Disorders - Post Traumatic Stress Disorder
Peltonen, K., Punamaki, R. L.
Increasing research is available on the preconditions for child mental health and optimal development in traumatic conditions, whereas less is known how to translate the findings into effective interventions to help traumatized children. This literature review analyses the effectiveness of psychosocial preventive interventions and treatments and their theoretical bases among children traumatized in the context of armed conflicts (war, military violence, terrorism and refugee). The first aim is to evaluate the effectiveness of preventive interventions in preventing emotional distress and impairment and promoting optimal emotionalcognitive and social development. The second task is to analyze the nature of the underlying mechanisms for the success of preventive interventions, and the theoretical premises of the choice of intervention techniques, procedures and tools. We found 16 relevant published studies, but an examination of them revealed that only four of them had experimental designs strong enough that they could be included in the meta-analysis. While the subjective reports of the researchers suggested that systematic preventive interventions were effective in decreasing PTSD and depressive symptoms among children traumatized due to armed conflict, the more objective results of the meta-analysis and the weaknesses in designs uncovered during the meta-analysis undermine such a conclusion. Additionally, a majority of the reported preventive interventions focused only on children's biased cognitive processes and negative emotions, while only a few aimed at influencing multiple domains of child development and improving developmental functioning on emotional, social and psychophysiological levels. It is concluded that substantial additional work needs to be done in developing effective preventive interventions and treatments for children traumatized by exposure to war and violence. Aggr. Behav. 36:95-116, 2010. (copyright) 2009 Wiley-Liss, Inc.
Aggressive Behavior, 36(2) : 95-116
- Year: 2010
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Stamatakos, M., Campo, J. V.
Purpose of Review: To review and summarize existing literature regarding pharmacological interventions for post-traumatic stress disorder (PTSD) in children and adolescents. A literature search limited to articles focused on the pharmacological treatment of children aged 0-18 years with a history of trauma and/or PTSD was conducted through the National Library of Medicine and PsychInfo, 1967-present, and each citation manually reviewed. Recent Finddings: Pharmacologic trials for pediatric PTSD are limited in scope and number, with one small double-blind, randomized controlled trial of the selective serotonin reuptake inhibitor (SSRI) sertraline. Two brief, small, double-blind, randomized controlled trials of imipramine for children and adolescents with acute stress disorder have been conducted, with mixed results. Only case reports or open-labeled trials have been conducted with alpha-adrenergic agents, other antidepressants, atypical antipsychotics, and antiepileptic agents. Summary: Data supporting the use of medications in the treatment of PTSD in children and adolescents are limited. SSRIs show promise and deserve additional study, but conclusive support for their use is not available as it is in adults. Additional research is needed, with other drugs of interest including other antidepressants, alpha-adrenergic agents, and possibly the antiepileptic agent carbamazepine. (copyright) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Current Opinion in Pediatrics, 22(5) : 599-604
- Year: 2010
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
Hetrick, SE., Purcell, R., Garner, B., Parslow, R.
Background: PTSD is an anxiety disorder related to exposure to a severe psychological trauma. Symptoms include re-experiencing the event, avoidance and arousal as well as distress and impairment resulting from these symptoms.Guidelines suggest a combination of both psychological therapy and pharmacotherapy may enhance treatment response, especially in those with more severe PTSD or in those who have not responded to either intervention alone.Objectives: To assess whether the combination of psychological therapy and pharmacotherapy provides a more efficacious treatment for PTSD than either of these interventions delivered separately.Search methods: Searches were conducted on the trial registers kept by the CCDAN group (CCDANCTR-Studies and CCDANCTR-References) to June 2010. The reference sections of included studies and several conference abstracts were also scanned.Selection criteria: Patients of any age or gender, with chronic or recent onset PTSD arising from any type of event relevant to the diagnostic criteria were included. A combination of any psychological therapy and pharmacotherapy was included and compared to wait list, placebo, standard treatment or either intervention alone. The primary outcome was change in total PTSD symptom severity. Other outcomes included changes in functioning, depression and anxiety symptoms, suicide attempts, substance use, withdrawal and cost.Data collection and analysis: Two or three review authors independently selected trials, assessed their 'risk of bias' and extracted trial and outcome data. We used a fixed-effect model for meta-analysis. The relative risk was used to summarise dichotomous outcomes and the mean difference and standardised mean difference were used to summarise continuous measures.Main results: Four trials were eligible for inclusion, one of these trials (n =24) was on children and adolescents. All used an SSRI and prolonged exposure or a cognitive behavioural intervention. Two trials compared combination treatment with pharmacological treatment and two compared combination treatment with psychological treatment. Only two trials reported a total PTSD symptom score and these data could not be combined. There was no strong evidence to show if there were differences between the group receiving combined interventions compared to the group receiving psychological therapy (mean difference 2.44, 95% CI -2.87, 7.35 one study, n=65) or pharmacotherapy (mean difference -4.70, 95% CI -10.84 to 1.44; one study, n = 25). Trialists reported no significant differences between combination and single intervention groups in the other two studies. There were very little data reported for other outcomes, and in no case were significant differences reported.Authors' conclusions: There is not enough evidence available to support or refute the effectiveness of combined psychological therapy and pharmacotherapy compared to either of these interventions alone. Further large randomised controlled trials are urgently required.
