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Introduction and Objective. We aimed to evaluate urinary functional outcomes of top-down holmium laser enucleation of the prostate (HoLEP) in patients who underwent transurethral resection of the prostate (TURP) for the management of benign prostatic hyperplasia (BPH) compared to patients with primary BPH. Materials and Methods. We carried out a retrospective analysis of patients who underwent top-down HoLEP for the management of recurrent BPH at our institution. Patients who had previously undergone TURP were assigned to group I, while those with no history of prostate surgery were allocated to group II. Preoperative clinical characteristics, enucleation time, resected tissue weight, morcellation time, energy used, and intraoperative and postoperative complications were recorded and statistically analyzed. Patients were followed up postoperatively at 1, 3, 6, and 12 months. The evaluation included the International Prostate Symptom Score (IPSS), quality of life assessment (QoL), maximum urinary flow rate (Qmax), postvoid residual urine test (PVR), and continence status. Results. Two hundred and sixty-nine patients were included in this study. Group I consisted of 68 patients with recurrent BPH, while group II included 201 patients. There were no statistically significant differences in preoperative characteristics between both groups. The median enucleation time for group I (67.5 min (25–200)) was not significantly longer than that for group II (60 min (19–165) ( p = 0.25 )). Operative outcomes, including morcellation time, resected weight, catheter duration, and hospital stay, were comparable between both groups. At 1, 3, 6, and 12 months, all urinary functional outcomes showed significant improvement, and there were no significant differences between the two groups. At 3 months’ follow-up, two patients in group I and three patients in group II experienced stress urinary incontinence (SUI). At the last follow-up visit, one patient from group I presented with persistent SUI. Conclusions. For managing recurrent and nonrecurrent cases of BPH, top-down HoLEP is safe with comparable urinary functional outcomes. Patients with a history of previous prostate surgery can be counselled that their prior transurethral procedure does not reduce the benefits of HoLEP.

This three-arm randomized trial tested a brief version of cognitive-behavioral conjoint therapy (bCBCT) delivered in two modalities compared to couples' psychoeducation in a sample of U.S. veterans with posttraumatic stress disorder (PTSD) and their intimate partners.Couples were randomized to receive (a) in-person, office-based bCBCT (OB-bCBCT), (b) bCBCT delivered via home-based telehealth (HB-bCBCT), or (c) an in-person psychoeducation comparison condition (PTSD family education [OB-PFE]). Primary outcomes were clinician-assessed PTSD severity (Clinician Administered PTSD Scale), self-reported psychosocial functioning (Brief Inventory of Psychosocial Functioning), and relationship satisfaction (Couples Satisfaction Index) at posttreatment and through 6-month follow-up.PTSD symptoms significantly decreased by posttreatment with all three treatments, but compared to PFE, PTSD symptoms declined significantly more for veterans in OB-bCBCT (between-group d = 0.59 [0.17, 1.01]) and HB-bCBCT (between-group d = 0.76 [0.33, 1.19]) treatments. There were no significant differences between OB-bCBCT and HB-bCBCT. Psychosocial functioning and relationship satisfaction showed significant small to moderate improvements, with no differences between treatments. All changes were maintained through 6-month follow-up.A briefer, more scalable version of CBCT showed sustained effectiveness relative to an active control for improving PTSD symptoms when delivered in-person or via telehealth. Both bCBCT and couples' psychoeducation improved psychosocial and relational outcomes. These results could have a major impact on PTSD treatment delivery within large systems of care where access to brief, evidence-based PTSD treatments incorporating family members are needed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is efficacious in improving PTSD symptoms and relationship adjustment among couples with PTSD. However, there is a need for more efficient delivery formats to maximize engagement and retention and to achieve faster outcomes in multiple domains. This nonrandomized trial was designed to pilot an abbreviated, intensive, multi-couple group version of CBCT for PTSD (AIM-CBCT for PTSD) delivered over a single weekend for 24 couples that included an active-duty service member or veteran with PTSD who had deployed in support of combat operations following September 11, 2001. All couples completed treatment. Assessments conducted by clinical evaluators 1 and 3 months after the intervention revealed significant reductions in clinician-rated PTSD symptoms (ds = -0.77 and -0.98, respectively) and in patients' self-reported symptoms of PTSD (ds = -0.73 and -1.17, respectively), depression (ds = -0.60 and -0.75, respectively), anxiety (ds = -0.63 and -0.73, respectively), and anger (ds = -0.45 and -0.60, respectively), relative to baseline. By 3-month follow-up, partners reported significant reductions in patients' PTSD symptoms (d = -0.56), as well as significant improvements in their own depressive symptoms (d = -0.47), anxiety (d = -0.60), and relationship satisfaction (d = 0.53), relative to baseline. Delivering CBCT for PTSD through an abbreviated, intensive multi-couple group format may be an efficient strategy for improving patient, partner, and relational well-being in military and veteran couples with PTSD.

Posttraumatic stress disorder (PTSD) affects not only the people suffering from the disorder but also those surrounding them. PTSD is one of the mental health difficulties most strongly associated with relationship distress (Whisman et al. 2000); it has a strong association with a range of family problems, including mental health difficulties in partners and children (Monson et al. 2009; Renshaw et al. 2011; Taft et al. 2011). PTSD can elicit responses from friends and family that are well-meaning but may maintain the symptoms of PTSD, such as helping the individual with PTSD avoid reminders of the trauma, which may over time erode these relationships and place increased burden on family members, leading to negative mental health outcomes (Caska and Renshaw 2011). These accommodative behaviors may also reinforce avoidance associated with PTSD (Figley 1989). Consistent with research documenting that negative social interactions in the wake of trauma are among the most robust risk factors for PTSD (e.g., see Wagner et al. under review for a review), negative family interactions have been linked to poorer individual cognitive-behavioral therapy outcomes (Monson et al. 2005; Tarrier et al. 1999). Moreover, individual evidence-based treatments for PTSD do not consistently improve relational functioning (e.g., Galovski et al. 2005; Monson et al. 2012a, b, c; Lunney and Schnurr 2007). Consequently, there have been efforts to develop and test dyadic treatments that improve relational functioning and PTSD and, in some cases, also improve the health and well-being of partners. The current chapter describes different ways to conceptualize couple treatment in the case of PTSD and reviews the efficacy of these interventions.

