Nightmares and PTSD

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The Use of a Synthetic Cannabinoid in the Management of Treatment-Resistant Nightmares in Posttraumatic Stress Disorder (PTSD)

The Use of a Synthetic Cannabinoid in the Management of Treatment-Resistant Nightmares in Posttraumatic Stress Disorder (PTSD)

Sleep disturbances, mainly insomnia and nightmares, are present in about 70% of those with PTSD. The esti- mates of nightmares vary from 24.8% [6] to 60.0% [7]. Various medications have been used in attempts to control PTSD sleep disturbances, including nightmares. A review of the abovementioned classes of medications, as well as other specific agents such as clonidine and cypro- heptadine, concludes, “to date an insufficient number of controlled studies are published to formulate evidence- based guidelines. Drawing on the available data it can be concluded that there is limited but promising evidence for prazosin and olanzapine for managing PTSD night- mares and insomnia” [8]. That article also points out that objective parameters for insomnia and nightmares need to be developed. The fact that so many agents have been used in attempts to manage nightmares highlights that management of these is difficult, and that there is room to explore other potentially useful classes of medi- cations. Anecdotal reports of relief from psychiatric symp- toms, with the use of marijuana or a pharmaceutical en- docannabinoid receptor agonist, have created interest in investigating the role of the endocannabinoid system in PTSD and other mood disorders [5]. The endocannabi- noid system has been implicated in the control of vari- ous behaviors including eating, addiction, and memory and in mediating both anxiolytic effects and pain re- sponses [6–8]. Endocannabinoids are thought to exert an effect through a variety of interactions with the CNS re- lated to PTSD. These include the hypothalamic–pituitary–
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Combat-Related PTSD Nightmares and Imagery Rehearsal: Nightmare Characteristics and Relation to Treatment Outcome

Combat-Related PTSD Nightmares and Imagery Rehearsal: Nightmare Characteristics and Relation to Treatment Outcome

Documenting the characteristics of recurrent nightmares in veterans with severe chronic PTSD adds to a theoretical under- standing of nightmares following trauma and suggests ways to improve their treatment. Our participants’ nightmares likely differed from the dreams targeted in some previous trials of Imagery Rehearsal. Other investigations included civilian survivors, who reportedly have less replicative dreams (e.g., only 21% of civilians in Davis et al., 2007); participants with subsyndromal PTSD; and some with dreams unrelated to a trauma (Davis & Wright, 2007; Krakow et al., 2001). In addi- tion, in some variations of Imagery Rehearsal, patients are in- structed to select a nonreplicative and less severe target dream, whereas we left the choice of nightmare to the veteran. It is possible that the different types of nightmares participants present with may be one variable explaining divergent treatment outcomes.
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Nightmares and Suicide

Nightmares and Suicide

The presence of nightmares before the trauma increases the likelihood of developing PTSD (Mellman, David, & Kulick-Bell, 1995) Presence of nightmares after trauma is associated with more severe PTSD (Mellman, David, Bustamente, Torres & Fins, 2001)

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Nightmares are typically defined as extremely frightening

Nightmares are typically defined as extremely frightening

Moreover, the effects of exposure have been demonstrated by might have been a result of a power issue as Spoormaker and van den Bout 27 would have needed an intervention group of n = 22 to pick up the difference in effect found for PTSD. The same applies to Neidhardt et al, 23 in which a sample size of 58 (SCL-90) 40 or 61 (SQ) 41 would have been needed per group to achieve adequate power to find this effect size. For the follow- up study, 35 17 participants were needed to significantly find the difference of d = 0.7. Burgess et al. 24 had enough power to de- termine effect sizes as small as d = 0.4.
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A comparison of PTSD and subthreshold PTSD symptom network structures

A comparison of PTSD and subthreshold PTSD symptom network structures

51 Figure 1a. Full Sample Network. Note: Blue nodes represent Criterion B “intrusive recollections;” Green nodes represent Criterion C “avoidant/numbing symptoms;” Red nodes represent Criterion D “hyper-arousal symptoms.” Node abbreviations are as follows: mem = intrusive memories; drm = nightmares; fls = flashbacks; ups = feeling upset in response to trauma reminders; phy = physiological reactivity to trauma reminders; avt = avoidance of thoughts and/or feelings about the trauma; avp = avoidance of people or places reminiscent of the trauma; amn = trouble remembering parts of the traumatic experience; lss = loss of interest in previously enjoyed activities; dst = feeling distant from people; nmb = feeling emotionally numb; ftr = future foreshortening;
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Eft for Ptsd

