life six months after discharge. Subjects completed surveys rating quality of life (MOS SF-36), post-traumatic stress disorder (PCL), and depression (PHQ-9)...
September 2012: Sleep Medicine
Erin Koffel
This study examined the reliability and validity of an expanded version of the Iowa Sleep Disturbances Inventory (ISDI; Koffel & Watson, 2010) in 2 samples (219 college students and 200 psychiatric patients). The expanded ISDI includes the scales Sleep Paralysis and Sleep Hallucinations. These scales, along with the Nightmares scale, help define a higher order factor entitled Unusual Sleep Experiences. This factor was distinct from the Insomnia and Lassitude factors that were reported previously. The expanded ISDI showed strong evidence of convergent and discriminant validity with the corresponding interview ratings on a clinician rating version of the ISDI...
September 2011: Psychological Assessment
Thomas C Neylan, Susanne G Mueller, Zhen Wang, Thomas J Metzler, Maryann Lenoci, Diana Truran, Charles R Marmar, Michael W Weiner, Norbert Schuff
BACKGROUND: Prolonged disruption of sleep in animal studies is associated with decreased neurogenesis in the dentate gyrus. Our objective was to determine whether insomnia severity in a sample of posttraumatic stress disorder (PTSD) patients and control subjects was associated with decreased volume in the CA3/dentate hippocampal subfield. METHODS: Volumes of hippocampal subfields in 17 veteran men positive for PTSD (41 +/- 12 years) and 19 age-matched male veterans negative for PTSD were measured with 4-T magnetic resonance imaging...
September 1, 2010: Biological Psychiatry
Patrick C Hayes, Charles L Weber, Michael B Gallagher, Gary J Drouillard
This case report describes a patient with reportedly new onset of tics, beginning at 21 years of age, in the context of posttraumatic stress disorder (PTSD) and comorbid alcohol abuse, with no known head injury. The setting is an American Society of Addiction Medicine intensive outpatient substance abuse rehabilitation program in an United States Army Medical Center. The patient is a 22-year-old male diagnosed with alcohol abuse and delayed PTSD who presented to the program's medical officer due to insomnia...
April 2009: CNS Spectrums
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