Substantial empirical evidence has indicated impairment in the cognitive functioning of patients with obsessive-compulsive disorder (OCD) despite inconsistencies. Although several confounding factors ...have been investigated to explain the conflicting results, the findings remain mixed. This study aimed to investigate cognitive dysfunction in patients with OCD using a meta-analytic approach.
The PubMed database was searched between 1980 and October 2012, and reference lists of review papers were examined. A total of 221 studies were identified, of which 88 studies met inclusion criteria. Neuropsychological performance and demographic and clinical variables were extracted from each study.
Patients with OCD were significantly impaired in tasks that measured visuospatial memory, executive function, verbal memory and verbal fluency, whereas auditory attention was preserved in these individuals. The largest effect size was found in the ability to recall complex visual stimuli. Overall effect estimates were in the small to medium ranges for executive function, verbal memory and verbal fluency. The effects of potentially confounding factors including educational level, symptom severity, medication status and co-morbid disorders were not significant.
Patients with OCD appear to have wide-ranging cognitive deficits, although their impairment is not so large in general. The different test forms and methods of testing may have influenced the performance of patients with OCD, indicating the need to select carefully the test forms and methods of testing used in future research. The effects of various confounding variables on cognitive functioning need to be investigated further and to be controlled before a definite conclusion can be made.
Many millions of people are affected by the trauma of war. Psychologists have a good understanding of how experiences of war impact on memory, but the significance of external environmental ...influences is often disregarded. Memory, War and Trauma focuses on our understanding of the psychosocial impact of war in its broadest sense. Nigel C. Hunt argues that, in order to understand war trauma, it is critical to develop an understanding not only of the individual perspective but also of how societal and cultural factors impact on the outcome of an individual's experience. This is a compelling book which helps to demonstrate why some people suffer from post-traumatic stress while other people don't, and how narrative understanding is important to the healing process. Its multidisciplinary perspective will enable a deeper understanding of both individual traumatic stress and the structures of memory.
Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Early evidence suggests that the ...psychological toll of these deployments many involving prolonged exposure to combat-related stress over multiple rotations--may be disproportionately high compared with the physical injuries of combat. In the face of mounting public concern over post-deployment health care issues confronting OEF/OIF veterans, several task forces, independent review groups, and a Presidential Commission have been convened to examine the care of the war wounded and make recommendations. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. RAND conducted a comprehensive study of the post-deployment health-related needs associated with these three conditions among OEF/OIF veterans, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need. This monograph presents the results of our study, which should be of interest to mental health treatment providers; health policymakers, particularly those charged with caring for our nation's veterans; and U.S. service men and women, their families, and the concerned public. All the research products from this study are available at http://veterans.rand.org. Data collection for this study began in April 2007 and concluded in January 2008. Specific activities included a critical review of the extant literature on the prevalence of post-traumatic stress disorder, major depression, and traumatic brain injury and their short- and long-term consequences; a population-based survey of servicemembers and veterans who served in Afghanistan or Iraq to assess health status and symptoms, as well as utilization of and barriers to care; a review of existing programs to treat servicemembers and veterans with the three conditions; focus groups with military servicemembers and their spouses; and the development of a microsimulation model to forecast the economic costs of these conditions over time. Among our recommendations is that effective treatments documented in the scientific literature, evidence-based care--are available for PTSD and major depression. Delivery of such care to all veterans with PTSD or major depression would pay for itself within two years, or even save money, by improving productivity and reducing medical and mortality costs. Such care may also be a cost-effective way to retain a ready and healthy military force for the future. However, to ensure that this care is delivered requires system-level changes across the Department of Defense, the Department of Veterans Affairs, and the U.S. health care system.
Structured for easy evaluation of learning outcomes and replete with useful Web sites and suggested reading, this book is an invaluable resource for clinicians seeking to understand the myriad ...factors that may influence a person's reaction to trauma.
Since the 1970s, understanding of the effects of trauma, including flashbacks and withdrawal, has become widespread in the United States. As a result Americans can now claim that the phrase ...posttraumatic stress disorder (PTSD) is familiar even if the American Psychiatric Association's criteria for diagnosis are not. As embedded as these ideas now are in the American mindset, however, they are more widely applicable, this volume attempts to show, than is generally recognized. The essays inCulture and PTSDtrace how trauma and its effects vary across historical and cultural contexts.
