The International Handbook of Psychopathic Disorders and the Law
... Military Medicine, 169(8), 64853. Booth-Kewley, S. & Larson, GE (2005). ... The so-calle... more ... Military Medicine, 169(8), 64853. Booth-Kewley, S. & Larson, GE (2005). ... The so-called psychopathic personality with special emphasis on his status in the selective service. Journal of the Medical Association of Georgia, 30, 46672. Conard, R. & Emanuel, R. (1998). ...
This multicenter, double-blind, placebo-controlled crossover study evaluated the efficacy of a ne... more This multicenter, double-blind, placebo-controlled crossover study evaluated the efficacy of a new oral contraceptive (OC) formulation containing drospirenone 3 mg and ethinyl estradiol (EE) 20 mug in treating symptoms of premenstrual dysphoric disorder (PMDD). The OC formulation or placebo was administered for 24 days in a 28-day cycle (24/4), rather than the usual 21-day active treatment, 7-day inert-pill regimen. Participants (N=64) were randomized to either study treatment for three cycles and then after a washout period of one treatment-free cycle switched to the alternate treatment. The mean decrease from baseline for total Daily Record of Severity of Problems (DRSP) scores while using drospirenone/EE was significantly greater than for placebo (-12.47, 95% CI=-18.28, -6.66; p<.001). A positive response (i.e., a score of 1 or 2 in the Clinical Global Impressions-Improvement scale) occurred in 61.7% and 31.8% of subjects while taking drospirenone/EE and placebo, respectively (p=.009). Drospirenone/EE, given in a 24/4 regimen, was superior to placebo for improving symptoms associated with PMDD.
ObjectiveWe tested the aspects of social support, unit cohesion, and religiosity hypothesized to ... more ObjectiveWe tested the aspects of social support, unit cohesion, and religiosity hypothesized to be protective factors for suicide among U.S. service members.MethodsThis case–control study compared U.S. Army soldiers who died by suicide while on active duty (n = 135) to controls of two types: those propensity score‐matched on known sociodemographic risk factors (n = 128); and those controls who had thought about, but not died by, suicide in the past year (n = 108). Data included structured interviews of next of kin (NOK) and Army supervisors (SUP) for each case and control soldier. Logistic regression analyses were used to examine predictors of suicide.ResultsPerceived social closeness and seeking help from others were associated with decreased odds of suicide, as reported by SUP (OR = 0.2 [95% CI = 0.1, 0.5]) and NOK (OR = 0.4 [95% CI = 0.2, 0.8]). Novel reports by SUP informants of high levels of unit cohesion/morale decreased odds of suicide (OR = 0.1 [95% CI = 0.0, 0.2]). Contra...
The Journal of nervous and mental disease, Feb 1, 2017
P osttraumatic stress disorder (PTSD) is a DSM-5 trauma and stressor-related disorder defined by ... more P osttraumatic stress disorder (PTSD) is a DSM-5 trauma and stressor-related disorder defined by the development of a constellation of symptoms in the aftermath of traumatic exposure. This can include direct exposure to actual or threatened death, serious injury or severe sexual violence, or learning of such experience in loved ones, or repeated exposure to the details of such experiences in others as a consequence of one's occupation (American Psychiatric Association, 2013). Posttraumatic stress disorder does not develop in all individuals who experience trauma, and it is not the most prevalent mental disorder to occur in the aftermath of trauma (Muscatelli et al., 2017). Still, epidemiological studies estimate the lifetime prevalence of PTSD at 9%, and at higher rates in at-risk populations including first-responders (Berger et al., 2012) and military personnel (Vasterling et al., 2016). Exposure to a traumatic event (or events) is a necessary element of the diagnosis of PTSD as is persistence of clinically significant distress or psychosocial or occupational impairment from symptoms for at more than one month. After these diagnostic requirements are met, however, the nature and quality of the symptoms that any given patient may develop is highly variable. Exposed individuals must experience only 2 (or in some instances 1) of the symptoms in each of 4 symptoms clusters (intrusion, avoidance, hyperarousal, and negative alterations in mood or cognition) from the list of 20 total symptoms described in the DSM-5. Hence, the PTSD may manifest as any of the many symptom combinations (Galatzer-Levy and Bryant, 2013). Adding to the complexity of presentation is the fact that PTSD rarely, if ever, occurs in a vacuum. Posttraumatic stress disorder is highly comorbid with disorders including depression, substance use, traumatic brain injury, and chronic pain—any of which may be present in a patient entirely separately from any traumatic experience or may develop concurrently with posttraumatic stress disorder as a result of the traumatic exposure(s). The idea that this complexity of presentation would have implications for diagnostic assessment, treatment, and prognosis