Computer training to reduce trauma symptoms

computing

Computer training applied in addition to psychotherapy can potentially help reduce the symptoms of post-traumatic stress disorder (PTSD). These are the results found by researchers from Ruhr-Universität Bochum and their collaborating partners in a randomized controlled clinical trial with 80 patients with PTSD. With the computerized training, the patients learned to appraise recurring and distressing trauma symptoms in a less negative light and instead to interpret them as a normal and understandable part of processing the trauma. The results are described by a team headed by Dr. Marcella Woud and Dr. Simon Blackwell from the Department of Clinical Psychology and Psychotherapy, together with the group led by Professor Henrik Kessler from the Clinic for Psychosomatic Medicine and Psychotherapy at the LWL University Hospital Bochum in the journal Psychotherapy and Psychosomatics, published online on 23 February 2021.

Intrusions are a core symptom of post-traumatic stress disorder. Images of the traumatic experience suddenly and uncontrollably re-enter consciousness, often accompanied by strong sensory impressions such as the sounds or certain smells at the scene of the trauma, sometimes even making patients feel as if they are reliving the trauma. “Patients appraise the fact that they are experiencing these intrusions very negatively; they are often afraid that it is a sign that they are losing their mind,” explains Marcella Woud. “The feeling of having no control over the memories and experiencing the wide variety of intense negative emotions that often accompany intrusions make them even more distressing, which in turn reinforces negative appraisals.”

A sentence completion task could help patients to reappraise symptoms

Consequently, trauma therapies specifically address negative appraisals of symptoms such as intrusions. The Bochum-based team set out to establish whether a computerized training targeting these appraisals could also reduce symptoms and, at the same time, help to understand more about the underlying mechanisms of negative appraisals in PTSD. During the training, the patients are shown trauma-relevant sentences on the computer, which they have to complete. For example: “Since the incident, I sometimes react more anxiously than usual. This reaction is under_tand_ble.” Or: “I often think that I myself am to blame for the trauma. Such thoughts are un_ound_d.” The patients’ task is to fill in the word fragment’s first missing letter and by doing so to systematically appraise the statements in a more positive way. The aim is thus to learn that their symptoms are normal reactions and part of the processing of what they have experienced.

Approximately half of the study participants underwent this “cognitive bias modification-appraisal” training, while the other half received a placebo control training—a visual concentration training—which was not designed to change negative appraisals. Both trainings took place during the first two weeks of the patients’ treatment in the clinic, with four sessions each week. One session lasted about 20 minutes. During and after the inpatient treatment, various measurements were collected to record any changes to the symptoms.

Fewer trauma symptoms

Patients who had participated in the appraisal training subsequently rated their symptoms such as intrusions and trauma-relevant thoughts less negatively than patients in the control group, and they also showed fewer other trauma-relevant symptoms after the training. “This leads us to conclude that the training appears to work—at least in the short-term,” says Marcella Woud. “Our study was not designed to examine long-term effects, which is something we will have to do in future studies on top of studying the training’s mechanisms in more detail.”

In addition to the behavioral data, the concentration of the stress hormone cortisol was assessed using hair samples of the patients. A decrease in negative trauma-appraisals was accompanied by a decrease in stress hormones. The team intends to explore this correlation in more detail via follow-up studies.

Transparent study design

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Three decades-old antibiotics could offer an alternative to opioid-based painkillers

Three decades-old antibiotics administered together can block a type of pain triggered by nerve damage in an animal model, UT Southwestern researchers report. The finding, published online today in PNAS, could offer an alternative to opioid-based painkillers, addictive prescription medications that are responsible for an epidemic of abuse in the U.S.

Over 100 million Americans are affected by chronic pain, and a quarter of these experience pain on a daily basis, a burden that costs an estimated $600 billion in lost wages and medical expenses each year. For many of these patients – those with cancer, diabetes, or trauma, for example – their pain is neuropathic, meaning it's caused by damage to pain-sensing nerves.

To treat chronic pain, prescriptions for opioid painkillers have increased exponentially since the late 1990s, leading to a rise in abuse and overdoses. Despite the desperate need for safer pain medications, development of a new prescription drug typically takes over a decade and more than $2 billion according to a study by the Tufts Center for the Study of Drug Development, explains study leader Enas S. Kandil, M.D., associate professor of anesthesiology and pain management at UTSW.

