Academic literature on the topic 'Psychological trauma and related clinical interventions'

Stressful life situations can generate chronic symptomatology, so it is of great concern to analyze preventive strategies. Psychological debriefing is an intervention for acute trauma, which verbalizes perceptions, thoughts, and emotions experienced during a recent traumatic event. The evidence surrounding its efficacy is controversial. This article discusses the efficacy of psychological debriefing based on systematic reviews and clinical practice guidelines. In all, nine systematic reviews were included. Only one of them found that psychological debriefing effectively decreased psychological stress, while the remaining eight found no significant effects for outcomes such stress, depressive and anxious symptoms, or development and severity of post-traumatic stress disorder. Moreover, two clinical trials found that the intervention had a significantly deleterious effect. Another study found a worsening in the symptomatology associated with the event. Of the eight clinical practice guidelines incorporated, none recommended psychological debriefing as an intervention for acute trauma. Some phenomena could explain the lack of success of the intervention in the scientific evidence. The bioethical conditions related to the traumatic scenario hinder its research, and its lack of standardization makes its evaluation in clinical trials problematic. Other variables such as ethnicity, personality, culture, gender, and history of traumatic experiences have been little considered in research. Nevertheless, the intervention may hinder the adequate processing of traumatic memory and emotions. Current evidence is consistent in not recommending psychological debriefing as an intervention for acute trauma, so its management should avoid it. It is suggested to promote research on preventive interventions to develop chronic traumatic symptomatology.

Trauma affects many children in various ways globally. According to SAMHSA (2017), the “occurrence of child trauma is very prevalent, and 75% of children reported experiencing at least one traumatic event by age 16”. Traumatic events consist of “psychological, physical, or sexual abuse; community or school violence; witnessing or experiencing domestic violence; national disasters or terrorism; commercial sexual exploitation; sudden or violent loss of a loved one; refugee or war experiences; military family-related stressors; physical or sexual assault; neglect; and serious accidents or life-threatening illness” (SAMHSA, 2017). This literature review evaluates three different attachment-based, trauma-informed interventions for young children 0-7 years of age which are: Attachment and Bio-Behavioral Catchup (ABC), Child-Parent Psychotherapy (CPP), and Parent-Child Interaction Therapy (PCIT). Throughout this review, childhood trauma will be defined, and the current occurrence rates will be discussed. Furthermore, the descriptions of the above therapies, clinical trials, and research findings will be examined, and a discussion of the literature review findings will follow.

Trauma affects many children in various ways globally. According to SAMHSA (2017), the “occurrence of child trauma is very prevalent, and 75% of children reported experiencing at least one traumatic event by age 16”. Traumatic events consist of “psychological, physical, or sexual abuse; community or school violence; witnessing or experiencing domestic violence; national disasters or terrorism; commercial sexual exploitation; sudden or violent loss of a loved one; refugee or war experiences; military family-related stressors; physical or sexual assault; neglect; and serious accidents or life-threatening illness” (SAMHSA, 2017). This literature review evaluates three different attachment-based, trauma-informed interventions for young children 0 - 7 years of age which are: Attachment and BioBehavioural Catchup (ABC), Child-Parent Psychotherapy (CPP), and Parent-Child Interaction Therapy (PCIT). Throughout this review, childhood trauma will be defined, and the current occurrence rates will be discussed. Furthermore, the descriptions of the above therapies, clinical trials, and research findings will be examined, and a discussion of the literature review findings will follow.

Although the fear response is an adaptive response to threatening situations, a number of psychiatric disorders feature prominent fear-related symptoms caused, in part, by failures of extinction and inhibitory learning. The translational nature of fear conditioning paradigms has enabled us to develop a nuanced understanding of extinction and inhibitory learning based on the molecular substrates to systems neural circuitry and psychological mechanisms. This knowledge has facilitated the development of novel interventions that may augment extinction and inhibitory learning. These interventions include nonpharmacological techniques, such as behavioral methods to implement during psychotherapy, as well as device-based stimulation techniques that enhance or reduce activity in different regions of the brain. There is also emerging support for a number of psychopharmacological interventions that may augment extinction and inhibitory learning specifically if administered in conjunction with exposure-based psychotherapy. This growing body of research may offer promising novel techniques to address debilitating transdiagnostic fear-related symptoms.

