Anxiety Disorders: Zatzick D

Grupp-Phelan J, Zatzick D. · No affiliation provided · J Pediatr. · Pubmed #15756209 No free full text.

This publication has no abstract.

Katon WJ, Zatzick D, Bond G, Williams J. · Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195-6560, USA. · J Trauma Stress. · Pubmed #17075915 No free full text.

Abstract: Randomized controlled trials have established the efficacy of psychotherapy and medication treatments for posttraumatic stress disorder (PTSD). Despite these advancements, many individuals do not receive guideline-concordant PTSD care. In an effort to advance dissemination of evidence-based PTSD treatments, the authors review several examples of dissemination efforts of mental health interventions. The first examples describe the dissemination of multifaceted collaborative care interventions for patients with depressive disorders and evidence-based interventions for patients with severe mental illness. The final example explores evolving efforts to adapt and disseminate interventions to acutely injured trauma survivors. For each example, the authors describe the problem with prior clinical approaches, the program to be disseminated, the barriers and levers to implementation and the progress in overcoming these barriers.

Zatzick D, Roy-Byrne P. · Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, USA. · Semin Clin Neuropsychiatry. · Pubmed #12874737 No free full text.

Abstract: This pharmacotherapy chapter outlines a series of recommendations regarding the delivery of medications for patients who present with posttraumatic stress disorders (PTSD) and related behavioral and emotional disturbances in the acute care medical setting. These recommendations integrate information previously articulated in PTSD treatment guidelines with clinical experiences derived from real world effectiveness trials. Information from clinical trials suggests that there are patient, provider, and system level considerations that serve to influence the delivery of pharmacotherapeutic interventions targeting PTSD in acute care. The current pharmacotherapy recommendations also integrate considerations regarding the delivery of psychotherapeutic interventions targeting PTSD among injured trauma survivors.

Zatzick D, Roy-Byrne P. · Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, Washington, USA. · Semin Clin Neuropsychiatry. · Pubmed #12874736 No free full text.

Abstract: The secondary prevention of posttraumatic stress disorder (PTSD) and related comorbidities among injured trauma survivors constitutes an important public health problem. This article outlines quality-of-care criteria that are intended to guide intervention development for PTSD in the acute care medical setting. The multiple demographic, injury, and service delivery system factors that characterize the acute care setting's clinical heterogeneity are discussed. A model of intervention development that begins with population-based descriptive studies and small pilots of efficacious PTSD treatments and evolves to the development of larger-scale multifaceted collaborative interventions is introduced. Collaborative interventions hold promise for injured trauma survivors treated in acute care settings because they combine evidence-based PTSD interventions and patient-centered supportive care.

Zatzick D. · Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA. · Semin Clin Neuropsychiatry. · Pubmed #12874735 No free full text.

Abstract: Each year in the United States approximately 2.5 million Americans incur injuries so severe that they require inpatient admissions to acute care medical settings. This article reviews the development of posttraumatic stress disorder (PTSD) and related comorbid medical conditions among injured trauma survivors. Between 10% and 40% of injured trauma survivors appear to develop PTSD in the weeks and months after their injury. The symptoms of PTSD are clearly linked to a broad spectrum of functional impairment and diminished well-being in injured patients. Although PTSD, depression, somatic amplification, and recurrent substance use are common disturbances after injury, it appears that few symptomatic trauma survivors receive formal mental health evaluation or treatment. Substantial perceived and structural barriers to accessing care exist for injured trauma survivors. The public health significance of these findings is discussed and implications for future intervention development are explored in the following chapters.

Zatzick D, Roy-Byrne P, Russo J, Rivara F, Droesch R, Wagner A, Dunn C, Jurkovich G, Uehara E, Katon W. · Department of Psychiatry and Behavioral Sciences, the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle 98104, USA. · Arch Gen Psychiatry. · Pubmed #15123495 links to  free full text

