Evolution of Treatment Modalities for Posttraumatic Stress Disorder: Top 100 Cited Articles From 1990 to 2020

Mohsan Ali; Bisal Naseer; Muhammad T. Siddal; Muhammad Talha; Damisha Jabeen; Areeba M. Mehmood; Maheen Hashmi; Muhammad U. Ahmed; Mujeeb U. Shad

doi:0.4088/PCC.24nr03767

This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s Terms & Conditions.

Original Research

Evolution of Treatment Modalities for Posttraumatic Stress Disorder: Top 100 Cited Articles From 1990 to 2020

Mohsan Ali, MBBS; Bisal Naseer, MBBS; Muhammad T. Siddal, MBBS; Muhammad Talha, MBBS; Damisha Jabeen, MBBS; Areeba M. Mehmood, MBBS; Maheen Hashmi, MBBS; Muhammad U. Ahmed, MBBS; and Mujeeb U. Shad, MD, MSCS

Published: December 12, 2024

Abstract

Objective: Posttraumatic stress disorder (PTSD) is seen in a substantial proportion of individuals experiencing trauma. The last few decades have been significant in terms of PTSD-related research; however, a quantitative charting of the evolution in evidence-based treatment modalities for PTSD is lacking. The objective of this study was to conduct a bibliometric analysis to bridge this gap in knowledge.

Methods: The database Scopus was searched in November 2022, with a timeframe set from 1990 to 2020. Only original articles were included. The 100 most-cited articles were compiled in the final list via manual screening. The selected studies primarily focused on the treatment modalities of PTSD. These articles were then analyzed for factors such as citation count, citations per year, citation trend, country of origin, and author affiliation. Microsoft Excel version 2016 and SPSS version 26 were used for the analysis.

Results: The 100 most-cited articles were published between 1990 and 2015. The number of citations was 35,549, with a maximum of 1,056 and a minimum of 315 (median = 282, interquartile range [IQR] = 139). The number of citations per year ranged between 7.03 and 46.5 (mean = 20.3009, median = 17.49, IQR = 11.215). Most of these articles were published in the Journal of Consulting and Clinical Psychology (25 articles); 2012 was the year with the peak citations per year, and the trend declined notably after 2016. The 5-year average citations reached their maximum during 2014–2018. The trend declined between 2019 and 2022. The year 2003 was the most productive in terms of academic outcome (10 articles). More than half of the 100 articles originated in the United States (77 articles), followed by the United Kingdom (8 articles) and Germany (7 articles). The total number of authors involved was 641 (median = 6, IQR = 4). A possible reason for the increase in citations around these articles is that the planned update to the current DSM version motivated considerable research, contributing to the increased citations around its release. Researchers focused on validating new diagnostic criteria and understanding their implications, resulting in a significant surge in publications and citations.

Conclusion: The data show that most of these articles originated from developed countries, pointing out the need to conduct more region-specific research in developing and underdeveloped areas as well.

Prim Care Companion CNS Disord 2024;26(6):24nr03767

Author affiliations are listed at the end of this article.

Bibliometrics is a quantitative research methodology used to evaluate research productivity in a given subject area within a field over time.¹It is an important mapping tool to establish research priorities and direct the allocation of funds by charting the emerging trends in science and technology. Moreover, bibliometric analysis can be utilized to acknowledge the major contributors in academia, whether they are authors, journals, institutions, or countries.²

Trauma is an event that exposes a person to the danger of death, physical injury, or sexual violence.^3,4Posttraumatic stress disorder (PTSD) is defined as the cluster of symptoms caused by “somatic, cognitive, affective, and behavioral effects of trauma.”^5(p83-93)One of every 3 young people experiences trauma, and of the exposed populace, every fourth child develops PTSD by the age of 18 years.⁴In 2017, a World Health Organization survey yielded a PTSD prevalence of 5.0% in the general population of high-income countries, 2.3% in upper-middle–income countries, and 2.1% in lower middle–income countries, respectively.⁶Moreover, the 2019 Global Burden of Disease report revealed an alarming number of 316 million adult war survivors suffering from PTSD and/or mental disorders worldwide, leading to 3 million disability-adjusted life years.⁷Also, the prevalence of PTSD in medical practitioners has been on a continuous rise since the onset of the COVID-19 pandemic; 25.4% of health care workers in the National Health Service screened positive for PTSD in 2021 by DSM-5 criteria.⁸If not treated in a timely manner, PTSD is said to contribute to increased suicide rates in 53.9% of females and 67.2% of males.⁹

Owing to the subjectively varied responses of PTSD patients to their triggers, diagnosing and treating PTSD has always posed a challenge to mental health experts.¹⁰Factors such as avoidance, social stigma, limited resources, ongoing conflicts, and wars make it difficult for trauma survivors to seek early professional help and compromise the efficacy of available treatment options.¹¹The last couple of decades have seen significant progress in terms of PTSD research.¹²However, there has been no quantitative charting of the evolution in evidence-based treatment modalities of PTSD in terms of improved outcomes. The objective of this study was to conduct a bibliometric analysis to bridge this gap in knowledge and aid the scientific community in determining future directions for PTSD treatment.

