Why Patients Choose Psychotherapy or Sertraline: From a Clinical Trial of PTSD Treatment

Stephanie Keller, MA
Doctoral Candidate; Department of Psychological Sciences, Case Western Reserve University, OH

First published in Psychiatry Weekly, October 21, 2013, 8(22).

Introduction

Why do some psychiatric patients prefer a particular treatment modality—or modalities—to another? This question is particularly conspicuous in the context of treating posttraumatic stress disorder (PTSD), for which several psychotherapy protocols show robust evidence of efficacy and exactly two medications—sertraline and paroxetine—have received FDA approval. Numerous lines of research have looked at whether patient preferences for PTSD treatment are shaped by the type of trauma experienced, ethnicity, sex, psychiatric comorbidity, previous PTSD treatment, and perceptions of how or why a treatment is believed to work.

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Abstract: Objective: We describe risk factors associated with patients experiencing physical restraint or seclusion in the psychiatric emergency service (PES).Methods: We retrospectively reviewed medical records, nursing logs and quality assurance data for all adult patient encounters in a PES over a 12-month period (June 1, 2011–May 31, 2012). Descriptors included demographic characteristics, diagnoses, laboratory values, and clinician ratings of symptom severity. ?2 and multivariate logistic regression analyses were performed.Results: Restraint/seclusion occurred in 14% of 5335 patient encounters

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Importance Although abuse of prescription opioids (POs) is a significant public health problem, few experimental studies have investigated the treatment needs of this growing population. Objective To evaluate, following brief stabilization with a combination of buprenorphine hydrochloride and naloxone hydrochloride dihydrate, the relative efficacy of 1-, 2-, and 4-week buprenorphine tapering regimens and subsequent naltrexone hydrochloride therapy in PO-dependent outpatients. Design, Setting, and Participants A double-blind, 12-week randomized clinical trial was conducted in an outpatient research clinic

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Abstract: Objective: To examine aptitude–treatment interaction (ATI) effects in cancer patients receiving psychooncological interventions (POIs).Method: N=36 cancer patients were treated with POI. Hierarchical linear regression was used to test two interaction effects between patient baseline characteristics (aptitudes) and process analyses of therapy sessions (treatment) on change in mental health during POI.Results: Patients with high emotional distress did best when their therapy reduced arousal, and patients with lower emotional distress benefited most if therapists emphasized arousal induction.

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Abstract: Hashimoto’s thyroiditis (HT) is an autoimmune thyroiditis that occurs frequently in middle-aged women. To date, there is no formally reported association between acute mania and hypothyroidism due to HT. We report a case of acute mania associated with hypothyroidism resulting from HT.

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Abstract: Objective: Premenstrual onset psychosis is a rare condition of unknown etiology for which no treatment trials have been conducted and whose existence as a definitive diagnosis continues to be debated. The literature includes individual case reports and small case series, leaving psychiatrists to make decisions about prescribing antipsychotic agents on a case-by-case basis.

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Abstract: Piracetam is a cognitive-enhancing agent that is used for the treatment of cognitive impairments of various etiologies. Little is known about its side effect profile, especially in those with psychiatric illness. We herewith present two cases with cognitive impairment who had contrasting responses to piracetam

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Abstract: Objective: The objective was to report a case of experienced psychosis during the treatment with methylphenidate (MPH) in a cocaine-dependent adult treated for attention-deficit/hyperactivity disorder (ADHD) with comorbid cocaine dependence.Conclusion: ADHD is a frequent comorbidity in substance use disorder (SUD) patients. MPH may be effective in treating ADHD symptoms in SUD patients, thus preventing possible adverse outcomes. Cocaine-induced psychosis may be a risk factor for development of psychosis in the presence of a concurrent treatment with MPH.

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Importance Posttraumatic stress disorder (PTSD) is a pervasive and often debilitating condition that affects many individuals in the general population and military service members. Effective treatments for PTSD are greatly needed for both veterans returning from Iraq and Afghanistan and veterans of other eras.

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June 3 marked the first White House Conference on Mental Health in 14 years. President Obama opened the event by describing how many people “suffer in silence” rather than seeking help: Source: WhiteHouse.gov We see it in the veterans who come home from the battlefield with invisible wounds of war, but who feel like seeking treatment is somehow a sign of weakness – when, in fact, it’s a sign of strength. We see it in the parents who would do anything for their kids, but who often fight their mental health battle alone – afraid that reaching out would invite judgment or reflect badly on them.

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