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My scholarly, clinical, and teaching activities apply interdisciplinary training in neuroscience/pharmacology and medicine/psychiatry to advance health and mental health care for psychiatric patients with disorders related to chronic and severe stress. As Director of Outpatient Mental Health for the VHA Palo Alto HCS, my work focuses on psychiatric disorders in military veterans. The goal is maximizing the use of evidence-based practices and reducing unnecessary medical burden of psychiatric treatments for stress-related disorders. I have conducted basic science research on the adverse effects of the stress hormone cortisol and applied research on the efficacy of medication treatments for posttraumatic stress disorder (PTSD). Currently, we are conducting research on the efficacy of innovative treatment approaches for PTSD and developing electronic medical records software tools that foster the use of evidence-based treatments and continuous monitoring of clinical outcomes and adverse effects. Clinically, we are developing and implementing clinical programs that improve access to mental health care and foster evidenced-based care.
Comparative Effectiveness Research in Veterans With PTSD
VA Cooperative Study CSP #591 is designed to compare the effectiveness of two types of
psychotherapy, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), for treating
posttraumatic stress disorder (PTSD) in male and female Veterans. Despite solid evidence that
both treatments are effective in Veterans and non-Veterans, there is a lack of evidence about
the effectiveness of these treatments compared with one another.
The sample will include 900 male and female Veterans with PTSD due to any traumatic military
event. Veterans who are eligible and agree to participate in the study will be randomly
assigned (by chance) to receive Prolonged Exposure or Cognitive Processing Therapy. The
standard "dose" of treatment is 12 weekly sessions but Veterans who improve more rapidly may
finish in fewer sessions and Veterans who improve more slowly may have additional sessions.
The primary outcome is improvement in PTSD symptoms after treatment. The outcome will be
measured at regular follow-up visits that will occur at the middle and at the end of
treatment and then 3 and 6 months later. The investigators will measure other outcomes,
including additional mental health problems, functioning, quality of life, and use of
treatments for mental and physical problems. The investigators also will measure Veterans'
treatment preference and examine whether Veterans who get the treatment they prefer do better
than Veterans who get the less-preferred treatment.
As a large multi-site trial with men and women, CSP #591 is designed to provide conclusive
information about whether one treatment is better than the other, overall and for different
types of patients-for example, men vs. women, combat Veterans vs. Veterans who experienced
military sexual trauma, and older vs. younger Veterans. Regardless of the outcome, patients
will have more information to help them make an informed decisions about which treatment to
choose and VA will have stronger evidence to help make care Veteran-centered.
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Side Effects of Antipsychotic Medications
Medications like olanzapine have been associated with the development of weight gain and
diabetes in some patients. It is not known if the increased risk of developing diabetes is a
direct effect on insulin or simply related to weight gain.
We hope to learn in this study whether or not olanzapine directly slows down insulin
secretion from the pancreas, thereby increasing the risk of developing diabetes.
Stanford is currently not accepting patients for this trial.
For more information, please contact Lilla Nikolics, Ms, 650-493-5000 Ext. 67289.