Early cognitive-behavioral therapy for post-traumatic stress symptoms after physical injury. Randomised controlled trial
Department of Liaison Psychiatry, Cardiff and Vale NHS Trust, University Hospital of Wales, Cardiff, UK. The British Journal of Psychiatry
(Impact Factor: 7.99).
Early single-session psychological interventions, including psychological debriefing following trauma, have not been shown to reduce psychological distress. Longer early psychological interventions have shown some promise.
To examine the efficacy of a four-session cognitive-behavioural intervention following physical injury.
A total of 152 patients attending an accident and emergency department displaying psychological distress following physical injury were randomised 1-3 weeks post-injury to a four-session cognitive-behavioural intervention that started 5-10 weeks after the injury or to no intervention and then followed up for 13 months.
At 13 months, the total Impact of Event Scale score was significantly more reduced in the intervention group (adjusted mean difference=8.4,95% CI 2.4-14.36). Other differences were not statistically significant.
A brief cognitive-behavioural intervention reduces symptoms of post-traumatic stress disorder in individuals with physical injury who display initial distress.
Available from: Arieh Y Shalev
- "Trials of exposure-based CBT have generally demonstrated moderately positive results in reducing PTSD or other symptoms in the long term (Table 1).conducted a study using modified Prolonged Exposure (PE) in rape, assault, and motor vehicle accidents survivors around 12 h after trauma, and found lower PTSD symptoms in the intervention group at 4 and 12 weeks after trauma, mainly for sexual assault victims. The same cohort also showed that PE might mitigate symptoms of PTSD in genetically predisposed individuals[35, 36•].Bryant et al. (2008)found 5 weeks of exposure-based CBT to be effective in reducing PTSD in participants who met acute stress disorder diagnostic criteria.Bisson et al. (2004)found a reduction of PTSD symptoms at 13 months—but not 3 months after the traumatic events, while a small study with 3 weeks of PE did not find significant symptom improvement in the PE group compared to supportive counseling. CBT without in-session exposure has shown effectiveness in some but not all studies.Sijbrandij et al. (2007)compared CBT to waitlist control subjects with acute PTSD and found that CBT accelerated recovery, but makes no long-term difference.Shalev et al. (2012), found that cognitive therapy fared as well as prolonged exposure 9 months[41•]after trauma exposure . "
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ABSTRACT: Post-traumatic stress disorder (PTSD) is a frequent, tenacious, and disabling consequence of traumatic events. The disorder’s identifiable onset and early symptoms provide opportunities for early detection and prevention. Empirical findings and theoretical models have outlined specific risk factors and pathogenic processes leading to PTSD. Controlled studies have shown that theory-driven preventive interventions, such as cognitive behavioral therapy (CBT), or stress hormone-targeted pharmacological interventions, are efficacious in selected samples of survivors. However, the effectiveness of early clinical interventions remains unknown, and results obtained in aggregates (large groups) overlook individual heterogeneity in PTSD pathogenesis. We review current evidence of PTSD prevention and outline the need to improve the disorder’s early detection and intervention in individual-specific paths to chronic PTSD.
- "Where individuals with epilepsy are highly susceptible to falling and obtaining severe brain damage during epileptic seizures , 73% of pregnant women require medical treatment from fall occurrence  where foetal deaths can occur from sustained injuries  and workplace falls are a leading cause of work related injury and of significant related costs . Furthermore, fall occurrences frequently inflict posttraumatic stress on the individual  , where adults over the age of 65 years suffer * Corresponding author. Tel.: +44 14184834143. "
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ABSTRACT: There are a significant number of high fall risk individuals who are susceptible to falling and sustaining severe injuries. An automatic fall detection and diagnostic system is critical for ensuring a quick response with effective medical aid based on relative information provided by the fall detection system. This article presents and evaluates an accelerometer-based multiple classifier fall detection and diagnostic system implemented on a single wearable Shimmer device for remote health monitoring. Various classifiers have been utilised within literature, however there is very little current work in combining classifiers to improve fall detection and diagnostic performance within accelerometer-based devices. The presented fall detection system utilises multiple classifiers with differing properties to significantly improve fall detection and diagnostic performance over any single classifier and majority voting system. Additionally, the presented multiple classifier system utilises comparator functions to ensure fall event consistency, where inconsistent events are outsourced to a supervisor classification function and discrimination power is considered where events with high discrimination power are evaluated to further improve the system response. The system demonstrated significant performance advantages in comparison to other classification methods, where the proposed system obtained over 99% metrics for fall detection recall, precision, accuracy and F-value responses.
Available from: Laura Nawijn
- "Recently, a pilot study found that 3 sessions of prolonged exposure therapy administered within 2 weeks after trauma reduced post-traumatic stress reactions at 1 and 3 months post-trauma . Other secondary preventive psychological interventions, such as brief Cognitive Behavioral Therapy (CBT), have yielded promising results [11,12] but can be applied only several weeks after trauma, when trauma-exposed individuals may already have developed acute PTSD. "
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ABSTRACT: Currently few evidence based interventions are available for the prevention of PTSD within the first weeks after trauma. Increased risk for PTSD development is associated with dysregulated fear and stress responses prior to and shortly after trauma, as well as with a lack of perceived social support early after trauma. Oxytocin is a potent regulator of these processes. Therefore, we propose that oxytocin may be important in reducing adverse consequences of trauma. The 'BONDS' study is conducted in order to assess the efficacy of an early intervention with intranasal oxytocin for the prevention of PTSD.
In this multicenter double-blind randomized placebo-controlled trial we will recruit 220 Emergency Department patients at increased risk of PTSD. Trauma-exposed patients are screened for increased PTSD risk with questionnaires assessing peri-traumatic distress and acute PTSD symptoms within 7 days after trauma. Baseline PTSD symptom severity scores and neuroendocrine and psychophysiological measures will be collected within 10 days after trauma. Participants will be randomized to 7.5 days of intranasal oxytocin (40 IU) or placebo twice a day. Follow-up measurements at 1.5, 3 and 6 months post-trauma are collected to assess PTSD symptom severity (the primary outcome measure). Other measures of symptoms of psychopathology, and neuroendocrine and psychophysiological disorders are secondary outcome measures.
We hypothesize that intranasal oxytocin administered early after trauma is an effective pharmacological strategy to prevent PTSD in individuals at increased risk, which is both safe and easily applicable. Interindividual and contextual factors that may influence the effects of oxytocin treatment will be considered in the analysis of the results.Trial registration: Netherlands Trial Registry: NTR3190.
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