This paper considers the manifestation and treatment of psychological trauma in the military. The article describes how military psychologists conceptualise psychological trauma within the culture of the Armed Forces (AF), which is reflected in the process of acquiring what has been referred to as cultural competency. Psychologists in this context acquire an understanding of the manner in which the psychological and organisational systems and culture of the military affect the presentation of psychological trauma, including post-traumatic stress disorder (PTSD). The paper outlines core psychological features of military life, including some of the ways in which the AF functions effectively as an adaptable fighting force. This highlights, for example, the potential for stigma within and between military personnel who experience mental health difficulties. The article proceeds to examine aspects of help-seeking in military mental healthcare, how symptoms can present at different stages in a deployment process, and the consequences that such problems can cause for military conduct and performance. Psychological care in the military is structured within an occupational mental health ethos, in which psychologists fulfil a range of clinical, organisational and leadership roles. These dynamics are explored with examples of care pathways and clarity on evidence-based interventions for trauma and PTSD in those experiencing military-related psychological injuries. Two vignettes are then offered to illustrate how some of these interventions can be used psychotherapeutically in addressing symptoms pertaining to hyperarousal, hypervigilance, guilt and shame.

Abstract Introduction Sleep and physical activity are related to psychological trauma. Less is known about how individuals with distinct sleep and activity profiles differ on specific clusters of trauma symptoms. Cambodian-Americans who survived the Pol Pot genocide experienced severe collective trauma. This analysis explored group differences between sleep/activity profiles on specific trauma symptoms among Cambodian-Americans. Methods Participants in a diabetes prevention trial for Cambodian-Americans (NCT02502929) met inclusion criteria for depression and high diabetes risk (but did not have diabetes). They wore wrist actigraphy (sleep) and hip actigraphy (physical activity) for 7 days (≥3 days to be included) and completed the 16-item trauma symptom scale of the Harvard Trauma Questionnaire (HTQ; N=166). Latent Profile Analyses identified profiles using 3 mean actigraphic sleep and activity variables: total nightly sleep time, sleep maintenance efficiency, and minutes in moderate-vigorous physical activity. ANOVAs explored differences between sleep/activity profiles on the HTQ, specifically total scores and the “Avoidance/Numbing” and “Re-experiencing/Hyperarousal” subscales. Models were adjusted for psychotropic medication use. Results Participants were predominantly women (79%), mean age 55.3, with elevated trauma symptoms (17% were higher than 2.5 cutpoint; mean±SD= 1.90±0.61). Sleep and physical activity patterns yielded a BIC best fit with 3 sleep/activity profiles: Inactive Poor Sleepers (n=30, 18%), Highly Active Short Sleepers (n=35, 21%), and Moderately Active Good Sleepers (n=101, 61%). Differences were observed between profiles on the HTQ total score (p=0.03). Tukey’s post hoc test revealed that Inactive Poor Sleepers exhibited greater HTQ scores than Highly Active Short Sleepers (p<0.05), but did not differ from Moderately Active Good Sleepers. There was also a significant difference between profiles in the Avoidance/Numbing subscale (p=0.01); Inactive Poor Sleepers had higher Avoidance/Numbing than Highly Active Short Sleepers (p<0.05, Cohen’s d: 0.47). There were no differences between profiles on the Re-experiencing/Hyperarousal subscale (p=.09). Conclusion Individuals with contrasting actigraphic sleep/activity profiles differed on trauma symptoms. Inactive Poor Sleepers may benefit from specific interventions for Avoidance/Numbing symptoms. Future analyses will evaluate how changes in sleep/activity profiles are longitudinally related to psychological health and diabetes risk following interventions. Support (If Any) 5R01DK103663

Attention-deficit/hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD) are highly comorbid among children and adolescents with a history of maltreatment and trauma. This comorbidity is linked to increased symptom severity and poor academic and social outcomes. Such negative outcomes are shown to have further negative outcomes during the college years. However, research has yet to directly examine the associations between ADHD, trauma exposure, and PTSD among college students. To address this gap, the current study examined the relations between childhood ADHD symptoms, lifetime trauma exposure, and current PTSD symptoms among a racially and ethnically diverse group of college students ( N = 454). Analyses controlled for symptoms of depression and anxiety and examined demographic differences. Findings indicated that college students with a childhood history of elevated ADHD symptoms reported significantly higher numbers of trauma exposure and PTSD symptoms. Findings also indicated that trauma-related arousal symptoms and more general depressive symptoms were the strongest mediators in the association between ADHD symptoms and trauma exposure. These results have implications for child and adolescent clinical interventions, as well as for college counseling and accessibility services related to psychological well-being and academic accommodations.