Abstract: CONTEXT: Although posttraumatic stress disorder (PTSD) and alcohol abuse frequently occur among acutely injured trauma survivors, few real-world interventions have targeted these disorders. OBJECTIVE: We tested the effectiveness of a multifaceted collaborative care (CC) intervention for PTSD and alcohol abuse. DESIGN: Randomized effectiveness trial. PARTICIPANTS: We recruited a population-based sample of 120 male and female injured surgical inpatients 18 or older at a level I trauma center. INTERVENTION: Patients were randomly assigned to the CC intervention (n = 59) or the usual care (UC) control condition (n = 61). The CC patients received stepped care that consisted of (1) continuous postinjury case management, (2) motivational interviews targeting alcohol abuse/dependence, and (3) evidence-based pharmacotherapy and/or cognitive behavioral therapy for patients with persistent PTSD at 3 months after injury. MAIN OUTCOME MEASURES: We used the PTSD symptomatic criteria (PTSD Checklist) at baseline and 1, 3, 6, and 12 months after injury, and alcohol abuse/dependence (Composite International Diagnostic Interview) at baseline and 6 and 12 months after injury. RESULTS: Random-coefficient regression analyses demonstrated that over time, CC patients were significantly less symptomatic compared with UC patients with regard to PTSD (P =.01) and alcohol abuse/dependence (P =.048). The CC group demonstrated no difference (-0.07%; 95% confidence interval [CI], -4.2% to 4.3%) in the adjusted rates of change in PTSD from baseline to 12 months, whereas the UC group had a 6% increase (95% CI, 3.1%-9.3%) during the year. The CC group showed on average a decrease in the rate of alcohol abuse/dependence of -24.2% (95% CI, -19.9% to -28.6%), whereas the UC group had on average a 12.9% increase (95% CI, 8.2%-17.7%) during the year. CONCLUSIONS: Early mental health care interventions can be feasibly and effectively delivered from trauma centers. Future investigations that refine routine acute care treatment procedures may improve the quality of mental health care for Americans injured in the wake of individual and mass trauma.

Osenbach JE, Stubbs J, Wang J, Russo J, Zatzick D. · Department of Psychiatry & Behavioral Sciences at the University of Washington School of Medicine in Seattle, Seattle, WA 98104, USA. · Psychiatry. · Pubmed #19366295 No free full text.

Abstract: Prior research suggests that involvement in a lawsuit may be associated with the development of enduring posttraumatic stress disorder (PTSD) symptoms as well as inflated and potentially invalid symptom reports. This research aimed to describe the spectrum of legal events experienced by injured trauma survivors and prospectively assessed the association between legal events and PTSD symptoms. Over a nine month period, hospitalized injury survivors were randomly screened for study participation. Legal events were prospectively assessed, and PTSD symptoms were reported twelve months after the injury. Linear regression was used to determine the association between legal events and higher PTSD symptom levels. Increasing numbers of legal events were associated with significantly higher PTSD symptom levels. Seeking legal counsel (34%), being a victim of non-violent crime (14%), and involvement in a lawsuit (9%) were the most common legal events reported. None of these categories of legal events, however, were associated with significantly higher PTSD symptom levels. Because injury survivors are frequently involved in a spectrum of legal events, it is important for future research to assess the cumulative burden of legal events, as these experiences may represent recurring stressful life events that have the potential to exacerbate PTSD symptoms.

Zatzick D, Jurkovich GJ, Rivara FP, Wang J, Fan MY, Joesch J, Mackenzie E. · Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Box 359896, 325 Ninth Ave, Seattle, WA 98104, USA. · Ann Surg. · Pubmed #18791363 No free full text.

Abstract: OBJECTIVE: To examine factors other than injury severity that are likely to influence functional outcomes after hospitalization for injury. SUMMARY BACKGROUND DATA: This study used data from the National Study on the Costs and Outcomes of Trauma investigation to examine the association between posttraumatic stress disorder (PTSD), depression, and return to work and the development of functional impairments after injury. METHOD: A total of 2707 surgical inpatients who were representative of 9374 injured patients were recruited from 69 hospitals across the US. PTSD and depression were assessed at 12 months postinjury, as were the following functional outcomes: activities of daily living, health status, and return to usual major activities and work. Regression analyses assessed the associations between PTSD and depression and functional outcomes while adjusting for clinical and demographic characteristics. RESULTS: At 12 months after injury, 20.7% of patients had PTSD and 6.6% had depression. Both disorders were independently associated with significant impairments across all functional outcomes. A dose-response relationship was observed, such that previously working patients with 1 disorder had a 3-fold increased odds of not returning to work 12 months after injury odds ratio = 3.20 95% (95% confidence interval = 2.46, 4.16), and patients with both disorders had a 5-6 fold increased odds of not returning to work after injury odds ratio = 5.57 (95% confidence interval = 2.51, 12.37) when compared with previously working patients without PTSD or depression. CONCLUSIONS: PTSD and depression occur frequently and are independently associated with enduring impairments after injury hospitalization. Early acute care interventions targeting these disorders have the potential to improve functional recovery after injury.