Seeking an alternative to opioids, Kandil and her UT Southwestern colleagues – including Hesham A. Sadek, M.D., Ph.D., professor of internal medicine, molecular biology, and biophysics; Mark Henkemeyer, Ph.D., professor of neuroscience; Mahmoud S. Ahmed, Ph.D., instructor of internal medicine; and Ping Wang, Ph.D., a postdoctoral researcher – explored the potential of drugs already approved by the Food and Drug Administration (FDA).

The team focused on EphB1, a protein found on the surface of nerve cells, which Henkemeyer and his colleagues discovered during his postdoctoral training nearly three decades ago. Research has shown that this protein is key for producing neuropathic pain. Mice genetically altered to remove all EphB1 don't feel neuropathic pain, he explains. Even mice with half the usual amount of this protein are resistant to neuropathic pain, suggesting EphB1's promise as a target for pain-relieving drugs. Unfortunately, no known drugs inactivate EphB1.

Exploring this angle further, Ahmed used computer modeling to scan a library of FDA-approved drugs, testing if their molecular structures had the right shape and chemistry to bind to EphB1. Their search turned up three tetracyclines, members of a family of antibiotics used since the 1970s. These drugs – demeclocycline, chlortetracycline, and minocycline – have a long history of safe use and minimal side effects, Ahmed says.

To investigate whether these drugs could bind to and inactivate EphB1, the team combined the protein and these drugs in petri dishes and measured EphB1's activity. Sure enough, each of these drugs inhibited the protein at relatively low doses. Using X-ray crystallography, Wang imaged the structure of EphB1 with chlortetracycline, showing that the drug fits neatly into a pocket in the protein's catalytic domain, a key portion necessary for EphB1 to function.

In three different mouse models of neuropathic pain, injections of these three drugs in combination significantly blunted reactions to painful stimuli such as heat or pressure, with the triplet achieving a greater effect at lower doses than each drug individually. When the researchers examined the brains and spinal cords of these animals, they confirmed that EphB1 on the cells of these tissues had been inactivated, the probable cause for their pain resistance. A combination of these drugs might be able to blunt pain in humans too, the next stage for this research, says Kandil.

Unless we find alternatives to opioids for chronic pain, we will continue to see a spiral in the opioid epidemic. This study shows what can happen if you bring together scientists and physicians with different experience from different backgrounds. We're opening the window to something new."

Enas S. Kandil, M.D., Associate Professor, Anesthesiology and Pain Management, UT Southwestern

Source:

UT Southwestern Medical Center

Posted in: Medical Science News | Medical Research News | Pharmaceutical News

Tags: Anesthesiology, Animal Model, Antibiotic, Cancer, Cardiology, Chronic, Chronic Pain, Crystallography, Diabetes, Drugs, Education, heat, Medicine, Minocycline, Molecular Biology, Nerve, Neuropathic Pain, Neuroscience, Opioids, Pain, Pain Management, pH, Prescription Drug, Protein, Receptor, Research, Tetracycline, Trauma, X-Ray

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Diagnosis of anemia

Anemia more often than not may be diagnosed by clinical features alone. A simple blood test is usually enough to confirm the diagnosis of the condition.

Diagnostic workup however is needed to ascertain the underlying cause of the anemia. (1-5)

History and physical examination

Diagnosis begins with a detailed history and physical examination.

The physician enquires about dietary habits to determine lack of iron and vitamin B12 or folates in diet.

They will ask about the medications that the patient takes. Aspirin for example leads to stomach ulcers that may bleed regularly to cause anemia.

The doctor may ask about menstrual patterns and history of heavy bleeding. Any other disease or family history of anemias is also enquired.

A detailed physical examination entails examination of the abdomen for enlarged spleen or liver. Signs of jaundice, kidney disease or cancers are looked for.

Severe anemia may lead to heart failure. This occurs when the heart is not pumping blood around the body efficiently.

A rectal examination that entails insertion of a lubricated gloved finger gently into the rectum may help detect hidden focus of rectal bleeding that is causing the anemia.

