Narrative exposure improves ptsd symptoms

ADULT PSYCHIATRY
F E B R U A R Y 2 0 0 9 • C L I N I C A L P S Y C H I A T R Y N E W S
Narrative Exposure Improves PTSD Symptoms B Y P AT R I C E W E N D L I N G
diers, aged 12-25 years (mean, 18 years), control in reducing reports of spirit pos- C H I C A G O — Short-term narrative ex- ating in Uganda that is notorious for its posure therapy can be effective in treat- ing posttraumatic stress disorder in child in highly affected groups like child sol- carried out by lay counselors with limit- occurred 7 years earlier, at age 11.
builds on the tradition of testimony ther- Boston University. “It’s also quite cost-ef- Similar results were reported by Dr.
One study involved 87 former
sociated with the event. This leads to ha- child soldiers who had been
abducted into the Lord’s
and 6 weeks of training, including direct Resistance Army, a guerilla
army operating in Uganda that
is notorious for its cruelty.
victims of war and organized violence be- cause it can be difficult for these patients to identify a single worst event, and mul- tiple traumatic events can distort autobi- scores decreased in all three groups, like- struct a narrative of their entire life from birth to the present, while focusing on all a brief period of peace in which child ab- Ertl, a Ph.D., candidate also at the Uni- lustrative media such as drawing or reen- tive control (60.84 to 46.68), and control intramuscularly administered drug. For example, the in- of 6.4 mg/dL in the group on oral olanzapine, by 11.6 Depot Nears Approval cidence of PDSS with olanzapine LAI is quite similar mg/dL in those on olanzapine LAI at 45 mg every 4
Olanzapine
to the 0.08% rate of systemic toxic reactions per in- weeks, by 1.6 mg/dL for those on 150 mg every 2 jection reported for intramuscular procaine penicillin weeks, and by 2.7 mg/dL for those on 405 mg every 4 At the annual psychiatric institute, Dr. Detke and her G (Sex. Transm. Dis. 1978;5:4-9), Dr. Detke noted.
weeks. LDL cholesterol increased nonsignificantly by colleagues presented several major studies of olanzap- She and her coinvestigators proposed several pre- 0.8 mg/dL in patients receiving 300 mg every 2 weeks.
ine LAI, including a large, 24-week, randomized, dou- cautions in giving olanzapine LAI, including a postin- Fasting triglycerides climbed by 11.3 mg/dL with 24 ble-blind efficacy trial; an analysis of treatment-related jection observation period of at least 3 hours in a weeks of oral olanzapine, and declined by 4.3 mg/dL metabolic changes; and an update on the complication health care facility, and a warning to patients not to op- with LAI therapy. HDL cholesterol levels were unaf- known as postinjection delirium/sedation syndrome.
erate a car or other machinery for the rest of the day.
There were 29 occurrences of postinjection deliri- Proper injection technique includes aspiration of the The maintenance therapy trial involved 1,065 adult um/sedation syndrome (PDSS) in 28 of the more than syringe for about 5 seconds prior to injection while schizophrenia patients who were stabilized on open- 2,000 patients involved in olanzapine LAI clinical trials label oral olanzapine for 4-8 weeks before double-blind through May 31, 2008. This works out to an incidence The metabolic parameters study involved 921 adults randomization to one of the four olanzapine LAI dos- of 0.07% per injection, based upon a total of more than with schizophrenia who were first stabilized on 10-20 ing schedules or to continued oral olanzapine. At 24 40,000 injections. The cumulative risk per patient after mg/day of oral olanzapine for 4 weeks, then ran- weeks, the rate of freedom from exacerbation was 1 year of treatment was 0.7%-1.2%, depending upon domized to 24 weeks of continued oral olanzapine or 93% in the oral treatment arm, 95% with LAI at 300 to olanzapine LAI at 150 mg every 2 weeks, 300 mg mg every 2 weeks, 90% with 405 mg every 4 weeks, The signs and symptoms of PDSS are those of olan- every 2 weeks, 45 mg every 4 weeks, or 405 mg every 84% with 150 mg every 2 weeks, and 69% with 45 mg zapine overdose. They include sedation, dizziness, con- fusion, disorientation, slurred speech, muscle spasms, In general, metabolic changes over the 24-week study Of patients on oral olanzapine, 21% experienced a weakness, altered gait, agitation, and extrapyramidal period were similar in the groups receiving oral and LAI clinically meaningful 7% or greater increase in weight.
symptoms. There have been two instances of seizure olanzapine. Roughly 20% of patients in either group So did 8% of patients on LAI at 45 mg every 4 weeks, and several episodes involving loss of consciousness but showed a 7% or greater gain in body weight. Interest- 16% on 150 mg every 2 weeks, 15% on 405 mg every 4 no arrhythmias or clinically meaningful decreases in vi- ingly, patients who were obese at baseline experienced weeks, and 21% on 300 mg every 2 weeks. On average, significant increases in body weight and body mass in- however, weight changes over the 24 weeks were mod- Most affected patients were hospitalized during their dex only on oral olanzapine. With LAI therapy, obese est, ranging from a mean 1.0-kg loss in the lowest-dose PDSS episode. All recovered completely in 1.5-72.0 patients showed a modest weight loss.
LAI arm to gains of 0.7-1.7 kg with the other three LAI hours with routine medical management. Overall, Mean fasting blood glucose rose by 3.1 mg/dL in the dosing schedules, and 1.3 kg with oral therapy.
70% of affected patients continued on olanzapine LAI olanzapine LAI–treated patients overall, although the Long-acting injectable risperidone administered afterward, underscoring the high value placed on a de- change from baseline was significant only for the sub- every 2 weeks was the first depot atypical antipsychotic group on 405 mg every 4 weeks. Blood glucose levels to reach the market. Also under FDA review is paliperi- Olanzapine LAI is given intramuscularly by deep rose to a similar degree in patients who received the done palmitate, an every-4-weeks injectable. Iloperi- gluteal injection. It’s thought that PDSS results from ac- done is another depot agent that is well along in the de- cidental intravascular injection, a potential risk with any Mean LDL cholesterol levels dropped by an average

Source: http://www.vivo.org/press/media_reports/e164/Clin-psychiatry-news-02-09.pdf?%20target=