Differentiation of depression and PTSD symptoms in combat veterans.
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Combat Disorders↗
Biomedical subjects
S P Cahill
Publications and source records attributed to S P Cahill.
Apparent symptom overreporting in combat veterans evaluated for PTSD.
Psychometric studies have consistently shown that combat veterans evaluated for posttraumatic stress disorder (PTSD) appear to overreport psychopathology as exhibited by (a) extreme and diffuse levels of psychopathology across instruments measuring different domains of mental illness, and (b) extreme elevations on the validity scale of the MMPI-MMPI-2, in a "fake-bad" direction. The phenomenon of this ubiquitous presentational style is not well understood at present. In this review we describe and delineate the assessment problem posed by this apparent symptom overreporting, and we review the literature regarding several potential explanatory factors. Finally, we address conceptual and practical issues relevant to reaching a better understanding of the phenomenon, and ultimately the clinical syndrome of combat-related PTSD, in both research and clinical settings.
Humans↗
Primary bone lymphoma (osteolymphoma).
Seventeen patients with primary lymphoma of bone are reviewed. In 15 patients treated with radical radiotherapy, local progression or recurrence occurred in four. The results support the use of radiotherapy alone, using doses of 45-50 Gy. Although small numbers prevent firm conclusions, the inclusion of the whole bone or regional nodes in the irradiated volume did not appear to improve results. Eight patients received systemic chemotherapy with no apparent improvement in rates of relapse. Two patients suffered pathological fractures after radiotherapy in the absence of recurrence at the fracture site; however, osteomyelitis, older age, Paget's disease, high-dose prednisolone and whole-bone radiotherapy may have added to the risk of fracture. Because of the many complex names and selection criteria applied to this condition, literature searching and comparison between studies was difficult. The simple term osteolymphoma is proposed, consistent with other primary bone conditions.
Adult↗
The relevance of the anxiety literature to research on eye movement desensitization.
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Anxiety Disorders↗
Flooding versus eye movement desensitization and reprocessing therapy: relative efficacy has yet to be investigated--comment on Pitman et al (1996)
Pitman et al. recently published a pair of studies on the relationship between indicators of emotional processing and outcome in flooding therapy (Compr Psychiatry 1996;37:409-416) and eye movement desensitization and reprocessing therapy (EMDR; Compr Psychiatry 1996;37:419-429). Among their conclusions, they asserted EMDR was found to be at least as effective flooding in the treatment of combat-related posttraumatic stress disorder (PTSD) and produced fewer adverse consequences. Although this research constitutes an important contribution to the literature on psychosocial treatments for PTSD, their conclusions regarding the relative effectiveness of these two treatments are unwarranted. The bases of our objections are that (1) assignment of participants to treatment conditions was nonrandom, and (2) several significant procedural differences existed between the two studies in addition to the specific treatments under investigation. These include different inclusion and exclusion criteria, the confounding of psychological treatment with psychiatric medication status, and differences in assessment procedures. Since the two treatments were not compared in a single head-to-head controlled trial, we conclude that their relative efficacy has yet to be investigated.
Cognitive Behavioral Therapy↗
Does EMDR work? And if so, why?: a critical review of controlled outcome and dismantling research.
Research on Eye Movement Desensitization and Reprocessing therapy (EMDR) was reviewed to answer the questions "Does EMDR work?" and "If so, Why?" This first question was further subdivided on the basis of the control group: (a) no-treatment (or wait list control), (b) nonvalidated treatments, and (c) other validated treatments. The evidence supports the following general conclusions: First, EMDR appears to be effective in reducing at least some indices of distress relative to no-treatment in a number of anxiety conditions, including posttraumatic stress disorder, panic disorder, and public-speaking anxiety. Second, EMDR appears at least as effective or more effective than several nonvalidated treatments (e.g., relaxation, active listening) for posttraumatic stress reactions. Third, despite statements implying the contrary, no previously published study has directly compared EMDR with an independently validated treatment for posttraumatic stress disorder (e.g., therapist-directed flooding). In the treatment of simple phobia, participant modeling has been found to be more effective than EMDR. Fourth, our review of dismantling studies reveals there is no convincing evidence that eye movements significantly contribute to treatment outcome. Recommendations regarding further research directions are provided.
Anxiety Disorders↗