Publications by authors named "Brian Trappler"

6 Publications

  • Page 1 of 1

Trauma healing via cognitive behavior therapy in chronically hospitalized patients.

Psychiatr Q 2007 Dec;78(4):317-25

SUNY Downstate, Kingsboro Psychiatric Center, Clarkson Avenue, Brooklyn, NY 11203, USA.

Rationale: This study examines the effect of Skill Training In Affect Regulation (STAIR) on a cohort of 24 inpatients with Schizophrenia with histories of significant trauma and Complex PTSD.

Method: Using a model of Trauma Healing proposed by the NYS Office of Mental Health, 24 patients underwent 12 weeks of group-based Cognitive Behavior Therapy. Treatment modalities focused on trust, safety, affect-regulation, identification of trauma triggers, and disrupting abuse-driven behaviors. A comparison group of patients received 12 weeks of supportive psychotherapy by therapists unfamiliar with Trauma Management. Treatment outcome was compared using the Modified Impact of Events, and Brief Psychiatric Rating Scales.

Results: Following completion of 12 weeks of therapy, only those patients undergoing therapy in Trauma Recovery showed improvement on items such as tension, excitement, hostility, suspiciousness, and anger-control.

Conclusion: These findings are an encouraging first step in trauma recovery of patients with chronic mental illness, histories of prolonged trauma, and Complex PTSD.
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December 2007

Impact of early lifetime trauma in later life: depression among Holocaust survivors 60 years after the liberation of Auschwitz.

Am J Geriatr Psychiatry 2007 Jan 11;15(1):79-83. Epub 2006 Oct 11.

Outpatient Division, Kingsboro Psychiatric Center, Brooklyn, NY, USA.

Rationale: Holocaust survivors, who experienced trauma 60 years ago, provide an opportunity to explore the impact of early lifetime trauma in later life and, in particular, the interplay of depression and posttraumatic stress disorder (PTSD). In this study, the authors contrast depressed Holocaust survivors (HD), nondepressed Holocaust survivors (HND), and older depressed persons (CD).

Methods: The sample consisted of 36 consecutive Holocaust survivors (mean age: 79 years) treated in a primary care practice, among whom 20 (56%) were diagnosed as having a major depressive disorder and 16 as nondepressed; 18 depressed non-Holocaust Jewish primary care patients served as controls (mean age: 84 years). The authors examined nine clinical and social variables. The Kruskal-Wallis, Mann-Whitney U, and chi(2) tests were used to contrast the groups. The authors used a conservative significance level of .01.

Results: In contrast to the CD group, the HD group was significantly older, more likely to report PTSD and guilt symptoms, to have higher Beck Anxiety Inventory (BAI) and Brief Psychiatric Rating Scale (BPRS) scores, and to have more impaired social functioning. In contrast to the HND group, the HD group was significantly more likely to report PTSD and guilt feelings, to have higher Hamilton Depression Scale (HAM-D), BAI, and BPRS scores, and to have more impaired social functioning. In contrast to the CD group, the HND group was significantly more likely to have PTSD symptoms and to have lower HAM-D and BPRS scores.

Conclusions: The prevalence of depression and PTSD symptoms were very high among survivors. Depressed survivors had significantly worse psychologic and social functioning than depressed controls. Depressed survivors had more PTSD symptoms than nondepressed survivors, although it is unclear as to the causal direction of the relationship between depression and PTSD.
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January 2007

Integrated problem-based learning in the neuroscience curriculum--the SUNY Downstate experience.

Brian Trappler

BMC Med Educ 2006 Sep 18;6:47. Epub 2006 Sep 18.

SUNY Downstate, Kingsboro Psychiatric Center, 681 Clarkson Avenue, Brooklyn, NY 11203, USA.

Background: This paper reports the author's initial experience as Block Director in converting a Conventional Curriculum into a problem-based learning model (PBL) for teaching Psychopathology. As part of a wide initiative in curriculum reform, Psychopathology, which was a six-week course in the second-year medical school curriculum, became integrated into a combined Neuroscience block. The study compares curriculum conversion at State University of New York (SUNY), Downstate, with the experiences at other medical centres that have instituted similar curricula reform.

Methods: Student satisfaction with the Conventional and PBL components of the Neuroscience curriculum was compared using questionnaires and formal discussions between faculty and a body of elected students. The PBL experience in Psychopathology was also compared with that of the rest of the Neuroscience Block, which used large student groups and expert facilitators, while the Psychopathology track was limited to small groups using mentors differing widely in levels of expertise.

