Objective: To evaluate whether posttraumatic stress disorder (PTSD) is related to outcomes in persons with severe mental illness (SMI) participating in a study of vocatinal rehabilitation programs

Background: PTSD is a common comorbid disorder in people with SMI, but it is unknown whether PTSD interferes with the ability to benefit from rehabilitation programs such as supported employment.

Methods: The relationships between PTSD and symptoms, health, quality of life, and work outcomes was examined in 176 clients with SMI participating in a 2-year randomized controlled trial of three vocational rehabilitation programs: supported employment based on the Individual Placement and Support model, a psychosocial rehabilitation program based on transitional employment, and standard services.

Results: The overall rate of current PTSD in the sample was 16%. Compared with clients without PTSD, clients with PTSD had more severe psychiatric symptoms, worse reported health, lower self-esteem, and lower subjective quality of life. Clients with PTSD who participated in the Individual Placement and Support model (the most effective vocational model of the three studied) also had worse employment outcomes over the 2-year study period than clients without PTSD, with lower rates of compeitive work, fewer hours worked, and fewer wages earned. Employment outcomes did not differ between clients with PTSD versus without PTSD in the other two vocational rehabilitation approaches.

Conclusion: The findings suggest that PTSD may contribute to worse work outcomes in clients participating in supported employment programs. Effective treatment of these clients with PTSD may improve their ability to benefit from supported employment.

The diagnosis for posttraumatic stress disorder (PTSD) requires that onset be initiated by a negative life event. The event is considered capable of producing PTSD if it creates a threat to the person's physical integrity and produces a reaction of shock and horror. The traumatic events most frequently described in the research literature are combat and rape. These events are well known to produce the three symptom clusters that comprise PTSD and include: (A) re-experiencing symptoms, such as nightmares, sudden unbidden intrusive images and thoughts of the event, and flashbacks; (B) symptoms classified as avoidance, including efforts to avoid thoughts and feelings related to the event, sense of foreshortened future, and emotional numbing; and (C) symptoms of hyperarousal, such as hypervigilance and exaggerated startle response.

The nature of PTSD, particularly that it emerges from significantly disturbing life experiences, may contribute to the limited inquiry about the presence of the disorder among youths. It is difficult to consider that children and teenagers are exposed to terrible events such as physical assault, rape, and mass violence, which frequently lead to sustained psychiatric problems. However, the reality is that children and adolescents experience more violence than adults and that PTSD appears among youth at a rate equivalent to that of adults.

Despite its heterogeneous symptomatology, obsessive-compulsive disorder (OCD) is currently conceptualized as a unitary diagnostic entity. Recent factor-analytic studies have identified several OCD symptom dimensions that are associated with different demographic variables, comorbidity, patterns of genetic transmission, and treatment response. Functional abnormalities in neural systems important for emotion perception, including the orbitofrontal cortex, lateral prefrontal cortex, anterior cingulate gyrus, and limbic regions, have been reported in OCD. In this review, we discuss the extent to which neurobiological markers may distinguish these different symptom dimensions and whether specific symptom dimensions, such as contamination/washing, are associated with abnormalities in emotion and, in particular, disgust, perception in OCD. Also discussed are findings that indicate that anxiety can be induced in healthy volunteers in response to OCD symptom-related material, and that associated increases in activity within neural systems important for emotion perception occur to washing- and hoarding-related material in particular in these subjects. Further examination of neural responses during provocation of different symptom dimensions in OCD patients will help determine the extent to which specific abnormalities in neural systems underlying emotion perception are associated with different symptom dimensions and predict treatment response in OCD.

Objective: As part of this national project, we examined barriers and strategies to implementation of two evidence-based practices (EBPs) in Indiana.

Background: Despite many advances in the knowledge base regarding mental health treatment, the implementation of EBPs in real-world setting remains poorly understood. The National EBP Project is a multi-state study of factors influencing implementation of EBPs.

Methods: Over a 15-month period we observed eight assertive community treatment (ACT) programs and six integrated dual disorders treatment (IDDT) programs and noted pertinent actions taken by the state mental health agency influencing implementation. We created a database containing summaries of monthly visits to each program and interviews with key leaders. Using this database and clinical impressions, we rated barriers and strategies at each site on seven factors: Attitudes, Mastery, Leadership, Staffing, Policies, Workflow, and Program Monitoring.

Results: At the site level, the most frequently observed barriers were in the areas of leadership, staffing and policies for ACT, and mastery and leadership for IDDT. Overall, barriers were more evident for IDDT than for ACT. Strategies were less frequently noted but generally paralleled the areas noted for barriers. However, our central finding was that ACT was generally more successfully implemented than IDDT throughout the state, and that this difference could be traced in large part to state-level factors relating to historical preparation for the practice, establishment of standards, formation of a technical assistance center, and funding.

Conclusion: In this case study, both state-level and site-specific factors influenced success of implementation of EBPs. To address these factors, the field needs systematic strategies to anticipate and overcome these barriers if full implementation is to be realized.

Anxiety is a common experience, particularly as a response to life stressors. However, severe and uncontrollable anxiety can become a mental disorder. Community studies indicate that 19% of men and 31% of women will develop some type of anxiety disorder during their lifetime. In one such study, the National Comorbidity Survey (NCS), risk factors associated with a lifetime of anxiety disorder included lower income, less education, living in the northeast, and being female. The impact of patient sex is profound in that it increases the likelihood of developing an anxiety disorder by 85% in women compared to men.

Panic disorder is characterized by brief but intense recurrent episodes of fear or discomfort. Diagnostic criteria require recurrent panic attacks in 1 month or one panic attack with continuous fear of other attacks. Symptoms associated with the panic attack include palpitations; sweating; feeling short of breath or a choking sensation; nausea or abdominal discomfort; feeling dizzy; having a sense of unreality; numbness or tingling; chills or hot flushes; and a fear of dying or losing control.

We review the attributes of inhibited and uninhibited infant temperaments, and their developmental trajectories into early adulthood. Inborn individual differences in infants' propensity to respond to novel people and objects are associated with persistent differences in the responsivity of the amygdala to novelty, as measured with functional magnetic resonance imaging, after more than 20 years of development. Because an inhibited temperament is a risk factor for developing later psychiatric disorders, particularly generalized social anxiety disorder, temperamental differences are confounds in neuroimaging and genetic studies. Longitudinal studies are a unique tool for understanding the developmental and temperamental risk factors for psychiatric disorder.