The aim of this service evaluation was to assess the effectiveness of a Cognitive Behavioural Therapy (CBT) group intervention for clients presenting with trauma-related difficulties within a part primary care, part ‘Improving Access to Psychological Therapies’ (IAPT) community service (Howells, 2004). Self-report measures were used to assess low mood, anxiety and trauma symptoms. This evaluation found that clients experienced a reduction in symptoms of anxiety and low mood; however, the difference in scores did not equate to a reliable change or improvement according to the IAPT reliable improvement index. Notwithstanding this, clients did report a change and improvement in trauma ‘symptoms’ by the end of this part of the intervention.

Background: Cancer-related traumatic stress symptoms, including posttraumatic stress disorder (PTSD), can significantly impact the quality of life and psychological adjustment of patients and survivors with cancer. Cognitive behavioral therapy (CBT) is an effective intervention previously shown to ameliorate non-cancer-related PTSD. Because of some of the unique aspects of cancer-related traumatic stress, such as the internal and ongoing nature of the traumatic stressor, it is important to review the overall efficacy of CBT interventions in populations with cancer. Objective: To review the findings of randomized clinical trials (RCTs) testing the efficacy of interventions with CBT components for cancer-related traumatic stress symptoms, including intrusion and avoidance, in adults with cancer. Methods: Eligible RCTs were identified via search of OVID, PubMed, EMBASE, and Scopus. Bayesian random effects analysis of treatment effect sizes (ES) was conducted in a portion of the studies for which data were available. Results: Nineteen RCTs met search criteria. Six trials reported reductions in traumatic stress symptoms as a result of the intervention and 13 studies reported null findings. Bayesian modeling based on 13 studies showed no overall discernible effect of interventions with CBT components on intrusion and avoidance symptoms. Conclusions: Most of the studies were not designed to target traumatic stress symptoms in highly distressed patients with cancer and did not include previously validated CBT components, such as cognitive restructuring and exposure. Thus, there was insufficient evidence from which to draw definitive conclusions about the efficacy of CBT interventions for the treatment of cancer-related traumatic stress symptoms, including PTSD. However, interventions with CBT components may have potential for the reduction of PTSD symptoms in highly distressed patients. Future research should focus on testing trauma-focused interventions in demographically and clinically diverse samples.

Background: Trauma is the leading cause of morbidity and mortality in the pediatric population. During the COVID-19 pandemic (COVID-19), different trends for pediatric trauma (PT) were described. This study aims to explore the trend over time of PT in our center, also considering the effects of COVID-19, focusing on trauma mechanisms, violence-related trauma (VRT) and intentionality, especially suicide attempts (SAs). Methods: All PT patients accepted at Niguarda Trauma Center (NTC) in Milan from January 2015 to December 2020 were retrospectively analyzed. We considered demographics and clinical variables and performed descriptive and year comparison analyses. Results: There were 684 cases of PT accepted at NTC: 84 in 2015, 98 in 2016, 125 in 2017, 119 in 2018, 114 in 2019 and 144 in 2020 (p < 0.001), 66.2% male, mean age 9.88 (±5.17). We observed a higher number of traffic-related, fall-related injuries and an increasing trend for VRT and SAs, peaking in 2020. We report an increasing trend over time for head trauma (p = 0.002). The Injury Severity Score did not significantly change. During COVID-19 we recorded a higher number of self-presenting patients with low priority codes. Conclusions: NTC is the adult level I referral trauma center for the Milan urban area with pediatric commitment. During COVID-19, every traumatic emergency was centralized to NCT. In 2020, we observed an increasing trend in SAs and VRT among PT patients. The psychological impact of the COVID-19 restriction could explain this evidence. The long-term effects of COVID-19 on the mental health of the pediatric population should not be underestimated. Focused interventions on psychological support and prevention of SAs and VRT should be implemented, especially during socio-demographic storms such as the last pandemic.