METHODS

The database Scopus was used for the bibliometric analysis. Regarding scientific publications, the available evidence and analysis suggest that Scopus has a wider scope than other databases such as PubMed and Web of Science.^13,14We selected 2 reviewers (M.T. and B.N.) to search the Scopus database in November 2022. The first list contained original research articles, which were segregated from review articles by Scopus filters. To yield the maximum number of articles in the analysis, the research studies on nonhuman subjects, those without abstract availability, and those in languages other than English were also included. The articles published from 1990 to 2020 were included irrespective of their publication journal. The following search term was used for retrieving articles from Scopus: “(TITLE-ABS KEY(((posttraumatic stress disorder) OR PTSD OR (traumatic stress disorders) OR (trauma-related disorders) OR (complex trauma)) AND ((treatment modalities) OR management OR therapeutics OR (treatment outcomes) OR (interventions integrated treatment) OR psychotherapy OR (pharmacological therapy) OR (drug therapy) OR psychedelics OR (diet therapy) OR (physical therapy) OR (exposure therapy) OR (neuromodulation therapy) OR (combined therapy) OR (accelerated resolution therapy) OR (eye movement desensitization and reprocessing) OR (cognitive behavioral therapy) OR (Stellate Ganglion Block)))).”

The selected studies primarily focused on the treatment modalities of PTSD. The appropriateness and relevance of the articles with the inclusion criteria were determined by thoroughly reviewing the abstracts. In case the abstracts were unavailable in Scopus, other sources were utilized to extract the abstracts and assess their suitability. The “cited by” filter was used to gather and organize the yielded articles. The most-cited 100 articles were thus compiled in the final list. Only those articles to which both reviewers agreed based on the inclusion criteria were included in the final list.

The analysis of the final list of articles was carried out using Scopus and manual screening. The total number of citations and number of citations per year were analyzed in terms of mean, median, and interquartile range (IQR). The Thomson Reuters journal citation reports were used to obtain the impact factors of the journals. Appropriate tables and graphs were generated using Microsoft Excel version 2016. SPSS version 26 was used to determine the correlation between the journal’s impact factor and its representation regarding the number of articles in the 100 most-cited articles. We considered a P value <.05 as significant. The subsequent search was conducted in the same manner to obtain the second list of most-cited review articles on the treatment modalities of PTSD.

RESULTS

Citation Count, Citations Per Year, and Citation Trends

Table 1 shows total citations and citations per year for the top 100 most-cited articles from 1990 to 2020. The number of citations was a minimum of 215 and a maximum of 1,056, with a median of 282 and an IQR of 139. The number of citations for all the articles was summed to a total of 35,549.

The number of citations per year ranged between 7.03 and 46.5, with a mean of 20.3009, median of 17.49, and IQR of 11.215. Also, if we look at the 10 most-cited research articles in this field since 2021 as of this writing, as these are the articles that are driving research, driving research, interesting trends towards research in newer treatments such as MDMA and ketamine in the form of robust clinical trials are revealed (Table 2).Figure 1 shows the total citations of the articles per year. The analysis revealed an exponential increase in the number of citations per year, with the most notable increase occurring between 2010 and 2012 and the peak citations per year being in 2012. After 2012, there was a smaller but almost similar number of citations per year up to 2016. After 2016, the trend decreased during the next few years.

Figure 2 shows the 5-year average citations. Our analysis revealed that the average increased exponentially over the 5-year intervals. Although during the 5 years between 2009 and 2013 the average citations were notably higher than the previous intervals, the most citations per 5 years were within the years 2014 and 2018. However, the average 5-year citations notably went down between the years 2019 and 2022 compared to the previous years.

Year of Publication, Origin, and Authorship

The 100 most-cited articles regarding evolution in therapeutic modalities for PTSD were published between 1990 and 2015. These articles originated from 15 different countries, with 2 being unidentified countries of origin. More than half of these articles originated from the United States (77 articles), followed by the United Kingdom (8 articles) and Germany (7 articles) (Figure 3).

The total number of authors involved in the publication of these articles is 641, with a median of 6 authors per article (IQR = 4). The number of authors in the 100 most-cited articles included in the study ranges from 1 to 21. The authors with 5 or more articles among the most-cited articles are listed in Table 3, which shows that most of these articles included in the study were coauthored by E.B. Foa (11 articles). Table 3 also shows the authors’ H index, which demonstrates the overall impact of the authors as measured by the author-specific citation frequency.

Further, if we analyze the trends of the number of articles published during the specified period (1990-2020) and plot against the year of publication, the year 2003 was the most productive year in terms of academic outcome, with 10 publications in that year (Figure 4). Table 4 shows the journals and respective number of published articles during the study period.

DISCUSSION

We provide a bibliometric analysis of the most-cited articles on PTSD to highlight significant developments in its understanding and management. This analysis can highlight critical areas in PTSD, both where research is ongoing and where it might be conducted in the future, which can be of great use to physicians and researchers. It can also aid in the development of collaboration among researchers from many disciplines, enabling them to investigate PTSD research further.

We observed a gradual increase in the number of articles published in the last 2 decades, with the maximum research productivity seen in 2003 and 2007 with 10 and 7 articles, respectively. The leading causes of the gradual increase may be the increasing trend in the prevalence of PTSD over the last decade, as well as the increasing rates of suicide and the everyday difficulties faced by military personnel who have this diagnosis.¹²⁵Over the years, these projects, funded mainly by US government agencies, have contributed to our improved understanding of the brain, human behavior, the consequences of chronic stress on the hypothalamic-pituitary-adrenal axis system, and improved treatment approaches. Still, the scholarly output on PTSD seems to be rising slowly compared to that on other psychiatric illnesses such as schizophrenia,¹²⁶bipolar disorder,¹²⁷and depression.¹²⁸

We chose citations per year as a more trustworthy metric to determine an article’s current influence because citation count alone is not an accurate indicator of an article’s scientific value.¹²⁹When articles were arranged according to citations per year, the most-cited article was by Resick et al (2002).¹⁷However, the article with the maximum number of citations was a relatively older article (1991) by Foa et al.¹⁵This result confirms that, even if an article’s impact is greater than that of an older article, it is likely to rank lower when evaluated only based on its citation count, as newly published articles take time to generate citation count. The author with the maximum number of articles among the top 100 was a female senior researcher, E.B. Foa, while 5 of 6 top performing authors were also female. This is a quite promising finding that female researchers have outpaced their male colleagues in research on PTSD. Still, we cannot negate the traditional gender disparity found in psychiatry¹³⁰and other fields of medicine,^131–133with only 42% of female psychiatrists in the United States.