Culture and PTSDexamines the applicability of PTSD to other cultural contexts and details local responses to trauma and the extent they vary from PTSD as defined in the American Psychiatric Association'sDiagnostic and Statistical Manual. Investigating responses in Peru, Indonesia, Haiti, and Native American communities as well as among combat veterans, domestic abuse victims, and adolescents, contributors attempt to address whether PTSD symptoms are present and, if so, whether they are a salient part of local responses to trauma. Moreover, the authors explore other important aspects of the local presentation and experience of trauma-related disorder, whether the Western concept of PTSD is known to lay members of society, and how the introduction of PTSD shapes local understandings and the course of trauma-related disorders.
By attempting to determine whether treatments developed for those suffering PTSD in American and European contexts are effective in global settings of violence or disaster,Culture and PTSDquestions the efficacy of international responses that focus on trauma.
Contributors:Carmela Alcántara, Tom Ball, James K. Boehnlein, Naomi Breslau, Whitney Duncan, Byron J. Good, Mary-Jo DelVecchio Good, Jesse H. Grayman, Bridget M. Haas, Devon E. Hinton, Erica James, Janis H. Jenkins, Hanna Kienzler, Brandon Kohrt, Roberto Lewis-Fernández, Richard J. McNally, Theresa D. O'Nell, Duncan Pedersen, Nawaraj Upadhaya, Carol M. Worthman, Allan Young
L'auteur cherche dans une nouvelle étude sur l'hystérie ce qui est susceptible d'être dégagé par rapport au modèle classique de la névrose. C'est à partir de l'expérience clinique que l'émergence de ...la projection conduit à penser sa place et sa fonction singulières au sein d'un fonctionnement psychique par ailleurs soutenu par le refoulement et le conflit interne. Les maux du corps si caractéristiques des symptômes hystériques relèvent alors d'un déplacement du même ordre lorsque les mots viennent à manquer. Dans certaines situations, la projection vient renverser cette tendance dominante par l'externalisation des mouvements pulsionnels et des fantasmes qui s'y attachent.
From the author of The Veteran's Survival Guide, The Veteran's PTSD Handbook addresses the obstacles that veterans face when filing for benefits related to post-traumatic stress disorder (PTSD). One ...of the greatest obstacles, John Roche writes, is establishing a connection between a veteran's service and PTSD. Because both combat stressors and noncombat stressors can cause PTSD and because of the difficulties in diagnosing the condition, filing a successful claim for benefits based on PTSD is difficult. In the same accessible, self-help style used in The Veteran's Survival Guide, Roche offers detailed instructions on how to prepare a well-grounded claim for veterans' benefits relating to PTSD. He also discusses the four years he spent helping one veteran establish a service connection for his PTSD claim with Veterans Affairs. This book will be required reading for any veteran or veteran's dependent who wishes to obtain his or her well-earned benefits and for those officials of veterans' service organizations who assist veterans with their claims.
Objective: To examine the efficacy of exposure-based cognitive-behavioral therapy (CBT) plus a structured family intervention (FCBT) versus psychoeducation plus relaxation training (PRT) for reducing ...symptom severity, functional impairment, and family accommodation in youths with obsessive-compulsive disorder (OCD). Method: A total of 71 youngsters 8 to 17 years of age (mean 12.2 years; range, 8-17 years, 37% male, 78% Caucasian) with primary OCD were randomized (70:30) to 12 sessions over 14 weeks of FCBT or PRT. Blind raters assessed outcomes with responders followed for 6 months to assess treatment durability. Results: FCBT led to significantly higher response rates than PRT in ITT (57.1% vs 27.3%) and completer analyses (68.3% vs. 35.3%). Using HLM, FCBT was associated with significantly greater change in OCD severity and child-reported functional impairment than PRT and marginally greater change in parent-reported accommodation of symptoms. These findings were confirmed in some, but not all, secondary analyses. Clinical remission rates were 42.5% for FCBT versus 17.6% for PRT. Reduction in family accommodation temporally preceded improvement in OCD for both groups and child functional status for FCBT only. Treatment gains were maintained at 6 months. Conclusions: FCBT is effective for reducing OCD severity and impairment. Importantly, treatment also reduced parent-reported involvement in symptoms with reduced accommodation preceding reduced symptom severity and functional impairment. (Contains 2 figures and 4 tables.)
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