Enhancing Completion of Cognitive Processing Therapy for Posttraumatic Stress Disorder with Quetiapine in Veterans with Mild Traumatic Brain Injury: a Case Series

Baig, Muhammad R.; Wilson, Jennifer; Lemmer, Jennifer A.; Beck, Robert D.; Peterson, Alan L.; Roache, John D.

doi:10.1007/s11126-019-09638-z

Cited by 14 publications

(14 citation statements)

References 53 publications

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“…Like other reviews on integrated care [ 33 – 38 , 40 ], the integration of TBI and MHSU care already exists at the micro-level in the form of treatments or interventions delivered by a healthcare professional. Studies included in this review also indicated some integrated care occurring at the meso-level, predominantly in the form of screening for TBI among individuals with MHSU or vice versa [ 50 , 51 , 61 , 75 , 83 , 91 , 98 ] and multidisciplinary care teams [ 49 , 55 , 56 , 67 , 90 ]. These meso-level studies were predominantly single program initiatives working on a relatively small scale.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from case studies, which predominantly comprised participants of a single sex or gender, none of the articles in this review reported sex- or gender-stratified data. Furthermore, two studies reported findings on men and women but were described as ‘sex’ [ 55 , 56 ] while 12 studies reported findings on males and females but were described as ‘gender’ [ 69 , 74 – 76 , 85 , 86 , 92 , 95 , 98 , 103 – 105 ]. Clear reporting of sex and gender data are needed to inform gender transformative integrated care.…”

Section: Discussionmentioning

confidence: 99%

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A systematic review on integrated care for traumatic brain injury, mental health, and substance use

et al. 2022

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Traumatic brain injuries (TBI) and mental health or substance use disorders (MHSU) are global public health concerns due to their prevalence and impact on individuals and societies. However, care for individuals with TBI and MHSU remains fragmented with a lack of appropriate services and supports across the continuum of healthcare. This systematic review provided an evidence-based foundation to inform opportunities to mobilize and adapt existing resources to integrate care for individuals with TBI and MHSU by comprehensively summarizing existing integrated activities and reported barriers and facilitators to care integration. MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Sociological Abstracts, and Dissertations & Theses Global were independently reviewed by two reviewers based on pre-determined eligibility criteria. Data on the integration activity, level and type of integration, reported barriers and facilitators, and the strategies aligning with the World Health Organization’s (WHO) Framework on Integrated Person-Centred Care were extracted to form the basis for a narrative synthesis. Fifty-nine peer-reviewed articles were included, describing treatments (N = 49), programs (N = 4), or screening activities (N = 7). Studies discussing clinical integration at the micro- (N = 38) and meso- (N = 10) levels, service integration at the micro- (N = 6) and meso- (N = 5) levels, and functional integration at the meso-level (N = 1) were identified. A minority of articles reported on facilitators (e.g., cognitive accommodations in treatment plans; N = 7), barriers (e.g., lack of education on cognitive challenges associated with TBI; N = 2), or both (N = 6), related to integrating care. This review demonstrated that integrated TBI and MHSU care already exists across a range of levels and types. Given the finite and competing demands for healthcare resources, cognitive accommodations across treatment plans to facilitate integrated TBI and MHSU care should be considered. Multidisciplinary teams should also be explored to provide opportunities for education among health professionals so they can be familiar with TBI and MHSU. Trial registration: Prospero Registration: CRD42018108343.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A systematic review on integrated care for traumatic brain injury, mental health, and substance use

et al. 2022

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“…[20][21][22][23][24][25][26][27][28] In a search for psychosedative medications that may enhance engagement in CPT, we reported case series data showing that quetiapine monotherapy, but not risperidone or valproate, increased engagement in therapy for 86% of 21 veterans, and 50% of those (i.e., 43% overall) achieved remission of PTSD. [29] Consistent with this, we propose that quetiapine may be an e cacious medication treatment for enhancing patient engagement in trauma-focused therapy and thereby improving recovery outcomes for veterans with PTSD who are offered CPT as a standard of care therapy (Fig. 1).…”

Section: Introductionmentioning

confidence: 53%

Quetiapine Augmentation of Cognitive Processing Therapy in Veterans with Posttraumatic Stress Disorder. Design and Methodology of a Pilot Study

Baig

Wilson

Beck

et al. 2021

Preprint

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BackgroundThe limited efficacy of first-line treatment of posttraumatic stress disorder (PTSD) with selective serotonergic reuptake inhibitors commonly leads to the use of multiple medications that still fail to achieve symptomatic remission. VA/DOD guidelines identify trauma-focused psychotherapies as the evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement. Cognitive processing therapy (CPT) is the most widely-used trauma-focused therapy in the VA system for Veterans with PTSD. Our previous results based on a case series suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in CPT, thereby improving clinical outcomes through direct medication effects and indirectly through greater engagement in CPT.Methods & ResultsWe report the study protocol of a pilot study. This randomized, double blind placebo-controlled study was designed to evaluate the feasibility, safety, and preliminary efficacy of completing a randomized trial of quetiapine vs. placebo as an adjunct to promote patient engagement in CPT treatment for PTSD.ConclusionsWe expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial.Trial Registration:NCT04280965

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“…In a previous observational study, we showed that quetiapine monotherapy, but not risperidone or valproate, increased engagement in therapy in 18 of 21 veterans with PTSD, and 50% of the patients with increased engagement achieved complete remission [70]. Unfortunately, local VA treatment guidelines specify that off-label use of atypical antipsychotics is permitted only after at least two failed trials of SSRIs.…”

Section: Introductionmentioning

confidence: 97%

Quetiapine augmentation of prolonged exposure therapy in veterans with PTSD and a history of mild traumatic brain injury: design and methodology of a pilot study

et al. 2020

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Background Selective serotonergic reuptake inhibitors (SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder (PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury (mTBI) is problematic since SSRIs could exacerbate post-concussion syndrome (PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy. Methods We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of mTBI. Discussion We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full- scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans. Trial registration NCT04280965.

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Enhancing Completion of Cognitive Processing Therapy for Posttraumatic Stress Disorder with Quetiapine in Veterans with Mild Traumatic Brain Injury: a Case Series

Cited by 14 publications

References 53 publications

A systematic review on integrated care for traumatic brain injury, mental health, and substance use

A systematic review on integrated care for traumatic brain injury, mental health, and substance use

Quetiapine Augmentation of Cognitive Processing Therapy in Veterans with Posttraumatic Stress Disorder. Design and Methodology of a Pilot Study

Quetiapine augmentation of prolonged exposure therapy in veterans with PTSD and a history of mild traumatic brain injury: design and methodology of a pilot study

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