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Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians.
In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance.
Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12.
Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.
This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
This chapter first traces the history of Bible in North America, and then the issue of publishing of the Scripture. The strongly Protestant cast of American history is indicated no better than in the intense personal application to Scripture undertaken by countless individuals in every generation from the early seventeenth century to the present. Americans also have sustained an enormous rate of bible publication and an even more astonishing appetite for literature about the Bible. The Scripture has been a vital element in American popular life, and has also provided powerful themes for Americans to define themselves politically, both as a people and as a nation. The chapter discusses the experiences of two minority groups in North America, Jews and the African Americans, for whom the Bible has been central. It ends with discussions on the Biblical scholarship, and the history of the Scripture in Canada.
Scripture was the soul of Christian belief and practice from the beginnings of the church. Quite early in the third century a more technical exegesis, following the methods of textual study in the grammatical, rhetorical and philosophical schools of the Graeco-Roman world, led to the emergence of the biblical commentary. If the purpose of preaching in the early church was to instruct in the Christian faith, then catechesis, or pre-baptismal instruction in the faith, can be distinguished from homilies, which were for the purpose of post-baptismal Christian instruction. Origen and those preachers of his circle or spiritual school of Christian philosophy used the method of allegorical interpretation with the goal of leading listeners to the likeness of God. The earliest attestation of Christian scholia in the technical sense comes in the late 300s, possibly with Pseudo-Athanasius, but definitely by the 390s with Evagrius, not to mention Hesychius of Jerusalem.