seems perhaps self-evident, but the impact of this complexity for those in the patient's life (loved ones, caregivers, clinicians, community members, and even other patients) may be of a more subtle nature. Because it is clear that PTSD is not a “one-size-fits-all diagnosis,” it follows that different treatments (pharmacology, psychotherapy, complementary, and alternative medicine) may differ in effectiveness depending on the specific symptoms experienced by a given patient. Beyond specific symptoms, other patient-related factors or treatment-specific factors may alter response to selected treatments. Moving the management of patients with PTSD forward will require an increased understanding of the specific factors that contribute to treatment efficacy (or lack thereof ) for particular symptoms or subtypes of PTSD. So, toowill be gaining insight into the degree towhich the timing or source of a given intervention may impact treatment outcome. Finally, understanding the degree to which any particular combination of symptoms or comorbidities may burden care providers or others with whom the patient interacts will help caregivers anticipate the social and occupational consequences of this disorder in individual patients. Each of these has implications for the choice and timing of an intervention to ensure the best fit between patient and treatment. In recent years, our understanding of the neurobiology of traumatic stress response has increased markedly. So, too has our understanding of the genetic and epigenetic risk factors for the development of PTSD. This knowledge has clarified our conceptualization of PTSD as an illness marked by heterogeneity of vulnerability, symptom expression, treatment response, and impact on the larger community (coworkers, loved ones, caregivers, other patients). This edition of The Journal of Nervous and Mental Disease reflects this forward progress. The studies in this volume describe aspects of this complex illness ranging from the burden on family caregivers to the extent to which social support and type of social support for PTSD sufferers may moderate treatment outcomes in relation to comorbid substance use and physical health functioning. Other studies herein describe the manner in which factors ranging from trauma(i.e., the severity and number of traumatic exposures) and patient-specific
The International Handbook of Psychopathic Disorders and the Law
... Military Medicine, 169(8), 64853. Booth-Kewley, S. & Larson, GE (2005). ... The so-calle... more ... Military Medicine, 169(8), 64853. Booth-Kewley, S. & Larson, GE (2005). ... The so-called psychopathic personality with special emphasis on his status in the selective service. Journal of the Medical Association of Georgia, 30, 46672. Conard, R. & Emanuel, R. (1998). ...
This multicenter, double-blind, placebo-controlled crossover study evaluated the efficacy of a ne... more This multicenter, double-blind, placebo-controlled crossover study evaluated the efficacy of a new oral contraceptive (OC) formulation containing drospirenone 3 mg and ethinyl estradiol (EE) 20 mug in treating symptoms of premenstrual dysphoric disorder (PMDD). The OC formulation or placebo was administered for 24 days in a 28-day cycle (24/4), rather than the usual 21-day active treatment, 7-day inert-pill regimen. Participants (N=64) were randomized to either study treatment for three cycles and then after a washout period of one treatment-free cycle switched to the alternate treatment. The mean decrease from baseline for total Daily Record of Severity of Problems (DRSP) scores while using drospirenone/EE was significantly greater than for placebo (-12.47, 95% CI=-18.28, -6.66; p<.001). A positive response (i.e., a score of 1 or 2 in the Clinical Global Impressions-Improvement scale) occurred in 61.7% and 31.8% of subjects while taking drospirenone/EE and placebo, respectively (p=.009). Drospirenone/EE, given in a 24/4 regimen, was superior to placebo for improving symptoms associated with PMDD.
ObjectiveWe tested the aspects of social support, unit cohesion, and religiosity hypothesized to ... more ObjectiveWe tested the aspects of social support, unit cohesion, and religiosity hypothesized to be protective factors for suicide among U.S. service members.MethodsThis case–control study compared U.S. Army soldiers who died by suicide while on active duty (n = 135) to controls of two types: those propensity score‐matched on known sociodemographic risk factors (n = 128); and those controls who had thought about, but not died by, suicide in the past year (n = 108). Data included structured interviews of next of kin (NOK) and Army supervisors (SUP) for each case and control soldier. Logistic regression analyses were used to examine predictors of suicide.ResultsPerceived social closeness and seeking help from others were associated with decreased odds of suicide, as reported by SUP (OR = 0.2 [95% CI = 0.1, 0.5]) and NOK (OR = 0.4 [95% CI = 0.2, 0.8]). Novel reports by SUP informants of high levels of unit cohesion/morale decreased odds of suicide (OR = 0.1 [95% CI = 0.0, 0.2]). Contra...
