Posttraumatic stress disorder treatment outcome research: The study of unrepresentative samples?

Spinazzola, Joseph; Blaustein, Margaret; Kolk, Bessel A. van der

doi:10.1002/jts.20050

Cited by 152 publications

(104 citation statements)

References 37 publications

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“…In the PTSD literature, psychiatric problems that do not fall within the framework of PTSD are generally referred to as "comorbid conditions," as if they occurred independently from the PTSD symptoms. By relegating them to seemingly unrelated "comorbid" conditions, fundamental trauma-related disturbances may be lost to scientific investigation, and clinicians may run the risk of applying treatment approaches that are not helpful (see Spinazzola, Blaustein, Van der Kolk, 2005). These concerns gave rise to an attempt to carefully delineate posttraumatic adaptations in the DSM-IV field trial.…”

Section: Developmental and Relational Issuesmentioning

confidence: 97%

Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma

et al. 2005

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Children and adults exposed to chronic interpersonal trauma consistently demonstrate psychological disturbances that are not captured in the posttraumatic stress disorder (PTSD) diagnosis. The DSM-IV (American Psychiatric Association, 1994) Field Trial studied 400 treatment-seeking traumatized individuals and 128 community residents and found that victims of prolonged interpersonal trauma, particularly trauma early in the life cycle, had a high incidence of problems with (a) regulation of affect and impulses, (b) memory and attention, (c) self-perception, (d) interpersonal relations, (e) somatization, and (f) systems of meaning. This raises important issues about the categorical versus the dimensional nature of posttraumatic stress, as well as the issue of comorbidity in PTSD. These data invite further exploration of what constitutes effective treatment of the full spectrum of posttraumatic psychopathology.

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Section: Developmental and Relational Issuesmentioning

confidence: 97%

Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma

et al. 2005

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“…[64][65][66] This is particularly problematic because PTSD patients with more severe and complex symptoms are often much more difficult to treat and therefore present a greater financial burden to the health care system. 67,68 Understanding the pathophysiology of PTSD may contribute to the development of better treatment strategies; however, if the pathophysiology differs in patients with different disease severity, the patient groups excluded from research are less likely to benefit from these advances. In fact, investigators of other psychiatric disorders such as schizophrenia and mood disorders have a long history of performing neuroimaging research with both unmedicated and medicated patients for this reason.…”

Section: Disadvantages Of Including Medication-free Patientsmentioning

confidence: 99%

Does neuroimaging research examining the pathophysiology of posttraumatic stress disorder require medication-free patients?

Lanius

Brewin

Bremner

et al. 2010

jpn

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Background:In an attempt to avoid unknown influence, most neuroimaging studies examining the pathophysiology of posttraumatic stress disorder (PTSD) exclude patients taking medications. Here we review the empirical evidence for relevant medications having a confounding effect on task performance or cerebral blood flow (CBF) in this population. The evidence for potentially confounding effects of psychotherapy in PTSD are also discussed. Methods: The literature that we reviewed was obtained through a PubMed search from 1980 to 2009 using the search terms posttraumatic stress disorder, PTSD, psychotropic medications, neuroimaging, functional magnetic res onance imaging, positron emission tomography, cerebral blood flow, CBF, serotonin-specific reuptake blocker, benzodiazepine, ketamine, methamphetamine, lamotrigine and atypical antipsychotic agents. Results: The empirical evidence for relevant medications having a confounding effect on task performance or CBF in relevant areas remains sparse for most psychotropic medications among patients with PTSD. However, considerable evidence is accumulating for 2 of the most commonly prescribed medication classes (serotonin-specific reuptake inhibitors and benzodiazepines) in healthy controls. Compelling data for the potentially confounding effects on brain areas relevant to PTSD for psychotherapeutic interventions are also accumulating. Conclusion: Neuroimaging studies examining the pathophysiology of PTSD should ideally recruit both medicated (assuming that the medication treatment has not resulted in the remission of symptoms) and unmedicated participants, to allow the findings to be generalized with greater confidence to the entire population of patients with PTSD. More research is needed into the independent effects of medications on task performance and CBF in regions of interest in PTSD. Neuroimaging studies should also take into account whether patients are currently engaged in psychotherapeutic treatment.

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“…People with psychotic disorders are usually excluded from scientific studies into the efficacy of PTSD treatments (Spinazzola, Blaustein, & Van der Kolk, 2005). Therefore, little is known about the usability of these treatments in people with psychosis (Bradley, Greene, Russ, Dutra, & Westen, 2005).…”

Section: Introductionmentioning

confidence: 99%

Treating trauma in psychosis with EMDR: A pilot study

Berg

Gaag

2012

Journal of Behavior Therapy and Experimental Psychiatry

119

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Posttraumatic stress disorder treatment outcome research: The study of unrepresentative samples?

Cited by 152 publications

References 37 publications

Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma

Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma

Does neuroimaging research examining the pathophysiology of posttraumatic stress disorder require medication-free patients?

Treating trauma in psychosis with EMDR: A pilot study

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