Understanding factors associated with intimate partner violence (IPV) treatment attendance is of particular importance given high rates of attrition from IPV counseling programs. Individuals who drop out from IPV counseling remain at an increased risk for recidivism. Although numerous studies have examined correlates of IPV treatment completion in civilian samples, no study to date has examined IPV treatment attendance in veterans. Thus, we sought to examine demographic, military, and diagnostic correlates of IPV session attendance in Veterans seeking IPV treatment. The current study examined data from 135 veterans presenting to IPV treatment within the Veteran Affairs (VA) healthcare system. Analyses were conducted from data collected as part of a randomized controlled trial evaluating the efficacy of a 12-session trauma-informed IPV intervention with veterans, Strength at Home. Results indicated that age, courtinvolvement, treatment condition, and substance use disorder were unique predictors of IPV session attendance above and beyond other demographic, military, and diagnostic predictors. Substance use disorder emerged as the most robust predictor of session attendance. These findings suggest that similar to civilian studies, routine assessment of substance use is indicated in IPV programs delivered within the VA healthcare system and that coordinated care between substance abuse and IPV treatment is needed. Our findings also suggest the need for additional efforts to enhance treatment initiation and retention among younger veterans.

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) is associated with improvements in patients' PTSD symptoms, partners' psychological distress, and relationship satisfaction. However, little is known about whether CBCT for PTSD is associated with changes in other relationship domains that have theoretical and clinical relevance to the relational context of PTSD. The current study is a secondary analysis of relational outcomes from an uncontrolled, within-group trial designed to examine whether an abbreviated, intensive, multi-couple group version of CBCT for PTSD (AIM-CBCT for PTSD) delivered in a retreat during a single weekend was associated with improvements in PTSD symptoms and relationship satisfaction. In this investigation, we examined whether AIM-CBCT for PTSD is also associated with improvements in ineffective arguing, supportive dyadic coping by partner, joint dyadic coping, and partners' accommodation of patients' PTSD symptoms. Participants were 24 couples who included a post-9/11 U.S. service member or veteran with PTSD. At 1- and 3-month follow-up, patients reported significant reductions in couples' ineffective arguing (ds = -.71 and -.78, respectively) and increases in supportive dyadic coping by partners relative to baseline (ds = .50 and .44, respectively). By 3-month follow-up, patients also reported significant increases in couples' joint dyadic coping (d = .57), and partners reported significant reductions in their accommodation of patients' PTSD symptoms (d = -.44). Findings suggest that AIM-CBCT for PTSD is associated with improvements in multiple relationship domains beyond relationship satisfaction but that these may be differentially salient for patients and partners.La terapia cognitivo-conductual conjunta para el trastorno por estrés postraumático (TCC para el TEPT) está asociada con mejoras en los síntomas de TEPT de los pacientes, en el distrés psicológico de sus parejas y en la satisfacción con la relación. Sin embargo, se sabe poco acerca de si la TCC para el TEPT está asociada con cambios en otros aspectos de la relación que son de interés teórico y clínico para el contexto relacional del TEPT. El presente estudio es un análisis secundario de los resultados relacionales de un ensayo intragrupal no controlado diseñado para analizar si una versión grupal multipareja, intensiva y abreviada de la TCC para el TEPT (MIA-TCC para el TEPT) practicada en un retiro durante un solo fin de semana estuvo asociada con mejoras en los síntomas de TEPT y en la satisfacción con la relación. En esta investigación, analizamos si la MIA-TCC para el TEPT también está asociada con mejoras en las discusiones ineficaces, en el afrontamiento diádico comprensivo de la pareja del paciente, en el afrontamiento diádico conjunto y en la adaptación de las parejas de los pacientes a sus síntomas de TEPT. Los participantes fueron 24 parejas en las que había un miembro o veterano de las Fuerzas Armadas de los Estados Unidos que prestó servicio con posterioridad al 11/9 y que tenía TEPT. En el seguimiento del mes y de los tres meses, los pacientes informaron reducciones significativas de las discusiones ineficaces de la pareja (ds = -0.71 y -0.78, respectivamente) y aumentos del afrontamiento diádico comprensivo de sus parejas en relación con el momento basal (ds = 0.50 y 0.44, respectivamente). En el seguimiento de los tres meses, los pacientes también informaron aumentos significativos del afrontamiento diádico conjunto de las parejas (d = 0.57), y sus parejas informaron reducciones significativas de su adaptación a los síntomas de TEPT de los pacientes (d = -0.44). Los resultados sugieren que la MIA-TCC para el TEPT está asociada con mejoras en varios aspectos de las relaciones aparte del de la satisfacción en la pareja, pero que estos pueden tener una importancia diferente para los pacientes y sus parejas.认知-行为联合治疗方法来治愈创伤后应激障碍（CBCT治疗PTSD）可以改善患者的PTSD症状、缓解伴侣的心理痛苦和提高关系满意度。然而，对于CBCT治疗PTSD是否与其他关系领域的变化相关却知之甚少，而这些关系领域与PTSD的关系背景具有理论相关性和临床相关性。本研究旨在对关系结果进行二次分析，来自一项非控制的组内试验，研究的是在一个周末的疗养中，提供的CBCT治疗PTSD（AIM-CBCT治疗PTSD）是否与PTSD症状和关系满意度的改善有关，治疗用的是简略的、密集的、多对夫妻集体版本。在这项调查中，我们研究了AIM-CBCT治疗PTSD是否也与这几项有关：无效争吵、伴侣的支持性对立应对、联合对立应对和伴侣对患者PTSD症状的适应性的改善。参与者是24对夫妇，其中包括一名9/11后的美国军人或患有创伤后应激障碍的老兵。在1个月和3个月的随访中，患者报告了夫妻无效争吵显著减少(ds分别为-0.71和-0.78)，而伴侣的支持性伴侣应对相对于基线(ds分别为0.50和0.44)有所增加。到3个月随访时，患者也报告说伴侣共同的对立应对能力显著增加（ds = 0.57），伴侣报告说对患者PTSD症状的迁就显著减少（ds = -0.44）。研究结果表明，AIM-CBCT治疗PTSD与关系满意度以外的多个关系领域的改善有关，但患者不同和伴侣不同，这些关系领域的改善其显著性也会不同。.

Cognitive-behavioral conjoint therapy (CBCT) for posttraumatic stress disorder (PTSD) has demonstrated efficacy for improving PTSD and comorbid symptoms and relationship adjustment. To enhance treatment efficiency and scalability, we developed a 2-day, abbreviated, intensive, multicouple group version of CBCT for PTSD (AIM-CBCT for PTSD). Prior work demonstrated that AIM-CBCT for PTSD wasassociated with reductions in PTSD and comorbid symptoms in a sample of 24 post-9/11 active duty military or veteran couples who received the treatment in a retreat format over a single weekend. The current study investigated secondary outcomes regarding trauma-related cognitions, psychosocial impairment, and insomnia. For trauma-related cognitions, reductions were nonsignificant and small at 1-month follow-up, ds = -0.14 to -0.32. However, by 3-month follow-up, there were significant, medium effect size reductions in total trauma-related cognitions, d = -0.68, and negative views of self and others, ds = -0.64 and -0.57, respectively, relative to baseline. There was also a nonsignificant, small-to-medium effect-size reduction in self-blame, d = -0.43, p = .053, by 3-month follow-up. For psychosocial impairment, there were significant and medium-to-large and large effect size reductions by 1- and 3-month follow-ups, ds = -0.73 and -0.81, respectively. There were nonsignificant, small effect size reductions in insomnia at both 1- and 3-month follow-ups relative to baseline, ds = -0.30 and -0.34, respectively. These findings suggest that AIM-CBCT for PTSD is associated with reductions in maladaptive posttraumatic cognitions and psychosocial impairment but that adjunctive interventions may be needed to address insomnia.