About three-fourths of the scholarly output came from the United States, followed by the United Kingdom and Germany. Moreover, 5 of 6 authors and institutes with maximum research output were also from the United States. This trend aligns with many other studies conducted in various research fields.^{126,128,134–137}This trend has several causes, the most significant of which is the financial support any nation provides. The US government, private sector organizations, and foundations such as the National Institutes of Health and National Science Foundation invest heavily in research and development. A robust higher education system, an elaborate collaborative network, a research infrastructure, and a competitive peer-review process contribute as well.¹³⁸Although the burden of PTSD in low- and middle-income countries is high,¹³⁹not even a single country with low resources was the primary contributor or leader of these highly impactful studies.¹⁴⁰The lack of high-impact studies in low- and middle-income countries is attributable to limited human development and expenditure in education and scientific research, limited access to technology and quality education, language barriers, political and social instability, and limited collaboration opportunities.¹⁴¹Also, prioritizing basic needs such as health care, nutrition, and sanitation over research is common in low-income countries. Therefore, it highlights the importance of developing a comprehensive health financing policy for these countries, allocating at least 15% of the national budget to health development.^142,143The journal that published the maximum number of articles was the Journal of Consulting and Clinical Psychology (25 articles), while the journal with the maximum impact factor was the American Journal of Psychiatry (17.7 in 2022). This pattern suggests that a journal’s relevance to the subject matter is more important than its impact factor.

Our results have some limitations. First, some articles might be missed, as only the Scopus database was utilized. Articles published before the 1980s, when a computerized system was put in place, are frequently overlooked by Scopus.¹⁴⁴Second, self-citations were not removed. Third, most articles were published in English, which could result in bias in the publishing language selection process. Interestingly, the publication of newer editions of the DSM often coincides with a surge in research in the relevant areas, as researchers and clinicians try to adapt to newer diagnostic criteria and explore their use. Futher analyses and research might investigate how these updates correlate with the trends in clinical practice.

CONCLUSION

The observed decline in citations in recent years may suggest a redirection of focus toward alternative areas of interest. Furthermore, the data indicate that most reviewed publications were produced in economically affluent nations, underscoring the importance of facilitating research specifically tailored to the unique contexts of emerging and underdeveloped regions.

Article Information

Published Online: December 12, 2024. https://doi.org/10.4088/PCC.24nr03767
© 2024 Physicians Postgraduate Press, Inc.
Submitted: May 11, 2024; accepted August 20, 2024.
To Cite: Ali M, Naseer B, Siddal MT, et al. Evolution of treatment modalities for posttraumatic stress disorder: top 100 cited articles from 1990 to 2020. Prim Care Companion CNS Disord. 2024;26(6):24nr03767.
Author Affiliations: King Edward Medical University, Lahore, Pakistan (Ali, Naseer, Ahmed); Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College, Lahore, Pakistan (Siddal); CMH Medical College, Lahore, Pakistan (Talha); Jinnah Sindh Medical University, Karachi, Pakistan (Jabeen); Sargodha Medical College, Sargodha, Pakistan (Mehmood); Dow University of Health Sciences, Karachi, Pakistan (Hashmi); University of Nevada, Las Vegas, Nevada (Shad).
Corresponding Author: Mohsan Ali, MBBS, King Edward Medical University, Neelagumbad, Anarkali, Lahore 54000, Pakistan ([email protected]).
Relevant Financial Relationships: None.
Funding/Support: None.

Clinical Points

The increased research output following the DSM updates suggests that clinicians should stay informed about DSM changes, as they may drive significant advancements in understanding and treating posttraumatic stress disorder (PTSD).
A substantial portion of PTSD research and its clinical applications originate in the United States, highlighting the need for international collaboration to address PTSD in diverse populations effectively.
Barriers to high-impact PTSD research in low- and middle income countries include limited resources and funding, emphasizing the importance of developing comprehensive health financing policies to improve PTSD treatment outcomes globally.

Quick Links:

$40.00

Buy this Article as a PDF

References

1. Mejia C, Wu M, Zhang Y, et al. Exploring topics in bibliometric research through citation networks and semantic analysis. Front Res Metr Anal. 2021;6:742311. PubMed CrossRef

2. Ellegaard O, Wallin JA. The bibliometric analysis of scholarly production: how great is the impact? Scientometrics. 2015;105:1809–1831. PubMed CrossRef

3. Center for Substance Abuse Treatment. Trauma-Informed Care in Behavioral Health Services. Substance Abuse and Mental Health Services Administration; 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD. https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/

4. Lewis SJ, Arseneault L, Caspi A, et al. The epidemiology of trauma and posttraumatic stress disorder in a representative cohort of young people in England and Wales. Lancet Psychiatry. 2019;6(3):247–256. PubMed CrossRef

5. van der Kolk BA, Pelcovitz D, Roth S, et al. Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma. Am J Psychiatry. 1996;153(7 Suppl):83–93.

