Exposure therapy

CBT (exposure therapy, cognitive restructuring, relaxation training, and social skills training) and pharmacotherapy are considered equally effective in SAD, but CBT can lead to a greater likelihood of maintaining response after treatment termination. Even after response, most patients continue to experience more than minimal residual symptoms. 

Davidson J, Lipper S, KUts CD, Mahorney S, Hammett E (1985) Platelet MAO activity in posttraumatic stress disorder. Am J Psychiatry 142 1341-1343 Davis M (2002) The role of NMDA receptors and MAP kinase in the amygdala in extinction of fear clinical implications for exposure therapy. Eur J Neurosci 16 395-398 DeBellis MD, Letter L, Trickett PK, Putnam FW (1994) Urinary catecholamine excretion in sexually abused girls. J Am Acad Child Adoles Psychiatry 33 320-327 Debiec J, LeDoux JE, Nader K (2002) Cellular and systems reconsolidation in the hippocampus. Neuron 36 527-538... 

Davis M, Myers KM (2002) The role of glutamate and gamma-aminobutyric acid in fear extinction clinical implications for exposure therapy. Biol Psychiatry 52 998-1007 Dawson VL, Kizushi VM, Huang PL, Snyder SH, Dawson TM (1996) Resistance to nemotox-icity in cortical cultures from neuronal nitric oxide synthase-deficient mice. J Nemosci... 

Although several studies have found that the combination of imipramine and behavioral therapy may be superior to either treatment alone, no studies have specifically examined the effects of combining the behavioral techniques with BZDs (132, 133,134, 135,136, 137 and 138). In a review of the literature, however, Wardle found that diazepam was superior to placebo in three of four studies in which patients also received exposure therapy ( 139). Combined treatment with BZDs and CBT may be advantageous for some patients, but it must be carefully designed to avoid potential problems ( 140). 

Norberg, M. M., Krystal, J. H., and Tolin, D. F. (2008). A meta-analysis of D-cycloserine and the facilitation of fear extinction and exposure therapy. Biol. Psychiatry 63, 1118—1126. 

Eye movement desensitization and reprocessing (EMDR) is a relatively new treatment of traumatic memories that involves elements of exposure therapy and CBT, combined with techniques (eye movements, hand taps, sounds) that create an alteration of attention back and forth across the person s midline. While the theory and research are still evolving with this form of treatment, there is some evidence that the therapeutic element unique to EMDR, attentional alteration, may facilitate accessing and processing traumatic material. 

TABLE 6.7. Recommended antidote protocol for emergency nerve agent exposure therapy ... 

Pediatric - Elderly Pre-existing Medical Conditions Could happen in closed environment No need for high casualties Post-exposure therapies is focus First responders and DeCon personnel... 

Kushner MG, Kim SW, Donahue C, Thuras P, Adson D, Kotlyar M, McCabe J, Peterson J, Foa EB (2007) D-cycloserine augmented exposure therapy for obsessive-compulsive disorder. Biol Psychiatry 62 835-838. 

In the case of exposure to nerve agents, immediate post-exposure therapy consisting of atropine, oxime and diazepam should be given by intramuscular injection from an autoinjector device on the appearance of the first significant signs of nerve agent poisoning. Three oximes are available in autoinjectors for self- or buddy-administration and these are pralidoxime as the methanesulphonate, methyl sulphate and chloride salts, obidoxime dichloride and HI-6 dichloride. 

GA GB GD GF VX Anticholinesterase agents. Pre-treatment with pyridostigmine. Post-exposure therapy Cholinergic blockage - atropine. Enzyme reactivation - oximes. Anticonvulsant - diazepam. Assisted ventilation. e. Suction for respiratory secretions. Occasional early transient tachycardia and/or hypotension followed by bradycardia and hypotension. 

Post-Exposure Therapy. The main principles of therapy for nerve agent poisoning are early treatment, assisted ventilation, bronchial suction, muscarinic cholinergic blockade (atropine), enzyme reactivation (2 Pam Chloride) and anticonvulsants (Diazepam). GD permanently binds to receptors in two minutes after that 2 PAM Cl is not useful. 

I. Post-Exposure Therapy. There is no specific treatment available for the treatment of mustard lesions. The aim of therapy is to relieve symptoms, prevent infections, and promote healing. Resolution of specific problems can be difficult to predict but the following may provide a guide. 

The ability of HuBChE to prevent toxicity induced by soman and VX was assessed in rhesus monkeys. A molar ratio of HuBChEiOP -1.2 was sufficient to protect monkeys against an i.v. bolus injection of 2 X LD50 of VX, while a ratio of 0.62 was sufficient to protect monkeys against an i.v. dose of 3.3 X LD50 of soman, with no additional post-exposure therapy. A remarkable protection was also seen against soman-induced behavioral deficits detected in the performance of a spatial discrimination task (Figure 6.5). 

Selective serotonin reuptake inhibitors (SSRIs) are the first-line therapy for PTSD. Efficacy for fluoxetine, paroxetine, and sertraline has been demonstrated in well-designed double-blind placebo-controlled studies to reduce all symptom domains (intrusive recollection, avoidance/numbness, and hyperarousal). - Other treatment options include the tricyclic antidepressants (TCAs) amitriptyline and imipramine and the irreversible monoamine oxidase inhibitor (MAOl) phenelzine, which have been shown to reduce re-experiencing. However, in comparison with SSRIs, TCAs and phenelzine are associated with a higher incidence of side-effects, risk of overdose, and poor compliance. Alprazolam has demonstrated anecdotal efficacy however, regular use of benzodiazepines is not recommended. Benzodiazepines can be used on an as-needed basis for specific symptoms (e.g. sleep disturbances). CBT has shown beneficial effects in relatively well-controlled studies, while the results with exposure therapy are... 

Blomhoff S, Tangen H, Hellstrom K et al. Randomized controlled general practice trial of sertraline, exposure therapy and combined treatment in generalized social phobia. Br J Psychiatry 2001 1 79 23-30. 

Keane, T. M. (1995). The role of exposure therapy in the psychological treatment of PTSD. National Centre for Post-Traumatic Stress Disorder Clinical Quarterly 5 1-6. 

Scavenger molecules for pretreatments and immediate post-exposure therapies Vesicants... 

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