The Journal of nervous and mental disease, Feb 1, 2017
P osttraumatic stress disorder (PTSD) is a DSM-5 trauma and stressor-related disorder defined by ... more P osttraumatic stress disorder (PTSD) is a DSM-5 trauma and stressor-related disorder defined by the development of a constellation of symptoms in the aftermath of traumatic exposure. This can include direct exposure to actual or threatened death, serious injury or severe sexual violence, or learning of such experience in loved ones, or repeated exposure to the details of such experiences in others as a consequence of one's occupation (American Psychiatric Association, 2013). Posttraumatic stress disorder does not develop in all individuals who experience trauma, and it is not the most prevalent mental disorder to occur in the aftermath of trauma (Muscatelli et al., 2017). Still, epidemiological studies estimate the lifetime prevalence of PTSD at 9%, and at higher rates in at-risk populations including first-responders (Berger et al., 2012) and military personnel (Vasterling et al., 2016). Exposure to a traumatic event (or events) is a necessary element of the diagnosis of PTSD as is persistence of clinically significant distress or psychosocial or occupational impairment from symptoms for at more than one month. After these diagnostic requirements are met, however, the nature and quality of the symptoms that any given patient may develop is highly variable. Exposed individuals must experience only 2 (or in some instances 1) of the symptoms in each of 4 symptoms clusters (intrusion, avoidance, hyperarousal, and negative alterations in mood or cognition) from the list of 20 total symptoms described in the DSM-5. Hence, the PTSD may manifest as any of the many symptom combinations (Galatzer-Levy and Bryant, 2013). Adding to the complexity of presentation is the fact that PTSD rarely, if ever, occurs in a vacuum. Posttraumatic stress disorder is highly comorbid with disorders including depression, substance use, traumatic brain injury, and chronic pain—any of which may be present in a patient entirely separately from any traumatic experience or may develop concurrently with posttraumatic stress disorder as a result of the traumatic exposure(s). The idea that this complexity of presentation would have implications for diagnostic assessment, treatment, and prognosis seems perhaps self-evident, but the impact of this complexity for those in the patient's life (loved ones, caregivers, clinicians, community members, and even other patients) may be of a more subtle nature. Because it is clear that PTSD is not a “one-size-fits-all diagnosis,” it follows that different treatments (pharmacology, psychotherapy, complementary, and alternative medicine) may differ in effectiveness depending on the specific symptoms experienced by a given patient. Beyond specific symptoms, other patient-related factors or treatment-specific factors may alter response to selected treatments. Moving the management of patients with PTSD forward will require an increased understanding of the specific factors that contribute to treatment efficacy (or lack thereof ) for particular symptoms or subtypes of PTSD. So, toowill be gaining insight into the degree towhich the timing or source of a given intervention may impact treatment outcome. Finally, understanding the degree to which any particular combination of symptoms or comorbidities may burden care providers or others with whom the patient interacts will help caregivers anticipate the social and occupational consequences of this disorder in individual patients. Each of these has implications for the choice and timing of an intervention to ensure the best fit between patient and treatment. In recent years, our understanding of the neurobiology of traumatic stress response has increased markedly. So, too has our understanding of the genetic and epigenetic risk factors for the development of PTSD. This knowledge has clarified our conceptualization of PTSD as an illness marked by heterogeneity of vulnerability, symptom expression, treatment response, and impact on the larger community (coworkers, loved ones, caregivers, other patients). This edition of The Journal of Nervous and Mental Disease reflects this forward progress. The studies in this volume describe aspects of this complex illness ranging from the burden on family caregivers to the extent to which social support and type of social support for PTSD sufferers may moderate treatment outcomes in relation to comorbid substance use and physical health functioning. Other studies herein describe the manner in which factors ranging from trauma(i.e., the severity and number of traumatic exposures) and patient-specific
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Papers by David Benedek