6. Koenen KC, Ratanatharathorn A, Ng L, et al. Posttraumatic stress disorder in the world mental health surveys. Psychol Med. 2017;47(13):2260–2274. PubMed CrossRef

7. Hoppen TH, Priebe S, Vetter I, et al. Global burden of posttraumatic stress disorder and major depression in countries affected by war between 1989 and 2019: a systematic review and meta-analysis. BMJ Glob Health. 2021;6(7):e006303. PubMed CrossRef

8. Scott HR, Stevelink SA, Gafoor R, et al. Prevalence of posttraumatic stress disorder and common mental disorders in healthcare workers in England during the COVID-19 pandemic: a two-phase cross-sectional study. Lancet Psychiatry. 2023;10(1):40–49. PubMed

9. Fox V, Dalman C, Dal H, et al. Suicide risk in people with posttraumatic stress disorder: a cohort study of 3.1 million people in Sweden. J Affect Disord. 2021;279:609–616. PubMed CrossRef

10. Pai A, Suris AM, North CS. Posttraumatic stress disorder in the DSM-5: controversy, change, and conceptual considerations. Behav Sci. 2017;7(1):7. PubMed

11. Kazlauskas E. Challenges for providing health care in traumatized populations: barriers for PTSD treatments and the need for new developments. Glob Health Action. 2017;10(1):1322399. PubMed CrossRef

12. Schrader C, Ross A. A review of PTSD and current treatment strategies. Mo Med. 2021;118(6):546–551. PubMed

13. Pranckutė R. Web of Science (WoS) and Scopus: the titans of bibliographic information in today’s academic world. Publications. 2021;9(1):12.

14. AlRyalat SAS, Malkawi LW, Momani SM. Comparing bibliometric analysis using PubMed, Scopus, and Web of Science Databases. J Vis Exp. 2019;(152):e58494. doi: 10.3791/58494 CrossRef

15. Foa EB, Rothbaum BO, Riggs DS, et al. Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling. J Consult Clin Psychol. 1991;59(5):715–723. PubMed CrossRef

16. Resick PA, Schnicke MK. Cognitive processing therapy for sexual assault victims. J Consult Clin Psychol. 1992;60(5):748–756. PubMed CrossRef

17. Resick PA, Nishith P, Weaver TL, et al. A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. J Consult Clin Psychol. 2002;70(4):867–879. PubMed CrossRef

18. Foa EB, Dancu CV, Hembree EA, et al. A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. J Consult Clin Psychol. 1999;67(2):194–200. PubMed CrossRef

19. Pitman RK, Sanders KM, Zusman RM, et al. Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biol Psychiatry. 2002;51(2):189–192. PubMed CrossRef

20. Cohen JA, Deblinger E, Mannarino AP, et al. A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. J Am Acad Child Adolesc Psychiatry. 2004;43(4):393–402. PubMed CrossRef

21. Cloitre M, Koenen KC, Cohen LR, et al. Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. J Consult Clin Psychol. 2002;70(5):1067–1074. PubMed CrossRef

22. Foa EB, Hembree EA, Cahill SP, et al. Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics. J Consult Clin Psychol. 2005;73(5):953–964. PubMed CrossRef

23. Schnurr PP, Friedman MJ, Engel CC, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007;297(8):820–830. PubMed CrossRef

24. Monson CM, Schnurr PP, Resick PA, et al. Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. J Consult Clin Psychol. 2006;74(5):898–907. PubMed CrossRef

25. Brady K, Pearlstein T, Asnis GM, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. JAMA. 2000;283(14):1837–1844. PubMed CrossRef

26. Marks I, Lovell K, Noshirvani H, et al. Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: a controlled study. Arch Gen Psychiatry. 1998;55(4):317–325. PubMed CrossRef

27. Resick PA, Galovski TE, Uhlmansiek MO, et al. A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. J Consult Clin Psychol. 2008;76(2):243–258. PubMed CrossRef

28. Stein BD, Jaycox LH, Kataoka SH, et al. A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial. JAMA. 2003;290(5):603–611. PubMed CrossRef

29. Raskind MA, Peskind ER, Kanter ED, et al. Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. Am J Psychiatry. 2003;160(2):371–373. PubMed CrossRef

30. van der Kolk BA, Dreyfuss D, Michaels M, et al. Fluoxetine in posttraumatic stress disorder. J Clin Psychiatry. 1994;55(12):517–522. PubMed

31. Krakow B, Hollifield M, Johnston L, et al. Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA. 2001;286(5):537–545. PubMed CrossRef

32. Raskind MA, Peskind ER, Hoff DJ, et al. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry. 2007;61(8):928–934. PubMed CrossRef

33. Cloitre M, Stovall-McClough KC, Nooner K, et al. Treatment for PTSD related to childhood abuse: a randomized controlled trial. Am J Psychiatry. 2010;167(8):915–924. PubMed CrossRef

34. Vermetten E, Vythilingam M, Southwick SM, et al. Long-term treatment with paroxetine increases verbal declarative memory and hippocampal volume in posttraumatic stress disorder. Biol Psychiatry. 2003;54(7):693–702. PubMed CrossRef

35. Keane TM, Fairbank JA, Caddell JM, et al. Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Behav Ther. 1989;20(2):245–260.

36. Vaiva G, Ducrocq F, Jezequel K, et al. Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma [published correction appears in Biol Psychiatry. 2003 Dec 15;54(12):1471]. Biol Psychiatry. 2003;54(9):947–949. PubMed CrossRef

37. Neuner F, Schauer M, Klaschik C, et al. A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an african refugee settlement. J Consult Clin Psychol. 2004;72(4):579–587. PubMed CrossRef

38. Davidson JR, Rothbaum BO, van der Kolk BA, et al. Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Arch Gen Psychiatry. 2001;58(5):485–492. PubMed CrossRef

39. Deblinger E, Lippmann J, Steer R. Sexually abused children suffering posttraumatic stress symptoms: initial treatment outcome findings. Child Maltreat. 1996;1(4):310–321.