A pelvic examination to exclude cause of bleeding may be needed in women with heavy periods and excessive menstrual bleed loss.

Pregnancy may lead to anemia and needs to be ruled out as a cause of anemia.

Laboratory tests for diagnosis of anemia

Diagnosis of anemia includes the following laboratory analyses and tests (1-5):

  • A routine blood count. Blood sample taken from a vein in the arm is assessed for blood counts. Anemia is detected if the level of haemoglobin is lower than normal.

    There may be fewer red blood cells than normal. Under the microscope the RBCs may appear smaller and paler than usual in case of iron deficiency anemia.

    The small size is termed microcytic anemia. In vitamin B12 of folate deficiency the RBCs may appear pale but larger than their usual size. This is called macrocytic anemia.

  • Ferritin stores – Ferritin is a protein that stores iron. If the blood levels of ferritin are low it indicates low iron stores in the body and helps detect iron deficiency anemia.
  • Blood tests include mean cell volume (MCV) and red blood cell distribution width (RDW).
  • Reticulocyte count is a measure of young RBCs. This shows if the RBC production is at normal levels.
  • Vitamin B12 and folate levels in blood – these help detect if the anemia if due to deficiency of these vitamins.
  • Bone marrow analysis to detect too many immature RBCs as seen in aplastic anemia or blood cancers. Lack of iron in bone marrow also points towards iron deficiency anemia.

    Bone marrow is obtained by inserting a hollow needle into the breast bone or hip bone and withdrawing small amount of the marrow. The sample is then placed on a glass slide and stained with special dyes. This is examined under the microscope.

  • Iron binding capacity. Lower capacity of iron binding indicates iron deficiency anemia.
  • In women of African, Mediterranean or Southeast Asia ancestry, mild anemia that does not respond to iron therapy may be due to thalassemia minor or sickle cell trait.

    These can be detected by genetic tests and electrophoresis of blood. Hemoglobin electrophoresis identifies various abnormal hemoglobins in the blood. It is used to diagnose sickle cell anemia, the thalassemias, and other inherited forms of anemia.

  • Complete work ups including assessment of hidden foci for bleeding in the abdomen or intestines. Liver and kidney functions are evaluated to check if the anemia is due to chronic liver or kidney disease.

Sources

  1. www.nhs.uk/Conditions/Anaemia-iron-deficiency-/Pages/Diagnosis.aspx
  2. www.cdph.ca.gov/…/mo-agb-anemiairondefhandout.pdf
  3. http://www.aafp.org/afp/1998/1015/p1475.html
  4. http://kidshealth.org/parent/medical/heart/anemia.html#
  5. http://www.nhs.uk/Conditions/Sickle-cell-anaemia/Pages/Diagnosis.aspx

Further Reading

  • All Anemia Content
  • What is Anemia?
  • Anemia Causes
  • Anemia Symptoms
  • Anemia Treatment
More…

Last Updated: Jun 4, 2019

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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What is a Vitrectomy?

A vitrectomy is a surgical procedure that may be carried out for a number of reasons:

  • improving vision in patients experiencing complications from diabetes
  • removing foreign bodies from the eye in cases of trauma
  • taking a biopsy to diagnose infections or diseases
  • as part of other operative procedures on the retina

The aim of the procedure in most cases is to remove the vitreous humour to allow access to other parts of the eye.

The vitreous humour is usually a transparent, gelatinous substance inside the eye, found behind the iris and the lens, and in front of the retina. Its only purpose is to give volume to the eye.

There are two different types of vitrectomies, posterior pars plana vitrectomy and anterior vitrectomy.

Posterior pars plana vitrectomy

This type of vitrectomy is carried out by a retina specialist. This procedure involves removing the vitreous gel from the eye through the pars plana, the region of the eye that is thought to have no function in the post-fetal period and as such is thought to be the safest point of entry into the eye. Surgical instruments are also introduced into the eye through the pars plana.

The vitreous jelly is dissected and then peeled or sucked out through small 1mm cuts made into the white of the eye. Any necessary repairs to the retina are carried out, as well as removing any foreign bodies, or, in the case of surgery to treat complications of diabetes, leaking blood vessels are sealed.