EBioMedicine 72, 103588 (2021). doi:10.1016/j.ebiom.2021.103588, Published by Elsevier, Amsterdam [u.a.]

This chapter reviews the extant literature on the interpersonal aspects of posttraumatic stress disorder (PTSD), with a focus on couple and family models of PTSD. Topics include the association of PTSD with a variety of family relationship problems in a range of traumatized populations. The role of relevant interpersonal constructs in the onset and maintenance of PTSD (e.g., social support, communication patterns) and the psychological effects of PTSD symptoms on family members and their interactions are discussed. In addition, models that take into account a range of relationship variables and the likely bidirectional association between individual and family functioning in PTSD are presented. Future directions for theory and research, as well as the clinical implications of this work, are outlined.

Approximately 14% of military personnel and veterans who have deployed to the combat theater are at risk for combat-related posttraumatic stress disorder (PTSD). The treatment of combat-related PTSD in active duty service members and veterans is challenging. Combat trauma may involve multiple high levels of exposure to different types of traumatic events (e.g., human carnage after explosive blasts, life threat/injuries to self/others, etc.). Many service members and veterans are unable or unwilling to receive treatment in government facilities due to avoidance, scheduling difficulties, transportation or parking problems, concerns about career advancement, or stigma associated with seeking treatment. Innovative treatment-delivery approaches are needed to help overcome these barriers. The present study is a randomized clinical trial to evaluate three versions of Cognitive Processing Therapy (CPT; [54]) for the treatment of combat-related PTSD in active duty military service members and veterans: (1) standard In-Office CPT, (2) In-Home Telebehavioral Health CPT from the provider's office to the participant's home, and (3) In-Home CPT in which the provider delivers treatment in the participant's home. Use of an equipoise-stratified randomization design allows participants to decline one of the treatment arms. This research design partly overcomes the problems active duty military and veterans face when receiving PTSD treatment by allowing them to opt out of one inappropriate or unacceptable treatment modality and still permitting randomization to the two remaining treatment modalities. This manuscript provides an overview of the research design and methods for the study.

Recent research supports the efficacy of Strength at Home-Men's Program (SAH-M), a trauma-informed group intervention designed to reduce use of intimate partner violence (IPV) in veterans (Taft, Macdonald, Creech, Monson, & Murphy, 2016). However, change-processes facilitating the effectiveness of SAH-M have yet to be specified. Alexithymia, a deficit in the cognitive processing of emotional experience characterized by difficulty identifying and distinguishing between feelings, difficulty describing feelings, and use of an externally oriented thinking style, has been shown to predict PTSD severity and impulsive aggression; however, no studies have investigated the relationship between alexithymia and IPV. As such, the current study examined the role of improvements in alexithymia as a potential facilitator of treatment efficacy among 135 male veterans/service members, in a randomized control trial SAH-M. After an initial assessment including measures of IPV and alexithymia, participants were randomized to an Enhanced Treatment as Usual (ETAU) condition or SAH-M. Participants were assessed three and six months after baseline. Results demonstrated a statistically significant association between alexithymia and use of psychological IPV at baseline. Moreover, participants in the SAH-M condition self-reported significantly greater reductions in alexithymia over time relative to ETAU participants. Findings suggest that a trauma-informed intervention may optimize outcomes, helping men who use IPV both limit their use of violence and improve deficits in emotion processing.

OBJECTIVE: This study sought to extend findings from a randomized controlled trial of the Strength at Home Men's Program (SAH-M) for intimate partner aggression (IPA) in military veterans by examining the impact of pretreatment posttraumatic stress disorder (PTSD) symptoms on treatment efficacy, and by examining new data on postintervention follow-up for individuals who received SAH-M after completing the enhanced treatment as usual (ETAU) wait-list control condition. METHOD: Using data from 125 male veterans who attended the SAH-M program immediately after an intake assessment or after waiting 6-month in the ETAU condition, this study used generalized linear modeling to examine predictors of physical and psychological IPA over a 9-month period of time. RESULTS: PTSD symptoms at intake significantly predicted both physical and psychological IPA use, even after accounting for the effects of treatment condition, time, and number of sessions attended. PTSD had a strong association with both physical and psychological IPA. An interaction between PTSD and SAH-M was observed for psychological IPA but not physical IPA, and the magnitude of the effect was not clinically significant. There was a significant effect of SAH-M in reducing IPA in the full sample, including previously unanalyzed outcome data from the ETAU condition. CONCLUSION: The study results suggest that while SAH-M does not need to be modified to address the interaction between PTSD and treatment, outcomes could be enhanced through additional direct treatment of PTSD symptoms. RESULTS extend prior analyses by demonstrating the effectiveness of SAH-M in reducing use of IPA in both the treatment and ETAU conditions. (PsycINFO Database Record(c) 2017 APA, all rights reserved). Language: en

The bidirectional association between posttraumatic stress disorder (PTSD) and intimate relationship functioning has been well established, and conjoint therapies for PTSD have been created to simultaneously improve PTSD and relationship distress. However, some couples are unwilling to participate in trauma-focused therapy; therefore, a present-focused version of cognitive–behavioral conjoint therapy for PTSD (pf-CBCT for PTSD) was created to decrease barriers to treatment. We propose that, along with trauma-focused cognitive–behavioral conjoint therapy for PTSD (CBCT for PTSD), pf-CBCT for PTSD can be used as part of a sequential approach to PTSD treatment. The various phases of pf-CBCT for PTSD and CBCT for PTSD may be flexibly delivered according to a particular couple’s unique needs and preferences. We present a case study to illustrate this approach of using both pf-CBCT for PTSD and CBCT for PTSD with trauma-focused sessions. The case study describes conjoint treatment of a woman with PTSD related to childhood sexual abuse and her cohabiting partner of 25 years. Discussion provides additional clinical considerations and directions for future research.

