Do repetitive concussions lead to chronic traumatic encephalopathy?

Abstract

Limitations include only short-term outcomes measured, and significant biases in more than one domain of included trials.A 2015 meta-analysis of 11 RCTs (N5424) evaluated whether EMDR or CBT was superior for the treatment of adult PTSD. 2 The trials included adults 18 years old and older with PTSD defined per DSM-III or -IV criteria. PTSD severity was measured using various standardized clinician and self-rated assessment tools pretreatment and posttreatment with EMDR and CBT (follow-up periods undefined). Although this meta-analysis included some of the 2018 meta-analysis trials, specific PTSD symptoms were investigated. Overall, EMDR minimally improved symptom scores compared with CBT (SMD -0.43; 95% CI, -0.86 to -0.01). Specifically, a meta-analysis for subscaled scores of PTSD symptoms indicated that EMDR was superior for decreasing intrusion (six trials, n5170; SMD -0.37; 95% CI, -0.68 to -0.06) and arousal severity (five trials, n5146; SMD -0.34; 95% CI, -0.68 to -0.01) compared with CBT. Avoidance severity was not significantly different between groups (n5170; SMD -0.42; 95% CI, -0.92 to 0.08). Limitations include difficulty with double blinding due to nature of psychotherapy, loss to follow-up .20% in five trials, potential biases, and lack of fidelity checks for treatment sessions.A 2007 RCT (N576) compared the efficacy of fluoxetine to EMDR in the treatment of PTSD. 3 The trial included adults 18 to 65 years old with PTSD per DSM-IV criteria with trauma exposure one year or more before intake. Patients were randomly assigned to receive eight weekly treatment sessions with EMDR (n524), fluoxetine (n526), or pill placebo (n526). The primary outcome (PTSD symptom severity) was measured using the Clinician-Administered PTSD Scale (CAPS, total severity score .50, asymptomatic end-state function ,20). CAPS scores were assessed at pretreatment, posttreatment, and six months posttreatment. The Structured Clinical Interview for DMS-IV was used for determination of PTSD and comorbid diagnoses. Posttreatment, 88% of EMDR, 81% of fluoxetine, and 65% of placebo completers no longer met PTSD diagnosis criteria. Of those, 29%, 15%, and 12% of EMDR, fluoxetine, and placebo completers became asymptomatic, respectively. Between-group comparisons immediately after treatment were not statistically significant. After an intent-to-treat analysis, EMDR produced moderate improvement in symptom severity posttreatment and at six-month follow-up for adults (effect size, 0.56, 0.65 respectively) compared with fluoxetine. EMDR achieved small improvements in symptoms only at six months in children compared with fluoxetine (effect size, 0.47). Comparison statistics were not available for this reported finding.