Suchergebnisse

STUDY OBJECTIVES: To examine the efficacy of imagery rehearsal (IR) combined with cognitive behavioral therapy for insomnia (CBT-I) compared to CBT-I alone for treating recurrent nightmares in military veterans with posttraumatic stress disorder (PTSD). METHODS: In this randomized controlled study, 108 male and female United States veterans of the Iraq and Afghanistan conflicts with current, severe PTSD and recurrent, deployment-related nightmares were randomized to six sessions of IR + CBT-I (n = 55) or CBT-I (n = 53). Primary outcomes were measured with the Nightmare Frequency Questionnaire (NFQ) and Nightmare Distress Questionnaire (NDQ). RESULTS: Improvement with treatment was significant (29% with reduction in nightmare frequency and 22% with remission). Overall, IR + CBT-I was not superior to CBT-I (NFQ: −0.12; 95% confidence interval = −0.87 to 0.63; likelihood ratio chi square = 4.7(3), P = .2); NDQ: 1.5, 95% confidence interval = −1.4 to 4.4; likelihood ratio chi square = 7.3, P = .06). CONCLUSIONS: Combining IR with CBT-I conferred no advantage overall. Further research is essential to examine the possibly greater benefit of adding IR to CBT-I for some subgroups of veterans with PTSD. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Title: Cognitive Behavioral Therapy (CBT) for Nightmares in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans; Identifier: NCT00691626; URL: https://clinicaltrials.gov/ct2/show/NCT00691626 CITATION: Harb GC, Cook JM, Phelps AJ, Gehrman PR, Forbes D, Localio R, Harpaz-Rotem I, Gur RC, Ross RJ. Randomized controlled trial of imagery rehearsal for posttraumatic nightmares in combat veterans. J Clin Sleep Med. 2019;15(5):757–767.

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a research project aimed at identifying risk and protective factors for suicide and related mental health outcomes among Army Soldiers. The New Soldier Study component of Army STARRS included the assessment of a range of cognitive and emotion processing domains linked to brain systems related to suicidal behavior including PTSD, mood disorders, substance use disorders, and impulsivity. We describe the design and application of the Army STARRS neurocognitive test battery to a sample of 56,824 soldiers. We investigate its structural and concurrent validity through factor analysis and correlation of scores with demographics. We conclude that, in addition to being composed of previously well-validated measures, the Army STARRS neurocognitive battery as a whole demonstrates good psychometric properties. Correlations of scores with age and sex differences mostly replicate previously published findings, highlighting moderate to large effect sizes even within this restricted age range. Factor structures of scores conform to theoretical expectations. This neurocognitive battery provides a brief, valid measurement of neurocognition that may be helpful in predicting mental health and military performance. These measures can be integrated with neuroimaging to offer a powerful tool for assessing neurocognition in Servicemembers.

IMPORTANCE: United States government personnel experienced potential exposures to uncharacterized directional phenomena while serving in Havana, Cuba, from late 2016 through May 2018. The underlying neuroanatomical findings have not been described. OBJECTIVE: To examine potential differences in brain tissue volume, microstructure, and functional connectivity in government personnel compared with individuals not exposed to directional phenomena. DESIGN, SETTING, AND PARTICIPANTS: Forty government personnel (patients) who were potentially exposed and experienced neurological symptoms underwent evaluation at a US academic medical center from August 21, 2017, to June 8, 2018, including advanced structural and functional magnetic resonance imaging analytics. Findings were compared with imaging findings of 48 demographically similar healthy controls. EXPOSURES: Potential exposure to uncharacterized directional phenomena of unknown etiology, manifesting as pressure, vibration, or sound. MAIN OUTCOMES AND MEASURES: Potential imaging-based differences between patients and controls with regard to (1) white matter and gray matter total and regional brain volumes, (2) cerebellar tissue microstructure metrics (eg, mean diffusivity), and (3) functional connectivity in the visuospatial, auditory, and executive control subnetworks. RESULTS: Imaging studies were completed for 40 patients (mean age, 40.4 years; 23 [57.5%] men; imaging performed a median of 188 [range, 4-403] days after initial exposure) and 48 controls (mean age, 37.6 years; 33 [68.8%] men). Mean whole brain white matter volume was significantly smaller in patients compared with controls (patients: 542.22 cm(3); controls: 569.61 cm(3); difference, −27.39 [95% CI, −37.93 to −16.84] cm(3); P < .001), with no significant difference in the whole brain gray matter volume (patients: 698.55 cm(3); controls: 691.83 cm(3); difference, 6.72 [95% CI, −4.83 to 18.27] cm(3); P = .25). Among patients compared with controls, there were significantly greater ventral ...