Results: Students appeared to indicate a preference toward conventional lectures and large PBL groups using expert facilitators in contrast to small group mentors who were not experts. Small PBL groups with expert mentors in the Psychopathology track were also rated favorably.

Conclusion: The study reviews the advantages and pitfalls of the PBL system when applied to a Neuroscience curriculum on early career development. At SUNY, conversion from a Conventional model to a PBL model diverged from that proposed by Howard S. Barrows where student groups define the learning objectives and problem-solving strategies. In our model, the learning objectives were faculty-driven. The critical issue for the students appeared to be the level of faculty expertise rather than group size. Expert mentors were rated more favorably by students in fulfilling the philosophical objectives of PBL. The author, by citing the experience at other major Medical Faculties, makes a cautious attempt to address the challenges involved in the conversion of a Psychopathology curriculum into a PBL dominated format.
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September 2006

Holocaust survivors in a primary care setting: fifty years later.

Psychol Rep 2002 Oct;91(2):545-52

Department of Psychiatry, SUNY Health Science Center at Brooklyn, 11203, USA.

Past studies have not assessed the prevalence of emotional disturbances in Holocaust survivors seeking medical treatment in a family practice environment. The present study examined the prevalence of lifetime (the presence of symptomatology at any time) and current posttraumatic stress disorder (PTSD) symptoms, general anxiety, and depression in Holocaust survivors seeking medical treatment in a primary care setting. 20 of the 27 Holocaust survivors in our sample received a current diagnosis of PTSD and reported significant symptoms of depression and general anxiety. Although 74% of the survivors were currently diagnosed with PTSD, participants in this study had reported an overall decline in reexperiencing, hyperarousal, and overall PTSD symptoms but exhibited increased avoidance and numbing symptoms throughout the lifespan. These preliminary results suggest that removing avoidance as a defense mechanism during the course of psychotherapy may leave these survivors without an adequate way for coping with their trauma, subsequently increasing their vulnerability to psychopathology. Implications for psychological interventions are provided.
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October 2002

The incidence and influence of early traumatic life events in patients with panic disorder: a comparison with other psychiatric outpatients.

J Anxiety Disord 2002 ;16(3):259-72

Department of Psychiatry, State University of New York Health Science Center at Brooklyn, NY 11203, USA.

Early traumatic life events, including childhood physical and sexual abuse, has been associated with increased risk for panic disorder in adulthood. We examined the incidence and influence of early traumatic life events in outpatients with panic disorder (n = 101), compared to outpatients with other anxiety disorders (n = 58), major depression (n = 19), or chronic schizophrenia (n = 22). Data were obtained by means of Structured Clinical Interviews and self-report questionnaires. The incidence of childhood physical abuse ranged from 16 to 40% and for childhood sexual abuse from 13 to 43% with no significant differences among the four diagnostic groups. Across all outpatient groups a history of childhood physical or sexual abuse was positively correlated to clinical severity. Patients with panic disorder who reported childhood physical abuse were more likely to be diagnosed with comorbid depression, to have more comorbid Axis I disorders, to score higher on symptom checklists as well as reporting a greater history of suicide attempts in the past year (5% vs. 0%); or lifetime (36% vs. 15%). Similar findings were noted, but not as robustly, for patients with panic disorder who reported childhood sexual abuse. There is a high rate of adverse early childhood events across diagnostic groups in psychiatric outpatients and these events are likely to influence the severity of the disorder but are unlikely to be a unique risk factor for any one type of disorder.
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February 2003

Using Fluoxetine in "Very Old" Depressed Nursing Home Residents.

Am J Geriatr Psychiatry 1996 Summer;4(3):258-262. Epub 2012 Aug 14.

SUNY Health Science Center.

Data are scarce concerning the utility of antidepressants among persons age 75 and over. The authors conducted an open clinical trial of fluoxetine among 29 patients (mean age = 89 years) with major depressive disorder ([MDD] 62%), major depression accompanying Alzheimer's disease (17%), vascular dementia (14%), and stroke (7%). At 12 weeks, of the 26 patients who had completed the study, 81% no longer had MDD and showed significant declines on the Ham-D and Zung depression scales. Nonresponders were more likely to have depression associated with a central nervous system disorder (P = 0.002). Side effects were rated as mild.
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August 2012