Post Traumatic Stress Disorder Treatment

Post Traumatic Stress Disorder Treatment – Objectives The aims of this study were to identify and analyze interventions for the treatment of post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder in vulnerable people, and to describe how these treatments are delivered using trauma-informed care.

Search strategy We searched published literature through November 2021 in electronic databases including MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science, and PTSDpubs for any research on the treatment of post-traumatic stress disorder in vulnerable adults. In addition to searching electronic databases, searches were conducted on websites of related organizations and other sources of gray literature. The characteristics and effects of the intervention were analyzed. We also look at how interventions are delivered and elements of trauma care are described.

Post Traumatic Stress Disorder Treatment

Results Twenty eight studies were included. We have identified four types of intervention: (1) trauma-focused psychotherapy; (2) non-trauma psychotherapy; (3) residential interventions; and (4) pharmacotherapy. The trauma-based intervention was a small case series, and the non-trauma-based treatment included four randomized controlled trials and was generally ineffective. Of the 10 studies describing trauma-specific care, the elements most frequently cited were physical and emotional safety, the ability to feel heard and understood, and flexibility of choice. Difficulties in providing care to this population have also been noted in the literature, including a lack of private spaces for therapy; concurrent use of psychoactive substances; and barriers to follow-up, including limited length of stay in various shelters and high staff turnover.

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Conclusion This initial review found a lack of high-quality research on post-traumatic stress disorder in susceptible people. Well-designed trials should be conducted taking into account the unique conditions of this population and describing the most important and necessary elements of trauma care.

Data sharing is not applicable as no data sets were generated and/or analyzed for this study. All data relevant to the research is included in the article or uploaded as additional information online.

This is an open access article distributed under a Creative Commons Attribution Non-Commercial License (CC BY-NC 4.0), which permits others to distribute, remix, adapt, use this work for non-commercial purposes, and license their derivative works under various conditions, provided the original work is properly cited, appropriate citations are given, any changes made are indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Post Traumatic Stress Disorder (ptsd): Symptoms & Treatment

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People living in vulnerable situations experience higher rates of mortality and morbidity than the general population.1 2 A common vulnerability factor for many disorders is trauma. An estimated 91% of homeless people have experienced at least one traumatic event3, and up to 99% have experienced childhood trauma4 5 A recent qualitative study investigated the pathways of men to long-term homelessness in Ontario. discovered that they had all experienced difficult childhood trauma

One consequence of exposure to trauma is post-traumatic stress disorder (PTSD) or complex PTSD (cPTSD). PTSD leads to re-experience of events, avoidance of reminders of events, and persistent heightened alertness and awareness of threats. cPTSD occurs as a result of a long-term threatening event from which the person has no escape (such as childhood abuse) and, in addition to symptoms of post-traumatic stress, results in regulatory problems, negative self-esteem, and difficulty maintaining relationships. 7 The incidence of diagnosed post-traumatic stress disorder in homeless individuals is significantly higher than in the Canadian population, ranging from 21% to 53%8-11, which may underestimate the true prevalence.

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Access to health care is a unique and complex issue for people living in vulnerable situations, and a history of trauma, often attributable to caregivers such as parents or other family members, makes it difficult to receive and participate in care.6 12 Being in vulnerable places also place people at risk of further trauma and victimization, such as further physical or sexual abuse and failure to meet basic needs such as food, safety, and personal hygiene. 5, 13, 14 self-medicate with alcohol or other substances. There are also difficulties in accessing adequate health care due to poverty and organizational barriers between health care providers. 15 These problems result in an underserved population with complex health needs for which traditional mental health care is not well equipped. 10,16,17 With Thus, the provision of health services to vulnerable housing populations requires some flexibility in terms of how services are provided, who provides them, when and where. One approach recommended in clinical guidelines is trauma-informed care.18-20