Eft for Ptsd

In an hour and a half, this young man went from being totally withdrawn with a stone-faced stare to an open, friendly young guy able to relate and talk to everyone at the retreat. That first night Carlin only had one drink and one cigarette with his friends, and then he slept through the night without any nightmares – an incredible improvement for him. In the days ahead we kept working on his war memories with EFT, and he continued to improve emotionally and physically. When he returned home, he had a short-term relapse and started drinking again in response to unresolved feelings around his friendships and his father. These challenges had nothing to do with the war or the war memories we had neutralized. The war memories no longer haunted him, in spite of all the tragedy he witnessed. Carlin continues to use EFT and has been enthusiastically introducing EFT to other veterans in his area as well as to family members. How is it that EFT can be so effective so quickly? And how can its results last so long? I believe that with EFT we are rewiring or re-integrating the person’s sensory memories and traumas so they are no longer compartmentalized into small fragments that haunt and threaten the person . EFT allows us to discharge the original and once useful and protective “freeze response” so that pieces of the trauma no longer take up valuable emotional energy. Once the memories and sensations from the trauma are integrated fully into consciousness by using EFT, the client no longer needs to be hyper vigilant to protect from the next possible attack. The trauma has been processed fully, on all levels, leaving room for normal every day thoughts and activities.
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PTSD and Sleep

PTSD and Sleep

fully understood. A complex interplay between sleep fragmentation and neuroendocrine pathways is suggested. The overlap of symptoms between PTSD and SDB raises diagnostic challenges that may require a novel approach in the methods used to diagnose the coexisting disorders. Similar therapeutic challenges face patients and providers when treating concomitant PTSD and SDB. Although continuous positive airway pressure therapy imparts a mitigating effect on PTSD symptomatology, lack of both acceptance and adherence are common. Future research should focus on ways to improve adherence to continuous positive airway pressure therapy and on the use of alternative therapeutic methods for treating SDB in patients with PTSD. Krakow, B., Hollifield, M., Johnston, L., Koss, M., Schrader, R., Warner, T. D., . . . Prince, H. (2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized controlled trial. Journal of the American Medical Association, 286, 537-545. doi:10.1001/jama.286.5.537 Context: Chronic nightmares occur frequently in patients with posttraumatic stress disorder (PTSD) but are not usually a primary target of treatment. Objective: To determine if treating chronic nightmares with imagery rehearsal therapy (IRT) reduces the frequency of disturbing dreams, improves sleep quality, and decreases PTSD symptom severity. Design, Setting, and Participants: Randomized controlled trial conducted from 1995 to 1999 among 168 women in New Mexico; 95% had moderate-to- severe PTSD, 97% had experienced rape or other sexual assault, 77% reported life-threatening sexual assault, and 58% reported repeated exposure to sexual abuse in childhood or adolescence. Intervention: Participants were randomized to receive treatment (n = 88) or to the wait-list control group (n = 80). The treatment group received IRT in 3 sessions; controls received no additional intervention, but continued
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How To Test Prazosin For Trauma Nightmares In Veterans

How To Test Prazosin For Trauma Nightmares In Veterans

Secondary outcome measures included the total 17-item CAPS score, the Nightmare Frequency Questionnaire-Revised (NFQ) (Krakow et al. 2002), the PTSD Dream Rating Scale (PDRS) (Esposito et al. 1999), and the Hamilton Depression Rating Scale (HAM-D) (Hamilton 1960). The 17-item CAPS uses a structured interview to rate all the symptoms of PTSD described in the DSM-IV on both frequency and intensity dimensions. The NFQ is an interviewer administered instrument that uses four scales differentially to quantify those nightmares and unpleasant dreams specifically with military trauma content as well as total nightmares and unpleasant dreams regardless of content. The PDRS is an interviewer administered instrument assessing patho- logic content of dreams associated with combat-related trauma. It assesses constructs and characteristics derived from empirically based dream content analyses. Characteristics consistent with combat trauma-related dreams such as settings, characters and objects similar to traumatic experience, high threat, low contem- poraneity and low distortion are given higher scores. The HAM-D is a 17-item interviewer rated scale for depression that assesses somatic symptoms, insomnia, mood, working capacity and inter- ests, psychomotor retardation, agitation and anxiety.
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Nightmares: from anxiety symptom to sleep disorder

Nightmares: from anxiety symptom to sleep disorder

This latter finding, however, was not replicated by a recent study 48 that compared these two types of nightmares and included a healthy control group as well. The three groups did not differ on any of these measures: total sleeping time, sleep-onset latency, REM latency, REM efficiency, REM density, REM percentage, SWS percentage, and the number of micro-arousals. Yet, both types of nightmares were associated with an elevated number of periodic limb movements. Persons with posttrau- matic nightmares experienced more and longer nocturnal awakenings—and thus a lower sleep efficiency—than persons with idiopathic nightmares and the control group. Insomnia seems to be related to posttraumatic nightmares in particular, and might (partly) be a function of a process caused by posttraumatic stress. It has often been suggested that a lowered arousal threshold characterizes sleep in PTSD, 13,40,48 although other studies have found an increased arousal threshold. 51,52
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POST-TRAUMATIC STRESS DISORDER PTSD Diagnostic Criteria PTSD Detection and Diagnosis PC-PTSD Screen PCL-C Screen PTSD Treatment Treatment Algorithm

POST-TRAUMATIC STRESS DISORDER PTSD Diagnostic Criteria PTSD Detection and Diagnosis PC-PTSD Screen PCL-C Screen PTSD Treatment Treatment Algorithm

Tricyclic antidepressants may help reduce symptoms of re-experiencing trauma but evidence of their effectiveness is mixed. Monoamine oxidase inhibitors such as phenelzine (Nardil) lead to moderate to good improvement in re-experiencing and avoidance symptoms and may reduce frequency of nightmares; these drugs may put patients with tyramine in their diet at risk for hypertensive crisis.