This chapter reviews evidence-based pharmacological treatments for posttraumatic stress disorder, acute stress disorder, and adjustment disorder in adults. Emphasis is given to treatments that have received the strongest recommendations in published practice guidelines, clinical trials, and meta-analyses. Mention is also made of pharmacological interventions introduced subsequent to changes in diagnostic definitions that occurred with the shift to the category trauma- and stress-related disorders in the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). Medications covered in this chapter are across a broad range of classes and include serotonin specific reuptake inhibitors (SSRIs), antipsychotics, anticonvulsants, and benzodiazepines. The discussion addresses medications used as monotherapy and as medication augmentation.

This chapter reviews trauma- and stressor-related disorders (TSRDs) as they relate to disaster, defined by the World Health Organization as “a severe disruption, ecological and psychosocial, which greatly exceeds the coping capacity of the affected community.” Some are human-made such as a terrorist event or shooting, while others are due to natural events such as earthquake or hurricane. Humanitarian emergencies are also a class of disasters. Since most but not all people and communities are resilient, the prevalence of TSRDs after disaster and what interventions are optimal is highly relevant to disaster recovery. The chapter discusses the impact of disaster preparedness, factors that influence how communities cope with disaster, and the effect of trauma and stress on populations. It goes on to review factors that influence susceptibility and resilience to disaster trauma, the range of psychological consequences of disaster, and early interventions for TSRDs in response to disaster.

Multigenerational legacies of suffering are universal and as old as humankind. Given ongoing worldwide violent atrocities, understanding and addressing their intergenerational consequences is vital. Transmission mechanisms explored range from the basic biological to the complex psychological, and the sociopolitical. The first and most frequently investigated offspring population is that of Nazi Holocaust survivors. The chapter synthesizes the research on these offspring and some of the more recently studied offspring groups. It then presents the major theory of multigenerational trauma transmission—Trauma and the Continuity of Self: A Multidimensional, Multidisciplinary Integrative Framework, that provides the bases for the first valid transmission assessment measure—the Danieli Inventory for Multigenerational Legacies of Trauma. Part II of the Danieli Inventory—Reparative Adaptation Impacts—is key to assessing the well-being of the second generation. Recommendations for further research and enhancing clinical interventions are included.

This chapter reviews psychiatric consultation for trauma and stress in medical-surgical patients. Hospitalization can induce psychologic or psychiatric disturbance and worsen the clinical condition of patients who are suffering from medical and surgical comorbidities. Some medical conditions can be related to stress related disorders indirectly, while others, such as critical illness/intensive care unit treatment or direct physical injury, are themselves traumatic stressors that can promote trauma and stressor-related disorders (TSRDs). Given the negative impact of stress-related disorders on quality of life, mental health clinicians should diagnose TSRDs to ensure patients receive appropriate care. Treatment and management can be provided in multiple forms of psychological therapies and psychopharmacology, and within a multidisciplinary team, particularly for the medical surgical patient. Psychiatrists, psychologists, and social workers must assist patients with terminal illnesses by optimizing end-of-life care, supporting patients and their families, and encouraging approaches to allow the transformative process of dying to be meaningful.

The scientific and clinical need to advance understanding of the processes related to Hispanic acculturation and its impacts is pressing. This chapter articulates how acculturation stress and related specific stressor events occur within distinct life domains or contexts. New research is juxtaposed to previous research that demonstrated how acculturation stressors cluster in unique, orthogonal, and independent life domains among both adult and adolescent Hispanics. This chapter refers to contexts of acculturation stress as spheres of life or domains that entail social and psychological interactions with the dominant, receiving culture. New research is presented on the relationship between acculturation stress context among adult Hispanics and mental health indicators. Understanding the contexts in which acculturation-related stress can impact Latinos is critical to health and behavioral health programming, where such information can assist in the development, adaptation, and tailoring of prevention and interventions that are more acceptable and relevant for this growing population.

This extensively revised new edition provides a practical guide to understanding, assessing and managing physical, psychological and social complications related to drug and alcohol use. It presents a clear review of the aetiology, epidemiology, prevention and treatment of the problematic use of and dependence on alcohol, illicit and prescribed drugs. In doing so it strikes a balance between theory, recent research and practical clinical guidance. New chapters focus on novel psychiatric substances, smoking cessation interventions, mutual aid groups and family interventions. Written by leading specialists in the field and closely following the MRCPsych curriculum, this book is an ideal resource for trainees preparing for their RCPsych membership examinations, but is also relevant to psychiatrists at all career levels. It will also appeal to other healthcare professionals, all of whom should be able to screen for alcohol and drug use disorders, deliver brief interventions, and signpost those with more severe disorders to specialist care.