Cochrane Database of Systematic Reviews, (7) : CD7316
- Year: 2010
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
Huemer, J., Erhart, F., Steiner, H.
PTSD in children and adolescents differs from the adult disease. Therapeutic approaches involve both psychotherapy and psychopharmacotherapy. OBJECTIVES: The current paper aims at reviewing studies on psychopharmacological treatment of childhood and adolescent PTSD. Additionally, developmental frameworks for PTSD diagnosis and research along with an experimental model of quenching and kindling in the context of stress exposure are presented. We conducted an extensive literature search of reviews on psychopharmacotherapy as well as studies on psychopharmacological treatment for PTSD among children and adolescents. We used the database PubMed and focused on the time period of the last 10 years up to January 2009. Pertinent earlier papers were also included.There are a limited number of studies specifically assessing the psychopharmacological treatment of PTSD in children and adolescents. The vast majority of them lack verification in RCTs. Only the use of imipramine, divalproex sodium and sertraline were already evaluated in RCTs. Future studies should take into account developmental approaches to the diagnosis and treatment of PTSD in children and adolescents. In this context, different underlying neurobiological patterns, which are reflected in distinct clinical symptomatology, require a precise investigation and a symptom-orientated psychopharmacological approach.
Child Psychiatry & Human Development, 41(6) : 624-640
- Year: 2010
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
Gilboa-Schechtman, E., Foa, E. B., Shafran, N., Aderka, I. M., Powers, M. B., Rachamim, L., Rosenbach, L., Yadin, E., Apter, A.
Objective To examine the efficacy and maintenance of developmentally adapted prolonged exposure therapy for adolescents (PE-A) compared with active control time-limited dynamic therapy (TLDP-A) for decreasing posttraumatic and depressive symptoms in adolescent victims of single-event traumas. Method Thirty-eight adolescents (12 to 18 years old) were randomly assigned to receive PE-A or TLDP-A. Results Both treatments resulted in decreased posttraumatic stress disorder and depression and increased functioning. PE-A exhibited a greater decrease of posttraumatic stress disorder and depression symptom severity and a greater increase in global functioning than did TDLP-A. After treatment, 68.4% of adolescents beginning treatment with PE-A and 36.8% of those beginning treatment with TLDP-A no longer met diagnostic criteria for posttraumatic stress disorder. Treatment gains were maintained at 6- and 17-month follow-ups. Conclusions Brief individual therapy is effective in decreasing posttraumatic distress and behavioral trauma-focused components enhance efficacy. Clinical trial registry information Prolonged Exposure Therapy Versus Active Psychotherapy in Treating Post-Traumatic Stress Disorder in Adolescents, URL: http://clinicaltrials.gov, unique identifier: NCT00183690. (copyright) 2010 American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 49(10) : 1034-1042
- Year: 2010
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Psychodynamic/Psychoanalysis
Kemp, M., Drummond, P., McDermott, B.
The present study investigated the efficacy of four EMDR sessions in comparison to a six-week wait-list control condition in the treatment of 27 children (aged 6 to 12 years) suffering from persistent PTSD symptoms after a motor vehicle accident. An effect for EMDR was identified on primary outcome and process measures including the Child Post-Traumatic Stress-Reaction Index, clinician rated diagnostic criteria for PTSD, Subjective Units of Disturbance and Validity of Cognition scales. All participants initially met two or more PTSD criteria. After EMDR treatment, this decreased to 25% in the EMDR group but remained at 100% in the wait-list group. Parent ratings of their child's PTSD symptoms showed no improvement, nor did a range of non-trauma child self-report and parent-reported symptoms. Treatment gains were maintained at three and 12 month follow-up. These findings support the use of EMDR for treating symptoms of PTSD in children, although further replication and comparison studies are required.