40. Bryant RA, Harvey AG, Dang ST, et al. Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling. J Consult Clin Psychol. 1998;66(5):862–866. PubMed CrossRef

41. Rothbaum BO, Hodges LF, Ready D, et al. Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. J Clin Psychiatry. 2001;62(8):617–622. PubMed CrossRef

42. Tarrier N, Pilgrim H, Sommerfield C, et al. A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder. J Consult Clin Psychol. 1999;67(1):13–18. PubMed CrossRef

43. Foa EB, Molnar C, Cashman L. Change in rape narratives during exposure therapy for posttraumatic stress disorder. J Trauma Stress. 1995;8(4):675–690. PubMed CrossRef

44. Marshall RD, Beebe KL, Oldham M, et al. Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed-dose, placebo-controlled study. Am J Psychiatry. 2001;158(12):1982–1988. PubMed CrossRef

45. Mayou RA, Ehlers A, Hobbs M. Psychological debriefing for road traffic accident victims. Three-year follow-up of a randomised controlled trial. Br J Psychiatry. 2000;176:589–593. PubMed CrossRef

46. Taylor S, Thordarson DS, Maxfield L, et al. Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. J Consult Clin Psychol. 2003;71(2):330–338. PubMed CrossRef

47. Foa EB, Riggs DS, Massie ED, et al. The impact of fear activation and anger on the efficacy of exposure treatment for posttraumatic stress disorder. Behav Ther. 1995;26(3):487–499.

48. Lange A, Rietdijk D, Hudcovicova M, et al. Interapy: a controlled randomized trial of the standardized treatment of posttraumatic stress through the internet. J Consult Clin Psychol. 2003;71(5):901–909. PubMed CrossRef

49. Mithoefer MC, Wagner MT, Mithoefer AT, et al. The safety and efficacy of {+/-}3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. J Psychopharmacol. 2011;25(4):439–452. PubMed CrossRef

50. Najavits LM, Weiss RD, Shaw SR, et al. “Seeking safety”: outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence. J Trauma Stress. 1998;11(3):437–456. PubMed

51. Jaycox LH, Foa EB, Morral AR. Influence of emotional engagement and habituation on exposure therapy for PTSD. J Consult Clin Psychol. 1998;66(1):185–192. PubMed CrossRef

52. Jones C, Skirrow P, Griffiths RD, et al. Rehabilitation after critical illness: a randomized, controlled trial. Crit Care Med. 2003;31(10):2456–2461. PubMed CrossRef

53. Roy-Byrne P, Craske MG, Sullivan G, et al. Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. JAMA. 2010;303(19):1921–1928. PubMed CrossRef

54. Foa EB, Hearst-Ikeda D, Perry KJ. Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. J Consult Clin Psychol. 1995;63(6):948–955. PubMed CrossRef

55. Brom D, Kleber RJ, Defares PB. Brief psychotherapy for posttraumatic stress disorders. J Consult Clin Psychol. 1989;57(5):607–612. PubMed CrossRef

56. Schnurr PP, Friedman MJ, Foy DW, et al. Randomized trial of trauma-focused group therapy for posttraumatic stress disorder: results from a department of veterans affairs cooperative study. Arch Gen Psychiatry. 2003;60(5):481–489. PubMed CrossRef

57. Feder A, Parides MK, Murrough JW, et al. Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry. 2014;71(6):681–688. PubMed CrossRef

58. Kataoka SH, Stein BD, Jaycox LH, et al. A school-based mental health program for traumatized Latino immigrant children. J Am Acad Child Adolesc Psychiatry. 2003;42(3):311–318. PubMed CrossRef

59. Cloitre M, Courtois CA, Charuvastra A, et al. Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices. J Trauma Stress. 2011;24(6):615–627. PubMed CrossRef

60. Bryant RA, Sackville T, Dang ST, et al. Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counseling techniques. Am J Psychiatry. 1999;156(11):1780–1786. PubMed CrossRef

61. Chhatwal JP, Davis M, Maguschak KA, et al. Enhancing cannabinoid neurotransmission augments the extinction of conditioned fear. Neuropsychopharmacology. 2005;30(3):516–524. PubMed CrossRef

62. Davidson J, Kudler H, Smith R, et al. Treatment of posttraumatic stress disorder with amitriptyline and placebo. Arch Gen Psychiatry. 1990;47(3):259–266. PubMed CrossRef

63. Goenjian AK, Steinberg AM, Najarian LM, et al. Prospective study of posttraumatic stress, anxiety, and depressive reactions after earthquake and political violence. Am J Psychiatry. 2000;157(6):911–916. PubMed CrossRef

64. van Minnen A, Arntz A, Keijsers GP. Prolonged exposure in patients with chronic PTSD: predictors of treatment outcome and dropout. Behav Res Ther. 2002;40(4):439–457. PubMed CrossRef

65. McDonagh A, Friedman M, McHugo G, et al. Randomized trial of cognitive behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. J Consult Clin Psychol. 2005;73(3):515–524. PubMed CrossRef

66. Hien DA, Cohen LR, Miele GM, et al. Promising treatments for women with comorbid PTSD and substance use disorders. Am J Psychiatry. 2004;161(8):1426–1432. PubMed CrossRef

67. Gelpin E, Bonne O, Peri T, et al. Treatment of recent trauma survivors with benzodiazepines: a prospective study. J Clin Psychiatry. 1996;57(9):390–394. PubMed

68. Rothbaum BO, Price M, Jovanovic T, et al. A randomized, double-blind evaluation of D-cycloserine or alprazolam combined with virtual reality exposure therapy for posttraumatic stress disorder in Iraq and Afghanistan War veterans. Am J Psychiatry. 2014;171(6):640–648. PubMed CrossRef