Image Credit: Saginbay / Shutterstock

Anterior vitrectomy

Anterior vitrectomies are carried out when vitreous gel leaks through the pupil and into the anterior (front) chamber of the eye. Eye trauma, cataracts of the lens, and corneal or glaucoma surgery, can cause this to occur. Anterior vitrectomies aim to minimize the risk of developing future problems due to leaking vitreous fluid, and to improve visual recovery.

Vitrectomy procedure: steps

Before the vitrectomy is done, pre-operative assessments are carried out. A full history is taken, covering both general and eye health, and details of medications prescribed for other conditions are discussed. Checks to ensure that anesthesia may be safely used on the individual patient will also be carried out. General anesthesia is usually used for vitrectomy procedures, but local anaesthetic can also be used if precisely placed.

Once a patient is underneath anesthesia, the eye is kept open with forceps. The doctor will make a small (1mm) incision, and cut through the pars plana, also known as the sclera or the white of the eye. A surgical microscope that allows a wide view of the inside of the eye, along with a magnified view, is inserted. Fiberoptic cables are also used to illuminate the inside of the eye. These instruments are inserted via separate openings. The vitreous fluid is then extracted using a vitrectomy probe and any retinal problems are treated at the same time. In diabetics, leaking blood vessels are laser-coagulated at this time.

The procedure usually takes several hours.

As vitreous jelly does not reform by itself, it is necessary to replace it with one of the substances below:

  • A gas bubble that is absorbed naturally over 2-3 weeks
  • Air that is absorbed within 24-36 hours
  • A blend of gas and air
  • An oil or heavy liquid that is surgically removed later

The chamber that was once filled with vitreous jelly will be filled naturally with aqueous humour after the gas and air have been absorbed.

Recovery from vitrectomy surgery

After vitrectomy surgery, vision will be blurred for several weeks. The eye will be sensitive and swollen, and improvement may not be seen until two weeks after the surgery.

If gas or oil has been used to replace the vitreous jelly, some patients are told to position their head in a downward tilt to ensure that the gas or oil is against the treated area of the retina, as gas will float to the top of the eye. Patients are asked to do this for around 4 to 14 days, for 50 minutes per hour, although this can change depending on the reason for the surgery. To make this more comfortable, neck pillows can be used. It is also advised that patients lie on their front when sleeping. All of these measures help the retina to heal in the right place.

Complications from vitrectomy procedures

Cataracts are known to occur after vitrectomies. The formation of cataracts has been linked to high oxygen levels in the proximity of the lens, which isn’t usually exposed to a lot of oxygen. It is hypothesized that the substances used to replace vitreous fluid do not keep oxygen away from the lens as efficiently as the natural vitreous fluid does. Retinal damage can also occur when air is inserted into the eye to replace the vitreous fluid.

If patients experience a significant decrease in vision quality, or increase in colored discharge, pain, swelling, light sensitivity or redness, emergency medical attention from an eye hospital should be sought.

Some patients may experience high pressure in the eye, which is treated with eye drops. Increased pressure in the eye can cause double vision and pain.

There is also a risk of infection, as with any surgical procedure. Infections will usually be treated with antibiotics.

Other complications include:

  • Bleeding in the eye
  • Damage to the lens
  • Problems with eye movement
  • Inflammation
  • Retinal re-detachment
  • Drooping eyelid
  • Distorted or blurred vision

Sources

  • https://www.asrs.org/patients/retinal-diseases/25/vitrectomy
  • www.ouh.nhs.uk/patient-guide/leaflets/files/100322vitrectomy.pdf
  • www.guysandstthomas.nhs.uk/…/vitrectomy.pdf
  • www.reviewofophthalmology.com/…/complications-of-vitreoretinal-surgery

Further Reading

  • All Vitrectomy Content

Last Updated: Feb 26, 2019

Written by

Lois Zoppi

Lois is a freelance copywriter based in the UK. She graduated from the University of Sussex with a BA in Media Practice, having specialized in screenwriting. She maintains a focus on anxiety disorders and depression and aims to explore other areas of mental health including dissociative disorders such as maladaptive daydreaming.

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