Sequencing-based studies have identified novel risk genes for rare, severe epilepsies and revealed a role of rare deleterious variation in common epilepsies. To identify the shared and distinct ultra-rare genetic risk factors for rare and common epilepsies, we performed a whole-exome sequencing (WES) analysis of 9,170 epilepsy-affected individuals and 8,364 controls of European ancestry. We focused on three phenotypic groups; the rare but severe developmental and epileptic encephalopathies (DEE), and the commoner phenotypes of genetic generalized epilepsy (GGE) and non-acquired focal epilepsy (NAFE). We observed that compared to controls, individuals with any type of epilepsy carried an excess of ultra-rare, deleterious variants in constrained genes and in genes previously associated with epilepsy, with the strongest enrichment seen in DEE and the least in NAFE. Moreover, we found that inhibitory GABAA receptor genes were enriched for missense variants across all three classes of epilepsy, while no enrichment was seen in excitatory receptor genes. The larger gene groups for the GABAergic pathway or cation channels also showed a significant mutational burden in DEE and GGE. Although no single gene surpassed exome-wide significance among individuals with GGE or NAFE, highly constrained genes and genes encoding ion channels were among the top associations, including CACNA1G, EEF1A2, and GABRG2 for GGE and LGI1, TRIM3, and GABRG2 for NAFE. Our study confirms a convergence in the genetics of common and rare epilepsies associated with ultra-rare coding variation and highlights a ubiquitous role for GABAergic inhibition in epilepsy etiology in the largest epilepsy WES study to date.

We evaluated the efficacy of Strength at Home Couples, a cognitive-behavioral trauma-informed intimate partner violence (IPV) preventive intervention for married or partnered military service members or veterans. No prior randomized controlled trial had supported the efficacy of such an intervention in this population. Participants included 69 male service members or veterans and their female partners. Recruitment was conducted from February 2010 through August 2013, and participation occurred within 2 Department of Veterans Affairs hospitals. All couples completed an initial assessment including diagnostic interviews and measures of physical and psychological IPV and were randomized by cohort to a supportive prevention couples group or Strength at Home Couples. All couples were reassessed at postintervention and at 6 and 12 months follow-ups. Both service members or veterans and their female partners engaged in fewer acts of reported physical and psychological IPV in the Strength at Home Couples condition relative to supportive prevention, and relative risk of physical violence was lower for both members of the dyad in Strength at Home Couples at follow-up assessments (male service member or veteran IPV relative risk [RR] =.53; female IPV RR =.43). Those in Strength at Home Couples evidenced significantly greater program completion than did those in supportive prevention (RR = 1.73; 95% confidence interval [1.00, 2.99]). Exploratory analyses did not find differences between groups on relationship satisfaction. RESULTS provide support for the efficacy of Strength at Home Couples in preventing physical IPV and reducing psychological IPV. These results have important implications for preventing violence and associated physical and mental health problems. : Trial Registry Name: Strength at Home Couples Program; Registration Number: NCT00827879; URL: https://clinicaltrials.gov/ct2/show/NCT00827879?term=strength+at+home&rank=1 (PsycINFO Database Record(c) 2016 APA, all rights reserved). Language: en

Posttraumatic growth (PTG) is defined as a positive psychological change that can emerge following a traumatic life event. Although documented in noninterventional studies of traumatized individuals, there are scant data on the potential for therapy to induce or improve PTG. Thus, the primary goal of this study was to examine changes in PTG in a controlled trial of cognitive-behavioral conjoint therapy for posttraumatic stress disorder versus waitlist (CBCT for PTSD; Monson & Fredman, 2012). We also examined whether pretreatment relationship satisfaction and PTSD symptomatology moderated change in PTG. There were 40 couples (75% with a female partner with PTSD) who were randomized to either immediate CBCT for PTSD or a 3-month waitlist (WL). Compared to WL, individuals who received treatment immediately demonstrated a significant increase in PTG. There was a moderate effect size between-group difference (Hedge's g = 0.45). There was a nonsignificant relationship with a moderate effect size (Hedge's g = 0.65) for the positive effect of pretreatment relationship satisfaction on the trajectory of PTG, but no effect of pretreatment PTSD symptoms. Results suggested that CBCT for PTSD facilitated PTG, even with a limited focus on PTG in this conjoint intervention. Future research should target PTG as a treatment goal and further examine the role of close others in facilitating development of PTG.

Numerous studies document an association between posttraumatic stress disorder (PTSD) and impairments in intimate relationship functioning, and there is evidence that PTSD symptoms and associated impairments are improved by cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD; Monson & Fredman, 2012). The present study investigated changes across treatment in clinician-rated PTSD symptom clusters and patient-rated trauma-related cognitions in a randomized controlled trial comparing CBCT for PTSD with waitlist in a sample of 40 individuals with PTSD and their partners (N = 40; Monson et al., 2012). Compared with waitlist, patients who received CBCT for PTSD immediately demonstrated greater improvements in all PTSD symptom clusters, trauma-related beliefs, and guilt cognitions (Hedge's gs -.33 to -1.51). Results suggest that CBCT for PTSD improves all PTSD symptom clusters and trauma-related cognitions among individuals with PTSD and further supports the value of utilizing a couple-based approach to the treatment of PTSD.

Research has consistently documented a bidirectional association between posttraumatic stress disorder (PTSD) symptoms and intimate relationship functioning. PTSD symptoms are associated with greater relationship distress, higher likelihood of divorce, decreased emotional intimacy, and increased sexual dysfunction. Conversely, specific relational factors and interaction patterns (e.g., hostility, partner accommodation of PTSD symptoms) can serve to maintain or exacerbate PTSD symptoms. Given this reciprocal relationship, several couple therapies for PTSD have been created and empirically examined. Therapies that have been empirically studied include behavioral family therapy, emotionally focused couple therapy, strategic approach therapy, and cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD). To date, CBCT for PTSD has accumulated the most supporting evidence in the most diverse samples. Collectively, these empirical studies suggest that CBCT for PTSD is associated with improvements in PTSD, comorbid mental health symptoms, some partners’ mental health symptoms, and relationship satisfaction. CBCT for PTSD is a 15-session, trauma-focused PTSD treatment that occurs within a conjoint context. The therapy includes three phases: (1) psychoeducation and safety building, (2) communication skills and dyadic approach tasks to undermine avoidance, and (3) cognitive change regarding historical trauma appraisals and here-and-now maladaptive cognitions that maintain PTSD symptoms and/or relationship problems. Given the evidence supporting conjoint therapies for PTSD, clinicians should consider systematically involving partners in PTSD treatments to facilitate treatment by targeting both individual and relationship factors maintaining PTSD symptoms, as well as cultivate the strength within the couple’s relationship to encourage them to confront PTSD as a team.