Up to 53% of patients with chronic nonmalignant pain demonstrate medication nonadherence, and many are nonadherent with behavior-change interventions for pain, presenting a significant challenge to providers managing this population and compromising patient-reported outcomes related to treatment efficacy, symptom control, and quality of life. Patients with chronic pain are often highly complex and present with numerous medical and psychological comorbidities. Many of these comorbidities, including mood, sleep, and substance use disorders, in addition to maladaptive coping with pain and varied clinician, health system, and family-related factors, can influence adherence to pain interventions. This chapter applies a biopsychosocial framework to guide the clinical assessment of nonadherence behaviors in chronic pain, including the identification of risk factors, mechanisms, and underlying processes of nonadherence, and presents strategies providers can potentially implement to enhance patient adherence to pharmacologic and behavioral therapies for pain management.

This chapter provides a brief overview of the current scientific evidence for the treatment of depression in type 2 diabetes. Considering the multiple adverse interactions between both conditions, treatment targets should always focus on diabetes-related medical outcome and improvement or remission of depression at the same time in people with diabetes. Depression can be treated with moderate to good results in depressed patients with type 2 diabetes by a variety of psychological and pharmacological interventions, with comparable results to the treatment of depressive patients without diabetes. Results regarding glycaemic control are inconsistent and indicate a low effectiveness of psychological interventions. Antidepressants demonstrated mild to moderate effect regarding better glycaemic control, but the results are still inconclusive and long-term effects are widely unknown. The chapter ends with a critical summary of methodological limitations of the research in that area and concludes with evidence-based recommendations for clinical practice.

This chapter discusses palliative psychology competencies in the eighth domain of palliative care, which addresses the legal and ethical aspects of palliative care. Firstly, the chapter reviews psychology ethical standards and principles discussing their application and relevance to the palliative care setting. Palliative psychology competencies are presented. Additionally, principles of medical ethics related to decision making are discussed. Complex case scenarios are discussed with the aid of clinical case vignettes. In particular, the discussion focuses on the ethical issues related to disclosure of a terminal prognosis, family conflicts, and intimate partner violence of patients with advanced illness. Psychological approaches and interventions are discussed in the context of the interdisciplinary palliative care tem approach.

Post-traumatic stress disorder and acute stress disorder are mental health conditions with a known onset, and prevention strategies can therefore be used to try to prevent the emergence of the full-blown disorder. This chapter provides an overview of the current evidence-based prevention strategies for post-traumatic stress disorder and acute stress disorder. In the first part, diagnostic and epidemiological features of these disorders are considered. The second part of the chapter reviews the evidence base of current preventive psychological and pharmacological interventions. Although some early trials on primary intervention have shown promising effects, it appears too soon to provide any definite recommendation in clinical practice. Importantly, many current widely disseminated treatments lack evidence, and some interventions (for example, debriefing) may, in fact, have a negative impact on the natural recovery after trauma. This chapter highlights the importance of using science-driven interventions to prevent post-traumatic stress disorder and acute stress disorder.

Although mental health service providers have focused on the effects of trauma and related interventions for decades, little is known about pervasive and historic trauma, particularly for socially marginalized individuals. Thus, clinical issues associated with sociopolitical oppression have been under-investigated. Coupled with the lack of sufficient cultural competence when working with diverse clients, mainstream clinicians frequently lack adequate case conceptualization skills and culturally sensitive interventions to assist clients from diverse backgrounds. Using traumatic stress as a framework for exploring evidence-based interventions to address long-term, pervasive marginalization and its psychological effects, the authors propose that mindfulness techniques are particularly beneficial to this client population. The authors reviewed culture-centered interventions to address traumatic stress for marginalized client populations, focusing on the mindfulness practice of Falun Gong. Recommendations for practice include the inclusion of traumatic stress theory and techniques in pre-service training, professional development training for practitioners focusing on mindfulness techniques with clients assessed with historical trauma, and Web-based training for clinical faculty to enhance their knowledge about traumatic stress, historical trauma, and associated interventions for clients from marginalized communities. The authors offer recommendations for future research that focuses on studies exploring the usefulness of Falun Gong in working with clients with traumatic stress.

