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Fear May Always Be Switched
‘On’ in Veterans with PTSD
© 2013 Shutterstock.com
Chronic trauma can inflict lasting
damage to brain regions associated with
fear and anxiety. Previous imaging studies of people with posttraumatic stress
disorder (PTSD) have shown that these
brain regions can over- or underreact
in response to stressful tasks, such as
recalling a traumatic event or reacting
to a photo of
a threatening
face. In a recent
study published
in Neuroscience
Letters and presented at the
annual meeting
of the American Psychiatry Association, researchers
have explored for the first time what
happens in the brains of combat veterans with PTSD in the absence of external triggers.
Their results show that the effects of
trauma persist in certain brain regions
even when combat veterans are not engaged in cognitive or emotional tasks and
face no immediate external threats. The
findings shed light on which areas of the
brain provoke traumatic symptoms and
represent a critical step toward better diagnostics and treatments for PTSD.
The study examined “spontaneous”
or “resting” brain activity in 104 veterans of combat from the Iraq and Afghanistan wars using functional magnetic resonance imaging. The researchers
found that spontaneous brain activity
in the amygdala, a key structure in the
brain’s “fear circuitry” that processes
fearful and anxious emotions, was significantly higher in the 52 combat veterans
with PTSD than in the 52 combat veterans without PTSD. The PTSD group
also showed elevated brain activity in
the anterior insula, a brain region that
regulates sensitivity to pain and negative emotions.
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SAMHSA Campaign Encourages Parents to Start
Conversations about Underage Drinking
A new national public service announcement (PSA) campaign that empowers parents
to talk to children as young as age 9 about the
dangers of underage drinking was recently
launched by the Substance Abuse and Mental
Health Services Administration (SAMHSA).
Saturday errands.
“Talk. They Hear You.” (http://www.
A perfect moment to talk about alcohol.
underagedrinking.samhsa.gov) raises parents’
awareness about these issues and arms them
with information they need to help them start
a conversation about alcohol with their children before their children become teenagers.
The campaign features a series of television, radio, and print PSAs in English and
Spanish. The PSAs show parents “seizing the moment” to talk with their children
about alcohol, such as while preparing dinner or doing chores together. By modeling behaviors through these PSAs, parents can see the many “natural” opportunities
for initiating the conversation about alcohol with their children.
Source. “New Underage Drinking Prevention Campaign Launches Today: ‘Talk. They Hear You.’” (2013, May
13). Retrieved May 23, 2013, from http://www.samhsa.gov/newsroom/advisories/1305134523.aspx.
Moreover, the PTSD group had lower activity in the precuneus, a structure
tucked between the brain’s two hemispheres that helps integrate information
from the past and future, especially when
the mind is wandering or disengaged
from active thought. Decreased activity
in the precuneus correlates with more
severe “re-experiencing” symptoms—
when victims re-experience trauma
over and over again through flashbacks,
nightmares, and frightening thoughts.
Source. “For Combat Veterans Suffering from PostTraumatic Stress Disorder, ‘Fear Circuitry’ in the Brain
Never Rests.” (2013, May 17). Retrieved May 23, 2013,
from http://ow.ly/lkPKR.
Federal Program Makes
Nursing Education Easier for
Veterans
At the White House Forum on
Military Credentialing and Licensing in
late April, U.S. Department of Health
and Human Services (USDHHS) Secretary Kathleen Sebelius announced a
new program to help military veterans
with health care experience or training,
such as medics, pursue nursing careers.
The program is designed to help veterans obtain bachelor’s degrees in nursing
by building on their unique skills and
abilities.
Administered by the Health Resources and Services Administration at
USDHHS, the Veterans’ Bachelor of
Science in Nursing Program will fund up
to nine cooperative agreements, of up to
$350,000 per year. Funding of $3 million
is expected to be awarded by the end of
fiscal year 2013 (September 30).
Program funding will go to accredited schools of nursing to increase veterans’ enrollment in and completion of
baccalaureate nursing programs, and to
explore ways to award academic credit
for prior military health care experience
or training. The institutions will also
train faculty to provide mentorships and
other supportive services.
This new program is an important
step forward in addressing needs identified in the February 2013 White House
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News
report, The Fast Track to Civilian Employment: Streamlining Credentialing
and Licensing for Service Members,
Veterans, and Their Spouses.
Information on applying for this
funding opportunity can be found at
http://www.grants.gov.
