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M. Agronin, MD
M. Alexander, PhD, MA
S. Ancoli-Israel, Ph.D
L. Boesky, PhD
R. Brown, PhD
A. Burstein, MD
R. Dougherty, PhD
J. Draud, MD, MS
P. Earley
G. Emslie, MD
L. Ereshefsky, PharmD
M. Forstein, MD
A. Frances, MD
M. Gold, MD
D. Goodman, MD
K. Gray, MD
D. Greenberg, MD
D. Greydanus, MD
R. Hendren, DO
R. Jackson, MD
R. Jain, MD, MPH
S. Jain, PsyD, LPC, MBA
J. Kane, MD
S. Katz, MSN PMH-CNS, BC
L. Kinsella, MD, FAAN
A. Krystal, MD
S. Levine, MD
J. Maldonado, MD
V. Maletic, MD, PA
B. McCarberg, MD
J. McGough, MD, MS
L. Miller, MD
L. Nagy, MD
H. Nasrallah, MD
S. Negi, MA, PhD
J. Nelson, MD
J. Newcomer, MD
G. Papakostas, MD
M. Piasecki, MD
J. Prince, MD
C. Raison, MD
P. Resnick, MD
A. Robb, MD
C. Rodgers, MD
M. Rosenberg, MD, PhD
J. Schim, MD
D. Schuyler, MD
S. Shea, MD
T. Simpatico, MD
T. Skale, MD
B. Smith, JD
T. Smith, MS Psych, PD, FASCP, LMHC, NCP
S. Sobel, MD
D. Sprague
Murray B. Stein, MD, MPH
R. Stille, MBA
V. Strasburger, MD
J. Tsuang, MD
S. Verma, MD
J. Victoroff, MD, MA
J. Weiner, MD, PhD
S. Yaffe, MD
A. Young, MD, MSHS
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Murray B. Stein, MD, MPHProfessor of Psychiatry and Family Preventative Medicine, University of California San Diego INjury and TRaumatic STress (INTRuST) Consortiumand VA San Diego Healthcare System San Diego, California
| Monday, November 2 02:30-03:45 p.m. |
177 - Convergence of Posttraumatic Stress Disorder and Traumatic Brain Injury VT
1.25 credits - Room: Breakers ABGH |
Murray B. Stein, MD, MPH, Professor of Psychiatry and Family Preventative Medicine, University of California San Diego INjury and TRaumatic STress (INTRuST) Consortiumand VA San Diego Healthcare System San Diego, California
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Dr. Stein examines the relationship of the two "signature injuries" experienced by Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) troops, posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). Studies show that a minority of individuals develop persistent emotional, somatic, and/or cognitive sequelae of traumatic exposure. Remarkably, the mechanism (emotional vs. biomechanical) or locus (head vs. other physical) of injury is a weak determinant of whether an individual develops PTSD, persistent postconcussive symptoms (PCS), or both. The frequent convergence of PTSD and PCS symptoms in military personnel is discussed, with an emphasis on studies that evaluate risk factors and outcomes. A general approach to management is discussed, as are new directions in diagnostic and therapeutic research. Upon the completion of this activity, participants will be able to: - List criteria for the diagnosis of mild traumatic brain injury (mTBI);
- Review the extent of symptom overlap between mTBI and posttraumatic stress disorder (PTSD); and
- Describe new directions in the diagnosis and management of comorbid mTBI and PTSD
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| Tuesday, November 3 05:45- 07:00 p.m. |
261 - Pharmacotherapy of Posttraumatic Stress Disorder: The Evidence Base RX PD
1.25 credits - Room: Mandalay Ballroom AB |
Murray B. Stein, MD, MPH, Professor of Psychiatry and Family Preventative Medicine, University of California San Diego INjury and TRaumatic STress (INTRuST) Consortiumand VA San Diego Healthcare System San Diego, California
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The evidence base for pharmacotherapy of PTSD has grown by leaps and bounds in the past 10 years. Early studies of amitriptyline and phenelzine showed some promise for treatment of PTSD. But sample sizes were small and larger-scale studies have not been conducted. Only one class of drugs, the selective serotonin reuptake inhibitor (SSRIs) has members of the class FDA-approved for PTSD. Numerous large, multi-center trials of SSRIs (and, more recently, several large trials with dual norepinephrine serotonin reuptake inhibitors [NSRIs]) conclusively demonstrate their short- and intermediate-term efficacy, but response rates are modest and the optimal duration of treatment is unclear. Furthermore, the efficacy of SSRIs in some populations (e.g., combat veterans with PTSD) has been questioned. As awareness of the prevalence and seriousness of PTSD has increased, so has the impetus to develop new and better treatments. Several other classes of medications, including anticonvulsants, atypical antipsychotics, and adrenergic agents (e.g., prazosin) have shown promise in relatively small studies for either monotherapy or adjunctive use. For some medications, large randomized controlled trials (RCTs) have been negative (e.g., the anticonvulsant tiagabine), whereas for others such trials are either ongoing (e.g., prazosin and risperidone) or have yet to be conducted (e.g., lamotrigine). A role for combined psychotherapy and pharmacotherapy of PTSD will be discussed. Upon the completion of this activity, particpants will be able to: - List FDA approved treatments for posttraumatic stress disorder (PTSD).
- Identify the different classes of psychotropic agents that may be useful in the treatment of PTSD.
- Discuss the limitations of the available evidence base for PTSD pharmacotherapy and of the need for more studies and better therapeutics.
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