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Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.
Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).
Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.
Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.
A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially ‘applied neuroscience’. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.
Around 80% of the world population of Northern Rockhopper Penguin Eudyptes moseleyi is found at Tristan da Cunha and Gough Island in the South Atlantic Ocean, where populations appear to be declining. However, numbers of birds at Middle Island, a small satellite island of Nightingale Island at Tristan Cunha, have not been counted since 1973 when an estimated 100,000 pairs were recorded. Updated population counts were obtained for all four islands at Tristan da Cunha (Tristan, Inaccessible, Nightingale and Middle islands) in 2009 providing a census of the whole island group and the first repeat count of Middle Island. Estimated breeding numbers at these four islands were Tristan 6,700 pairs, Inaccessible 54,000 pairs, Nightingale 25,000 pairs and 83,000 pairs at Middle Island. These counts confirm that Tristan da Cunha is a vitally important site for this ?Endangered? species holding over 65% of the global population and that breeding number have been relatively stable over the last 30 years.
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