Asunto(s)
Internado y Residencia , Psiquiatría , Humanos , Retroalimentación , Psicoterapia/educación , Psiquiatría/educaciónRESUMEN
OBJECTIVE: The purpose of this article was to review the literature regarding diagnosis, pathogenesis, and treatment of post-traumatic stress disorder (PTSD) associated with cancer. METHOD: We surveyed studies examining the validity of diagnostic scales commonly used to measure PTSD in patients with cancer. Neurobiological underpinnings of PTSD and cancer, including inflammation as the physiological mechanism linking these comorbidities, were examined. Psychopharmacologic and psychotherapeutic treatment of PTSD symptoms in patients with cancer was reviewed. In addition, potential drug-drug interactions between psychotropic medications commonly used to treat PTSD and anti-cancer agents were reviewed. RESULTS: Multiple studies demonstrated the validity of the PTSD Checklist Civilian Version (PCL-C) in diagnosing PTSD in patients with cancer. Research has shown that PTSD as defined in DSM-IV appears to be a better model for conceptualizing distress in patients with cancer than a generalized "distress" model. Epidemiologic studies have shown an increased incidence of PTSD associated with cancer; however, literature regarding characteristics of PTSD in patients with cancer is cross-sectional in nature. SIGNIFICANCE OF RESULTS: Future research focusing on longitudinal, prospective studies to identify patients at risk, determine causal or aggravating factors, and develop preventive interventions is needed. Further study of PTSD in patients with cancer may help increase recognition of this disorder, optimize treatment, and enhance the quality of life of these individuals.
Asunto(s)
Antineoplásicos/farmacología , Neoplasias , Psicotrópicos/farmacología , Trastornos por Estrés Postraumático , Adulto , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Comorbilidad , Interacciones Farmacológicas , Humanos , Neoplasias/diagnóstico , Neoplasias/epidemiología , Neoplasias/etiología , Neoplasias/terapia , Psicotrópicos/efectos adversos , Psicotrópicos/uso terapéutico , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/terapiaRESUMEN
Sleep disturbances are core symptoms of posttraumatic stress disorder (PTSD) and are often resistant to treatment. One reason for the recent use of atypical antipsychotics in PTSD appears to be their effects on sleep. Study objectives were (1) to evaluate preliminarily the sleep effects of adjunctive risperidone, and (2) to evaluate the use of sleep diaries versus the more standard retrospective sleep assessments. This was a pilot, open-label, 12-week, flexible-dose trial of adjunctive risperidone in male veterans with a primary diagnosis of chronic, combat-related PTSD, partially responsive to current medications. Diagnostic interviews were administered at baseline, and PTSD ratings were obtained at baseline and at 6 and 12 weeks. Self-report sleep measures, including morning logs, were obtained at baseline and 6 weeks. Seventeen patients completed at least 6 weeks of the trial. Global ratings of sleep disturbance improved. Changes in frequency of awakenings and reductions in trauma-related dreams were only evident via morning log assessments. Nighttime awakening frequency derived from the sleep logs but not from the Pittsburgh Sleep Quality Index (PSQI) decreased significantly. There were no changes in the PSQI nightmare item; however, sleep log data indicated a reduced proportion of traumatic dreams at 6 weeks. Preliminary results suggest that adjunctive risperidone may benefit sleep disturbances associated with chronic PTSD. Prospective logs may be more sensitive to change than are retrospective scales.
Asunto(s)
Antipsicóticos/uso terapéutico , Trastornos de Combate/tratamiento farmacológico , Disomnias/tratamiento farmacológico , Risperidona/uso terapéutico , Veteranos/psicología , Anciano , Antipsicóticos/efectos adversos , Enfermedad Crónica , Trastornos de Combate/diagnóstico , Trastornos de Combate/psicología , Quimioterapia Combinada , Disomnias/diagnóstico , Disomnias/psicología , Humanos , Masculino , Registros Médicos , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Estudios Retrospectivos , Risperidona/efectos adversos , VietnamAsunto(s)
Antipsicóticos/uso terapéutico , Trastornos de Combate/tratamiento farmacológico , Risperidona/uso terapéutico , Veteranos/psicología , Antipsicóticos/efectos adversos , Enfermedad Crónica , Trastornos de Combate/diagnóstico , Trastornos de Combate/psicología , Quimioterapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Risperidona/efectos adversos , Resultado del Tratamiento , VietnamRESUMEN
Posttraumatic stress disorder (PTSD) is associated with high rates of medical service use and with self-reported poor health. Male veterans admitted to a rehabilitation unit for PTSD (N=55) or alcohol dependence (N=38) were evaluated for comorbid psychiatric and medical conditions and health risk factors. Patients with PTSD were more likely to have osteoarthritis, diabetes, heart disease, comorbid depression, obesity, and elevated lipid levels. These findings suggest that there may be a relationship between specific medical conditions, possibly mediated by behavioral risk factors, among the aging population of veterans with PTSD.