Source. “Translating Veterans’ Medical Skills
Into Nursing Careers.” (2013, April 29). Retrieved
May 22, 2013, from http://www.hhs.gov/news/
press/2013pres/04/20130429a.html.
Parents Unaware of ‘Study
Drug’ Use in Teens
Teens nationwide are being tempted
to use a “study drug”—a prescription
stimulant or amphetamine agent—to
gain an academic edge. However, a
poll from the University of Michigan
shows only 1 in 100 parents of teens
ages 13 to 17 believes their teen has
used a study drug.
Study drugs refer to stimulant medications typically prescribed for the treatment of attention-deficit/hyperactivity
disorder (ADHD); commonly prescribed medicines include brand names
Adderall®, Concerta®, Ritalin®, and
Vyvanse®.
Among parents of teens who have
not been prescribed a stimulant medication for ADHD, just 1% said they believe their teen has used a study drug to
help study or improve grades. However,
recent national data from Monitoring
the Future indicate that 10% of high
school sophomores and 12% of high
school seniors say they have used an amphetamine or stimulant medication not
prescribed by their physician.
The poll indicates a clear mismatch
between what parents believe and what
their children are reporting. But even
though parents may not be recognizing
these behaviors in their own children,
the poll also showed that one half of parents say they are very concerned about
this abuse in their communities.
White parents were most likely to say
they are “very concerned” (54%), compared with Black (38%) and Hispanic/
Latino (37%) parents.
Despite this concern, only 27% of
parents polled said they have talked
to their teens about using study drugs.
Black parents were more likely to have
discussed this issue with their teens
(41%), compared with White (27%) or
Hispanic (17%) parents.
Nearly 80% of parents polled support a policy to require students with
a prescription for ADHD medications
to keep their pills in a secure location
such as the school nurse’s office—a
Brain Activity Changes Well Before Depression Patients Feel Effects After Nerve Stimulation
© Brain Stimulation 2013
For nearly a decade, physicians have used implanted electronic stimulators to treat severe depression in
people who do not respond to standard antidepressant therapy. Now, preliminary brain scan studies are beginning to reveal the processes occurring in the brain during stimulation and may provide some clues about
how the device improves depression.
Researchers from Washington University School of Medicine in St. Louis found that vagus nerve stimulation
brings about changes in brain metabolism weeks or even months before patients begin to feel better. The findings have been published online in the journal Brain Stimulation.
The study team followed 13 people with treatment-resistant depression. Their symptoms had not improved after many months of treatment, with as many as five different antidepressant medications. Most had
been depressed for at least 2 years, but some patients had been clinically depressed for more than 20 years.
All of the participants had surgery to insert a device to electronically stimulate the left vagus nerve. Once
activated, the device delivers a 30-second electronic stimulus to the vagus nerve every 5 minutes.
To establish the nature of the treatment’s effects on brain activity, the researchers performed positron emission tomography (PET) brain imaging before the initiation of stimulation, and again 3 and 12 months after
stimulation had begun.
Eventually, 9 of the 13 participants experienced improvements in depression with the treatment. However,
in most cases it took several months for improvement to occur.
Remarkably, in those who responded, the scans showed significant changes in brain metabolism following 3 months of stimulation, which
typically preceded improvements in symptoms of depression by several months.
Although the patients remained on antidepressant agents for several months after their stimulators were implanted, many of those who
responded to the device eventually were able to stop taking medication.
Additionally, the PET scans demonstrated that structures deeper in the brain also start to change several months after nerve stimulation
begins. Many of those structures have high concentrations of brain cells that release dopamine. There is a consensus forming among depression researchers that problems in dopamine pathways may be particularly important in treatment-resistant depression. The finding that
vagus nerve stimulators influence those pathways may explain why the therapy can help and why, when it works, its effects are not transient.
Patients who respond to vagus nerve stimulation tend to get better and stay better.
Source. “Nerve Stimulation for Severe Depression Changes Brain Function.” (2013, May 7). Retrieved May 23, 2013, from http://news.wustl.edu/news/Pages/25384.aspx.
JOURNAL OF PSYCHOSOCIAL NURSING • VOL. 51, NO. 7, 2013
7
News
few cases, homicidal. Although obtaining insurance authorization delayed care
and took clinicians away from other duties, only 1 of the 53 requests for authorization was denied. Median total time
in the ED was 8.5 hours, with the shortest stay lasting 3 hours and the longest
recorded stay lasting 20 hours.