Clinical Child Psychology & Psychiatry, 15(1) : 5-25
- Year: 2010
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Eye movement desensitisation and reprocessing (EMDR)
Cohen, J. A., Bukstein, O., Walter, H., Benson, R. S., Chrisman, A., Farchione, T. R., Hamilton, J., et-al
This Practice Parameter reviews the evidence from research and clinical experience and highlights significant advances in the assessment and treatment of posttraumatic stress disorder since the previous Parameter was published in 1998. It highlights the importance of early identification of posttraumatic stress disorder, the importance of gathering information from parents and children, and the assessment and treatment of comorbid disorders. It presents evidence to support trauma-focused psychotherapy, medications, and a combination of interventions in a multimodal approach. (copyright) 2010 American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 49(4) : 414-430
- Year: 2010
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Catani, C., Mahendran, K., Ruf, M., Schauer, E., Elbert, T., Neuner, F.
Background: The North-Eastern part of Sri Lanka had already been affected by civil war when the 2004 Tsunami wave hit the region, leading to high rates of posttraumatic stress disorder (PTSD) in children. In the acute aftermath of the Tsunami we tested the efficacy of two pragmatic short-term interventions when applied by trained local counselors. Methods: A randomized treatment comparison was implemented in a refugee camp in a severely affected community. 31 children who presented with a preliminary diagnosis of PTSD were randomly assigned either to six sessions Narrative Exposure Therapy for children (KIDNET) or six sessions of meditation-relaxation (MED-RELAX). Outcome measures included severity of PTSD symptoms, level of functioning and physical health. Results: In both treatment conditions, PTSD symptoms and impairment in functioning were significantly reduced at one month post-test and remained stable over time. At 6 months follow-up, recovery rates were 81% for the children in the KIDNET group and 71% for those in the MED-RELAX group. There was no significant difference between the two therapy groups in any outcome measure. Conclusion: As recovery rates inthe treatment groups exceeded the expected rates of natural recovery, the study provides preliminary evidence for the effectiveness of NET as well as meditation-relaxation techniques when carried out by trained local counselors for the treatment of PTSD in children in the direct aftermath of mass disasters. (copyright) 2009 Catani et al; licensee BioMed Central Ltd.
BMC Psychiatry, 9 :
- Year: 2009
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Narrative exposure therapy (NET)
, Meditation
, Relaxation
Berger, R., Gelkopf, M.
Background: On December 26, 2004, a tsunami hit the southern coast of Sri Lanka, leaving thousands dead and injured. Previous research has found significant mental health problems among children exposed to major disasters. School-based universal interventions have shown promise in alleviating distress and posttraumatic symptomatology in children and adolescents. This study evaluated the efficacy of a school-based intervention in reducing stress-related symptomatology among Sri Lankan children exposed to the tsunami. Methods: In a quasi-randomized controlled trial 166 elementary school students (ages 9-15) with significant levels of tsunami exposure and previous traumatic background were randomly assigned to a 12-session structured program 'ERASE Stress Sri Lanka' (ES-SL) or to a waiting list (WL) religious class control group. Students were assessed 1 week prior and 3 months after the intervention on measures of posttraumatic symptomatology [including posttraumatic stress disorder (PTSD) and severity of posttraumatic symptomatology], depression, functional problems, somatic problems and hope. Results: This study shows a significant reduction on all outcome variables. PTSD severity, functional problems, somatic complaints, depression and hope scores were all significantly improved in the ES-SL group compared to the WL group. No new cases of PTSD were observed in the experimental group. Conclusion: This study adds to the growing body of evidence suggesting the efficacy of school-based universal approaches in helping children in regions touched by war, terror and disaster and suggests the need to adopt a two-stage approach toward dealing with trauma-exposed students, namely, starting with a universal intervention followed by targeted specialized interventions for those still suffering from posttraumatic distress. Copyright (copyright) 2009 S. Karger AG.