OBJECTIVE The primary goal of the present study was to investigate whether pre-treatment relationship satisfaction predicted treatment drop-out and posttraumatic stress disorder (PTSD) symptom outcomes within a trial of cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson & Fredman, 2012). Additionally, we examined the influence of pre-treatment relationship distress on relationship outcomes. METHOD Thirty-seven patients and their intimate partners who participated in a course of CBCT for PTSD were assessed for PTSD symptoms with the Clinician-Administered PTSD Scale and PTSD Checklist, and for intimate relationship functioning with the Dyadic Adjustment Scale. CBCT for PTSD is a conjoint therapy designed to improve PTSD symptoms and enhance relationship functioning. Patients had to meet diagnostic criteria for PTSD to be included in the study; however, couples were not required to be in distressed relationships to receive treatment. RESULTS Neither patients' nor partners' pre-treatment relationship satisfaction, nor their interaction, predicted treatment drop-out (ORs = .97-1.01) or completing patients' post-treatment PTSD symptom severity (sr2 ≤ .03). However, participants who were in distressed relationships prior to treatment made greater gains in relationship satisfaction compared with those who began treatment in more satisfied relationships (g = 1.02). CONCLUSIONS Among patients receiving CBCT for PTSD, treatment drop-out and improvements in PTSD symptoms may be independent of pre-treatment relationship functioning, whereas improvements in relational functioning may be greater among those distressed prior to treatment.

There is increasing recognition that combat-related posttraumatic stress disorder (PTSD) affects the service member or veteran who experienced the trauma, his or her partner, and their relationship more broadly. Reactions by partners and other loved ones can also serve as impediments to, or facilitators of, recovery in the wake of trauma exposure. In this article, we highlight research findings related to the association between PTSD symptoms and intimate relationship functioning in service members and veterans from the current conflicts and describe the application of cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD; Monson & Fredman, 2012), a disorder-specific couple therapy designed to simultaneously decrease PTSD symptoms and enhance intimate relationship functioning, to a veteran with combat-related PTSD and his wife. We conclude by discussing the powerful role that partners can play in helping individuals with combat-related PTSD recover from the disorder through improved communication, decreased couple-level avoidance, and modification of cognitions held by either member of the couple that can maintain PTSD symptoms and/or relationship distress.

Veteran and active duty populations evidence higher rates of intimate partner aggression (IPA) than comparable civilian groups, perhaps due in part to their unique service-related experiences. IPA offender treatment programs that take military background into consideration are not widely available, and it is unclear to what extent there is a perceived need for them among clinicians who serve service members and Veterans. Strength at Home (SAH) is a promising 12-session cognitive-behavioral group intervention designed to address IPA perpetration in military populations. While clinical support for SAH is emerging, the extent to which service members and Veterans find it appropriate and helpful is not yet known. Goals of the current study were threefold: (a) assess the perceived need for a military-specific IPA program among Veterans Administration and community domestic violence (DV) program providers; (b) conduct a pilot study to examine the feasibility and preliminary effectiveness of SAH in a sample drawn from a diverse, multicultural community; and (c) conduct focus groups to obtain participant feedback on the SAH protocol. Findings from the provider survey suggested a need for specialty programs to treat military personnel who perpetrate IPA of mildtomoderate severity. Results of the SAH pilot study ( n = 6) indicated decreased psychological aggression and increased anger control from baseline to 6-month follow-up. Focus group feedback indicated participants found the program to be helpful and appropriate across a wide variety of ethno-cultural variables. As more service members and Veterans of the Iraq/Afghanistan war era reintegrate into our communities, it will become increasingly important for providers in both private and public sectors of care to understand the unique needs of this treatment population, and to have access to effective IPA treatment programs.

This study conducted secondary analyses of a published trial and sought to determine if different domains of psychosocial functioning (e.g., daily living, work, nonfamily relationships) improved following trauma-focused treatment for posttraumatic stress disorder (PTSD). Cognitive processing therapy (CPT), an empirically supported treatment that involves evaluating trauma-related beliefs and written trauma accounts, was compared to its components: CPT without the written accounts or written accounts only in a sample of 78 women with PTSD secondary to interpersonal violence. Overall and individual domains of functioning significantly improved with treatment and results were similar across treatment groups, Fs (2, 150) ≥ 11.87, ps < .001. Additionally, we investigated whether changes in different PTSD symptom clusters were associated with outcomes in domains of psychosocial functioning, after collapsing across treatment condition. Multiple hierarchical linear regression analyses revealed that overall clinician-assessed PTSD symptom reduction was associated with outcomes in all domains of functioning, βs = .44 to .68, ps < .001. Additionally, improvements in the emotional numbing symptom cluster were associated with outcomes in the nonfamily relationships domain, β = .42, p < .001, and improvements in the hyperarousal symptom cluster were associated with outcomes in the overall, daily living, and household tasks domains, βs = .34 to .39, ps < .01. Results suggest that it may be important to monitor improvements in emotional numbing and hyperarousal symptoms throughout treatment to increase the likelihood of changes in psychosocial functioning.

A number of studies have documented that posttraumatic stress disorder (PTSD) symptoms in "one" partner are negatively associated with their intimate partner's psychological functioning. The present study investigated intimate partners' mental health outcomes (i.e., depression, anxiety, and anger) in a sample of 40 partners of individuals with PTSD within a randomized waitlist controlled trial of cognitive-behavioral conjoint therapy for PTSD (Monson & Fredman, 2012). There were no significant differences between active treatment and waitlist in intimate partners' psychological functioning at posttreatment. Subgroup analyses, however, of partners exhibiting clinical levels of distress at pretreatment on several measures showed reliable and clinically significant improvements in their psychological functioning at posttreatment and no evidence of worsening. Results suggest that cognitive-behavioral conjoint therapy for PTSD may have additional benefits for partners presenting with psychological distress.

Interpersonal difficulties are common among veterans with posttraumatic stress disorder (PTSD) and are associated with poorer treatment response. Treatment outcomes for PTSD, including relationship functioning, improve when partners are included and engaged in the therapy process. Cognitive-behavioral conjoint therapy for PTSD (CBCT) is a manualized 15-session intervention designed for couples in which one partner has PTSD. CBCT was developed specifically to treat PTSD, engage a partner in treatment, and improve interpersonal functioning. However, recent research suggests that an abbreviated CBCT protocol may lead to sufficient gains in PTSD and relationship functioning, and yield lower dropout rates. Likewise, many veterans report a preference for receiving psychological treatments through clinical videoteleconferencing (CVT) rather than traditional face-to-face modalities that require travel to VA clinics. This manuscript describes the development and implementation of a novel randomized controlled trial (RCT) that examines the efficacy of an abbreviated 8-session version of CBCT (“brief CBCT,” or B-CBCT), and compares the efficacy of this intervention delivered via CVT to traditional in-person platforms. Veterans and their partners were randomized to receive B-CBCT in a traditional Veterans Affairs office-based setting (B-CBCT-Office), CBCT through CVT with the veteran and partner at home (B-CBCT-Home), or an in office-delivered, couple-based psychoeducation control condition (PTSD Family Education). This study is the first RCT designed to investigate the delivery of B-CBCT specifically to veterans with PTSD and their partners, as well as to examine the delivery of B-CBCT over a CVT modality; findings could increase access to care to veterans with PTSD and their partners. Keywords: Cognitive behavioral conjoint therapy, Videoconferencing, Veterans, Home-based care, Couple therapy, Randomized controlled trial