Zatzick D, Roy-Byrne PP. · Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 9th Avenue, Seattle, WA 98104-2499, USA. · Psychiatr Serv. · Pubmed #17158486 links to  free full text

Abstract: OBJECTIVE: Approximately 37 million acute care injury visits are made in the United States each year, and 2.5 million individuals are so severely injured that they require inpatient hospitalization. Few investigations have used pharmacoepidemiologic methods to determine which medications with strong theoretical support for secondary prevention of posttraumatic stress disorder (PTSD) are already in widespread use in acute care settings. METHODS: The investigators conducted a population-based assessment of medication administration for randomly selected adolescents (N=113) and adults (N=152) hospitalized at a level 1 trauma center after physical injury. Medication prescription at the time of surgical inpatient discharge was assessed by review of automated medical records. RESULTS: Opiate analgesic medications were prescribed to between 82 and 88 percent of injury survivors; 34 to 46 percent of patients also received nonopiate analgesic prescriptions. Between 11 and 16 percent of patients were prescribed antihistamines. Benzodiazepines, anticonvulsants, corticosteroids, beta-adrenergic blockers, and all other psychotropic medications were prescribed to less than 10 percent of adolescent and adult patients. CONCLUSIONS: Theoretical rationales exist for the testing of multiple compounds in the prevention of PTSD; pharmacoepidemiologic data inform which of these medications are already in widespread use and therefore may be most appropriate for testing in randomized trials. Efficacy trials and basic research could focus on the development of compounds that target both pain and anxiety for testing in the secondary prevention of PTSD after injury.

Zatzick D, Russo J, Grossman DC, Jurkovich G, Sabin J, Berliner L, Rivara F. · Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, PO Box 359896, 325 Ninth Avenue, Seattle, Washington 98104-02499, USA. · J Pediatr Psychol. · Pubmed #16093520 No free full text.

Abstract: OBJECTIVE: Few investigations have comprehensively assessed the scope of impairment of injured adolescents presenting to acute care inpatient settings. METHODS: Randomly sampled injured adolescent inpatients and their parents were screened for posttraumatic stress (PTS) and depressive symptoms, preinjury alcohol use, and preinjury trauma. Linear regression was used to assess which clinical, demographic, and injury characteristics were independently associated with increased levels of adolescent PTS and depressive symptoms. RESULTS: Fifty-seven percent [corrected] of adolescent-parent dyads endorsed high levels of PTS or depressive symptoms and/or high preinjury alcohol use. Adolescent female gender, greater levels of preinjury trauma, greater subjective distress at the time of the injury, and greater parental depressive symptoms were independently associated with increased levels of adolescent PTS and depressive symptoms. CONCLUSIONS: The adoption of early screening and intervention procedures that broadly consider the scope of impairment of injured adolescents and their family members could enhance the quality of acute care mental health service delivery.

Holtzheimer PE, Russo J, Zatzick D, Bundy C, Roy-Byrne PP. · Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Harborview Medical Center, 325 Ninth Ave., Box 359911, Seattle, WA 98104-2499, USA. · Am J Psychiatry. · Pubmed #15863800 links to  free full text

Abstract: OBJECTIVE: Posttraumatic stress disorder (PTSD) is often comorbid with other psychiatric disorders but often goes unrecognized. The effects of PTSD comorbidity are unclear, especially in patients with severe mental illness. The authors assessed short-term clinical outcome in severely depressed psychiatric inpatients with and without comorbid PTSD. METHOD: From patients hospitalized between 1995 and 2000, all patients with depression and comorbid PTSD (N=587) were selected and matched with depressed patients without PTSD (N=587). Clinical outcome was assessed with a semistructured, physician-administered battery. Differences between the two groups were examined, with overall burden of psychiatric illness entered as a covariate in the analyses. RESULTS: Relative to depressed patients without PTSD, depressed patients with PTSD had, at discharge, greater psychiatric symptom severity and higher levels of depression and hostility. Depressed patients with comorbid PTSD also had a significantly higher rate of being discharged against medical advice (odds ratio=6.10, 95% CI 2.96-12.57). CONCLUSIONS: PTSD comorbidity correlates with poorer short-term clinical outcome and greater likelihood of discharge against medical advice in severely depressed psychiatric inpatients. Better recognition of PTSD comorbidity may improve overall care of these patients.

Zatzick D, Russo J, Rivara F, Roy-Byrne P, Jurkovich G, Katon W. · Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104-2499, USA. · Gen Hosp Psychiatry. · Pubmed #15694219 No free full text.

Abstract: Each year, approximately 2.5 million Americans require inpatient admissions after sustaining traumatic physical injuries. Few investigations have assessed the routine detection and treatment of acute care inpatients with high levels of posttraumatic distress. A representative sample of 101 hospitalized patients with acute injuries was screened for posttraumatic stress disorder (PTSD) and depressive symptoms, as well as substance intoxication. Patients' medical records were reviewed for documentation of psychiatric symptoms and diagnoses and the initiation of early evaluation and treatment. High levels of PTSD and/or depressive symptoms were present in over 50% of patients. Although providers frequently noted symptomatic distress, few symptomatic patients received formal diagnoses, evaluations or treatment. Patients who had positive substance toxicology screens on admission infrequently received in-depth evaluation or treatment. A substantial number of injured trauma survivors have high levels of symptomatic distress that are inconsistently evaluated and treated in the acute care medical setting. Mental health interventions appear to be feasibly and effectively delivered from trauma centers. Therefore, ongoing investigation and policy initiatives informing the detection and treatment of patients with psychiatric disturbances in acute care could substantially enhance the quality of mental health care for injured survivors of individual and mass trauma.