69. Mueser KT, Rosenberg SD, Xie H, et al. A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness. J Consult Clin Psychol. 2008;76(2):259–271. PubMed CrossRef

70. Aerni A, Traber R, Hock C, et al. Low-dose cortisol for symptoms of posttraumatic stress disorder. Am J Psychiatry. 2004;161(8):1488–1490. PubMed CrossRef

71. Deblinger E, Mannarino AP, Cohen JA, et al. Trauma-focused cognitive behavioral therapy for children: impact of the trauma narrative and treatment length. Depress Anxiety. 2011;28(1):67–75. PubMed CrossRef

72. Knaevelsrud C, Maercker A. Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial. BMC Psychiatry. 2007;7:13. PubMed CrossRef

73. Chard KM. An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. J Consult Clin Psychol. 2005;73(5):965–971. PubMed CrossRef

74. Stein MB, Kline NA, Matloff JL. Adjunctive olanzapine for SSRI-resistant combat related PTSD: a double-blind, placebo-controlled study. Am J Psychiatry. 2002;159(10):1777–1779. PubMed CrossRef

75. Tucker P, Zaninelli R, Yehuda R, et al. Paroxetine in the treatment of chronic posttraumatic stress disorder: results of a placebo-controlled, flexible-dosage trial. J Clin Psychiatry. 2001;62(11):860–868. PubMed CrossRef

76. van der Kolk BA, Spinazzola J, Blaustein ME, et al. A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance. J Clin Psychiatry. 2007;68(1):37–46. PubMed

77. Adler AB, Bliese PD, McGurk D, et al. Battlemind debriefing and battlemind training as early interventions with soldiers returning from Iraq: randomization by platoon. J Consult Clin Psychol. 2009;77(5):928–940. PubMed CrossRef

78. Rothbaum BO, Astin MC, Marsteller F. Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) for PTSD rape victims. J Trauma Stress. 2005;18(6):607–616. PubMed CrossRef

79. Connor KM, Sutherland SM, Tupler LA, et al. Fluoxetine in post-traumatic stress disorder. Randomised, double-blind study. Br J Psychiatry. 1999;175:17–22. PubMed CrossRef

80. Goenjian AK, Karayan I, Pynoos RS, et al. Outcome of psychotherapy among early adolescents after trauma. Am J Psychiatry. 1997;154(4):536–542. PubMed CrossRef

81. Schelling G, Kilger E, Roozendaal B, et al. Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study. Biol Psychiatry. 2004;55(6):627–633. PubMed CrossRef

82. Andrade J, Kavanagh D, Baddeley A. Eye-movements and visual imagery: a working memory approach to the treatment of post-traumatic stress disorder. Br J Clin Psychol. 1997;36(2):209–223. PubMed CrossRef

83. Bass JK, Annan J, McIvor Murray S, et al. Controlled trial of psychotherapy for Congolese survivors of sexual violence [published correction appears in N Engl J Med. 2014 Jun 26;370(26):2547]. N Engl J Med. 2013;368(23):2182–2191. PubMed CrossRef

84. Taylor FB, Martin P, Thompson C, et al. Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study. Biol Psychiatry. 2008;63(6):629–632. PubMed CrossRef

85. Melnyk BM, Alpert-Gillis L, Feinstein NF, et al. Creating opportunities for parent empowerment: program effects on the mental health/coping outcomes of critically ill young children and their mothers. Pediatrics. 2004;113(6):e597–e607. PubMed CrossRef

86. Hertzberg MA, Butterfield MI, Feldman ME, et al. A preliminary study of lamotrigine for the treatment of posttraumatic stress disorder. Biol Psychiatry. 1999;45(9):1226–1229. PubMed CrossRef

87. Eftekhari A, Ruzek JI, Crowley JJ, et al. Effectiveness of national implementation of prolonged exposure therapy in Veterans Affairs care. JAMA Psychiatry. 2013;70(9):949–955. PubMed CrossRef

88. Zatzick D, Roy-Byrne P, Russo J, et al. A randomized effectiveness trial of stepped collaborative care for acutely injured trauma survivors. Arch Gen Psychiatry. 2004;61(5):498–506. PubMed CrossRef

89. Foa EB, Zoellner LA, Feeny NC, et al. Does imaginal exposure exacerbate PTSD symptoms? J Consult Clin Psychol. 2002;70(4):1022–1028. PubMed CrossRef

90. Paunovic N, Ost LG. Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behav Res Ther. 2001;39(10):1183–1197. PubMed CrossRef

91. Neuner F, Onyut PL, Ertl V, et al. Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial. J Consult Clin Psychol. 2008;76(4):686–694. PubMed CrossRef

92. Mithoefer MC, Wagner MT, Mithoefer AT, et al. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. J Psychopharmacol. 2013;27(1):28–39. PubMed CrossRef

93. Raskind MA, Peterson K, Williams T, et al. A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. Am J Psychiatry. 2013;170(9):1003–1010. PubMed CrossRef

94. Zayfert C, DeViva JC. Residual insomnia following cognitive behavioral therapy for PTSD. J Trauma Stress. 2004;17(1):69–73. PubMed CrossRef

95. Wessa M, Flor H. Failure of extinction of fear responses in posttraumatic stress disorder: evidence from second-order conditioning. Am J Psychiatry. 2007;164(11):1684–1692. PubMed CrossRef

96. March JS, Amaya-Jackson L, Murray MC, et al. Cognitive-behavioral psychotherapy for children and adolescents with posttraumatic stress disorder after a single-incident stressor. J Am Acad Child Adolesc Psychiatry. 1998;37(6):585–593. PubMed CrossRef