Radicalization to violence is a world social phenomenon that is related to mental health in multiple ways, not only because psychological factors and psychopathology are determinants of violent radicalization, but also because psychological distress, grief, and trauma are significant public health consequences of this form of violence. The complexity of violent radicalization manifestations and its increasing association with severe psychopathology in lone actors suggests that there is an important role for clinicians to play in supporting and complementing the work of frontline psychosocial services, as well as contributing to the transdisciplinary network needed to develop effective intervention models. However, given the risks of medicalizing forms of social suffering and of being co-opted by ideologically driven political interests, this professional involvement cannot take place without continuous ethical reflection and systemic evaluation. This chapter will describe the clinical model of intervention developed in Quebec (Canada), and discuss some of the organizational, clinical, and ethical challenges encountered.

Paranoid personality disorder (PPD) has held an uncertain position in psychiatric nosology, but remains a construct of interest because of its frequent presentation in the community and clinic. It remains misunderstood, in part due to a superficial similarity to schizophrenia and other psychotic disorders. Stronger relationships are found with trauma-related psychopathology and other impulsive, emotionally unstable personality disorders. From this point of view, PPD can be best understood through recent epidemiological, neurobiological, and psychological research. This literature is reviewed and summarized for the clinician to guide the processes of screening, assessment, and treatment planning. While the field awaits definitive treatment studies, some clues are available from preliminary studies. This research points to the need for interventions that account for the habitual nature of PPD-related behaviors, and directly target the issue of mistrust by utilizing interaction with the therapist as a form of exposure and new learning.

Chapter 2 identifies and describes developmental and clinical psychological concepts that may be useful in forensic Miller evaluations when addressing Miller’s standards for immaturity. Concepts related to the decisional immaturity factor include two models of psychosocial immaturity and the “maturity gap” concept. The dependency immaturity factor is examined through the lens of trauma concepts and individual differences in dependency. The offense context factor offers conceptual ways of thinking about the impact of immaturity on the offense drawn from reasoning in other types of forensic evaluations. The prospects for rehabilitation factor is examined with concepts related to amenability to rehabilitation and the appropriateness of interventions. Concepts relevant for Miller’s “irreparable corruption” include life-course-persistent and adolescence-limited offending patterns, psychopathy, sophistication and maturity, and the Risk-Needs-Responsivity model. A model is provided for the forensic process of analyzing irreparable corruption. Finally, several concepts from general developmental psychology are reviewed for their relevance to Miller cases.

In palliative care, there is a need to develop and use better tools for clinical assessment and intervention that address illness-related stressors. Eye movement desensitization and reprocessing (EMDR), originally developed as a psychotherapy treatment for posttraumatic stress disorder, has shown efficacy in pain and symptom management. Research studies indicate that EMDR, a culturally adaptable, evidence-informed treatment that targets emotional distress and associated physical symptoms, can reduce the physical and emotional distress of serious illness and side effects successfully. This chapter considers the development of EMDR and its use in the psychological support of people with trauma, including those living with or recovering from serious illness. It outlines the basic EMDR trauma protocol and eight phases of treatment, examining an exploratory process that may help palliative care patients further understand the relationship between body and mind. Additionally, the chapter will outline other EMDR protocols used with persons experiencing pain. Information about basic and advanced training, continuing education, and professional resources is included.

The chapter outlines the prevalence of traumatic events in the lives of our nation’s children and adolescents and highlights populations that are particularly vulnerable to trauma exposure. The chapter outlines the clinical features of pediatric posttraumatic stress disorder (PTSD) and describes considerations for differential diagnosis. Common comorbid diagnoses are described, as are the short- and long-term academic consequences of trauma exposure. Screening tools for trauma exposure and PTSD are presented. The chapter provides an overview of the strategies and interventions used in schools to mitigate the impact of trauma on students and describes approaches to monitoring the impact of these efforts at the micro, macro, and mezzo levels. Resources for school staff supporting trauma exposed students are provided.

Trauma- and stressor-related disorders (TSRD) are disabling psychiatric disorders that have distinct diagnostic criteria; however, some share commonly endorsed symptoms including disturbed sleep. This chapter provides a comprehensive description of sleep–wake disturbances common in TSRD and summarizes the evidence for empirically supported psychotherapeutic and pharmacological treatments for these sleep disturbances. There are few controlled studies of the applicability of currently available sleep-focused interventions to the management of disturbed sleep in TSRD. However, there is evidence supporting the efficacy of some psychotherapeutic and pharmacological treatments for the sleep disturbances in TSRD. Future investigations should include randomized clinical trials that combine treatments focused on sleep with treatments effective in managing other symptoms of TSRD.