Zatzick D, Jurkovich G, Russo J, Roy-Byrne P, Katon W, Wagner A, Dunn C, Uehara E, Wisner D, Rivara F. · Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, Washington 98104-2499, USA. · J Trauma. · Pubmed #15345986 No free full text.

Abstract: BACKGROUND: Injured survivors of individual and mass trauma receive their initial evaluation in acute care. Few investigations have comprehensively screened for posttraumatic stress disorder (PTSD) symptoms and related comorbidities across sites. METHODS: This investigation included 269 randomly selected injury survivors hospitalized at two level 1 trauma centers. All patients were screened for PTSD, depressive, and peritraumatic dissociative symptoms during their surgical inpatient admission. Prior traumatic life events and alcohol abuse/dependence also were assessed. RESULTS: In this study, 58% of the patients demonstrated high levels of immediate posttraumatic distress or alcohol abuse/dependence. Regression analyses identified greater prior trauma, female gender, nonwhite ethnicity, and site as significant independent predictors for high levels of posttraumatic distress. CONCLUSIONS: High levels of posttraumatic distress, recurrent trauma, and alcohol abuse/dependence were present in more than half of acute care inpatients. Early mental health screening and intervention procedures that target both PTSD and alcohol use should be developed for acute care settings.

Roy-Byrne PP, Russo J, Michelson E, Zatzick D, Pitman RK, Berliner L. · Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, Seattle, Washington 98104-2499, USA. · Depress Anxiety. · Pubmed #15022142 No free full text.

Abstract: Prevention of post-traumatic stress disorder (PTSD) in trauma victims is an important public health goal. Planning for the studies required to validate prevention strategies requires identification of subjects at high risk and recruitment of unbiased samples that represent the larger high-risk population (difficult because of the avoidance of many trauma victims). This study recruited high-risk victims of interpersonal violence (sexual or physical assault) presenting to an urban emergency department for prospective 1- and 3-month follow-up. Of 546 victims who were approached about participating, only 56 agreed to be contacted and only 46 participated in either the 1- or 3-month interviews. Of the 46, 43 had been previously victimized with a mean of over six traumas in the group; 21% had prior PTSD, 85% had prior psychiatric illness, and 37% had prior substance abuse. Sixty-seven percent had positive urine for alcohol or drugs on presentation. Fifty-six percent developed PTSD at 1 or 3 months with the rate declining between 1 and 3 months. There was high use of medical and psychiatric services. These findings document both the difficulty of recruiting large samples of high-risk assault victims to participate in research, and the high rate of prior traumatization, PTSD, substance use, and psychiatric morbidity in these subjects which, if still active at the time of victimization, may complicate efforts to document preventive treatment effects.

Roy-Byrne P, Berliner L, Russo J, Zatzick D, Pitman RK. · Department of Psychiatry and Behavioral Science, University of Washington, Harborview Medical Center, 325 9th Avenue, Box 355911, Seattle, WA 98104-2499, USA. · J Nerv Ment Dis. · Pubmed #12637842 No free full text.

Abstract: To determine the treatment preferences (, medication, counseling, or both) for victims of recent trauma at risk for posttraumatic stress disorder and the determinants of those choices, preferences were elicited from 466 consecutive victims of physical or sexual assault at an urban emergency department as part of the routine clinical evaluation by emergency department social workers. Demographics, assault characteristics, and clinical history were used to predict preference. More than 80% of victims expressed an interest in treatment, with more interested in counseling (76%) than medication (62%). Female gender and assaults of a sexual nature were most highly predictive of preference for medication, whereas female gender, sexual assault, a history of psychiatric treatment, and perceived life threat from the trauma were most predictive of preference for counseling and preference for any treatment. Because treatment preferences were easily obtained from assault victims seeking emergency care, the elicitation of these treatment preferences and the consideration of them in the treatment planning process could facilitate engagement in treatment and overcome the avoidance of treatment by some victims.

Cerda G, Zatzick D, Wise M, Greenhalgh D. · Shriners Hospital for Children, Northern California, Sacramento, USA. · J Burn Care Rehabil. · Pubmed #10935820 No free full text.

This publication has no abstract.