97. Smith P, Yule W, Perrin S, et al. Cognitive-behavioral therapy for PTSD in children and adolescents: a preliminary randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2007;46(8):1051–1061. PubMed CrossRef

98. Litz BT, Engel CC, Bryant RA, et al. A randomized, controlled proof-of-concept trial of an Internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder. Am J Psychiatry. 2007;164(11):1676–1683. PubMed CrossRef

99. Cohen JA, Mannarino AP, Iyengar S. Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: a randomized controlled trial. Arch Pediatr Adolesc Med. 2011;165(1):16–21. PubMed CrossRef

100. Brady KT, Dansky BS, Back SE, et al. Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: preliminary findings. J Subst Abuse Treat. 2001;21(1):47–54. PubMed CrossRef

101. Bryant RA, Felmingham K, Kemp A, et al. Amygdala and ventral anterior cingulate activation predicts treatment response to cognitive behaviour therapy for post-traumatic stress disorder. Psychol Med. 2008;38(4):555–561. PubMed CrossRef

102. Zucker TL, Samuelson KW, Muench F, et al. The effects of respiratory sinus arrhythmia biofeedback on heart rate variability and posttraumatic stress disorder symptoms: a pilot study. Appl Psychophysiol Biofeedback. 2009;34(2):135–143. PubMed CrossRef

103. Layne CM, Saltzman WR, Poppleton L, et al. Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2008;47(9):1048–1062. PubMed CrossRef

104. Foa EB, Rauch SA. Cognitive changes during prolonged exposure versus prolonged exposure plus cognitive restructuring in female assault survivors with posttraumatic stress disorder. J Consult Clin Psychol. 2004;72(5):879–884. PubMed CrossRef

105. Braun P, Greenberg D, Dasberg H, et al. Core symptoms of posttraumatic stress disorder unimproved by alprazolam treatment. J Clin Psychiatry. 1990;51(6):236–238. PubMed

106. Mills KL, Teesson M, Back SE, et al. Integrated exposure-based therapy for co occurring posttraumatic stress disorder and substance dependence: a randomized controlled trial. JAMA. 2012;308(7):690–699. PubMed CrossRef

107. Difede J, Cukor J, Jayasinghe N, et al. Virtual reality exposure therapy for the treatment of posttraumatic stress disorder following September 11, 2001. J Clin Psychiatry. 2007;68(11):1639–1647. PubMed

108. Yehuda R, Daskalakis NP, Desarnaud F, et al. Epigenetic biomarkers as predictors and correlates of symptom improvement following psychotherapy in combat veterans with PTSD. Front Psychiatry. 2013;4:118. PubMed CrossRef

109. Jaycox LH, Cohen JA, Mannarino AP, et al. Children’s mental health care following Hurricane Katrina: a field trial of trauma-focused psychotherapies. J Trauma Stress. 2010;23(2):223–231. PubMed CrossRef

110. Hien DA, Wells EA, Jiang H, et al. Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. J Consult Clin Psychol. 2009;77(4):607–619. PubMed CrossRef

111. Morland LA, Greene CJ, Rosen CS, et al. Telemedicine for anger management therapy in a rural population of combat veterans with posttraumatic stress disorder: a randomized noninferiority trial. J Clin Psychiatry. 2010;71(7):855–863. PubMed CrossRef

112. Bryant RA, Moulds ML, Guthrie RM, et al. Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder. J Consult Clin Psychol. 2003;71(4):706–712. PubMed CrossRef

113. Scheeringa MS, Weems CF, Cohen JA, et al. Trauma-focused cognitive behavioral therapy for posttraumatic stress disorder in three-through six year-old children: a randomized clinical trial. J Child Psychol Psychiatry. 2011;52(8):853–860. PubMed CrossRef

114. Zohar J, Yahalom H, Kozlovsky N, et al. High dose hydrocortisone immediately after trauma may alter the trajectory of PTSD: interplay between clinical and animal studies. Eur Neuropsychopharmacol. 2011;21(11):796–809. PubMed CrossRef

115. Mitchell JM, Bogenschutz M, Lilienstein A, et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med. 2021;27(6):1025–1033. PubMed CrossRef

116. Chen R, Sun C, Chen JJ, et al. A large-scale survey on trauma, burnout, and posttraumatic growth among nurses during the COVID-19 pandemic. Int J Ment Health Nurs. 2021;30(1):102–116. PubMed CrossRef

117. Feder A, Costi S, Rutter SB, et al. A randomized controlled trial of repeated ketamine administration for chronic posttraumatic stress disorder. Am J Psychiatry. 2021;178(2):193–202. PubMed CrossRef

118. Norman SB, Feingold JH, Kaye-Kauderer H, et al. Moral distress in frontline health care workers in the initial epicenter of the COVID-19 pandemic in the United States: relationship to PTSD symptoms, burnout, and psychosocial functioning. Depress Anxiety. 2021;38(10):1007–1017. PubMed CrossRef

119. Schnurr PP, Chard KM, Ruzek JI, et al. Comparison of prolonged exposure vs cognitive processing therapy for treatment of posttraumatic stress disorder among US veterans: a randomized clinical trial. JAMA Netw Open. 2022;5(1):e2136921. PubMed CrossRef

120. Reed GM, First MB, Billieux J, et al. Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. World Psychiatry. 2022;21(2):189–213. PubMed CrossRef

121. Mitchell JM, Ot’alora G M, van der Kolk B, et al. MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Nat Med. 2023;29(10):2473–2480. PubMed CrossRef

122. Oprel DAC, Hoeboer CM, Schoorl M, et al. Effect of prolonged exposure, intensified prolonged exposure and STAIR+prolonged exposure in patients with PTSD related to childhood abuse: a randomized controlled trial. Eur J Psychotraumatol. 2021;12(1):1851511. PubMed CrossRef