In 2005, we reported on a family as having Frias syndrome (OMIM: 609640), with four affected members displaying a pattern of congenital defects nearly identical to those observed in a mother and son described by Frias [Frias et al. (1975). Birth Defects Orig Artic Ser 11:30–33]. These defects included growth deficiency, facial anomalies, and hand and foot alterations. We had the opportunity to study this family again due to the birth of another affected girl, who presented with similar facial characteristics to those of her elder half-sister and the rest of affected relatives, which consisted of mild exophthalmia, bilateral palpebral ptosis, downslanting palpebral fissures, and hypertelorism. We performed array-CGH, which identified an identical interstitial deletion of chromosome 14q22.1–q22.3 in the mother and two daughters. The deletion is 4.06 Mb in length and includes the BMP4 gene, a member of the bone morphogenetic protein (BMP) family of secreted proteins. A review of the literature showed that deletions or mutations of this gene underlie congenital defects affecting brain, eye, teeth, and digit development. Although the clinical manifestations of the current family correlate with the defects observed in patients having either 14q22–q23 deletions or mutations of BMP4, they show a milder phenotype. In order to understand the clinical variability, we evaluated the already known functional characteristics of the BMP gene members. This gene family plays an important role during early embryogenesis, and the complex synergistic functions and redundancies of the BMPs led us to conclude that haploinsufficiency of BMP4 is likely to be responsible for the clinical expression of Frias syndrome. © 2013 Wiley Periodicals, Inc.

We present a girl with the characteristic clinical picture associated with Marden-Walker syndrome (MWS; OMIM 248700), including mask-like face with blepharophimosis, joint contractures, intellectual disability, a multicystic dysplastic kidney and cerebral dysgenesis. The long-term follow-up allowed us to monitor the evolution of the phenotype in this patient, and among the main findings we highlight the following: demyelination of the pyramidal tract demonstrated by transcranial magnetic stimulation and the involvement of the levator muscles of angle of mouth in fixed facial expression with relative integrity of the rest of the facial expression muscles. A 244 k array comparative genomic hybridization (aCGH) was carried out and showed a de novo interstitial deletion of approximately 2.84 Mb affecting only the cytoband 21q22.11 (genome coordinates chr21:31,874,016-34,711,763). We selected 10 of the most recent published cases with either total or partial deletions of cytoband 21q22.11 that provided good characterization of the genomic size or the genes in the deleted regions. We observed that in nine of the 10 cases the deleted regions included the RUNX1 gene in 21q22.12, which is not affected in the current patient's deletion or in that of Patient 3 from Roberson et al. [2011]. After a comparison of shared deleted genes between cases, and correlation of their potential phenotypes, we concluded that the pattern of defects considered for a diagnosis of MWS may represent part of the phenotypic expression of a partial or total deletion of 21q22.11.

In this brief report, we present information on the Strength at Home intervention to treat male active duty or military veteran perpetrators of intimate partner violence (IPV) as well as preliminary pilot study findings. Strength at Home is a 12-session cognitive-behavioral group intervention developed by the authors that is based on a social information processing model of IPV perpetration. Six men referred to two intervention groups and five collateral female partners participated in this pilot study. Findings indicated large reductions for most indices of physical and psychological IPV from pre-treatment to 6-month follow-up. These initial results are promising though the small sample size and other study limitations preclude our ability to draw firm conclusions.

Burnout impacts adversely on professional and personal life, and holds implications for patient care. Current research on burnout mainly focuses on established general practitioners but it is unclear how early the signs of burnout really start. This work seeks to identify whether specific GP trainee groups are particularly at risk of burnout and the aspects of training they find stressful.A longitudinal cohort study, collecting qualitative and quantitative data through a single mode of data collection (questionnaire) took place with trainees from all GP training years (ST1-3), across a vocational training scheme (n = 48). Data gathered included the Oldenburg Burnout Inventory (OLBI).Higher than anticipated levels of burnout were displayed by all trainees. A sub-group self reporting higher levels of burnout comprised all-female, UK-trained-at-undergraduate GP trainees, with a partner but no children. Top reported stressors included knowledge/uncertainty, workload/time pressures and ePortfolio. Less than 50% of trainees perceived their burnout levels to be as high as their OLBI showing potential lack of insight.This research demonstrates that high levels of burnout are experienced in GP trainees as early as the first year of training. Early identification of burnout amongst trainees is essential by GP educators to help protect the future GP workforce.

The current study sought to determine if different spheres of social adjustment, social and leisure, family, and work and income improved immediately following a course of cognitive processing therapy (CPT) when compared with those on a waiting list in a sample of 46 U.S. veterans diagnosed with posttraumatic stress disorder (PTSD). We also sought to determine whether changes in different PTSD symptom clusters were associated with changes in these spheres of social adjustment. Overall social adjustment, extended family relationships, and housework completion significantly improved in the CPT versus waiting-list condition, η(2) = .08 to .11. Hierarchical multiple regression analyses revealed that improvements in total clinician-rated PTSD symptoms were associated with improvements in overall social and housework adjustment. When changes in reexperiencing, avoidance, emotional numbing, and hyperarousal were all in the model accounting for changes in total social adjustment, improvements in emotional numbing symptoms were associated with improvements in overall social, extended family, and housework adjustment (β = .38 to .55). In addition, improvements in avoidance symptoms were associated with improvements in housework adjustment (β = .30), but associated with declines in extended family adjustment (β = -.34). Results suggest that it is important to consider the extent to which PTSD treatments effectively reduce specific types of symptoms, particularly emotional numbing and avoidance, to generally improve social adjustment.

Military deployments often introduce a variety of family-related stressors for both service members and their family members. The purpose of this chapter is to summarize what is known about the effects of deployment, and associated family-related experiences during deployment, on service members and their families. Following a review of the existing literature, preliminary study findings are presented regarding the nature and consequences of deployment family experiences for the postdeployment health and adjustment of service members deployed in support of the recent wars in Afghanistan (Operation Enduring Freedom; OEF) and Iraq (Operation Iraqi Freedom; OIF). These findings, based on a nationally representative sample of 1,046 OEF/OIF veterans, revealed that contemporary war veterans experience a variety of both objective and subjective family stressors during deployment. In turn, these experiences, as well as deployment social support from loved ones, demonstrate unique relationships with a variety of postdeployment mental health and adjustment outcomes. The chapter concludes with a discussion of future directions for research in this area, underscoring the need for additional prospective studies and more attention to the nature of family stressors experienced by family members.

Cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) has been shown to reduce symptoms of PTSD in a veteran population. This study explored patterns of self-reported symptom change during CPT. Veterans (N = 60) with PTSD were randomized to receive CPT immediately or after 10 weeks. We hypothesized that those treated immediately would evidence initial symptom stability followed by decline compared with those who waited, whose PTSD symptoms would remain stable. The best model fit based on deviance statistics and Bayesian information criteria comparisons was one in which participants treated immediately showed more rapid initial decline followed by a slower rate of PTSD symptom improvement relative to those who waited, who showed a stable level of symptomatology. Findings suggest that CPT produces quick and maintained improvements in veterans. The effect sizes for change between those who received CPT immediately and those who waited were approximately medium sized. Implications of findings are discussed.

Many individuals with posttraumatic stress disorder (PTSD) experience problems in their intimate relationships; there also is evidence that family dysfunction is associated with poorer individual treatment outcomes (see Monson, Fredman, & Dekel, 2010). As a result, clinicians and researchers alike have called for the development and testing of couple/family-based treatments for patients with PTSD and their loved ones (Riggs, Monson, Glynn, & Canterino, 2009). There is only one published randomized trial of conjoint therapy for PTSD. Glynn and colleagues (1999) found that veterans receiving behavioral family therapy after individual exposure treatment had statistically significant improvements in interpersonal problem solving compared with veterans who received individual exposure only. Although not statistically significant, improvements in positive symptoms of PTSD (i.e., reexperiencing, hyperarousal) in the combined condition were approximately twice that obtained in the exposure-only condition. Uncontrolled trials of other types of conjoint therapy have found improvements in overall PTSD symptoms and relationship adjustment (e.g., MacIntosh & Johnson, 2008) and avoidance symptoms (Sautter, Glynn, Thompson, Franklin, & Han, 2009), whereas others have found improvements in relationship satisfaction only and not PTSD symptoms (e.g., Rabin & Nardi, 1991). Cognitive–behavioral conjoint therapy for PTSD (CBCT for PTSD; Monson & Fredman, in press) was designed to decrease PTSD symptoms and improve relationship adjustment. A prior uncontrolled study of CBCT for PTSD with male Vietnam combat veterans and their wives found pre- to posttreatment improvements in veterans’ symptoms of PTSD and its comorbidities, wives’ relationship satisfaction, and wives’ mental health functioning (Monson, Schnurr, Stevens, & Guthrie, 2004; Monson, Stevens, & Schnurr, 2005). The overall goal of the current uncontrolled study was to test a revised version of the therapy in a sample that varied in the gender of the identified patient, type of trauma, and sexual orientation of the partners. The primary hypotheses were that CBCT for PTSD would be associated with significant improvements in the PTSD-identified partners’ PTSD symptoms and the couples’ relationship adjustment across treatment. Secondary hypotheses were that the treatment would be associated with improvements in comorbid conditions in both partners.

Objective Video teleconferencing (VTC) is used for mental health treatment delivery to geographically remote, underserved populations. However, few studies have examined how VTC affects individual or group psychotherapy processes. This study compares process variables such as therapeutic alliance and attrition among participants receiving anger management group therapy either through traditional face-to-face delivery or by VTC. Method The current study represents secondary analyses of a randomized noninferiority trial (Morland et al., in press) in which clinical effectiveness of VTC delivery proved noninferior to in-person delivery. Participants were male veterans (N = 112) with posttraumatic stress disorder (PTSD) and moderate to severe anger problems. The present study examined potential differences in process variables, including therapeutic alliance, satisfaction, treatment credibility, attendance, homework completion, and attrition. Results No significant differences were found between the two modalities on most process variables. However, individuals in the VTC condition exhibited lower alliance with the group leader than those in the in-person condition. Mean self-leader alliance scores were 4.2 (SD = 0.8) and 4.5 (SD = 0.4), respectively, where 5 represents strongly agree and 4 represents agree with positive statements about the relationship, suggesting that participants in both conditions felt reasonably strong alliance in absolute terms. Individuals who had stronger alliance tended to have better anger outcomes, yet the effect was not strong enough to result in the VTC condition producing inferior aggregate outcomes. Conclusion Our findings suggest that even if group psychotherapy via VTC differs in subtle ways from in-person delivery, VTC is a viable and effective means of delivering psychotherapy.

Posttraumatic stress disorder (PTSD) is often considered the primary problematic outcome of child sexual abuse (CSA). However, a number of other, relatively understudied negative sequelae appear to be prevalent as well. Data from 269 adolescents with a CSA history from the National Survey of Adolescents—Replication Study were therefore used to examine the prevalence of risky behaviors (i.e., problematic alcohol and drug use, delinquent behavior) and depression in this sample. The frequencies of these problems in youth with and without a history of PTSD also were examined. Results indicated that risky behaviors and depression were reported as or more frequently than PTSD. Among youth with a history of PTSD, depression and delinquent behavior were more common than among those without a history of PTSD. However, there were no differences between adolescents with and without a history of PTSD in reported problematic substance use. Findings highlight the need for comprehensive trauma-informed interventions for CSAexposed adolescents.

Recent research on goal processes has identified three important factors associated with successful goal pursuit: appraisal, regulation, and affective motivation. In the present study, we examined whether these processes of goal pursuit predicted exercise behavior for women over time. One hundred and six US undergraduate university student women completed measures of exercise behavior and goal processes twice over the course of a semester. It was hypothesized that more positive exercise goal appraisals, stronger regulatory functions, and higher goal-related affect would predict more exercise behavior four weeks later, controlling for baseline exercise. Hierarchical multiple regression analyses revealed that planning and negative affect were most predictive of higher levels of exercise at follow-up. Implications for understanding exercise behavior are discussed. Overall, the findings support the basic theoretical supposition that goal-systems/self-regulatory theory is a valuable framework through which behavior can be understood.

OBJECTIVE Partner accommodation of posttraumatic stress disorder (PTSD) symptoms (i.e., altering one's own behaviors to minimize patient distress and/or relationship conflict due to patients' PTSD symptoms) has been shown to be positively associated with patient and partner psychopathology and negatively associated with patient and partner relationship satisfaction cross-sectionally. However, the prognostic value of partner accommodation in treatment outcomes is unknown. The goals of the present study were to determine if partner accommodation decreases as a function of couple therapy for PTSD and if pretreatment partner accommodation moderates the efficacy of couple therapy for PTSD. METHOD Thirty-nine patients with PTSD and their intimate partners (n = 39) were enrolled in a randomized controlled trial of cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson & Fredman, 2012) and received CBCT for PTSD immediately or after 3 months of waiting. Blinded assessors determined clinician-rated PTSD symptoms and patient-rated PTSD and depressive symptoms and relationship satisfaction at baseline, midtreatment/4 weeks of waiting, and posttreatment/12 weeks of waiting. RESULTS Contrary to expectation, partner accommodation levels did not change over time for either treatment condition. However, baseline partner accommodation significantly moderated treatment outcomes. Higher levels of partner accommodation were associated with greater improvements in PTSD, depressive symptoms, and relationship satisfaction among patients receiving CBCT for PTSD compared with waiting list. At lower levels of partner accommodation, patients in both groups improved or remained at low levels of these outcomes. CONCLUSIONS Individuals with PTSD who have more accommodating partners may be particularly well-suited for couple therapy for PTSD.