Psychotherapy & Psychosomatics, 78(6) : 364-371
- Year: 2009
- Problem: Post Traumatic Stress Disorder
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Psychoeducation, Skills training, Other Psychological Interventions, Physical activity, exercise, Other complementary & alternative interventions
Hasanovic, M., Srabovic, S., Rasidovic, M., Sehovic, M., Hasanbasic, E., Husanovic, J., Hodzic, R.
Background: The 1992-1995 war in Bosnia and Herzegovina (BH) has had a tremendous impact on civilians; thousands of inhabitants were left with numerous traumatic experiences. Many children suffered or witnessed horrifying acts of violence and aggression. Although young trauma victims are often resilient, many experience mental health difficulties, including PTSD. The aim of the study was to estimate whether psychosocial support given by the School Project of Humanitarian Association of " Prijateljice" reduced posttraumatic consequences in students in primary and secondary schools in Bosnia and Herzegovina after 1992-1995 war. Subjects and methods: A stratified sample of 336 students in primary and secondary schools located in two entities of North-East Bosnia and Herzegovina, involved in psychosocial support, was compared with 72 voluntarily selected same-age students from the same schools who were not involved in this project. Data were collected on two occasions, beginning of December 2005 and end of May 2006, by using a self-evaluation survey method for measuring symptoms of posttraumatic stress disorder (PTSD) according to DSM IV. The Index of Children Post-traumatic reactions were used. Results: The severity of PTSD symptoms among students involved in the School Project decreased from (mean(plus or minus)standard deviation=35.3(plus or minus)10.2 to 26.7(plus or minus)8.7) (t=13.1, P<0.001, Paired sample test), whereas in the group with no psychosocial assistance this reduction was from (29.7(plus or minus)10.9 to 28.1(plus or minus)1.8) (t=0.9, P=0.396, Paired sample test). Conclusion: This study suggests that work with students by giving them psychosocial support within the School Project resulted in significant reduction of PTSD symptoms' severity. (copyright) Medicinska naklada.
Psychiatria Danubina, 21(4) : 463-473
- Year: 2009
- Problem: Post Traumatic Stress Disorder
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Gelkopf, M., Berger, R.
BACKGROUND: Since September 2000 Israeli children have been exposed to a large number of terrorist attacks. A universal, school-based intervention for dealing with the threat of terrorism as well as with terror-related symptoms, ERASE-Stress (ES), was evaluated in a male religious middle school in southern Israel. The program was administered by the homeroom teachers as part of the school curriculum. It consists of 12 classroom sessions each lasting 90 minutes, and included psycho-educational material, skill training and resiliency strategies delivered to the students by homeroom teachers. METHODS: One hundred and fourteen 7th and 8th grade students were randomly assigned to the ES intervention or were part of a waiting list (WL). They were assessed on measures of posttraumatic symptomatology, depression, somatic symptoms and functional problems before and 3 months after the intervention or the WL period. RESULTS: Three months after the program ended, students in the experimental group showed significant reduction in all measures compared to the waiting-list control group. CONCLUSIONS: The ERASE-Stress program may help students suffering from terror-related posttraumatic symptoms and mitigate the negative effects of future traumatic experiences. Furthermore, a school-based universal program such as the ERASE-Stress may potentially serve as an important and effective component of a community mental health policy for communities affected by terrorism.
Journal of Child Psychology & Psychiatry & Allied Disciplines, 50(8) : 962-971
- Year: 2009
- Problem: Post Traumatic Stress Disorder
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Skills training, Other Psychological Interventions
Jordans, M. J. D., Tol, W. A., Komproe, I. H., DeJong, J. V. T. M.
Background: There is a growing body of literature on interventions addressing psychosocial wellbeing and mental health of children affected by violence in low- and middle-income countries. Method: This systematic review of PubMed, PsychINFO, and PILOTS identified 500 publications (1991-2008) on interventions. Results: Sixty-six publications (12 treatment outcome studies and 54 intervention descriptions, covering a range of treatment modalities) met inclusion criteria. Most interventions are evaluated positively, while some studies lack evidence for efficacy and effectiveness. Conclusions: Scarcity of rigorous studies, diversity of interventions, and mixed results of evaluations demonstrate a need to identify evidence-based interventions. The literature presents consensus on a number of treatment-related issues, yet the application remains limited across interventions. (copyright) 2009 The Author. Journal compilation (copyright) 2009 Association for Child and Adolescent Mental Health.
Child & Adolescent Mental Health, 14(1) : 2-14
- Year: 2009
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)