These numbers do not include a
handful of patients who boarded in
the ED over the weekend while waiting for an inpatient bed to become
available. They exclude uninsured
patients and those with Medicare,
which does not require prior authorization.
With approximately 1.6 million psychiatric admissions among people with
private insurance nationwide each year,
38 minutes of phone time to obtain
authorization translates into approximately 1 million hours of wasted psychiatrist time.
requirement that would prohibit students from carrying medicines of this
nature that could potentially be shared
with, or sold to, other students.
Source. “One in Ten Teens Using ‘Study Drugs,’
But Parents Aren’t Paying Attention.” (2013, May 20).
Retrieved May 23, 2013, from http://ow.ly/ll1TU.
Psychiatric Care ‘On Hold’
as Providers Wait for
Authorization
© 2013 Shutterstock.com
A study published in Annals of Emergency Medicine reports lengthy waits for
severely ill psychiatric patients in need
of immediate hospitalization in the Boston area, due in part to time-consuming
prior authorizations required by insurance companies.
Psychiatrists spent, on average,
38 minutes on the telephone getting
authorization. In 10% of cases, it took
more than 1 hour to obtain insurance
authorization; in one case, authorization
took 5 hours of psychiatrist time.
In the study, over a 3-month period, researchers tabulated how long
psychiatric patients who were deemed
in need of inpatient admission stayed
in the emergency department (ED)
prior to being hospitalized and the
amount of time that the ED psychiatrists spent obtaining authorization
from the patient’s insurer. A group
of psychiatric residents at Cambridge
Health Alliance working in the psychiatric ED with acutely ill psychiatric patients collected the data.
Most patients required hospitalization because they were suicidal or, in a
8
Source. “1 Million Hours of Psychiatrist Time Wasted
on Phone Annually Getting Insurance Approvals for
Hospitalization of the Mentally Ill.” (2013, April 23).
Retrieved May 23, 2013, from http://www.eurekalert.org/
pub_releases/2013-04/pfan-1mh041713.php.
Reprioritization of Treatment
Goals Improves Outcomes for
Anorexia Patients
A multinational randomized clinical trial has found that patients with
severe and enduring anorexia nervosa
will not only stick with treatments
but also make significant improvements with just a slight modification
of the standard goals and methods of
treatment.
More than 85% of those who enrolled
in the trial completed treatment—almost three times the usual retention
rate. After 8 months of outpatient treatment, patients in both treatment groups
reported improved quality of life, reduced symptoms of mood disorders, and
enhanced social adjustment.
The study, published online by the
journal Psychological Medicine, was the
first randomized clinical trial for chronic
anorexia nervosa. It compared two standard treatments but modified them in
ways that made them more suitable for
individuals with such a profound and
persistent disorder. The treatments—
cognitive-behavioral therapy (CBT)
and specialist supportive clinical management (SSCM)—were altered to focus on retention, improved quality of
life, and to avoid “further failure experiences.”
The researchers enrolled 63 patients,
all women, at two clinical centers. The
average body mass index (BMI) of study
participants was 16.2, with a range from
11.8 to 18.5. Participants had lived with
severe anorexia for at least 7 years, with
an average duration of illness of more
than 15 years.
Thirty-one patients were assigned
to CBT and 32 to SSCM. Both treatments involved 30 outpatient therapy sessions over 8 months. Patients
were assessed at the end of treatment,
with follow-up assessments 6 and 12
months later.
Results from both treatments were
comparable, with significant improvements ranging from “moderate” to
“large” on many measures. CBT had
a greater impact on eating-disorder
symptoms and readiness to change.
SSCM produced larger improvements
in health-related quality of life and depression. Average BMI for both groups
increased from 16.2 to 16.8, approximately 4%.
One crucial element of this trial
was the decision to reprioritize how
the goals of treatment were presented
to those enrolled in this study. Treatment of newly diagnosed adolescents
and young adults tends to focus on
weight recovery. For this study, treatment goals were set collaboratively—
by the care team and the patient—
with less emphasis on weight gain and
more on quality of life, reduction of
mood disorders, and enhanced social
adjustment.
Source. “Rethinking Treatment Goals Improves Results
for Those with Persistent Anorexia.” (2013, May 7).
Retrieved May 23, 2013, from http://www.uchospitals.
edu/news/2013/20130508-anorexia.html.
doi:10.3928/02793695-20130523-89
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