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Post-traumatic stress disorder (PTSD): the treatment of PTSD in adults and children

Post-traumatic stress disorder (PTSD): the treatment of PTSD in adults and children

‘flashbacks’ or nightmares, which can be very distressing and disorientating. There can also be physical reactions, such as shaking and sweating. Because the memory can be very intense and upsetting, some PTSD sufferers may avoid people or situations that remind them of the trauma, or try to ignore the memories and avoid talking about the event. Some people may also forget significant parts of the traumatic event. Other people will think about the event constantly, which stops them coming to terms with it (they may, for instance, ask themselves why the event happened to them or how it could have been prevented).
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Insomnia symptoms, nightmares and suicidal ideation in a university sample

Insomnia symptoms, nightmares and suicidal ideation in a university sample

There is promising research showing that insomnia and nightmares may both be related to suicidal ideation, but few studies have assessed whether these relations remain after controlling for related mental disorders such as depression, anxiety, and PTSD. Determining whether the effects of insomnia and nightmares explain suicidal thoughts and behaviors beyond mental disorders such as depression, anxiety, and PTSD is an important part of determining whether insomnia and nightmares should be considered risk-factors for suicide. Additionally, since insomnia symptoms may be influenced by nightmares, and vice versa, insomnia symptoms and nightmares must each be shown to be related to suicidal ideation independent of one another to be considered a risk-factor. If insomnia symptoms and nightmares are related to suicide
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Treatment of nightmares with prazosin

Treatment of nightmares with prazosin

Five patients experienced rapid return of distressing nightmares during post-. prazosin washout, with four discontinuing the study for open-label prazosin[r]

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Call of Cthulhu Jovian Nightmares CH0367

Call of Cthulhu Jovian Nightmares CH0367

Set in its entirety onboard the Jovian Discoverer IV, an orbital gas-mining platform (or ‘rig’) in Jupiter orbit, the adventure assumes that the Investigators are all convict-workers [r]

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Page 101. deadly nightmares of the obstetrician.

Page 101. deadly nightmares of the obstetrician.

This case points out the necessity of an early first trimester scan for the diagnosis of pregnancy, to determine the exact location of pregnancy, especially in developing countries l[r]

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REFRACTIVE SURGERY NIGHTMARES Dr.ATHIYA AGARWAL

REFRACTIVE SURGERY NIGHTMARES Dr.ATHIYA AGARWAL

The ASCRS White Paper recommends elevation of the flap, culture, and irrigation of the stromal bed with antibiotic solution (fortified vancomycin 50 mg/mL for rap[r]

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Kitchen Nightmares Usa Episode Guide

Kitchen Nightmares Usa Episode Guide

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PTSD 101: 2010 VA/DoD Clinical Practice Guideline for PTSD: Anger, Aggression, and PTSD

PTSD 101: 2010 VA/DoD Clinical Practice Guideline for PTSD: Anger, Aggression, and PTSD

Place Your computer work station Purpose Statement This web based course is part of the PTSD 101 education series which are presented by experts in their field to increase provider knowledge related to the assessment and treatment issues of Post-Traumatic Stress Disorder (PTSD). PTSD is one of the major disorders seen in Veterans; however, there is a disparity in respect to

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PTSD Check.pdf

PTSD Check.pdf

event check one or more of the boxes to the right to indicate that: (a) it happened to you personally; (b) you witnessed it happen to someone else; (c) you learned about it happening to[r]

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PTSD and Suicide

PTSD and Suicide

Conversely, studies that documented a protective effect either adjusted for psychiatric comorbidity statistically or examined study populations with high levels of psychopathology. While it is hard to imagine that PTSD actually protects individuals from death from suicide, it is possible that such findings were the result of methodological choices or biases. For example, depression and its symptoms frequently co-occur with PTSD. In samples with high levels of comorbid PTSD and depression statistical adjustment for depression would obscure the part of the effect of PTSD on suicide that is due to this comorbidity. This adjustment would drive observed associations towards the null (e.g., that PTSD has no effect on death by suicide) and perhaps beyond it to demonstrate a protective effect. In fact, when strictly adhering to traditional epidemiologic methods, adjustment for a variable that is on the “causal pathway” between a predictor of interest and an outcome (i.e., PTSD -> Depression -> Suicide) is not recommended because these variables are thought to play an etiologically important role that is worthy of description rather than adjustment. In addition, in studies conducted entirely among samples with psychopathology (e.g., patients with depression or patients discharged from inpatient units), numerically smaller effects may be observed due to the use of a very high-risk study population. In these studies, the risk of suicide conferred by PTSD may not be enough to demonstrate an increased association, when compared to the very elevated suicide risk among a reference group with depression and/or other forms of psychopathology. The use of a high-risk reference group could make ratio measures of effect appear null or even protective if the predictor of interest has a weaker association with the outcome than the other risk factors that characterizes the study sample. Perhaps all results are evidence of different pieces of truth
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