This chapter focuses on the clinical interventions most commonly delivered in problem-solving courts. The chapter begins with a discussion of the Risk-Needs-Responsivity Model, which provides a foundational context for the interventions used in problem-solving courts and highlights the importance of targeting offender needs—criminogenic needs—related to key outcomes (e.g., reduced recidivism, reduced relapse to drug use). The authors then discuss the various screening and risk assessment procedures used to admit offenders to problem-solving courts, the clinical interventions used in problem-solving courts (e.g., cognitive-behavioral interventions, 12-step programs, therapeutic communities, case management, trauma-informed care), and the use of evidence-based practices in problem-solving courts. The authors note the role of problem-solving courts as a watchdog for service provision and conclude with a section discussing “next steps” for expanding evidence-based interventions in problem-solving courts.

Introduction: The homeless population has a high prevalence of alcoholism and consumption of other drugs, which also means that they are at greater risk of developing all complications resulting from alcohol abuse. (MILER et al, 2021). The medical attention for homeless population is a device of the Unified Health System that claims social, health policies and the guarantee of fundamental rights (BRASIL, 2009). Methods: Evaluation of protocols and referral flows for the treatment of patients with ‘mental disorders and due to alcohol use’, of the medical attention for homeless population in the city of Petrópolis (Rio de Janeiro), between April / 2020 and April 2021, data from e-SUS, and literature review. Results: The city of Petrópolis (Rio de Janeiro) registered 259 people without home, 84.8% are men, all people are adults between 20-74 years old, 98% are born Brazilians, 92% reported alcohol consumption, and alcohol with other drugs 61% (cocaine, crack, marijuana, solvent, tobacco). There was 3 patients with diagnose of Wernicke-Korsakoff syndrome: 2 men and 1 woman (aged 60-65 years) in the period from April 2020 - April 2021 (BRAZIL, 2021 The medical attention for homeless population approach to alcoholism includes the CAGE and AUDIT tests, symptomatic treatment and brief psychological interventions. aimed at weaning, and the Clinical Institute Withdrawal Assessment of Alcohol Scale Revised scale to quantify the degree of abstinence. However, the majority of users do not want total cessation, generally they choose to reduce consumption (secondary prevention), and later recovery and reintegration into society, highlighting that self-help groups and social assistance have a prominent role (tertiary prevention) (MARSCHARLL; GREGANTI, 2002; LONGO, et al., 2013). Conclusion: Despite confounding / aggravating factors such as social determinants in health, and the difficulties of the health network, the medical attention for homeless population is fundamental in the secondary and tertiary prevention of neurological diseases due to chronic alcohol consumption; complex cases require complex interventions, that is, individualization, adaptation and flexibility.

Background: Traumatic Brain Injury (TBI) is an anatomical or functional injury that affects the skull or brain and other associated structures. When analyzing the occurrence of TBI in the geriatric population, Ground Level Fall (GLF) is the main mechanism of trauma. Objectives: To understand the scenario of TBI from GLF in the elderly, characterizing it, in order to point out associated factors and its consequences. Desing and setting: Systematic review at the University of Pernambuco in Recife city. Methods: This is a systematic review of articles indexed in the MEDLINE/ Pubmed, LILACS, BDENF and BINACIS databases and two other works from Google Scholar in April 2021. Original articles in Portuguese and English that met the objectives of this review and were published in the last ten years (2011-2021) were included. Results: Four articles were included. The mean age of elderly who developed TBI from GLF was around 80 years, with a higher prevalence in females. In ad- dition, it was observed that most victims already had associated comorbidities and medications, such as anticoagulants, antiplatelet agents and antiarrhythmic agents. Patients had an average length of hospital stay from 2 to 7.7 days. Limbs and Face injuries were observed. Conclusions: TBI from GLF in the elderly is frequent and even though the length of hospital stay and deaths related to this trauma were low, physical and psychological consequences are also associated to this injury. Clinical Trial or Systematic Review Registration: 254698, https://www.crd.york. ac.uk/prospero/

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.