123. Kanstrup M, Singh L, Göransson KE, et al. Reducing intrusive memories after trauma via a brief cognitive task intervention in the hospital emergency department: an exploratory pilot randomised controlled trial. Transl Psychiatry. 2021;11(1):30. PubMed

124. Brewin CR, Miller JK, Soffia M, et al. Posttraumatic stress disorder and complex posttraumatic stress disorder in UK police officers. Psychol Med. 2022;52(7):1287–1295. PubMed CrossRef

125. O’Donnell J, Logan J, Bossarte R. Ten-year trend and correlates of reported posttraumatic stress disorder among young male veteran suicide decedents results from the National Violent Death Reporting System, 16 US States, 2005- 2014. Suicide Life Threat Behav. 2019;49(5):1473–1487. PubMed

126. Sun HL, Bai W, Li XH, et al. Schizophrenia and inflammation research: a bibliometric analysis. Front Immunol. 2022;13:907851. PubMed CrossRef

127. Zakaria WNA, Wijaya A, Al-Rahbi B, et al. Emerging trends in gene and bipolar disorder research: a bibliometric analysis and network visualisation. Psychiatr Genet. 2023;33(3):102–112. PubMed

128. Xu D, Wang YL, Wang KT, et al. A scientometrics analysis and visualization of depressive disorder. Curr Neuropharmacol. 2021;19(6):766–786. PubMed

129. Basic metrics based on papers and citations. 2016. Retrieved October 30, 2023. https://harzing.com/popbook/ch2_2_1.htm

130. Sheikh MH, Chaudhary AMD, Khan AS, et al. Influences for gender disparity in academic psychiatry in the United States. Cureus. 2018;10(4):e2514. PubMed CrossRef

131. Tanvir I, Hassan A, Alahmadi S, et al. Ethnic and gender diversity in pathology: a dream deferred. Cureus. 2023;15(5):e38528. PubMed CrossRef

132. Merone L, Tsey K, Russell D, et al. Sex inequalities in medical research: a systematic scoping review of the literature. Womens Health Rep. 2022;3(1):49–59.

133. Naseer B, Ali M, Azhar N. COVID-19 research in South Asia: a bibliometric analysis of the 100 most-cited articles. GMS Hyg Infect Control. 2023;18:Doc22. PubMed CrossRef

134. Ahmad T, Murad MA, Baig M, et al. Research trends in COVID-19 vaccine: a bibliometric analysis. Hum Vaccin Immunother. 2021;17(8):2367–2372. PubMed CrossRef

135. Shah SM, Ahmad T, Chen S, et al. A bibliometric analysis of the one hundred most cited studies in psychosomatic research. Psychother Psychosom. 2021;90(6):425–430. PubMed CrossRef

136. Wang W, Liu X, Wang D, et al. The 100 most cited papers in radiotherapy or chemoradiotherapy for cervical cancer: 1990-2020. Front Oncol. 2021;11:642018. PubMed CrossRef

137. Khan MS, Usman MS, Fatima K, et al. Characteristics of highly cited articles in interventional cardiology. Am J Cardiol. 2017;120(11):2100–2109. PubMed CrossRef

138. Boroush M. National patterns of R&D resources: 2018–19 data update. 2021. Retrieved October. 30:2023. https://ncses.nsf.gov/pubs/nsf21325.

139. Seedat S, Suliman S. In: Nemeroff CB, Marmar CR, eds. PTSD in Low- and Middle-Income Countries. Oxford University Press; 2018.

140. Acharya KP, Pathak S. Applied research in low-income countries: why and how? Front Res Metr Anal. 2019;4:3. PubMed

141. Helmy M, Awad M, Mosa KA. Limited resources of genome sequencing in developing countries: challenges and solutions. Appl Transl Genom. 2016;9:15–19. PubMed CrossRef

142. Kirigia JM, Barry SP. Health challenges in Africa and the way forward. Int Arch Med. 2008;1(1):27. PubMed

143. Khayyat NT, Lee JD. A measure of technological capabilities for developing countries. Technol Forecast Soc Change. 2015;92:210–223.

144. Falagas ME, Pitsouni EI, Malietzis GA, et al. Comparison of PubMed, Scopus, Web of Science, and Google Scholar: strengths and weaknesses. FASEB J. 2008;22(2):338–342. PubMed CrossRef

Evolution of Treatment Modalities for Posttraumatic Stress Disorder: Top 100 Cited Articles From 1990 to 2020

Abstract

METHODS

RESULTS

Citation Count, Citations Per Year, and Citation Trends

Year of Publication, Origin, and Authorship

DISCUSSION

CONCLUSION

Article Information

Clinical Points

$40.00

References

Evolution of Treatment Modalities for PTSD

The authors provide a bibliometric analysis of the most-cited articles published from 199...

Emerging Approaches in Schizophrenia

Stay informed with expert videos from Dr. Phillip Harvey and Dr. Christoph Correll regarding new research in schizophrenia. Read articles about emerging therapies like xanomeline-trospium and iclepertin, that target new pathways and may shape the future of schizophrenia care.

Notice of Retraction: Gawash A, et al. Association of Body Dysmorphic–Induced Anabolic-Androgenic Steroid Use With Mental Health Outcomes: A Systematic Review. Prim Care Companion CNS Disord. 2023;25(5):23r03532.

Cyproheptadine and Dexamethasone Dependence

Three cases of cyproheptadine and dexamethasone dependence are presented, with individuals...

Unexpected Hypersensitivity to Bupropion

A 33-year-old man with a history of depression presented to the emergency department with ...