The Substance Abuse and Mental Health Services Administration has defined trauma-informed care as a program, organization, or system that recognizes the widespread impact of trauma and understands possible pathways to healing; recognize signs and symptoms of injury to staff, customers and others associated with the system; and respond by fully integrating trauma knowledge into policies, procedures, practices and situations21. In 2010, Hopper18 outlined four core principles of trauma information assistance in homeless services: trauma awareness, safety, choice and empowerment, and approach. The National Center for Homeless Families lists several reasons why programs should be made aware of trauma,22 including that trauma can affect how people access services, including treating people and services as unsafe; recognize that people adapt to trauma to protect themselves, including substance abuse, becoming aggressive, or withdrawing; and programs and services cannot be “universal”.

None of the five major clinical guidelines for the treatment of post-traumatic stress disorder23 address the treatment of homelessness, with the exception of the National Institutes of Health and Care Quality guidelines, which state that “methods of accessing services are tailored to needs. particular population.” people with post-traumatic stress disorder, … including the homeless.” It doesn’t explain what the accessor method is. Recent clinical practice guidelines for homeless and vulnerable individuals do not include treatment for post-traumatic stress disorder, although they do recommend trauma-specific care without explaining what it is.20

Post Traumatic Stress Disorder: A Psychiatric Disorder Requiring Urgent Attention

People living in vulnerable situations are unique among those with PTSD because of their very high level of exposure to trauma; frequent use of substances to self-medicate symptoms; high degree of accompanying physical and mental illness; difficulty forming caring relationships; and difficulties accessing traditional health services, often due to poverty and systemic barriers. We undertook this preliminary review to examine the literature on what treatments are used in this population and how trauma-specific care is used to deliver those treatments.

This initial review aims to provide an overview of the literature on the treatment of post-traumatic stress disorder and chronic post-traumatic stress disorder in vulnerable people, how these treatments are provided and, if trauma-based assistance has been used, how it has been implemented.

We conducted our initial review according to the methodological framework proposed by Arcsey and O’Malley24, in addition to the methodology guidelines published by the Joanna Briggs Institute Methodology for Review Reviews.25 Our review also followed the preferred reporting elements for systematic reviews and meta-analyses. addition to the Scope Review Checklist (PRISMA). 26,27

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The Medical Librarian (AH) searched the electronic databases at MEDLINE, Embase, PsycINFO (via Ovid), CINAHL (via EBSCO), The Cochrane Library (via Wiley), Web of Science, and PTSDpubs (via Proquest) from early to March 2020. and updated in November 2021. The search was peer-reviewed in accordance with recommendations from the Electronic Tracing Strategy Peer Review (PRESS)28. The complete search strategy is available in the Supplementary File (Supplementary Online Appendix 1). No language or publication date restrictions apply. A thorough and focused search of gray literature was conducted to identify non-indexed studies, including unpublished trial data, dissertations, abstracts, and conference proceedings. The Canadian Medicines and Health Technology Agency’s Gray Issues Checklist was used to construct our gray literature search, as well as to identify key websites (i.e. organizations dedicated to the homeless). We also performed a manual search in the list of identified report references from additional relevant studies that were not included in the original search.

We included published and unpublished primary studies reporting quantitative, qualitative, mixed or multi-method studies covering comparative and non-comparative methods to evaluate PTSD interventions in vulnerable adults (ages 18 years and older). . For the purposes of this review, vulnerable populations are defined as those who are homeless, living in makeshift housing, living temporarily, and/or at risk of becoming homeless. 29 Study designs included randomized controlled trials (RCTs), cluster RCTs, and quasi-experimental studies. , cohort studies, cross-sectional studies/surveys, case studies and controls before and after studies. We’ve excluded reviews, comments, and editorials.

Excerpts from our comprehensive search strategy were loaded into the Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org). The selection process includes phase I (title and abstract) and phase II (full text) to identify relevant studies. In both phases, titles were reviewed by two independent reviewers (AB, KC, and MK; NEE in November 2021) after

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