There is a dearth of empirical literature characterizing the various forms of trauma experienced by men court mandated to intervention for intimate partner violence (IPV) perpetration. We investigated the potentially traumatic events (PTEs) experienced by men (N = 217) court mandated to enroll in a 41-week group IPV perpetrator program, as well as the relationships between PTEs, posttraumatic stress disorder (PTSD) symptoms, and IPV. Findings indicated that 94% of participants reported experiencing at least 1 PTE in their lifetime, and participants experienced an average of over 6 out of 14 types of PTEs. A significant association was found between the number of PTEs experienced and frequency of self-reported perpetration of physical and psychological IPV. PTSD symptoms were also related to both forms of IPV perpetration and mediated the relationship between experiencing PTEs and psychological IPV perpetration. Our findings have implications for understanding how trauma and PTSD symptoms may increase risk for IPV and for developing trauma-informed interventions for this population.

OBJECTIVE: We evaluated the efficacy of the Strength at Home Men's Program (SAH-M), a trauma-informed group intervention based on a social information processing model to end intimate partner violence (IPV) use in a sample of veterans/service members and their partners. To date, no randomized controlled trial has supported the efficacy of an IPV intervention in this population. METHOD: Participants included 135 male veterans/service members and 111 female partners. Recruitment was conducted from February 2010 through August 2013, and participation occurred within 2 Department of Veterans Affairs hospitals. Male participants completed an initial assessment that included diagnostic interviews and measures of physical and psychological IPV using the Revised Conflict Tactics Scales and were randomly assigned to an enhanced treatment as usual (ETAU) condition or SAH-M. Those randomized to SAH-M were enrolled in this 12-week group immediately after baseline. Those randomized to ETAU received clinical referrals and resources for mental health treatment and IPV services. All male participants were reassessed 3 and 6 months after baseline. Female partners completed phone assessments at the same intervals that were focused both on IPV and on the provision of safety information and clinical referrals. RESULTS: Primary analyses using hierarchical linear modeling indicated significant time-by-condition effects such that SAH-M participants compared with ETAU participants evidenced greater reductions in physical and psychological IPV use (β = -0.135 [SE = 0.061], P =.029; β = -0.304 [SE = 0.135], P =.026; respectively). Additional analyses of a measure that disaggregated forms of psychological IPV showed that SAH-M, relative to ETAU, reduced controlling behaviors involving isolation and monitoring of the partner (β = -0.072 [SE = 0.027], P =.010). CONCLUSIONS: Results provide support for the efficacy of SAH-M in reducing and ending IPV in male veterans and service members. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01435512. Language: en

We describe a patient with a 1.34 Mb microdeletion at chromosome band 17q22, which is also present in his affected mother. To better delineate this microdeletion syndrome, we compare the clinical and molecular characteristics of 10 previously reported cases and our patient. Of these, the present patient has the smallest deletion which includes five genes: MMD, TMEM100, PCTP, ANKFN1, and NOG. We compare the clinical manifestations described in relation to NOG, since this is the only gene whose loss is shared by our patient and the other eight patients. Previously, the clinical patterns associated with NOG mutations have been included under the general term “NOG-related symphalangism spectrum disorder (NOG-SSD).” Based on our analyses, and considering that there is a clinical correlation observed in cases with a “17q22 microdeletion including NOG” of which the main characteristics can be contributed to loss of this gene, we propose that the clinical patterns observed in these patients should be named as NOG-spectrum disorder-contiguous gene syndrome (NOGSD-CGS). This designation is important for clinicians because when a patient has defects concordant with alterations of NOG but also presents other anomalies not related to this gene, they would be able to suspect the existence of a microdeletion affecting 17q22, therefore, allowing an early diagnosis. This will also enable the clinician to provide the family with adequate information about the prognosis and the risk of reoccurrence in future potential offspring. © 2015 Wiley Periodicals, Inc.

Warburg-Micro syndrome (WARBM) is an autosomal recessive syndrome characterized by microcephaly, microphthalmia, microcornea, congenital cataracts, optic atrophy and central nervous system malformations. This syndrome is caused by mutations in the RAB3GAP1/2 and RAB18 genes, part of the Rab family, and in the TBC1D20 gene, which contributes to lipid droplet formation/metabolism. Here we present a patient with clinical diagnosis of WARBM syndrome, who did not have mutations in either the RAB3GAP1/2 genes, in the main exons of RAB18, nor in the TBC1D20 gene. However, the analysis with CGH-array detected a 9.6 Mb deletion at 1q43-qter. We performed a genotype-phenotype correlation using 20 previously published patients in whom the coordinates of the deleted regions were defined. The comparative analysis revealed that the current patient and three of the other 20 patients share the loss of six genes, four of which are related with the family of G proteins, and are strongly expressed in the brain, retina, heart and kidney. Consequently, their haploinsufficiency may result in different combinations of clinical alterations, including some of those of WARBM syndrome. In addition, the haploinsufficiency of other genes may contribute to other defects and clinical variability. Additionally, for the genotype-phenotype correlation, one must also consider molecular pathways that can result in the observed alterations. To early confirm a genetic diagnosis is essential for the patient and family. The current patient was considered as having a recessive syndrome, but since he had a >de novo> deletion, there was not an increased recurrence risk., Fundación 1.000 sobre Defectos Congénitos, Spain.

Aims: To test the feasibility of online alcohol screening and brief intervention (BI) by comparing (i) two approaches to inviting all students to be screened, and (ii) a minimal versus a more extensive BI. Methods: Freshmen students at one university were randomized to receive one of two types of email invitations to an online anonymous: (i) general health assessment, or (ii) alcohol-specific assessment. All were linked to the same alcohol screening survey. Those with unhealthy alcohol use (AUDIT >8) were randomly assigned to minimal or more extensive online alcohol BI. Results: In both invitation groups (4008 students), 55% of students completed the online screening. Overall, 37% of men and 26% of women had unhealthy alcohol use. Compared to mini- mal BI, more extensive BI was associated with intention to seek help among men and with a greater increase in readiness to change among women. One month after BI, 75% of students completed another assessment, 33% of women and 15% of men with unhealthy alcohol use at baseline no longer had unhealthy alcohol use. There were no significant differences on drinking measures by BI random- ization group. Conclusions: Over half of an entire freshman class of college students were reached by email and completed alcohol screening and brief intervention. Even an alcohol-specific invitation did not deter students. Although brief interventions that differed had some gender specific effects on readiness to change and intention, in general, unhealthy alcohol use decreased after brief interven- tion. Web screening and brief intervention show promise for addressing unhealthy alcohol use by college students.